In vitro fertilisation

Reflections on 40 years of IVF

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The past

For many practitioners of in vitro fertilisation (IVF) today, it must be hard to comprehend the disdain and disgust with which the introduction of IVF as a therapy for infertility was greeted. The ethical and legal wrangling about human reproductive cloning and the current debate over trans‐generational (germline) genome editing gives a small flavour of how IVF was seen then. What was regarded as an irrelevant, disruptive, and unethical practice is now effectively mainstream treatment in most countries of the world.

The journey from bench to bedside was fraught with difficulties – both technical and social.1 It took almost 10 years from the proof of principle of IVF in Robert Edwards’ Cambridge laboratory to the first live birth 40 years ago in Oldham, UK, achieved by Edwards, Steptoe, and Purdy. To be an IVF parent then was considered too shameful to admit, to be an IVF child was to be considered a freak, and to be an IVF practitioner or to be conducting embryo research led to one being likened to Frankenstein or Dr Mengele. Indeed, when Edwards and Steptoe applied for a Medical Research Council (MRC) grant to fund their work in 1971, they received entirely hostile referees’ reports,2 suggesting that the referees either did not believe that IVF was able to solve the problem of infertility or that it was not a problem worth solving. Despite these funding setbacks, the hostile social environment in which they worked, and the many technical problems that they had to overcome, they pressed on undaunted, buoyed up largely by the many letters that they received from people suffering with infertility and the willing supply of patients that came to their Oldham clinic. The hostile social and professional environment was such that, even after the births of Louise Brown in 1978 and Alistair Montgomery in 1979, the situation for Edwards, Steptoe, and Purdy did not improve. As Steptoe had to retire from his NHS post in Oldham, they sought support from the NHS and the University in Cambridge to continue the work there, but were unsuccessful, and were forced to relocate and adapt a private clinic at Bourn Hall, which set them back 2 years. During this hiatus, the Australian clinics in Melbourne took the lead, only to be hampered themselves by the same social abreaction in the form of state legislation that restricted their capacity to undertake research on human embryos. Edwards, Steptoe, and Purdy started taking patients at Bourn Hall in 1982, the same year that the Government set up a committee of enquiry into IVF chaired by Mary Warnock. This committee reported in 1984 and recommended the setting up of a Human Fertilisation and Embryology Authority (HFEA), to oversee treatment and research using human embryos. The HFEA finally came into existence in 1990 after a prolonged struggle to salvage embryo research from initially very hostile houses of parliament.3

The present

Efficacy and safety

Despite the fact that we have much to celebrate regarding the introduction of IVF, it is clear that the efficacy of the technology, despite continuing improvement, remains limited (can you imagine any other branch of medicine or surgery accepting and working with a 70% failure rate?), and its safety is still not fully demonstrated: being live born is not the same as being a healthy adult. Potential epigenetic effects of superovulation, culture conditions, media constituents, and embryo or gamete manipulation have never been studied in the long term,4 and only a few have been studied in the short term. In the early days of IVF, neither the MRC nor the Department of Health thought IVF important enough to consider long‐term follow‐up for babies, and still only scant information about health follows the various registers internationally. At least intracytoplasmic sperm injection (ICSI) was followed up strictly after its introduction in Belgium, and some pre‐implantation genetic diagnosis (PGD) centres still follow the children that they have helped to be born free of genetic disease.

Multiple embryo transfer

Increasing evidence has accumulated from well‐designed studies about the disadvantages and risks of multiple embryo transfer, not only in terms of prematurity with a multiple birth, but also the effects of vanishing twins that may accompany the transfer of more than one embryo.5 There is still a general reluctance to move wholly to single embryo transfer, However; the success of embryo vitrification is likely to change this, although evidence of its long‐term safety is still being collected.

