Добірка наукової літератури з теми "Gamete donation; IVF; legal relationships"

Assisted reproductive technology (ART) is a multibillion dollar market in the United States (U.S.), generating a continual demand for oocyte donors whose gametes contributed to 12.6% of all ART cycles in 2012. Oocyte donation is a variant of in vitro fertilization (IVF) that is typically used when an intended mother cannot produce healthy oocytes of her own and instead uses oocytes provided by a third party in an attempt to produce one or more children. When oocyte donation was first developed, oocyte donors were selected among family and friend groups but, increasingly, active solicitation of anonymous donors and brokering the relationship between donor and recipient has become part of the services offered by fertility clinics. In addition, recipients may choose to work with an independent donor agency to find a suitable donor before completing the IVF procedure at a fertility clinic.

Gamete donation offers a unique opportunity to compare men and women's relationships to reproductive decision-making, unlike other reproductive processes, which typically involve women's bodies much more asymmetrically. I address medical and reproductive decision-making by examining how a gamete donor's partner may be involved in the donation process. Some countries explicitly involve a donor's partner by legally requiring spousal consent for donation, but this is not the case for the U.S. In the absence of any formal regulation, what are the expectations for involving a donor's partner? Through a content analysis of materials from donation programs across the U.S., I examine how donation programs configure the partner's role. Overall, I find that there are quite different expectations for partner involvement in egg versus sperm donation. Such differences, I argue, both stem from and reinforce existing issues navigating boundaries between intimate relationships and women's medical and reproductive autonomy.

Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of ‘older’ ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.

ART and, in particular, IVF and ICSI, are essentially a laboratory experiment, but which, due to its specificity, goes beyond the disciplinary boundaries, explicitly acquiring an ethical-axiological dimension in the interaction zone of the members of a particular community involved in child-bearing. At the same time, it is noted that the activity and choice of a way to solve problems with childbirth has a characteristic severity, due to the traditions and level of civil and social maturity of a country, due, among other things, to the level and achievements of technical equipment in this industry of knowledge and practice. According to foreign studies, about half of all subfertile people (having problems with childbirth, but potentially able to become parents) in developed countries are trying to overcome their infertility with the help of medicine, and research data indicate that the proportion of such individuals is growing. The most difficult problems of reproduction are associated with low quality of oocytes (eggs) or low ovarian reserve (both age and hereditary, as well as associated with past diseases or iatrogenic); aspermia and deep teratozoospermia (the presence of only pathological forms of sperm in the ejaculate), can not give hope to a couple (or individual) to have genetically related offspring. However, donor programs create additional opportunities for social (non-biological) motherhood / paternity. Donation of oocytes (ova) is found in ART programs at least 3 times more often than donation of spermatozoa (for heterosexual couples, but not for single women). At the moment, donation of gametes and embryos raises a number of ethical, legal, medical and socio-psychological issues that require competent support from experts of a wide range of specialists, as well as competent, non-commercial, primarily due to the interaction between donors and recipients. The analysis of possible modifications of family and kinship ties is based on the idea of transforming social relations, in which assisted reproductive technologies (ART) play a fundamental role, building a system of “new kinship and new family.” By entering into the intimate process of the birth of life and acting as a regulator of the composition of participants in this process through the stimulation of responsibility to present and future relatives, reproductive technologies affect the initial moral requirements in the community, redefining universal values based on the specific situation. Scenarios of childbearing through ART with the involvement of additional participants (donors of sperm, oocytes or embryos) are possible in the context of the legal field, but legally fixed anonymity of the donor (except for the relative of the recipient) leaves many unresolved issues related to the problems of hereditary diseases, genetic abnormalities and epigenetic changes; in addition, there is a problem associated with the possibility of unintentional incest, as well as the difficulties of the child’s self-identification and the closeness of his genealogy. Solutions to these issues are postponed until later, thereby initiating future dramatic situations, ethical conflicts and dilemmas with a poorly predictable positive outcome.

Background: Among the achievements of modern fertility technologies available to contemporary humans, we could mention the freezing technique to fertility preservation, and subsequently, unmarried childbearing. The only way for having children was having sexual intercourse with the opposite gender in the past years; however, with the advent of this technology, even without such a relationship, it is possible to have a child. This process could be termed unmarried childbearing or single-status fertilities. This is one of the resent subjects in medical fertility; however, there is no research in this field, in Iran. Methods: This was an applied and theoretical research in the theology field; thus, no research material was implemented. The main method of this research was the bookcase approach. Result: In countries such as the USA, UK, and Australia, where there are more coherent laws about employing modern fertility techniques, this issue is addressed and specific laws exist in this regard. However, despite widespread use of this technique in Iran, we have no law in this respect except for the Fetal Donation Act of 2003, which only covers the general issues. In other words, the social fertility mandate has remained silent given permission, prohibition, and its conditions and effects on the child lineage in Iran's laws. Freezing gametes is practiced in our country for a wide range. Besides, single-status fertility is occurring worldwide. Accordingly, this seems to be among the problems facing our society, and may also be illegally conducted in some cases, in Iran. In Islamic law, the permissible instances of reproductive rights include births through marriage, not otherwise, as well as births employing reproductive aids in terms of meeting the Islamic law. On the other hand, some individuals believe that this case can be regarded as some kind of inoculation with the involvement of a donor agency, and some jurists have voted to allow it. Therefore, these jurists explicitly accepted the use of donor gamete in the form of marital relations. The legislature of the Islamic Republic of Iran also emphasizes on donation to lawful couples in the law of donation approach. Therefore, using donated gametes for childbearing is excluded in singles. Additionally, Judaism and all branches of Christianity, except for the liberal protestant denomination prohibit unmarried childbearing. While the approach to the issue differs from one country to another, the USA Supreme Court has recognized and protected free relationships, family formation, and decisions on births, as freedom rights. The UK law has subjected the provision of services to single women to the welfare of children resulting from the process. However, in France, the provision of infertility treatment services to single individuals is prohibited. According to Australia law, any single or heterosexual individual without receiving medically-assessed services, i.e., referred to as ‘‘clinically infertile’’ cannot use this technology for having children. Conclusion: In some countries, like the USA, bearing a child at a single status is legal; however, in some other regions, like the UK and Australia, it is permitted under special conditions. In some countries, like France, this action is prohibited. There is no law about this matter in Iran. The 167 article of the constitution addresses considering the Islamic verses and narrations on preserving the destination of the generation or acquiring the benefits and disposing of the corruption. In conclusion, the only way to have a child and to realize the principle of reproduction is permitted in the framework of religious marriage; thus, bearing a child at a single status is illegal and prohibited, in Iran.

