Infertility & ART

Friday, July 20, 2012


08:30-10:00
IN-VITRO MATURATION (IVM): A PROCEDURE SUITABLE FOR ALL PATIENTS?
Capsule
IVM is an experimental procedure that makes it possible to undergo IVF without the need for stimulation and the risk of hyperstimulation syndrome. IVM may be useful in PCOS patients who are very sensitive to stimulation, provided that in RCT it proves to be more advantageous than different forms of milder stimulation. IVM also provides an obvious advantage of immediate aspiration, maturation, and eggs fertilization or freezing without stimulation before chemo- or radiotherapy. However, although it is an effective procedure, with results almost comparable to IVF, its long-term risks are still unknown. The question is: What advantage does IVM provide to all other patients?
Chairpersons S.F. Loh, Singapore
J. Dor, Israel
M.M. Dolmans, Belgium
08:30-09:30
Debate: IVM is a niche procedure that does not offer any real advantage, compared with a milder form of stimulation in most patients, including in PCOS patients
Proposition: IVM does not offer any advantage over current IVF practice, and the associated risks are unknown
N. Gleicher, USA
Opposition: IVM results are comparable to standard IVF, and it has obvious advantages over standard IVF
M. Benkhalifa, France
Discussion
09:30-10:00 Discussants:
N. Gleicher, USA
M. Benkhalifa, France
Tricks of the trade; Expert panel on:
1. Mild stimulation or no stimulation for IVM?
2. HCG: Dose timing?
3. Luteal phase support: Is IVM different than IVF?

10:00-10:20 Coffee break

10:20-11:50
GAMETE CRYOPRESERVATION
Capsule
There are ever-growing indications of the need for an effective, reliable freezing method for oocytes and embryos. The many possible techniques require elucidation of the best approach.
Chairpersons N Gleicher, USA
S. Nair, Singapore
10:20-10:40 Clinical aspects of ovarian tissue cryopreservation
J. Dor, Israel
10:40-11:05 Fertility Preservation for medical and social indications
J. Donnez, Belgium
11:05-11:25 Safety of ovarian cortex transplantation: there is a risk of reimplanting malignant cells?
M.M. Dolmans, Belgium
11:25-11:50 Ovarian cortex freezing: what is the best method?
J. Donnez, Belgium

11:50-12:10 Poster viewing

12:10-13:40
LUTEAL PHASE SUPPORT IN INFERTILITY
Supported by an unrestricted grant from Abbott
Capsule
The controversy around luteal phase support – when should we support, with what and for how long – continues. While there is no doubt of the need to support the luteal phase with progestogens in Infertility treatments, the question remains: for how long? The role of progestogens in recurrent miscarriage is even more complex and is based on expert opinion rather than on level 1 proof
Chairpersons H. Carp, Israel
S. Daya, Canada
12:10-12:40 Improving results in Fertility Programs
S. Nair, Singapore
12:40-13:10 Luteal support with progestogens in Infertility
A. Patki, India
13:10-13:40 Role of progestogens in early pregnancy
P. van de Weijer, New Zeeland
Objective Role of progestogens in implantation and early pregnancy

13:40-14:30 Lunch break

14:30-16:00
REPRODUCTIVE TOURISM
Supported in part by the Kiran Infertility Centre, Hyderabad, India
Capsule
Cross-border reproductive care also known as reproductive tourism, is a growing phenomenon which has its roots in general medicine, and was extended to infertility to provide whatever services and treatments that patients can't obtain at home due to cost, time, or regulatory restrictions. It is estimated that 1% of treatments for IVF, egg donation, PGD, surrogacy, and treatments of unmarried or homo-lesbian community are done "away from home". Surrogacy which is banned or greatly regulated in most countries, have lately "migrated" to specialized centers in India. Awareness of the stress involved, the different standard of practice can help reduce stress
Chairpersons K.D. Sekhar, India
S Daya, Canada
Z. Ben Rafael, Israel
14:30-15:00 What are the various motives for patients to travel?
S. Sekhar, India
15:00-15:30 Can we assure patients safety and autonomy away from home and "the pregnancy". The Kiran Infertility Centre experience
K.D. Sekhar, India
15:30-16:00 Developing international standards for cross boarder services, who's responsibility it is?
N. Gleicher, USA
Objective: To learn about the motives, the solutions, safety and the need for international guidelines

