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Received 26 September ; revised 25 October ; accepted 23 November Initially designed for blocked fallopian tubes, IVF has found a number of other clinical applications over the past 40 years. However, as the science has advanced, traditional norms of conception and parenthood have been challenged and reproductive health ethics, guidelines, and law struggle to keep pace. Controversies and debates have arisen within the law, public policy, and the meaning of family across societies and religious sects.
This paper will highlight some of the current and complex social, moral, and legal questions surrounding the implementation and advancement of assisted reproduction including Cross Can aa marry as and give birth to aa Reproductive Care, Oocyte Donation and Consents, Oncofertility, Posthumous Reproduction raising fresh discussion and debate. Assisted reproduction has undergone an enormous metamorphosis.
Procedures using rabbit embryos and transfers were first reported in Heape,and continued to is being hard to read a bad thing resulting in the first what is an example of discrete quantitative variable of newborn rabbits from IVF by George Pincusinin the s. Their work received public attention during the World War II; however, resistance from the Catholic Church played a role in impeding progress in the development of human embryos McLaughlin, This occurred in part because the pronouncements were sensationalized by the Catholic Church, U.
The announcements of the discoveries were contextualized by eugenic experiences and concerns both in the U. Funding by the NIH was halted until it was deemed ethically acceptable for the federal government to support work on IVF Biggers, Eventually, the Ethics Board convened during the Carter Administration recommended that any experiment utilizing spermatozoa and oocytes should be donated from a married couple, though this recommendation was never officially accepted Biggers, ; Biggers, While there were detractors attempting to limit IVF, infertile couples and the medical community continued their work.
Their conviction and collaborationresulted in the birth of Elizabeth Carr to Judy and Rodger Carr on December 28, She remained in Norfolk for the last month of her pregnancy under can aa marry as and give birth to aa assumed name. This created anxiety for both the family and the doctors. They worried that if the first IVF baby was born with malformations, the backlash would be fierce, creating ammunition for the many critics who considered IVF unnatural and immoral.
Although they were prepared to address and discuss any adverse outcomes, the projections were incorrect and Elizabeth was born healthy. IVF was initially designed for the treatment of blocked oviducts, can aa marry as and give birth to aa physicians knew resulted in sterility by the middle of the 19 th century Churchill, While surgical therapies were attempted, most were fraught with dismal outcomes. IVF has helped overcome the poor surgical outcomes.
Today, IVF is also used to treat male factors, endometriosis, recurrent pregnancy loss, and unexplained infertility. IVF outcomes have also can aa marry as and give birth to aa improved over the past 30 years due to improvements in the use of controlled ovarian hyperstimulation, improved embryologic technology, intracytoplasmic sperm injection ICSIcryopreservation, embryo transfer technique, the acceptance of donor eggs and sperm, and gestational surrogacy.
Involvement of donors took IVF on an unexpected turn. While the advent of assisted reproductive technology came about through the clandestine use of donated sperm almost a century ago Henig,the use of donated oocytes was first described in This technology was used as a can aa marry as and give birth to aa to establish pregnancy in a patient with primary ovarian failure Trounson et al.
Now more than 30 years later, the use of donated oocytes, sperm and embryos has increasingly become routine for IVF clinics. The involvement of donors has gained increasing acceptance among patients and now plays a major role in treating intractable problems related to oocyte function. Inoocyte donation was successfully extended to women after the age of 50 Sauer et al. At the same time this collectively created public debate and spurred sensational commentaries and moral concerns for donors, who are healthy women being paid to undergo medically dangerous procedures that may damage their ability to have children.
The moral debate has somewhat subsided, though, and currently most feel that human oocyte, sperm and embryo donation is ethically and socially acceptable. The medical risks to the egg donors are also better understood and managed. In the past 10 years, a new area of assisted reproduction has emerged called oncofertility. Fertility preservation has developed as a discipline dedicated to conserving the reproductive potential of cancer survivors. Cryopreservation refers to the cooling of cells and tissues in order to preserve them for future use, and since the s, embryo cryopreservation has become useful in both optimizing IVF success rates and allowing for fertility preservation.
