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© 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
Hum
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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
Hum
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