**9. Ethical problems arising from donor gametes in IVF, especially the right to privacy of donors and of children to know their parents**

From a bioethical point of view, in our opinion, there are a number of issues with respect to whether the donation of gametes, both eggs and sperm, should be anonymous or not. We consider these four the most important: (a) to know whether the good of the child should prevail in the overall assessment of the process, as we believe it should; (b) to determine whether the privacy of the donors should be ensured; (c) to assess whether the interests of assisted reproduction clinics should be safeguarded; and (d) to establish whether even the good of society should be ensured.

### **9.1 Good of the child**

With regard to children, it seems obvious that they have the right to know their biological origin, i.e. to know who their parents are. This is not only for emotional reasons, which must also be considered, but mainly for medical ones, since it cannot be ruled out that it may be necessary during the child's life to know who his parents are, if he has a genetic disease that needs to be identified, in order to be diagnosed and treated.

Moreover, this policy is in accordance with the first major document developed by the United Nations in 1989, on the 'Rights of the Child', which, in Article 7, defines that one of those rights is the right of the child to know his or her parents.

### **9.2 Good of the donors**

In relation to donors, there is a trend towards suppressing anonymity in gamete donation, which may be a negative factor for donors. This is because, if the parentchild relationship can be established, it could lead to parental obligations for the donors that they may not want to assume. This is especially so if we also take into account that there are websites specialising in genetic matters that can match people who were born through gamete donation, so it can be determined if they have a genetic relationship [81].

### **9.3 Good of the assisted reproduction clinics**

There is no doubt that suppressing anonymity in gamete donation can dramatically reduce the number of donors who attend those clinics, as has already happened in the United Kingdom, which is undoubtedly an added difficulty for these practices. In addition, it is also possible that if anonymity is suppressed, it will particularly affect younger donors, which could be detrimental to IVF procedures, since gametes from older donors are usually of lower quality.

### **9.4 Good of society**

One risk of anonymous donation is that a donor can make a donation repeatedly and in different places, in the absence of real control over the process. This could

facilitate marital consanguinity, which is certainly a not insignificant public health problem.

It has also been argued that in a society immersed in a clear demographic winter, reducing births by IVF (given the high number of these) could negatively impact it.

To prevent any difficulties that anonymous donation might have, the creation of an 'Assisted Human Reproduction Information System' (SIRHA) has been proposed. This would collect data on all donations made, identifying donors through a European code, and thus avoiding the problems posed by multiple donations from the same donor.

Certainly, the solution to this problem is controversial, so it would probably be positive to consider the one already proposed by Penningsin 1997 with his 'double track' policy, an option that would allow donors to participate in an anonymous or non-anonymous programme. However, and also in our opinion, while this proposal could guarantee the hypothetical rights of assisted reproduction clinics, donors and the couples who use these techniques, does it guarantee the right of children to know their parents if the latter choose the option of anonymous donor? [82].

### **10. Use of IVF for the production of saviour siblings**

Saviour siblings are children produced by IVF who are used as donors of haematopoietic material to treat a sick sibling. Their use entails objective medical, social and ethical issues.

A first ethical aspect to consider is the low efficacy of use. Thus, initial studies by Verlinsky found that 33 embryos were used to produce only one saviour sibling, i.e. its efficacy was 3% [83]. In another paper by the same group, the percentage was 2.5% [84] and in another, approximately 1% [85]. Even in a larger study, in which data were collected from the Reproductive Genetics Institute in Chicago itself and other leading assisted reproduction centres in Australia, Belgium, Turkey and the United States, the efficacy was 1.15% [86].

Obviously, the low efficacy of this technique overshadows the bioethical judgement it merits. But in addition, in order to establish such a judgement, it must also be considered that: (1) with the production of saviour siblings, the child produced is being instrumentalised; (2) to achieve this end requires the use of means that inevitably necessitate the destruction of human embryos, in part, as a consequence of the technique itself and, in part, due to the eugenic selection by PGD to find a 'histocompatible sibling' who is suitable as a donor; and (3) there are alternative techniques to obtain the desired good ethically: the use of umbilical cord blood stored in public or private banks may be an alternative in the near future, from both a medical and bioethical point of view, to treat children who require transplantation of haematopoietic material and who do not have an immunologically compatible family member who can act as a donor. That is to say, in all likelihood, saviour siblings will have ceased to be useful before their production becomes widespread.

