Electroforesis bidimensional

Assisted reproductive technology was first introduced in 1984 in Iran and the first Iranian infant conceived by gamete intra-fallopian transfer was born in 1989 (Abedini, Ghaheri & Omani Samani, 2016). Indeed, the use of IVF in a range of contexts such

as Pre-implantation Genetic Diagnosis (PGD) as a preventive measure for diseases

with a genetic basis or for sex selection, sperm, egg and embryo donation, surrogacy, fertility preservation and animal conservation (freezing of egg, sperm and embryo) are commonplace in Iran. Important to note that no ART is allowed to single parents, homosexuals and non-heterosexuals (Tremayane & Akhondi, 2016). Thus, third party donation is only available to married couples. In other Muslim countries, where the majority of Muslims are Sunni, they do not allow third party donation in any form (Inhorn, 2006a).

3.5.1 ART by Egg Donation: Key Issues and Controversies

The important challenging issues in the field of third party reproduction consist of adultery, incest, and lack of biological descent. In Islam, reproduction outside of marriage is considered adultery (Zina), which is strictly forbidden in Islam. The other troubling aspect of third party donation is the potential for incest among the offspring of unknown donors. Similarly, third party donation confuses issues of kinship, descent, and inheritance. It destroys a child’s lineage and leads to a “mixture of relations” (Inhorn, 2006b).

As Tremayne and Sheibani (2006) summarised the new techniques of ART, particularly third party reproduction, have given birth to a new form of kinship, which encompasses biological, medical, legal, religious, ethical and moral aspects. To highlight some of the concerns regarding ART is the lineage and inheritance. While the child takes its lineage (parentage, kinship) from both sides, it is the paternal side, which has dominance over the maternal. The following is what Tremayne and Akhondi (2016) have outlined regarding the complications of third party involvement and Islamic law. In the Islamic law, the primary significance of lineage is that of paternity, closely tied to legitimacy, through which a child acquires its legal identity and religion. Under Islamic law, inheritance rights are exclusively linked to biological relatedness and to marriage as between the wife and the husband.

The clear proof of blood relatives to inheritance is seen in the case of adopted children. Although adoption has been allowed in Iran for several decades now, the adopted child does not have an automatic right to inherit from his adoptive parents (Tremayne & Akhondi, 2016). The child belongs to its biological parent and inherits from them but takes its name from the adoptive or social parent (Sanei, 1998). Thus, the subsequent Fatwas and laws make a clear distinction between the biological parent and the carrier parent in the case of gamete donation and emphasize the priority of nature over nurture (Tremayne & Sheibani, 2006).

3.5.2 ART by Egg Donation: Legitimization

In Iran, in order to legitimize third party gamete donation, the suggestion was that of temporary marriage (Haeri, 1989), a uniquely Shia practice, which is similar to permanent marriage but has a time limit agreed between the two parties and can be

between one hour to 99 years (Makarem Shirazi, 2004; Tremayne, 2009). This would allow the infertile party to receive gametes from the donor, who would be the temporary spouse and therefore a legitimate donor. The gametes would then be fertilized on a petri dish, but without any bodily contact, taking place between the two parties (Khamenei, 1999; Sistani, 1999).

The issue of sperm donation is out of the question and the religion bans sperm donation and prohibited by law. Therefore, sperm donation is replaced by embryo donation (Alizadeh & Samani, 2014). According to the law, embryo donors should be married couples who are ethically and legally healthy and capable. Although gamete donation is legitimized in Iran, there is no possibility of egg donation by sisters, and recipients of donated eggs tend to conceal egg donation. The main reason for this concealment is concern about socially negative attitudes toward the ARTs methods when using donated eggs in Iranian culture, and this concern leads the couples to hide egg donation from family and friends in order not to lose their support and as a result they have to endure stress when using such techniques (Hadizadeh-Talasaz, Latifnejad Roudsari & Simbar, 2015).

Interaction with egg donors created both financial and psychological problems for infertile couples. Most donors donate eggs for financial gain. Women expressed concern over the interaction of their husband with egg donors. Because in Iran, the egg donor should be a widow or divorced woman yet this situation made the infertile women worry about the relationship between their spouses with donors and consequently made them frightened of the stability of their own marital relationship (Ebrahimzadeh Zagami et al., 2019).

Lack of support from the partner can make women’s mental health worse during failed treatment and increase their stress. Likewise, men may feel left out of treatment cycles as the focus is largely directed towards the women. Although most women accept treatment because of the husband’s great interest in the child, they feel guilty due to the infertility problem and fear divorce or remarriage of the spouse (Ebrahimzadeh Zagami et al., 2019; Ranjbar, Behboodi-Moghadam, Borimnejad, Ghaffari & Akhondi, 2015).

3.5.3 ART by Egg Donation: Donor Anonymity

In Iran the donor’s personal information will be recorded and kept confidential, and every effort should be made to preserve donor privacy. Therefore, disclosure of the donor’s identity requires judicial process or a court order (Larijani & Zahedi, 2007). The required rules of confidentiality often lead to the anonymity of the biological parent and thereby make it impossible for the child to know their identity and possibility of inheriting from them (Gooshki & Allahbedashti, 2015).

3.5.4 ART by Egg Donation: Costs and Success Rate

Although ART in Iran is expensive and not free to anyone under any conditions, the cost is relatively lower than neighbouring countries with better economic situations and stronger currencies. The relative cost differences encourage infertile couples from foreign countries to travel to Iran to undergo ART. In 2011, the average cost of IVF ranged from $2250 to $3600 in government and private centres (Abedini, Ghaheri & Omani Samani, 2016). In vitro fertilization is expensive and not subsidized by the Iranian state and more than 75% of IVF cycles in Iranian couples are unsuccessful (Ebrahimzadeh Zagami et al., 2019). The egg donation processes cost around $7290

(1000,000,000 Rials Iranian currency) (personal communication). Currently most of these services are offered by the private clinics only. The Ministry of Health also plans to increase the number of infertility clinics in the public sector (Tremayne, 2012; Tremayne & Akhondi, 2016).