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IVF should only be available to women in a relationship MP2 9 th April 2013.

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Presentation on theme: "IVF should only be available to women in a relationship MP2 9 th April 2013."— Presentation transcript:

1 IVF should only be available to women in a relationship MP2 9 th April 2013

2 The cost of raising a child The cost of raising a child to the age of 21 has soared to £222,458, with parents paying 58% more than a decade ago (LV=, 2013). The annual ‘Cost of a Child: from Cradle to College' report by insurer LV= found that the average cost is up by more than £4,000 since Education and childcare continue to be the biggest expenses. The cost of education, including uniforms, after school clubs and university costs (private school fees not included) has now reached £72,832 on average.

3 With the cost of raising children at such startling levels, single women looking after children by themselves are at greater risk of financial instability and stresses in comparison to their partnered counterparts. These financial problems have repercussions for the single parent families in question, their wider networks and the national economy and welfare state. Is it right to create a situation in which bringing up a child alone is more ‘accessible’, considering the wider financial implications?

4 NICE IVF Guidelines Criteria for referral for IVF (newly updated): When considering IVF as a treatment option for people with fertility problems, discuss the risks and benefits of IVF in accordance with the current Human Fertilisation and Embryology Authority (HFEA) Code of Practice. [new 2013]Human Fertilisation and Embryology Authority (HFEA) Code of Practice Inform people that normally a full cycle of IVF treatment, with or without intracytoplasmic sperm injection (ICSI), should comprise 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s). [new 2013] In women aged under 40 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 3 full cycles of IVF, with or without ICSI. If the woman reaches the age of 40 during treatment, complete the current full cycle but do not offer further full cycles. [new 2013] In women aged 40–42 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 1 full cycle of IVF, with or without ICSI, provided the following 3 criteria are fulfilled:

5 NICE IVF Guidelines - they have never previously had IVF treatment - there is no evidence of low ovarian reserve (see recommendation ) - there has been a discussion of the additional implications of IVF and pregnancy at this age. [2013 addition] Where investigations show there is no chance of pregnancy with expectant management and where IVF is the only effective treatment, refer the woman directly to a specialist team for IVF treatment. [2013 addition] In women aged under 40 years any previous full IVF cycle, whether self- or NHS-funded, should count towards the total of 3 full cycles that should be offered by the NHS. [2013 addition] Take into account the outcome of previous IVF treatment when assessing the likely effectiveness and safety of any further IVF treatment. [2013 addition] Healthcare providers should define a cancelled IVF cycle as one where an egg collection procedure is not undertaken. However, cancelled cycles due to low ovarian reserve should be taken into account when considering suitability for further IVF treatment. [2013 addition]

6 Religion The beliefs of a number of religious groups do not condone IVF procedures – either altogether or in the situation where a woman is not in a relationship. The following slides outline the stance of some of these religious groups. The Roman Catholic Church: has long rejected any reproductive technologies that manipulate human embryos. condones procedures that "assist" conception that would happen naturally = that the egg and the sperm must meet on their own and this union must occur within the biological mother's natural reproductive system. allows two types of reproductive assistance, Intrauterine Insemination (IUI) and Gamete Intrafallopian Tube Transfer (GIFT). forbids third-party reproduction, specifically egg donation and surrogacy, whether traditional or gestational.

7 Religion Judaism: In Jewish teachings IVF using the father and mother’s sperm and eggs is generally accepted (although there is some debate here), but it requires rabbinical supervision to be considered halachic, or in accordance with Jewish law. When considering donated eggs or sperm, there again is not a complete consensus. With respect to egg donation and surrogacy, there is debate as to whether the status of the child is based on the egg donor’s heritage, the woman carrying the child, or both. In response to this ambiguity, recently a law was passed in Israel which forbids third- party reproduction, specifically egg donation and surrogacy, whether traditional or gestational, that allows women to donate their eggs for infertile couples. The law provides that a baby born through IVF will be the legal child of the birth mother, rather than the egg donor. The egg donor’s identity is not disclosed, but a national database will allow recipients of egg donations to check the religion of the donor. There has been recent controversy related to rulings by some Israeli Orthodox rabbis that whether a child is Jewish under the rules of matrilineal descent relies on the donor’s descent, not the birth mother, as language pertaining to the subject of procreation and descent in Jewish text references the “seed.”

