This document discusses fertility issues in Europe. It notes that approximately 25 million EU citizens experience fertility problems. Medically assisted reproduction (MAR) treatments have increased substantially in Europe over the past decade, with over 400,000 MAR cycles performed in 2005. One in six people experience fertility problems during their reproductive years. The causes of infertility can be due to physiological factors in men, women or both, and in some cases no cause is identified.
1. Fertility Europe advocates for improving access to medically assisted reproduction (MAR) treatments and ensuring equitable access across Europe. They promote preventing infertility through education and protecting reproductive health.
2. Infertility is classified as a disease and affects approximately 15% of the European population. MAR techniques like IVF have helped people dealing with infertility issues become parents but access varies significantly across countries.
3. Fertility Europe calls for ensuring rights of those affected by infertility through reimbursed or state-funded infertility treatments, education to promote informed decision making, and addressing physical, financial and social barriers to access.
Hardworking individual with diverse background including 6 years of construction experience, 2 years of logistics and supply work, and 4 years in administration with the US Army. Seeks to utilize skills in time management, critical thinking, problem solving and attention to detail developed over 14 years in the Army, including as a training room manager and enlisted aide, to contribute value to a new employer.
This document appears to be an art catalog from 2009 featuring various artworks including paintings, photographs, and sculptures. It includes the titles and artists of the pieces as well as some images of the artworks. The document also includes a short story titled "Dead Beat" by Devin Gregory and another untitled short story by Kaitlyn White.
1. The document discusses several upcoming enhancements to Cornerstone's learning and talent management platform, including: allowing managers to view indirect reports and dotted line relationships in the Universal Profile; introducing a rewards system with badges and points awarded for completing training; configuring training completion pages and signatures; integrating Google Calendar for event registration; improving search functionality within communities; and adding tags to help discover content in communities. The enhancements are aimed at improving the user experience and engagement with Cornerstone's talent management solutions.
April '16 - Recruiting, Onboarding & MobileDana S. White
The document discusses new features and enhancements to Cornerstone OnDemand's talent management solutions, including:
1) A redesign of the talent pool feature to allow easier management of talent pools and adding candidates to requisitions from talent pools.
2) A static URL enhancement for career sites to allow sharing of customized search results.
3) A new onboarding custom report to provide reporting on onboarding and forms data.
4) Mobile application capabilities including uploading documents and completing pre-screening questions directly on mobile devices.
England is located in the United Kingdom off the northwestern coast of mainland Europe. It shares borders with Scotland to the north and Wales to the west. The capital and largest city is London. England has a population of over 55 million and its primary language is English. Some key facts about England include its parliamentary government system, economy as one of the largest in the world, and prominent figures that have advanced science like Isaac Newton.
The document discusses American hurdler Aries Merritt's performance at the 2015 World Championships in Beijing while battling kidney disease. It reveals that Merritt has a rare genetic disorder affecting his kidneys, and is currently functioning at only 20% capacity. After the World Championships, Merritt will return to the US for an urgent kidney transplant from his sister. Despite his health challenges, Merritt ran season-best times of 13.25 in the opening round and 13.08 in the semifinals, the fastest of all competitors. He hopes to make the podium in the finals before focusing on his recovery from transplant surgery the following week.
This document lists over 50 sponsors that support Washington County Memorial Hospital including local businesses, medical professionals, banks, and construction companies. The sponsors range from emergency air transport services to pharmacies to accounting firms to veterinary suppliers.
1. Fertility Europe advocates for improving access to medically assisted reproduction (MAR) treatments and ensuring equitable access across Europe. They promote preventing infertility through education and protecting reproductive health.
2. Infertility is classified as a disease and affects approximately 15% of the European population. MAR techniques like IVF have helped people dealing with infertility issues become parents but access varies significantly across countries.
3. Fertility Europe calls for ensuring rights of those affected by infertility through reimbursed or state-funded infertility treatments, education to promote informed decision making, and addressing physical, financial and social barriers to access.
Hardworking individual with diverse background including 6 years of construction experience, 2 years of logistics and supply work, and 4 years in administration with the US Army. Seeks to utilize skills in time management, critical thinking, problem solving and attention to detail developed over 14 years in the Army, including as a training room manager and enlisted aide, to contribute value to a new employer.
This document appears to be an art catalog from 2009 featuring various artworks including paintings, photographs, and sculptures. It includes the titles and artists of the pieces as well as some images of the artworks. The document also includes a short story titled "Dead Beat" by Devin Gregory and another untitled short story by Kaitlyn White.
1. The document discusses several upcoming enhancements to Cornerstone's learning and talent management platform, including: allowing managers to view indirect reports and dotted line relationships in the Universal Profile; introducing a rewards system with badges and points awarded for completing training; configuring training completion pages and signatures; integrating Google Calendar for event registration; improving search functionality within communities; and adding tags to help discover content in communities. The enhancements are aimed at improving the user experience and engagement with Cornerstone's talent management solutions.
April '16 - Recruiting, Onboarding & MobileDana S. White
The document discusses new features and enhancements to Cornerstone OnDemand's talent management solutions, including:
1) A redesign of the talent pool feature to allow easier management of talent pools and adding candidates to requisitions from talent pools.
2) A static URL enhancement for career sites to allow sharing of customized search results.
3) A new onboarding custom report to provide reporting on onboarding and forms data.
4) Mobile application capabilities including uploading documents and completing pre-screening questions directly on mobile devices.
England is located in the United Kingdom off the northwestern coast of mainland Europe. It shares borders with Scotland to the north and Wales to the west. The capital and largest city is London. England has a population of over 55 million and its primary language is English. Some key facts about England include its parliamentary government system, economy as one of the largest in the world, and prominent figures that have advanced science like Isaac Newton.
The document discusses American hurdler Aries Merritt's performance at the 2015 World Championships in Beijing while battling kidney disease. It reveals that Merritt has a rare genetic disorder affecting his kidneys, and is currently functioning at only 20% capacity. After the World Championships, Merritt will return to the US for an urgent kidney transplant from his sister. Despite his health challenges, Merritt ran season-best times of 13.25 in the opening round and 13.08 in the semifinals, the fastest of all competitors. He hopes to make the podium in the finals before focusing on his recovery from transplant surgery the following week.
This document lists over 50 sponsors that support Washington County Memorial Hospital including local businesses, medical professionals, banks, and construction companies. The sponsors range from emergency air transport services to pharmacies to accounting firms to veterinary suppliers.
This document discusses egg donation in Cyprus and the associated issues. It provides background on egg donation procedures and risks. Cyprus has become a hub for fertility tourism due to low costs, short wait times, and a large number of willing egg donors, many of whom are lower-income immigrants. However, the industry lacks regulation, raising health and ethical concerns. Donors may feel pressured and not fully understand risks. The document recommends improving regulation and transparency to better protect donors and minimize health inequalities between recipients and donors.
Female Genital Mutilation for Healthcare Professionalsmeducationdotnet
1. My first response would be to ensure the 6-year-old's immediate medical needs are addressed, contact child protective services, and seek guidance on next steps from social work and police regarding her safety and potential legal issues.
2. I would need to examine the child to assess for medical complications of FGM, contact on-call pediatrician for consult, and consider notifying authorities if FGM is identified given its illegality.
