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European Society of Human Reproduction and Embryology

COURSE 10

Joint ASRM / ESHRE Pre-congress Course

Recent advances in reproductive medicine

18 June 2006 Prague - Czech Republic

Contents
Program Submitted contributions Physiology of habitual abortion – N. Macklon (NL) Habitual abortions – pathophysiology & diagnosis – J.S. Sanfilippo (USA) Role of uterine reconstruction inrecurrent pregnancy loss – J. S. Sanfilippo (USA) Ovarian reserve testing in IVF: A systematic review – C.B.N. Lambalk (NL) Advanced maternal age: Is it feasible? – S. Ory (USA) Overview of clinical application of PGD – P. Braude (UK) PGD – Aneuploidy screening: What is the evidence – S.J. Ory (USA) page 3 page 8 page 2

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page 48 page 65 page 75 page 80

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Course 10 - Joint ASRM /ESHRE pre-congress course “Difficult problems in infertility: recurrent spontaneous abortions and advanced maternal age” Coordinators: J.S. Sanfilippo (USA) and B.C. Tarlatzis (GR) 09:00 - 09:30 Physiology of early pregnancy loss - N. Macklon (NL) 09:30 - 09:45 Discussion 09:45 - 10:15 Recurrent spontaneous abortions – pathophysiology and diagnosis J. S. Sanfilippo (USA) 10:15 - 10:30 Discussion10:30 - 11:00 Coffee Break 11:00 - 11:30 Role of uterine reconstruction in recurrent pregnancy loss J.S. Sanfilippo (USA) 11:30 - 11:45 Discussion 11:45 - 12:15 Uterine surgery in failed IVF - M. Camus (B) 12:15 - 12:30 Discussion 12:30 - 13:30 Lunch break 13:30 - 14:00 Assessment of ovarian reserve - C. Lambalk (NL) 14:00 - 14:15 Discussion 14:15 - 14:45 Advanced maternal age: is it feasible? - S.Ory (USA) 14:45 - 15:00 Discussion 15:00 - 15:30 Coffee break 15:30 - 16:00 Overview of clinical application of preimplantation genetic diagnosis P. Braude (UK) 16:00 - 16:15 Discussion 16:15 - 16:45 Preimplantation genetic diagnosis – Aneuploidy Sceening: What is the evidence? - S. Ory (USA) 16:45 - 17:00 Discussion 17:00 - 18:00 SIG Reproductive Endocrinology Business Meeting

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Thephysiology of habitual abortion N.S. Macklon Professor, Department of Reproductive Medicine, University Medical Centre, Utrecht The Netherlands

Learning Objectives At the end of this lecture, the participant should be able to 1. Discuss the definitions and incidence of pre-clinical pregnancy loss 2. List the value and limitations of urinary hCG measurements as a marker of early pregnancy loss. 3.Summarize the evidence supporting the embryo as the major cause of early pregnancy loss. 4. Discuss the importance of early pregnancy loss as a determinant of fertility, and of IVF outcome. 5. Understand the limited effects of medical interventions thus far demonstrated in the treatment of early pregnancy loss

Lecture Summary Even when circumstances for conception are deemed optimal, the maximalchance of conceiving a clinically recognized pregnancy in one cycle is around 30%, rising to 40% in young women undergoing timed insemination with sperm from donors of proven fertility (Macklon et al, 2002). Pregnancies may be lost at any time between fertilization and implantation, or up to term. A proportion of these losses are clinically revealed as miscarriages. However, it has become clearthat a large number of the conceptions fail before the woman becomes aware that she might have been pregnant. These early pregnancy losses, sometimes termed ‘occult’ pregnancies, have been defined as pregnancies that terminate so soon after implantation that no clinical suspicion exists as to its having existed. The introduction of sensitive assays for hCG and the possibility provided by in-vitrofertilization (IVF) to observe the events from ovulation to on-going pregnancy has enabled the previously elusive ‘black box’ of early pregnancy to be investigated (Macklon et al, 2002). With new techniques in cytogenetics, our understanding of the natural limits of human fecundity and of the natural phenomenon of ‘habitual’ pregnancy loss has increased. Study of this phenomenon is aided by the...