EXCEMED Reproductive Medicine Extracts, Spring-Summer 2014

ImprovIng the patIent’s lIfe through

medIcal educatIon

HIGHLIGHTS on EXCEMED aCTIvITIES In reproductive medicine

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annual conference outcomesspotlight on Implantation: opening the black box

Workshop outcomesearly evaluation of fetal echocardiography

future focusfertility preservation following cancer: an emerging challenge

upcomIng In eXcemed reproductIve medIcIneeducational activities on the horizon

Your eXcemedeXcemed: improving reproductive medicine through medical education

Continuing medical education is our sole focus and our passion. we pour our energy and expertise into delivering the best for healthcare professionals, with patients as the ultimate beneficiaries. This is CME excellence. our educational programmes in reproductive medicine are designed to suit the needs of physicians, scientists and biologists from all over the world who want to be at the cutting edge of research and patient care.

EXCEMED

spotlight on “Implantation: opening the black box”

almost 400 clinicians, biologists and researchers working in fertility medicine and arT attended the 2014 CME-accredited annual Meeting in reproductive Medicine. organised by EXCEMED, the meeting took place on 23-24 May, in Budapest, Hungary.

This international conference is held annually and has become a key event for professionals working in arT, from all over the world.

presentations focused on the following important subjects relating to human embryo implantation:• Key biological aspects of human embryo

implantation• State-of-the-art techniques to maximise

implantation• Evidence-based recommendations to achieve

the best outcomes from arTpresentations provided excellent opportunities for the participants to expand their knowledge of many aspects of arT.

This publication highlights key presentations at the meeting, and provides an update on recent and forthcoming activities in reproductive medicine that are being developed by EXCEMED •

Annual Meeting on reproductive

medicine focused on implantation,

especially RIF

Excellent presentations on human embryo implantation

23-24 MAy BuDapEST, HunGary

http://www.excemed.org

2 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 Abbreviations are defined in the Glossary, page 6

Improving implantation in ART by endometrial injury/scratching


Clinical evidence is emerging – including data from RCTs and Cochrane reviews – indicating that endometrial injury/scratching has a place in IVF. However, more research and better-quality evidence is required before endometrial injury can be considered as a standard practice.

Immune- or stem-cell populations may be activated at the time of injury and this may support improved receptivity in the next cycle. However, there is also biological im-plausibility. For example, the injury is su-perficial (affecting only the functionalis layer), therefore tissue at the site of dam-age is expected to be lost at menstruation, explained Dr aplin. It may be that endome-trial injury promotes a beneficial inflam-matory process where cellular memory and signalling improve over long distanc-es, within tissues. In a debate at the meeting, Dr raine-Fenning argued in favour of scratching and Dr Khalaf presented the case for caution. at the end of the debate, a large majority of participants voted in favour of scratching •

FroM LEFT

dr nick raine-fenning(university of nottingham, uK) described endometrial injury as a well-tolerated, affordable procedure dr John aplin (university of Manchester, uK) outlined the physiological cascade of events that occur after endometrial injurydr Yacoub khalaf (King’s College London, uK) called for further research in endometrial injury

There is no evidence regarding effect of

endometrial injury on adverse events, such as

pain and bleeding

Endometrial injury appears to promote a

beneficial inflammatory environment for

implantation

Certainly, endometrial injury (scratching) results in a cascade of events that may im-prove implantation rates, but physical and clinical evidence remains mixed. There is biological plausibility in the theory of en-dometrial scratching. Dr aplin showed how local injury to the endometrium caus-es a range of events (Figure 1), together with changes in gene-expression patterns.

figure 1: injuries to epithelial tissue surfaces, such as the endometrium, are generally associated with the features listed

• platelet deposition; clot formation• tissue-specific inflammatory infiltrate• epithelial repair (epiboly)• Influx of myofibroblasts• matrix deposition• Wound closure• local remodelling• minimal fibrosis;

no scarring in mucosal tissues

rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 3GoT A CoMMEnT oR quEsTIons? E-MAIl [email protected]

The endometrium: a biosensor for implantation

Research is revealing the events that surround peri-implantation. These advances in our understanding may help to improve IVF success rates. Equally, they may give us a clearer picture of the normal physiological mechanisms that govern implantation.

