Response to commentary on manuscript: “The impact of fresh versus cryopreserved testicular sperm on intracytoplasmic sperm injection (ICSI) pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis”

9 12 2013

To the Editor:

We appreciate the insightful comments of Dr. Kim (1). As he correctly states, the use of fresh versus cryopreserved sperm has been controversial. While the use of frozen sperm from men with obstructive azoospermia appears to yield equivalent outcomes to fresh sperm, the application to men with nonobstructive azoospermia (NOA) is less certain (2). However, if proven equivalent, Dr. Kim correctly emphasizes the significant logistical and economic burdens that could be improved for couples. Additionally, we agree with his assessment on the importance of methodology. We as male reproductive specialists do not have a standardized, evidence-based protocol for the cryopreservation of sperm. As such, we believe that there should be some caution in mentioning an established detrimental effect of cryopreservation. The analyses that produced such findings suffer the same methodological dependence that is inherent within essentially any cryopreservation data to date (3). Moreover, as data from men with obstructive azoospermia suggest equivalent outcomes, it appears that cryopreservation does not irreparably impact sperm function (2). Read the rest of this entry »

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Why should we discard all abandoned human embryos?

5 08 2013

To the Editor:

In the June 2013 issue of Fertility and Sterility, the Ethics Committee of the American Society for Reproductive Medicine published its latest opinion on the disposition of abandoned embryos (1), updated from 2004 (2). This is an important contribution to the literature on this timely issue, an issue that requires swift resolution.

At the conclusion of its 2013 article, the Committee writes:
“If a program reasonably determines…that embryos have been abandoned, the Ethics Committee concludes that the program may dispose of the embryos by removal from storage and thawing without transfer. In no case should embryos deemed abandoned be donated to other couples or be used in research” (emphasis added, 1849).

I agree with the Committee that clinics ought to be allowed to discard abandoned embryos. However, the Committee does not offer any argument to support their stronger claim that, if clinics are to do anything with abandoned embryos, they are morally permitted only to expressly discard them. (This lack of explicit argument is mirrored in their 2004 piece.) While we can reasonably expect that much discussion about this went on behind the scenes, presenting this position here—equipped with a normative prescription for clinicians about the disposition of abandoned embryos—without any explicit support, leaves the Committee’s position open to serious criticism. It is appropriate to ask the Committee for a statement of their reasons for making the strong conclusion that they do. Read the rest of this entry »