Discover the latest advancements in infertility treatment with the 2022 guidelines from the French College of Obstetricians and Gynecologists, paving the way for first-line management strategies in couples facing infertility challenges.
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[First line management of infertile couple. Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2022.].
Sonigo et al., Gynecol Obstet Fertil Senol 2024
DOI: 10.1016/j.gofs.2024.01.014
Updated Guidelines for First-Line Management of Infertility
New Information: The 2010 CNGOF clinical practice guidelines for managing infertile couples have been updated, addressing 28 key questions across five major themes.
Importance: These updates provide current, evidence-based recommendations for the initial assessment and management of infertility, reflecting advances in knowledge and technology since 2010.
Contributions to Literature: The guidelines incorporate the latest systematic reviews and adhere to the GRADE® methodology, ensuring high-quality recommendations.
- Infertility work-up timing is now age-dependent: after 1 year before age 35, and after 6 months post-35.
- Initial work-up includes a 3D ultrasound for antral follicle count, tubal permeability assessment, Anti Mullerian hormone assay, and vaginal swabbing for vaginosis.
- Hysterosonography and diagnostic hysteroscopy are not first-line if 3D ultrasound is normal; Chlamydia trachomatis serology and post-coital testing are not recommended.
- For men, first-line tests include spermogram, spermocytogram, and spermoculture; further tests are recommended if abnormalities are found.
- No BMI threshold contraindicates medical infertility management; a Mediterranean diet, physical activity, and cessation of smoking/cannabis are advised.
- Alcohol consumption should be limited to less than 5 glasses per week for fertility concerns.
- Ovulation induction is not recommended for normo-ovulatory women without abnormalities; gonadotropin stimulation and ovulation monitoring are advised to prevent multiple pregnancies during intrauterine insemination.
- Laparoscopy is suggested before age 30 if no abnormalities are found; surgical management of hydrosalpinx is recommended before ART.
- Operate on polyps > 10 mm, myomas 0,1,2, and synechiae before ART; no systematic recommendation for asymptomatic uterine septa and isthmoceles.
These recommendations were validated by 40 national experts, ensuring a strong consensus in the updated guidelines.