bluuebunny/crossref_metadata_2025_split huggingface dataset:
International Guidelines and Significant Advances in Diagnosis
Authors: Teede Helena 
Published: January 2024

Objective: To develop and translate rigorous, comprehensive evidence-based guidelines for diagnosis, assessment, and treatment, to improve the lives of those with polycystic ovary syndrome (PCOS) worldwide. Here we will focus on diagnosis. Participants: Extensive health professional and consumer or patient engagement informed the guideline priority areas. International society-nominated panels included consumers, and experts in paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, psychology, dietetics, exercise physiology, sleep, bariatric/metabolic surgery, public health, other co-opted experts, project management, evidence synthesis and translation. Evidence: Best practice, evidence-based guideline development involved extensive evidence synthesis and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework covered evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Process: Governance included an international advisory board, project board and five guideline development groups with 52 members, consumer, and translation committees. The Centre for Research Excellence in Women’s Health in Reproductive Life, funded by the Australian National Health and Medical Research Council (NHMRC), and led by Monash University, partnered with the American Society for Reproductive Medicine, the Endocrine Society, the European Society of Endocrinology and the European Society of Human Reproduction and Embryology. Thirty-six organisations collaborated with international meetings over nine months. Fifty-five prioritised clinical questions involved 52 systematic and three narrative reviews, generating evidence-based and consensus recommendations with accompanying practice points. Committee members nominated by collaborating organisations provided international peer review, and evidence expert-reviewed methods and outputs were submitted to NHMRC for independent review. Recommendations: PCOS should be diagnosed using the revised consensus Rotterdam criteria, which are now updated to evidence-based criteria in the International Guideline. In adults this requires the presence of two of i) clinical/biochemical hyperandrogenism ii) ovulatory dysfunction and iii) polycystic ovaries on ultrasound or elevated anti-mullerian hormone (AMH) levels, after other causes of these features are excluded. Where irregular menstrual cycles and hyperandrogenism are present, ultrasound or AMH are not required for diagnosis. In adolescents, both hyperandrogenism and ovulatory dysfunction are required, with ultrasound and AMH not recommended, due to poor specificity. Conclusion: Overall, evidence in PCOS is low to moderate quality. Based on high prevalence and significant health impact, greater priority, funding, and research is recommended. Guideline translation will be extensive including multilingual education outputs and evidence-based resources for consumers (the ASKPCOS app), healthcare professionals and policy makers.
The Prevalence of PCOS in South Asia
Authors: Patil Madhuri 
Published: January 2024

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, with ethnic diversity in its manifestation. South Asian patients have a much higher prevalence of PCOS than the controls. A greater PCOS burden among South Asian than White women receiving infertility care has been reported. South Asian patients showed an increased degree of hirsutism, early onset of symptoms, severe insulin resistance, metabolic risks (impaired glucose tolerance (IGT), insulin resistance (IR), diabetes mellitus (DM), hyperlipidemia) and endometrial pathology as compared with Caucasians. South Asians with PCOS also have greater odds of being centrally obese, with one third having the metabolic syndrome that bears no relationship to the androgenic phenotype. South Asians with PCOS manifest early and seek health-care pre-maritally, with irregular menses and hirsutism predominating. They have greater central obesity in proportion to a ‘lower’ BMI, which is linked to their metabolic risk. MetS affects one-third, with age [Formula: see text]35 years, Acantosis Nigricans and BMI [Formula: see text]25 kg/m2 (Asian cut off) having significant association. In a study when Chinese, Filipina and South Asians were compared, the prevalence of PCOS and obesity was significantly higher in South Asians whereas that of diabetes was higher among Filipinas. Genetic components play important roles in the pathogenesis of PCOS, and genome-wide association studies of PCOS have also suggested that similar genetic risk factors exist between Asian and Caucasian patients. Among women with PCOS, Asians have been reported to have lower insulin (vs. Black and Hispanic women) and higher glucose (vs. non-Hispanic White women) levels in response to an oral glucose load. Greater awareness in the clinicians about the differences in PCOS and diabetes among south Asian subgroups is important for targeting screening and prevention efforts. Due to the baseline ethnic predisposition to metabolic syndrome, comprehensive metabolic screening, and counselling regarding future risks of chronic disease should be provided.
Pregnancy and Early Life Complications of PCOS
Authors: Thien Tan Chau 
Published: January 2024

