Alabama IVF ruling may halt uterus transplants.

Scientists fear wider research impacts if other states label frozen embryos "children".

In re: the disposition of frozen embryos: 2022.

Debates regarding reproductive rights have waxed and waned since the early twentieth century. The current front-and-center debate draws this discussion into tighter focus. Challenges to reproductive rights, changes in definitions of personhood and a pending decision regarding Roe v Wade could change the management and options regarding the disposition of frozen embryos. This commentary outlines how changes in abortion law and reproductive rights could potentially impact the options available to both patients and clinics.

Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues.

Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be 'universal'.

A View from the past into our collective future: the oncofertility consortium vision statement.

PURPOSE: Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. METHODS: The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. RESULTS: This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. CONCLUSION: The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.

National survey on the opinions of French specialists in assisted reproductive technologies about social issues impacting the future revision of the French Bioethics laws.

INTRODUCTION: France is known for its conservative and unique position in assisted reproductive technologies (ARTs). At the eve of the future revision of French Bioethics laws, we decided to conduct a national survey to examine the opinions of French specialists in ARTs about social issues. MATERIAL AND METHODS: Descriptive study conducted in May 2017 in a university teaching hospital using an anonymous online questionnaire on current issues in ARTs. The questionnaire was sent by email to 650 French ARTs specialists, both clinicians and embryologists. RESULTS: After 3 reminders, 408 responses were collected resulting in a participation rate of 62.7% (408/650). Concerning pre-implantation genetic testing, 80% of the physicians were in favor of expanding the indications, which in France are presently limited to incurable genetic diseases. Authorizing elective Fertility Preservation was supported by 93.4% of the specialists, but without social coverage for 86.3% of them. Concerning gamete donation, 77.4% of the French ARTs specialists were in favor of giving a financial compensation to donors, 92% promoted preserving their anonymity and 80.9% were against a directed donation. ARTs for single heterosexual women were supported by 63.4% of the French specialists and by 72.5% for lesbian couples. The legalization of surrogacy was requested by 55.2%. DISCUSSION: Pending the revision of the French Bioethics laws, this survey provides an overview of the opinion of the specialists in ARTs on expanding ARTs for various social indications.Because of the evolution of social values, a more liberal and inclusive ART program is desired by the majority of ART specialists in France.

Inconsistent Mandated Access to Fertility Preservation: A Review of Relevant State Legislation.

With improvement in cancer therapies, there has been an increasing emphasis on survivorship, including options for fertility preservation. Fertility preservation is the process of either protecting or saving gametes or reproductive tissues for potential future procreation. Methods and outcomes of fertility preservation have similarly been rapidly advancing. Before initiation of gonadotoxic therapy, health care providers must consider future fertility of patients and provide options for fertility preservation. Nonetheless, the cost of fertility preservation can be prohibitory. Depending on a patient's state of residence, insurance may be mandated to cover, or offer to cover, the cost of fertility preservation. State legislation continues to change; however, legislation at the federal level has been proposed to make this coverage more cohesive. This commentary reviews current state legislation regarding mandates to cover the cost of fertility preservation for patients at risk for iatrogenic infertility and outlines the importance of developing federal legislation to improve patient access to care.

Fertility Preservation Legislation in the United States: Potential Implications for Transgender Individuals.

Gender-affirming hormones may compromise gonadal function leading to subfertility or infertility. Fertility preservation (FP; i.e., egg and sperm "freezing") before starting hormones offers future options to transgender individuals. In the United States, FP is extremely expensive and rarely covered by medical insurance; state-specific laws govern required benefits. Recent changes in insurance mandates in Connecticut, Delaware, Illinois, Maryland, New Hampshire, New York, and Rhode Island have expanded FP coverage, but implications of these changes for transgender individuals are unclear. State-by-state advocacy to expand insurance coverage for FP in individuals whose medically necessary treatments compromise fertility should consider the needs of transgender individuals desiring biological parenthood.

[Thoughts on the revision of the bioethics law in the field of assisted reproductive technologies (ART). The end of a conceptual framework?] / Réflexions autour de la révision de la loi bioéthique dans le domaine de l'assistance médicale à la procréation - Une rupture du cadre conceptuel ?

This contribution aims at analysing and presenting a comparative dimension concerning the issues raised for the upcoming French Bioethics law revision in the field of assisted reproductive technologies (ART) : access of female same-sex couples and single women to ART ; the authorization of post-mortem procreation ; enlarging eligibility criteria for oocyte self-conservation ; and lifting the anonymity of gamete donation. These questions touch at the very heart of the French bioethics model conceived in 1994, and their revision would constitute a conceptual upheaval.

The Impact of the Law in Helping or Hindering Fertility Preservation for Children with Cancer Facing Gonadotoxic Therapies.

