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Ethics in Re

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Lana Lotter

on 25 March 2014

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Transcript of Ethics in Re

1. Various assisted reproductive technologies
2. Ethical issues in assisted reproduction
3. The ethics of assisted reproduction
HIV concordant/discordant couples
Ova/sperm donation
4. Research project: ova/sperm donation by students
5. The group's opinion/conclusion
6. References

Assisted Reproductive Technologies
Ovulation induction
Artificial insemination (IUI)
In-vitro fertilisation
IVF with egg/sperm donor
Gamete Intrafallopian Transfer (GIFT)
Preimplantation genetic diagnosis
Sex selection
Ethics & Surrogacy
Assisted reproduction in HIV
Discordant/concordant couples

The aim of assisted reproduction


Available options for HIV+ males and HIV- females

Options for HIV+ females and HIV- males

Ethical issues in
sperm & ovum donation
Research Project
Ethical issues in Assisted Reproduction
Distributive justice
Pre-implantation diagnosis/sex determination
Multiple pregnancies
What happens to the fertilised eggs that are not used?
Ethical issues surrounding ova/sperm donation
Informed consent
Impacts the AUTONOMY of the donor
Technical procedure not always fully understood

Assisted Reproduction
& Ethics

Assisted reproduction
& religion
Do you think assisted reproduction should be available to all?

Would you consider donating your ova/sperm?
Types of surrogacy

Types of arrangements

Ethical considerations in Surrogacy


Risks and benefits of assisted reproduction in HIV positive couples
Possible risks

Possible benefits
Decreased HIV infection in uninfected partners and children
Promotion of safe intercourse
Psychological benefits to the couple
Meeting the needs of HIV positive patients

Ethical consideration
Autonomy of the parents


“Everyone has the right to have access to health care services, including reproductive health care.”
Informed consent
Disclosure or non-disclosure of donor's identity
Invasive procedures in a healthy woman without clinical gain to herself
Amount of donations possible
Posthumous sperm retrieval

Disclosure or non-disclosure of donor’s identity

Right of the donor to remain anonymous


Child not knowing their biological parents
- Identity struggles
- Absent family medical history
Ethical issues regarding donor conception
Invasive procedures in a healthy woman without clinical benefit
Benefit to infertile couple
Risks associated with invasive procedures like ovum donation

Becoming an ova donor...
Psychological evaluation
Physical examination & Blood tests
Informed consent
Ovarian stimulation and ova retrieval
Fertilisation and implantation
Only 6 pregnancies allowed per donor
Becoming a sperm donor...
Pre-screening – sperm sample analysis
Informed consent
Sperm donation (130 straws, 13 ejaculations
Only 6 pregnancies allowed per donor

Surrogate mothers
Commissioning couples
Commissioning couple
Surrogate mothers
Surrogate mothers
Commissioning couples
Surrogate mothers
Source: National Health Act 61, S. 27, 1st Sess. (2003)
Amount of Donations
Helping multiple couples


Many children sharing DNA
Increase in recessive mutations and diseases
Increased risk of unintentional incest

sperm retrieval
Autonomy of the diseased
- Informed consent
View of the National Health Act

Research Question
Is it ethical to target students for ova/sperm donation?
Literature Review: the use of University Students as Ova and Sperm donors
Target Age Group: 21-24 yo
Ideal Donor Characteristics...
- Female
- Male
- Both

Literature review: Ethics regarding
donation from a young population group

Donor motivation (e.g. high cost of tuition)
Lack of proper counseling
Target groups

Ethics regarding
donation from a young population group

The risk to financial incentive ratio
Targeting the financial vulnerability of men
Less emphasis on the altruistic reasoning

“ Sperm banks treat men more like employees who are expected to clock in on a regular basis and sperm donors respond by calling the money ’income’ or ‘wages’.

Research Assignment
to get an indication of the perceptions of students surrounding the issues of assisted reproduction, financial incentives and the intentional targeting of students in donor recruitment
Cross-sectional study
63 third year medical students
Statistical analysis:


Laws & Regulations
Central data bank
Live births

Egg source
Sperm source
Uninfected partner
Unborn child
Rights based justice
Distributive justice
Research Assignment: Student sample
54% of students: donation = morally right
57% of students found it ethical that they are the targeted population in donor recruitment programs

No: “Students may be more eager to receive money”

59% found it not unethical to provide financial incentive to potential donors
90% agreed that the judgement of students could be clouded by such incentives
69% believed that students would be at risk of psychological complications regarding their decision to donate later in life
44% of students say they would donate
2 out of 63 MBChB III students have donated sperm/ova before

“Yes, if it was easy to donate an ovum like sperm. However, it requires an operation, so no.”

