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Desy A, Marre D. The reproductive journeys of French women over 40 seeking assisted reproductive technology treatments in Spain. Soc Sci Med 2024; 351:116951. [PMID: 38743990 DOI: 10.1016/j.socscimed.2024.116951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
Fertility decline is a complex phenomenon resulting from converging social and cultural changes that are governed through politics. As it has been discussed in many studies, the European's low fertility rate goes hand in hand with the trend of maternity postponement. Although in many European countries over the last decades reproduction is envisaged as an individual choice that can be made at older ages, having a child after a certain age can be impossible -either "naturally" or using assisted reproductive technology-depending on the medical and legislative possibilities and limits of the country in which people live. In the extremely diverse European reproscape, reproductive legislations have forced but also allowed many people to seek reproductive treatments outside their home countries. Spain is a leading destination in Europe for cross border reproductive travel and, of the foreigners it receives, the French are the largest group. Despite having a history of strong pro-natalist policies, France has been one of the strictest European countries regarding access to medically assisted procreation. Until 2022, only heterosexual couples in which women were under 43 years of age could access treatments. Despite the recent opening of access to "all women", including single women and same-sex female couples, women over 43 years of age were once again excluded from the new legal framework and therefore remain condemned to travel abroad to access reproductive treatments. In this article, we analyze the experience of French women over 40 who cross the Spanish border to access reproductive treatments in order to fulfill their desire to have children. Through ethnographic data emerging from six years of participant observation and in-depth interviews with 15 women, we explore why they remain excluded from the French system of reproductive governance and the obstacles they face during their reproductive journey.
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Affiliation(s)
- Alexandra Desy
- AFIN Barcelona Research Group and Outreach Center, Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Spain, c/Vila i Puig s/n, 08193, Cerdanyola del Vallès, Barcelona, Spain.
| | - Diana Marre
- AFIN Barcelona Research Group and Outreach Center, Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Spain, c/Vila i Puig s/n, 08193, Cerdanyola del Vallès, Barcelona, Spain
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Baiocco R, Favini A, Pistella J, Carone N, Speranza AM, Lingiardi V. Prosocial and externalizing behaviors in children raised by different-and same-gender parent families: new directions in parenting research. Front Psychol 2024; 14:1325156. [PMID: 38292531 PMCID: PMC10825949 DOI: 10.3389/fpsyg.2023.1325156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Limited research focused on the association between parenting practices and children's prosocial and externalizing behaviors comparing same- and different-gender parent families. The present study considered 76 Italian families (73% same-gender and 27% different-gender parent families) with 8-year-old (SD = 2.17; 49% assigned female at birth) children born through assisted reproductive techniques, to explore parenting practices and children's prosocial and externalizing behaviors. Method We ran a Multiple-group-by-couple Structural Equation Model in which we estimated the predictive role of parenting on children's behaviors, controlling for age, gender, and family socioeconomic status using the Maximum Likelihood estimation. Results Results showed that both same- and different-gender parent families reported high levels of parental warmth and very low levels of hostility and rejection; regarding children's behaviors, both same- and different-gender parent families reported high levels of prosociality and low levels of externalizing behaviors. In addition, same-gender parents reported significantly higher levels of children's prosociality and parental warmth than different-gender parents. Regarding associations between parenting practices and behaviors, we found a positive association between positive parenting practices and increasing children's prosocial behaviors and decreasing children's externalizing behaviors, in both same- and different-gender families, controlling for family background characteristics. Conclusion The present study encourages future research to investigate how specific parenting practices can influence behavioral adjustment in children, focusing on same-gender parent families.
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Affiliation(s)
- Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Ainzara Favini
- Department of Humanities, University of Foggia, Foggia, Italy
| | - Jessica Pistella
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Nicola Carone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Eaf D, L A, W S, M W, Kt Z, Cicco C D, V M, A S, D T, Tm D, TM D. Real-world assessment of the patient-centredness of endometriosis care: European countries benchmarked by patients. Best Pract Res Clin Obstet Gynaecol 2023; 87:102311. [PMID: 36754664 DOI: 10.1016/j.bpobgyn.2022.102311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
European patients cross the borders of their countries to receive more patient-centred healthcare. Benchmarking across European countries for the patient-centredness of endometriosis care had yet to be performed. This study proved the factorial structure and reliability of translation of the ENDOCARE questionnaire in nine different languages. Moreover, the benchmark potential of the ENDOCARE questionnaire was shown by the significant between-country variance for case-mix-adjusted overall and dimensional patient-centredness scores, explaining 3-9% of the total variance in patient-centredness assessed across 10 European countries. Compared with the least patient-centred country, endometriosis care was more patient-centred in Denmark, Italy and Belgium. 'Reaching a diagnosis quickly' and 'physicians demarcating the endometriosis complexity level which they can treat' were consistently rated of more-than-average importance and were experienced negatively by more than half of the European sample. National and European policymakers and specialized clinics are prompted to monitor their patient-centredness and set up improvement projects.
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Affiliation(s)
- Dancet Eaf
- Leuven University Fertility Centre, University Hospitals Leuven, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Ameye L
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Sermeus W
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Welkenhuysen M
- Leuven University Fertility Centre, University Hospitals Leuven, Belgium
| | - Zondervan Kt
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, UK; European Network for Endometriosis, UK
| | - De Cicco C
- Campus Bio-medico University Rome, Italy; European Network for Endometriosis, UK
| | - Mijatovic V
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Schreurs A
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Timmerman D
- Department of Development and Regeneration, KU Leuven, Belgium
| | - D'Hooghe Tm
- Department of Development and Regeneration, KU Leuven, Belgium; European Network for Endometriosis, UK
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Marre D, Leinaweaver J. Solidarity exclusions: Problematizing kinship and humanitarianism from the perspective of transnational adoption. AMERICAN ANTHROPOLOGIST 2023; 125:9-22. [PMID: 38550402 PMCID: PMC10976316 DOI: 10.1111/aman.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/15/2022] [Indexed: 11/13/2022]
Abstract
What is, or should be, the role of solidarity within the (transnationally adoptive) family? In Spain, solidaridad is a prized value in family life, political organization, and humanitarian action, yet adoption professionals actively discouraged its use as a motivation for transnational adoption. This article offers a genealogy of the concept of solidaridad, a consideration of its enduring currency in kinship discourse in Spain, and a critical analysis of case studies from our respective research projects. We show that kinship and humanitarianism are considered very differently in terms of their temporalities and entailments-the terms, and specificities, of their engagements. We argue that solidaridad's multivocality within the transnational adoptive family context has broader significance for kinship, both adoptive and nonadoptive, as well as for social and political engagement across inequality. Solidaridad's exclusions from transnational adoption reveal how kinship and humanitarianism both involve the work of identifying, accommodating, and resolving social difference. [adoption, humanitarianism, kinship, law, Spain].
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Brandão P, Garrido N. Commercial Surrogacy: An Overview. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:1141-1158. [PMID: 36580941 PMCID: PMC9800153 DOI: 10.1055/s-0042-1759774] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide. METHODS This is a review of the literature published in the 21st century on commercial surrogacy. RESULTS A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers. CONCLUSION Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Nicolás Garrido
- University of Valencia, Valencia, Spain
- IVI Foundation, Valencia, Spain
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Pinto da Silva S, de Freitas C, Silva S. Medical ethics when moving towards non-anonymous gamete donation: the views of donors and recipients. JOURNAL OF MEDICAL ETHICS 2022; 48:616-623. [PMID: 34172523 DOI: 10.1136/medethics-2020-106947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 06/13/2023]
Abstract
Drawing on the views of donors and recipients about anonymity in a country that is experiencing a transition towards non-anonymous gamete donation mandated by the Constitutional Court, we explore how the intersection between rights-based approaches and an empirical framework enhances recommendations for ethical policy and healthcare. Between July 2017 and April 2018, 69 donors and 147 recipients, recruited at the Portuguese Public Bank of Gametes, participated in this cross-sectional study. Position towards anonymity was assessed through an open-ended question in a self-report questionnaire, which was subject to content analysis. Preference for an anonymous donation regime was mentioned by 82.6% of donors and 89.8% of recipients; and all those with children. Instead of the rights-based reasoning used by the Constitutional Court, donors highlighted concerns over future relationships and recipients focused on socioethical values linked with the safeguard of safety, privacy and confidentiality. The remaining participants advocated the choice between anonymity or non-anonymity (double-track policy), invoking respect for their autonomy. The complex, diverse ethical views and reasoning of donors and recipients expand a traditionally dichotomous discussion. Their perspectives challenge the transition towards non-anonymity and international guidelines, raising awareness to the need for their involvement in the design of policies to enable choice according to their values and preferences, and of psychosocial counselling responsive to their socioethical concerns and sensitive to their parental status. Empirical frameworks complement rights-based approaches to uphold justice, fairness and equal respect, and to incorporate utility, beneficence and non-maleficence in policymaking and healthcare in the transition towards non-anonymity.
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Affiliation(s)
- Sandra Pinto da Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cláudia de Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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McLean L, Ros ST, Hollond C, Stofan J, Quinn GP. Patient and clinician experiences with cross-border reproductive care: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1943-1952. [PMID: 35339328 DOI: 10.1016/j.pec.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception. METHODS Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020. RESULTS Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce. CONCLUSIONS While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety. CLINICAL PRACTICE IMPLICATIONS This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.
