Egg donation and human embryonic stem-cell research

Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes

PURPOSE

Human oocytes are arguably one of the most important cell types in humans, yet they are one of the least investigated cells. Because oocytes are limited in number, the use of high-quality oocytes is almost entirely in reproduction. Furthermore, regulatory hurdles for research on gametes and regulations on funding related to research on gametes present significant obstacles to research and the advancement of reproductive treatments. Here we report the outcomes of the largest compensated oocyte donation program for research in the USA to date, and probably worldwide.

METHODS

Women who participated in oocyte donation for research between 2008 and 2017 were contacted in a phone interview and completed a standardized questionnaire.

RESULTS

Of 114 participants, 98 oocyte donors completed donation, donating 1787 mature MII oocytes and a total of 86 skin biopsies. Complication rate, including minor complications, of oocyte donation was 8/98, or 8.1%, for which two involved follow-up. Fifty-seven donors answered questions about their experience. Participants were incentivized primarily by money and a desire to help others and reported an overall favorable experience. Most, but not all, human subjects recalled that they had donated for research, and approximately half recalled that their oocytes were being used specifically for stem cell research.

CONCLUSIONS

Compensated oocyte donation provides a reliable path to obtaining high-quality oocytes for research and is reviewed favorably by oocyte donors. The continuation of programs that offer compensation for oocyte donation is invaluable to continued progress and advancements in stem cell research and human embryology, and for the advancement of novel reproductive treatments.

[Internationalization, science and health: global regenerative medicine and the parallel markets]

Regenerative medicine involves a paradigm change due to organism regeneration at cellular and tissue level - a controversial contemporary issue and difficult to regulate. This article presents a summary of the main scientific, economic, social and regulatory global trends, analyzed according to relevant theoretical dilemmas in medical anthropology and in the sociology of science and health. This is especially true of the construction of a 'collective frame of reference' on the new biological and ontological entities, the shaping of biological citizenship, and governance through uncertainty. Empirical evidence is also presented on a key aspect in regulation and governance, namely the emergence of a new transnational demand in health research through the establishment of parallel markets for ova and experimental cellular therapies. Qualitative data collected for a broader research paper is analyzed, as well as journal reviews and information gathered during interviews with international leaders. The paper concludes with a discussion on the importance on international governance of clinical trials and on further exploration, towards a multilevel harmonization of a diversity of normative practices.

Regulation of Assisted Reproductive Technologies: Gains and Losses

Technology assessment and regulatory strategies have been proffered as ways of addressing concerns and problems arising from availability of certain medical technologies. Regulation especially is invoked as a remedy that can deliver several objectives—as a way of assuring quality care; as a way of preventing medical malpractice and negligence; as a remedy for market failure; as a way of improving performance and efficiency; and as a way of even achieving national health objectives or wider social goals such as equity and accountability. It is assumed that the key issues in regulation are its design and having proper monitoring and enforcement.

 The article reviews the regulations instituted to address issues arising from the use of reproductive technologies. Through such analysis, the article seeks to draw attention to the field of technology assessment and regulation in general as applicable to biomedical technologies, in a context of overall commercialisation of medical and health care.

Genre, parenté et techniques de reproduction assistée : bilan et perspectives après 30 ans de recherche

Ce numéro d’Enfances Familles Générations propose de se pencher sur les problématiques actuelles soulevées par les techniques de reproduction assistée (TRA) au regard des questions de parenté et de genre. Si, dans un monde globalisé, diverses possibilités reproductives sont désormais accessibles, celles-ci soulèvent de nombreuses questions socioanthropologiques du point de vue des rapports de pouvoir qu’elles engendrent, des pratiques et des régulations parfois très différentes dont elles font l’objet, ainsi que des significations individuelles et culturelles qui leur sont attribuées. Ces questions ont donné lieu à une littérature riche et abondante au cours des trente dernières années, en particulier dans le monde anglo-saxon. Cet article introductif est ainsi l’occasion de faire dialoguer davantage, en soulignant leurs apports respectifs, des travaux relevant de traditions différentes, en particulier dans les mondes francophones et anglophones. À partir de ce bilan des questionnements majeurs qu’a suscités l’étude des TRA dans les domaines du genre et de la parenté, nous soulignons les enjeux qui restent en suspens et qui mériteraient selon nous de faire l’objet de plus amples investigations. Le fil conducteur de notre propos, sur la base de la littérature disponible et des enquêtes menées jusqu’ici en sciences sociales, est d’insister sur la dimension du genre comme inextricable de l’expérience et de l’étude des techniques de reproduction assistée.

