bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiometabolic Risk Factors in Adolescent Women’s Health
Authors: Cedars Marcelle
Published: January 2024

Despite significant advances in diagnosis and treatment, cardiovascular disease (CVD) remains a major cause of mortality and morbidity for men and women. While disease rates are somewhat declining for men, risk for women, and earlier age at onset, is increasing. As with many common conditions, prevention and/or early intervention for those at risk, leads to better long-term outcome than treatment and secondary prevention. In order to better achieve reduction in disease in adulthood, we need to recognize critical periods of vulnerability for disease development. These include broadly the maternal environment, but also early childhood and adolescence, two periods with rapid growth and development, where environmental “insults” may have long-lasting impact. As suggested by the Developmental Origins of Adult Disease (DoAD) and the Dutch famine studies, the in-utero environment is a critical window. And maternal health leading into pregnancy, maternal health during pregnancy and any potential environmental exposures, will all impact childhood and likely adult health. Careful studies across childhood, particularly with emphasis on BMI and BMI trajectories and adverse social situations and abuse, are producing informative data regarding the importance of this critical time-period for both awareness and intervention. And, interventions, as simple as improving diet and sleep, may improve our ability for early intervention in simple ways to improve women’s health and longevity.
How to Diagnose Endometriosis to Improve Fertility Treatment
Authors: Hull Mary Louise
Published: January 2024

There is a 25-50% higher incidence of endometriosis in infertility populations and there is a 30-50% higher incidence of infertility for people with endometriosis with a significantly lower monthly chance of fertility than healthy women (2-10% vs 15-20%). However, because of the need for surgery, endometriosis is often diagnosed after starting ART treatment, with an estimate that 43-63% of those with an unexplained infertility have undiagnosed endometriosis. Diagnosing endometriosis during rather than before infertility treatments reduces the likelihood of reporting a birth and increases the chance of having a high order number of IVF cycles.

Our Guest, Dr Matthew Leonardi will describe how specialised endometriosis scans can be used to diagnose endometriosis, including caveats around interpreting scans and the use of MRI. Professor M. Louise Hull will present cases demonstrating how endometriosis imaging diagnostics can improve clinical decision making in fertility practice.
How to Minimize Future Fertility Risks Associated with the Surgical Management of Miscarriage
Authors: Chung Jacqueline
Published: January 2024

Miscarriage is a distressing event that can have a profound and lasting impact on a woman’s physical and emotional well-being. Although the causes of miscarriage are not always clear, it is estimated that up to 20% of all pregnancies end in miscarriage. After a miscarriage, women may experience a range of emotions, including grief, guilt, and anxiety. In some cases, medical intervention may be necessary to remove any remaining tissue from the uterus, prevent infection, and reduce the risk of complications.

Surgical management is often recommended for incomplete or recurrent miscarriage. However, traditional surgical procedures can lead to the development of intrauterine adhesions, which can cause further complications and fertility problems. Intrauterine adhesions occur when scar tissue forms inside the uterus, usually as a result of damage to the uterine lining. This can cause the walls of the uterus to stick together, making it difficult for a fertilized egg to implant and grow, and potentially leading to infertility.

To minimize the risk of intrauterine adhesions and preserve future fertility, ultrasound-guided manual vacuum aspiration (USG-MVA) has been developed as an alternative approach to traditional surgical management of miscarriage. USG-MVA is a minimally invasive procedure that involves using a handheld syringe to remove any remaining tissue from the uterus under ultrasound guidance. The use of ultrasound guidance ensures accurate catheter placement, leading to complete evacuation of the uterine contents and minimizing discomfort by reducing the number of suction catheters passes and unnecessary endometrial damage.

USG-MVA has been shown to be a safe and effective method for managing miscarriages while preserving future fertility. The procedure is effective and can be performed in an outpatient setting, reducing the need for hospitalization, and minimizing associated costs. Additionally, USG-MVA has been found to have a lower risk of intrauterine adhesions compared to traditional surgical evacuation.
How to Prevent Early Ovulation/Luteinization During an IVF Cycle
Authors: Morimoto Yoshiharu
Published: January 2024

In ovarian stimulation for artificial reproductive medicine, we sometimes encounter progesterone elevation (PL; Premature luteinization) on the day of ovulation trigger.

