Saudi Fertility Group 7th Annual Meeting, Bahrain

Start Date: Friday 07-Dec-2018
End Date: Friday 07-Dec-2018

This event is sponsored by Her Excellency Bahrain Minister of Health Miss Faeqa bint Saeed Alsaleh.
Participants in the conference are a wide range of international, local lecturers and attendees from the entire gulf region.
This conference entitled Contemporary Practice in Infertility comes as part of the society responsibility to interact with the community in large, providing accurate health information and education in the up to date knowledge and development in fertility treatment and technology.
It gives me a great pleasure to welcome all participants to the Seventh Scientific Symposium of SFG of SSOG.
The three main tasks of the conference are:
• First, is to provide us with an opportunity to share experiences and update our knowledge for the benefit of our practices and clients.
• Second, is to keep the wheel of CME and active research running for the progress in reproductive health and medical science.
• Third task is “social” as by meeting old friends or making new ones, the bond grows stronger among us and between generations.

This Activity has been accredited to all health providers by the Saudi Commission for Health Specialties (SCFHS) and awarded (16) CME/PD credit hours, also has been accredited by Bahrain National Health Regulatory Authority [NHRA] and awarded (10) NHRA CME credit hours.
On your behalf, we thank her Excellency Bahrain Minister of Health Miss Faeqa bint Saeed Alsaleh for her continuous support to the society, Science and research on all aspects of medicine.
Finally, I thank all speakers, chairpersons and sponsoring companies for participating in this annual event and I wish you all an enjoyable experience.

Best Regards,
President of Saudi Fertility Group (SFG)
Dr. Hamad Al-Sufyan [FRCOG]

Dr. Hamad Al-Sufyan [President]
Consultant in Reproductive Medicine and IVF
Vice-President of Saudi OB-Gyn Society (SOGS)
President of Saudi Fertility Group (SFG)  MBBS 1982 King Faisal University Dammam, Saudi Arabia, FRCOG Royal College London, UK.  Subspecialty in Reproductive Medicine - IVF University of Bristol, UK. August 1996.  Consultant in Reproductive Medicine and IVF, Obstetrics and Gynecology in Thuriah Medical Center.  King Faisal Specialist Hospital Consultant in Reproductive Medicine and IVF 1993-2004 (more than 10 yrs), Co-coordinator of Riyadh Reproductive Medicine Club. 

Dr. Nareman Al Turairi [Scientific Committee]
Consultant in Reproductive Medicine and IVF
MBBS 1998, SBOG and ABOG 2005.  Instructor in Basic Operative Surgical Skills in Security Forces Hospital Program 2007 Instructor in Management of Obstetrics Emergency and Trauma in Security Forces Hospital Program 2006.  Best paper in the Resident Research Day 2001, Best Employee in 2003.  Presented in Riyadh OB-Gyn Club meeting Dilemma in Breech Delivery.  Attended many symposiums and conferences.

Mrs. Enass Abu Al Hawa [Admin Committee]

Mrs. Rania Manasrah [Admin Committee]

Eng. Ramy Mokhtar [IT & Designs Committee]

Mrs. Flerida Almora [Member]

Mr. Charles Mangahas [Member]

Mrs. Irene Cillo [Member]