Acceptability of stem cell therapy by pregnant women

BACKGROUND

Cell-based therapies may soon be used to treat disorders in the perinatal period. Our aim was to assess pregnant women's knowledge, attitudes, and acceptance of different types of stem cell therapies.

METHODS

Pregnant women attending an Australian tertiary center were asked to complete a questionnaire to seek their views on the potential therapeutic use of stem cells in the future. Outcome measures were women's acceptability of different types of stem cell therapies for themselves and their baby, ethical concerns, knowledge, and willingness to use stem cells for different indications.

RESULTS

A total of 150 women completed the questionnaire. More women were happy to use any stem cell type (82%) than placental stem cells only (12.5%), adult stem cells only (2%), embryonic stem cells only (0), and 3.5 percent would not use. With respect to use for their baby, more women were happy to use any stem cell type (83%) than placental stem cells only (13%), embryonic stem cells only (2%), adult stem cells only (0), and 2 percent would not use. Ethical concerns were highest with embryonic stem cells (25%), than adult stem cells (11%), and placental stem cells (10%). Twelve percent of women were very confident and 66 percent reasonably confident with their knowledge, whereas 17 percent understood little and 5 percent reported no understanding. Acceptance of using any stem cell therapy was 75 percent for severe medical disorders, 57 percent for moderate disorders, and 25 percent for mild medical disorders.

CONCLUSIONS

Pregnant women are confident with their knowledge of stem cells and overwhelmingly support their use to treat both themselves and their baby. The level of this support, however, is proportionate to the severity of the medical disorder. (BIRTH 39:2 June 2012).

Egg donation for stem cell research: ideas of surplus and deficit in Australian IVF patients' and reproductive donors' accounts

We report on a study undertaken with an Australian in vitro fertilisation (IVF) clinic to understand IVF patients' and reproductive donors' perceptions of oocyte (egg) donation for stem cell research. Such perspectives are particularly valuable because IVF patients form a major recruitment group for oocyte donation for research, and because patients and donors have direct experience of the medical procedures involved. Similar studies of oocyte donation have been carried out elsewhere in the world, but to date very little social science research has been published that reports on donation for research, as distinct from donation for reproduction. Our respondents expressed a distinct unwillingness to donate viable oocytes for stem cell research. In our analysis we consider a number of factors that explain this unwillingness. These include the labour of oocyte production, the inscrutability of oocytes (the lack of a test to identify degrees of fertility) and the extent to which the oocytes' fertility sets the parameters for all downstream reproductive possibilities. We draw on the science studies literature on affordances to make sense of the social intractability of oocytes, and compare them with the respondents' much greater willingness to donate frozen embryos for human embryonic stem cells research.

New York State's landmark policies on oversight and compensation for egg donation to stem cell research

In 2009, New York became the first US state to implement a policy permitting researchers to use public funds to reimburse women who donate oocytes directly and solely to stem cell research, not only for the woman's out-of-pocket expenses, but also for the time, burden and discomfort associated with the donation process. The debate about the propriety of such compensation was recently renewed with the publication of a stem cell study in which women were provided with compensation for donating their eggs. This article explores the scientific and ethical rationales that led to New York's decision to allow donor compensation. The multifaceted deliberation process and comprehensive policies may serve as a model for other states and countries considering the issue of oocyte donor compensation.

Trends in embryo disposition decisions: patients' responses to a 15-year mailing program

BACKGROUND

This study examined the responses of patients of a Belgian fertility center to mailed requests to make or renew an embryo disposition decision (EDD), over a period of 15 years, to investigate trends in the decisions.

METHODS

A retrospective analysis was performed on a mailing program from 1992 to 2006, for patients, of the Department of Reproductive Medicine, Ghent University Hospital (Belgium), from whom embryos had been cryopreserved at least 2 years.

