Should a gamete bank verify the non-medical information provided by a donor?

Over the years, cases of fraud have been discovered where donors have been lying about their characteristics. The question raised by such cases is what the responsibility of the gamete bank is for the non-medical information provided by the donor. The problem is that extended donor profiles contain a large amount of information about different aspects of the donor's life and that not all this information can be verified or is worth verifying. Two cases are scrutinized in more detail: education and criminal record. The proposed solution is to split the donor information into a verified and a non-verified part with the non-verified part falling under the responsibility of the donor. The question of what information should be included in the verified part of the donor profile is still open.

Student views on recognition and payment options for gamete donation in New Zealand

BACKGROUND

Demand for donor gametes in New Zealand significantly outweighs the number of willing donors. Payment for donation has been suggested as a viable solution to increase the supply and attract more donors in acknowledging the time, effort and inconvenience associated with donation.

AIMS

Internationally, university students are a commonly targeted group for paid gamete donation. This study aims to explore the views of university students in New Zealand to gauge their support and concerns relating to a range of options to recognise donors, including payment.

METHODS

Two hundred and three tertiary students completed a questionnaire exploring their views on various forms of recognition for donation and concerns relating to payment.

RESULTS

Participants indicated the greatest support for reimbursement for expenses directly related to the donation process. Payment constituting explicit financial advantage was regarded least favourably. Participants held concerns that payment would attract people donating for the 'wrong' reasons and lead to donors concealing relevant histories. Further concerns included payment increasing costs for recipients and causing disparities in access to gametes.

CONCLUSIONS

The findings of this study suggest that within a New Zealand context a culture of gift-giving and altruism are strongly held principles towards reproductive donation, including among the student population. This highlights the need to consider alternative strategies to commercial models to overcome donor shortages which are in line with the cultural and legislative context of New Zealand.

Feasibility and impact of haplogroup matching for mitochondrial replacement treatment

Mitochondrial replacement technology (MRT) aims to reduce the risk of serious disease in children born to women who carry pathogenic mitochondrial DNA (mtDNA) variants. By transplanting nuclear genomes from eggs of an affected woman to enucleated eggs from an unaffected donor, MRT creates new combinations of nuclear and mtDNA. Based on sets of shared sequence variants, mtDNA is classified into ~30 haplogroups. Haplogroup matching between egg donors and women undergoing MRT has been proposed as a means of reducing mtDNA sequence divergence between them. Here we investigate the potential effect of mtDNA haplogroup matching on clinical delivery of MRT and on mtDNA sequence divergence between donor/recipient pairs. Our findings indicate that haplogroup matching would limit the availability of egg donors such that women belonging to rare haplogroups may have to wait > 4 years for treatment. Moreover, we find that intra-haplogroup sequence variation is frequently within the range observed between randomly matched mtDNA pairs. We conclude that haplogroup matching would restrict the availability of MRT, without necessarily reducing mtDNA sequence divergence between donor/recipient pairs.

Eggonomics: Vitrification and bioeconomies of egg donation in the United States and Spain

Regulations governing assisted reproduction control the degree to which gamete donation is legal and how people providing genetic material are selected and compensated. The United States and Spain are both global leaders in fertility treatment with donor oocytes. Yet both countries take different approaches to how egg donation is regulated. The US model reveals a hierarchically organized form of gendered eugenics. In Spain, the eugenic aspects of donor selection are more subtle. Drawing upon fieldwork in the United States and Spain, this article examines (1) how compensated egg donation operates under two regulatory settings, (2) the implications for egg donors as providers of bioproducts, and (3) how advances in oocyte vitrification enhances the commodity quality of human eggs. By comparing these two reproductive bioeconomies we gain insight into how different cultural, medical, and ethical frameworks intersect with egg donor embodied experiences.

When elective egg freezers become egg donors: practical and ethical issues

Many people hope that the unused and unwanted eggs frozen by women for self-use could be applied to reduce the shortage of donor eggs. However, several practical (additional screening and counselling) and ethical (informed consent and reimbursement) issues may dampen this hope. This paper also considers the question of whether elective egg freezers who want to donate their eggs should be reimbursed for the costs they have met for the IVF cycle and storage. It is argued that a partial reimbursement for the collection (hormonal stimulation and retrieval) is morally acceptable because it is limited to proven expenses (and does not violate the altruism rule) and because the recipients should contribute to the costs of a scheme from which they are benefiting. The storage fee should be paid by the egg freezer herself and no reward for effort, time and inconvenience should be given. This compromise benefits both donors and recipients.

University students' opinion on gamete donor identification regimes

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.

Elective egg freezers' disposition decisions: a qualitative study

OBJECTIVE

To explore the factors that influence elective egg freezers' disposition decisions toward their surplus-frozen oocytes.

DESIGN

Qualitative.

SETTING

Not applicable.

PATIENT(S)

Thirty-one participants: 7 past; 6 current; and 18 future oocyte disposition decision-makers.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Qualitative thematic analysis of interview transcripts.

