Transcript PowerPoint-presentatie - Medisch Centrum Kinderwens

Oocyte donation:
controversial issues in clinical practice.
Results in a program of reciprocal donation.
Henk Ruis
MD, Obst & Gyn, PhD, CEO Stg Geertgen
Behandelcentum Stg Geertgen, Elsendorp
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Conflict of interest: none
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Framework for gamete donation
EU Tissue Directive
2004/23/EC
Technical directives
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Framework for gamete donation
EU Tissue Directive
Landelijke richtlijn
Embryo Act
Dutch Donor Registration Act
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Framework for gamete donation
EU Tissue Directive
Landelijke richtlijn
Embryo Act
Dutch Donor Registration Act
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Types of gamete donation
•
•
•
•
Altruistic donation
Donation with payment to donor
Sharing
Reciprocal donation – ‘wederkerigheid’
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Reciprocity – wederkerigheid
• Reciprocity refers to responding to a positive action
with another positive action, rewarding kind actions
• Wederkerigheid is de onderlinge verplichting binnen
een relatie om een gift te beantwoorden met een
tegengift
• Cooperative reciprocal tendencies i.e. inclinations to
give back in a cooperative manner, are called positive
reciprocity.
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Solidarity
Vertical
Health Insurance system in Netherlands
• State controled mandatory health insurance
• ‘General Law on Exceptional Healthcare Costs’
• Premiums may not be related to health status or age
• Risk equalisation with a common risk pool.
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Reciprocity
A form of horizontal solidarity
Local Exchange Trading System – LETS
• Is a locally initiated, democratically organised, not-for-profit
community enterprise that provides a community information
service and record transactions of members exchanging goods and
services by using the currency of locally created LETS Credits.
• For instance, a member may earn credit by doing childcare for one
person and spend it later on carpentry with another person in the
same network.
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Donation of gametes
• No provisions for donation of gametes by
government
• Historicaly shortage of donors and donor material
• At time of change from A to B donors: Minister of
Health promised to facilitate the recruitment of
donors
• Limited to production of 2 information flyers :
one for donors and one for recipients
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Donation of gametes
Donor recruitment
private initiative is necessary
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Donation of gametes
Reciprocity system
One patient is in need of donor sperm
Other patient is in need of donor oocytes
Reciprocity system - ‘wederkerigheid’
Bank
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Donation of gametes:
Is there a need?
The primary recipients of donor sperm are
• heterosexual couples suffering from severe male
infertility
• lesbian couples
• single women
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Donation of gametes:
Is there a need?
The primary recipients of donor sperm at Stg Geertgen
are
• heterosexual couples suffering from severe male
infertility - 1/3
• lesbian couples - 1/3
• single women - 1/3
For use in IUI or IVF/ICSI
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Donation of gametes
Sperm donation at Stg Geertgen
• 30% of patients bring own sperm donor
• 30% of patients use sperm from Stg Geertgen
altruistic sperm donor bank
• 20% of patients use sperm from external donor bank
• 20% participate in reciprocity system
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Donation of gametes:
Is there a need?
The primary recipients of oocyte donation
at Stg Geertgen are
• Patients suffering from severe female infertility
eg. POF, genetic indication
• Intra-relational donation - lesbian couples
For use in IVF/ICSI
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Donation of gametes
Oocyte donation at Stg Geertgen
• 50% of patients bring own oocyte donor
• 50% by reciprocity system
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Donation of gametes:
Sperm - oocytes
Stg Geertgen in 2012
Only 30% of need for donor semen is
fullfilled by reciprocity
More requests for oocytes through
reciprocity than offered
Sperm donor from bank is a realistic
option
Donor oocytes from bank is currently
not a real option
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Donation of gametes
• Free choice to become a donor
• Counseling by fertility specialist
– risks of treatment
• Counseling by fertility psychologist
– implications of donation – B donor – psychosocial stability
• Donor participating in reciprocity: extra counseling
• Sign inform consent
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Donation of gametes
• Maximum age =
– 37 years
– ±50 years
•
•
•
•
Psychosocial stable person
Serological tests ok
Genetics ok
Healthy life style ok
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Donation of gametes: is there a need?
Results with natural cycle Donor IUI
Stg Geertgen in 2012
Donor IUI 2012
Donor IUI 2013 (1-5)
2257
785
Number of cycles
Pregnant per cycle
227
10,1%
Ongoing pregnancy rate per cycle
157
6,9%
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65/695
10,3%
9,4%
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Donation of gametes: is there a need?