3. The child is at risk for infections, bleeding, pain, and long-term sexual and psychological issues from undergoing this traumatic procedure. Her well-being and protection from further harm is
Fertility Europe is launching its #40reasons campaign and the second annual European Fertility Week to bring greater awareness to fertility issues in Europe. The campaign highlights 40 reasons why fertility matters from social, economic, and health perspectives. It comes at a time when fertility rates across Europe are declining below replacement levels, threatening Europe's economic and cultural influence. European Fertility Week aims to spark an open dialogue around fertility to reduce stigma and advocate for equal access to fertility treatments.
Kissito Healthcare Presient and CEO, Tom Clarke, met with OB-GYN professionsals from Carillion Hospital on September 30th to discuss Kissito's international child and maternal healthcare operations in Uganda and Ethiopia.
1. MEP Norica Nicolai hosted a debate on infertility policy in the EU after a report revealed numerous barriers to access infertility services across EU nations.
2. The report, supported by Merck and produced by Fertility Europe and ESHRE, presented a comparative account of infertility policies in 9 EU states and calls for urgent action to address health inequalities.
3. Nicolai and infertility advocacy groups recommend 5 actions: prioritizing infertility on public health agendas; including fertility in demographic plans; promoting gender equality; allowing workplace flexibility for treatment; and updating the EU's comparative analysis of assisted reproduction policies.
Maternal and neonatal mortality remain major global public health issues. The document discusses definitions of maternal mortality and its causes. Nearly 99% of maternal deaths occur in developing countries. The three delays model outlines reasons for delays in seeking and obtaining care. Historical interventions like traditional birth attendants and antenatal care alone were not effective in reducing mortality. Skilled attendance at delivery is now recognized as the most important intervention, as major complications cannot be predicted and timely, effective emergency care is critical.
Choice for women: have your say on a new plan to tackle reproductive, materna...DFID
More than a third of a million women die every year from complications during pregnancy and childbirth. Improving reproductive, maternal and newborn health in the developing world is a major priority for the UK Government. DFID is therefore developing a new business plan.
To inform the plan we are holding a 12 week consultation, which will close on 20 October 2010. We want to hear what people in the UK and around the world have to say on the subject of reproductive, maternal and newborn health. This will help us to understand different viewpoints, how these issues might vary in different countries, and how DFID could work better with partners.
If you want to discuss the consultation with colleagues, partners or users of services, we have created this presentation document to help you stimulate discussion. Once you have gathered responses submit your feedback online or use our template response document and email your comments.
To find out more visit http://www.dfid.gov.uk/choiceforwomen
This document discusses Ethiopia's current approach to reducing maternal and neonatal mortality. It provides context on the situation globally and in Ethiopia, including key definitions. The major causes of maternal and neonatal death are presented. Interventions shown to be effective for reducing mortality include increasing access to family planning, skilled birth attendants, and emergency obstetric and newborn care. Evidence-based practices like active management of the third stage of labor and clean delivery are emphasized.
This document provides an overview of health in Europe in 2014. It discusses key health indicators such as life expectancy, mortality rates, prevalence of diseases, and determinants of health. Some of the main findings are:
- Life expectancy has continued to increase across European countries but gaps remain between countries. Healthy life expectancy is lower than overall life expectancy.
- Mortality from major diseases like heart disease, stroke and cancer have declined over the past decade but there are still differences between countries.
- Non-communicable diseases like diabetes and dementia are increasing while communicable diseases are declining.
- Health risks like smoking, excessive alcohol consumption and obesity remain challenges, though consumption patterns differ between countries.
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: DISEASE AND HEALTHGeorge Dumitrache
Disease is defined as an abnormal condition that affects an organism, while health is the level of functional and metabolic efficiency of a living being. The document discusses disease and health from global, national, and personal perspectives. It provides questions to consider for a research project on factors that influence health and disease internationally, within individual countries, and among communities and families. A number of websites are also listed as resources on related health topics such as life expectancy, infant mortality, obesity, and access to healthcare worldwide.
Baby-making : what the new reproductive treatments mean for families & society V Somasundram
A book review presentation on Baby-making : what the new reproductive treatments mean for families & society by Bart Fauser & Paul Devroey for H6792, Science & Technology Sources & Services.
Presented by Nurashikin Jasni & V Somasundram on 16 October 2012
Module IIIMaternal Health ______________________________________.docxmoirarandell
Module III
Maternal Health _______________________________________________
Introduction
In the Module we will explore maternal health paying particular attention to global disparities in the support and care mothers around the world get, the factors that promote such disparities, causes of maternal mortality and morbidity, the impact of reproductive patterns on the health of children, and mechanisms to reduce maternal morbidity and mortality, particularly in low-and –middle income countries.
At the end of this Module you should be able to articulate the following:
Critical Skills
1. Explain the global trends in maternal health.
2. Identify the key players and they play in promoting maternal health.
3. Be able to identify the causes of maternal mortality and morbidity in the U.S and other countries, particularly developing nations.
4. Explain mechanisms used to reduce maternal morbidity and mortality.
5. Be familiar with at least two development organizations/NGOs and their work around maternal health.
Maternal Health at a Glance
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While most women look forward to motherhood (and their spouses to fatherhood), for too many women, motherhood is a torturous experience associated with suffering, ill-health and even death. It is estimated that about 800 women die from pregnancy- or childbirth-related complications around the world every day. Consider the following few facts about maternal health (WHO):
· Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth – about 287 000 women in 2010 alone. Most of them died due to preventable cause like not being able to access skilled routine and emergency care.
· The FOUR main maternal mortality causes are: severe bleeding, infections, unsafe abortion, and hypertensive disorders (pre-eclampsia and eclampsia). After delivery bleeding is very serious condition, if unattended, it can kill even a healthy woman within two hours.
· Of the more than 136 million women who give birth a year, about 20 million of them experience pregnancy-related illness after childbirth.
· About 16 million girls aged between 15 and 19 give birth each year, accounting for more than 10% of all births. Complications from pregnancy and childbirth are the leading cause of death among girls 15-19 in developing nations.
· The state of maternal health mirrors the gap between the rich and the poor. Less than 1% of maternal deaths occur in high-income countries. The lifetime risk of dying from complications in childbirth or pregnancy for a woman in the developing world is an average of one in 150 compared to one in 3800 in developed countries. Of the 800 women who die every day,440 live in sub-Saharan Africa, 230 in Southern Asia and five in high-income countries.
· Most maternal deaths can be prevented through skilled care at childbirth and access to emergency obstetric c ...
1) Abortion law and policy varies widely across Europe, with some countries having complete bans and others allowing abortion on request. This results in women traveling ("abortion tourism") to obtain abortions in countries with more liberal laws.
2) While abortion tourism means abortion illegality is less of a public health issue in Europe, it does come at personal costs to women who face stigma and must travel.
3) The ideal law according to the author would be for abortion to be decriminalized, available on request, and provided through public health services to eliminate the need for travel.
