bluuebunny/crossref_metadata_2025 huggingface dataset:
#328 : Fertilization and Embryo Quality of Human Mature Oocytes with Morphological Abnormalities After Intracytoplasmic Sperm Injection (ICSI)
Authors: Sudiman Jaqueline , Adnyana IB Putra , Widianti I Gusti Ayu , Suardika Anom
Published: January 2024

Background and Aims: The dysmorphism of oocytes either extra or intracytoplasmic could decrease viability and developmental competence of oocytes. There are several reports describing that specific dysmorphisms are related with decrease in fertilization and embryo competence. The aim of this research is to investigate fertilization and embryo quality of specific dysmorphic mature oocytes obtained from ICSI.

Method: A retrospective analysis was performed in 183 patients with 1700 mature oocytes. Mature oocytes were classified as normal morphology (control), oocytes with intra-cytoplasmic dysmorphism (fragile oocytes, inclusion bodies, vacuoles, mild granularity of cytoplasm, severe granularity of cytoplasm, and central granulation), and oocytes with extra-cytoplasmic dysmorphism (granulation in perivitelline space, polar body fragmentation, large perivitelline space, and abnormal zona pellucida). All oocytes were inseminated with ICSI. Oocytes were cultured and scored on day 3 then some of them were transferred. The rest of oocytes were extended culture until day 5. Day 3 embryos were classified based on grading by Kamardi et al., 2021. Grade 1 and 2 embryos are considered good quality embryos. Day 5 embryos were classified based on modified grading by Gardner and Schoolcraft., 1999.

Results: Overall, fertilization rate was significantly lower in the dysmorphic oocytes compared to control (P<0.01). Good quality embryo development on day 3 was significantly lower in oocytes with severe granularity of cytoplasm compared to control (P<0.05). Looking at embryo development on day 5, oocytes with inclusion bodies and central granulation had significantly lower on good quality blastocyst (P<0.05).

Conclusion: The fertilization potential of dysmorphic oocytes in our study was lower compared to normal morphology oocytes, however, only severe granularity of cytoplasm, inclusion bodies and central granulation related with poor embryo quality on day 3 and day 5. In this study, we were able to define several specific of oocyte dimorphism related with lower fertilization and embryo quality.
#368 : Non-Invasive PGT: A Preliminary Experience
Authors: Kanoi Rashi , Ramakrishna Sujatha , Gutgutia Rohit
Published: January 2024

Background and Aims: Trophectoderm biopsy is an invasive procedure, triggering concerns about its impact on embryo viability and implantation potential. The discovery of cell-free embryonic DNA in spent culture medium could serve as a non-invasive method to analyze the chromosomal status of embryos and provide a better representation of the entire embryo since the DNA originates from both ICM and TE.

We aimed to retrospectively analyze the reliability of carrying out non-invasive PGT (niPGT) on a group of patients and see if this procedure can be offered to those undergoing IVF-PGT cycles as a safer alternative.

Method: Test group embryos (N=23) underwent non-invasive PGT by spent blastocyst media analysis and were compared with control group embryos (N=25) subjected to invasive PGT. Clinical history and age of women from both groups were similar. Spent media was extracted as per the genomic partner’s instructions. Data was collected from cycles that took place from April 2022 to November 2022.

Results: PGT results of embryos from both groups were compared and were as follows: euploid embryos were lower (34.7% vs. 48%); aneuploid (43.4% vs. 44%) and no DNA detected embryos (4.3% vs. 4%) were similar; non-informative embryos were higher (17.4% vs. 0%) in test group as compared to control.

Conclusion: Our initial findings suggest that detection capabilities of niPGT could be limited as we are losing out on some embryos due to higher non-informative/no DNA detected results and lower number of euploid embryos. However, this is a retrospective study assessing preliminary usage of a new technology for non-invasive genomic testing and the sample size is small to draw a definitive conclusion. A prospective study with a larger sample size is needed to confirm our findings and see if this method can be a suitable alternative to PGT.
#386 : Warming Vitrified Oocytes in a Fraction of the Current Required Time Results in Superior Survival Rates
Authors: Brewer Amber , Guerrero Carlos , VerMilyea Lindsey
Published: January 2024

Background and Aims: Oocyte vitrification and warming is very time consuming. Oocyte vitrification protocols are different from that of embryos or blastocysts, while warming protocols allow all to be warmed the same. For blastocysts, frequently only one device is warmed per patient; however, numerous devices are required in oocyte warming. We aim to evaluate whether vitrified oocytes can successfully survive a warming protocol involving only Thawing Solution (TS) with a total elapsed warming time of a mere 90 seconds.

Methods: 58 vitrified donor oocytes (Treatment Group) were prospectively warmed in January 2023. 71 vitrified donor oocytes (Control Group) warmed in 2022 were retrospectively analyzed.

Both groups were vitrified in Kitazato or Irvine Scientific Vit Kit with identical protocols (elapsed time approximately 17-minutes). In both groups the TS was equilibrated to 37-degrees for a minimum of 2-hours. The Control Group was warmed in Irvine Scientific Vit Kit (1-minute TS, 3-minute DS, 8-minute WS) for a total warming time of 12-minutes. Warming for the Treatment Group was in Irvine Scientific Vit Kit Warm-NX, TS only, for 90-seconds.

Results: After Chi-square analysis, [Formula: see text] value < 0.05 reflected significance. The Control Group warmed with 90.1% survival. The Treatment Group resulted in 98.3% survival, ([Formula: see text] -value = 0.056). Survival at 3-hours post warm in the Control Group was 100%. At this point for the Control Group, ICSI was performed, and the oocytes placed back into the incubator for resulting embryo culture. For the Treatment Group, oocyte survival was re-assessed at 1-hour and 24-hours, and 100% survival was maintained over the course of 24-hour incubation, with little-to-no visible cryo-damage.

