bluuebunny/crossref_metadata_2025 huggingface dataset:
#331 : Bilateral Endometriomas Masquerading Synchronous Endometrial and Ovarian Cancer (SEOC) in an Infertile Female
Authors: Kathuria Priyanka
Published: January 2024

Background and Aims: Endometriomas are diagnosed in clinical practice by imaging (mostly ultrasound) in females presenting with infertility. CA-125 level is an adjuvant investigation which may be indicative of endometriosis. A few research questions that are yet to be answered. Is ultrasound a sufficient modality to diagnose endometrioma? Is there any cut off as far as the measurement of endometrioma is concerned to step up the imaging modality to MRI?

Synchronous endometrial and ovarian cancer (SEOC) is a rare phenomenon with an incidence of 1.4 - 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with endometrial carcinoma of lower stage and grade in premenopausal age group.

Method: A 32-year-old female with Severe Dysmenorrhea and Secondary infertility had clinical evidence of bilateral endometriomas of 4-5 cm on ultrasound. She underwent hysterolaparoscopy. On hysteroscopy, endometrium was polypoidal and vascular, looking suspicious for malignancy. Hence endometrial biopsy was taken. On laparoscopy, B/L ovaries were enlarged, multiloculated, solid-cystic with granular surface and adhered in POD, decision for staging laparotomy with frozen section was taken. Frozen section was suggestive of Borderline tumor. Eventually, fertility sparing surgical staging was done (BSO + infracolic omentectomy + peritoneal biopsies). Peritoneal cytology was negative for malignant cells.

Results: Histopathological examination revealed Endometriod adenocarcinoma grade 1a/1a in both endometrial and ovarian components with no involvement of omentum and peritoneum. Immunohistochemistry demonstrated P53 to be moderately positive in endometrium and strongly positive in ovary, whereas ER, PR was positive in both tumors of endometrium and ovary and WT-1 negative in ovaries. Hence diagnosed as SEOC and not metastatic tumor. Mirena was inserted in follow up and repeat biopsy is awaited.

Conclusion: Suspicion of ovarian endometroid carcinoma must born in mind in cases with large bilateral endometriomas with long-standing endometriosis.
#366 : Adjuvants to Prevent Reformation of Adhesions Following Adhesiolysis for Asherman Syndrome
Authors: Guo Jun , Shi Xiaoyu , Yu Fei , Cao Jinghong , Xia Enlan , Zhai Jianjun , Mol Ben W.J. , Li Tin-Chiu
Published: January 2024

Background and aims: Two international guidelines published on the management of Asherman syndrome (AS) have made recommendations on various adjuvant methods to prevent intrauterine reformation. Nevertheless, the effectiveness of these methods when used in primary or secondary prevention settings is different. Our aim is to assess the effectiveness of various adjuvant methods for the secondary prevention of intrauterine adhesions (IUAs).

Methods: Articles were considered eligible if they included subjects with AS before surgery and compared a chosen method with either a control or a comparison group (using another method). The primary outcome was IUA reformation rate at follow-up hysteroscopy.

Results: A total of 29 studies [15 randomised controlled trial (RCTs)] and 14 cohort studies) were included. Adhesion reformation with various methods to prevented IUA reformation when compared with controls were: second-look hysteroscopy:[risk ratio(RR) 0.21, 95% confidence interval (CI) 0.05 to 0.90 (P=0.02)];intrauterine contraceptive device: RR: 0.64, 95% CI: 0.36 to 1.12 (P=0.12);continuous intrauterine balloon: RR: 0.18, 95% CI: 0.05 to 0.68 (P=0.01);intermittent intrauterine balloon: RR: 0.50, 95% CI: 0.31 to 0.80 (P=0.004);anti-adhesion gel: RR: 0.80, 95% CI: 0.58 to 1.10 (P=0.17);amnion graft:RR:0.63, 95% CI:0.44 to 0.91 (P=0.01).

Conclusions: In conclusion, among various adjuvant therapies in secondary prevention of IUA, second look hysteroscopy and IUB can be considered as an option to reduce adhesion recurrence.
#122 : Extrapolating Endometriosis Diagnosis Using Imaging and Machine Learning: The Imagendo Project
Authors: Avery Jodie , Zhang Yuan , Wang Hu , O’Hara Rebecca , Condous George , Leonardi Mathew , Knox Steven , Carneiro Gustavo , Hull Mary-Louise
Published: January 2024

Background and Aims: Currently, it takes an average of 6.4 years to obtain a diagnosis for endometriosis. To address this delay, the IMAGENDO project combines ultrasounds (eTVUS) and Magnetic Resonance Images (eMRI) using Artificial Intelligence (AI). Our preliminary data has shown that a multimodal AI approach objectively assesses imaging data from eTVUS and eMRIs and improves diagnostic accuracy for endometriosis. Our first example shows how automated detection of Pouch of Douglas (POD) obliteration can be augmented by a novel multimodal approach.

Aim: To improve eMRI detection of POD obliteration, by leveraging detection results from unpaired eTVUS data.

Method: Retrospective specialist private and public imaging datasets of the female pelvis were obtained. After pre-training a machine learning model using 8,984 MRIs from a public dataset, we fine-tuned the algorithm using 88 private eMRIs, to detect POD obliteration. We then introduced another 749 unpaired eTVUSs to further improve our diagnostic model.

Results: To resolve confounding problems with our eMRI datasets due to artefacts, mislabelling, and misreporting, we used model checking, student auditing and expert radiology review. Our results illustrated effective multimodal analysis methods which improved the POD obliteration detection accuracy from eMRI datasets. This model improved the Area Under the Curve (AUC) from 65.0% to 90.6%.

