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In March 2012, an article in The Straits Times entitled 'Freezing eggs could reverse falling birth rate' suggested that employing the latest oocyte cryopreservation techniques could both foster individual women's reproductive autonomy and impact Singapore's fertility rate, which in recent years has consistently been among the world's lowest. The article cited both local and international fertility specialists' approval of elective oocyte cryopreservation for young women wishing to protect their reproductive potential against ageing and as a potential antidote to the contemporary 'delay and defer' model of family-building. Later in 2012, the Ministry of Health announced a review of oocyte cryopreservation policy taking into account related medical, scientific and ethical issues, while the Singapore College of Obstetricians and Gynaecologists endorsed oocyte cryopreservation as an "important, safe and efficient technology". This paper outlines and analyses the arguments and empirical evidence used both to support and oppose offering elective oocyte cryopreservation as a routine fertility service, before concluding that this remains unjustifiable on the basis of insufficient evidence of its clinical efficacy and safety as regards either pregnancy rates or birth outcomes. If it is to be made available at all for these reasons in Singapore, it should be subjected to rigorous clinic-specific evaluation in accordance with accepted clinical and ethical norms.

There are substantial numbers of frozen embryos in storage that will not be used by those who produced them for their own fertility treatment. One option for such embryos is to donate them to others to use in their fertility treatment. There has been considerable debate about how this process should be organized. In the US, there are embryo adoption programmes that mediate between those relinquishing embryos and potential recipients. This is a form of conditional embryo donation, where the relinquishing couple can choose the recipient of their embryo. This article examines the ethical debate over conditional embryo donation for family building and explores the question of whether those who have unused frozen embryos should be able to determine who receives their embryos. The main objections to conditional embryo donation are examined: first, the embryo is not a person and therefore such concern over the placement of an embryo is unwarranted; secondly, potential donors might impose morally problematic conditions on who should receive their embryo; and thirdly, there are practical difficulties regarding organizational arrangements and the associated costs involved. It will be concluded that these objections can be countered and that if people wish to donate and receive embryos in this way there is no ethical objection to them doing so., (© 2013 John Wiley & Sons Ltd.)

We investigated the use of adoptively transferred donor-derived cytomegalovirus (CMV) specific cytotoxic T lymphocytes (CTL) as immune reconstitution postallogeneic transplant in a phase 2 study. Fifty patients were infused with a single dose of 2 × 10(7)cells/m(2) after day 28 post-transplant. Twenty-six patients reactivated CMV posttransplant (only 5 post-CTL infusion) and 9 required therapy with ganciclovir or foscarnet (only 1 post-CTL infusion). There was 1 case of fatal CMV disease, attributable to high levels of antithymocyte globulin at the time of T cell infusion. We compared the patients in the phase 2 study with a group of contemporaneous controls also treated at the trial centers. There was no increase in acute or chronic graft-versus-host disease attributable to CTL infusion; overall and progression-free survival were similar in both groups. There was a reduction in the percentage of patients who required CMV directed antiviral therapy (17% vs 36%, P = .01) and in the total number of treatment days in the cohort receiving CTL (3.4 days vs 8.9 days, P = .03) without a reduction in CMV reactivation rates. We postulate that adoptively transferred cells are able to expand in response to viral antigen, limit viral replication, and prevent progression to tissue infection. This study was registered on the Australian Clinical Trial Registry as #ACTRN12605000213640 and #ACTRN12607000224426.

Uncontrolled cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplantation causes significant morbidity and mortality. Adoptive transfer of CMV-specific cytotoxic T lymphocytes (CTLs) is a promising therapy to treat reactivation and prevent viral disease. In this article, we describe the generation of clinical-grade CMV-specific CTLs directly from granulocyte colony-stimulating factor-mobilized hemopoietic progenitor cell (G-HPC) products collected for transplantation. This method requires less than 2.5% of a typical G-HPC product to reproducibly expand CMV-specific CTLs ex vivo. Comparison of 11 CMV CTL lines generated from G-HPC products with 52 CMV CTL lines generated from nonmobilized peripheral blood revealed similar expansion kinetics and phenotype. G-HPC-derived CTLs produced IFN-γ after reexposure to CMVpp65 antigen and exhibited CMV-directed cytotoxicity but no alloreactivity against transplantation recipient-derived cells. Seven patients received CMV-specific CTL lines expanded from G-HPC products in a prophylactic adoptive immunotherapy phase I/II clinical trial. Use of G-HPC products will facilitate integration of CTL generation into established quality systems of transplantation centers and more rapid inclusion of T cell therapies into routine clinical care., (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