Conclusions: Vitrified oocytes exhibit outstanding survival when warmed with a highly modified and considerably faster protocol than current practice. The extended oocyte survival of at least 24-hours shows a very favorable outcome for the accelerated warming protocol and gives credibility to the survival assessment.
#17 : Clinical Efficacy of IVIG Depending on the Peripheral Blood NK Cell Proportions in Women with Recurrent Pregnancy Loss
Authors: Hur YooJin , Lee Ji Sun , KIM Dong Ja , Lee Taek Hoo , Park Joon Cheol
Published: January 2024

Backgrounds and Aims: Etiology of repeat pregnancy loss (RPL) is complex, approximately 50% of cases of RPL had been classified as unexplained. Nowadays, elevated peripheral blood NK cell proportions are supposed to be related to RPL, and IVIG could down-regulate the NK cell levels. However, the efficacy of IVIG in RPL women is still under debates. The aims of this study were to evaluate the clinical outcomes of IVIG in RPL women with elevated peripheral blood NK cell proportions (PbNK), and to analyze the efficacy depending on the levels of PbNK.

Methods: In this retrospective study, 916 women suffered two more miscarriages were evaluated from Jan. 2002 to Aug. 2022. After excluding the genetic, anatomic, endocrinologic causes and antiphospholipid antibody syndrome, 383 unexplained RPL women with elevated PbNK were enrolled. IVIG were treated 400 mg/kg in every three weeks, started right after a positive pregnancy test. Clinical pregnancy outcomes and miscarriage were evaluated.

Results: Mean age of enrolled women was 35.24±4.31 years old, mean parity was 0.15±0.36 and mean number of miscarriages was 2.79±1.46 (min 2–max 14). Mean PbNK was 17.74±5.82 (12.0–45.3%). During the IVIG infusion, no serious side effects were found. Among 238 pregnant women, 48 women suffered miscarriage unfortunately. Excluding the termination cases related with chromosomal abnormality and congenital anomalies, live birth rate was 80.9%. In 4 subgroups (NK<15%, 15–20%, 20–25%, <25%), the live birth rates tended to decrease as the PbNK increased, statistically insignificant (84.0%, 82.1%, 72.5%, 65.0%). Mean gestational weeks (GW), preterm birth rates under 37th GW and preterm birth rates under 34th GW were similar in each group.

Conclusion: IVIG treatment in RPL women with elevated peripheral blood NK cell proportions could be beneficial without serious side effects. Even in higher elevated level of NK cell proportion, it could be effective as well.
#141 : Enhanced Luteal Support Following IVF/ICSI for Women with Two or More Good-Quality Embryo Transfer Failures Using Both Subcutaneous and Vaginal Progesterone: A Retrospective Cohort Study
Authors: Dao Viet Quoc , Da Silva Sarah Martins
Published: January 2024

Background and Aims: Utilizing progesterone to support the luteal phase (LP) in in vitro fertilization is a well-established practice. Subcutaneous progesterone (SC-P) administration has shown pregnancy rates comparable to vaginal progesterone (Vag-P). However, data are not available regarding the efficacy of combining SC-P with Vag-P for women with multiple good-quality embryo transfer (ET) failures. Therefore, this study aims to evaluate the effectiveness of adding SC-P to Vag-P in women who had not conceived following two or more good-quality ETs.

Method: A retrospective cohort analysis of data collected from a university-affiliated fertility centre in the UK between January 2020 to May 2022. A total of 224 embryo transfer cycles, including 65 fresh embryo transfer (fresh-ET) cycles and 159 frozen embryo transfer (FET) cycles in women who had not conceived or experienced miscarriages following two or more good-quality ETs, were analysed. The luteal support protocol was either micronized Vag-P (gel 90mg daily in fresh-ET cycles or pessaries 800mg daily in FET cycles) plus SC-P 25mg once daily (enhanced group) or Vag-P alone (control group). The pregnancy outcomes between the two groups were compared. Clinical pregnancy rates (CPR) represented the primary outcome.

Results: In fresh-ET cycles, the enhanced group resulted in higher CPR than the control group. However, statistical significance was not achieved (40% (14/35) vs. 30% (9/30), p=0.40; multivariate analysis adjusted OR 1.54, 95% CI 0.48–4.93, p=0.468). In FET cycles, CPRs were comparable between the enhanced group and the control group (32.3% (21/65) vs. 31.9 % (30/94), p=0.958; multivariate analysis adjusted OR 0.98, 95% CI 0.47–2.03, p=0.953). In both fresh and frozen cycles, no significant difference was observed regarding the positive pregnancy test and miscarriage rates between the two groups.

Conclusion: Adding SC-P to Vag-P did not improve pregnancy outcomes for women who had not conceived following two or more good-quality ETs.
#194 : Predictive Value of Serum Kisspeptin in Early First Trimester Pregnancy During IVF Treatment: A Prospective Study
Authors: Li He
Published: January 2024

Background and Aims: Kisspeptin is an emerging biomarker for the discrimination of viable pregnancy. The aim of the study is to determine whether serum kisspeptin can predict the first trimester miscarriage and compare it with serum hCG in the prediction of the first trimester miscarriage.

