Intra-Family Gamete Donation: A Solution to Concerns Regarding Gamete Donation in China?

Gamete donation from third parties is controversial in China as it severs blood ties, which are considered of utmost importance in Confucian tradition. In recent years, infertile couples are increasingly demonstrating a preference for the use of gametes donated by family members to conceive children—known as “intra-family gamete donation.” The main advantage of intra-family gamete donation is that it maintains blood ties between children and both parents. To date there is no practice of intra-family gamete donation in China. In this paper, we investigate intra-family adoption in China in order to illustrate that intra-family gamete donation is consistent with Confucian tradition regarding the importance of maintaining blood ties within the family. There are several specific ethical issues raised by intra-family gamete donation. It may, for example, result in consanguinity and the semblance of incest, lead to confused family relationships, and raise concerns about possible coercion of familial donors. Confucian tradition provides a new approach to understand and deal with these ethical issues in a way that Western tradition does not. As a result, we suggest intra-family gamete donation could be an acceptable solution to the problem of infertility in China. However, further discussion and open debates on the ethical issues raised by intra-family gamete donation are needed in China.     

Donation of embryos for human development and stem cell research

Using donated human embryos for scientific research raises ethical questions about the donation process. We describe a two-stage consent process designed to help couples make informed decisions about embryo disposition. This consent methodology minimizes conflict of interest, respects patient choice, and provides a much-needed resource to patients and the research community.     

Implications of reproductive technologies for birth and developmental outcomes: imprinting defects and beyond

Assisted reproductive techniques (ARTs) have been widely used over the past two decades to help infertile couples conceive. Recent studies on the ART-conceived population have raised concern about the possible risks of these techniques, in particular with regard to increased incidence of growth and developmental disorders. Some of these effects might be linked to genomic imprinting defects, although current evidence does not allow definite conclusions to be drawn. This review summarises studies that have examined effects of gamete and embryo manipulations on imprinted genes, and discusses the evidence for and against effects of ARTs on offspring health, and in particular imprinting-related conditions.     

Embryo donation and receipt in Australia: views on the meanings of embryos and kinship relations

Research on embryo donation and receipt continues to grow, highlighting how specific national contexts shape views and experiences. The present article reports on a qualitative study on embryo donation and receipt in Australia. Interviews were conducted with 15 participants: embryo donors and those seeking to donate (6), embryo recipients and those seeking donors (3), people with embryos in storage or previously in storage (5), and egg donors where resulting embryos were donated to a third party (1). A deductive thematic analysis identified four key themes: understandings of embryos as cells, potential children, and/or children; a focus on relationships between “siblings”; importance of language and “family words” in discussing relationships; and extended family members having difficulty understanding the concept of embryo donation. The article concludes with a consideration of the implications of the findings in terms of the practice of embryo donation and the policies that surround it.     

2PN cell donation in Germany. Or: How the German Embryo Protection (Act) undermines itself

In contrast to embryo donation, the permissibility of 2PN cell donation is highly controversial in Germany. This article is based on there being a legal loophole with respect to 2PN cell donation, which results from an inconsistency within the Embryo Protection Act on the normative status of 2PN cells. Following that thesis, the article argues that, on the basis of the normative criterion totipotency (i.e. the capacity to develop into a born human being), 2PN cells should also be considered human embryos within the meaning of the Act and thereby be protected by that Act in the same way as embryos. However, the normative assumption that 2PN cells should already be endowed with human dignity and the right to life has absurd consequences. Moreover, the consistent continuation of the Embryo Protection Act, as well as of the underlying ethical position or argumentation (i.e. the potentiality argument), leads to the even more absurd consequence of having to place every human somatic cell under the protection of human dignity and the right to life. As totipotency or the developmental potential therefore cannot delimit entities considered worthy of protection (i.e. human embryos) from entities considered not worthy of protection (i.e. 2PN cells, gametes, hESC, hiPSC and human somatic cells), it is not a suitable normative criterion. As a paradigmatic case, 2PN cell donation demonstrates that by retaining this normative criterion the now obsolete German Embryo Protection (Act) ultimately undermines itself.     

