The risky business of advanced paternal age: neurodevelopmental and psychosocial implications for children of older fathers.

The last several decades are notable for an increase in the percentage of births attributable to men in their 40s and 50s. There is general recognition of offspring health risks related to advanced maternal age, however, fewer patients and providers are informed about the impacts of advanced paternal age (APA). This review examined the literature investigating the association between APA and offspring outcomes, specifically, neurodevelopmental, psychiatric, academic, and behavioral impairment, the impact of paternal health decline and death, and the influence of age on parenting behaviors. This analysis revealed that children, and even grandchildren, of older fathers face significantly increased incidence rates of psychiatric disease and behavioral impairment. The data do not show evidence of superior parenting behaviors among men with APA. Finally, children of men with APA are significantly more likely to experience early bereavement, which is associated with psychological and developmental consequences. An understanding of the degree to which APA can negatively impact the offspring is imperative for patient counseling and development of practice guidelines.

Is it time to establish age restrictions in ART?

Providers specializing in reproductive medicine are treating increasing numbers of women pursuing parenthood in their 40s, 50s, and beyond. The rise in later-life parenting can be linked to factors ranging from the advent of assisted reproductive technologies and donor oocytes to the highly publicized pregnancies of older celebrities. We explore the medical and psychosocial implications of this trend for both older parents and their children. We also discuss ethical arguments regarding older parents' access to fertility care, existing professional guidelines, and both public and provider opinions about setting age limits for fertility treatment. Finally, we share preliminary considerations of whether age policies should be established, applied to men as well as women, and standardized or considered on a case-by-case basis.

Blurring the line between life and death: a review of the psychological and ethical concerns related to posthumous-assisted reproduction.

Posthumous-assisted reproduction (PAR), though viewed unfavourably by some, is desirable to many individuals whose partners die prior to the completion of family building. PAR is technically feasible for males and females both pre- and post-mortem and these procedures have previously been completed on numerous occasions. However, such treatment is associated with three primary ethical concerns: autonomy; beneficence; and justice for the living, the deceased, and the soon-to-be conceived. Further, there are many psychological risks of PAR which may affect all involved parties. As such, early psychological counselling of patients and surviving family members is warranted.

Donor conception from the viewpoint of the child: positives, negatives, and promoting the welfare of the child.

Use of donor egg and donor sperm has made parenthood a possibility for many who could not achieve it through natural conception. The use of donor gametes may also permit prospective parents to mitigate a number of health problems for the hoped-for child. Promoting the welfare of the hoped-for child, however, includes not only the consideration of good physical health but also necessitates consideration of psychological, emotional, and social well-being. This paper will review the impact of donor conception from the viewpoint of the resulting child including the psychological, emotional, and social well-being of donor-conceived children. It will discuss the topic of disclosure and closely consider the expansion of donor conception to older parents from the viewpoint of the child.

Follow-up assessment of excluded oocyte donor candidates.

AIM: In 2005 16,161 fresh and frozen egg donation embryo transfer cycles were performed in the U.S.A. Use of egg donation continues to increase and, as such, the number of women who apply to be egg donors will also increase. Up to 44% of women who apply to be egg donors will ultimately be rejected. We suggest that women pursuing egg donation may not anticipate that they may be excluded from the program. Further, we suggest that many of them are unprepared to receive the information that they have been rejected from an egg donor program based on either medical or psychological grounds. In this brief report, we share our clinical experiences with women who were rejected from our egg donation program. We suggest that egg donation programs have an ethical obligation to follow up with women they have rejected from their program. METHODS AND RESULTS: This paper reports on the experiences of the excluded donors from our clinic and reveals that being excluded creates a negative emotional impact which can include disappointment, fear, anger, and sadness. For most excluded donors this reaction is short-term but for some it is more long-lasting and more seriously upsetting. CONCLUSIONS: The scope of this paper is limited in that it reports on clinical experiences rather than results of a controlled study. This paper suggests that researchers and clinicians have an ethical obligation to follow up with rejected donors to assess and address the emotional impact of being excluded from a donor program.

Comparative assessment of pre- and post-donation attitudes towards potential oocyte and embryo disposition and management among ovum donors in an oocyte donation programme.

BACKGROUND: In anonymous oocyte donation programmes, the disposition of retrieved oocytes and subsequent embryo management are at the discretion of the IVF programme and the oocyte recipients, as donors waive all rights following their donation. Nonetheless, donors are routinely made aware of ways in which oocytes and resulting embryos may be used and elect to proceed with the process even in the presence of reservations to some clinical scenarios before their donation. The aim of our study was to examine oocyte donors' attitudes to oocyte and embryo disposition and management and how initial reservations change over the course of the donation process. METHODS: Oocyte donors in a university-based IVF programme were asked about their willingness to donate in relation to various clinical scenarios during the initial screening interview and at the post-donation exit interview. Results were tabulated as 'yes' or 'no'. RESULTS: At the pre-donation interview, 72% of donor candidates expressed reservations to one or more clinical scenarios. More reservations were expressed at the post-donation interview compared with the pre-donation interview. The greatest reservations were donating to recipients >50 years of age (P < 0.05). Despite this, 97% of donors were willing to donate again. CONCLUSION: Oocyte donors' attitudes towards various clinical scenarios changed following their donation, reflecting overall greater reservations following the donation process. Although speculative, donors may be more willing to assert their opinions or donor attitudes become more restrictive.

Assessment of wishes regarding disposition of oocytes and embryo management among ovum donors in an anonymous egg donation program.

Revealing possible clinical scenarios to potential anonymous donors for their donated oocytes appears to uncover ambivalence in the majority of prospective candidates about their donation and unwillingness in some to proceed. Full disclosure to a prospective donor candidate of the program's policies for directives of donated oocytes and embryo management emphasizes the importance of the informed consent process and how it may affect the decision to donate.