Transitioning from IVF practice to restorative reproductive medicine.

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Alicia James
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1 Transitioning from IVF practice to restorative reproductive medicine. Tadeusz Wasilewski Białystok

2 Białystok Medical University in Branicki Palace - town of the first in vitro in Poland Cathedral - Divine Mercy town

3 Supraśl

4 Thank You Phil Suprasl Poland

5 Reproductive medicine today Infertility as a family, social and clinical problem Assissted Reproductive Technology (ART) as a response of medicine In vitro fertilization - embryo transfer

6 Medical complications of in vitro Ovarian hyperstimulation syndrome Multiple pregnancies Reduced health rates in children

7 Multiple pregnancies (30%) Prematurity Low birth weight Increased perinatal mortality

8 Reduced health rates in children Hansen M, Bower C, Milne E, de Klerk N, J Kurinczuk. Assisted reproductive technologies and the risk of birth defects a systematic review. Human Reproduction 2005, 20(2), Conclusion: Risk of congenital defects associated with ART increases by 30 40%

Assisted reproductive technologies and the risk of birth defects a

9 Radical experiment on the genome

10 Ethical aspects of in vitro Life not for every child - selection - cryopreservation - preimplantation diagnostics - embryoreduction

11 View of ESHRE According to ESHRE (European Society of Human Reproduction and Embriology) recommendations treatment of infertility should result in birth of a healthy child. Lambert RD. Safety issues in assisted reproductive technology: aetiology of health problems in singleton ART babies. Hum Reprod Oct;18:

12 New views Physicians and biomedical researchers must be sufficiently proficient to find alternatives or to develop new ethically acceptable medical solutions to prevent iatrogenic problems

13 The Declaration of Helsinki It is the duty of the physician in medical research to protect the life, health, privacy, and dignity of the human subjects. (Article 10).

14 Work in the IVF Clinic

15 In vitro - life & death

16 Goodbye in vitro Where is my family?? How long do I have to stay in the freezer? Who is my grandmother? Who is my father? Who is my mother?

17 Embryo is my little patient NaProMedica place of realisation

18 Preliminary data - first two years of work Objective retrospective analysis of efficacy of treatment with natural methods in couples diagnosed with intertility Patients & Metods 412 couples diagnosed and treated in NaProMedica (Bialystok, Poland) from January 2009 to November 2010 (more than one visit). Standard diagnostic procedures & CrMS (at least 3 months) & natural procreative support Poland

diagnosed and treated in NaProMedica (Bialystok, Poland) from January 2009 to November 2010 (more

19 Patients characteristics our patients come from all over Poland & from Germany UK Ukraine Belarus Poland

20 Patients characteristcs (n=412) Age, years mean ±SD (95% CI) IQR Female Male 33.7 ± ± 6.0 ( ) ( ) Poland

21 Female age sub-groups y y y y N = 67 N = 216 N = 83 N = ± ± ± ± 1.9 Poland

22 HistoryofofinIVvitro & IUI History & IUI 11.65% 29.37% Poland

23 Time of Infertility Time Before first visit (years) Mean±SD 95% CI Median Range 4.9 ± Poland

24 Time of treatment - in months Time Mean±SD 95% CI Median Range 8.5 ± 6.3 (5.5) I group Positive TEST 6.6 ± II group Negative TEST 8.9 ± In NaProMedica (months) (Test t; p=0.007) 70 / % Poland

25 Positive TEST vs. Female Age Factor Chi2 Pearson p=0.07 Poland

26 The highest efficacy efficacy in the group The highest - with moderateinfertility infertility duration moderate duration χ2 Pearson df = 3 p< Poland

27 Preliminary data - first two years of work Results of total 412 couples 70 conceived (positive TESTS) (16.99 % ) mean time of infertility 4.9 ± 3.3 years mean time of the diagnostic procedures & treatment in NaProMedica ± 6.3 months Poland

28 NaProMedica Team Agnieszka Ostrowska, FCP Agata Szadkowska, FCP Marta Wiesławska, FCP Ewa Rucińska, M.A. Emilia Matejczuk, M.A. KatarzynaSnitkowska, RN Irena Depczyńska, RN Katarzyna Gierasimiuk, RN Monika Rainko, RN Maria Łazewska, M.D. Tadeusz Wasilewski, M.D. Jolanta Wasilewska, M.D. Poland

29 Respect, protect, love and serve life, every human life! John Paul II - Evangelium vitae

Assisted reproductive technologies (ART) in Canada: 2011 results from the Canadian ART Register

1 Assisted reproductive technologies (ART) in Canada: 2011 results from the Canadian ART Register Joanne Gunby, M.Sc. CARTR Co-ordinator Email: gunbyj@mcmaster.ca Supported by the IVF Directors Group of