Misplaced Pages

#473526

134-406: Artificial insemination may employ assisted reproductive technology , sperm donation and animal husbandry techniques. Artificial insemination techniques available include intracervical insemination ( ICI ) and intrauterine insemination ( IUI ). Where gametes from a third party are used, the procedure may be known as ' assisted insemination '. The first recorded case of artificial insemination

268-484: A Moscow court ruled that a single man who applied for gestational surrogacy (using donor eggs) could be registered as the only parent of his son, becoming the first man in Russia to defend his right to become a father through a court procedure. The surrogate mother’s name was not listed on the birth certificate ; the father was listed as the only parent. However, courts do not always take the side of such parents. In 2014,

402-573: A preimplantation genetic diagnosis (PGD, a potential expansion of IVF), which can be used for sex selection, such as in Iran and the United States . The rate of complications increases as more and more embryos are implanted. Many countries have no restriction on how many embryos may be transferred into the uterus at the same time, increasing the risk of multiple pregnancy and resultant potential complications. These complications may affect both

536-399: A sperm donor is used. Additionally, an egg donor may be used and so the recipient patient uses artificial insemination to carry a child that she is not genetically related to, and that may or may not be related to her partner (if she has one), depending on how the sperm is acquired. This is typically an option for women who are unable to use their own eggs due to age and/or health concerns and

670-613: A Moscow court denied registration of the baby born via surrogacy to the single man; the decision was upheld on appeal. Ukraine has seen a significant increase in international surrogacy since 2015, when the practice was banned in several Asian countries that had been popular destinations. Surrogacy is completely legal in Ukraine. However, only healthy mothers who have had at least one child before can become surrogates. Ukrainian surrogate mother are mostly from small towns or rural areas. The full surrogate package may cost around $ 50,000, with

804-783: A baby themselves for medical reasons. Also at least one parent must have a genetic link to the baby ( egg donors are therefore frequently used). Gay couples and single parents are prohibited to use gestational surrogates. Surrogacy is legally allowed in Belarus from 2006, however, major clients for such kind of services in this country are mainly Russian citizens. According to Belarusian legislation, surrogacy can be used here due to strict medical indications by married heterosexual couples and single women (for single women only in case they are able to provide their own oocytes). Unlike Russia or Ukraine, in Belarus Intended Mother

938-691: A certain degree, when other factors become limiting instead. n s can be further split into: n c may be split into: n s may be split into: Thus, the factors can be presented as follows: With these numbers, one sample would on average help giving rise to 0.1–0.6 children, that is, it actually takes on average 2–5 samples to make a child. Assisted reproductive technology Assisted reproductive technology ( ART ) includes medical procedures used primarily to address infertility . This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or

1072-498: A clomiphene treatment has a chance to establish a pregnancy in 8% of cycles and costs $ 780, the expected cost is $ 9,400 to establish a pregnancy, compared to an IVF cycle (cycle fecundity 40%) with a corresponding expected cost of $ 46,800 ($ 18,700 × 40%). For the community as a whole, the cost of IVF on average pays back by 700% by tax from future employment by the conceived human being. In Europe , 157,500 children were born using assisted reproductive technology in 2015, according to

1206-461: A couple would seek to use artificial insemination using the male partner's sperm. In the case of such couples, before artificial insemination is turned to as the solution, doctors will require an examination of both the male and female involved in order to remove any and all physical hindrances that are preventing them from naturally achieving a pregnancy including any factors which prevent the couple from having satisfactory sexual intercourse. The couple

1340-402: A cycle. The success rate increases with increasing TMSC, but only up to a certain count, when other factors become limiting to success. The summed pregnancy rate of two cycles using a TMSC of 5 million (may be a TSC of ~10 million on graph) in each cycle is substantially higher than one single cycle using a TMSC of 10 million. However, although more cost-efficient, using a lower TMSC also increases

1474-690: A fairly blatant breach of the NHS Constitution for England which provides that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS. For example, the Cheshire, Merseyside and West Lancashire Clinical Commissioning Group insists on additional conditions: Some treatments are covered by OHIP (public health insurance) in Ontario and others are not. Women with bilaterally blocked fallopian tubes and are under

SECTION 10

#1732791293474

1608-454: A favourable international surrogacy destination, as pregnant women in Canada receive high-quality, publicly funded healthcare throughout pregnancy, during delivery, and after birth. This reduces the risk of pregnancy complications, which is often a significant concern of commissioning parents. While surrogacy is unregulated in most regions of Mexico , many intended parents travel to Mexico for

1742-549: A few U.S. states also permit surrogacy for foreign commissioning parents, Canada does not discriminate on the basis of marital status or sexual orientation. Canada is also attractive because it is fairly efficient in granting legal parental rights, declaring legal parenthood and issuing birth certificates within weeks of birth. This contrasts with other countries with lengthier processes that often deter commissioning parents wanting to quickly return home with their new babies. Canada's strong and universal healthcare system also makes it

1876-405: A form of embryo profiling ), and sometimes even of oocytes prior to fertilization . PGD is considered in a similar fashion to prenatal diagnosis . PGD is an adjunct to ART procedures, and requires in vitro fertilization to obtain oocytes or embryos for evaluation. Embryos are generally obtained through blastomere or blastocyst biopsy. The latter technique has proved to be less deleterious for

2010-425: A form of medical tourism . A person who can become pregnant is considered to have fertility issues if they are unable to have a clinical pregnancy after 12 months of unprotected intercourse. Infertility , or the inability to get pregnant, affects about 8-12% of couples looking to conceive or 186 million people globally. In some places, rates of infertility surpass the global average and can go up to 30% depending on

2144-469: A fraction of the cost in Western Europe. Treatment prices are notably lower than in countries like UK, France, Germany, while success rates remain comparable to those in top European clinics. Chișinău, the capital, is home to modern clinics with skilled professionals who offer high-quality care, attracting patients from neighboring regions and Western Europe. Additionally, Moldova’s cost of living

