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Embryodonation first experiences in the Netherlands. MCK Fertility Centre Leiderdorp Jacqueline Pieters, gynaecologist October 4 th 2013. www.ava pete r.com /‎ Welcome to the AVA-Peter clinic based in St. Petersburg. http://www.embryodonation.com.

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embryodonation first experiences in the netherlands

Embryodonationfirst experiences in the Netherlands

MCK Fertility Centre

Leiderdorp

Jacqueline Pieters, gynaecologist

October 4th 2013

slide2

www.avapeter.com/‎

Welcometo the AVA-Peterclinicbased in St. Petersburg.

embryodonation first experiences in the netherlands1
Embryodonationfirst experiences in the Netherlands

Basis:

Onlysurplusembryos of completed family

after IVF treatment

Nocreation of embryoswith donor eggand donor sperm

embryodonation first experiences in the netherlands2
Embryodonationfirst experiences in the Netherlands

“Third party reproduction”

involving

geneticmaterialcompletelyexternaltocouple:

emotional, psychological, moral, ethicalandlegal issues,

more than in otherforms of ART

Goedeke 2009, Hammarberg 2008, Bovin 2001

embryodonation first experiences in the netherlands3
Embryodonationfirst experiences in the Netherlands

WHAT IS THE STATUS OF THE EMBRYO???

Parentalperception:

The embryo =

- a child

- a potentialfuture human being

- a collection of cells

motivationforandagainstdonatingtoothers

embryodonation first experiences in the netherlands4
Embryodonationfirst experiences in the Netherlands

WHAT IS THE STATUS OF THE EMBRYO???

motivesforandagainstdonation:

= already a child: deservesto live /

unbearablenottoknow of

= a potential human being: same

= a collection of cells: easy todiscard?

embryodonation first experiences in the netherlands5
Embryodonationfirst experiences in the Netherlands

WHAT IS THE STATUS OF THE EMBRYO???

motivesforandagainstdonation:

= already a child: deservesto live /

unbearablenottoknow of

= a potential human being: same

= a collection of cells: easy todiscard?

More motivatedcontra-donation?

More motivatedpro-donation?

but much emotional and financial investment?

de Lacey 2007, Hammerberg 2006, de Lacey2005, Nactigall 2005, Lyerly 2004, McMahan 2003

embryodonatio n first experiences in the netherlands
Embryodonationfirst experiences in the Netherlands

The Ethics Committee of the ASRM

states that :

embryos are deserving a special respect, but they are not afforded the

same 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. FertSteril 2009; 92: 1818–1819.

embryodonation first experiences in the netherlands6
Embryodonationfirst experiences in the Netherlands

First described: 1983

Limited research world-wide

In somecountriesprohibited/

In othercountriesapproved

Notallcountriessamepractice:

anonimityvs open communicationbetween

donor-recipient families

embryodonation first experiences in the netherlands7
Embryodonationfirst experiences in the Netherlands

UK, USA, Europe:

“UNCONDITIONED donation”

No contact between donors andrecepients (exceptionspossible)

New Zealand, Australia:

“CONDITIONED donation”

Since 2005: open & non- anonymus procedure

separate and joint counselling of both sides

embryodonation first experiences in the netherlands8
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

MacCallum & S. Golombok. Embryo donation families: mothers’ decisions regarding disclosure of donor conception.

Hum Reprod 2007; 22: 2888–2895

embryodonation first experiences in the netherlands9
Embryodonationfirst experiences in the Netherlands

In the Netherlands, existinglegislationpermits embryodonation->

- Embryowet

Other Dutch lawsand 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 2004

to access the identity of the donors upon reaching age 16

embryodonation first experiences in the netherlands10
Embryodonationfirst experiences in the Netherlands

The Embryowet explicitlyspeaks of DONATIONandnot of adoption!