### **11. Possibility of using IVF for social purposes other than women's fertility**

### **11.1 Gestational surrogacy**

'Surrogate motherhood is an assisted procreation practice by which a woman gestates an embryo with which she has no biological relationship on behalf of a contracting couple or individual, having to relinquish the child to them after its birth. This practice normally entails a financial remuneration for the pregnant

**205**

*Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

ized, similarly objectifying him' [87].

cal [89], so it also affects altruistic surrogacy.

autonomous decision to have children.

uncritically.

women and their rights.

woman; when this is not the case, it is called altruistic surrogacy. From a medical perspective, potential problems for the surrogate and for children born through this practice should be taken into account, especially the existence of possible disabilities in the child. The bioethical aspects are of most interest because the practice of surrogacy objectifies the expectant mother, by using her body for a purpose other than her own good, treating her as a commodity, as a thing. The same is true for the child because it makes him a disposable object, something that can be instrumental-

However, it could be argued that acceptance of the pregnancy by the surrogate could be justified as an expression of their personal autonomy, although in the vast majority of cases, it is reasonable to admit that their autonomy is expressed against a background of desperation and vulnerability, so it is difficult to accept this practice

This practice, however, presents objective bioethical difficulties for the surrogate. First of all, commercial surrogacy objectifies the woman, by using her body for an end other than her own good, by treating her as a commodity, as something that can be bought and sold, like a thing, which is incompatible with the dignity of

Secondly, it is not ethically admissible because of the social injustice that nonaltruistic surrogacy entails, given that only those contracting parents or individuals who are financially well off can benefit from it, i.e. it could become exploitation of

Third, surrogacy ruptures what has come to be called the 'mother-child bond',

Fourth, in our ethical assessment of surrogacy there is a further difficulty, due to the selection processes to which potential surrogates are often subjected. These clearly and directly undermine their dignity, since very strict personal requirements are commonly insisted upon to guarantee the quality of the 'product' that the woman may gestate. Fifth, it should also be taken into account whether future surrogate mothers are always informed of the problems that their pregnancy may entail, i.e. if they are guaranteed to sign an informed consent, which, it seems, is not always the case [90]. It also presents objective bioethical issues related to the children, because a child is always a gift that is given to parents, never a right of parents to acquire it. If this right to a child were prioritised, he or she would be denied the consideration of absolute good in and of himself. He would become a disposable object, something instrumentalisable, i.e. he would be treated as an object. Not all that one wishes acquires the category of right. Desires for parenthood have as their limits the dignity of children and the protection of their fundamental rights. Defending the right of parents to have a child—with no ethical limitations whatsoever—could violate the rights of the child, although it should be established that the right to a child should not be confused with the right to parenthood, because no one can prevent the

Whatever the reasons put forward to defend the right of parents to a child, no action justifies violation of the fundamental right of children not to be treated as an object. If children were an object of desire of parents, their life would have no more value than that which the parents wished to give it, which is clearly unacceptable. A further bioethical issue that arises in relation to gestational surrogacy is the consideration that it is not ethically acceptable whenever it is paid, but it is acceptable when it is altruistic surrogacy. In our view, the latter is not admissible either,

economically weak women by economically strong couples or individuals.

which can be defined as the emotional relationship developed by the mother towards her child during pregnancy. This emotional and biological relationship between mother and child strengthens throughout pregnancy and is important for the normal development of the child [88]. It seems that this 'bond' is largely biologi-

### *Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

*Innovations in Assisted Reproduction Technology*

**10. Use of IVF for the production of saviour siblings**

United States, the efficacy was 1.15% [86].

problem.

and ethical issues.

facilitate marital consanguinity, which is certainly a not insignificant public health

It has also been argued that in a society immersed in a clear demographic winter, reducing births by IVF (given the high number of these) could negatively impact it. To prevent any difficulties that anonymous donation might have, the creation of an 'Assisted Human Reproduction Information System' (SIRHA) has been proposed. This would collect data on all donations made, identifying donors through a European code, and thus avoiding the problems posed by multiple donations from the same donor. Certainly, the solution to this problem is controversial, so it would probably be positive to consider the one already proposed by Penningsin 1997 with his 'double track' policy, an option that would allow donors to participate in an anonymous or non-anonymous programme. However, and also in our opinion, while this proposal could guarantee the hypothetical rights of assisted reproduction clinics, donors and the couples who use these techniques, does it guarantee the right of children to know their parents if the latter choose the option of anonymous donor? [82].

