In many countries, PGD is permitted under very stringent conditions for medical use only, as is the case in  France ,  Switzerland ,  Italy  and the  United Kingdom . [ 16 ] [ 17 ]  Whilst PGD in Italy and Switzerland is only permitted under certain circumstances, there is no clear set of specifications under which PGD can be carried out, and selection of embryos based on sex is not permitted. In France and the UK, regulations are much more detailed, with dedicated agencies setting out framework for PGD. [ 18 ] [ 19 ]  Selection based on sex is permitted under certain circumstances, and genetic disorders for which PGD is permitted are detailed by the countries' respective agencies.


In contrast, the  United States  federal law does not regulate PGD, with no dedicated agencies specifying regulatory framework by which healthcare professionals must abide. [ 16 ]  Elective sex selection is permitted, accounting for around 9% of all PGD cases in the U.S., as is selection for desired conditions such as  deafness  or  dwarfism . [ 20 ]


Based on the specific analysis conducted:


PGT-M (Preimplantation Genetic Testing for monogenic diseases) : It is used to detect hereditary diseases caused by the  mutation  or alteration of the DNA sequence of a single gene. [ 21 ]


PGT-A (Preimplantation Genetic Testing for aneuploidy) : It is used to diagnose numerical abnormalities ( aneuploidies ). [ 22 ]


Human germline engineering is a process in which the human genome is edited within a  germ cell , such as a sperm cell or oocyte (causing heritable changes), or in the  zygote  or embryo following fertilization. [ 23 ]  Germline engineering results in changes in the genome being incorporated into every cell in the body of the offspring (or of the individual following embryonic germline engineering). This process differs from  somatic cell  engineering, which does not result in heritable changes. Most human germline editing is performed on individual cells and non-viable embryos, which are destroyed at a very early stage of development. In November 2018, however, a Chinese scientist,  He Jiankui , announced that he had created the first human germline genetically edited babies. [ 24 ]


Genetic engineering relies on a knowledge of human genetic information, made possible by research such as the  Human Genome Project , which identified the position and function of all the genes in the human genome. [ 25 ]  As of 2019,  high-throughput sequencing  methods allow  genome sequencing  to be conducted very rapidly, making the technology widely available to researchers. [ 26 ]


Germline modification is typically accomplished through techniques which incorporate a new gene into the genome of the embryo or germ cell in a specific location. This can be achieved by introducing the desired DNA directly to the cell for it to be incorporated, or by replacing a gene with one of interest. These techniques can also be used to remove or disrupt unwanted genes, such as ones containing mutated sequences.


Whilst germline engineering has mostly been performed in  mammals  and other animals, research on human cells  in vitro  is becoming more common. Most commonly used in human cells are  germline gene therapy  and the engineered nuclease system  CRISPR/Cas9 .


Gene therapy  is the delivery of a  nucleic acid  (usually DNA or  RNA ) into a cell as a pharmaceutical agent to treat disease. [ 27 ]  Most commonly it is carried out using a  vector , which transports the nucleic acid (usually DNA encoding a therapeutic gene) into the target cell. A vector can  transduce  a desired copy of a gene into a specific location to be  expressed  as required. Alternatively, a  transgene  can be inserted to deliberately disrupt an unwanted or mutated gene, preventing  transcription  and  translation  of the faulty gene products to avoid a disease  phenotype .


Gene therapy in patients is typically carried out on somatic cells in order to treat conditions such as some  leukaemias  and  vascular diseases . [ 28 ] [ 29 ] [ 30 ]
Human germline gene therapy in contrast is restricted to  in vitro  experiments in some countries, whilst others prohibited it entirely, including  Australia ,  Canada ,  Germany  and Switzerland. [ 31 ]


Whilst the  National Institutes of Health  in the US does not currently allow  in utero  germline gene transfer clinical trials,  in vitro  trials are permitted. [ 32 ]  The NIH guidelines state that further studies are required regarding the safety of gene transfer protocols before  in utero  research is considered, requiring current studies to provide demonstrable efficacy of the techniques in the laboratory. [ 33 ]  Research of this sort is currently using non-viable embryos to investigate the efficacy of germline gene therapy in treatment of disorders such as inherited  mitochondrial diseases . [ 34 ]


Gene transfer to cells is usually by vector delivery. Vectors are typically divided into two classes –  viral  and  non-viral .


Viruses  infect cells by transducing their genetic material into a host's cell, using the host's cellular machinery to generate viral proteins needed for replication and proliferation. By modifying viruses and loading them with the therapeutic DNA or RNA of interest, it is possible to use these as a vector to provide delivery of the desired gene into the cell. [ 35 ]


Retroviruses  are some of the most commonly used viral vectors, as they not only introduce their genetic material into the host cell, but also copy it into the host's genome. In the context of gene therapy, this allows permanent integration of the gene of interest into the patient's own DNA, providing longer lasting effects. [ 36 ]


Viral vectors work efficiently and are mostly safe but present with some complications, contributing to the stringency of regulation on gene therapy. Despite partial inactivation of viral vectors in gene therapy research, they can still be  immunogenic  and elicit an  immune response . This can impede viral delivery of the gene of interest, as well as cause complications for the patient themselves when used clinically, especially in those who already have a serious genetic illness. [ 37 ]  Another difficulty is the possibility that some viruses will randomly integrate their nucleic acids into the genome, which can interrupt gene function and generate new mutations. [ 38 ]
This is a significant concern when considering germline gene therapy, due to the potential to generate new mutations in the embryo or offspring.


Non-viral methods of nucleic acid  transfection  involved injecting a naked DNA  plasmid  into cell for incorporation into the genome. [ 39 ]  This method used to be relatively ineffective with low frequency of integration, however, efficiency has since greatly improved, using methods to enhance the delivery of the gene of interest into cells. Furthermore, non-viral vectors are simple to produce on a large scale and are not highly immunogenic.


Some non-viral methods are detailed below:


Zinc-finger nucleases  (ZFNs) are enzymes generated by fusing a zinc finger DNA-binding domain to a DNA-cleavage domain. Zinc finger recognizes between 9 and 18 bases of sequence. Thus by mixing those modules, it becomes easier to target any sequence researchers wish to alter ideally within complex genomes. A ZFN is a  macromolecular  complex formed by monomers in which each subunit contains a zinc domain and a  FokI endonuclease domain.  The FokI domains must dimerize for activities, thus narrowing target area by ensuring that two close DNA-binding events occurs. [ 44 ]


The resulting cleavage event enables most genome-editing technologies to work. After a break is created, the cell seeks to repair it.


The success of using ZFNs in gene therapy depends on the insertion of genes to the chromosomal target area without causing damage to the cell. Custom ZFNs offer an option in human cells for gene correction.


There is a method called  TALENs  that targets singular nucleotides. TALENs stand for transcription activator-like effector nucleases. TALENs are made by  TAL effector DNA-binding domain  to a DNA cleavage domain. All these methods work by as the TALENs are arranged. TALENs are "built from arrays of 33-35 amino acid modules…by assembling those arrays…researchers can target any sequence they like". [ 44 ]  This event is referred as Repeat Variable Diresidue (RVD). The relationship between the amino acids enables researchers to engineer a specific DNA domain. The TALEN enzymes are designed to remove specific parts of the DNA strands and replace the section; which enables edits to be made. TALENs can be used to edit genomes using  non-homologous end joining  (NHEJ) and  homology directed repair .


The CRISPR/Cas9 system ( CRISPR  – Clustered Regularly Interspaced Short Palindromic Repeats,  Cas9  – CRISPR-associated protein 9) is a genome editing technology based on the  bacterial  antiviral CRISPR/Cas system. The bacterial system has evolved to recognize viral nucleic acid sequences and cut these sequences upon recognition, damaging infecting viruses. The gene editing technology uses a simplified version of this process, manipulating the components of the bacterial system to allow location-specific gene editing. [ 45 ]


The CRISPR/Cas9 system broadly consists of two major components – the Cas9  nuclease  and a  guide RNA  (gRNA). The gRNA contains a Cas-binding sequence and a ~20  nucleotide  spacer sequence, which is specific and complementary to the target sequence on the DNA of interest. Editing specificity can therefore be changed by modifying this spacer sequence. [ 45 ]


Upon system delivery to a cell, Cas9 and the gRNA bind, forming a  ribonucleoprotein  complex. This causes a  conformational change  in Cas9, allowing it to cleave DNA if the gRNA spacer sequence binds with sufficient  homology  to a particular sequence in the host genome. [ 46 ]  When the gRNA binds to the target sequence, Cas will cleave the  locus , causing a  double-strand break  (DSB).


The resulting DSB can be  repaired  by one of two mechanisms –


Since NHEJ is more efficient than HDR, most DSBs will be repaired  via  NHEJ, introducing gene knockouts. To increase frequency of HDR, inhibiting genes associated with NHEJ and performing the process in particular  cell cycle  phases (primarily  S  and  G2 ) appear effective.


CRISPR/Cas9 is an effective way of manipulating the genome  in vivo  in animals as well as in human cells  in vitro , but some issues with the efficiency of delivery and editing mean that it is not considered safe for use in viable human embryos or the body's germ cells. As well as the higher efficiency of NHEJ making inadvertent knockouts likely, CRISPR can introduce DSBs to unintended parts of the genome, called off-target effects. [ 47 ]  These arise due to the spacer sequence of the gRNA conferring sufficient sequence homology to random loci in the  genome , which can introduce random mutations throughout. If performed in germline cells, mutations could be introduced to all the cells of a developing embryo.


There are developments to prevent unintended consequences otherwise known as off-target effects due to gene editing. [ 48 ]  There is a race to develop new gene editing technologies that prevent off-target effects from occurring with some of the technologies being known as biased off-target detection, and Anti-CRISPR Proteins. [ 48 ]  For biased off-target effects detection, there are several tools to predict the locations where off-target effects may take place. [ 48 ]  Within the technology of biased off-target effects detection, there are two main models, Alignment Based Models that involve having the sequences of gRNA being aligned with sequences of genome, after which then the off-target locations are predicted. [ 48 ]  The second model is known as the Scoring-Based Model where each piece of gRNA is scored for their off-target effects in accordance with their positioning. [ 48 ]


In 2015, the International Summit on Human Gene Editing was held in  Washington D.C. , hosted by scientists from China, the UK and the U.S. The summit concluded that genome editing of somatic cells using CRISPR and other genome editing tools would be allowed to proceed under  FDA  regulations, but human germline engineering would not be pursued. [ 32 ]


In February 2016, scientists at the  Francis Crick Institute  in  London  were given a license permitting them to edit human embryos using CRISPR to investigate early development. [ 49 ]  Regulations were imposed to prevent the researchers from implanting the embryos and to ensure experiments were stopped and embryos destroyed after seven days.


