2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? No; For women not living in a heterosexual couple? No
b. Risk of transmission of a disease
For a heterosexual couple? No; For women not living in a heterosexual couple? No
c. Other Yes
Since the law n°2021-1017 of 2 August 2021 on bioethics, medically assisted procreation is no longer conditional on medical criteria. The criteria linked to medically established pathological infertility or the transmission of a particularly serious disease, which conditioned access to MAP, have been removed. Recourse to MAP is now conditional on the existence of a parental project (Article L. 2141-2 of the Public Health Code).
Both laws are in force now in Greece:
This law mostly regulates issues of affiliation with the child to be born by medically assisted reproduction. This law also legalizes post-mortem insemination and surrogate motherhood, under certain conditions which are specified in the relevant articles.
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In 2005, Law 3305 was enacted regarding Medically Assisted Procreation in Greece. Whereas the previous law 3089 regulates mainly issues of affiliation of the child to be born with her parents, this law supplements the previous one and mainly regulates the way in which Units of MAP function. It describes the methods of MAP, conditions of application, informed consent issues, cryopreservation of gametes, gamete donation, embryo research, surrogacy, traceability etc. Moreover it provides for both administrative and penal sanctions for the perpetrators in case of violation of the law. It also establishes the responsible control mechanism, namely the National Authority for Medically Assisted Reproduction. According to this law methods of MAR are applied in a way which safeguards respect to the freedom of the individual and the right to development of personality (i.e. a right protected by the Greek Constitution), as well as the satisfaction of the desire to have a child , always according to the principles of Bioethics. The law further stipulates that the above mentioned application shall always take into consideration the welfare of the child to be born.
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Indicate if process of revision is ongoing and, in your answers, provide information on provision in the draft law: not actually
Indicate if process of revision is ongoing and, in your answers, provide information on provision in the draft law: intention of revision in the near future
There is no specific law in Republic of San Marino. In the case of infertility heterosexual couples are guaranteed links with the Italian reference centers to proceed with MAP. All questions related to MAP with the possible donation of gametes are the same answers as for Italy.
6. Is donation of sperm/oocytes/embryos permitted in your country? sperm Yes / oocytes Yes / embryos No.
Donated embryos can only be used for research purposes in vitro, not for assisted reproduction.
Simultaneous use of donated egg and sperm is not allowed. An exception has been made for lesbian couples so that an oocyte may be collected from one of the women, fertilized with donor sperm, and the resulting embryo implanted into the womb of the other woman in the couple.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? Yes. National guidelines set maximum amount for compensation to donors. In addition to documented travel expenses, sperm donors may receive NOK 750 and oocyte donors NOK 5300 per donation. Amounts have been set to compensate donors for their time and possible inconveniences incurred by the donation.
8. Are there specific criteria for donation of sperm/oocytes/embryos? sperm Yes / oocytes Yes / embryos No.
Criteria for donation of sperm:
Criteria for donation of oocytes:
To prevent the use of sperm from diseased donors and to ensure that information about the donor (name, address) can be provided to the child when reaching 15 years of age, Norwegian citizenship or permanent habitual permission is required.
There will be an interview to ensure that the decision of the donor has the necessary maturity and an altruistic motivation and to ensure that the donor understands the consequences and is informed that future children may make contact. The donor must give a written consent. If the consent is withdrawn, unused sperm/oocytes must be destroyed.
Donation of embryos is forbidden.
Testing of donors follow the procedures and criteria set out in the EU Directives on tissues and cells.
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes. The Biotechnology Act requires that the attending physician select a suitable donor. It is recommended that the physician chooses a donor that has a close physical resemblance to the parents-to-be. Donors should not be chosen based on other criteria.
10. Are there special measures for the prevention of consanguinity? Yes.
A national registry of donors has been established to enable children that are conceived in Norway by donor sperm or donor oocyte to know the identity of the donor when reaching the age of 15 (or 18 for those born from gametes donated before 2021),
Sperm from one donor can be used by up to 6 families, this is specified in the consent form. The number of donation cycles for an oocyte donor is limited to 3. There is no maximum number of families.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes. Rules of parentage for the second mother (the women not giving birth) have been established.
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? Yes.
The HFEA permits UK licensed clinics to compensate egg donors up to the fixed amount of £750 per cycle of donation and up to £35 per clinic visit for sperm donors. Guidance is provided to clinics in the HFEA’s Code of practice (https://www.hfea.gov.uk/media/2793/2019-01-03-code-of-practice-9th-edition-v2.pdf) and HFEA General Directions (http://ifqtesting.blob.core.windows.net/umbraco-website/1547/2017-04-03-general-direction-0001-version-4-final.pdf).