->this item has been extensivelydiscussed in Dutch Parliament in 2008

The womanwhogivesbirthto the child is the biologicalandlegalmother,

& her husband is the legalfather(BW)

Openness is muchencouraged

Regarding the fundamental right toknow of onesgeneticorigin

In the Embryowet is stated: theremaybeno financial gain

from procedures withgametedonation

embryodonation first experiences in the netherlands11
Embryodonationfirst experiences in the Netherlands

ESHRE Task Force on EthicsandLaw

2002: guidelines on

gameteandembryodonation

Specificindications:

  • no otherpossibilities
  • othertreatmentsfailed
  • risk of transmission of seriousgeneticdisease
  • no paymentfordonation of biologicalmaterial
embryodonation first experiences in the netherlands12
Embryodonationfirst experiences in the Netherlands

ESHRE Task Force on EthicsandLaw

2002: guidelines on

gameteandembryodonation

Specificindications:

  • no otherpossibilities
  • othertreatmentsfailed
  • risk of transmission of seriousgeneticdisease
  • no paymentfordonation of biologicalmaterial
embryodonation first experiences in the netherlands13
Embryodonationfirst experiences in the Netherlands

American Society forReproductiveMedicine

2006: guidelinesfor

gameteandembryodonation

Donors:

. must provide a medicalandgenetichistory

. shouldbescreenedfor relevant transmittableinfections

. ifpossiblegeneticallyscreened

. informed consent document signed

-> psychologicalcounsellingtoaid in decision

embryodonation first experiences in the netherlands14
Embryodonationfirst experiences in the Netherlands

American Society forReproductiveMedicine

2006: guidelinesfor

gameteandembryodonation

Donors:

. must provide a medicalandgenetichistory

. shouldbescreenedfor relevant transmittableinfections

. ifpossiblegeneticallyscreened

. informed consent document signed

-> psychologicalcounsellingtoaid in decision

Whenrefusingabove, embryosshould NOT betransferred!

embryodonation first experiences in the netherlands15
Embryodonationfirst experiences in the Netherlands

American Society forReproductiveMedicine

2006: guidelinesfor

gameteandembryodonation

Potentialrecipients:

. must provide a medicalhistory

. shouldbescreenedfor relevant transmittableinfections

. no genetic screening necessary

. informed consent document signed

-> psychologicalcounsellingtoaid in decision

embryodonation first experiences in the netherlands16
Embryodonationfirst experiences in the Netherlands

American Society forReproductiveMedicine

2006: guidelinesfor

gameteandembryodonation

Potentialrecipients:

. must provide a medicalandgenetichistory

. shouldbescreenedfor relevant transmittableinfections

. no genetic screening necessary

. informed consent document signed

-> needpsychologicalcounsellingtoaid in decision

Recipients must take full responsibilityfor the childthatmayresultfrom the transfer!

embryodonation first experiences in the netherlands17
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

embryodonation first experiences in the netherlands18
Embryodonationfirst experiences in the Netherlands

MCK Fertility Centre Protocol

checked and approvedbyMinistry of Health, Welfare and Sports

= Clearindications, contra-indications and limitations

forboth the embryo-donors and acceptors

embryodonation first experiences in the netherlands19
Embryodonationfirst experiences in the Netherlands

Currentnumber of storedembryosready fordonation: 55

(medicalhistory, contracts, bloodscreening and all formscompleted)

Notallpaperwork ready: 41 embryos

slide27

Embryodonationfirst experiences in the Netherlands

Currentnumber of storedembryosfordonation: 55, from 19 donors

(medicalhistory, contracts, bloodscreening and all formscompleted)

Details donors:

heterosexual couples: 12

homosexual couples: donor sperm: 2

single mothers: donor sperm: 5

ownsperm: 10

donorsperm: 2

embryodonation first experiences in the netherlands20
Embryodonationfirst experiences in the Netherlands

Currentnumber of storedembryosfordonation: 55, from 19 donors

(medicalhistory, contracts, bloodscreening and all formscompleted)