In November 2018, Chinese scientist  He Jiankui  announced that he had performed the first germline engineering on viable human embryos, which have since been brought to term. [ 24 ]  The research claims received significant criticism, and Chinese authorities suspended He's research activity. [ 50 ]  Following the event, scientists and government bodies have called for more stringent regulations to be imposed on the use of CRISPR technology in embryos, with some calling for a global  moratorium  on germline genetic engineering. Chinese authorities have announced stricter controls will be imposed, with  Communist Party  general secretary  Xi Jinping  and  government  premier  Li Keqiang  calling for new gene-editing legislations to be introduced. [ 51 ] [ 52 ]


As of January 2020, germline genetic alterations are prohibited in 24 countries by law and also in 9 other countries by their guidelines. [ 53 ]  The  Council of Europe 's Convention on Human Rights and Biomedicine, also known as the Oviedo Convention, has stated in its article 13 "Interventions on the human genome" as follows: "An intervention seeking to modify the human genome may only be undertaken for preventive, diagnostic or therapeutic purposes and only if its aim is not to introduce any modification in the genome of any descendants". [ 54 ] [ 55 ]  Nonetheless, wide public debate has emerged, targeting the fact that the Oviedo Convention Article 13 should be revisited and renewed, especially due to the fact that it was constructed in 1997 and may be out of date, given recent technological advancements in the field of genetic engineering. [ 56 ]


The Lulu and Nana controversy refers to the two Chinese twin girls born in November 2018, who had been genetically modified as embryos by the Chinese scientist He Jiankui. [ 24 ]  The twins are believed to be the first genetically modified babies. The girls' parents had participated in a clinical project run by He, which involved IVF, PGD and genome editing procedures in an attempt to edit the gene  CCR5 . CCR5 encodes a protein used by  HIV  to enter host cells, so by introducing a specific mutation into the gene  CCR5 Δ32  He claimed that the process would confer  innate resistance to HIV . [ 57 ] [ 58 ]


The project run by He recruited couples wanting children where the man was  HIV-positive  and the woman uninfected. During the project, He performed IVF with sperm and eggs from the couples and then introduced the CCR5 Δ32 mutation into the genomes of the embryos using CRISPR/Cas9. He then used PGD on the edited embryos during which he sequenced biopsied cells to identify whether the mutation had been successfully introduced. He reported some  mosaicism  in the embryos, whereby the mutation had integrated into some cells but not all, suggesting the offspring would not be entirely protected against HIV. [ 59 ]  He claimed that during the PGD and throughout the pregnancy,  fetal DNA  was sequenced to check for off-target errors introduced by the CRISPR/Cas9 technology, however the NIH released a statement in which they announced "the possibility of damaging off-target effects has not been satisfactorily explored". [ 60 ] [ 61 ]  The girls were born in early November 2018, and were reported by He to be healthy. [ 59 ]


His research was conducted in secret until November 2018, when documents were posted on the Chinese clinical trials registry and  MIT Technology Review  published a story about the project. [ 62 ]  Following this, He was interviewed by the  Associated Press  and presented his work on 27 November at the Second International Human Genome Editing Summit which was held in  Hong Kong . [ 57 ]


Although the information available about this experiment is relatively limited, it is deemed that the scientist erred against many ethical, social and moral rules but also China's guidelines and regulations, which prohibited germ-line genetic modifications in human embryos, while conducting this trial. [ 63 ] [ 64 ]  From a technological point of view, the CRISPR/Cas9 technique is one of the most precise and least expensive methods of gene modification to this day, whereas there are still a number of limitations that keep the technique from being labelled as safe and efficient. [ 64 ]  During the First International Summit on Human Gene Editing in 2015 the participants agreed that a halt must be set on germline genetic alterations in clinical settings unless and until: "(1) the relevant safety and efficacy issues have been resolved, based on appropriate understanding and balancing of risks, potential benefits, and alternatives, and (2) there is broad societal consensus about the appropriateness of the proposed application". [ 64 ]  However, during the second International Summit in 2018 the topic was once again brought up by stating: "Progress over the last three years and the discussions at the current summit, however, suggest that it is time to define a rigorous, responsible translational pathway toward such trials". [ 64 ]  Inciting that the ethical and legal aspects should indeed be revisited G. Daley, representative of the summit's management and Dean of Harvard Medical School depicted Dr. He's experiment as "a wrong turn on the right path". [ 64 ]


The experiment was met with widespread criticism and was very controversial, globally as well as in China. [ 65 ] [ 66 ]  Several  bioethicists , researchers and medical professionals have released statements condemning the research, including  Nobel laureate   David Baltimore  who deemed the work "irresponsible" and one pioneer of the CRISPR/Cas9 technology, biochemist  Jennifer Doudna  at  University of California, Berkeley . [ 60 ] [ 67 ]  The director of the NIH,  Francis S. Collins  stated that the "medical necessity for inactivation of CCR5 in these infants is utterly unconvincing" and condemned He Jiankui and his research team for 'irresponsible work'. [ 61 ]  Other scientists, including  geneticist   George Church  of  Harvard University  suggested gene editing for disease resistance was "justifiable" but expressed reservations regarding the conduct of He's work. [ 68 ]


The Safe Genes program by DARPA has the goal to protect soldiers against gene editing war tactics. [ 69 ]  They receive information from ethical experts to better predict and understand future and current potential gene editing issues. [ 69 ] [ non-primary source needed ]


The  World Health Organization  has launched a global registry to track research on human genome editing, after a call to halt all work on genome editing. [ 70 ] [ 71 ] [ 72 ]


The  Chinese Academy of Medical Sciences  responded to the controversy in the journal  Lancet , condemning He for violating ethical guidelines documented by the government and emphasising that germline engineering should not be performed for reproductive purposes. [ 73 ]  The academy ensured they would "issue further operational, technical and ethical guidelines as soon as possible" to impose tighter regulation on human embryo editing.


Editing embryos, germ cells and the generation of designer babies is the subject of ethical debate, as a result of the implications in modifying genomic information in a heritable manner. This includes arguments over unbalanced gender selection and gamete selection. [ 74 ]


Despite regulations set by individual countries' governing bodies, the absence of a standardized regulatory framework leads to frequent discourse in discussion of germline engineering among scientists, ethicists and the general public.  Arthur Caplan , the head of the Division of Bioethics at  New York University  suggests that establishing an international group to set guidelines for the topic would greatly benefit global discussion and proposes instating "religious and ethics and legal leaders" to impose well-informed regulations. [ 75 ]


In many countries, editing embryos and germline modification for reproductive use is illegal. [ 76 ]   As of 2017, the U.S. restricts the use of germline modification and the procedure is under heavy regulation by the FDA and NIH. [ 76 ]   The American  National Academy of Sciences  and  National Academy of Medicine  indicated they would provide qualified support for human germline editing "for serious conditions under stringent oversight", should safety and efficiency issues be addressed. [ 77 ]   In 2019, World Health Organization called human germline genome editing as "irresponsible". [ 78 ]


Since genetic modification poses risk to any  organism , researchers and medical professionals must give the prospect of germline engineering careful consideration. The main ethical concern is that these types of treatments will produce a change that can be passed down to future generations and therefore any error, known or unknown, will also be passed down and will affect the offspring. [ 79 ]   Theologian  Ronald Green  of  Dartmouth College  has raised concern that this could result in a decrease in  genetic diversity  and the accidental introduction of new diseases in the future. [ 80 ]


When considering support for research into germline engineering, ethicists have often suggested that it can be considered unethical not to consider a technology that could improve the lives of children who would be born with  congenital disorders . Geneticist George Church claims that he does not expect germline engineering to increase societal disadvantage, and recommends lowering costs and improving education surrounding the topic to dispel these views. [ 8 ]  He emphasizes that allowing germline engineering in children who would otherwise be born with congenital defects could save around 5% of babies from living with potentially avoidable diseases. Jackie Leach Scully, professor of social and  bioethics  at  Newcastle University , acknowledges that the prospect of designer babies could leave those living with diseases and unable to afford the technology feeling marginalized and without medical support. [ 8 ]  However, Professor Leach Scully also suggests that germline editing provides the option for parents "to try and secure what they think is the best start in life" and does not believe it should be ruled out. Similarly,  Nick Bostrom , an  Oxford   philosopher  known for his work on the risks of  artificial intelligence , proposed that "super-enhanced" individuals could "change the world through their creativity and discoveries, and through innovations that everyone else would use". [ 81 ]


Many bioethicists emphasize that germline engineering is usually considered in the best interest of a child, therefore associated should be supported.  Dr James Hughes , a bioethicist at  Trinity College, Connecticut , suggests that the decision may not differ greatly from others made by parents which are well accepted – choosing with whom to have a child and using contraception to denote when a child is conceived. [ 82 ]   Julian Savulescu , a bioethicist and philosopher at Oxford University believes parents "should allow selection for non‐disease genes even if this maintains or increases social inequality", coining the term  procreative beneficence  to describe the idea that the children "expected to have the best life" should be selected. [ 83 ]  The  Nuffield Council on Bioethics  said in 2017 that there was "no reason to rule out" changing the DNA of a human embryo if performed in the child's interest, but stressed that this was only provided that it did not contribute to societal inequality. [ 8 ]  Furthermore, Nuffield Council in 2018 detailed applications, which would preserve equality and benefit humanity, such as elimination of hereditary disorders and adjusting to warmer climate. [ 84 ]  Philosopher and Director of Bioethics at non-profit Invincible Wellbeing  David Pearce [ 85 ]  argues that "the question [of designer babies] comes down to an analysis of risk-reward ratios - and our basic ethical values, themselves shaped by our evolutionary past." According to Pearce,"it's worth recalling that each act of old-fashioned sexual reproduction is itself an untested genetic experiment", often compromising a child's wellbeing and pro-social capacities even if the child grows in a healthy environment. [ 86 ]  Pearce thinks that as technology matures, more people may find it unacceptable to rely on "genetic roulette of natural selection". [ 87 ]


Conversely, several concerns have been raised regarding the possibility of generating designer babies, especially concerning the inefficiencies currently presented by the technologies. Green stated that although the technology was "unavoidably in our future", he foresaw "serious errors and health problems as unknown genetic side effects in 'edited' children" arise. [ 88 ]  Furthermore, Green warned against the possibility that "the well-to-do" could more easily access the technologies "..that make them even better off". This concern regarding germline editing exacerbating a societal and financial divide is shared amongst other researches, with the chair of the Nuffield Bioethics Council Professor Karen Yeung stressing that if funding of the procedures "were to exacerbate social injustice, in our view that would not be an ethical approach". [ 8 ]


Social and religious worries also arise over the possibility of editing human embryos. In a survey conducted by the  Pew Research Centre , it was found that only a third of the Americans surveyed who identified as strongly  Christian  approved of germline editing. [ 89 ]  Catholic leaders are in the middle ground. This stance is because, according to  Catholicism, a baby is a gift from God, and Catholics believe that people are created to be perfect in God's eyes. Thus, altering the genetic makeup of an infant is unnatural. In 1984, Pope John Paul II addressed that genetic manipulation in aiming to heal diseases is acceptable in the Church. He stated that it "will be considered in principle as desirable provided that it tends to the real promotion of the personal well-being of man, without harming his integrity or worsening his life conditions". [ 90 ]  However, it is unacceptable if designer babies are used to create a super/superior race including cloning humans. The Catholic Church rejects human cloning even if its purpose is to produce organs for therapeutic usage. The Vatican has stated that "The fundamental values connected with the techniques of artificial human procreation are two: the life of the human being called into existence and the special nature of the transmission of human life in marriage". [ 91 ]  According to them, it violates the dignity of the individual and is morally illicit.


