ImprovIng the patIent’s lIfe through
medIcal educatIon
HIGHLIGHTS on EXCEMED aCTIvITIES In reproductive medicine
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annual conference outcomesspotlight on Implantation: opening the black box
Workshop outcomesearly evaluation of fetal echocardiography
future focusfertility preservation following cancer: an emerging challenge
upcomIng In eXcemed reproductIve medIcIneeducational activities on the horizon
Your eXcemedeXcemed: improving reproductive medicine through medical education
Continuing medical education is our sole focus and our passion. we pour our energy and expertise into delivering the best for healthcare professionals, with patients as the ultimate beneficiaries. This is CME excellence. our educational programmes in reproductive medicine are designed to suit the needs of physicians, scientists and biologists from all over the world who want to be at the cutting edge of research and patient care.
EXCEMED
spotlight on “Implantation: opening the black box”
almost 400 clinicians, biologists and researchers working in fertility medicine and arT attended the 2014 CME-accredited annual Meeting in reproductive Medicine. organised by EXCEMED, the meeting took place on 23-24 May, in Budapest, Hungary.
This international conference is held annually and has become a key event for professionals working in arT, from all over the world.
presentations focused on the following important subjects relating to human embryo implantation:• Key biological aspects of human embryo
implantation• State-of-the-art techniques to maximise
implantation• Evidence-based recommendations to achieve
the best outcomes from arTpresentations provided excellent opportunities for the participants to expand their knowledge of many aspects of arT.
This publication highlights key presentations at the meeting, and provides an update on recent and forthcoming activities in reproductive medicine that are being developed by EXCEMED •
Annual Meeting on reproductive
medicine focused on implantation,
especially RIF
Excellent presentations on human embryo implantation
23-24 MAy BuDapEST, HunGary
2 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 Abbreviations are defined in the Glossary, page 6
Improving implantation in ART by endometrial injury/scratching
23-24 MAy BuDapEST, HunGary
Clinical evidence is emerging – including data from RCTs and Cochrane reviews – indicating that endometrial injury/scratching has a place in IVF. However, more research and better-quality evidence is required before endometrial injury can be considered as a standard practice.
Immune- or stem-cell populations may be activated at the time of injury and this may support improved receptivity in the next cycle. However, there is also biological im-plausibility. For example, the injury is su-perficial (affecting only the functionalis layer), therefore tissue at the site of dam-age is expected to be lost at menstruation, explained Dr aplin. It may be that endome-trial injury promotes a beneficial inflam-matory process where cellular memory and signalling improve over long distanc-es, within tissues. In a debate at the meeting, Dr raine-Fenning argued in favour of scratching and Dr Khalaf presented the case for caution. at the end of the debate, a large majority of participants voted in favour of scratching •
FroM LEFT
dr nick raine-fenning(university of nottingham, uK) described endometrial injury as a well-tolerated, affordable procedure dr John aplin (university of Manchester, uK) outlined the physiological cascade of events that occur after endometrial injurydr Yacoub khalaf (King’s College London, uK) called for further research in endometrial injury
There is no evidence regarding effect of
endometrial injury on adverse events, such as
pain and bleeding
Endometrial injury appears to promote a
beneficial inflammatory environment for
implantation
Certainly, endometrial injury (scratching) results in a cascade of events that may im-prove implantation rates, but physical and clinical evidence remains mixed. There is biological plausibility in the theory of en-dometrial scratching. Dr aplin showed how local injury to the endometrium caus-es a range of events (Figure 1), together with changes in gene-expression patterns.
figure 1: injuries to epithelial tissue surfaces, such as the endometrium, are generally associated with the features listed
• platelet deposition; clot formation• tissue-specific inflammatory infiltrate• epithelial repair (epiboly)• Influx of myofibroblasts• matrix deposition• Wound closure• local remodelling• minimal fibrosis;
no scarring in mucosal tissues
rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 3GoT A CoMMEnT oR quEsTIons? E-MAIl [email protected]
The endometrium: a biosensor for implantation
Research is revealing the events that surround peri-implantation. These advances in our understanding may help to improve IVF success rates. Equally, they may give us a clearer picture of the normal physiological mechanisms that govern implantation.
