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In this e-newsletter:
1. Apply now for ESHRE's Embryologist Certification
2. The EU - connection
Cross Border Care - high on the Commission's agenda
3. ESHRE campus / educational activities
GnRH agonist for triggering of final oocyte maturation – time for a paradigm shift
The maternal embryonic interface
Still 3 spaces left in our 'Endoscopy course'
4. ESHRE news
ESHRE's publishes updated PGD guidelines
New PGD Consortium Steering Committee
5. News in reproductive medicine
The origin of genetic diversity
6. ESHRE calendar
The online application system for ESHRE's Embryologist Certification is open until 15 December 2010 (midnight CET). The application is open for MEMBERS ONLY. Please note that spaces are limited to 250 applications.
The embryologist exam will take place on Saturday 2 July 2011, 15:00 - 17:15 on the premises of ESHRE's Annual Meeting in Stockholm.
In order to apply you will have to fill in two forms: the application itself and the logbook. Both forms can be saved on the ESHRE website. When all forms are completed, you can submit the entire application. Once you submit your full application, a new page will be generated for you which needs to be printed and then signed by yourself and by your supervisor / laboratory manager or clinic manager and sent in as a hardcopy to the ESHRE office. Your electronic application will not be registered until this signed form has reached the office.
Applicants will be notified of their status by the Central Office before 15 February 2011. Logbook requirements, rules and application forms can all be found on the Embryology Certification website.
For questions please contact Catherine Plas at catherine@eshre.eu or at +32 (0) 2 263 64 63.
All necessary information will be posted on the Embryology Certification website. Please check regularly for updates.
In recent years, the provision of cross-border care in Europe has received considerable policy attention. Considering patients face a range of unresolved legal, financial and administrative issues, it was good news to hear that the European Parliament's public health committee voted on 27 October in favour of rules that could pave the way for Europeans to receive medical treatment anywhere in the European Union.
An agreement was reached in the following points:
- Patients can seek medical care in another country without prior authorisation.
- For hospital stays and specialised care, patients could need pre-authorisation from their national health system.
- A country could only refuse to authorise cross-border care in a very limited number of circumstances.
- The 25 million Europeans with rare diseases would be covered under the proposed law.
Earlier in June, the European Council agreed on a draft Directive on cross-border care. The positive vote of the EU Council opened a new perspective on cross-border care and on the use of eHealth as a tool to facilitate the mobility of EU citizens. The draft Directive proposed that, as a general rule, patients would be allowed to receive healthcare in another member state and be reimbursed up to the level of reimbursement applicable for the same or similar treatment in their national health system, if the patients are entitled to this treatment in their country of affiliation. In case of overriding reasons of general interest, a member state may limit the reimbursement for cross-border healthcare; member states may manage the outgoing flows of patients by requiring prior authorisation for certain treatments (those which involve overnight hospital accommodation, require a highly specialised and cost intensive medical infrastructure or which raise concerns with regard to the quality or safety of care) or via the application of the 'gate-keeping principle', for example by the attending physician.
The draft directive was part of the social agenda package of 2 July 2008, which focused on three objectives: (1) to guarantee that all patients have care that is safe and of good quality, (2) to support patients in the exercise of their rights to cross border healthcare; and (3) to promote cooperation between health systems.
"Most countries in Europe spend less than 1% of their health budgets on cross-border care, and only if you have 3% of care outside of your borders you get distortions in the system," says Daniel Mart, a GP in Luxembourg and a member of the Standing Committee for European Doctors. Approximately 7% of Luxembourg's medical payments are cross border, the highest figure in the EU.
There seems to be remarkably little systematic information on the volume and scope of cross-border care, and in particular on the perspectives and outcomes of cross-border care at the patient level. Some surveys on experiences of cross-border patients indicate that this group of patients encounters problems regarding travelling (financially and logistically), emotional issues associated with distance from home, unfamiliarity with access procedures and continuity of care. (see Groene et al, 2009).
For more information please read the Parliament's press release from 27 October 2010 and the press release of the European Council from June 2010. You will also find relevant documents in ESHRE's EU archive, which is accessible for members only.
Background
In the European Union the governing of health systems is the responsibility of each member state, but in some cases, as ruled by the European Court of Justice (ECJ), EU citizens who seek treatment in another EU member state should be covered by their own health system. This is especially the case for rare conditions and very specialised treatments.
However, health services remained excluded from the general Services Directive in spring 2006 (the so-called 'Bolkestein Directive'), despite the many ECJ rulings showing that they are to be considered as an economic activity and that Community law applies to them.
To provide clarity and legal certainty on the issue as well as support for co-operation between national health systems, the European Commission decided to establish an EU framework to ensure cross-border access to healthcare services. According to the EU executive, the current scale of cross-border mobility amounts to 1% (€10 billion) of overall EU-27 public health spending (€1,000 billion).
The European Parliament adopted the cross-border directive in April 2009, but it stalled ever since at the European Council, where health ministers struggled to pass the deal.
Cross border care in reproductive medicine
In the area of reproductive medicine, cross border treatment is a well-known phenomenon. "Cross border reproductive care is becoming more widespread, but is fraught with safety concerns," says Dr. Francoise Shenfield, coordinator of ESHRE's Task Force on Cross Border Reproductive Care.
