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October 2016

Study on Zika

Zika Virus and Infertility

ubcJon Havelock MD, FACOG, FRCSC
The University of British Columbia
Faculty of Medicine
Department of Obstetrics and Gynaecology
Division of Reproductive Endocrinology & Infertility
Children’s & Women’s Hospital
RoomD415A-4500 Oak Street
Vancouver, BC V6H 3N1, Canada
Phone 604 875-2000 X4310
Fax 604 875-2987
E mail: [email protected]

Consent Form

Study Title: Current practices in screening and management of Zika virus in Canadian fertility centres

Study Team
Principal Investigator
Dr. Jon Havelock
Obstetrics and Gynecology

Dr. Bonnie Woolnough
PGY-4 Obstetrics and Gynecology

Purpose: You are being asked to be in this study because you are a gynecologic reproductive endocrinologist practicing in Canada. You were contacted as a member of the Canadian Fertility and Andrology Society via the member list.

The purpose of this study is to determine the current practices of fertility specialists in Canada regarding screening and treatment practices for couples with potential exposure to Zika virus (ZIKV).

Although ZIKV has been documented in humans since the 1950s, it has recently emerged as a disease of significant public health concern, largely due to the strong association between ZIKV and microcephaly in fetuses of infected mothers.  It would be particularly devastating if a pregnancy were to be affected by ZIKV in a preventable situation such as in the setting of fertility treatments, where there is opportunity for risk screening prior to conception. Given that travel and sexual transmission are both modes of transmission of ZIKV documented in Canada, appropriate screening at the time of fertility treatments represent a potential interruption of ZIKV transmission.

We hope the information gathered will identify any areas where we can improve management provided to fertility patients with regard to ZIKV across the country.

Study Procedures: The study involves completion of a short electronic questionnaire. It will take less than 5 minutes to complete.

Benefits: You will not benefit from being in this study. There are no costs involved in being in the research. You will receive no compensation for participating.

Risk: There are no foreseeable risks to you for participating in the study.

Confidentiality: Results from this study may be reported in scientific papers and presented in educational settings and at professional conferences. However, the information presented and participants will be anonymous. Dr. Havelock and his research team will have access to the information. Representatives of the University of British Columbia Research Ethics Board may review the study to ensure it follows appropriate laws and guidelines. All data collected will be kept confidential and will not be shared with anyone outside the study unless required by law. You will not be named in any publications or presentation that may come from this study.

Data will be kept securely with password protection for five years following completion of the project and will be destroyed confidentially after that time.

If you have any questions or concerns regarding the study please contact the principal investigator, Dr. Jon Havelock at 604-422-7276.

If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail [email protected] or call toll free 1-877-822-8598.

Participant Consent:

Taking part in this study is entirely up to you. You have the right to refuse to participate in this study. If you decide to take part, you may choose to pull out of the study at any time without giving a reason and without any negative impact.  If the questionnaire is completed, it will be assumed that consent has been given.

Media Release AHR Act

Media Release

Press Release
October 04, 2016

Canadian Fertility and Andrology Society (CFAS) Welcomes Government of Canada intent to introduce regulations to support the Assisted Human Reproduction Act

The Canadian Fertility and Andrology Society (CFAS) welcomes the announcement from the Government of Canada to strengthen and clarify the regulatory framework of the laws that govern the practice of reproductive medicine in Canada, the Assisted Human Reproduction Act (2004) and Processing and Distribution of Semen for Assisted Conception Regulations (1996). Practitioners and patients alike seek clarification and simplification of these laws, in particular with respect to the screening and testing for the third party reproductive technologies like sperm and egg donation, and gestational surrogacy. For the benefit of all Canadians, regulation resulting from these laws needs to keep pace with the ever-changing landscape of this high-tech and rapidly evolving field of medicine.