It is important to ensure the safety of the mother by not increasing the implantation rate when this means that potentially ab-normal embryos might implant. Dr Macklon suggested that the new ques-tion to pose is not how we can improve im-plantation in all cases, but whether this is something we should be doing.

dr nick macklon (university of Southampton, uK) explained how research is opening the black box of early, preclinical pregnancy losses in humans


implantation failures are commonnormal human reproduction is character-ized by a high rate of embryo loss, either before or just after implantation. Chromosomal abnormalities may be evident in the majority of embryos, there-fore it is unsurprising that implantation failures are common. The endometrium (decidualising endo-metrial stromal cells in particular) acts as a biosensor, preventing the implantation of abnormal embryos (Figure 2): • High-quality embryos actively signal to

induce expression of supportive endo-metrial factors

• Low-quality embryos trigger a cellular stress response, thus leading to im-plantation failure

• This mechanism safeguards the moth-er, preventing the uterus from pro-longed investment in embryos that are likely to be abnormal.

new areas of researchStudying the physiological signals within the endometrium represents a new area for research and development. By understanding the events better, we may have a clearer understanding as to why live birth rates per embryo transfer after IvF remain at relatively static levels, despite improvements in other aspects of arM. Future avenues for research should be to confirm whether reduced embryo selec-tivity (i.e. failure to discriminate between high- and low-quality embryos) is a key reason for recurrent miscarriage. The implications of this, and the devel-opment of interventions that normalize the decidual phenotype, should be a focus of clinical and research attention •

Knowledge of implantation physiology is relevant to

assisted reproduction and natural conception

figure 2: natural selection of embryos. Decidualising endometrial stromal cells serve as sensors on quality of implantation.


Evidence needed for adjuvant therapy use in ART


There is an urgent need for clinical trials to determine definitively whether adjuvant and complementary therapies offer benefit to people undergoing ART. until then, clinicians have a duty to be honest with patients and to not advocate therapies that have no evidence of any benefit.

advocating the use of adjuvant or comple-mentary treatments for people with rIF may have biological plausibility but does not have current evidence of efficacy. Dr Cheong asked clinicians to be honest with patients regarding the limits of reproduc-tive science, and adopt a supportive role rather than suggest non-evidence-based interventions in more difficult cases.

a supportive approach could focus on the following:• optimizing modifiable lifestyle factors

(such as diet, exercise, smoking, alcohol consumption)

• addressing contributory surgical factors (such as uterine, tubal, ovarian pathologies and anomalies)

• assessing the difficulties in embryo transfer in previous treatment cycles

• re-evaluating the patient’s history and investigations

presently, explained Dr Cheong, there is no robust evidence for many of the im-munological therapies that are emerging. Further trials are needed, for example, to confirm whether administering glucocor-ticoids during the peri-implantation phase of arT has any significant benefit on clini-cal outcome. The same is also true for IvIG, TnF-inhibitors and intralipid therapy. Indeed, intralipid therapy is associated with a high rate of allergic reactions, thrombocytope-nia and hypercoagulability, and is therefore not recommended, Dr Cheong explained •

dr Ying cheong (university of Southampton, uK) urged clinicians to recommend only evidence-based treatments for couples undergoing arT

Current and emerging technologies for genetic testing (antonio capalbo, Italy)• Several methods are available

for accurate 24-chromosome aneuploidy screening with different capabilities and limitations

• Despite providing higher-resolution results, microarray based CCS me-thods are labour-intensive, costly, and have a long turnaround time