Conclusion: We have been able to improve the accuracy of diagnosing endometriosis from eMRIs using a novel POD obliteration detection method. Our method extracts knowledge from unpaired eTVUSs and applies it to eMRI datasets. The detection of POD obliteration is automated from eMRI data. Combining images for corresponding endometriosis signs using algorithms, is the first step in improving the imaging diagnosis of endometriosis, when compared to surgery, and allows extrapolation of results when either imaging modality is missing. This will enable women to obtain a faster diagnosis, where adequate scanning is available, prior to undertaking surgery.
#128 : Is Non-Closure Suitable as a Skin Closure Technique for 5 mm Laparoscopic Port-Site? - A Randomised Controlled Trial of Non-Closure Versus Transcutaneous Suture
Authors: Hamdan Mukhri , Zulkifli Nusaibah
Published: January 2024

Background and Aims: Laparoscopy has become the access of choice even in complex abdomino-pelvic surgery cases and more abdominal access ports have been used to assist with the surgery. Systematic review done on skin closure of 5 mm laparoscopic port-site showed comparable outcome between sutured and sutureless technique. Transcutaneous suture is better than subcuticular suture in the sutured group sub-analysis. No RCT were found comparing skin closure versus non-closure technique using simple dressing only.

Method: Randomised controlled trial – non superiority in Gynaecology Department, University Malaya Medical Centre in 2019. Based on power calculation, 40 subjects are needed. Each patient act as their own control – each will receive NC and TS for comparison.

40 patients (n=80) were included for final analysis. The 5 mm port site will be assigned with skin closure using NC versus TS where the surgical incision wound is covered with routine dressing after the operation. The primary outcome is the scar appearance at day 90 from the patient and blinded surgeons’ point of view. Secondary outcomes are patient satisfaction and pain at day 14, and wound complications.

Results: Cosmetic outcome in terms of scar appearance at day 90 showed no difference between NC and TS rated by the patient (MD 5.25 [0.07, 10.57], p 0.053) and the surgeon (MD 0.88 [0.08, 1.83], p 0.07). Pain is better perceived in NC group (MD 3.6 [0.19, 6.96], p 0.039) and patient satisfaction at day 14 is also better in NC group (MD 11.8 [4.18, 19.33], p 0.03). There was no significant difference in terms of wound complications and no surgical site infection were observed in both groups.

Conclusion: NC and TS techniques have comparable cosmetic outcome and wound complications. Pain perception is better in NC than TS.
#250 : Patient Satisfaction with Ultrasound-Guided Manual Vacuum Aspiration in the Management of First Trimester Pregnancy Loss
Authors: Chau Olivia See Yung , Ng Karen , Ip Patricia , Law Tracy SM , Chung Jacqueline PW
Published: January 2024

Background: Ultrasound-guided manual vacuum aspiration (USG-MVA) has been shown to be safe and effective alternative to traditional surgical evacuation in managing first trimester pregnancy loss. This study aims to determine patient satisfaction and acceptability of USG-MVA for the management of their first-trimester miscarriage.

Methods: This was a single-center cross-sectional study conducted in a university-affiliated tertiary hospital. Patients with delayed miscarriage of [Formula: see text]12 weeks of gestation or incomplete miscarriage who underwent USG-MVA were invited to complete a questionnaire 2-hour post-procedure to evaluate their experience. The Client Satisfaction Questionnaire-8 (CSQ-8) was used to assess patient satisfaction and acceptability to USG-MVA in addition to questions evaluating patient’s perception to the procedure.

Results: From 2018 to 2023, a total of 137 patients were recruited and all of which completed the questionnaire. Results indicate that patients were highly satisfied with the procedure, with CSQ-8 mean scores of 27 (SD 3.3, range 14-32). 135 (98.5%) patients were satisfied with the procedure, 129 (94.2%) of patients would wish to choose USG-MVA if they required surgical evacuation again and 128 (93.4%) patients would recommend USG-MVA to a friend.

Conclusions: USG-MVA is a feasible, effective, safe and highly acceptable alternative to surgical treatment for the management of first-trimester miscarriage. The option of USG-MVA can be presented as a treatment option when counselling for the management of first trimester miscarriage.
#367 : The Use of Intrauterien Balloon Therapy in Reproductive Medicine and Surgery
Authors: Shi Xiaoyu , Guo Jun , Saravelos Sotirios , Huang Xiaowu , Xia Enlan , Feng Limin , Li Tin-chiu
Published: January 2024

Background and Aims: The use of balloon therapy in obstetric practice, especially in postpartum haemorrhage is well established and has recently been reviewed. However, little attention has been drawn regarding the use of intrauterine balloon (IUB) in gynaecological practice. This study focuses on the various usage of IUB in gynaecological practice.

Methods: An electronic literature search through Medline, EMBASE and Clinicaltrial.gov from inception to August 2022 was conducted with mesh combinations of the following keywords: balloon, uterus, gynaecology, Foley catheter, complication, tamponade, hysteroscopy and laparoscopy.

Results: The study focuses on the 3 following areas: (1) Indications: prevention & removal of intrauterine adhesions, management of ectopic pregnancy, facilitation of endoscopic surgery and other clinical usages; (2) Practical aspects of balloon therapy including ultrasound guidance, choice of balloon, inflation volume, duration of balloon therapy; and (3) Potential complications including pain, infection, uterine rupture and how they can be avoided.