This paper reports on and discusses the findings of an online survey initiated by the Donor Sibling Registry of 108 parents of children conceived following oocyte donation. Respondents generally supported early disclosure of donor conception to the child, although some bias in favour of disclosure cannot be excluded, given the recruitment source. Even so, extensive uncertainty regarding the optimum time for disclosure was evident. Around half of the parents who had either expressly chosen (50.0%), or had been given no choice of, an anonymous donor (54.1%) subsequently wished they had used an open-identity donor. A total of 87% of respondents showed interest in identifying and making contact with their donor and with other families containing children sharing the same donor, and 19% had already made such contact. The survey revealed considerable variations in respondents' experiences of clinic practices regarding the availability of counselling, information provided about choice of donor type, advice regarding disclosure and the reporting of births, indicating keys areas for improved professional practice. This paper reports on and discusses the findings of an online survey initiated by the Donor Sibling Registry of 108 parents of children conceived following ooctye donation. Respondents generally supported early disclosure of donor conception to the child, although extensive uncertainty regarding the optimum time for disclosure was evident. Around half of the parents who had either expressly chosen, or had been given no choice of, an anonymous donor subsequently wished they had used an open identity donor. A number of respondents showed interest in identifying and making contact with their donor and with other families containing children sharing the same donor, and a minority had already made such contact. The survey revealed considerable variations in respondents' experiences of clinic practices regarding the availability of counselling, information provided about choice of donor type, advice regarding disclosure and the reporting of births, indicating keys areas for improved professional practice., (Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Aspergillus fumigatus infections are the leading cause of invasive fungal infection-related deaths in stem cell transplant patients, and may be amenable to correction with adoptive immunotherapy providing T lymphocytes specific for A. fumigatus. However, a clinically usable source of antigen and a reliable procedure for the generation of large numbers of Aspergillus-specific T lymphocytes to clinical-grade standards is not available., Methods: An environmental strain of A. fumigatus (WMAfES) was isolated and cultured using materials and reagents suitable for clinical manufacture. Water-soluble lysate from germinated conidia of WMAfES was used as the antigen source. Peripheral blood mononuclear cells were stimulated with antigen-pulsed autologous dendritic cells on days 0 and 7. Cells were expanded with a cocktail of interleukin (IL)-2, IL-7 and IL-15 from days 7 to 21., Results: We obtained a mean 32.8-fold increase in cell numbers over 21 days of culture (n = 8). Resultant cultures were predominantly effector and central memory CD4(+) T cells, which produced T-helper (h)1 and Th17 cytokines when restimulated with A. fumigatus antigen derived from environmental or clinically isolated A. fumigatus. Cultured cells exhibited a high level of specific expansion and chemokine production when restimulated. Moreover, cultured cells cross-reacted with antigens from other fungi, including Penicillium, Candida albicans and other non-fumigatus Aspergillus species., Conclusions: We describe a simple, robust, reproducible and clinically applicable procedure using a clinically appropriate antigen preparation for the expansion of polyfunctional A. fumigatus-specific T cells from normal donors of varying HLA types.

Background Aims: Varicella zoster virus (VZV) causes life-long latent infection in healthy individuals, which reactivates in 10-68% of stem cell transplant patients. Reconstituting immunity through adoptive transfer of T cells specific for VZV may aid in the prophylaxis and treatment of VZV infections. The potential for generating T cells specific for VZV using a clinically approved VZV vaccine strain was investigated., Methods: The Varivax® vaccine was used to stimulate peripheral blood mononuclear cells from healthy donors. Only reagents approved for clinical manufacture were used. Monocyte-derived dendritic cells pulsed with Varivax (R) were used to stimulate autologous mononuclear cells at a responder to stimulator ratio of 10:1. On day 7, a second stimulation was performed; 20 U/mL interleukin (IL)-2 were added from day 7 and 50 U/mL IL-2 from day 14 onwards. Cell phenotype and functionality were assessed after 21 days of culture., Results: A mean increase of 11-fold in cell number was observed (n= 18). Cultures were mainly T cells (mean CD3 (+) 89.7%, CD4 (+) 54.2%, CD8 (+) 28.7%) with effector and central memory phenotypes. Cells produced one or more T helper (Th)1 cytokine (interferon-γ, tumor necrosis factor-α and IL-2), and CD4 (+) (but not CD8 (+) ) cells expressed the cytoxicity marker CD107 when restimulated with VZV antigens., Conclusions: We have demonstrated a clinically applicable method that yields high numbers of highly reactive T cells specific for VZV. We propose that reconstructing host immunity through adoptive transfer of VZV-specific T cells will reduce the frequency of clinical VZV infection in the period of severe immune suppression that follows allogeneic stem cell transplantation.

