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IVF, same-sex couples and the value of biological ties
Abstract
Ought parents, in general, to value being biologically tied to their children? Is it important, in particular, that both parents be biologically tied to their children? I will address these fundamental questions by looking at a fairly new practice within IVF treatments, so-called IVF-with-ROPA (Reception of Oocytes from Partner), which allows lesbian couples to 'share motherhood', with one partner providing the eggs while the other becomes pregnant. I believe that IVF-with-ROPA is, just like other IVF treatments, morally permissible, but here I argue that the increased biological ties which IVF-with-ROPA allows for do not have any particular value beside the satisfaction of a legitimate wish, because there is no intrinsic value in a biological tie between parents and children; further, I argue that equality within parental projects cannot be achieved by redistributing biological ties.
... The success of ROPA IVF can vary greatly and depends on several factors such as the overall health of the partners and their reproductive systems, their age and the quality of the eggs and of the donor sperm. Both medical and non-medical factors may contribute to the desire for shared motherhood IVF, for instance the psychological willingness to share a biological and a genetic connection with the offspring, the impossibility of the eggdonor partner becoming pregnant or the risk of the receiving partner in carrying the pregnancy, and especially the use of oocyte donation (Di Nucci, 2016). ...
... Successively, five articles were excluded because two were abstracts (Brando et al., 2022;Esguerra et al., 2019) and had not been published as a full article in a journal, one was a case report (van Bentem et al., 2020), one was a duplicate (N uñez et al., 2021) and one was not written in English (Mesnil et al., 2023). Finally, 16 articles were included in the SWOT analysis (Bodri et al., 2018;Brandão et al., 2022;Carpinello et al., 2016;Di Nucci, 2016;Golombok et al., 2023;Kahn, 2023;Machin, 2014;Marina et al., 2010;Mascarenhas et al., 2022;Matorras et al., 2023;Mesnil et al., 2023;N uñez et al., 2021;Shaw et al., 2023;Woodward and Norton, 2006;Yeshua et al., 2015, Zeiler andMalmquist, 2014). ...
... When both mothers are actively involved in the ROPA procedure, they are better able to bond over the well-being of their future child than in the case of donor sperm IUI or autologous IVF (Di Nucci 2016; Marina et al., 2010). In this way, potential relationship problems can be prevented, both between the women themselves and with the child, due to an imbalance of biological parentage (Di Nucci, 2016;Pennings, 2016). ...
... 7/9as all-out, because obviously there are also other urgent considerations of justice, such as for example climate change, which might at least go the other way, trump or even ultimately silence the ones which we are focusing on in this paper.But especially given the clarifications in the previous footnote, at least the latter is probably unlikely. And in fact, one important distinction between biological parenthood and non-biological parenthood, from a climate point of view, is that the latter is more climate-friendly than the former -but again this is not the focus of the present paper.3 Here one could insist that we cannot restrict talk of 'preference for biological parenthood' to the alternative of nonbiological parenthood and that, for say the climate reasons already mentioned, one should also include another alternative to which one prefers biological parenthood, namely non-parenthood. ...
... I believe this is a discussion worth having, and that indeed the taxonomy (i) biological parenthood; (ii) non-biological parenthood; (iii) non-parenthood is in fact more helpful when having all-out discussions that also include for example climate considerations or, for that matter, anti-natalism as well; but again, that is beyond the scope here.4 This broad understanding of 'biological' to include both genetics and gestation ought not to be confused with an altogether different discussion about whether biological ties -understood to be either genetic ties or gestational ties -are necessary and/or sufficient for parenthood[3][4] .5 I easily can (continue): post-partum depression, periods, maternal mortality rates, abortion restrictions, pregnancy/delivery complications and on it goes. ...
This article argues that reproductive technologies are problematic despite widening (and when publicly funded also _democratizing_) access to parenthood for particularly vulnerable groups, such as LGBTQ+ and those suffering from infertility. The problem with reproductive technologies is _biological_ parenthood, which reinforces patriarchy.
... Recently, the practice of "reception of oocytes from partner" or ROPA in IVF allows both lesbians to become "biological mothers" of the child. With ROPA, lesbians can share motherhood by using one partner's egg for the other partner's pregnancy (Di Nucci, 2016). Based on a study using samples of all types of lesbian mothers in the US, Pelka (2009) finds that lesbian partners using ROPA "feel equitable biological ties" to alleviate feelings of jealousy and inferiority that may be associated with being a social/non-biological mother in lesbian family (p. ...
... This practice also resembles several controversial reproductive practices such as egg donation and surrogacy. Although many fertility specialists in Europe assert the psychological benefits of ROPA for both lesbian parents and their distinctions from "egg donor" and "surrogate," given these practices take place between partners (Dondorp et al., 2010;Marina et al., 2010;Pennings, 2016); it raises questions about the ultimate effects of genetic connections in parenting and how reproductive technologies radically affect the previous moral and ethical frameworks of family-making (Di Nucci, 2016;Lahl, 2017). ...
