bluuebunny/crossref_metadata_2025 huggingface dataset:
P-754 Chronic poor healing wounds of post cesarean scar diverticulum: altered angiogenesis and immunobiology
Authors: Yang X , Liu Z
Published: June 2023

Study question

To detect the influences of cesarean section scar diverticula (CSD) on the pregnancy outcomes in ART and explore the mechanisms.

Summary answer

In the CSD group, the cumulative live birth rate （CLBR） was significantly reduced, accompanied by excessive proliferation of fibroblasts and expansion of vascular proliferation.

What is known already

Diverticulum can reduce the chances of embryo implantation and may lead to spontaneous miscarriages if the implantation is close to or in the CSD. The accumulation of bloody fluid can be detected in approximately 42% of women with large CSD. The trapped blood is slowly released and could affect cervical mucus, sperm transport, and implantation. The previously data have revealed that disrupted uterus microbiota is closely associated with local inflammatory cytokines which could also be a clue for impaired fecundity in CSD.

Study design, size, duration

This retrospective cohort study was conducted using data from a single, large university-affiliated fertility center. Data was retrospective analyzed among women underwent ART procedure from May 2010 to March 2021. Follow-up basic experiments to explore relevant mechanisms.

Participants/materials, setting, methods

Data was retrospective analyzed among 31375 women underwent ART procedure in the Sixth affiliated Hospital of Sun Yat-sen University. To optimize the precision of the study, patients in the CSD group and the NCS group were matched using propensity score matching method. Perform hysteroscopy and obtain cervical swab and endometrial tissue of lower segment. To explore the difference of uterine cavity environment between CSD group and vaginal birth (VB) group by histopathological and immunological analysis.

Main results and the role of chance

The CS group had significantly lower CLBR compared to NCS group. Histopathological analysis showed that the higher prevalent of chronic endometritis is accompanied by excessive fibroblast proliferation at the lower segment of uterus and significantly exaggerated vascular proliferation in situ. Intrauterine inflammatory cytokines including IL-1α, IL-1β, IL-6, IL-8, TNF-α and SDF-1α were also increased in CSD group.

Limitations, reasons for caution

The main limitation of our study is its retrospective nature and single center, which might have underestimated the total number of women with CSD and could lead to a bias.

Wider implications of the findings

Lay emphasis on anti-infective therapy, modulate the imbalance of reproductive tract flora and enhance early lesion healing post-operation are of great necessity. Future studies exploring the preventive and therapeutic strategies of CSD should focus on immune inflammatory response and angiogenesis.

Trial registration number

Not applicable
P-758 Impact of serum estradiol levels prior to progesterone administration in artificial frozen embryo transfer cycles:a retrospective study over 26,000 cycles
Authors: Chen Q
Published: June 2023

Study question

To investigate whether serum estradiol (E2) levels prior to progesterone administration in the FET-cycle affect the Clinical pregnancy rate (CPR) and live birth rate (LBR).

Summary answer

High serum E2 levels prior to progesterone administration in Artificial endometrial preparation are associated with a decreased live birth rate and clinical pregnancy rate .

What is known already

Although the use of FET has progressively increased, it is still unknown whether a specific endometrial preparation protocol should be favored over another. Owing to their minimal need for clinic visits and a larger scheduling flexibility, artificial cycles for FET are widely used. Additional to the ultrasonographic endometrial thickness check prior to FET, the need for endocrine monitoring in artificial cycles remains unclear. Specifically, the value of proliferative phase serum hormone measurements remains a point of discussion.

Study design, size, duration

A total of 26,194 artificial FETs performed in a Tertiary-care academic medical centre between 2016 and 2021 were subdivided into 3 groups according to the following late-proliferative serum E2 level percentiles: ≤p33.3 (E2 ≤118 pg/ml; n = 8784), p33.4–p66.6 (E2 from 118.1 to 231.9 pg/ml; n = 8662) and ≥p66.7 (E2 ≥232 pg/ml; n = 8748).

Participants/materials, setting, methods

A retrospective study over 26,194 cycles,from 2016 to 2021 were included.Univariable and multivariable logistic regression analysis was performed.

Main results and the role of chance

In 26,194 cycles, there were significant differences in CPR and LBR among the tri-sectional quantiles groups with E2 levels. After stratifying the analysis by age, BMI, infertility diagnosis, type of embryo transferred, number of transferred embryos, infertility factors, method of fertilization, and endometrial thickness on transfer day, there were still significant differences in CPR and LBR among the tri-sectional quantiles group with E2 levels. Multivariate regression analysis showed that female age, thin endometrium, high serum E2 level, tubal factor infertility were risk factors for CPR and LBR, ICSI fertilization, blastocyst transfer, the number of transferred embryos, ovulation disorder infertility and male factor infertility were protective factors for CPR and LBR, BMI was only a risk factor for LBR.

Limitations, reasons for caution

•Different routes of administration affect serum estrogen levels,and the relationship of serum estrogen levels and endometrial estrogen concentrations is unclear

Wider implications of the findings

High miscarriage rate following FET has been a point of debate in literature.Future research should definitely focus on the the usefulness of serum E2 evaluation to optimize the success rate.