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Affiliation(s)
- Laura McLean
- Morsani College of Medicine, University of South Florida, Tampa, USA.
| | - Stephanie T Ros
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | | | - Jordan Stofan
- Morsani College of Medicine, University of South Florida, Tampa, USA
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Meier S, Ramos-Ortiz J, Basille K, D'Eramo AC, Diaconu AM, Flores LJ, Hottle S, Mason-Yeary K, Ruiz Y, DeMaria AL. Cross-border reproductive healthcare attitudes and behaviours among women living in Florence, Italy. BMC Health Serv Res 2022; 22:238. [PMID: 35189893 PMCID: PMC8862247 DOI: 10.1186/s12913-022-07621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of women living in Italy and seeking cross-border reproductive care (CBRC), especially for medically assisted reproduction (MAR), has increased. The purpose of this study was to explore CBRC attitudes and behaviours among a cohort of reproductive-aged women who have never engaged in CBRC to gauge social and cultural perceptions and gain a deeper understanding of family planning discourse. METHODS In-depth interviews were conducted during May - June 2018 with 30 women aged 18-50 living in or around Florence, Italy and enrolled in the Italian healthcare system. Interviews offered in-depth insight into CBRC attitudes, behaviours, and experiences among a cohort of women living in Italy who had never engaged in CBRC. Researchers used an expanded grounded theory through open and axial coding. Emergent themes were identified via a constant comparison approach. RESULTS Three themes and two subthemes emerged from the data. Participants discussed how limitations in Italy's access to MAR can lead women to seek reproductive healthcare in other countries. Women had mixed feelings about the effect of religion on legislation and reproductive healthcare access, with many views tied to religious and spiritual norms impacting MAR treatment-seeking in-country and across borders. Participants perceived infertility and CBRC-seeking as socially isolating, as the motherhood identity was highly revered. The financial cost of traveling for CBRC limited access and exacerbated emotional impacts. CONCLUSIONS Findings offered insight into CBRC perceptions and intentions, presenting a deeper understanding of the existing family planning discourse among reproductive-aged women. This may allow policymakers and practitioners to address social and cultural perceptions, increase access to safe and effective local care, and empower women in their family planning decisions.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Jaziel Ramos-Ortiz
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Kelsie Basille
- School of Nursing, Purdue University, West Lafayette, IN, USA
| | | | - Adria M Diaconu
- Department of Health & Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Lesley J Flores
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Savannah Hottle
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | | | - Yumary Ruiz
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA.
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Cross-border reproductive care: an Ethics Committee opinion. Fertil Steril 2022; 117:954-962. [PMID: 35216836 DOI: 10.1016/j.fertnstert.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
Cross-border reproductive care is a growing worldwide phenomenon, raising questions about why assisted reproductive technology patients travel for care, what harms and benefits may result, and what duties health care providers may have in advising and treating the patients who travel for reproductive services. Cross-border care may benefit or harm assisted reproductive technology stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. This document replaces the previous document of the same name, last published in 2016.
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Kirkman-Brown J, Calhaz-Jorge C, Dancet EAF, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac001. [PMID: 35178481 PMCID: PMC8847071 DOI: 10.1093/hropen/hoac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services? SUMMARY ANSWER For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure. WHAT IS KNOWN ALREADY Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received. PARTICIPANTS/MATERIALS, SETTING, METHODS Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered. MAIN RESULTS AND THE ROLE OF CHANCE In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support. LIMITATIONS, REASONS FOR CAUTION The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring. STUDY FUNDING/COMPETING INTEREST(S) The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. †ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Jackson Kirkman-Brown
- Centre for Human Reproductive Science, University of Birmingham, IMSR, Birmingham, UK
- Correspondence address. University of Birmingham, IMSR, Birmingham B15 2TT, UK. E-mail: ;
| | | | - Eline A F Dancet
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mariana Martins
- University of Porto, Faculty of Psychology and Education Sciences, Porto, Portugal
| | - Kelly Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Petra Thorn
- Private Practice, Couple and Family Therapy, Infertility Counseling, Mörfelden, Germany
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Strombeek-Bever, Belgium
| | - Lucy Frith
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
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Altmann J, Kummer J, Herse F, Hellmeyer L, Schlembach D, Henrich W, Weichert A. Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany. Arch Gynecol Obstet 2021; 306:59-69. [PMID: 34605992 PMCID: PMC9300520 DOI: 10.1007/s00404-021-06264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. OBJECTIVE The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. METHODS We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. RESULTS We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. CONCLUSION Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.
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Affiliation(s)
- J Altmann
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany. .,Berlin Institute of Health, Berlin, Germany.
| | - J Kummer
- Department of Obstetrics and Gynecology, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - F Herse
- Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center-A Joint Cooperation Between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin, Berlin, Germany
| | - L Hellmeyer
- Department of Obstetrics and Gynecology, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - D Schlembach
- Clinic of Obstetric Medicine, Vivantes Hospital Neukoelln, Berlin, Germany
| | - W Henrich
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany
| | - A Weichert
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany.,Center for Prenatal Diagnosis, Bergmannstrasse 102, Berlin, Germany
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Miner SA. Cultural health capital and the stratification of reproduction in Czech and Spanish egg donation markets. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1887-1902. [PMID: 34453321 DOI: 10.1111/1467-9566.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
This article explores the ways that fertility clinics in the Czech Republic and Spain attract international fertility clients for fertility treatment involving egg donation. I draw upon a content analysis of 18 fertility clinics' advertising materials and 31 in-depth interviews with fertility professionals in the Czech Republic and Spain, and Canadian fertility travellers to show how clinics use cultural health capital (CHC) to persist as popular destination sites for fertility travellers. I argue that the use of evidence-based medicine and patient-centred care combined with bioracial discourses are strategies by which clinics create a culture of fertility care that is legible to white, middle-class, hetero travellers. My interviews with fertility patients who travelled to these sites show the ways in which CHC is interactional-I document how fertility travellers desire these specific practices that are both created for and marketed to them. By expanding the definition of CHC to show how fertility clinics market and fertility travellers expect a particular culture of fertility medicine, I elucidate the interactions between clinics and professionals that reinforce ideals of white motherhood and the stratification of reproduction.
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Affiliation(s)
- Skye A Miner
- Department of Sociology, McGill University, Montreal, QC, Canada
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Caughey LE, Lensen S, White KM, Peate M. Disposition intentions of elective egg freezers toward their surplus frozen oocytes: a systematic review and meta-analysis. Fertil Steril 2021; 116:1601-1619. [PMID: 34452749 DOI: 10.1016/j.fertnstert.2021.07.1195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. DESIGN A systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Actual EEFs (women with oocytes in storage), potential EEFs (women investigating elective oocyte cryopreservation or about to freeze their oocytes), and women of reproductive age (women in the community aged ≥18 years). INTERVENTION(S) A systematic review was undertaken and electronically searched MEDLINE, Embase, and PsycINFO on the Ovid platform for conference abstracts and peer-reviewed articles, published in English after January 1, 2010. A search strategy combined synonyms for oocyte, cryopreservation, donation, disposition, elective, and attitude. Eligible studies assessed disposition outcomes (how an oocyte was disposed of) and disposition intentions (how women intend to dispose of an oocyte) and/or the psychosocial determinants underlying disposition outcomes and intentions. The Joanna Briggs Institute Prevalence Tool was used to assess the risk of bias. A meta-analysis using random effects was applied to pool proportions of women with similar disposition intentions toward their oocytes. MAIN OUTCOME MEASURE(S) Disposition outcomes and intentions toward surplus frozen oocytes: donate to research; donate to others; discard; unsure. Psychosocial determinants (beliefs, attitudes, barriers, and facilitators) of disposition outcomes and intentions. RESULT(S) A total of 3,560 records were identified, of which 22 (17 studies) met the inclusion criteria (8 studies from Europe, 7 from North America, and 2 from Asia). No studies reported on past oocyte disposition outcomes. Seventeen studies reported on the future disposition intentions of 5,446 women. Only 2 of the 17 studies reported on the psychosocial determinants of oocyte disposition intentions. There was substantial heterogeneity in the pooled results, which was likely a result of the significant variation in methodology. Actual EEFs were included in eight studies (n = 873), of whom 53% (95% confidence interval [CI], 44-63; I2, 87%) would donate surplus oocytes to research, 31% (95% CI, 23-40; I2, 72%) were unsure, 26% (95% CI, 17-38; I2, 92%) would donate to others, and 12% (95% CI, 6-21; I2, 88%) would discard their eggs. Psychosocial determinants: One study reported that 50% of these women were aware of friends and/or family having difficulty conceiving, which may have contributed to their willingness to donate to others. Potential EEFs were included in 4 studies (n = 645), of whom 38% (95% CI, 28-50; I2, 84%) would donate to research, 32% (95% CI, 17-51; I2, 91%) would donate to others, 29% (95% CI, 17-44; I2, 89%) would discard, and 7% (95% CI, 1-27; I2, 77%) were unsure. Psychosocial determinants: No studies. Women of reproductive age were included in 5 studies (n = 3,933), of whom 59% (95% CI, 48-70; I2, 97%) would donate to research and 46% (95% CI, 35-57; I2, 98%) would donate to others. "Unsure" and "discard" were not provided as response options. Psychosocial determinants: One study reported that the facilitators for donation to others included a family member or friend in need, to help others create a family, financial gain, to further science, and control or input over the selection of recipients. Barriers for donation included fear of having a biological child they do not know or who is raised by someone they know. CONCLUSION(S) No studies reported on the disposition outcomes of past EEFs. Disposition intentions varied across the three groups; however, "donating to research" was the most common disposition preference. Notably, the second disposition preference for one-third of actual EEFs was "unsure" and for one-third of potential EEFs was "donate to others." There were limited studies for actual and potential EEFs, and only two studies that explored the psychosocial determinants of oocyte disposition intentions. Additionally, these data suggest that disposition decisions change as women progress on their egg freezing journey, highlighting the importance of ongoing contact with the fertility team as intentions may change over time. More research is needed to understand the psychosocial determinants of oocyte disposition decisions so fertility clinics can provide EEFs with the support and information they need to make informed decisions about their stored eggs and reduce the level of uncertainty reported among EEFs and the potential risk of psychological distress and regret. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO 2020: CRD42020202733.
