IVF News

Montreal, Quebec- Researchers at the conjoint meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society will present data on the extent of the use of Preimplantation Genetic Diagnosis (PGD) and its effectiveness as treatment accessory to IVF.

PGD, first performed on human embryos in the late 1980?s, requires that one or two cells, or blastomeres, be removed from an embryo and analyzed for genetic or chromosomal defects. PGD is recommended for patients who have a history of heritable genetic disease, unexplained recurrent pregnancy loss or several failed IVF cycles, and for women of advanced maternal age.

Dr Jacques Cohen of Reprogenetics in West Orange, New Jersey will present data from 100 United States IVF centers that referred PGD testing to one reference laboratory. From 1995 to February 2005, a total of 4079 cases testing for aneuploidy (chromosomal abnormalities) were performed by the lab on a total of 33, 572 embryos. The average age of the female patients was 37.5 and 32% of the embryos analyzed were normal. In 3331 of the cases, the patients had embryos transferred; on average, two normal embryos were transferred. For patients in 2540 of these cycles, information was obtained on pregnancy results: there were 931 pregnancies, with 1218 fetal heartbeats observed, 640 deliveries, 341 on-going pregnancies and 164 miscarriages. The researchers observed that the pregnancy rate varied greatly depending on the IVF center and the diagnosis for the patients? infertility.

Jill Fisher of Reprogenetics will report on 539 PGD cases referred to the laboratory from 100 US IVF clinics for testing for translocations. During the period from 1995 to February 2005, the lab analyzed 4,597 embryos to determine if a segment of a chromosome had relocated on that chromosome or moved to another chromosome. The patients? average age was 34 and 19% of the embryos tested normal. However, in 422 cycles patients were able to have an embryo transferred with an average of 1.3 normal embryos per transfer. Pregnancy information was available for 462 cycles; of these, there were 138 pregnancies and 176 fetal heartbeats. There have so far been 113 deliveries among this group, with 40 on-going pregnancies and 15 miscarriages. Previously, these patients had miscarried 88% of their pregnancies; after PGD, the miscarriage rate was down to 9%.

From the Reproductive Genetics Institute in Chicago, IL, Dr. Yury Verlinsky reports on 3631 PGD cycles. Of these, 756 analyzed embryos for single gene disorders and/or preimplantation HLA matching (human lymphocyte antigen) for couples at high risk of having a child with a genetically transmitted disease or who already had a child needing matched stem-cell transplantation from a sibling. This screening resulted in the transfer of 1292 embryos resulting in 244 clinical pregnancies, the birth of 210 babies, and 35 on-going pregnancies. Aneuploidy detection was the goal of 2646 test cycles for poor-prognosis IVF patients with an average age of 38.5. Their testing led to 2110 transfers of 4486 normal embryos, 554 clinical pregnancies, the birth of 411 infants and 91 on-going pregnancies. Couples who were carriers of balanced translocations underwent 232 cycles of PGD with 162 transfers of 275 normal embryos resulting in 57 clinical pregnancies and the birth of 42 healthy children. Overall the accuracy rate for PGD at the Institute was 99.5%; 80% of cases had normal or HLA-matched embryos available for transfer.

Scientists at the Reproductive Genetics Institute also investigated the value of additional testing for aneuploidy for embryos undergoing PGD for Mendelian disorders (genetic diseases) and HLA typing. Two thousand and seventy-four blastomeres were tested for copy numbers of a variety of different chromosomes and the results indicated that without testing the copy number of the chromosome on which the disease causing gene is found, misdiagnosis in PGD for single gene disorders cannot be ruled out. They especially recommend aneuploidy testing for patients seeking PGD for HLA matching because many of those patients are of advanced reproductive age.

Researchers at New York University investigated the connection between embryo aneuploidy and morphology. Reviewing all of their cases of IVF with PGD for aneuploidy done over a three and a half year period, they found that, in 58 cases, 412 of 524 biopsied embryos were aneuploid. Normal embryos were average in appearance and their morphology scores were not significantly different from abnormal embryos. Blastomere asymmetry (difference in the size and shape of blastomeres within one embryo) was seen in 72 embryos, of which 86% tested abnormal. For part of the study, investigators were blinded to all PGD and embryo transfer records and used Day-3 embryo selection criteria (a visual standard) to recommend the likely candidate embryos for transfer. In this exercise, 6 cycles with embryos evaluated solely on looks would have had only aneuploid embryos transferred.

