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Abstract

Embryo donation is a radical mutation affecting the conception of individuals. In some cases, embryo donation may be the only solution available to remedy the problem of infertility, enabling the accomplishment of parent-born offspring without a genetic link. According to French law, the embryo is not a “simple” element of the human body, but a “potential person.”

This chapter aims to consider, from the perspective of a practitioner, some issues, including ethical issues, of the legislative framework of embryo donation in France. It is based on the principles given in the Law of Bioethics, i.e., anonymity, volunteering and gratuity, in the name of the ethical principle of equality of chances, i.e., justice, and prevention of commercial use of embryos. The status embryo donation in France includes the rights and obligations that are taken in equal parts in the regulations governing gamete donation and adoption in a speciﬁc ethical perspective, but raises a contrario ethical problems.

Regarding the choice and matching of embryos offered for donation, since there are few true genetic contraindications to intra-conjugal in vitro fertilization (IVF), this must also apply to embryo donation (i.e., the same risks and the same guarantees). However, differences exist regarding the autonomy and comprehensiveness of information available to couples who undergo IVF who have the choice whether to accept the risk or not, as this is not the case in embryo donation as currently regulated.

Embryo donation is scarce despite information campaigns, driving couples to undertake crossborder treatments, which leads to a discrimination according to the ﬁnancial level of couples.

In Europe and elsewhere, the laws, where they exist, and practices of embryo donation vary widely from one country to another. Further thought on the ethical virtues and defects of the framed practices is needed to enhance the debate.

Introduction

The story of embryo donation is a very good example of the conceptual complexities of parentage generated by assisted reproductive techniques (ARTs) with a third-party donor, and of the ethical questions and issues raised.

Embryo donation has been allowed in France since 1999 – approval was renewed in 2011 (Law n 2011-814 of 7 July 2011 relating to bioethics), but the practice of donation of supernumerary embryos by a couple (donor) to another couple (recipient) goes back more than 30 years in some parts of the world.

The ﬁrst case, reported in 1983, was that of a non-frozen embryo donation obtained using IVF (Trounson et al.1983) which resulted in a pregnancy that ended in miscarriage. At the same time, (Buster 1985) described the ﬁrst pregnancies resulting from donation of embryos obtained without IVF, by washing the uterus of donors. This method was quickly made obsolete by the introduction, success, and development of the embryo freezing technique. The same year, Trounson and Mohr reported the ﬁrst pregnancy after transfer of a frozen embryo, which ended in late abortion, and Zeilmaker et al. (1984) reported the birth of the ﬁrst children.

The annual worldwide report on the activities of ART for the year 2011, presented in 2015, notes that of the 1,281,472 cycles of all techniques, 62,811 involved donations of embryos (4.9 %).

Embryo Donation In France

This chapter aims to consider, from the perspective of a practitioner who has followed the ethical debates generated since the beginning of this technique, some of the issues regarding the legislative framework of embryo donation in France.

Historical And Legislative Framework

In France, embryo donation is covered by the Law of Bioethics of 29 July 1994, and the ﬁrst implementing decree dates from 1999; no technical difﬁculty in itself justiﬁed the 10-year period before obtaining the ﬁrst birth (2004). The law introduces collective responsibility via the concept of multidisciplinary accredited centers bringing together the various participants in the ART process. It stipulates that French ART centers are required to apply annually to couples with supernumerary frozen embryos to clarify their wishes as to their future. Four options are available to them:

Extend the storage of embryos to a maximum period of 5 years;
Stop storage of embryos, the couple having no further parental plan;
Donate the embryos for research;
Donate the embryos to an infertile couple.

The procedures for the donation/reception of embryos are very strict, based ﬁrst on the principles of anonymity, volunteering, and gratuity. There is no ﬁnancial compensation, and the donor couple cannot aspire to any afﬁliation with the child, will not know the recipient couple, the outcome of the gift, or the future of the embryo.