16:00-16:30 Coffee break

16:30-18:00
SURGICAL INTERVENTIONS BEFORE ART
Capsule
The search for the true etiology of repeated implantation failure, which commonly occurs after IVF /ET, has also led to more surgical solutions of various problems which seem to be associated with infertility, but without true evidence that they are the cause thereof. These procedures include more diagnostic hysteroscopy offered after failures, septum separation, endometrioma operations, myomectomies and the like. Nonetheless, in most cases, it is hard to identify supporting level 1 evidence in the literature. When should we operate and when not? Can we base our decision entirely on evidence?
Chairperson O. Coll, Spain
Z. Ben-Rafael, Israel
16:30-16:50 What do and don't we know about the need of myomectomy before IVF?
Z. Ben-Rafael, Israel
16:50-17:15 Intra uterine adhesions "Prevention and Treatment"; a major challenge
R. Campo, Belgium
17:15-17:40 Uterine septum: Should we operate all patients or only following pregnancy failure?
J. Donnez, Belgium
17:40-18:00 A new approach to the diagnosis of adenomyosis “Hysteroscopic exploration of the sub endometrial myometrium"
R. Campo, Belgium

Saturday, July 21, 2012


08:30-10:00
MALE INFERTILITY
Capsule
Should we be satisfied with the results of ICSI or try to improve sperm quality and selection?

Chairpersons M. Lau , Singapore
G. Tritto, Italy
R. Agrawal, UK
08:30-09:30
Debate: Treatment of teratospermia: "IMSI or just ICSI"?
Proposition: IMSI is an innovative technique that allows better sperm selection
M. Benkhalifa France
Opposition: To date, there is no real proof of the advantage of IMSI over ICSI in teratospermia
M. Dirnfeld, Israel
Discussion
09:30-10:00 Reconstructive Microsurgery-(ReMiS) principles in Male reproductive Surgery
G. Tritto, Italy

10:00-10:20 Coffee break

10:20-11:50
OBESITY AND INFERTILITY
Capsule
This debate is likely to persist for a protracted period. Should we exclude obese women from treatment based on the notion that they might have a lower success rate and more complications during pregnancy? Or should we accept the notion that women in our society are becoming more obese, that they will have difficulties implementing weight restriction policy, and they are more likely to need help for infertility? 
Chairperson R. Aurell, Spain
D.S. Seidman, Israel
10:20-11:05
Debate: Obesity is associated with a lower success rate of infertility treatments and higher risks and complications during pregnancy, hence access to fertility treatments should be determined by female body mass index (BMI)
Yes: S. Daya, Canada
No: O. Coll, Spain
Discussion
11:05-11:30 Implantation failure in oocyte donation
O. Coll, Spain
11:30-11:50 Are patients entitled to seek legally forbidden treatments outside their own country?
G.N.  Allabadia, India
Objectives Upon completion of this session, the audience will have learned:
  • Arguments for restricting access to fertility treatments based on BMI
  • Arguments for not restricting access to fertility in high BMI
  • Poor success associated with interventions for weight loss
  • The conflict between BMI and age

11:50-12:10 Poster viewing

12:10-13:40
CONTROVERSIES IN PREIMPLANTATION GENETIC DIAGNOSIS (PGD) AND SCREENING (PGS)
Capsule
The proposed goal of PGS was to improve pregnancy rates in IVF and reduce spontaneous abortion rates, by selecting the best embryos for transfer. So far, however,  studies have failed to prove the concept. The question is whether or not we should continue to refine the technique or declare that PGS for detection of aneuploidy is a risky procedure that should be avoided. Similarly, PGD for mitochondrial DNA disorders is a new and controversial procedure which, in many situations, may serve to reduce, although not eliminate, the genetic risk. What are the pros and cons of its clinical application? Furthermore, the use of Array CGH (comparative genomic hybridization) overcomes many of the Chromosomal CGH limitations, however both are limited in regards of ploidy detection.
Chairperson S. Daya, Canada
12:10-13:10
Debate: PGS remains an experimental tool
Proposition: PGS should be banned from routine clinical use due to inferior results and higher embryonic risk
N. Gleicher, USA
Opposition: The ability to prevent fetal aneuploidy by pre-implantation genetic diagnosis supports extensive clinical applications
K.W.R. Choy, Hong Kong
Discussion
13:10-13:40 Can array CGH overcome the PGS shortcomings?
K.W.R. Choy, Hong Kong

13:40-14:30 Lunch break

14:30-16:00
HOT CONTROVERSIES ON ART CLINICAL ISSUES
Chairperson Z. Ben-Rafael, Israel

Discussants:
N. Gleicher, USA
S. Daya, Canada
M. Benkhalifa, France

Round table discussion and expert opinions:    
1.    What to prefer: Ovarian reserve tests or simply response to stimulation?
2.    How do we choose the initial dose of FSH?
3.    Protocols for IVF in patients with endometriosis
4.    Strategies to prevent OHSS: do we have a winner?
5.    Assisted zona hatching: should it be continued? To whom?
6.    Difficult ET: what is the next step?
7.    Luteal support in IVF: PO? PV? IM? For how long?
8.    Any rule for PGD in patients with recurrent miscarriages?
9.    Less expensive IVF: how can it be achieved?

