VenueKipriotis Village - Congress venue

Psalidi, 85 300, Kos

Greece

www.kipriotis.gr

LanguageThe official language of this course will be English

General information

1

Learning effectiveness project

The world of CME is changing with many different live and online formats, and Serono Symposia International Foundation (SSIF) is

continually trying to improve its CME activities.

With your participation in a structured series of evaluations, SSIF can provide cutting-edge learning activities designed to give you

the greatest value from the time you invest.

SSIF is running the learning effectiveness project for this meeting.

Before the conference, you were asked to complete a Pre-event questionnaire to evaluate your knowledge on the specific topics

that will be covered during the conference.

During the conference we kindly ask you to assess the program in various domains such as whether you were satisfied with the

meeting, whether it met the stated learning objectives, whether the contents were neutral and will be applicable to your daily practice.

After the event, you will be involved in two additional steps:

• Post-event: three weeks after the event we will email you a short questionnaire which will give you the opportunity to tell us how

much of what you learned has had an affect on your know-how and daily practice.

• Follow-up: three-months after the event, we will contact you with the final questionnaire.

We will collate and analyse your responses and use the results to improve and develop our ongoing programs.

Of course, we commit to maintaining the confidentiality of the information you provide and we will inform you about the results of

the process regarding the activity that you attended.

Thank you very much for participating in this project!

follow us onwww.twitter.com/SSIF_RM

2

Born after ART:from the laboratory to the delivery room

Serono Symposia International Foundation conference on:

Born after ART: from the laboratory to the delivery roomKos, Kos - June 24, 2012

Aim of the conferenceIncreased longevity coupled with changes in women’s position in society have resulted in a delay in the age of childbearing and as many as

50% of patients requesting infertility treatment face the problem of reproductive ageing. This special symposium is an overview on ART

consequences, implications that can develop in managing pregnancies after ART cycles. The symposium will be especially relevant for expert

physician involved in fetal medicine and reproductive medicine who want to update in developments in these fields, as weel as all those

interested in the care of pregnant woman and their babies.

Learning objectivesParticipants of this symposium will:

• Receive a comprehensive overview of factors influencing delayed fertility

• Be updated on tools aimed at individualizing complications and clinical approaches in pregnancies after ART

• Debate challenging clinical perspectives to familiarize with different and therapeutic avenues

• Individualize the result and the complications of pregnancies after IVF treatments

Target audienceThis program is targeted to clinicians working in the specialist field of fetal medicine and assisted reproductive medicine.

All Serono Symposia International Foundation programs are organized solely to promote the exchange and dissemination of scientific and medical information. Noforms of promotional activities are permitted. All Serono Symposia International Foundation programs are made possible thanks to educational grants receivedfrom: Centre d’Esclerosi Multiple de Catalunya, ComtecMed, Congrex Sweden, Congrex Switzerland, Cryo-Save, Datanalysis, Esaote, European Society ofEndocrinology, Fondazione Humanitas, Fundación IVI, ISFP International Society for Fertility Preservation, ISMH International Society of Men’s Health, K.I.T.E.,Merck Serono, Sanofi-Aventis, University of Catania, Vall d'Hebron University Hospital.

