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This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

This study assessed the influence of adding embryos with different embryo quality on pregnancy rate and multiple pregnancy rate (MPR). The study included 1891 IVF transfers performed at two centres with different embryo transfer policies. Pregnancy rate and MPR were analysed following three models and then including embryo quality. A predictive mathematical model and two scatter plots were constructed. The model based on embryo independence was incompatible with the observed data, while both the ground and collaborative models provided excellent fits. The collaborative model, however, predicted multiple pregnancies, especially triplets, more accurately. Transfer of additional embryos, irrespective of embryo quality, always increased pregnancy rate and MPR. When implantation rate was low, there was a marked increase in pregnancy rate but only a relatively small increase in MPR. In contrast, with higher implantation rates, the increase in pregnancy rate was mainly due to the increase in MPR, with the same singleton pregnancy rate. Transfer of additional embryos, irrespective of embryo quality, follows a collaborative pattern and always results in an increase in pregnancy rate and MPR. The scatter plots accurately predicted the influence of the different combinations of number and embryo quality on pregnancy rate and MPR.

Pluvio J. Coronado1, Rafael Sanchez-Borrego2, Miguel A. Ruiz3, Laura Baquedano4, Sonia Sanchez5, Cristina Argudo6, Micaela Fernandez-Abellan7, Silvia Gonzalez8, Eva Iglesias9, Jackie Calleja10, Jesus Presa11, Alfonso Duque12, Fernando Ruiz13, Borja Otero14, Javier Rejas15,∗, the AEEM Collaborative Group 1 Hospital Universitario San Carlos, Madrid, Spain 2 Clinica Diatros, Barcelona, Spain 3 Universidad Autonoma de Madrid, School of Psychology, Madrid, Spain 4 Hospital Universitario Miguel Servet, Zaragoza, Spain 5 Hospital Sagrado Corazon, Barcelona, Spain 6 Clinica Begona, Gijon, Spain 7 Clinica Quiron, Malaga, Spain 8 Gabinete Medico Velazquez, Madrid, Spain 9 Hospital de Valme, Sevilla, Spain 10 Clinica Quiron, Madrid, Spain 11 Hospital Clinico de Jaen, Jaen, Spain 12 Clinica Ruber, Madrid, Spain 13 Hospital Clinico Universitario, Valencia, Spain 14 Hospital Universitario de Cruces, Baracaldo, Spain 15 Pfizer SLU, Health Economics and Outcomes Research Department, Alcobendas, Spain