Evidence and consensus on technical aspects of embryo transfer

BACKGROUND Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available. OBJECTIVE AND RATIONALE This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners' performance. SEARCH METHODS A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET. OUTCOMES The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined. LIMITATIONS, REASONS FOR CAUTION Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based. WIDER IMPLICATIONS ET is the last procedural step in an ART treatment and is a crucial step towards achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research. STUDY FUNDING/COMPETING INTEREST(S) No funding. A.D.A. has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.Peer reviewe

Coding in medically assisted reproduction : the status of the implementation of the Single European Code for reproductive cells and tissues

STUDY QUESTION: To evaluate the implementation of the coding systems in medically assisted reproduction (MAR) centres in the European Union (EU). SUMMARY ANSWER: Our data show that a significant number of MAR centres use the Single European Code (SEC), but it also shows certain limitations to the coding. WHAT IS KNOWN ALREADY: Traceability and identification of tissue and cells used for clinical application are extremely important as it is one of the key aspects of quality and safety both for the donors and the recipients. Patients as well as tissues and cells move across the European continent and far beyond, hence a uniform coding system was very much needed. The coding of tissues and cells from human origin was already embedded in the EU directives 2004/23/EC. The use of the Single European Code (SEC) on tissues and cells was enforced in 2017 for tissues and cells distributed within the EU or exported from the EU. The SEC ensures standardization within the EU, allowing the integration of the two existing codes (ISBT-128 and Eurocode) within the SEC structure. Likewise, in the MAR field, the SEC was launched in order to ensure the traceability of reproductive tissues and cells. Gametes and embryos from partner donation as well as reproductive cells and tissues of allogeneic donation were excluded from the SEC as long as they remain in the centre of origin. STUDY DESIGN, SIZE, DURATION: A cross-sectional survey aimed to gain insight into the use of SEC by MAR centres was conducted between 5 November and 15 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: The online survey was distributed among the ESHRE members. MAIN RESULTS AND THE ROLE OF CHANCE: The survey results highlight the strengths and weaknesses in the practical use of the SEC. The data from the survey showed that the SEC code is something that is known in the MAR field. Our data showed that over half of the respondents were using the SEC in their centre. On the other hand, there is also criticism about the use of SEC in MAR, especially that the added value for traceability and identification in ART is found to be rather limited. LIMITATIONS, REASONS FOR CAUTION: The survey response rate was rather low (4.84%). The view of the use of SEC discussed in this paper still provides insight into the use of the SEC in several MAR centres. WIDER IMPLICATIONS OF THE FINDINGS: The survey highlights some knowledge gaps concerning coding. This information can be used to develop tools to increase knowledge of the SEC.Peer reviewe

Virtual consultation (VC) in fertility and obstetrics and gynaecology services: An analysis of patient and clinician satisfaction

Objective: To assess patient and clinician satisfaction and identify any differences between the two with the use of video consulting (VC) in the fields of obstetrics and gynaecology (O&G) and fertility in Wales. Design: A retrospective electronic survey study. Setting: All public hospitals in Wales that used virtual methods for delivery of fertility and/or O&G appointments during and after the COVID‐19 pandemic between August 2020 and March 2022. Population: Patients awaiting an appointment on the National Health Service, who have attended virtual fertility or O&G appointments in Wales, and fertility and O&G clinicians who have conducted appointments virtually. Methods: Analysis of patient and clinician responses to a VC satisfaction survey delivered after their consultation taking place between August 2020 and March 2022. Main Outcome Measures: Patient and clinician satisfaction rates with the use of virtual consultation in fertility and O&G appointments. Results: In satisfaction data collected from 420 patients and 161 clinicians, 83% of patients and 63% of clinicians reported their VC quality to be ‘very good’ or ‘excellent’. Difficulties when using VC were experienced by a minority of patients (1%–9%) and clinicians (1%–8%) and most patients (52v82%) and clinicians (34%–67%) found several aspects of VC to be ‘very beneficial’. Fertility patients rated their VC experience more positively than O&G patients. Conclusions: Most patients and clinicians were satisfied with their VC experience. Patients were more satisfied with the use of VC than clinicians. Fertility patients were more satisfied with the use of VC than O&G patients

Study Empowerment for inclusion

Il contributo ha come scopo principale quello di sottolineare come, anche in contesti universitari, un intervento pedagogico sul metodo di studio possa essere per tutti gli studenti, e in particolare per le persone con disabilit\ue0 o con Disturbo Specifico di Apprendimento (DSA), una efficace via per l\u2019autodeterminazione e per l\u2019inclusione. A partire da una attenta analisi della situazione internazionale in termini di dispositivi offerti dai centri di eccellenza universitari internazionali che accolgono studenti con disabilit\ue0 e DSA, presentiamo il Progetto Inclusione 3.0 nella sezione relativa alla costruzione di un percorso di Study Empowerment rivolto a studenti universitari con dislessia che, attraverso un sistema integrato di dispositivi tecnologici, permetta di creare luoghi e tempi di vita universitaria inclusiva