This presentation delves into the wide-ranging effects of Polycystic Ovary Syndrome (PCOS) on women’s lives, specifically exploring its manifestations during adolescence and pregnancy. Starting with PCOS in early life, we delve into the hormonal shifts of puberty and their connection to PCOS development. Challenges of diagnosing PCOS in adolescents are discussed, along with the distinct cardiometabolic and psychological issues they face. The section concludes with pragmatic insights into the 2023 PCOS Guideline’s recommendations for managing PCOS during these pivotal years. Moving to PCOS during pregnancy, attention shifts to the complex hormonal and physiological adjustments the female body undergoes to support foetal growth. PCOS-related mechanisms that might contribute to pregnancy complications are examined. In addition, we present evidence from 2023 PCOS Guideline meta-analyses revealing the various pregnancy complications in this high-risk population. Concluding, we navigate antenatal care terrain aligned with the 2023 Guideline and present evidence on metformin’s role in PCOS pregnancies. This presentation provides a comprehensive view of PCOS from adolescence to pregnancy. By integrating up-to-date guidelines and evidence, it aims to equip healthcare professionals with practical insights for navigating PCOS’s complexities, ultimately improving patient care.
Cardiometabolic Complications of PCOS
Authors: Joham Anju 
Published: January 2024

Polycystic ovary syndrome (PCOS) has reproductive, metabolic, dermatological, and psychological clinical features. While the reproductive features have been the best recognised; however, in more in recent times, the metabolic characteristics and extended cardiometabolic sequelae of PCOS have gained increasing acknowledgment. Women with PCOS have higher rates of obesity, longitudinal weight gain and central adiposity compared to women without PCOS ( 1 , 2 ). Insulin resistance is a key pathophysiological feature in PCOS, is present independent of obesity and is exacerbated by obesity ( 3 ) and contributes to metabolic complications. Women with PCOS have a 1.9-fold increased risk of metabolic syndrome and clustering of cardiovascular risk factors ( 4 ). The incidence of type 2 diabetes is higher and onset earlier in women with PCOS, independent of body mass index ( 5 ). Dyslipidaemia is increased in women with PCOS, with the relationship largely mediated by obesity ( 6 ). Despite clustering of cardiovascular risk factors, the question of whether women with PCOS face an elevated risk of cardiovascular disease have remained uncertain. Nevertheless, more recent, and substantial evidence indicates that women with PCOS are indeed at an increased risk of cardiovascular disease. This is supported by higher odds ratios and/or incidence rate ratios for composite cardiovascular disease, ischaemic heart disease, stroke, and cardiovascular mortality. It is important to acknowledge, however, that the overall risk of cardiovascular disease among pre-menopausal women remains low ( 7 ).
Impact of Prestimulation Treatment
Authors: Kaul-Mahajan Nalini 
Published: January 2024

