bluuebunny/crossref_metadata_2025 huggingface dataset:
Lean Management in an IVF Laboratory
Authors: Tuong Ho Manh
Published: January 2024

The early spread of Lean started in the auto industry. Toyota gained knowledge from others and developed its own management system by employing and inventing methods that fit its needs and situation. It developed the Toyota Production System, called “LEAN”. In healthcare, Lean transformation is a process of changing old mindsets and organizational cultures. It is a long-term process that takes time and effort from the whole organization.

Lean management is not to solve major problems of the organization, it is about hundreds or thousands of small problems that occur in the system every day. We have to learn together, think together, and start taking action to improve every day, and continue doing so as long as we can. The ultimate goal of Lean is to provide products/services at a lower cost and higher quality, to increase the value of our products/services to our customers.

IVF demand has been increasing worldwide, yet competition has been fiercer. The IVF cost has been increasing. Lean management in IVF laboratories that aims to improve IVF lab procedure flow, reducing risks/errors, adding value to IVF lab services. As the IVF business has developed very fast, IVF staff shortages are a big issue. Overworked conditions in IVF laboratories can harm procedure quality, patient safety, service quality and lead to losing staff and patients. Lean management can help us to improve the lab flow and efficiency and reduce the pressure of staff shortages. By improving efficiency, reducing errors, and adding value to the service, it will accumulatively provide a better-quality service with less costs.

The presentation describes how our system in Vietnam approached and applied Lean management in IVF laboratories to reduce waste, improve laboratory quality with staff involvement and satisfaction.
What Medically Assisted Reproduction Should Be Offered in Unexplained Infertility?
Authors: Mol Ben
Published: January 2024

Conflict of Interest:

BWM is supported by a NHMRC Investigatorgrant (GNT1176437). BWM reports consultancy and travel support from Merck, Guerbet and Organon and research funding from Merck.

In up to half of all couples who seek medical assistance for infertility a direct cause for their inability to conceive cannot be identified and they are therefore labelled as having unexplained infertility. Unexplained infertility is characterized by normal ovulation, tubal patency, and a normal (or slightly deviant) semen analysis in the male partner according to WHO-criteria. The causes of unexplained infertility remain, as determined by its definition, largely unknown.

Available treatments for unexplained infertility include intrauterine insemination (IUI) with ovarian hyperstimulation, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), but also tubal flushing or lifestyle interventions. Treatments like IUI and IVF might on one hand be effective because they increase the number of possible conceptions, for example by creating multiple follicles or embryos, but they also might overcome an unknown barrier for conception.

Since, in couples labelled with unexplained infertility natural conception by definition never can be excluded, the prognostic profile of couples for such natural conception is instrumental. I will argue that understanding of prognosis for natural conception should be one of the cornerstones for the management of infertility. If the prognosis for a ‘spontaneous pregnancy’ within a reasonable time frame is high enough, it might be justified to delay treatment in these couples for some time. After that, IUI should be the treatment of first choice.
The Use of Websites and Modern Apps (i.e.: Ask PCOS, Ask Early Menopause, EndoZone)
Authors: Bidargaddi Niranjan
Published: January 2024

Access to unprecedented information at finger tips has both benefits and drawback. In this talk I examine the transformative role of websites and mobile apps in access to, and the delivery of health information, specifically in reproductive and endometriosis healthcare. It sheds light on the challenges and solutions. The talk is organised in two parts. Initially, I delve into search engines and social media, illuminating the role of social algorithms in health information distribution. While these algorithms have made information more accessible, they often prioritize commercial interests over medical accuracy. By using examples like YourFertility and Endozone, I outline an alternative health-focused algorithm design, which prioritise accurate, reliable health information. Next, I shift the focus to mobile apps and wearables. These tools are easily integrated into our daily routines and collect user data continuously. The challenge here is to separate the wheat from the chaff - to identify quality resources from a vast pool of options, while also addressing issues of data overreach, highlighting the need for regulation. I will explore a case study demonstrating the potential of apps for micro-level observation and intervention. By tailoring micro-interventions based on user biometric fluctuations within daily contexts, apps can transform how we approach self-management.
Optimizing Cardiometabolic Health in Patients Planning for Pregnancy
Authors: Legro Richard
Published: January 2024

Optimizing cardiometabolic health during pregnancy is rarely successful given the limited time and tools available. This must be addressed prior to pregnancy and appropriate screening and intervention will be reviewed. Generally, a more aggressive approach with responsibility assumed by the treating fertility provider is the proposed solution.
Implications of Cardiometabolic Changes in Menopausal Medicine
Authors: Robins Jared
Published: January 2024

This lecture will describe the impact of menopause on cardiovascular and metabolic health. Menopause represents a significant transition in a woman’s life, marked by hormonal fluctuations that contribute to various physiological changes. This lecture will explore the underlying mechanisms behind these alterations and their potential health consequences. Ultimately, this lecture aims to provide healthcare professionals with the knowledge to implement effective strategies for risk assessment, prevention, and management to promote better cardiovascular and metabolic health in menopausal women.