?We need to work to increase the availability of preimplantation genetic diagnosis and its use for patients for whom it is indicated. Strategic use of PGD techniques can ultimately result in fewer pregnancies lost to miscarriage and a reduction in the number of multiple pregnancies when we can be sure we are transferring just one or two normal embryos,? said William Gibbons, MD, President-Elect of SART.

Figures released this week by the International Committee for Monitoring Assisted Reproductive Technology (ICMART), show that IVF success rates in America are almost double those in Europe. The finding was reported at the American Society for Reproductive Medicine (ASRM) conference that took place in Montreal, Canada. American fertility specialists pointed to the figures as an indication of how European women with a poor chance of conceiving were being unfairly penalised. In the US, fertility treatment is more often undertaken by higher income groups that demand greater numbers of embryos to be implanted, leading to greater success from the treatment.

The results in the report were compiled from 1,429 clinics in 49 countries in the year 2000. Researchers found that 31 per cent of IVF cycles in the US led to babies being delivered, compared to 19.4 per cent in Britain and 16.4 per cent for Europe as a whole. Britain's figures compared well to Germany, at 14.8 per cent, but fell short of Denmark at 21.9 per cent. The world average for IVF cycles leading to live birth is 18.6 per cent.

Last year in the UK measures were introduced by the Human Fertilisation and Embryology Authority (HFEA), that allow women under forty to have a maximum of two embryos transferred, while older women are allowed a maximum of three. Currently in Britain three quarters of women having IVF have two embryos transferred, nine per cent have a single embryo transferred and the rest have three. The current practice is under review as the HFEA recently announced a public consultation on whether to follow other European countries that place a limit on numbers of embryos transferred per treatment cycle.

Doctors and the HFEA warn that the higher the number of embryos transferred per IVF cycle the greater the risk of multiple births, which in turn increases the possibility of premature births, cerebral palsy, low birth weight and other complications for both mother and child. Research has shown that twins are four times more likely to be stillborn or die in their first week than single births, the risks for triplets are seven times higher. In Britain, 26 per cent of successful fertility procedures results in twins, compared with 31.7 per cent in the US.

Dr David Adamson, the vice-president of ASRM and chair of ICMART, criticised Britain and other European countries for their current policy. He commented, 'I think it has probably resulted in having fewer multiples but also results in some women with poorer prognosis receiving fewer embryos than would be appropriate to optimise their chances of pregnancy.' Dr Adamson believes the decision as to how many embryos to implant should be left to doctors, 'Single-embryo transfer can be an excellent option for younger women with a good prognosis, but setting a limit of one embryo is not appropriate clinical care for all patients.'

John Paul Maytum, of the HFEA, responded by saying that, 'Our primary role as fertility regulator is to ensure that IVF treatment is as safe as possible. We know that having multiple births is the single biggest risk of IVF, both to mothers and to the children. The actions we have taken over recent years have reduced this risk dramatically.'

The ICMART study also highlighted the rising popularity of fertility treatment. There are now more than 2000 fertility clinics in the world, an increase of 20 per cent since the committee reported in 1998, with 20 per cent of the total number in the US. The US also saw 19 per cent of the world's IVF cycles and 47 per cent of the world's egg donor cycles. Overall, the report estimates that assisted reproduction resulted in between 197,000 and 220,000 babies born in the year 2000, which shows a 28 per cent rise in two years.

A report in the UK's Independent on Sunday newspaper says that women should be warned not to leave it too long to try for a baby. Reporters spoke to Dr Richard Kennedy from the British Fertility Society (BFS), who said that women are 'lulled into a false sense of security by success stories of couples becoming parents later in life' and have 'very high expectations' about what fertility treatment can achieve.

The reporters interviewed a couple who have been experiencing difficulties trying to get pregnant. Elaine Riding, 37, said she expected to be a mother within a year of beginning IVF treatment. 'We presumed, wrongly, that if you do it the right way - you get married, get a roof over your head and have a little money in the bank - everything would be OK', she said. However, the article reports that the Ridings are 'among thousands of couples' who are 'part of a new childless generation unable to conceive because they have left it too late'.

While bold journalistic statements such as these may be overstating the situation, it is still advisable not to pin hopes on IVF if trying to become parents at a later age. Dr Kennedy said that it is not only the individuals concerned were responsible for these false expectations. He said that it was good that women should be able to pursue careers, but that 'Government and employers must take on board that women are more fertile in their younger years'.