Saviour siblings are children produced by IVF who are used as donors of haematopoietic material to treat a sick sibling. Their use entails objective medical, social

A first ethical aspect to consider is the low efficacy of use. Thus, initial studies by Verlinsky found that 33 embryos were used to produce only one saviour sibling, i.e. its efficacy was 3% [83]. In another paper by the same group, the percentage was 2.5% [84] and in another, approximately 1% [85]. Even in a larger study, in which data were collected from the Reproductive Genetics Institute in Chicago itself and other leading assisted reproduction centres in Australia, Belgium, Turkey and the

Obviously, the low efficacy of this technique overshadows the bioethical judgement it merits. But in addition, in order to establish such a judgement, it must also be considered that: (1) with the production of saviour siblings, the child produced is being instrumentalised; (2) to achieve this end requires the use of means that inevitably necessitate the destruction of human embryos, in part, as a consequence of the technique itself and, in part, due to the eugenic selection by PGD to find a 'histocompatible sibling' who is suitable as a donor; and (3) there are alternative techniques to obtain the desired good ethically: the use of umbilical cord blood stored in public or private banks may be an alternative in the near future, from both a medical and bioethical point of view, to treat children who require transplantation of haematopoietic material and who do not have an immunologically compatible family member who can act as a donor. That is to say, in all likelihood, saviour siblings will have ceased to be useful before their production becomes widespread.

**11. Possibility of using IVF for social purposes other than women's** 

'Surrogate motherhood is an assisted procreation practice by which a woman gestates an embryo with which she has no biological relationship on behalf of a contracting couple or individual, having to relinquish the child to them after its birth. This practice normally entails a financial remuneration for the pregnant

**204**

**fertility**

**11.1 Gestational surrogacy**

woman; when this is not the case, it is called altruistic surrogacy. From a medical perspective, potential problems for the surrogate and for children born through this practice should be taken into account, especially the existence of possible disabilities in the child. The bioethical aspects are of most interest because the practice of surrogacy objectifies the expectant mother, by using her body for a purpose other than her own good, treating her as a commodity, as a thing. The same is true for the child because it makes him a disposable object, something that can be instrumentalized, similarly objectifying him' [87].

However, it could be argued that acceptance of the pregnancy by the surrogate could be justified as an expression of their personal autonomy, although in the vast majority of cases, it is reasonable to admit that their autonomy is expressed against a background of desperation and vulnerability, so it is difficult to accept this practice uncritically.

This practice, however, presents objective bioethical difficulties for the surrogate. First of all, commercial surrogacy objectifies the woman, by using her body for an end other than her own good, by treating her as a commodity, as something that can be bought and sold, like a thing, which is incompatible with the dignity of women and their rights.

Secondly, it is not ethically admissible because of the social injustice that nonaltruistic surrogacy entails, given that only those contracting parents or individuals who are financially well off can benefit from it, i.e. it could become exploitation of economically weak women by economically strong couples or individuals.

Third, surrogacy ruptures what has come to be called the 'mother-child bond', which can be defined as the emotional relationship developed by the mother towards her child during pregnancy. This emotional and biological relationship between mother and child strengthens throughout pregnancy and is important for the normal development of the child [88]. It seems that this 'bond' is largely biological [89], so it also affects altruistic surrogacy.

Fourth, in our ethical assessment of surrogacy there is a further difficulty, due to the selection processes to which potential surrogates are often subjected. These clearly and directly undermine their dignity, since very strict personal requirements are commonly insisted upon to guarantee the quality of the 'product' that the woman may gestate.

Fifth, it should also be taken into account whether future surrogate mothers are always informed of the problems that their pregnancy may entail, i.e. if they are guaranteed to sign an informed consent, which, it seems, is not always the case [90].