At the conclusion of this lecture the attendee will:

1. Understand menopausal associated hormonal changes and their associated cardiovascular risk factors

2. Understand how menopause can lead increased risks for type-2 diabetes and metabolic syndrome.

3. Understand how metabolic changes in menopause leads to increased risk for osteoporosis

4. Develop personalized approaches to mitigate the cardiometabolic risks associated with menopause
Management of PCOS in Adolescence - Can We Improve Future Fertility by Treating Before and in Adolescence
Authors: Shah Duru
Published: January 2024

PCOS is a multifunctional disorder with an evolving concept. Various studies have shown that this condition affects 8-13% of women of Reproductive age with 5-15% of them being adolescent girls. The physiological pubertal changes can mask the features of PCOS, hence leading to a challenging and a delayed diagnosis during adolescence mainly due to overlapping of symptoms which are mixed with menstrual irregularities, cosmetic issues and anxiety dominating affected girls. Various causative factors have been implicated to cause PCOS, with interaction between genetics, intrauterine maternal environment, and lifestyle. A strong family history in first degree relatives in addition to epigenetic changes and obesity can influence the early onset of PCOS in adolescents. It is important to achieve a timely diagnosis & appropriate management during adolescence in order to tackle co-morbidities associated with PCOS and ensure a smooth transition to adulthood. Identifying at-risk adolescents can prevent PCOS in future and make patients aware of seeking timely treatment.

As the adolescent matures into the phase of life when she would like to have children, she can be efficiently managed with lifestyle changes, oral contraceptive pills, androgens, and insulin sensitizers.

Pre and Periconceptual management are of crucial importance in a woman having PCOS, as adverse influences on fetal development can cause diseases in the affected fetus due to epigenetic changes.

Maternal factors like under/ over nutrition, obesity and Insulin Resistance can contribute to Impaired fetal nutrition and metabolic dysfunction.

Hence correction of maternal insulin resistance and hyperandrogenism is important before conception, stressing the need of correct Nutrition during pregnancy to avoid transmission of PCOS to the fetus.

There is an increased risk of PCOS in overweight girls between 7-13 yrs. of age, while being overweight after age 13, further worsens the chance of developing PCOS. Adolescents with BMI > 40 are known to have 23-fold increased risk of developing PCOS. Hence being mindful of weight during childhood and adolescence can go a long way in preventing the onset of PCOS across future generations.
Debate 2: Cross Border Reproductive Care Should Be Banned
Authors: Kovacs Gab , Patel Nayana
Published: January 2024

Motion: For

The opinions expressed in this debate are not the personal opinions of the presenter but are points raised to provide a debate.

CBRC is defined as “movement of persons from one jurisdiction to another in order to access or provide treatment.

Often called “reproductive tourism” but it is “reproductive exile”

Existed for many years before fertility treatment-Irish women going to England for abortion.

Why? Either unavailable or more affordable.

Avoid legal, religious, or ethical restrictions

Do we want to encourage breaking the laws of home?

Do we encourage exploitation of poor donors/surrogates?

Do we want to encourage avoidance of record keeping of donors?

CONCERNS

Health and safety

Legal difficulties, e.g., passport for child

Exploitation

Children as a “commodity”

Children abandoned e.g., Abnormalities

SAFEGUARDS

Balance rights of individuals against rights of children

Need global guidelines/laws- UNTIL THEN; BAN CBRC.

Motion: Against

Cross-border reproductive care (CBRC) has become a dynamic global phenomenon encompassing various fertility treatments and practices, including surrogacy, embryo donation, age limit, marital status, cost considerations, advanced technology, support systems, known clinician or clinic preference, frozen embryo use, international job transfers, sex selection, PGTA restrictions, and restrictions on the number of embryos transferred.

This debate revolves around the motion against banning CBRC, acknowledging its multifaceted nature and the need for comprehensive evaluation of its legal, ethical, and economic implications. CBRC has emerged as a lifeline for individuals facing restrictive reproductive laws in their home countries, offering hope and expanded choices for family building.

Critics express concerns over potential exploitation, inadequate regulations, and safety risks associated with CBRC. Ethical dilemmas arise regarding patient autonomy, justice, and discrimination, particularly for LGBTQI individuals seeking fertility treatments in less legally restrictive countries.

International organizations such as ESHRE, ASRM, ICMART, and IFFS have initiated efforts to collect data and set guidelines for CBRC. However, more work is needed to establish standardized data registries and harmonize laws to accurately assess the magnitude and scope of CBRC worldwide.

A balanced approach to CBRC involves collaborative global governance and cooperation to address challenges while upholding patient rights and ensuring responsible practices. Facilitating access to advanced fertility treatments and safeguarding against potential risks are paramount considerations in shaping the future of cross-border reproductive care.

In conclusion, the complexities surrounding CBRC warrant thoughtful deliberation and international collaboration. Rather than imposing a blanket ban, an inclusive approach focusing on transparency, safety, and ethical considerations will foster a responsible and balanced implementation of cross-border reproductive care.
#289 : Mitochondrial Activator BGP-15 Protects Sperm from DNA Damage During Sperm Recovery for Assisted Reproductive Technology
Authors: Gonzalez Macarena , Connaughton Haley , Barry Michael , Robker Rebecca , Rose Ryan
Published: January 2024

Background and Aims: The recovery of sperm by assisted reproductive technology (ART) results in significant DNA damage. Elevated levels of DNA damage in sperm have been linked to poor-quality embryos and increased pregnancy loss after ART. Therefore, in this study, we aimed to investigate potential of the new mitochondrial activator BGP-15 to prevent sperm DNA damage in an in vitroejaculate over time. Additionally, we sought to determine whether BGP-15 can preserve sperm quality during various sperm recovery techniques used in ART.

