Anonymity and secrecy options of recipient couples and donors, and ethnic origin influence in three types of oocyte donation.

BACKGROUND: This study compares recipient couples' and donors' motivations towards the type of donation and attitudes concerning secrecy or disclosure of the mode of conception in three oocyte donation groups: couples and their donor for a known donation, couples and their donor for a permuted anonymous donation (known-anonymous) and couples without a donor, on a waiting list for a donation (anonymous). METHODS: Data collected by two psychologists through semi-structured interviews of 135 recipient couples and 90 donors before oocyte donation were analysed retrospectively. RESULTS: In known donation (42 couples), donors were preferentially family members with a blood tie (54.7%). Choosing their donor seemed mainly for the couple's reassurance rather than to access the child's origins as 50% wanted secrecy. On the other hand, in known-anonymous donation (48 couples), donors were more frequently chosen among friends (41.6%; P = 0.038). These couples were either open to disclosure (45.8%; P = 0.002) or remained hesitant (39.6%). In anonymous donation (45 couples), 49% chose not to seek a donor mostly in order to maintain secrecy towards the child (77.3%). Among the 51% who sought but could not find a donor, only 30.4% wanted secrecy. Recipients from North Africa and from Europe preferred anonymous or known-anonymous donation (83.3 and 75.6%), whereas sub-Saharan Africans opted more often for known donation (63%; P < 0.001). Among Europeans (90 couples), 50% were in favour of disclosure compared with only 8.9% of recipients from North or sub-Saharan Africa (45 couples; P < 0.001). CONCLUSIONS: A diversity of attitudes and cultural differences exist among recipient couples and donors regarding oocyte donation; this pleads for maintaining access to different types of oocyte donation as well as for psychological counselling prior to treatment.

Preimplantation genetic diagnosis in an HIV-serodiscordant couple carrier for sickle cell disease: lessons from a case report.

Since 1999, the Erasme Hospital Fertility Clinic has carried a special programme for patients with HIV seropositivity. The philosophy of the programme is to give access to these patients in a secure environment to the same technological facilities available to any other patients. Many of these patients being native from sub-Saharan countries, they are often sickle cell disease (SCD) carriers, a common autosomal recessive disorder in these regions, and a severe affection in homozygotes. We hereby report, for the first time, the birth of a healthy sickle haemoglobin (HbS) heterozygous baby after preimplantation genetic diagnosis (PGD) for SCD in an HIV-serodiscordant couple of HbS mutation carriers with longstanding infertility. The prospective mother was 35 years old and HIV positive with an undetectable viral load under highly active antiretroviral therapy. One carrier embryo was transferred and resulted in the birth of a healthy HbS carrier baby girl. Despite stimulation difficulties, sometimes described in HIV patients, PGD represents an interesting additional technology, especially in populations where the coexistence of both diseases is frequent. PGD could even be preferred to prenatal diagnosis for couples of HbS carriers if the woman is HIV positive, as invasive prenatal samplings carry a risk of materno-foetal viral transmission.

[Medically assisted reproduction in couples carrying the human immunodeficiency virus]. / L'assistance médicale à la procréation chez les couples porteurs du virus de l'immunodéficience humaine.

Today, in developed countries, many HIV-infected people remain in good health thanks to antiviral medication, and a growing number of them want to have children. The benefit of resorting to assisted procreation and the contamination prevention strategies, throughout pregnancy, are summarized as well as the changes in ethical considerations. The balance between the importance of the message of prevention and the benefit for patients of being assisted in their desire for a child, has evolved towards a growing interest for medical intervention in order to avoid the risks of spontaneous conception outside health care structures. We are presenting the medical structure adapted at Erasme hospital and the 38 first requests taken into account by our pluridisciplinary team. This approach, which is coherent from a scientific point of view, respects both the autonomy of people, carrying HIV as well as the essential interest of the child, in being born uninfected, and also has the enormous advantage of allowing access to parenthood without destroying the consistency and coherence of the message of prevention of sexual contamination.

[What kind of support do couples expect when undergoing IVF treatment? Study and perspectives]. / Quel soutien les couples en traitement de FIV attendent-ils de l'équipe soignante? Enquête et pistes de réflexion.

