Reproductive medicine:

good servant but bad boss?

Hana Konečná, Czech Republic

Education in fertility awareness: from prevention to action: whose duty?

27th ESHRE Annual Meeting, Stockholm 2011

Supported by GACR P407/10/0822

Prevention

Magic formula of recent decades.

offers people the opportunity to avoid

suffering offers state economies the opportunity

to save money

Primary – secondary – tertiary

Risky factors in RM

advanced age,

smoking,

obesity,

sexually transmitted diseases,

alcohol consumption

environmental factors

Lifestyle-related factors and access to medically assisted reproduction, Human Reproduction, Vol.00, No.0 pp. 1–6, 2010

Prevention and treatment of infertility in modern society, ESHRE Campus 2010, Istanbul Turkey

Primary prevention in CR

Health 21 – „Health-for-all policy for the twenty-first

century"

Warsaw Declaration for a Tobacco-free Europe

European Alcohol Action Plan

European Charter on Counteracting Obesity.

Green Paper – Promoting healthy diets and physical

activity

Joint United Nations Programme on HIV/AIDS

Global strategy for the prevention and control of sexually

transmitted infections

Protocol on Water and Health

Environment for Europe

Primary prevention in CR - effect

everybody knows, numbers of smokers, obese, … not declining

feelings of guilt, inflow of “good advice” from the surroundings

healthism, lifestylism, orthorexia

Secondary prevention - RM

Screening - to avoid severity

of disease

Gyneacology (papp smear tests,

mammograph, ...)

Andrology?

Secondary prevention - RM

Screening

Gyneacology (papp smear tests,

mammograph, ...)

„Got balls? So watch out!“

„Got balls? So watch out!“

„Got balls? So watch out!“

Interpreting research results

results gained from high-risk population:

how to use them in „normal“ population?

yes/no strategy

small numbers interpreting, difference

between statistical and clinical significance

mathematical tools used

Secondary prevention - problems

false positive and false negative tests

spermiogram as a screening? - the right

not to know?

mathematic tools

Tertiary prevention

mild stimulation protocols

mild microsurgery MESA, TESE

small number of embryos transfered

3rd party reproduction

psychosocial support - coping with

problem

... men also have something to say about

conception

Mathematical tools

Grimes, D., A., Schulz, K., F. (2002). Bias and causal associations in observational research. Lancet 2002; 359: 248–52.

Goodman, S. N. 1999. Towards evidence-based medical statistics, II: the Bayes factor. Ann. Intern. Med. 130:1005-1013.

Grunkemeier, G., L., Wu, Y, X., Anthony P. Furnary, A., F. (2009). What Is the Value of a p Value? Ann Thorac Surg 2009; 87:1337-1343

Lee, J., J. (2011). Demystify Statistical Significance—Time to Move on From the P Value to Bayesian Analysis. Editorials. JNCI Vol. 103, Issue 1 | January 5, 2011

Mathematical tools

Matematical tools

Factor „TIME“

„advanced age“

not involved

in preventive programmes

RM as a good servant

reliable and safe contraception

↓

unwanted pregnancy prevention

(pregnancy coming too early)

RM as a bad boss?

But when is the one

sufficiently ready for responsive

parenting?

(economically secured, in stable partnership,

personally mature, ...)

↓

Side effects of reliable contraception is

imposing responsibility...

ESHRE Task Force

Reproduction and Society

Campaign for:

increase public awareness concerning risk

factors affecting a couple’s fecundity

a realistic perception of what can/can’t be

overcome by ART

factors affecting an earlier onset of

family building among young couples

RM as a good servant

ART

↓

chance for many couples suffering from

infertility

RM as a bad boss?

But when to stop treatment

– more and more new technologies are available, still chance to stay open“?

Obama´s „yes, we can“ interpreted as

„yes, you must“ (continue)“?

Dill, S. (2010). Facing failure: finding new strenght. IFFS Munich

Gurgan, T. (2010). What to do after IVF/ICSI failure. IFFS Munich.

Prevention

„How to prevent the burden

of the decision-making?

From prevention to action

Whose duty?

What level of the prevention?

What validity of research in prevention?

Whose competence to do campaigns?

Whose justification?

Thank you for your

patience and kind attention

hana@adamcr.cz