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ESHRE 2011 Stockholm

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ESHRE 2011 Stockholm

  1. 1. Reproductive medicine: good servant but bad boss? Hana Konečná, Czech Republic Education in fertility awareness: from prevention to action: whose duty? 27th ESHRE Annual Meeting, Stockholm 2011 Supported by GACR P407/10/0822
  2. 2. Prevention Magic formula of recent decades.  offers people the opportunity to avoid suffering  offers state economies the opportunity to save money Primary – secondary – tertiary
  3. 3. Risky factors in RM  advanced age,  smoking,  obesity,  sexually transmitted diseases,  alcohol consumption  environmental factors Lifestyle-related factors and access to medically assisted reproduction, Human Reproduction, Vol.00, No.0 pp. 1–6, 2010 Prevention and treatment of infertility in modern society, ESHRE Campus 2010, Istanbul Turkey
  4. 4. Primary prevention in CR  Health 21 – „Health-for-all policy for the twenty-first century"  Warsaw Declaration for a Tobacco-free Europe  European Alcohol Action Plan  European Charter on Counteracting Obesity.  Green Paper – Promoting healthy diets and physical activity  Joint United Nations Programme on HIV/AIDS  Global strategy for the prevention and control of sexually transmitted infections  Protocol on Water and Health  Environment for Europe
  5. 5. Primary prevention in CR - effect  everybody knows, numbers of smokers, obese, … not declining  feelings of guilt, inflow of “good advice” from the surroundings  healthism, lifestylism, orthorexia
  6. 6. Secondary prevention - RM Screening - to avoid severity of disease Gyneacology (papp smear tests, mammograph, ...) Andrology?
  7. 7. Secondary prevention - RM Screening Gyneacology (papp smear tests, mammograph, ...)
  8. 8. „Got balls? So watch out!“
  9. 9. „Got balls? So watch out!“
  10. 10. „Got balls? So watch out!“
  11. 11. Interpreting research results  results gained from high-risk population: how to use them in „normal“ population?  yes/no strategy  small numbers interpreting, difference between statistical and clinical significance  mathematical tools used
  12. 12. Secondary prevention - problems  false positive and false negative tests  spermiogram as a screening? - the right not to know?  mathematic tools
  13. 13. Tertiary prevention  mild stimulation protocols  mild microsurgery MESA, TESE  small number of embryos transfered  3rd party reproduction  psychosocial support - coping with problem
  14. 14. ... men also have something to say about conception
  15. 15. Mathematical tools Grimes, D., A., Schulz, K., F. (2002). Bias and causal associations in observational research. Lancet 2002; 359: 248–52. Goodman, S. N. 1999. Towards evidence-based medical statistics, II: the Bayes factor. Ann. Intern. Med. 130:1005-1013. Grunkemeier, G., L., Wu, Y, X., Anthony P. Furnary, A., F. (2009). What Is the Value of a p Value? Ann Thorac Surg 2009; 87:1337-1343 Lee, J., J. (2011). Demystify Statistical Significance— Time to Move on From the P Value to Bayesian Analysis. Editorials. JNCI Vol. 103, Issue 1 | January 5, 2011
  16. 16. Mathematical tools
  17. 17. Matematical tools
  18. 18. Factor „TIME“ „advanced age“ not involved in preventive programmes
  19. 19. RM as a good servant reliable and safe contraception ↓ unwanted pregnancy prevention (pregnancy coming too early)
  20. 20. RM as a bad boss? But when is the one sufficiently ready for responsive parenting? (economically secured, in stable partnership, personally mature, ...) ↓ Side effects of reliable contraception is imposing responsibility...
  21. 21. ESHRE Task Force Reproduction and Society Campaign for:  increase public awareness concerning risk factors affecting a couple’s fecundity  a realistic perception of what can/can’t be overcome by ART  factors affecting an earlier onset of family building among young couples
  22. 22. RM as a good servant ART ↓ chance for many couples suffering from infertility
  23. 23. RM as a bad boss? But when to stop treatment – more and more new technologies are available, still chance to stay open“? Obama´s „yes, we can“ interpreted as „yes, you must“ (continue)“? Dill, S. (2010). Facing failure: finding new strenght. IFFS Munich Gurgan, T. (2010). What to do after IVF/ICSI failure. IFFS Munich.
  24. 24. Prevention „How to prevent the burden of the decision-making?
  25. 25. From prevention to action Whose duty? What level of the prevention? What validity of research in prevention? Whose competence to do campaigns? Whose justification?
  26. 26. Thank you for your patience and kind attention hana@adamcr.cz

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