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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. Conflict of interest: none. F ramework for gamete donation. EU Tissue Directive

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Oocyte donation: controversial issues in clinical practice.

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Oocyte donation 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

Upcoming challenges, Leiderdorp, 04.10.2013


Oocyte donation controversial issues in clinical practice

Conflict of interest: none

Upcoming challenges, Leiderdorp, 04.10.2013


F ramework for gamete donation

Framework forgametedonation

EU Tissue Directive

2004/23/EC

Technical directives

Upcoming challenges, Leiderdorp, 04.10.2013


F ramework for gamete donation1

Framework forgametedonation

EU Tissue Directive

Landelijke richtlijn

Embryo Act

Dutch Donor Registration Act

Upcoming challenges, Leiderdorp, 04.10.2013


F ramework for gamete donation2

Framework forgametedonation

EU Tissue Directive

Landelijke richtlijn

Embryo Act

Dutch Donor Registration Act

Upcoming challenges, Leiderdorp, 04.10.2013


Types of gamete donation

Types of gametedonation

  • Altruisticdonation

  • Donationwithpaymentto donor

  • Sharing

  • Reciprocaldonation – ‘wederkerigheid’

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity wederkerigheid

Reciprocity – wederkerigheid

  • Reciprocityrefers to responding to a positive action with another positive action, rewarding kind actions

  • Wederkerigheidis 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.

Upcoming challenges, Leiderdorp, 04.10.2013


Solidarity vertical

SolidarityVertical

Health Insurance system in Netherlands

  • State controledmandatoryhealth insurance

  • ‘General Law on Exceptional Healthcare Costs’

  • Premiums may not be related to health status or age

  • Risk equalisation with a common risk pool.

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity a form of horizontal solidarity

ReciprocityA form of horizontalsolidarity

Local Exchange TradingSystem – LETS

  • Is a locally initiated, democratically organised, not-for-profitcommunity 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.

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes

Donation of gametes

  • No provisionsfordonation of gametesbygovernment

  • Historicalyshortage of donors and donor material

  • At time of change from A to B donors: Minister of Health promisedtofacilitate the recruitment of donors

  • Limited toproduction of 2 information flyers :

    onefor donors andoneforrecipients

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes1

Donation of gametes

Donor recruitment

private initiative is necessary

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes reciprocity system

Donation of gametesReciprocity system

One patient is in need of donor sperm

Other patient is in need of donor oocytes

Reciprocity system - ‘wederkerigheid’

Bank

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes is there a need

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

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes is there a need1

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

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes sperm donation at stg geertgen

Donation of gametesSpermdonation 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

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes is there a need2

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

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes oocyte donation at stg geertgen

Donation of gametesOocytedonation at Stg Geertgen

  • 50% of patients bring own oocyte donor

  • 50% by reciprocity system

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes s perm oocytes stg geertgen in 2012

Donation of gametes: Sperm - oocytesStg Geertgen in 2012

Only 30% of needfor donor semen is fullfilledbyreciprocity

Sperm donor from bank is a realisticoption

More requestsforoocytesthroughreciprocitythanoffered

Donor oocytesfrom bank is currentlynota realoption

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes2

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

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes3

Donation of gametes

  • Maximum age =

    • 37 years

    • ±50 years

  • Psychosocial stable person

  • Serological tests ok

  • Genetics ok

  • Healthy life style ok

Upcoming challenges, Leiderdorp, 04.10.2013


Donation of gametes is there a need results with natural cycle donor iui stg geertgen in 2012

Donation of gametes: is there a need? ResultswithnaturalcycleDonor IUIStg Geertgen in 2012

Upcoming challenges, Leiderdorp, 04.10.2013


Oocyte donation controversial issues in clinical practice

Donation of gametes: is there a need? ResultswithDonor oocytes- freeze/thaw of embryosStg Geertgen in 2012

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity

Reciprocity

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity1

Reciprocity

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity2

Reciprocity

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity3

Reciprocity

  • No needforfertilitytourism

  • Reduce time ‘start totreat’ (<3 months)

  • ‘Matching’ of donor andrecipient is possible

  • Outcomes are good

  • Patient is in charge of treatment

  • Acceptedby society

  • Acceptanceby professional body is growing

Upcoming challenges, Leiderdorp, 04.10.2013


Reciprocity4

Reciprocity

  • Number of patientsthatwillenrole in reciprocitydonation system is limited

  • Banking of donor oocytesby vitrification will change strategy

  • Use of vitrifiedoocytesfrom‘donor oocytebank’ willresult inlessoocytesnecessary per recipient

  • Costreductionthrough ‘donor oocyte bank’

  • Follow up of childrenand families in reciprocaldonation program is mandatory

Upcoming challenges, Leiderdorp, 04.10.2013


Teamwork behandelcentrum stg geertgen pater rossaertstraat 3 5424 tg elsendorp

Teamwork Behandelcentrum Stg GeertgenPater Rossaertstraat 3 - 5424 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

- CorineAldenzee

- Veronique de Brouwer

- Judith Dongelmans

- Kristelvan 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

- AnjaHezemans

- 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

- FrenkHabraken - concierge

- Martine Nijs - wetenschappelijk adviseur

- Janine Ruis - juridisch medewerker

- Marcel Ruis- human resources manager

- Tina Ruis – patientenbegeleiding - donatie

Upcomingchallenges, Leiderdorp, 04.10.2013


Oocyte donation controversial issues in clinical practice

Thankyou!

Upcoming challenges, Leiderdorp, 04.10.2013


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