• Quantitative polymerase chain reaction has been developed for the purpose of blastocyst pGS and provides rapid, accurate and cost-effective screening

• all CCS methods provide accurate aneuploidy screening when used on multiple trophectoderm cell sam-pled at the blastocyst stage; single-cell analysis poses several issues

• The introduction of next-generation sequencing platforms in IvF will further reduce the costs of pGS or preimplantation genetic diagnosis and will allow new levels of genetic testing to be explored in IvF

Immunological modulation; regulation of endometrial receptivity(nathalie lédée, france)• During the implantation window,

there is a necessary immune switch for fetal tolerance that has a central role for uterine natural killer cells

• at this phase, documenting the local immune reaction may be useful for those with repeated and unexplained implantation failures, to help identify uterine immunological mechanisms and provide personalized IvF treatment

understanding endometrial ‘omics’ (signe altmäe, estonia)• ‘omics’ high-throughput

analyses are revolutionizing our understanding of endometrial physiology and pathophysiology

• although there is much informa-tion from gene expression studies, there is a lack of consensus:

- knowledge of clinical application is limited: more well-designed studies are needed

- proteomics and metabolomics will likely be important in the near future

In bRIEF

Clinicians should be supportive and honest

with couples about likely levels of success

rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 5Follow us HTTpS://www.FaCEBooK.CoM/EXCEMED

new classification proposed for RIF


A new classification has been proposed that aims to provide clear guidance on how to confirm RIF.

The proposed classification describes rIF as ‘the absence of implantation, defined by a negative serum hCG 14 days after oocyte collection, after two consecutive IvF cycles, ICSI or frozen embryo replacement, where the cumulative number of transferred embryos was no less than four for cleavage-stage embryos and no less than two for blasto-cyst, with all embryos being of good quality and appropri-ate developmental stage’.

Dr n raine-Fenning advocated the widespread adoption of this new classification. He outlined the five stages of the implantation process (namely, rolling, apposition, adhesion, invasion, and vas-cularization), adding that implantation should only be con-sidered when invasion of the embryo is complete and it is formally embedded within the endometrium. The timepoints when implantation can be confirmed, and when implantation failure can be diagnosed, have not been clear in previous classifications •

dr nick raine-fenning (university of nottingham, uK) suggested a new classification of rIF that clarifies the timepoints for confirming rIF

AH in the era of blastocyst culture/ vitrification (Basak Balaban, turkey)• aH for fresh cleavage-stage ET

does not improve live-birth rates• Cumulative pregnancy rate just

reaches significance in favour of aH for all patient groups; significance more evident for women with rIF

• There are insufficient data to show the superiority of blastocyst transfers over cleavage-stage ET supported with aH

• Total zona removal for blastocyst transfers performed in certain patient groups may be a better than partial aH (depending on physiology)

• More rCTs are needed before making any recommendations for standard practice

Management of RIF: what can the clinician and embryologist do? (Ying cheong, uk; denny sakkas, usa)• Lifestyle modifications, surgical

interventions dictated by clinical history and findings and modification of arT procedures are approaches that may help in the clinical management of rIF

• The embryologist and IvF laboratory can help in the management of rIF by:

- Strict quality control- properly caring for gametes/

embryos- using optimum sperm-selection

techniques to ensure the best sperm are used

- assessing embryos using improved and validated morphological screening or new noninvasive and invasive tools

Key biological processes in implantation (John Aplin, uK)• Implantations fail in the majority

of karyotypically abnormal pregnancies

• Many normal embryos miscarry, usually due to maternal factors (e.g. poor decidualization, spiral arteries that resist remodelling, errors of meiosis, especially in women > 40 years old, failure of immune recognition and abnorma-lities in blood clotting system)

In bRIEF

A new classification should provide clear guidance

on confirming RIF

Timepoints for confirming implantation or

its failure have been unclear in the past

6 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014

EXCEMED: improving reproductive medicine through medical education

youR EXCEMED

EXCEMED – Excellence in Medical Education – is the new name of serono symposia International Foundation (ssIF). our new name marks an exciting point in our evolution, but our focus on education in reproductive medicine, ART and all aspects of fertility care remains paramount.