It is important to ensure the safety of the mother by not increasing the implantation rate when this means that potentially ab-normal embryos might implant. Dr Macklon suggested that the new ques-tion to pose is not how we can improve im-plantation in all cases, but whether this is something we should be doing.
dr nick macklon (university of Southampton, uK) explained how research is opening the black box of early, preclinical pregnancy losses in humans
23-24 MAy BuDapEST, HunGary
implantation failures are commonnormal human reproduction is character-ized by a high rate of embryo loss, either before or just after implantation. Chromosomal abnormalities may be evident in the majority of embryos, there-fore it is unsurprising that implantation failures are common. The endometrium (decidualising endo-metrial stromal cells in particular) acts as a biosensor, preventing the implantation of abnormal embryos (Figure 2): • High-quality embryos actively signal to
induce expression of supportive endo-metrial factors
• Low-quality embryos trigger a cellular stress response, thus leading to im-plantation failure
• This mechanism safeguards the moth-er, preventing the uterus from pro-longed investment in embryos that are likely to be abnormal.
new areas of researchStudying the physiological signals within the endometrium represents a new area for research and development. By understanding the events better, we may have a clearer understanding as to why live birth rates per embryo transfer after IvF remain at relatively static levels, despite improvements in other aspects of arM. Future avenues for research should be to confirm whether reduced embryo selec-tivity (i.e. failure to discriminate between high- and low-quality embryos) is a key reason for recurrent miscarriage. The implications of this, and the devel-opment of interventions that normalize the decidual phenotype, should be a focus of clinical and research attention •
Knowledge of implantation physiology is relevant to
assisted reproduction and natural conception
figure 2: natural selection of embryos. Decidualising endometrial stromal cells serve as sensors on quality of implantation.
4 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 Abbreviations are defined in the Glossary, page 6
Evidence needed for adjuvant therapy use in ART
23-24 MAy BuDapEST, HunGary
There is an urgent need for clinical trials to determine definitively whether adjuvant and complementary therapies offer benefit to people undergoing ART. until then, clinicians have a duty to be honest with patients and to not advocate therapies that have no evidence of any benefit.
advocating the use of adjuvant or comple-mentary treatments for people with rIF may have biological plausibility but does not have current evidence of efficacy. Dr Cheong asked clinicians to be honest with patients regarding the limits of reproduc-tive science, and adopt a supportive role rather than suggest non-evidence-based interventions in more difficult cases.
a supportive approach could focus on the following:• optimizing modifiable lifestyle factors
(such as diet, exercise, smoking, alcohol consumption)
• addressing contributory surgical factors (such as uterine, tubal, ovarian pathologies and anomalies)
• assessing the difficulties in embryo transfer in previous treatment cycles
• re-evaluating the patient’s history and investigations
presently, explained Dr Cheong, there is no robust evidence for many of the im-munological therapies that are emerging. Further trials are needed, for example, to confirm whether administering glucocor-ticoids during the peri-implantation phase of arT has any significant benefit on clini-cal outcome. The same is also true for IvIG, TnF-inhibitors and intralipid therapy. Indeed, intralipid therapy is associated with a high rate of allergic reactions, thrombocytope-nia and hypercoagulability, and is therefore not recommended, Dr Cheong explained •
dr Ying cheong (university of Southampton, uK) urged clinicians to recommend only evidence-based treatments for couples undergoing arT
Current and emerging technologies for genetic testing (antonio capalbo, Italy)• Several methods are available
for accurate 24-chromosome aneuploidy screening with different capabilities and limitations
• Despite providing higher-resolution results, microarray based CCS me-thods are labour-intensive, costly, and have a long turnaround time
• Quantitative polymerase chain reaction has been developed for the purpose of blastocyst pGS and provides rapid, accurate and cost-effective screening
• all CCS methods provide accurate aneuploidy screening when used on multiple trophectoderm cell sam-pled at the blastocyst stage; single-cell analysis poses several issues
