Ethics of oocyte banking for third-party assisted reproduction: a systematic review

Ethics of oocyte banking for third-party assisted reproduction: a systematic review Abstract BACKGROUND The demand for donor oocytes has increased dramatically over the years. Today people in need of ART with the use of donor oocytes can appeal to commercial or public donor oocyte banks. The introduction of oocyte banks has shed a new light on the practice of ART using donor oocytes. The establishment and maintenance of oocyte banks should be sensitive to the ethical considerations. However, it is currently unclear which ethical aspects have to be taken into account. OBJECTIVE AND RATIONALE The aim of this article is to identify the ethical aspects of establishing and maintaining oocyte banks for third-party ART. SEARCH METHODS A systematic search was performed in July 2016 and February 2017 in both PubMed and Embase using a search string that combined synonyms for oocytes, donation or banking, reproductive care and ethics. We included a wide variety of English-language articles with a reasoned description of ethical aspects or moral considerations on oocyte donation or banking for third-party ART. OUTCOMES The practice of oocyte banking consists of three components, namely, the intake, storage and distribution of donor oocytes, and each is associated with multiple ethical challenges. The majority of the literature discusses ethical aspects with regard to the intake of donor oocytes, taking into account both the interests of the donor and those of the potential child. Ethical aspects related to the donor are the risks and psychosocial impact of donation, motivations and compensation in donor recruitment, and requirements for informed consent. Ethical aspects related to the potential child are 2-fold: first, the welfare standard and the selection of donors, and second, anonymity and disclosure. Ethical aspects of storing donor oocytes for ART are quality standards, confidentiality, issues of ownership and control, and international transport of donor oocytes. Ethical aspects of the distribution of donor oocytes concern the selection of recipients and the acceptability of treatment of ‘non-traditional’ families in particular, prioritization of recipients in case of scarcity, cross-border reproductive care, matching of recipients and donor oocytes, informed consent and counselling for recipients. WIDER IMPLICATIONS Our review demonstrates that multiple ethical aspects have to be taken into account when establishing and maintaining an oocyte bank. Yet, for many of these aspects there is no consensus regarding what approach should be employed. Remarkably, the existing literature focuses mainly on ethical aspects related to the intake of donor oocytes, while aspects related to storage and distribution of donor oocytes are less often addressed. An important gap in the existing literature should therefore be acknowledged. To conclude, our findings can serve as a starting point for clinicians in the field of ART, to conceptualize what challenges arise when establishing and maintaining oocyte banks for third-party ART. The review may also stimulate policy makers to set up a trustworthy and adaptive governance structure for the intake, storage and distribution of donor oocytes. oocyte banking, third-party ART, donor recruitment, recipient selection, ethics, systematic review Introduction The demand for donor oocytes for third-party assisted reproduction is continuously growing. In Europe, the number of treatments with the use of donor oocytes has increased from 6530 in 14 countries in the year 2000, to 40 244 in 26 countries in the year 2013 (Nygren et al., 2004; Calhaz-Jorge et al., 2017). Reasons for this increased demand are delayed parenthood, broadened treatment indications, and growing societal acceptance of alternative family structures (American Society of Reproductive Medicine (ASRM), 2013a; de Wert et al., 2014; Pennings et al., 2014). Additionally, many people seek treatment with donor oocytes across international borders because of national legislation or a shortage of donors in their country of residence (Shenfield et al., 2010). Today, people in need of ART) using donor oocytes can appeal to commercial or public donor oocyte banks. Resulting from major improvements in vitrification technologies, human oocytes can now be stored safely and efficiently, and successfully used after thawing for IVF treatment (Mertes et al., 2012). The introduction of oocyte banks sheds a new light on the practice of ART with donor oocytes. Both the flexibility and safety of the oocyte donation treatment have been optimized (de Melo-Martin and Cholst, 2008; Mertes et al., 2012). More fundamentally, the cryopreservation of oocytes offers an important alternative for the ethical, legal and religious concerns regarding embryo cryopreservation (Lavery et al., 2016; de Melo-Martin and Cholst, 2008). Still, the practice of oocyte banking is ethically sensitive because of three main reasons. First, oocyte banking for third-party ART is dependent on voluntary donations by healthy women who receive no therapeutic benefit from the donation procedure (leaving egg sharing practices out of consideration), and is ultimately aimed at the birth of a child (Bakker et al., 2017). In ART with patients’ own gametes, physicians have a dual responsibility towards the infertile patient and the child conceived by means of their assistance (Bredenoord et al., 2008). In ART with donor oocytes, this responsibility is extended towards the welfare of the donor. Second, the development of the oocyte vitrification technique has enabled the possibility to store donor oocytes for a longer period of time. The long-term storage of donor oocytes challenges current informed consent procedures of donors and recipients (Stroud and O’Doherty, 2015). Third, the high demand for donor oocytes and remaining scarcity in many countries manifests the ethical problem of the fair distribution of donor oocytes (Pennings, 2001). While the number of oocyte banks is growing, the practical implications of the three ethically sensitive components of oocyte banking have not yet been well defined. The aim of this paper is to identify the ethical aspects arising in establishing and maintaining oocyte banks for third-party ART as mentioned in the literature. The results of this systematic overview can guide clinicians and regulators towards an ethically responsible practice of oocyte banking for third-party ART. Methods Design In order to identify the ethical aspects of oocyte banking for third-party ART we performed a systematic literature search. In the field of bioethics different types of systematic reviews exist, differing in relation to the type of question the review addresses (normative or descriptive) and the type of literature that is being reviewed (normative or empirical) (McDougall, 2013). Because our review aims to answer a descriptive question of normative literature, namely ‘what are the ethical aspects of oocyte banking for third-party ART’, the Systematic Review of Reasons approach of Sofaer and Strech is most suitable. A Systematic Review of Reasons is used to systematically identify the reasons and arguments for or against a normative position, claim or phenomenon given in the literature (Strech and Sofaer, 2012). The Systematic Review of Reasons approach incorporates the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and allows for a thematic analysis typical for qualitative research (Moher et al., 2009). However, since the approach of Sofaer and Strech has been criticized for being practically challenging and there is currently no other widely used alternative, we modified it slightly. To identify key themes among different article types we did not use their comprehensive approach, but performed a thematic synthesis (Barnett-Page and Thomas, 2009). Search strategy The literature search according to PRISMA guidelines (Moher et al., 2009) was performed in the databases PubMed and Embase using a search string that combined synonyms for oocytes, donation or banking, reproductive care and ethics (Table I). The search was performed in July 2016 and repeated in February 2017. Additional data were collected by identifying relevant references cited in key articles and guidelines from several Reproductive Medicine and Biomedical Ethics associations (Tables III and IV). Table I Search and selection strategy for a systematic review of the ethics of oocyte banking for third-party ART. Databases PubMed, Embase Search keywords Exposure: [oocyte* OR egg OR ovum OR gamete*] AND [donor* OR donation OR bank* OR cryopreservation OR cryostorage OR cryobank OR vitrification OR freezing] AND [assisted reproduction OR assisted reproductive technologies OR fertility OR infertility OR reproductive medicine OR reproductive care OR reproductive health] AND [ethic* OR moral OR responsibilities] Other sources Additional papers were identified through references identified from key articles and guidelines from Reproductive Medicine and Biomedical Ethics associations: American Society of Reproductive Medicine ESHRE Nuffield Council on Bioethics Inclusion criteria Published in English in peer-reviewed journals (no date cut off) Papers that focus on ART and oocyte donation or banking Papers discussing ethical aspects or moral considerations Exclusion criteria Papers not in English Full articles not available Papers that did not focus on oocyte donation or banking Papers without discussion of ethical aspects and moral considerations Categories of articles Papers concerning the ethics of oocyte banking for ART Papers of reproductive health and bioethical associations Papers concerning oocyte banking for research purposes and biobanking Databases PubMed, Embase Search keywords Exposure: [oocyte* OR egg OR ovum OR gamete*] AND [donor* OR donation OR bank* OR cryopreservation OR cryostorage OR cryobank OR vitrification OR freezing] AND [assisted reproduction OR assisted reproductive technologies OR fertility OR infertility OR reproductive medicine OR reproductive care OR reproductive health] AND [ethic* OR moral OR responsibilities] Other sources Additional papers were identified through references identified from key articles and guidelines from Reproductive Medicine and Biomedical Ethics associations: American Society of Reproductive Medicine ESHRE Nuffield Council on Bioethics Inclusion criteria Published in English in peer-reviewed journals (no date cut off) Papers that focus on ART and oocyte donation or banking Papers discussing ethical aspects or moral considerations Exclusion criteria Papers not in English Full articles not available Papers that did not focus on oocyte donation or banking Papers without discussion of ethical aspects and moral considerations Categories of articles Papers concerning the ethics of oocyte banking for ART Papers of reproductive health and bioethical associations Papers concerning oocyte banking for research purposes and biobanking Table I Search and selection strategy for a systematic review of the ethics of oocyte banking for third-party ART. Databases PubMed, Embase Search keywords Exposure: [oocyte* OR egg OR ovum OR gamete*] AND [donor* OR donation OR bank* OR cryopreservation OR cryostorage OR cryobank OR vitrification OR freezing] AND [assisted reproduction OR assisted reproductive technologies OR fertility OR infertility OR reproductive medicine OR reproductive care OR reproductive health] AND [ethic* OR moral OR responsibilities] Other sources Additional papers were identified through references identified from key articles and guidelines from Reproductive Medicine and Biomedical Ethics associations: American Society of Reproductive Medicine ESHRE Nuffield Council on Bioethics Inclusion criteria Published in English in peer-reviewed journals (no date cut off) Papers that focus on ART and oocyte donation or banking Papers discussing ethical aspects or moral considerations Exclusion criteria Papers not in English Full articles not available Papers that did not focus on oocyte donation or banking Papers without discussion of ethical aspects and moral considerations Categories of articles Papers concerning the ethics of oocyte banking for ART Papers of reproductive health and bioethical associations Papers concerning oocyte banking for research purposes and biobanking Databases PubMed, Embase Search keywords Exposure: [oocyte* OR egg OR ovum OR gamete*] AND [donor* OR donation OR bank* OR cryopreservation OR cryostorage OR cryobank OR vitrification OR freezing] AND [assisted reproduction OR assisted reproductive technologies OR fertility OR infertility OR reproductive medicine OR reproductive care OR reproductive health] AND [ethic* OR moral OR responsibilities] Other sources Additional papers were identified through references identified from key articles and guidelines from Reproductive Medicine and Biomedical Ethics associations: American Society of Reproductive Medicine ESHRE Nuffield Council on Bioethics Inclusion criteria Published in English in peer-reviewed journals (no date cut off) Papers that focus on ART and oocyte donation or banking Papers discussing ethical aspects or moral considerations Exclusion criteria Papers not in English Full articles not available Papers that did not focus on oocyte donation or banking Papers without discussion of ethical aspects and moral considerations Categories of articles Papers concerning the ethics of oocyte banking for ART Papers of reproductive health and bioethical associations Papers concerning oocyte banking for research purposes and biobanking Table III Articles of reproductive medicine and biomedical ethical associations. References Country Paper type Scope of paper Aim of paper 127 ASRM (2016a) USA Committee opinion Medical errors involving gamete donation To provide an overview of the reasons for disclosure of medical errors with gametes and embryos, and recommendations for practice 128 ASRM (2016b) USA Committee opinion CBRC To provide an overview of the ethical aspects of CBRC, and recommendations for practice 129 ASRM (2013a) USA Committee opinion Oocyte donation for postmenopausal women To provide an overview of the ethical aspects of oocyte donation in postmenopausal women, and recommendations for practice 130 ASRM (2013b) USA Committee opinion Access to ART and childrearing ability To provide an overview of the interest of fertility patients and the welfare of the child, and recommendations for practice for patient selection 131 ASRM (2013c) USA Committee opinion Disclosure in gamete donation To provide an overview of the pro and contra reasons for disclosure, and recommendations for practice 132 ASRM (2009) USA Report Obligations and rights of donors To outlines the interests, obligations, and rights of both male and female gamete donors 133 ASRM (2004) USA Report Payment of oocyte donors To provide an overview of the ethical issues concerning payment of oocyte donors, and recommendations for practice 134 ESHRE Task Force on Ethics and Law de Wert et al. (2014) Multiple (Europe) Discussion and recommendation ART for alternative family structures To provide an overview of ethical principles regarding the access to ART for single, gay and trans-sexual people 135 ESHRE Task Force on Ethics and Law Dondorp et al. (2014) Multiple (Europe) Discussion and recommendation Genetic screening of gamete donors To explore the ethical issues involved in the genetic screening of gamete donors, and provide recommendations for practice 136 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation CBRC To outline the ethical aspects of CBRC, and provide recommendations for practice 137 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation Access to ART To provide an overview of the arguments for funded ART and prioritization of patients, and recommendations for practice 138 ESHRE Task Force on Ethics and Law Pennings et al. (2007a) Multiple (Europe) Discussion and recommendation Oocyte donation in general To explicate the ethical considerations regarding oocyte donation, and provide recommendations for practice 139 ESHRE Task Force on Ethics and Law Pennings et al. (2007b) Multiple (Europe) Discussion and recommendation Welfare of the child in ART To analyse the responsibility of the fertility specialist towards the welfare of the future child, and provide recommendations for practice 140 ESHRE Task Force on Ethics and Law Pennings et al. (2006) Multiple (Europe) Discussion and recommendation Posthumous assisted reproduction To outline the ethical aspects of posthumous assisted reproduction, and provide recommendations for practice 141 ESHRE Task Force on Ethics and Law (2004) Multiple (Europe) Discussion and recommendation Cryopreservation of gametes To explicate the guidelines concerning informed consent procedures of postmortem donation of cryopreserved gametes 142 ESHRE Task Force on Ethics and Law (2002) Multiple (Europe) Discussion and recommendation Gamete and embryo donation To outline the ethical considerations regarding gamete and embryo donation, and provide recommendations for practice 143 Nuffield Council on Bioethics (2011) UK Report Tissue donation for medicine and research To outline the ethical aspects of tissue donation for medicine and research, and provide recommendations for practice References Country Paper type Scope of paper Aim of paper 127 ASRM (2016a) USA Committee opinion Medical errors involving gamete donation To provide an overview of the reasons for disclosure of medical errors with gametes and embryos, and recommendations for practice 128 ASRM (2016b) USA Committee opinion CBRC To provide an overview of the ethical aspects of CBRC, and recommendations for practice 129 ASRM (2013a) USA Committee opinion Oocyte donation for postmenopausal women To provide an overview of the ethical aspects of oocyte donation in postmenopausal women, and recommendations for practice 130 ASRM (2013b) USA Committee opinion Access to ART and childrearing ability To provide an overview of the interest of fertility patients and the welfare of the child, and recommendations for practice for patient selection 131 ASRM (2013c) USA Committee opinion Disclosure in gamete donation To provide an overview of the pro and contra reasons for disclosure, and recommendations for practice 132 ASRM (2009) USA Report Obligations and rights of donors To outlines the interests, obligations, and rights of both male and female gamete donors 133 ASRM (2004) USA Report Payment of oocyte donors To provide an overview of the ethical issues concerning payment of oocyte donors, and recommendations for practice 134 ESHRE Task Force on Ethics and Law de Wert et al. (2014) Multiple (Europe) Discussion and recommendation ART for alternative family structures To provide an overview of ethical principles regarding the access to ART for single, gay and trans-sexual people 135 ESHRE Task Force on Ethics and Law Dondorp et al. (2014) Multiple (Europe) Discussion and recommendation Genetic screening of gamete donors To explore the ethical issues involved in the genetic screening of gamete donors, and provide recommendations for practice 136 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation CBRC To outline the ethical aspects of CBRC, and provide recommendations for practice 137 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation Access to ART To provide an overview of the arguments for funded ART and prioritization of patients, and recommendations for practice 138 ESHRE Task Force on Ethics and Law Pennings et al. (2007a) Multiple (Europe) Discussion and recommendation Oocyte donation in general To explicate the ethical considerations regarding oocyte donation, and provide recommendations for practice 139 ESHRE Task Force on Ethics and Law Pennings et al. (2007b) Multiple (Europe) Discussion and recommendation Welfare of the child in ART To analyse the responsibility of the fertility specialist towards the welfare of the future child, and provide recommendations for practice 140 ESHRE Task Force on Ethics and Law Pennings et al. (2006) Multiple (Europe) Discussion and recommendation Posthumous assisted reproduction To outline the ethical aspects of posthumous assisted reproduction, and provide recommendations for practice 141 ESHRE Task Force on Ethics and Law (2004) Multiple (Europe) Discussion and recommendation Cryopreservation of gametes To explicate the guidelines concerning informed consent procedures of postmortem donation of cryopreserved gametes 142 ESHRE Task Force on Ethics and Law (2002) Multiple (Europe) Discussion and recommendation Gamete and embryo donation To outline the ethical considerations regarding gamete and embryo donation, and provide recommendations for practice 143 Nuffield Council on Bioethics (2011) UK Report Tissue donation for medicine and research To outline the ethical aspects of tissue donation for medicine and research, and provide recommendations for practice Table III Articles of reproductive medicine and biomedical ethical associations. References Country Paper type Scope of paper Aim of paper 127 ASRM (2016a) USA Committee opinion Medical errors involving gamete donation To provide an overview of the reasons for disclosure of medical errors with gametes and embryos, and recommendations for practice 128 ASRM (2016b) USA Committee opinion CBRC To provide an overview of the ethical aspects of CBRC, and recommendations for practice 129 ASRM (2013a) USA Committee opinion Oocyte donation for postmenopausal women To provide an overview of the ethical aspects of oocyte donation in postmenopausal women, and recommendations for practice 130 ASRM (2013b) USA Committee opinion Access to ART and childrearing ability To provide an