Summer Institute on Assisted Reproduction

June 3-5, 2024, UCS Research Centre, INRS, 385 Sherbrooke street East, Montréal, Québec, H2X 1E3 (next to Sherbrooke metro station)

Full program

Monday, June 3, 2024

• 10.30 am: Theme 1 – Experiences of Infertility

  Fertility disruptors (Géraldine Delbès, Institut national de la recherche scientifique, Centre Armand Frappier Santé Biotechnologies)

  For more than half a century, statistics have shown that human reproduction is in decline. Indeed, the birth rate has been falling globally since the 1950s. Although this rate can be influenced by social changes and conscious decisionmaking, there is a great deal of evidence pointing to the negative influence of environmental toxins on reproduction. Furthermore, the global increase in demand for fertility clinics (Kushnir, Barad et al. 2017) is a good indicator of the increase in reproductive abnormalities. Professor Delbès’ presentation will address the epidemiological and experimental evidence related to how environmental influences impact reproduction. By detailing the important advances enabling improved understandings of reproductive physiology, endocrinology, genetics and epigenetics, this presentation will address the known effects of lifestyle and the chemical environment.

  Fertility treatments: Burdens and premature discontinuation (Katherine Péloquin, Université de Montréal)

  Despite advances in assisted reproduction (AR), the arduous nature of fertility treatments prompts 20-30% of couples to discontinue them before pregnancy, even in cases where the prognosis is favorable and financial means are available. While the World Health Organization considers adherence to treatment to be essential to its efficacy, fundamental knowledge of fertility treatment adherence and the factors associated with premature discontinuation is lacking. Existing retrospective studies attribute discontinuation to the physical and psychological burden of treatment, and to the relational tensions arising from the AR process. However, understanding of the precise nature of the psychological and relational issues that influence this decision to discontinue treatment remains limited. Based on data collected from 310 couples undergoing AR over a 2-year period, Prof. K. Péloquin’s presentation will address the patient, treatment and fertility clinic factors that contribute to the psychological burden of the AR process in the context of infertility, and to premature discontinuation of fertility treatments. Possible avenues for clinical assessment and intervention will be identified to better meet the needs of couples in their AR journey.

  11.45 am: Clinical workshop

• 1.30 pm : Theme 2 – The Stakes of Surrogacy

  The challenges of surrogacy (Stefanie Carsley, University of Ottawa)

  Professor Carsley will present results from her ongoing qualitative study entitled “Surrogacy Laws in Canada: Exploring Intended Parents’ Experiences and Perspectives.” The study explores intended parents’ experiences working with surrogates, lawyers, counsellors, physicians and agencies. It also investigates how intended parents understand, view and engage with federal laws that criminalize paid surrogacy, and provincial laws that govern parentage, surrogacy agreements and the provision of fertility treatments. In this talk, Professor Carsley will focus on intended parents’ experiences working with surrogacy agencies and will discuss intended parents’ concerns about these agencies’ varied practices.

  Current challenges in the regulation of surrogacy in Canada (Vanessa Gruben, University of Ottawa)

  Professor Gruben will draw on the results of her ongoing research project, Surrogates’ Voices: Exploring Experiences, Insights and Perspectives to explore current challenges in the regulation of surrogacy in Canada. The study explores (1) who becomes a surrogate; (2) why and how they do it; (3) who works with surrogates; (4) surrogates’ experiences prior to conception, during pregnancy and after birth; 5) whether and how Canadian surrogates may be vulnerable in these arrangements. Professor Gruben will discuss the concerns arising from the various roles agencies play, including matching intended parents with surrogates and managing the reimbursement process. She will also consider the need for hospital policies that are responsive to the needs of surrogates.

  2.45 pm: Clinical Workshop

• 3.30-5.30 pm : Roundtable with people involved in assisted reproduction

  Discussion about assisted reproduction with a surrogate, a sperm donor conceived person, an infertile man and an egg donor.

Tuesday, June 4, 2024

• 9.00am: Theme 3 – Fertility Pathways for Trans People

  Cracking complexities: Considering the unique egg freezing barriers of transgender and gender diverse individuals living in Canada (Elgin Pecjak, University of Ottawa)

  In their 2021 census data, Statistics Canada found that there are over 100,815 transgender and gender diverse (TGGD) identifying people over the age of 15 living in Canada. While desires for biogenetic parenthood have been well explored among cisgender, heterosexual women seeking out reproductive technologies, TGGD individuals are far less researched, especially when it comes to reproductive technology use. Elgin Pecjak’s presentation explores oocyte cryopreservation, or egg freezing, by contextualizing TGGD individuals in pre-existing egg freezing data from around the globe. While TGGD individuals experience the same barriers to egg freezing as cisgender women including medical risks, financial cost, and complex success rates, they must also navigate nuanced and complex barriers including gender dysphoria, transphobia, and hormone replacement therapy when seeking out egg freezing. This presentation uses Elgin Pecjak’s own dissertation research to explore the similarities and differences that TGGD individuals face in comparison to cisgender women. In doing so, expanding the much-needed research and dialogue regarding the reproductive needs of TGGD individuals living in Canada.

