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Chapter 18 The donation of preembryos
Chapter 18 The donation of preembryos
BACKGROUND
By definition a preembryo from IVF for donation has no lineal genetic relation to either party of the recipient couple. There are no data on the use of donor preembryos in human beings. However, the demand to adopt children suggests that there may be a use for this service, but, in contrast to basic IVF, it would seem that the demand for this service would be relatively less.
MEDICAL INDICATIONS
The primary indications for the giving and receiving of a preembryo are rare. The procedure would apply to a couple, the female partner of whom had one of the medical indications for a donor oocyte (chapter 1 7) and the male partner of whom had one of the indications for the use of donor sperm (chapter 16). If no donor oocytes were available but a donor preembryo was, a patient who required a donor oocyte would have an alternative. Donor preembryos might become available from several sources. The most likely is from preembryos in excess of those thought desirable for transfer to the donor for treatment of her own infertility. This situation might arise if non transferred preembryos were cryopreserved for future use by the donor and subsequent events made such use undesirable or impossible; fresh preembryos might unexpectedly become available if some serious illness, accident, or even death prevented their intended transfer. In very rare circumstances, fresh preembryos might unexpectedly become available because of an unexpected result after insemination. For example, if experience with a patient with oligospermia or other abnormality predicted only a 25% fertilization rate and on subsequent trials a large number of oocytes, e.g., 12, happened to be available for insemination, all12 might be inseminated with the hope of having the optimum three or four fertilized oocytes for transfer. If all 12 oocytes did, in fact, fertilize-a 50S
Supplement 1
highly unlikely event-several preembryos would become available for donation. At the current level of operations, both circumstances would require prompt action for the viability of the preembryos to be preserved if facilities for cryopreservation were not immediately available. RESERVATIONS ABOUT THE PROCEDURE
There were concerns about the possibility of genetic defects in the preembryo similar to those with donor sperm or a donor oocyte, but data have allayed those concerns. There are ethical concerns pertaining to the use of third-party gametes for a couple, neither one of whom would have a lineal genetic relation to the offspring. This relationship is analogous to adoption, although that relationship generally refers to children already born. The ethical concerns include the potential effect on families of the donor and the recipient and the possible effect on the child. The legal status of a donor preembryo is in a state of evolution, with a growing tendency to protect the conceptus under civil and criminal law. RATIONALE FOR THE PROCEDURE
There are no risks to the donor other than those risks already accepted in the treatment of her own infertility (see chapters 11 and 17) and no risks to the recipient except the risk associated with transfer in the normal in vitro process. Thus, there are no substantial incremental risks to either the donor or the recipient in a donor preembryo program. Concerns about the genetic defects of the preembryo can be diminished with the use of a genetic screen of the sperm and oocyte donor, as outlined in Appendix B. However, this may not always be feasible, because the availability of a preembryo may be unanticipated. No data exist on the consequences of the use of donor preembryos to the individual or to society. It has been suggested that the use of donor preembryos Fertility and Sterility
is similar in concept to adoption and that the only difference is the time the adoption occurred. However, the situations are by no means parallel. Traditional adoption is accepted as a solution to an established unfortunate situation, i.e., an extant child without rearing parents. The donation of a preembryo is deliberate to allow the couple to bear a potential child and, particularly, to accommodate the desire of the potential mother for carrying a child to viability. It may be argued with some merit that for the recipient couple, this experience more closely approximates normal human reproduction than does traditional adoption. Legislation specifYing rearing rights and duties in offspring of preembryo donation has been passed in only one state (Texas) (1). This legislation treats the woman in whom the preembryos are placed and her spouse as the legal parents for all purposes and excludes the donating couple from any rearing role. Given the parallels between preembryo donation and gamete donation, it is likely that legislatures and courts in other states will follow this approach (see chapter 3).
CONSIDERATIONS AND RECOMMENDATIONS OF THE COMMITTEE
Because of the general concern over the use of third-party gametes, the use of existing preembryos for donation remains controversial. There may be potential recipients or groups in the position to
Vol. 62, No.5, November 1994
offer this service who find that the reservations outweigh the benefits to the couple, i.e., that the procedure is not in the best interests of the persons integrally and adequately considered, and therefore they would not wish to participate in a donor preembryo program. The Committee finds the use ofpreembryos from IVF for donation ethically acceptable. The Committee further agrees that several guidelines should apply. As with the use of donor oocytes and sperm, there should be no compensation to the donors for the preembryo. This does not exclude reasonable reimbursement for expenses, time, risk, and in convenience in connection with the donation. Anonymity, as traditionally practiced with adoption, may be a desirable goal, but there seem to be no compelling reasons to exclude transfer of a donor preembryo among parties known to each other. Disposition of spare embryos should be discussed prior to cycle initiation and at appropriate intervals thereafter. Suitable legal documents releasing the preembryo need to be executed by the donors immediately prior to transfer (see chapter 21). Since the preembryo may have been created for use within a family, the customary genetic screening may not have been done, and the ethnic background and age of the donor may not have been considered. Recipients should be made aware of this possibility. REFERENCE 1. Tex SB 512, 73rd Leg, RS (1993).
