GRH D 16 00001 Manuscript
GRH D 16 00001 Manuscript
GRH D 16 00001 Manuscript
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The International Federation of Fertility Societies (IFFS) is a federation of national membership societies
that have an interest in the clinical and research aspects of reproduction and fertility. IFFS is a nongovernmental organization (NGO) in official relations with the World Health Organization (WHO).
Copyright
2016
by
International
Federation of Fertility Societies (IFFS).
All rights reserved. No part of this
publication may be reproduced by any
means without the prior written consent
of the IFFS.
The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of the IFFS concerning the legal
status of any country, territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries. The editorial board members and survey respondents are
responsible for the views and comments, respectively, expressed in this publication and they
do not necessarily represent the decisions, policy, or views of the IFFS.
Page 3 of 224
Page 4 of 224
Number of centres
Legislation and guidelines
Insurance coverage
Marital status
Number of embryos for transfer in assisted reproductive technology (ART)
Cryopreservation
Posthumous insemination
Donation
Anonymity
Micromanipulation
Oocyte maturation
Welfare of the child
Fetal reduction
Preimplantation genetic diagnosis
IVF gestational carriers
Experimentation with embryonic cells
Cloning
Status of the embryo
Sex selection
Fertility preservation
Reporting mechanisms
Same sex/ single parenting policy
Cross border reproductive care
Conclusions
PREFACE
International Federation of Fertility Societies (IFFS) Surveillance 2016 represents several milestones.
Surveillance 2016 serves as the first edition of the new online IFFS journal, Global Reproductive Health.
Surveillance 2016 represents a broader joint effort of the IFFS and World Health Organization (WHO) in
association with the IFFS status as a non-governmental organization (NGO) in official relations with
WHO. WHO representatives participated in the reorganization and reformatting of the 2012 questionnaire
and expansion of the database of contacts among global public health officials and experts in order to
supplement the pre-existing Surveillance contact list. We anticipate, that as we fulfill our responsibilities in
our relations with WHO, that our joint activities in subsequent editions will likely continue to expand.
An entirely new survey was developed and used for Surveillance 2016. The contract for conducting the
online questionnaire, follow-up, data analysis an ultimate product development was awarded to Medtech
For Solutions. The previous Excel spreadsheet was abandoned in favor of a streamlined, more focused
web-based questionnaire that eliminated redundancies and sought more focused information in evolving
areas of interest. A few sections were added addressing reporting mechanisms, policies regarding access
Page 5 of 224
for same sex and single parenting individuals, as well as policies governing cross-border reproductive
care.
The questionnaire (2015 survey or questionnaire) consisted of 97 questions in English, and took the
average respondent 2.5 hours to complete (cumulative onsite time). The online survey was launched on
October 1, 2015 and requests to participate were submitted to over 600 individuals in 215 countries for
preparation of the publication of Surveillance 2016. The survey officially ended on December 31, 2015,
however responses were received as late as March 1, 2016 and were included in the report. Ultimately,
responses were received from respondents in 75 countries with 70 providing data sufficient to be included
in the overall analysis. Not all countries provided complete responses to all queries and the number of
countries responding varied as noted within the chapter discussion and tabulation of topic responses.
Surveillance 2016 represents the culmination of the efforts of many. I am profoundly grateful to the
respondents listed below who committed a great deal of time and effort to accurately compile and convey
the information that was sought. A very talented editorial board was assembled and Drs. Sonia Allan,
Basak Balaban, Manish Banker, Peter Brinsden, John Buster, Edgar Mocanu, Hrishikesh Pai, and Paul
Le Roux all contributed substantially to the revision of the questionnaire, the selection of new content, the
analysis of the data, and the individual organization and production of each section. Dr. Marcos Horton
deserves special mention for doggedly and successfully pursuing countries that had not responded to the
initial invitation to participate and assuming extra editorial duties. Kathleen Miller, from Medtech For
Solutions, was a superb managing editor and was indispensable to the final product. She had essential
roles throughout the process including oversight of the development of the new questionnaire, execution
of the online survey, compilation and distribution of the data, facilitation of the online development of the
manuscript, and production of the figures and tables. Dr. Sheryl van der Poel also made unique
contributions. During her tenure at WHO, she served as a liaison between WHO and IFFS and made
numerous suggestions pertaining to content, organization and language for both the development of the
questionnaire and this final report. She played a key role in the revision of the 2009 International
Committee Monitoring Assisted Reproductive Technologies (ICMART)-WHO Glossary on Assisted
Page 6 of 224
Reproductive Terminology and was invaluable in ensuring that our terminology was consistent with the
new draft 2016 glossary on terminology for fertility care and infertility. I would also like to acknowledge the
IFFS officers, Board of Directors, and administrative staff for their unflagging support and contributions.
Surveillance 2016 serves as a record and an overview of the practice, policies and activities associated
with assisted reproductive technology (ART) as it existed globally, at the end of 2015. It also, provides an
evaluation of specific national and global trends over time that concern specific, and sometimes
controversial, topics and issues. However, there are significant limitations to this report. All aspects of
ART are dynamic and continuing to change. The respondents for the 2016 edition represent the majority
of countries with the most active ART services worldwide; however, the experiences of over 100 countries
are not depicted in this report despite intensive efforts to find representative respondents to include them.
The responses to the questionnaire were provided by one or two well-informed individuals in each country
but these responses were not validated and may contain inherent accuracies. Caution should be taken
when interpreting or re-presenting these data. There are limitations in the completeness and quality of the
surveillance data reported, including the variability in respondents from countries who provided feedback
to surveys in 2013 versus in 2016. Nevertheless, this report remains the only source of information that
provides a global overview of ART practices. Potential partnerships with other global organizations and
an increase in awareness of this IFFS data collection should improve the quality in years to come.
Nevertheless, Surveillance 2016 attests to a robust and expanding scope of ART practices, policies, and
activities among nations around the world while highlighting significant and important differences with a
review of trends that have occurred the triennium.
Steven J Ory
Editor-in -Chief, Surveillance 2016
July 2016.
LIST OF PARTICIPANTS
Participant Name
Participant Country
Argentina
Marcos Horton
Argentina
Sonia Allan
Australia
Wilfried Feichtinger
Austria
Ahmta Chowdhury
Bangladesh
Juliet Skinner
Barbados
Karen Broome
Barbados
Oleg Tishkevich
Belarus
Christine Wyns
Belgium
Brazil
Tanya Timeva
Bulgaria
Cameroon
Mark Evans
Canada
Albert Yuzpe
Canada
Adrian Gamelin
Canada
Fernando Zegers-Hochschild
Chile
Li Rong
China
Guido Parra
Colombia
Clara Esteban
Colombia
Dejan Ljiljak
Croatia
Mardesic Tonko
Czech Republic
Josephine Lemmen
Denmark
Pablo Valencia
Ecuador
El Salvador
Aivar Ehrenberg
Estonia
Andrei Soritsa
Estonia
Anna Heino
Finland
Dominique de Ziegler
France
Page 7 of 224
Jan-Steffen Krussel
Germany
Basil C. Tarlatzis
Greece
Guatemala
Sergio Bendana
Honduras
Kenneth Mao
Attila Torok
Hungary
Sonia Malik
India
Hrishikesh D. Pai
India
Indonesia
Iran
Iraq
Joseph Schenker
Israel
Foad Azem
Israel
Andrea Borini
Italy
Osamu Ishihara
Japan
Mazen Elzibdeh
Jordan
Raja Alkaraki
Jordan
Vyacheslav Lokshin
Kazakhstan
Alfred Murage
Kenya
K.K.Iswaran
Malaysia
Mali
Mexico
Alejandro Chavez-Badiola
Mexico
Myanmar
Ken Daniels
New Zealand
Oladapo Ashiru
Nigeria
Arne Sunde
Norway
Oman
Roberto E. Epifano
Panama
Panama
Roger Molinas
Paraguay
Peru
Eileen M. Manalo
Philippines
Katarzyna Koziol
Poland
Carlos Calhaz-Jorge
Portugal
Ioana Rugescu
Romania
Mircea Onofriescu
Romania
Anna Smirnova
Russian Federation
S. Hassan
Saudi Arabia
Rokhaya Thiam Ba
Senegal
PC Wong
Singapore
Martin Petrenko
Slovak Republic
Slovenia
Silke Dyer
South Africa
Paul Le Roux
South Africa
South Korea
Montserrat Boada
Spain
Sanjeeva S.P.Godakandage
Sri Lanka
Kjell Wanggren
Sweden
Lars Hamberger
Sweden
Gabriel de Candolle
Switzerland
Taiwan (China*)
Frank Broekmans
The Netherlands
Catherine Minto-Bain
Samuel Ramsewak
Kharouf Mahmoud
Tunisia
M. Ertan Kervancioglu
Turkey
F Shenfield
United Kingdom
Allan Pacey
United Kingdom
Rita Vernocchi
Uruguay
Page 8 of 224
David Adamson
USA
Kevin Doody
USA
Francisco Risquez
Venezuela
Alfredo Levy
Venezuela
Page 9 of 224
CHAPTER 1: NUMBER OF CENTRES
Compiling an accurate tabulation of the number of centres providing assisted reproductive technology
(ART) services remains a formidable challenge. The number of countries where centres are licensed,
registered, or where oversight is otherwise provided, continues to increase and reliable estimates may be
made in these countries from that point forward. Significant global progress has been made in
establishing ART registries and oversight over the intervening three years. The 2016 data for these
countries may represent a more accurate and complete estimate than previous estimates with an ability
to utilize the registries to determine ART centre numbers. However, many countries still lack national ART
registries, clinic-specific information is collected sporadically (if at all), and there are no reliable estimates
on clinic numbers. The 2016 data set offers a more comprehensive attempt to determine the total number
of ART centres worldwide but over 100 countries contacted did not complete the 2015 questionnaire.
While this poses a significant limitation to the study, many of the non-responding countries are known to
not have ART programmes or are believed to have a small number of centres.
Overall, 74 countries had respondents who provided data about number and type of centres (Table 1). Of
the estimated total number of centres reported, there is an increase from approximately 3800 in 2012 to
5353 in 2015. However, Surveillance 2016 includes 14 additional countries, which did not report in 2012.
Most of the respondents that provided information for both years have reported a modest increase in the
total number of clinics or no significant change. Comparing the 2013 to the 2016 publications, 49
countries reported by their respective respondents in both surveys, 25 were new to the 2016 edition and
10 that reported in 2013 did not report for 2016. Of countries whose representatives have provided
reliable estimates for both years, Argentina, Bulgaria, Finland, India, Ireland, Kazakhstan, Peru, Saudi
Arabia, Turkey and Venezuela appear to have had significant increases and only Brazil and the United
States reported a decrease of 5 or more centres. Of the 10 countries that only had responses in 2013,
only Egypt (58) and Vietnam (13) previously reported having greater than 10 centres. The apparent large
increase in the total number of centres reported this year appears to reflect more complete capture of
data from a greater number of country representatives and perhaps a modest overall increase in the
number of centres in a few countries.
This year, respondents were queried regarding the types of centres included in their countries, including
designations for public, private, hospital, university based and private practitioner models. The private
physician clinic model appears to be the most prevalent type and the sole practitioner, the least.
CHAPTER 1. Table 1 - Number of Centres
Year
Private or
Public
UniversityBased Clinic
Public
HospitalBased Clinic
Sole
Practitioner
Clinic
23-25
30-44
60
22
34
Australia
63
76
59
12
Austria
25
25
27
20
Bangladesh
13
Barbados
Belarus
Belgium
16-30
31
34
Brazil
150
200
180
126
27
18
Bulgaria
16
23
31
30
Cameroon
31
28
Chile
8-9
China
102-300
>200
358
Colombia
19-21
27
25
Croatia
7-11
13
12
30
38
42
36
Canada
Czech Republic
2010
(N)
2013
(N)
2016
(N)
Private
Physician
Clinic
Argentina
Country
Page 10 of 224
18-22
18-21
12
10
6-8
11
10
52-55
58
El Salvador
Estonia
Finland
19-20
18
24
14
France
90-106
100
104
58
40
46
134
92
32
50-60
~ 60
66
46
10
Guatemala
Honduras
9-12
11
Hungary
12
14
13
Iceland
Egypt
Germany
Greece
India
500
500-600
1000
995
Indonesia
26
Iran
62
37
24
Iraq
13
Ireland
Israel
Italy
Ivory Coast
7-8
28
24-30
29
34
17
360
350
350
200
25
100
25
Japan
606-618
591
587
388
63
72
64
Jordan
20
10
Kazakhstan
12
19
15
Kenya
Latvia
4-5
Libya
9-10
8-10
Malaysia
36
17
10
Mali
Uncertain
~ 30
48
35
Myanmar
Netherlands
13
12
New Zealand
Nigeria
50
35
Norway
11
10
12
14
Mexico
Oman
Panama
12
Paraguay
5-7
12
50
Portugal
24
28
24
14
Romania
21
17
80
110- 130
170
115
55
24-30
30
50
10
34
Senegal
Singapore
11
11
South Africa
12-15
15
20
18
South Korea
142
150
148
54
60
34
177-203
>100
371
281
90
15-16
16
17
11
26
26
25
72-78
76
79
34
35
10
Peru
Philippines
Poland
Russian Federation
Saudi Arabia
Slovak Republic
Slovenia
Spain
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
Page 11 of 224
Togo
Tunisia
12
Turkey
112-116
131
153
31
80
33
Uganda
UK
66
71 -117
78
78
Uruguay
450-480
430
410
320
15
60
15
Venezuela
17-18
10
30
22
Vietnam
11-12
13
3524-3870
3701-3890
5353
3145
596
555
460
73
USA
Totals
* Reporting separately for this report
Page 12 of 224
CHAPTER 2: LEGISLATION AND GUIDELINES
The practice of assisted reproductive technology (ART) is usually regulated by legislation promulgated in
each country. Guidelines of professional societies, licensing bodies, and agency oversight also influence
current ART practice. Of the 75 countries that responded to the questionnaire submitted in 2015, 70
provided sufficient information to be included in this analysis on legislation and guidelines.
In the previous 2013 International Federation of Fertility Societies (IFFS) Surveillance report, more than
90% of the country representatives reporting had legislation and/or guidelines regulating ART treatment.
Legislation and guidelines are continually evolving and, for the most part, have established restrictions on
various applications of the practice of ART. While some of these developments are intended to enhance
the safety, access, and transparency of ART, other developments have limited or curtailed practices and
techniques that are widely accepted and practiced in other countries. While the overall trend appears to
be one of increasing uniformity and access, the local practices of ART vary significantly among regions
and cultures and are ultimately determined by the local stakeholders. These stakeholders include patient
advocacy groups, local healthcare providers, professional organizations, local and national government
agencies, insurance and other organizations responsible for payment, legislative bodies, and religious
organizations. As the practice of ART has become more pervasive within private and public health care
services and a greater number of patients have been impacted, subsequent public awareness, scrutiny,
and interest have been magnified.
Advances in the genetic assessment of embryos, trends in cross border reproductive care, ethical
debates regarding the appropriateness of preserving anonymity for gamete donation, and proscriptions
on gestational carriers are examples of topics that have received extensive attention over the past three
years. Thus, many of these issues and related aspects of ART have been recently addressed in
legislation and guidelines.
Surveillance 2016 offers a more detailed look at recently implemented legislation and guidelines
compared to past efforts. The 2016 survey also highlights specific topics that received unique legislative
attention. This more detailed questionnaire attempted to engage international respondents uniquely
suited to provide the most reliable information. Specific queries to address the process for institution and
monitoring of licenses for ART centres, affiliated labs, clinicians, lab directors, and staff were included in
the 2016 questionnaire and provide a unique comparison of systems of governance among different
countries (Table 1).
ANALYSIS OF THE SURVEY
Data was received from 93 respondents in 75 countries in this 2016 IFFS Surveillance Report survey. In
this chapter, data deemed adequate for analysis was received from 70 countries. Of the 70 counties
whose reports were deemed adequate for analysis, 40 (57.1%) had legislation promulgated in their
country to regulate ART. Of these 40 countries, 41% had additional ART society guidelines in their
country and 15.7% had legislation alone to regulate practice.
Out of all 70 countries, 24.3% of respondents had only national society guidelines without any formal
legislation. In 18.6% of these countries, there were no regulatory structures in the form of legislation or
guidelines (Table 1).
When queried regarding updates in legislation since the 2012 survey, 35% of the countries had new
legislation and 48.5% had no updates. The remainder of respondents were unsure whether updates had
occurred. Table 2 and Chart 1 list and illustrate the various aspects of ART addressed by legislation in the
past three years in rank order, illustrating the most prevalent topics in new legislation.
In the countries in which updated legislation had occurred, the respondents noted that access to ART had
not been restricted nor applications limited in 60% of countries. In 28% of countries, new legislation was
perceived as having negatively affected access, and 12% replied that there had been a variable effect.
Page 13 of 224
The relationship of media attention to allegations of violations of ART regulations was also assessed. In
23% of countries, respondents were aware of reports of violations, 57% responded that there had been
no publicity related to ART violations, and in the remainder of countries it was unknown.
1) The ART centre itself
The licensing criteria, monitoring of governance, and identification of the credentialing bodies pertaining
to ART centres was assessed separately:
The Survey noted that 70% of countries had licensing criteria for ART centres as a whole unit. Of these,
73% relied on an examination or certification procedure, 57% utilized on-site inspection, and 63% used a
period report. Some countries employed combined strategies.
Monitoring of ART centres was performed in 64% of countries. The principal mechanisms employed in the
countries that had systems in place for monitoring included: on-site inspection (87%); a national registry,
(73%); and a periodic report (64%). Twenty-two percent of the countries with monitoring also submitted
their data to an international registry.
Government employees were responsible for monitoring ART centres in 58% of countries; independent
agencies and medical officers were equally responsible for monitoring in 40% of countries. Two percent
of countries utilized monitoring with unofficial agencies.
2) Reproductive medicine physicians
In 50% of countries, licensing or credentialing criteria exist for reproductive medicine specialist physicians
or endocrinologists who have undergone special training in ART medicine. This was accomplished in over
90% of countries by certification examination.
Thirty-seven percent of countries perform ongoing monitoring of reproductive medicine physicians.
3) OB / GYN practicing ART
In 41% of countries, there were licensing criteria for obstetrician gynecologist physicians practicing ART,
accomplished by examination or certification in 91% of cases. It was not clear how many of these
countries had separate sub-specialization fellowship programmes for reproductive medicine specialists,
and overlap likely exists between the categories of obstetrician gynecologist with and without further
fellowship qualifications.
4) The ART laboratory
In 59% of countries, there were licensing requirements specific to the ART laboratory rather than the
whole centre. The majority of countries relied on a certification system in 89% of cases. An onsite
inspection system was performed in 61% of countries, and a periodic report was performed in 44% of
countries laboratories.
Fifty-one percent of countries had ongoing monitoring criteria for the ART labs, and the majority (61%)
used onsite inspection for this process. Government employees performed the monitoring in 43% of
countries, medical officials in 18%, independent agencies in 14%, and unofficial agencies in 2% of
countries.
5) Lab director and lab staff
In 51% of countries, there were licensing criteria for the lab director and 36% had licensing criteria for the
lab staff. In more than 80% of cases this was accomplished by examination and certification.
Ongoing monitoring was performed in 30% of countries for the lab director and 19% for lab staff, using
similar mechanisms to the original licensing criteria.
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6) Monitoring of ART outcomes
The respondents were queried regarding mechanisms for monitoring ART outcomes. In 34% of countries
a national registry was used. Fourteen percent reported that they presented data to an international
registry and 31% had periodic reports submitted from ART units on their ART outcomes. Verification was
accomplished by on-site inspections in 16% of countries. This was performed in 34% of countries by
government employees, 18% by medical officials, 12% by independent agencies, and 3% by unofficial
agencies.
7) Penalties for violation of governance, licensure or credentialing
In 57% of 70 countries responding, penalties were in place for violations of governance, licensure, or
credentialing. In 27% of countries responding there were no penalties in place, and it was unknown
whether penalties existed in 16%.
A variety of penalties existed across the different countries. In 19%, a fine could be imposed, in 33% the
IVF unit could lose its registration or be closed, criminal prosecution or imprisonment was possible in 23%
of countries, and one country reported that publication of the details of an IVF units infraction was a
potential penalty.
DISCUSSION
In more than 80% of countries, ART was regulated by legislation, guidelines, or a combination of both.
Over the last 3 years, legislation was updated in 35% of countries and the changes were perceived as
positive in the majority of cases.
The perception of acceptable and best practice in reproductive medicine is continuing to evolve. New
initiatives are underway in licensing and legislation, and professional societies guidelines often reflect
these changes. The respondents viewed the changes implemented as a positive development, in that
they did not restrict access or limit the application of ART in 60% of cases.
This survey accurately surveyed 70 countries, which was an improvement compared with the 2013 survey
published where only 60 countries had complete data for analysis. In addition, there was more meaningful
data obtained about the topics updated in recently introduced legislation. There was also an in-depth
analysis of how the different facets of an ART centre are licensed and monitored over time.
The issues that received the most attention in legislation were insurance coverage for ART, limits on the
numbers of embryos for transfer, role of marital status in determining access, cross-border reproduction,
gamete donation, sex selection, preimplantation genetic testing (PGT), and same sex parenting policies.
SUMMARY
The chapter on Legislation and Guidelines in this Surveillance 2016 included complete data from 70
countries, which was more extensive than previous IFFS reports. The 2015 questionnaire was intended to
elicit more specific data for each topic, and provide more detailed information about international ART
practices. More than 80% of countries used legislation, guidelines, or a combination of both to regulate
ART practice. New legislation had been introduced in 35% of countries since 2012, and 60% of these
updates were perceived to be positive by the respondents. The focus of new legislation over the past
three years included insurance coverage, access to ART services based on marital and relationship
status, cross-border reproduction, performance of gamete donation, and limits on the number of embryos
for transfer. More countries are adopting measures to promote safety, efficacy, and standardization, but a
variety of mechanisms has been employed to accomplish this.
Page 15 of 224
Municipal
Laws/Statutes/
Ordinances
Professional
Organization
Standards/
Guidelines
Federal/National
Laws/Statutes/
Ordinances/
Policies
Licensing Body
No regulations
Agency
Regulations/
Oversight
Country
Argentina
NO
YES
YES
NO
NO
YES
YES
Australia
NO
YES
YES
NO
YES
YES
YES
Austria
NO
YES
NO
YES
NO
YES
YES
Bangladesh
NO
NO
NO
NO
NO
NO
NO
Barbados
YES
NO
NO
NO
NO
NO
YES
Belarus
NO
YES
NO
NO
NO
YES
YES
Belgium
NO
YES
NO
NO
NO
NO
NO
Brazil
NO
YES
NO
NO
YES
NO
YES
Bulgaria
NO
YES
NO
YES
YES
YES
YES
Cameroon
YES
NO
NO
NO
NO
NO
YES
Canada
NO
YES
YES
NO
NO
NO
YES
Chile
YES
NO
NO
NO
NO
NO
YES
China
NO
YES
NO
NO
YES
YES
YES
Colombia
YES
NO
NO
NO
NO
NO
YES
Czech Republic
NO
YES
NO
NO
NO
YES
YES
Denmark
NO
YES
NO
NO
YES
YES
YES
Ecuador
YES
NO
NO
NO
NO
NO
YES
El Salvador
YES
NO
NO
NO
NO
NO
NO
Estonia
NO
YES
NO
NO
YES
YES
NO
Finland
NO
YES
NO
NO
YES
YES
YES
France
NO
YES
NO
NO
YES
YES
NO
Germany
NO
YES
YES
NO
YES
YES
YES
Greece
NO
YES
NO
NO
YES
YES
NO
Guatemala
NO
NO
NO
NO
YES
YES
YES
Honduras
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
Hungary
NO
YES
NO
NO
NO
NO
YES
India
YES
NO
NO
NO
NO
NO
YES
Indonesia
NO
YES
YES
YES
YES
YES
YES
Iran
NO
YES
NO
NO
YES
Unknown
Unknown
Iraq
NO
YES
NO
NO
NO
YES
YES
Ireland
YES
NO
NO
NO
NO
NO
YES
Israel
NO
YES
NO
NO
NO
YES
YES
Italy
NO
YES
YES
NO
NO
NO
YES
Japan
YES
NO
NO
NO
NO
NO
YES
Jordan
NO
NO
NO
NO
NO
YES
YES
Kazakhstan
NO
YES
NO
NO
NO
YES
YES
Kenya
YES
NO
NO
NO
NO
NO
NO
Malaysia
NO
NO
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
NO
NO
NO
Mexico
YES
NO
NO
NO
NO
NO
NO
Myanmar
YES
NO
NO
NO
NO
NO
NO
Netherlands
NO
YES
NO
NO
NO
YES
YES
Nigeria
YES
NO
NO
NO
NO
NO
YES
Norway
NO
YES
NO
NO
NO
YES
NO
Panama
NO
YES
NO
NO
NO
NO
NO
Paraguay
YES
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
NO
NO
Philippines
YES
NO
NO
NO
NO
Unknown
YES
Portugal
NO
YES
NO
NO
YES
YES
NO
Romania
NO
YES
NO
NO
YES
YES
YES
Page 16 of 224
Russian Federation
NO
YES
YES
NO
NO
YES
NO
Saudi Arabia
NO
NO
NO
NO
NO
YES
YES
Senegal
YES
NO
NO
NO
NO
NO
YES
Singapore
NO
NO
NO
NO
NO
YES
NO
Slovak Republic
NO
YES
NO
NO
NO
NO
YES
South Africa
NO
YES
NO
NO
NO
NO
YES
South Korea
NO
YES
NO
NO
NO
NO
YES
Spain
NO
YES
NO
NO
NO
NO
YES
Sri Lanka
YES
NO
NO
NO
NO
NO
YES
Sweden
NO
YES
YES
YES
NO
YES
YES
Switzerland
NO
YES
YES
NO
NO
YES
YES
Taiwan (China*)
NO
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
NO
NO
NO
Tunisia
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Turkey
NO
YES
NO
NO
NO
NO
NO
UK
NO
YES
NO
NO
NO
YES
YES
Uruguay
NO
YES
NO
NO
NO
NO
NO
USA
NO
YES
YES
NO
YES
NO
YES
NO
NO
NO
NO
NO
YES
YES
Venezuela
* Reporting separately for this report
27%
Insurance coverage
13%
10%
Marital status
10%
7%
Gamete donation
7%
Sex selection
6%
6%
6%
Reporting mechanisms
6%
Surrogacy
4%
Anonymity
3%
3%
Cryopreservation
3%
Posthumous reproduction
1%
Micromanipulation
1%
1%
1%
Cloning
1%
Fertility Preservation
1%
Oocyte maturation
0%
Fetal Reduction
0%
Page 17 of 224
Page 18 of 224
CHAPTER 3: INSURANCE COVERAGE
INTRODUCTION
The provision of assisted reproductive technology (ART) therapy has seen a constant growth in recent
years due to a better understanding of the causes of infertility and an increased opportunity to avail of in
vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments in a larger number of countries
worldwide. In a recent publication, the International Committee Monitoring Assisted Reproductive
Technologies (ICMART) world report detailed results from years 2008, 2009, and 2010 and showed an
annual increase to each preceding year of 9.0%, 6.4%, and 13.1%, respectively (1). The reported ART
utilization rates (number of initiated cycles per million population) varied widely from 4,775 in Israel, 2,337
in Australia/New Zealand, to the lowest rates in Latin America (152) and sub-Saharan Africa (87). Such
variations are likely due to treatment availability and the possibility that access to care may be limited by
lack of financial support for couples in need. The previous (2013) IFFS Surveillance report analyzed data
from 60 countries and showed the number of countries providing cover for ART to be decreasing (60% in
2010 and 52% in 2013), possibly due to respondent profile variability (2). The importance of this chapter
lies in detailing the global ART insurance coverage and in particular, revealing the gap between service
need and financial support from states and private insurers.
ANALYSIS OF THE SURVEY
The present survey is comprised of data from 70 countries with respondents providing data on this topic
(a 17% increase compared to 2013). We acknowledge limitations in the completeness and quality of data
associated with the issue of insurance coverage, as in previous reports. For example, only one question
was answered by all respondents from 70 countries, and one had as few as 35 country respondents,
making data difficult to compare with previous years in order to observe trends.
Only 37 countries (53%) reported providing coverage for infertility treatments. Among the 35 out of 67
countries (52%) where reimbursement was regulated (Table 1), 26 reported regulations on the national
level. Furthermore, a large proportion of government funding was reported to be provided on the national
level in 32/47 (68%) of responding countries with the remaining at local or regional level. However, the
extent of number of cycles, and the limitations on public health support and access to ART care can vary
greatly from country to country and in some cases, within regions or states of a country. The extent of
insurance coverage for ART was measured as either complete or partial. Of the 52 respondents, 15
countries provide national complete coverage (29%) though a national health plan, whereas nine
countries offer state/ provincial/ regional complete coverage (17.3%). Six countries (11.6%) reported full
coverage by private insurance. A partial national health plan coverage is offered in 22 countries (42%);
partial state/ provincial/ regional in seven countries (13%), and partial private insurance in eight countries
(15%).
Twenty-four countries (36%) of 66 respondents provide no ART insurance coverage compared to 40%
reported in a different cohort of countries represented in the 2013 report. Large countries from the
Western Pacific and Southeast Asian regions (India, China, the Philippines, Hong Kong(China)) and
some from Central and Latin American region (Mexico, Columbia, Venezuela) are not financially
supporting any ART activity (Chart 1). Of the 46 countries that reported providing some level of
government funding, 34 have a national plan (74%), nine (19%) have regional plans, and 4 (7%) have
local plans. With regard to changes from the previous 2013 report, of those 56 countries with
respondents, 32 (57%) reported no insurance modifications, five recorded a reduction in access to
coverage or reimbursement, and 16 an increase in coverage. Specifically, for example, Slovakia reported
initiation of cross-border reproductive care coverage for ART, and Japan reported the introduction of an
age limit for insurance coverage of less than 43 years for women.
Specific limitations in funding of ART were reported for 62 countries. Half of these countries (31/62)
reported offering funding based on fertility status (Table 2, Chart 2), however in 20 (32%) countries, both
primary and secondary infertility were reported to be covered by insurance. Similarly, 18% reported to
Page 19 of 224
have ART reimbursement tied to a policy of elective single embryo transfer (eSET), while only five of 37
countries reported basing their funding upon duration of infertility (Table 3, Chart 3) (Turkey, Finland, UK,
USA: three years; Romania: two years). The age profile of patients covered by ART health plans varies
widely, with 31 out of 39 countries imposing an age limit (range of 39 to 50 years old for the woman). For
example, Italy and Greece reported 50 as the upper limit, while 24 countries reported limits between 4045 years of age for the woman.
Interestingly, only three countries (Chile, Japan, and Switzerland) out of 35 reported that their ART
reimbursement is tied to income. Of the 37 countries that had respondents who answered this question,
29 have a limit on the number of cycles covered by insurance. For example, respondents from Australia,
Russia, Israel, Estonia, Greece, Panama, and Switzerland reported that their countries do not limit the
number of cycles reimbursed. Romania, Canada and Chile reimburse one cycle only, while Belgium,
Japan, Singapore, and the USA (USA is individual state specific) reported that they offer up to six
reimbursed treatments.
Details of fertility treatments that are covered by insurance (as reported by country respondents) are
present in Tables 4 through 6 and Charts 4 through 7. Interestingly, coverage for pre-implantation genetic
testing (PGT) for diseases (previously defined as PGD) is exclusively present in Israel and European
countries, while in four European countries (Spain, Portugal, Finland, and Czech Republic) PGT for
screening (previously defined as PGS) is also covered. It is noteworthy that no country representative
reported reimbursements for either oocyte or ovarian tissue cryopreservation for non-medical reasons.
DISCUSSION
The percentage of countries whose respondents reported providing ART coverage has modestly
increased since the last report and now stands at 64% of reporting countries. In 29% of countries, the
reimbursement coverage has increased from the previous report, offering reassurance that policy makers
realize the societal importance of supporting fertility therapy. Respondents from some countries with large
populations (e.g., India, China) report not providing funding for ART treatments. Considering the
significant shift toward eSET worldwide, it is noteworthy that only 18% of countries tie their ART
reimbursement programmes to an eSET policy. eSET in ART has the potential for significant costeffectiveness when considering the care for multiple newborns born through ART who often present with
medical complications and prematurity. The cost savings for an eSET policy linked to national ART
reimbursement policies perhaps requires greater research and assessment at the country level. Similarly,
PGT for disease detection, a procedure with clear medical indications, is covered only in Israel and a few
European countries. Cross-border reproductive care is a world phenomenon and the Slovakian initiative
to reimburse cross-border ART therapy is unique; however, no details on the eligibility criteria were
provided.
SUMMARY
Insurance coverage for ART remains an area of great disparity as reported among the worlds countries.
This report notes a modest increase in coverage, with 74% of countries providing a reported coverage at
various levels through a national, regional/provincial, or state plan. Eligibility criteria for funding and
expanded equity of access are areas that require greater exploration.
CHAPTER 3. Table 1 - Are there regulations that address reimbursement of ART procedures in your country?
State/Provincial/
Regional Laws/
Statutes/
Ordinances
Municipal Laws/
Statutes/
Ordinances
Agency
Regulations/
Oversight
Professional/
Organization
Standards/
Guidelines
Cultural practice
Religious decree
Federal/National
Laws/Statutes/
Ordinances
No regulations
Argentina
NO
NO
NO
NO
NO
NO
NO
NO
Australia
NO
YES
YES
NO
NO
NO
NO
NO
Austria
NO
YES
NO
NO
NO
YES
NO
NO
Bangladesh
NO
NO
NO
NO
NO
NO
YES
YES
Barbados
YES
Belarus
NO
NO
NO
NO
NO
NO
NO
NO
Country
Page 20 of 224
Belgium
Brazil
YES
NO
Bulgaria
Cameroon
NO
Canada
NO
Chile
YES
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
YES
China
YES
NO
NO
NO
NO
NO
NO
Colombia
NO
NO
NO
NO
NO
NO
NO
NO
Czech Republic
NO
YES
NO
NO
NO
YES
NO
NO
Denmark
NO
YES
NO
NO
NO
NO
NO
NO
Ecuador
YES
El Salvador
YES
NO
NO
NO
NO
NO
NO
NO
Estonia
NO
YES
NO
NO
NO
NO
NO
NO
Finland
NO
YES
NO
NO
YES
NO
NO
NO
France
NO
YES
NO
NO
NO
Unknown
NO
NO
Germany
NO
YES
YES
NO
NO
YES
NO
NO
Greece
YES
NO
Guatemala
Unknown
NO
NO
NO
NO
NO
NO
Honduras
NO
NO
NO
NO
NO
NO
NO
Hungary
NO
YES
NO
NO
NO
NO
NO
NO
India
YES
YES
Iran
NO
Unknown
NO
NO
NO
NO
NO
NO
Ireland
YES
NO
NO
NO
NO
NO
NO
NO
Israel
YES
YES
NO
YES
YES
NO
NO
NO
Italy
NO
NO
YES
NO
NO
NO
NO
NO
Japan
NO
YES
YES
YES
NO
NO
YES
NO
NO
NO
NO
NO
NO
Jordan
NO
Kazakhstan
YES
Kenya
YES
Malaysia
NO
NO
NO
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
NO
NO
NO
NO
Mexico
YES
NO
NO
NO
NO
NO
NO
NO
Myanmar
YES
NO
NO
NO
NO
NO
YES
Unknown
Netherlands
NO
YES
NO
NO
NO
NO
NO
NO
Nigeria
NO
NO
NO
NO
NO
NO
NO
NO
Norway
NO
YES
Panama
YES
NO
NO
NO
NO
NO
NO
NO
Paraguay
YES
NO
NO
NO
NO
NO
NO
NO
Philippines
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
YES
Portugal
Romania
YES
Russian Federation
YES
Saudi Arabia
YES
NO
NO
NO
YES
YES
YES
Senegal
NO
NO
NO
NO
NO
NO
NO
NO
Singapore
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
Slovak Republic
South Africa
YES
NO
South Korea
NO
YES
Spain
NO
Sri Lanka
YES
Sweden
NO
Switzerland
NO
NO
Taiwan (China*)
NO
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
Tunisia
YES
Turkey
YES
YES
NO
NO
NO
NO
NO
NO
UK
NO
NO
YES
NO
NO
NO
NO
NO
Page 21 of 224
Uruguay
NO
NO
NO
NO
NO
YES
YES
USA
NO
NO
YES
NO
NO
YES
YES
NO
NO
Venezuela
NO
NO
NO
NO
NO
NO
NO
NO
Primary infertility
Secondary infertility
Family building
Argentina
NO
NO
NO
Australia
YES
YES
Austria
NO
NO
Bangladesh
NO
NO
NO
Belarus
YES
Unknown
YES
NO
NO
Belgium
NO
NO
Brazil
YES
YES
Bulgaria
YES
YES
NO
Cameroon
NO
NO
YES
YES
Canada
YES
Chile
China
NO
NO
NO
Czech Republic
NO
NO
NO
Denmark
YES
Ecuador
YES
YES
El Salvador
NO
NO
NO
Estonia
NO
NO
NO
Finland
NO
NO
NO
France
YES
YES
YES
Germany
NO
NO
NO
Greece
NO
NO
NO
Guatemala
NO
NO
NO
Honduras
YES
YES
YES
YES
Hungary
YES
YES
YES
India
NO
NO
NO
Iran
Unknown
Unknown
Unknown
Page 22 of 224
Ireland
NO
NO
NO
Israel
YES
YES
YES
Italy
YES
YES
NO
Japan
YES
YES
Unknown
Jordan
Unknown
Unknown
Unknown
Kazakhstan
YES
YES
YES
Malaysia
YES
YES
Unknown
Unknown
Myanmar
NO
NO
NO
Netherlands
YES
YES
YES
Nigeria
NO
NO
NO
Norway
NO
NO
NO
Panama
NO
NO
NO
Paraguay
NO
NO
NO
Peru
NO
NO
NO
Portugal
YES
YES
NO
Romania
YES
YES
NO
Russian Federation
NO
NO
NO
Saudi Arabia
YES
YES
YES
Senegal
NO
NO
NO
Singapore
YES
YES
NO
Slovak Republic
YES
YES
Mali
Unknown
South Africa
NO
NO
South Korea
YES
YES
NO
Spain
YES
YES
NO
Sri Lanka
NO
NO
NO
Sweden
YES
NO
Switzerland
NO
NO
NO
Taiwan (China*)
NO
NO
YES
Tunisia
YES
Turkey
YES
NO
NO
UK
NO
NO
NO
Uruguay
NO
NO
NO
USA
NO
NO
YES
Venezuela
* Reporting separately for this report
NO
NO
NO
Page 23 of 224
Income levels
Age
Argentina
Country
No
No
No
eSET
No
Australia
Unknown
No
Yes
Unknown
Austria
No
No
Yes
No
Belgium
No
No
Yes
Yes
No
Brazil
No
No
Yes
Bulgaria
No
Unknown
Yes
No
Canada
No
Yes
Yes
Yes
Chile
No
NO
No
No
Colombia
NO
No
NO
NO
Czech Republic
No
No
Yes
Yes
Denmark
No
No
Yes
No
Estonia
No
No
Yes
No
Finland
Yes
No
Yes
No
France
No
No
Yes
No
Germany
No
No
Yes
No
Greece
No
No
Yes
No
Hungary
No
No
Yes
No
Ireland
No
No
No
No
Israel
No
No
Yes
Yes
Italy
No
Yes
Yes
No
Japan
No
No
Yes
No
Malaysia
No
No
Yes
No
Yes
Netherlands
No
No
Yes
Norway
No
No
No
No
Portugal
Yes
No
Yes
No
Romania
No
No
Yes
No
Russian Federation
No
No
No
No
Saudi Arabia
No
No
Yes
No
Singapore
No
No
Yes
No
Slovak Republic
No
No
Yes
No
South Korea
No
Yes
Yes
No
Page 24 of 224
Spain
No
No
Yes
Sweden
No
No
Yes
No
Switzerland
Yes
No
Yes
No
Turkey
Yes
No
Yes
Yes
UK
No
Yes
No
Uruguay
Yes
Yes
No
Unknown
Yes
USA
No
Income
14%
Duration of Infertility
No
Unknown
84%
9%
2%
89%
Age
2%
82%
eSET
18%
16%
79%
2%
3%
CHAPTER 3. Table 4 - Does insurance coverage or government funding typically cover the following ART services?
Diagnostic
Evaluation
Fertility
Medications
Intrauterine
insemination
IVF
ICSI
Argentina
YES
YES
YES
YES
Australia
YES
YES
YES
YES
Austria
NO
YES
NO
Bangladesh
NO
NO
Barbados
NO
NO
Belarus
YES
NO
NO
NO
NO
NO
NO
NO
Belgium
YES
YES
YES
YES
YES
NO
NO
NO
Brazil
YES
NO
YES
YES
YES
NO
NO
Bulgaria
NO
YES
NO
YES
YES
NO
NO
NO
Cameroon
YES
NO
NO
NO
NO
NO
NO
NO
Canada
YES
NO
YES
YES
YES
YES
NO
NO
Chile
YES
YES
YES
YES
YES
YES
NO
NO
China
NO
NO
NO
NO
NO
NO
NO
NO
Colombia
YES
NO
NO
NO
NO
NO
NO
NO
Czech Republic
YES
YES
YES
YES
NO
NO
YES
YES
Denmark
YES
YES
YES
YES
YES
Unknown
YES
NO
Ecuador
YES
NO
NO
NO
NO
NO
NO
NO
NO
Country
Assisted
hatching
PGT-M
PGT-A
YES
NO
NO
NO
YES
Unknown
NO
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
NO
Estonia
YES
YES
NO
YES
YES
NO
NO
NO
Finland
YES
YES
YES
YES
YES
YES
YES
YES
France
YES
YES
YES
YES
YES
YES
YES
NO
Germany
YES
YES
YES
YES
YES
NO
NO
NO
Greece
YES
YES
NO
NO
NO
NO
NO
NO
Page 25 of 224
Guatemala
YES
NO
NO
NO
NO
NO
NO
NO
Honduras
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
Hungary
YES
YES
YES
YES
YES
YES
NO
NO
India
NO
NO
NO
NO
NO
NO
NO
NO
Iran
YES
YES
NO
NO
NO
NO
NO
NO
Ireland
NO
NO
NO
YES
YES
NO
NO
NO
Israel
YES
YES
YES
YES
YES
YES
YES
NO
Italy
YES
YES
YES
YES
YES
NO
NO
NO
Japan
NO
NO
NO
YES
YES
YES
NO
NO
Jordan
NO
NO
NO
NO
NO
NO
NO
NO
Kazakhstan
NO
NO
NO
YES
YES
YES
NO
NO
Kenya
NO
NO
NO
NO
NO
NO
NO
NO
Malaysia
YES
YES
YES
YES
YES
YES
NO
NO
Mali
YES
NO
NO
NO
NO
NO
NO
NO
Mexico
NO
NO
YES
NO
NO
NO
NO
NO
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Netherlands
YES
YES
YES
YES
YES
NO
YES
NO
Nigeria
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
NO
YES
NO
Myanmar
YES
YES
YES
Panama
YES
YES
YES
Paraguay
NO
NO
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
NO
NO
NO
Philippines
NO
NO
NO
NO
NO
NO
NO
NO
Portugal
YES
YES
YES
YES
YES
YES
YES
YES
Romania
YES
YES
NO
YES
Russian Federation
YES
YES
NO
YES
YES
NO
NO
NO
Saudi Arabia
NO
NO
NO
NO
NO
NO
NO
NO
Senegal
NO
NO
NO
NO
NO
NO
NO
NO
Singapore
NO
YES
YES
YES
YES
YES
NO
NO
Slovak Republic
YES
YES
NO
YES
NO
NO
NO
NO
South Africa
YES
NO
NO
NO
NO
NO
NO
South Korea
YES
YES
YES
YES
YES
YES
NO
NO
Spain
YES
YES
YES
YES
YES
Unknown
YES
YES
Sri Lanka
NO
NO
NO
NO
NO
NO
NO
NO
Sweden
YES
YES
YES
YES
YES
NO
YES
NO
Switzerland
YES
YES
YES
NO
NO
NO
NO
NO
Taiwan (China*)
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
NO
NO
Turkey
YES
YES
YES
YES
YES
YES
YES
NO
UK
YES
YES
YES
YES
YES
Unknown
Unknown
NO
Uruguay
YES
YES
YES
YES
YES
NO
NO
NO
USA
YES
NO
NO
NO
NO
NO
NO
NO
Venezuela
NO
NO
NO
NO
NO
NO
NO
NO
Norway
Tunisia
Page 26 of 224
CHAPTER 3. Table 5 - Does insurance coverage or government funding typically cover the following ART third party reproduction services?