Higher progesterone levels on the ovulation trigger have been indicated to induce adverse effects in pregnancy and implantation. This effect’s mechanism is considered an asynchrony between the embryo and the endometrium. PL is commonly defined as an elevation of serum progesterone over 1.5 ng/ml; however, the threshold values differ from the studies. PL had been evaluated by several predictors such as a single progesterone level, progesterone/ estradiol ratio, and progesterone/oocyte ratio. Some conditions may easily induce PL. In poor responder patients, a higher dose of FSH is used and that hormonal milieu provides a condition for premature luteinization.

The physiological mechanism for PL has been studied; however, it is yet clarified. Since PL occurs during ovarian stimulation, FSH administration may contribute to PL. HCG trigger timing may also be an essential factor in raising progesterone.

In the cases of premature luteinization, the freeze-all can be an appropriate means to keep pregnancy possibility. On the other hand, some studies indicate that the low success rates are attributable to the low quality of the embryo, not to hormonal or endocrinological disturbances. In this theory, the freeze-all strategy is not enough for a solution. Concerning impaired endometrium receptivity induced at premature luteinization, it has been reported to cause implantation failure.

It has been indicated that PL affects pregnancy and live birth rates. Therefore, we are required to prevent PL by selecting appropriate ovarian stimulation protocol to achieve high pregnancy rates, optimal trigger timing, and use of medications such as corticosteroids or metformin that may prevent PL.
Prevention of OHSS
Authors: Lee Jung Ryeol
Published: January 2024

Ovarian hyperstimulation syndrome (OHSS), perhaps the most serious complication arising from in vitro fertilization (IVF), is rare but life-threatening in some cases. In this lecture, we will first delve into the pathophysiology of OHSS and hallmark features such as hemoconcentration, hypercoagulability, electrolyte imbalances, fluid loss into third space, and renal insufficiency. In addition, clinical vignettes will illustrate some of the most severe cases of OHSS.

Next, various methods for identifying patients at high risk of OHSS will be discussed. Available literature indicates that younger age and polycystic ovarian syndrome (PCOS) may be associated with the incidence of OHSS. Ovarian reserve markers such as anti-müllerian hormone (AMH) and antral follicle counts (AFC) have been suggested as useful screening tools. Also, stimulation cycle profiles, such as developing multiple follicles, peak serum estradiol levels, and the number of retrieved oocytes, may aid in identifying those at high risk.

To lower the incidence of OHSS, modifying controlled ovarian stimulation (COS) protocols is essential. Evidence suggests that gonadotropin-releasing hormone (GnRH) antagonist protocol is beneficial in reducing the risk of OHSS. Medications such as dopamine agonists, aspirin, and metformin may be associated with lower risk while using clomiphene citrate remains controversial. “Coasting,” which is holding gonadotropins for several days to decrease the OHSS risk, has been suggested as another strategy. Triggering could be done differently using a GnRH agonist. Cycle segmentation by cryopreserving oocytes and embryos is also a feasible option.

Close monitoring and early detection of symptoms are essential for prompt intervention and management of OHSS. By implementing preventative measures and closely monitoring patients, physicians may reduce the incidence and severity of OHSS and ensure safer fertility treatments.
Debate 3: Genetically Tested Embryos Expected to Have Mild Adult Disease Should Not Be Transferred
Authors: Yan Junhao , Gabbett Michael
Published: January 2024

