Some IVF patients are being offered risky, unsafe techniques which
have not been developed with clinical trial and which offer dubious
benefits, according to an extraordinary article in the journal Reproductive BioMedicine Online (RBO).
Writing in the journal founded by Robert Edwards, who won a Nobel
Prize for developing IVF, two British scientists have made a devastating
critique of the IVF industry. Rachel Brown and Joyce Harper, of
University College London, say:
“In 1978, the first child
conceived by IVF was born. In the following 33 years, numerous
technologies and techniques have been developed ... However, these
techniques have rarely been robustly tested and approved before they are
routinely offered to infertile couples. In other cases, a development
in our scientific understanding of a technique has failed to be quickly
incorporated into clinical changes. This raises the concern that some of
the techniques offered to some patients offer little or no benefit, and
in the worse cases is not confirmed to be safe.”
Brown and Harper worry that even riskier techniques -- such
as artifical gametes -- are being developed, yet scientists may not be
ready to change their ways to put patient safety first and to use
randomised trials to test safety and efficacy.
As an example of undue haste, they point at preimplantation
genetic screening of embryos. There have been 11 randomised trials for
this technique, some of which revealed serious limitations. However, say
Brown and Harper, “This improved scientific knowledge has done little
to slow the use of PGS, and despite the evidence from multiple RCT to
suggest it is incapable of improving clinical outcomes, PGS continues to
be routinely used in a clinical setting.”
The authors also hint that commercial considerations may
play a role in the promotion of techniques before they have been proven
safe and effective. “Although the same could be said for all areas of
medicine, assisted reproductive technology in particular has developed a
very strong commercial backing. It is therefore particularly important
to ensure that all new technologies are adequately and rigorously tested
for both safety and efficiency, ideally before being used clinically.”
Furthermore, there is a danger of hurting emotionally
vulnerable patients: “some of the techniques offered to some patients
offer little or no benefit, and in the worse cases [are] not confirmed
to be safe. This is a particular concern as many of the techniques
discussed here are often reserved for already vulnerable patients, such
as those with recurrent IVF failure.”
Rarely have such reservations about the progress of IVF appeared in a professional journal. This article,
"The clinical benefit and safety of current and future assisted
reproductive technology" is required reading for anyone interested in
the ethical dimension of assisted reproduction.