Oocyte cryopreservation

Previously, this was undertaken as a last resort in the face of ageing and a lack of a partner, and was thus too late to be really effective.6 The freezing of oocytes as natural insurance against the reduction of fertility with ageing and against the increased risk of adverse genetic outcomes with age is a recent change in practice, and the demand for this is likely to increase further, especially if the legal time limit of 10 years for storage can be relaxed.

Pre‐implantation genetic screening and other new technologies

The debate about pre‐implantation genetic screening for aneuploidy (PGS/PGT‐A) has raged for nearly 25 years, with few good controlled studies, and with little prospect that any well‐designed trials with current genetic technologies will be undertaken, despite the opportunities for doing so.7 It seems that priority is given to making a healthy profit by offering new techniques to vulnerable patients rather than first establishing that the techniques are efficacious and safe. Indeed, the paucity of randomised studies and proper prospective follow‐up when new technologies are introduced is a sad hallmark of the IVF profession today. Is it not time that our professional societies and colleges stood firm on the need for sound scientific rationale, together with an insistence on proper studies and follow‐up, before allowing or supporting the application of new techniques? Is the absence of such careful studies a consequence of the largely private treatment of IVF in the UK and the USA? And might the lack of mandatory guidelines from the National Institute for Health and Care Excellence (NICE), leading to the postcode lottery in the provision of IVF on the NHS, be responsible for this unfortunate situation?

Role of the HFEA

There are many in the UK who still baulk at the Human Fertilisation and Embryology Act (HFE Act), through which the regulation of assisted reproduction occurs, because of a perception that it has been a brake on research and innovative practice. It is noteworthy, however, that the presence of such regulation has enabled the reasonably smooth public and legal acceptance of the most recent reproductive technology: mitochondrial replacement therapy (MRT) for inherited mitochondrial disease.8 The introduction of MRT here in the UK will be accompanied by the mandatory long‐term follow‐up of offspring (with parental consent). Although not the first country to undertake MRT, the first case in the USA received significant legal and ethical criticism for its lack of transparency and lack of proper follow‐up and oversight.9 Moreover, the rapid extension of MRT from avoidance of genetic disease to infertility therapy in some unregulated countries, despite the lack of any real scientific basis, gives cause for concern.

The study of the biology and role of mitochondria in development is blossoming, and improvement in cell culture and stem cell technology is allowing us to begin to understand the processes leading up to gastrulation, which can now be studied effectively in vitro for the first time.10 All of this has been achieved within the window of 14 days of development set out as a legal limit by the HFE Act; this limit has been followed by some other countries, but not by all. Thus, up to now the Act does not seem to have been a constraint on good laboratory research, including that of the genome editing of embryos.11 The need to know more about the later post‐implantation stages, such as gastrulation and germ cell formation, and the mechanisms governing reproductive success or failure, is likely to reopen public and legal discussion about the 14‐day rule: a pragmatic red line drawn up as a compromise between public concern and scientific imperative.

The future

The future for this specialty is likely to be just as interesting and controversial as the previous 50 years because of its intimate involvement with the reproductive process and the health of future generations. Indeed, perhaps the biggest changes that the future brings will not be technological but social and ethical, with yet further challenges to our established ways of thinking about sex, gender, sexuality, reproduction, pregnancy, and the family. IVF has already contributed to massive social change and promises to lead to even more! Although the use of artificial intelligence (AI) and robotics will no doubt make its impact in assisted reproductive technology (ART) diagnosis and the IVF laboratory, as it has in diagnostic radiology and repetitive delicate assembly tasks, it is genome editing in human reproduction that is probably going to be the most controversial topic in biology for the foreseeable future. The possibility of editing embryos to remove harmful mutations, or creating gametes in vitro from cell lines that have undergone genome editing, challenges our ethical prejudices and our duties and responsibilities to future generations.12 PGD [or Preimplantation Genetic Testing for Mutation (PGT‐M), as we currently know it] may no longer be necessary once this new technology becomes efficacious and safe,13 and the number of embryos that would be available to be replaced or frozen would be significantly improved over the current use of PGD, which is wholly dependent on finding the unaffected embryos amongst a small developing cohort. Genome editing in this context might therefore be regarded as more ethical than PGD, as it would result in the destruction of fewer embryos.

