Over the last decade, we have witnessed major improvements in both the efficacy and safety of ART. This is the result of constant progress in all disciplines involved in our field, including molecular biology, reproductive genetics, cryobiology, pharmacology and clinical standards in practice. In the infertility section of the congress, leading experts, each in their own field, with active participation of congress delegates in an intimate and interactive atmosphere, will bring together the consensus and state-of-the-art summaries on many topics that were once controversial and disputed. Also, ongoing controversies will be addressed in the popular format of open debates, a format that has become so closely identified with BCGIP-COGI meetings.
Pre-implantation Diagnosis and Screening
Pre-implantation genetic screening (PGS) has brought great hope and promise to our field. Early enthusiasm was replaced by skepticism and disappointment following several negative publications in leading journals. Nowthe pendulum is swinging again, with new methods for sampling and analysis being introduced. Similar methods are applied for pre-implantation genetic diagnosis (PGD), as the extent and scope of PGD use are escalating. In many programs, PGD cycles have become a considerable percentage of treatment cycles, and many non-infertile patients are now undergoing ART. Advances in techniques and instrumentation for PGS/PGD will be covered in dedicated sessions.
Poor responders have always been and will probably remain the most difficult and frustrating patient group in our field. Nevertheless, we have come to recognize that there are now treatment regimens that can dramatically change the significantly compromised prognosis of poor responders. Advances have been made in the definition (ESHRE-Bologna consensus), prediction (new ultrasound and serum biomarker criteria),genetic susceptibility (i.e., FSH receptor polymorphism, fragile-x gene polymorphism) and, perhaps also therapeutic interventions (i.e., androgens, GnRH antagonists and other adjuvant therapies). A session of update presentations combined with panel discussion will focus on poor responders.
The endometrium has been the most neglected component in the reproductive process. New insights into endometrial function and dysfunction in the process of implantation have emerged, by means of invasive (Endometrial Receptivity Array) and non-invasive (endometrial fluid analysis) diagnosis. Novel interventions (mechanical irritation, intrauterine G-CSF, and use of stem cells) have been proposed in order to enhance endometrial receptivity.
Luteal Phase Support
Despite the longstanding recognition that luteal phase support is mandatory in ART cycles, there is no consensus yet regarding the composition (Progesterone alone? Estrogen?), route and formulation (vaginal, IM, oral) and optimal duration of administration. The problem of luteal phase support following the use of GnRH agonists as the ovulatory trigger becomes more relevant and "pressing" with the increased use of GnRH antagonist protocols in high responder patients.
Non-invasive Prenatal Diagnosis
The aim of non-invasive prenatal testing (NIPD) is to obtain diagnostic information about a pregnancy without causing harm to the unborn child. Currently, diagnosis of genetic conditions (e.g. Down syndrome, other aneuploidies) during a pregnancy is performed using invasive procedures, such as amniocentesis or CVS, which carry a slight risk for miscarriage.
The discovery of circulating cell-free fetal DNA (cffDNA) in maternal plasma allowed for the development of alternative methodologies that may facilitate safe non-invasive prenatal diagnosis (NIPD). Thus, the main challenge to non-invasive prenatal testing (NIPD) is the very small amount of fetal DNA that is present in maternal circulation.
The congress will offer a great opportunity to discuss and debate topics of intense interest and controversy such as analysis of cell free fetal nucleic acids, the role of small RNA and micro RNAs, the role of conventional aneuploidy markers in the era of non-invasive prenatal diagnosis, the role of sonography in the NIPD era, the Intersection of Genetic Technologies and Prenatal Diagnosis - Where have we been and where are we going?, Prenatal array CGH – yield and issues and are we really close to replacing conventional karyotyping with universal aCGH . The world leaders in NIPD research and diagnosis will present and discuss the most recent innovations in this field.
Facing the Non-communicable Diseases (NCD) Global Epidemic
Cardiovascular diseases, diabetes, cancers and chronic respiratory diseases are the common non-communicable diseases (NCDs). While maternal under-nutrition and its links to future NCDs in offspring have been more widely studied, similar mechanisms may apply to other conditions such as maternal malaria and HIV/AIDS which also result in low birth weight and SGA babies. Recently the NCD Global Epidemic was described as a "slow motion disaster” by the General Director of WHO.
It's quite clear that the battle for prevention of NCDs begins during intrauterine life. Thus management strategies of maternal conditions predisposing the offspring to "programming of NCD" are essential and will be discussed and debated by the key world opinion leaders during the Congress.