2278-402: A higher risk of caesarean delivery and premature birth . In theory, ART can solve almost all reproductive problems, except for severe pathology or the absence of a uterus (or womb), using specific gamete or embryo donation techniques. However, this does not mean that all women can be treated with assisted reproductive techniques, or that all women who are treated will achieve pregnancy. As

2412-696: A low frequency of point mutations in the next generation. No significant differences were observed in the frequency or spectrum of mutations between naturally conceived fetuses and assisted-conception fetuses. This suggests that with respect to the maintenance of genetic integrity assisted conception is safe. Current data indicate little or no increased risk for postpartum depression among women who use ART. Study results indicate that ART can affect both women and men's sexual health negatively. Usage of assisted reproductive technology including ovarian stimulation and in vitro fertilization have been associated with an increased overall risk of childhood cancer in

2546-614: A maximum number of children one donor may produce. Prior to the change in the law, the limit in the number of children born to each donor depended upon practitioners at fertility clinics, and Belgian and Spanish clinics were purchasing donor sperm from abroad to satisfy demand for treatments. Anonymous donation was permitted in Belgium and is a legal requirement in Spain. These two countries also allowed single heterosexual and single and coupled lesbians to undergo fertility treatment. Ironically, at

2680-495: A meaningful answer, e.g. definition of success and calculation of the total population. These rates can be influenced by age, overall reproductive health, and if the patient had an orgasm during the insemination. The literature is conflicting on immobilization after insemination has increasing the chances of pregnancy. Previous data suggests that it is statistically significant for the patient to remain immobile for 15 minutes after insemination, while another review article claims that it

2814-592: A means of confused identity in a child and a disruption in traditional marital practices and procreation. Catholicism; however, generally views any third party involved in marriage or procreation to be an intrusion, and thus commonly views gestational surrogacy as an intrusion to the marital bond. Religion has led to legal bans on surrogacy in some countries. For instance, in Costa Rica the Catholic church successfully lobbied to ban surrogacy. Some countries, such as

SECTION 20

#1732791293474

2948-448: A medical setting, it is important to bring intimacy and family-centeredness into this process, as this promotes connectedness and inclusiveness in what can be seen as a hostile and discriminatory environment. LGBTQ couples or individuals typically have to navigate more complexities and barriers than heterosexual couples when undergoing fertility treatment, such as stigma and carrier decisions, so allowing room for intimacy and connectedness in

3082-461: A moderate male factor, the incapability to ejaculate in vagina and an idiopathic infertility. A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates . For the man, a TMS of more than 5 million per ml is optimal. In practice, donor sperm will satisfy these criteria and since IUI is a more efficient method of artificial insemination than ICI and, because of its generally higher success rate, IUI

3216-449: A more efficient delivery of the sperm. In general terms, IUI is usually regarded as more efficient than ICI or IVI. It is therefore the method of choice for single and lesbian women wishing to conceive using donor sperm since this group of recipients usually require artificial insemination because they do not have a male partner, not because they have medical problems. Owing to the high number of these recipients using donor sperm services, IUI

3350-405: A more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The woman lies on her back and the syringe is inserted into the vagina. Care is optimal when inserting the syringe, so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of

3484-514: A natural way as if the sperm had been deposited in the vagina through intercourse. The woman is therefore advised to lie still for about half-an-hour to assist conception. One insemination during a cycle is usually sufficient. Additional inseminations during the same cycle may not improve the chances of a pregnancy. Ordinary sexual lubricants should not be used in the process, but special fertility or 'sperm-friendly' lubricants can be used for increased ease and comfort. When performed at home without

3618-462: A number of countries (including Germany, Spain, and the UK) which use the somewhat vague notion of "natural age of procreation". In 2017, the steering council of France's Agency of Biomedicine established an age limit of 43 for women using ART. 10 countries have no age limit for ART. These include Austria, Hungary , Italy and Poland . Most European countries allow donations of gametes by third parties. But

3752-424: A partner, in the presence of her partner, or by her partner. ICI was previously used in many fertility centers as a method of insemination, but its popularity in this context has waned as other, more reliable methods of insemination have become available. During ICI, air is expelled from a needleless syringe which is then filled with semen which has been allowed to liquify. A specially-designed syringe, wider and with

3886-422: A private donor may be used. Semen supplied by a sperm bank prepared for ICI or IUI use is suitable for ICI. ICI is a popular method of insemination amongst single and lesbian women purchasing donor sperm on-line. Although ICI is the simplest method of artificial insemination, a meta-analysis has shown no difference in live birth rates compared with IUI. It may also be performed privately by the woman, or, if she has

4020-994: A result of the 1992 Fertility Clinic Success Rate and Certification Act, the CDC is required to publish the annual ART success rates at U.S. fertility clinics. Assisted reproductive technology procedures performed in the U.S. has over than doubled over the last 10 years, with 140,000 procedures in 2006, resulting in 55,000 births. In Australia , 3.1% of births in the late 2000's are a result of ART. The most common reasons for discontinuation of fertility treatment have been estimated to be: postponement of treatment (39%), physical and psychological burden (19%), psychological burden (14%), physical burden (6.32%), relational and personal problems (17%), personal reasons (9%), relational problems (9%), treatment rejection (13%) and organizational (12%) and clinic (8%) problems. Many Americans do not have insurance coverage for fertility investigations and treatments. Many states are starting to mandate coverage, and

4154-407: A sharp drop in the number of ART cycles carried out, from more than 102,000 in 2003 to fewer than 57,000 the following year. Since then the figure has remained stable. 17 countries limit access to ART according to the age of the woman. 10 countries have established an upper age limit, varying from 40 ( Finland , Netherlands ) to 50 (including Spain, Greece and Estonia). Since 1994, France is one of

Artificial insemination - Misplaced Pages Continue

4288-478: A study from 2021, lesbian women undergoing IUI had an average clinical pregnancy rate of 13.2% per cycle and 42.2% success rate giving the average number of cycles at 3.6. The rates of successful pregnancy for artificial insemination are 10-15% per menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles. However, these pregnancy rates may be very misleading, since many factors have to be included to give