16:00-16:30 Coffee break

16:30-18:00
ASSESSMENT AND TREATMENT OF OVARIAN RESERVE
Capsule
Age-related decreased ovarian reserve (DOR) remains a common, frustrating, easily diagnosed condition. However, the absence of criteria for diagnosis of DOR makes it difficult to assess and compare the prevalence of diagnosis and results of treatments. In fact, most cases are diagnosed retrospectively by the response to treatments. Questions have been raised with regard to the real effect of increasing the dose or modifying the stimulation protocols and the results
Chairpersons S. Daya, Canada
D.S. Seidman, Israel
16:30-16:50 Can we agree on common criteria to classify decreased ovarian reserve?
R. Aurell, Spain
16:50-17:35
Debate: Can we improve pregnancy rates of patients with DOR by better stimulation?
Proposition: Better protocols can improve stimulation and pregnancy rates
N. Gleicher, USA
Opposition: No evidence that results can be improved by better stimulation
M. Dirnfeld, Israel
Discussion
17:35-18:00 Discussants
N. Gleicher, USA
M. Dirnfeld, Israel
R. Aurell, Spain
Tricks of the trade; expert opinion on:
  1. Do we need to assess AMH, FSH, or both?
  2. The place of natural cycle or minimal stimulation
  3. Does DHES has a role in the treatment, and if so, what?
  4. Should we withold IVF based on female age?

Sunday, July 22, 2012


08:30-10:00
TREATMENT OF PCOS PATIENTS
Capsule
The controversy over the management of Polycystic Ovarian Syndrome (PCOS) continues. The debate here is on the best way in which to achieve pregnancy in PCOS patients while minimizing risks. Mild stimulation IVF, IVM, ovarian drilling or GnRH to trigger ovulation: what direction, if any, is preferable? Different points of view – any winner?
Chairperson Z. Ben-Rafael, Israel
D.S. Seidman, Israel
08:30-09:35
Debate: Prevention OHSS one or many strategies?
GnRH-a to trigger ovulation should be used in all PCOS patients to prevent OHSS
S. Kol, Israel
Mild stimulation in PCOS patients will decrease OHSS without compromising the result of treatment
S. Daya, Canada
IVM for PCOS patients
M. Benkhalifa, France
Discussion
09:35-10:00 Micro nutrients and fertility
R. Agrawall, UK

10:00-10:20 Coffee break

10:20-11:50
EVIDENCE-BASED MEDICINE (EBM): "HOLY GRAIL" OR MORE DOUBTS?
Capsule
This debate is certian to continue. Evidence-based medicine (EBM) has becomethe new "Holy Grail" of clinical decision making. Of course, EBM is, however, only as good (or bad) as the best available evidence (BAE). BAE, in turn, is dependent on the quality of published studies, which are often weak because of poor study design, flawed statistical evaluations, or outright fraud. Meta-analysis of randomized clinical trials (as propagated by Cochrane)have become a favored tool in establishing BAE, often overlooking that many of these trials are seriously under powered and, therefore, do not allow for the conclusions they claim.  EBM may, therefore, possibly be viewed with the same healthy degree of skepticism as that for IBM programmers who brought "garbage in, garbage out" to the early days of software development
Chairperson Z. Ben-Rafael, Israel
10:20-11:20
Debate: EBM: What's next?
Proposition: EBM represents the only valid approach towards medical decision making
S. Daya, Canada
Opposition: EBM has limited value in daily clinical care and cannot replace clinical judgment
N. Gleicher, USA
Discussion
11:20-11:50 Can we really conduct efficacy trials in intracytoplasmic sperm injection (ICSI) with pregnancy as the outcome when the conclusion is likely to be worthless because of post randomized manipulation?
S. Daya, Canada
Objectives Upon completion of this session, the audicne will have learned:
  • How BAE is established
  • Advantages and limitations of BAE
  • Levels of evidence and how they are established
  • Different clinical study formats and their respective advantages and disadvantages