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Affiliation(s)
- Lucy E Caughey
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia.
| | - Sarah Lensen
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
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Purkayastha M, Roberts SA, Gardiner J, Brison DR, Nelson SM, Lawlor D, Luke B, Sutcliffe A. Cohort profile: a national, population-based cohort of children born after assisted conception in the UK (1992-2009): methodology and birthweight analysis. BMJ Open 2021; 11:e050931. [PMID: 34281932 PMCID: PMC8291329 DOI: 10.1136/bmjopen-2021-050931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To generate a large cohort of children born after assisted reproductive technology (ART) in the UK between 1992 and 2009, their naturally conceived siblings (NCS) and matched naturally conceived population (NCP) controls and linking this with health outcome data to allow exploration of the effects of ART. The effects of fresh and frozen embryo transfer on birth weight (BW) were analysed to test the validity of the cohort. PARTICIPANTS Children recorded on the Human Fertilisation and Embryology Authority (HFEA) register as being born after ART between 1992 and 2009, their NCS and matched NCP controls linked to Office for National Statistics birth registration dataset (HFEA-ONS cohort). This cohort was further linked to the UK Hospital Episode Statistics database to allow monitoring of the child's post-natal health outcomes up to 2015 (HFEA-ONS-HES subcohort). FINDINGS TO DATE The HFEA-ONS cohort consisted of 75 348 children born after non-donor ART carried out in the UK between 1 April 1992 and 31 July 2009 and successfully linked to birth registration records, 14 763 NCS and 164 823 matched NCP controls. The HFEA-ONS-HES subcohort included 63 877 ART, 11 343 NCS and 127 544 matched NCP controls further linked to health outcome data. The exemplar analysis showed that children born after fresh embryo transfers were lighter (BW difference: -131 g, 95% CI: -140 to -123) and those born after frozen embryo transfers were heavier (BW difference: 35 g, 95% CI: 19 to 52) than the NCP controls. The within-sibling analyses were directionally consistent with the population control analyses, but attenuated markedly for the fresh versus natural conception (BW difference: -54 g; 95% CI: -72 to -36) and increased markedly for the frozen versus natural conception (BW difference: 152 g; 95% CI: 113 to 190) analyses. FUTURE PLANS To use this cohort to explore the relationship between ART conception and short-term and long-term health outcomes in offspring.
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Affiliation(s)
- Mitana Purkayastha
- Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Stephen A Roberts
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Julian Gardiner
- Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
- Department of Education, University of Oxford, Oxford, UK
| | - Daniel R Brison
- Department of Reproductive Medicine, St Mary's Hospital, Manchester, UK
| | - Scott M Nelson
- Department of Obstetrics & Gynaecology, School of Medicine, Dentistry & Nursing, Reproductive & Maternal Medicine, University of Glasgow, Glasgow, UK
| | - Deborah Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol Bristol Population Health Science Institute, Bristol, UK
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Alastair Sutcliffe
- Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
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Eustache F, Drouineaud V, Mendes N, Delépine B, Dupont C, Mirallié S, Papaxanthos A, Metzler-Guillemain C, Rives-Feraille A, Magnan F, Grèze C, Hennebicq S, Koscinski I, Drapier H, Frapsauce C, Mayeur A, Carlotti MA, Mons J, Schmitt F, May-Panloup P, Blagosklonov O, Brugnon F, Mestres S, Cabry R, Fauque P, Loup-Cabaniols V, Ravel C, Lévy R, Patrat C, Thibault E, Frydman N, Bujan L, Morinière C, Ducrocq B, Rives N. Fertility preservation and sperm donation in transgender individuals: the current situation within the French CECOS network. Andrology 2021; 9:1790-1798. [PMID: 34236139 DOI: 10.1111/andr.13075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many studies reported that reproductive desire could be high among transgender (TG) individuals. In France, fertility preservation (FP) and sperm donation were very little proposed to TG individuals until recently, mainly because the Bioethics Law allows the use of Assisted Reproductive Technologies (ART) only in infertile couples and prohibits surrogacy. OBJECTIVES To evaluate the distribution of care on the French territory concerning fertility preservation and sperm donation in TG individuals. MATERIALS AND METHODS A multicentric national survey was carried out between January 2019 and October 2020 in 28 ART centres of the French CECOS (Centres d'Etudes et de Conservation des Oeufs et du Sperme) network. Each centre was questioned to find out how many TG individuals came, were informed and cared for FP and sperm donation. RESULTS Concerning FP, 71.4% of centres received TG individuals and performed gamete cryopreservation; 581 TG individuals consulted for FP. TG women were more likely to desire (P<0.0001) and achieve (P<0.0001) FP than TG men. Concerning sperm donation in couples including a TG man, 68% of centres offer the complete course from the first consultation to the completion of the ART cycles; 122 offspring has been conceived with sperm donation in couples including a TG man since 1999. DISCUSSION Our results showed that even if all centres do not propose FP or sperm donation in TG individuals, these ART are present throughout the French territory. The major point is that both FP and sperm donation in TG individuals have grown significantly and that the care of these patients is improving year after year. CONCLUSION In France, most of CECOS centres can take care of TG individuals for FP and sperm donation. The French Bioethics law allows these latter, and TG individuals can benefit from a financial support of the national health care insurance for FP and sperm donation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Florence Eustache
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Véronique Drouineaud
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Nicolas Mendes
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Béatrice Delépine
- CECOS Champagne-Ardenne, Chu de Reims Hôpital d'Enfants, REIMS, Cedex, 51092, France
| | | | - Sophie Mirallié
- CECOS Pays de la Loire Nantes Service de Biologie de la reproduction, Nantes, Cedex 1, 44093, France
| | - Aline Papaxanthos
- CECOS Aquitaine, BORDEAUX Maternité CHU Pellegrin, Bordeaux, 33076, France
| | | | - Aurélie Rives-Feraille
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
| | - Fanny Magnan
- Service D'Histologie-Embryologie, Cytogénétique, Biologie de La Reproduction / CECOS, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Jean Verdier, Bondy, France
| | - Cécile Grèze
- CECOS Alsace, STRASBOURG CMCO, Schiltighem, 67303, France
| | - Sylviane Hennebicq
- CECOS Rhône Alpes, GRENOBLE Hôpital Couple Enfant CHU GRENOBLE CEDEX 9, Cedex, France
| | - Isabelle Koscinski
- CECOS Lorraine Nancy, Maternité régionale Universitaire, Nancy, 54042, France
| | - Hortense Drapier
- Biologie de la Reproduction-CECOS, Hôpital de La Cavale Blanche, Brest, 29200, France
| | - Cynthia Frapsauce
- Service de Médecine et Biologie de la Reproduction-CECOS, CHRU Bretonneau, Tours, 37000, France
| | - Anne Mayeur
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | | | - Joffrey Mons
- CECOS Océan Indien LA REUNION Centre, d'AMP CHU de La Réunion Saint- Pierre, Cedex, 97448, France
| | - Françoise Schmitt
- CECOS ALSACE Mulhouse Groupe Hospitalier, de la Région de Mulhouse et Sud Alsace, MULHOUSE, Cedex, 68070, France
| | - Pascale May-Panloup
- CECOS Pays de Loire, Antenne Angers, Laboratoire de Biologie de la Reproduction, Angers University Hospital, Angers, 49000, France
| | - Oxana Blagosklonov
- Service de Biologie et Médecine, de la Reproduction-Cryobiologie, CECOS CHRU Jean Minjoz, Besancon, 25030, France
| | - Florence Brugnon
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | - Stéphanie Mestres
- CECOS Auvergne, Clermont FERRAND CHU Estaing, CLERMONT FERRAND CEDEX 1, Clermont, 63003, France
| | | | | | - Vanessa Loup-Cabaniols
- CECOS Languedoc Roussillon, MONTPELLIER Hôpital Arnaud de Villeneuve, Montpellier, 34295, France
| | - Célia Ravel
- CECOS Bretagne, RENNES Hôpital Sud, Rennes, 35200, France
| | - Rachel Lévy
- CECOS Paris TENON Hôpital, Tenon, Paris, 75020, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction-CECOS, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre, Université de Paris, Paris, 75014, France
| | - Emmanuelle Thibault
- CECOS Provence Alpes, Côte d'Azur NICE Centre de reproduction CHU de NICE, Nice, 06202, France
| | - Nelly Frydman
- CECOS Paris BECLERE, Hôpital Antoine Béclère, CLAMART, Cedex, 92140, France
| | - Louis Bujan
- CECOS Midi Pyrénées, TOULOUSE Hôpital Paule de Viguier, Toulouse, 31059, France
| | | | - Bérengère Ducrocq
- CECOS Nord LILLE CHRU, de LILLE Hôpital Calmette Lille, Cedex, 59037, France
| | - Nathalie Rives
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, 76031, France
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Kentenich H. Überlegungen zum Verbot der Eizellspende. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1373-2533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Monden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Hum Reprod 2021; 36:1666-1673. [PMID: 33709110 PMCID: PMC8129593 DOI: 10.1093/humrep/deab029] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How many twins are born in human populations and how has this changed over recent decades? SUMMARY ANSWER Since the 1980s, the global twinning rate has increased by a third, from 9.1 to 12.0 twin deliveries per 1000 deliveries, to about 1.6 million twin pairs each year. WHAT IS KNOWN ALREADY It was already known that in the 1980s natural twinning rates were low in (East) Asia and South America, at an intermediate level in Europe and North America, and high in many African countries. It was also known that in recent decades, twinning rates have been increasing in the wealthier parts of our world as a result of the rise in medically assisted reproduction (MAR) and delayed childbearing. STUDY DESIGN, SIZE, DURATION We have brought together all information on national twinning rates available from statistical offices, demographic research institutes, individual survey data and the medical literature for the 1980-1985 and the 2010-2015 periods. PARTICIPANTS/MATERIALS, SETTING, METHODS For 165 countries, covering over 99% of the global population, we were able to collect or estimate twinning rates for the 2010-2015 period. For 112 countries, we were also able to obtain twinning rates for 1980-1985. MAIN RESULTS AND THE ROLE OF CHANCE Substantial increases in twinning rates were observed in many countries in Europe, North America and Asia. For 74 out of 112 countries the increase was more than 10%. Africa is still the continent with highest twinning rates, but Europe, North America and Oceania are catching up rapidly. Asia and Africa are currently home to 80% of all twin deliveries in the world. LIMITATIONS, REASONS FOR CAUTION For some countries, data were derived from reports and papers based on hospital registrations which are less representative for the country as a whole than data based on public administrations and national surveys. WIDER IMPLICATIONS OF THE FINDINGS The absolute and relative number of twins for the world as a whole is peaking at an unprecedented level. An important reason for this is the tremendous increase in medically assisted reproduction in recent decades. This is highly relevant, as twin deliveries are associated with higher infant and child mortality rates and increased complications for mother and child during pregnancy and during and after delivery. STUDY FUNDING/COMPETING INTEREST(S) The contribution of CM was partially supported by the European Research Council (ERC) under the European Union's Horizon 2020 Research and Innovation Programme (grant No 681546, FAMSIZEMATTERS), Nuffield College, and the Leverhulme Trust. The contribution of GP was partially supported by the French Agence Nationale de la Recherche (grant No ANR-18-CE36-0007-07). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Christiaan Monden