MOTION: For

Next generation sequencing (NGS) technology has been widely used in the field of genetic diseases, mainly focusing on the diagnosis of genetic diseases, newborn screening, prenatal screening, preimplantation genetic test (PGT) and other fields such as the treatment of cancer. In the field of reproductive medicine, there are still some issues that engendered controversy about the application of PGT. On one hand, disputes over whether using PGT to treat late-onset diseases is ethical remain. On the other hand, some tested embryos are “available” to transfer, while others are “discarded” embryos that are “unavailable” because they are detected carrying certain genetic flaws. But there are still some embryos biopsied expected to have some genetic abnormality that might or not cause malfunction, including embryos with copy number variant of uncertain significance (VUS), embryos tested with adult-onset genetically anomalousness, embryos of balanced translocation as well as mosaic embryos. So how to dispose of this group of embryos in clinical practice is a hot issue up to now. In this debate, we reviewed the relevant case reports and original research combined with the joint consensus or committee opinion to state our proposition: embryos tested with possible abnormal genetic characteristics and thus expected to have mild adult disease should not be transferred. Parents undergoing PGT may wish to avoid the lifelong concern caused by the chance that their children may develop adult-onset conditions. The transfer of embryos expected to have mild adult disease is contrary to their original intention of seeking PGT treatment. Whether intentional or incidental, the discovery and request for transfer of embryos likely to result in the birth of offspring with health-affecting conditions pose ethical dilemmas for physicians and their staff, patients, and society.

MOTION: AGAINST

Preimplantation genetic testing provides couples with powerful reproductive choices. The technology allows individuals to avoid giving birth to children with significant health issues and developmental disability. Additionally, serious familial adult-onset conditions, such as predisposition to cancer or dementia, can be screened out of future generations.

Polygenetic risk scores will be the next leap in genetic testing technology. This data can used to determine the chances of an embryo developing adult-onset conditions such as cardiovascular disease, diabetes, mental illness and even gout. This presentation argues that there is a limit at which society should stop screening embryos for disease and draws upon practical observations and well-accepted ethical frameworks to support the case.
#77 : A Micro 3D Printed Device for Intracytoplasmic Sperm Injection Removes the Requirement for a Holding Pipette and Reduces Complexity of the Procedure
Authors: Inge Megan , McLennan Hanna , Heinrich Shauna , Blanch Adam , Wallace Samuel , Waite Michael , Love Allison , Gardner David , Thompson Jeremy
Published: January 2024

Background and Aims: One of the most skilled procedures performed by embryologists is intracytoplasmic sperm injection (ICSI), which takes significant experience to master. Conducting the procedure requires a high level of concentration with training a significant burden on clinical laboratory efficiency. Advancement of a micro 3D printed device to hold oocytes has removed the requirement for a holding pipette, reducing the complexity of the ICSI procedure. This study shows that the microICSIÔ device reduces the technical difficulty of ICSI, improving the speed and precision of the procedure.

Method: ICSI was performed conventionally (C-ICSI) and within the microICSIÔ device on abattoir derived porcine denuded oocytes matured in vitro for 39-44 h in NCSU-23 medium containing eCG, hCG, porcine follicular fluid, EGF and insulin. Timing data was captured by video recording for pipette setup and injection time per oocyte for two embryologists and compared between each technique. Oocyte injection time was taken from when a sperm loaded injection pipette was in focus with the oocyte until the injection pipette was removed from the oocyte.

Results: Results were compared between C-ICSI and microICSIÔ (Mean ± SD). Pipette setup time was reduced from 278 ± 21 seconds to 109 ± 3 seconds by removing the holding pipette. During the procedure, absence of a holding pipette resulted in embryologists adjusting their hands on average only 3 times during oocyte injection compared to 10 times for C-ICSI when moving between microinjector, pipette and microscope controllers. Oocyte traceability was also improved due to the microICSIÔ device’s numbered array. Embryologist’s injection time was reduced from 42 ± 12 seconds for C-ICSI to 14 ± 5 seconds for microICSIÔ per oocyte.

Conclusion: The microICSIÔ device reduces pipette set-up time and the complexity of the ICSI procedure, reducing the time required for oocyte injection by half.
#154 : The Creation of a New Embryo Culture Medium with 31 Optimal Components Derived from Human Oviduct Fluid: A Prospective Multicenter Randomised Trial
Authors: Utsunomiya Takafumi , Yao Tatsuma , Itoh Hiroko , Kai Yufuko , Kumasako Yoko , Setoguchi Miwa , Nakagata Naomi , Tsutsumi Osamu , Yanagida Kaoru , Fukuda Yoshinori , Kono Tomohiro
Published: January 2024

Background and Aims: Although culture conditions were recognized as key points, an optimal culture medium formulation, which closely resembles natural human oviduct fluid (HOF), has not been obtained yet.

