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Fertility Society of Australia Conference held in Adelaide:
December 1997

FICST

A Sydney fertility clinic is trialing a new IVF technique on couples with male factor problems and unexplained infertility. A team from North Shore ART told the Fertility Society of Australia Conference that the procedure called FICSIT combined the successful fertilisation technique of ICSI with the fallopian tube transfer of freshly inseminated embryos.

The clinic said that data supplied by IVF units in Australia and New Zealand for 1994-95 showed a much higher live birth-viable pregnancy rate for women undergoing GIFT (21 to 22 percent) when eggs and sperm were put together in the fallopian tubes compared with IVF (12 to 14 percent) when embryos were transferred to the uterus.

The trial's team said it was evident that the pregnancy potential of the embryos formed in the natural environment of the fallopian tubes during GIFT was significantly higher than for embryos developed in vitro for two or three before transfer.

In the FICSIT technique, about three or four eggs are removed while the woman is under general anaesthetic and quickly transferred to the laboratory where a waiting scientist injects a single sperm into each oocyte. The best two or three injected oocytes are then immediately placed in the fallopian tubes via laparoscopy while the woman is still under the anaesthetic. Any excess eggs are later microinjected with sperm and, if fertilisation occurs, the resulting embryos are cryopreserved for future use.

Dr Ric Porter, of North Shore ART, said the downside of the FICSIT technique was that it was unclear whether fertilisation had occurred. However, 25 patients, took part in the seven-month trial and five pregnancies (20 percent) were achieved.

He said the study demonstrated that oocytes microinjected with sperm immediately after collection fertilised at rates equivalent to the standard ICSI procedure and the resultant embryos were capable of initiating viable pregnancies.

EMBRYO DESTRUCTION

Hundreds of unclaimed frozen embryos belonging to Victorian couples which were due to be destroyed on January 1 have received a three-month reprieve.

The embryos were due to be disposed under state legislation which came into effect at the start of the year prohibiting the storage of embryos after five years.

The reprieve aims to allow clinics time to trace couples who own the embryos. Couples can apply for extensions to the time limit, donate the embryos or ask that they be destroyed.

Janet Anderson, a counsellor from Melbourne's Monash IVF clinic, told the Adelaide conference her clinic had sent letters to 80 couples who had their embryos in storage for more than five years. The letter gave the couples choices about the fate of their embryos in long-term storage.

Only 38 replies were received and four couples could not be traced. "Substantial numbers of people did not respond even though it was clear from the letter sent to them that their embryos would be destroyed if they did not reply,'' Ms Anderson said. "It may be the case that those who did not reply found the decision they were faced with even more difficult than those who did reply."

Of the replies received, the majority of couples wanted their embryos destroyed; while others sought an extension to either use them or consider their decision or offered to donate them.

IVF BABIES

A Melbourne study reported that babies conceived through in-vitro fertilisation are more likely to be born pre-term and of lower birthweight.

The study looked at 478 singleton births conceived at Monash IVF over eight years and compared them with a group of 2385 naturally conceived infants. Alison Venn, of the Centre for the Study of Mothers' and Children's Health, Victoria, said that the high incidence of pre-term birth and low birthweight was an important cause of mortality in IVF pregnancies.

The incidence of low birthweight (less than 2500g) in IVF pregnancies was higher 12.1 percent compared with the control group 5.5 percent.

The rate of pre-term births for the IVF group was 15.3 percent compared with only 6.5 percent and babies who were small for gestational age were 14.6 percent (IVF) compared with 10.7 percent.

Ms Venn said singleton IVF births were significantly more likely to be pre-term and of lower birthweight even after adjustments were taken into consideration for maternal age, prior miscarriages, maternal hypertension and pre-eclampsia.

However, another study presented at the conference found that IVF babies did not over-use health-care resources during their first postnatal year. The study by the Northern Clinical School of Sydney's Royal North Shore Hospital compared the health of IVF-conceived babies with a group of those conceived naturally by mothers of similar age. The IVF babies were not found to have required more visits to general practitioners or admissions to hospital than the naturally conceived infants. However, the IVF babies were more likely to be fully immunised and have had a far greater number of visits to childhood health care centres.

SA LAWS

Tough laws governing IVF treatment in South Australia placed restrictions on infertile couples unheard of in the wider community. Sheryl deLacey, a lecturer at the school of nursing at Adelaide's Flinders University, said the legislation discriminated against infertile couples because of their need for medical treatment.

Ms deLacey said that the laws put the rights of yet-to-be-conceived children ahead of the infertile couple. Under the Reproductive Technology Act (SA, 1988) and an amendment in 1995, an infertile couple can only receive fertility treatment if they have no outstanding criminal charges; no convictions for sexual or violence-related offences and never have had a child removed from their care.

