Tragic outcome of post-menopausal pregnancy: An obstetric commentary

Ethico-legal issues related to ovarian tissue transplantation

Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.

Pregnancy beyond 65: report of a unique case and discussion of a controversial issue

We present the case report of a 66-year-old woman who was attended at our gynaecology department at a tertiary university hospital in Barcelona, Spain for a high-risk pregnancy and comment on the obstetric implications and bioethical issues. We retrospectively analysed clinical data about the case and bibliographic references related to the issue. The woman underwent in vitro fertilisation of donated embryos in a private centre and came to our unit at 27 weeks of gestation for pregnancy care. At 33 weeks, she presented pre-eclampsia and a caesarean section was performed. She gave birth to healthy twin boys. Four months later, she returned to our centre with the diagnosis of ovarian cancer and died 30 months after delivery. We present the clinical course and management of this pregnancy and comment on the obstetric implications, the impact on maternal and neonatal health, and bioethical issues related to assisted reproduction techniques in pregnancies beyond the natural reproductive age.

Ovules vieillissants, mères sans âge? Infertilité féminine et recours au don d’ovocytes en Suisse

Cette contribution1 examine l’impact des possibilités d’extension de la fertilité féminine ouvertes par le don d’ovocytes sur les significations de l’« âge limite de la maternité », dans le contexte suisse où cette technique est interdite. En me focalisant sur les expériences de femmes recourant au don d’ovocytes en cas d’infertilité liée à l’âge, je montrerai comment cette technique ouvre un espace de contestation et de négociation des limites biologiques de la fertilité. La première partie examine l’utilisation des normes biologiques et statistiques du déclin de la fertilité dans le cadre du diagnostic; la deuxième montre comment les significations des limites d’âge se transforment au fil du parcours de procréation médicalement assistée (PMA); la troisième met en lumière quelques stratégies utilisées pour reconfigurer l’« horloge biologique ».