The European Society of Human Reproduction and Embryology (ESHRE) has published a position paper on intrafamilial medically assisted reproduction (IMAR) concluding that the practice is 'morally acceptable' in some circumstances.
IMAR refers to an assisted reproduction procedure where a third party (in this instance a family member) is involved as either a donor or surrogate. The purpose of the report is to provide guidance to professionals when dealing with requests for IMAR between family members of different generations and degrees of consanguinity, although it said 'in the large majority of IMAR cases, there is no consanguinity involved'.
It recommended that first-degree intergenerational arrangements (such as where a daughter donates eggs to her mother to be fertilised using the mother's partner's sperm) need 'special scrutiny' in view of the increased risk of autonomous decision-making being undermined. It said third-degree (cousin) consanguinity (defined in the report as the mixing of gametes from people who are closely genetically related), though 'acceptable in principle', requires additional counselling and risk reduction. In cases of consanguinity there is an increased genetic health risk for the resulting child.
The report concludes that first (brother, sister, parent, child) and second-degree (aunt, uncle, niece, nephew) consanguineous IMAR should not be offered except in situations where the gametes are not in fact mixed, such as where a lesbian woman intends to mix her brother's sperm with eggs from her partner to conceive a child, where IMAR may be justified.
The Task Force recommended assessing each request for IMAR on an individual basis but cited four key general principles as necessary to the assessment process: autonomy, beneficence, non-maleficence and justice. Dr Wybo Dondorp, deputy coordinator of the Task Force, said doctors must aim to produce a 'net benefit over harm for all parties involved'.
It also emphasised the importance of informed consent, counselling and risk reduction and recommended counselling for all parties in order to help ensure an informed decision had been made. 'Genetic counselling is appropriate to assess the increased risk of conceiving a child affected by a serious recessive disease', said Professor Guido de Wert, coordinator of the Task Force.
The Task Force said withholding IMAR may be justified if there is a high risk of harm to the child, or if undue pressure is being applied to any of the parties. It emphasised that the national laws on incest and consanguinity must be adhered to carefully.
Finally, noting the ethical conflict this area presents, the Task Force recommended practitioners should have the right to refer patients to another clinic if they feel uncomfortable performing certain IMAR procedures. The Task Force acknowledged that further research is necessary in order to develop a better understanding of the impact of IMAR, and to develop stronger professional guidance.
The report was published online in the journal Human Reproduction.