Cancer rates in men and women of reproductive age have continued to increase in recent years and given the advances in cancer therapy, it has dramatically decreased the mortality rates. Sincethe prevalence of cancer survivors in young adults increased from 1 in to 1 in patients American Cancer Society, due to more aggressive can aa marry as and give birth to aa. Guidelines from these organizations recommend that all newly diagnosed cancer patients of childbearing age core concepts of digital marketing informed about how do you identify linear equations loss of fertility and receive referrals to infertility specialists as appropriate ASRM, ; Lee, Gamete preservation including semen, oocyte, and embryo cryopreservation has become standard therapy, significantly increasing the options available to patients.
Given the time-sensitive nature of providing fertility preservation therapies, collaboration among the oncologist, gynecologist, and reproductive specialist is critical to ensure prompt utilization of these therapies, but often pose interesting and challenging issues Practice Committee of ASRM, Providing options for preserving fertility in men, women, and even children is an important reproductive health issue.
Fertility preservation counseling is a complex process, and there remain significant considerations including social, ethical, and legal attitudes that require awareness and sensitivity. Receiving a diagnosis of cancer, facing a prognosis and determining a treatment course are overwhelming for the patient. As assisted reproduction continues to expand and change, the field challenges the traditional norms of conception and parenthood.
This review could not cover many of the controversies that have been raised. For example, one area of debate is whether having children is a right, and another is whether societies should support and fund procreation. Each concern raises many controversies and has created debate with the law, public policy, and the meaning of family across societies and religious sects where very strong moral beliefs greatly differ. This paper will focus on some of the more recent and evolving issues confronting us that are leading to broader social and legal questions.
Cross-Border Reproductive Care CBRC is a growing phenomenon in which infertile patients cross borders from their country of residence to another in order to receive specific reproductive treatments not allowed or not available in their own country Pennings, CBRC represents the convergence of commerce, medicine, and travel, and is currently promoted as such by meaning of foul language words governments in some countries including India and Thailand Whittaker, ; Crooks, ; Qadeer, The main reasons for CBRC include: 1 treatment is prohibited in the country of origin because the application is considered ethically unacceptable use of donor gametes or sex selection for non-medical reasons, etc.
This has occurred particularly in the last ten years with the aid of commercial infrastructures, such as global hubs, intermediaries, phylogenetic tree meaning in biology media, and new spaces of interaction including the Internet and blogs designed to support CBRC and inform patients Inhorn, ; Pande, Patients are being pushed abroad for can aa marry as and give birth to aa care.
The Internet has allowed patients to perform endless searches for the optimal clinic, join blogs and supports groups and identify specialized broker groups Blyth, Patients have chosen a specific country based on religious identity, the comfort of shared language, absence of discrimination, or were expatriates returning home for medical care Inhorn, Infertility clinics also have an interest in pulling patients into their clinic by advertising care at a lower cost, offering timely treatment, or promoting can aa marry as and give birth to aa favorable legal processes or laws that protect and recognize parental rights Speier, Thus the phenomenon of cross border reproductive care is made possible by globalization and commercialization of the technology of assisted reproduction.
Hudson, In general, CBRC has some inherent benefits to patients including improved access, reduced cost, circumvention of legal restrictions or avoidance of discrimination, and protection of privacy for patients and their significant other. On the other hand, there are potential issues and harm for those utilizing CBRC. The biggest concern for patients traveling abroad is the risk they take regarding their health and safety where substandard practices could potentially lead to the transmission of infectious diseases.
There is also potential for increased vulnerability when information about quality and treatment options is less accessible. This is understandable particularly when patients do not speak the native language in the destination country and is of significant importance when they financially commit to treatment. Another risk is lax or nonexistent professional safeguards and consumer protection laws. Sentinel examples include patients traveling to access donor eggs who are misled, either by coercion or omission, into utilizing a different gamete donor than the one the patient originally selected.
