bluuebunny/crossref_metadata_2025 huggingface dataset:
#210 : The Comparison of Agonist Trigger and Dual Trigger in Our IVF Population - A Single Center Retrospective Study
Authors: Pandey Seema , Vaishnav Pratik , Yadav Akhileshwar
Published: January 2024

Background: For years, human chorionic gonadotropin (hCG) has been the trigger of choice for oocyte maturation due to its molecular and biological similarity with LH, but its longer half-life compared to LH contributes to the ovarian hyperstimulation syndrome (OHSS) in hyper responders. Besides, hCG lacks FSH activity, which plays a role in the in vitro maturation of oocytes.

Gonadotropin-releasing hormone (GnRH) agonists which can bring endogenous release of both FSH and LH and have a shorter mean duration of LH surge, and effectively reduce the incidence of OHSS in high responders. However, the substitution of agonist as trigger is associated with the risk of empty follicle syndrome, increased early pregnancy loss and decreased rates of ongoing pregnancy. The idea of a dual trigger where hCG component could serve as a rescue in case of poor response to GnRH-agonist, occurring in about 2.71% of ART population, and agonist bringing FSH & LH surge simultaneously leading to improved oocyte quality was the basis for present study.

Aim & objective:

To observe the difference between agonist trigger and dual trigger in various ovarian reserve groups.

Materials & Methods:

Retrospective cohort study in patients attending Eva fertility clinic & IVF center between 2021-2022.

Total patients =157

agonist trigger =57

dual trigger = 100

Age: 24 years to 41 years

Average BMI 26

AMH :2.0 ng-6.6 ng/ml

Primary outcome:

Clinical pregnancy rate & ongoing pregnancy rate

Secondary outcome:

Blastocyst formation rate

Total M2 achieved.

Result: Pregnancy’ in (AMH: <2 ng/mL)- no significant difference between the various groups in terms of distribution of Pregnancy ([Formula: see text]2= 0.209, p = 1.000). (Table 1)

Pregnancy’ in (AMH: 2-5 ng/mL)- no significant difference ([Formula: see text]2= 0.023, p = 0.880). (Table 2)

Pregnancy’ in (AMH: >5 ng/mL)- no significant difference ([Formula: see text]2= 0.286, p = 0.711). (Table 3)

Limitation of the study- small sample size, lack of plain hCG trigger group to compare as an arm 3.

Conclusion: Dual trigger treatment with GnRH agonist and hCG is not inferior in terms of live birth rate, blastocyst, & M2 oocytes compared to GnRH agonist & hCG trigger apart from avoiding the danger of OHSS.
#212 : Does Hyaluronic Acid-Containing Transfer Media Improve the Live Birth Rate in Frozen Embryo Transfer Cycles?
Authors: Chandra Vipin , Aggrawal Ritesh , Shah Naval
Published: January 2024

Background and Aims: The glue is typically composed of hyaluronan, a natural substance found in the female reproductive tract, and other nutrients that help to support the embryo. The glue is believed to improve the chances of successful implantation by helping the embryo adhere to the uterine lining and promoting communication between the embryo and the uterine environment. The effectiveness of embryo glue is still being studied, and limited evidence on its benefits is available. The objective of our study is to find the effect of hyaluronidase containing transfer media (Embryo Glue) on ART outcomes.

Method: This retrospective study is based on central hospital recorded data between January 2015 and January 2022. The females aged 20-40 years and Body mass index (BMI) of 18.0 to 35 kg/m2 were included.

Results: Univariate logistic regression showed that the duration of progesterone administration on (6-Days vs 7-days (OR 1.693; (1.045-2.740); P = 0.032), endometrial thickness on the day of P start (OR 1.167; (1.056-1.290); P = 0.002), Embryo Glue (ref. Standard treatment) (OR 1.700; 95% (1.364-2.118); P<0.001) were independent factors for predicting live birth. Multivariate logistic regression analysis showed that female age (OR 0.927; (0.893-0.963) P < 0.001), Number of blastocysts transferred (DET), (ref. SET) (OR 1.618; (1.086-2.410); P = 0.018), Endometrial thickness at the day of P start (OR 1.147; (1.014-1.298); P = 0.029) and Embryo Glue (ref. Standard treatment) (OR 1.593; (1.170-2.168); P = 0.003) were independent factors for predicting live birth.

Conclusion: Embryo glue has shown significant outcomes in the present study and effectively improves IVF success and implantation rates. However, the decision to use embryo glue should be made on a case-by-case basis in consultation with a fertility specialist, and it may not be necessary or beneficial for all IVF procedures.
#244 : Reproductive Outcomes of Conventional In Vitro Fertilization and Intracytoplasmic Sperm Injection in Patients with Non-Severe Male Infertility Across Poor and Different Suboptimal Ovarian Response Categories
Authors: Yang Rui , Jiesisibieke Dina , Tian Tian , Li Rong , Liu Ping , Qiao Jie
Published: January 2024

Background and Aims: For non-severe male factor infertility patients with poor and sub-optimal ovarian response, are there any differences in reproduction outcomes between IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) methods?

Methods: Retrospective cohort study. Patients with non-severe male infertility and poor ovarian response who underwent in vitro fertilization or intracytoplasmic sperm injection at the Center for Reproductive Medicine, Peking University Third Hospital between 2009 and 2019 were included in this study (n = 30,352).