Dr. Jeff Roberts, President of the CFAS, states, “The practice of IVF in Canada is much safer today for both mother and child. With advances in technologies for the screening of embryos and the higher pregnancy rates using newer freezing methods we have less apprehension about banking embryos and transferring single embryos back to the uterus, irrespective of the woman’s age. Pregnancy rates in Canada have been steadily improving year after year, and multiple pregnancy rates have never been lower, dropping over the past decade from 29.5% to 10.1%. The continued provision of safe and effective reproductive technologies to Canadians will require a team approach involving the fertility clinics, scientists, paramedical professionals and government, both provincial and federal. These are truly exciting times.”

We echo the sentiments of our Minister of Health Jane Philpott, who said “There have been major scientific advancements in these areas, which have benefited many Canadians as they build their families. Our laws need to adapt so that they can continue to ensure that the risks posed are minimized and families are supported”. The CFAS is prepared to act as an experienced and knowledgeable resource for Health Canada and assist in the development of regulation.

About the CFAS

The CFAS is a multidisciplinary national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The mission of the CFAS is to responsibly advance reproductive science and medicine in Canada through leadership, research, education, and guidance for both professionals and patients alike. The CFAS aims to promote excellence in the field of assisted reproduction to the benefit of Canadians and children born of this technology.

For interviews, contact:

Mark Evans, Executive Director, Canadian Fertility and Andrology Society
Cell: 613 869-4396
e-mail: [email protected]

Notice of Intent – Canada Gazette

July 2016

Preliminary Agenda: Novice Level

Preliminary Agenda: Novice Level

8:00 am Course Registration
8:30 am Welcome, Introductions, and course objectives – Denise Ozenne
9:00 am PGS 2.0: Evolution of Day 3 to Day 5 Practices – Kelly Ketterson
9:30 am Optimizing Laboratory Conditions for a Successful PGS Program – Jason Swain, PhD
 10:00 am Mitigating Risk in the IVF laboratory Workflow as it pertains to PGS – Charles Bormann, PhD
 10:30 am Real World Biopsy Video Review: All the Right Moves – Catherine Welch, MBA, TS (ABB)
 11:15 am  Networking Break
 11:30 am  Hands – on Session
 12:45 pm  Lunch and Featured Presentation
Next  Generation IVF: Advancing Technologies to Improve IVF  – Mt Sinai Guest Speaker
 1:45 pm  Hands-on Session
 3:00 pm  Networking Break
 3:15 pm  Hands-on Session
 4:30 pm  Ask the Expert: Panel Activity – All Embryology Trainers
 5:00 pm  Meeting Conclusion

Preliminary Agenda: Experienced Level

Preliminary Agenda: Experienced Level

8:00 am Course Registration
8:30 am Welcome, Introductions, and course objectives – Denise Ozenne
9:00 am A Clinical Evidence Update to PGS – Kelly Ketterson
9:30 am Optimizing Laboratory Conditions for a Successful PGS Program – Jason Swain, PhD
 10:00 am  Mitigating Risk in the IVF laboratory Workflow as it pertains to PGS – Charles Bormann, PhD
 10:30 am  Real World Biopsy Video Review: All the Right Moves – Catherine Welch, MBA, TS (ABB)
 11:15 am  Networking Break
 11:30 am  Hands – on Session
 12:45 pm  Lunch and Featured Presentation
Next  Generation IVF: Advancing Technologies to Improve IVF  – Mt Sinai Guest Speaker
 1:45 pm  Hands-on Session
 3:00 pm  Networking Break
 3:15 pm  Hands-on Session
 4:30 pm  Ask the Expert: Panel Activity – All Embryology Trainers
 5:00 pm  Meeting Conclusion

Counselors SIG

Counselors SIG

I have just returned home from a concert (Mandy Patinkin – anyone familiar with him??).  I have heard him perform a number of times and am always amazed at his voice and his stage presence.  Many of his songs were familiar, some were new arrangements of familiar songs and other songs were completely new to me.

