Medical Tourism

Dr LYNDON HALE

MBBS, FRANZCOG, CREI

Presentation Content

• IVF/ART Terminology

what are we talking about

• Australian/Virtus : IVF clinics

features of Australian IVF

clinics

• Who might want to access treatment

in Australia

IVF/ART Terminology

• Gametes

• IVF

• IVF/ICSI

• PGD, PGS

• Embryo transfer • Cleavage stage

• Blastocyst stage

Human oocyte (egg) in cumulus

Human Sperm

Morphology

Sperm washed, smeared

on glass slide, fixed,

stained (Shorr stain) and

examined under oil

immersion (1000x).

Note many abnormally

shaped sperm (arrows)

Catching sperm for ICSI

IntraCytoplasmic Sperm Injection

Micromanipulation (ICSI)

equipment

Human embryo development (

day 2 )

Extended culture of human embryos

Day 3 Day 4/5 Day 5 Day 5/6

Morula Early blastocyst Blastocyst 8 cells

Storage of frozen embryos

Time lapse imaging of human

embryo development in vitro

PGD: Pre-implantation genetic diagnosis

• Aneuploidy screening

• Monogenic screening

• Sex selection

Embryo biopsy

Embryo biopsy (video)

Preimplantation Genetic Diagnosis

(PGD)

NORMAL 13, 16, 18, 21, 22 - 22

FISH

CGH Microarray 46XX (Template 46XY)

Who do we treat?

• Couples Heterosexual Same sex

• Single Patients

• 3rd Party reproduction

3rd or more party reproduction

• Donor

– Sperm

– Egg

– Embryo

• Surrogacy

3rd party remuneration

• Altruistic: expense reimbursement

• Commercial arrangement

Australian/Virtus IVF

• Longevity

• Scale

• Scientific excellence

• Accreditation

• Success rates

• Range of treatment options

• Legal framework

Australia’s 1st IVF Baby: I980

Longevity

• Were at the beginning

• MIVF 3rd birth in the world

• Very few units disappeared

• No multi-clinician units closed

Scale

• Virtus ~ 12,000 cycles per year (40% of

Australian market)

– Melbourne IVF

– IVF Australia: Sydney

– QFG: Queensland Fertility Group

• Monash IVF Group

• City Fertility

• Genea

Scientific excellence

• Many IVF initiatives originated in

Australia

• Early adoption of new techniques

• Preferred research partners for large

pharma groups

Research & Development

Our research department is the largest and most productive of any Australian IVF program

• Egg freezing & tissue transplantation • Chronic viral illness group • Molecular biology • Follicle health physiology • Psycho-social & epidemiology • Implantation failure study group • Male infertility • Endocrine & Metabolic disorders • Clinical trials

World firsts

World firsts

Melbourne IVF & The Royal Women’s

Hospital Fertility Preservation Service

achieved world’s first pregnancy and

births from ovarian tissue grafted in the

anterior abdominal wall of a Victorian

woman

Accreditation/Legislation

• RTAC

• ISO

• State-based health law

• NHMRC Guidelines

Success Rates

• All pregnancies reported to ANZARD

• National yearly report

• Victoria yearly report

– Transparency of outcome

Who may want to access treatment?

• Expatriate Australians

• Reputational/scientific excellence

• Legislative assurance

• Anonymity

• Privacy

What is not allowed

• Commercial gamete donation

• Commercial surrogacy arrangements

• Embryo sex selection for family

balancing

Emerging trends

• Social egg freezing

• Genetic screening; increasing use for

screening for disease? Role for

desireable traits

• Uterine transplantation, 1st birth

reported

Thank you

Thank You