The couples also must "have no diseases or disabilities which would interfere in their ability of capacity to parent a child". In order to prove "their exemplary character", all infertile couples seeking treatment must secure the signature of a Justice of the Peace as witness to their statutory declaration that they are eligible to receive fertility treatment.

"The question of whether better or happier children will be produced by excluding couples comprised of socially dubious character is a eugenic one which ought to be publicly scrutinised," Ms deLacey said. "It raises the question about whether or not you can actually assess who will make good parents and who won't ... normal run-of-the-mill fertile people wouldn't be precluded from reproducing because of criminal records.

"Those same regulations create a paradox for practitioners who may be called upon to assist reproduction because of disability or disease, while simultaneously being required to discriminate against the disabled or ill on the grounds of a parenting ability which must, at best, be judged speculatively."

Ms deLacey said that in that past year, Australia had witnessed an increased number of public claims of injustice in relation to access to assisted reproduction technology. These claims heard in law courts or anti-discrimination tribunals included the issues of access to IVF by single women (SA), lesbian women's access to donor sperm (Queensland), de facto couples access to infertility treatment (Victoria). Ms deLacey said that while these cases had received wide media coverage, many Australians were unaware of the "unjust" laws existing in South Australia.

LEBIAN v STRAIGHTS

Lesbian couples were often better prepared for parenthood than most heterosexual couples, Henry Wellsmore, of Newcastle's Lingard Fertility Centre, told the conference that the lesbian couples who took part in his study had long considered the implications of bringing a child into their lives. He said lesbian couples were far more open about the child's conception than were "straight couples" who had also used donor sperm to achieve a pregnancy.

Mr Wellsmore said that in December 1995 the Lingard clinic began treating single women and lesbian couples with donor sperm. As part of his study, he interviewed 14 lesbian couples and 25 single women.

Some of the issues common to both groups were: access to male role-models; the child's "need" for a father and the problems faced when answering the question "where is my dad?; legal issues and the challenge of a developing a family structure. He said single women were often "seeking a toy" when they sought fertility treatment.

ART ACCEPTANCE

In another study presented at the conference, it was shown that Australians were becoming more accepting of single women and lesbian couples receiving infertility treatment.

Pia Broderick, of the School of Psychology at Perth's Murdoch University, found respondents to her survey were more concerned about the stability of the potential parents' relationship than with their sexual preferences.

The study of 218 women and 153 men also examined the community's general acceptance of fertility treatment.

Ms Broderick found a high approval for assisted reproductive technology being accessible to traditional infertile couples (married and de facto heterosexual couples of child-bearing age) and a growing acceptance of single women and lesbian couples to the same treatment.

Female respondents were more approving of access to ART than males, and younger respondents (18-35 years) were more approving than older respondents (over 35 years).

Religion played a strong predictor of disapproval of assisted reproductive technology, with Roman Catholics strongly disapproving of all aspects of ART.

SPERM DONOR STUDY

Sperm donors in Australia are more prepared to have their semen used by single women and lesbian couples than donors from New Zealand, according to research by Queensland Fertility Group staff.

Of a survey of donors in the two countries, 64 percent of the men who donated sperm in Brisbane said they had no objection to their semen being used by lesbians, compared with 36 percent of donors at an Auckland clinic.

When asked if their sperm could be given to single women seeking to have a baby, 79 percent of the Brisbane respondents agreed, while only 46 percent were willing in New Zealand.

QFG's Heather Pollock told the conference that the significantly more liberal attitude by local donors could simply reflect societal attitude differences between the two countries or to the higher percentage of tertiary educated donors in the Brisbane programme (43 percent compared with 35 percent).

Of the donors in New Zealand, 59 percent already had their own children, compared with 36 percent of the Queensland donors. The average age of a Brisbane donor was 31, while Auckland donors averaged 33 years.

Ms Pollock said there had been a move away from the use of anonymous donors, who had most often been medical students, to "known donors" who were willing for their identity to be released to resulting children when they reached adulthood.

Another paper presented at the conference examined patient satisfaction to a programme using sperm by a known donor.

Helen Kane said of the small study of five couples, carried out through the Prince Henry Institute of Medical Research in Melbourne, four of the sperm donors had been the brothers of the husbands and the other was a friend of one of the wives.

Most of the infertile couples surveyed said they chose to have a known donor because they wanted to have the donor's biological knowledge; characteristics of the donor were known; the donor and child could maintain a relationship; and there were fewer "risks" compared with using the sperm of anonymous donors.

Ms Kane said the study's participants expressed positive feelings about their decision to use known donors and they did not report any negative repercussions as a result.

Most of the couples said they would tell the child about their conception and the identity of their biological father.

We would like to thank the Friends of the Queensland Fertility Group for allowing us to reproduce this article on our webpage.

 

 

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