Presentations at ESHRE

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Dr. Hans van der Slikke: "It's the third of July in 2001, and we're in Lausanne at the ESHRE Conference. Next to me is Professor Hans Evers from Maastricht and he will be the next president of ESHRE. Good morning, Hans."

Professor Hans Evers: "Good morning."         

Dr. Hans van der Slikke: "You were so kind to give us a little overview of the highlights of this 17th ESHRE Conference. What do you think are the most impressive presentations you saw?"

Professor Hans Evers: "I'm a clinician so you have to allow me some leeway but I visited predominantly clinical sessions and I was impressed by many papers on external effects on reproduction. We have always thought that some factors might influence, for example, sperm quality, oocyte quality, and fertilization but now it's getting more and more obvious and clear that amongst those factors are really household items like smoking and being overweight. The overweight issue has especially been found out quite nicely at this meeting. There is such a strong correlation between overweight and effects in natural reproduction and also in IVF that the best way to advise a woman who is overweight is to lose weight. It's much better, much more efficient, and much more cost effective than any of the new reproductive medicine treatments. I was impressed by the results there. 

The same holds for smoking; we have always thought that smoking is not good for you and we know of several diseases related to smoking but fertility also is effected in such a heavy way that fertilization results in IVF may be halved in people who smoke…. That's surprising even to me and so I was surprised to see it, and I can say positively surprised because it's good that we ban smoking. I hope that in this way by losing weight and by stopping smoking that patients can contribute so much to their treatment that either the treatment is no longer necessary or at least they have the emotional feeling that they have contributed in a major way to the success which they do of course."

Dr. Hans van der Slikke: "It seems you're talking now about women but yesterday one of the keynote lecturers, Professor Skakkebaek from Denmark, talked about the environmental influence on male sperm."

Professor Hans Evers: "Yes, that's another aspect which is becoming more and more exciting, it's an aspect that we have always neglected a little bit because you could always argue that studies from the 1950's and from the 2000's are not comparable because the methods of investigating sperm were different then and now. What Skakkebaek showed is that in long-term studies in the same laboratory with the same technicians and without much variation among the technicians you see a decline in sperm quality. He could also relate it to other problems in the male genital tract; he could show abnormalities of the testes, the penis, and problems in early use related to the urogenital track in little boys that at an adult age were reflected in low sperm counts and infertility in males as well. They have a quite clear hypothesis that the substitutes that we take in our daily food and environmental factors that come to us via air- and water pollution are the main causes of this decrease so they are continuing these studies but it's obvious. That was what the impression of the public was in the audience that they are on the right track and that we should really fear for a decrease in reproductive capacities both in men and in women."

Dr. Hans van der Slikke: "After Skakkebaek there was another lecture which made it clear that influences on the embryo are already very important for later life."

Professor Hans Evers: "Yes, that was by Professor Barker from Southhampton. It's a theory that has been around for quite some time already and the problem with the Barker theory is that people are shooting more and more holes in it. In the beginning it sounded very fascinating that women who got small children and when the children grew up they had more cardiovascular problems. It's getting more and more clear that it is not that simple. There has been a follow-up study of the women giving birth to these children and these women have a seven-fold increase in hypertension and cardiac problems. So it may even be that there is a genetic component and that is correlated with the result and it's not being small as a baby which determines your later life problems but there is a gene in the family which makes on one hand the mother becoming pre-eclamptic and giving birth to small babies and on the other hand is inherited by the baby to give it problems. So it's not quite clear for me that this hypothesis is still valid but people are working on it and it is an interesting hypothesis but it may be of less significance in the near future."

Dr. Hans van der Slikke: "This afternoon the results of the consortium on IVF in Europe will be published again after the first draft, one could say, in Bologna last year. Can you tell us something about this consortium?"

Professor Hans Evers: "Yes, I've seen the results, the consortium is composed of members from all membership countries of ESHRE in so far as those countries have representative figures. What they do is they collect the figures on a national basis and then add them up on a European basis. What you see is that this consortium, which gathers two times a year to coordinate the efforts and to present the data shows very clearly, as opposed to the United States, in Europe there is a clear tendency towards the replacement of fewer embryos. We have been extremely annoyed in the first report by the high number of multiple pregnancies, which is a disaster, as opposed to the United States where the tendency is to put back more and more embryos to increase the success rates and to give the patients what they pay for. Fortunately in Europe we are much more modest and we realize that multiple pregnancy is not what we're suppose to have; our women don't have a uterus that can support a twin easily. What you see is that in the Northern countries of Europe one has gone back from three to two to even single embryo replacements as an average and in the south of Europe it still is a little bit lagging behind but they are now gradually going back from three to two. The result is that although the pregnancy figures remain almost the same compared to the first report, the multiple pregnancy figures are finally declining although they are still quite high in some countries of Europe. It's a little bit of a problem to see that in some countries the overall results can only be good at the cost of a 40% multiple pregnancy rate, whereas, for example, in Finland they have excellent results with less than 10% multiple pregnancies and that's due to the good selection of embryos and the elective single embryo transfer."

Dr. Hans van der Slikke: "So this will be presented by Professor Nygren?"

Professor Hans Evers: "Yes."

Dr. Hans van der Slikke: "Any other highlights we can expect today or tomorrow?"

Professor Hans Evers: "Of course, there are many highlights on the basic science fields. The cloning issue is all over this meeting and the replacement of older eggs and rejuvenating the older eggs. Of course, that's an effort that everyone is interested in especially because we know that there is a certain group of women who have aging of the eggs in a rather fast way so in their thirties they already have eggs that are very difficult to fertilize. If you can improve the quality of those eggs without effecting their genetic component, that would be a big issue. The problem there is that it can be misused and that's one of my main goals during my presidency. I am so strongly opposed to misuse of reproductive techniques by all kind of crooks that are around us and that use these techniques to raise hopes in infertile couples that are not justified. What I hope to achieve in these two years is that we get a decent group of fertility experts in Europe that use these techniques and that can prove that they are worthwhile of the trust of the public but we should get rid of all these people trying to clone human beings or to make pregnancies in sixty-two year old women only for the money."

Dr. Hans van der Slikke: "I think this is a very good message to end this interview. Thank you very much, Hans."

Professor Hans Evers: "Thank you, it was a pleasure."