AMA Journal of Ethics^®

Opinion 2.055 - Ethical Conduct in Assisted Reproductive Technology

The following guidelines are intended to emphasize the value of existing standards to ensure ethical practices in assisted reproductive technology (ART):

(1) The medical profession’s development of technical and ethical guidelines for ART should continue. Education of the profession and patients should be pursued through widely disseminated information. Such material should include information on clinic-specific success rates.

(2) Fertility laboratories not currently participating in a credible professional accreditation program are encouraged to do so. Professional self-regulation is also encouraged through signed pledges to meet established ethical standards and to comply with laboratory accreditation efforts. Physicians who become aware of unethical practices must report such conduct to the appropriate body. Physicians also should be willing to provide expert testimony when needed. Specialty societies should discuss the development of mechanisms for disciplinary action, such as revocation of membership, for members who fail to comply with ethical standards.

(3) Patients should be fully informed about all aspects of ART applicable to their particular clinical profile. A well-researched, validated informed consent instrument would be useful for the benefit of patients and professionals. Payment based on clinical outcome is unacceptable.

(4) Physicians and clinicians practicing ART should use accurate descriptors of available services, success rates, and fee structure and payment obligations in promotional materials.

If legislation on regulation of ART laboratories, advertising practices, or related issues is adopted, it should include adequate financial resources to ensure the intended action can be implemented. Improved legislative protection may be needed to protect physicians and their professional organizations when they provide testimony on unethical conduct of colleagues.

Opinion 2.14 - In Vitro Fertilization

The technique of in vitro fertilization and embryo transplantation enables certain couples previously incapable of conception to bear a child. It is also useful in the field of research directed toward an understanding of how genetic defects arise and are transmitted and how they might be prevented or treated. Because of serious ethical and moral concerns, however, any fertilized egg that has the potential for human life and that will be implanted in the uterus of a woman should not be subjected to laboratory research.

All fertilized ova not utilized for implantation and that are maintained for research purposes shall be handled with the strictest adherence to the Principles of Medical Ethics, to the guidelines for research and medical practice expressed in the Council’s opinion on fetal research, and to the highest standards of medical practice.

Opinion 2.04 - Artificial Insemination by Known Donor

Any individual or couple contemplating artificial insemination by husband, partner, or other known donor should be counseled about the full range of infectious and genetic diseases for which the donor or recipient can be screened, including communicable disease agents and diseases. Full medical history disclosure and appropriate diagnostic screening should be recommended to the donor and recipient but are not required.

Informed consent for artificial insemination should include disclosure of risks, benefits, and likely success rate of the method proposed and potential alternative methods. Individuals should receive information about screening, costs, and procedures for confidentiality, when applicable. The prospective parents or parent should be informed of the laws regarding the rights of children conceived by artificial insemination, as well as the laws regarding parental rights and obligations.

Sex selection of sperm for the purposes of avoiding a sex-linked inheritable disease is appropriate. However, physicians should not participate in sex selection for reasons of gender preference. Physicians should encourage a prospective parent or parents to consider the value of both sexes.

If semen is frozen and the donor dies before it is used, the frozen semen should not be used or donated for purposes other than those originally intended by the donor. If the donor left no instructions, it is reasonable to allow the remaining partner to use the semen for artificial insemination but not to donate it to someone else. However, the donor should be advised of such a policy at the time of donation and be given an opportunity to override it.

Opinion 2.05 - Artificial Insemination by Anonymous Donor

Thorough medical histories must be taken of all candidates for anonymous semen donation. All potential donors must also be screened for infectious or inheritable diseases which could adversely affect the recipient or the resultant child. Frozen semen should be used for artificial insemination because it enables the donor to be tested for communicable disease agents and diseases at the time of donation, and again after an interval before the original semen is used, thus increasing the likelihood that the semen is free of blood-borne pathogens. Physicians should rely on the guidelines formulated by relevant professional organizations, such as the American Society of Reproductive Medicine, the Centers for Disease Control and Prevention, and the Food and Drug Administration, in determining which disorders to screen for and which procedures to use in screening. Physicians should maintain a permanent record which includes both identifying and non-identifying health and genetic screening information. Other than exceptional situations where identifying information may be required, physicians should release only non-identifying health-related information in order to preserve the confidentiality of the semen donor.

Physicians should maintain permanent records of donors to fulfill the following obligations: (1) to exclude individuals from the donor pool who test positive for infectious or inheritable diseases, (2) to limit the number of pregnancies resulting from a single donor source so as to avoid future consanguineous marriages or reproduction, (3) to notify donors of screening results which indicate the presence of an infectious or inheritable disease, and (4) to notify donors if a child born through artificial insemination has a disorder which may have been transmitted by the donor.

Informed consent for artificial insemination should include disclosure of risks, benefits, likely success rate of the method proposed and potential alternative methods, and costs. Both recipients and donors should be informed of the reasons for screening and confidentiality. They should also know the extent of access to non-identifying and identifying information about the donor. Participants should be advised to consider the legal ramifications, if any, of artificial insemination by anonymous donor.

The consent of the husband is ethically appropriate if he is to become the legal father of the resultant child from artificial insemination by anonymous donor. Anonymous donors cannot assume the rights or responsibilities of parenthood for children born through therapeutic donor insemination, nor should they be required to assume them.

In the case of single women or women who are part of a homosexual couple, it is not unethical to provide artificial insemination as a reproductive option.

Sex selection of sperm for the purposes of avoiding a sex-linked inheritable disease is appropriate. However, physicians should not participate in sex selection of sperm for reasons of gender preference. Physicians should encourage a prospective parent or parents to consider the value of both sexes.

In general, it is inappropriate to offer compensation to donors to encourage donation over and above reimbursement for time and actual expenses.