• The introduction of next-generation sequencing platforms in IvF will further reduce the costs of pGS or preimplantation genetic diagnosis and will allow new levels of genetic testing to be explored in IvF
Immunological modulation; regulation of endometrial receptivity(nathalie lédée, france)• During the implantation window,
there is a necessary immune switch for fetal tolerance that has a central role for uterine natural killer cells
• at this phase, documenting the local immune reaction may be useful for those with repeated and unexplained implantation failures, to help identify uterine immunological mechanisms and provide personalized IvF treatment
understanding endometrial ‘omics’ (signe altmäe, estonia)• ‘omics’ high-throughput
analyses are revolutionizing our understanding of endometrial physiology and pathophysiology
• although there is much informa-tion from gene expression studies, there is a lack of consensus:
- knowledge of clinical application is limited: more well-designed studies are needed
- proteomics and metabolomics will likely be important in the near future
In bRIEF
Clinicians should be supportive and honest
with couples about likely levels of success
rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 5Follow us HTTpS://www.FaCEBooK.CoM/EXCEMED
new classification proposed for RIF
23-24 MAy BuDapEST, HunGary
A new classification has been proposed that aims to provide clear guidance on how to confirm RIF.
The proposed classification describes rIF as ‘the absence of implantation, defined by a negative serum hCG 14 days after oocyte collection, after two consecutive IvF cycles, ICSI or frozen embryo replacement, where the cumulative number of transferred embryos was no less than four for cleavage-stage embryos and no less than two for blasto-cyst, with all embryos being of good quality and appropri-ate developmental stage’.
Dr n raine-Fenning advocated the widespread adoption of this new classification. He outlined the five stages of the implantation process (namely, rolling, apposition, adhesion, invasion, and vas-cularization), adding that implantation should only be con-sidered when invasion of the embryo is complete and it is formally embedded within the endometrium. The timepoints when implantation can be confirmed, and when implantation failure can be diagnosed, have not been clear in previous classifications •
dr nick raine-fenning (university of nottingham, uK) suggested a new classification of rIF that clarifies the timepoints for confirming rIF
AH in the era of blastocyst culture/ vitrification (Basak Balaban, turkey)• aH for fresh cleavage-stage ET
does not improve live-birth rates• Cumulative pregnancy rate just
reaches significance in favour of aH for all patient groups; significance more evident for women with rIF
• There are insufficient data to show the superiority of blastocyst transfers over cleavage-stage ET supported with aH
• Total zona removal for blastocyst transfers performed in certain patient groups may be a better than partial aH (depending on physiology)
• More rCTs are needed before making any recommendations for standard practice
Management of RIF: what can the clinician and embryologist do? (Ying cheong, uk; denny sakkas, usa)• Lifestyle modifications, surgical
interventions dictated by clinical history and findings and modification of arT procedures are approaches that may help in the clinical management of rIF
• The embryologist and IvF laboratory can help in the management of rIF by:
- Strict quality control- properly caring for gametes/
embryos- using optimum sperm-selection
techniques to ensure the best sperm are used
- assessing embryos using improved and validated morphological screening or new noninvasive and invasive tools
Key biological processes in implantation (John Aplin, uK)• Implantations fail in the majority
of karyotypically abnormal pregnancies
• Many normal embryos miscarry, usually due to maternal factors (e.g. poor decidualization, spiral arteries that resist remodelling, errors of meiosis, especially in women > 40 years old, failure of immune recognition and abnorma-lities in blood clotting system)
In bRIEF
A new classification should provide clear guidance
on confirming RIF
Timepoints for confirming implantation or
its failure have been unclear in the past
6 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014
EXCEMED: improving reproductive medicine through medical education
youR EXCEMED
EXCEMED – Excellence in Medical Education – is the new name of serono symposia International Foundation (ssIF). our new name marks an exciting point in our evolution, but our focus on education in reproductive medicine, ART and all aspects of fertility care remains paramount.