8 Religion Islam As reproductive technologies have evolved so rapidly, modern Muslim jurists have found it necessary to research the subject of assisted reproduction as it relates to the Koran. They reached an Ijtihad (decision based on Islamic Law) on IVF and determined that the practice is permissible provided that the semen and ovum are from a couple who are legally married and that the fertilization takes place during their marriage, but not after divorce or the death of the husband. The Sunni Muslim (Sunni’s represent about percent of the Muslim population) position on third party reproduction states that no third party should interfere with the marital acts of sex and procreation. This means that a third party donor is not allowed, whether he or she is providing sperm, eggs, embryos or a uterus. The use of a third party in any respect is considered adultery. All forms of surrogacy are forbidden. A Muslim woman may not serve as a donor or surrogate, nor a man as sperm donor.

9 Eugenics Darwin and natural selection Natural selection is the gradual non-random process whereby biological traits become either more or less common in a population as a function of differential reproduction of their bearers. It is a key mechanism of evolution. Darwin intended to compare natural selection with artificial selection/selective breeding or human interference in animal and plant breeding. As opposed to artificial selection in which humans favour specific traits, in natural selection the environment acts as a sieve through which only certain variations can pass. (Darwin, 1859)

10 Eugenics Eugenics is the applied science of the bio-social movement which advocates practices to improve the genetic composition of the population, usually a human population. It is a social philosophy advocating the improvement of human hereditary traits through the promotion of higher reproduction of more desired people and traits, and reduced reproduction of less desired people and traits. Eugenics was the motivation for some government policies in Europe and the USA in the first half of the 20 th century that included forced sterilisations, selective breeding and ‘racial hygiene’.

11 Sperm as a commodity Consumers can peruse donor catalogues listing race, ethnicity, height, weight, hair colour/texture, skin tone, facial structure, IQ, years in education, talents, hobbies, religious convictions, temperament etc of the men whose sperm is for sale. Both sperm donors and their sperm are subjected to stringent forms of testing and screening to ensure their health and marketability of their product. Sperm has become a commodity in contemporary market driven society. The marketing and sale of sperm keeps alive eugenic ideals by allowing the consumer to select a donor with particular traits. The selling of sperm has become like the selling of any other commercially marketed product. Sperm banking and the popular eugenics of its clients combine to perpetuate the myth that all desirable human traits are transmitted genetically, and that the traits most characteristic of certain races and social classes are the most desirable universal human traits. (Daniels C.R. & Golden J. 2004)

12 Financial Implications on NHS An IVF cycle can cost the NHS around £1,300, if using frozen embryos. Using eggs which are removed, inseminated and having the embryos implanted back into the body without having being frozen costs just over £3000. A cycle of intracytoplasmic sperm injections costs the NHS an extra £500 in addition to the £3000 figure above.

13 Single Parents & Poverty Single parents are: Twice as vulnerable to poverty compared to their partnered counterparts. Limited with regards to hours that can be worked, thus capping and/or reducing income. They are often in low paid, unskilled work. *Two out of three single families live in poverty* The Government is currently making changes to reduce benefits including cuts to child benefit and reduction of childcare element of working tax credits. These changes, and others, would work against single parent families.

14 Adoption and Fostering [This information is about looked after children in England for the year ending 31 March 2012] There were 67,050 looked after children in England, of which only 3,450 were adopted. 50,260 were cared for in a foster placement. This represents 75 per cent of all children looked after at 31 March % were boys and 45% girls 2% were aged under 1 year 74% were aged between 1 and 4 STATUTORY GUIDANCE ON ADOPTION: ELIGIBILITY CRITERIA This guidance is issued under section 7 of the Local Authority Social Services Act 1970, requiring local authorities in their social services functions to act under the general guidance of the Secretary of State. 4. A person or couple cannot apply for an assessment of their suitability to adopt unless they meet, or would meet, the eligibility criteria to apply for an adoption order. The criteria is: the prospective adopter(s) is single, married, in a civil partnership or are an unmarried couple (same sex or opposite sex) and 21 years old;

