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Ivf commercialization in element in gynaecology

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IVF Commercialization in element in Gynaecology

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Ivf commercialization in element in gynaecology

  1. 1. IVF : COMMERCIALIZATION IN ELEMENT IN GYNAECOLOGY Dr. Hemant Zaveri
  2. 2. Any new concept !  they will laugh at you first
  3. 3. Any new concept !  Then they ignore you
  4. 4. Any new concept !  Then they will suspect you
  5. 5. Any new concept !  then they fight you
  6. 6. Any new concept !  Then you will believe new concept
  7. 7. Any new concept !  Then concept will established
  8. 8. Any new concept !  Then concept will rule on you!!!
  9. 9.  Infertility affects 15 % of couples, and 50-70 % of male infertility is potentially correctable so it name As: Subfertility …….
  10. 10. DECREASING SPERM QUALITY & QUANTITY: A GLOBAL PROBLEM? OR JUST IN DATA???????
  11. 11. Evaluation of decreasing sperm count Decreasing sperm quality & Quantity just in Data??????? Environmental Health Perspectives 108 (10) (Oct. 10, 2000); E. Carlsen et al. British Medical Journal 305 (Sept. 12, 1992).
  12. 12. Reduction in sperm density Decreasing sperm quality & Quantity just in Data??????? What is reality
  13. 13. Reduction in sperm density Decreasing sperm quality & Quantity just in Data??????? Journal of Andrology,Vol. 28, No. 2, March/April 2007
  14. 14. Reduction in sperm morphology quality Decreasing sperm quality & Quantity just in Data??????? What is relity !! Journal of Andrology,Vol. 30, No. 5, September/October 2009
  15. 15. Impact of the New WHO Guidelines on Diagnosis and Practice of Male Infertility 1 Reality 1.The Open Reproductive Science Journal, 2011, 3, 7-15
  16. 16. What is problem ?  growing population of India
  17. 17. What is problem ?  Growing population of India
  18. 18. What is problem ?  Infertility ?
  19. 19. What is problem ?  Infertility ?
  20. 20. What is problem ?  Infertility ?
  21. 21. Incidence of infertility  Previous: Rare ??????  Present:Very common ??????
  22. 22. Incidence of infertility  Previous: Rare ??????  Present:Very common ??????  Increasing age of married couple
  23. 23. Incidence of infertility  Present:Very common (Pseudo Infertility)
  24. 24. Figure 2. Prevalence of primary infertility and secondary infertility, presented as the percent of women who seek a child, and as the percent of all women of reproductive age, in 1990 and 2010. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356
  25. 25. Absolute change in prevalence of primary and secondary infertility, measured as the percent of women who seek a child and as the percent of all women of reproductive age, between 1990 and 2010. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356
  26. 26. In Vitro Fertilisation (IVF) is a last resort in Past !!!!!!!!!!!!  But Now it’s first choice !!!
  27. 27. In Vitro Fertilisation (IVF) is a last resort  But Now it’s first choice !!!
  28. 28. Need for fast conception The Ideal Infertile couple
  29. 29. Need for fast conception The Ideal Infertile couple
  30. 30. What is IVF  In vitro fertilization
  31. 31. What is IVF  In variable fertilisation (100% sure)
  32. 32. What is IVF  In vitro fertilization
  33. 33. What is IVF  In vitro fertilisation  In variable fertilisation (100% sure)
  34. 34. Previous: tubal factor only  Previous: tubal factor only  Present:  Any couple !!!!!
  35. 35. Indications  Previous: tubal factor only  FallopianTube Damage/Tubal Factor  Bilateral blocked Fallopian tubes  Failed reversal ofTubectomy  The only options for treating significant tubal damage are surgical repair or bypassing the tubes with IVF.This decision must be carefully individualized in each situation.
  36. 36. Indications  Present:  Male Factor Infertility  Failed reversal ofVasectomy/Tubectomy  Obstructive azoospermia  Endometriosis  Severe endometriosis  Age Related Infertility  Premature Menopause  Anovulation  Unexplained Infertility  Preimplantation GeneticTesting (PGT