  Supporting decisions about fertility preservation for young trans and non-binary people (Kévin Lavoie, Université Laval)

  Due to improvements in reproductive technologies as well as recent legislative advances in Quebec and Canada, it is now possible for young trans and non-binary people (TNB) to preserve their gametes (sperm, eggs) to use later in life if they decide to start a family. This option offers them the possibility of being genetically linked to their future child. Fertility preservation is a recent practice with little international scrutiny. Use of this assisted procreation technique raises a number of personal, family, and ethical issues, in particular pressure from parents who value fertility preservation at an age when their child does not necessarily aspire to parenthood. Professor Lavoie will present a decision-making support tool based on the results of a participatory ‘photo-voice’ study conducted with young TNBs and individual interviews with parents. This tool uses a trans-affirmative approach to guide the professional practices of health and social services practitioners.

  10.15 am: Clinical workshop

• 11.00 am: Theme 4 – Stratification of Reproduction

  White coats in a grey zone: Ethical issues in the care of patients with advanced paternal age (Vincent Couture, Université Laval)

  In Canada, the age at which parents conceive their first child has been rising since the 1970s. To date, the focus of scientific and health care professionals’ attention has been on the age of mothers. This has influenced the ways that women are informed about issues related to reproductive aging, as well as the ways that they are monitored during pregnancy. As far as men are concerned, there is limited interest in late fatherhood. Yet studies show that a father’s age at conception has a range of health effects. Health research highlights, among other things, a link between advanced paternal age (APA) and: reduced fertility, increased miscarriage and increased risk of the child developing various complex genetic conditions. In addition, psychosocial research is examining the effect of fathers’ age on child development. Despite this recent interest, a number of grey areas remain. To begin this work, Professor Couture’s presentation will begin by clarifying the basic concepts relating to late fatherhood. We will then review the state of empirical research on the subject. We will then look in more detail at the main ethical issues surrounding late fatherhood from the point of view of care staff. These reflections will feed into the discussion on the evolution of norms in the field of human reproduction and the way in which they need to adapt to the dual reality of the deconstruction of gendered preconceptions and the ageing of the population.

  Global fertility markets: (Re)Producing babies, reproducing whiteness (Amrita Pande, University of Cape Town)

  Cross-border reproductive flows involve clients traveling across the world to fulfil their dreams of having a genetically related baby or a baby tailor-made to their expectations. In this presentation, based on a decade-long multi-sited ethnography of such reproductive flows and the global fertility industry, Professor Pande will argue that parental desires about their offspring cannot be discussed merely as intimate or private choices, but are a critical frame for analysing racialisation of reproduction. She uses an intersection of feminist studies of race and reproduction, critical race studies and critical whiteness studies from the south, to argue that, on the one hand, these choices bring attention to the need to understand reproductive desires as cosmopolitan, traveling and affective. On the other hand, these choices mask stark instances of “flexible eugenics” (Taussig, Rapp and Heath 2008)—wherein whiteness is reaffirmed as a universal and worthy choice.

  12.15 pm: Clinical workshop

• 2.00 pm: Theme 5 – Anonymity and Access to One’s Origins

  After anonymity: The experience of gamete donors contacted by their donor offspring (Anaïs Martin, Université du Québec en Outaouais)

  Donor conception has long been organised in a way that has ensured that gamete donors are anonymous. However, since the early 2000s, donor conceived people have been claiming their right to know their origins. Some have used genetic genealogy websites to bypass anonymity restrictions and find their donor. Contacts between donors and offspring that were previously thought to be impossible, have thus been established. Empirical studies on the topic are still scarce and mostly focus on donor conceived people. But what about gamete donors? How do they experience the end of their anonymity? Dr. Martin’s presentation will present the findings of an exploratory study conducted with 13 men and 12 women who have donated sperm or eggs in the United States, Australia and Canada, between the 1970s and the 2010s, and who have been contacted by donor offspring. Dr. Martin will look at how their perception of anonymity has changed over the course of their lives and how they have seen their role as donors since being contacted.

  Access to one’s origins in donor conception is never just access to one’s origins (Astrid Indekeu, Katholieke Universiteit Leuven)

  Debates about or abolishment of donor anonymity and the development of direct-to-consumer genetic testing changed the field of donor conception immensely. It created possibilities for donor conceived people to access/search for information about their origins as well as challenges. Practice and research show that accessing one’s origins is not about individual connections but new networks that are created and new relationships that need to be defined (pioneering relationships) for donor conceived people, donors and their families.