Method: We incubated donated human semen specimens untreated or treated with BGP-15, then examined sperm motility and DNA damage (DNA fragmentation and oxidation). Semen samples were then processed using different clinical sperm recovery methods: simple wash (SW), swim-up (SU) and density gradient centrifugation (DGC); and the purified sperm underwent further analysis including motility, vitality, ROS levels, mitochondrial membrane integrity and mitochondrial membrane potential (MMP), and DNA damage.

Results: Semen samples incubated with BGP-15 demonstrated improved sperm motility and reduced DNA damage levels. SW samples had the highest sperm count, while SU had the highest vitality and DNA integrity, but the lowest MMP. DGC sperm had increased MMP after BGP-15 Treatment. Although BGP-15 treatment only reduced sperm DNA fragmentation in SW samples, it reduced DNA oxidation in all recovery methods.

Conclusion: Our findings indicate that clinical manipulation of patient semen samples can negatively impact sperm quality, and different sperm recovery methods have unique effects. However, the addition of BGP-15 to clinical processes can preserve sperm quality, potentially leading to improved embryo quality and ART success.
#362: Importance of Monitoring Progesterone(P4) Values a Day Before D5 FET and Effect of Intervention with Progesterone Supplements in Cases with Low P4 Values
Authors: Chirumamilla Lakshmi , Ambavarapu Divya Reddy , Volesingamreddy Pranitha Reshmi
Published: January 2024

Background and Aims: Our study was carried out at a tertiary fertility Centre- Hyderabad, to study the importance of monitoring P4 values, day before D5FET and intervention with progesterone supplements in case of low levels and its outcome.

Methods: This is a retrospective cohort study done by analyzing all D5FET cases and cases with low P4 values were given progesterone supplements and its effect on outcome were studied. Done between 1/01/22-31/03/23, a period of 15 months. Excluded donor, D3nD6 cycles.

Results: In a 15 months period, there were 466 D5FET cycles which were included in our study. The age group of women were between 21-45 years and their P4 values, day before D5FET were studied. Around 290(62.2%) cases had levels between 11-20 ng/ml. Among them, 217 conceived being 74.8%. There were 79(16.9%) people who had levels between 21-30 ng/ml among whom 60 conceived with success rate being 75.9%. There were 97 cases who had levels less than 10 ng/ml. If their levels were less than 8ng/ml, they received aqueous progesterone 25 mg subcutaneously twice, 12 hours apart. If levels were between 8-10 ng/ml, they received micronized progesterone 200 mg per rectum twice, 12 hrs apart. The positive pregnancy rate came up to 76.2% among people who received supplementation. In fact, there were 4 people who had levels <5 ng/ml, all four received aqueous progesterone and conceived.

Conclusion: Our study concludes that evaluating P4 values day before D5FET is of vital importance. Timely supplementation helps in positive pregnancy rate at par with people with optimum levels of P4.
#394 : The Efficacy of an Individualized Dose of Follitropin Delta on Ovary Reproductive Stimulation and Clinical Outcomes
Authors: Kesiman Dyatmika Maheswari , Cakradiningrat Kadek Dwi , Kesumadana I Wayan
Published: January 2024

Background and Aims: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Mullerian hormone (AMH) and body mass index (BMI) for ovarian stimulation.

Methods: In this present manuscript, we aimed to gather all available data published between 2018–2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF).

Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Therefore, all post hoc derived analyzes and subgroups of patients who participated in subsequent studies support this statement.

Conclusion: Despite the relatively limited range of data in the current literature, most authors provide strong evidence to support the later use of this drug according to patient profiles and overcoming ethnic limitations. Others disagree with these observations, but this topic and this drug have great potential. As such, additional research is needed to fill existing knowledge gaps and extend this experience to a larger scale. Demonstrate overcoming all limitations.
#8 : The Effect of IVF-ET Electro-Ultrasound Therapy on the Outcome of Frozen Embryo Transfer in Patients with Thin Endometrium
Authors: Wu Qiongfang , Tian Lifeng , Zhao Yan , Xu Tao , Chen Jia , Huang Jialuv , Xu Dingfei , Xia Leizheng , Nie Ling , Li Mengxi
Published: January 2024

Background and Aims: This study are to investigate the clinical indicators of the infertile population of IVF-ET thin endometrium patients after electro-ultrasound treatment, record the observational data and analyze the clinical effectiveness of this treatment method.

Method: Patients undergoing IVF-ET freeze-thaw embryo transfer from March 2022 to November 2022 were screened, and those who met the entry criteria were randomly grouped by random number table method. Treatment group (n=32): patients who received electro-ultrasound therapy; patients treated with electro-ultrasound (MLD-C7000) once a day for 30 minutes for 7 days for 1-3 sessions in the context of conventional FET preparation of the endothelium. Control group (n=69): Routine FET preparation of the endometrium without.