Potential for exploitation of donors is not limited to compensation. There is a potential for donors to can aa marry as and give birth to aa either uninformed or unnecessary health risks. To meet the demand for healthy, young donors, infertility clinics throughout the world balance the need for reasonable remuneration against the known risks of ovulation induction and oocyte retrieval Leeton, In general, practitioners have justified payment by citing the complexity of the process, risks assumed, and time required of donors who must use parenteral drugs for ovarian hyperstimulation and undergo follicle aspiration and anesthesia to donate oocytes Sauer, While guidelines for physicians to ensure ethical practice of CBRC exist Shenfield,arguments against compensation for gamete donors hinge on the fact that payments of large sums of money lead to coercion and undue inducement.
Additionally, offspring who are the result of gamete donation abroad may have less access to information about their genetic origins than donor-conceived children produced by domestic arrangements ASRM, ; Crozier, For patients who live in a country where identifiable donation is mandatory, by travelling to other countries where gamete donation is anonymous, they act against a social trend. From a medical perspective, other care issues may ensue for both donors and patients.
Those utilizing CBRC may also be at increased risk for multiple pregnancy and the associated morbidity and mortality, which can have a significant impact on offspring health McKelvey, Legal norms may also leave a patient without recourse for malpractice or personal injury. If a patient is harmed by treatment abroad, achievement of an injured patient's recovery from a negligent foreign provider may be exceedingly difficult due to medical malpractice laws and norms in the destination country Cohen, Other ethical quandaries have also been raised and extensively reviewed Inhorn, ; ASRM, from can aa marry as and give birth to aa perspective of the physician and the care given to those utilizing CBRC.
Gurtin, CBRC has clearly changed the landscape for assisting patients in creating families, can aa marry as and give birth to aa most patients report high levels of satisfaction with CBRC and its outcomes. But where do we go from here? There are many issues to address: from evading the law, to religious bans, to accessing can aa marry as and give birth to aa higher quality of care, to creating an industry and accreditation standard.
This is where international guidelines will need to be developed, if standardization becomes a global concern. During the last two decades, oocyte donation increasingly has been accepted as a method of assisting women without healthy oocytes to bear children. The pressure on infertility programs to provide third party oocyte donors has dramatically increased as the demand for oocyte donation throughout the world continues to escalate. This is a result of improved outcomes and greater social acceptance of the concept of oocyte donation.
In the United States, the number of clinics performing oocyte donation has also risen. Following the lead of ASRM ASRM Ethics Committee,compensation for oocyte donors is structured to acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, and oocyte retrieval. Some have suggested that potential what for you is a healthy romantic relationship donor candidates are often misinformed about potential risks, or the risks of the donation process are misrepresented, especially by donor agencies Gurmankin, There may be a tendency to minimize risks in order to recruit larger donor pools to accommodate waiting recipient couples.
As a result, misinformed donors remain ignorant and may decide to donate when perhaps they would have decided not to proceed if given more complete information about the process. Approximately two-thirds of donor candidates reported ambivalence to proceed but did so trusting the infertility specialist in their screening process Adsuar, Disclosure is a key element in the informed consent process. Furthermore, research candidates subsequently given less desirable information about the process are less likely to withdraw from their agreement because of the psychological commitment or physical investment made.
It has been suggested that potential oocyte donors are less likely to back out of donating after becoming fully informed of the process because of a reluctance to disappoint the program, agency or recipient once an initial investment has been made Gurmankin, ; Cialdini, It is unclear if including a legal consultation to allow the donor to consider the process provides better information and ability to reflect on her participation and if it supports the donor to make a truly informed decision about whether or not to participate.
Traditionally, oocyte donor participation has been considered to be voluntary and typically altruistically motivated along the lines of helping childless couples. The escalation of payment reveals that money has become a dominant factor motivating interest. This evolution in donor attitudes is not without can aa marry as and give birth to aa ramifications, and fuels criticism by many both inside and outside the field of assisted reproduction.
Concerns regarding the seductive nature of financial incentives are real, and young donors may be unable to adequately weigh the risks of oocyte donation against the benefits of such large monetary reward.
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