overview of the interest of fertility patients and the welfare of the child, and recommendations for practice for patient selection 131 ASRM (2013c) USA Committee opinion Disclosure in gamete donation To provide an overview of the pro and contra reasons for disclosure, and recommendations for practice 132 ASRM (2009) USA Report Obligations and rights of donors To outlines the interests, obligations, and rights of both male and female gamete donors 133 ASRM (2004) USA Report Payment of oocyte donors To provide an overview of the ethical issues concerning payment of oocyte donors, and recommendations for practice 134 ESHRE Task Force on Ethics and Law de Wert et al. (2014) Multiple (Europe) Discussion and recommendation ART for alternative family structures To provide an overview of ethical principles regarding the access to ART for single, gay and trans-sexual people 135 ESHRE Task Force on Ethics and Law Dondorp et al. (2014) Multiple (Europe) Discussion and recommendation Genetic screening of gamete donors To explore the ethical issues involved in the genetic screening of gamete donors, and provide recommendations for practice 136 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation CBRC To outline the ethical aspects of CBRC, and provide recommendations for practice 137 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation Access to ART To provide an overview of the arguments for funded ART and prioritization of patients, and recommendations for practice 138 ESHRE Task Force on Ethics and Law Pennings et al. (2007a) Multiple (Europe) Discussion and recommendation Oocyte donation in general To explicate the ethical considerations regarding oocyte donation, and provide recommendations for practice 139 ESHRE Task Force on Ethics and Law Pennings et al. (2007b) Multiple (Europe) Discussion and recommendation Welfare of the child in ART To analyse the responsibility of the fertility specialist towards the welfare of the future child, and provide recommendations for practice 140 ESHRE Task Force on Ethics and Law Pennings et al. (2006) Multiple (Europe) Discussion and recommendation Posthumous assisted reproduction To outline the ethical aspects of posthumous assisted reproduction, and provide recommendations for practice 141 ESHRE Task Force on Ethics and Law (2004) Multiple (Europe) Discussion and recommendation Cryopreservation of gametes To explicate the guidelines concerning informed consent procedures of postmortem donation of cryopreserved gametes 142 ESHRE Task Force on Ethics and Law (2002) Multiple (Europe) Discussion and recommendation Gamete and embryo donation To outline the ethical considerations regarding gamete and embryo donation, and provide recommendations for practice 143 Nuffield Council on Bioethics (2011) UK Report Tissue donation for medicine and research To outline the ethical aspects of tissue donation for medicine and research, and provide recommendations for practice References Country Paper type Scope of paper Aim of paper 127 ASRM (2016a) USA Committee opinion Medical errors involving gamete donation To provide an overview of the reasons for disclosure of medical errors with gametes and embryos, and recommendations for practice 128 ASRM (2016b) USA Committee opinion CBRC To provide an overview of the ethical aspects of CBRC, and recommendations for practice 129 ASRM (2013a) USA Committee opinion Oocyte donation for postmenopausal women To provide an overview of the ethical aspects of oocyte donation in postmenopausal women, and recommendations for practice 130 ASRM (2013b) USA Committee opinion Access to ART and childrearing ability To provide an overview of the interest of fertility patients and the welfare of the child, and recommendations for practice for patient selection 131 ASRM (2013c) USA Committee opinion Disclosure in gamete donation To provide an overview of the pro and contra reasons for disclosure, and recommendations for practice 132 ASRM (2009) USA Report Obligations and rights of donors To outlines the interests, obligations, and rights of both male and female gamete donors 133 ASRM (2004) USA Report Payment of oocyte donors To provide an overview of the ethical issues concerning payment of oocyte donors, and recommendations for practice 134 ESHRE Task Force on Ethics and Law de Wert et al. (2014) Multiple (Europe) Discussion and recommendation ART for alternative family structures To provide an overview of ethical principles regarding the access to ART for single, gay and trans-sexual people 135 ESHRE Task Force on Ethics and Law Dondorp et al. (2014) Multiple (Europe) Discussion and recommendation Genetic screening of gamete donors To explore the ethical issues involved in the genetic screening of gamete donors, and provide recommendations for practice 136 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation CBRC To outline the ethical aspects of CBRC, and provide recommendations for practice 137 ESHRE Task Force on Ethics and Law Pennings et al. (2008) Multiple (Europe) Discussion and recommendation Access to ART To provide an overview of the arguments for funded ART and prioritization of patients, and recommendations for practice 138 ESHRE Task Force on Ethics and Law Pennings et al. (2007a) Multiple (Europe) Discussion and recommendation Oocyte donation in general To explicate the ethical considerations regarding oocyte donation, and provide recommendations for practice 139 ESHRE Task Force on Ethics and Law Pennings et al. (2007b) Multiple (Europe) Discussion and recommendation Welfare of the child in ART To analyse the responsibility of the fertility specialist towards the welfare of the future child, and provide recommendations for practice 140 ESHRE Task Force on Ethics and Law Pennings et al. (2006) Multiple (Europe) Discussion and recommendation Posthumous assisted reproduction To outline the ethical aspects of posthumous assisted reproduction, and provide recommendations for practice 141 ESHRE Task Force on Ethics and Law (2004) Multiple (Europe) Discussion and recommendation Cryopreservation of gametes To explicate the guidelines concerning informed consent procedures of postmortem donation of cryopreserved gametes 142 ESHRE Task Force on Ethics and Law (2002) Multiple (Europe) Discussion and recommendation Gamete and embryo donation To outline the ethical considerations regarding gamete and embryo donation, and provide recommendations for practice 143 Nuffield Council on Bioethics (2011) UK Report Tissue donation for medicine and research To outline the ethical aspects of tissue donation for medicine and research, and provide recommendations for practice Table IV Articles concerning biobanking and oocyte banking for research purposes. References Country Paper type Scope of paper Aim of paper 144 Baylis and Widdows (2015) UK Analysis Biobanking of embryo’s and oocytes for research To outline the ethical challenges of long-term storage of oocytes and embryos 145 Dickenson (2006) UK Discussion Oocyte banking for research To analyse the concept of property in the body in relation to oocyte banking for research 146 O’Doherty et al. (2011) USA Discussion Governance of biobanking To design an adaptive governance structure for genomic tissue biobanks 147 Rothstein (2005) USA Analysis Ethics of biobanking To provide an ethical analysis of biobanking 148 Stroud and O’Doherty (2015) USA Analysis Biobanking of embryo’s and oocytes for research To discuss the ethically sustainable governance of biobanking eggs and embryos for research 149 Waldby and Mitchell (2006) UK Book chapter Biobanking and tissue economies To discuss the sociological and ethical aspects of increasing commercialization of tissue donation and biobanking References Country Paper type Scope of paper Aim of paper 144 Baylis and Widdows (2015) UK Analysis Biobanking of embryo’s and oocytes for research To outline the ethical challenges of long-term storage of oocytes and embryos 145 Dickenson (2006) UK Discussion Oocyte banking for research To analyse the concept of property in the body in relation to oocyte banking for research 146 O’Doherty et al. (2011) USA Discussion Governance of biobanking To design an adaptive governance structure for genomic tissue biobanks 147 Rothstein (2005) USA Analysis Ethics of biobanking To provide an ethical analysis of biobanking 148 Stroud and O’Doherty (2015) USA Analysis Biobanking of embryo’s and oocytes for research To discuss the ethically sustainable governance of biobanking eggs and embryos for research 149 Waldby and Mitchell (2006) UK Book chapter Biobanking and tissue economies To discuss the sociological and ethical aspects of increasing commercialization of tissue donation and biobanking Table IV Articles concerning biobanking and oocyte banking for research purposes. References Country Paper type Scope of paper Aim of paper 144 Baylis and Widdows (2015) UK Analysis Biobanking of embryo’s and oocytes for research To outline the ethical challenges of long-term storage of oocytes and embryos 145 Dickenson (2006) UK Discussion Oocyte banking for research To analyse the concept of property in the body in relation to oocyte banking for research 146 O’Doherty et al. (2011) USA Discussion Governance of biobanking To design an adaptive governance structure for genomic tissue biobanks 147 Rothstein (2005) USA Analysis Ethics of biobanking To provide an ethical analysis of biobanking 148 Stroud and O’Doherty (2015) USA Analysis Biobanking of embryo’s and oocytes for research To discuss the ethically sustainable governance of biobanking eggs and embryos for research 149 Waldby and Mitchell (2006) UK Book chapter Biobanking and tissue economies To discuss the sociological and ethical aspects of increasing commercialization of tissue donation and biobanking References Country Paper type Scope of paper Aim of paper 144 Baylis and Widdows (2015) UK Analysis Biobanking of embryo’s and oocytes for research To outline the ethical challenges of long-term storage of oocytes and embryos 145 Dickenson (2006) UK Discussion Oocyte banking for research To analyse the concept of property in the body in relation to oocyte banking for research 146 O’Doherty et al. (2011) USA Discussion Governance of biobanking To design an adaptive governance structure for genomic tissue biobanks 147 Rothstein (2005) USA Analysis Ethics of biobanking To provide an ethical analysis of biobanking 148 Stroud and O’Doherty (2015) USA Analysis Biobanking of embryo’s and oocytes for research To discuss the ethically sustainable governance of biobanking eggs and embryos for research 149 Waldby and Mitchell (2006) UK Book chapter Biobanking and tissue economies To discuss the sociological and ethical aspects of increasing commercialization of tissue donation and biobanking Study selection and inclusion criteria The title and abstract of the studies were screened, followed by a full text screening using inclusion and exclusion criteria by one researcher (E.M.K.) (Table I). A second researcher (A.M.E.B.) checked the selection results for consistency. Discrepancies were discussed and successfully overcome within the research group. We excluded articles not written in English, when no full texts were available, and if no ethical aspects, reasoned opinions or moral considerations regarding oocyte banking for third-party ART were given (Fig. 1). We understood ethical aspects as overarching categories for actions or situations where something has to be considered because of ethical reasons, principles or values (Mertz et al. 2016). These ethical reasons are mostly derived from the midlevel principles of biomedical ethics, as defined by Beauchamp and Childress, including beneficence, non-maleficence, autonomy and justice (Beauchamp and Childress, 2013). Articles with a single mentioning of the word ‘ethics’ were excluded. We included all sorts of articles in which ethical aspects and moral considerations regarding oocyte banking for third-party ART were provided, including commentaries, editorials, book chapters, essays, etc. (McCullough et al. 2004). In the literature that resulted from our search, we found few or no ethical aspects with regard to the banking or long-term storage of donor oocytes. Therefore, we complemented our search with key articles concerning oocyte banking for research purposes and biobanking, in which the ethical aspects regarding (long-term) storage are more extensively debated. Figure 1 View largeDownload slide Flow diagram of the selection and inclusion of articles in a systematic review of the ethics of oocyte banking for third-party ART. Figure 1 View largeDownload slide Flow diagram of the selection and inclusion of articles in a systematic review of the ethics of oocyte banking for third-party ART. There is currently no clear view on how to do a quality assessment of the included literature in a Systematic Review of Reasons. For reasons of transparency, we mention here that we considered publications that appeared in an international peer-reviewed journal or a book chapter of sufficient quality to be included in the review (McDougall, 2013; Mertz, 2017). Yet, the arguments and moral considerations in these publications can be ethically mistaken or poor. At the same time, we decided to include these considerations since our review is first of all descriptive (and not normative). Moreover, inclusion reduces the risk of individual bias in the attempt to assess the quality. Data extraction and analysis The full texts of the selected articles were read carefully by EMK, and data extraction was checked by AMEB and ALB. Our first strategy was to collect the contextual data of the included articles, such as the aim and scope, the country of origin, and the article type (Tables II–IV). We used a thematic analysis approach to identify key themes among different article types (Barnett-Page and Thomas, 2009). Ethical aspects and moral considerations regarding the practice of oocyte banking for ART were coded, and closely related codes categorized into themes determined by consensus within our study team. Table II Articles concerning the ethical aspects of oocyte banking. References Country Paper type Scope of paper Aim of paper 1 Abdalla and Studd (1989) UK Commentary Oocyte donation in general To share experiences with the practice of oocyte donation 2 Ahuja and Simons (1998) UK Opinion Recruitment of oocyte donors for ART To argue that the safety of oocyte donation is the main priority in ethical practice of oocyte donation 3 Ahuja, Simons and Edwards (1999) UK Opinion Recruitment of oocyte donors for ART To discuss the HFEA policy on altruistic oocyte donation 4 Alberta et al. (2013) USA Analysis Recruitment of oocyte donors for ART To provide insight into the donor recruitment policies of different donor agencies 5 Alberta et al. (2014) USA Analysis Recruitment of oocyte donors for ART To provide insight into risk disclosure in recruitment advertisements of donor agencies and IVF clinics 6 Barratt et al. (1998) Multiple Guideline Gamete donation in general To provide an overview of ethical standards in gamete donation 7 Barritt et al. (2007) USA Commentary Oocytes cryopreservation technique To describe instructions for ethical research on human oocytes 8 Benshushan and Schenker (1998) Israel Review Posthumous reproduction To provide an overview the ethical aspects of posthumous reproduction 9 Benward (2015) USA Review Recipient counselling To examine the ethical concerns of mandatory counselling for gamete recipients 10 Black (2010) USA Guideline Recipient counselling To outline the interests and rights of gamete donors to guide nursing professionals in ethical sound practice 11 Blyth and Cameron (1998) UK Opinion Welfare of the child in ART To criticize the use of the welfare standards in assessing the acceptability of ART 12 Blyth et al. (2011) UK Essay CBRC To outline an ethical framework for counsellors regarding the treatment of patients from abroad 13 Boutelle (2014) Australia Review Oocyte donation in general To explore the characteristics, motivations and experiences of oocyte donors 14 Braverman (2015) USA Essay Recipient counselling To clarify the role of the mental health professional in third-party assisted reproduction 15 Burrell (2012) Finland Analysis ART in general To examine discussions in the application of the Finnish Act on ART 16 Byrd et al. (2002) UK Survey Oocyte donation in general To identify the motivations and experiences of oocyte donors 17 Cohen (1997) USA Essay ART in general To argue whether, and if so to what extent new reproductive techniques should be regulated 18 Cook et al. (2013) USA Review Oocyte donation and cryopreservation To explore outcomes of donor IVF cycles with cryopreserved oocytes and the utilization of extra embryos after fresh transfers 19 Crawshaw et al. (2013) UK Analysis Donor registration To identify the experiences of donor conceived adults, donors, non-donor-conceived adult children of donors with a voluntary DNA-based register 20 Daniels (2000) New Zealand Essay Payment to gamete donors To explore the interplay between pragmatics, policy and ethics considering monetary payment for gamete donors 21 Dean and Edwards (1994) UK Review Oocyte donation in postmenopausal women To outline the ethical aspects of oocyte donation in menopausal women 22 Deech (1998) UK Review Gamete banking To provide an overview of the regulatory and ethical responsibilities of gamete banks in the UK 23 Dickenson (2011) UK Analysis ART To argue for an alternative, non-commercial, system to realize (ethical) progress in the practice of ART 24 Dillon and Fiester (2012) USA Discussion Posthumous donation To debate the current informed consent procedures of posthumous gamete donation 25 Eisenberg and Schenker (1997) Israel Review Oocyte donation in postmenopausal women To provide an overview of the medical and ethical aspects of oocyte donation in menopausal women 26 Englert (1996) Belgium Opinion Oocyte donation in general To argue that the shortage of donor oocytes challenges ethical responsible organization of oocyte donation 27 Fauser and Garcia Velasco (2017) The Netherlands Editorial Oocyte donation in general To address the concerns regarding the risks of breast cancer after donating oocytes 28 Freeman (2015) USA Review Disclosure in gamete donation To provide an overview of the psychosocial evidence and ethical debate on disclosure in gamete donation 29 Frith (2001) UK Opinion Anonymity in gamete donation To outline the ethical and practical arguments on non-anonymous donation 30 Gil-Arribas et al. (2016) Spain Review Genetic screening of oocyte donors To identify the arguments on carrier genetic test of donors in oocyte donation 31 Golombok et al. (1999) UK Survey Post-ART family functioning To identify the quality of parenting and issues of disclosure in post ART families 32 Gosden and Gosden (2012) USA Opinion ART To provide an overview of the practical, social and ethical aspects of the new vitrification technique for ART 33 Guerin (1998) France Opinion Payment of gamete donors To discuss the experience of French CECOS Federation regarding anonymous gamete donation 34 Hamilton (1998) UK Discussion Recruitment of oocyte donors for ART To criticize the proposal of the HFEA to withdraw remuneration of donors 35 Heng (2006) Singapore Essay Transnational oocyte donation To discuss the ethical issues that come with transnational or international oocyte donation 36 Heng (2007a) Singapore Discussion Transnational sperm and egg donation To discuss the legal and ethical issues in the international transaction of donor sperm and oocytes 37 Heng (2007b) Singapore Opinion CBRC To address the question if fertility specialists refer local patients abroad for shared or commercialized oocyte donation 38 Hostiuc (2013) Romania Survey ART To identify the opinions of young physicians on the acceptability of third-party ART 39 Ilioi and Golombok (2015) UK Review Post-ART family functioning To review articles on the psychosocial development of adolescence conceived through ART 40 Inhorn (2010) USA Review CBRC To provide an overview of bioethical Islamic perspectives on CBRC 41 Inhorn and Gürtin (2011) UK Discussion CBRC To provide an overview of the discussion and future research agenda with regards to CBRC 42 Isasi and Knoppers (2007) Canada Analysis Payment of gamete donors To provide an overview of the use of financial compensations for oocyte donation in various jurisdictions 43 Jones and Cohen (2001) USA and France Review ART To identify the ethical aspects upon which consensus exists in multiple guidelines on ART 44 Kääriäinen et al. (2005) Multiple Discussion ART and genetics To give an overview of the ethical aspects of ART and genetics 45 Kalfoglou and Geller (2000) USA Qualitative interview study Oocyte donation in general To identify the motives and experiences of oocyte donors 46 Keehn et al. (2012) USA Analysis Recruitment of oocyte donors for ART To systematically identify the ethical aspects of online oocyte donor recruitment 47 Klein and Sauer (2010) USA Discussion Oocyte donation in general To identify the arguments concerning compensation, oocyte donation for postmenopausal women and egg-sharing 48 Klitzman and Sauer (2015) USA Commentary Payment of gamete donors To comment on an ASRM statement on the ethical aspects of donor compensation 49 Klitzman (2016) USA Qualitative interview study Recruitment of oocyte donors for ART To identify ethical concerns of IVF providers and patients on the practice and policy of donor agencies 50 Knoppers and Le Bris (1993) Canada Review ART To outline the international ethical and legal aspects of ART 51 Landau (2005) Israel Discussion Oocyte donation for postmenopausal women To outline the arguments regarding the acceptability