The Foundation has provided world-class education to thousands of healthcare professionals over the past four decades. During this time, over 1500 international scientific congresses have been organized, with more than 500 proceedings published in leading international journals. EXCEMED has pioneered online CME courses since 2000; the organization over-sees an expanding portfolio of e-learning activities including video lectures, CME-accredited online courses and symposia. These digital ventures reach over 12,500 people per month via the website or through EXCEMED’s e-newsletters. as a non-profit global organization, EXCEMED is dedicated to improving the patient’s life through the provision of in-dependent, high-impact CME to scientists, physicians, nurses, pharmacists and other healthcare professionals. upcoming EXCEMED events of relevance to specialists in reproductive medicine are summarized on the back page of this publication •EXCEMED has an
innovative educational programme in
reproductive medicine
AH, assisted hatchingAMH, anti-Müllerian hormoneART, assisted reproductive technologyCCs, comprehensive chromosomal screeningCME, continuing medical educationCos, controlled ovarian stimulationEACCME, European accreditation Council for CMEET, embryo transferhCG, human chorionic gonadotrophinICsI, intracytoplasmic sperm injectionIVIG, intravenous immunoglobulinIVF, in vitro fertilisationIuGR, intrauterine growth retardationlH, luteinising hormoneoHss, ovarian hyperstimulation syndromePCos, polycystic ovarian syndromePGs, preimplantation genetic screeningRCT, randomized controlled trialRIF, recurrent implantation failureRM, reproductive medicinesET, single embryo transfersGA, small for gestational ageTnF, tumour necrosis factor
GlossARy
The EXCEMED E-learning programme in RM offers a new format of online interactive courses, accredited by EACCME.• The first module, on aMH is due
to launch in January 2015. This module follows a case study-based learning approach, with the content led by professor antonio La Marca, university of Modena and reggio Emilia, Italy
• The online CME activities combine timely, insightful content with the convenience of home or workplace study. Courses are available for anyone wishing to participate
• participants who obtain a satisfactory score on the post-test can obtain a certificate of completion
• To know more: http://reproductive-medicine.excemed.org/
E-lEARnInG
extracts 7Follow us www.LInKEDIn.CoM/CoMpany/EXCEMED---EXCELLEnCE-In-MEDICaL-EDuCaTIon?TrK=BIz-CoMpanIES-CyM
Early evaluation of fetal echocardiography
woRKsHoP ouTCoMEs
Technological advances in ultrasonography now enable echocardiography to be performed from as early as 13–16 weeks’ gestation.
In april 2014, physicians specialising in ultrasound and obstetrics participated in a 2-day workshop on fetal echocardiography, held in in Siena, Italy. This workshop taught participants the correct methodology to perform early fetal echocardiography, how to op-timize acquisition of the correct images, and how to evaluate the role of colour/power Doppler in fetal echocardiography.
The prenatal diagnosis of congenital heart dis-eases is important for optimizing obstetrical and neonatal care. Early fetal echocardiography now facilitates visualization of the major cardiac structures from a very early stage of pregnancy. Fetal echocardiography requires the use of high-resolution ultrasound equipment, ade-quate transducer frequencies and specific sys-tem settings – all of which must be changed in real time to reach the best resolution, for in each patient and for each condition.
The normal fetal echocardiogram is targeted to visualise:• visceral situs and cardiac position• Four-chamber view, with two separate
atrio-ventricular valves• aortic and pulmonary outflow tracts• Two great arteries of similar size• Evidence of ductal and aortic arches.