"Although ESHRE has no objection to patients seeking treatments outside their home country, we believe there should be a Code of Practice (COP) to protect patients, donors and potential surrogates." Dr. Shenfield is hoping to receive approval end of November in the next Executive Committee meeting, in order to publish the COP. Professionals in the field will hopefully sign up to these standards.
"The COP will provide guidance for fertility centers and physicians, and we hope it will encourage policy makers and regulators to create a legal framework to enable centres to abide by these rules." The Task Force recently published the first ever study on ART patients crossing borders in Europe; the group is now planning to study the demographics, motivation and compensation of egg donors in Europe.
For more information on this group and their activities, please visit the ESHRE website.
'GnRH agonist for triggering of final oocyte maturation – time for a paradigm shift'
(organised by the SIG Reproductive Endocrinology)
3 December 2010 in Madrid, Spain
The course will focus on the physiological basis of GnRH agonist (GnRHa) triggering to induce final oocyte maturation and the clinical applications of this approach.
Although described 20 years ago, it was not until GnRH antagonist protocols were introduced for the prevention of a premature LH surge that GnRHa triggering of final oocyte maturation became an option again as an alternative to hCG triggering. Despite the fact that hCG effectively secures final oocyte maturation and ovulation, its use as a surrogate for LH has several drawbacks, first and foremost a sustained luteotropic effect, facilitating ovarian hyperstimulation syndrome (OHSS).
In contrast, GnRHa is as effective as hCG for the induction of ovulation, and apart from an endogenous LH surge, a FSH surge is also elicited, similar to the natural mid-cycle surge of gonadotrophins. Importantly, the risk of OHSS after GnRHa triggering is negligible, due to the significantly shorter half-life of endogenous LH as compared to hCG.
Until recently, prospective randomized studies reported a poor clinical outcome when GnRHa was used to trigger final oocyte maturation in IVF/ICSI GnRH antagonist protocols, presumably due to a luteal phase deficiency, despite standard luteal phase supplementation with progesterone and oestradiol. As GnRHa triggering of final oocyte maturation could possess advantages over hCG triggering not only in terms of a reduced if not eliminated risk of OHSS, but also the retrieval of more mature oocytes, and a higher patient convenience, the challenge has been to rescue the luteal phase. In the literature now several studies report a luteal phase rescue with a reproductive outcome comparable to that of hCG induced final oocyte maturation. Thus, although more research is needed to further explore the optimal luteal phase support after GnRHa triggering, this mode of triggering is now a valid alternative with potential benefits.
The physiological background of GnRHa triggering, the impact of this protocol on the luteal phase, the different approaches to support the luteal phase, and other clinically relevant issues will be discussed. At the end of the course, participants should be able to select patient categories that may benefit from triggering with GnRHa instead of hCG; to implement the protocol and to have adequate knowledge regarding luteal phase support.
This course is suitable for doctors, paramedics, embryologists and counsellors with an interest in infertility and reproductive medicine.
'The maternal embryonic interface'
(organised by the SIGs Early Pregnancy, Endometriosis and Endometrium and Stem Cells)
2-3 December in Valencia, Spain
This attractive programme incorporates the interests of 3 ESHRE special interest groups and addresses themes common to each of these areas of both clinical and basic interests.
The two day meeting will include the following topics: The window of implantation and beyond, endometriosis, gametogenesis and implantation and placentation.
Each session will provide a platform for discussion regarding 'state-of-the-art' tools for mechanistic studies, what is new in the context of endocrine regulation and basic biology, the role of stem cells underpinning physiological and pathological processes and clinical translation.
Along with invited presentations juniors will have the opportunity to present short oral communications selected from submitted abstracts. The remainder of accepted abstracts will be presented in poster format.
The course aims to provide a forum for discussion on themes of crucial importance to the maternal fetal interface. It is of particular interest for clinicians, scientists and paramedics working in the field of implantation, stem cells and endometriosis in the context of early pregnancy success and failure.
We have only 3 spaces left in our Campus Course: 'Endoscopy in reproductive medicine'
(organised by the SIG Reproductive Surgery)
24-26 November in Leuven, Belgium
This course intends to give participants more information on the place and interest of endoscopic surgery in reproductive medicine. It will also offer improved suturing skills and insight into applications during surgery. This course is for all those with an interest in endoscopy and endoscopic reproductive surgery.
The course will focus on the importance of endoscopic diagnosis and surgery in reproductive medicine and has three important parts:
1) Live surgical teaching during two days with interactive live surgery from expert centres demonstrating procedures dedicated to reproductive health
2) Hands on training: evaluation of laparoscopic skills and suturing course
3) The theoretical part includes lectures on the most important issues in reproductive endoscopy, such as:
- diagnostic and operative hysteroscopy - transvaginal laparoscopy - operative endoscopy for myomectomy, endometriosis and reproductive surgery related to ART
More information on ESHRE workshops can be found in our Calendar.
