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February 2017

February Message from the Office

Message from the Office

Dear members,

Subsequent to the Board meeting at the end of January, the CFAS is geared up for an ambitious year to deliver on our key strategic priorities of education, government and public relations, member engagement, and clinical leadership all of which shall be supported through a balanced budget.

Education. The theme for the annual meeting in Vancouver is “Healthy Body, Healthy Baby” where we look at aspects that contribute to healthy outcomes for children born of ART. An early draft of the program is available on the CFAS web site. Many recognized international and Canadian speakers promise to make the annual meeting a memorable one.

CFAS is more than an annual meeting. Each of the Special Interest Groups have plans to offer something to CFAS members. NSIG is holding a 1-day nursing summit in Toronto on April 28, which is followed by a 1-day embyology summit on the 29th (organized by Merck), also in Toronto. We have plans to hold a third edition of the Gatekeepers Dilemma in June. CFAS members benefit from preferential pricing on regional meetings and events and will be notified directly as new educational opportunities arise.

Government and Public Relations. The increasing oversight of federal and provincial governments necessitate that the CFAS position itself as a strong central voice for ART in Canada. We made significant progress in 2016, but there is considerable work still to do. We will be monitoring progress with AHRA regulations and support actions that will decriminalize compensation for donors and surrogates. We will monitor and contribute to the development of standards by the College of Physicians and Surgeons of Ontario and advocate for national standard for ART. We will partner with organizations like Accreditation Canada and Canadian Standards Association to realize a national framework for quality assurance in the field. Finally, we will use the collective strength and expertise of CFAS members to achieve these goals.

Having a strong voice means having a presence in the public domain as well. We extended our voice in 2016 with increased exposure in the media, but we will aim higher in 2017. This year, we will start to develop patient information brochures that can be utilized by Clinics. We will increase our presence on social media and extend our connections with the media to ensure accurate information is made available in the public domain.

Clinical Leadership. CFAS members are making significant progress on development of guidelines and standards of practice. As provincial and federal governments look to increase oversight of ART, the importance of guidelines for our Society are even more critical. The CFAS has committed financial resources to support members in these efforts. A new publication process will ensure relevant experts have input into standards before they become publicly available. Finally, all members will have a chance to provide input. The following guidelines are at various stages of development:

  • Assisted Reproduction and Advanced Age initiated by Ethics and Law SIG
  • DNA Fragmentation Testing initiated by Andrology SIG
  • Standards for Reporting on Third Party Implications Counselling initiated by Counseling SIG
  • Competency Framework for the Canadian Fertility Nurse initiated by the Board and facilitated by a Nursing sub Committee
  • PGS, Clinical Practice Guideline
  • Recurrent Implantation Failure, Clinical Practice Guideline
  • Thin Endometrium, Clinical Practice Guideline
  • Social Egg Freezing, Clinical Practice Guideline
  • Obesity and fertility treatment, Clinical Practice Guideline

In addition to the guidelines, ART Lab SIG will publish a certification exam for embryologists and andrologists by end of 2017. This initiative strengthens the credibility of the field. Finally, nursing is undertaking an ambitious project to establish competencies for the fertility nurse which will then become part of a more comprehensive orientation program for new nurses. Expect this project to run several years.

The CFAS office is engaged in other initiatives to support members and clinics. It is expected that a group liability insurance program will be made available in 2017 to some 18 clinics that have expressed interest. The program will increase protection for clinics while reducing their costs. The program can evolve to include coverage for frozen gametes – an area where there is currently a major gap in coverage. This project is evolving slower than expected, but we expect more clinics to participate as the value becomes clear.

We look forward to delivering more value to CFAS members and to the field in general over 2017. Many challenges and opportunities lie ahead.

Mark Evans
Executive Director

November 2016

Notice to the Members – AHRA

Dear CFAS Colleagues:

As you may know, Health Canada is asking for public comment on the the Assisted Human Reproduction Act (AHRA), specifically:

  • Safe use of reproductive tissues in third party reproduction (section 10)
  • Reimbursement of surrogates and gamete donors (Section 12)
  • Inspection and enforcement (sections 45 to 58).

