Non-obstructive idiopathic azoospermia vs azoospermia with antecedents of cryptorchidism: ways and probabilities of becoming parents

Background Non-obstructive azoospermia (NOA) with history of cryptorchidism and idiopathic NOA are the most common forms of NOA without genetic aetiology. Of all patients with one of these two types of NOA, only a few will have a positive TEsticular Sperm Extraction (TESE). Of those with positive extraction followed by sperm freezing, not all will have a child after TESE-ICSI. What are the ways and probabilities of taking home a baby for patients with NOA and a history of cryptorchidism compared with patients with idiopathic NOA? Results Patients with idiopathic NOA or NOA and a history of cryptorchidism who underwent their first TESE were included. The patients were divided into two groups: Group 1 was composed of 125 patients with idiopathic NOA and Group 2 of 55 patients with NOA and a history of surgically treated cryptorchidism. Our results showed that more than half of the NOA patients succeeded in becoming parents. The main way to fulfil their plans for parenthood is to use sperm or embryo donation (72%) for men with idiopathic NOA, whereas the majority of men with NOA and a history of cryptorchidism had a child after TESE-ICSI (58.8%). Conclusions In our centre, before considering TESE for a patient with NOA, we explain systematically TESE-ICSI alternatives (sperm donation, embryo donation or adoption). As a result, the couple can consider each solution to become parents.

Cloning and Embryo Splitting in Mammalians: Brief History, Methods, and Achievements

Embryo splitting is one of the newest developed methods in reproductive biotechnology. In this method, after splitting embryos in 2-, 4-, and even 8-cell stages, every single blastomere can be developed separately, but the embryos are genetically identical. Embryo splitting, as an approach in reproductive cloning, is extensively employed in reproductive medicine studies, such as investigating human diseases, treating sterility, embryo donation, and gene therapy. In the present study, cloning in mammalians and cloning approaches are briefly reviewed. In addition, embryo splitting and the methods commonly used in embryo splitting and recent achievements in this field, as well as the applications of embryo splitting into livestock species, primate animals, and humans, are outlined. Finally, a perspective of embryo splitting is provided as the conclusion.

P–765 Embryo donation pregnancies are at high risk even in young recipients

Study question Are pregnancies after embryo donation (ED) at higher risk of complications than those issued from autologous frozen-thawed embryo transfer (FET)? Summary answer Even in young women, the risk of pregnancy induced hypertension (PIH) is four time higher in pregnancies after ED versus controls. What is known already After oocyte donation, a higher risk of PIH is well described. It is more controversial after sperm donation. The risk origin remains uncertain, even though an immunological explanation seems most likely. In ED, the fetus being fully allogeneic to his parents may be less well-tolerated. Very few data are reported about pregnancies after ED. The same allogenic model exists in surrogacies, but pregnancy complications are not well described in the literature. Study design, size, duration This anonymous, multicenter, comparative observational retrospective cohort study included all singleton ED pregnancies diagnosed at 7–8 weeks, from January 2003 to December 2018, in six French ART centers. For each, two controls were matched among autologous FET pregnancies. 209 pregnancies were included: 73 ED and 136 controls. Multiple pregnancies were excluded because of their increased associated obstetrical risks. Participants/materials, setting, methods Controls were matched according to pregnancy date, parity and women’s age. The first two singleton pregnancies after each index case meeting the selection criteria were retained. Each center coordinator collected information on infertility, pregnancy pathologies, outcomes and newborns. Statistical methods included univariate and multivariate analyses. According to French practice, all women were under 44 y/o. The main outcome was the percentage of PIH for ED versus controls. Main results and the role of chance ED was indicated for genetic disease in 17 cases (23.3%), double total infertility in 28 cases (38.3%), and double partial/total infertility in 35 cases (47.9%). Groups were comparable in age (mean age: 34.5 ± 8.6 versus 34.5 ± 4.5; p = 0.68), BMI, except for parity (more nulliparity in ED group: 90.4% vs 79.4%; p = 0.04). Pregnancy outcomes were similar for ED and control groups, the percentages of deliveries being 80.8% and 83.8%, respectively (p = 0.58). PIH occurred significantly more frequently among ED than control pregnancies (24.6% versus 11.9%; P = 0.04), with the difference mainly observed for severe forms: preeclampsia and HELLP (17.5% vs 4.6%; p = 0.01). No eclampsia was reported. In contrast, isolated hypertension frequency was comparable (7.0% vs. 7.3%, p = 0.94). Regarding labor and delivery mode, in ED group C-section was more frequent (47.3% vs 29.2%; p = 0.03). In neonatal data, no difference was found between ED and control group for prematurity, weight and height at birth, Apgar score, Small for gestational age, Large for gestational age and sex ratio. Seven neonatal malformations were recorded in ED group and 3 in the control group (NS). Limitations, reasons for caution Retrospective study in a relatively long period when different endometrial preparation for frozen-thawed embryo transfer and embryo cryopreservation method were used. Relatively limited number of ED because of low practice in France. No analysis of embryo stage at transfer (cleaved embryo or blastocyst). Wider implications of the findings: The PIH risk must be acknowledged to inform couples and provide careful pregnancy monitoring. A special care for gestational carrier should also be done since the allogenic situation is the same than in ED recipients. Trial registration number Not applicable