of oocyte donation in postmenopausal women 52 Levine (2010) USA Analysis Recruitment of oocyte donors for ART To analyse the compliance of advertisements for oocyte donors in student newspapers with ethical guidelines 53 Lindheim et al. (2001) USA Survey Payment of oocyte donors To identify the influence of payment on women’s decision to donate oocytes 54 Londra et al. (2014) USA Review ART To review the ethical and legal aspects of ART 55 Mahlstedt and Greenfeld (1989) USA Discussion ART To discuss the ethical aspects of preparing patients for ART with donor gametes 56 Marcus and Brinsden (1996) UK Review Oocyte donation in postmenopausal women To review best practices and ethical aspects of embryo or oocyte donation in postmenopausal women 57 Maunder (2004) UK Review ART and Human Rights To provide an overview of applicable Human Rights in ART 58 McGee et al. (2001) USA Opinion Anonymity in gamete donation To argue against anonymity in gamete donation and in favour of early disclosure 59 McGee et al. (2013) USA Book chapter Oocyte and embryo donation To provide an overview of the ethical issues in oocyte and embryo donation 60 McLaughlin et al. (1998) UK Opinion Recruitment of oocyte donors for ART To argue to allow only purely altruistic men and women who have parental experience as gamete donors 61 McWhinnie (1998) UK Discussion Welfare of the child in ART To debate and address the rights and needs of children born from gamete donation 62 de Melo-Martin and Cholst (2008) USA Discussion Oocyte donor recruitment To evaluate the ethical concerns related to the selection of participants for research on oocyte cryopreservation techniques 63 de Melo-Martín (2014) USA Opinion Anonymity in gamete donation To criticize the arguments on the ban of anonymous gamete donation 64 Merlet (2009) France Review French legislation in ART To provide an overview of the legal framework on ART in French within the European context 65 Mertes et al. (2012) Belgium Discussion Oocytes cryopreservation technique To discuss the ethical implications of cryopreservation of oocytes and the issue of payment to oocyte donors 66 Mizukami et al. (2005) USA Survey Posthumous oocyte donation To identify laypeople’s views on the acceptability of posthumous oocyte donation 67 Murray et al. (2006) UK Survey Post-ART family functioning To identify the wellbeing of children and parents and in postoocyte donation families regarding disclosure issues 68 Murphy (2009) USA Discussion Gamete donation in general To discuss the ethical desirability of gamete donation 69 Nakhuda (2010) USA Discussion Posthumous gamete donation To discuss the ethical aspects of posthumous ART 70 Novaes (1989) France Analysis Oocyte donors recruitment To examine donor recruitment policies and the role of the recruiting agent 71 O’Donnell (2000) UK Analysis Property in gametes To analyse the nature of gametes to formulate a legal framework for ART 72 Papadimos and Papadimos (2004) USA Opinion Oocyte donation in general To argue that the consent of young student oocyte donors who are paid is invalid 73 Parker (2004) UK Opinion Posthumous gamete donation To argue that one should allow posthumous donation but encourage individuals to make their wishes explicit 74 Pattinson (2012) UK Review Payment for gamete donation To examine the role of a national gamete donation system in the ethical and legal implementation of financial incentives 75 Paulson and Sauer (1994) UK Opinion Oocyte donation for postmenopausal women To argue for the acceptability of oocyte donation in women over 50 years 76 Paulson et al. (1994) UK Discussion Oocyte donation for postmenopausal women To debate the acceptability of oocyte donation in postmenopausal women 77 Pennings (1999) Belgium Analysis Welfare of the child in ART To analyse three standards for the evaluation of the welfare of the child in assessing the acceptability of ART 78 Pennings (2000) Belgium Opinion Matching of donor oocytes and recipients To argue for the possibility for recipients to choose (the characteristics of) their donor 79 Pennings (2001) Belgium Discussion Selection and prioritization of donor oocyte recipients To outline the ethical criteria for the allocation of the scarce supply of donor oocytes 80 Pennings (2005) Belgium Commentary Recruitment of oocyte donors for ART To argue for alternative strategies to recruit gamete donors 81 Pennings (2007) Belgium Commentary ART To provide an overview of Belgian legislation on ART and the disposition of embryos and gametes 82 Pennings (2012) Belgium Opinion Anonymity in gamete donation To argue against a retrospective law on donor anonymity 83 Pennings (2015) Belgium Analysis Recruitment of oocyte donors for ART To analyse the role of an altruistic motive in gamete donation 84 Pennings (2017) Belgium Opinion Disclosure in gamete donation To argue that non-disclosure does not negatively influence the wellbeing of the child 85 Pennings and Gurtin (2012) Multiple Book chapter Recruitment of oocyte donors for ART To provide an overview of the ethical aspects in gamete donor recruitment 86 Pennings et al. (2012) Multiple Book chapter Transnational gamete donation To provide an overview of the legal and ethical aspects of transnational gamete donation 87 Pennings et al. (2014) Multiple Survey Oocyte donation in general To identify the characteristics and motivations of oocyte donors in 11 European countries 88 Pettee and Weckstein (1993) USA Survey Oocyte donation in general To identify the attitudes of postoocyte donation parents on oocyte donation 89 Purewal and van den Akker (2009) UK Review Oocyte donation in general To review the findings regarding the psychosocial determinants of oocyte donation and extrapolate women’s experiences of donation 90 Raes et al. (2016) Belgium Analysis Disclosure in gamete donation To analyse whether or not a directive counselling approach is ethically justified in the context of DC disclosure 91 Ravelingien and Pennings (2013) Belgium Analysis Anonymity in gamete donation To analyse the right to know once genetic origin in gamete donation and paternity testing 92 Ravitsky (2014) UK Commentary Anonymity in gamete donation To react to the arguments of de Melo-martin against non-anonymous gamete donation 93 Readings et al. (2011) UK Survey Disclosure in gamete donation To identify parents’ decisions in gamete donation and surrogacy families regarding disclosing the child’s origin of conception 94 Reame (1999) USA Discussion Informed consent for ART patients To discuss the unique issues of informed consent for ART patients 95 Reame (2000) USA Discussion ART To discuss the policy recommendations of the Institute of Medicine regarding the ethical aspects of ART 96 Robertson (1989) USA Review Oocyte donation in general To provide an overview of the legal and ethical issues of oocyte donation 97 Rothenberg (1996) USA Analysis Feminists perspectives on oocyte donation To evaluate the acceptability of oocyte donation through multiple feminism theories 98 Sauer and Kavic (2006) USA Review Oocyte and embryo donation To review the ethical, social, legal and medical aspects of oocyte and embryo donation 99 Schaefer et al. (2012) UK Survey Informed consent of oocyte donors To examine donor consent forms on information of embryonic research with donated oocytes 100 Schenker (1993) Israel Discussion Oocyte donation in general To provide an overview of the ethical and legal aspects of ART 101 Schenker (1995) Israel Discussion Oocyte donation in general To discuss the ethical and legal framework of oocyte donation 102 Schenker (2005) Israel Review Religious perspectives on ART To provide insight into the religious perspectives on ART for counselling of donors and recipients 103 Schenker (2013) Israel Discussion Jewish perspectives on ART To evaluate the acceptability of ART in the light of Jewish law 104 Shenfield and Steele (1995) UK Opinion Payment for gamete donation To argue against a financial compensation for oocyte donors 105 Shenfield (1997) UK Opinion Disclosure in gamete donation To outline the arguments on disclosure and argue that it is up to the parents to decide 106 Shenfield (2012) UK Commentary CBRC To comment on the argument to seek harmonization in European Union law on ART 107 Shufaro and Schenker (2012) Israel Discussion Oocyte donation for postmenopausal women To provide overview of the arguments on oocyte donation in postmenopausal women 108 Shufaro and Schenker (2014) Israel Discussion Oocyte donation for postmenopausal women To provide an overview of the arguments on oocyte donation in postmenopausal women 109 Siegel (2015) USA Analysis Informed consent of oocyte donors To analyse the desirability and implementation of informed consent of oocyte donors (for ART) to embryonic research 110 Smajdor (2008) UK Opinion Oocyte donation for postmenopausal women To question desirability of oocyte donation in general 111 Söderström-Anttila et al. (2001) Finland and Sweden Review Oocyte donation for ART To provide an overview of the medical, psychological and ethical aspects of oocyte donation for infertility treatment 112 Steinbock (2004) USA Discussion Payment of oocyte donors To discuss the ethical arguments regarding payment of oocyte donors 113 Tomlinson and Sakkas (2000) UK Opinion Oocyte cryopreservation technique To opt for a moral obligation for standardized cryopreservation practices 114 Vajta et al. (2015) Italy Review Oocyte cryopreservation technique To explicate work safety issues in the fertility laboratory 115 van den Akker (2006) UK Review Psychological aspects of third-party ART To examine the importance of the genetic link in gamete donation 116 Van Hoof and Pennings (2011) Belgium Analysis CBRC To determine the moral grounds for extraterritorial legislation on CBRC 117 Van Hoof and Pennings (2012) Belgium Analysis European legislation on ART To analyse the European Court of Human Rights Judgements in relation to ART 118 Van Hoof et al. (2015) Belgium Review CBRC To provide an overview of the ethical aspect regarding CBRC and the responsibility of physicians 119 Vasireddy and Bewley (2013) UK Commentary Oocyte donation for postmenopausal women To discuss the medical, social and ethical aspects of oocyte donation in postmenopausal women 120 de Wachter (2004) The Netherlands Discussion ART To explicate the ethical issues regarding cryobiology in human reproduction 121 de Wachter and de Wert (1987) The Netherlands Review ART To provide an overview of the debate on reproductive technology in the Netherlands 122 Waldby et al. (2013) Australia Survey Payment of oocyte donors To identify the attitudes of fertility patients, reproductive donors and young, non-patient women on payment of oocytes donors 123 Wilde et al. (2014) UK Review Donor registration and disclosure To give an overview of best practices and underlying principles regarding donor registration and disclosure 124 Wolowelsky and Grazi (2014) Israel Discussion Jewish perspectives on ART To discuss the Jewish perspectives on ART and give recommendations for counselling of Jewish patients 125 Wong (2017) Australia Analysis Donor selection and matching To explore the process of donor selection in ART and the consequences of matching for donor offspring 126 Zweifel (2015) USA Review Welfare of the child in ART To identify the ethical aspects of gamete donation in relation to the welfare of the child References Country Paper type Scope of paper Aim of paper 1 Abdalla and Studd (1989) UK Commentary Oocyte donation in general To share experiences with the practice of oocyte donation 2 Ahuja and Simons (1998) UK Opinion Recruitment of oocyte donors for ART To argue that the safety of oocyte donation is the main priority in ethical practice of oocyte donation 3 Ahuja, Simons and Edwards (1999) UK Opinion Recruitment of oocyte donors for ART To discuss the HFEA policy on altruistic oocyte donation 4 Alberta et al. (2013) USA Analysis Recruitment of oocyte donors for ART To provide insight into the donor recruitment policies of different donor agencies 5 Alberta et al. (2014) USA Analysis Recruitment of oocyte donors for ART To provide insight into risk disclosure in recruitment advertisements of donor agencies and IVF clinics 6 Barratt et al. (1998) Multiple Guideline Gamete donation in general To provide an overview of ethical standards in gamete donation 7 Barritt et al. (2007) USA Commentary Oocytes cryopreservation technique To describe instructions for ethical research on human oocytes 8 Benshushan and Schenker (1998) Israel Review Posthumous reproduction To provide an overview the ethical aspects of posthumous reproduction 9 Benward (2015) USA Review Recipient counselling To examine the ethical concerns of mandatory counselling for gamete recipients 10 Black (2010) USA Guideline Recipient counselling To outline the interests and rights of gamete donors to guide nursing professionals in ethical sound practice 11 Blyth and Cameron (1998) UK Opinion Welfare of the child in ART To criticize the use of the welfare standards in assessing the acceptability of ART 12 Blyth et al. (2011) UK Essay CBRC To outline an ethical framework for counsellors regarding the treatment of patients from abroad 13 Boutelle (2014) Australia Review Oocyte donation in general To explore the characteristics, motivations and experiences of oocyte donors 14 Braverman (2015) USA Essay Recipient counselling To clarify the role of the mental health professional in third-party assisted reproduction 15 Burrell (2012) Finland Analysis ART in general To examine discussions in the application of the Finnish Act on ART 16 Byrd et al. (2002) UK Survey Oocyte donation in general To identify the motivations and experiences of oocyte donors 17 Cohen (1997) USA Essay ART in general To argue whether, and if so to what extent new reproductive techniques should be regulated 18 Cook et al. (2013) USA Review Oocyte donation and cryopreservation To explore outcomes of donor IVF cycles with cryopreserved oocytes and the utilization of extra embryos after fresh transfers 19 Crawshaw et al. (2013) UK Analysis Donor registration To identify the experiences of donor conceived adults, donors, non-donor-conceived adult children of donors with a voluntary DNA-based register 20 Daniels (2000) New Zealand Essay Payment to gamete donors To explore the interplay between pragmatics, policy and ethics considering monetary payment for gamete donors 21 Dean and Edwards (1994) UK Review Oocyte donation in postmenopausal women To outline the ethical aspects of oocyte donation in menopausal women 22 Deech (1998) UK Review Gamete banking To provide an overview of the regulatory and ethical responsibilities of gamete banks in the UK 23 Dickenson (2011) UK Analysis ART To argue for an alternative, non-commercial, system to realize (ethical) progress in the practice of ART 24 Dillon and Fiester (2012) USA Discussion Posthumous donation To debate the current informed consent procedures of posthumous gamete donation 25 Eisenberg and Schenker (1997) Israel Review Oocyte donation in postmenopausal women To provide an overview of the medical and ethical aspects of oocyte donation in menopausal women 26 Englert (1996) Belgium Opinion Oocyte donation in general To argue that the shortage of donor oocytes challenges ethical responsible organization of oocyte donation 27 Fauser and Garcia Velasco (2017) The Netherlands Editorial Oocyte donation in general To address the concerns regarding the risks of breast cancer after donating oocytes 28 Freeman (2015) USA Review Disclosure in gamete donation To provide an overview of the psychosocial evidence and ethical debate on disclosure in gamete donation 29 Frith (2001) UK Opinion Anonymity in gamete donation To outline the ethical and practical arguments on non-anonymous donation 30 Gil-Arribas et al. (2016) Spain Review Genetic screening of oocyte donors To identify the arguments on carrier genetic test of donors in oocyte donation 31 Golombok et al. (1999) UK Survey Post-ART family functioning To identify the quality of parenting and issues of disclosure in post ART families 32 Gosden and Gosden (2012) USA Opinion ART To provide an overview of the practical, social and ethical aspects of the new vitrification technique for ART 33 Guerin (1998) France Opinion Payment of gamete donors To discuss the experience of French CECOS Federation regarding anonymous gamete donation 34 Hamilton (1998) UK Discussion Recruitment of oocyte donors for ART To criticize the proposal of the HFEA to withdraw remuneration of donors 35 Heng (2006) Singapore Essay Transnational oocyte donation To discuss the ethical issues that come with transnational or international oocyte donation 36 Heng (2007a) Singapore Discussion Transnational sperm and egg donation To discuss the legal and ethical issues in the international transaction of donor sperm and oocytes 37 Heng (2007b) Singapore Opinion CBRC To address the question if fertility specialists refer local patients abroad for shared or commercialized oocyte donation 38 Hostiuc (2013) Romania Survey ART To identify the opinions of young physicians on the acceptability of third-party ART 39 Ilioi and Golombok (2015) UK Review Post-ART family functioning To review articles on the psychosocial development of adolescence conceived through ART 40 Inhorn (2010) USA Review CBRC To provide an overview of bioethical Islamic perspectives on CBRC 41 Inhorn and Gürtin (2011) UK Discussion CBRC To provide an overview of the discussion and future research agenda with regards to CBRC 42 Isasi and Knoppers (2007) Canada Analysis Payment of gamete donors To provide an overview of the use of financial compensations for oocyte donation in various jurisdictions 43 Jones and Cohen (2001) USA and France Review ART To identify the ethical aspects upon which consensus exists in multiple guidelines on ART 44 Kääriäinen et al. (2005) Multiple Discussion ART and genetics To give an overview of the ethical aspects of ART and genetics 45 Kalfoglou and Geller (2000) USA Qualitative interview study Oocyte donation in general To identify the motives and experiences of oocyte donors 46 Keehn et al. (2012) USA Analysis Recruitment of oocyte donors for ART To systematically identify the ethical aspects of online oocyte donor recruitment 47 Klein and Sauer (2010) USA Discussion Oocyte donation in general To identify the arguments concerning compensation, oocyte donation for postmenopausal women and egg-sharing 48 Klitzman and Sauer (2015) USA Commentary Payment of gamete donors To comment on an ASRM statement on the ethical aspects of donor compensation 49 Klitzman (2016) USA Qualitative interview study Recruitment of oocyte donors for ART To identify ethical concerns of IVF providers and patients on the practice and policy of donor agencies 50 Knoppers and Le Bris (1993) Canada Review ART To outline the international ethical and legal aspects of ART 51 Landau (2005) Israel Discussion Oocyte donation for postmenopausal women To outline the arguments regarding the acceptability of oocyte donation in postmenopausal women 52 Levine (2010) USA Analysis Recruitment of oocyte donors for ART To analyse the compliance of advertisements for oocyte donors in student newspapers with ethical guidelines 53 Lindheim et al. (2001) USA Survey Payment of oocyte donors To identify the influence of payment on women’s decision to donate oocytes 54 Londra et al. (2014) USA Review ART To review the ethical and legal aspects of ART 55 Mahlstedt and Greenfeld (1989) USA Discussion ART To discuss the ethical aspects of preparing patients for ART with donor gametes 56 Marcus and Brinsden (1996) UK Review Oocyte donation in postmenopausal women To review best practices and ethical aspects of embryo or oocyte donation in postmenopausal women 57 Maunder (2004) UK Review ART and Human Rights To provide an overview of applicable Human Rights in ART 58 McGee et al. (2001) USA Opinion Anonymity in gamete donation To argue against anonymity in gamete donation and in favour of early disclosure 59 McGee et al. (2013) USA Book chapter Oocyte and embryo donation To provide an overview of the ethical issues in oocyte and embryo donation 60 McLaughlin et al. (1998) UK Opinion Recruitment of oocyte donors for ART To argue to allow only purely altruistic men and women who have parental experience as gamete donors 61 McWhinnie (1998) UK Discussion Welfare of the child in ART To debate and address the rights and needs of children born from gamete donation 62 de Melo-Martin and Cholst (2008) USA Discussion Oocyte donor recruitment To evaluate the ethical concerns related to the selection of participants for research on oocyte cryopreservation techniques 63 de Melo-Martín (2014) USA Opinion Anonymity in gamete donation To criticize the arguments on the ban of anonymous gamete donation 64 Merlet (2009) France Review French legislation in ART To provide an overview of the legal framework on ART in French within the European context 65 Mertes et al. (2012) Belgium Discussion Oocytes cryopreservation technique To discuss the ethical implications of cryopreservation of oocytes and the issue of payment to oocyte donors 66 Mizukami et al. (2005) USA Survey Posthumous oocyte donation To identify laypeople’s views on the acceptability of posthumous oocyte donation 67 Murray et al. (2006) UK Survey Post-ART family functioning To identify the wellbeing of children and parents and in postoocyte donation families regarding disclosure issues 68 Murphy (2009) USA Discussion Gamete donation in general To discuss the ethical desirability of gamete donation 69 Nakhuda (2010) USA Discussion Posthumous gamete donation To discuss the ethical aspects of posthumous ART 70 Novaes (1989) France Analysis Oocyte donors