RESULTS

In 15 years, 3840 EDD forms were prepared for 2334 couples or female patients. The number of forms increased from 21 in 1992 to 558 in 2006. Each year, around a third of the forms were not returned. In general, a quarter of patients who received more than one form never answered. Donation to others for reproduction was overall the least popular option and decreased over the years. The rising trend in decisions to discard reversed into a negative trend from the introduction of donation for science (1997). Since then, donation for science has been the most popular option and its popularity increased with time. In 15 years, 2504 embryos were donated for science. More than a quarter of the patients who chose more than one final EDD in different years did not select the same EDD the second time.

CONCLUSIONS

This study showed a positive trend in donation for science and a negative trend in donation to others and discarding. A substantial number of individual patients chose different types of EDDs in consecutive mailings, which shows that advance EDD directives should be used with caution.

From reproductive work to regenerative labour

The identification and valorization of unacknowledged, feminized forms of economic productivity has been an important task for feminist theory. In this article, we expand and rethink existing definitions of labour, in order to recognize the essential economic role women play in the stem cell and regenerative medicine industries, new fields of biomedical research that are rapidly expanding throughout the world. Women constitute the primary tissue donors in the new stem cell industries, which require high volumes of human embryos, oöcytes, foetal tissue and umbilical cord blood. Such material is generally given for free in the advanced industrial democracies, constituted as a surplus (‘spare’ embryos) or waste (umbilical cord ‘afterbirth’, cadaveric foetuses, poor quality oöcytes) whose generative powers should not be withheld from others. At the same time, among impoverished female populations in developing nations, such biological material is now often procured through frankly transactional relations, where women undertake risky procedures for small fees. In each case, female bodily productivity is mobilized to support bioeconomic research, yet the economic value involved in these relations is largely unacknowledged. In this article, we consider both the gift economy and the transactional economy for reproductive tissues as a form of labour. In order to fully conceptualize the specificities of feminized productivity in the bioeconomy, we distinguish between earlier feminist theories of reproductive labour and the emerging practices generated by stem cell research, which we term regenerative labour. We consider how historical transformations in the regulation of feminized labour and the technical repertoires of stem cell research renegotiate the productivity limits of female reproductive biology, opening it out to novel and profitable forms of surplus value and enrolling women in complex negotiations over their role in bioeconomic activity.

Payment of egg donors in stem cell research in the USA

Arguments have been put forth as to whether women who donate oocytes for human embryonic stem cell (HESC) research should be compensated, but data regarding this issue have been scant. Recently in the United States, several States have begun funding HESC research, and patient recruitment efforts have begun. This paper lays out relevant arguments and presents data concerning this issue. Researchers are finding that women are unwilling to donate eggs altruistically, which is hampering the progress of research. These efforts are examined, and data on potential donors' views are presented. The absence of payment, rather than ethical concerns, appears to explain opposition to donation. Women also appear generally ignorant of policies in this area. It is suggested that policy discussions shift focus from whether to pay, to how much would be appropriate, and how to decide; and that research and public and professional education be increased to heighten understanding and awareness of these issues.

Derivation of human embryonic stem cell lines from parthenogenetic blastocysts

Parthenogenesis is one of the main, and most useful, methods to derive embryonic stem cells (ESCs), which may be an important source of histocompatible cells and tissues for cell therapy. Here we describe the derivation and characterization of two ESC lines (hPES-1 and hPES-2) from in vitro developed blastocysts following parthenogenetic activation of human oocytes. Typical ESC morphology was seen, and the expression of ESC markers was as expected for alkaline phosphatase, octamer-binding transcription factor 4, stage-specific embryonic antigen 3, stage-specific embryonic antigen 4, TRA-1-60, and TRA-1-81, and there was absence of expression of negative markers such as stage-specific embryonic antigen 1. Expression of genes specific for different embryonic germ layers was detected from the embryoid bodies (EBs) of both hESC lines, suggesting their differentiation potential in vitro. However, in vivo, only hPES-1 formed teratoma consisting of all three embryonic germ layers (hPES-2 did not). Interestingly, after continuous proliferation for more than 100 passages, hPES-1 cells still maintained a normal 46 XX karyotype; hPES-2 displayed abnormalities such as chromosome translocation after long term passages. Short Tandem Repeat (STR) results demonstrated that the hPES lines were genetic matches with the egg donors, and gene imprinting data confirmed the parthenogenetic origin of these ES cells. Genome-wide SNP analysis showed a pattern typical of parthenogenesis. All of these results demonstrated the feasibility to isolate and establish human parthenogenetic ESC lines, which provides an important tool for studying epigenetic effects in ESCs as well as for future therapeutic interventions in a clinical setting.

