Tag: multiple pregnancy

Bioethics News

Murky picture of IVF complications in UK

Five years ago, a paper published in the BMJ came to the startling conclusion that IVF was more dangerous than abortion in the UK. The 2007 UK Confidential Enquiry into Maternal Death recorded four deaths directly related to IVF via ovarian hyperstimulation syndrome and three deaths related to multiple pregnancy after IVF. Thus, more deaths were related to OHSS than to abortion (two) despite many fewer IVF procedures (for example, there were 48,829 IVF cycles v 198,500 abortions in the UK in 2007).

Has the situation improved since then?

UK authorities are making it very difficult to find out, suggests Dr Geeta Nargund in BioNews. She points out that the UK’s fertility watchdog, the Human Fertilisation and Embryology Authority, reported a “slight increase” in severe OHSS incidents in 2015. However, at 40%, the increase was far from slight. She writes indignantly:

The HFEA should be putting this alarming statistic on the front page and discussing methods to reverse this trend. Yet the very opposite appears to be the case. It is impossible to extract the number of OHSS cases from this report and it has only come to light thanks to the persistence of Guardian science reporter Hannah Devlin… there remain questions about whether any maternal deaths that may be linked to OHSS have been reported.

She argues that the HFEA should expose OHSS complications and should make renewal of the licences of IVF clinics conditional upon the incidence of OHSS. “By this means, the welfare and safety of women undergoing IVF treatment would be more effectively protected.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Kudos to Quebec IVF Docs for Reducing the # of Multiple Pregnancies

Françoise Baylis reviews some of the proposed changes to public funding of IVF in Quebec and explains why these changes will not increase the multiple pregnancy rate.

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In August 2010, the province of Quebec began public funding of IVF. Insured services included the transfer of one or two embryos in women 36 years of age or under, and the transfer of up to 3 embryos (including no more than two blastocyst stage embryos) in women 37 years of age or over. Predictably, these regulations resulted in a dramatic reduction in the number of multiple pregnancies in the province (from 27.2% in 2009 to 5.2% in 2013).

Four years later, the Quebec government is now looking to radically revamp its IVF program (see here and here). On November 28, 2014, the government tabled Bill 20, An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation. Bill 20 replaces public funding of IVF under the provincial health insurance plan with a sliding scale of tax credits. At one end of the spectrum, families earning less than $50,000 a year will be eligible for an 80% tax credit. At the other end of the spectrum, families earning more than $120,000 a year will be eligible for a 20% tax credit. Bill 20 also limits the number of embryos that may be transferred into a woman per cycle. Single embryo transfer will be mandated for women under 37, while women between the ages of 37-42 will be eligible for double embryo transfer.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

EMBRYO REDUCTION

EMBRYO REDUCTION

“We believe that even a single foetal reduction is ethically questionable and that the practice should not be in use at all”.

One of the main consequences of the use of In Vitro Fertilization is the significant increase in multiple pregnancies; however this can also be caused by ovarian stimulation and intrauterine insemination.

It is widely known that multiple pregnancies increase the risk of suffering from other medical problems in both mothers and their foetuses.

That is why the number of implanted embryos is often regulated in order to reduce the number of multiple pregnancies, especially when there is no decrease in the rate of pregnancy and live births with single embryo transfer, when compared to multiple embryo transfer (Fertil Steril 95; 491, 2010), although not all experts are in agreement on this fact.

As a consequence, some countries have passed laws which regulate the number of embryos that can be transferred, limiting them to no more than two or three. Other countries do not have any regulations to this effect.

At any rate, it is clear that multiple pregnancies still occur and the way to “solve” this issue is to try to reduce the number of foetuses in order to increase the survival rate of those which remain after said reduction.

But before we continue, it is important to first understand what we mean when we say foetus reduction as opposed to selective termination (Reproductive BioMedicine Online, 26; 542-554, 2013). The latter term refers to eliminating foetuses which suffer from some medical condition, Down Syndrome in particular while the first term refers to the elimination of healthy foetuses, and its only aim is to “solve” the problem of multiple pregnancies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.