I reflected how that was a bit like being on the Executive of CSIG.  Many of the activities are familiar.  We meet, we attempt to meet.  We discuss, we share, we plan, we process.  Other activities are new arrangements of familiar activities.  We try to develop new educational opportunities, we attempt to come up with great speakers and innovative programs for the annual conference.  We tried to find new ways to engage the membership.  Other activities are completely new including task forces, webinars and new ways to communicate amongst ourselves.

To be sure, an incredible learning experience!  Gratefully, I am supported right across the country.  From Lori Parker as Past Chair in N.S. to Sharna Cohen, Education Chair in Ontario, to  Holly Yager , Vice Chair and Communication Chair in B.C.  Great country-wide representation but certainly creates a few challenges when trying to find a common time to connect!

The Professional Day for the 2016 Annual Meeting is planned.  Our panel will include a counsellor, a lawyer and a physician  speaking on  “Should we or Shouldn’t we? Establishing Best Practices in Assessment and Reporting of Third Party Implications Counselling”.  From what we know will be a lively discussion, the plan to jump start the task force addressing the standardization of forms.

We are developing a Webinar that will be focusing on Male Infertility.  Dr. Keith Jarvi,will update us on the medical aspects and Dr. Bill Potok will increase our understanding of the psychological components.

We are posting articles on the list serve, hoping that members will read and comment on the articles and share relevant clinical experiences.  However, we are exploring Facebook as a new, more creative ways to get CSIG members to read and comment on articles and share relevant clinical experiences.  Stay tuned!

Finally, Toronto has been challenged by Halifax to outdo them in having an amazing and creative Counsellor’s dinner during the Annual Meeting.  Is that possible???  Donna Jacobs is definitely up to the challenge!  Details to follow!!!!

As always, your thoughts, comments, suggestions are encouraged.

Jan Silverman
Chair, CSIG



Letter from the Executive Director

Letter from the Executive Director

Dear Members,

The Board of Directors met in Montreal on June 17th and 18th.  We present here a short summary of that meeting as well as any plans that may be of interest to members.

Brief Summary of the Board of Director’s Meeting, June 17-18, 2016

2016/17 Budget:  The Finance Committee proposed a balanced budget for 2016/17, which was approved by the Board.  The budget included the following noteworthy items:

  • Funds allocated to develop a standard exam for embryology. The exam, which will be developed over then next 12 months, will be professionally developed and administered.
  • Funds allocated to support development of a nurse education and training strategy. A Committee, chaired by Eileen McMahon, a nurse practitioner from Mount Sinai and Board member, includes representation from BC, Alberta, Quebec, Ontario and Halifax.
  • Funds allocated to support publication of Clinical Practice Guidelines: Under the direction of Dr. Min, CPG Director, money has been set aside help accelerate the process of guideline development. Specifically, funds are available to bring committee members together where most of the work is accomplished.
  • Funds allocated to support media relations – Funds will support the CFAS in its effort to augment the Society’s voice and be more present to the media, public, and key stakeholders.

The CFAS would like to acknowledge and thank Merck, Ferring, and EMD Serono for becoming Platinum level sponsors again in 2016/17. The generous support of these three companies in particular is enabling the Society to commit financial resources in a way that benefits members and the Society as a whole.   CFAS will invest intelligently in its future and in the future of ART in Canada.

Clinical Practice Guidelines: At the most recent Board meeting, it was agreed that the CFAS should make clinical practice guidelines accessible to the general public.  Guidelines are now available to the general public on our web site and will be available in French and English. While publishing guidelines underscores our commitment to transparency, the Board also believes guidelines help promote the excellent work done by the CFAS and its volunteers.  On June 30, 2016, CFAS issued a press release announcing that the release of Clinical Practice Guidelines to the Public. (See press release http://bit.ly/29hRwkI )
Upcoming Clinical Practice Guidelines: Two guidelines currently under development by the CPG Committee include one on ‘Obesity’ and another on Age limits and Fertility Treatments’.

New Process for CFAS Document Production – The Board approved a new guideline and policy on how documents endorsed by the CFAS will be developed and approved for publishing.  The new process allows for engagement of the Special Interest Groups early on in the development process and ensures appropriate input from other disciplines, if needed.  The Communications Committee will review a first draft prior to distribution of a guideline to member, who will also have an opportunity to comment.  All CFAS documents require Board approval before being published.

