Sperm donor attitudes and experiences with direct-to-consumer genetic testing.

Objective: To identify factors influencing sperm donor willingness to participate in direct-to-consumer genetic testing, comfort with sharing genetically identifiable data in commercial genetic testing databases, and likelihood to donate sperm again. Design: Cross-sectional online anonymous survey. Setting: Multicenter, 2 large American sperm banks from July 1, 2020 to July10, 2021. Patients: Sperm donors from 1980 to 2020. Interventions: None. Main outcome measures: Associations between donor demographic characteristics, donation history, and attitudes toward direct-to-consumer genetic testing. Results: A total of 396 donors completed the survey. Most donations (61.5%) occurred from 2010 to 2020, and 34.3% were nonidentified donations. Nonidentified donors were less comfortable with their genetic data being shared than open-identity donors (25.4% vs. 43.8%) and were less likely than open-identity donors to donate sperm again (43.3% vs. 72.1%). Donors who donated after the inception of direct-to-consumer genetic testing in 2007 were less likely to participate in commercial genetic testing than those who donated before 2007 (25.8% vs. 37.1%). Most donors (87.4%) have disclosed their donation(s) to current partners, but fewer have disclosed them to their families (56.6%) or children (30.5%). Of the donors who had been contacted by donor-conceived persons, 79.5% were identified via direct-to-consumer genetic testing. Overall, 61.1% of donors would donate again regardless of direct-to-consumer genetic testing. Conclusions: Direct-to-consumer genetic testing is playing a dynamic role in sperm donor identification, but donors seem willing to donate again. Implication counseling regarding future linkage and contact from donor-conceived persons needs to be standardized for potential donors before donation.

Status of online sperm donation and sperm bank in Japan.

Facilities worldwide offering donor sperm insemination face sperm donor shortages. There are also known dangers of online information about sperm donation and using donated sperm to conceive without the involvement of medical professionals. Therefore, the authors investigated 140 Web sites retrieved by common Japanese search engines using sperm donation-related keywords. The authors assessed them according to criteria, but most were deemed unsafe (96.4%). Ultimately, 2 personal and 3 company Web sites provided adequate information. However, the personal Web sites lacked representative individual information and the company Web sites had issues including high costs, overseas location of facilities performing insemination, and possible non-Japanese origin of donated sperm.

Genitourinary cancer patients have worse baseline semen parameters than healthy sperm bankers.

BACKGROUND: While the spermatotoxic properties of cancer treatments such as chemotherapy and radiation therapy are widely recognized, the effect of malignancy itself on male fertility is not clearly understood. OBJECTIVES: To determine whether malignancy is associated with diminished semen quality prior to spermatotoxic treatment among sperm bankers. MATERIALS AND METHODS: Retrospective database review of de-identified records was obtained for all episodes of sperm banking performed at a cryobank from January 2004 to May 2017 for one of the following reasons: 'future use' (e.g., military deployment and gender reassignment); infertility; benign disease; and malignancy, further categorized as testicular, other genitourinary (GU), solid non-GU, hematologic, or unspecified. Dependent variables of interest were ejaculatory volume, sperm concentration, % motility, and total motile sperm count (TMSC), as well as post-thaw TMSC. RESULTS: A total of 1558 patients met the inclusion criteria. Multivariable regression analysis on log-transformed data controlling for age demonstrated decreased ejaculatory volume and sperm concentration, % motility, and TMSC in the infertility group as compared to the 'future use' group (p < 0.001). Testicular cancer was associated with decreased sperm concentration, TMSC, and post-thaw TMSC (p < 0.001); other GU malignancy was associated with decreased ejaculatory volume (p < 0.001). Benign disease, solid non-GU malignancy, hematologic malignancy, and unspecified malignancy were not associated with decreased parameters. DISCUSSION: In addition to sperm bankers with known fertility issues, sperm bankers with testicular and other GU malignancy had worse baseline semen parameters as compared to individuals pursuing banking for future use. These findings can inform patient counseling and consent prior to sperm banking and disease treatment. CONCLUSION: Individuals with testicular and other GU malignancy who banked spermatozoa before undergoing spermatotoxic therapy demonstrated worse baseline semen parameters as compared to individuals banking spermatozoa for non-medical reasons.

Delayed childbearing and female ageing impair assisted reproductive technology outcome in survivors of male haematological cancers.

