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first world conference on luteinizing hormone in ART: landing in latin America7-8 April 2017 - Mexico City, Mexico

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CMe ProviderEXCEMED is a non-profit foundation dedicated, since the last four decades, to the development of high-quality medical education programmes all over the world.

EXCEMED adheres to the guidelines and standards of the European Accreditation Council for Continuing Medical Education (EACCME®) which states that continuing medical education must be balanced, independent, objective, and scientifically rigorous.

EXCEMED adheres to the principles of the Good CME Practice group (gCMEp).

OverviewThis conference will review and further enlighten the main topics discussed during the First world conference on luteinizing hormone (LH) in ART: A flight of discovery in Naples, Italy on 27-28 May 2016. The role of LH during folliculogenesis has heightened curiosity for at least three decades. In particular, the scientific community is still divided over recognizing the relevance of LH containing drugs during controlled ovarian stimulation (COS). Availability of recombinant drugs has offered, for the first time, the opportunity to explore the role of the follicle stimulating hormone (FSH) and LH separately. Despite this opportunity, the role of recombinant LH is still a matter of debate. This conference will show evidence from basic science to clinical practice regarding the use of recombinant LH and will illustrate its possible benefits as well as its physiopathological mechanism. Guided by an experts, participants will grasp the rationale for using recombinant LH in assisted reproductive technology as well as understand the role of LH in human reproduction.

Learning objectivesBy attending this conference, participants will be able to:•Understand the physiology of LH and its role in ovulation induction•Grasp the state of the art regarding the use of recombinant LH•Individualise groups of patients that required LH during stimulation protocols•Identify specific ovarian reserve markers and genotype polymorphisms useful for tailoring treatments

and choosing the best approach

Target audienceThis programme is intended for clinicians, embryologists, biologists and scientists from Latin America working in ART.

first world conference on luteinizing hormone in ART:landing in latin America

Continuing Medical educationEXCEMED (www.excemed.org) is accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) to provide the following CME activity for medical specialists. The EACCME® is an institution of the European Union of Medical Specialists (UEMS), www.uems.net

The CME conference “first world conference on luteinizing hormone in ART: landing in latin America” held on 7-8 April 2017 in Mexico City, Mexico is designated for a maximum of 6 (six) hours of European CME credits (ECMEC). Each medical specialist should claim only those credits that he/she actually spent in the educational activity. EACCME® credits are recognized by the American Medical Association (AMA) towards the Physician’s Recognition Award (PRA). To convert EACCME® credit to AMA PRA category 1 credit, please contact the AMA.

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Our programme allows you to add your voice to the conversation. We wish you a unique learning experience.Express your opinion, pose questions and engage with us. During this conference we offer feedback formats suited to all tastes: case studies, panel discussions with the experts and question cards. Our objective is to help you get the most from your learning experience with us.

Any questions for the experts? Please ask: use a question card.

VenueThis educational conference takes place at the:presidente Intercontinental mexico cityCampos Eliseos 218 Col. PolancoCiudad de México, Mexico

LanguageThe official language of this conference is English.Simultaneous translation will be provided from English to Spanish and vice versa.

CME ProviderEXCEMED - Excellence in Medical EducationProgramme and Relations Manager: Flaminia MasproneT +39 06 420413 206 - F +39 06 420413 677flaminia.masprone@excemed.orgMedical Advisor: Alessandro Conforticonfale@hotmail.it

for any logistic inquiry, please contact:Meridiano Congress InternationalEvent Manager: Giorgia Di EgidioT +39 06 88 595 245 - F +39 06 88595 234giorgia.diegidio@meridiano.it

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carlo AlviggiFederico II University of NaplesNaples, Italy

sandro c. EstevesANDROFERT - Andrology & Human Reproduction ClinicCampinas, Brazil

Robert fischerFertility Centre HamburgHamburg, Germany

peter humaidanFertility ClinicSkive Regional Hospital and Faculty of Health Aarhus UniversitySkive, Denmark

Local chairAntonio m. gutiérrez gutiérrezDirector General Instituto VIDALeón, Gto, México

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12:00 Welcome lunch and registration

14.00 Opening R. Fischer (Germany)

Welcome A.M. Gutiérrez Gutiérrez (México)

Introduction C. Alviggi (Italy)

session I lh: Taking off from basic science...flying through clinical practice

14.15 l1 lh vs hcg: formulations and physiological differences S. C. Esteves (Brazil)

14.40 l2 polymorphism of lh and its receptor and their application to clinical practice C. Alviggi (Italy)

