© 2001 The British Fertility Society

1464-7273/2001

Human Fertility (2001) 4, 221–222

The Partnerships in women’s health symposium, held on 17

January 2001 at the Royal College of General Practitioners,

London, provided a stimulating and topical study day for

gynaecological and fertility nurses. The symposium included

discussion of topical issues, including: polycystic ovary syn-

drome (PCOS) and its implications; the role of the Human

Fertilisation and Embryology Authority (HFEA); the politics of

cloning; endometriosis and its causes, treatments and impact

on fertility; ethical issues in assisted reproduction; and an

overview of the Human Rights Act.

Polycystic ovary syndrome (PCOS) and its implications

Helen Wilson, Clinical Nurse Specialist in Reproductive

Medicine, St Mary’s Hospital, Paddington, presented an excel-

lent overview of PCOS and its implications for fertility. The con-

dition is complex and has long-term health effects for sufferers.

Key signs include obesity, hirsutism, oligomenorrhoea, cystic

ovaries, and high testosterone and LH concentrations, which

contribute to fertility problems. The health risks associated with

the disease including cardiovascular disease and diabetes were

explored and data from research on twins that provide evidence

of familial links were discussed. Fertility treatments include

anti-oestrogen therapies, Dianette, electrolysis and laser treat-

ment for hirsutism. The presentation highlighted the impor-

tance of the nurse specialist’s role in the management of PCOS.

More nurses are undertaking the work in specialist centres

such as St Mary’s and are involved in the assessment of women

with PCOS by ultrasonography and hormone assays. The long-

term health implications and familial links require skilled nurs-

ing care to support women suffering from this disorder.

The role of the HFEA and the politics of cloning

Jane Denton, Director of the Multiple Birth Foundation, Queen

Charlotte’s and Chelsea Hospital, London, provided a valuable

presentation on the role of the HFEA and the politics of

cloning. The HFEA evolved from the work of the Warnock

Committee in the mid-1980s. The Human Fertilisation andEmbryology Act 1990 created an authority to license and monitor

clinics performing in vitro fertilization (IVF), donor insemi-

nation and human embryo research. The HFEA has a code of

practice that provides guidance for clinical practice and keeps a

formal register of information on all treatment cycles. It records

details of both the donors and the children born as a result

of treatment. The HFEA publishes an annual report and infor-

mation can be accessed via their website at www.hfea.gov.uk.

Cloning and related issues generate public concern and re-

quire professional scrutiny. All clinics undertaking research on

human embryos have to be licensed by the HFEA. The politics

of cloning were highlighted in 1997 when the Roslin Institute

announced the birth of Dolly the sheep, the first cloned mam-

mal. The technique involved replacing the nucleus of an un-

fertilized egg with the nucleus of a cell derived from an adult

sheep. The HFEA made it clear that it would not issue a licence

for research with the aim of developing human reproductive

cloning, but recognized that there may be great benefits from

research using nuclear transfer technology with a therapeutic

aim. The HFEA and the Human Genetics Commission (HGC)

recommended to the Secretary of State that consideration

should be given to specifying regulations in other categories

for which licensed embryo research could take place, to allow

this work to develop. The Chief Medical Officer made recom-

mendations that closely reflected those of the HFEA and the

HGC. Further review of this politically sensitive issue requires

parliamentary approval for future legislation.

Endometriosis – causes, treatments and impact on fertility

Edward Morris, Senior Registrar, Guy’s and St Thomas’

Hospital, London, gave an excellent talk on endometriosis, a

condition that affects up to 22% of women and causes distressing

symptoms such as dysmenorrhoea and subfertility. The cause is

unknown but possible pathogenesis includes retrograde men-

struation and autoimmune disease. Foci of endometriosis are fre-

quently found in sites such as the myometrium (adenomyosis),

the ovaries and the peritoneum and, as with the endometrium,

these foci respond to stimulation by oestrogenic hormones. Pain

is a debilitating symptom and sufferers require specialist help

and information via support groups and appropriate manage-

ment of pain relief to improve quality of life. Although inter-

vention is unlikely to effect a total cure, owing to the recurrent

nature of this condition, treatments include the oral contracep-

tive pill, gonadotrophin releasing hormone (GnRH) analogues

and surgery. The disease often improves spontaneously during

pregnancy or the menopause. It is clear that endometriosis is not

understood fully by healthcare professionals and it is important

not to raise women’s expectations of a cure for the condition.

Ethical issues in assisted conception

Sarah Frost, Fertility Nurse Specialist, King’s College Hospital,

London, gave a stimulating presentation on some of the ethical

issues associated with assisted reproduction. Fertility is an area

that generates many moral and ethical dilemmas for nursing

practice and many nurses have to deal with very difficult situ-

ations on a daily basis. Issues include making the difficult

decision of whether to treat certain couples, the treatment of

Partnerships in women’s health: RCN Gynaecological Nurses’ Forum andFertility Nurse Group

Debbie Barber

Oxford Fertility Unit, Level 4 Women’s Centre, John Radcliffe Maternity Hospital, Headington, Oxford OX3 9DU, UK

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single women and lesbian couples, the use of donor eggs by

older women, and funding issues and the postcode lottery for

fertility treatment. The value of a unit’s ethics committee in ad-

vising on difficult cases was discussed, in particular the value

of team support when working with an ethics committee on

decision-making on access to treatment. No one individual

should be responsible for deciding on a couple’s access to treat-

ment. Each unit has policies on the provision of treatment for

specific subgroups, for example same sex couples. Many of the

issues are contentious and attract negative attention from the

media and the public. Staff working in the area have to protect

not only the couples pursuing treatment, but also the welfare of

children born as a result of treatment.

Human Rights Act – overview and focus on infertilityissues

Helen Caufield, Solicitor and Health Policy Analyst for the

Royal College of Nursing, London, provided a very stimulating

talk entitled ‘Human Rights Act: a focus on infertility’. It was

suggested that, under the Human Rights Act, a patient could

challenge issues related to fertility treatment. For example,

Article 12 stipulates that ‘Men and women of marriageable age

have the right to marry and to found a family according to the

national laws governing the exercise of this right’. Units that

have previously made policies in relation to the availability of

treatment may find such policies challenged by patients in

court. It is important to establish appropriate policies on the

grounds of clinical effectiveness which lawfully can be built

into guidelines for the prioritization of treatment. The HumanRights Act will become an everyday aspect of healthcare pro-

vision in the future. Decisions on the efficacy, appropriateness

and priority of treatment may be challenged by any individual.

The field of fertility treatment provides a potentially explosive

arena for patients’ rights under the Act.

The symposium was supported by Wallace Women’s Healthcare

and the Royal College of Nursing.

222 D. Barber

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