Among the most important changes: in order to have access to heterologous fertilization techniques, when male and female gametes donated by persons other than members of the recipient couple are used, a careful clinical assessment of the benefit/risk balance of the treatment is necessary, and special attention must be paid to obstetric complications, the potential effects of neonatology and any risks to maternal, maternal and newborn health. Access is granted to couples where one of the people is a carrier of sexually transmitted viral diseases such as HIV, HBV or HCV. Medical records should be compiled in more detail by describing the procedures of the MPA, the decision on the number of embryos to be created and the embryos to be retained. The recent decision of the Italian Constitutional Court of 9. April 2014 , which legitimized heterologous artificial insemination for the first time in Italy and declared unconstitutional the articles of Law No. 40 of 19 February 2004 prohibiting heterologous insemination, is therefore an emblematic example of this dynamic process in constant evolution. There are interesting ethical and legal considerations regarding the use of donor sperm. There is no U.S. federal regulation for AI, and different states differ in their legal attention to the issue. Questions may arise such as: Who is the legal father of a child born with the sperm of a man other than the husband? If a couple who have a child in this way divorces, is the ex-husband responsible for the maintenance obligation? If a child conceived in this way has a birth defect, can the physician be charged with professional misconduct? What are the inheritance rights of a child conceived by the sperm of a man other than his legal father? If several women become pregnant with sperm from a single donor, what are the effects if the resulting half-siblings meet later in life? Should seeds be used for the selective selection of certain hereditary traits and what are the moral implications? An example of such an attempt at selective breeding is a sperm bank in California with sperm donated by Nobel Prize winners. What happens if sperm from another donor, including donors of another breed, is accidentally used? This has already happened. In 2004, the Italian Parliament adopted a law (Law 40/2004) on medically assisted procreation (MAR). Over the years, all previous attempts to introduce legislation in this area have failed due to bitter conflicts, both in the cultural and legal fields in Italy, between those who consider that strict and detailed legislative control is necessary and those who consider that minimal legal intervention is necessary with regard to access to and use of the MRA .
Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK. Risk factors for legally induced abortion mortality in the United States. Obstet Gynecol. 2004;103:729–37. “He was our biological child; my egg, Daniel`s sperm,” Ana Carla said. “Because the baby would come out of someone else`s vagina unless we had a legal document saying the baby was actually our child and we wanted that baby and it wouldn`t be associated with the surrogate in any way, we had to go through all of that, even though it seems like it could have been a much easier process.” In the Netherlands, the 2002 Embryos Act  regulates ART procedures and prohibits both the reproductive cloning of human beings and the creation of hybrids and chimeras. The Act distinguishes between reproductive cloning and research-based somatic cell nuclear transfer (SCN) and introduces a five-year moratorium on SCNT. The creation of human embryos for research purposes is prohibited by law.
A reassessment of the policy by the Dutch cabinet in 2007 resulted in the continuation of the existing policy for the foreseeable future . The Latvian Law on ART Procedures is regulated by the 2002 Law on Sexual and Reproductive Health . “The purpose of this law is to define legal relationships in the field of sexual and reproductive health, with the aim of protecting the unborn life and sexual and reproductive health of every human being.” Article 13 of Chapter 5 defines “medical impregnation” as an artificial fusion of male and female gametes. Only heterosexual couples or women subject to the medical treatment facility upon written request have access to MAR treatments. In vitro fertilization is performed “with gametes from a donor or genetic relatives”. Article 15 prohibits the fusion of human and animal gamete nuclei for the purpose of fertilization; introduce a human embryo into the system of a primate or animal of another species; obtaining a human embryo for scientific research and its use as a tissue and organ donor; use the gametes of the donor or embryo for commercial purposes; choose the sex of the child during medical fertilization, except in the case of sex-related genetic diseases; and at the same time implant more than three fertilized ovaries into a woman`s body. Human cloning is prohibited. With respect to “surrogacy”, the Human Fertilisation and Embryology Act 2008  amends the Surrogacy Arrangements Act 1985 . Under current law, it is illegal to advertise to a surrogate or third parties in order to negotiate a surrogacy agreement on a commercial basis. The Human Fertilization and Embryology Act of 1990 created for the first time a legal procedure for married parents to grant them legal parenthood and obtain a parenting order. The 2008 law extended the right to apply for a parenting order to unmarried and same-sex couples (Articles 33-54, published on 6 April 2010). The Act “Assisted fertilization and embryo protection” (RT I 1997, 51, 824)  was enacted in Estonia in July 1997 and consists of 5 sections and 36 paragraphs and regulates the following procedures: artificial insemination, IVF and embryo research.
Laboratories conducting embryo research require a license from the National Medico-Legal Affairs Authority and the written consent of both gamete donors . More recently (9. April 2014) , the Constitutional Court legitimized heterologous artificial insemination and declared unconstitutional the articles of Law No. 40 of 19 February 2004 prohibiting heterologous insemination: a) Article 4, paragraph 3: “It is prohibited to use heterologous assisted procreation techniques”; (b) Article 9, paragraphs 1 and 3, which prohibit the exclusion of paternity and anonymity of the mother; (c) Article 12 § 1, which provides for penalties for anyone who uses gametes from persons outside the applicant couple for reproductive purposes. Article 5 states: “The health of the child born may be affected by the selection of gametes or embryos which have been shown to be free from serious diseases. The determination of the sex of the child may be influenced if the gametes used in assisted fertility treatment are those of the couple and the child born from these gametes would be at significant risk of serious disease if the child were of the opposite sex. Stored gametes and embryos must be destroyed in the event of the death of the person whose gametes are affected or in the event of the death of the donor (Article 4). Instead of destroying gametes and embryos, they can be “used for other lawful purposes if consent to such use has been obtained from the person(s) whose gametes are affected or whose gametes produced the embryos” . Below is a summary of the MAR and HER legislation for the 28 countries of the European Union.
In States where there is a legal vacuum, the authors have reported, where appropriate, guidelines, ethical indications or general laws that do not fully control this important area of medicine. Same-sex marriage has been legalized by the United States. Supreme Court in Obergerfell v. Hodges in 2015, but several areas of law remain gender-specific and marriage-centric in law, meaning that applying laws written for “equal” heterosexual couples to same-sex couples has harsher effects on same-sex couples. Frati P, Busardò FP, Vergallo GM, Pacchiarotti A, Fineschi V. Surrogacy: where Italy stands now and where Europe is going. Can the genetic mother be considered the legal mother? J Forensic Leg Med. 2015;30:4–8. Article 8 establishes the legal determination of filiation and stipulates that the mother and father may not refuse the parental rights of the unborn child after their written consent. If a lesbian couple has a child through artificial insemination, only the biological parent is recognized as the legal guardian.