This document provides a summary of a policy audit report on fertility that analyzed policies in 9 EU countries. It finds that over 25 million EU citizens are affected by infertility, though rates of infertility are difficult to compare across countries due to different data methodologies. Fertility rates in the 9 countries range from 1.32 in Spain and Poland to 2.01 in France. The report includes country profiles of fertility policies, diagnosis and treatment availability, funding, and awareness efforts in each of the Czech Republic, France, Germany, Italy, Poland, Romania, Spain, Sweden, and the UK.
This document is a policy audit report on fertility that analyzes fertility policies and treatment landscapes in 9 EU countries: Czech Republic, France, Germany, Italy, Poland, Romania, Spain, Sweden, and the United Kingdom. The report finds that while infertility affects over 25 million EU citizens, there is significant variation among the countries in terms of legislation, available treatments, eligibility criteria, and public funding/reimbursement for fertility treatments. Key issues addressed include limited health literacy and education on infertility, stigma surrounding the topic, and demographic challenges facing EU countries as total fertility rates remain below replacement levels in all nations examined. The report aims to further discussion on supporting policies that address these issues and facilitate progress for EU citizens dealing with infertility.
GIRHL's mission is to increase access and quality of reproductive health care globally through research, development, and implementation of innovative solutions. They identify problems through collaboration with local healthcare workers and engineers. Their programs focus on obstetric fistula and maternal health in developing countries. For obstetric fistula, they develop new evaluation techniques and devices to manage incontinence. For maternal health, they are developing a device called the Prenabelt to prevent stillbirth and low birthweight.
This document provides quantitative data and comparisons on aging populations and healthcare systems across several European countries and the United States. Some key findings presented include: the percentage of populations over 65 and over 80 is increasing dramatically in coming decades, especially in Italy, Spain and France; potential support ratios are declining as populations age in all countries studied; and satisfaction with healthcare systems is generally low across Europe despite high levels of public and private spending on health as a percentage of GDP.
The document summarizes a conference on healthy aging and longevity in Europe organized by the International Longevity Centre (ILC) Europe Network. It provides an agenda for the conference including sessions on prevention and health interventions to live longer, vaccination rates across Europe, and creating age-friendly cities. The document also shares results from ILC's Healthy Ageing and Prevention Index, which ranks countries on metrics like life expectancy, health spending, and environment. It finds gaps between Western and Eastern European countries and recommends increased investment in prevention to help populations age healthier and live longer.
Vaccination rates among adults in Europe are lower than recommended levels despite evidence that vaccines prevent deadly diseases in older populations. To improve rates by 2020, efforts should focus on increasing vaccination among healthcare workers, empowering consumers with independent information on immunization, and promoting immunization as part of a cultural norm of healthy aging. Behavioral economics approaches could also help convince more adults to receive recommended vaccines.
Pandora's eggs: Social Darwinism v. Economic Rationalism in access to IVFLouise Miller Frost
assisted reproduction remains a hot topic, polarising opinions. This paper examines some of the dominant discourses and the underlying assumptions and philosophies.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
This document discusses egg donation in Cyprus and the associated issues. It provides background on egg donation procedures and risks. Cyprus has become a hub for fertility tourism due to low costs, short wait times, and a large number of willing egg donors, many of whom are lower-income immigrants. However, the industry lacks regulation, raising health and ethical concerns. Donors may feel pressured and not fully understand risks. The document recommends improving regulation and transparency to better protect donors and minimize health inequalities between recipients and donors.
Female Genital Mutilation for Healthcare Professionalsmeducationdotnet
1. My first response would be to ensure the 6-year-old's immediate medical needs are addressed, contact child protective services, and seek guidance on next steps from social work and police regarding her safety and potential legal issues.
2. I would need to examine the child to assess for medical complications of FGM, contact on-call pediatrician for consult, and consider notifying authorities if FGM is identified given its illegality.
3. The child is at risk for infections, bleeding, pain, and long-term sexual and psychological issues from undergoing this traumatic procedure. Her well-being and protection from further harm is
Fertility Europe is launching its #40reasons campaign and the second annual European Fertility Week to bring greater awareness to fertility issues in Europe. The campaign highlights 40 reasons why fertility matters from social, economic, and health perspectives. It comes at a time when fertility rates across Europe are declining below replacement levels, threatening Europe's economic and cultural influence. European Fertility Week aims to spark an open dialogue around fertility to reduce stigma and advocate for equal access to fertility treatments.
Kissito Healthcare Presient and CEO, Tom Clarke, met with OB-GYN professionsals from Carillion Hospital on September 30th to discuss Kissito's international child and maternal healthcare operations in Uganda and Ethiopia.
1. MEP Norica Nicolai hosted a debate on infertility policy in the EU after a report revealed numerous barriers to access infertility services across EU nations.
2. The report, supported by Merck and produced by Fertility Europe and ESHRE, presented a comparative account of infertility policies in 9 EU states and calls for urgent action to address health inequalities.
3. Nicolai and infertility advocacy groups recommend 5 actions: prioritizing infertility on public health agendas; including fertility in demographic plans; promoting gender equality; allowing workplace flexibility for treatment; and updating the EU's comparative analysis of assisted reproduction policies.
Maternal and neonatal mortality remain major global public health issues. The document discusses definitions of maternal mortality and its causes. Nearly 99% of maternal deaths occur in developing countries. The three delays model outlines reasons for delays in seeking and obtaining care. Historical interventions like traditional birth attendants and antenatal care alone were not effective in reducing mortality. Skilled attendance at delivery is now recognized as the most important intervention, as major complications cannot be predicted and timely, effective emergency care is critical.
Choice for women: have your say on a new plan to tackle reproductive, materna...DFID
More than a third of a million women die every year from complications during pregnancy and childbirth. Improving reproductive, maternal and newborn health in the developing world is a major priority for the UK Government. DFID is therefore developing a new business plan.
To inform the plan we are holding a 12 week consultation, which will close on 20 October 2010. We want to hear what people in the UK and around the world have to say on the subject of reproductive, maternal and newborn health. This will help us to understand different viewpoints, how these issues might vary in different countries, and how DFID could work better with partners.
If you want to discuss the consultation with colleagues, partners or users of services, we have created this presentation document to help you stimulate discussion. Once you have gathered responses submit your feedback online or use our template response document and email your comments.
To find out more visit http://www.dfid.gov.uk/choiceforwomen
This document discusses Ethiopia's current approach to reducing maternal and neonatal mortality. It provides context on the situation globally and in Ethiopia, including key definitions. The major causes of maternal and neonatal death are presented. Interventions shown to be effective for reducing mortality include increasing access to family planning, skilled birth attendants, and emergency obstetric and newborn care. Evidence-based practices like active management of the third stage of labor and clean delivery are emphasized.
This document provides an overview of health in Europe in 2014. It discusses key health indicators such as life expectancy, mortality rates, prevalence of diseases, and determinants of health. Some of the main findings are:
- Life expectancy has continued to increase across European countries but gaps remain between countries. Healthy life expectancy is lower than overall life expectancy.
- Mortality from major diseases like heart disease, stroke and cancer have declined over the past decade but there are still differences between countries.
- Non-communicable diseases like diabetes and dementia are increasing while communicable diseases are declining.
- Health risks like smoking, excessive alcohol consumption and obesity remain challenges, though consumption patterns differ between countries.