In the future, selection for genetic traits compatible with environmental changes that are happening to our planet may become essential for the survival of our species, although, for the time being, this remains in the world of science fiction.

Conclusion

Since its early days as a pariah of clinical and research practice, IVF has come to occupy a central place in reproductive medicine. With the award of the Nobel Prize to Bob Edwards in 2010, its important role in science and medicine has now been recognised. Despite this recognition, IVF still retains elements of controversy in its present practice and future prospects, presaging of yet more battles to be fought, both nationally and internationally.

Genetic profiling could improve IVF success

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There are three sources of variability in fertility – genetics, the family environment and the individual environment.

Genetic profiling could help determine whether an embryo created through in-vitro fertilisation (IVF) is likely to successfully transfer to the womb, increasing the success rate of the procedure.

It’s part of a field of work looking at the role of genetics in fertility.

‘Understanding why some people do not have children, and developing treatments for them is extremely important,’ said Joris Vermeesch, professor of molecular cytogenetics and genome research at KU Leuven in Belgium. ‘People sometimes spend years of their life trying to get pregnant, and it doesn’t work.’

Despite advances in IVF, its success for each cycle – counted via the so-called baby take-home rate – is only 30%. But a project called SARM, led by Prof. Vermeesch, aimed to improve that figure by looking at ways to identify which embryos were unlikely to survive in the womb.

Already, in 2009, scientists at KU Leuven had discovered that most early IVF embryos were unstable — at high risk of having the wrong number of chromosomes or loss or gain of chromosomal fragments. This made them much less likely to develop properly, leading to failed embryo transfers — and frustration for prospective parents.

Prof. Vermeesch led that initial research. As part of SARM he and his team wanted to find a better a way to detect those imbalances, a method they could apply in IVF to boost its chances of success.

Experiments in human fertility are constrained by ethical boundaries. The scientists worked with cow embryos because bovine reproductive systems mirror those of humans at this stage of embryonic development.

Haplotyping

Using a technique called haplotyping, which determines which gene sets come from which parents, the researchers succeeded in analysing the genetic make-up of an embryo’s cells. This new technique allowed them to determine which embryos are chromosomally unstable and which are more likely to thrive.

The same technology can identify whether an embryo is affected by genetic disease. To reduce the risk of transmission, clinics can simply decide not to transfer those embryos.

‘If we can do these tests on all IVF embryos it’s possible and likely that the success rate of IVF will increase,’ Prof. Vermeesch said. ‘You eliminate those embryos with chromosomal abnormalities and you only transfer those with fewer or no abnormalities.’

Infertility affects 10% of couples in the world, a growing demographic challenge with a human cost. Embarking on having a family later in life is one clear cause, poor lifestyles another, but reproductive health isn’t just about age or wellbeing — some of it is also in our genes.

Scientists exploring the role of genetics in these trends have found that heritability plays a significant part, which is not yet well understood.

‘If we can do these tests on all IVF embryos it’s possible and likely that the success rate of IVF will increase.’

Joris Vermeesch, KU Leuven, Belgium

If there are few environmental constraints and a population cohort follows certain social norms — taking the pill and living through the era of sexual liberation, or postponing childbearing because of pressures in the job or housing market — then genetic factors become more of a factor in the differences in reproductive fertility.

Some problems, like endometriosis, polycystic ovary syndrome or premature menopause, are highly genetic, says Dr Nicola Barban from the Institute for Social and Economic Research at the University of Essex, UK.

Dr Barban is a scientific collaborator on Sociogenome, a project run by Professor Melinda Mills at the University of Oxford, UK, that looks at how infertility is influenced by genetics and environment. It’s the first study to look at these two factors together.