The Foundation has provided world-class education to thousands of healthcare professionals over the past four decades. During this time, over 1500 international scientific congresses have been organized, with more than 500 proceedings published in leading international journals. EXCEMED has pioneered online CME courses since 2000; the organization over-sees an expanding portfolio of e-learning activities including video lectures, CME-accredited online courses and symposia. These digital ventures reach over 12,500 people per month via the website or through EXCEMED’s e-newsletters. as a non-profit global organization, EXCEMED is dedicated to improving the patient’s life through the provision of in-dependent, high-impact CME to scientists, physicians, nurses, pharmacists and other healthcare professionals. upcoming EXCEMED events of relevance to specialists in reproductive medicine are summarized on the back page of this publication •EXCEMED has an

innovative educational programme in

reproductive medicine

AH, assisted hatchingAMH, anti-Müllerian hormoneART, assisted reproductive technologyCCs, comprehensive chromosomal screeningCME, continuing medical educationCos, controlled ovarian stimulationEACCME, European accreditation Council for CMEET, embryo transferhCG, human chorionic gonadotrophinICsI, intracytoplasmic sperm injectionIVIG, intravenous immunoglobulinIVF, in vitro fertilisationIuGR, intrauterine growth retardationlH, luteinising hormoneoHss, ovarian hyperstimulation syndromePCos, polycystic ovarian syndromePGs, preimplantation genetic screeningRCT, randomized controlled trialRIF, recurrent implantation failureRM, reproductive medicinesET, single embryo transfersGA, small for gestational ageTnF, tumour necrosis factor

GlossARy

The EXCEMED E-learning programme in RM offers a new format of online interactive courses, accredited by EACCME.• The first module, on aMH is due

to launch in January 2015. This module follows a case study-based learning approach, with the content led by professor antonio La Marca, university of Modena and reggio Emilia, Italy

• The online CME activities combine timely, insightful content with the convenience of home or workplace study. Courses are available for anyone wishing to participate

• participants who obtain a satisfactory score on the post-test can obtain a certificate of completion

• To know more: http://reproductive-medicine.excemed.org/

E-lEARnInG

http://reproductive-medicine.excemed.org/

http://reproductive-medicine.excemed.org/

extracts 7Follow us www.LInKEDIn.CoM/CoMpany/EXCEMED---EXCELLEnCE-In-MEDICaL-EDuCaTIon?TrK=BIz-CoMpanIES-CyM

Early evaluation of fetal echocardiography

woRKsHoP ouTCoMEs

Technological advances in ultrasonography now enable echocardiography to be performed from as early as 13–16 weeks’ gestation.

In april 2014, physicians specialising in ultrasound and obstetrics participated in a 2-day workshop on fetal echocardiography, held in in Siena, Italy. This workshop taught participants the correct methodology to perform early fetal echocardiography, how to op-timize acquisition of the correct images, and how to evaluate the role of colour/power Doppler in fetal echocardiography.

The prenatal diagnosis of congenital heart dis-eases is important for optimizing obstetrical and neonatal care. Early fetal echocardiography now facilitates visualization of the major cardiac structures from a very early stage of pregnancy. Fetal echocardiography requires the use of high-resolution ultrasound equipment, ade-quate transducer frequencies and specific sys-tem settings – all of which must be changed in real time to reach the best resolution, for in each patient and for each condition.

The normal fetal echocardiogram is targeted to visualise:• visceral situs and cardiac position• Four-chamber view, with two separate

atrio-ventricular valves• aortic and pulmonary outflow tracts• Two great arteries of similar size• Evidence of ductal and aortic arches.