Pregnancy established in an infertile patient after transfer of a donated embryo fertilised in vitro.

In vitro fertilisation after stimulation of the ovulatory cycle has led to successful pregnancy. If more oocytes are recovered than are needed they may be left unfertilised, preserved, or donated to a recipient couple from whom oocytes cannot be obtained. A case of human pregnancy initiated by transfer of a donated embryo fertilised in vitro is reported. The donor was a 42 year old woman with primary infertility from whom six follicles were aspirated after stimulation of the ovulatory cycle. The recipient was a 38 year old infertile woman who had undergone several unsuccessful attempts for artificial insemination from a donor. Five oocytes were recovered from the donor''s six follicles, four of which were inseminated with spermatozoa of the donor''s husband and the fifth with a frozen sample of semen. Three of the four embryos fertilised by her husband were returned to the donor and the fifth was transferred to the recipient. No pregnancy was recorded in the donor, but pregnancy was confirmed in the recipient, though spontaneous abortion occurred after 10 weeks. This case will give useful information for further study of in vitro fertilisation, but also raises many ethical issues.     

Human embryonic stem cell lines: socio-legal concerns and therapeutic promise

Stem cell lines would be very valuable for the repair of diseased or damaged organs. Stem cells derived from adult tissues raise few ethical problems, and would not be rejected if derived from the patient. They show considerable plasticity and might be appropriate for some clinical conditions, but they tend not to grow well in culture. Stem cells derived from the early human embryo proliferate indefinitely in culture and can give rise to many different tissues, but their derivation requires destruction of the embryo, which is not ethically acceptable in some countries. Other countries allow strictly regulated destructive research on human embryos, usually those that have been produced for infertile couples in infertility clinics. Embryos that are no longer required for the couple's own reproductive project could be donated for research rather than just discarded. Different approaches are being developed to avoid immunological rejection of embryonic stem cells used for therapy. Derivation of embryonic stem cell lines by somatic cell nuclear transfer ('cloning') from the patients themselves might be one possible approach, but is unlikely to be used in routine clinical practice if more cost-effective methods are available.     

Experiencing infertility--social work dilemmas in child adoption procedures

The research deals with experiencing infertility and its consequences in the adoption of a child and focuses on infertile couples that have wished to adopt a child and joined a program preparing them to be foster parents. The results show that most of the infertile couples experience infertility very much as being different from couples with children as well as having to cope with the feelings of deep emotional loss resulting from the inability to reproduce biologically. There is therefore the question whether these facts should be taken into account by the profession (i.e. social workers) when dealing with child adoption as, according to most of the respondents of our survey, the process of coming to terms with infertility and its consequences is an important factor in establishing healthy family relationships and the child's identity within the adoptive family. We concluded from the results of the research that the infertile couples preparation program for adopting a child carried out by the Society of Adoptive Families "Deteljica", is a comprehensive autopoietic social workers' answer to the needs of participants for a successful adoption of a child, as it makes it possible to supply these future adoptive parents with the requisite information and experience and provides support to the entire family upon accepting a child in its midst, while its fundamental attribute is offering help to couples in overcoming the traumas resulting from their infertility.     

Clinical implications of developments in in vitro fertilisation.

