Medically assisted procreation in times of COVID-19: what impact on health care system organization and the reproductive rights of couples?
Keywords:
COVID-19, pandemic emergency, medically assisted procreation, constitutional rights, medical liabilityAbstract
Background and aim: The emergency caused by the spread of COVID-19 has overwhelmed health care facilities and required the reorganization of health systems in many nations worldwide. A year after its appearance, measures aimed at further containing disease transmission through massive vaccination campaigns. In pregnancy, vaccination should be administered with caution, in light of the lack of reliable data, since pregnant women have been excluded from experimentation. The pandemic has had a significant impact on assisted reproduction procedures in Italy. Methods: The authors have set out to analyze the measures issued by the Italian government in order to counter the spread of COVID-19, in addition to the national and international guidelines on assisted reproduction. Discussion: The purpose of these documents is precautionary in nature: such measures are based on the principles of responsibility and solidarity, essential to stave off the saturation of health systems, curb contagion, but also to lay out a set of rules to starting a pregnancy while preserving the health of couples, operators and newborns. The authors also expound upon the rights claimed by couples seeking access to MAP (i.e. the right to become a parent, the couple's right to health, interest in demographic development). Conclusions: The coronavirus disease 2019 (COVID-19) has had a major impact on infertile couples. Since the pandemic broke out, Italy, like most European countries, has interrupted most ordinary activities of the centers operating in the field of assisted fertilization. We believe that access to assisted fertilization techniques by sterile and infertile couples should be part of the right to health rather than of the supposed right to become parents or the increase in the birth rate, also evoked as the COVID-19 pandemic unfolded. The current system of compensation and reimbursements needs to be reconfigured in order to prevent any form of discrimination.
References
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed 2020; 91: 157-160.
Monteleone PAA, Nakano MSL, Lazar V, Gomes AP, Martin H, Bonetti T. A review of initial data on pregnancy during the COVID-19 outbreak: implications for assisted reproductive treatments. JBRA Assist Reprod 2020; 24: 219–225.
Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, Lane HC, Memish Z, Oh MD, Sall AA, Schuchat A, Ungchusak K, Wieler LH; WHO Strategic and Technical Advisory Group for Infectious Hazards. COVID-19: towards controlling of a pandemic. Lancet. 2020 Mar 28; 395: 1015-1018.
Wahlster S, Sharma M, Lewis AK, Patel PV, Hartog CS, Jannotta G, Blissitt P, Kross EK, Kassebaum NJ, Greer DM, Curtis JR, Creutzfeldt CJ. The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers: A Global Survey. Chest 2021; 159: 619-633.
Farrell TW, Francis L, Brown T, Ferrante LE, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults. J Am Geriatr Soc 2020; 68: 1143-1149.
Marinelli E, Busardò FP, Zaami S. Intensive and pharmacological care in times of COVID-19: A “special ethics” for emergency? BMC Med Ethics 2020; 21: 117.
Bonaccorsi G, Pierri F, Cinelli M, Flori A, Galeazzi A, Porcelli F, Schmidt AL, Valensise CM, Scala A, Quattrociocchi W, Pammolli F. Economic and social consequences of human mobility restrictions under COVID-19. Proc Natl Acad Sci U S A 2020; 117: 15530-15535.
L'Angiocola PD, Monti M. COVID-19: the critical balance between appropriate governmental restrictions and expected economic, psychological and social consequences in Italy. Are we going in the right direction? Acta Biomed 2020; 91: 35-38.
Raffaetà R. Another Day in Dystopia. Italy in the Time of COVID-19. Med Anthropol 2020; 39: 371-373.
Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res 2020; 291: 113190.
Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, Lahiri D, Lavie CJ. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020; 14: 779-788.
Zaami S. New psychoactive substances: concerted efforts and common legislative answers for stemming a growing health hazard. Eur Rev Med Pharmacol Sci. 2019; 23: 9681-9690.
Catalani V, Arillotta D, Corkery JM, Guirguis A, Vento A, Schifano F. Identifying New/Emerging Psychoactive Substances at the Time of COVID-19; A Web-Based Approach. Front Psychiatry 2021; 11: 632405.
