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Pellegrini L, De Angelis F, Tartaglia S, Toschi M, Galliano D, Pellicer A, Cozzolino M. The international transportation of frozen embryos does not affect IVF outcomes. Arch Gynecol Obstet 2023; 308:989-995. [PMID: 37318611 DOI: 10.1007/s00404-023-07092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The regulated transportation of cryopreserved human embryos resulting from assisted reproduction treatments offers opportunities for patients undergoing embryo transfer in other regions/countries. However, the principal concern for fertility clinics is maintaining unaltered embryo quality to ensure satisfactory clinical outcomes. The aim of the study was to evaluate the efficacy of the transportation process comparing the survival rate and competence of transported embryos to embryos produced and transferred on-site, in frozen embryo transfer cycles. METHODS This retrospective study assessed the outcomes of 621 blastocysts thawed at IVI Roma (Italy) between March 2021 and March 2022. Autologous or donated oocytes fertilized in vitro, cultured to the blastocyst stage, and cryopreserved in IVI Roma clinic (Group A, n = 450), were compared to embryos generated in IVI Spain clinics and transported to IVI Roma (Group B, n = 171). RESULTS Groups A and B respectively showed no significant difference in embryo survival rates after thawing (N = 440/450, 97.8% vs. N = 168/171, 98.2%, p = 0.71), pregnancy rates (N = 221/440, 50.23% vs. N = 77/168, 45.83%, p = 0.33), clinical pregnancy rates (N = 200/440, 45.45% vs. N = 62/168, 36.90%, p = 0.06), and miscarriage rates (N = 42/221, 19,00% vs. 21/77, 28.57%, p = 0.13), even after stratification for the source of the oocyte. Logistic binomial regression considering donor oocytes, preimplantation genetic testing, and patients' age, did not show any significant results on embryo survival and IVF outcomes. CONCLUSION The regulated transport of cryopreserved blastocysts did not affect embryo survival rate or IVF outcomes. Our data support the safety of embryo cryopreservation and medical transportation services, allowing clinics and patients to transport embryos with no significant risk to embryo competence.
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Affiliation(s)
| | | | - Silvio Tartaglia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Marco Toschi
- IVI-RMA Roma, Via Federico Calabresi 11, 00169, Rome, Italy
| | | | | | - Mauro Cozzolino
- IVI-RMA Roma, Via Federico Calabresi 11, 00169, Rome, Italy.
- Universidad Rey Juan Carlos, Calle Tulipan, 28933, Mostoles, Madrid, Spain.
- Fundacion IVI-IIS la Fe, Valencia, Spain.
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McDermott O, Ronan L, Butler M. A comparison of assisted human reproduction (AHR) regulation in Ireland with other developed countries. Reprod Health 2022; 19:62. [PMID: 35248065 PMCID: PMC8898507 DOI: 10.1186/s12978-022-01359-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Assisted human reproduction (AHR) treatment is not regulated in Ireland although it has been practiced since 1987. Thus, Ireland is one of the only European countries without any form of AHR specific regulation. This literature review research aimed to provide a comprehensive and comparative overview of AHR regulation and any associated literature to compare Ireland and other developed countries. Methods Systematic searches were conducted in several databases (Google Scholar, Web of Science, MEDLINE, SCOPUS and official government websites) utilising search strings in relation to AHR legislation for each country under review. A final review of 155 research articles were eligible after screening related to legislation in each country for inclusion. The findings were synthesised and summarised by legislation in each country. Results Different countries offer different levels of ART and IVF provision and services in terms of the type of services allowed, financial support, age, sex and eligibility of recipients. The UK’s oversight legislation combined with the Netherlands financial legislation section provides as being most effective hybrid model of best practice for adoption in Ireland. Conclusions This research concluded that there is no AHR legislation in any country that can be described as all-encompassing in terms of the services allowed, financial support and age of recipients. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years in order to meet Irish patient needs. Ireland is one of the only European countries without any form of assisted human reproduction specific regulation. This research aimed to review of assisted human reproduction regulations to compare Ireland with other developed countries. There is no assisted reproduction legislation in any country that can be described as perfect. The UK’s legislation combined with the Netherlands financial legislation section is concluded as being most effective hybrid model of best practice for adoption in Ireland. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years.