Results: In all groups, intracytoplasmic sperm injection cycles involved older patients and a longer duration of infertility, while body mass index, AMH, and bFSH levels were similar. Independent of the number of oocytes retrieved, intracytoplasmic sperm injection significantly increased the fertilization rate, while in vitro fertilization cycles showed a higher implantation rate, clinical pregnancy rate, and live birth rate. No differences were observed in most obstetric outcomes, including abortion, early abortion, multiple fetus, cesarean delivery, gestational age, and congenital malformations rates. However, in vitro fertilization cycles showed higher preterm delivery rates and lower birth weights in groups with 4-6, and 7-9 oocytes retrieved. A higher female/male infant ratio was observed in intracytoplasmic sperm injection cycles when 4-6 oocytes were retrieved.

Conclusions: In patients with non-severe male infertility and poor or suboptimal ovarian response, even if intracytoplasmic sperm injection increased the fertilization rate, in vitro fertilization exhibited significant advantages in implantation, clinical pregnancy, and live birth rates. Our study indicates that poor ovarian response is not an indication for intracytoplasmic sperm injection in couples with non-severe male infertility.
#262 : Clinical Outcomes of Embryo Transfer After micro-RNA Based Endometrial Receptivity Analysis (MIRA)
Authors: Hayashi Nao , Enatsu Noritoshi , Okamoto Eri , Kokeguchi Shoji , Shiotani Masahide , Yang Eric Pok , Hsu An , Hong Jun Jie , Wang Tiffany
Published: January 2024

Background and Aims: To date, more than 2,500 micro-RNAs (miRNAs) have been discovered and some of which are considered to play important roles in window of implantation (WOI). In this study, we aimed to evaluate the efficacy of a miRNA-based endometrial receptivity analysis (MIRA) in IVF patients.

Method: Patients who were planning for frozen-thawed embryo transfer (ET) cycles with a good quality single-blastocyst after at least 1 previous implantation failure history were recruited for the study. Endometrial tissue samples were collected at the mock ET cycle of hormone replacement therapy on day 5 (120 hours) of progesterone administration. Embryo transfer was conducted at the consecutive or the next cycle by reference to the MIRA result.

Results: 38 patient samples were collected along with their clinical information such as age, BMI, and implantation failure history.

Out of the 38 samples analyzed, MIRA found 84.2% (32/38) to be receptive, 13.2% (5/38) to be pre-receptive, and 2.6% (1/38) to be post-receptive.

A total of 33 patients underwent personalized-ET at the time of statistical analysis. The overall clinical pregnancy rate was 81.8% (27/33), and for each endometrial stages were 81.5% (22/27) for receptive, 80.0% (4/5) for pre-receptive, and 100% (1/1) for post-receptive.

Higher rates of non-receptivity were seen in patients with higher BMI and patients who were 36 years old or older.

Conclusion: Patients who utilized MIRA, have shown good pregnancy rates of 81.8%. Patients with an abnormal BMI have a higher likelihood of experiencing a displaced window of implantation. BMI could also be an additional factor to consider when recommending patients to undergo endometrial receptivity testing in the future, aside from implantation failure history.
#263 : Follitropin Delta for Controlled Ovarian Stimulation: Evaluating Dose Equivalence Approach
Authors: Alibasya Aerul Chakra , Hasmoro Tribowo , Yudha Christianti F. , Nurfadhilah Athiyya , Angella Gita
Published: January 2024

Background and Aims: The use of Follitropin Delta (FD) according to ESTHER-1 study algorithm for controlled ovarian stimulation (COS) protocol yielded less sufficient ovarian response in our previous experience. On the other hand, phase II and III FD clinical dose-response trials have provided dose equivalence concept between FD and Follitropin Alpha (FA) in which 10 mcg of FD was equivalent to 150 IU of FA.[Formula: see text] This study, therefore, aimed to explore an alternative approach to dose individualization of FD according to dose equivalence with FA.

Methods: This was a prospective observational study. Inclusion criteria were patients who underwent IVF with FD for COS. Starting dose of each patient was prescribed according to the investigator’s experience using conventional FA dose (IU) which was then converted to FD dose (mcg) based on dose equivalence data.

Results: A total of 108 women were recruited in this study. 80% of the participants were good prognosis patients. The median daily dose and total dose of FD were 15 mcg and 162 mcg, respectively (Table 1).

This study observed favorable laboratory outcomes including number of retrieved oocytes, mature oocytes, fertilization rate, number and top-quality embryos at either the cleavage or blastocyst stage. In addition, 75% of the subjects acquired a surplus of frozen embryos which could be transferred in the next cycle (Table 2).

Remarkable clinical outcomes were noted as follows: biochemical pregnancy of 74.2%, clinical pregnancy of 67.7%, and lowincidence of ovarian hyperstimulation syndrome (OHSS) of 3.7% (Table 3).

Conclusion: Dose equivalence approach of FD to FA during COS results in favorable IVF outcomes in relation to both the embryology laboratory and clinical outcomes. This result supports the establishment of dose equivalence concept between FD and FA for routine clinical practice of IVF.
#282 : Maximizing IVF Success Rates: Optimized Simulation Using a Novel Decision-Support Tool
Authors: Patel Nayana , Diwekar Urmila , Patel Niket , Patel Molina , Bhadarka Harsha , Ghoghari Paresh , Vyas Kairavi
Published: January 2024

Background and Aims: A mathematical procedure and a decision support tool, Opt-IVF, were developed to overcome the shortcomings of the current IVF practice of dosage profile determination by trial and error, which can provide a personalized model and optimized drug treatment. This paper describes the decision support tool for improving outcomes of IVF treatment for both antagonist and agonist protocols used in real practice. We present the results of two clinical trials.

Method: Our earlier work developed models for agonist and antagonist protocols based on an analogy between superovulation and batch crystallization. This model was customized for each patient using two days of follicular data, and the optimal control method was applied to optimize the dosage profile. Validation of the model was conducted with retrospective data from 150 patients from India and 50 from the United States. Opt-IVF reduced total hormone dosage by 20 to 60%, reduced US testing by 50 to 75%, and provided a higher number of oocytes and high-quality embryos.