The HFEA also permits benefits in kind, such as egg sharing. Egg sharing arrangements where a woman who needs IVF treatment agrees to share her eggs with another woman needing donated eggs, in return for free or reduced rate treatment. Again guidance is contained in the HFEA code of practice: https://www.hfea.gov.uk/media/2793/2019-01-03-code-of-practice-9th-edition-v2.pdf
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes.
a) The HFEA provides guidance to UK licensed clinics in its Code of Practice: https://www.hfea.gov.uk/media/2793/2019-01-03-code-of-practice-9th-edition-v2.pdf
Clinics should refer to the relevant professional body guidelines on age limits before accepting gametes for the treatment of others. Gametes for the treatment of others should not be taken from anyone under the age of 18. A donor must not be selected because they are known to have a particular gene, chromosome or mitochondrial abnormality that, if inherited by any child born as a result of the donation, may result in that child having or developing:
a) serious physical or mental disability
b) A serious illness
c) Any other serious medical condition
The use of gametes from donor known to have an abnormality as described above, should be subject to consideration of the welfare of any resulting child and should normally have approval from a clinical ethics committee.
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes. Centres are not expected to match the ethnic background of the recipient to that of the donor. Where a prospective recipient is happy to accept a donor from a different ethnic background, the centre can offer treatment, subject to the normal welfare of the child assessment.
10. Are there special measures for the prevention of consanguinity? Yes. The HFEA maintains a register of all donors and patients who have had a child using donor gametes. Children born following donor conception who intend to enter into an intimate physical relationship can submit a joint application to the HFEA to establish whether they are genetically related. Also, anyone who intends to marry, or enter into a civil partnership may submit a joint application to establish whether they are genetically related. A single donor can contribute to a maximum of 10 families. After this limit is reached the donor can no longer be used, one reason for this being to reduce the risk of consanguinity.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes.
The legal provisions on who can be a child’s legal parent and what conditions must be met is set out in the HFEA Act.
Where a woman in a civil partnership is seeking treatment using donor sperm, or embryos created using donor sperm, the woman’s civil partner will be treated as the legal parent of any resulting child unless, at the time of placing the embryo or sperm and eggs in the woman, or of her insemination:
a) A separation order was in force, or
b) It is shown that the civil partner did not consent to the placing in her of the sperm and eggs, or embryos, or to the insemination
Where a woman is being treatment together with a female partner (not a civil partner) using donor sperm, or embryos created with donor sperm, the female partner will be the other legal parent of any resulting child if, at the time the eggs and sperm, or embryos, are placed in the woman or she is inseminated, all the following conditions apply:
a) Both the woman and her female partner have given a written, signed notice (subject to the exemption for illness, injury or physical disability) to the centre consenting to the female partner being treated as the parent of any resulting child
b) Neither consent was withdrawn (or superseded with a subsequent written note) before insemination/transfer, and
c) The patient and the female partner are not close relatives (within prohibited degrees of relationship to each other as defined in section 58(2), part 2, HFE Act 2008)
19. Is there an important current debate in your country on these or related issues? No
20. Delegations are invited to provide information on particular cases encountered in their country.
There is as yet no case law on medically assisted procreation.
Unfortunately, the only text available in English is the draft bill, which is slightly different from the version that has been adopted.
3. Are MAP procedures covered by the social secirity system? Yes. Infertility is defined as a disease.
4. Are there specific criteria for such coverage? Yes. Procedures are covered for infertile couples (infertility is considered a disease), for women up to 42 years (natural generative age, estimated by the professional society)
5. Is the financial coverage limited to a number of MAP procedures? Yes. Social health insurance covers up to 4 intrauterine insemination procedures (IUI) and up to 6 in vitro procedures (IVF)
2. Are there specific criteria for access to MAP?
a. Infertility
i. for a heterosexual couple? Yes.
ii. for women not living in a heterosexual couple? Non
b. Risk of transmission of a disease (please specify the risk and/or disease)
i. for a heterosexual couple? Yes
ii. for women not living in a heterosexual couple?
Access to MAP for homosexual couples, for whatever reason, is not accepted.
6. Is donation of sperm/oocytes/embryos permitted in your country? sperm Yes/oocytes Yes/embryos No
Embryo donation as well as MAP with both gametes donated is not allowed (Art. 13, Art. 7), on the basis of the principle that the child born with the MAP procedure should be genetically related to at least one of the parents.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No. Financial rewards are explicitly prohibited. However, any expenses generated by the donation may be reimbursed (Art. 10).
