Herman Tournaye

Les services médicaux d'aide à la reproduction peuvent-ils justifier leur discrimination envers les couples homosexuels?

RésuméBien quil existe de multiples moyens dobtenir lenfant désiré par les femmes homosexuelles, un nombre croissant de couples homosexuels se tournent vers les centres de médecine de la reproduction afin de réaliser des inséminations avec sperme de donneur. Cette pratique dinsémination de couples de femmes homosexuelles reste controversée dans le monde de la reproduction. Les données retrouvées dans la littérature ne démontrent aucun effet négatif sur le développement de lenfant né au sein dun couple homosexuel. Les seules objections à aider ces couples sont donc dordre purement éthique.AbstractAlthough lesbian women have a variety of ways to become mothers, an increasing number of lesbian couples attend fertility centres asking for donor insemination. The practice of inseminating lesbian couples remains a controversial topic within the reproductive medicine world. A review of the literature did not reveal harmful effects of lesbian motherhood on child development. Furthermore, this treatment is highly effective with an expected cumulative pregnancy rate of 60% after three intra-uterine inseminations with superovulation using clomifene citrate. The only objection to medically assisted procreation in these couples is therefore purely ethical. The extensive experience of the AZ-VUB Centre for Reproductive Medicine that played a pioneer role in this field, is illustrated in this article.

Pregnancy outcome and neonatal data on children born after ICSI with testicular sperm in obstructive and non-obstructive azoospermia

BACKGROUNDnRegistries on outcome of ICSI pregnancies obtained with testicular sperm do not differentiate between obstructive (OA) and non-obstructive azoospermia (NOA). We evaluated the pregnancy outcome and neonatal data on children born after ICSI using testicular sperm of men with histologically proven OA or NOA.nnnMETHODSnPregnancies obtained after ICSI using testicular sperm of men with defined NOA (n = 70) were compared with those of men with OA (n = 204).nnnRESULTSnMultiple birth rates in NOA and OA couples, respectively, were 21 versus 27% (P = NS), overall preterm delivery rates were 38 versus 26% (NS), and prematurity rates were 24 versus 13% for singletons (NS) and 86 versus 54% for twins (relative risk 1.59, 95% confidence interval 1.04-2.42). Median gestational age for singletons was 38.3 versus 39.3 weeks, respectively (P < 0.05). The low birth weight rates were 34 versus 31%, respectively (NS). The early perinatal mortality rate was 66 versus 15 per 1000 births, respectively, (NS). Major congenital malformations were observed in 4 versus 3%, respectively, of the live born babies (NS). Prenatal karyotypes showed 7% de-novo abnormalities in the NOA group versus 1% in the OA group (NS).nnnCONCLUSIONSnOur data do not show differences between NOA and OA pregnancies except for a strong tendency towards a lower gestational age in singletons and a higher percentage of premature twins in the NOA group. Although our data are based on a limited sample, the differences observed call for further analysis. Given the low pregnancy rates after ICSI with NOA, a multicentre study, differentiating NOA and OA patients, would be recommended.