Last month, three London-based fertility clinicians wrote an editorial in the British Medical Journal that warned women about 'leaving it too late' to start a family. One of the authors, Melanie Davis, from University College London, told the Independent on Sunday that her clinic sees many women who have achieved much but left it too late to have children. But, she said, the women themselves should not be blamed: 'Women are the victims because society demands so much from us', she said. She added that 'the problem, though, is that despite fantastic advances in science, there is always going to be a cut-off point where your eggs will no longer be viable'.

We are pleased to offer a new human ES cell culture class entitled ?Human
embryonic stem cells to embryoid bodies: a first step in lineage restriction
and differentiation.? This course focuses on development of optimization of
embryoid bodies in culture. According to current literature, developing
healthy embryoid bodies is an important technique enabling human ES cells to
develop into germ specific layers. This is a two-day course that teaches
hands-on techniques such as initiation of embryoid body (EBs) cultures from
adherent hES cell colonies, optimal digestion of organized EBs and plating
of the resulting cells. Also included are lectures and discussion topics
critical for success in lineage restriction. We are also intending to
cluster students with similar research interests in the same session.

Please Note: this course does not teach techniques that involve terminal
differentiation of cells into specific lineages (e.g. cardiomyocytes,
osteoblasts, neuronal cells, hematopoietic cells)

Prerequisite: You must be comfortable with human ES cell culture and
currently culturing the cells in your laboratory.

Fees:
The fee is $700 (for academic and non-profit researchers).

To enroll in this new class, please see:
www.wicell.org/uploads/media/application_for_eb_class.pdf,
For a schedule, see:
www.wicell.org/uploads/media/schedule_for_the_website.pdf

Currently we have courses on:
11/17/05-11/18/05
12/15/05-12/16/05
1/26/06-1/27/06
2/23/06-2/24/06
3/23/06-3/24/06


Thank you,
Erika Mitchen

--
Erika R. Mitchen, M.S.
Administrative Project Specialist/ Registrar
WiCell Research Institute
PO Box 7365
Madison, WI 53707-7365

Tel: 608-441-8019
E-mail: [email protected]

Human eggs and sperm derived from embryonic stem (ES) cells could become a reality in the next five to ten years, says Professor Harry Moore, of the UK's Sheffield University. Other scientists think it could be even sooner, according to a report in the Observer newspaper. The issues arising from 'artificial gametes' need addressing now, according to ethicist Anna Smajdor of Imperial College, London. Ms Smajdor will be speaking on this topic tomorrow at the annual conference of Progress Educational Trust, the UK's assisted reproduction and human genetics educational charity.

Earlier this year, Behrouz Aflatoonian, a member of the Sheffield University team, told the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) that human ES cells can develop into 'primordial germ cells' (PGCs) - the cells that eventually become eggs or sperm. The research built on earlier work by US scientists, who managed to derive mouse eggs from ES cells, and that of a Japanese team who produced mouse sperm in a similar way. The work suggests that mature eggs and sperm could eventually be produced in the laboratory and used to treat infertility, and could potentially allow same sex couples and post-menopausal women to have genetically-related children. Such cells could also be used in 'therapeutic cloning' research, in place of donated eggs.

According to Smajdor, the UK government has so far failed to address all the possibilities this technology opens up. 'There are no existing governmental insights or guidance as to how ethical issues related to these areas might be approached. It is something we need to address', she said. Professor Moore says that it will be 'at least five to ten years' before human eggs and sperm can be produced using ES cells. 'We can make immature sperm and egg cells in this way, but so far have not been able to turn them into mature egg and sperm', he told the Observer, adding 'we have to demonstrate the technique is safe, and that takes time'. However, US scientist Dr Peter Nagy disagrees. 'This is a dramatic idea but the basic technology is not new', he told the newspaper, adding 'I think we will be using it within two to four years'.

Professor Moore says that it would be possible to use the technology to make eggs from stem cells created from a man's skin cells, allowing gay couples to have children genetically related to both men. However, Moore says 'this is not what the technology is being developed for. It is being attempted as a way to alleviate infertility which is still a cause of considerable unhappiness for many couples'. Josephine Quintavalle, of the pro-life pressure group Comment on Reproductive Ethics, said she would not support anything that paved the way for women past the menopause or gay men to have children. 'We need to have respect for nature', she said. Moore pointed to the 'huge outcry' when in vitro fertilisation was first used, and scientists were accused of playing God. But, he said 'it has brought immense happiness for parents who could not have had children otherwise'.

