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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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The odds of post-thawing survival rate of cleavage-stage embryos after vitrification or slow freezing.CI, confidence interval; OR, odds ratio. Total events: 1064 (vitrification), 937 (slow freezing). Test for heterogeneity: χ2 = 15.94, df = 2 (P = 0.001). Test for overall effect: Z = 3.73 (P = 0.0002). Reprinted from Loutradi et al. (2008) with permission from Elsevier.
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DMP012F3: The odds of post-thawing survival rate of cleavage-stage embryos after vitrification or slow freezing.CI, confidence interval; OR, odds ratio. Total events: 1064 (vitrification), 937 (slow freezing). Test for heterogeneity: χ2 = 15.94, df = 2 (P = 0.001). Test for overall effect: Z = 3.73 (P = 0.0002). Reprinted from Loutradi et al. (2008) with permission from Elsevier.

Mentions: Vitrification results in significantly improved survival of frozen–thawed cleavage stage blastocysts and pregnancy rates, compared with standard cryopreservation (Fig. 3) (Loutradi et al., 2008; Youssry et al., 2008). However, there are concerns regarding the high concentrations of potentially cytotoxic cryoprotectants used during the vitrification process (Loutradi et al., 2008).


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)

The odds of post-thawing survival rate of cleavage-stage embryos after vitrification or slow freezing.CI, confidence interval; OR, odds ratio. Total events: 1064 (vitrification), 937 (slow freezing). Test for heterogeneity: χ2 = 15.94, df = 2 (P = 0.001). Test for overall effect: Z = 3.73 (P = 0.0002). Reprinted from Loutradi et al. (2008) with permission from Elsevier.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

DMP012F3: The odds of post-thawing survival rate of cleavage-stage embryos after vitrification or slow freezing.CI, confidence interval; OR, odds ratio. Total events: 1064 (vitrification), 937 (slow freezing). Test for heterogeneity: χ2 = 15.94, df = 2 (P = 0.001). Test for overall effect: Z = 3.73 (P = 0.0002). Reprinted from Loutradi et al. (2008) with permission from Elsevier.
Mentions: Vitrification results in significantly improved survival of frozen–thawed cleavage stage blastocysts and pregnancy rates, compared with standard cryopreservation (Fig. 3) (Loutradi et al., 2008; Youssry et al., 2008). However, there are concerns regarding the high concentrations of potentially cytotoxic cryoprotectants used during the vitrification process (Loutradi et al., 2008).

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