During February 1979 to December 1983, 831 infertile couples were treated by in vitro fertilisation and embryo transfer. The problems they faced included deciding on the number of oocytes to be collected at laparoscopy, the numbers to be donated or fertilised, the numbers of embryos to be transferred and frozen, and whether abnormal embryos should be used for research or discarded. The 831 patients received a total of 1530 treatment cycles. Of the 763 patients for whom complete data were available, 136 (17.8%) became pregnant. The rate of pregnancy, however, increased dramatically from 7.4% when only one embryo was transferred to 21.1% and 28.1% when two and three embryos were transferred, respectively. The chance of multiple pregnancy also increased with the number of embryos transferred, but the risk (2% for twins) was far outweighed by the relatively poor result after transferring a single embryo. Out of 40 embryos freeze-thawed, 23 survived thawing and were transferred; of these, 4 (17%) resulted in pregnancy. Thirty four transfers of donor oocyte embryos also resulted in four pregnancies (12%), but two of these ended in abortion. Neither microscopy nor any other available test can determine the potential of an oocyte to result in pregnancy, so that discarding oocytes that may look abnormal simply reduces the chances of conception--both for the patient and for any prospective recipient of donor oocyte embryos. In any case, abnormal embryos tend to die when growth is allowed to continue in vitro. Probably all oocytes harvested from a patient should be inseminated and the utilisation of the embryos decided once the number developed is known.     

BEFORE I WAS AN EMBRYO,I WAS A PRE-EMBRYO: OR WAS I?

Issues surrounding human embryos are poignant and profound. Should research be conducted on them? Should they be discarded? Should they be donated to infertile couples? The Warnock Report was a landmark in providing guidelines limiting experimentation on human embryos to the first 14 days after fertilization, at which time implantation of the embryo is complete and the primitive streak has appeared.² However, these embryological features were not considered sufficiently distinctive to bestow upon this 14-day period a separate classification. This situation changed when, in 1986, Anne McLaren suggested the use of the terms ‘pre-embryo’ or ‘conceptus' to designate “the entire product of the fertilized egg up to the end of the implantation stage” and the term ’embryo‘ for “that small part of the pre-embryo or conceptus, first distinguishable at the primitive streak stage, that later develops into the foetus.”³ In this paper we look critically at the term ‘pre-embryo’, and we shall present the case for an alternative set of terms, namely, embryo-placenta and embryo-fetus. We consider this latter to be biologically-based terminology, that does not have any connotation of restricted moral value as the term pre-embryo does for some.     

Biogenetic ties and parent‐child relationships: The misplaced critique

According to an almost axiomatic standard in bioethics, moral commitment should ground parents’ relationship with their children, rather than biogenetic relatedness. This standard has been used lately to express skepticism about extending existing assisted reproductive treatments (ARTs) to same‐sex couples and to research into novel fertility interventions for those couples, but this skepticism is misplaced on several grounds. As a matter of access and equity, same‐sex couples seem presumptively entitled to genetic relatedness to their children as far as possible both in regard to existing ARTs and to novel ARTs under investigation. For those worried about the effects of trying to secure biogenetic relatedness for same‐sex couples, it may be noted that same‐sex couples will only ever be a fraction of the parents implicated in propping up “biologism,” as the expectation of biogenetic relatedness it is sometimes called. The cultural force of biologism would survive almost intact even if no same‐sex couples were ever to have genetically related children. It is therefore hard to see why same‐sex couples should forfeit aspirations to biogenetic relationships with their children or enjoy less subsidy for ARTs than the subsidy given to different‐sex couples. As matter of moral consistency, the full implications of the biologism critique have yet to be evaluated relative to different‐sex couples.     

Risque viral lié au virus de l’hépatite C en AMP

Medical assistance to procreation in a couple where one or both parents has hepatitis C viral infection (HCV) raises the issue of the transmission of the infection to the baby and/or of possible contamination of both the technicians and the gemetes or embryos from virus-free parents in the laboratory. It becomes essential to assess transmission risk in Assisted Reproductive Techniques (ART) in order to clearly define the management of couples according to their viral status. To define the HCV transmissibility risk in ART related to the presence of virus in semen from infected infertile men, RNA HCV-detection was performed in sera, and semen and sperm fractions obtained after Percoll gradient centrifugation. RNA HCV was detected in 5% (2/39) of the semen tested: in the raw semen, in the seminal fluid and in the cell pellet but never after Percoll selection. According to these results, we suggest a strategy for HCV infected infertile men who need ART.     