PURPOSE: To analyse the impact of female characteristics on assisted reproductive technology outcome among male haematological cancer survivors. METHODS: A retrospective analysis of 93 haematological cancer survivors attending our tertiary referral fertility centre between June 1998 and June 2017 for achieving fatherhood with assisted reproductive technology treatments. RESULTS: A progressive increase in the median female age was observed during the study period (32.2 years until the year 2007 and 36.9 years from the year 2012). Fifty-five out of 93 patients were treated with intracytoplasmic sperm injection (ICSI) (113 ovarian stimulations, 108 ICSI procedures). Cryopreserved ejaculated sperm was used in 28 couples, fresh sperm in 19, and thawed testicular sperm in 8 couples. Mean female age at ovarian stimulation was 37.0 ± 4.7 years. Twenty-six pregnancies resulted in a full-term birth (23% per started ovarian stimulation; 43.6% per couple) and 33 children were born. No significant differences were observed according to source of sperm (fresh, frozen, testicular) and multivariate analysis confirmed that maternal age was the only variable inversely related to the cumulative delivery rate, being five times lower (15.7%) when the female partner was ≥ 40 years (OR = 0.22, 95% CI 0.06-0.77) vs. 58.3% with younger women (p = 0.0037). CONCLUSIONS: Delayed childbearing and female ageing affect ICSI outcome in couples where the male is a survivor of haematological cancer. This topic should be discussed when counselling male cancer patients about fertility preservation.

Fertility preservation of patients with testicular cancer.

Background: Testicular cancer (TC) is one of the most common malignancies in young men of reproductive age. Although TC is a curable malignancy with a high survival rate, its treatment requires various cytotoxic modalities and negatively impacts spermatogenesis; therefore, the fertility preservation of patients with TC has been studied. Methods: In order to give an overview of fertility preservation in patients with TC, the literature was reviewed. Original and review articles were identified and examined on the basis of PubMed database searches. Results: Chemotherapy and radiotherapy damage spermatogenesis and retroperitoneal lymph node dissection negatively impacts ejaculatory function. Testicular sperm extraction facilitates successful sperm retrieval in patients with TC with postchemotherapy azoospermia. Although preserved sperm is used with a very low frequency (8%), the conception rates in those who have used sperm are not inferior. Conclusion: The number of studies is limited, and because numerous treatment factors affect fertility, outstanding questions remain about preserving the fertility of patients with TC. Further studies are necessary in order to determine the best means of preventing and treating infertility in patients with TC.

Creating a family through connection websites and events: ethical and social issues.

Over the years, connection websites and speed dating events have increasingly attracted singles and couples who cannot have a child in the 'traditional' way. These initiatives bring together candidate gamete providers and recipients with the promise of offering more freedom of choice than fertility centres or sperm banks currently do. Depending on the level of contact desired, the role of the gamete provider may range from not being involved at all to sharing full parental rights and obligations. In this paper, we take a look at the ethical and social issues that emerge with these new forms of family arrangements. We suggest that, although the private arrangements promote greater autonomy and control for all parties involved, risks and questionable assumptions are also at play. In particular, risks involve insufficient screening of the involved donor or co-parent, particularly in terms of motives and psychological characteristics. One must also be wary of the risk of unregulated commercialization and, more importantly, of disappointments and legal conflicts caused by unclear or changing expectations. We also warn for the risk of reinforcing heterosexist and genetic norms of parenting and valid family building.

Sperm cryopreservation and reproductive outcome in male cancer patients: a systematic review.

This systematic review of the literature reports on the use and effectiveness of sperm banking programmes for cancer patients. Thirty studies with 11798 patients were included. The aggregated rate of use of cryopreserved semen was 8% (95% CI 8 to 9%). A statistically significant correlation emerged between the mean and median duration of follow-up and the rate of use (R(2) = 0.46; P = 0.03). The rate of patients discarding their frozen sample was reported in 11 studies. The aggregated rate was 16% (95% CI 15 to 17%). The rate of patients who used their frozen semen and achieved parenthood was reported in 19 papers. The aggregated rate was 49% (95% CI 44 to 53%). The rate of patients achieving parenthood with the use of frozen sperm is low and, from an economical perspective, the effectiveness of programmes of sperm banking might therefore be questioned. On the other hand, the low rate of patients discarding their frozen samples and the correlation between rate of use and duration of follow-up suggest that the calculated 8% rate of use may be an under-estimation and that cumulative rate of use may be substantially higher. Specific studies are, however, required to clarify this issue.

The attitudes of infertile male patients toward the use of artificial insemination by donor: a korean regional survey.