‘What we know is that some women can conceive when they’re in their 40s or late 40s, and some women have problems much earlier in time,’ he explained. ‘We are (investigating) the end of the reproductive window where there’s more variability due to genetics.’

One strand of the project looked at the role of genetics compared with environment and individual choice and studied differences between identical twins, who share 100% of their genome, and fraternal twins, who share 50% of their genomes. The research found that genes make up 15-45% of the factors that determine the number of children a person ends up having, depending on the sample.

Dr Barban stresses that the methods could not be used to predict when an individual might have children because other factors are also involved. ‘Think of three possible sources of variability,’ he said. ‘Genetics, the family environment, the individual environment.’

In 2010, around 48.5 million couple worldwide were unable to have a baby after five years of trying. Image credit - Horizon

Data pool

Next, the Sociogenome researchers wanted to analyse the genome itself. To create their bank of data, the team persuaded 250 other scientists to share their records and formed a massive data pool — roughly 251,000 participants of European ancestry for age at first birth and 343,000 for number of children ever born.

They focused on demographic traits that both men and women share. While fertility research has traditionally focused on the female patient, researchers on Sociogenome wanted to look at both men and women.

‘Much of the research on infertility is on women only but we think that both men and women should be studied,’ Dr Barban said.

This strand of the project probed which parts of individual genes affect child-bearing. It identified 12 genetic loci, or parts of the gene, that can explain around 1% of variation in the age at which a person has their first baby — which may not seem like a lot. But although the results don’t say much about individual fertility at a population level they’re significant, Dr Barban says, because understanding 1% of the genetic predisposition of thousands of people builds a picture of a population’s fertility.

The next phase, with 800,000 participants, aims to show which parts of the gene are expressed in hormones, brain activity and other biological processes — shedding further light on why some people are more fertile than others.

All this doesn’t yet answer the tricky questions of why a particular individual is infertile but it lays the ground for a more sophisticated understanding of the causes of infertility.

‘I think finding the genes that are connected with some of these biological mechanisms could be a very first step towards drug development,’ Dr Barban said.

Are IVF pregnancies more ‘precious’?

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Two pregnant women

Do women with IVF pregnancies need special attention?

  • Women who have gone through fertility treatment often say it had a huge emotional and psychological impact on them and their partners.

In many cases, couples have spent years trying to conceive before going through several cycles of IVF, which can be expensive and traumatic, with no guarantee of success.

So are pregnancies achieved through assisted fertility treatments viewed as inherently more precious to everyone involved?

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“Until you go home with your baby in your arms, that anxiety is always there.”

Susan SeenanInfertility Network UK

A study from Plymouth University published last month suggests they are. Dr Yaniv Hanoch asked 160 Israeli obstetricians and gynaecologists whether they would recommend a test for a serious medical condition during pregnancy.

He found that doctors were three times more likely to recommend the test, which carried a small risk, for a natural pregnancy than for an IVF pregnancy.

Dr Hanoch, associate professor in psychology, said: “When considering a procedure that may endanger a pregnancy, the value ascribed to loss of that pregnancy may seem greater if the pregnancy was achieved by tremendous effort.”

In 2005, Minkoff and Berkowitz published a study in the American journal, Obstetrics and Gynecology entitled ‘The Myth of the Precious Baby’.

It said that because increasing numbers of pregnant women were aged over 40 and more were pregnant thanks to assisted reproductive technologies, this had resulted in more ceasarean deliveries, reinforcing the idea among obstetricians that they were dealing with ‘precious babies’.

Ante-natal check up
IVF women often want reassurance on aches and pains during pregnancy

On the ground, there is less evidence of sensitivity and understanding from health professionals towards women with IVF pregnancies.

Susan Seenan, from the Infertility Network UK, says the system lets these women down.

“When these women finally go to their GP and say they are pregnant, they are referred for ante-natal care and that’s it.