Background: It is widely accepted that infertility and involuntary childlessness, and the decision to engage with assisted reproduction technology (ART) services as a patient, donor or surrogate can entail wide-ranging psychosocial issues. Psychosocial counselling has, therefore, become valued as an integral element of ART services. The objective of this study was to begin to map out what exists globally by the way of guidelines for infertility counselling., Methods: Data were analysed from formal guidelines produced by seven national infertility counselling bodies, onetransnational infertility counselling organization, reports of the American Society for Reproductive Medicine Ethics Committee and Practice Committee and the ESHRE Task Force on Ethics and Law. Additional sources of data were the International Infertility Counseling Organization and counselling colleagues internationally., Results: Four broad areas concerning contemporary practice in infertility counselling are identified: (i) the legal mandate for counselling; (ii) eligibility credentials for individuals carrying out professional counselling activities; (iii) different forms of counselling and (iv) counselling practice in relation to specific elements of assisted reproduction treatment., Conclusions: Internationally, the development of infertility guidelines is best described as a 'work in progress', although key trends are evident.

This article reports on a systematic review of English language, peer-reviewed publications from 13 empirical studies with donor-conceived children and adults regarding their experiences and perceptions of donor conception. A total of 19 articles that met the inclusion criteria were reviewed. These were identified by means of a bibliographic search of four electronic databases for the period 1990-2011 and supplemented by the authors' personal knowledge of work in this field. No reports from such studies appeared prior to 2000, and more than half have been published since 2008, demonstrating the relative novelty of research in this field. Much of the reviewed research evidence concerns individuals conceived through sperm donation conducted under a regime promoting both anonymity and nondisclosure. Consequently, there is little research that pertains to individuals conceived through other forms of collaborative reproduction, nor to those conceived under arrangements and regimes in which early parental disclosure is both advocated and practised and the identity of the donor and of other genetic relatives may be accessible to donor-conceived individuals. The studies consistently report that most donor-conceived people have an interest in securing information about their genetic and biographical heritage - more information than most of them have been able to obtain. Although a number of methodological limitations in the research base are identified, the authors conclude that the evidence is sufficiently robust to promote the implementation of policies and practices that promote transparency and openness in collaborative reproduction, thus reflecting the importance of maximising future choices and opportunities for donor-conceived people.

This exploratory qualitative study investigates the experiences of eight adults conceived following anonymous sperm donation who had discovered the identity both of their donor and of donor half-siblings and had established contact with each other. It focuses primarily on participants' reflections on genetic and social kinship relationships. Data were collected from this group as well as from the son of the donor and the donor-conceived half-sister of one participant by means of semistructured interviews utilizing asynchronous email and digitalized voice recording. Participants discussed their experience of genetic disconnection resulting from learning of their donor-conceived status and of revising their personal biographies and developing new kinship networks as a result of discovering the identity of their donor and the existence of donor half-siblings. The study highlights participants' agency expressed through their ability to draw on both genetic and non-genetic elements of their inheritance to redefine their self-identity and extend their familial/kinship networks in meaningful ways., (Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Cross-border reproductive services (CBRS) is a phenomenon discussed worldwide. The major challenges associated with CBRS are the lack of data on the number of patients travelling for treatment and lack of transparency regarding the quality and safety of treatment procedures, especially in countries that have not yet introduced legislation or binding professional guidelines. This has given rise to practices that range from dubious to irresponsible treatment. Given that pan-European (let alone globally encompassing) legislation or guidelines are unlikely to appear quickly if at all, the authors suggest the implementation of ethically based minimum standards of care to which clinics and service providers can adhere on a voluntary basis. Such minimum standards of care can result in providing infertility treatment that is transparent, accountable and carried out responsibly for all parties involved.

Background Aims: Influenza viruses cause potentially fatal respiratory infections in stem cell transplant patients. Specific T cells provide long-lived host adaptive immunity to influenza viruses, and the potential for generating such cells for clinical use was investigated., Methods: The inactivated influenza vaccine (Fluvax) approved for human use was used as the antigen source. Monocyte-derived dendritic cells pulsed with Fluvax were used to stimulate autologous peripheral blood mononuclear cells (PBMC) on days 0 and 7. Cells were expanded with interleukin (IL)-2 from day 7 onwards. Cell numbers and phenotype were assessed on day 21. The presence of influenza virus-specific cells was assessed by cytokine production and proliferative responses following restimulation with influenza antigens., Results: Over 21 days of culture, a mean fold increase of 26.3 in cell number was observed (n = 7). Cultures were predominantly effector and central memory CD4+ cells, and expressed a phenotype characteristic of activated antigen-specific cells capable of B-cell helper function. Cytotoxic CD4+ and CD8+ cells specific for influenza and a high percentage of CD4+ cells specific for each of three influenza viruses targeted by Fluvax (H1N1, H3N2 and Brisbane viruses) were generated. In addition, T cells expanded when restimulated with antigens derived from influenza viruses., Conclusions: We have demonstrated a clinically usable method for producing influenza virus-specific T cells that yield high numbers of highly reactive CD4+ cells suitable for adoptive immunotherapy. We propose that reconstructing host immunity through adoptive transfer of influenza virus-specific T cells will reduce the frequency of influenza-related deaths in the period of severe immune suppression that follows stem cell transplantation.

