bluuebunny/crossref_metadata_2025 huggingface dataset:
O-025 Value of hysteroscopy
Authors: Haimovich S
Published: August 2021

Abstract text

The 3 main characters in any ART are the uterus, the endometrium, and the embryo. With the rutinary use of 2D US and especially 3D US in infertile patients we are able to assess most of the uterine anomalies and intrauterine pathologies.

Until recently, the assessment of the endometrial cavity with hysteroscopy was reserved only for cases of IVF failure, as a complementary evaluation to ensure that nothing was missed during the ultrasound scan.

We also need to remember how hysteroscopy was performed in the past and, unfortunately, in some cases even today. In the old days, to assess the endometrial cavity, it was required to take the patient to the operating room and under general anesthesia, dilate the cervix to then introduce a large diameter hysteroscope only for diagnostic purposes.

The prevalent working model in ART today is in close collaboration between Fertility specialists, Ultrasound and Hysteroscopy units in order to improve patient’s outcome.

In our center, a diagnostic hysteroscopy is performed as part of the diagnostic workup of the infertility patient. It is performed in office setting and without anesthesia, by the staff of the reproduction and infertility unit.

When we look at hysteroscopy as an in-office procedure and no longer as a procedure performed in operating room, we appreciate that it is something that all infertility patients can benefit from.

The right question to ask now would be “Is there a benefit in performing a hysteroscopy to all our patients?”.

Ultrasound is not perfect, especially when evaluating the endometrium. The gold standard and the only modality that we have to assess the endometrium with direct visualization is hysteroscopy. Chronic endometritis, adhesions and adenomyosis are only a few examples of what can be assessed by direct vision of the endometrial cavity.

The advantages of a simple, inexpensive, office procedure such as hysteroscopy outweigh any other consideration against it.

During my talk all these points will be presented helping to understand why hysteroscopy is becoming an indispensable tool in every assisted fertility unit.
O-071 The ovarian endometriotic cyst
Authors: Nisolle M
Published: August 2021

Abstract text

"The ovarian endometriotic cyst”

Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility.

Patients suffering from endometriosis frequently present an already reduced ovarian reserve, assessed by AMH dosage or by antral follicular count during TVS.

Pain and infertility are the main indications for endometrioma surgery which is a complex procedure as endometriosis leads to inflammation around the lesions, causing fibrosis.

Three main surgical procedures have been described: the ovarian cystectomy, the endometrioma ablation or the combined technique.

During the cystectomy, after ovarian mobilization and adhesions lifting, an incision of the cortex is realized to find a cleavage plane between the cyst wall and the ovarian cortex. Traction and countertraction movements are performed to carefuly dissociate the cyst from the ovarian cortex. It is crucial to handle the ovarian tissue as atraumatically as possible. With this technique, the cyst wall as well as the surrounding fibrosis are excised with the risk of oocytes removal responsible for decreased ovarian reserve.

The ablative surgery is defined by the fenestration and vaporization of the endometrioma cyst. The ablation is carried out using a laser or plasma energy or electrocoagulation. Once the endometrial cyst has been emptied of its contents, the entire internal surface of the endometrioma must be sprayed or evaporated using the different chosen techniques. Where feasible, the cyst may be turned inside out to facilitate further treatment.

The combined technique associates partial cystectomy (80-90%) and ablation of the 10-20% remaining endometrioma. This method is especially useful while operating large endometriomas. It prevents excessive bleeding or damage to the ovarian tissue.

In cases of large ovarian endometrioma, the three-step approach has been proposed, consisting on an opening and drainage of the cyst followed by a 3 months’ administration of Gn-RH agonists in order to reduce its diameter and vascularization. A second surgical procedure is then scheduled to ablate the remaining cyst wall.

In conclusion, it is crucial to keep in mind that endometriosis and especially the presence of endometrioma reduce fertility whereas in the majority of cases, the ovarian reserve is already diminished in relation to the patient's age. Ovarian preservation must be one of our priorities in young patients of childbearing age and it is therefore really important to carry out surgeries that are as atraumatic as possible.

Trial registration number:

Study funding:

Funding source:
O-064 Artificial intelligence in embryo selection of IVF
Authors: Zhang X
Published: August 2021

Abstract text

Some studies have discussed the use of artificial intelligence and machine learning in the assessment and selection of embryos for in vitro fertilization. Complete artificial intelligence acquired using CNN’s dark box algorithm could be highly useful in assessing in embryos, though it could be difficult to perform the external validation necessary to confirm its value. But due to the inherent drawbacks in complete artificial intelligence assessing in vitro developmental embryos, such as lacking results of discard embryos, dislocations between computer scientist and embryologist, low explanatory values in dark box algorithm, here, we suggest training computers to recognize the target region (internal pellucid zone region) and the features of embryos, then continuously score the embryos starting at in vitro fertilization through the zygote to the blastocyst stage. Parameters suitable for use with various endpoints in treatment sequence could be found by AI. Further clinical studies should be performed to validate the parameters and AI needed.