Polycystic ovarian syndrome (PCOS) is one of the commonest endocrine disorders encountered in women of reproductive age. It is characterised by an altered Androgen metabolism which leads to irregular menses, anovulation and hyperandrogenism (HA). It is associated with hyperinsulinaemia and obesity which aggravate the HA status. Ovulation induction and controlled ovarian stimulation pose a unique challenge in these patients. The endocrine disturbance leads to arrest of follicular growth and patients may either not respond to OI drugs are may hyper-respond leading to a risk of OHSS. The best strategy to improve outcome of IVF in PCOS patients is still under consideration. This lecture will address pre-treatment (IVF) drugs and strategies that ameliorate HA, decrease the risk of OHSS and improve cycle outcome. Selection of the safest and most effective OS protocols will be discussed. Use of segmental IVF in PCOS patients has almost eliminated OHSS- it involves using an antagonist protocol with a GnRH agonist trigger and a freeze all strategy. The pros and cons of this strategy will be discussed. We will also look at the current status of Metformin Inositols, Vit D in PCOS patients and their role in improving IVF outcome. Use of pre-treatment hormones/OCP’s and their effect on IVF outcome will be deliberated. Lifestyle change and weight reduction are important to improve the HI & HA status and have become a fundamental requirement in these young women. The challenge patients face in achieving weight reduction goals due to the inherent metabolic disturbances needs to be recognised. At the end of the lecture the delegate would be able to have a better understanding of the current status of various pre-treatment strategies used in PCOS patients undergoing IVF.
Optimising Ovulation Induction in PCOS
Authors: Patil Madhuri 
Published: January 2024

Biochemical, Metabolic and Endocrine changes in PCOS result in reproductive impairment in women with PCOS. Controlled ovarian stimulation (COS) may be associated with • Unpredictable response • Response may be slow • Hyper-response - OHSS • Risk of Cyst Formation • Poor oocyte quality • Miscarriage • Cycle cancellation So, the ovulation induction protocol should be efficacious and safe resulting in a singleton live birth, minimising complications, and risks like ovarian hyperstimulation syndrome (OHSS), multiple pregnancies and cancellation of cycles. For this special consideration should be given to prediction of response, pre-treatment, choosing the right ovulation induction (OI) protocol with right dose and analogue, using GnRH agonist trigger instead of hCG, preventing late follicular phase rise in progesterone, or following the segmentation protocol. We can maximize the success rates by stimulation individualization based on age, AMH, AFC and amended further for BMI. AMH is considered as more sensitive marker to define follicle excess than AFC as it appraises more follicle classes - preantral and early antral. One should probably use mild stimulation protocols where gonadotropins are given in combination with oral ovulogens or the low dose step up protocol. It is essential that we use GnRH antagonist protocol and administer GnRH agonist if there is risk of OHSS. If segmentation protocol is used one could also use the progesterone primed ovarian stimulation instead of GnRG antagonist. One could reduce the incidence of OHSS by laparoscopic ovarian drilling and use of Metformin and aspirin before assisted reproduction. If the patient is at risk of developing OHSS during stimulation then one could administer cabergoline, intravenous infusion of calcium gluconate or albumin and methylprednisolone. But freezing all embryos and transferring them in a subsequent cycle increase the efficacy and reduce complications of ART in PCOS women. Elective single embryo transfer(eSET) should be the norm to reduce the multiple pregnancy rate. Conclusion Thus, in all ART cycles individualised COS with freeze all and eSET could help in increasing the success of ART and reducing stress and anxiety and complications in these women.
Social and Psychological Aspects - Communicating with Our Patients
Authors: Shah Duru 
Published: January 2024

PCOS is a common endocrine disorder with its worldwide prevalence being almost 20%, affecting women throughout every stage of their lives and is well known for its multifactorial nature. Due to its variation in phenotype, a delay in the diagnosis and hence treatment, adds to the woes of PCOS girls and women, who are already harrowed by its distressing symptoms. Hence depression, anxiety, mood, and mental health disorders are strongly prevalent in women with PCOS. Body shaming and negative body image have a profound impact on the quality of life of women with cosmetic issues. On the other hand, women with infertility have many social issues especially in countries wherein fertility is considered as a bane for women leading to depression and anxiety. Hence, decoding the relationship between mental health and PCOS can help address and improve psycho-social outcomes in such women. Counselling and communication along with evidence based behavioural interventions is the need of the hour to help PCOS women cope with their issues. Along with lifestyle counselling programs, flexible psychological counselling with an individualized approach can promote positive mental health in women with PCOS, whilst management of their physical health is commenced. In India, the PCOS Society of India, has created an organized Awareness Program called “Vijeyata-the winner” for women through Physical Sessions, Webinars, social media, YouTube Videos, supported by a grant, which educates women on the subject. The sessions also assess their knowledge through a poll conducted via pre and post sessions and helps them suspect whether they may be at risk of PCOS and encourages them to see their physicians for their problems. The details of this program will be discussed during this Session.
Contingency Plan and Emergency Protocols - What You Need to Know
Authors: Pope Adrianne 
Published: January 2024

