Approaches to improve the diagnosis and management of infertility

Abstract

BACKGROUNDRecent 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.METHODSSpecialist 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.RESULTSIt 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.CONCLUSIONSGreater 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.

LH receptor gene expression in cumulus cells in women entering an ART program

“…Several patient characteristics are directly related to the response to ART treatment, which consequently dictates the need for reliable, personalized diagnostic and therapeutic approaches to optimize efficacy as well as safety outcomes. In this context, it is crucial for more genetic factors, which are involved in folliculogenesis and ovulation, to be examined whether or not they participate in the desirable outcome of an ART treatment [4].…”

Male infertility in China: laboratory finding for AZF microdeletions and chromosomal abnormalities in infertile men from Northeastern China

“…It is remarkable that AZF region microdeletions and chromosomal abnormalities have become clinically important since assisted reproductive techniques (ART), such as intracytoplasmic sperm injection (ICSI), have been introduced to clinical treatments successfully [1,2,9,10]. However, AZF microdeletion and chromosomal abnormality have potential chances to be transmitted readily from infertile fathers to their offspring by ICSI/IVF.…”

Single nucleotide polymorphisms in the Anti-Müllerian hormone (AMH Ile49Ser) and Anti-Müllerian hormone type II receptor (AMHRII −482 A>G) as genetic markers in assisted reproduction technology

“…Despite several years of clinical experience, precise prediction of ovarian response to controlled ovarian stimulation (COS) remains difficult. Both the variability in patient characteristics and in the response to IVF treatment illustrate the need for personalized management strategies in order to reduce the rates of cancelled IVF cycles and to optimize efficacy and safety outcomes [2,3]. Genetic variation in signaling pathways of the ovary could play an important role in ovarian response and IVF outcomes.…”