08:00 - 08:30
Welcome and Introduction
Session - 1
Chaired By Prof. Haifa Al-Turki and Dr. Hanan Alssubaei
08:30 - 08:50
GnRHa Trigger-state of ART.
08:50 - 09:00
09:00 - 09:20
Current evidence on freeze all.
09:20 - 09:30
Session - 2 [Debate]
Chaired and Coordinated By Dr. Tawfig Gaafer [Debate controversial Issues in ART]
09:30 - 10:00
Which Protocol in IVF?
[Dr. Dania AlJaroudi & Dr. Hisham Ayoub]
10:00 - 10:30
Role of Hysteroscopy in ART
[Dr. Abdullaziz Al Shahrani & Dr. Mamdouh Escander]
10:30 – 11:00
PGS for Gender Selection, to offer or not?  
[Dr. Abdalla Salih & Dr. Saad Al Hassan]
11:00 - 11:20
Andrology Case Presentation.
11:20 – 12:45
Friday Prayer and Asser Prayer and Lunch
Opening Ceremony and Rewards
12:45 – 13:00
13:00 – 13:15
Her Excellency, Bahrain Minister of Health [Miss Faeqa bint Saeed Alsaleh]
13:15 – 13:30
Session - 3
Chaired By Dr. Alyah Alsaadoun
13:30 - 13:50
Current evidence on IVF augmented with PGS.
13:50 - 14:00
14:00 - 14:20
From POR to low prognosis the new POSEIDON.
14:20 - 14:30
14:30 - 14:50
Bio-Regulation of PGD in Bahrain and other GCC countries.
14:50 - 15:00
Session - 4
Chaired By Prof. Abdul-Aziz Al Mulhim & Dr. Mohamed Albugnah
15:00 - 15:20
Making of OncoFertility Consortium Saudi Arabia; challenges and breakthroughs.
15:20 - 15:30
15:30 - 15:50
9 - Challenges in handling OncoFertility samples in the laboratory.
15:50 - 16:00
Session - 5
Chaired By Dr. Marzouk Abdulfatah
16:00 - 16:20
Progesterone Support in ART.
16:20 - 16:30
16:30 - 16:50
Does duostim delivery on its promises: routine ART practice.
16:50 - 17:00

Prof. Haifa Al-Turki
Professor and Director of OB-Gyne at King Fahad University Teaching Hospital, Imam Abdel-Rahman Bin Faisal University, Saudi Arabia

Dr. Hanan Al-Subaie
Senior Consultant Obstetrics and Gynecology - Bahrain / Saudi Arabia

Dr. Tawfig Gaafar
Medical Director of Maternity Hospital and Head of IVF Unit.
Habib Medical Group, Olaya, Riyadh, Kingdom of Saudi Arabia

Dr. Alyah Alsaadoun
Consultant OB-Gyne / Reproductive Medicine Director of Alya Hospital Kuwait

Prof. Abdulaziz Al-Melhem
Consultant and Professor of OB-Gyne at King Fahad University Hospital, Imam Abdel-Rahman Bin Faisal University, Saudi Arabia

Dr. Mohamed Al Bugnah
Senior Consultant in IVF and Reproductive Medicine in Al Habib Medical Group.

Dr. Marzouk Abdulfatah
Senior Consultant and Director OB-Gyne Department at King Abdulaziz Military Base Dhahran, Saudi Arabia

Dr. Peter Humidan
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.

Dr. Kemal Ozgur
Dr. Kemal Ozgur completed his primary and secondary education at TED Ankara College. Dr. Ozgur graduated from Hacettepe University Faculty of Medicine in 1987, and then underwent an internship education in Obstetrics and Gynecology in Israel at the Telaviv University Faculty of Medicine.  Afterwhich he continued his specialist training in Obstetrics and Gynecology at the Akdeniz University Faculty of Medicine. As a qualified specialist he held the position of associate professor in the Obstetrics and Gynecology department. During this time he established an Assisted Reproduction Technology (ART) unit at the university and served as its first Director. To continue his education and training in Fertility he then worked as a researcher in the Department of Reproductive Endocrinology, University of Stellenbosch Faculty of Medicine, in Tygerberg, South Africa, for 6 months and then as a research fellow at the Jones Institute, Norfolk, Virginia, USA for 2 years. On his return to Antalya, Turkey he established Antalya IVF in 2000, a private ART center providing all fertility related services. As Clinic Director he has seen the clinic grow from 200 IVF cycles to the current 1700 IVF cycles a year. Dr. Ozgur has also published numerous scientific studies in peer-reviewed IVF journals and has also presented numerous scientific studies both nationally and internationally at IVF congresses.

Dr. Dania AL-Jaroudi
Dr. Dania AL-Jaroudi is a practicing REI consultant at King Fahad Medical City, Riyadh, Saudi Arabia. She has completed her fellowship in REI at McGill University, Montreal Canada, in 2004. She had also obtained her masters of health administration from the University of Minnesota, USA in 2014. She is currently the chairperson of Reproductive Endocrinology and Infertility Medicine department at King Fahad Medical City, Riyadh, Saudi Arabia.
She has published more than 12 papers in reputed journals and has been serving as an editorial board member in reputable journals.