  37. 37. ACCEPTANCE BY PEOPLE
  38. 38. Facts on IVF  Facts  truth: IVF is only the last option  truth: IVF is only for affluent people  truth: IVF is limited to a younger population only  truth: IVF is successful in all cases  truth: IVF requires admission in the hospital  truth: IVF always result in multiple pregnancies like twins or triplets  truth: IVF babies have a significantly high risk of birth defects and malformations  truth: IVF is not at all covered by insurance  truth: IVF is dangerous
  39. 39. Acceptance by people  Present : reality-  Who Does it Help?  In-Vitro Fertilization and Side effects  Woman’s Painful journey  Maternal Age and Blastocyst Development high failure rate  Frozen Blastocyst Cycles  The Future
  40. 40. In vitro fertilization & Next generation
  41. 41. Producing healthy human beings
  42. 42. IVF future Robotic Sperm !!!!
  43. 43. Robotic Sperm !!!!
  44. 44. Why it was not accepted by drs as routine?  ICSI: Should it be Restricted to Male Infertility  Drugs to induce ovulation  Ova harvesting  Embryo transfer  The outcome  LACK OF CONFIDENCE  LACK OF SENIORS SUPPORT  LACK OF KNOWLEDGE FROMWHERETO LEARN  HOWTO ESTABLISH LAB etc…..  Success rate
  45. 45. Success rate !!! Reality
  46. 46. Success rate !!! Reality
  47. 47. Success rate !!! Reality
  48. 48. Future of IVF:  Blood Bank replaced by Sperm banks
  49. 49. Future of IVF: Sperm Bank
  50. 50. Future of IVF: Embryo Bank Technology  Previous & Present: -Ease of getting equipment & loans -support of companies -disposables& media -hormones( refine technology) -ovum pick up -embryo transfer( role of USG) -endocrinology & lab support -availability of embryologyst - knowledge & skill - ICSI ,IMSCI, PICSI,PGS, PGD,ERRAY , LAH, STEMCELL etc…..
  51. 51. Future of IVF: Embryo Bank Technology
  52. 52. Service at door step Future of IVF: Embryo  By companies  By doctors  By laboratories
  53. 53. Medicine updates: Embryo Donation
  54. 54. In vitro fertilization may leads to Human cloning
  55. 55. In vitro fertilization may leads to Human cloning
  56. 56. In vitro fertilization may leads to Human cloning
  57. 57. Technology burden on Doctors!!!!  Previous & Present: -Ease of getting equipment & loansWho will Pay??? -support of companiesWe have to oblige them!! -disposables& media -hormones( refine technology) -ovum pick up -embryo transfer( role of USG) -endocrinology & lab support -availability of embryologyst - knowledge & skill - ICSI ,IMSCI, PICSI,PGS, PGD,ERRAY , LAH, STEMCELL etc…..
  58. 58. Failed Technology  Assisted reproductive technology  INTRACYTOPLASMIC SPERM INJECTION (ICSI)  GAMETE INTRAFALLOPIANTRANSFER (GIFT)  ZYGOTE INTRAFALLOPIANTRANSFER (ZIFT)
  59. 59. Pseudo Benefits  Fast conception  Early identification of factor  Demand & supply  Dhiraj & dhakka  Multiple pregnancy  LSCS  Both party happiness  Remote centre franchise for drs
  60. 60. Service at door step full commercialization  By companies  By doctors  By laboratories
  61. 61. Medicine updates Side effects !!!  Previous:  Clomiphene citrate  Present:  Various options  GnRH Agonists  GnRH Antagonists  Gonadotropins  hCG  Progesterone  Medrol  Doxycycline  Side Effects !!!!!
  62. 62. Complications Higher risk of ovarian tumours after ovarian stimulation for in- vitro fertilization
  63. 63. Side Effects of IVF: Filure!!
  64. 64. Side Effects of IVF: Ectopic Pregnancy
  65. 65. Side Effects of IVF: Risk of Birth defects
  66. 66. Why IVF as for none?
  67. 67. Conclusion Understand the reproductive potential of couple undergoing IVF Success of ICSI (few data) Male Factors Infertility IVF ~40% live birth ratesVery low as compare to normal pregnancy Female Factors Infertility IVF Higher results than other infertility causes ~25% live birth rates Very low as compare to normal pregnancy
  68. 68. What is IVF?

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