Page 15 - Focus on REPRODUCTION SEP 2015

Updates to regulation and reimbursement in Europe
There have been one or two updates to our regulation and reimbursement chart published in the May issue of Focus on Reproduction. Details were supplied by members of the Committee of National Representatives.
Switzerland
A referendum held in Switzerland in June resulted in an overwhelming vote in favour of PGD and PGS. The referendum vote - with 62% in support - would thus amend the existing constitution to include the two previously outlawed procedures. The referendum would also remove restrictions on the number of embryos generated in an IVF cycle, which have so far been limited to those that ‘can be immediately implanted’. The vote, if confirmed and incorporated into the constitution, would thus make embryo freezing legal and encourage single embryo transfer.
‘So we should be allowed to culture more than three 2PN zygotes, to freeze
embryos and perform PGD and PGS,’ says Felix Roth, CNR member for Switzerland. ‘However, according to Swiss law one has the right to challenge such a vote - within a period of 100 days and with 50,000 signatures of those who didn’t accept the referendum result. This deadline is 22nd September.’ If such a challenge is accepted by the government, a second popular vote would be required in Spring 2016.
In this case, says Roth, the earliest date for any modified Swiss legislation would be 2017. However, if the challenge fails (through insufficient signatures, for example), legislation allowing embryo freezing, PGD and PGS could be effective by Spring 2016.
France
CNR member Pierre Boyer has clarified the legal position of PGD and PGS in France, which in our table in May was listed as ‘not allowed’. PGS is indeed not allowed, but PGD - as for the same
indications as prenatal diagnosis - is allowed in a small number of specialist centres (Paris-Clamart, Montpelier , Strasbourg and recently Nantes, all of them university-based public centres). Boyer also notes that full social reimbursement for IVF and ICSI is only available to women under 43 years.
Hungary
There was also some confusion over our listing that PGS is not allowed in Hungary. As far as we can tell from information supplied by CNR member Peter Kovacs, ‘PGS is still considered experimental by the Human Reproduction Committee and could only be practised if the clinic received an approval for it [from] the Human Reproduction Committee . . . PGS is not allowed for routine, everyday use.’ This position was confirmed as correct by Professor György Kosztolanyi, President of the Hungarian National Human Reproduction Committee.
Receiving joint honorary membership of ESHRE at the 1998 Annual Meeting in Gothenburg.
committee and, even at the age of 102, self-published a book on the religious, legal and bioethical implications of ART for defining ‘personhood’. His last book appeared just a few months ago, a memoir of the early days of IVF in the USA.
Today, the eponymous Jones Institute for Reproductive Medicine in Norfolk is named in honour of Howard and Georgeanna. Together, they demonstrated the validity of ovarian stimulation with hMG in what would become the forerunner of today's universal low dose protocols.
The Joneses published, either individually or together, more than 400 peer-reviewed papers and received nine honorary degrees. Georgeanna Jones died in 2005.
Howard Jones, 1910-2015
The death of Howard Jones at the age of 104 marked the close of a remarkable chapter in the history of IVF, for Howard was a pioneer of IVF in the USA in much the same way as was his friend and colleague Robert Edwards in Britain. Yet Howard had only come into IVF following his official retirement at the age of 65, setting up the USA’s first IVF programme with his wife Georgeanna in 1980.
Leaving Johns Hopkins in Baltimore in 1978, they were moving to a new division of reproductive endocrinology at the Eastern Virginia Medical School in Norfolk, Virginia, on the very day of Louise Brown’s birth in England. Invited to comment on the news by a local journalist, and asked what it would take to have a test-tube baby in the USA, Howard replied in his characteristic laconic way, ‘Just a little money’. That proved enough to set the Norfolk programme in motion and, after a frustrating year pursuing pregnancies in a natural cycle, Norfolk finally achieved its first success in its 13th patient to receive gonadotrophins. Delivery by Caesarean section followed on 28th December 1981.
Howard and Georgeanna were frequent and welcome visitors to ESHRE’s annual meetings, and in 1998 in Gothenburg were jointly awarded honorary membership of ESHRE. Like Bob Edwards, Howard was ever sensitive to the ethical issues raised by assisted reproduction, and their initial work in Norfolk had also been delayed by public protest. Howard was a founding father of the ASRM’s ethics
SEPTEMBER 2015 // Focus on Reproduction 15