Doppler techniques (colour and power) are also used to optimize fetal heart images. organised by Dr Filiberto Maria Severi (Department of paediatrics, obstetrics and reproductive Medicine, Siena university, Italy), the workshop provided participants with a com-plete understanding of the ultrasound settings needed to perform good fetal echocardiography. The most important scanning planes of the normal fetal heart (apical four chamber view, subcostal four chamber view, long-ax-is aorta, long-axis pulmonary artery, short-axis ventricles, aortic arch view) were covered in detail, and discussed from both a clin-ical and a diagnostic perspective. The rules of fetal echocardiography, together with practical suggestions to improve the experience for clinicians and patients alike, were also presented.

Fetal echocardiography now facilitates

visualization of the major cardiac structures from a very early stage

of pregnancy

Participants learned the correct methodology to perform early fetal

echocardiography, how to optimize acquisition of the correct images and how to evaluate the role of colour/

power Doppler in fetal echocardiography

throughout the year, eXcemed organizes workshops in specialist areas relevant to reproductive medicine and early pregnancy. Working in small groups, attendees have the opportunity to gain clinically focused guidance from world experts in the field. Below is a report on the fetal echocardiography workshop, held in april 2014, in siena, Italy


uPCoMInG In EXCEMED REPRoDuCTIVE MEDICInE

ivF preceptorship Hamburg, Germany4 - 5 July

sCIEnTIFIC oRGAnIsERr. Fischer, Germany

challenging issues in reproductive medicine Moscow, russia8 August

sCIEnTIFIC oRGAnIsERr. Fischer, Germany

ivF preceptorship London, uK5 - 6 september

sCIEnTIFIC oRGAnIsERS. Lavery, uK

AIMthis is the first Ivf preceptorship in germany. dr fischer’s fertility center in hamburg was one of the first to introduce certified quality management according to Iso 9001

KEy ToPICsphysiology of lh, lh in stimulation protocols, implementing quality management systems in the fertility clinic, risk management in the art laboratory

AIMthis workshop focuses predominantly on pcos, implantation failure and endometriosis

KEy ToPICsaetiology of pcos and its management, new strategies to avoid implantation failure, new guidelines for treating endometriosis

AIMthis preceptorship is dedicated to providing new insights on hot topics in rm

KEy ToPICspcos, cos, rIf, new laboratory techniques and equipment for optimisation of Ivf, protocols to improve implantation potential and endometrial receptivity

TARGET AuDIEnCEphysicians with expertise in art

FoRMATlectures, workshops, Q&a discussion and a visit to the clinic and laboratory premises

TARGET AuDIEnCEphysicians working in art

FoRMATlectures, case studies and much opportunity for discussion


FoRMATlectures, case studies and much opportunity for discussion

eXcemed is offering a wide range of excellent online and live educational events in the coming months. please visit www.excemed.org to see the latest news on the reproductive medicine educational programme.

rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 9Follow us http://twitter.com/eXcemeD_rm


8th ivF preceptorship: current practice in the 21st century Madrid and valencia, Spain25 - 26 september

sCIEnTIFIC oRGAnIsERsJ. a. García velasco, a. requena and E. Bosch, Spain

international School of ultrasound in obstetrics and Gynecology “paolo mascagni” Workshop on monitoring of fetal growthSiena, Italy26 - 27 september

sCIEnTIFIC oRGAnIsERF.M. Severi, Italy

AIMthis unique preceptorship is delivered through an innovative mix of evidence-based lectures, interactive case studies, working groups and video sessions across two leading centres in Ivf care

KEy ToPICscos and the role of lh, rIf, set, new laboratory techniques and equipment for optimization of Ivf, including current evidence on hysteroscopy for women with infertility

AIMthis course aims to give a complete understanding of the role of ultrasound in deteriming fetal growth, weight and wellbeing

KEy ToPICssga fetuses, macrosomia, Iugr, fetal weight index, use/application of ultrasound examinations

TARGET AuDIEnCEclinicians with < 5 years’ experience in art

FoRMATlectures, interactive case studies and workshops, and Q&a discussions.

