bluuebunny/crossref_metadata_2025 huggingface dataset:
Teamwork Makes the Fertility Dream Work
Authors: Moore Rebecca
Published: January 2024

Teamwork makes the fertility dream work: this presentation will discuss what “teamwork” means in the workplace, and more specifically the fertility nursing team. It will explore why teamwork is important in the fertility nursing team and look at the characteristics of good teamwork, such as communication, mutual respect, collaboration, cooperation and conflict resolution, participation, and supportive and positive attitudes. Furthermore, recognising and setting common goals within a team will also be explored. Fertility specific examples of what successful teamwork looks like will be provided, along with discussion around what happens when the team does not function well. The aim of this presentation will be to focus specifically on the fertility nursing team and recognising the dynamic and crucial role it has in the function of a fertility clinic, but also the fertility journey for the patient.
Adenomyosis and Endometriomas & Assessing the Rectosigmoid Colon
Authors: Piessens Sofie
Published: January 2024

Endometriosis is a common and often debilitating gynaecological disorder that affects 5-10% of women. The prevalence is even higher among women with symptoms of endometriosis. Approximately 80% of women suffering from endometriosis have superficial lesions while 20% have deep infiltrating endometriosis. Laparoscopy has always been considered the gold standard for diagnosing endometriosis as it allows diagnosis of both forms of endometriosis and often immediate removal of superficial endometriosis. The removal of deep infiltrating endometriosis is however significantly more complex, particularly when pouch of Douglas obliteration, bowel nodules or bladder nodules are present. Unless it was diagnosed preoperatively, the removal can usually not be completed because a multidisciplinary approach is often required with the involvement of a urologist or a colorectal surgeon.

Over the last 15 years it has been well established in the literature that transvaginal ultrasound allows preoperative diagnosis of deep infiltrating endometriosis. The preoperative diagnosis of DIE with transvaginal ultrasound facilitates a more patient-centred approach to endometriosis management because an accurate preoperative documentation of the location and extent of the disease allows for referral to an endometriosis expert and/or bowel surgeon, better preoperative planning, less repetitive surgery, and better outcomes for women.

The presentation on ‘Endometriomas and Adenomyosis’ will highlight the importance of these findings as red flags for the presence of deep endometriosis but also touch on how these conditions change over time with pregnancy and menopause. The presentation on ‘Assessing the rectosigmoid colon’ gives an overview on how to systematically assess the rectosigmoid for the presence of deep endometriosis nodules, and when this assessment must be included in the assessment of the pelvis.
Diagnosing Superficial Endometriosis with Ultrasound?
Authors: Leonardi Mathew
Published: January 2024

This presentation focuses on the utility of ultrasound in diagnosing superficial endometriosis, a challenging condition to detect using traditional imaging methods. Superficial endometriosis refers to lesions on the surface of pelvic organs and peritoneum, causing severe pain and infertility.

The presentation will highlight ultrasound’s potential as a non-invasive and cost-effective tool for detecting superficial endometriosis. Transvaginal and specialized ultrasound procedure approaches will be discussed including saline-infusion sonoPODography, enabling precise visualization of superficial lesions.

Understanding sonographic features to distinguish superficial endometriosis from other pelvic pathologies was stressed, underscoring the role of skilled sonographers and clinicians. Early detection through ultrasound can lead to timely intervention and improved patient outcomes.
Assessing the Uterosacral Ligaments
Authors: Leonardi Mathew
Published: January 2024

This presentation focused on evaluating uterosacral ligaments, crucial anatomical structures supporting the uterus within the pelvic cavity. These ligaments are the most common site of deep endometriosis.

Historically, it was thought that normal uterosacral ligaments could not be seen with ultrasound. Current literature suggests deep endometriosis visualization on ultrasound has a low sensitivity, suggesting even abnormal uterosacral ligaments are being inadequately evaluated.

In this presentation, it will demonstrate that both normal and abnormal uterosacral ligaments can be visualized on ultrasound. The approach to sonographic visualization will be elucidated. The scenario of severe posterior compartment deep endometriosis and adhesions will be discussed to guide imaging experts to break down very complex anatomical distortion.
The Different Biopsy Techniques
Authors: Malhotra Keshav
Published: January 2024

Preimplantation genetic testing needs access to genomic DNA in order to execute a genetic test on a preimplantation embryo. Normally a few cells must be extracted or ‘biopsied’ from the embryo to achieve this. Embryo biopsy evolved from attempts in the 1960s and early 1970s to sex farm animal embryos to now utilizing it to screen and select human embryos based on Ploidy, or avoid monogenic disorders. In October 1989, the first clinical cleavage stage biopsies and single cell PGT to determine the sex of the embryos were conducted. It has now evolved to utilize Trophectoderm cells. The advent of Laser has allowed the biopsy process to shift away from mechanical and chemical hatching and techniques also now involve Laser to separate the cells from the blastocyst. Here is a short summary of the different biopsy stages.

