Approaches to improve the diagnosis and management of infertility
Identifieur interne : 001761 ( Istex/Corpus ); précédent : 001760; suivant : 001762Approaches to improve the diagnosis and management of infertility
Auteurs : P. Devroey ; B. C. J. M. Fauser ; K. DiedrichSource :
- Human Reproduction Update [ 1355-4786 ] ; 2009.
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 2627 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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DOI: 10.1093/humupd/dmp012
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Fauser</name><affiliation><mods:affiliation>Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Diedrich, K" sort="Diedrich, K" uniqKey="Diedrich K" first="K." last="Diedrich">K. Diedrich</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:BE666B80C033767BF08B3E0A5D38C703EA8F30ED</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1093/humupd/dmp012</idno><idno type="url">https://api.istex.fr/document/BE666B80C033767BF08B3E0A5D38C703EA8F30ED/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001761</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Approaches to improve the diagnosis and management of infertility</title><author><name sortKey="Devroey, P" sort="Devroey, P" uniqKey="Devroey P" first="P." last="Devroey">P. Devroey</name><affiliation><mods:affiliation>Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium</mods:affiliation></affiliation><affiliation><mods:affiliation>4Correspondence address. Tel: 32-2-477-66-60; Fax: 32-2-477-66;</mods:affiliation></affiliation></author><author><name sortKey="Fauser, B C J M" sort="Fauser, B C J M" uniqKey="Fauser B" first="B. C. J. M." last="Fauser">B. C. J. M. Fauser</name><affiliation><mods:affiliation>Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Diedrich, K" sort="Diedrich, K" uniqKey="Diedrich K" first="K." last="Diedrich">K. Diedrich</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Human Reproduction Update</title><idno type="ISSN">1355-4786</idno><idno type="eISSN">1460-2369</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009">2009</date><biblScope unit="volume">15</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="391">391</biblScope><biblScope unit="page" to="408">408</biblScope></imprint><idno type="ISSN">1355-4786</idno></series><idno type="istex">BE666B80C033767BF08B3E0A5D38C703EA8F30ED</idno><idno type="DOI">10.1093/humupd/dmp012</idno><idno type="ArticleID">dmp012</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1355-4786</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 2627 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>P. Devroey</name><affiliations><json:string>Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium</json:string><json:string>4Correspondence address. Tel: 32-2-477-66-60; Fax: 32-2-477-66;</json:string></affiliations></json:item><json:item><name>B.C.J.M. Fauser</name><affiliations><json:string>Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands</json:string></affiliations></json:item><json:item><name>K. Diedrich</name><affiliations><json:string>Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>infertility work-up</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>in vitro fertilization</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ovarian response</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>predictive factors</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>single embryo transfer</value></json:item></subject><articleId><json:string>dmp012</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>review-article</json:string></originalGenre><abstract>BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 2627 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. 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Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissionsoxfordjournals.org</p></availability><date>2009-04-20</date></publicationStmt><notesStmt><note>The Third Evian Annual Reproduction (EVAR) Workshop Meeting (2627 April 2008) was organized to discuss personalized approaches to the diagnosis and management of infertility and was supported by an unrestricted educational grant from Merck Serono S.A.Geneva. The content of this manuscript is based on the presentations and discussions of the EVAR Workshop Meeting. The meeting was chaired by P.D. (Free University Brussels, Brussels, Belgium), K.D. (University Clinic of Schleswig-Holstein, Luebeck, Germany) and B.C.J.M.F. (University Medical Center, Utrecht, The Netherlands). The speakers included Carlo Alviggi (Universit degli Studi di Napoli Federico II, Naples, Italy), Esther Baart (University Medical Center, Utrecht, The Netherlands), Christopher Barrat (Ninewells Hospital, Dundee, UK), Christina Bergh (Sahlgrenska University Hospital, Gothenburg, Sweden), Frank Broekmans (University Medical Center, Utrecht, The Netherlands), Johannes L.H. Evers (Maastricht University Medical Center, Maastricht, The Netherlands), Georg Griesinger (University Clinic of Schleswig-Holstein, Luebeck, Germany), Stephen Keay (University of Warwick, Coventry, UK), Franois Olivennes (ART unit Eylau La Muette, Paris, France), Gamal Serour (Al-Azhar University, Cairo, Egypt), Catherine Staessen (Vrije Universiteit, Brussels, Belgium), Arne Sunde (St Olav's University Hospital in Trondheim, Norway), Christos Venetis (Aristotle University of Thessaloniki, Greece) and Hakan Yarali (Hacettepe University, Ankara, Turkey). Colin M. Howles (Merck Serono S.A.Geneva) and Julian Jenkins (previously of Merck Serono S.A.Geneva) were in attendance.