15 Cost of privately-funded IVF These costs are an illustration of privately-funded IVF. The example costs are from IVF package quotes at ‘The Bridge Hospital’, London Bridge. These figures exclude HFEA fee, scanning and medications which incur an additional fee. Standard IVF - £3,300 IVF 3 cycle package - £8,000 Egg donation - £6,500 (anon) £5,760 (known donor) Egg donation - £8,800 (UK Based) £10,500 (International Donor)

16 Children of IVF Single mothers can struggle with parenthood and are typically associated with lower socioeconomic status than two-parent households. Furthermore, single parenthood is associated with increased risks for both mothers and babies, with both at more risk of suffering poor health outcomes. The strain of living under such financial and social circumstances are associated with higher incidence of domestic abuse towards children and there is indication that children in single parent households have a higher incidence of psychiatric problems.

17 Children of IVF On average, children in single parent families do less well than those in two-parent households in terms of both psychological adjustment and academic achievement. They are also less likely to go on to higher education and more likely to leave home and become parents themselves at an early age.

18 Children of IVF Studies of children raised in fatherless families from the outset (sometimes described as ‘solo’ mother families) are now beginning to appear in recent research. It still remains a poorly researched area due to the quick progression of reproductive technologies and there have been few longitudinal studies that show the effects of donor insemination. There is currently no research that shows the effects of disclosing to children that they are the product of an IVF pregnancy. Should we advocate IVF availability to single women before we truly know the long-term implications for the families themselves and society as a whole?

19 Children of IVF Findings suggestive of an association between secrecy about genetic parentage and negative outcomes for children have come from two major sources: research on adoption and the family therapy literature. It has been demonstrated that adopted children benefit from knowledge about their biological parents, and that children who are not given such information may become confused about their identity, and are more at risk from suffering emotional problems.

20 Children of IVF As well as considering a woman’s desire to have children, should we not also consider the future outlook for the one parent child in question? Making IVF available to single women will possibly contribute to problems regarding their offspring’s knowledge, or lack thereof, about their biological background.

21 How has the use of IVF and ICSI treatment changed over time? Overall, IVF and ICSI use has increased steadily since Number of women treated with IVF and ICSI started in 1992 to 2007 Note: The figures given for ICSI treatment include those for SUZI cycles. The number of women treated with IVF increased until Since then, the number treated has remained constant at about 18,500 women per year. The first babies conceived following ICSI treatment in Belgium were born in As it was more successful even with poor quality sperm, ICSI began to replace SUZI treatment and the outcome rates began to improve. SUZI is no longer used. By 2006 ICSI and IVF were used to treat roughly equal numbers of women having fertility treatment. ICSI was originally used only for the treatment of couples with male factor infertility. It is now used for a wider range of problems including unexplained infertility. Before ICSI was developed, couples with severe male factor problems had a very low chance of conceiving following IVF. Many couples in this situation used donor insemination or adopted

22 How has the use of IVF and ICSI treatment changed over time?

23 Is it right that the NHS, what with the many strains it is currently under, should have to fund and deal with a further (possibly substantial) increase in the number of IVF cases it must handle? Apart from the standard plan of care for IVF couples, the NHS would surely have to implement a more comprehensive plan for single women, considering the additional issues that have come to light. More work would possibly be required, for example, with regards to counselling and legal matters.

24 A ‘right to family life’? The above statement is an a common misquotation. Article 8 of the European Convention on Human Rights is ‘the right to respect for private and family life’. 1. Everyone has the right to respect for his private and family life, his home and his correspondence. 2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. However - a right to respect for family life is not necessarily the same thing as a right to have a family. The Government, taxpayers and the NHS do not have an absolute duty or obligation to provide people with a family, surely?

