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Rights and responsibilities in IVF

Posted 01-26-2008 at 03:45 PM by ivf News Reporter
Dr Robert Norman
Sep 3, 2007

Assisted Reproductive Technology (ART) has come a long way since the early 1980s when a few Australian Universities and hospitals started their journey with IVF and associated technologies. Many couples went through numerous cycles of IVF without success while the clinical and scientific techniques were developed.

The first pregnancy was in the early days of 1980 at the Royal Women's Hospital in Melbourne and was followed by more pregnancies centred around Melbourne units which ultimately became Melbourne IVF and Monash IVF.

It was not long before groups in Adelaide started to achieve pregnancies particularly at Flinders Medical Centre and The Queen Elizabeth Hospital.

Since then Australian Scientists have been at the forefront of developing these technologies particularly through the groups at Monash (Trounsen and colleagues) and the University of Adelaide (Cox, Matthews and colleagues).

Australian units were the first to introduce donor eggs, frozen embryos and frozen eggs into the repertoire of modern IVF and were at the forefront of the development of techniques around sperm injection (ICSI) and Pre-Implantation Genetic Diagnosis (PGD). In addition they were the first to develop lifestyle programs to optimise the conditions in which women became pregnant. They have been world leaders in reducing the numbers of embryos to be transferred so that some IVF units now put back almost exclusively only one embryo and they retain world-class pregnancy rates.

All this has been done in an environment where the Federal Government, through Medicare, has made IVF treatment relatively inexpensive and as a result reduced the risk taking by both doctors and clients who participate in this process. Australian science has also been a major contributor through its fundamental discoveries in embryology, genetics and biotechnology. Close to 3 per cent of all babies in Australia are now born from IVF and we may soon approach the Danish mark of 5 per cent.

Amidst this glowing picture one must ask whether everything is as rosy as it appears.

Pregnancy rates are still patchy across Australia and the introduction of the Medicare Safety Net, which has reduced costs to patients to very low amounts, has coincided with a rapid increase in the use of IVF and a reduction in the use of other simpler technologies such as ovulation induction, intrauterine insemination and lifestyle modification.

There is still a strong case to be made that congenital abnormality rates are higher among children who have been born from IVF and ICSI although this may be a contribution of the parent rather than the technology.

Any twin pregnancy is at much higher risk of problems at birth and in pregnancy than a singleton baby and we still are producing 20 per cent of babies by multiple pregnancies.

Even single babies from IVF have double the chance of dying or having complications.

Newer genetic technologies are suggesting that gene silencing (epigenetics) can be substantially altered by the process of embryo culture, especially when extended embryo culture occurs blastocyst. There are a number of clinical diseases that can be detected at birth which, although rare, are possibly associated with the IVF technology.

We have seen the rise of reproductive tourism whereby patients fly to the United States to have surrogacy, donor embryos or sex selection of their offspring where the local laws inhibit these procedures to be performed.

Donor eggs are rare in Australia but women can fly to Russia or Spain and be given eggs with relatively little difficulty.

We are seeing the rise of IVF mega businesses whereby some of the people running IVF units are more interested in the financial aspects than the medical components of IVF.

In some places IVF is almost becoming a production line whereby diagnosis is ignored merely to get a patient into the IVF process and thereby produce a baby. With this, couples are happy to have a healthy baby but a diagnosis is never made and no research investment occurs to improve our knowledge.

Australian scientists and clinicians have been spectacularly successful in their contribution to modern assisted reproductive technology.

Numerous commendable changes have been introduced into the process that makes Australian IVF among the best in the world.

This is supported by the Medicare system which is incredibly generous for couples and clinics offering this technology.

The increasing privatisation of many units, the lack of research and the financial incentives to perform IVF, rather than simpler procedures, cast a shadow over the future of Australia's ability to remain at the forefront of this technology.

Dr Robert Norman is director of the Research Centre for Reproductive Health and Professor of obstetrics and gynaecology at Adelaide University.
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