Supplement 1
51S
BACKGROUND
By definition a preembryo from IVF for donation has no lineal genetic relation to either party of the recipient couple. There are no data on the use of donor preembryos in human beings. However, the demand to adopt children suggests that there may be a use for this service, but, in contrast to basic IVF, it would seem that the demand for this service would be relatively less.
MEDICAL INDICATIONS
The primary indications for the giving and receiving of a preembryo are rare. The procedure would apply to a couple, the female partner of whom had one of the medical indications for a donor oocyte (chapter 1 7) and the male partner of whom had one of the indications for the use of donor sperm (chapter 16). If no donor oocytes were available but a donor preembryo was, a patient who required a donor oocyte would have an alternative. Donor preembryos might become available from several sources. The most likely is from preembryos in excess of those thought desirable for transfer to the donor for treatment of her own infertility. This situation might arise if non transferred preembryos were cryopreserved for future use by the donor and subsequent events made such use undesirable or impossible; fresh preembryos might unexpectedly become available if some serious illness, accident, or even death prevented their intended transfer. In very rare circumstances, fresh preembryos might unexpectedly become available because of an unexpected result after insemination. For example, if experience with a patient with oligospermia or other abnormality predicted only a 25% fertilization rate and on subsequent trials a large number of oocytes, e.g., 12, happened to be available for insemination, all12 might be inseminated with the hope of having the optimum three or four fertilized oocytes for transfer. If all 12 oocytes did, in fact, fertilize-a 50S
Supplement 1
highly unlikely event-several preembryos would become available for donation. At the current level of operations, both circumstances would require prompt action for the viability of the preembryos to be preserved if facilities for cryopreservation were not immediately available. RESERVATIONS ABOUT THE PROCEDURE
There were concerns about the possibility of genetic defects in the preembryo similar to those with donor sperm or a donor oocyte, but data have allayed those concerns. There are ethical concerns pertaining to the use of third-party gametes for a couple, neither one of whom would have a lineal genetic relation to the offspring. This relationship is analogous to adoption, although that relationship generally refers to children already born. The ethical concerns include the potential effect on families of the donor and the recipient and the possible effect on the child. The legal status of a donor preembryo is in a state of evolution, with a growing tendency to protect the conceptus under civil and criminal law. RATIONALE FOR THE PROCEDURE
There are no risks to the donor other than those risks already accepted in the treatment of her own infertility (see chapters 11 and 17) and no risks to the recipient except the risk associated with transfer in the normal in vitro process. Thus, there are no substantial incremental risks to either the donor or the recipient in a donor preembryo program. Concerns about the genetic defects of the preembryo can be diminished with the use of a genetic screen of the sperm and oocyte donor, as outlined in Appendix B. However, this may not always be feasible, because the availability of a preembryo may be unanticipated. No data exist on the consequences of the use of donor preembryos to the individual or to society. It has been suggested that the use of donor preembryos Fertility and Sterility
is similar in concept to adoption and that the only difference is the time the adoption occurred. However, the situations are by no means parallel. Traditional adoption is accepted as a solution to an established unfortunate situation, i.e., an extant child without rearing parents. The donation of a preembryo is deliberate to allow the couple to bear a potential child and, particularly, to accommodate the desire of the potential mother for carrying a child to viability. It may be argued with some merit that for the recipient couple, this experience more closely approximates normal human reproduction than does traditional adoption. Legislation specifYing rearing rights and duties in offspring of preembryo donation has been passed in only one state (Texas) (1). This legislation treats the woman in whom the preembryos are placed and her spouse as the legal parents for all purposes and excludes the donating couple from any rearing role. Given the parallels between preembryo donation and gamete donation, it is likely that legislatures and courts in other states will follow this approach (see chapter 3).
CONSIDERATIONS AND RECOMMENDATIONS OF THE COMMITTEE
Because of the general concern over the use of third-party gametes, the use of existing preembryos for donation remains controversial. There may be potential recipients or groups in the position to
Vol. 62, No.5, November 1994
offer this service who find that the reservations outweigh the benefits to the couple, i.e., that the procedure is not in the best interests of the persons integrally and adequately considered, and therefore they would not wish to participate in a donor preembryo program. The Committee finds the use ofpreembryos from IVF for donation ethically acceptable. The Committee further agrees that several guidelines should apply. As with the use of donor oocytes and sperm, there should be no compensation to the donors for the preembryo. This does not exclude reasonable reimbursement for expenses, time, risk, and in convenience in connection with the donation. Anonymity, as traditionally practiced with adoption, may be a desirable goal, but there seem to be no compelling reasons to exclude transfer of a donor preembryo among parties known to each other. Disposition of spare embryos should be discussed prior to cycle initiation and at appropriate intervals thereafter. Suitable legal documents releasing the preembryo need to be executed by the donors immediately prior to transfer (see chapter 21). Since the preembryo may have been created for use within a family, the customary genetic screening may not have been done, and the ethnic background and age of the donor may not have been considered. Recipients should be made aware of this possibility. REFERENCE 1. Tex SB 512, 73rd Leg, RS (1993).
Supplement 1
51S