4P Medicine comes to ART
Prevent
complications
Predict
outcomes
Personalize
treatment
Participation
by patients
Predict live birth
 Ovarian reserve
 Age
 Cause of infertility
 Smoking status
 Duration of infertility
 Obstetric h...
Predict oocyte yield and ovarian response by AMH
Nelson, et al Hum Reprod. 2007
Predict live birth with AMH
La Marca and Nelson et al Reprod Biomed Online. 2011
If you think of “predict” in conventional...
Predict live birth and oocyte quality with AFC
<34 34-38 34-38
Holte et al Fertil Steril 2011
OR 1.23 (95% CI 1.10, 1.37)
Predict complications
Nelson, et al. Hum Reprod. 2009
Normal Response
Reduced Response
Negligible Response
High Response
1...
Personalizing treatment - AMH stratification
10
20
40
Protocol
Mild strategy
Antagonist Control
HCG Trigger
Mild strategy
...
Personalize treatment and prevent complications
2
4
6
8
10
12
14
16
EggYield
Reduced AMH
Antagonist
1 – 4.9
Pmol/L
Normal
...
Personalize the number of embryos transferred
Nelson, et al. Lancet 2012
Participation of patients in healthy living
Mackay, Nelson, et al. PLOS Med 2012
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Nelson interpretation of biomarkers and cos adjustment for patients with different demographic characteristics and pathologies

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Nelson interpretation of biomarkers and cos adjustment for patients with different demographic characteristics and pathologies

  1. 1. 4P Medicine comes to ART Prevent complications Predict outcomes Personalize treatment Participation by patients
  2. 2. Predict live birth  Ovarian reserve  Age  Cause of infertility  Smoking status  Duration of infertility  Obstetric history  IVF history  Pharmacodynamics  BMI Nelson and Lawlor PLoS Med. 2011 Jan 4;8(1):e1000386. IVFpredict.com
  3. 3. Predict oocyte yield and ovarian response by AMH Nelson, et al Hum Reprod. 2007
  4. 4. Predict live birth with AMH La Marca and Nelson et al Reprod Biomed Online. 2011 If you think of “predict” in conventional terms of low medium, or high risk Age (years) AMH (ng/mL) <0.4 0.4 – 2.8 ≥2.8 >37 0.05 (0.01 to 0.16) 0.18 (0.12 to 0.26) 0.29 (0.17 to 0.44) 31 – 37 0.09 (0.02 to 0.24) 0.27 (0.21 to 0.35) 0.40 (0.28 to 0.54) <31 0.13 (0.04 to 0.36) 0.38 (0.26 to 0.51) 0.52 (0.38 to 0.67) *Values in parenthesis are 95% confidence intervals
  5. 5. Predict live birth and oocyte quality with AFC <34 34-38 34-38 Holte et al Fertil Steril 2011 OR 1.23 (95% CI 1.10, 1.37)
  6. 6. Predict complications Nelson, et al. Hum Reprod. 2009 Normal Response Reduced Response Negligible Response High Response 1.0 5.0 15 AMH ‘Normal’ & SAFE Maximal Recruitment Advantageous? Risk of OHSS increased Excess burden Few eggs Long course Agonist control SAFE - BUT Reduced Recruitment Dis-advantageous? Mild stimulation Antagonist control Risk of OHSS decreased Reduced burden Lower egg yield
  7. 7. Personalizing treatment - AMH stratification 10 20 40 Protocol Mild strategy Antagonist Control HCG Trigger Mild strategy Antagonist Control Agonist Trigger Long Down-regulation Agonist Control Flare Agonist Age (y) 3025 35 45 50 AMH (pmol/L) 50 50 40 30 20 10 70 40 Excessive High Normal Reduced Response Category Nelson, et al. RBM Online 2012
  8. 8. Personalize treatment and prevent complications 2 4 6 8 10 12 14 16 EggYield Reduced AMH Antagonist 1 – 4.9 Pmol/L Normal Agonist 5 – 15 Pmol/L Centre1 Centre 2 High AMH >15 Pmol/L Antagonist P < 0.001 10 20 30 Antagonist %Cycles HighAMH >15 Pmol/L P < 0.001 Reduced OHSS Excessive response Nelson, et al. Hum Reprod. 2009
  9. 9. Personalize the number of embryos transferred Nelson, et al. Lancet 2012
  10. 10. Participation of patients in healthy living Mackay, Nelson, et al. PLOS Med 2012

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