Trial registration number:

Study funding:

Funding source:
O-242 Metabolic coupling and spermatogenesis
Authors: Bing Y
Published: August 2021

Abstract text

The microenvironment of spermatogenesis mainly consists of Sertoli cells, Leydig cells, and peritubular cells. The traditional theory considers that spermatogenesis is regulated by hypothalamus-pituitary gland- gonadal axis. In the hypothalamus-pituitary gland- gonadal axis, the microenvironmental cells are mainly regulated by the hormones, which are secreted by the hypothalamus or/and pituitary gland. Meanwhile, Sertoli cells and Leydig cells also secrete related factors to feedback the functions of the hypothalamus and pituitary gland. With the development of research, it has found that metabolic disorders are closely related to the spermatogenesis. Some components involving in lipid metabolism pathways, including saturated fatty acids, cholesterol, and triglycerides, etc. affect the functions of Sertoli and Leydig cells through metabolic coupling pathway. The disorder function of Sertoli and Leydig impairs the microenvironment of spermatogenesis, which finally leads to spermatogenic failure. Current studies have found that the imbalance of lipid metabolism can affect the intestinal flora, which induces the changes of related metabolites, and finally leads to the occurrence of male infertility. Based on the current research, we regulated the lipid metabolism by Omega-3 and metformin in clinic, the activity of spermatogenesis can be remolded.

Trial registration number:

Study funding:

Funding source:
O-170 Predictive value of cytoplasmic granulation patterns during IVF in MII oocytes from young donors
Authors: Hu J , Molinari E , Darmon S , Albertini D F , Barad D H , Gleicher N
Published: August 2021

Study question

Do ooplasm granulation patterns of donor MII oocytes have similar predictive values for in vitro fertilization (IVF) outcomes as they have in older infertile women?

Summary answer

Ooplasm granulation patterns of donor MII oocytes are predictive for IVF outcomes in young oocyte donors even more pronounced than in older poor prognosis patients.

What is known already

Cytoplasmic granules had been noticed for years, with data mostly focused on central granulation. Dispersed granulations were mentioned but lacked analysis.

Study design, size, duration

A retrospective cohort study during 2017-2020.

Participants/materials, setting, methods

We investigated 776 fresh and 381 vitrified-thawed MII oocytes from carefully selected young donors (mean, 26.7±2.7; range, 21-35 years) and determined cytoplasmic granulation patterns during intracytoplasmic sperm injection as fine, central, uneven, dispersed and peripheral (see only in thawed oocytes). Fertilization, pregnancy and live-birth rates in fresh and thawed donor oocytes were analyzed

Main results and the role of chance

In fresh donor oocytes: 2PN rates significantly trended down from 96.3% to 90.7%, 89.2%, 66.7% from fine to central, uneven, dispersed granulations; overall pregnancy rates trended down from 48.8% to 29.0%, 19.0% and 6.4%, as did live birth rates (42.1%, 21.6%, 12.5%, 6.4%), from fine to uneven, central and dispersed granulations. Known-pregnancy and known-live-birth analyses showed similar findings. Thawed donor oocytes demonstrated similar trends, though with significantly worse outcomes than fresh oocytes. Peripheral granulation, unique to vitrification and thawing, always demonstrated the worst IVF outcomes. Interestingly, granulation patterns were mostly disassociated from morphologic embryo grades in fresh and thawed donor oocytes.

Limitations, reasons for caution

As a retrospective cohort study, some cases had to be excluded for lack of information. The scoring system may have diluted the real contribution of an oocyte when two or more embryos were transferred.

Wider implications of the findings

Ooplasm granulation patterns have predictive values for fertilization, pregnancy and live birth in IVF cycles, supporting integration of them into embryo selection, and suggesting that ooplasm granulation patterns reflect intrinsic features of oocytes that relate to oocyte quality, cytoplasmic maturity and developmental competence, but are largely independent of clinical co-variables.

Trial registration number

NA
P-745 The efficacy of Buscopan® in reducing pain during ultrasound-guided manual vacuum aspiration (USG-MVA): A double-blind randomised placebo-controlled trial
Authors: Chung J P W , Law T , Sahota D , Mak J , Li T C
Published: August 2021

Study question

Does Buscopan® reduce abdominal pain experienced by women undergoing ultrasound-guided manual vacuum aspiration (USG-MVA)?

Summary answer

The addition of 20mg Buscopan® intravenous injection was not associated with a statistical reduction in pain score but leads to a higher patient satisfaction score.

What is known already

Ultrasound-guided Manual Vacuum aspiration is a feasible and effective out-patient treatment option for treating early pregnancy loss. However, it is associated with a moderate amount of pain due to uterine contraction.

Study design, size, duration

This randomised, double-blinded, placebo-controlled trial was conducted in a university-affiliated tertiary hospital. The study assessed whether 1 ml of 20mg Buscopan® intravenous injection 5 minutes before the USG-MVA will reduce the abdominal pain experienced by the women immediately and 2 hours after the procedure. Participants were randomised between June 2018 to January 2020 using a computer-generated number series in a 1:1 ratio.

Participants/materials, setting, methods

Women aged 18 years or older with first-trimester miscarriage undergoing the USG-MVA procedure were eligible. In total, 122 participants out of 128 eligible were included. Of whom, 111 underwent the USG-MVA procedure, 60 randomised to the Buscopan® group, and 62 to the placebo group.