Polar Body Biopsy : — Polar bodies are small cells produced during the process of oogenesis (egg development) in females. — Since polar bodies contain genetic material from the egg, they can be biopsied to indirectly infer the genetic status of the egg. — This technique is less common and has limitations, but it can be used in certain situations.

Blastomere Biopsy (Day 3 Biopsy) : — Performed on the third day after fertilization when the embryo has around 8 cells. — A single cell (blastomere) is removed from the embryo for genetic testing. — Mosaicism cannot be ruled out thus questioning the efficacy of this technique.

Trophectoderm Biopsy (Day 5-7 Biopsy) : — Performed at the blastocyst stage, typically on the fifth or sixth day of embryonic development. — Usually, 5-10 cells from the trophectoderm are removed for genetic testing. — This technique is now gold standard and allows determination of mosaicism.

The embryo biopsy revolution’s 30-year saga is still unfolding, and non-invasive genetic testing holds potential to revolutionize the way embryos are tested for genetic disorders.
How Many Cells Should Be Biopsied? - Perspectives From Embryologist and Genetic Testing Lab
Authors: Cheng Ching-Wen
Published: January 2024

The biopsy process for PGT-A involves picking up a few cells from the outer layer of the embryo trophectoderm, when the embryo has developed into blastocyst stage. The biopsy procedure of PGT-A has been refined over years, but it could potentially have a slight impact on embryo implantation.

Theoretically, removal of a few cells from the outer layer of the embryo might disrupt its natural processes to some extent. Besides, a few research results indicated that the number of biopsied cells may have slight influence on the clinical outcomes of PGT-A. Meanwhile, others show no significant differences in implantation rate between biopsied and non-biopsied groups.

Therefore, in this presentation, we will discuss which is the appropriate number of cells to pick up for PGT-A, and share the clinical statistical results of the number of cells we have biopsied in our center.
Preimplantation Genetic Testing for Single Gene Conditions and Aneuploidy
Authors: Handyside Alan
Published: January 2024

It is now over 30 years since the first pregnancies and live births following IVF, embryo biopsy and preimplantation genetic testing (PGT) were reported in 1990. Since then, methods for genetic analysis at the single-cell level have evolved alongside the rapid advances in human genetics and sequencing of the human genome. With the development of methods for whole genome amplification, such as multiple displacement amplification (MDA), genome-wide analysis is now possible. This has led to the development of microarray or next generation sequencing (NGS) based methods for genome-wide haplotyping of parental chromosomes in embryo samples and enabled universal linkage-based testing for monogenic diseases combined with molecular cytogenetic analysis of chromosome abnormalities. These comprehensive methods have also recently been exploited to calculate polygenic risk scores for common multifactorial conditions, such as diabetes, cardiovascular disease, and cancer. Although controversial, polygenic risk scoring may have a role for reducing residual risk of breast cancer, for example, in combination with PGT for pathogenic variants. Finally, there is now evidence that cell-free DNA in spent culture medium at the blastocyst stage may originate from nuclear DNA shedding from the trophectoderm. In the future, therefore, it may be possible to use this cell-free DNA for genome-wide analysis and comprehensive PGT to avoid embryo biopsy.
MitoHOPE: Introduction to the Australian Mitochondrial Donation Project
Authors: Carroll John
Published: January 2024

Mitochondrial Donation provides a means of reducing the risk of transmitting mitochondrial genetic disease. If successful, families who have suffered in many cases across generations, will be freed from the risks of inheriting mitochondrial genetic disease in their future children. In response to mito community advocacy led by the Mito Foundation, Maeve’s Law, was passed in March 2022 to allow the introduction of mitochondrial donation in Australia.

The mitochondrial donation procedure involves removing the nuclear DNA from the egg or zygote of from a woman with a mitochondrial DNA (mtDNA) mutation and transferring it to an enucleated egg or zygote from a donor with healthy mtDNA. Although this technique has been used in animal models for many years and has undergone significant preclinical testing in humans, it is use in the clinic remains at an early stage and, to date, only a small number of babies have been born.

To introduce mitochondrial donation in Australia, an extensive regulatory and licensing procedure has been established and the MRFF has funded a Mitochondrial Donation Pilot Program, including a clinical trial. The mitoHOPE (Healthy Outcomes Pilot and Evaluation) Program integrates expertise in clinical genetics, oocyte and embryo development, mitochondrial disease, reproductive technologies, ethics, law, and health economics. The program was developed in conjunction with the mito community and this engagement will inform all steps of the implementation. Our partners include Monash IVF, the Mito Foundation and Newcastle University (UK).