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Approaches to improve the diagnosis and management of infertility</title><author><orgName>on behalf of the Evian Annual Reproduction (EVAR) Workshop Group 2008</orgName></author><author xml:id="author-2"><persName><forename type="first">P.</forename><surname>Devroey</surname></persName><affiliation>Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium</affiliation><affiliation>4Correspondence address. Tel: 32-2-477-66-60; Fax: 32-2-477-66;</affiliation></author><author xml:id="author-3"><persName><forename type="first">B.C.J.M.</forename><surname>Fauser</surname></persName><affiliation>Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands</affiliation></author><author xml:id="author-4"><persName><forename type="first">K.</forename><surname>Diedrich</surname></persName><affiliation>Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany</affiliation></author></analytic><monogr><title level="j">Human Reproduction Update</title><idno type="pISSN">1355-4786</idno><idno type="eISSN">1460-2369</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009"></date><biblScope unit="volume">15</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="391">391</biblScope><biblScope unit="page" to="408">408</biblScope></imprint></monogr><idno type="istex">BE666B80C033767BF08B3E0A5D38C703EA8F30ED</idno><idno type="DOI">10.1093/humupd/dmp012</idno><idno type="ArticleID">dmp012</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-04-20</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 2627 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>infertility work-up</term></item><item><term>in vitro fertilization</term></item><item><term>ovarian response</term></item><item><term>predictive factors</term></item><item><term>single embryo transfer</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-04-20">Created</change><change when="2009">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/BE666B80C033767BF08B3E0A5D38C703EA8F30ED/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="review-article"><front><journal-meta><journal-id journal-id-type="publisher-id">humupd</journal-id><journal-id journal-id-type="hwp">humupd</journal-id><journal-title>Human Reproduction Update</journal-title><issn pub-type="ppub">1355-4786</issn><issn pub-type="epub">1460-2369</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/humupd/dmp012</article-id><article-id pub-id-type="publisher-id">dmp012</article-id><article-categories><subj-group subj-group-type="heading"><subject>Reviews</subject></subj-group></article-categories><title-group><article-title>Approaches to improve the diagnosis and management of infertility</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Devroey</surname><given-names>P.</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="corresp" rid="cor1">4</xref></contrib><contrib contrib-type="author"><name><surname>Fauser</surname><given-names>B.C.J.M.</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Diedrich</surname><given-names>K.</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><collab>on behalf of the Evian Annual Reproduction (EVAR) Workshop Group 2008</collab><xref ref-type="fn" rid="FN1">†</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Center of Reproductive Medicine</addr-line>, <institution>Free University Brussels</institution>, <addr-line>Laarbeeklaan 101, 1090 Brussels</addr-line>, <country>Belgium</country></aff><aff id="af2"><label>2</label><addr-line>Department of Reproductive Medicine and Gynaecology</addr-line>, <institution>University Medical Center</institution>, <addr-line>Heidelberglaan 100, 3584 CX Utrecht</addr-line>, <country>The Netherlands</country></aff><aff id="af3"><label>3</label><addr-line>Department of Obstetrics and Gynecology</addr-line>, <institution>University Clinic of Schleswig-Holstein</institution>, <addr-line>Campus Luebeck, 23538 Luebeck</addr-line>, <country>Germany</country></aff><author-notes><fn id="FN1"><label>†</label><p>The Third Evian Annual Reproduction (EVAR) Workshop Meeting (26–27 April 2008) was organized to discuss personalized approaches to the diagnosis and management of infertility and was supported by an unrestricted educational grant from Merck Serono S.A.—Geneva. The content of this manuscript is based on the presentations and discussions of the EVAR Workshop Meeting. The meeting was chaired by P.D. (Free University Brussels, Brussels, Belgium), K.D. (University Clinic of Schleswig-Holstein, Luebeck, Germany) and B.C.J.M.F. (University Medical Center, Utrecht, The Netherlands). The speakers included Carlo Alviggi (Università degli Studi di Napoli Federico II, Naples, Italy), Esther Baart (University Medical Center, Utrecht, The Netherlands), Christopher Barrat (Ninewells Hospital, Dundee, UK), Christina Bergh (Sahlgrenska University Hospital, Gothenburg, Sweden), Frank Broekmans (University Medical Center, Utrecht, The Netherlands), Johannes L.H. Evers (Maastricht University Medical Center, Maastricht, The Netherlands), Georg Griesinger (University Clinic of Schleswig-Holstein, Luebeck, Germany), Stephen Keay (University of Warwick, Coventry, UK), François Olivennes (ART unit Eylau La Muette, Paris, France), Gamal Serour (Al-Azhar University, Cairo, Egypt), Catherine Staessen (Vrije Universiteit, Brussels, Belgium), Arne Sunde (St Olav's University Hospital in Trondheim, Norway), Christos Venetis (Aristotle University of Thessaloniki, Greece) and Hakan Yarali (Hacettepe University, Ankara, Turkey). Colin M. Howles (Merck Serono S.A.