Embryodonation first experiences in the Netherlands MCK Fertility Centre Leiderdorp Jacqueline...
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Transcript of Embryodonation first experiences in the Netherlands MCK Fertility Centre Leiderdorp Jacqueline...
Embryodonation
first experiences in the Netherlands
MCK Fertility CentreLeiderdorp
Jacqueline Pieters, gynaecologist
October 4th 2013
www.avapeter.com/Welcome to the AVA-Peter clinic based in St. Petersburg.
First attempt of fresh embryo adoption
4 790
Further attempts of fresh embryo adoption
3 990
Frozen embryo adoption
2 800
http://www.embryodonation.com
Embryodonationfirst experiences in the Netherlands
Basis:Only surplus embryos of completed family
after IVF treatment
No creation of embryos with donor egg and donor sperm
Embryodonationfirst experiences in the Netherlands
“Third party reproduction”involving
genetic material completely external to couple:
emotional, psychological, moral, ethical and legal issues, more than in other forms of ART
Goedeke 2009, Hammarberg 2008, Bovin 2001
WHAT IS THE STATUS OF THE EMBRYO???
Parental perception:
The embryo =- a child
- a potential future human being- a collection of cells
motivation for and against donating to others
Embryodonationfirst experiences in the Netherlands
WHAT IS THE STATUS OF THE EMBRYO???motives for and against donation:
= already a child: deserves to live /unbearable not to know of
= a potential human being: same
= a collection of cells: easy to discard?
Embryodonationfirst experiences in the Netherlands
WHAT IS THE STATUS OF THE EMBRYO???motives for and against donation:
= already a child: deserves to live /unbearable not to know of
= a potential human being: same
= a collection of cells: easy to discard?
Embryodonationfirst experiences in the Netherlands
More motivated contra-donation?
More motivated pro-donation?
but much emotional and financial investment?
de Lacey 2007, Hammerberg 2006, de Lacey2005, Nactigall 2005, Lyerly 2004, McMahan 2003
The Ethics Committee of the ASRMstates that :
embryos are deserving a special respect, but they are not afforded thesame status as persons.
However, it is crucial to consider the wellbeing of the future child at every step of
the process.
Embryodonationfirst experiences in the Netherlands
American Society for Reproductive Medicine: defining embryo donation. Fert Steril 2009; 92: 1818–1819.
First described: 1983Limited research world-wide
In some countries prohibited / In other countries approved
Not all countries same practice:anonimity vs open communication between
donor-recipient families
Embryodonationfirst experiences in the Netherlands
UK, USA, Europe:
“UNCONDITIONED donation”No contact between donors and recepients (exceptions possible)
New Zealand, Australia:
“CONDITIONED donation”Since 2005: open & non- anonymus procedure
separate and joint counselling of both sides
Embryodonationfirst experiences in the Netherlands
Concerns rose about the possible adverse effects of secrecy With regard to family relationships and the psychological wellbeing of the
children.
As a result there has been a worldwide change in disclosure policy
Embryodonationfirst experiences in the Netherlands
MacCallum & S. Golombok. Embryo donation families: mothers’ decisions regarding disclosure of donor conception. Hum Reprod 2007; 22: 2888–2895
In the Netherlands, existing legislation permits embryodonation ->
- Embryowet
Other Dutch laws and codes:
- Wet Donorgegevens Kunstmatige Bevruchting- Wet inzake Veiligheid en Kwaliteit Lichaamsmateriaal (WVKL)- Nederlands Burgerlijk Wetboek (BW) -Wet Geneeskundige Behandelingsovereenkomst (WGBO)- Wet Medisch-wetenschappelijk Onderzoek (WMO)
the previous practice of anonymous donation has been replaced since 2004to access the identity of the donors upon reaching age 16
Embryodonationfirst experiences in the Netherlands
The Embryowet explicitly speaks of DONATION and not of adoption!