RESULTS

Six inter-related themes were identified related to the decision-making process which are as follows: decisions are dynamic; triggers for the final decision; achieving motherhood; conceptualization of oocytes; the impacts of egg donation on others; and external factors affecting the final disposition outcome. All women reported a type of trigger event for making a final decision (e.g., completing their family). Women who achieved motherhood were more open to donating their oocytes to others but were concerned about the implications for their child and felt responsibility for potential donor children. Women who did not achieve motherhood were unlikely to donate to others due to the grief of not becoming a mother, often feeling alone, misunderstood, and unsupported. Reclaiming oocytes (e.g., taking them home) and closure ceremonies helped some women process their grief. Donating to research was viewed as an altruistic option as oocytes would not be wasted and did not have the "complication" of a genetically-linked child. There was a general lack of knowledge around disposition options at all stages of the process.

CONCLUSION(S)

Oocyte disposition decisions are dynamic and complex for women, exacerbated by a general lack of understanding of these options. The final decision is framed by: whether women achieved motherhood, dealing with grief if they did not achieve motherhood, and considering the complexities of donating to others. Additional decision support through counseling, decision aids, and early consideration of disposition when eggs are initially stored may help women make informed decisions.

Egg donation in the age of vitrification: A study of egg providers' perceptions and experiences in the UK, Belgium and Spain

IVF treatment involving donated eggs increases yearly. Numerous technical and commercial transformations have reshaped how eggs are retrieved, stored and managed. A key transformation is vitrification; a 'fast freezing' method that allows efficient preservation of eggs, and therefore more flexibility in use, giving rise to new commercial possibilities. There has been limited focus on egg providers' experiences in the context of vitrification and related commercialisation. We report findings from a study in the UK, Spain and Belgium, where we interviewed 75 egg providers. Comparing experiences within different donation 'regimes' allows an exploration of how varying national practices and policies shape information-giving and women's experiences. In the UK, a system of 'informed gift-giving' was described, where egg providers saw their actions as not-for-profit and felt relatively well informed. In Belgium, the system was presented as 'trusted tissue exchange': with less information-giving than in the UK, but clinics were trusted to act responsibly. In Spain, a 'closed-door, market-driven' system was described, whereby egg providers received little information and expressed concerns about generation of excess profit. Our findings extend understandings of how egg donation is managed at the national level and how donation regimes produce specific experiences, expectations and subjectivities amongst tissue providers.

Gamete and embryo donation for research: what might shape the willingness to donate among gamete donors and recipients?

PURPOSE

Research using gametes and embryos donated by reproductive and third-party donors contributed to substantial, albeit contentious achievements. The views of gamete donors and recipients on donation for research and the underpinning role of attitudes towards research have been seldom explored and are yet to be incorporated into ethical, legal, and regulatory landscapes. From a cultural standpoint, this study adapts and explores psychometric properties of the Portuguese version of the Research Attitudes Questionnaire (RAQ), and analyzes the willingness of gamete donors and recipients to donate gametes and embryos for research and its association with sociodemographic, reproductive characteristics, and attitudes towards research.

METHODS

Between July 2017 and June 2018, 71 donors and 165 recipients completed a self-administered questionnaire at the Portuguese Public Bank of Gametes. Willingness to donate and attitudes towards research were measured with a 5-point Likert scale. RAQ psychometric characteristics were explored.

RESULTS

Two RAQ components were identified: "trustworthiness of research" and "critical perspective". Most participants were willing to donate gametes and embryos: donors more willing to donate gametes and male recipients more willing to donate gametes and embryos. Higher RAQ scores, indicating a more positive attitude towards research, were observed on the component "trustworthiness of research" among those willing to donate gametes and embryos and on the component "critical perspective" among those willing to donate embryos.

CONCLUSION

These findings help foster inclusivity, diversity, and responsiveness of research and call for upstream engagement of male and female gamete donors and recipients, promoting a trustworthy, anticipatory, democratic, and people-centered approach to policies, regulations, and practices in human gamete and embryo research.

Fertility stakeholders' concerns regarding payment for egg and sperm donation in New Zealand and Australia

New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.

OUP accepted manuscript

STUDY QUESTION

What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services?

SUMMARY ANSWER

For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure.

WHAT IS KNOWN ALREADY

Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place.

STUDY DESIGN, SIZE, DURATION

A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support.

LIMITATIONS, REASONS FOR CAUTION

The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research.

WIDER IMPLICATIONS OF THE FINDINGS

These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring.

STUDY FUNDING/COMPETING INTEREST(S)

The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare.

DISCLAIMER

This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation.

The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type.

^†ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

Emotions towards potential genetic offspring among oocyte donors: a cross-sectional study

Background

The presence of maternal emotions towards the offspring resulting from assisted reproductive techniques (ART) has been previously reported in oocyte donors. However, there is limited information about the presence of these emotions in oocyte donors during the ART process and before pregnancy. The aim of this study was to evaluate the emotions of oocyte donor women towards the potential genetic offspring and to compare them with women treated with ART by using own oocytes.

Methods

A cross-sectional study was conducted on 100 women who were divided into two groups of oocyte donors and those treated with ART and using autologous oocyte. At the time of oocyte retrieval. Using a validated questionnaire, the emotions toward potential offspring (EPO) resulting from ART and its three dimensions (including imagination, sense of ownership, and importance of treatment outcome) were measured and compared in two groups.

Results

Comparison of the EPO in the two groups showed that the emotions in all three dimensions were lower in oocyte donors than the other group (p < 0.001). Moreover, in oocyte donors, the mean score of the scale of the importance of treatment outcome dimension was higher than the other two scales (p < 0.001).

Conclusion

The results of the study showed that there is a significant emotion toward the potential offspring in oocyte donors. The presence of these emotions thus should be considered in formulating the ethical charter of ART by using oocyte donation.