Progress is now underway to establish our governance arrangements, an oocyte donation program, clinical pathways into the clinical trial and an underpinning research program to ensure the safety and efficacy of mitochondrial donation as it is being introduced into the clinic.
Ovarian Rejuvenation for Diminished Ovarian Reserve
Authors: Kim Ji Hyang
Published: January 2024

Addressing fertility challenges, particularly those stemming from advancing maternal age, requires innovative and effective solutions. This presentation navigates the frontier of ovarian rejuvenation for diminished ovarian reserve, examining whether it remains a myth or emerges as a promising reality.

The lecture offers a comprehensive review of various ovarian rejuvenation technologies available today. It will investigate the clinical studies, accumulated evidence, and overall clinical utility, creating a foundation for understanding the effectiveness and limitations of each approach.

A significant portion will be dedicated to the role and potential of Platelet-Rich Plasma (PRP) treatments in ovarian rejuvenation. This segment will include clinical study data and firsthand experiences, providing a practical perspective on PRP application.

Further, an exploration into the basic research that supports PRP usage will be presented. This knowledge illuminates how PRP might influence the ovarian environment and potentially restore ovarian function.

In conclusion, the lecture aims to initiate dialogue on ovarian rejuvenation and rehabilitation as alternative treatment strategies for patients contending with diminished ovarian reserve. Through this exploration, the presentation hopes to offer insights into the current landscape of fertility treatments in women with diminished ovarian reserve.
Reproductive Immunology and Embryo Acceptance
Authors: Robertson Sarah
Published: January 2024

Pregnancy is a test of the fundamental laws of transplantation immunology - the coexistence of genetically disparate tissues without host immune rejection. Advances over recent decades show that implantation and placental development depend on an active state of maternal immune tolerance, and breakdown of tolerance is a key contributor to infertility and recurrent pregnancy loss. Tolerance in pregnancy depends on regulatory T (Treg) cells, which are critical to inhibit effector immunity, constrain inflammation, and support maternal vascular adaptations that allow placental access to maternal nutrient supply. Treg cell defects are implicated in disorders of embryo implantation and placental development, but the origins of Treg cell dysfunction are unknown. In recent studies, we have comprehensively analysed the phenotypes and transcriptional profile of peripheral blood Treg cells in individuals with early pregnancy failure (recurrent miscarriage and recurrent implantation failure). Compared to fertile women, women with early pregnancy failure have fewer total Treg cells and altered Treg cell phenotypes, accompanied by lower Treg:Th1 and Treg:Th17 ratios. RNAseq demonstrates an aberrant Treg cell gene expression profile in early pregnancy failure, with upregulation of pro-inflammatory genes including CSF2, IL4, IL17A, IL21, and IFNG. Our data indicate that Treg cell defects in women with early pregnancy failure can arise due to loss of lineage fidelity associated with impaired FOXP3 regulation. Factors including metabolic function, luteal phase progesterone, and male partner seminal fluid components are all implicated in causing Treg cell deficit. Treg cells may be a useful target for therapeutic interventions to improve uterine receptivity, but this will depend on developing diagnostic tests that are informative. Moreover, safe, and effective interventions to modulate these cells are in their infancy, and personalized approaches matched to specific diagnostic criteria will be needed.
PGT-A: What Is Its Value in Treating Recurrent Pregnancy Loss?
Authors: Yan Junhao
Published: January 2024

PGT has been widely applied in the world, but its effectiveness for the treatments of recurrent pregnancy loss is still inconclusive. There is currently no consensus over the precise definition of RPL, according to the ESHRE guideline in 2022, a diagnosis of Recurrent Pregnancy Loss (RPL) could be considered after the loss of two or more pregnancies. The etiology of RPL is complex and highly heterogeneous, the higher proportion of embryo aneuploidy is an important reason, which can be affected significantly by maternal age. RPL has been listed as one of the common indications for PGT-A worldwide. However, the new RPL guideline by EHSRE in 2022, indicated that limited evidence for PGT in couples with RPL shows no clear benefit of treatment with very low quality. We reviewed the published studies, three retrospective studies showed that PGT-A may improve live birth rate for RPL patients, while two studies showed negative results. Most importantly, there were no randomized studies published on the application of PGT-A among RPL couples. Our data also showed similar cumulative live birth rates between PGT-A group and the control, regardless of maternal age, but PGT-A may favour in reducing miscarriage recurrence risk for RPL couples over 37 years old who obtained transferrable embryos. The presence of mosaic embryos and false positive/negative results, which can cause a high rate of cycle cancellation, may be the main reasons that compromise the efficacy of PGT-A. The cost-effectiveness of PGT-A is another important concern. In conclusion, there is still no sufficient evidence to support whether PGT-A can effectively improve the pregnancy outcomes for RPL couples, and proper-designed RCT is required in the future.
The Clinical Embryologist: Past, Present and Future Challenges
Authors: Boediono Arief
Published: January 2024