8. Are there specific criteria for donation of sperm/oocytes/embryos? sperm Yes/oocytes Yes/embryos NA
A person may donate his/her gametes to one center only (Art. 11). The donors must be of legally mature age, healthy and mentally competent (Art. 14). Donated gametes may not be used in cases where that would constitute illicit consanguinity (Art. 14).
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? No. Such non-medical criteria are not contained in the law, but may be considered in practice, as far as circumstances allow.
10. Are there special measures for the prevention of consanguinity? Yes. Donated gametes may be used until children are born in two different families (Art. 29).
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No legal provisions
16. Is donation of sperm/oocytes/embryos anonymous? Yes
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation?
i. For the child him or herself No; ii. For the parents No; iii. For a court Yes
a. Identity of the donor(s)
i. For the child him or herself No; ii. For the parents No; iii. For a court Yes
b. Certain health information concerning the donor(s)
i. For the child him or herself Yes; ii. For the parents Yes; iii. For a court Yes
c. Other information
i. For the child him or herself No; ii. For the parents No; iii. For a court No
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? No
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? Yes; For women not living in a heterosexual couple? No
b. Risk of transmission of a disease
For a heterosexual couple? No; For women not living in a heterosexual couple? No
c. Other
See Art. 3 in Act no. 55/1996 (Artificial fertilisation may only be carried out if: a) the woman undergoing the procedure has been living with a man, married or in a non-formalised relationship, continuously for at least three years, and they have both given written consent in the presence of witnesses.
b) the age of the couple may be deemed natural, inter alia with regards to the welfare of the child as he/she grows up.
c) the mental and physical health and the social circumstances of the couple are good, and
d) other procedures to overcome infertility have failed or are unavailable.)
19. Is there an important current debate in your country on these or related issues? Yes. As previously stated, a debate has been ongoing on the necessity of revising the law on artificial insemination, specifically with regards to issues pertaining to embryonic stem cell research.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. NA
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples?
b. possible for women not living in a heterosexual couple?
Based on the principles of equality and non-discrimination, it is proposed that the legislation will provide that assisted human reproduction services should be available to people irrespective of their gender, marital status or sexual orientation subject to consideration of the welfare of any future children.
19. Is there an important current debate in your country on these or related issues? NA
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. NA
19. Is there an important current debate in your country on these or related issues? Yes. Legislation pertaining to assisted human reproduction (AHR) is currently being developed. The draft General Scheme of legislative provisions has been completed and submitted to the relevant parliamentary committee which published the report of its review in July 2019, making recommendations which include proposals related to both broad policy objectives and more technical amendments. Its recommendations are being considered during the ongoing process of drafting this the AHR Bill. Until the enactment of the Children and Family Relationships Act 2015, the provision on assisted human reproduction treatment was largely unregulated. There has been and will continue to be widespread stakeholder engagement and national debate on these sensitive and complex matters.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
Roche -v- Roche & ors (2009)
Supreme Court unanimously dismissed an appeal by a separated mother requesting to have three frozen embryos implanted in her womb against the wishes of her estranged husband.
The appeal was brought on the following grounds:
Judgment
Legally Enforceable Agreement:
During their treatment the parties signed four consent forms as required by the clinic. As consent forms, they were found not to contain the necessary criteria for legal contracts.
None of the consent forms dealt with the three surplus frozen embryos, therefore, there was no evidence that the respondent gave his consent to their implantation.
Constitutional Protection:
Article 40.3.3 of the Irish Constitution protects the right to life of the unborn “with due regard to the equal right to life of the mother”. The Court interpreted this provision as meaning there must be a physical link between the unborn and the mother i.e. implantation in the womb.
The Court decided that the purpose of the 8th Amendment to the Constitution (1983 Referendum) was to prevent the de-criminalisation of abortion and that issues relating to IVF were not considered or foreseen.
A number of the Judgments stated that if respect for an embryo were carried to the point of equating it to the “unborn” a situation might arise where some methods of contraception e.g. morning after pill would be outlawed.
High Court Ruling: http://www.courts.ie/Judgments.nsf/bce24a8184816f1580256ef30048ca50/e5617d292b7b6b268025724800329992?OpenDocument
Supreme Court Ruling: http://www.courts.ie/Judgments.nsf/0/0973CBD1FD5204028025768D003D60F7
MR and Anor – v- An tArd Chlaraitheoir & Ors [2014]
This case concerned an arrangement whereby a woman agreed to act as a surrogate for her sister and brother-in-law (the commissioning couple). The commissioning couple provided the genetic material (egg and sperm), which ultimately resulted in the birth of twins. The commissioning couple sought to have the birth register altered so that both the commissioning couple were registered as the legal parents. The Registrar refused to do so, on the principle that he woman who has given birth to a child is always regarded as the legal mother. That refusal was challenged in the High Court.