15.05 l3 Who needs lh supplementation? P. Humaidan (Denmark)

15.30 coffee break

15.50 case study S. C. Esteves (Brazil)

16.20 panel discussion

17.20 End of the first day

friday, 7 April 2017 saturday, 8 April 2017

08.30 Wrap up R. Fischer (Germany)

session II Encountering turbulence: impaired outcomes in IVf

08.45 l4 poor responder definition: are we on the right path? S. C. Esteves (Brazil)

09.10 l5 “low prognosis” concept: a new proposed stratification by pOsEIDON Working group P. Humaidan (Denmark)

09.35 l6 getting the right dosage to the right patient: The importance of ovarian sensitivity in ovarian stimulation C. Alviggi (Italy)

10.00 case study C. Alviggi (Italy)

10.30 panel discussion

11.30 coffee break

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l : Lecture : Case studies : Panel discussion

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session III On the correct flight path: new strategies to manage impaired IVf response

11.45 l7 “maximum output with minimum efforts”: Is it possible to estimate the number of oocytes I need to optimize IVf success? S. Esteves (Brazil)

12.05 l8 The application of double stimulation (Duostim) in cOs to increase the number of oocytes/embryos in ART C. Alviggi (Italy)

12.25 l9 The balance between “quality and quantity” in ART: how to manage the risk of an excessive ovarian stimulation P. Humaidan (Denmark)

12.45 case study P. Humaidan (Denmark)

13.15 panel discussion

13.50 concluding remarks

14.00 End of the conference

closing lunch

EXCEMED adheres to guidelines of the European Accreditation Council for Continuing Medical Education (EACCME®) and all other professional organizations, as applicable, which state that programmes awarding continuing education credits must be balanced, independent, objective and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices, and other products (other than those uses indicated in approved product labeling/package insert for the product) may be presented in the programme (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We ask all presenters to provide participants with information about relationships with pharmaceutical or medical equipment companies that may have relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it is only intended to inform participants of any potential conflicts so that participants may form their own judgements, based on full disclosure of the facts. Further, all opinions and recommendations presented during the programme and all programme-related materials neither imply an endorsement nor a recommendation on the part of EXCEMED. All presentations represent solely the independent views of the presenters/authors.

The following faculty provided information regarding significant commercial relationships and/or discussions of investigational or non-EMEA/FDA approved (off-label) uses of drugs:

carlo Alviggi Declared receipt of honoraria or consultation fees from Merck

sandro c. Esteves Declared receipt of honoraria or consultation fees from Merck and Besins

Robert fischer Declared no potential conflict of interest

peter humaidan Declared receipt of unrestricted research grants from Merck, MSD and Ferring; of honoraria or consultation fees for lectures from Merck and MSD

The following faculty have provided no information regarding significant relationship with commercial supporters and/or discussion of investigational or non-EMEA/FDA approved (off-label) uses of drugs as of 13 March 2017.

Antonio m. gutiérrez gutiérrez

Disclosure of faculty relationships

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sandro c. Esteves

ANDROFERTAndrology & Human Reproduction ClinicCampinas, Brazil

Sandro Esteves is Medical and Scientific Director of ANDROFERT-Andrology and Human Reproduction Clinic a referral Fertility Center for male reproduction in Brazil. Dr. Sandro earned his MD. in 1990 from the University of Campinas (UNICAMP), Brazil, where he did residency training in General Surgery and Urology. He completed his training in the United States (1995-1996) as a Research Fellow at the Cleveland Clinic’s Center for Reproductive Medicine. He was awarded a Master Degree in Surgery in 1998, obtained at the University of Campinas (UNICAMP, Brazil), and a PhD. in Medicine (Urology) in 2001, at the Federal University of São Paulo (UNIFESP, Brazil). Dr. Esteves is Board-certified Urologist by the Brazilian Society of Urology (SBU), and certified ART Center director and IVF Consultant by the Brazilian Society of Assisted Reproduction (SBRA) and RedLatinoAmericana de Reprodución Asistida (RedLara). He is a Collaborating Professor in the Department of Surgery (Division of Urology) at UNICAMP (Campinas, Brazil) and Honorary Professor of Reproductive Medicine at the Faculty of Health, University of Aarhus, Denmark. Sandro Esteves is also Research Collaborator at both the Cleveland Clinic’s American Center for Reproductive Medicine (USA) and the Genetic Unit, Department of Biology, Universidad Autónoma de Madrid,