Doppler techniques (colour and power) are also used to optimize fetal heart images. organised by Dr Filiberto Maria Severi (Department of paediatrics, obstetrics and reproductive Medicine, Siena university, Italy), the workshop provided participants with a com-plete understanding of the ultrasound settings needed to perform good fetal echocardiography. The most important scanning planes of the normal fetal heart (apical four chamber view, subcostal four chamber view, long-ax-is aorta, long-axis pulmonary artery, short-axis ventricles, aortic arch view) were covered in detail, and discussed from both a clin-ical and a diagnostic perspective. The rules of fetal echocardiography, together with practical suggestions to improve the experience for clinicians and patients alike, were also presented.
Fetal echocardiography now facilitates
visualization of the major cardiac structures from a very early stage
of pregnancy
Participants learned the correct methodology to perform early fetal
echocardiography, how to optimize acquisition of the correct images and how to evaluate the role of colour/
power Doppler in fetal echocardiography
throughout the year, eXcemed organizes workshops in specialist areas relevant to reproductive medicine and early pregnancy. Working in small groups, attendees have the opportunity to gain clinically focused guidance from world experts in the field. Below is a report on the fetal echocardiography workshop, held in april 2014, in siena, Italy
8 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 Abbreviations are defined in the Glossary, page 6
uPCoMInG In EXCEMED REPRoDuCTIVE MEDICInE
ivF preceptorship Hamburg, Germany4 - 5 July
sCIEnTIFIC oRGAnIsERr. Fischer, Germany
challenging issues in reproductive medicine Moscow, russia8 August
sCIEnTIFIC oRGAnIsERr. Fischer, Germany
ivF preceptorship London, uK5 - 6 september
sCIEnTIFIC oRGAnIsERS. Lavery, uK
AIMthis is the first Ivf preceptorship in germany. dr fischer’s fertility center in hamburg was one of the first to introduce certified quality management according to Iso 9001
KEy ToPICsphysiology of lh, lh in stimulation protocols, implementing quality management systems in the fertility clinic, risk management in the art laboratory
AIMthis workshop focuses predominantly on pcos, implantation failure and endometriosis
KEy ToPICsaetiology of pcos and its management, new strategies to avoid implantation failure, new guidelines for treating endometriosis
AIMthis preceptorship is dedicated to providing new insights on hot topics in rm
KEy ToPICspcos, cos, rIf, new laboratory techniques and equipment for optimisation of Ivf, protocols to improve implantation potential and endometrial receptivity
TARGET AuDIEnCEphysicians with expertise in art
FoRMATlectures, workshops, Q&a discussion and a visit to the clinic and laboratory premises
TARGET AuDIEnCEphysicians working in art
FoRMATlectures, case studies and much opportunity for discussion
TARGET AuDIEnCEphysicians with expertise in art
FoRMATlectures, case studies and much opportunity for discussion
eXcemed is offering a wide range of excellent online and live educational events in the coming months. please visit www.excemed.org to see the latest news on the reproductive medicine educational programme.
rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 9Follow us http://twitter.com/eXcemeD_rm
uPCoMInG In EXCEMED REPRoDuCTIVE MEDICInE
8th ivF preceptorship: current practice in the 21st century Madrid and valencia, Spain25 - 26 september
sCIEnTIFIC oRGAnIsERsJ. a. García velasco, a. requena and E. Bosch, Spain
international School of ultrasound in obstetrics and Gynecology “paolo mascagni” Workshop on monitoring of fetal growthSiena, Italy26 - 27 september
sCIEnTIFIC oRGAnIsERF.M. Severi, Italy
AIMthis unique preceptorship is delivered through an innovative mix of evidence-based lectures, interactive case studies, working groups and video sessions across two leading centres in Ivf care
KEy ToPICscos and the role of lh, rIf, set, new laboratory techniques and equipment for optimization of Ivf, including current evidence on hysteroscopy for women with infertility
AIMthis course aims to give a complete understanding of the role of ultrasound in deteriming fetal growth, weight and wellbeing
KEy ToPICssga fetuses, macrosomia, Iugr, fetal weight index, use/application of ultrasound examinations
TARGET AuDIEnCEclinicians with < 5 years’ experience in art
FoRMATlectures, interactive case studies and workshops, and Q&a discussions.
