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Embryodonation first experiences in the Netherlands

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

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  1. Embryodonationfirst experiences in the Netherlands MCK Fertility Centre Leiderdorp Jacqueline Pieters, gynaecologist October 4th 2013

  2. www.avapeter.com/‎ Welcometo the AVA-Peterclinicbased in St. Petersburg.

  3. http://www.embryodonation.com

  4. Embryodonationfirst experiences in the Netherlands Basis: Onlysurplusembryos of completed family after IVF treatment Nocreation of embryoswith donor eggand donor sperm

  5. 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

  6. 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

  7. 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?

  8. 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

  9. 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.

  10. Embryodonationfirst experiences in the Netherlands First described: 1983 Limited research world-wide In somecountriesprohibited/ In othercountriesapproved Notallcountriessamepractice: anonimityvs open communicationbetween donor-recipient families

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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!

  19. 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

  20. 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!

  21. 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

  22. 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

  23. Embryodonationfirst experiences in the Netherlands Currentnumber of storedembryosready fordonation: 55 (medicalhistory, contracts, bloodscreening and all formscompleted) Notallpaperwork ready: 41 embryos

  24. 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

  25. 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

  26. 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

  27. 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

  28. Embryodonationfirst experiences in the Netherlands Interviews: Medicalhistory Geneticand family diseases Views on donation Perspective of embryo Opennesstochild (acceptor) Opennesstootherchildren (donor)

  29. 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?

  30. Embryodonationfirst experiences in the Netherlands Views of donors andacceptors Perspective of donation: “givinghappinesstoothers” Notgiving a childaway, but a possibilityto a child

  31. 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

  32. Embryodonationfirst experiences in the Netherlands Views of donors andacceptors Perspective of donation otheropinions? “discussedwithownparentsandfriends, mostlypositivereactions” It is ourowndecision, we cannotdiscard of these preciousembryoswhomightgivehappinesstosomeoneelse

  33. 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!

  34. Embryodonationfirst experiences in the Netherlands Contract todonate

  35. Embryodonationfirst experiences in the Netherlands Contract to transfer embryosto MCK fordonation

  36. Embryodonationfirst experiences in the Netherlands Personalitycharcteristics of donors

  37. Embryodonationfirst experiences in the Netherlands Contract torecieve

  38. Embryodonationfirst experiences in the Netherlands Untiltoday: 14 donation procedures of single embryotransfers in 9 women Results: 2 pregnancies: • 1 miscarriage • 1 live birth !

  39. Embryodonationfirst experiences in the Netherlands Press release March 5th 2013: First child in the Netherlands, bornafterembryodonation procedure via MCK Fertility Centre

  40. Embryodonationfirst experiences in the Netherlands Positivenews in times of crisis.. Voor het eerst Nederlandse baby uit embryodonatie Datum: 5 maart 2013 12:04

  41. 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!

  42. Embryodonationfirst experiences in the Netherlands THANK YOU!

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