Tag Archives: IUI

Dr Shantabai Gulabchand Oration on Cross-Border Reproductive Tourism at the ET2010, Lavasa

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Widow claims human right to use dead husband’s sperm

 

The UK’s High Court has ruled that it may have been unlawful for a widow to have removed her dead husband’s sperm. Despite UK law requiring valid written consent for the storage and use of sperm, the 42-year-old widow obtained emergency Court permission to have sperm collected from her 31-year-old husband’s body hours after he unexpectedly died from complications with a routine operation to remove his appendix in June 2007. She now seeks authorisation to undergo IVF abroad using his sperm. Giving the judgment, Mr Justice Charles said: ‘I am not satisfied it is possible to lawfully remove sperm from a dead person who has not given effective advanced consent’. 

The mother-of-one pleaded that the couple had wanted another child, discussed their desire with family and friends and had sought information regarding IVF together. She explained that they had not thought to have him provide written permission because they had not feared that the minor surgery would be fatal. While the attempt to construct retrospective consent with evidence of his intentions holds little legal weight in light of the clear statutory provisions, her lawyer also argued that disposal of his sperm would contravene her human right to establish a family (protected under article 8 of the European Convention on Human Rights, enshrined in UK law by the Human Rights Act 1998). Because fresh sperm will lose viability over time, the Court authorised the emergency sample collection pending later legal resolution. Upon closer examination at the hearing, Mr Justice Charles questioned the decision. 

The final decision now resides with the Human Fertilisation and Embryology Authority (HFEA), which regulates gamete storage and its use. If permission is denied, then the HFEA decision will likely be legally challenged as was done by Diane Blood in a similar case in 1997. HFEA chair, Lisa Jardine, commented that the organisation sympathises with these ‘difficult’ situations but ‘must operate within the legislation’. 

This case, like the landmark Blood case, may turn on the statutory loophole that provides the HFEA discretionary powers to dispense with the consent requirements for the sperm to be exported – in accordance with an EU citizen’s right to receive health treatment in another member state. 

Diane Blood ultimately won a protracted legal battle through the English Courts in 1997 and was able to conceive two sons using her late husband’s sperm. The Bloods attempted to start a family but Stephen Blood contracted meningitis and lapsed into a coma – his sperm was collected shortly before he died in 1995. The HFEA refused Mrs Blood authorisation to use the sperm as she did not have written consent from her husband. The High Court upheld the authority’s decision because the HFE Act does not provide discretionary powers to waive domestic consent requirements. The Court of Appeal agreed but also decided that the authority could have used a statutory discretion to allow the transport of Blood’s sperm to Belgium for treatment.

In Blood’s case, Lord Hoffman noted that the sperm’s storage was unlawful without the requisite written consent. However, given the unprecedented circumstances, he realised it was necessary for the clinic to store the sperm first and decide the legality later. He commented that he did not foresee the Courts would consider the legality of exporting unlawfully stored sperm again. A decade later, posthumous sperm has unlawfully been stored pending resolution of new legal arguments and Mr Justice Charles has likewise declared the case a ‘novelty’ in the law. 

Following the Blood case, the Government held a review of the law. The 1998 report concluded that the ‘written consent’ requirement should remain. Coincidentally, on the same day last week, MPs in the lower house of Victoria, Australia passed a package of reproductive law reforms which included a controversial clause to allow women to conceive using their partner’s posthumous gametes provided she has prior written consent.

Posted by: Goral Gandhi, MSc

                  Laboratory Director

                  Rotunda – The Center For Human Reproduction

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‘Internet sperm’ founder jailed

John Gonzalez, the founding director of a controversial UK-based online company – ‘ManNotIncluded.com’, which delivered fresh sperm to women for DIY-insemination – was sentenced last week at the Wood Green Crown Court in London to sixteen months incarceration for five counts of fraudulent activities. Judge Juliet May QC said that he had ‘siphoned off thousands of
pounds’ in a ‘sustained course of fraudulent conduct’ and banned him from being a company director for five years.
The Department of Business, Enterprise and Regulatory Reform (BERR) led the investigation, which uncovered shocking business practices – including one client receiving sperm in a dirty coffee canister, while two former employees describe how women were given sperm from donors with completely different characteristics than requested. Gonzalez was successfully
prosecuted for lying to officials, forging documents and falsifying debts to evade relinquishing assets to creditors while illegally embezzling those funds to support an opulent lifestyle. Ultimately, he pleaded guilty to two counts of fraudulent trading, one count of financial misconduct, one count of forgery and one count of perjury.
Gonzalez launched the online business June 2002 amidst stormy criticism, claiming the website was the world’s first to courier fresh sperm and insemination equipment directly to lesbian, single and medically infertile couples who paid to register on the site, charging up to £7,000 for delivery. Some critics viewed the service as a threat to the family unit and dubbed the site ‘morals not included’.
Gonzalez’s service illustrated a loophole in current UK regulation, which governs frozen gamete storage and use, but not ‘fresh’ sperm. Medical practitioners and government authorities warned that this kind of service poses a potential threat to women’s and the resulting child’s health because the fresh sperm is not screened for any diseases. The Human Fertilisation and Embryology 1990 Act requires sperm donations to be quarantined for up to 180 days for testing. Some infections such as HIV may take up to three months to incubate, meaning that an HIV test at the time of the donation may not detect the virus even though the donor might be carrying it.
The service also presented potential legal complications. Under UK law, donors whose sperm is obtained through HFEA licensed clinics are not the legal parents of any resulting offspring. However, the legal position on the parentage of children born via sperm donated outside of HFEA license is unclear.
Gonzalez maintains that ManNotIncluded.com boasted 20 pregnancies and more than 5,000 customers. In December 2004, Gonzalez illegally liquidated the company with debt totalling over £220,000 and then continued to trade under a slightly different name. Meanwhile, he embezzled £185,000 from these company accounts.