Details donors:

procedure of embryodonation to oneassignedrecipient: 2

non- kaukasion donor: 1

embryodonation first experiences in the netherlands21
Embryodonationfirst experiences in the Netherlands

Currentnumber of storedembryosfordonation: 55, from 19 donors

(medicalhistory, contracts, bloodscreening and all formscompleted)

Rejected donors:

embryoswithuse of oocytesfromanonymouseggdonor: 1

spermdonor has reached the limit of 25 children : 2

Risk embryoscarry a geneticmutation: 1

Donor withdrawn: 1

embryodonation first experiences in the netherlands22
Embryodonationfirst experiences in the Netherlands

Procedure both donors/ recipients:

  • Consultationwithgynaecologist JP - 1 hour
  • Consultationwithmedicalpsychologist AB- 1 hour
  • Ifnecessary more consultations, bloodscreening
  • Contracts , informed consent, consent to transfer embryos, allanamnesticformsfilledandsigned
embryodonation first experiences in the netherlands23
Embryodonationfirst experiences in the Netherlands

Interviews:

Medicalhistory

Geneticand family diseases

Views on donation

Perspective of embryo

Opennesstochild (acceptor)

Opennesstootherchildren (donor)

embryodonation first experiences in the netherlands24
Embryodonationfirst experiences in the Netherlands

Interviews:

Medicalhistory

Geneticand family diseases

Views on donation

Perspective of embryo

Opennesstochild (acceptor)

Opennesstootherchildren (donor)

Donors: family complete, partners agree?

Recipients: grief of owninfertilitymanaged?

embryodonation first experiences in the netherlands25
Embryodonationfirst experiences in the Netherlands

Views of donors andacceptors

Perspective of donation:

“givinghappinesstoothers”

Notgiving a childaway,

but a possibilityto a child

embryodonation first experiences in the netherlands26
Embryodonationfirst experiences in the Netherlands

Views of donors andacceptors

Perspective of donation

conditions?

“wishfor the childtohave a safe, warm and happy life withgoodfutureprospects”

Trust in MCK Fertility Centre

embryodonation first experiences in the netherlands27
Embryodonationfirst experiences in the Netherlands

Views of donors andacceptors

Perspective of donation

otheropinions?

“discussedwithownparentsandfriends, mostlypositivereactions”

It is ourowndecision, we cannotdiscard of these preciousembryoswhomightgivehappinesstosomeoneelse

embryodonation first experiences in the netherlands28
Embryodonationfirst experiences in the Netherlands

Views of donors andacceptors

Perspective of openness:

“Child is alwayswelcome at 16 years of age”

&

Needfor assistance in howtotell the otherchildren,

knowingtheywill never beableto search for the child!

embryodonation first experiences in the netherlands30
Embryodonationfirst experiences in the Netherlands

Contract to transfer embryosto MCK fordonation

embryodonation first experiences in the netherlands31
Embryodonationfirst experiences in the Netherlands

Personalitycharcteristics of donors

embryodonation first experiences in the netherlands33
Embryodonationfirst experiences in the Netherlands

Untiltoday:

14 donation procedures of single embryotransfers

in 9 women

Results: 2 pregnancies:

  • 1 miscarriage
  • 1 live birth !
embryodonation first experiences in the netherlands34
Embryodonationfirst experiences in the Netherlands

Press release March 5th 2013:

First child in the Netherlands,

bornafterembryodonation procedure via MCK Fertility Centre

embryodonation first experiences in the netherlands35
Embryodonationfirst experiences in the Netherlands

Positivenews in times of crisis..

Voor het eerst Nederlandse baby uit embryodonatie

Datum: 5 maart 2013 12:04

slide44

New procedure = Teamwork!!!

Important requirements:

  • Precision in data handling
  • Cautiousand alert cooperation in team
  • Goodcommunicationwithclients
  • Carefulandrobust storage of data

Special thankstoErlandaBunnig, secretary

and Brigitte Arends, embryologist!