bluuebunny/crossref_metadata_2025 huggingface dataset:
#296 : Identification and Validation of Two Novel Therapeutic Targets for Endometriosis with Artificial Intelligence (AI)
Authors: Wang Chi Chiu , Pun Frank W , Liu Bonnie Hei Man , Lin Yuezhen , Ren Feng , Zhavoronkov Alex
Published: January 2024

Background and Aims: It is urgent need to develop new-effective and well-tolerable medical treatment for endometriosis, but normal drug development is tedious, costly and time-consuming. Artificial intelligence (AI) is a powerful tool to drive discovery of novel druggable targets. Here we aim to use AI to identify novel therapeutic targets for endometriosis treatment.

Method: Targets associated with endometriosis were prioritized by PandaOmics (a well-established AI-driven target identification platform). Expression levels of druggable targets were tested in human endometriotic lesions. Functional characterizations of the targets were performed by in-vitro and in-vivo endometriosis models. Viability, proliferation and apoptosis were examined.

Results: Analysis of 11 public endometriosis bulk transcriptomics databases revealed 2 lists of high confidence and novel druggable targets. Tow novel targets ENDO01 and ENDO02 were selected based on ranking in PandaOmics, consistency of significant dysregulated expression across comparisons, as well as literature evidence relevant to disease-driving mechanisms. Differential expressions were confirmed in human endometriosis tissues. siRNA targeting ENDO01 and ENDO02 significantly reduced cell viability and proliferation, as well as enhanced apoptosis in endometriotic cells in-vitro; and significantly decreased lesion volume and weight with reduced proliferative and enhanced apoptosis in-vivo.

Conclusion: Two novel targets for endometriosis were identified with AI and validated by in-vitro and in-vivo experiments within a short period. The study demonstrated how AI could speed up the novel target discovery process from years to months. For diseases remaining incurable or with high morbidity, the application of AI in target discovery could be a new therapeutic regimen that benefits patients.
#343 : Social Aspects Affecting Dysmenorrhea and Adenomyosis Women in Indonesia
Authors: Putrinadia Aninditya V , Melinawati Eriana , Budihastuti Uki Retno
Published: January 2024

Background and Aims: Dysmenorrhea is a common gynecological disorder occurs in women during their reproductive years, especially in women with adenomyosis and it will change daily function which have negative impact on social life. The high prevalence of menstrual disorder requires appropriate prevention and treatment efforts by recognizing the risk factors and found coping strategies and pain acceptance which can improve social aspects affecting dysmenorrhea and adenomyosis women.

Method: This study is conducted in three general hospitals in Indonesia using retrospective data with determined inclusion and exclusion criterias. We used patient medical record with dysmenorrhea and adenomyosis. We analyze their risk factors and outcomes of social aspect in affecting dysmenorrhea and adenomyosis women using statistic program with significant p value [Formula: see text] 0.05.

Results: In the last three years 250 patients came to the hospital with chief complaints of abdominal pain especially when their periods. Some of them diagnosed with adenomyosis with or without abnormal uterine bleeding and 160 of them have had surgery with histopathological results showing adenomyosis tissue. All patients who met the inclusion criteria were analyzed further using the questionnaires to find out more about social factors that affect psychological condition of patients with adenomyosis. This research is still ongoing.

Conclusion: We can conclude that more than 50% patients with dysmenorrhea is caused by adenomyosis, and they have psychological problems because of that with any significant factors which affect those social aspects in dysmenorrhea and adenomyosis women still analyzed.
#123 : Caveolin-1 Function and Regulation in Mouse Uterus During Early Pregnancy and Under Human In Vitro Decidualization
Authors: Zhuo Song
Published: January 2024

Background and Aims: Endometrial decidualization is a step in establishing and maintaining pregnancy. Senescence was considered to accompany with decidualization. Failure to clear senescence during decidualization could cause pregnancy abnormalities. Caveolin-1, as a scaffold protein, play a role in senescence, but the expression, regulation and function were not very clear in uterine endometrium. Here, we investigated the profile of Caveolin-1 in mouse and human decidualization to tease out the potential relationship among the Caveolin-1, senescence and decidualization.

Method: ICR strain mice and immortalized human endometrial stromal cells (ESCs) were used.

Immunofluorescence, Western-Blot, Real-time PCR were used to detect the levels of molecules.

Results: In endometrium of mice during early pregnancy, the expression of Caveolin-1 gradually decreased in stroma and epithelium before embryo implantation. However, the level of Caveolin-1 converts in stromal cell after implantation.

Estrogen could stimulate expression of Caveolin-1 in epithelium and progesterone could up-regulate level of Caveolin-1 in endometrial stromal cells. In vitro, expression of Caveolin-1 was up-regulated during decidualization in mESCs, while the level of Caveolin-1 was reduced during decidualization in hESCs. siRNA of Caveolin-1 could promote the expression of IGFBP-1 (decidualization biomarker) and senescence in hESCs, while over-expression of Caveolin-1 had the opposite results. In mESCs, Caveolin-1 seems to play a different role in decidualization, over-expression of Caveolin-1 could promote decidualization and senescence in mESCs, but siRNA depressed it.

Blastocysts-derived TNF and hCG stimulated Caveolin-1 in mice and depressed it in human decidual cells, respectively. Caveolin-1 levels are also regulated by high glucose and insulin.

