New challenges through the advances of reproductive medicine: pregnancy at advanced maternal age, egg donation, surrogacy


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2021-1-HU01-KA220-HED-000027613 - COHRICE

Erasmus++

 

TEACHERS GUIDE

6. New challenges through the advances of reproductive medicine: pregnancy at advanced maternal age, egg donation, surrogacy


SLIDE 2
Outline the logic of your presentation so that the students can follow where you are in your train of thought! Repeatedly refer back to this logical sequence in your presentation. The slide titled 'Debated topics' illustrates the overall structure of the entire presentation, while the 'Introduction' slide articulates the differences between the medical and patient perspectives using a first-person narrative. It also draws attention to the role of the medical professional in bridging this gap. The entire structure of the presentation points in this direction: to make it explicit that communication is a fundamental part of the medical role.

SLIDE 3
This slide recalls what has already been discussed and provides a further overview of the various forms of assisted reproductive technology (ART).

SLIDE 4 - 5
The graphs shown are intended to illustrate the social development of the last few decades and to encourage students to link what has already been discussed with the new topic and to think about "New challenges through the advances of reproductive medicine: pregnancy at advanced maternal age, egg donation, surrogacy".

SLIDE 6
On the slides, to help understand the difficulties and psycho-social aspects, which result from stigmatization, from the patient's perspective.


SLIDE 7 - 10
The first topic is the advanced age of mothers. The discussion of the medical perspective on this topic takes place in two steps by giving definitions and discussing pregnancy complications and the maternal risk due to possible co-morbidities, as well as the psych-osocial burden of late motherhood.

SLIDE 11-12
The discussion around increased parental age focuses first on possible pitfalls of ART with increased maternal age, then with increased paternal age. On the one hand, the medical aspects are highlighted, but on the other hand, important areas of clinical embryology are discussed, which have a significant influence on the development of the first days of embryo division and can ultimately influence the outcome of the pregnancy.

SLIDE 13 -20
It is essential to discuss the topic of egg and embryo donation, as it differs from the topic of sperm donation and is the subject of controversial debate throughout Europe.
Students can be involved here by talking about experiences from their environment and discussing case studies from everyday professional life, after which cases with very different causes and indications for egg/embryo donation can be discussed on one or more slides.


SLIDE 21 -24
The topic of surrogacy is also an important point that should not be forgotten in the presentation and discussion, as surrogacy, which can be motivated in very different ways, poses new challenges for both medicine and psychology.


SLIDE 25 - 26
Science is evolving and preimplantation genetic testing is becoming more and more interesting. A significant proportion of clinically recognized pregnancies end in miscarriage. It is plausible to think of preimplantation genetic testing (PGT) as a means of increasing pregnancy rates and minimizing the risk of fetal aneuploidy.

SLIDE 27
Related challenges in the future

SLIDE 28
Take home messages


LITERATURE:
Saxena P, Mishra A, Malik S. Surrogacy: ethical and legal issues. Indian J Community Med. 2012 Oct;37(4):211-3. doi: 10.4103/0970-0218.103466. PMID: 23293432; PMCID: PMC3531011.

Robertson JA. Egg freezing and egg banking: empowerment and alienation in assisted reproduction. J Law Biosci. 2014 Mar 28;1(2):113-136. doi: 10.1093/jlb/lsu002. PMID: 27774158; PMCID: PMC5033547.

Stoop D, Maes E, Polyzos NP, Verheyen G, Tournaye H, Nekkebroeck J. Does oocyte banking for anticipated gamete exhaustion influence future relational and reproductive choices? A follow-up of bankers and non-bankers. Hum Reprod. 2015 Feb;30(2):338-44. doi: 10.1093/humrep/deu317. Epub 2014 Nov 28. PMID: 25432922.

Lang M, Zhou M, Lei R, Li W. Comparison of pregnancy outcomes between IVF-ET pregnancies and spontaneous pregnancies in women of advanced maternal age. J Matern Fetal Neonatal Med. 2023 Dec;36(1):2183761. doi: 10.1080/14767058.2023.2183761. PMID: 36852437.

Bayrampour H, Heaman M, Duncan KA, Tough S. Advanced maternal age and risk perception: a qualitative study. BMC Pregnancy Childbirth. 2012 Sep 19;12:100. doi: 10.1186/1471-2393-12-100. PMID: 22988825; PMCID: PMC3490979.

Mor N, Machtinger R, Yinon Y, Toussia-Cohen S, Amitai Komem D, Levin M, Sivan E, Meyer R. Outcome of two sequential singleton pregnancies and twin pregnancies among primiparous women at advanced age undergoing IVF. Arch Gynecol Obstet. 2020 Nov;302(5):1113-1119. doi: 10.1007/s00404-020-05700-5. Epub 2020 Jul 18. PMID: 32683483.

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor entity providing the grant can be held responsible for them.