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Friday, December 14, 2012

Rolling back promises of anonymous donation




Over the years, a lot of donors have offered their sperm for fertility purposes on the condition that their identities remain anonymous.

This practice, for oocytes as well, has not proved popular in all quarters, since information about the genetics of the donors can be useful in the medical care of children born with those gametes. Not only that, but information about the identity of the donors can be useful in the psychological development of the same children.

Some jurisdictions have moved to make certain information about donors available to children born with their gametes.  That changes the terms of donation in the future, but it does little to resolve matters for those conceived with anonymous gametes.

Some advocates want to roll back confidentiality agreements entirely.  For example, Damian Adams and Caroline Lorbach have said this: “Donor conception practices in Australia have left thousands of donor-conceived people, their families and gamete donors bereft of information. The lack of a nationally timeline-consistent approach to information access has driven these people to seek support and information from self-help groups, online communities and even their own DNA.” They argue that “current practices continue to fail donor-conceived people, their families and gamete donors.” They want “all donor offspring” to have “the right to know their genetic family history,” otherwise “they will continue to suffer discrimination, and potentially risk psychological and physical trauma. “ (See ‘Accessing donor conception information in Australia,”  At:  http://sites.thomsonreuters.com.au/
journals/2012/06/15/journal-of-law-and-medicine-update-june-2012/

By contrast to a Law Reform Committee recommendation to roll back the rule of confidentiality that governed gamete donation for many men in Victoria, Guido Pennings argues that undoing the terms of donation – namely, overriding the promise of anonymity – will undermine trust, do damage to donors and their current families, and drive gamete donors away in the future.

He also describes this ‘right to know’ movement as part of a larger ideology, namely a certain normative understanding of what families are and how they should be constituted. Throwing up obstacles to gamete donation, he thinks, serves to discredit gamete donation and opens the door to not only disclosure of donor identity but to donor responsibility for the children as well.  It’s an interesting interpretation of the right-to-know movement that leaves very little room for anonymity.   (See Guido Pennings. How to kill gamete donation: retrospective legislation and donor anonymity. Human Reproduction 2012 (10): 2882-2885.)

Saturday, December 8, 2012

Freezing eggs -- no longer experimental.



The Practices Committees for the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have reviewed data regarding the role of cryopreserved oocytes in fertility medicine, and they recommend inclusion of this practice where appropriate in clinical medicine. In other words, they declare that the practice is no longer experimental.  Well, they do offer one cautionary note:  freezing oocytes for the purposes of delaying childbearing, for reasons entirely unrelated to health.  But their own analysis opens the door to doing exactly that, under some circumstances.

The Committees report that similar success rates exist whether using vitrified oocytes or fresh oocytes for IVF/ICSI in regard to fertilization and pregnancy rates. They report no increase in chromosomal abnormalities or birth defects compared to conventional IVF/ICSI. 

The Committees recommend that cryopreserved oocytes can therefore be recommended as appropriate when managing gonadotoxin therapies, ovarian excision, premature ovarian failure, unavailability of sperm from intended partner, and as an alternative for those unable or unwilling to cryopreserve embryos.

The Committees decline to recommend the use of cryopreserved oocytes for – as they say – the sole purpose of circumventing reproductive aging in health women. They say that no relevant data exist for these so-called ‘social reasons’ for wanting cryopreserved oocytes. Relevant data are non-existent they say for the safety, efficacy, cost-effectiveness, and emotional risks. They worry that marketing cryopreservation of oocytes as response to reproductive aging may give false hope and encourage postponement of childbearing.  This would be a mistake they say because of the low success rates for pregnancy of women as they age, especially those who freeze their oocytes after age 38.

Strictly speaking, data may be missing for this group of women, but it is unlikely to be materially different from other uses of cryopreserve oocytes. A woman who freezes oocytes for social reasons may not leave these oocytes frozen for periods longer than is done for other reasons, and the woman might not be of advanced maternal age either. For example, a woman who plans to become a surgeon might well freeze her eggs at age 22, fully intending to use them at age 33. This time span might be no different from a woman who freezes oocytes when having her ovaries removed because of a high risk of cancer. 

The Committees are right that data for these uses is lacking, but there is no reason in advance to suspect that the data that will emerge will be materially different from other uses of cryopreserved oocytes. Some uses of oocyte freezing for 'social purposes' will parallel the ways in which these oocytes are used in other circumstances. So, those are really no longer experimental either.

(The full report is at:  http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/Ovarian_tissue_and_oocyte%281%29.pdf )