IVF 2021 – OPTIMISTIC FUTURE? MUDr. Štěpán Machač, Ph.D. IVF Clinic, Olomouc
IVF 2018 • Around 2,4 million ART cycles are estimated each year, with about 500 000 babies born. • 2-6% live births in Europe by ART. • World data analysis 2013. • Delivery rate per aspiration 19,2%. • Cumulative delivery rate per single started cycle 27,4%. Human Fatemi, 8th IVIARM Congress, Palma, 2019
VISION IN IVF - TARGETS • Achieve the highest success rate (take home baby rate). • Successfully treat all reproductive medicine diagnosis. • Use up-to-date procedures and technics. • Introduce new evidence based methods. • Safety women + reduce burden of ART. • Child health. • Cost. • Access to care.
ART TREATMENT – OVARIAN STIMULATION • Minimize Complications and Risks. • Cycle Cancellation (poor responder). • Avoid multiple pregnancy. • OHSS. • Maximize Beneficial Effects. • Singleton live birth at term.
VISIONAIRES IN IVF Bart Fauser Norbert Gleicher Juan Garcia Velasco
VISIONARY IN IVF Norbert Gleicher Center Human Reproduction, New York, N.Y., USA; Foundation for Reproductive Medicine, New York, USA; Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, N.Y., USA; • Reproductive immunology. • DHEA. • FET of aneuploid embryos after PGT-A • Stimulation of low responder a poor prognosis patients.
VISIONARY IN IVF Worldwide declines of in vitro fertilization (IVF) birth rates and their probable causes – unpublished. 35% Live Birth per Fresh ART Cycle (%) 30% 25% 20% 15% 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 U.S. annual live birth rates following autologous IVF cycles 1995 to 2014
VISIONARY IN IVF • Database (ANZARD) https://npesu.unsw.edu.au/, accessed December 25, 2018. • Canada Fertility & Andrology Society Annual Reports (CARTR) https://cfas.ca/cartr-annual- reports/, accessed November 20, 2018- • Japan Society of Assisted Reproduction. • Latin American Network of Assisted Reproduction( www.redlara.com, accessed November 20, 2018). • Hum (www.hfea.gov.uk/fertility- clinics-success-rates.html), accessed November 20, 2018 and CDC for United States.
ELECTIVE SINGLE ET Australia and New Zealand Canada Japan Latin America UK US 90% 80% 70% % SET in Fresh ART Cycles 60% 50% 40% 30% 20% 10% 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
VISIONARY IN IVF Japan 250000 16% 14% Live Birth per Fresh ART cycle (%) Total Fresh Autolgous Cycles 200000 12% 10% 150000 8% 100000 6% 4% 50000 2% 0 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Cycles Live Birth Rate
VISIONARY IN IVF Australia and New Zealand 50000 25% Live Birth per Fresh ART cycle (%) 45000 Total Fresh Autolgous Cycles 40000 20% 35000 30000 15% 25000 20000 10% 15000 10000 5% 5000 0 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Cycles Live Birth Rate
VISIONARY IN IVF Table 1. Newly introduced additions that may have adversely affected IVF outcomes Embryo selection Extended embryo culture to blastocyst Elective single embryo transfer (eSET) Closed embryo incubation systems with time lapse imaging Preimplantation genetic screening (PGS)* Mild ovarian stimulations “ Mini- IVF” Natural cycle IVF Patient-friendly IVF Cycle interruptions All freeze cycles with frozen-thawed cycle to follow Embryo banking with combined frozen-thawed cycle to follow
VISIONARY IN IVF Bart Fauser University Medical Center Utrecht, Department of Reproductive Medicine • International consensus on the definition of PCOS. • Worldwide trend towards milder and safer IVF. • Editor in Chief Reproductive Biomedicine Online. • Former Chair od WHO steering committee for infertility guidelines.
BASIC QUESTIONS • Do we know what to report? • Standard success rate in IVF. • What procedures and techniques help to achieve our vision?
WHAT TO REPORT? 2004
VISIONARY IN IVF
VISIONARY IN IVF
VISIONARY IN IVF
VISIONARY IN IVF Juan Antonio Garcia Velasco IVIRMA , Director of IVF Madrid • Co-Editor of Reproductive Biomedicine Online. • Endometriosis and hypo- and hyper-ovarian. stimulation response • Reproductive immunology. • Onco-fertility preservation. • Personalized IVF stimulation.
ART 2021 • Big data will help individualize much more the treatments. OPTIMISTIC • Much better embryos selection – SET all. • More simple treatment. • Better results due to better. understanding of areas that we do not understand now.
TAYLORED ART - INDIVIDUALIZED 37% Hershkop et al, RBMO, 2017
PATIENTS CENTRED MEDICINE • Looks back to the individual patient. • Best health care to each of them. • Based on careful individual observation. • Takes into account patients: • Preferences • Economical resources
AUTHORITIES AND MASS MEDIA
AUTHORITY STRATEGY Strategy 2017-20 Treatment add ons 3.3. One area of work that we have already started is treatment ‘add ons’ which have become a feature of many IVF services. Increasingly, patients are being offered a variety of treatments – including drug regimes, methods for culturing embryos and treatment procedures – with the claim that they improve the chances of a successful pregnancy. Some patient feedback indicates that many now see such treatments as an indicator of a good service. Yet the evidence base for many of these treatments is weak. Our new website will give information about these add ons and we are discussing collaborative work with the professional bodies and patient groups. How might we want to progress this work further in 2017-20? Treatment costs 3.4. We are not an economic regulatora, nd have no direct levers to pull around the cost of treatment, but this is one of patients’ top concerns. Although our new website won’t list prices for each clinic, it will give patients information about the range of costs across UK clinics. It will also give patients a chance to give feedback on the patient ratings feature about whether they paid what the clinic estimated treatment would cost.
AUTHORITY STRATEGY Harper J. et al., HumReprod, 2017
MASS MEDIA
OHSS REPORTED Daily Mail, Fertility Clinics accused of covering up potentially fatal side effects of IVF
GOOD PHYSICIAN TREATS THE DISEASE GREAT PHYSICIAN TREATS THE PATIENT WHO HAS THE DISEASE
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