Lesbian motherhood is an emerging practice among Chinese lesbian couples. Although this form of family-making might be appealing to Chinese lesbians who cannot legally marry their partners, lesbian mothers are subject to substantial risks and challenges arising from the lack of recognition by Chinese authorities and other family members. This study focuses on an anonymous lesbian’s confession about her motherhood. It conducts a case analysis to investigate the incompatibility between transnational reproductive services and national household regulations and Marriage Law. This study analyses the persistence of patriarchy in a lesbian family, which suppresses women’s agency both corporeally and in family roles. Through this analysis, this paper intends to explore lesbian mothers’ vulnerabilities as they face a continuum of patriarchal exploitation in the absence of legal and social recognition. It also questions the radical challenge that lesbian motherhood is often assumed to make to male dominance and gendered norms.
... En general, los autores que abogan en favor de la FIV con ROPA lo hacen en función de los beneficios psicosociales previstos en la pareja al combinar un vínculo genético y biológico (p. ej., situaciones de desigualdad legal, distribución de cargas, poder de crianza, celos, etc.) 14,51 . Por regla general, suele respetarse la voluntad de la pareja, aunque las opciones alternativas deben ser expuestas por el médico tratante a la pareja, así como los riesgos y consecuencias médicas, biológicas, legales y éticas. ...
... Entienden que los tratamientos de reproducción asistida se deben aplicar únicamente ante la falta de hijos de forma involuntaria como una intervención destinada a reparar un defecto biológico 15 . Estas posiciones puramente biologicistas chocan con los deseos (legítimos o no) de las parejas lesbianas reproductivamente sanas de procrear un hijo juntas 51,55,56 . ...
Objetivo: Identificar los aspectos clínicos, éticos y legales de la fertilización in vitro (FIV) con el método de recepción de ovocitos de la pareja (ROPA).
Método: Se realizaron búsquedas bibliográficas de publicaciones desde 2009 en las bases de datos CINAHL, Medline, Scopus y PsycINFO. Una primera búsqueda inicial se centró en «técnicas de reproducción asistida» y «homosexualidad» como conceptos amplios. Posteriormente, una segunda búsqueda se centró en «lesbianas» y «método ROPA» específicamente.
Resultados: Se incluyeron 11 artículos. Se identificaron 4 áreas temáticas: 1) búsqueda del vínculo biológico compartido en la maternidad de las parejas lesbianas; 2) riesgos relacionados con el tratamiento de FIV con ROPA; 3) consideraciones éticas y aceptabilidad médica de dicha técnica, y 4) marco legal y jurídico actual en España de la FIV con ROPA.
Conclusiones: La novedad de la técnica FIV con ROPA no está en los componentes del procedimiento, sino en la experiencia reproductiva compartida, en los riesgos médicos que puede acarrear y en las cuestiones éticas que plantea. Los profesionales de la salud deberían conocer estos aspectos para poder ofrecer una adecuada atención a estas parejas.
... If we take genetic transmission to be the essence of reproduction and genetic resemblance as the key to understanding biological parenthood, this leads to a number of other problems and anomalies. Many scholars have queried the tendency to overprivilege genetic accounts of parenthood, with good grounds (Segers et al. 2019;Nucci 2016;Mertes 2014;Hill 2017, 29-96;Romanis and Brown 2024). However, in addition to these objections, we believe there are further reasons to look sceptically at the idea that genes are a necessary or sufficient component of reproduction. ...
In recent decades, ethicists have engaged with new developments in human reproductive technologies from a variety of angles. Yet there has been relatively little effort to problematize the concept of reproduction itself. In this paper, we examine the question of what reproduction is and its relationship with biology. We show that reproduction is commonly assumed to entail biological parenthood—an assumption that we term “the biological reproduction paradigm.” Drawing on Sally Haslanger’s analysis of the biological/social division between sex and gender, we suggest that the concept of reproduction is socially constructed, despite its apparently biological nature. In turn, we argue that the supposed necessity of the relationship between reproduction and biological parenthood leads to a situation in which access to a variety of medical, legal, and social goods is constrained on the basis of spurious, inconsistent, and undertheorized assumptions. Finally, we note that, given the socially constructed nature of reproduction, we cannot take it for granted that the term “reproduction” signifies the same thing among different interlocutors and in different contexts.
... Adoption and spontaneous pregnancy (with a friend or acquaintance) are plans of only a minority. Our data suggest that homosexual women value biological motherhood, as previous studies have indicated, although this is not yet clear and obviously varies greatly from patient to patient (Di Nucci, 2016;Voultsos et al., 2019;Costa et al., 2020). ...
Objective:
Lesbian couples must resort to adoption or donated semen to achieve parenthood, the latter usually involving assisted reproductive technology. The aim of this study is to assess homosexual women's knowledge about assisted reproductive techniques, the importance of perceived genetic and gestational relationships for their future mother-child bond, as well as their reproductive plans.
Methods:
This is an observational study based on an anonymous survey disseminated online in several countries on different continents, addressed to homosexual women.
