Genealogically bewildered individuals and forensic identification: a review of current and emerging solutions

The increasing use of assisted reproductive technologies (ART) with donor gametes is driven by rising infertility rates, delayed parenthood, and the need to prevent hereditary diseases. Greater social acceptance of diverse family structures, advancements in reproductive medicine, and improving success rates also contribute. Accessibility, affordability, and cross-border reproductive care further expand ART's reach, making donor gametes a preferred option for many individuals and couples worldwide. The widespread application of ART has led to an increasing number of donor-conceived individuals, many of whom are now reaching reproductive maturity. This demographic shift introduces significant challenges for traditional forensic genetic identification methods, which rely on biological reference samples from genetically related individuals. The absence of such samples complicates the identification process, particularly for individuals conceived via gamete donation or adoption, where biological and legal parentage are incongruent. Conventional forensic genetic analyses, including short tandem repeat (STR) and single nucleotide polymorphism (SNP) profiling of autosomal, Y-chromosome, X-chromosome, and mitochondrial DNA, exhibit limited efficacy in these scenarios. While these methods can sometimes identify individuals conceived using a single donor gamete, they are insufficient for cases involving dual donor gametes or mitochondrial replacement therapy. Emerging methodologies such as forensic genetic genealogy, DNA methylation profiling, and human microbiome analysis offer innovative approaches but necessitate further clinical validation and standardization.

Stringent Regulations of Oocyte Donation Among Jewish Women in Israel: Characteristics and Outcomes of the National Oocyte Donation Program in One Central IVF Unit

On September 5, 2010, the Israeli Parliament passed a law that allows Israeli female residents to donate their oocytes to infertile Israeli female residents. This law includes unique restrictions that do not exist in other countries. Our aim was to characterize Israeli oocyte donors and recipients and the outcomes of the oocyte donation program as regulated by national law. This retrospective study included 26 financially compensated volunteer donors (mean age 29 ± 3.52 years) and 69 recipients (mean age 44.6 ± 3.53 years) who underwent 30 intracytoplasmic sperm injection cycles and 166 embryo transfers (ETs) in our unit between March 2016 and November 2020. Stringent legal caveats unique to Israel (e.g., Jewish/Moslem donor only to Jewish/Moslem recipient, only unmarried donor, eggs in one cycle restricted to ≤ 3 recipients, donated sperm only from non-Jewish donors, and more) were meticulously applied. Sociodemographic characterizations of donors and recipients were reviewed, and pregnancy and obstetric outcomes were determined. Variables that were significant in achieving live births among the recipients were examined. Twenty-five donors and all 69 recipients were Jewish, and most were unmarried and childless. The main indication for seeking egg donation was age ≥ 40 years/perimenopause (80%). One-half of the recipients used donor sperm and one-half used partner sperm. The pregnancy, clinical pregnancy, live birth, and miscarriage rates were 28.6%, 19.2%, 18.2%, and 2.8%. The live birth rate was negatively associated with multiple ETs. Maternal complications included hypertensive disorders of pregnancy (18.2%), gestational diabetes mellitus (32.3%), and caesarean sections (78.8%). There were no adverse neonatal outcomes. In conclusion, few young women are interested in donating oocytes in Israel. Pregnancy and live birth rates are lower than published values in other egg donation programs.

Third-party reproduction: a treatment that grows with societal changes

Third-party reproduction refers to the use of eggs, sperm, or embryos that have been donated by a third person (the donor) to enable individuals or couples (the intended parents) with infertility to have a child. This differs from the traditional father-mother family model with no third parties involved. Third-party reproduction is also used by couples that are unable to reproduce by traditional means, same-sex couples, and men and women without a partner. This has emerged as a treatment option with great success rates in a scene of changing family constellations. Consequently, this therapeutic alternative has become a realistic solution which has brought great satisfaction and happiness to people who otherwise would have not been able to achieve parenthood if these options were not medically and legally available.

Embryo donation: motivations, experiences, parenting, and child adjustment

Embryo donation raises unique challenges for donors, recipients, and the resultant child, yet little is known about the outcomes for those involved. This review summarizes research on the motivations for donating and receiving embryos from others and the experiences that follow, including the outcomes for parenting and child adjustment. Research has shown that given the varied ways in which embryo donation is practiced, understanding the outcomes within different legislative and cultural contexts is vital. The lack of information on outcomes means that counselors and psychologists have little empirical evidence to guide them. Gaps in existing knowledge are identified as well as areas for future research.

Balancing embryo donation and double gamete donation

Huele and colleagues started a debate on the comparison between embryo donation and double donation. Although I largely agree with their final conclusion, I believe that the perspective of the recipients needs to be added to get a more complete picture. The present contribution focuses on that perspective and advances other arguments to balance the two methods. The main argument in favour of double donation is the difference in perceived meaning for the recipients compared to surplus embryos. The main arguments in favour of embryo donation are the fair distribution of scarce resources (i.e. donor gametes) and the principle of non-maleficence through the avoidance of unnecessary oocyte donation cycles. The balance would be to put both treatments on an equal footing.

Social egg freezing and donation: waste not, want not

The trend towards postponement of childbearing has seen increasing numbers of women turning towards oocyte banking for anticipated gamete exhaustion (AGE banking), which offers a realistic chance of achieving genetically connected offspring. However, there are concerns around the use of this technology, including social/ethical implications, low rate of utilisation and its cost-effectiveness. The same societal trends have also resulted in an increased demand and unmet need for donor oocytes, with many women choosing to travel overseas for treatment. This has its own inherent social, medical, financial and psychological sequelae. We propose a possible pathway to address these dual realities. The donation of oocytes originally stored in the context of AGE banking, with appropriate compensatory mechanisms, would ameliorate AGE banking concerns, while simultaneously improving the supply of donor oocytes. This proposed arrangement will result in tangible benefits for prospective donors, recipients and society at large.