Add the specialty areas of your choice to tailor excemed.org to your professional interests.
Save & Create free account
No thanks, just apply selection
I already have an account. Login

User login

We offer our registered users tailored information, free online courses and exclusive content.

Can't find your password?
Reset it here.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

IVF Preceptorship London

IVF Preceptorship London
  • Reproductive medicine

Resource type

Publication

Expert physicians working in assisted reproductive medicine attended a live educational course at IVF Hammersmith in London, UK on 5 6 September 2014, and gained new insights on hot topics in reproductive medicine through an interactive programme which focused on polycystic ovary syndrome (PCOS), controlled ovarian stimulation, recurrent implantation failure and new laboratory techniques and equipment for the optimisation of IVF procedures.

The preceptorship programme was chaired by Stuart Lavery from IVF Hammersmith and included lectures followed by specific case studies, providing participants with up-to-date knowledge and the opportunity to share their experiences with peers and speakers, as well as a visit to the IVF Hammersmith clinic, a Centre of Excellence for assisted reproductive technology.

 

Managing complications of ovarian stimulation

Antonio La Marca from the Institute of Obstetrics and Gynecology at the University of Modena and Reggio Emilia in Italy kicked off the meeting by looking at the newest biomarkers that predict the success of oocyte retrieval. The unique relationship of anti-Müllerian hormone (AMH) with ovarian reserve makes it the best marker to predict ovarian response in controlled ovarian stimulation (COS) protocols, and using it with antral follicle count (AFC) allows individualisation of therapy and improved outcomes. ‘The number of oocytes retrieved is an important prognostic variable for IVF success, providing vital information for planning COS regimens,’ said Dr Sesh Kamal Sunkara (King's College London, London) who went on to discuss whether there was an optimal range for “the number of retrieved oocytes” to maximise live birth in IVF. Dr Sunkara also discussed the relationship between the number of oocytes retrieved and clinical outcomes in IVF, including rates of fertilisation, implantation, miscarriage and live births. Dr La Marca considered the European Society of Human Reproduction and Embryology (ESHRE) Bologna criteria, and asked whether there was a need to revisit the criteria in the context of poor ovarian response (POR), even though there is a lack of large-scale, prospective, randomised, controlled trials comparing the different management strategies. He went on to review clinical cases with the participants, looking at different COS protocols and ovarian responses.

 

Polycystic Ovary Syndrome (PCOS): supporting the luteal phase

After a review of the etiology and diagnosis of PCOS by Dr Roy Homburg from Queen Mary Medical School, London, Dr Sunkara addressed the various interventions available for the management of infertility in PCOS, looking at strategies for the prevention of ovarian hyperstimulation syndrome (OHSS), avoidance of pregnancy complications and management of pregnancy in women with PCOS. Dr Tim Child (The Institute of Reproductive Sciences, Oxford, UK) reviewed the rationale for luteal phase support (LPS) in PCOS to maximise the chances of embryo implantation, comparing the different hormones, routes of administration, and regimes that are available and balancing each with their attendant costs, risks, patient acceptability and side-effects. The participants looked at PCOS patient case studies in a session lead by Drs Homburg and Sunkara, which incorporated an update on how to use new diagnostic tools, and issues in infertility and pregnancy complications, and laboratory and clinical outcomes.

 

Improving oocyte quality and reducing implantation failure

London IVF

The second day of the meeting began with a session on aspects of implantation presented by Dr Cristina Hickman, Head of Embryology at Boston Place Clinic, London. Dr Hickman examined how different COS protocols can affect oocyte and embryo morphology and quality. ‘We know that gonadotropin stimulation alters the environment of the follicle,‘ she said, and the close connection between the follicle environment and its associated oocyte means that it’s possible that the hormonal mileu may affect the quality of oocytes and embryos.

Preimplantation genetic diagnosis (PGD)is a well-established technique for reducing the risk of severe genetic disease for fertile couples. Dr Antonio Capalbo (G.EN.E.R.A. Centre for Reproductive Medicine, Rome, Italy) reviewed the timing for biopsy in the preimplantation window and looked at worldwide trends in PGD methodologies. ‘Morphology and/or morphokinetic assessment of preimplantation development has been a mainstay of embryo selection criteria, but they are insufficient by themselves to significantly improve IVF transfer outcomes,’ he said. The new technique of preimplantation genetic screening (PGS) is now being widely used when a low IVF success rate might be attributable to chromosomal aneuploidies in the embryo, and blastocyst stage trophectoderm (TE) biopsy has shown encouraging clinical outcomes.

Dr Capalbo reviewed the latest single-cell genomics methodologies based on DNA microarrays, single-nucleotide polymorphism arrays, quantitative real-time PCR or next-generation sequence analysis in his presentation, and this was followed by an investigation of the challenges involved in improving endometrial receptivity and implantation failure, presented by Dr Renato Fanchin, of the Antoine Beclere Hospital, University of Paris Sud, Clamart, France. More than 60% of embryos fail to implant in the uterus, a result of gamete quality and laboratory performance. Endometrial and myometrial defects should also be ruled out, and Dr Fanchin looked at the role of uterine receptivity in case of implantation failures, particularly the possible detrimental role of high serum estradiol (E2) levels that may result from COH. He compared the ‘freeze-all’ approach with ‘Natural Ovarian Stimulation (NATOS)’, and looked at the effect of supraphysiologic E2 levels on uterine contractions and uterine receptivity.

Terms of use

This is a copyrighted resource for the sole purpose of education. Resource may be used for classroom training only and must remain as is, including the branding and EXCEMED logo. It is backed by a publishing license, signed by the author.

Preceptorship
London, United Kingdom
Sep 5 - 6, 2014
Target audience
physicians
EACCME®
by Excemed
Reproductive medicine