Conclusions: IUB therapy is a simple, inexpensive and effective method that can be applied in various gynaecological conditions ranging from IUA to intrauterine haemorrhage. Complications are rare, but in most cases can be avoided with correct use.
#85 : Microdissection Testicular Sperm Extraction (Micro-Tese) in Men Non-Obstructive Azoospermia with Very Small Testicular Volume: A Case Series Report
Authors: Dang Tuan Anh , Nguyen Hoang , Cao Anh , Le Anh , Bui Len , Le Hoang , Nguyen Huong
Published: January 2024

Background and Aims: Testicular atrophy is a common clinical manifestation of NOA, with a rate of 79.1%. The results of sperm retrieval using the mTESE method in a special NOA for testicular atrophy with volume [Formula: see text]5ml are currently inconsistent. As a result, we present the results of sperm retrieval using the mTESE method to patient NOA, who has a bilateral testicular volume [Formula: see text]5ml.

Methods: A case series report of NOA with bilateral testicular volume [Formula: see text]5ml that indicated mTESE surgery to collect sperm at the assisted reproductive technology center of Tam Anh Ha Noi General Hospital between January 2022 and December 2022.

Results: Four of seven NOA patients (57.1%) had successful sperm retrieval using the mTESE method, with bilateral testicular volume [Formula: see text]5 ml and a mean FSH level of 40,5 ± 21,9 (24,1-87,6) mIU/mL. In which case, 3/4 of patients simply require surgery on the monolateral testicular is sufficient sperm.

Conclusions: Testicular atrophy does not appear to impair sperm retrieval results by the mTESE method, even the sperm retrieval rate tends to be higher in NOA patients with bilateral testicular volume [Formula: see text] 5ml.
#110 : Diagnostic Approach and Clinical Recommendations for Non-obstructive Azoospermia: Global Andrology Forum Survey Results
Authors: Huang Zhongwei , Benny Paula , Sashidharan Shaili , Rambhatla Amarnath , Shah Rupin , Agarwal Ashok
Published: January 2024

Background and Aims: Non-obstructive azoospermia (NOA) is the most common form of male infertility, characterized by an absence of sperm in ejaculate and is caused by testicular failure. While NOA afflicts 10-38.3% of infertile males, there is no specific recommendations in EAA/EAU guidelines on its clinical diagnosis or WHO guidelines on semen analysis. Therefore, we conducted a global survey to assess the standard approach of practitioners in the diagnosis and management of NOA.

Method: The Global Andrology Forum (GAF) conducted a survey on 436 independent practicing entities from 55 countries. We compiled data from 336 respondents (andrologists, urologists, fertility specialists). Information collected included frequency of NOA, varicocele, frequency of obtaining semen, interval between obtaining semen samples, hormone evaluation (FSH, LH, prolactin, total/free testosterone, SHBG, estradiol, inhibin), genetic testing (karyotype, Y-chromosome deletion, CFTR, Kal1) and referral to genetic counsellors.

Results: The majority of participants (80%) either reported <10% or 10-25% NOA frequency in their population (Fig. 1A). 40.6% of participants stated that 10-25% of men with NOA cases have a clinically significant varicocele (Fig. 1B). For NOA diagnosis, majority of participants cited the requirement of at least two semen samples, with a period of 14-29 days as the interval between two semen analyses. To achieve high-quality semen, consideration must be given to an abstinence period (2-7days) and the complete collection of ejaculates. The survey reported FSH (97%), LH (86.9%) and total testosterone (92.9%) tests as most frequently used for NOA patients (Fig. 2A). The initial hormonal evaluation of a patient with suspected NOA should include total testosterone levels and LH, as these hormones are the primary regulators of spermatogenesis. Karyotype analysis (86.2%), Y-microdeletion (88.3%), CFTR (21.9%) and Kal1 (2.7%) were most routinely performed genetic tests (Fig. 2B). Referrals to genetic counsellors is recommended as these defects have the potential to be passed to future generations.

Conclusion: This global study evaluates NOA frequency, clinical diagnosis and management by specialists, in an effort to fill the gap in NOA research. Concomitantly, we provide GAF expert recommendations to enhance our collective understanding of NOA, optimize patient care and improve the management of NOA.
#255 : Disrupted CD147 Causes the Acrosomal Defects of Round Spermatids and Male Infertility
Authors: Chen Hao , Ye Mei
Published: January 2024

Background and Aims: CD147 is a well-known cancer cell migration and metastasis regulator. In the reproductive tract, our previous results revealed that CD147 regulates the apoptosis of spermatocytes and migration of spermatogonia and spermatocytes in the testis. However, the spermatogenesis process was inhibited at the round spermatid stage in our CD147-Stra8-Cre conditional knockout mice. We then further explored the mouse phenotypes and its underlying mechanisms.

Method: CD147-Stra8-Cre conditional knockout mice (CD147-cKODDx4) were generated by cross-breeding the CD147 flox mice and DDx4-Cre male mice. Testis were collected for histological and molecular analyses.

Results: The testis size and weight were significantly decreased in CD147-cKODDx4 mice compared to the control mice. There were no elongated spermatozoa in the CD147-cKODDx4 seminiferous tubules and cauda epididymis. PNA staining demonstrated the acrosomal defects on 3-5 stage of round spermatids. Consistent with morphological results, single cell-seq also demonstrated the round spermatid development loss. Mechanically, the IPO5 was identified as the interaction protein with CD147 and affected the round spermatids developments.

