Dr. Giles Palmer
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Dr. Giles Palmer

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    Dr. Giles Palmer Dr. Giles Palmer Presentation Transcript

    • Cross Border Fertility Treatment ASSISTED REPRODUCTION- IVF Giles Palmer-Mitera IVF Unit www.kosmogonia.gr
    • Assisted Reproduction
      • 1978 Natural cycle - in Vitro fertilization/ embryo transfer First child born
      • Success rate=25%
      • 2009 >3.5 million children Born
      • 1-3% children born through ART
    • Initial consultation, Medical history, semen analysis, hormonal profile etc Fertility Treatment 1 2 3 4 5 6 Hormonal Stimulation E2 Blood test, U/S scan Ovulation trigger ~12 days Implantation support Pregnancy test +14 days Down regulation 0-14 days 36 hours Egg retrieval Sperm Preparation Fertilization Embryo culture & Embryo transfer +2-6 days
    • Initial consultation, Medical history, semen analysis, hormonal profile etc Fertility Treatment 2 3 5 6 Minimum 2 visits Minimum Days 3 Implantation support Pregnancy test +14 days Down regulation 0-14 days 36 hours Embryo culture & Embryo transfer +2-6 days
    • Assisted Reproduction
      • Initially for treatment for Tubal damage
      • Ovarian Stimulation
      • Hormonal disorders, Endometriosis etc
      • Male factor, Donor Sperm
      • Embryo freezing, Egg donation, Surrogacy
      • Embryo selection against genetic inherited diseases
      • Intra-cytoplasmic sperm injection, Azospermia, Testicular Biopsy, Post Humous Fertilization
      • Genetic Screening, sex selection
      • In vitro maturation of oocytes
      • Oocyte Freezing, Ovarian Freezing, HLA Typing (Savior Sibling)
      • Egg banking, Same sex couples
    • Assisted Reproduction
      • Initially for treatment for Tubal damage
      • Ovarian Stimulation
      • Hormonal disorders, Endometriosis etc
      • Male factor, Donor Sperm
      • Embryo freezing, Egg donation, Surrogacy
      • Embryo selection against genetic inherited diseases
      • Intra-cytoplasmic sperm injection, Azospermia, Testicular Biopsy, Post Humous Fertilization
      • Genetic Screening, sex selection
      • In vitro maturation of oocytes
      • Oocyte Freezing, Ovarian Freezing, HLA Typing (Savior Sibling)
      • Egg banking, Same sex couples
    • Assisted Reproduction
      • Initially for treatment for Tubal damage
      • Ovarian Stimulation
      • Hormonal disorders, Endometriosis etc
      • Male factor, Donor Sperm
      • Embryo freezing, Egg donation, Surrogacy
      • Embryo selection against genetic inherited diseases
      • Intra-cytoplasmic sperm injection , Azospermia, Testicular Biopsy, Post Humous Fertilization
      • Genetic Screening, sex selection
      • In vitro maturation of oocytes
      • Oocyte Freezing, Ovarian Freezing, HLA Typing (“Savior Sibling”)
      • Egg banking, Same sex couples
    • IVF Cost
      • Is IVF Medically necessary ?…Mainly private health care
      • Great differences in cost
      • In Europe inequality of Funding:
      • Denmark -5 cycles fully reimbursed, Ireland, Ukraine non-existent
      • UK 3 / 4 pay for fertility treatment ~4500 €, Australia ~5000 €, USA 10,000+
      • Total cost: treatment plus medication
      • 30 countries, reported 418 111 cycles (Cx)
      • Huge differences with success rates, no. embryos transferred, multiple pregnancy rate
      • pregnancy rate/transfer
      • UK 23.9%, Greece 30.5%
      • Only 16/49 units in Greece gave data 10 110 Cx
      European Figures
      • Climate of reducing multiple pregnancy (SET)- Mainly N. European countries
      No. Embryos transferred % 0 0 30.6 69.4 Sweden 15 49.7 21.9 13.3 Greece 1.4 7.3 43.3 48 Belgium 4 3 2 1
    • Push and Pull factors
      • Shortage of resources: Techniques unavailable, long waiting lists,
      • “ Post code Lottery”
      • Legal restrictions
      • High cost- high compared to many European countries
      • Patient right and choice to seek medical treatment as a “consumer”
      • No legal/ religious restrictions,
      • availability of “prohibited” techniques
      • Low cost-
      • High success rate of treatment
      • “ Holiday package” ??
