09.05.2026. održan je simpozijum u hotelu Radisson Blue-Old Mill u Beogradu. Simpozijum je organizovan povodom preseljenja ordinacije Milenković u novi prostor kao i početka rada IVF laboratorije.
Predavanja na simpozijumu su održali :
Profesor dr. sci. med. Mats Brännström, Odeljenje za ginekologiju I akušerstvo Univerzitetske bolnice Sahlgrenska, Geteborg; Prodekan za nauku Sahlgrenska akademije Univerziteta u Geteborgu, Švedska. Vanredni profesor, Baylor Medicinski fakultet, Hjuston, SAD.
Dr sci. med. Cesar Diaz; Medicinski direktor IVIRMA GLOBAL – Severna Evropa, London; Klinički senior lektor Univerziteta u Glazgovu, Velika Britanija.
Docent dr sci. med. Jan Olofsson; Karolinska Institut, Odeljenje za ginekologiju Univerzitetska bolnica Karolinska Stokholm, Švedska
Profesor dr sci. med. Katarina Stefanović; Klinika za ginekologiju i akušerstvo Kliničkog centra Srbije, Medicinski fakultet u Beogradu, Srbija.
Dr Elias Tsakos; direktor i osnivač Embryo Clinic IVF, Solun; Direktor odeljenja za robotsku ginekološku hirurgiju bolnice Sv. Luka, Solun, Grčka.
U daljem tekstu je zažetak predavanja na engleskom jeziku namenjen i stručnoj javnosti i pacijentima.
Personalized Progesterone in IVF - Are We There Yet?
Jan I. Olofsson, MD PhD, Assoc. Professor
Independent Consultant, Global Reproductive Health/Medicine
Progesterone is indispensable in early pregnancy. It prepares the uterine lining for embryo implantation, suppresses uterine contractions, and modulates the immune response that would otherwise reject the embryo. In IVF, where the natural hormonal environment is disrupted by ovarian stimulation or replaced entirely by exogenous hormones in frozen embryo transfer (FET) cycles, adequate progesterone support is not optional — it is essential.
Yet for decades, “adequate” has meant the same standard dose for every patient. We now know this is not good enough.
In programmed FET cycles — where no functioning corpus luteum exists — studies consistently show that around 30–40% of women on standard vaginal progesterone (800 mg/day) fail to reach the serum threshold of 10 ng/mL associated with successful implantation. Factors such as higher BMI, vaginal dysbiosis, and differences in pharmaceutical formulation all contribute to this variability. Intra-individual reproducibility is high — poor absorbers tend to remain poor absorbers — which gives prior serum monitoring predictive value in subsequent cycles.
The evidence is now strong enough to recommend serum progesterone monitoring in programmed FET — and same-day rescue with an alternative route (subcutaneous, rectal, intramuscular, or oral dydrogesterone) if levels fall below threshold. In natural cycle FET, the picture is more nuanced, and monitoring needs differ depending on whether ovulation is spontaneous or hCG-triggered.
Raising serum progesterone, however, may not always be sufficient. In conditions such as endometriosis and PCOS, endometrial progesterone resistance — impaired receptor signaling despite adequate circulating levels — can prevent a normal implantation response. This shifts the challenge from pharmacokinetics to endometrial biology. Several RCTs are currently underway; their results are needed before further practice change.
Take-home message: We are partially there. Serum-guided, individualized luteal phase support is becoming clinical practice. But ensuring adequate circulating levels is necessary but not sufficient — endometrial receptor competence is the missing variable.
Uterus Transplantation – From Experimental Research to Clinical Treatment
Mats Brännström
Uterus transplantation (UTx) has evolved over the past two decades from an experimental concept into a clinically established treatment for women with absolute uterine factor infertility (AUFI), a condition affecting approximately 1 in 300 women. The field originated from a patient-driven clinical question in the late 1990s and has since developed through a systematic translational research strategy integrating animal experimentation, surgical innovation, reproductive medicine, transplantation science, and long-term follow-up.
The Swedish translational UTx program, conducted between 1999 and 2012, involved progressive studies in mouse, rat, pig, sheep, and baboon models before moving to clinical application. This stepwise approach established principles for vascular surgery, graft preservation, immunosuppression, embryo transfer, pregnancy management, and recipient safety.
In 2012–2013, the world’s first clinical trial of live donor UTx was performed in Sweden. Nine women underwent transplantation, and in 2014 the first live birth after UTx occurred. The trial demonstrated proof-of-concept for the procedure, ultimately resulting in multiple healthy births and an 86% cumulative take-home baby rate among women with viable grafts.
Subsequent developments have included deceased donor UTx, minimally invasive and robotic donor surgery, refinement of recipient procedures, and establishment of international registries to monitor outcomes and improve patient safety. Current global data indicate more than 160–180 UTx procedures and over 70–80 births worldwide, with increasing use of robotic-assisted surgery and expanding international collaboration. Long-term follow-up studies of children born after UTx have so far demonstrated normal cognitive, neuropsychiatric, and physical development.
UTx is now transitioning from an experimental intervention to a recognized clinical treatment in selected centers, with growing international acceptance and public healthcare support in some countries.