Conclusion: The present study reveals a novel role of CD147, uncovers new mechanism underlying male infertility, and provides promising targets for the development of infertility diagnosis and treatment.
#305 : Preparation of Epididymal/Testicular Spermatozoa; Technical Aspects and Its Impact on Success
Authors: Eltemimy Hesham , Gwynn Alexander , Ozcan Fulya , Ferraro Joanna , Sjoblom Cecilia
Published: January 2024

Background and Aims: The introduction of ICSI 30 years ago paved the way for epididymal/testicular spermatozoa to be used to fertilise oocytes in couples undergoing ART. Currently, spermatozoa is recovered from the epididymis or testis using varying approaches, including micro-surgery and fine-needle aspiration, mostly in men with obstructive and nonobstructive azoospermia. The samples delivered to the laboratory for processing are of varying quality with regards to amount of material/tissue, presence of spermatozoa, and other cells. The success of processing the tissue can have a direct impact on the outcome of the subsequent ICSI and our aim for this review was to identify ways to improve the preparation techniques for epididymal/testicular samples. Ethics approval was obtained from WSLHD HREC Ref 5583QA.

Methods: The review included 527 ICSI cycles for 311 patients (2016-2022) where epididymal/testicular spermatozoa had been used. Approaches for sample preparation included mini-gradient centrifugation and removal of red blood cells using erythrocyte lysis buffer (ELB). In cases with severe oligoasthenozoospermia (105 cycles, 79 patients), a phosphodiesterase inhibitor (PI) was added to induce motility.

Results: Employing mini-gradient centrifugation or adding ELB did not result in lost spermatozoa for any cases, but vastly reduced sample debris allowing for easier identification of spermatozoa. Fertilisation rate after ICSI was 57.9±1.2%. Motile spermatozoa were found and injected in all 105 samples after addition of PI and the fertilisation rate after ICSI was 55.3±2.7. To date cycles with PI have resulted in 26 live births with no abnormalities and all infants were of appropriate weight for gestational age.

Conclusions: Employing precise preparation techniques for epididymal/testicular samples is paramount to allow for timely identification of motile spermatozoa for ICSI and assure optimal overall outcome. Sharing and discussing successful approaches with the wider embryology community allows for discussion and refining of techniques which can benefit all.
#139 : Outcomes of IVF-ET in Overweight/Obese and Normal-Weight Women with PCOS
Authors: Huang Shuo , Yang Rui , Wang Yuanyuan , Li Rong , Qiao Jie
Published: January 2024

Background and Aims: Overweight/obese women with polycystic ovary syndrome (PCOS) have poorer pregnancy outcomes, compared to normal-weight women. Body mass index (BMI) is a risk factor of in vitro fertilization-embryo transfer (IVF-ET). This study is to compare the outcomes of IVF-ET between the overweight/obese and normal-weight women with PCOS.

Method: We performed a retrospective cohort study in a large reproductive center of a university hospital. The participants were the women with PCOS who underwent IVF-ET. We compared live birth, miscarriage and other clinical outcomes between the women with BMI ≥25 (overweight/obese group) and 18≤BMI<25 (normal-weight group).

Results: We included 3733 women with PCOS who underwent the first IVF-ET cycle from Jan 2016 to Dec 2020. 1693 of them were overweight/obese and had longer stimulation days and more doses of gonadotropins, while less numbers of oocytes retrieved and good quality embryos. Live birth rates were significantly lower in overweight/obese women, compared with normal-weight women (29.8% vs. 36.2%, OR 0.8 (0.7, 0.9)). Clinical pregnancy rates were significantly lower (38.5% vs. 43.0%, OR 0.8 (0.7, 0.9)). Miscarriage rates were significantly higher in overweight/obese women, compared with normal-weight women (21.5% vs. 14.6%, OR 1.6 (1.2, 2.1)). Multivariate logistic regression analysis showed BMI was an independent risk factor.

Conclusion: Overweight/obese women with PCOS had poorer outcomes of IVF-ET, compared to normal-weight women with PCOS.
#104 : Live Birth Rate After Preimplantation Genetic Testing for Monogenic Disorders (PGT-M) for Thalassemia in Vietnamese Patients
Authors: Ho Lan Tram , Luu Tam , Tran Cam , Nguyen Nhung , Le Anh , Nguyen Tri , Ma Mai , Ho Vu , Ha Anh , Ho Tuong
Published: January 2024

Background and Aims: Thalassemia is a hereditary blood disorder with diverse clinical manifestation inherited by autosomal recessive manner which affected 1.5% of the population. Clinically, there are two major forms: [Formula: see text]-thalassemia and [Formula: see text]-thalassemia. Palliative treatment of the severe forms by blood transfusion is eventually compromised by the concomitant problems of iron overload, alloimmunization, and bloodborne infections. In Vietnam, there are approximately 13.8% cases of thalassemia carriers in the entire population. PGT-M aims to characterize the genetic status of embryos resulting from in vitro fertilization (IVF) cycles. Herein, we report the clinical outcome of using PGT-M in couples who are thalassemia carriers.

Methods: This was a case series report conducted at IVFMD, My Duc Hospital, Vietnam between April 2019 and April 2022. A total of 38 couples who underwent IVF cycle in combination with PGT-M were enrolled in this study. Trophectoderm biopsy samples undergone whole-genome amplification, followed by next-generation sequencing (NGS) via the MiSeq platform for aneuploidy screening. Specific-targeted genes were performed for thalassemia detection in the next step.

Results: PGT-M was performed on a total of 128 blastocysts from 38 couples. Among 128 blastocysts, 92 (71.9%) were euploid. The rate of unaffected blastocysts was 38.0% and heterozygous blastocysts was 27.2% among euploid blastocysts. Single blastocyst transfer was performed in 30 couples and underwent 34 cycles. The clinical pregnancy rate was 50.0% and the overall live birth rate was 41.2%.