Embryologist is an essential part of infertility care defined as a highly skilled and well-trained person who can work in teamwork to execute continuous tasks with near-zero error and pay attention to detail with excellent clinical judgment. At the very beginning, embryologist’s routine daily tasks were quite simple including processing the sperm and eggs for natural insemination. Following that, advanced infertility treatment emerged quickly including intracytoplasmic sperm injection (ICSI), vitrification-warming, embryo shipping, intracytoplasmic morphologically sperm injection (IMSI), as well as trophectoderm biopsy as a source of chromosomal copy number testing or monogenic disorders analysis. Collectively, the implementation of such improved treatments renders complexity in the IVF laboratory that could be simplified in the future. Apparently, the implementation of advanced technology in the field of IVF nowadays has two main purposes. The first is to improve the IVF success rate including finding precise markers for embryo selection such as genomics, proteomics, and metabolomics fingerprint and images-based artificial intelligence algorithm for embryo selection. The second is to standardize or simplify routine daily tasks in the embryology laboratory by implementing automated software such as for laboratory quality control maintenance, a microfluidic system that allows standardization of handling gametes, micro-robotic for immobilizing sperm for ICSI, fully automated semen analysis, electronic tagging of laboratory devices to improve traceability. All such automated systems will serve as advanced clinical decision tools to boost IVF success rate and infertility care quality. An elevated automated system in the future in an embryology laboratory would impact the clinical embryologist in terms of reduced quantity and conversely, increased qualities of highly scientific embryologists with proper education. Embryologist roles may change from conventional routine daily tasks to well-trained and experienced embryologists who are able to scientifically evaluate the effectiveness of certain approaches or potential clinical use of such implementation in their clinical laboratory setting.
Single Step, Two-Steps, and Microfluidics in Embryo Culture. How Do They Measure up in Improving Embryo Quality?
Authors: Gardner David K.
Published: January 2024

The issues surrounding the culture of the preimplantation human embryo are distinct from those associated with the propagation of somatic cells, given that the starting point of culture, the pronucleate oocyte, and the final stage of development, the blastocyst, are as distinct as any two cell types can be with regards to their nutrient requirements and metabolism. Furthermore, the cleavage stage period of embryo development is exquisitely sensitive to its environment and has limited capacity to regulate against disruptions in its surroundings, especially changes in pH.

Historically the media used in human IVF, such as Human Tubal Fluid medium, were based on simple salt solutions but lacked key regulators of blastomere function, specifically amino acids. A resurgence of research in embryo metabolism and physiology in the 1980s paved the way for the development of Sequential media, designed not only to accommodate the changing requirements of the embryo itself (both in terms of carbohydrates and amino acids), but which were also based on available data on the dynamic/differing composition of the Fallopian tube and uterus. Sequential media, especially when used in combination with isolettes, were shown to be highly effective in supporting blastocyst development and significantly increased implantation rates, thereby facilitating the worldwide movement to single embryo transfer. However, while this approach partially satisfied the changing nutrient requirements of the embryo, and further facilitated the removal of toxins built up in the culture drop over 48h, such as ammonium, it necessitated moving embryos. Unless undertaken using warmed gassed isolettes, moving embryos inevitably resulted in shifts in temperature and pH.

With the advent of time-lapse, there began a growing movement towards the use of one-step media in order to keep the embryo within an imaging incubator. To facilitate this, hybrid type media were formulated, and while they do not accommodate the dynamic requirements of the preimplantation period, their use meant embryos were not exposed to changes in either temperature or pH. To date, clinical data have reported similar outcomes using both media approaches, plausibly due to a trade-off of the inherent limitations of either approach.

An alternative approach proposed decades ago, is to provide the embryo with a gradient of nutrients within a perfusion system, thereby facilitating a dynamic culture environment without the need to move embryos. Unfortunately, until recently, the technology to support this concept has not been available. However, the recent development of 3D printing using 2-photo lithography, has made it possible to create embryo-specific perfusion systems. Hence, we are now able to evaluate the potential of such dynamic systems and could find ourselves on the verge of a new era in embryo culture.
Follicle Fitness: Key Factors for Ovarian Health and Better Contraceptive Strategies
Authors: Russell Darryl
Published: January 2024

The ovarian follicle is an important endocrine organ that controls the female reproductive cycle through hypothalamic-pituitary-ovarian hormonal communication, an intricate network that governs reproductive fitness. Using genomics and molecular techniques our research is uncovering the processes by which ovarian folliculogenesis and oocyte development is regulated by the interplay of endocrine and paracrine signals that mediate coordinated growth and remodelling of the follicle, oocyte maturation and ultimately ovulation of a mature oocyte. We are investigating the consequences of dysregulation of hormones or their signalling networks that can lead to reproductive disorders such as polycystic ovary syndrome (PCOS) or impaired fertility through failure of ovulation or oocyte developmental competence. Ovulation is the pivotal event where the mature oocyte, surrounded by the expanded cumulus complex, is released from the follicle into the fallopian tube. This event is a critical target for understanding causes of infertility, developing therapies to reverse these causes, and also developing new contraceptives that do not disrupt endocrine function. In particular we are interrogating the molecular genomics of ovarian responses to the LH-surge and the steroids progesterone, androgen, estrogen, and others. Deciphering this endocrine network enriches our understanding of female reproductive biology and opens new avenues for interventions and fertility treatments.
Basic Research on Oncofertility for Further Technological Innovation
Authors: Suzuki Nao
Published: January 2024