Results: There were no significant differences in basic data (P > 0.05). The endometrial thickness on the day of conversion 7.75±2.00 mm was significantly higher in the treatment group than the endometrial thickness on the day of conversion 6.39±0.67 mm in the control group (P<0.05). The biochemical pregnancy rate and clinical pregnancy rate in the treatment group were higher than those in the control group, but the differences were not statistically significant (P > 0.05).

Conclusion: In IVF-ET patients with thin endometrium, electro-ultrasound therapy device can effectively improve the endometrial thickness of patients with a trend of beneficial effects on clinical outcomes and can be one of the methods to improve the success rate in patients with thin endometrium. However, further increase in sample size is needed in the future to improve the accuracy of the results.
#41 : The Effectiveness of GnRH Agonist Administration Prior to Frozen-Thawed Embryo Transfer with Artificial Cycle: A Systematic Review and Meta-Analysis of Different Protocols and Infertile Populations
Authors: Ho Nguyen Tuong , Ho Dang Khanh Ngan , Tomai Xuan Hong , Hu Yu-Ming , Ho Yen-Ping , Lin Shyr-Yeu , Wang Ruey-Sheng , Lee Yi-Xuan , Tan Shun-Jen , Kao Shu-Huei , Tzeng Chii-Ruey
Published: January 2024

Background and Aims: We investigated the use of GnRHa pretreatment with different protocols and durations of treatment on pregnancy outcomes in women undergoing FET with artificial cycles (AC-FET).

Method: A systematic search of PubMed, EMBASE, Google Scholar, and Cochrane library was performed to include only eligible peer-reviewed studies in English published before September 01, 2022. This review was registered on PROSPERO (CRD42022299259)

Results: A total of 41 studies (43021 individuals) were included with low to moderate risk of bias. Overall, GnRHa pretreatment improved clinical pregnancy rate (CPR) (OR=1.27, 95%CI:1.12-1.44), implantation rate (IR) (OR=1.24, 95%CI:1.07-1.45), live birth rate (LBR) (OR=1.31, 95%CI:1.07-1.60) and endometrial thickness (MD=0.16, 95%CI:0.03-0.30). Subgroup analyses of randomized and non-randomized studies both demonstrated the benefits of GnRHa pretreatment in CPR, IR, and LBR. Protocols using depot GnRHa (OR=1.19, 95%CI:1.04-1.36) showed a better LBR than daily GnRHa (OR=1.04, 95%CI:0.93-1.16). Women administered GnRHa for more than one cycle had better CPR (OR=2.01, 95%CI:1.29-3.13) and IR (OR=2.14, 95%CI:0.98-4.67) than those treated with GnRHa within one cycle before FET ([OR=1.18, 95%CI:1.04-1.33] and [OR=1.16, 95%CI:1.01-1.32], respectively). In women with PCOS, pituitary suppression with GnRHa significantly improved CPR (OR=1.24, 95%CI:0.98-4.67), LBR (OR=1.22, 95%CI:1.05-1.42) and reduced the miscarriage rate (OR=0.75, 95%CI:0.59-0.95). In contrast, women with regular menstruation had a higher endometrial thickness (MD=0.16, 95%CI: 0.04-0.28) but no significant improvements in pregnancy outcomes. GnRHa pretreatment considerably improved IR (OR=2.21, 95%CI:1.60-3.07) in women with adenomyosis and CPR (OR=1.74, 95%CI:1.12-2.71), and LBR (OR=1.67, 95%CI:1.06-2.63) in women with endometriosis.

Conclusion: GnRHa pretreatment, especially with longer suppression duration and the use of depot GnRHa, demonstrates a beneficial role during AC-FET cycles. Individuals with PCOS benefit from GnRHa pretreatment, though this FET protocol should be carefully considered in ovulatory women with regular menstruation. Albeit having the potential, effectiveness of this protocol on adenomyosis or endometriosis remains controversial and requires more rigorous investigation
#52 : Cumulative Live Birth Rates (CLBR) According to the Number of Oocytes Retrieved in Minimal Stimulation In Vitro Fertilization (IVF) Treatment
Authors: Ong-Jao Ednalyn , Mendiola Rudie Frederick , Perillo Gayla , Francisco Fides Marie
Published: January 2024

Background and Aims: Ovarian stimulation is necessary for IVF in order to stimulate the development of multiple follicles in a single cycle. To optimize ovarian stimulation, there is a need to know the optimum number of oocytes retrieved to achieve a live birth.

This retrospective study aimed to evaluate the relationship between the number of oocytes retrieved and the cumulative live birth rates among patients undergoing mild stimulation IVF treatment in a private fertility clinic in the Philippines.

Method: Ovulation was induced using clomiphene citrate in combination with lower doses of gonadotropins. Final oocyte maturation was triggered with hCG or GnRHa. Mature eggs were fertilized using intracytoplasmic sperm injection. Only 1 to 2 embryos were transferred per cycle.