We report the views of 33 women who were involved in an altruistic oocyte donation program about provisions under Canada's Assisted Human Reproduction Act 2004 to prohibit donor compensation and to establish a Personal Health Information Registry. The participants had been either donors of oocytes to a recipient known to them (15) or recipients of such donation (18) through services provided by a clinic in a large Canadian city, and they each participated in a semi-structured face-to-face or telephone interview. Among the 15 donor participants, seven were friends of the recipient, six were sisters, one was a niece of the recipient, and one donor donated twice, once to her sister and once to a friend. In eight cases the donor and recipient participated in interviews independently. At the time of interview, 11 of the 25 separate cases had resulted in a live birth and one in an ongoing pregnancy, so that "successful" and "unsuccessful" donations were equally represented among participants. While divergent views were reported among and between donors and recipients on an altruistic model versus a compensated model of donation, most participants largely endorsed the establishment of a personal health information registry.

Background: Currently, there is little evidence about conditional relinquishment of frozen embryos to others for family-building. This paper begins to address this gap by reporting findings from a study that investigated the experiences of couples who chose to relinquish their embryos conditionally through an embryo 'adoption' programme., Methods: An exploratory qualitative study was conducted between September 2008 and December 2009. Participants were recruited from a Christian embryo 'adoption' programme in the USA. Forty-three people (18 couples and 7 wives) participated in in-depth email interviews., Results: The data show that the following factors contributed to the participants choosing an embryo 'adoption' programme: how they conceptualized their embryos; dislike of alternative disposition options available; conceptions of their parental responsibility towards their embryo and a desire to have an 'open' relinquishment with (varying) degrees of information-sharing and contact arrangements between themselves and recipient couples., Conclusions: This study identifies a diversity of views on embryo relinquishment and some couples' wishes for elements of conditional relinquishment that are offered by embryo 'adoption' programmes. A range of disposition options should be available to enhance choice for those with unused embryos so that they can relinquish in ways that are both morally and practically acceptable to them. The current polarized debate concerning the language of embryo 'adoption' detracts attention from the practical considerations of formulating 'best practice' in this area. These considerations are better addressed by the use of less politically charged terminology such as 'conditional relinquishment'.

This paper reports on a Canadian study of the views of 15 women who had altruistically donated oocytes to a friend or a relative for family building and 18 women who had received oocytes donated by a friend or a relative towards disclosure of the donation to both the donor-conceived child and the child(ren) of the donor. Semi-structured interviews were undertaken with participants either in person or by telephone. The vast majority of donors and recipients reported concordance regarding disclosure. There was a greater tendency towards disclosure than for non-disclosure, especially where the donation had resulted in the birth of a child. Nevertheless, participants expressed considerable ambiguity around the optimum time for disclosure. The study highlights unique characteristics in co-ordinating disclosure plans to children in both families when the donors also had young child(ren) and how the relationships between donors and recipients and their families may be expected to impact on, and be impacted by, their disclosure decisions. These include the psychological and social costs that may occur when donors and recipients disagree regarding disclosure. Findings from this study contribute to the currently limited research evidence on disclosure to children in both donor and recipient families following known oocyte donation. This paper reports on a Canadian study of the views of 15 women who had altruistically donated oocytes to a friend or a relative for family building and 18 women who had received oocytes donated by a friend or a relative towards disclosure of the donation to both the donor-conceived child and the child(ren) of the donor. Semi-structured interviews were undertaken with participants either in person or by telephone. The vast majority of donors and recipients reported concordance regarding disclosure. There was a greater tendency towards disclosure than for non-disclosure, especially where the donation had resulted in the birth of a child. Nevertheless, participants expressed considerable ambiguity around the optimum time for disclosure. The study highlights unique characteristics in co-ordinating disclosure plans to children in both families when the donors also had young child(ren), and how the relationships between donors and recipients and their families may be expected to impact on, and be impacted by, their disclosure decisions. These include the psychological and social costs that may occur when donors and recipients disagree regarding disclosure. Findings from this study contribute to the currently limited research evidence on disclosure to children in both donor and recipient families following known oocyte donation., (Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: BK virus (BKV) infection causes hemorrhagic cystitis posthemopoietic stem-cell transplant and graft loss in renal transplant recipients. Reactivation occurs in up to 60% of patients in both groups. Treatment-related cellular immunosuppression is a major contributor to the development of BKV-related disease, but the targets of the immune response are not well characterized. Immunotherapy by adoptive transfer of cellular effectors has been shown to be effective in controlling and preventing some virus-related diseases in transplant recipients, particularly Epstein-Barr virus and cytomegalovirus. Infusion of BKV-specific T cells may potentially reconstitute functional BKV immunity and reduce clinical complications of BKV infection., Methods: BKV-specific T cells for clinical use in adoptive immunotherapy were generated using monocyte-derived dendritic cells pulsed with overlapping peptide mixes spanning the five BKV proteins VP1, VP2, VP3, large T antigen, and small T antigen. Phenotypic and functional characteristics of the cells were investigated as well as their antigen specificity., Results: Expanded CD4(+) and CD8(+) cells responded to restimulation with BKV peptides principally from VP1, large T, or small T antigens; produced multiple cytokines; and showed cytotoxic activity against antigen-coated targets., Conclusions: Possible clinical uses for BKV-specific T cells generated using this method include immune reconstitution posthemopoietic stem-cell transplantation or prophylaxis and treatment of immune deficiency in renal transplant recipients, fulfilling the need for effective therapy for BKV-related hemorrhagic cystitis and renal dysfunction.

