bluuebunny/crossref_metadata_2025 huggingface dataset:
#269 : Replacing Crude ICSI: Improving Poor Egg Reserve and Poor Responder Patient Outcomes by Replacing Conventional ICSI with Positive Rheotaxis Extended Drop (PRED-ICSI) Technique
Authors: Kandari Sayali , Kadam Kaushal
Published: January 2024

Background and Aims: Positive rheotaxis extended drop (PRED) has been described by Martin et al, 2017 showing sperm with <1% DFI index. Our results on 25 embryonic failure patients presented in WebRepro 2021 PRED showed improved outcomes. (18% vs 45% Utilized blastocyst rate) vs Conventional-ICSI (C-ICSI)

To evaluate effects in poor egg reserve we designed a prospective comparative pilot study of patients with low AMH or poor responder status evaluating PRED-ICSI vs C-ICSI

Method: PRED-ICSI vs C-ICSI alternated every cycle of poor responder or poor egg quality for a period of 3 months from Jan 23[Formula: see text], 2023, to March 23[Formula: see text], 2023.

Results: Age of male partner and female partner were higher in PRED-ICSI. The egg reserve and attempt number were similar. Semen parameters trended higher in conventional ICSI vs PRED ICSI group.

PRED-ICSI had higher fertilization than C-ICSI (74% C-ICSI vs 80% PRED ICSI). Results trend higher in utilized blastocyst rate (47% C-ICSI vs 64% PRED ICSI).

In the C-ICSI group 4 patients who had D3 frozen or with Embryo transfer had only grade b or lower embryos available vs No patients with grade b or lower embryos in the PRED-ICSI group. 3 patients had cycle cancellation due to no embryos in C-ICSI group vs 1 patients in PRED-ICSI group.

Patients with grade AA/AB blastocysts were 7 out of 12 in Conventional ICSI group (50%) vs 8 out of 12 in PRED-ICSI (66.67%).

Conclusion: This data furthers proof that PRED-ICSI can replace C-ICSI in patients with poor egg reserve or poor responder status. PRED-ICSI can effectively replace C-ICSI as a superior zero additional cost technique for selection of spermatozoa with an improved sperm chromatin pool vs Conventional ICSI which is a crude method of sperm selection.
#316 : Improved Time to Pregnancy When Combining an Artificial Intelligence Score and Morphology Grading for Embryo Selection During IVF
Authors: Storr Ashleigh , Diakiw Sonya , Hall Jonathan , Nguyen Tuc , Moreton Jarrod , Perugini Don , Perugini Michelle
Published: January 2024

Background and Aims: Embryo selection is critical in determining IVF success yet continues to be challenging due to the subjectivity of morphology grading methods, especially when grading fair/average quality embryos. Improving embryo selection could optimise implantation rates and minimise financial/emotional burden on patients. Artificial Intelligence (AI) algorithms represent promising, non-invasive methods of standardising embryo grading and potentially increasing IVF success rates. This study assessed whether an AI algorithm (Life Whisperer Viability) for evaluating the likelihood of clinical pregnancy improves time to pregnancy (TTP) when compared to or combined with standard morphology grading.

Method: 305 de-identified 2D images of day 5 blastocysts (121 fresh/184 frozen) with matched clinical pregnancy outcomes (fetal heartbeat at first scan) from women who underwent IVF treatment from 2020-2023 were retrospectively assessed. All images were taken prior to transfer/freezing. TTP was assessed using a simulated cohort ranking method, with TTP being defined as the average number of transfers needed to obtain a clinical pregnancy.

Results: A positive linear correlation of LWV scores with pregnancy outcomes was observed (p<0.001). ROC-AUC results indicate that LWV is selecting embryos leading to pregnancy at least as well, if not better, than Gardner morphology grading (0.641 vs 0.624), with further improvement observed when LWV and Gardner grading were combined. The TTP analysis showed a 7.3% reduction in TTP when using LWV over Gardner grading. Combined use of LWV+Gardner grading reduced TTP by up to 10.8%, with the largest improvement (5.3%) seen in the frozen group, where there was a higher distribution of average quality embryos.

Conclusion: LWV showed improved embryo rankingand reduction in the estimated average number oftransfers needed to achieveclinical pregnancy. Furthermore, evaluation of TTP supports the combined use of LWV+Gardner grading, showing that they work synergistically to further improve ranking performance when selecting average quality embryos.
#341 : Does Only the Stage Matters? Influence of a Blastocyst Scoring System on Clinical Pregnancy and Live Birth Outcomes with Fresh Set: A Concluding Study
Authors: Lim Cheryl , Chan Melinda , Phoon Jessie
Published: January 2024

Background: Blastocyst culture with single embryo transfer (SET) is now routinely offered to our IVF patients at KK IVF. We have been using a simplified scoring system since 2016 in our routine assessment of blastocysts.

Aims: This retrospective study aims to conclude our centre’s scoring system for fresh blastocyst for Day 5(D5) ET.

