From July 5 to 8, representatives from Carrot attended the 36th annual (and first fully virtual) conference hosted by the European Society of Human Reproduction and Embryology (ESHRE). ESHRE collaborates with scientists, clinicians, embryologists, midwives, nurses, psychologists, mental health experts, ethicists, representative patient groups, legal experts, and policy makers globally to promote continuous improvement in scientific research and clinical practice in fertility care and broader reproductive health issues. This year, there were over 12,000 virtual attendees representing 136 countries at the fully-virtual conference, with 47% of attendees from Europe and 53% from the rest of the world.
There were many important lectures and plenaries throughout the conference. Our team was unable to attend them all, but here are a few of biggest takeaways from the sessions we attended.
Frequency of elective single embryo transfers (eSET) continues to increase, and fertility preservation for the purpose of delayed child-bearing is on the rise in Europe
The European IVF Consortium (EIM), which collects data from 91% of European countries active in assisted reproductive technology (ART), presented data covering a number of areas including fertility preservation, number of transferred embryos, and usage of preimplantation genetic testing (PGT). Based on data from 11 countries, their findings show that the use of both semen and oocyte cryopreservation continues to significantly rise where legally allowed. Their data also indicated that the number of transferred embryos is declining for the majority of reporting countries, leading to a decrease in the percentage of twin and triplet deliveries after IVF/intracytoplasmic sperm injection (ICSI).
Data from the International Committee Monitoring Assisted Reproductive Technologies (ICMART) also revealed a decrease in multiple births and an increase in single embryo transfer (SET), although the ICMART study did not differentiate their data between single embryo transfer (only one embryo available for ET) and elective single embryo transfer.
Preferences and policies to consider for patients, donors, and children for donor-assisted reproduction continue to be highly debated
Throughout one lecture series, there was a general agreement that an individual’s right to know their genetic origins is a fundamental component impacting psychological well-being. Additionally, health professionals and organizations generally expressed a positive view towards having access to identifying donor information.
Similarly, a discussion about the rise of low-cost DNA testing kits pointed out that this availability has given adoptees and children born through donor assisted reproduction the ability to identify their genetic origins and vice versa. Final remarks questioned whether there is a need for new legislation to best maintain privacy and the wishes of donors as well as those born through donor-assisted reproduction.
Experts voiced a need for further enhancement of patient fertility awareness and education
While there have been positive developments in fertility awareness and education, opportunities for patients to increase their knowledge on the topic and its subsequent impact on their future plans remain. One fertility clinic in the Netherlands referenced data showing that 80% of patients forget information presented by their doctor immediately after their visit — and 50% remember the information incorrectly.
The study presented during this lecture used a mobile application to provide interactive educational information to assess change of knowledge, self-reliance, and consumption of fertility care. Conclusions revealed that patients who used the app ultimately achieved a higher level of knowledge and perceived quality of care. This suggests that huge gaps in knowledge remain, and few individuals think about future planning or when to start attempting pregnancy, if a future family is desired.
Interruptions of fertility care due to COVID-19 have negatively impacted patient mental health
Multiple lectures addressed how loss of access to care due to COVID-19 relates to mental health and the patient experience. Many speakers attributed increased levels of stress and anxiety to uncertainty.
Many speakers shared their suggestions for how clinics and practitioners can best help their patients manage stress and anxiety during uncertain times, including:
- Guiding patients to psychological counseling when appropriate
- Developing more direct and personalized sources of communication (for example, a customized app) aimed at reducing uncertainty
- Helping individuals better understand the reality of access to fertility care and other health care, for example, within a fluctuating COVID-19 environment
Innovations impacting clinical care: Laboratory to clinical decision-making
Many new initiatives and innovations in reproductive medicine were highlighted during ESHRE, both inside and outside the laboratory. A few of the most notable we saw included:
- New artificial intelligence-powered tools to assess outcomes for ART patients are proliferating. In one study highlighted by a group in France, they detailed an experimental evolutive predictive tool that readjusts the probability of live birth as new information becomes available during an ART cycle. The probabilities and predictions were based upon data from the French ART registry. This tool, and others like these AI and machine learning algorithmic tools, will help to assist both clinicians and patients with their decision-making processes while also providing evidence that can help with personalized counseling for patients throughout their treatment processes.
- Preimplantation genetic testing (PGT) and expanded carrier screening were other areas of active research and ethical debate. Agilent’s OnePGT solution, in particular, was interesting — this technology is being developed to integrate pre-implantation genetic testing, allowing for PGT-A, PGT-M, and PGT-SR from a single biopsy (however, currently being used for research purposes only). Expanded carrier screening and the ability to assess those attempting pregnancy for a greater number of heritable diseases was not only discussed technically but also ethically.
- Automation and machine learning in the laboratory continue to be highly debated topics as new products are developed and introduced. There was no question that automation of time-lapse embryo imaging has assisted in basic research and the understanding of early human embryo development. From a clinical and practical perspective, conclusions were that these automations will likely continue to increase costs in the short-term and will continue to require highly-trained embryologists for gamete and embryo manipulation, as well as for the final interpretation of outcome data. It had been suggested that these increased costs could be offset by an increase in SETs, increase in singleton pregnancy rates, a potentiality for higher live birth rates, and a stronger potential for a decrease in time to pregnancy.
At Carrot, our members are at the core of everything we do. We look forward to putting these insights into action and collaborating with leading global experts to support Carrot members throughout their journeys across our 40+ (and growing) supported countries. If you would like to learn more about Carrot, reach out today.