Planning for a disaster or untoward event is usually the last thing on people’s minds in an ART unit but unfortunately it is a reality. Identifying possible risks and implementing plans to address or mitigate these is now considered best practice. This presentation will outline potential risks and strategies to assist in managing unexpected events. The focus will be on creating a risk register, developing plans, and creating scenarios to aid in training staff in dealing with adverse events. The goal will be to create an awareness of untoward events or natural disasters that have had an impact on ART clinics around the world and how people have adapted practices to ensure patient, gamete, embryo, staff, and equipment safety.
How to Perform a Baseline Ultrasound for Subfertility
Authors: Deslandes Alison 
Published: January 2024

The presentation, “How to Perform a Baseline Ultrasound for Subfertility,” delves into the crucial role of ultrasound in assessing and diagnosing subfertility in female patients. This educational session aims to equip healthcare professionals with essential knowledge and skills to perform baseline ultrasounds effectively. The presentation will emphasise the value of ultrasound as a non-invasive and informative diagnostic tool. Attendees will gain insights into the specific indications for baseline ultrasound, including assessment of pelvic structures, antral follicle counting, and evaluation for common pathologies contributing to subfertility. The presentation will then explore the step-by-step procedure for performing a baseline ultrasound, focusing on patient preparation, transducer selection, and image acquisition techniques. Furthermore, the session will delve into common ultrasound findings associated with subfertility, enabling practitioners to recognise and interpret potential abnormalities accurately. Through this presentation, healthcare professionals will enhance their proficiency in baseline ultrasound, empowering them to contribute significantly to the diagnosis and management of subfertility, ultimately supporting their patients on their journey towards achieving successful pregnancies.
Soft Markers and the Siding Sign
Authors: Deslandes Alison 
Published: January 2024

This presentation aims to equip healthcare professionals with valuable insights into the role of soft markers and the siding sign as part of a comprehensive ultrasound to detect endometriosis. Attendees will learn; — What soft markers and the sliding sign are — Technical considerations to assessing soft marker and the sliding sign — The diagnostic value of these findings and; — Limitation of these findings including how these should be used in clinical management and considerations for communicating these to patients.
When to MRI
Authors: Knox Steven 
Published: January 2024

MRI is a non-invasive second line tool which can make a valuable contribution to the diagnosis and pre surgical mapping of pelvic endometriosis. It is validated and serves as an adjunct to high quality ultrasound. It has particular strengths in the mapping of complex obliterative deep cul de sac disease and adjacent organ involvement. It has high sensitivity and specificity in diagnosing pelvic endometriosis and can upstage the degree of endometriosis compared to diagnostic laparoscopy. The use of MRI for endometriosis in Australia has significantly increased in the last 5 years and there is growing national and international research occurring in this space. Access has also improved dramatically for patients since the allocation of $25m of funding to make available Medicare funding for MRI imaging of suspected significant endometriosis by the Federal Government in mid-2022. As clinician and community awareness of improved MRI access grows, it is even more important to have a working knowledge of the strengths and weaknesses of MRI for anyone involved in the diagnosis, workup, and management of patients with suspected or proven endometriosis.
Introduction - Biopsy: A Major Factor that Can Impact the Clinical Outcome of PGTs
Authors: Chi Ling 
Published: January 2024

