PubMed · 13495327
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O DAUWE. 1957-10-12. [Artificial fertilization].. https://pubmed.ncbi.nlm.nih.gov/13495327/
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Parliament will soon be asked to decide about the future regulation of IVF in the United Kingdom. Given that IVF is now considered to be a routine clinical procedure and the fact that we live in an age of unprecedented emphasis on autonomy and patient rights, the justification for continuing to regulate this form of treatment will undoubtedly be challenged. This article considers the four key reasons why the Human Fertilisation and Embryology Authority (HFEA) was originally established-to protect patients and their children, to allay public concerns, to protect scientific freedom and to protect IVF practitioners from claims of unethical behaviour-and asks to what extent these reasons are still valid today. Acknowledging that there are difficulties and frustrations with the HFEA, the article warns that all parties-patients, researchers, IVF practitioners and society-have a lot to lose by limiting the scope of regulation. It concludes that before moving too quickly to get rid of the HFEA as we know it, we need to think carefully about whether the burdens and restrictions imposed by regulation are sufficiently onerous to justify this loss.
OBJECTIVE: To update clinicians on different gonadotropin regimens for ovarian stimulation for IVF including the use of urinary and recombinant gonadotropins, the value of added LH to FSH in the stimulation regimen, the use of GnRH agonists and antagonists, and the role of minimal stimulation protocols. DESIGN: Literature review and critical analysis of major articles during the last five years on ovarian stimulation for IVF. CONCLUSION(S): Urinary and recombinant gonadotropins, for ovarian stimulation for IVF, are probably equally safe and effective. The higher cost for recombinant products limits their worldwide use in IVF. Conflicting data exist regarding the benefit of adding LH to FSH in the stimulation regimens. The use of different GnRH-agonists, of varying potency, may account for different levels of LH suppression. Adding LH should be considered in severe situations of LH suppression such as with the use of potent GnRH-agonists or when GnRH-antagonists are introduced during the course of stimulation. GnRH-antagonists provide advantages to patients in terms of fewer injections, shorter stimulation days, and avoidance of adverse effects of agonists. The incidence of ovarian hyperstimulation syndrome is probably less with antagonists compared to agonists, with the option to use an agonist as a surrogate LH surge. Fixed and early start of the antagonist is probably more effective than an individualized and late start. The earlier reported lower pregnancy rates with antagonists compared to agonists is not fully understood and needs to be continually monitored. Minimal stimulation protocols using a combination of clomiphene citrate and gonadotropins are attractive and should be considered in some patients owing to lower costs and acceptable success rates. The optimal stimulation protocol for IVF should be an individualized regimen based on the patient's ovarian physiology and prior IVF experience, if any.
Professional societies that are stakeholders in preimplantation genetic diagnosis have democratically elected officers and favor self-regulation. Their practice guidelines are cognizant of societal needs and allow for introduction of new technologies. These societies have demonstrated the ability for professional self-regulation by collection, validation, and promulgation of center-specific results.