4422-601: A top destination for infertility treatment for people in the United States. Women from countries such as the United States and the United Kingdom may travel for IVF treatment and medications to save money. The cost of one IVF cycle in the United States averages US $ 15,000, while for comparable treatment in Mexico it is about US $ 7,800, Thailand $ 6,500, India $ 3,300, and Iran $ 2,500. When calculating these costs,

4556-436: A tube attached which may be inserted empty into the vagina after which liquefied semen is poured into the tube. These methods are designed to ensure that semen is inseminated as close as possible to the cervix and that it is kept in place there to increase the chances of conception. Intrauterine insemination (IUI) involves injection of washed sperm directly into the uterus with a catheter . Insemination in this way means that

4690-406: A value on a certain height, age, eye colour, hair texture, blood type and ethnicity . According to sociology professor Lisa Jean Moore , there is "anecdotal evidence" that sperm from blonde, blue-eyed men is most in demand. Denmark has a well-developed system of sperm export. This success mainly comes from the reputation of Danish sperm donors for being of high quality and, in contrast with

4824-430: A want for a greater variety of gamete donors. Stricter laws or an inability to meet the criteria necessary in ones respective countries are other possible reasons. The practice is influenced by the attitudes and sperm donation laws in the host country . There is generally a demand for sperm donors who have no genetic problems in their family, 20/20 eyesight, with excellent visual acuity , a college degree, and sometimes

4958-602: A woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman." According to CDC, "they do not include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved." In Europe, ART also excludes artificial insemination and includes only procedures where oocytes are handled. The World Health Organization (WHO), also defines ART this way. Ovulation induction

5092-479: Is a central goal in Israel, a leading fertility tourism destination for in vitro fertilization (IVF) treatment with over three decades of major technologies in the assisted reproduction industry. The trajectory of assisted reproductive technology is outlined through the expansion of IVF, the globalization of donating gametes , and the privatization of service. Many Europeans travel to the United States because of

5226-400: Is a form of conception device , may be inserted into the vagina following insemination and may be left in place for several hours. Using this method, a woman may go about her usual activities while the cervical cap holds the semen in the vagina close to the entrance to the cervix. Advocates of this method claim that it increases the chances of conception. One advantage with the conception device

5360-575: Is a lack of laws or guidelines for surrogacy and many custody battles have resulted in outlawing surrogacy and deeming parental rights to the surrogate over the intended parents, or fully legalizing surrogacy all together. In countries where surrogacy is banned, there have been many instances where the intended parents go to different destination for surrogacy, but then have difficulty bringing their new children back to their countries. Also, there are some countries that ban commercial surrogacy, but allow unpaid "altruistic surrogacy" and also provide contracts to

5494-588: Is also allowed for married lesbian couples, as German parliament allowed same-sex marriages in Germany . In July 2020, the French Parliament allowed assisted reproductive technology also for lesbian couples and single women. Cuban sources mention that assisted reproduction is completely legal and free in the country. The Government of India has notified the Surrogacy (Regulation) Act 2021 and

Artificial insemination - Misplaced Pages Continue

5628-402: Is also given a fertility test to determine the motility, number, and viability of the male's sperm and the success of the female's ovulation. From these tests, the doctor may or may not recommend a form of artificial insemination. The results of investigations may, for example, show that the woman's immune system may be rejecting her partner's sperm as invading molecules. Women who have issues with

5762-430: Is also important. A female under 30 years of age has optimal chances with IUI; A promising cycle is one that offers two follicles measuring more than 16 mm, and estrogen of more than 500 pg/mL on the day of hCG administration. However, GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles according to a randomized controlled trial . One of

5896-529: Is also the main ART sought by Canadians traveling to the U.S, and is the sought procedure for 80% of cross-border treatments by Canadians. Sex selection is prohibited in many countries, including the United Kingdom , Australia and Canada , India , except when it is used to screen for genetic diseases. Some women wishing to be sure of a child's sex may travel to countries where it is legal to perform

6030-414: Is an exception, with a birth defect rate of almost a fifth compared to the general population. It may be explained by that sperm banks accept only people with high sperm count. Germ cells of the mouse normally have a frequency of spontaneous point mutations that is 5 to 10-fold lower than that in somatic cells from the same individual. This low frequency in the germline leads to embryos that have

6164-416: Is associated with an increased risk of birth defects. Artificial reproductive technology is becoming more available. Early studies suggest that there could be an increased risk for medical complications with both the mother and baby. Some of these include low birth weight, placental insufficiency, chromosomal disorders, preterm deliveries, gestational diabetes, and pre-eclampsia (Aiken and Brockelsby). In

6298-437: Is considered. Gestational surrogacy, even commercial is absolutely legal in Russia, being available for practically all adults willing to be parents. Foreigners have the same rights for assisted reproduction as Russian citizens. Within 3 days after the birth the commissioning parents obtain a Russian birth certificate with both their names on it. Genetic relation to the child (in case of donation) doesn’t matter. On 4 August 2010,

6432-414: Is critical, as the window and opportunity for fertilization is little more than twelve hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve

6566-418: Is directed at heterosexual couples. Indeed, many sperm banks seem reluctant to inform donors that most of their donations will be used for lesbians and single women. To improve the way society talks about and carries out donor insemination inclusive language may be used. One way to do this is to bring LGBTQ narratives into this process, with a particular emphasis on this being a family-centered process. Even in

6700-488: Is done via IVF . Some countries have laws which restrict and regulate who can donate sperm and who is able to receive artificial insemination. Some women who live in a jurisdiction which does not permit artificial insemination in the circumstance in which she finds herself may travel to another jurisdiction which permits it . Compared with natural insemination , artificial insemination can be more expensive and more invasive, and may require professional assistance. Timing

6834-506: Is growing. For specific examples, refer to the fiction sections in individual subarticles, e.g. surrogacy , sperm donation and fertility clinic . In addition, reproduction and pregnancy in speculative fiction has been present for many decades. Fertility tourism Fertility tourism (also referred to as reproductive tourism or cross border reproductive care ) is the practice of traveling to another country or jurisdiction for fertility treatment , and may be regarded as