Rethinking parenthood within assisted reproductive technology: The need for regulation in Nigeria

In Nigeria, reproduction is highly valued, with many people desiring to produce a child ‘in their own image and likeness’. Previously, aspiring parents often resorted to adoption. Today, the availability of assisted reproductive technologies (ARTs) has provided options other than adoption for those desiring to procreate. Through ARTs, aspirations for a family may be attained through an exchange of reproductive goods and services, and not necessarily through traditional heterosexual relationships. ARTs have altered the perception of parenthood as it exists in Nigeria, and courts face a difficult task in defining parenthood within Nigerian jurisprudence, as they can only adjudicate based on extant law. Although ARTs provide greater individual choices for fulfilling the desire to procreate, they raise a number of ethical and legal issues that evolving legal systems, such as that in Nigeria, are ill-equipped to manage. This paper describes the traditional assignment of parenthood under indigenous laws and other sources of law within the Nigerian jurisprudence. We carried out an in-depth study of the Nigerian legislative framework and found that there are no laws directly regulating parenthood, procreation and ARTs in Nigeria. We also found that the extant laws are only tangentially related and do not answer the relevant questions sufficiently well, especially concerning succession, nationality and assignment of responsibility in collaborative reproduction. We conclude by highlighting the need for and recommending a regulatory framework on ARTs with a particular focus on providing a definition for parenthood achieved through ARTs in Nigeria.     

Epigenetic disorders and altered gene expression after use of Assisted Reproductive Technologies in domestic cattle

The use of Assisted Reproductive Technologies (ARTs) in modern cattle breeding is an important tool for improving the production of dairy and beef cattle. A frequently employed ART in the cattle industry is in vitro production of embryos. However, bovine in vitro produced embryos differ greatly from their in vivo produced counterparts in many facets, including developmental competence. The lower developmental capacity of these embryos could be due to the stress to which the gametes and/or embryos are exposed during in vitro embryo production, specifically ovarian hormonal stimulation, follicular aspiration, oocyte in vitro maturation in hormone supplemented medium, sperm handling, gamete cryopreservation, and culture of embryos. The negative effects of some ARTs on embryo development could, at least partially, be explained by disruption of the physiological epigenetic profile of the gametes and/or embryos. Here, we review the current literature with regard to the putative link between ARTs used in bovine reproduction and epigenetic disorders and changes in the expression profile of embryonic genes. Information on the relationship between reproductive biotechnologies and epigenetic disorders and aberrant gene expression in bovine embryos is limited and novel approaches are needed to explore ways in which ARTs can be improved to avoid epigenetic disorders.     

Epigenetic disorders and altered gene expression after use of Assisted Reproductive Technologies in domestic cattle

The use of Assisted Reproductive Technologies (ARTs) in modern cattle breeding is an important tool for improving the production of dairy and beef cattle. A frequently employed ART in the cattle industry is in vitro production of embryos. However, bovine in vitro produced embryos differ greatly from their in vivo produced counterparts in many facets, including developmental competence. The lower developmental capacity of these embryos could be due to the stress to which the gametes and/or embryos are exposed during in vitro embryo production, specifically ovarian hormonal stimulation, follicular aspiration, oocyte in vitro maturation in hormone supplemented medium, sperm handling, gamete cryopreservation, and culture of embryos. The negative effects of some ARTs on embryo development could, at least partially, be explained by disruption of the physiological epigenetic profile of the gametes and/or embryos. Here, we review the current literature with regard to the putative link between ARTs used in bovine reproduction and epigenetic disorders and changes in the expression profile of embryonic genes. Information on the relationship between reproductive biotechnologies and epigenetic disorders and aberrant gene expression in bovine embryos is limited and novel approaches are needed to explore ways in which ARTs can be improved to avoid epigenetic disorders.     