DONOR
GESTATIONAL CARRIER
Embryos
'Traditional'
(surrogate mother's
ova with a
prospective parent's
sperm)
'Gestational'
(donated ova and
commissioning
male's sperm)
'Gestational'
(donated ova and
donated sperm)
Egg
YES
YES
NO
NO
NO
NO
NO
Australia
YES
YES
YES
NO
NO
NO
NO
Austria
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Bangladesh
'Gestational'
(commissioning
couple's ova and
sperm)
Sperm
Argentina
Country
Barbados
NO
NO
NO
NO
NO
NO
NO
Belarus
NO
NO
NO
NO
NO
NO
NO
Belgium
NO
NO
NO
NO
NO
NO
NO
Brazil
NO
NO
NO
Unknown
NO
NO
NO
Bulgaria
NO
NO
NO
NO
NO
NO
NO
Cameroon
NO
NO
NO
NO
NO
NO
NO
Canada
NO
NO
NO
Unknown
Unknown
Unknown
Unknown
Chile
NO
NO
NO
NO
NO
NO
NO
China
NO
NO
NO
NO
NO
NO
NO
Colombia
NO
NO
NO
NO
NO
NO
NO
Czech Republic
NO
NO
NO
NO
NO
NO
NO
Denmark
YES
YES
NO
NO
NO
NO
NO
Ecuador
NO
NO
NO
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
NO
Estonia
NO
NO
NO
NO
NO
NO
NO
Finland
YES
YES
YES
NO
NO
NO
NO
France
YES
YES
YES
NO
NO
NO
NO
Germany
NO
NO
NO
NO
NO
NO
NO
Greece
NO
NO
NO
NO
NO
NO
NO
Guatemala
NO
NO
NO
NO
NO
NO
NO
Honduras
NO
NO
NO
NO
NO
NO
NO
Hungary
YES
YES
YES
NO
NO
NO
NO
Page 27 of 224
India
NO
NO
NO
NO
NO
NO
NO
Iran
NO
NO
NO
NO
NO
NO
NO
Ireland
NO
NO
NO
NO
NO
NO
NO
Israel
NO
NO
NO
NO
NO
NO
NO
Italy
NO
NO
NO
NO
NO
NO
NO
Japan
NO
NO
NO
NO
NO
NO
NO
Jordan
NO
NO
NO
NO
NO
NO
NO
Kazakhstan
NO
NO
NO
NO
NO
NO
NO
Kenya
NO
NO
NO
NO
NO
NO
NO
Malaysia
NO
NO
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
NO
NO
NO
Mexico
NO
NO
NO
NO
NO
NO
NO
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Netherlands
YES
YES
YES
Unknown
YES
Unknown
Unknown
Nigeria
NO
NO
NO
NO
NO
NO
NO
Norway
YES
NO
NO
NO
NO
NO
Paraguay
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
Philippines
NO
NO
NO
NO
NO
NO
NO
Portugal
YES
YES
YES
NO
NO
NO
NO
Romania
YES
Myanmar
NO
YES
Russian Federation
NO
NO
NO
NO
NO
NO
NO
Saudi Arabia
NO
NO
NO
NO
NO
NO
NO
Senegal
NO
NO
NO
NO
NO
NO
NO
Singapore
NO
NO
NO
NO
NO
NO
NO
Slovak Republic
NO
NO
NO
NO
NO
NO
NO
South Africa
NO
NO
NO
NO
NO
NO
NO
South Korea
NO
NO
NO
NO
NO
NO
NO
Spain
YES
YES
NO
NO
NO
NO
NO
Sri Lanka
NO
NO
NO
NO
NO
NO
NO
Sweden
YES
YES
NO
NO
NO
NO
NO
Switzerland
YES
NO
NO
NO
NO
NO
NO
Taiwan (China*)
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Unknown
NO
NO
NO
Tunisia
NO
NO
NO
NO
NO
NO
Turkey
NO
NO
NO
NO
NO
NO
NO
UK
YES
YES
YES
Unknown
Unknown
Unknown
Unknown
Uruguay
YES
YES
YES
NO
YES
NO
YES
USA
NO
NO
NO
NO
NO
NO
NO
Venezuela
NO
NO
NO
NO
NO
NO
NO
Page 28 of 224
CHAPTER 3. Table 6 - Does insurance coverage or government funding typically cover the following ART cryopreservation services?
Cryopreservation from
an IVF cycle
Supernumera
ry embryos
Oocytes
Sperm
Embryos
Testicular
tissue
Ovarian
tissue
Oocytes
Sperm
Embryos
Testicular
tissue
Ovarian
tissue
Argentina
NO
YES
NO
NO
NO
Unknown
Unknown
NO
NO
NO
Unknown
Unknown
Australia
Austria
Supernumera
ry oocytes
Country
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
NO
NO
NO
NO
NO
Bangladesh
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Barbados
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Belarus
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Belgium
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Brazil
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
Bulgaria
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Cameroon
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Canada
NO
NO
YES
YES
YES
YES
Unknown
NO
NO
NO
NO
Unknown
Chile
YES
NO
NO
NO
NO
Unknown
Unknown
NO
NO
NO
Unknown
Unknown
China
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Colombia
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Czech Republic
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Denmark
YES
YES
YES
YES
YES
Unknown
YES
NO
NO
NO
NO
NO
Ecuador
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Estonia
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Finland
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
France
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
NO
NO
Germany
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Greece
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Guatemala
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Unknown
Honduras
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Hungary
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
India
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Iran
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Ireland
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Page 29 of 224
Israel
YES
YES
YES
YES
YES
NO
YES
Italy
YES
YES
YES
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
Japan
YES
YES
NO
NO
NO
NO
NO
Jordan
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Kazakhstan
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Kenya
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Malaysia
NO
NO
NO
NO
NO
NO
YES
YES
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
Mexico
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Unknown
Unknown
Unknown
NO
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Netherlands
YES
YES
Nigeria
NO
NO
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Norway
YES
Paraguay
NO
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Peru
Philippines
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Portugal
Unknown
YES
YES
YES
NO
YES
YES
NO
NO
NO
NO
NO
Romania
YES
YES
Russian Federation
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Saudi Arabia
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Myanmar
NO
YES
Senegal
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Singapore
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Slovak Republic
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
South Africa
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
South Korea
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Spain
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
Sri Lanka
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Sweden
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
Switzerland
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Taiwan (China*)
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Tunisia
YES
YES
YES
YES
YES
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Turkey
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
UK
NO
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
Uruguay
NO
YES
NO
NO
YES
YES
NO
NO
NO
YES
YES
NO
USA
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Venezuela
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Page 30 of 224
Page 31 of 224
REFERENCES
1. Dyer S, Chambers GM, de Mouzon J, Nygren KG, Zegers-Hochschild F, Mansour R, et al.
International Committee for Monitoring Assisted Reproductive Technologies world report:
Assisted Reproductive Technology 2008, 2009 and 2010. Hum Reprod 2016;31(7):1588-609.
2. Ory SJ (Ed.). IFFS Surveillance 2013. Available at: https://c.ymcdn.com/sites/iffs.siteym.com/resource/resmgr/iffs_surveillance_09-19-13.pdf. Accessed August 9, 2016.
Page 32 of 224
CHAPTER 4: MARITAL STATUS
INTRODUCTION
A stable, legal heterosexual relationship (marriage) is reported to be a requirement for assisted
reproductive technology (ART) services in most countries offering treatment. The concept of marriage has
been expanded to include couples or individuals in a stable same sex relationship. This current survey
also addresses provisions for care for single individuals and patients in same sex relationships, including
their acceptance as legal parents, and the type of treatments offered to them.
In Surveillance 2013, only marital status and relevant laws pertaining to access to ART were addressed.
In this survey, access to ART based on relationship status was explored in the following categories:
Page 33 of 224
the use of traditional gestational carriers and 15 countries were reported to allow embryo donation with
gestational carriers for single women desiring pregnancies. Forty of the 54 responding country
respondents reported that diagnostic evaluation of single men was permitted but only 14 of these
countries were reported to permit advanced treatments, including in vitro fertilization (IVF). Respondents
from 30 countries reported to offer treatment to male same sex partners, female same sex partners, and
transgender couples.
SUMMARY
Most countries reportedly offered infertility treatment to women regardless of their relationship status.
Laws and guidelines in some countries often limit access to services to specific population groups or to
specific treatments such as IVF, pre-implantation genetic testing (PGT) for disease, and the use of
gestational carriers.
CHAPTER 4. Table1 - To access IVF or ART services, are a couple or an individual required to be in a recognized or stable heterosexual relationship?
Are these requirements governed by?
+
+
Barbados
Belarus
Belgium
Brazil
Bulgaria
Cameroon
+
+
Colombia
+
+
Denmark
+
+
Ecuador
El Salvador
Estonia
Finland
France
Chile
Czech Republic
+
+
Canada
China
Agency
Regulations/
Oversight
Religious decree
Bangladesh
Cultural practice
Austria
State/Provincial/
Regional
Laws/Statutes/
Ordinances
Professional
Organization
Standards/
Guidelines
Australia
Federal/National
Laws/Statutes/
Ordinances
Argentina
Unknown
No requirement
Yes
Country
Germany
Greece
Guatemala
Honduras
Hungary
Indonesia
Iran
Iraq
Ireland
+
+
+
+
+
+
Israel
Italy
Japan
Jordan
Kazakhstan
+
+
Page 34 of 224
Kenya
Malaysia
Mali
Mexico
Myanmar
Netherlands
Nigeria
Norway
+
+
Panama
Paraguay
Peru
Philippines
Portugal
Romania
+
+
Russian Federation
Saudi Arabia
Senegal
Singapore
Slovak Republic
South Africa
South Korea
+
+
Spain
+
+
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
Tunisia
Turkey
+
+
UK
Uruguay
USA
Venezuela
Page 35 of 224
CHAPTER 4. Table 2 - If there is no requirement for an official or stable heterosexual union, is IVF or ART services accessible to?
Single women
Transgender
Belgium
Brazil
Bulgaria
Canada
Chile
Colombia
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Ecuador
El Salvador
Estonia
Finland
Germany
Greece
Guatemala
Honduras
Ireland
Israel
Mexico
Netherlands
Nigeria
+
+
Paraguay
Peru
Romania
Russian Federation
South Africa
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Panama
Spain
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Denmark
+
+
UK
Uruguay
USA
Venezuela
Unknown
No
Belarus
Barbados
Yes
Intersex Individuals
Unknown
No
Yes
Unknown
No
Yes
Unknown
No
Yes
Unknown
No
Australia
Yes
Argentina
No
Yes
Country
Single men
+
+
+
+
+
+
CHAPTER 4. Table 3 - Does your country have laws that recognize the same-sex partner of a person who has used assisted reproduction as a legal parent of the resulting
child?
Same sex partner of a woman
Country
Yes
Argentina
Australia
Austria
No
Yes
No
Bangladesh
Barbados
Belarus
Belgium
Brazil
Bulgaria
Cameroon
Canada
Unknown
+
+
+
Page 36 of 224
Chile
China
Colombia
Czech Republic
Denmark
Ecuador
El Salvador
Estonia
Finland
France
+
+
Germany
+
+
Greece
Guatemala
Honduras
Hungary
India
Indonesia
Iran
Iraq
Ireland
Israel
+
+
+
Italy
Japan
Jordan
Kazakhstan
Kenya
Mali
Malaysia
Mali
Mexico
Myanmar
Kenya
Malaysia
Mali
Mexico
Myanmar
Netherlands
+
+
Nigeria
Norway
+
+
Panama
Paraguay
Peru
Philippines
Portugal
Romania
Russian Federation
Saudi Arabia
Senegal
Singapore
Slovak Republic
South Africa
+
+
South Korea
Spain
+
+
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
+
+
Page 37 of 224
Tunisia
Turkey
UK
+
+
Uruguay
USA
+
+
+
Venezuela
Chart 2: Does your country have laws that recognize the same-sex partner of a person
who has used assisted reproduction as a legal parent of the resulting child?
Yes
No
Unknown
26%
Same Sex Partner of A Woman
70%
4%
17%
Same Sex Partner of A Man
79%
4%
Page 38 of 224
CHAPTER 5: NUMBER OF EMBRYOS FOR TRANSFER IN ART
INTRODUCTION
The Worlds first in vitro fertilization (IVF) baby, born in 1978, resulted from the recovery of a single oocyte
from a natural cycle followed by fertilization with sperm in a culture dish, and transfer of the resulting
single embryo to the uterus of the woman. However, shortly thereafter, it became apparent that IVF
production and subsequent transfer of multiple embryos was associated with a greater success rate, and
that controlled ovarian hyperstimulation or multiple follicular stimulation was performed in order to
produce more oocytes and respectively more embryos. It became common practice to transfer three, four,
or more embryos to achieve a better chance of a pregnancy. However, it soon became apparent that
large numbers of twins and higher order multiple (HOMs; triplets and greater) births resulted in an
unacceptably high fetal and maternal complication rate. Multiple pregnancies remain the single greatest
risk of assisted reproductive technology (ART) despite great concern and efforts to reduce this risk over
the past two decades.
The incidence of twin and HOM births quadrupled after 1980 the beginning of the ART era and
peaked in many countries in the 1990s. Many countries addressed this alarming public health problem
with a variety of initiatives intended to reduce the number of embryos transferred (2). A dramatic
reduction in multiple pregnancies, particularly HOMs, followed in most countries but considerable
variation continues to exist in the strategies employed and their efficacy in reducing multiple rates.
Limitations on the number of embryos permitted for transfer has had a profound effect on multiple rates;
however, the continued practice of controlled ovarian hyperstimulation (COH) that results in high numbers
of oocyte maturation (with or without intra-uterine insemination [IUI; procedure within which the number of
embryos generated cannot be controlled]) remains an important contributor to multiple pregnancies,
especially HOMs.
The risk of fetal, neonatal, and infant death is considerably increased for twins, triplets, and quadruplets.
For example, the perinatal mortality and infant mortality rates for singleton vs. multiple births in England
and Wales for the year 2013 (1) were as follows: - Neonatal deaths: 2.4 vs. 13.8 per 1,000 live births;
Infant deaths: 3.6 vs. 17.7 per 1,000 live births, and post-neonatal deaths: 1.1 vs. 3.9 per 1,000 live
births. For quadruplets, the mortality rate was 40 to 50% higher than for triplets. This increase in perinatal
mortality is primarily due to premature delivery, but also to utero-placental compromise and an increased
rate of congenital anomalies amongst these infants. Maternal complications of triplet and HOM births
include pregnancy-induced hypertension, ante-partum and post-partum haemorrhage, and severe
anemia.
An intensive effort to inform patients of the extensive and severe risks of multiple pregnancies has served
to inform the debate and promote broader patient acceptance of more restrictive embryo transfer policies.
However, some patients are still insistent on the transfer of an inappropriate number of embryos for a
variety of reasons and some clinicians advocate and practice transfer of an excessive number of
embryos. The methods by which this problem is addressed (or not addressed) vary enormously among
countries and remains one of the most contentious issues in ART.
During the past 10 years in Europe, especially within the last five years, a variety of measures have been
employed to greatly limit the number of embryos that can be transferred. Most recently, studies from
Sweden, Denmark, the Netherlands, and Belgium have shown that single embryo transfer (SET),
especially when combined with frozen/thawed embryo transfer (FET) in a subsequent cycle, achieves
pregnancy and live birth rates equivalent to the transfer of two and even three or more embryos, without
the complications of twin and HOM pregnancies and births. Several countries now have firm guidelines or
regulations allowing only SET for certain categories of patients. The United Kingdom regulatory body has
put in place measures to ensure that national and clinic specific multiple pregnancy rates must be
maintained at below 10% of all IVF births. Thus, increasingly, practitioners are advocating the transfer of
a
single
embryo.
Page 39 of 224
Some recommended indications for SET:
The American Society of Reproductive Medicine (ASRM) in their recent Practice Committee Report on
SET (3,4) recommended the following as guidelines for considering SET:
Some European countries are recommending a tighter criterion for SET, setting the age for SET at <37 or
38. The British Fertility Society (BFS) in 2015 recommended that at least 50% of embryo transfers should
be SET and never more than two embryos (5). The effect of this policy would be to bring the multiple
pregnancy rate down to <10%. They recommend that practitioners consider the following factors:
Oocyte age <35: 1 country = 1 embryo only, 8 countries = 2 embryos, 8 countries = 3 embryos, 2
countries = 4 embryos, and 4 countries with no response.
Oocyte age 35-39: No countries limited to 1 embryo, 7 countries = 2 embryos, 9 countries = 3
embryos, 2 countries = 4 embryos, and 5 countries with no response.
Oocytes age >40: No countries limited to 1 embryo, 3 countries = 2 embryos, 11 countries = 3
embryos, 4 countries = 4 embryos, and 5 countries with no response.
Page 40 of 224
Of note is that only one country (USA, individual state specific) established new guidelines to reduce the
recommended number of embryos for transfer from 2 to 1 for women <35 years of age, based on
blastocyst stage.
In response to the question about criteria for the number of embryos to be transferred (Table 4), 26
countries had respondents who provided responses regarding the age of the donor oocyte recipient: 11
countries answered 'yes, 5 answered 'no,' and 10 answered 'not addressed.' When considering the age
of the donor: 7 countries answered 'yes.' 8 'no.' and 11 answered 'not addressed. Regarding the quality
of the embryos as a determinant: 11 countries answered 'yes,' 8 'no,' and 7 answered 'not addressed.
Regarding the stage of the embryo (cleavage or blastocyst stage): 7 countries answered 'yes,' 10 'no,'
and 9 'not addressed.' The tables below list the individual policies of the countries' respondent responses
regarding the number of embryos allowed for transfer, which also in some cases included qualifying or
detailed comments provided by some respondents.
DISCUSSION
There is clear evidence that a major effort has been made in most countries to reduce the number of
embryos transferred in an IVF cycle, but there is still room for considerable improvement. There are
clinics in a few countries that reportedly continue to condone the transfer of an excessive number of
embryos. However, the data presented in Surveillance 2016 do show an overall reduction in the number
of embryos transferred and a significant trend to increasing the proportion of single embryo transfers.
SUMMARY
The evidence from this 2016 International Federation of Fertility Societies (IFFS) Survey supports the
notion that there has been an increase in the proportion of countries with legislation or clinical guidelines
restricting the number of embryos permissible for transfer to women undergoing IVF/ART cycles (59% vs.
38% in 2013). Respondents reported a variety of sanctions that have been imposed by the 17 countries
that noted that penalties exist for non-compliance, ranging from revocation of a clinic's license to practice
ART, to substantial fines, to prison terms for responsible individuals.
Progress in the actual reduction of the number of embryos transferred has been more gradual but
improvements in culture systems, embryo selection methods, and cryopreservation technology have led
to improved embryo implantation rates and live birth rates. As these advances become evidence-based
and are more consistently applied, further reductions in multiple embryo transfers and multiple pregnancy
rates should become evident.
Chapter 5. Table 1 - Are the number of embryos transferred regulated in your country by?
Country
Agency
Regulations/Over
sight
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/
Ordinances
Argentina
Australia
Cultural practice
Not regulated
X
Austria
Bangladesh
Barbados
Belarus
Belgium
Brazil
X
X
Bulgaria
Cameroon
X
X
Canada
Chile
China
Colombia
X
X
Czech Republic
Denmark
Ecuador
El Salvador
X
X
X
Religious
Decree
Page 41 of 224
Estonia
Finland
France
Germany
Greece
X
X
Guatemala
Honduras
Hong Kong (China*)
Hungary
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kazakhstan
Kenya
Malaysia
Mali
Mexico
Myanmar
Netherlands
Nigeria
Norway
Panama
Paraguay
Peru
Philippines
Portugal
X
X
Romania
Russian Federation
Saudi Arabia
X
X
Senegal
Singapore
Slovak Republic
South Africa
South Korea
Spain
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
X
X
Tunisia
Turkey
UK
X
X
Uruguay
USA
Venezuela
X
X
Page 42 of 224
Chapter 5. Table 2 - If the number of embryos transferred is under governance in your country, is there a penalty for violation?
Country
YES
NO
Argentina
Australia
Austria
Bangladesh
UNKNOWN
Barbados
Belarus
Belgium
Brazil
Bulgaria
no response
Cameroon
Canada
Chile
China
Colombia
Czech Republic
Denmark
Ecuador
El Salvador
Estonia
X
X
Finland
France
Germany
Greece
Guatemala
Honduras
Hong Kong (China*)
Hungary
India
Indonesia
Iran
Iraq
Page 43 of 224
Ireland
Israel
Italy
Japan
Jordan
Kazakhstan
Kenya
Malaysia
Mali
Mexico
Myanmar
Netherlands
Nigeria
Norway
Panama
Paraguay
Peru
Philippines
Portugal
Romania
Russian Federation
Saudi Arabia
Senegal
Singapore
X
X
Slovak Republic
South Africa
X
X
10 years in jail
South Korea
Spain
X
X
Law 14/2006 establishes penalties of 1001-10.000 Euros if >3 embryos are transferred
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
UK
Uruguay
USA
Venezuela
Day 2
Day 3
Day 5
Day 2
Day 3
Day 5
Day 2
Day 3
Day 5
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
Addressed
Belarus
Brazil
Bulgaria
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
China
Estonia
Germany
Greece
Hungary
India
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
Addressed
Japan
Jordan
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Singapore
South Africa
Page 44 of 224
Spain
Sweden
Switzerland
Taiwan (China*)
Turkey
4
2
4
2
UK
Uruguay
USA
Quality of
the Embryos
Stage of
the Embryo
Not addressed
Not addressed
YES
NO
Belarus
YES
YES
YES
Not addressed
Brazil
YES
YES
YES
YES
Bulgaria
YES
NO
NO
NO
Not addressed
Not addressed
Not addressed
Not addressed
Colombia
YES
YES
YES
YES
Czech Republic
YES
YES
NO
NO
Estonia
NO
NO
NO
NO
Not addressed
Not addressed
NO
NO
YES
UNKNOWN
YES
YES
Not addressed
Not addressed
Not addressed
Not addressed
YES
YES
YES
YES
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Myanmar
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Singapore
YES
NO
NO
NO
South Africa
NO
NO
NO
NO
China
Germany
Greece
Hong Kong (China*)
Hungary
India
Japan
Jordan
Spain
NO
NO
NO
NO
Sweden
YES
NO
YES
YES
Switzerland
Not addressed
Not addressed
YES
YES
Taiwan (China*)
Not addressed
Not addressed
Not addressed
Not addressed
Turkey
YES
NO
NO
NO
UK
YES
YES
YES
UNKNOWN
Uruguay
NO
NO
YES
NO
USA
NO
YES
YES
YES
REFERENCES
1. Office for National Statistics. Statistical bulletin: Childhood, Infant and Perinatal Mortality in
England and Wales: 2013; March 2015.
2. Maheshwari A, Griffiths S, Bhattacharya S. Global variations in the uptake of single embryo
transfer. Hum Reprod Update 2011;17(1):10720.
3. Practice Committee of the Society for Assisted Reproductive Technology, Practice Committee of
the American Society for Reproductive Medicine. Elective single-embryo transfer. Fertil Steril
2012; 97:83542.
4. Practice Committee of the American Society for Reproductive Medicine, Practice Committee of
the Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: A
Committee Opinion. Fertil Steril 2013;99:44-6.
5. Harbottle S, Hughes C, Cutting R, Roberts S, Brison D; Association Of Clinical Embryologists
(ACE) & The British Fertility Society (BFS). Elective single embryo transfer: an update to UK Best
Practice Guidelines. Hum Fertil 2015;18(3):165-83.
Page 45 of 224
CHAPTER 6: CRYOPRESERVATION
There has been considerable interest in the field of cryopreservation of human tissue for over 200 years.
Recent advances in freezing reproductive tissues have potentiated several new clinical applications.
Initial development of slow freezing techniques and subsequent vitrification technology coupled with
newer cryoprotectants in various combinations have advanced the field considerably. Sperm, oocytes,
and embryos can now be frozen at various stages of development, allowing for safer and more
efficacious assisted reproductive technology (ART) treatments as well as allowing for the
cryopreservation of gametes and embryos for fertility preservation (1).
Human ART today, routinely in a majority of in vitro fertilization (IVF) laboratories, utilizes both sperm and
embryo cryopreservation. Sperm banking is indicated for cancer patients facing gonadotoxic therapy.
Preservation of testicular tissue obtained from prepubertal boys undergoing gonadotoxic treatment and
those with cryptorchidism has been performed but is still experimental. Techniques to induce in vitro
spermatogenesis are being developed with the aim of preserving fertility in patients affected by diseases
such as Klinefelter Syndrome and Sertoli cell only syndrome (2). Embryo cryopreservation offers the
opportunity to avoid repeated ovarian stimulation, optimizes achieving embryo-endometrial synchrony,
and facilitates performing single embryo transfer (SET). The improved results of embryo cryopreservation
have been an essential component for preimplantation genetic testing, especially when trophectoderm
biopsy is performed. (3). Oocyte cryopreservation for fertility preservation is now being widely used in the
majority of clinical ART centres. It is indicated for fertility preservation in patients of reproductive age
facing treatment of malignancies or chronic illnesses in which the underlying disease or its treatment
would likely result in loss of fertility potential. It is also commonly performed for donor oocyte banking and
elective postponement of childbirth. Cited advantages are that it eliminates certain ethical, moral, and in
some jurisdictions, legal obstacles to embryo freezing. The limited available studies suggest that the
technique of vitrification of oocytes has higher pregnancy rates as compared to slow-freezing (4). The
advent of donor egg cryobanks with cryopreserved oocytes allows larger supplies of potential donor
oocytes to be produced and avoids the need for cycle synchronization with the recipient (5). Oocyte
cryopreservation also allows for the quarantining of human immunodeficiency virus (HIV) affected oocytes
(6,7). A more controversial but increasingly prevalent application involves offering oocyte vitrification to
healthy women with good reproductive potential with the intent of extending their reproductive lifespan
(8).
Potential concerns regarding the effects of cryopreservation on the embryo genome have been
addressed in various studies. The limited numbers of long-term follow-up human studies provide
reassurance but they are mostly derived from retrospective studies with some methodological
weaknesses
(9).
Ovarian tissue cryopreservation is still considered an experimental procedure. It is indicated for patients
who require immediate gonadotoxic treatment without the opportunity for oocyte or embryo freezing and
is the only option available for prepubertal girls. Vitrification of ovarian tissue was found to be similar to
slow freezing, and both preserved the morphologic integrity of the ovarian tissue (10). Orthotopic
transplantation of the cortical strips from the tissue has been successful, and live births have been
reported. However, it could not be ascertained whether ovulation from a remaining, untreated ovary
produced the pregnancy (11). In vitro activated ovarian tissue cryopreservation and transplantation is a
new method requiring more clinical research. This procedure involves stimulation of dormant follicles
within the cryopreserved tissue graft prior to transplantation, in order to generate mature oocytes shortly
after transplantation (12).
ANALYSIS OF SURVEY (TABLES 1-2)
Of the 68 respondents that provided information on this topic, the results show that 27 countries are
regulated by cryopreservation laws or statutes; 15 have only guidelines and nine have both statutes and
guidelines to follow. However, 17 of these countries were reported to have no regulations or guidelines,
follow individual practice policies, or are guided by cultural or religious decrees.
Page 46 of 224
Cryopreservation of fertilized oocytes and embryos was permitted at all stages through blastocyst
development in all the participating countries except Italy, which permits oocyte cryopreservation but not
embryo freezing. Prior to 2008, the law in Italy banned embryo freezing and permitted that a maximum of
three oocytes per cycle be inseminated. Transfer of all embryos produced was required, prohibiting
surplus embryo production and freezing. In May 2009, the Constitutional Court declared this law to be
unconstitutional, removing most of its limitations. The changes allowed embryo selection and
cryopreservation in specific cases (13). Venezuela now permits embryo cryopreservation, which was not
allowed at the time of publication of Surveillance 2013; cryopreservation of oocytes, ovarian, testicular
tissue has been and remains acceptable. In the Netherlands, though permitted, fertilized egg freezing is
not practiced, yet oocyte cryopreservation is commonly used. In Ireland, the issue of personhood with
regard to the embryo has raised ethical questions and led to the passage of legislation restricting the
creation of excess embryos with the intent of avoiding cryopreservation and the need to discard unused
embryos. However, after the Supreme Court of Ireland judgment of 2009 stated that embryos in storage
are not guaranteed a right to life, the Irish Medical Council altered its guidelines to no longer specifically
require that embryos "must be used for normal implantation and must not be deliberately destroyed (14).
The permissible duration for embryo cryopreservation varies between countries. There is no limit reported
for the duration of storage in most of the countries. There is however a reported limit of five years in
Belgium, China, Denmark, Norway, Romania, South Korea, Sweden, Switzerland, Turkey, Australia,
Greece, Barbados, Mali, and Chile. An extension of five years is permitted in Belgium and in South Korea
as well. The limit on embryo cryopreservation is seven years in Estonia and 10 years in Austria, Hungary,
Singapore, South Africa, Taiwan (China), UK, Ecuador and Hong Kong (China*). In the UK, the
cryopreserved embryos should be transferred before the age 50 of the female partner, and until such time
embryo storage can be extended beyond 10 years. The issue of time limit for cryopreservation of
gametes and embryos has not been specifically addressed in the Czech Republic, Uruguay, Cameroon,
India, Jordan, Germany, Mexico, Paraguay, or Sri Lanka. Survey participants from Ireland, the
Philippines, Portugal, and Kenya did not provide an answer to the question, and the answer is unknown
to those from France, Slovak Republic, Netherlands, and Malaysia. In Japan, embryos can remain
cryopreserved for as long as the couple is married and the female partner is within reproductive age.
Spain permits embryo storage until the age of 59 years for the female partner. The American Society for
Reproductive Medicine (ASRM) guidelines in the USA recommend storage for an unlimited time, but
unclaimed embryos should be discarded after five years of unsuccessful attempts to contact the individual
or couple and if there are no written instructions from the couple concerning disposal (15).
All countries with respondents, except Uruguay, permit oocyte cryopreservation. Senegal and
Bangladesh have no developed programmes and oocyte cryopreservation has never been performed.
Oocyte preservation is reported to be permitted for medical indications such as cases of ovarian
hyperstimulation syndrome, failure to obtain a sperm sample, and for fertility preservation for cancer
patients only, and specifically not for non-medical (social) indications in Austria, Denmark, France,
Hungary, Norway, Singapore, Turkey, Cameroon, Jordan, and Saudi Arabia.
Ovarian and testicular tissue preservation is reported to not be permitted in Bulgaria, Taiwan (China*),
Nigeria, El Salvador, and Bangladesh. In the countries where it is reported to be permitted, fertility
preservation in anticipation of cancer treatment is the main indication for its practice. A few countries
including Uruguay, Cameroon, Ecuador, and Barbados report acceptance of testicular tissue
cryopreservation, but not for ovarian tissue.
SUMMARY
Cryopreservation of human gametes and embryos has found broad application in the practice of assisted
reproduction and has contributed to its overall safety and efficacy. A successful cryopreservation
programme for both gametes and embryos is an important component for any ART programme. It can
promote optimal success rates, reduce the risk of multiple pregnancy, and effectively address unique
patient needs, such as those that require genetic testing or screening, cancer treatment, and special
measures to reduce risk of the IVF process (e.g., those at risk for ovarian hyperstimulation). The
Page 47 of 224
responses in the current questionnaire indicate broader acceptance of cryopreservation technologies but
considerable variation around the world in their regulation and implementation reflecting individual cultural
concerns. In addition, various service providers have self-imposed ethnic, societal, or religion based
policies guiding these practices. The long-term follow-up of the children born following an IVF cycle from
frozen embryos has been reassuring thus far, but there is limited long-term data regarding children who
are born following a cycle from frozen oocytes. It is recommended that circumstances governing the
duration of storage and disposal of frozen gametes and embryos be addressed in writing prior to the start
of a treatment cycle of such use.
CHAPTER 6. Table 1 How is cryopreservation governed?
Cryopreservation of
fertilized eggs
BY STATUTES
Allowed
Austria
Belarus
Belgium
Bulgaria
China
Czech Republic
Denmark
Estonia
France
Hungary
Israel
Kazakhstan
Norway
Romania
Russian federation
Cryopreservation of Ovarian /
testicular tissue
Cryopreservation of oocytes
Practiced
Allowed
Practiced
Allowed
Infrequently
Infrequently
Infrequently
No
Infrequently
Infrequently
Infrequently
Infrequently
Infrequently
+
+
+
Infrequently
Infrequently
Infrequently
Infrequently
Infrequently
Slovak Republic
South Africa
Infrequently
Spain
Sweden
South Korea
Singapore
Specific conditions
Infrequently
Infrequently
Taiwan (China*)
No
Tunisia
Infrequently
Turkey
Infrequently
Infrequently
Infrequently
No
Switzerland
UK
Uruguay
Cryopreservation of oocytes
Allowed
Practiced
Allowed
Practiced
Allowed
Argentina
Cameroon
Only Testicular
tissue allowed
Colombia
Ecuador
India
Ireland
Infrequently
commonly used
Specific conditions
+
Only Testicular
tissue allowed
For medical
conditions
+
Page 48 of 224
Italy
No
Infrequently
commonly used
Japan
Infrequently
Jordan
Infrequently
Infrequently
Never performed
Netherlands
Nigeria
No
Philippines
Infrequently
Senegal
unknown
Never performed
unknown
USA
Infrequently
Venezuela
Cryopreservation of Ovarian /
testicular tissue
Cryopreservation of oocytes
Allowed
Practiced
Allowed
Practiced
Allowed
Australia
Brazil
Finland
Specific conditions
Infrequently
Greece
Infrequently
Iran
Infrequently
Infrequently
Infrequently
Infrequently
Germany
Portugal
Saudi Arabia
Cryopreservation of Ovarian /
testicular tissue
Cryopreservation of oocytes
Allowed
Practiced
Allowed
Practiced
Allowed
Testicular tissue
allowed
Specific conditions
Canada
Chile
Infrequently
El Salvador
Infrequently
Infrequently
No
Guatemala
Honduras
Kenya
Infrequently
Malaysia
Infrequently
Infrequently
Mali
Infrequently
Infrequently
Mexico
Panama
Infrequently
Infrequently
Paraguay
Peru
Sri Lanka
Infrequently
Infrequently
Infrequently
Infrequently
Cryopreservation of oocytes
RELIGIOUS
Allowed
Not for non-medical
Bangladesh
conditions
* Reporting separately for this report
Cryopreservation of Ovarian /
testicular tissue
Practiced
Allowed
Practiced
Allowed
Specific conditions
Infrequently
unknown
Never performed
No
Bangladesh
*Non-Medical conditions include the deliberate deferral of child-bearing for personal reasons. Medical conditions include
cryopreservation for a future cycle of fertility treatment due to an existing condition or disease, requiring an immediate toxic
pharmaceutical or any other intervention that would be contrary to immediately attempting a pregnancy.
Page 49 of 224
CHAPTER 6. Table 2 - The Duration of storage of cryopreserved fertilized eggs, and country specific comments
Country
Austria
Belgium
Bulgaria
No limit
China
5 years
Czech Republic
Denmark
Not addressed
7 years
France
Unknown
Hungary
10 years
By statutes
Israel
No limit
Kazakhstan
No limit
Norway
5 years
Romania
5 years
Russian federation
No limit
Singapore
10 years
Slovak Republic
Unknown
South Africa
10 years
Spain
5 years
Estonia
South Korea
MH Instruction letter
5 years
Until female age 50 years
Sweden
5 years
Switzerland
5 years
Only zygotes
Taiwan (China*)
10 years
Tunisia
No limit
Turkey
5 years
UK
10 years
Uruguay
Argentina
No limit
Cameroon
Not addressed
Colombia
No limit
Ecuador
India
Couple consent
Not addressed
Informed consent of both partners, with annual renewals
Clinical history of gamete donors, Genetic test, psychological
assessment, infectious diseases tests and previous
quarantine.
4 9 years
Not addressed
By Guidelines
Ireland
Italy
No limit
Japan
Not addressed
Jordan
Not addressed
Netherlands
Nigeria
Unknown
No limit
Philippines
Senegal
No limit
USA
No limit
Venezuela
No limit
Australia
5 years
Brazil
No limit
Germany
Not addressed
Greece
5 years
10 years
Iran
No limit
Married couples
Portugal
Saudi Arabia
No limit
Barbados
5 years
Canada
No limit
None
Chile
5 years
El Salvador
No limit
Guatemala
No limit
Page 50 of 224
Honduras
No limit
Ireland
No limit
Kenya
Malaysia
Mali
Mexico
5 years
Not addressed
Panama
No limit
Paraguay
Not addressed
Peru
Sri Lanka
Religion
Unknown
No limit
Not addressed
No limit
Bangladesh
No limit
REFERENCES
1. Griveau JF, Lopes M, Jouve G, Veau S, Ravel C, Morcel K. Vitrification: principles and results. J
Gynecol Obstet Biol Reprod (Paris) 2015;44(6):485-95. French.
2. Goossens E, Tournaye H. Male fertility preservation, where are we in 2014? Ann Endocrinol
(Paris) 2014;75(2):115-7.
3. Konc J, Kanyo K, Kriston R, Somoskoi B, Cseh S. Cryopreservation of embryos and oocytes in
human assisted reproduction. Biomed Res Int 2014:307268.
4. Glujovsky D, Riestra B, Sueldo C, Fiszbain G, Repping S, Nodar F, et al. Vitrification versus slow
freezing for women undergoing oocyte cryopreservation. Cochrane Database Syst Rev 2014;9:
CD010047.
5. Cobo A, Remohi J, Chang CC, Nagy ZP. Oocyte cryopreservation for donor egg banking. Reprod
Biomed Online 2011;23(3):341-6.
6. Vajta G, Rienzi L, Ubaldi FM. Open versus closed systems for vitrification of human oocytes and
embryos. Reprod Biomed Online 2015;30(4):325-33.
7. Bielanski A. A review of the risk of contamination of semen and embryos during cryopreservation
and measures to limit cross-contamination during banking to prevent disease transmission in ET
practices. Theriogenology 2012;77(3):467-82.
8. Cobo A, Garcia-Velasco JA. Why all women should freeze their eggs. Curr Opin Obstet Gynecol
2016;28(3):206-10.
9. Kopeika J, Thornhill A, Khalaf Y. The effect of cryopreservation on the genome of gametes and
embryos: principles of cryobiology and critical appraisal of the evidence. Hum Reprod Update
2015;21(2):209-27.
10. Sanfilippo S, Canis M, Smitz J, Sion B, Darcha C, Janny L, et al. Vitrification of human ovarian
tissue: a practical and relevant alternative to slow freezing. Reprod Biol Endocrinol 2015;13:67.
11. Practice Committee of American Society for Reproductive Medicine. Ovarian tissue
cryopreservation: a committee opinion. Fertil Steril 2014;101(5):1237-43.
12. Meirow D, Roness H, Kristensen SG, Andersen CY. Optimizing outcomes from ovarian tissue
cryopreservation and transplantation; activation versus preservation. Hum Reprod
2015;30(11):2453-6.
13. Levi Setti PE, Albani E, Cesana A, Novara PV, Zannoni E, Baggiani AM, et al. Italian
Constitutional Court modifications of a restrictive assisted reproduction technology law
significantly improve pregnancy rate. Hum Reprod 2011;26(2):376-81.
14. Sills ES. Murphy SE. Determining the status of non-transferred embryos in Ireland: a conceptus
of case law and implications for clinical IVF practice. Philos Ethics Humanit Med 2009; 4:8.
15. Ethics Committee of the American Society for Reproductive Medicine. Disposition of abandoned
embryos: a committee opinion. Fertil Steril 2013;99(7):1848-9.
Page 51 of 224
CHAPTER 7: POSTHUMOUS REPRODUCTION
The assessment of applications of posthumous reproduction was expanded in the 2015 questionnaire to
support the Surveillance 2016 report. The 2013 report noted that 25% of countries allowed posthumous
insemination, but did not specify the circumstances, including the permissibility of immediate postmortem
extraction of gametes and specific limitations pertaining to recovery of sperm, ova, and embryos.
Posthumous reproduction can occur at two different stages. Firstly, it may include the immediate
extraction of sperm, ova, or excision of reproductive tissue from a comatose person who is usually brain
dead. Immediate testicular sperm extraction has also been performed on males following complete
cessation of cardiac activity. Immediate extraction is often not addressed by existing legislation and is
usually performed following an urgent court order. Recent updates in legislation are now targeting this
controversial topic in many countries.
Posthumous reproduction can also occur through the utilization of products (gametes, reproductive
tissue, or embryos) that had been cryopreserved before the individual died. New cryopreservation
techniques (slow freezing or vitrification) allow stored sperm, ova, and embryos to be used many years
after freezing, and thus with the potential to be used long after the demise of the person whose
reproductive products had been stored. Increasingly, patients are freezing gametes or embryos for fertility
preservation after they have been diagnosed with cancer and before they receive gonadotoxic therapy in
the hope that they may preserve their reproductive potential to be used at a later date. This reproductive
option usually arises at an inopportune time, when the patients are forced to confront several difficult
issues simultaneously relating to their cancer treatment, including decisions regarding the disposition of
their gametes, reproductive tissue, or embryos in the event of their death. Other complicated cases
include occasions in which a person may die unexpectedly and their partner may wish to proceed with
fertility treatment using their cryopreserved biological material with or without previously obtained express
written permission. These cases may be further complicated when the decreased individual may have
verbally expressed their wish to have children together, but not formally made an agreement or given
written consent.
Actual utilization of cryopreserved gametes, reproductive tissue, or embryos after the death of a person
depend on existing legislation, prior written legal agreements or consent documentation, and family input
about the wishes of the decreased person. The onus often falls on the courts to determine whether the
person may have truly wished to procreate after their death. Although the courts have generally tended
to err on the side of caution and deny most of these requests, recent international media attention in
some of these cases has led some governments to update legislation in this area.
ANALYSIS OF SURVEY (TABLES 1-4)
There were respondents from 63 countries who had responded to the questionnaire that addressed
questions about whether posthumous reproduction procedures were allowed in their countries. Frozen
sperm insemination was reported to be permitted in 27% of countries, insemination of frozen ova from a
decreased woman was reported to be allowed in 24% of countries, and in 30% of countries transfer of
frozen embryos from a deceased person was reported to be allowed. Immediate posthumous procedures
in brain dead or just deceased patients were reported to be allowed in 14% of countries.