Dr. Hisham Ayoub
Consultant OB-Gyn and Reproductive Endocrinology.
Founder and Director of Fertility and IVF Division in the Department of Obstetrics & Gynaecology, Prince Sultan Medical Military City, Riyadh, Saudi Arabia.
Director of Medical Administration, Prince Sultan Medical Military City, Riyadh, Saudi Arabia.
Director of the Reproductive Endocrinology and Infertility Fellowship Program in the Saudi Council for Health Specialties.
Previous President of the Middle East Fertility Society (2009 – 2011).

Dr. Abdullaziz Al Shahrani
•    MBBS from King Saud University in 1994.
•    Saudi Board Obstetrics and Gynecology in 1999.
•    King Faisal Specialist Hospital Fellowship in Infertility and Laparoscopic Surgery in 2003.
•    IVF from McGill University Montreal Canada 2005.
•    Fellowship in Reproductive Medicine in McGill University Montreal Canada in 2005.
•    Fellowship in Reproduction Surgery from McGill University Montreal Canada in 2005.
•    Consultant of IVF and Laparoscopic Surgery at Thuriah Medical Center from 2005 to 2013.
•    Founder of Bnoon Medical Center in 2013.
•    Medical Director and Consultant Infertility IVF, Laparoscopic Surgery in Bnoon Medical Center since 2013 till date.

Dr. Mamdouh Escander
Dr. Mamdoh Eskandar obtained his MBBS from King Saud University, Saudi Arabia in 1989.  He completed his Canadian Board of Obstetrics and Gynecology at the University of Manitoba, Canada in 1997, and went on to obtain his subspecialty in Reproductive Endocrinology and Infertility from University of Western Ontario, Canada in 1999.  He is presently a Professor of Obstetrics and Gynecology, consultant IVF at King Khalid University, Saudi Arabia.  He has been author or coauthor of more than 40 research papers in both national and international journals.

Dr. Abdalla Salih
Dr. Abdalla Salih is a Senior Sub-speciality Consultant in Reproductive Medicine with many years of experience, particularly in IVF and related Assisted Reproductive Technologies (ART);
1982 MBBS, University of Khartoum, Sudan
1992 Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) London, UK
1995 Master of Medical Science degree (MMedSci) in Assisted Reproduction Technology, University of Nottingham, UK.
2004 Doctor of Medicine (MD) Degree, University of Sheffield, UK.
2009 Fellowship of the Royal College of Obstetricians and Gynaecologists (FRCOG) London, UK.
Dr. Abdalla Salih trained in different clinical and academic departments of obstetrics and gynaecology in the UK. He was appointed Clinical Director, CARE Fertility IVF programme, Sheffield, UK (2002-2005) before moving to Saudi Arabia where he lead the team that successfully set up the new Reproductive Medicine Department at King Fahad Medical City, Riyadh, a JCI accredited facility with the largest IVF programme for the Ministry of Health. As a Chairman to the department he supervised all department activities including clinical services, training, education and research over a period of nine years during which he was appointed as an Assistant Professor of Obstetrics and Gynaecology at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Dr. Abdalla Salih joins Thuriah Medical Center with a commitment to delivering high quality assisted reproductive technology service maintaining at all times the highest possible success rates and maximum patient satisfaction.