SECTION 50

#1732791293474

6968-532: Is legal. The United States is occasionally sought as a location for surrogate mothers by couples seeking a green card in the US, since the resulting child can get birthright citizenship in the United States and can thereby apply for green cards for the parents when the child turns 21 years of age. Surrogacy costs in USA between $ 95,000 and $ 150,000 for the complete package, including fertilization, legal fees, compensation,

7102-524: Is no limit as to how many families may use the donation of one sperm donor. Some countries such as United Kingdom and Sweden , have a shortage of sperm donors . Sweden now has an 18-month-long waiting list for donor sperm. As a consequence of the shortage of donor sperm in UK in the late 1990s and the early years of the 21st century, British women travelled to Belgium and Spain for donor insemination, until those two countries changed their laws and imposed

7236-457: Is not true for eggs, resulting in many Canadian women leaving the country for such procedures. There are differing amounts of laws and regulations on surrogacy around the world regarding the legality of surrogacy, who can be a surrogate or receive this service, if fertility tourism is legal, and if surrogates can be compensated for their services; dictate where potential parents travel to obtain surrogacy. For instance, there are places where there

7370-402: Is not. A point of consideration, is that it does cost the patient or healthcare system to remain immobile for 15 minutes if it does increase the chances. For couples with unexplained infertility , unstimulated IUI is no more effective than natural means of conception. The pregnancy rate also depends on the total sperm count , or, more specifically, the total motile sperm count (TMSC), used in

7504-558: Is one of the more cost-effective avenues to parenting. While clinic based IUI may be open to many, it typically still includes hetero-reproductive narratives which dates from the early days of fertilization procedures when these were often exclusively for married couples and when there was a resistance in many societies to extend these services to the LGBTQ+ community. Indeed, in the early days, there were very few fertility clinics which would provide services to single women and lesbian couples. In

7638-408: Is only available to heterosexual couples, married or otherwise, and sperm donation is prohibited. Today, 21 countries provide partial public funding for ART treatment. The seven others, which do not, are Ireland , Cyprus , Estonia , Latvia , Luxembourg , Malta , and Romania . Such subsidies are subject to conditions, however. In Belgium , a fixed payment of €1,073 is made for each full cycle of

7772-405: Is that fresh, non-liquefied semen may be used. The man may ejaculate straight into the cap so that his fresh semen can be inserted immediately into the vagina without waiting for it to liquefy, although a collection cup may also be used. Other methods may be used to insert semen into the vagina notably involving different uses of a conception cap. These include a specially designed conception cap with

7906-400: Is therefore the most popular method of insemination today at a fertility clinic. The term 'artificial insemination' has, in many cases, come to mean IUI insemination. It is important that washed sperm is used because unwashed sperm may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins . (Prostaglandins are also the compounds responsible for causing

8040-432: Is usually the insemination procedure of choice for single women and lesbians using donor semen in a fertility centre. Lesbians and single women are less likely to have fertility issues of their own and enabling donor sperm to be inserted directly into the womb will often produce a better chance of conceiving. A 2019 showed that pregnancy rates were similar between lesbian women and heterosexual women undergoing IUI. However, it

8174-448: Is usually used in the sense of stimulation of the development of ovarian follicles by fertility medication to reverse anovulation or oligoovulation . These medications are given by injection for 8 to 14 days. A health care provider closely monitors the development of the eggs using transvaginal ultrasound and blood tests to assess follicle growth and estrogen production by the ovaries. When follicles have reached an adequate size and

SECTION 60

#1732791293474

8308-429: Is very affordable, which makes travel, accommodation, and overall expenses significantly lower than in many other fertility destinations. This combination of low treatment and living costs with high success rates has made Moldova an appealing and accessible choice for individuals seeking fertility treatments abroad. India and other Asian countries are the main destinations for U.S. women seeking fertility treatment, being

8442-619: Is written not only in the legal birth certificate issued by local authorities, but also appear in the medical birth certificate given by the Maternity House, where delivery of the surrogate mother took place. This gives to the Intended Parents legal ability to take baby directly from the Maternity house, being sure that no one will claim parental rights over the children born via surrogacy. In Belarus only healthy women in

8576-695: The European Society of Human Reproduction and Embryology (ESHRE). But there are major differences in legislation across the Old Continent. A European directive fixes standards concerning the use of human tissue and cells, but all ethical and legal questions on ART remain the prerogative of EU member states . Across Europe, the legal criteria per availability vary somewhat. In 11 countries all women may benefit; in 8 others only heterosexual couples are concerned; in 7 only single women; and in 2 ( Austria and Germany ) only lesbian couples. Spain

8710-584: The Federal Constitutional Court ruled that it is unconstitutional, that the health insurance companies have to bear only 50% of the cost for IVF. On 2 March 2012, the Federal Council has approved a draft law of some federal states, which provides that the federal government provides a subsidy of 25% to the cost. Thus, the share of costs borne for the pair would drop to just 25%. Since July 2017, assisted reproductive technology

8844-449: The fertile window during ovulation. However, a randomized trial of insemination after ovarian hyperstimulation found no difference in live birth rate between single and double intrauterine insemination. A Cochrane found uncertain evidence about the effect of IUI compared with timed intercourse or expectant management on live birth rates but IUI with controlled ovarian hyperstimulation is probably better than expectant management. Due to

8978-523: The vagina during sexual intercourse . It is painless and is the simplest, easiest and most common method of artificial insemination involving the introduction of unwashed or raw semen into the vagina at the entrance to the cervix , usually by means of a needleless syringe. ICI is commonly used in the home, by self-insemination and practitioner insemination. Sperm used in ICI inseminations does not have to be 'washed' to remove seminal fluid so that raw semen from

9112-454: The 1950s in research conducted by University of Iowa medical school researchers Jerome K. Sherman and Raymond Bunge. In the United Kingdom, the British obstetrician Mary Barton founded one of the first fertility clinics to offer donor insemination in the 1930s, with her husband Bertold Wiesner fathering hundreds of offspring. In the 1980s, direct intraperitoneal insemination (DIPI)