Legislation to allow immediate posthumous reproduction was reported to be present in 34% of these
countries, whereas 42% of countries reportedly allowed posthumous sperm insemination. Thirty-four
percent of countries allowed insemination of frozen ova, 45% countries had legislation allowing
posthumous transfer of frozen embryos.
Although legislation may exist in some countries allowing the procedures, the data from the respondents
addressing actual application of these procedures indicate that they are performed infrequently.
Respondents from 65 countries reported in response to whether posthumous reproduction procedures
were actually performed in their countries. Frozen sperm insemination was done in 25% of countries,
insemination of frozen ova from a decreased woman was done in 15% of countries, and in 25% of
countries, transfer of frozen embryos from a deceased person was performed. Immediate posthumous
procedures in brain dead or recently deceased patients was infrequently performed (11% of countries).
Page 52 of 224
The use of immediate posthumous extraction of gametes was reported to be infrequent (11% of
countries), and the usage of frozen ova was reported to be practiced in 15% of these countries. The nonimmediate posthumous use of sperm for insemination was reportedly used more often in 25% of
countries, and the transfer of frozen embryos was reported to be performed in 25% of these countries.
Where legislation existed about posthumous reproduction, the procedures were reported to be mostly
covered by federal law (immediate posthumous 57%, insemination with frozen sperm 67%, insemination
of frozen ova 67%, implantation of frozen embryos 70%). In less than 10% of countries, the legislation
was addressed via state laws or agency oversight. In approximately 10% of countries the topic was
covered by professional society guidelines, and in 10% of countries, respondents reported that religious
decree affected practice.
Tables 1 through 4 show whether respondents stated that legislation exists, if procedures are allowed, or
if procedures are actually done in their country, for the following categories: immediate posthumous
reproduction, posthumous insemination with sperm, insemination of frozen ova, and posthumous embryo
transfer respect. The most recent questionnaire provided respondents the opportunity to provide
additional details regarding the practice of posthumous reproduction with specific information about
unique applications, oversight, and actual prevalence of practices.
In more than a third of countries with respondents providing feedback, there was legislation in place to
govern posthumous reproduction. These data show that there is a definite trend internationally to include
this topic in national legislation, and most countries were reported to do so through federal legislation.
Fertility clinics and courts are often confronted with difficult decisions regarding disposition of
cryopreserved gametes, reproductive tissue, and embryos following the death or demise of a donor when
his or her clear preferences and instructions are not available. It is beneficial to have legislation in place
to assist medical practitioners and legal practitioners with such decisions.
SUMMARY
Based upon this Surveillance report, posthumous reproduction is increasing on a global scale and being
addressed by national-level legislation (usually by federal statute). Controversies in this area, as
highlighted by the respondents, include the circumstances in which posthumous gametes, or reproductive
tissue may be obtained and conditions in which gametes, reproductive tissue, and embryos may be
utilized after death.
CHAPTER 7. Table 1 - Immediate posthumous collection of sperm or oocytes
Posthumous collection allowed
Legislation is present governing procedure
Posthumous immediate extraction is used
CHAPTER 7. Table 2 - Posthumous sperm insemination
Posthumous sperm insemination allowed
Legislation is present governing procedure
Posthumous sperm insemination is used
CHAPTER 7. Table 3 - Posthumous insemination of frozen ova
Posthumous insemination of frozen ova allowed
Legislation is present governing procedure
Posthumous sperm insemination is used
CHAPTER 7. Table 4 - Posthumous Transfer of Frozen Embryos
Posthumous transfer of frozen embryos allowed
Legislation is present governing procedure
Posthumous transfer of frozen embryos is used
% of countries
14%
34%
11%
% of countries
27%
42%
25%
% of countries
24%
34%
15%
% of countries
30%
45%
25%
Page 53 of 224
CHAPTER 8: DONATION
Gamete and embryo donation are well-established assisted reproduction procedures that are increasingly
used around the world. Egg donation is performed either with fresh oocytes, or, since the advent and
clinical application of vitrification (1), with vitrified-warmed oocytes. The widespread use of egg vitrification
has significantly altered the practice of assisted reproduction and more clinics are banking oocytes for
future donation, as the clinical pregnancy results in egg donation cycles have been found to be similar
between fresh and frozen eggs (2). However, additional clinical evidence is needed to address the
comparison of obstetric, neonatal, and long term child outcomes. Recently, both the American Society for
Reproductive Medicine and European Society of Human Reproduction and Embryology (ESHRE) have
described oocyte vitrification as a safe and efficient procedure (3,4), rendering it no longer an
experimental procedure.
There are significant differences in the use and regulations applied to gamete donation between different
countries, even in the same continent or in countries with similar cultural and religious background. This
situation is clearly reflected in Europe, where periodic reporting to the European IVF (in vitro fertilization)
Monitoring Consortium (EIM)/ ESHRE registry has shown the imbalance of IVF/ intracytoplasmic sperm
injection (ICSI) to egg donation cycles in some countries (5). Also, countries regulate differently the
allowance of male and female gamete donation; consequently, there has been a surge of cross-border
reproductive care for patients to access care to obtain specific sex gamete donation procedures in order
to avoid restrictions in their home countries. This is raising new, challenging ethical questions (6).
ANALYSIS OF SURVEY
Countries whose representatives have responded to the questions on donation for both the previous 2013
report and this current report, do report changes since the last publication. For example, in Italy, sperm
donation for assisted reproductive technology (ART), previously banned, is currently allowed following a
2014 court ruling. Out of these countries, 13% completely ban all gamete and embryo donation, as
reported to include the following: Bangladesh, El Salvador, Jordan, the Philippines, Saudi Arabia,
Senegal, Tunisia, and Turkey. (Table 1) When gamete donation is reported to be allowed, most of those
surveyed stated that the country allows both male and female gamete donations (Table 1, Chart 1).
However, in some countries, gamete donation is differentially regulated depending on sex (Tables 2-3,
Charts 2-3). Germany, Japan, Norway, and Switzerland are reported to only allow sperm donation, but do
not permit egg donation. Interestingly, only Israel reflects the opposite position, i.e. Israel is reported to
allow egg donation but has some restrictions regarding sperm donation. None of these countries are
reported to allow embryo donation from a previous IVF cycle with the exception of Germany that allows
this type of embryo donation. A number of the countries respondents reported that they permit both
sperm and egg donation, but do not allow embryo donation, including Belarus, Bulgaria, Cameroon,
Denmark, Israel, Italy, Malaysia, Sweden, and Taiwan (China).
Almost 57% (37/65 respondents) described sperm and oocyte donation as commonly used in their
countries, in contrast with embryo donation, with 23% eliciting commonly used responses (Table 4).
Some country respondents reported that both sperm and egg donation were infrequently used, for
example in Cameroon, China, France, Iran, Italy, Japan, Kazakhstan, Malaysia, Romania, Singapore,
South Korea, and Sri Lanka. The respondents reported that local regulations and restrictions on donors
account for some of these differences, because the social, political, and cultural backgrounds of these
countries vary.
The majority of countries who had respondents who were surveyed (almost 55%) reported that their
countries do not allow the de-novo generation of embryos with donor gametes for purposes of donation,
encompassing the countries that ban embryo donation noted above with the exception of Belarus. An
additional group of countries including Brazil, Chile, Ecuador, Estonia, Finland, Greece, Iran, Netherlands,
Nigeria, Portugal, Romania, Singapore, Spain, and Uruguay were reported by respondents to specifically
forbid this form of embryo donation. Twenty-three (37%) countries were reported to permit this form of
Page 54 of 224
embryo donation, and two of which (Italy and Belarus) were reported to not allow conventional embryo
donation from previous IVF cycles. Seven (8%) countries had respondents leave this question
unanswered, or had answered that the situation was unclear or unknown. Finally, the following countries
reportedly permit both forms of embryo donation: Australia, Austria, Barbados, Canada, Czech Republic,
France, Guatemala, Hungary, India, Kazakhstan, Panama, Paraguay, Russia, Slovak Republic, South
Africa, Sri Lanka, Trinidad & Tobago, UK, USA, and Venezuela.
A new technique called cytoplasmic transfer (see Chapter 10, Micromanipulation).has been developed
with the principal intention of avoiding mitochondrial disorders. This requires an oocyte or fertilized
embryo cytoplasmic donation from a non-affected female donor in order to replace the cytoplasm of an
affected female recipient. This process of cytoplasmic transfer is reported to be allowed in Canada, Chile,
Guatemala, India, Kazakhstan, Mexico, Russia, Slovak Republic, and Uruguay. However, 14 respondents
(around 23%) acknowledge that the status of potential legislation or regulation of cytoplasmic donation is
unknown or unclear, and that it is possible that cytoplasmic donation could be used in an experimental
environment. Thirty-nine countries (63%) were reported to not allow the procedure. This is an active
research and clinical field, with several recent, significant advances reported by UK researchers. It is not
surprising that the UK representative responded negatively to these questions, although the UK Human
Fertilisation and Embryology Authority (HFEA) recently (October 2015, during the official completion
dates of this survey) approved cytoplasmic transfer as a procedure for mothers at risk to pass on serious
mitochondrial diseases to their children, but not for other fertility treatments (7).
Respondents reported that ovarian tissue donation is allowed in countries including Australia, Belgium,
Canada, Chile, Finland, Guatemala, India, Kazakhstan, Mexico, Russia, Slovak Republic, UK, and the
USA, representing 21% of those surveyed. A majority of the respondents (35 countries; 55%) reported
that this procedure was not permissible and 15 respondents (24%) answered that the status was
unknown.
Similarly, testicular tissue donation followed the same pattern of response as ovarian tissue donation,
with the exception of the UK, where the respondent stated that it is unknown if this procedure is allowed,
although the respondent noted that the HFEA does provide a flow diagram for testicular tissue donation,
under strict guidelines that requires prior authorization (8).
Regulation of third party reproduction was reported to affect 63% (39 of the 62 countries). Most of the
European countries were reported to be highly regulated for sperm and egg donation by federal/national
laws or statutes, except for Ireland and Belgium that have no regulation on this issue. Canada, Australia,
and the USA have either national or state/provincial laws governing third party reproduction. (Table 3) On
the contrary, in most of Latin America, respondents reported no regulation regarding third party
reproduction, and the same situation was reported for several Caribbean countries including Barbados
and Trinidad & Tobago. This was also the case in several southeast Asian countries (Sri Lanka, Malaysia,
Mali, and Bangladesh). Some countries in Latin America were, however, reported to be regulated by third
party reproduction (namely government agencies), including Brazil and Mexico. In the case of Colombia
and Uruguay, there is regulation by law that was reported, but only concerning sperm donation.
Compensation for donors is reported to be permitted in most countries, although the amount of
compensation varies widely. As noted in Table 5, donors are reported to often be reimbursed for their
time and expenses, but in some countries, for example in the USA, Spain, Portugal, Russia, Belarus,
India, Iran, Cameroon, Nigeria, Venezuela, and Chile, compensation goes beyond simple reimbursement
(in the USA this varies per state law). In Canada, France, Italy, and Japan, the respondents reported that
compensation to donors is illegal; and in other countries, it was reported that minimum and maximum
fees could be payed to donors. (Table 6.)
Most countries (53/62, 85.5%) had respondents who reported that qualifications had been established for
individuals to become a sperm or egg donor, although this issue was less clear for embryo donors, where
19 countries had respondents who reported that this issue was either not addressed or unknown (Table
7).
Page 55 of 224
SUMMARY
According to this report, the practice of gamete and embryo donation continues to be increasing
worldwide; despite this, social acceptance and use is reported to be restricted in some countries.
Respondents often perceived this to be due to ethical, legal, or religious constraints. Restrictive policies
can pose additional emotional stress, financial burdens, and may result in forms of discrimination for
access to care for couples and individuals obliged to travel abroad to receive desired treatments. Most of
the European countries that had respondents who were surveyed are highly regulated by laws, statutes,
or government regulatory authorities. Although a minority of countries are reported to completely ban any
form of donation, some countries are reported to have regulations restricting some types of donation (for
example, embryo donation from either a previous IVF cycle or the de-novo generation of IVF embryos for
donation). Other countries are reported to have discordant views toward sperm versus egg donation. In
North, Central, and South America, it is reported that gamete and embryo donation is more
homogeneously utilized. Cytoplasmic donation is reported to be used primarily within experimental
environments, and most of the countries surveyed reported to infrequently use either ovarian or testicular
tissue donation.
CHAPTER 8. Table 1 - Is third party reproduction allowed/permitted in your country?
Country
Sperm donation
Oocyte donation
De novo generation
of embryos for
donation purposes
Cytoplasmic donation
Argentina
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Australia
YES
YES
YES
YES
UNKNOWN
YES
YES
NO
Austria
YES
YES
YES
YES
NO
NO
Bangladesh
NO
NO
NO
NO
NO
NO
Barbados
YES
YES
YES
YES
NO
NO
Belarus
YES
YES
NO
YES
NO
NO
NO
Belgium
YES
YES
YES
UNKNOWN
UNKNOWN
YES
YES
Brazil
YES
YES
YES
NO
NO
NO
NO
Bulgaria
YES
YES
NO
NO
NO
NO
NO
Cameroon
YES
YES
NO
NO
NO
NO
NO
Canada
YES
YES
YES
YES
YES
YES
YES
Chile
YES
YES
YES
NO
YES
YES
YES
China
YES
NO
NO
NO
NO
NO
NO
Colombia
YES
YES
YES
NO
NO
NO
Czech Republic
YES
YES
YES
NO
NO
NO
Denmark
YES
YES
NO
NO
NO
NO
NO
Ecuador
YES
YES
YES
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
NO
Estonia
YES
YES
YES
NO
NO
UNKNOWN
UNKNOWN
Finland
YES
YES
YES
NO
NO
YES
YES
France
YES
YES
YES
YES
NO
UNKNOWN
UNKNOWN
Germany
YES
NO
YES
NO
NO
NO
YES
NO
Greece
YES
YES
YES
NO
UNKNOWN
UNKNOWN
UNKNOWN
Guatemala
YES
YES
YES
YES
YES
YES
YES
Honduras
YES
YES
UNKNOWN
YES
YES
YES
Hungary
YES
YES
YES
YES
NO
NO
NO
India
YES
YES
YES
YES
YES
YES
YES
Iran
YES
YES
YES
NO
UNKNOWN
UNKNOWN
UNKNOWN
Israel
NO
YES
NO
NO
NO
NO
NO
Italy
YES
YES
NO
YES
NO
NO
NO
Japan
YES
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
Jordan
NO
NO
NO
NO
NO
NO
NO
Kazakhstan
YES
YES
YES
YES
YES
YES
YES
Malaysia
YES
YES
NO
NO
NO
NO
NO
Mali
UNKNOWN
UNKNOWN
UNKNOWN
NO
NO
NO
NO
Mexico
YES
YES
UNKNOWN
YES
YES
YES
YES
Netherlands
YES
YES
YES
NO
NO
NO
NO
Page 56 of 224
Nigeria
YES
Norway
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
Panama
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Paraguay
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Peru
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Philippines
NO
NO
NO
NO
NO
NO
NO
Portugal
YES
YES
YES
NO
UNKNOWN
UNKNOWN
UNKNOWN
Romania
YES
YES
YES
NO
NO
NO
NO
Russian Federation
YES
YES
YES
YES
YES
YES
YES
Saudi Arabia
NO
NO
NO
NO
NO
NO
NO
Senegal
NO
NO
NO
NO
NO
NO
NO
Singapore
YES
YES
YES
NO
NO
NO
NO
Slovak Republic
YES
YES
YES
YES
YES
YES
YES
South Africa
YES
YES
YES
YES
NO
NO
NO
South Korea
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Spain
YES
YES
YES
NO
NO
NO
NO
Sri Lanka
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
YES
YES
NO
NO
NO
NO
NO
Switzerland
YES
NO
NO
NO
NO
UNKNOWN
UNKNOWN
Taiwan (China*)
YES
YES
NO
NO
NO
NO
NO
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Tunisia
NO
NO
NO
NO
NO
NO
NO
Turkey
NO
NO
NO
NO
NO
NO
NO
UK
YES
YES
YES
YES
NO
YES
UNKNOWN
Uruguay
YES
YES
YES
NO
YES
NO
NO
USA
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Venezuela
YES
* Reporting separately for this report
Page 57 of 224
CHAPTER 8. Table 2 - Are there regulations that govern third party reproduction in your country?
Embryo donation from
a previous IVF cycle
De novo generation of
embryos for donation
purposes
Cytoplasmic donation
Testicular tissue
donation
Oocyte donation
Sperm donation
Argentina
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Australia
YES
YES
YES
YES
YES
YES
YES
YES
Austria
YES
YES
YES
YES
UNKNOWN
YES
UNKNOWN
YES
Bangladesh
NO
NO
NO
NO
NO
NO
NO
NO
Barbados
NO
NO
NO
NO
NO
NO
NO
NO
Belarus
YES
YES
Belgium
YES
YES
YES
UNKNOWN
UNKNOWN
YES
YES
NO
Brazil
YES
YES
YES
NO
NO
NO
NO
NO
Bulgaria
YES
YES
YES
YES
NO
YES
YES
NO
Cameroon
YES
YES
NO
NO
NO
NO
NO
NO
Canada
YES
YES
YES
YES
YES
YES
YES
YES
UNKNOWN
Country
YES
Chile
NO
NO
NO
NO
NO
NO
NO
China
YES
YES
YES
YES
NO
NO
NO
NO
Colombia
YES
NO
NO
NO
NO
NO
NO
Czech Republic
YES
YES
YES
YES
NO
NO
NO
NO
Denmark
YES
YES
Ecuador
NO
NO
NO
NO
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
NO
NO
Estonia
YES
YES
YES
YES
NO
UNKNOWN
UNKNOWN
NO
Finland
YES
YES
YES
YES
YES
YES
YES
YES
France
YES
YES
YES
YES
YES
UNKNOWN
YES
Germany
YES
YES
YES
YES
UNKNOWN
YES
YES
YES
Greece
YES
YES
YES
YES
NO
NO
NO
NO
Guatemala
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Honduras
NO
NO
NO
YES
YES
YES
Hungary
YES
YES
YES
YES
NO
NO
NO
NO
India
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
YES
Iran
NO
NO
YES
NO
NO
NO
NO
NO
Ireland
NO
NO
NO
NO
NO
NO
NO
NO
Israel
YES
YES
YES
NO
YES
YES
YES
NO
Italy
YES
YES
YES
YES
NO
NO
NO
NO
Japan
YES
NO
NO
YES
NO
NO
NO
NO
Kazakhstan
YES
YES
YES
YES
YES
YES
YES
YES
Malaysia
NO
NO
NO
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
NO
NO
NO
NO
Mexico
YES
YES
YES
YES
YES
YES
YES
NO
YES
Netherlands
YES
YES
YES
YES
YES
NO
NO
Nigeria
YES
YES
YES
NO
NO
NO
NO
Norway
YES
YES
YES
YES
YES
YES
NO
YES
Panama
NO
NO
NO
NO
NO
NO
NO
NO
Paraguay
NO
NO
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
NO
NO
NO
Portugal
YES
YES
YES
YES
NO
NO
NO
NO
Romania
YES
YES
YES
YES
NO
NO
NO
NO
Russian Federation
YES
YES
YES
YES
NO
NO
NO
NO
Saudi Arabia
NO
NO
NO
NO
NO
NO
NO
NO
Senegal
NO
NO
NO
NO
NO
NO
NO
NO
Singapore
YES
YES
YES
YES
YES
YES
YES
YES
Slovak Republic
YES
YES
YES
YES
YES
YES
YES
YES
Page 58 of 224
South Africa
YES
YES
YES
NO
NO
NO
NO
YES
South Korea
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Spain
YES
YES
YES
YES
NO
NO
NO
NO
Sri Lanka
NO
NO
NO
NO
NO
NO
NO
NO
UNKNOWN
Sweden
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Switzerland
YES
YES
YES
YES
NO
NO
NO
NO
Taiwan (China*)
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
NO
NO
NO
NO
NO
NO
NO
Tunisia
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
NO
YES
NO
Turkey
YES
YES
UK
YES
Uruguay
YES
YES
YES
NO
YES
NO
NO
YES
NO
USA
YES
YES
YES
YES
YES
YES
YES
YES
Venezuela
NO
NO
NO
NO
NO
NO
NO
NO
Sperm donation
Oocyte donation
Embryo Donation
Cytoplasmic donation
Ovarian tissue
donation
Testicular donation
Argentina
No Regulation
No Regulation
No Regulation
Unknown
Unknown
Unknown
Australia
State/Provincial/Regional
Laws/Statutes/Ordinances,
Agency Regulations/Oversight,
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances,
Agency Regulations/Oversight,
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances, Agency
Regulations/Oversight,
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances,
Agency Regulations/Oversight,
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances,
Agency Regulations/Oversight,
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances,
Agency Regulations/Oversight,
Professional Organization
Standards/Guidelines
Austria
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Bangladesh
Religious decree
Religious decree
No regulations
No regulations
No regulations
Barbados
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Belarus
Federal/National
Laws/Statutes/Ordinances,
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances,
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances,
Professional Organization
Standards/Guidelines
Belgium
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Brazil
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight
Page 59 of 224
Bulgaria
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Cameroon
No regulations, Professional
Organization
Standards/Guidelines
Canada
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Chile
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
China
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Colombia
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
No regulations
No regulations
Czech
Republic
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
Denmark
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Ecuador
No regulations, Professional
Organization
Standards/Guidelines
No regulations, Professional
Organization
Standards/Guidelines
El Salvador
No regulations
No regulations
Estonia
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
No regulations
Federal/National
Laws/Statutes/Ordinances
Finland
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
France
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Germany
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances, No
regulations, Professional
Organization
Standards/Guidelines
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
No regulations
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Greece
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Unknown
Unknown
Unknown
Guatemala
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Hong Kong
(China*)
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Hungary
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
India
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Iran
Agency Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances,
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Ireland
Agency Regulations/Oversight,
No regulations
Agency Regulations/Oversight,
No regulations
Agency Regulations/Oversight, No
regulations
Agency Regulations/Oversight,
No regulations
Agency Regulations/Oversight,
No regulations
Agency Regulations/Oversight,
No regulations
Israel
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Italy
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Japan
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
No regulations
No regulations
Kazakhstan
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Malaysia
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Mali
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Mexico
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Netherlands
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
No regulations
No regulations
No regulations
Nigeria
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Unknown
Unknown
Unknown
Norway
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Panama
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Paraguay
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Portugal
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Romania
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Russian
Federation
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
No regulations, Professional
Organization Standards/Guidelines
Agency Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances
Page 60 of 224
Singapore
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Slovak
Republic
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
South Africa
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
South Korea
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Spain
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines,
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
Sri Lanka
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Sweden
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Unknown
Unknown
Unknown
Switzerland
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Taiwan
(China*)
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Unknown
Unknown
Unknown
Unknown
Trinidad and
Tobago
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Turkey
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
UK
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Unknown
Federal/National
Laws/Statutes/Ordinances
Unknown
Uruguay
Federal/National
Laws/Statutes/Ordinances
USA
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines, Agency
Regulations/Oversight,
Federal/National
Laws/Statutes/Ordinances,
State/Provincial/Regional
Laws/Statutes/Ordinances
Venezuela
Professional Organization
Standards/Guidelines, No
regulations
Professional Organization
Standards/Guidelines, No
regulations
Professional Organization
Standards/Guidelines, No
regulations
Professional Organization
Standards/Guidelines, No
regulations
Professional Organization
Standards/Guidelines, No
regulations
Professional Organization
Standards/Guidelines, No
regulations
Page 61 of 224
CHAPTER 8. Table 4 - How often is third party reproduction performed in programmes within your country?
Country
Sperm donation
Oocyte donation
Argentina
Commonly Used
Commonly Used
Australia
Commonly Used
Commonly Used
Austria
Commonly Used
Bangladesh
Never
Performed
Infrequently
Used
Never
Performed
Barbados
Commonly Used
Commonly Used
Commonly Used
Infrequently
Used
Belarus
Belgium
Commonly Used
Commonly Used
Brazil
Commonly Used
Commonly Used
Bulgaria
Commonly Used
Commonly Used
Cameroon
Infrequently
Used
Infrequently
Used
Canada
Commonly Used
Commonly Used
Embryo donation
from
a previous
IVF cycle
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Commonly Used
Infrequently
Used
Never
Performed
Commonly Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Infrequently
Used
Chile
Commonly Used
Commonly Used
China
Infrequently
Used
Infrequently
Used
Colombia
Commonly Used
Commonly Used
Czech Republic
Commonly Used
Commonly Used
Denmark
Commonly Used
Infrequently
Used
Ecuador
Commonly Used
Commonly Used
Commonly Used
Commonly Used
Infrequently
Used
Estonia
Commonly Used
Commonly Used
Never
Performed
Infrequently
Used
Finland
Commonly Used
Commonly Used
Commonly Used
France
Infrequently
Used
Germany
Commonly Used
Infrequently
Used
Never
Performed
Infrequently
Used
Infrequently
Used
El Salvador
De novo generation of
embryos for donation
purposes
Cytoplasmic
donation
Ovarian tissue
donation
Testicular tissue
donation
Infrequently Used
Unknown
Unknown
Unknown
Infrequently Used
Unknown
Unknown
Unknown
Infrequently Used
Unknown
Unknown
Unknown
Never Performed
Commonly Used
Infrequently Used
Unknown
Unknown
Never Performed
Commonly Used
India
Commonly Used
Commonly Used
Commonly Used
Iran
Infrequently
Used
Infrequently
Used
Ireland
Commonly Used
Commonly Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Israel
Italy
Japan
Kazakhstan
Malaysia
Mali
Unknown
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Unknown
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Infrequently
Used
Infrequently Used
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Unknown
Unknown
Never Performed
Never Performed
Unknown
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Commonly Used
Never Performed
Never Performed
Never Performed
Infrequently Used
Never Performed
Never Performed
Infrequently Used
Commonly Used
Never Performed
Never Performed
Never Performed
Never Performed
Unknown
Never Performed
Infrequently
Used
Infrequently Used
Unknown
Unknown
Unknown
Unknown
Never Performed
Mexico
Commonly Used
Commonly Used
Commonly Used
Commonly Used
Netherlands
Commonly Used
Commonly Used
Infrequently
Used
Never Performed
Nigeria
Commonly Used
Commonly Used
Commonly Used
Infrequently Used
Commonly Used
Never
Performed
Never
Performed
Never Performed
Norway
Never Performed
Never Performed
Never Performed
Infrequently Used
Commonly Used
Never Performed
Unknown
Never Performed
Never Performed
Commonly Used
Never Performed
Unknown
Commonly Used
Commonly Used
Unknown
Never Performed
Unknown
Commonly Used
Commonly Used
Unknown
Unknown
Commonly Used
Hungary
Never Performed
Never Performed
Commonly Used
Commonly Used
Never Performed
Commonly Used
Commonly Used
Commonly Used
Never Performed
Commonly Used
Commonly Used
Hong Kong
(China*)
Never
Performed
Never
Performed
Never Performed
Commonly Used
Guatemala
Honduras
Unknown
Never Performed
Commonly Used
Greece
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Unknown
Never
Performed
Never
Performed
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Unknown
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Page 62 of 224
Panama
Commonly Used
Commonly Used
Paraguay
Commonly Used
Commonly Used
Peru
Commonly Used
Commonly Used
Portugal
Commonly Used
Commonly Used
Romania
Infrequently
Used
Infrequently
Used
Russian
Federation
Commonly Used
Commonly Used
Never
Performed
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Infrequently
Used
Saudi Arabia
Senegal
Singapore
Slovak Republic
Commonly Used
Commonly Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Infrequently
Used
Infrequently Used
Unknown
Unknown
Unknown
Infrequently Used
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Infrequently
Used
Infrequently Used
Never Performed
Infrequently Used
Commonly Used
Never Performed
Never Performed
Never Performed
Commonly Used
Commonly Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Infrequently
Used
Never
Performed
South Africa
Commonly Used
Commonly Used
Commonly Used
Never Performed
Never Performed
Never Performed
South Korea
Infrequently
Used
Infrequently
Used
Unknown
Unknown
Unknown
Unknown
Unknown
Infrequently Used
Never
Performed
Never Performed
Never Performed
Infrequently Used
Unknown
Unknown
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never Performed
Spain
Commonly Used
Commonly Used
Commonly Used
Sri Lanka
Infrequently
Used
Infrequently
Used
Sweden
Commonly Used
Commonly Used
Switzerland
Commonly Used
Never
Performed
Taiwan (China*)
Commonly Used
Commonly Used
Trinidad and
Tobago
Commonly Used
Commonly Used
Turkey
Never
Performed
Never
Performed
UK
Commonly Used
Commonly Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Uruguay
Commonly Used
Commonly Used
Commonly Used
USA
Commonly Used
Commonly Used
Commonly Used
Infrequently Used
Commonly Used
Infrequently
Used
Unknown
Venezuela
Commonly Used
Never Performed
Never Performed
Never Performed
Infrequently Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never Performed
Never Performed
Never Performed
Never Performed
Never
Performed
Infrequently
Used
Never Performed
Commonly Used
Commonly Used
Commonly Used
Never
Performed
Never
Performed
Infrequently
Used
Infrequently Used
Never Performed
Never Performed
Never Performed
Infrequently Used
Page 63 of 224
CHAPTER 8. Table 5 - If third party reproduction is allowed/permitted in your country, are donors compensated?
Country
Argentina
Australia
Austria
Bangladesh
Barbados
Belarus
Belgium
Brazil
Bulgaria
Cameroon
Canada
Chile
China
Colombia
Czech
Republic
Denmark
Ecuador
El Salvador
Estonia
Finland
France
Germany
Greece
Guatemala
Honduras
Hong Kong
(China*)
Hungary
India
Iran
Ireland
Israel
Italy
Sperm
donors
Oocyte
Donors
Embryo
donors
Cytoplasmic donation
Ovarian
tissue
Testicular
Tissue
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
Unknown
Unknown
Unknown
Reimbursement for
time and expenses
No
No
No
Unknown
Unknown
Unknown
Unknown
Unknown
No
No
No
No
Reimbursement for
time and expenses
Unknown
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
No
No
No
Unknown
No
No
No
Unknown
No
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Unknown
No
No
No
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
No
No
No
No
No
Unknown
Unknown
Unknown
No
No
No
No
NO
UNKNOWN
UNKNOWN
UNKNOWN
Reimbursement for
time and expenses
No
No
No
No
No
No
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
No
No
No
No
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
Unknown
Unknown
Unknown
No
Unknown
Unknown
Unknown
No
No
No
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
No
Unknown
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Unknown
Unknown
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
No
No
No
No
Unknown
Unknown
Unknown
Unknown
Unknown
No
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
No
No
Unknown
No
Reimbursement for
time and expenses
Japan
No
Kazakhstan
No
No
No
No
No
No
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Malaysia
Mali
Mexico
Netherlands
Nigeria
Norway
Unknown
Unknown
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Panama
Unknown
Paraguay
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Unknown
No
No
No
Unknown
Reimbursement for
time and expenses
Unknown
Unknown
Reimbursement for
time and expenses
Unknown
Unknown
Unknown
No
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Reimbursement for
time and expenses
Unknown
Unknown
Unknown
Page 64 of 224
Peru
Portugal
Romania
Russian
Federation
Saudi
Arabia
Senegal
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
No
No
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
No
Unknown
Unknown
Unknown
No
No
No
No
No
Unknown
Unknown
Unknown
No
No
No
No
No
No
No
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
No
No
No
Reimbursement for
time and expenses
Slovak
Reimbursement for
Republic
time and expenses
Reimbursement for
South Africa
time and expenses
South
Reimbursement for
Korea
time and expenses
Compensated Beyond
Spain
Reimbursement
Reimbursement for
Sri Lanka
time and expenses
Reimbursement for
Sweden
time and expenses
Reimbursement for
Switzerland
time and expenses
Taiwan
Reimbursement for
(China*)
time and expenses
Trinidad
Reimbursement for
and Tobago
time and expenses
Reimbursement for
UK
time and expenses
Reimbursement for
Uruguay
time and expenses
Compensated Beyond
USA
Reimbursement
Compensated Beyond
Venezuela
Reimbursement
* Reporting separately for this report
Singapore
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Reimbursement for
time and expenses
Reimbursement for
time and expenses
No
No
No
No
Reimbursement for
time and expenses
Unknown
Unknown
Unknown
No
No
No
No
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Reimbursement for
time and expenses
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
No
No
Unknown
Unknown
No
Unknown
Unknown
Unknown
No
No
Compensated Beyond
Reimbursement
Compensated Beyond
Reimbursement
Unknown
No
Unknown
Unknown
Cytoplasmic
donation
Ovarian
tissue
Testicular
Tissue
Max
Amount
Min
Amount
Oocyte
donors
Max
Amount
Min
Amount
No min or max
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Belarus
Unknown
Unknown
Argentina
Sperm
donors
No min or max
Bangladesh
Country
Belgium
No min or max
No min or max
No min or max
No min or max
No min or max
No min or max
Brazil
No min or max
No min or max
Not addressed
Not addressed
Not addressed
Not addressed
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
No min or max
No min or max
Unknown
Unknown
Unknown
Not addressed
Not addressed
Not addressed
Bulgaria
Cameroon
Chile
Colombia
Unknown
Enter values
200
300
400
Enter values
500000
700000
Not addressed
Not addressed
Enter values
350
500
No
NO
Denmark
Enter values
Ecuador
No min or max
Enter values
2400
El Salvador
No min or max
Estonia
No min or max
No min or max
Not addressed
Not addressed
Greece
Enter values
300
300
Enter values
1200
1200
Not addressed
Unknown
Unknown
Unknown
Guatemala
Enter values
2500
4000
Enter values
6500
8000
Not addressed
Not addressed
Not addressed
Not addressed
No min or max
Not addressed
No min or max
Hungary
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
India
No min or max
No min or max
No min or max
Unknown
Unknown
Unknown
Israel
No min or max
No min or max
Mali
Netherlands
Unknown
Unknown
Unknown
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Nigeria
Enter values
Panama
Unknown
Enter values
Paraguay
Not addressed
Unknown
Peru
Portugal
Enter values
10
120
Enter values
Not addressed
Unknown
Unknown
Unknown
2000
Unknown
Unknown
Unknown
Unknown
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Unknown
Unknown
Enter values
500
680
Page 65 of 224
Romania
Not addressed
Not addressed
Russian Federation
No min or max
No min or max
Slovak Republic
No min or max
South Africa
Enter values
Spain
Not addressed
Sri Lanka
No min or max
Not addressed
No min or max
200
500
Enter values
7000
7000
No min or max
No min or max
No min or max
No min or max
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
No min or max
No min or max
2000
3000
Enter values
8000
Enter values
UK
Enter values
35
Enter values
750
Not addressed
Venezuela
Not addressed
No min or max
No min or max
Enter values
USA
Not addressed
No min or max
Not addressed
Uruguay
Not addressed
Unknown
No min or max
No min or max
No min or max
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Not addressed
Not addressed
Not addressed
Not addressed
CHAPTER 8. Table 7 - If third party reproduction is allowed/permitted in your country, are the qualifications to be a donor based upon medical, mental health and/or any lifestyle
(age and occupational) criteria?
Country
Argentina
YES
YES
YES
Australia
YES
YES
YES
Austria
YES
YES
Not addressed
Unknown
Unknown
Unknown
YES
YES
Bangladesh
Barbados
Belarus
YES
YES
Belgium
YES
YES
Brazil
YES
YES
YES
Bulgaria
YES
YES
Unknown
Cameroon
YES
YES
YES
Canada
YES
YES
NO
Chile
YES
YES
Not addressed
YES
China
YES
YES
NO
Colombia
YES
YES
YES
Czech Republic
YES
YES
YES
Denmark
YES
YES
Ecuador
YES
YES
El Salvador
YES
YES
Estonia
YES
YES
YES
Finland
YES
YES
YES
France
YES
YES
YES
Germany
YES
Not addressed
Not addressed
Greece
YES
YES
YES
Guatemala
YES
YES
YES
Honduras
YES
YES
Not addressed
YES
YES
YES
Hungary
YES
YES
YES
India
YES
YES
YES
Iran
YES
YES
YES
Ireland
NO
NO
NO
Israel
YES
YES
YES
YES
Italy
Japan
Not addressed
Kazakhstan
YES
YES
YES
Malaysia
YES
YES
Not addressed
Mali
Unknown
Unknown
Unknown
Not addressed
Not addressed
Not addressed
Netherlands
YES
YES
YES
Nigeria
YES
YES
YES
Norway
YES
Mexico
Panama
YES
YES
Unknown
Paraguay
YES
YES
YES
Peru
YES
YES
YES
Page 66 of 224
Portugal
YES
YES
YES
Romania
YES
YES
YES
Russian Federation
Senegal
YES
YES
NO
Not addressed
Not addressed
Not addressed
Singapore
YES
YES
Slovak Republic
YES
YES
YES
South Africa
YES
YES
Unknown
South Korea
NO
NO
Spain
YES
Sri Lanka
YES
YES
YES
Sweden
YES
YES
Not addressed
Switzerland
YES
Taiwan (China*)
YES
YES
YES
NO
YES
UK
YES
YES
YES
Uruguay
YES
YES
YES
USA
YES
YES
YES
Venezuela
YES
YES
Not addressed
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
Kuwayama M, Vajta G, Kato O, Leibo SP. Highly effective vitrification method for cryopreservation of
human oocytes. Reprod Biomed Online 2005;11(3):300-8.
Cobo A, Meseguer M, Remoh J, Pellicer A. Use of cryo-banked oocytes in an ovum donation
programme: a prospective, randomized, controlled, clinical trial. Hum Reprod 2010;25:223946.
Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, Barri P, Diedrich K;
ESHRE Task Force on Ethics and Law. Oocyte cryopreservation for age-related fertility loss. Hum
Reprod 2012;27(5):1231-7.
Practice Committees of American Society for Reproductive Medicine; Society for Assisted
Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril 2013;99(1):3743.
Kupka MS, DHooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, De Geyter
Ch, Goossens V; European IVF-Monitoring Consortium (EIM); Europeann Society of Human
Reproduction and Embryology (ESHERE). Assisted reproductive technology in Europe, 2011: results
generated from European registers by ESHRE. Hum Rep 2016;31(2) 233-48.
Pennings G, de Wert G, Shenfield F, Cohen J, Tarlatzis B, Devroey P. ESHRE task force on ethics
and law 15: cross-border reproductive care. Hum Rep 2008;23(10):2182-4.
Human Fertilisation & Embryology Authority. Mitochondrial donation. Available at:
http://www.hfea.gov.uk/9933.html. Accessed August 9, 2016.
Human Fertilization & Embryology Authority; Human Tissue Authority. Regulation of ovarian and
testicular
tissue.
Available
at:
http://www.hfea.gov.uk/docs/Regulation_of_ovarian_and_testicular_tissue_-_flow_diagram.pdf.
Accessed August 9, 2016.
Page 67 of 224
CHAPTER 9: ANONYMITY
Anonymous gamete donation is still reported to be the most prevalent practice for sperm and oocyte
donation around the world. However, there has been a gradual trend in some countries toward a more
open approach in obtaining information from donors, with the intent of sharing with prospective parents
and for potential disclosure to future offspring (1). In some cases, donors may also obtain some limited
information from the offspring but this practice remains more controversial and has had a much more
limited application. There are inevitable conflicts of interests involving ethical and legal considerations,
and these include the rights of autonomy and privacy of the prospective parents, the right of privacy of the
donor, and the right of the child to know his/her genetic origins (2).
The ability for a donor to remain anonymous can no longer be ensured. Recently, current technologies
include affordable massive gene sequencing, commercial direct-to-consumer genetic testing, and the
creation of human DNA databases have made assurances of anonymity increasingly problematic and
difficult, if not impossible to ensure. This lack of an ability to ensure donor anonymity profoundly impacts
the practice of anonymous gamete and embryo donation, and currently results in additional debates and
considerations that address ethical, legal, and medical implications of this practice (3).
In the vast majority of countries, the respondents surveyed (45/56, 80%), reported no modifications in
regulations that address anonymity since 2012 (the time of the previous International Federation of
Fertility Societies [IFFS] questionnaire), and 12.5% reported the issue as unknown (Table 1).
A few countries had respondents who reported modifications in their regulations within the triennium. One
example is Australia, where more information is currently required from the donor and offspring. This
information includes identifying and non-identifying data from the donor to be provided to the offspring
and non-identifying data from the offspring to be provided to the donor. These modifications have been
reported to be implemented within both state/provincial laws and by professional organization guidelines.
In Argentina, it was reported that an extensive reform of the Civil Code to include assisted reproductive
technology (ART) filiation took place in 2013, and has led to a registry of newborns from ART procedures,
leaving open the possibility that offspring from a donor ART cycle can request non-identifying data from
the donor (when they reach the age of 18, and only after obtaining a court order). The respondent from
Hong Kong (China) also reports new policies from regulatory agencies allowing the ability to request
information from the donor to be provided to the offspring. In Uruguay, the respondent reported that
modifications to national laws have implied that information can be provided to offspring under certain
circumstances.
In total, 13 countries had respondents who reported having no regulations regarding information
addressing anonymity, including Barbados, Bangladesh, Canada, Chile, Ecuador, Guatemala, Honduras,
Kenya, Malaysia, Mexico, Nigeria, Panama, Paraguay, Peru, Sri Lanka, Trinidad & Tobago, and Tunisia
(Table 2).
Every European country which had a respondent who was surveyed, with the exception of Ireland, have
national laws requiring potential disclosure of information regarding donors or offspring, although the
situation is not homogeneous among all European countries with regard to the type of information
disclosed and how it is implemented. Table 3 shows the type of disclosure in some countries with laws in
place, reflecting the wide variety of practices in each country assessed. Nonetheless, Australia, Belgium,
and the UK are the countries that are reported to currently be more open to full disclosure of donor and
offspring information to both parties (identifying and non-identifying data). When asked if it is customary to
disclose this information, regardless of the existence of laws or regulations, most of the respondents in
these countries reported having laws that require disclosure as customary (Table 4).
Cameroon, Bangladesh, Jordan, and Nigeria respondents report that this issue is addressed through
cultural practice and religious decree. In the case of Ireland, this issue is reported to be addressed by
standards and guidelines from professional organizations, and the same situation was reported to apply
Page 68 of 224
to the USA, Canada, Colombia, Japan, and Mali, where no federal laws exist regarding this issue. In Iran,
it was reported that government agencies and national laws regulate anonymity, and identifying data from
donors can be provided to offspring in certain circumstances. A similar situation exists was reported to
exist in Brazil, where identifying data from donors to offspring, and from offspring to donors, can be
disclosed under certain conditions, and is overseen by a government agency. Table 3 allo shows the
multiple approaches that are reported to be used by different countries to address the issue of donor
anonymity.
SUMMARY
In brief, based upon this report, donor and offspring anonymity remains the most commonly practiced
form of donor gamete treatment in the majority of countries with respondents who were surveyed.
Recently, regulatory agencies and professional organizations have promoted changes that have gradually
established a trend toward disclosing more information from donors to prospective parents and future
offspring, or from offspring to donors. This data is provided freely and openly in some countries (e.g., UK,
Australia, and Belgium), or released only under certain circumstances or court orders in other countries.
Anonymity and issues revolving around disclosure in gamete donation remains a matter of scientific and
ethical debate worldwide.