Method: Data of 694 patients with fresh Intracytoplasmic Sperm Injection (ICSI) cycle and SET on D5 done between Jan 2018 and Dec 2020 were analysed. Only patients with 1[Formula: see text] cycle stimulation attempt and embryos cultured in single-step media under pre-mixed incubator conditions were included in this study. Rates of clinical pregnancy (CPR), multiple pregnancy (MPR), miscarriage (MISCR) and livebirth (LBR) were investigated. Data were classified into stage and grade of blastocyst transferred respectively as: Fully Expanded (FE), Early Expanded (EE), Early Blastocyst (EBL); A, B, C and Pseudo (P-; with at least 20% blastomeres excluded from the formation of blastocyst) and subjected to Chi-square test for significance, p<0.05. Blastocysts are scored in our centre first according to the stage of blastocyst development, followed by a grading assessment on the cohesion and cell number of the inner cellular mass (ICM) and trophectoderm cells (TE). The blastocyst grade equivalent by Gardner’s classification system of the ICM and TE is in parentheses - A=(AA), B=(AB, BA,BB) and C=(AC,CA,BC,CB). Blastocysts void of ICM are deemed non-transferrable.

Results: CPR significantly different across stages of BL transferred (p = 0.00001). Transferring EBL is associated with a significantly higher MISCR (p=0.004). Multiple pregnancy was observed in groups with expanded blastocyst transferred only and MPR appears higher when top grade BL transferred (p=0.45). LBR is incremental with better quality BL transferred (p=0.000049).

Conclusion: Stage of blastocyst development and a graded ICM at ET improve pregnancy and livebirth outcomes. Miscarriage risk is incremental with early blastocyst transferred. Suboptimal embryos remain transferrable as can still result in viable pregnancies and livebirths when there’s no better selection.
#353 : Microfluidic Preparation of Spermatozoa: A Potential Approach in Assisted Reproductive Technology
Authors: Ho Nguyet Minh , Do Thuy Huong , Ho Sy Hung , Nguyen Manh Ha
Published: January 2024

Background and Aims: While density gradient centrifugation (DGC) is a conventional method in sperm preparation, this method can induce reactive oxygen species (ROS) which cause sperm dysfunction, sperm DNA damage, a recent advancement in sperm processing using microfluidic system is believed to reduce damage and to select the good quality sperm. The aim of this study was to evaluate the effectiveness of sperm preparation between DGC method and microfluidic system.

Method: 30 semen samples were separated into 2 equal small samples, each sample was processed by DGC methods (control) and microfluidic (intervention) respectively. Pre- and post processing parameters was evaluated according to WHO-2010 and the DNA fragmentation index (DFI) was determined by flow cytometry technique.

Results: The result showed that DFI values from the microfluidic preparation (0.67 ± 0.53%) was significantly lower than that of the DCG group (1.18 ± 13.73%). In particular, for semen samples with high DFI (>15%), the microfluidic system showed a noticeable reduction in DFI compared to the results from the DGC method. The progressive motile sperm recovery rate was higher in the intervention group (39.75 ± 19.20 vs 32.14 ± 18.14). Our data also showed that the vitality and mobility of sperm in the microfluidic group was higher than those of the DGC group (97.9 ± 2.21 vs 96.56 ± 4.11%, 96.36 ± 2.60 vs 95.06 ± 2.35%, respectively). However, there was no difference in sperm progressive motility and sperm morphology between two groups.

Conclusions: There were significant improvement in sperm DFI and progressive motility in the microfluidic system. With this result, microfluidic system is a potential approach to reduce DNA fragmentation for ICSI procedures.
#24 : The Effect of the COVID-19 Pandemic on Levels of Stress, Anxiety, and Depression Among Infertile Couples. A Cross-Sectional Study
Authors: Chua Ai Chen , Hamdan Mukhri , Tan Albert Chao Chiet
Published: January 2024

Background and Aims: Many infertile couples require assisted conception and success rate depends on patient’s age. Hence, time is a huge factor. Therefore, due to postponement of fertility services and fear of COVID-19 during the pandemic, we hypothesized that these couple would experience a heightened level of stress, anxiety and depression.

Method: This cross-sectional study was done in the reproductive unit, University Malaya Medical Centre, Kuala Lumpur, between July 16, 2021, and December 17, 2021. 165 patients were included in the final analysis. Couples who were planned for fertility treatment were recruited and asked to answer an anonymous electronic survey that contained depression, anxiety, and stress scales (DASS-21).

Results: From univariate analysis, stress was found to be significant in 20–30-year-old, Chinese patients, degree and postgraduate degree holders, patients with endometriosis, and those that have had infertility for 5 years. Anxiety was significant in 20–30-year-old, males, Chinese and Indian patients, diploma, degree, and postgraduate degree holders, and couples with infertility for at least 5 years and between 5–10 years. Depression was also prevalent among males, Chinese and Indian patients, degree holders, and patients with endometriosis. Multivariate logistic regression was subsequently performed, taking into account potential confounders in the prediction of clinically significant psychological distress. Mild 1.3E7 (2.2E6-8.0E7), p = 0.001 and moderate 2.7E7 (4.9E6-1.4E8), p = 0.001 stress levels were found to be significant among the 20–30-year-old age group. Other background variables, however, did not contribute significantly to the psychological distress.

