Dr. Peter Humidan

Short Curriculum Vitae
Peter Humaidan is a specialist in reproductive endocrinology, professor at The Fertility Clinic, Skive Regional Hospital, Faculty of Health Aarhus University and Honorary professor at Faculty of Health Southern University, Odense, Denmark. Peter Humaidan obtained his doctoral degree (DMSc) from University of Aarhus, Denmark, focusing on the role of LH during the follicular and luteal phases in controlled ovarian stimulation. During his scientific work he has primarily focused on developing individualized ovarian stimulation and luteal phase support protocols. ICOS - individualized controlled ovarian stimulation - therefore, is an integral part of his clinical work. His research interests include the use of GnRH antagonist protocols, GnRH agonist trigger, OHSS prediction and prevention, and reproductive endocrinology. He is the founder of the international society “The Copenhagen GnRHa Triggering Workshop Group”, which published a number of articles on the use of GnRHa trigger. Moreover, he is the co-founder of the POSEIDON working group which established new stratification criteria for the low prognosis patient. He is currently deputy of the ESHRE SIG for endocrinology and has authored and co-authored more than 130 papers (H-index 31) in peer-reviewed international journals. Finally, he is the co-author of the Danish guidelines for OHSS prevention. Peter Humaidan has a wide scientific network and is frequently invited as a speaker at international conferences. 

Session - 1
08:30 AM - 08:50 AM   
GnRHa Trigger-state of ART.  [Dr. Peter Humidan]

Human chorionic gonadotropin (hCG) has been used as a surrogate for the mid-cycle surge of LH for several decades due to structural and biological similarities between the two molecules. Although hCG effectively secures final oocyte maturation and ovulation, its use has several drawbacks - first and foremost a sustained luteotropic effect, facilitating ovarian hyperstimulation syndrome (OHSS).
After the introduction of the GnRH antagonist protocol, final oocyte maturation can be triggered with a single bolus of a GnRHa.
The initial studies from 2005, however, reported a poor clinical outcome when GnRHa was used to trigger final oocyte maturation in patients who received a fresh transfer. The problem appeared to be a luteal phase deficiency, despite standard luteal phase supplementation with progesterone and estradiol.
Over the years several studies have been performed, introducing the "modified" luteal phase support concept after GnRHa trigger which rescues the luteal phase, resulting in ongoing pregnancy rates similar to those of hCG trigger – and result in an almost elimination of OHSS. Thus, GnRHa trigger is likely to become the future gold standard trigger concept.

Session - 3
14:00 PM – 14:20 PM
From POR to low prognosis the new POSEIDON.  [Dr. Peter Humidan]

The incidence of poor ovarian response (POR) during ART has generally been reported to vary from 9 – 24 %. Until the establishment of the ESHRE Bologna criteria for POR (2011) no strict criteria to define POR existed, hampering the conclusions drawn from clinical trials and meta-analyses. However, after their introduction even the Bologna criteria were criticized of describing a heterogenous group of patients with different success rates after ART. Importantly, no clinical recommendations for handling of the POR patient were given. In contrast, The Poseidon Group recently proposed a new stratification system in an attempt to further define the group of low prognosis patients, taking into account ovarian reserve and age, which are the two most prominent key factors to predict success in ART (Alviggi et al., 2016; Humaidan et al., 2016). In this stratification system four different sub-groups of low prognosis (POR) patients are defined as well as the suggested matching protocols and regimens, which might increase the success rate of the patient. Moreover, Poseidon introduces a new measure for successful ART treatment, namely, the number of oocytes needed in each specific patient to obtain one euploid embryo for transfer. The so-called Poseidon Calculator which is currently being developed will enable clinicians to calculate this new measure, also taking into account site specific parameters. During this lecture an updated review of strategies and adjuvants as well as future therapeutical options for the low prognosis (POR) patient will be presented. Although, the handling of the poor responder patient still represents a therapeutic challenge, there might be some light “at the end of the tunnel”.

Session - 5
16:00 PM – 16:20 PM
Progesterone Support in ART.  [Dr. Peter Humidan]

The luteal phase of all stimulated IVF/ICSI cycles is abnormal. The main reason for the luteal phase defect (LPD) is the multi-follicular development achieved during ovarian stimulation, leading to supra-physiological levels of steroids (progesterone and estradiol) secreted by a high number of corpora lutea during the early luteal phase, which directly inhibit the release of LH from the pituitary via feedback actions at the hypothalamic-pituary axis level. This reduction in circulating endogenous LH has a detrimental effect on the early-mid luteal phase, as LH plays a crucial role for the steroidogenic activity of the corpus luteum in terms of progesterone production. Thus, luteal phase support with progesterone remains mandatory in fresh transfer cycles after ovarian stimulation for IVF/ICSI treatment. Moreover, with the introduction of new embryo culture systems and in particular vitrification of supernumerary embryos, the live birth rate after frozen-thaw embryo transfer is now similar to, and in many cases superior to that of fresh embryo transfer. This has created a paradigm shift in stimulation policies, in which GnRHa is used for ovulation trigger, followed by segmentation and subsequent transfer in either an HRT frozen-thaw cycle or a natural cycle. For scheduling purposes many centers favor the HRT cycle. Although, poorly defined, until recently a "standard" luteal phase progesterone support was considered sufficient for all patients undergoing fresh as well as frozen-thaw embryo transfer; however, recent scientific evidence questions this policy. During the last decade personalization - or individualization became the "mantra" of ovarian stimulation, and the concept subsequently moved on to the choice of ovulation trigger. Indeed, near future suggests personalization of the luteal phase support as well. This will demand monitoring of the mid-luteal phase in terms of serum progesterone, as the mid-luteal progesterone level seems to play a pivotal role for reproductive success in ART.

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