It also presents objective bioethical issues related to the children, because a child is always a gift that is given to parents, never a right of parents to acquire it. If this right to a child were prioritised, he or she would be denied the consideration of absolute good in and of himself. He would become a disposable object, something instrumentalisable, i.e. he would be treated as an object. Not all that one wishes acquires the category of right. Desires for parenthood have as their limits the dignity of children and the protection of their fundamental rights. Defending the right of parents to have a child—with no ethical limitations whatsoever—could violate the rights of the child, although it should be established that the right to a child should not be confused with the right to parenthood, because no one can prevent the autonomous decision to have children.

Whatever the reasons put forward to defend the right of parents to a child, no action justifies violation of the fundamental right of children not to be treated as an object. If children were an object of desire of parents, their life would have no more value than that which the parents wished to give it, which is clearly unacceptable.

A further bioethical issue that arises in relation to gestational surrogacy is the consideration that it is not ethically acceptable whenever it is paid, but it is acceptable when it is altruistic surrogacy. In our view, the latter is not admissible either,

because it also objectifies the child by demanding quality standards, which if they are not met may affect their fundamental rights, and even their life.

### **11.2 Social freezing**

As we discussed in a previously published paper [91], 'when eggs or ovarian tissue are not frozen for medical causes, the process is called "social freezing". In this case, there are two fundamental reasons why a woman might choose to undergo this procedure: the first is that she has not found a partner who she considers suitable for a matter as important as creating a family, and the second is for professional reasons. In the latter case, the woman considers that becoming pregnant at a young age—usually before age 35—could harm her professional career, prompting her to freeze her eggs for use at a later date. The biological reasons that underlie social freezing are that women's fertility declines with age, especially due to a decrease in ovarian function, owing to a reduction in the number of eggs'.

### **11.3 Ethical assessment**

Aside from the aforementioned biomedical and social problems, social freezing unquestionably presents ethical concerns. In our opinion [91], 'the main one is that, although not explicit, it implicitly objectifies the woman by prompting her to make a decision that is disguised a good for her when, as reported, this practice entails objective negative medical consequences for the user and also for her child'. According to Martinelli et al., '"Social egg freezing" is a paradigmatic demonstration of how the medicalization of women's bodies can be used to mask social and cultural anxieties about aging'.

However, 'we believe there is another ethical difficulty, derived from the fact that it is hard to guarantee the autonomy of women to make such a decision if they are not provided with adequate information on the risks and benefits entailed in social freezing, something that is not always easily verifiable, as previously mentioned' [91].

'Another ethical problem that social freezing may pose is the possible social inequality between groups of women who work in economically powerful companies, which can bear the costs of social freezing for their employees and those who work in companies that cannot do so. Another question therefore arises: to avoid social injustice, should social freezing be supported with public funds? We believe the answer should be that, given the myriad of objective medical problems that exist some of vital importance—and that have to be treated with these funds, would it not be creating a problem of distributive justice? Finally, it should also be pointed out that social freezing implies that fertile women, capable of conceiving and carrying a child naturally, renounce this, substituting natural conception for IVF.

This not only reduces the possibilities of eventually becoming pregnant but also, as mentioned, increases the health risks for mother and child. It must be carefully considered whether the advantage of using young eggs compensates for the risks derived from the processes required in social freezing' [91].

### **12. Possible misleading advertising that assisted reproduction clinics may present to attract clients**

The main vehicle used by assisted reproduction clinics to attract new customers is to advertise their efficacy, expressed in terms of pregnancy rates and live births achieved per ovarian stimulation cycle.

**207**

are used.

*Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

are presented below.

mean rate of 18.31%.

that the woman undergoes.

18.81%.

the world.

'misleading advertising' aimed at bringing in more clients.

between 12.0 and 48.6%, with a mean rate of 30.7%.