The objective is twofold:

First, to meet the desire for a child of couples with the dual impossibility of conceiving without recourse to other ARTs (or the combination of a sperm donation and egg donation, which is prohibited in France for the purpose of avoiding commercial drift).
Second, to consider a future for spare

embryos frozen after ART other than destruction or use for research, while mitigating the excesses of ART (excessive success, or, seen more positively, the consequences of good practices that limit the number of transferred embryos).

Legal Issues In Embryo Donation

The Status Of Embryo Donation Versus Donation Of Gametes And Adoption

The regulation governing embryo donation in France draws inspiration from the regulation managing the donation of gametes and adoption. This double afﬁliation makes for a peculiar mix (Epelboin 2008).

Embryo donation cannot simply be assimilated to gamete donation for several reasons. Jacques Testard, the biologist at the origin of the ﬁrst IVF birth in France in 1981, wrote that “besides the fact that already constituted embryo is rightfully considered a human being (and is likely to become a person), it is also an organism with established genome, since subsequent to genetic lottery which ﬁrst characterize the male and female meiosis and the association of gametes in fertilization” (Testard 2004, p. 33).

The embryo is the heir of its genetic parents, and therefore the source of potential genetic accidents (aneuploidy, translocations, mutations) that may affect the born person. However, the embryo being absolutely foreign to the host couple, there is no ability to take into account any potential risk factors compounded by matching with the recipient woman, except those known as the maternal–fetal incompatibility (Testard 2004).

Embryo Donation: Stepbrother Of The Donation Of Gametes

Embryo donation is assimilated to donor ART with regards to the principles of anonymity and gratuity. Both share the same technical conditions for donor couples: collection of the consent of the donor couple; transmission of this consent to the judge who can undertake the interview of the donor; and identiﬁcation of safety rules.

It is the same for recipient couples who, in turn, have an obligation to undertake discussions with the multidisciplinary team, one of whom will be a psychologist, and formalize their consent in front of a judge or a notary. This judge or notary delivers information on the consequences of receiving an embryo (the same as of gamete donation) with regard to the laws of ﬁliation.

Embryo Donation: Stepbrother Of Adoption

According to French law, the embryo is not a “simple” element of the human body, but a “potential person” – what causes the differentiation in law is the donation of gametes. The procedures for embryo donation therefore include a court order, and are close to those undertaken by couples adopting a child.

ART center practitioners must issue a certiﬁcate stating that the legal conditions have been checked and that there are no medical or psychological contraindications, as for an “in utero adoption.” The code of public health (Article L2141-6) stipulates that embryo reception is subject to a decision of the judicial authority. The judge ensures that the embryo recipient couple fulﬁls conditions envisaged in law, and he/she orders all investigations to assess “the conditions of reception this couple is likely to offer the unborn child on family, educational and psychological,” and even a social inquiry (sometimes at the couples’ expense); however, unlike adoption, the court’s refusal is not able to be questioned.

Nevertheless, as in the case of adoption after failure of ART, the court decision comes after years of treatment (and pain and disappointment) with a view to founding a family. A refusal built around the appreciation of a danger to entrust an embryo to a couple whose home does not seem consistent to a lawman would be in total contradiction to the previous medical decision and therapeutics and call it into question! This possibility of refusal by the judicial authority introduces a presumption of good parenting, absent in other ARTs. In comparison with gamete donation and adoption, the juridical regimen of embryo donation is therefore unprecedented.

Which Embryos To Provide For Donation?

The question of which embryos to provide for donation has been the subject of much debate as it can lead to identiﬁcation of categories of embryos that would be attributed to recipient couples also characterized. At ﬁrst, some advocated the acceptance of all supernumerary embryos “with few exceptions,” but differentiating so that couples accepting embryos “at potential risk” would be a priority. This position, which tends to rely on a greater or lesser willingness to procreate, presented the great risk of making a choice according to biological or sociological assessments of the host couple. An advanced justiﬁcation was that this strategy would allow, even if nobody wanted to receive “at risk” embryos, them “a chance of life, what was the wish of the parents” (Testard 2004).