This public consultation is critical for the government in not just the drafting of regulation, BUT more broadly in opening up the Act itself for discussion. Opening the Act is the only means we have to affect change to the law, specifically the prohibition on compensation of surrogates and gamete donors (sections 6 and 7). Many of us feel that this law has greatly limited access to fertility services within Canada, and dramatically pushed costs beyond reach for most patients. Without opening the Act the opportunity to address this problem may be lost, and we have until November 25th to voice our collective opinion.

There are several critical aspects of the Act that we believe merit comment:

1. Compensation (payment) of surrogates and gamete donors
Although comment on sections 6 and 7 of the Act (prohibition of the payment of compensation for surrogates and the purchase of gametes, respectively) was not requested in this public consultation, this is the time to submit comments. We ask that you share the impact on both your patients and medical practice as a whole. We are also surveying the membership on the question of compensation to aid in the drafting of a collective response from CFAS reflecting a majority opinion. This subject raises a multitude of moral and ethical issues so there will certainly be conflicting opinions among stakeholders. Kindly take a moment to complete this three-question survey by Sunday, November 13th.

2. Reimbursement of surrogates and gamete donor
These regulations will determine what expenses incurred by donors and surrogates can be legally reimbursed. Attached is the latest version of Annex A of the CSA standards, “Reimbursements of Expenditures for Donors and Surrogates”, which was prepared by a task force of stakeholders and Health Canada. We request that you provide critical comment on this document and the potential impact of this federal administrative system on your practice as we assume that the government will reference it during the drafting of regulations on reimbursement.

3. Criminalization of activities
Violation of the present AHR laws currently results in charges under the criminal code with significant prison sentences and fines (up to 10 years and $500,000 fine). There appears to be broad support for decriminalization of the Act in favour of imposing solely fines, and not prison time.

Technical aspects of future regulations related to the safe use of reproductive material in third party treatments will likely reference standards developed out of the work of Health Canada’s Expert Working Group on Safety of Organs and Tissues for Transplantation and Assisted Reproduction in collaboration with Canadian Standards Association (CSA), a group where we have strong representation. The latest version of this document will be available for public consultation shortly. As part of this process, the federal regulation of all reproductive material will be consolidated under one document. This involves incorporating the Health Products and Food Branch Regulations on the Processing and Distribution of Semen for Assisted Conception – “Sperm Regs”. We are also involved in this process through the above CSA work.

The CFAS board has created a subcommittee to help collect opinions from across the country and specific disciplines within our field, and to assist the CFAS in formulating a response to Health Canada that will reflect the needs of our patients and values as our society. We strongly encourage you and your clinics to submit separate opinions, as the volume of responses is a critical factor in the government’s decision to open the Act for public consultation.

RECOMMENDED ACTIONS FOR CFAS MEMBERS:

1. Submit your comments before November 25th, 2016 to:

Office of Policy and International Collaboration, Biologics and Genetic Therapies Directorate

Mail: Locator 0601B, Tunney’s Pasture
100 Eglantine Driveway
Ottawa, Ontario
K1A 0K9 613-957-2991 (telephone)
Fax: 613-952-5364 (fax)
Email: bgtd_ahr-dpbtg_pa@hc-sc.gc.ca

2. Complete this very short, but important member survey on the topic of compensation for egg donors, sperm donors and gestational carriers. Your opinion on this topic is critical for the discussion. Here is the link:

https://www.surveymonkey.com/r/59CQQYS

3. Send a copy of your Health Canada submission to the CFAS President as it will aid in the drafting of the Society’s response:

Jeff Roberts MD
CFAS President
1719 Rue Grand Trunk, Unit 301
Montreal, QC H3K 1M1
JRoberts@pacificfertility.ca

4. Encourage your patients to send comments on the topic of donor and surrogate compensation or other aspects of the Act that impact on their care to Health Canada. Patients should also use the address listed above.

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: JHavelock@pacificfertility.ca
www.obgyn.ubc.ca

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
UBC
604-422-7276

Co-Investigator
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 RSIL@ors.ubc.ca 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: mark.evans@cfas.ca

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
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