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For couples where one or both partners are infected with human immunodeficiency virus or hepatitis C, the doors to receiving fertility care are opening as a result of better antiviral medication, better long-term prognosis and consequent changes in attitude. In line with this, fertility centres electing to treat couples with blood-borne viral (BBV) infection need to re-examine their policies and procedures to ensure the safety of their staff and both non-infected and infected patients during assisted reproduction treatments. At a time when the European Tissue Directive aims to introduce quality standards for assisted reproduction throughout Europe, we highlight the risks involved when treating patients with known BBV infections and argue that safety cannot be met with any certainty unless samples from such patients are handled within a separate high security laboratory or laboratory area, technically adapted to ensure minimal cross-contamination risk to uninfected gametes and embryos. [ABSTRACT FROM AUTHOR]

Between the many ethical questions that are still in debate around gamete donation, the authors analyse some of them including why oocyte and sperm donation are experienced very differently by couples, despite their apparent similarity, and stress the ethical impact of the difficulties of donor recruitment in all oocyte donation programs. The various types of donors (occasional, relational, IVF patient, and professional) are described with their motivations, resistances, advantages and disadvantages. The contradictory consequences with free or paid donation and the particular risks of oocyte donation (in comparison to sperm donation), both for the donor as for the recipient, are highlighted. The paper also examines the actual debate of gamete donors'' CMV serology status, as well as the question of eventual quarantine of donated oocytes. The problem of maintaining anonymity is then analysed in ethical terms but also in terms of technical efficacy. A strategy which, due to the decision of retaining anonymity, increases treatment efficacy by avoiding wastage of oocytes offered as a donation, is described. The pregnancy rate per donor oocyte pickup rises from 35% to 99% using this strategy, significantly reducing shortage. [Copyright &y& Elsevier]

Teams practising medically assisted reproduction techniques try to avoid viruses as much as possible. Attitudes towards chronic carriers of viruses are rapidly changing, especially for human immunodeficiency virus (HIV) patients. We focus our attention on the legitimacy of systematic screening before assisted reproductive techniques and the need for specialized approaches including an adapted laboratory for viral hazards as well as the need for a multidisciplinary team. Specificities of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) carriers and the hypothesis of a reduced fertility potential are discussed. Are male HIV carriers a new indication for assisted reproductive techniques in order to prevent virus transmission? It is largely proven that sperm gradient preparation techniques efficiently decrease viral loads and therefore have a protective effect on contamination risk during assisted reproductive techniques. Although a few thousand assisted reproductive technique cycles were performed in the world for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Two examples of contaminations during insemination are examined. Many questions remain unresolved, such as the lack of standardized techniques for semen preparation or virus detection or the relative merits of intrauterine insemination or ICSI to prevent HIV contamination during assisted reproductive techniques. The authors plead for well‐structured, separate programmes of care linked to research objectives. [ABSTRACT FROM AUTHOR]