The paradoxical perspectives facing teams are to accept the maximum number of embryos for donation in order to better meet demand, while discarding the embryos that are “at risk,” the risk being predominantly classiﬁed as genetic or viral. In France, the age of the donors and recipients is not speciﬁed in the legislative texts (out, as for all assisted procreation, is set for men using the fuzzy formula “of reproductive age,” set for women, due to their ﬁnancial support, is set at their 43rd birthday). Decisions are the responsibility of centers, which regularly review their indications.

The age of the donor, preceding family events, the indication for assisted procreation, or the techniques used raise questions with multiple answers. Thus, embryos from women 40 years and over (due to increased risks of miscarriage and Down syndrome) or which are at viral (HIV or hepatitis infection in one or both parents) or genetic risk are unanimously excluded. According to CECOS (Centers of Study and Conservation of the Oocytes and Semen), the age of the father should be limited to 45 years due to an increased risk of miscarriage and birth defects, but is this risk more than that resulting, for instance, from smoking, misfeeding, occupation, etc., which are not taken into account at the time of inclusion?

In terms of viral risk, every measure possible is implemented at the time of ART attempts to prevent transmission of HIV (Morlat et al. 2013).

The persistent reluctance regarding the residual risk of embryo donation from couples with HIV arises from universal and negative representations of this infection, and persists even when the requirement for repeated negative viral loads in the infected patient was absolute, their disease was stable at the time of the IVF attempt leading to conception of embryos, and safe children are born.

Genetically, some parental genetic or chromosomal factors can motivate the exclusion of embryos. Rigor in gaining a personal and family history is required, but the donor couple can refuse the constraint of additional genetic checks at the time of donation, particularly as they will have one or several children without a particular anomaly (Bettahar-Lebugle et al. 2007). Three examples of medical issues that justiﬁed the need for ART, from clinical experience, may shed light on the matter:

In utero exposure to diethylstilbestrol (Distilbène ), a medication prescribed in the USA until 1971 and in France until 1977 to pregnant women with a history of miscarriages, the adverse effects of which were mostly miscarriages, premature births, and infertility of uterine origin in the exposed generation, who were therefore candidates for ART. Recent studies on the third generation born from exposed women indicate an increased risk of hypospadias (abnormality of the urethra stoma) in boys, caused by a possible epigenetic mechanism. Diethylstilbestrol is considered to be an endocrine disruptor (Tournaire et al. 2014).
Cystic ﬁbrosis, an autosomal-dominant disease linked to a defect in the cystic ﬁbrosis trans membrane conductance regulator (CFTR) protein, the prognosis of which has greatly improved in recent decades, with lengthening of life expectancy and consequently plans for children. Men are deﬁnitely sterile by azoospermia (absence of sperm in the ejaculate), while infertility is inconsistent in women. There are no particular problems with ARTs but they must be preceded by genetic counseling and conﬁrmation of the absence of the mutation in the partner of the person with cystic ﬁbrosis. In this case, the risk to the child is regarded to be similar to that of the general population and does not justify a speciﬁc antenatal diagnosis.
Microdeletion of the Y chromosome, a so-called abnormality “de novo” often discovered in the etiologic checking of azoospermic males. IVF can be performed after testicular biopsy by intra-cytoplasmic sperm injection (ICSI).

These situations do not lead to refusal of ART in couples needing it. The aim is to clarify the reasons for a speciﬁc procedure for embryo donation, since the probability of transmission to the child is the same in these situations.

In the ﬁrst case, the still unclear or currently undervalued transgenerational effects of an endocrine disruptor are met. In the second, transmission to the embryo of an abnormal CFTR protein in the heterozygous condition is known, but the risk of homozygous disease is identical, after the other parent has been checked for CFTR, to that of the general population. In the third case, in the case of a male embryo, the reality is the transmission of the microdeletion of the Y chromosome, and subsequent sterility, in the boy as they grow up. In all cases potential exists and there are known consequences, making IVF and embryo transfer acceptable after sufﬁcient information is given to infertile couples. Nevertheless, for maximum safety, these embryos are generally not selected for donation. The inclusion or exclusion of these embryos for donation is partly based on personal representations of the risk/beneﬁt ratio of the members of the medical team.