Health-related quality of life and functional changes in DMD: A 12-month longitudinal cohort study

In Duchenne muscular dystrophy (DMD) little has been reported on the association between clinical outcome measures and patient health-related quality of life (HRQOL) tools. Our study evaluated the relationship between 12 month changes on the Generic Core Scales (GCS), the Multidimensional Fatigue Scale and the Neuromuscular Module of the PedsQL\u2122 with several outcome measures (6 minute walk test, North Star Ambulatory Assessment and timed items) in ambulatory DMD. Ninety-eight ambulatory DMD in a multicentric setting were included in the study. At baseline, the PedsQL\u2122 inventories correlated with almost all the functional measures On the Child Self-Report there was a significant decrease between baseline and 12 months on the PedsQL\u2122 GCS and its first domain, in parallel with the decrement in the functional outcome measures. Correlation between the 12 month changes on the PedsQL\u2122 inventories and functional measures were almost all negligible. Similar results were obtained on the Parent Proxy-Report.In conclusion, PedsQL\u2122 correlates with the level of impairment at baseline, but this does not hold true when 12 month changes are considered. Further studies comparing different tools are needed to better elucidate the complexity of the relationship between HRQOL and functional performances

ESHRE guideline: female fertility preservation.

Study questionWhat is the recommended management for women and transgender men with regards to fertility preservation (FP), based on the best available evidence in the literature?Summary answerThe ESHRE Guideline on Female Fertility Preservation makes 78 recommendations on organization of care, information provision and support, pre-FP assessment, FP interventions and after treatment care. Ongoing developments in FP are also discussed.What is known alreadyThe field of FP has grown hugely in the last two decades, driven by the increasing recognition of the importance of potential loss of fertility as a significant effect of the treatment of cancer and other serious diseases, and the development of the enabling technologies of oocyte vitrification and ovarian tissue cryopreservation (OTC) for subsequent autografting. This has led to the widespread, though uneven, provision of FP for young women.Study design size durationThe guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 November 2019 and written in English were included in the review.Participants/materials setting methodsBased on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee.Main results and the role of chanceThis guideline aims to help providers meet a growing demand for FP options by diverse groups of patients, including those diagnosed with cancer undergoing gonadotoxic treatments, with benign diseases undergoing gonadotoxic treatments or those with a genetic condition predisposing to premature ovarian insufficiency, transgender men (assigned female at birth), and women requesting oocyte cryopreservation for age-related fertility loss.The guideline makes 78 recommendations on information provision and support, pre-FP assessment, FP interventions and after treatment care, including 50 evidence-based recommendations-of which 31 were formulated as strong recommendations and 19 as weak-25 good practice points and 3 research only recommendations. Of the evidence-based recommendations, 1 was supported by high-quality evidence, 3 by moderate-quality evidence, 17 by low-quality evidence and 29 by very low-quality evidence. To support future research in the field of female FP, a list of research recommendations is provided.Limitations reasons for cautionMost interventions included are not well studied in FP patients. As some interventions, e.g. oocyte and embryo cryopreservation, are well established for treatment of infertility, technical aspects, feasibility and outcomes can be extrapolated. For other interventions, such as OTC and IVM, more evidence is required, specifically pregnancy outcomes after applying these techniques for FP patients. Such future studies may require the current recommendations to be revised.Wider implications of the findingsThe guideline provides clinicians with clear advice on best practice in female FP, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in FP.Study funding/competing interestsThe guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. R.A.A. reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work; D.B. reports grants from Merck Serono and Goodlife, outside the submitted work; I.D. reports consulting fees from Roche and speaker's fees from Novartis; M.L. reports personal fees from Roche, Novartis, Pfizer, Lilly, Takeda, and Theramex, outside the submitted work. The other authors have no conflicts of interest to declare.DisclaimerThis guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at  www.eshre.eu/guidelines.) †ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE

Developing a core outcome set for future infertility research : An international consensus development study

STUDY QUESTION: Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed? SUMMARY ANSWER: A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY: Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION: A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE: The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS: Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form

ESHRE good practice recommendations for add- ons in reproductive medicine

The draft of the paper “ESHRE Good practice recommendations for add-ons in reproductive medicine” was published for public review for 4 weeks, between 1 November and 1 December 2022. This report summarizes all reviewers, their comments and the reply of the working group and is published on the ESHRE website as supporting documentation to the paper. During the stakeholder review, a total of 274 comments (including 24 duplicates) were received from 46 reviewers. Reviewers included professionals and representatives of donor-conceived offspring organisations. The comments were focussed on the content of the guideline (209 comments), language and style (31 comments), or were remarks that did not require a reply (10 comments). All comments to the language and format were checked and corrected where relevant. The comments to the content of the paper (n=209) were assessed by the working group and where relevant, adaptations were made in the paper (n=94; 45%). Adaptations included revisions and/or clarifications of the text, and amendments to the recommendations. For a number of comments, the working group considered them outside the scope of the paper or not appropriate/relevant (n=115; 55%).peer-reviewe

