Recommendations on the horizon and beyond


Published 09 July 2018

Nathalie Vermeulen, ESHRE's Senior Research Specialist with responsibility for guidelines, reviews recent publications and previews upcoming ESHRE guidelines and shorter practical recommendation documents.

The ESHRE guideline programme is booming with an ever increasing number of guidelines published and in development. It is only six months since the last full ESHRE evidence-based guideline on recurrent pregnancy loss was presented, and the next, on ovarian stimulation for ART, is already in its final stages for stakeholder consultation before the end of the year. This guideline will outline recommendations on preferred stimulation protocols, pre-treatments and luteal phase support.

But this, of course, is not the only plan. Last year, at our Annual Meeting in Geneva, kick-off meetings were organised for two new evidence-based guidelines, with working-groups now fully operational. First, a guideline on female fertility preservation for different indications is now in preparation to outline indications, patient selection, treatments and information provision. A second project will focus on assisted reproduction for patients with viral infections or diseases, with emphasis on reducing the risk of transmission to offspring, partner and clinical and laboratory professionals. For both guidelines, our expert groups are currently working on selecting and synthesising the scientific evidence, before starting the preparation of recommendations. Both documents are expected by the end of 2019. The highly successful guideline on endometriosis from 2013 is also due for an update, and this too will be concluded by 2020.

In addition to evidence-based guidelines, ESHRE is also producing several briefer recommendations for good practice. Interest in such recommendation documents reflects a need in the field for practical information and advice - and also reflects a lack of existing evidence in certain areas. Earlier this year, ESHRE formalised its approach towards these “recommendations for good practice” documents in a manual (available on the ESHRE website). Applying this nine-step process hopes to guarantee delivery of high quality documents developed by appropriate experts, based on observational data (if available), and finalised with stakeholder consultation.

Again, several recommendation documents can be expected shortly. Later this year, a working group on ultrasound will complete recommendations on ultrasound for oocyte pick-up in ART. Similarly, a document of recommendations for surgery in deep endometriosis is being prepared, consistent with and following the ESGE, ESHRE, and WES recommendations for ovarian endometrioma published last year (Saridogan et al, 2017). A third publication will probably be an update of the PGD guidelines from 2011 for which four working groups are already working simultaneously on four recommendation documents - the organisation of a PGT centre, embryo biopsy for PGT, detection of single gene defects/monogenic disorders (PGT-M) and detection of chromosomal, numerical and structural aberrations (PGT-A, PGT-SR).

And there is still more, as new projects are regularly proposed to us by the SIG co-ordinators, and approved for development by the Executive Committee. Indeed, ESHRE 2018 was host to several kick-off meetings for new projects, including key performance indicators for the IVF clinic, a classification of ectopic pregnancy on imaging, and time lapse technology.
Information on our existing guidelines and recommendations, and on future projects, can be found on the ESHRE website (www.eshre.eu/guidelines).