- University of Oxford, OX1 2JD Oxford, UK
- Nuffield College, OX1 1NF Oxford, UK
- Leverhulme Centre for Demographic Science, OX1 1JD Oxford, UK
| | - Gilles Pison
- French Institute for Demographic Studies (INED), 75980 Paris, France
- French Museum of Natural History (UMR 7206), 75005 Paris, France
| | - Jeroen Smits
- Global Data Lab, Institute for Management Research, Radboud University, 6525 XZ Nijmegen, the Netherlands
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Live birth and clinical outcome of vitrification-warming donor oocyte programme: an experience of a single IVF unit. ZYGOTE 2021; 29:410-416. [PMID: 33818353 DOI: 10.1017/s0967199421000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medically assisted reproductive (MAR) treatments using donated oocytes are commonly applied in several countries to treat women who cannot conceive with their own gametes. Historically, in Italy, gamete donation has been prohibited but, in 2014, the law changed and gamete donation became allowed for couples undergoing MAR treatments. Consequently, in the last decade, there has been an increase in application of the oocyte donation programme. This study reports an egg-donation programme's clinical efficacy, based on importing donated vitrified oocytes from cryo-banks located in a foreign country. For this, we conducted a retrospective analysis of data from a single reproductive unit located in Italy (Donna Salus Women's Health and Fertility, Bozen). The study group consisted of 681 vitrified oocytes, which were warmed and culture to be replaced in 100 recipients. The survival rate after warming was 79.1% (n = 539/681), whereas the fertilization and blastulation rates were 90.2% (n = 486/539) and 47.9% (n = 233/486), respectively. Positive pregnancy test, clinical pregnancy rates, and live-birth rates per embryo transfer were 37.8%, 31.1% and 28.4%, respectively. The multiple pregnancy rate was 0.7%. This study is one of the first to report on the efficacy of a donor oocyte programme in Italy using imported vitrified oocytes. The above data may reassure women who are undertaking donation programmes using vitrified oocytes imported from commercial egg banks.
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Miner SA. "I would want to pay her": Challenging altruistic egg exchanges in Canada through moral patchworks. Soc Sci Med 2021; 272:113733. [PMID: 33556813 DOI: 10.1016/j.socscimed.2021.113733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
Studies surrounding egg donation often occur within existing legal marketplaces showing how language of altruism and gift is employed to uphold gendered standards of femininity and morality. This article examines how women negotiate those gendered and moral standards under the Canadian Assisted Human Reproduction Act (AHRA), which prohibited the market exchange of eggs through the criminalization of paid egg donation. Through 71 in-depth semi-structured interviews with health care professionals (n = 51) and egg donation recipients (n = 20), I argue that participants in these exchanges use a patchwork of moral framings to question the ethicality of the act and the gendered links between altruism, morality and femininity. These market participants employ moral patchworks consisting of subverting, circumventing and rejecting the legally defined ethical practice of donation. By explicitly discussing payment and gifts as moral egg donation exchanges, recipients and fertility professionals suggest that egg donors' reproductive labor should be monetarily recognized. This article considers the ethical implications of these moral patchworks for understanding how gender is reproduced and undone in market exchanges.
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Affiliation(s)
- Skye A Miner
- Department of Sociology, McGill University, Room 712, Leacock Building, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada.
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21
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Bioethical issues and legal frameworks of surrogacy: A global perspective about the right to health and dignity. Eur J Obstet Gynecol Reprod Biol 2020; 258:1-8. [PMID: 33387981 DOI: 10.1016/j.ejogrb.2020.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/14/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Modern advances in assisted reproduction technology (ART) have disrupted the traditional concept of parenthood. Every year, thousands of people travel abroad from their home countries in order to circumvent restrictive legislation or to benefit from lower fees. In a similar context, surrogacy raises many bioethical and legal issues. The present paper will address the main questions arising from the debate prompted by surrogacy, focusing on international legislation, and looking critically at the different legislative models. As a result of worldwide heterogeneity in policies, legal approaches, and access to ART throughout the world, a growing number of would-be parents are seeking treatment abroad. The lack of regulation on cross-border surrogacy in low income countries can undermine the dignity and rights of women as even modest economic compensation determines a significant purchasing power. The international effort should be aimed at creating an international regulatory framework from which guidelines useful to national governments derive. An international agreement would provide a solid legal basis for the protection of surrogate women. In order to limit the economic interests linked to procreative tourism, so as to truly protect global health and women's rights, legislative uniformity is therefore necessary between the various states.
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Agarwal A, Panner Selvam MK, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, Pushparaj PN, Robert KA, Ambar R, Iovine C, Durairajanayagam D, Henkel R. A scientometric analysis of research publications on male infertility and assisted reproductive technology. Andrologia 2020; 53:e13842. [PMID: 33236365 DOI: 10.1111/and.13842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/21/2022] Open
Abstract
Assisted reproductive technologies (ART) are considered as one of the primary management options to address severe male factor infertility. The purpose of this study was to identify the research trends in the field of male infertility and ART over the past 20 years (2000-2019) by analysing scientometric data (the number of publications per year, authors, author affiliations, journals, countries, type of documents, subject area and number of citations) retrieved using the Scopus database. We used VOS viewer software to generate a network map on international collaborations as well as a heat map of the top scientists in this field. Our results revealed a total of 2,148 publications during this period with Cleveland Clinic Foundation contributing the most (n = 69). The current scientometric analysis showed that the research trend on ART has been stable over the past two decades. Further in-depth analysis revealed that density gradient centrifugation (46%) and intracytoplasmic sperm injection (59.2%) are the most reported techniques for sperm separation and ART, respectively. Additionally, azoospermia was the most studied clinical scenario (60.6%), with majority of articles reporting pregnancy rate (47.25%) as the primary reproductive outcome for ART. This study provides insight into the current focus of research in the area of male infertility and ART as well as the areas that require further research in future.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Cătălina Barbăroșie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | | | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rafael Ambar
- Department of Urology, Sexual and Reproductive Medicine, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Jacobson H. Cross-border reproductive care in the USA: Who comes, why do they come, what do they purchase? REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:42-47. [PMID: 33204864 PMCID: PMC7653003 DOI: 10.1016/j.rbms.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/06/2020] [Accepted: 09/03/2020] [Indexed: 05/24/2023]
Abstract
This article explores the participation of non-US-resident patients/clients in the US reproductive market, garnering a picture of cross-border reproductive care (CBRC) into the USA by drawing on the existing literature, identifying the frequency of and motivations for such arrangements, the primary sending countries, and the reproductive services sought. I find that although the expense of US CBRC necessarily limits the patient/client pool, it is largely non-economic factors that drive CBRC into the USA. The US CBRC patient/client base, which is diverse in terms of national origin, race and sexual orientation, is recruited by the US fertility industry and drawn to the full range of assisted reproductive technology (ART) services, such as in-vitro fertilization, surrogacy, oocyte donation and preimplantation genetic screening/preimplantation genetic diagnosis, available in the US market which are often restricted or limited in their countries of origin. CBRC patients/clients enjoy the legal clarity for establishing parentage and citizenship for their children available in the USA, as well as what some view as a medically and ethically superior ART market.