Conclusion: Disruption of fertility treatment during the COVID-19 pandemic was associated with a significant psychological impact on patients’ mental health, especially among the younger age group. Psychological assessment and counselling should be mandatory if there are prolonged unscheduled disruption in provision of fertility treatment to infertile couples.
#84 : Should Women Who Had Recurrent Miscarriage be Offered Karyotyping Analysis of the Product of Conception: A Survey of Patients’ View
Authors: Cheung Wing Ching , Chung Pui Wah Jacqueline
Published: January 2024

Background and Aims: Recurrent miscarriage (RM) affects 2-3% of couples. Approximately 60% of miscarriages result from fetal aneuploidy. Current international guidelines do not recommend routine genetic analysis of product of conception (POC). Nevertheless, a national survey reported that 78% of women wanted to know the cause of their miscarriage. In addition, a majority of patients thought they had done something wrong, leading to miscarriages. The identification of the cause of their miscarriages may help to reduce their guilty feelings. This study aims to assess women’s views on the karyotyping of the POC to determine if the existing guideline should be amended.

Method: Women who attended the Obstetrics and Gynecology outpatient clinic were recruited. They were asked to fill in a questionnaire consisting of 24 questions.

Results: A total of 149 women were recruited. The desire to know the karyotype of POC, which was assessed by a 100 mm Visual analogue Scale, was 85.1 ± 24.3 (mean ± SD). 77.6% of women expressed that they wanted to perform karyotyping of POC even though they were informed that there was no apparent beneficial effect of genetic testing of POC on the prognosis. Nevertheless, only 10.7% of women were given the option to check the karyotype. More than one-third of women were willing to spend equal to or more than two thousand Hong Kong dollars on a karyotyping test, which is comparable to the current market price (Figure 1).

Conclusion: Our findings suggested that women had a strong desire to know the karyotyping of POC even though they were well informed of the limitation of the karyotype test. To respect and empower our clients, physicians should consider offering the karyotype of POC.
#156 : Patient Decision Making and Trends in Embryo Disposal
Authors: Mitchell Nicole , Johnson Kerri , Zhang Shelley , Sorby Kelli
Published: January 2024

Background and Aims: Embryo cryopreservation is common in IVF, allowing for surplus embryos to be utilised in subsequent cycles. As such, for a variety of reasons, patients may need to contend with embryo disposition decisions. This study looked at trends surrounding patient decisions to dispose of cryopreserved embryos.

Method: A retrospective study was conducted on the consented embryo disposals of 230 patients between 2019 and 2023. Variables analysed included number of live births, number of embryos for disposal, embryo mosaicism, and reasons behind the decision to dispose of their embryos. The length of time between the date the consent was signed and the last IVF cycle, IVF live birth and initial contact with the clinic was also established.

Results: A large proportion of patients (43.9%) did not specify why they chose to discard their embryos, however of those who did, there were three main categories (embryos reaching their expiry (27.9%), the return of mosaic PGT results (24.0%), and patients completing their family (22.5%). Of the 57 patients who chose to discard after being contacted regarding their embryo expiry, 19.3% initially chose to extend their storage before opting to discard. Surprisingly, only 62.2% of patients had at least one live birth prior to submitting their disposal consent, and waited, on average, 1.6 years from the date of their most recent live birth to discard. Furthermore, there was an average of 1.8 years between patients’ last IVF cycle and the decision to discard, with an average of 86.5 days elapsing from the point of initial contact with the clinic until the date the disposal consent was signed.

Conclusion: Many patients retain their embryos in storage until their expiry, and this point of contact prompts them to make decisions regarding the disposition of their biomaterial, and the reasons behind discard decisions are not solely associated with achieving a live birth.
#174 : Preconception Risk Factors and Interventions to Prevent Adverse Maternal, Perinatal, and Child Health Outcomes
Authors: Padhani Zahra Ali , Avery Jodie , Tessema Gizachew , Damabi Negin Mirzaei , Lassi Zohra
Published: January 2024

Background and Aims: Preconception period allows to explore and intervene how women’s health conditions and certain risk factors could affect the mother and newborn’s health, once she becomes pregnant. Limited studies have been conducted on adolescents and young adults, and relatively little is known about the factors underlying the continued increase in the adverse outcomes. Thus, we aimed to identify existing evidence on preconception risk factors and interventions to improve the health of adolescents, young adults, and their children.

Method: We conducted a scoping review following the 2020 PRISMA guidelines by systemically populating the searches identified from online databases such as Medline, Embase, Cochrane Library etc. We included studies looking at preconception risk factors and interventions among adolescents and young adults and their impact on perinatal, maternal, and child outcomes. We included systematic and scoping reviews and overview of reviews published in the last 10 years. Two review authors independently evaluated and screened studies for eligibility and extracted data on Covidence software; followed by a descriptive and thematic analysis.

Results: The study identified several preconception risk factors such as malnutrition, teen-pregnancy, substance abuse, violence, infections, poor oral health, and chronic diseases. Preconception risk factors contributed to high risk of preterm birth, pre-eclampsia, gestational diabetes, congenital malformation, and neural tube or congenital heart defect. Interventions such as women empowerment, psychological counselling, food fortification; integration of nutrition initiatives, nutritional supplementation, preconception management of epilepsy, and phenylketonuria, pre-pregnancy diabetic care have contributed to improving these outcomes.