Conclusion: Data from this study showed a favorable live birth rate after PGT-M for thalassemia. We should encourage carrier couples to undergo PGT-M to eliminate the transfer of this disorder through the next generation.
#145 : Effect of Intra-Ovarian Instillation of Autologous Platelet Rich Plasma on Live Birth Rate in POSEIDON 3 versus POSEIDON 4 Group: A Prospective Follow-Up Study
Authors: Patel Garima , Singh Neeta , Malhotra Neena , Mahey Reeta , Saini Monika
Published: January 2024

Background and Aims: Various anecdotal cases have been reported regarding platelet rich plasma (PRP), demonstrating successful pregnancy outcomes. But the data still remains elusive, especially for women of Asian ethnicity, who have a rapid decline in ovarian reserve when compared to the Caucasian population. We aim to study the effect of intra-ovarian PRP on live birth rate (LBR) in POSEIDON-3 versus POSEIDON-4 group.

Method: Prospective interventional study conducted at tertiary care institute (July 2020-April 2022). 72-women between 20-40 years with idiopathic poor ovarian reserve (AMH[Formula: see text]1.2 ng/ml; AFC[Formula: see text]5) and a normal uterine cavity were enrolled. A 1.5 ml-PRP prepared from 30 ml venous-blood, was instilled in each ovarian stroma between day 6-10 of menses with 3-consecutive months follow-up to assess ovarian-reserve parameters (FSH, AMH, AFC). Patients showing improvement (AFC[Formula: see text] 5) were enrolled in antagonist-IVF cycles and categorised into two groups: POSEIDON-3 vs 4 groups. Paired/signrank test and Independent/ranksum test compared clinical parameters between the two-groups.

Results: Out of 72 participants, 16.67% responded in 1 [Formula: see text]  month of follow-up (AFC: 5 vs 3, p[Formula: see text]0.001), 43% in 2 [Formula: see text]  month (AFC: 6 vs 3, p[Formula: see text]0.001) and 12.5% in 3 [Formula: see text]  month (AFC:4 vs 3, p[Formula: see text]0.001). 20 participants showed no improvement. Excluding one, 43 underwent antagonist-cycle. Although number of oocytes retrieved was similar (6.35 ± 1.83 vs 5.75 ± 1.35, p=0.21), the dose of HMG requirement was higher in POSEIDON-4 (1450 ± 96.53 vs 1190.3 ± 66.49, p=0.04) thus depicting the effect of advanced age. There was no significant difference in dose of rFSH requirement (2705.6 ± 48.93 vs 2737 ± 54.74, p=0.71), fertilisation rate (60.86% vs 57.86%, p=0.66), CPR (25% vs 25.8%, p=0.95) and LBR (22.6% vs 16.66%, p=0.66) between the two-groups.

Conclusion: Intra-ovarian PRP improves the LBR in low-prognosis patients irrespective of age. PRP improves the ovarian reserve which translates into better reproductive outcomes in a population of women who were planned and counselled for donor-oocyte IVF.
#237 : The Application of Noninvasive Implantation Capability Screening (NICS®) Resulted in Improved Clinical Outcomes in Patients with Recurrent Pregnancy Loss or Repeated Implantation Failure
Authors: Lu Sijia
Published: January 2024

Background and Aims: Chromosomal abnormalities are frequently observed in early human embryos, particularly in patients experiencing repeated pregnancy loss (RPL) or repeated implantation failure (RIF). Although preimplantation genetic testing for aneuploidy (PGT-A) is a common technique for screening embryo ploidy, it comes with the risks associated with embryo biopsy. To address this issue, we developed the NICS assay, which evaluates embryos using spent culture medium (SCM) and thus reduces the risks associated with embryo biopsy. However, further evaluation is required to determine the clinical applicability of NICS for patients with RPL or RIF.

Method: This retrospective cohort study analyzed 303 patients with RPL or RIF between July 2018 and May 2021. These patients underwent aneuploidy screening using the NICS assay and were thus categorized into the NICS group. The non-NICS group consisted of patients who received conventional morphology embryo transfer during the same period. Routine intracytoplasmic sperm injection (ICSI) was performed, and the embryos were placed in droplets. Approximately 30 [Formula: see text] L of blastocyst medium from each embryo was transferred into cell lysis buffer, followed by DNA library preparation using the ChromInst kit from Yikon Genomics.

Results: In patients with RPL, the NICS group demonstrated significantly lower rates of miscarriage per frozen embryo transfer (FET) than the non-NICS group, 17.9% vs 42.6%. Furthermore, the NICS group exhibited significantly higher rates of ongoing pregnancies (40.7% vs 25.0%) and live births (38.9% vs 20.6%) compared to the non-NICS group.

In the case of patients with RIF, the NICS group showed higher clinical pregnancy rates per FET compared to the non-NICS group. Specifically, the clinical pregnancy rates, 46.9% vs 28.7%.

Conclusion: The present study demonstrates that the use of NICS for selecting euploid embryos can effectively reduce the incidence of miscarriage in patients experiencing RPL, as well as improve the clinical pregnancy rate in those experiencing RIF.
#238 : rsERT Guided Personalized Embryo Transfer Improves Clinical Outcomes in RIF Patients
Authors: Lu Sijia
Published: January 2024

Background and Aims: Narrowed or shifted window of implantation (WOI) is acknowledged to be one of the endometrial origins of embryo implantation failure, especially in patients with repeated implantation failure (RIF). RNA-Seq-based endometrial receptivity test (rsERT) was developed to assess the endometrial receptivity (ER) and guide the personalized embryo transfer (pET). Clinical studies were conducted to evaluate the clinical utility of rsERT in RIF patients.