CHAPTER 9. Table 1 - If you responded to the Surveillance survey 2012, have there been any modifications to legislation or guidelines on anonymity of donors?
Country
Argentina
Australia
Austria
No modifications
Bangladesh
No modifications
Belarus
No modifications
Belgium
No modifications
Brazil
No modifications
Bulgaria
Unknown
Cameroon
No modifications
Canada
No modifications
Chile
No modifications
Colombia
No modifications
Czech Republic
No modifications
Ecuador
Unknown
Estonia
No modifications
Finland
No modifications
France
No modifications
Germany
Unknown
Greece
No modifications
Guatemala
Unknown
Hungary
No modifications
India
No modifications
Iran
No modifications
Italy
No modifications
Japan
No modifications
Jordan
No modifications
Kazakhstan
No modifications
Malaysia
Unknown
Mali
Unknown
Mexico
No modifications
Netherlands
No modifications
Nigeria
No modifications
Norway
No modifications
Panama
No modifications
Paraguay
No modifications
Page 69 of 224
Philippines
No modifications
Portugal
No modifications
Romania
No modifications
Russian Federation
No modifications
Senegal
Unknown
Singapore
No modifications
Slovak Republic
No modifications
South Africa
No modifications
South Korea
No modifications
Spain
No modifications
Sweden
No modifications
Switzerland
No modifications
Taiwan (China*)
No modifications
No modifications
Tunisia
No modifications
Turkey
No modifications
UK
No modifications
Uruguay
USA
No modifications
Venezuela
No modifications
CHAPTER 9. Table 2 - Are there practices or regulations that address anonymity in your country?
Country
Argentina
No practices or
regulations
Federal/National
Laws/Statutes/
Ordinances
NO
YES
Australia
Municipal
Laws/Statutes/
Ordinances
Agency
Regulations/
Oversight
Professional
Organization
Standards/
Guidelines
Cultural practice
Religious
decree
NO
NO
NO
YES
NO
NO
YES
YES
YES
YES
NO
NO
YES
Austria
YES
YES
Bangladesh
YES
Barbados
NO
Belarus
State/Provincial/
Regional
Laws/Statutes/
Ordinances
UNKNOWN
Belgium
NO
NO
NO
YES
YES
YES
Brazil
YES
Bulgaria
YES
YES
Cameroon
NO
Canada
YES
Chile
NO
China
NO
YES
YES
Colombia
YES
Czech Republic
YES
Denmark
Ecuador
NO
YES
YES
Estonia
YES
Finland
YES
France
YES
Germany
YES
Greece
YES
YES
Guatemala
YES
Honduras
YES
NO
NO
NO
Hong Kong
(China*)
NO
NO
YES
Hungary
YES
India
YES
Iran
NO
YES
NO
NO
YES
NO
NO
NO
Ireland
NO
NO
NO
NO
NO
YES
NO
NO
Israel
Italy
Japan
Jordan
YES
YES
YES
YES
YES
Page 70 of 224
Kazakhstan
YES
Kenya
YES
Malaysia
NO
Mali
YES
Mexico
YES
Netherlands
Nigeria
YES
YES
YES
NO
Norway
NO
NO
NO
YES
YES
NO
YES
Panama
YES
NO
NO
NO
NO
NO
NO
NO
Paraguay
YES
NO
NO
NO
NO
NO
NO
NO
Peru
YES
NO
NO
NO
UNKNOWN
NO
YES
YES
NO
YES
YES
Portugal
YES
Romania
YES
Russian
Federation
YES
Saudi Arabia
Senegal
NO
NO
NO
NO
NO
UNKNOWN
YES
Singapore
YES
Slovak Republic
YES
South Africa
YES
South Korea
YES
Spain
YES
Sri Lanka
YES
NO
YES
YES
NO
NO
Sweden
YES
YES
Switzerland
YES
Taiwan (China*)
NO
NO
NO
YES
NO
YES
Trinidad and
Tobago
YES
Tunisia
YES
Turkey
YES
UK
YES
Uruguay
YES
USA
NO
Venezuela
NO
NO
NO
Argentina
Not Allowed
Not mentioned
Not mentioned
Australia
Allowed
Allowed
Allowed
Not mentioned
Not mentioned
Country
Austria
Bangladesh
Not Allowed
Unknown
Unknown
Unknown
Unknown
Not mentioned
Not mentioned
Not mentioned
Not mentioned
Belarus
Unknown
Unknown
Unknown
Unknown
Belgium
Allowed
Allowed
Allowed
Barbados
Brazil
Cameroon
Canada
Denmark
Finland
Germany
Allowed
Allowed with conditions
Not Allowed
Not Allowed
Allowed
Allowed
Not Allowed
Not Allowed
Allowed
Allowed
Not Allowed
Not Allowed
Not mentioned
Allowed
Not Allowed
Allowed
Not mentioned
Guatemala
Unknown
Unknown
Unknown
Unknown
Honduras
Unknown
Unknown
Unknown
Unknown
Allowed
Hungary
Allowed
India
Allowed
Not Allowed
Allowed
Not Allowed
Allowed
Iran
Unknown
Unknown
Unknown
Ireland
Not Allowed
Not Allowed
Not Allowed
Not Allowed
Not Allowed
Not Allowed
Unknown
Unknown
Unknown
Unknown
Kazakhstan
Malaysia
Page 71 of 224
Mali
Not mentioned
Not mentioned
Not mentioned
Not mentioned
Unknown
Allowed
Not Allowed
Nigeria
Allowed
Not Allowed
Not Allowed
Not Allowed
Norway
Allowed
Netherlands
Panama
Unknown
Unknown
Unknown
Unknown
Paraguay
Unknown
Unknown
Unknown
Unknown
Not mentioned
Not mentioned
Not mentioned
Not mentioned
Not Allowed
Not Allowed
Not Allowed
Not Allowed
Not mentioned
Not mentioned
Not mentioned
Not mentioned
Not Allowed
Not Allowed
Not Allowed
Not Allowed
Allowed
Not Allowed
Not Allowed
Unknown
Unknown
Unknown
Unknown
Allowed
Allowed
Not mentioned
Not Allowed
Not Allowed
Peru
Romania
Russian Federation
Slovak Republic
South Africa
Sri Lanka
Sweden
Switzerland
Trinidad and Tobago
Allowed
Not Allowed
Unknown
Unknown
Unknown
Unknown
Allowed
Allowed
Allowed
Unknown
Unknown
Unknown
Unknown
UK
USA
Venezuela
Argentina
Customary
Australia
Customary
Country
Austria
Bangladesh
Not customary
Unknown
Unknown
Customary
Customary
Varies
Unknown
Customary
Unknown
Unknown
Unknown
Varies
Varies
Varies
Varies
Belarus
Unknown
Unknown
Unknown
Unknown
Belgium
Barbados
Not customary
Customary
Varies
Customary
Cameroon
Customary
Not customary
Not customary
Not customary
Canada
Customary
Varies
Varies
Varies
Varies
Not customary
Varies
Not customary
Varies
Varies
Not customary
Not customary
Unknown
Unknown
Unknown
Unknown
Chile
Denmark
Finland
Germany
Varies
Guatemala
Unknown
Unknown
Unknown
Unknown
Honduras
Unknown
Unknown
Unknown
Unknown
Unknown
Not customary
Hong Kong
(China*)
Customary
Hungary
Customary
India
Customary
Customary
Customary
Ireland
Not customary
Not customary
Not customary
Not customary
Kazakhstan
Not customary
Not customary
Not customary
Not customary
Malaysia
Unknown
Unknown
Unknown
Unknown
Mali
Unknown
Unknown
Unknown
Unknown
Not customary
Customary
Unknown
Unknown
Nigeria
Customary
Not customary
Unknown
Not customary
Norway
Customary
Netherlands
Panama
Unknown
Unknown
Unknown
Unknown
Paraguay
Unknown
Unknown
Unknown
Unknown
Romania
Varies
Varies
Varies
Varies
Russian Federation
Varies
Varies
Varies
Varies
Not customary
Slovak Republic
Not customary
Not customary
Not customary
South Africa
Customary
Customary
Not customary
Not customary
Sri Lanka
Customary
Not customary
Customary
Not customary
Switzerland
Varies
Varies
Not customary
Not customary
Trinidad and
Tobago
Unknown
Unknown
Unknown
Unknown
Varies
Varies
Varies
Varies
UK
Page 72 of 224
USA
Customary
Customary
Customary
Customary
Unknown
Unknown
Unknown
Unknown
Venezuela
* Reporting separately for this report
REFERENCES
1. van den Akker O. A review of family donor constructs: current research and future directions.
Hum Reprod Update 2006;12(2):91-101.
2. ESHRE Task Force on Ethics and Law. III. Gamete and embryo donation. Hum Reprod
2002;17(5):1407-8.
3. Harper JC, Kennett D, Reisel D. The end of donor anonymity: how genetic testing is likely to drive
anonymous gamete donation out of business. Hum Reprod 2016 ;31(6) :1135-40.
Page 73 of 224
CHAPTER 10: MICROMANIPULATION
INTRODUCTION
Micromanipulation techniques in the context of this Surveillance report are interventions performed on the
oocyte or embryo with the specific intention of improving assisted reproductive treatment outcomes.
These micromanipulation assisted reproductive technology (ART) procedures include intracytoplasmic
sperm injection (ICSI), assisted hatching (AH), and various types of embryo biopsy. All of these particular
procedures have been employed for some time but their value and specific indications are still debated.
MICROINSEMINATION OR INTRACYTOPLASMIC SPERM INJECTION (ICSI):
Since its introduction to clinical practice in 1992, ICSI has been used effectively for couples with
significant male factor infertility. In patients undergoing ART with surgically retrieved spermatozoa for
obstructive or non-obstructive azoospermia and in those patients with significant quantitative and
qualitative sperm abnormalities, ICSI is usually obligatory to achieve an effective oocyte fertilization rate.
Although commonly employed for other milder, male factor parameters, benefit is less clearly established.
ICSI is recommended in the setting of mild male factor (as defined by a minimum of one semen
parameter abnormality per World Health Organization [WHO]). In addition, it has been empirically used
for cases of previous fertilization failure, poor-quality oocytes, cryopreserved oocytes, in vitro maturation
oocytes and diminished ovarian reserve (1). The American Society for Reproductive Medicine (ASRM)
Practice Committee opines that the routine use of ICSI in non-male factor infertility is not supported by
adequate data (2).
With the widespread application of in vitro fertilization (IVF) and ICSI in infertility management, the health
of offspring produced has been an ongoing concern. The interventions involved, parental age, and factors
underlying infertility have all been suggested to be associated with adverse epigenetic effects on the
offspring. Cases of severely impaired spermatogenesis are associated with specific chromosomal
anomalies, especially a high frequency of Y-chromosomal micro deletions. ICSI is a more invasive
intervention than conventional fertilization and confers heightened potential concerns regarding risk of
congenital anomalies in children conceived with ICSI (3). A systematic literature review from 1985 to May
2014 suggested that there was a slightly higher risk of genitourinary congenital malformation such as
hypospadias and cryptorchidism in children conceived with ICSI compared to IVF offspring. However, a
subsequent analysis of selective, higher quality studies did not find an increased risk (4). Frequency of
imprinting disorders, metabolic syndromes, and various malignancies have also been assessed among
IVF and IVF/ICSI children. A direct link between IVF/ICSI and the studied disorders has not been
established (5).
ASSISTED HATCHING (AH):
AH is a technique used to improve ART success rates by facilitating the emergence of the embryo from
the zona pellucida. It involves the artificial thinning or breaching of the zona pellucida, using either
acidified Tyrode's solution, a glass microneedle, laser photo ablation, or a piezo micromanipulator. It has
been utilized for poor prognosis embryos based on factors including zona thickness, blastomere
number, fragmentation rates, and maternal age. The ASRM Practice Committee in 2014 recommended
against the routine use of AH for all patients undergoing IVF. Although there is good evidence that the
clinical pregnancy rates are slightly improved in poor prognosis patients, the evidence that it improves live
birth rates remains insufficient (6).
Assisted hatching has been associated with a higher risk of monozygotic twin pregnancy in patients with
a maternal age less than 35 years. However, a Cochrane database review in 2012 did not find an
association between monozygotic twinning and assisted hatching in either fresh or frozen transfer cycles
(7).
EMBRYO BIOPSY:
The procurement of embryonic DNA for pre-implantation genetic testing (PGT) may utilize PGT for
aneuploidies (PGT-A), PGT for monogenic/single gene defects (PGT-M), and PGT for chromosomal
Page 74 of 224
structural rearrangements (PGT-SR). Overall assessment of the safety of the biopsy on the embryo, and
determination of the optimal stage of development for biopsy for safety and efficacy are ongoing.
Recent studies have concluded that trophectoderm biopsy of a blastocyst rather than cleavage stage
biopsy may be preferable. The cleavage stage embryos are believed to be more vulnerable to injury with
resultant slower development and a higher chance of embryonic death. Also, the higher level of
mosaicism at this stage increases the embryonic misdiagnosis rate even when cellular diagnosis is
correct. Some experts believe that the removal of a euploid cell from a mosaic cleavage stage embryo
may result in a higher aneuploid cellular load, which could have further deleterious effects. Moreover,
pregnancy rates are higher when trophectoderm biopsy for preimplantation genetic screening is
performed at the blastocyst stage, although recent reports of a high frequency of mosaicism in
trophectoderm biopsies have now cast doubt on the specificity of the use of PGT for identifying euploidy,
i.e., normal embryos that are diploid (8).
CYTOPLASMIC AND MITOCHONDRIAL TRANSFER:
Cytoplasmic transfer was a technique initially attempted to prevent serious mitochondrial disease. It
involves the transfer of a small amount of ooplasm from a healthy donor oocyte to a recipient oocyte,
creating a heteroplasmic oocyte. The presumed mutated mitochondrial DNA (mtDNA) of the recipient
oocyte is not removed, but healthy donor mitochondrial DNA is added to it. However, there are three
modifications of the cytoplasmic approach that are currently being actively researched and applied in
experimental clinical trials. In the pronuclear transfer technique, the pronuclei from the zygote of the
affected woman are inserted into the enucleated donor zygote containing nonpathogenic mtDNA. The
second is the spindle transfer technique, in which the metaphase II spindle of chromosomes from the
unfertilized oocyte of an affected woman is transferred to an enucleated donor oocyte. The most recent is
the polar body transfer technique. In these methods, the nuclear chromosomes are from the two parent
gametes, but the mtDNA is primarily inherited from the donor oocyte. The risk of epigenetic abnormalities
is unknown and further clinical research and long term child outcome data are needed before direct
clinical application (9).
In the USA, the Food and Drug Administration (FDA) has oversight of technology pertaining to techniques
for mtDNA transfer. These procedures may be undertaken as clinical trials, after appropriate approvals
are awarded. The Human Fertilisation and Embryology Authority (HFEA) in the UK has permitted
mitochondrial replacement techniques as a clinical procedure since the end of 2015, proposing that these
techniques be restricted to clinics licensed specifically to perform them and monitor outcomes (10).
ANALYSIS OF SURVEY (TABLE 1)
Of the 63 respondents that addressed this topic, ART legislation or guidelines were reported to be
applicable to micromanipulation procedures in 40 countries. Eighteen countries were reported to be
governed by statute. Activities were reported to be conducted within published guidelines within a further
16 countries, and activities were also reported to be covered under both statutes and guidelines in six
countries. There are neither laws nor guidelines for the main micromanipulation techniques of ICSI and
AH reported by respondents from 23 countries.
ICSI was reported to be allowed by statute or guidelines, and commonly practiced in all countries that are
represented in this report. ICSI with surgically retrieved sperm is reported to be infrequently used in
Belarus, Denmark, Germany, Jordan, Kenya, Malaysia, Mali, Senegal, and Sri Lanka.
Assisted hatching is also a generally accepted procedure in all countries represented in this report except
for Bangladesh and Mali, where it is reportedly never performed. In Tunisia, the frequency of its use was
unknown to the respondent.
Embryo or oocyte biopsy is reported to never be performed in Bangladesh, Mali, Norway, and the
Philippines. Blastomere biopsy on cleavage stage embryos was reportedly not allowed to be performed in
Austria and Germany but polar body and trophectoderm biopsy were reported to be allowed. Countries
whose respondents stated that embryo biopsy could be performed but not polar body biopsy include
Page 75 of 224
Colombia, Denmark, Ecuador, Guatemala, Hong Kong (China), Iran, Mexico, the Netherlands, Paraguay,
and Sweden. Trinidad and Tobago infrequently do blastomere biopsy, but do not perform polar body or
trophectoderm biopsy.
Cytoplasmic transfer is reported to be used infrequently throughout the world. As noted and presented in
greater detail in Chapter 8, cytoplasmic transfer is reported to be "commonly used" in only four countries:
Kazakhstan, Cameroon, Slovak Republic, and Uruguay. It is reported to be used infrequently in India,
Israel, and Mexico. Mitochondrial transfer is reported to be used infrequently in the UK, Cameroon, Israel,
Slovak Republic, and Mexico. The other countries that had respondents fill out the questionnaire stated
that their countries do not perform cytoplasmic or mitochondrial transfer.
SUMMARY
ICSI remains the primary method of achieving fertilization for severe or mild male factor infertility and is
utilized by all countries with respondents reporting for this Surveillance 2016. It is also commonly used for
other instances of non-male factor infertility but these other applications are not currently recommended
by large regional and some national professional societies. AH is reported to be utilized in all but two
countries sampled. Embryo biopsy for PGT is reported to be performed in a large majority of countries
and is reported to be usually preferentially performed on trophectoderm from blastocysts.
Cytoplasmic and mitochondrial transfer, which may ultimately be used to prevent serious mitochondrial
disease, remain experimental with very limited clinical application worldwide with few respondents
reporting their country to be utilizing these techniques. Pronuclear and spindle transfer are the newer
research refinements but have even more limited use reported by the countries represented in this 2016
Surveillance report.
Chapter 10. Table 1 How Is Micromanipulation Governed?
ICSI allowed
No
Other
Yes
Not used
Yes
BB
CT, MT
Belgium
Infrequent
CT, MT unknown
Bulgaria
CT, MT unknown
No
Yes
Austria
No
Yes
By statutes
Country
Not
mentioned
How ART
is
governed?
China
CT, MT unknown
Czech Republic
CT, MT unknown
Hungary
CT
Israel
CT, MT
Kazakhstan
MT unknown
Norway
Infrequent
Romania
Infrequent
Russian Federation
Singapore
CT, MT
South Africa
Infrequent
CT, MT
Spain
Infrequent
MT
CT unknown
Sweden
Infrequent
CT, MT unknown
MT unknown
CT, MT
Switzerland
Infrequent
CT
Turkey
CT, MT
Page 76 of 224
UK
Infrequent
Cameroon
Infrequent
Finland
Infrequent
CT, MT
Germany
Infrequent
BB, CT, MT
Greece
Infrequent
CT, MT unknown
Portugal
Infrequent
CT, MT unknown
Slovak Republic
Other
No
Yes
Not used
No
No
Yes
Yes
Country
Not
mentioned
Yes
How ART
is governed
ICSI allowed
Guidelines
Argentina
CT, MT unknown
Australia
Belarus
CT, MT
Ecuador
PBB
CT, MT
India
Infrequent
TB
Italy
Infrequent
CT, MT unknown
Japan
CT, MT unknown
Jordan
Infrequent
BB
MT
Netherlands
Infrequent
Nigeria
Philippines
Saudi Arabia
Senegal
Taiwan (China*)
Venezuela
Infrequent
Cameroon
Infrequent
Finland
Infrequent
CT, MT
Germany
Infrequent
BB, CT, MT
Greece
Infrequent
CT, MT unknown
CT, MT unknown
CT
MT unknown
CT, MT unknown
Not mentioned
BB, TB unknown
MT unknown
Portugal
Infrequent
Slovak Republic
Bangladesh
Never
performed
None
Canada
CT, MT unknown
Chile
Infrequent
CT, MT unknown
Denmark
Infrequent
CT, MT unknown
Colombia
Infrequent
El Salvador
Estonia
Infrequent
France
Infrequent
Guatemala
Not mentioned
Iran
Ireland
CT, MT unknown
CT, MT
CT, MT unknown
CT, MT
Page 77 of 224
Malaysia
Kenya
Mali
Mexico
Infrequent
Panama
Infrequent
Paraguay
Infrequent
MT unknown
Peru
MT unknown
Sri Lanka
Infrequent
Unknown
Infrequent
Infrequent
CT, MT
Tunisia
Unknown
Uruguay
Not mentioned
Infrequent
USA
MT unknown
CT, MT
*Other Micromanipulation includes Polar body biopsy (PBB), Blastomere biopsy (BB) and Trophectoderm
biopsy (TB), Cytoplasmic transfer (CT), and Mitochondrial transfer (MT).
REFERENCES
1. Babayev SN, Park CW, Bukulmez O. Intracytoplasmic sperm injection indications: how rigorous?
Semin Reprod Med. 2014;32(4):283-90.
2. Practice Committees of the American Society for Reproductive Medicine and Society for Assisted
Reproductive Technology. Intracytoplasmic sperm injection (ICSI) for non-male factor infertility: a
committee opinion. Fertil Steril 2012;98(6):1395-9.
3. Pinborg A, Henningsen AK, Malchau SS, Loft A. Congenital anomalies after assisted reproductive
technology. Fertil Steril 2013;99(2):327-332.
4. Massaro PA, MacLellan DL, Anderson PA, Romao RL. Does intracytoplasmic sperm injection
pose an increased risk of genitourinary congenital malformations in offspring compared to in vitro
fertilization? A systematic review and meta-analysis. J Urol 2015;193(Suppl 5):1837-42.
5. Fauser BC, Devroey P, Diedrich K, et al. Health outcomes of children born after IVF/ICSI: a
review of current expert opinion and literature. Reprod Biomed Online 2014;28(2):162-82.
6. Practice Committee of the American Society for Reproductive Medicine; Practice Committee of
the Society for Assisted Reproductive Technology. Role of assisted hatching in in vitro
fertilization: a guideline. Fertil Steril 2014;102(2):348-51.
7. Carney SK, Das S, Blake D, Farquhar C, Seif MM, Nelson L. Assisted hatching on assisted
conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Cochrane
Database Syst Rev 2012;12:CD001894.
8. Brezina PR, Kutteh WH. Clinical applications of preimplantation genetic testing. BMJ 2015;350:
g7611.
9. Amato P, Tachibana M, Sparman M, Mitalipov S. Three-parent in vitro fertilization: gene
replacement for the prevention of inherited mitochondrial diseases. Fertil Steril 2014;101(1):31-5.
10. Board on Health Sciences Policy, Institute of Medicine. Ethical and social policy considerations of
novel techniques for prevention of maternal transmission of mitochondrial DNA diseases. In:
Claiborne A, English R, Kahn J, eds. Mitochondrial Replacement Techniques: Ethical, Social, and
Policy Considerations. Washington (DC): National Academies Press (USA), 2016.
Page 78 of 224
CHAPTER 11: OOCYTE MATURATION
INTRODUCTION
In-vitro maturation (IVM) following the recovery of immature oocytes was first suggested in the early
1990s as an option for improving potential fertilization rates of women undergoing in vitro fertilization
(IVF). Currently, the major difference between this technique as it is typically performed, and conventional
IVF treatment, is that oocyte retrieval is performed without prior controlled ovarian hyperstimulation
(COH), and the immature oocytes recovered are subsequently cultured in vitro in enhanced culture
environments until they complete maturation at the metaphase II (MII) stage. Several potential
advantages of IVM have been cited, including improved safety by eliminating risk of ovarian
hyperstimulation syndrome (OHSS), particularly for patients with polycystic ovarian syndrome (PCOS)
and reduced cost and greater convenience with less stress to the patient by eliminating COH. However,
clinical adaptation has been slow because of concerns pertaining to a lower overall clinical success, need
for development of competency to perform the laboratory technique, limited follow-up data regarding the
health of the resulting offspring, and the possible inducement of permanent changes in the expression of
imprinted genes when compared to conventional IVF treatment (1).
ANALYSIS OF THE SURVEY (Tables 1-2, Charts 1-2)
Oocyte maturation: This survey topic included analyzable data from feedback from respondents from 64
countries. The procedure is reported to be permitted in 57 of these countries, whereas in two countries
(Bangladesh and Belarus) it is reported to not be allowed. The situation was not reported by respondents
in five countries (Australia, Mali, Paraguay, Sri Lanka, and Tunisia). In the majority of the countries,
oocyte maturation is reported not to be overseen by an authority whereas in 14 countries application is
reported to be primarily regulated by federal/ national rules or voluntarily by professional organization
standards and guidelines. Oocyte maturation was reported to be commonly used in only in nine countries.
DISCUSSION
Despite evidence of a modest increase in the utilization of IVM as noted from the IFFS Surveillance 2010
until 2013, the current survey results in 2016 provide very similar information when compared with 2013.
Since current data have not shown the clinical efficiency of the technique to offer superior results to
conventional IVF treatment, new clinical evidence will be needed to promote wider application of IVM.
SUMMARY
IVM offers significant hypothetical advantages over conventional IVF but the extant reported clinical
experience does not yet support broader application, which has limited its adoption. This situation has not
significantly changed over the past three years.
CHAPTER 11.. Table 1 Parameters for oocyte maturation. Country
Is oocyte maturation
performed in your country?
Infrequently Used
Argentina
YES
NO
Australia
UNKNOWN
UNKNOWN
Unknown
YES
NO
Infrequently Used
Austria
Bangladesh
NO
NO
Never Performed
Barbados
YES
NO
Infrequently Used
Belarus
NO
NO
Infrequently Used
Belgium
YES
NO
Infrequently Used
Brazil
YES
NO
Infrequently Used
Bulgaria
YES
YES
Infrequently Used
Cameroon
YES
NO
Commonly Used
Canada
YES
NO
Infrequently Used
Chile
YES
China
YES
NO
Infrequently Used
Colombia
YES
NO
Infrequently Used
Infrequently Used
Page 79 of 224
Czech Republic
YES
UNKNOWN
Infrequently Used
Denmark
YES
UNKNOWN
Infrequently Used
Ecuador
YES
NO
Infrequently Used
El Salvador
Yes
NO
Infrequently Used
Estonia
YES
NO
Infrequently Used
Finland
YES
YES
Infrequently Used
France
YES
YES
Infrequently Used
Germany
YES
NO
Infrequently Used
Greece
YES
YES
Infrequently Used
Guatemala
YES
NO
Never Performed
YES
YES
Infrequently Used
Hungary
YES
NO
Infrequently Used
India
YES
YES
Infrequently Used
Iran
YES
UNKNOWN
Commonly Used
Ireland
YES
NO
Infrequently Used
Israel
YES
NO
Commonly Used
Italy
YES
YES
Infrequently Used
Japan
YES
NO
Infrequently Used
Jordan
YES
NO
Infrequently Used
Kazakhstan
YES
NO
Commonly Used
Kenya
Malaysia
Mali
NO
Unknown
YES
NO
Never Performed
UNKNOWN
NO
Never Performed
Mexico
YES
NO
Infrequently Used
Netherlands
YES
UNKNOWN
Never Performed
Nigeria
YES
YES
Commonly Used
Norway
YES
YES
Infrequently Used
Panama
YES
NO
Infrequently Used
Paraguay
UNKNOWN
NO
Never Performed
Peru
YES
NO
Infrequently Used
Philippines
YES
Portugal
YES
NO
Infrequently Used
Romania
YES
YES
Infrequently Used
Russian Federation
YES
NO
Infrequently Used
Saudi Arabia
YES
YES
Commonly Used
Senegal
Commonly Used
NO
Singapore
YES
Slovak Republic
YES
YES
Commonly Used
South Africa
YES
NO
Infrequently Used
South Korea
YES
NO
Spain
YES
NO
Infrequently Used
UNKNOWN
NO
Infrequently Used
Sweden
YES
UNKNOWN
Infrequently Used
Switzerland
YES
NO
Infrequently Used
Taiwan (China*)
YES
UNKNOWN
Infrequently Used
YES
NO
Infrequently Used
Tunisia
UNKNOWN
NO
Unknown
Turkey
YES
YES
Infrequently Used
UK
YES
YES
Infrequently Used
Uruguay
YES
NO
Commonly Used
USA
YES
NO
Infrequently Used
Venezuela
YES
NO
Infrequently Used
Sri Lanka
Infrequently Used
Page 80 of 224
CHAPTER 11. Table 2 - If oocyte maturation is regulated in your country, how is it done?
Country
Argentina
No
regulations
Federal/National
Laws/Statutes/
Ordinances
State/Provincial/
Regional Laws/
Statutes/Ordinances
Municipal
Laws/Statutes/
Ordinances
Agency Regulations/
Oversight
Professional
Organization
Standards/
Guidelines
YES
Australia
Austria
Bangladesh
YES
Belarus
YES
Belgium
Bulgaria
YES
Cultural
practice
Religious
decree
Unknown
Page 81 of 224
Cameroon
Canada
YES
Chile
YES
China
YES
Czech Republic
Denmark
Ecuador
YES
El Salvador
YES
Estonia
YES
Finland
YES
YES
France
Germany
YES
YES
YES
Greece
Guatemala
YES
YES
YES
India
YES
Iran
YES
Ireland
YES
Israel
YES
Italy
Japan
YES
YES
Jordan
YES
Kazakhstan
Malaysia
YES
Mali
YES
Mexico
Netherlands
YES
Nigeria
YES
Norway
YES
Panama
YES
Paraguay
YES
Peru
YES
Philippines
Portugal
Romania
Russian Federation
YES
YES
Saudi Arabia
YES
Senegal
Singapore
YES
Slovak Republic
YES
South Africa
YES
Spain
YES
Sri Lanka
YES
YES
Sweden
Switzerland
YES
Taiwan (China*)
Tunisia
YES
YES
Turkey
YES
UK
YES
Uruguay
USA
YES
Venezuela
YES
YES
REFERENCES
1. Paulson RJ, Fauser BC, Vuong LT, Doody K. Can we modify assisted reproductive technology
practice to broaden reproductive care access? Fertil Steril 2016;105(5):1138-43.
Page 82 of 224
CHAPTER 12: WELFARE OF THE CHILD
The ultimate goal of all infertility treatments is the birth of a single healthy baby. Initial early observational
studies of neonates provided reassurance that assisted reproductive technology (ART) interventions were
not associated with adverse outcomes. More recently, larger population-based studies with longer and
more thorough follow-up have raised concerns regarding an increased frequency of abnormalities. Early
reports published after intracytoplasmic sperm injection (ICSI) was established as a new method of
fertilization reported an expected incidence of birth defects, comparable to the general population.
However, de-novo sex chromosome anomalies and structural autonomic anomalies were increased in
newborns after ICSI but not after in vitro fertilization (IVF), presumed to be inherited through the paternal
pathway and thus not due to the ICSI treatment itself (1). Other studies described a higher incidence of
birth defects (2,3) in newborns after ICSI compared to IVF. It is not clear whether this effect, if significant,
is a result of the intervention or if it instead represents an increase in the baseline anomaly rate in an
infertile population (as reported in a systematic review in 2014) (4). There is evidence to support both
hypotheses. Considering the widespread use of ART in general, and ICSI in particular (which is
increasingly being used for non-male factor indications), follow-up of children born following ART is
essential.
ANALYSIS OF THE SURVEY
Of the 68 countries that had respondents providing answers for the current survey concerning this topic,
31 (45.6%) report having legislation addressing the welfare of the child (Table 1, Chart 1). Most of these
countries were in Europe and included Belgium, Bulgaria, the Czech Republic, Estonia, Finland, France,
Germany, Greece, Norway, Romania, Russia, Slovak Republic, Spain, Sweden, Switzerland, and the UK.
Other countries reported to have pertinent legislation were Australia, Barbados, Canada, China, Iran,
Israel, Jordan, Philippines, Singapore, South Korea, Tunisia, Turkey. Latin American countries included
Brazil, Colombia, Panama, and Uruguay. Some countries have addressed this with multiple mechanisms,
such as national, state, and municipal laws, and include Australia, the Philippines, Russia and Sweden.
This topic was reported to not be addressed by 26 countries (38.2%), all of which have no reported
legislation. Five countries were reported to have an unknown status on these issues (Cameroon,
Denmark, India, the Netherlands, and Saudi Arabia). Six countries had respondents who gave no
response. (Table 1). Hong Kong (China) has reported to have oversight by a government agency, and
Australia, Brazil, Germany, Iran, and the Philippines have been reported to have an agency oversight as
well as legislation. Jordan and India have been reported to address the welfare of the child by religious
decree and cultural practice. The latter was also reported by respondents from Cameroon, the
Philippines, Russia, Slovak Republic, and the USA. Nineteen countries were reported to have
professional organizations that address the welfare of the child, including Argentina, Australia, Belarus,
Brazil, Cameroon, El Salvador, Finland, Germany, India, Ireland, Japan, Mali, Nigeria, the Philippines,
Russia, Senegal, Slovak Republic, Sweden, and the USA.
However, when the questionnaire asked the respondents if formal assessment of welfare of the child was
an obligatory part of the initial evaluation of prospective parents in fertility clinics, 40 respondents (61%)
answered negatively (Table 2, Chart 2). The following countries were reported to include the welfare of
the child as part of a routine infertility evaluation: Australia, Ecuador, Finland, Guatemala, Hong Kong
(China*), India, Ireland, Israel, Norway, Paraguay, the Philippines, Romania, Senegal, Slovak Republic,
Sweden, Trinidad & Tobago, Turkey, and the UK (18/65 or 28%).
As part of the future welfare of the child evaluation and its familial and social environment, additional
questions were posed to the respondents to determine whether prospective parents are asked about their
background, including any previous clinical, psychiatric, or criminal history. Results are depicted in Table
2. Twenty-seven countries (41%) had respondents report that topics such as history of family violence,
harming a child, or prior history of contacting social services regarding care of other children were not
being addressed prior to initiation of fertility treatment. Eleven countries (18%), had respondents note that
a history of alcohol or drug abuse was not sought prior to fertility treatment, including Austria, Barbados,
France, India, Japan, Jordan, Mexico, Panama, South Africa, South Korea, Tunisia, and the USA. Forty
Page 83 of 224
four countries (70%) were reported to inquire about serious mental or physical illness that could
potentially impact child care, and 43 (66.1%) reported that counseling about the risk of the child for a
serious medical condition was included prior to initiation of fertility treatment. Furthermore, Austria, India,
Japan, Mexico, Panama, South Korea, Tunisia, and the USA had respondents report that prospective
parents are not routinely evaluated for any of these issues. Forty-four countries (44/65 respondents,
67.7%) were reported to have the ability to deny fertility services when a potential significant risk of
affecting the future welfare of a child was determined to exist. (Table 2).
DISCUSSION
The results of the survey reflect a heterogeneous approach to the assessment of the welfare of the child.
The current survey does show a clear trend towards more extensive and consistent assessment prior to
initiating treatment. For example, the UKs Human Fertilisation and Embryology Authority (HEFA)s code
of practice refers to guidance notes about the assessment process, mechanisms for obtaining further
information, and circumstances for refusing treatment (5). The survey also reveals insufficient information
and resources for the assessment and management of these issues. This is reflected by a significant
percentage of respondents responding to several questions with unknown or no response (data not
fully shown in tables).
SUMMARY
The assessment of the welfare of the child is assuming increasing importance among countries that
perform ART and is being addressed with many different models. This 2016 Surveillance report does
show a clear trend in comparison to the 2013 report toward more extensive and consistent assessment
prior to initiating therapy. Welfare of the child is reported to be primarily addressed by federal or local
laws/statutes, and, in countries reported to be without legislation, professional organizations usually
provide guidelines and standards to properly assess prospective parents.
CHAPTER 12. Table 1 - Are there practices or regulations that address the welfare of the child in your country?
NO
NO
NO
NO
YES
NO
YES
YES
NO
NO
YES
Belgium
YES
Brazil
YES
Bulgaria
YES
Canada
UNKNOWN
UNKNOWN
NO
YES
Chile
NO
China
NO
Colombia
UNKNOWN
YES
UNKNOWN
YES
YES
YES
YES
Denmark
UNKNOWN
Ecuador
YES
El Salvador
YES
yes
Estonia
YES
Finland
YES
France
YES
NO
Greece
Guatemala
UNKNOWN
YES
YES
Czech Republic
Germany
NO
YES
Belarus
Cameroon
NO
Religious decree
NO
Cultural practice
NO
YES
Professional
Organization
Standards/
Guidelines
NO
Barbados
NO
YES
Agency
Regulations/
Oversight
NO
Bangladesh
Municipal
Laws/Statutes/
Ordinances
Austria
State/Provincial/
Regional
Laws/Statutes/
Ordinances
YES
Australia
Federal/
National
Laws/Statutes
/Ordinances
Argentina
No practices or
regulations
Country
YES
YES
YES
YES
NO
NO
YES
YES
UNKNOWN
UNKNOWN
Page 84 of 224
YES
YES
UNKNOWN
Iran
Ireland
YES
YES
YES
YES
NO
NO
NO
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
YES
UNKNOWN
UNKNOWN
YES
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
Israel
YES
YES
Italy
NO
Japan
YES
Jordan
YES
Kazakhstan
YES
Kenya
YES
Malaysia
YES
Mali
YES
Mexico
NO
Netherlands
UNKNOWN
YES
UNKNOWN
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Nigeria
Norway
YES
Panama
YES
Paraguay
YES
Peru
YES
Philippines
Portugal
YES
Romania
Russian Federation
Saudi Arabia
YES
YES
YES
YES
NO
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Senegal
Singapore
YES
Slovak Republic
YES
South Africa
UNKNOWN
YES
YES
YES
NO
UNKNOWN
NO
NO
South Korea
YES
Spain
YES
Sri Lanka
YES
NO
Sweden
NO
YES
Switzerland
NO
NO
NO
YES
YES
YES
Taiwan (China*)
YES
YES
Tunisia
YES
Turkey
YES
UK
YES
Uruguay
YES
USA
YES
Venezuela
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
NO
NO
Page 85 of 224
CHAPTER 12. Table 2 Assessment or concerns regarding the welfare of the child.Is a formal assessment of the welfare of the child an obligatory part of the
fertility clinic evaluation of prospective parents?
Argentina
No
Unknown
Australia
Yes
Yes
Austria
No
Unknown
Country
Bangladesh
No
Yes
Barbados
No
Yes
Belarus
Unknown
Unknown
Belgium
No
Yes
Brazil
No
Yes
Bulgaria
No
Unknown
Cameroon
No
Yes
Canada
No
Yes
Chile
No
Yes
China
No
Unknown
Colombia
NO
Yes
Czech Republic
No
Yes
Denmark
No
Yes
Ecuador
Yes
YES
El Salvador
no
Yes
Estonia
No
Yes
Finland
Yes
Yes
France
No
Yes
Germany
No
Yes
Greece
No
Yes
Guatemala
Yes
Yes
Yes
Yes
Hungary
No
Unknown
India
Yes
Yes
Iran
No
Unknown
Ireland
Yes
Yes
Israel
Yes
Yes
Italy
No
Unknown
Page 86 of 224
Japan
No
Jordan
Unknown
Yes
No
Unknown
No
Unknown
Unknown
Yes
Kazakhstan
Malaysia
Mali
Unknown
Mexico
No
Yes
Netherlands
No
Yes
Nigeria
Unknown
Yes
Norway
Yes
Yes
Panama
No
No
Paraguay
Yes
Unknown
Peru
No
Philippines
Yes
Yes
Portugal
No
Yes
Romania
Yes
Yes
Russian Federation
No
Yes
Saudi Arabia
No
No
Senegal
Yes
Unknown
Singapore
No
Unknown
Slovak Republic
Yes
Yes
South Africa
No
Yes
South Korea
No
Unknown
Spain
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
No
Unknown
Yes
Yes
Yes
No
Yes
Unknown
Unknown
Yes
Yes
Tunisia
No
Unknown
Turkey
Yes
Yes
UK
Yes
Yes
Uruguay
No
Yes
USA
No
Yes
Unknown
Yes
Venezuela
* Reporting separately for this report
Page 87 of 224
CHAPTER 12. Table 2 - Are prospective parents asked about the following information?
Country
Previous convictions
related to harming a
child
A history of violence
or serious discord
within the family
Drug or alcohol
abuse
YES
Argentina
NO
NO
NO
YES
YES
Australia
YES
YES
YES
YES
YES
Austria
NO
NO
NO
NO
NO
NO
Bangladesh
NO
NO
NO
YES
YES
YES
Barbados
NO
NO
NO
NO
YES
YES
Belarus
NO
NO
NO
YES
YES
UNKNOWN
Belgium
YES
YES
YES
YES
YES
YES
Brazil
NO
NO
NO
YES
YES
YES
Bulgaria
NO
NO
NO
YES
YES
YES
NO
UNKNOWN
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Cameroon
Canada
Chile
NO
NO
YES
YES
NO
NO
China
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
UNKNOWN
Colombia
NO
NO
YES
YES
YES
YES
Czech Republic
NO
NO
NO
YES
YES
YES
Denmark
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
YES
Ecuador
NO
NO
NO
YES
YES
YES
YES
YES
YES
El Salvador
Estonia
NO
NO
NO
YES
NO
YES
Finland
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
YES
France
YES
NO
YES
NO
NO
NO
Germany
NO
NO
NO
YES
YES
YES
Greece
NO
NO
NO
YES
YES
YES
Guatemala
YES
YES
YES
YES
YES
YES
NO
NO
Hong Kong
(China*)
Hungary
YES
NO
YES
YES
YES
YES
YES
India
NO
NO
NO
NO
NO
NO
Iran
YES
YES
YES
YES
YES
YES
Ireland
YES
YES
YES
YES
YES
YES
Israel
YES
YES
YES
YES
YES
YES
Italy
NO
NO
NO
YES
YES
YES
Japan
NO
NO
NO
NO
NO
NO
Jordan
NO
NO
NO
NO
NO
YES
Kazakhstan
Kenya
NO
NO
YES
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Malaysia
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Mali
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
YES
Mexico
NO
NO
NO
NO
NO
NO
Netherlands
NO
NO
NO
YES
YES
YES
Nigeria
YES
YES
YES
YES
YES
Norway
YES
YES
YES
YES
YES
YES
Panama
NO
NO
NO
NO
NO
NO
Paraguay
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Peru
YES
YES
YES
YES
YES
YES
Philippines
NO
YES
YES
YES
YES
YES
Portugal
NO
NO
NO
YES
YES
YES
Romania
YES
YES
YES
YES
YES
YES
Russian Federation
NO
NO
NO
YES
YES
YES
Saudi Arabia
NO
NO
NO
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
NO
NO
YES
YES
YES
UNKNOWN
NO
YES
YES
UNKNOWN
YES
YES
Senegal
Singapore
Slovak Republic
South Africa
NO
NO
NO
NO
YES
South Korea
NO
NO
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
Spain
YES
Page 88 of 224
Sri Lanka
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
NO
NO
NO
YES
YES
NO
Switzerland
NO
NO
NO
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
YES
YES
YES
Taiwan (China*)
Trinidad and
Tobago
Tunisia
Turkey
YES
YES
YES
UK
YES
YES
YES
Uruguay
UNKNOWN
YES
YES
YES
YES
YES
YES
YES
YES
USA
NO
NO
NO
NO
Venezuela
NO
NO
UNKNOWN
YES
NO
REFERENCES
1. Bonduelle M, Liebaers I, Deketelaere V, Derde M-P, Camus M, Devroey P, et al. Neonatal data
on a cohort of 2889 infants born after ICSI (1991-1999) and of 2995 infants born after IVF (19831999). Hum Reprod 2002;17:671-94.
2. Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk of major birth defects after intracytoplasmic
sperm injection and in vitro fertilization. N Engl J Med 2002;346:725-30.
3. Wen J, Jiang J, Ding C, Dai J, Liu Y, Xia Y, et al. Birth defects in children conceived by in vitro
fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril 2012;97(6):1331-7.
4. Simpson JL. Birth defects and assisted reproductive technologies. Semin Fetal Neonatal Med
2014;19(3):177-82.
5. Human Fertilisation & Embryology Authority. HFEA Code of Practice 8. Welfare of the Child
Available at: http://www.hfea.gov.uk/5473.html. Accessed August 10, 2016.
Page 89 of 224
CHAPTER 13: FETAL REDUCTION
INTRODUCTION
Multiple pregnancy remains the primary risk of all infertility treatment involving ovulation induction agents
and has been the focus of intense public health scrutiny for two decades. Multiple pregnancy and high
order multiple pregnancy (HOM), in particular, confer substantial fetal, neonatal, and maternal risk (see
Chapter 5). In essence, two approaches have been adopted to reduce this risk. Many countries have
adopted strict measures to limit the number of embryos transferred and have confirmed the efficacy of
this approach with subsequent substantial reductions in multiple rates, particularly HOMs. Countries that
have not developed legislation or guidelines to reduce the number of embryos transferred continue to see
high HOM rates. In addition, countries in which significant numbers of ovulation induction cycles with
gonadotropins (controlled ovarian hyperstimulation or super-ovulation with or without intra-uterine
insemination) are performed experience significant numbers of multiple pregnancies, especially HOMs.
Fetal or selective reduction (FR) has most often been employed in these circumstances to mitigate this
risk. While highly controversial and unacceptable to many, fetal reduction has been shown to significantly
reduce risk to the mother and surviving progeny (1).
ANALYSIS OF THE SURVEY
Respondents from 66 countries provided analyzable data for this topic. The respondents could select one
of four answers regarding the status of FR: allowed (21 countries); allowed with permission (21 countries);
not allowed (13 countries); and not addressed or status unknown (11 countries) (Table 1, Chart 1).
FR is reported to be frequently used in four countries: Belarus, Bulgaria, Czech Republic, and Greece. It
is reported to be infrequently used in 39 countries, and not practiced at all in 14 countries (Table 2, Chart
2).
The survey results show that the practice of FR was reported to be mandated: by federal law in 21
countries; by state laws or statutes in four countries; by agency regulations in four countries; by
professional organizational standards or guidelines in nine countries; and by cultural practices or religious
decrees in two countries (Table 3).
A new category was added to this years questionnaire, which queried respondents on their countrys
regulation or monitoring of FR practices. Nineteen countries were reported to monitor regularly, 11
countries were reported to partially or inconsistently monitor, and 19 countries were reported to have no
provisions (Table 4, Chart 3).
As noted in Surveillance 2013, most South American countries are reported to not allow the FR
procedure. Many European countries were reported to have in existence some legislation regulating
reduction but the respondents noted that they are inconsistently monitored. Venezuela is the only country
in which fetal reduction is reported to be infrequently performed although it is not legally permissible.
In 2013, respondents from Brazil and Latvia reported the practice of FR even though it was not allowed
by statute or approved by guidelines. In 2016, the respondent from Brazil noted that FR is allowed with
certain conditions, although it was reported to be infrequently performed. The respondent from Latvia did
not submit a response to this issue for the 2016 survey.
SUMMARY
Most of the countries represented in this 2016 Surveillance were reported to permit FR but the
respondents noted that it is infrequently performed. Most respondents report some form of ongoing
regular monitoring but 19 countries were reported to not have strict regulations for monitoring. As noted in
2013, the majority of the respondents who report outright prohibition of FR in their country are in South
America, and according to the respondents, this appears to reflect their countrys religious and cultural
preferences.
Page 90 of 224
Allowed
Not addressed
Argentina
Australia
+
+
Bangladesh
Barbados
Belarus
Belgium
Brazil
+
+
Cameroon
Canada
Chile
China
+
+
Colombia
Czech Republic
+
+
Denmark
Ecuador
El Salvador
Estonia
Finland
France
+
+
Germany
Greece
Guatemala
Hong Kong (China*)
+
+
Hungary
India
+
+
Iran
Ireland
Israel
Italy
Japan
+
+
Jordan
Kazakhstan
Kenya
Malaysia
+
+
Mali
Mexico
Netherlands
Nigeria
Norway
Panama
Paraguay
Peru
Philippines
Portugal
Romania
Russian Federation
+
+
Saudi Arabia
Senegal
Singapore
Slovak Republic
South Africa
Unknown
Austria
Bulgaria
Not allowed
+
+
South Korea
Spain
Page 91 of 224
Sri Lanka
Sweden
Switzerland
+
+
Taiwan (China*)
Tunisia
Turkey
UK
+
+
Uruguay
USA
+
+
Venezuela
Yes
No
Argentina
Unknown
If yes, frequency
Australia
Infrequently used
Austria
Infrequently used
Bangladesh
Barbados
Infrequently used
+
Belarus
Belgium
Frequently used
Brazil
Infrequently used
Bulgaria
Frequently used
Cameroon
Infrequently used
Canada
Chile
Infrequently used
Infrequently used
+
China
Infrequently used
Colombia
Infrequently used
Czech Republic
Frequently used
Denmark
Infrequently used
Ecuador
El Salvador
Estonia
Finland
+
+
Infrequently used
Page 92 of 224
France
Infrequently used
Germany
Infrequently used
Greece
Frequently used
Guatemala
Infrequently used
Hungary
Infrequently used
India
Infrequently used
Iran
Infrequently used
Ireland
Infrequently used
Israel
Italy
Infrequently used
+
Japan
Infrequently used
Jordan
Infrequently used
Kazakhstan
Infrequently used
Kenya
Malaysia
+
+
Mali
Infrequently used
+
Mexico
Infrequently used
Netherlands
Infrequently used
Nigeria
Infrequently used
Norway
Panama
Paraguay
Peru
Philippines
Portugal
Infrequently used
Romania
Infrequently used
Russian Federation
Infrequently used
Saudi Arabia
Senegal
Singapore
Infrequently used
+
Infrequently used
Slovak Republic
South Africa
South Korea
Spain
Infrequently used
Infrequently used
Sri Lanka
Sweden
Switzerland
Taiwan (China*)
Infrequently used
Infrequently used
+
Tunisia
Infrequently used
Turkey
Infrequently used
UK
Uruguay
USA
Infrequently used
Venezuela
Infrequently used
Page 93 of 224
Chapter 13. Table 3 If allowed/permitted in your country, are there regulations that address selective fetal reduction?
Country
No
regulations
Federal/National
Laws/Statutes/
Ordinances
Australia
State/Provinci
al/
Regional
Laws/
Statutes/
Ordinances
Municipal
Laws/Statutes/
Ordinances
Agency
Regulations/
Oversight
YES
Belgium
YES
NO
NO
NO
NO
YES
Brazil
YES
Bulgaria
YES
Cameroon
YES
Canada
YES
YES
NO
China
YES
Colombia
YES
Czech Republic
NO
NO
NO
NO
NO
YES
Unknown
YES
Denmark
Unknown
Ecuador
YES
Finland
NO
YES
YES
France
YES
Germany
YES
Greece
YES
Hong Kong
(China*)
YES
Hungary
NO
YES
YES
India
YES
Unknown
Iran
YES
Ireland
YES
Israel
YES
Unknown
Kazakhstan
YES
Malaysia
YES
Mexico
NO
YES
NO
NO
NO
NO
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
NO
YES
NO
NO
NO
NO
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Mexico
Netherlands
Religious
decree
YES
Belarus
Netherlands
Cultural
practice
YES
Austria
Jordan
Professional
Organization
Standards/
Guidelines
Page 94 of 224
Nigeria
YES
Norway
YES
Romania
YES
Russian
Federation
YES
Saudi Arabia
NO
Singapore
YES
YES
YES
YES
YES
NO
YES
Slovak Republic
South Africa
YES
YES
Unknown
YES
NO
Switzerland
Tunisia
YES
Turkey
YES
UK
YES
USA
YES
NO
NO
NO
NO
YES
Yes
No
Argentina
Australia
Austria
Bangladesh
Partially (inconsistently)
Barbados
Belarus
Belgium
Brazil
Bulgaria
+
+
Cameroon
Canada
China
+
+
Colombia
Czech Republic
+
+
Denmark
Ecuador
Finland
+
+
France
Germany
Greece
Guatemala
Hong Kong (China*)
+
+
Hungary
India
Iran
Ireland
Israel
+
+
Japan
Jordan
Kazakhstan
+
+
Malaysia
Mali
Mexico
Netherlands
Nigeria
Norway
Panama
Paraguay
Peru
Portugal
Romania
Unknown
+
+
+
Page 95 of 224
Russian Federation
Saudi Arabia
Senegal
Singapore
+
+
Slovak Republic
South Africa
South Korea
Spain
Sweden
Switzerland
Tunisia
Turkey
+
+
UK
Uruguay
USA
Venezuela
+
+
+
REFERENCE
1. Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years experience. Fetal Diagn Ther 2014; 35:6982.
Page 96 of 224
CHAPTER 14: PREIMPLANTATION GENETIC DIAGNOSIS (PGD) AND PREIMPLANTATION
GENETIC SCREENING (PGS)
INTRODUCTION
Preimplantation genetic testing (PGT) is a test performed to analyze the DNA from oocytes (polar bodies)
or embryos (cleavage stage or blastocyst) for human leukocyte antigen (HLA)-typing or for determining
genetic abnormalities. These include: PGT for aneuploidy (PGT-A), PGT for monogenic/single gene
defects (PGT-M), and PGT for chromosomal structural rearrangements (PGT-SR). This terminology now
supplants the terminology preimplantation genetic diagnosis (PGD) and screening (PGS). Since the field
and the 2015 questionnaire used the terminology PGD and PGS, the tables of responses reflect the older
terms. However, this chapter will adopt the new terminology.
PGT-M for monogenic/single gene defects (PGT-M) has been used for detection of molecular defects
linked with specific inherited diseases in embryos prior to uterine transfer. Non-affected embryos are
selected and transferred to the patient with the expectation of producing a child free of that disease.
Additional PGT-M applications include generation of embryos followed by selection by HLA haplotype to
produce a savior sibling for a family member afflicted with a potentially lethal disease that may be
treated with hematopoietic stem cell transplantation or other cell or organ transplantation.
PGT-M was initially performed on cleavage stage (8-cell) and involved removal of 1 or 2 blastomeres (1).
Currently PGT-M is most often performed with trophectoderm biopsy at the blastocyst stage and involves
removal of a greater number of cells than typically performed with cleavage stage embryos. Biopsied
blastocysts are usually cryopreserved for subsequent transfer following completion of the molecular
analysis. Molecular diagnosis may be done using fluorescent in situ hybridization (FISH), polymerase
chain reaction (PCR) whole genome amplification (WGA), microarrays, or next generation sequencing
(NGS) technology (2-10). Unaffected blastocysts are transferred back after thaw. Since embryos with
genetic abnormalities are discarded, the decision to utilize PGT-M implies that patients are making a
moral distinction between termination of an implanted pregnancy and discarding an affected embryo (111).
There are nine general categories for which PGT is currently used:
1. Autosomal single gene disorders (5-7)
2. Some chromosomal rearrangements (5-7)
3. X-linked diseases (5-7)
4. HLA typing (5-7)
5. Cancer predisposition genes (8)
6. Mitochondrial DNA disorders (9)
7. PGT-A for embryonic aneuploidy (5-7,12-16)
8. Adult onset disorders (10)
9. Non-medical sex selection (5,6)
PGT-A and PGT-SR were previously defined as preimplantation genetic screening (PGS). PGT-SR and
PGT-A are used increasingly to identify structural or numerical chromosomal abnormalities, respectively,
as an adjunct to IVF (12-16). PGT identifies euploid blastocysts for transfer to increase implantation and
live birth rates. When optimally performed, PGT-A and PGT-SR augments strategies to perform
successful elective single embryo transfer (eSET) and avoid multiple pregnancies. Current diagnostics
focus on analysis of 24 chromosome numbers for evaluation and transfer of only euploid embryos.
Different molecular techniques used for this propose include FISH, comparative genome hybridization
(CGH), array CGH (aCGH), digital polymerase chain reaction (dPCR), single-nucleotide polymorphism
(SNP) array, real-time quantitative PCR (qPCR), and NGS (12-16). Earlier versions of PGS utilized FISH,
which was only able to evaluate smaller subsets of chromosomes (usually only 5-10), instead of the 24
chromosomes performed with newer molecular technology (12-16). Randomized controlled trials (RCT)
assessing PGS performed with FISH showed no significant improvement in pregnancy and live birth rates
(12). Evidence with the newer technologies offer more encouraging results. Since 24 chromosome
technology has emerged, there have been three level one RCTs using either qPCR based
comprehensive chromosomal screening (CCS) or rapid aCGH showing significant improvements in
Page 97 of 224
ongoing pregnancy rates, birth rates, and single pregnancy rates from SET with PGT (13-15). The two
most commonly used molecular techniques, qPCR and aCGH, appear to produce similar results (16).
SNP microarray and NGS are increasingly reported in recent studies. Despite this progress, recent
reports of a high frequency of mosaicism in trophectoderm biopsies have now cast doubt on the
specificity of PGT for identifying euploid embryos (17).
ANALYSIS OF THE SURVEY (TABLES 1-7, CHARTS 1-4)
Respondents from 66 countries addressed this topic of PGT-M for single gene disorder. It was reported
that PGT-M is permitted in 57 countries by statutes, laws, or guidelines (Table 1). It is reported to not be
addressed in one country and not allowed in eight countries. PGT-M is regulated by guidelines that
govern its use in 26 of the 63 countries in which it is reported to be condoned. It is not regulated in 36
countries, and its status is unknown by the respondent of one country (Table 2). PGT-M for single gene
disorders is reported to be commonly performed as a clinical service in 23 of 67 countries, infrequently
performed in 33 countries, never performed in nine countries, and not reported by the respondents for two
countries (Table 4). PGT-M for single gene disorders is reported by the respondents as being acceptable
to prevent or allow disease in the child to be born from the embryo in 58 out of 64 of these countries
(Table 5). Respondents also reported that it was acceptable for producing an offspring to serve as a cell
donor (savior sibling) for a diseased family member in 31 of 64 countries; PGT-M is permissible for the
assistance of creating a child for an immunologically matched donor in 19 of 64 countries. It is acceptable
for generating an embryo with a selected disease (e.g., genetic congenital deafness) to be used for
procreation in 19 of 64 countries, and for generating a diseased embryo for research or experimentation
in 3 of 64 countries.
PGT-A for aneuploidy was reported by the respondents to be permitted in 57 of 66 countries by statutes,
laws, and guidelines, not addressed by eight countries, and not allowed in seven countries (Table 1).
When allowed for screening for aneuploidy, it was reported to be regulated by guidelines that govern its
use in 27 of 63 countries, not regulated in 30, and respondents did not report for six countries (Table 2).
PGT-A for genetic sex selection was reported to be allowed in 21 of the 66 countries, not addressed by
five countries, and reported by respondents to not be allowed in 41 countries. When reported to be
allowed for sex selection, PGT-A is regulated by guidelines that govern its use in 16 of 63 countries, not
regulated in 39, and respondents did not report for eight countries. PGT-A for aneuploidy was reported by
the respondents to be commonly performed as a clinical service in 28 of 67 countries, infrequently
performed in 24 countries, never performed in 13 countries, and not reported by two countries (Table 4).
PGT-A for aneuploidy performed in tandem with PGT-M for single gene disorders was reported by the
respondents to be commonly performed as a clinical service in 17 of 67 countries, infrequently performed
in 28 countries, never performed in 12 countries, and respondents for 10 countries did not report.
Regulatory bodies reported by respondents to be governing PGT in their countries range from none to
various combinations of federal, provincial, municipal, various agencies, and professional organizations
(Table 3). Thus 27 of 61 countries with respondents providing feedback have reported no regulations
governing PGT. Respondents representing 29 countries reported governances by federal authorities, one
by provinces, five by regulatory agencies, and 13 by professional organizations. Centres providing PGT
services include sole practitioners in private clinics in 12 of 56 countries, large multiple practitioner clinics
in 26 countries, hospital based clinics in 20 countries, university clinics in 23 countries, and public
hospitals in 15 countries (more than one response was permitted) (Table 6).
PGT-M for single gene disorders is reported to be considered an established (not experimental) medical
practice in 55 of 62 countries. PGT-A and PGT-SR are considered established (not experimental)
techniques in 32 of 62 countries. PGT-M for single gene disorders performed in tandem with PGT-A for
aneuploidy is now considered an established medical practice in 29 of 62 countries (Table 7).
DISCUSSION
Compared to Survey 2013, PGT-M now comprises an increasing percentage of assisted reproductive
technology (ART) services throughout the world. Its application, however, is often reported as being
restricted by statute or local clinical tradition. It is reported by the respondents to be prohibited in only
eight countries. PGT-M for single gene disorders is reported to be commonly performed as a clinical
Page 98 of 224
service in 23 of 67 countries, infrequently performed in 33 of 67 countries, never performed in nine of 67
countries, and respondents did not respond on this issue for two of 67 countries. Now a well-established
and reliable procedure, PGT-M has a low error rate when performed in experienced centres. A number of
drawbacks remain. These include the high cost and inefficiency of IVF as a platform, requirements for
development to blastocyst stage, and compromised birth rates (even in fertile women), because PGT-A
eliminates some embryos for transfer. (Table 1)
Although not considered to be experimental, PGT-M was reported to be frequently denied insurance
reimbursement in the USA and is usually not covered except for some single gene disorders and selected
chromosomal defects. However, with the advent of new genetic screening tests, utilization of PGT-M by
fertile couples in the USA, European Union, and the Middle Eastern region is reported by respondents to
be expanding with the detection of carriers who are at risk for transmission of genetic disorders to their
progeny and who are otherwise reluctant to have children. In addition, identification of common but
devastating genetic mutations, such as BRCA, are now possible by PGT-M. The availability of new
molecular genetic tests, public initiatives surrounding specific genetic diseases, and increasing Internet
marketing of tests and identification of carriers should increase demand for PGT-M worldwide (2-5,7).
(Table 1)
Compared to Survey 2013, PGT-A and PGT-SG are reported to constitute an increasing proportion of
ART service effort throughout the world (Table 2). These two types of PGT are reported by the survey
respondents to be allowed in 57 of the 66 countries by statutes, laws, and guidelines, however the
respondents did not report on this technology in eight of the 63 countries. However, they did report that
they were not allowed in seven of the 46 countries. When reported to be allowed for aneuploidy, they are
reported to be regulated by guidelines that govern their use in 27 of the 63 countries and not regulated in
30 countries. Six respondents of the 63 respondent countries did not answer the query.
SUMMARY
PGT is reported to be increasingly available and more commonly performed worldwide when compared to
results from Surveillance 2013. PGT offers benefits, is generally considered safe, and has an acceptably
low frequency of errors. PGT-M clearly prevents women from delivering offspring with serious genetic
disorders, avoids terminations, and brings peace of mind to many couples that are fearful of, or would not
otherwise attempt to have children. The newer technologies for performing PGT-A for aneuploidy are
superior to FISH and may play a major role in the reduction of multiple pregnancies by virtue of improved
embryo selection for eSET. PGT-A and PGT-SR are reported to be more commonly performed but recent
concerns about their reliability may limit universal application.
CHAPTER 14. Table 1 - Is pre-implantation genetics allowed/permitted in your country?
Country
Argentina
YES
YES
YES
Australia
YES
UNKNOWN
UNKNOWN
Austria
YES
YES
NO
Bangladesh
NO
NO
NO
Barbados
YES
YES
NO
Belarus
YES
YES
YES
Belgium
YES
YES
NO
Brazil
YES
YES
NO
Bulgaria
YES
YES
NO
Cameroon
NO
NO
NO
Canada
YES
YES
NO
Chile
YES
YES
YES
China
YES
YES
NO
Colombia
YES
YES
YES
Czech Republic
YES
YES
NO
Denmark
YES
NO
NO
Ecuador
YES
YES
YES
Estonia
YES
YES
NO
Page 99 of 224
Finland
YES
YES
France
YES
NO
NO
NO
Germany
YES
YES
UNKNOWN
Greece
YES
YES
YES
Guatemala
YES
YES
YES
YES
YES
Hungary
YES
NO
India
YES
YES
NO
Iran
YES
NO
YES
Ireland
YES
YES
NO
Israel
YES
NO
NO
Italy
YES
YES
NO
NO
Japan
YES
NO
NO
Jordan
YES
YES
YES
Kazakhstan
YES
YES
NO
Malaysia
YES
YES
YES
Mali
NO
NO
NO
Mexico
YES
YES
YES
Netherlands
YES
YES
UNKNOWN
Nigeria
YES
YES
YES
Norway
NO
NO
Panama
YES
YES
YES
Paraguay
YES
YES
YES
Peru
YES
YES
YES
Philippines
NO
NO
NO
Portugal
YES
YES
NO
Romania
YES
YES
NO
Russian Federation
YES
YES
NO
Saudi Arabia
YES
YES
YES
Senegal
NO
NO
NO
Singapore
YES
NO
NO
Slovak Republic
YES
YES
NO
South Africa
YES
YES
NO
South Korea
NO
NO
NO
Spain
Sri Lanka
YES
YES
NO
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
YES
NO
NO
Switzerland
YES
NO
NO
Taiwan (China*)
YES
YES
NO
YES
YES
YES
Tunisia
YES
NO
NO
Turkey
YES
YES
NO
UK
YES
YES
NO
Uruguay
NO
YES
NO
USA
YES
YES
YES
Venezuela
YES
YES
YES
CHAPTER 14. Table 2 - If allowed/permitted, are there regulations that govern these techniques in your country?
Country
Argentina
NO
NO
NO
Australia
YES
YES
YES
Austria
YES
YES
YES
Bangladesh
NO
NO
NO
Barbados
NO
NO
NO
Belarus
NO
NO
NO
Belgium
YES
YES
NO
Brazil
YES
YES
NO
Bulgaria
YES
YES
YES
Cameroon
NO
NO
NO
Canada
NO
NO
Chile
NO
NO
NO
China
YES
YES
YES
Colombia
NO
NO
NO
Czech Republic
YES
YES
NO
Denmark
YES
Ecuador
NO
NO
NO
Estonia
NO
NO
YES
Finland
YES
YES
YES
France
YES
YES
YES
Germany
YES
YES
YES
Greece
YES
YES
YES
Guatemala
NO
NO
NO
YES
YES
Hungary
YES
UNKNOWN
NO
India
NO
NO
NO
Iran
NO
NO
NO
Ireland
NO
NO
NO
Israel
YES
Italy
YES
YES
NO
Japan
YES
YES
YES
Jordan
NO
NO
NO
Kazakhstan
YES
YES
YES
Malaysia
NO
NO
Mali
NO
NO
NO
NO
Mexico
NO
NO
NO
Netherlands
YES
YES
UNKNOWN
Nigeria
YES
YES
YES
Norway
YES
YES
YES
Panama
NO
NO
NO
Paraguay
NO
NO
NO
NO
Peru
NO
NO
Portugal
YES
YES
Romania
YES
YES
YES
Russian Federation
NO
NO
YES
Saudi Arabia
NO
NO
NO
Singapore
YES
Slovak Republic
YES
YES
NO
South Africa
NO
NO
YES
Spain
YES
YES
YES
Sri Lanka
NO
NO
NO
Sweden
YES
YES
Switzerland
YES
YES
UNKNOWN
UNKNOWN
NO
NO
Tunisia
NO
Turkey
YES
YES
NO
UK
YES
YES
NO
Uruguay
NO
YES
NO
USA
NO
NO
NO
Venezuela
NO
NO
NO
Taiwan (China*)
NO
CHAPTER 14. Table 3 - If these techniques are regulated in your country, how is it done?
Country
PGD-Single Gene
PGS-Aneuploidy
PGS-Sex Selection
No regulations
Professional Organization Standards/Guidelines
State/Provincial/Regional Law/Statute/
Ordinance
No regulations
Professional Organization Standards/Guidelines
State/Provincial/Regional Laws/Statutes/
Ordinances
No regulations
Professional Organization Standards/Guidelines
State/Provincial/Regional Laws/Statutes/
Ordinances
Austria
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Bangladesh
No regulations
No regulations
No regulations2
Barbados
No regulations
No regulations
No regulations
Belarus
Belgium
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Brazil
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Bulgaria
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Cameroon
No regulations
Professional Organization Standards/Guidelines
Argentina
Australia
Canada
China
No regulations
No regulations
Federal/National Laws/Statutes/Ordinances
Colombia
No regulations
No regulations
No regulations
Czech Republic
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
Denmark
Federal/National Laws/Statutes/Ordinances
Estonia
No regulations
Finland
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
No regulations
Professional Organization Standards/Guidelines
No regulations
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
France
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Germany
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Greece
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Guatemala
No regulations
No regulations
No regulations
Hong Kong
(China*)
Agency Regulations/Oversight
Agency Regulations/Oversight
Hungary
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
India
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Ireland
No regulations
No regulations
No regulations
Italy
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Japan
Ecuador
Iran
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Kazakhstan
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Kenya
No regulations
No regulations
No regulations
Malaysia
No regulations
No regulations
No regulations
Mali
No regulations
No regulations
No regulations
Mexico
No regulations
No regulations
No regulations
Netherlands
Federal/National Laws/Statutes/Ordinances
Unknown
Unknown
Nigeria
Norway
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Panama
No regulations
No regulations
No regulations
Paraguay
No regulations
No regulations
No regulations
Peru
No regulations
No regulations
No regulations
Portugal
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Agency Regulations/Oversight
Russian Federation
No regulations
No regulations
Federal/National Laws/Statutes/Ordinances
Saudi Arabia
No regulations
No regulations
No regulations
Singapore
Federal/National Laws/Statutes/Ordinances
Slovak Republic
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
South Africa
No regulations
No regulations
Federal/National Laws/Statutes/Ordinances
Spain
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Sri Lanka
No regulations
No regulations
No regulations
Sweden
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Switzerland
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Taiwan (China*)
Unknown
Unknown
No regulations
No regulations
Romania
No regulations
Tunisia
No regulations
No regulations
Turkey
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
UK
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Uruguay
Federal/National Laws/Statutes/Ordinances
No regulations
Professional Organization Standards/Guidelines
No regulations
Venezuela
Professional Organization Standards/Guidelines
* Reporting separately for this report
USA
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
PGS
(Aneuploidy)
Argentina
Commonly Performed
Commonly Performed
Commonly Performed
Infrequently Performed
Australia
Commonly Performed
Unknown
Unknown
Unknown
Austria
Commonly Performed
Commonly Performed
Infrequently Performed
Never Performed
Country
Bangladesh
Never Performed
Never Performed
Never Performed
Never Performed
Barbados
Infrequently Performed
Infrequently Performed
Infrequently Performed
Never Performed
Belarus
Infrequently Performed
Commonly Performed
Infrequently Performed
Infrequently Performed
Belgium
Commonly Performed
Infrequently Performed
Infrequently Performed
Unknown
Brazil
Commonly Performed
Commonly Performed
Commonly Performed
Unknown
Bulgaria
Infrequently Performed
Infrequently Performed
Infrequently Performed
Unknown
Never Performed
Never Performed
Never Performed
Never Performed
Commonly Performed
Commonly Performed
Unknown
Never Performed
Infrequently Performed
Cameroon
Canada
Chile
Infrequently Performed
Commonly Performed
Commonly Performed
China
Infrequently Performed
Infrequently Performed
Infrequently Performed
Never Performed
Colombia
Infrequently Performed
Commonly Performed
Commonly Performed
Infrequently Performed
Czech Republic
Commonly Performed
Commonly Performed
Commonly Performed
Never Performed
Denmark
Infrequently Performed
Not Answered
Not Answered
Not Answered
Ecuador
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Never Performed
El Salvador
Never Performed
Never Performed
Never Performed
Estonia
Unknown
Unknown
Unknown
Unknown
Finland
Commonly Performed
Commonly Performed
Never Performed
Never Performed
Infrequently Performed
France
Infrequently Performed
Never Performed
Infrequently Performed
Germany
Infrequently Performed
Infrequently Performed
Unknown
Unknown
Greece
Commonly Performed
Commonly Performed
Commonly Performed
Commonly Performed
Guatemala
Never Performed
Commonly Performed
Never Performed
Never Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Not Answered
Hungary
Infrequently Performed
Infrequently Performed
Infrequently Performed
Unknown
India
Infrequently Performed
Infrequently Performed
Infrequently Performed
Not Answered
Iran
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Ireland
Commonly Performed
Commonly Performed
Commonly Performed
Infrequently Performed
Israel
Commonly Performed
Commonly Performed
Commonly Performed
Commonly Performed
Italy
Infrequently Performed
Infrequently Performed
Unknown
Never Performed
Japan
Infrequently Performed
Unknown
Unknown
Unknown
Jordan
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Kazakhstan
Infrequently Performed
Commonly Performed
Commonly Performed
Never Performed
Unknown
Unknown
Unknown
Unknown
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Kenya
Malaysia
Mali
Never Performed
Never Performed
Never Performed
Never Performed
Mexico
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Netherlands
Commonly Performed
Never Performed
Never Performed
Never Performed
Nigeria
Commonly Performed
Commonly Performed
Commonly Performed
Commonly Performed
Norway
Never Performed
Never Performed
Never Performed
Never Performed
Panama
Infrequently Performed
Commonly Performed
Infrequently Performed
Commonly Performed
Paraguay
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Peru
Infrequently Performed
Commonly Performed
Infrequently Performed
Infrequently Performed
Portugal
Infrequently Performed
Infrequently Performed
Not Answered
Not Answered
Romania
Infrequently Performed
Infrequently Performed
Never Performed
Not Answered
Russian Federation
Infrequently Performed
Commonly Performed
Infrequently Performed
Infrequently Performed
Saudi Arabia
Commonly Performed
Commonly Performed
Commonly Performed
Commonly Performed
Never Performed
Never Performed
Never Performed
Never Performed
Singapore
Commonly Performed
Never Performed
Never Performed
Never Performed
Slovak Republic
Commonly Performed
Commonly Performed
Commonly Performed
Never Performed
South Africa
Commonly Performed
Commonly Performed
Commonly Performed
Never Performed
South Korea
Commonly Performed
Infrequently Performed
Infrequently Performed
Never Performed
Never Performed
Senegal
Spain
Commonly Performed
Commonly Performed
Commonly Performed
Sri Lanka
Infrequently Performed
Infrequently Performed
Unknown
Unknown
Sweden
Commonly Performed
Never Performed
Never Performed
Never Performed
Switzerland
Never Performed
Never Performed
Never Performed
Never Performed
Taiwan (China*)
Commonly Performed
Infrequently Performed
Infrequently Performed
Never Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
Tunisia
Never Performed
Never Performed
Never Performed
Never Performed
Turkey
Commonly Performed
Commonly Performed
Infrequently Performed
Never Performed
UK
Infrequently Performed
Infrequently Performed
Infrequently Performed
Never Performed
Uruguay
Not Answered
Commonly Performed
Not Answered
Not Answered
USA
Commonly Performed
Commonly Performed
Commonly Performed
Commonly Performed
Venezuela
Infrequently Performed
Infrequently Performed
Infrequently Performed
Infrequently Performed
CHAPTER 14. Table 5 - Is Pre-Implantation Genetic Diagnosis (Single Gene) accepted for use to prevent or allow disease?
In the child to
be born from
the embryo
For assisting in
generating a child
on behalf of a
diseased sibling
For assisting in
generating a child for
any immunologically
donor matched
diseased child
For assisting in
generating an
embryo on behalf of
a diseased sibling
For assisting in
generating an embryo for
any immunologically
donor matched diseased
child
To be manifested in
the child to be born
from the embryo
Argentina
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Australia
YES
YES
YES
YES
YES
YES
YES
Austria
YES
NO
NO
NO
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Country
Bangladesh
Barbados
YES
YES
YES
YES
YES
YES
NO
Belarus
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Belgium
YES
YES
YES
YES
YES
YES
YES
Brazil
YES
YES
YES
YES
YES
YES
NO
Bulgaria
YES
YES
NO
YES
NO
NO
NO
Cameroon
NO
NO
NO
NO
NO
NO
NO
Canada
YES
NO
NO
NO
NO
NO
NO
Chile
NO
NO
NO
NO
NO
NO
NO
China
YES
YES
NO
YES
NO
NO
NO
Colombia
YES
NO
NO
NO
NO
YES
NO
Czech Republic
YES
YES
YES
YES
UNKNOWN
NO
NO
Denmark
YES
YES
NO
UNKNOWN
NO
YES
NO
Ecuador
YES
YES
YES
YES
NO
Estonia
YES
NO
NO
NO
NO
YES
NO
Finland
YES
NO
NO
NO
NO
NO
NO
France
YES
YES
NO
YES
YES
NO
NO
Germany
YES
NO
NO
NO
NO
YES
NO
Greece
YES
YES
UNKNOWN
YES
UNKNOWN
YES
NO
Guatemala
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Hong Kong
(China*)
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Hungary
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
India
YES
YES
YES
YES
YES
YES
YES
Iran
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
Ireland
YES
YES
YES
NO
NO
NO
NO
Israel
YES
YES
YES
YES
YES
UNKNOWN
NO
Italy
YES
NO
NO
NO
NO
YES
NO
Japan
YES
NO
NO
NO
NO
UNKNOWN
UNKNOWN
Jordan
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Kazakhstan
YES
YES
YES
YES
YES
YES
NO
Malaysia
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Mali
NO
NO
NO
NO
NO
NO
NO
Mexico
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Netherlands
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
Nigeria
YES
YES
NO
NO
NO
NO
Norway
YES
YES
YES
YES
NO
NO
NO
Panama
YES
YES
YES
YES
YES
YES
UNKNOWN
Paraguay
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Portugal
YES
YES
NO
YES
NO
NO
NO
Romania
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
YES
UNKNOWN
Russian Federation
YES
YES
YES
YES
YES
UNKNOWN
UNKNOWN
Saudi Arabia
YES
YES
NO
YES
NO
YES
NO
Senegal
NO
NO
NO
NO
NO
NO
NO
Singapore
YES
NO
NO
NO
NO
NO
NO
Slovak Republic
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
South Africa
YES
YES
YES
YES
YES
YES
NO
South Korea
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Spain
YES
NO
YES
NO
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
YES
YES
YES
UNKNOWN
UNKNOWN
YES
NO
Switzerland
YES
NO
NO
NO
NO
YES
NO
Taiwan (China*)
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Trinidad and
Tobago
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Tunisia
YES
NO
NO
NO
NO
NO
NO
Turkey
YES
YES
YES
YES
YES
YES
NO
UK
YES
YES
YES
NO
NO
NO
NO
Uruguay
YES
YES
NO
YES
YES
YES
NO
Sri Lanka
USA
YES
YES
NO
YES
NO
YES
NO
Venezuela
YES
YES
YES
YES
YES
UNKNOWN
NO
CHAPTER 14.Table 6 - Are there specific centres or institutions where these techniques are only allowed/permitted to be performed?
Country
PGD-Single Gene
PGS-Aneuploidy
PGS-Sex Selection
Argentina
Unknown
Unknown
Unknown
Austria
Unknown
Unknown
Unknown
Barbados
Belarus
Belgium
Public Hospital-based
University-based clinic
Hospital-based clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Brazil
Bulgaria
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Cameroon
Unknown
Unknown
Unknown
Unknown
Chile
China
Public Hospital-based
Public Hospital-based
Colombia
Hospital-based clinic
Sole Practitioner clinic
Hospital-based clinic
Sole Practitioner clinic
Denmark
Public Hospital-based
Ecuador
France
University-based clinic
Germany
University-based clinic
Large, Private physician clinic 5 or > physicians
Unknown
Unknown
Greece
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Guatemala
Unknown
University-based clinic
Hospital-based clinic
University-based clinic
Hospital-based clinic
Hungary
Public Hospital-based
University-based clinic
Unknown
India
Public Hospital-based
Large, Private physician clinic 5 or > physicians
Public Hospital-based
Large, Private physician clinic 5 or > physicians
Iran
Ireland
Israel
Unknown
Unknown
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Public Hospital-based
University-based clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Unknown
Unknown
Japan
Unknown
Jordan
Public Hospital-based
University-based clinic
Hospital-based clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Kazakhstan
Malaysia
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
University-based clinic
Hospital-based clinic Large, Private physician
clinic 5 or > physicians
Mali
Unknown
Unknown
Unknown
Mexico
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Netherlands
University-based clinic
Unknown
Unknown
Nigeria
Panama
Paraguay
Unknown
Unknown
Unknown
Peru
University-based clinic
Large, Private physician clinic 5 or > physicians
Portugal
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Saudi Arabia
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Senegal
Unknown
Unknown
Unknown
Singapore
Hospital-based clinic
Slovak Republic
University-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
South Africa
South Korea
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Unknown
Unknown
Romania
Russian Federation
Spain
Sri Lanka
University-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Large, Private physician clinic 5 or >
physicians
Unknown
Sweden
Switzerland
Trinidad & Tobago
Turkey
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Unknown
Unknown
Unknown
Unknown
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
UK
Uruguay
USA
Venezuela
Unknown
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Unknown
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Public Hospital-based
University-based clinic
Hospital-based clinic
Sole Practitioner clinic
Small Private physician clinic <5 physician
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
CHAPTER 14. Table 7 - Are these techniques considered experimental or part of established medical practice?
Pre-implantation Genetic Diagnosis
(Single Gene)
Argentina
Australia
Unknown
Unknown
Austria
Country
Bangladesh
Barbados
Experimental
Not addressed
Not addressed
Belarus
Experimental
Experimental
Experimental
Belgium
Brazil
Bulgaria
Not addressed
Not addressed
Not addressed
Not addressed
Unknown
Not addressed
Not addressed
Not addressed
Cameroon
Canada
Chile
China
Not addressed
Not addressed
Not addressed
Colombia
Not addressed
Not addressed
Not addressed
Czech Republic
Denmark
Ecuador
Estonia
Experimental
Experimental
Experimental
Finland
Not addressed
Established medical practice
France
Not addressed
Germany
Unknown
Greece
Guatemala
Hong Kong (China*)
Not addressed
Not addressed
Hungary
Experimental
Experimental
India
Iran
Not addressed
Ireland
Experimental
Experimental
Israel
Experimental
Italy
Japan
Experimental
Unknown
Unknown
Jordan
Kazakhstan
Malaysia
Mali
Mexico
Not addressed
Not addressed
Not addressed
Experimental
Experimental
Not addressed
Not addressed
Not addressed
Not addressed
Netherlands
Experimental
Not addressed
Nigeria
Norway
Experimental
Experimental
Panama
Paraguay
Not addressed
Not addressed
Not addressed
Peru
Not addressed
Not addressed
Not addressed
Portugal
Romania
Russian Federation
Saudi Arabia
Unknown
Unknown
Unknown
Senegal
Singapore
Slovak Republic
Not addressed
South Africa
South Korea
Experimental
Spain
Sri Lanka
Sweden
Switzerland
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Turkey
Not addressed
Not addressed
Not addressed
UK
Experimental
Experimental
USA
Venezuela
REFERENCES
1. Simpson JL: Preimplantation genetic diagnosis at 20 years. Prenat Diagn 2010;30(7):682-95.
2. Simpson JL, Rechitsky S, Kuliev A. Next generation sequencing for preimplantation genetic
diagnosis. Fertil Steril 2013;99(5):1203-4.
3. Treff NR, Fedick A, Tao X, Devkota B, Taylor D, Scott RT Jr. Evaluation of targeted next-
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Gestational carriers
Argentina
NO
NO
Australia
YES
YES
Austria
NO
NO
Bangladesh
NO
NO
Barbados
NO
NO
Belarus
YES
NO
Belgium
YES
YES
Brazil
YES
YES
Bulgaria
NO
NO
Cameroon
NO
NO
Canada
YES
YES
Chile
YES
YES
China
NO
NO
Colombia
YES
YES
Czech Republic
YES
NO
Denmark
NO
NO
Ecuador
YES
NO
El Salvador
NO
NO
Estonia
NO
NO
Finland
NO
NO
France
NO
NO
Germany
NO
NO
Greece
YES
NO
Guatemala
YES
YES
Honduras
UNKNOWN
YES
Hungary
NO
NO
India
YES
NO
Iran
YES
YES
Israel
NO
YES
Italy
NO
NO
Japan
NO
NO
Jordan
NO
NO
Kazakhstan
NO
NO
Malaysia
NO
NO
UNKNOWN
UNKNOWN
Mexico
YES
YES
Netherlands
NO
NO
Nigeria
YES
NO
Norway
NO
NO
Panama
NO
NO
Paraguay
UNKNOWN
UNKNOWN
Peru
YES
YES
Philippines
NO
NO
Portugal
NO
NO
Romania
YES
YES
Russian Federation
YES
NO
Saudi Arabia
NO
NO
Senegal
NO
NO
Singapore
NO
NO
Slovak Republic
NO
NO
South Africa
YES
NO
South Korea
UNKNOWN
UNKNOWN
Mali
Spain
NO
NO
Sri Lanka
YES
UNKNOWN
Sweden
NO
NO
Switzerland
NO
NO
Taiwan (China*)
NO
NO
NO
NO
Tunisia
NO
NO
Turkey
NO
NO
UK
YES
YES
Uruguay
YES
NO
USA
YES
YES
Venezuela
YES
UNKNOWN
CHAPTER 15. Table 2 - Are there regulations that govern gestational carriers in your country?
Country
Gestational carriers
Argentina
NO
NO
Australia
YES
YES
Austria
YES
YES
Bangladesh
NO
NO
Barbados
NO
NO
Belarus
YES
Belgium
Brazil
YES
YES
Bulgaria
YES
YES
Cameroon
NO
NO
Canada
YES
YES
Chile
NO
NO
China
YES
YES
Colombia
NO
NO
Czech Republic
YES
NO
Denmark
Ecuador
NO
NO
El Salvador
NO
NO
Estonia
YES
YES
Finland
YES
France
YES
YES
YES
Germany
YES
YES
Greece
YES
NO
Guatemala
NO
NO
Honduras
NO
NO
Hungary
NO
NO
India
YES
UNKNOWN
Iran
NO
NO
Ireland
NO
NO
Israel
YES
YES
Italy
YES
YES
Japan
YES
NO
Kazakhstan
NO
NO
Malaysia
NO
NO
Mali
NO
NO
Mexico
YES
YES
Netherlands
YES
YES
Nigeria
YES
YES
Norway
YES
YES
Panama
YES
YES
Paraguay
NO
NO
Peru
NO
NO
Portugal
YES
YES
Romania
YES
YES
Russian Federation
YES
YES
Saudi Arabia
NO
NO
Senegal
NO
NO
Singapore
YES
YES
Slovak Republic
YES
YES
South Africa
YES
YES
South Korea
UNKNOWN
UNKNOWN
Spain
NO
NO
Sri Lanka
NO
NO
Sweden
YES
YES
Switzerland
YES
YES
UNKNOWN
YES
Taiwan (China*)
Trinidad and Tobago
NO
NO
Tunisia
NO
NO
Turkey
YES
YES
UK
YES
YES
Uruguay
NO
NO
USA
YES
YES
Venezuela
NO
NO
CHAPTER 15. Table 3 - If gestational carriers are regulated in your country, how is it done?