Trial registration number

Not applicable
O-095 Different phenotypes of PCOS: Implications to clinical practice
Authors: Franks S
Published: June 2023

Polycystic ovary syndrome (PCOS) is a very common, heterogeneous syndrome which presents with a spectrum of clinical and biochemical features. It is associated with both reproductive and metabolic dysfunction and has a negative impact on long term health, including mental health. Although there appears to be a common genetic background to PCOS, regardless of presentation, environmental factors, including diet, play an important part in determining the phenotype. The most commonly used diagnostic criteria, the Rotterdam criteria, takes account of the heterogenous nature of the syndrome but the spectrum of presentation can be categorised as four clinical and biochemical subtypes which comprise (A) ovulatory dysfunction, hyperandrogenism, polycystic ovaries (PCO), (B) ovulatory dysfunction, hyperandrogenism but without PCO, (C) hyperandrogenism without ovulatory dysfunction but with PCO and (D) ovulatory dysfunction with PCO but without hyperandrogenism. These are not rigid categories since some women may go from one to another, for example weight gain may lead to anovulation in a woman who previously had hirsutism but regular cycles. Nevertheless, the diagnostic sub-category has a significance influence on clinical management.

Women who have both hyperandrogenism and ovulatory dysfunction (A&B) are at higher risk of metabolic dysfunction which is exacerbated by obesity (and carries a high long-term risk of diabetes and cardiovascular disease) and so merit thorough investigation which includes assessment of glucose tolerance and lipids. Those who have predominantly ovulatory problems may require fertility treatment or regulation of menses but some who simply have irregular menses may need no specific treatment. Symptoms of hyperandrogenism (hirsutism, acne, alopecia) can be particularly distressing and may be best managed in collaboration with a dermatologist. The negative impact of PCOS on mental health is a very common problem, the high prevalence of which has only recently been appreciated. Not surprisingly, it is particularly relevant in those women who have moderate to severe symptoms of hyperandrogenism.

In summary, PCOS is a syndrome characterised by a variety of symptoms and endocrine abnormalities and it is important to tailor treatment individually, according to the need for symptom relief and with regard to concerns about long-term health.
O-140 studying the effect of mosaicism on the outcome of micro-TESE among Klinefelter syndrome patients
Authors: Al-Ahwani A , Dawood R , Fawzy A , Elrefaey F , AlAhwany H
Published: June 2023

Study question

Does mosaicism affect sperm retrieval rate in Klinefelter patients?

Summary answer

Patients with mosaic Klinefelter syndrome (KS) have a higher success rate of sperm retrieval than those with non-mosaic KS.

What is known already

Klinefelter syndrome is characterised by the presence of an extra X chromosome in male individuals leading to a 47XXY karyotype and rarely to 46XY/47XXY Mosaicism; it is the most common sex chromosomal aneuploidy and the most common genetic cause of Azoospermia (Kanakis GA et al., 2018 and Gravholt CH et al.,2018). It accounts for 3–4% of male infertility cases and 10–12% of men with Azoospermia (Winters SJ,2018).

Study design, size, duration

After approval of the ethical committee of the faculty of medicine at Cairo University, This prospective study was conducted where 70 men who complained of primary infertility and azoospermia and were diagnosed with Klinefelter Syndrome were recruited for this study between 1/11/2021 and 30/11/2022. Patients with previous testicular disease (torsion, trauma) or who had a history of undescended testes or received chemotherapy or radiotherapy were excluded.

Participants/materials, setting, methods

Seventy patients (n = 70) aged between 20 and 50 who fit the inclusion criteria were recruited and underwent micro_TESE. Semen analysis (Azoospermia), hormonal profile, scrotal colour doppler ultrasonography, Karyotyping and FISH for Y and X chromosomes were performed. Statistical analysis was conducted using SPSS 22nd edition.

Main results and the role of chance

Our study groups comprised 14 patients with mosaic KS and 56 with non-mosaic KS. The clinical characteristics were not significantly different statistically between the two groups. Micro_TESE was performed in all 70 patients; in 26 patients (37.1%), mature sperm were found in the wet preparation.

No statistically significant correlation was found between the presence of spermatozoa in the extraction specimen and age, serum follicle-stimulating hormone, serum testosterone, prolactin or oestradiol. The statistically significant predictor variable for sperm extraction was mosaicism, luteinising hormone, testicular volume and FISH. The sperm retrieval rate of the patients with mosaic and non-mosaic KS was 57.1% and 32.1%, respectively.

Limitations, reasons for caution

1) Larger (n) number of patients was needed.

2) Despite our valuable findings, further studies should be performed to illuminate the relation between FISH for X and Y chromosomes and sperm retrieval rate success.

Wider implications of the findings

Klinefelter patients with mosaicism should be offered high sperm retrieval rate during IVF counselling.

Trial registration number

n/a
P-172 Effect of anti-centromere antibodies on multi pronuclear formation
Authors: Kumagawa Y , Ihara K , Tokoro M , Fukunaga N , Asada Y
Published: June 2023

Study question

Do the anti-centromere antibodies (ACA) affect the multi pronuclear formation (MPF) rate?