recruitment To examine donor recruitment policies and the role of the recruiting agent 71 O’Donnell (2000) UK Analysis Property in gametes To analyse the nature of gametes to formulate a legal framework for ART 72 Papadimos and Papadimos (2004) USA Opinion Oocyte donation in general To argue that the consent of young student oocyte donors who are paid is invalid 73 Parker (2004) UK Opinion Posthumous gamete donation To argue that one should allow posthumous donation but encourage individuals to make their wishes explicit 74 Pattinson (2012) UK Review Payment for gamete donation To examine the role of a national gamete donation system in the ethical and legal implementation of financial incentives 75 Paulson and Sauer (1994) UK Opinion Oocyte donation for postmenopausal women To argue for the acceptability of oocyte donation in women over 50 years 76 Paulson et al. (1994) UK Discussion Oocyte donation for postmenopausal women To debate the acceptability of oocyte donation in postmenopausal women 77 Pennings (1999) Belgium Analysis Welfare of the child in ART To analyse three standards for the evaluation of the welfare of the child in assessing the acceptability of ART 78 Pennings (2000) Belgium Opinion Matching of donor oocytes and recipients To argue for the possibility for recipients to choose (the characteristics of) their donor 79 Pennings (2001) Belgium Discussion Selection and prioritization of donor oocyte recipients To outline the ethical criteria for the allocation of the scarce supply of donor oocytes 80 Pennings (2005) Belgium Commentary Recruitment of oocyte donors for ART To argue for alternative strategies to recruit gamete donors 81 Pennings (2007) Belgium Commentary ART To provide an overview of Belgian legislation on ART and the disposition of embryos and gametes 82 Pennings (2012) Belgium Opinion Anonymity in gamete donation To argue against a retrospective law on donor anonymity 83 Pennings (2015) Belgium Analysis Recruitment of oocyte donors for ART To analyse the role of an altruistic motive in gamete donation 84 Pennings (2017) Belgium Opinion Disclosure in gamete donation To argue that non-disclosure does not negatively influence the wellbeing of the child 85 Pennings and Gurtin (2012) Multiple Book chapter Recruitment of oocyte donors for ART To provide an overview of the ethical aspects in gamete donor recruitment 86 Pennings et al. (2012) Multiple Book chapter Transnational gamete donation To provide an overview of the legal and ethical aspects of transnational gamete donation 87 Pennings et al. (2014) Multiple Survey Oocyte donation in general To identify the characteristics and motivations of oocyte donors in 11 European countries 88 Pettee and Weckstein (1993) USA Survey Oocyte donation in general To identify the attitudes of postoocyte donation parents on oocyte donation 89 Purewal and van den Akker (2009) UK Review Oocyte donation in general To review the findings regarding the psychosocial determinants of oocyte donation and extrapolate women’s experiences of donation 90 Raes et al. (2016) Belgium Analysis Disclosure in gamete donation To analyse whether or not a directive counselling approach is ethically justified in the context of DC disclosure 91 Ravelingien and Pennings (2013) Belgium Analysis Anonymity in gamete donation To analyse the right to know once genetic origin in gamete donation and paternity testing 92 Ravitsky (2014) UK Commentary Anonymity in gamete donation To react to the arguments of de Melo-martin against non-anonymous gamete donation 93 Readings et al. (2011) UK Survey Disclosure in gamete donation To identify parents’ decisions in gamete donation and surrogacy families regarding disclosing the child’s origin of conception 94 Reame (1999) USA Discussion Informed consent for ART patients To discuss the unique issues of informed consent for ART patients 95 Reame (2000) USA Discussion ART To discuss the policy recommendations of the Institute of Medicine regarding the ethical aspects of ART 96 Robertson (1989) USA Review Oocyte donation in general To provide an overview of the legal and ethical issues of oocyte donation 97 Rothenberg (1996) USA Analysis Feminists perspectives on oocyte donation To evaluate the acceptability of oocyte donation through multiple feminism theories 98 Sauer and Kavic (2006) USA Review Oocyte and embryo donation To review the ethical, social, legal and medical aspects of oocyte and embryo donation 99 Schaefer et al. (2012) UK Survey Informed consent of oocyte donors To examine donor consent forms on information of embryonic research with donated oocytes 100 Schenker (1993) Israel Discussion Oocyte donation in general To provide an overview of the ethical and legal aspects of ART 101 Schenker (1995) Israel Discussion Oocyte donation in general To discuss the ethical and legal framework of oocyte donation 102 Schenker (2005) Israel Review Religious perspectives on ART To provide insight into the religious perspectives on ART for counselling of donors and recipients 103 Schenker (2013) Israel Discussion Jewish perspectives on ART To evaluate the acceptability of ART in the light of Jewish law 104 Shenfield and Steele (1995) UK Opinion Payment for gamete donation To argue against a financial compensation for oocyte donors 105 Shenfield (1997) UK Opinion Disclosure in gamete donation To outline the arguments on disclosure and argue that it is up to the parents to decide 106 Shenfield (2012) UK Commentary CBRC To comment on the argument to seek harmonization in European Union law on ART 107 Shufaro and Schenker (2012) Israel Discussion Oocyte donation for postmenopausal women To provide overview of the arguments on oocyte donation in postmenopausal women 108 Shufaro and Schenker (2014) Israel Discussion Oocyte donation for postmenopausal women To provide an overview of the arguments on oocyte donation in postmenopausal women 109 Siegel (2015) USA Analysis Informed consent of oocyte donors To analyse the desirability and implementation of informed consent of oocyte donors (for ART) to embryonic research 110 Smajdor (2008) UK Opinion Oocyte donation for postmenopausal women To question desirability of oocyte donation in general 111 Söderström-Anttila et al. (2001) Finland and Sweden Review Oocyte donation for ART To provide an overview of the medical, psychological and ethical aspects of oocyte donation for infertility treatment 112 Steinbock (2004) USA Discussion Payment of oocyte donors To discuss the ethical arguments regarding payment of oocyte donors 113 Tomlinson and Sakkas (2000) UK Opinion Oocyte cryopreservation technique To opt for a moral obligation for standardized cryopreservation practices 114 Vajta et al. (2015) Italy Review Oocyte cryopreservation technique To explicate work safety issues in the fertility laboratory 115 van den Akker (2006) UK Review Psychological aspects of third-party ART To examine the importance of the genetic link in gamete donation 116 Van Hoof and Pennings (2011) Belgium Analysis CBRC To determine the moral grounds for extraterritorial legislation on CBRC 117 Van Hoof and Pennings (2012) Belgium Analysis European legislation on ART To analyse the European Court of Human Rights Judgements in relation to ART 118 Van Hoof et al. (2015) Belgium Review CBRC To provide an overview of the ethical aspect regarding CBRC and the responsibility of physicians 119 Vasireddy and Bewley (2013) UK Commentary Oocyte donation for postmenopausal women To discuss the medical, social and ethical aspects of oocyte donation in postmenopausal women 120 de Wachter (2004) The Netherlands Discussion ART To explicate the ethical issues regarding cryobiology in human reproduction 121 de Wachter and de Wert (1987) The Netherlands Review ART To provide an overview of the debate on reproductive technology in the Netherlands 122 Waldby et al. (2013) Australia Survey Payment of oocyte donors To identify the attitudes of fertility patients, reproductive donors and young, non-patient women on payment of oocytes donors 123 Wilde et al. (2014) UK Review Donor registration and disclosure To give an overview of best practices and underlying principles regarding donor registration and disclosure 124 Wolowelsky and Grazi (2014) Israel Discussion Jewish perspectives on ART To discuss the Jewish perspectives on ART and give recommendations for counselling of Jewish patients 125 Wong (2017) Australia Analysis Donor selection and matching To explore the process of donor selection in ART and the consequences of matching for donor offspring 126 Zweifel (2015) USA Review Welfare of the child in ART To identify the ethical aspects of gamete donation in relation to the welfare of the child CBRC, cross-border reproductive care. Table II Articles concerning the ethical aspects of oocyte banking. References Country Paper type Scope of paper Aim of paper 1 Abdalla and Studd (1989) UK Commentary Oocyte donation in general To share experiences with the practice of oocyte donation 2 Ahuja and Simons (1998) UK Opinion Recruitment of oocyte donors for ART To argue that the safety of oocyte donation is the main priority in ethical practice of oocyte donation 3 Ahuja, Simons and Edwards (1999) UK Opinion Recruitment of oocyte donors for ART To discuss the HFEA policy on altruistic oocyte donation 4 Alberta et al. (2013) USA Analysis Recruitment of oocyte donors for ART To provide insight into the donor recruitment policies of different donor agencies 5 Alberta et al. (2014) USA Analysis Recruitment of oocyte donors for ART To provide insight into risk disclosure in recruitment advertisements of donor agencies and IVF clinics 6 Barratt et al. (1998) Multiple Guideline Gamete donation in general To provide an overview of ethical standards in gamete donation 7 Barritt et al. (2007) USA Commentary Oocytes cryopreservation technique To describe instructions for ethical research on human oocytes 8 Benshushan and Schenker (1998) Israel Review Posthumous reproduction To provide an overview the ethical aspects of posthumous reproduction 9 Benward (2015) USA Review Recipient counselling To examine the ethical concerns of mandatory counselling for gamete recipients 10 Black (2010) USA Guideline Recipient counselling To outline the interests and rights of gamete donors to guide nursing professionals in ethical sound practice 11 Blyth and Cameron (1998) UK Opinion Welfare of the child in ART To criticize the use of the welfare standards in assessing the acceptability of ART 12 Blyth et al. (2011) UK Essay CBRC To outline an ethical framework for counsellors regarding the treatment of patients from abroad 13 Boutelle (2014) Australia Review Oocyte donation in general To explore the characteristics, motivations and experiences of oocyte donors 14 Braverman (2015) USA Essay Recipient counselling To clarify the role of the mental health professional in third-party assisted reproduction 15 Burrell (2012) Finland Analysis ART in general To examine discussions in the application of the Finnish Act on ART 16 Byrd et al. (2002) UK Survey Oocyte donation in general To identify the motivations and experiences of oocyte donors 17 Cohen (1997) USA Essay ART in general To argue whether, and if so to what extent new reproductive techniques should be regulated 18 Cook et al. (2013) USA Review Oocyte donation and cryopreservation To explore outcomes of donor IVF cycles with cryopreserved oocytes and the utilization of extra embryos after fresh transfers 19 Crawshaw et al. (2013) UK Analysis Donor registration To identify the experiences of donor conceived adults, donors, non-donor-conceived adult children of donors with a voluntary DNA-based register 20 Daniels (2000) New Zealand Essay Payment to gamete donors To explore the interplay between pragmatics, policy and ethics considering monetary payment for gamete donors 21 Dean and Edwards (1994) UK Review Oocyte donation in postmenopausal women To outline the ethical aspects of oocyte donation in menopausal women 22 Deech (1998) UK Review Gamete banking To provide an overview of the regulatory and ethical responsibilities of gamete banks in the UK 23 Dickenson (2011) UK Analysis ART To argue for an alternative, non-commercial, system to realize (ethical) progress in the practice of ART 24 Dillon and Fiester (2012) USA Discussion Posthumous donation To debate the current informed consent procedures of posthumous gamete donation 25 Eisenberg and Schenker (1997) Israel Review Oocyte donation in postmenopausal women To provide an overview of the medical and ethical aspects of oocyte donation in menopausal women 26 Englert (1996) Belgium Opinion Oocyte donation in general To argue that the shortage of donor oocytes challenges ethical responsible organization of oocyte donation 27 Fauser and Garcia Velasco (2017) The Netherlands Editorial Oocyte donation in general To address the concerns regarding the risks of breast cancer after donating oocytes 28 Freeman (2015) USA Review Disclosure in gamete donation To provide an overview of the psychosocial evidence and ethical debate on disclosure in gamete donation 29 Frith (2001) UK Opinion Anonymity in gamete donation To outline the ethical and practical arguments on non-anonymous donation 30 Gil-Arribas et al. (2016) Spain Review Genetic screening of oocyte donors To identify the arguments on carrier genetic test of donors in oocyte donation 31 Golombok et al. (1999) UK Survey Post-ART family functioning To identify the quality of parenting and issues of disclosure in post ART families 32 Gosden and Gosden (2012) USA Opinion ART To provide an overview of the practical, social and ethical aspects of the new vitrification technique for ART 33 Guerin (1998) France Opinion Payment of gamete donors To discuss the experience of French CECOS Federation regarding anonymous gamete donation 34 Hamilton (1998) UK Discussion Recruitment of oocyte donors for ART To criticize the proposal of the HFEA to withdraw remuneration of donors 35 Heng (2006) Singapore Essay Transnational oocyte donation To discuss the ethical issues that come with transnational or international oocyte donation 36 Heng (2007a) Singapore Discussion Transnational sperm and egg donation To discuss the legal and ethical issues in the international transaction of donor sperm and oocytes 37 Heng (2007b) Singapore Opinion CBRC To address the question if fertility specialists refer local patients abroad for shared or commercialized oocyte donation 38 Hostiuc (2013) Romania Survey ART To identify the opinions of young physicians on the acceptability of third-party ART 39 Ilioi and Golombok (2015) UK Review Post-ART family functioning To review articles on the psychosocial development of adolescence conceived through ART 40 Inhorn (2010) USA Review CBRC To provide an overview of bioethical Islamic perspectives on CBRC 41 Inhorn and Gürtin (2011) UK Discussion CBRC To provide an overview of the discussion and future research agenda with regards to CBRC 42 Isasi and Knoppers (2007) Canada Analysis Payment of gamete donors To provide an overview of the use of financial compensations for oocyte donation in various jurisdictions 43 Jones and Cohen (2001) USA and France Review ART To identify the ethical aspects upon which consensus exists in multiple guidelines on ART 44 Kääriäinen et al. (2005) Multiple Discussion ART and genetics To give an overview of the ethical aspects of ART and genetics 45 Kalfoglou and Geller (2000) USA Qualitative interview study Oocyte donation in general To identify the motives and experiences of oocyte donors 46 Keehn et al. (2012) USA Analysis Recruitment of oocyte donors for ART To systematically identify the ethical aspects of online oocyte donor recruitment 47 Klein and Sauer (2010) USA Discussion Oocyte donation in general To identify the arguments concerning compensation, oocyte donation for postmenopausal women and egg-sharing 48 Klitzman and Sauer (2015) USA Commentary Payment of gamete donors To comment on an ASRM statement on the ethical aspects of donor compensation 49 Klitzman (2016) USA Qualitative interview study Recruitment of oocyte donors for ART To identify ethical concerns of IVF providers and patients on the practice and policy of donor agencies 50 Knoppers and Le Bris (1993) Canada Review ART To outline the international ethical and legal aspects of ART 51 Landau (2005) Israel Discussion Oocyte donation for postmenopausal women To outline the arguments regarding the acceptability of oocyte donation in postmenopausal women 52 Levine (2010) USA Analysis Recruitment of oocyte donors for ART To analyse the compliance of advertisements for oocyte donors in student newspapers with ethical guidelines 53 Lindheim et al. (2001) USA Survey Payment of oocyte donors To identify the influence of payment on women’s decision to donate oocytes 54 Londra et al. (2014) USA Review ART To review the ethical and legal aspects of ART 55 Mahlstedt and Greenfeld (1989) USA Discussion ART To discuss the ethical aspects of preparing patients for ART with donor gametes 56 Marcus and Brinsden (1996) UK Review Oocyte donation in postmenopausal women To review best practices and ethical aspects of embryo or oocyte donation in postmenopausal women 57 Maunder (2004) UK Review ART and Human Rights To provide an overview of applicable Human Rights in ART 58 McGee et al. (2001) USA Opinion Anonymity in gamete donation To argue against anonymity in gamete donation and in favour of early disclosure 59 McGee et al. (2013) USA Book chapter Oocyte and embryo donation To provide an overview of the ethical issues in oocyte and embryo donation 60 McLaughlin et al. (1998) UK Opinion Recruitment of oocyte donors for ART To argue to allow only purely altruistic men and women who have parental experience as gamete donors 61 McWhinnie (1998) UK Discussion Welfare of the child in ART To debate and address the rights and needs of children born from gamete donation 62 de Melo-Martin and Cholst (2008) USA Discussion Oocyte donor recruitment To evaluate the ethical concerns related to the selection of participants for research on oocyte cryopreservation techniques 63 de Melo-Martín (2014) USA Opinion Anonymity in gamete donation To criticize the arguments on the ban of anonymous gamete donation 64 Merlet (2009) France Review French legislation in ART To provide an overview of the legal framework on ART in French within the European context 65 Mertes et al. (2012) Belgium Discussion Oocytes cryopreservation technique To discuss the ethical implications of cryopreservation of oocytes and the issue of payment to oocyte donors 66 Mizukami et al. (2005) USA Survey Posthumous oocyte donation To identify laypeople’s views on the acceptability of posthumous oocyte donation 67 Murray et al. (2006) UK Survey Post-ART family functioning To identify the wellbeing of children and parents and in postoocyte donation families regarding disclosure issues 68 Murphy (2009) USA Discussion Gamete donation in general To discuss the ethical desirability of gamete donation 69 Nakhuda (2010) USA Discussion Posthumous gamete donation To discuss the ethical aspects of posthumous ART 70 Novaes (1989) France Analysis Oocyte donors recruitment To examine donor recruitment policies and the role of the recruiting agent 71 O’Donnell (2000) UK Analysis Property in gametes To analyse the nature of gametes to formulate a legal framework for ART 72 Papadimos and Papadimos (2004) USA Opinion Oocyte donation in general To argue that the consent of young student oocyte donors who are paid is invalid 73 Parker (2004) UK Opinion Posthumous gamete donation To argue that one should allow posthumous donation but encourage individuals to make their wishes explicit 74 Pattinson (2012) UK Review Payment for gamete donation To examine the role of a national gamete donation system in the ethical and legal implementation of financial incentives 75 Paulson and Sauer (1994) UK Opinion Oocyte donation for postmenopausal women To argue for the acceptability of oocyte donation in women over 50 years 76 Paulson et al. (1994) UK Discussion Oocyte donation for postmenopausal women To debate the acceptability of oocyte donation in postmenopausal women 77 Pennings (1999) Belgium Analysis Welfare of the child in ART To analyse three standards for the evaluation of the welfare of the child in assessing the acceptability of ART 78 Pennings (2000) Belgium Opinion Matching of donor oocytes and recipients To argue for the possibility for recipients to choose (the characteristics of) their donor 79 Pennings (2001) Belgium Discussion Selection and prioritization of donor oocyte recipients To outline the ethical criteria for the allocation of the scarce supply of donor oocytes 80 Pennings (2005) Belgium Commentary Recruitment of oocyte donors for ART To argue for alternative strategies to recruit gamete donors 81 Pennings (2007) Belgium Commentary ART To provide an overview of Belgian legislation on ART and the disposition of embryos and gametes 82 Pennings (2012) Belgium Opinion Anonymity in gamete donation To argue against a retrospective law on donor anonymity 83 Pennings (2015) Belgium Analysis Recruitment of oocyte donors for ART To analyse the role of an altruistic motive in gamete donation 84 Pennings (2017) Belgium Opinion Disclosure in gamete donation To argue that non-disclosure does not negatively influence the wellbeing of the child 85 Pennings and Gurtin (2012) Multiple Book chapter Recruitment of oocyte donors for ART To provide an overview of the ethical aspects in gamete donor recruitment 86 Pennings et al. (2012) Multiple Book chapter Transnational gamete donation To provide an overview of the legal and ethical aspects of transnational gamete donation 87 Pennings et al. (2014) Multiple Survey Oocyte donation in general To identify the