Main results and the role of chance

The median abdominal pain scores in the Buscopan® group were 16.0% and 21.2% lower than the placebo group immediately post-procedure and 2 hours after the procedure in the Buscopan® group. Repeated measures ANOVA indicated that the both vaginal and abdominal pain scores improved significantly with the time (Vaginal F(1,108)= 180.1,p<0.0001;

Abdominal

F(1,108)=83.41,p<0.001) but not with group. No difference was noted in the complications and side effects profile. The physiological stress measured by Log10 sAA levels reduced significantly with time (F(2.8,286.1)= 6.3, p < 0.001) but not with group (F = 0.1, p = 0.96). Women randomised to Buscopan® had a significantly higher (p = 0.032) mean VAS satisfaction scores compared to those receiving placebo (79.0±17.3 vs 73.4±24.1).

Limitations, reasons for caution

This study was a single-centre study, thus one should be cautious in the overall generalisability of the results.

Wider implications of the findings

Few studies have evaluated the use of anti-spasmodic agents to minimise uterine contraction pain in women undergoing outpatient uterine evacuation. We consider Buscopan® a useful adjunct in the pain control of USG-MVA to specifically reduce uterine cramps. Further larger studies are required to evaluate its efficacy

Trial registration number

ChiCTR1800014590
P–035 Mathematical model of the signaling cascade during mouse sperm capacitation
Authors: Prelle B. D , Lybaert P , Gall D
Published: August 2021

Study question

Modeling the feedback loop controlling sperm capacitation to study the reversibility/irreversibility of the process

Summary answer

We demonstrate the existence of a feedback loop between pH increase and hyperpolarization, inducing bistability and possibly the reversibility of the capacitation process.

What is known already

The process of mammalian capacitation does need an influx of calcium ions through the transmembrane Catsper Channel Complex. This plasmic membrane channel, which is activated by an increase in either the intracellular pH or the membrane potential, is a sperm-specific protein that is localized in the sperm flagella. Two other sperm specific transporters, sNHE and SLO3, found in the flagella, have been shown to control protons influx and transmembrane voltage respectively, and could work together in a feedback loop keeping the sperm in a high pH state with hyperpolarized membrane.

Study design, size, duration

Mathematical model

Participants/materials, setting, methods

Not applicable

Main results and the role of chance

The results given by this minimal theoretical model are robust as the predicted qualitative behavior can accommodate to a wide span of physiological parameters variations.

Limitations, reasons for caution

The model and its parameters are mainly based on in vitro results of the literature, so that the in vivo implications should be inferred carefully.

Wider implications of the findings: The possible reversibility of the capacitation process could have major clinical implications, relevant for the optimization of sperm preparation in assisted reproductive techniques and cryopreservation procedures.

Trial registration number

Not applicable
P–065 Advanced paternal age does affect egg donation program outcomes?
Authors: Miguens M , Quinteir. Retamar A M , Acosta D , Veg. Balbuena G , Carreras E , Coscia A , Papier S
Published: August 2021

Study question

Does increasing paternal age has a negative impact in fertilization (FR), blastulation (BR), clinical pregnancy (CPR) and miscarriage (MR) rates in an egg donation program?

Summary answer

The increase paternal age in an egg donation program has not a negative impact in fertilization rate, blastulation rate, clinical pregnancy rates and miscarriage rates.

What is known already

It is well documented that semen quality is affected with increasing paternal age but there is no evidence-based definition of what is advanced paternal age. There is controversial information about if the increasing paternal age affects in vitro fertilization results, and when this negative impact could begin.

Study design, size, duration

This was a single center retrospective cohort study, involving 485 first single embryo transfer of an egg donation program, from January 2017 to December 2019.

Participants/materials, setting, methods

All first embryo transfer of egg donation cycles performed at CEGyR, Buenos Aires, Argentina were included. Elevated sperm DNA fragmentation (TUNEL >20), sperm bank, and testicular biopsy cycles were excluded. Patients were divided according to male partner age: (1) <41, (2) 41–44, (3) 45–50 and (4) >50 years old. Group (1) was considered the control group. Statistical analyses were performed for FR and BR with ANOVA and CPR and MR with chi-squared tests.

Main results and the role of chance

The number of patients in group (1) was 200, in (2) 130, in (3) 117 and in (4) 38. Male average age was 36,8 in group (1), 42,2 in (2) 47,1 in (3) and 54,2 in group (4). The FR in group (1) was 72,60%, in group (2) was 73%, in (3) was 75% and 73% in (4). ANOVA results for FR: F = 0,65 (p: 0,58). The BR, defined as the relation between the total number of blastocysts over the number of fertilized oocytes in a cycle, was in group (1) 46,35%, in group (2) was 45%, in group (3) 46%, and in group (4) 42%. ANOVA results for BR F = 0,36 (p:0,78). The CPR in group (1) was 42,19%. Comparing with the other groups: group (2) was 37,09% (chi-square statistic=0,64 p:0,43); group (3) 34,58% (2,32 p:0,13); and group (4) was 32,43% (1,48 p:0,22). The MR in group (1) was 12,49%. Comparing with the other groups: group (2) was 18,55% (chi-square statistic=2,31 p:0,12); group (3) 14,94% (1,01 p:0,32); and group (4) was 15,85% (0,91 p:0,33). For all results analyzed there were not a statistically difference between groups.

Limitations, reasons for caution

The main limitation of this study was its retrospective design based on data from a single center which may be subject of bias.

Wider implications of the findings: Further large prospective studies are required to make meaningful comparisons. Our findings give no support for a general recommendation.