ESHRE publishes updated PGD guidelines
ESHRE has published a set of guidelines for best practice Preimplantation Genetic Diagnosis (PGD)/Screening (PGS) to give information and guidance to potential and existing PGD centres.
The four guidelines include one outlining the organisation of a PGD centre and three related to the methods used: amplification-based testing, fluorescence in situ hybridisation (FISH)-based testing and polar body/embryo biopsy.
“The guidelines are a detailed update to the Consortium’s initial PGD guidelines, published in the same journal in 2005. They have been developed as a set which, taken together, form a complete best-practice compendium,” said Gary Harton, chairman of ESHRE’s PGD Consortium.
The development of new technologies, the evolution of current methods and in light of recent advice from ESHRE on how best practice guidelines should be written, the PGD Consortium believed it necessary to update the existing guidelines.
The first guideline on the organisation of a PGD centre includes the basic requirements of an IVF/PGD centre, transport PGD (when the gametes and embryos to be tested are in a different centre than the patient), inclusion/exclusion criteria for patients, staffing, genetic counseling and accreditation of a centre.
The three more technical guidelines cover lab requirements, clinical protocols and follow-up recommendations after diagnosis for each of the PGD methodologies: amplification-based testing, FISH-based testing and polar body/embryo biopsy.
The guidelines on amplification-based and FISH-based testing also outline quality control and quality assurance and the diagnostic confirmation of untransferred embryos. Freezing of embryos after biopsy is covered in the fourth guideline on the use of embryo biopsy in PGD/PGS.Pre-implantation genetic screening (PGS) has been included in all guidelines. Although current evidence suggests it may be ineffective at the embryo cleavage stage using current technology, PGS may still show improved delivery rates if used at the blastocyst stage or on polar bodies. The ESHRE group decided deliberately to include PGS recommendations to assist every professional in the reproductive field to develop the best laboratory and clinical practice possible.
The full set of guidelines have been published on the ESHRE website.
Last year, for the first time, the PGD Steering Committee wrote statutes. The statutes lay out who can become a member of the PGD Steering Committee and for how long. They further explain how new members are to be elected: "Candidates for the Steering Committee shall be elected by a secret 'yes/no' ballot of ESHRE centres with full or transport PGD membership, and held in the intervening period between general meetings."
"Irrespective of the number of candidates or vacant positions, a 'yes' vote by at least 51% of full members and transport centres shall constitute the minimum vote in favour required to elect each candidate." The final version of the statutes was approved in September 2010.
Recently, all full members were invited to vote on the re-election of current members of the committee along with a vote to add two new members. Of 56 centres invited, 34 replied. The following members were re-elected: Céline Moutou, Katerina Vesel and Siobhan Sengupta. Georgia Kokkali and Leeanda Wilton were elected as new members to the Steering Committee.
Following this vote the Steering Committee of the ESHRE PGD Consortium consists now of the following members:
Gary Harton (chair), Joanne Traeger-Synodinos (deputy chair), Joyce Harper (past chair), Céline Moutou, Katerina Vesel, Siobhan Sengupta, Georgia Kokkali, Leeanda Wilton, Martine De Rycke, Tugce Pehlivan, Pamela Renwick, Edith Coonen and Francesco Fiorentino.
Next year, during the Consortium meeting in Stockholm the two longest standing members will have to either step down or be re-elected. All members of the Steering Committee take part in one of the following working groups:
- Database- Accreditation- Misdiagnosis monitoring and auditing- Molecular methods- FISH External Quality Assessment (EQA)- PCR EQA- Arrays
For more information on the statutes and the ESHRE PGD Consortium please visit the ESHRE website.
ESHRE journals
Editor’s choice
Rienzi, L. et al., Predictive value of oocyte morphology in human IVF: a systematic review of the literature
You can find more news and articles in our Press Room and in our Journals.
A protein that influences where DNA crossover occurs
In a recent issue of Nature, American scientists report the discovery of the protein Xnd-1 which plays a key role in choosing where crossovers between chromosomes occur.
"This regulatory protein influences where genetic material gets exchanged between maternal and paternal chromosomes during the process of creating eggs and sperm," says Dr. Judith Yanowitz, assistant professor of obstetrics and gynecology at the Pitt School of Medicine in Baltimore.
The researchers suggest that not only may Xnd-1 affect the way chromosomes are packaged in the nucleus as chromatin, but it may also alter a component of chromatin that is maintained through species evolution.
Read the press release related to the article. For the full article please visit the journal's website.
More news can be found in our PRESS ROOM or you can subscribe to our RSS feed for professionals in the field of reproductive medicine.
Women’s health aspects of PCOS
18 November, Amsterdam, Netherlands
Fertility preservation in cancer
(organised by the TF Fertility Preservation in Severe Diseases)
25-26 November, Bologna, Italy
Raising competence in psychosocial care
(organised by the SIG Psychology and Counselling)
3-4 December, Amsterdam, Netherlands
Array technologies to apprehend developmental competence and endometrial receptivity: limits and possibilities
(organised by the TF Basic Reproductive Science)
6 December, Brussels, Belgium
Mark your calendar for our 27th Annual Meeting / Stockholm, Sweden/ 3-6 July 2011