Results: A total of 1,431 patients that had 1,817 fresh and frozen transfer cycles were included. Average age of women was 35.70 ± 3.97 (min. 20, max. 46). Binary logistic regression shows that age is a predictor of live birth, with a critical value of 34.6 years.

CLBR was estimated using Kaplan-Meier survival analysis, with the number of oocytes as the time factor. The estimated mean number of oocytes retrieved for cases that had live birth was 8.90 ± 0.30. Half of the cases that had live birth had an estimated oocyte number of 7.0 ± 0.194. Live birth steadily increased with the number of oocytes but declined beyond 25 oocytes. Retrieval of 6 to 9 oocytes was enough to achieve 40-60% CLBR. In comparison, conventional IVF recommends 8 to 15 oocytes to achieve similar CLBR.

Conclusion: Retrieval of lower numbers of oocytes with minimal stimulation IVF can produce desirable success rates comparable to rates achieved with higher numbers of retrieved oocytes in conventional IVF.
#114 : Is Mild Stimulation IVF Better for Women with Previous Poor Outcome Following Conventional High-Dose Stimulation?
Authors: Ponusamy Sharmila Thevi , Lim Michelle Sheng Rong , Chen Jang Jih , Wong Pak Seng
Published: January 2024

Background and Aims: With the aim of yielding higher number of oocytes, high gonadotrophin doses are often used in ovarian stimulation protocols which may have a detrimental impact on oocyte and subsequently embryo quality. Alternatively, mild stimulation (MS) protocols mimic physiological folliculogenesis with a low dosage of gonadotropins and aims to produce better-quality oocytes with a reduced aneuploidy rate. This study investigates the clinical outcome of patients who had multiple attempts of IVF cycles with both MS and high-dose conventional stimulation (HS) protocol.

Method: A retrospective analysis was carried out on 26 patients who had a total of 108 IVF cycles from 2017-2022. The MS protocol involves administration of Letrozole/Clomiphene from Day 2 for 5 days followed by highly purified menotrophin (150-225IU) on alternate days starting after Day 3 whereas in HS protocol, [Formula: see text]300IU of daily dose of gonadotrophins were given. ICSI was performed for all mature oocytes and the resulting embryos were cultured to blastocyst stage for preimplantation genetic testing for aneuploidy (PGT-A). Clinical outcomes such as the rate of fertilisation, degeneration, blastocyst utilisation, aneuploidy, clinical pregnancy, and live birth were analysed with Chi-square and Fisher’s exact test.

Results: The fertilisation rate (p=0.00140) and blastocyst utilisation rate (p=0.00966) are significantly higher with MS compared to the HS protocol. The degeneration rate did not differ among the treatments (p=0.50248). The pregnancy and live birth rates are higher following MS compared to HS but this is not statistically significant due to low number of patients. Aneuploidy rate is shown to be significantly higher in HS compared to MS (p=0.00975). On average, 3 cycles of MS are required to produce a live birth.

Conclusion: Patients with poor outcome to conventional hyperstimulation cycles may benefit from MS protocols. MS is cost-effective with lower treatment burden and has been shown in this small study to produce better clinical outcomes.
#132 : Outcomes and Related Risk Factors of Heterotopic Pregnancy in IVF-ET Cycles
Authors: Dong Xianghua , Gao Mingxia
Published: January 2024

Background and Aims: In vitro fertilization-embryo transfer (IVF-ET) has demonstrated significant success in treating infertility, but it can also introduce complications and risks such as heterotopic pregnancy (HP), which can lead to ectopic pregnancy rupture and bleeding, potentially endangering the patient’s life and fertility. This study aims to investigate the outcomes and associated risk factors of HP following IVF-ET, providing clinical insights for HP treatment.

Methods: A retrospective analysis was conducted on the clinical data, treatment, and pregnancy outcomes of patients with HP after IVF-ET admitted to First Hospital of Lanzhou University from Jan. 2012 to Dec. 2022. Statistically significant risk factors were identified and subjected to logistic regression analysis.

Results: Our data revealed a HP incidence of 1.27%. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). Among patients receiving laparoscopic surgery, 49.18% (30/61) had a history of pelvic surgery, 39.34% (24/61) underwent a fresh IVF cycle, and 60.66% (37/61) had a freeze-thaw cycle. The live birth rate was 83.67% (41/49) for those with a visible fetal germ and 85.37% (35/41) for those with a visible fetal heartbeat prior to surgery. Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P<0.05).

Conclusion: The incidence of HP in IVF-ET is much higher than in natural conception. Laparoscopic surgery is an effective treatment for HP, which does not seem to impact the ongoing pregnancy and live birth rates of the intrauterine gestational sac. However, the patient’s pregnancy outcome can be influenced by several factors, such as the average diameter and development of the intrauterine gestational sac prior to surgery, as well as the duration of the surgery.
#167 : Role of Endometrial Receptivity Using 3D Doppler Ultrasound on Pregnancy Outcome of IVF-FET Cycles
Authors: Gul Rohina , Khan Haroon Latif , Nisar Rameen , Sardar Saba
Published: January 2024

Background: The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends primarily on the quality of the embryo and the receptivity of the uterus. In addition to embryo quality the receptivity of the endometrium plays a role in the implantation process. Uterine receptivity is widely accepted as one of the main limiting factors in IVF outcomes. Endometrial thickness and endometrial pattern have been regarded as indicators for endometrial receptivity.

