The law on artificial insemination: an italian anomaly.

The law on medically assisted procreation in Italy, from its entering into force, has undergone numerous amendments. This has been due to the fact that those citizens, directly affected by its imposed prohibitions, have not given in, bringing their requests before the courts, both nationally and internationally. Over the years, the courts through numerous rulings have significantly changed a law clearly incapable of protecting the rights of those involved. Currently Italy has an acceptable law on M.A.P. which is the result of the strong willing of citizens affected by problems of sterility or infertility. The aim of this paper is to present an historical summary of the troubled path which the issue, from every perspective, has faced and is still facing today. As well, it will document how, in Italy, the case-law and, therefore, the law's interpretation and application by the judges have contributed, in the end, to shaping a positive legislation.

Cross-border reproductive care for law evasion: a qualitative study into the experiences and moral perspectives of French women who go to Belgium for treatment with donor sperm.

One consequence of the legal diversity in Europe is that legal restrictions on treatments can be evaded by going abroad. Many French lesbian couples and single women are crossing the border to Belgium because they are denied access to treatments with donor sperm at home. This is the first qualitative research study into the experiences and moral perspectives of these women. Between June 2012 and May 2013, 11 lesbian couples and 2 single women were recruited at the department of reproductive medicine at Ghent University Hospital. The data from the semi-structured interviews was analysed using inductive thematic analysis. The results show that these women face several additional challenges to the already difficult process of cross-border treatment. Before they can start the treatment, they can only obtain information from the internet or from stories of friends who also went abroad for treatment with donor sperm. During the treatment, they need to find local clinics or physicians to monitor their cycle. Several women managed to game the French system to ensure partial reimbursement for their treatment when they were successful in finding a physician who was willing to prescribe drugs and perform tests. Most women had difficulties justifying their absence from work. In general these women felt that they were discriminated against and that their rights were not protected because of who they are. In that regard, the lack of legal recognition of the genetically unrelated partner in their country was particularly hard to cope with for the lesbian couples. These women have to develop many different strategies to deal with the difficulties they face during cross-border reproductive care. It is concluded that it is very important that they find a physician who is willing to support them in their 'baby project'.

Gamete donation in France: the future of the anonymity doctrine.

In France, since the approval of the first bioethics laws in 1994, the principle of the anonymity of sperm donors has prevailed. This choice is regularly challenged, namely by children who have been conceived under these conditions and have now reached adulthood. In this paper, we will briefly describe the reasons that led practitioners of assisted reproduction to endorse the anonymity principle in 1994. Secondly, we will elaborate on the reasons why this principle is becoming so controversial today. Finally, we shall examine two possible outcomes of the debate, highlighting their respective legitimacy as well as their consequences, as far as the rights of children, the notion of the family, and medical practice are concerned.

Sperm retrieval from terminally ill or recently deceased patients: a review.

OBJECTIVE: Requests for sperm extraction in terminally ill or recently deceased patients have been increasing with the gained acceptance and success of assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection. This review aims to outline the many challenges associated with these requests. MATERIALS AND METHODS: The medical literature surrounding ethical and legal issues of posthumous sperm extraction was examined. RESULTS: Several issues within the field of sperm extraction in the terminally ill patient and the postmortem patient still arouse a significant amount of debate and controversy. One controversial factor surrounds the issue of consent for the tissue extraction and determining when family consent is valid. Other discussions have involved ethical issues, logistics (including cost), and legal issues. CONCLUSIONS: A medical center protocol governing sperm extraction from terminally ill or recently deceased patients would be beneficial, and would likely alleviate stress among the patients' families and healthcare providers. To overcome some of the difficulties surrounding the issue of consent, it might also be valuable for men about to get married or enter into a similar relationship to document their wishes for sperm retrieval should a tragic situation arise. This could be done in the same way that they would prepare a living will.

[Infertility treatment in men with Klinefelter syndrome]. / Assistert befruktning ved Klinefelters syndrom.

BACKGROUND: Klinefelter syndrome is the most common chromosomal aberration in men with azoospermia. The revision of the Norwegian biotechnology law in 2004 allows infertile couples with this diagnosis to become genetic parents. Surgical sperm extraction has to be performed to enable identification of possible sperm production. The preliminary approval to use this procedure (stated in the biotechnology law) was extended in 2007. This paper presents a short overview of the infertility investigation and treatment in men with Klinefelter syndrome. MATERIAL AND METHODS: The paper is based on more than 10 years of clinical experience in workup and treatment of infertile couples with the diagnosis Klinefelter syndrome. In addition, a non-systematic search in Pubmed and Medline has been carried out. RESULTS: Use of a microscopy during testicular sperm extraction increases the possibility of finding sperm in men with Klinefelter syndrome. The microsurgical procedure also reduces the risk of complications. If the diagnostic recovery has identified testicular sperm, there is a high predictive value of finding sperm in a subsequent surgical procedure. INTERPRETATION: The optimal method for successful sperm recovery in men with Klinefelter syndrome implies the use of microsurgery. This surgical method should therefore be considered established in Norway.

Assisted reproductive technology: official data on the application of the Italian law.

In 2004, the Italian parliament enacted Law 40/2004, which established new rules for assisted reproductive technology and included a very long and detailed list of restrictions. Since its enactment, the law has given rise to heated discussion at a national and international scientific level. In June 2007 a report presented to the Italian parliament published data from the National Institute of Health regarding the application of the law in 2005. From an overall comparison of data from the years 2003 (before Law 40/2004) and 2005, it emerges that the situation has been significantly altered by the application of this law. These data clearly demonstrate a drop in the percentage of pregnancies, and a consequent drop in the number of children born; a higher percentage of treatments that do not reach the transfer stage or that have a low possibility of success (non-elective embryo transfer); a decrease in the number of oocytes inseminated but an increase in the number of embryos transferred; a higher incidence of multiple births, with consequent immediate and future negative effects for the children and their mother; an increase in the number of pregnancies with a negative outcome.