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Human Reproduction Update Advance Access originally published online on April 20, 2009
Human Reproduction Update 2009 15(4):391-408; doi:10.1093/humupd/dmp012
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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Approaches to improve the diagnosis and management of infertility

P. Devroey1,4, B.C.J.M. Fauser2, K. Diedrich3 and on behalf of the Evian Annual Reproduction (EVAR) Workshop Group 2008{dagger}

1 Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium 2 Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 3 Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany

4 Correspondence address. Tel: +32-2-477-66-60; Fax: +32-2-477-66; E-mail: paul.devroey{at}uzbrussel.be

BACKGROUND: Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26–27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts.

METHODS: Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge.

RESULTS: It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches.

CONCLUSIONS: Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.

Key words: infertility work-up / in vitro fertilization / ovarian response / predictive factors / single embryo transfer

{dagger} The Third Evian Annual Reproduction (EVAR) Workshop Meeting (26–27 April 2008) was organized to discuss personalized approaches to the diagnosis and management of infertility and was supported by an unrestricted educational grant from Merck Serono S.A.—Geneva. The content of this manuscript is based on the presentations and discussions of the EVAR Workshop Meeting. The meeting was chaired by P.D. (Free University Brussels, Brussels, Belgium), K.D. (University Clinic of Schleswig-Holstein, Luebeck, Germany) and B.C.J.M.F. (University Medical Center, Utrecht, The Netherlands). The speakers included Carlo Alviggi (Università degli Studi di Napoli Federico II, Naples, Italy), Esther Baart (University Medical Center, Utrecht, The Netherlands), Christopher Barrat (Ninewells Hospital, Dundee, UK), Christina Bergh (Sahlgrenska University Hospital, Gothenburg, Sweden), Frank Broekmans (University Medical Center, Utrecht, The Netherlands), Johannes L.H. Evers (Maastricht University Medical Center, Maastricht, The Netherlands), Georg Griesinger (University Clinic of Schleswig-Holstein, Luebeck, Germany), Stephen Keay (University of Warwick, Coventry, UK), François Olivennes (ART unit Eylau La Muette, Paris, France), Gamal Serour (Al-Azhar University, Cairo, Egypt), Catherine Staessen (Vrije Universiteit, Brussels, Belgium), Arne Sunde (St Olav's University Hospital in Trondheim, Norway), Christos Venetis (Aristotle University of Thessaloniki, Greece) and Hakan Yarali (Hacettepe University, Ankara, Turkey). Colin M. Howles (Merck Serono S.A.—Geneva) and Julian Jenkins (previously of Merck Serono S.A.—Geneva) were in attendance.

Received on November 5, 2008; revised February 19, 2009; accepted on March 18, 2009


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