A survey conducted by the Mayo Clinic in the Midwestern United States in 2017 saw that most of the participants agreed against the creation of designer babies with some noting its eugenic undertones. [ 92 ]  The participants also felt that gene editing may have unintended consequences that it may be manifested later in life for those that undergo gene editing. [ 92 ]  Some that took the survey worried that gene editing may lead to a decrease in the genetic diversity of the population in societies. [ 92 ]  The survey also noted how the participants were worried about the potential socioeconomic effects designer babies may exacerbate. [ 92 ]  The authors of the survey noted that the results of the survey showed that there is a greater need for interaction between the public and the scientific community concerning the possible implications and the recommended regulation of gene editing as it was unclear to them how much those that participated knew about gene editing and its effects prior to taking the survey. [ 92 ]


In Islam, the positive attitude towards genetic engineering is based on the general principle that Islam aims at facilitating human life. However, the negative view comes from the process used to create a designer baby. Oftentimes, it involves the destruction of some embryos. Muslims believe that "embryos already has a soul" at conception. [ 93 ]  Thus, the destruction of embryos is against the teaching of the Qur'an, Hadith, and Shari'ah law, that teaches our responsibility to protect human life. To clarify, the procedure would be viewed as "acting like God/Allah".  With the idea, that parents could choose the gender of their child, Islam believes that humans have no decision to choose the gender, and that "gender selection is only up to God". [ 94 ] [ contradictory ]


Since 2020, there have been discussions about American studies that use embryos without embryonic implantation with the CRISPR/Cas9 technique that had been modified with HDR (homology-directed repair), and the conclusions from the results were that gene editing technologies are currently not mature enough for real world use and that there is a need for more studies that generate safe results over a longer period of time. [ 95 ]


An article in the journal  Bioscience Reports  discussed how health in terms of genetics is not straightforward and thus there should be extensive deliberation for operations involving gene editing when the technology gets mature enough for real world use, where all of the potential effects are known on a case-by-case basis to prevent undesired effects on the subject or patient being operated on. [ 96 ]


Social aspects also raise concern, as highlighted by Josephine Quintavelle, director of  Comment on Reproductive Ethics  at  Queen Mary University of London , who states that selecting children's traits is "turning parenthood into an unhealthy model of self-gratification rather than a relationship". [ 97 ]


One major worry among scientists, including  Marcy Darnovsky  at the  Center for Genetics and Society  in  California , is that permitting germline engineering for correction of disease phenotypes is likely to lead to its use for cosmetic purposes and enhancement. [ 8 ]  Meanwhile,  Henry Greely , a bioethicist at  Stanford University  in California, states that "almost everything you can accomplish by gene editing, you can accomplish by embryo selection", suggesting the risks undertaken by germline engineering may not be necessary. [ 88 ]  Alongside this, Greely emphasizes that the beliefs that genetic engineering will lead to enhancement are unfounded, and that claims that we will enhance intelligence and personality are far off – "we just don't know enough and are unlikely to for a long time – or maybe for ever".


Digyny  (also  digynia ) refers to the process of a  diploid   ovum  becoming fertilized by a  haploid   sperm . The result of digyny is a  triploid   zygote . In humans, both  gametes  (ovum and sperm) are normally haploid and give rise to a diploid zygote. [ 1 ]


Digyny results in  gestational  abnormalities in humans, including an abnormally small  placenta  and a very growth-restricted fetus. As a result, the majority of triploid pregnancies are  spontaneously aborted . The  incidence rate  of a live-born triploid human is approximately 1 in 50,000.


This  developmental biology  article is a  stub . You can help Wikipedia by  expanding it .


Hormonal regulation occurs at every stage of  development . A milieu of hormones simultaneously affects development of the  fetus  during  embryogenesis  and the mother, including  human chorionic gonadotropin  (hCG) and  progesterone  (P4).


Human chorionic gonadotropin  (hCG),  progesterone ,  17β-estradiol ,  endorphins  and  gonadotropin-releasing hormone  (GnRH) synthesis are rapidly upregulated by the developing embryo following fertilization of the ovum. [ 1 ] [ 2 ] [ 3 ]


During early embryonic development,  paracrine / juxtacrine  signaling of hCG induces  blastulation  and  neurulation .  An in vitro model of early human embryogenesis ( human embryonic stem cells  (hESCs)) has demonstrated that hCG promotes cell proliferation via the LH/hCG receptor (LHCGR).  hCG signaling upregulates the expression of  steroidogenic acute regulatory protein  (StAR)-mediated cholesterol transport and the synthesis of progesterone in hESC.  The production of progesterone at this time induces embryroid body (akin to blastulation) and rosette (akin to neurulation) formation in vitro. Progesterone induces the differentiation of  pluripotent  hESC to neural precursor cells. [ 4 ] [ 5 ]


Suppression of P4 signaling following withdrawal of progesterone, or treatment with the progesterone receptor antagonist RU-486 ( mifepristone ), inhibits the differentiation of hESC colonies into embryoid bodies ( blastulation ) or  rosettes  ( neurulation ).  RU-486, a drug commonly used to terminate pregnancy in its early stages, acts not only to abort the embryo, but also to inhibit normal embryonic development. [ 4 ] [ 5 ]


Pregnancy -associated  hormones  such as hCG and sex steroids regulate numerous biological processes in the maternal system prior to and during pregnancy. The embryo orchestrates biological changes that occur in both the embryo and the mother.  The embryo upregulates hCG, drives growth of the cell, and upregulates P4 production driving development. hCG and P4 direct changes in the mother to enable successful pregnancy (see below) via upregulation of specific hormones that act to direct both endocrinological and biological changes within the mother for successful pregnancy. [ citation needed ]


The early embryo has 1–2 weeks in order to produce sufficient hCG in order to stabilize the endometrial lining to allow for blastocyst attachment.  The dramatic increase in trophoblastic and corpus luteal hCG synthesis signals both blastocyst  [ 5 ]  and corpus luteal  [ 6 ]  production of P4, crucial for the maintenance of the  endometrium .


hCG secreted by cytotrophoblastic cells of the blastocyst controls endometrial tissue remodeling by both activation of matrix matalloproteinases (MMPs) that control the maternal extracellular matrix and inhibition of tissue-inhibitors of matrix-metalloproteinases (TIMP). hCG mediates invasion and attachment to the endometrium. [ 7 ]  Low levels of hCG increase risk of  pre-eclampsia . [ 8 ]


Uterine  angiogenesis  is upregulated by human chorionic gonadotropin and progesterone and downregulated by estrogen.  The balance of influences of progesterone and estrogen determine the state of angiogenesis in the uterus during early pregnancy. [ 9 ] [ 10 ]


High levels of progesterone produced by the embryonic  placenta  regulate  lymphocyte  proliferation at the maternal-fetal interface, locally suppressing maternal  immune response  against the developing embryo. [ 11 ]


Negative feedback of progesterone inhibits hypothalamic pulsatile GnRH neurosecretion, ovulatory GnRH release and pituitary gonadotropin surges thereby effectively preventing further follicular maturation. [ 12 ] [ 13 ] [ 14 ]


Progesterone regulates metabolism of  carbohydrates ,  proteins , and  lipids , resulting in physiological changes associated with pregnancy. The mix of hormones characteristic of early pregnancy promote natural growth of maternal tissues and weight gain. [ 15 ]  In the second half of pregnancy, progesterone and prolactin prepare the mammary glands for lactation. [ 16 ]


Estrogens and progesterone promote mammary epithelial cell proliferation resulting in the formation of the primary and secondary ductal structure.  Progesterone induces formation of tertiary side-branches in the mammary glands during puberty and during the luteal phase of the  menstrual cycle  upon which lobuloalveolar structures form under the influence of  prolactin .  Prolactin stimulates  lactogenesis . [ 16 ] [ 17 ]


hCG appears to be  soporific  during pregnancy; levels of hCG correlate with sleep changes during pregnancy, and administration of hCG increases sleep in rats likely via neuronal LHCGR. [ 18 ]


The  Ericsson method  is an  assisted reproductive technology  for  sex selection , used before  implantation . In this method, sperm that will give rise to male versus female children are separated by moving at different speeds through a protein solution.


When used to increase the likelihood of a female child, studies have resulted in between 70% and 80% female children. [ 1 ] [ 2 ] [ 3 ]


When used to increase the likelihood of a male child, studies have resulted in between 50% [ 2 ]  and 75% male children. [ 3 ]


The Ericsson method is based on the belief that X-sperm swim slower than Y-sperm. Sperm are placed atop a "column" of increasingly thicker layers of albumin, and allowed to swim down into the solution. After a certain time period has elapsed, the sperm can be separated into the faster and slower swimmers. If the couple desires a male baby the faster swimmers are  artificially inseminated , and if the couple desires a female baby the same procedure is enacted with the slower swimmers. [ citation needed ]


This method differs from the  Shettles method , which does not utilize  artificial insemination .


It was developed and patented by Dr.  Ronald Ericsson . The method has been in use since the mid-1970s.


The below references were taken from 123 published papers. These references represent the initial scientific research, the concepts behind altering the sex ratio, the clinical results and the social and demographic history of people who elect to use this technology for a wanted sex selected child.


Fecundity  is defined in two ways; in  human demography , it is the potential for reproduction of a recorded  population  as opposed to a sole  organism , while in  population biology , it is considered similar to   fertility , [ 1 ] [ 2 ] [ 3 ]  the natural capability to produce offspring, [ 4 ]  measured by the number of  gametes  (eggs), seed set, or asexual propagules.