Embryonic stem cells in science and medicine: An invitation for dialogue

Embryonic stem cells hold tremendous promise both medically and commercially. Researchers anticipate stem cell therapeutics to have an impact on conditions ranging from diabetes to Parkinson's disease. As with many medical therapies based on donated tissues, the shortage of donated egg cells or embryos required to produce the stem cell lines significantly limits the advance of research. A number of factors affect the supply of donated material, including federal and state issues and perceived ethical constraints. Furthermore, similar to the donation of other living tissue, donation of raw material is not without risk and inconvenience, particularly for the egg donor. The first article of this 2-part series provides an overview of stem cells and the current regulatory regime in the United States regarding pluripotent stem cells. In the second article, we examine the similarities and differences compared with other medical therapies that require donated human material, such as biologics (plasma and other blood-derived products) and organs, as well as the current state of the art and certain ethical considerations, such as origin of the cells and risk to the donor.     

CLONING, PARENTHOOD, AND GENETIC RELATEDNESS

In this paper I examine what I take to be the best case for reproductive human cloning, as a medical procedure designed to overcome infertility, and argue that it founders on an irresolvable tension in the attitude towards the importance of being ‘genetically related’ to our children implied in the desire to clone. Except in the case where couples are cloning a child they have previously conceived naturally, cloning is unable to establish the right sort of genetic relation to make couples the parents of their cloned child. If anybody is the genetic parent of a cloned child it is the natural parent(s) of the DNA donor. Paradoxically, in order to resist the claims of the parents of the donor to the cloned child, the argument for human reproductive cloning must place more weight on the intention to parent a child, than we do in cases of ordinary reproduction. It must insist that the parental relation is established by the intentions of the couple who bring a clone into the world and not by their genetic relation to the child. The emphasis placed on intention as establishing the parental relationship works to undermine the justification for cloning in the first place. For cloning to play a useful role as a reproductive technology, it must allow couples to become parents who could do so no other way. However, to the extent that intention is sufficient to establish parenthood, adoption or surrogacy, which are existing alternatives to cloning, will serve equally well to allow couples to become parents.     

The pros and cons of human therapeutic cloning in the public debate

Few issues linked to genetic research have raised as much controversial debate as the use of somatic cell nuclear transfer technology to create embryos specifically for stem cell research. Whereas European countries unanimously agree that reproductive cloning should be prohibited there is no agreement to be found on whether or not research into therapeutic cloning should be permitted. Since the UK took the lead and voted in favour of regulations allowing therapeutic cloning the public debate has intensified on the Continent. This debate reflects the wide spectrum of diverse religious and secular moralities that are prevalent in modern multicultural European democratic societies. Arguments range from putting forward strictly utilitarian views that weight the moral issues involved against the potential benefits that embryonic stem cell research may harbour to considering the embryo as a human being, endowed with human dignity and human rights from the moment of its creation, concluding that its use for research is unethical and should be strictly prohibited. Given the current state of dissension among the various European states, it is difficult to predict whether 'non-harmonisation' will prevail or whether in the long run 'harmonisation' of legislation that will allow stem cell research will evolve in the EU.     

"He won't be my son": Middle Eastern Muslim men's discourses of adoption and gamete donation

In the Sunni Muslim world, religious mandates prohibit both adoption and gamete donation as solutions to infertility, including in the aftermath of in vitro fertilization (IVF) failures. However, both of these options are now available in two Middle Eastern countries with significant Shi'ite Muslim populations (Iran and Lebanon). On the basis of fieldwork in multisectarian Lebanon, I examine in this article attitudes toward both adoption and gamete donation among childless Muslim men who are undertaking IVF with their wives. No matter the religious sect, most Muslim men in Lebanon continue to resist both adoption and gamete donation, arguing that such a child "won't be my son". However, against all odds, some Muslim men are considering and undertaking these alternatives to family formation as ways to preserve their loving marriages, satisfy their fatherhood desires, and challenge religious dictates, which they view as out of step with new developments in science and technology. Thus, in this article I examine the complicated intersections of religion, technology, marriage, and parenthood in a part of the world that is both poorly understood and negatively stereotyped, particularly in the aftermath of September 11, 2001.     