9246-809: The Assisted Reproductive Technology (Regulation) Act 2021 to regulate the practice of ART. Prior to that, the National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India published by the Ministry for Health and Family Welfare, Government of India in the year 2005 was governing the field. Indian law recognises the right of a single woman, who is a major, to have children through ART. Some couples may find it difficult to stop treatment despite very bad prognosis, resulting in futile therapies. This has

9380-454: The IVF process, to help women work through some of these mixed emotions. Films and other fiction depicting emotional struggles of assisted reproductive technology have had an upswing in the latter part of the 2000s decade, although the techniques have been available for decades. As ART becomes more utilized, the number of people that can relate to it by personal experience in one way or another

9514-459: The IVF process. The woman must be aged under 43 and may not carry out more than six cycles of ART. There is also a limit on the number of transferable embryos, which varies according to age and the number of cycles completed. In France, ART is subsidized in full by national health insurance for women up to age 43, with limits of 4 attempts at IVF and 6 at artificial insemination. Germany tightened its conditions for public funding in 2004, which caused

9648-536: The NHS and there can be long waiting lists. Many patients therefore pay for immediate treatment within the NHS or seek help from private clinics. In 2013, the National Institute for Health and Care Excellence (NICE) published new guidelines about who should have access to IVF treatment on the NHS in England and Wales. The guidelines say women aged between 40 and 42 should be offered one cycle of IVF on

9782-459: The NHS if they have never had IVF treatment before, have no evidence of low ovarian reserve (this is when eggs in the ovary are low in number, or low in quality), and have been informed of the additional implications of IVF and pregnancy at this age. However, if tests show IVF is the only treatment likely to help them get pregnant, women should be referred for IVF straight away. This policy is often modified by local Clinical Commissioning Groups , in

9916-729: The UK, notable pioneers in this respect were the British Pregnancy Advisory Service (BPAS) and the Pregnancy Advisory Service (PAS), both of which operated before statutory control of fertility services in 1992, and the London Women's Clinic (LWC) which provided artificial insemination to single women and lesbians from 1998. Most donor insemination procedures undertaken in many countries today are for lesbian couples or single mainly lesbian women, yet much of their rhetoric and advertising

10050-516: The United States, Canada, Georgia, Ukraine, and Russia are popular foreign surrogacy destinations. Eligibility, processes and costs differ from country to country. Previously popular destinations, India, Nepal, Thailand, and Mexico have since 2014 banned commercial surrogacy for non-residents or allow it only for heterosexual married couples. Thailand criminalized surrogacy by foreigners and same-sex couples in 2014, prompted by incidents of surrogate parents behaving badly. The most notable of those cases

10184-708: The age from 20 to 35 years old, who are in legal marriage and have at least one healthy child can be surrogate mothers. Essential conditions of surrogacy agreement, that should be notarized, are also specified in the Law "On Assisted Reproductive Technologies". People travel to the United States for surrogacy procedures for the high quality of medical technology and care, as well as the high level of legal protections afforded through some US state courts to surrogacy contracts as compared to other countries. Increasingly, same sex couples who face restrictions using IVF and surrogacy procedures in their home countries travel to US states where it

10318-554: The age of 40 have treatment covered but are still required to pay test fees (around CA$ 3,000–4,000). Coverage varies in other provinces. Most other patients are required to pay for treatments themselves. Israel's national health insurance, which is mandatory for all Israeli citizens, covers nearly all fertility treatments. IVF costs are fully subsidized up to the birth of two children for all Israeli women, including single women and lesbian couples. Embryo transfers for purposes of gestational surrogacy are also covered. On 27 January 2009,

10452-558: The agency's fee. Canada has recently become a more popular foreign surrogacy destination, with almost half the babies born to Canadian surrogates in British Columbia in 2016 and 2017 being for foreign parents. Numerous reasons have been proposed to explain Canada's rising popularity as an international surrogacy destination. For one, Canada is one of the few destinations that still allows surrogacy for foreign commissioning parents. While, Greece, Ukraine, Russia, Georgia and

10586-487: The average time taken to achieve pregnancy. Women whose age is becoming a major factor in fertility may not want to spend that extra time. The number of samples (ejaculates) required to give rise to a child varies substantially from person to person, as well as from clinic to clinic. However, the following equations generalize the main factors involved: For intracervical insemination : The pregnancy rate increases with increasing number of motile sperm used, but only up to

10720-480: The cervix – such as cervical scarring, cervical blockage from endometriosis , or thick cervical mucus – may also benefit from artificial insemination, since the sperm must pass through the cervix to result in fertilization. Nowadays artificial insemination in humans is mainly used as a substitute for sexual intercourse for women without a male partner who wish to have their own children—such as women in lesbian relationships and single women—and thus where sperm from

10854-404: The child's genetic parents must be a U.S. citizen for the child to be considered a U.S. citizen. In other words, the only way for the child to acquire U.S. citizenship automatically at birth is if he/she is biologically related to a U.S. citizen. Further, in some countries, the child will not be a citizen of the country in which he/she is born because the surrogate mother is not legally the parent of

10988-473: The child. This could result in a child being born without citizenship. There are many differing religious views surrounding surrogacy with regards to lineage and heritability, motherhood, and marital fidelity. Judaism , Hinduism , Islam , and other Christian denominations outside of Catholicism generally approve of surrogacy, but each with some concerns. With Judaism, there are concerns regarding legitimacy and most tend to believe that motherhood belongs to

11122-461: The cost is relatively low, and which give the intended parents legal rights over the newborn child, whether by streamlined adoption procedures or direct parental rights. India was a main destination for surrogacy because of the relatively low cost until international surrogacy was outlawed in 2015. Although there are no official figures available, a 2012 United Nations report counted around 3,000 fertility clinics in India. India's surrogacy business

11256-641: The costs of flight tickets, medical procedures and hotels, this represented roughly a third of the price of the procedure in the UK and a fifth of that in the US. In 2013, surrogacy by foreign homosexual couples and single parents was banned. In 2015, the government banned commercial surrogacy in India and permitted entry of embryos only for research purposes. Liberal legislation makes Russia attractive for "reproductive tourists" looking for techniques not available in their countries. Intended parents come there for oocyte donation, because of advanced age or marital status (single women and single men) and when surrogacy