There is limited information about the presence of maternal emotions in egg donor women during the assisted reproductive techniques (ART) process and before pregnancy. The aim of this study was to evaluate these emotions of women towards the potential genetic offspring and to compare them with women treated with ART by using own oocytes. A cross-sectional study was conducted on 100 women who were divided into two groups of egg donor and those treated with ART and using autologous oocyte. At the time of oocyte retrieval and using a validated questionnaire, the emotions toward potential offspring (EPO) resulting from ART and its three dimensions (including imagination, sense of ownership, and importance of treatment outcome) were measured and compared in two groups. Out of 100 women. Comparison of the EPO in the two groups showed that the emotions in all three dimensions were lower in egg donors than the other group. Moreover, in egg donors, the mean score of the scale of the importance of treatment outcome dimension was higher than the other two scales. The results of the study showed that there is a significant emotion toward the potential offspring in oocyte donors. The presence of these emotions thus should be considered in formulating the ethical charter of ART by using oocyte donation.

Balancing embryo donation and double gamete donation

Huele and colleagues started a debate on the comparison between embryo donation and double donation. Although I largely agree with their final conclusion, I believe that the perspective of the recipients needs to be added to get a more complete picture. The present contribution focuses on that perspective and advances other arguments to balance the two methods. The main argument in favour of double donation is the difference in perceived meaning for the recipients compared to surplus embryos. The main arguments in favour of embryo donation are the fair distribution of scarce resources (i.e. donor gametes) and the principle of non-maleficence through the avoidance of unnecessary oocyte donation cycles. The balance would be to put both treatments on an equal footing.

Oocyte donation: not all oocyte cryobanks are the same

RESEARCH QUESTION

Is the efficacy of imported vitrified oocyte donation affected by the cryobank of origin?

DESIGN

Longitudinal cohort study, including 249 completed oocyte warming cycles from 200 recipients (January 2016-July 2020). No severe male factor was included. Vitrified oocytes were provided by three Spanish cryobanks. Primary outcome was cumulative live birth delivery rate (CLBR) per completed oocyte warming cycle.

RESULTS

After warming 1535 oocytes, 1244 survived (81.0%) and 945 fertilized (76.0%); embryo utilization rate was 65.3%. The overall CLBR per completed cycle was 47.0% but was lower in cryobank 1 (31.2%) versus cryobank 2 (56.0%, P = 0.0010) and cryobank 3 (50.8%, P = 0.0241). Multivariate logistic regression analysis identified survival of four or more oocytes as the strongest predictor for delivery (P = 0.0282). Only 202 out of 249 oocyte warming cycles had four or more survived oocytes in a proportion that was significantly lower in cryobank 1 versus cryobank 2 (70.1% versus 89.0%, P = 0.0020); comparison with cryobank 3 (81.0%) was not significant. In the 202 oocyte warming cycles, CLBR in cryobank 1 (37.0%) was lower versus cryobank 2 (58.8%, P = 0.0115) and cryobank 3 (60.8%, P = 0.0019), suggesting a reduced viability in oocytes from cryobank 1 that survived warming.

CONCLUSIONS

Differences were found in the efficacy of imported vitrified oocytes in relation to the cryobank of origin. Each centre needs to evaluate the results internally when starting a collaboration with an oocyte cryobank to establish the necessary measures to maximize treatment efficacy.

Exploring the knowledge and attitudes of women of reproductive age from the general public towards egg donation and egg sharing: a UK-based study

STUDY QUESTION

What are the knowledge and views of UK-based women towards egg donation (ED) and egg sharing (ES)?

SUMMARY ANSWER

Lacking knowledge of the practices of ED and ES could be an influential factor in donor egg shortages, rather than negative perceptions or lack of donor anonymity and financial incentives.

WHAT IS KNOWN ALREADY

The increasing age of women trying to conceive has led to donor egg shortages, with ED and ES failing to meet demand. Indeed, in recent years in the UK, ES numbers have fallen. This results in long waiting lists, forcing patients abroad for fertility treatment to take up cross border reproductive care. Previous research suggests a lack of knowledge of ED among members of the general public; however, no study has yet assessed knowledge or views of ES in the general public.

STUDY DESIGN, SIZE, DURATION

Six hundred and thirty-five UK-based women over 18 years were voluntarily recruited from social media community groups by convenience sampling. The recruitment period was from February to April 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants completed a previously validated questionnaire regarding female fertility, ED and ES, including knowledge, perceptions and approval of the practices and relevant legislation. This included ranking key benefits and issues regarding egg sharing. The questionnaire was completed using the online Qualtrics survey software. Statistical analysis was conducted using SPSS.

MAIN RESULTS AND THE ROLE OF CHANCE

Regarding knowledge of ED and ES, 56.3% and 79.8%, respectively had little or no prior knowledge. Upon explanation, most approved of ED (85.8%) and ES (70.4%). A greater proportion of respondents would donate to a family member/friend (49.75%) than to an anonymous recipient (35.80%). Overall, ES was viewed less favourably than ED, with ethical and practical concerns highlighted. Women aged 18-30 years were significantly more likely to approve of egg donation practice compared to those aged >30 years (P < 0.0001). Those against ES found fears of financial coercion or negative psychological wellbeing the most concerning. About 35.8% and 49.7% would personally consider anonymous and known ED, respectively, whilst 56.7% would consider ES. Those answering in favour of egg sharing were significantly more likely to give higher benefit ratings compared to those against the practice (P < 0.001). Most agreed (55.8%) with and were not deterred to donate (60.1%) by the 'Disclosure of Donor Identity' legislation. Only 31.6% agreed with the compensatory cap; however, 52.7% would not be more motivated to donate by an increased cap.

