Semen donor recruitment in an oocyte donation programme

Italian Constitutional Court removes the prohibition on gamete donation in Italy

In 2004, The Italian Constitutional Court prohibited treatments involving gamate donation, embryo donation, embryo cryopreservation (except under exceptional circumstances), and the transfer of more than three embryos. Basically three statements were made by the Court: the ban violates a couple's fundamental right to health, to self-determination and to have a child. Here, the consequences of such a decision and the legal challenges that ensued are discussed.

Report of results obtained in 2,934 women using donor sperm: donor insemination versus in vitro fertilization according to indication

OBJECTIVE

To demonstrate that the use of donor sperm leads to varying outcome rates and that its use has evolved.

DESIGN

Retrospective observational cohort study.

SETTING

University-affiliated private IVF setting.

PATIENT(S)

Women (2,934) undergoing donor insemination (DI) or IVF with donor sperm (IVF-D).

INTERVENTION(S)

None.

MAIN OUTCOME MEASUREMENT(S)

We evaluated the distribution of the clinical indications for the use of donated sperm, studying the reproductive outcome.

RESULT(S)

A total of 1,663 DI (57%) and 1,271 IVF-D (43%) were performed. There were significant differences in the indications for the use of donated sperm (DI vs. IVF-D). Regarding pregnancy rates (PR), cases of nonobstructive azoospermia presented the highest rate (29.1%), whereas cases of intracytoplasmic sperm injection (ICSI) failures and single women showed rates of 27.6% and 22.6%, respectively. Meanwhile, patients with ICSI failures achieved the highest PRs in IVF cycles (48.7%), whereas nonobstructive azoospermia and single women showed rates of 42.0% and 38.2%, respectively. There have been significant increases in the use of donated sperm in single women.

CONCLUSION(S)

Single women, which also represented the oldest group, show a lower probability of achieving pregnancy, and thus represent a subfertile population. Associated factors could include advanced maternal age.

Mirror gametes donation

Candidate recipients of donor gametes have a moral obligation to make a contribution to the system from which they benefit by reciprocating. They can do this as a couple when the partner of the person who has no usable gametes donates and receives the mirror gametes in return. In an indirect exchange system, the couple receives bonus points for their donation so that their waiting time for the gametes is reduced or even fully canceled. A system of strict reciprocity is rejected as unfair because it excludes categories of people from access to donor gametes. Also candidate recipients who for medical or psychological reasons do not qualify as donors should have access to donor gametes on the basis of points collected on other criteria. Not only contribution but also need (the wish to have a child) should be taken into account when allocating donor gametes. The mirror exchange system can alleviate the shortage of both sperm and egg donation in an ethically acceptable way.

Maximum number of live births per donor in artificial insemination

BACKGROUND

The maximal number of live births (k) per donor was usually determined by cultural and social perspective. It was rarely decided on the basis of scientific evidence or discussed from mathematical or probabilistic viewpoint.

METHODS AND RESULTS

To recommend a value for k, we propose three criteria to evaluate its impact on consanguinity and disease incidence due to artificial insemination by donor (AID). The first approach considers the optimization of k under the criterion of fixed tolerable number of consanguineous mating due to AID. The second approach optimizes k under fixed allowable average coefficient of inbreeding. This approach is particularly helpful when assessing the impact on the public, is of interest. The third criterion considers specific inheritance diseases. This approach is useful when evaluating the individual's risk of genetic diseases. When different diseases are considered, this criterion can be easily adopted. All these derivations are based on the assumption of shortage of gamete donors due to great demand and insufficient supply.

CONCLUSIONS

Our results indicate that strong degree of assortative mating, small population size and insufficient supply in gamete donors will lead to greater risk of consanguinity. Recommendations under other settings are also tabulated for reference. A web site for calculating the limit for live births per donor is available.