Reformbedürftigkeit des Fortpflanzungsmedizinrechts

In Germany, technologies and procedures that serve to induce pregnancy are strongly regulated or forbidden by the embryo protection law. Marie-Theres Merrem initially takes a critical look at the current legal situation, with particular emphasis on egg, semen and embryo donation, elective single embryo transfer, gestational surrogacy, post-mortem fertilization, and egg freezing. Based on this, implementation proposals for a renewed Reproductive Medicine Act are presented, which takes current scientific knowledge, social values and the needs of those affected into account.

Reimagining disability: the screening of donor gametes and embryos in IVF

In this article, we examine how disability is figured in the imaginaries that are given shape by the reproductive projects and parental desires facilitated by the bio-medical techniques and practices of assisted reproductive technologies (ARTs) that involve selection and screening for disability. We investigate how some users of ARTs understand and deploy these imaginaries in ways that are both concordant with and resistant to the understanding of disability embedded within the broader sociotechnical and social imaginaries. It is through users’ deliberations, choices, responses, and expectations that we come to understand how these imaginaries are perpetuated and resisted, and how maintaining them is also dependent upon the individual actions and actors who have internalized them. Our examination is grounded in a close analysis of a small selection of interviews drawn from data gathered during a 4-year project funded by the Australian Research Council exploring the Australian experience of cross border reproductive treatment, looking particularly at surrogacy, and gamete and embryo donation. Our interviewees were individuals or couples who used gamete or embryo donation, coupled at times with surrogacy in attempting to have a child. Participants discussed their views on testing, screening, and future disability.

The ethics of embryo donation: what are the moral similarities and differences of surplus embryo donation and double gamete donation?

ABSTRACT Over the years, the demand for ART with donated embryos has increased. Treatment can be performed using donated ‘surplus embryos’ from IVF treatment or with embryos intentionally created through so-called ‘double gamete donation’. Embryo donation is particularly sensitive because treatment results in the absence of a genetic link between the parent(s) and the child, creating complex family structures, including full genetic siblings living in another family in the case of surplus embryo donation. In this paper, we explore the ethical acceptability of embryo donation in light of the similarities and differences between surplus embryo donation and double gamete donation. We will argue that no overriding objections to either form of embryo donation exist. First of all, ART with donated embryos respects patients’ reproductive autonomy by allowing them to experience gestational parenthood. It also respects IVF patients’ reproductive autonomy by providing an additional option to discarding or donating surplus embryos to research. Second, an extensive body of empirical research has shown that a genetic link between parent and child is not a condition for a loving caring relationship between parent(s) and child. Third, the low moral status of a pre-implantation embryo signifies no moral duty for clinics to first use available surplus embryos or to prevent the development of (more) surplus embryos through double gamete donation. Fourth, there is no reason to assume that knowledge of having (full or half) genetically related persons living elsewhere provides an unacceptable impact on the welfare of donor-conceived offspring, existing children of the donors, and their respective families. Thus, patients and clinicians should discuss which form of ART would be suitable in their specific situation. To guarantee ethically sound ART with donated embryos certain conditions have to be met. Counselling of IVF patients should involve a discussion on the destination of potential surplus embryos. When counselling donors and recipient(s) a discussion of the significance of early disclosure of the child’s mode of conception, the implications of having children raised in families with whom they share no genetic ties, expectations around information-exchange and contact between donor and recipient families or genetically related siblings is warranted. Importantly, conclusions are mainly drawn from results of empirical studies on single gamete donation families. To evaluate the welfare of families created through surplus embryo donation or double gamete donation additional empirical research on these particular families is warranted.