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February 18, 2019

In-vitro fertilisation debate in Kenya

The Constitution provides that every person has the right to the highest attainable standard of healthcare services, including reproductive care. What great length can a couple go to ensure they get a child? This is the question on the minds of many Kenyans when the IVF term started going round.

The In-Vitro Fertilisation Bill 2014, sponsored by Millie Odhiambo Mabona, seeks to regulate IVF process, prohibit certain practices in connection with IVF, establish an IVF Authority; make provision in relation to children born of IVF process.

The Bill defines IVF as fertilisation in a laboratory dish or test tube of sperm with eggs which have been obtained from an ovary, whether or not the process of fertilisation is completed in the laboratory dish or test tube.

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including advanced maternal age; damaged or blocked fallopian tubes, pelvic inflammatory disease or prior reproductive surgery; endometriosis; male factor infertility, including decreased sperm count and blockage; and unexplained infertility.

If the Bill is passed into law, Kenya will join countries like USA, UK, South Africa and Australia, which already have legislative framework on IVF procedures.

The first successful birth of a ‘test tube baby’ occurred in 1978. Louise Brown was born as a result of natural cycle IVF without any stimulation. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010.

Some of the complications of IVF procedures include: multiple births, spread of infectious disease; ovarian stimulation; and birth defects. Ectopic pregnancy may also occur if a fertilised egg develops outside the uterus, usually in the fallopian tubes and requires immediate destruction of the foetus.

There are specific risks to the offspring too. Limited long-term follow-up data suggest that IVF may be associated with an increased incidence of hypertension, impaired fasting glucose, increase in total body fat composition, advancement of bone age, subclinical thyroid disorder, early adulthood clinical depression and binge drinking.

During egg retrieval, there’s a small chance of bleeding, infection, and damage to surrounding structures like bowel and bladder (transvaginal ultrasound aspiration) as well as difficulty in breathing, chest infection, allergic reactions to medication, or nerve damage (laproscopy).

Research shows that if the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early, to examine that male offspring is at higher risk for sperm abnormalities. Emerging issues around the practice of IVF include: how to deal with leftover embryos or eggs; what happens in cases of mix up in the laboratories (misidentified gametes, transfer of wrong embryos); pre-implantation genetic diagnosis or screening — where parties choose traits that they want; profit desire of the industry; pregnancy post menopause; same-sex couples, single and unmarried parents; the place of anonymous donors; discarding unwanted embryos; religious response; and the place of culture in society.

Proponents of the Bill argue that by enacting it, the country would be taking a lead in helping couples who are not able to have children due to fertility problems conceive through in-vitro fertilisation.

The Bill is a response to the need for a legal framework for regulation of human reproductive technologies and in particular vitro- fertilisation in humans.

The opponents, including religious organisations, argue that although IVF is meant to give childless couples a chance at parenthood, the medical procedure raises serious legal, ethical and health questions which have not been dealt with in the Bill.

Ethical issues the group raises includes what happens to extra embryos which remain after a woman attains pregnancy, arguing that disposing them of would be equal to abortion. They argue that the nature of IVF is such that due to the expense, technical skill needed and health risk to the female donor, more eggs are collected and fertilised than would be used in one cycle of attempting pregnancy.

The Christian professionals also argued that the process was prone to being abused by scientists who might decide to put unused embryos to illegal research.

Time is ripe to have a discussion as a country on whether IVF is proper or not.

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