Results with Donor oocytes - freeze/thaw of embryos
Stg Geertgen in 2012
Number
of cycles
Stg Geertgen
Landelijke
registratie
238
Number
of
patients
123
Number of
embryos
thawed
301
% Survival
235 78,1%
Mean numebr of
embryos per
thawing
1,1 (1-4)
Number of
transfers
209
Mean number
% Clinical
of embryos per pregnancy rate
ET
per transfer
1,1 (1-2)
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11,9%
Miscarriage
rate
30,6%
1124
7513
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15%
32,6%
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Reciprocity
Not a free system.
Voluntary and informed choice
All information concerning
reciprocity is published on website
and in brochure
Stg Geertgen is open and clear
about the reciprocity system
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Reciprocity
Reciprocity is undermining national
(vertical) solidarity system of health
care.
“Het systeem van ‘faire
wederkerigheid’ ….. . Als het echter
gaat om het doneren van
geslachtscellen lijkt de rol van de
overheid eerder beperkend dan
stimulerend.”
Minister van Volksgezondheid, Welzijn en Sport, mw. drs.
E.I. Schippers 11.07.2013
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Reciprocity
Recipient is pregnant, but
donor is not.
This is of course possible, this issue is
discussed in detail during cousneling
sessions with psychologist and fertility
specialist.
If issue is not accepted by patient,
treatment will not commence.
Stg Geertgen 2012 - 2013
• 10 donors are not pregnant but are
still undergoing treatment
• 2 stopped treatment
• 1 couple received oocytes resulting in
pregnancy but partner semen was
never donated to bank
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Reciprocity
•
•
•
•
•
•
•
No need for fertility tourism
Reduce time ‘start to treat’ (<3 months)
‘Matching’ of donor and recipient is possible
Outcomes are good
Patient is in charge of treatment
Accepted by society
Acceptance by professional body is growing
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Reciprocity
• Number of patients that will enrole in reciprocity donation
system is limited
• Banking of donor oocytes by vitrification will change
strategy
• Use of vitrified oocytes from ‘donor oocyte bank’ will
result in less oocytes necessary per recipient
• Cost reduction through ‘donor oocyte bank’
• Follow up of children and families in reciprocal donation
program is mandatory
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Teamwork
Behandelcentrum Stg Geertgen
Pater Rossaertstraat 3 - 5424 TG Elsendorp
Directie
- Henk Ruis - algemeen directeur
- Han Michgelsen - medisch directeur
- Erik Unterhorst - directeur laboratorium
- Bas Ruis - directeur beheer
Gynaecologen
- Carola Backx
- Eric Mendels
- Han Michgelsen
- Henk Ruis
Fertiliteitsartsen
- Daniëlle Bax
- Marieke van den Broek
- Frank van Heerebeek
- Mathilde Kuijpers
- Dolf Wissmann
Psychologen
- Martje Ubbens
- Marloes Verhulst
- Judith Zegers
Gespecialiseerd verpleegkundigen
- Corine Aldenzee
- Veronique de Brouwer
- Judith Dongelmans
- Kristel van Lieverloo
- Marie-Louise van de Loo
- Dorien Philipsen
- Jeanne van Santvoort
- Simone Verboven
- Tiny Wagemaker
- Brigitte van den Woldenberg
- Brigitte Zimmerman
Secretariaat
- Ad de Beer
- Anky Buijs
- Anja Hezemans
- Susan Hoevenaars
- Lia Scheltenaar
- Gerda Schrauwen
Medisch receptionistes
- Karin van Dommelen
- Judith Drouen
- Hilke van Duijnhoven
- Hilde van Heck
- Rodette Janssen
- Karin Leenders
- Astrid Michiels
- Marianne Peeters
- Stefanie Sam
- Ine Schepers
- Judith de Visser
Sr Klinisch embryologen
- Erik Unterhorst
- Martine Nijs
Andrologie Analisten
- Marianne Huijbers
- Linsey van Lieverloo
- Rita Martens
- Roger van de Wetering
- Peter Wiering
IVF-analisten
- Dorien van der Heijden
- Corlinda Martens
- Marleen Sevenster
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Donorenbegeleiding
- Dirk van Bragt
- Bauke Geeris
Doktersassistentes
- Suzan Klomp
- Monica van Os
Apotheker
- Pieter Weerts
Apothekersassistentes
- Petra Coopmans
- Thea Muijsers
- Annette Roelands
- Antonie van de Ven
- Heidi Vereijken
Facilitair medewerksters
- Joke Bekx
- Tini van Berlo
- Thea van der Cruijsen
- Karin Sterken
- Stella van Tilborg
- Ingrid Verwegen
Kwaliteitsmedewerkers
- Sharon de Bruin
- Anneke van Dommelen
- Frenk Habraken - concierge
- Martine Nijs - wetenschappelijk adviseur
- Janine Ruis - juridisch medewerker
- Marcel Ruis- human resources manager
- Tina Ruis – patientenbegeleiding - donatie
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Thank you!
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