PURPOSE: Infertile couples interested in nonspouse artificial insemination by donor (AID) not only require a thorough understanding of the medical procedure but also must scrutinize the effects it will have on family relationships, including those on the infant to be born. We conducted a series of surveys in couples with male infertility to collect information necessary for AID counseling. MATERIALS AND METHODS: A total of 384 cases with noncurable male infertility were enrolled in this inquiry survey. The questionnaire consisted of 18 items that assessed demographic characteristics, background information concerning the choice to use AID, subjective experiences, long-term effects, and an overall evaluation. RESULTS: A total of 126 surveys were returned (32.8%). AID was first suggested by the husband in about half of the cases. The major reason for considering the procedure was to form a complete family. Two-thirds of the couples were anxious about the procedure, most often about possible congenital or acquired deformities in the infant. After the birth of the child, most couples were positive about their decision to have used AID. About half of the couples felt that the child was their own and expected not to tell the child about AID. Overall, about 50% of the couples were satisfied with the procedure. CONCLUSIONS: Those who underwent AID experienced various psychological effects, including anxiety about the child to be born. To overcome these problems, sufficient medical information and consultation about the process of selecting the donor and about AID procedures should be provided before the procedure is used.

MORE AND LESS THAN EQUAL: How Men Factor in the Reproductive Equation.

In both social science and medicine, research on reproduction generally focuses on women. In this article, we examine how men's reproductive contributions are understood. We develop an analytic framework that brings together Cynthia Daniels' conceptualization of reproductive masculinity (2006) with a staged view of reproduction, where the stages include the period before conception, conception, gestation, and birth. Drawing on data from two medical sites that are oriented to the period before pregnancy (preconception health care and sperm banks), we examine how gendered knowledge about reproduction produces different reproductive equations in different stages of the reproductive process. We conclude with a new research agenda that emerges from rethinking the role of men and masculinity in reproduction.

Sperm cryopreservation for Chinese male cancer patients: a 17-year retrospective analysis in an assisted reproductive unit in Hong Kong.

OBJECTIVE: To review sperm cryopreservation usage rates, corresponding reproductive outcomes, and the current situation in our locality. DESIGN: Retrospective case series. SETTING: Assisted Reproductive Technology Unit of the Department of Obstetrics and Gynaecology, Prince of Wales Hospital and the Chinese University of Hong Kong. PARTICIPANTS: There were 130 Chinese male patients who underwent sperm cryopreservation before proceeding to gonadotoxic treatment from January 1995 to January 2012. MAIN OUTCOME MEASURES: Demographic data, type of cancers and treatments, semen analysis, and reproductive outcomes. RESULTS: The median patient age was 27 (range, 15-43) years. Most (85%) were single at the time of referral. Over half of the patients (51%) had testicular cancer. Five patients declined sperm cryopreservation after counselling. Among the remaining 125 men, 122 men were able to produce sperm by masturbation but 12 were found to have azoospermia, leaving a total of 110 who proceeded to semen cryopreservation. There were no significant differences in semen parameters between different cancer types. After gonadotoxic treatment, in up to 32% (n=11/34) of the patients, semen analysis yielded deterioration; four patients had azoospermia. Four patients (4%, n=4/110) came back to use their thawed semen for in-vitro fertilisation (intracytoplasmic sperm injection), which resulted in three successful singleton pregnancies. CONCLUSION: Sperm cryopreservation is a simple and effective way of preserving the fertility potential of male patients undergoing gonadotoxic treatment. This procedure is underutilised and deserves increased awareness by all possible means.

Sperm banking and the cancer patient.

The current concepts, recommendations, and principles of sperm banking as it pertains to the comprehensive care of young men of reproductive age with cancer are reviewed. Obstacles to sperm banking are addressed as well as future directions for fertility-preserving technologies. All cancer therapies-chemotherapy, radiation, and surgery-are potential threats to a man's reproductive potential. In addition, cancer itself can impair spermatogenesis. Thus, sperm cryopreservation prior to initiating life-saving cancer treatment offers men and their families the best chance to father biologically related children and should be offered to all men with cancer before treatment. Better patient and provider education, as well as deliberate, coordinated strategies at comprehensive cancer care centers are necessary to make fertility preservation for male cancer patients a priority during pretreatment planning.

Sperm banking for male cancer patients: social and semen profiles

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1 percent), prostate (15.3 percent), Hodgkin’s lymphomas (9.2 percent), non-Hodgkin’s lymphomas (7.1 percent), leukemia (3.1 percent) and other malignancies (9.2 percent). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5 percent) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20 percent of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.

The fate of cryopreserved sperm acquired during vasectomy reversals.

