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Double gamete and embryo donation Poland


Published on

ESHRE 2016

Published in: Government & Nonprofit
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Double gamete and embryo donation Poland

  1. 1. I declare that I have no commercial or financial interests pertaining to the subject of this presentation or its content. Conflict of interest
  2. 2. Some most recognizable Polish specialities
  3. 3. Short summary of ART history in Poland 1987 – the first successful IVF 2015 – the first legal Act on Infertility During 28 years of performance the ART procedures: 1. 31% - pregnancy rate in National Programme of Reimbursement (2013-2016) 2. App. 50 ART centres 3. „What’s not forbidden is allowed”: •. Open acces to ART for heterosexual couples, single individuals and lesbians •. No public system of certification or State’s control over ART centres •. PGD, oocyte donations, sperm donations, embryo donations •. No public databases: rate of success, number of cycles, children’s outcome, offspring limitation in case of Third Party Reproduction Neoliberal paradise without State involvement’s inducing deep debate on ethical issues and patients’ rights
  4. 4. The embryo battle Anti-IVF piquet in front of ART centre. „Mary – frozen”, „Martin – frozen”, „Alex – frozen”, „Ola – frozen”, „Matthew - he only succeeded” Anti-abortion piquet
  5. 5. How has the embryo become the main actor in Polish IVF debate? Restrictive anti-abortion law since 1993 (Law on family planning, protection of human fetuses and the conditions under which pregnancy termination is permissible, 7th January 1993) Cultural and linguistic shift • „the unborn child” instead of „embryo” • „a mother” instead of „a pregnant woman” "I can almost hear the cry of despair of those tens of thousands of frozen embryos” (Jarosław Gowin, the former Minister of Justice) Legislators: We care about all embryos and we will prove it
  6. 6. Kliknij ikonę, aby dodać obraz Map of stakeholders' influence on legislative process’s shape • The Government's belief that compromise with the Catholic Church is unavoidable • ART centres’ experts support • None of representatives of patients in a legislative committee • „Better worse than nothing” approach in NGOs environment („we will aim at liberalising the Act later on”) • 76% of Poles supported the access to IVF for marital and (62%) non-marital couples (Public Opinion Research Centre, March 2015)
  7. 7. So how exactly „the embryo- compromise” was politically reached?
  8. 8. Results Art. 21.3. states that the embryos will be mandatory given for donation in the following cases: „1. the expiry of the contractual deadline for the storage of embryos, but not longer than 20 years from the date on which the embryos were transferred to the bank of reproductive cells and embryos or 2. the death of both donors or - if the embryo was created as a result of gamete donation - the death of female recipient and her husband or partner"
  9. 9. Unexpected (?) results • Infertility defined as medical condition (male and female partners) • Both partners' official consents requested Single women and lesbian couples were excluded Question: What should have been done with embryos created before Act coming into the force?
  10. 10. Kliknij ikonę, aby dodać obraz• Poland’s Ombudsman has requested the constitutional court to review the text: law discriminates against single women, depriving them of access to the procedure • Possible violation of Art. 8 of Convention on Human Rights • Possible violation on Tissue Directive: donations shall not be compulsory • Lack of deep insight in psychosocial effect of compulsory donations, i.e. disruption of family life and chronological continuity of generations, abuse on the individual's privacy, some individuals may treat embryo donation as embryo adoption and feel it as „forced abandonment of the child”
  11. 11. • Even so restrictive Act was considered "too liberal" by new rulling party Law and Justice and new amendments to the Act are being prepared: ban on embryo freezing, only one oocyte may be fertilized and the period of "compulsory embryo donation" will be probably shortened to 3 years instead of 20 • Ministry of Health cancelled the National Programme of IVF Reimbursement • Ministry of Health announced preparation the brand new programme titled "National Programme on Procreation" costed the same amount of money: Vice - Minister of Health, Jarosław Pinkas, commented on content of the new programme: "As far as educations is concerned, which we are lacking at the moment. One should know what to do to avoid fertility problems(…). I mean a disastrous life style, inappropriate clothing like too tight underwear and disobeying some rational rules of how one should look after themselves” • Local municipalities have started to prepare their own programmes of IVF reimbursement to help their citizens to deal with the lack of the governmental support conclusions
  12. 12. Thank you for your attention „I have a brother thanks to IVF. Please, remember that other children are waiting for their siblings too. Matylda, Poland”
  13. 13. How ART centres used the lack of the Law • Patients’ monitoring over ART centres in Poland (n=37 ART centres) • SET policy treated freely • Information given to patients treated freely (i.e. bHCG pregnancy factor; cycles with ET only) • Strong biomedical approach locating „IVF-issues” on medical experts’ side to avoid ideological entanglement