Results:
From the 549 participants, most reported being well informed about reproductive options including assisted reproductive technology. The majority want to be a mother as part of a couple, mainly through assisted reproduction or step adoption of their partner's child. The importance of a genetic or gestational relationships with their future child varies greatly between women. Among the sampled women, pregnancy was believed to have a slightly greater impact on the future mother-child connection compared to genetics.
Conclusions:
Homosexual women are well informed about the assisted reproductive technology treatments. The majority considers it important to become a mother as a couple, mainly through assisted reproduction or step adoption of their partner's child. The importance given to gestation or genetic mother-child relationships varies greatly between women, and it seems they believe pregnancy may have a slightly greater impact on the future mother-child connection compared to genetics.
... Biological motherhood may be defined by gestation or genetics, and the importance given to each factor varies considerably (Di Nucci, 2016;Thornton & Resetkova, 2021). In our study, most patients say that pregnancy is very or extremely important. ...
Objective:
To evaluate female couples' reproductive choices, the importance given to genetics and pregnancy and their expectations regarding mother-child relationship.
Methods:
Observational study based on an anonymous survey applied to 217 patients during 2021. The survey was given to female couples under reproductive treatment in a private fertility clinic. The outcomes were divided into 3 main groups: the choice of their reproductive treatment, motherhood and biological links, and their plans for future reproductive treatments.
Results:
Most patients found it easy to choose their treatments and roles. The choice was mainly driven by success rates, costs, and simplicity, except for ROPA for which sharing biological motherhood was the main reason. Most couples consider genetics and pregnancy important but, in the end, they believe they will have a similar connection to their child, regardless of the role played. In the future, some couples consider doing the same treatment while others consider inverting roles.
Conclusions:
Most female couples have no difficulty when it comes to choosing a reproductive treatment or role to play, mainly based on costs, success rates and the possibility of sharing biological motherhood with the ROPA method. These patients give great importance to genetics and pregnancy, but they expect a similar connection to their child regardless of the type of treatment and the roles played.
... As homosexuals have been gradually accepted, raising children is assumed to stabilize same-sex relationships. With the advancement of ART and related industries such as sperm banking, in vitro fertilization (IVF), and surrogacy, homosexuals can now achieve their fertility goals (15). Moreover, a surrogacy incident involving a Chinese actress has brought surrogacy into the spotlight and exposed a certain segment of the female population who desire a child and do not want to face the risks of pregnancy or changes in body shape (16). ...
China's birth rates hit a record low in 2021. The high demand for having children has spawned a massive market for surrogacy, which, however, is a dilemma in China involving a series of moral and legal issues under the current circumstances. First, special populations, including infertile patients, families who have lost their sole child, and homosexuals, wanted to have children, giving rise to surrogacy. Then, the development of and innovation in assisted reproductive technology allowed surrogacy to mature. A high return offsets a high risk, and consequently, an underground surrogacy market has emerged, causing various social issues for the Chinese Government, such as civil disputes, gender disproportion, crime, and the spread of disease. At the same time, surrogacy violates moral ethics, traditional Chinese culture, and the rights and interests of vulnerable groups.
... Ebeveynler ile çocuklar arasındaki biyolojik bağların içsel bir değeri olmadığı sadece organik bağ içerdiği; buna karşı ROPA IVF'te her iki ebeveynin de çocuk sahibi olmayı arzuladığını savunan yorumcular bu yöntemi ahlaken uygulanabilir bulmaktadır. [36] Yine İsveç Ulusal Tıp Etiği Konseyi Şubat 2013'te yayımladıkları yardımlı üreme hakkındaki raporunda çocuk ile ebeveynler arasındaki genetik bağın çocuğun sağlığı ile ilgili diğer faktörlerden daha az önemli olduğu kanaatini belirtmiştir. [20] Tam aksi yönde Velleman, kişinin akrabalarını ve özellikle de ebeveynlerini tanımasının kimlik oluşumunda yeri doldurulamaz bir önemi olduğunu savunmaktadır. ...
Assisted Reproductive Technologies (ART) are widely used all over the world for couples who want to have children. Ethical debates about IVF in most countries no longer examine ART procedurally. Although IVF is used so frequently and widely, it includes some ethical concerns. In addition, with ART, parents can choose the gender and physical characteristics of their children; Homosexual individuals or single women can have children. Many different treatments such as mitochondrial replacement therapies, gamete and embryo donation, and surrogacy are possible with ART. Can we do everything that is medically and technically possible? Before making a judgment about an application that focuses on people, especially about new technologies, two basic questions must be asked: “What would happen if everyone made this application?” and “what does this practice lead to?”. In this way, we can easily see the consequences of a ethical practice in a particular field when spread to the public. Defending reproductive autonomy and the desire to have children under all conditions makes the child an object of the parents. For this reason, while developing ART, not only the reproductive freedom of individuals or the right for one to make their own decisions but also the rights of the child should be considered. In addition, biotechnologies that aim to improve and change humans attack human dignity and creation. This article aimed to discuss ART from an ethical perspective, both from a technical and social aspect.