Results: The primary outcome measures studied for two clinical trials with Opt-IVF include total hormonal dosage, % follicles retrieved, MII oocytes, Embryos, and Grade A Embryos. Results showed that Opt-IVF reduces drug dosage and testing and increases the number of embryos, Grade A embryos, and high-quality blastocysts significantly. Subgroup analysis showed improvements in outcomes were more significant for both Poor-responder and PCOS patients than for normal responders. Pregnancy rates were significantly higher with Opt-IVF patients than with standard protocol control patients.

Conclusions: A mathematics-based approach to dosage profile determination results in optimal mature follicles, better embryos, and higher pregnancy with reduced dosage and the need for testing.
#287 : A Comparison of hCG Trigger Versus Dual Trigger for Final Oocyte Maturation in Poor Ovarian Responders Undergoing Minimal Stimulation
Authors: Ho Sy Hung , Nguyen Viet Quang , Duong Hoang Long , Hoang Thi Thanh Thuy , Tran Danh Cuong
Published: January 2024

Background and Aims: Traditionally, hCG has been used for oocyte triggering. However, women with poor ovarian response manifest low oocyte yield and compromised occyte quality. More recently, a combination of hCG and GnRHa (dual trigger) has been shown to improve follcile collection yield and oocyte maturation. The aim of the study is tocompare the result of final oocyte maturation and the embryo formation between two groups of poor ovarian responders undergoing minimal stimulation after triggering by hCG alone versus dual trigger.

Method: This randomized control trial was conducted at National Assisted Reproductive Center, National Hospital of Obstetrics and Gynecology. Patients defined as poor ovarian responders according to the Bologna criteria were equally divided into two groups: control (hCG trigger) and investigation (dual trigger) groups. The group received the hCG trigger (6500 IU) and the investigation group received the dual trigger (0.2 mg of Triptorelin plus 6500 IU of hCG). Minimal stimulation IVF protocols consist of 5 days of 100mg clomiphene citrate and small amounts of gonadotropin.

Results: One hundred and two patients were included in the study, with 51 women in each treatment group. Dual triggering showed a significant higher number of retrieved oocytes (5.35 ± 3.13 vs 4.35 ± 2.44, P=0.038) and metaphase II oocytes (4.25 ± 3.12 vs 3.35 ± 2.02, P=0.043). Although not reaching statistical significances, increases in the number of fertilized oocytes, embryos, and number of top-quality embryos (TQE) were observed.

Conclusion: Dual trigger for final oocyte maturation is associated with better IVF outcome in poor ovarian responders undergoing minimal stimulation.

Acknowledgements: The authors are grateful to all physicians, administrative staff at the National Assisted Reproductive Technology Center, National Hospital of Obstetrics and Gynecology, Vietnam for allowing and supporting us to undertake this research.
#304 : Comparing GnRH Agonist and GnRH Antagonist Protocols for IVF-ET Outcomes in Patients with Endometriosis: A Meta-Analysis
Authors: Paik Haerin , Hong Yeon Hee , Kim Seul Ki , Lee Jung Ryeol
Published: January 2024

Background and Aims: Endometriosis is known to have detrimental effects on fertility, but there is no consensus on the optimal stimulation protocol for IVF-ET in patients with endometriosis. The study aimed to compare the IVF outcomes of gonadotropin-releasing hormone (GnRH) agonist protocols versus antagonist protocols in patients diagnosed with endometriosis.

Method: We performed a meta-analysis of studies that compared IVF outcomes of GnRH agonist versus antagonist protocols in patients with endometriosis. Through literature search, we retrieved 222 articles, and the last search date was April 7, 2023. Among them, six studies which met inclusion criteria were eligible for final analysis. The primary outcome was clinical pregnancy. Random effects and fixed effects models were applied according to I2 statistics.

Results: The use of GnRH agonist was associated with higher clinical pregnancy rate (Odds ratio (OR) 1.61, 95% CI 1.35–1.93, 6 studies, [Formula: see text]<0.00001, I2=16%), higher live birth rate (OR 1.75, 95% CI 1.32–2.33, 3 studies, [Formula: see text]<0.0001, I2=12%), and similar miscarriage rate. The total dose of gonadotropin did not differ between the two methods, but the GnRH agonist protocol had a longer duration of stimulation (WMD 1.34, 95% CI 0.44–2.24, 5 studies, I2=98%), retrieved more oocytes (WMD 2.23, 95% CI 0.58–3.88, 3 studies, [Formula: see text]=0.0008, I2=97%), more MII oocytes (WMD 2.81, 95% CI 2.34–3.28, 3 studies, [Formula: see text]<0.00001, I2=0), and more embryos (WMD 1.90, 95%CI 1.13–2.67, 3 studies, [Formula: see text]<0.00001, I2=68%).

Conclusion: Patients with endometriosis may benefit from using GnRH agonist protocol in the IVF-ET cycle, as it may be associated with a higher clinical pregnancy rate and live birth rate. Even though the stimulation duration is longer, more oocytes, mature oocytes, and embryos may be expected. Although the findings of this study may be potentially beneficial for clinicians, it is crucial to conduct additional randomized prospective trials with larger cohorts to further validate the results.
#314 : Comparison of Dual-Trigger and Human Chorionic Gonadotropin-Only Trigger Among Diminished Ovarian Reserve Who Underwent Intracytoplasmic Sperm Injection: A Retrospective Cohort Study
Authors: Nguyen Thanh H N T
Published: January 2024

Background and Aims: Diminished ovarian reserve (DOR) remains one of the greatest challenges for ART treatment. The objective of this study was to compare the laboratory outcomes of dual trigger and human chorionic gonadotropin (HCG) trigger alone in the final oocyte maturation for DOR patients.