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Meier S, Ramos-Ortiz J, Basille K, D'Eramo AC, Diaconu AM, Flores LJ, Hottle S, Mason-Yeary K, Ruiz Y, DeMaria AL. Cross-border reproductive healthcare attitudes and behaviours among women living in Florence, Italy. BMC Health Serv Res 2022; 22:238. [PMID: 35189893 PMCID: PMC8862247 DOI: 10.1186/s12913-022-07621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of women living in Italy and seeking cross-border reproductive care (CBRC), especially for medically assisted reproduction (MAR), has increased. The purpose of this study was to explore CBRC attitudes and behaviours among a cohort of reproductive-aged women who have never engaged in CBRC to gauge social and cultural perceptions and gain a deeper understanding of family planning discourse. METHODS In-depth interviews were conducted during May - June 2018 with 30 women aged 18-50 living in or around Florence, Italy and enrolled in the Italian healthcare system. Interviews offered in-depth insight into CBRC attitudes, behaviours, and experiences among a cohort of women living in Italy who had never engaged in CBRC. Researchers used an expanded grounded theory through open and axial coding. Emergent themes were identified via a constant comparison approach. RESULTS Three themes and two subthemes emerged from the data. Participants discussed how limitations in Italy's access to MAR can lead women to seek reproductive healthcare in other countries. Women had mixed feelings about the effect of religion on legislation and reproductive healthcare access, with many views tied to religious and spiritual norms impacting MAR treatment-seeking in-country and across borders. Participants perceived infertility and CBRC-seeking as socially isolating, as the motherhood identity was highly revered. The financial cost of traveling for CBRC limited access and exacerbated emotional impacts. CONCLUSIONS Findings offered insight into CBRC perceptions and intentions, presenting a deeper understanding of the existing family planning discourse among reproductive-aged women. This may allow policymakers and practitioners to address social and cultural perceptions, increase access to safe and effective local care, and empower women in their family planning decisions.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Jaziel Ramos-Ortiz
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Kelsie Basille
- School of Nursing, Purdue University, West Lafayette, IN, USA
| | | | - Adria M Diaconu
- Department of Health & Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Lesley J Flores
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Savannah Hottle
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | | | - Yumary Ruiz
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA.
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Bioethical issues and legal frameworks of surrogacy: A global perspective about the right to health and dignity. Eur J Obstet Gynecol Reprod Biol 2020; 258:1-8. [PMID: 33387981 DOI: 10.1016/j.ejogrb.2020.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/14/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Modern advances in assisted reproduction technology (ART) have disrupted the traditional concept of parenthood. Every year, thousands of people travel abroad from their home countries in order to circumvent restrictive legislation or to benefit from lower fees. In a similar context, surrogacy raises many bioethical and legal issues. The present paper will address the main questions arising from the debate prompted by surrogacy, focusing on international legislation, and looking critically at the different legislative models. As a result of worldwide heterogeneity in policies, legal approaches, and access to ART throughout the world, a growing number of would-be parents are seeking treatment abroad. The lack of regulation on cross-border surrogacy in low income countries can undermine the dignity and rights of women as even modest economic compensation determines a significant purchasing power. The international effort should be aimed at creating an international regulatory framework from which guidelines useful to national governments derive. An international agreement would provide a solid legal basis for the protection of surrogate women. In order to limit the economic interests linked to procreative tourism, so as to truly protect global health and women's rights, legislative uniformity is therefore necessary between the various states.
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Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS. Psychology of infertility and assisted reproductive treatment: the Italian situation. J Psychosom Obstet Gynaecol 2017; 38:1-3. [PMID: 27750491 DOI: 10.1080/0167482x.2016.1244184] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this work is to propose a brief comment about the role of psychology in the cases of infertility and assisted reproductive treatments with particular reference to the Italian situation.
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Affiliation(s)
- Salvatore Giovanni Vitale
- a Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Valentina Lucia La Rosa
- b Unit of Psychodiagnostics and Clinical Psychology , University of Catania , Catania , Italy
| | | | - Antonio Simone Laganà
- a Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
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Riezzo I, Neri M, Bello S, Pomara C, Turillazzi E. Italian law on medically assisted reproduction: do women's autonomy and health matter? BMC WOMENS HEALTH 2016; 16:44. [PMID: 27449932 PMCID: PMC4958410 DOI: 10.1186/s12905-016-0324-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
Background In Italy in 2004, a very restrictive law was passed on medically assisted reproduction (MAR) (Law 40/2004) that placed Italy at the most conservative end of the European spectrum. The law was widely criticized and many couples seeking MAR brought their cases before the Italian Civil Courts with regard to pre-implantation genetic diagnosis (PGD), donor insemination and the issue of consent. Ten years on, having suffered the blows of the Italian Constitutional Court, little remains of law 40/2004. Discussion In 2009, the Constitutional Court declared the maximum limit of the number of embryos to be produced and transferred for each cycle (i.e. three), as stated in the original version of the law, to be constitutionally illegitimate. In 2014, the same Court declared as unconstitutional the ban on donor insemination, thus opening the way to heterologous assisted reproduction. Heterologous MAR is therefore perfectly legitimate in Italy. Finally, in 2015 a further ruling by the Constitutional Court granted the right to access MAR to couples who are fertile but carriers of genetic diseases. However, there is still much room for criticism. Many couples and groups are still, in fact, excluded from MAR. Same-sex couples, single women and those of advanced reproductive age are, at the present time, discriminated against in that Italian law denies these subjects access to MAR. Summary The history of Law 40/2004 has been a particularly troubled one. Numerous rulings have, over the years, dismantled much of a law constructed in violation of the rights and autonomy of women and couples. However, a number of troubling issues still exist from what is left of the law and the debate is still open at national and transnational level regarding some of the contradictions and gaps in the law highlighted in this article. Only by abolishing the final prohibitions and adopting more liberal views on these controversial yet crucial issues will Law 40/2004 become what it should have been from the start, i.e. a law which outlines the ‘rules of use’ of MAR and not, as it has been until now, a law of bans which sets limits to the freedom to reproduce.
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Affiliation(s)
- Irene Riezzo
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori, 1, 71100, Foggia, Italy
| | - Margherita Neri
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori, 1, 71100, Foggia, Italy
| | - Stefania Bello
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori, 1, 71100, Foggia, Italy
| | - Cristoforo Pomara
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori, 1, 71100, Foggia, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori, 1, 71100, Foggia, Italy.
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Turillazzi E, Frati P, Busardò FP, Gulino M, Fineschi V. The European Court legitimates access of Italian couples to assisted reproductive techniques and to pre-implantation genetic diagnosis. MEDICINE, SCIENCE, AND THE LAW 2015; 55:194-200. [PMID: 24777348 DOI: 10.1177/0025802414532245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
On 28 August 2012, the European Court of Human Rights (ECHR) issued a judgment regarding the requirements for the legitimate access of couples to assisted reproductive techniques (ART) and to pre-implantation genetic diagnosis (PGD). This judgment concerns the case of an Italian couple who found out after their first child was born with cystic fibrosis that they were healthy carriers of the disease. When the woman became pregnant again in 2010 and underwent fetal screening, it was found that the unborn child also had cystic fibrosis, whereupon she had the pregnancy terminated on medical grounds. In order to have the embryo genetically screened prior to implantation under the procedure of PGD, the couple sought to use in vitro fertilisation to have another child. Since article 1 of the Italian law strictly limits access to ART to sterile/infertile couples or those in which the man has a sexually transmissible disease, the couple appealed to the European court, raising the question of the violation of articles 8 and 14 of the European Convention on Human Rights. The applicants lodged a complaint that they were not allowed legitimate access to ART and to PGD to select an embryo not affected by the disease. The European Court affirmed that the prohibition imposed by Italian law violated article 8 of the European Convention on Human Rights. Focusing on important regulatory and legal differences among EU Nations in providing ART treatments and PGD, we derived some important similarities and differences.
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Affiliation(s)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Matteo Gulino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
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8
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Surrogate motherhood: Where Italy is now and where Europe is going. Can the genetic mother be considered the legal mother? J Forensic Leg Med 2015; 30:4-8. [PMID: 25623186 DOI: 10.1016/j.jflm.2014.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/09/2014] [Indexed: 11/23/2022]
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9
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Turillazzi E, Neri M, Riezzo I, Frati P, Fineschi V. Informed consent in Italy-traditional versus the law: a gordian knot. Aesthetic Plast Surg 2014; 38:759-64. [PMID: 24879042 DOI: 10.1007/s00266-014-0337-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Italian law no. 86 of 5 June 2012, which establishes a set of rules on the matter of breast implants, came into effect in July 2012. The law is at the center of a widespread and animated cultural debate that in recent years has been taking place in Italy. DISCUSSION The fundamental prohibition imposed by the law concerns the age limit. Breast implants for exclusively aesthetic purposes are allowed only if the legal age (18 years) has been reached. This prohibition does not apply in cases of severe congenital malformations certified by a physician operating within the National Health Service or by a public health care institution. The legal imposition of an age limit raises a number of perplexities: one at a bioethical level and one that is strictly juridical. In fact, it is impossible to deal with this issue unless the wider debate concerning the self-determination and autonomy of underage patients in biomedical matters is considered. It appears, then, that the issue is again exclusively related to the peculiarity of cosmetic surgery, which when aimed at correcting "only" the pathologic experiences of self-image, does not acquire the dignity of therapy. If, however, the improvement of self-image serves to achieve a better psycho-emotional balance and favors the development of social relations undermined by evident physical defects, age restrictions can be disregarded. The authors believe the real risk is that the law imposed by the Italian state is based on assumptions and preformed value judgments. Furthermore, in the understanding of needs, legislation often is biased toward objective biophysical problems without attaching due importance to subjective psychological and social problems. While acknowledging the seriousness of the issue, the authors do not agree with the legislature's rigidity. However, plastic surgeons must form a plan for addressing the concerns about breast implants and evaluating whether they are appropriate for adolescents, taking into account the unique psychological and developmental considerations of adolescent cosmetic surgery patients. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Busardò FP, Gulino M, Napoletano S, Zaami S, Frati P. The evolution of legislation in the field of Medically Assisted Reproduction and embryo stem cell research in European union members. BIOMED RESEARCH INTERNATIONAL 2014; 2014:307160. [PMID: 25147794 PMCID: PMC4134786 DOI: 10.1155/2014/307160] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 12/04/2022]
Abstract
Medically Assisted Reproduction (MAR), involving in vitro fertilisation (IVF), and research on embryos have created expectation to many people affected by infertility; at the same time it has generated a surplus of laws and ethical and social debates. Undoubtedly, MAR represents a rather new medical field and constant developments in medicine and new opportunities continue to defy the attempt to respond to those questions. In this paper, the authors reviewed the current legislation in the 28 EU member states trying to evaluate the different legislation paths adopted over the last 15 years and highlighting those EU countries with no specific legislation in place and MAR is covered by a general health Law and those countries in which there are no laws in this field but only "guidelines." The second aim of this work has been to compare MAR legislation and embryo research in EU countries, which derive from different origins ranging from an extremely prohibitive approach versus a liberal one, going through a cautious regulatory approach.
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Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Matteo Gulino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Simona Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
- Neuromed, Istituto Mediterraneo Neurologico (IRCCS), Via Atinense 18, Pozzilli, 86077 Isernia, Italy
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Levi Setti PE, Porcu E, Patrizio P, Vigiliano V, de Luca R, d’Aloja P, Spoletini R, Scaravelli G. Human oocyte cryopreservation with slow freezing versus vitrification. Results from the National Italian Registry data, 2007–2011. Fertil Steril 2014; 102:90-95.e2. [DOI: 10.1016/j.fertnstert.2014.03.052] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
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12
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Frati P, Gulino M, Pacchiarotti A, D'Errico S, Sicuro L, Fineschi V. A survey of Italian physicians' opinion about stem cells research: what doctors prefer and what the law requires. BIOMED RESEARCH INTERNATIONAL 2014; 2014:480304. [PMID: 24877099 PMCID: PMC4022064 DOI: 10.1155/2014/480304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/25/2014] [Accepted: 04/04/2014] [Indexed: 12/14/2022]
Abstract
To evaluate the Italian physicians' knowledge/information level about the therapeutic potential of stem cells, the research choice between embryonic and cordonal stem cells, and the preference between autologous and heterologous storage of cordonal stem cells, we performed a national survey. The questionnaire--distributed to 3361 physicians--involved physicians of different religious orientations and of different medical specialities. Most of the physicians involved (67%) were Catholics, and the majority were gynaecologists and paediatricians (43%) who are mainly in charge to inform future mothers about the possibility of cordonal stem cells conservation. The majority of the physicians interviewed do not have specific knowledge about stem cells (59%), most of them having only generic information (92%). The largest part of physicians prefer to use umbilical cord blood cells rather than embryonic stem cells. Nevertheless, a large percentage of physicians were in favour of embryo research, especially when embryos are supernumerary (44% versus 34%). Eighty-seven % of the physicians interviewed proved to have a general knowledge about stem cells and believe in their therapeutic potential. They prefer research on cordonal stem cells rather than on embryo stem cells. Although they are in favour of heterologous stem cells donation, they still prefer cryopreservation for personal use.
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Affiliation(s)
- Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome La Sapienza, Viale Regina Elena 336, 00161 Rome, Italy
- Istituto Neurologico Mediterraneo, Neuromed, IRCCS, 86170 Isernia, Italy
| | - Matteo Gulino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome La Sapienza, Viale Regina Elena 336, 00161 Rome, Italy
| | - Arianna Pacchiarotti
- Department of Obstetric Gynaecological and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Stefano D'Errico
- Legal Medicine Unit, Hospital “Campo di Marte”, 55100 Lucca, Italy
| | - Lorella Sicuro
- Italian National Institute of Statistics, 34 Via Caduta del Forte, 65121 Pescara, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome La Sapienza, Viale Regina Elena 336, 00161 Rome, Italy
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Levi Setti PE, Albani E, Morenghi E, Morreale G, Delle Piane L, Scaravelli G, Patrizio P. Comparative analysis of fetal and neonatal outcomes of pregnancies from fresh and cryopreserved/thawed oocytes in the same group of patients. Fertil Steril 2013; 100:396-401. [DOI: 10.1016/j.fertnstert.2013.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/17/2013] [Accepted: 03/21/2013] [Indexed: 01/29/2023]
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14
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What is the optimal means of preparing the endometrium in frozen–thawed embryo transfer cycles? A systematic review and meta-analysis. Hum Reprod Update 2013; 19:458-70. [DOI: 10.1093/humupd/dmt030] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Levi Setti PE, Albani E, Matteo M, Morenghi E, Zannoni E, Baggiani AM, Arfuso V, Patrizio P. Five years (2004-2009) of a restrictive law-regulating ART in Italy significantly reduced delivery rate: analysis of 10,706 cycles. Hum Reprod 2012; 28:343-9. [PMID: 23175501 DOI: 10.1093/humrep/des404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Was the delivery rate of ART cycles negatively affected by the enactment of the Law 40/2004 by the Italian Parliament which imposed a long list of restrictions for ART procedures? SUMMARY ANSWER This large and extensive comparative analysis of ART outcomes prior to and after the introduction of the Law 40 revealed a significant reduction in pregnancy and delivery rates per cycle, independent of age or other clinical variables, once the law went into effect. WHAT IS KNOWN ALREADY Several studies have been published on the effect of Law 40/2004 on ART outcomes, some authors demonstrating a negative impact of the Law in relation to specific etiologies of infertility, other authors showing opposite conclusions. STUDY DESIGN, SIZE, DURATION Retrospective clinical study of 3808 patients treated prior to the enactment of the Law, September 1996-March 2004 (Group I) and 6898 treated during the Law, March 2004-May 2009 (Group II). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 10 706 ART cycles were analysed, 3808 performed before and 6898 after the application of the Law. An intention-to-treat statistical analysis was performed to detect pregnancy and delivery rates (pregnancies ≥ 24 weeks) per started cycle. A P value of <0.05 was considered statistically significant. We analysed different outcomes: differences in fertilization, pregnancy and delivery rate, multiple pregnancies and miscarriage rates between the two time periods. MAIN RESULTS AND THE ROLE OF CHANCE The delivery rate for started cycle was 20% before and 16.0% after the introduction of the Law representing a 25% reduction (P < 0.001). The multivariate analysis, corrected by female age of >38 years, duration of infertility, basal FSH level and number of retrieved oocytes, showed a 16% lower delivery rate (odds ratio: 0.84; confidence interval: 0.75-0.94). This statistical approach removed the risk that the observed effects were due to chance and confirmed unequivocally that the Law was an independent factor responsible for the reduced likelihood of a successful outcome. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study. A prospective randomized study, with patients treated in the same time period and randomized to restrictions or not, would have minimized potential limitations due to differences in years of treatments. WIDER IMPLICATIONS OF THE FINDINGS Our findings based on the analysis of such a large number of cycles proved clearly and unequivocally that imposing restrictions on the practice of ART penalized patients. These data represent a relevant clinical contribution for countries still debating the enactment of restrictive limitations of ART.
