A Self-Assessment Guide for Health Care Organizations - IFC

Standard EPR.6 [Reproductive health practices/IVF]
The organization sets policies and oversees practices relating to fertility treatment.
Intent of EPR.6
Organizations providing fertility services develop and implement reproductive health policies for fertility treatment (e.g. IVF), which take
account of legal, social and ethical considerations.
IVF services raise many important ethical issues that should be addressed in the policies. For example:
• When embryos are formed outside the body, what should be done with those that are not transferred
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Is it acceptable to use them for research
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Could they be donated to another infertile couple
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Should they be frozen for future use Or should they be destroyed
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And who has the right to make these decisions
• Donation of gametes (egg and sperm)
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What criteria are used to determine who may donate and who may receive gametes (e.g. age, relationship status, family size, etc)
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What procedures are followed for recruiting, counseling and treating donors
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What rules apply to the compensation of donors
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What are the rules determining anonymity, or otherwise, of donors
• Ethical questions concern the practice of transferring several embryos in order to increase the likelihood of pregnancy. (If all the embryos
successfully implant, the woman faces the prospect of a high order multiple pregnancy, with its attendant increased risks of obstetric
complications, premature birth and disability 12 ).
Sex selection using IVF techniques presents a wide range of important ethical, legal and social implications. A significant ethical concern is
that sex selection for non-medical reasons may reinforce discrimination, particularly against women and girls. 13
Informed consent by women for all reproductive services is required. Services are carried out based on standardized procedures by qualified
practitioners. And, a registry is kept to track the outcomes.
Measurable Element Look for Score Observations
What is required
1) Fertility treatment is
integrated into a wider
reproductive and child
health package of
services. 14
How is this element
assessed
Fertility treatment is a part of the
local maternal health scope of
services.
0 5 10 Why did you give this score
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2) The organization has
written policies regarding
assisted reproductive
health technologies that
ensure that the rights of
women as users of these
technologies are within the
boundaries of legal and
ethical considerations.
Policies and procedures address
assisted reproductive health
technologies, including IVF. These
should address key ethical issues
(e.g. including those outlined
above) – especially in countries
where regulations are not
well-defined.
Policies must include the rights of
women, including egg donors
(where applicable).
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12
WHO. (2003) Assisted reproduction in developing countries-facing up to the issues. Progress in Reproductive Health Research. No. 63. Available on:
www.who.int/reproductive-health/hrp/progress/63/63.pdf
13
WHO Genomic Resource Center. Available at: www.who.int/genomics/gender/en/index4.html
14
See a discussion of policy regarding infertility treatment in India, available at: www.searo.who.int/LinkFiles/Reporductive_Health_Profile_infertility.pdf
IFC Self-Assessment Guide for Health Care Organizations 33