Conclusion: The findings of the study helped in identifying existing interventions and its impact on perinatal, maternal, and child outcomes. It highlighted the research gaps on preconception risk factors and interventions in different contexts and geographical settings. It suggests prioritisation of future research by development of strategies to improve preconception health at adolescence.
#309 : Menstrual Pain Related Endometriosis in Indonesia: Assessing Information Access Gap Through Social Media
Authors: Kusumaningtyas Intan , Kusuma Berli , Prasetyo Yohanes Danang , Sawarno Anto , Kusumaningtyas Tiara
Published: January 2024

Background and Aims: In Indonesian culture, most of us forced by wrong believed that menstrual pain is something normal and not a sign of pathology. While most Indonesian women in the past have a little access to gain the right information about menstrual pain that contribute to the delay treatment. In this era of social media like Instagram. Some use for seeking medical information like menstrual pain related to endometriosis symptoms. This study aims to know the role of social media to give Indonesian woman an access to gain right information about menstrual pain as one of endometriosis symptoms in Bahasa.

Method: We searched several Bahasa hashtags “nyerihaid” and “nyerimenstruasi” (menstrual pain), “nyeriendometriosis” (endometriosis pain), “endometriosisinindonesia” (endometriosis in Indonesia).

Results: We found that “nyerihaid” as the most common symptoms of endometriosis resulting to the most uploaded posts (156.196 posts) and “nyerimenstruasi” (3487 posts). Most of the information were related to herbal and other products marketing information that claimed can reduce menstrual pain (80.45%) and recipes for herbal mixture (5.45%). The reliable information sources about menstrual pain from health practitioner only (14.14%). For “nyeriendometriosis” has only (15 posts) and all from reliable health practitioner sources (100%). For “endometriosisinindonesia” (1120 posts), we found reliable information sources from health practitioners and health facility (54.05%), that consist of personal account (37.84%) and business account (16.22%). We also found endometriosis community forum information (17.57%) and herbal product marketing information (28.37%).

Conclusion: Our study shows social media as an effective platform to educate woman about menstrual pain related to endometriosis, considering the coverage of population in Indonesian geographical barrier. Yet this potency of social media for educating and empowering woman in Bahasa using common symptoms like menstrual pain from the reliable sources is still very limited.
#355 : “No One Asked Me If I’m Alright”: A Mixed Methods Study Exploring Information/Support Needs and Challenges Engaging Men Diagnosed with Male-Factor Infertility
Authors: Obst Kate , Oxlad Melissa , Turnbull Deborah , McPherson Nicole
Published: January 2024

Background and Aims: Men desire to be actively involved in preconception care. However, health systems do not consistently or proactively engage men and there is little acknowledgement of their needs during this time. The lack of gender-specific service provision in infertility treatment likely contributes to men’s poorer mental wellbeing following infertility diagnosis and infertility treatment. This research sought to understand males’ psychosocial and support needs when diagnosed with male-factor infertility.

Method: Mixed methods design, assessing men who had undergone diagnosis and/or treatment for male-factor infertility in past five years within Australia. Study comprised: 1) online survey (assessing psychological functioning, fertility knowledge, information sources, social support and perception of resources) and 2) semi-structured interviews to further explore participants’ lived experiences of male-factor infertility. Participants were recruited through Andrology clinics, social media, infertility support pages and ANZICA counsellors.

Results: During their infertility journeys, participants mostly received information fertility doctors/nurses and the internet. However, their preferred method of informational knowledge would be through a verified male infertility website. Qualitative data were analysed by reflexive thematic analysis, which resulted in three key themes, each with two sub-themes, summarising pertinent aspects of men’s lived experiences when diagnosed with male-factor infertility (Figure 1). The majority of participants were in later stages of their fertility journey, indicating they felt more prepared to discuss their experiences given most (or all) of the initial-stage emotional and physical intensity of their diagnosis and active treatment had passed.

Conclusion: There is a clear need for in/fertility services to implement proactive support approaches that engage directly with male patients and acknowledge the complexity of lived experiences when receiving a diagnosis of male-factor infertility.
#25 : The Prediction Value of EEVA in the Timelapse GERI Incubator for the Blastocyst Morphology
Authors: Dinh Hop Vu , Lien Huong Nguyen Thi , Mai Huong Tran , Manh Cuong An , Thuy Linh Nguyen Thị , Tu Anh Phi Thi
Published: January 2024

Background and Aims: Time-lapse monitoring of embryo development may represent a superior way to culture and select embryos in vitro. The EEVA Test records the development of each embryo with a cell-tracking system and predicts the potential (High, Medium or Low) that an embryo will form a blastocyst based on automated detection and analysis of time-lapse imaging information of early cell division stage. The blastocyst grade will help clinicians in selecting the best embryos for transfer to increase pregnancy rates and reduce multiple pregnancies.

The aim of this study is to determine the correlation between EEVA score and some blastocyst morphological parameters.

Methods: Retrospective analysis study on 2522 embryos with indication for prolonging embryo culture to the blastocyst stage in time-lapse GERI incubator from January 2020 to June 2022.

Results: Embryos with E1 and E2 score had significant higher morphological ratios of ICM A, ICM B, TE A, TE B, blastocoele expansion ratios of BL5,6 and lower morphological ratios of ICM D, TE D,compared with embryos having E3, E4, E5 score, p<0.01.

Embryos with E3 score had significant higher morphological ratios of ICM A, ICM B, TE A, TE B, blastocoele expansion ratios of BL5,6 and lower morphological ratios of ICM D, TE D, compared with embryos having E4, E5 score, p<0.01.

