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?