11390-550: The costs of the hotel, travel, and hospital stay may also be considered in addition to the medical treatment. Egg donation is illegal in a number of European countries including Germany , Austria , and Italy . Many women then will seek treatment in places where the procedure is allowed, such as Spain and the United States where donors can be paid for their donation. Almost half of all IVF treatments with donor eggs in Europe are performed in Spain. IVF with anonymous egg donation

11524-748: The country. Areas with lack of resources, such as assisted reproductive technologies (ARTs), tend to correlate with the highest rates of infertility. The main procedures sought are in vitro fertilization (IVF), artificial insemination by a donor, as well as surrogacy . These methods are types of assisted reproductive technology (ARTs). Each of these three methods have varying popularity in different countries, with one method being more sought after in these destinations compared to another method in another country. People are mainly driven towards fertility tourism due to lack of resources and high costs, while other contributing factors include cultural, religious, legal, and safety and efficacy issues. Other impacts on

11658-603: The destinations for 40% of U.S. women seeking IVF and 52% seeking IVF with egg donation. The success rate of embryonic transfer through IVF has continually increased, resulting in more pregnancy outcomes. In recent years, Mexico has become a destination for cross-border IVF treatment due to its liberal ART and egg donation policies with over 50 clinics throughout the country that utilize assisted reproductive technology. Mexico does not have legal regulations that restrict or prohibit IVF or egg donations in Mexican clinics, making it

11792-549: The eggs are mature enough, an injection of the hormone hCG initiates the ovulation process. Egg retrieval should occur from 34 to 36 hours after the hCG injection. In vitro fertilization is the technique of letting fertilization of the male and female gametes (sperm and egg) occur outside the female body. Techniques usually used in in vitro fertilization include: Less commonly used techniques in in vitro fertilization are: A pre-implantation genetic diagnosis procedure may be conducted on embryos prior to implantation (as

11926-593: The embryo, therefore it is advisable to perform the biopsy around day 5 or 6 of development. Sex selection is the attempt to control the sex of offspring to achieve a desired sex in case of X chromosome linked diseases. It can be accomplished in several ways, both pre- and post-implantation of an embryo, as well as at birth. Pre-implantation techniques include PGD, but also sperm sorting . Other assisted reproduction techniques include: The majority of IVF-conceived infants do not have birth defects . However, some studies have suggested that assisted reproductive technology

12060-417: The fallopian tube where fertilization takes place. Although many fertilization procedures, such as IUI are typically carried out in a medical setting, society is increasingly recognizing the important role that this plays in the lives of individuals who might otherwise not conceive through heterosexual penetrative sexual intercourse. Artificial insemination using a sperm donor for LGBTQ+ individuals and couples

12194-653: The first option to consider, as there are occasions when its cause is a mild disorder that can be solved with more conventional treatments or with behaviors based on promoting health and reproductive habits. With ART, the process of sexual intercourse is bypassed and fertilization of the oocytes occurs in the laboratory environment (i.e., in vitro fertilization ). In the US, the Centers for Disease Control and Prevention (CDC) defines ART to include "all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from

12328-405: The first two cycles of ovarian hyperstimulation and IUI. However, for women aged over 40 years, there appears to be no benefit after a single cycle of COH/IUI. Medical experts therefore recommend considering in vitro fertilization after one failed COH/IUI cycle for women aged over 40 years. A double intrauterine insemination theoretically increases pregnancy rates by decreasing the risk of missing

12462-609: The higher success rates and more liberal regulations under the Fertility Clinic Success Rate and Certification Act, which was passed in 1992. In the United States, affiliation between the right and left sides of the political spectrum motivated the protection of human life, even during the in vitro embryonic stages. Moldova has become a popular fertility tourism destination in  Europe due to its highly competitive pricing for assisted reproductive technologies (ARTs) like in vitro fertilization (IVF), often at

12596-488: The identity of the donor when they reach adulthood. In France, the principle of anonymous donations of sperm or embryos is maintained in the law of bioethics of 2011, but a new bill under discussion may change the situation. In the United Kingdom, all patients have the right to preliminary testing, provided free of charge by the National Health Service (NHS). However, treatment is not widely available on

12730-505: The insurance plan, state policies and regulations, and the underlying cause of infertility. Several states have mandated insurers to provide coverage for infertility services. IUI can be used in conjunction with controlled ovarian hyperstimulation (COH). Clomiphene Citrate is the first line, Letrozole is second line, in order to stimulate ovaries before moving on to IVF. Still, advanced maternal age causes decreased success rates; women aged 38–39 years appear to have reasonable success during

12864-533: The involved parties. The citizenship and legal status of a child resulting from surrogacy can be problematic. The Hague Conference Permanent Bureau identified the question of citizenship of these children as a "pressing problem" in the Permanent Bureau 2014 Study (Hague Conference Permanent Bureau, 2014a: 84-94). According to the Bureau of Consular Affairs, U.S. Department of State, either one or both of

12998-405: The lack of reliable evidence from controlled clinical trials, it is not certain which semen preparation techniques are more effective (wash and centrifugation; swim-up; or gradient) in terms of pregnancy and live birth rates. Intrauterine tuboperitoneal insemination (IUTPI) involves injection of washed sperm into both the uterus and fallopian tubes . The cervix is then clamped to prevent leakage to

13132-446: The largest U.S. study, which used data from a statewide registry of birth defects, 6.2% of IVF-conceived children had major defects, as compared with 4.4% of naturally conceived children matched for maternal age and other factors ( odds ratio , 1.3; 95% confidence interval , 1.00 to 1.67). ART carries with it a risk for heterotopic pregnancy (simultaneous intrauterine and extrauterine pregnancy). The main risks are: Sperm donation

13266-423: The law in the other Nordic countries, gives donors the choice of being either anonymous or non-anonymous to the receiving couple. The maximum amount of families that may use the sperm of one donor is capped at 12. Nordic sperm donors tend to be tall, with rarer features like blond hair or different color eyes and a light complexion, and highly educated and have altruistic motives for their donations, partly due to