Looking into the future of cell-based therapy

Recent research points to the future of regenerative medicine. In the past year, a handful of research groups have demonstrated that mature, adult cells could be "reprogrammed" to a very primitive, embryonic state via the forced expression of four genes (Oct-3/4, c-Myc, Klf4, and Sox2). These induced pluripotent cells (or iPS) share features with embryonic stem (ES) cells and generate tissues from all three embryonic germ layers (ectoderm, mesoderm, and endoderm). iPS cells are also capable of the ultimate demonstration of developmental potency, ie, when injected into an early mouse embryo, they contribute to the formation of an entire mouse including its germline. While the reprogramming of human fibroblasts into iPS cells remains to be seen, it is nevertheless difficult to overstate the value that this new research contributes to the field of regenerative medicine and its academic relative developmental biology. Herein, we attempt to bring these monumental works into greater focus and comment on how they work to shape the future of cellular therapies.

Stem Cell Research Ethics: Consensus Statement on Emerging Issues

This article is a consensus statement by an international interdisciplinary group of academic experts and Canadian policy-makers on emerging ethical, legal and social issues in human embryonic stem cells (hESC) research in Canada. The process of researching consensus included consultations with key stakeholders in hESC research (regulations, stem cell researchers, and research ethics experts), preparation and distribution of background papers, and an international workshop held in Montreal in February 2007 to discuss the papers and debate recommendations. The recommendations provided in the consensus statement focus on issues of immediate relevance to Canadian policy-makers, including informed consent to hESC research, the use of fresh embryos in research, management of conflicts of interest, and the relevance of public opinion research to policy-making.

Developmental reprogramming after chromosome transfer into mitotic mouse zygotes

Until now, animal cloning and the production of embryonic stem cell lines by somatic cell nuclear transfer have relied on introducing nuclei into meiotic oocytes. In contrast, attempts at somatic cell nuclear transfer into fertilized interphase zygotes have failed. As a result, it has generally been assumed that unfertilized human oocytes will be required for the generation of tailored human embryonic stem cell lines from patients by somatic cell nuclear transfer. Here we report, however, that, unlike interphase zygotes, mouse zygotes temporarily arrested in mitosis can support somatic cell reprogramming, the production of embryonic stem cell lines and the full-term development of cloned animals. Thus, human zygotes and perhaps human embryonic blastomeres may be useful supplements to human oocytes for the creation of patient-derived human embryonic stem cells.

Responsible oversight of human stem cell research: the California Institute for Regenerative Medicine's medical and ethical standards

California voters recently approved $3 billion over 10 years for public funding of stem cell research through the California Institute for Regenerative Medicine (CIRM). Geoffrey Lomax and colleagues discuss the principles that guided the CIRM regulations.

Human Embryonic Stem Cell Research: An Australian Perspective

A conscience vote of individual parliamentarians in the Australian government last month regarding amendments to current legislation regulating human embryonic stem cell research yielded a surprising outcome. Despite opposition by the Australian Prime Minister, the Senate and House of Representatives voted to adopt the recommendations of the Lockhart Review and approve human somatic cell nuclear transfer, thus providing a consistent national policy for all researchers in Australia.

What about the women? Ethical and policy aspects of egg supply for cloning research

As more and more countries open their doors to human cloning and embryonic stem cell research, scientists will be confronted with one fundamental problem: where will all the eggs come from? The mass harvesting of eggs raises serious issues about women's health, status and well-being. This paper critically examines proposals for ova supply such as altruistic donation, surplus IVF eggs and commercial sale. It questions the meaningfulness of informed consent and the risk-benefit ratio in a climate where powerful economic and social forces increasingly view the risks to women as the necessary trade-off for scientific advance.