The development of in vitro fertilization (IVF) in the UK, in 1978, proved a major breakthrough in the process of human reproduction, which had remained constant in human history. The impact of IVF and the ensuing assisted reproductive technologies (ARTs) has not been limited in revolutionizing the "natural" practice of biological reproduction, but has reached out to and affected almost every institution in society. Family and kinship, as the social expression of reproduction and the institutions which are the most transparently structured realm of human life are those most profoundly affected by ARTs. Although literature on the implications of ARTs is in general abundant, this article presents new insights on their impact on family and kinship in Iran, which remains a unique case in the Muslim world. It explores the particular way ARTs, especially third-party donation, have been endorsed and practiced in Iran, and their consequences for the family, the infertile individuals, and their position vis-à-vis their kin and social group. The conclusion points to the lack of clarity concerning the initial rulings by the Islamic jurists, who allowed the practice of ARTs, and which has led to a number of unintended consequences regarding the legal, religious, cultural, and ethical issues, affecting the family, its structure and the relationship between the kin group. These consequences range, inter alia, from the question of the anonymity of third-party donor, to the permissibility of gamete donation between blood relatives, and to the absence of enforceable legislation.

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.

The task of legally characterising complex interpersonal relationships presents a challenge to lawyers, legislators and academics. In law, relationships between parties are commonly characterised in terms of competing sets of rights. The parties are characterised as adversaries, in conflict, and this conflict is resolved by balancing the competing rights of one against the other. Under this model, rights create metaphorical boundaries between autonomous liberal individuals. Relational theories of rights challenge the dominant liberal model of the individual and their legal relations by exchanging the metaphor of boundaries for a study of real relationships. In this way, rights function to facilitate and structure relationships between parties, rather than to keep parties separated. Under a relational model, the autonomy of each person can only be understood in the context of their relationships. The rights-holder can not be viewed in isolation. In this thesis, I consider the legal relationships between Australian parties to gamete donation. In particular, I argue that the relationships may have been well described by a liberal model of rights in the past, but that the liberal model is no longer adequate to characterise the developing interpersonal relationships between the parties. I demonstrate that relational theories of rights provide a sound theoretical basis for characterising the increasingly relational parties to gamete donation, as they exist now and into the future. In addition to describing technological, social and legal developments in donor conception from the early 1900’s to the present day, I place these developments in the context of a broad social shift from liberal to a post-liberal society. In particular, this social shift is characterised by decreased separation between domains of public and private, and represents a deep psychological shift in our understanding of the individual as increasingly interpersonal and relational. In the context of gamete donation in Australia, this shift is manifested in increasing exchange of information between parties over time. In particular, disclosure of information about donors to donor-conceived offspring has been a significant political and academic focus. My thesis first demonstrates a link between the broad post-liberal social shift and changing concept of the individual to the evolving relationships between parties to gamete donation and, second, advocates for the current trajectory of change towards increasingly relational parties to gamete donation.
Thesis (Ph.D.) -- University of Adelaide, Law School, 2015

We’re used to blaming randomness or cosmic injustice when we don’t get the child we want, or when we get the one we don’t. Now cutting-edge interventions promise to deliver us from the vagaries of natural conception and the genetic lottery: Birth control and abortion prevent parenthood; gamete donation and IVF make procreation possible; and prenatal testing can detect debilitating offspring diseases even before pregnancy. These undertakings are still riddled with uncertainty—sometimes things just don’t work out; but that’s no reason to turn a blind eye when bad behavior is at fault. The American legal system protects against professional negligence in other inherently risky activities, from riding in a car to preparing a meal. Courts lay off when fate or accidents are responsible—when deer pop out onto dark roads, or homemade chicken is undercooked. But the law doesn’t hesitate to respond when auto crashes are traced to defective brakes, or food poisoning to unsanitary farming. Reproductive medicine and technology shouldn’t be any different—the stakes are high, and important interests hang in the balance. Just because would-be parents are accustomed to disappointment—because many of us have resigned ourselves to spontaneous miscarriage, or unplanned pregnancy, or an unexpected roll of the genetic dice—doesn’t make those outcomes any less serious, or misconduct that produces them any less worthy of recovery. Reproductive negligence today goes undeterred, unreported, and unredressed—the architecture of rights for procreation deprived, imposed, and confounded equips us to rethink and resolve the controversies that lie ahead.