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1Upcoming challenges, Leiderdorp, 04.10.2013
Oocyte donation: controversial issues in clinical practice.
Results in a program of reciprocal donation.
Henk RuisMD, Obst & Gyn, PhD, CEO Stg Geertgen
Behandelcentum Stg Geertgen, Elsendorp
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Conflict of interest: none
Upcoming challenges, Leiderdorp, 04.10.2013
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Framework for gamete donation
Upcoming challenges, Leiderdorp, 04.10.2013
EU Tissue Directive2004/23/ECTechnical directives
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Framework for gamete donation
Upcoming challenges, Leiderdorp, 04.10.2013
EU Tissue Directive
Landelijke richtlijnEmbryo ActDutch Donor Registration Act
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Framework for gamete donation
Upcoming challenges, Leiderdorp, 04.10.2013
EU Tissue Directive
Landelijke richtlijnEmbryo ActDutch Donor Registration Act
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Types of gamete donation
• Altruistic donation• Donation with payment to donor• Sharing• Reciprocal donation – ‘wederkerigheid’
Upcoming challenges, Leiderdorp, 04.10.2013
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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.
Upcoming challenges, Leiderdorp, 04.10.2013
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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.
Upcoming challenges, Leiderdorp, 04.10.2013
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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.
Upcoming challenges, Leiderdorp, 04.10.2013
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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
Upcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametes
Donor recruitment
private initiative is necessary
Upcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametesReciprocity system
One patient is in need of donor sperm Other patient is in need of donor oocytes
Reciprocity system - ‘wederkerigheid’
Upcoming challenges, Leiderdorp, 04.10.2013
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
Upcoming challenges, Leiderdorp, 04.10.2013
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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/ICSIUpcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametesSperm 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
Upcoming challenges, Leiderdorp, 04.10.2013
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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 infertilityeg. POF, genetic indication
• Intra-relational donation - lesbian couples
For use in IVF/ICSI
Upcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametesOocyte donation at Stg Geertgen
• 50% of patients bring own oocyte donor• 50% by reciprocity system
Upcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametes: Sperm - oocytes
Stg Geertgen in 2012
Only 30% of need for donor semen is fullfilled by reciprocity
Sperm donor from bank is a realistic option
More requests for oocytes through reciprocity than offered
Donor oocytes from bank is currently not a real option
Upcoming challenges, Leiderdorp, 04.10.2013
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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
Upcoming challenges, Leiderdorp, 04.10.2013
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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
Upcoming challenges, Leiderdorp, 04.10.2013
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Donation of gametes: is there a need? Results with natural cycle Donor IUI
Stg Geertgen in 2012
Upcoming challenges, Leiderdorp, 04.10.2013
Donor IUI 2012 Donor IUI 2013 (1-5)
Number of cycles 2257 785
Pregnant per cycle 227 10,1% 82 10,3%
Ongoing pregnancy rate per cycle 157 6,9% 65/695 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
Upcoming challenges, Leiderdorp, 04.10.2013
Number of cycles
Number of
patients
Number of embryos thawed % Survival
Mean numebr of embryos per
thawingNumber of transfers
Mean number of embryos per
ET
% Clinical pregnancy rate
per transferMiscarriage
rate
Stg Geertgen 238 123 301 235 78,1% 1,1 (1-4) 209 1,1 (1-2)25
11,9% 30,6%
Landelijke registratie 7513
112415% 32,6%
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Reciprocity
Upcoming challenges, Leiderdorp, 04.10.2013
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
Upcoming challenges, Leiderdorp, 04.10.2013
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
Upcoming challenges, Leiderdorp, 04.10.2013
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
Upcoming challenges, Leiderdorp, 04.10.2013
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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
Upcoming challenges, Leiderdorp, 04.10.2013
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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
Upcoming challenges, Leiderdorp, 04.10.2013
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!
Upcoming challenges, Leiderdorp, 04.10.2013