Development and Investigation of a Free and Informed Choice Process for Embryo Donation to Stem Cell Research in Canada

OBJECTIVES

To develop and investigate a consent process that satisfies the Assisted Human Reproduction (AHR) Act and the Canadian Institutes of Health Research (CIHR) Stem Cell Guidelines, furthers free and informed choice, and fosters embryo donation to human embryonic stem cell (hESC) research.

METHODS

Consultations were undertaken with an hESC scientist, in vitro fertilization (IVF) team members, and the ethicist-author of the CIHR Guidelines to review the AHR Act, the CIHR Stem Cell Guidelines, the established consent process for embryo donation at University Hospital, London Health Sciences Centre, the characteristics of patients appropriate for contact, and strategies for sensitive recruitment. Invitation-to-participate packages were sent to patients.

RESULTS

Patients deemed appropriate for contact had indicated their intent to donate embryos to research, had embryos that had been cryopreserved for more than five years, had not received donor gametes, and had publicly listed addresses, with no suggestion of separation of the parties. Strategies developed to promote anonymity, confidentiality, and informed choice included a "firewall" between clinical and research teams and documents reiterating that, if embryos were donated, the woman would have to undergo additional IVF treatment to have a child. Of 40 couples contacted, only 22 agreed to donate embryos to the hESC study. One couple no longer wished to donate embryos to research, one package was returned as undeliverable, and no response was received from 16 couples.

CONCLUSIONS

The consent requirements of the AHR Act and the CIHR Stem Cell Guidelines should be met. Consider delaying the request for final consent until a significant time after IVF treatment to ensure that patients no longer want their embryos for reproductive purposes and are free from perceptions of coercion. A consent process promoting free and informed choice, sensitive recruitment, and donation of embryos for hESC research should be developed by the Canadian professional bodies.

Merging fields: stem cells in neurogenesis, transplantation, and disease modeling

Traditionally, applied stem cell research has been segregating into strategies aiming at endogenous repair and cell transplantation. Recent advances in both fields have unraveled unexpected potential for synergy between these disparate fields. The increasing dissection of the step-wise integration of adult-born neurons into an established brain circuitry provides a highly informative blueprint for the functional incorporation of grafted neurons into a host brain. On the other hand, in vitro recapitulation of developmental differentiation cascades permits the de novo generation of various neural cell types from pluripotent embryonic stem (ES) cells. Advanced tools in stem cell engineering enable not only genetic selection and instruction of disease-specific donor cells for neural replacement but also the exploitation of stem cells as transgenic cellular model systems for human diseases. In a comparative approach we here illuminate the functional integration of neurons derived from endogenous and transplanted stem cells, the evolving technologies for advanced stem cell engineering and the impact of cloned and mutated stem cells on disease modeling.

Governing stem cell research in California and the USA: towards a social infrastructure

Owing to the restrictive human embryonic stem cell (hESC) policies of the US government, the question of whether to pursue human embryonic stem cell experiments has dominated the ethical and political discourse concerning such research. Explicit attention must now turn to problems of implementing the research on a large scale: in the 2004 US elections, California voters approved a state initiative for stem cell research, earmarking $3 billion in direct spending over 10 years. This article explores three ethical and political problem areas emerging out of the California program, the resolution of which will help set the trajectory of hESC research in the US and abroad, and then proposes an institutional approach to help address them: a network of public stem cell banks in the US that feature transparent and shared governance.

Egg harvesting for stem cell research: medical risks and ethical problems

Increasingly, researchers are seeking eggs from young women to be used for embryo cloning procedures. The harvesting of multiple eggs often involves the administration of drugs that have not been approved for this purpose. Also these drugs have not been adequately studied for their long-term effects on women despite research providing some evidence of significant harm to women in both the short and long term. Current practices follow a historical pattern of exposing women to risks that ultimately prove unacceptable. In addition, egg harvesting is taking place in a research climate marked by conflicts of interest, the misleading use of language to describe research goals, and a commercial push that may lead to the exploitation of young women. In this article, we outline these matters and explain how they are leading to an international campaign for a moratorium on egg harvesting for cloning purposes.