TARGET AuDIEnCEphysicians with expertise in ultrasound and obstetrics

FoRMATultrasound examinations in pregnant women, using numerous different approaches

ivi 1:1 intensive shadow coursevalencia, Spain,27 - 29 october

sCIEnTIFIC oRGAnIsERE. Bosch, Spain

ivF preceptorship naples, Italy6 - 7 november

sCIEnTIFIC oRGAnIsERsF. Maria ubaldi, L. rienzi,F. zullo, Italy

AIMthis intensive one-to-one clinical course provides a unique and exclusive opportunity to work directly alongside experts in Ivf, shadowing their practice

KEy ToPICsconsultations covering general aspects of Ivf management, diagnostic and therapeutic hysteroscopies, oocyte donation clinics

AIMthis preceptorship in Ivf takes place in the clinical setting of genera, a pioneering new centre for art services

KEy ToPICssubjects of current and future interest in Ivf clinical management

TARGET AuDIEnCEclinicians with < 5 years’ experience in art

FoRMATsessions involve shadowing consultations and procedures in a working clinic, in daily practice


FoRMATlectures, workshop, Q&a discussion and visit to the clinic premises



international conference on fertility preservation paris, France3 December

sCIEnTIFIC oRGAnIsERsr. Frydman and M. Grynberg, France

embryology courseSt petersburg, russia28-29 november

sCIEnTIFIC oRGAnIsERsr. Fischer, GermanyT. Hardarson, Swedenp. nagy, uSa

AIMthis course represents a partnership between eXcemed and alpha (scientists in rm)

KEy ToPICschemotherapy-induced loss of follicles, cancer and testicular function, impact of radiotherapy on gonadal function, fertility in cancer survivors, fertility preservation strategies, medical treatments for gonadal damage, ovarian stimulation in cancer patients, ovarian tissue transplantation and cryopreservation

AIMthis course represents a partnership between eXcemed and alpha (scientists in rm), with alpha providing substantial input into the scientific programme

KEy ToPICsnew technologies in embryology, latest laboratory practice guidelines, optimizing laboratory conditions, culture environments and selection criteria for human embryos

TARGET AuDIEnCEphysicians and scientists working in reproductive medicine or oncology

FoRMATlectures and Q&a discussion sessions

TARGET AuDIEnCEscientists, embryologists, biologists and interested clinicians with experience in this field.

FoRMATlectures, workshop and much opportunity for discussion

cryopreservation: focus on fertility preservationBrussels, Belgium16-17 January, 2015

sCIEnTIFIC oRGAnIsERsM.M. Dolmans and J. Donnez, Belgium

AIMinnovative meeting that includes oral presentations that present the best research findings from young physicians and researchers

KEy ToPICsall aspects of cryopreservation

TARGET AuDIEnCEphysicians and scientists working in reproductive medicine

FoRMATkeynote lectures, workshops, Q&a discussion and oral presentations

EXCEMED is a non-profit organization dedicated to providing CME to healthcare professionals. This newsletter is intended for healthcare professionals and provides a brief summary of a selection of previous educational events. EXCEMED will make reasonable efforts to include accurate and current information, wherever possi-ble, but makes no warranties or representations as to its accuracy or completeness. This information is provided “as is” without warranty of any kind, either express or implied, including but not limited to implied warranty of fitness for particular purpose. EXCEMED has implemented and maintains a Quality Management System which fulfils the requirements of the ISo 9001:2008 standard for the activity of design and provision of training events in the healthcare sector.

© EXCEMED, 2014. all rights reserved.

EXCEMED Excellence in Medical Education, Salita di S. nicola da Tolentino, 1/b, 00187 rome, Italy. © Copyright 2014 EXCEMED. all rights reserved.