Summary answer

MPF rate was higher in patients with ACA. The MPF rate of ACA patients with antibody titers ≥160-fold was significantly higher than in titers 40-fold.

What is known already

ACA is an anti-nuclear antibody (ANA), and specifically recognizes the centromere. Recently, several studies have reported that the rate of oocyte maturation is lower in patients with ACA. Moreover, in MI oocytes collected from ACA patients, female chromosomes were frequently dispersed in the cytoplasm.

Study design, size, duration

A total of 4756 patients from our clinic were tested for ANA before oocyte retrieval from January 2014 to December 2021. After retrospective ANA testing, patients were classified according to 3 groups; 62 ACA patients (with only ACA), 1134 non-ACA patients (with ANA but not with included ACA) and 3560 non-ANA patients (without ACA and any ANA).We considered ACA-positive levels at titers ≥40. ACA patients were further classified into 6 groups by antibody titer.

Participants/materials, setting, methods

The MPF rate after ICSI was compared in the 3 groups (ACA patients, non-ACA patients, non-ANA patients) and at 6 ACA titers in each group (titer of ACA; 40-fold, 80-fold, 160-fold, 320-fold, 640-fold, ≥1280-fold).MPF rate was calculated by dividing the number of embryos that formed three or more pronuclei by the number of embryos inseminated by ICSI.Ryan's method was used for multiple comparisons of ratios.

Main results and the role of chance

MPF rate was 3.8% (1997/53240) in non-ANA patients, 4.3% (733/17003) in non-ACA patients, and 32.1% (351/1092) in ACA patients, being significantly higher in ACA vs other groups (P<.01). In comparisons between ACA titers, MPN rate was 8.7% (4/46) at 40-fold , 13.0% (3/23) at 80-fold , 36.1% (56/155) at 160-fold , 32.4% (48/148) at 320-fold , 36.0% (111/308) at 640-fold , and 31.3% (129/412) at ≥ 1280-fold, respectively. MPN rate of patients with titers ≥160-fold was significantly higher than with 40-fold.

Limitations, reasons for caution

A potential limitation of the present study is the small sample size. This is because ACA patients account for only 1% of patients who underwent ART treatments.

Wider implications of the findings

MPF rate in ACA patients was significantly higher than in non-ANA and non-ACA patients and was also significantly higher in ACA patients with titers of ≥ 160-fold vs 40-fold. The dispersion of the female chromosome in the cytoplasm of MI oocytes may be a cause of MPN formation.

Trial registration number

None
O-155 Building bridges to harmonize different data collection systems worldwide - need and challenges
Authors: Kupka M S
Published: June 2023

In order to transfer data from individual IVF centers and a national register into a regional register and then merge this data into a world register, certain basic definitions must be established.

The treatment strategies of each country are influenced by the legislative and insurance framework.

The expectations of patient couples also vary greatly from region to region.

All of this can only work if there are definitions of what data is to be collected and in what way.

Above all, there are difficulties in creating statistics when the raw data first has to be adjusted and merged.

This article is intended to point out some difficulties, but also to show solution concepts.
O-199 Imprinting disorders in singletons conceived by assisted reproductive technology in Sweden
Authors: Ye M , Palomares A , Iwarsson E , Rodriguez-Wallberg K , Öberg S
Published: June 2023

Study question

Is singleton birth from assisted reproductive technology (ART) associated with imprinting disorders (IDs) independent of parental infertility and other background factors?

Summary answer

Singletons conceived using intracytoplasmic sperm injection (ICSI) and frozen embryos have higher risks of Beckwith-Wiedemann syndrome (BWS), Prader-Willi syndrome (PWS) and Silver-Russell syndrome (SRS).

What is known already

Previous studies have suggested elevated risk of IDs in children conceived with ART compared with children conceived with spontaneous conception (SC). It is not clear to what extent the observed associations could be explained by parental infertility and related risk factors. Knowledge on specific ART procedures and their association with IDs is also limited.

Study design, size, duration

A nationwide register-based cohort study was carried out in which all liveborn singletons in 1997-2017 in Sweden were included with follow-up to 2018.

Participants/materials, setting, methods

Among 1 998 825 singletons, 60 210 were conceived using ART. The International Classification of Diseases (ICD) version 10 was used to identify three distinct ID groups: PWS/SRS, BWS, and central precocious puberty (CPP). Cox regression, combined with inverse probability treatment weights to account for birth year, parity, pregnancy loss history, parental age and country of origin, was used to compare ART singletons with all SC singletons and those born to couples with known infertility.

Main results and the role of chance

A total of 1012 children were diagnosed with the IDs of interest (654 PWS/SRS, 255 BWS, and 109 CPP), and 49 of them were conceived through ART. Compared with all SC singletons, higher risk of PWS/SRS and BWS was observed in ART singletons and the weighted hazard ratios (wHRs) were 1.57 [95% CI, 1.09-2.26] and 2.57 [95% CI, 1.60-4.12], respectively. The elevated risks remained when comparison was restricted to SC singletons of couples with known infertility, though the wHR for BWS was somewhat attenuated (1.87, 95% CI: 1.04-3.36). No difference in risk of CPP was observed between singletons conceived with and without ART irrespective of parental infertility. Further subgroup analysis revealed that ICSI in combination with frozen embryo transfer was responsible for the higher risks of PWS/SRS (wHR 6.32, 95% CI: 3.34-11.95) and BWS (wHR 9.04, 95% CI: 4.34-18.82).