GLOBAL PERSPECTIVE CAMBRIDGE IGCSE: DISEASE AND HEALTHGeorge Dumitrache
Disease is defined as an abnormal condition that affects an organism, while health is the level of functional and metabolic efficiency of a living being. The document discusses disease and health from global, national, and personal perspectives. It provides questions to consider for a research project on factors that influence health and disease internationally, within individual countries, and among communities and families. A number of websites are also listed as resources on related health topics such as life expectancy, infant mortality, obesity, and access to healthcare worldwide.
Baby-making : what the new reproductive treatments mean for families & society V Somasundram
A book review presentation on Baby-making : what the new reproductive treatments mean for families & society by Bart Fauser & Paul Devroey for H6792, Science & Technology Sources & Services.
Presented by Nurashikin Jasni & V Somasundram on 16 October 2012
Module IIIMaternal Health ______________________________________.docxmoirarandell
Module III
Maternal Health _______________________________________________
Introduction
In the Module we will explore maternal health paying particular attention to global disparities in the support and care mothers around the world get, the factors that promote such disparities, causes of maternal mortality and morbidity, the impact of reproductive patterns on the health of children, and mechanisms to reduce maternal morbidity and mortality, particularly in low-and –middle income countries.
At the end of this Module you should be able to articulate the following:
Critical Skills
1. Explain the global trends in maternal health.
2. Identify the key players and they play in promoting maternal health.
3. Be able to identify the causes of maternal mortality and morbidity in the U.S and other countries, particularly developing nations.
4. Explain mechanisms used to reduce maternal morbidity and mortality.
5. Be familiar with at least two development organizations/NGOs and their work around maternal health.
Maternal Health at a Glance
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While most women look forward to motherhood (and their spouses to fatherhood), for too many women, motherhood is a torturous experience associated with suffering, ill-health and even death. It is estimated that about 800 women die from pregnancy- or childbirth-related complications around the world every day. Consider the following few facts about maternal health (WHO):
· Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth – about 287 000 women in 2010 alone. Most of them died due to preventable cause like not being able to access skilled routine and emergency care.
· The FOUR main maternal mortality causes are: severe bleeding, infections, unsafe abortion, and hypertensive disorders (pre-eclampsia and eclampsia). After delivery bleeding is very serious condition, if unattended, it can kill even a healthy woman within two hours.
· Of the more than 136 million women who give birth a year, about 20 million of them experience pregnancy-related illness after childbirth.
· About 16 million girls aged between 15 and 19 give birth each year, accounting for more than 10% of all births. Complications from pregnancy and childbirth are the leading cause of death among girls 15-19 in developing nations.
· The state of maternal health mirrors the gap between the rich and the poor. Less than 1% of maternal deaths occur in high-income countries. The lifetime risk of dying from complications in childbirth or pregnancy for a woman in the developing world is an average of one in 150 compared to one in 3800 in developed countries. Of the 800 women who die every day,440 live in sub-Saharan Africa, 230 in Southern Asia and five in high-income countries.
· Most maternal deaths can be prevented through skilled care at childbirth and access to emergency obstetric c ...
1) Abortion law and policy varies widely across Europe, with some countries having complete bans and others allowing abortion on request. This results in women traveling ("abortion tourism") to obtain abortions in countries with more liberal laws.
2) While abortion tourism means abortion illegality is less of a public health issue in Europe, it does come at personal costs to women who face stigma and must travel.
3) The ideal law according to the author would be for abortion to be decriminalized, available on request, and provided through public health services to eliminate the need for travel.
This document provides a summary of a policy audit report on fertility that analyzed policies in 9 EU countries. It finds that over 25 million EU citizens are affected by infertility, though rates of infertility are difficult to compare across countries due to different data methodologies. Fertility rates in the 9 countries range from 1.32 in Spain and Poland to 2.01 in France. The report includes country profiles of fertility policies, diagnosis and treatment availability, funding, and awareness efforts in each of the Czech Republic, France, Germany, Italy, Poland, Romania, Spain, Sweden, and the UK.
This document is a policy audit report on fertility that analyzes fertility policies and treatment landscapes in 9 EU countries: Czech Republic, France, Germany, Italy, Poland, Romania, Spain, Sweden, and the United Kingdom. The report finds that while infertility affects over 25 million EU citizens, there is significant variation among the countries in terms of legislation, available treatments, eligibility criteria, and public funding/reimbursement for fertility treatments. Key issues addressed include limited health literacy and education on infertility, stigma surrounding the topic, and demographic challenges facing EU countries as total fertility rates remain below replacement levels in all nations examined. The report aims to further discussion on supporting policies that address these issues and facilitate progress for EU citizens dealing with infertility.
GIRHL's mission is to increase access and quality of reproductive health care globally through research, development, and implementation of innovative solutions. They identify problems through collaboration with local healthcare workers and engineers. Their programs focus on obstetric fistula and maternal health in developing countries. For obstetric fistula, they develop new evaluation techniques and devices to manage incontinence. For maternal health, they are developing a device called the Prenabelt to prevent stillbirth and low birthweight.
This document provides quantitative data and comparisons on aging populations and healthcare systems across several European countries and the United States. Some key findings presented include: the percentage of populations over 65 and over 80 is increasing dramatically in coming decades, especially in Italy, Spain and France; potential support ratios are declining as populations age in all countries studied; and satisfaction with healthcare systems is generally low across Europe despite high levels of public and private spending on health as a percentage of GDP.
The document summarizes a conference on healthy aging and longevity in Europe organized by the International Longevity Centre (ILC) Europe Network. It provides an agenda for the conference including sessions on prevention and health interventions to live longer, vaccination rates across Europe, and creating age-friendly cities. The document also shares results from ILC's Healthy Ageing and Prevention Index, which ranks countries on metrics like life expectancy, health spending, and environment. It finds gaps between Western and Eastern European countries and recommends increased investment in prevention to help populations age healthier and live longer.
Vaccination rates among adults in Europe are lower than recommended levels despite evidence that vaccines prevent deadly diseases in older populations. To improve rates by 2020, efforts should focus on increasing vaccination among healthcare workers, empowering consumers with independent information on immunization, and promoting immunization as part of a cultural norm of healthy aging. Behavioral economics approaches could also help convince more adults to receive recommended vaccines.
Pandora's eggs: Social Darwinism v. Economic Rationalism in access to IVFLouise Miller Frost
assisted reproduction remains a hot topic, polarising opinions. This paper examines some of the dominant discourses and the underlying assumptions and philosophies.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
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2. Fertility Matters
What is at stake across Europe regarding Fertility for the years to come
1 Who we are .........................................................................................................................2
2. Key facts on Fertility...............................................................................................................4
ART fact sheet June 2010 from the European Society for Human Reproduction and
Embryology (ESHRE)................................................................................................................5
ART fact sheet June 2010 from the European Society for Human Reproduction and
Embryology (ESHRE)................................................................................................................6
3 Its consequences.......................................................................................................................7
4 Medically Assisted Reproduction ...........................................................................................9
5 Ethics .....................................................................................................................................11
6 Equality of Access to Treatment............................................................................................12
7 Criteria to ensure Equity of Access to Treatment..................................................................14
8 Protection, Prevention and Education....................................................................................16
9 Towards a European Pact to address Reproductive Health: Recommendations by Fertility
Europe.......................................................................................................................................19
Glossary....................................................................................................................................21
References.................................................................................................................................22
Correspondence address: office@fertilityeurope.eu
Fertility Europe VZW
Cyriel Buyssestraat 2
9820 Merelbeke
Belgium
1 Who we are
Fertility Europe history and
values
In 2008, a small group of European associations
involved with fertility issues felt the need to
establish a uniting European umbrella
organisation, based on democracy, transparency
3. and being a truly representative body and voice of
those concerned with fertility problems, in
discussions with the policymakers and the media.
