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Agopiantz M, Dap M, Mougniotte G, Bertholdt C, Morel O. [Altruistic surrogacy in France: Context and perspectives]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:436-439. [PMID: 38340981 DOI: 10.1016/j.gofs.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/07/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Mikaël Agopiantz
- Service de médecine de la reproduction, CHRU de Nancy, université de Lorraine, 10, avenue Dr.-Heydenreich, 54000 Nancy, France.
| | - Matthieu Dap
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Guillaume Mougniotte
- Laboratoire de biologie de la reproduction, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Charline Bertholdt
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
| | - Olivier Morel
- Service d'obstétrique, CHRU de Nancy, université de Lorraine, Nancy, France
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O'Keeffe R. Womb to rent: the ethical and legal implications of surrogacy in Ireland. Ir J Med Sci 2024; 193:549-554. [PMID: 37831359 DOI: 10.1007/s11845-023-03546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Surrogacy is a form of assisted human reproduction whereby a surrogate woman carries a pregnancy for a commissioning couple or individual. There are two types of surrogacy, traditional and gestational. Worldwide we have seen a rapid increase in the use of surrogacy. Despite this, there is a lack of consensus internationally on the laws governing surrogacy. In Ireland, surrogacy remains largely unregulated. Currently, there is no specific legislation for surrogacy. This review aims to discuss its current regulatory status and associated ethical issues. AIMS On surrogacy from an Irish legal perspective, this study is to (i) demonstrate the lack of legislation, (ii) describe the Health Bill 2022 and (iii) examine the challenges surrounding surrogacy and Irish case law. On surrogacy from an Irish ethical perspective, this study is to (iv) discuss the ethical issues surrounding autonomy, (v) discuss the ethical issues surrounding non-maleficence, (vi) discuss the ethical issues surrounding justice and (vii) evaluate ethical issues specific to commercial surrogacy: (1) child welfare and (2) commodification and exploitation of children and women's bodies. CONCLUSION Surrogacy has raised several ethical issues. There are issues surrounding autonomy of the surrogate and commissioning couple, child welfare, exploitation and commodification, non-maleficence and justice. There are also significant legal concerns with surrogacy. It is neither legal nor illegal in Ireland. This creates challenges for the commissioning couple particularly in terms of custody of the child.
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Affiliation(s)
- Rachel O'Keeffe
- The National Maternity Hospital, Holles Street, Dublin, Dublin 2, Ireland.
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Šuľová M, Popper M. Altruistic help or taking advantage of the situation? Social representations of surrogate motherhood. J Health Psychol 2024; 29:186-199. [PMID: 37534593 DOI: 10.1177/13591053231189411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Concerning Europe, the lay public, mainly in Central regions, still lacks information about what surrogacy is and how the process works in practice. It is one of the most controversial methods of assisted reproduction precisely because it goes against traditional social norms and ideas about the conception of life. The main aim of our study was to map the social representations of lay people that are formed in internet discussions. We focused on discussion forums over a time span of the last 10 years, from 2013 to 2022. We were also interested in whether perceived risks or benefits formed the core of social representations. Through a reflexive thematic analysis, we identified two distinct constructions of social representations of surrogacy, finding that value settings in terms of liberalism and conservatism appear to have the greatest influence on the anchoring and objectification of surrogacy.