Limitations, reasons for caution

The use of the Swedish ICD-10 did not allow distinction of PWS and SRS. The number of CPP cases in ART singletons was too small (N = 3) to make inference.

Wider implications of the findings

This study found that ART-conceived singletons, particularly those conceived using ICSI and frozen embryos, had a higher risk of IDs independent of parental infertility. However, the underlying mechanism is not clear, and the role of type and severity of infertility warrants further investigation.

Trial registration number

not applicable
O-215 Negative impact of the reduction in family income following the SARS CoV 2 Covid 19 pandemic on access to Assisted Procreation : observational study
Authors: Pacchiarotti A
Published: June 2023

Study question

What are the consequences of the health emergency and the consequent restrictive measures on the economic accessibility of medically assisted procreation techniques.

Summary answer

Reduction of family income rate and consequentely bias of PMA attempts rate

What is known already

- The birth rate in Italy over the past 10 years has been declining rapidly and continuously

- Fertility income correlation has an inversely proportional trend demonstrated in a study conducted by the Ministry of Economy and Finance and Istat

- Pandemic has further impoverished Italian families

Study design, size, duration

This is a transversal observational study conducted at the Assisted PReproduction Center of the San Filippo Neri hospital in Rome between Jenuary 2021 and December 2022

The results were obtained by administering an online questionnaire consisting of 20 multiple choice questions to which the participants answered anonymously.

Participants/materials, setting, methods

Two hundred and ninety-five patients were enrolled with an overall average age of 37.5 years (minimum age 25, maximum age 47).

Main outcomes measures. Bias of PMA attempts rate. Reduction of family income rate

Main results and the role of chance

Majority of people said they have not seen their desire for offspring reduced since the onset of health emergency. the willingness to use MAP techniques during the pandemic remained unchanged for 58.7% of respondents, increased for 12.5% and decreased for the remaining 28.8%. The individuals who have declared to have momentarily renounced to the procedures of PMA have been 31.7%, of these 24% has renounced because of economic factors. When asked about the cost of the necessary medical procedures, 62.5% of the participants considered the price in public facilities to be “adequate” and 79.8% defined the cost in private clinics as “excessive”.

Limitations, reasons for caution

A limitation of the study may be the comprehension of the questionnaire, since it could not be speieged verbally. The administration was done online, so there is no assurance that it was received by everyone. Therefore, the percentage of patients who did not respond may be overestimated

Wider implications of the findings

The study and analysis of these data provides a current overview of the condition of infertile couples in our country, so that all useful interventions can be put in place to restore the interest and economic conditions necessary for the initiation of medically assisted procreation.

Trial registration number

not applicable
O-226 Is there a place for polygenic risk scoring in PGT (PGT-P)?
Authors: Handyside A H
Published: June 2023

Preimplantation genetic testing (PGT), by embryo biopsy and genetic testing for inherited diseases and chromosome abnormalities following IVF, is now well established world-wide. PGT for monogenic conditions (PGT-M) is generally performed for childhood-onset, lethal disorders, but is increasingly accepted for certain adult-onset conditions, conditions with available treatment options or conditions with lower penetrance. Over recent years, machine learning methods applied to large genomic datasets, including genome-wide association studies (GWAS) using single nucleotide polymorphism (SNP) genotyping, has enabled polygenic risk scores (PRSs) to be calculated to identify individuals who are at elevated risk for a broad range of conditions including important common multifactorial diseases, such as coronary artery disease (CAD), diabetes, hypertension and various cancers. It is now possible to perform genome-wide SNP genotyping of embryo biopsy samples with the same accuracy as adult genomic DNA and the first live birth following PGT for polygenic risk scoring (PGT-P) was reported in 2019 (Treff et al (2019) Front Endocrinol 10, 845) . The clinical application of PGT-P is controversial and raises many practical, ethical and societal issues. To examine the question ‘is there a place for PRS in PGT’, the example of predisposition to breast cancer will be reviewed.
O-246 The molecular mechanism of miR-96-5p in the pathogenesis and treatment of polycystic ovary syndrome
Authors: Li X
Published: June 2023

Study question

Polycystic ovary syndrome, characterized by the androgen excess and arrest of antral follicles, is lacking novel specific diagnostic biomarkers and therapeutic targets.

Summary answer

Study of the molecular mechanisms of microRNAs in the etiology and its potential applications in PCOS provides the insight.

What is known already

Some of molecular mechanisms of microRNAs have been demonstrated involved in the etiology of PCOS

Study design, size, duration

Clinically, we collected the samples of serum, follicular fluid (FF) and primary human granulosa cells (hGCs) of PCOS patients (n = 70) vs. non-PCOS women (n = 60). Experimentally, we carried out studies with 3-types of induced PCOS-like mice.

Participants/materials, setting, methods

By analysing the expression levels of miR-96-5p in serum, follicular fluid (FF) and primary human granulosa cells (hGCs) of PCOS patients (n = 70) vs. non-PCOS women (n = 60). as well as in ovaries from 3-types of induced PCOS-like mice.