Nowadays, blastocyst biopsy is widely used in preimplantation genetic tests (PGTs), especially in preimplantation genetic testing for aneuploidy (PGT-A). Compared to polar body biopsy and cleavage stage biopsy, blastocyst biopsy has a higher consistency in the genetic analysis of human embryos and has a less impact on embryo implantation potentials. However, the consistency of genetic tests and the clinical outcome of post blastocyst biopsy can vary depending on biopsy practitioners. This workshop will discuss the handling of blastocyst biopsy procedure with the purpose of helping participants further advance their blastocyst biopsy techniques. We will review the procedure step by step including post biopsy cryopreservation through formal lectures, salon talks, panel discussions and hands-on training. We will also discuss trouble shootings from the perspective of an embryology lab and that of a genetic testing lab.
Common Mistakes While Performing an Embryo Biopsy
Authors: Mantravadi Krishna 
Published: January 2024

Embryo biopsy for Pre-Implantation Genetic Testing (PGT) is an advanced intervention in embryology lab requiring technical preciseness. Improper technique can influence the process of genetic evaluation, genetic report, and the reproductive outcomes. Following are few tips and tricks which help in optimizing the embryo biopsy technique : — It is not recommended to perform embryo biopsy in the same lab where regular embryo cultures are done. Use of UV light and Ethanol for sterilization of consumables might increase the VOCs (volatile organic compounds) and this might affect the embryo development. — Skill of micro-manipulation for an embryologist is very essential for a smooth biopsy technique — Additional care needs to be exercised when inner cell mass is at the site of biopsy or embryo has completely hatched — Negative suction pressures in the biopsy and holding pipettes during biopsy technique have to be well controlled. This avoids damage to the tissues. — Minimum of 6-8 trophectoderm cells need to be biopsied — Post biopsy we need to ensure that there is no remnant tissue on the biopsy pipette. This might bring about cross contamination of DNA. — While tubing care needs to be exercised to avoid excess buffer in the PCR tube. This can increase the chances of “NO DNA” detection. — Post biopsy its preferable to wait for one hour to assess significant damages to the embryo before vitrification — Embryos that have completely hatched need additional care at vitrification. Trophectoderm tissue is very sticky and might get adherent to the culture dish or the cryo-device. — Biopsied tissue post tubing needs to be stored at minus 20 degrees C till it gets shipped for genetic evaluation.
Blastocyst Biopsy - Genetics Lab Perspective
Authors: Gebhardt Kathryn 
Published: January 2024

The use of genomics in assisted reproduction has significantly grown over recent years. Preimplantation Genetic Testing for monogenic diseases (PGT-M) and/or numerical/structural chromosomal abnormalities (PGT-A/PGT-SR) are tools for embryo selection aimed at identifying nonaffected and/or euploid embryos in a cohort produced during an IVF cycle. This technology holds the potential to assist in determining whether an embryo created through in-vitro fertilisation (IVF) is likely to result in implantation, increasing the success rate of the procedure and decreasing time to pregnancy (when used appropriately). Genomics in IVF also offers increased options and information to patients when determining their treatment path. A critical aspect of this technology is the embryo biopsy, which can be performed at multiple stages of embryo development. Studies have determined that the embryo biopsy procedure can have a detrimental impact on the developing embryo. A lesser considered impact is the detrimental effect of biopsy on the preimplantation genetic testing result. Embryologists are faced with the delicate balance of performing a biopsy which yields a suitable sample for downstream testing, while minimising any harm to the developing embryo. From the embryo biopsy, biopsy sample handling (washing and tubing), storage and transport to the genetics laboratory, the success of the genetics laboratory is dependent, in part, on the starting material received from the embryology laboratory. This presentation will focus on the is importance of the coordination between clinical teams, embryology, and genetics scientists to optimise genetic test results and patient outcomes.