PURPOSE: Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collected intraoperatively from 48 vasectomy reversal patients. MATERIALS AND METHODS: Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreserved. RESULTS: Among couples who stored sperm 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples the men were azoospermic after surgery, 2 men had 10,000 to 15,000 sperm per ml. in the ejaculate with limited motility and 2 had 1 to 2 million sperm per ml. with limited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of the remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year. CONCLUSIONS: Cryopreservation of sperm collected at vasectomy reversal is recommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm injection included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopreserved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vasectomy reversal was 43.7% but the time to pregnancy after surgery was lengthy (average 1 year). These findings may be helpful for counseling couples who are planning vasectomy reversal surgery and may be considering intraoperative sperm banking.

PIP: This is a follow-up study on the cryopreserved sperm specimens acquired during vasectomy reversal. The sample was composed of 75 men from whom 48 (64%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissues, and 13 vials of vassal sperm were cryopreserved. The result indicates that among the couples who stored sperm, 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. 7 couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples, the men were azoospermazoic after surgery, 2 men had 10,000-15,000 sperm/ml in the ejaculate with limited motility, and 2 had 1-2 million sperm/ml with limited motility. Intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of the 7 women, 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%), but the time to pregnancy ranged from 4-18 months with an average of 1 year. Therefore, intraoperative collection and cryopreservation of epididymal and testicular sperm are recommended during vasectomy reversal surgery.

Decline in semen quality among fertile men in Paris during the past 20 years.

BACKGROUND: Several studies have suggested a population-wide decline in the quality of semen over the past 50 years, but clear evidence for decreasing semen quality in recent decades is lacking. METHODS: From 1973 through 1992 we measured the volume of seminal fluid, the sperm concentration, and the percentages of motile and morphologically normal spermatozoa in 1351 healthy fertile men. The data on the semen samples were collected at one sperm bank in Paris. The data in each calendar year were analyzed as a function of the year of donation, the age of each patient, the year of birth, and the duration of sexual abstinence before semen collection. RESULTS: There was no change in semen volume during the study period. The mean concentration of sperm decreased by 2.1 percent per year, from 89 x 10(6) per milliliter in 1973 to 60 x 10(6) per milliliter in 1992 (P < 0.001). During the same period the percentages of motile and normal spermatozoa decreased by 0.6 percent and 0.5 percent per year, respectively (both P < 0.001). After adjustment in multiple regression analyses for age and the duration of sexual abstinence, each successive calendar year of birth accounted for 2.6 percent of the yearly decline in the sperm concentration and for 0.3 percent and 0.7 percent, respectively, of the yearly declines in the percentages of motile and normal spermatozoa (all P < 0.001). CONCLUSIONS: During the past 20 years, there has been a decline in the concentration and motility of sperm and in the percentage of morphologically normal spermatozoa in fertile men that is independent of the age of the men.

[Judgment of 18 October 1990]. / Urt. v. 18.10.1990--8 AZR 344/89 (Niedersachsen).

PIP: The plaintiff sued his health insurance carrier to recover the costs of freezing and storage of his sperm. The procedure was recommended by his doctor as a precautionary measure after the defendant was treated for cancer of the scrotum with radiation therapy. The court dismissed the suit, ruling that freezing and storage of sperm is not a medical treatment under the German Social Security Code and thus does not have to be covered by health insurance. It reasoned that such procedures do not serve to cure or alleviate an ailment, especially infertility, since the plaintiff would still remain infertile. It considered the doctor's recommendation merely as advice for planning the future life of the plaintiff.^ieng

Public policies and reproductive technology: a feminist critique.

PIP: Reproductive technology comprises abortion, contraception, amniocentesis (more than 40 genetic disorders can be diagnosed), chorionic villus sampling, genetic screening (to reduce the risk of chromosomal defects such as Down syndrome, sickle cell anemia, Tay-Sachs disease, and cystic fibrosis), in vitro fertilization, artificial insemination by spouse or donor, the development of sperm banks, storage of frozen sperm (cryopreservation), the development of artificial wombs, techniques for predetermining the sex of a fetus, and nursery environments to maintain a fetus removed from the womb in the 1st trimester. In recent years, the demand for these services has increased because of higher infertility and the drop in the number of babies available for adoption. Surrogacy is especially controversial: it has become a symbol of the dehumanization of modern life and the exploitation of women. The feminist perspective discloses how patriarchal values about the subordinate status of women, about the nature of motherhood, infertility, and the family are both implicit and explicit in prevailing thinking about reproduction. The new technology offers women who wish to remain unmarried the opportunity to have a family, and it enables lesbian women to bear children. The research literature favors a Eurocentric nuclear family without any awareness that in Canada, and in the Western world, new forms of family life have been evolving as couples marry, divorce, and remarry. There is no awareness either that in other cultures this Eurocentric nuclear model is dysfunctional. Because of the rigid notion of the 2-parent nuclear family, the 3rd parties who are involved in either surrogate relationships or artificial insemination are deprecated. The feminist literature is more critical of the nuclear family, but it has been sometimes inconsistent on the relevant issues.^ieng

A critical review of the physics and statistics of condoms and their role in individual versus societal survival of the AIDS epidemic.

