Ovary

STRAW+10 involved a 2-day, in-person meeting hosted at the 2011 Annual Meeting of NAMS. On the first day, international experts gave oral presentations reviewing recent data bearing on the goals, as part of a public symposium, followed by comments and discussion from the audience. The first two sessions focused on data from prospective cohort studies of midlife women, clinical findings related to trajectories of change in menstrual, endocrine and ovarian markers of reproductive aging, and data relevant to how these trajectories vary by ethnicity, body size, and smoking status. A particular focus was on patterns of change in AMH, inhibin B, FSH, estradiol and AFC and their inter-relationships. A third session focused on emerging evidence related to staging reproductive aging in the context of cancer treatment, chronic illness including cancer and HIV-AIDS, and endocrine disorders including polycystic ovarian syndrome (PCOS) and primary ovarian insufficiency (POI, otherwise known as premature ovarian failure). At the end of day one, a panel reviewed and participants discussed modifications that had been proposed by symposium speakers. STRAW+10 explicitly considered feasibility of applying criteria in low resource countries.
Subsequently, 41 invited scientists convened to develop consensus and propose modifications to the STRAW model. These participants had clinical and/or research experience in female reproductive aging and included scientists from several key research groups in the United States, Canada, Australia, the Netherlands and South Africa, representatives from the NIH funded cohort studies of midlife women that have biological samples^{60 (link)} including SWAN, the Michigan Bone Health and Metabolism Study (MBHMS), SMWHS, Biodemographic Models of Reproductive Aging (BIMORA), and the Penn Ovarian Aging Study (POAS) as well as the Australian MWMHP, as well as junior investigators who submitted qualifying posters.
Three breakout groups were formed based on scientific expertise and interest. Group 1 reviewed criteria for STRAW Stages −4 to −2. Group 2 reviewed criteria for STRAW Stages −1 to +2. Each of these two groups was subdivided into two subgroups and assigned a rapporteur. Each subgroup proposed modifications to the STRAW paradigm separately, considering criteria for the relevant stages in healthy women and the weight of evidence concerning the appropriateness of applying these criteria to smokers and women regardless of body size. Each subgroup of Group 1 and of Group 2 then reviewed the recommendations of their paired subgroup and discussed points of disagreement until consensus was reached. Group 3 discussed staging in the context of endocrine disorders and chronic illness and proposed modifications. This group then integrated with one of the Group 1 or Group 2 subgroups.
On the second day, the 41 scientists convened to review and discuss proposed modifications. First, Group 1 and Group 2 reviewed the other group’s recommendations proposed on the previous day. In this way, all groups reviewed all stages under consideration (Stages −4 to +2) Then, the group at-large met to discuss each proposal and final recommendations were adopted by consensus. Preliminary recommendations of the STRAW+10 Workshop were presented at the NAMS annual meeting on September 22 with comments and requests for clarification considered by the STRAW+10 program committee.