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Affiliation(s)
- P E Levi Setti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Istituto Clinico Humanitas, IRCCS, University of Milan School of Medicine, Rozzano, Milano 20084, Italy.
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Affiliation(s)
- Giuseppe Remuzzi
- Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
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The 2004 Italian legislation on the application of assisted reproductive technology: epilogue. Eur J Obstet Gynecol Reprod Biol 2012; 161:187-9. [PMID: 22285685 DOI: 10.1016/j.ejogrb.2011.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 10/20/2011] [Accepted: 12/02/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate how the unique Italian fertility regulations (≤3 inseminated oocytes/cycle, transfer of all embryos, prohibition of embryo cryopreservation) affected outcomes of ART. STUDY DESIGN Case-control study from the Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. We compared outcomes of ART patients between five years before (n=1791) and five years after (n=2474) the implementation of the law. RESULTS The mean embryo transfer (ET) rate was 3.1±2.1 and 1.7±1.1 before and after the law. Significantly more ICSI procedures were performed in women above 35 years old during the post-law period. The ET rate was higher before (88.6%) than after (80.5%) the law (OR 1.9, 95% CI 1.6, 2.2) especially in women >37 years undergoing ICSI (88.2 vs. 76.1%; OR 2.3, 95% CI 1.3, 4.2). The clinical pregnancy rates were practically unchanged but the proportion of triplet births significantly decreased after the law (10.3 vs. 4.1%, OR 2.7, 95% CI 1.4, 5.0). CONCLUSION In contrast to interim analyses, we found that the statutory obligation to transfer all available embryos produced from up to three inseminated oocytes reduced the ET rates, especially in older women, and decreased the triplet births rate.
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Barritt J, Luna M, Sandler B, Duke M, B. Copperman A. Elective oocyte freezing for the preservation of fertility. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojog.2012.21005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Is there still a role for reconstructive microsurgery in tubal infertility? Curr Opin Obstet Gynecol 2011; 23:200-5. [DOI: 10.1097/gco.0b013e328345522a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zawawi M. Donated materials in assisted reproductive technologies: an ethico-legal analysis of art legislations worldwide. J Med Ethics Hist Med 2010; 3:2. [PMID: 23908737 PMCID: PMC3714004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/15/2010] [Indexed: 11/09/2022] Open
Abstract
This paper provides an appraisal of countries that have legislations pertaining to assisted reproductive technologies (ART). In doing so, the paper highlights the emphasis on the protection of reproductive freedom of the couples seeking ART treatment. This belief is grounded primarily on the basic notion of liberalism that attaches primary importance to respect for individual freedom, which is the foundation of the notion of reproductive rights as understood by western standards today. The main aim of the appraisal is to see how these legislations address the drastic changes in familial relationships when ART involves the use of donated materials.
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Noyes N, Porcu E, Borini A. Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. Reprod Biomed Online 2009; 18:769-76. [PMID: 19490780 DOI: 10.1016/s1472-6483(10)60025-9] [Citation(s) in RCA: 299] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Over the past decade, the number of reported live births resulting from oocyte cryopreservation has rapidly increased. To appreciate the true number of children born, verified live births were tabulated and assessed. A literature search was performed; authors were then contacted to verify birth outcomes and provide updates. A database including all verified live born infants was constructed. A total of 58 reports (1986-2008) were reviewed, which included 609 live born babies (308 from slow freezing, 289 from vitrification and 12 from both methods). Additionally, 327 other live births were verified. Of the total 936 live borns, 1.3% (12) were noted to have birth anomalies: three ventricular septal defects, one choanal and one biliary atresia, one Rubinstein-Taybi syndrome, one Arnold-Chiari syndrome, one cleft palate, three clubfoot and one skin haemangioma. Compared with congenital anomalies occurring in naturally conceived infants, no difference was noted. With more live born data accumulating, this procedure may become mainstream as a fertility preservation option, particularly for women diagnosed with malignancy requiring cytotoxic therapy. A registry would help to assure the safest, most expeditious development of this technology.