Main results and the role of chance

Clinically, we demonstrated that the elevated circulating miR-96-5p levels were significantly correlated with the PCOS disordered endocrine clinical features, and the area under the curve of receiver operating characteristic was 0.8344, with 75.71% specificity and 80% sensitivity. Mechanically, we identified miR-96-5p as an androgen-regulated miRNA that directly targets the forkhead transcription factor FOXO1. Inhibition of miR-96-5p decreased estrogen synthesis, while decreasing the cell proliferation index of KGN via regulating the expression of FOXO1 and its downstream genes. Inversely, inhibition of FOXO1 abrogated the effect of miR-96-5p on estrogen synthesis and proliferation index. Of note, ovarian intra-bursal injection of miR-96-5p agomir rescued the phenotypes of dehydroepiandrosterone-induced PCOS like mice.

Limitations, reasons for caution

This study needs a large-scale clinical investigation to confirm the specificity and sensitivity of miR-96-5p as a clinical biomaker.

Wider implications of the findings

In conclusion, our results clarified a vital role of miR-96-5p in the pathogenesis of PCOS and might serve as a novel diagnostic biomarker and therapeutic target for PCOS.

Trial registration number

no
O-306 Genome-wide association meta-analysis supports the association between MUC1 and ectopic pregnancy
Authors: Pujol Gualdo N , Mägi R , Laisk T
Published: June 2023

Study question

Can we identify genetic variants associated with ectopic pregnancy by undertaking the first genome-wide association study leveraging two large-scale biobank initiatives?

Summary answer

We identified two novel genome-wide significant associations with ectopic pregnancy, highlighting MUC1 as the most plausible affected gene.

What is known already

Ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Despite being a common early pregnancy complication, the genetic predisposition to this condition remains understudied and no large scale genetic studies have been performed so far.

Study design, size, duration

A GWAS meta-analysis including 7,070 women with ectopic pregnancy and 248,810 controls from Estonian Biobank and the FinnGen study. Several post-GWAS analysis were conducted to characterise the genetic signals, as well as to analyse the genetic and phenotypic relationships with the condition.

Participants/materials, setting, methods

We identified ectopic pregnancy cases from national registers by ICD codes (ICD-10 O00), and all remaining women were considered controls.

Main results and the role of chance

We identified two genome-wide significant loci on chromosomes 1 (rs4971091, p = 5.32x10-9 ) and 10 (rs11598956, p = 2.41x10-8 ). Follow-up analyses propose MUC1, an epithelial glycoprotein with an important role in barrier function, as the most likely candidate for the association on chromosome 1. We also characterise the phenotypic and genetic correlations with other phenotypes, identifying a genetic correlation with smoking and diseases of the (genito)urinary and gastrointestinal system, and phenotypic correlations with various reproductive health diagnoses, reflecting the previously known epidemiological associations.

Limitations, reasons for caution

The main limitation is that the findings apply to European-based ancestry populations and we only captured maternal genomes.

Wider implications of the findings

This study encourages the use of large scale genetic datasets to unravel genetic factors linked to ectopic pregnancy, which is difficult to study in experimental settings. Increased sample size might bring additional genetic factors associating with ectopic pregnancy and inform its heritability.

Trial registration number

not applicable
P-040 The Role of ACE2 and DNA fragmentation index on covid-19 post infected, healthy and infertile men
Authors: Mohammed A
Published: June 2023

Study question

to investigate the relationship between ACE2 and DNA fragmentation index and their impact on men’s reproductive system in covid-19 post-infected patients.

Summary answer

the drastic effect of covid-19 on the male reproductive system might be due to elevated DFI and ACE2 levels.

What is known already

In the last two years, many studies had been devoted to uncovering the depraved impact of covid-19 by measuring ACE2 concentrations or sperm DNA fragmentation but no study was applied to measure both parameters, this study performed on both parameters to figure out the role of angiotensin-converting enzyme (ACE2) with seminal fluid parameters and DNA fragmentation index in covid-19 post infected men and infertile patient in comparison to healthy fertile men.

Study design, size, duration

This prospective cohort study was conducted from November 2021 to June 2022. one hundred and nine men who participated in this study.

Participants/materials, setting, methods

The participants were divided into four groups: post-infected men with Covid-19 who recovered from Covid-19 infection with a recovery interval of no more than three months from the time of symptoms onset and all were fertile married men, healthy fertile men who haven't been infected with Covid-19 in the last three months obtain normal seminal fluid parameters as control, The third group is composed of oligospermia, while the fourth group is constituted of azoospermia volunteers

Main results and the role of chance

In this study, the result showed that the seminal fluid parameters for post-infected men with covid-19; were demotion in sperm concentration, total count, motility, and morphology with a p-value < 0.001 when compared with healthy men. DNA fragmentation in post-infected men was 4 times higher than in non-infected and it was found that post-infected men had 10 times more ACE2 concentrations in comparison with healthy men. The study showed that in oligospermia and azoospermia volunteers own a high ACE2 level compared to healthy volunteers and that the oligospermia subjects have a significantly high sperm DNA fragmentation index.