Country
Gestational carriers
Argentina
No regulations
No regulations
Australia
State/Provincial/Regional Laws/Statutes/Ordinances
Austria
State/Provincial/Regional Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Bangladesh
No regulations
Religious decree
Religious decree
Barbados
No regulations
No regulations
Bulgaria
No regulations
No regulations
Cameroon
No regulations
Canada
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Chile
No regulations
No regulations
China
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Colombia
No regulations
No regulations
Belarus
Brazil
Czech Republic
Ecuador
El Salvador
No regulations
No regulations
Estonia
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Finland
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
France
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Greece
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Guatemala
No regulations
No regulations
Honduras
No regulations
No regulations
Hungary
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
India
Iran
No regulations
No regulations
Ireland
No regulations
No regulations
Israel
Federal/National Laws/Statutes/Ordinances
Japan
No regulations
Kazakhstan
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Mali
No regulations
No regulations
Mexico
Municipal Laws/Statutes/Ordinances
Municipal Laws/Statutes/Ordinances
Netherlands
Nigeria
Norway
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Panama
No regulations
No regulations
Paraguay
No regulations
No regulations
Portugal
Federal/National Laws/Statutes/Ordinances
Romania
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Russian Federation
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Singapore
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Slovak Republic
South Africa
Federal/National Laws/Statutes/Ordinances
South Korea
No regulations
No regulations
Sri Lanka
No regulations
No regulations
Sweden
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Switzerland
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Taiwan (China*)
Unknown
Federal/National Laws/Statutes/Ordinances
No regulations
No regulations
Turkey
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
UK
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Uruguay
Federal/National Laws/Statutes/Ordinances
USA
Venezuela
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Argentina
Country
Infrequently Used
Infrequently Used
Australia
Infrequently Used
Infrequently Used
Austria
Never Performed
Never Performed
Bangladesh
Never Performed
Never Performed
Barbados
Never Performed
Never Performed
Belarus
Commonly Used
Never Performed
Belgium
Infrequently Used
Infrequently Used
Brazil
Infrequently Used
Infrequently Used
Bulgaria
Never Performed
Never Performed
Cameroon
Never Performed
Never Performed
Canada
Commonly Used
Infrequently Used
Chile
Unknown
Unknown
China
Never Performed
Never Performed
Colombia
Infrequently Used
Commonly Used
Czech Republic
Infrequently Used
Never Performed
Ecuador
Infrequently Used
Never Performed
El Salvador
Never Performed
Estonia
Never Performed
Never Performed
Finland
Never Performed
Never Performed
France
Never Performed
Never Performed
Germany
Never Performed
Never Performed
Greece
Commonly Used
Never Performed
Infrequently Used
Infrequently Used
Honduras
Never Performed
Infrequently Used
Hungary
Never Performed
Never Performed
India
Commonly Used
Unknown
Iran
Infrequently Used
Never Performed
Ireland
Infrequently Used
Infrequently Used
Israel
Infrequently Used
Never Performed
Italy
Never Performed
Never Performed
Japan
Infrequently Used
Unknown
Kazakhstan
Infrequently Used
Infrequently Used
Guatemala
Malaysia
Never Performed
Unknown
Unknown
Never Performed
Never Performed
Mexico
Infrequently Used
Infrequently Used
Netherlands
Infrequently Used
Never Performed
Nigeria
Commonly Used
Infrequently Used
Norway
Never Performed
Never Performed
Panama
Unknown
Unknown
Paraguay
Unknown
Unknown
Peru
Infrequently Used
Infrequently Used
Portugal
Never Performed
Never Performed
Romania
Infrequently Used
Infrequently Used
Mali
Russian Federation
Commonly Used
Never Performed
Saudi Arabia
Never Performed
Never Performed
Senegal
Never Performed
Never Performed
Singapore
Never Performed
Never Performed
Slovak Republic
Never Performed
Never Performed
South Africa
Commonly Used
Never Performed
South Korea
Infrequently Used
Unknown
Sri Lanka
Infrequently Used
Unknown
Sweden
Never Performed
Never Performed
Switzerland
Never Performed
Never Performed
Taiwan (China*)
Never Performed
Never Performed
Never Performed
Never Performed
Turkey
Never Performed
Never Performed
UK
Infrequently Used
Infrequently Used
Uruguay
Commonly Used
USA
Commonly Used
Infrequently Used
Infrequently Used
Unknown
Venezuela
* Reporting separately for this report
CHAPTER 15. Table 5 - If gestational carriers are allowed/permitted in your country, are gestational carriers compensated?
Country
Gestational carriers
Argentina
Unknown
Unknown
Australia
Unknown
Unknown
No
No
Austria
Bangladesh
Barbados
Belarus
Belgium
Brazil
Bulgaria
No
No
Canada
No
No
Chile
Unknown
Unknown
China
No
No
UNKNOWN
No
No
No
Unknown
Unknown
Finland
No
No
France
No
No
Germany
No
No
Greece
No
Guatemala
Colombia
Czech Republic
Denmark
Ecuador
El Salvador
Estonia
Honduras
Hungary
Unknown
No
No
India
Unknown
Iran
Unknown
Unknown
No
No
Ireland
Israel
Kazakhstan
Malaysia
Mali
No
Unknown
Unknown
No
No
Mexico
Unknown
Unknown
Netherlands
Unknown
Unknown
Nigeria
Panama
Unknown
Unknown
Paraguay
Unknown
Unknown
Peru
Unknown
Unknown
Romania
Russian Federation
No
No
No
Saudi Arabia
Senegal
No
No
Unknown
Unknown
No
No
Slovak Republic
South Africa
No
No
No
Unknown
Unknown
Spain
Sri Lanka
Taiwan (China*)
Trinidad and Tobago
No
No
Unknown
Unknown
UK
USA
Venezuela
Unknown
Gestational carrier
Min Amount
Max Amount
Argentina
Unknown
Unknown
Bangladesh
Unknown
Unknown
Belarus
Enter values
Belgium
No min or max
No min or max
Brazil
No min or max
No min or max
Bulgaria
Unknown
Unknown
Cameroon
Unknown
Unknown
Chile
Unknown
Unknown
Colombia
50000
NO
Ecuador
Enter values
Estonia
Not addressed
Greece
Enter values
Guatemala
10000
10000
10000
10000
10000
Not addressed
Unknown
Unknown
Unknown
Hungary
Not addressed
Not addressed
India
No min or max
Unknown
Israel
No min or max
Mali
Not addressed
Netherlands
Not addressed
Not addressed
Nigeria
Enter values
Panama
Unknown
Unknown
Paraguay
Not addressed
Not addressed
Peru
Romania
Unknown
Unknown
Unknown
Not addressed
Not addressed
Russian Federation
No min or max
Slovak Republic
Not addressed
Not addressed
South Africa
No min or max
Not addressed
UK
Not addressed
Not addressed
USA
No min or max
No min or max
Unknown
Unknown
Venezuela
CHAPTER 15. Table 7 - If gestational carrier arrangements are allowed/permitted in your country, are the qualifications to be a gestational carrier based upon medical, mental
health and/or any lifestyle (age and occupational) criteria
Gestational carrier
Argentina
Not addressed
Not addressed
Australia
YES
YES
Unknown
Unknown
Country
Bangladesh
Belarus
YES
Belgium
YES
YES
Brazil
YES
YES
Unknown
Unknown
Bulgaria
Cameroon
NO
NO
Canada
YES
YES
Chile
Unknown
Unknown
China
NO
NO
Colombia
YES
YES
Not addressed
Not addressed
Czech Republic
Ecuador
YES
Estonia
Not addressed
Finland
NO
NO
France
Not addressed
Not addressed
Germany
Not addressed
Not addressed
Not addressed
Greece
YES
NO
Guatemala
YES
YES
Honduras
Not addressed
YES
Hungary
Not addressed
Not addressed
India
YES
Not addressed
Iran
YES
YES
Ireland
NO
NO
Israel
YES
Kazakhstan
YES
YES
Malaysia
Not addressed
Not addressed
Mali
Not addressed
Not addressed
Mexico
Not addressed
Not addressed
YES
Not addressed
Netherlands
Nigeria
YES
YES
Panama
Unknown
Unknown
Paraguay
Unknown
Unknown
Peru
YES
YES
Romania
YES
YES
Russian Federation
YES
Senegal
Not addressed
Not addressed
Slovak Republic
Not addressed
Not addressed
South Africa
YES
NO
Sri Lanka
YES
Not addressed
Not addressed
Not addressed
Sweden
Taiwan (China*)
NO
NO
Unknown
Unknown
UK
YES
YES
Uruguay
YES
USA
Venezuela
YES
YES
Unknown
Unknown
REFERENCES
1. Golombok S, MacCallum F, Murray C, Lycett E, Jadva V. Surrogacy families: parental
functioning, parent-child relationships and childrens psychological development at age 2. J Child
Psychol Psychiatry 2006;47(2):213-22.
Yes
(with
restrictions)
No
Argentina
Australia
Yes
Yes
(with
restrictions)
No
X
X
Austria
Yes
(with
restrictions)
No
X
X
X
X
Unknown
Yes
Barbados
Unknown
Bangladesh
Belarus
Unknown
X
X
X
Belgium
Brazil
Bulgaria
Cameroon
Canada
Denmark
Colombia
Czech Republic
X
X
Chile
China
X
X
X
X
Ecuador
X
X
X
X
Estonia
Finland
France
Germany
Greece
Guatemala
Hungary
India
X
X
X
Ireland
Israel
Italy
X
X
Japan
X
X
Iran
X
X
Jordan
Kazakhstan
Malaysia
Mali
Mexico
Netherlands
Nigeria
X
X
Panama
Paraguay
Peru
Philippines
Russian Federation
X
X
X
X
X
X
X
X
Switzerland
Sri Lanka
Sweden
X
X
Spain
X
X
Slovak Republic
South Korea
South Africa
Senegal
Singapore
Saudi Arabia
X
X
Tunisia
Turkey
X
X
Uruguay
USA
X
X
X
X
X
X
Venezuela
* Reporting separately for this report
Taiwan (China*)
UK
X
X
Romania
Portugal
X
X
Norway
X
X
X
X
X
X
Yes
(with
restrictions)
No
Argentina
Unknown
Yes
Yes (with
restrictions)
No
Australia
X
X
X
X
X
Brazil
Bulgaria
Cameroon
X
X
Estonia
Finland
X
X
Guatemala
X
X
Germany
X
X
X
X
X
X
Greece
El Salvador
X
X
Hungary
India
X
X
Denmark
X
X
China
X
X
Chile
France
X
X
X
X
X
X
Iran
Ireland
Italy
Japan
Unknown
X
X
Belgium
Czech Republic
No
Belarus
Canada
Yes
(with
restrictions)
Bangladesh
Barbados
Yes
Austria
Unknown
X
X
X
X
X
X
Jordan
Kazakhstan
Malaysia
Mali
Mexico
Netherlands
Nigeria
Norway
Panama
Paraguay
X
X
X
X
Philippines
Portugal
Romania
Russian Federation
X
X
Peru
X
X
X
X
Senegal
Singapore
X
X
Saudi Arabia
X
X
Slovak Republic
X
X
South Africa
South Korea
Spain
Sri Lanka
Sweden
X
X
Switzerland
X
X
Tunisia
Turkey
UK
USA
Venezuela
CHAPTER 16.Table 1.c - Is experimentation on the pre-implantation embryo being performed by clinical or research programmes?
Embryonic stem cell research
Country
Commonly
Performed
Infrequently
Performed
Argentina
Australia
Never
Performed
Commonly
Performed
Infrequently
Performed
X
X
Never
Performed
Unknown
X
Austria
Bangladesh
X
X
Barbados
Belarus
Belgium
Brazil
Bulgaria
Cameroon
Canada
X
X
Chile
China
Czech Republic
Denmark
Colombia
El Salvador
Estonia
Finland
France
Germany
Greece
Guatemala
Hungary
X
X
X
India
Iran
Ireland
Italy
Japan
X
X
X
X
Jordan
Kazakhstan
Malaysia
Mali
Mexico
X
X
Netherlands
Nigeria
Norway
Panama
Paraguay
X
X
Peru
Philippines
Portugal
Romania
Russian Federation
Saudi Arabia
Senegal
Singapore
X
X
South Africa
X
X
Spain
Sri Lanka
Sweden
Switzerland
X
X
Taiwan (China*)
X
X
Tunisia
Turkey
UK
Slovak Republic
South Korea
X
X
X
X
X
X
X
USA
Venezuela
X
X
CHAPTER 16. Table 2.a - Are there regulations that address experimentation on the pre-implantation embryo?
Research on donated unused embryos for stem cell research
embryos for stem cell research
Yes
Australia
Austria
No
Banned
No
Banned
Belarus
X
X
Belgium
Brazil
X
X
X
Bulgaria
Cameroon
Unknown
X
X
Barbados
Chile
China
Yes
X
Bangladesh
Canada
Unknown
Colombia
Czech Republic
Denmark
Finland
France
Germany
Greece
Guatemala
X
X
X
X
X
Hungary
India
Iran
Ireland
Israel
Italy
Japan
X
X
Jordan
Kazakhstan
X
X
X
X
X
X
Malaysia
Mali
Mexico
Netherlands
Nigeria
X
X
Norway
Panama
X
X
X
Paraguay
Peru
X
X
Philippines
Portugal
Romania
X
X
Russian Federation
Saudi Arabia
X
X
Senegal
Singapore
X
X
X
X
Slovak Republic
South Africa
South Korea
Spain
Sri Lanka
X
X
Sweden
Switzerland
Taiwan (China*)
X
X
X
Tunisia
Turkey
UK
USA
Venezuela
* Reporting separately for this report
Australia
Austria
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Bangladesh
No regulations
No regulations
No regulations
Belgium
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Brazil
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
Cameroon
No regulations
Canada
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
China
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances/
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Czech Republic
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Estonia
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Finland
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
France
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Germany
Federal/National Laws/Statutes/Ordinances
Greece
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Hungary
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
India
State/Provincial/Regional Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Israel
Federal/National Laws/Statutes/Ordinances
Japan
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Mali
No regulations
No regulations
No regulations
Mexico
No regulations
No regulations
No regulations
Netherlands
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Norway
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Panama
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Paraguay
No regulations
No regulations
No regulations
Portugal
No regulations
Romania
Federal/National Laws/Statutes/Ordinances
Saudi Arabia
Religious decree
Cultural practice
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
Cultural practice
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
Cultural practice
Professional Organization Standards/Guidelines
Senegal
Unknown
Unknown
Unknown
Singapore
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
South Africa
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
South Korea
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Spain
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Sri Lanka
No regulations
No regulations
No regulations
Sweden
Federal/National Laws/Statutes/Ordinances
Switzerland
Federal/National Laws/Statutes/Ordinances
UK
Federal/National Laws/Statutes/Ordinances
Uruguay
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
USA
State/Provincial/Regional Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Federal/National Laws/Statutes/Ordinances
Venezuela
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Country
Research on donated
unused
pre-implantation
embryos
Comments
Argentina
Unknown
Unknown
Unknown
Australia
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
Bangladesh
Unknown
Unknown
Unknown
Belarus
Unknown
Unknown
Unknown
Belgium
Brazil
Bulgaria
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
Cameroon
Unknown
Unknown
Canada
Ethics Panel
National Ethics/Oversight
Panel
Unknown
Chile
China
Ethics Panel
Czech Republic
Ethics Panel
Denmark
Finland
France
National Ethics/Oversight
Panel
Local or national
Institutional Review
Board
Local or national
Institutional Review
Board
Ethics Panel
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
Ethics Panel
National Ethics/Oversight Panel
National Ethics/Oversight Panel
Greece
Other
Other
Other
Guatemala
Unknown
Unknown
Unknown
Other
Other
National Ethics/Oversight
Panel
Local or national
Institutional Review
Board
National Ethics/Oversight
Panel
Hungary
India
Local or national
Institutional Review
Board
Local or national
Institutional Review
Board
National Ethics/Oversight
Panel
Local or national Institutional
Review Board
Kazakhstan
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
Malaysia
Unknown
Unknown
Unknown
Mali
Unknown
Unknown
Unknown
Mexico
Unknown
Unknown
Unknown
Netherlands
Local or national
Institutional Review
Board
Nigeria
Unknown
Unknown
Unknown
Norway
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
Panama
Unknown
Unknown
Unknown
Paraguay
Unknown
Unknown
Unknown
Portugal
Other
Other
Romania
Unknown
Unknown
Unknown
Russian Federation
Ethics Panel
Ethics Panel
Ethics Panel
Saudi Arabia
National Ethics/Oversight
Panel,Ethics Panel,
Local or national
Institutional Review
Board
National Ethics/Oversight
Panel,Ethics Panel,
Local or national Institutional
Review Board
National Ethics/Oversight
Panel,Ethics Panel,
Local or national Institutional
Review Board
Singapore
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
South Africa
Other
Other
Other
Iran
Italy
Not allowed
Japan
Jordan
South Korea
Spain
Not allowed
Local or national
Institutional Review
Board
Local or national
Institutional Review
Board
Ethics Panel
Ethics Panel
Sweden
Local or national
Institutional Review
Board
Switzerland
Ethics Panel
Ethics Panel
Ethics Panel
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
National Ethics/Oversight
Panel
UK
USA
Local or national
institutional review
board,
National Ethics/Oversight
Panel
Venezuela
Unknown
Sri Lanka
Turkey
Unknown
Unknown
National Ethics/Oversight Panel
Unknown
REFERENCES
1. National Institutes of Health. Report of the Human Embryo Research Panel: Final Draft.
September 27, 1994. Bethesda, MD: National Institutes of Health, 1994.
2. Council on Human Reproductive Technology. For embryo researchers. Available at:
http://www.chrt.org.hk/english/embryo/embryo.html. Accessed August 10, 2016.
3. Cattapan A, Snow D. Of research and reproduction: defining embryo research in Canada.
Monash Bioeth Rev 2015;33(4):379-395.
Reproductive cloning
Therapeutic cloning
Argentina
UNKNOWN
UNKNOWN
Australia
NO
Austria
NO
NO
Bangladesh
Reproductive cloning
Therapeutic cloning
UNKNOWN
UNKNOWN
YES
UNKNOWN
UNKNOWN
Barbados
NO
NO
UNKNOWN
UNKNOWN
Belarus
NO
NO
Belgium
NO
UNKNOWN
UNKNOWN
Brazil
NO
NO
Bulgaria
NO
NO
UNKNOWN
UNKNOWN
Cameroon
NO
NO
NO
NO
Canada
NO
NO
YES
Chile
NO
NO
China
NO
YES
NO
YES
Colombia
NO
NO
UNKNOWN
UNKNOWN
Czech Republic
NO
UNKNOWN
YES
Denmark
NO
NO
UNKNOWN
UNKNOWN
Ecuador
NO
NO
Estonia
NO
NO
Finland
NO
NO
France
NO
NO
Germany
NO
NO
Greece
NO
Guatemala
NO
NO
NO
NO
Hungary
NO
NO
India
NO
NO
UNKNOWN
UNKNOWN
Iran
NO
YES
NO
YES
Ireland
NO
NO
Italy
NO
NO
Japan
NO
NO
Jordan
NO
NO
Kazakhstan
NO
NO
Malaysia
NO
NO
Mali
YES
NO
NO
UNKNOWN
UNKNOWN
Netherlands
NO
NO
UNKNOWN
UNKNOWN
Nigeria
NO
NO
NO
NO
Mexico
Norway
NO
Panama
NO
NO
UNKNOWN
UNKNOWN
Paraguay
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
NO
NO
NO
NO
YES
Peru
NO
NO
Philippines
NO
NO
Portugal
NO
NO
Romania
NO
NO
Russian Federation
NO
NO
Saudi Arabia
NO
NO
Senegal
NO
NO
Singapore
NO
NO
Slovak Republic
NO
NO
South Africa
NO
South Korea
NO
NO
Spain
NO
NO
Sri Lanka
UNKNOWN
UNKNOWN
Sweden
NO
NO
Switzerland
NO
NO
Taiwan (China*)
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
NO
NO
Tunisia
Turkey
NO
NO
UK
NO
NO
Uruguay
UNKNOWN
UNKNOWN
USA
NO
NO
UNKNOWN
Venezuela
NO
NO
UNKNOWN
UNKNOWN
Reproductive cloning
Therapeutic cloning
Argentina
Unknown
Unknown
Australia
Bangladesh
Unknown
Unknown
Belarus
Unknown
Unknown
Comments
Ethics Panel
Local or National Institutional Review Board
Belgium
Cameroon
Unknown
China
Ethics Panel
Ethics Panel
Czech Republic
Unknown
Guatemala
Unknown
Unknown
India
Kazakhstan
Malaysia
Unknown
Unknown
Mali
Unknown
Unknown
Mexico
Unknown
Unknown
Netherlands
Unknown
Unknown
Nigeria
Unknown
Unknown
Panama
Unknown
Unknown
Greece
Unknown
Other
Iran
Paraguay
Unknown
Unknown
Romania
Unknown
Unknown
South Africa
Sri Lanka
Ethics Panel
Unknown
Unknown
Turkey
Venezuela
Unknown
Unknown
Reproductive cloning
Therapeutic cloning
Argentina
UNKNOWN
UNKNOWN
Australia
NO
Austria
NO
NO
Bangladesh
UNKNOWN
UNKNOWN
Barbados
NO
NO
Belarus
NO
NO
NO
NO
Belgium
Bulgaria
Cameroon
NO
NO
Canada
NO
NO
Chile
NO
NO
China
NO
Czech Republic
NO
YES
El Salvador
NO
NO
Estonia
NO
NO
Finland
NO
NO
France
NO
NO
Germany
NO
NO
Greece
NO
UNKNOWN
Guatemala
NO
NO
Hungary
NO
NO
India
UNKNOWN
UNKNOWN
Iran
NO
Ireland
no
No
Italy
NO
NO
Japan
NO
NO
Jordan
NO
NO
Kazakhstan
NO
NO
Malaysia
UNKNOWN
UNKNOWN
Mali
NO
NO
Mexico
NO
NO
Netherlands
NO
NO
Nigeria
UNKNOWN
UNKNOWN
Norway
NO
NO
Panama
NO
NO
Paraguay
UNKNOWN
UNKNOWN
Peru
NO
NO
Philippines
NO
NO
Portugal
Romania
NO
NO
Russian Federation
NO
NO
Senegal
UNKNOWN
UNKNOWN
Singapore
NO
NO
Slovak Republic
NO
NO
South Africa
NO
Spain
NO
NO
Sri Lanka
UNKNOWN
UNKNOWN
Sweden
NO
NO
Switzerland
NO
NO
NO
NO
Tunisia
NO
Turkey
NO
NO
NO
UK
NO
NO
USA
NO
NO
Venezuela
NO
NO
CHAPTER 17. Table 4 - Are there regulations that address cloning in your country?
If the answer is yes, who regulates experimentation on the pre-implantation embryo?
Country
Argentina
Australia
Austria
Bangladesh
Barbados
Reproductive cloning
Banned
Therapeutic cloning
Yes
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
No regulations
Unknown
Belarus
Banned
Banned
Belgium
Banned
Yes
Cameroon
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
State/Provincial/Regional Laws/Statutes/Ordinances
Banned
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Agency Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/Ordinances
No
Bulgaria
Therapeutic cloning
Banned
No
Brazil
Reproductive cloning
Banned
Banned
Unknown
Unknown
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
No
No
Canada
Banned
Banned
Chile
Banned
Banned
China
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Banned
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Unknown
Unknown
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Banned
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
No regulations
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Banned
Yes
Yes
Banned
Banned
Yes
No
Guatemala
No
No
Hungary
Yes
Banned
India
Yes
Yes
Iran
Banned
No
NO
NO
Ireland
Israel
Yes
Yes
Italy
Banned
Banned
State/Provincial/Regional
Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
Japan
Yes
Yes
Jordan
Banned
Banned
Kazakhstan
No
No
Malaysia
No
No
Mali
No
No
No regulations
Mexico
No
No
No regulations
No regulations
Unknown
Unknown
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Netherlands
Nigeria
No
No
Norway
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Panama
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Paraguay
No
No
No regulations
No regulations
Peru
No
No
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Philippines
No
No
Romania
Banned
Banned
Russian Federation
Banned
Banned
Saudi Arabia
Banned
Banned
Unknown
Unknown
Senegal
Singapore
Slovak Republic
Yes
Yes
Banned
Banned
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
South Africa
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
South Korea
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Spain
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Sri Lanka
No
No
No regulations
No regulations
Sweden
Banned
Banned
Switzerland
Taiwan (China*)
No
No
Unknown
Unknown
No
No
Banned
Banned
Turkey
Banned
Banned
UK
Banned
Banned
USA
Banned
Yes
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
State/Provincial/Regional Laws/Statutes/Ordinances
No
No
No regulations
No regulations
Venezuela
* Reporting separately for this report
CHAPTER 17. Table 5 - Is cloning being performed by clinical or research programmes in your country?
Country
Argentina
Never Performed
Never Performed
Australia
Never Performed
Infrequently Performed
Austria
Never Performed
Never Performed
Bangladesh
Unknown
Unknown
Barbados
Never Performed
Never Performed
Belarus
Never Performed
Never Performed
Belgium
Never Performed
Unknown
Brazil
Never Performed
Never Performed
Bulgaria
Unknown
Unknown
Cameroon
Never Performed
Never Performed
Canada
Never Performed
Never Performed
Chile
Never Performed
Never Performed
China
Never Performed
Infrequently Performed
Czech Republic
Never Performed
Unknown
Denmark
Never Performed
Never Performed
El Salvador
Never Performed
Never Performed
Estonia
Never Performed
Never Performed
Finland
Never Performed
Never Performed
France
Never Performed
Never Performed
Germany
Never Performed
Never Performed
Greece
Never Performed
Unknown
Guatemala
Never Performed
Never Performed
Never Performed
Never Performed
Hungary
Never Performed
Never Performed
India
Never Performed
Never Performed
Iran
Never Performed
Infrequently Performed
Ireland
Never Performed
Never Performed
Italy
Never Performed
Never Performed
Japan
Never Performed
Never Performed
Jordan
Never Performed
Never Performed
Kazakhstan
Never Performed
Never Performed
Malaysia
Never Performed
Never Performed
Mali
Never Performed
Never Performed
Mexico
Never Performed
Never Performed
Netherlands
Never Performed
Never Performed
Nigeria
Never Performed
Never Performed
Norway
Never Performed
Never Performed
Panama
Unknown
Unknown
Paraguay
Unknown
Unknown
Peru
Never Performed
Never Performed
Philippines
Never Performed
Never Performed
Portugal
Never Performed
Never Performed
Romania
Never Performed
Never Performed
Russian Federation
Never Performed
Never Performed
Saudi Arabia
Never Performed
Never Performed
Senegal
Unknown
Unknown
Singapore
Never Performed
Never Performed
Slovak Republic
Never Performed
Never Performed
South Africa
Never Performed
Never Performed
South Korea
Never Performed
Never Performed
Spain
Never Performed
Never Performed
Sri Lanka
Unknown
Unknown
Sweden
Never Performed
Never Performed
Switzerland
Never Performed
Never Performed
Taiwan (China*)
Unknown
Unknown
Never Performed
Never Performed
Tunisia
Never Performed
Never Performed
Turkey
Never Performed
Never Performed
UK
Never Performed
Never Performed
USA
Never Performed
Infrequently Performed
Venezuela
Never Performed
Never Performed
REFERENCES
1. Ogura A, Inoue K, Wakayama T. Recent advancements in cloning by somatic cell nuclear
transfer. Philos Trans R Soc Lond B Biol Sci 2013;5;368(1609):20110329.
2. Trounson AO. Future and applications of cloning. Methods Mol Biol 2006;348:319-32.
3. Hill JR. Incidence of abnormal offspring from cloning and other assisted reproductive
technologies. Ann Rev Anim Biosci 2014;2:307-21.
Response
Argentina
Yes
Australia
Yes
Austria
No
Bangladesh
Unknown
Barbados
Unknown
Belarus
Unknown
Belgium
No
Brazil
Yes
Bulgaria
No
Cameroon
Unknown
Canada
Unknown
Chile
No
China
Unknown
Colombia
YES
Czech Republic
No
Denmark
Ecuador
El Salvador
Unknown
Yes
Unknown
Estonia
No
Finland
No
France
No
Germany
No
Greece
Yes
Guatemala
Yes
Unknown
Yes
India
Unknown
Iran
Yes
120
Ireland
YES
Israel
Yes
Italy
Yes
Japan
No
Jordan
Yes
Kazakhstan
No
Kenya
No
Malaysia
126
No
Mali
Unknown
Mexico
Unknown
Netherlands
Unknown
Nigeria
No
Norway
No
Panama
Unknown
Peru
No
Philippines
Yes
Portugal
No
Romania
No
Russian Federation
Yes
280
Saudi Arabia
Yes
40
Senegal
Unknown
Singapore
No
Slovak Republic
Yes
South Africa
No
South Korea
No
Spain
No
Sri Lanka
No
Sweden
Unknown
Switzerland
Unknown
Taiwan (China*)
84
No
No
Tunisia
Unknown
Turkey
No
UK
Yes
Uruguay
Unknown
USA
No
Argentina
Yes
Australia
No
Country
Austria
No
Bangladesh
Unknown
Barbados
Unknown
Belarus
Unknown
Belgium
No
Brazil
No
Bulgaria
Cameroon
Canada
No
Unknown
Yes
Chile
No
China
Unknown
Colombia
Unknown
Czech Republic
Unknown
Denmark
Unknown
DEATH
Ecuador
No
El Salvador
Unknown
Estonia
No
Finland
No
France
No
Germany
No
Greece
Yes
Guatemala
No
Unknown
Hungary
No
India
Unknown
Iran
Yes
Ireland
Yes
Italy
No
Japan
No
Jordan
Yes
Kazakhstan
No
Kenya
125
No
Malaysia
Unknown
Mali
Unknown
Mexico
Unknown
Netherlands
Unknown
Nigeria
No
Norway
No
Panama
No
Paraguay
Unknown
Peru
No
Philippines
Yes
Portugal
No
Romania
No
Russian Federation
No
Saudi Arabia
Yes
Senegal
39
Unknown
Singapore
No
Slovak Republic
Yes
South Africa
No
South Korea
No
Spain
No
Sri Lanka
No
Sweden
Unknown
Switzerland
Unknown
Taiwan (China*)
No
No
Tunisia
84
Unknown
Turkey
No
UK
Yes
Uruguay
Unknown
USA
Yes
CHAPTER 18. Table 3- Through which governing bodies or agencies, is this time of human existence determined?
Country
Federal/National
Laws/Statutes/
Ordinances
State/Provincial/
Regional Laws/
Statutes/Ordinances
Municipal
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Cultural
practice
Religious
decree
NO
NO
YES
NO
YES
Unknown
Unknown
Unknown
Unknown
Unknown
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Argentina
YES
NO
Australia
YES
YES
Austria
Unknown
Bangladesh
Unknown
Barbados
Unknown
Belarus
Unknown
Belgium
YES
Brazil
YES
Unknown
Bulgaria
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Cameroon
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Canada
YES
NO
NO
NO
NO
NO
NO
Chile
NO
China
Unknown
Czech Republic
YES
Ecuador
YES
YES
YES
El Salvador
Finland
YES
YES
NO
NO
NO
NO
Germany
NO
NO
YES
YES
Greece
YES
NO
NO
NO
NO
NO
NO
Guatemala
YES
YES
YES
YES
YES
YES
YES
YES
YES
Unknown
YES
India
Iran
YES
YES
Israel
YES
Italy
YES
NO
Jordan
YES
YES
Kazakhstan
YES
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
YES
NO
NO
Unknown
Unknown
Unknown
NO
NO
NO
YES
Mexico
Netherlands
Panama
Philippines
NO
NO
NO
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
NO
NO
YES
NO
YES
YES
NO
NO
NO
NO
YES
YES
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
NO
NO
NO
NO
NO
YES
Saudi Arabia
Unknown
Singapore
YES
Slovak Republic
YES
South Africa
NO
Switzerland
YES
Tunisia
NO
YES
Unknown
Russian Federation
Taiwan (China*)
NO
UNKNOWN
Romania
Senegal
NO
NO
YES
NO
NO
NO
NO
NO
Unknown
Turkey
YES
UK
YES
Uruguay
YES
USA
NO
CHAPTER 18. Table 4 - If yes, through which governing bodies or agencies is this time frame determined?
Federal/National
Laws/Statutes/
Ordinances
State/Provincial/
Regional Laws/
Statutes/Ordinances
Municipal Laws/Statutes/
Ordinances
Agency Regulations/
Oversight
Professional
Organization
Standards/
Guidelines
Cultural
practice
Religious
decree
YES
NO
NO
NO
YES
NO
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Canada
YES
NO
NO
NO
NO
NO
NO
Finland
YES
NO
NO
NO
NO
NO
NO
Greece
NO
NO
NO
NO
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Country
Argentina
YES
Belgium
Cameroon
Guatemala
Unknown
YES
Jordan
YES
YES
Mali
NO
NO
NO
NO
YES
NO
NO
Mexico
Unknown
Unknown
Unknown
NO
NO
NO
YES
Netherlands
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Panama
NO
NO
NO
NO
NO
NO
NO
Paraguay
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Philippines
YES
Romania
NO
YES
YES
NO
NO
NO
Saudi Arabia
Senegal
Unknown
Unknown
Unknown
Unknown
YES
Slovak Republic
South Africa
NO
South Korea
Unknown
UK
USA
* Reporting separately for this report
NO
NO
NO
YES
YES
YES
Unknown
Unknown
Unknown
NO
NO
YES
NO
YES
YES
NO
NO
NO
Preimplantation genetic testing (PGT)-A and PGT-SR (previously PGS): PGT-A with sex
chromosome identification on in vitro fertilization (IVF) embryos is performed and embryos of the
desired sex are selected for transfer. IVF with PGT is more precise than other sex selection
methods, being successful for the desired sex in up to 99% of cases (2). Some clinics combine
sorting with IVF and PGT to enrich sperm toward X or Y to then obtain larger numbers of
embryos of the desired sex (3).
PGT-M/ PGT-A and PGT-SR (previously PGD/PGS): PGT-M for single gene disorders and PGTA for embryo/sex selection are frequently combined in tandem (3).
Intrauterine Insemination (IUI) with sperm sorting: Sperm cells are separated by flow cytometry,
an automated in vitro process that separates sperm into X- or Y-enriched semen for insemination
(4).
Selective fetal reduction: Reduction is performed to select embryos of the desired sex.
Country
Sperm sorting
Selective fetal
reduction
Argentina
YES
YES
UNKNOWN
NO
Australia
YES
UNKNOWN
UNKNOWN
UNKNOWN
Austria
YES
NO
NO
YES
Bangladesh
NO
No
no
UNKNOWN
Barbados
NO
NO
NO
NO
Belarus
YES
YES
NO
NO
Belgium
NO
NO
NO
NO
Brazil
YES
NO
UNKNOWN
YES
Bulgaria
NO
NO
YES
YES
Cameroon
NO
NO
NO
YES
Canada
NO
NO
NO
NO
Chile
YES
YES
NO
NO
China
YES
NO
NO
NO
Colombia
YES
YES
UNKNOWN
YES
Czech Republic
NO
NO
UNKNOWN
NO
Denmark
YES
NO
NO
UNKNOWN
Ecuador
YES
YES
YES
UNKNOWN
Estonia
NO
NO
NO
UNKNOWN
Finland
NO
NO
NO
NO
France
YES
NO
NO
NO
UNKNOWN
UNKNOWN
YES
YES
Germany
Greece
YES
YES
UNKNOWN
YES
Guatemala
YES
YES
YES
NO
UNKNOWN
Hungary
NO
NO
NO
YES
India
YES
NO
NO
YES
Iran
YES
YES
UNKNOWN
YES
Ireland
YES
NO
YES
YES
Israel
YES
NO
Italy
NO
NO
NO
NO
Japan
NO
NO
UNKNOWN
UNKNOWN
Jordan
YES
YES
UNKNOWN
NO
Kazakhstan
NO
NO
YES
YES
Malaysia
YES
YES
YES
YES
Mali
NO
NO
NO
NO
Mexico
YES
YES
YES
NO
YES
Netherlands
NO
UNKNOWN
UNKNOWN
UNKNOWN
Nigeria
YES
YES
YES
NO
Norway
NO
NO
NO
YES
Panama
YES
YES
YES
NO
Paraguay
YES
YES
UNKNOWN
NO
Peru
YES
YES
YES
NO
Philippines
NO
NO
NO
NO
Portugal
NO
NO
YES
NO
Romania
NO
NO
NO
NO
Russian Federation
NO
NO
NO
UNKNOWN
Saudi Arabia
YES
YES
YES
YES
Senegal
NO
NO
NO
NO
Singapore
YES
NO
NO
NO
Slovak Republic
NO
NO
NO
NO
South Africa
NO
NO
NO
NO
South Korea
NO
NO
NO
NO
Spain
NO
NO
NO
YES
Sri Lanka
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
NO
NO
UNKNOWN
UNKNOWN
Switzerland
NO
NO
NO
UNKNOWN
Taiwan (China*)
NO
NO
UNKNOWN
UNKNOWN
YES
YES
YES
NO
Tunisia
NO
NO
NO
NO
Turkey
NO
NO
NO
NO
UK
NO
NO
NO
YES
Uruguay
NO
NO
NO
NO
USA
YES
YES
YES
YES
Venezuela
YES
YES
YES
NO
No
Unknown
45%
PGT-M with PGT -A Sex Selection
48%
6%
30%
64%
6%
26%
Sperm Sorting
52%
22%
30%
52%
18%
CHAPTER 19. Table 2 - If allowed/permitted, are there regulations that govern these techniques in your country?
Country
Sperm sorting
Selective fetal
reduction
Argentina
NO
NO
UNKNOWN
UNKNOWN
Australia
YES
YES
UNKNOWN
YES
Austria
YES
YES
YES
NO
Bangladesh
NO
NO
NO
NO
Barbados
NO
NO
NO
NO
Belarus
NO
NO
NO
NO
Belgium
NO
NO
NO
YES
Brazil
YES
NO
UNKNOWN
YES
Bulgaria
YES
YES
YES
YES
Cameroon
NO
NO
NO
YES
Chile
NO
NO
NO
NO
China
YES
YES
YES
YES
Colombia
NO
NO
NO
YES
Czech Republic
NO
NO
UNKNOWN
NO
Canada
UNKNOWN
Denmark
YES
Ecuador
NO
NO
NO
NO
Estonia
YES
YES
YES
UNKNOWN
Finland
YES
YES
YES
YES
France
YES
YES
YES
YES
Germany
YES
YES
NO
YES
Greece
YES
YES
UNKNOWN
YES
Guatemala
NO
NO
NO
YES
Hungary
YES
NO
NO
YES
India
NO
NO
NO
NO
Iran
NO
NO
NO
NO
Ireland
NO
NO
NO
NO
Italy
NO
NO
NO
NO
Japan
YES
YES
UNKNOWN
UNKNOWN
Jordan
NO
NO
NO
UNKNOWN
Kazakhstan
NO
YES
YES
YES
Malaysia
NO
NO
NO
Mali
NO
NO
NO
NO
Mexico
NO
NO
NO
YES
UNKNOWN
Netherlands
UNKNOWN
UNKNOWN
UNKNOWN
Nigeria
YES
YES
YES
NO
Norway
YES
YES
YES
YES
Panama
NO
NO
NO
NO
Paraguay
NO
NO
NO
NO
Peru
NO
NO
NO
NO
Portugal
NO
Romania
YES
YES
YES
Russian Federation
NO
YES
YES
NO
NO
NO
YES
Saudi Arabia
Singapore
YES
YES
Slovak Republic
NO
NO
NO
NO
South Africa
YES
YES
YES
YES
Spain
YES
YES
NO
YES
Sri Lanka
NO
NO
NO
NO
Sweden
YES
Switzerland
YES
YES
YES
YES
NO
NO
NO
NO
Turkey
NO
NO
UK
NO
NO
NO
YES
Uruguay
NO
NO
NO
USA
NO
NO
YES
NO
NO
Venezuela
NO
NO
NO
NO
CHAPTER 19. Table 3 - If these techniques are regulated in your country, how is it done?
Pre-implantation Genetic Testing
for Sex Selection
Sperm sorting
Argentina
No regulations
Professional Organization Standards/Guidelines
No regulations
Unknown
Australia
State/Provincial/Regional
Laws/Statutes/Ordinances
State/Provincial/Regional
Laws/Statutes/Ordinances
State/Provincial/Regional
Laws/Statutes/Ordinances
Austria
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Bangladesh
No regulations
No regulations
Barbados
No regulations
No regulations
No regulations
Belarus
Belgium
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Country
Brazil
Bulgaria
Canada
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
China
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Colombia
No regulations
Unknown
Municipal Laws/Statutes/Ordinances
Czech Republic
Federal/National Laws/Statutes/Ordinances
Unknown
Unknown
Ecuador
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Estonia
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Unknown
Finland
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
France
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Germany
Federal/National Laws/Statutes/Ordinances
No regulations
Federal/National Laws/Statutes/Ordinances
Greece
Agency Regulations/Oversight
Federal/National Laws/Statutes/Ordinances
Unknown
Federal/National Laws/Statutes/Ordinances
Guatemala
No regulations
No regulations
No regulations
Hungary
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
India
Iran
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Ireland
No regulations
No regulations
No regulations
Italy
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
Japan
No regulations
Kazakhstan
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Kenya
No regulations
No regulations
No regulations
Malaysia
No regulations
No regulations
No regulations
Mali
No regulations
No regulations
No regulations
Mexico
No regulations
No regulations
Netherlands
Unknown
Unknown
Unknown
Nigeria
Norway
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Municipal Laws/Statutes/Ordinances
Panama
No regulations
No regulations
State/Provincial/Regional
Laws/Statutes/Ordinances
Paraguay
No regulations
No regulations
No regulations
Peru
No regulations
No regulations
No regulations
Romania
Agency Regulations/Oversight
Agency Regulations/Oversight
Agency Regulations/Oversight
Russian
Federation
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
No regulations
Religious decree
Cultural practice
Professional Organization Standards/Guidelines
Saudi Arabia
South Africa
Spain
Sri Lanka
Switzerland
Taiwan (China*)
Trinidad &
Tobago
Turkey
No regulations
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
State/Provincial/Regional
Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Unknown
Unknown
No regulations
Federal/National Laws/Statutes/Ordinances
No regulations
No regulations
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
State/Provincial/Regional
Laws/Statutes/Ordinances
UK
USA
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Venezuela
* Reporting separately for this report
Agency Regulations/Oversight
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
No regulations
Professional Organization Standards/Guidelines
Sperm sorting
Unknown
Australia
Unknown
Unknown
Infrequently Performed
Austria
Never Performed
Never Performed
Infrequently Performed
Bangladesh
Never Performed
Never Performed
Never Performed
Barbados
Never Performed
Never Performed
Never Performed
Belarus
Infrequently Performed
Never Performed
Never Performed
Belgium
Unknown
Unknown
Unknown
Brazil
Unknown
Unknown
Unknown
Bulgaria
Unknown
Commonly Performed
Commonly Performed
Cameroon
Never Performed
Infrequently Performed
Infrequently Performed
Canada
Never Performed
Never Performed
Infrequently Performed
Chile
Infrequently Performed
Never Performed
Never Performed
Never Performed
China
Never Performed
Never Performed
Colombia
Infrequently Performed
Never Performed
Infrequently Performed
Czech Republic
Never Performed
Unknown
Never Performed
Ecuador
Infrequently Performed
Never Performed
Infrequently Performed
El Salvador
Never Performed
Never Performed
Never Performed
Estonia
Unknown
Never Performed
Unknown
Finland
Never Performed
Never Performed
Never Performed
France
Infrequently Performed
Never Performed
Never Performed
Germany
Unknown
Unknown
Infrequently Performed
Greece
Commonly Performed
Unknown
Commonly Performed
Guatemala
Never Performed
Infrequently Performed
Unknown
Hungary
Unknown
Unknown
Infrequently Performed
India
Never Performed
Iran
Infrequently Performed
Never Performed
Never Performed
Ireland
Infrequently Performed
Infrequently Performed
Infrequently Performed
Israel
Commonly Performed
Infrequently Performed
Italy
Never Performed
Never Performed
Japan
Unknown
Unknown
Infrequently Performed
Jordan
Infrequently Performed
Infrequently Performed
Unknown
Infrequently Performed
Kazakhstan
Never Performed
Commonly Performed
Infrequently Performed
Kenya
Unknown
Unknown
Unknown
Malaysia
Infrequently Performed
Unknown
Infrequently Performed
Mali
Never Performed
Never Performed
Never Performed
Mexico
Infrequently Performed
Commonly Performed
Unknown
Netherlands
Never Performed
Never Performed
Infrequently Performed
Nigeria
Commonly Performed
Commonly Performed
Infrequently Performed
Norway
Never Performed
Never Performed
Infrequently Performed
Panama
Commonly Performed
Infrequently Performed
Unknown
Paraguay
Infrequently Performed
Never Performed
Unknown
Peru
Infrequently Performed
Unknown
Unknown
Portugal
Infrequently Performed
Romania
Infrequently Performed
Russian Federation
Infrequently Performed
Unknown
Unknown
Saudi Arabia
Commonly Performed
Infrequently Performed
Infrequently Performed
Senegal
Never Performed
Never Performed
Never Performed
Singapore
Never Performed
Never Performed
Never Performed
Slovak Republic
Never Performed
Never Performed
Never Performed
South Africa
Never Performed
Never Performed
Never Performed
South Korea
Never Performed
Unknown
Commonly Performed
Spain
Never Performed
Never Performed
Commonly Performed
Sri Lanka
Unknown
Unknown
Unknown
Sweden
Never Performed
Unknown
Unknown
Switzerland
Never Performed
Never Performed
Never Performed
Taiwan (China*)
Never Performed
Unknown
Unknown
Infrequently Performed
Never Performed
Never Performed
Tunisia
Never Performed
Never Performed
Never Performed
Turkey
Never Performed
Never Performed
Unknown
UK
Never Performed
Never Performed
Infrequently Performed
USA
Commonly Performed
Infrequently Performed
Infrequently Performed
Venezuela
Infrequently Performed
Infrequently Performed
Infrequently Performed
CHAPTER 19. Table 5 - Are there specific centres or institutions where these techniques are only allowed/permitted to be performed?