Our aim is to make an ideal embryo culture medium close to HOF components, and to evaluate the quality of this medium with embryo quality and clinical outcomes in assisted reproductive technology (ART) by a prospective randomized controlled trial (RCT).

Method: Study I: HOF was collected laparoscopically from patients (n = 28) with normal pelvic findings. According to HOF analysis results, the new medium ‘OVIT’ was designed. Study II: Embryos (2 pronuclei (2PN) = 9,633) were assigned from 1,435 patients. The blastulation rate (BR), good BR (gBR), utilized (transferred/cryo-preserved) BR (uBR), pregnancy rate (PR), and miscarriage rate (MR) were compared between the OVIT and control groups by RCT.

Study III: The neonatal healthiness who were concepted by ART using OVIT and /or control medium was compared between two groups.

Results: The novel medium ‘OVIT’ was produced according to 31 HOF components. The concentrations of essential amino acids (e-AAs) were lower in OVIT than in current media, yet the opposite was true for non-e-AA concentrations. gBR and uBR were higher in the OVIT group than in the control group. In the older female group, gBT and uBR were significantly higher in the OVIT group.

The neonatal conditions of those who were born by ART using OVIT and/or control medium were similar.

Conclusion: HOF components and AA concentrations were analysed, and the results indicated numerous differences between OVIT and current media. This medium provides a better culture condition and improves embryo quality. This study has found novel perspectives for older patients having difficulties in producing embryos of good quality and indicated the superior quality of OVIT compared with the quality of traditional media.
#208 : The Adverse Effects of Vitrification on Embryo Development and Metabolic Health in Mice Offspring
Authors: Chen Qiaoyu , Chen Miaoxin
Published: January 2024

Background and Aims: Embryo vitrification is widely applied as a routine procedure of assisted reproductive technology. Cohort studies showed frozen embryo transfer (FET) was associated with an elevated risk of adverse maternal and neonatal outcomes compared with fresh embryo transfer. This study aimed to explore the effects of blastocyst vitrification on embryo development and long-term metabolic health in mice.

Method: Mitochondrial function, apoptotic levels and cell numbers were examined in blastocysts with/without vitrification. Implantation rates, fetal growth and placentation were analysed after fresh and frozen blastocyst transfer. Energy consumptions were measured by indirect calorimetry. Metabolic tests were performed in adult mice offspring, including glucose tolerance, insulin tolerance and pyruvate tolerance. Serum lipid profiles were examined, and fetal and adult hepatic transcriptome status were detected by RNA-sequencing and qRT-PCR.

Results: Mitochondrial dysfunction increased apoptotic levels and decreased cell numbers were observed in vitrified blastocysts. The implantation and live pup rates on embryonic day18.5 were not significantly different between the fresh and frozen groups. However, fetal weights and placental efficiencies such as the ratio of labyrinth layer/ junctional zone and microvascular density were significantly reduced after FET. Offspring aged 36 weeks in the FET group had decreased whole energy consumption, impaired glucose and pyruvate tolerance, insulin resistance, higher serum triglyceride, low-density lipoprotein and total cholesterol levels compared with the fresh group. However, these metabolic effects were not observed in mice offspring aged 14 weeks. The FET group also had altered hepatic gene expression and signaling pathways related to metabolic regulation, apoptotic cell clearance, and regulation of response to reactive oxygen species etc.

Conclusion: The data indicated that blastocyst vitrification has short-term and long-term adverse effects in the mouse model. Further studies are needed to optimize vitrification procedure.
#233 : Deep Learning Classification Integrating Embryo Images with Associated Clinical Information from IVF Treatments
Authors: Salih Mohamed
Published: January 2024

Background and Aims: With the advent of artificial intelligence (AI), there is potential for AI applications in areas limited by human subjectivity, such as embryo selection. Therefore, we aimed to develop an AI model that integrates the advances of computer vision for embryo images with machine learning for clinical information.