LIMITATIONS, REASONS FOR CAUTION

There were several limitations of the study, including the use of convenience sampling and the voluntary nature of participation opening the study up to sampling and participation bias. Finally, closed questions were predominantly used to allow the generation of quantitative data and statistical analysis. However, this approach prevented opinion justification and qualitative analysis, limiting the depth of conclusions drawn.

WIDER IMPLICATIONS OF THE FINDINGS

To our knowledge, this is the first study to survey the general public's knowledge and views of ED/ES using a previously validated questionnaire. The conclusion that lack of knowledge could be contributing to the current donor shortfall in the UK demonstrates that campaigns to inform women of the practices are necessary to alleviate donor oocyte shortages.

STUDY FUNDING/COMPETING INTEREST(S)

No external funds were used for this study. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

NA.

'Nothing will stop me from giving the gift of life': a qualitative analysis of egg donor forum posts

Online spaces are increasingly important for our collective consciousness and provide an opportunity to document changing ideas, subjectivities and experiences surrounding new reproductive technologies. This paper reports on the first study of egg donation and online discussion boards in UK-based forums. Using thematic analysis, we investigated how donors use online forums and explored how they present themselves as possible donors in online spaces. Three major themes were identified: 'using online forums to exchange knowledge and experiences', 'egg donation as a gift' and 'having a drive to donate'. Findings from the study reveal how donors enter online spaces looking for advice, presenting themselves as available and weaving themselves into an online community. There exist multiple ways in which donors construct and narrate their own participation in the process of egg donation. Presenting a donor identity in these online forums is not a straightforward matter of helping by giving but also involves a specific drive. While more research is needed on the range of possible motivations, this study gives a better understanding of the available online information and the co-construction of donor identities on discussions boards.

Prospective longitudinal cohort study of uterine arteries Doppler in singleton pregnancies obtained by IVF/ICSI with oocyte donation or natural conception

STUDY QUESTION

Do uterine arteries Doppler studies show different pulsatility index (UtA-PI) measurements in IVF/ICSI pregnancies with oocyte donation (OD) as compared to natural conceptions?

SUMMARY ANSWER

In IVF/ICSI pregnancies with OD, UtA-PI is reduced by an average of about 40% as compared to pregnancies with natural conception.

WHAT IS KNOWN ALREADY

OD pregnancies present worse pregnancy outcomes as compared to natural conception, particularly for increased incidence of pre-eclampsia (PE). Recent evidence shows that IVF/ICSI pregnancies with frozen blastocyst transfer also present higher prevalence of PE and 15% lower UtA-PI as compared to pregnancies after fresh blastocyst transfers.

STUDY DESIGN, SIZE, DURATION

Prospective, longitudinal matched cohort study performed in the Fetal Medicine and Obstetric Departments of San Raffaele Hospital in Milan, between 2013 and 2018. The analysis is based on 584 Doppler observations collected from 296 women with different method of conception (OD n = 122; natural conception n = 174).

PARTICIPANTS/MATERIALS, SETTING, METHODS

IVF/ICSI viable singleton pregnancies with OD and natural conception control pregnancies matched for BMI and smoking, performing repeated UtA-PI measurements at 11-34 weeks. Miscarriages, abnormalities, twins, significant maternal diseases and other types of ARTs were excluded. Log mean left-right UtA-PI was used for analysis with linear mixed model (LMM) and correction for significant confounders. Pregnancy outcome was also analyzed.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants after OD were older and more frequently nulliparous (mean age: OD 43.4, 95% CI from 42.3 to 44.6; natural conception 35.1, 95% CI from 34.5 to 35.7; P-value < 0.001; nulliparous: OD 96.6%; natural conception 56.2%; P-value < 0.001). Mean pulsatility index was lower in OD (UtA-PI: natural conception 1.22; 95% CI from 1.11 to 1.28; OD 1.04; 95% CI from 0.96 to 1.12; P-value < 0.001). A significant effect of parity, gestational age (GA) modeled with a cubic polynomial and BMI was described in the LMM. The mean Log UtA-PI was on average 37% lower in OD as compared to natural conception pregnancies at LMM (P-value < 0.001). We also found a significant interaction between longitudinal UtA-PI Doppler and GA. Therefore, at 11 weeks' gestation the Log UtA-PI was 42% lower and, at 34 weeks, the differences reduced to 32%. GA at delivery and birth weight were statistically lower in OD group; however, birthweight centile was not statistically different. Preeclampsia was 11-fold more common in the OD group (0.6% and 6.6%, P-value = 0.003). No other significant difference in pregnancy outcome was shown in the study groups (gestational diabetes mellitus, small or large for GA).

LIMITATIONS, REASONS FOR CAUTION

It was not possible to properly match for maternal age and to blind the assessment given the major differences between cohorts; however, we did not find significant within-groups effects related to maternal age. Future research is needed to reassess outcomes and correct them for maternal characteristics (e.g. cardiovascular function).

