1. Is sperm/egg/embryo donation an option?

2. in different ways

3.  System check: don’t go from the frying pan into the fire  Consider genetic issues, hidden male issues (remember older men), endocrinology (macrocytosis), structure, immune, metabolic (insulin resistance), clotting, infection

4.  Clear egg factor Egg donation  Clear sperm donationSperm donation  CombinedDouble donation  Simply failed IVF++Egg vs DD (male link)  Embryo donationWho?  Gestational surrogacyWho?

5. Commis. Genetic Birth Nurture Commis. Genetic Birth Nurture Embryo donation = Birth x 2 & Nurture x 2 = 4/8 (compare adoption (<2/8) to gestational surrogacy(7/8)

6.  Identifiable or anonymous  If identifiable, known (sister/friend)or other (incl. reciprocal)  More information or less information  Ethnicity & type of donor (student/mother)  Travel or no travel  Shared risk?

7.  Identifiable or anonymous  More heterosexual couples choose anonymous  More choice patients choose identifiable  More information or less information  Ethnicity & type of donor (Cryos/other)  An Irish sperm bank?

8.  A distinct need exists  Which should be catered for  Regulation  Parental model = 6/8  A child to love  Deserve to succeed  We should support them

9.  Difficult transition w female << 40 (“unfair”)  Lack of causal clarity impedes transition  Time lapse/PGS has a role (but expensive)  But egg trumps sperm++  “My heart is broken”  How to resolve the conflict - own/donor split?  Medical, financial & emotional needs

10.  Does the embryo have siblings?  If not, why not?  Consanguinity  Recipients are very special  Need to travel (don’t want my children to meet my children)

11.  A medical need  Avoid exploitation  Legislation (UK/IRL)  We owe a duty of care & should provide

12.  Male: mostly genetic, evolving  Female: mostly by birth, cf Abbott judgement  Gattica: a brave new world (nightmare?)  Genetic justice? (rights & responsibilities)  The wisdom of Solomon  One step at a time

13.  Those who donate sperm & receive sperm  Those who donate & receive eggs  Those who donate & receive embryos  Those who carry & those they carry for

14.  A child to love  Its not complicated  Love makes the world go around  Emotional Glue  Hope, success, family  Questions!