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Affiliation(s)
- Heather Jacobson
- Department of Sociology and Anthropology, The University of Texas at Arlington, Arlington, TX, USA
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Inhorn MC. Reprint: Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:110-121. [PMID: 34136666 PMCID: PMC8178439 DOI: 10.1016/j.rbms.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/10/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Malmanche H. Relational surrogacies excluded from the French bioethics model: a euro-american perspective in the light of Marcel Mauss and Louis Dumont. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:24-29. [PMID: 33204862 PMCID: PMC7653006 DOI: 10.1016/j.rbms.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
In the French context of prohibition of surrogacy by a legislative framework established in 1994, couples are using surrogacy abroad to create their family. Why does surrogacy not find room in the landscape of donor-conceived families in France? Based on a survey among French intended parents using surrogacy in the USA and Belgium, and a 2-year ethnography on medical practice in a fertility centre in Belgium, this study shows that surrogacy is, in fact, a particular type of gift: the gift of gestational capacity. The preconceptional journey in Belgium or in the USA is a relational process that allows complementary places and statuses to be acquired. This process will transform applicants into intended parents (recipients), and candidates into surrogates (donors). The relationships created by the gift have the particularity of being woven around responsibility towards the fetus. It is the hierarchy of encompassing and encompassed responsibilities in relation to the fetus that organizes the relationships and actions of each protagonist: parents, grandparents, surrogate, surrogate's partner and children, etc. The article thus shows that surrogacy, because it is a gift of a particular type, has no place in the French bioethics model, which is, in fact, built entirely on the notion of 'donation without a donor' in a therapeutic and medicalized view of reproductive donations.
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Bhatia R. Doing and undoing nation through ART: a Franco-American comparison. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:65-72. [PMID: 33305028 PMCID: PMC7710507 DOI: 10.1016/j.rbms.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
This article explores a Franco-American comparison of assisted reproductive technology (ART), specifically as it relates to sex selection and cross-border reproduction. As a basis for comparison, the nation can materialize in the form of state structure just as much as in cultural-economic assemblages or ideologies that breach geopolitical boundaries. By juxtaposing many contrasts between the French and US contexts - departure versus destination country, highly regulated versus deregulated governance, medical versus social applications, and access (or lack thereof) via public versus private health insurance sectors - it may be difficult to imagine how these extremes occupy a common continuum of globalized market channels. I suggest that invisible or semi-visible reproductive practices along with ART governance provide an avenue to stake out or protect the 'French' way of being and doing ART just as much as they make the 'American' way simultaneously elusive and easy to appropriate. Ultimately, both the French and American approaches to ART collude in the institutionalization of globalized markets. Through the case of cross-border and (sex) selective ART, it is possible to see how both the French and the Americans are involved in the undoing and doing of nation via ART as global assemblage.
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Stuyver I, Somers S, Provoost V, Wierckx K, Verstraelen H, Wyverkens E, Van Glabeke L, T’Sjoen G, Buysse A, Pennings G, De Sutter P. Ten years of fertility treatment experience and reproductive options in transgender men. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 22:294-303. [PMID: 34240072 PMCID: PMC8118233 DOI: 10.1080/26895269.2020.1827472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Up to 2018, the Belgian law stated that transgender people who wanted to change their legal sex had to undergo physical gender affirming treatment. This included gonadectomy to a medically possible and justified extent, which entailed that they had to accept the fact that they could no longer reproduce. However, research has shown that many transgender people desire to have children. AIMS (1) to describe a cohort of transgender men and their respective cisgender female partners, to share our experiences with their request for donor conception, and to evaluate their disclosure intentions to the child, (2) to explore how the couples approach current and future reproductive options. METHODS This mixed method study presents data from a retrospective analysis of patient records and from a qualitative interview study. The couples were selected from the group of transgender men who - together with their respective cisgender female partners - applied for sperm donation at Ghent University Hospital between 2002 and 2012. RESULTS Forty-seven transgender men with a cisgender female partner requested treatment with anonymous donor sperm for a first child as a couple. Forty-one requests were accepted for treatment. We found that most couples requesting treatment intended to disclose the use of donor sperm to their future child (n = 34) while 24 couples were planning to inform the child about the parent's transgender identity. The six couples we interviewed saw donor conception as the preferred route to become parents. Adoption was seen as less obvious. The couples' attitudes toward stem cell-derived gametes reflected the significance of the genetic link with the child for both parents. DISCUSSION Not all participants in our study were aware of their reproductive options. To be able to make a well-informed decision, transgender people should be counseled about all options at the time of transition.
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Affiliation(s)
- Isabelle Stuyver
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - Sara Somers
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
| | - Veerle Provoost
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Sciences, Ghent University, Gent, Belgium
| | - Katrien Wierckx
- Department of Endocrinology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Hans Verstraelen
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Gent, Belgium
| | - Elia Wyverkens
- Department of Applied Psychology, Howest University of Applied Sciences, Brugge, Belgium
| | - Lien Van Glabeke
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - Ann Buysse
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Guido Pennings
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Sciences, Ghent University, Gent, Belgium
| | - Petra De Sutter
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
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Creux H, Diaz M, Grynberg M, Papaxanthos-Roche A, Chansel-Debordeaux L, Jimenez C, Frantz S, Chevalier N, Takefman J, Hocké C. National survey on the opinions of French specialists in assisted reproductive technologies about social issues impacting the future revision of the French Bioethics laws. J Gynecol Obstet Hum Reprod 2020; 49:101902. [PMID: 32889113 DOI: 10.1016/j.jogoh.2020.101902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/16/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION France is known for its conservative and unique position in assisted reproductive technologies (ARTs). At the eve of the future revision of French Bioethics laws, we decided to conduct a national survey to examine the opinions of French specialists in ARTs about social issues. MATERIAL AND METHODS Descriptive study conducted in May 2017 in a university teaching hospital using an anonymous online questionnaire on current issues in ARTs. The questionnaire was sent by email to 650 French ARTs specialists, both clinicians and embryologists. RESULTS After 3 reminders, 408 responses were collected resulting in a participation rate of 62.7% (408/650). Concerning pre-implantation genetic testing, 80% of the physicians were in favor of expanding the indications, which in France are presently limited to incurable genetic diseases. Authorizing elective Fertility Preservation was supported by 93.4% of the specialists, but without social coverage for 86.3% of them. Concerning gamete donation, 77.4% of the French ARTs specialists were in favor of giving a financial compensation to donors, 92% promoted preserving their anonymity and 80.9% were against a directed donation. ARTs for single heterosexual women were supported by 63.4% of the French specialists and by 72.5% for lesbian couples. The legalization of surrogacy was requested by 55.2%. DISCUSSION Pending the revision of the French Bioethics laws, this survey provides an overview of the opinion of the specialists in ARTs on expanding ARTs for various social indications.Because of the evolution of social values, a more liberal and inclusive ART program is desired by the majority of ART specialists in France.
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Affiliation(s)
- Hélène Creux
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France; Reproductive Center, Polyclinique Saint Roch, 550 avenue du colonel André Pavelet, 34070 Montpellier, France.
| | - Marie Diaz
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Michaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France; Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique- Hôpitaux de Paris, Bondy, France
| | - Aline Papaxanthos-Roche
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Lucie Chansel-Debordeaux
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Clément Jimenez
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Sandrine Frantz
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Nicolas Chevalier
- Reproductive Center, Polyclinique Saint Roch, 550 avenue du colonel André Pavelet, 34070 Montpellier, France
| | - Janet Takefman
- Department of Obstetrics and Gynecology, McGill UniversityHealth Center Reproductive Center, McGill University, Montreal, Quebec, Canada
| | - Claude Hocké
- Department of reproductive medicine, Bordeaux University Hospital, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
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Shenfield F, Messinis I, Mahmood T. EBCOG position statement on “Ethical analysis of cross-border reproductive care”. Eur J Obstet Gynecol Reprod Biol 2020; 252:568-569. [DOI: 10.1016/j.ejogrb.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
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Lasheras G, Mestre-Bach G, Clua E, Rodríguez I, Farré-Sender B. Cross-Border Reproductive Care: Psychological Distress in A Sample of Women Undergoing In Vitro Fertilization Treatment with and without Oocyte Donation. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:129-135. [PMID: 32681625 PMCID: PMC7382677 DOI: 10.22074/ijfs.2020.5997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/13/2019] [Indexed: 12/05/2022]
Abstract
Background Cross-border reproductive care (CBRC) refers to the movement of patients to foreign countries
for fertility treatment. Limited evidence indicates that this phenomenon is associated with a risk of psychologi-
cal distress, but few studies on the psychological impact of CBRC are currently available. The aim of this study
was to compare the anxiety and depression levels of a group of cross-border patients with a local Spanish patient
group, both of which underwent in vitro fertilization (IVF) treatment. We also sought to explore the clinical,
sociodemographic and personality profiles of the CBRC group and local women. Materials and Methods This present cross-sectional study was conducted on 161 infertile females (71 CBRC
patients and 90 local women) who were undergoing IVF treatment. The following questionnaires were used to
collect data: Spielberger State Anxiety Inventory (STAI-S), the Beck Depression Inventory-II (BDI-II) and the
Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Sociodemographic, clinical, reproductive and CBRC
variables were also recorded. Results CBRC patients, specifically CBRC oocyte recipients, showed higher levels of anxiety compared to lo-
cal women. However, no significant differences in depression scores were found between both groups. Finally,
when analysing personality, the Activity scale scores of the ZKPQ were found to be higher in CBRC oocyte
recipients, which indicated a greater tendency for general activity and higher energy levels. Conclusion CBRC oocyte recipient women may have greater vulnerability to anxiety than local women prior
to infertility treatment. Screening and psychological support protocols for anxiety in this population should be
considered.