Scientific organizersRobert Fischer

Fertility Centre Hamburg

Hamburg, Germany

Kypros Nicolaides

The Fetal Medicine Foundation

London, UK

Scientific secretariatSerono Symposia International Foundation

Salita di San Nicola da Tolentino 1/b

00187 Rome, Italy

Associate Project Manager: Chloé Xilinas

Tel.: + 39 06 420413 505 - Fax: + 39 06 420413 677

E-mail: info@seronosymposia.org

Serono Symposia International Foundation

is a Swiss Foundation with headquarters in

14, rue du Rhône, 1204 Geneva, Switzerland

Organizing secretariatTighisti Amare

The Fetal Medicine Foundation

137 Harley Street

London, W1G 6BG

United Kingdom

Tel.: + 44 (0)207 034 3070

Fax: + 44 (0)207 034 3071

fmfeducation@fetalmedicine.com

3

List of faculty membersCarlos Alviggi

Federico II University

Napoli, Italy

Renato Fanchin

Hôpital A. Béclère

University Paris-Sud 11

Clamart, France

Robert Fischer

Fertility Centre Hamburg

Hamburg, Germany

Angelique J. Goverde

University Medical Centre

Utrecht, The Netherlands

Giuseppe Grimadi

Genesis - Grimaldi Medical group IVF Center

IVF/ICSI unit

Rome, Italy

Leanne Jones

Laboratory of Genetics

The Salk Institute for Biological Studies

La Jolla, USA

Neri Laufer

Hadassah University Hospital

Ein Karem, Jerusalem, Israel

Markus Montag

University of Bonn

Bonn, Germany

Kypros Nicolaides

The Fetal Medicine Foundation

London, UK

Antonio Pellicer

Instituto Valenciano de Infertilidad (IVI)

Valencia, Spain

List of faculty members

4

Carlos Simon

Instituto Valenciano de Infertilidad (IVI)

Valencia, Spain

Avi Tsafrir

IVF Unit, Department of Obstetrics and Gynaecology

Shaare-Zedek Medical Center

Hebrew University Medical School

Jerusalem, Israel

Dagan Wells

Nuffield Department of Obstetrics & Gynaecology

University of Oxford

John Radcliffe Hospital

Oxford, UK

5

Scientific programSunday, June 24 - 2012

08.30 Registration

09.00 SSIF welcomeR. Fischer, Germany

09.15 Scientific Organizers’ welcomeR. Fischer, Germany; K. Nikolaides, UK

Session I Infertility and obstetric complications

Chairmen: C. Grimaldi, Italy; K. Nikolaides, UK

09.30 L1 - Biological versus chronological ovarian ageC. Alviggi, Italy

10.00 L2 - Selection of embryos to avoid multiple pregnanciesM. Montag, Germany

10.30 L3 - PCOS: infertility and obstetrical problemsA. Goverde, The Netherlands

11.00 Coffee break

11.30 L4 - Preimplantation screening and diagnosisD. Wells, UK

12.00 L5 - Implantation and obstetric complications C. Simon, Spain

12.30 L6 - Obstetrical problems in ageing patientsA. Tsafrir, Israel

13.00 Lunch

Workshops

13.50 L7 - Preimplantation screening and diagnosis D. Wells, UK

15.20 L8 - Ultrasound in ART R. Fanchin, France

16.50 Coffee break

Session II Fertility; past, present and future

Chairmen: N. Laufer, Israel; A. Pellicer, Spain

17.10 L9 - Oocyte donation A. Pellicer, Spain

17.40 L10 - Germ line stem cells ageing D.L. Jones-A., USA

18.10 L11 - Fertility preservation: oncology and social reasons N. Laufer, Israel

6

Serono Symposia International Foundation adheres to guidelines of the European Accreditation Council for Continuing Medical Education

(EACCME) and all other professional organizations, as applicable, which state that programs awarding continuing education credits must

be balanced, independent, objective, and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices,

and other products (other than those uses indicated in approved product labeling/package insert for the product) may be presented in the

program (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We ask all

presenters to provide participants with information about relationships with pharmaceutical or medical equipment companies that may

have relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it is only intended

to inform participants of any potential conflicts so participants may form their own judgments, based on full disclosure of the facts. Further,

all opinions and recommendations presented during the program and all program-related materials neither imply an endorsement, nor a

recommendation, on the part of Serono Symposia International Foundation. All presentations solely represent the independent views of the

presenters/authors.

