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Courbiere B, Le Roux E, Mathieu d'Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigne M, Chanavaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. [French clinical practice guidelines developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease]. Gynecol Obstet Fertil Senol 2022; 50:211-219. [PMID: 35063688 DOI: 10.1016/j.gofs.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To provide clinical practice guidelines about fertility preservation (FP) for women with benign gynecologic disease (BGD) developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease. METHODS A steering committee composed of 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices related to FP for BGD. Then 114 key stakeholders including various healthcare professionals (n=108) and patient representatives (n=6) were asked to participate in a modified Delphi process via two online survey rounds from February to September 2020 and a final meeting. Due to the COVID-19 pandemic, this final meeting to reach consensus was held as a videoconference in November 2020. RESULTS Survey response of stakeholders was 75 % (86/114) for round 1 and 87 % (75/86) for round 2. Consensus was reached for the recommendations for 28 items, that have been distributed into five general categories: (i) Information to provide to women of reproductive age with a BGD, (ii) Technical aspects of FP for BGD, (iii) Indications for FP in endometriosis, (iv) Indications for FP for non-endometriosis BGD, (v) Indications for FP after a fortuitous diagnosis of an idiopathic diminished ovarian reserve. CONCLUSION These guidelines provide some practice advice to help health professionals better inform women about the possibilities of cryopreserving their oocytes prior to the management of a BGD that may affect their ovarian reserve and fertility. STUDY FUNDING/COMPETING INTEREST(S) The CNGOF (Collège National des Gynécologues Obstétriciens Français) funded the implementation of the Delphi process.
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Affiliation(s)
- B Courbiere
- Department of gynecology-obstetric and reproductive medicine, hôpital La Conception, AP-HM, Marseille, France; Aix-Marseille université IMBE, CNRS, IRD, Avignon université, Marseille, France.
| | - E Le Roux
- Inserm, CIC 1426, unité d'épidémiologie clinique, hôpital universitaire Robert-Debré, AP-HP Nord-université de Paris, Paris, France; Inserm, ECEVE UMR 1123, université de Paris, Paris, France
| | - E Mathieu d'Argent
- Department of gynecology-obstetric and reproductive medicine, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Torre
- Department of gynecology-obstetric and reproductive medicine, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - C Patrat
- Inserm U1016, service de biologie de la reproduction - CECOS, AP-HP centre - université de Paris, site Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Poncelet
- Department of gynecology - obstetrics/UFR SMBH Leonard de Vinci, centre hospitalier de René Dubos/université Sorbonne Paris Nord - université Paris 13, Cergy-Pontoise, France
| | - J Montagut
- Institut francophone de recherche et d'études appliquées à la reproduction, Ifreares Toulouse, Toulouse, France
| | - A-S Gremeau
- Department of gynecologic surgery and IVF, university hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - H Creux
- Department of gynecology-obstetric and reproductive medicine, clinique Saint-Roch, Montpellier, France
| | - M Peigne
- Department of reproductive medicine and fertility preservation, hôpital Jean-Verdier, université Sorbonne Paris Nord-Paris 13, AP-HP, Bondy, France
| | | | - L Dirian
- EndoFrance, Association française de lutte contre l'endométriose, Paris, France
| | - X Fritel
- Inserm CIC-P 1402, department of gynecology-obstetric and reproductive medicine, CHU Poitiers, Poitiers, France
| | - J-L Pouly
- Department of gynecology-obstetric, centre hospitalier Moulins Yzeure, Moulins, France
| | - A Fauconnier
- Department of gynecology and obstetrics/research unit 7285 risk and safety in clinical medicine for women and perinatal health, CHI Poissy-Saint-Germain-en Laye/Paris-Saclay university, Poissy, France
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Courbière B, Roux EL, Mathie. D’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigne M, Chavanaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. P–454 Oocyte vitrification for fertility preservation in women with benign gynecological disease: French national clinical guidelines with a modified Delphi consensus process. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there consensual clinical practices about fertility preservation (FP) for benign gynecological diseases BGD)?
Summary answer
A consensus study using the modified Delphi method identified 28 consensual practices concerning oocyte vitrification for fertility preservation in women with benign gynecological disease.
