Using family members as gamete donors or gestational carriers
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2017). Using family members as gamete donors or gestational carriers. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2017.02.118
Ethics Committee of the American Society for Reproductive Medicine. Using family members as gamete donors or gestational carriers. Fertility and sterility. 2017. doi:10.1016/j.fertnstert.2017.02.118
Ethics Committee of the American Society for Reproductive Medicine. "Using family members as gamete donors or gestational carriers." Fertility and sterility, 2017.
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RRM Academy Synopsis
ASRM finds adult family donors and surrogates generally acceptable
A 2017 ASRM Ethics Committee opinion holds that adult family donors and surrogates are generally ethically acceptable with full counseling. The Committee would bar a brother's sperm with a sister's eggs. It advises extra time for screening.
Key Findings
Adult relatives serving as gamete donors or gestational surrogates is "generally ethically acceptable," the Committee holds, given full information and counseling for every participant.
The Committee holds that arrangements combining gametes of first-degree relatives, such as a brother's sperm with a sister's eggs, should be prohibited, along with any that "simulate incestuous unions."
The Committee holds that adult child-to-parent arrangements "require caution" because of coercion risk. Parent-to-adult-child help is "acceptable in limited situations." Programs should not allow minors to take part.
The Committee advises programs to plan more time for screening and counseling than for unrelated donors. Denial is "ethically justified" when assessment shows consistent concerns about undue pressure or unhealthy family dynamics.
The Committee cites a review that put the added risk of major malformations and genetic disease from first-cousin procreation at 1.7% to 2.8%, over a 3% to 4% background risk.
The ASRM Ethics Committee's Position
“The use of adult intrafamilial gamete donors and gestational surrogates is generally ethically acceptable when all participants are fully informed and counseled, but consanguineous arrangements or ones that simulate incestuous unions should be prohibited.”
Quoted verbatim from this paper.
Interpretation
The document is an ethics opinion. It reasons from principles, an analogy to family organ donation, and reported cases. The Committee says data are limited on donors, recipients, and children born this way. Studies of those children have overall shown positive psychological outcomes but involved small numbers of individuals. The Committee states that the report is not the only approved standard of practice. The opinion replaces the Committee's 2012 document of the same name.
RRM Context
RRM looks for the cause of a couple's infertility and works to restore their own fertility. This opinion addresses third-party arrangements that use a relative's gametes or uterus. The Committee encourages research on long-term effects for parents, offspring, and relatives.
Our editorial summary of this paper, not the article's abstract.
Abstract
The use of adult intrafamilial gamete donors and gestational surrogates is generally ethically acceptable when all participants are fully informed and counseled, but consanguineous arrangements or ones that simulate incestuous unions should be prohibited. Adult child-to-parent arrangements require caution in order to avoid coercion, and parent-to-adult child arrangements are acceptable in limited situations. Programs that choose to participate in intrafamilial arrangements should be prepared to spend additional time counseling participants and ensuring that they have made free, informed decisions. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:797-803).
Ethics Committee of the American Society for Reproductive Medicine, 2018
Ethics and Policy › Reproductive Ethics › Third Party Reproduction · Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 28347494 28347494 DOI 10.1016/j.fertnstert.2017.02.118 10.1016/j.fertnstert.2017.02.118 Ethics Committee of the American Society for Reproductive Medicine et al. 2017, Ethics Committee of the American Society for Reproductive Medicine 2017