Table 3 New recommendations included in the SIRU guidelines with specific reason

2.10.1.

Exposure to mercury may interfere with female and male fertility. Attention should be given to professional and dietary exposure to mercury.

Based on Henriques et al., 2019 [22]

2.14.

Inform women who had a previous cesarean section that they should wait for at least 10 months after the intervention prior to initiate pregnancy seeking to reduce the risk of uterine rupture.

Based on Matorras et al., 2019 [23]

3.3.1.

Despite some evidence on the association between HPV infection and female and male infertility, there is no indication to investigate its presence because the infection does not modify the subsequent fertility work-up.

Based on Weinberg et al., 2020 [24] and Yuan et al., 2020 [25]

3.9.3.

Diagnosis of proximal tubal block does not impact on the success of intrauterine insemination. These women should receive the same management as those with bilateral patency. Conversely, the diagnosis of distal block halves the chance of success.

Based on Tan et al., 2019 [26]

4.2.3.

Offer surgery for varicocele to infertile men with an indication to IVF, including men with non-obstructive azoospermia.

Based on Esteves et al., 2016 [27] and Kirby et al., 2016 [28]

10.5.4.

Inform women scheduled for IVF that a regular physical exercise in the period preceding the attempt can increase the success of the procedure.

Based on Rao et al., 2018 [29]

11.1.4.1

In good prognosis women (such as young women who had a prior clinical pregnancy for IVF), consider continuing beyond the limit of three full IVF cycles. This decision should be carefully evaluated and justified taking into utmost consideration the balance between risks and benefits.

Panel decision (unanimity). Recommendation long debated within the panel [46]

12.3.8.

Consider prescribing myo-inositol prior to IVF because it can reduce the total dose of administered gonadotropins.

Based on Zheng et al., 2017 [30] and Laganà et al., 2018 [31]

12.4.2.

Consider trigger with GnRH agonists in women at risk of ovarian hyperstimulation syndrome.

Based on Mizrachi et al., 2020 [32]

12.4.5.

Consider dopamine agonists to prevent ovarian hyperstimulation syndrome in women at risk.

Based on Tang et al., 2016 [33]

12.6.10.

Inform women that single embryo transfer does not fully protect from twin pregnancy. IVF pregnancies are at 2–3-time higher risk of monozygotic twins.

Based on Hviid et al., 2018 [34] and Busnelli et al., 2019 [35]

12.6.11.

Inform women that IVF is associated with a higher risk of placental anomalies (placenta praevia, placental abruption and abnormal cord insertion).

Based on Vermey et al., 2019 [36]

12.6.14.

Inform women on the possibility to perform preimplantation genetic screening for aneuploidies but clarify that it cannot increase the chance of pregnancy.

Decision panel (no unanimity). Based on Lee et al., 2015 [37], and Cornelisse et al., 2020 [38]. Recommendation long debated within the panel [47]

15.3.4.

Women undergoing oocytes donation should be informed about the increased obstetrics risks, including preterm birth, hypertensive disorders and low weight newborns. The counseling should be tailored to the specific condition of the woman.

Based on Jeve et al., 2016 [39], Masoudian et al., 2016 [40] and Mascarenhas et al., 2017 [41]

16.1.4.

Consider the provision of information with written material and audio-visual media because they actively involve and empower the patients and can improve fertility preservation decision-making.

Based on Wang et al., 2019 [42]

16.1.12

Offer ovarian cortex freezing in prepubertal or young girls who are preparing for medical treatment for cancer that is likely to make them infertile if:

• they are well enough to undergo surgery

• this will not worsen their condition and

• enough time is available before the start of their cancer treatment.

Based on ASRM [45] and AIOM guidelines (see before).

17.2.3.

Even if rare, inform people who are considering IVF treatment with or without ICSI that newborns are at increased risk of imprinting disorders.

Based on Cortessis et al., 2018 [43]