... The ROPA method (from Spanish: recepción de ovocitos de pareja; in English: reception of oocytes from partner), also called lesbian-shared IVF or co-IVF, consists of an assisted reproductive technique for female couples in which a member of the couple provides the oocytes (donor or genetic mother), and the other receives the resulting embryo and gestates (recipient or gestational mother) [6,7]. With the ROPA method, both women actively participate in the generation of their child, which means they are able to share biological motherhood [8,9]. Women may choose the ROPA method due to medical reasons. ...
Purpose
To compare reproductive outcomes of the ROPA method (reception of oocytes from partner) to IVF with autologous oocytes. To study the impact of the absence of a genetic link between the embryo and its recipient in reproductive outcomes.
Methods
Retrospective multicentric cohort study performed from January 2011 to December 2020 in 18 fertility clinics in Spain. A total of 99 ROPA (73 couples) and 2929 non-ROPA cycles (2334 couples or single patients) of women younger than 38 years old with no known female fertility disorder were included. Clinical outcomes were compared between both groups and included positive pregnancy test, clinical pregnancy, miscarriage, ectopic pregnancy, pre-term birth, live birth, weeks of gestation at birth, and newborn weight at birth.
Results
No differences were found between groups in clinical outcomes. The total clinical pregnancy rates per embryo transfer were 57% and 50.2% (p = 0.15) and the live-birth rates were 46.1% and 40.9% (p = 0.14) for the ROPA and non-ROPA groups, respectively. When adjusted to age and BMI of donors and recipients, there were also no differences in live-birth rates between both groups. The cumulative live-birth rate per ROPA cycle was 73.7% and the cumulative live-birth rate per couple was 78.3%.
Conclusion
Clinical outcomes following the ROPA method and IVF with autologous oocytes were found to be similar. These findings suggest no impact of the absence of genetic ties between the embryo and the uterus on reproductive treatments’ outcomes. Data regarding the outcomes of the ROPA method are reassuring.
... Another issue is that one child can have only one biological father, requiring identification of a single intended genetic parent by each SSM couple. Although the value of parent-child biological ties has been convincingly argued to be minimalsee Di Nucci [23] such ties may, particularly when unequal in a parental unit, affect prospective parental power, influence and responsibility in ways that are not fully understood. To circumvent such issues some SSM couples may seek fraternal twinning with dual paternity as a solution. ...
Social and legal equality for same-sex male couples continues to grow in many countries. Consequently, increasing numbers of same-sex male couples are seeking assisted reproductive technology to achieve parenthood. Fertility treatment for same-sex male couples is an undoubtedly complex issue and raises a variety of ethical concerns. Relevant considerations include ethical issues relating to the surrogate and a possible egg donor, the commissioning same-sex couple, the welfare of the child and the fertility clinic itself. This work analyses these arguments in the context of modern fertility services, providing reflection on the evidence present and what it means for clinicians today. Herein, we argue that fertility treatment for same-sex male couples via surrogacy agreements are acceptable, subject to considerations of each individual case, as in all assisted reproductive treatment. It is in the interest of open and equal access to health services that barriers to assisted reproductive technology for same-sex male couples should be minimised where possible.
... For instance, it has been argued from the child's perspective that access to one's genetic family history is important for one's identity formation and that knowledge of one's genetic origins may contribute to developing a sense of who we are (Velleman 2005;Brighouse and Swift 2014a). Other authors have given elaborate critiques of this argument (Haslanger 2009;Di Nucci 2016). 1 Yet, as said, we will not go into this. Instead, we will consider the issue of the desire for a genetically related child from the perspective of the future parents mainly by exploring two hypotheses: first, we explore the case for satisfying the desire for genetic parenthood in view of a subjective desire satisfaction theory; second, we examine the hypothesis that meeting the desire for genetic parenthood would contribute to people's presumed intermediate need for parenthood. ...
People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns.
... Current reproductive technologies include assisted reproduction treatments, such as intra-uterine insemination (IUI), in vitro fertilisation (IVF) and the reception of oocytes from a partner (ROPA). The ROPA method involves the participation of two women, whereby one provides the oocytes that are subsequently inseminated with the sperm of an anonymous donor, and the other woman receives the embryos and may become pregnant (Machin 2014;Di Nucci 2016). A different method of conception is self-insemination (SI), a low-cost procedure in which a woman (or her partner) inserts semen into the vagina without medical intervention (Correa 2012;Crouch et al. 2013). ...
The use of reproductive technologies has expanded beyond cases of infertility, and opportunities for individuals of different sexual orientations to use such technologies for conception have increased. The authors examined the challenges and limitations faced by women in same-sex relationships seeking conception services in São Paulo, Brazil. They interviewed 16 women in same-sex relationships who conceived children using reproductive technologies. Access to public health services for conception remains limited and exclusive to infertile heterosexual couples. Women in same-sex relationships are forced to select between costly medical treatments in the private sector, or self-insemination with sperm from a known donor. In this study, individuals reported that they experienced adverse effects of treatments; were treated with technologies for infertility when they were, in fact, fertile; and were exposed to unnecessary and invasive interventions. Growing political conservatism and the reduction of investment in public health services are factors that can directly affect sexual and reproductive health, including that of lesbians. Public policies that enable same-sex couples to conceive have yet to be developed in many countries, and a clearer articulation of the right to evidence-informed, rights-based care, consistent with national and international guidelines is a much-needed next step.