Human demography considers only human fecundity, at its culturally differing rates, while population  biology  studies all  organisms . The term  fecundity  in population biology is often used to describe the rate of offspring production after one time step (often annual). In this sense, fecundity may include both  birth rates  and survival of young to that time step. While levels of fecundity vary geographically, it is generally a consistent feature of each culture.  Fecundation  is another term for  fertilization .


In  obstetrics  and  gynecology , fecund-ability is the probability of being  pregnant  in a single  menstrual cycle , and fecundity is the probability of achieving a live birth within a single cycle. [ 5 ]


In ecology ,  fecundity is a measure of the reproductive capacity of an individual or population, typically restricted to the reproductive individuals. It can be equally applied to sexual and asexual reproduction, as the purpose of fecundity is to measure how many new individuals are being added to a population. [ 6 ]   Fecundity may be defined differently for different ecological studies to explain the specific data the study examined. For example, some studies use apparent fecundity to describe that their data looks at a particular moment in time rather than the species' entire life span. In other studies, these definitions are changed to better quantify fecundity for the organism in question. This need is particularly true for  modular organisms , as their modular organization differs from the more typical unitary organism, in which fecundity is best defined through a count of offspring. [ 7 ]


Parity is the organization of fecundity into two distinct types,  semelparity, and iteroparity.


Semelparity occurs when an organism reproduces only once in its lifetime, with death being a part of its reproductive strategy. These species produce many offspring during their one reproductive event, giving them a potential advantage when it comes to fecundity, as they are producing more offspring.


Iteroparity is when a species reproduces multiple times over its lifetime. This species' strategy is to protect against the unpredictable survivability of their offspring, in which if their first litter of offspring dies, they can reproduce again and replace the dead offspring. It also allows the organism to care for its offspring, as they will be alive during their development. [ 8 ]


There are a multitude of factors that potentially affect the rates of fecundity. For example:  ontogeny ,  population density  and  latitude .


Ontogeny


Fecundity in iteroparous organisms often increases with age but can decline at older ages. Several hypotheses have been proposed to explain this relationship. For species with declining growth rates after maturity, the suggestion is that as the organism's growth rate decreases, more resources can be allocated to reproduction. Other possible explanations exist for this pattern for organisms that do not grow after maturity. These explanations include: increased competence of older individuals; less fit individuals have already died off; or since life expectancy decreases with age, older individuals may allocate more resources to reproduction at the expense of survival. [ 6 ]  In semelparous species, age is frequently a poor predictor of fecundity. In these cases, size is likely a better predictor. [ 9 ]


Population density is often observed to negatively affect fecundity, making fecundity density-dependent. The reasoning behind this observation is that once an area is overcrowded, fewer resources are available for each individual. Thus there may be insufficient energy to reproduce in high numbers when offspring survival is low. Occasionally high density can stimulate the production of offspring, particularly in plant species, because if there are more plants, there is food to lure pollinators, who will then spread that plant's pollen and allow for more reproduction. [ 6 ]


There are many different hypotheses to explain the relationship between latitude and fecundity. One claimed that fecundity increases predictably with increasing latitude. Reginald Morean proposed this hypothesis, the explanation being that there is higher mortality in seasonal environments. [ citation needed ]


A different hypothesis by David Lack attributed the positive relationship to the change in daylight hours found with changing latitudes. These differing daylight hours, in turn, change the hours in which a parent can collect food. He also accounts for a drop in fecundity at the poles due to their extreme amounts of day lengths, which can exhaust the parent. [ 10 ]


Fecundity intensity due to seasonality is a hypothesis proposed by Phillip Ashmole. He suggests latitude affects fecundity due to seasonality increasing with increasing latitudes. This theory relies on the mortality concept proposed by Moreau but focuses on how seasonality affects mortality and, in turn, population densities. Thus in places with higher mortality, there is more food availability, leading to higher fecundity. Another hypothesis claims that seasonality affects fecundity due to varying lengths of breeding seasons. This idea suggests that shorter breeding seasons select a larger clutch size to compensate for the reduced reproduction frequency, thus increasing those species' fecundity. [ 10 ]


Fecundity is a significant component of  fitness .  Fecundity selection  builds on that idea. This idea claims that the genetic selection of traits that increase an organism's fecundity is, in turn, advantageous to an organism's fitness. [ 10 ]


Fecundity Schedule


Fecundity Schedules are data tables that display the patterns of birth amongst individuals of different ages in a population. These are typically found in  life tables  under the columns Fx and mx.


Fx lists the total number of young produced by each age class, and mx is the mean number of young produced, found by finding the number of young produced per surviving individual. For example, if you have 12 individuals in an age class and they produced 16 surviving young, the Fx is 16, and the mx is 1.336. [ 9 ]


Infecundity is a term meaning "inability to conceive after several years of exposure to the risk of pregnancy." This usage is prevalent in medicine, especially  reproductive medicine , and in  demographics .  Infecundity  would be synonymous with  infertility , but in demographic and medical use  fertility  (and thus its  antonym   infertility ) may refer to quantity and rates of offspring produced, rather than any physiological or other limitations on reproduction. [ 11 ]


Additionally, social trends and societal norms may influence fecundity, though this influence tends to be temporary. Indeed, it is considered impossible to cease reproduction based on social factors, and fecundity tends to rise after a brief decline.


Fecundity has also been shown to increase in  ungulates  with relation to warmer weather. [ citation needed ]


In sexual  evolutionary biology , especially in sexual selection, fecundity is contrasted to  reproductivity .


Fertility fraud  is the failure on the part of a  fertility doctor  to obtain consent from a patient before inseminating her with his own sperm. This normally occurs in the context of people using  assisted reproductive technology  (ART) to address fertility issues.


The term is also used in cases where donor eggs are used without consent [ 1 ]  and more broadly, in instances where doctors and other medical professionals exploit opportunities that arise when people use assisted reproductive technology to address fertility issues. This may give rise to a number of different  types of fraud  involving insurance, unnecessary procedures, theft of eggs, and other issues related to fertility treatment. [ 2 ]


The main sense of fertility fraud is non-consensual insemination of a patient by her doctor, but there are other types as well. [ 3 ] [ 4 ]


The first " test tube baby " was facilitated by  Robert Edwards  in 1978, and he allegedly used eggs without the consent of the women involved. [ 1 ]


One of the earliest cases involving egg theft occurred in 1987 in Garden Grove, California, in a clinic run by doctor  Ricardo Asch , [ 5 ]  and his partners doctors Sergio Stone and Jose Balmaceda. [ 6 ]  Asch took eggs from women undergoing diagnostic procedures and used them in fertility procedures in other women. [ 5 ]
Asch and his two partners were accused of taking eggs and embryos from patients without their consent, using them to cause pregnancies in other women, and defrauding insurance companies. [ 7 ]  The eggs of at least 20 women were used, [ 8 ]  and at least fifteen live births resulted. [ 9 ]  Thirty-five patients filed legal actions against Asch. [ 7 ]  An estimated 67 women were victims of egg or embryo theft. [ 5 ]  Asch and Balmaceda left the country and avoided trial. Stone faced trial in the case and was sentenced to three years probation for mail fraud. He was fined $50,000 by the judge in the case, required to repay more than $14,000 in restitution to insurance companies, and had to wear an electronic monitoring device. [ 6 ]


In the "Egg Affair" in Israel in 2000, police investigated two doctors who were accused of intentionally creating extra eggs in patients needing fertility procedures, and then without their patients' knowledge harvesting and selling the eggs to other fertility patients. [ 10 ]


In Italy in 2016, famed Italian gynecologist  Severino Antinori , known as the "grandmothers' obstetrician" because of his reputation for helping women over 60 to bear children, was arrested on suspicion of stealing eggs by removing them from a patient's ovaries without her consent under the guise of performing a procedure on her to remove an ovarian cyst. Antinori had recently hired a Spanish nurse at his clinic, and then diagnosed her with an ovarian cyst for the sole purpose of harvesting her eggs without her knowledge. Antinori was arrested at a Rome airport, charged with aggravated robbery and causing personal injury, and placed under house arrest. [ 11 ] [ 12 ]


There have been numerous cases of a healthcare provider fraudulently substituting their own sperm for donor sperm, resulting in pregnancy and birth. [ 4 ]


There are many other types of fertility fraud, and they may take place at various stages of the process: [ 3 ] [ 4 ]


Hundreds of children have been fathered by non-consensual insemination worldwide by their physicians, including in the United States, Canada, and the Netherlands, but without specific laws outlawing it, the legal consequences are unclear. Sometimes other laws related to fertility fraud are used against the physician, such as mail, travel, or wire fraud, while others face civil suits. Some physicians have faced ethics charges by the governing bodies of their profession and lost their license to practice medicine. [ 4 ]


In the United States, medical students in the 1960s and 1970s donated sperm, and later while trying to develop their practice as a physician, may have gone on to use their own sperm in order to establish a track record of success. There were no laws on the books at the time prohibiting such activity. [ 30 ]


Activists have pushed for legislation that would make fertility fraud a crime, and as of February 2022, seven U.S. states have passed laws, and seven others were considering it. [ 30 ]


In the United States, over fifty fertility doctors have been accused of fraud in connection with donating sperm according to a February 2022 news report. [ 30 ]


In 2020, Somethin' Else and  Sony Music Entertainment  released a podcast telling the story of Jan Karbaat and his children called "The Immaculate Deception".


