Hans Evers

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          "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."
       
       

  "Good morning."         
       
       

         "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?"
       
       

 "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."

"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."
       
       

  "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."
       
       

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

  "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."
       
       

   "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?"

   "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."
       
       

  "So this will be presented by Professor Nygren?"
       
       

  "Any other highlights we can expect today or tomorrow?"
       
       

  "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."
       
       

  "I think this is a very good message to end this interview.  Thank you very much, Hans."
       
       

Articles

OBGYN.net Conference CoverageFrom the ESHRE 2001 Conference - Lausanne, Switzerland

Presentations at ESHRE

          "Good morning, it's the third of July of 2001 and we're in  Lausanne at the 17th ESHRE Conference.  Next to me is Professor Hans  Evers who will be the Chairman of ESHRE this afternoon.  Good morning,  Hans."
       
       

  "I want to discuss with you ESHRE and what ESHRE is.  Could you tell us about it, but first the acronym?"
       
       

  "ESHRE  is  the European Society for Human Reproduction and Embryology.  It was  founded eighteen years ago by Professor Robert Edwards and Jean Cohen  from Paris.  It was a reaction to the fact that infertility and  reproductive endocrinology were dispersed over many, many small  organizations in Europe and there was a definite need for one big  organization.  Fortunately, because of their extreme efforts, it took  off very well.  At our first meeting in Bonn, Germany we had 500  participants and it grew very fast till at this moment we have over  4,000 participants at this annual meeting so we are quite glad about  this.  The aim of ESHRE is to stimulate research and also clinical  treatment of infertility and people with problems in the field of  infertility.  ESHRE is also intended to stimulate basic research -  developments into the discovery of follicle maturation, sperm  maturation, implantation, and early pregnancy so it is about all of  reproductive life from fifteen years till forty-five and even beyond."
       
       

  "So it's not a society of clinicians only?"
       
       

  "No,  it's not a society of clinicians only:  it's about half and half; there  are 60% clinicians and 40% basic scientists.  That's also the goal of  not only our annual meeting but also our journals to bring together the  scientists and clinicians in such a way that the clinicians can have the  maximum advantage of interaction with the scientists that new  discoveries reach the clinics rapidly but also in a responsible way  without t much haste - that's the main issue.  I would say we are  inclined, especially in the western world, to introduce new treatments  too fast into the clinic and that's what ESHRE wants to regulate.   Evaluate something very thoroughly before you introduce it but if it is  proven of benefit then don't hesitate too much."
       
       

   "That means that you also need guidelines.  I learned that you are  talking with the European Board and College of Obstetrics and Gynecology  to give some guidelines for further education of fertility doctors."
       
       

  "Yes,  what we would like to start together with the European board is a  credentialing system of clinics for secondary teaching and training in  reproductive medicine which includes visits to those centers that have  asked for accreditation and also at regular intervals checking of their  procedures and their protocols.  This means we need guidelines so ESHRE  is composed of twelve special interest groups who devote themselves to  one of the aspects of reproduction.  One of the main issues of those  special interest groups is to write guidelines and to strive to  consensus on those guidelines, and we publish them as soon as they are  available on the web.  We ask all our members to comment on them, to  suggest changes, and once they have been on the web for a certain time  they are approved and we have printed copies available for all members."
       
       

  "I'm sure you will also have the guidelines online."
       
       

  "Yes,  all of them will be online because, especially in reproductive medicine,  the changes are so very fast that once they are printed they are  out-of-date already.  We try to keep them up-to-date online but we  collect them every two years in booklets to distribute among the  members."
       
       

  "It's a European society, does this mean that the members are all Europeans?"
       
       

  "It  started as a purely European society, the first five years we had  predominantly European members, now more and more members are joining  from outside Europe.  Now one-third of the members are from outside  Europe.  In fact, our fifth biggest member country is the USA so we are  gradually increasing towards the USA and Canada.  We have many, many  members in the Middle East and since our annual meetings have always  been of high quality, I think, they attract many people not only to the  meetings but also to the society. "
       
       

  "Thank you very much, Hans.  I wish you a lot of luck with your presidency next year."
       
       

  "It was a pleasure.  I'm proud that I was elected and I'll be looking forward to do it."
       
       

Author | Hans Evers

Articles

Presentations at ESHRE

ESHRE - European Society for Human Reproduction and Embryology