Method: This study is a prospective case-control design including 178 women who had experienced early miscarriage (n = 21) and viable single pregnancy (n = 157), following frozen-thawed transfer (FET) from May 2019 to December 2019. Serum samples on 14 days, 21 days and 28 days after FET were collected for kisspeptin and hCG detection. Trial registration number: NCT03940495

Results: On day 21 after FET, serum kisspeptin levels were significantly lower in the early miscarriage group [0.260(0.185-0.375)] vs in the viable single pregnancy group [0.370(0.280–0.495)] (p=0.005). Similar results were showed on day 28 after FET, the serum kisspeptin levels were significantly lower in the early miscarriage group [0.27(0.2–0.33)] vs in the viable single pregnancy group [0.670(0.455–1.235)] (p<0.001). But on day 14 after FET, serum kisspeptin levels were comparable in the early miscarriage group [0.260(0.210–0.325)] and in the viable single pregnancy group [0.280(0.215–0.340)] (p=0.551). Serum kisspeptin levels on day 21 and 28 have a poor predictive value of miscarriage compared with serum hCG levels. [Day 21: area under the curve = 0.687 (kisspeptin) and 0.816 (hCG); Day 28: area under the curve = 0.896 (kisspeptin) and 0.909 (hCG)].

Conclusion: Serum kisspeptin on day 14 failed to discriminate between miscarriage and ongoing pregnancies, and on day 21, 28 has a poor predictive value of miscarriage.

Funding: This study was supported by the Special Project for Clinical Research in the Health Industry of the Shanghai Municipal Health Commission (20194Y0036).
#207 : Mendelian Randomization Study Reveals a Casual Effect of Blood Lipids and Apolipoprotein on Uterine Fibroids
Authors: Liu Yanxu
Published: January 2024

Background and Aims: Despite an early insight into the risk factors of uterine fibroids (UFs), there is still controversy about the roles of blood lipids and apolipoprotein on UFs. Therefore, to provide more reliable evidence, we investigated the causal effect of blood lipids and apolipoprotein on the risk of UFs through Mendelian randomization (MR).

Method: We utilized the large genome-wide association studies of blood lipids and apolipoprotein as instruments and integrated them in the inverse-variance-weighted (IVW) model in two-sample MR to investigate their causal relationship in large sample sizes. To eliminate potential pleiotropy, we listed a conclusive table of genes related to confounding factors, such as body mass index, waist circumference, blood pressure, glucose, hypertension, the metabolic syndrome and smoking and removed the repeated SNPs in the exposure data.To adjust for multiple comparisons, the statistical significance of the MR effect estimates was evaluated in a false discovery rate correlation of less than 5%. Neither pleiotropy nor heterogeneity was reported in all MR sensitivity analysis, including IVW, MR-Egger, simple median, weighted median, weighted mode and Mendelian Randomization Pleiotropy Residual Sum and Outlier methods.

Results: Total triglycerides, very low-density lipoprotein (VLDL) cholesterol, including large, medium and small VLDL particles and free cholesterol in large VLDL cholesterol showed positive association with UFs. Meanwhile, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1, free cholesterol in small and medium VLDL and total cholesterol are not statistically related to the development of UFs.

Conclusion: Exposure to various aberrant blood lipids increases the risk of UFs, providing genetic evidence for the vital role of aberrant lipid levels in the pathogenesis of UFs. Meanwhile, our results provided genetic insights suggesting intervention in blood lipids might be a prospective strategy in the early prevention and treatment of UFs.
#346 : A 5-Year Retrospective Cross-Sectional Study on theAssociation of Obesity with Myoma Uteri, Endometrial Polyps, Adenomyosis and Polycystic Ovarian Syndrome
Authors: Defensor Pamela Grace
Published: January 2024

Background and Aims: To assess the association of obesity with myoma uteri, endometrial polyp, adenomyosis and polycystic ovary syndrome (PCOS)

Method: A retrospective cross-sectional study was performed on a cohort of 586 women consulting at the outpatient department of a tertiary government institution from 2016 to 2020. Age-adjusted logistic regression models were used to assess the association of obesity with the diseases.

Results: No significant association between obesity and myoma uteri (p:0.91), endometrial polyp (p:0.49) and adenomyosis (p:0.56) were observed. A direct association between obesity and PCOS (p<0.01) was observed wherein obese women were five times more likely to have PCOS than non-obese women, regardless of age.

Conclusion: There is no association between obesity and myoma uteri, endometrial polyp and adenomyosis in obese Filipino women. Age seems to have a more direct association in the presence of these diseases. There is a direct association of obesity and polycystic ovary syndrome.
#382 : Congenital Adrenal Hyperplasia with Concomitant Mullerian Agenesis: A Rare Occurance in 46 XX Disorders of Sexual Development (DSD)
Authors: Wahyuni Zulfia , Yuad Haviz
Published: January 2024

Background and Aims: The most common cause of 46 XX DSD is due to congenital adrenal hyperplasia with varying degree of virilization. Females with CAH do not produce anti mullerian hormone (AMH), therefore the internal genitalia, which are mullerian derivatives, are develop normally. We report a unique case of CAH with absent uterus, cervix, and fallopian tube.

Method: The clinical, laboratory, and imaging findings of the patient are presented with literature review.

Results: We report an ongoing case of a 20-year-old patient with ambiguous genitalia and primary amenorrhea. She was born from a healthy mother and raised as a female. There was no family history of the same disorder. On physical examination we found that she had normal height, normal blood pressure, palatoschizis, undeveloped breast (Tanner stage 1), and clitoral virilization with single urovaginal opening (Prader stage 3). We performed a G-Banded chromosome analysis, with 46 XX results. Laboratory test showed her 17-hidroxyprogesterone level was 176,93 ng/ml, FSH level was 3,06 mIU/ml, LH level was 2,21 mIU/ml, and estradiol level was 18,0 pg/mL. Ultrasound imaging revealed the absence of uterus, cervix, and vagina, as well as abnormal appearance of ovarium. We have planned to perform a complete MRI study for other anomalies as we suspected this patient had Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome type II.

Conclusion: In the presence of external genitalia and urinary tract malformations in patients with CAH, it is important to investigate for possible associated mullerian anomalies. A comprehensive approach in diagnosis could lead to a better outcome in a patient’s treatment and wellbeing.
#6 : Effects of Co-Treatment of GnRH-Analog Alone or in Combination with Aromatase Inhibitor or Progestin on Endometrial - Integrin Expressions in Women with Recurrent Miscarriage
Authors: Ahmad Mohd Faizal
Published: January 2024

Background and Aims: Recurrent miscarriage (RM) is postulated caused by endometrium receptivity. We aimed to assess the expression of ανβ3 integrin in endometrium tissue during the window of implantation (WOI) following GnRH analog alone or in combination with either aromatase inhibitor (AI) or progestin (PrG) to consolidate the outcome.

Method: A randomized control trial (RCT) was done in Hospital Canselor Tuanku Muhriz (HCTM) UKM. Women with RM were divided into three groups - Group I-GnRHa, Group II–GnRHa + AI, or Group III–GnRa + PrG. The endometrial tissue biopsy was taken during the luteal phase (between LH+7 and LH+9), then repeated biopsy post-treatment. The ανβ3 integrin expression was evaluated for pre- and post-treatment. The intensity and distribution in endometrial glands were done using HSCORE system.

Results: 39 women with RM were included with 13 in each group. The mean age was older in Group I; 38.00 ± 4.9 years old with mean BMI of 25.7 ± 2.44 kg/m2. Group II had significantly the highest intensity and distribution of ανβ3 integrin expression > 50 following the treatment; from 28.6% to 42.9% (p < 0.05), and an increase in HSCORE following the treatment from 1.82 ± 0.70 to 2.36 ± 0.56 (p < 0.05). Meanwhile, Group I HSCORE noted was elevated; from 1.90 ± 0.91 to 2.29 ± 0.77, and Group III was also elevated from 1.67 ± 0.77 to 1.90 ± 0.87. However, all were not statistically significant (p > 0.05).

Conclusion: The ανβ3 integrin expression can be significantly elevated with GnRHa and AI as pre-treatment, thus aiming for better implantation results among women with RM.
#106 : The Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients with Poor Ovarian Response: A Systematic Review and Meta-Analysis
Authors: Liu Jiajia , Gao Mingxia
Published: January 2024

Background and Aims: Poor ovarian response (POR) is a pathological condition characterized by a reduced ovarian response to gonadotropin stimulation. This condition presents with a low number of developed follicles during the ovulation induction cycle, low blood estradiol (E2) peak, high gonadotropin dosage, fewer retrieved oocytes, increased cycle cancellation rate, and low clinical pregnancy rate. POR is a significant challenge in assisted reproductive technology. Autologous platelet-rich plasma (PRP) has emerged as a potential therapy for POR, but its efficacy remains controversial. This meta-analysis aims to determine the effect of intraovarian infusion of PRP on ovarian reserve and pregnancy outcomes in patients with POR.

Methods: This study was designed as a Meta-analysis. Women diagnosed with POR based on POSEIDON or Bologna criteria were included. Primary outcomes included anti-Müllerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 levels, while secondary outcomes were the number of retrieved oocytes and embryo quality.

Results: Seven prospective cohort studies involving 202 participants were included. Intra-ovarian infusion of autologous PRP significantly increased AMH (SMD: 0.20, 95% CI: 0.05–0.36; P=0.01), AFC (SMD: 0.92, 95% CI: 0.59–1.25, P<0.05), and E2 (SMD: 3.46, 95% CI: 1.13–5.79; P=0.004) levels in patients with POR. PRP also decreased LH levels in POR (SMD: −1.17, 95% CI: −2.28 to −0.06; P=0.04). However, no statistically significant effect on FSH levels in POR was observed (SMD: −0.17, 95% CI: −0.78 to 0.44; P=0.59). Furthermore, PRP positively impacted the number of retrieved oocytes and embryo quality in IVF cycle patients.

Conclusion: This meta-analysis indicates that intra-ovarian injection of autologous PRP can improve ovarian reserve and pregnancy outcomes in patients with POR.
#107 : Association Between COVID-19 Vaccination Status and Spontaneous Abortion in Pregnant Women
Authors: Simanjuntak Leo , Simanjuntak Benhard Christopher
Published: January 2024

Background and Aims: Pregnant women are at greater risks for morbidity and mortality if infected by the COVID-19. Vaccination is critical in mitigating the risks. However, there is still limited data around safety profiles of COVID-19 vaccines in pregnant women especially in Indonesia. Therefore, this study is aimed to determine the association of COVID-19 vaccination status on the occurrence of spontaneous abortion in pregnant women in Indonesia.

Method: This cross-sectional study was carried out from March-June 2022 at a private maternity clinic in Medan, Indonesia. Participants who agreed to participate were asked to sign the informed consent. Participants then were interviewed, and their diagnosis was confirmed using ultrasonography. Demographic data, vaccination status, parity, gestational age and the diagnosis were collected and statistically analyzed. The Chi-square test or Fisher’s exact test were done to analyze the categorical variables.

Results: Of the 319 participants, 267 (84%) vaccinated and 52 (16%) unvaccinated. All the vaccinated participants received at least 1 dose to 3 doses of COVID-19 vaccine before pregnancy confirmation. There were 70 (22%) participants with spontaneous abortion and 249 (78%) with normal pregnancy. All our participants were having < 20 weeks of gestation, and majority were in reproductive age (82%) and primiparous (55%). Multiparity or gestational age were associated with spontaneous abortion occurrence (p < 0.05). We did not find association between pregnant women vaccination status and spontaneous abortion occurrence (p > 0.05).

Conclusion: Our data indicated that COVID-19 vaccination history was not associated with spontaneous abortion occurrence, and thus, adding information regarding the safety of COVID-19 vaccination in pregnancy, especially in Indonesia.
#143 : Assessment of Ovarian Reserve in Infertile Women with Hypothyroidism
Authors: Shima Umme Tahmina
Published: January 2024

Background: Impaired thyroid function may affect the follicular growth and development and reduces the number of follicles in ovaries. Thus, hypothyroidism may cause the reduction of ovarian reserve in women with reproductive age group. This study aimed to assess the ovarian reserve in infertile hypothyroid women.

Methods: This cross-sectional study was conducted in Reproductive Endocrinology and Infertility Unit, Dhaka Medical College Hospital, Bangladesh from July 2021 to June 2022. Total 167 hypothyroid infertile women of 20–35 years of age who had S. TSH level >2.5 mIU/L with normal/low free T4 were included. Ovarian reserve was evaluated by serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). Thyroid autoimmunity was also assessed by measuring anti thyroid per oxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). Then the relationship of ovarian reserve, thyroid hormones and anti-thyroid antibodies were assessed.

Results: Among the 167 women with hypothyroidism, 124 (74.3%) patients had sub-clinical hypothyroidism (SCH) and rest 43 (25.7%) had overt hypothyroidism. Infertile women with overt hypothyroidism had significantly higher TPOAb(+) (67.4%) and TgAb (+) (46.5%) than those of subclinical hypothyroid women (TPOAb+ve : 29%, TgAb+ve : 29.8%, p-value: 0.014). Correlation analysis showed that there was significant negative correlation between AMH and TSH (r: −0.029, p-value: 0.024), TPOAb (r: −0.053, p value: 0.011), TgAb (r: −0.083, p-value: 0.018). Diminished ovarian reserve was significantly associated with overt hypothyroidism in this study population (p-value: 0.001). 33(26.6%) and 23(53.5%) of SCH and overt hypothyroid women had diminished ovarian reserve respectively.

Conclusion: Anti-Mullerian hormone was negatively associated with increased TSH level and with anti-thyroid antibodies (TPOAb and TgAb). Diminished ovarian reserve was significantly associated overt hypothyroidism. So, the study findings suggest that hypothyroidism has a negative effect on ovarian reserve.
#196 : Office Hysteroscopy Results in Patients with Recurrent Implantation Failure at Tam Anh General Hospital
Authors: Vu Thi Ngoc , Thi Huyen La , Minh Thuy Nguyen , Phuc Hieu Nguyen , Quang Do Le , Thu Hanh Tran Thi , Le Hoang
Published: January 2024

Background and Aims: To describe the clinical characteristics and evaluate the results of office hysteroscopy in patients with recurrent implantation failure at Tam Anh General Hospital.

Methods: A descriptive study on 151 patients at Tam Anh General Hospital who had failed embryo transfer twice or more consecutively was carried out from January 2021 to March 2023.

Results: 151 patients were included in the study, 41,1% of which had unexplained infertility. The mean age and duration of infertility were 34,5 ± 5,2 years and 5,7 ± 3,4 years, respectively. 55,0% of patients exhibited uterine cavity abnormalities during office hysteroscopy, with the most common is endometritis accounting for 29.8%. The median time to perform the procedure was 3 (2) minutes, the mean VAS pain score was 3,2 ± 1,1 points. No complications related to office hysteroscopy were noted.

Conclusions: A office hysteroscopy was able to detect intrauterine pathologies which were missed by other investigative modalities. In individuals who have experienced repeated implantation failure, office hysteroscopy is a safe and practical approach that should be recognized as a crucial tool for intrauterine evaluation.
#276 : Impact of Previous Cesarean Delivery on Pregnancy and Neonatal Outcomes of Subsequent In Vitro Fertilization/Intracytoplasmic Sperm Microinjection and Single Frozen-Thawed Embryo Transfer
Authors: Cao Kexin , Zhang Qian , Li Jie , Liu Xinyu , Yan Yueyue , Zhou Wei , Ni Tianxiang , Yan Junhao
Published: January 2024

Background and Aims: Cesarean delivery (CD) rates continue to rise worldwide. Prior studies have indicated that CD is associated with not only various gynaecological symptoms and obstetric complications but also lower probability of subsequent fertility. However, the recognition about impact of CD on clinical outcomes in subsequent IVF/ICSI-FET is very limited. The purpose was to investigate the effects of previous CD on pregnancy and neonatal outcomes in single frozen-thawed embryo transfer (FET) cycles so that women with a previous cesarean delivery can be given detailed fertility counseling during the ART process.

Methods: This is a large retrospective cohort study including a total of 5,750 patients who desired to transfer single vitrified-thawed blastocyst from the same oocyte retrieval cycle as their last live birth between January 2011 and January 2021 in a center for reproductive medicine in Shandong, China, comprising FET cycles of 3,853 previous single CD and 1,897 previous single vaginal delivery (VD).

Results: Women with a previous CD had significantly lower rates of biochemical pregnancy (64.52% vs. 71.48% before propensity score matching (PSM), P<0.001; and 65.58% vs. 71.49% after PSM, P<0.001), clinical pregnancy (58.16% vs. 65.79% before PSM, P<0.001; and 59.22% vs. 66.17% after PSM, P<0.001) and live birth (48.17% vs. 55.82% before PSM, P<0.001; and 49.29% vs. 56.10% after PSM, P<0.001) than those with a previous VD. Meanwhile, the CD rate was significantly higher in the CD group (97.85% vs. 18.53% before PSM, P<0.001; and 98.02% vs. 20.51% after PSM, P<0.001). The rates of multiple pregnancy, miscarriage, ectopic pregnancy, multiple live birth, labor complications and preterm and neonatal outcomes were comparable between the two groups.