25 References Baird S.L. (2007) Designer Babies: Eugenics Repackaged or Consumer Options? Technology Teacher vol 66 (7), Clamar, A. (1989) Psychological implications of the anaonymous pregnancy. In Offerman-Zuckerberg, J. (ed.), Gender in Transition: A New Frontier. Plenum Press, New York, USA. Daniels C.R. & Golden J. (2004) Procteative Compounds: popular eugenics, artificial insemination and the rise of the American sperm banking industry. Journal of Social History vol 38 (1), Darwin C. (1859) The Origin of Species, University of Pennsylvania Press, Department of Education (2012) Children looked after by local authorities in England, including adoption [online] Available from: [Accessed on: 04 April 2013] Department of Education (2011) Statutory guidance on adoption [online] Available from: [Accessed on: 06 April 2013] Department of Health (2007) Maternity Matters: choice, access and continuity of care in a safe service. London: Department of Health. Ferri, E. (1976) Growing Up in a One Parent Family. NFER, Slough, UK. Golombok, S., Spencer, A. and Rutter, M. (2006) Children in Lesbian and Single-parent households: psychosexual and psychiatric appraisal. Journal of Child Psychology and Psychiatry, 24:4, Golombok, S. (1998) New families, old values: considerations regarding the welfare of the child (DEBATE) Golombok, S., Tasker, F. and Murray, C. (1997) Children raised in fatherless families from infancy: family relationships and the socioemotional development of children of lesbian and single heterosexual mothers. J. Child Psychol. Psychiatry, 38, 783–791

26 References Harrison, A (2013) Adoption map launched to encourage would-be adopters [ online]Available from: [Accessed on 8 th April 2013] Hoopes, J.L. (1990) Adoption and identity formation. In Brodzinsky, D.M. and Schechter, M.D. (eds), The Psychology of Adoption. OxfordUniversity Press, Oxford, UK. Karpel, M. (1980) Family secrets. Family Proc., 19, 295–306. McLanahan, S. and Sandefur, G. (1994) Growing Up with a Single Parent: What Hurts. What Helps. Harvard University Press, Cambridge, MA. Neate, R. and Stewart, H. (2011) Women bear the brunt as Birmingham hits hard times again. Available from: National Institute for Clinical Excellence (2012) NICE consults on updated recommendations for treating infertility [online] Available from: [Accessed on 23rd th February 2013] National Health Service North West London (2012) IVF Policy [online] Available from: [Accessed on 23 rd February 2013] Papp, P. (1993) The worm in the bud: secrets between parents and children. In Imber-Black, E. (ed.), Secrets in Families and Family Therapy. Raleigh, V.S., Hussey, D., Seccombe, I et al (2010) Ethnic and Social inequalities in women’s experience of maternity care in England: results of a national survey. Journal of the Royal Society of Medicine, 103:5, Richards M. (2008) Artificial insemination and eugenics: celibate motherhood, eutelegenesis and germinal choice. Study of History, Philosophy, Biology and Biomedical Science vol 39, Sants, H.J. (1964) Genealogical bewilderment in children with substitute parents. B. J. Med. Psychol., 37, 133–141. Schechter, M.D. and Bertocci, D. (1990) The meaning of the search. In Brodzinsky, D.M. and Schechter, M.D. (eds) The Psychology of Adoption. Oxford University Press, Oxford, USA.

27 References Silver L.M. (2000) Reprogenetics: third millennium speculation. EMBO Reports vol 1 (5), Snowden, R. (1990) The family and artificial reproduction. In Bromham, et al. (eds), Philosophical Ethics in Reproductive Medicine. Manchester University Press, Manchester, UK. Snowden, R., Mitchell, G.D. Snowden, E.M. (1983) Artificial Reproduction: A Social Investigation. George Allen & Unwin, London, UK. Triggle, N. (2012) NHS trusts in debt double in year [online] Available from: [Accessed on 8 th April 2013] Triseliotis, J. (1973) In Search of Origins: The Experiences of Adopted People. Routledge & Kegan Paul, London, UK. Weinraub, M. and Gringlas, M. (1995) Single parenthood. In Bornstein M.H. (ed.), Handbook of Parenting. Vol. 3. Status and Social Conditions of Parenting. Lawrence Erlbaum Associates, Hove.

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