Conclusions: The blastocyst morphological parameters were associcated with the EEVA score. The rate of blastocyst with the ICM A, ICM B, TE A, TE B, BL 5,6 tended to decrease and the rate of blastocyst with ICM D; TE D tended to increase for embryos with low EEVA score. In other words, the good quality blastocyst rate tended to decrease, and the bad quality blastocyst rate tended to increase for embryos with low EEVA score.
#37 : Improved Pregnancy Prediction Performance in an Updated Deep-Learning-Based Embryo Selection Model: A Retrospective Independent Validation Study Using 3,960 Single Blastocyst Transfer Cycles
Authors: Ueno Satoshi , Okimura Tadashi , Kato Keiichi
Published: January 2024

Background and Aims: Generally, the performance of deep learning models is improved by increasing the size of the training dataset. However, to the best of our knowledge, there has been no study on the effect of increasing training data on the performance of pregnancy prediction using the same deep-learning model.

Method: A total of 3,960 blastocyst transfer cycles (1 patient, 1 cycle) were retrospectively analyzed. Embryos were stratified according to SART age groups. The quality and scoring of embryos were assessed by iDAScore v2.0 (iDA-V2; Vitrolife, Sweden), v1.0 (iDA-V1; Vitrolife, Sweden), and Gardner grading (GG). The discriminative performance of pregnancy prediction for each embryo scoring model was compared using the area under the curve (AUC) of the receiver operating characteristic curve for each maternal age group.

Results: In the AUCs of the < 35 years age group (n = 757) for pregnancy prediction, the AUC of iDAV2 was significantly higher than that of GG (0.718 vs. 0.694, p = 0.015). For the 35-37 years age group (n = 821), the AUC of iDA-V2 was significantly higher than that of iDA-V1 (0.712 vs. 0.696, p = 0.035). In the AUCs of the 41–42 years age group (n = 715), the AUC of iDA-V2 was significantly different from that of GG (0.745 vs. 0.696, P = 0.007). In the > 42 years age group (n = 660) and 38–40 years age group (n = 1,007), there were no significant difference among the groups.

Conclusion: The present study suggests that the performance of deep learning models for pregnancy prediction will be improved by increasing the size of the training data. Therefore, in a deep-learning model for pregnancy prediction, continuously collecting training data is an important step for improving the performance of updated AI models.
#38 : Maternal Age Affects Morula Compaction and Cell Polarity of Human Embryos
Authors: Ezoe Kenji , Miki Tetsuya , Kato Keiichi
Published: January 2024

Background and Aims: With the exception of chromosome segregation errors, the molecular and biochemical mechanisms responsible for advanced maternal age (AMA)-related reduced embryo developmental competence remain unclear. In women of AMA, the blastocyst formation rate has been reported to decline due to an increase in embryo arrest at the morula stage. Therefore, we aimed to reveal the impact of AMA on cellular events during compaction, as assessed using morphokinetic analysis. We also assessed the possible influence of AMA on the expression of cell polarity markers, yes-associated protein (YAP) and protein kinase C-[Formula: see text] (PKC[Formula: see text]), during blastomere compaction.

Method: We retrospectively analysed 2,058 fertilized oocytes, which were stratified by maternal age according to the Society for Assisted Reproductive Technology classification (< 35, 35-37, 38–40, 41–42, and > 42 years). The effects of AMA were assessed in relation to embryo morphokinetics and morphological alterations. Furthermore, 20 voluntarily donated human embryos were used for immunofluorescence staining of YAP and PKC-[Formula: see text].

Results: Delayed embryonic compaction and an increased number of extruded blastomeres post compaction were observed in the > 42-year group. The time interval from the eight-cell stage to compaction initiation was prolonged with increasing age. The number of YAP-positive cells in the outer cells of the morulae was significantly higher in the young age group than in the AMA groups. The PKC[Formula: see text] fluorescence intensity in the cortical region of the morulae was significantly lower in the AMA groups than in the young age groups.

Conclusion: Delayed compaction and blastomere extrusion occur more frequently in embryos from women of AMA due to insufficient regulation of cell polarity, which may lead to morula arrest. Further research is required to reveal the impacts of AMA on the mechanism underlying the expression of cell polarity factors and develop methods to avoid AMA-associated morula arrest.
#63 : Clinical Prognosis of Human Blastocysts Showing Spontaneous Collapsing: A Systematic Review and Meta-Analysis
Authors: Bickendorf Kate , Qi Fang , Peirce Kelli , Natalwala Jay , Chapple Vincent , Liu Yanhe
Published: January 2024

Background and Aims: Spontaneous collapsing (SC) is a relatively new viability biomarker of human blastocysts which is only detectable via time-lapse videography. However, the prognosis of affected blastocysts remains poorly understood, with systematic review and meta-analysis absent from literature. This study is the first to comprehensively evaluate the clinical prognosis of SC blastocysts, including ploidy status, pregnancy, live birth and miscarriage rates.