characteristics and motivations of oocyte donors in 11 European countries 88 Pettee and Weckstein (1993) USA Survey Oocyte donation in general To identify the attitudes of postoocyte donation parents on oocyte donation 89 Purewal and van den Akker (2009) UK Review Oocyte donation in general To review the findings regarding the psychosocial determinants of oocyte donation and extrapolate women’s experiences of donation 90 Raes et al. (2016) Belgium Analysis Disclosure in gamete donation To analyse whether or not a directive counselling approach is ethically justified in the context of DC disclosure 91 Ravelingien and Pennings (2013) Belgium Analysis Anonymity in gamete donation To analyse the right to know once genetic origin in gamete donation and paternity testing 92 Ravitsky (2014) UK Commentary Anonymity in gamete donation To react to the arguments of de Melo-martin against non-anonymous gamete donation 93 Readings et al. (2011) UK Survey Disclosure in gamete donation To identify parents’ decisions in gamete donation and surrogacy families regarding disclosing the child’s origin of conception 94 Reame (1999) USA Discussion Informed consent for ART patients To discuss the unique issues of informed consent for ART patients 95 Reame (2000) USA Discussion ART To discuss the policy recommendations of the Institute of Medicine regarding the ethical aspects of ART 96 Robertson (1989) USA Review Oocyte donation in general To provide an overview of the legal and ethical issues of oocyte donation 97 Rothenberg (1996) USA Analysis Feminists perspectives on oocyte donation To evaluate the acceptability of oocyte donation through multiple feminism theories 98 Sauer and Kavic (2006) USA Review Oocyte and embryo donation To review the ethical, social, legal and medical aspects of oocyte and embryo donation 99 Schaefer et al. (2012) UK Survey Informed consent of oocyte donors To examine donor consent forms on information of embryonic research with donated oocytes 100 Schenker (1993) Israel Discussion Oocyte donation in general To provide an overview of the ethical and legal aspects of ART 101 Schenker (1995) Israel Discussion Oocyte donation in general To discuss the ethical and legal framework of oocyte donation 102 Schenker (2005) Israel Review Religious perspectives on ART To provide insight into the religious perspectives on ART for counselling of donors and recipients 103 Schenker (2013) Israel Discussion Jewish perspectives on ART To evaluate the acceptability of ART in the light of Jewish law 104 Shenfield and Steele (1995) UK Opinion Payment for gamete donation To argue against a financial compensation for oocyte donors 105 Shenfield (1997) UK Opinion Disclosure in gamete donation To outline the arguments on disclosure and argue that it is up to the parents to decide 106 Shenfield (2012) UK Commentary CBRC To comment on the argument to seek harmonization in European Union law on ART 107 Shufaro and Schenker (2012) Israel Discussion Oocyte donation for postmenopausal women To provide overview of the arguments on oocyte donation in postmenopausal women 108 Shufaro and Schenker (2014) Israel Discussion Oocyte donation for postmenopausal women To provide an overview of the arguments on oocyte donation in postmenopausal women 109 Siegel (2015) USA Analysis Informed consent of oocyte donors To analyse the desirability and implementation of informed consent of oocyte donors (for ART) to embryonic research 110 Smajdor (2008) UK Opinion Oocyte donation for postmenopausal women To question desirability of oocyte donation in general 111 Söderström-Anttila et al. (2001) Finland and Sweden Review Oocyte donation for ART To provide an overview of the medical, psychological and ethical aspects of oocyte donation for infertility treatment 112 Steinbock (2004) USA Discussion Payment of oocyte donors To discuss the ethical arguments regarding payment of oocyte donors 113 Tomlinson and Sakkas (2000) UK Opinion Oocyte cryopreservation technique To opt for a moral obligation for standardized cryopreservation practices 114 Vajta et al. (2015) Italy Review Oocyte cryopreservation technique To explicate work safety issues in the fertility laboratory 115 van den Akker (2006) UK Review Psychological aspects of third-party ART To examine the importance of the genetic link in gamete donation 116 Van Hoof and Pennings (2011) Belgium Analysis CBRC To determine the moral grounds for extraterritorial legislation on CBRC 117 Van Hoof and Pennings (2012) Belgium Analysis European legislation on ART To analyse the European Court of Human Rights Judgements in relation to ART 118 Van Hoof et al. (2015) Belgium Review CBRC To provide an overview of the ethical aspect regarding CBRC and the responsibility of physicians 119 Vasireddy and Bewley (2013) UK Commentary Oocyte donation for postmenopausal women To discuss the medical, social and ethical aspects of oocyte donation in postmenopausal women 120 de Wachter (2004) The Netherlands Discussion ART To explicate the ethical issues regarding cryobiology in human reproduction 121 de Wachter and de Wert (1987) The Netherlands Review ART To provide an overview of the debate on reproductive technology in the Netherlands 122 Waldby et al. (2013) Australia Survey Payment of oocyte donors To identify the attitudes of fertility patients, reproductive donors and young, non-patient women on payment of oocytes donors 123 Wilde et al. (2014) UK Review Donor registration and disclosure To give an overview of best practices and underlying principles regarding donor registration and disclosure 124 Wolowelsky and Grazi (2014) Israel Discussion Jewish perspectives on ART To discuss the Jewish perspectives on ART and give recommendations for counselling of Jewish patients 125 Wong (2017) Australia Analysis Donor selection and matching To explore the process of donor selection in ART and the consequences of matching for donor offspring 126 Zweifel (2015) USA Review Welfare of the child in ART To identify the ethical aspects of gamete donation in relation to the welfare of the child References Country Paper type Scope of paper Aim of paper 1 Abdalla and Studd (1989) UK Commentary Oocyte donation in general To share experiences with the practice of oocyte donation 2 Ahuja and Simons (1998) UK Opinion Recruitment of oocyte donors for ART To argue that the safety of oocyte donation is the main priority in ethical practice of oocyte donation 3 Ahuja, Simons and Edwards (1999) UK Opinion Recruitment of oocyte donors for ART To discuss the HFEA policy on altruistic oocyte donation 4 Alberta et al. (2013) USA Analysis Recruitment of oocyte donors for ART To provide insight into the donor recruitment policies of different donor agencies 5 Alberta et al. (2014) USA Analysis Recruitment of oocyte donors for ART To provide insight into risk disclosure in recruitment advertisements of donor agencies and IVF clinics 6 Barratt et al. (1998) Multiple Guideline Gamete donation in general To provide an overview of ethical standards in gamete donation 7 Barritt et al. (2007) USA Commentary Oocytes cryopreservation technique To describe instructions for ethical research on human oocytes 8 Benshushan and Schenker (1998) Israel Review Posthumous reproduction To provide an overview the ethical aspects of posthumous reproduction 9 Benward (2015) USA Review Recipient counselling To examine the ethical concerns of mandatory counselling for gamete recipients 10 Black (2010) USA Guideline Recipient counselling To outline the interests and rights of gamete donors to guide nursing professionals in ethical sound practice 11 Blyth and Cameron (1998) UK Opinion Welfare of the child in ART To criticize the use of the welfare standards in assessing the acceptability of ART 12 Blyth et al. (2011) UK Essay CBRC To outline an ethical framework for counsellors regarding the treatment of patients from abroad 13 Boutelle (2014) Australia Review Oocyte donation in general To explore the characteristics, motivations and experiences of oocyte donors 14 Braverman (2015) USA Essay Recipient counselling To clarify the role of the mental health professional in third-party assisted reproduction 15 Burrell (2012) Finland Analysis ART in general To examine discussions in the application of the Finnish Act on ART 16 Byrd et al. (2002) UK Survey Oocyte donation in general To identify the motivations and experiences of oocyte donors 17 Cohen (1997) USA Essay ART in general To argue whether, and if so to what extent new reproductive techniques should be regulated 18 Cook et al. (2013) USA Review Oocyte donation and cryopreservation To explore outcomes of donor IVF cycles with cryopreserved oocytes and the utilization of extra embryos after fresh transfers 19 Crawshaw et al. (2013) UK Analysis Donor registration To identify the experiences of donor conceived adults, donors, non-donor-conceived adult children of donors with a voluntary DNA-based register 20 Daniels (2000) New Zealand Essay Payment to gamete donors To explore the interplay between pragmatics, policy and ethics considering monetary payment for gamete donors 21 Dean and Edwards (1994) UK Review Oocyte donation in postmenopausal women To outline the ethical aspects of oocyte donation in menopausal women 22 Deech (1998) UK Review Gamete banking To provide an overview of the regulatory and ethical responsibilities of gamete banks in the UK 23 Dickenson (2011) UK Analysis ART To argue for an alternative, non-commercial, system to realize (ethical) progress in the practice of ART 24 Dillon and Fiester (2012) USA Discussion Posthumous donation To debate the current informed consent procedures of posthumous gamete donation 25 Eisenberg and Schenker (1997) Israel Review Oocyte donation in postmenopausal women To provide an overview of the medical and ethical aspects of oocyte donation in menopausal women 26 Englert (1996) Belgium Opinion Oocyte donation in general To argue that the shortage of donor oocytes challenges ethical responsible organization of oocyte donation 27 Fauser and Garcia Velasco (2017) The Netherlands Editorial Oocyte donation in general To address the concerns regarding the risks of breast cancer after donating oocytes 28 Freeman (2015) USA Review Disclosure in gamete donation To provide an overview of the psychosocial evidence and ethical debate on disclosure in gamete donation 29 Frith (2001) UK Opinion Anonymity in gamete donation To outline the ethical and practical arguments on non-anonymous donation 30 Gil-Arribas et al. (2016) Spain Review Genetic screening of oocyte donors To identify the arguments on carrier genetic test of donors in oocyte donation 31 Golombok et al. (1999) UK Survey Post-ART family functioning To identify the quality of parenting and issues of disclosure in post ART families 32 Gosden and Gosden (2012) USA Opinion ART To provide an overview of the practical, social and ethical aspects of the new vitrification technique for ART 33 Guerin (1998) France Opinion Payment of gamete donors To discuss the experience of French CECOS Federation regarding anonymous gamete donation 34 Hamilton (1998) UK Discussion Recruitment of oocyte donors for ART To criticize the proposal of the HFEA to withdraw remuneration of donors 35 Heng (2006) Singapore Essay Transnational oocyte donation To discuss the ethical issues that come with transnational or international oocyte donation 36 Heng (2007a) Singapore Discussion Transnational sperm and egg donation To discuss the legal and ethical issues in the international transaction of donor sperm and oocytes 37 Heng (2007b) Singapore Opinion CBRC To address the question if fertility specialists refer local patients abroad for shared or commercialized oocyte donation 38 Hostiuc (2013) Romania Survey ART To identify the opinions of young physicians on the acceptability of third-party ART 39 Ilioi and Golombok (2015) UK Review Post-ART family functioning To review articles on the psychosocial development of adolescence conceived through ART 40 Inhorn (2010) USA Review CBRC To provide an overview of bioethical Islamic perspectives on CBRC 41 Inhorn and Gürtin (2011) UK Discussion CBRC To provide an overview of the discussion and future research agenda with regards to CBRC 42 Isasi and Knoppers (2007) Canada Analysis Payment of gamete donors To provide an overview of the use of financial compensations for oocyte donation in various jurisdictions 43 Jones and Cohen (2001) USA and France Review ART To identify the ethical aspects upon which consensus exists in multiple guidelines on ART 44 Kääriäinen et al. (2005) Multiple Discussion ART and genetics To give an overview of the ethical aspects of ART and genetics 45 Kalfoglou and Geller (2000) USA Qualitative interview study Oocyte donation in general To identify the motives and experiences of oocyte donors 46 Keehn et al. (2012) USA Analysis Recruitment of oocyte donors for ART To systematically identify the ethical aspects of online oocyte donor recruitment 47 Klein and Sauer (2010) USA Discussion Oocyte donation in general To identify the arguments concerning compensation, oocyte donation for postmenopausal women and egg-sharing 48 Klitzman and Sauer (2015) USA Commentary Payment of gamete donors To comment on an ASRM statement on the ethical aspects of donor compensation 49 Klitzman (2016) USA Qualitative interview study Recruitment of oocyte donors for ART To identify ethical concerns of IVF providers and patients on the practice and policy of donor agencies 50 Knoppers and Le Bris (1993) Canada Review ART To outline the international ethical and legal aspects of ART 51 Landau (2005) Israel Discussion Oocyte donation for postmenopausal women To outline the arguments regarding the acceptability of oocyte donation in postmenopausal women 52 Levine (2010) USA Analysis Recruitment of oocyte donors for ART To analyse the compliance of advertisements for oocyte donors in student newspapers with ethical guidelines 53 Lindheim et al. (2001) USA Survey Payment of oocyte donors To identify the influence of payment on women’s decision to donate oocytes 54 Londra et al. (2014) USA Review ART To review the ethical and legal aspects of ART 55 Mahlstedt and Greenfeld (1989) USA Discussion ART To discuss the ethical aspects of preparing patients for ART with donor gametes 56 Marcus and Brinsden (1996) UK Review Oocyte donation in postmenopausal women To review best practices and ethical aspects of embryo or oocyte donation in postmenopausal women 57 Maunder (2004) UK Review ART and Human Rights To provide an overview of applicable Human Rights in ART 58 McGee et al. (2001) USA Opinion Anonymity in gamete donation To argue against anonymity in gamete donation and in favour of early disclosure 59 McGee et al. (2013) USA Book chapter Oocyte and embryo donation To provide an overview of the ethical issues in oocyte and embryo donation 60 McLaughlin et al. (1998) UK Opinion Recruitment of oocyte donors for ART To argue to allow only purely altruistic men and women who have parental experience as gamete donors 61 McWhinnie (1998) UK Discussion Welfare of the child in ART To debate and address the rights and needs of children born from gamete donation 62 de Melo-Martin and Cholst (2008) USA Discussion Oocyte donor recruitment To evaluate the ethical concerns related to the selection of participants for research on oocyte cryopreservation techniques 63 de Melo-Martín (2014) USA Opinion Anonymity in gamete donation To criticize the arguments on the ban of anonymous gamete donation 64 Merlet (2009) France Review French legislation in ART To provide an overview of the legal framework on ART in French within the European context 65 Mertes et al. (2012) Belgium Discussion Oocytes cryopreservation technique To discuss the ethical implications of cryopreservation of oocytes and the issue of payment to oocyte donors 66 Mizukami et al. (2005) USA Survey Posthumous oocyte donation To identify laypeople’s views on the acceptability of posthumous oocyte donation 67 Murray et al. (2006) UK Survey Post-ART family functioning To identify the wellbeing of children and parents and in postoocyte donation families regarding disclosure issues 68 Murphy (2009) USA Discussion Gamete donation in general To discuss the ethical desirability of gamete donation 69 Nakhuda (2010) USA Discussion Posthumous gamete donation To discuss the ethical aspects of posthumous ART 70 Novaes (1989) France Analysis Oocyte donors recruitment To examine donor recruitment policies and the role of the recruiting agent 71 O’Donnell (2000) UK Analysis Property in gametes To analyse the nature of gametes to formulate a legal framework for ART 72 Papadimos and Papadimos (2004) USA Opinion Oocyte donation in general To argue that the consent of young student oocyte donors who are paid is invalid 73 Parker (2004) UK Opinion Posthumous gamete donation To argue that one should allow posthumous donation but encourage individuals to make their wishes explicit 74 Pattinson (2012) UK Review Payment for gamete donation To examine the role of a national gamete donation system in the ethical and legal implementation of financial incentives 75 Paulson and Sauer (1994) UK Opinion Oocyte donation for postmenopausal women To argue for the acceptability of oocyte donation in women over 50 years 76 Paulson et al. (1994) UK Discussion Oocyte donation for postmenopausal women To debate the acceptability of oocyte donation in postmenopausal women 77 Pennings (1999) Belgium Analysis Welfare of the child in ART To analyse three standards for the evaluation of the welfare of the child in assessing the acceptability of ART 78 Pennings (2000) Belgium Opinion Matching of donor oocytes and recipients To argue for the possibility for recipients to choose (the characteristics of) their donor 79 Pennings (2001) Belgium Discussion Selection and prioritization of donor oocyte recipients To outline the ethical criteria for the allocation of the scarce supply of donor oocytes 80 Pennings (2005) Belgium Commentary Recruitment of oocyte donors for ART To argue for alternative strategies to recruit gamete donors 81 Pennings (2007) Belgium Commentary ART To provide an overview of Belgian legislation on ART and the disposition of embryos and gametes 82 Pennings (2012) Belgium Opinion Anonymity in gamete donation To argue against a retrospective law on donor anonymity 83 Pennings (2015) Belgium Analysis Recruitment of oocyte donors for ART To analyse the role of an altruistic motive in gamete donation 84 Pennings (2017) Belgium Opinion Disclosure in gamete donation To argue that non-disclosure does not negatively influence the wellbeing of the child 85 Pennings and Gurtin (2012) Multiple Book chapter Recruitment of oocyte donors for ART To provide an overview of the ethical aspects in gamete donor recruitment 86 Pennings et al. (2012) Multiple Book chapter Transnational gamete donation To provide an overview of the legal and ethical aspects of transnational gamete donation 87 Pennings et al. (2014) Multiple Survey Oocyte donation in general To identify the characteristics and motivations of oocyte donors in 11 European countries 88 Pettee and Weckstein (1993) USA Survey Oocyte donation in general To identify the attitudes of postoocyte donation parents on oocyte donation 89 Purewal and van den Akker (2009) UK Review Oocyte donation in general To review the findings regarding the psychosocial determinants of oocyte donation and extrapolate women’s experiences of donation 90 Raes et al. (2016) Belgium Analysis Disclosure in gamete donation To analyse whether or not a directive counselling approach is ethically justified in the context of DC disclosure 91 Ravelingien and Pennings (2013) Belgium Analysis Anonymity in gamete donation To analyse the right to know once genetic origin in gamete donation and paternity testing 92 Ravitsky (2014) UK Commentary Anonymity in gamete donation To react to the arguments of de Melo-martin against non-anonymous gamete donation 93 Readings et al. (2011) UK Survey Disclosure in gamete donation To identify parents’ decisions in gamete donation and surrogacy families regarding disclosing the child’s origin of conception 94 Reame (1999) USA Discussion Informed consent for ART patients To discuss the unique issues of informed consent for ART patients 95 Reame (2000) USA Discussion ART To discuss the policy recommendations of the Institute of Medicine regarding the ethical aspects of ART 96 Robertson (1989) USA Review Oocyte donation in general To provide an overview of the legal and ethical issues of oocyte donation 97 Rothenberg (1996) USA Analysis Feminists perspectives on oocyte donation To evaluate the acceptability of oocyte donation through multiple feminism theories 98 Sauer and Kavic (2006) USA Review Oocyte and embryo donation To review the ethical, social, legal and medical aspects of oocyte and embryo donation 99 Schaefer et al. (2012) UK Survey Informed consent of oocyte donors To examine donor consent forms on information of embryonic research with donated oocytes 100 Schenker (1993) Israel Discussion Oocyte donation in general To provide an overview of the ethical and legal aspects of ART 101 Schenker (1995) Israel Discussion Oocyte donation in general To discuss the ethical and legal framework of oocyte donation 102 Schenker (2005) Israel Review Religious perspectives on ART To provide insight into the religious perspectives on ART for counselling of donors and recipients 103 Schenker (2013) Israel Discussion Jewish perspectives on ART To evaluate the acceptability of ART in the light of Jewish law 104 Shenfield and Steele (1995) UK Opinion Payment for gamete donation To argue against a financial compensation for oocyte donors 105 Shenfield (1997) UK Opinion Disclosure in gamete donation To outline