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The 13th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI) Held jointly with The German Society of Obstetrics & Gynecology
Maritim Hotel, Berlin, Germany, November 4-7, 2010 |
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| Infertility & ART |
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Thursday, November 4, 2010
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| 17:30-19:00 |
Opening Session |
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Keynote Lectures - Leaders' prospective on the future Technology-based advances in obstetrics, gynecology and infertility facilitates earlier, less-invasive diagnosis: What does the future hold for our main subdisciplines? |
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Fetomaternal Medicine Genetic diagnosis on fetal cells in maternal blood: Will it ever become routine? |
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Gyn-Oncology Ovarian Cancer: Can new markers change the fate of the disease? |
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Reproductive Medicine
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| 19:00-20:30 |
Opening Cocktails |
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Friday - Sunday, November 5-7, 2010 |
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Session 1 |
The End of Preimplantation Genetic Screening (PGS) or Only the Beginning? |
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Capsule |
Preimplantation genetic diagnosis (PGD) was initially introduced to identify single gene defects, but evolved under the acronym “PGS” (preimplantation genetic screening) into a tool to detect embryo aneuploidy. The proposed goal was to improve pregnancy rates in IVF, and reduce spontaneous abortion rates, but so far studies have failed to prove the concept. The question now is whether we should declare that the introduction of PGS for these indications is one of the major ART-related failures, and discontinue the practice completely, or should we keep refining the technique, using newer technologies such as comparative genomic hybridization (CGH), and later embryo diagnosis via trophectoderm biopsy. |
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Debate: PGS is an Experimental Tool that Should be Banned from Routine Clinical Use!
Proposition: PGS, as currently practiced, is associated with inferior results and should not be routinely offered
Opposition: The beneficial effects of preimplantation genetic diagnosis for aneuploidy support extensive clinical applications
Discussion |
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Polar body array CGH prediction of embryo ploidy: Is this the future of IVF? |
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Objectives |
Upon completion of this debate, the audience will learn: |
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* The hypothesis that makes PGS an attractive proposition * Reasons why PGS, as performed, failed to meet expectations * New technologies and techniques, which, potentially, may positively affect PGS results * What the IVF field, in general, can learn from the PGS experience * Learn about CGH and its role in future PGS |
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Session 2 |
Assessment and Treatment of Ovarian Reserve |
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Capsule |
Diminished ovarian reserve (DOR) remains a common, frustrating and underdiagnosed condition. Lack of criteria for diagnosis makes it difficult to assess and compare prevalence of diagnosis and results of treatments. Indeed, questions have been raised as to whether DOR even lends itself to treatment and, if so, whether treatment regimen results differ |
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Accurate diagnosis of diminished ovarian reserve (DOR): Age-specific? |
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Debate: Has anti-Müllerian Hormone (AMH) become Essential in Assessing Ovarian Reserve?
Yes / No
Discussion |
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Debate: Can Diminished Ovarian Reserve be Treated Effectively?
Yes / No
Discussion | |
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Objectives |
Upon completion of these debates, the audience will have learned the following: |
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* How DOR is defined in the literature * Why age-specific ovarian reserve determination improves sensitivity of diagnosis of DOR * What the best methodologies for diagnosing DOR * Whether DOR lends itself to treatment |
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Session 3 |
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Round Table Discussion |
Experts’ opinions and audience interaction on hot controversial topics in ART: |
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Should we resect a uterine septum before starting IVF
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Which fibroids should be removed before starting IVF
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Should endometrioma be excised before ART
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Cheaper IVF: How can this be achieved?
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Should tests of ovarian reserve be routinely performed?
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Should day 3 FSH be stopped because of its poor prognostic properties
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Should we go back to purified urinary FSH for IVF, since pregnancy rates are similar to or better than rFSH?
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Should PGD be routine in recurrent miscarriages?
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IVF in endometriosis: Regular or extended (3-month) down regulation
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Acupuncture for IVF is over-rated: Is this seen merely as a placebo effect?
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How can ET be improved?
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Assisted zona hatching: Should it be continued?