Background: As a result of “advances in Oncology” and “advances in Reproductive Medicine” in recent years, some cancer survivors have achieved live births after cancer treatment. The world’s first report on ovarian tissue cryopreservation (OTC) and thawed-ovarian tissue transplantation in young patients with Hodgkin’s lymphoma by Professor Donnez and colleagues in Belgium in 2004 was a breakthrough in this research field. On the other hand, the report on ovarian transplantation in humans by Dr. Morris in the United States in 1906, the success of frozen ovarian thawing and transplantation in rodents by Dr. Parrott in the United Kingdom in 1960, and the success of Dr. Gosden in England in OTC using the slow freezing method in large animals in 1994 were important research results that led to Professor Donnez’s success. The current standard technique for OTC is slow freezing, and many reports of live births have been obtained. However, further technological innovation is needed for further progress in Oncofertility. I will give a talk titled “Basic Research on Oncofertility for Further Technological Innovation” focusing on the research results of our institution.

Methods: I report on the following research topics: 1) the establishment of the ovarian vitrification freezing method, 2) the ovarian toxicity of new molecularly targeted drugs, and 3) the detection of minimal residual disease (MRD).

Results: 1) the establishment of the ovarian vitrification freezing method, 2) the ovarian toxicity of new molecularly targeted drugs, and 3) the detection of minimal residual disease (MRD).

Results: The following research topics will be reported: 1) Successful establishment of ovarian vitrification freezing method, 2) Results on ovarian toxicity of molecularly targeted drugs (PARP Inhibitor), 3) Results on detection of MRD (minimal residual disease).

Conclusions: Further technological innovation should be needed for further progress in Oncofertility for the CAYA cancer patients.
Preserving Fertility for Patients Who are Gender Diverse and Transitioning
Authors: Sukcharoen Nares
Published: January 2024

Fertility preservation is the process of storing eggs, sperm, or embryos for future use. It can be an option for transgender people who want to have biological children in the future. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition showed the detrimental impact on the gonadal function and the future fertility, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. Early and regular counselling regarding future fertility, the treatment approach for fertility preservation and/or family-building in transgender and gender nonbinary individuals are very important. Fertility preservation should be offered to all transgender patients ideally prior to medical or surgical treatment.

Fertility preservation options for transgender men are oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation with in vitro maturation (IVM). Semen cryopreservation or testicular tissue cryopreservation is one of the fertility preservation options for transwomen. However, there is relatively limited data and clinical information regarding fertility preservation for transgender individuals.

Recently, there is a growing awareness of fertility preservation counselling prior to initiation of gender-affirming care. However, numerous studies have reported a limited standard of care with many transgender patients who are experiencing inadequate fertility counselling. Further prospective studies are needed for better quality fertility services and parenting options for transgender and nonbinary individuals. In conclusion, the denial of access to fertility services to transgender individuals and nonbinary persons is not justified.
Does Lifestyle Modification Work and if So, How Do We Deliver an Effective Program
Authors: Legro Richard
Published: January 2024

Lifestyle modification has not lived up to its promise in patients with PCOS and infertility. This is partly due to the difficulty in implementing this in clinical practice and to over-estimation of its benefits. Nonetheless there are benefits as well as limitations which will be reviewed in the lecture.
Management of PCOS IVF Cycle
Authors: Shah Duru
Published: January 2024

PCOS is the most common Endocrine and Metabolic disorder in reproductive age women, being the most common cause of anovulatory Infertility. PCOS is a vicious circle of Insulin Resistance, Hyperandrogenism and improper LH secretions. This leads to ovulatory dysfunction, anovulation and hence infertility. Studies have observed impaired oocyte maturation and sub optimal and endometrial receptivity in women with PCOS. Hence management in such patients is aimed to enhance pretreatment and stimulation protocols for better pregnancy outcomes.

Pretreatment with insulin sensitizers, antiandrogens and achieving optimization of weight before a stimulation cycle helps achieve optimum cycle outcomes. Multiple ovarian stimulation protocols have been used to prevent LH surge during controlled ovarian stimulation including GnRh agonist, antagonist, or progestin primed protocol. Similar pregnancy rates have been observed using both agonist or antagonist protocols, while the prevalence of OHSS is considerably lower with antagonist and progestin protocols.