Objective: To compare the ultra-sonographic endometrial characteristic in relation to blood flow on Doppler between pregnant and non-pregnant groups of FET patients in IVF/ ICSI cycles.

Methods: This cross-sectional study is approved by the Institutional Ethical Committee (IEC) of Hameed Latif Hospital. Our study consists of 200 women who have come for FET cycle. On 18th day of period cycle, endometrial thickness, resistance index was obtained by transvaginal sonography. In the combined analysis, endometrial thickness groups (group 1: <9 mm; group 2: [Formula: see text]9 mm) were subdivided into two endometrial patterns (triple-line and diffused). The women were divided into the [Formula: see text]-HCG positive and [Formula: see text]-HCG negative groups. For statistical analysis chi-square and Fisher’s exact tests was used. Multiple logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were applied to determine the best predictive variables.

Results: The women in [Formula: see text]-HCG positive group were significantly younger as compared to [Formula: see text]-HCG negative group. Endometrial thickness was ¿ 9mm and RI was lower in group 1. A significant association was found between endometrial pattern and pregnancy outcome. (p-value = 0.01. ROC curve revealed that for ultrasound parameters the area under the curve was around 0.5.

Conclusion: Endometrium pattern and thickness and resistive index on Doppler may better predictor for pregnancy; combined endometrial characteristics do not predict outcomes.
#295 : Comparison of In Vitro Fertilization in Couples with HIV Infection with Negative Viral Load Versus Non-Infected Couples: A Case-Control Study
Authors: Muharam Natadisastra R , Wiweko Budi , Pratama Gita , Yuningsih Tita , Bagastoro Aswan , Abigail Anindita , Maidarti Mila , Harzif Achmad Kemal , Sumapraja Kanadi , Hestiantoro Andon
Published: January 2024

Background and Aims: The development of Advanced Reproductive Technology (ART) changes many aspects and perspectives towards reproductive health. Current in vitro fertilization (IVF) protocols reduce the risk of Human Immunodeficiency Virus (HIV) transmission to their partners and offspring. This study compares IVF outcome in couples in which at least one partner is HIV positive with negative viral load versus couples in which neither partner is diagnosed with HIV.

Method: A total of 100 couples undergoing IVF were categorized into two groups. HIV-positive with negative viral load group in which at least one partner is infected (n = 50) and non-HIV group in which neither partner is diagnosed with HIV (n = 50) are collected from medical record in our center during the same period. The main outcomes were total oocyte retrieved, normal fertilized egg or 2 pronucleus (2PN) one day after fertilization and good quality embryos based on number of embryos that transferred and frozen for IVF procedure. Differences between groups were determined statistically using the Mann-Whitney test.

Results: There is a significant difference between HIV-positive with negative viral load groups compared to non-HIV groups in terms of total oocyte retrieved (p = 0,005) and normal fertilized egg one day after fertilization (p = 0.017). There is no significant difference in the number of good quality embryos (p = 0.076) between two groups.

Conclusion: The data suggested that couples with HIV-positive women have poorer total oocyte retrieved and normal fertilized egg outcome compared to non-HIV couple. HIV infection might affect success rates of IVF treatments.
#317 : The Clinical Outcome of Ovarian Stimulation Undergoing Intrauterine Insemination with Follitropin Delta in Indonesian Women
Authors: Lubis Hilma Putri , Halim Binarwan , Adenin Ichwanul
Published: January 2024

Background and Aims: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples due to its simplicity and low cost. Numerous studies have shown that IUI cycles with controlled ovarian stimulation (COS) result in higher pregnancy rates compared to those without COS. Follitropin delta, a novel recombinant FSH (rFSH) can be used for controlled ovarian stimulation in women undergoing assisted reproductive technologies (ART) and was dosed individually based on serum anti-Müllerian hormone (AMH) concentration and body weight. In this study, we used a simplified dosage equivalent method. The aim of this study was to compare the efficacy and safety of follitropin delta in its simplified dosage equivalent regimen with follitropin alfa in a conventional dose regimen in Indonesian women undergoing intrauterine insemination.

Method: A single-center, retrospective observational study from January 2020 to December 2022 was performed in 228 IUI cycles in Halim Fertility Center, Indonesia. Controlled Ovarian Stimulation was performed during IUI cycles and divided into two groups: group I received follitropin delta with a simplified dosage equivalent regimen, and group II received follitropin alfa with a conventional dose. The baseline characteristics, cycle parameters, and IUI outcomes of both groups were compared.

Results: Our study included 228 IUI cycles with the follitropin delta group (114 IUI cycles) and the follitropin alfa group (114 IUI cycles). The clinical pregnancy rate was higher in the follitropin delta than the follitropin alfa but there was no significant difference between the groups (p>0.05). The multiple pregnancy rate and Ovarian Hyperstimulation Syndrome (OHSS) rates were lower in follitropin delta than follitropin alfa but there was no significant difference between the groups (p>0.05).