Dr. Saad Al Hassan
Is a Consultant and Head Section of Reproductive Medicine, Department of Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Center (KFSHRC), Riyadh. He obtained MBBS degree from King Faisal University, Dammam. He has been trained in the British Isles and worked there for more than 14 years. Certificate of Full Registration as a Medical Practitioner was granted by General Medical Council (GMC). Initially he got the Licentiate of Midwifery (LM), The Rotunda Hospital, Dublin, Ireland. He obtained the membership (MRCOG), then the Fellowship (FRCOG) of the College of Obstetricians and Gynecologists, London, UK. He gets Certificate for Subspecialty of Reproductive Medicine, Nottingham University Research and Treatment Unit in Reproduction, U.K. In addition to the clinical works, a Master of Medical Science in Assisted Reproduction Technology (MMSci-ART) obtained from Nottingham University, Nottingham, U.K.
Postgraduate teaching is one of his interests and abilities. He has been involved in theoretical and bedside teaching for the last 30 years. He is an Examiner and an Author of Part I and II Examination for Saudi Specialty Certificate of Obstetrics and Gynecology (SSCOG) since 1999 to date.
He was the Director of Residency Training Program, then the Director Fellowship Program, Reproductive Medicine, Department of Obstetrics and Gynecology KFSHRC. He was a member in the Saudi Council for Health Specialties (SCHS), Scientific Board of Obstetrics & Gynecology.
Currently he is a Member of the Infertility Practice Regulations Committee, Ministry of Health and Chairman of Infertility Practice Evaluations subcommittee, Ministry of Health. His interest is in ethical and religious issues related to the practice in Reproductive Medicine especially in Saudi Arabia.
He was Member of the Credential Committee for Medical Certification Evaluation, Saudi Council for Health Specialties and was the chairman of RCOG Representative Committee of Saudi Arabia, Royal College of Obstetricians and Gynecologists, UK.

Dr. Hamoud Al Matrafi
Graduated from College of Medicine King Faisal University in Dammam 1982, in 1994 obtained Canadian Board in Urology from Dal Hawse University, Halifax – Canada.  Fellowship in male infertility and Erectile Dysfunction from the same university.
He was the Head Division of Urology and the Director of Male Infertility in King Fahad National Guard Hospital until he moved to Thuriah Medical Center in September 2011.
He is the first one who start microdissection TESE in Saudi Arabia in 2003.
He is one of the most experts in this field until now he did more than 800 cases.
Dr. Matarfi is the Head Division of Urology and Andrology in Thuriah Medical Center from 2011 till present.

Dr. Mariam Dashti
Dr. Maryam A.G. Dashti, Bahraini Scientist, obtained her PhD from King’s college, London University. She is senior in the field of In Vitro Fertilization and Pre-Implantation Genetic Diagnosis. She was an Assistant Professor, Department of Microbiology 1989- 2014 and is in Department of Molecular Medicine 2004-present, College of Medicine and Medical sciences, Arabian Gulf University.
Dr. Dashti has been working in the field of assisted conception since 1988 and was one of the main founders of the first IVF unit in Bahrain in the Military Hospital in 1989, and the main founder of Al-jawhara Fertility Hospital in 2011. In both places, she occupied the position of scientific and managing director, in addition to directing and supervising the IVF labs. Also, she was voluntarily and actively involved in licensing other IVF labs/  centers in Bahrain as an evaluator through the ministry of health, 1990- 2008. Outside Bahrain, she cooperated in optimizing the facilities and services in a number of IVF centers in UAE and Lebanon and she pays continuous visits to other facilities around the globe for follow up of advances in the field of ART.
Over the last 27 years, she has attended more than 50 hands on workshops, attachments and international meetings in different fields of assisted reproduction and Genetic Testing of embryos. Also she has many publications in national and international journals, in addition to numerous scientific presentations and lectures.
Socially she has been very active in enhancing the public awareness to fertility problems and inheritance of genetic disorders which can be controlled through IVF/ PGD programs. In this lineage, she has given many lectures, talked on TV/ radio and written many articles in daily local papers since 1990 until present.  
Dr. Dashti is also involved in ISO 9001/ CAP Quality management program in Fertility set ups and provides upgrade and quality assurance consultations for other IVF labs in the area. Her work and extra curricula activities were appreciated by UNESCO, The Middle East Fertility Society, Bahrain Family Planning Association, Bahrain Medical Bulletin, Bahrain Medical society, The Royal Academy for medical specialists, Bahrain Defense Force Hospital, The College of Medicine and Medical Sciences, Arabian Gulf University, The Ministries and Directorates of Health in the GCC, The Ministry of Education in Kingdom of Bahrain, Cairo University. As being the main founder of two main Fertility centers in Bahrain, Dr. Maryam Dashti focuses her present interest and potential towards empowering the programs for genetic testing and stem cell technologies.  Families with inherent disorders will have the opportunity to diagnose any Chromosomal or Genetic abnormality in their embryos during the first week of development, therefore preventing unwanted abnormal pregnancies. Application of Pre- Implantation Genetic Screening and Diagnosis is considered the technique of choice for better pregnancy success rate and better pregnancy outcome. Dr. Dashti aims to establish a state of the ART fertility and Genetics Center of her own to provide par excellence services to the needy ones.