Conclusion: Caveolin-1 play a role in ESCs decidualization, but the mode of action was different between species. A low level of Caveolin-1 will benefit for human decidualization, disorder of Caveolin-1 could impair decidualization.
#288 : Comparison of OVOIL and OVOIL HEAVY in the Clinical IVF Laboratory on Fertilization, Blastocyst Utilization and Transfer Outcomes
Authors: Kathryn Gurner H , Kelley R.L , Lee Y.S , Gardner D.K
Published: January 2024

Background and Aims: OVOIL HEAVY (Hv-OIL, Vitrolife) is a new synthetic oil, which compared to a paraffin oil OVOIL, has increased viscosity which may benefit handling, and provide osmolality and pH stabilisation. Being synthetically derived, Hv-OIL may reduce risk of impurities/contaminants. The manufacturer reports that Hv-OIL improves mouse and human embryo development 1 . The aim of this study was therefore to compare the effect of Hv-OIL vs OVOIL on IVF/ICSI cycle outcomes.

Method: OVOIL and Hv-OIL were used across alternating fortnights for all patients in one laboratory between June 2022 and March 2023 (n=1,116 patients). Donor-recipient, egg thaw and egg freeze cycles were excluded. Embryos were cultured in G-TL media (Vitrolife) under 6.5% CO2, 5% O2 in an Embryoscope+.

Results: Hv-OIL (n=554) had no effect on fertilisation rate compared to OVOIL (n=562) following either IVF (53.9% vs 55.1%) or ICSI (61.2% vs 60.5%). Utilisation rate per 2PN was similarly unaffected by oil type (51.2%± 0.01 vs 48.2%± 0.02), and this was unchanged by method of insemination. Hv-Oil had no impact on blastocyst development rate compared to OvOil (64.2 vs 61.5%), and the number of top-quality blastocysts (Gardner grade 4/5AA) per 2PN was not different (14.5% vs 16.6%). Positive hCG (46.52% vs 50.1%), fetal heart (27% vs 32%) and fetal sac (31% vs 36%) rate from fresh, single Day 5 transfers was not different between Hv-Oil (n=210 ETs) and OvOil (n=230 ETs) respectively. Osmolality of culture media in Embryoscope+ slides was not different following 7 days of incubation in either oil.

Conclusion: There were no observed differences in fresh cycle outcomes with use of Hv-OIL as an oil overlay. However, the impact of Hv-OIL on live birth and FET outcomes, specific patient populations or use in different types of culture systems remains to be evaluated.
#21 : Letrozole Can Be a Good Adjuvant for In Vitro Fertilization (IVF) Procedure in Patient with Ovarian Endometriosis
Authors: Choo Chang-Woo , Lee Won-Don , Lim Jin-Ho
Published: January 2024

Background and Aims: To evaluation the pregnancy rate in IVF procedure with letrozole in patient with ovarian endometrioma.

Method: Prospective study performed by single physician at primary fertility center. From August 2016 to November 2019, 109 cycles of IVF were performed from couples who were diagnosed as endometrioma. 40 women were diagnosed during ovarian cystectomy, 69 were by transvaginal ultrasonography. In 64 cycles, gonadotrophic releasing hormone (GnRH) antagonist protocol was used, and in another 45 cycles, gonadotrophin releasing hormone agonist (GnRHa) protocol were applied. In every cycle, 10 mg of letrozole was added from the start of gonadotrophin till the end of ovarian stimulation.

Results: Women’s age was 36.10±3.67, and the number of their previous IVF cycle was 2.66±1.63. AMH was 2.30±2.31, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) on the third day of menstruation were 9.40±5.26, 7.81±4.60 and 54.1±44.2. Start dosages and total dosages of recombinant FSH were 314.32±74.99 and 2541.37±992.77, and serum E2 and progesterone on trigger day were 1220.06±1072.49 and 0.92±0.79. The endometrial thickness was 9.20±1.46. The number of obtained oocytes was 9.05±5.94 and metaphase II(M2) oocytes were 6.71±4.12. 1.91±0.42 embryos were transferred to the uterine cavity and 2.68±2.58 surplus embryos were cryopreserved. Pregnancy rate was diagnosed if serum beta human chorionic gonadotrophin (hCG) level was above 5 ng/ml on 14th day after oocyte retrieval, and the result was 44.95% (49/109). Clinical pregnancy rate which was defined if gestational sac was visualized by transvaginal ultrasonography after at least 21st days after oocyte retrieval, and the result was 24.77% (27/109).

Conclusion: In IVF procedure for the patients with ovarian endometrioma, just adding letrozole to conventional controlled ovarian hyperstimulation protocol can reduce serum peak E2 level without make harmful effect on uterine endometrium, and result in comparable pregnancy rate.
#53 : Pregnancy Outcome After Hydrosalpinx Aspiration in In-Vitro Fertilization Cycle
Authors: Ong-Jao Ednalyn , Mendiola Rudie Frederick , Perillo Gayla , Francisco Fides Marie
Published: January 2024

Background and Aims: Hydrosalpinx is a severe manifestation of tubal disease-causing infertility in women. It has an adverse effect on the outcome of in vitro fertilization (IVF), reducing live birth rate (LBR) by 50% compared to other tubal factors. Laparoscopic salpingectomy can effectively improve IVF outcome but is contraindicated in some women. It can also be expensive and is not without complications.

Ultrasound-guided hydrosalpinx aspiration is a cheaper, less invasive procedure alternative to salpingectomy. It has been shown to improve clinical and ongoing pregnancy rates compared to patients with no aspiration. However, the published literature on the effectiveness of hydrosalpinx aspiration is equivocal.

Method: This retrospective study aimed to evaluate the outcome of minimal stimulation (mild) IVF cycles wherein the women underwent hydrosalpinx aspiration prior to embryo transfer at a private fertility clinic in the Philippines.

Results: A total of 98 IVF cycles satisfied the inclusion criteria. The average patient age was 35.22 ± 4.57 and average duration of infertility was 5.87 ± 3.70 years.