What Are The Matching Rules Between Embryos And Recipient Couples?

The matching rules deﬁned by CECOS concern ﬁrst ethnicity, morphotype and blood groups, and should be applied wherever possible. The pairing in embryo donation, as in gamete donation, essentially aims for any dissimilarity between the child and recipient parents to not be identiﬁable (Brunet 2011). The main question remains the risk of disabilities of genetic origin, since the law does not consider that the use of pre-implantation diagnosis (PGD) for all embryos can be accommodated. With no possibility of PGD, recipient couples must be given information on any excess risk (age of the donor or otherwise) and this must be supplemented with prenatal diagnosis to provide reassuring news in early pregnancy after concerns have been sown.

The issue of PGD before embryo donation has not been raised when developing or revising texts, but embryo control would enlighten the real risk signiﬁcantly more than checks carried out on the genetic parents of the embryo: the aim would be to exclude embryos “at real risk” discovered during PGD, rather than to exclude embryos “at potential risk.” It would be logical to aim to produce children genetically better constituted than those of natural procreation, but this is both unrealizable under the conditions of very limited implementation of PGD in France, and, mainly, not desirable if one does not strive for the “perfect child.”

As with IVF, the respect of the autonomy of decision of the recipient couple must include information eliminating the assumption that biomedical intervention would guarantee them against the risk of abnormalities, a risk that can be ignored and subsequently experienced with the evolution of science. It would be irresponsible not to address the issue, and it is necessary to try to offer the recipient couple the maximum security, but does the security need to be superior?

Any procreation is “at risk.” Since there are few true genetic contraindications to intraconjugal IVF, this ﬁnding must also apply to embryo donation (i.e., the same risks and the same guarantees), otherwise this would create arbitrary categories of persons whose predicted medical problems could generate stricter attitudes regarding retention of these donated embryos. The danger, according to Testard (2004), is for it to be believed that human beings (persons or embryos) exist that are exempt from genetic risk, or to draw an arbitrary border between “healthy” and “at risk” embryos.

The difference is based on the autonomy and competence related to information available to couples who undergo IVF and who have the choice whether to accept a risk, although it is not the case in embryo donation as currently regulated. Most of the possible information concerning the donors or the embryo itself remains in the ownership of the practitioners responsible for the pairing, who make these decision regarding intervention, inclusion or exclusion alone, exposing couples to the illusion of safety and practitioners to undue unshared responsibility.

Parenting And Filiation Issues

With assisted procreative techniques, new modes of human conception have successively emerged, which, in turn, have generated a radical change in the concept of kinship, tossing out the pre-existing models. Anthropology, sociology, and psychoanalysis have taught us to consider that the ﬁliation of a person is a subtle blend of the innate (genetic capital) and asset (educational capital).

Parentage issues emerging from the debate on embryo donation equally affect the different actors and subjects of this medical reproductive course.

Parents who have performed the act of donation: can there be a detrimental impact on their future life, or transformation of their family and social image (generosity of the gift, or regret at not having been able to take on additional pregnancy)?
Parents who sought donation: will they be satisﬁed by their parenthood, acquired after a long medical course, or will they consider their child as having a foreign share in them? Will the technique separating the procreation of others of their gestation for the same embryo interfere in the acquisition of their parenting?
The child resulting from embryo donation: will he ﬁnd his place within the layers of the generations? What genealogy will he be able to associate with?
The children of the donor couple: will they be affected by the incomplete knowledge of possible siblings born from another mother?
Society: how will society incorporate these new families of unprecedented composition?

Answers to all of these questions are conditional on the maintenance, or the revelation, of the secret regarding the mode of procreation, both to the child and to the family and relational group, and question the principle of anonymity.

Motivations And Reservations Of The Donors

During consultations with couples who are considering donating their supernumerary embryos, it appears that most have completed their family, by choice or due to maternal age. Their choice between destruction, donation to research, and donation to another couple is inﬂuenced by their perception, which is very personal, of the supernumerary embryos, which inﬂuences their motivation for and/or their reservations against giving them.