the arguments on disclosure and argue that it is up to the parents to decide 106 Shenfield (2012) UK Commentary CBRC To comment on the argument to seek harmonization in European Union law on ART 107 Shufaro and Schenker (2012) Israel Discussion Oocyte donation for postmenopausal women To provide overview of the arguments on oocyte donation in postmenopausal women 108 Shufaro and Schenker (2014) Israel Discussion Oocyte donation for postmenopausal women To provide an overview of the arguments on oocyte donation in postmenopausal women 109 Siegel (2015) USA Analysis Informed consent of oocyte donors To analyse the desirability and implementation of informed consent of oocyte donors (for ART) to embryonic research 110 Smajdor (2008) UK Opinion Oocyte donation for postmenopausal women To question desirability of oocyte donation in general 111 Söderström-Anttila et al. (2001) Finland and Sweden Review Oocyte donation for ART To provide an overview of the medical, psychological and ethical aspects of oocyte donation for infertility treatment 112 Steinbock (2004) USA Discussion Payment of oocyte donors To discuss the ethical arguments regarding payment of oocyte donors 113 Tomlinson and Sakkas (2000) UK Opinion Oocyte cryopreservation technique To opt for a moral obligation for standardized cryopreservation practices 114 Vajta et al. (2015) Italy Review Oocyte cryopreservation technique To explicate work safety issues in the fertility laboratory 115 van den Akker (2006) UK Review Psychological aspects of third-party ART To examine the importance of the genetic link in gamete donation 116 Van Hoof and Pennings (2011) Belgium Analysis CBRC To determine the moral grounds for extraterritorial legislation on CBRC 117 Van Hoof and Pennings (2012) Belgium Analysis European legislation on ART To analyse the European Court of Human Rights Judgements in relation to ART 118 Van Hoof et al. (2015) Belgium Review CBRC To provide an overview of the ethical aspect regarding CBRC and the responsibility of physicians 119 Vasireddy and Bewley (2013) UK Commentary Oocyte donation for postmenopausal women To discuss the medical, social and ethical aspects of oocyte donation in postmenopausal women 120 de Wachter (2004) The Netherlands Discussion ART To explicate the ethical issues regarding cryobiology in human reproduction 121 de Wachter and de Wert (1987) The Netherlands Review ART To provide an overview of the debate on reproductive technology in the Netherlands 122 Waldby et al. (2013) Australia Survey Payment of oocyte donors To identify the attitudes of fertility patients, reproductive donors and young, non-patient women on payment of oocytes donors 123 Wilde et al. (2014) UK Review Donor registration and disclosure To give an overview of best practices and underlying principles regarding donor registration and disclosure 124 Wolowelsky and Grazi (2014) Israel Discussion Jewish perspectives on ART To discuss the Jewish perspectives on ART and give recommendations for counselling of Jewish patients 125 Wong (2017) Australia Analysis Donor selection and matching To explore the process of donor selection in ART and the consequences of matching for donor offspring 126 Zweifel (2015) USA Review Welfare of the child in ART To identify the ethical aspects of gamete donation in relation to the welfare of the child CBRC, cross-border reproductive care. Results Search and selection After de-duplication, the search yielded 603 articles, which were supplemented by 28 articles through the reference checking of key articles. We included six key articles regarding oocyte banking for research purposes and biobanking. In total, 149 articles were included for further analysis (Fig. 1). Characteristics of included articles The majority of the articles originate from Western countries, especially from the USA (n = 49), UK (n = 41) and Belgium (n = 15). A total of 14 articles are multinational and conducted across Europe. Most articles included in our review are discussions (n = 35), reviews (n = 30), reasoned opinions (n = 26) and ethical analyses (n = 22). Characteristics of the included articles can be found in Tables II–IV. Synthesis of the ethical aspects Our review identified a great variety of ethical aspects. We identified three overall themes referring to the different stages in oocyte banking, namely the intake, storage and distribution of donor oocytes. We then clustered closely related ethical aspects and moral considerations applicable to one of the three stages in sub themes. The overall themes illustrate the course of the donated oocytes within the oocyte bank, while the subthemes relate to the moral actors involved in that particular stage. The themes and subthemes are described below. Importantly, one should be aware that our systematic review does not provide ‘all things considered’ conclusions about what is ethically responsible practice, but a comprehensive overview of the ethical aspects as discussed in the literature. Moreover, the results of our review neither involve nor replace the critical analysis and weighing of the identified aspects and considerations, but provide a starting point to do so (Sofaer and Strech, 2012). Intake The majority of the literature discusses ethical aspects with regard to the intake of donor oocytes, taking into account both the interests of the donor and the potential child. The following ethical aspects concerning the donor have been identified: first, the risks and psychosocial impact of donation; second, the motivations and reasonable compensation in donor recruitment; and third, the requirements for informed consent. Ethical aspects in relation to the potential child are 2-fold: first, welfare standards and the selection of donors, and second, anonymity and disclosure. Considerations with regard to the donor The risks and psychosocial impact of donation Many articles address the physical risk and psychosocial impact of oocyte donation for donors (Novaes, 1989; Schenker, 1993; Cohen, 1997; Ahuja and Simons, 1998; Barratt et al., 1998; Deech, 1998; Hamilton, 1998; Ahuja et al., 1999; Kalfoglou and Geller, 2000; O’Donnell, 2000; Reame, 2000; McGee et al., 2001; Söderström-Anttila et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2004; Dickenson, 2006; Sauer and Kavic, 2006; van den Akker, 2006; de Melo-Martin and Cholst, 2008; Smajdor, 2008; American Society of Reproductive Medicine (ASRM), 2004, 2009; Murphy, 2009; Purewal and van den Akker, 2009; Black, 2010; Klein and Sauer, 2010; Mertes et al., 2012; Pennings et al., 2007a, 2012; Cook et al., 2013; Boutelle, 2014; Londra et al., 2014). The physical risks of oocyte retrieval mentioned in the literature are the risks of ovarian hyperstimulation syndrome as a result of multiple donations or conventional stimulation protocols, and the relatively small risks of infertility after oocyte retrieval (Schenker, 1993; Cohen, 1997; Söderström-Anttila et al., 2001; Pennings et al., 2007a; Smajdor, 2008; Black, 2010; Klein and Sauer, 2010; Cook et al., 2013; Boutelle, 2014; Londra et al., 2014). The literature also stipulates the potential long-term risks for (ovarian and breast) cancer as a result of continued hormone stimulation (Ahuja and Simons, 1998; Ahuja et al., 1999; Söderström-Anttila et al., 2001; Black, 2010; Boutelle, 2014; Fauser and Garcia Velasco, 2017). Recent studies seem to suggest the unlikeliness of an increased risk for cancer of oocyte donors, although follow-up data on the health and wellbeing of oocyte donors are required for confirmation and reassurance (Fauser and Garcia Velasco, 2017). Still, the literature emphasizes that the ‘no harm principle’ requires that serious efforts should be made to minimize the risks for donors (Pennings et al., 2007a; de Melo-Martin and Cholst, 2008). Several efforts to minimize harm to the donor are proposed in the literature. First, a careful selection of donors by excluding young childless women, or women with known risks factors (Barratt et al., 1998; ASRM, 2004; Black, 2010; McGee et al., 2013; Pennings et al., 2007a, 2014). Second, to implement mild stimulation protocols and limiting the number of cycles per donor to a maximum of five (Ahuja and Simons, 1998; Ahuja et al., 1999; Reame, 2000; Söderström-Anttila et al., 2001; Sauer and Kavic, 2006; ASRM, 2009; Cook et al., 2013; Pennings et al., 2007a, 2014). Third, to monitor possible donations to multiple clinics, to ensure donors do not exceed the maximum number of donations (ASRM, 2009; Sauer and Kavic, 2006). Regarding the psychosocial impact of donation, the literature addresses the possible emotional impact on the donor of the existence of a donor child, especially in the relatively rare situation where the donor donated as a nulliparous and later discovers she is not able to conceive herself (Hamilton, 1998; O’Donnell, 2000; ASRM, 2004; Purewal and van den Akker, 2009; Mertes et al., 2012). To prevent a great emotional burden for donors in relation to the existence of (multiple) donor offspring, the American Society for Reproductive Medicine (ASRM) advises to limit the number of donor offspring per donor (ASRM, 2009). This limitation also takes into account the potential emotional impact on the donor offspring when learning that they have multiple genetic siblings. The ASRM does not suggest a specific number for limitation, but in Belgium the limit is set at six recipients per donor (Pennings, 2007). The literature suggests that additional studies regarding the long-term psychological impacts on donors should be performed (van den Akker, 2006; Purewal and van den Akker, 2009). Motivations and reasonable compensation in donor recruitment A second ethical aspect identified in the literature is the responsible recruitment of donors (Abdalla and Studd, 1989; Novaes, 1989; Robertson, 1989; Schenker, 1993, 1995; Shenfield and Steele, 1995; Englert, 1996; Deech, 1998; Guerin, 1998; Hamilton, 1998; McLaughlin et al., 1998; Ahuja et al., 1999; Daniels, 2000; Reame, 1999, 2000; Jones and Cohen, 2001; Lindheim et al., 2001; Söderström-Anttila et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; ASRM, 2004; Papadimos and Papadimos, 2004; Steinbock, 2004; van den Akker, 2006; Isasi and Knoppers, 2007; Merlet, 2009; Black, 2010; Klein and Sauer, 2010; Levine, 2010; Dickenson, 2006, 2011; Burrell, 2012; Keehn et al., 2012; Pattinson, 2012; Hostiuc, 2013; McGee et al., 2013; Waldby et al., 2013; Alberta et al., 2013, 2014; Boutelle, 2014; Londra et al., 2014; Pennings et al., 2007a, 2014; Klitzman and Sauer, 2015; Pennings, 2005, 2015). The discussion regarding donor recruitment revolves around what is considered a ‘right’ motivation as well as a ‘reasonable’ compensation for donation. With regard to donors’ motivations, many authors emphasize that donation should be performed within a gift-relationship, with donors being altruistically motivated (Shenfield and Steele, 1995; Deech, 1998; Guerin, 1998; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; Papadimos and Papadimos, 2004; van den Akker, 2006; Isasi and Knoppers, 2007; Pennings et al., 2007a; Merlet, 2009; Purewal and van den Akker, 2009; Pennings, 2005, 2015). Others argue that altruism is only one amongst several motivations of donors, and consider mixed motivations (e.g. partly altruistic and partly financial) acceptable, as long as care for others remains an important consideration (Boutelle, 2014; Isasi and Knoppers, 2007; Mertes et al., 2012; Pennings et al., 2012; Pennings, 2015). In countries without commercial oocyte donation (i.e. without payment for oocytes), there is serious shortage of donor oocytes (Daniels, 2000; Shenfield et al., 2010; Pennings et al., 2012, 2014). As a result, long waiting lists for recipient parents exist (Pennings, 2001). Strategies for donor recruitment have been profoundly debated (Novaes, 1989; Robertson, 1989; Schenker, 1993; Shenfield and Steele, 1995; Deech, 1998; Guerin, 1998; Hamilton, 1998; McLaughlin et al., 1998; Ahuja et al., 1999; Daniels, 2000; Reame, 1999, 2000; Lindheim et al., 2001; Soderstrom-Anttila et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; ASRM, 2004; Maunder, 2004; Papadimos and Papadimos, 2004; Steinbock, 2004; Kääriäinen et al., 2005; Sauer and Kavic, 2006; Isasi and Knoppers, 2007; Merlet, 2009; Black, 2010; Klein and Sauer, 2010; Dickenson, 2006, 2011; Nuffield Council on Bioethics, 2011; Burrell, 2012; Keehn et al., 2012; Pattinson, 2012; Hostiuc, 2013; McGee et al., 2013; Waldby et al., 2013; Boutelle, 2014; Londra et al., 2014; Pennings et al., 2007a, 2012, 2014; Klitzman and Sauer, 2015; Pennings, 2005, 2015; Klitzman, 2016). To diminish scarcity some stipulate the importance of public awareness regarding the need for (altruistic) donors (Abdalla and Studd, 1989; Shenfield and Steele, 1995; Ahuja et al., 1999; Pennings et al., 2012; Pennings, 2005, 2015), while others suggest to increase the amount of money provided to donors (Ahuja et al., 1999; Isasi and Knoppers, 2007; Pennings, 2015). The ‘intervention ladder’ of the Nuffield Council on Bioethics illustrates potential strategies in donor recruitment, ranging from ‘altruistic focused’ to ‘non-altruistic focused’ interventions. The altruistic focused rungs of the ladder are: (i) information about the need for the donation of bodily material; (ii) recognition of, and gratitude for, altruistic donation; (iii) interventions to remove barriers and disincentives to donation; and (iv) interventions to prompt or encourage those already disposed to donate for altruistic reasons. The non-altruist rungs are: (v) interventions offering associated benefits in kind to encourage those who would not otherwise have contemplated donating; and lastly (vi) financial incentives that leave the donor in a better financial position. The Nuffield Council argues that their intervention ladder should not be seen as moving from ethical actions to unethical actions, but rather from actions that are ethically straightforward to those that are ethically more complex. Moreover, the Council points out that a variety of terminology is used in relation to the provision of money to donors, including, ‘rewards’, ‘reimbursements’, ‘compensations’, ‘incentives’ and ‘payments’ (Nuffield Council on Bioethics, 2011). In the literature several arguments against ‘non-altruistic’ interventions (i.e. payment and monetary incentives) are pointed out. First, to allow payment for oocytes results in the commodification of bodily material (Robertson, 1989; Deech, 1998; Daniels, 2000; Lindheim et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; ASRM, 2004; Steinbock, 2004; Isasi and Knoppers, 2007; Smajdor, 2008; Merlet, 2009; Nuffield Council on Bioethics, 2011; McGee et al., 2013; Waldby et al., 2013; Londra et al., 2014; Klitzman and Sauer, 2015; Pennings, 2005, 2007, 2015). Second, payments and incentives act as an undue inducement compromising informed consent (ASRM, 2004; Robertson, 1989; Deech, 1998; Reame, 1999, 2000; Lindheim et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; Papadimos and Papadimos, 2004; Steinbock, 2004; Isasi and Knoppers, 2007; Smajdor, 2008; Nuffield Council on Bioethics, 2011; Pattinson, 2012; Pennings et al., 2012; Waldby et al., 2013; Pennings, 2005, 2015) Third, payment potentially exploits women (Robertson, 1989; Pettee and Weckstein, 1993; Shenfield and Steele, 1995; Englert, 1996; Rothenberg, 1996; Reame, 1999; ASRM, 2004; Steinbock, 2004; Isasi and Knoppers, 2007; Dickenson, 2011; Pennings et al., 2007a, 2012; McGee et al., 2013; Waldby et al., 2013; Pennings, 2005, 2015). Fourth, payment may incentivize donors to falsify information, which could compromise the welfare of the donor child (Shenfield and Steele, 1995; Guerin, 1998; ASRM, 2004; Steinbock, 2004; Pennings et al., 2012; McGee et al., 2013). Fifth, payment to donors increases the treatment costs reducing the accessibility of third-party ART for recipients (Shenfield and Steele, 1995; Daniels, 2000; Pennings, 2001). Multiple arguments in favour of providing money to donors are mentioned in the literature. First, money compensates the donor’s personal and financial sacrifices (Söderström-Anttila et al., 2001; Isasi and Knoppers, 2007; Pennings et al., 2007a, 2012; Waldby et al., 2013). Second, money encourages the act of donation which increases the amount of donor oocytes, enabling the treatment of more recipient parents (Novaes, 1989; Robertson, 1989; Englert, 1996; Guerin, 1998; Daniels, 2000; Steinbock, 2004; Isasi and Knoppers, 2007; Nuffield Council on Bioethics, 2011; Keehn et al., 2012; Pennings et al., 2012; Pennings, 2015) Third, the expression of altruistic donation is not necessarily compromised by a financial compensation (Table V) (Klein and Sauer, 2010; Novaes, 1989; Nuffield Council on Bioethics, 2011; Pennings, 2015). Table V Arguments in favour and against the payment of oocyte donors. Donors should not be paid to prevent/diminish Donors should be paid to provide/enable The commodification of bodily material16,20,22,42,48,53,54,59,64,80,81,83,96,110,112,122,133,142,143 Compromised informed consent by undue inducements16,22,42,53,72,74,80,83,86,94,95,110,112,122,133,142,143 Potential exploitation of poor women23,26,42,59,80,83,86,88,94,96,106,112,122,133,138 Donors to falsify information putting the welfare of the child at risk33,59,86,106,112,133 Rise of treatment costs for recipients20,79,106 A compensation for personal and financial sacrifices42,111,122,138 An encouragement for the altruistic act of donation20,26,33,42,46,70,83,86,96,112,143 An increase in the amount of oocyte donors47,70,83,143 Donors should not be paid to prevent/diminish Donors should be paid to provide/enable The commodification of bodily material16,20,22,42,48,53,54,59,64,80,81,83,96,110,112,122,133,142,143 Compromised informed consent by undue inducements16,22,42,53,72,74,80,83,86,94,95,110,112,122,133,142,143 Potential exploitation of poor women23,26,42,59,80,83,86,88,94,96,106,112,122,133,138 Donors to falsify information putting the welfare of the child at risk33,59,86,106,112,133 Rise of treatment costs for recipients20,79,106 A compensation for personal and financial sacrifices42,111,122,138 An encouragement for the altruistic act of donation20,26,33,42,46,70,83,86,96,112,143 An increase in the amount of oocyte donors47,70,83,143 Superscript numbers refer to the studies in Tables II–IV. Table V Arguments in favour and against the payment of oocyte donors. Donors should not be paid to prevent/diminish Donors should be paid to provide/enable The commodification of bodily material16,20,22,42,48,53,54,59,64,80,81,83,96,110,112,122,133,142,143 Compromised informed consent by undue inducements16,22,42,53,72,74,80,83,86,94,95,110,112,122,133,142,143 Potential exploitation of poor women23,26,42,59,80,83,86,88,94,96,106,112,122,133,138 Donors to falsify information putting the welfare of the child at risk33,59,86,106,112,133 Rise of treatment costs for recipients20,79,106 A compensation for personal and financial sacrifices42,111,122,138 An encouragement for the altruistic act of donation20,26,33,42,46,70,83,86,96,112,143 An increase in the amount of oocyte donors47,70,83,143 Donors should not be paid to prevent/diminish Donors should be paid to provide/enable The commodification of bodily material16,20,22,42,48,53,54,59,64,80,81,83,96,110,112,122,133,142,143 Compromised informed consent by undue inducements16,22,42,53,72,74,80,83,86,94,95,110,112,122,133,142,143 Potential exploitation of poor women23,26,42,59,80,83,86,88,94,96,106,112,122,133,138 Donors to falsify information putting the welfare of the child at risk33,59,86,106,112,133 Rise of treatment costs for recipients20,79,106 A compensation for personal and financial sacrifices42,111,122,138 An encouragement for the altruistic act of donation20,26,33,42,46,70,83,86,96,112,143 An increase in the amount of oocyte donors47,70,83,143 Superscript numbers refer to the studies in Tables II–IV. All things considered, the literature seems to suggest that a ‘reasonable compensation’ for expenses, and physical and emotional discomfort (corresponding to rungs 3–4 on the Nuffield intervention ladder) is justifiable (McLaughlin et al., 1998; Söderström-Anttila et al., 2001; Byrd et al., 2002; ASRM, 2004; Steinbock, 2004; Sauer and Kavic, 2006; Isasi and Knoppers, 2007; Pennings et al., 2007a; Burrell, 2012; Waldby et al., 2013; Londra et al., 2014). While the ASRM suggests that a reasonable compensation should not exceed 5000 US dollars per cycle, in European countries a total of ~900 euros per cycle is considered acceptable (ASRM, 2004; Nuffield Council on Bioethics, 2011). A proposed strategy to avoid commodification is to provide a fixed compensation per cycle irrespective of the number and quality of the retrieved oocytes, and the (phenotypical) characteristics of the donor (ASRM, 2004; Steinbock, 2004; Keehn et al., 2012; Pennings et al., 2007a, 2012). Additionally, the ASRM advises that clinics offering financial incentives should safeguard the possibility of undue influences and exploitation of donors through careful counselling to guarantee sufficient informed consent (ASRM, 2004). Requirements for informed consent A third ethical aspect related to the intake of oocytes identified in the literature, are the requirements of informed consent for donors (Novaes, 1989; Ahuja and Simons, 1998; Barratt et al., 1998; Benshushan and Schenker, 1998; Hamilton, 1998; Ahuja et al., 1999; Kalfoglou and Geller, 2000; Lindheim et al., 2001; Papadimos and Papadimos, 2004; de Melo-Martin and Cholst, 2008; ASRM, 2004, 2009; Black, 2010; Dickenson, 2006, 2011; Schaefer et al., 2012; McGee et al., 2013; Alberta et al., 2014; Boutelle, 2014; Dondorp et al., 2014; Londra et al., 2014; Pennings et al., 2007a, 2014; Siegel, 2015). The majority of the literature suggests that potential donors should be provided with information on the medical risks, the legal and emotional aspects, the expected discomfort and possible psychosocial implications of their donation (Hamilton, 1998; Ahuja et al., 1999; Lindheim et al., 2001; Pennings et al., 2007a; de Melo-Martin and Cholst, 2008; ASRM, 2004, 2009; Black, 2010; Dickenson, 2011; McGee et al., 2013; Alberta et al., 2014; Boutelle, 2014; Londra et al., 2014). Moreover, potential donors may have unrealistic beliefs about their contribution, therefore, the expected outcomes of the treatment with donor oocytes should be explained (Ahuja et al., 1999; Pennings et al., 2007a; ASRM, 2009). Multiple authors suggest that clinics should provide psychological counselling to prospective donors to enhance the likelihood of significant understanding of the potential impact of donation in order to give sufficient informed consent (ASRM, 2004, 2009; Black, 2010; Deech, 1998; Söderström-Anttila et al., 2001). Over the years, it is increasingly proposed to treat donors as interested stakeholders with a certain degree of control over their donated tissue, and not merely as providers of genetic material (ASRM, 2009; Dickenson, 2006; Dondorp et al., 2014). The acceptable level of control is an important aspect of the informed consent procedure for oocyte donors. We will elaborate on this aspect in the second section of this review regarding the storage of donor oocytes. Considerations with regard to the future child Welfare standards and the selection of donors The literature demonstrates that consensus exists that the fertility specialist has professional responsibilities in ART with regard to the welfare of the potential child (Blyth and Cameron, 1998; Hamilton, 1998; Pennings et al., 2007b; Dondorp et al., 2014). To what extent the welfare of the child should be protected is evaluated on the basis of three thresholds. First, the ‘minimum welfare principle’ entails the view that (assisted) reproduction is morally acceptable when the expected life standard of the resulting child will not be worse than death. Second, the ‘reasonable welfare standard’ entails the view that (assisted) reproduction is morally acceptable when the expected life standard of the resulting child is reasonable and there is no high risk of serious harm. Third, the ‘maximum welfare principle’ entails the view that one should not knowingly and intentionally bring a child into the world in less than ideal circumstances (Table VI) (Bredenoord et al., 2008; Pennings, 1999). Table VI Standards to assess the welfare of the child. 