Editorial development: Shalene Chugh, Linda Edmondson, Michèle piraux, Emma wadland

Contributors: rene Frydman, Michael Grynberg, Sesh Sunkara, Irene zerbetto

Design: www.katehouben.com

www.excemed.org

http://www.katehouben.com


rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014 extracts 11

Fertility preservation following cancer: an emerging challenge

FuTuRE FoCus

we are in an exciting and interesting time, when oncologists and reproductive endocrinologists across the globe rise to the challenge of providing fertility services for people with a history of cancer.—sCIEnTIFIC oRGAnIsERsrene Frydman (Suresnes, France) and Michael Grynberg (Bondy, France)

Developments in oncology have improved long-term survival rates for many types of malignancy. However, to survive cancer is no longer enough. The emphasis is shifting, to enable people to live the most normal life possible after cancer; this includes giving them the best possible opportu-nity to have their own biological children. However, the science and clinical practice of fertility preservation in people with cancer remains at a pioneering-level. approaches to fertility preservation vary greatly, depending on the age of the patient, the type of malignancy and the rM services that are available locally. Techniques are being developed, but their long-term success is not proven.

organize services; offer urgent careIt is possible for reproductive medicine clinics to offer ‘emergency’ care to people, even when the window between diagnosis and initiation of cancer treatment is narrow. But providing rapid support and intervention requires well-informed oncologists and adaptable fertility clinics. The emergency service must encompass rapid coun-selling and treatment; the long-term service must offer tissue/gamete storage and arT.

Currently only around 30% of on-cologists routinely refer patients of child-bearing potential for reproduc-tive counselling. But the need for cli-nicians to provide adequate fertility preservation to people with cancer is likely to rise considerably over the coming years.

the paris conferenceThese emerging issues have prompted us to or-ganize the inaugural international conference on fertility preservation. This one-day event is suitable for oncologists and specialists in reproductive endocrinology or fertility care. Lectures and discussions aim to stimulate future improvements in research and clinical practice. Topics to be covered include:• Chemotherapy-induced loss of follicles,• Cancer and testicular function• Impact of radiotherapy on gonadal function• Fertility in cancer survivors• Fertility preservation strategies• Medical treatments for gonadal damage• ovarian stimulation in cancer patients• ovarian tissue transplantation and

cryopreservation

Fertility preservation is not a magic situation; it is not one where oncologists or reproductive endocrinologists can over-promise success to their patients. However, it is very important that we now develop and test techniques that offer greater hope to people, so that their life after cancer treatment can routinely include the right to have a family. please join us in paris, this December, to take these early steps forward in fertility preservation for people with cancer.

As more patients survive cancer,

preserving their right to have children will become

an expectation of treatment and a standard aspect of clinical practice

best practices in cancer treatment, emerging data on

cryopreservation, tissue transplantation

and gonadal stimulation strategies,

will be presented at the Paris conference

EXCEMED, in partnership with ALPHA (Scientists in Reproductive Medicine) is organizing a pioneering conference at which oncologists and specialists in reproductive endocrinology will discuss strategies for supporting fertility in people with cancer. The meeting takes place on 3 December 2014 in Paris, France

GoT A CoMMEnT oR quEsTIons? E-MAIl [email protected]

12 extracts rEproDuCTIvE MEDICInE SprInG-SuMMEr 2014

www.excemed.orgit’s active in here

IMPRoVInG THE PATIEnT’s lIFE THRouGH

MEDICAl EDuCATIon

EXCEMED at your fingertips> six specialty micro sites, including reproductive

medicine> Accessible and accredited e-learning packages> A world-class repository of CME knowledge and

learning materials > Monthly updates about our events and resources

in reproductive medicine> Register with us online and access it all – free

better outcomes for patients start here. with over 40 years of experience, EXCEMED has been delivering continuing medical education (CME) longer than any other provider.


EXCEMED Reproductive Medicine Extracts, Spring-Summer 2014

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