New Terms of Reference published for Special Interest Groups (SIGs). In an effort to level the playing field and establish common terms of reference for all SIGs, the Board released a standard template of terms.  Of import to members, the terms include the following:

  1. 3 year elected term for each position: Chair, Vice-Chair, Secretary-Treasurer.
  2. 2 successive terms permitted
  3. Flexibility to accommodate smaller SIGs that may not be able to comply with 1 and 2 above
  4. Sub-Committees are at the discretion of each SIG
  5. No exclusions of a members from a SIG
  6. Clear mandate for each SIG, to be developed by SIG Executives and submitted to the Board

Update on important activities:  

  • Nominations to the Board of Directors – An announcement for nominations went out July 6 and will close August 7, 2016. Three new directors will be elected and three will come off the Board, as per CFAS By-Laws
  • SIG elections – With the introduction of new SIG Terms of Reference, elections for vacant positions will commence in the next few weeks. The CFAS office will send out a notice to members to call for nominations. Elections will take place completely electronically.
  • Seed Grant program to award another $15,000 in grants – The Seed Grant program, initiated in 2015, was launched again in 2016. Eight (8) applications were received, three of which will be selected by a sub-committee. Winners will be announced at the annual meeting and each will receive $5,000 in seed grant money for their respective project.
  • Abstracts – Members who submitted an abstract for the Toronto Conference will have been notified by now whether their abstract was accepted. Abstracts were evaluated by 56 volunteer judges using a blinded scoring system.   This year, 93 abstracts will be on display.
  • Award nominations – Nominations for awards were received up until the close on June 30. For a list of awards, go to https://cfas.ca/about-cfas/awards/ . In an effort to promote the importance of these awards, winners will be highlighted on the CFAS website, with permission of course.

Upcoming Professional Development Opportunities:

  • Epigenetics Workshop, Vancouver 2016 – The Epigenetics workshop will traverse the country with the final meeting culminating in Vancouver in November 2016. This is in keeping with our commitment to engage all corners of the country
  • Gatekeeper’s Dilemma – After two successful workshops in Toronto (2013, 2016), plans are underway to holding a Gatekeeper’s Dilemma workshop in the west in early 2017.
  • Embryology Biopsy Workshop – This one-day workshop, sponsored by Illumina will allow for 20-25 embryologists to attend a workshop on embryo biopsies. Two sessions targeted to novice and experienced embryologists will occur on September 20 (Experienced) and September 21 (Novice)
  • ESHRE Semen Analysis Course – A 4-day course in semen analysis is being planned for early 2017. This course was delayed due to challenges of finding lab space in Toronto.

Gatekeeper’s Dilemma

On June 29th, the CFAS hosted an ethics workshop where members tackled challenges associated with allocating and prioritizing IVF funding to Ontario patients.    The program was organized by the CFAS in conjunction with the Department of Bioethics at the University of Toronto.  The sold out event was attended by CFAS members from all disciplines and included Ministry of Health representatives from the Ontario Fertility Program.

Key themes emerged during the workshop, which we think are relevant for clinics and policy makers to consider.

Goals of the Ontario Fertility Program – Access or Outcomes:  As stated on the MOHLTC website, the focus of the Ontario Fertility Program is about access. “The government is contributing to the costs of fertility services to improve affordability and access.” However, it was acknowledged at the workshop that interpretation of the purpose of the program varies among stakeholders – including patients – and thus implementation strategies vary accordingly.  Programs vary between an outcome-centred approach (e.g. triaging younger patients) and an access-centred approach (e.g. triaging older patients) or something in between (e.g. lottery or first-come-first-served).  Framing the program in terms of these two potentially competing alternatives are an important consideration for policy makers and healthcare providers.