In 2020, HBO released the documentary  Baby God  chronicling the life of Quincy Fortier.  [ 13 ]


In 2021, The Dutch three-part miniseries  Seeds of Deceit  tells the story of Dutch fertility doctor Jan Karbaat, who inseminated his patients with his own sperm. [ 25 ]


In 2022, Netflix released the documentary  Our Father  by  Jason Blum  in the  true crime  genre about the Donald Cline case in the 1970s and 1980s, to mixed reviews. [ 31 ] [ 32 ]


Forced fatherhood  or  imposed paternity , occurs when a man becomes a father against his will or without his consent. It can include deception by a partner about her ability to get pregnant or use of  contraceptives , birth control sabotage,  paternity fraud  and  sexual assaults  of males that result in pregnancy. [ 1 ]


"Sperm theft" (also known as "unauthorized use of  sperm ", " spermjacking " or "spurgling" (a  portmanteau  of sperm and  burgling )), [ 2 ] [ 3 ]  refers to a specific form of forced fatherhood in which a man's semen is used to impregnate a woman without his consent. Although the term uses the word " theft ", it more closely falls under a state of  fraud  or  breach of contract . Stealing of sperm in itself without using it for successful insemination is not illegal and is difficult to prove. It usually has no bearing on issues like  child support . It is considered an issue in the  men's rights movement . [ 4 ]


Forced fatherhood falls into three main categories: [ 5 ]


The prevalence of imposed paternity is difficult to measure. Research for the  Centers for Disease Control and Prevention  in 2011 found that approximately 10.4% (or an estimated 11.7 million) of men in the United States reported ever having an intimate partner who tried to get pregnant when they did not want to or tried to stop them from using birth control. [ 6 ]  In a survey of 5000 women for the British magazine  That's Life , 42% stated that they would lie about using birth control in order to get pregnant, in spite of the wishes of their partner. [ 7 ]


Forced fatherhood (namely a woman becoming pregnant against a man's will or without his consent) is not illegal anywhere. Cases are usually reported in connection with disputes over  child support . When the obligation to provide child support is challenged by men who allege that their sperm had been stolen or otherwise used to inseminate a woman without their consent, courts will typically enforce the doctrine of  strict liability : namely, that a man is liable to support a child conceived with his sperm, irrespective of the circumstances of conception, including any criminal conduct on the part of the mother. [ 8 ] [ 9 ]  Plaintiff arguments of  tort  liability for  fraud  or  misrepresentation  typically do not hold up. Courts are also thought to be reluctant to remedy such grievances as it would mean ruling that a child was born as a result of deception. [ 10 ]  In some cases, a victim of sperm theft can sue the perpetrator for emotional trauma inflicted. [ 11 ]


Myrisha S. Lewis has written that male victims of contraceptive fraud, sexual assault, and statutory rape should not be "punished with child support liability, but instead receive compensation for the unauthorized use of their biological products." She argues that the policy of strict liability unjustly penalises male victims of sexual assault. She contrasts their status with that of voluntary sperm donors, who are exempt from child support liability. [ 12 ]


In a "landmark ruling" establishing the legal principle that a man's semen is his own property,  Lord Chief Justice ,  Lord Judge , the most senior judge in England and Wales, ruled in favor of six unnamed men who sued the  NHS  for damages after their sperm samples were lost. The men were all cancer patients who had been advised to freeze their sperm due to the risk of chemotherapy damaging their fertility. Lord Judge,  Master of the Rolls  Sir Anthony Clarke, and Lord Justice Wilson ruled that the sperm samples were legally the property of the men, and dismissed the argument made by the NHS that the samples should be given the same status as discarded  toenails  or  hair . [ 13 ]


Steve Moxon  has written, "it must only be a matter of time before the absurdity of 'sperm theft' is stamped upon. The position at the moment is that of a dam held back by 'the best interests of the child' concept, which is proxy for 'the best interests of the state' in not paying child support. It only takes one case to successfully assert the rights of the deceived man for the dam wall to break." [ 14 ]


In her article, "It's ten o'clock: do you know where your sperm are?", Laura Wish Morgan highlights the strict liability theory of parentage. She notes cases where the father has been held liable for child support even if he was underage at the time of conception, and thus a victim of  statutory rape  ("The sexual intercourse in these cases is "factually voluntary" and thus intentional, even if it is nonconsensual in the criminal sense"). Morgan also documents a "somewhat troubling" case where a woman raped a man after he had gotten drunk at a party and passed out, and thus he did not knowingly or willingly have intercourse with her. The mother also admitted that she had done this. Nevertheless, the court held him liable for child support ("the wrongful conduct of the mother in causing conception did not obviate the father's support obligation"). Morgan concludes: "to all men who complain about paying child support for children they did not want, the simple advice is, "Shut up and put on a condom. And dispose of it yourself." [ 8 ]


In Germany, sperm theft is known as  samenraub . The phrase entered the popular lexicon after a 2001  tabloid  scandal involving  Boris Becker  and a resulting headline in  Bild :  War es Samenraub?  ('Was it semen robbery?'). [ 15 ]  Becker had claimed that a child he fathered with a Russian waitress was conceived when she stole his sperm after  oral sex . He alleged that she inseminated herself following a tryst in a linen cupboard at the London restaurant  Nobu . Subsequently, he reversed his stance, accepted fatherhood and agreed to take responsibility for the child. [ 16 ]  In 2013 the phrase was included in the  Duden . [ 17 ] [ 18 ]


A man's request to be relieved of paying child support was rejected by a Munich court. The child was conceived from an egg fertilized with his sperm without his permission. He revoked his consent for his sperm to be used after he and his ex-wife separated and said that she twice forged his signature at an  IVF  clinic. However, the court said that he was not clear enough when he revoked his consent and the clinic had no reason to doubt the validity of what he alleged were forged signatures. [ 19 ]


In 2012, two male  gynaecologists  were ordered by a  Dortmund  court to pay child support in place of the biological father. They had helped a mother conceive twins via artificial insemination using the father's sperm, but did so without the father's consent. A contract had stipulated that his sperm was to be destroyed after a year. [ 20 ]


On 4 February 2013, the 22nd civil senate of the  Hamm  Higher Regional Court dismissed a man's claim for indemnification for exemption from maintenance obligations in the so-called "semen robbery process" and thus deviated from the lower court judgment of the Dortmund Regional Court. The man alleged that his signature on the informed consent form had been forged and that his sperm sample had been used for artificial insemination without permission. The court rejected his argument. [ 21 ] [ 22 ]


In 2022, a 39-year-old woman received a 6-month suspended jail sentence for poking holes in a condom to get pregnant with a man with whom she was in a  friends-with-benefits  relationship. She wanted to enter a serious relationship while she knew he did not. She failed to get pregnant. [ 23 ]


In Israel,  stealing sperm  ( גנבת זרע ) is a common phrase used to denote a woman sleeping with a man in order to get pregnant without telling him. It receives ample media coverage. [ 24 ]  Some consider that the issue is unbalanced in favor of women and men who fall victim to "sperm theft" should also have the right to say no to parenthood. [ 25 ]


In 2012, the Tiberias Family Court ruled against a man who asked to be excused from paying  child support , claiming the mother of his child had "stolen his sperm" in order to get pregnant. In dismissing the suit, the judge ruled that "even if her biological father's claims are true, they are not sufficient to prevent the minor from succeeding in her current suit." The judge also cited other cases in which men had been ordered to pay child support, even though they had argued they were "fathers against their will". [ 26 ] [ 27 ]


In 2013, in a "milestone verdict", a  Tel Aviv  court ordered a woman to pay her former partner  ₪ 110,000 ($31,000) in damages. She had informed him that she was infertile and persuaded him to not to use contraception. Subsequently, she became pregnant and sued him for child support after he refused to acknowledge paternity of the child. Previous judgements had gone against him. [ 28 ]  In January 2017, the compensation imposed on the woman was revoked after the district court hearing the appeal ruled that the sex did not result from misrepresentation, and it was not proven that the plaintiff was interested at the time in the defendant's medical condition or the need to use contraception. [ 29 ]


On 4 September 2018, a Tel Aviv court partially accepted the suit of a man claiming "forced fatherhood". Judge Shifra Glick determined that the defendant had been dishonest with the plaintiff, had asked him not to use contraceptives, and had told him that she was using an  IUD , thereby "making the plaintiff a parent against his will". The plaintiff's claims of robbery, negligence and fraud were rejected. The plaintiff was awarded limited compensation of  ₪ 40,000 ($11,160). [ 30 ]


In September 2013, the  Italian Supreme Court  ruled against a man who claimed that the conception of his son was a result of semen theft. He said that he never had sex with the woman and claimed she had stolen a test tube containing his seminal fluid. The court stated that he had failed to prove that a theft took place, but ruled that the fact of his biological connection to the child was sufficient to require him to pay maintenance, regardless of the circumstances: "paternity is attributed as a juridical consequence of conception, so that the biological element is decisive, and, since there is also no need for a conscious will to procreate, no relevance can be attributed to the wants of the alleged father". They affirmed the lower court's award of €350 per month child support to the woman and he was also ordered to pay her €1000 in compensation. [ 31 ] [ 32 ]


An episode of the  SVT  investigative programme  Uppdrag granskning , entitled "Spermiestölden", spoke to a number of people who were conceived with stolen sperm over the period 1985 to 1996. It came to light when they began tracing their biological fathers as adults. The fathers had submitted sperm samples at  Halmstad  hospital whilst undergoing fertility treatment with their wives, but it was then used to impregnate other women without their permission. [ 33 ] [ 34 ]  The mothers believed the sperm was supplied by voluntary donors. The doctor involved is now deceased. As the events occurred over 35 years ago, legal action is considered time-barred in  Sweden . One of the men involved submitted his case to the  European Court of Human Rights , claiming a breach of  Article 8  of the  European Convention on Human Rights . [ 35 ]  His counsel said "It should go without saying that the public may not use individuals' gametes without their consent. It is also important that the European Court of Human Rights states that violations of human rights cannot be time-barred until you know that your rights have been violated." [ 36 ]


A court in  İzmir  province,  Turkey , dismissed the paternity lawsuit of a 61-year-old man who insisted that the mother, who gave birth to twin boys via  in vitro fertilization  in 2015, stole his sperm. A DNA test in 2018 proved that he was the father and he was mandated to pay maintenance for them. The judge stated that sperm cannot be considered movable property. [ 37 ]


In June 2000, the Birmingham High Court rejected Jonathan Evans' challenge to a child support order. Evans cited a letter the child's mother had written him in which she admitted to inseminating herself with his sperm after retrieving it from a used condom whilst he was in the shower. The judge ruled that, irrespective of how the baby was conceived, Evans was the legal father and was required to pay maintenance. [ 38 ] [ 39 ]  The case was discussed on  BBC Radio 4 's  Woman's Hour . [ 40 ]


Daily Mail  columnist  Liz Jones  admitted in 2011 to stealing the sperm of her ex-husband  Nirpal Dhaliwal  from a condom and trying to become pregnant. [ 3 ]  She did not get pregnant. Dhaliwal wrote "Luckily for me, my little troopers stayed loyal and didn't go to work for her, otherwise I could've found myself a father, emotionally and financially trapped by her for the rest of my life." [ 41 ]


In 2011,  The Daily Telegraph  reported on an unnamed woman who forged her ex-husband's signature at an IVF clinic, allowing doctors to create embryos using his frozen sperm. She subsequently gave birth to two children via the procedure. The man had stored his frozen sperm at the  Bourn Hall Clinic  in Cambridge after undergoing  arthritis  treatment that could have left him infertile. He said he had no knowledge of the procedure until three years later. He was ordered to pay her an additional £100,000 to help raise the children. The woman said, "I have no regrets, I would do it again." [ 42 ]