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Many women would ask a male friend to father their child

A survey of 3,103 men and women, has found that 45 per cent of women surveyed would consider asking a male friend to father their child in the absence of a suitable partner.

The report by the company reveals that both men and women have concerns about fertility issues, with two thirds of the women polled that were not in current relationships expressing doubts over their ability to conceive naturally, and 26 per cent of men voicing similar concerns.

The most intriguing trend to come out of the survey was women’s willingness to consider alternative means to conception in the absence of a suitable partner. Women between the ages of 28 and 31 were most likely to entertain the idea of turning to a male friend in absence of a partner, while half of the single female survey respondents thought about meeting a partner on a frequent basis. Many women questioned also made it clear that they would consider a ‘second best’ option in the event that they were unable to find their ‘ideal’ partner.

Psychologist Linda Papadopoulos commented on the changing social norms of parenting, which were challenging the conventional nuclear family unit. She stated that ‘reconstituted families, same sex families, and single parents are much more prevalent these days, and rather than ascribing to the ‘norm’ it seems that women and men are more flexible with their definition of ‘family”.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Father’s age and Infertility

Among couples with fertility problems, those in which the man is over age 35 have lower pregnancy rates and increased chances of miscarriage, a new study shows.

To come to this conclusion, French researchers looked at more than 12,000 couples who went to a fertility clinic in France. In most of the cases, the couples were being treated due to the man’s infertility. The couples underwent a total of 21,239 intrauterine inseminations (IUIs). The researchers found that women over age 35 had a pregnancy rate of 8.9 percent, compared to 14.5 percent in younger women.

“But we also found that the age of the father was important in pregnancy rates — men over 35 had a negative effect. And, perhaps more surprisingly, miscarriage rates increased where the father was over 35,” study author Dr. Stephanie Belloc, of the Eylau Center for Assisted Reproduction in Paris, said in a prepared statement. This is the first study to document such a strong paternal effect on reproductive outcomes.

“How DNA damage in older men translates into clinical practice has not been shown up to now. Our research proves for the first time that there is a strong paternal age-related effect on IUI outcomes, and this information should be considered by both doctors and patients in assisted reproduction outcomes,” Belloc said. “We believe that the use of IVF or ICSI should be suggested to infertile patients where either party is over 35 years of age,” she added.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Intrauterine Insemination is the First Line Treatment For Infertility

 

Intrauterine insemination (IUI) is a procedure in which sperm are placed directly into the uterine cavity through a catheter near the time of ovulation. This procedure is most commonly performed when there are problems with the sperm, such as low count or low motility, or an incompatibility between the sperm and the cervical mucus. It can also be performed to overcome problems associated with a man’s inability to ejaculate inside the woman’s vagina due to impotence, premature ejaculation or other medical conditions.It is the most common procedure-in fact, the first line therapy for unexplained infertility. IUI increases the chances of pregnancy because the sperm are placed directly in the uterus, bypassing the cervix and improving the delivery of the sperm to the egg.

IUIs can be performed either with the partner’s sperm or with donor sperm. It is recommended that the patient abstain from sexual intercourse for two to three days before the procedure. In some cases, it may be necessary for the female to take medication to induce ovulation if her cycles are not regular. The male will provide a semen sample one to two hours before the procedure is to be performed. The semen will be washed, a procedure in which the sperm is separated from the seminal fluid and the quality of the sperm is analyzed. Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity immediately following the IUI procedure. If pregnancy does not result from the initial IUI, the procedure may be repeated during the following cycles.
We expect a 15% chance of success with IUI cycles combined with clomiphene citrate or letrozole. The success rates go up by nearly 10% with use of gonadotrophins (Fertility Injections). At Rotunda, from 1992, we must have performed over 5000 IUI cycles for in-house patients & over 12,000 IUI cycles for referred cases, who are monitored by their respective gynecologist & walk in only for the IUIs.

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