Dr. Ghadah Ghourab
Completed her residency training in Obstetrics and Gynaecology at Security Forces Hospital in 2009.
Obtained the MRCOG, Arab Board and Saudi Board certification in Obstetrics and Gynaecology in 2009.
In 2012, she completed a two-year fellowship training in Reproductive Endocrinology and Infertility at King Faisal Specialist Hospital and Research Center.
She joined IVF Hammersmith, Imperial NHS Trust, London UK, in August 2014 where she worked for one year as a Clinical Fellow in Reproductive Medicine.
Her special interests are Fertility Preservation and Recurrent Miscarriage.

Dr. Murid Javed
Dr. Murid Javed is Director of ART Laboratories at Thuriah Medical Center, Riyadh.  He is certified Laboratory Director by Canadian Fertility and Andrology Society.  He is member of the Practice Committee and Chair of Certification Committee of American College of Embryology.  He is an active member of many professional societies including ESHRE, ASRM and CFAS.
He has been in the profession of Reproductive Physiology since 1981 and his interests include study of male and female reproductive systems, laboratory aspects of handling sperm and oocytes and long term cryopreservation of gametes, embryos and tissues. His initial research experiments from 1981 to 1986 were on application of Clinical Embryology in research animals.  During this time he also earned M.Sc. (Hons) degree in Animal Reproduction.  In 1986, he went to Washington State University, USA for PhD in Embryo Physiology. There he learned all aspects of Embryology at advanced level and earned PhD degree in 1990.  His PhD research was on determination of glucose utilization by embryos at different stages of development and use of amniotic and allantoic fluid for culture of embryos.  He had the opportunity to complete his post doctorate fellowships in two of the World’s best Embryology Laboratories; first at Kyoto University, Japan and then at University of Georgia, Athens, USA.  At these institutions, he conducted research on in vitro fertilization, embryo culture and embryo vitrification.  
In 1997, he migrated to Canada and settled in Toronto where he worked at Toronto Institute for Reproductive Medicine for more than 4 years.  In 2001, he was selected by University of Michigan, USA as Senior Clinical Technologist to establish oocyte, sperm and embryo cryopreservation facility for cancer patients.  He was then selected by Toronto Centre for Advanced Reproductive Technology as Clinical Embryologist where he worked for 8 years under the directions of Professor Dr. Robert Casper.  In 2010, he took the responsibility of Director ART Laboratories at Astra Fertility Clinic which had 4 locations across Greater Toronto Area.  In Oct 2015, he was selected as Director ART laboratories at Thuriah Medical Center.
Dr. Javed has extensive research and clinical experience in all aspects of Assisted Reproductive Technology.  He has published extensively and has written a book chapter.  He likes to share knowledge, train new staff and implements all measures for best care of sperm, eggs and embryos in the laboratory.  The topic of his talk is “Strategies to Overcome Male Factor Infertility – A Laboratory Prospective”.

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.

09:00 AM - 09:20 AM     
Current evidence on freeze all.  [Dr. Kemal Ozgur]

Purpose In segmented ART treatment or so-called ‘freeze-all’ strategy fresh embryo transfer is deferred, embryos cryopreserved, and the embryo transferred in a subsequent frozen embryo transfer (FET) cycle. The purpose of this cohort study was to compare a GnRHa depot with an oral contraceptive pill (OCP) programming protocol for the scheduling of an artificial cycle FET (AC-FET) after oocyte pick-up (OPU).
Methods This retrospective cohort study was conducted on prospectively performed segmented ART cycles performed between September 2014 and April 2015. The pregnancy, treatment duration, and cycle cancellation outcomes of 170 OCP programmed AC-FET cycles were compared with 241 GnRHa depot programmed AC-FET cycles.
Results No significant difference was observed in the per transfer pregnancy and clinical pregnancy rates between the OCP and GnRHa groups, 72.0 versus 77.2 %, and 57.8 versus 64.3 %, respectively. Furthermore, the early pregnancy loss rate was non-significantly different between the OCP and GnRH protocol groups, 19.8 versus 16.7 %, respectively.
However, nine (5.29 %) cycles were cancelled due to high progesterone in the OCP protocol group, while no cycles were cancelled in the GnRHa protocol group and the time taken              

