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Keynotes

Keynote Lectures

Sunday, 3rd October 2021 | 17:30 - 18:00

'Intramural myomas and infertility: should we remove them?

 

 

 

 

 

 

 

 

 

 

 

 

 

Fibroids cause a variety of symptoms in 30–40% of cases, depending on their location and size, although many are asymptomatic. Due to the current trend of postponed childbearing and improvements in medical care resulting in longer reproductive timeline, fibroids are increasingly more frequently seen in women seeking help for infertility.

It is clear that women with submucosal myomas experience significantly lower implantation, clinical pregnancy, ongoing pregnancy and live birth rates, as well as significantly higher miscarriage rates, hence the need to treat submucosal fibroids is widely accepted. But the effect of non-cavity-distorting uterine fibroids is still subject of an ongoing debate and fibroids in other locations (FIGO types 3, 4, 5, 6, 2–5) continue to present a clinical conundrum.

All published studies and meta-analyses concur that non-cavity-distorting intramural myomas do indeed have a deleterious impact on IVF outcomes and many authors recommend their surgical removal but we may ask a crucial question: “If the negative impact of myomas is linked to size and proximity to the uterine cavity, why not try a medical approach to reduce their size and force them further into the myometrium” to provoke a migration effect. This may be a novel way of maintaining fertility for the management of symptomatic fibroids.

Therefore, the question: "Should the intramural myomas be removed in
infertile women?" remains a source of controversy and will be discussed during the lecture by Professor Jacques Donnez, former President of the ESGE and a leading expert in the field of reproductive medicine.

 

Monday, 4th October 2021 | 12:30 -13:00

'Uterine anomalies: start all over again?'

 

 

 

 

 

 

There has been much debate on the definition and classification of uterine septum and the value of surgical treatment to improve reproductive outcomes recently. Publication of the ESHRE/ESGE classification of Mullerian anomalies triggered the debate in 2013 and this reached a new climax in 2020 following the publication of two articles in Human Reproduction. These two articles concluded that the reproductive outcomes following surgery and expectant management were similar. This attracted much criticism from many leading clinicians internationally and caused confusion amongst patients.

There is no-one better than Professor Grigoris Grimbizis, former President of the ESGE and lead author of many publications in this field, including the ESHRE/ESGE Classification, to give us an overview of where we currently stand in terms of definition and treatment of uterine anomalies. He will cover these issues in his keynote lecture entitled 'Uterine anomalies: start all over again?'

 

Tuesday, 5th October 2021 | 12:30 -13:00

'Risk-Reducing Strategies for Ovarian Cancer:
role of prophylactic salpingo-oophorectomy and opportunistic salpingectomy'

 

 

 

 

 

 

 

 

 

 

 

 

 

Ovarian cancer (OC) is the commonest cause of death among gynaecological cancers. Despite advances in drug discovery and treatment strategies, long term survival rates have improved only marginally over the last 30 years, with 10-year survival rates at around 30%. Most women who get ovarian cancer die from it. Screening for ovarian cancer has not been shown to reduce mortality and is unavailable in the general population. In the absence of a robust screening strategy, surgical prevention remains the key strategy to reduce the risk of ovarian cancer.

Risk-reducing salpingo-oophorectomy (RRSO) is the most effective method of surgical prevention. With increasing genetic testing in clinical practice, identification of moderate risk OC susceptibility genes, and the improving ability to estimate risk based on family history and other risk factors, has led to an expanding role for RRSO including for women at intermediate risk (5–10% lifetime risk) of ovarian cancer. With increasing uptake of RRSO for prevention of ovarian cancer, more women will be exposed to the long-term consequences of premature surgical menopause.

Alternatives to RRSO such as opportunistic salpingectomy and early salpingectomy combined with delayed oophorectomy are now being evaluated in clinical trials. The future era will be one of model based on personalised ovarian cancer risk prediction coupled with risk adapted tailored or targeted prevention
strategies.

Professor Ranjit Manchanda, a leading expert in this field will be giving a keynote lecture to cover these issues in Rome at the ESGE 30th Annual Congress.

 

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