St A - In Vitro Fertilisation

Question 1

Define infertility

Answer 1

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

Name some factors affecting a woman’s fertility?

Answer 2

Ovulation disorder, tubal factor and endometriosis.

Question 3

What factors affect a man’s fertility

Answer 3

• Seminal abnormality,
• Immunological,
• Coital dysfunction

Question 4

What are some methods to treat infertility?

Answer 4

• In vitro fertilisation,
• intrauterine insemination,
• IVF with intracytoplasmic sperm injection,
• Use of donor sperm/eggs,
• Surrogacy

Question 5

Describe the process of in vitro fertilisation?

Answer 5

1) Egg production stimulated by hormone therapy (supressed by GnRH agonist, stimulated by FSH and then maturation hCG),
2) Egg retrieved from ovary (ultrasound-guided transvaginal aspiration or laproscopy)
3) Sperm sample provided,
4) Egg and sperm combined to allow fertilization,
5) transfer into uterus after 2-6 days. Progesterone given for luteal phase support

Question 6

What are some of the risks associated with IVF?

Answer 6

• Ovarian hyperstimulation syndrome (can cause abdominal bloating, nausea/vomiting, breathlessness or leg swelling)
• Transfer of several embryos (multiple births),
• Welfare of the child (1990 - need for father, 2008 - need for supportive parenting)

Question 7

What are the IVF guidlines in scotland

Answer 7

If under 40 then can be given 3 cycles of IVF on the NHS (infertility with appropriate cause of any duration, unexplained fertility of 2 years or unexplained infertility follow 6-8 cycles of insemination - same sex)
40-42 years old can have 1 cycle of IVF on NHS if they have not had IVF before, no evidence of low ovarian reserve, discussion of pregnancy at that age.

Question 8

What is the role of the Human Fertilisation and Embryology Authority (HFEA)

Answer 8

They are a regulator and information provider. They regulate treatment (inspect and license clinics) and research (licenses for human embryo research)

Question 9

What are some ethical issues surrounding IVF?

Answer 9

• Who should be able to access it? Heterosexual, homosexual couples? Single women? (Elizabeth Pearce)
• If gametes are frozen then how long should they be kept for and what happens in event of death.
• Is it okay to pay donors? should there be a limit to number of children created? Should children be able to find out who their biological parents are.

Question 10

What is mitochondrial donation?

Answer 10

Technique that allows those at risk of passing on certain mitochondrial conditions to avoid that risk. There is pro-nucleus transfer or maternal spindle transfer.

Question 11

What are important ethical considerations to consider with mitochondrial donation?

Answer 11

1) Modification of the embryos and changing the germline.
2) Implications for identity and the status of the mitochondria donor,
3) General views on the permissibility of techniques,
4) Licensing models and further regulatory issues

Question 12

What are the different types of surrogacy?

Answer 12

Partial - Surrogate mother inseminates herself with commissioning father’s sperm.
Full - IVF (commissioning couples egg and sperm mixed in vitro and then transferred)

Question 13

In surrogacy who is the legal mother?

Answer 13

The surrogate mother