Method: Three AI models were developed, trained, and tested using a database comprised of a total of 1503 international treatment cycles (Thailand, Malaysia, and India): 1) A Clinical Multi-Layer Perceptron (MLP) for patient clinical data. 2) An Image Convolutional Neural Network (CNN) AI model using blastocyst images. 3) A fusion model using a combination of both models. All three models were evaluated against their ability to predict clinical pregnancy and live birth. Each of the models were further assessed through a visualisation process where the importance of each data point clarified which clinical and embryonic features contributed the most to the prediction.

Results: The experiments achieved the following results for predicting clinical pregnancy, the MLP model achieved a strong performance of 81.76% accuracy, 90% average precision and 0.91 AUC, the CNN model achieved a performance of 66.89% accuracy, 74% average precision and 0.73 AUC, the Fusion model achieved 82.42% accuracy, 91% average precision and 0.91 AUC. From the visualisation process we found that female age and female BMI to be the most clinical factors, whilst Trophectoderm to be the most important blastocyst feature.

Conclusion: The fusion AI model integrating clinical features and embryo images made more informed predictions, achieving better performance than separate models alone. This study demonstrates that AI for IVF applications can increase prediction performance by integrating blastocyst images with patient clinical information.
#252 : Granulosa Cell Metabolism is Differentially Impacted by Obesity and Aging and Correlated With Oocyte Competence
Authors: Morimoto Atsushi , Rose Ryan , Smith Kirsten , Dinh Doan ‘Thao’ , Umehara Takashi , Winstanley Yasmyn , Morimoto Yoshiharu , Russell Darryl , Robker Rebecca
Published: January 2024

Background and Aims: Aging and obesity are associated with female infertility, with mitochondrial dysfunction proposed as an underlying factor; but our understanding of energy metabolism within the ovary remains limited.

Method: This study focused on the granulosa cells surrounding the oocyte and investigated mitochondrial function, glycolytic function, total ATP production, and fatty acid metabolism using real-time metabolic analysis (Seahorse XFe96) to understand the effects of obesity and aging on energy metabolism. Mouse models were used to precisely isolate the effects of aging and obesity, with parallel studies conducted on human granulosa cells.

Results: In mice, aging impaired both mitochondrial function and glycolytic function, while obesity primarily reduced mitochondrial function. Mice with both aging and obesity showed massively impaired granulosa cell metabolism. Next, the metabolic profile of granulosa cells in the follicular fluid of a cohort of 130 women who underwent IVF/ICSI cycles was measured. Aging primarily impaired mitochondrial function, with ATP production biased towards glycolysis, and no correlation was found with glycolytic function. Obesity primarily affected ATP production efficiency in mitochondria. Correlations between granulosa cell energy metabolism and embryonic development were also found. Mitochondrial spare capacity was associated with more retrieved oocytes, glycolytic reserve capacity was associated with Day 3 embryo quality, and mitochondrial ATP production was associated with improved blastocyst formation rates. Analysis of patient diagnoses revealed that in patients with normal ovarian function, only ATP production efficiency was decreased by aging, whereas in patients diagnosed with conditions of impaired ovarian function, mitochondrial function was more important. Interestingly, patients with adequate mitochondrial function showed good embryonic development, whereas those with very high mitochondrial and glycolytic energy metabolism showed a negative correlation with embryonic development, which was also observed in patients with ovarian dysfunction.