A European representative
association
Today Fertility Europe is the largest and most
representative association of European
organisations involved with fertility issues with
members from over 20 European countries. In
our national organisations we are all involved on a
daily basis with assisting those affected by
difficulties in conceiving.
Our goals
The fact that so many people across Europe need
reliable information on fertility, its protection and
improvement, and on infertility, its treatment and
options has led us to work together and we share
four main goals:
- To improve the rights of those affected by
difficulties in conceiving;
- To build a strong cross border network
amongst European patients and health
professionals in order to achieve the sharing
of best practise;
- To promote societal changes regarding the
perception of infertility;
- To promote education in the area of the
protection of reproductive health and a pro-
active approach to family planning.
Special Families Campaign
All over Europe, people are struggling to conceive
and Fertility Europe has the deepest respect for
those in this position. However, although difficult
for some, they can and do move on, and often
create a special family on their own.
In 2011, Fertility Europe started the Special
Families campaign. We have asked those people
who have had to go the extra mile to become a
family, to share their story through
www.fertilityeurope.eu
The idea is to send a Postcard of Hope, whether
you are a family with children after treatment,
adopted, naturally conceived after years of trying,
still waiting for your dream to come true, a family
of two or other “special” family.
Within a few months we received hundreds of
stories with photographs and strong personal
messages.
4. Fertility Europe members
Belgium
De Verdwaalde Ooievaar Netwerk
Fertiliteit
http:// deverdwaaldeooievaar.be/
Bulgaria
Iskambebe
www.iskambebe.bg
Sdruzhenie Zachatie
www.zachatie.org/
Croatia
Association RODA
www.roda.hr
Czech Republic
ADAM
http://www.adamcr.cz/
Denmark
Landsforeningen for ufrivilligt
barnlose
www.lfub.dk
Finland
Lapsettomien yhdistys Simpukka ry
http://www.simpukka.info/
France
Maia
http://www.maia-asso.org/
Greece
Kiveli
www.kiveli.gr/
Magna Mater
http://www.magnamater.gr/
Hungary
Országos Lombikbébi Támogató
Alapitvány
http://www.lombikbebialapitvany.hu/
Iceland
Tilvera
www.tilvera.is
Israel
CHEN - Patient Fertility Association
http://www.amotatchen.org/
Italy
Amica Cicogna
www.amicacicogna.it/
The Netherlands
Freya - Vereniging voor
vruchtbaarheidsproblemen
http://www.freya.nl/
Norway
ØNSKEBARN
http://www.onskebarn.no/
Poland
Nasz Bocian
http://www.nasz-bocian.pl/
Portugal
APFertilidade - Associação Portuguesa
de (Fertilidade
www.apfertilidade.org
Romania
SOS Infertilitatea
www.infertilitate.com
Slovak Republic
Občianske združenie BOCIAN
http://www.bocianoviny.sk/
Sweden
Barnlängtan
www.barnlangtan.com/
Switzerland
Verein Kinderwunsch
http://www.kinderwunsch.ch/
United Kingdom
Infertility Network UK
http://www.infertilitynetworkuk.com/
2.Key facts on Fertility
Fertility Europe represents 25 million people who have difficulties in conceiving across Europe
through 23 patient associations and interest groups in 22 countries
5. 0
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
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1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5
N u m b e r o f M e d ic a lly A s s is te d R e p ro d u c t io n C y c le s in E u ro p e 1 9 9 6 - 2 0 0 5
The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Since that time over five million
individuals have been born worldwide following in vitro fertilisation. Professor Robert G. Edwards, the
physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010.
For 1 on 6 Fertility is an issue
i
One in six people worldwide experience some
form of fertility problem at least once during their
reproductive lifespan meaning that a potential ii
25
million EU citizens are estimated to be having
difficulties in conceiving.
Europe performs the most cycles of
MAR worldwide...
iii
Europe leads the world in the number of cycles
taking place, initiating approximately 54% of all
reported Medically Assisted Reproduction (MAR)
treatment cycles.
... and faces a constant increase
In 2005 the number of MAR treatment cycles in
the EU exceeded 400,000 compared to
approximately 200,000 cycles ten years earlier so
an increase of 100% (see figure 1)
iv
Infertility is a medical condition
Infertility is recognized by the World Health
Organization as a disease and, without
investigations and treatment, this medical
condition prevents people of reproductive age
from fulfilling the life goal of becoming a parent.
v
People should be referred for investigations if
they not have conceived while having regular
unprotected sexual intercourse after 1 year and up
to 2 years. However if there is something in their
medical history which indicates a fertility problem
e.g. amenorrhoea, or where the female is aged 36
or over (given the impact of the age of the female
on the success of treatment), investigations and
possible treatment should be considered sooner.
This includes those diagnosed with secondary
infertility. Secondary infertility is defined as
infertility in a couple who already had at least one
pregnancy. This can be a pregnancy resulting in
the birth of a baby or a pregnancy that has
miscarried, resulted in an ectopic pregnancy or led
to a decision to terminate the pregnancy for
medical reasons.
i
ART fact sheet June 2010 from the
European Society for Human
Reproduction and Embryology
(ESHRE).
http://www.eshre.eu/ESHRE/English/Guidelines-
Legal/ART-fact-sheet/page.aspx/1061
ii
According to Eurostats 2008: 48,7 %
of the 497,4 millions EU citizens are between 14
and 49 years old : 14-25 y. old (12,5 % ); 25-49 y.
old (36,2%) = 242 millions
1/6 of 242 millions = 40,3 millions.
A potential of 25 millions EU citizens are estimated
to be have difficulties in conceiving.
iii
6. Comparative Analysis of Medically
Assisted Reproduction in the EU:
Regulation and Technologies European
Society for Human Reproduction and
Embryology (ESHRE).
http://www.eshre.eu/binarydata.aspx?
type=doc&sessionId=q1m1djzhvbgxisyxggghuo55/
MAR_for_web[2].pdf
iv
ART in Europe, Publications from 1997 to 2006,
ESHRE
http://www.eshre.eu/page.aspx/1758
v
People who have not conceived after 1
year of regular unprotected sexual
intercourse should be offered further
clinical investigation including semen
analysis and/or assessment of
ovulation. (...)
Where there is a history of
predisposing factors (such as
amenorrhoea, oligomenorrhoea, pelvic
inflammatory disease or undescended
testes), or where a woman is aged 35
years or over, earlier investigation should
be offered.