“Even when they make it known they have had IVF, they are seen as just another pregnant lady.”

She says sometimes even when women reveal they have suffered miscarriages or have had fertility issues, there is a lack of sympathy.

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Some women like to feel they have access to extra information as required, even if it’s just a phone number to speak to a midwife about any aches or pains.”

Mr Tim ChildOxford Fertility Unit

She says fertility treatment is widely recognised to be a physically, psychologically and financially demanding process – and it can leave women feeling they have been on an ’emotional rollercoaster’.

“A lot of women feel very anxious, because they have been through so much, and many women really do worry that everything will be OK.

“Until you go home with your baby in your arms, that anxiety is always there. People need to understand why they are feeling vulnerable and anxious.

“If they have been through the IVF system they will have had a lot of attention, appointments, blood tests and scans – and they expect that attention to continue.”

Instead, many women are left feeling isolated when they are most in need of reassurance.

Seenan says this could be remedied by providing support in the form of a phoneline to call in times of anxiety or information leaflets to read.

Research does seem to confirm higher levels of anxiety in women with IVF pregnancies, says Julie Jomeen, professor of midwifery at Hull University, who adds that their feelings can mean they want a more medicalised approach to their pregnancy.

Older mums-to-be may request a caesarean section delivery, believing that it is safer, for example.

An obstetrician discussing options with a pregnant womanSome women choose not reveal they had fertility treatment

Or a woman who is scared of losing her baby throughout pregnancy, may need reassurance that normal symptoms of pregnancy, such as backache, are not something more serious.

Mr Tim Child, medical director at the Oxford Fertility Unit at the University of Oxford, acknowledges that women who have conceived naturally can have anxieties too, but he says it would be understandable if IVF women felt they needed more support.

“Some women like to feel they have access to extra information as required, even if it’s just a phone number to speak to a midwife about any aches or pains.”

He says not all women want to disclose that they have been through IVF because there is still some stigma attached to it. Others may want to be treated the same as every other woman, so their IVF history may not always appear on their personal notes.

Medically, there are slightly higher risks of complications in IVF pregnancies, particularly if the woman is older, has underlying health problems or is having twins, so Mr Child says consultants should be vigilant.

A study is currently underway at Oxford into how midwives care for women have had fertility treatment.

When women with IVF pregnancies are open about their anxieties, what they are looking for is not special treatment in the belief that their baby is more precious than anyone else’s, but reassurance and support during the final stages of a long and emotional journey.

Even when the baby is born, it doesn’t end, Susan Seenan says.

“Because the baby has been wanted for so along, you put pressure on yourself to be a perfect parent. So you’re not allowed to complain when it cries at night or doesn’t feed well. But in the end, we are just parents like anyone else.”

Warning of three-person IVF ‘risks’

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Concerns about the safety of a pioneering therapy that would create babies with DNA from three people have been raised by researchers.

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The advanced form of IVF could eliminate debilitating and potentially fatal mitochondrial diseases.

Writing in the journal Science, the group warned that the mix of DNA could lead to damaging side-effects.

The expert panel that reviewed the safety of the technique said the risks described would be “trivial”.

The UK is leading the world in the field of “mitochondrial replacement”. Draft regulations to allow the procedure on a case-by-case basis will be produced this year and some estimate that therapies could be offered within two years.

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One of our prime interests is about the safety of these techniques.”

Prof Doug Turnbull Mitochondrial replacement researcher

Mitochondria are the tiny, biological “power stations” that provide nearly every cell, which make up the body, with energy. They are passed from a mother, through the egg, to her child.

But if the mother has defective mitochondria then it leaves the child starved of energy, resulting in muscle weakness, blindness and heart failure. In the most severe cases it is fatal and some families have lost multiple children to the condition.

The proposed therapy aims to replace the defective mitochondria with those from a donor egg.

