![Success rates
11/27/201839
IVF success rates are the percentage of all IVF procedures
which result in a favorable outcome. Depending on the
type of calculation used, this outcome may represent the
number of confirmed pregnancies, called the pregnancy
rate, or the number of live births, called the live birth rate.
The success rate depends on variable factors such as
maternal age, cause of infertility, embryo status,
reproductive history and lifestyle factors.
Maternal age: Younger candidates of IVF are more likely to
get pregnant. Women older than 41 are more likely to get
pregnant with a donor egg.[3]
Reproductive history: Women who have been previously
pregnant are in many cases more successful with IVF
treatments then those who have never been pregnant.[3]
Due to advances in reproductive technology, IVF success
rates are substantially higher today than they were just a
few years ago.](https://image.slidesharecdn.com/unite-vii-181127053311/85/Unite-VII-39-320.jpg)
Unite VII
- 1. Sanjeev Kumar Shah National Open College Sanepa, Lalitpur 11/27/20181 Unit: VII Reproductive Health Issues and Conventions
- 2. Reproductive Health Issues and Conventions Common reproductive health issues: Harmful practices, unwanted pregnancy, unsafe abortion, reproductive tract infections including sexually transmitted diseases and HIV/AIDS, gender- based violence, infertility, malnutrition and anemia, and reproductive tract cancers. - International Conference on Population and Development (ICPD) o Goals of ICPD o Guiding principles of ICPD 11/27/20182
- 3. Reproductive health Concept The word "Reproductive Health" implies both men and women. Men are partners in reproduction and sexuality. Men's reproductive health and their behaviors impact on women's reproductive health and children's well-being and society as well Reproductive health can be defined as the state of physical, mental and social well-being in all matters relating to the reproductive system, its functions and processes. It implies that people are able to have a safe and satisfying sex life, capability to reproduce and the freedom to decide when and how often to do so. (http://www.who.int/topics/reproductive_health/en/). 11/27/20183
- 4. Contd.. This definition implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Men and women have the right to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice that are not against the law. 11/27/20184
- 5. Contd.. Lot of attention have been given to RH by many countries after the world population conference in 1974, as population grew rapidly in developing countries. Reproductive health issues have been strongly addressed after the International Conference on Population and Development (ICPD) held at Cairo in 1994. Reproductive health is a bilateral subject with parallel need of male and females. 11/27/20185
- 6. Contd.. Reproductive health is a universal concern, but is of special importance for women particularly during the reproductive years. However, men also demand specific reproductive health needs and have particular responsibilities in terms of women's reproductive health because of their decision-making powers in some reproductive health matters. Reproductive health is a fundamental component of an individual’s overall health status and a central determinant of quality of life 11/27/20186
- 7. Principle of RH As per ICPD, RH has following main principles Putting people at centre RH as new approach Individual choice promote prosperity Women rights Participation and partnership 11/27/20187
- 8. life cycle perspective for reproductive health. Reproductive health is a crucial feature of healthy human development and of general health. It may be a reflection of a healthy childhood, is crucial during adolescence, and sets the stage for health in adulthood and beyond the reproductive years for both men and women. Reproductive life span does not begin with sexual development at puberty and end at menopause for a woman or when a man is no longer likely to have children. Rather, it follows throughout an individual’s life cycle and remains important in many different phases of development and maturation. 11/27/20188
- 9. Contd.. At each stage of life, individual reproductive health needs may differ. However, there is a cumulative effect across the life course, and each phase has important implications for future well- being. An inability to deal with reproductive health problems at any stage in life may set the scene for later health problems. This is known as the life cycle perspective for reproductive health. 11/27/20189
- 10. Rights in RH There is a long history of recognizing reproductive health among the essential human rights. Acknowledgements of reproductive health from a human rights perspective are embedded in: The Universal Declaration of Human Rights, 1948; The Convention on the Elimination of All Forms of Discrimination Against Women, 1979; The programme of Action, from the International Conference on Population and Development, Cairo 1994; and the Platform for Action at the Fourth World Conference on Women, Beijing 1995. 11/27/201810
- 11. Contd.. Three rights in particular were identified: The right of couples and individuals to decide freely and responsibly the number and spacing of children and to have the information and means to do so; The right to attain the highest standard of sexual and reproductive health; and, The right to make decisions free of discrimination, coercion or violence. 11/27/201811
- 12. Rights contd.. Other rights are as, the right to health in general the right to reproductive choice the right to receive reproductive health services the right of men and women to marry and found a family the right of individuals to make reproductive decisions free of discrimination, coercion and violence the right of the family to special protection and sometimes, concepts of special rights in 11/27/201812
- 13. Importance of Reproductive Health Support to understand the Reproductive health is a human right stated in international law. Reproductive health plays an important role in morbidity, mortality and life expectancy. Reproductive health problems are the leading cause of women’s ill health and mortality worldwide. So study of RH support to minimize the problems Supports to deal with reproductive health problems at any stage in life may set the scene for later health problems 11/27/201813