In his judgment of 5th March 2013, Judge Abbott found in favour of the commissioning couple. He held that the genetic mother, and not the birth mother, was the mother, and that the person with the genetic/blood link was entitled to be registered as the parent on the birth certificate.
In February 2014, the State appealed Judge Abbott’s decision on the grounds that: it could create uncertainty regarding the parentage and parental rights of children born as a result of egg donation; demean the role of birth mother; lead to an opinion that commercial surrogacy is not unlawful; and result in the Registrar requiring genetic proof of maternity for every birth.
In November 2014 the Supreme Court overturned the High Court decision on the basis that the case had raised important, complex and social issues which are best addressed by the Oireachtas rather than the judiciary.
High Court Ruling: http://www.courts.ie/Judgments.nsf/bce24a8184816f1580256ef30048ca50/e3f0dc917872554c80257b250052dab3?OpenDocument
Supreme Court Ruling: http://www.courts.ie/Judgments.nsf/0/E238E39A6E756AB480257D890054DCB6
Children and Family Relationships Act 2015 – Parts 2 and 3 deals with parentage matters arising from donor assisted human reproduction. It is available at http://www.irishstatutebook.ie/eli/2015/act/9/enacted/en/html
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes. Under the Children and Family Relationships Act 2015, gamete and embryo donation are permitted on a non-anonymous basis. In addition, this legislation provides for the establishment of a National Donor-Conceived Person Register, which will allow donor-conceived children to access certain information regarding the gamete/embryo donor involved in procedures leading to their conception. It is intended that the proposed legislation pertaining to assisted human reproduction will deal with the broader issues relating to donor conception (e.g. age limits, screening, storage periods, the avoidance of consanguinity and donation for research purposes).
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? Yes. Under the Children and Family Relationships Act 2015, commercial gamete and embryo donation is prohibited. Gamete and Embryo donation may only operate on an altruistic basis and the reimbursement of reasonable expenses incurred as part of the donation process will be permitted. Reasonable expenses, for the purposes of the Act means: travel costs, medical expenses and any legal or counselling costs incurred by the donor.
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes. The Children and Family Relationships Act 2015, sets out a number of criteria in relation to the consent of gamete/embryo donors. For instance, a donor must be over 18 and must give consent in writing, having confirmed that s/he has been informed that s/he will not be the parent of a child born through the donation. The consent must be witnessed. The donor must agree, when consenting, to the inclusion of information about him/her on the National Donor-Conceived Person Register. The consent must also indicate that the donor understands that a donor-conceived child may seek to contact her/him. Assisted human reproduction clinics should be satisfied that where donated gametes/embryos are being imported from another jurisdiction, the consent process in the other jurisdiction is in line with the stipulations set out above. Under the proposed assisted human reproduction legislation, donors will undergo medical screening in accordance with requirements set out under SI No. 158/2006 European Communities (Quality and Safety of Human Tissues and Cells) Regulations 2006
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? No
10. Are there special measures for the prevention of consanguinity? Ireland has a relatively small population size, which could increase the risks of inadvertent consanguinity between individuals conceived using gametes from the same donor. It is proposed that the assisted human reproduction legislation will place a maximum limit of four families to which gametes/embryos from the same donor can be donated.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes.
Under the Children and Family Relationships Act 2015, the parents of a donor-conceived child who is born as a result of a donor assisted human reproduction procedure are
(a) the mother, and
(b) the husband, civil partner or cohabitant, as the case may be, of the mother.
The Act of 2015 does not encompass surrogacy.
19. Is there an important current debate in your country on these or related issues? NA
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
16. Is donation of sperm/oocytes/embryos anonymous? NA
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation? NA
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? NA
19. Is there an important current debate in your country on these or related issues? NA
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. NA
19. Is there an important current debate in your country on these or related issues? No
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. NA
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? Yes; For women not living in a heterosexual couple No?
b. Risk of transmission of a disease
For a heterosexual couple? Yes (HIV); For women not living in a heterosexual couple? No
c. Other NA
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? Yes
b. possible for women not living in a heterosexual couple? No
2. Are there specific criteria for access to MAP? Biological examinations as laid down by the French Bioethics Law.
Medical reasons:
a. Infertility:
For a heterosexual couple? Yes; For women not living in a heterosexual couple? Yes
b. Risk of transmission of a disease
For a heterosexual couple Yes?; For women not living in a heterosexual couple? Yes
c. Other N/A