In vitro fertilisation (IVF)

Question 1

Infertility

Answer 1

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

Question 2

3 concepts of parenthood

Answer 2

begetting
gestating
caring

Question 3

Factors affecting fertility

Answer 3

age, smoking, weight (BMI >30 or BMI <19), environmental factors

Question 4

what are factors which effect women fertility specifically

Answer 4

– Ovulationdisorder–21%
– Tubal factor 15-20%
– Endometriosis – 6-8%

Question 5

what are factors which effect mens fertility specifically

Answer 5

– Semenabnormality
– Immunological
– Coitaldysfunction

Question 6

what are the 5 steps to IVF

Answer 6

1. egg production stimulated by hormone therapy
2. eggs retrieved from the ovary
3. sperm sample provided
4. eggs and sperm are combined to allow fertilisation
5. fertilised eggs are introduced into the uterus

Question 7

Risks associated with IVF

- ovarian hyperstimulation syndrome

Answer 7

– Can occur thanks to superovulation in response to the
drugs
– Abdominal bloating, nausea/vomiting, breathlessness, leg swelling

Question 8

Risks associated with IVF

- transfer of several embryos

Answer 8

– multiple births

– Recommendation is for single embryo transfer

Question 9

“Supportive parenting” 2008

Answer 9

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.

Question 10

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

Answer 10

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

Question 11

NICE England IVF guidance

Answer 11

recommended3 cycles <40 yrs old
• In England 208 clinical commissioning groups;
• 24 met national guidelines 
• 50–2 cycles
• 127–1 cycle
• 7– no IVF

Question 12

how many IVF procedures are successful

Answer 12

26.5%

Question 13

Regulation of IVF

Answer 13

• Human Fertilisation and Embryology Authority (HFEA)

– Regulator and information provider

Question 14

what does the HFEA regulate

Answer 14

• Treatment (inspect & license clinics)
• Research (licenses for human embryo research)
• Human Fertilisation and Embryology Act 1990, 2008
• Why regulate?(risks,moral,ethics,history)

Question 15

Single women case for IVF

Answer 15

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

Question 16

. Gametes

Answer 16

– Frozen

• Must state how long and what happens in event of death

Question 17

paying doners

Answer 17

not allowed in the UK

Question 18

limit on children

Answer 18

only 10 families

Question 19

Should children be able to find out who their biological parents are?

Answer 19

2005: change in law you can seek out your biological parents

Question 20

Embryos (graded: use immediately, freeze, discard

or research)

Answer 20

Embryos (graded: use immediately, freeze, discard
(or research))
– How many should be made?
– How many should be implanted?
– What do we do with spares?

Question 21

Reproductive tourism

Answer 21

– Cost
– Waiting lists
– Avoid legal restrictions

Question 22

IVF with mitochondrial replacement

Answer 22

• 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)

Question 23

4 considerations for mitochondrial replacement

Answer 23

– 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

Question 24

Partial surrogacy:

Answer 24

surrogate mother inseminates herself with commissioning father’s sperm

Question 25

Full surrogacy:

Answer 25

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)

Question 26

2 key reports: in surrogacy

Answer 26

Brazier Report & Warnock Report