The biochemical pregnancy rate was 48% and the clinical pregnancy rate was 39.8%. Live birth rate was 35.7%, which is comparable to that of mild IVF patients without hydrosalpinx. There was a negative correlation between patient age and biochemical pregnancy rate, clinical pregnancy rate, and LBR, however, the correlations were statistically insignificant (Pearson correlation, P = 0.081, 0.197, and 0.344, respectively). Binary logistic regression analyses showed that age, infertility type, infertility factor, basal hormone levels, and number of eggs retrieved were not predictive of the success of IVF among the women in the study.

Conclusion: Our results show that hydrosalpinx aspiration is a safe and effective option in improving pregnancy and live birth rates in women undergoing mild IVF.
#113 : Transdermal Oestrogen (GEL) for Endometrial Preparation in Frozen-Thawed Embryo Transfer
Authors: Shukri Rahilah Ahmad , Zain Murizah Mohd , Mohammad Nurul Mawaddah
Published: January 2024

Background and Aims: Frozen-thawed embryo transfer (FET) requires a synchronization between endometrium and embryo. Pregnancy and live birth rates are proven to be significantly higher with FET due to better endometrial receptivity. In this study, we look at effectiveness oftwo oestrogen preparations in hormone replacement therapy (HRT) FET cycle on the pregnancy outcomes.

Method: This is a retrospective analysis of 200 HRT FET cycles from 1st Jan 2020-31st December 2021, divided into 2 groups. Group 1 (n=100) received T Progynova 6 mg/day and Group 2 (n=100) received Oestrogel 6 mg/day (17B oestradiol 0.06% gel Besins France) starting on day 1 of menses, without GnRH agonist pituitary downregulation. The oestrogen dose was adjusted accordingly to achieve endometrial thickness (ET) of minimum 8 mm, prior to initiation of vaginal progesterone. The pregnancy outcomes (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, early pregnancy loss and ectopic pregnancy rates), duration of oestrogen usage and endometrial thickness measurement prior to embryo transfer were analysed.

Results: The biochemical pregnancy rate in this study was 39%, with a clinical pregnancy rate of 31%. Comparing both preparations, the biochemical pregnancy rate (p=0.562), clinical pregnancy rate (p=0.705), ongoing pregnancy rate (p=0.623), and early pregnancy loss rate (p=0.705) were not statistically significant. The duration required to achieve optimal endometrial thickness (p=0.212), and endometrial thickness measurement prior to vaginal progesterone commencement (p=0.335) were comparable.

Conclusion: Oestrogel is a non-inferior option to oestradiol valerate for endometrial preparation in HRT FET cycles, especially for patients with high risk of venous thromboembolism due to its safety profile.
#162 : Effect of r-LH Supplementation in Controlled Ovarian Stimulation in Antagonist Protocol of IVF
Authors: Wijaya Liva , Shafira Nadia , Abidin Boy , Halim Ayang , Hasmoro Tri Bowo , Wiweko Budi
Published: January 2024

Background and Aims: Adding LH to FSH can increase the mean of retrieved oocytes and cumulative embryos. LH stimulates the theca cells to secrete androgens, which are converted to estrogens during folliculogenesis. Women with long GnRH agonist downregulation, GnRH antagonist protocol, poor ovarian reserve, and patients with hypogonadotropic hypogonadism may have advantages in using exogenous LH. Here we show our experience using r-LH in our clinic concerning oocyte retrieval and maturity rates.

Methods: We retrospectively took data from patients who underwent antagonist protocol from January 2021- January 2023 in Mbrio IVF Clinic Jakarta. Forty-three patients were stimulated by r-FSH (n=9) and a combination of r-FSH and r-LH (co-treatment) (n = 34) for 9-11 days and triggered by r-HCG or dual trigger (r-HCG and GnRHa). We statistically analyzed the retrieval rate, maturation rate, and OSI (ovarian sensitivity index) by independent-T and Mann-Whitney U tests. The level of significance was set at p < 0.05.

Results: The mean age (33 vs. 35 yo), estrogen level, and trigger treatment were similar in both groups. The median AMH level in group r-FSH was higher than the co-treatment group (p 0.012; 4.44 vs. 1.75). The median retrieval and mean maturation rates were equivalent in both groups (100% vs. 90.9%; 78.5% vs. 80%). The OSI was higher in r-FSH than the second group but statistically insignificant. (p 0.20; 5.42 vs. 3.29).

Conclusions: Adding LH to FSH in antagonist protocol gives both groups the same retrieval and maturity rate. Although they had comparable OSI, the AMH level in the co-treatment was lower than in the first group. The lower AMH level group gets advantages from the co-treatment in this data. We need larger data and complex analysis to validate the result.
#184 : Dual Triggers of Ovidrel and Buserelin Improves the Outcome of In Vitro Fertilization in Yasmin Fertility Clinic
Authors: Jovito Axel , Siregar Fahreza Akbar , Yulinda Dafi , Regan Louis , Wiweko Budi
Published: January 2024

Introduction: Controlled ovarian stimulation (COS) is a technique used in in vitro fertilization (IVF) to stimulate multiple ovarian follicles at the same time before oocyte retrieval. “Dual triggering” for final oocyte maturation using a gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) can improve clinical outcomes during in vitro fertilization. We thought that further investigation regarding the efficacy of dual triggers was warranted. In this study, we aim to investigate the outcome of dual triggering in IVF with a combination of a single dose of a GnRH agonist (Buserelin) and rhCG (Ovidrel).

Methods: This retrospective study subjected 22 women who underwent IVF with dual triggers of Ovidrel and Buserelin in Yasmin IVF Center, Dr. Cipto Mangunkusumo General Hospital in Jakarta. Demographic data was gathered from paper-based patient treatment medical records.