Encountering infertility and involuntary childlessness and undergoing infertility treatment are acknowledged as stressful experiences that impact on individuals' psychological and emotional health – and for which access to psychosocial counselling by a skilled mental health professional may be beneficial. Evidence of patients', gamete donors' and surrogates' experiences indicates that utilization of infertility treatment in another country may not only exacerbate these psychosocial adversities, but may also pose additional risks to the psychological or physical health of participants, thus further emphasizing the need for competent psychosocial counselling services in cross-border reproductive care. However, this is a largely neglected topic in recent discussions of both CBRC itself and of infertility counselling practice. This paper extends the previous work undertaken by two of the authors to begin to map out practice issues within an ethical framework for counsellors when working with clients, donors, surrogates, individuals conceived following infertility treatment and existing children in clients', donor's and surrogates' families where cross-border reproductive treatment is considered or undertaken., (Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: We sought the views of women who took part in an altruistic known oocyte donation program to provide insights into the dynamics of known oocyte donation in Canada., Methods: Semi-structured interviews were conducted face-to-face or by telephone with 15 Canadian women who had donated oocytes to a friend or a relative for family-building and 18 women who had received oocytes donated by a friend or a relative in the eight years prior to the interview., Results: Donors and recipients recounted few problems with their experiences of oocyte donation. Donors' positive experiences were contingent on their desire to facilitate the family-building aspirations of a friend or relative and the trusting relationship they had with their recipient. These dynamics subsequently affected their perceptions regarding the embryos created using their oocytes and their relationship with any child born as a result of their donation. Most donors would not donate their oocytes to an anonymous recipient and would not support donating unused embryos created with their oocytes to an unknown recipient., Conclusion: Altruistic known donation is an important feature of oocyte donation programs in Canada, where commercial procurement of gametes is forbidden. Legal clarity, information, and psychosocial counselling are essential to minimize relationship problems in known oocyte donation.

Background: There are few systematic studies of the incidence of cross-border fertility care and even fewer reports of qualitative research with those undertaking treatment outside their country of origin. This paper reports findings from a qualitative study of UK residents with experience of cross-border care: the socio-demographic characteristics of UK travellers; their reasons for seeking treatment abroad; the treatments they sought; the destinations they chose and the outcomes of their treatment., Methods: Data regarding cross-border fertility treatment were collected from a purposive sample of 51 people by means of in-depth, semi-structured interviews between May 2009 and June 2010. Data were analysed using a systematic thematic coding method and also subjected to quantitative translation., Results: Patient motivations for travelling abroad are complex. A desire for timely and affordable treatment with donor gametes was evident in a high number of cases (71%). However, most people gave several reasons, including: the cost of UK treatment; higher success rates abroad; treatment in a less stressful environment and dissatisfaction with UK treatment. People travelled to 13 different countries, the most popular being Spain and the Czech Republic. Most organized their own treatment and travel. The mean age of women seeking treatment was 38.8 years (range 29-46 years) and the multiple pregnancy rate was 19%., Conclusions: UK residents have diverse reasons for, and approaches to, seeking overseas treatment and do not conform to media stereotypes. Further research is needed to explore implications of cross-border treatment for donors, offspring and healthcare systems.