    • Europe’s Patchwork Legislation
    • Europe’s Patchwork Legislation
    • Europe’s Patchwork Legislation
      • Oocyte donation-largest growing sector in assisted reproduction
      • One donor donates –several recipients
      • Little regulation in Eastern European countries
      • Spain leader in cross-border destination >3000 donors/year
      • Greece-allowed but anonymous
    • Market Data
      • ESHRE Task Force for Law & Ethics (2008 ) – Francoise Shenfield
      • Data from 6 countries, 1 month Study
      • 1230 Cx (~25,000/ year )
      • Italy (31.8% ), Germany (14.4%), Netherlands (12.1%), France (8.7%)
      • Main Reason-avoid legal restriction: Germans, Norwegians, Italians and French
      • British-Difficulty of access (34.%)
      • Partial reimbursement 13.4%, total reimbursement 3.8%
    • Greece….medical destination
      • Relatively Inexpensive treatment,
      • low flight costs
      • Liberal Legislation: N2002,N2005
      • allowing gamete donation, Surrogacy, genetic testing etc
      • High Success rates:
      • Reputation, Experienced, trained abroad Health care-workers
      • 49 IVF units operating in Greece
      • Location-adjacent countries
      • Unclear costs- but no as cheap reimbursement?
      • Units not inspected - to date
      • EU Directive on Human Tissue and Cells not in force- to date
      • No official figures
      • Lacking patient care and follow up
      • Many units operating outside Medical establishments
      • Lone/budget travelers
    • Greece….medical destination
      • Relatively Inexpensive treatment,
      • low flight costs
      • Liberal Legislation: N2002,N2005
      • allowing gamete donation, Surrogacy, genetic testing etc
      • High Success rates:
      • Reputation, Experienced, trained abroad Health care-workers
      • 49 IVF units operating in Greece
      • Location-adjacent countries
      • Unclear costs- cheap but not as cheap, reimbursement?
      • Units not inspected - to date
      • EU Directive on Human Tissue and Cells not in force- to date
      • No official figures
      • Lacking patient care and follow up
      • Many units operating outside Medical establishments
      • Lone/ Budget travelers
    • Greece’s IVF Market
      • Greece
      • ~15000 cycles year
      • ~1800-3000 €
      • Success rate 30.5% per Transfer
      • From Overseas:
      • Overseas patients ~2000
      • Vast majority oocyte donation
      • Cost ~4000 €
      • Mainly from UK, Italy
      • 3 Units- Crete, Athens, Thessaloniki
      • Mitera Assisted Conception Unit
      • 1502 insemination,1088 IVF cycles 2008
      • 2500 € IVF
      • Pregnancy per transfer 42%
      • No Donor Oocyte policy
      • 30 overseas couples
      • Greek expats, UK (donor sperm ), Switzerland, Germany
    • Oocyte Donation in Greece
      • N.389/2002, N.3305/2005
      • Un-paid, Anonymous Donors, age limit <35 years old
      • Revised Legislation ΦΕΚ 1287/ 2008 Compensation 800 € plus 600 € travelling expenses No trafficking
      • Large number of foreign women donating oocytes
      • Source of infertile Patients internet / Doctor to Doctor relationship
    • IVF & Internet
      • Internet use
      • Fast and anonymous information resource
      • Readily available
      • Inexpensive mode of communication
      • Internet users are of reproductive age
      • Growing number of online private health care guides
      • Answering E-mails
      • Accuracy of medical advice
      • Legality
      • Time consuming
      • Internet patient are demanding
      • Worthy of recruiting patients?
      • Chat rooms/Forum/message
      • Ivf-connections, Fertility-friends
      • Exchange experiences
      • Information
      • Misleading ???
    • Kosmogonia.gr study
      • The use of the internet for IVF information in Greece - trends and patients opinions – Palmer. G.A, Triantafillou. T, Spiropoulou. I. and Walters R.J
      • …… .established IVF information resource for Greeks, ……..expressing the wish to directly communicate online with their healthcare provider.
      • The frequency and nature of email use varied greatly depending upon the country of origin
      • Valued and established information resource to seek treatment overseas.
      • Donor oocytes 39%, Surrogacy 8%, Sex selection 5%
    • “ IVF Tourism”
      • “ Tricked into high expectations with no official figures”
      • “ Unsafe Clinics”-medical standards differ….
      • “ Dangerous treatment” Suzi Leather chair HFEA 2006
      • “ Bypass” laws
      • Anecdotal evidence of exploitation of women
      • No insurance , No patient follow up
    • The Way Forward
      • EU estimates 1% healthcare spending is given to foreign citizens
      • EU Directive proposes:
      • 1. Legal framework reimbursement
      • 2. Common Principals Healthcare/ safety
      • 3. Establish transfer of patients information and records
      • EU “..to insure right of couples to universal access of infertility treatment”
      • ESHRE “Treatments of proven benefit should be easily available through-out Europe irrespective of patient’s income or place of residence”
      • Keith Pollard- Treatments abroad.com “…97% of patients willing to travel for treatment again”
      • Introduced ratings and reviews system
    • The Way Forward
      • EU of infertility treatment
      • In Greece:
      • Organized structure of Health care, dedicated staff
      • Organized handling of accommodation & travel
      • International Standards, Quality Assurance, Accreditation, Adoption of best practices
      • Safety for all concerned-Donors and Patients
      • Insurance, Follow up
      • Patients opinions !!!