Result: Patients who received dual triggers therapy, the average oocyte obtained in the study sample was 11.83 in women under 35 years old (group 1) and 8.27 in women above 35 years old (group 2). The average of embryo day 3 was (7.29 vs 4.40). The average BMI in our study sample was (21.54 vs 24.60), the duration of infertility average was (6.14 vs 8). For the average blastocyst, fertilization rate, cleavage rate, and blastocyst rate consecutively (4.86 vs 3.07, 66.76 vs 66.18, 101.78 vs 87.83, 83.57 vs 73.90).

We found the pregnancy rate was 34,28% (14,28% vs 20,0%) which we assessed based on a positive bHCG result and a P4 value after fresh embryo transfer. No cases of ovarian hyperstimulation syndrome were reported in either group.

Conclusion: Dual triggering of Ovidrel and Buserelin may be a useful maturation treatment to maximize the outcome of mature oocytes in IVF patients. However, further investigation will be needed.
#245 : The Clinical Outcome of Different Embryo Transfer Strategies After Late Rescue ICSI Procedure
Authors: Yang Rui , Tian Tian , Zhu Xiaxuan , Li Rong , Liu Ping , Qiao Jie
Published: January 2024

Background and Aims: To evaluate the safety profile and effectiveness of freeze-all blastocyst transfer when applied in the late rescue intracytoplasmic sperm injection (r-ICSI). All participants reproductive Centre of Peking University Third Hospital received treatment from 2009 to 2019 were included. A total of 2,270 patients met the inclusion criteria who encountered an unexpected total fertilization failure (TFF) during 149,054 cycles of in vitro fertilization (IVF) and adopted a late r-ICSI procedure.

Methods: Patients were grouped according to the transfer strategies (926 women in Group 1 performing fresh embryo transfer (ET), 365 women in Group 2 performing freeze-all ET, 716 women in Group 3 experiencing a blastulation failure, and another 263 women without available D3 embryos). Different embryo transfer strategies after r-ICSI procedure. Main outcome measure(s) The live birth rate (LBR), cumulative live birth rate (cLBR), and conservative cLBR.

Results: The TFF occurred in 7.4% of all IVF cycles. Group 1 tended to be older at oocyte retrieval [33.00 (30.00-37.00) vs. 31.00 (29.00-35.00), P<0.001], with longer infertile years [5.00 (3.00-8.00) vs. 3.00 (2.00-6.00), P<0.001], higher FSH levels [7.10 (5.71- 8.69) vs. 6.61 (5.25-7.95) mIU/mL, P<0.001], more gonadotropin consumption [2850.00 (1950.00-4125.00) vs. 2325.00 (1800.00-3150.00) IU, P<0.001], and oocytes retrieved were also fewer [10.00 (6.00-15.00) vs. 13.00 (9.00-19.00), P<0.001]. Group 2 has achieved considerably better clinical outcomes both in LBR of the first ET cycle (37.53 vs. 4.64%) and cLBR (52.60 vs. 8.21%). After adjustment for covariates using binary logistic regression analyses, Group 2 was still linked to better obstetric performances in calculations for LBR [OR: 11.77, 95% CI (8.42-16.45)], cLBR [OR: 11.29, 95% CI (7.84-16.27)] and conservative cLBR [OR: 2.55, 95% CI (1.83-3.55)]. Two groups had a similar miscarriage rate, and no newborns with malformations or congenital diseases were reported.

Conclusions: Our study highlighted r-ICSI as a safe and effective alternative when frustrated couples came up against unexpected TFF. Freeze-all blastocyst stage ET serves as the optimal strategy for late rescue ICSI. However, regarding women with limited oocytes available for r-ICSI use, weighing the benefits against the cost might be prudent before implementing in vitro blastulation.
#72 : Embryo Quality and Pregnancy Outcome from Oocytes with Smooth Endoplasmic Reticulum (SER) Aggregates
Authors: Adelia Reski , Hardiani Fitri , Boediono Arief , Sini Ivan
Published: January 2024

Background and Aims: Calcium stored and released by the Smooth Endoplasmic Reticulum - SER which has an important role in oocyte maturation, fertilization, and embryo development. The presence of SER aggregate result in the disturbance of calcium stores and its occillation which in turn affect fertilization, embryo develompent, and increasing risk of abnormal cromoseme outcome. Alpha-ESHRE Consensus (2011), strongly recomended to not perform insemination on any oocytes with SER. In the other hand, some previous studies show that healthy babies had been born from oocytes presenting this dymorphism. The aim of this study was to evaluate embryo quality and pregnancy outcome patients derived from oocytes with SER.

Method: This study was a crosssectional analysis from 2017-2019 of 223 MII oocytes with SER from 82 women underwent Intra cytoplasmic sperm injection - ICSI. Prior to ICSI, each oocyte was evaluated for the presence of SER Aggregates. The embryological outcome measures were the fertilization rate, embryo quality day 3 and day 5, and pregnancy rates.

Results: This study result shown that from 223 oocytes with SER, 89.5% oocytes can be fertilized. Day 3 embryo 66.6% ± 0.000 qualified as good embryo, but only 29.1% ± 0.000 on day 5 embryo. The Pregnancy rate was 30.0%, with 2 miscarriages. It is important to give a well information to the patients on the risk of birth malformations as well as whether a decreased chance of pregnancy exists.

