IVF Flashcards
Define 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.
-Describes people who have difficulties (or
may find it impossible) to have children naturally.
-It is a dysfunction (NOT a disease), a socially constructed disease,
What percentage of couples are affected by infertility ?
- ~ 1 in 7 couples may have difficulty conceiving (~3.5 million people)
- Number of couples who are infertile is ~ 5%.
For every 100 couples trying to conceive naturally, how many will conceive after:
- 1 month
- 6 months
- 1 year
- 18 months
- 2 years
What are the chances of pregnancy occurring within the next year after 3 years of trying without success?
For every 100 couples trying to conceive naturally: – 20 will conceive within 1 month – 70 will conceive within 6 months – 85 will conceive within 1 year – 90 will conceive within 18 months – 95 will conceive within 2 years
After 3 years of trying without success, chances of pregnancy occurring within the next year is 25% or less.
What are the main causes of infertility ? State the proportion of infertility due to each cause.
• Factors affecting general fertility; age, smoking, weight (BMI >30 or BMI <19), environmental factors
• Factors affecting a woman’s fertility
– Ovulation disorder–21%
– Tubal factor 15-20%
– Endometriosis–6-8%
• Factors affecting a man’s fertility (25%)
– Semen abnormality
– Immunological
– Coital dysfunction
• Unexplained – 28%
Identify the main methods used to treat infertility. .
Assisted Reproductive Technologies (ART):
- In vitro fertilisation (IVF)
- Intrauterine insemination (IUI)
- IVF with intracytoplasmic sperm injection (ICSI)
- Use of donor sperm/eggs
- (Surrogacy)
Outline the procedure of in vitro fertilisation.
1) Egg production stimulated by hormone therapy
- Suppress (GnRH agonist) then stimulate (FSH), then maturation (hCG)
2) Eggs retrieved from ovary
- Ultrasound-guided transvaginal aspiration, or laparoscopy
3) Sperm sample provided
4) Eggs and sperm combined to allow fertilisation
- Use ICSI if necessary; leave in incubator; check after 16-30 hrs
5) Fertilized eggs introduced into uterus
- Transfer after 2 - 6 days; use ultrasound; use progesterone for luteal phase support
Identify risks associated with IVF for both mother, and child.
• Ovarian hyperstimulation syndrome
– Can occur thanks to superovulation in response to the
drugs
– Abdominal bloating, nausea/vomiting, breathlessness, leg swelling
• Transferral of several embryos – multiple births
– Recommendation is for single embryo transfer
• Welfare of the child
– 1990: the need for a father
– 2008: the need for supportive parenting
Outline the Scottish Government’s most recent recommendations for IVF on the NHS.
GUIDELINES FOR IVF IN SCOTLAND (UPDATED 2017, FROM 2013)
• <40 years old: 3 (used to be 2) cycles of IVF. Conditions:
– 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
• 40–42 years old: 1 cycle of IVF. Conditions:
– No IVF before
– No evidence of low ovarian reserve
– Discussion of implications of IVF and pregnancy at this age
What is meant by those who state that IVF is a post code lottery ?
In Scotland (and advised by NICE), 3 cycles for <40 years old
In different places in England, these targets were met with very varying success (some 3 cycles, others 2 cycles, others 1 cycle, others no cycle)
What proportion of IVF treatment using own fresh eggs is successful ?
26.5% of IVF treatments, using own fresh eggs, successful
What proportion of IVF cycles is funded by the NHS in Scotland ? How much does on cycle cost ?
- 6/10 cycles NHS funded (in Scotland)
* 1 cycle costs ~ £3500
Describe the role of the HFEA in regulating assisted reproduction in the UK.
• Human Fertilisation and Embryology Authority (HFEA)
– Regulator and information provider
– Regulate:
a) Treatment (inspect and license clinics)
b) Research (licenses for human embryo research)
Identify and discuss some of the ethical issues arising at key stages in the IVF process.
- Who should be able to access IVF?
• Heterosexual couples
– See NICE guidelines and Scottish Govt Guidance (2017)
• Same sex couples
– 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)
• Single women
– Case of Elizabeth Pearce (Ealing PCT) – using sperm bought from the US, and IVF funded by NHS
(Remember HFE Act 2008: “supportive parenting”) - Gametes
– Frozen
• Must state how long and what happens in event of death
– Donated
• Is it okay to pay donors? In UK: “compensation”; not so elsewhere (max 750 GBP)
• Should there be a limit to number of children created?
– In the US: one man fathered 150 children; UK: limit = 10 families
• Should children be able to find out who their biological parents are? 2005: change in law - 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 (people going abroad for IVF, where cheaper, smaller waiting lists, avoiding legal restrictions)
- If come back to the UK, may add burden to NHS through possible complications
Describe the case of the same sex couple in GGC about IVF.
An NHS GGC spokeswoman said yesterday “treatment acceptance criteria” had at first been applied to the couple as they would have been to any other.
She said: “As a couple, these two individuals are biologically incapable of conceiving and the board, therefore, initially took the view that the couple did not meet the necessary criteria to receive NHS-funded treatment.
“The board has, however, reconsidered its position in light of other regulations, including the Human Fertilisation and Embryology Act 2008 and Equality Act (Sexual Orientation) regulations 2007, and has now decided to offer treatment to this couple”
Describe the case of the single women and IVF.
Miss Pearce, who receives child tax credit and housing benefit, cited Articles 8 and 14 of the European Convention on Human Rights – the right to respect for family and private life and the prohibition of discrimination.
She told the Mail: ‘I believe that it is my right as a woman to be a mother. The fact that I am single is irrelevant.