Country
PGS-Sex Selection
Sperm sorting
Argentina
Unknown
Unknown
Unknown
Austria
Unknown
Unknown
Small Private physician clinic <5 physician
Sole Practitioner clinic
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Bangladesh
Belarus
Brazil
Unknown
Bulgaria
Cameroon
Unknown
Unknown
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Unknown
Chile
Unknown
Colombia
Denmark
Ecuador
Unknown
Large, Private physician clinic 5 or > physicians
Germany
Unknown
Greece
Public Hospital-based
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Guatemala
Unknown
Hungary
Unknown
Unknown
Unknown
Unknown
India
Iran
Unknown
Unknown
Jordan
Public Hospital-based
University-based clinic
Hospital-based clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Kazakhstan
Mali
Unknown
Unknown
Unknown
Ireland
Unknown
Unknown
Public Hospital-based
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Sole Practitioner clinic
Unknown
Netherlands
Unknown
Unknown
University-based clinic
Nigeria
Mexico
Panama
Paraguay
Unknown
Peru
Saudi Arabia
Senegal
Unknown
Unknown
Unknown
Unknown
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Unknown
Unknown
Unknown
South Africa
South Korea
Spain
Sri Lanka
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
UK
Unknown
USA
Public Hospital-based
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Sole Practitioner clinic
Public Hospital-based
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Sole Practitioner clinic
Public Hospital-based
University-based clinic
Hospital-based clinic
Large, Private physician clinic 5 or > physicians
Small Private physician clinic <5 physician
Sole Practitioner clinic
Venezuela
CHAPTER 19. Table 6 - Are these techniques considered experimental or part of established medical practice?
Pre-implantation Genetic Testing
(PGT-A for Sex Selection)
Country
Argentina
Sperm sorting
Unknown
Unknown
Australia
Unknown
Unknown
Austria
Not addressed
Not addressed
Bangladesh
Not addressed
Not addressed
Barbados
Not addressed
Not addressed
Not addressed
Belarus
Experimental
Experimental
Brazil
Unknown
Bulgaria
Not addressed
Cameroon
Not addressed
Not addressed
Canada
Not addressed
Not addressed
Chile
Not addressed
China
Unknown
Unknown
Unknown
Colombia
Not addressed
UNKNOWN
Czech Republic
Not addressed
Unknown
Not addressed
Ecuador
Estonia
Experimental
Unknown
Unknown
Finland
Not addressed
Not addressed
Not addressed
France
Not addressed
Unknown
Germany
Unknown
Not addressed
Greece
Unknown
Guatemala
Not addressed
Unknown
Hungary
Experimental
Not addressed
India
Not addressed
Iran
Unknown
Unknown
Ireland
Not addressed
Not addressed
Israel
Experimental
Italy
Not addressed
Not addressed
Japan
Unknown
Unknown
Unknown
Jordan
Kazakhstan
Unknown
Malaysia
Not addressed
Not addressed
Not addressed
Mali
Experimental
Not addressed
Mexico
Not addressed
Not addressed
Not addressed
Netherlands
Not addressed
Not addressed
Nigeria
Norway
Not addressed
Experimental
Not addressed
Panama
Experimental
Experimental
Paraguay
Not addressed
Not addressed
Not addressed
Peru
Not addressed
Not addressed
Not addressed
Portugal
Experimental
Romania
Not addressed
Not addressed
Not addressed
Russian Federation
Not addressed
Not addressed
Not addressed
Saudi Arabia
Not addressed
Senegal
Unknown
Unknown
Unknown
Slovak Republic
Not addressed
Not addressed
Not addressed
South Korea
Not addressed
Not addressed
Spain
Not addressed
Not addressed
Sri Lanka
Unknown
Unknown
Switzerland
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Not addressed
Turkey
Not addressed
Not addressed
Not addressed
UK
Not addressed
Not addressed
USA
Experimental
Venezuela
South Africa
REFERENCES
1. Dondorp W, De Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, Barri P, Diedrich K.
ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons. Hum Reprod
2013;28(6):1448-54.
2. Macklin R. The ethics of sex selection and family balancing. Semin Reprod Med 2010;28(4):31521.
Continued increased survival rates of reproductive age cancer patients and increasing expectations of
survival in these individuals is likely to fuel expanding international demand for fertility preservations that
will be reflected in the next 3-year survey. Fertility preservation for these applications was first assessed
in Surveillance 2016 and there are no prior data available for historical comparison.
CHAPTER 20. Table 1 - Is fertility preservation of reproductive tissues allowed/permitted in your country?
Sperm
(non-medical
indications)
Sperm
(medical
indications)
Oocytes
(non-medical)
Oocytes
(medical
indications)
Preimplantation
embryos
(non-medical
indications)
Preimplantation
embryos
(medical
indications)
Ovarian tissue
(non-medical
indications)
Ovarian tissue
(medical
indications)
Testicular tissue
(non-medical
indications)
Testicular tissue
(medical
indications)
Argentina
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Australia
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Austria
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
Bangladesh
NO
UNKNOWN
NO
NO
NO
NO
NO
NO
NO
NO
Barbados
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
Country
Belarus
UNKNOWN
YES
UNKNOWN
YES
NO
YES
NO
YES
NO
YES
Belgium
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Brazil
YES
YES
YES
YES
YES
YES
YES
YES
YES
Bulgaria
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
Cameroon
NO
YES
NO
YES
NO
NO
NO
NO
NO
YES
Canada
YES
YES
YES
YES
YES
YES
UNKNOWN
YES
YES
YES
Chile
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
China
YES
YES
YES
YES
NO
YES
NO
YES
NO
YES
Colombia
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Czech Republic
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Denmark
YES
YES
NO
YES
NO
YES
NO
YES
NO
YES
YES
Ecuador
YES
YES
YES
YES
YES
YES
NO
NO
YES
El Salvador
YES
YES
YES
YES
no
no
no
no
no
No
Estonia
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Finland
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
France
YES
YES
NO
YES
NO
YES
NO
YES
NO
YES
Germany
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
Greece
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Guatemala
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Honduras
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Hungary
YES
YES
NO
YES
NO
YES
NO
YES
NO
YES
India
YES
YES
YES
YES
YES
YES
UNKNOWN
YES
UNKNOWN
YES
Iran
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
Ireland
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Israel
YES
YES
YES
NO
YES
NO
YES
YES
YES
Italy
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
Japan
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Jordan
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
Kazakhstan
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Malaysia
YES
YES
YES
YES
YES
YES
YES
YES
Mali
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Mexico
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Netherlands
UNKNOWN
YES
YES
YES
UNKNOWN
YES
UNKNOWN
YES
UNKNOWN
Nigeria
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
Norway
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
Panama
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Paraguay
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Peru
YES
YES
YES
YES
YES
YES
YES
YES
Philippines
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
Portugal
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
Romania
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Russian Federation
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
YES
UNKNOWN
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Saudi Arabia
Senegal
YES
UNKNOWN
Singapore
YES
YES
NO
YES
NO
YES
NO
YES
NO
YES
Slovak Republic
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
South Africa
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
South Korea
YES
YES
YES
YES
YES
YES
UNKNOWN
YES
UNKNOWN
YES
Spain
UNKNOWN
YES
UNKNOWN
YES
NO
YES
UNKNOWN
YES
UNKNOWN
YES
Sri Lanka
UNKNOWN
YES
UNKNOWN
YES
UNKNOWN
YES
UNKNOWN
YES
UNKNOWN
YES
Sweden
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Switzerland
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
Taiwan (China*)
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
Trinidad and
Tobago
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Turkey
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
UK
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Uruguay
NO
YES
NO
NO
NO
NO
NO
NO
YES
YES
USA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Venezuela
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Tunisia
YES
YES
YES
YES
YES
Ovarian tissue
(medical
indications)
Testicular tissue
(non-medical
indications)
Testicular tissue
(medical
indications)
Pre-implantation
embryos
(medical
indications)
Pre-implantation
embryos
(non-medical
indications)
Oocytes
(medical
indications)
Oocytes
(non-medical)
Sperm
(medical
indications)
Sperm
(non-medical
indications)
Argentina
Infrequently
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Australia
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
Austria
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Commonly
Used
Bangladesh
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Country
Never
Performed
Barbados
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Never
Performed
Never
Performed
Belarus
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Belgium
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Unknown
Commonly
Used
Infrequently
Used
Commonly
Used
Unknown
Commonly
Used
Brazil
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Bulgaria
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Commonly
Used
Commonly
Used
Unknown
Unknown
Unknown
Unknown
Cameroon
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Canada
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Unknown
Infrequently
Used
Unknown
Unknown
Chile
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
China
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Colombia
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Czech Republic
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Commonly
Used
Denmark
Infrequently
Used
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Ecuador
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Never
Performed
Never
Performed
Commonly
Used
Commonly
Used
El Salvador
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Estonia
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Finland
Commonly
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
France
Commonly
Used
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Germany
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Greece
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Commonly
Used
Guatemala
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Honduras
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Hong Kong
(China*)
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Commonly
Used
Commonly
Used
Unknown
Infrequently
Used
Never
Performed
Commonly
Used
Hungary
Infrequently
Used
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
India
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Unknown
Commonly
Used
Unknown
Commonly
Used
Iran
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Ireland
Commonly
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Commonly
Used
Commonly
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Israel
Infrequently
Used
Infrequently
Used
Infrequently
Used
Italy
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Never
Performed
Never
Performed
Never
Performed
Commonly
Used
Unknown
Unknown
Japan
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Jordan
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Kazakhstan
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Kenya
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Infrequently
Used
Infrequently
Used
Unknown
Unknown
Unknown
Unknown
Malaysia
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Mali
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Infrequently
Used
Never
Performed
Mexico
Infrequently
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Netherlands
Unknown
Commonly
Used
Infrequently
Used
Infrequently
Used
Unknown
Commonly
Used
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Nigeria
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Unknown
Unknown
Unknown
Unknown
Norway
Infrequently
Used
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Panama
Unknown
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Paraguay
Infrequently
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Commonly
Used
Peru
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Philippines
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Infrequently
Used
Infrequently
Used
Portugal
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Romania
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Russian
Federation
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Commonly
Used
Saudi Arabia
Infrequently
Used
Commonly
Used
Never
Performed
Infrequently
Used
Infrequently
Used
Commonly
Used
Never
Performed
Unknown
Never
Performed
Commonly
Used
Senegal
Never
Performed
Infrequently
Used
Never
Performed
Singapore
Infrequently
Used
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Never
Performed
Slovak Republic
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
South Africa
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Commonly
Used
South Korea
Infrequently
Used
Spain
Infrequently
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Unknown
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Sri Lanka
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Unknown
Infrequently
Used
Unknown
Unknown
Sweden
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Switzerland
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Never
Performed
Never
Performed
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Taiwan (China*)
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Infrequently
Used
Commonly
Used
Unknown
Unknown
Unknown
Unknown
Trinidad and
Tobago
Infrequently
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Never
Performed
Never
Performed
Never
Performed
Never
Performed
Tunisia
Unknown
Commonly
Used
Unknown
Commonly
Used
Unknown
Commonly
Used
Unknown
Never
Performed
Never
Performed
Commonly
Used
Turkey
Never
Performed
Commonly
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
Never
Performed
Infrequently
Used
UK
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Unknown
Infrequently
Used
Infrequently
Used
Commonly
Used
Uruguay
USA
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Venezuela
Commonly
Used
Commonly
Used
Commonly
Used
Commonly
Used
Infrequently
Used
Infrequently
Used
Infrequently
Used
Unknown
CHAPTER 20. Table 3 - If cryopreservation is permitted in your country, how is fertility preservation for the following cells and tissues, for non-medical indications, e.g.
deliberate deferral of child bearing for personal reasons, regulated in your country?
Country
Sperm
Oocytes
Pre-implantation Embryos
Ovarian Tissue
Testicular Tissue
Argentina
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Australia
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/ Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/ Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/ Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/ Ordinances
Austria
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
State/Provincial/Regional
Laws/Statutes/
Ordinances
Federal/National
Laws/Statutes/Ordinances
Bangladesh
No regulations
No regulations
No regulations
No regulations
No regulations
Barbados
No regulations
No regulations
No regulations
No regulations
No regulations
Belarus
No regulations
No regulations
No regulations
No regulations
No regulations
Belgium
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Brazil
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Bulgaria
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Cameroon
No regulations
No regulations
No regulations
No regulations
No regulations
Canada
No regulations
No regulations
No regulations
No regulations
No regulations
Chile
No regulations
No regulations
No regulations
No regulations
No regulations
China
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
Colombia
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
Czech
Republic
Ecuador
El Salvador
Estonia
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Germany
No regulations
No regulations
Greece
No regulations
No regulations
No regulations
No regulations
No regulations
Guatemala
No regulations
No regulations
No regulations
No regulations
No regulations
Honduras
No regulations
No regulations
No regulations
No regulations
No regulations
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Finland
France
Hong Kong
(China*)
India
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Iran
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Federal/National
Laws/Statutes/Ordinances
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Federal/National
Laws/Statutes/Ordinances
Religious decree
Cultural practice
Federal/National
Laws/Statutes/Ordinances
Religious decree
Cultural practice
Federal/National
Laws/Statutes/Ordinances
Religious decree
Cultural practice
Italy
No regulations
No regulations
No regulations
No regulations
No regulations
Japan
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Jordan
Religious decree
Cultural practice
Religious decree
Cultural practice
Religious decree
Cultural practice
Religious decree
Cultural practice
Religious decree
Cultural practice
Kazakhstan
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Kenya
No regulations
No regulations
No regulations
No regulations
No regulations
Malaysia
No regulations
No regulations
No regulations
No regulations
No regulations
Mali
No regulations
No regulations
No regulations
No regulations
No regulations
Mexico
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
No regulations
Ireland
Israel
Netherlands
Nigeria
Panama
No regulations
No regulations
No regulations
No regulations
No regulations
Paraguay
No regulations
No regulations
No regulations
No regulations
No regulations
Peru
No regulations
No regulations
No regulations
No regulations
No regulations
Philippines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Portugal
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Romania
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Russian
Federation
No regulations
No regulations
No regulations
No regulations
No regulations
Saudi Arabia
Unknown
Unknown
Unknown
Unknown
Unknown
Senegal
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
South Africa
No regulations
No regulations
No regulations
No regulations
No regulations
Spain
No regulations
No regulations
No regulations
No regulations
No regulations
Sri Lanka
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
State/Provincial/Regional
Laws/Statutes/ Ordinances
No regulations
Professional Organization
Standards/Guidelines
Singapore
Slovak
Republic
Sweden
No regulations
Switzerland
Federal/National
Laws/Statutes/Ordinances
Taiwan
(China*)
No regulations
No regulations
Unknown
Unknown
Unknown
Trinidad and
Tobago
No regulations
No regulations
No regulations
No regulations
No regulations
Tunisia
No regulations
No regulations
No regulations
No regulations
No regulations
Turkey
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
UK
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Uruguay
No regulations
USA
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
* Reporting separately for this report
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Venezuela
CHAPTER 20. Table 4 - If cryopreservation is allowed in your country, how is fertility preservation for medical indications, (e.g. malignancies, required treatment with or
exposure to toxic agents) regulated?
Pre-implantation
Country
Sperm
Oocytes
Ovarian Tissue
Testicular Tissue
Embryos
Argentina
Austria
Bangladesh
Barbados
Belarus
Belgium
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Unknown
Unknown
Unknown
Unknown
Unknown
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Brazil
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Bulgaria
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Cameroon
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
Canada
No regulations
No regulations
No regulations
No regulations
No regulations
Chile
No regulations
No regulations
No regulations
China
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Ecuador
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
El Salvador
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Estonia
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Finland
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Unknown
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
France
Federal/National
Laws/Statutes/Ordinances
Pre-implantation Embryos
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Germany
No regulations
No regulations
No regulations
No regulations
Greece
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Colombia
Czech
Republic
Denmark
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Unknown
Guatemala
No regulations
No regulations
No regulations
No regulations
No regulations
Honduras
No regulations
No regulations
No regulations
No regulations
No regulations
Hong Kong
(China*)
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
No regulations
Federal/National
Laws/Statutes/Ordinances
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Religious decree
Cultural practice
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Kenya
No regulations
No regulations
No regulations
No regulations
No regulations
Malaysia
No regulations
No regulations
No regulations
No regulations
No regulations
Mali
No regulations
No regulations
No regulations
No regulations
No regulations
Mexico
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Hungary
India
Iran
Ireland
Israel
Italy
Japan
Jordan
Kazakhstan
Netherlands
Nigeria
Norway
Agency
Regulations/Oversight
Unknown
Unknown
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Panama
No regulations
No regulations
No regulations
No regulations
No regulations
Paraguay
No regulations
No regulations
No regulations
No regulations
No regulations
Peru
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Agency
Regulations/Oversight
Federal/National
Laws/Statutes/Ordinances
Russian
Federation
No regulations
No regulations
No regulations
No regulations
No regulations
Saudi Arabia
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
Philippines
Portugal
Romania
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Spain
No regulations
No regulations
No regulations
No regulations
No regulations
Sri Lanka
No regulations
No regulations
No regulations
No regulations
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
State/Provincial/Regional
Laws/Statutes/ Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
No regulations
Federal/National
Laws/Statutes/Ordinances
Unknown
Unknown
No regulations
No regulations
No regulations
No regulations
No regulations
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Federal/National
Laws/Statutes/Ordinances
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
Professional Organization
Standards/Guidelines
Professional Organization
Standards/Guidelines
No regulations
Senegal
Singapore
Slovak
Republic
South Africa
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Switzerland
Federal/National
Laws/Statutes/Ordinances
Taiwan
(China*)
Trinidad &
Tobago
Federal/National
Turkey
Laws/Statutes/Ordinances
Federal/National
UK
Laws/Statutes/Ordinances
Federal/National
Uruguay
Laws/Statutes/Ordinances
Professional Organization
USA
Standards/Guidelines
Professional Organization
Venezuela
Standards/Guidelines
No regulations
* Reporting separately for this report
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
South Korea
Sweden
Agency
Regulations/Oversight
Agency
Regulations/Oversight
Professional Organization
Standards/Guidelines
Testicular tissue
(non-medical
indications)
Ovarian tissue
(medical
indications)
Ovarian tissue
(non-medical
indications)
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
10 years
10 years
10 years
Unknown
10 years
Unknown
Unknown
Unknown
Unknown
Not
addressed
Austria
Pre-implantation
embryos
(medical
indications)
10 years
Pre-implantation
embryos
(non-medical
indications)
Australia
Oocytes
(medical
indications)
No Limit
Oocytes
(non-medical
indications)
Argentina
Sperm
(medical
indications)
Sperm
(non-medical
indications)
Country
Not
addressed
Not
addressed
10 years
Not
addressed
Bangladesh
Unknown
Unknown
Unknown
Unknown
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Barbados
No Limit
No Limit
No Limit
No Limit
5 years
5 years
Not
addressed
Not
addressed
No Limit
No Limit
10 years
10 years
10 years
10 years
Belarus
10 years
10 years
10 years
Belgium
10 years
10 years
10 years
10 years
5 years
5 years
Brazil
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Not
addressed
Not
addressed
Unknown
Not
addressed
Not
addressed
No Limit
Bulgaria
No Limit
No Limit
No Limit
No Limit
Unknown
Unknown
Not
addressed
Cameroon
Not
addressed
Not
addressed
Not
addressed
Unknown
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Canada
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Not
addressed
No Limit
Not
addressed
No Limit
5 years
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Chile
No Limit
China
Not
addressed
No Limit
No Limit
No Limit
Not
addressed
5 years
Not
addressed
Not
addressed
Not
addressed
Colombia
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Czech Republic
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Denmark
No Limit
No Limit
Not
addressed
Not
addressed
No Limit
No Limit
Ecuador
No Limit
No Limit
49 years
49 years
49 years
49 years
Estonia
No Limit
No Limit
No Limit
No Limit
7 years
7 years
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
France
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Germany
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Greece
5 years
5 years
5 years
5 years
5 years
5 years
5 years
5 years
5 years
5 years
No Limit
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Guatemala
No Limit
No Limit
No Limit
No Limit
Not
addressed
Honduras
5 years
10 years
5 years
10 years
No Limit
No Limit
Hong Kong
(China*)
10 years
10 years
10 years
10 years
10 years
10 years
10 years
10 years
10 years
10 years
Hungary
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
10 years
Not
addressed
Not
addressed
Not
addressed
Not
addressed
India
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Iran
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Ireland
No Limit
No Limit
No limit
No Limit
No limit
No limit
No limit
No limit
No limit
No limit
Israel
No Limit
No Limit
No Limit
No Limit
No Limit
Italy
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Japan
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Jordan
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Kazakhstan
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Malaysia
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Mali
5 years
Mexico
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Netherlands
Unknown
No Limit
No Limit
No Limit
Unknown
No Limit
Unknown
No Limit
Unknown
No Limit
No Limit
Not
addressed
No Limit
Not
addressed
Not
addressed
Nigeria
No Limit
Norway
Unknown
Unknown
5 years
No Limit
No Limit
No Limit
No Limit
5 years
No Limit
No Limit
No Limit
Unknown
5 years
5 years
No Limit
No Limit
Panama
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Paraguay
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Peru
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Portugal
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Romania
5 years
No Limit
5 years
5 years
5 years
Unknown
Unknown
Unknown
5 years
5 years
Russian
Federation
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Saudi Arabia
No Limit
No Limit
No Limit
No Limit
Unknown
Unknown
No Limit
No Limit
Senegal
No Limit
Not
addressed
Not
addressed
Not
addressed
No Limit
Not
addressed
Not
addressed
No Limit
Not
addressed
Singapore
10 years
Not
addressed
Unknown
Not
addressed
Unknown
Not
addressed
Unknown
Not
addressed
Unknown
Not
addressed
Slovak Republic
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
South Africa
10 years
10 years
10 years
10 years
10 years
10 years
No Limit
No Limit
10 years
10 years
Not
addressed
South Korea
Spain
50 years
50 years
Sri Lanka
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Sweden
No Limit
56 years
No Limit
45 years
50 years
45 years
Not
addressed
Not
addressed
Unknown
Not
addressed
Switzerland
5 years
No Limit
5 years
No Limit
Not
addressed
Not
addressed
Not
addressed
No Limit
Not
addressed
No Limit
Taiwan (China*)
Not
addressed
Not
addressed
Not
addressed
Not
addressed
10 years
Not
addressed
Not
addressed
Not
addressed
Not
addressed
10 years
Trinidad and
Tobago
No Limit
No Limit
No Limit
Unknown
No Limit
No Limit
No Limit
Not
addressed
No Limit
No Limit
No Limit
No Limit
Unknown
Not
addressed
Unknown
No Limit
Tunisia
Unknown
No Limit
Turkey
5 years
5 years
UK
10 years
55 years
10 years
55 years
10 years
55 years
No Limit
No Limit
No Limit
No Limit
Uruguay
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
USA
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Venezuela
No Limit
No Limit
* Reporting separately for this report
No Limit
No Limit
Unknown
Unknown
Unknown
Unknown
No Limit
No Limit
5 years
No Limit
No Limit
5 years
5 years
5 years
REFERENCES
1. McLaren JF, Bates GW. Fertility preservation in women of reproductive age with cancer. Am J
Obstet Gynecol 2012;207(6):455-62.
2. Woodruff TK. Oncofertillity: a grand collaboration between reproductive medicine and
oncology. Reproduction 2015;150(3):S1-10.
3. Meirow D, Roness H, Kristensen SG, Andersen CY. Optimizing outcomes from ovarian
tissue cryopreservation and transplantation; activation versus preservation. Hum Reprod
2015;30(11):2453-6.
4. Rosendahl M, Greve T, Andersen C. The safety of transplanting cryopreserved ovarian tissue in
cancer patients: a review of the literature. J Assist Reprod Genet 2013;30(1):11-24.
5. Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum
Reprod Update 2016;22(4):440-9.
6. Picton HM, Wyns C, Anderson RA, Goossens E, Jahnukainen K, Kliesch S, Mitchell RT,
Pennings G, Rives N, Tournaye H, van Pelt AM, Eichenlaub-Ritter U, Schlatt S; ESHRE Task
Force On Fertility Preservation In Severe Diseases. A European perspective on testicular tissue
cryopreservation for fertility preservation in prepubertal and adolescent boys. Hum Reprod
2015;30(11):2463-75.
OB/GYN physicians
ART centers
ART laboratory
ART laboratory
REI training
Argentina
YES
YES
YES
YES
YES
YES
Australia
YES
YES
YES
YES
UNKNOWN
UNKNOWN
Austria
YES
NO
YES
NO
YES
NO
Bangladesh
NO
NO
NO
NO
NO
NO
Barbados
NO
NO
NO
NO
NO
NO
Belarus
YES
YES
YES
YES
UNKNOWN
UNKNOWN
Belgium
YES
NO
YES
YES
NO
NO
Brazil
YES
YES
YES
YES
YES
YES
Bulgaria
YES
YES
YES
YES
YES
Cameroon
NO
NO
NO
NO
NO
NO
Canada
NO
YES
YES
NO
NO
NO
Chile
NO
NO
NO
NO
NO
NO
China
YES
YES
YES
YES
YES
YES
Colombia
YES
NO
NO
YES
YES
NO
Czech Republic
YES
YES
YES
YES
YES
YES
Denmark
YES
UNKNOWN
UNKNOWN
NO
NO
NO
Ecuador
YES
NO
NO
NO
NO
NO
El Salvador
NO
NO
NO
NO
NO
NO
Estonia
YES
Finland
YES
YES
YES
YES
YES
YES
France
YES
NO
NO
YES
YES
NO
YES
YES
Germany
YES
YES
NO
YES
YES
NO
Greece
YES
YES
UNKNOWN
YES
YES
UNKNOWN
Guatemala
NO
NO
NO
NO
NO
NO
Honduras
NO
NO
NO
NO
NO
NO
YES
YES
Hungary
YES
NO
NO
YES
NO
NO
India
YES
Indonesia
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Iran
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Iraq
NO
NO
NO
NO
NO
NO
Ireland
YES
YES
YES
YES
YES
YES
Israel
YES
NO
NO
YES
YES
NO
Italy
YES
NO
NO
YES
NO
NO
Japan
YES
YES
YES
NO
NO
NO
Jordan
NO
NO
NO
NO
NO
NO
Kazakhstan
YES
YES
YES
YES
NO
NO
Kenya
NO
NO
NO
NO
NO
NO
Malaysia
NO
NO
NO
NO
NO
NO
Mali
NO
YES
YES
NO
NO
UNKNOWN
Mexico
YES
NO
NO
YES
NO
NO
Myanmar
NO
NO
NO
NO
UNKNOWN
UNKNOWN
Netherlands
NO
YES
UNKNOWN
YES
YES
NO
Nigeria
NO
NO
NO
NO
NO
NO
Norway
YES
NO
NO
YES
NO
NO
Panama
NO
NO
NO
NO
NO
NO
Paraguay
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
NO
Philippines
NO
NO
NO
NO
NO
NO
Portugal
YES
NO
NO
YES
NO
NO
Romania
YES
YES
Russian Federation
YES
NO
NO
NO
NO
NO
Saudi Arabia
YES
YES
YES
YES
YES
YES
Senegal
NO
NO
NO
NO
NO
NO
Singapore
YES
YES
YES
YES
YES
YES
Slovak Republic
YES
YES
YES
YES
YES
YES
South Africa
YES
YES
NO
YES
YES
YES
South Korea
YES
Spain
YES
Sri Lanka
NO
NO
NO
NO
NO
Sweden
YES
NO
NO
Switzerland
YES
YES
YES
YES
YES
NO
YES
Taiwan (China*)
YES
NO
YES
YES
NO
NO
NO
NO
NO
NO
NO
Tunisia
NO
NO
NO
NO
NO
NO
Turkey
YES
NO
YES
YES
YES
NO
UK
YES
YES
YES
YES
YES
YES
Uruguay
YES
NO
NO
YES
NO
NO
USA
YES
YES
YES
YES
YES
YES
Venezuela
NO
NO
NO
NO
NO
NO
Professional
Organization
Standards/
Guidelines
Licensing Body
Agency Regulations/
Oversight
Municipal Laws/
Statutes/Ordinances
State/Provincial/
Regional Laws/
Statutes/Ordinances
Federal/National
Laws/Statutes/
Ordinances/Policies
No regulations
Country
Argentina
NO
YES
YES
NO
NO
YES
YES
Australia
NO
YES
YES
NO
YES
YES
YES
Austria
NO
YES
NO
YES
NO
YES
YES
Bangladesh
NO
NO
NO
NO
NO
NO
NO
Barbados
YES
NO
NO
NO
NO
NO
YES
Belarus
NO
YES
NO
NO
NO
YES
YES
Belgium
NO
YES
NO
NO
NO
NO
NO
Brazil
NO
YES
NO
NO
YES
NO
YES
Bulgaria
NO
YES
NO
YES
YES
YES
YES
Cameroon
YES
NO
NO
NO
NO
NO
YES
Canada
NO
YES
YES
NO
NO
NO
YES
Chile
YES
NO
NO
NO
NO
NO
YES
China
NO
YES
NO
NO
YES
YES
YES
Colombia
YES
NO
NO
NO
NO
NO
YES
Czech Republic
NO
YES
NO
NO
NO
YES
YES
Denmark
NO
YES
NO
NO
YES
YES
YES
Ecuador
YES
NO
NO
NO
NO
NO
YES
El Salvador
YES
NO
NO
NO
NO
NO
NO
Estonia
NO
YES
NO
NO
YES
YES
NO
Finland
NO
YES
NO
NO
YES
YES
YES
France
NO
YES
NO
NO
YES
YES
NO
Germany
NO
YES
YES
NO
YES
YES
YES
Greece
NO
YES
NO
NO
YES
YES
NO
Guatemala
NO
NO
NO
NO
YES
YES
YES
Honduras
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
Hungary
NO
YES
NO
NO
NO
NO
YES
India
YES
NO
NO
NO
NO
NO
YES
Indonesia
NO
YES
YES
YES
YES
YES
YES
Iran
NO
YES
NO
NO
YES
Unknown
Unknown
Iraq
NO
YES
NO
NO
NO
YES
YES
Ireland
YES
NO
NO
NO
NO
NO
YES
Israel
NO
YES
NO
NO
NO
YES
YES
Italy
NO
YES
YES
NO
NO
NO
YES
Japan
YES
NO
NO
NO
NO
NO
YES
Jordan
NO
NO
NO
NO
NO
YES
YES
Kazakhstan
NO
YES
NO
NO
NO
YES
YES
Kenya
YES
NO
NO
NO
NO
NO
NO
Malaysia
NO
NO
NO
NO
NO
NO
NO
Mali
NO
NO
NO
NO
NO
NO
NO
Mexico
YES
NO
NO
NO
NO
NO
NO
Myanmar
YES
NO
NO
NO
NO
NO
NO
Netherlands
NO
YES
NO
NO
NO
YES
YES
Nigeria
YES
NO
NO
NO
NO
NO
YES
Norway
NO
YES
NO
NO
NO
YES
NO
Panama
NO
YES
NO
NO
NO
NO
NO
Paraguay
YES
NO
NO
NO
NO
NO
NO
Peru
NO
NO
NO
NO
NO
NO
NO
Philippines
YES
NO
NO
NO
NO
Unknown
YES
Portugal
NO
YES
NO
NO
YES
YES
NO
Romania
NO
YES
NO
NO
YES
YES
YES
Russian Federation
NO
YES
YES
NO
NO
YES
NO
Saudi Arabia
NO
NO
NO
NO
NO
YES
YES
Senegal
YES
NO
NO
NO
NO
NO
YES
Singapore
NO
NO
NO
NO
NO
YES
NO
Slovak Republic
NO
YES
NO
NO
NO
NO
YES
South Africa
NO
YES
NO
NO
NO
NO
YES
South Korea
NO
YES
NO
NO
NO
NO
YES
Spain
NO
YES
NO
NO
NO
NO
YES
Sri Lanka
YES
NO
NO
NO
NO
NO
YES
Sweden
NO
YES
YES
YES
NO
YES
YES
Switzerland
NO
YES
YES
NO
NO
YES
YES
Taiwan (China*)
NO
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
NO
NO
NO
Tunisia
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Turkey
NO
YES
NO
NO
NO
NO
NO
UK
NO
YES
NO
NO
NO
YES
YES
Uruguay
NO
YES
NO
NO
NO
NO
NO
USA
NO
YES
YES
NO
YES
NO
YES
Venezuela
YES
NO
NO
NO
NO
NO
YES
CHAPTER 21. Table 3a - How is monitoring of governance, licensure or credentialing carried out?
Physicians with advanced
Country
ART centers
REI training
Comments
National registry
National registry
International Registry
Periodic report
On-site Inspection
Argentina
Recertification
Periodic report
On-site Inspection
Australia
National registry
Unknown
On-site Inspection
Austria
Recertification
On-site Inspection
Unknown
Unknown
Bangladesh
Barbados
On-site Inspection
National registry
National registry
Recertification
Periodic report
Periodic report
On-site Inspection
On-site Inspection
Belarus
Recertification
Recertification
National registry
National registry
Periodic report
On-site Inspection
Belgium
Brazil
Bulgaria
Recertification
National registry
National registry
National registry
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
Recertification
Recertification
Recertification
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
Cameroon
Other (Please explain in comments section)
National registry
National registry
National registry
Periodic report
Periodic report
Periodic report
Recertification
Recertification
National registry
On-site Inspection
On-site Inspection
Unknown
Unknown
Unknown
Unknown
Canada
Chile
China
Colombia
Periodic report
On-site Inspection
Czech Republic
Recertification
National registry
Denmark
On-site Inspection
Ecuador
On-site Inspection
El Salvador
Unknown
Estonia
Finland
Recertification
National registry
National registry
National registry
Periodic report
On-site Inspection
On-site Inspection
Unknown
Unknown
On-site Inspection
Unknown
On-site Inspection
National registry
Periodic report
France
On-site Inspection
National registry
International Registry (e.g. ICMART)
Periodic report
Germany
On-site Inspection
Greece
Unknown
Unknown
Periodic report
Periodic report
On-site Inspection
On-site Inspection
Recertification
Recertification
National registry
National registry
Guatemala
In preparation.
Periodic report
On-site Inspection
Recertification
Hungary
National registry
India
On-site Inspection
National registry
Recertification
Recertification
Recertification
Recertification
Indonesia
Recertification
Iran
On-site Inspection
Unknown
Unknown
Iraq
National registry
National registry
National registry
Ireland
Recertification
Recertification
Israel
National registry
National registry
Italy
On-site Inspection
National registry
National registry
National registry
Periodic report
Recertification
Recertification
Japan
Recertification
Jordan
Unknown
Unknown
Unknown
Periodic report
Recertification
Recertification
Kazakhstan
On-site Inspection
Mali
National registry
Recertification
Periodic report
Mexico
On-site Inspection
Myanmar
Recertification
Recertification
Recertification
Netherlands
On-site Inspection
Recertification
Unknown
Nigeria
Unknown
Unknown
Unknown
National registry
National registry
National registry
Periodic report
Norway
On-site Inspection
Panama
National registry
National registry
Peru
Philippines
Periodic report
Periodic report
National registry
Periodic report
Portugal
On-site Inspection
National registry
Periodic report
Periodic report
National registry
National registry
National registry
Periodic report
Recertification
Recertification
Periodic report
On-site Inspection
Romania
Recertification
Russian Federation
On-site Inspection
On-site Inspection
Saudi Arabia
Recertification
Senegal
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
Recertification
Recertification
Recertification
Singapore
Periodic report
On-site Inspection
Recertification
Slovak Republic
South Africa
On-site Inspection
Periodic report
South Korea
On-site Inspection
National registry
On-site Inspection
Spain
Recertification
National registry
Sweden
Recertification
National registry
Periodic report
On-site Inspection
Switzerland
Recertification
National registry
National registry
Periodic report
Recertification
Unknown
On-site Inspection
Taiwan (China*)
Recertification
Other (Please explain in comments section)
Tunisia
National registry
On-site Inspection
National registry
Unknown
Unknown
National registry
Periodic report
Turkey
Recertification
On-site Inspection
National registry
UK
On-site Inspection
Uruguay
National registry
National registry
Recertification
Recertification
Recertification
Recertification
Unknown
Unknown
USA
Recertification
International Registry (e.g. ICMART)
Venezuela
* Reporting separately for this report
CHAPTER 21. Table 3b - How is monitoring of governance, licensure or credentialing carried out?
Country
ART laboratory
National registry
Argentina
ART Outcomes
Unknown
Unknown
Unknown
Comments
Scientific Society (SAMeR)
accreditation process
On-site Inspection
Other (Please explain in comments section)
Australia
On-site Inspection
On-site Inspection
National registry
Recertification
Periodic report
Austria
Bangladesh
Unknown
Unknown
Unknown
Unknown
Barbados
On-site Inspection
On-site Inspection
On-site Inspection
Belarus
Belgium
National registry
National registry
Periodic report
On-site Inspection
Recertification
Brazil
National registry
National registry
National registry
National registry
Periodic report
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
Recertification
Recertification
Recertification
On-site Inspection
On-site Inspection
On-site Inspection
Periodic report
Bulgaria
On-site Inspection
Cameroon
Other (Please explain in comments section)
Periodic report
Periodic report
Periodic report
Canada
China
National registry
Voluntary participation in a
national database of ART
outcomes by Canadian clinics.
No standard national or
provincial monitoring process in
place specific to ART. physicians
are monitored through
respective provincial colleges.
Recertification
Recertification
Recertification
Recertification
National registry
On-site Inspection
On-site Inspection
National registry
Colombia
Periodic report
Periodic report
On-site Inspection
On-site Inspection
Czech Republic
Recertification
Unknown
Unknown
Unknown
Unknown
El Salvador
Unknown
Unknown
Unknown
Unknown
Estonia
On-site Inspection
On-site Inspection
On-site Inspection
National registry
Denmark
Ecuador
Periodic report
Finland
On-site Inspection
On-site Inspection
Periodic report
On-site Inspection
National registry
Unknown
Unknown
National registry
National registry
National registry
National registry
National registry
Periodic report
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
Unknown
Periodic report
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
On-site Inspection
Recertification
Recertification
Recertification
Recertification
Hungary
On-site Inspection
On-site Inspection
On-site Inspection
National registry
India
On-site Inspection
Unknown
Unknown
National registry
France
Periodic report
On-site Inspection
Germany
On-site Inspection
Greece
Guatemala
Unknown
Indonesia
International Registry (e.g. ICMART)
Iran
Unknown
Unknown
Unknown
Unknown
Iraq
National registry
National registry
National registry
National registry
Recertification
Recertification
National registry
Unknown
National registry
Ireland
On-site Inspection
Israel
On-site Inspection
National registry
National registry
Italy
On-site Inspection
National registry
Japan
Periodic report
Jordan
Unknown
Unknown
Unknown
Unknown
Kazakhstan
Periodic report
Unknown
Unknown
Periodic report
National registry
Mexico
Periodic report
Periodic report
On-site Inspection
Myanmar
Unknown
Unknown
Unknown
Unknown
Netherlands
Recertification
Recertification
Recertification
Periodic report
In preparation.
Nigeria
Unknown
Unknown
Unknown
Periodic report
Unknown
National registry
Norway
On-site Inspection
Panama
Unknown
Unknown
Unknown
Unknown
Philippines
Periodic report
Periodic report
Periodic report
On-site Inspection
Unknown
National registry
Portugal
Periodic report
On-site Inspection
National registry
Periodic report
Periodic report
Periodic report
National registry
Periodic report
Romania
On-site Inspection
Recertification
Periodic report
National registry
National registry
On-site Inspection
Recertification
Recertification
Unknown
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
Periodic report
On-site Inspection
On-site Inspection
On-site Inspection
On-site Inspection
Recertification
Recertification
Recertification
Recertification
Saudi Arabia
Senegal
Singapore
Periodic report
Periodic report,
On-site Inspection
Slovak Republic
Recertification
Other (Please explain in comments section)
On-site Inspection
National registry
Recertification
South Africa
Periodic report
South Korea
On-site Inspection
Switzerland
National registry
Periodic report
Unknown
Periodic report
National registry
Periodic report
Taiwan (China*)
On-site Inspection
Recertification
Other (Please explain in comments section)
On-site Inspection
Unknown
Unknown
National registry
National registry
National registry
National registry
National registry
Periodic report
Periodic report
On-site Inspection
Periodic report
On-site Inspection
On-site Inspection
Tunisia
Turkey
On-site Inspection
Recertification
On-site Inspection
Recertification
Recertification
National registry
UK
On-site Inspection
Uruguay
National registry
On-site Inspection
National registry
Recertification
Recertification
National registry
International Registry (e.g. ICMART)
USA
Periodic report
On-site Inspection
Venezuela
Unknown
Unknown
CHAPTER 21. Table 4a - Who monitors the adherence of governance, licensure or credentialing in your country?