1. Minimum welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child will not be worse than death77 2. Reasonable welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child is reasonable and there is no high risk of serious harm77 3. Maximum welfare principle ART with donor oocytes is not morally acceptable in circumstances less than ideal77 1. Minimum welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child will not be worse than death77 2. Reasonable welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child is reasonable and there is no high risk of serious harm77 3. Maximum welfare principle ART with donor oocytes is not morally acceptable in circumstances less than ideal77 Superscript numbers refer to the studies in Table II. Table VI Standards to assess the welfare of the child. 1. Minimum welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child will not be worse than death77 2. Reasonable welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child is reasonable and there is no high risk of serious harm77 3. Maximum welfare principle ART with donor oocytes is not morally acceptable in circumstances less than ideal77 1. Minimum welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child will not be worse than death77 2. Reasonable welfare principle ART with donor oocytes is morally acceptable when the expected life standard of the resulting child is reasonable and there is no high risk of serious harm77 3. Maximum welfare principle ART with donor oocytes is not morally acceptable in circumstances less than ideal77 Superscript numbers refer to the studies in Table II. The welfare standard which is employed in practice effects the standards for the selection of donors. The literature indicates that in the selection of donors for third-party ART the ‘reasonable welfare standard’ is generally employed (Novaes, 1989; Schenker, 1993; Blyth and Cameron, 1998; Deech, 1998; Hamilton, 1998; Pennings, 1999; Pennings et al., 2007a, 2007b; Dondorp et al., 2014). However, the practical implications of this principle for donor selection are not much discussed in the literature. Several articles argue that oocyte donors should be younger than 35–38 years to minimize the risk for aneuploidy in oocytes, thereby seriously compromising the success rates of treatment (Deech, 1998; Dondorp et al., 2014; Zweifel, 2015). Furthermore, it is reasoned that clinics should assess the donors’ personal and family medical history while carefully keeping medical records in case follow up is needed (De Wachter and De Wert, 1987; Novaes, 1989; Robertson, 1989; Schenker, 1993; Cohen, 1997; Deech, 1998; Jones and Cohen, 2001; Dondorp et al., 2014). However, some argue that autosomal recessive disorders, such as cystic fibrosis, will often not be found if only the donors’ family history is identified. The ASRM therefore recommends carrier testing of oocyte donors (ASRM, 2009; Dondorp et al., 2014). Still, despite current guidelines on genetic screening of donors, cases have been reported of donor offspring with rare severe genetic diseases (Dondorp et al., 2014). As a result, a relatively new discussion regarding the advisability of whole genome sequencing of oocyte donors emerges in the literature (O’Donnell, 2000; Kääriäinen et al., 2005; Dondorp et al., 2014; Londra et al., 2014; Gil-Arribas et al., 2016). It is proposed that sequencing of oocyte donors enables a more comprehensive screening process at relatively low cost (Dondorp et al., 2014). Thus far, this practice has been discouraged because of its novelty, the impact on donors and potential false insurance for recipients (Dondorp et al., 2014; Kääriäinen et al., 2005). Anonymity and disclosure The acceptability of anonymous or non-anonymous donation has been profoundly debated in the literature over the years, and is still a controversial topic (Ahuja et al., 1999; van den Akker, 2006; ASRM, 2009, 2013c; de Wachter and Wert, 1987; Mahlstedt and Greenfeld, 1989; Novaes, 1989; Robertson, 1989; Knoppers and Le Bris, 1993; Schenker, 1993; Shenfield and Steele, 1995; Cohen, 1997; Shenfield, 1997; McWhinnie, 1998; Golombok et al., 1999; O’Donnell, 2000; Reame, 2000; Frith, 2001; Soderstrom-Anttila et al., 2001; Byrd et al., 2002; ESHRE Task Force on Ethics and Law, 2002; Maunder, 2004; Murray et al., 2006; Readings et al., 2011; Van Hoof and Pennings, 2011; Shufaro and Schenker, 2012; Crawshaw et al., 2013; McGee et al., 2001, 2013; Ravelingien and Pennings, 2013; de Melo-Martín, 2014; Londra et al., 2014; Ravitsky, 2014; Wilde et al., 2014; Freeman, 2015; Ilioi and Golombok, 2015; Zweifel, 2015; Raes et al., 2016; Pennings, 2005, 2012, 2017). The discussion in the literature mainly revolves around whether there is a right to know one’s genetic origin (ASRM, 2013c; Mahlstedt and Greenfeld, 1989; Robertson, 1989; Schenker, 1993; Cohen, 1997; Shenfield, 1997; McWhinnie, 1998; Frith, 2001; McGee et al., 2001; ESHRE Task Force on Ethics and Law, 2002; Ravelingien and Pennings, 2013; de Melo-Martín, 2014; Ravitsky, 2014; Zweifel, 2015; Pennings, 2012, 2017) and the potential negative influence on the wellbeing of the child of secrecy regarding the role of the donor (Mahlstedt and Greenfeld, 1989; Pettee and Weckstein, 1993; Golombok et al., 1999; McGee et al., 2001; Soderstrom-Anttila et al., 2001; de Melo-Martín, 2014; Pennings, 2017). Interestingly, the debate in the literature concerning anonymity shows a contradiction with regard to the importance of genetic relatedness: while genetic relatedness is considered insignificant in the recipient parent–child relationship, it is considered very important in the donor–child relationship (Freeman, 2015). This academic disagreement is reflected in the international diversity of donor anonymity legislation. In countries in which donor anonymity is legally permitted only non-identifiable information of the donor is registered and shared with the recipients (Byrd et al., 2002; Burrell, 2012). In countries in which anonymity is prohibited, the child can make an appeal for this information at a particular age as well (Pennings, 2012). For the child to be able to seek this information (s)he is dependent on the honesty of the parents regarding his or her conception (van den Akker, 2006; ASRM, 2013c; Frith, 2001; Soderstrom-Anttila et al., 2001; Readings et al., 2011; Pennings, 2012; Londra et al., 2014). Also, several studies indicate that recipients’ decision to (non-)disclose is influenced by the attitude of the public, and professionals of fertility clinics in particular, regarding the importance of honesty about the origin of the child’s conception (Wilde et al., 2014; Freeman, 2015). These two aspects give rise to the question, frequently discussed in the literature, to what extent clinics should counsel recipient parents into disclosing the origin of their child’s conception (van den Akker, 2006; ASRM, 2013c; Mahlstedt and Greenfeld, 1989; McGee et al., 2001; Ravelingien and Pennings, 2013; Londra et al., 2014; Wilde et al., 2014; Benward, 2015; Zweifel, 2015; Raes et al., 2016; Pennings, 2017). The literature agrees that oocyte banks should at least inform both donors and recipients about the current policy of information sharing, and acknowledge that most professionals do not have a neutral position regarding recipients’ decision on disclosure (ASRM, 2009; Wilde et al., 2014; Benward, 2015). Furthermore, despite the fact that several studies have not found an empirically measurable effect of (non-)disclosure on the wellbeing of the child, many advise to counsel parents towards disclosure (Londra et al., 2014; McGee et al., 2001; Nuffield Council on Bioethics, 2011; Pennings, 2017; Wilde et al., 2014; Zweifel, 2015). Storage Relatively little literature discusses the ethical aspects of the storage of donor oocytes. Yet, the practice of oocyte banking shows similarities with the storage of human tissue in biobanks for medical research, a practice which is more extensively discussed in the academic literature. The following section provides an overview of the ethical aspects of storing donor oocytes for ART mentioned in the literature on oocyte banking, supplemented by ethical aspects inspired by literature regarding biobanking and oocyte banking for research purposes. The identified aspects are (i) quality standards and confidentiality; (ii) issues of ownership and control; and (iii) the increase of international transport of donor oocytes. Quality standards and confidentiality Several studies on ART explicate the importance of carefully supervising the medical procedures involving genetic material of a third party (Knoppers and Le Bris, 1993; Schenker, 1993; Deech, 1998; Tomlinson and Sakkas, 2000; de Wachter, 2004; ESHRE Task Force on Ethics and Law, 2002, 2004; Pennings, 2007; Gosden and Gosden, 2012; Dondorp et al., 2014; Stroud and O’Doherty, 2015; Vajta et al., 2015; ASRM, 2009, 2016a). It is suggested that oocyte banks should establish up to date protocols that stipulate requirements for laboratory and treatment facilities and professional qualities (Barratt et al., 1998; Deech, 1998; Tomlinson and Sakkas, 2000; ESHRE Task Force on Ethics and Law, 2004; Barritt et al., 2007; Gosden and Gosden, 2012; Vajta et al., 2015; ASRM, 2016a, 2016b). There is limited literature that addresses the work safety and responsibilities of the embryologist working with vitrification techniques in the laboratory (ESHRE Task Force on Ethics and Law, 2004; de Melo-Martin and Cholst, 2008; Vajta et al., 2015). In these articles it is argued that the execution of these vitrification techniques is not without risk, therefore safety regulations should be a prime concern for clinics (ESHRE Task Force on Ethics and Law, 2004; de Melo-Martin and Cholst, 2008; Vajta et al., 2015). Furthermore, the literature suggests that oocyte banks should maintain accurate records of the origin of the donor oocytes and the conditions under which these were obtained (Deech, 1998; ASRM, 2009; Knoppers and Bris, 1993; Novaes, 1989; Schenker, 1993; Pennings et al., 2007a; Stroud and O’Doherty, 2015). Proper registration of the origin of the oocytes facilitates the possibility of control and supervision (Pennings, 2007) and is also considered important to guarantee the confidentiality of the personal information of donors (Stroud and O’Doherty, 2015). There is limited literature that discusses the maximum storage period of donated oocytes. However, several articles indicate the maximum storage period of embryos resulting from ART and frozen oocytes for self-use. A maximum storage period between 5 and 10 years is proposed (ESHRE, 2004; Pennings et al., 2007a, 2007b; Jones and Cohen, 2001; de Wachter, 2004). Ownership and control Questions of who owns and controls the destination of the oocytes may arise once donor oocytes are stored in banks. We used additional key articles regarding oocyte banking for research purposes and biobanking in which the aspect of ownership and control is identified (Baylis and Widdows, 2015; Dickenson, 2006; O’Doherty et al., 2011; Rothstein, 2005; Stroud and O’Doherty, 2015; Waldby and Mitchell, 2006). While several authors argue that bodily material cannot be owned the way we own non-bodily goods (Dickenson, 2006; Waldby and Mitchell, 2006), some argue that the banks become the owner of the biomaterials once it is donated, while others argue that banks are mainly taking the material into ‘custody’ with the donors retaining ownership or ‘rights of say’ (Waldby and Mitchell, 2006; Stroud and O’Doherty, 2015). Moreover, it is emphasized that because the donor donates the tissue to a bank within a ‘gift relationship’, the banks are required to recognize the act of ‘altruistic care for the wellbeing of others’ that is embedded in the donation of the donor. In storing and using donated tissue, banks should thus respect the wishes of the donor (Dickenson, 2006; Rothstein, 2005). The literature shows that reproductive material is valued differently from ‘normal’ bodily tissue because of the assumed potential for life and greater emotional attachment (Dickenson, 2006; Baylis and Widdows, 2015). This seems to influence the perspectives on ownership and the resulting degree of control. These attitudes are evident in the discussion on postmortem usage of donor oocytes (and sperm) (Parker, 2004; Mizukami et al., 2005; Pennings et al., 2006; Nakhuda, 2010; Burrell, 2012; Dillon and Fiester, 2012). When the donor dies, the oocytes can continue to be used for reproductive treatment, donated to research or destroyed, dependent on legislation or the donors preferences (Pennings et al., 2006, 2012). Multiple authors recommend clinics to encourage donors to make their preferences explicit as a part of the informed consent procedure at the start of donation (Deech, 1998; Burrell, 2012; Dillon and Fiester, 2012). Others propose to organize consent on postmortem usage as an ongoing process because of the possibility that donors may change preferences, and thus increase the possibilities for donors to control their donated reproductive tissue (Baylis and Widdows, 2015; Stroud and O’Doherty, 2015). For the same reasons, it is argued that donors have a right to withdraw from donation during the course of their life (O’Donnell, 2000). International transport Banking allows the international import and export of donor oocytes. Clinics in countries with a donor shortage import gametes from countries with donors in surplus. The import and export of donor sperm has been standard practice for many years, and the number of donor oocytes which is transported between clinics is growing (Pennings and Gurtin, 2012). Few articles in the literature address the transport of gametes, and oocytes in particular (Burrell, 2012; Deech, 1998; Heng, 2006, 2007a; Pennings and Gurtin, 2012; Pennings et al., 2007a). International transport of donor oocytes is considered beneficial for patients because it diminishes the need to travel abroad for treatment (Pennings and Gurtin, 2012). Nonetheless, aiming to avoid malpractices and trade in oocytes, the ESHRE taskforce advises that clinics should not import oocytes that are collected from women abroad (Pennings et al., 2007a). If clinics do import donor oocytes, the ESHRE taskforce proposes that the centre which imports the oocytes shares responsibility towards the foreign donor, and should verify whether the oocytes are obtained according to ethical standards (Pennings et al., 2007a). It is also advised that the exchange of gametes between banks should not be a profit-making business, and good co-operation and feedback between the banks concerned is required (Deech, 1998). By contrast, some argue that if clinics cannot live up to the demand, then refraining from importing donor oocytes is unfair to recipients. Still, it is proposed that to ensure responsible import and export of oocytes, a coherent regulatory framework for the ethical recruitment of oocyte donors across international borders should be formulated (Heng, 2006). Distribution This last section provides an overview of the ethical aspects related to the distribution of donor oocytes. Ethical aspects identified in the literature with regard to the access to treatment for recipients mainly evolve around the selection of recipients and ‘cross-border reproductive care’ (CBRC). Another identified aspect, but which is hardly addressed in the literature, is the prioritization of recipients in case the supply of donor oocytes is scarce. The final two identified aspects are the matching of recipients with donor oocytes, and the requirements for informed consent and counselling for recipients. Access to treatment for recipients Selection of recipients and the welfare of the child The criteria for access to ART with donor oocytes for recipients mentioned in the literature are increasingly grounded in the expected wellbeing of the future child over the years (McWhinnie, 1998; Jones and Cohen, 2001; Pennings, 2001; Söderström-Anttila et al., 2001; Byrd et al., 2002; van den Akker, 2006; Pennings et al., 2007b, 2008; ASRM, 2013a, 2013b; Braverman, 2015; Zweifel, 2015). As discussed above, the welfare of the child is evaluated on the basis of three thresholds (Table VI). While the literature concerning donor selection seems to support the reasonable welfare standard, the larger part of the literature regarding recipient selection embraces the maximum welfare standard. A review article articulates the position that multiple clinics are convinced that ‘a moral obligation exists to conceive children under the best conditions possible’ (Braverman, 2015). Many propose that examining the expected parental capabilities of recipients could optimize these conditions (Pennings, 2001; Pennings et al., 2007a, 2007b, 2008; Cook et al., 2013; ASRM, 2013b; Braverman, 2015). Others argue that fertility professionals cannot hold double standards; the reasonable welfare standard should be used for both recipient and donor selection (de Wert et al., 2014). The discussion in the literature on recipient selection mainly revolves around the accessibility to treatment with donor oocytes of postmenopausal women (Schenker, 1993; Dean and Edwards, 1994; Paulson and Sauer, 1994; Marcus and Brinsden, 1996; Eisenberg and Schenker, 1997; Hamilton, 1998; Pennings, 2001; Soderstrom-Anttila et al., 2001; Maunder, 2004; Landau, 2005; Smajdor, 2008; Klein and Sauer, 2010; Vasireddy and Bewley, 2013; ASRM, 2013a; Shufaro and Schenker, 2012, 2014; Zweifel, 2015). Several articles emphasize that late parenthood could negatively influence the welfare of the child, because of early parental death, and a low societal acceptance of parenthood at advanced age (Schenker, 1993; Dean and Edwards, 1994; Paulson and Sauer, 1994; Söderström-Anttila et al., 2001; ASRM, 2013a; Shufaro and Schenker, 2012, 2014; Zweifel, 2015). Opponents contest these arguments by referring to the individual’s right to procreate. Denying oocyte donation to postmenopausal women negates this fundamental right (Dean and Edwards, 1994; Paulson and Sauer, 1994; Pennings, 2001; Maunder, 2004; Landau, 2005; ASRM, 2013a; Londra et al., 2014; Shufaro and Schenker, 2012, 2014; Zweifel, 2015). Five additional selection criteria for recipients are mentioned in the debate about ART for postmenopausal women. First is the expected medical risk for both mother and child (e.g. pregnancy-induced hypertension, gestational diabetes and caesarean sections) (Dean and Edwards, 1994; Paulson and Sauer, 1994; Schenker, 1995; Marcus and Brinsden, 1996; Söderström-Anttila et al., 2001; Landau, 2005; Vasireddy and Bewley, 2013; ASRM, 2013a; Shufaro and Schenker, 2012, 2014; Zweifel, 2015). The ASRM advices that women for whom pregnancy imposes elevated risks should be thoroughly screened and counselled by a physician experienced in the care of high-risk obstetrical patients (ASRM, 2013a). Second, is the medical need or expected chances for successful treatment (Marcus and Brinsden, 1996; Pennings, 2001; Shufaro and Schenker, 2012). Third, is the opportunity of experiencing parenthood (i.e. primary versus secondary infertility) (Pennings, 2001; Shufaro and Schenker, 2012). Fourth, is nationality and whether to accept foreign patients (Pennings, 2001; van Hoof and Pennings, 2011). Fifth, is the capacity to pay, since expensive treatment will ultimately result in limited access for recipients (Hamilton, 1998; Pennings, 2001; Shufaro and Schenker, 2012). Similar arguments are identified in the literature discussing the acceptability of ART for what are sometimes called ‘non-nuclear families’ (i.e. departing from the traditional heterosexual married couple), including single, gay, lesbian and trans-sexual patients (de Wachter and de Wert, 1987; Knoppers and Le Bris, 1993; Schenker, 1993; Hamilton, 1998; Jones and Cohen, 2001; van den Akker, 2006; Pennings, 2007; Dickenson, 2011; Burrell, 2012; Hostiuc, 2013; de Wert et al., 2014). In countries in which treatment of these non-nuclear families is not allowed, ‘relationship status’ is identified as an additional selection criterion (Jones and Cohen, 2001). See Table VII for an overview of the selection criteria used for recipients, as published in the literature. The access of same-sex male couples to oocyte banks is particularly ethically controversial because of the involvement of a gestational surrogate (van den Akker, 2006). The ethical concerns in relation to surrogacy largely correspond to the ethical aspects of oocyte donor recruitment (i.e. physical risks and psychosocial impacts, appropriate motivation and reasonable compensation, and anonymity and disclosure). However, a comprehensive overview of the ethical aspects of gestational surrogacy is outside the scope of this review. Table VII Criteria for selecting and prioritizing recipients of oocyte donation. Criteria for selection Criteria for prioritization Parental capabilities14,18,21,75,79,81,100,107,108,111,126,129,130,134,137 Medical risks21,51,56,75,101,107,108,111,119,126,129 Chances for successful treatment56,79,107 Primary versus secondary infertility79,107 Nationality79,116 Capacity to pay34,79,107 Relationship status15,23,34,38,43,50,81,100,115,121,134 Medical need79 Chances for successful treatment25,48,79 Waiting time79 Medical urgency79 Phenotypic matching79 Criteria for selection Criteria for prioritization Parental capabilities14,18,21,75,79,81,100,107,108,111,126,129,130,134,137 Medical risks21,51,56,75,101,107,108,111,119,126,129 Chances for successful treatment56,79,107 Primary versus secondary infertility79,107 Nationality79,116 Capacity to pay34,79,107 Relationship status15,23,34,38,43,50,81,100,115,121,134 Medical need79 Chances for successful treatment25,48,79 Waiting time79 Medical urgency79 Phenotypic matching79 Superscript numbers refer to the studies in Tables II–IV. Table VII Criteria for selecting and prioritizing recipients of oocyte donation. Criteria for selection Criteria for prioritization Parental capabilities14,18,21,75,79,81,100,107,108,111,126,129,130,134,137 Medical risks21,51,56,75,101,107,108,111,119,126,129 Chances for successful treatment56,79,107 Primary versus secondary infertility79,107 Nationality79,116 Capacity to pay34,79,107 Relationship status15,23,34,38,43,50,81,100,115,121,134 Medical need79 Chances for successful treatment25,48,79 Waiting time79 Medical urgency79 Phenotypic matching79 Criteria for selection Criteria for prioritization Parental capabilities14,18,21,75,79,81,100,107,108,111,126,129,130,134,137 Medical risks21,51,56,75,101,107,108,111,119,126,129 Chances for successful treatment56,79,107 Primary versus secondary infertility79,107 Nationality79,116 Capacity to pay34,79,107 Relationship status15,23,34,38,43,50,81,100,115,121,134 Medical need79 Chances for successful treatment25,48,79 Waiting time79 Medical urgency79 Phenotypic matching79 Superscript numbers refer to the studies in Tables II–IV. Prioritization in case of scarce supply Prioritization of recipients is considered an important ethical issue in countries in which the demand for ART with donor oocytes is high, but the supply is minimal (Pennings, 2001). Although the principle of justice demands that oocyte banks establish carefully considered policies regarding prioritization, very little literature addresses this issue (Eisenberg and Schenker, 1997; Pennings, 2001; Klein and Sauer, 2010). The limited literature shows that it is believed that donor oocytes are valuable and scarce, which should not go to waste. On that account it is proposed that recipients should be prioritized on their expected chances for successful treatment (Pennings, 2001). One article that briefly addresses the issue of prioritization argues that young women who undergo menopause at a premature age (<40 years) should be prioritized over women who had menopause within the normal range (>40 years) because treatment with donor oocytes can be their only chance to achieve gestational motherhood (Eisenberg and Schenker, 1997). However, others argue that prioritizing women with premature menopause over women who undergo menopause ‘naturally’, based on the argument that the second group of women ‘have had their chance’, is unjust. Both groups of women cannot be held accountable for the cause of their remaining desire to have children (Klein and Sauer, 2010). Other criteria for prioritization mentioned in the literature are waiting time, medical urgency, and phenotypic matching (Pennings, 2001) (Table VII). The ASRM proposes to take into account the preferences of donors in allocating their oocytes to recipient parents, although it is emphasized that clinics should prevent the discrimination of recipient parents (ASRM, 2009). Cross-border reproductive care The legislation on ART and the availability of donor oocytes differ internationally. Patients from countries in which treatment with donor oocytes is not allowed, or inaccessible due to shortage or high costs, seek CBRC (Shenfield et al., 2010; ASRM, 2016b). Multiple articles identify the ethical concerns related to CBRC. One ethical aspect identified in the literature is whether clinics have an obligation to treat patients from abroad (Pennings, 2001; Heng, 2007b; Pennings et al., 2008; Merlet, 2009; Inhorn, 2010; Blyth et al., 2011; Pennings and Gurtin, 2012; Shenfield, 2012; van Hoof and Pennings, 2011, 2012; van Hoof et al., 2015; ASRM, 2016b). Some authors state that it is morally problematic if clinics treat large numbers of foreign patients, since this disadvantages local patients (Pennings, 2001; ASRM, 2016b) and disrespects the regulatory system of the country of origin (van Hoof et al., 2015). Others argue that the duty of caregivers and the right to care of patients outweighs these concerns, and requires a tolerant attitude of clinics towards patients seeking treatment abroad (Pennings, 2001; van Hoof and Pennings, 2011; van Hoof et al., 2015). A second aspect mentioned in the literature is that cross CBRC reinforces ‘stratified reproduction’: when only certain categories of people (e.g. individuals who are financially and/or geographically advantaged) are empowered to reproduce, while others are disempowered (Inhorn and Gürtin, 2011). Furthermore, the literature proposes to at least inform patients considering treatment abroad about the risks and benefits, and to formulate international standards on CBRC (Pennings et al., 2008; van Hoof et al., 2015; Merlet, 2009). Matching donor oocytes and recipients Several studies discuss the practice of matching donors and recipients (Pennings, 2000, 2001; Söderström-Anttila et al., 2001; Sauer and Kavic, 2006; de Melo-Martin and Cholst, 2008; ASRM, 2009; Gil-Arribas et al., 2016; Klitzman, 2016; Wong, 2017). While commercial oocyte banks provide recipients with an increased control in choosing phenotypic characteristics of the donor, non-commercial oocyte banks generally match only for minimal phenotypical characteristics (Pennings, 2000; Söderström-Anttila et al., 2001; Sauer and Kavic, 2006). Moreover, the current scarcity of donor oocytes in many countries diminishes the possibilities for matching (Pennings, 2001; ASRM, 2009). Still, some believe that the creation of oocyte banks will result in a greater choice in donor characteristics, which optimizes the matching of recipient parents and donor oocytes (de Melo-Martin and Cholst, 2008; Pennings, 2000). There seems to be no consensus as to what extent of matching is desirable. It is either understood as a result of the commercialization of ART, or as a means to increase the autonomy of recipient parents (Pennings, 2000; Klitzman, 2016): some argue for the latter and emphasize that ensuring the possibility for recipient parents to choose between donors increases recipients’ control over their treatment process, and could help them in accepting the donor’s role in the creation of their family (Pennings, 2000). Others argue that facilitating matching by phenotypic characteristics stimulates normative judgements regarding non-nuclear families. Not prioritizing matching would reduce stigma and generate acceptance of alternative family structures (Wong, 2017). Informed consent and counselling of recipients The last ethical aspect identified in the literature concerns the importance of sufficient informed consent and proper counselling for recipients during treatment with donor oocytes (Mahlstedt and Greenfeld, 1989; Pettee and Weckstein, 1993; Marcus and Brinsden, 1996; Reame, 1999, 2000; Söderström-Anttila et al., 2001; Schenker, 2005; van den Akker, 2006; Blyth et al., 2011; ASRM, 2013a; Benward, 2015; Braverman, 2015). With regard to the informed consent of recipients, the literature emphasizes the importance of providing information about possible risks, and the expected effectiveness of the treatment to ensure an autonomous decision of recipients when starting treatment (Mahlstedt and Greenfeld, 1989; Reame, 1999, 2000; van den Akker, 2006; de Melo-Martin and Cholst, 2008; Benward, 2015; van Hoof et al., 2015). Some authors also argue that for recipients to sufficiently understand the implications of treatment with donor oocytes, it is important to inform them about the process of oocyte retrieval and cryopreservation of the donor oocytes (de Melo-Martin and Cholst, 2008; van Hoof et al., 2015). The literature shows that due to the involvement of a third person, ART with donor oocytes asks for more thorough counselling of the recipient(s), in comparison with more general ART, such as IVF (Söderström-Anttila et al., 2001; van den Akker, 2006; ASRM, 2013b). It is proposed that recipients should be extensively counselled on the psychological impact of third-party ART, and the possible short- and long-term influences for parenting (i.e. how to deal with the issue of disclosure, as discussed above) (Söderström-Anttila et al., 2001; ASRM, 2013b). The literature seems to suggest that counselling recipients is even more important—and most difficult—when treatment was refused or unsuccessful (de Melo-Martin and Cholst, 2008; Zweifel, 2015). Also, some articles articulate that counselling should be sensitive to recipients’ different religious and cultural beliefs regarding third-party ART (Eisenberg and Schenker, 1997; Schenker, 2005, 2013; Wolowelsky and Grazi, 2014). Discussion Based on a broad systematic review of the literature, we identified the ethical aspects arising in establishing and maintaining oocyte banks for third-party ART. The main ethical aspects are related to the intake of donor oocytes, which consider the interests of the donor as well as the future child. Ethical aspects related to the welfare of the donor are the medical and psychosocial risks of donation, motivation and reasonable compensation in donor recruitment, and requirements for informed consent. Ethical aspects related to the child are 2-fold: first, the reasonable welfare standard and donor selection, and second, anonymity and disclosure. We identified few ethical aspects with regard to the storage of donor oocytes for third-party ART in the literature. Therefore, we complemented our search with literature on oocyte banking for research purposes and biobanking. The main ethical aspects of storing donor oocytes are the quality standards and confidentiality, issues of ownership and control, and the international transport of donor oocytes. Identified ethical aspects of the distribution of donor oocytes concern the selection and prioritization of recipients, CBRC, matching of recipients and donor oocytes, and requirements for informed consent and counselling of recipients. Our review shows that numerous ethical aspects have to be taken into account when establishing and maintaining an oocyte bank. Yet, what is considered the correct approach towards many of these ethical aspects is a matter of debate. The first ethically sensitive components of oocyte banking, namely, the intake of donor oocytes, is still generally recognized. Nonetheless, we identified a gap in the existing literature with regard to the second and third component of oocyte banking, namely the long-term storage and distribution of donor oocytes. An important observation of our review is that both donors and recipients are subjected to high standards. For example, the discussion concerning the desirability of improved genetic screening of oocyte donors demonstrates the practice’s tendency to tip the scale from the reasonable welfare standard in favour of the maximum welfare standard. Another illustration of this tendency is the observation that a measure of maximization of the child’s wellbeing is already considered when selecting recipients. This is exemplified in the debate addressing the access to ART with donor oocytes for non-traditional families, and postmenopausal women in particular. While indeed physicians in reproductive medicine have a responsibility to protect the future child from serious harm, the tendency to idealize the circumstances of conception is ethically questionable because it might jeopardise fair access. Besides, it could be that choices in donor and recipient selection are inexplicitly grounded in moral judgements about who is considered an ‘appropriate donor’ as well as an ‘appropriate parent’. To establish ethically responsible and fair criteria for donor and recipient selection, critical evaluation of these assumptions is warranted. A second important observation of our review is that the involvement of the oocyte donor seems to stop after she has successfully donated her oocytes (i.e. except for non-anonymous donors’ responsibilities towards the donor child). For instance, while an oocyte donor is subordinated to the clinics’ high standards, she has little say with regard to which recipient might receive her donated oocytes. Similarly, recipients endure an exhaustive selection process, but are hardly involved in the process of selecting donors (except at commercial oocyte banks). However, in the literature regarding biobanking the interests of the tissue donors after their donation is increasingly underlined. Questions about how donors can be treated as interested stakeholders by means of facilitating increased control over their donated tissue are being asked more often. Furthermore, so called ‘benefit sharing’, including sharing of information, providing financial benefits, and other measures that recognize the contributions of donors, are progressively proposed or implemented (Rothstein, 2005; O’Doherty et al., 2011). Hence, we should evaluate whether the current model of (little to no) involvement of oocyte donors and recipients in oocyte banking for third-party ART is still desirable nowadays, or whether we should re-invent existing measures of recognition, input and control of both the oocyte donors and donor oocyte recipients. Thirdly, our review of the literature demonstrates that the distribution component of oocyte banking, and the prioritization of recipients in case of scarcity in particular, receives little attention. An ethical analysis is necessary to examine to what extent substantial criteria can be formed or whether the pluralistic views as identified in our review allow only for a procedural prioritization. Since the scarcity of donor oocytes will probably not be resolved in the near future, discussion about what is considered a fair manner of distributing donor oocytes amongst recipients can no longer wait. We believe our findings serve as an important starting point for different stakeholders in the field of ART to conceptualize what challenges could potentially arise when establishing and maintaining oocyte banks for third-party ART. Finally, our review demonstrates that the intake and distribution of donor oocytes are closely related components of oocyte banking. Policy makers and oocyte bank managers should be aware that choices made to assure the ethical intake of donor oocytes ultimately influence the practice of distribution, and vice versa. This interaction, accompanied by the continuing discussion about the right approach towards the ethical aspects of oocyte banking, requires a trustworthy and adaptive governance structure that involves all parties of interest (O’Doherty et al., 2011). A first step would be to investigate the moral considerations and attitudes of different stakeholders of oocyte banks on how, according to them, the intake, storage and distribution of bank donor oocytes should be organized. Limitations To the best of our knowledge, this review is the first to put forward a comprehensive examination of the ethical aspects of oocyte banking for third-party ART, as provided by the literature. Our overview of the ethics of oocyte banking is limited in the sense that we did not include ethical aspects regarding the desirability of oocyte donation. Second, because we looked for articles with a thorough discussion of ethical aspects of oocyte banking for third-party ART, we chose to exclude a large number of articles if ethical aspects were not mentioned in title and abstract. As such, it is possible that we might have excluded relevant articles. Nonetheless, the goal of this review was to provide a comprehensive overview of the ethical aspects of oocyte banking, not of all the relevant literature (McDougall, 2013). Third, since a limited number of articles in our search addressed the issue of long-term storage, we ‘borrowed’ the ethical aspects mentioned in the literature on oocyte banking for research purposes and biobanking. Although, both oocyte and biobanks engage in the intake, storage, and distribution of biomaterials, our choice for this analogy can be contested. A fundamental difference between both practices is the aim of the practice. While biobanks collect biomaterials for research purposes, the banking of donor oocytes is aimed at fertility treatment and the creation of a child. The practice of oocyte banking thus has an additional responsibility towards recipient parents and the children resulting from treatment. Lastly, oocyte donation regulations vary across countries, which influences the results and conclusions of studies. Therefore, awareness of the country of origin of included articles is of great importance when interpreting our results (Tables II–IV). Conclusion The practice of oocyte banking for third-party ART consists of three components: the intake, storage and distribution of donor oocytes, each accompanied by many ethical challenges. The main ethical aspects are related to the wellbeing of the oocyte donors and the future child, while few aspects with regard to responsible storage and fair distribution of donor oocytes are identified. Accordingly, a significant gap in the existing literature should be acknowledged. An important observation is that current procedures of donor and recipient selection, as well as their degrees of involvement in these processes, might need reconsideration. To conclude, the interaction between policy choices concerning the intake and distribution of donor oocytes, and the continuing discussion regarding the right approach to the ethical aspects of oocyte banking, require a trustworthy and adaptive governance structure in which it is vital to involve all different stakeholders. Conflict of interest A.M.E. Bos and B.C.J.M. Fauser are the initiators of the UMC Utrecht oocyte bank in the Netherlands. The authors have no further relevant financial, personal or professional competing interests to declare in relation to this research. Acknowledgements We would like to thank M. Onrust for her contribution to the data collection and analysis of this review. Authors’ roles E.M.K. was responsible for the original article design, data collection and analysis, drafting and revision for important intellectual content. A.M.E.B., R.V.D.G., B.C.J.M.F. and A.L.B. were responsible for the concept and design, providing important intellectual input, critically reviewing the drafts and final approval of the article. A.L.B. is professor of Ethics in Biomedical Innovation at the University Medical Centre of Utrecht, and the guarantor for this article. She accepts full responsibility for the work and the conduct of the study. Her involvement was critical to every phase of this work and she controlled the decision to publish. Funding Funding was provided by the Dutch Organization for Health Research and Development (ZonMw) (Grant number 70-73000-98-200). References Abdalla H , Studd JW . Egg donation and medical ethics . Br Med J 1989 ; 299 : 120 . Google Scholar CrossRef Search ADS Ahuja KK , Simons EG . Cancer of the colon in an egg donor: policy repercussions for donor recruitment . Hum Reprod 1998 ; 13 : 227 – 231 . Google Scholar CrossRef Search ADS PubMed Ahuja KK , Simons EG , Edwards RG . 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Ethics of oocyte banking for third-party assisted reproduction: a systematic review