Method: Systematic review and meta-analysis were performed according to PRISMA, with protocol registered with PROSPERO (CRD42022373749). Studies were searched for in PUBMED, EMBASE and the Cochrane Library on 10 October 2022, using key words relevant to “blastocyst collapse” and “Time-Lapse Imaging”. Data were summarised by risk ratios (RRs) and their 95% confidence intervals (CIs). All meta-analyses were performed with fixed-effect models using RevMan 5.4

Results: A total of 7 retrospective cohort studies were eventually included from 196 records identified through the initial search. The incidence of SC was 37.0% (2516/6801) amongst 7 studies (ranging from 17.4% to 56.2%). SC was associated with significantly lower clinical pregnancy rate (2 studies, n=736; RR=0.77, 95% CI=0.65-0.91; [Formula: see text]2=30%), ongoing pregnancy rate (4 studies, n=2147; RR=0.73, 95%CI=0.64-0.82; [Formula: see text]2=0%), live birth rate (2 studies, n=816; RR=0.78, 95%CI=0.65-0.94; [Formula: see text]2=56%), and reduced euploidy rate (3 studies, n=3569; RR=0.71, 95% CI=0.66-0.78; [Formula: see text]2 =69%). However, miscarriage rate was not significantly different between blastocysts with or without SC (4 studies, n=1358; RR=1.28, 95%CI=0.93-1.76; [Formula: see text]2=0%). Significant heterogeneity was detected between the studies included for evaluation of live birth rates ([Formula: see text]2=56%, P=0.13) and ploidy rates ([Formula: see text]2=69%, P=0.04). Further subgroup analysis according to (a) different definition of SC, (b) collapse occasions, and (c) whether the transferred blastocyst had been genetically tested; showed unchanged trends.

Conclusion: Our results indicate strong negative implications following SC in human blastocysts. SC should be a recognised criterion for the deselection of blastocysts for intrauterine transfer.
#66 : Degree of Re-Expansion of Biopsied Blastocysts at Vitrification Affects the Developmental Competence of Blastocyst After Trophectoderm Biopsy
Authors: Miki Tetsuya , Ezoe Kenji , Aruga Mariko , Narisawa Mika , Okimura Tadashi , Kato Keiichi
Published: January 2024

Background and Aims: In recent years, preimplantation genetic testing (PGT) has frequently involved a trophectoderm (TE) biopsy at the blastocyst stage, followed by vitrification. However, the factors influencing the viability of biopsied blastocysts after warming are unknown. Thus, these factors should be determined before developing the vitrification protocol following TE biopsy. The present study aimed to analyze the association between the time intervals between biopsy and vitrification, morphological characteristics after the biopsy, and blastocyst outgrowth.

Methods: In this study, we used discarded vitrified blastocysts donated for research by consenting couples. To observe the morphological changes, TE biopsies were performed and cultured in a time-lapse incubator. Based on the degree of re-expansion at vitrification, the blastocysts were classified into four groups: 0%, 1-49%, 50–99%, and ≥100%. The blastocysts were vitrified after 0–3 h of TE biopsy. The warmed blastocysts were cultured on fibronectin-treated dishes for 96 h to examine the competence of the outgrowth.

Results: The outgrowth area was significantly less extensive in the blastocysts that were vitrified 2 h following the biopsy. The proportion of 50–99% of re-expansion was significantly higher in the blastocysts after 2 h of biopsy. Multivariate linear regression analysis showed that the blastocyst outgrowth area was substantially smaller when the degree of re-expansion was 50–99%.

Conclusions: Vitrification of blastocysts in the late stages of re-expansion following TE biopsy impairs the developmental competence of the blastocyst. Therefore, while vitrifying blastocysts after TE biopsy, we should consider the time intervals after the biopsy as well as the progression of re-expansion.
#69 : Decline in Mitochondrial Function of Human Embryo with Maternal Aging
Authors: Hashimoto Shu , Morimoto Yoshiharu
Published: January 2024

Background and Aims: Female fertility declines with age, due to increased chromosomal aneuploidy and possible reduced mitochondrial function in the embryo.

Method: We outlined how mitochondrial function in human embryos, as predicted from oxygen consumption rate (OCR) measurements, changes in pre-implantation stage, and what factors, particularly maternal age, affect mitochondrial function in embryos.

Results: The structure of the mitochondrial inner membrane and its respiratory function developed with embryo development, while the copy number of mitochondrial DNA per specimen was transiently reduced compared to that of the oocyte. The undifferentiated state of the inner cell mass cells appears to be associated with a low OCR. In contrast, the copy number of mitochondrial DNA increased in trophoblast cells and mitochondrial aerobic metabolism increased.

The OCRs at morulae stage decreased with maternal age, but there was no relationship between maternal age and the copy number of mitochondrial DNA at any stages. The higher oxygen spent at the morula stage; the shorter time was needed for development to the mid-stage blastocyst.

Conclusion: The mitochondrial respiratory function of human embryos developed along with embryonic growth. Mitochondrial function at morula stage declined with their maternal age and reduced mitochondrial function decreased the rate of development from morula to blastocyst.
#78 : Can Short-Term Insemination with Cumulus Reduction Improve IVF Success?
Authors: Morris Jessica
Published: January 2024

Background and Aims: Short-term insemination (STI) reduces the exposure time of gametes to accumulation of cell detritus and reactive oxygen species. Thus, our study aimed to explore if the use of STI combined with cumulus reduction (CR) improves IVF success through laboratory measures.

Method: A prospective randomised study was initiated in November 2021. The study group (SG) used STI with a four-hour co-incubation period of oocytes and sperm, inseminated 39 hours post trigger injection. The control group (CG) used standard insemination protocol with 18-hour co-incubation period, inseminated at least 3 hours post trigger injection. Oocytes in both groups underwent CR, were cultured in continuous culture media (Origio 1-Step), undisturbed from fertilisation check to Day 5 (370C, 5% O2, 6% CO2).Results were compared by fertilisation, blastocyst formation, day 5 utilisation, overall utilisation, and clinical pregnancy rates (Fisher exact tests).