Zaami S, Marinelli E, Varì MR. New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective. Front Psychiatry 2020; 11: 700.
Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry Res 2020; 289: 113096.
Montanari Vergallo G, Zaami S, Marinelli E. The COVID-19 pandemic and contact tracing technologies, between upholding the right to health and personal data protection. Eur Rev Med Pharmacol Sci 2021; 25: 2449-2456.
Fontanet A, Autran B, Lina B, Kieny MP, Karim SSA, Sridhar D. SARS-CoV-2 variants and ending the COVID-19 pandemic. Lancet 2021; 397: 952-954.
Greaney AJ, Loes AN, Crawford KHD, Starr TN, Malone KD, Chu HY, Bloom JD. Comprehensive mapping of mutations in the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human plasma antibodies. Cell Host Microbe 2021; 29: 463-476.e6.
Conti P, Caraffa A, Gallenga CE, Kritas SK, Frydas I, Younes A, Di Emidio P, Tetè G, Pregliasco F, Ronconi G. The British variant of the new coronavirus-19 (Sars-Cov-2) should not create a vaccine problem. J Biol Regul Homeost Agents 2021; 35:1-4.
Society for Maternal-Fetal Medicine (SMFM), Statement: SARS-CoV-2 Vaccination in Pregnancy. Issued December 1st 2020. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2591/SMFM_Vaccine_Statement_12-1-20_(final).pdf (Accessed 10th June 2021).
Smith DD, Pippen JL, Adesomo AA, Rood KM, Landon MB, Costantine MM. Exclusion of Pregnant Women from Clinical Trials during the Coronavirus Disease 2019 Pandemic: A Review of International Registries. Am J Perinatol 2020; 37: 792-799
Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, Nahabedian J, Anderson K, Gilboa SM. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 769-775.
Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, Woodworth KR, Nahabedian JF 3rd, Azziz-Baumgartner E, Gilboa SM, Meaney-Delman D; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1641-1647.
European Parliament resolution of 13 November 2020 on the impact of COVID-19 measures on democracy, the rule of law and fundamental rights (2020/2790(RSP)). Available at: https://www.europarl.europa.eu/doceo/document/TA-9-2020-0307_EN.html (Accessed on 10th June 2021).
Monteleone PA, Nakano M, Lazar V, Gomes AP, de H Martin, Bonetti TC. A review of initial data on pregnancy during the COVID-19 outbreak: implications for assisted reproductive treatments. JBRA Assist Reprod 2020; 24: 219-225.
American Society for Reproductive Medicine COVID-19: Suggestions On Managing Patients Who Are Undergoing Infertility Therapy Or Desiring Pregnancy. Issued on 12th March 2021. Available at: https://www.asrm.org/news-and-publications/covid-19/covid-19-press-releases-and-announcements/covid-19-suggestions-on-managing-patients-who-are-undergoing-infertility-therapy-or-desiring-pregnancy/
ESHRE. Coronavirus Covid-19: ESHRE statement on pregnancy and conception. 27th February 2020 Available at: https://www.eshre.eu/Press-Room/ESHRE-News#CoronaStatement27feb
IFFS - International Federation for Fertility Societies updates and resources related to the coronavirus pandemic and COVID-19. 2020. Available at: https://www.iffsreproduction.org/general/custom.asp?page=COVID-19
Veiga A, Gianaroli L, Ory S, Horton M, Feinberg E, Penzias A. Assisted reproduction and COVID-19: A joint statement of ASRM, ESHRE and IFFS. Fertil Steril. 2020; 114: 484-485.
ESHRE COVID-19 Working Group, Gianaroli L, Ata B, Lundin K, Rautakallio-Hokkanen S, Tapanainen JS, Vermeulen N, Veiga A, Mocanu E. The calm after the storm: re-starting ART treatments safely in the wake of the COVID-19 pandemic. Hum Reprod 2021; 36:275-282.
Anifandis G, Messini CI, Daponte A, Messinis IE. COVID-19 and fertility: a virtual reality. Reprod Biomed Online 2020; 41: 157–9.