Cross-border reproductive care (CBRC) has attracted considerable attention in media and professional publications. The aim of this review is to present a critical narrative overview of the published evidence on CBRC. A systematic search of key academic databases was undertaken with no time restrictions set for publication. This was supplemented by additional searches of key websites, reference chaining and enquiries to people working in the field. A total of 54 items are included in the review, including both empirical research studies (18) and debate papers (36). The key themes discussed are: terminology and definitions; incidence; experiences; explanations; implications; and policy responses. Significant methodological limitations and gaps in the literature are identified. Evidence on incidence is scant, though it suggests that CBRC is increasing. The literature suggests legal, social and political drivers, which vary in importance geographically and between individuals. Limited findings on patient perceptions suggest a broadly positive patient experience. Suggested policy responses include prohibition, regulatory harmonization and harm minimization. There is a need for better international data collection tools and both quantitative and qualitative work which encompasses views of patients, donors, surrogates and professionals and which explores the implications for healthcare services in sending countries., (Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

This qualitative study sought to provide an in-depth understanding of the experiences of couples who have relinquished their stored frozen embryos to one or more infertile couples. All couples were recruited through a U.S. based not-for-profit, prolife, Christian "embryo adoption" agency. In-depth semistructured interviews were undertaken via e-mail. Implications for practice strategies, including effective ways for educating couples with surplus frozen embryos are offered., (PsycINFO Database Record Copyright (c) 2010 APA, all rights reserved)

Objective: To obtain pertinent information from individuals who have either experienced cross-border reproductive care, or have considered doing so., Design: International online survey of patients in collaboration with patient support groups in Australia and Canada., Result(s): Analysis of data is based on 95 usable responses, of which 28 were from individuals who indicated that they had previously participated in cross-border reproductive care. Key areas investigated in the survey included the reasons for undertaking or considering cross-border reproductive care, the specific reproductive services sought, countries in which reproductive care is sought, and participants' experiences of cross-border reproductive services. This study identified the availability of counseling services and other factors affecting patient experiences as important issues that participants considered should be taken into account by potential users of cross-border reproductive care. The internet and other media were shown to be significant sources of information about reproductive services in other countries., Conclusion(s): This study highlights an essential need for accessible, accurate, and reliable information to help ensure safe and high quality care, as well as emphasizing the role that clinics in patients' home countries, feedback from other patients, governments, regulatory agencies, and Internet-based services might play in making this information more readily available., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Cytomegalovirus (CMV) and its therapy continue to contribute to morbidity and mortality in hemopoietic stem cell transplantation (HSCT). Many studies have demonstrated the feasibility of in vitro generation of CMV-specific T cells for adoptive immunotherapy of CMV. Few clinical trials have been performed showing the safety and efficacy of this approach in vivo. In this study, donor-derived, CMV-specific T cells were generated for 12 adult HSCT patients by stimulation with dendritic cells transduced with an adenoviral vector encoding the CMV-pp65 protein. Patients received a prophylactic infusion of T cells after day 28 after HSCT. There were no infusion related adverse events. CMV DNAemia was detected in 4 patients after infusion but was of low level. No patient required CMV-specific pharmacotherapy. Immune reconstitution to CMV was demonstrated by enzyme linked immunospot assay in all recipients with rapid increases in predominantly CMV-pp65 directed immunity in 5. Rates of graft-versus-host disease, infection, and death were not increased compared with expected. These results add to the growing evidence of the safety and efficacy of immunotherapy of CMV in HSCT, supporting its more widespread use. This study was registered at www.anzctr.org.au as #ACTRN12605000213640.

This paper examines the main ethical argument used to support the use of sex selection for non-medical reasons, namely that sex selection for non-medical reasons should be allowed on the grounds of reproductive autonomy. A critique of this argument is offered, concluding that sex selection for non-medical reasons should not be permitted.

Protein Z (PZ) is a vitamin K dependent serine protease inhibitor, which along with its cofactor Protein Z-dependant protease inhibitor (ZPI) has anti-Xa activity. PZ has previously been reported to be elevated in patients with end-stage chronic kidney disease (CKD) on haemodialysis but not in non-dialysed CKD patients raising the possibility that PZ may have a role in the bleeding diathesis of patients on haemodyalisis. PZ was measured in controls (n = 18), CKD on haemodialysis (n = 23) and CKD not on dialysis (n = 23). Patients on vitamin K antagonists, with acute inflammatory conditions (as measured by CRP) or liver dysfunction were excluded PZ levels were reduced in CKD patients when compared to levels in the control group (1.35 mug/mL vs 1.80 respectively, p = 0.022). Subgroup analysis revealed a trend toward reduction in mean PZ in the CKD subgroups (non-dialysed CKD group 1.37 (p = 0.08); haemodialysis 1.33 (p = 0.12)). There were no significant differences in the PZ levels for different stages of non-dialysed CKD patients when stratified by the level of glomerular filtration rate (GFR). These data show that PZ levels were reduced in patients with CKD, and not elevated in patients on haemodialysis, arguing against a role for PZ in the bleeding diathesis of renal failure. This finding is in contradiction to a previous report which found PZ to be elevated in patients on haemodialysis.