Results: A total of 152 patients were randomised into the SG while 107 patients were allocated to the CG to February 2023. The STI protocol showed a significant increase in blastocyst formation (SG 71.6% vs CG 63.6%; p<0.05), and rate of day 5 utilisation (SG 88.9% vs CG 80.9%; p<0.05). This far, no differences have been observed in fertilisation (SG 76.2% vs CG 76.5%; p>0.05), overall utilisation (SG 58.8% vs CG 54.1%; p>0.05), nor clinical pregnancy rates (SG 40.0% vs CG 40.5%; p>0.05).

Conclusion: This study reports an increased number of blastocysts, and good quality utilisable day 5 blastocysts when using the STI protocol, with no negative impact to results.Future studies should include the analysis of cumulative pregnancy rates, and live birth rates.
#92 : An Artificial Intelligence Algorithm Outperforms Highly Variable Embryologist Grading for Predicting the Likelihood of Pregnancy Outcome from Embryo Images
Authors: VerMilyea Matthew , Hall Jonathan , Perugini Michelle , Nguyen Tuc , Perugini Don , Diakiw Sonya
Published: January 2024

Background and Aims: Embryologist evaluation of embryos is critical for ensuring successful pregnancy outcomes. Standard, manual evaluation is variable, subjective, and time-consuming. The aim of this study was to evaluate whether an artificial intelligence (AI) algorithm can standardize and improve embryo evaluation during IVF.

Method: 20 images of blastocyst-stage embryos on day 5 of in vitro development were selected to represent a range of morphological qualities. All embryos had been transferred and the clinical pregnancy outcome was known for each embryo based on detection of fetal heartbeat at first ultrasound scan (∼7-9 weeks gestation). 50% of embryos in the dataset resulted in pregnancy.

158 embryologists made a total of 236 attempts at providing their evaluation of the morphological quality of the 20 embryo images using the Gardner system. The embryologist-assigned grades were then used to generate their prediction of whether that embryo would lead to pregnancy or not (≥ 3BB indicated a pregnancy prediction, and <3BB indicated a non-pregnancy prediction).

The same 20 embryo images were also assessed by a previously developed viability AI algorithm for evaluating the likelihood of clinical pregnancy based on embryo images. An AI score of ≥5.0/10 indicated a pregnancy prediction, and <5.0/10 indicated a non-pregnancy prediction. The AI algorithm provided the same score for each embryo image regardless of how many times the analysis was performed.

Results: The AI algorithm correctly predicted pregnancy outcome for 14/20 embryo images (70%). Embryologists also correctly predicted 14/20 images in 14/236 attempts (6%), and in 1 attempt correctly predicted 15/20 images. In the remaining 221 attempts (94%) embryologists correctly predicted between 6-13 images, representing a range of accuracies from 30-75%.

Conclusion: This study demonstrates the inherent variability and lack of objectivity associated with an embryologist’s evaluation of embryos. It highlights the benefits of accurate AI algorithms for standardizing embryo assessment
#148 : A Comprehensive Analysis of the Cells Originating from Tripolar Mitosis in the Preimplantation Embryo
Authors: King Tracey , Sorby Kelli
Published: January 2024

Background and Aims: Tripolar mitosis (TM) is cellular division resulting in three daughter cells instead of the typical identical two. Historically studies have grouped all types of aberrant mitosis together providing insufficient evidence to make clinical decisions. This study examined the fate of tripolar mitosis daughter cells and their impact on embryo development and clinical outcomes.

Method: A retrospective analysis of 14,450 embryos cultured in EmbryoScope+ was conducted. Embryos were assessed for cleavage stage TM events; mitosis with two concurrent cleavage furrows. TM embryos were categorised by the mitotic cycle of the TM event; Mitosis 1 (TM1), Mitosis 2 (TM2), Mitosis 3 (TM3) or multiple TM (MTM). TM embryo clinical outcomes were compared to embryos from the same IVF cycles. Timelapse footage was used to assess TM daughter cells outcomes.

Results: The incidence of TM embryos (n=448) was 3.1% (TM1 n=118, TM2 n=206, TM3 n=98, MTM n=26). TM1 embryos displayed significantly later pronuclei fade times than control embryos (26.7 vs 25.0 HPI, p<0.001) and first cleavage time (29.7 vs 28.1 HPI, p<0.001). Utilisation rate for TM1 (6.6%), TM2 (39.3%) and MTM (11.6%) was significantly reduced compared to control embryos (53.4%, n=2,432, p<0.001). TM3 embryos showed no reduction in utilisation (59.2%).

TM embryos demonstrated significantly lower clinical pregnancy and live birth rate (26.8% & 19.6% respectively, n=56) compared to control embryos (45.7% & 34.5%, p<0.01). TM1 embryos had no clinical pregnancies (n=5).

At the compaction stage 98.1% of TM embryos had excluded cells. In 97.0% of cases excluded cells originated from TM daughter cells. Trophectoderm biopsy yielded no significant difference in euploidy rate between TM (46.1%) and control (40.1%) embryos.