Methods: In this retrospective study,we evaluated 130 DOR women (dual group, n=75 and HCG group, n=45) underwent intracytoplasmic sperm injection (ICSI) between July 2020 and February 2023 at the Assisted Reproductive Department, Hung Vuong Hospital. DOR was defined as antral follicle count [Formula: see text]5 and serum anti-Müllerian hormone level [Formula: see text]1.2ng/mL.

All patients using the GnRH antagonist protocolwith frozen embryo transfer. Baseline characteristics and cycle parameters, as well as IVF outcomes of both groups were compared. Generalized linear model (GLM) with negative binomial distribution for retrieved oocytes outcome and binomial distribution for other outcomes such as maturation rate, fertilization rate, rate of successfully achieving blastocytes and day-3 embryos.

Results: Baseline characteristics were similar between the dual trigger group and the HCG group for age (p=0.2), AFC (p=0.44), AMH (p=0.76), BMI (p = 0.12), indication and number of priorARTcycles. The dual-trigger group had a significantly higher number of retrieved oocytes (95% CI 0.125–2.437, p=0.03), metaphase oocyterate (OR = 1.90, 95% CI 1.05–3.43; p=0.033). Fertilized oocyte rate (OR 1.42, 95% CI 2.015–0.795, p=0.967) andday-3 embryos (OR = 1.42, 95% CI 2.70–.73, p=0.294) were comparable in two groups.

Conclusions: Our data suggests that dual trigger for final oocyte maturation might improve laboratory outcomes of IVF cycles in DOR patients.
#315 : Determination of Clinical Pregnancy and Live Birth Rates in Autologous Cycles for Women Between 40 and 46 Years Old
Authors: Owens Lucy , Ekanayake Tegan , Green Mark , Zander-Fox Deirdre , Vollenhoven Beverley
Published: January 2024

Background and Aims: It is well-documented that fertility rates decline with maternal age, however there is limited information on the success rates for women between 40 to 50 years old using their own eggs. Many ART providers set differing maternal age limits for accessing treatment, with minimal clinical evidence to support these limits being set. The aim of this study was to identify clinical and live birth rates for women aged 40 to 46 at egg pick-up (EPU), who used autologous oocytes and ET (with or without pre-implantation genetic testing (PGT)).

Method: A retrospective cohort study was performed on 7,521 autologous EPU cycles undertaken between 2015 and 2020 for women between 40 and 46 years old at clinics in Victoria, Australia. Maternal age was determined by age at the time of EPU. Clinical pregnancy rate (CPR) and live birth rate (LBR) outcomes were calculated following the transfer of a single fresh or frozen blastocyst stage embryo. Outcomes were also determined for PGT-tested compared with non-PGT-tested frozen embryo transfer (FET) cycles based on maternal age at time of embryo creation and analysed at each age by Fisher’s exact test.

Results: CPR and LBR declined with increasing maternal age for both fresh and frozen single blastocyst ETs (Tables 1 and 2), with no live births for women who had eggs collected at 46 years old. Equally, outcomes were lower for fresh compared with frozen ET cycles (P<0.0001). In FET cycles, while LBR declined with age for non-PGT cycles, LBR remained steady and was higher between age 40 and 45 years than when a PGT-tested embryo was transferred (P<0.02).

Conclusion: Increasing maternal age at EPU was negatively associated with clinical outcomes, especially after the age of 43 years. Transfer of a PGT-tested embryo did however maintain a high LBR irrespective of maternal age.
#336 : Improving Success of Intrauterine Insemination
Authors: Porag Mafruha Khanam
Published: January 2024

Background and Aims: IUI is one of the most used methods to treat various forms of infertility. The aims were to compare the success rate of IUI with that of timed intercourse, review the methods used to time the IUI with ovulation, identify the factors to determine IUI outcome, compare the success rate of double IUI vs single IUI.

Method: This is a cross-sectional prospective study conducted at a Private Fertility Centre, Chattogram, Bangladesh over a period of 40 months from 996 patients who underwent IUI. Variables such as age of women, cause of infertility, drugs used for COH, number of mature follicles, endometrial thickness post wash sperm count, type of IUI (single IUI and double IUI) were recorded and statistically analyzed.

Results: The age for females and males were 18-41 and 23-52 respectively. The mean endometrial thickness was 8.9 mm ± 0.2 mm. Pregnancy rate for total motile sperm count less than 10 million was 7.2%. The successful conception rate for females were the age 28 was 9.6% compared to the whole group at 12%. Among 996 patients, 109 patients (10.94%) had successful conception. 209 patients (20.98%) underwent double IUI out of which 40 patients (19.14%) had a successful conception while 787 patients (79.01%) underwent single IUI out of which 69 patients (8.76%) had successful conception.

Conclusion: IUI is currently a successful treatment modality for infertility especially as invasive treatment for couples with unexplained infertility, male factor infertility, anovulation, female less than 30 years of age. The numbers of motile sperms, appropriate endometrial thickness, have a remarkable impact on the outcome of IUI. Double IUI increases the success rate significantly.