Trial registration number

Not applicable
P–076 Probability of sperm retrieval in azoospermic patients and mRNA expression profile of JMJD1A, TNP2 and PRM2 : in a subset of karachi population
Authors: Amjad S , Mushtaq S , Rehman R , Zahid N , Munir A , Siddiqui P Q R
Published: August 2021

Study question

To access successfulness of sperm retrieval by evaluating the mRNA expression profile of JMJD1A, TNP1, TNP2, PRM1 and PRM2 in patients undergoing surgical sperm retrieval procedure.

Summary answer

Probability of sperm retrieval in azoospermia is decreased when mRNA expression profile of JMJD1A TNP2 and PRM2 in testicular tissue is decreased.

What is known already

Studies have been done on expression of JMJD1A in non-obstructive azoospermic patients in other part of the world with smaller sample size but this is the first study in Pakistan with larger number of patients. Study design, size, duration: Crossectional study, 100 azoospermic patients coming for purpose of sperm retrieval by TESE or micro-TESE in Australian Concept Infertility Medical Center, Karachi,from March, 2018 to December, 2019

Participants/materials, setting, methods

All recruited azoospermic patients were evaluated by history, physical examination, and hormonal assessment. RNA was extracted by pureLink RNA Micro kit and mRNA expression of the JMJD1A, TNP1, TNP2, PRM1 and PRM2 genes was determined using innu-SCRIPT One Step RT_qPCR SyGreen kit. For quantitative variables independent t test and for categorical variables chi-square/ Fisher Exact test was used. Unadjusted and adjusted prevalence ratio were reported by using cox regression algorithm. Main results and the role of chance: The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. Azoospermic men in the successful sperm retrieval group had significantly decreased expression of JMJD1A (P < 0.001), TNP2(P < 0.001), and PRM2 (P 0.008). In addition to this regarding hormonal parameters: FSH (P 0.004), LH(P < 0.001), TSH(P<.011) were significantly different in azoospermic men with successful and unsuccessful sperm retrieval. In multivariate analysis, after adjusting for the other covariates, a significant association was found between JMJD1A, TNP2, PRM2 and successful sperm retrieval (p-value <0.05).

Limitations, reasons for caution

It is unicentric and outcomes for fertilization were not assessed. Azoospermic patients from multi-centeres were difficult because of lack of facility of sperm retrieval procedures at these centers and it was difficult to follow the fertrilization outcome.

Wider implications of the findings: This will be useful for making the decision in azoospermic men to proceed for ICSI or not. In addition to this, the repetition of unnecessary surgical procedures can be avoided, as the azoospermic men often undergo number of rounds of ICSI, with the hope of becoming biological father.

Trial registration number

non-clinical trials
P–086 High level of sperm DNA breaks in infertile men with varicocele: its association with sperm cells death, seminal oxidative stress, and spermatic parameters
Authors: Ammar O , Mehdi M
Published: August 2021

Study question

Our objectives were to determine the extent of nuclear sperm injury in varicocele patients with and without altered spermatic parameters and to investigate its relationship with apoptosis and oxidative stress.

Summary answer

Oxidative stress (OS) in the varicocele patients may play a role in the etiology of nuclear sperm DNA damage associated with apoptosis.

What is known already

Varicocele is associated with high level of DNA Breaks.

Study design, size, duration

Ejaculated sperm samples from 51 patients diagnosed with varicocele and 29 fertile men were examined. According to the guidelines, the patient’s sperm samples were classified into varicocele with normal semen parameters (n = 11) and varicocele with abnormal semen parameters (n = 40).

Participants/materials, setting, methods

Sperm DNA breaks was assessed using terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The proportion of both viable and dead spermatozoa with externalized phosphatidylserine was detected by the bivariate annexin V cy3/6-CFDA staining method. Seminal malondialdehyde (MDA) amounts and antioxidant enzymes activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were measured spectrophotometrically.

Main results and the role of chance

Sperm DNA Breaks, viable spermatozoa with externalized PS, and MDA levels were significantly higher in studied subgroups of patients with varicocele, either with normal or with abnormal semen parameters than controls. The seminal antioxidant enzymes activities were significantly reduced in both subgroups of patients with varicocele compared to the controls. The percentage of spermatozoa with fragmented DNA was positively correlated to the MDA level as well as the proportion of viable spermatozoa with externalized PS. However, the decreased seminal antioxidant status was negatively correlated with the increased proportion of sperm DNA fragmentation and apoptotic spermatozoa.

Limitations, reasons for caution

We suggest further comparative studies connecting the varicocele patients with and without altered spermatic parameters representing high level of DNA fragmentation with more apoptotic and oxidative stress markers.

Wider implications of the findings: This study reveals that impaired seminal antioxidant profile and increased seminal level of lipid peroxidation may be involved in the pathophysiological mechanisms of cell death-mediated DNA breaks in patients with varicocele.

Trial registration number

Not applicable
P–094 Kidney function impairment in primary infertile men
Authors: Fallara G , Boeri L , Candela L , Pozzi E , Belladelli F , Capogrosso P , Cazzaniga W , Ventimiglia E , Schifano N , Costa A , Cignoli D , Cornelius J , Mattei A , Montorsi F , Salonia A
Published: August 2021

Study question

We investigated the prevalence of kidney function impairment in a homogeneous cohort of white-European primary infertile men.

