Gamete and embryo donation regulation in human assisted reproduction technologies: Disclosure or nondisclosure?

The use of donated gametes and embryos in assisted reproduction techniques (ART) makes it necessary to examine interests that involve relevant ethical and legal considerations, which include the autonomy and privacy rights of the intended parents, donors’ right to privacy and the right of the minors to know their genetic origin. This article presents arguments to consider policies of more openness to obtain information from donors in order to protect the child’s best interest in knowing his/her genetic origins. It concludes with the situation in Mexico, where ART has been carried out with donated gametes since several years ago; however, due to the absence of regulations to control these procedures, each establishment imposes its own criteria for the operation of its programs.

Sobre la posibilidad de la donación de embriones en Hispanoamérica / On the possibility of embryo donation in Hispanic America

Los estudios empíricos sobre donación de embriones realizados en paísesdesarrollados indican que lo más probable sería el descarte de los embriones, y en caso de donarlos sería mayormente con fines de investigación, y eventualmentecon fines asistenciales. En Hispanoamérica, prácticamente no existen estudios sobre las opiniones de los participantes en técnicas de reproducción humana asistida (TRHA) complejas, respecto de las posibilidades de la disposición de losembriones sobrantes en dichas técnicas. Además, tampoco hay marcos legislativos contra los cuales se pueda contrastar opiniones o preferencias de los pacientes.Trabajos realizados en Ecuador, Chile y Perú son antecedentes directos y base para la realización de un estudio latinoamericano. Existe una necesidad de llevar a cabo un estudio descriptivo acerca de si las parejas latinoamericanas donarían sus embriones o no, que beneficiaria a varias áreas (práctica clínica, investigación, bioética, bioderecho, etc.).

Empirical studies regarding embryo donation in developed countries show that the most probable action would be to discard surplus embryos and, if they would donate them, the preferred option would be for research, and eventually to other couples. There are not enough studies in Hispanic America about the opinions of those who have participated in assisted reproductive technologies (ART) regarding embryo disposition of surplus embryos. Moreover, thereare scarce specific laws regulating ART in order to contrast peopleÆs opinion. Works performed in Ecuador, Chile and Peru are also preceding works and basis to design a Latin American Study on embryo donation. It is necessary to perform a descriptive study on Latin American couples opinions regarding embryo donation, which would benefit several areas (clinical practice, research,bioethics, biolaw, etc.).

Tipos de ansiedad frente a la donación hipotética de embriones para investigación. Una aproximación desde la perspectiva de género

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Abstract: An article published recently explored the kinds of anxiety displayed by couples that have been treated with assisted fertilization techniques, IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) towards the hypothetical embryo donation for research. The study shows that the more frequent kinds of anxiety, in agreement with the methodology of Gottschalk et al, are guilt anxiety and separation anxiety. This work intends to give a reflection as an essay on the probable relationship present between gender and these kinds of anxiety. Reproductive medicine. Basic definitions The different clinical presentations of infertility and sterility have given origin to their study in a novel area called reproductive medicine. Reproductive medicine is in charge of the prevention, diagnosis and opportune treatment of the problems of human fertility. A reproductive problem is that one present in the couple who does not obtain a spontaneous pregnancy. Sterility is the inability of the man or the woman to conceive. Primary sterility is acknowledged when the couple, after a year of sexual relations without use of contraceptive method and with deliberate search of descendants, has not become pregnant. Secondary sterility occurs when the couple, after conceiving, does not obtain a new gestation after trying for two or more years. On the other hand, infertility is the inability to produce a living child. Therefore, primary infertility is suffered by the couple who has a gestation without a suitable ending (abortion, repeated loss of gestation, etc.), and the secondary infertility occurs when after a childbirth with at least one child being born alive, they cannot attain a new gestation upon maturity. After a complete medical evaluation, the treatment plan could include simple techniques of assisted fertilization (like the intrauterine insemination) or complex techniques of assisted fertilization (like IVF and ICSI). IVF technique begins with the ovarian hyperstimulation with exogenous hormones, in a controlled way, and the transvaginal ovular capture guided by ultrasound; then, every ovum with a high quality is incubated with sperm treated previously in the gamete laboratory by an embryologist. After the gamete meeting, a culture of the zygote is done to be able to visualize the cellular division and thus to demonstrate its fertilization. Later the transference to the uterus is made. The pregnancy probability increases with the number of transferred embryos: 9% with one, 18% with two, 29% with three and 32% with four. The rest of produced embryos is cryopreserved. The success of the technique, understood like «baby in house¼, cannot exceed 40%, basically because the knowledge of the molecular mechanisms that regulate the implantation of the human embryo is still very limited. ICSI technique consists in the same steps that the IVF, but differs in the way of fertilization, which is done here by a direct injection of a sperm into the cytoplasm of an ovum. The use of these new techniques as tools to the service of human reproduction have undertaken the analysis and the debate in this kind of treatments, with special emphasis on the psycho-logical, social and ethical aspects. This is so because now appears the possibility (unthinkable before), of 5 relatives as parents: the genetic mother (the ovum producer), the biological mother (who held the pregnagcy), the social mother (who will take care of the product in postpartum), the genetic father (sperm producer), and the social father (who will take care of the product in postpartum). Anxiety in reproductive medicine The emotional and psychological aspects have been, in general, little studied and understood in the population of the couples that have fertility problems. Usually it is accepted that the reproductive problems have repercussions in the psychological sphere, but still it is discussed that the psychological factor is a cause of fertility problems. At the beginning of this type of studies, it could have suggested that women with a traditional feminine roll are more anxious than men, but they would not show levels of depression nor of sexual or marital dissatisfaction. Nevertheless, the taller will depend largely on the conceptions that settle down around the relation between masculinity and paternity, femininity and maternity. Gender perspective Gender perspective makes reference to the academic, illustrated and scientific conception that synthesizes the theory, the liberating philosophy and the policy, created by the women in the femnist culture. Gender perspective allows to analyze and to understand the characteristics that define women and men in a specific way, as well as their similarities and differences. This gender perspective analyzes the vital possibilities of women and of men: the sense of their lives, their expectations and opportunities, the complex and diverse social relations, that occur between both genders, as well as the institutional and daily conflicts that they must face and the ways in which they do it. The feminist gender analysis is detractive of the patriarchal order, it contains specific criticism of the injurious, destructive, oppressive and alienated aspects that are present due to the generic organization based on the inequality, injustice, and political hierarchy sustained by people based on gender. The category of captivity for the feminine gender and of dominion for the masculine gender cannot escape to the scope of the reproductive medicine and to the theoretical possibility which is becoming more and more real, of using human embryos for research. Guilt anxiety Guilt anxiety can be associated independently with the disapproving vision of Christianity in the West, in respect to the reproductive medicine in general and to the donation of embryos in particular, wether its aim is reproductive or not. It would be possible to locate a first instance of patriarchal dominion through the Church and the exerted control over sexuality and reproductivity in the Family, and a second one of patriarchal dominion when the previous one not being enough, it uses reproductive medicine like a dominion agent on the feminine captivity, that is, the "motherspouse" captivity. Separation anxiety It is possible to consider what the series of procedures involved arouses in a so technified reproductive medicine: the solitude sensation that can experience a human body when self perceived by itself like a biological body; like another object more of the technological and science to the service of the human reproduction. Solitude, isolation, loss of what has been gained or isolation from what it is about to be gained through the technique (the non had son until the moment to go to receive diagnosis). If one considers the embryo like a being of equal ontological value that an adult, these will be a greater anxiety of separation when donating embryos. Final considerations Reproductive medicine has too many matters not sufficiently explored. Other sciences should make new theoretical constructions, besides psychology (which should study empirically and theoretically if the anxiety is the same when people is thinking about embryo donation, and when they are donating the embryos). For example, anthropology must review and (eventually) redefine some concepts as family, incest and others. Law must create new norms about gamete and embryo donation, and contribute with the legal definitions of "father", "mother", "son"; maybe even make laws regarding the legal disposition of cryopre-served embryos, etc. Finally, real world is too complicated as are our mental maps and schemes.