WIDER IMPLICATIONS OF THE FINDINGS

This finding reproduces our previous discovery of lower UtA-PI in frozen as compared to fresh blastocyst transfer. The vast majority of OD is obtained by the use of cryopreservation. We speculate that increased uterine perfusion may be the physiological response to compensate dysfunctions both in the mother and in the placenta.

STUDY FUNDING/COMPETING INTEREST(S)

This is a non-funded study. The authors do not declare competing interest.

TRIAL REGISTRATION NUMBER

N/A.

Expanded carrier screening should not be mandatory for gamete donors

More and more centers are imposing expanded carrier screening (ECS) on their gamete donors. In some clinics and gamete banks, gamete donors are not given this right, contrary to the freedom to decline genetic screening in the general population. The possible social and psychological burdens that are recognized for infertility patients and the general population are downplayed for gamete donors. The procedure of imposing ECS on gamete donors shows that the interests of the recipients are valued higher than those of the donors. The general ethical argument defended here is the principle of proportionality: the burdens imposed on donors have to be balanced against the potential benefits for the offspring and the recipients. The risk reduction of ECS is below 1% and is too small to outweigh the potential dangers and disadvantages for donors. The conclusion is that clinics may ask, but not compel, donors to submit to ECS provided that they offer appropriate genetic and psychological counseling.

Financial compensation of oocyte donors: an Ethics Committee opinion

Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery and not vary according to the planned use of the oocytes or the number or quality of oocytes retrieved. This document replaces the document of the same name published in 2016.

"I would want to pay her": Challenging altruistic egg exchanges in Canada through moral patchworks

Studies surrounding egg donation often occur within existing legal marketplaces showing how language of altruism and gift is employed to uphold gendered standards of femininity and morality. This article examines how women negotiate those gendered and moral standards under the Canadian Assisted Human Reproduction Act (AHRA), which prohibited the market exchange of eggs through the criminalization of paid egg donation. Through 71 in-depth semi-structured interviews with health care professionals (n = 51) and egg donation recipients (n = 20), I argue that participants in these exchanges use a patchwork of moral framings to question the ethicality of the act and the gendered links between altruism, morality and femininity. These market participants employ moral patchworks consisting of subverting, circumventing and rejecting the legally defined ethical practice of donation. By explicitly discussing payment and gifts as moral egg donation exchanges, recipients and fertility professionals suggest that egg donors' reproductive labor should be monetarily recognized. This article considers the ethical implications of these moral patchworks for understanding how gender is reproduced and undone in market exchanges.

Mild stimulation should be mandatory for oocyte donation

The increasing commercialization of oocyte donation is a source of concern. This evolution is expressed in the fact that oocyte donors’ interests are not a priority. For decades now, people mention that oocyte donation holds serious health risks for donors, as if this is an unavoidable given. However, most of the harm is caused by high hormonal stimulation. The risk/benefit balance of high stimulation compared to the risk/benefit balance of mild stimulation does not justify causing greater harm to donors, especially given the fact that donors submit to the procedure without any medical benefit for themselves and to help others.

[Comparative survey of French oocyte donor's profile and motivations between nulliparous and multiparous donors, 2017-2018]

OBJECTIVES

Since the authorization of French nulliparous women to donate oocytes, who are the new donors? What are the similar and differential points with the initial donors who have already procreated?

METHODS

Retrospective multicenter cohort study using a questionnaire.

RESULTS

The return rate is 90.7% with 248 donor files from 5 French assisted reproductive technology (ART) centers, included between 1 January 2017 and 31 December 2018. The average age is 31,0 years. More than two thirds of women have a higher educational level than the license. Donation is spontaneous or relational in 69% and 25% of cases, respectively. Among nulliparous donors, 37% don't know the possibility of self-preservation but after information, 80% wish to benefit from it versus 32% of multiparous women if they were given the opportunity.

CONCLUSIONS

This study by the Study Group for Egg Donation (GEDO) highlights the particularities of French oocytes donors. The 2015 decree allowed to diversify the origin of the donation, which remains mainly altruistic but the possibility of self-preservation for nulliparous donors also seems to motivate women. This link between donation and self-preservation poses an ethical problem that needs to be approached and resolved in the next Bioethics Law framing Assisted Reproductive Technologies (ART).

Views of French oocyte donors at least 3 years after donation

RESEARCH QUESTION

The study aimed to evaluate the percentage of oocyte donors who regretted their donation at least 3 years later.

DESIGN

Between December 2018 and January 2019, this single-centre study sought to contact by telephone all women who had donated oocytes during the 6-year period from 2010 to 2015 at the Lille Centre for the study and storage of eggs and spermatozoa (CECOS).

RESULTS

Among 118 women, 72 responded to the questionnaire by telephone and were included in the study. The response rate was 61%. No woman regretted having donated an oocyte, and 89% said that they would do it again in the same situation. The survey distinguished two types of donors: 'relational' (58%) and 'altruistic' (42%); some of their responses differed. Ninety per cent of the women had talked about the donation to family and friends. Among them, 74% felt supported by their family and friends, and 72% by their partner. The donation was something that 76% of the women sometimes thought about; 83% felt that this donation was something useful that they had accomplished. Finally, most donors felt that oocyte donation should remain unremunerated and anonymous.

CONCLUSIONS

None of the donors we interviewed regretted their donation. In France, the current principles governing this donation appear satisfactory to oocyte donors.