Nanotubes d'imogolite : transition ordre-désordre et dynamique de l'eau nanoconfinée

Ce travail de thèse est dédié à l'étude des nanotubes d'imogolite et des propriétés structurales et dynamiques de l'eau confinée dans leur cavité. La stœchiométrie de ces tubes hydrophiles est SiAl₂O₇H₄ et leur diamètre interne est d'environ 1,5 nm. Dans le premier chapitre du manuscrit, l'état de l'art concernant les nanotubes d'imogolite est développé, avec un accent particulier sur le confinement de l'eau. Dans le second chapitre, les techniques expérimentales utilisées dans la thèse sont présentées. Ce chapitre comprend aussi des sections qui détaillent les formalismes de diffusion des rayons X et des neutrons. Le chapitre trois est consacré à la théorie des simulations de dynamique moléculaire, avec les potentiels atomiques utilisés et la procédure employée pour obtenir, à partir de trajectoires simulées, les observables de rayons X et de neutrons. Les chapitres quatre et cinq présentent les résultats obtenus au cours de la thèse. Dans le chapitre quatre, la structure du nanotube sec est déterminée et une transition ordre-désordre du sous-réseau formé par les hydroxyles internes du tube, prédite par les simulations de dynamique moléculaire, est observée expérimentalement. La transition est d'abord caractérisée par les simulations, en définissant un paramètre d'ordre et en le corrélant à des quantités expérimentales. L'existence de la transition est démontrée par diffusion élastique des neutrons, et elle est ensuite étudiée plus en détail par diffusion quasi-élastique et inélastique des neutrons, qui mettent en évidence son caractère complexe. Le chapitre cinq étudie la structure et la dynamique de l'eau à l'intérieur des nanotubes. L'arrangement périodique des molécules d'eau à l'intérieur des imogolites est d'abord illustré grâce aux simulations de dynamique moléculaire. Cette périodicité le long de l'axe longitudinal est ensuite confirmée expérimentalement par diffusion des rayons X in situ. La dynamique de l'eau confinée est étudiée en divisant les molécules d'eau en deux catégories, à savoir l'eau "lente" et l'eau "rapide", en fonction de leurs coefficients de diffusion déduits de la dynamique moléculaire. Les expériences de diffusion quasi-élastique des neutrons sont expliquées en ces termes, avec deux composantes associées à ces deux catégories. Enfin, la présence d'un mode de vibration caractéristique de l'eau adsorbée sur la paroi est mise en évidence par diffusion inélastique des neutrons.This thesis work is dedicated to the study of imogolite clay nanotubes and to the structural and dynamical properties of water confined in their cavity. The stoichiometry of these hydrophilic nanostructures is SiAl₂O₇H₄ and their inner diameter is about 1.5 nm. In the first chapter of the manuscript, the state of the art regarding imogolite nanotubes is developed, with a special focus on water confinement. In the second chapter, the experimental techniques used in the thesis are presented. This chapter also includes sections presenting the X-ray and neutron scattering formalisms. Chapter three is dedicated to the theory of Molecular Dynamics simulations, detailing the atomic potential used and the procedure employed to obtain, from simulated trajectories, the X-ray and neutron observables. Chapter four and five present the results obtained during the thesis. In chapter four, the structure of the dry nanotube is determined and an order-disorder transition of the tube's inner hydroxyl sublattice, predicted by Molecular Dynamics simulations, is shown to be observed experimentally. The transition is first characterized by simulations, by defining an order parameter and correlating it to experimental quantities. The transition experimental occurrence is shown by means of elastic neutron scattering experiments, and it is further investigated by means of quasi-elastic and inelastic neutron scattering experiments, which highlight its complex character. Chapter five investigates the structure and the dynamics of water inside imogolite nanotubes. It starts by illustrating, by means of Molecular Dynamics simulations, the periodic arrangement of water molecules inside imogolites. This periodicity along the longitudinal axis is then confirmed experimentally thanks to in-situ X-ray scattering experiments. The dynamics of confined water is investigated by dividing water molecules into two categories, i.e. “slow” and “fast” water, according to their diffusion coefficients deduced from molecular dynamics simulations. The experimental quasi-elastic measurements are explained in these terms, by finding two components associated to these two categories. Finally, the presence of a vibration mode characteristic of water adsorbed on the wall is evidenced by inelastic neutron scattering