The type of protocol utilized for ovarian stimulation, the trigger used or the type of Gonadotropin ideal for PCOS women is still debatable. In order to avoid complications due to ovarian hyperstimulation, a freeze all strategy has been adopted worldwide as the optimum protocol for PCOS women, giving superior success rates, especially in PCOS women due to the disparity in endometrial receptivity.

Various studies done on the Preparation of the Endometrium for a thaw cycle, have shown no difference in live birth rates following different methods. The route and type of progesterone luteal phase support and optimum progesterone values prior to embryo transfer also need further evaluation.

Recent metanalysis have proved that hormone replacement cycles are associated with a lower risk of Preterm birth, but a higher risk of larger babies and pre-eclampsia. Further studies are needed to establish whether there is any long-term effect on the metabolic and growth parameters of children born out of frozen embryos.
Is Unexplained Infertility Underdiagnosed Infertility? How Far Should We Look?
Authors: Robins Jared
Published: January 2024

Unexplained infertility is defined when couples are unable to conceive despite undergoing thorough medical assessments that do not reveal any identifiable cause for their infertility. Because this is a diagnosis of exclusion, a comprehensive workup must be performed to rule out known etiologies for the couple’s infertility. This lecture aims to discuss the scope of these investigations and cutting-edge research exploring the complexities of this diagnosis. By delving into the depts of available diagnostic tools, attendees will be better equipped to navigate unexplained infertility and to counsel patients with this diagnosis. Ultimately this lecture will help health care providers to gain insight into how far they should extend their investigations to establish the diagnosis of “unexplained infertility” to help couples overcome this difficult obstacle to conception.
Innovative Medical Treatments for Endometriosis
Authors: Johnson Neil
Published: January 2024

This presentation will focus on the following innovative areas in medical treatments for endometriosis. Where were we, say, a decade ago compared to where we are now? What diagnostic techniques should we employ to define the population we should treat? Does gold standard surgical treatment help patients avoid unwanted medical treatment - or should it now be the other way round? Do we still believe that medical treatment is not indicated for infertility related to endometriosis? What are the genuinely evidence-based innovative medical treatments for endometriosis?

Consensus statements and guidelines represent a clear line in the sand of what may be considered gold standard practice of the time – the World Endometriosis Society’s consensus on current management of endometriosis (2013) 1 provides a good perspective on where we were around a decade ago; the ESHRE Guideline (2022) 2 reflects best practice today.

There is growing consensus that a laparoscopic (+/- histological) diagnosis is no longer practical, or indeed needed, in most cases to implement the whole gamut of medical treatment, even though the entire evidence base for treating endometriosis hinges on laparoscopic diagnosis. Hence, “in 2023, there is a strong case for treatment of endometriosis to be based on a clinical diagnosis of ‘likely endometriosis’ supported by imaging findings, when appropriate, in lieu of a traditional diagnosis by laparoscopy +/- histology”.

Following laparoscopic surgery, those not intending to conceive should consider the levonorgestrel intrauterine system or combined oral contraceptive pill for at least 18-24 months to reduce the recurrence of endometriosis-related pain symptoms; 2 following surgery for either endometriomas or deep endometriosis, long term hormone therapy should be considered to reduce the chance of recurrence.2 Given the respective evidence bases, progestin hormone therapy may be preferable to the combined oral contraceptive pill to turn the tide of increasing prevalence of endometriosis. 3

While medical treatment has not been recommended to improve fertility, indeed a delaying effect on fertility through medical treatment has traditionally been highlighted, innovative analysis methods, including network meta-analysis, have raised the question whether some medical treatments (dydrogesterone and GnRH agonists) might benefit fertility – and this is merit-worthy of further investigation. GnRH antagonists and aromatase inhibitors are the innovative medical treatments that have shifted from ‘showing potential’ to ‘recommended’, so we will delve into the data supporting this to discover that, for aromatase inhibitors, this remains far from convincing, but for GnRH antagonists, these present a genuine innovative medical treatment option for those suffering from endometriosis.
Population Trends in the World and the Asia Pacific Region
Authors: Gray Edith
Published: January 2024

This presentation explores the population trends in both the global and Asia-Pacific regions, examining the underlying factors that influence population growth and population age structure. The presentation highlights the importance of understanding fertility rates and their implications to population ageing, particularly in the context of the Asia-Pacific region. Fertility rates have declined in all regions of the world, however there is still substantial diversity across the globe. In high- and middle-income countries, fertility is now at low levels, some at extremely low levels. In low-income countries, the levels of fertility are more variable, with some countries seeing substantial decline, while others have declined, but at a slower rate. Because of low fertility, some countries have seen substantial population ageing in recent decades, and in the absence of migration, are experiencing depopulation. Other countries, buoyed by their migration policies, are ageing at a slower rate, and do not face the implications of a declining population.