->this item has been extensively discussed in Dutch Parliament in 2008
The woman who gives birth to the child is the biological and legal mother,
& her husband is the legal father (BW)
Openness is much encouragedRegarding the fundamental right to know of ones genetic origin
In the Embryowet is stated: there may be no financial gain from procedures with gamete donation
Embryodonationfirst experiences in the Netherlands
ESHRE Task Force on Ethics and Law2002: guidelines on
gamete and embryodonation
Specific indications:
no other possibilities other treatments failed
risk of transmission of serious genetic disease
no payment for donation of biological material
Embryodonationfirst experiences in the Netherlands
ESHRE Task Force on Ethics and Law2002: guidelines on
gamete and embryodonation
Specific indications:
no other possibilities other treatments failed
risk of transmission of serious genetic disease
no payment for donation of biological material
Embryodonationfirst experiences in the Netherlands
American Society for Reproductive Medicine2006: guidelines for
gamete and embryodonation
Donors:. must provide a medical and genetic history
. should be screened for relevant transmittable infections. if possible genetically screened
. informed consent document signed-> psychological counselling to aid in decision
Embryodonationfirst experiences in the Netherlands
American Society for Reproductive Medicine2006: guidelines for
gamete and embryodonation
Donors:. must provide a medical and genetic history
. should be screened for relevant transmittable infections. if possible genetically screened
. informed consent document signed-> psychological counselling to aid in decision
When refusing above, embryos should NOT be transferred!
Embryodonationfirst experiences in the Netherlands
American Society for Reproductive Medicine2006: guidelines for
gamete and embryodonation
Potential recipients:. must provide a medical history
. should be screened for relevant transmittable infections. no genetic screening necessary
. informed consent document signed-> psychological counselling to aid in decision
Embryodonationfirst experiences in the Netherlands
American Society for Reproductive Medicine2006: guidelines for
gamete and embryodonation
Potential recipients:. must provide a medical and genetic history
. should be screened for relevant transmittable infections. no genetic screening necessary
. informed consent document signed-> need psychological counselling to aid in decision
Recipients must take full responsibility for the child that may result from the transfer!
Embryodonationfirst experiences in the Netherlands
several different rights are at stake:
. the rights of autonomy and privacy of the donors. the rights of privacy of the recipient parents
. the rights of the children to know their origins
Considering:. recipients like to uphold their rights to privacy
. whereas donors like to know who are the recipients of their embryos
Embryodonationfirst experiences in the Netherlands
MCK Fertility Centre Protocolchecked and approved by Ministry of Health, Welfare and Sports
= Clear indications, contra-indications and limitationsfor both the embryo-donors and acceptors
Embryodonationfirst experiences in the Netherlands
Current number of stored embryos ready for donation: 55(medical history, contracts, bloodscreening and all forms
completed)
Not all paperwork ready: 41 embryos
Embryodonationfirst experiences in the Netherlands
Current number of stored embryos for donation: 55, from 19 donors(medical history, contracts, bloodscreening and all forms completed)
Details donors:
heterosexual couples: 12
homosexual couples: donor sperm: 2single mothers: donor sperm: 5
own sperm: 10
donorsperm: 2
Embryodonationfirst experiences in the Netherlands
Current number of stored embryos for donation: 55, from 19 donors(medical history, contracts, bloodscreening and all forms completed)
Details donors:
procedure of embryodonation to one assigned recipient: 2non- kaukasion donor: 1
Embryodonationfirst experiences in the Netherlands
Current number of stored embryos for donation: 55, from 19 donors(medical history, contracts, bloodscreening and all forms completed)
Rejected donors:
embryos with use of oocytes from anonymous eggdonor: 1spermdonor has reached the limit of 25 children : 2
Risk embryos carry a genetic mutation: 1
Donor withdrawn: 1
Embryodonationfirst experiences in the Netherlands
Procedure both donors/ recipients:
I. Consultation with gynaecologist JP - 1 hourII. Consultation with medical psychologist AB- 1 hourIII. If necessary more consultations, bloodscreeningIV. Contracts , informed consent, consent to transfer embryos,
all anamnestic forms filled and signed
Embryodonationfirst experiences in the Netherlands
Interviews:
Medical historyGenetic and family diseases
Views on donationPerspective of embryo
Openness to child (acceptor)Openness to other children (donor)
Embryodonationfirst experiences in the Netherlands
Interviews:
Medical historyGenetic and family diseases
Views on donationPerspective of embryo
Openness to child (acceptor)Openness to other children (donor)
Donors: family complete, partners agree?Recipients: grief of own infertility managed?
