09:00 - 09:30
Adjuvant therapy in IVF What evidence?
Dr. Majeed Al Oum, UAE
09:30 - 10:00
Benefits for the couple from Andrological assessment of the husband.
Dr. Abdulaziz Baazeem, Jeddah, KSA
A male factor component to infertility is found in over 50% of affected couples. Yet the focus, and subsequently the burden of treatment, is often set on the female partner. We aim to outline some of the potential risks that can be associated with such an approach, as well as the benefits of performing an adequate assessment of the male partner by a qualified specialist.
10:00 - 10:30
From Stem Cells to Gametes is in-vitro Gametogenesis possible.
Prof. Björn Heindryckx, Belgium
For both men and women experiencing infertility, current treatment options rely on the premise that both partners produce functional haploid gametes. The primary need for stem cell-derived (SCD) gametes originates from the desire of sterile individuals to have their own genetic offspring if they cannot be helped by the currently available methods of assisted reproductive technology. These patients lack functional oocytes or sperm to reproduce and can currently only be helped by gamete donation. Pluripotent stem cells (PSC) have been shown to give rise to most of the cell types of an individual, including differentiation potential towards gametes. In order to produce gametes for patients, the PSC should genetically match the infertile person. Hence PSCs have to be developed through somatic cell nuclear transfer (SCNT) or induced pluripotent stem cells (iPSC). While iPSC production has already been established well for a long time in human, the process of SCNT has now become successful in human, with the derivation of several embryonic stem cell lines from human SCNT embryos.
Furthermore, it has become clear that PSCs may exist in different states of pluripotency, being the naive and primed pluripotent state, that differ, amongst others, in their differentiation potential towards germ cells, as shown in mice. The greatest success thus far to produce SCD gametes in mice has been achieved using naive PSCs as starting population; therefore naive human PSCs should be established. Several groups have now succeeded in the establishment of naive human PSC, and recent evidence demonstrated that these cells have the potential to differentiate efficiently towards primordial germ cells in human.
Finally, differentiation protocols have to be optimised to further differentiate primordial germ cells towards functional and mature oocytes or sperm. Remarkably, functional SCD gametes have been produced successfully in mouse, completely in vitro, resulting in life offspring, albeit to a lower efficiency compared to in vivo produced gametes. In human, primordial germ cells can be produced from PSC, still, the last step to produce functional oocytes or sperm, remains to be established. It will be important to assess the (epi-)genetic normality in depth of the SCD gametes and test the functionality of these cells before any clinical application should be considered in human.
10:30 - 11:00
Failed fertilization or Embryonic development after ICSI: Diagnosis & Treatment.
Prof. Björn Heindryckx, Belgium
Failed fertilization after intracytoplasmic sperm injection (ICSI) still occurs in up to 5% of all the cycles. The main cause of fertilization failure after ICSI is an oocyte activation deficiency. Oocyte activation is characterized by a series of intracellular calcium (Ca2+) rises released from the inositol trisphosphate receptor (IP3R) present in the oocyte, and triggered by the sperm-related factor phospholipase C zeta (PLCz). Hence, both the sperm and the oocyte play crucial roles in the start of oocyte activation; deficiencies in them can lead to failed fertilization after ICSI. To distinct a sperm- from an oocyte-related factor, heterologous ICSI of human sperm into mouse oocytes is proposed to determine the activation potential of sperm. Given the higher activation potential of human PLCz compared to mouse PLCz, this test might not be sensitive enough to reveal more subtle abnormalities in PLCz. Therefore, assessment of the precise Ca2+ pattern caused by the sperm could be of added value to reveal more accurately the cause of failed or low fertilization after ICSI. Our recent evidence shows that determining the precise Ca2+ pattern caused by the sperm in mouse or human oocytes is beneficial to reveal the cause of fertilization failure. Also genetic screening of the PLCz gene can provide new information, and more and more mutations are reported. The application of Assisted Oocyte Activation (AOA) during ICSI is mostly able to overcome fertilization failure and can result in successful pregnancies at a high efficiency rate. Still, the success of AOA is largely dependent on the specific method that is used. Interestingly, a correct series of Ca2+ oscillations has been also correlated with later stages of such as embryonic developmental potential and even post-implantation events in animal models. The first cleavages are almost exclusively oocyte-driven, depending on mRNAs and proteins already present in the oocyte. Hence, early embryonic developmental arrest, could be resolved by changing the inferior oocyte cytoplasm by a donor cytoplasm, a technique called Nuclear Transfer. It remains to be elucidated for which infertility indications this Nuclear Transfer technology could be beneficial.
11:00 - 11:30
Novelties in LPS in fresh and frozen embryo transfer cycles.