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Affiliation(s)
- Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain. Electronic Address:
| | - Gemma Mestre-Bach
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain.,Facultad de Ciencias de la Salud. Universidad Internacional de La Rioja, La Rioja, Spain
| | - Elisabet Clua
- Department of Obstetrics, Gynaecology and Reproduction, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Department of Obstetrics, Gynaecology and Reproduction, Dexeus University Hospital, Barcelona, Spain
| | - Borja Farré-Sender
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
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Inhorn MC. Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 10:46-57. [PMID: 32760816 PMCID: PMC7393315 DOI: 10.1016/j.rbms.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/29/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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Igareda González N. Legal and ethical issues in cross-border gestational surrogacy. Fertil Steril 2020; 113:916-919. [PMID: 32327242 DOI: 10.1016/j.fertnstert.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 01/17/2023]
Abstract
This article aims to identify the main legal and ethical issues around international surrogacy. Owing to the legal diversity and ethical background of such a globalized practice, a review of the key existing literature on these two matters has been identified and analyzed. The article also identifies and analyzes the most significant legal solutions provided by supranational jurisdictions when dealing with cases of international surrogacy. The scope of the article includes the efforts to reach a minimum legal framework at the international level, with the aim not to standardize but to provide common legal solutions to those travelling abroad to have a child by means of surrogacy.
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Calhaz-Jorge C, De Geyter CH, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V. Survey on ART and IUI: legislation, regulation, funding and registries in European countries: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod Open 2020; 2020:hoz044. [PMID: 32042927 PMCID: PMC7002185 DOI: 10.1093/hropen/hoz044] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/14/2019] [Indexed: 12/02/2022] Open
Abstract
STUDY QUESTION How are ART and IUI regulated, funded and registered in European countries? SUMMARY ANSWER Of the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding (also available in the 39 countries) varies across and sometimes within countries and national registries are in place in 31 countries. WHAT IS KNOWN ALREADY Some information devoted to particular aspects of accessibility to ART and IUI is available, but most is fragmentary or out-dated. Annual reports from the European IVF-Monitoring (EIM) Consortium for ESHRE clearly mirror different approaches in European countries regarding accessibility to and efficacy of those techniques. STUDY DESIGN, SIZE, DURATION A survey was designed using the online SurveyMonkey tool consisting of 55 questions concerning three domains—legal, funding and registry. Answers refer to the countries’ situation on 31 December 2018. PARTICIPANTS/MATERIALS, SETTINGS, METHODS All members of EIM plus representatives of countries not yet members of the Consortium were invited to participate. Answers received were checked, and initial responders were asked to address unclear answers and to provide any additional information they considered important. Tables of individual countries resulting from the consolidated data were then sent to members of the Committee of National Representatives of ESHRE, asking for a second check. Conflicting information was clarified by direct contact. MAIN RESULTS AND THE ROLE OF CHANCE Information was received from 43 out of the 44 European countries where ART and IUI are performed. Thirty-nine countries reported specific legislation on ART, and artificial insemination was considered an ART technique in 35 of them. Accessibility is limited to infertile couples in 11 of the 43 countries. A total of 30 countries offer treatments to single women and 18 to female couples. In five countries ART and IUI are permitted for treatment of all patient groups, being infertile couples, single women and same sex couples, male and female. Use of donated sperm is allowed in 41 countries, egg donation in 38, the simultaneous donation of sperm and egg in 32 and embryo donation in 29. Preimplantation genetic testing (PGT) for monogenic disorders or structural rearrangements is not allowed in two countries, and PGT for aneuploidy is not allowed in 11; surrogacy is accepted in 16 countries. With the exception of marital/sexual situation, female age is the most frequently reported limiting criteria for legal access to ART—minimal age is usually set at 18 years and maximum ranging from 45 to 51 years with some countries not using numeric definition. Male maximum age is set in very few countries. Where permitted, age is frequently a limiting criterion for third-party donors (male maximum age 35 to 55 years; female maximum age 34 to 38 years). Other legal constraints in third-party donation are the number of children born from the same donor (in some countries, number of families with children from the same donor) and, in 10 countries, a maximum number of egg donations. How countries deal with the anonymity is diverse—strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), mixed system (anonymous and non-anonymous donations) and strict non-anonymity. Public funding systems are extremely variable. Four countries provide no financial assistance to patients. Limits to the provision of funding are defined in all the others i.e. age (female maximum age is the most used), existence of previous children, maximum number of treatments publicly supported and techniques not entitled for funding. In a few countries, reimbursement is linked to a clinical policy. The definition of the type of expenses covered within an IVF/ICSI cycle, up to what limit and the proportion of out-of-pocket costs for patients is also extremely dissimilar. National registries of ART and IUI are in place in 31 out of the 43 countries contributing to the survey, and a registry of donors exists in 18 of them. LIMITATIONS, REASONS FOR CAUTION The responses were provided by well-informed and committed individuals and submitted to double checking. Since no formal validation was in place, possible inaccuracies cannot be excluded. Also, results are a cross section in time and ART and IUI legislations within European countries undergo continuous evolution. Finally, several domains of ART activity were deliberately left out of the scope of this ESHRE survey. WIDER IMPLICATIONS OF THE FINDINGS Results of this survey offer a detailed view of the ART and IUI situation in European countries. It provides updated and extensive answers to many relevant questions related to ART usage at national level and could be used by institutions and policymakers in planning services at both national and European levels. Study funding/competing interest(s) The study has no external funding, and all costs were covered by ESHRE. There were no competing interests. ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
- C Calhaz-Jorge
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ESHRE Central Office, Belgium
| | - C H De Geyter
- Institute of Reproductive Medicine and Gynecological Endocrinology (RME), Basel, Switzerland
| | - M S Kupka
- Center for Reproductive Medicine, Gynaekologicum Hamburg, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Mocanu
- Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - G Scaravelli
- Registro Nazionale della Procreazione Medicalmente Assistita, Istituto Superiore di Sanità, Roma, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands
| | - S Vidakovic
- Clinical Center Serbia, ``GAK'' Institute for Obstetrics and Gynecology, Belgrade, Serbia
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Lindheim SR, Madeira JL, Ludwin A, Kemner E, Parry JP, Sylvestre G, Pennings G. Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2019; 9:1-10. [PMID: 31934649 PMCID: PMC6951275 DOI: 10.1016/j.rbms.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/11/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
This retrospective study surveyed decision-making and challenges among 78 gay cisgender male couples utilizing in-vitro fertilization (IVF) and a gestational carrier. While most couples (67.1%) found the decision to actively pursue fertility treatment 'not difficult', 32.9% felt that it was 'somewhat difficult' or 'very or extremely difficult'. Almost 30% of couples had not undertaken financial planning for treatment, which introduced delays of > 2 years for 25.3% of participants. Conceiving twins was 'important to very important' in 52.3% of couples, and 84.2% of couples chose to transfer two embryos to 'increase the odds' or reach an ideal family size in a single attempt despite increased complications with multiple pregnancies. Paternal leave was granted for one partner in 47.3% of couples, and for both partners in 43.2% of couples. One-third of couples reported experiencing discrimination, prompting a partner to seek employment, and 38% changed jobs or careers. For 80.3% of couples, the estimated cost exceeded US$100,000. Couples where one partner was aged > 50 years were significantly more likely to find the decision to actively pursue fertility treatment 'very or extremely difficult' (28.6%), and less likely to agree on becoming parents (64.3%). Gay male couples undergoing assisted reproduction face challenges regarding decision-making, lack of infertility benefits and discrimination, which appear to be influenced by age and country of residence. Policy and educational changes are needed, including broader fertility benefits, more egalitarian parental leave, and greater awareness of risks inherent to multiple gestation.
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Affiliation(s)
- Steven R. Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | | | - Artur Ludwin
- Department of Gynaecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynaecology, Private Medical Center, Krakow, Poland
| | - Emily Kemner
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
- Wright-Patterson Medical Center, Department of Obstetrics and Gynecology, Wright-Patterson Air Force Base, Dayton, OH, USA
| | | | - Georges Sylvestre
- Department of Obstetrics and Gynecology, Flushing Medical Center, Flushing, NY, USA
| | - Guido Pennings
- Bioethics Institute Ghent, Ghent University, Department of Philosophy and Moral Science, Gent, Belgium
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Degli Esposti S, Pavone V. Oocyte provision as a (quasi) social market: Insights from Spain. Soc Sci Med 2019; 234:112381. [PMID: 31252241 DOI: 10.1016/j.socscimed.2019.112381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.
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Affiliation(s)
- Sara Degli Esposti
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain; Centre for Business in Society (CBiS), Coventry University, Jaguar Building, Coventry CV1 5DL, UK.
| | - Vincenzo Pavone
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain.