Summary answer

Mild kidney function impairment characteristics were found in 9% of asymptomatic and unaware patients presenting for primary infertility investigation.

What is known already

Infertile men have shown a worse overall health status compared to the fertile counterpart. We investigated the prevalence of kidney function impairment in a homogeneous cohort of white-European primary infertile men.

Study design, size, duration

In this corss-sectional study, complete clinical and laboratories data from a cohort of 557 consecutive men aged >18 years, presenting for primary infertility investigation were analyzed.

Participants/materials, setting, methods

Comorbidities (as scored with the Charlson Comorbidity Index (CCI)) were collected in each patient. Primary outcome was the presence of functional impairment of the kidney (defined as an estimated glomerular filtration rates <90 ml/min/1.73m², according to the Kidney Outcomes Quality Initiative). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) function was used for eGFR calculation. Logistic regression analyses tested the association between kidney function impairment and clinical and semen features.

Main results and the role of chance

Of 557, 51 (9.3%) patients depicted at least a mild loss of kidney function (eGFR<90 ml/min /1.73m²). Median [interquartile (IQR)] age was 38 (35–42) years for normal kidney function group vs. 41 (36–46.5) years for those with impaired renal function (p < 0.001). Those with impaired renal function had also a higher BMI [26.1 (24.4–27.8) vs. 24.9 (23.2–26.8); p = 0.002] and higher numbers of comorbidities [CCI≥ 1 in 11 (21.5%) vs. 40 (7.9%) patients (p < 0.001)]. Of note, they had more frequently history of hypertension [10 (19.6%) vs. 31 (6.1%), p = 0.001]. Groups did not differ in terms of hormonal and semen features. At logistic regression analysis, older age and CCI≥1 were associated with a higher risk of impaired eGFR (OR 1.06; 95%CI 1.01–1.11; p = 0.016 and OR 2.41; 95%CI 1.06–5.15; p = 0.028, respectively)(table). No association was found between sperm parameters and eGFR impairment (all p > 0.05), after accounting for age, CCI, BMI, FSH, testicular volume, and varicocele.

Limitations, reasons for caution

Mild kidney function impairment characteristics were found in 9% of asymptomatic and unaware patients presenting for primary infertility investigation. Age and the rate of comorbidities are associated with reduced eGFR. Wider implications of the findings: This novel finding confirms growing data on a significant association of male infertility with a poorer overall male health status.

Trial registration number

Not applicable
P–128 Audit of testicular sperm in assisted conception for non-azoospermic infertile couples
Authors: Merrett C , Schlager D , Yasmin E , Seshadri S , Serhal P , Ralph D , Sangster P
Published: August 2021

Study question

What live birth rate do we see when we use testicular sperm in ART for non-azoospermic couples after at least one previous failed cycle?

Summary answer

In our cohort of couples 24% had a live birth using testicular sperm and therefore was not higher than national average ART rates.

What is known already

There is increased interest in using testicular sperm in assisted reproduction technology (ART) to improve outcomes after previous failed cycles. Mehta et al. reported results of a 50% live birth rate using testicular sperm in the first cycle for couples with oligospermia and a history of failed cycles with ejaculated sperm. We aim to audit our results in a similar population of couples.

Study design, size, duration

St Peters Andrology Centre in London, United Kingdom completed 128 surgical testicular sperm retrievals reviewed between the two-year period of 2018–2019. We conducted a retrospective audit of their paper-based records to identify those couples with injectable sperm on their semen analysis and who had previous cycles attempts using ejaculated sperm.

Participants/materials, setting, methods

We identified 27 couples who underwent testicular sperm extraction despite having an ejaculated semen analysis with injectable sperm and at least one previous failed cycle. A systematic review of their paper and electronic medical record was conducted to assess live birth rates and fertilization rates from ART.

Main results and the role of chance

Couples had an average male age of 41 (range 31–60) and an average female age of 38 (range 30–45). The men had an average serum testosterone of 15 nmol/L (range 8–35 nmol/L) and an average serum FSH of 8.9 IU/L (range 1.7–30 IU/L). 59% (n = 17) of men had a DNA fragmentation index completed with an average score of 41% (range 31%–51[Y1]%). In the women the mean serum anti-Müllerian hormone (AMH) was 15.8 pmol/l (range 1–64 pmol/l). With ejaculated sperm the fertilization rate was 59% (95% CI [27%, 59%]) and blastocyst conversion rate was 43% (95% CI [50%, 69%]). There was no statistical significance with testicular sperm where the fertilization rate was 58% (95% CI [51%, 65%]) and blastocyst conversion rate was 54% (95% CI [40%, 67%]). Overall, there were 7 clinical pregnancies in this population of couples. Of these clinical pregnancies, 2 miscarried and 5 progressed to a live birth. This audit yielded a live birth rate per cycle of 15% and a live birth rate per couple of 24%.

Limitations, reasons for caution

Limitations of the study are low number of patients and absence of a control group.

Wider implications of the findings: We recommend caution and further analysis going forward using testicular sperm in ART where ejaculated sperm in available.

Trial registration number

Not applicable
P–147 The impact of blastocyst morphological parameters on live birth and singleton birthweight in single blastocyst transfer cycles
Authors: Wang X , Zhang S , Lin G
Published: August 2021

Study question

Does blastocyst morphological parameters: blastocyst expansion degree(Expansion), inner cell mass (ICM), and trophectoderm (TE) grades affect live birth and singleton birthweight in single blastocyst transfer cyles?