In conclusion, the drastic effect of covid-19 on the male reproductive system might be due to elevated DNA fragmentation and ACE2 levels, and there is a statistically significant positive correlation between the DNA fragmentation index and ACE2 levels.

Limitations, reasons for caution

number of post-infected men with covid-19

Wider implications of the findings

1- A positive relationship exists between DNA fragmentation index percentage (DFI) and angiotensin-converting enzyme level (ACE 2).

2- Covid-19 infection alters sperm parameters such as concentrations, total sperm count, motility, and morphology.

3- The percentage of DNA fragmentation rose significantly after covid-19 infection.

Trial registration number

self funding
P-162 Numeric Embryo Quality Scoring Index (NEQsi) is Predictive of IVF Cycle Outcome at any Endometrial Thickness
Authors: Pierson H , Invik J , Meriano J , Cadesky K , Laskin C , Pierson R
Published: June 2023

Study question

Is it possible to use NEQsi to determine the statistical contributions of embryo quality and endometrial thickness (ET) to IVF cycle outcome?

Summary answer

Yes. Analytics revealed that the likelihood of pregnancy is reliably predicted by the quality of the embryo at any endometrial thickness.

What is known already

ET is widely utilized to assess the quality of endometrial preparation in IVF cycles. The connection between endometrial thickness and cycle outcome is divided in the literature; studies report correlation between ET and cycle outcome while others find no link between the two. Regardless, the statistical interactions between ET and embryo quality remain understudied. NEQsi was recently developed as a method for converting Gardner embryo grades to interval variables for use in statistical modeling. The combination of NEQsi scores and endometrial thickness measurements provides an opportunity to assess the contributions of embryo quality and ET on IVF cycle outcomes.

Study design, size, duration

We conducted a retrospective analysis including IVF cycles conducted at a Canadian multi-clinician fertility care centre (n = 1623). Data were acquired from a chart review of deidentified patient files from 2014 – 2021.

Participants/materials, setting, methods

Participants were all patients who underwent single embryo transfer and had endometrial thickness measurements, Gardner embryo grading, and ultrasound based endometrial receptivity testing (usER) as part of their care program. No interventions were made. Gardner embryo grades on file were created using EmbryoScope (Vitrolife, Göteborg Sweden) and converted to NEQsi scores. We conducted multivariate statistical modelling analysis to determine the combined contribution of embryo grade and endometrial thickness on IVF cycle outcome.

Main results and the role of chance

NEQsi scores ranged from 3 – 11 (mean 8.32 ± 1.78 SD). Endometrial thicknesses ranged from 3.1 mm to 20.2 mm (mean 9.69 ± 2.23 SD). A positive linear relationship was observed between NEQsi score and probability of pregnancy. Multivariate logistical regression determined that embryo grade was a highly significant predictor of cycle outcome (p < 0.0001). Endometrial thickness was not a statistically significant predictor of cycle outcome (p = 0.585).

Limitations, reasons for caution

We acknowledge that the single centre design is a limitation of this study. Future investigation with more cycles and multiple centres will strengthen the study and interpretation of the data.

Wider implications of the findings

The application of NEQsi was simple and this work confirms the utility of the NEQsi in conducting statistical analyses with embryo quality as a covariate. In addition, our findings imply that cancellation of embryo transfers based on ET measurements may not be warranted.

Trial registration number

Not applicable
P-230 Does laser-assisted hatching improve pregnancy rates : a retrospective analysis
Authors: Kanoi R , Ramakrishnan S , Mondal S , Gutgutia R
Published: June 2023

Study question

Is there any effect of laser-assisted zona drilling in improving pregnancy outcomes in women undergoing vitrified-warmed embryo transfers?

Summary answer

Our data suggests that there is evidence of possible improvement in pregnancy rates with laser-assisted hatching of embryos among women >40 years of age.

What is known already

Mammalian embryo is surrounded by a glycoprotein shell called zona pellucida. The embryo must hatch out of this shell for it to implant in the uterus. However, certain factors such as sub-optimal in vitro culture conditions, advanced maternal age, zona-hardening due to vitrification and warming, among others, negatively impact the ability of the embryo to escape from the matrix surrounding it. Laser-assisted hatching is the safest and easiest technique available to overcome the problem of hatching by artificially disrupting the zona, though there isn’t sufficient data available on whether this has any actual benefit or is just a fancy add-on.

Study design, size, duration

Retrospective cohort study comparing embryo transfer results of 88 women whose embryos underwent LAH prior to transfer with that of a control group of women. Data was collected from embryo transfers that took place between March 2021 to December 2022.

Participants/materials, setting, methods

Beta-hCG results of women (N = 88) whose embryos underwent LAH prior to transfer was compared with the results of transfer without LAH in women (N = 88) of similar age and clinical history. Patient age, clinical indications and embryo grades were comparable across both groups. LAH was performed immediately post-warming of blastocysts using a 1.48 µm diode to drill the zona at a point opposite the ICM. Data was analyzed using independent t test and chi square test.