Background: In 2005, UK legislation was changed requiring any donor of gametes or embryos used in the treatment of others to agree to the disclosure of their identity to any offspring reaching the age of 18., Methods and Results: This paper analyses responses of a survey of existing donors' views on the removal of donor anonymity that was undertaken by the Department of Health (UK) as part of its review that preceded changes to the law on donor anonymity. The survey provides an insight into what it is about the loss of anonymity that some donors find problematic, indicating that although some donors will be reluctant to donate under conditions of non-anonymity, others have concerns about the removal of anonymity that can be addressed., Conclusions: This paper identifies factors, in particular counselling, support and better information that could maintain gamete donor recruitment in the context of the UK's policy of non-anonymous and non-remunerated donation.

This paper explores the problem of China's 'missing' girls--estimated to run into many millions. It considers the impact of the underpinning Confucian value system in China that has produced a culture of son preference and which, together with China's compulsory family planning program and 'one child policy', has effectively established a 'one son policy'. Discussion of the various means by which the birth or survival of daughters have traditionally been prevented provides the context for identifying the contribution of new sex selection procedures to the maintenance of son preference in contemporary Chinese society. The paper concludes that China's son preference is not simply a personal problem for the millions of 'missing girls' who were destined to live a shorter life and for the surviving girls who continue to face considerable discrimination simply because they are of the 'wrong' sex; it heralds a social and demographic disaster of major proportions for which neither the government nor the people of China appear to have the will or the means to forestall., (Copyright 2006 John Wiley & Sons, Ltd.)

Background: The UK government has decided to introduce, from 2005, rules that will allow donor-conceived persons to have access to identifying information concerning their donor. This has led to many concerns regarding future gamete donor recruitment., Methods: Semen donors who had been recruited between 1988 and 2002 were invited to take part in a telephone interview. The interview sought these previous donors' views on issues associated with recruitment, attitudes regarding information sharing and views concerning the offspring. Responses regarding information sharing were compared with their views recorded at the time of recruitment., Results: All 32 donors were recruited altruistically. Eighteen (56%) held the same views concerning the provision of identifying information as they did at the time of recruitment. Of those who had changed their views, eight (25%) expressed a willingness to be more open and four (12%) now wished to be anonymous having previously been unsure. Half of the donors would still have donated if they had been required to be identified to offspring, one-quarter would not have and one-quarter were undecided, although the majority of these said they may have donated under an open system., Conclusion: The study shows that it is possible to recruit identifiable donors at this clinic and this suggests that it may be possible for other clinics to do likewise.

This article considers two key policy documents concerning donor-assisted conception in the UK, The British Fertility Society's Recommendations for Good Practice on the Screening of Egg and Embryo Donors and the Human Fertilisation and Embryology Authority's Guidance for Egg Sharing Arrangements. It discusses both the process and the evidence used in formulating those sections of the documents which relate to donor anonymity. The paper concludes that psycho-social policy developments in assisted conception, such as those relating to donor anonymity, should be subjected to comparable levels of rigour and scrutiny to those that are applied in the formulation of medical and scientific policies.

