Strategies to Improve Outcomes of Ovulation Induction and Assisted Reproductive Technology (ART): The Iraqi Consensus

Abstract

The ESHRE 2019 Guidelines provide clinicians with valuable evidence-based recommendations to optimize ovarian induction and ovarian stimulation in in vitro fertilization (IVF). However, data from such guidelines are primarily based on randomized controlled trials with highly selected populations that are conducted under very controlled conditions. To complement evidence from clinical guidelines and further improve treatment outcomes, seven Iraqi experts gathered to evaluate opinions on the specific approaches during an IVF cycle in Iraq and developed 15 statements agreed upon: The Iraqi Consensus. A Delphi consensus was conducted to formulate expert opinion on how assisted reproductive technology outcomes could be improved. Step 1 involved the scientific Board, comprising the scientific coordinator, who developed the initial statements and supporting references, which were discussed/amended by seven experts, and refined the final statements and references. Step 2 involved 30 Iraqi experts voted on their level of agreement/disagreement with each statement. Consensus was reached if the proportion of participants agreeing/disagreeing with a statement was >66%. Step 3 data was collected and analyzed then communicated to participating experts. Consensus was achieved for 15 statements with high level of agreement in >85% of statements, tackling follicular development/gonadotropins; pituitary suppression; final oocyte maturation triggering; luteal-phase support. This represents the collective point of view of the experts that took part in the consensus development and are based on local practice. This Delphi consensus provides a real-world clinical perspective from Iraqi experts and complements the international guidelines, and may help to further improve treatment outcomes in Iraq and the region.