Main results and the role of chance

Women from both test and control groups were further stratified into the following sub-groups based on age – A (25-29 years), B (30-34 years), C (35-39) and D ( >40 years). Beta-hCG results were assessed and was found to be lower in sub-groups A (57.1% vs. 78.5%) and B (46.4% vs. 67.7%) of the test group as compared to control. It was marginally higher in test group C as compared to that of control (50% vs. 47.3%). However, we found an increase in pregnancy outcomes of test sub-group D in comparison to control (83.3% vs. 20%).

Limitations, reasons for caution

This is a retrospective, preliminary study to assess initial results of effect of LAH on vitrified-warmed embryo transfer outcomes. A prospective study with a larger sample size is needed to confirm our results in both frozen and fresh embryos.

Wider implications of the findings

Our results indicate that laser-assisted hatching does not provide any advantage except possibly in older women above the age of 40 years. Thus we can select the exact group of patients who would benefit with this add-on and offer it to them routinely to improve their pregnancy rates.

Trial registration number

Not applicable
P-271 How much should you tolerate? The tolerance level of gas mixtures percentage in premixed gases
Authors: Seow Pei Yin E
Published: June 2023

Study question

Does the percentage of tolerance level of gas mixtures for premixed gas affect blastocyst formation rate?

Summary answer

A lower percentage of gas tolerance level can improve the blastocyst formation rate by providing a more optimal pH in the culture microenviroment.

What is known already

Benchtop incubators that use premixed gases are regarded as one of the most common incubators used in many IVF setups. The level of CO2 in the mixture has a direct impact on the media’s pH whereby an increase in the CO2 level will result in a lower pH and vice versa. Most media companies require a percentage of 6.0-6.5% to achieve an acceptable pH range of 7.2-7.4 for optimal culture microenvironment. However, it is often taken for granted that the CO2 and pH of the medium is within the acceptable range due to the “certificate” provided by these gas companies.

Study design, size, duration

This is a retrospective study looking at the average blastocyst formation rate from January 2018-December 2022 on 1665 cycles.

Participants/materials, setting, methods

The total MII collected and inseminated was 21,631. The mean women’s age was 37 ± 4.2 years old. All the embryos were cultured in the same laboratory conditions using BT 37 Planer (Origio) and K-Minc (Cook) incubators. From January 2018 to July 2020, all the patient’s embryos were cultured with premixed gas of 5% tolerance level (n = 940) and from Aug 2020-December 2022, all of the embryos were cultured with premixed gas of 2% tolerance level (n = 725).

Main results and the role of chance

It was found that the average blastocyst rate was significantly increased when the gas tolerance level was 2% (57.09%) when compared to when the gas tolerance level was 5% (52.11%) (p < 0.05).

Limitations, reasons for caution

Different gas companies may use different methods of measuring the gas percentage levels. Therefore, it is advisable to be cautious and impose internal QC on the gas mixture percentage on individual cylinders.

Wider implications of the findings

A lower gas tolerance level may provide a more optimal accuracy of gas percentage to achieve the desired pH for embryo culture and to improve IVF outcomes.

Trial registration number

not applicable
P-313 Dysregulation of endometrial stromal serotonin homeostasis impairs decidualization in patients with recurrent implantation failure via phosphatidylcholine metabolism
Authors: Sheng X , Tian J , Yan G , Sun H
Published: June 2023

Study question

Does abnormal serotonin homeostasis contribute to impaired endometrial decidualization in patients with recurrent implantation failure (RIF)?

Summary answer

Abnormal serotonin homeostasis in patients with RIF, which is accompanied by decreased expression of monoamine oxidase (MAO), affects decidualization of endometrial stromal cells.

What is known already

Previous studies have found that the expression of MAO, which metabolizes serotonin, is reduced in the endometrium of patients with RIF, and serotonin can induce disruption of implantation in rats. However, whether abnormal serotonin homeostasis leads to impaired decidualization in patients with RIF and the mechanism remains unclear.

Study design, size, duration

Endometrial samples from 31 patients with RIF and 31 fertile patients were used to investigate the expression levels of MAOA, MAOB, and serotonin. We isolated human endometrial stromal cells to investigate the role of MAOA, MAOB and serotonin in inducing decidualization in vitro and further explored the mechanism using RNA-seq and LC/MS analyses.

Participants/materials, setting, methods

The levels of serotonin in the endometrium of patients with RIF were detected by ELISA and immunohistofluorescence, and the key genes of abnormal serotonin metabolism were analyzed combined with single-cell sequencing data. The effects of MAO on the decidualization of stromal cells were investigated using human endometrial stromal cells in vitro induced decidualization model and mouse artificially induced decidualization model. The potential mechanisms of MAO regulating decidualization were explored by RNA-seq and LC/MS analysis.

Main results and the role of chance

We found that women with RIF have abnormal serotonin metabolism in the endometrium and attenuated MAO in endometrial stromal cells. Endometrial decidualization was accompanied by increased MAO in vivo and in vitro. Attenuated MAO caused increased local serotonin content in the endometrium, impairing stromal cell decidualization. RNA-seq and LC/MS analyses showed that abnormal lipid metabolism, especially phosphatidylcholine metabolism, was involved in MAO-deficiency induced defective decidualization. Furthermore, decidualization defects were rescued by phosphatidylcholine supplementation.

