IVF : COMMERCIALIZATION IN ELEMENT IN GYNAECOLOGY

Dr. Hemant Zaveri

Any new concept !

they will laugh at you first

Any new concept !

Then they ignore you

Any new concept !

Then they will suspect you

Any new concept !

then they fight you

Any new concept !

Then you will believe new concept

Any new concept !

Then concept will established

Any new concept !

Then concept will rule on you!!!

Infertility affects 15 % of couples, and 50-70 % of male infertility is potentially correctable so it name As: Subfertility …….

DECREASING SPERM QUALITY & QUANTITY: A GLOBAL PROBLEM?OR JUST IN DATA???????

Evaluation of decreasing sperm count Decreasing sperm quality & Quantity just in Data???????

Environmental Health Perspectives 108 (10) (Oct. 10, 2000); E. Carlsen et al.British Medical Journal 305 (Sept. 12, 1992).

Reduction in sperm density Decreasing sperm quality & Quantity just in Data??????? What is reality

Reduction in sperm density Decreasing sperm quality & Quantity just in Data???????

Journal of Andrology, Vol. 28, No. 2, March/April 2007

Reduction in sperm morphology quality Decreasing sperm quality & Quantity just in Data??????? What is relity !!

Journal of Andrology, Vol. 30, No. 5, September/October 2009

Impact of the New WHO Guidelines on Diagnosis and Practice of Male Infertility 1 Reality

1. The Open Reproductive Science Journal, 2011, 3, 7-15

What is problem ?

growing population of India

What is problem ?

Growing population of India

What is problem ?

Infertility ?

What is problem ?

Infertility ?

What is problem ?

Infertility ?

Incidence of infertility

Previous: Rare ??????

Present: Very common ??????

Incidence of infertility

Previous: Rare ??????

Present: Very common ?????? Increasing age of married couple

Incidence of infertility

Present: Very common (Pseudo Infertility)

Figure 2. Prevalence of primary infertility and secondary infertility, presented as the percent of women who seek a child, and as the percent of all women of

reproductive age, in 1990 and 2010.

Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356

Absolute change in prevalence of primary and secondary infertility, measured as the percent of women who seek a child and as the percent of all women of

reproductive age, between 1990 and 2010.

Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356

In Vitro Fertilisation (IVF) is a last resort in Past !!!!!!!!!!!!

But Now it’s first choice !!!

In Vitro Fertilisation (IVF) is a last resort

But Now it’s first choice !!!

Need for fast conception The Ideal Infertile couple

Need for fast conception The Ideal Infertile couple

What is IVF

In vitro fertilization

What is IVF

In variable fertilisation (100% sure)

What is IVF

In vitro fertilization

What is IVF

In vitro fertilisation In variable fertilisation (100% sure)

Previous: tubal factor only Previous: tubal factor only

Present: Any couple !!!!!

Indications

Previous: tubal factor only Fallopian Tube Damage/Tubal Factor

Bilateral blocked Fallopian tubes Failed reversal of Tubectomy

The only options for treating significant tubal damage are surgical repair or bypassing the tubes with IVF. This decision must be carefully individualized in each situation.

Indications

Present: Male Factor Infertility

Failed reversal of Vasectomy/ Tubectomy Obstructive azoospermia

Endometriosis Severe endometriosis

Age Related Infertility Premature Menopause Anovulation

Unexplained Infertility Preimplantation Genetic Testing (PGT

ACCEPTANCE BY PEOPLE

Facts on IVF

Facts truth: IVF is only the last option  truth: IVF is only for affluent people truth: IVF is limited to a younger population

only truth: IVF is successful in all cases truth: IVF requires admission in the hospital truth: IVF always result in multiple

pregnancies like twins or triplets truth: IVF babies have a significantly high risk

of birth defects and malformations truth: IVF is not at all covered by insurance truth: IVF is dangerous

Acceptance by people

Present : reality- Who Does it Help? In-Vitro Fertilization and Side effects Woman’s Painful journey Maternal Age and Blastocyst

Development high failure rate Frozen Blastocyst Cycles The Future

In vitro fertilization & Next generation

Producing healthy human beings

IVF future Robotic Sperm !!!!

Robotic Sperm !!!!

Why it was not accepted by drs as routine?

ICSI: Should it be Restricted to Male Infertility Drugs to induce ovulation Ova harvesting Embryo transfer The outcome LACK OF CONFIDENCE LACK OF SENIORS SUPPORT LACK OF KNOWLEDGE FROM WHERE TO LEARN HOW TO ESTABLISH LAB etc…..

Success rate

Success rate !!! Reality

Success rate !!! Reality

Success rate !!! Reality

Future of IVF:

Blood Bank replaced by Sperm banks

Future of IVF: Sperm Bank

Future of IVF: Embryo Bank Technology Previous & Present: -Ease of getting equipment & loans -support of companies -disposables& media -hormones( refine technology) -ovum pick up -embryo transfer( role of USG) -endocrinology & lab support -availability of embryologyst - knowledge & skill - ICSI ,IMSCI, PICSI,PGS, PGD,ERRAY , LAH, STEMCELL etc…..

Future of IVF: Embryo Bank Technology

Service at door step Future of IVF: Embryo By companies By doctors By laboratories

Medicine updates: Embryo Donation

In vitro fertilization may leads to Human cloning

In vitro fertilization may leads to Human cloning

In vitro fertilization may leads to Human cloning

Technology burden on Doctors!!!!

Previous & Present: -Ease of getting equipment & loans Who will

Pay??? -support of companies We have to oblige them!! -disposables& media -hormones( refine technology) -ovum pick up -embryo transfer( role of USG) -endocrinology & lab support -availability of embryologyst - knowledge & skill - ICSI ,IMSCI, PICSI,PGS, PGD,ERRAY , LAH,

STEMCELL etc…..

Failed Technology

Assisted reproductive technology

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

GAMETE INTRAFALLOPIAN TRANSFER (GIFT)

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT)

Pseudo Benefits

Fast conception Early identification of factor Demand & supply Dhiraj & dhakka Multiple pregnancy LSCS Both party happiness Remote centre franchise for drs

Service at door step full commercialization By companies By doctors By laboratories

Medicine updatesSide effects !!! Previous:

Clomiphene citrate Present:

Various options GnRH Agonists GnRH Antagonists Gonadotropins  hCG Progesterone Medrol  Doxycycline

Side Effects !!!!!

Complications Higher risk of ovarian tumours after ovarian stimulation for in-vitro fertilization

Side Effects of IVF: Filure!!

Side Effects of IVF: Ectopic Pregnancy

Side Effects of IVF: Risk of Birth defects

Why IVF as for none?

Conclusion

Understand the reproductive potential of couple undergoing IVF

Success of ICSI (few data)

Male Factors Infertility IVF~40% live birth rates Very low as

compare to normal pregnancy Female Factors Infertility IVF

Higher results than other infertility causes~25% live birth rates Very low as compare to normal

pregnancy

What is IVF?