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Approaches to improve the diagnosis and management of infertility.

Devroey P, Fauser BC, Diedrich K, Evian Annual Reproduction (EVAR) Workshop Group 20 - Hum. Reprod. Update (2009)

Bottom Line: Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment.CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes.Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

View Article: PubMed Central - PubMed

Affiliation: Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium. paul.devroey@uzbrussel.be

ABSTRACT
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

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Variation in reproductive ageing.Adapted with permission from te Velde and Pearson (2002). Curve 1 shows the Gaussian distribution of variation of age at menopause, Curve 2 the variation of age of transition from cycle regularity to irregularity, Curve 3 the variation in age of becoming sterile and Curve 4 the variation in age of becoming infertile.
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DMP012F1: Variation in reproductive ageing.Adapted with permission from te Velde and Pearson (2002). Curve 1 shows the Gaussian distribution of variation of age at menopause, Curve 2 the variation of age of transition from cycle regularity to irregularity, Curve 3 the variation in age of becoming sterile and Curve 4 the variation in age of becoming infertile.

Mentions: Ovarian reserve represents the remaining population of primordial and resting follicles (Gougeon, 1996) and is generally defined as the quantity and quality of the follicles present in the ovary (Broekmans et al., 2006). For operational purposes, the ovarian reserve can be defined as the number of antral follicles present in the ovaries at a given time that can be stimulated into dominant follicle growth by exogenous follicle-stimulating hormone (FSH). Women with a so-called ‘normal’ ovarian reserve will develop an average of 8–10 dominant follicles in response to conventional ovarian stimulation, with a corresponding number of oocytes (Broekmans et al., 2006). Although chronological age is the major determinant of ovarian reserve, there is considerable individual variability in the rate of ovarian ageing (Fig. 1) (te Velde and Pearson, 2002). Therefore, accurate tests of ovarian reserve may allow individualized predictions of oocyte yield and ART treatment outcome in terms of ongoing pregnancy (Broekmans et al., 2006).


Approaches to improve the diagnosis and management of infertility.

Devroey P, Fauser BC, Diedrich K, Evian Annual Reproduction (EVAR) Workshop Group 20 - Hum. Reprod. Update (2009)

Variation in reproductive ageing.Adapted with permission from te Velde and Pearson (2002). Curve 1 shows the Gaussian distribution of variation of age at menopause, Curve 2 the variation of age of transition from cycle regularity to irregularity, Curve 3 the variation in age of becoming sterile and Curve 4 the variation in age of becoming infertile.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2691653&req=5

DMP012F1: Variation in reproductive ageing.Adapted with permission from te Velde and Pearson (2002). Curve 1 shows the Gaussian distribution of variation of age at menopause, Curve 2 the variation of age of transition from cycle regularity to irregularity, Curve 3 the variation in age of becoming sterile and Curve 4 the variation in age of becoming infertile.
Mentions: Ovarian reserve represents the remaining population of primordial and resting follicles (Gougeon, 1996) and is generally defined as the quantity and quality of the follicles present in the ovary (Broekmans et al., 2006). For operational purposes, the ovarian reserve can be defined as the number of antral follicles present in the ovaries at a given time that can be stimulated into dominant follicle growth by exogenous follicle-stimulating hormone (FSH). Women with a so-called ‘normal’ ovarian reserve will develop an average of 8–10 dominant follicles in response to conventional ovarian stimulation, with a corresponding number of oocytes (Broekmans et al., 2006). Although chronological age is the major determinant of ovarian reserve, there is considerable individual variability in the rate of ovarian ageing (Fig. 1) (te Velde and Pearson, 2002). Therefore, accurate tests of ovarian reserve may allow individualized predictions of oocyte yield and ART treatment outcome in terms of ongoing pregnancy (Broekmans et al., 2006).

Bottom Line: Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment.CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes.Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

View Article: PubMed Central - PubMed

Affiliation: Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium. paul.devroey@uzbrussel.be

ABSTRACT
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

Show MeSH
Related in: MedlinePlus