Medical Practitioners’ Perspective

Sperm/ova donation

Sperm/ova donation amongst students

Would you donate your ova/sperm?
Our opinion:
- Is it ethical?
- Advertising
- Process
- Other options?
1. Asghari F. Ethical Issues in Surrogate Motherhood. Journal of Reproduction and Infertility. 2008;9(1):30-35.
2. Ameling R. The business of egg and sperm donation. Scholars strategy network. [Online] 2013 [access 2014, March 13]; Available http://www.scholarsstrategynetwork.org/sites/default/files/ssn_key_findings_almeling_on_egg_and_sperm_donation.pdf
3. Chang L. Assisted reproduction [Online] 2008 [access 2014, March 15]; Available: http://www.webmd.com/baby/healthtool-assisted-reproduction
4. Children's Act 38, Section. 9, 1st Sess. (2005)
5. Daniels KR, Lewis GM. Donor insemination: The gifting and selling of semen. Social science and medicine.[Online]1996 [access 2014, March 14]; 42(11), 1521–1536; Available: http://www.sciencedirect.com/science/article/pii/0277953695002510
6. Daniels KR, Hall DJ, Semen donor recruitment strategies—a non-payment based approach. Journal of Human Reproduction [Online] 1997 access 2014, March 14] 12(10) 2330–2335; Available: [
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8. Estes SJ, Ginsburg ES. Use of assisted reproduction in HIV and hepatitis infected couples. Uptodate;[Online] 2014 [access 2014, March 17]; Available: http://www.uptodate.com/contents/use-of-assisted-reproduction-in-hiv-and-hepatitis-infected-couples?
9. Inhorn MC. Making Muslim babies: IVF and gamete donation in sunni versus shi’aislam. Electronic Journal of Culture, Medicine and Psychiatry [Online] 2006 [access: 2014, March 17]; 30(4); Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705533/
10. Milbank J. The ethics of sperm donation. BioNews Issue 513. 22 June 2009. http://www.bionews.org.uk/page_46109.asp
11. Moodley K. ASSISTED REPRODUCTION IN HIV-POSITIVE COUPLES. Bioethics unit – Tygerberg devision. University of Stellenbosch. [Online] 2007 [access 2014, March 16]; Available: http://academic.sun.ac.za/stellmed/cpd/Default.aspx

“Some people are comfortable, but I’m not. Even though I really would be grateful if someone donated for me.”
"Guys just want to give their sperm away and get their money"
Source: Delivery man official trailer (2013). Available from youtube.com
Source: Interview with Greg at Aevitas Fertility Clinic.
Source: Ethical issues regarding donor conception. Available from youtube.com
Source: Inside egg donation. Available from youtube.com
Roman Catholic

Source: Children’s Act 38 of 2005, chapter 19 (ss 292-303)
Yes: “Students, especially medical students, have a broader baseline of why it is needed- research, helping others to reproduce- the decision is therefore more informed”
No: “Students may be more eager to receive money”
Bibliography (cont.)
12. Nienaber A. ‘The grave’s a fine and private place’: A preliminary exploration of the law relating to posthumous sperm retrieval for procreation. 2010. University of Pretoria.[Online] [access 2014, March 17]; Available: http://repository.up.ac.za/bitstream/handle/2263/17228/Nienaber_Grave's(2010).pdf?sequence=1
13. Nosarka S, Kruger TF. Surrogate motherhood. South African Medical Journal. 2005 Dec;95(12):942, 944, 946.
14. Parker MJ.Till Death Us Do Part: the ethics of postmortem gamete donation. Journal of Medical Ethics. 2004;30:387-388
15. Schenker JG. Assisted reproductive practice: Religious perspectives. Reproductive Biomedicine Online [Online] 2005 [access 2014, March 17]; 10(3); Available: http://web.a.ebscohost.com.ez.sun.ac.za/ehost/pdfviewer/pdfviewer?vid=3&sid=2daf533e-5a1e-4e2a-87b7-40439d4b9073%40sessionmgr4004&hid=4204
16. Schneider J. Fatal colon cancer in a young egg donor: a physician mother's call for follow-up and research on the long-term risks of ovarian stimulation. Fertility and Sterility. [Online] [access: 2014, March 15] 2008;90(5); Available: http://www.ncbi.nlm.nih.gov/pubmed/18314117
17. Shenfield F, Pennings G, Cohen J, Devroey P, de Wert G, Tarlatzis B. ESHRE Task Force on Ethics and Law 10: surrogacy. Journal of Human Reproduction. 2005 Oct; 20(10):2705-7. Epub 2005 Jun 24.; ESHRE Task Force on Ethics and Law
18. Sperm Donation. The centre for Bioethics and culture network. [Online] [access 2014, March 15]; Available: http://www.cbc-network.org/issues/making-life/sperm-donation/
19. Spriggs M, Charles T. Should HIV discordant couples have access to assisted reproductive technologies? Journal of Medical Ethics. 2003;29:325–329
20. Storck S. In Vitro Fertilization (IVF) [Online] 2012 [access 2014, March 15]; Available:http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm
21. The National Health Act 61 of 2003.A guide- Second edition. Berger J, Hassim A, Heywood M, Honermann B, Krynauw M, Rugege U, editors. CONTROL OF USE OF BLOOD, BLOOD PRODUCTS,TISSUE AND GAMETES IN HUMANS. Cape Town: Siber Ink CC; 2013. pp. 81-95.
22. Unknown Author. Infertility Treatment: An Overview [Online] [Access 2014, March 16] Available: http://www.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/Outline.htm
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