In January 2019, a father lost his claim for damages from IVF Hammersmith. His ex-partner forged his signature on a consent form in order to conceive a child using a frozen egg fertilized with his sperm at the clinic. The court accepted that his signature had been forged and the insemination procedure was done without his consent, but denied his claim for compensation, on the grounds of public policy that damages cannot be awarded for the birth of a healthy child. [ 43 ]  The law has since changed to require photographic identification as well as a signature to ensure that the man authorising the use of frozen embryos is indeed the father. [ 44 ]


The Guardian  reported on a man who gave a sperm sample to a  Harley Street  fertility clinic in the 1960s for analysis. Unbeknownst to him, the sample was used to impregnate couples undergoing fertility treatment at the clinic. Now in his 80s, he learned that he has a daughter as a result. Her parents were told the donor was a medical student. The man maintained he never gave permission for the use of his sperm for anything except fertility analysis but said "I'm too old to be angry now. Not really, no." [ 45 ]


In July 2022 in the  House of Commons ,  Flick Drummond   MP  raised the case of a constituent whose sperm was used by his ex-partner to become pregnant without his consent. Drummond characterized this as "not just 'sperm theft', but a form of sexual assault and a violation of my constituent's rights", but noted that, according to the  Crown Prosecution Service , there is no law to deal with this act as a sexual assault. She asked  Attorney General   Suella Braverman  to look into amending the law. [ 46 ]


In 1981, former  NYPD  Detective and whistleblower  Frank Serpico  argued that he should not have to pay child support because the mother deceived him into the pregnancy. The mother denied this, but a female friend of hers testified in support of his account. She said that the mother intended to seduce Serpico to get pregnant and that she deliberately stopped taking birth control pills, but had assured him that she was still taking them. The judge ruled in Serpico's favor, stating that the mother's planned and intentional deceit barred her from any financial benefit at the father's expense. However, this was overruled by a higher court, which decided the charges of fraud were irrelevant and the only consideration was the "best interests of the child". The tribunal ruled that he had to pay maintenance of around $900 per month. [ 47 ]  One of Serpico's lawyers was  Karen DeCrow , a former director of the National Organization for Women. DeCrow told the court "Autonomous women making independent decisions about their lives should not expect men to finance their choice". [ 10 ]


In  SF vs. TM  (1996), "S.F." was a man who passed out intoxicated at a party in the home of a woman ("T.M."), who raped him while he was unconscious. S.F. had no knowledge of this until he woke up the following morning with his lower clothes removed. T.M. became pregnant as a result of the rape and S.F. was ordered to pay child support. He appealed, arguing that he "did not knowingly and willfully participate in any sexual activity with the mother of the minor child." S.F. further asserted that being compelled to pay child support for a child conceived as a result of non-consensual intercourse deprived him of property rights and equal protection under the law. He produced expert testimony that it was possible for a male to get an  erection  and  ejaculate  while unconscious. The court nevertheless rejected his argument, stating that "the child is an innocent party... any wrongful conduct on the part of the mother should not alter the father's duty to provide support for the child." S.F. was ordered to pay $106.04 per month in child support, plus $8,960.64 in arrears. [ 48 ]  The dissenting opinion described the mother's misconduct as "reprehensible" and a "misdemeanor" and said a male rape victim should be required to pay child support only if the mother cannot support the child herself. [ 49 ]


In 1997, the  Louisiana Court of Appeal  ruled against Emile Frisard in his suit against Debra Rojas. Frisard was visiting his sick parents in hospital when Rojas, a nurse at the hospital, offered to perform  oral sex  on him, provided he wore a condom. Frisard accepted and after the act was complete, Rojas kept the condom and used Frisard's semen to impregnate herself. She subsequently sued him for child support. Frisard argued that he only consented to oral sex and never consented to the use of his sperm for insemination purposes. Frisard was ordered to pay $436.81 per month in child support, $17,901.21 in arrears and 5% in court costs. Addressing the issue of Rojas' self-insemination without Frisard's consent, the court dismissed the point: "[Frisard's] own testimony showed that he had some sort of sexual contact with the plaintiff around the time frame of alleged conception." The fact of any sexual contact between them was sufficient to hold Frisard liable for child support. [ 50 ] [ 48 ]


A  Massachusetts  court awarded Richard Gladu $108,000 in compensation from Boston IVF after the fertility clinic impregnated his ex-wife with their frozen embryos without his consent, resulting in the birth of a daughter. Gladu was awarded $98,000 for the cost of raising his then seven-year-old daughter, and $10,000 for emotional distress. [ 51 ] [ 52 ]


The  Illinois Appellate Court  ruled that Richard O. Phillips could press a claim for emotional distress against his former partner Sharon Irons, overruling the circuit court which had dismissed Phillips' suit in 2003. Phillips claimed that Irons surreptitiously kept his semen in her mouth after  oral sex  and used it to self-inseminate, later giving birth to a daughter. The court ruled that Phillips' claims, if true, meant that Irons "deceitfully engaged in sexual acts, which no reasonable person would expect could result in pregnancy, to use plaintiff's sperm in an unorthodox, unanticipated manner yielding extreme consequences." The appellate court dismissed Phillips' claims of fraud and theft: "when plaintiff 'delivered' his sperm, it was a gift – an absolute and irrevocable transfer of title to property from a donor to a donee. There was no agreement that the original deposit would be returned upon request." [ 53 ]


In 2015, Layne Hardin and his former partner Katherine LeBlanc (of  Houston ,  Texas ) sued Texas Andrology Services and Hardin's former girlfriend, Tobie Devall, charging that Devall had illegally acquired Hardin's frozen sperm from the facility and used it to get pregnant. Devall claimed that she did so with Hardin's agreement. While still in a relationship with LeBlanc, Hardin had a  vasectomy  and had eight vials of  sperm  frozen. An agreement between Hardin, LeBlanc and the facility stated that only LeBlanc would have access to the sperm. A jury found in favor of Hardin and LeBlanc. Texas Andrology Services was ordered to pay $250,000 apiece to Hardin and LeBlanc. Devall was ordered to pay $125,000 to Hardin and $250,000 to LeBlanc. [ 54 ]  On appeal, the compensation was reduced to $19,500. [ 55 ]


A  New York  court ordered Deon Francois to pay child support to his ex-wife Chaamel after she forged his signature and allegedly had it notarized with a stolen seal and used his frozen sperm sample to conceive a daughter through a fertility clinic. Francois sued the New York University clinic for $9 million, insisting that they should pay the child support. [ 56 ]


Joe Pressil of Houston Texas sued 'Advanced Fertility', a Texas fertility clinic, in 2011. Pressil claimed that the clinic accepted a semen sample from a woman claiming to be his wife and then performed in vitro fertilization, resulting in the birth of twins. Pressil says this was all done without his knowledge or consent and he only found out about it when he found receipts from the clinic. He claimed she smuggled the sperm to the clinic after saving their used condoms after sex. He said the entire situation had caused him mental harm and economic distress due to substantial child support payments. [ 57 ]


Maelo Ruiz  claimed that a fan named Karla Ankara Toledo stole his sperm from a  Venezuela   sperm bank  and used it to conceive twin girls. He announced he was taking legal action. Toledo countersued for child maintenance. [ 58 ]


In 2019, a story circulated on the  internet  that a  Las Vegas  hotel cleaner had become pregnant after stealing sperm from a millionaire's used condom and successfully sued him for child support. The story was later revealed to be a  satire . [ 59 ]


Derrick Rose  claimed that  NBA  players are taught to flush their condoms down the toilet or take them away after sexual intercourse so that women cannot use the sperm to impregnate themselves. [ 60 ]


Cosmopolitan  did a feature on spurglary in 2013. Marriage and family therapist Carla Willis-Brandon stated "I've begun to notice a growing trend in the number of women tricking men into having a baby, usually by lying about contraception... these women usually hope a child will smooth over issues in the relationship. If she's with a man who's commitment-phobic, she might feel a baby will 'seal the deal'". However, she knew only one couple in this situation who stayed together afterwards. One man interviewed said his friend was spurgled, but said this was "the making of him." A woman recounted that she got pregnant after she stopped taking the pill without telling her boyfriend, hoping he would marry her. Instead, he broke off the relationship and moved overseas. [ 61 ]


Make a Mom , a company which sells  home insemination  kits, ran a series of adverts on  X  encouraging women to retrieve sperm from discarded condoms without their partner's knowledge and inseminate themselves with it. They used taglines like "Don’t Need Permission, Made My Decision" and showed a video of a woman doing this, with the text "Woman quietly sneaks condom from trash to perform home insemination while her partner sleeps in the other room. What do you think about this? Is this legal? Will he still owe child support?" [ 62 ] [ 63 ]


In  Ancient Greek Mythology ,  Myrrha  fell in love with her father  Cinyras  and tricked him into having sexual intercourse with her ("climb[ed] into his bed one dark night, when her nurse had made him too drunk to realize what he was doing"). She was transformed into a  myrrh  tree and gave birth to their son  Adonis . [ 64 ]


The  Osiris myth  of  Egyptian mythology  describes how  Nephthys , the childless twin sister of  Isis , tricked Isis' husband  Osiris  into fathering a child ( Anubis ) with her either by pretending to be Isis or by getting Osiris drunk. After his birth,  Anubis  was raised by Isis. [ 65 ]  At a later point in time, Isis reassembled the body of the murdered Osiris, and succeeded in becoming pregnant with  Horus  from the seed of Osiris. [ 66 ]


In  Plato 's  Symposium ,  Penia , the goddess of  poverty , conceives  Eros  with  Poros : "Now Poros who was the worse for  nectar —there was no  wine  in those days—went into the garden of  Zeus  and fell into a heavy sleep, and  Penia  considering her own straitened circumstances, plotted to have a child by him, and accordingly she lay down at his side and conceived  Eros ". [ 67 ]


The idea of demons haunting people in their sleep can be found in  Jewish  and  Christian  mythology (see  Lilith ). They feed on the life energy of sleeping people with whom they mate at night. A  succubus  steals the semen of the sleeping man unnoticed, who can only remember it the next day in the form of a dream. During the early modern  witch hunts ,  sexual intercourse  with the  devil  was regarded as an act deliberately desired by a warlock or a witch, with the devil appearing to men in the form of a succubus and women as an incubus. The  Malleus Maleficarum  describes how the succubus changed after coitus and, unnoticed by the man, how its semen was then used in the form of an incubus to impregnate a woman. [ 68 ] [ 69 ] [ 70 ]


The Bible  describes two cases of sperm stealing, in which a man is seduced by a woman under false pretences and becomes an unwitting sperm donor. Each case, with the exception of Lot and his daughters, involves a direct ancestor of the biblical  King David . The women are sympathetic, shown acting for noble reasons.


