IVF

Question 1

What are the factors affecting fertility in both sexes?

Answer 1

• age
• smoking
• weight
• environmental factors

Question 2

What are the factors affecting fertility in females?

Answer 2

• ovulation disorder
• tubal factor
• endometriosis

Question 3

What are the factors affecting fertility in males?

Answer 3

• semen abnormality
• immunological
• coital dysfunction
• unexplained

Question 4

What are the methods that can be used to treat infertility?

Answer 4

• in-vitro fertilisation
• intrauterine insemination
• IVF with intracytoplasmic sperm injection
• use of donor sperm/eggs
• surrogacy

Question 5

What are the 5 steps of in-vitro fertilisation?

Answer 5

1. egg production stimulated by hormone therapy (suppress with GnRH antagonist then stimulate with FSH and cause maturation with hCG)
2. eggs collected (ultrasound guided or laparoscopy)
3. sperm sample provided
4. eggs and sperm combined to fertilise
5. fertilised eggs introduced into uterus (using ultrasound, progesterone used for luteal phase support)

Question 6

What are the risks associated with IVF?

Answer 6

• ovarian hyperstimulation syndrome (superovulation in response to drugs - abdo bloating, nausea/vomiting, breathlessness, leg swelling)
• transferral of several births (multiple births which are riskier - recommendation is single embryo transfer)
• welfare of child (ethical - 1990: need for father, 2008: need for supportive parenting)

Question 7

What is supportive parenting?

Answer 7

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, and of any other child who may be affected by the birth

Question 8

What are the Scottish government’s recommendations on IVF?

Answer 8

• if under 40: 3 cycles of IVF
• if infertility is with an appropriate cause of any duration
• if unexplained infertility for 2 years in heterosexual couples
• if unexplained infertility following 6-8 cycles of donor insemination in same-sex couples
• if 40-42: 1 cycle
• no IVF before
• no evidence of low ovarian reserve
• discussion of implications of IVF and pregnancy at this age

Question 9

What is the role of the HFEA?

Answer 9

• regulator and information provider
• regulate treatment (inspect and license clinics)
• research (licenses for human embryo research)

Question 10

What are some ethical issues surrounding IVF?

Answer 10

• who should be able to access it? (heterosexual/same-sex couples/single women)
• what do we do with the gametes?
• frozen (how long? and what happens in a couple when someone dies??
• donated (is payment okay? should there be a limit? should children be able to find out who biological parents are?)
• embryos (how many should be made/implanted? what to do with spares?)
• reproductive tourism (cost/waiting lists/avoids legal restrictions)

Question 11

What is IVF with mitochondrial replacement?

Answer 11

technique that allows those at risk of passing on certain mitochondrial conditions to avoid that risk

Question 12

What are the considerations with IVF with mitochondrial replacement?

Answer 12

• modification of embryos and changing the germline
• implications for identity and status of mitochondria donor
• general views on permissibility of techniques
• licensing models and further regulatory issues

Question 13

Describe how mitochondrial transfer is done

Answer 13

Pro-nuclear transfer (done after fertilisation):

• parents nuclear material removed from egg with unhealthy mitochondria
• placed inside donor egg (which previously had its nuclear material removed and destroyed)

Maternal spindle transfer (done before fertilisation):

• mothers nucleus removed from egg with unhealthy mitochondria
• placed inside donor egg (which previously had its nucleus removed and destroyed) and fertilised

Question 14

What are the types of surrogacy?

Answer 14

• partial: surrogate mother inseminates herself with commissioning father’s sperm
• full surrogacy: IVF

Question 15

What are some issues with surrogacy agreements?

Answer 15

• they are not unlawful but unenforceable (surrogacy act 1985)
• in UK, surrogate mother is always legal mother from birth (parents need to adopt the child)