Session [2] Debate
09:30 - 10:00
Which Protocol in IVF?
[Dr. Dania AlJaroudi & Dr. Hisham Ayoub]
10:00 - 10:30
Role of Hysteroscopy in ART
[Dr. Abdullaziz Al Shahrani & Dr. Mamdouh Escander]
10:30 – 11:00
PGS for Gender Selection, to offer or not?
[Dr. Abdalla Salih & Dr. Saad Al Hassan]
11:00 – 11:20   
Andrology Case Presentation.  [Dr. Hamoud Al Matrafi]

Session [3]
13:30 – 13:50
Current evidence on IVF augmented with PGS.  [Dr. Kemal Ozgur]
Parallel innovations in laboratory technologies and procedures over the last decade has seen the reproductive outcomes of IVF improve significantly. In vitro culture technology innovations have led to increased blastulation rates and as a result blastocyst transfers, with a concomittant increase in reported implantation rates. Cryopreservation technology innovations have led to the reporting of survival rates consistently >90%, with the use of vitrification. Comprehensive chromosome screening (CCS) innovations have led to clinically recognizable error rates of <0.5%, with single embryo transfers (SET) of screened embryos resulting in live birth rates equivalent to multi-embryo embryo transfers (ET) of unscreened embryos. Importantly, the increased survival rates of developmentally competent vitrified-warmed blastocysts have resulted in the increased use of frozen embryo transfers (FET), with implantation and live birth rates reported to be at least equivalent to those of fresh blastocyst transfers. With the reproductive outcomes of FET no longer inferior to those of fresh ET, clinicians have the opportunity to investigate how to exploit the benefits (i.e. endometrial receptivity) of FET and the optimal scheduling of procedures for transferring all embryos into physiologically normal intrauterine conditions of FET. The freeze-all strategy known as segmented-IVF has been purported to be a viable alternative to conventional IVF, especially if any conditions resulting from controlled ovarian stimulations (COS) have the potential to adversely affect the reproductive outcomes of fresh ET. Moreover, by combining blastocyst culture, blastocyst CCS, blastocyst vitrification, and blastocyst FET may achieve the best possible live birth outcomes in IVF.

14:00 – 14:20
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”.

14:30 – 14:50
Bio-Regulation of PGD in Bahrain and other GCC countries. [Dr. Mariam Dashti]

Genetic data are predictive, permanent, and extremely sensitive. Unlike infertility conditions, genetic errors in humans can not be reversed or rectified, but they can be prevented in future generations. Currently, intervention of pre-implantation genetic Diagnosis (PGD) in assisted reproduction has been used in detection of many genetic and chromosomal abnormalities. PGD is preferred to prenatal genetic testing as it imposes lower health risks to mothers and is ethically more acceptable in cultures with reservation on abortion.
 Accreditation of genetic labs assists in improving patient’s care and protecting public health. The guidelines and recommendations for best practice offered by ESHRE- PGD consortium and PGDIS are quiet elaborate and are extremely helpful in establishment of an efficient PGD facility. Yet, at levels of quality assurance and service maintenance, labs offering such highly complex tests require proper accreditation by a robust program such as ISO. The College of American Pathologists (CAP), used the internationally recognized ISO 15189 to standardize labs of cytogenetics in 1976 and molecular pathology in 1991. Currently, within the regulatory framework for embryo genetic testing, ISO programs are upgraded to accommodate standardization of PGD labs.
Accordingly, Increasing numbers of countries globally are moving progressively towards acquiring CAP accreditation for their PGD laboratories as a direct indicator of quality for their services.
The main aim of PGD laboratory accreditation is to provide valid results to clients, namely: service users, clinics, clinicians, and most importantly patients. Therefore, assessment of PGT laboratory by an external auditor would ensure whether genetic testing services provided are of sufficient standard. This presentation will highlight the current  situation of PGD laboratory accreditation in the countries of the Gulf Cooperation Council (GCC) and will discuss the consequences of lack of regulatory supervision and surveillance.

