Adams Talk from Fertility Associates
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Adams Talk from Fertility Associates

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Year 13 Ethics talk with Fertility Associates

Year 13 Ethics talk with Fertility Associates

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  • Failure to ovulate – underweight, PCOS, early menopause Tubal damage - preventing egg and sperm meeting, can be caused by previous STD, PID, surgery Endometriosis - uterus tissue invades and damages neighbouring reproductive tissue Age – fertility pretty much halves between ages of 37 and 40
  • Developmental – UDT Body temp - fever, hot baths, laptops Chemical - paint, lead, pesticides, anabolic steroid Medical - radiation, chemo Lifestyle - drugs, smoking

Transcript

  • 1. Assisted Reproductive Technology A.R.T. Adam Nancekivell, BSc Embryologist
  • 2. Journey to a BabyFor some people the journey isshort…•Think about starting a family•Successful pregnancy 3
  • 3. Journey to a BabyFor others the journey is longer…•Think about starting a family•Is there a fertility issue toovercome?•What can be done?•What does it cost?•What is treatment like?•Successful pregnancy 4
  • 4. Is there a fertility issue to overcome? 5
  • 5. Is there a fertility issue? 1 Year is key timeframeFailure to become pregnant after 1 year of unprotected intercourse is a key indicator of infertility 6
  • 6. Is there a fertility issue?Causes of Infertility• Male 40%• Female 40%• Combined/unknown 20%
  • 7. Is there a fertility issue?Causes of Infertility - Female• Failure to ovulate• Tubal damage• Endometriosis• Age 8
  • 8. Is there a fertility issue?Causes of Infertility – Male• Genetic• Developmental• High body temperature• Physical injury• Chemicals / hormones• Medical• Lifestyle factors 9
  • 9. What can be done?What can be done?• Optimize lifestyle factors• See a fertility specialist regarding A.R.T. 10
  • 10. What can be done?Optimise lifestyle factors 11
  • 11. What can be done?Don’t smoke... 12
  • 12. What can be done?Smoking is bad for fertility and thehealth of future children Women Men • By-products detectable • Sperm production, in fluid around eggs motility, morphology and • Menopause occurs 1 to increases DNA damage 4 years earlier • Child born to a father who • Zona pellucida (‘egg smokes has 4 X risk of shell’) thicker childhood cancer
  • 13. What can be done?Smoking is also bad for treatment outcomes • Male smoking significantly reduces success rates • Female smoking halves pregnancy rates & doubles risk of early pregnancy loss • …and there is no public funding for female smokers 14
  • 14. What can be done?Be a healthy weight... 15
  • 15. What can be done? Impact of BMI on female fertility Public funding cut off Human Reproduction UpdateHoman, G.F. et al. Hum Reprod Update 2007 13:209-223; doi:10.1093/humupd/dml056
  • 16. Impact of BMI on male fertility What can be done? • Overweight men (BMI over 28) have sperm counts 22% lower Pregnancy and live birth outcomes according to paternal BMI 45 Pregnancy loss 40 Live birth/OPU 35 30 % 25 20 15 10 5 0 20 - 24.9 25 - 29.9 30 - 34.9 Paternal BMI rangeBakos et al., 2011, Paternal Obesity and ART Pregnancy 17
  • 17. What can be done?Cut out or cut right back onalcohol and coffee 18
  • 18. What can be done?See a fertility specialist for a first consultation
  • 19. What can be done? The First Consultation• History from both partners• Blood test on woman to check hormones• Ultrasound exam on woman• Sperm test arranged for man 20
  • 20. What does it cost?
  • 21. What does it cost? The First ConsultationPublicly-funded Consultation• Need GP referral• Must meet criteria •Both NZ residents •18+ months infertility if woman <35 yrs OR •12+ months infertility if woman >35 yrs + OR •Known severe cause of infertility Interesting to note that men•Additional criteria in Akld andNorthland can be old, overweight, smokers! •Woman under 40 yrs •Woman’s BMI =< 32 •Woman non-smoker• $0• 1-2 months wait for appt
  • 22. What does it cost? The First ConsultationPublicly-funded Consultation Privately-funded Consultation• Need GP referral •No referral• Must meet criteria •No criteria •Both NZ residents •$190 - $260 •18+ months infertility if woman • immediate – 2 week wait for appt <35 yrs OR •12+ months infertility if woman >35 yrs + OR •Known severe cause of infertility•Additional criteria in Akld andNorthland •Woman under 40 yrs •Woman’s BMI =< 32 •Woman non-smoker• $0• 1-2 months wait for appt
  • 23. TreatmentFertility Treatment using A.R.T.
  • 24. TreatmentUsed mainly to assist…• Heterosexual couples with infertility issues• Lesbian couples who need a sperm donor• Single women who need a sperm donor• Families with history of genetically- inherited disease 25
  • 25. TreatmentFive Core ART Treatments• Clomiphene / Ovulation Induction (OI)• Intrauterine Insemination (IUI) / Donor Insemination (DI)• In Vitro Fertilisation (IVF)• Intracytoplasmic Sperm Injection (ICSI)• Embryo Biopsy 26