Method: 566 RIF patients with rsERT and pET in multi-centers from 2019-2022 were included in this retrospective study, which was defined as rsERT-pET group. RIF patients without rsERT and pET in the same period was used as control for comparison. rsERT-pET group was further divided into normal WOI (nWOI) and shifted WOI (sWOI) groups. Clinical pregnancy rate and ongoing pregnancy rate were therefore compared among these groups by nonparametric statistical approaches.

Results: The intrauterine pregnancy and ongoing pregnancy rates of rsERT-pET group were receptively 55.0% and 46.2%, which were significantly higher than those of the control group (55.0% vs 35.1%, OR = 2.26, p-value = 2.33×10[Formula: see text]; 46.2% vs 19.8%, OR = 3.45, p-value = 4.08×10[Formula: see text] ). We further evaluated the intrauterine pregnancy rates of sWOI and nWOI and found remarkably better pregnancy outcomes in patients from nWOI group compared to those in sWOI group patients (62.4% vs 50.4%, OR = 1.64, p-value = 0.005).

Conclusion: The pET guided by the result of rsERT significantly improved the clinical outcomes in patients with RIF based on the intrauterine pregnancy rate and the ongoing pregnancy rate, indicating the clinical potential of rsERT method.
#318 : Embryomap: A Flexible Tool for Preimplantation Biopsy Samples
Authors: Gebhardt Kathryn
Published: January 2024

EmbryoMap is a streamlined workflow for chromosome copy number variation analysis and has been optimised and analytically validated to maximise the accuracy of results and reproducibility in the users’ hands. 

EmbryoMap’s improved chemistry enables increased assay flexibility by allowing various sample input types. Users can adapt EmbryoMap to lab requirements, including starting material of blastomere, blastocyst, polar body biopsies or various other sample input alternatives.

EmbryoMap DNA libraries can also be used as starting material for concurrent testing in complementary workflows, increasing the capacity to perform testing from a single sample.

In this study, we demonstrated EmbryoMap’s flexibility by performing concurrent CNV analysis followed by linkage-based haplotyping using the EmbryoMap library product as input for KaryoMap v2.0.  

Genomic DNA from commercial cell lines were used to evaluate the platform performance. EmbryoMap sequencing-ready libraries were used as input for Infinium KaryoMap v2.0 BeachChip arrays.

EmbryoMap CNV analysis was performed with eMap software. KaryoMap v2.0 analysis was performed with kMap software.

Sample performance was assessed using default QC settings for each platform. The reproducibility of haplotyping between the EmbryoMap libraries and bulk genomic DNA was evaluated. 

All samples passed EmbryoMap QC and produced karyotype matched CNV charts, qualifying the EmbryoMap libraries for KaryoMap v2.0 analysis. All samples passed the KaryoMap v2.0 QC metrics. The haplotyping result from EmbryoMap samples was highly concordant with the expected inheritance pattern derived from bulk genomic DNA. QC parameters for ADO and miscalls were within the expected range. 

This proof of concept demonstrates that EmbryoMap libraries are suitable for linkage-based analysis using KaryoMap v2.0. Additional experiments show these libraries can be used in additional workflows such as PGT-SR, and STR PGT-M, amongst others.
#201 : Comparison of the Sensitivity of Detecting Cervical Bacteria with Next Generation Sequencing and Third Generation Sequencing Technologies
Authors: Chang Wei-Fang , Chang Shu-Min , Chu Pei-Ling , Chen Yi-Hsiu , Lee Rui-Hua , Lee Yi-Xuan , Tan Shun-Jen , Wang Ruey-Sheng , Ho Jason Yen-Ping , Lin Shyr-Yeu , Tzeng Chii-Ruey , Hu Yu-Ming
Published: January 2024

Background and Aims: In in vitro fertilization (IVF) cycles, some patients suffering with vaginosis showed poor reproductive outcome even transferring with good quality embryos. The aim of this pilot study was to evaluate whether the species of Lactobacillus could be detected by next generation sequencing (NGS) and Third generation sequencing (TGS).

Method: 18 Patients aged 32–48 years-old who visited our fertility center from February 2021 to June 2022 with previous failure of transfer cycle were included. Exclusion criteria was antibiotic treatment within 3 months prior to enrolment. Genomic DNA of cervical microbiota taken from Cervico vaginal swabs in all patients were extracted and amplified. NGS was performed following the protocol of Ion 16S Metagenomics Kit by detecting V2–4–8 and V3–6, 7–9 regions of 16S. Amplicons were sequenced with Ion GeneStudio S5 Prime System. For TGS, full length of 16S was sequenced with Single Molecule, Real-Time (SMRT) Sequencing (Pacific Biosciences) and analyzed.

Results: All of the 18 cervical samples could be amplified with V2–4–8 and V3–6, 7–9 primers and the genus could be 100% identified by NGS. However, most of the Lactobacillus includes L. crispatus, L. jensenii. and L. gasseri showed indistinguishable except of L. iners. On the other hand, TGS clearly identified all Lactobacillus. For Gardnerella, Atopobium and Prevotella, TGS and NGS showed equivalent sensitivity in genus level. However, due to the sequence similarity, Escherichia/Shigella could not be identified from the Lactobacillus.

Conclusion: In this report, we aim to compare the sensitivity of detecting bacteria by 16S amplification method. Preliminary results suggest that NGS can distinguish bacterium causes vaginosis in genus level, but there might be misleading if the existence of pathogen such as Escherichia/Shigella. Till now, TGS still exhibits the best sensitivity for distinguish Lactobacillus in species level.
#261 : Nutrition Intervention in Endometriosis Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Meidyana Shafira , Sari Eka Fitria
Published: January 2024

Background: Endometriosis is a chronic disease that affects approximately 10% of reproductive-age women, and one of the primary symptoms is pain, which can significantly impact quality of life and productivity. This has resulted in substantial income loss for women across the world.