Tipos de ansiedad de parejas tratadas con fecundación asistida frente a la donación hipotética de embriones para investigación en una clínica privada en Lima, Perú / Types of anxiety reported by couples treated with assisted fertilization vis a vis hypothethical embryo donation for research purposes in a private clinic in Lima, Peru

Introducción: La donación de embriones presenta características especiales en el marco latinoamericano, donde no existe la constante de los países desarrollados de tener embriones criopreservados sobrantes. Además, la religiosidad cristiana occidental es un poco mayor. La necesidad de regular desde lo ético y lo jurídico la práctica de la donación de embriones sugiere que se pueden tomar en cuenta las opiniones de los involucrados: los pacientes, los profesionales de la salud, y la sociedad. El objetivo de este estudio es explorar la esfera de los pacientes mediante la búsqueda de tipos de ansiedad frente a la donación hipotética de embriones para investigación. Material y métodos: Con un diseño descriptivo y transversal se realizó una entrevista semiestructurada, individual y grabada, a 32 pacientes en una clínica privada en Lima, Perú, que habían acudido a técnicas complejas de fecundación asistida (FIV e ICSI); al transcrito de la entrevista se le aplicó la escala de ansiedad del método de análisis de la conducta verbal de Gottschalk et al., identificándose el tipo de ansiedad predominante en cada entrevistado. Resultados: Los tipos de ansiedad más comunes frente a la donación de embriones para investigación en este grupo de participantes fueron la ansiedad por sentimiento de culpa, la ansiedad por separación y la ansiedad por vergüenza. Divididos por género, los tipos de ansiedad más comunes para el género masculino fueron la ansiedad por culpa, vergüenza y separación; para el femenino, la ansiedad por culpa, separación y vergüenza.

INTRODUCTION: Embryo donation displays special characteristics within the Latin American context, where spare cryopreserved embryos are not currently available as is the case of industrialized countries. The Catholic church also plays a significant role. The need to regulate ethically and legally the practice of embryo donation suggests that we need to take into account the opinions from the main key players: patients, health professionals, and society. The objective of this study is to explore the patients perceptions vis a vis potential embryo donation for research purposes. MATERIALS AND METHODS: A descriptive, cross-sectional design included a tape recorded semi-structured interview administered to 32 patients attending a private clinic in Lima, Peru. Participants had undergone complex techniques of assisted fertilization (FIV and ICSI). The verbal Gottschalk analytical method was used to identify predominant anxiety manifestations in the interviews. RESULTS: The most common types of anxiety associated with embryo donation for research in this group of participants were guilt, separation anxiety and shame. Divided by gender, the more common types of anxiety reported by men were guilt, shame and separation anxiety. Women reported guilt, separation anxiety and shame.