Conclusion: These results provide new insights into the underlying metabolic dysfunction that occurs with female infertility.
#375 : Sperm Quality and its Association with Embryonic Aneuploidy Outcomes in Preimplantation Genetic Testing for Aneuploidies (PGT-A)
Authors: Susanto Sarah , Azzahra Tiara Berliana , Iffanolida Pritta Ameilia , Mutia Kresna , Riayati Oki , Wiweko Budi
Published: January 2024

Background and Aims: The global prevalence of infertility is approximately 12% of couples worldwide. An epidemiological study by the World Health Organization (WHO) revealed the prevalence of infertility in low- and middle-income countries is 16.5%.1About 50% of the cases of infertility was found to be male infertility. Only one-third of patients that underwent IVF leads to clinical pregnancy. Sperm characteristics has been shown to contribute to IVF failure. The embryo developed through IVF may be aneuploid. The chromosomal composition can be examined using PGT-A.[Formula: see text]

This study aims to determine the relationship between aneuploidy findings and poor-quality sperm, in terms of volume, concentration, morphology, motility, and DNA Fragmentation Index (DFI).

Methods: This is a cross-sectional study. Sperm analysis data from 25 patients at Yasmin Fertility Clinic from 2020-2023 and 63 embryonic PGT-A results from the same patients obtained from Indonesian Reproductive Medicine Research and Training Center was included. Normality and correlation analysis was done using SPSS.

Results: This analysis included data from 25 couples and 63 embryos. From the samples of embryo, about 66.67% (0.00-100.00%) were aneuploid with either monosomy, trisomy, or mosaic. The most common sperm abnormalities are oligoastenoteratozoospermia with 11 (17.46%) cases, followed by oligozoospermia (N = 7(11.11%)) and oligoteratozoospermia (N= 7(11.11%)). Infertility among 31 (49.2%) couples are caused by maternal condition. Sperm morphology is negatively correlated with aneuploidy percentage along withits types. Negative correlation can be seen in between sperm concentration and mosaicism, and between sperm DFI with number of aneuploid chromosome, monosomy, and mosaicism. However, the only statistically significant finding correlation is between sperm motility and mosaicism, which is correlated positively (r = 0.260, p = 0.043).

Conclusion: A significant positive association was found between sperm motility and chromosomal mosaicism.
#40 : Correlation Between Pre-Trigger Estradiol Levels and the Number of Mature Oocytes in Patients Who Underwent In Vitro Fertilization
Authors: Shafira Nadia , Wijaya Liva , Halim Ayang , Abidin Boy , Hasmoro Tri Bowo , Wiweko Budi
Published: January 2024

Background and Aims: Strong association between pre-trigger estradiol levels on the day of human Chorionic Gonadotropin (hCG) administration and the number of mature oocytes retrieved was widely reported. Consequently, higher estradiol levels measured might give a prediction of the higher number of mature oocytes retrieved on Ovum Pick Up (OPU) procedure. This study was done to investigate the correlation between pre-trigger estradiol levels and number of mature oocytes retrieved in patients who underwent In Vitro Fertilization (IVF) cycles in Indonesian population.

Method: A cross sectional study was done at Mbrio IVF Clinic, Mitra Keluarga Hospital Kelapa Gading, Jakarta, Indonesia. Data was collected from the medical records of 77 patients who underwent IVF cycles between September 2021 and March 2023. The level of estradiol on the hCG administration day and the number of mature oocytes retrieved were analysed to find any correlation between both variables using the Spearman Test.

Results: There were 77 women who underwent IVF procedures with the age range between 27 and 45-year-old (mean 35,5 ± 4,52). Most of them (83%) had primary infertility and had infertility between 1 to 14 years (mean 5,5 ± 3,48). These subjects came to the clinic mostly due to both male and female factors (49,4%), followed by male factor only (27,3%). E2 on hCG day ranged between 194 to 13.000 pg/ml with the median 2.709 pg/ml, and the mature oocytes retrieved ranged between 0 and 31 with a median of 8 oocytes. A statistically significant correlation (r = 0.827; p<0.01) was found between the estradiol level and mature oocytes retrieved.