TARGET AuDIEnCEphysicians with expertise in ultrasound and obstetrics
FoRMATultrasound examinations in pregnant women, using numerous different approaches
ivi 1:1 intensive shadow coursevalencia, Spain,27 - 29 october
sCIEnTIFIC oRGAnIsERE. Bosch, Spain
ivF preceptorship naples, Italy6 - 7 november
sCIEnTIFIC oRGAnIsERsF. Maria ubaldi, L. rienzi,F. zullo, Italy
AIMthis intensive one-to-one clinical course provides a unique and exclusive opportunity to work directly alongside experts in Ivf, shadowing their practice
KEy ToPICsconsultations covering general aspects of Ivf management, diagnostic and therapeutic hysteroscopies, oocyte donation clinics
AIMthis preceptorship in Ivf takes place in the clinical setting of genera, a pioneering new centre for art services
KEy ToPICssubjects of current and future interest in Ivf clinical management
TARGET AuDIEnCEclinicians with < 5 years’ experience in art
FoRMATsessions involve shadowing consultations and procedures in a working clinic, in daily practice
TARGET AuDIEnCEphysicians with expertise in art
FoRMATlectures, workshop, Q&a discussion and visit to the clinic premises
10 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 Abbreviations are defined in the Glossary, page 6
uPCoMInG In EXCEMED REPRoDuCTIVE MEDICInE
international conference on fertility preservation paris, France3 December
sCIEnTIFIC oRGAnIsERsr. Frydman and M. Grynberg, France
embryology courseSt petersburg, russia28-29 november
sCIEnTIFIC oRGAnIsERsr. Fischer, GermanyT. Hardarson, Swedenp. nagy, uSa
AIMthis course represents a partnership between eXcemed and alpha (scientists in rm)
KEy ToPICschemotherapy-induced loss of follicles, cancer and testicular function, impact of radiotherapy on gonadal function, fertility in cancer survivors, fertility preservation strategies, medical treatments for gonadal damage, ovarian stimulation in cancer patients, ovarian tissue transplantation and cryopreservation
AIMthis course represents a partnership between eXcemed and alpha (scientists in rm), with alpha providing substantial input into the scientific programme
KEy ToPICsnew technologies in embryology, latest laboratory practice guidelines, optimizing laboratory conditions, culture environments and selection criteria for human embryos
TARGET AuDIEnCEphysicians and scientists working in reproductive medicine or oncology
FoRMATlectures and Q&a discussion sessions
TARGET AuDIEnCEscientists, embryologists, biologists and interested clinicians with experience in this field.
FoRMATlectures, workshop and much opportunity for discussion
cryopreservation: focus on fertility preservationBrussels, Belgium16-17 January, 2015
sCIEnTIFIC oRGAnIsERsM.M. Dolmans and J. Donnez, Belgium
AIMinnovative meeting that includes oral presentations that present the best research findings from young physicians and researchers
KEy ToPICsall aspects of cryopreservation
TARGET AuDIEnCEphysicians and scientists working in reproductive medicine
FoRMATkeynote lectures, workshops, Q&a discussion and oral presentations
EXCEMED is a non-profit organization dedicated to providing CME to healthcare professionals. This newsletter is intended for healthcare professionals and provides a brief summary of a selection of previous educational events. EXCEMED will make reasonable efforts to include accurate and current information, wherever possi-ble, but makes no warranties or representations as to its accuracy or completeness. This information is provided “as is” without warranty of any kind, either express or implied, including but not limited to implied warranty of fitness for particular purpose. EXCEMED has implemented and maintains a Quality Management System which fulfils the requirements of the ISo 9001:2008 standard for the activity of design and provision of training events in the healthcare sector.
© EXCEMED, 2014. all rights reserved.