The Department of Health (DH) is seeking views on artificial gametes, as part of its current review of the HFE Act. The public are invited to respond formally to the DH. BioNews readers and any other interested individuals are also invited to informally debate their views on this topic, on a DH-funded online discussion forum run by Progress Educational Trust - the charity that publishes BioNews. Issues such as children for same sex couples and the shortage of donated gametes are currently being discussed in the 'Artifical Gametes' area. Feedback from this time-limited website will be submitted to the DH after the public consultation closes on 25 November 2005. Your views are much valued and all are welcome to contribute.

The New Zealand Government is to make $500,000 in funding available for preimplantation genetic diagnosis (PGD) for 'high-risk couples'. Pete Hodgson, the Minister of Health, says that this funding will allow about 40 women or couples per year access to embryo testing for genetic conditions such as Huntington's disease, haemophilia and cystic fibrosis. People who wish to access the funding should initially see their own doctor, and the funding will be available through district health boards beginning in the first half of 2006.

PGD involves taking a single cell from a 2-4 day old embryo created using in vitro fertilisation (IVF), performing a genetic or chromosome test on that cell, and then returning one or two unaffected embryos to the womb. In New Zealand, the procedure, including the IVF, costs about $12,000 a time. The Health Ministry will allow couples at 'high-risk' of passing on a serious genetic disorder up to two attempts at the procedure - but the funding will not extend to screening older mothers for chromosome disorders. Everyone seeking PGD will receive 'genetic and psychosocial counselling from appropriately qualified counsellors'.

Pete Hodgson said that the Government is making the funding available because 'for some couples the chance of serious genetic conditions has meant that becoming parents has been too risky'. He added that many couples in the past have had to 'get pregnant first and test the developing fetus for disorders later'. As this situation was seen to be undesirable, the Government decided to fund PGD: 'by testing first and ensuring that embryos with serious genetic disorders are not implanted, we can make it much easier for those couples to have healthy children', he said.

Groups supporting people with various genetic conditions have welcomed the news. John Forman, the executive director of Organisations for Rare Disorders, said that the public funding of PGD is 'a tremendous step forward, which a lot of families have been waiting for for a long time'. Kate Russell, chief executive of the Cystic Fibrosis Association in New Zealand, says that several couples she knows will want access to the tests as soon as the funding becomes available. However, the Catholic Church is opposed to the idea of funding for PGD. It says that funding PGD is the same as funding terminations and argues that funds would be better spent on treating sick people. A spokesman for the group Right to Life said that they oppose PGD 'because it entails discrimination against the human embryo because it has a potential for disability'.

A new study carried out at the University of Illinois in Chicago shows that most people would not choose the sex of their baby, if given the option. The findings, published in the journal Fertility and Sterility, are based on an online survey of 1,197 men and women aged between 18 and 45. Just eight per cent of the participants said they would opt for sex selection using currently available 'sperm sorting' technology, a figure that rose to 18 per cent if it were possible to determine gender simply by taking a pill. Study leader Tarun Jain said the results should 'ease the fears' of those who believe sex selection will become widespread when it is readily available in the US.

Sex selection for non-medical reasons is controversial in the US and elsewhere. Both the International Federation of Gynecology and Obstetrics and the American College of Obstetricians and Gynecologists oppose its use. However, the American Society of Reproductive Medicine (ASRM) has said that it supports sex selection for family balancing reasons, provided the methods used are proved to be safe and effective. In the UK, the Human Fertilisation and Embryology Authority (HFEA) ruled in 2003 that parents should not be allowed to choose the sex of their babies.

The sperm sorting technique, developed in 2001, exploits the fact that the chromosome that determines a baby's sex comes from the sperm. Whether a sperm carries an X (female) or Y (male) chromosome affects the amount of DNA it contains, so 'male' and 'female' sperm can be separated on this basis. Microsort, the company that markets the technology, claims that its success rate is 91 per cent for girls, and 76 per cent for baby boys. Patients are required to undergo between three to five cycles of intrauterine insemination, at an average cost of $2,500 (about ?1440) per attempt. Only eight per cent of survey respondents said they would opt to use the technique - a figure that rose to 12 per cent if it could be done in only one treatment cycle, and if it were covered by health insurance.

