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3002 > 61 In Vitro Fertilisation > Flashcards

61 In Vitro Fertilisation Flashcards

1
Q

What is infertility?

A
  • A dysfunction - not a disease
  • A socially constructed disease
  • A “terrible disease affecting our sexuality and well being” (Lord Winston)
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2
Q

How many couples have difficulty conceiving?

A

~ 1 in 7 ( ~ 3.5 million)

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3
Q

What is the % of couples who are infertile?

A

~ 5%

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4
Q

After 3 years of trying to conceive naturally without success, chances of pregnancy occurring within the next tear is…

A

<25%

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5
Q

Factors affecting fertility?

A
  • Age
  • Smoking
  • Weight (BMI>30 or BMI<19)
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6
Q

Factors affecting a woman’s fertility?

A
  • Ovulation disorder (21%)
  • Tubal factor (15-20%)
  • Endometriosis (6-8%)
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7
Q

Factors affecting a man’s fertility?

A 
25%
• Semen abnormality
• Azoospermia
• Immunological
• Coital dysfunction
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8
Q

What is % of unexplained causes of fertility?

A

28%

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9
Q

Methods to treat infertility?

A

Assisted Reproductive Technologies (ART):

  1. In vitro fertilisation (IVF) - 2016: 68,000 treatment cycles
  2. Intrauterine insemination (IUI)
  3. IVF with intracytoplasmic sperm injection (ICSI)
  4. Use of donor sperm/eggs
  5. Surrogacy
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10
Q

What are the ages of IVF?

A
  1. Egg production stimulated by hormone therapy
    • Suppress (GnRH agonist) then stimulate (FSH) then maturation (hCG)
  2. Eggs retrieved from ovary
    • Egg collection:
    Ultrasound-guided transviginal aspiration or laparoscopy
  3. Sperm sample provided
  4. Eggs and sperm combined to allow fertilisation
    • Use ICSI if necessary; leave in incubator; check after 16-30hrs
  5. Fertilized egg introduced into uterus
    • Transfer after 2-6 days; use ultrasound; use progesterone for luteal phase support
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11
Q

Risks associated with IVF?

A
  1. Ovarian hyperstimulation syndrome:
    • Due to super ovulation in response to the drugs
    • Abdominal bloating, nausea/ vomiting, breathlessness, leg swelling
  2. Transferral of several embryos - multiple births:
    • Recommendation is for single embryo transfer
  3. Welfare of the child:
    • 1990 - need for a father
    • 2008 - need for supportive parenting
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12
Q

Define the term “supportive parenting”

A

A woman shall not be provided with treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need for supportive parenting), and of an other child who may be affected by the birth

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13
Q

Guidelines for IVF in Scotland (updated 2017, from 2013)?

A

• <40 years old: (2 - 2013) 3 cycles of IVF
– Infertility with an appropriate cause of any duration
– Unexplained infertility of 2 years (heterosexual couples)
– Unexplained infertility following 6-8 cycles of donor insemination (same sex couples)

• 40-42 years old: 1 cycles of IVF
– No IVF before
–No evidence of low ovarian reserve
– Discussion of implications of IVF and pregnancy at this age

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14
Q

What % of IVF treatments, using own fresh eggs is successful?

A

26.5%

• 65% of women <37

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15
Q

What was the regulation of IVF when it was first introduced?

A
  • 1978: 1st ‘test-tube” baby - Louise Brown
  • Warnock Report 1984
  • Human Fertilisation and Embryology Authority (HFEA)
  • Human Fertilisation and Embryology Act 1990, 2008
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16
Q

What is HFEA?

A

Human Fertilisation and Embryology Authority:

  1. Regulator and info provide
  2. Regulate:
    • Treatment (inspect and license clinics)
    • Research (licenses for human embryo research)
17
Q

What are the ethical issues surrounding IVF?