Good Ethical Practices:  Despite the variation in allocation models adopted by clinics, the general consensus at the workshop was that despite these variations, current processes represent an array of different ethical approaches reflecting good standards, yet in need of further review and refinement. No single ethical solutions were identified.   Certainly, having an ethical framework from which to assess allocation models helped participants to clarify issues.

Complexity of patient’s needs: Part of the challenge for clinicians and the Ministry in allocating scarce resources for the Ontario Fertility Program is that patient circumstances are complex.  Participants agreed that sorting through the permutations and combinations of clinical criteria to prioritize patients is practically and logistically impossible.  Add to that, the importance of social, personal, financial and other patient needs as well, and it is easy to understand why different approaches to the allocation of funding exists in Ontario.  The complexity of the issue may not have been fully appreciated by the Ministry when introducing the Ontario Fertility Program. While the government relegated decisions concerning access to the clinicians, the clinicians were left with decisions that are not simply clinical in nature, but potentially include socio-economic, cultural, and other value based factors – factors the system is not equipped to address.

Transparency: According to participants in the workshop, the various allocation strategies employed throughout Ontario have resulted in added stress for the patient population it has aimed to help.  While clinicians have been transparent about which allocation models have been employed within their respective clinics, there was agreement that the lack of system-wide transparency has been a missing element for patients.  The lack of system-wide transparency can significantly add to anxiety as patients attempt to select a program that will enhance their likelihood of accessing funded treatment. Enabling patients to easily identify which models are used in clinics across the province would mitigate some of the negative and stressful aspects associated with patient’s selection of a clinic.

What’s Next?

Dialogue with the MOHLTC and the Ontario Fertility Program. Participants from the Ministry of Health benefited from the discussion and we expect they will share lessons learned internally.  The CFAS and its Ontario representatives can continue a dialogue with the Ministry and help inform any upcoming changes or improvements to the program.  In particular, we feel that there is a good opportunity to better outline the goals of the program while considering both access and outcomes.  Both concepts are relevant in terms of government accountability for the $70-million-dollar annual investment in the program.

Oral Presentation and CFAS: At the workshop, Dr Tom Gotz, Gynecologic Reproductive Endocrinology & Infertility fellow at the University of Toronto, presented a survey of clinic practices on funding allocation models. He will be presenting the results of the study again at the annual CFAS meeting in Toronto.  A follow-up survey may be in the works as a number of clinics have shifted allocation strategies since the program was first introduced.

Future Ethics Workshops – A majority of the workshop participants expressed an interest in having a follow-up discussion on the topic of funding allocation at the end of the first year.  The CFAS will endeavour to hold another meeting and invite the Ministry of Health to attend again.  In addition, we have received numerous suggestions on future ethics workshops.

June 2016

CPG Publication

Clinical Practice Guidelines

June 23, 2016

Re: Release of Clinical Practice Guidelines to the public

Dear CFAS Members,

The Board of Directors recently discussed the merits of making Clinical Practice Guidelines available and accessible to the general public. Currently, Guidelines only available to active members in good standing on the member section of the CFAS website.  Consistent with our values of providing transparency, the Board concluded that Clinical Practice Guidelines should be made accessible to the public on the non-member section of the CFAS web site.  This decision is consistent with practices followed by ASRM and ESHRE.

There will be an ordered process by which documents will be made available to the public.  First, the office of the CFAS will announce the publication of a Clinical Practice Guideline to members only.  (Members will already have had opportunity to provide input to the documents as part of the development process).   A week or so following the member communication, the office will issue a press release, if appropriate, announcing the publication of a new clinical practice guideline by the Society.   The purpose of the media release is to the promote the leadership role of the CFAS and to allow for coordinated media interviews by CFAS spokespersons on the specific guideline.

Each Guideline published by the CFAS will contain the following statement outlining the intended use and limitations of a guideline.

This document is based on available evidence to date, often in a rapidly advancing field of study. Recommendations may not reflect emerging evidence and are subject to change. Clinical guidelines are intended as an aid to clinical judgement, and not to replace it. Clinical guidelines do not prevent clinicians from exercising freedom in their good clinical practice, nor relieve them of their responsibility to make appropriate decisions based on their own knowledge and experience.