[Preliminary study on the experience of egg donors at the CHRU in Tours: Key features for future research]

OBJECTIVES

This exploratory survey aims to identify the obstacles to egg donation (ED), based on the donors' experience. Despite 30 years of practice and awareness-raising campaigns, ED in France suffers from a shortage of female donors due to a lack of knowledge of this donation (Agence de la biomédecine, 2017).

METHOD

Qualitative study by semi-directive interviews conducted between January and August 2018 at the CHRU in Tours with 15 egg donors in the postoperative period.

RESULTS

The donation generated a sense of pride and personal accomplishment among the donors, in contrast to the lack of recognition of their actions by professionals and their entourage. Physical commitment does not seem to be a barrier to donation. The organisational and logistical constraints were identified as one of the main obstacles, while 70% of the interviewees stressed the benevolence of the practitioners. Finally, the donation opened up questions for them on female fertility, maternity and the role of gender norms in gamete donation.

CONCLUSION

The survey reveals the technical dimension of ED imposed by the biomedical system deplored by donors, and highlights the need to recognize their actions. Physical engagement is not a major obstacle, unlike organizational and relational aspects. This study opens up an important field of investigation, which should be explored in particular in the perspective of a French bioethical reform of ED.

Support for recognition and payment options for egg and sperm donation in New Zealand and Australia

STUDY QUESTION

To what extent do infertility clinic patients, fertility industry professionals and members of the public support different forms of payment and recognition for egg and sperm donation?

SUMMARY ANSWER

While participants expressed support for reimbursement of expenses for both egg and sperm donation, payment constituting explicit financial advantage was regarded less favourably although potentially necessary to address donor gamete shortages.

WHAT IS KNOWN ALREADY

In both New Zealand and Australia, commercial inducement for the supply of gametes is prohibited. This prohibition has been argued to contribute to limited availability of donor gametes with the effect of increasing waiting lists and/or the pursuit of potentially unregulated cross-border reproductive care by domestic patients requiring donor gametes.

STUDY DESIGN, SIZE, DURATION

The study was a mixed methods study drawing on data from a questionnaire completed by 434 participants from across New Zealand and Australia between November 2018 and March 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Stakeholders involved in donor-assisted conception (past and present infertility patients, gamete recipients and donors), fertility industry professionals and members of the public were recruited following online advertisement of the study. All participants spoke English and primarily identified as Caucasian. Participants anonymously completed an online questionnaire gauging their support for a range of recognition and payment options. Dependent samples t-tests were used to probe for differences in support of recognition and payment options in relation to egg and sperm donation. Linear regression models were used to determine factors predicting support for the different options for both egg and sperm donation. Thematic analysis was used to identify main themes in free text question responses.

MAIN RESULTS AND THE ROLE OF CHANCE

Broadly, there was agreement that donors be reimbursed for medical expenses, travel time, unpaid time away from work relating to treatments and out-of-pocket expenses directly related to the gamete donation process, with greater support suggested for egg versus sperm donors. Items gauging support for non-material recognition and tokens of thanks for donations were not significantly different between egg and sperm donation programmes (P &gt; 0.05) nor rated as highly as reimbursement alternatives. Lowest ratings of support were indicated for the outright payment or reward of donors for the supply of their gametes, options that would leave donors in better financial positions. Qualitatively, themes valuing gamete donation as ideally relating to gifting were identified, although counterbalanced in opinion by concepts of fairness in reimbursing gamete donors for their costs. Where payment over and above the reimbursement of costs was supported, this was related to pragmatic considerations of limited supply of donor gametes.

LIMITATIONS, REASONS FOR CAUTION

This study used a cross-sectional design and consequently causal inferences cannot be made. Additionally, participants particularly professional fertility staff, were required to self-report on politically sensitive and legal issues with the potential for social desirability response bias. Snowball sampling may have led to participation of like-minded individuals, thus limiting generalizations of findings.

WIDER IMPLICATIONS OF THE FINDINGS

In a climate of global commercialization of reproductive medicine, limited donor gamete availability and rising incidences of cross-border reproductive care, the findings of this study can be used as a basis for further discussion between regulators and professional industry stakeholders with respect to shaping ethical policy and practice relating to donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

No external funds were sought for this work. None of the authors have any competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Egg donors' motivations, experiences, and opinions: A survey of egg donors in South Africa

The objective of this study was to gain information from egg donors in South Africa (SA) which could be pertinent to policy development on egg donation. The study was conducted on egg donors in the database of a Cape Town-based egg donation agency who donated within a year preceding the study. 150 egg donors from the population of 226 participated in an online survey. The main results are: 95% of respondents experienced egg donation as being positive. However, 7% of respondents report not giving proper informed consent, and a similar percentage of respondents also report not knowing whether any medical risks actually materialised as sequelae to their donations. This is a cause for concern and should be investigated further. Regarding donor anonymity, which is currently the legal position in SA, 79% of respondents indicated that they would still have donated had they been legally required to release their identities. Accordingly, possible legal reform away from the current system of donor anonymity seems unlikely to significantly impact the supply of donated eggs. Regarding motivation, respondents report being primarily motivated by wanting to help infertile women. However, respondents believe that a fair and realistic amount of compensation would be about 60% higher than what is currently paid as the national standard fixed amount. This fixed-amount compensation system should be further investigated in terms of its legality, impact on donor profile, and its current amount.