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Progesterone in IVF: PO? PV? IM? |
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Session 4 |
Endometriosis During Reproductive Years |
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Capsule |
Poor correlation between clinical stages of endometriosis and symptoms, pain and infertility, makes it difficult to assess the results of therapy. The limited understanding of the pathophysiology of this enigmatic condition creates a real need to frequently scrutinize the working theory and to tailor the treatment to the patient’s needs |
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Debate: Which Treatment Offers Longstanding Remission for Chronic Pelvic Pain in Young Women with Endometriosis?
Proposition: Surgery with preservation of fertility is the treatment of choice
Opposition: Medical treatment can preserve fertility without the burden of surgery
Discussion |
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Estroprogestin or progestin: Which is the best hormonal treatment for endometriosis? |
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How to reduce postsurgical adhesion in endometriosis
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Objectives |
Upon completion of this session, the audience will have acquired knowledge about the following: |
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* Correlation between stages of infertility and endometriosis
* How and when to choose between available treatments * Reasons, risks and prevention of surgically-induced adhesion * Steroid treatment: Which and when |
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Session 5 |
In Vitro Maturation (IVM) |
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Capsule |
IVM is becoming more effective: Benefits, risk and pitfalls of the procedure |
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Debate: Will IVM Ever Replace Standard IVF?
Yes: Results of IVM are comparable to standard IVF with or without stimulation
No: IVM does not offer any advantage over current IVF practice Discussion |
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What are the optimal preparation and aspiration techniques? |
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IVM as an alternative for poor and over responders, PCO, frozen immature eggs |
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Objectives |
Upon completion of this session, the audience will have acquired: |
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* Understanding of the place of IVM in comparison to IVF * Understanding of the laboratory procedures * Understanding the best preparation and aspiration procedures * Special indications for IVM |
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Session 6 |
Preservation of Fertility |
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Capsule |
Freezing and Transplantation of ovarian and testicular tissue is encouraging, however it is essential to improve survival rate and preserve full functionality! |
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Counter-views / Debate: Preservation of Fertility: What can we Offer?
• Autotransplantation of fresh or frozen human ovarian tissue? • Freezing a whole ovary cortex or others? Discussion |
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Multipotent adult germ line stem cells: New therapeutic hope?
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Session 7 |
Laboratory Techniques |
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Capsule |
How to improve laboratory efficiency in order to avoid mistakes in an IVF laboratory
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Round Table Discussion |
Laboratory experts’ opinions and audience interaction on basic aspects of laboratory work in ART: |
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How to avoid mistakes in an IVF laboratory
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Electronic witnessing: Pros, cons, bar coding and RFIDs
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Oocytes and embryo markers of viability
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Simplified-IVF approaches: Are they evidence-based?
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Selecting the best embryos: Genomics, proteomics and time-laps?
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Vitrification vs slow freezing
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Vitrification: Has it killed the need for expensive freezing machines?
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Vitrification: Heralded the era of successful egg freezing for medical therapy and social liberation
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Oocytes freezing: Are babies born healthy? |
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Objectives |
Upon completion of this session, the audience will acquire: |
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* Strategies for minimizing risk, especially that of mixed-up gametes and ET * Strategies for robust, reliable, informative and objective markers of oocyte and embryo viability * Strategies for optimizing cost-effective cryopreservation of oocytes and embryos |
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Session 8 |
New Cryotechnologies for Gametes, Ovarian Tissue and Stem Cells |
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Capsule |
The optimum method for cryopreserving oocytes and ovarian tissue is yet to be decided, exploring new cryopreservation technologies can diversify the choice and enhance clinical efficiency |
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Debate: What are the Best Methods for the Cryopreservation of Human Oocytes?
