1. The Straits Times, 16 March 2012

2. Image source: Amazon.com 3. The authors.Professor Bart Fauser & Professor Paul Devroey 4. Outline1. How to design a baby?2. What couples want and how we deal with it3. The infertility epidemic4. Infertility treatments for fertile people5. Who pays? : the social implications6. How far can we go? 5. How to design a baby? 6. Assisted reproductive techniques In vitro fertilisation (IVF) 7. Fathers of IVFRobert Edwards & Patrick Steptoe 8. Worlds First IVF baby Images: The Telegraph, UK 9. Issues with IVF Respond with too few eggs Ovarian hyper simulation syndrome Ability of an embryo to implant in the uterus(30to 60 %) Risks of multiple pregnancies Unable to treat male inferitility micromanipulationtechnique 10. Assisted reproductive techniques Micromanipulation or Micro-insemination sperm transfer (MIST) Image: Journal of Clinical Endocrinology & Metabolism 11. The Straits Times, 25 April 1989, Page 1 12. The Straits Times, 25 April 1989, Page 1 13. Assisted reproductive techniques Intracytoplasmic sperm injection (ICSI) Image: MyFertilityChoices.com 14. IVF vs. ICSI Figures for Europe In 2001, 49 % of all assisted reproductive techniques were with ICSI In 2003, proportion increased to 55% and to 63 % in 2005 In some European countries use of ICSI outweighed IVF Germany (70%), Italy (73%), Belgium (75%), Spain (83%) & Turkey (97%) - as of 2005 IVF remains the dominant technique in UK, Netherlands,Denmark & Sweden 15. A. In vitro fertilisation (IVF) B. Micromanipulation or Micro-insemination sperm transfer (MIST) C. Intracytoplasmic sperm injection (ICSI)Image: Journal of Clinical Endocrinology & Metabolism 16. What couples want and how wedeal with it? 17. Singleton or twin pregnancy? 18. The Infertility Epidemic Image: MedIndia.net 19. Causes of infertility Blocked tubes / hormonal problems (female) Low sperm count or morphology (male) Female age Uterine dyfunction Ovarian dyfunction Sperm dyfunction Premature menopause Image: Infobarrel.com 20. Infertility Treatments forFertile People 21. Preimplantation genetic screening (PGD) A technique which screens multiple IVF embryos Used to improve embryo selection for IVF increase the chance of pregnancy and make single embryo transfer more efficient. Used to select embryos which are unaffected by suspect gene from fertile parents 22. Saviour siblings Parents conceive a healthy, disease-free baby Use the babys blood cells are used to cure the elder child suffering from diseases Approved by the Human Fertilisation & EmbryologyAgency in UK Controversies & moral issues 23. Gender selection In the name of family balancing Not allowed in most European countries, but not disallowed in US Ensues an ethical debate, which is not easy to resolve Approved only on the grounds of medical indication where serious hereditary sex-related disease is to be avoided. 24. Fertility preservation Preserve the fertility of those undergoing treatment or those who postpone having kids Oncologists have a responsibility to refer patients to reproductive specialists Egg-freezing used by healthy, fertile women who are keen to establish careers before starting a family 25. Surrogacy Image source: Guardian.co.ukImage source: JustFamilies.org 26. Who Pays? :The Social Implications 27. Infertility: a disease? WHOs definition of reproductive health... that people are able to have a responsible , satisfying andsafe sex life and that they have the capability to reproduce andthe freedom to decide if, when and how often to do so. 1 Anything short of the above ideal therefore falls short of WHOsdefinition of health which is the state of complete physical, mentaland social well being. 21 http://www.who.int/topics/reproductive_health/en/index.html2 http://www.who.int/about/definition/en/print.html 28. Infertility: a disease? The authors argument....if we accept WHO claim that health is not just the absence of diseases but is also a psycho- social state of well-being, that reproductive health is not just about having children but having the potential to meet ones reproductive rights to safe and fulfilling parenthood, then the treatment of infertility does indeed lay claim to social support. (p. 207) 29. Labelling infertility as a disease JustificationforFunding 30. Paying for infertility treatment Little consistency among European governments about who should pay Denmark had the most generous state funding policies in Europe , providing reimbursement s for up to 3 cycles of treatments In May 2001, Danish government announced that IVF & ICSIwould no longer be provided as free public healthtreatment Nevertheless, in 2007, the 4 to 9 % of all children born inDenmark had been conceived by assisted reproduction 31. Treatment in developing countries Role of children is associated with cultural beliefs andpractice in these countries Growth of IVF in China & India keeping pace with theirrapid economic growth Investigation and treatment of infertility remain largelyneglected in poorer regions of Latin America, Asia &Africa Case for treatment would be stronger if cost of IVF waslesser Could be done by simplifying the investigations andtreatments 32. Whose responsibility? Assisted reproduction does have potential to contributeto total fertility and influence population structure Reasons for not having children are not just biological Working hours, child care, maternity leave, etc. Some countries have adopted pro-fertility policies toencourage childbirth E.g. Spains baby bonus, Frances code de familie Authors bring an economical perspective on fundingassisted reproduction UK Study 33. How Far Can We Go? 34. Robert Edwards Awarded Nobel prize in Medicine in 2010 IVF was introduced in 1976 Opposition from theCatholic Church Extent to which IVFhas necessitated thediscarding of embryos 35. Looking ahead. Posthumous reproduction Pregnancy in older women 36. In conclusion.