In vitro fertilisation (IVF) Flashcards
Infertility
a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse
3 concepts of parenthood
begetting
gestating
caring
Factors affecting fertility
age, smoking, weight (BMI >30 or BMI <19), environmental factors
what are factors which effect women fertility specifically
– Ovulationdisorder–21%
– Tubal factor 15-20%
– Endometriosis – 6-8%
what are factors which effect mens fertility specifically
– Semenabnormality
– Immunological
– Coitaldysfunction
what are the 5 steps to IVF
- egg production stimulated by hormone therapy
- eggs retrieved from the ovary
- sperm sample provided
- eggs and sperm are combined to allow fertilisation
- fertilised eggs are introduced into the uterus
Risks associated with IVF
- ovarian hyperstimulation syndrome
– Can occur thanks to superovulation in response to the
drugs
– Abdominal bloating, nausea/vomiting, breathlessness, leg swelling
Risks associated with IVF
- transfer of several embryos
– multiple births
– Recommendation is for single embryo transfer
“Supportive parenting” 2008
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 any other child who may be affected by the birth.
Guidelines for IVF in Scotland (updated 2017, from 2013) SIGN
under 40, 3 cycles of IVF funded on the NHS if meet the following criteria:\
– Infertility with an appropriate cause of any duration or
– Unexplained infertility of two years - heterosexual couples
– Unexplained infertility following six to eight cycles of donor insemination – same sex couples
NICE England IVF guidance
recommended3 cycles <40 yrs old • In England 208 clinical commissioning groups; • 24 met national guidelines • 50–2 cycles • 127–1 cycle • 7– no IVF
how many IVF procedures are successful
26.5%
Regulation of IVF
• Human Fertilisation and Embryology Authority (HFEA)
– Regulator and information provider
what does the HFEA regulate
- Treatment (inspect & license clinics)
- Research (licenses for human embryo research)
- Human Fertilisation and Embryology Act 1990, 2008
- Why regulate?(risks,moral,ethics,history)
Single women case for IVF
Case of Elizabeth Pearce (Ealing PCT) – using sperm bought from the US, and IVF funded by NHS
. Gametes
– Frozen
• Must state how long and what happens in event of death
paying doners
not allowed in the UK
limit on children
only 10 families
Should children be able to find out who their biological parents are?
2005: change in law you can seek out your biological parents
Embryos (graded: use immediately, freeze, discard
or research)
Embryos (graded: use immediately, freeze, discard (or research)) – How many should be made? – How many should be implanted? – What do we do with spares?
Reproductive tourism
– Cost
– Waiting lists
– Avoid legal restrictions
IVF with mitochondrial replacement
- 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)
4 considerations for mitochondrial replacement
– Modification of embryos and changing the germline
– Implications for identity and the status of the mitochondria donor
– General views on the permissibility of the techniques
– Licensing models and further regulatory issues
Partial surrogacy:
surrogate mother inseminates herself with commissioning father’s sperm
Full surrogacy:
IVF (commissioning couple’s egg & sperm mixed in vitro and then transferred
In UK surrogate mother is always the legal mother from birth (parental order or adoption required)
2 key reports: in surrogacy
Brazier Report & Warnock Report