American Society for Reproductive Medicine Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic. Latest updated on 20th May 2021. Available at: https://www.asrm.org/news-and-publications/covid-19/statements/patient-management-and-clinical-recommendations-during-the-coronavirus-covid-19-pandemic/
European Society for Human Reproduction and Embryology. Coronavirus Covid-19: ESHRE statement on pregnancy and conception. Issued on 26th March 2020. Available at: https://www.eshre.eu/Press-Room/ESHRE-News#COVID19WG
Vaiarelli A, Bulletti C, Cimadomo D, Borini A, Argento C, Alviggi C, et al. Are there specific patients candidate for oocyte collection during COVID-19 pandemic? Fertil. Steril. Dialog. 2020 . Available at: https://www.fertstertdialog.com/posts/64914-are-there-specific-patients-candidate-for-oocyte-collection-during-covid-19-pandemic
SBRH - Sociedade Brasileira de Reprodução Humana COVID-19: Acompanhamento de pacientes submetidas às terapias de reprodução assistida ou que desejam engravidar. June 2020. Available at: https://www.sbrh.org.br/?p=5013
COVID-19 e Reprodução Assistida - Comunicado Conjunto Sbra | Redlara. Issued on 20th Match 2020. Available at: https://redlara.com/blog_detalhes_covid19.asp?USIM5=534 (Accessed on 10th June 2021).
ReProdução Assistida E Covid-19 | Nota Conjunta Sbra E Redlaranota Conjunta Sbra e Redlara. Issued on 17th March 2020. Available at: https://sbra.com.br/noticias/reproducao-assistida-e-covid-19-nota-conjunta-sbra-e-redlara/
La Marca A, Niederberger C, Pellicer A, Nelson SM. COVID-19: lessons from the Italian reproductive medical experience. Fertil Steril 2020; 113: 920-922.
Rodriguez-Wallberg KA, Wikander I. A global recommendation for restrictive provision of fertility treatments during the COVID-19 pandemic. Acta Obstet Gynecol Scand 2020; 99: 569–70.
Anifandis G, Messini CI, Daponte A, Messinis IE. COVID-19 and fertility: a virtual reality. Reprod Biomed Online 2020; 41: 157-159.
Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020; 222: 415-426.
Zaami S, Montanari Vergallo G, Napoletano S, Signore F, Marinelli E. The issue of delivery room infections in the Italian law. A brief comparative study with English and French jurisprudence. J Matern Fetal Neonatal Med 2018; 31: 223-227.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395: 809–15
Deniz M, Tezer H. Vertical transmission of SARS CoV-2: a systematic review. J Matern Fetal Neonatal Med 2020:1-8.
Simões E Silva AC, Leal CRV. Is SARS-CoV-2 Vertically Transmitted? Front Pediatr 2020; 8: 276.
Marinelli E, Negro F, Varone MC, Trojano G, Del Rio A, Zaami S. Perinatal and post-partum infections in times of Coronavirus: are compliance with cautionary measures and safety protocols key factors in staving off litigation. It Journ Gyn Obs 2020; 32: 189.
Schwartz DA. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med 2020; 144: 799–805.
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clin Infect Dis 2021; 72: 862–4.
Italian Ministry of Health. Linee di indirizzo per la rimodulazione dell'attività programmata. Issued on 16th March 2020. Available at: https://portale.fnomceo.it/wp-content/uploads/2020/03/Copia_DocPrincipale_9_Allegato1_Linee_di_Indirizzo_organizzazione_attivita_programmata_differibile.pdf (Accessed on 10th June 2021).
Italian Ministry of Health. Chiarimenti: Linee di indirizzo per la rimodulazione dell'attività programmata differibile in corso di emergenza da COVID-19. Available at: https://www.sicp.it/wp-content/uploads/2020/04/Min-Sal_circolare-chiarimenti-rimodulaz-attività-sanitaria-differibile_30-mar-20.pdf (Accessed on 10th June 2021).