Acknowledgment: The authors are grateful to all who participated in the preparation of this manuscript.
#344 : Intrauterine Platelet-Rich Plasma and Peripheral Blood Mononuclear Cells Doubles Clinical Pregnancy Rate in Recurrent Implantation Failure: Efficacies Obscured by Non-Randomized Controlled Trials - Two Meta-Analyses
Authors: Chow Ezri , Chow Tony K. F.
Published: January 2024

Background and Aims: Recurrent implantation failure (RIF) is a frustrating problem confronting prospective mothers following embryo transfer. Two promising intrauterine immunotherapies, plasma-rich plasma (PRP) and peripheral blood mononuclear cells (PBMC) infusions, have been investigated with mixed results, leaving experts querying if these are “add-on treatments getting out of hand?”. The current meta-analyses aim to identify the source of the conflicting evidence and determine the true efficacy of IU-PRP and IU-PBMC.

Method: A systematic search was conducted on April 30, 2023, using OVID Medline and Embase. Eligible articles pertaining to the efficacy of IU-PRP and IU-PBMC upon clinical pregnancy in fertility research were retrieved. Risk ratios and confidence intervals were calculated via the random effects model (Cochrane Review Manager).

Results: IU-PRP

Pooled data: 26 studies, 3016 participants, RR=1.64(1.41-1.90), X2=0.009, I2=44%, showing significant heterogeneity.

RCTs: 15 studies, 1557 participants with RR=2.02(1.71-2.39), X2p=0.43, I2=2%.

Non-RCTs: 11 studies, 1459 participants with RR=1.34(1.19-1.52), X2p=0.39, I2=5%.

Subgroup analysis: homogenous effect sizes with non-overlapping 95%CI, X2p=0.0001, I2=93.4%. (Figure 1)

IU-PBMC

RCTs: 6 studies, 652 participants, RR=2.17(1.71-2.74), X2p=0.92, I2=0%.

Non-RCTs: 6 studies, 866 participants, RR=1.43(1.20-1.70), X2p=0.69, I2=0%.

Subgroup analysis: homogenous effect sizes with non-overlapping 95%CI, X2p=0.005, I2=87.4%. (Figure 2)

Conclusion:

Non-RCTs provide savings in cost and time that can lead to early awareness of innovative therapies. This may be counterproductive in RIF research due to flawed non-randomized controls: retrospective cohorts, women refusing consent to therapy, women without RIF or having first IVF attempt. Intervention groups therefore may have a higher baseline risk of failure, resulting in apples-to-oranges comparisons that obscure the actual efficacy. Randomization is fundamental in reducing patient selection bias and the RCTs in these analyses demonstrated that IU-PRP and IU-PBMC doubles the clinical pregnancy rate in RIF patients. A debate into the role of non-RCTs in RIF research is essential to avoid a potential systemic problem.
#387 : Enlightening the Management of Chocolate Cysts Before IVF Treatment: Case Reports of 3 Young Endometriosis-Associated Ovarian Cancer Patients with Ovulation Induction History
Authors: Zhao Yiwei , Zhu Jie , Ye Taiyang , Zhao Aimin
Published: January 2024

Background and Aims: Endometriosis is a common estrogen-dependent disease that occurs mostly in women of childbearing age and is characterized by ectopic growth of endometrial glands and stroma. Endometriosis may present as malignant transformation and the two most common malignancies in this situation are ovarian clear cell carcinoma and endometrioid adenocarcinoma. Rare cases of endometriosis-associated ovarian cancer (EAOC) after in-vitro fertilization (IVF) treatment were reported before, and the relationship between the usage of ovulation induction medications and the development of ovarian cancer is controversial. This study aims to summarize the characteristics of EAOC patients with IVF treatment history.

Method: All history, clinical data, imaging data, operative documents, and follow-up of 3 cases of endometriosis-associated ovarian cancer with IVF treatment history were reviewed, among the 793 patients undergoing surgeries for ovarian malignancy at the Gynecology Department, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, from 2019 to 2022.

Results: 3 EAOC patients under the age of 40 who had undergone controlled ovarian hyperstimulation (COH) for IVF treatment were identified in the cases review. The 3 infertility women underwent 3, 4, and 6 cycles of ovulation induction and achieved 1, 0, and 1 time of pregnancy, respectively. Unfortunately, none of them reached a pregnancy outcome over 12 weeks. After staging surgery, the 3 patients were diagnosed with Stage IA clear cell carcinoma, Stage IIB clear cell carcinoma, and Stage IIB adenosquamous carcinoma, respectively. The latter two patients had undergone two times of needle aspiration and sclerosis for chocolate cysts, and the surgical records also showed more severe abdominal adhesion and poor prognosis.

Conclusion: Patients with endometriosis cysts need to be very careful when seeking IVF treatment, especially in the order of treatment of cysts and ovulation induction. Repeated needle aspiration and sclerosis for ovarian cysts are not recommended.
#35 : Tail-First Sperm Injection Significantly Improved the Fertilization Rates More Than the Head-First Sperm Injection Regardless of the Elasticity of the Oocyte Membrane Following Piezo-ICSI
Authors: Hiraoka Kenichiro , Uchida Nozomi , Nakajo Hayata , Sato Moe , Ishikawa Saki , Sujino Toshio , Komiya Akira , Takayanagi Yuko , Nako Yurie , Tajima Makiko , Kawai Kiyotaka
Published: January 2024

Background and Aims: Little information is available for investigating the effect of the direction of sperm injected into the cytoplasm on clinical results for human oocytes following intracytoplasmic sperm injection (ICSI). This study aimed to examine the impact of the direction of sperm (head-first or tail-first) injected into the cytoplasm on fertilization and embryo development for high-elasticity or low-elasticity human oocytes following the Piezo-ICSI.

