1. In Vitro Fertilisation Flashcards
What is infertility?
– A dysfunction (but not a disease)
– A socially constructed disease as women are there for reproductive purposes
– A “terrible disease affecting our sexuality and well being”
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
What are methods to treat infertility?
Assisted reproductive technologies: • Intrauterine insemination (IUI) • In vitro fertilisation (IVF) • IVF with intracytoplasmic sperm injection (ICSI) • Use of donor sperm/eggs • Surrogacy
What are the stages of IVF?
- Egg production stimulated by hormone therapy
- Suppress (GnRH agonist) then stimulate (FSH) then maturation (hCG) - Eggs retrieved from ovary
- Egg collection. Ultrasound-guided transviginal aspiration or laparoscopy - Sperm sample provided
- Eggs and sperm combined to allow fertilisation
- Use ICSI if necessary; leave in incubator; check after 16-30hrs - Fertilized egg introduced into uterus.
- Transfer after 2-6days; use ultrasound; use progesterone for luteal phase support
Risks associated with IVF?
- Ovarian hyperstimulation sundrome- Can occur thanks to super ovulation in response to the drugs
- Transferral of several embryo’s i.e. multiple births- Recommendation is for single embryo transfer
- Welfare of the child; 1990 “the need for a father” require considering, changed in 2008 to “need for supportive parenting”
Define the term “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.
What are the guidelines for IVF in Scotland?
<40yearsold:23cyclesofIVF
– 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
40–42yearsold:1cycleofIVF
– No IVF before
– No evidence of low ovarian reserve
– Discussion of implications of IVF & pregnancy at this age
What % of IVFs using fresh eggs are successful?
26.5
Slide 12
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What are the ethical issues surrounding IVF?
- Who should be able to access IVF?
- Use of gametes?
- Embryos (graded: use immediately, freeze, discard or research)
- Reproductive tourism
What are the 3 groups of people that present with ethical issues when receiving IVF?
Heterosexual couples
Homosexual couples
Single women
What was the homosexual couple case study for IVF?
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)
What was the Elizabeth Pearce case study for IVF?
SINGLE WOMEN RECEIVING IVF
Case of Elizabeth Pearce (Ealing PCT) – using sperm bought from the US, and IVF funded by NHS
What are the ethical issues surrounding gametes in IVF?
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