(Spain). He holds an honorary title of Clinical Tutor in Urology at the University of Edinburgh (UK). His research/clinical interests include male infertility, reproductive endocrinology, cleanroom technology, and quality management. Dr. Esteves has published over 200 scientific papers in peer-reviewed journals, authored over 70 book chapters, and presented over 150 papers at both national and international scientific meetings. His current Hirsch index (hindex) is 27 while his citation count is more than 2,500. Sandro is also a Faculty member of F1000Prime in the area of reproductive endocrinology & infertility since 2016. He has served as an editor of 5 textbooks related to male infertility, reproductive medicine, and assisted reproductive technology. He is also the guest editor of 3 special issues in scientific journals on topics related to reproductive medicine. Dr. Sandro serves on the Editorial Board of several Journals and is Associate Editor of International Brazilian Journal of Urology and Frontiers in Reproductive Endocrinology (Section Reproduction). Dr. Esteves has been invited as guest speaker at many international meetings in over 30 countries. He is the recipient of the “Alumni of the Year” Award from the Cleveland Clinic Center for Reproductive Medicine, and the Star Award from the American Society for Reproductive Medicine for the last 4 years.

carlo Alviggi

Federico II UniversityNaples, Italy

Carlo Alviggi obtained his MD degree (1994) with a specialty in Obstetrics and Gynaecology (1998), and a PhD in 2001 at the Faculty of Medicine, University of Naples “Federico II”, Italy. In 1998 he was a visiting fellow in the IVF Unit of the Imperial College of London–Hammersmith Campus, where he also collaborated with the Department of Immunology (Imperial College of London). Thereafter, he collaborated with the Laboratory of Immunology of the Italian National Research Council (Naples), the laboratory of Autoimmunity and Tolerance of the University of California (Los Angeles). This collaborative network resulted in various publications some of which concern new hypotheses on the pathogenesis of pelvic endometriosis. Over recent years, he has been working as associate professor in reproductive medicine at the Fertility Unit of the University of Naples “Federico II” (Department of Neuroscience, Reproductive Science and Odontostomatology). Dr Alviggi has

published extensively and has been invited to lecture at over 100 international meetings dealing with reproductive medicine and gynaecological endocrinology. He has also served as adhoc reviewer for international journals in these fields. He has participated in several national and international (phase II-III) multicentric, prospective randomised trials. Dr Alviggi’s current research interests are the role of LH in folliculogenesis, the use of LHcontaining drugs in patients undergoing ovarian controlled stimulation for IVF, the pathogenesis of pelvic endometriosis, oncofertility, reproductive endocrinology and the genetics of human reproduction.

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Robert fischer

Fertility Centre HamburgHamburg, Germany

Robert Fischer is founder and Medical Director of the IVF unit at the Fertility Center Hamburg - one of Germany’s largest and leading IVF centres. In July 1998 the Fertility Center Hamburg was one of the first centres in Germany, and worldwide, to introduce certified quality management according to the ISO 9001. In 2002, the IVF laboratory became ISO 17025 certified. Prior to these developments, in 1983 he pioneered and was medical director of the first outpatient IVF unit in Hamburg. Author of numerous publications in national and international scientific journals and books, as well as lecturer at conferences worldwide, he is also an active member of the American Society of Reproductive Medicine, founding member of the European Society of Human Reproduction and past member of its advisory committee

as well as founding member of the German reproductive organisations, “AG Gynäkologische Endokrinologie und Fortpflanzungsmedizin” and “Berufsverband Reproduktionsmedizinischer Zentren”.

Antonio m. gutiérrez gutiérrez

Director General Instituto VIDALeón, Gto, México

Antonio M. Gutiérrez Gutiérrez graduated from the Faculty of Medicine of Guanajuato´s University (Mexico), completed his specialization in Obstetrics and Gynecology at the Mexican Institute for Social Service Hospital (IMSS) in León, Guanajuato. His postgraduate studies were conducted in Valencia, Spain at Instituto Valenciano de Infertilidad (where he was a research fellow in reproductive medicine) and at the University of Valencia (Md and PhD). He is certified by the Mexican Council of Gynecology and Obstetrics and is the Head of the Research Institute for Animal Reproduction in León Gto. He is a pioneer in research studies on fertility preservation and director of Instituto Vida - a group of fertility clinics widespread in Mexico. In addition, he is a member of the Society of Gynecology and Obstetrics of León,

Guanajuato, the Mexican Association of Reproductive Medicine, the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. He is the author and/or co-author of several books and articles in specialty journals.