However, an ethical issue that may occur is if the data presented by these clinics are correct or are manipulated to improve their efficacy, i.e. whether there is

We evaluated this issue in a recent paper [92], the most relevant aspects of which

Based on data published by the ESHRE in 2014, the PR and LBR following IVF in Europe between 1997 and 2010 varied between 22.28 and 29.2% for the PR, with a mean rate of 26.41%, and between 13.07 and 22.4% for the LBR, with a mean rate of

When ICSI was used, these same rates varied between 23.37 and 29.9% for the PR, with a mean rate of 27.22%, and between 12.68 and 21.10% for the LBR, with a

After analysing data from the 13 studies that we consider most representative, the mean CLBR is 26.6%, after one cycle; 38.3% after two cycles; 57.4% after three cycles and 66.0% in cases of more than three cycles, with a mean rate of 56.3% [92]. The CLBR varies by country of course, and thus the lowest in Europe is Italy, with 18.3% and the highest in Poland, with 36.5%. This rate is 24.7% in Russia, 38.1% in Canada and 41.8% in the United States, the country with the highest rate in

To compare the data referred to above with the data published by private assisted reproduction clinics on their websites, we analysed the data presented by 123 private clinics [92]. Surprisingly, none of the clinics we looked at provides data on the CLBR. These rates ranged between 28.0 and 72.2%, with a mean of 47.2%. The same rates for women under 35 years of age varied between 39.0 and 82.4%, with a mean of 59.0%; for women between the ages of 35 and 39 years of age, it ranged from 27.0 to 77.8%, with a mean of 47.4%; and for women older than 40 years of age, it varied

When the data provided by the 169 assisted reproduction clinics on their websites were compared with the data reported by the same clinics to various scientific societies, it was found that the mean PR per stimulation cycle was 47.2% when autologous oocytes were used and 65.0% with donor oocytes, according to their websites. However, the rates per ovarian stimulation cycle of these same clinics presented by the Fertility Society were 30.55% for IVF and 32.59% for ICSI, which means that the figures provided by the 169 assisted reproduction clinics on their websites are 49.5% higher than reported by the same clinics to the relevant scientific societies when autologous oocytes are used and 108.9% higher when donor oocytes

Another rather startling aspect is that 16 of these clinics claim on their websites

In conclusion, it may be said that many countries, assisted reproduction clinics present data on their websites that are not consistent with those obtained from the scientific societies. It is also notable that those clinics do not present data on LBRs, which is the rate that best matches the real likelihood that assisted reproduction

to guarantee that a pregnancy will be achieved in 100% of cases.

treatments will eventually lead to the goal of parenthood [92].

The aforementioned data refer to the PR and LBR per ovarian stimulation cycle. However, these data do not seem to be the most appropriate to evaluate the efficacy of assisted reproduction clinics, because normally women who attend them undergo more than one cycle (usually three) to increase the efficacy of the technique, in terms of having the desired child. We therefore feel that it is better to use the 'cumulative pregnancy rate' (CPR) or the 'cumulative live birth rate' (CLBR), understood as the success rates that are achieved after all ovarian stimulation cycles

### *Bioethics of Assisted Reproductive Technology DOI: http://dx.doi.org/10.5772/intechopen.90727*

*Innovations in Assisted Reproduction Technology*

**11.2 Social freezing**

**11.3 Ethical assessment**

cultural anxieties about aging'.

because it also objectifies the child by demanding quality standards, which if they

As we discussed in a previously published paper [91], 'when eggs or ovarian tissue are not frozen for medical causes, the process is called "social freezing". In this case, there are two fundamental reasons why a woman might choose to undergo this procedure: the first is that she has not found a partner who she considers suitable for a matter as important as creating a family, and the second is for professional reasons. In the latter case, the woman considers that becoming pregnant at a young age—usually before age 35—could harm her professional career, prompting her to freeze her eggs for use at a later date. The biological reasons that underlie social freezing are that women's fertility declines with age, especially due to a decrease in

Aside from the aforementioned biomedical and social problems, social freezing unquestionably presents ethical concerns. In our opinion [91], 'the main one is that, although not explicit, it implicitly objectifies the woman by prompting her to make a decision that is disguised a good for her when, as reported, this practice entails objective negative medical consequences for the user and also for her child'. According to Martinelli et al., '"Social egg freezing" is a paradigmatic demonstration of how the medicalization of women's bodies can be used to mask social and

However, 'we believe there is another ethical difficulty, derived from the fact that it is hard to guarantee the autonomy of women to make such a decision if they are not provided with adequate information on the risks and benefits entailed in social freezing, something that is not always easily verifiable, as previously mentioned' [91]. 'Another ethical problem that social freezing may pose is the possible social inequality between groups of women who work in economically powerful companies, which can bear the costs of social freezing for their employees and those who work in companies that cannot do so. Another question therefore arises: to avoid social injustice, should social freezing be supported with public funds? We believe the answer should be that, given the myriad of objective medical problems that exist some of vital importance—and that have to be treated with these funds, would it not be creating a problem of distributive justice? Finally, it should also be pointed out that social freezing implies that fertile women, capable of conceiving and carrying a child