... Several authors have asked about the moral significance of the wish to have a genetically related child, and whether this is proportionate to the potentially high health risks, especially to the future offspring. 5,9,17,48,62,77,80 It is, however, difficult to operationalise the principle of proportionality. Further ethical reflection will be needed to assess the moral significance of genetic relatedness in parent-child relationships and how this may or may not affect people's reproductive autonomy. ...
In this review we aim to provide an overview of the most important ethical pros and cons of stem cell derived gametes (SCD-gametes), as a contribution to the debate about reproductive tissue engineering. Derivation of gametes from stem cells holds promising applications both for research and for clinical use in assisted reproduction. We explore the ethical issues connected to gametes derived from embryonic stem cells (both patient specific and non-patient specific) as well as those related to gametes derived from induced pluripotent stem cells. The technology of SCD-gametes raises moral concerns of how reproductive autonomy relates to issues of embryo destruction, safety, access, and applications beyond clinical infertility.
One of the most provocative claims in current climate ethics is that we ought to have fewer children, because procreation brings new people into existence and thereby causes large amounts of additional greenhouse gas emissions. The public debate about procreation and climate change is frequently framed in terms of the question of whether people may still have any children at all. Yet in the academic debate it is a common position that, despite the large carbon impact of procreation, it is still permissible to have one or two children per couple, if having children is needed for the parents' lives to go well. In this article, we propose a defence and a principled formulation of this procreative prerogative: agents are permitted to procreate if the goods that procreation provides are essential to their lives going well and cannot be replaced by other goods, nor be realized by lower‐emissions alternatives. This principle implies that procreative decisions require case‐by‐case assessment in which agents' self‐reflection, individual circumstances, and social context play a significant role.
In her recent paper, Emanuele Mangione proposes combining maternal spindle transfer (MST) and reciprocal effortless in vitro fertilisation (ReIVF) to enable both females to have genetic and gestational ties with the same child, which can particularly benefit lesbian couples. This response rejects Mangione’s proposal for the reason that the additional biological ties created by MST+ReIVF, compared with the reception of oocytes from partner (ROPA), are unnecessary. ROPA is currently the most effective method for redistributing biological ties within lesbian couples, allowing one member to provide the egg and the other to carry the fetus. The additional biological ties created by MST+ReIVF are quantitatively too small to significantly enhance parental bonding or couple relationships, and their potential harms to both prospective parents and children outweigh any minor benefits. Furthermore, like ROPA, MST+ReIVF fails to address deeper feminist concerns. Therefore, I propose a new idea: combining in vitro gametogenesis with ectogenesis, which can offer far more reproductive choices and greater potential to address deeper feminist concerns than MST+ReIVF.
In this chapter, I focus on how the Solo Mother by Choice (SMBC) is represented in anti-donation discourse and in fertility clinics. Despite research evidencing that donor-conceived children are not disadvantaged, anti-donation debate focuses on the moral ambiguity of creating single parents. Although most UK clinics welcome solo patients, most fertility clinics focus on couples, biological infertility, and pregnancy loss and therefore, because SMBC often do not fit these narratives, they are sometimes overlooked and under-represented. These experiences can lead to feelings of liminality in which SMBC exist in an ambiguous space between ethical/unethical, fertility/infertile, advantaged/disadvantaged, and natural/unnatural.
Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members.
The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) families have expanded our understanding of who counts as family, to include legal as well as chosen ties. Yet, nonbiological parents in LGBTQ families are vulnerable to invalidation and erasure in social institutions, including health care, legal, and educational settings, where genetic and gestational linkages are privileged. The current study was guided by a queer phenomenological perspective to examine how LGBTQ parents experience and respond to dominant norms related to family relatedness and membership and thus queer the family. This mixed-methods study sampled 250 LGBTQ parents (including cisgender women and trans/nonbinary participants) to examine the question: In what ways does genetic asymmetry matter for families? The qualitative and quantitative analyses yielded three primary findings that revealed experiences of erasure and discrimination, as well as proactive strategies and active resistance used to counteract these difficulties. Themes were organized by (a) encountering marginalization and invalidation: health care, schools, and beyond; (b) strategic actions and discursive practices toward parental equality; and (c) confronting and resisting the need for legal, symbolic, and parenting strategies. This study documents ways in which nonbiological LGBTQ parents, in particular, embrace and resist societal norms for biological connectedness. Implications for nursing professionals include our finding that reproductive and perinatal contexts were particular sites of invalidation, necessitating education about the range of queer, nonbiological, and trans/nonbinary parents so that all parents are included in professional health care encounters.