Conclusion: Compared to VD, a previous CD is associated with a significant reduction in the rates of biochemical pregnancy, clinical pregnancy and live birth in patients undergoing subsequent single frozen-thawed blastocyst transfer.
#335 : Ovarian Cortex with Higher Vascularization Density is Associated with Higher PTEN Expression After Transplantation on CAM
Authors: Ayuandari Sarrah , Dewanto Agung , Widad Shofwal
Published: January 2024

Background and Aim: Before being applied on the clinical settings, the establishment of ovarian tissue cryopreservation and transplantation process should be optimum. The vascularization after transplant is depended on the ovarian tissue size, which influence the follicular recruitment. It may then affect the post-transplantation survival.

Methods: On chorionic-allantoic membrane (CAM) of 8-days-old, fertilized eggs, goat ovarian tissue samples (Capra hircus) were split into pre- and post-transplantation groups. Each group was subsequently divided into 2.5×2.5×1, 5×5×1, and 10×10×1 mm size. Vascularization density and vascularization surface area was analysed and correlated with PTEN protein expressions.

Results: Pre- and post-transplantation samples were taken from a total of 36 strips of ovarian tissue. The vascularization density was found to be the highest in the 2.5×2.5×1 mm transplantation samples compared to the pre-transplantation samples (9.54±3.2; 15.46±1.85; P<0,05). Meanwhile the vascularization surface area was also significantly higher after transplantation regardless the size of ovarian tissue (P<0,05). Interestingly, the vascularization surface area was observed to be significantly higher in the cortex area adhered to CAM compared to more distant than the CAM. To magnify the vascularization results, in the 2.5×2.5×1 mm transplantation sample, it was shown that the higher PTEN expression after transplantation. Concurrently in the 10×10×1 mm transplantation, PTEN protein expressions were significantly lower in primordial follicles after transplantation (P<0.05). These results were also mutual for total number of primordial follicles in 2.5×2.5×1 mm, which were higher after transplantation (mean rank 11.92±2.56) compared to the other size groups (10.88±1.48; 9.72±6.36).

Conclusions: The most vascularized ovarian tissue samples were found to be 2.5×2.5×1 mm in size and it was found to express more PTEN in the primordial follicles. As a result, compared to the other sample sizes, it also showed the least post-transplantation decline in the number of primordial follicles, indicating less follicular burn-out than the group with larger tissue surface area.
#389 : Fertility Preservation During Chemotherapy Treatment by NAD+ Repletion in Mice
Authors: Gilchrist Robert , Ho Wing-Hong Jonathan , Marinova Maria B , Listijono Dave R , Bertoldo Michael J , Richani Dulama , Lynn-Jee Kim , Brown Amelia , Riepsamen Angelique H , Cabot Safaa , Bustamante Sonia , Zhong Ling , Selesniemi Kaisa , Wong Derek , Goss Dale M , Li Catherine , Araki Toshiyuki , Livingston David J , Turner Nigel , Sinclair David A , Walters Kirsty A , Homer Hayden A , Wu Lindsay E
Published: January 2024

Background and Aims: Chemotherapy induced ovarian failure and infertility is an important concern in female cancer patients of reproductive age or younger, and non-invasive, pharmacological approaches to prevent chemotherapy induced infertility are urgently needed. Here we investigate whether pharmacological elevation of nicotinamide adenine dinucleotide (NAD+) ameliorates chemotherapy induced female infertility in mice.

Method: 8-week-old C57BL6 female mice were treated +/- chemotherapy (doxorubicin, Dox; 10 mg/kg) and +/- nicotinamide mononucleotide (NMN; 200 mg/kg i.p. once and 2 g/L in drinking water on-going), an orally bioavailable metabolic precursor to NAD+. Effects on fertility were measured by impact on ovarian reserve and folliculogenesis, ovulation rates and breeding performance. Effects on the ovarian NAD+ metabolome were assessed by mass spectrometry. A potential adverse effect of NMN on the efficiency of chemotherapy was assessed using a xenograft model of mammary cancer.

Results: NMN treatment did not prevent a decline in the ovarian reserve caused by chemotherapy but did maintain the health of the remaining primordial follicle and total follicle populations, leading to a restoration in oocyte yield in chemo-treated mice (Dox vs Dox+NMN; P<0.007), culminating in an increase in pups born/mating in chemo+NMN treated mice (P<0.05). Chemo caused ovarian NMN, NADP+ and NADPH depletion, and NADPH was restored by NMN, which likely contributes to Dox detoxification. Importantly, treatment of the breast cancer mouse model with NMN reduced tumour growth and did not impair the efficacy of chemotherapy drugs in vivo or in diverse cancer cell lines.

Conclusion: Overall, these findings raise the possibility that NAD+ precursors could be a non-invasive strategy for maintaining ovarian function and fertility in cancer patients, with potential benefits in cancer therapy.
#391 : Oocyte Cryopreservation — A Five Year Follow Up Study on its Utilization and Outcome
Authors: Baid Rashmi , Pai Hrishikesh D , Palshetkar Nandita
Published: January 2024

Background & Aim: Oocyte cryopreservation is a boon for women undergoing Assisted reproductive technology (ART). Apart from cancer patients it is recently promoted as a mode of fertility insurance to overcome the age-related decline in fertility, endometriosis, primary ovarian insufficiency, etc. The objective of the study was to evaluate the clinical applications of oocyte freezing and its efficacy in terms of pregnancy outcome.