All rights reserved © 2016 Canadian Fertility and Andrology Society. This document may not be reproduced in its entirety or in part without the expressed written consent of the Canadian Fertility and Andrology Society.

The CFAS will publish French and English versions of the guideline along with a summary for lay readers.  Guidelines related to individual Special Interest Groups will not automatically be made public.

During the week of June 27th, the CFAS will announce its decision to release guidelines to the public and will announce the release of Guidelines for Third Party Reproduction.  The intent of this correspondence is to give members advanced notice of this new directive.

We trust that members will be supportive of this initiative.

Yours Sincerely,
Mark G. Evans
Executive Director
On behalf of the Board of Directors of the CFAS

Lignes directrices de pratique clinique

Lignes directrices de pratique clinique

Le 23 juin 2016

Objet : Communication des Lignes directrices de pratique clinique au public

Chers membres de la SCFA,

Le Conseil d’administration a discuté récemment des avantages de rendre les Lignes directrices de pratique clinique disponibles et accessibles au grand public. À l’heure actuelle, les Lignes directrices ne sont accessibles qu’aux membres actifs en règle, dans la section réservée aux membres du site Web de la SCFA. En accord avec les principes de transparence de la Société, le Conseil a conclu que les Lignes directrices de pratique clinique devraient être accessibles au public dans la section du site Web de la SCFA réservée aux non-membres. Cette décision est conforme aux politiques appliquées par l’ASRM et l’ESHRE.

Les documents seront mis à la disposition du public selon un processus ordonné. Le bureau de la SCFA annoncera d’abord la publication des Lignes directrices de pratique clinique à l’intention des membres seulement. (Les membres auront déjà eu l’occasion de faire part de leurs observations sur les documents dans le cadre du processus d’élaboration.) Environ une semaine après la communication aux membres, le bureau émettra, s’il y a lieu, un communiqué de presse annonçant la publication par la Société de nouvelles lignes directrices de pratique clinique. Le communiqué de presse vise à promouvoir le rôle de leadership de la SCFA ainsi qu’à faciliter la coordination des entrevues accordées aux médias par les porte-parole de la SCFA au sujet des Lignes directrices.

Chacune des Lignes directrices publiées par la SCFA inclura la déclaration suivante décrivant l’utilisation prévue et les limites d’une ligne directrice.

Ce document est basé sur les données probantes disponibles à ce jour, dans un domaine d’étude qui évolue rapidement. Les recommandations ne reflètent pas nécessairement des données récentes et elles peuvent être modifiées en tout temps. Les Lignes directrices cliniques sont destinées à assister le jugement clinique, et non pas à le remplacer. Les lignes directrices cliniques n’empêchent pas les cliniciens d’exercer leur liberté de jugement dans le cadre de la bonne pratique clinique, et ne les dégagent pas davantage de leur responsabilité de prendre des décisions appropriées à partir de leurs connaissances et de leur expérience.

Tous droits réservés © 2016 Société canadienne de fertilité et d’andrologie. Ce document ne peut être reproduit en tout ou en partie sans le consentement écrit exprès de la Société canadienne de fertilité et d’andrologie.

La SCFA publiera une version française et une version anglaise des lignes directrices, accompagnées d’un résumé à l’intention des lecteurs profanes. Les Lignes directrices visant les Groupes d’intérêts spéciaux ne seront pas rendues publiques systématiquement.

Au cours de la semaine du 27 juin, la SCFA annoncera sa décision de mettre ses Lignes directrices à la disposition du public et elle annoncera la publication de ses Lignes directrices touchant la Procréation avec la participation d’un tiers. Cette correspondance a pour but de donner aux membres un préavis au sujet de ces nouvelles lignes directrices.

Nous espérons que les membres appuieront cette initiative.

Avec mes cordiales salutations,

Mark G. Evans
Directeur général
Au nom du Conseil d’administration de la SCFA

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