When the embryo is regarded as the fruit of a past plan, rather than as a set of cells, couples have several motivations for this gift:

In relation to their past history: they see their donation as an extension of their parental project. Some mention the notion of the returning of a debt, including couples who beneﬁted from a sperm donor to procreate.
In relation to the supernumerary embryos: the expressed wish can be to give them a chance for a future, or, for other couples, not to give them up for destruction or to the anonymity of research. They evoke a responsibility in which they still feel invested with respect to their embryos, with a right of affective projection on their becoming children, and of the difﬁculties of giving potential “biological brothers and sisters” that are not socially related to their children.

Although aware of the rules regarding anonymity of the gift, some express their regret at not being able to have control over the choice of the recipient couple. In the renouncement they would like to obtain “warranties” of a beautiful life for the potential human person resulting from their ﬁrst desire. The desire of donor parents, when expressed, is to receive “non-identifying information” on the result of their donation and recipient couple. At the very least, the desire to know the outcome of their donation (selected embryos or not, uterine transfer or not) is often expressed.

These considerations, broadly discussed as part of the donation of gametes, cannot be seen in the same terms when it is about “potential human persons” already conceived in the course of a previous personal life.

At the end of 2012, in France there were more than 3000 couples with no further parental plans who had checked “embryo donation” on the annual letter from the French Biomedecine Agency, but for whom the approach was not pursued. Twenty-nine children were born from 136 embryo donation attempts, with 117 couples having beneﬁted from embryo reception and 173 waiting.

The difference in numbers probably lies in the complexity of the stages of the process, the emergence of reluctance by couples in the course of receiving information on the principles and practice of the donation, but also the mixed undertakings of some of the medical profession, which, according to its own projections, will not send the necessary reminders to the couples at the end of the process.

Host Couples And Their Children

Procreation via embryo reception in France meets the regulatory requirements of anonymity, but there is a need for updated discussion on the deﬁnition of kinship, the predominance or not of the biological over the social, and questioning of the biological origins (present in donated gametes). Confusion often occurs between genetic and genealogical links, i.e., biological determinism and sharing of history and lineage, respectively.

Anonymity And Family Secrets

In sperm donation, the position of professionals is to advise parents to reveal to the child his mode of conception. However, few parents wish to do so (Kunstmann et al. 2010). Little is known about the number of couples who actually inform the child, regardless of declarations of intent. The quest for knowledge of the biological father carried out by some young adults born from sperm donation and calling for the lifting of anonymity remains marginal; it is not expressed as the search for another father, but as a right to know their origins.

In oocytes donation, a more recent technique, not enough studies question the mothers about the revelation of the mode of conception to the child. Experience from monitoring pregnancies suggests, surprisingly, concealment of the “foreign” oocyte by recipient mothers, whose motherhood is shaped during the time of pregnancy by interaction with the fetus, and continues at the time of the delivery, at which point parentage is assigned in both physical and legal terms (Epelboin 2013).

Births After Embryo Donation

At the birth of the child of a “host mother,” ﬁliation is established as though the couple had procreated naturally (it cannot be contested), while in the adoption, the judgment, made remotely from birth, creates the ﬁliation. Parents are free to reveal or not to the child the secret of his conception, although there is a high probability of it being automatically raised, especially if there is no matching according to the criterion of blood groups or with the widespread DNA testing in various circumstances.

The revelation of his mode of conception to the child born from embryo donation can bring out imaginary thoughts concerning the original family and biological siblings. Whatever his quality of life and understanding of the history of his social parents, how are they not to envisage the possibility of devaluing self-interpretations, such as having been frozen, put on hold, disinvested, then given? It is clear there is a gap in our knowledge about the impact of the “environment of conception” and the effect of conception and pregnancy on subsequent quality of life.

How can we not accept the legitimacy of a request for access to this knowledge, since questions relating to being a former “potential human person” could arise later in the course of his life regarding another life that could have been his, if the embryo that became him had been chosen on the day of the ﬁrst embryonic transfer to the donor?