Worlds apart or two sides of the same coin? Attitudes, meanings, and motives of potential oocyte and sperm donors in Austria

Purpose

Gamete donors and recipients of such donations have been explored by previous studies, which mostly focus on post-donation scenarios. Our study analyses the general willingness to donate oocytes or sperm and focuses on differences between potential female and male donors in attitudes, meanings, and motives in a pre-donation setting.

Methods

An electronic survey (n = 555 students) was used in this anonymous observational study. To enable comparisons between men and women regarding their attitudes, meanings, and motives and their willingness to donate gametes, we designed two separate questionnaires.

Results

The sample was divided into three groups based on the willingness to donate: potential donors (n = 133; women: 48.1%, men: 51.9%); doubtful donors (n = 207; women: 75.8%, men: 24.2%); and non-donors (n = 215; women: 68.3%, men: 31.7%). The group of potential male donors (39.2%) was significantly larger than the group of potential female donors (16.9%). Significant differences regarding altruism, the meaning of one’s self-worth, and passing on the own genes were found between doubtful and potential donors. Potential donors attached less value to altruism but more value to the enhancement of one’s self-worth and passing on one’s genes than doubtful donors. The motive of passing on one’s genes and altruistic motives were more important to men than to women.

Conclusion

This study helps to create a better understanding of potential donors in the existing donation framework and supports the evaluation of the given regimes in the context of designing an improved framework.

What constitutes a reasonable compensation for non-commercial oocyte donors: an analogy with living organ donation and medical research participation

There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this 'reasonable compensation' in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors' motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits.

Regulatory responses to assisted reproductive technology: a comparative analysis of Spain and Israel

PURPOSE

The market of assisted reproductive technologies (ARTs) is rapidly evolving, raising growing ethical and social dilemmas. This paper compares the regulatory responses to technological and market developments in Israel and Spain, both intensive users of ART. We identify strengths and deficiencies in the regulation of ART in these two countries.

METHODS

We developed a conceptual framework to classify the factors affecting regulations and priority setting, and applied it using a Delphi survey combined with in-depth interviews. We selected two panels of experts from various fields, trying to simulate the bioethics committees of Israel and Spain.

RESULTS

ART is often wrongfully perceived as a solution to age-related infertility. Both panels embraced alternative solutions. The impact of private commercial interest on regulations is resulting in excessive practices such as the repeat of ineffective cycles and the push of sometimes unnecessary treatment add-ons. Our findings show experts dissatisfaction with the regulations of donor-eggs concerning reimbursement and registries in both countries.

CONCLUSIONS

The adequacy of ART to solve age-related infertility should be confronted with alternative approaches, with emphasis on the distribution of accurate information. The magnitude of ART markets, particularly the use of donor-eggs, should raise the need for additional societal debate and the reform of regulations. The impact factors analysis leads us to question the current regulatory framework, which could be improved by nominating a non-governmental statutory central regulatory agency in Israel and by reforming the Spanish agency.

Oocyte provision as a (quasi) social market: Insights from Spain

The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.

Oocyte donor age has a significant impact on oocyte recipients' cumulative live-birth rate: a population-based cohort study

OBJECTIVE

To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles.

DESIGN

A population-based retrospective cohort study.

SETTING

Not applicable.

PATIENT(S)

All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30-34, 35-37, 38-40, and ≥41 years, and recipient age as <35, 35-37, 38-40, 41-42, 43-44, and ≥45 years.

RESULT(S)

The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30-34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35-37 years, 22.6% in donors aged 38-40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38-40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60; 95% CI, 0.43-0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14; 95% CI, 0.04-0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR.

CONCLUSION(S)

We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 years.

In search of stool donors: a multicenter study of prior knowledge, perceptions, motivators, and deterrents among potential donors for fecal microbiota transplantation

Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection. Stool donors are essential, but difficult to recruit and retain. We aimed to identify factors influencing willingness to donate stool. This multi-center study with a 32-item questionnaire targeted young adults and health care workers via social media and university email lists in Edmonton and Kingston, Canada; London and Nottingham, England; and Indianapolis and Boston, USA. Items included baseline demographics and FMT knowledge and perception. Investigated motivators and deterrents included economic compensation, screening process, time commitment, and stool donation logistics. Logistic regression and linear regression models estimated associations of study variables with self-assessed willingness to donate stool. 802 respondents completed our questionnaire: 387 (48.3%) age 21-30 years, 573 (71.4%) female, 323 (40%) health care workers. Country of residence, age and occupation were not associated with willingness to donate stool. Factors increasing willingness to donate were: already a blood donor (OR 1.64), male, altruism, economic benefit, knowledge of how FMT can help patients (OR 1.32), and positive attitudes towards FMT (OR 1.39). Factors decreasing willingness to donate were: stool collection unpleasant (OR 0.92), screening process invasive (OR 0.92), higher stool donation frequency, negative social perception of stool, and logistics of collection/transporting feces. We conclude that 1) blood donors and males are more willing to consider stool donation; 2) altruism, economic compensation, and positive feedback are motivators; and 3) screening process, high donation frequency, logistics of collection/transporting feces, lack of public awareness, and negative social perception are deterrents. Considering these variables could maximize donor recruitment and retention.