Physicians with advanced
ART centers
Country
REI training
Government Employees
Government Employees
Government Employees
Government Employees
Independent Agencies
Medical Officials
Comments
Argentina
Other (Please explain in comments section)
Australia
Austria
Bangladesh
Barbados
Independent Agencies
Medical Officials
Government Employees
No one
No one
No one
No one
No one
Medical Officials
Government Employees
Medical Officials
Medical Officials
Belarus
Medical Officials
Belgium
Brazil
Government Employees
Government Employees
Government Employees
Government Employees
Government Employees,
Government Employees
Government Employees
Government Employees
Bulgaria
Cameroon
Medical Officials
Medical Officials
Medical Officials
No one
No one
No one
Canada
Government Employees
Government Employees
Medical Officials
Medical Officials
Government Employees
Medical Officials
Colombia
Unofficial Agencies
Unofficial Agencies
Unknown
Czech Republic
Government Employees
Government Employees
Denmark
Medical Officials
No one
No one
Government Employees
Independent Agencies
Independent Agencies
No one
No one
China
Ecuador
Independent Agencies
El Salvador
No one
Estonia
Government Employees
Finland
Government Employees
Government Employees
Government Employees
France
Independent Agencies
Medical Officials
Medical Officials
Government Employees
Government Employees
Unknown
Medical Officials
Medical Officials
Independent Agencies
Independent Agencies
No one
Guatemala
No one
No one
No one
Government Employees
Medical Officials
Government Employees
Government Employees
Germany
Greece
Medical Officials
Hungary
Medical Officials
India
Government Employees
ICMR panel
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Iran
Government Employees
Government Employees
Government Employees
Iraq
Independent Agencies
Government Employees
Government Employees
Ireland
Independent Agencies
Medical Officials
Medical Officials
Israel
Government Employees
No one
No one
Italy
Government Employees
No one
No one
Japan
Medical Officials
Medical Officials
Medical Officials
Indonesia
Jordan
Government Employees
Government Employees
Government Employees
No one
No one
No one
No one
No one
Government Employees
Government Employees
Government Employees
Mexico
Government Employees
Unofficial Agencies
Myanmar
Independent Agencies
Independent Agencies
Independent Agencies
Unknown
Unknown
Unknown
Kazakhstan
Malaysia
Mali
Netherlands
No one
Nigeria
No one
Norway
Government Employees
Panama
No one
No one
No one
Government Employees
Government Employees
Government Employees
Philippines
Portugal
Independent Agencies
No one
No one
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Independent Agencies
No one
No one
No one
No one
Government Employees
Government Employees
Government Employees
Independent Agencies
Independent Agencies
Independent Agencies
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Independent Agencies
No one
No one
No one
Romania
Russian Federation
Government Employees
Government Employees
Saudi Arabia
Medical Officials
Senegal
Singapore
Slovak Republic
South Africa
Independent Agencies
South Korea
Government Employees
Spain
Government Employees
Sri Lanka
No one
Sweden
Government Employees
Government Employees
Switzerland
Medical Officials
Independent Agencies
Taiwan (China*)
Government Employees
Medical Officials
Unknown
No one
No one
No one
Tunisia
Government Employees
No one
No one
Government Employees
Government Employees
Government Employees
Turkey
Medical Officials
Medical Officials
Independent Agencies
Independent Agencies
Independent Agencies
Government Employees
Government Employees
UK
Other (Please explain in comments section)
Government Employees
Uruguay
Government Employees
USA
Venezuela
Medical Officials
Medical Officials
Medical Officials
No one
No one
No one
CHAPTER 21. Table 4b - Who monitors the adherence of governance, licensure or credentialing in your country?
Country
ART laboratory
Government Employees
Argentina
ART Outcomes
Unknown
Unknown
Unknown
Government Employees
Comments
Scientific Society
(SAMeR) accreditation
process
Australia
Independent Agencies
Austria
Independent Agencies
Independent Agencies
Independent Agencies
Government Employees
No one
No one
No one
No one
No monitoring
mechanism has been
established as yet
No one
No one
No one
No one
Barbados Medical
Council
Medical Officials
Medical Officials
Medical Officials
Bangladesh
Barbados
Belarus
Government Employees
Government
employees are from
AFMPS and SPF
Belgium
Government Employees, Other (Please explain
in comments section)
Bulgaria
Cameroon
No one
No one
No one
No one
No one
Brazil
China
Medical Officials
Czech
Republic
Canada
Colombia
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Unofficial Agencies
Unofficial Agencies
Unofficial Agencies
Government Employees
Government Employees
Government Employees
Unofficial Agencies
Government Employees
Medical Officials
Denmark
No one
No one
No one
No one
Ecuador
Independent Agencies
Independent Agencies
Independent Agencies
Independent Agencies
El Salvador
No one
No one
No one
No one
Estonia
Government Employees
Government Employees
Government Employees
Finland
Government Employees
Government Employees
Government Employees
Government Employees
France
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Independent Agencies
Independent Agencies
No one
Independent Agencies
No one
No one
No one
No one
Government Employees
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Germany
Greece
Guatemala
The National
Authority for
Medically Assisted
Reproduction.
Hong Kong
Hungary
India
ICMR panel
Unknown
Unknown
Indonesia
Government Employees
Medical Officials
Iran
Government Employees
Government Employees
Iraq
Medical Officials
Medical Officials
Medical Officials
Unofficial Agencies
Ireland
Independent Agencies
Independent Agencies
Independent Agencies
Independent Agencies
Israel
Government Employees
Government Employees
No one
Government Employees
Italy
Government Employees
No one
No one
Government Employees
Medical Officials
Japan
Self monitoring by
hospital medical
directors
Jordan
Government Employees
No one
No one
No one
No one
No one
No one
Government Employees
Government Employees
Government Employees
Kazakhstan
Malaysia
Mali
Mexico
Government Employees
Myanmar
Unknown
Unknown
Unknown
Unknown
Netherlands
Independent Agencies
Unknown
Unknown
No one
Nigeria
No one
No one
No one
No one
Norway
Government Employees
Government Employees
Panama
Unknown
Unknown
Unknown
Unknown
Philippines
Portugal
Independent Agencies
No one
No one
Independent Agencies
Government Employees
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Romania
The college of
Physicians and
Pharmacists
Medical Officials
Government Employees
Russian
Federation
Saudi Arabia
Report to Association
of reoriductiv medecin
No one
Senegal
No one
No one
No one
No one
Government Employees
Government Employees
Government Employees
Government Employees
Independent Agencies
Independent Agencies
Independent Agencies
Independent Agencies
Government Employees
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Singapore
Slovak
Republic
South Africa
Independent Agencies
South Korea
Government Employees
Re-accreditation also
undertaken by the
Reproductive
Technologies
Accreditation
Committee (RTAC) of
Australia and New
Zealand
Health insurance
companies
Independent Agencies
Independent Agencies
No one
No one
No one
Spain
No one
No special licensing
system.
Sri Lanka
Sweden
Switzerland
Taiwan
(China*)
Government Employees
Government Employees
Medical Officials
Government Employees
Trinidad and
Tobago
No one
No one
No one
No one
Tunisia
Government Employees
No one
Government Employees
Government Employees
Government Employees
Government Employees
Government Employees
Government
Medical Officials
Medical Officials
Medical Officials
Employees,Medical Officials
Independent Agencies
Independent Agencies
Independent Agencies
Turkey
UK
Uruguay
Government Employees
Government Employees
Government Employees
Government Employees
Government Employees
Government Employees
Medical Officials
Medical Officials
Medical Officials
Medical Officials
Independent agencies
Independent agencies
Independent agencies
No one
No one
No one
USA
Venezuela
Inspection and
licensing of ART is
performed by the
HFEA. Professional
Bodies deal with the
training and
revaluation of staff.
No one
Describe penalties
No
No
Yes
Yes
Australia
Austria
No
Yes
Bangladesh
No
Unknown
Barbados
No
Yes
Belarus
Unknown
Unknown
Belgium
Yes
Yes
REDLARA- restrictions to the center .
changes in accreditation
Yes
Brazil
Yes
Unknown
Yes
Administrative
Cameroon
No
No
Canada
Yes
No
Chile
No
NO
Bulgaria
China
Yes
Yes
1. Fine
2. Be disqualified the ART License
Colombia
NO
YES
Czech Republic
Yes
Yes
Depending on the severity of violation, the clinic can be ( and already was) closed.
Denmark
No
Yes
Fine
Ecuador
Unknown
Unknown
No
Unknown
El Salvador
Estonia
No
Yes
Fines.
Revocation of license.
Possibility of fine, losing license
Finland
No
Yes
France
No
No
Germany
Yes
Yes
on site visit, re-visit, in worst case scenarios IVF license is not renewed
Greece
Yes
Yes
Guatemala
No
Unknown
Honduras
Hong Kong
Hungary
NO
Unknown
Yes
No
Yes
Yes
Sealing lab
Suspension of license
Imprisonment
ART center will be closed
Unknown
India
Indonesia
No
Yes
Iran
Yes
No
Iraq
No
No
Ireland
No
No
Israel
Yes
Yes
court/license
Yes
Fine
Suspension of license
Italy
No
Japan
Yes
No
Jordan
No
No
Kazakhstan
Yes
Yes
Kenya
NO
Malaysia
Unknown
Unknown
Mali
Unknown
Unknown
Mexico
No
Unknown
Myanmar
No
Unknown
Netherlands
No
Unknown
Nigeria
No
No
Norway
No
Yes
Panama
Yes
Yes
Suspension license
Paraguay
No
No
Peru
No
No
Yes
One IVF practitioner was admonished regarding practice of surrogacy which is not
acceptable based on the PSRM ethical guidelines.
Yes
Yes
The National Transplant Agency and Health Ministry will revoke the license.
Related with how serious is the violation it can go even in court for criminal
prosecution .
Yes
Yes
Unknown
Unknown
Yes
Senegal
No
No
Singapore
No
Yes
Slovak Republic
No
Yes
Philippines
Portugal
No
No
Yes
Romania
Russian Federation
Saudi Arabia
No
South Africa
Yes
South Korea
Unknown
Yes
Spain
Unknown
Yes
Sri Lanka
Financial penalties
No
Sweden
No
Yes
Switzerland
No
Yes
Taiwan (China*)
No
Yes
No
No
Tunisia
No
Unknown
Turkey
Unknown
Yes
Yes
UK
No
Uruguay
No
USA
Yes
Venezuela
No
possible imprisonment
NO
REFERENCES
1. European IVF-Monitoring Consortium (EIM); for the European Society of Human Reproduction and
Embryology (ESHRE). Kupka MS, DHooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA,
Calhaz-Jorge C, De Geyter C, and Goossens V. Assisted reproductive technology in Europe, 2011:
results generated from European registers by ESHRE. Hum Reprod 2016;31(2):233-48.
2. McTavish A, Akande V, Cutting R, Bloor D. Quality Manual. Incorporating HFEA Standard Licence
Conditions. Available at: http://www.hfea.gov.uk/docs/Quality_Manual_June_2011.pdf Accessed
August 11, 2016.
3. Belva F, Roelants M, Painter R, Bonduelle M, Devroey P, De Schepper J. Pubertal development in
ICSI children. Hum Reprod 2012;27(4):1156-61.
Other respondent countries included only single women (Barbados, Greece, Nigeria, and Uruguay); same
sex female married couples (Austria and Sweden); single women and same sex women in married
relationships (Chile, Ecuador, Estonia, Finland); single women, same sex women in married relationships,
and intersex people (the Netherlands); and single women, same sex women in married relationships,
intersex, and transgender people (Denmark).
Cameroon, China, Honduras, Hungary, India, Iran, Israel, Italy, Kazakhstan, Malaysia, and Peru reported
diagnostic evaluation as available for single women and single men. El Salvador added to that women in
same sex married relationships. The Philippines and Venezuela added to that again by including men in
same sex married relationships.
The Russian Federation, Slovak Republic, and Turkey reported that diagnostic evaluation was available
in their respective countries to single women, single men, transgender, and intersex people.
Access to diagnostic evaluation by single women was mentioned by 51 (73%) of the respondents; women
in same sex relationships by 34 (49%) of the respondents; intersex people by 31 (44%) of the
respondents; single men by 30 (43%) of the respondents; transgender people by 29 (41%) of the
respondents; and men in same sex relationships by 26 (37%) of the respondents.
Intra-Uterine Insemination (IUI)
Twenty four respondent countries did not report on any availability of IUI for non-heterosexual coupled
people. Australia, Belgium, Brazil, Canada, Ireland, Romania, and the UK reported that IUI is available to
all people regardless of relationship status, sex, or gender identity. The USA was similar, although did not
select same sex male married couples in this section.
Saudi Arabia and Senegal reported its availability for intersex people, whereas France reported for
transgender people.
Barbados, Greece, Nigeria, Uruguay, Hungary, India, Israel, Peru, Belarus, and the Russian Federation
for single women. Austria, Sweden, and Norway for same sex female married couples. Chile, Ecuador,
Estonia, Finland, the Netherlands, El Salvador, Argentina, Bulgaria, Germany, Guatemala, and Paraguay
for both single women and women in same sex married couples.
Denmark, Mexico, South Africa, South Korea, Spain, and Trinidad and Tobago reported IUI for single
women and women in same sex married couples, and transgender and intersex people.
Honduras and Kazakhstan reported IUI for single women and single men. Venezuela and Panama adding
to single women and men, same sex female and same sex male couples.
Access to IUI by single women was therefore mentioned by thirty nine of the respondents (56%); women
in same sex relationships by thirty two of the respondents (46%); intersex people by sixteen of the
respondents (23%); transgender people by fifteen of the respondents (21%); single men by twelve of the
respondents (17%); and men in same sex relationships by nine of the respondents (13%). Presumably
the countries that responded that men may access IUI must be alluding to circumstances in which that
male seeks the treatment of a female (e.g., a gestational carrier mother).
In-Vitro Fertilization (IVF)
Twenty five countries (36%) did not select IVF as being available to single people, people in same sex
relationships, or transgender or intersex people. In contrast, Mexico, Australia, Belgium, Canada, Ireland,
Romania, the UK, and the USA all report the availability of IVF to all such people. The respondent from
Brazil also selected all such people, except intersex.
Other respondents selected varied availability of IVF as follows:
Respondents from Barbados, Greece, Nigeria, Belarus, the Russian Federation, Kazakhstan, Panama,
Uruguay, and Hungary reported that donor eggs were available for single women. In Chile, Estonia,
Finland, Bulgaria, Guatemala, Paraguay, Spain, the Netherlands, and Argentina, it was reported that
donor eggs are available to both single women, and women in same sex married couples. Trinidad and
Tobago reported donor eggs as available for single women, women in same sex married couples,
transgender, and intersex individuals. Israel, India, Peru and Honduras report that donor eggs are
available for single women and single men.
In Venezuela, donor eggs were reported as available for single women, single men, women in same sex
married couples, and men in same sex married couples.
Access to donor eggs by single women was therefore mentioned by 35 (50%) of the respondents; women
in same sex relationships by 22 (31%) of the respondents; single men by 16 (23%) of the respondents;
transgender people by 13 (19%) of the respondents; intersex people by 12 (17%) of the respondents; and
men in same sex relationships by 12 (17%) of the respondents (17%).
Donor Embryos
Thirty five (50%) of 70 respondents reported that donor embryos were not available to single,
transgender, intersex people, or to people in same sex couples. Again, donor embryos may or may not be
available to heterosexual couples, or permitted at all in these countries. Donor embryos were reported as
being available to all people regardless of relationship status, sex, or gender identity in South Africa,
South Korea, Brazil, Australia, Belgium, Canada, Romania, Ireland, the United Kingdom, and the USA. In
France, donor embryos were reported as being available for transgender people. In Israel, donor embryos
were reported as being available to single men.
In Barbados, Greece, Nigeria, Belarus, the Russian Federation, Kazakhstan, Panama, Uruguay, India,
and Hungary, donor embryos were reported to be available for single women. In Chile, Estonia, Finland,
Bulgaria, Guatemala, Paraguay, Spain, the Netherlands, and Argentina, it was reported that donor
embryos are available to both single women, and women in same sex married couples. Trinidad and
Tobago reported donor embryos as available for single women, women in same sex married couples,
transgender individuals, and intersex individuals. Peru and Honduras report that donor embryos are
available for single women and single men. In Venezuela donor embryos were reported as available for
single women, single men, women in same sex married couples, and men in same sex married couples.
Access to donor eggs by single women was therefore mentioned by 24 (34%) of the respondents; women
in same sex married couples by 21 (30%) of the respondents; single men by 14 (20%) of the
respondents; transgender people by 12 (17%) of the respondents; intersex people by 11 (16%) of the
respondents; and men in same sex relationships by 11 (16%) of the respondents.
Gestational Carrier Arrangements
Traditional gestational carrier - i.e. in which the gestational carrier (mother's) ova are inseminated
with a prospective parent's sperm
Fifty five (79%) of the 70 responding countries did not report permitting traditional gestational carrier
(TGC) arrangements.
Seven countries (Brazil, Australia, Belgium, Canada, Romania, USA, and Mexico) reported allowing
traditional gestational carriers regardless of relationship status, sex, or gender identity. Israel reported
allowing single men to access traditional gestational carriers, while Nigeria, the Russian Federation,
Kazakhstan, and Peru reported allowing single women to access traditional gestational carriers. The
Netherlands reported allowing access by single women and women in same sex relationships. Honduras
reported allowing access to traditional gestational carriers by single women and single men.
Country
Argentina
No requirement
Australia
No requirement
Austria
Yes
Federal/National Laws/Statutes/Ordinances
Yes
Bangladesh
Barbados
No requirement
Belarus
No requirement
Belgium
No requirement
Brazil
No requirement
Bulgaria
No requirement
Cameroon
Yes
Canada
No requirement
Chile
China
No requirement
Colombia
No requirement
Czech Republic
Yes
Yes
Denmark
No requirement
Ecuador
No requirement
El Salvador
No requirement
Estonia
No requirement
Finland
No requirement
France
Yes
Germany
No requirement
Greece
No requirement
Guatemala
No requirement
Honduras
No requirement
State/Provincial/Regional Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Yes
Agency Regulations/Oversight
Hungary
Yes
Federal/National Laws/Statutes/Ordinances
India
Yes
Indonesia
YES
Religious decree
Iran
Yes
Federal/National Laws/Statutes/Ordinances
YES
Religious decree
Iraq
Ireland
No requirement
Israel
No requirement
Italy
Yes
Japan
Yes
Yes
Federal/National Laws/Statutes/Ordinances
Cultural practice
Religious decree
Yes
Federal/National Laws/Statutes/Ordinances
Jordan
Kazakhstan
Kenya
Malaysia
Mali
Mexico
Myanmar
Unknown
Yes
Yes
No requirement
Unknown
Netherlands
No requirement
Nigeria
No requirement
Norway
Yes
Panama
No requirement
Paraguay
No requirement
Peru
No requirement
Philippines
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Yes
Portugal
Yes
Romania
No requirement
Federal/National Laws/Statutes/Ordinances
Russian Federation
No requirement
Professional Organization Standards/Guidelines
Cultural practice
Religious decree
Professional Organization Standards/Guidelines
Cultural practice
Yes
Saudi Arabia
Yes
Senegal
Singapore
Yes
Federal/National Laws/Statutes/Ordinances
Yes
Federal/National Laws/Statutes/Ordinances
Professional Organization Standards/Guidelines
Cultural practice
Slovak Republic
South Africa
No requirement
Yes
South Korea
Spain
Sri Lanka
No requirement
Unknown
Sweden
Yes
Federal/National Laws/Statutes/Ordinances
Switzerland
Yes
Federal/National Laws/Statutes/Ordinances
Taiwan (China*)
Yes
Federal/National Laws/Statutes/Ordinances
No requirement
Tunisia
Yes
Federal/National Laws/Statutes/Ordinances
Turkey
Yes
Federal/National Laws/Statutes/Ordinances
UK
No requirement
Uruguay
USA
No requirement
Venezuela
* Reporting separately for this report
No requirement
No requirement
CHAPTER 22. Table 2 - If there is no requirement for an official or stable heterosexual union, is IVF or ART services accessible to?
Country
Single women
Single men
Transgender
Intersex Individuals
Argentina
YES
NO
YES
NO
NO
NO
Australia
YES
YES
YES
YES
YES
YES
Barbados
YES
NO
YES
NO
NO
NO
Belarus
YES
NO
UNKNOWN
UNKNOWN
UNKNOWN
Belgium
YES
YES
YES
YES
YES
Brazil
YES
YES
YES
YES
YES
YES
Bulgaria
YES
NO
YES
NO
UNKNOWN
UNKNOWN
Canada
YES
YES
YES
YES
YES
YES
Chile
YES
YES
YES
NO
NO
UNKNOWN
YES
Colombia
NO
NO
NO
NO
NO
NO
Denmark
YES
NO
YES
NO
YES
YES
Ecuador
YES
NO
YES
NO
NO
NO
El Salvador
YES
YES
YES
NO
UNKNOWN
UNKNOWN
Estonia
YES
NO
YES
NO
UNKNOWN
UNKNOWN
Finland
YES
YES
YES
YES
NO
NO
Germany
YES
NO
YES
NO
UNKNOWN
UNKNOWN
Greece
YES
NO
NO
NO
NO
NO
Guatemala
YES
NO
YES
NO
NO
NO
Honduras
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Ireland
YES
YES
YES
YES
YES
YES
Israel
YES
NO
NO
NO
NO
NO
Mexico
YES
YES
YES
YES
YES
YES
Netherlands
YES
UNKNOWN
YES
UNKNOWN
UNKNOWN
UNKNOWN
Nigeria
YES
NO
NO
NO
NO
NO
Panama
YES
NO
YES
NO
NO
NO
Paraguay
YES
YES
YES
YES
YES
YES
Peru
YES
YES
YES
YES
YES
YES
Romania
YES
NO
NO
NO
NO
NO
Russian Federation
YES
NO
UNKNOWN
NO
UNKNOWN
UNKNOWN
South Africa
YES
YES
YES
YES
YES
YES
Spain
YES
YES
NO
YES
YES
YES
NO
YES
NO
YES
YES
UK
YES
YES
YES
YES
YES
YES
Uruguay
YES
NO
YES
NO
NO
NO
USA
YES
YES
YES
YES
YES
YES
Venezuela
YES
YES
YES
YES
UNKNOWN
UNKNOWN
CHAPTER 22. Table 3 - Does your country have laws that recognize the same sex partner of a person who has used assisted reproduction as a legal parent of the resulting
child?
Same sex partner of a woman
Argentina
Country
YES
YES
Australia
YES
YES
Austria
YES
NO
Bangladesh
NO
NO
Barbados
NO
NO
Belarus
NO
NO
Belgium
YES
YES
Brazil
YES
YES
Bulgaria
NO
NO
Cameroon
NO
NO
UNKNOWN
UNKNOWN
Chile
NO
NO
China
NO
NO
Colombia
NO
NO
Czech Republic
NO
NO
Denmark
YES
YES
Ecuador
NO
NO
El Salvador
NO
NO
Estonia
NO
NO
Finland
YES
YES
Canada
France
NO
NO
UNKNOWN
UNKNOWN
Greece
NO
NO
Guatemala
NO
NO
Honduras
NO
NO
NO
NO
Hungary
NO
NO
India
NO
NO
Indonesia
NO
NO
Germany
Iran
NO
Iraq
NO
NO
Ireland
YES
YES
Israel
YES
NO
Italy
NO
NO
Japan
NO
NO
Jordan
NO
NO
Kazakhstan
NO
NO
Kenya
NO
NO
Malaysia
NO
NO
Mali
NO
NO
Mexico
YES
NO
UNKNOWN
UNKNOWN
Netherlands
YES
YES
Nigeria
NO
NO
Norway
YES
NO
Panama
NO
NO
Paraguay
NO
NO
Peru
NO
NO
Philippines
NO
NO
Portugal
NO
NO
Romania
NO
NO
Russian Federation
NO
NO
Saudi Arabia
NO
NO
Senegal
NO
NO
Singapore
NO
NO
Slovak Republic
NO
NO
South Africa
YES
YES
South Korea
NO
NO
Spain
YES
NO
Sri Lanka
NO
NO
Sweden
YES
YES
Switzerland
NO
NO
Taiwan (China*)
NO
NO
NO
NO
Tunisia
NO
NO
Turkey
NO
NO
UK
YES
YES
Uruguay
YES
NO
USA
YES
YES
Venezuela
NO
NO
Myanmar
NO
Argentina
Australia
Single women
Diagnostic Evaluation
IUI
IVF
Donor Egg
Donor Sperm
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Austria
Barbados
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Single men
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Embryos
GC
Traditional GC
Same sex
female couples
Diagnostic Evaluation
IUI
Donor Egg
Donor Sperm
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Embryos
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Same sex
male couples
Transgender
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Intersex Individuals
Belarus
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Belgium
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
Diagnostic Evaluation
Brazil
Bulgaria
Cameroon
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
China
Diagnostic Evaluation
Diagnostic Evaluation
Czech
Republic
Diagnostic Evaluation
Diagnostic Evaluation
Canada
Chile
Denmark
Ecuador
El Salvador
Estonia
Finland
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
IUI
IVF
PGS
Donor Sperm
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Donor Egg
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
IUI
IVF
PGS
Donor Sperm
Diagnostic Evaluation
Greece
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
IUI
IVF
PGD
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
Donor Sperm
France
Germany
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
GC
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Diagnostic Evaluation
Guatemala
Honduras
Hungary
India
Iran
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
Italy
Diagnostic Evaluation
Diagnostic Evaluation
Kazakhstan
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
Malaysia
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Netherlands
Nigeria
Norway
Panama
Paraguay
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IVF
PGD
PGS
Donor Egg
GS - donated ova/donated
sperm
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
PGS
Donor Egg
Donor Embryos
GC
Traditional GC
Mexico
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Israel
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
Ireland
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
GC
Traditional GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
Diagnostic Evaluation
IUI
IVF
Diagnostic Evaluation
IUI
IVF
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
Diagnostic Evaluation
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Peru
Diagnostic Evaluation
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos GC
Traditional GC
Diagnostic Evaluation
IVF
PGS
Single Women
Donor Sperm
Donor Egg
Donor Embryos
Philippines
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Romania
Russian
Federation
Diagnostic Evaluation
Single Women
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Diagnostic Evaluation
IUI
IVF
Saudi Arabia
Senegal
Singapore
Diagnostic Evaluation
Diagnostic Evaluation
Slovak
Republic
Diagnostic Evaluation
Diagnostic Evaluation
South Africa
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
South Korea
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Spain
Diagnostic Evaluation
Switzerland
Diagnostic Evaluation
Diagnostic Evaluation
Trinidad and
Tobago
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Turkey
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Sweden
UK
Uruguay
Diagnostic Evaluation
Diagnostic Evaluation
IUI
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GS - donated ova/donated
sperm
Diagnostic Evaluation IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GS - donated ova/donated
sperm
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Diagnostic Evaluation
IUI
IVF
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
Diagnostic Evaluation
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
Donor Sperm
Donor Egg
Donor Embryos
USA
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Venezuela
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Diagnostic Evaluation
IUI
IVF
PGD
PGS
Donor Sperm
Donor Egg
Donor Embryos
GC
Traditional GC
Country
Lower cost
ART
services
Higher quality
ART services
ART services
unavailable in
their home
country
Egg donation
Embryo
donation
Sperm
donation
Gestational
carriers
Traditional
gestational
carriers
Not addressed
Argentina
YES
YES
YES
Unknown
Unknown
Unknown
Not addressed
Australia
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
NO
NO
YES
YES
NO
NO
YES
NO
NO
Austria
Bangladesh
YES
NO
Unknown
NO
NO
NO
NO
NO
Barbados
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
Unknown
Unknown
Unknown
Unknown
Belarus
YES
YES
YES
Belgium
YES
YES
YES
Brazil
YES
YES
YES
YES
Bulgaria
YES
YES
YES
YES
Cameroon
YES
YES
YES
YES
Canada
YES
YES
YES
NO
Chile
NO
YES
YES
YES
China
YES
YES
NO
Colombia
YES
YES
Czech Republic
YES
YES
Denmark
YES
YES
NO
NO
YES
YES
YES
NO
NO
Unknown
Unknown
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
Unknown
Unknown
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
NO
Ecuador
YES
YES
El Salvador
YES
Not addressed
NO
YES
YES
Estonia
YES
NO
YES
YES
Unknown
NO
NO
NO
Finland
YES
YES
YES
YES
YES
YES
NO
NO
France
NO
YES
YES
NO
NO
YES
NO
NO
Germany
YES
YES
YES
NO
NO
Unknown
NO
NO
Unknown
Unknown
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
Greece
Guatemala
YES
YES
Hungary
YES
YES
YES
NO
Unknown
NO
Not addressed
Not addressed
India
YES
YES
YES
YES
YES
YES
YES
Unknown
Iran
Ireland
YES
YES
YES
YES
NO
NO
Unknown
Unknown
Unknown
YES
Unknown
Unknown
Unknown
YES
YES
Unknown
Israel
YES
YES
YES
YES
NO
YES
Italy
NO
YES
YES
NO
NO
NO
NO
NO
Japan
NO
YES
NO
NO
NO
NO
NO
NO
Jordan
YES
YES
YES
Kenya
YES
Unknown
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Malaysia
YES
YES
YES
YES
Unknown
YES
Unknown
Unknown
Mali
YES
YES
YES
YES
YES
NO
NO
NO
Mexico
YES
YES
YES
YES
Unknown
YES
YES
YES
Netherlands
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Nigeria
YES
YES
YES
YES
YES
YES
YES
Unknown
Norway
NO
NO
NO
NO
NO
NO
NO
NO
Panama
YES
YES
YES
YES
YES
YES
Unknown
Unknown
Paraguay
Not
addressed
YES
Not
addressed
YES
YES
Not
addressed
NO
NO
YES
YES
YES
YES
Peru
Philippines
YES
YES
YES
Portugal
Unknown
Unknown
YES
YES
Unknown
Romania
YES
YES
NO
NO
NO
NO
NO
NO
NO
Russian Federation
YES
YES
YES
YES
YES
YES
YES
NO
Saudi Arabia
YES
YES
YES
NO
NO
NO
NO
NO
Senegal
YES
YES
YES
NO
NO
NO
NO
NO
Singapore
NO
YES
YES
NO
NO
NO
NO
NO
Slovak Republic
YES
YES
YES
YES
YES
YES
NO
NO
South Africa
YES
YES
YES
YES
YES
YES
NO
NO
South Korea
YES
YES
Spain
YES
YES
YES
YES
YES
YES
NO
NO
Sri Lanka
YES
YES
YES
YES
YES
YES
Unknown
Unknown
NO
Sweden
Unknown
YES
YES
NO
NO
NO
NO
Switzerland
NO
YES
YES
NO
NO
UNKNOWN
NO
NO
Taiwan (China*)
YES
YES
YES
YES
NO
YES
NO
NO
YES
Unknown
YES
YES
YES
YES
NO
NO
Tunisia
YES
YES
NO
Not addressed
Not
addressed
Not
addressed
Not addressed
Not addressed
Turkey
YES
YES
YES
NO
NO
NO
NO
NO
Unknown
Unknown
YES
Unknown
Unknown
Unknown
YES
YES
Uruguay
YES
YES
YES
YES
YES
YES
USA
YES
YES
YES
YES
YES
YES
YES
YES
UK
CHAPTER 23. Table 2 - Do people travel from your country to seek assisted reproduction?
Lower cost
ART services
Higher quality
ART services
ART services
unavailable in their
home country
Egg donation
Argentina
Unknown
Unknown
Unknown
Unknown
Australia
YES
Unknown
YES
YES
YES
Austria
NO
NO
NO
YES
YES
Unknown
YES
Country
Bangladesh
Embryo
donation
Sperm donation
Gestational
carriers
Traditional
surrogacy
Unknown
YES
Unknown
YES
YES
YES
YES
NO
YES
YES
Unknown
Unknown
Unknown
Unknown
Unknown
YES
YES
YES
YES
YES
Barbados
Belarus
YES
Belgium
NO
NO
YES
YES
YES
Unknown
Unknown
Unknown
Brazil
NO
YES
YES
YES
NO
NO
Unknown
Unknown
Bulgaria
YES
YES
YES
YES
NO
YES
NO
NO
Cameroon
YES
YES
YES
YES
YES
Canada
YES
Unknown
NO
YES
YES
Unknown
YES
Unknown
Chile
NO
NO
NO
NO
NO
NO
YES
YES
China
YES
YES
NO
NO
NO
NO
NO
NO
Colombia
YES
YES
YES
YES
YES
YES
Unknown
Unknown
Czech Republic
NO
NO
YES
NO
NO
NO
YES
Denmark
Ecuador
YES
El Salvador
YES
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
Estonia
NO
Unknown
YES
Unknown
Unknown
Unknown
YES
Unknown
Finland
NO
NO
YES
NO
NO
NO
YES
YES
France
NO
NO
YES
YES
YES
YES
YES
YES
Germany
YES
YES
YES
YES
YES
NO
YES
YES
Unknown
YES
NO
NO
NO
NO
NO
Unknown
Guatemala
NO
YES
YES
NO
Not
addressed
YES
YES
YES
Hong Kong
(China*)
YES
Greece
YES
Hungary
NO
NO
YES
YES
YES
NO
Unknown
Unknown
India
YES
YES
YES
YES
YES
YES
YES
Unknown
Iran
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not
addressed
Not addressed
Not
addressed
Not
addressed
Unknown
Ireland
YES
NO
YES
YES
YES
YES
Unknown
Israel
YES
YES
YES
YES
NO
NO
YES
Italy
YES
YES
YES
YES
YES
YES
YES
YES
Japan
YES
Jordan
Not
addressed
Kenya
Unknown
Malaysia
Mali
YES
YES
YES
YES
YES
Not addressed
Not addressed
Not
addressed
Not
addressed
YES
YES
Not addressed
YES
Unknown
Unknown
Unknown
NO
YES
YES
YES
Unknown
Unknown
Unknown
Unknown
YES
YES
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Not
addressed
Not
addressed
YES
Mexico
YES
YES
YES
YES
YES
YES
YES
Netherlands
NO
YES
YES
YES
YES
NO
NO
NO
Nigeria
YES
YES
YES
YES
YES
YES
YES
YES
Norway
YES
YES
YES
YES
YES
YES
NO
Panama
NO
YES
NO
NO
NO
NO
Paraguay
YES
YES
Not addressed
UNKNOWN
Unknown
Unknown
Unknown
Unknown
Peru
NO
NO
NO
NO
NO
NO
Philippines
YES
YES
Not addressed
NO
NO
NO
YES
YES
Portugal
NO
Unknown
YES
NO
NO
NO
YES
Unknown
Romania
NO
YES
NO
YES
YES
NO
NO
NO
NO
NO
NO
Russian
Federation
YES
YES
NO
Saudi Arabia
YES
YES
NO
NO
NO
Not
addressed
Not
addressed
Senegal
NO
YES
NO
YES
NO
YES
NO
NO
Singapore
YES
YES
YES
YES
Unknown
Unknown
YES
YES
Unknown
Slovak Republic
Unknown
Unknown
NO
YES
YES
YES
Unknown
South Africa
NO
NO
NO
NO
NO
NO
NO
NO
South Korea
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Spain
Not
addressed
Not addressed
Not addressed
Not addressed
Not
addressed
Not addressed
Not
addressed
Not
addressed
Sri Lanka
Unknown
Unknown
Sweden
Switzerland
NO
YES
YES
Unknown
YES
Unknown
YES
YES
YES
YES
YES
Unknown
Unknown
YES
NO
YES
YES
Unknown
NO
Unknown
Unknown
YES
YES
YES
Unknown
YES
YES
YES
NO
Unknown
NO
YES
YES
Unknown
YES
YES
Not addressed
Unknown
Unknown
Unknown
Unknown
Turkey
NO
YES
NO
YES
YES
YES
YES
YES
UK
YES
NO
YES
YES
YES
YES
Unknown
Unknown
Uruguay
YES
YES
YES
YES
YES
YES
USA
YES
NO
NO
NO
NO
NO
NO
NO
Taiwan (China*)
Trinidad and
Tobago
Tunisia
CHAPTER 23. Table 2 - Are there regulations that govern cross border reproduction in your country?
Participant Country
Argentina
Australia
Austria
No regulations
Bangladesh
No regulations
Federal/National Laws/Statutes/Ordinances
No regulations
Barbados
No regulations
No regulations
Belarus
Belgium
Federal/National Laws/Statutes/Ordinances
No regulations
Brazil
No regulations
No regulations
Bulgaria
No regulations
No regulations
Cameroon
No regulations
No regulations
Canada
No regulations
No regulations
Chile
No regulations
China
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
Colombia
No regulations
No regulations
Czech Republic
No regulations
No regulations
Denmark
No regulations
Federal/National Laws/Statutes/Ordinances
Ecuador
No regulations
No regulations
El Salvador
No regulations
Estonia
No regulations
No regulations
Finland
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
France
No regulations
No regulations
Germany
No regulations
Federal/National Laws/Statutes/Ordinances
Greece
Federal/National Laws/Statutes/Ordinances
No regulations
Guatemala
No regulations
No regulations
No regulations
Hungary
No regulations
No regulations
India
Iran
No regulations
No regulations
Ireland
No regulations
No regulations
Israel
No regulations
Italy
No regulations
No regulations
Japan
No regulations
No regulations
Jordan
No regulations
No regulations
Kenya
No regulations
No regulations
Malaysia
No regulations
No regulations
Mali
No regulations
No regulations
Mexico
No regulations
No regulations
Netherlands
No regulations
No regulations
Nigeria
No regulations
No regulations
Norway
Federal/National Laws/Statutes/Ordinances
No regulations
Panama
No regulations
No regulations
Paraguay
No regulations
No regulations
Peru
No regulations
No regulations
Philippines
No regulations
Portugal
No regulations
No regulations
Romania
No regulations
No regulations
Russian Federation
No regulations
No regulations
Saudi Arabia
Senegal
Unknown
Singapore
Federal/National Laws/Statutes/Ordinances
Slovak Republic
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
South Africa
No regulations
No regulations
South Korea
No regulations
Spain
No regulations
Sri Lanka
No regulations
No regulations
Switzerland
No regulations
No regulations
Taiwan (China*)
Federal/National Laws/Statutes/Ordinances
Federal/National Laws/Statutes/Ordinances
No regulations
No regulations
Tunisia
No regulations
No regulations
Turkey
State/Provincial/Regional Laws/Statutes/Ordinances
State/Provincial/Regional Laws/Statutes/Ordinances
UK
Federal/National Laws/Statutes/Ordinances
No regulations
Uruguay
No regulations
USA
No regulations
Unknown
Sweden
No regulations
CHAPTER 23. Table 4 - Are there regulations regarding the import of reproductive tissue into your country?
Country
Ova
Spermatozoa
Zygotes
Argentina
YES
YES
YES
Australia
YES
YES
YES
Austria
NO
NO
NO
Bangladesh
NO
NO
NO
Barbados
NO
NO
NO
Belarus
UNKNOWN
UNKNOWN
UNKNOWN
Belgium
YES
YES
YES
Brazil
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Bulgaria
Cameroon
NO
YES
NO
Canada
NO
YES
UNKNOWN
Chile
YES
YES
Not addressed
China
Not addressed
Not addressed
Not addressed
Colombia
YES
YES
YES
Czech Republic
YES
YES
YES
Denmark
YES
YES
YES
Ecuador
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Estonia
YES
YES
YES
Finland
YES
YES
YES
France
YES
YES
YES
Germany
YES
YES
YES
Greece
YES
YES
YES
Guatemala
NO
NO
NO
YES
YES
YES
Hungary
YES
YES
YES
India
YES
YES
YES
Iran
UNKNOWN
UNKNOWN
UNKNOWN
Ireland
YES
YES
YES
Israel
YES
YES
Italy
YES
YES
Japan
NO
NO
NO
Jordan
Not addressed
Not addressed
Not addressed
Kenya
NO
NO
NO
Malaysia
NO
NO
NO
Mali
NO
NO
NO
Mexico
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
El Salvador
Netherlands
YES
Nigeria
NO
NO
NO
Norway
YES
YES
YES
Panama
NO
NO
NO
Paraguay
Not addressed
Not addressed
Not addressed
Peru
NO
NO
NO
Philippines
YES
YES
YES
Portugal
YES
YES
YES
Romania
NO
YES
NO
Russian Federation
YES
YES
YES
Saudi Arabia
Senegal
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Singapore
YES
YES
YES
Slovak Republic
YES
YES
YES
South Africa
YES
YES
YES
South Korea
Not addressed
Not addressed
Not addressed
Spain
Sri Lanka
Sweden
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
YES
YES
YES
Switzerland
Taiwan (China*)
Trinidad and Tobago
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
UNKNOWN
Tunisia
Not addressed
Not addressed
Not addressed
Turkey
Not addressed
Not addressed
Not addressed
UK
YES
YES
YES
Uruguay
YES
YES
YES
USA
YES
YES
YES
CHAPTER 23. Table 5 - Are there regulations regarding the export of reproductive tissue into your country?
Country
Ova
Spermatozoa
Zygotes
Argentina
YES
YES
YES
Australia
YES
YES
YES
Austria
NO
NO
NO
Bangladesh
NO
NO
NO
Barbados
NO
NO
NO
Belarus
UNKNOWN
UNKNOWN
UNKNOWN
Belgium
YES
YES
YES
Brazil
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Bulgaria
Cameroon
Canada
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
Chile
YES
YES
Not addressed
China
Not addressed
Not addressed
Not addressed
Colombia
YES
YES
YES
Czech Republic
YES
YES
YES
Denmark
YES
YES
YES
Ecuador
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Estonia
YES
YES
YES
Finland
YES
YES
YES
France
YES
YES
YES
Germany
YES
YES
YES
Greece
YES
YES
YES
Guatemala
NO
NO
NO
NO
NO
NO
El Salvador
Hungary
UNKNOWN
UNKNOWN
UNKNOWN
India
YES
YES
YES
Iran
NO
NO
NO
Ireland
YES
YES
YES
Israel
NO
NO
NO
Italy
YES
YES
YES
Japan
NO
NO
NO
Jordan
Not addressed
Not addressed
Not addressed
Kenya
NO
NO
NO
Malaysia
NO
NO
NO
Mali
NO
NO
NO
Mexico
NO
NO
NO
UNKNOWN
UNKNOWN
UNKNOWN
Netherlands
Nigeria
NO
NO
NO
Norway
YES
YES
YES
Panama
NO
NO
NO
Paraguay
Not addressed
Not addressed
Not addressed
Peru
NO
NO
NO
Philippines
YES
YES
YES
Portugal
YES
YES
YES
Romania
YES
YES
YES
Russian Federation
YES
YES
YES
Saudi Arabia
YES
YES
YES
Senegal
NO
NO
NO
Singapore
YES
YES
YES
Slovak Republic
YES
YES
YES
South Africa
YES
YES
YES
South Korea
Not addressed
Not addressed
Not addressed
Spain
YES
YES
YES
UNKNOWN
UNKNOWN
UNKNOWN
Sweden
YES
YES
YES
Switzerland
YES
YES
YES
UNKNOWN
UNKNOWN
YES
Sri Lanka
Taiwan (China*)
Trinidad and Tobago
NO
NO
NO
Tunisia
Not addressed
Not addressed
Not addressed
Turkey
Not addressed
Not addressed
Not addressed
UK
YES
YES
YES
Uruguay
YES
YES
YES
USA
YES
YES
YES