Should IVF doctors inform patients of all potential risks?
Progress Educational Trust
16 September 2003
Many science and medical journalists will have spent last week in Salford, attending the annual Festival of Science, hosted by the British Association for the Advancement of Science (BA). Judging from newspaper coverage over the last week, there was plenty at the conference to keep the media busy. But one presentation in particular, given by Professor Lord Winston, certainly caught their eye.
Professor Winston, according to a number of media reports the following day, talked of his worries about the safety of many procedures offered in IVF units, suggesting that patients are unable to give properly informed consent to treatment because they are largely unaware of safety concerns. He also argued for the need for more research to be carried out on animals and on human embryos before new treatments are offered in the clinic to patients.
Some of Professor Winston's comments will be concurred with by fellow IVF practitioners and by scientists working in reproductive biology. The sometimes speedy transfer of new techniques from the laboratory to the clinic, for instance, is something about which others in IVF have expressed concern. However, other comments reported in the media have provoked accusations of scare-mongering and alarming patients unnecessarily.
Professor Winston is constantly in the media spotlight and is no doubt aware that most public audiences that he addresses contain at least one journalist. This is a perennial problem for high profile individuals working in controversial areas of medicine, who are continually watched by journalists in search of a good story. But such high profile individuals, who are usually well aware of how the media works, also have a responsibility to be balanced and fair. And, when the views that they express depart substantially from the current state of thinking, they should be clear that such views are personal ones with which others might not agree.
One treatment which Professor Winston mentioned in his talk at the BA conference was blastocyst transfer, a procedure which involves keeping IVF embryos in the laboratory for up to five days after fertilisation (instead of the normal two days) in the hope that a later transfer to the womb will increase the chance of a pregnancy. This procedure is not widely practiced in IVF clinics in the UK and there is some disagreement in the profession about its safety and efficacy. However, another procedure which he also mentioned - embryo freezing - is widely practiced in IVF clinics across the world and has led to the birth of many thousands of babies. Professor Winston has concerns about the safety of embryo freezing, but his views are not shared by the majority of his peers. Embryo freezing, which has been carried out in animals since the late 1960s and in humans since 1984, is thought by most in the field to be safe and effective. As with all assisted reproductive techniques, however, it needs to be monitored through proper follow-up studies on children born as a result of the treatment.
There is a need for more research in reproductive medicine. We should guard against quick transfer of new techniques from the laboratory to the clinic where there has not been sufficient research in animals or on human embryos. Patients should of course be informed of the known risks if IVF and related procedures. But that information must be presented to them in a balanced way. Any safety issues that patients are alerted to should represent the current state of knowledge and be backed up by sound evidence.
© Copyright Progress Educational Trust
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.
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