Continue reading the main story

Method one: Embryo repair 1) Two eggs are fertilised with sperm, creating an embryo from the intended parents and another from the donors 2) The pronuclei, which contain genetic information, are removed from both embryos but only the parents’ is kept 3) A healthy embryo is created by adding the parents’ pronuclei to the donor embryo, which is finally implanted into the womb

Continue reading the main story

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But mitochondria have their own DNA, albeit a tiny fraction of the total. It means a baby would have genetic information from mum, dad and a second woman’s mitochondria.

The concerns raised – by scientists at the University of Sheffield, the University of Sussex and Monash University in Australia – are about a poor match between the mitochondrial DNA and that from the parents.

The woman who lost all her children

Sharon Bernardi and her son Edward, who died last year aged 21

Every time Sharon Bernardi became pregnant, she hoped for a healthy child.

But all seven of her children died from a rare genetic disease that affects the central nervous system – three of them just hours after birth.

When her fourth child, Edward, was born, doctors discovered the disease was caused by a defect in Sharon’s mitochondria.

Edward was given drugs and blood transfusions to prevent the lactic acidosis (a kind of blood poisoning) that had killed his siblings.

Five weeks later Sharon and her husband, Neil, were allowed to take Edward to their home in Sunderland for Christmas – but his health slowly began to deteriorate.

Edward survived into adulthood, dying in 2011 at the age of 21.

Now Sharon is supporting medical research that would allow defective mitochondria to be replaced by DNA from another woman.

They said there was an interaction between the DNA in the mitochondria and the rest which is packaged in a cell’s nucleus.

Their studies on fruit flies suggested that a poor match of genetic information between the nucleus and mitochondria could affect fertility, learning and behaviour.

“Describing it as like changing the batteries in a camera is too simplistic,” Dr Klaus Reinhardt from the University of Sheffield told the BBC.

He added : “It is not at all our intention to be a roadblock, we think it is fantastic that for women affected there could be a cure.

“We have pointed out one or two points which need to be looked at.”

‘Trivial’

The Human Fertilisation and Embryology Authority, which regulates fertility treatment in the UK, commissioned a review into the safety of the technique.

Prof Robin Lovell-Badge, who was on the review panel, disagreed. He said humans had diverse mitochondrial and nuclear DNA, so any consequences of poor matches would have already become apparent.

He told the BBC news website: “Humans are breeding between races and producing healthy children all the time. If there is an effect then it must be very trivial as it’s not been noticed.”

He has called for further safety testing, such as research into the risks posed by any defective mitochondria which might still be passed onto a child.

Prof Doug Turnbull, who is developing the mitochondrial replacement therapy at Newcastle University, insisted: “One of our prime interests is about the safety of these techniques.

“It’s perfectly reasonable to draw some of these concerns, I just don’t share the same concerns.

“Mismatch between the mitochondrial and nuclear genome is a potential risk, but I don’t think it’s personally as big a risk as they’re saying.”

Mitochondrion
Hundreds of mitochondria in every cell provide energy

The idea has also raised ethical concerns from groups concerned about the impact of altering human genetic inheritance.

In a statement, the Human Fertilisation and Embryology Authority said: “The panel of experts convened by the HFEA to examine the safety and efficacy of mitochondria replacement carefully considered the interaction between nuclear and mitochondrial DNA and concluded that the evidence did not show cause for concern.

“As in every area of medicine, moving from research into clinical practice always involves a degree of uncertainty. Experts should be satisfied that the results of further safety checks are reassuring and long term follow-up studies are crucial.

“Even then patients will need to carefully weigh up the risk and benefits for them.”

Three-person IVF moves closer in UK.

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The UK has moved closer to becoming the first country to allow the creation of babies from three people.

The Human Fertilisation and Embryology Authority (HFEA) has advised the government that there is no evidence the advanced forms of IVF were unsafe.

The fertility regulator’s public consultation also showed “general support” for the idea as the benefits outweighed the risks.

A final decision on whether to press ahead rests with ministers.