Gestational Diabetes Mellitus - Towards a Universal Consensus
Diabetes during pregnancy presents serious risks to both the woman and her offspring. Undiagnosed or poorly managed diabetes or hyperglycemia during pregnancy is associated with a significantly higher risk of maternal and perinatal morbidity and mortality as well as poor pregnancy outcomes including spontaneous abortions, stillbirths, congenital anomalies, macrosomia, need for caesarean delivery, and assisted deliveries. The speakers will discuss recent innovations in diagnosing GDM. Evidence will be brought on the cost effectiveness of universal screening of GDM based on the newest diagnostic criteria and there will be discussions of national and international projects dealing with changes in health care policy – Towards a consensus including highlights from the NIH Consensus Conference that will be held in October 2012, Washington D.C., US.
Obesity and Pregnancy Outcome
Obesity is a growing threat to women of childbearing age. Half the population is either overweight or obese. Increased maternal weight or excessive weight gain in pregnancy is associated with adverse pregnancy outcomes. A substantial number of women who die during pregnancy, childbirth, or puerperium are either obese or overweight. For the offspring, maternal obesity is a major risk factor for childhood obesity, which persists into adulthood independent of other factors. Topics to be discussed in this session: Obesity and Reproduction. Maternal and Fetal Risks and Outcome, Does it matter what pregnant women eat? Impact of maternal nutrition on pregnancy outcome, Interventions to improve pregnancy outcome in obese pregnancy; implications for mother and child. To weigh or not: where do we stand, where do we go next? What should we advise? The role of bariatric surgery in the treatment of obesity and its impact on pregnancy outcome.
Fetal Congenital Anomalies
Congenital malformations are more common in infants of diabetic women than in children of non-diabetic women. The etiology, pathogenesis and prevention of diabetes-induced malformations have spurred considerable clinical and basic research efforts. The ultimate aim of these studies has been to obtain an understanding of the teratogenic process, which may enable precise preventive therapeutic measures in diabetic pregnancies. Key leaders will discuss the following: Are congenital anomalies preventable? MRI Diagnosis of Congenital Anomalies in Diabesity; Use or Abuse? Sonographic Diagnosis of congenital anomalies in Diabesity. Options and difficulties of ultrasound in obese pregnant women. Critical evaluation - Ultrasound surveillance in Diabesity: Any extra scans needed?
New Frontiers in Prediction and Prevention of Preeclampsia
Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. The possible use of a screening test with high predictive accuracy in patients with high-risk or low-risk of preeclampsia remains to be investigated. Effective primary prevention is not possible because the causes are still unknown, but to identify and to modify susceptible risk factors might decrease the frequency of preeclampsia. We therefore will discuss the pathogenesis of preeclampsia, Epidemiology and risk factors, Gestational hypertension vs. preeclampsia – Is it the same disease? Risk stratification of hypertensive pregnancy disorders. Is prediction and prevention of preeclampsia possible? Which prophylactic therapy should we use in women at high risk for PET?
DoHAD - Developmental Origins of Health and Disease - Mother and Offspring
The concept of fetal programming and its consequences is paradigm changing. It highlights that pregnancy offers a window of opportunity to provide maternal care services: it can not only reduce the traditionally known maternal and perinatal morbidity and mortality indicators, but also has great potential for intergenerational prevention of several chronic diseases, such as diabetes, arterial hypertension, cardiovascular disease, and stroke. Thus, with one high-quality intervention related to maternal and child health services, it is now possible to achieve several objectives with far-reaching health and economic benefit.
The Placenta; New Insights into Basic and Clinical Research
This session will discuss and debate various topics related to Maternal, Placental, Fetal Dialogues and its Influence on Pregnancy Outcome: Placental origins of Diabesity; Cardiovascular consequences of placental diseases; Placental – Maternal dialogue and the origin of preeclampsia; Fetal growth restriction - The role of the placenta; Trans-Placental Transport - A Biological Model of the Placental Barrier
Additional related topics that will be discussed:
Abnormal fetal growth - Challenging the extremes
Labor and delivery – Prevention of asphyxia
Controversies to consensus: prenatal genetic diagnosis
Perinatal infections - from antenatal diagnosis to appropriate neonatal treatment
Preterm delivery - Innovations and future prospectives
Challenging the limits of viability
Perinatal medicine around the world
Thrombophilia and pregnancy complications
The first trimester: a window of opportunities: screening for adverse perinatal outcome
Novel approach to multiple pregnancies