Mithilfe der Verfahren des Embryo-Splittings werden unter Laborbedingungen aus einem Embryo mehrere, genetisch identische Embryonen gewonnen. Gegenwärtig wird in Fachbeiträgen debattiert, die in der Nutztierzucht etablierten Verfahren auf die humane Reproduktionsmedizin auszuweiten. Eine solche Anwendung wird derzeit flächendeckend als reproduktives Klonen verstanden und ist in allen Staaten per Gesetz oder Richtlinie untersagt. Bei der Prüfung ausgewählter Einwände gegen die prinzipielle Zulässigkeit einer Anwendung des Embryo-Splittings als assistierter Reproduktionstechnologie zeigt sich, dass sich die Einwände gegen das reproduktive Klonen nicht auf den Fall des Splittings übertragen lassen. Insbesondere liegt dem Splitting nicht die ‚narzisstische‘ Replikation des Genoms einer bereits lebenden Person zugrunde. Die Gleichsetzung mit anderen Formen des reproduktiven Klonens verdeckt darüber hinaus eigene regulative Fragen zum Umgang mit gesplitteten Embryonen, die hinsichtlich einer potenziellen klinischen Anwendung adressiert werden müssen. Schließlich wird deutlich, dass die Maßgabe, Embryonen zu schützen, bisher einseitig als ausreichender Grund für eine restriktive Regulierung des Splittings herangezogen wurde. Diese Argumentation erweist sich in einer pluralistischen Gesellschaft jedoch als unzureichend.
This article identifies ways that judges, lawyers, researchers, and policy makers may attend to the role of gender and gender dynamics facing same‐sex couples upon divorce or other relationship dissolution. When same‐sex couples marry, the legal system and society at large may project conceptions of gender onto same‐sex couples, often in a manner that conflicts with couples' intentions and practices. Gender and gender dynamics may affect the bases for dissolution, the financial aspects of dissolution, and the determination of child custody. The article also suggests directions for future research on the impact of gender on the dissolution of same‐sex relationships. In the context of same‐sex relationships, the legal system may apply standards or ideals upon couples in a manner in tension with the couple's expectations, in part because of assumptions rooted in the historically gendered nature of marriage. Gender and gender dynamics may affect the bases for dissolution, the financial awards made in the context of dissolution, and the determination of child custody. Researchers, judges, practitioners, and policy makers would do well to attend to the role of gender and dynamics in the context of the dissolution of same‐sex relationships.
Is the wish to be biologically related to your children legitimate? Here, I respond to an argument in support of a negative answer to this question according to which a preference towards having children one is biologically related to is analogous to a preference towards associating with members of one’s own race. I reject this analogy, mainly on the grounds that only the latter constitutes discrimination; still, I conclude that indeed a preference towards children one is biologically related to is morally illegitimate because, in the context of parental love, biological considerations are normatively irrelevant.
Same-sex parenthood is controversial subject. In this paper, we provide insights into the attitudes and experiences of self-reported lesbians regarding parenthood or the prospect of becoming a parent in the current Greek social and cultural context. In Greece, lesbians are not allowed access to in vitro fertilisation (IVF), while a solitary (‘single’) woman is allowed access for medical reasons. Fifty-nine (59) semi-structured in-depth interviews were conducted with women. What emerged from our data was a clear trend for participants to wish to have their own biological children based mostly on the belief that pregnancy would lead to a sense of self-completeness and/or fulfilment. Women also reported the negative impact of prejudice and social oppression on their reproductive autonomy. Interviewees reported that their reproductive choices were negatively influenced by their family and the wider socio-cultural environment. Even within a semi-permissive legal framework, impaired social acceptance of lesbian parenthood prohibits lesbians from becoming mothers. A major reason responsible for the positive attitude of most participants to shared biological motherhood was an altruistic attitude towards their partners.
Purpose:
Egg sharing in female couples can be used to allow dual participation of female couples in the pregnancy process. The oocyte donor-partner provides the eggs and the recipient partner provides the uterine environment for gestation. We present descriptive data of our experience in female couples to establish a better understanding of utilization of co-in vitro fertilization (Co-IVF) for social and medical reasons.
Methods:
Female couples enrolled in a third party reproduction program that engaged in at least one Co-IVF cycle were included. Previous assisted reproductive technology (ART) cycle data, Co-IVF cycle information and pregnancy outcomes were evaluated.
Results:
Female couples (n=21) who participated in Co-IVF cycles were analyzed. Over time, 16/21 (76%) of couples achieved at least one pregnancy, 9 (42%) couples delivered, and there are another 5 (23%) ongoing pregnancies.
Conclusion:
Our analysis presents descriptive data and sheds realistic expectations for Co-IVF couples. Co-IVF cycles can result in a shared experience with regard to the process of creating a family, while preserving a female couple's desire for dual partner participation in the gestational process. We encourage centers treating female couples to consider departing from traditional nomenclature of "donors" and "recipients" and adopting the nomenclature "Co-IVF" to describe the modern understanding of the shared experience. Even if female couples have experienced prior unsuccessful cycles, couples ultimately retain an excellent prognosis for reproductive success using Co-IVF.
The increasing acceptance of lesbian couples in medically assisted reproduction has led to new, unusual requests. This paper discusses the request for egg transfer from one partner to the other. In the first part, different analogies (egg donation, embryo donation, surrogacy and mitochondrial replacement) are made in order to find out whether one of these can help us determine whether this procedure is acceptable. It is shown that there are major difficulties with all analogies. In the second part, two balances are developed between the medical risks and costs of in vitro fertilisation (IVF) and intrauterine insemination on the one hand and the medical risks of IVF and the psychosocial benefits on the other hand. The final conclusion is that the disadvantages of the procedure can be compensated by the psychosocial advantages and thus can be accepted.
Female same-sex couples in Sweden have had access to fertility treatment within public health care since 2005. Treatment is generally tax funded, with a minimal of personal expenses. After birth, both mothers gain legal status as the child's parents. This article draws on findings from interviews with 29 lesbian mothers, all of whom have sought treatment at fertility clinics within the Swedish public health care system. Parts of the interviews in which the mothers describe deficiencies in the provided treatment have been scrutinized in detail. Results show how heteronormative assumptions about the family and a feeling of exposure in the role of patient give rise to vulnerability in lesbian mothers. Furthermore, neither routines nor the offered treatment are adapted to lesbian women's specific needs. Regarding dealing with deficiencies, the interviews are filled with expressions of acceptance, which rhetorically minimize the impact of potential stressors. A main conclusion is that legal inclusion of lesbians in fertility treatment is of groundbreaking importance to lesbians with a desire to become parents. The next step is to address heteronormativity within the health care institutions in order to develop treatment adapted to lesbian couples’ specific needs.
In vitro fertilization (IVF) with reception of oocytes from partners (ROPA) allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a "legitimate" medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project (though not allowed in regular health care). But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF.
In nine lively essays, bioethicist J. David Velleman challenges the prevailing consensus about assisted suicide and reproductive technology, articulating an original approach to the ethics of creating and ending human lives. He argues that assistance in dying is appropriate only at the point where talk of suicide is not, and he raises moral objections to anonymous donor conception. In their place, Velleman champions a morality of valuing personhood over happiness in making end-of-life decisions, and respecting the personhood of future children in making decisions about procreation. These controversial views are defended with philosophical rigor while remaining accessible to the general reader. Written over Velleman's 30 years of undergraduate teaching in bioethics, the essays have never before been collected and made available to a non-academic audience. They will open new lines of debate on issues of intense public interest.
In a series of recent papers David Velleman has argued that it is morally wrong to bring a child
into existence with the intention that the child will not have contact with one or both biological
parents. (Velleman, 2005, 2008) Put another way, “other things being equal, children should be
raised by their biological parents.” (Velleman, 2005 362fn 3) The primary targets of his
argument are those who use anonymous donor egg or sperm to conceive a child. On his view,
there is a significant value in being parented by and having ongoing contact with one’s biological
relatives. “What is most troubling about gamete donation is that it purposely severs a connection
of the sort that normally informs a person’s sense of identity, which is composed of elements that
must bear emotional meaning, as only symbols and stories can.” (Velleman, 2005 363) Let’s be
clear. He is not just interested in the possibility of having information about one’s biological
progenitors, but actual knowledge by acquaintance. So the kind of profile that is typically made
available by gamete donors or in closed adoptions is insufficient, and even information that is
revealed through open records is not enough. A face-to-face relationship with both biological
progenitors is, unless there are substantial overriding considerations, morally required.
Although research indicates that single parenting is not by itself worse for children than their being brought up by both their parents, there are reasons why it is better for children to have more than one committed parent. If having two committed parents is better, everything else being equal, than having just one, I argue that it might be even better for children to have three committed parents. There might, in addition, be further reasons why allowing triparenting would benefit children and adults, at least in some cases. Whether or not triparenting is on the whole preferable to bi- or monoparenting, it does have certain advantages (as well as shortcomings) which, at the very least, warrant its inclusion in debates over the sorts of family structures we should allow in our societies, and how many people should be accepted in them. This paper has the modest aim of scratching the surface of this wider topic by challenging the necessity of the max-two-parents framework.
What is it that makes someone a parent? Many writers--call them 'monists'--claim that parenthood is grounded solely in one essential feature that is both necessary and sufficient for someone's being a parent. We reject not only monism but also 'necessity' views, in which some specific feature is necessary but not also sufficient for parenthood. Our argument supports what we call 'pluralism', the view that any one of several kinds of relationship is sufficient for parenthood. We begin by challenging monistic versions of gestationalism, the view that gestation uniquely grounds parenthood. Monistic and necessity gestationalism are implausible. First, we raise the 'paternity problem'--necessity gestationalists lack an adequate account of how men become fathers. Second, the positive arguments that necessity gestationalists give are not compelling. However, although gestation may not be a necessary condition for parenthood, there is not good reason to think that it is sufficient. After further rebutting an 'intentionalist' account of parenthood, in which having and acting on intentions to procreate and rear is necessary for parenthood, we end by sketching a pluralistic picture of the nature of parenthood, rooted in causation, on which gestation, direct genetic derivation, extended custody, and even, sometimes, intentions, may be individually sufficient for parenthood.