—Geneva) and Julian Jenkins (previously of Merck Serono S.A.—Geneva) were in attendance.</p></fn><corresp id="cor1"><label>4</label>Correspondence address. Tel: <phone>+32-2-477-66-60</phone>; Fax: <fax>+32-2-477-66</fax>; E-mail: <email>paul.devroey@uzbrussel.be</email></corresp></author-notes><pub-date pub-type="ppub"><season>July-August</season><year>2009</year></pub-date><pub-date pub-type="epub"><day>20</day><month>4</month><year>2009</year></pub-date><volume>15</volume><issue>4</issue><fpage>391</fpage><lpage>408</lpage><history><date date-type="received"><day>5</day><month>11</month><year>2008</year></date><date date-type="rev-recd"><day>19</day><month>2</month><year>2009</year></date><date date-type="accepted"><day>18</day><month>3</month><year>2009</year></date></history><copyright-statement>© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2009</copyright-year><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/uk/"><p>The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p></license><abstract><sec><title>BACKGROUND</title><p>Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26–27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts.</p></sec><sec><title>METHODS</title><p>Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge.</p></sec><sec><title>RESULTS</title><p>It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches.</p></sec><sec><title>CONCLUSIONS</title><p>Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.</p></sec></abstract><kwd-group><kwd>infertility work-up</kwd><kwd><italic>in vitro</italic> fertilization</kwd><kwd>ovarian response</kwd><kwd>predictive factors</kwd><kwd>single embryo transfer</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Approaches to improve the diagnosis and management of infertility</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Approaches to improve the diagnosis and management of infertility</title></titleInfo><name type="corporate"><namePart>on behalf of the Evian Annual Reproduction (EVAR) Workshop Group 2008</namePart></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Devroey</namePart><affiliation>Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium</affiliation><affiliation>4Correspondence address. Tel: 32-2-477-66-60; Fax: 32-2-477-66;</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B.C.J.M.</namePart><namePart type="family">Fauser</namePart><affiliation>Department of Reproductive Medicine and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.</namePart><namePart type="family">Diedrich</namePart><affiliation>Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="review-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2009</dateIssued><dateCreated encoding="w3cdtf">2009-04-20</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 2627 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.</abstract><note type="footnotes">The Third Evian Annual Reproduction (EVAR) Workshop Meeting (2627 April 2008) was organized to discuss personalized approaches to the diagnosis and management of infertility and was supported by an unrestricted educational grant from Merck Serono S.A.Geneva. The content of this manuscript is based on the presentations and discussions of the EVAR Workshop Meeting. The meeting was chaired by P.D. (Free University Brussels, Brussels, Belgium), K.D. (University Clinic of Schleswig-Holstein, Luebeck, Germany) and B.C.J.M.F. (University Medical Center, Utrecht, The Netherlands). The speakers included Carlo Alviggi (Universit degli Studi di Napoli Federico II, Naples, Italy), Esther Baart (University Medical Center, Utrecht, The Netherlands), Christopher Barrat (Ninewells Hospital, Dundee, UK), Christina Bergh (Sahlgrenska University Hospital, Gothenburg, Sweden), Frank Broekmans (University Medical Center, Utrecht, The Netherlands), Johannes L.H. Evers (Maastricht University Medical Center, Maastricht, The Netherlands), Georg Griesinger (University Clinic of Schleswig-Holstein, Luebeck, Germany), Stephen Keay (University of Warwick, Coventry, UK), Franois Olivennes (ART unit Eylau La Muette, Paris, France), Gamal Serour (Al-Azhar University, Cairo, Egypt), Catherine Staessen (Vrije Universiteit, Brussels, Belgium), Arne Sunde (St Olav's University Hospital in Trondheim, Norway), Christos Venetis (Aristotle University of Thessaloniki, Greece) and Hakan Yarali (Hacettepe University, Ankara, Turkey). Colin M. Howles (Merck Serono S.A.Geneva) and Julian Jenkins (previously of Merck Serono S.A.Geneva) were in attendance.</note><subject><genre>keywords</genre><topic>infertility work-up</topic><topic>in vitro fertilization</topic><topic>ovarian response</topic><topic>predictive factors</topic><topic>single embryo transfer</topic></subject><relatedItem type="host"><titleInfo><title>Human Reproduction Update</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1355-4786</identifier><identifier type="eISSN">1460-2369</identifier><identifier type="PublisherID">humupd</identifier><identifier type="PublisherID-hwp">humupd</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>391</start><end>408</end></extent></part></relatedItem><identifier type="istex">BE666B80C033767BF08B3E0A5D38C703EA8F30ED</identifier><identifier type="DOI">10.1093/humupd/dmp012</identifier><identifier type="ArticleID">dmp012</identifier><accessCondition type="use and reproduction" contentType="copyright">The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. 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