- 14. Development of Reproductive Health Before 1978 Alma-Ata Conference Basic health services in clinics and health centers Primary health care declaration 1978 MCH services started with more emphasis on child survival Family planning was the main focus for mothers Safe motherhood initiative in 1987 Emphasis on maternal health Emphasis on reduction of maternal mortality Reproductive health, ICPD in 1994 Emphasis on quality of services Emphasis on availability and accessibility Emphasis on social injustice Emphasis on individuals woman's needs and rights 11/27/201814
- 15. Contd.. Millennium development goals and reproductive health in 2000 MDGs are directly or indirectly related to health MDG 4, 5 and 6 are directly related to health, while MDG 1,2,3, and 7 are indirectly related to health World Summit 2005, declared universal access to reproductive health “Sexual and reproductive health is fundamental to the social and economic development of communities and nations, and a key component of an equitable society.” lancet-2006 11/27/201815
- 16. Components of Reproductive Health Quality family planning services Promoting safe motherhood: prenatal, safe delivery and post natal care, including breast feeding; Prevention and treatment of infertility Prevention and management of complications of unsafe abortion; Safe abortion services, where not against the law; Treatment of reproductive tract infections, including sexually transmitted infections; Information and counseling on human sexuality, responsible parenthood and sexual and reproductive health; Active discouragement of harmful practices, such as female genital mutilation and violence related to 11/27/201816
- 17. Global Indicators of RH Fertility Life Expectancy Perinatal Mortality Low birth weight Maternal Mortality 11/27/201817
- 18. Fertility Fertility is a measure of the average number of births women in a society have. Fertility influences the rate of natural growth of a population. It is impacted by couples’ ability to control reproduction and by infant survival. To replace itself, a population must have a fertility rate of 2.1 children per woman There has been a marked decline in fertility and increase in life expectancy in developed countries of the world. Fertility rates continue at high levels in many less developed countries, particularly in Africa and Asia. 11/27/201818
- 19. Life expectancy Life expectancy is the number of years a newborn baby can expect to live if current mortality trends continue. It is a common indicator of the overall health and socio-economic wellbeing of a society. Life expectancy is heavily influenced by infant and maternal mortality. Life expectancy has lengthened markedly over the 20th century, in large part due to improvements in health care, preventive measures, sanitation and nutrition. There remain marked disparities in life expectancy between genders, countries and regions of the world, 11/27/201819
- 20. Factors affecting to LE The factors that noticeably affect life expectancy are poverty, environmental and occupational exposures, Individual risk factors such as smoking, obesity, Access to health care, Disease spread such as AIDS. 11/27/201820
- 21. Perinatal mortality Perinatal mortality is a significant indicator of the health status of pregnant women and their newborns. Perinatal deaths are infant deaths that occur within the first week of life and stillbirths. Of the 4 million babies that die each year during the first month of life, 3 million of them die in the last trimester of pregnancy or during the first week of life, considered the perinatal period. 11/27/201821
- 22. Contd.. Ninety-eight percent of early childhood deaths occur in the developing regions of the world. 6.3 million perinatal deaths occur worldwide each year, of which 3.3 million are stillbirths and 1/3rd of stillbirths occur during delivery. Deaths during delivery are closely related to place of delivery and care at delivery. In developing countries, approximately 40% of deliveries take place in a health facility; 57% or less occur under the care of a skilled birth attendant. 11/27/201822
- 23. Causes of Perinatal Mortality Causes of Perinatal Mortality poor maternal health or nutritional status inadequate care during pregnancy poor management of complications during pregnancy or delivery preterm birth unsanitary delivery maternal infections, such as malaria or syphilis neonatal tetanus 11/27/201823
- 24. Low birth weight Low birth weight is infant weight of less than 2500 grams at birth. 20 million low birth weight infants are born each year around the world. 96% of low birth weight infants are born in developing countries. ( Asia, with 77 million annual births, has the greatest number of births of any region in the world. There the incidence of low birth weight is also the highest in the world; 18.3% of infants born in Asia are low birth weight. More than half of the low birth weight infants in the region are born in India. The incidence of low birth weight in Africa, ranging from approximately 12% to 16%, varies relatively little 11/27/201824
- 25. Figure of LBW Number and Percent of Births that are Low Birth weight WORLDWIDE 20,629,000 15.5 % Africa 4,320,000 14.3 % Asia 14,195,000 18.3 % Europe 460,000 6.4 % Latin Am./Carribean 1,171,000 10.0 % North America 343,000 7.7 % More developed countries 916,000 7.0 % Less developed countries 19,713,000 16.5 % Least developed countries 4,968,000 18.6 % Source: UNICEF and WHO. Low birth weight. Country, Regional and Global Estimates,2004. 11/27/201825
- 26. Causes of LBW The major causes of LBW are directly related to maternal health, nutrition, disease and other conditions during pregnancy 11/27/201826
- 27. Magnitude of Reproductive Health Problems 1/5th of the world wide Borden of illness and premature death 1/3rd of the illness and death among women is in reproductive age. Problem related to pregnancy and childbearing present the measure portion of healthy year of life lost to women of reproductive age. One women die/minuet due to the pregnancy related causes. This adds up to more than ½ million mothers lost each year. Every year at least 70,000 women die of consequence of unsafe abortion and many more suffer complications. It is estimated that one out of every 11 babies in developing countries die during the first period of life. This adds up to 10.7 million infant death. Similarly 4 million children between 1-5 year die every year. 11/27/201827