Method: Retrospective observational study of all patients undergoing oocyte cryopreservation from 2016 to 2021 in Lilavati Hospital & Research Centre, Mumbai, India.

Result: 221 patients undergoing oocyte cryopreservation were included. Oocyte cryopreservation was done for different indications like azoospermia (50.2%, most common), planned oocyte freezing (41.17%), fertility preservation (1.36%), endometriosis (0.45%), ejaculatory dysfunction (1.8%), husband with active hepatitis B infection (3.62%) and unavailability of husband on the day of egg retrieval (3.62%). A total of 1715 mature oocytes were frozen. 41.17% women were normo-responder, 38.91% were poor responder and 19.90% were hyper-responder. The oocytes of 59 patients (return rate-26.7%) have been thawed and 162 women (73.3%) remain in storage. Out of 508 oocytes frozen for these 59 patients utilizing their oocytes, around 474 oocytes were recovered post-warming (recovery rate 93.3%). A total of 59.3% patients created embryos with a partner, and 40.6% used donor sperm. The mean fertilization rate was 65.8% of surviving oocytes. Of 59 patients, 44 (74.5%) planned a fresh embryo transfer, out of which 20 patients tested positive for pregnancy (pregnancy rate 45.45%).

Conclusion(s): We report the outcomes of patients opting for oocyte cryopreservation, which is useful for patient counselling. Limited evidence is available in terms of utilization rate, post warming survival of oocytes, fertilization and pregnancy rate. Further studies over long period of time with larger cohorts are needed.
#5 : Associated Factors with Premenstrual Syndrome and Premenstrual Dysphoric Disorder Among Female Medical Students: A Cross-Sectional Study
Authors: Trieu Vy Ngo Dinh , Bui Linh Phuong , Hoang Long Bao , Tran My Thi Tra , Nguyen Huy Vu Quoc , Tran Linh Manh , Pham Tung Thanh
Published: January 2024

Background and Aims: Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD) are two premenstrual disorders that have been reported in many countries and have gradually become predominant concerns The study aimed to determine potential risk factors associated with PMS and PMDD

Method: Three hundred two female student participants who were 18 – 45 years old completed a questionnaire including demographic characteristics, lifestyle factors, and a Vietnamese Premenstrual Syndrome Screening Tool (PSST). We then followed up participants during at least two menstrual cycles using the Daily Record of Severity of Problems (DRSP). The PMS and PMDD diagnosis were established using The Carolina Premenstrual Assessment Scoring System (C-PASS), based on the American College of Obstetrics and Gynecology (ACOG) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Results: According to the C-PASS, 35 out of 302 students (11.6%; 95%CI: 8.2-15.7%) met the diagnosis of PMS (31 students) or PMDD (4 students). We found that age at menarche (PR = 0.77, 95%CI: 0.63 - 0.96), having negative Rh blood type (PR=4.43, 95%CI: 1.95 to 10.08), being moderately depressed or higher (PR=2.81, 95%CI: 1.24 to 6.36), and consuming caffeine more than three times per week were statistically associated with having PMS/PMDD after adjusting for other variables.

Conclusion: The prominent risk factors for PMS and PMDD were negative Rhesus blood type, menarche age, caffeine consumption, and self-reported depression.
#94 : Study to Improve Clinical Results of Male Infertility Treatment ROSI (Round Spermatid Injection) with Correcting Genetic Expression by Histone Deacetylase Inhibitor
Authors: Tanaka Atsushi , Takemoto Youichi , Nakajima Daisuke , Nagayoshi Motoi , Tanaka Phar.B. Izumi , Watanabe Seiji
Published: January 2024

Background and Aims: While the histone deacetylase inhibitor Scriptaid has been reported to be effective to improve ROSI results, there are also reports that offspring born after its use are stunted. In order to examine the conflicting results of basic research, experiments were conducted using mice, and the results are reported herein.

Method: B6D2F1 mice were used, with Scriptaid liquid at 250nM in 10% SPS-HTF and 5mM strontium chloride, and Gx-TL (Vitrolife) was used as the embryo culture medium. Comparisons were made among three groups: (1) immersion of round spermatid cells in Scriptaid solution for 10 minutes before ROSI, (2) immersion of oocytes in Scriptaid solution for 16-18 hours after ROSI, and (3) conventional method without using Scriptaid.

Results: No abnormalities were observed in the newborn offspring from all three groups, and their growth curves were normal at 10 weeks of age. There were no signs of stunting, which had been a concern. No abnormalities were found in the offspring born to the first generation.

Conclusion: In basic animal experiments using the histone deacetylase inhibitor Scriptaid, normal results were obtained. The Ministry of Health, Labour and Welfare requires submission of an application for basic experiments using human gametes for ROSI. The problem is the judgment that the histone deacetylase inhibitor directly affects nucleic acids, but the histones targeted by the inhibitor are nucleosomes, not nucleic acids. Furthermore, the inhibitor does not target gene expression specific to the histones, and therefore does not constitute genome editing by definition. After obtaining approval for basic experiments, we aim to conduct basic experiments using human gametes and accumulate data on the risks and safety of this method.
#199 : Does Hysteroscopic Evaluation of Uterine Characteristic Improve Outcome of Thin Endometrium in Patients with a History of Repeated Implantation Failures?
Authors: Namshir Narangerel
Published: January 2024

Background: Repeated implantation failure (RIF) is a problem for many patients suffering from infertility and their physicians. Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Recently, hysteroscopy is an accurate method for evaluating the endometrial integrity, with the ability to treat uterine pathology for repeated implantation failure patients.

Objective: The aim of this study to evaluate the incidence of uterine pathology among infertile women with a history of two implantation failures after IVF and estimate the effect of diagnostic hysteroscopy and hysteroscopic procedures in uterine cavity on achieving a pregnancy in these patients in Mongolia.