Superior Institute of Health (ISS), National Center of Transplants (CNT). Prevention measures of transmission of new Coronavirus infection (SARS-CoV-2) in Italy for reproductive cells and ART treatments. Issued on 17th March 2020 (Prot.605/CNT2020; 2020. Available at: https://www.sierr.it/images/pdf/Prot._605.CNT.2020_Misure_di_prevenzione_SARS_COV2_per_cellule_riproduttive_PMA_Aggiornamento_13.03.2020.pdf (Accessed on 10th June 2021).
Comunicazione congiunta Fondazione PMA Italia e SIFES. Issued on 16th March 2020. Available at: http://www.pma-italia.it/IT/news.xhtml/news/258-comunicazione-congiunta-fondazione-pma-italia-e-sifes (Accessed on 10th June 2021).
Superior Institute of Health (ISS), National Center of Transplants (CNT). Prevention measures of transmission of new Coronavirus infection (SARS-CoV-2) in Italy for reproductive cells and ART treatments. Update issued on 5th May 2020.Available at: https://www.iss.it/documents/20126/0/prot.+16223+del+6+Maggio+2020.pdf/f93ee12d-2ef9-c59f-12af-f46278160b4b?t=1588946541050 (Accessed on 10th June 2021).
Negro F, Marinelli S. Is there anything left of the Italian law governing medically-assisted procreation? Clin Ter 2021; 171: e57–9.
Biondi S. Access to medical-assisted reproduction and pgd in Italian law: a deadly blow to an illiberal statute? commentary to the European Court on Human Rights's decision Costa and Pavan v Italy (ECtHR, 28 August 2012, App. 54270/2010). Med Law Rev 2013; 21: 474-86.
Bertelli M, Paolacci S, Placidi G, Scaccia G, Chiurazzi P, Fulcheri E, Malacarne D, Lichterman B, Petralia P. Combined use of medically-assisted reproductive techniques: a new bioethical issue. Acta Biomed 2019; 90: 58-61.
Zaami S. Assisted heterologous fertilization and the right of donorconceived children to know their biological origins. Clin Ter 2018;169:e39–43. https://doi.org/10.7417/T.2018.2052.
Ethics Committee of the American Society for Reproductive Medicine. Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee. Fertil Steril 2020; 113: 270-294.
Montanari Vergallo G., Marinelli E., di Luca N.M., Zaami S., Gamete Donation: Are Children Entitled to Know Their Genetic Origins? A Comparison of Opposing Views. The Italian State of Affairs, European Journal of Health Law, 2018, 25(3), pp. 322–337
Douglas T, Savulescu J. Destroying unwanted embryos in research. Talking Point on morality and human embryo research. EMBO Rep. 2009r;10:307-12.
Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and “Procreative Tourism”. What Does the Future Hold from the Ethical and Legal Perspectives? Medicina 2021; 57: 47.
Valongo A. Human rights and reproductive choices in the case-law of Italian and European courts. Eur J Health Law. 2014r; 21: 123-40.
Negro F, Varone MC, Del Rio A. Advances in Medically-assisted procreation technologies: can malpractice claims and “reproductive damage” be identified? Clin Ter 2020: 225–8.
Cippitani R. Ethical issues and law-making power: how European case law has rewritten Italian law on medically assisted reproduction. Monash Bioeth Rev. 2019; 37: 46-67.
Montanari Vergallo G. Freedom of Scientific Research and Embryo Protection Under Italian and European Court of Human Rights' Jurisprudence. Brief European Legislation Overview. Eur J Health Law 2021; 28: 3-25..
Brown MT. The Moral Status of the Human Embryo. J Med Philos 2018; 43: 132-158.
Napoletano S, Del Rio A. Reproductive medicine between advancement and ethics. Clin Ter 2018: 108–9.
Sullivan-Pyke C, Dokras A. Preimplantation Genetic Screening and Preimplantation Genetic Diagnosis. Obstet Gynecol Clin North Am 2018; 45: 113-125.
Montanari Vergallo G. A child of two mothers: what about the father? Italian overview. Acta Biomed 2019; 90: 319-325.
Di Luca A. Commentary to the paper: A child of two mothers: what about the father? Italian overview. Acta Biomed 2021; 92: e2021071.
