P-345 A Universalist Approach to the Registration of the Information of Gamete/Embryo Donners: an Experience from Avicenna Infertility Clinic

Study question

Legal systems justify registering information of donners on the basis of protecting identity and health of resulting children. Is this a universal rule?

Summary answer

Apparently, mentioned registration of information of gamete/embryo donners is not justifiable under all legal systems.

What is known already

In countries like Iran, there is a partial legal approach, due to religious reasons, to donation, while legal status of resulting children is not clear. For instance, as for the filiation of these children, should they be considered as filius nullius?  In Iran, following the famous Shī‘ī religious opinion, the donner is considered as the parent while the receiver is at most the step one. Under such a system, many receivers prefer to keep the donation information strictly confidential. Even donners take such a stance so as to safeguard themselves against likely legal liabilities in future. Confidentiality is justified here.

Study design, size, duration

In order for us to put forward a justifiable position, first, we examine the existing relevant Iranian laws, such as the Embryo Donation Act (2003). Secondly, certain empirical data in this regard shall be brought in. The aforesaid position shall be attempted to be based on these two steps.

Participants/materials, setting, methods

Apart from the positive legal materials, some questionnaires filled out by a number of patients using Avicenna Infertility Clinic services and also a few judicial cases as decided by Iranian courts shall be taken into account for this study. As for the questionnaire, it contained ten sentences which were scored on the basis of 5-point Likert Scale. The answers were finally evaluated based on the Cronbach alpha calculation.

Main results and the role of chance

Even if one embraces the justification of the information due to protecting identity and health of resulting children, this does not work well as long as the issue of filiation is not legally determined in a crystal clear way. In this case, registration of donners’ information just adds another claimant to the group of filiation claimants which makes the situation worse. This is why both donners and receivers wish to keep the donation information completely confidential so that themselves and the children may live a normal life in the country. Otherwise, demand for this method of fertility treatment would seriously fall. The analysis of the statistic results also confirms the claim that neither of donners and receivers groups do not agree with the registration and disclosure of the data.

On this basis, we do not believe that a universalist legal approach to the issue of data registration in this area is a defendable stance. Therefore, we are inclined to see the issue in the light of other crucial aspects of the donation method, e.g. that of filiation. The guiding principle seems to be the well being of the receiving couples and the resulting children.

Limitations, reasons for caution

We do not see a particular problem (limitation or caution) in the way of our research.

Wider implications of the findings

It seems that not only is this study beneficial to the Iranian health policy makers, it will also be useful in a comparative context.

Trial registration number

not applicable

The randomised uterine septum transsection trial (TRUST): design and protocol

BACKGROUND

A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus.

METHODS/DESIGN

A multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised.

DISCUSSION

Hysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed.

TRIAL REGISTRATION

Dutch trial registry ( NTR1676 , 18th of February 2009).