Conclusion: TM1, TM2 and MTM embryos displayed significantly reduced developmental potential. TM3 did not appear to be detrimental to embryo development. Despite TM not affecting euploidy, TM embryos demonstrated lower implantation potential and live birth rate.
#159 : Aneuploidy Embryos Rate in Good Prognosis Patients After Fertilization Using ICSI and IMSI Methods
Authors: Raharjo Reza , Boediono Arief , Sini Ivan , Indrasari Wahyu
Published: January 2024

Background and Aims: Embryo aneuploidy is caused by many factors, including patient age, sperm quality and sperm selection method. There are several methods for selecting sperm, ICSI (intracytoplasmic sperm injection) and IMSI (intracytoplasmic morphologically selected sperm injection). Previous study related to the effect of sperm selection methods on aneuploidy embryos rate is still very rare. This study aims to determine the effect of selecting sperm methods on the aneuploidy embryos rate, especially in the good prognosis patient group.

Method: A total of 67 patients with a good prognosis (AFCs[Formula: see text]6; AMH[Formula: see text]1,2) were grouped based on the method of selecting sperm. Furthermore, the fertilized oocytes that become blastocyst embryos were biopsied in the trophectoderm of the cell and compared between the two treatments.

Results: The results of the study showed that the sperm selection method did not significantly affect the aneuploidy embryos rate (P>0.05). The percentage of aneuploidy embryos in the ICSI method was 28.1%, while in the IMSI method it was 24.3%.

Conclusion: The conclusion of this study is that the sperm selection method does not affect the aneuploidy embryos rate in patients with a good prognosis.
#181 : The Importance of Inner Cell Mass Ratio for Embryo Grade Prediction Using Artificial Intelligence
Authors: Lee Chae Yoon , Lee Chae Yoon , Heo Jin , Kim Hyung Min , Park Jong Hyuk , Chung Mi Kyung
Published: January 2024

Background and Aims: While reports suggest that the Inner Cell Mass (ICM) ratio may impact pregnancy rates, the Gardner criteria for grading ICM does not specify the ICM size or ratio. This study investigates the potential impact of the ICM ratio on predicting ICM grades using artificial intelligence.

Methods: The study analyzed 1,963 Day 5 blastocyst images obtained from seven IVF clinics between June 2011 and May 2022. The images were matched with metadata, including ICM grade and ICM ratio. ICM ratio was computed as the ratio of the ICM area to the embryo area. ICM was graded according to the Gardner criteria and only ICM A and C grade groups were used to avoid ambiguity. Two CNN (Convolutional Neural Network) models were built: one with embryo images including ICM ratio and one without.

Results: The use of ICM ratio in conjunction with the original grading model resulted in an improved model performance. Logistic regression analysis revealed the ICM ratio as a significant variable impacting embryo grade, with a p-value of less than 0.001. The coefficient for ICM ratio demonstrated an 8-fold increase in the odds ratio for grade A embryos with every 1-unit increase.

Conclusions: We demonstrated that the CNN model could predict ICM grades with fair accuracy and that the inclusion of the ICM ratio significantly improved its performance. While CNNs are widely used for image analysis by extracting features from patterns, they may not effectively learn the characteristics of an area. To capture the important area-related features, measured values should be considered along with the image. Furthermore, the ICM ratio appears to be a significant feature that embryologists consider when grading embryos in clinical settings, beyond the Gardner criteria. Additional studies are warranted to investigate other features for evaluating ICM.
#307 : Establishment of an Early Blastocyst Stage Classification System and Its Implications for Clinical Pregnancy and Live Birth Outcomes
Authors: Caddy Melissa , Boekel Kym , Zander-Fox Deirdre , Green Mark
Published: January 2024

Background and Aims: Sub-optimal embryo development on day 5 often leads to the transfer of an early blastocyst (EB) stage embryo, especially for women >38 years of age. Yet there are few studies of reported outcomes, nor an industry-wide EB classification system to identify EBs for fresh transfer with the best outcomes. Hence, this study aimed to determine clinical outcomes and whether an EB-stage classification system could be beneficial.

Method: A retrospective cohort study analysed 537 cycles undertaken between 2019 and 2022 at two large clinics, in which patients had on day-5 a single fresh EB stage embryo transferred. A novel EB classification system was developed and applied to determine clinical pregnancy rate (CPR) and live birth rate (LBR) outcomes, as well as the effects of maternal age ([Formula: see text] or > 38 years of age). EB stage embryos were classified into four categories based on day-5 morphological features from highest (EB-A) to lowest (EB-D) quality. Data were analysed using Fisher’s exact and non-parametric analyses.

Results: Transfer of a fresh EB embryo resulted in a 20.1% CPR and 14.7% LBR. Classification of EBs into four distinct sub-groups identified differences in CPR and LBR (LBR: EB-A 23.4%; EB-B 10.3%; EB-C 12.9%; EB-D 7.6%). Similar CPR and LBR trends were determined for patients [Formula: see text] 38 years of age (LBR:26.7%,14.2%,19.0%, 2.1%) and >38 years of age (LBR:17.5%,4.3%,5.8%,2.7%), with an overall lower LBR for women >38 years of age (8.0%) compared with [Formula: see text] 38 years old (19.5%; P<0.05).

Conclusion: Whilst pregnancies and live births can result from an EB transfer, LBR varied by >15% between different morphological classifications. If required, transfer of a late-stage EB results in a higher LBR, especially for women [Formula: see text] 38 years of age. Use of an EB classification system would benefit clinical decisions around when to transfer an EB stage embryo.