IVF

Question 1

Intentional Parents

Question 2

Genetic Parents

Question 3

Gestational Mother

Question 4

Nurturing Parents

Question 5

Factors affecting a woman’s fertility

Answer 5

• Abnormal ovulation (e.g. polycystic ovary syndrome, early menopause)
• Blockage of fallopian tubes
• Age

Question 6

Factors affecting a man’s fertility

Answer 6

• Low sperm count/quality

- Damage to testicles and/or failure to ejaculate

Question 7

Assisted Reproductive Technologies

Answer 7

• Intrauterine Insemination
• In Vitro Fertilisation
• IVF with Intracytoplasmic Sperm Injection
• Use of donor sperm/eggs
• Surrogacy

Question 8

In Vitro Fertilisation (IVF)

Answer 8

• 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

Question 9

Risks associated with IVF

Answer 9

• 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)?

Question 10

Supportive Parenting

Answer 10

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.

Question 11

IVF Guidelines in Scotland

Answer 11

• 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.

Question 12

Regulation of IVF

Answer 12

• 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

Question 13

Ethical issues surrounding IVF

Answer 13

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.

Question 14

IVF with Mitocholdrial Replacement

Answer 14

• 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.

Question 15

Pronuclear Transfer

Answer 15

• Repair is done after fertilisation

- Parents nuclear material is removed and placed inside donor egg

Question 16

Maternal Spindle Transfer

Answer 16

• Repair is done before fertilisation

- mother nucleus put into donor egg and then fertilised.

Question 17

Regulation of IVF with Mitochondrial Replacement

Answer 17

• 3rd Feb 2015 - House of Commons voted to amend Human Fertilisation and Embryology Act 2008 to allow mitochondrial donation.
• 24th Feb 2015 - House of Lords voted to allow mitochondrial donation to be licensed for use.
• 15th Dec 2016 - HFEA approved use of mitochondrial donation in specific circumstances
• 16th Mar 2017 - first approved clinic application.

Question 18

Partial Surrogacy

Answer 18

Surrogate mother inseminates herself with commissioning father’s sperm

Question 19

Full Surrogacy

Answer 19

IVF (commissioning couple’s egg and sperm mixed in vitro and then transferred)

Question 20

Surrogacy

Answer 20

• 50% of cases involve known surrogates. Disputes arise in approximately 5% of cases. 100-180 surrogate arrangements per year in UK (50-80 births).
• Surrogacy agreements are not unlawful but they are unenforceable due to the Surrogacy Act 1985.
• In UK, surrogate mother is always legal mother from birth so parental order or adoption is required.
• Brazier Report
• Warnock Report