Methods: We retrospectively investigated 2717 high-elasticity oocytes and 907 low-elasticity oocytes between May 2016 and December 2022. Of 2717 high-elasticity oocytes, 1148 were injected sperm head-first, and 1569 were injected sperm tail-first into the cytoplasm by Piezo-ICSI. Of 907 low-elasticity oocytes, 480 were injected head-first, and 427 were injected sperm tail-first into the cytoplasm. The membrane of high-elasticity oocytes was robust and was ruptured artificially by the piezo-pulse. The membrane of low-elasticity oocytes was weak and spontaneously ruptured without the piezo-pulse. The rates of degeneration, fertilization (2PN), 0PN, 1PN, [Formula: see text]3PN, abnormal cleavage, and good-quality day-3 embryos were evaluated in both groups.

Results: Table 1 shows the effect of sperm direction on fertilization and embryo development for high-elasticity oocytes. The fertilization rate of tail-first group was significantly higher than the head-first group. The 0PN rate of tail-first group was significantly lower than the head-first group. The good quality Day-3 embryo rate of tail-first group was significantly higher than the head-first group.

Table 2 shows the effect of sperm direction on fertilization and embryo development for low-elasticity oocytes. The fertilization rate of the tail-first group was significantly higher than the head-first group. However, no significant difference was observed in other comparable items.

Conclusions: Tail-first sperm injection significantly improved the fertilization rates more than the head-first sperm injection regardless of the elasticity of the oocyte membrane following Piezo-ICSI.
#55 : Ooplasm Diameter as a Predictor for Pre-Implantation Development in Intracytoplasmic Sperm Injection Cycles
Authors: Mendiola Rudie Frederick , Ong-Jao Ednalyn , Perillo Gayla , Francisco Fides Marie
Published: January 2024

Background and Aims: The use of noninvasive measures such as ooplasm diameter (OD) for oocyte evaluation to predict the results of intracytoplasmic sperm injection (ICSI) is of great clinical importance. In this study, we determine whether OD is a significant predictor for pre-implantation development in intracytoplasmic sperm injection cycles in order to select good quality oocytes.

Method: A total of 1,130 treatment cycles from 1,130 women who underwent oocyte retrieval during mild stimulation cycles between February 2018 to June 2019 were retrospectively reviewed. The correlation of OD with embryonic outcomes was analyzed.

Results: The logistic regression analysis demonstrated that the OD was not correlated with embryonic outcomes. However, our preliminary analysis demonstrated that the embryonic outcomes in the oocytes with small or large OD tended to be lower than those oocytes with optimal OD. Therefore, we stratified the oocytes into six groups according to the OD using statistical software (Group A, OD < 110.19; B 110.19 [Formula: see text] OD < 112.22; C, 112.22 [Formula: see text] OD < 113.67; D, 113.67 [Formula: see text] OD < 115.01; E, 115.01 [Formula: see text] OD < 116.02; F, 116.02 [Formula: see text] OD). The highest blastocyst utilization rate was observed in Group D. The blastocyst utilization rate in Group A (the smallest-diameter group) and F (the largest-diameter group) were significantly lower than that in Group C and D.

Conclusion: The optimal range of OD is associated with the higher blastocyst utilization rate after ICSI. These results suggest that OD might be used as a predictive parameter to select/de-select the oocytes for insemination, leading to better control of the quantity and quality of the embryos obtained, reducing to a minimum the ethical issues related to excess embryos.
#62 : Time-Lapse Imaging Analysis of Embryo Development: A Dynamic-Image-Based Prediction Model for Blastocyst Formation During Early 80 Hours Development
Authors: Zhao Mingpeng , Fan Jing , Li Xuemei , Lli Hanhui , Zhang Chaofan , Chan David Yiu Leung
Published: January 2024

Background and Aims: The objective is to develop a novel algorithm for context learning through time-lapse imaging and compare its performance with static learning for blastocyst formation prediction.

Method: Time-lapse imaging (TLI) was used to capture images of over 400 embryos between 19 to 80 hours after insemination with approximately 30,000 frames. The study employed two network input strategies for blastocyst formation prediction - utilizing static (A model) and dynamic image-based (B model) prediction models. The proposed algorithm for context learning through time-lapse imaging involves deep learning methods for identifying subtle changes in the embryo’s developmental stages through the time series of images. The convolutional neural network (CNN) and long short-term memory (LSTM) methods are leveraged to extract features and maintain context over the culture duration.

Results: The study found that early-stage prediction of blastocyst formation was challenging, with both network input strategies achieving an overall prediction accuracy of less than 80%. However, B model prediction outperformed A model prediction, with a prediction value of 75% compared to 68% (p < 0.05). Moreover, the B model is more effective for detecting delayed blastocyst formation, with 45.5% of the delays (>1 days) being correctly predicted compared with 36.4% for the A model.

Conclusion: In conclusion, the study demonstrated that a dynamic-image-based prediction model utilizing the proposed algorithm for context learning through TLI outperforms the static-image-based prediction model. The proposed algorithm enables a more comprehensive analysis of the embryos, considering subtle changes over time, which enables improved prediction of blastocyst formation with more robust performance in the future. This study represents a significant step forward in the development of advanced data mining methods that can enable reliable and accurate predictions of embryo development.
#73 : Common Problems Faced by Indian Assisted Reproductive Technologies Laboratory Professionals
Authors: Leong William , Varghese Alex , Wang Rui , Catt Sally
Published: January 2024

Background and Aims: There has been tremendous growth in the offering of Assisted Reproductive Technologies (ART) in India creating a critical shortage of experienced clinical embryologists thus inevitably leading reduced training opportunities. The aim of this study was to investigate problems faced by laboratory professionals in the ART industry in India.

Method: An online questionnaire survey was distributed to ART laboratory professionals globally through professional societies, social media, and email databases. The questionnaire included demographic questions and open-ended questions on problems faced by ART laboratory professionals at the clinic level, professional level, and personal level. The survey was active from May 2016 until February 2017. The Indian data was collected and analysed as a global sub-population. The identified common problems were used to categorise the responses and the percentage distribution was calculated.