Conclusion: Oocyte with SER still has the ability to develop and has the potential to support pregnancy.
#79 : Triptorelin Triggered Cycles Improve Embryo Viability Compared to HCG Triggered Cycles
Authors: Lim Adelle Yun Xin , Zepeda Alexa , Hickman Cristina
Published: January 2024

Background and Aims: Embryo quality is directly related to pregnancy rate as previously demonstrated by CHLOE-EQ. CHLOE-EQ Score is an automatic embryo viability score provided by CHLOE (Fairtility). It might provide key performance indicators (KPI) to measure how different protocols impact embryo quality. KPIs are objective measures for systematically monitoring and evaluating the IVF laboratory, a critical element of every IVF clinic Quality Management System. KPIs currently rely on definitions which are simple to assess (fertilisation, cleavage, blastulation), we do not routinely use other biomarkers to monitor operations. The aim of the study was to assess how trigger protocols influence CHLOE-EQ embryo viability score.

Method: Retrospective comparative analysis with 1684 time-lapse videos collected between February-June 2022 in a single private clinic. Embryos were automatically assessed by CHLOE-EQ, an AI embryologist support tool. Assessment of trigger protocol, CHLOE-EQ Score and demographic bias was measured using t-test.

Results: Embryos derived from cycles triggered with Triptorelin had better quality than those triggered with HCG (CHLOE EQ Score: 3.4±4.03, n=524 vs 3.02±3.85, n=1127, p=0.03). The difference could not be explained by age, PCOS, low ovarian reserve, fibroids, polyps. However, the type of trigger did not affect embryo utilisation [250/524 (47.70% vs 485/1127(43.03%), p>0.05].

CHLOE-EQ Score is predictive of utilisation (AUC=0.88, n=1677, baseline=45%, p<0.001), blastulation (AUC=0.90, n=1681, baseline=62.2%, p<0.001) and selection for transfer (AUC=0.92, n=1677, baseline=2.7%, p<0.001).

Conclusion: Triptorelin triggered cycles improve embryo viability, as measured by CHLOE-EQ automatic score, compared to HCG triggered cycles. CHLOE-EQ provides monitoring of clinical practices to determine if protocols influence clinical outcomes and KPIs. CHLOE-KPI can provide KPI insights to detect and prevent non-conformances before they get a chance to affect clinical outcome. Early prevention of operational anomalies provides an opportunity to improve standards of care.
#172 : The Comparison of Intra-Cytoplasmic Sperm Injection (ICSI) Treatment Outcome for Patient Stimulated with Progestine-Primed Ovarian Stimulation (PPOS) and Gonadotrophin-Releasing Hormone Agonist (GnRHa) Long Protocol
Authors: Chee Fam May , Lee Su Xian , Tan Yien Tze , Tee Sze Tian
Published: January 2024

Background and Aims: GnRHa long protocol is a traditional method with benefits such as synchronisation of follicular development, higher oocytes recovery, and improved endometrial thickness but it possesses higher fees with long injection timeline. However, PPOS is an ovarian stimulation protocol that can block the surge of luteinizing hormone (LH) through progesterone instead of the traditional method. This prospective randomized trial is to investigate whether PPOS can be as effective as GnRHa long protocol in ICSI treatment for patients.

Method: A total of 55 patients with mean age 36.67 who underwent ICSI cycle in TMC Fertility Centre Ipoh, Malaysia from Jan 2015 to December 2022 was analysed between PPOS and GnRHa long protocol. The embryological and clinical outcomes were measured using statistical analysis T-test with a significant value at p<0.05. Patients above 42-years-old was excluded in this study.

Results: Basic characteristics such as infertility duration, age, anti-mullerian hormone (AMH), antra-follicle count (AFC) and body mass index (BMI) were comparable in both groups. There was no significant difference found between PPOS and GnRHa long protocol in the number (mean± SD) oocytes retrieved [9.33±7.38 vs 8.55±7.44, p=0.352]; fertilized oocytes [5.79±4.92 vs 4.03±4.12, p=0.081]; number of blastocysts formed [4.35±2.82 vs 3.11±3.23, p=0.147] and utilized blastocysts [2.79±1.42 vs 2.35±2.66, p=0.300]. There was also no significant difference in clinical pregnancy rate (p=0.456) in both groups. No patient from either group experienced cycle cancellation due to the low number of oocytes expected. No ovarian hyperstimulation (OHSS) syndrome was reported from both groups as well.

Conclusion: PPOS in combination with embryo cryopreservation as an ovarian stimulation regimen was as effective as GnRHa long protocol during controlled ovarian stimulation (COH) under different endocrinal mechanisms as it can achieve comparable embryological and clinical outcome. Hence, it can be an alternative treatment for infertile patients in ART in terms of cost and treatment timeline.
#319 : Blastocyst Formation Prediction Based on Deep Learning Model from 3-Day Embryo Images in Time-Lapse Incubator Using Data Augmentation
Authors: Lee Sangho , Choi Kyoung Hee , Hwang Sohyun , Kim Jihyang
Published: January 2024

Background and Aims: Current literature suggests that blastocyst ET (Embryo Transfer) at day 5 improves pregnancy outcomes compared with cleavage ET at day 3. However, blastocyst ET poses potential challenges due to the risk of developmental arrest at the cleavage stage. Therefore, accurately predicting blastocyst formation in embryos will help determining optimal days for embryo culture. The aim of our study is to develop a deep learning-based classification model that can predict blastocyst formation based on 3-day embryo images captured from Time-Lapse incubators.

Method: A total of 200 embryo images were collected at 72 hours after ICSI (Intracytoplasmic Sperm Injection), with 100 forming blastocysts and 100 failing to do so. The images were annotated by RectLabel for object detection and segmentation, and data augmentation techniques were applied to enhance the dataset. A pre-trained ResNet model was used as the basis for our classifier model, and optimization was performed using the Adam optimizer and BCEWithLogitsLoss as the loss function. Model performance was evaluated through classification accuracy and AUC score.