Summary answer

The effects of blastocyst morphological parameters on live birth and singleton birthweight are different between biopsied blastocysts cycles and non-biopsied blastocysts cycles.

What is known already

It has been known that blastocysts with highest scores for three blastocyst morphological parameters achieve highest pregnancy rates, however, very few studies have comparatively analysed the effect of individual parameters on live birth and singleton birthweight about single blastocyst transfer cycles.

Study design, size, duration

This retrospective study involved all single blastocyst transfers cycles and their live birth outcome and singleton birthweight during the period from January 2014 to August 2019 at a tertiary care center.

Participants/materials, setting, methods

A total of 28515 single blastocyst transfer cycles were available for analysis and were divided into four groups: biopsied blastocysts cycles (BBC), thawed blastocysts cycles(TBC), blastocysts from thawed cleavage embryos cycles(BTCEC) and fresh blastocysts cycles(FBC). The primary outcome were live birth and singleton birthweight. Multiple logistics regression and linear regression analyses were respectively performed to investigate the effect of blastocyst morphological parameters on live birth and birthweight after adjusting potential confounders.

Main results and the role of chance

While analyzing the effect on live birth, we found that live birth of grade B ICM were lower than grade A ICM , live birth of grade C TE were lower than grade A TE and Expansion doesn’t matter. Those result were same in three kinds of non-biopsied cycles. While all three parameters were statistically independently significant in biopsied blastocysts cycles.

While analyzing the effect on singleton birthweight, only Expansion was found to be statistically significant in biopsied blastocysts cycles, and birthweight of Expansion grade 5 was lower than Expansion grade 6(P = 0.005),with a mean difference of 57g(3375.12±527.91 versus 3318.42±510.33). Limitations, reasons for caution: Most blastocysts with poor grade, especially ICM grade C, were not transferred, then the effect of poor grade such as ICM grade C were still unknown.

Wider implications of the findings: The study identified the association between blastocyst morphological parameters and live rate and compared the relative importance of three parameters in different kind of cycles through large size comparative analysis, which would help selecting high-quality embryos for transfer.

Trial registration number

Not applicable
P–153 Comparison outcome of vitrified human embryos stored in vapor phase liquid nitrogen (LN2) and direct LN2
Authors: Park E A , Kang K Y , Lee J H , Lee J Y , Kim H S , Choi H S , Song G Y , Moon E H , Shiin M Y , Hur Y J , Yu E J , Kim R , Koong M K , Lee K A , Kim M J
Published: August 2021

Study question

Is vapor cryopreserved LN2 storage beneficial for clinical outcomes of vitrified human embryos that are frozen compared to vitrified human embryos having direct contact with LN2.

Summary answer

There are no significant differences compared to clinical outcomes of human embryos stored in LN2 vapor and direct store in LN2.

What is known already

There has been concerned about potential cross-contamination and biohazard issues of embryos for long term storage using direct LN2. This study aimed to compare clinical outcomes of human embryos transfer between vapor phase and liquid LN2.

Study design, size, duration

The embryo has undergone vitrification for long term storage with vapor or direct contact in LN2. After the thawing of the embryo, we checked on the survival rates. We transferred only one or two embryos per patient and kept analyzing the implantation and pregnancy rates

Participants/materials, setting, methods

This retrospective study was carried out from January 2018 to December 2019 with 3272cycles 4713embryos; vitrified for long term storage in vapor phase or direct contact with LN2. We compared the clinical outcomes of frozen embryo transfer cycles using vitrified for long term storage in vapor phase and direct contact with LN2. Clinical outcomes monitored were embryo survival, subsequent implantation and pregnancy after single or double embryo transfer

Main results and the role of chance

A total of 4713 fertilized human embryos are vitrified and then stored in LN2 vapor (n = 2520 cycles) or direct contact LN2 (n = 752 cycles). The study showed that the blastocyst stored in vapor able to retain full development. Survival was 97.8% (vapor) and 97.6% (direct contact LN2), and the vapor storage of human embryos had no significant difference in survival rates after a long term storage. For single blastocyst transfer, pregnancy and implantation rates were 51.5%, 52.4% in vapor, 54.6%, 54.9% in direct LN2; respectively (p=NS). In double blastocyst transfer, the pregnancy and implantation rates were 61.8%, 42.0% in vapor and 64.7%, 44.5% in direct LN2; respectively (p=NS). There were also no significant differences between two groups.

Limitations, reasons for caution

The study showed that the blastocyst stored in vapor can retain full development. A vapor storage system thus is safe and effective for long term vapor storage of vitrified human embryos.Within the limits of this study, there was no detection of an adverse effect of vapor storage.

Wider implications of the findings: Vapor storage systems thus represent a useful alternative for safe and effective long-term storage of vitrified human embryos that can avoid cross contamination chances from having direct contact with LN2.

Trial registration number

Not applicable
P–162 Laser-assisted collapse of blastocysts prior to vitrification improves clinical outcomes
Authors: Ten J , Guerrero J , Rodríguez-Arnedo A , Martí L , Herreros M , Díaz N , Sellers R , Tió M C , Bernabeu A , Llácer J , Bernabeu R
Published: August 2021

Study question

What is the effect of artificial laser-assisted collapse before vitrification on pregnancy and implantation rates after transfer of vitrified-warmed blastocysts?