What is known already
Clinical Practical international guidelines are still published in oncology for offering standardized information and care for adults and children with cancer. Recently, the ESHRE Female Fertility Preservation Guideline Development Group published recommendations for healthcare professionals involved in fertility preservation for post-pubertal women and transgender adolescents and young adults. However, benign gynecological indications weren’t distinctly individualized of malignant conditions. There’s a lack of large cohort studies assessing the risks and outcome of FP for benign gynecological diseases. Healthcare professionals need consensus for defining the “good” indications of FP for benign gynecological diseases that could impair fertility.
Study design, size, duration
A steering group composed by 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices concerning fertility preservation for benign gynecological disease. Then, 114 key stakeholders including various healthcare professionals (n = 108) and patient representatives(n = 6) were asked to answer at two rounds of a modified Delphi via an online survey from February to September 2020.
Participants/materials, setting, methods
Participants had to score 42 items for the first round and 31 for the second round using a nine-point Likert scale. These statements were distributed into five categories: Information to deliver to age-reproductive women with a BGD (n = 9), technical aspect of fertility preservation for BGD (n = 6), indications of FP for endometriosis (n = 13), indications of FP for none-endometriosis BGD (n = 10), idiopathic diminished ovarian reserve in the absence of gynecologic and endocrinologic diseases (n = 4).
Main results and the role of chance
Survey response of stakeholders was 75% (86 out of 114) for the round 1 and 87% (75 out of 86) for the round 2. Consensus recommendations were achieved for 28 items, and no consensus between stakeholders was achieved in the remaining items. Stakeholders rated the importance of an age-specific information concerning the risk of diminished ovarian reserve after surgery and the necessity to inform about the benefice/ risk balance of oocyte vitrification, in particular about the chance of live-birth according to the age at the time of oocyte vitrification. They endorsed oocyte vitrification as the reference FP technique for those benign indications. Experts rejected to determine lower and upper age limits in women for fertility preservation. FP shouldn’t be offered in rAFS stages I and II endometriosis without endometriomas.
Limitations, reasons for caution
Experts were only French native speakers from France, and Belgium. It would have been interesting to conduct this survey with experts from other continents.
Wider implications of the findings: At our knowledge, we present here the first guideline s focusing on FP in women with BGD, following a designed scientific Delphi procedure. These guidelines could be useful for gynecologists to better inform women with benign gynecological diseases about the indication or not to offer a FP procedure.
Trial registration number
Not applicable
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Affiliation(s)
- B Courbière
- APHM Hôpital de la Conception / Aix Marseille Univ, Gynecology- Obstetrics and reproductive Medicine, Marseille, France
| | - E L Roux
- Hôpital Universitaire Robert Debré- AP-HP/ Inserm- Université de Paris, Unité d’épidémiologie clinique Inserm- CIC 1426 / ECEVE UMR 1123, Paris, France
| | - E Mathie. D’Argent
- APHP Hôpital Tenon /Université Pierre-et-Marie-Curie Paris 6, Department of Gynecology-Obstetric and Reproductive Medicine- Centre expert en endométriose C3E, Paris, France
| | - A Torre
- CHU Rouen, Department of Gynecology - Obstetric and Reproductive Medicine, Rouen, France
| | - C Patrat
- APHP centre – Université de Paris- site Cochin- Inserm U1016, Service de Biologie de la Reproduction – CECOS, Paris, France
| | - C Poncelet
- CH rené Dubos / Université Sorbonne Paris Nord - Université Paris 13, Gynecology - Obstetrics / UFR SMBH leonard de Vinci, Cergy-Pontoise, France
| | - J Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, Toulouse, France
| | - A S Gremeau
- University Hospital Clermont-Ferrand, Gynecologic surgery and IVF, Clermont-Ferrand, France
| | - H Creux
- Clinique Saint Roch, Gynecology-Obstetric and Reproductive Medicine, Montpellier, France
| | - M Peigne
- AP-HP Hôpital Jean Verdier / Université Sorbonne Paris Nord- Paris 13, Reproductive Medicine and Fertility Preservation, Bondy, France
| | | | - L Dirian
- EndoFrance, Association Française de lutte contre l’endométriose, Paris, France
| | - X Fritel
- CHU Poitiers, Gynecology- Obstetric and Reproductive Medicine / Inserm CIC-P 1402, Poitiers, France
| | - J L Pouly
- CH Moulins Yzeure, Gynecology-Obstetric, Moulins, France
| | - A Fauconnier
- CHI Poissy-Saint-Germain-en Laye / Paris -Saclay University, Gynecology and Obstetrics / Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Poissy, France
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