Results: The CNN-based classifier models demonstrated a considerable accuracy of 87.5% and an AUC of 0.896 in predicting blastocyst formation, with sensitivity and specificity of 91.7% and 81.3%, respectively. It was found that without data augmentation, the model degraded to an accuracy of 62.5% and an AUC of 0.631.

Conclusion: Our study competently developed a classification model for predicting blastocyst formation using 3-day embryo images from a Time-Lapse incubator and demonstrated the effectiveness of data augmentation techniques in limited data sets. This deep learning-based model may contribute as a beneficial tool in IVF (In Vitro Fertilization) process.
#180 : Exploring the Understanding and Attitudes of Infertile Couples: An Insightful Survey from Five Central Java Hospitals
Authors: Budihastuti Uki Retno , Laqif Abdurahman , Melinawati Eriana , Prakosa Teguh , Pangestu Mulyoto , Wijayanti Agung Sari , Dafhonsa Meycha , Chasanah Meriska Dewi , Putrinadia Aninditya Verinda
Published: January 2024

Background and Aims: In Indonesia, infertility is not only a medical issue but also a significant social problem. Childlessness often carries a stigma of failure, victimizing couples. This research aims to enhance our understanding of the health-seeking behavior patterns of infertility patients and their access to infertility treatment in Indonesia. Additionally, we aim to examine the factors contributing to difficulties in accessing infertility clinics for couples and analyze the impact of education level, gender, and culture on these challenges.

Method: This research employs a cross-sectional study design. An interviewer-administered survey was conducted with 250 male and female infertility patients recruited from five hospitals in Central Java between April and June 2023. Participants were self-selected, and the data were subjected to descriptive statistical analysis. Subjects were handpicked and not chosen randomly. Inclusion criteria: women and men aged 20-45 years, experiencing infertility problems for more than a year, willingness to be interviewed, actively seeking infertility treatment, capable of participating in interviews, and not currently undergoing an IVF program. Exclusion criteria: malignant disease, ongoing moderate IVF program, and pregnancy. Data analysis was performed using SPSS 25.

Results: In the univariate analysis, a significant relationship was found between gender differences and access to infertility services in aspects of discrimination (p=0.006), culture (p=0.006), gender sensitivity (p=0.027), and understanding (p=0.013). However, the multivariate analysis significantly associated only discrimination (p=0.037; OR=4.33) and understanding (p=0.021; OR=5.63). This research is still ongoing.

Conclusion: Female infertility patients experience more discrimination related to their infertility and possess a greater understanding of infertility and access to infertility services than male infertility patients. The infertility conditions cause women to face more discrimination than men, leading them to be more inclined to seek solutions, such as infertility services. In addition, an increased understanding of infertility makes women more likely to access infertility services.
#176 : The Relationship Between Blastocyst Morphology and PGD Result
Authors: Saidatuzzahroh Nur
Published: January 2024

Background and Aims: Blastocyst morphology has been clinically assessed during the selection of blastocyst for transfer and cryopreservation, and the morphological grading scheme has gained wide acceptance. Blastocyst grading according to Gardner et al. (20) early blastocyst, blastocoel less than half of the blastocyst (1AA), blastocyst with blastocoel more than half of the blastocyst (2AA), blastocyst with blastocoel fill the blastocyst (3AA), and Expanded Blastocyst (4AA/4BB/4CC). Morphology blastocyst with good quality determining the success of PGD. Preimplantation genetic diagnosis (PGD) are routine procedures performed in many in vitro fertilization (IVF) clinics. In patients with genetic or chromosomal abnormalities, PGD is an integral part of the IVF program. This study aims to determine whether embryos with normal blastocyst morphology have euploidy result on the PGD test.

Method: Observational research study.

Results: Dari 22 embryo blastocyst yang di PGD, 59% embryo euploidy 4AA/4BB, 22,7% embryo low level mosaicism 4AA/4BB, 13% embryo aneuploidy 2AA/3AA and 4,5% embryo multiple aneuploidy 3AA. The result suggested that the euploidy rate of blastocyst grade 4AA was the highest.

Conclusion: Based on data, embryo morphology with quality 4AA/4BB show PGD result Euploidy was the highest. Euploidy of embryo is one of the important factors affecting embryo implantation and development. Euploidy of blastocyst during PGD treatment was found to be correlated with morphological assessment (Gardner grade)
#281 : IVF Outcome of Good Prognosis Patients Based on Sperm Morphology Grading Using Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Technique
Authors: Aziz Arif Sofyan , Boediono Arief , Rizal Muhammad , Indrasari Wahyu , Rahmawati Pitra , Szeifoul  , Sini Ivan R
Published: January 2024

Background and Aims: Spermatozoa morphology is one of the factors that can influence the success of IVF. IMSI is a technique that provides various selection criteria of sperm head’s morphology and the presence of vacuoles with a total magnification of over 6,000. The purpose of this study was to compare the embryo development of good prognosis patients based on sperm morphology grading using IMSI technique.

Method: This study was a retrospective analysis performed at Morula IVF Jakarta from 2019 to 2022 based on good prognosis patients (age [Formula: see text] 38 years, AFC [Formula: see text] 7, AMH [Formula: see text] 1.1). There were two groups in this study, (A) sperm grade I and II, (B) sperm grade III and IV, based on Vanderzwalden et al. (2008). The number of patients in group (A) was 1035 patients, and group (B) was 345 patients. The parameters observed in this study were fertilization rate (FR), top embryo quality rate on day 3 (D3) and day 5 (D5), blastocyst rate (BR).