Moura A, Silva S, de Freitas C, Abreu L, Baía I, Samorinha C. Concerns with educating the public about donating and receiving gametes. Eur J Contracept Reprod Health Care 2019; 24: 420-421.
Marinelli S. No more only one mom? European Court of Human Rights and Italian jurisprudences’ ongoing evolution. Clin Ter 2020; 170: e36–43.
Delbon P, Conti A. Medically Assisted Procreation and Fast-Moving Developments in Science and Law: Ethical and Legal Issues in Heterologous Procreation in Italy. J Public Health Res 2015; 4: 554.
Taneja A, Das S, Hussain SA, Madadin M, Lobo SW, Fatima H, Menezes RG. Uterine Transplant: A Risk to Life or a Chance for Life? Sci Eng Ethics. 2019; 25: 635-642.
Zaami S, Marinelli E, di Luca NM, Montanari Vergallo G. Ethical and medico-legal remarks on uterus transplantation: may it solve uterine factor infertility? Eur Rev Med Pharmacol Sci 2017; 21: 5290-5296.
Segers S. The path toward ectogenesis: looking beyond the technical challenges. BMC Med Ethics 2021; 22: 59.
Rossant J. Gene editing in human development: ethical concerns and practical applications. Development. 2018; 145: dev150888.
Cyranoski D. Ethics of embryo editing divides scientists. Nature 2015; 519: 272.
Piergentili R, Del Rio A, Signore F, Umani Ronchi F, Marinelli E, Zaami S. CRISPR-Cas and Its Wide-Ranging Applications: From Human Genome Editing to Environmental Implications, Technical Limitations, Hazards and Bioethical Issues. Cells 2021; 10: 969.
Wang L, Li MY, Qu C, Miao WY, Yin Q, Liao J, Cao HT, Huang M, Wang K, Zuo E, Peng G, Zhang SX, Chen G, Li Q, Tang K, Yu Q, Li Z, Wong CC, Xu G, Jing N, Yu X, Li J. CRISPR-Cas9-mediated genome editing in one blastomere of two-cell embryos reveals a novel Tet3 function in regulating neocortical development. Cell Res 2017; 27: 815-829.
Marinelli S, Del Rio A. Beginning of life ethics at the dawn of a new era of genome editing: are bioethical precepts and fast-evolving biotechnolo-gies irreconcilable? Clin Ter 2020: 407–11.
Perez Rojo F, Nyman RKM, Johnson AAT, Navarro MP, Ryan MH, Erskine W, Kaur P. CRISPR-Cas systems: ushering in the new genome editing era. Bioengineered 2018; 9: 214-221.
Zaami S, Piergentili R, Marinelli E, Montanari Vergallo G. Commentary - CRISPR-based techniques: Cas9, Cas13 and their applications in the era of COVID-19. Eur Rev Med Pharmacol Sci 2021; 25: 1752-1761.
Uddin F, Rudin CM, Sen T. CRISPR Gene Therapy: Applications, Limitations, and Implications for the Future. Front Oncol 2020; 10: 1387.
Del Rio A, Negro F, Umani Ronchi F. Comment on the article by Zaami S, et al. "CRISPR-based techniques: Cas9, Cas13 and their applications in the era of COVID-19". Eur Rev Med Pharmacol Sci 2021; 25: 1752-1761. Eur Rev Med Pharmacol Sci 2021; 25: 2830-2833.
Poller W, Dimmeler S, Heymans S, Zeller T, Haas J, Karakas M, Leistner DM, Jakob P, Nakagawa S, Blankenberg S, Engelhardt S, Thum T, Weber C, Meder B, Hajjar R, Landmesser U. Non-coding RNAs in cardiovascular diseases: diagnostic and therapeutic perspectives. Eur Heart J 2018; 39: 2704-2716.
Vallone C, Rigon G, Gulia C, Baffa A, Votino R, Morosetti G, Zaami S, Briganti V, Catania F, Gaffi M, Nucciotti R, Costantini FM, Piergentili R, Putignani L, Signore F. Non-Coding RNAs and Endometrial Cancer. Genes (Basel) 2018; 9: 187.