This not only reduces the possibilities of eventually becoming pregnant but also, as mentioned, increases the health risks for mother and child. It must be carefully considered whether the advantage of using young eggs compensates for the risks

**12. Possible misleading advertising that assisted reproduction clinics** 

The main vehicle used by assisted reproduction clinics to attract new customers is to advertise their efficacy, expressed in terms of pregnancy rates and live births

are not met may affect their fundamental rights, and even their life.

ovarian function, owing to a reduction in the number of eggs'.

naturally, renounce this, substituting natural conception for IVF.

derived from the processes required in social freezing' [91].

**may present to attract clients**

achieved per ovarian stimulation cycle.

**206**

However, an ethical issue that may occur is if the data presented by these clinics are correct or are manipulated to improve their efficacy, i.e. whether there is 'misleading advertising' aimed at bringing in more clients.

We evaluated this issue in a recent paper [92], the most relevant aspects of which are presented below.

Based on data published by the ESHRE in 2014, the PR and LBR following IVF in Europe between 1997 and 2010 varied between 22.28 and 29.2% for the PR, with a mean rate of 26.41%, and between 13.07 and 22.4% for the LBR, with a mean rate of 18.81%.

When ICSI was used, these same rates varied between 23.37 and 29.9% for the PR, with a mean rate of 27.22%, and between 12.68 and 21.10% for the LBR, with a mean rate of 18.31%.

The aforementioned data refer to the PR and LBR per ovarian stimulation cycle. However, these data do not seem to be the most appropriate to evaluate the efficacy of assisted reproduction clinics, because normally women who attend them undergo more than one cycle (usually three) to increase the efficacy of the technique, in terms of having the desired child. We therefore feel that it is better to use the 'cumulative pregnancy rate' (CPR) or the 'cumulative live birth rate' (CLBR), understood as the success rates that are achieved after all ovarian stimulation cycles that the woman undergoes.

After analysing data from the 13 studies that we consider most representative, the mean CLBR is 26.6%, after one cycle; 38.3% after two cycles; 57.4% after three cycles and 66.0% in cases of more than three cycles, with a mean rate of 56.3% [92].

The CLBR varies by country of course, and thus the lowest in Europe is Italy, with 18.3% and the highest in Poland, with 36.5%. This rate is 24.7% in Russia, 38.1% in Canada and 41.8% in the United States, the country with the highest rate in the world.

To compare the data referred to above with the data published by private assisted reproduction clinics on their websites, we analysed the data presented by 123 private clinics [92]. Surprisingly, none of the clinics we looked at provides data on the CLBR. These rates ranged between 28.0 and 72.2%, with a mean of 47.2%. The same rates for women under 35 years of age varied between 39.0 and 82.4%, with a mean of 59.0%; for women between the ages of 35 and 39 years of age, it ranged from 27.0 to 77.8%, with a mean of 47.4%; and for women older than 40 years of age, it varied between 12.0 and 48.6%, with a mean rate of 30.7%.

When the data provided by the 169 assisted reproduction clinics on their websites were compared with the data reported by the same clinics to various scientific societies, it was found that the mean PR per stimulation cycle was 47.2% when autologous oocytes were used and 65.0% with donor oocytes, according to their websites. However, the rates per ovarian stimulation cycle of these same clinics presented by the Fertility Society were 30.55% for IVF and 32.59% for ICSI, which means that the figures provided by the 169 assisted reproduction clinics on their websites are 49.5% higher than reported by the same clinics to the relevant scientific societies when autologous oocytes are used and 108.9% higher when donor oocytes are used.

Another rather startling aspect is that 16 of these clinics claim on their websites to guarantee that a pregnancy will be achieved in 100% of cases.

In conclusion, it may be said that many countries, assisted reproduction clinics present data on their websites that are not consistent with those obtained from the scientific societies. It is also notable that those clinics do not present data on LBRs, which is the rate that best matches the real likelihood that assisted reproduction treatments will eventually lead to the goal of parenthood [92].