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Affiliation(s)
- N Noyes
- Department of Obstetrics and Gynecology, NYU Fertility Center, NYU School of Medicine, New York 10016, USA.
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Release of sICAM-1 in oocytes and in vitro fertilized human embryos. PLoS One 2008; 3:e3970. [PMID: 19092999 PMCID: PMC2599884 DOI: 10.1371/journal.pone.0003970] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/06/2008] [Indexed: 11/23/2022] Open
Abstract
Background During the last years, several studies have reported the significant relationship between the production of soluble HLA-G molecules (sHLA-G) by 48–72 hours early embryos and an increased implantation rate in IVF protocols. As consequence, the detection of HLA-G modulation was suggested as a marker to identify the best embryos to be transferred. On the opposite, no suitable markers are available for the oocyte selection. Methodology/Principal Findings The major finding of the present paper is that the release of ICAM-1 might be predictive of oocyte maturation. The results obtained are confirmed using three independent methodologies, such as ELISA, Bio-Plex assay and Western blotting. The sICAM-1 release is very high in immature oocytes, decrease in mature oocytes and become even lower in in vitro fertilized embryos. No significant differences were observed in the levels of sICAM-1 release between immature oocytes with different morphological characteristics. On the contrary, when the mature oocytes were subdivided accordingly to morphological criteria, the mean sICAM-I levels in grade 1 oocytes were significantly decreased when compared to grade 2 and 3 oocytes. Conclusions/Significance The reduction of the number of fertilized oocytes and transferred embryos represents the main target of assisted reproductive medicine. We propose sICAM-1 as a biochemical marker for oocyte maturation and grading, with a possible interesting rebound in assisted reproduction techniques.
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Feinberg EC, Levens ED, DeCherney AH. Reply of the Authors: Tubal reanastomosis or IVF? Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Advances in genomic science and reproductive medicine are hastening the day when parents will be able to select or design desired traits for their children. This possibility raises a series of challenging questions: will our ability to choose our children’s biological inheritance deform parenting? Will it diminish children’s freedom by making them creatures of their parents’ whims? Will it widen social divisions, creating a ‘genobility’? Will it recreate the horrors of early twentieth century eugenics? In this perspective article I reply that while these are all important questions, the answers do not necessarily rule out the judicious use of human genetic engineering.
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Affiliation(s)
- Ronald M Green
- Ethics Institute, Dartmouth College, Haldeman Center, 27 North Main Street, Hanover, NH, USA
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Assisted reproductive technology: official data on the application of the Italian law. Reprod Biomed Online 2008; 16 Suppl 1:5-9. [PMID: 18348784 DOI: 10.1016/s1472-6483(10)60393-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 2004, the Italian parliament enacted Law 40/2004, which established new rules for assisted reproductive technology and included a very long and detailed list of restrictions. Since its enactment, the law has given rise to heated discussion at a national and international scientific level. In June 2007 a report presented to the Italian parliament published data from the National Institute of Health regarding the application of the law in 2005. From an overall comparison of data from the years 2003 (before Law 40/2004) and 2005, it emerges that the situation has been significantly altered by the application of this law. These data clearly demonstrate a drop in the percentage of pregnancies, and a consequent drop in the number of children born; a higher percentage of treatments that do not reach the transfer stage or that have a low possibility of success (non-elective embryo transfer); a decrease in the number of oocytes inseminated but an increase in the number of embryos transferred; a higher incidence of multiple births, with consequent immediate and future negative effects for the children and their mother; an increase in the number of pregnancies with a negative outcome.
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Discarded human spermatozoa, eggs and embryos for personnel training and practice in assisted reproduction. Reprod Biomed Online 2008; 15 Suppl 2:5-6. [PMID: 18088514 DOI: 10.1016/s1472-6483(10)60543-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An ethical issue that has been largely overlooked is the use of discarded human gametes and embryos for personnel training in clinical assisted reproduction technology, e.g. intracytoplasmic sperm injection and preimplantation genetic diagnosis. Unlike experimental research for generating peer-reviewed journal publications and intellectual property, there is no similar paper trail or smoking gun if human gametes and embryos are utilized solely for personnel training without the patient's knowledge and consent. For many assisted reproduction laboratories in private practice that are not affiliated with research or academic institutions, there are often difficulties in procuring animal material for personnel training. In contrast, discarded human gametes and embryos are readily available and can be convenient for training inexperienced personnel in assisted reproduction techniques. Very often, only verbal consent is obtained from patients, without written documentation, and this situation can potentially lead to abuse. For example, fertility clinics and laboratories may conduct training courses and workshops for generating additional income and revenue; and there is a possibility of discarded human material being utilized for such profit-making ventures without patients' prior knowledge. Hence, it is the moral duty and obligation of international professional bodies to advocate and draft clearly defined regulatory guidelines and legislative framework for this purpose.
