Selecting What? Pre-implantation Genetic Diagnosis and Screening Trajectories in Spain

Pavone, Vincenzo; Funes, Sara Lafuente

doi:10.1007/978-3-319-58220-7_6

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…The Spanish reproductive market relies on flexible regulation, which enables reproductive tourism and egg donation treatments (Kroløkke 2014; Rivas and Álvarez 2021; Molas 2021). Clinics provide varied services to fee-paying clients, particularly in relation to egg donation and preimplantation genetic testing (PGT; Pavone and Lafuente 2017; Perler 2021). Egg providers’ reproductive capacity (transferred through their gametes) is crucial in attracting patients from other countries, and thus the two aspects are mutually reinforcing and shape the market in one direction that makes them highly dependent on the availability of oocytes (Lafuente-Funes 2020).…”

Section: Why Spain and Why Vitrification: A Strong Reproductive Marke...mentioning

confidence: 99%

The Role of Vitrification in Spanish Reproductive Labs: A Cryo-revolution Led by Strategic Freezing

Funes

2023

Science, Technology, & Human Values

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Assisted reproductive technologies have expanded vastly and are frequently addressed using the language of revolution. The last two decades witnessed important transformations in Spanish repromarkets, some of which are linked to one freezing technique: vitrification. This cryotechnique tends to be presented by professionals as revolutionary as well, even if in a humbler way: a technique with the capacity to revolutionize reproductive labs. Celebrated for its ability to freeze oocytes, the introduction and assimilation of vitrification have implied many transformations in Spanish clinics and the broader reproductive industry in Spain. This paper describes the role of vitrification from the point of view of the labs, drawing on interviews with professionals and observations of laboratory work, and focusing on the changes, which include but are not restricted to freezing oocytes. I argue that vitrification has increased the role of cryopreservation in reproductive labs overall in Spain, expanding the use of strategic, short-term freezing of embryos. This is discussed as part of a “cryomedicalized” turn, using Charlotte Kroløkke and Anna Sofie Bach’s term, which enlarges the scope of medicalization through optimization and prevention, in the context of late reproduction and a strong reproductive market.

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Section: Why Spain and Why Vitrification: A Strong Reproductive Marke...mentioning

confidence: 99%

The Role of Vitrification in Spanish Reproductive Labs: A Cryo-revolution Led by Strategic Freezing

Funes

2023

Science, Technology, & Human Values

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Ready for polygenic risk scores? An analysis of regulation of preimplantation genetic testing in European countries

Siermann,

van der Schoot,

Bunnik

et al. 2024

Human Reproduction

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STUDY QUESTION Would the different regulatory approaches for preimplantation genetic testing (PGT) in Europe permit the implementation of preimplantation genetic testing using polygenic risk scores (PGT-P)? SUMMARY ANSWER While the regulatory approaches for PGT differ between countries, the space provided for potential implementation of PGT-P seems limited in all three regulatory models. WHAT IS KNOWN ALREADY PGT is a reproductive genetic technology that allows the testing for hereditary genetic disorders and chromosome abnormalities in embryos before implantation. Throughout its history, PGT has largely been regarded as an ethically sensitive technology. For example, ethical questions have been raised regarding the use of PGT for adult-onset conditions, non-medical sex selection, and human leukocyte antigen typing for the benefit of existing siblings. Countries in which PGT is offered each have their own approach of regulating the clinical application of PGT, and a clear overview of legal and practical regulation of PGT in Europe is lacking. An emerging development within the field of PGT, namely PGT-P, is currently bringing new ethical tensions to the forefront. It is unclear whether PGT-P may be applied within the current regulatory frameworks in Europe. Therefore, it is important to investigate current regulatory frameworks in Europe and determine whether PGT-P fits within these frameworks. STUDY DESIGN, SIZE, DURATION The aim of this study was to provide an overview of the legal and practical regulation of the use of PGT in seven selected European countries (Belgium, France, Germany, Italy, the Netherlands, Spain, and the UK) and critically analyse the different approaches with regards to regulatory possibilities for PGT-P. Between July and September 2023, we performed a thorough and extensive search of websites of governments and governmental agencies, websites of scientific and professional organizations, and academic articles in which laws and regulations are described. PARTICIPANTS/MATERIALS, SETTING, METHODS We investigated the legal and regulatory aspects of PGT by analysing legal documents, regulatory frameworks, scientific articles, and guidelines from scientific organizations and regulatory bodies to gather relevant information about each included country. The main sources of information were national laws relating to PGT. MAIN RESULTS AND THE ROLE OF CHANCE We divided the PGT regulation approaches into three models. The regulation of PGT differs per country, with some countries requiring central approval of PGT for each new indication (the medical indication model: the UK, the Netherlands), other countries evaluating each individual PGT request at the local level (the individual requests model: France, Germany), and countries largely leaving decision-making about clinical application of PGT to healthcare professionals (the clinical assessment model: Belgium, Italy, Spain). In the countries surveyed that use the medical indication model and the individual requests model, current legal frameworks and PGT criteria seem to exclude PGT-P. In countries using the clinical assessment model, the fact that healthcare professionals and scientific organizations in Europe are generally negative about implementation of PGT-P due to scientific and socio-ethical concerns, implies that, even if it were legally possible, the chance that PGT-P would be offered in the near future might be low. LIMITATIONS, REASONS FOR CAUTION The results are based on our interpretation of publicly available written information and documents, therefore not all potential discrepancies between law and practice might have been identified. In addition, our analysis focuses on seven—and not all—European countries. However, since these countries are relevant players within PGT in Europe and since they have distinct PGT regulations, the insights gathered give relevant insights into diverse ways of PGT regulation. WIDER IMPLICATIONS OF THE FINDINGS To the best of our knowledge, this is the first paper that provides a thorough overview of the legal and practical regulation of PGT in Europe. Our analysis of how PGT-P fits within current regulation models provides guidance for healthcare professionals and policymakers in navigating the possible future implementation of PGT-P within Europe. STUDY FUNDING/COMPETING INTEREST(s) This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 813707. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

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Selecting What? Pre-implantation Genetic Diagnosis and Screening Trajectories in Spain

Cited by 2 publications

References 37 publications

The Role of Vitrification in Spanish Reproductive Labs: A Cryo-revolution Led by Strategic Freezing

The Role of Vitrification in Spanish Reproductive Labs: A Cryo-revolution Led by Strategic Freezing

Ready for polygenic risk scores? An analysis of regulation of preimplantation genetic testing in European countries

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