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Affiliation(s)
- Mária Šuľová
- Institute for Research in Social Communication SAS, Slovak Republic
| | - Miroslav Popper
- Institute for Research in Social Communication SAS, Slovak Republic
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Attawet J, Alsharaydeh E, Brady M. Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review. Health Care Women Int 2024:1-19. [PMID: 38252790 DOI: 10.1080/07399332.2024.2303520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
The surge in demand for surrogacy treatments, combined with regulatory loopholes, has spurred the widespread adoption of global commercial surrogacy. This phenomenon poses potential risks to all involved parties, including surrogates and children, encompassing ethical, legal, physical, and psychological concerns. Although commercial surrogacy is under discussion in various jurisdictions, some countries may reintroduce legislation on the matter. In addressing this intricate landscape, the researchers performed an integrative review of existing literature with the intention of providing guidance to researchers and policymakers. The researchers emphasized notable legal and ethical challenges linked to commercial surrogacy. Surrogates often experience disempowerment and oppression, exacerbated by the contractual nature of these arrangements, perpetuating structural inequalities. Children born through commercial surrogacy, especially internationally, risk losing cultural heritage and future benefits. Banning commercial surrogacy may drive it underground, harming surrogates. Reconsidering prohibitions without penalizing surrogates could mitigate downstream issues and safeguard them from exploitation.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
- Charles Darwin Centre for Evidence-Based Practice: A JBI Affiliated Group, Darwin, Northern Territory, Australia
| | - Ethar Alsharaydeh
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
| | - Mark Brady
- School of Law, Faculty of Arts and Society, Charles Darwin University, Casuarina, Northern Territory, Australia
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Agopiantz M, Dap M, Martin E, Meyer L, Urwicz A, Mougel R, Malmanche H. Assisted reproductive technology in France: The reproductive rights of LGBT people. J Gynecol Obstet Hum Reprod 2023; 52:102690. [PMID: 37913923 DOI: 10.1016/j.jogoh.2023.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/15/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND In 2021, France authorized ART with sperm donor for female couples and single women. OBJECTIVES We summarize here the possibilities of ART among LGBT people in France to date, pointing out the main restrictions for LGBT reproductive rights, requiring future legislative changes. RESULTS Despite the latest modification of the French bioethics laws which notably opens ART to female couples, French legislation still excludes most LGBT people from parenthood through ART, especially gay men and transgender people in most cases. Surrogacy, ROPA, co-parenting and directed sperm donation are banned. CONCLUSIONS Legalize ROPA and overcome gender issues for trans people are necessary. A French model of surrogacy is to be considered.
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Affiliation(s)
- Mikaël Agopiantz
- Department of Reproductive medicine, CHRU de Nancy, Université de Lorraine, Nancy, France.
| | - Matthieu Dap
- Department of Gynecology and Obstetrics, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Elena Martin
- Department of Medical gynecology, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Larissa Meyer
- Association Réseau fertilité France (R2F), Paris, France
| | | | - Romane Mougel
- Department of Reproductive medicine, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Hélène Malmanche
- Research unit Sexual and reproductive Health and Rights, Ined, Paris, France
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Brandão P, Monseur B, Melo P, Gonçalves-Henriques M, Ceschin N, Reis-Soares S, Sousa-Santos R, Bellver J. Shared IVF among female couples: clinical outcomes of the Reception of Oocytes from the Partner (ROPA) method. Reprod Biomed Online 2023; 47:103284. [PMID: 37542844 DOI: 10.1016/j.rbmo.2023.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023]
Abstract
RESEARCH QUESTION What is the population undergoing the ROPA (Reception of Oocytes from Partner) method and what are the outcomes of the technique? DESIGN Case series of all ROPA treatments carried out between 2011 and 2020 in 18 fertility clinics in Spain. Demographic characteristics, cycle features, laboratory and clinical outcomes, and the intentions regarding the disposition of surplus embryos were analysed. RESULTS Donor patients were on average 3.5 years younger than recipients (P = 0.001). No significant differences were found in body mass index or anti-Müllerian hormone. In 13% of cases, fertility issues were found: poor ovarian reserve (6.8%); endometriosis (2.9%); and polycystic ovary syndrome (2.2%). Including cases of advanced age (38 years old or older), more than one-half of couples (53.6%) had some condition that could affect fertility. Mean number of mature oocytes per cycle was 10 (+/- 5.7), and fertilization rate was 74.5% (+/- 18.8). Mean number of viable embryos was 3.2 (+/- 1.5). Surplus embryos were cryopreserved in 50.4% of cycles. Outcomes after embryo transfers from ROPA, and subsequent frozen cycles were as follows: positive pregnancy test (61.0%), clinical pregnancy (54.1%) and miscarriage rate (16.1%). Other outcomes were live birth rate per embryo transfer (44.7%); multiple pregnancy rate (5.4%); per cumulative ROPA cycle (48.6%); and per couple (61.6%). CONCLUSION The outcomes of the ROPA method are reassuring. About one-half of the ROPA cycles resulted in a live birth and one-quarter of the cycles had surplus embryos after achieving a live birth. Main neonatal outcomes were also reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Ginemed Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | | | | | - Nathan Ceschin
- Department of Reproductive Medicine, Feliccità Fertility Institute, Curitiba, Paraná, Brazil
| | | | - Ricardo Sousa-Santos
- Faculty of Medicine, University of Porto, Porto, Portugal; Medically Assisted Reproduction Centre, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - José Bellver
- Department of Reproductive Medicine, IVIRMA Valencia, Valencia, Spain; IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
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Kompanje EJ, Epker JL. Making a dead woman pregnant? A critique of the thought experiment of Anna Smajdor. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:341-351. [PMID: 37606813 PMCID: PMC10491701 DOI: 10.1007/s11017-023-09642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/23/2023]
Abstract
In a thought-provoking article - or how she herself named it, 'a thought experiment' - the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman's dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates.