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“Statute of limitations” redeemed by cyberspace. Fertil Steril 2007; 88:1478-9; author reply 1479. [DOI: 10.1016/j.fertnstert.2007.07.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Research on human stem cells and embryos creates ethical issues. Here I discuss ten frequently used arguments against research and point out their weaknesses. These arguments include the possessed potentiality of the embryo per se and, in contrast to other cell systems, the "slippery slope" argument, the right of disposal of parents, totipotency versus pluripotency, the burden of proof for research, natural versus artificial, and three arguments based on the precaution principle (the open biological questions, uncertainty regarding clinically applicable therapies, and the problem solving rule). I finally suggest a different answer to the ethical questions concerning research on human embryos and embryonic stem cells, which takes into consideration their biological context.
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Affiliation(s)
- Silvia Camporesi
- IFOM-IEO CAMPUS, Foundations of life sciences and their ethical consequences, Milan, Italy.
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Heng BC. Oocyte cryopreservation as alternative to embryo cryopreservation – some pertinent ethical concerns. Reprod Biomed Online 2007; 14:402-3. [PMID: 17359599 DOI: 10.1016/s1472-6483(10)60885-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fineschi V, Neri M, Di Donato S, Pomara C, Riezzo I, Turillazzi E. An immunohistochemical study in a fatality due to ovarian hyperstimulation syndrome. Int J Legal Med 2006; 120:293-9. [PMID: 16741744 DOI: 10.1007/s00414-006-0104-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 04/27/2006] [Indexed: 11/24/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a complication occurring in the luteal phase of a menstrual cycle in which ovulation induction or ovarian hyperstimulation for assisted reproduction techniques has been performed. Our report concerns the death of a 31-year-old woman with primary infertility on recombinant follicle stimulating hormone therapy (Gonal-F) who developed a fatal adult respiratory distress syndrome. Immunohistochemical investigation of lung and uterine samples was performed utilizing monoclonal antibodies for antisurfactant apoprotein (PE-10) and polyclonal antibodies anti-IL-6, IL-8, IL-10, TNFalpha for lungs, and polyclonal antibodies anti-beta-HCG (human chorionic gonadotropin) for uterus. The knowledge of macroscopic and histologic findings should be of special interest for all those who perform autopsies in these victims. The exact pathogenesis of OHSS remains a mystery; so for the diagnosis of suspected OHSS, the forensic pathologist must use all the modern laboratory armament to validate the diagnosis in the extremely rare fatal cases due to this syndrome.
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Affiliation(s)
- Vittorio Fineschi
- Department of Forensic Pathology, University of Foggia, Policlinico Ospedali Riuniti, Via Luigi Pinto no. 1, Foggia, 71100, Italy.
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Jones DG, Towns CR. Navigating the quagmire: the regulation of human embryonic stem cell research. Hum Reprod 2005; 21:1113-6. [PMID: 16361280 DOI: 10.1093/humrep/dei461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Embryonic stem (ES) cell research has garnered almost unprecedented attention. Debate over the boundaries of such research is ongoing, and the regulation of the field varies widely between countries. This article identifies and evaluates the four major positions that emanate from current international regulations. ES cell policies may ultimately impact on public health, and hence they must be both rigorous and transparent. We contend that these goals will only be achieved if policy is both ethically consistent and clinically realistic with regard to the ability to achieve therapeutic goals. We conclude that policies allowing the ongoing extraction of stem cells from spare in vitro fertilization embryos and the creation of embryos for research (within set limitations) cope most adequately with the tension between varying views on the moral status of the human embryo and the therapeutic potential inherent within ES cell research.
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Affiliation(s)
- D G Jones
- Department of Anatomy and Structural Biology, University of Otago, Dunedin, New Zealand.
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