IVF Flashcards
Intentional Parents
Genetic Parents
Gestational Mother
Nurturing Parents
Factors affecting a woman’s fertility
- Abnormal ovulation (e.g. polycystic ovary syndrome, early menopause)
- Blockage of fallopian tubes
- Age
Factors affecting a man’s fertility
- Low sperm count/quality
- Damage to testicles and/or failure to ejaculate
Assisted Reproductive Technologies
- Intrauterine Insemination
- In Vitro Fertilisation
- IVF with Intracytoplasmic Sperm Injection
- Use of donor sperm/eggs
- Surrogacy
In Vitro Fertilisation (IVF)
- Egg production stimulated by hormone therapy - suppress (GnRH agonist) then stimulate (FSH), then maturation (hCG).
- Egg collection - ultrasound-guided transvaginal aspiration or laparoscopy
- Sperm sample provided
- Eggs and sperm combined to allow fertilisation - use ICSI if necessary; leave in incubator; check after 16-30hrs
- Fertilised eggs introduced into uterus - transfer after 2-6 days; use ultrasound; use progesterone for luteal phase support
Risks associated with IVF
- Ovarian Hyperstimulation Syndrome - can occur due to superovulation in response to the drugs
- Transferral of several embryos - multiple births - recommendation is for single embryo transfer
- Welfare of the Child - the need for a father (1990)? the need for supportive parenting (2008)?
Supportive Parenting
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.
IVF Guidelines in Scotland
- Under 40s are entitled to 3 cycles of IVF if they fit the criteria: infertility with an appropriate cause of any duration or unexplained infertility of two years in heterosexual couples or unexplained infertility following 6 to 8 cycles of donor insemination for same sex couples.
- 40-42 age range are entitled to 1 cycle of IVF granted they have never had IVF before, there’s no evidence of low ovarian reserve and there is a discussion of implications of IVF and pregnancy at this age.
Regulation of IVF
- Human Fertilisation and Embryology Authority (HFEA) are the regulator and information provider. They regulate treatment (inspect and license clinics) and research (licenses for human embryo research).
- Human Fertilisation and Embryology Act 1990, 2008
Ethical issues surrounding IVF
1 - Who should be allowed access? - Heterosexual couples, Homosexual Couples (there was a very public case in 2009 where the NHS said no but the decision was then overturned and changes were made to guidance), Single Women (case of Elizabeth Pearce - used sperm which was bought from United States, and IVF was funded by NHS). Supportive Parenting.
2 - Gametes - must state how long and what happens to frozen eggs in the event of death. Donated - is it okay to pay donors? should there be a limit to how many children one person can create? should children be able to find out who their biological parents are?
3 - Embryos (used immediately, frozen, discarded, research) - how many should be made? how many should be implanted? what do we do with spares?
4 - Reproductive Tourism - cost, waiting lists, avoid legal restrictions.
IVF with Mitocholdrial Replacement
- Technique allows those at risk of passing on certain mitochondrial conditions (carried by mitochondrial DNA) to avoid that risk.
- Pronuclear or maternal spindle transfer
- 4 considerations - 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.
Pronuclear Transfer
- Repair is done after fertilisation
- Parents nuclear material is removed and placed inside donor egg