The account of  Lot  and  his daughters  is in Genesis 19:30–38:


30 And Lot went up out of  Zoar , and dwelt in the mountain, and his two daughters with him; for he feared to dwell in Zoar: and he dwelt in a cave, he and his two daughters.
 31 And the firstborn said unto the younger, Our father  is  old, and  there is  not a man in the earth to come in unto us after the manner of all the earth:
 32 Come, let us make our father drink  wine , and we will lie with him, that we may preserve seed of our father.
 33 And they made their father drink wine that night: and the firstborn went in, and lay with her father; and he perceived not when she lay down, nor when she arose.
 34 And it came to pass on the morrow, that the firstborn said unto the younger, Behold, I lay yesternight with my father: let us make him drink wine this night also; and go thou in,  and  lie with him, that we may preserve seed of our father.
 35 And they made their father drink wine that night also: and the younger arose, and lay with him; and he perceived not when she lay down, nor when she arose.
 36 Thus were both the daughters of Lot with child by their father.


In the  Book of Genesis ,  Tamar  deceives her father-in-law  Judah  into having sexual intercourse with her by pretending to be a  prostitute . When Judah discovers that Tamar is pregnant he prepares to have her killed, but recants and confesses when he finds out that he is the father (Genesis 38:11–26). [ 72 ]  The twins  Perez  (Peretz) and  Zerah  were conceived as result (Genesis 38:27–30). The former is the patrilineal ancestor of King David, according to the  Book of Ruth  (4:18–22). [ 73 ]


In  Roald Dahl 's novel  My Uncle Oswald ,  the titular character plots to steal sperm from famous men and sell it to women who want children sired by geniuses. Intended victims include  Pablo Picasso ,  Sigmund Freud ,  Albert Einstein ,  H. G. Wells ,  Joseph Conrad ,  Igor Stravinsky , Sir  Arthur Conan Doyle ,  Giacomo Puccini ,  Claude Monet ,  Henri Matisse ,  James Joyce ,  Sergei Rachmaninoff ,  Pierre-Auguste Renoir , and  Rudyard Kipling . [ 74 ]


The main theme of the 2004 UK TV drama "Whose Baby?", starring  Andrew Lincoln  and  Sophie Okonedo , is focused around an instance of sperm theft. The female lead character inseminates herself in the shower with a used condom after a one-night stand. The male lead character finds out years later as he is contacted by child support agency.


The CW  television series  Jane the Virgin  centers around a young woman whose life is changed when she is accidentally impregnated with a man's  sperm  sample by mistake. The series later had an incident of sperm stealing. [ 75 ]


Episodes of  CSI: Crime Scene Investigation , [ 76 ]   The Young and the Restless , [ 77 ]   Archer , [ 78 ]   Bored to Death , [ 79 ]   Sunset Beach , [ 80 ]   Boston Legal , [ 81 ]   You're the Worst , [ 82 ]   Being Mary Jane , [ 83 ]   Neighbours , [ 84 ]   Bridgerton , [ 85 ]   Diagnosis Murder , [ 86 ]   Passions , [ 87 ]   Days of Our Lives , [ 88 ]   All My Children , [ 89 ]   The Game , [ 90 ]   Creamerie , [ 91 ]   Ray Donovan , [ 92 ]   The Good Wife , [ 93 ]   Hannibal , [ 94 ]   The Cleveland Show , [ 95 ]  and  Law and Order: Special Victims Unit [ 96 ]  have also featured sperm theft storylines.


In  Batman comics , some versions of the  Damian Wayne  backstory imply that he was conceived as a result of  Bruce Wayne  being drugged by  Talia al Ghul . [ 97 ] [ 98 ]


In  John Irving 's  The World According to Garp , Garp is born as a result of his mother raping a brain-damaged soldier in a field hospital. [ 99 ]


In the  independent film   Your Sister's Sister ,  the lesbian character seduces a friend, whom she does not realize is her sister's love interest, using a broken condom to impregnate her. [ 100 ]


Gamete intrafallopian transfer  ( GIFT ) is a tool of  assisted reproductive technology  against  infertility . Eggs are removed from a woman's ovaries, and placed in one of the  fallopian tubes , along with the man's sperm. The technique, first attempted by  Steptoe  and  Edwards [ 1 ]  and later pioneered by endocrinologist  Ricardo Asch , allows fertilization to take place inside the woman's uterus. [ 2 ]


With the advances in IVF the GIFT procedure is used less as pregnancy rates in  IVF  tend to be equal or better and do not require  laparoscopy  when the egg is put back. [ 3 ]


It takes, on average, four to six weeks to complete a cycle of GIFT. First, the woman must take a fertility drug to stimulate egg production in the  ovaries . The doctor will monitor the growth of the ovarian follicles, and once they are mature, the woman will be injected with  human chorionic gonadotropin  (hCG). The eggs will be harvested approximately 36 hours later, mixed with the man's sperm, and placed back into the woman's  fallopian tubes  using a  laparoscope .


A woman must have at least one normal fallopian tube in order for GIFT to be suitable. It is used in instances where the fertility problem relates to sperm dysfunction, and where the couple has idiopathic (unknown cause) infertility. Some patients may prefer the procedure to  IVF  for ethical reasons, since the fertilization takes place inside the body. [ 4 ]  This is a semi invasive procedure and requires laparoscopy.


As with most fertility procedures, success depends on the couple's age and the woman's egg quality. It is estimated that approximately 25–30% of GIFT cycles result in pregnancy, [ 5 ]  with a third of those being twins or triplets, etc.
The First GIFT baby in the UK was Todd Holden born in October 1986. The first application of this method in Latin America was held in Argentina on 13 May 1986, and was led by Dr. Ricardo Asch, the treatment was successfully completed with the birth of Manuel Campo Lopez. [ 6 ]
In Venezuela, the first GIFT babies were Luis Hernández, Rosa Helena Hernández and Luisa Hernández, who were born on 24 June 1987 and were also the first triplets to be born using the GIFT method.


Gamete intrafallopian transfer is not technically  in vitro  fertilisation because with GIFT, fertilisation takes place inside the body, not on a petri dish. Some Catholic moral theologians are nevertheless concerned with it because they "consider this to be a replacement of the marital act, and therefore immoral." [ 7 ] [ 8 ]


Gynography  (Spanish:  ginógrafo [ 1 ] ) is defined as " radiography  of the  female genital organs " that uses "air or other gas" that is injected  intraperitoneally  as a  contrast medium . The gynograph was invented by Abner I. Weisman, a medical doctor.  The  gynograph  is a new improved  gynoroentgenologic  apparatus used by  gynecologists  and  radiologists  in performing  hysterosalpingography .  The advantage of the gynograph over  uterosalpingography  – which involves the installation of foreign material into the uterus – is that it is "practically free from complications" such as  intravasation  of the  venous sinuses  of the  uterus ,  pulmonary emboli , foreign body retention  cysts ,  pelvic peritonitis ,  rupture  of the  fallopian tube , and death.  The only known rare  side effect  is the occasional flaring-up of an old chronic  salpingitis . [ 2 ]


Gynographic survey  is the term for the method of surveying the female genital tract that involves gaseous  insufflations , instillation of small amounts of an  opaque  substance, and the instillation of a foreign  radiopaque  material. [ 2 ] [ 3 ]


In feminist literature, the term  gynographic criticism  is used by gynographic critics  (gynographic critiques) as a form of " sexualized  language" or gendered way of writing by  syntax . [ 4 ]   In statistics, the term gynography is used as a title for the statistical presentations of topics about women, such as marriage and family including mean (average) age, etc.


The practice of induced  abortion —the deliberate termination of a  pregnancy —has been known since  ancient times . Various methods have been used to perform or attempt abortion, including the administration of  abortifacient  herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. The term  abortion , or more precisely  spontaneous abortion , is sometimes used to refer to a naturally occurring condition that ends a pregnancy, that is, to what is popularly called a  miscarriage . But in what follows the term  abortion  will always refer to an induced abortion.


Abortion laws  and their enforcement have fluctuated through various eras. In much of the  Western world  during the 20th century,  abortion-rights movements  were successful in having abortion bans repealed. While abortion remains legal in most of the West, this legality is regularly challenged by anti-abortion groups. The  Soviet Union  under  Vladimir Lenin  is recognized as the first modern country to legalize induced elective abortion care. [ 2 ]  In the twentieth century  China  used induced abortion as part of a "one-child policy" birth control campaign in an effort to slow population growth.


The Vedic and  smrti  laws of India reflected a concern with preserving the male seed of the three upper castes; and the religious courts imposed various penances for the woman or excommunication for a priest who provided an abortion. [ 3 ]  Part of the epic  Ramayana  describes abortion performed by barber surgeons. [ 4 ]  The only evidence of the death penalty being mandated for abortion in the ancient laws is found in  Assyrian Law , in the Code of Assura, c. 1075 BCE; [ 5 ]  and this is imposed only on a woman who procures an abortion against her husband's wishes. The first recorded evidence of induced abortion is from the Egyptian Ebers Papyrus in 1550 BCE. [ 6 ]


Many of the methods employed in early cultures were non-surgical. Physical activities such as  strenuous labor ,  climbing ,  paddling ,  weightlifting , or  diving  were a common technique. Others included the use of irritant leaves,  fasting ,  bloodletting , pouring hot water onto the abdomen, and lying on a heated  coconut shell . [ 7 ]  In virtually all cultures, abortion techniques developed through observation, adaptation of obstetrical methods, and  transculturation . [ 8 ]  Physical means of inducing abortion, including  battery ,  exercise , and tightening the  girdle  were still often used as late as the  Early Modern Period  among English women. [ 9 ]


Archaeological  discoveries indicate early  surgical  attempts at the extraction of a  fetus ; however, such methods are not believed to have been common, given the infrequency with which they are mentioned in ancient medical texts. [ 10 ]


An 8th-century  Sanskrit  text instructs women wishing to induce an abortion to sit over a pot of steam or stewed  onions . [ 11 ]  The technique of  massage  abortion, involving the application of pressure to the pregnant  abdomen , has been practiced in  Southeast Asia  for centuries. One of the  bas reliefs  decorating the temple of  Angkor Wat  in  Cambodia , dated  c.  1150 , depicts a  demon  performing such an abortion upon a woman who has been sent to the  underworld . [ 6 ]