Dr. Nicolaos P. Polyzos, Spain
Progesterone supplementation is an essential part of assisted reproduction owing to the luteal phase defect observed either following ovarian stimulation for IVF/ICSI or in artificially prepared frozen embryo transfer cycles. Over the last decades different routes of progesterone administration have been utilized with differences in local and systemic absorption, pharmacokinetics and side effects. The scope of the current presentation is to present the novelties in the Luteal phase Support strategies in modern ART, the effect of progesterone formulations in fresh and frozen embryo transfer cycles and the new treatment strategies aiming towards and individualized Luteal phase support iLPS based on the measurement of serum progesterone levels.
13:00 - 13:30
How to prepare endometrium for FET Cycle.
Dr. Hakan Yarali, Turkey
Despite the worldwide trend of performing more frozen embryo transfer (FET) cycles, the search for the best protocol to obtain the most receptive endometrium is still ongoing. Natural cycle (NC), either true NC or modified NC and hormonal replacement treatment (HRT) are the two most commonly used protocols to prepare and prime the endometrium prior to FET. Less commonly mild stimulation with letrozole, clomiphene citrate or exogenous gonadotropins is used. In NC or modified NC protocol, luteal phase support may or may not be employed. In this lecture, FET preparation protocols as well as the available comparative data will be presented. Due to the recent emerging data of increased pregnancy induced hypertension cases associated with the use of HRT, one can predict that more and more NC/m-NC will be performed in the future.
Personalized medicine is required to maximize efficacy and safety and minimize treatment burden, and preparation of endometrium for FET is, obviously, not an exception. An optimal exposure of the endometrium to progesterone (P4) in terms of timing and concentration, is of crucial importance to maximize the reproductive outcome in a FET cycle using either the NC or HRT. The serum P4 level which has been shown to be impacted by the route of administration, is still the best proxy for the endometrial P4 level. Until recently, serum P4 was not monitored in HRT cycles, assuming that ‘one size fits all’. Importantly, there seems to be marked inter-personal differences in circulating P4 levels, following the same dose and route of P4 administration in an HRT cycle resulting in differences in reproductive outcomes after transfer of high-quality embryos. Until now, to our knowledge, the impact of circulating serum P4 levels on reproductive outcomes in HRT cycles has been reported in a total of 11 studies, including our recent study. Although these studies were heterogenous in population, route, type and dose of P4 administration, stage of embryo transfer, and the day of serum P4 measurement higher reproductive outcomes were reported when the serum P4 level was above a threshold, ranging from 8.75 to 22.00 ng/ml. In line with these studies, we recently reported that in patients treated with vaginal P gel twice daily (bid), the ongoing pregnancy rate was significantly lower, if their serum P4 level on the warmed blastocyst transfer day was lower than 8.75 ng/ml. A recent study also reported that marked inter-personal difference in serum P4 may exist in NC affecting reproductive outcome. Our very recent data on rescuing FET-HRT cycles (frozen-warmed blastocyst transfer), if the serum P4 level is lower than 8.75ng/ml one day prior to the scheduled embryo transfer (6th day of P4 administration), with additional supplementation with a 25mg s.c. daily P4 dose will be presented. Finally, the paucity of data on timing of FET will be discussed.
13:30 - 14:00
Artificial intelligence and embryo selection.
Mrs. Mayyas Jaweesh, Riyadh, KSA
Since the start of IVF, the assisted reproductive technologies (ARTs) have been accompanied by lots of innovations, for example, intracytoplasmic sperm injection (ICSI), time-lapse monitoring of embryos, and PGS. All those are innovative techniques that increased the success of the ART.
In the same trend choosing the best embryos to be transferred to the patient was always debated and is completely decided by the skilled embryologists working in the IVF Lab along with the opinion of the IVF doctors. This process is subjective and can widely vary between different embryologist according to their skills and experience.
In order to be efficient in decision making the need arises to use computers to make the best choice, and this could be done by the stability of making subjective decisions using a standardised method based on experience.
Everyday in the IVF Lab we read the development of the embryos as a routine part of our job and indeed this is the challenge. This routine method can not give us an accurate result on which embryo should be transferred and which one will give a positive pregnancy test, and this is the limitation of the visual assessment.
Recently, the use of artificial intelligence (AI) techniques is being widely researched whether for embryo or sperm selection. The use of AI within infertility clinics is not yet a reality and this is largely due to the different techniques that been suggested to be used in the daily routine work of the IVF laboratories, which causes some uncertainty in their use.
The advantages of using this technique is decreasing the embryos time outside the incubator especially for clinics who do not have embryos-cope. second to avoid any circumstances the embryologist might be going through and could affect their work efficiency.
The application of AI in IVF will be significant, especially in embryo evaluation and selection, assessment of ovarian reserve parameters and sperm selection.
Should we treat Endometriosis before IVF Cycle?
14:00 - 14:30
Dr. Tarek Baghdady, Riyadh, KSA
14:30 - 15:00
Dr. Majed Hodhod, Riyadh, KSA