- Human oocytes cryopreservation: The slow freezing technique
- Human oocyte cryopreservation: Vitrification of oocytes
Discussion |
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Vitrification of blastocysts: This is the way to go! |
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Freeze/drying of spermatozoa or stem cells: What are the advantages and pitfalls? |
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Session 9 |
ICSI-Treatment or Over-Treatment? |
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Capsule |
Capsule ICSI is an important, but invasive technology that enhances fertilization in certain indications, and arguably creates more embryos and minimizes the risk of total failed fertilizations. However, some clinics now use ICSI as the only insemination technique for all cases of IVF. To support such technology as a replacement for conventional in vitro insemination, we must explore concerns about safety and cost-effectiveness of such practice? Should the application of an invasive insemination procedure be undertaken unless indicated and its safety proven beyond doubt; and by what criterion should that conclusion be drawn? |
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Debate: Should ICSI Replace Conventional Insemination in all Cases of IVF?
Pros: ICSI is efficacious and safe, and ought to replace in vitro insemination for IVF
Cons: ICSI should be performed by indication only
Discussion |
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Removal of polar bodies, blastomeres and trophoblast is becoming more common-place: Does the method of zona breaching matter? |
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Objectives |
Upon completion of this debate, the audience will have learn: |
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* To understand the role of ICSI in all cases of IVF when male factor is excluded * To evaluate the risk involved in ICSI procedure * To assess the value of ICSI to all patients seeking IVF treatment * To evaluate the effects on offspring of fertilizing oocytes with compromised sperm compared with apparently normal sperm * To understand why some clinics have made the decision to move to ICSI for all patients seeking IVF * Learn about the concerns related to Zona breaching |
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Session 10 |
Polycystic Ovarian Syndrome (PCOS) |
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Capsule |
PCOS is a risk factor for insulin resistance: Are all PCOS patients at risk? |
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Debate: Treating Anovulatory PCOS Patients: What should be the First Choice?
Ovulation induction Ovarian drilling IVM
Discussion |
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What proofs do we, or do we not have for the long-term risks of PCOS women? |
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Objectives |
To acquire knowledge about the following: |
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* The most effective primary treatment for PCOS * Advantages and limitations of treatment options * Long term risks of PCOS |
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Session 11 |
Mild Stimulation for IVF |
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Capsule |
Proponents of mild IVF claim that this is the way for ART especially in an era of single embryo transfer. IVM technology is the real "Mild" alternative. Can we agree on what the future holds? |
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Organized and supported by The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) |
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Debate: Mild IVF or IVM What Direction should We Take?
Proposition: Mild IVF is the way to go
Opposition: IVM is the alternative to IVF
Discussion |
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Which patient can benefit from Natural/modified natural cycle IVF? |
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Objectives |
To acquire knowledge about the following: |
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* What is “mild” stimulation and what are its advantages and disadvantages * Which patients are the most likely candidates for such stimulation * Arguments in favor of and against IVM without stimulation |
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Session 12 |
Regulation and Payments for Egg Donors |
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Capsule |
Regulation can be as constraining as it is hoped to be supportive in the provision of an ‘ethical’ framework. Without regulation of any kind, bad practice can escalate and become the norm. With regulation, excessive strictures can reduce, or even inhibit some patients’ opportunities, whilst compelling others to travel abroad for treatment – often to countries without rules. Among the many known instances is also the example of egg donations. Limitations on payment in some countries, combined with donors being identifiable, have also resulted in many recipients traveling annually to other countries. Can a balance be found to encourage a sufficient supply of donated eggs so that donors and recipients can be treated closer to home in a safe, regulated environment? |
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Strict regulation limits patient choice, as well as results of treatment! |
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Debate: Should Egg Donors Receive Payment or Only a Modest Sum with Receipts for Necessary Expenses?
Pros: Egg donation should be an act of altruism, such that only modest, receipted expenses are paid, in line with current regulations in some countries, irrespective of the effects on supply Cons: Egg donors should comply with the "free market" rule, or at the very least, have an acceptable upper limit
Discussion |
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Objectives |
To acquire knowledge regarding the following: |
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* Current situation in several different countries, with contrasting regulations * The debate on funding egg donors * Understanding the ethical dimension, such that there are different dimensions packaged as ‘ethics’ * The real problems faced by recipients * The importance of egg donation as a treatment option * Limitations on free choice of patients and physicians by current regulation |
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