Condom failure rates for HIV are substantially greater than for pregnancy, even for highly motivated people who may reach the limit set by allowed manufacturing imperfections. This makes condoms ineffective for lifelong protection from HIV-infected sexual partners; therefore, in general, condoms provide inadequate risk reduction for the individual. Nevertheless, they are sufficiently effective that if everyone used condoms, the AIDS epidemic would stop. Quantitative public health goals to reduce the "reproductive rate" of HIV from an estimated 4-12 people infected per infected person to below 1 are needed. Government and scientific testing of condoms could be improved statistically and by utilizing relevant physics.

PIP: The failure rate for condoms in terms of failing to protect one from infection from HIV transmission can now be accurately estimated based on physics and statistics. The risk of HIV infection is much higher than the risk of pregnancy in the context of protecting one in a life-time relationship. This is because pregnancy can only occur a few days a month, so condom failure on infertile days does not get taken into account when calculating failure rates. Even if the condom is used in an optimum way so that the only failure rate is that of manufacturing tolerance, there is not enough protection for an individual over an entire life time. However, if everyone used a condom, every time they had sex, the epidemic could be stopped. Currently for every person who is HIV-infected, 4 to 12 more people will contract the virus. In order for the epidemic to stop, this number must be below 1. The best possible way to do this is to encourage the government to monitor more strictly the production tolerances of condoms. To prove the point, effectiveness rates for pregnancy are first discussed and then cross applied to HIV-protection. Through an explanation of inspection and an application of probability it is shown that imperfections are currently being missed. Currently only a small percentage of condoms are tested and an extrapolation of the condition of a lot is then made. Also a failure rate of 0.4% is allowed per batch. In addition, the tests are used are only to find holes several orders of magnitude bigger than necessary for the transmission of the HIV virus. In the context of the discussion, on the role of condoms in the prevention of AIDS, a model describing the choice of sexual partners to avoid AIDS is presented.

Judgment of 27 April 1989.

PIP: In the Federal Republic of Germany, the plaintiff sought reimbursement through his statutorily mandated health insurance for the cost of storing sperm in a sperm bank. He had resorted to the use of a sperm bank because he had to undergo radiation treatment for cancer and wanted to prevent any possible future children from being harmed. The court denied reimbursement, pointing out that under the statutory insurance scheme a person can obtain reimbursement of costs for medical services that are useful and sufficient for curing or ameliorating health, but not for services that are unnecessary or uneconomical. It ruled that, although the plaintiff's cancer needed treatment, sperm bank services in no way constituted treatment of an illness. It also held that the services of a sperm bank did not constitute an "aid" necessary to prevent a threatened handicap, to secure the success of treatment, or to compensate for a physical handicap, and were not part of the process of homologous artificial insemination--2 services that, at the time of the plaintiff's payment for the sperm bank services, were covered by statutorily mandated health insurance.^ieng

Law on Health, 10 November 1987.

PIP: The following are provisions of this Aargau, Switzerland Law relating to assisted reproduction: "Article 50. (1) A woman can be artificially inseminated if she is married, and a written consent is submitted by both partners, as long as natural procreation is not possible. The medical procedure of artificial insemination must be performed by a physician. (2) Artificial insemination inside the body with sperm other than the husband's is allowed if a prior insemination with the husband's sperm was unsuccessful or impossible or if by allowing this procedure congenital diseases can be avoided. (3) Insemination outside the body is only allowed if all other methods of treatment appear hopeless. It may only be realized with the sperm of the husband and the egg of the wife. It may only be realized in hospitals with a gynecology and maternity department with general permission of the state health department. Each embryo must be implanted. (4) Gametes may only be kept alive during the treatment period. Experimentation on and manipulation of embryos as well as of the hereditary characteristics of the gametes and embryos is forbidden. Measures undertaken to influence the sex or other attributes of the child are prohibited. Therapeutical measures on embryos are permissible to avoid a serious illness and as long as the hereditary characteristics are not changed. (5) Commercial sperm banks, insemination with the sperm and eggs of deceased people, surrogate-motherhood, egg donations as well as the transfer of embryos to third persons are not allowed."^ieng