Results: The result study showed that (FR) were significantly increased (P=0.000) in group (A) compared to group (B), which was 77.28% and 72.90%. In addition, group (A) had significantly (D3), which was 51.37% (P=0.012) compared to group (B) 46.92%. On the other hand (D5) and (BR) were significantly increased (P=0.000) in group (A), by about 42.58% and 48.01%, contrasted to group (B), which was only 36.11% and 39.21%.

Conclusion: Grade I and II sperm of IMSI technique significantly increased IVF outcome in good prognosis patient.
#297 : The Impact of Large Perivitelline Space and Fragmented Polar Body Oocytes on the Quality of Embryos and Pregnancy Loss in IVF Program
Authors: Rizki Syifa Ghufrani , Widyastuti Rini , Gunarwati Deka Putri , Al-Anshori Akhmad Afifudin , Dinanty Diar Trie , Nuraisah Gita Salmah , Khaerulloh Muhammad , Riyanti Aida , Prodjokusumo Fachry Achmad , Wiweko Budi
Published: January 2024

Background and Aims: Extracytoplasmic oocyte abnormalities such as Large Perivitelline Space (LPVS) and Fragmented Polar Body (FrPB) are frequently detected in human oocytes during IVF procedures. The purpose of this research is to determine the relationship of LPVS, FrPB, and their combination on embryo quality and pregnancy loss.

Method: The 36 positive pregnancy cases from under 40 years old patients that underwent ICSI using normospermia at RS Pondok Indah IVF Centre were observed. Patients were stimulated with r-FSH utilizing an antagonist protocol for 10-11 days, then r-HCG was administered as a trigger 36 hours before retrieval. Oocytes were classified as follows: (a) normal, (b) large perivitelline space (LPVS), (c) polar body fragmentation (FrPB), and (d) a combination of LPVS and FrPB. The Shapiro-Wilk and Kruskal-Wallis tests were used to determine the effect between each of the categories of oocyte with D3 and D5 embryo quality, along with pregnancy loss.

Results: The results indicate that there was no significant distinction among the groups in terms of embryo quality on D3 and D5, as well as pregnancy loss (p=0.187, 0.881, and 0.561, respectively).

Conclusion: It could have been concluded that LPVS, FrPB, and their combination have no impact on embryo quality and pregnancy loss.
#32 : Female Genital Tuberculosis with Primary Subfertility — A Case Report
Authors: Farooq Fariha
Published: January 2024

Background and Aims: Tuberculosis is a major health problem with worldwide incidence of about 10.4 million people TB in 2015, out of which more than 60% were in Asia. There is no single diagnostic test for female genital tuberculosis so diagnosis is made after considering various factors such as family history, general physical examination, culture and PCR tests and also the diagnostic hysteroscopy and laparoscopy. Here we report a case of asymptomatic female genital tuberculosis in which diagnosis was made on the basis of laparoscopic findings as well as histopathology.

Method: Patient 30 years with no symptom, planned to have laparoscopy and proceed as workup for primary subfertility and ultrasound showing 44 * 22 mm cyst with internal echoes in right adnexal region, with impression of right endometriotic cyst.

Results: Laparoscopy showed normal uterus. There was 0.5 * 0.6 cm granuloma on surface fundus of uterus, adhesions in Pouch of Doughlas. Right tube had gross hydrosalpinx with fimbrial phymosis, and golf stick appearance. Right ovary was buried under right tube and had cyst of size 4 * 5 cm, on drainage caseous material. Left tube had moderate hydrosalpinx and left ovary was completely buried in adhesions. No fill and spill of dye on dyes test.

Adhesiolysis was done and anatomy restored. Right tubo ovarian mass drained and caseous material removed. Uterine fundal caseous material removed and collected for histopathology which confirmed the diagnosis. Giant cell with granuloma and caseous necrosis was confirmed on histopathology.

Conclusion: Female genital tuberculosis is associated with late presentation due to asymptomatic nature of disease. Hysteroscopy and laparoscopy with microbiological tests on samples taken during laparoscopy has made the diagnosis near to confirmatory. Correct and complete medical treatment gives good results.
#149 : Improved Embryo Quality of Infertile Women at Different Ages by Oral Administration of an Antioxidant Mixture
Authors: Takahashi Yuji , Qin Junwen , Akasaki Masayoshi
Published: January 2024

Background and Aims: Oxidative stress is known to affect oocyte/embryo quality. In the previous meeting of ASPIRE, an antioxidant mixture (AOM) developed by us was shown to improve oocyte/embryo quality. Since oxidative stress is related to aging of body, AOM may be able to support the oocyte/embryo quality of women at advanced ages. We therefore examined the effects of AOM administration on the oocyte/embryo quality of women at different ages.

Method: AOM supplement was given orally for at least one and half month (at most 7 months) to infertile women who had participated in at least one IVF/ICSI program and whose quality of embryos was poor or fair. After the supplementation period, oocyte-pickup was carried out, and either IVF or ICSI was subjected to the patients. Then, the data of oocyte maturity, fertilization, developmental capacity, and bioavailability of embryos (No. of embryos transferred and cryopreserved) were collected retrospectively.

Results: The effects of AOM on the embryo quality of women at different ages were compared (Age groups were: [Formula: see text] 30yr; 31 [Formula: see text] 35yr; 36 [Formula: see text] 40yr; 41yr[Formula: see text]). In all groups, oocyte retrieval and maturation rates were slightly increased. More evidently, the developmental capacity, especially blastocyst formation, was significantly improved by AOM in all groups ([Formula: see text] 30yr: 20.0% vs 63.6%; 31 [Formula: see text] 35yr; 30.8% vs 68.9%; 36 [Formula: see text] 40yr: 36.4% vs 60.8%; 41yr[Formula: see text]: 36.4% vs 52.9%). Accordingly, the number of embryos cryopreserved was markedly increased ([Formula: see text] 30yr: 0.3±0.6 vs 1.8±2.4; 31 [Formula: see text] 35yr; 0.7±0.9 vs 1.4±1.2; 36 [Formula: see text] 40yr: 0.6±0.8 vs 1.1±1.0; 41yr[Formula: see text]: 0.0±0.0 vs 0.6±0.9), indicating that embryo quality in all groups was improved.