Aims: This study aimed to systematically review the evidence of nutrition interventions for improving pain in endometriosis patients based on randomized controlled trials (RCTs) and to perform a meta-analysis of the risk difference in mean visual analogue scale (VAS) between the treatment group and control.

Methods: A comprehensive search strategy was used in PubMed, Embase, Cochrane Library, and Scopus using the keywords endometriosis, diet, nutrition, and pain. Screening, full-text review, and risk assessment were performed by two independent reviewers, and risk assessment bias was conducted using Risk of Bias 2 (RoB2).

Results: The search resulted in 1,084 records, and eight studies were included in the review. Most studies were concluded to have low risk of bias based on RoB2 assessment, with two studies with some concern and one study with high risk of bias according to missing outcome data in reports. A total of 225 cases and 245 controls, laparoscopically confirmed with endometriosis, were included in this review. Nutrition interventions included in this review were vitamin C, D, E, fish oils, and complementary diet therapy for 8-24 weeks. Meta-analysis using a random-effect model showed an 18% risk reduction in mean VAS in the treatment group compared to the control. Although this analysis found substantial heterogeneity within the study (I2=82.51%), this finding can be explained by subgroup analysis, in which fish oils showed a positive mean risk difference with a large confidence interval.

Conclusions: This study found that nutrition interventions show promising effects in alleviating pain in endometriosis. However, further research, especially RCTs for comparing nutrition intervention and medical treatments in managing endometriosis pain, is still much needed. These findings highlight the importance of exploring alternative, non-pharmacological approaches in endometriosis management, which could potentially improve the quality of life for patients.
#20 : Follitropin Delta Can Play a Good Role in Both Patients with High Serum AMH Level and Patients with Low Serum AMH Level in IVF
Authors: Choo Chang-Woo , Lee Won-Don , Lim Jin-Ho
Published: January 2024

Background and Aims: To evaluation clinical efficacy of follitropin delta in IVF procedure for Korean.

Method: This is a prospective study performed by single physician at primary fertility center. From December 2020 to November 2021, total 82 cycles of IVF were performed. 70% of total cycles was performed using gonadotrophic releasing hormone (GnRH) antagonist protocol, and another 30% of cycles were gonadotrophin releasing hormone agonist (GnRHa) protocol.

Results: Average duration of infertility was 2.2± 1.5 years. AMH levels were 2.4± 2.4 ng/ml. The number of obtained oocytes were 8.9± 5.0. Mean daily dose of follitropin delta were 10.3± 2.5 mcg, and total dosage were 121.8± 25.5 mcg. Duration of stimulation were 9.9± 2.0 days. Biochemical pregnancy rate was 38% and clinical pregnancy rate was 27%. No cases of severe ovarian hyperstimulation syndrome were developed.

Conclusion: For both patients with good ovarian reserve, and the patients with poor ovarian reserve, follitropin delta can play a good role. With its discriminative fixed dosing protocol, follitropin delta gives more convenient way for both physicians and patients with minimal risk of OHSS, without having detrimental effect on pregnancy rate.
#68 : Effect of Botulinum Toxin in the Treatment of Refractory Vaginismus
Authors: Gul Rohina , Khan Yousaf Latif , Iqbal Maryam , Sardar Saba , Nisar Rameen
Published: January 2024

Background: Vaginismus is a body’s automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, the vaginal muscles tighten up on their own. It can range from mildly uncomfortable to almost impossible penetration. Hence, we need to pay more attention to the multidimensionality of this disorder’s biological, psychological, and social dimensions and its treatment.

Objective: To see the efficacy of botulinum injection in success rate of treatment of vaginismus were counselling sessions and using different method of dilatation failed.

Methods: It was a case control study conducted at tertiary care hospital from January 2021 to December 2022. 120 women were recruited, 50 with vaginismus and 70 were without vaginismus. Females diagnosed with moderate to severe vaginismus who failed to respond to counseling sessions and use of dilators was included. A designed questionnaire was used for data collection and entered in SPSS version 25. The Chi-square test was used to compare categorical variables. The level of significance was 5%.

Results: The mean age of women and duration of marriage was 28.4±2.63 and 4.16±1.36 years. Women who suffered with vaginismus were depressed. 28(56%) couple had good relationship and good communication after marriage. 41(82.0%) women were not sexually abused. Out of 50 couples, 23(46%) had excellent sexual knowledge. Before injection Botox examination under anesthesia was done, there was no local pathology, 17(34%) could admit one finger and 33(66%) could admit two fingers. A significant relationship was found between case control with outcome after Botulinum injection (p-value=0.00). The success rate of this treatment was 74%.

Conclusion: Botulinum toxin blocks release of acetylcholine, inhibiting neuromuscular transmission and leading to muscle paralysis. This therapy intensely relieved the inappropriate spasms, allowing resumption of intercourse.
#96 : The Efficacy of Platelet Rich Plasma Therapy in Thin Endometrium Undergoing Frozen Thawed Embryo Transfer in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis
Authors: Chilmawati Laili , Dewanto Agung , Chandra Lukman Ade , Alkaff Muhammad Lutfi
Published: January 2024

Background and Aim: Endometrium is one of the main factors in implantation and pregnancy. Adequate thickness of the endometrium is crucial for successful embryo implantation. Thin endometrium significantly increases the risk of embryo implantation failure, as the pregnancy rate in women. Intrauterine infusion of platelet rich plasma (PRP) is a new approach that has been suggested for the treatment of thin endometrium. This meta-analysis was conducted systematically to evaluate the efficacy of PRP therapy on endometrial thickness and pregnancy rates.