A
  1. Who should be able to access IVF?
  2. Use of gametes?
  3. Embryos (graded: use immediately, freeze, discard or research)
  4. Reproductive tourism
18
Q

What are the 3 groups of people that present with ethical issues when receiving IVF?

A

Heterosexual couples
Homosexual couples
Single women

19
Q

What was the homosexual couple case study for IVF?

A

NHS Greater Glasgow and Clyde – very public case in 2009; at first NHS GGC said no, but then overturned that decision (now included in SGG 2013)

20
Q

What was the Elizabeth Pearce case study for IVF?

A

SINGLE WOMEN RECEIVING IVF

Case of Elizabeth Pearce (Ealing PCT) – using sperm bought from the US, and IVF funded by NHS

21
Q

What are the ethical issues surrounding gametes in IVF?

A

If frozen…

  • Must state how long
  • What happens in event of death?

If donated….

  • Is it okay to pay donors? In the UK compensation is allowed
  • Should there be a limit to number of children created? UK limit is 10 families, US no limit
  • Should children be able to find out who their biological parents are? In 2005, change in law to allow children to access info
22
Q

Ethical issues surrounding embryo’s in IVF?

A
  • How many should be made?
  • How many should be implanted?
  • What do we do with spares?
23
Q

Ethical issues surrounding reproductive tourism?

A
  • Cost
  • Waiting lists
  • Avoid legal restrictions
24
Q

What is IVF with mitochondrial replacement?

A
  • Media: “3 parent IVF”
  • Recent HFEA report: mitochondrial donation
  • Technique that allows those at risk of passing on certain mitochondrial conditions (carried on mtDNA) to avoid that risk
  • Pro-nuclear transfer or maternal spindle transfer
  • HFEA held public consultation (2012)
25
Q

What 4 things must be considered in IVF with mitochondrial replacement?

A
  • Modification of embryos and changing the germline
  • Implications for identity and the status of the mitochondria donor
  • General veins on the permissibility of the techniques
  • Licensing models and further regulatory issues
26
Q

What occurs in pronuclear transfer in IVF with mitochondrial replacement? (repair is done after fertilisation)

A
  1. • Parent’s fertilised egg with parent’s nuclear material and unhealthy mitochondria
    • Donor’s fertilised egg with donor nuclear material and healthy mitochondria
  2. • Parents’ nuclear material removed
    • Donor material removed and destroyed
  3. Parents’ nuclear material placed inside donor egg
27
Q

What occurs in maternal spindle transfer in IVF with mitochondrial replacement? (repair is done before fertilisation)

A

1.
• Mother’s egg with mother’s nucleus and unhealthy mitochondria
• Donor’s egg with donor nucleus and healthy mitochondria

2.
• Mother’s nucleus removed
• Donor’s nucleus removed and destroyed

  1. Mother’s nucleus placed inside donor egg and fertilised
28
Q

What are the regulation changes that have occurred in response to IVF with mitochondrial replacement?

A
  • House of Commons: 03/02/15: MPs voted to amend the Human Fertilisation and Embryology Act 2008 and allow mitochondrial donation
  • House of Lords: 24/02/15 peers voted to allow mitochondrial donation to be licensed for use
  • HFEA: 15/12/16 approved use of mitochondrial donation in certain, specific cases
  • HFEA: 16/03/17 approved first clinic application (Newcastle)
29
Q

What is partial surrogacy?

A

Surrogate mother inseminated herself with commissioning father’s sperm

30
Q

What is full surrogacy?

A

IVF (commissioning couple’s egg and sperm mixed in vitro and then transferred)

31
Q

Who is the legal mother from birth (surrogacy cases)?

A
  • Surrogate mother

* Parental order or adoption required

32
Q

What is the Surrogacy Act 1985?

A

Surrogacy agreements are not unlawful but they are unenforceable

33
Q

What are the 2 key reports on surrogacy?

A

Brazier and Warnock Report

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