2019 HIGHLIGHTS OF THE ANNUAL MEETING OF THE EUROPEAN SOCIETY OF HUMAN REPRODUCTION AND EMBRYOLOGY 23rd-26th June 2019 Austria, Vienna The purpose of this report is to capture highlights from the ESHRE 2019 congress. The REPROFACTS faculty has selected the studies presented in this report; putting study findings in perspective and extracting the practice points. The faculty members were independent in their choice of studies and their evaluation and this report is based on the REPROFACTS 2019 Post-ESHRE meeting. The development of this congress report has been financially supported by MERCK KGaA, whereas MERCK KGaA had no influence on the content and scientific opinions presented in the congress report do not necessarily represent the position of MERCK KGaA. MERCK KGaA is not responsible for the content of the report. Consequently, MERCK KGaA does not give any warranty, express or implied, regarding the scientific use of this report, orregarding any other particular use for any purpose, and MERCK KGaA therefore is not liable for any direct, indirect, incidental, or consequential damages related to the use of the information contained herein. August 2019 GBPMLR/NONF/0819/0199 Sponsored by INTRODUCTION TO REPROFACTS INTRODUCTION TO REPROFACTS The Annual Meeting of ESHRE is considered by many to be the world’s major and most important Faculty members event in the field of reproductive science and medicine. The latest Annual Meeting was held in Vienna, from 24 to 26 June 2019, attracting 12,003 delegates from 130 countries. All relevant innovations Prof. Dr. med. habil. Jürgen M. in reproductive science found a platform for exchange and communication at ESHRE 2019. The main Dr. rer. nat. Jens Hirchenhain Weiss Düsseldorf. Subspeciality: clinical scientific program consisted of 234 peer-reviewed oral communications and 63 invited lectures, with Lucerne. Subspecialities: female infertility embryology an additional 789 posters in electronic format. and ovarian stimulation The key themes ranged from the role of luteal phase support, male infertility and the importance of Prof. Dr. med. Heribert Kentenich Prof. med. Ludwig Wildt Berlin. Subspecialities: safety and quality, counselling the patient, to debates on the increased incidence of ICSI and freeze-all. The ESHRE 2019 Innsbruck. Subspeciality: endocrinology program was truly packed with inspiring content. law and ethics, psychology Priv.-Doz. Dr. rer. nat. Verena However, the wealth and breadth of information can make it challenging for individual delegates to Prof. Dr. med. Michael von Wolff Nordhoff, Bern. Subspecialities: fertility preservation, not only understand the general themes but to also single out and focus on the truly relevant news Münster. Subspecialities: basic science ovarian reserve, early pregnancy from each subspecialty. For that reason, the REPROFACTS initiative was founded in Germany in 2011. and reproductive genetics Eight experts in different subspecialties share among them the whole scientific program of the Prof. Dr. med. Kazem Nouri Prof. Dr. med. Michael Zitzmann Vienna. Subspecialities: endometrium, annual meeting, visiting the lectures, browsing the posters, speaking to the presenters, investigating Münster. Subspeciality: andrology the background and finally selecting what they think represents the “must-know” content from the endometriosis, surgery conference. Nine days after the conclusion of the ESHRE meeting, the REPROFACTS meeting was held in Frankfurt, Germany. The REPROFACTS faculty presented their selection of studies to a large audience of practicing clinicians and embryologists, putting study findings in perspective and extracting the practice points. The faculty is totally independent in their choice of studies and their evaluation. This report contains some of the key highlights from the REPROFACTS meeting 2019. CONTENTS CONTENTS Reproductive endocrinology Progesterone on the day of embryo transfer Ovarian tumour risk after ART AMH as a driving force of PCOS Mobile apps and fertility Predicting luteal progesterone levels Fertility preservation AMH levels in adolescence and the presence of PCOS Oocyte aging Endometriosis and the endometrium IVF after caesarean section GnRHa therapy before IVF Outcomes from different ovarian tissue grafting sites Frozen embryo transfer and miscarriage rate Linzagolix for endometriosis pain Clinical embryology Endometrial scratching after one failed IVF/ICSI cycle Gene editing – past, present and future ICSI versus conventional IVF Ovarian stimulation and infertility Impact of the time interval between ovulation triggering and oocyte injection Long vs classical antagonist protocol Blastocyst morphology and NIPGT-A accuracy Comparing biosimilar to originator recombinant follitropin alfa Freeze-all