(http://www.ncbi.nlm.nih.gov/books/NBK45
927/)
Causes of infertility
vi
20-30% of infertility cases are linked to physiological causes in men, 20-35% to physiological causes in women,
and 25-40% of cases are due to a joint problem. In 10-20% no cause is found.
vi
ART fact sheet June 2010 from the European Society for Human Reproduction and
Embryology (ESHRE).
http://www.eshre.eu/ESHRE/English/Guidelines-Legal/ART-fact-sheet/page.aspx/1061
7. 2 1 %
1 4 %
6 %
3 %
2 4 %
2 %
6 %
2 8 %
1 1 %
C a u s e s o f in f e rtility
v i R e la tiv e fr e q u e n c y o f th e d if fe r e n t c a u s e s o f in fe r tility
T h e to ta l is g r e a te r th a n 1 0 0 % b e c a u s e s o m e c o u p le s h a v e m o r e th a n o n e c a u s e .
OvulatoryFailure
Tubal
Damag
e
Endometriosi
s
Mucus
defect/dysfunctio
n
Sperm
defects/dysfunctio
n
Othermale
infertility
Coital
failure
Unexplained
Other
s
3Its consequences
8. Most people affected by problems in conceiving find it difficult to deal with, both physically and
emotionally.
Infertility can lead to depression
Infertility is a medical condition which can cause
severe side effects such as depression. There is a
widespread mistaken belief that life continues as
before. The childlessness, the prolonged
uncertainty, and the monthly attempts to become
pregnant, sometimes over several years, can affect
every aspect of a person’s life, as well as
impacting on relationships with partners, family
members and friends.
Emotional troubles
If infertility is prolonged, studies have found that
people go through an extremely stressful and
emotional experience. Their sense of self, their
identity and the meaning and purpose of life are
challenged.
The experiences of couples who have had
infertility treatment in the United Kingdom: results
of a survey performed in 1997:
vii
Tearfulness 97%
Depression/isolation 94%
Anger 84%
Inadequacy 72%
Guilt/shame 62%
Suicidal feelings 20%
Societal troubles and isolation
As the years go by, this is a burden that many
people bear. People experience an impaired ability
to function normally in society for long periods of
time. For some, events such as the announcement
of pregnancies within close circles, children's
birthdays, and religious celebrations related to
nativity, Mother’s Day and other similar occasions
are extremely distressing, difficult to deal with and
are a painful reminder of their fertility problems.
Medical treatments that can help to resolve this
problem have been developed. However infertility
can still be a socially taboo subject.
People often have to face stereotypes, prejudices,
misunderstandings and guilty feelings. Thus some
people do not dare to address this issue with
friends and family. Little by little they become
socially isolated, even more so if children are
present in their network and neighbourhood.
Professional troubles
The impact of fertility problems on men and
women may also affect their professional life.
They need to take time out from their career for
investigations and treatment.
The role of patient associations
Patient associations contribute to the reduction of
anxiety levels by informing those affected of the
reproductive biology, the pathology and the
treatment options.
They emphasize the role of counseling and its
benefits as well as the importance of offering it at
an early stage.What society do we want?
Society is changing, and with it, the average age of conception with the largest number of
treatments being undergone by women aged between the ages of 30 and 39. Infertility is an
important and increasing issue for Europe. We can't ignore the impact of all the consequences
linked to infertility in our society.
“Having been through infertility myself and benefited directly from the support offered by
the patient association, I recognized how important that support is and got involved.”
Clare Lewis-Jones MBE, Chief Executive, Infertility Network UK &
Chair of Fertility Europe
9. They also offer support groups which provide an
additional forum for the explanation of many areas
of reproductive medicine and the impact of related
technology.
They can reduce the sense of isolation by allowing
people to meet others with similar problems.
vii
Kerr J. et al. (1999) The experiences of
couples who have had infertility treatment
in the United Kingdom : results of a
survey performed in 1997. Human Reprod.
Vol 14 : 934-938.
4Medically Assisted Reproduction
10. What are the different treatments?
Medically Assisted Reproduction (MAR)
treatments include fertilisation in vivo such as
simple hormonal treatments and insemination
(Intra-uterine Inseminaton - IUI), as well as in vitro
fertilisation (IVF) and intracytoplasmic sperm
injection (ICSI).
Some specifics about IVF
viii
IVF is a process by which an egg is fertilised by
sperm in vitro (“in glass”) i.e. outside the body.
IVF is a treatment for infertility when other
methods of assisted reproductive technology have
failed. IVF is performed by monitoring a woman’s
ovulatory process and collecting ovum or ova (egg
or eggs) from the woman’s ovaries and placing
them with sperm in a fluid medium in a petri dish
within a laboratory for hopeful fertilisation
resulting in an embryo/s. The embryos obtained
following this procedure are transferred back into
the uterus.
Additional techniques that are routinely used in
MAR include ovarian stimulation to retrieve
multiple eggs, ultrasound-guided transvaginal
oocyte retrieval directly from the ovaries, egg and
sperm preparation, as well as culture and selection
of resultant embryos before embryo transfer back
into the uterus.
MAR may also assist in the treatment of male
infertility e.g. abnormal sperm. In such cases, ICSI
may be used, where a sperm cell is injected
directly into the egg cell. ICSI is used when sperm
have difficulty penetrating the egg or when sperm
numbers are very low.
Gamete donation
MAR may also be offered for those who are not
able to use their own gametes (egg and/or sperm)
by using donated gametes.
viii
Wikipedia
http://en.wikipedia.org/wiki/In_vitro_fertilisation
11. 5Ethics
Access to Medically Assisted Reproduction creates
a philosophical dilemma regarding the future of
the children born.
In order to raise the issue with public authorities,
the media and the general public, Fertility Europe
is actively contributing to the bioethical and
societal reflection.
Our objective is to bring different views and
perspectives to these debates bearing in mind our
tireless promotion of progressive policies, effective
practices and universal human rights i.e.
1. The right to found a family
and to procreate;
2. The wellbeing and welfare of
children to come;
3. Responsibilities of the future
parents towards the
community;
4. The right of deciding to become
parents through treatments or
not.
Denisa Priadková, Chair of Občianske združenie
BOCIAN & Fertility Europe Vice-Chair
“I see the need for regulations, best
practice exchange and ethics on
European level and identified huge
need for prevention and education.”
12. Examples of disparities across Europe
Reimbursement of In Vitro Fertilisation / ICSI across Europe in Public Centers and Number of cycles reimbursed across Europe, data provided
from the FE members associations, April 2012
Countries Laboratory Drugs Consultations Blood Ultra Sounds
Number of cycles
IUI
Number of cycles
IVF/ICSI
Czech Rep. 100% 100% 100% 100% 100% 6 4 or 3*
France 100% 100% 100% 100% 100% 6 4 to 5
Poland** 3
Portugal 100% 69% 100% 100% 100% 3 3
Romania***
Slovakia 75% 75% 100% 100% 100% 0 0 to 2 or 3
Sweden 100% 100% 100% 100% 100% 6 0 to 3
UK 0 or 100%**** 0 or 100% 0 or 100% 0 or 100% 0 or 100% 0 to 6 0 to 3
: No reimbursement
* Czech Rep.: 4 if the first 2 with Single Embryo Transfer (SET) or 3 without SET
** Poland: will provide from July 2013 on financing for 15,000 couples; both married and unmarried, for up to three in-vitro procedures for three years after
other fertility treatments fail.