Methods: We conducted a systematic review and meta-analysis of the retrieved randomized controlled trial (RCT). Studies on the intra uterine infusion of PRP in women undergoing frozen thawed embryo transfer (FET) in assisted reproductive technology (ART), identified by conducting a systematic search, using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar. Data were extracted and analyzed independently using random effects model or common effects model according to heterogeneity. Risk of bias assessment was assessed using RoB 2 tools.

Results: Five RCTs involving 377 patients were included in the endometrial thickness outcome. The endometrial thickness between PRP and control group showed a significant probability of increasing endometrial thickness in PRP group (MD 0,83, 95% CI 0,40-1,26, I 2 84%, p<0,01). The rates of chemical pregnancy were significantly higher in PRP group (RR 2,73, 95% CI 1,41-5,27, I 2 51%, p=0,15). The rates of clinical pregnancy were significantly higher in PRP group (RR 1,75, 95% CI 1,29-2,39, I 2 62%, p<0,01). According to RoB evaluation, the overall studie’s quality was minimally bias.

Conclusions: In this systematic review, we concluded that PRP was an effective therapy to increase endometrial thickness and as alternative treatment strategy for thin endometrium undergoing FET in ART. Although this study retrieved some RCT, we suggested that additional RCT were needed to increase the power of study.
#100 : Can the Dual Trigger be Effective in Improving Oocyte Maturation and Embryo Quality Compared to the HCG Trigger or the GnRH-a Trigger?
Authors: Ahn Young Sun , Kim Kwang Rae , Shin Mi Sun , Lee Jee Eun , Lee Jee Eun
Published: January 2024

Background and Aims: HCG was the standard trigger of final oocyte maturation in IVF cycles. An alternative trigger with gonadotropin releasing hormone agonist (GnRH-a) was effective in reducing OHSS. But GnRH-a trigger induced increased luteal insufficiency and cycle cancellation. A dual trigger (HCG with GnRH-a) was introduced to reduce OHSS, luteal insufficiency and cycle cancellation.

This study was designed to compare the effect of dual trigger on final oocyte maturation n embryo quality with conventional HCG trigger and GnRH-a trigger.

Method: We conducted this retrospective cohort study of patients who underwent IVF antagonist cycles from Jan. 2020 to Dec. 2022. Patients undergoing their oocyte retrieval 36 hours after trigger with only HCG 10,000 units, or only leuprolide acetate 40 units, or a dual trigger of HCG 5000 units with leuprolide acetate 40 units. Male factor infertility and oocyte donor cycle were excluded. The main outcomes were retrieved mature oocyte rate and fertilization rate. Secondary outcomes include implantation rate and pregnancy rate.

Results: Total 3266 patients were included. Dual trigger was in 2279, GnRH-a in 282 and HCG in 705 cycles. Patients using GnRH-a were younger (33.7± 4.0 years) compared to those receiving dual trigger (37.8±2.3 years) and HCG only (37.2±3.2 years) (p<0.01). Because GnRH-a groups were younger, despite low total gonadotropin dose, the larger number of oocytes were retrieved. Dual trigger resulted in no difference in mature oocyte ratio, compared to HCG trigger and GnRH-a trigger (63.0%, 58.3%, 62.8% p: 0.074). Analysis did not show any statistical differences in fertilization rate between the types of triggering methods. Cycel cancellation due to no oocyte recovered from multiple follicles aspirated was shown only in GnRH-a cycle (6 cases. 2.1%).

Conclusion: Compared to HCG trigger and GnRH-a trigger, the dual trigger showed no difference in mature oocyte rate and fertilization rate. To reduce OHSS and cycle cancellations, dual trigger could be considered the standard care in IVF without decreasing oocyte quality.
#101 : A Direct Healthcare Cost Analysis of Recombinant LH Versus hMG Supplementation on FSH During Controlled Ovarian Hyperstimulation in the GnRH-Antagonist Protocol
Authors: Chang Jui-Chun , Lin Wei-Szu , Chen Ming-Jer , Lin Ching-Heng
Published: January 2024

Background and Aims: We have previous proposed a retrospective matched-case control study comparing the effect of recombinant LH versus hMG supplementation on FSH during COH in the GnRH-antagonist protocol. The result showed the cumulative live birth rate (CLBR) was significantly higher the in the LH group (53% vs. 64%, p=0.02). In this study we aim to do the cost analysis between these two groups based on our previous study.

Method: The analysis consisted of 425 IVF and ICSI cycles performed in Taichung Veterans General Hospital, Taiwan between 2013 and 2018 in our previous study. They were chosen by Propensity score matching with balanced age, anti-mullerian hormone (AMH) level, and oocyte retrieval date. There were 259 cycles in hMG ± FSH group and 166 cycles in LH ± FSH group. The total cost related to treatment of each patient was recorded.

Results: The treatment cost was showed in Table 1. The total treatment cost per patient was significantly higher in the LH than in the hMG group (USD 4194.93 ± 713.6 vs. $ 4466.33 ± 793.18 p=0.001). However, the mean costs per live birth in the hMG goup was higher with US $7875.42, vs. US $6928.83 in the LH group. The analysis of CLBR in the two groups in different treatment cost range results were showed in Figure 1 and Table 2. The CLBR was almost higher in the LH group in each range except for range between USD 5000-5499. When treatment cost between $4000-4499, the CLBR was significantly higher in the LH group than in the hMG group (81.8% vs. 54.3% p=0.006).

Conclusions: The cost analysis showed that recombinant LH is more cost effectiveness than hMG supplementation on FSH during COH in the GnRH-antagonist protocol.