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Handbook of WMA Policies
World Medical Association S-2006-01-2022
WMA STATEMENT
ON
ASSISTED REPRODUCTIVE TECHNOLOGIES
Adopted by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
and revised by the 73rd
WMA General Assembly, Berlin, Germany, October 2022
PREAMBLE
Assisted Reproductive Technology [ART] encompasses a wide range of techniques designed
primarily to aid individuals unable to conceive without medical assistance.
ART is defined as any fertility treatments in which either gametes or embryos are handled.
Assisted reproductive technologies may raise profound ethical and legal issues. Views and
beliefs on assisted reproductive technologies vary both within and among countries and are
subject to different regulations in different countries.
Central to much of the debate in this area are issues around the moral status of the embryo, the
way in which ART is viewed morally, societally and religiously, the child/ren born from ART,
and the rights of all participants involved, i.e. donors, surrogates, the child/ren and the intended
parents are just some of the issues central to the debate in ART. Whilst consensus can be
reached on some issues, there remain fundamental differences of opinion that are more difficult
to resolve.
Assisted conception differs from the treatment of illness in that the inability to become a parent
without medical intervention is not always regarded as an illness. Notwithstanding, the inability
to conceive may also be as a result of prior illness.
In many jurisdictions, the process of obtaining consent must follow a process of information
giving and the offer of counselling and might also include a formal assessment of the patient
in terms of the welfare of the potential child.
Faced with the progress of new technologies of assisted reproduction, physicians should keep
in mind that not everything that is technically feasible is ethically acceptable. Genetic
manipulation that does not have a therapeutic purpose is not ethical, nor is the manipulation on
the embryo or foetus without a clear and beneficial diagnostic or therapeutic purpose.
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RECOMMENDATIONS
1. Physicians involved in providing assisted reproductive technologies should always
consider their ethical responsibilities towards all parties involved in a reproductive plan,
which may include the future child/ren, donor, surrogate or parents. If there is compelling
evidence that a future child, donor, surrogate or parent would be exposed to serious harm,
treatment should not be provided.
2. As with all other medical procedures, physicians have an ethical obligation to limit their
practice to areas in which they have relevant expertise, skill, and experience and to respect
the autonomy and rights of patients.
3. In practice this means that informed consent is required as with other medical procedures;
the validity of such consent is dependent upon the adequacy of the information offered to
the patient and their freedom to make a decision, including freedom from coercion or other
pressures or influences to decide in a particular way.
4. The consent process should include providing the participant/s with understandable,
accurate and adequate information about the following:
• The purpose, nature, procedure, and benefits of the assisted reproductive technology
that will be used.
• The risks, burdens and limitations of the assisted reproductive technology that will be
used.
• The success rates of the treatment and possible alternatives, such as adoption.
• The availability of psychological support for the duration of the treatment and, in
particular, if a treatment is unsuccessful.
• The measures protecting confidentiality, privacy and autonomy, including data security
measures.
5. The following should be discussed during the informed consent process:
• Detailed medical risks;
• whether or not all biological samples involved in ART, including but not limited to
donor eggs, sperm, gametes and genetic information, may be used for research
purposes;
• The risks of multiple donations and donating at multiple clinics;
• Confidentiality and privacy issues;
• Compensation issues.
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Handbook of WMA Policies
World Medical Association S-2006-01-2022
6. Donors, surrogates and any resulting child/ren seeking assisted reproductive technologies
are entitled to the same level of confidentiality and privacy as for any other medical
treatment.
7. Assisted reproductive technology involves handling and manipulation of human gametes
and embryos. There are different levels of concern with the handling of such material, yet
there is general agreement that such material should be subject to specific safeguards to
protect from inappropriate, unethical, or illegal use.
8. Physicians should uphold the principles in the WMA Statement on Stem Cell Research,
WMA Statement on Human Genome Editing, the WMA Declaration of Helsinki, and the
WMA Declaration of Reykjavik – Ethical Considerations Regarding the Use of Genetics
in Health Care.