*** Romania: Since 2011 a pilot fund from the Health Ministry partially funded the consultations and IVF procedures (no laboratory, no drugs, no blood reimbursed)
for 800 couples and partial reimbursement for one IVF cycle for a limited number of couple
**** UK: Dependent on the postcode
6 Equality of Access to Treatment
Why should there be equity of
access to treatments?
Ensure sustainable population growth
rates
Addressing reproductive care is a challenge that
European governments are tackling whilst
addressing the maintenance of balanced
populations with sustainable population growth
rates. However, infertility may be erroneously side
lined and is considered to be a low priority on the
public health care stage in many European
countries.
European Parliament’s resolution
ix
The European Parliament notes that infertility is
a medical condition which can cause severe side
effects such as depression. It points out that
infertility is on the increase occurring in
approximately 15 % of people, and therefore calls
on the Member States to ensure the rights of
those affected to universal access to infertility
treatment.
The right to found a family and to
procreate
x
A recent jurisprudence from the European Court
of Justice has stated that Article 8 of the
European Convention on Human Rights provides
a right to respect for one’s “private and family
life, home and his correspondence” and that it
could be applied in case of Medically Assisted
Reproduction (MAR) because of the special
importance of the right to found a family and to
procreate.
Diverse legislations across Europe
xi
19 Member States of the European Union have
specific legislations in place for MAR. In the
remaining 8 countries, MAR is covered by the
general health legislation. Israel, Switzerland,
Croatia and Norway have different legislation in
place.
13. Inequality of access to treatment
There is inequality of access to fertility treatment
right across Europe. Some countries provide well
– some do not. Inequalities consist of disparity in
the treatments which are permitted in some
countries, the eligibility criteria to treatment and
in reimbursement policies. In some countries, the
right of access to fertility treatment does not
necessarily mean that there is also a right to
public funding of that treatment.
Treatment reimbursement
Fertility treatment is fully reimbursed in some
countries but the number of cycles being funded
varies. In others, it is only partially reimbursed
with only treatments up to, but not including,
MAR such as In Vitro Fertilisation (IVF), being
reimbursed forcing those whose only chance of
conceiving using such treatment into the private
sector or outside their own country.
Quality in MAR
As with every medical treatment, MAR has to be a
treatment of quality requiring four dimensions
from the patient's perspective.
1 Safety
A safe treatment avoids the most common risks
encountered with MAR such as Ovarian
Hyperstimulation Syndrome (OHSS) or multiples
pregnancies. These consequences can highly
impact both on the mother and/or children's
health.
2 Effectiveness
The success rates (pregnancy rate, delivery rate...)
of the different MAR treatments are important to
patients who need transparent information on
the procedures they will undergo in order to
make informed decisions.
3 Patient centred
Treatment should be patient centered and not
technology centered: communication between
patients and clinics, counseling, emotional
support, patient involvement, privacy and
competence of clinics and staff are elements
facilitating the wellbeing of the patient.
4 Access
Inequalities consist of the variation of eligibility
criteria being employed to access treatment, the
types of treatments permitted and the disparity in
reimbursement.
ix
Resolution on the demographic
future of Europe from the European
Parliament (2008).
http://www.europarl.europa.eu/sides/getDoc.do?
pubRef=-//EP//NONSGML+COMPARL+PE-
392.248+01+DOC+PDF+V0//EN&language=EN
x
European Court of Justice: Case of
S.H. and others v. Austria judgment 1 April
2010.
http://cmiskp.echr.coe.int/tkp197/viewhbkm.asp?
sessionId=81266049&skin=hudoc-
en&action=html&table=F69A27FD8FB86142BF01C
1166DEA398649&key=93863&highlight=
xi
Comparative Analysis of Medically
Assisted Reproduction in the EU:
Regulation and Technologies European
Society for Human Reproduction and
Embryology (ESHRE).
http://www.eshre.eu/binarydata.aspx?
type=doc&sessionId=q1m1djzhvbgxisyxggghuo55/
MAR_for_web[2].pdf
xi 20-30% of infertility cases are
linked to physiological causes in men, 20-
14. 35% to physiological causes in women,
and 25-40% of cases are due to a joint
problem. In 10-20% no cause is found.
Report from the University of Bristol,
Department of Obstetrics & Gynaecology
by Professor Michael Hull: brief summary
taken from an extensive review published
in Human Reproduction in 1992.
xii
Law evasion and unequal access
to treatment leads to cross-border
reproductive care: Shenfield et al. (in
press, 2009) Shenfield, F., de Mouzon, J.,
Pennings, G., Ferraretti, A.P.F., Andersen,
A.N., de Wert, G., Goossens, V. And Van
den Eede, B., on behalf of the ESHRE
Taskforce on cross border reproductive
care 2009.
7 Criteria to ensure Equity of Access to Treatment
Access to Medically Assisted Reproduction (MAR)
treatments should be governed by the same
principles as other health services, namely needs
assessment, clinical effectiveness and cost
effectiveness.
It is inequitable for fertility patients to be subject to
wider access criteria - arising perhaps from social
value judgement - which cannot be fully justified. In
general, the main eligibility criteria for access to
MAR treatments are the age of the female, the
couples’ marital status (married or legally living
together), and the existence of previous children
from the current or a previous relationship.
Health needs assessment
Health needs assessment is a systematic and equal
method for reviewing the health issues faced by a
population, leading to agreed priorities and
resource allocation that will improve health and
reduce inequalities.
Clinical effectiveness
Disparities in MAR process
15. Clinical effectiveness is the ability of a procedure
or treatment to achieve the desired result.
Specifically, how well a particular test or treatment
works when used in the 'real world', rather than in
carefully controlled clinical trials. Clinical
effectiveness is not the same as efficacy.
Cost effectiveness
Cost effectiveness is a type of economic evaluation
used to determine the best use of money
available for medical care (Value for money). A
test or treatment is said to be 'cost-effective' if it
leads to a better result than would otherwise be
achieved by using the resources in other ways.
17. This subject is about three issues gathered
together as one, promoting protection and
prevention to Europe’s politicians and political
institutions and educating the public about the
causes of infertility.
Indeed the importance of the protection of fertility
and the prevention of infertility has not been of
great enough significance to governments, health
agencies and social organisations dealing with
fertility.
European governments need to be more active in
promoting public protection of fertility and
prevention of infertility. Infertility needs to be
considered a medical condition as much in need of
support as other chronic conditions which attract
funding and for which there are prevention
campaigns.
In fact preventive measures can start before
conception, maybe even before people realize they
wish to have children. But preventive thinking
might also be important for couples who intend to
have children much later in life.
Lifestyle choices can impact on future fertility. If
people are aware of this they may consider
lifestyle changes which could help their fertility in
the future.
How to protect fertility and
prevent infertility
One method of prevention should include
information on the types of fertility disorders, the
possibilities of detection, chances and risks of
treatments, their psychosocial and ethical context.
This knowledge is essential for informed decision-
making and to overcome the dilemma such
decisions may cause.
Governments which promote and support birth
control should equally inform the public of the risk
to their fertility from delaying having a child.
Governments should also work towards family
friendly environments, to make sure delaying
parenthood is not the only answer for men and
women who have not found a balanced
professional, social or economic situation.