Results: Among 136 survey responders, 79 provided responses on problems faced by ART laboratory professionals, including 11 junior embryologists, 19 embryologists, 31 senior embryologists, 18 managers and directors. The problems identified from the responses were ‘overworking’ (18%), ‘respect / recognition’ (16%), ‘clinician and embryologist relationship’ (14%), ‘management’ (12%), ‘lack of training’ (11%), ‘regulation / certification’ (7%), ‘blamed for clinical outcomes’ (7%), ‘decision making’ (6%), ‘salary’ (5%), ‘staffing’ (3%).

When stratified into roles, the top problems for junior embryologists were ‘overworking’ (21%), ‘respect / recognition’ (21%), and ‘lack of training’ (21%), for embryologists was ‘overworking’ (21%), for senior embryologists was ‘respect / recognition’ (18%) and ‘management’ (18%), for managers and directors was ‘respect / recognition’ (21%).

Conclusion: The problems faced in the Indian ART industry are broad but are prioritised differently by staff members depending on their roles. Future research should investigate reasons underlining these problems and strategies to improve staff wellbeing particularly considering the recently introduced government regulations on ART in India.
#88 : Correlation Between AMH Levels and Aneuploidy Rates in Patients Over 40 Years of Age: A Novel Finding
Authors: Alhelou Yousef , Hamdan Mukhri , Razali Nuguelis , Ali Jaffar
Published: January 2024

Background and Aims: AMH is a crucial biomarker of ovarian reserve and predictor of ovarian response to stimulation. Ovarian reserve is inversely proportional to women’s age, consequently lower AMH levels are seen in older women particularly at [Formula: see text]40 yrs of age. A correlation between age and embryo aneuploidy was established but not with AMH level. We hypothesize that older women with good ovarian reserve produce less aneuploid embryos and produce the same blastocyst rate.

Method: A retrospective study was undertaken involving 507 IVF cycles in patients aged [Formula: see text]40 years who had ICSI with PGT-A using NGS. The cycles were categorized into three main cohorts based on the patient’s AMH level: low (< 1.1 ng/mL), moderate (>1.1 to [Formula: see text] 3.0 ng/mL) and high (> 3.0 ng/mL). Each cohort was subdivided into 3 age sub-cohorts as follow: (40 to <42), (42 to <44), and (>44). Our primary outcome was aneuploidy rate whereas the secondary outcome was blastulation rate.

Results: The results will be mentioned in sequence: low AMH, moderate AMH and, high AMH levels. In the [Formula: see text]40 to < 42 age group, the aneuploidy rates were 78.2%, 72.3% and, 67.2%, respectively (n = 232; p = 0.027). The blastulation rates were 53.8%, 47.7% and, 48.5% respectively (p> 0.05). In the [Formula: see text]42 and <44 age group, the aneuploidy rates were 89.2%, 83.2% and, 81.5% respectively (n = 136 p=0.039). The blastulation rates were 45.2%, 46.2% and, 43.8% respectively p> 0.05. In the [Formula: see text]44 age group, the aneuploidy rates were 93.9%, 91.2% and, 89.4% respectively (n = 139; p = 0.043). The blastulation rates were 41.2%, 39.2% and, 38.8% respectively (p>0.05).

Conclusion: The aneuploidy rates rises when AMH levels decreases; whereas the blastulation rates was not associated with AMH levels in the population studied.
#89 : Higher Euploidy Rate in Embryos Generated by ICSI Using Sperm Obtained After Microfluidics Sperm Sorting (MFSS). A Randomised Controlled Trial
Authors: Alhelou Yousef , Hamdan Mukhri , Razali Nuguelis , Ali Jaffar
Published: January 2024

Background and Aims: MFSS is a state-of-the-art technology that has the ability to sort a subpopulation of sperm cells with lower DNA fragmentation index (DFI), higher motility and higher normal forms without the need for centrifugation.

Methods: A randomised controlled trial that included 925 couples that were planned for ICSI with day 5/6 biopsy, PGT-A with Next Generation Sequencing (NGS) and blastocyst vitrification. The embryo transfer was planned for future cycles. The inclusion criteria for women were age (18–45), BMI (18–30), AMH level more than 1.1 ng/ml, regular menstrual cycle and normal uterine ultrasound. Whereas the inclusion criteria for men were age (18–50), fresh semen sample with count more than 10 million/ml and total motility more than 30%. Semen samples were randomly assigned with 1:1 ratio to either preparation by routine density gradient (DG) or (MFSS). The primary outcome of the study is PGT-A aneuploidy results. The secondary outcome is the fertilisation rate, and blastocyst development rate.

Results: The study was performed between January 2020 and July 2021. 463 semen samples were prepared with density gradient and 462 semen samples were sorted with microfluidic sperm sorting. All of the prepared semen samples were used for ICSI. The euploid embryo rate for the embryos resulted from density gradient preparation was 53.1% versus 59.3% for the embryos resulted from microfluidics sperm sorting (p=0.0034). The fertilisation rate was 77.9% for density gradient group versus 78.3% microfluidics group (p=0.063) and blastocyst rate was 51.6% for the density gradient group versus 59.2% for the microfluidics group (p=0.058).