Limitations, reasons for caution

This study found that impaired serotonin metabolic homeostasis and abnormally reduced MAO expression were one of the reasons for repeated implantation failure. However, the source and other potential function of serotonin in the endometrium remain to be further explored.

Wider implications of the findings

This study shows new insights into the mechanisms of serotonin homeostasis in human endometrial decidualization and provides new biomarkers or targets for the treatment of patients with RIF.

Trial registration number

not applicable
P-314 PlasmaShotting: a new method of treating “thin” endometrium
Authors: Kazantsev V , Feoktistov A
Published: June 2023

Study question

Is a new method of subendometrial platelet-rich plasma (PRP) injection (PlasmaShotting) effective in patients with “thin” endometrium?

Summary answer

PlasmaShotting showed higher efficiency in the group of patients with “thin” endometrium compared to conventional intrauterine infusion of platelet-rich plasma

What is known already

The problem of “thin” endometrium is one of the urgent challenges of modern reproductive medicine. In patients suffering from this condition, there is a decrease in the pregnancy rate and an increase in miscarriage rates.

“Thin” endometrium is less than 7 mm according to ultrasound. To correct this condition, many methods have been proposed: hormone replacement therapy with high doses of estrogens, aspirin, GnRH agonists, vitamin E, pentoxifylline, sildenafil, intrauterine infusion of colony-stimulating factors (G-CSF) and PRP, but none of the proposed methods has shown enough effectiveness.

Study design, size, duration

To evaluate the effectiveness of PlasmaShotting we organized a study that included 72 people. Inclusion criteria were age less than 40 years, endometrial thickness less than 6.5 mm on days 8-10 of hormone replacement therapy, and 3 or more unsuccessful embryo transfers of excellent quality embryos before.

Participants/materials, setting, methods

The patients were divided into 2 groups:

Group 1 (23 patients) underwent hysteroscopy with submucosal injections of platelet-rich plasma (PRP - PlasmaShotting) on days 10-12 of the cycle.

Group 2 (49 patients) underwent intrauterine infusion of platelet-rich plasma (PRP) on days 10-12 of the cycle

Main results and the role of chance

The clinical pregnancy rate in group 1 was 47.8% (n = 11), and in group 2 was 34.6% (n = 17).

The live births rate in group 1 was 34.7% (n = 8), and in group 2 was 20.4% (n = 10).

The miscarriage rate was in group 1 was 13.1% (n = 3), and in group 2 was 14.2% (n = 7)

Limitations, reasons for caution

The research on the effectiveness of PlasmaShotting should be continued

Wider implications of the findings

PlasmaShotting as a new method of treating “thin” endometrium can be used in patients who can't achieve pregnancy

Trial registration number

not applicable
P-327 Intrauterine fluid in patients with cesarean section defects in association with ivf outcomes
Authors: Le Duc T , Le H , Nguyen P H , Tham C D , Nguyen T L H
Published: June 2023

Study question

This study evaluate the effect of cesarean section scar defects associated with intrauterine fluid during endometrial preparation on pregnancy outcomes.

Summary answer

Patients with Cesarean section scar defect and intrauterine fluid during endometrial preparation had a substantially lower pregnancy outcome compared to those without uterine fluid.

What is known already

The Cesarean section rate in developed countries has increased continuously, leaving many short-term and long-term consequences. Intrauterine fluid, which reported incidence may reach 40% in patients who have had a previous caesarean section, may play an important role in reducing endometrial receptivity and further impair pregnancy outcomes.

Study design, size, duration

This is a retrospective cohort study performed on patients who had undergone frozen embryo transfer at an Assisted Reproductive Technology Center from January 2019 to December 2019.

Participants/materials, setting, methods

2,350 patients without intrauterine fluid and 74 patients with Cesarean section scar defect who had intrauterine fluid during endometrial preparation but none at progesterone supplementation were analyzed. Multiple logistic regression was performed for the probability of the pregnancy outcome of embryo transfer and measured the association with the status of intrauterine fluid, age, endometrial thickness, number of previous transfer, number of embryos, type of infertility, and difficult embryo transfer at the alpha level of 0.05%.

Main results and the role of chance

The outcomes among 2,424 patients undergoing cryopreserved embryo transfer were 59.45% for pregnancy rate, 8.7% for biochemical pregnancy rate, 50.33% for clinical pregnancy rate, and 43.15% for ongoing pregnancy rate. The analysis of multiple logistic regression indicated that the presence of intrauterine fluid during endometrial preparation did not affect the pregnancy rate. However, in patients with intrauterine fluid, there was an increased rate of biochemical pregnancy (OR 2.46, 95%CI 1.35-4.50) and a reduced rate of ongoing pregnancy (OR 0.54, 95%CI 0.32-0.89).

Limitations, reasons for caution

The major limitations of the present study are the retrospective design and small number of patients with uterine fluid. Additionally, the composition of the uterine fluid (eg, blood, mucus, purulent, or transparent) cannot be classified by an ultrasound exam.

Wider implications of the findings

Intrauterine fluid may be an innovative and controllable factor that should be considered in patients who have a history of caesarean section in order to improve pregnancy outcomes.

Trial registration number

Not Applicable