versus fresh embryo transfer Andrology De novo mutations affecting male infertility Safety, psychology and counselling Impact of male factors on ICSI outcomes ART and risk of congenital heart defects Sperm morphology as a marker of nuclear quality and epigenetic status The long-term health of IVF-ICSI babies A large prospective trial in unselected population confirms that A large prospective trial in unselected population confirms that low serum progesterone on the day of embryo transfer impairs low serum progesterone on the day of embryo transfer impairs pregnancy outcome in artificial cycles, O-1731 pregnancy outcome in artificial cycles, O-1731 REPRODUCTIVE ENDOCRINOLOGY E. Labarta Demur et al E. Labarta Demur et al REPRODUCTIVE ENDOCRINOLOGY Background blastocyst transfer after endometrial preparation After adjusting for the confounders age, body with 2x400mg vaginal progesterone. On the Artificial frozen-thawed embryo transfer cycle mass index (BMI), endometrial thickness, serum day of embryo transfer, the serum level of regimens often exclusively employ vaginal E2, number of embryos transferred and origin of progesterone was measured.1 progesterone for secretory transformation of the oocytes, low progesterone levels defined as <8.8 endometrium and for early pregnancy support.2 ng/mL remained a significant negative predictor Results for ongoing pregnancy (OR 0.39, 95% CI:0.28- In a previous publication, Elena Labarta et al 1 The mean serum progesterone level was 0.53, p=0.000). have already suggested that the serum levels of 12.0±5.8 ng/mL. Serum progesterone levels progesterone achieved by vaginal administration were associated with ongoing pregnancy in Key Findings may be insufficient for optimal outcomes for univariate analysis. Women with serum P levels a substantial proportion of oocyte donation This study adds to the existing concerns about <8.8 ng/mL (percentile 30) had a significantly recipients.3 only using vaginal progesterone for luteal phase lower ongoing pregnancy rate compared to support in the context of an anovulatory artificial 1 patients above this threshold. (Figure 1) cycle, where endometrial receptivity and early Watch Prof. Ludwig Wildt discuss measuring progesterone Study Summary in the luteal phase pregnancy completely rely on the exogenous The present prospective cohort study included progesterone source.3-6 1155 patients undergoing either autologous or heterologous frozen-thawed embryo transfers in artificial anovulatory cycles. All patients had a 60 58.0 Practice message 50 Artificial frozen-thawed embryo transfer cycles are highly vulnerable due to absence of a corpus luteum.3,6 Vaginal progesterone alone might not be sufficient in this scenario.3 39.8 40 30 20 Ongoing Pregnancy Rate (%) Ongoing Pregnancy Rate 10 0 <8.8 ng/mL ≥8.8 ng/mL Serum progesterone levels RR 0.69, CI: 0.59-0.79, p<0.0001 Figure 1: Ongoing pregnancy rate at different levels of serum progesterone1 Luteal serum progesterone levels cannot be predicted Antimüllerian Hormone as a driving force of PCOS, in IVF patients - A prospective study of 432 IVF/ICSI cycles, independently from insulin-resistance, O-0091 O-1771 G. Robin et al L. Thomsen et al REPRODUCTIVE ENDOCRINOLOGY REPRODUCTIVE ENDOCRINOLOGY Background Results Background Two to three days after oocyte retrieval, serum progesterone levels were measured. The The optimal serum progesterone level in the Polycystic ovary syndrome (PCOS) patients In the control patients, AMH was only associated following predictors of progesterone levels were 1 luteal phase of a fresh in vitro fertilization (IVF) often have high serum luteinizing hormone with age and number of follicles. assessed by linear regression modelling:1 (LH) levels, which may contribute to an excess cycle after controlled ovarian stimulation, is still of androgen via theca cell stimulation.1 There In PCOS patients, higher AMH was related to under debate. It is assumed that the number of 1 Age is also high correlation between elevated Anti- increases and decreases in many variables. corpora lutea is a strong determinant of the total (Figure 1) amount of circulating progesterone.2 Müllerian hormone (AMH) serum levels and BMI follicle numbers in the polycystic ovary.1 The As yet, little is known about other determinants association of AMH with LH levels, hypothetically Key Findings of ovarian progesterone production and Number of final follicles via central stimulation of gonadotropin-releasing These observations hint at a stimulatory subsequent serum progesterone levels in the hormone (GnRH) neurons by AMH, has not yet effect of AMH on LH secretion which drives Type of ovulation trigger 1 luteal phase of an IVF cycle. been demonstrated in humans. an AMH dependent phenotype of PCOS (e.g. hyperandrogenic