Page 23 - Focus on reproduction january 2016

SIG SOCIOCULTURAL ASPECTS 0F (IN)FERTILTY
SIG’s precongress course proves popular at ASRM
US audience largely committed to oocyte cryopreservation for non-medical reasons
While we are finalising the first report
from our European oocyte
cryopreservation survey - to which we
are now adding ovarian tissue
cryopreservation - we successfully
organised the ESHRE postgraduate
course in October at the ASRM annual
meeting in Baltimore. The topical subject
was the pros and cons of oocyte cryopreservation versus embryo freezing.
We had 150 in attendance, and our speakers included embryologists Laura Rienzi and Cristina Magli on science and practice in the lab, followed by clinical outcomes and sociocultural and ethico-legal considerations from Professor Siladitya Bhattacharya and myself.
This was a very well attended course, with many questions asked. With vitrification now established as the favoured cryopreservation method in many parts of the world, the practical message from Laura was ‘keep it simple and keep it fast’ - and do not disturb the cells, whether oocytes or embryos, by adding components or extra steps to protocol. She concluded that vitrification best maintains the oocyte’s competence to develop in vitro and is most effective for improving clinical results, and that evidence is accumulating that the outcome and safety of oocyte cryopreservation are similar to embryo freezing .
Cristina discussed the value of genetic diagnosis and screening for both the oocyte and embryo. She reported that the chromosome analysis of oocytes has revealed that more net errors in aneuploid zygotes occur in meiosis II and that premature chromatid
separation is the prevalent form of errors at meiosis I. The chromosome analysis of embryos has revealed high levels of mosaicism at the cleavage stage, which, she said, can cause misdiagnosis, and low levels of mosaicism at the blastocyst stage. However, in regularly developing
embryos, biopsy at previous stages is highly predictive of the blastocyst’s chromosome condition. Cristina also reviewed her own group’s work on the analysis of blastocyst fluid as a marker of viability.
Siladitya Bhattacharya outlined the value of meta- analysis, and how the removal of one study may change the final picture. Going back to the original data and not taking any meta-analyses for granted was a valuable tip. On the question of outcome, he concluded from the data that frozen-thawed embryo transfer lowers the risk of preterm babies, increases maternal safety but could be associated with large-for- gestational age offspring - whilst the pregnancy rate in poor prognosis women was unclear.
The debate about freezing oocytes for non-medical indications was very energetic, as was the discussion on what medical reasons other than the classical cancer indications might be considered for oocyte cryopreservation, such as Turner’s mosaics or endometriosis. Nevertheless, when asked if they would advise their daughter to cryopreserve oocytes, or even consider oocyte cryopreservation themselves, most women (and men) in the audience were positive about the technique. Despite the enthusiasm, the discussion emphasised that we still have an ethical imperative to gather data on the efficiency of oocyte cryopreservation in non-medical indications, and to follow up the offspring born to ensure that the technique does not affect the ‘welfare’ of the future child. Such discussion underlined the importance of our own ESHRE study, a prospective full data gathering with eventual use and success rates presented according to indication and patient age.
Plans for Helsinki
Our precongress course for this year’s Annual Meeting, organised with the SIGs Early Pregnancy and Ethics & Law, is titled What happens in utero lasts a lifetime: A multi-disciplinary approach to improving preconception and early pregnancy care. Full details are on the ESHRE website and, with such multidisciplined interest, early registration is recommended.
Françoise Shenfield Co-ordinator SIG Sociocultural aspects of (in)fertility
STEERING COMMITTEE
Speakers at the ESHRE precongress course at this year’s ASRM annual meeting; from left, Siladitya Bhattacharya, Françoise Shenfield, Laura Rienzi and Cristina Magli.
Françoise Shenfield (GB), Co-ordinator Paul Devroey (BE), Deputy
Anna Pia Ferraretti (IT), Deputy Virginie Rozée (FR), Junior Deputy
JANUARY 2016 // Focus on Reproduction 23