13400-401: The lubricant can inhibit the sperm motility. When an ovum is released, semen is introduced into the woman's vagina , uterus or cervix , depending on the method being used. Sperm is occasionally inserted twice within a 'treatment cycle'. Intracervical insemination (ICI) is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into

13534-583: The mother and the child. Birth defects have been thought to arise from IVF, however not enough information is available on this topic. In 2005, 35% of all IVF–ET births in the US were multiple births (twins, triplets, or more). The burden of multiple births generated by placing too many embryos is carried by the individuals and the home country. Two thousand babies are born from treatments using sperm donations every year. A woman may go to another country to obtain artificial insemination by donor. The motivation to seek donors from outside countries may come from

13668-463: The myometrium to contract and expel the menses from the uterus, during menstruation .) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate. Using this technique, as with ICI, fertilization takes place naturally in the external part of the fallopian tubes in the same way that occurs following intercourse. For heterosexual couples, the indications to perform an intrauterine insemination are usually

13802-772: The need for fertility treatments from other countries include those who are infertile, single, of older age, or identify as a part of the LGBTQIA+ community. With these rising conditions, people end up having to travel to other countries in order to get the fertility treatments not accessible to them in their home countries. About 20,000 to 25,000 women (often accompanied by their partners) annually seek cross-border assisted reproductive technology (ART) services. Some countries are more popular than others as IVF destinations due to higher success rates and fewer regulations. Even small countries such as Barbados provide JCI-accredited IVF treatment aimed at women from abroad. Reproduction

13936-738: The offspring, which may be caused by the same original disease or condition that caused the infertility or subfertility in the mother or father. That said, In a landmark paper by Jacques Balayla et al. it was determined that infants born after ART have similar neurodevelopment than infants born after natural conception. ART may also pose risks to the mother. A large US database study compared pregnancy outcomes among 106,000 assisted conception pregnancies with 34 million natural conception pregnancies. It found that assisted conception pregnancies were associated with an increased risk of cardiovascular diseases , including acute kidney injury and arrhythmia . Assisted conception pregnancies were also associated with

14070-421: The person who actively delivers the child. Hinduism views infertility as a curse to be cured by any means necessary, generally approving of surrogacy. There is Islamic religious concern centered mainly around the importance of and confusion of lineage and inheritance. Other Christian denominations have a wide variety of views from encouraging surrogacy as it shares the blessing of parenthood, to viewing surrogacy as

14204-403: The potential to give ART providers a difficult decision of whether to continue or refuse treatment. Some assisted reproductive technologies have the potential to be harmful to both the mother and child, posing a psychological and/or physical health risk, which may impact the ongoing use of these treatments. In Israel, there is research supporting using ART, including recycled lab materials from

14338-427: The preferred technique over intrauterine insemination. Intratubal insemination (ITI) involves injection of washed sperm into the fallopian tube , although this procedure is no longer generally regarded as having any beneficial effect compared with IUI. ITI however, should not be confused with gamete intrafallopian transfer , where both eggs and sperm are mixed outside the woman's body and then immediately inserted into

14472-439: The presence of a professional, aiming the sperm in the vagina at the neck of the cervix may be more difficult to achieve and the effect may be to 'flood' the vagina with semen, rather than to target it specifically at the entrance to the cervix. This procedure is sometimes referred to as ' intravaginal insemination' (IVI). Sperm supplied by a sperm bank will be frozen and must be allowed to thaw before insemination. The sealed end of

14606-426: The process can improve the experience for individuals, reduce stress, and minimize barriers that target marginalized individuals. Lesbian couples may either select a friend or family member as their sperm donor or choose an anonymous donor. After a sperm donor is selected, a couple can proceed with donor sperm IUI. IUI is an economic option for same-sex couples and can be done without the use of medication. According to

14740-584: The prominent private clinic in Europe has published a data A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were associated with the live-birth rate The steps to follow in order to perform an intrauterine insemination are: The cost breakdown for Intrauterine Insemination (IUI) involves several components. The procedure itself typically ranges from $ 300 to $ 1,000 per cycle without insurance. The cost of

14874-487: The purpose of surrogacy. Mexico is one of only several countries in the world which allow foreigners, LGBTQ+ couples, and single intended parents to access surrogacy. The legality of surrogacy was confirmed by the 2021 ruling by the Supreme Court of Mexico which found that restrictions placed on access to surrogacy based on marital status, sexuality, or nationality unconstitutional. The cost of surrogacy in Mexico

15008-412: The rate of use is 278% higher in states with complete coverage. There are some health insurance companies that cover diagnosis of infertility, but frequently once diagnosed will not cover any treatment costs. Approximate treatment/diagnosis costs in the United States, with inflation, as of 2023 (US$ ): Another way to look at costs is to determine the expected cost of establishing a pregnancy. Thus, if

15142-433: The recipient patient's partner or by a sperm donor whose identity is known or unknown. Artificial insemination techniques were originally used mainly to assist heterosexual couples to conceive where they were having difficulties, but with the advancement of techniques in this field, notably ICSI , the use of artificial insemination for such couples has largely been rendered unnecessary. However, there are still reasons why

15276-439: The recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm. Semen used is either fresh, raw, or frozen. Where donor sperm is supplied by a sperm bank, it will always be quarantined and frozen, and will need to be thawed before use. The sperm is ideally donated after two or three days of abstinence, without lubrication as

15410-642: The relatively low monetary compensation in Nordic countries. More than 50 countries worldwide are importers of Danish sperm, including Paraguay , Canada , Kenya , and Hong Kong . US sperm is equally sought out for. Denmark and the United States both claim that they have the largest sperm bank supply. Specifically, the California Cryobank believes it is the largest sperm bank in the world. The donations from this sperm bank has reached over 100 countries and accounts for over 75,000 births globally. There

15544-406: The sample to ensure that he does not carry a transmissible disease. Sperm from a sperm bank will also be suspended in a semen extender which assists with freezing, storing and shipping. If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to