- 28. Contd.. Six out of 10 women in many countries have sexually transmitted diseases. One million people die each year as a result of RTI other than HIV/AIDS. For women aged between 15-45 years in developing countries the second highest burden of disease ( after maternal morbidity and mortality) comes from STD and they account for nearly 15% of all health lost in this age. There are an estimated 333 million new cases of STD per year Rape and other forms of sexual violence are increasing though many rape are unreported because of stigma and trauma associated with them and lack of sympathetic treatment from legal system 2 million girls between the age 5-15 are introduced into the commercial sex market each year Study of domestic violence suggests that widespread in most societies. It is a frequent cause of suicide among women and murder. 11/27/201828
- 29. Major RH problems Perinatal and Maternal death Neonatal, infant and child death Teen age and high risk pregnancy Low birth weight Illegal abortion RTI, STD and HIV/AIDS Adolescent health problems Infertility Elderly health problems Female Genital mutilation Sex selective abortion Rape Gender based violence 11/27/201829
- 30. RH issues in Nepal Family planning Safe motherhood Adolescent RH Neonatal Health HIV/AIDS Infertility Abortion care Elderly women Gender based violence Sex selective abortion Marital rape Female dignity and right 11/27/201830
- 31. Approaches to address the RH problems Initiation of Safe motherhood program Improve the institutional delivery services Increasing the prenatal service accessibility Proper care of new born, neonates and infants Early diagnosis and treatment of STD and HIV AIDS and infertility Improvement of social inclusion and Gender equality Reduction of teen age pregnancy and unsafe abortion Awareness on reducing Female genital mutilation and sex selective abortion Care of adolescent and elderly women 11/27/201831
- 33. Meaning and concept 11/27/201833 In vitro fertilization or fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body: in vitro ("in glass"). The term in vitro, from the Latin meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or Petri dishes. Today, the scientific term in vitro is used to refer to any biological procedure that is performed outside the organism in which it would normally have occurred, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found.
- 34. Contd.. 11/27/201834 The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy. IVF techniques can be used in different types of situations. It is a technique of assisted reproductive technology for treatment of infertility.
- 35. Contd.. 11/27/201835 IVF techniques are also employed in gestational surrogacy, in which case the fertilized egg is implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate. In some situations, donated eggs or sperms may be used. Some countries ban or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism, but it restrictions on to single females, lesbians and surrogacy arrangements. Due to the costs of the procedure, IVF is mostly attempted only after less expensive options have failed.
- 36. History of IVF 11/27/201836 The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. With egg donation and IVF, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66. After the IVF treatment many couples are able to get pregnant without any fertility treatments
- 37. Medical uses 11/27/201837 IVF may be used to overcome female infertility where it is due to problems with the fallopian tubes, making fertilization in vivo difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low.
- 38. Contd.. 11/27/201838 IVF treatment is appropriate in cases of unexplained infertility for women that have not conceived after 2 years of regular unprotected sexual intercourse. IVF is also considered suitable in cases where any of its expansions is of interest, surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term
- 39. Success rates 11/27/201839 IVF success rates are the percentage of all IVF procedures which result in a favorable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history and lifestyle factors. Maternal age: Younger candidates of IVF are more likely to get pregnant. Women older than 41 are more likely to get pregnant with a donor egg.[3] Reproductive history: Women who have been previously pregnant are in many cases more successful with IVF treatments then those who have never been pregnant.[3] Due to advances in reproductive technology, IVF success rates are substantially higher today than they were just a few years ago.
- 40. Contd.. 11/27/201840 A 2012 summary compiled by the Society for Reproductive Medicine which reports the average IVF success rates in the United States per age group <35 35-37 38-40 41-42 Pregnancy rate 47.6 38.9 30.1 20.5 • In 2006, Canadian clinics reported an average pregnancy rate of 35%. • A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child .
- 41. Complications 11/27/201841 Multiple births: The major complication of IVF is the risk of multiple births. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. LBW: Recent evidence also suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons. Spread of infectious disease: chronic disease like HB, HIV/AIDS
- 42. €ontd.. 11/27/201842 Other risks to the egg provider/retriever A risk of ovarian stimulation is the development of ovarian hyper-stimulation syndrome, This results in swollen, painful ovaries. In moderate cases, ovaries swell and fluid accumulated in the abdominal cavities and may have symptoms of heartburn, gas, nausea or loss of appetite. During egg retrieval, there’s a small chance of bleeding, infection, and damage to surrounding structures like bowel and bladder as well as difficulty in breathing, chest infection, allergic reactions to medication Ectopic pregnancy may also occur if a fertilized egg develops outside the uterus, usually in the fallopian tubes and requires immediate destruction of the foetus. Birth defects: A review in 2013 came to the result that infants resulting from IVF have a relative risk of birth defects of 1.32 (95% confidence interval 1.24–1.42) compared to naturally conceived infants