Examining the evidence: progesterone supplementation during fresh and frozen embryo transfer

Autor: Elena H. Yanushpolsky, Kaylen Silverberg, Robert Boostanfar, Daniel B. Shapiro
Jazyk: angličtina
Předmět:
Zdroj: Reproductive BioMedicine Online. :S1-S14
ISSN: 1472-6483
DOI: 10.1016/S1472-6483(14)50063-6
Popis: ART has evolved over time and frozen-thawed embryo transfer (FET) is now a frequently performed, successful option. During the last decade, cryopreservation techniques have received considerable interest, whereas interest in the priming and preparation of the endometrium prior to and after embryo transfer was more limited. The available evidence for the rationale and timing of progesterone supplementation as well as an understanding of the differences among progesterone formulations with respect to efficacy, optimum use, and patient preference is worth examining. A Summit was convened to review the literature on progesterone supplementation in ART and after FET and to provide guidance on the most clinically relevant issues. Utilizing an innovative consensus-building model to examine the evidence, Summit faculty drafted summit statements prior to the meeting, completed a literature search, and created a presentation based on this. At the conclusion of their discussion the faculty developed final summit statements, evaluating the strength of the evidence supporting each statement, and rating their level of support for each statement. The clinically relevant topic areas were the rationale for progesterone supplementation, timing and appropriate dosing, whether progesterone sérum levels reflect outcomes, and distinguishing among progesterone formulations with respect to efficacy, tolerability, and patient preference/satisfaction.CME INFORMATIONExamining the Evidence: Progesterone Supplementation During Fresh and Frozen Embryo TransferCME ObjectivesAfter completing this educational activity, you should be able to:•Demonstrate a clinical understanding of the rationale for progesterone supplementation after fresh and frozen-embryo transfer;•Distinguish between progesterone formulation choices and its impact on efficacy;•Recognize the role of patient preference on the selection of progesterone formulation (i.e. convenience, tolerability, compliance).Statement of Need and PurposeAssisted reproductive technologies have evolved over time such that frozen-thawed embryo transfer (FET) is now a frequently performed and successful option. During the last decade, cryopreservation techniques have received considerable interest, whereas interest in the priming and preparation of the endometrium prior to and after embryo transfer was more limited. The available evidence, largely based on fresh embryo transfer data, for the rationale and timing of progesterone supplementation as well as an understanding of the differences among progesterone formulations with respect to efficacy, optimum use, and patient preference is worth examining. A Summit was convened to critically review the literature on progesterone supplementation in assisted reproductive transfer cycles in general, and after FET and to provide guidance on the most clinically relevant issues. Utilizing a unique and innovative consensus-building learning model to examine the current evidence, Summit faculty drafted potential summit statements prior to the meeting, completed an extensive literature search, and created a presentation based on this research. At the conclusion of their discussion, the entire faculty developed final summit statements, evaluating the strength of the evidence supporting each statement, and rating their level of support for each statement. The clinically relevant topical areas were the rationale for progesterone supplementation, timing and appropriate dosing regimen of progesterone administration, whether progesterone serum levels reflect outcomes, and distinguishing among progesterone formulations with respect to efficacy, tolerability, and patient preference/satisfaction.Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Penn State College of Medicine and CORE Medical Education, LLC. Penn State College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.Credit DesignationPenn State College of Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Crédits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Date of Original Release/ReviewThis supplement was published in Reproductive BioMedicine Online. The original release date is 30 December 2014 and is eligible for AMA PRA Category 1 Crédit™ through 30 December 2015.FacultyChairman:Daniel B. Shapiro, MDReproductive Biology Associates - Atlanta, GeorgiaFaculty:Robert Boostanfar, MDClinical Assistant Professor at the Keck School of Medicine, Department of Obstetrics and Gynecology, University of Southern California - Los Angeles, CaliforniaKaylen M. Silverberg, MDTexas Fertility Center - Austin, TexasElena H. Yanushpolsky, MDAssistant Professor, Harvard Medical SchoolDirector, Center for Infertility and Reproductive Surgery at South Shore Hospital - Boston, MassachusettsDisclosure of Conflicts of InterestAccording to the disclosure policy of the Penn State College of Medicine, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with the commercial companies related to this activity. All relevant relationships that are identified are reviewed for potential conflicts of interest. If a conflict of interest is identified, it is the responsibility of the Penn State College of Medicine to initiate a mechanism to resolve the conflict(s). The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.The following faculty has reported real or apparent conflicts of interest that have been resolved:•Dan Shapiro is a consultant/advisor to Merck, Merck-Serono and OvaScience. He is on the speakers' bureau of Actavis, Merck and Merck-Serono and received a research grant from Actavis•Robert Boostanfar is a consultant/advisor to Actavis, Merck and Ferring. He is on the speakers' bureau of Actavis, Merck and Ferring, and received a research grant from Activis and Merck•Kaylen Silverberg is on the speakers' bureau of Actavis and received a research grant from Actavis•Elena H. Yanushpolsky has nothing to discloseThe following reviewers/planners/authors have reported real or apparent conflicts of interest:•Otto Ratz, MD has nothing to disclose•Christina Culbert, MSc has nothing to disclose•P. Susan Jordan has nothing to disclosePenn State faculty and staff involved in the planning and reviews of this material have nothing to disclose.ProviderFor questions about CME credits, contact Penn State College of Medicine, Continuing Education at 717-531-6483 or ContinuingEd@hmc.psu.edu and reference course #G5483-14-R.Commercial SupportThis CME activity is supported by an educational grant from Actavis Pharmaceuticals.Disclosure of Unlabeled UseThis educational activity may contain discussion of published and/or investigational uses of agents that are not approved or indicated by the FDA. Neither Penn State College of Medicine nor CORE Medical Education, LLC recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Penn State College of Medicine or CORE Medical Education, LLC. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.Instruction for ParticipationThe estimated time to complete is 90 minutes. There are no fees for participating in and receiving CME credit for this online activity. During the period of 30 December 2014-30 December 2015 participants must 1) read the learning objectives and faculty disclosures; 2) read the full content of the activity and reflect upon its teachings; 3) successfully complete the post-test with a passing score of 75% and the evaluation at the end of the activity.To obtain credit, participants must complete the Post-Test and Evaluation Form and submit it to: Penn State College of Medicine, Continuing Education, (G220), 44 E Granada Ave., Rm 1108, PO Box 851, Hershey, PA 17033 USA or fax to 717-531-5604 or send via email to ContinuingEd@hmc.psu.edu and reference course #G5483-14-R.Review ProcessThe entire faculty discussed the content at a peer-review planning session; the chair reviewed the activity for accuracy and fair balance, and a member of the External CME Advisory Board, who is without conflict of interest, reviewed the activity to determine whether the material is evidence-based, objective and demonstrated fair balance.AcknowledgmentThis Supplement is derived from a planning teleconference series which was held December 2013 through February 2014 and was independently developed by Penn State College of Medicine and CORE Medical Education LLC, pursuant to an educational grant from Actavis Pharmaceuticals (formerly known as Watson Pharmaceuticals). The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher, or the commercial supporter.DisclaimerParticipants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedure, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without the evaluation of their patients' conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
Databáze: OpenAIRE
Externí odkaz: