The news of a woman without knowing how to give birth to the baby of another patient after an embryo confusion in a Brisbane FIV laboratory has reached the headlines in Australia and worldwide. The anguish that this incident will have caused to all involved is undoubtedly significant.
A report published by Monash IVF, the company that operates the Brisbane clinic, affirms that “it adheres to strict laboratory security measures (including multiple steps identification processes) to safeguard and protect embryos in their care.”
He also says that the company’s own initial investigation concluded that the incident was “the result of human error.”
It will follow an independent investigation that will presumably shed light on how human error could occur when there are several steps identification processes.
At a broader level, this incident poses questions about how common are IVF errors and to what extent they can be prevented.
The enhumination of the IVF industry
Because people have children later in the life of what they used to, some struggle to conceive and resort to assisted reproductive technologies.
These include in vitro fertilization (IVF) and intracitoplasmic sperm (ICSI) sperm injection that imply the management of sperm and eggs (gametes) in the laboratory to form embryos. If there is more than one embryo available after a treatment cycle, you can freeze and store for later use.
Increasingly, assisted reproductive technologies are also being used by single women, same -sex couples and women who freeze their eggs to preserve their fertility.
For these reasons, the fertility industry is booming. In 2022, more than 100,000 reproductive treatment cycles were carried out in Australian fertility clinics, more than 25 percent in the number of cycles made in 2017.
IVF industry regulation
In Australia, the IVFR industry is more regulated than in many other parts of the world.
To operate, clinics must be licensed by the Reproductive Technology Accreditation Committee and comply with their practice code.
In relation to storage and precise identification of embryos, the clinics of the States Code must provide evidence of the implementation and review of:
Policies and procedures to identify when, how and by whom the identification, coincidence and verification for gametes, embryos and patients are recorded at all stages of the treatment process, including the maintenance of digital and manual records.
The code of stating that clinics must inform serious adverse events to the Reproductive Technology Accreditation Committee. The list of what is considered a serious adverse event includes any incident that “arises from a mixture of gamete or embryo identification.”
Clinics must also adhere to the ethical guidelines of the National Council for Medical Research and Medical Research on the use of reproductive technology in clinical practice and research.
Finally, states and territories have laws that regulate aspects of the IVFare industry, such as the requirements to inform adverse events and other data to state authorities.
Thousands of pregnancies in Australia each year are conceived using assisted reproductive technologies. Fountain: Shuttersock, conversation / Lee Charlie
In the United Kingdom, the Human Fertilization and Embryology Authority regulates the IVF industry and requires that clinics denounce adverse incidents. These are reported as degree A, B or C, where A is the most serious and implies “severe damage to a person, or important damage to many.” Adverse incidents data are reported in an annual report publicly available.
However, in the United States, the IVF industry is largely not regulated, and clinics do not have to inform adverse incidents. However, the clinics of the American Society of Reproductive Medicine must have rigorous procedures to prevent the loss, damage or evil direction of gametes and embryos and have the ethical obligation to reveal errors to all affected patients.
How common are IVF errors?
There are no global data on IVF errors, so it is not possible to know how common they are. But we learn about some of the most serious incidents when they are reported in the media.
While the recent embryo confusion is the first known incident of this nature in the History of 40 years of Australia, we have seen reports from other errors in Australian clinics. These include the alleged use of the incorrect donor sperm, embryos destroyed due to pollution and inaccurate genetic tests that resulted in the destruction of potentially viable embryos.
In the United Kingdom, the most recent report of the Human Fertilization and Embryology Authority says that there was an incident of degree A in 2023–24. This was the first degree incident reported since 2019–20 when there were two.
In the US, some notable errors include malfunction of the storage tank in two clinics that destroyed thousands of eggs and embryos.
The demands have also appeared for embryo confusion. In a case of 2023, a woman from Georgia delivered a black baby even though she and her sperm donor are white. Subsequently, biological parents demanded the child’s custody. Despite wanting to raise him, the woman who had given birth resigned from the five -month -old boy to avoid a legal fight he could not win, he said.
In the United States, some argue that most errors are not reported because reports are not mandatory and due to the absence of significant regulation.
There are no global data on IVF errors, so we don’t know how common they are. Fountain: Shuttersock, conversation / Seventy -four
Can IRIV errors be prevented?
Despite the strict regulation and supervision of the Australian IVF industry, there has been an incident with long -range psychological and potentially legal consequences.
Until independent research reveals how “human error” caused this confusion, it is not possible to say what additional measures MONASH IVF should take to ensure that this never happens again.
An IVF Laboratory is a high pressure environment, and any research must analyze whether personnel levels are adequate. Personnel training is also relevant, and it is essential, all Junior laboratory personnel have adequate supervision.
Finally, perhaps Australia should adopt the United Kingdom model and data on adverse events reported to the Reproductive Technology Accreditation Committee, available to the public in an annual report. To reassure the public, this report could include what measures the clinics take to prevent errors from occurring again.
Karin Hammarberg is an attached member of senior research at the School of Public Health and Preventive Medicine at Monash University. The University of Monash is not connected to Monash FIV and the incident mentioned in the article.