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Affiliation(s)
- Erwin J.O. Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jelle L. Epker
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Montanari Vergallo G, Gulino M. Is whole-body gestational donation without explicit consent a valid alternative to surrogate motherhood? An ethical analysis through analogy reasoning and principlist approach. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:387-391. [PMID: 37470913 DOI: 10.1007/s11017-023-09634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
| | - Matteo Gulino
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
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Nogueira A, Ammar O, Bilir E, Iftene L, Torrero I, Ceschin N, Nogueira-Silva C, Brandão P. University students' opinion on gamete donor identification regimes. J Assist Reprod Genet 2023:10.1007/s10815-023-02832-w. [PMID: 37233867 DOI: 10.1007/s10815-023-02832-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE This study aims to evaluate the opinion of university students about the identification or nonidentification of gamete donation and the probability of donation according to the different regimes. METHODS This was a cross-sectional observational study based on an online anonymous survey including questions about sociodemographic data, reasons for considering donations, information about the donation process and legislation, and their opinions about the different regimes and how they would influence donations. RESULTS In total, 1393 valid responses were obtained, with a mean age of 24.0 years (SD = 4.8), most of the respondents being female (68.5%), living in a relationship (56.7%), and without children (88.4%). The main reasons for considering donation would be altruism and monetary compensation. Overall, it was found that participants were poorly informed about the donation procedure and legislation. Students revealed preference for nonidentified donation, and they were less likely to donate in an open identity regime. CONCLUSION Most university students consider themselves poorly informed about gamete donation, express a preference for nonidentified gamete donation, and would less likely donate on an open identity basis. Thus, an identified regime may be less attractive to potential donors and lead to a decrease in the availability of gamete donors.
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Affiliation(s)
- Ana Nogueira
- Medical School, University of Minho, Universidade Do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Omar Ammar
- Ar-Razi Private Hospital, 60 Street, Ramadi, Iraq
| | - Enes Bilir
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Ignácio Torrero
- University Cardenal Herrera, Carrer Lluís Vives, 1, 46115 Alfara del Patriarca, Valencia, Spain
| | - Nathan Ceschin
- Feliccità Fertility Institute, Rua Conselheiro Dantas, 1154-Prado Velho, Curitiba, Paraná, 80220-191, Brazil
| | - Cristina Nogueira-Silva
- Medical School, University of Minho, Universidade Do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Pedro Brandão
- Ginemed Porto, Avenida da Boavista, 1243, 4100-130, Porto, Portugal.
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Brandão P, Ceschin N. Lesbian shared IVF: the ROPA method: a systematic review. Porto Biomed J 2023; 8:e202. [PMID: 37152625 PMCID: PMC10158901 DOI: 10.1097/j.pbj.0000000000000202] [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: 10/08/2021] [Accepted: 01/09/2023] [Indexed: 05/09/2023] Open
Abstract
The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, Valencia, Spain
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Corresponding author. Address: Plaza de la Policia Local 3, 46015, Valencia, Spain, E-mail address:
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