These questions also exist in adopted children, are not relevant after gamete donation. Dreifuss-Netter (2004) analyzed the afﬁrmation of the principle of anonymity present both in the Civil Code and the Code of Public Health in the sense that it avoids links of human relations between donors, recipients, and the child. She details the contradiction with the right of access to origins, stated in Article 7 of the United Nations Convention on the Rights of the Child. Since 2002, a National Council has been established for access to origins of adopted persons (and wards of the state). The legislator wished to establish a kinship between adoption and embryo donation, but what access to their origins would be given to children born from embryo donation?

In this ﬁeld there is no “ready-to-think” opinion, but the recent extension of stepfamilies trivializes the concept of the multiplication of kinship networks, and could be used as the basis for discussion of the issue of lifting of secrecy in the context of embryo donation. As an example of other models, Canadian legislation includes the following elements in regulation of assisted procreation: no protocol obliging destruction of embryos, the right to know your origins after adoption, and national programs for adoption of embryos. The concept is that of “having a pair”: the children of the donor couple and those adopted in utero, “siblings of genes,” are considered socially as “cousins” and will reshape genealogical links. The model of “snowﬂakes,” described by Collard and Zonaben (2013), is that of putting the families in contact to meet, and possibly go on holiday together with children that were twinned in incubators as embryos, the proscription of incest being guaranteed by the children having full information. This model also raises the possibility of new families created by sibling and not parental structure.

Embryo Donation: A New Model Of Parenting

What part of our biological or social history is preponderant? Is it possible to separate them? What models do we need to meet? In Anthropology of Parenting the psychoanalyst Geneviève Delaisi de Parceval (2007) asks about assisted reproduction, “can it shed light about the developments of kinship occurring during these transactions”? She recalls that “the adoption as children donation is a very common practice to palliate infertility in many societies.” The anthropologist Francoise Heritier (1996) wrote in a very current way that “All ersatzes of natural procreation we discover today have – or had – more or less institutional respondents in various historical or current societies (.. .). Without the use of technical devices which it was impossible to put in work (.. .), the simple game of social rules and speciﬁc representations of the person has contributed to the invention here and there of original situations which overcome individual sterility (.. .). The child is not always necessarily conceived in the womb of the “mother”, and parents may be more than two.”

In a large work, the anthropologist Maurice Godelier (2004) redeﬁnes kinship with reference to different stages of the “manufacture” of the child, that is to say, conception, gestation, and parturition. “While in our societies, the woman who gave birth to a child was seen as both the progenitor and mother of this child, from the time where we can artiﬁcially sever the three naturally indivisible moments of making this one, the question arises as to what are, for the child born in such conditions, the various women who have one after the other contributed to his birth … [The parental] functions are mostly divisible, and sharable, and can therefore be redistributed in very different ways.”

In embryo donation, when a potential human is issued from elsewhere (another couple), pregnancy is the time during which the nourishing role of the mother expresses itself, and is ﬁnalized at birth, determining ﬁliation. In direct opposition to that of well-known “surrogate mothers” pregnant after transfer of another couple’s embryo, for their beneﬁt, pregnancy after embryo donation is a motherhood of substitution, which is initiated as a contract and becomes a social reality through pregnancy.

The Traditional Circulation Of Children

The anthropologist Suzanne Lallemand (1993) described the widespread systems of kinship called “classiﬁcatory.” These are a set of relatives more or less biologically afﬁliated with the child, or who belong to the biological or social group of the parents.

In many places in the world, children are not systematically brought up in the parental home. Lallemand gives examples of the circulation of children in many societies by distinguishing two types of transfers: adoption and guarding (or fosterage). The ﬁrst “can implicate the secret of origins, is supposed to … be lasting, non-reversible, and deprives the parents of their rights and duties relating to the child.” This type of transfer reminds us of regulations in force in France for plenary adoption … and embryo donation. In contrast, the second is “a momentary situation, it ﬁts to circumstances since it assumes sharing or alternating parental prerogatives.” There is, therefore, in this practice, no ambiguity in relation to the secret of origins (as well as in the Canadian model of embryo donation) (Lallemand 1993).

