1. 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
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2. Conflict of interest: none
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3. Framework for gamete donation
EU Tissue Directive
2004/23/EC
Technical directives
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4. Framework for gamete donation
EU Tissue Directive
Landelijke richtlijn
Embryo Act
Dutch Donor Registration Act
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5. Framework for gamete donation
EU Tissue Directive
Landelijke richtlijn
Embryo Act
Dutch Donor Registration Act
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6. Types of gamete donation
Altruistic donation
Donation with payment to donor
Sharing
Reciprocal donation – ‘wederkerigheid’
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7. 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.
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8. Upcoming challenges, Leiderdorp, 04.10.2013
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.
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9. 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.
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10. Upcoming challenges, Leiderdorp, 04.10.2013
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
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11. Upcoming challenges, Leiderdorp, 04.10.2013
Donation of gametes
Donor recruitment
private initiative is necessary
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12. Donation of gametes Reciprocity system
One patient is in need of donor sperm Other patient is in need of donor oocytes Reciprocity system - ‘wederkerigheid’
Bank
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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
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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
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15. Donation of gametes Sperm 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
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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
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17. Donation of gametes Oocyte donation at Stg Geertgen
50% of patients bring own oocyte donor
50% by reciprocity system
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18. 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
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19. Upcoming challenges, Leiderdorp, 04.10.2013
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
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20. Upcoming challenges, Leiderdorp, 04.10.2013
Donation of gametes
Maximum age =
37 years
±50 years
Psychosocial stable person
Serological tests ok
Genetics ok
Healthy life style ok
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21. Upcoming challenges, Leiderdorp, 04.10.2013
Donation of gametes: is there a need? Results with natural cycle Donor IUI Stg Geertgen in 2012
Donor IUI 2012
Donor IUI 2013 (1-5)
Number of cycles
2257
785
Pregnant per cycle
,1%
,3%
Ongoing pregnancy rate per cycle
,9%
65/ ,4%
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22. Donation of gametes: is there a need
Donation of gametes: is there a need? Results with Donor oocytes - freeze/thaw of embryos Stg Geertgen in 2012
Number of cycles
Number of patients
Number of embryos thawed
% Survival
Mean numebr of embryos per thawing
Number of transfers
Mean number of embryos per ET
% Clinical pregnancy rate per transfer
Miscarriage rate
Stg Geertgen
238
123
301
78,1%
1,1 (1-4)
209
1,1 (1-2) 25
11,9%
30,6%
Landelijke registratie
7513
1124
15%
32,6%
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23. Upcoming challenges, Leiderdorp, 04.10.2013
Reciprocity
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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24. Upcoming challenges, Leiderdorp, 04.10.2013
Reciprocity
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
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25. Upcoming challenges, Leiderdorp, 04.10.2013
Reciprocity
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
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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26. Upcoming challenges, Leiderdorp, 04.10.2013
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
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27. Upcoming challenges, Leiderdorp, 04.10.2013
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
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28. Upcoming challenges, Leiderdorp, 04.10.2013
Teamwork Behandelcentrum Stg Geertgen Pater Rossaertstraat 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
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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29. Upcoming challenges, Leiderdorp, 04.10.2013
Thank you!
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