Abstract
World Congress on Building Consensus in Gynecology, Infertility and Perinatology
Barcelona, Spain, 3–6 May 2012.
On 3–6 May 2012 The World Congress on Building Consensus out of Controversies in Gynecology, Infertility and Perinatology was held in Barcelona (Spain) and as usual there was discussion of topics from the disciplines of obstetrics, gynecology and infertility. The congress was very well organized, with a very satisfactory attendance of approximately 1000 participants.
In the field of maternal–fetal medicine interesting presentations were made on the prevention of intrauterine growth restriction and on the anomalies of fetal hemodynamics. The strategies proposed make it possible to prevent subsequent diseases in the child such as hypertension, diabetes, obesity, arteriosclerosis and other dislipemias. If these diseases later affect women who become mothers, they will increase morbidity on the fetus, thus potentially creating a dangerous vicious circle. Modern obstetrics identifies these risks and avoids the alteration of epigenetic factors that could be fatal for the health of the future child.
The crucial importance of preventing prematurity was covered very well in the keynote lectures presented by K Nicolaides (King’s College London, UK) and R Romero (National Institute of Health, MD, USA), which clearly stated the need for proper prenatal control and the benefits of treatment with natural progesterone as prophylaxis against preterm birth. Important works were also presented on the use of the uterine pessary to keep the uterine cervix closed in cases of short cervix detected by ultrasound, so that pregnancy can be prolonged until risk-free fetal viability can be achieved. Another issue debated in this section was the management of multiple pregnancies, which was dealt with from the perspective of maternal–fetal medicine with a view to finding the correct method of managing these pregnancies, with special attention to monochorionic twins and their serious complications. A consensus was reached on the time to finalize pregnancies that should never exceed 37 weeks in the case of monochorionic pregnancies without complications and 38–39 weeks for dichorionic twins.
In the gynecology section there were very interesting debates on laparoscopic surgery of deep endometriosis and the advantages that could be offered by robotic surgery, both in this indication and in other gynecological pathologies that need a myomectomy or a standard, or even radical, hysterectomy in cases of a uterine–ovarian oncological condition.
There was a special relevance in the presentation of the results of the two clinical trials carried out with ulipristal acetate, a selective progesterone receptor modulator for the medical treatment of uterine myomas. It is remarkable to see how a treatment that was initially proposed for the preoperative correction of anemia and a general poor state of patients with excessive uterine bleeding due to myomas led to very early amenorrhea with very few secondary effects and a high degree of efficacy in reducing the size of the myomas. This therapeutic approach has made it possible for the authors to avoid many surgical procedures in patients with uterine myomas that had previously been considered to require surgical treatment.
All of the sessions that dealt with matters related to menopause were well attended, as were those that covered contraceptive techniques. In these sessions new molecules and new administration routes were presented that will increase efficacy, safety and most of all, compliance by patients. In this regard, the last decade has seen the evolution of hormone-replacement therapy to relieve symptoms in menopausal patients, and the authors have moved on from giving high doses of hormone preparations that contain estrogens and/or progesterone and maintaining them over long periods of time to only treating patients who have serious symptoms that adversely affect their wellbeing. The same evolution has taken place with hormonal contraceptives, in which the doses of estrogens have been reduced, estrogen and gestagen molecules have been changed, and the form of administration has also undergone changes.
There were also some very interesting sessions in the area of reproductive medicine for the treatment of infertility, with in-depth discussions of the new physiopathological mechanisms that regulate ovarian function both in connection with the secretion of steroidal hormones as well as with ovulation itself. The current state of knowledge in this field permitted a wide-ranging debate of the different protocols for stimulating ovulation and their application to assisted reproduction techniques. A consensus was reached on the number of oocytes necessary to achieve a pregnancy with a baby delivered at term accepting the concept of ‘oocyte to baby rate’, and it seems that 14–18 oocytes are necessary in order to achieve a full-term pregnancy. This strategy is in line with the philosophy of combining mild stimulation protocols that respect the ovarian physiology and yield six to eight mature oocytes in each cycle with informing the patients of the accumulated pregnancy rates that are reached with one or two stimulation cycles and follicular aspiration and the successive transfers of fresh embryos plus later transfers of frozen and thawed embryos. The recommendation would be to use mild stimulation protocols with low risk of ovarian hyperstimulation combining gonadotropin releasing hormone antagonists with low doses of gonadotropins and ovulatory discharge with a bolus of a gonadotropin releasing hormone agonist.
Preimplantation genetic diagnosis and preimplantation genetic screening were other star topics that were the subject of wide-ranging debate. Recent studies of comparative genomic hybridization were presented that showed how this technique makes it possible to analyze all the chromosomes of the embryo and not just the eight to ten chromosomes that are available when using FISH. Results were also presented on preimplantational genetic diagnosis of monogenic diseases through PCR and microarray techniques.
Last but not least, the Congress heard the presentation of a recent and very extensive epidemiological study from Australia that confirmed the greater risk of congenital anomalies presented by children born as a result of assisted reproduction techniques, especially following intracytoplasmic sperm injection. However, it was made clear that this risk was more due to the condition of previous infertility presented by these patients rather than to the treatment that they had undergone.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.