Overall, 77 per cent of respondents who wanted more than one child either said they preferred an equal number of boys and girls, or they had no preference as to the sex of their children. Dr Jain said the findings suggested that 'people still want to leave things up to chance and not rely on science for everything'. The results are in contrast to an earlier study by the group, in which a survey of 561 American women undergoing treatment for infertility showed that 41 per cent would choose the sex of their baby, if sex selection was offered at no additional cost. Jain said the different findings of the two studies were significant, but not surprising. He pointed out that infertile couples may feel they have only one chance to have a child, while the general population assumes the opportunity for more children.

The European Court of Human Rights (ECHR) has today issued its judgment in the case of Evans v the United Kingdom. Natallie Evans, a British woman seeking the right to be able to use her own frozen IVF embryos, asked the court last September to rule whether UK law preventing her using stored frozen embryos, created using her former partner's sperm, violated her human rights under Articles 8 (right to respect for private and family life) and 14 (freedom from discrimination) of the European Convention on Human Rights. She also asked the ECHR to consider whether the embryos themselves had a right to life under Article 2.

Today, the ECHR unanimously ruled that there had been no violation of Article 2 concerning the actual embryos; unanimously that there had been no violation of Article 14 concerning the way Ms Evans was treated by the law; and, by five votes to two, that there had been no violation of Article 8. The ECHR found that the UK was not obliged to take positive legislative steps to ensure that a woman who begins IVF treatment in order to have a genetically-related child should be permitted to implant embryos after the withdrawal of consent by her former partner. It said that the UK's legislation had 'struck a fair balance' between the competing interests at stake, including those of the community as a whole, which is entitled to have laws giving 'certainty' in what is often a contentious area of medicine. It said that because there is little consensus across EU member states as to how this area should be regulated, the UK government enjoys a 'wide margin of appreciation' when deciding what its own laws should be. The court pointed out that having a clear or 'bright line' approach - that helps to create certainty and maintain public confidence in the law - is desirable. However, it did point out that this 'bright line' did not necessarily have to be drawn at the point of continued storage or use of frozen embryos, but could be drawn elsewhere, such as at the point of creation of the embryo. Or, said the court, it would be possible to legislate to say that such consent should become irrevocable - in any case, it said, 'a fairer balance' could arguably be struck.

The court went on to conclude that because there had been no violation of the right granted under article 8, it was unnecessary to consider whether - as a result of the breach of her Article 8 rights - she had in fact been discriminated against, contrary to Article 14.

Two of the seven judges - Judges Traja and Mijovic - dissented on the Article 8 point, saying that the majority decision 'gave excessive weight to public policy considerations and to the State's margin of appreciation without paying due attention to the nature of the individual rights in conflict'. They said that the right to IVF procreation had a 'higher ranking value' and therefore deserved 'a fairer balancing than that struck by the 1990 Act' and that the exceptional nature of Ms Evans' case - the fact it affects 'the very core' of her right - should have warranted a 'deeper consideration', as not to do so is 'unacceptable under the Convention'. In short, they argued that 'the dilemma between Natallie's right to have a child and her former partner's right not to become a father should not be resolved on the basis of such a rigid scheme and the blanket enforcement by the UK law of one party's withdrawal of consent'. They said that the withdrawal of one party's consent should generally be taken to prevail, except in situations where the other party has no other means to have a genetically-related child and has no existing children.

The embryos in question were created in 2001 using Ms Evans' own eggs and sperm from her then partner, Howard Johnston, who later withdrew his consent to their use. The UK's law, in the form of the Human Fertilisation and Embryology (HFE) Act 1990, requires continued consent from both parties in order for embryos to be used or remain in storage. A withdrawal of consent means that the embryos should be destroyed. The embryos represent Ms Evans' last chance to have her own biologically related child, as her ovaries were removed when they were found to be cancerous. It was at this point that she also agreed to store embryos created with her partner's sperm - rather than frezzing her eggs or using donor sperm to create embryos. At a hearing last year, permission was granted to keep the embryos in storage while the human rights case was heard and until an outcome was finalised, a legal process that normally takes several years. However, the ECHR expedited Ms Evans' claim because of the exceptional nature of the case.

The ECHR ended its judgment by saying that parties had the ability to ask that the case be heard by the Grand Chamber of the European Court of Human Rights. In a statement to the press, Muiris Lyons, the solicitor acting for Ms Evans, said that this, along with the fact that the five majority judges expressed their 'great sympathy for the plight of Natallie', and the strength of the dissenting judgment, had convinced her to request that the case be referred to the Grand Chamber. 'This will involve us applying on her behalf for the case to be referred', he said, adding 'her application will then be considered by a panel of 5 new judges who will decide whether or not to refer the case to the Grand Chamber. If Natallie is successful then her case will be considered by the Grand Chamber which consists of 17 judges'. In its ruling, the ECHR also reminded the UK Government that it must take appropriate measures to ensure that Natallie Evans' embryos are not destroyed until the judgment became final or pending any further order.