9. Physicians should, where appropriate, provide ART in a non-discriminatory manner.
Physicians should not withhold services based on nonclinical considerations such as marital
status.
Multiple pregnancies
10. Replacement of more than one embryo will raise the likelihood of more than one embryo
implanting. This is offset by the increased risk of premature labour and other complications
in multiple pregnancies, which can endanger the health of both the mother and child/ren.
Practitioners should follow professional guidance on the maximum number of embryos to
be transferred per treatment cycle.
11. If multiple pregnancies occur, selective termination or fetus reduction will only be
considered on medical grounds and with the consent of all participants involved to increase
the chances of the pregnancy proceeding to term, provided this is compatible with
applicable laws and codes of ethics.
Donation
12. Donation should follow counselling and be carefully controlled to avoid abuses, including
coercion or undue influence of potential donors. Explicit instructions should be provided
about what will be done with any donated samples if the donor is known to have died prior
to implantation.
13. The WMA holds the view that gamete donation should at best not be commodified, thus
serving a humanitarian benefit.
14. To ensure appropriate controls and limits on methods used to encourage donations, this
must be done in a manner that complies with national law and ethical guidance. Physicians
should advocate for and contribute to such ethical guidance if it does not exist.
15. Due to the widespread use of genetic technology and registries, it has become possible to
identify donors, despite clinics and donors’ attempts to maintain strict confidentiality. A
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child/ren born as a result of donation may in future contact donors. Potential donors must
be made aware of this possibility as part of the consent process.
16. Where a child is born following donation, families should be encouraged and supported to
be open with the child about this, irrespective of whether or not domestic law entitles the
child to information about the donor. This may require the development of supportive
materials, which should be produced to a national normative standard.
Surrogacy
17. Where a woman is unable, for medical reasons, to carry a child to term, surrogate pregnancy
may be used to overcome childlessness unless prohibited by national law or the ethical rules
of the National Medical Association or other relevant organizations. Where surrogacy is
legally practiced, great care must be taken to protect the interests of all parties involved.
18. Prospective parents and surrogates should receive independent and appropriate legal
counsel.
19. Medical tourism for surrogacy purposes should be discouraged.
20. Commercial surrogacy should be condemned. However, this must not preclude
compensating the surrogate mother for necessary expenses.
21. The rights of surrogate mothers must be upheld, and great care must be taken to ensure that
they are not exploited. The rights of surrogate mothers include, but are not limited to:
• Having her autonomy respected;
• Where appropriate, having health insurance;
• Being informed about any medical procedure and the potential side effects;
• Where possible, choosing her medical team if side effects develop;
• Having psychological help at any point during the pregnancy;
• Having medical expenses such as doctor visits, the actual birthing process, fertilization
and any examinations related to the surrogacy covered by the intended parent/s;
• Loss if income covered if unable to work during the pregnancy;
• Receiving the compensation and/or reimbursements agreed to in any legal agreement
Pre-implantation Genetic Diagnosis (PGD)
22. Pre-implantation genetic diagnosis (PGD) and pre-implantation genetic screening (PGS)
may be performed on early embryos to search for the presence of genetic or chromosomal
abnormalities, especially those associated with severe illness and very premature death, and
for other ethically acceptable reasons, including identifying those embryos most likely to
implant successfully in women who have had multiple spontaneous abortions.
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23. It is recommended to encourage screening for infectious diseases in sperm donors and to
determine whether to inform donors of positive tests.
24. Physicians must never be involved with sex selection unless it is used to avoid a serious
sex-chromosome related condition, such as Duchenne’s Muscular Dystrophy.
Research
25. Physicians have an ethical duty to comply with such regulation and to help inform public
debate and understanding of these issues.
26. Research on human gametes and embryos should be carefully controlled and monitored
and in accordance with all applicable national laws and ethical guidelines.
27. Views and legislation differ on whether embryos may be created specifically for, or in the
course of, research. Physicians should act in accordance with the declarations of Taipei and
Helsinki, as well as all applicable local laws and ethical and professional standards advice.
28. The principles of the Convention on Human Rights and Biomedicine should be followed.
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