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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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Related in: MedlinePlus

Images of in vitro embryonic development showing morphology changes from culture Day 0 to Day 5.
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DMP012F2: Images of in vitro embryonic development showing morphology changes from culture Day 0 to Day 5.

Mentions: An increased understanding of the metabolic needs of embryos and improvements in cell culture media have enabled prolonged in vitro culture of embryos (Fig. 2) (Papanikolaou et al., 2008). Extension of the in vitro culture period now allows the transfer of Day 5 blastocyst-stage rather than early cleavage-stage embryos (Blake et al., 2007). A recent meta-analysis showed significantly higher rates of clinical pregnancy (OR 1.27, 95% CI 1.03–1.55; P = 0.02) and live births (OR 1.39, 95% CI 1.10–1.76; P = 0.005) following the transfer of blastocyst-stage compared with cleavage-stage embryos (Papanikolaou et al., 2008). Given the speed at which laboratory techniques have evolved, it is essential to compare procedures and outcomes to elucidate the best practices for maximal embryo viability.


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)

Images of in vitro embryonic development showing morphology changes from culture Day 0 to Day 5.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

DMP012F2: Images of in vitro embryonic development showing morphology changes from culture Day 0 to Day 5.
Mentions: An increased understanding of the metabolic needs of embryos and improvements in cell culture media have enabled prolonged in vitro culture of embryos (Fig. 2) (Papanikolaou et al., 2008). Extension of the in vitro culture period now allows the transfer of Day 5 blastocyst-stage rather than early cleavage-stage embryos (Blake et al., 2007). A recent meta-analysis showed significantly higher rates of clinical pregnancy (OR 1.27, 95% CI 1.03–1.55; P = 0.02) and live births (OR 1.39, 95% CI 1.10–1.76; P = 0.005) following the transfer of blastocyst-stage compared with cleavage-stage embryos (Papanikolaou et al., 2008). Given the speed at which laboratory techniques have evolved, it is essential to compare procedures and outcomes to elucidate the best practices for maximal embryo viability.

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