Take-home message: Uterus transplantation represents one of the most successful examples of translational reproductive medicine, transforming a previously untreatable form of infertility into a realistic clinical option. Careful patient selection, multidisciplinary expertise, surgical innovation, and long-term outcome monitoring remain essential for the continued safe expansion of the field.
PCOS/PMOS After Menopause – Morbidity and Hormonal Changes
Mats Brännström
Polycystic ovary syndrome (PCOS) is one of the most common (12-15%) endocrine disorders in reproductive-aged women and has traditionally been viewed primarily as a reproductive condition associated with hyperandrogenism, menstrual dysfunction, and infertility. However, increasing attention has been directed toward the long-term health consequences of PCOS beyond the reproductive years. More recently, the condition has also been referred to as PMOS (Postmenopausal Metabolic Ovarian Syndrome), emphasizing the metabolic pathophysiology of several organs.
This presentation summarized findings from the unique Gothenburg PCOS prospective cohort study, in which women diagnosed with PCOS during 1956–1965 were followed longitudinally into older age, including assessments at mean ages of approximately 50, 70, and 81 years. These long-term data provide rare insights into endocrine, metabolic, cardiovascular, and psychological outcomes in ageing women with PCOS.
The hormonal profile changes substantially with ageing. FSH levels increase continuously with age but remain persistently lower in women with PCOS even into their eighties. Testosterone and free androgen index gradually decline, and after menopause women with PCOS are generally no longer biochemically hyperandrogenic. Nevertheless, clinical manifestations such as hirsutism may persist into advanced age.
Women with PCOS demonstrate increased rates of obesity, hypertension, type 2 diabetes, and metabolic syndrome during midlife, confirming the unfavorable cardiometabolic risk profile associated with the disorder. However, despite these increased risk factors, long-term follow-up did not demonstrate significantly increased cardiovascular morbidity, cardiovascular mortality, or total mortality compared with controls. Rates of depression and anxiety are increased among during the fertile period in women with PCOS/PMOS, but they appeared similar to controls in older age.
Take-home message: PCOS/PMOS evolves across the lifespan and, also after menopause. Although women with PCOS/PMOS have persistently increased cardiometabolic risk factors and ongoing clinical symptoms such as hirsutism, current long-term data do not show increased cardiovascular mortality or overall mortality. Continued long-term follow-up and preventive metabolic care remain important in ageing women with PCOS/PMOS.
Fertility Preservation: 20 Years of Experience and LongTerm Outcomes
Cesar Diaz
Fertility preservation (FP) has become a cornerstone of care for young women at risk of treatmentrelated ovarian damage. Improved survival across cancer types has shifted priorities from shortterm cure to longterm quality of life, with reproductive potential recognized as a key survivorship outcome. Large longitudinal cohorts now provide robust evidence that FP techniques—including ovarian stimulation with letrozolebased protocols—do not adversely affect oncological outcomes, even in hormonedependent breast cancer.
Despite this, ovarian damage remains common. Up to half of women develop premature ovarian insufficiency or diminished ovarian reserve following treatment, strongly driven by age and the gonadotoxic risk of chemotherapy rather than baseline ovarian reserve alone. Fertility preservation mitigates but does not eliminate this risk, reinforcing the need for early counselling and accurate risk stratification.
Realworld utilization of cryopreserved material is modest but higher than previously reported with prolonged followup. Importantly, a substantial proportion of pregnancies after FP occur spontaneously, indicating that fertility preservation does not compromise natural reproductive potential. Reproductive outcomes—whether spontaneous or assisted—are predominantly determined by age and ovarian reserve at diagnosis rather than the preservation technique used.
Takehome message: Fertility preservation is safe, effective and essential, but it does not fully prevent ovarian damage. Early referral, informed counselling and realistic expectations remain central to highquality oncofertility care.
Follicular Activation: Clinical Evidence and Future Perspectives
Follicular activation strategies aim to restore fertility in women with severely diminished ovarian reserve or premature ovarian insufficiency by reactivating dormant primordial follicles. Ovarian fragmentation disrupts the Hippo signalling pathway, increases nuclear localisation of YAP and promotes follicular growth. This biological rationale underpins approaches such as ovarian fragmentation for follicle activation (OFFA) and newer, less invasive techniques of invivo follicular activation (IVFA).
Early clinical data show that follicular growth and, in some cases, oocyte retrieval and pregnancy are possible following these interventions. Responses, however, are highly heterogeneous and strongly influenced by patient phenotype. Outcomes appear more favourable in carefully selected populations—particularly women with occult POI—while benefits in classical poor responders are limited. Although molecular and preclinical data are compelling, clinical results remain modest and sample sizes small.
Comparative data suggest that IVFA may achieve biological effects similar to surgical fragmentation, potentially reducing invasiveness while preserving efficacy. Nevertheless, these techniques remain experimental, and further controlled trials are required to define their true clinical value, optimal patient selection and longterm safety.
Takehome message: Follicular activation represents a promising frontier for selected patients with ovarian insufficiency, but it is not yet a standard therapy. Careful selection, realistic counselling and further clinical validation are essential.