Increased incidence of obstetric and perinatal complications in pregnancies achieved using donor oocytes and single embryo transfer in young and healthy women. A prospective hospital-based matched cohort study

In this single-center matched-cohort study, women who underwent IVF/ICSI with donor oocytes between 2007 and 2014 (n = 259) were compared to women undergoing autologous cycles during the same time period (n = 515). The matching (1:2) took into consideration the women's age, type of treatment (IVF/ICSI), and year of embryo transfer. All women were healthy and below 40 years of age at the time of IVF/ICSI, and the treatments were performed using a strict policy of single embryo transfer. Multiple logistic regression analysis, adjusted for body mass index (BMI), smoking, and parity, showed a four times increased risk of gestational hypertensive disorders (adjusted odds ratio, AOR 4.25; 95% confidence interval (CI), 2.61-6.92) and pre-eclampsia (AOR 3.99; 95% CI 2.27-7.00) in pregnancies achieved with donor oocytes. There was also a higher rate of cesarean section in women who gave birth after oocyte donation (AOR 1.69; 95% CI 1.22-2.35) and a higher risk of postpartum hemorrhage >1000 mL (AOR 1.59; 95% CI, 1.11-2.27). After further adjustment for preeclampsia in the logistic regression analysis, no additional increased perinatal risks were found. The incidence of preterm delivery, low weight at birth, need of neonatal intensive care, Apgar scores, and incidence of perinatal death were also similar between the groups.

Doação de gametas: questões sociais e éticas (não) respondidas em Portugal

Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.

"I want us to be a normal family": Toward an understanding of the functions of anonymity among U.S. oocyte donors and recipients

BACKGROUND

Anonymity remains the more common practice in gamete donations, but legislation prohibiting anonymity with a goal of protecting donor-conceived children's right to know their genetic origins is becoming more common. However, given the dearth of research investigating the function of anonymity for donors and recipients, it is unclear whether these policies will accomplish their goals. The aim of this study was to explore experiences with anonymity among oocyte donors and recipients who participated in an anonymous donor oocyte program and to understand the ways in which anonymity functions for them.

METHODS

Semistructured interviews were conducted with 50 women: 28 oocyte donors and 22 recipients who were recruited from an academic center for reproductive medicine in the United States.

RESULTS

Donors and recipients view anonymity both as a mechanism to protect the interests of all parties (recipients, donors, and donor-conceived children) and as a point of conflict. Specifically, three key areas were identified where both donors and recipients saw anonymity as having an important role: relieving anxieties about family structures and obligations; protecting their interests and those of donor-conceived children (while acknowledging where interests conflict); and managing the future.

CONCLUSION

As gamete donation increasingly moves away from the practice of anonymity, examining why anonymity matters to stakeholders will be helpful in devising strategies to successfully implement identity-release options.

Migrant extractability: Centring the voices of egg providers in cross-border reproduction

This paper explores reproductive justice from the perspective of those at the beginning of the value chain of reproduction. This vantage point of egg providers can help lend important insights into the wider processes of family-making across borders today. It centres on ethnographic research conducted on contemporary cross-border egg provision performed by female migrant workers in Spain. Through this intersectional perspective, we stand to gain deeper insights into cross-border reproduction more widely. Egg provision can be a way for migrant women to gain temporary financial benefit. In a system that does not provide equal access for migrants to work and care, female migrants make themselves extractable commodities. As such, they are both a commodity and a worker at the same time. The example of female migrant workers providing eggs can be used to reflect more generally on egg provision, and on cross-border reproduction and reproductive justice models as used in queer cross-border family-building. Taken within the broader framework of reproductive justice, and with the struggles of lesbian, gay, bisexual and transgender cross-border reproduction in mind, the paper begins by asking how three intersecting inequalities due to (1) migration/citizenship, (2) joblessness/contract working and (3) race facilitate the industry of cross-border reproduction? In what ways do female migrant workers mobilize their reproductive potential, including time, whiteness, other racial/phenotypic similarity to commissioning parents, and unstable work lives in cross-border egg donation? The paper ends with an argument for focusing analytical and political attention on the needs of those providing eggs; the most prized material resources for cross-border reproduction.

Oocyte donors’ awareness on donation procedure and risks: A call for developing guidelines for health tourism in oocyte donation programmes

Objective

In the recent years, oocyte donation programmes have widely spread worldwide becoming the drive of health tourism. In some countries, donation programmes are tightly regulated, whereas in others, the guidelines or regulations are not well defined. To evaluate donors’ awareness of the donation programmes and the ethical consequences in enrolling these programmes.

Material and Methods

A detailed questionnaire-based survey was conducted to evaluate the donors’ main drive to get involved in the donation programme and the donor’s knowledge and awareness of risk factors.

Results

The majority of the donors (70%) were undergoing donation programmes for financial gains through compensation. The donors were especially not aware of the long-term medical risks and the possibility of identity exposure through genetic screening.

Conclusion

The main duty of health professionals is to counsel donors about the basic procedures and any possible problems they may face during the donation programmes. Reimbursement of oocyte donors is a slippery slope in oocyte donation programmes. High compensation may make women think that donation is a profession without considering possible risks. Furthermore, with the wider use of direct-to-consumer genetic testing, and genetic anonymity may be at risk, thus the donors have to be counselled properly. Therefore, in this era of health tourism, it is crucial to set up well-defined counselling bodies in all oocyte donation centres and enable donors to make an informed choice in becoming oocyte donors.

Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review)

PURPOSE

Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda.

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium.

RESULTS

Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives.

CONCLUSION

CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.