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PubMed2004

Taskforce 7: Ethical considerations for the cryopreservation of gametes and reproductive tissues for self use.

This seventh statement of the ESHRE Task Force on Ethics and Law considers ethical questions and specific dilemmas surrounding the cryopreservation of gametes and reproductive tissue. This is of particular relevance with advancing techniques for cryopreservation and the desire of many individuals to preserve fertility after cancer, chronic illness, iatrogenic complications of treatment or simply with advancing age.

Adult↗
PubMed2004

Legal harmonization and reproductive tourism in Europe.

Legislation of ethical issues illustrates the uneasy mix of ethics and politics. Although the majority has the political right to express its moral views in the law, a number of important ethical values like autonomy, tolerance and respect for other people's opinions urge the majority to take the minorities' position into account. Ignoring pluralism in society will inevitably lead to reproductive tourism. Although European legislation and harmonization in the domain of medically assisted reproduction is presented as a partial solution to this phenomenon, it is argued that European legislation should be avoided as much as possible. Regulation of these private ethical matters should be left to the national parliaments. A soft or compromise legislation will keep reproductive travelling to a minimum. Reproductive tourism is a safety valve that reduces moral conflict and expresses minimal recognition of the others' moral autonomy.

Abortion, Induced↗
PubMed2006

Posthumous sperm retrieval: analysis of time interval to harvest sperm.

BACKGROUND: Current recommendations regarding posthumous sperm retrieval (PSR) are based on a small number of cases. Our purpose was to determine the time interval from death to a successful procedure. METHODS: Seventeen consecutive PSR procedures in 14 deceased and 3 neurologically brain-dead patients at two male infertility centres [Sheba Medical Center (SMC), Tel-Hashomer, Israel and University of California San Francisco (UCSF), San Francisco, CA, USA] were analysed. Main outcome measures were retrieval of vital sperm, pregnancies and births. RESULTS: PSR methods included resection of testis and epididymis (n = 8), en-block excision of testis, epididymis and proximal vas deferens with vasal irrigation (n = 6), electroejaculation (EEJ) (n = 2) and epididymectomy (n = 1). PSR was performed 7.5-36 h after death. Sperm was retrieved in all cases and was motile in 14 cases. In two cases, testicular and epididymal tissues were cryopreserved without sperm evaluation, and in one case, no motility was detected. IVF and ICSI were performed in two cases in which sperm had been retrieved 30 h after death, and both resulted in pregnancies and live births. CONCLUSIONS: Viable sperm is obtainable with PSR well after the currently recommended 24-h time interval. PSR should be considered up to 36 h after death, following appropriate evaluation. No correlation was found between cause of death and chance for successful sperm retrieval.

Cryopreservation↗
PubMed2006

ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction.

This article analyses the different ethical aspects of posthumous assisted reproduction. Two situations are distinguished: cases in which the gametes or embryos are used by the surviving partner and cases in which the gametes or embryos are made available for third persons. The moral evaluation of the procedure depends on whether the act is restricted to the existing parental project. A major difficulty for the moral evaluation is the inconclusiveness of the empirical data on the psychosocial development of children born after this procedure. The Task Force concluded that posthumous reproduction by a partner is acceptable if the following conditions are met: written consent has been given by the deceased person, the partner received extensive counselling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply.

Advisory Committees↗
PubMed2005

Cancer and fertility: ethical and legal challenges.

Preserving the fertility of younger cancer patients requires coordinated efforts and attention to ethical issues by oncologists and fertility specialists. Although sperm is easily stored, freezing eggs or ovarian tissue is still experimental and should not be offered except as part of an experimental protocol. When gametic material is stored for later use, written directives for posthumous use may be given effect, and subsequently born children may be recognized as legal offspring of the deceased. Concerns about the welfare of offspring resulting from an expected shortened life span of the parent are not sufficient reason to deny cancer survivors assistance in reproducing.

Adult↗
PubMed2005

Legal issues related to parenthood after cancer.

Cancer and procreation raise a host of novel legal issues involving the rights of those trying to create families after cancer treatment and any resulting children, as well as the responsibilities of those who assist them. Recent court decisions, although neither consistent nor plentiful, highlight the emerging legal issues for patients, providers, and offspring. This article explores a number of legal issues related to cancer and parenthood, including: 1) patients' cryopreservation of sperm, eggs, or embryos and subsequent access to and use by them or their former partners; 2) fertility preservation in minor patients; 3) posthumous reproduction and legal parentage issues for children born from cryopreserved embryos or gametes; 4) wrongful life or wrongful birth claims of children born following their parents' cancer treatments; 5) access to, and discrimination in, medical treatment or alternative family-building options; and 6) professional responsibility and liability for providers relating to the potential fertility impact of cancer treatment. The limited, evolving court decisions, through the application of legal principles such as negligence, malpractice, discrimination, and parentage principles, provide some guidance for patients, providers, and policymakers in approaching the unique challenges presented by fertility preservation in the context of cancer treatments.

Adolescent↗
PubMed1998

Buy baby: the European Union and regulation of human reproduction.

In its decision in ex parte Blood the Court of Appeal relied on European Community (EC) law to hold that the Human Fertilization and Embryology Authority had acted unlawfully in taking its decision to prevent Mrs Blood from exporting sperm taken from her dying husband without his written consent. The Blood case raises the issue of the extent to which EC law may affect the regulation of human reproduction in the Member States. Responding to fears that such national regulation might be 'swept away' by the commodifying nature of EC law, this article considers the scope of the potential application of EC law to regulation of human reproduction. The cautious conclusion is that, while there may be some increase in deregulatory pressures, the 'vertical relationship' of supreme EC law to national law may turn out to be less significant than 'horizontal relationships' between policy-makers within and between the EU and its Member States.

European Union↗
PubMed1994

A child at all costs: posthumous reproduction and the meaning of parenthood.

The creation of babies by assisted and collaborative techniques of reproduction, such as in-vitro fertilization or cryopreservation of gametes and embryos, stimulates strong emotions and fantasies about life, death, sexuality and immortality. Particularly, the cryopreservation of spermatozoa for post-mortem reproduction forces us to come to terms with the meaning of human reproduction, and the extent of individual rights to procreate using artificial means.

Cryopreservation↗
PubMed1998

Genes, embryos, and future people.

Testing embryonic cells for genetic abnormalities gives us the capacity to predict whether and to what extent people will exist with disease and disability. Moreover, the freezing of embryos for long periods of time enables us to alter the length of a normal human lifespan. After highlighting the shortcomings of somatic-cell gene therapy and germ-line genetic alteration, I argue that the testing and selective termination of genetically defective embryos is the only medically and morally defensible way to prevent the existence of people with severe disability, pain and suffering that make their lives not worth living for them on the whole. In addition, I consider the possible harmful effects on children born from frozen embryos after the deaths of their biological parents, or when their parents are at an advanced age. I also explore whether embryos have moral status and whether the prospects for disease-preventing genetic alteration can justify long-term cryopreservation of embryos.

Age of Onset↗
PubMed1999

Commentary: legal and ethical aspects of sperm retrieval.

Author argues that the adequacy of "reasonably inferred consent" as a justification for the retrieval of sperm posthumously or after persistent vegetative state suffers from definitional ambiguity, faulty comparisons, and ultimately may justify practices that are not in the interest of survivors or children yet to be conceived.

Brain Death↗