Evaluation of Blastomere Biopsy Using a Mouse Model Indicates the Potential High Risk of Neurodegenerative Disorders in the Offspring

Preimplantation genetic diagnosis (PGD), used in clinical practice, is offered to couples that may suffer from a monogenetic disorder, chromosome aneuploidy, or X-linked disease. However, blastomere biopsy, as an indispensable manipulation during the PGD procedure has not been assessed for its long term health implications. Using a mouse model, we investigated the effect of blastomere biopsy of in vitro cultured four-cell embryos on preimplantation development efficiency, postnatal growth, and physiological and behavioral activity compared with control, non-biopsied embryos. The mice generated after blastomere biopsy showed weight increase and some memory decline compared with the control group. Further protein expression profiles in adult brains were analyzed by a proteomics approach. A total of 36 proteins were identified with significant differences between the biopsied and control groups, and the alterations in expression of most of these proteins have been associated with neurodegenerative diseases. Furthermore hypomyelination of the nerve fibers was observed in the brains of mice in the biopsied group. This study suggested that the nervous system may be sensitive to blastomere biopsy procedures and indicated an increased relative risk of neurodegenerative disorders in the offspring generated following blastomere biopsy. Thus, more studies should be performed to address the possible adverse effects of blastomere biopsy on the development of offspring, and the overall safety of PGD technology should be more rigorously assessed.Preimplantation genetic diagnosis (PGD)¹ has been one of the main clinical components of assisted reproductive technologies (ARTs) since 1990 (1). At present, infertile couples experiencing recurrent miscarriage or X chromosome-linked diseases are most likely to benefit from PGD.The treatment of human infertility by ARTs has gained widespread application, but it is disconcerting to many researchers that the clinical procedures used in ARTs are rapidly outpacing the underlying science. ART procedures are generally considered to be safe, but recent studies suggest a small increase in birth defects and low birth weights in ART children (2, 3). In addition, several clinical studies have reported an increased frequency of Beckwith-Wiedemann syndrome or Angelman syndrome caused by an imprinting defect among children conceived with ARTs (4, 5). These potential risks cause serious unease and justify more serious assessments of ARTs. However, moral, ethical, and legal issues complicate assessments of the genetic quality of ART-derived human conceptions, and significant genetic and demographic differences exist among couples participating in the ARTs, so a definitive assessment of the risks associated with this technology has been difficult to achieve. Therefore, appropriate animal models provide an important tool for studying potential effects of ARTs on the health and development of mammalian embryos (6).In many ART procedures, embryos are kept for a short time in a synthetic culture medium before transfer into their recipient mothers. Animal data have demonstrated that in vitro embryo culture and related procedures may be associated with epigenetic changes, perturbed genomic imprinting, and alterations in fetal growth (7). Some evidence also suggested that the culture environment may produce specific abnormalities during fetal and postnatal development (8–10). In the studies using mouse models, more marked changes in adult physiology, including onset of hypertension, were observed (11).As with other ARTs, the protocol required for PGD necessitates embryo manipulation and culture in vitro. However, in contrast to other ARTs, PGD involves embryo biopsy of one or two blastomeres at the eight-cell stage. Some studies have shown that blastomere biopsy does not have negative effects on embryo viability (12, 13), and offspring have been produced using embryo splitting technology, which is similar to the biopsy process, in at least six different domesticated species, including mouse (14), rabbit (15), sheep (16), bovine (17), goat (18), horse (19), pig (20), and in a preliminary non-human primate study one rhesus monkey (21). However, there is still a shortage of proof to convince the public that there is no potential risk to such animals conceived by this technology.To address this issue, we developed a mouse model to study the effects of blastomere biopsy on early embryo development and on postnatal physiological phenotype and behavior. A global proteomics method was also performed to study correlative protein expression profiles in adult brains and to indicate the possibility of neural degenerative disorders in adult conceived following biopsy technology.