OBJECTIVES: To assess the management of the supportive aspects of treatment for couples having attempted an in vitro fertilization treatment. MATERIAL AND METHODS: Three groups of couples were contacted by questionnaire (successful treatment, unsuccessful treatment treatment, outcome still unknown). RESULTS: 48% considered it necessary to offer psychological support after the diagnosis. 80% considered it difficult to have a thorough representation of the physical aspects of an In Vitro Fertilization treatment but mostly they were surprised by their lack of an accurate emotional representation. All couples expected an availability and receptiveness from the infertility team but the unsuccessful treatment group was less satisfied and felt significantly (P < 0.001) less well supported. The most difficult moments mentioned were the numerous moments of waiting and the announcement of the final result. Emotional support was regularly provided by the nurses but 20% wanted psychological counselling. Two thirds of all couples considered that a psychological follow-up should be proposed to couples for whom the treatment remain unsuccessful. CONCLUSIONS: Results show the need for better emotional preparation of couples. As for the emotional support during treatment, the need for psychological counselling appears after the diagnosis of infertility as well as a constant demand of availability and empathy on behalf of the team. Post-treatment counselling may be particularly important also. Failure as well as lack of support at that time seemed to colour the way couples regard the whole support provided during treatments.

ART in HIV-infected couples: has the time come for a change of attitude?

Today, in developed countries, many HIV-infected people remain in good health thanks to antiviral medication. A growing number of them want to have children. Medical possibilities for preventing contamination of the partners of seropositive men, through assisted reproduction, and of children thanks to antiviral medicines during pregnancy, are summarized. These changes result in ethical considerations which lead the authors to question the conventional systematic medical advice against pregnancy and has encouraged them to assist reproduction for a number of these couples. Today, the balance between the importance of the message of prevention and the benefit for patients of being assisted in their desire for a child has tilted towards medical intervention. It would seem legitimate today to intervene in the most favourable situations rather than see these couples take the risk of spontaneous conception outside health care structures. This implies the need to adapt medical structures (separate laboratory, appropriate procedure, precise protocols). This approach, which is coherent from the scientific point of view, respects both the autonomy of people carrying HIV as well as the essential interests of the child, in being born uninfected, and also has the enormous advantage of allowing access to parenthood without destroying the consistency of the message of prevention of sexual contamination.

[Aspects of scientific research and technical progress in human fertility]. / Aspects de recherche scientifique et progres techniques en fertilite humaine.

The development of an outstanding in vitro fertilization program greatly benefits from the contribution of research because it remains an unfailing source of questions on human reproduction, as much in the fields of physiology and pathology as in those of psychology and sociology. This paper shows five major themes that are tackled by the laboratory of biology and psychology of human fertility and the Fertility Clinic, whether it's endocrinology (the ovarian renin and angiotensin regulation), cellular metabolism (embryo metabolism), genetics (preimplantation genetic diagnosis) or cancerology (ovarian tissue conservation before or after chemo- or radiotherapy), all of these are crossed by the fifth (the psychological and ethical aspects of in vitro fertilization) which gives a human dimension to the biological work, since it's a very special biology that it's our own reproduction, the very base of the specie's survival.

Comparison of pregnancy outcome after intracytoplasmic sperm injection and in-vitro fertilization.

The aim of this study was to compare pregnancy characteristics and perinatal outcome of intracytoplasmic sperm injection (ICSI) pregnancies with pregnancies obtained after in-vitro fertilization (IVF). Retrospectively, 145 ICSI pregnancies were matched with 145 IVF pregnancies using the last menstruation data. The main outcome measures were preclinical and clinical abortions, ectopic pregnancies, multiple gestations, prenatal morbidity, prematurity, Caesarean section, birthweight, perinatal mortality and malformations for singletons, twins and triplets. Although patients were significantly younger (P < 0.001) in ICSI (31 years) than in IVF (33 years), their infertility duration (5 years) was similar. The mean number of transferred embryos (2.7 embryos per transfer) was similar in IVF and ICSI. The rates of preclinical (15%) and clinical abortions (11% in ICSI versus 15% in IVF) were not different. Four ectopic pregnancies were observed in the IVF group and none in the ICSI group. In ICSI, two minor malformations were detected and two therapeutic abortions were performed respectively for polymalformations and suspicion of cystic fibrosis. The rate of congenital malformation was 2.8% in ICSI and 2.2% in IVF. In this last group, one therapeutic abortion for malformation of neural tube was performed and two minor malformations were detected. The rate of aborted embryonic sacs before 16 weeks of gestation was not significantly lower in ICSI compared with IVF (13.7% versus 20%). The rate of multiple gestations was similar in both groups (31% in IVF and 35% in ICSI). The number of Caesarean sections was similar in IVF and in ICSI and was twice as frequent for twins versus singletons. The number of singletons born by Caesarean section was 21% after ICSI and 17% after IVF. Mean birthweights and gestational ages at birth for twins were significantly higher (P < 0.05) in ICSI than in IVF (2488 versus 2281 g and 36.5 versus 35.5 weeks). This difference was not observed for singletons. In conclusion, pregnancy characteristics and perinatal outcome after ICSI showed no increase in the number of pathologies in comparison with IVF.