Often discussed clinical topics at Helsinki

Among the topics discussed most during this year’s ESHRE meeting was endometrial scratching. Whereas a Cochrane review of 2012 advised “not to perform endometrial injury on the day of oocyte retrieval because it appears to significantly reduce clinical and ongoing pregnancy rates”, a second Cochrane review has evaluated endometrial scratch in IUI. According to this analysis, it appeared to increase the chance of pregnancy and live birth significantly.
Another issue of major interest was Preimplantation Genetic Screening (PGS). Next generation sequencing presents an accurate genomic approach but about 30 % of chromosomally normal embryos (according to this method) fail to implant after transfer. A novel approach to embryo assessment based on the quantification of mitochondrial DNA found in the trophectoderm cells of a blastocyst in combination with aneuploidy screening seems to offer major advances. With this method, Dr Fragouli was able to demonstrate that embryos with elevated levels of mitochondrial DNA rarely implant.
Use of the freeze-all protocol was another topic of discussion. Whereas it is already often applied for OHSS rescue and prevention, a novel study presented during ESHRE analysed data from 12 centres and more than 16,000 treatment cycles in the USA, suggesting that freeze-all protocols are associated with significantly improved IVF outcomes for most patients, and especially for mature women over 35.
The reasoning for freeze-all as a routine protocol in IVF is based on the concern that ovarian stimulation has a detrimental effect on endometrial receptivity, and on the hope that transfer in a subsequent natural cycle may be more efficient. Final confirmation however, can only come from large randomized controlled trials, two of which are ongoing (one under the direction of the UK’s National Institute for Health Research and due to report in 2020, and a Dutch multicentre trial under the direction of the Netherlands Organisation for Health research and Development and due to complete in 2019).
References:
1. Nastri CO, Gibreel A, Raine-Fenning N, et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database Syst Rev. 2012; 7: CD009517.
2. Poster P-287, Endometrial scratching for pregnancy following sexual intercourse or intrauterine insemination (IUI): a Cochrane systematic review and meta-analysis.
3. Presentation O-059, Monday 4 July 2016, 16.15
Clinical implications of mitochondrial DNA quantification on pregnancy outcomes: a blinded prospective non-selection study
4.Presentation O-239, Wednesday 6 July 2016, 11.30
Multi-center study demonstrates freeze-all IVF protocols are correlated with higher ongoing pregnancy rates in women of advanced maternal age
5. Presentation o-123, Tuesday 5 July 2016, 10.00 Fewer live-births with repeated single embryo transfer as compared to initial double embryo transfer; time to question the efficacy of embryo cryopreservation?