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1 (4 30 ) 9:30-16:40 參! ( 路 22 ) 倫理 律 理 錄 車 車 參 :40~10:20 Strategies to rescue the poor quality oocyte The outcome of ICSI of fresh versus 10:20~11:00 cryopreserved sperm obtained from sperm retrieval Controlled ovarian stimulation in patients with 11:20~12:00 endometriosis An update and what has changed of vitrification 12:00~12:40 in artificial reproduction Most cost-effective treatment protocol for 林 13:40~14:20 patients with poor ovarian response Setting standards and code of practice bring to 14:20~15:00 better ART outcomes: Progress toward benchmarks overall 15:20~16:00 倫理 ( 倫理 ) 麟 16:00~16:40 理 ( 律 )

2 不 卵 略 Strategies to rescue the poor quality oocyte 刺 卵 量 卵 量 卵 裂 量 率 率 刺 卵療 量 卵 责 卵 臨 不 卵 不 卵 識 不 什 卵 便 卵 不 卵 類 1 不 卵 germinal vesicle oocyte 2 裂 I 卵 metaphase I oocyte (3) 卵 不 oocyte scoring (4) 卵 oocyte degeneration 4 卵 論 (1) (2) 不 卵 裂 I 卵 剂量 刺 FSH 類 hcg 卵 卵 卵 metaphase II, 卵 行 不 卵 15% 卵 不 10% 不 卵 5% 裂 I 卵 不 卵 Oocyte in vitro maturation IVM 不 卵 养 力卵 不 卵 力 不 内 卵 (Coticchio et al., 2012) 养 留 数 臨 现 數 卵 数 異 率 臨 (3) 卵 不 卵 没 識 4 卵

3 卵 卵 Intracytoplasmic sperm injection, ICSI) 見 率 5% 19% 不 刺 裂 细 缩 对 卵 2011 年 臨 雷 卵 laser-assisted thinning ICSI, 了 率 率 率 2006 年 没 類 雷 卵 療 卵 不 简单 卵 更 References: 1. The ICSI procedure from past to future: a systematic review of the more controversial aspects. Patrizia Rubino, Paola Vigano`, Alice Luddi, and Paola Piomboni. Human Reproduction Update Vol.22, No.2 pp Oocyte scoring enhances embryo-scoring in predicting pregnancy chances with IVF where it counts most. Lazzaroni-Tealdi E, Barad DH, Albertini DF, Yu Y, Kushnir VA, Russell H, Wu YG, Gleicher N. PLoS One Dec 2;10(12):e

4 冷 立 泌尿 泌尿 若 卵 冷 臨 率 冷 冷 力 力 卵 力 略 冷 / 冷 不 塞 塞 卵 率 率 冷 降 不 理 不 療 參

5 Controlled ovarian stimulation in patients with endometriosis

6 An update and what has changed of vitrification in artificial reproduction 1. Principles of vitrification 2. Review of vitrification methodology Different carrier systems Cryoprotectants Open vs. close system 3. Applications in different fields of artificial reproduction Oocyte freezing Embryo freezing 2PN, cleavage stage, blastocyst Ovarian tissue freezing Future 4. Automated system?

7 Most cost-effective treatment protocol for patients with poor ovarian response 林 Poor ovarian response (POR) has always been a challenge for clinicians and accounts for 9-24% of all patients undergoing IVF/ICSI cycles. There is a lack of consensus on the definition of POR and a huge variation in treating women with previous POR. Although many studies have been performed to seek for a method of efficient ovarian stimulation for infertile women with POR, there is insufficient evidence to support the routine use of any particular protocol. A variety of stimulation regimes have been employed for the management of poor responders. It is generally believed that the starting dose of gonadotropins should be primarily increased for women with low ovarian reserve. Nevertheless, this strategy is often of limited effectiveness and moreover, clinical improvement obtained with doses more than 450 IU/day is very rare. The most prevalent protocols for treating poor responders at present are GnRH-a low-dose long protocol, GnRH-a luteal LP (stop protocol), GnRH-a flare-up protocols, GnRH-a micro-dose flare protocol and GnRH antagonist protocol. Unfortunately, neither of these protocols has been especially effective in improving ovarian response in poor responders. Therefore, hormonal manipulations to augment a follicular recruitment and coordinate subsequent antral follicle growth during ovarian stimulation have been performed. Hormonal manipulations include concomitant growth hormone (GH), LH supplementation, luteal estradiol pretreatment, LH pretreatment, DHEA supplementation, testosterone pretreatment, and aromatase inhibitor co-treatment. There is no universally accepted COS protocol for poor responders, and individualized approach is necessary to increase the cost-effectiveness. Although oocyte donation is a successful alternative treatment for POR women with diminished ovarian reserve, we must devote our best efforts to use patients own oocytes for successful pregnancy. Referances: 1. Trends in poor responder research: lessons learned from RCTs in assisted conception. Athanasios Papathanasiou,BelindaJ.Searle, NicoleM.A.King, Siladitya Bhattacharya. Human Reproduction Update, Vol.22, No.3 pp , A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number), Fertil Sterilit 2016; Vol 105, Issue 6, Pages A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF: a multicenter randomized non-inferiority trial. M.A.Youssef et al, Hum Reprod 2017; 32 (1):

8 Setting standards and code of practice bring to better ART outcomes: Progress toward benchmarks overall 1. IVF SOP 2. 立 練流 3. 立 流 4. 益 References: 1. Revised guidelines for good practice in IVF laboratories (ESHRE 2015) 2. Organization and Management of IVF Units: A Practical Guide for the Clinician. Steven D. Fleming Alex C. Varghese 2016

9 倫理 麟 不 度 不 易 類 來 良 老 更 易 療 類 倫理 年來 療 不 臨 療 倫理 不 年 識 類 不 識 利 什 類 利 類

10 理 律 流 4. 參 料 年 度 錄 論 更 論 link: 識 論了 行 度 識 了 切 論 不 見 更 理 論 識 行 不 論 度 參 更 論