The Choice Between Embryo Donation And Double Donation Of Gametes

Between the complexity of the process and waiting times, many couples who are candidates for embryo donation resign themselves to taking costly steps in bordering countries where the offer of donations is numerically superior and where the legislative supervision differs, notably regarding the remuneration of donors. Besides the lack of opportunities in France, other motivations can lead couples to choose, if they can afford it ﬁnancially, to go abroad for double gamete donation. This choice is expressed as the desire to free themselves and the child of a history that is not theirs, separated from the parental plan of other people, and to start the family romance with a future child designed for them from gametes whose anonymity suits them, without prior affect.

Given this comprehensive perspective, it seems urgent to reconsider access to double gamete donation in France, which would need to be statutorily supervised to avoid abuse.

Ethical Considerations In Europe

The laws, where they exist, and practices regarding embryo donation vary widely from one country to another. At a European level, guidelines published in 2002 by the European Society of Human Reproduction (ESHRE) (ESHRE 2002) have highlighted ethical considerations concerning gametes and embryo donation. Basic principles are outlined, focusing, as in France, on the issues raised by the meaning of genetic links, regulation, and the necessity of taking into account the welfare of the child. Relevant speciﬁc aspects concern anonymity, compensation for donation, and the consent, screening and assessment of donors and recipients.

Concerning anonymity, the conclusions are that there is no single ideal solution, as several different rights are to be respected: parents’ autonomy and privacy, donor’s privacy, the child’s right to know his/her origin, etc. The proposed system frames the choice about the anonymity or identiﬁability of the donor, to keep the donation secret or not, within the right of parental autonomy – there is no objection per se to known donation.

Concerning payment, the ESHRE Task Forces states that, in principle, there should be no payment for the donation of biological material; this does not exclude reasonable compensation for the effort of the donor, but note that in many countries a gratuity is not applied.

Concerning recruitment and screening of the donors, these processes should include psychological evaluation of their general abilities and intellectual capacity. There is no consensus on the psychosocial indications for gamete or embryo donation. However, it is speciﬁed that special attention should be given to the fact that donating and/or receiving gametes has long-term implications and, surprisingly, nothing is speciﬁed in the case of embryo donation!

Conclusion

Embryo donation is a radical mutation that affects the conception of individuals. In some cases, embryo donation may be the only solution available to remedy the problem of infertility, enabling the accomplishment of parent-born offspring without a genetic link. Debate on this subject is open within society, which raises ideological questions involving conﬂicting interests – those of donor and recipient couples and that of the child, whose origins are complex, though his ﬁliation is legally clear. Questions may be extended to the anthropological knowledge of societies in which sharing systems of parenting exist. The status of embryo donation in France includes the rights and obligations that are taken in equal parts in the regulations governing gamete donation and adoption in a speciﬁc ethical perspective. The legislative framework for this technology in France, which reasserts, as for donations of gametes, the principles of anonymity and gratuity/ being free from payment (in the name of the ethical principle of equality of chances), justice, and prevention of commercial uses of embryos, raises a contrario ethical problems.

Concerning gratuity, if there is no commercial questions, it is scarceness in spite of the campaigns of information, and the infertile couples will experiment cross-border treatments conditioned by their economic possibilities, opposite to the principle of justice. With respect to anonymity, the limited autonomy of recipient couples in the donor decision, as they are not involved in the selection of embryos and matching, and doubts about the beneﬁcence–non-maleﬁcence of all protagonists in the building of their genealogical history is a concern.

Reconsidering the possibility of framed double gamete donation as an alternative to embryo donation should meet the desire of sterile couples to free themselves and their child of a history that can be considered to be a burden.

At a time when some American institutions offer the sale of surplus embryos to couples experiencing double infertility for a price of up to US$20,000, rational thinking on the virtues and defects of a framed practice is still relevant.

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