Summary answer

The artificial shrinkage by laser-induced collapse before vitrification significantly increased the implantation and clinical pregnancy rates after single thawed embryo transfer.

What is known already

Freeze all, cycle segmentation and, in general, single embryo transfer (SET) strategies (for example trophectoderm biopsy-based aneuploidy testing) have targeted blastocysts vitrification as the best option for reproductive practice worldwide. Artificial shrinkage seems to be a pre-vitrification parameter associated with an increased embryo survival after warming and implantation rate. However, the available medical evidence shows controversial results with only a limited number of prospective studies assessing the subject.

Study design, size, duration

This prospective cohort study evaluated 394 women who underwent a frozen blastocyst transfer at Instituto Bernabeu between July and December 2020. All patients were prepared with substitutive cycle and received single blastocyst embryo transfers.

Participants/materials, setting, methods

Before embryo vitrification on day 5 of development, some expanded and/or early hatching blastocysts (A/B ASEBIR categories) were artificial laser-assisted collapsed. (n = 83, study group). 311 embryos of the same quality and day of development were not collapsed (control group). We compared the embryo survival rate, clinical, implantation and miscarriage rates between groups. The statistical analysis was performed using SPSS (version 20.0).

Main results and the role of chance

The two groups were comparable in terms of maternal age (39.79 ± 3.83, control group; 40.21 ± 4.45, study group; p = 0.341). Embryo survival rate resulted in 100% in both groups.

Regarding clinical outcomes, collapsed blastocysts significantly increased the positive pregnancy test and the clinical pregnancy and implantation rate compared to the control group, respectively (positive test: 69,9% vs 43,4%, p = 0.000018, odds ratio (OR)= 3.02 [95% CI 1.80–5.08]; clinical pregnancy and implantation: 56,6% vs 35,4%, p = 0.000041, OR = 2.39 [95% CI 1.46–3.90]). The miscarriage rate was not affected by the blastocyst collapse effect (23,6% in the control group vs 27,6% in the study group, p = 0.593, OR = 1.23 [95% CI 0.57–2.68]).

Limitations, reasons for caution

This is a non-randomized controlled study. Additional RCTs are warranted to corroborate our findings.

Wider implications of the findings: Considering the large number of blastocyst vitrification cycles that are carried out worldwide, artificial laser-assisted collapse before vitrification has the potential to increase the clinical results in benefit of many patients.

Trial registration number

Not applicable
P–249 Does the re-expansion of thawed embryos affect the clinical outcomes of human blastocyst vitrification?
Authors: Huong T , Ph. Th. Tú A , Mai L H , Doã. Thảo N , Mạnh C A
Published: August 2021

Study question

Is that essential for prolonged culture of thawed blastocysts in order to be fully re-expanded before transferring?

Summary answer

Ongoing pregnancy rates decreased in blastocysts that not fully re-expanded after thawing. What is known already: The thaw survival of blastocysts is examined based on morphology of inner cell mass (ICM) and trophectoderm (TE). However, thawed blastocysts experience multiple changes in morphology and might be collapse after thawing due to the presence of blastocoel cavity. It is then difficult to evaluate blastocyst quality. Therefore, the blastocyst re-expansion is considered as a criteria to assess quickly the competent embryos. It also reflects the status energy metabolism from high quality embryo. After all, there are still some controversial opinions about the influence of re-expansion status after thawing.

Study design, size, duration

This was a retrospective study based on data collected between October 2019 and December 2020. A total 528 thawed blastocysts which were divided into two groups according to the post-thaw reexpansion status: fully re-expanded blastocysts (n = 416), partial or no re-expanded blastocysts (n = 112). The re-expansion status of blastocyst was assess prior to loading on the catheter by senior embryologists.

Participants/materials, setting, methods

Primary outcome is ongoing pregnancy. Only frozen single D5 transfer cycles were included. We excluded the frozen sperm/oocytes/embryos donation cycles, missing data, non-intact embryos after thawing. Statistical analyses were performed with T or chi-squared tests. Multivariable regression analysis was performed adjusting for the following confounding factors: age, BMI, embryo quality, re-expansion status, biopsied blastocyst.

Main results and the role of chance

Female age, BMI, number of previous cycles, endometrial thickness, positive HCG results, clinical pregnancy rate were comparable among patients within two groups. The rate of ongoing pregnancy rate in group 1 was significant higher compared with group 2 (51 vs 40.2, p < 0.05). The number of good quality blastocyst transferred in group 1 was higher than in group 2 (p < 0.001). However, under the same embryo quality, there were no difference between clinical pregnancy rate and ongoing pregnancy rate between two groups. When logistic regression were performed: only embryo quality, but not the re-expansion status, was noted to be an independent predictor of ongoing pregnancy (OR = 3.53;95% CI; 1.734–7.184;p=0.001).

Limitations, reasons for caution

The main limitation of the study is its retrospective design.

Wider implications of the findings: Clinical outcomes are comparable between re-expanded blastocyst and partial or no re-expanded blastocysts, although ongoing pregnancy can be improved when embryos are fully expanded. As expected, blastocysts quality has the most important impact on ongoing pregnancy rate.