Wang Y, Zhang Y, Chen J, Wang M, Zhang T, Luo W, Li Y, Wu Y, Zeng B, Zhang K, Deng R, Li W. Detection of SARS-CoV-2 and Its Mutated Variants via CRISPR-Cas13-Based Transcription Amplification. Anal Chem 2021; 93: 3393-3402.
Pardi N, Hogan MJ, Weissman D. Recent advances in mRNA vaccine technology. Curr Opin Immunol 2020; 65: 14-20.
Guevara ML, Persano S, Persano F. Lipid-Based Vectors for Therapeutic mRNA-Based Anti-Cancer Vaccines. Curr Pharm Des 2019; 25: 1443-1454.
Piergentili R, Zaami S, Cavaliere AF, Signore F, Scambia G, Mattei A, Marinelli E, Gulia C, Perelli F. Non-Coding RNAs as Prognostic Markers for Endometrial Cancer. Int J Mol Sci 2021; 22: 3151.
Thin KZ, Tu JC, Raveendran S. Long non-coding SNHG1 in cancer. Clin Chim Acta 2019; 494: 38-47.
COVID-19 situation update worldwide, as of week 21, updated 10 June 2021. Available at: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases (Accessed on 10 June 2021).
Italian High Institute of Health. Istituto Superiore di Sanità, Procreazione medicalmente assistita: ridotti di un terzo, durante il lockdown, i cicli nei Centri iscritti al Registro rispetto al 2019 Procreazione medicalmente assistita: ridotti di un terzo, durante il lockdown, i cicli nei Centri iscritti al Registro rispetto al 2019. Issued on 11th November 2020. Available at: https://www.iss.it/news/-/asset_publisher/gJ3hFqMQsykM/content/procreazione-medicalmente-assistita-ridotti-di-un-terzo-durante-il-lockdown-i-cicli-nei-centri-iscritti-al-registro-rispetto-al-2019 (Accessed on 10 June 2021).
Raccomandazioni GISS 06.04.2020 ultima revisione. Issued on 6th April 2020. Available at: https://www.sigo.it/wp-content/uploads/2020/04/Raccomandazioni_GISS_PMA_06.04.2020.pdf (Accessed on 10 June 2021).
Arrêté royal instaurant un remboursement forfaitaire pour les traitements de l'infertilité féminine. (M.B. 14/10/2008). Available at: https://www.ieb-eib.org/ancien-site/pdf/ar-20081006-remboursement-fiv.pdf (Accessed on 10 June 2021).
Prime Minister Decree, issued on 12th January 2017. Decreto recante Definizione e aggiornamento dei livelli essenziali di assistenza, di cui all'articolo 1, comma 7, del decreto legislativo 30 dicembre 1992, n. 50. Available at: https://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=58669&completo=true (Accessed on 10 June 2021).
Statement from British Fertility Society (BFS) and Association of Reproductive Clinical Scientists (ARCS). Available at: https://www.britishfertilitysociety.org.uk/2020/03/30/statement-from-british-fertility-society-and-association-of-reproductive-and-clinical-scientists-for-fertility-staff/ (Accessed on 10 June 2021).
Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The Italian health system and the COVID-19 challenge. Lancet Public Health 2020; 5: e253.
Regional legislature of Lombardy. Ordinances n. X/2344, issued on 19th September 2014, and n. X/2611, issued on 7th November 2014.
Aassve A, Cavalli N, Mencarini L, Plach S, Livi Bacci M. The COVID-19 pandemic and human fertility. Science 2020; 369: 370-371.
Montanari Vergallo G. The transforming family: Heterologous fertilization and the new expressions of family relationships in Italian jurisprudence and European Court of Human Rights rulings. Medical Law International. 2019; 19: 282-297.
Valongo A. Human rights and reproductive choices in the case-law of Italian and European courts. Eur J Health Law 2014; 21: 123-40.
Marinelli S. Medically-assisted procreation and the rise of off-center, new types of "parenthood": it is incumbent upon lawmakers to intervene. Clin Ter 2019; 170: e241-e244.
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