EXCEMED Excellence in Medical Education, Salita di S. nicola da Tolentino, 1/b, 00187 rome, Italy. © Copyright 2014 EXCEMED. all rights reserved.
Editorial development: Shalene Chugh, Linda Edmondson, Michèle piraux, Emma wadland
Contributors: rene Frydman, Michael Grynberg, Sesh Sunkara, Irene zerbetto
Design: www.katehouben.com
www.excemed.org
rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 11
Fertility preservation following cancer: an emerging challenge
FuTuRE FoCus
we are in an exciting and interesting time, when oncologists and reproductive endocrinologists across the globe rise to the challenge of providing fertility services for people with a history of cancer.—sCIEnTIFIC oRGAnIsERsrene Frydman (Suresnes, France) and Michael Grynberg (Bondy, France)
Developments in oncology have improved long-term survival rates for many types of malignancy. However, to survive cancer is no longer enough. The emphasis is shifting, to enable people to live the most normal life possible after cancer; this includes giving them the best possible opportu-nity to have their own biological children. However, the science and clinical practice of fertility preservation in people with cancer remains at a pioneering-level. approaches to fertility preservation vary greatly, depending on the age of the patient, the type of malignancy and the rM services that are available locally. Techniques are being developed, but their long-term success is not proven.
organize services; offer urgent careIt is possible for reproductive medicine clinics to offer ‘emergency’ care to people, even when the window between diagnosis and initiation of cancer treatment is narrow. But providing rapid support and intervention requires well-informed oncologists and adaptable fertility clinics. The emergency service must encompass rapid coun-selling and treatment; the long-term service must offer tissue/gamete storage and arT.
Currently only around 30% of on-cologists routinely refer patients of child-bearing potential for reproduc-tive counselling. But the need for cli-nicians to provide adequate fertility preservation to people with cancer is likely to rise considerably over the coming years.
the paris conferenceThese emerging issues have prompted us to or-ganize the inaugural international conference on fertility preservation. This one-day event is suitable for oncologists and specialists in reproductive endocrinology or fertility care. Lectures and discussions aim to stimulate future improvements in research and clinical practice. Topics to be covered include:• Chemotherapy-induced loss of follicles,• Cancer and testicular function• Impact of radiotherapy on gonadal function• Fertility in cancer survivors• Fertility preservation strategies• Medical treatments for gonadal damage• ovarian stimulation in cancer patients• ovarian tissue transplantation and
cryopreservation
Fertility preservation is not a magic situation; it is not one where oncologists or reproductive endocrinologists can over-promise success to their patients. However, it is very important that we now develop and test techniques that offer greater hope to people, so that their life after cancer treatment can routinely include the right to have a family. please join us in paris, this December, to take these early steps forward in fertility preservation for people with cancer.
As more patients survive cancer,
preserving their right to have children will become
an expectation of treatment and a standard aspect of clinical practice
best practices in cancer treatment, emerging data on
cryopreservation, tissue transplantation
and gonadal stimulation strategies,
will be presented at the Paris conference
EXCEMED, in partnership with ALPHA (Scientists in Reproductive Medicine) is organizing a pioneering conference at which oncologists and specialists in reproductive endocrinology will discuss strategies for supporting fertility in people with cancer. The meeting takes place on 3 December 2014 in Paris, France
GoT A CoMMEnT oR quEsTIons? E-MAIl [email protected]
12 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014
www.excemed.orgit’s active in here
IMPRoVInG THE PATIEnT’s lIFE THRouGH
MEDICAl EDuCATIon
EXCEMED at your fingertips> six specialty micro sites, including reproductive
medicine> Accessible and accredited e-learning packages> A world-class repository of CME knowledge and
learning materials > Monthly updates about our events and resources
in reproductive medicine> Register with us online and access it all – free
better outcomes for patients start here. with over 40 years of experience, EXCEMED has been delivering continuing medical education (CME) longer than any other provider.