Conclusion: Follitropin delta with a simplified dosage equivalent regimen showed higher efficacy and similar safety compared with follitropin alfa in conventional dosing regimen in Indonesian women undergoing Intrauterine insemination.
#30 : Optimal Number of Fresh and Cryopreserved Mature Oocytes to Achieve at Least One Top-Quality Blastocyst
Authors: Hoang Thuy , Le Thao , Nguyen Quynh , Nguyen Loc , Huynh Nhu
Published: January 2024

Background and Aims: The final success of the IVF treatment cycle is to achieve a healthy baby. However, it depends on many factors, including the quality of the embryo transferred. Meanwhile, the number of high-quality embryos is correlated with the number of mature oocytes (both fresh and cryopreserved ones) for ICSI. Up to now, no study has yet established a cut-off value for the number of fresh and cryopreserved mature oocytes required for a successful cycle. The objective of this study is to assess the number of fresh and cryopreserved mature oocytes per cycle to achieve at least one good-quality blastocyst.

Method: This is a descriptive cross-sectional study that included 126 cycles with at least one frozen-thawed oocyte cycle at Tam Anh General Hospital’s fertility center from March to October 2022. To determine the number of fresh and cryopreserved mature oocytes for at least one good-quality blastocyst, we built a multivariable linear regression model, combining ROC curve and Nomogram chart to evaluate the effectiveness of the influence of the variables (number of mature oocytes, age, AMH, and BMI).

Results: At each cycle, the mean number of good-quality blastocysts (type 1 and type 2) was 1.95 ± 1.91 with a ratio of 37.57 ± 30.53%, in which there was no difference in blastocyst quality between fresh and cryopreserved oocytes. The number of fresh and cryopreserved mature oocytes for ICSI to achieve at least one good-quality blastocyst in the frozen-thawed cycle was seven mature oocytes.

Conclusion: Our study presents that the optimal cut-off number of fresh and cryopreserved mature oocytes is seven oocytes to achieve at least one good-quality blastocyst. The results of our study can be a reference so doctors can predict the oocyte number to improve efficiency and reduce costs for patients during IVF treatment.
#242 : Correlation of Sperm DNA Fragmentation with Laboratory Performance in Good and Poor Prognosis Patient Groups at Morula IVF Jakarta
Authors: Hikmawati Nurul , Rahmawati Pitra , Boediono Arief , Sini Ivan Rizal
Published: January 2024

BACKGROUND AND AIMS: Infertility in males contributes to about 40% of cases of infertility in couples, either as the main factor or along with female factors. Fragmentation of sperm DNA is known as a cause of male infertility, which impacts the failure of couples to undergo assisted reproductive programs, such as embryo development and recurrent miscarriage. However, some literature studies are still debating this. This research aims to determine the correlation between sperm DNA fragmentation and IVF laboratory performance.

METHODS: Infertile couples undergoing an in vitro fertilization program at Morula IVF Jakarta in 2022 are the samples for this study. We divided them into two groups: good prognosis (maternal age [Formula: see text]38 years, AFC[Formula: see text]7; AMH[Formula: see text]1.1) and poor prognosis (maternal age > 38 years, AFC <7, AMH<1.1). Sperm DNA fragmentation was examined using the sperm chromatin dispersion (SCD) assay. Correlation statistical analysis using the Spearman test (p-value <0.05).

RESULTS: Based on receiver operating characteristic (ROC) curve analysis, it was found that the sperm DNA fragmentation rate >14.9% had a significant negative correlation with IVF laboratory performance, particularly in the fifth-day embryo quality and blastocyst rate in the good prognosis group. Whereas in the group with poor prognosis, all laboratory performance parameters were not affected by high sperm DNA fragmentation values.

CONCLUSIONS: Sperm DNA fragmentation rate > 14.9% correlated with fifth-day embryo quality and a lower blastocyst rate in the good prognosis group.
#80 : Barriers and Enablers to a Healthy Lifestyle in Couples with Infertility: A Mixed-Methods Systematic Review
Authors: Torkel Sophia , Wang Rui , Norman Robert , Zhao Lijun , Liu Kai , Moran Lisa , Cowan Stephanie
Published: January 2024

Background and Aims: While there is a recognised role of optimising lifestyle (diet and physical activity) in the management of infertility, factors influencing the lifestyle behaviours of people with infertility are not well understood. The aim of this study was to describe the barriers and facilitators to achieving or prescribing a healthy lifestyle in the management of infertility from the perspectives of couples and health professionals.

Method: Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL Plus were searched for quantitative and qualitative primary studies (12[Formula: see text] September 2022) that explored barriers and enablers to lifestyle behaviours for infertility management. Data were analysed by inductive thematic analysis with themes mapped to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour model.

Results: After screening 10703 citations and 82 full texts, there were 23 included studies (13 quantitative, 8 mixed-methods and 2 qualitative) with 18 studies including women with infertility, 10 men with infertility and 6 health professionals. From the perspectives of people with infertility, themes related to capability (e.g., strategies for behaviour change), opportunity (e.g., limited time, resources and money) and motivation (e.g., interplay between lifestyle and emotional state); themes mapped to 8 TDF domains. From the perspectives of health professionals, themes related to capability (e.g., identification of patients appropriate for lifestyle intervention), opportunity (e.g., time constraints and organisational factors) and motivation (e.g., professional responsibility); themes mapped to 6 TDF domains.