Conclusion: Semen samples prepared with MFSS for ICSI generated higher euploidy embryos following PGT-A with NGS.
#142 : “No Result” Embryos After PGTA: Should They Be Disposed?
Authors: Cam Van Nguyen Thi
Published: January 2024

Background and Aims: Sometimes the preimplantation genetic testing for aneuploidy (PGTA) results return with “no result” (NR) even though the percentage of this type of result is quite small. Our desire was to rebiopsy these embryos and reanalysis, then determining whether it is efficient to perform reanalysis in “no result” embryos with different embryo qualities and evaluating the efficacy of rebiopsied blastocyst transfers.

Materials and Methods: Performing trophectoderm rebiopsy for inconclusive blastocysts after PGTA test. The blastocysts would be transferred if the second analysis was eligible.

Results: From September 2020 through December 2022, 2838 embryos were biopsied and tested for PGTA, 95 samples were returned as “no result”, accounting for 3.3%. There was no difference between the embryo quality grades in NR embryos (p>0.05), but the NR day 5 embryos was statistically higher than the group of day 6 embryos (85.3% vs 14.7%, p<0.05). The rate of ICM grade A was significantly higher than the rate of ICM grade C (42.1% vs 23.2%, p<0.05). However, TE grade B group was significantly higher than the group of TE grade A and TE group C. We performed re-biopsy and repeated PGTA test for 67 eligible embryos, 66/67 (98.5%) samples had results. The euploid rate after the second analysis was 46.3%. 16 euploid cases were transferred after the second analysis, the warming survival rate was 100% and the ongoing pregnancy rate was 56.3% (9/16) and there were 7 live births. The ongoing pregnancy rate in the group of good blastocyst grade (grade 1, 2) was higher than those in the group of poor blastocyst grade (grade 3) (44.4% vs 11.2%, respectively).

Conclusions: Performing re-biopsy and repeat PGTA testing can reduce the risk of embryo wastage, increasing the chance of embryo transfer for patients indicated for PGTA. However, in cases of poor-quality embryo re-biopsy, the pregnancy rate after embryo transfer is very low even though the biopsy result is euploid. Therefore, it is necessary to weigh the benefits and risks of rebiopsy in cases where embryo quality is not eligible to optimize efficiency of time and cost for the patients.
#175 : Cohort Study of Post-Thawed Blastocyst Morphology is Associated with the Clinical Pregnancy of the Single Embryo Transfer Cycle
Authors: Sugianto Sally Kurnia , Alawiyyah Tuthi , Annas Jimmy Yannuar , Arifin Benediktus , Afdlal Szeifoul , Boediono Arief , Sini Ivan R
Published: January 2024

Background and Aims: Frozen Embryo Transfer is the final step in undergoing IVF treatment. One of the important parts in the success of the FET cycle is the quality of the transferred embryos. The ability of blastocyst post-thawed recovery indicated embryo potential. However, there is limited understanding of the factors that influence recovery of post-thawed blastocyst embryos. This study aims to examine whether blastocyst morphology post-thawed correlates with clinical pregnancy rate.

Method: In a retrospective cohort study, analysis data of Morula IVF Surabaya was conducted from January 2022 – February 2023, thawed blastocyst with a post-thaw cell survival rate of 50%–100% were observed for morphological characteristics prior to transfer. Then, recovery of blastocoel expansion was graded as A, fully expanded; B, re-expanded; and C, not expanded.

Results: The primary outcome was the clinical pregnancy rate per cycle. In the 134 cycles reviewed, the clinical pregnancy rate (CPR) reached 5.5% of the not expanded; 29.4% of the re-expanded; and 56.92% of the full expanded blastocyst group (p<0.005).

Conclusion: Post-thawed fully expanded blastocysts are associated with a higher clinical pregnancy rate. However, embryos with a poor morphology post-thawed still demonstrate a considerable probability of clinical pregnancy.
#253 : Administration of Umbilical Cord-Derived Mesenchymal Stem Cells Secretome to Sperm Preparation Medium: A Pilot Study
Authors: Margiana Ria , Lestari Silvia Werdhy , Wibowo Theresa Devi Siswani Tjandra , Saoemi Huriyah Adani , Supardi Supardi
Published: January 2024

Background and Aims: As previously known, umbilical cord-derived mesenchymal stem cells (UC-MSCs) secretome has antioxidant potential that can reduce oxidative and nitrosative stress. This study is very important because understanding the effect of the UC-MSCs secretome on spermatozoa can assist in the development of sperm quality improvement techniques. This study aims to examine the sperm concentration and velocity before and after the addition of UC-MSCs secretome as a modification in sperm preparation with time duration and concentration variation.

Method: A pilot study used a secretome produced at Dr. Cipto Mangunkusumo Hospital. Ejaculate samples were collected from married couples who already had children and the results of the semen analysis showed normozoospermia and DNA fragmentation index examination at a good level (15%). Sperm preparation was done using the Swim-up method. Samples were divided into 7 treatments with different ratios of secretions and ejaculate and washing medium (1:1 and 1:2) with incubation time durations (30, 45, and 60 minutes) to find optimal conditions to be used in further studies. The sperm concentration and velocity were observed before and after incubation.

Results: Based on the results, it can be observed differences in sperm concentration and velocity from various incubation methods using UC-MSCs secretome. The 1:1 (v/v) secretome treatment had the highest spermatozoa concentration (68 million/mL), while the 1:2 (v/v) secretome treatment had the fastest spermatozoa velocity (30.51 μm/s), with the same incubation time of 45 minutes. The treatment group that was given UC-MSCs secretome 1:1 (60 minutes) and 1:2 (60 minutes) had slower spermatozoa velocity (22.91 μm/s and 21.45 μm/s, respectively) compared to the control group (26.39 μm/s).

Conclusion: The administration of UC-MSCs secretome to the sperm preparation medium could increase the concentration and velocity of spermatozoa after incubation. However, this conclusion is provisional and needs further study to support this technique’s development.