Infertility is equally shared by
both genders
The general public need to know that infertility is
not solely a woman’s problem and that 45-70 % of
cases are caused by either male factors or joint
factorsxii
. As such infertility is a problem shared by
both partners and therefore both genders.
Education on the causes of infertility must include
information for men on reproductive health and
what can impact on their fertility. To do this
effectively, fertility must be separated out from
virility to show it has nothing to do with
masculinity.
The best place to start educating people on what
impacts on their fertility and the causes of
infertility is with teenagers and young adults, as
they are the potential parents of the future, and
infertility will be a major concern for a large
proportion of them without that education. Any
education curriculum about reproduction must
include a component on infertility to ensure
informed decision-making.
xii
Infertility Network UK's educational leaflet on
Lifestyles impacting on future fertility
18. Sexually transmitted
infections
The prevention of sexually transmitted
infection is vital for health in general; it is
important that the public is aware that this
is a minority cause of infertility and can be
linked to less than 10 % of causes.
However, in countries which do not provide
sexual education the amount of infertility
cases caused by sexually transmitted
diseases seems to be higher than in
countries which apply such programs.
Delaying parenthood
Little is done to advise young adults about
the effect of delaying parenthood which is a
major cause of fertility problems. Fertility in
women drops dramatically from their mid
30’s and to a lesser extent in men.
In addition, the intervening years exposes
them and their partners to longer periods of
risk such as (i) Changes in egg quality and
number; (ii) Changes in quality of sperm; (iii)
Potential to make a normal embryo may be
les; (iv) Fibroids and early pregnancy losses
which could also have a detrimental effect
on their fertility.
Smoking
Smoking is known to be detrimental to
fertility. Women who smoke are twice
as likely to have fertility problems as
those who don’t and also often have a
shorter reproductive life as they tend to
have an earlier menopause.
Excess or binge drinking
Excess or binge drinking can make it
harder to conceive for both men and
women, affecting sperm and egg
production.
Recreational drugs
Recreational drugs, even those which
you may think are not particularly
harmful such as cannabis, may have an
impact on both male and female fertility.
Weight
Weight problems can affect your fertility if
you are very overweight or underweight.
Obesity is linked to ovulation problems for
women and with lower sperm counts for
men. Women who are very underweight is
not good for their fertility either; They need
some body fat in order to produce eggs
normally.
Anabolic steroids
Anabolic steroids, which men
sometimes take to improve their
performance in sports and boost
muscle, may lead to serious fertility
problems. They can cause the testicles
to shut down completely, and the
effects are not always reversible.
Eating disorders
Eating disorders can lead to fertility
problems. Women who are anorexic
often find that their periods stop, and
this can have a lasting impact even if a
woman is able to maintain a normal
weight in the future. Bulimia is linked
with polycystic ovary syndrome, a
condition which affects the way
women’s ovaries work.
19. 9Towards a European Pact to address Reproductive
Health: Recommendations by Fertility Europe
One in six people across Europe experience some form of fertility problem at least once during their
reproductive life span, meaning that a potential 25 million EU citizens are estimated to be having difficulties in
conceiving. Infertility is recognized as a disease by both world and regional agencies such as the World Health
Organization. Over the last 35 years medically assisted reproduction techniques have been developed from
simple hormone treatments and artificial insemination up to and including in vitro fertilisation (IVF). Over 5
million people have been born worldwide thanks to IVF.
Ethics
People have the basic right to decide
on the number of children they have,
and when they have them. The
responsibility of couples and individuals in the
exercise of this right should take into account
the needs of their living and future children, as
well as their responsibilities towards the
community.
1
There are different ways of resolving
involuntary childlessness, a full range of
Medically Assisted Reproduction (MAR)
treatments, as well as adoption. Those
affected should also have the option of
deciding against these treatments and
alternatives and decide to live a life without
children. Both options can bring a happy and
fulfilled life.
2
There are known risks in pregnancy in
relation to age and therefore more
information and national community
debate is required before decisions about
assisting not only older women but also older
men i.e. women and men past the natural age
of conceiving to become parents.
3
Donation of gametes on commercial basis
is ethically unacceptable.4
Access to Care
Infertility is a medical condition and a
health need which should be covered
as such by national social insurance
systems.
5
The inclusion of a full range of Medically
Assisted Reproduction (MAR)
treatments in the provision of basic
health care at least partially depends on the
general level of welfare in society.
6
Fertility investigations and treatment
should be reimbursed across Europe,
and treatments of proven benefit to
patients should be made available,
irrespective of the patient's income and place
of residence.
7
To avoid unjustified discrimination the
principles of needs assessment, cost
effectiveness and clinical effectiveness
should be used to determine the level of
8
20. reimbursement for all assisted reproduction
possibilities.
Safe and Quality
Treatments
People with difficulties in conceiving
should be given accurate information in
a range of formats and languages on all
assisted reproduction possibilities, as well as
adoption and a life without child, as well as
being allowed to accept or to reject the
diagnosis or treatment without discrimination.
9
Those undergoing MAR as well as
those donating gametes should
sign an informed consent
document ensuring that the risks and benefits
of treatment are described in a balanced,
evidence-based framework, and that
appropriate warnings are given when
evidence is inadequate to assess the efficacy
or safety of specific drugs, devices or
procedures.
10
Access to psychological
counseling should be offered in
the framework of fertility11
investigations and treatments. People should
be offered implications counseling,
particularly if their treatment includes the use
of donated gametes and embryos. They
should be informed about any potential long
term risks and psychological, social and
medical ramifications.
Prevention and Education
Public prevention of infertility has
been inadequate to date and
governments have a responsibility
to promote unbiased rational information
about all causes, implications and treatments
options to help remove the myths and
misunderstandings.
12
Male infertility needs to be
highlighted as contributing to half
of the causes. Infertility can no
longer be considered a “woman’s” problem.
13
Education of the next generation
about infertility and its
implications needs to start now.14
Patients associations across
Europe should be recognized as a
driving force behind multi-
stakeholders prevention campaigns to make
education programmes happen.
15
21. xiii
Glossary
Assisted Reproduction Technology (ART): all treatments that include in vitro handling of human
gametes (eggs and sperm) and embryos to establish a pregnancy – often called MAR (Medically
Assisted Reproduction)
Delivery rate: number of deliveries per 100 cycles (aspiration or embryo transfer cycles)
Embryo: the product up to eight weeks after fertilisation, later it is called a fetus
Embryo donation: transfer of an embryo that did not originate from the recipient and her partner
Endometriosis: condition where endometrial tissue grows in areas other than the uterine cavity
Fertilisation: a sperm penetrates the egg leading to a combination of genetic material resulting in a
fertilised egg
Gamete: a reproductive cell, egg in females and sperm in males
Infertility: a disease of the reproductive system defined by the failure to conceive after 12 months of
regular unprotected sexual intercourse
Intracytoplasmic sperm injection (ICSI): process by which an egg is fertilised by injecting a single
sperm into the egg
Intrauterine Insemination (IUI): the insemination of washed semen directly into the uterus
In vitro fertilisation (IVF): fertilisation of an egg by sperm in a laboratory dish
21 Fertility Matters - May 2013