If the techniques were approved it could help a handful of families each year. Around one in 6,500 children develop serious “mitochondrial disorders” which are debilitating and fatal.

Research suggests that using mitochondria from a donor egg can prevent the diseases.

However, it would result in babies having DNA from two parents and a tiny amount from a third donor.

Concerns have been raised both about the safety and the ethics of creating such babies.

The results of a public consultation at the end of 2012 showed there was support for the idea.

Prof Neva Haites, who was on the expert panel supervising the consultation, said: “Broadly speaking the public was in favour of these novel techniques being translated into treatments.

“They felt that any ethical concerns were outweighed by potential benefits.”

One of the main issues raised was of a “slippery slope” which could lead to other forms of genetic modification.

‘Power stations’

Mitochondria are the tiny biological power stations that give energy to nearly every cell of the body.

Defects can leave the body starved of energy, resulting in muscle weakness, blindness, heart failure and death in the most extreme cases.

The cigar-shaped mitochondria are passed only from mother to child. A father does not pass on his mitochondria through his sperm.

Scientists have devised two techniques that allow them to take the genetic information from the mother and place it into the egg of a donor with healthy mitochondria. It is like taking two fried eggs and switching the yolks.

The result is a baby with genetic information from three people, as mitochondria have their own genes in their own DNA.

The implications are not just for the couple and the child. If the therapy was performed it would have ramifications through the generations as scientists would be altering human genetic inheritance.

‘Recommendations’

The HFEA has advised that any changes to the law should be only for the modification of mitochondria to overcome serious diseases and that there should still be a ban on changes to the main nuclear DNA, which contains the vast majority of a person’s genetic code.

It also recommended continuing research and that any children born through these techniques, and possible the children’s children, be monitored closely.

Any time soon?

These therapies using sperm and eggs from three people are not yet ready to be performed in the clinic. However, it is thought that scientists in the UK and the US are getting close to the point where it will be possible.

Prof Robin Lovell-Badge, part of the expert panel analysing the science, said there was “still no evidence to suggest the techniques are unsafe,” but he said further experiments were needed for reassurance.

“Safety is absolutely not a black and white issue. In reproductive medicine in particular it is not possible to be absolutely certain about the consequences of any new treatment until children are born.

“Someone at some point is going to have to take the brave decision to go ahead with it.”

Some of the researchers involved believe they may be ready to make the leap in three to five years – if everything goes to plan, something which is by no means certain.

There was vigorous discussion at the HFEA Open Meeting, where the advice to ministers was agreed, around issues of identification. In sperm and egg donation the donor is identified.

The meeting agreed to advise ministers that there should be no right for the child to know the identity of the donor, however, the HFEA will tell ministers that public opinion was mixed.

Mr Hossam Abdalla, clinical director of the Lister Fertility Clinic in London, told the meeting: “If a child wants to know about that, why are we so restrictive… why are we telling them we they can’t have this access?”

‘Astounded’

Prof Lisa Jardine, chairwoman of the HFEA, said the UK was in one of the most advanced positions in the world.

“Other countries are astounded that we’re this far on in the discussions,” she said.

However, she pointed out the techniques would be used only for mitochondrial disorders: “This is not a Rubicon or a slippery slope.”

One of the pioneers of the field, Prof Doug Turnbull, from Newcastle University, said: “The techniques we are working on could help hundreds of women have healthy children.”

He said more research was required, but it was now “crucial” that the government approved the techniques in the UK.

The Department of Health said mitochondrial diseases could have a “devastating impact” on families and it would consider the HFEA’s advice.

Making three-person IVF legal would not require a new act of Parliament, but would require a vote in both the Commons and the Lords.

Speaking after the meeting Dr David King, the director of Human Genetics Alert, said: “Historians of the future will point to this as the moment when technocrats crossed the crucial line, the decision that led inexorably to the disaster of genetically engineered babies and consumer eugenics.