Conclusion: Several interacting factors influence lifestyle behaviours in couples with infertility which can be targeted for optimisation of future interventions. There is a need for more qualitative research to gain insights into the perspectives of couples with infertility and health professionals for further exploration of the complex and interacting factors which shape lifestyle during the stressful journey of infertility and fertility treatment.
#91 : Development of a Combined Artificial Intelligence Score for Evaluating Both Embryo Ploidy and Viability to Aid in Embryo Selection During IVF
Authors: Diakiw Sonya , VerMilyea Matthew , Perugini Michelle , Nguyen Tuc , Perugini Don , Hall Jonathan
Published: January 2024

Background and Aims: Artificial intelligence (AI) is being increasingly used for non-invasive evaluation of embryo quality during IVF. Previous studies described development of AI for selecting embryos likely to be euploid (genetics AI), or likely to lead to clinical pregnancy (viability AI), based on analysis of images of blastocysts on day 5 of development. The aim of this study was to determine if a combination of these AI scores could be used to effectively evaluate both outcomes.

Method: 936 embryo images with pre-implantation genetic testing for aneuploidies (PGT-A) outcomes, and 479 embryo images with clinical pregnancy outcomes, were retrospectively obtained from 12 IVF clinics in 5 countries.

Performance was evaluated for each AI score alone, and the average score of the two AIs. The ability to select euploid or viable embryos was evaluated using ROC-AUC analyses, and a simulated cohort ranking method reported in the literature.

Results: The average score of the two AIs was generally as effective at selecting euploid embryos as the genetics AI, and just as effective at selecting viable embryos as the viability AI. Results for both analyses are presented below.

Conclusion: An AI score that can evaluate both embryo ploidy and viability simultaneously is useful for selecting preferred embryos for analysis or transfer. These results suggest that it is feasible to generate a single score for evaluating overall embryo quality using a non-invasive approach.
#310 : Infertility Misperception and Improper Health Seeking Behavior Between Urban and Rural Area in Indonesia
Authors: Kusuma Berli , Harzif Achmad Kemal
Published: January 2024

Background and Aims: The prevalence of infertility among reproductive-age couples in Indonesia is around 10-15%. Lack of understanding, misleading myths and negative attitude could result in improper behavior. This study aims to reveal the discrepancy between perception and behavior towards infertility in urban and rural area in Indonesia.

Method: Cross-sectional study using internet-based questionnaire was given to 408 individuals which divided into two groups, Java and outside Java representing urban and rural population respectively. All participants were above 18 years old who completed the questionnaire from October 2020 to April 2021.

Results: Half respondents from both groups consider infertility a disease. All respondents have excellent access to information. Although more than 80% of subjects from each group have been exposed to infertility information, better understanding was observed in urban community. The majority of each group answered smoking as the main risk factor for infertility, followed by stress and advanced age. More respondents in rural areas have the wrong perception that stress cause infertility. Furthermore, they seek unwarranted advice, as 19.5% came to midwives and only 9.1% came to general practitioners. This study showed 35.6% of subjects in urban group and 41.6% in rural group are considered late to seek healthcare assistance. Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options.

Conclusion: Misperceptions about infertility are more prevalent in rural groups compared to urban group. Fertility education among both groups needs to be improved in order to optimize the chance of conceiving and having a healthy baby.
#330 : Factors Affect Infertile Woman to Access Infertility Services in Central Java, Indonesia
Authors: Putrinadia Aninditya V , Budihastuti Uki Retno , Melinawati Eriana , Dafhonsa Meycha
Published: January 2024

Background and Aims: Infertility is defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse and approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. However, infertility has a strong social impact in the culturally and socioeconomically diverse Indonesia, both in cities and rural areas. A woman who experiences infertility is seen as an abnormality or weakness of that person because it is closely related to her deterministic nature to conceive and give birth. The high percentage of female factors in relation to infertility and the existing studies on the infertility related factors in women leads to the researcher interest to study the factors influencing infertility in women. In this study we analyzed some factors affect access to infertility services, especially for the women.

Method: This method of research is cross sectional study. An interviewer-administered survey was conducted with 30 infertile women recruited in Moewardi Hospital between April until June 2023. Participants were randomized-selected, and data was described to statistical analysis. Inclusion criteria: Women aged 20-45 years, experiencing infertility problems >1 year, willing to be interviewed, seeking infertility treatment, able to conduct interviews, not currently undergoing an IVF program. Exclusion criteria: malignant disease, moderate IVF program, pregnancy. The data was analyzed using SPSS 25 and significant if the p value <0.05.

Results: There was a significant relationship between several factors such as discrimination (p=0.003), culture (p=0.015), and knowledge (p=0.019) to access infertility services. Meanwhile, there was no significant association between financial factors (p=0.766) and gender sensitivity (p=0.064) with access ability to infertility services among infertile women.

Conclusion: Infertile women who experience discrimination, cultural pressure, and have better knowledge related to infertility will find it easier to access infertility services.