This article explores the experience of lesbians seeking gestation by means of reproductive technologies involving donor insemination and two biological mothers: one who provides the eggs and the other who carries the embryo in her womb. This model is called Reception of Oocytes from Partner (ROPA). This article considers the processes that are required for this procedure in Brazil. It is a study carried out from in-depth, semi-structured interviews with five lesbian couples in Sao Paulo, in 2011. Cultural changes in the paths to the construction of a family by means of biomedicine can be characterized by the formulation of a reflective style of project that repeatedly reconsiders the data in search of its ultimate feasibility. The study reveals the desire to involve both partners, the importance of donor health history and the connection to the families of origin.
This article presents a critical review of different lines of empirical research on adopted persons' search for their birth parents and identifies questions and issues that are in need of further study. The review covers research on the demographic and psychological characteristics of searchers and their motives for searching. Research findings are also used to evaluate the validity of three different theoretical frameworks that have been offered as explanations for why adopted persons search for their birth parents.
This article argues that to gain a more complete understanding of how lesbian families experience parenthood outside of the heterosexual context, scholars must consider how co-parents negotiate a parental identity, rather than presuming that women parents want to mother. Drawing on in-depth interviews with 17 women in a state that denies them parental legal rights, this article asks how a non—biologically related and non—legally related woman parent determines a parental identity in a social system that continually reminds her of her liminal position. Interviewees divided roughly evenly into the self-identified categories of “mother” and “father” and a collectively generated category of “mather,” a hybrid of the two words. The word mather served to anchor co-parents in otherwise uncertain seas, but the other groups felt their parental identity was significantly constrained by ill-fitting role expectations based on gender. We conclude by addressing the possibility for alternative family forms to transform the institution of gendered parenting.
We herein present the initial experiences of the CEFER Institute of Reproduction in the formation of a new family model: two biological mothers, lesbians, one who provides the eggs and the other who carries the embryo in her womb. We have called this family model ROPA (Reception of Oocytes from PArtner). It is a pioneer event in Spain and among the first at a worldwide level.
Fourteen lesbian couples have undergone treatment using the ROPA technique. This paper briefly describes the technique. Six pregnancies have been obtained from 13 embryo transfers. There were two miscarriages and there are three ongoing pregnancies, one of them twins. One healthy female baby was born. The following aspects are addressed: (i) legal status of lesbian couples in Western countries; (ii) the lesbian couple's access to assisted reproduction techniques; (iii) ethical aspects; (iv) medical acceptability; and (v) single mother versus lesbian mothers.
In countries where the ROPA technique is legal, it offers lesbian couples a more favourable route, involving both partners, to start a family, and doctors who treat lesbian couples must be sensitive to this new family model.
Previous research has not adequately addressed how gay and lesbian couples emotionally negotiate unequal biological ties to their children. Because each co-parent has the potential to be their child's biological parent and because same-sex couples highly value relationship equality, unequal biological ties to children may cause feelings of jealousy between co-parents. To counter this, increasing numbers of lesbian couples have been using in-vitro fertilization (IVF) to biologically co-mother, using the eggs of one partner and the womb of the other. While hardly common, this strategy can affect the emotional dynamics between the co-mothers and their children. This article explores how variables common to many lesbian-led families (including method of conception) may contribute to or protect against jealousy. Presented data comes from an 18-month ethnographic study of 30 lesbian-led families with young children living in a major northeastern city. Ten couples adopted infants, 10 couples used assisted insemination (AI), and 10 couples used IVF to biologically co-mother. Lesbians' use of IVF to co-mother has not been previously studied. Methods included in-depth interviews, participant observation, and self-administered questionnaires. Couples who adopted or used IVF reported less jealousy than couples who conceived using AI. Factors that correlate with the likelihood of experiencing maternal jealousy include both partners wanting to be a birth mother, perceptions of unequal biological ties to children, and infertility. Professionals serving lesbian co-mothers should be sensitive to the presence and absence of the above factors.
Does genetic relatedness define who is a mother or father and who incurs obligations towards or entitlements over children? While once the answer to this question may have been obvious, advances in reproductive technologies have complicated our understanding of what makes a parent. In a recent publication Bayne and Kolers argue for a pluralistic account of parenthood on the basis that genetic derivation, gestation, extended custody and sometimes intention to parent are sufficient (but not necessary) grounds for parenthood. Bayne and Kolers further suggest that definitions of parenthood are underpinned by the assumption that 'being causally implicated in the creation of a child is the key basis for being its parent'. This paper examines the claim that genetic relatedness is sufficient grounds for parenthood based on a causal connection between genetic parents and their offspring. I argue that parental obligations are about moral responsibility and not causal responsibility because we are not morally accountable for every consequence to which we causally contribute. My account includes the conditions generally held to apply to moral responsibility, i.e. freedom and foreseeability. I argue that parental responsibilities are generated whenever the birth of a child is a reasonably foreseeable consequence of voluntary actions. I consider the implications of this account for third parties involved in reproductive technologies. I argue that under some conditions the obligations generated by freely and foreseeably causing a child to exist can be justifiably transferred to others.
Fathers and abortion
- Di Nucci
Mothers, fathers, and “mathers”: negotiating a lesbian co-parental identity
- Padavic