“This was the moment at which they casually tossed the bioethical consensus of the last 30 years into the trash. And for what?

“Not so mothers could avoid having sick babies, because they could do that already, through egg donation. It was so that a few dozen mothers who insisted they must be genetically related to their child could be satisfied.”

Source:BBC

 

 

 

 

 

Should Men Be Allowed to Father Children After They’re Dead?

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Fertility-treatment innovations mean that all sorts of people who would not have been able to have a baby a generation ago are now able to bring life into the world. Now, some are arguing the ranks of the newly fertile should include dead people.

In Australia, a woman was granted permission last month to use her dead husband’s sperm in an in-vitro fertilization (IVF) attempt to create a child. In Israel, grieving grandparents are petitioning a court to allow them to use their dead son’s sperm to conceive a grandchild. And in California, a woman is due in three months with her husband’s child — even though her husband died not long before she got pregnant.

The rules of post-humous baby-making are only now being written, but it’s a dicey undertaking because individual situations vary so widely. It’s not uncommon for soldiers on the brink of a dangerous deployment to freeze sperm so that their wives can have a child should they die. And patients diagnosed with cancer are increasingly turning to fertility preservation to ensure they can become parents. But what happens when the patient dies, as in the California case in which the husband froze sperm prior to cancer treatment and indicated his desire for his wife to bear his child? And how to rule on the Israeli grandparents’ quest for a grandchild from their son who was injured last year and died after two weeks in a coma?

“That’s much less straightforward,” says Theresa Erickson, the San Diego attorney for the pregnant California woman. “Creating a grandchild is much different than creating a child. Imagine what the child will think: My dad’s dead and he never even knew I existed. It’s a pretty sticky ethical and moral dilemma.”

Erickson’s client had little problem gaining access to her husband’s sperm; a California law governing the posthumous use of sperm requires a fetus be in utero within two years of the death, assuming the donor gave consent before he died. Erickson is petitioning for her client’s husband’s name to be listed on the birth certificate.

In Israel, 27-year-old Ohad Ben-Yaakov wasn’t married or in a committed relationship. But his parents, Mali and Dudi Ben-Yaakov, had his sperm extracted and are waiting for a ruling from the country’s attorney general to find out whether they can use IVF to impregnate a surrogate with his child. “If we were entitled to donate the organs of our son why are we not entitled to make use of his sperm in order to bring offspring to the world?” they asked in Haaretz, an Israeli newspaper.

Israel is already IVF-crazy; health insurance pays for as many IVF cycles as needed to achieve the birth of up to two babies. In 2003, it codified guidelines surrounding posthumous reproduction that allow a spouse or partner to use a dead man’s sperm unless he had specified that was unacceptable.

“This notion of presumed consent, that we can assume that a man would want to have genetic children after his death, that was really pushing the envelope at the time in comparison with other countries,” says Vardit Ravitsky, an Israeli-born assistant professor in the Bioethics Programs at the Université de Montréal Faculty of Medicine. But the ministry refused to allow a man’s mother or father similar access, concluding that parents have no legal standing regarding their children’s fertility, “[n]ot in their lifetime, and certainly not when they are dead.”

In Australia, Jocelyn Edwards and her husband, Mark, were on the brink of signing the paperwork to commence fertility treatment when he was killed last year in a work accident. Although it’s illegal to use sperm without donor consent in New South Wales, where they lived, a judge ruled in favor of Edwards, who had the support of her late husband’s parents and siblings.

“Mark would be so happy,” Edwards said outside the court, according to the Daily Telegraph. “We’re going to have our baby.”

Related Topics: IVF, posthumous sperm donation, Pregnancy, sperm donor, sperm extraction, Family & Parenting, Infertility
Read more: http://healthland.time.com/2011/06/03/should-men-be-allowed-to-father-children-after-theyre-dead/#ixzz22ye1Aa4c

 

Source: http://healthland.time.com