  • 26. TreatmentThe Basics = Sperm + Egg 27
  • 27. TreatmentClomiphene / Ovulation Induction (OI) DAYS OF WOMAN’S CYCLE • Tablet taken between day 2 and 6 of woman’s cycle • Increases the level of follicle stimulating hormone (FSH) to stimulate egg production • Involves some blood tests and scans to time intercourse • Mainly used where there is a problem with ovulation 28
  • 28. Intrauterine Insemination (IUI) and TreatmentDonor Insemination (DI) NUMBER OF SPERM TO FERTILISE EGG 20,000,000 for Intercourse 1,000,000 for IUI • Sperm is washed • At ovulation, sperm is placed into uterus using a catheter • Mainly used for: o Heterosexual couples where there is a mild male infertility or the female has mild endometriosis o Lesbian couples o Single women 29
  • 29. Treatment In Vitro Fertilisation (IVF)• Conception takes place outside the body• Drugs stimulate and mature eggs• Eggs are aspirated using a fine needle• Sperm is washed and approx 50,000 are introduced to egg in a petri dish• After 3-5 days embryo is transferred into uterus• Mainly used with more serious female infertility issues 30
  • 30. 31
  • 31. TreatmentIntracytoplasmic Sperm Injection (ICSI) • Conception also takes place outside the body as per IVF • 1 sperm is injected into each mature egg • Used when there is a serious sperm issue (quality and/or quantity) 32
  • 32. 33
  • 33. Treatment Embryo development (I)Fertilised egg 8 cell embryo – day 3– 18hrs after adding sperm 34
  • 34. Treatment Embryo development (II)Blastocyst – day 5-6 Hatching blastocyst – day 5-6 35
  • 35. TreatmentEmbryo Biopsy • To test for genetically-inherited diseases • One cell is removed from embryo and tested • If all OK embryo is placed in uterus 36
  • 36. 37
  • 37. TreatmentFertility treatment success rates improving IVF/ICSI implantation rate in women < 37 DI implantation rate in women < 37 50%30% 45%25% 40% 35%20% 30%15% 25% 20%10% 15% 10%5% 5%0% 0% Year Year
  • 38. TreatmentBut woman’s age is still key factor Birth rate from a single IVF egg collection including use of any frozen embryos within 6 months 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% <30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45+ Womans age 39
  • 39. What does it cost?
  • 40. What does it cost? Fertility Treatment using ART Publicly-funded Treatment • Must meet criteria •Both NZ residents •Woman under 40 yrs •Woman’s BMI =< 32 •Woman non-smoker •Limit on 2 kids under 12 at home • Must have CPAC* score 65+ • $0 • 1 month wait (IUI) – 12 rounds • 1.5 year wait (IVF + ICSI) – 2 rounds* Clinical Priority Assessment Criteria
  • 41. What does it cost? Fertility Treatment using ART Publicly-funded Treatment Privately-funded Treatment • Must meet criteria • approx $ 1,900 (IUI) •Both NZ residents • approx $ 11,000 (IVF) •Woman under 40 yrs • approx $13,000 (ICSI) •Woman’s BMI =< 32 • approx 1 month wait •Woman non-smoker • unlimited rounds •Limit on 2 kids under 12 at home • Must have CPAC* score 65+ • $0 • 1 month wait (IUI) – 12 rounds • 1.5 year wait (IVF + ICSI) – 2 rounds* Clinical Priority Assessment Criteria
  • 42. Treatment Legal Matters• HART Act 2004 – Human Assisted Reproductive Technologies – Governs use of ART in New Zealand• ACART – Advisory Committee on Assisted Reproductive Technologies – Formulates policies and advice specific to New Zealand• ECART – Ethics Committee on Assisted Reproductive Technologies – Consider and determine applications for those ART procedures that are not deemed to be ‘established’ in the HART Act 43
  • 43. Treatment ART Guiding Principals• The health and well-being of children born should be an important consideration in all decisions ART.• The human health, safety, and dignity of present and future generations should be preserved and promoted.• The health and well-being of women must be protected in the use of these procedures.• Individuals must make an informed choice and give informed consent.• Donor offspring should be made aware of their genetic origins and be able to access information about origins.• The needs, values, and beliefs of Māori should be considered and treated with respect.• The different ethical, spiritual, and cultural perspectives in society should be considered and treated with respect. 44
  • 44. Treatment Emotional Matters• Going through ART can be an emotional rollercoaster• Coping with – Infertility – Financial stress – Ethical dilemmas – Waiting for outcome of ECART applications – Different levels of motivation for treatment – Hormonal effects of fertility drugs – Medical interventions – Unsuccessful treatment – Comments from family and friends 45
  • 45. TreatmentCounseling Service• Emotional health is as important as physical health!• Counselling is also compulsory for some procedures using ART – Surrogacy – Embryo donation – Sperm or egg donation• Free for publicly-funded treatment• $140 / hour for privately-funded treatment