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Ha-Vinh P, Régnard P, Sebahoun-Gil S. [Medical service use for infertility in French private sector]. SANTE PUBLIQUE 2019; Vol. 31:137-152. [PMID: 31210509 DOI: 10.3917/spub.191.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study presents nationally representative estimates and trends for infertility service use among women aged 25-43 and men aged 25-49 in France in 2013-2016. METHODS Two retrospective repeated cross-sectional analyses for years 2013 to 2016 were performed on the statutory French health care insurance reimbursement database for independent workers. Use rate was calculated on the number of individuals who underwent at least one infertility service within the studied year per women and men who utilized health services the same year. RESULTS 1.69% [IC 95%: 1.65; 1.72] of women aged 25-43 who utilized health services had used infertility services during the year 2016: 1.5% used ovulation induction, 0.7% ultrasound monitoring of follicles, 0.3% embryo transfer, 0.3% in vitro fertilization.The use increased significantly from 2013 to 2016 for the following services: ultrasound monitoring of follicles (+ 10%), intracytoplasmic sperm injection (+ 12%), freezing of embryos (+ 32%), thawing of embryos (+ 29%), embryo cryopreservation (+ 88%).In a multivariate analysis, the use was higher among women aged 30-39 years, with a liberal profession, living in the North-east or the south-east, in Corsica or over-seas, receiving health care outside the French territory.0.19% [IC 95%: 0.18; 0.20] of men aged 25-49 years had used infertility services during the year.There was a significant increase from 2013 to 2016 of the proportion of users for sperm freezing (+ 19.18%) and sperm cryopreservation for fertility preservation when cytotoxic therapy is required (+ 84.92%). CONCLUSION Some increases resulted from expanded indications. Follow-up will be required in case of legislative enlargement for access to certain techniques.
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Whittaker A, Inhorn MC, Shenfield F. Globalised quests for assisted conception: Reproductive travel for infertility and involuntary childlessness. Glob Public Health 2019; 14:1669-1688. [PMID: 31204900 DOI: 10.1080/17441692.2019.1627479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The global movement of people across international borders to undergo assisted reproductive treatment is common, although there is little accurate data. In this article, we synthesise findings from our own empirical research on reproductive travel in addition to a review of clinical, ethical, legal, and regulatory complexities from studies on reproductive travel since 2010. Motivations for travel include legal and religious prohibitions; resource considerations; lack of access to gametes and reproductive assistors; quality and safety concerns; and personal preferences. Higher risks to mothers and children are associated with multiple embryo transfer and subsequent multiple and higher order pregnancies and the average older age of women undertaking reproductive travel. The potential exploitation of other women as providers of oocytes or surrogacy services, the lack of equity in access to assisted reproduction and the ambiguous legal status of children conceived from international reproductive travel are important ethical considerations. A range of significant legal issues remain given variable and limited international regulation. Scholarship on this trade necessarily engages with issues of power and gender, social inequities, global capitalism and the private decision-making of individuals seeking to form families. Research gaps remain given recent changes in the organisation, demands and destinations of the trade.
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Affiliation(s)
- Andrea Whittaker
- School of Social Sciences, Faculty of Arts, Monash University , Melbourne , Australia
| | - Marcia C Inhorn
- Anthropology and International Affairs, Council on Middle East Studies, The MacMillan Center, Yale University , New Haven , CT , USA
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Larsson M. Opportunities and challenges in assisted reproduction - The Swedish example. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:A1. [PMID: 31056446 DOI: 10.1016/j.srhc.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kool EM, van der Graaf R, Bos AME, Pieters JJPM, Custers IM, Fauser BCJM, Bredenoord AL. Stakeholders views on the ethical aspects of oocyte banking for third-party assisted reproduction: a qualitative interview study with donors, recipients and professionals. Hum Reprod 2019; 34:842-850. [PMID: 30927419 PMCID: PMC9185857 DOI: 10.1093/humrep/dez032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 01/28/2023] Open
Abstract
STUDY QUESTION What are the moral considerations held by donors, recipients and professionals towards the ethical aspects of the intake and distribution of donor bank oocytes for third-party assisted reproduction? SUMMARY ANSWER Interviews with oocyte donors, oocyte recipients and professionals demonstrate a protective attitude towards the welfare of the donor and the future child. WHAT IS KNOWN ALREADY The scarcity of donor oocytes challenges the approach towards the many ethical aspects that arise in establishing and operating an oocyte bank for third-party assisted reproduction. Including experiences and moral considerations originating from practice provides useful insight on how to overcome these challenges. STUDY DESIGN, SIZE, DURATION The project was set-up as a qualitative interview study and took place between October 2016 and August 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS We conducted 25 semi-structured interviews with professionals engaged in the practice of oocyte banking (n = 10), recipients of donor oocytes (n = 7) and oocyte donors (n = 8). Key themes were formulated by means of a thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE Based on the interviews, we formulated four main themes describing stakeholders’ views regarding the ethical aspects of the intake and distribution of donor bank oocytes. First, respondents articulated that when selecting donors and recipients, healthcare workers should prevent donors from making a wrong decision and safeguard the future child’s well-being by minimizing health risks and selecting recipients based on their parental capabilities. Second, they proposed to provide a reasonable compensation and to increase societal awareness on the scarcity of donor oocytes to diminish barriers for donors. Third, respondents considered the prioritization of recipients in case of scarcity a difficult choice, because they are all dependent on donor oocytes to fulfil their wish for a child. They emphasized that treatment attempts should be limited, but at least include one embryo transfer. Fourth and finally, the importance of good governance of oocyte banks was mentioned, including a homogenous policy and the facilitation of exchange of experiences between oocyte banks. LIMITATIONS, REASONS FOR CAUTION The possibility of selection bias exists, because we interviewed donors and recipients who were selected according to the criteria currently employed in the clinics. WIDER IMPLICATIONS OF THE FINDINGS Respondents’ moral considerations regarding the ethical aspects of the intake and distribution of donor oocytes demonstrate a protective attitude towards the welfare of the donor and the future child. At the same time, respondents also questioned whether such a (highly) protective attitude was justified. This finding may indicate there is room for reconsidering strategies for the collection and distribution of donor bank oocytes. STUDY FUNDING/COMPETING INTEREST(s) This study was funded by ZonMw: The Dutch Organization for Health Research and Development (Grant number 70-73000-98-200). A.M.E.B. and B.C.J.M.F. are the initiators of the UMC Utrecht oocyte bank. J.J.P.M.P. is the director of the MCK Fertility Centre. IMC is working as a gynaecologist at the AMC Amsterdam oocyte bank. During the most recent 5-year period, BCJM Fauser has received fees or grant support from the following organizations (in alphabetic order): Actavis/Watson/Uteron, Controversies in Obstetrics & Gynaecologist (COGI), Dutch Heart Foundation, Dutch Medical Research Counsel (ZonMW), Euroscreen/Ogeda, Ferring, London Womens Clinic (LWC), Merck Serono (GFI), Myovant, Netherland Genomic Initiative (NGI), OvaScience, Pantharei Bioscience, PregLem/Gedeon Richter/Finox, Reproductive Biomedicine Online (RBMO), Roche, Teva and World Health Organization (WHO). The authors have no further competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E M Kool
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - J J P M Pieters
- MCK Fertility Centre, Center of Reproductive Medicine, Simon Smithweg 16, Leiderdorp, The Netherlands
| | - I M Custers
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
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Borgstrøm MB, Nygaard SS, Danielsen AK, Kesmodel US. Exploring motivations, attitudes and experiences of oocyte donors: A qualitative study. Acta Obstet Gynecol Scand 2019; 98:1055-1062. [DOI: 10.1111/aogs.13583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Buhl Borgstrøm
- The Fertility Clinic, Department of Obstetrics and Gynecology Herlev Gentofte HospitalUniversity of Copenhagen Herlev Denmark
| | - Siv S. Nygaard
- Department of Obstetrics and Gynecology Herlev Gentofte HospitalUniversity of Copenhagen Herlev Denmark
| | - Anne K. Danielsen
- Department of Gastroenterology Herlev Gentofte HospitalUniversity of Copenhagen Herlev Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynecology Herlev Gentofte HospitalUniversity of Copenhagen Herlev Denmark
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Simopoulou M, Sfakianoudis K, Giannelou P, Pierouli A, Rapani A, Maziotis E, Galatis D, Bakas P, Vlahos N, Pantos K, Koutsilieris M. Treating Infertility: Current Affairs of Cross-border Reproductive Care. Open Med (Wars) 2019; 14:292-299. [PMID: 30931395 PMCID: PMC6434662 DOI: 10.1515/med-2019-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022] Open
Abstract
Infertility patients are willing to travel abroad to receive the medical treatment of choice. A 2010 study reported that approximately 25,000 couples travel abroad annually seeking infertility treatment. The purpose of this review is to analyze the criteria and risks related to cross-border reproductive care (CBRC) from the perspective of the patients and explore the issues raised regarding the country of origin and the destination country. A computerized search was performed in PubMed employing respective keywords. The total number of published articles provided by our PubMed search was 1905. Criteria for selecting the destination country include: the economic status, legislation, quality of care and anonymity. Despite the fact that CBRC is becoming a familiar concept, it raises concerns for the practitioner and issues of a social and bioethical nature. Most of them stem from the fact that health care acquires a commercialization aspect. Medical tourism entails several risks, such as misconceptions regarding the destination country, and legal issues arising from differences in the judiciary systems. Larger studies evaluating all aspects of CBRC are imperative. Quality assurance, a consensus and a common platform of practice, along with a system of international governance based on human rights, are a necessity for CBRC patients.