Trial registration number

Not applicable
P–281 Is it worth to go to blastocyst when there are less than 4 embryos on day 3?
Authors: Gonzale. Marti B , Pessah C , Entezami F
Published: August 2021

Study question

Are pregnancy rates similar with blastocyst transfer compared to D3 transfer for patient with a poor embryo yield.

Summary answer

In poor prognosis patients, more D3 embryos are needed to result in similar outcome compared to single blastocyst and it increases the multiple pregnancy risk.

What is known already

Good prognosis patients benefit from a blastocyst transfer rather than cleavage-stage embryo because day 3 morphology has limited predictive value for subsequent developmental. A Cochrane meta-analysis in 2016 found a higher live birth rate per transfer in the blastocyst group compared to cleavage-stage and no difference in miscarriage and multiple pregnancies.

However, in unselected patients, studies have yielded conflicting results and especially in poor prognosis patients at risk of transfer cancellation.

A threshold of four good embryos on the third day has been previously correlated with blastocyst yield and live birth rate compared with cleavage-stage embryo transfer.

Study design, size, duration

We analyzed the outcome of 1115 cycles with less than 4 embryos during 2019–2020 and compared the results between two groups of D3 and D5 transfers.

Participants/materials, setting, methods

Amongst 1115 study cycles, in 691 cycles a D3 transfer was performed and in 424 cycles a D5 transfer was performed. We compared transfer cancellation rates, mean number of transferred embryos and ongoing pregnancy rates between the two groups and also in subgroups with female age <37 and female age >37. The statistical analyses were done by Chi square and t-test for paired samples.

Main results and the role of chance

In the overall study population, the mean female age was 36.3 ± 4.3 years, the mean number of obtained embryos was 2.4 ± 1.0, the mean number of transferred embryos was 1.4 ± 0.8. 17.2% of the cycles resulted in transfer cancellation (6.2% in D3 transfer group and 35.0% in D5 transfer group). After D3 transfer the ongoing pregnancy rate (OPR) per transfer was 21.5% compared to 39.7% in D5 transfers (p < 0.05). A similar pattern was observed in subgroups of age <37 years and >37 years with OPR per transfer significantly higher when D5 transfer was performed. Notably more embryos were transferred on D3 compared to D5 (mean number 1.4 for D3 and 1 for D5). Nonetheless, OPR were similar per cycle in both groups and subgroups of different ages.

Limitations, reasons for caution

A prospective randomized controlled trial is needed to confirm these results that are consistent with previously reports on retrospective and observational studies.

Wider implications of the findings: In poor prognosis patients with low embryo yield, D3 and D5 transfers result in similar OPR per cycle. Transferring at blastocyst stage is not inferior to D3, despite the high cancellation rate, and appears safer permitting a single embryo transfer to avoid multiple pregnancy.

Trial registration number

Not applicable
P–354 Analysis of pregnancy and miscarriage rates in anti-centromere antibodies (ACA)-positive patients treated with ART
Authors: Kida Y , Tokoro M , Kitasaka H , Yoshimura T , Fukunaga N , Asada Y
Published: August 2021

Study question

Do ACA have an effect on pregnancy and miscarriage rates of human embryos?

Summary answer

The present results suggest that in ACA-positive cases, the pregnancy rate per transfer was significantly lower, although the miscarriage rate was not affected.

What is known already

We have previously shown that patients with high levels of anti-centromere antibody (ACA), (one of the anti-nuclear antibodies (ANA)), frequently have dispersal of the female chromosomes in the cytoplasm. Additionally, we reported that the clinical outcome was characterized by a low oocyte maturation rate following ovum pick up and high multiple pronuclear formation rate after fertilization. However, the post-implantation course of embryos with ACA-positive cases has not yet been reported. Therefore, in this study, we analyzed the pregnancy and miscarriage rates in ACA-positive patients treated with Assisted Reproductive Technologies (ART).

Study design, size, duration

6581 patients who underwent embryo transfer after antinuclear antibody testing between January 2014 and February 2020 were included in the analysis.

Participants/materials, setting, methods

The subjects were classified into three groups: ANA-negative (without ACA or any other ANA), ACA-positive (with only ACA) and ANA-positive (with ANA but not ACA). The cycle in which the gestational sac was confirmed was considered a positive pregnancy. The pregnancy and miscarriage rates were compared among the groups using “Ryan Test” for statistical analysis.

Main results and the role of chance

Of the 6581 eligible cases, the incidence of antinuclear antibody were 71.3% (4695/6581; ANA-negative), 0.9% (61/6581; ACA-positive) and 27.7% (1825/6581; ANA-positive). The pregnancy rates based on the total number of embryo transfer cycles for each were ANA-negative: 31.5% (5283/16792), ACA-positive: 17.6% (41/233), and ANA-positive: 32.4% (1891/5833). The pregnancy rates were significantly lower in the ACA-positive group than in the other groups. The miscarriage rate was 29.4% (1553/5283) in ANA-negative, 31.7% (13/41) in ACA-positive, and 28.0% (529/1891) in ANA-positive, with no significant difference between the three groups.

Limitations, reasons for caution

Retrospective analysis

Wider implications of the findings: ACA-positive patients may benefit from a treatment strategy to increase the absolute number of oocytes by obtained in order to increase the chances of normal fertilization and attainment of implantation.

Trial registration number

none