Embryodonationfirst experiences in the Netherlands
Views of donors and acceptors
Perspective of donation:“giving happiness to others”
Not giving a child away, but a possibility to a child
Embryodonationfirst experiences in the Netherlands
Views of donors and acceptors
Perspective of donation conditions?
“wish for the child to have a safe, warm and happy life with good future prospects”
Trust in MCK Fertility Centre
Embryodonationfirst experiences in the Netherlands
Views of donors and acceptors
Perspective of donation other opinions?
“discussed with own parents and friends, mostly positive reactions”
It is our own decision, we cannot discard of these precious embryos who might give happiness to
someone else
Embryodonationfirst experiences in the Netherlands
Views of donors and acceptors
Perspective of openness:“Child is always welcome at 16 years of age”
&Need for assistance in how to tell the other
children, knowing they will never be able to search for the child!
Embryodonationfirst experiences in the Netherlands
Contract to donate
Embryodonationfirst experiences in the Netherlands
Overeenkomst tot het afstaan van embryo’s na in vitro fertilisatie ten behoeve van donatie
Contract to transfer embryos to MCK for donation
Embryodonationfirst experiences in the Netherlands
Verklaring overbrengen embryo’s naar Medisch Centrum Kinderwens Leiderdorp
Hierbij verklaar ik / verklaren wij*
(naam) ......................................................... ,geboren ..-..-......;
en
(naam) ......................................................., geboren ..-..-.... ..
dat ik / wij* de embryo’s die over zijn gebleven uit mijn/ onze* IVF-behandeling dd …./…./………….
Personality charcteristics of donors
Embryodonationfirst experiences in the Netherlands
Persoonlijkheidskenmerken van embryodonor code..... (man / vrouw)* Gegevens van de donor (persoonlijke kenmerken) ten tijde van de intake Gelieve alle velden in te vullen
Hieronder treft u 33 persoonlijkheidskenmerken aan. Bij ieder van deze kenmerken gelieve aan te geven in hoeverre het kenmerk op u van toepassing is. Plaats een X in het veld van toepassing. Helemaal niet van toepassing
Bij uitstek van toepassing
Spontaan .. .. .. .. ..
Optimistisch .. .. .. .. ..
Ondernemend .. .. .. .. ..
Ambitieus .. .. .. .. ..
Zorgzaam .. .. .. .. ..
Gesloten .. .. .. .. ..
Verlegen .. .. .. .. ..
Contract to recieve
Embryodonationfirst experiences in the Netherlands
Geachte mevrouw/meneer Hieronder vindt u de overeenkomst met betrekking tot het accepteren ingevroren embryo’s na IVF of ICSI , welke zijn gedoneerd door een ander ouderpaar. Overeenkomst tot accepteren van afgestane embryo's
Until today:14 donation procedures of single embryotransfers
in 9 women
Results: 2 pregnancies:
•1 miscarriage
•1 live birth !
Embryodonationfirst experiences in the Netherlands
Press release March 5th 2013:
First child in the Netherlands, born after embryodonation procedure via MCK Fertility Centre
Embryodonationfirst experiences in the Netherlands
Positive news in times of crisis..
Embryodonationfirst experiences in the Netherlands
Voor het eerst Nederlandse baby uit embryodonatieDatum: 5 maart 2013 12:04
New procedure = Teamwork!!!
Important requirements:I. Precision in data handlingII. Cautious and alert cooperation in teamIII. Good communication with clientsIV. Careful and robust storage of data
Special thanks to Erlanda Bunnig, secretary and Brigitte Arends, embryologist!
Embryodonationfirst experiences in the Netherlands
THANK YOU!