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Affiliation(s)
- Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527, Athens, Greece.,Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Polina Giannelou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece
| | - Aikaterini Pierouli
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Galatis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Bakas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlahos
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Igareda González N. Regulating surrogacy in Europe: Common problems, diverse national laws. EUROPEAN JOURNAL OF WOMENS STUDIES 2019. [DOI: 10.1177/1350506819835242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the diverse legal approaches towards surrogacy in Europe, there are common socio-legal arguments attempting to legitimise it amongst the European Union member states. Regardless of the prevailing regulation in each country, surrogacy in general is confronted with common criticisms and faces similar obstacles. For instance, the operative definition of altruism is put under question in countries where altruistic surrogacy is permitted. Surrogacy is also considered an attack on a woman’s dignity and a risk to children’s welfare. Behind such claims, however, rests the common yet unsubstantiated belief in a natural maternal instinct. Furthermore, a clear misunderstanding about the bonding theory still persists. Common debates around surrogacy in Europe show us that, beyond the national margin of appreciation, surrogacy challenges basic definitions of motherhood, filiation and family. These challenges are deeply permeated by gender stereotypes which partially explain the national similarities among the legal diversities.
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Ethical issues and law-making power: how European case law has rewritten Italian law on medically assisted reproduction. Monash Bioeth Rev 2018; 37:46-67. [PMID: 30569425 DOI: 10.1007/s40592-018-0088-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The paper relates to the actual extent of the "margin of appreciation" of national law-making power in Europe when it takes ethical issues into consideration. This occurs when the use of technoscience may affect fundamental interests. The discretion of the legislature is limited, particularly by the transnational system arising from the European legal integration within both the European Union and the Council of Europe. The two schemes of integration, although there are differences between them, converge to put national legislation under pressure, particularly when it considers ethical matters. As a matter of fact, ethical issues cannot be approached at the national level alone but must be addressed at least at the continental level. An important role in the work of shaping the ethical rules from a continental perspective is played not by the national legislatures, but by the dialogue between the different levels of the judiciary. This role is inescapable and cannot be replaced by legislation, even if it is approved in a transnational plan. The function of the case law in regulating phenomena with ethical implications is studied, taking into consideration the case of Italian Law no. 40 of 2004 concerning medically assisted reproduction. Over the last 15 years, this law, which is inconsistent with many fundamental ethical principles, but has not been amended by the legislature, has been in the process of being corrected by the dialogue between European and national case law.
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La Marca A, Dal Canto M, Buccheri M, Valerio M, Mignini Renzini M, Rodriguez A, Vassena R. A novel transnational fresh oocyte donation (TOD) program based on transport of frozen sperm and embryos. Hum Reprod 2018; 34:285-290. [DOI: 10.1093/humrep/dey331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- A La Marca
- Clinica EUGIN, University of Modena and Reggio Emilia, Modena, Italy
| | - M Dal Canto
- Clinica EUGIN, Modena, Italy
- Biogenesi, Reproductive Medicine Centre, Monza, Italy
| | | | | | - M Mignini Renzini
- Clinica EUGIN, Modena, Italy
- Biogenesi, Reproductive Medicine Centre, Monza, Italy
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46
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Stapleton P, Skinner D. Cross‐Border Reproductive Care: Two Lenses in Political Science. WORLD MEDICAL & HEALTH POLICY 2018. [DOI: 10.1002/wmh3.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, Inhorn MC, Patrizio P. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35:1277-1288. [PMID: 29808382 PMCID: PMC6063838 DOI: 10.1007/s10815-018-1181-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium. RESULTS Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CONCLUSION CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.
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Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany.
- Department of Reproductive Medicine, National Research Center, Cairo, Egypt.
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Gohar Rahimi
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Lynn M Westphal
- Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Pasquale Patrizio
- Department of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
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Madero S, Gameiro S, García D, Cirera D, Vassena R, Rodríguez A. Quality of life, anxiety and depression of German, Italian and French couples undergoing cross-border oocyte donation in Spain. Hum Reprod 2018; 32:1862-1870. [PMID: 28854722 DOI: 10.1093/humrep/dex247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 06/30/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the quality of life (QoL) and mental health of infertile heterosexual couples from different nations (Italy, Germany and France) undergoing cross-border oocyte donation (OD) in Spain? SUMMARY ANSWER Women have lower QoL and more anxiety than their male partners; overall French couples have lower QoL than their Italian and German counterparts. WHAT IS KNOWN ALREADY In Europe, thousands of couples move across national borders annually to seek ARTs, primarily OD, driven mainly by legal restrictions in their countries of origin. Most research shows that infertility and ARTs affect patients' mental health and QoL. The decision to undergo reproductive care abroad might add further emotional and practical complexity. Reliable information on how this experience affects the mental health and QoL of cross-border reproductive care (CBRC) patients is lacking. Moreover, most research has focused on women, and further research on male partners and intercultural differences is needed. STUDY DESIGN, SIZE, DURATION Cross-sectional study including 548 heterosexual individuals (347 women, 201 men) from Italy, Germany and France seeking IVF with donated oocytes in Barcelona, Spain between March and November 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 432 couples were invited to participate and handed a questionnaire set. Questionnaires were answered separately and anonymously by each member of the couple on the day of embryo transfer. The questionnaire set included the Fertility Quality of Life (FertiQoL) instrument, the generic Hospital Anxiety and Depression Scale (HADS) instrument and three close-ended questions assessing perceived usefulness, desire, and use of psychological support. The overall response rate was 63.4%. MAIN RESULTS AND THE ROLE OF CHANCE Men reported significantly higher scores than women in the emotional (+13.74; P < 0.001), mind-body (+13.39; P < 0.001) and social (+4.11; P < 0.01) FertiQoL domains, at multilevel analysis controlled for confounder factors. Intercultural differences in QoL of couples were seen. French individuals had significantly lower emotional (-6.44; P < 0.01), mind-body (-7.41; P < 0.001) and relational scores (-6.41; P < 0.001) compared to Italians. Germans showed higher social scores (+6.41; P < 0.001) but lower relational scores (-8.94; P < 0.002) than Italians. Men reported significantly lower anxiety scores for the HADS than their partners (-1.38; P < 0.001), and German couples reported lower anxiety (-1.70; P = 0.003) and depression than their Italian counterparts (-1.56; P < 0.001). French patients were more likely to have required support by a mental health professional due to fertility problems in the past (+0.19; P < 0.001). LIMITATIONS, REASONS FOR CAUTION The scope of this study is limited to heterosexual couples undergoing cross-border OD. Caution on the interpretation of the results in men is advised, mainly because only three men for every five women completed the questionnaire. WIDER IMPLICATIONS OF THE FINDINGS These findings call for further work to identify the true nature of the differences in QoL and mental health observed. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- S Madero
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Park Place Cardiff, CF10 3AT, UK
| | - D García
- Fundació Privada EUGIN, Travessera de les Corts 318, Barcelona 08029, Spain
| | - D Cirera
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - R Vassena
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - A Rodríguez
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
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Kool EM, Bos AME, van der Graaf R, Fauser BCJM, Bredenoord AL. Ethics of oocyte banking for third-party assisted reproduction: a systematic review. Hum Reprod Update 2018; 24:615-635. [DOI: 10.1093/humupd/dmy016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- E M Kool
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
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Mulder CL, Serrano JB, Catsburg LAE, Roseboom TJ, Repping S, van Pelt AMM. A practical blueprint to systematically study life-long health consequences of novel medically assisted reproductive treatments. Hum Reprod 2018; 33:784-792. [PMID: 29635479 PMCID: PMC5925779 DOI: 10.1093/humrep/dey070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/27/2018] [Indexed: 01/27/2023] Open
Abstract
In medicine, safety and efficacy are the two pillars on which the implementation of novel treatments rest. To protect the patient from unnecessary or unsafe treatments, usually, a stringent path of (pre) clinical testing is followed before a treatment is introduced into routine patient care. However, in reproductive medicine several techniques have been clinically introduced without elaborate preclinical studies. Moreover, novel reproductive techniques may harbor safety risks not only for the patients undergoing treatment, but also for the offspring conceived through these techniques. If preclinical (animal) studies were performed, efficacy and functionality the upper hand. When a new medically assisted reproduction (MAR) treatment was proven effective (i.e. if it resulted in live birth) the treatment was often rapidly implemented in the clinic. For IVF, the first study on the long-term health of IVF children was published a decade after its clinical implementation. In more recent years, prospective follow-up studies have been conducted that provided the opportunity to study the health of large groups of children derived from different reproductive techniques. Although such studies have indicated differences between children conceived through MAR and children conceived naturally, results are often difficult to interpret due to the observational nature of these studies (and the associated risk of confounding factors, e.g. subfertility of the parents), differences in definitions of clinical outcome measures, lack of uniformity in assessment protocols and heterogeneity of the underlying reasons for fertility treatment. With more novel MARs waiting at the horizon, there is a need for a framework on how to assess safety of novel reproductive techniques in a preclinical (animal) setting before they are clinically implemented. In this article, we provide a blueprint for preclinical testing of safety and health of offspring generated by novel MARs using a mouse model involving an array of tests that comprise the entire lifespan. We urge scientists to perform the proposed extensive preclinical tests for novel reproductive techniques with the goal to acquire knowledge on efficacy and the possible health effects of to-be implemented reproductive techniques to safeguard quality of novel MARs.
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Affiliation(s)
- Callista L Mulder
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joana B Serrano
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lisa A E Catsburg
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Academic Medical Centre, Meibergdeef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Centre, Meibergdeef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ans M M van Pelt
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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