  3.15 pm: Clinical workshop

• 4.30 pm-6.30 pm: Public event - Launch of the podcast Born of a Fraud

  With Sabrina Zeghiche (Université du Québec en Outaouais)

  Conversation about fertility fraud and podcasting as a format for disseminating research

  ‘I feel I came to life through the back door, with a false ID’… These were Ambre’s words when discovering that the doctor who had inseminated her mother used his own sperm instead of the intended sample. Like Ambre, hundreds of people have learned that their conception was the result of insemination fraud. So far, nearly 60 doctors around the world have been implicated. How could such fraud be perpetrated? What ethical principles does it trample on? What impact does it have on the families concerned? What preventive and punitive measures can be put in place? These are just some of the issues addressed in the documentary podcast “Born of a Fraud”, which will be launched during the Summer Institute on Assisted Reproduction. In this podcast, a team from the Canada Research Chair in Third Party Reproduction and Family Ties, led by Dr. Sabrina Zeghiche gives the floor to families and experts to shed light on the thorny issue of insemination fraud. The launching event organized by the Summer Institute on Assisted Reproduction will provide an opportunity to present the podcast, the study on which it is based, and to discuss the opportunities offered by podcasts for presenting research results to the general public. The event will be open to all.

Wednesday, June 5, 2024

• 8.30 am : Theme 6 - Children in third-party procreation

  UK Longitudinal Study of Assisted Reproduction Families (Vasanti Jadva, City, University of London)

  Professor Jadva’s presentation will summarise findings from the Longitudinal Study of Assisted Reproduction Families, a 20-year study that has been following families with a child born following surrogacy, egg donation and sperm donation. The families in the study are headed by heterosexual couples, and have been visited at 7 time points, at ages 1, 2, 3, 7, 10, 14 and 20 years, to collect data on family functioning and psychological adjustment. Professor Jadva will present key findings from this study with a particular focus on how the donor conceived children feel about the method of their conception.

  Witnessing the surrogate pregnancy of your mother: Clinical issues and considerations (Isabel Côté, Université du Québec en Outaouais)

  Research into surrogacy has focused mainly on the experiences of the surrogates, the intended parents and, to a lesser extent, the children born as a result. We know little about how the relatives of surrogates, including their children, are involved in the process. However, the children of surrogates, who share their mother’s daily life, are directly confronted with the latter’s surrogacy and all the impacts it can have on their family’s life. Based on qualitative data collected with young Canadians (n = 62), Professor Côté’s presentation will examine how these children make sense of their mother’s surrogacy, the emotions they experience throughout the process, and the ways they are involved in the day-to-day household tasks that support their mother during her pregnancy. Clinical approaches to supporting these children will also be proposed.

  9.45 am: Clinical workshop

• 10.30 am: Theme 7 – Underexamined topics in assisted reproduction

  Recent innovations in ART and their ethical implications (Heidi Mertes, Ghent University)

  In the quest to help ever more infertility patients achieve parenthood, ever more intrusive techniques are introduced into the clinic, such as uterus transplantation, mitochondrial transfer and in vitro gametogenesis. Also, genetic screening in the context of reproduction is constantly expanding. However, these innovations do not only offer hope, but also come with a number of ethical concerns. Professor Mertes’ presentation will discuss both ethical concerns on the individual level, related to safety, wellbeing and misleading of patients and on the societal level, related to justice and the reinforcement of gender and family norms.

  Ethics and aesthetics of embryo donation: The Canadian study (Corinna Guerzoni, Università di Bologna)

  Globally, the existence of stored embryos presents a complex challenge, as a significant portion of these embryos are deemed “surplus” for reproductive purposes and are indefinitely cryopreserved. Various solutions have been proposed, ranging from discarding excess embryos to offering them for donation, either for research or for family-building purposes. The ethical implications of embryo disposition are a contentious issue not only at the political level (Cromer 2023), but also for individuals facing decisions about the fate of these embryos, and for clinics dealing with administrative, financial, and legal dilemmas (Lyerly et al. 2010;  O‘Brien 2010).

  While embryo donation tends to be considered as a last resort within the realm of reproductive technologies (Guerzoni forthcoming), it is experiencing increased popularity as a fertility solution (Huele et al. 2020). Consequently, the growing prominence of embryo donation has ignited intense debates surrounding divergent perspectives on life, rights, ownership, human dignity, and kinship, making it a contentious issue. Professor Guerzoni’s presentation presents initial findings from the ongoing InVitroFutures project, a comparative ethnographic investigation into embryo donation practices in both Canada and Spain. The focus is on the Canadian segment, highlighting how ethical concerns associated with embryo donation, voiced by donors, recipients, IVF specialists, and agency personnel, contribute to shaping the understanding of reproduction and relatedness.

  11.45 am: Clinical workshop