Materials and Methods: The retrospective study population included infertile women who attended the outpatient department of the Creation and Love Women’s infertility clinic, between August 2020 and July 2022 in Mongolia. The study inclusion criteria were women who had more than two RIF of IVF/ET cycle. Pregnancy and nonpregnancy rate after hysteroscopic procedures were analyzed included in patients reports archived in clinical data.

Results: Hysteroscopy were performed on 35 women who had at least two RIFs. The participants’ mean age was 40.3±5.3 and mean duration of infertility year was evaluated 5.53±3.7. Mean AMH level was 1.4±1.6 ng/ml.

All patients were diagnosed abnormal uterine cavity by hysteroscopy.

Out of 35 patients participated in this study who underwent hysteroscopic evaluation, 20 patients (57.1%) showed synechiae (mild, moderate and severe synechiae).

Second most frequent hysteroscopic finding was the endometrial polyp, accounting for 15 (42.9%) patients.

Pregnancy rate after hysteroscopic procedures was 8 patients (23%) in this study group. The duration of infertility year was significantly different in pregnant and nonpregnant women underwent hysteroscopic correction (p<0.05).

Conclusion: The intrauterine pathology diagnosed by hysteroscopy in patients with previous IVF failure were found all patients in this study. The synechiolysis was common abnormality in Mongolia may cause by artificial abortion. The correction of abnormalities such as and polyp synechiolysis might improve the outcome of successful pregnancy rate.
#306 : Enhancing Myoma Detection in Robot-Assisted Myomectomy: Evaluating the Efficacy of Intracorporeal Ultrasonography
Authors: Lee Jungyun , Paik Haerin , Hong Yeon Hee , Kim Seul Ki , Lee Jung Ryeol
Published: January 2024

Background and Aims: Robot-assisted myomectomy is being widely implemented in gynecologic surgery, with strength in cases with multiple myomas. To maximize myoma detection during surgery, intracorporeal ultrasonography (USG) has been introduced. The study aims to evaluate the efficacy of intracorporeal USG in robot-assisted myomectomy.

Method: This was a retrospective study of patients who underwent robot-assisted myomectomy from January 2022 to February 2023. The cases with preoperative pelvis magnetic resonance imaging (MRI) and which utilized intracorporeal USG during surgery were identified. Demographic and operative variables were analyzed, along with myoma extraction rates, which were determined as the proportion of surgically removed myomas compared to the number identified in preoperative MRI, and the number of additional myomas removed during the operation.

Results: In all patients, the number of myomas removed was greater than the number of myomas in preoperative MRI (12.4 ± 8.6 vs. 7.9 ± 5.0, [Formula: see text]<0.001). An average of 4.5 additional myomas were found, and the extraction rate was 167%. For subgroup analysis, patients were stratified according to preoperative myoma counts: 1-5(n=22), 6-9(n=17), and 10 or more(n=17). For all three groups, more myomas were detected in surgery with the use of intracorporeal USG (Median 4 vs 5, [Formula: see text]=0.001, 7 vs 12, [Formula: see text]<0.001, 12 vs 18, [Formula: see text]=0.005, respectively) and the number of additional myomas removed increased in proportion to the preoperative myoma count. There was a positive correlation between the number of myomas identified in preoperative MRI and the number of additional myomas removed (Pearson’s correlation coefficient: 0.292, p=0.029).

Conclusion: Intracorporeal ultrasound improves myoma detection, as significantly more myomas are removed during surgery than anticipated based on preoperative MRI. Moreover, this study demonstrates a positive correlation between the number of myomas identified in preoperative MRI and the additional myomas removed during surgery. Intracorporeal ultrasound may be particularly advantageous for patients with multiple myomas detected on preoperative MRI.
#334 : Tackling Complex Infertility Patient: A Case Report
Authors: Nabila Putri , John Clifford E. , Ekapatria Christofani F.C
Published: January 2024

Background: Infertility is a common problem presented in women with endometriosis especially as it is often associated with poor quality of life. Therefore, surgical Intervention has been considered as the first-line treatment of choice. On the other hand, surgery itself has detrimental effects on ovarian reserve and is associated with ovarian failure.

Case Report: We present a case of a 39-year-old woman para 1 with multiple myoma uteri, bilateral endometriosis cyst, left hydrosalpinx, deep infiltrating endometriosis (DIE), and adhesion (Figure 1). She comes with a history of heavy abnormal uterine bleeding, lower abdominal pain, and unable to conceive 11 years after their first child despite adequate unprotected intercourse. The patient was anemic (Hemoglobin 7.30 g/dL) with low Anti Mullerian Hormone (AMH; 0.26 mg/ml). We decided to perform laparoscopic uterine myoma with multiple bilateral endometrial cysts, left salpingectomy, and adhesiolysis (Figure 2). Patient then underwent an ultra-long protocol with three cycles of leuprolide acetate 3.75 mg. Ovum pick-up was performed and we retrieved five M-II oocytes and from embryo culture, two embryos with good and moderate quality were collected for vitrification procedure. Prior frozen embryo transfer, extra acetylsalicylic acid 80 mg once a day and estradiol valerate 4 mg thrice a day were given for 18 days. The patient soon became pregnant after a few weeks of embryo transfer with βHCG of 185 mIU/m.

Conclusion: Individualized treatment plans based on the patient’s symptoms and respective reproductive goals are important points to be discussed in endometriosis-associated infertility patients. Surgical intervention before IVF/ICSI is deemed as necessary to preserve ovarian reserve and to restore normal anatomy to increase the success rate of embryo implantation.