Introduction: This paper reports on a qualitative empirical study of the experiences of women (and their partners) attending one UK assisted conception unit, who have considered egg sharing., Aims: In the absence of any published research of the experiences of people contemplating egg sharing and the considerable concerns that egg sharing had generated (for an overview see Blyth, 2002), the major purpose of the study was to examine the experiences not only of those who had considered and proceeded with egg sharing but also those who had considered, but had then decided against, egg sharing. In addition, since the views of male partners are frequently overlooked in studies of assisted conception treatment (cf. Ahuja, Mostyn, & Simons, 1997) the project actively sought the involvement of the women's partners. The study was designed to explore couples' motivation for egg sharing, their experiences of treatment, attitudes regarding information about egg sharing treatment and outcomes, and attitudes towards egg sharing., Methods: The centre sent a written invitation to participate in the study to all women who had indicated an interest in egg sharing and who had received both information and counselling in advance of proceeding (n = 60). Of these, 43 had decided to proceed after the counselling session and 17 had decided not to do so. Expressions of interest in participating in the study were received from 20 women: (a) five women had proceeded with egg sharing but had not been successful with their own treatment at the time of interview--all husbands/partners also participated (n = 10); (b) seven women had proceeded with egg sharing and had conceived (one of whom had conceived unexpectedly without assisted conception services)--5 couples and 2 women participated (n = 12); (c) six women decided to proceed with egg sharing, however an insufficient number of eggs were available following egg retrieval to enable egg sharing to take place--all husbands/partners also participated (n = 12); (d) two women decided not to proceed--and both husbands/partners participated (n = 4). The study data were derived from retrospective semi-structured interviews conducted by the author with these 20 women and 18 husbands/partners. Respondents also completed a paper exercise following the interview indicating their level of agreement or disagreement with a number of statements relating to egg sharing that were derived from responses to the HFEA's consultation on the withdrawal of payment to donors (HFEA 1998a.). While there was an overall 33% response rate, the response rate for those who had decided to proceed with egg sharing (41.9%) was greater than for those who had decided not to proceed (11.8%). Consequently, this study under-represents the views of women and their partners who had considered, but then rejected, egg sharing. Couples agreeing to participate in the research were given a choice of being interviewed together or separately and in their own home or at an alternative venue. This choice of separate or joint interviews was offered as part of the explicit effort to involve men in the study and to maximize participant choice. Twelve couples agreed to be interviewed separately; six couples were interviewed together and two women whose partners did not take part in the study were interviewed alone. There was no evidence of any significant differences in interview data between joint and separate interviews. Indeed, there was little disagreement between partners at all; this is probably not surprising, given that they will have discussed their decision about egg sharing together and will be aware of each other's views about at least some of the issues discussed during interview. All except four interviews took place in respondents' own homes. Two interviews took place in the centre at the respondents' requests and two interviews were conducted by telephone because of geographical considerations. All interviews were audio-recorded with respondents' permission and subsequently transcribed verbatim. The research was conducted in accordance with the British Psychological Society Statement of Ethical Principles for Conducting Research with Human Subjects (British Psychological Society, 2002). Ethical approval was given by the University of Huddersfield Ethics Committee.

Egg sharing is an arrangement in which a woman is offered free or reduced-cost assisted conception treatment in return for 'donating' oocytes for the treatment of another woman, the cost of her treatment being subsidized by the recipient of her oocytes. Egg sharing has been developed for a variety of reasons: to ameliorate donor oocyte shortages, to avoid potential health risks to non-patient donors and, given the limited availability of publicly funded assisted conception treatment in the UK, to make treatment more readily available to individuals on lower incomes, thus expediting treatment by reducing waiting lists. This paper outlines the development and current status of egg sharing in the UK through analysis of responses to a consultation on payment to gamete donors initiated by the Human Fertilisation and Embryology Authority (HFEA) and the HFEA's Guidance for Egg Sharing Arrangements.

It was not by my choice that my ancestral home is nothing more than a sample jar. (Whipp, 2000) There can be few more basic rights than a right to one's identity...a right not to be deceived about one's true origins. (Freeman, 1996) This article provides an overview of existing arrangements for the management of information on genetic origins in donor-assisted conception, that is, treatment involving sperm, eggs or embryo donation. The balance of this article reflects the fact that much of the debate on information on genetic origins in donor-assisted conception has been dominated by sperm donation. A detailed discussion of the rather different issues of egg and embryo donation would have added significantly to its complexity and length. The article considers what donor-conceived people wish to know about their genetic origins and how this might be seen as a human rights issue. The possibility of conflict between the interests and rights of donors and recipients of donated gametes or embryos is discussed, and possible policy and legislative options are outlined. The paper concludes that a donor-conceived person's own definition of their best interests should form the basis for the facilitation of access to information about their genetic origins.

Developments in assisted human reproduction (AHR) have aroused considerable debate and interest around the world, with most governments accepting that they are matters of public policy. This politicization of AHR is explored in the context of a consideration of the oft-used term "the best interests of the child." This "rallying call" is frequently cited as the primary concern in the determination of policy. This article is based on the contention that it is important to examine the interplay between the three main groups directly influencing "best interest" outcomes for AHR offspring. These groups are the professionals, the parents, and the state. It seeks to examine how this high-sounding and well-meaning commitment is addressed, advanced, or ignored in the interplay of these groups.

Section 31 of the Human Fertilization and Embryology Act 1990 permits people born as a result of licensed treatments provided in the UK to seek certain information about their genetic origins held on the Human Fertilization and Embryology Authority (HFEA) Register of Information. The precise nature of such information is to be specified in Regulations that have yet to be determined by the Secretary of State. The Register comprises data submitted to the Authority by licensed centres on HFEA Donor Information Form (91) 4. This paper reports on a survey of views of licensed centres concerning the adequacy of this form and centres' experiences of gathering information from donors. The survey shows that centres' experiences vary considerably, and the authors argue that there is a case for the sharing of centres' experiences and dissemination of effective strategies. The paper further discusses the nature of information that might become available to individuals seeking information from the HFEA. While requests for non-identifying information concerning the donor cannot be made prior to 2010, any information made available then is inevitably dependent on current practice in centres. The authors conclude that current variability in practice does not best serve the interests of donor offspring who may seek information about their genetic origins.