Children diagnosed with cancer who require treatment with chemotherapy and/or radiation therapy have ever-increasing survival rates. However, as a result of such treatment they face the added, and significant, burden of infertility into their futures. Options for fertility preservation and future reproduction for such children do exist, but some such options continue to be considered experimental. Collaborative multidisciplinary teams support children and their families to make decisions about such options in the treatment environment. When collection of gonadal tissue from children is consented to in such circumstances, it is subject to stringent institutional clinical and human research ethics review, often in both the pediatric oncology setting and the fertility setting in which it will be preserved, examined and, potentially, used. Laws and guidelines may support the collection and use of reproductive tissue from children for treatment and research, subject to meeting consent requirements concerning the child and/or their parent(s). This article examines such laws across Australia. It also examines the legal complexities found in some jurisdictions that may hinder research and practice, consequently having a negative impact on the prospects for children with cancer, in relation to their fertility preservation and possibilities for future reproduction.

The UK´s anomalous 10-year limit on oocyte storage: time to change the law.

There has been a growing recognition in the UK that the statutory storage limit for frozen eggs, which currently stands at 10 years, requires a review. The UK regulator, the Human Fertilization and Embryology Authority (HFEA), has recognized the problem and the Equality and Human Rights Commission is also sympathetic with the demand to change the current legislation. There is also strong desire on the part of assisted reproductive technology (ART) professionals and patients to change the current guidelines. For many women, the available alternatives of transporting their eggs to an overseas destination or having them fertilized with donor sperm and then stored as embryos is objectionable.

Preserving the reproductive potential of transgender and intersex people.

BACKGROUND: The bodies of some transgender and intersex people have been mutilated and their minds subjected to immense distress. Their gender has often been determined by others. Loss of fertility used to be considered an inevitable consequence of treatment. OBJECTIVE: To review the issue of preserving the reproductive potential of transgender and intersex people. METHODS: A narrative review based on a wide-ranging search of the literature in multiple disciplines. RESULTS: Major technological advances have facilitated reproduction for transgender and intersex people in the last few years. A majority of trans-adults believe that fertility preservation should be offered to them. Deferment of surgery for intersex people is often best practice; gonadectomy in infancy closes off fertility options and determines a gender they may later regret. CONCLUSIONS: Transgender and intersex people should be able to consent to or decline treatment, especially radical surgery, themselves. Preservation of reproductive potential and sexual function must be given a high priority. Treatment by multidisciplinary teams can provide a strong emphasis on mental health and well-being. Detailed information about options, an absence of any coercion and enough time are all needed in order to make complex, life-changing decisions.

Oncofertility and the Rights to Future Fertility.

The field of oncofertility, or fertility preservation for patients facing a cancer diagnosis, has seen significant scientific breakthroughs that allow adults and children undergoing fertility-threatening cancer treatment to preserve their fertility for a life after cancer. These breakthroughs also raise complex legal issues for patients and clinicians. While the current scholarship tangentially discusses the disposition of genetic material in regards to pediatric patients, this Special Communication examines the current legal framework as applied to disputes regarding the disposition of genetic material between the oncofertility patient and donor, and provides a potential new solution for courts to use in determining the rights of parties in disputes involving donated genetic material.

Preservación de la fertilidad de la mujer. Vitrificación de ovocitos / Fertility preservation of women: oocyte vitrification

La criopreservación de ovocitos humanos permite retrasar la fertilidad y es también una opción para mujeres que van a someterse a un tratamiento oncológico/autoinmune. Permite también crear un banco de ovocitos para la donación, en los centros de reproducción asistida. La legislación permite la utilización de ovocitos criopreservados durante toda la vida fértil de la mujer, con lo que su conservación podría prolongarse hasta los 48-50 años. La vitrificación de ovocitos consiste en un método de congelación ultrarrápido en el que se utilizan crioprotectores para evitar la formación de cristales de hielo en el interior de la célula. El tratamiento para el proceso de vitrificación de ovocitos es similar a un tratamiento de fecundación in vitro, y finaliza en el momento de la obtención de los óvulos. Los óvulos así conseguidos se clasifican en el laboratorio según su madurez y calidad. Los aptos serán criopreservados mediante la técnica de vitrificación y se mantendrán en tanques de nitrógeno líquido hasta su utilización con fines reproductivos (AU)

Cryopreservation of human oocytes to delay fertility also be an option for women who are going to be subjected to a cancer/autoimmune treatment. It allows for creating a bank of oocytes for donation in assisted reproduction centers. The legislation allows the use of cryopreserved oocytes throughout the reproductive life of women with what conservation could last up to 48-50 years. Oocyte vitrification is a ultrafast freezing method in which cryoprotectants are used to prevent the formation of ice crystals within the cell. Treatment for oocyte vitrification process is similar to IVF treatment, ending at the time of obtaining the ova. The eggs obtained in the laboratory are classified according to maturity and quality. The apartments will be cryopreserved by vitrification technique tanks and maintained in liquid nitrogen until used for reproductive purposes (AU)

[PRESERVING FERTILITY AND FUTURE DEATH]. / PRÉSERVATION DE LA FERTILITÉ ET LA MORT À VENIR: UNE DOUBLE PEINE?

The fertility preservation when it is threatened is a right enshrined in the french law on bioethics. It is most often performed before gonadotoxic treatments for cancers with a long survival. When the patient has a limited life expectancy, is the preservation of fertility lawful? The authors present the arguments for and against the preservation of fertility in this particular situation and give driving they adopt in their team.