The following faculty provided information regarding significant commercial relationships and/or discussions of investigational or non-

EMEA/FDA approved (off-label) uses of drugs:

Carlos Alviggi

Renato Fanchin

Robert Fischer

Angelique J. Goverde

Giuseppe Grimadi

Leanne Jones

Neri Laufer

Markus Montag

Kypros Nicolaides

Antonio Pellicer

Carlos Simon

Avi Tsafrir

Dagan Wells

Disclosure of faculty relationships

AbstractsKey slides

L1 - Biological versus chronological ovarian age

Carlos AlviggiFederico II UniversityNapoli, Italy

8

L2 - Selection of embryos to avoid multiple pregnancies

Markus MontagUniversity of BonnBonn, Germany

9

L3 - PCOS: infertility and obstetrical problems

Angelique J. GoverdeUniversity Medical CentreUtrecht, The Netherlands

10

L4 - Preimplantation screening and diagnosis

Dagan WellsNuffield Department of Obstetrics & Gynaecology; University of Oxford; John Radcliffe HospitalOxford, UK

11

The first challenge in life is the implantation process with maternal immune system interaction. Inadequate implantation and

placentation during the establishment of human pregnancy is thought to lead to ectopic pregnancy, biochemical pregnancy, miscarriage,

and obstetric complications such as preeclampsia, fetal growth restriction or placental acretisms. Decidualization of the human

endometrium, which involves morphological and biochemical modifications of the endometrial stromal cells, is a prerequisite for

adequate trophoblast invasion and placenta formation. During placentation, the extravillous trophoblast invades through the decidualized

endometrium to engraft and remodel uterine spiral arteries. Our group have investigated the proteome and secretome that regulates

in vitro decidualization process, and combined with published genomic information to model the human decidual interactome (1). In

this presentation we will present endometrial data supporting the preparation of the decidua during implantation and their impact on

obstetric complications.

(1) Garrido-Gómez T, Domínguez F, López JA, Camafeita E, Quiñonero A, Martínez-Conejero JÁ, Pellicer A, Conesa A, Simón C. Modeling human endometrial decidualization

from the interaction between proteome and secretome. (2011). J Clin Endocrinol Metab. 96(3):706-16

L5 - Implantation and obstetric complications

Carlos SimonInstituto Valenciano de Infertilidad (IVI)Valencia, Spain

12

The rates of women giving birth at advanced maternal age (AMA, > age 40) and very advanced maternal age (VAMA, > 45) have been

rising in the last decade. This trend is related to the worldwide trend of delaying childbirth and to the increasing use of Assisted

Reproductive Techniques (ART) by older women, most importantly oocyte donation. Some complications are much more common

among pregnant women after age 40 as compared with younger women. Hypertensive disorders including preeclampsia occur in 10-

30% of women, as are the rates of diabetes in pregnancy. These complications are even more common after age 45. Reported cesarean

delivery rates are 40-80% in this group, significantly higher than in control groups of younger women. This high rate seems to be a

result of high rate of elective surgery without trial of labor, which may be related to patients or doctors' preferences in the setting of a

so-called 'precious' pregnancy. A high prevalence of multifetal pregnancies in egg donation cycles also contributes to cesarean delivery

rates. Although seldom reported, dystocia is not more prevalent in older patients as compared with younger women.

With regard to neonatal results, preterm deliveries (< 37 weeks) are slightly more common in AMA age, but the rate of very preterm

deliveries (< 32-34 weeks) as well as birth weight < 1500 gr. are comparable to control groups. Neonatal acidosis, low Apgar scores

and congenital malformation rates are comparable to control groups. Data regarding an increased risk for neonatal mortality are

conflicting. Similarly, it is difficult to draw definite conclusions whether oocyte donation pregnancies are associated with increased

risks as compared with endogenous oocyte pregnancies at same maternal age.

In general, obstetrical outcome of this group of women are favorable, and the vast majority will deliver a healthy baby at term. Patient

attempting to conceive at advanced age should receive proper counseling and preparation, including assessment of diabetes and

hypertension.

