Embryodonation first experiences in the Netherlands

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

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


“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


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?


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?


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.


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


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


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


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


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


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


ESHRE Task Force on Ethics and Law2002: guidelines on


Specific indications:

no other possibilities other treatments failed

risk of transmission of serious genetic disease

no payment for donation of biological material


American Society for Reproductive Medicine2006: guidelines for


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




Donors:. must provide a medical and genetic history

. should be screened for relevant transmittable infections. if possible genetically screened


When refusing above, embryos should NOT be transferred!




Potential recipients:. must provide a medical history

. should be screened for relevant transmittable infections. no genetic screening necessary





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!


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


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


Current number of stored embryos ready for donation: 55(medical history, contracts, bloodscreening and all forms

completed)

Not all paperwork ready: 41 embryos


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



Details donors:

procedure of embryodonation to one assigned recipient: 2non- kaukasion donor: 1



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


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


Interviews:

Medical historyGenetic and family diseases

Views on donationPerspective of embryo

Openness to child (acceptor)Openness to other children (donor)


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?


Views of donors and acceptors

Perspective of donation:“giving happiness to others”

Not giving a child away, but a possibility to a child



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



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



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!


Contract to donate


Overeenkomst tot het afstaan van embryo’s na in vitro fertilisatie ten behoeve van donatie

Contract to transfer embryos to MCK for donation


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


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


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 !


Press release March 5th 2013:

First child in the Netherlands, born after embryodonation procedure via MCK Fertility Centre


Positive news in times of crisis..


Voor het eerst Nederlandse baby uit embryodonatieDatum: 5 maart 2013 12:04

http://www.nu.nl/algemeen/3359365/eerst-nederlandse-baby-embryodonatie-.html



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!


THANK YOU!

Documents

Embryodonation first experiences in the Netherlands