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Philippa Taylor

New warnings on risks of popular infertility treatments

Philippa Taylor is Head of Public Policy at CMF. She has an MA in Bioethics from St Mary’s University College and a background in policy work on bioethics and family issues.
The views expressed do not necessarily reflect those of CMF.

Hot on the heels of warnings last week about one in ten babies suffering birth defects after ICSI (intracytoplasmic sperm injection) come more warnings about the use of drugs in fertility treatments that is putting both women and children at real risk to their health.

In some ways neither news item should come as a great surprise as the risks of both have been known about for years. However the fertility industry is a big commercially driven, money-making business and the danger is these risks are too often downplayed or ignored.  These new reports should serve as a reminder that money appears to be putting the health of women and children at risk.

Last week a large new study from Australia found a significantly increased risk of handicap for children born using the common and popular infertility treatment, ICSI.  It found that one in ten children conceived using the fertility treatment ICSI have birth defects.

This study was widely reported in the media.  ICSI involves injecting one sperm directly through the shell of an egg and depositing it inside.  It is used when sperm quantity or quality is not sufficient to achieve fertilisation through normal intercourse. The major advantage of ICSI is that as long as some sperm can be obtained, even in very low numbers, fertilisation is possible.

The Australian research followed 1,000 babies born by IVF or ICSI for five years, and followed 500 five-year-old children who were conceived naturally. The unadjusted risk of a birth defect was 5.8% following natural conception, compared with 7.2% following IVF, and 9.9% after ICSI.

ICSI is inceasingly popular in the UK with around half of fertility treatment cycles in the UK using it.  The number of babies born in the UK through using ICSI has steadily increased since it was introduced in 1992.

The HFEA produces long-term data on fertility treatments so I did a quick calculation of their figures for numbers of live babies born using ‘micro-manipulation treament’ (99% of which are through using ICSI, none through IVF).

Between 1992-2005 there were approximately 37,800 babies born using ICSI.  It does not take a good mathematician to work out that, in the UK alone, one in ten would give a rough total of 3,700 babies born with handicap as a result of ICSI up to 2005.

The journal article warns:Although the large majority of births resulting from assisted conception were free of birth defects, treatment with assisted reproductive technology was associated with an increased risk of birth defects, including cerebral palsy, as compared with spontaneous conception. In the case of ICSI, but not IVF, the increased risk of birth defects persisted after adjustment for maternal age and several other risk factors.

So why might using ICSI carry these extra risks of handicap?

The risks mostly stem from the fact that nature no longer selects sperm – it is the embryologist in the laboratory who does this. ICSI bypasses natural selection of sperm (eliminates competition) because only one sperm is used.

The following concerns have arisen from using ICSI:

  • The risks of using sperm that potentially carry genetic abnormalities; it is thought that males eligible for ICSI carry a higher rate of genetic defects.
  • The risks of using sperm with structural defects: although there is no absolute evidence that a physically abnormal sperm has abnormal genes, these sperm would not normally be able to fertilise an egg.
  • The potential for damage (eg. from the needle or the chemicals used in the procedure), especially damage to the chromosomes.
  • the risk of introducing foreign material into the oocyte: some culture media may contain heavy metals known to be toxic to sperm.

ICSI has been described as an experiment on a large scale, using children as subjects. This new research shows that too many children are bearing the brunt of the costs of this experiment.

The other news to hit the headlines is a direct accusation that IVF clinics are putting money before safety by using aggressive fertlity drugs that put women’s and children’s health at unjustified risk. The use of high doses of drugs to stimulate the ovaries for egg production can cause ovarian hyper-stimulation syndrome (OHSS), with symptoms such as chest pains, shortness of breath and, in rare cases, kidney failure and death. It can also cause chromosomal abnormalities in the resulting embryos.

Again, this has been a long-term concern with fertility treatment but the news today is that there were almost 30,000 cases of OHSS between 1991 and 2007 in the UK, according to figures obtained from the Human Fertilisation and Embryology Authority (HFEA) in response to a request under the Freedom of Information Act.  OHSS is now one of the biggest causes of maternal mortality in England and Wales.

I’m sure the women at Cambridge University currently being directly targetted by one clinic for their eggs would think twice if they knew more about the long-term dangers to their health and fertility from these drugs.  But do they know?

These reports should be a challenge to clinics offering fertility treatments and to the regulator, the HFEA. What are their obligations to prospective parents and to children born from such procedures, when doctors know there are risks involved? Are women being told of these risks? Is money put before safety? Is data being kept hidden? Is the use of prenatal diagnosis leading to more abortions after ICSI? When IVF and ICSI children grow up, will we see lawsuits and claims for healthcare costs against doctors and clinics?

Of course fertility treatments have brought the joy of parenthood to many thousands of couples facing the hearbreak of infertility. However, the costs that come with this are ignored or dismissed by fertility clinics, and yet are paid for, with their pockets and their health, by couples desperate to conceive.  The risks from eggsploitation cannot be ignored forever.
[For some further Christian reflections on infertility treatments more generally, this blog by Peter Saunders may be of interest.]

Posted by Philippa Taylor
CMF Head of Public Policy

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