It has taken almost two decades to establish a legal basis for fertility treatment in Finland. Two years ago, most of the Parliamentary Legal Affairs Committee wanted to limit treatments to heterosexual couples. However, there was no agreement on the rights of egg and sperm donors to choose anonymity. So the government withdrew the proposal, and it went back to the Ministry of Justice for review. Now, a new version of the Fertility Law is before the Legal Affairs Committee of the Parliament.

The key features of the proposed new legislation are:

1) Fertility treatment will be provided for single women and to lesbian couples, as well as to heterosexual couples.

2) There will be no age limit for treating women or men. The law says that it will be down to a patient's doctor to evaluate the medical risks or benefits of the possible treatment and/or the pregnancy for the woman, before starting treatment.

3) All egg and sperm donors will be identifiable and registered. At the age of 18, a donor-conceived child will be able to apply to the registry for information concerning their donor's identity.

6) Any embryos already created using anonymous egg or sperm donations, currently in frozen storage, will have to be used or destroyed within six months of Parliament enacting the new law.

5) Surrogacy will not be allowed.

6) Only fertility clinics authorised by the Ministry of Health will be allowed to perform fertility treatments.

FERTILITY TREATMENTS IN FINLAND: CURRENT PRACTICE

To date, fertility treatments in Finland have been carried out to a high ethical and medical standard, despite the absence of legislation. We are one of the leading countries for single embryo transfer in IVF treatment, and we have successfully minimised the rate of multiple pregnancies. We transfer one, or at most two embryos, and still obtain high pregnancy rates. The accepted highest age for treating women is about 45 years in all private clinics, and up to 40 years in publicly-funded clinics.

Up until now, egg and sperm donors have been able to choose between anonymous or known donation, with most opting to remain anonymous. In our clinic, Felicitas, only healthy women under 35 can donate eggs, and all recipient couples must see a consultant before starting the treatment. The waiting time for fertility treatment with donated eggs is approximately one year, and there is constant need for more egg donors. Last year there were approximately 800 treatment cycles using donated eggs in Finland, with the numbers rising every year.

The practice of surrogacy in Finland is currently only permitted using the commissioning mother's own egg [full surrogacy]. A few single women and lesbian couples have used surrogacy, treatment that is always provided with help of a consultant.

CONCERNS WITH THE PROPOSED NEW LAW

Clinicians have raised concerns about some aspects of the new Finnish law. First, with respect to the proposed surrogacy ban, we think it is unfair that women without a uterus will be denied access to infertility treatment. If the woman's ovaries are functioning, we do not see why she should be penalised, as this is a medical condition. This also seems inconsistent with the proposal to treat single women and lesbian couples.

Secondly, we are afraid that if only known egg or sperm donors are permitted, we might lose many donors, making such treatments even more difficult to carry out. It will mean that many couples will travel abroad, and we feel that so-called 'fertility tourism' is not the proper way of helping couples who need treatment with donated gametes. In the original law proposed two years ago, this problem was elegantly solved, in my opinion. Donors could have chosen to be known or not, and in the case of anonymity, the donor would have given a description of themselves to be given to the child after the donor's death (should the parents have informed the child about the circumstances of their conception). This could be a useful compromise for the present law proposal as well, and a solution for this very difficult problem.

Thirdly, we are concerned about the fate of existing frozen embryos belonging to couples who have been treated using anonymously donated gametes. There are currently many ongoing donor assisted treatments and pregnancies in various clinics, and hundreds of embryos stored in Finland. Those embryos belong to the treated couples and I believe nobody else should have the right to decide what to do with them. Many of the couples want to have genetic siblings for their children, a possibility that will be destroyed by the new law.

However, as a clinician working at the biggest private fertility clinic in Finland, I also feel there are positive aspects to the proposed new law - for example, the fact that all clinics will have to meet certain standards set by the authorities. This will help us, as well as the patients. The final decision on the law will be made by Parliament this spring, after MPs have heard from infertility specialists. About half of all MPs are still against the new law, mainly because it advocates the treatment of single women and lesbian couples. It seems likely that this issue will trigger a lively discussion in Parliament, as well as amongst Finnish citizens.