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Oocyte donation: controversial issues in clinical practice.

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. Conflict of interest: none. F ramework for gamete donation. EU Tissue Directive

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Oocyte donation: controversial issues in clinical practice.

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  1. 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 Upcoming challenges, Leiderdorp, 04.10.2013

  2. Conflict of interest: none Upcoming challenges, Leiderdorp, 04.10.2013

  3. Framework forgametedonation EU Tissue Directive 2004/23/EC Technical directives Upcoming challenges, Leiderdorp, 04.10.2013

  4. Framework forgametedonation EU Tissue Directive Landelijke richtlijn Embryo Act Dutch Donor Registration Act Upcoming challenges, Leiderdorp, 04.10.2013

  5. Framework forgametedonation EU Tissue Directive Landelijke richtlijn Embryo Act Dutch Donor Registration Act Upcoming challenges, Leiderdorp, 04.10.2013

  6. Types of gametedonation • Altruisticdonation • Donationwithpaymentto donor • Sharing • Reciprocaldonation – ‘wederkerigheid’ Upcoming challenges, Leiderdorp, 04.10.2013

  7. Reciprocity – wederkerigheid • Reciprocityrefers to responding to a positive action with another positive action, rewarding kind actions • Wederkerigheidis 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

  8. SolidarityVertical Health Insurance system in Netherlands • State controledmandatoryhealth 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

  9. ReciprocityA form of horizontalsolidarity Local Exchange TradingSystem – LETS • Is a locally initiated, democratically organised, not-for-profitcommunity 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

  10. Donation of gametes • No provisionsfordonation of gametesbygovernment • Historicalyshortage of donors and donor material • At time of change from A to B donors: Minister of Health promisedtofacilitate the recruitment of donors • Limited toproduction of 2 information flyers : onefor donors andoneforrecipients Upcoming challenges, Leiderdorp, 04.10.2013

  11. Donation of gametes Donor recruitment private initiative is necessary Upcoming challenges, Leiderdorp, 04.10.2013

  12. Donation of gametesReciprocity system One patient is in need of donor sperm Other patient is in need of donor oocytes Reciprocity system - ‘wederkerigheid’ Bank Upcoming challenges, Leiderdorp, 04.10.2013

  13. 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

  14. 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 Upcoming challenges, Leiderdorp, 04.10.2013

  15. Donation of gametesSpermdonation 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

  16. 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 Upcoming challenges, Leiderdorp, 04.10.2013

  17. Donation of gametesOocytedonation at Stg Geertgen • 50% of patients bring own oocyte donor • 50% by reciprocity system Upcoming challenges, Leiderdorp, 04.10.2013

  18. Donation of gametes: Sperm - oocytesStg Geertgen in 2012 Only 30% of needfor donor semen is fullfilledbyreciprocity Sperm donor from bank is a realisticoption More requestsforoocytesthroughreciprocitythanoffered Donor oocytesfrom bank is currentlynota realoption Upcoming challenges, Leiderdorp, 04.10.2013

  19. 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

  20. 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

  21. Donation of gametes: is there a need? ResultswithnaturalcycleDonor IUIStg Geertgen in 2012 Upcoming challenges, Leiderdorp, 04.10.2013

  22. Donation of gametes: is there a need? ResultswithDonor oocytes- freeze/thaw of embryosStg Geertgen in 2012 Upcoming challenges, Leiderdorp, 04.10.2013

  23. Reciprocity Upcoming challenges, Leiderdorp, 04.10.2013

  24. Reciprocity Upcoming challenges, Leiderdorp, 04.10.2013

  25. Reciprocity Upcoming challenges, Leiderdorp, 04.10.2013

  26. Reciprocity • No needforfertilitytourism • Reduce time ‘start totreat’ (<3 months) • ‘Matching’ of donor andrecipient is possible • Outcomes are good • Patient is in charge of treatment • Acceptedby society • Acceptanceby professional body is growing Upcoming challenges, Leiderdorp, 04.10.2013

  27. Reciprocity • Number of patientsthatwillenrole in reciprocitydonation system is limited • Banking of donor oocytesby vitrification will change strategy • Use of vitrifiedoocytesfrom‘donor oocytebank’ willresult inlessoocytesnecessary per recipient • Costreductionthrough ‘donor oocyte bank’ • Follow up of childrenand families in reciprocaldonation program is mandatory Upcoming challenges, Leiderdorp, 04.10.2013

  28. Teamwork Behandelcentrum Stg GeertgenPater 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 - CorineAldenzee - Veronique de Brouwer - Judith Dongelmans - Kristelvan 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 - AnjaHezemans - 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 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 - FrenkHabraken - concierge - Martine Nijs - wetenschappelijk adviseur - Janine Ruis - juridisch medewerker - Marcel Ruis- human resources manager - Tina Ruis – patientenbegeleiding - donatie Upcomingchallenges, Leiderdorp, 04.10.2013

  29. Thankyou! Upcoming challenges, Leiderdorp, 04.10.2013

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