In the Asia-Pacific region there are substantial demographic shifts underway. The population has been declining in Japan for over 10 years, and is also declining in South Korea and most recently, China. All populations have very low fertility rates, with South Korea the lowest in the world, at 0.8 in 2021. Japan and South Korea also have very low immigration rates. In 2023, India overtook China as the world’s most populous country. While most regions of the world now have low population growth, populations in Africa are still growing rapidly, fuelled by a young population structure. This provides the region with a potential ‘demographic dividend’ which can contribute to economic opportunities. By outlining the drivers of population change, their implications, policy responses, and future challenges, this presentation will provide insights into the complexities of demographic shifts in today’s world.
Economic and Social Implications of Negative Population Growth
Authors: Wang Yuan Yuan
Published: January 2024

With the rapid development of China’s socioeconomic status, the increasing life quality, and the changing attitudes on marriage and childbearing among people of childbearing age, China has entered an era of negative population growth since 2022. Although China has introduced various policies to encourage births since 2013, the number of births has not increased as expected, but has declined rapidly. Looking back at the historical trend of population change in some developed countries, population decline is an “inevitable” process that many countries have to go through in the process of social and economic development. For China, after more than 30 years of its one-child policy, its population situation has some unique features. Although the willingness of young couples to have children is declining and the number of births is decreasing, there are significant problems such as advanced pregnancy, infertility, and childbearing after caesarean section, which in turn pose a threat to the health of mothers and children and lead to heavy medical burdens. Therefore, how to improve the treatment effectiveness and safety of infertility, the quality of maternal and child health care and the ability to treat high-risk maternal and foetal complications are major issues that China’s maternal and child health care system has to face and deal with urgently.
How to Share Information Giving in Underprivileged Communities
Authors: Sini Ivan
Published: January 2024

Infertility is a global disease and one of the major causes of psychosocial issues within reproductive group. This affects multilayer of socio economy strata including in developing world. Awareness and information of infertility in the community varies depending on the level of education. One of other key challenges in improving quality of reproductive care in infertility is accessibility. This implies to availability of resources and facility infrastructures.

Health education generally varies in between socio economy background. Indonesia as example has different demographic layers which is stratified into upper, middle, and lower income. Although the country’s GDP continue to grow, large proportion of the community falls into the category of middle-income market. Their typical education degree are at high school level. Healthcare information are mostly delivered proactively through primary healthcare providers and social media plays significant role in as information source. Government and professional society organizations have important responsibility in how the information is delivered accurately and effectively. Reproductive campaign requires good strategy at public policy and budget associated with it.

At the professional level, it is the duty of the providers to share proportional and accurate healthcare information irrespective of the patient’s background. However, to allow patients to make a well-informed decision, it is important that healthcare professionals to have good communication skills. They need to have sufficient time in delivering the message to educate the patients of proposed treatment plan. Theoretically this may not be applicable when supply of counselling time is not available due to lack of healthcare resources. For lengthy reproductive counselling, information can be provided by doctors and nurses. Empowerment of nurses and allied healthcare workers will extend the information shared by the doctors. They may be able to address other non-clinical matters to build trust and will assist patients in making decisions.
Management of Poor Ovarian Response
Authors: Kaul - Mahajan Nalini
Published: January 2024

Poor ovarian response (POR) occurs in approximately 9-24% of patients in ART. It presents a challenge to the reproductive consultant and causes immense emotional distress to the couple. Over the last few decades, ART has seen an improvement on both the clinical and embryological front however, adequate management of POR remains elusive. Etio-pathogenesis of the condition is poorly understood and varying definitions of POR have been used in studies.

In recent years the POSEIDON criteria have been proposed to define this group of ‘low-prognosis’ patients and to optimize management. POSEIDON groups are assigned based on age and ovarian reserve. The patient groups are thus the unexpected poor responder’s having a normal ovarian reserve and the expected poor responders who have a poor ovarian reserve, to begin with.

Management strategies to improve oocyte numbers and quality include manipulation of pituitary suppression and OS regimes, addition of LH and use of mild stimulation. The Duo- stim protocol has proved successful in increasing egg numbers, using the follicular and luteal phases of the same cycle. Adjuvant therapies which have shown promise in recent years are the use of Testosterone gel, Growth hormone, Co-enzyme Q10. Ovarian rejuvenation using Intra-ovarian platelet-rich plasma, ovarian activation and use of autologous stem cells is exciting and ongoing research in this area may yield evidence in future. The speaker will share her experience with the use of IOPRP for improving ovarian reserve during the lecture.
#124 : Microtubule Stability is Associated with the Functional Activity of Mitochondria for the Mouse Preimplantation Embryo Development
Authors: Lee Jae Ho , Kim Yu Jin , Cho Min Jung , Koo Yun Dong , Chang JuYi
Published: January 2024

Background and Aims: Mitochondria have a pivotal role in the quality of embryos and good development to a healthy embryo pregnancy. Also, mitochondrial dysfunction increases during the aging of the embryos. But there is still a debate about the main cause of mitochondrial dysfunction in the aged embryos. We investigate that effect of microtubule stabilizer (MTS) as Taxol, EpD and microtubule disturber (MTD) as VNB in the preimplantation embryo of the mouse.