15678-421: The semen in the vagina. The syringe (and catheter if used) may be left in place for several minutes before removal. The woman can bring herself to orgasm so that the cervix 'dips down' into the pool of semen, again replicating closely vaginal intercourse, and this may improve the success rate. Following insemination, fertile sperm will swim through the cervix into the uterus and from there to the fallopian tubes in

15812-475: The situations vary depending on whether sperm or eggs are concerned. Sperm donations are authorized in 20 EU member states; in 11 of them anonymity is allowed. Egg donations are possible in 17 states, including 8 under anonymous conditions. On 12 April, the Council of Europe adopted a recommendation which encourages an end to anonymity. In the UK, anonymous sperm donations ended in 2005 and children have access to

15946-420: The sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus. Donor sperm is sometimes tested for mucus penetration if it is to be used for ICI inseminations but partner sperm may or may not be able to pass through the cervix. In these cases, the use of IUI can provide

16080-513: The sperm may vary widely, with prices per vial ranging from $ 500 to $ 1,000 or more from a sperm bank. Additional expenses might include consultation fees, ovulation-inducing medication, ultrasounds, and blood tests. The extent of insurance coverage for fertility treatments, including Intrauterine Insemination (IUI), varies considerably. Some insurance plans may cover some of the costs, while others may not provide any financial support for fertility treatments. Coverage depends on various factors, such as

16214-417: The straw itself must be cut off and the open end of the straw is usually fixed straight on to the tip of the syringe, allowing the contents to be drawn into the syringe. Sperm from more than one straw can generally be used in the same syringe. Where fresh semen is used, this must be allowed to liquefy before inserting it into the syringe, or alternatively, the syringe may be back-loaded. A conception cap, which

16348-453: The success rate of artificial insemination, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth. Sperm can be provided fresh or washed . Washed sperm is required in certain situations. Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank will be frozen and quarantined for a period, and the donor will be tested before and after production of

16482-462: The surrogate receiving less than 50% of that amount. Surrogates in Ukraine have zero parental rights over the child, as stated on Article 123 of the Family Code of Ukraine. Thus, a surrogate cannot refuse to hand the baby over in case she changes her mind after birth. Only married couples can legally go through gestational surrogacy in Ukraine, but they have to be able to prove they cannot carry

16616-404: The syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is to replicate as closely as possible a natural deposit of

16750-662: The time, many Belgian and Spanish clinics were buying sperm from British clinics donated by British donors, and they were able to use that sperm according to local laws and limits. In addition, lesbian women from France and eastern Europe travelled to these countries in order to achieve a pregnancy by an anonymous donor since this treatment was not available to them in their own countries. British fertility tourists must therefore now travel to other countries particularly those that do not include children born to foreigners in their national totals of children produced by each donor. Britain also imports donor sperm from Scandinavia but can only limit

16884-491: The use of fertility medication . When used to address infertility, ART may also be referred to as fertility treatment. ART mainly belongs to the field of reproductive endocrinology and infertility . Some forms of ART may be used with regard to fertile couples for genetic purpose (see preimplantation genetic diagnosis ). ART may also be used in surrogacy arrangements, although not all surrogacy arrangements involve ART. The existence of sterility will not always require ART to be

17018-418: The use of that donor's sperm to ten families in the UK itself, so that more children may be produced elsewhere from the same donor. At least 250 Swedish sperm recipients travel to Denmark annually for insemination. Some of this is also due to that Denmark also allows single women to be inseminated. It is illegal to pay donors for eggs or sperm in Canada. Women can still import commercial U.S. sperm, but that

17152-616: The vagina, best achieved with a specially designed double nut bivalve (DNB) speculum. The sperm is mixed to create a volume of 10 ml, sufficient to fill the uterine cavity , pass through the interstitial part of the tubes and the ampulla , finally reaching the peritoneal cavity and the Pouch of Douglas where it would be mixed with the peritoneal and follicular fluid . IUTPI can be useful in unexplained infertility , mild or moderate male infertility, and mild or moderate endometriosis. In non-tubal sub fertility, fallopian tube sperm perfusion may be

17286-527: Was John Hunter in 1790, who helped impregnate a linen draper's wife. The first reported case of artificial insemination by donor occurred in 1884: William H. Pancoast , a professor in Philadelphia, took sperm from his "best looking" student to inseminate an anesthetized woman without her knowledge. The case was reported 25 years later in a medical journal. The sperm bank was developed in Iowa starting in

17420-409: Was estimated at around $ 1 billion annually. Indian surrogates became increasingly popular amongst intended parents in industrialized nations because of the relatively low costs and easy access offered by Indian surrogacy agencies. Clinics charged people between $ 10,000 and $ 28,000 for the complete package, including fertilization, the surrogate's fee, and delivery of the baby at a hospital. Including

17554-413: Was found that there is a significantly higher multiple gestation rate among lesbian women undergoing ovulation induction (OI) when compared to lesbian women undergoing natural cycles. Unlike ICI, intrauterine insemination normally requires a medical practitioner to perform the procedure. One of the requirements is to have at least one permeable tube, proved by hysterosalpingography. The infertility duration

17688-417: Was occasionally used, where doctors injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting them find the oocyte at the ovary or after entering the genital tract through the ostium of the fallopian tube . There are multiple methods used to obtain the semen necessary for artificial insemination, and the sperm used in artificial insemination may be provided by

17822-555: Was that of Baby Gammy , a twin born with Down syndrome and left behind by the Australians who contracted his birth (his sister, who was not born with the disorder, was taken with them to Australia). It did not help that Gammy's biological father was also a convicted sex offender. Fertility tourism for surrogacy is driven by legal restrictions in the home country or the incentive of lower prices abroad. Popular destinations are those which permit commercial gestational surrogacy , where

17956-571: Was the first European country to open ART to all women, in 1977, the year the first sperm bank was opened there. In France , the right to ART is accorded to all women since 2019. In the last 15 years, legislation has evolved quickly. For example, Portugal made ART available in 2006 with conditions very similar to those in France, before amending the law in 2016 to allow lesbian couples and single women to benefit. Italy clarified its uncertain legal situation in 2004 by adopting Europe's strictest laws: ART

#473526