Session [4]
15:00 – 15:20
Making of OncoFertility Consortium Saudi Arabia; challenges and breakthroughs.  [Dr. Ghadah Ghourab]
The oncofertility consortium Saudi Arabia (OCSA) was established in March 2018 with the vision of providing world class fertility cryopreservation services to cancer patients in Saudi Arabia.
The oncofertility consortium is an international multi-institutional group that assesses the impact of cancer and its treatment on reproductive health. It was founded by Dr. Teresa Woodruff in 2007 with a mission of expanding fertility options for cancer survivors.
In February 2018, Dr Teresa Woodruff visited Riyadh, Saudi Arabia and a meeting was held with the founding members of OCSA with the aim of developing a framework for Saudi Arabia to become a member of the International Oncofertility Consortium. This ultimately paved the way for the establishment of OCSA which has over 90 members today from all over the Kingdom of Saudi Arabia.
In the space of a few months OCSA has established all the guidelines for fertility preservation in Saudi Arabia as well as taken large strides in the process of legalizing fertility preservation in a country where this has long been illegal.
Once legalized , and with the standard operating procedures and guidelines as well as specialized centers already in place, fertility preservation can finally be offered to the thousands of cancer patients in Saudi Arabia who were previously faced with the bleak prospect of losing all hope of parenthood after cancer treatment.

15:30 – 15:50
Challenges in handling OncoFertility samples in the laboratory.  [Dr. Murid Javed]

This talk will focus on handling in the laboratory, oncofertility specimens, from male and female cancer patients.  Emphasis will be placed on using the proven techniques and procedures to preserve gametes or tissues.  Difficulties in preserving gametes in certain situations will be highlighted.  Reasons for recent storage failures will be explained and methods to prevent these disasters will be provided.  Pros and cons of experimental techniques will be discussed.               

Session [5]
16:00 – 16:20
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.

16:30 – 16:50
Does duostim delivery on its promises: routine ART practice.  [Dr. Kemal Ozgur
Study objective: To investigate the efficacy of DuoStim (dual phase ovarian stimulation) in infertile patients with a poor ovarian response (POR) after follicular phase ovarian stimulation (FPOS).
Background: Studies have shown that it might be possible to increase the number of oocytes retrieved in poor ovarian response patients by performing DuoStim, thereby, increasing the effectivity of a single IVF treatment.
Materials and methods: All patient-couples included in this retrospective observational study underwent autologous ICSI with the intention of blastocyst freeze-all and FET between May 2017 and August 2018. Patients underwent conventional ovarian stimulation (OS) in both the FP and luteal phase (LP), with FPOS starting on day 2 of the cycle and LPOS starting on the day of FPOS oocyte retrieval. All patients underwent a transvaginal ultrasound (TVS) clinical examination on day 2 of their cycle, to assess ovarian reserve (OR), with DOR patients counselled on the possibility of DuoStim. POR patients underwent Duostim on clinical assessment at FPOS oocyte retrieval; ≤5 oocytes were retrieved after FPOS and at least 4 antral follicles of ≥5mm were present. In Duostim patients, follicles ≤10-12mm were not aspirated at FPOS oocyte retrieval.
Results: In total 60 patients underwent DuoStim during the study period. The median age of the patients who underwent Duostim was 36.1 (32.6-38.8) years and their median antral follicle count (AFC) was 6.0 (3.0-9.0). The LPOS duration was significantly shorter than FPOS. The median oocyte number, mature oocyte rate, and blastocyst rate were not significantly different for FPOS and LPOS. More FPOS resulted in the development of blastocysts for cryopreservation (26 vs 20). There was also no significant difference in the per transfer pregnancy rates of FPOS and LPOS (70.5% vs 66.7%)
Conclusion: DuoStim increases the efficacy of IVF in POR patients, with the chance of freeze-all increasing from 43.3% to 58.3%.