L6 - Obstetrical problems in ageing patients

Avi TsafrirIVF Unit, Department of Obstetrics and Gynaecology; Shaare-Zedek Medical Center; Hebrew University Medical SchoolJerusalem, Israel

13

L7 - Preimplantation screening and diagnosis

Dagan WellsNuffield Department of Obstetrics & Gynaecology; University of Oxford; John Radcliffe HospitalOxford, UK

14

L8 - Ultrasound in ART

Renato FanchinHôpital A. Béclère; University Paris-Sud 11Clamart, France

15

Oocyte donation (OD) has become one of the most successful alternatives in assisted reproduction (AR) because it is applied to women

in whom the possibilities with their own oocytes are seriously impaired because of age due to the social changes that have delayed

childbearing. It was initially introduced as an alternative method to treat premature ovarian failure in the 80’s, but it became widely

extended and its indications include repetitive implantation failure in AR, low responders, severe endometriosis, hereditary diseases,

numerical or structural chromosomal abnormalities, recurrent miscarriage, and established menopause.

We have analyzed the outcome of OD in several publications over the years. Recently, we measured the success of OD according to

cumulative newborn rates (CNBR) per number of embryos required to achieve at least one newborn (EmbR), considering also the

relevance of age and infertility etiology. Survival curves and Kaplan-Meier methods were employed to analyze CNBR with respect to the

number of EmbR in a retrospective cohort of OD subjects.

CNBR increase rapidly (up to 64.8%) between one and five EmbR, moderately (85.2%) between five and fifteen, and slowly thereafter,

reaching a plateau at 15 embryos (92.4%) and peaking after 25 EmbR (96.8%), demonstrating that the chances of success vary as failed

attempts accumulate. Patient age was not a negative factor for receiving donated oocytes, and indication for OD was also irrelevant to

outcome. Data gave an overall mean number of 2.6 (CI 2.5-2.6) embryo transfers and 5.8 transferred embryos per newborn (CI 5.8-5.8).

Due to some difficulties in the management of donors and recipients, we developed a very strong vitrification program. In a randomized

prospective trial, we included 600 recipients based on a computer randomization list in vitrification (N=300) or fresh groups (N=300).

Vitrification was performed by the Cryotop method. The primary end point was the ongoing pregnancy rate (OPR) per randomized

patient The OPR was 43.7% and 41.7% in the vitrification and fresh groups respectively. Thus, vitrification is considered today a very

helpful tool in our OD program for several reasons. First, synchronization between donor and recipient is not a problem anymore;

Second, there is no waiting list or bleeding in our foreign patients because the patient gets started once the oocytes have been vitrified;

Third, we can apply the same safety measures that for sperm, namely we are able to check the infectious status of the donor 6 months

after the retrieval of the eggs. This is very reassuring for our patients; Last, but not least, the success of our OD program has not been

hampered by vitrification.

L9 - Oocyte Donation

Antonio PellicerInstituto Valenciano de Infertilidad (IVI)Valencia, Spain

16

L10 - Germ line stem cells ageing

Leanne JonesLaboratory of Genetics; The Salk Institute for Biological StudiesLa Jolla, USA

17

L11 - Fertility preservation: oncology and social reasons

Neri LauferHadassah University HospitalEin Karem, Jerusalem, Israel

18

Notes

19

Notes

20

Serono Symposia International Foundation Representative officeSalita di San Nicola da Tolentino 1/B 00187 Rome, Italy.T +39.06.420.413, F +39.06.420.413.677

Headquarters14, Rue du Rhone, 1204 Geneva, Switzerland

Copyright © Serono Symposia International Foundation, 2012. All rights reserved

Improving the patient’s life through medical educationwww.seronosymposia.org

l d T di S NiS litee officativesentReprernational Fono Symposia IntSer

mosynores.wwwImproving the pa

g

ltino 1/B 00187 Rome, Itl T

oundationnational F

r.oaispom tient’s life through medical education

education

14, Rue du Rhone, 1204 serHeadquart

T +39.06.420.413, F +39.06.420.413.677ola da Ta di San NicSalit

a, Switzerlandv Gene

06.420.413.677.yalentino 1/B 00187 Rome, Itol T o

ono Symposia IntCopyright © Ser

oundation, 2012. All rights rernational F mposia Int

edeserv hts r