Conclusion: Although it was more beneficial for younger women, AOM administration was very effective to improve oocyte/embryo quality in all age groups. Our present results strongly suggest that AOM can ameliorate age-dependent decrease of embryo quality.
#29 : A Retrospective Review of Patients Undergoing Fertility Preservation in a Tertiary Institution in Singapore Over 10 Years
Authors: Goh Charissa , Ee Tat Xin , Viardot-Foucault Veronique , Phoon Jessie Wai Leng
Published: January 2024

Background and Aims: Early detection and advancement in cancer treatments have drastically improved survivorship. Hence, there is a shift towards long-term quality of life goals such as protecting the oncologic patient’s fertility potential. The study aims to determine the uptake and use of fertility preservation options in women presenting at a tertiary institution in Singapore. This is the first review to outline the uptake rates, methods and fertility outcomes among women undergoing fertility preservation in Singapore.

Method: The study is a retrospective review of premenopausal female patients presenting to a single tertiary institution between 2010 and 2019 for fertility preservation. Our primary outcome measures are the uptake rate, type of fertility preservation undertaken and live birth rate. Our secondary outcome are reasons for decline of fertility preservation.

Results: Forty-one patients were referred between 2010 and 2019. There were 2 referrals received in 2010 compared to 10 referrals in 2019. Twenty-nine patients underwent fertility preservation procedures, with 27 (93.1%) successful fertility preservation procedures performed. Most of the patients opted for embryo cryopreservation (44.4%) or oocyte cryopreservation (33.3%). Three patients (11.1%) underwent ovarian tissue cryopreservation. Two patients (7.4%) opted for a combination of oocyte and embryo cryopreservation and 1 patient (3.7%) had a combination of ovarian tissue and oocyte cryopreservation. There were 3 successful live births. One patient achieved a live birth from stored embryos achieved from in-vitro maturation subsequent fertilisation. The other two patients achieved live births from stored embryos and oocytes respectively. The most commonly cited reason for declining fertility preservation was financial limitations (41.7%).

Conclusion: While the referral rates have been increasing over the years, the rates remain low. Further studies can be done to assess the barriers to fertility preservation referrals. Funding for fertility preservation procedures may increase uptake in this group of women.
#205 : Pre-Orchidectomy Fertility Preservation in a Regional Queensland Centre - Patient Attitudes to Sperm Banking
Authors: Stehr Emma , Desai Devang , Ravichandran Kapilan
Published: January 2024

Background and Aims: Fertility preservation for testicular cancer remains an essential part of the pre-operative radical orchidectomy discussion. In Australia, testicular cancer is estimated to account for 1.1% of all new male cancer diagnoses, with greater than 800 new cases a year diagnosed in Australia.

Toowoomba Hospital and its urology service covers a large geographical area, extending from Toowoomba to the northern territory border. This poses both an access issue for both urological review and subsequent fertility interventions.

Despite geographical barriers, pre-operative sperm banking (cryopreservation) remains generally recommended prior to operative intervention.

The aim of this study was to investigate adherence to guidelines and identification of barriers or reasons for patients not wanting to engage with fertility preservation.

Method: A retrospective analysis of patients undergoing a radical inguinal orchidectomy for the purposes of testicular cancer. Patient records were examined for discussion of fertility preservation and patient outcomes for attending a fertility-consultation.

Results: Between 2016-2022, 54 patients underwent a radical orchidectomy at the Toowoomba Hospital. All patients pre-operatively had discussion surrounding fertility preservation and where patient accepted, referrals were made to the closest fertility provider. The majority of patients who refused pre-operative sperm banking had clear reasoning including completion of family.

Conclusion: Fertility preservation discussions were part of all interactions pre-operatively where appropriate. Patient reasoning for declining preservation services were varied.
#356 : Concurrent Growing Teratoma Syndrome and Gliomatosis Peritonei in Childbearing Woman with Mature Ovarian Teratoma: A Case Report
Authors: Nasfy Siti Nawwal Ahmad , Hamid Habibah Abdul , Fauzi Maryam Kameelah Mohamad , Khairuddin Azalea
Published: January 2024

Gliomatosis peritonei (GP) is a rare clinical condition associated with ovarian teratomas of any grade, in which benign glial implants develop on the peritoneal surface of the abdomen. Growing teratoma syndrome (GTS) is a rare entity defined as the appearance of benign enlarging peritoneal implants that occur during or after chemotherapy for malignant germ cell tumors but are histologically mature teratomas without any malignant component. Complete surgical resection is essential for the diagnosis and treatment of GTS. We report an association scarcely described in the literature to date, in which both GP and GTS were observed in a patient treated with chemotherapy for immature ovarian teratoma. We encountered a patient with suspected concurrent GTS and Gliomatosis peritonei 2 months after chemotherapy, and a second-look fertility-sparing surgery confirmed the diagnosis. A tumor suspected to be GTS was observed in a nulliparous woman in her 20’s immediately after the completion of three cycles of bleomycin, etoposide, and cisplatin therapy after fertility-sparing surgery for stage IIIb ovarian immature teratoma. As ovarian germ cell tumors are characterized by a young onset, fertility-sparing surgery is performed in most cases. Total tumor resection affects the prognosis of GTS; therefore, minimally invasive surgery before tumor growth is advisable.