Beginning of life ethics Flashcards
(27 cards)
What is infertility?
A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse [in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner]
Couples who’ve been trying to conceive for more than 3 years the likelihood of getting pregnant naturally within the next year is 25% or less. True or false?
True
List 3 factors affect a woman’s fertility?
Abnormal ovulation (e.g. polycystic ovary syndrome, early menopause)
Damage to Fallopian tubes (e.g. surgery, PID)
Endometriosis
List 2 factors that affect a man’s fertility?
Low sperm count/quality
Damage to testicles and/or failure to ejaculate
List 5 Assisted Reproductive Technology based methods to treat infertility
Intrauterine insemination (IUI)
In vitro fertilisation (IVF)
IVF with intracytoplasmic sperm injection (ICSI)
Use of donor sperm/eggs
Surrogacy
define Ovarian hyperstimulation syndrome
Occurs when a woman’s ovaries swell and leak fluid into the body. This condition is a complication that can occur in women who receive fertility treatments that stimulate the ovaries to produce more eggs than usual.
There are rare cases of OHSS occurring spontaneously.
name 2 risks associated with IVF
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
How does supportive parenting impact the treatment a women can receive?
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 (updated 2017, from 2013) for 40-42 yr olds?
what’s the max number of cycles they are given?
no IVF before
no evidence of low ovarian reserve
also discuss the implications of IVF and pregnancy at this age
only given 1 cycle of IVF if they’ve had;
women aged 40+ how many cycles of IVF are they given?
only given 1 cycle of IVF
how many cycles of IVF are women given if they are aged less than 40?
3 cycles of IVF
What are the Guidelines for IVF in Scotland (updated 2017, from 2013) for less and 40yr olds?
infertility with an appropriate cause of any duration or unexplained
unexplained infertility of two years - heterosexual couple
unexplained infertility following 6 to 8 cycles of donor insemination - same sex couples
Describe some of the risks associated with IVF for the mother?
ectopic pregnancy - 3% of IVF pregnancies result in this
ovarian hyperstimulation syndrome
multiple pregnancies miscarriage pregnancy-related high blood pressure and pre-eclampsia gestational diabetes anaemia and heavy bleeding needing a caesarean section
Describe some of the risks associated with IVF for the child?
low birth weight
premature birth
congenital birth defects.
explain why children born via IVF are more likely to have birth defects
Patients undergoing IVF are older than the general fertile population and increased female age increases the risk for a genetic abnormality
what are the ethical issues surround IVF
Access to IVF (on the NHS) - Heterosexual couples
See NICE guidelines & Scottish Govt Guidance (2013)
Homosexual 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”
Ethical issues surrounding IVF (II)
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
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
Ethical issues surrounding IVF (III)
Embryos (graded: use immediately, freeze, discard (or research))
How many should be made?
How many should be implanted?
What do we do with those not used?
Reproductive tourism
Cost
Waiting lists
Avoid legal restrictions
define IVF with mitochondrial replacement?
Is a new form of reproductive invitro fertilization (IVF)
Works by replacing a women’s abnormal mitochondrial DNA (mt-DNA) with the donor’s healthy one
IVF with mitochondrial replacement benefits
Allows those at risk of passing on certain mitochondrial conditions (carried on mtDNA) to avoid that risk
how’s the genetic information transfered in IVF with mitochondrial replacement?
Pro-nuclear transfer or maternal spindle transfer
what are the 4 ethical considerations identified by HEFA in regards to IVF with mitochondrial replacement?
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
does HEFA allow the use of mitochondrial donation in all cases of IVF?
no
HFEA only approves the use of mitochondrial donation in certain, specific cases.
define partial surrogacy
Partial surrogacy: surrogate mother inseminates herself with commissioning father’s sperm