Method: We performed preimplantation embryo culture with MTS and MTD. Then we assess development ratio and mitochondria functional activity between control and MTS and MTD. We performed comparable analysis of mitochondrial motility between MTS treated and MTD treated embryos by confocal live imaging.

Results: In the MTS treated embryos, well-developed embryos with microtubules formation were present in the ooplasm. However, in the MTD treated embryos group, less development and poor microtubule polymer formation was observed in the ooplasm. Microtubules was also demonstrated by depolymerization and the clustering form in the ooplasm of MTD treated embryos. The high dynamic movement of the cytoskeleton with a mitochondrion compared to the MTD treated embryos.

Conclusion: Our data suggest that the new function of MTS as Taxol, EpD shows promoting competence of embryo development with enhanced activity of a mitochondrial function. Therefore, MTS is useful as a supplement in vitro culture media of embryos.
#364 : Precision Medicine and Artificial Intelligence in the Area of Infertility: Update Applications and Perspectives
Authors: Sellami Afifa , Daoud Salima , Abdelkafi Olfa , Amor Maroua Ben , Moalla Faradis , Rebai Tarak
Published: January 2024

Background and Aims: Artificial intelligence (AI) is performing an important role in different fields of medicine and is gradually converting medical practices in patient management. With growing progress in digital technologies and computing infrastructure, numerous applications in reproductive medicine and Assisted Reproductive Techniques (ART) have currently emerged. In this review, we outline recent breakthroughs in AI technologies, their applications in the management of male infertility and the challenges for further progress in assisted reproductive technology.

Method: A non-systematic review of the literature was performed by screening PubMed up to August April 2023. We used the search terms including “artificial intelligence”, “male infertility”, “female infertility”, “Reproduction”, “precision medicine” and “Assisted Reproductive Technology”.

Results: New digital systems for semen analysis can offer potential applications in male infertility diagnosis, clinical decisions and medical research. Predictive models for sperm quality using alternative algorithmic models is promising as a first step to evaluate male fertility. The use of new robotic microsurgical tools could represent an optimal approach for testicular sperm retrieval with important reduce in time and efforts involved in the surgery procedure. Also, AI algorithms may help physicians to more accurate diagnosis and individualized treatment of infertile women. AI integration in Assisted Reproductive Technology is promising for the best embryos selection with more developing potential and prediction of pregnancy outcomes. Precision medicine involves not just looking at genes but also in proteomics and molecular cell levels.

Conclusion: There are still many challenges on how Artificial intelligence could be implemented in reproductive medicine.
#383 : The Correlation Between Serum Estradiol, Luteinizing Hormone (LH), and Progesterone on Day Human Chronic Gonadotropin (hCG) with In Vitro Fertilisation (IVF) Outcome
Authors: Azzahra Tiara Berliana , Susanto Sarah , Riayati Oki , Iffanolida Pritta Ameilia , Mutia Kresna , Wiweko Budi
Published: January 2024

Background and Aims: Serum estradiol, LH, and progesterone have been studied for many years as they were considered to have relation with the pregnancy outcome in IVF procedure. The aim of this study is to determine the serum estradiol, LH, progesterone, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy distribution of IVF patients; and to determine the correlation between serum estradiol, LH, and progesterone on day hCG with IVF outcome.

Method: This is an observational study that was conducted in Yasmin IVF Clinic from 2013 until 2021. There were 416 samples. The serum estradiol, LH, and progesterone were collected from the IVF patient on day hCG. The IVF outcomes were collected by hCG blood test (biochemical pregnancy), USG (clinical pregnancy), and being checked after several months (ongoing pregnancy). The statistical analysis used IBM SPSS Statistics 26.

Results: The serum estradiol, LH, progesterone, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy were distributed abnormally. There is no significant difference between serum estradiol on hCG day with biochemical pregnancy (p=0.81), clinical pregnancy (p=0.205), and ongoing pregnancy (p=0.117). There is no significant difference between serum LH on hCG day with biochemical pregnancy (p=0.606), clinical pregnancy (p=0.45), and ongoing pregnancy (p=0.396). There is no significant difference between serum progesterone on hCG day with biochemical pregnancy (p=0.363), clinical pregnancy (p=0.942), and ongoing pregnancy (p=0.352).

Conclusion: There is no significant difference between serum estradiol, LH, and progesterone on day hCG with IVF outcome.