Japanese documents show records of induced abortion from as early as the 12th century. It became much more prevalent during the  Edo period , especially among the peasant class, who were hit hardest by the recurrent  famines  and high taxation of the age. [ 12 ]   Statues  of the  Boddhisattva   Jizo , erected in memory of an abortion,  miscarriage ,  stillbirth , or young childhood death, began appearing at least as early as 1710 at a  temple  in  Yokohama  (see  religion and abortion ). [ 13 ]


The native  Māori  people of New Zealand  colonisation  terminated pregnancies via miscarriage-inducing drugs, ceremonial methods, and girding of the abdomen with a restrictive  belt . [ 14 ]  Another source claims that the Māori people did not practice abortion, for fear of  Makutu , but did attempt abortion through the  artificial induction  of  premature labor . [ 15 ]


Much of what is known about the  methods and practice  of abortion in  Greek  and  Roman  history comes from early classical texts. Abortion, as a gynecological procedure, was primarily the province of women who were either midwives or well-informed laypeople. In his  Theaetetus ,  Plato  mentions a midwife's ability to induce abortion in the early stages of pregnancy. [ 16 ] [ 17 ]  It is thought unlikely that abortion was punished in Ancient Greece. [ 18 ]  A fragment attributed to the poet Lysias "suggests that abortion was a crime in Athens against the husband, if his wife was pregnant when he died, since his unborn child could have claimed the estate." [ 19 ]


The ancient Greeks relied upon the herb  silphium  as an abortifacient and contraceptive. The plant, as the chief export of  Cyrene , was driven to  extinction ; it is suggested that it might have possessed the same abortive properties, as some of its closest extant relatives in the family  Apiaceae . Silphium was so central to the Cyrenian economy that most of its  coins  were embossed with an image of the plant. [ 20 ]
 Pliny the Elder  (23–79 CE) cited the refined oil of  common rue  as a potent abortifacient.  Serenus Sammonicus  wrote of a concoction which consisted of rue,  egg , and  dill . Soranus, Dioscorides,  Oribasius  also detailed this application of the plant. Modern scientific studies have confirmed that rue indeed contains three abortive compounds. [ 21 ]
 Birthwort , a herb used to ease  childbirth , was also used to induce abortion.  Galen  included it in a potion formula in  de Antidotis , while Dioscorides said it could be administered by mouth, or in the form of a  vaginal  pessary also containing  pepper  and  myrrh . [ 22 ]


The Greek playwright  Aristophanes  noted the abortifacient property of pennyroyal in 421 BCE, through a humorous reference in his  comedy ,  Peace . [ 23 ]   Hippocrates  (c. 460 – c. 370 BCE), the  Greek  physician, would advise a  prostitute  who became pregnant to jump up and down, touching her buttocks with her heels at each leap, so as to induce miscarriage. [ 24 ]  Other writings attributed to him describe instruments fashioned to dilate the  cervix  and  curette  inside of the  uterus . [ 25 ]


Soranus , a 2nd-century Greek physician, prescribed  diuretics ,  emmenagogues ,  enemas , fasting, and bloodletting as safe abortion methods, although he advised against the use of sharp instruments to induce miscarriage, due to the risk of organ  perforation . He also advised women wishing to abort their pregnancies to engage in energetic walking, carrying heavy objects, riding animals, and jumping so that the woman's heels were to touch her buttocks with each jump, which he described as the "Lacedaemonian Leap". [ 24 ] [ 26 ]  He also offered a number of recipes for herbal baths, rubs, and  pessaries . [ 24 ]  In  De Materia Medica Libri Quinque , the Greek  pharmacologist   Dioscorides  listed the ingredients of a draught called "abortion wine"–  hellebore ,  squirting cucumber , and  scammony – but failed to provide the precise manner in which it was to be prepared. [ 27 ]  Hellebore, in particular, is known to be  abortifacient . [ 28 ]


Tertullian , a 2nd- and 3rd-century  Christian   theologian , described surgical implements which were used in a procedure similar to the modern  dilation and evacuation . One tool had a "nicely adjusted flexible frame" used for dilation, an "annular blade" used to curette, and a "blunted or covered hook" used for extraction. The other was a "copper needle or spike". He attributed ownership of such items to Hippocrates,  Asclepiades ,  Erasistratus ,  Herophilus , and  Soranus . [ 29 ]


Aulus Cornelius Celsus , a 1st-century  Roman   encyclopedist , offered an extremely detailed account of a procedure to extract an already-dead fetus in his only surviving work,  De Medicina . [ 30 ]  In Book 9 of  Refutation of all Heresies ,  Hippolytus of Rome , another Christian theologian of the 3rd century, wrote of women tightly binding themselves around the middle so as to "expel what was being conceived". [ 31 ]


Botanical preparations  reputed to be abortifacient were common in  classical literature  and  folk medicine . Such folk remedies, however, varied in  effectiveness  and were not without the risk of  adverse effects . Some of the  herbs  used at times to terminate pregnancy are  poisonous .


A list of plants which cause abortion was provided in  De viribus herbarum , an 11th-century  herbal  written in the form of a  poem , the authorship of which is incorrectly attributed to  Aemilius Macer . Among them were rue,  Italian catnip ,  savory ,  sage ,  soapwort ,  cyperus , white and black hellebore, and  pennyroyal . [ 27 ]   Physicians in the Islamic world  during the medieval period documented the use of  abortifacients , commenting on their effectiveness and prevalence. [ 32 ]


Colonial Americans were advised to use careful measurements in a recipe by  Benjamin Franklin  for an abortifacient. He used the recipe as an example in a book he published to teach mathematics and many useful skills, and calls the recipe a solution to "the misfortune" of an unwanted pregnancy for "unmarry'd women". [ 33 ]  Franklin was following a tradition that had existed in England and Europe.


King's American Dispensatory  of 1898 recommended a mixture of  brewer's yeast  and pennyroyal tea as "a safe and certain abortive". [ 34 ]  Pennyroyal has been known to cause complications when used as an abortifacient. In 1978 a pregnant woman from Colorado died after consuming 2  tablespoonfuls  of pennyroyal  essential oil [ 35 ] [ 36 ]  which is known to be  toxic . [ 37 ]  In 1994 a pregnant woman, unaware of an  ectopic pregnancy  that needed immediate medical care, drank a tea containing pennyroyal  extract  to induce abortion without medical help. She later died as a result of the untreated ectopic pregnancy, mistaking the  symptoms  for the abortifacient working. [ 23 ]


For thousands of years,  tansy  has been taken in early pregnancy to restore menstruation. [ 38 ]  It was first documented as an  emmenagogue  in  St. Hildegard of Bingen's   De simplicis medicinae . [ 27 ]


A variety of  juniper , known as  savin , was mentioned frequently in European writings. [ 6 ]  In one case in England, a  rector  from  Essex  was said to have procured it for a woman he had impregnated in 1574; in another, a man advised his pregnant girlfriend to use  black hellebore  and savin be boiled together and drunk in  milk , or else chopped  madder  boiled in  beer . Other substances reputed to have been used by the English include  Spanish fly ,  opium ,  watercress  seed,  iron sulphate , and iron chloride. Another mixture, not abortifacient, but rather intended to relieve  missed abortion , contained  dittany ,  hyssop , and hot water. [ 9 ]


The root of  worm fern , called "prostitute root" in French, was used in France and Germany; it was also recommended by a Greek physician in the 1st century. In  German  folk medicine, there was also an abortifacient  tea , which included  marjoram ,  thyme ,  parsley , and  lavender . Other preparations of unspecified origin included crushed  ants , the saliva of  camels , and the tail hairs of  black-tailed deer  dissolved in the fat of  bears . [ 11 ]


The  Stoics  believed the fetus to be plantlike in nature, and not an animal until the moment of birth, when it finally breathed air. They therefore found abortion morally acceptable. [ 19 ] [ 39 ]


Aristotle  wrote that, "[T]he line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive." [ 40 ]  Before that point was reached, Aristotle did not regard abortion as the killing of something human. [ 41 ] [ 42 ] [ 43 ]  Aristotle considered the embryo to  gain a human soul  at 40 days if male and 90 days if female; before that, it had vegetable and animal souls.


The  Oath , ascribed to  Hippocrates , forbade the use of  pessaries  to induce abortion. Modern scholarship suggests that pessaries were banned because they were reported to cause vaginal ulcers. [ 44 ]  This specific prohibition has been interpreted by some medical scholars as prohibiting abortion in a broader sense than by pessary. [ 27 ]


One such interpretation was by  Scribonius Largus , a Roman medical writer: "Hippocrates, who founded our profession, laid the foundation for our discipline by an oath in which it was proscribed not to give a pregnant woman a kind of medicine that expels the embryo or fetus." [ 45 ]  Other medical scholars disagree, believing that Hippocrates sought to discourage physicians from trying dangerous methods to abort a fetus. [ 46 ]  This may be born out by the fact that the oath originally also prohibited  surgery  (at the time, it was far more dangerous, and  surgeons  were a separate profession from  physicians ). [ 47 ]


Soranus acknowledges two parties among physicians: those who would not perform abortions, citing the Hippocratic Oath, and the other party, his own. Soranus recommended abortion in cases involving health complications as well as emotional immaturity, and provided detailed suggestions in his work  Gynecology . [ 48 ] [ 49 ]


In the  Roman Republic  and  Principate , abortion was punished only when it violated the  father's right  to make decisions about rearing his offspring. [ 18 ] : 3   The  Stoics  did not view the fetus as a person, and the Romans did not punish abortion as homicide. [ 50 ]  Following a  divorce , a pregnant woman could choose to have an abortion based on the view that "the embryo formed part of the mother's own organs." [ 51 ]  Although abortion was commonly accepted in the  Roman Empire , around 211 AD the emperors  Septimius Severus  and  Caracalla  banned abortion as infringing on parental rights; temporary exile was the punishment. [ 19 ]


The 3rd-century legal compilation  Pauli sententiae  (attributed to  Julius Paulus ) wrote: "Those who give an abortifacient or a love potion, and do not do this deceitfully, nevertheless, [because] this sets a bad example, the  humiliores   will be banned to a mine, and the  honestiores  will be banned to an island after having forfeited (part of) their property, and if on account of that a woman or man perishes, then they [Pharr: the giver] will receive the death penalty." [ 52 ]  Paulus distinguishes between punishments for the upper and lower classes ( honestiores  and  humiliores ) but seems to refer more to the killing of the woman who takes the abortifacient rather than to the killing of the fetus itself.


The Roman jurist  Ulpian  wrote in the  Digest : "An unborn child is considered being born, as far as it concerns his profits," meaning that in  Roman inheritance law  a  posthumous child  was entitled to the same share of its predeceased father's estate as children born before his death. [ citation needed ]  Abortion continued to be practiced "with little or no sense of shame". [ 53 ]