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peter humaidan

Fertility ClinicSkive Regional Hospital and Faculty of HealthAarhus UniversityAarhus, Denmark

Peter Humaidan is a specialist in reproductive endocrinology, Professor at The Fertility Clinic at Skive Regional Hospital, Aarhus University, Denmark, and Honorary Professor at Odense University, Denmark. He trained at the Sahlgrenska University Hospital, Gothenburg, Sweden. During his scientific work he has primarily focused on developing individualized treatment protocols for the infertile patient. His doctoral thesis (DMSc) explored the role of LH during the follicular and luteal phases in controlled ovarian stimulation. His main fields of interest are triggering ovulation with GnRH agonist, the use of GnRH antagonists, and OHSS prevention. He is the founder of the international society “The Copenhagen GnRHa Triggering Workshop Group” and board member of the ESHRE SIG Endocrinology Group. He has authored 100 + articles

(H-index 26) in international peer reviewed journals as well as the Danish guidelines for OHSS prevention and chapters in textbooks. Peter Humaidan has a wide international scientific network and is frequently invited as a speaker at international conferences.

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polymorphism of lh and its receptor and their application to clinical practice

Learning objectives:•Illustrate LH and its receptor polymorphism •Depict physiopathological features of LH and its receptor polymorphism •Propose the practical utility of genotype characterization of infertile women

C. Alviggi (Italy)L2

Learning objectives:•Emphasize the importance of LH and hCG functions in female fertility•Analyze the physiopathological differences between LH and hCG •Illustrate the differences among LH/hCG formulations

lh vs hcg: formulations and physiological differencesS.C. Esteves (Brazil)L1

NOTES NOTES

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poor responder definition: are we on the right path?

Learning objectives:•Underline the importance of adequately identifying “poor” responder women•Illustrate the different poor responder definitions available in literature•Discuss pros and cons of the new Bologna criteria

S.C. Esteves (Brazil)L4

Learning objectives:•Focus on basic scientific evidence regarding the importance of LH activity during ovarian

stimulation•Illustrate which subgroup of patients could benefit from LH supplementation•Discuss LH dosage and protocols adopted in clinical practice

Who needs lh supplementation?P. Humaidan (Denmark)L3

NOTES NOTES

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getting the right dosage to the right patient: the importance of ovarian sensitivity in ovarian stimulation

Learning objectives:•Explain the physiopathological mechanism regulating ovarian sensitivity•Depict the concept of hypo-response to controlled ovarian stimulation•Evaluate the therapeutic strategy to manage hypo-responder women

C. Alviggi (Italy)L6

Learning objectives:•Illustrate the concept of low prognosis•Evaluate the differences between low prognosis according to POSEIDON criteria and poor

response according to the Bologna criteria•Discuss how applying the new classification could improve clinical practice

“low prognosis” concept: a new proposed stratification by pOsEIDON Working groupP. Humaidan (Denmark)L5

NOTES NOTES

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Learning objectives:•Explain the rationale for identifying the appropriate number of eggs in IVF procedures•Illustrate the new POSEIDON practical algorithm to predict the number of eggs required to

maximize IVF success•Demonstrate how to apply the new POSEIDON algorithm in clinical practice

“maximum output with minimum efforts”:Is it possible to estimate the number of oocytes I need to optimize IVf success?S. Esteves (Brazil)L7

The application of double stimulation (Duostim) in cOs to increase the number of oocytes/embryos in ART

Learning objectives:•Understand the physiological mechanism of double stimulation •Illustrate how to perform double stimulation in clinical practice•Define the clinical applications of double stimulation strategies

C. Alviggi (Italy)L8

NOTES NOTES

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Learning objectives:•Define hyper-response and its implication in clinical practice•Stress the importance of an adequate balance between quality and quantity in IVF•Explain practical strategies to minimize the risk of excessive ovarian stimulation

The balance between “quality and quantity” in ART: how to manage the risk of an excessive ovarian stimulationP. Humaidan (Denmark)L9

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All EXCEMED programmes are organized solely to promote the exchange and dissemination of scientific and medical information. No forms of promotional activities are permitted. There may be presentations discussing investigational uses of various products. These views are the responsibility of the named speakers, and do not represent an endorsement or recommendation on the part of EXCEMED. This independent programme is made possible thanks to an educational grant received from Fertility Centre Hamburg, Ferty School, Istituto Ricerche Genetiche, This independent programme is made possible thanks to educational grants received from: Ferty School, Istituto di Ricerche Genetiche, Merck KGaA Darmstadt Germany, MVZ Fertility Center Hamburg and San Raffaele Hospital Milan.

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