Conclusion: Pre-trigger Estradiol level can be used as a predictor for the number of mature oocytes retrieved in IVF cycle as these two variables are strongly correlated to each other. A multi-centre study with larger sample size is needed to validate current data.
#57 : A Prediction Model of Low Birthweight in Singleton Pregnancies Reduced from Dichorionic Twin Pregnancies
Authors: Tang Minyue , Wang Guiquan , Zhu Yimin
Published: January 2024

Background and Aims: The incidence of twin pregnancies has risen over the last few decades, mainly attributed to assisted reproduction techniques (ART). Fetal reduction (FR) can significantly reduce low birthweight (LBW) risk in twins. However, the LBW risk is still higher in singletons reduced from twins than for primary singletons. Many factors, such as maternal factors, FR timing and approach may affect LBW risks after FR and no relevant prediction models have been reported to date. The main objective of this study is to develop a nomogram to predict LBW risk in singleton pregnancies reduced from dichorionic (DC) twins.

Method: We retrospectively reviewed and analyzed the data on women with (DC) twin pregnancies who underwent FR in Women’s Hospital, Zhejiang university, School of medicine in July 2005 to August 2021. Logistic LASSO regression was used to identify the most relevant variables associated with LBW. The nomogram was constructed and receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision clinical analysis were used for model performances assessment and visualization. The model was evaluated by cohorts produced by 500 resampling bootstrap analysis to testify the stability.

Results: A total of 471 patients were enrolled in the analysis. At last, seven independent predictive factors for LBW were identified and integrated to construct the nomograms, including maternal height, nulliparous, conception mode, reasons for FR, gestational age at FR, gestational diabetes, pregnancy hypertensive disease. The AUC of our prediction model was 0.793, which was validated by internal (AUC 0.762) confirmation with bootstrap analysis. The nomogram had well-fitted calibration curves. Decision curve analysis demonstrated that the nomogram was clinically useful.

Conclusion: We made the first attempt to develop a reliable predictive nomogram for the risk of LBW in DC twin pregnancies reduced to singletons, providing a useful guide for clinicians and patients in making appropriate FR decisions.
#74 : Rare Presentation of Bilateral Haemorrhagic Pleural Effusions in Ovarian Hyperstimulation Syndrome
Authors: Cheong Yee Tsing , Tarmizi Hatta , Wahab Ana Vetriana A , Loh Yoke Ling
Published: January 2024

Background and Aims: Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation. Pleural effusions seen in OHSS usually are accompanied by marked ascites. Isolated pleural effusion without ascites is extremely rare. Here, we report a case of severe OHSS with rare presentation of isolated bilateral haemorrhagic pleural effusions following controlled ovarian hyperstimulation in in vitro fertilization (IVF).

Method: We present a case of a 31-year-old lady with polycystic ovarian syndrome (PCOS) undergoing IVF where antagonist regime was used. To reduce OH SS risk, agonist trigger was given followed by cryopreservation. The patient was discharged well after oocyte retrieval. She needed admission the following day due to worsening abdominal pain. Cabergoline was started together with analgesia. On day 4 admission, she developed left haemorrhagic pleural effusion which was drained. Her condition improved initially but pleural effusion recurred after a few days and this time was bilateral. Pleural fluid drainage was repeated.

Results: Patient recovered and was discharged well after 3 weeks of hospitalization. Five months later, we performed frozen embryo transfer where two day-3 embryos were transferred (both 8-cell Grade 1). She had a successful singleton pregnancy. At 38 weeks of gestation, she delivered a healthy boy weighing 3.67 kg via Caesarean section.

Conclusion: Pleural effusion as sole presentation of severe OHSS is a very rare occurrence. Despite close monitoring during ovarian stimulation and rigid guidelines, OHSS still occurs. Early detection and prompt intervention by a multidisciplinary team are crucial to ensure successful management of this serious complication.
#105 : Single Day 5 Versus Day 6 Euploid Blastocyst Transfer: The Impact of Embryo Quality on Pregnancy Outcomes
Authors: Le Thang , Nguyen Thuy , Phan Quy , Phi Anh , Giap Phuong , Nguyen Huong , Le Hoang
Published: January 2024

Background and Aims: Selecting embryos with the highest implantation potential is crucial to in vitro fertilization (IVF) success. The day of biopsy, Day 5 (D5) or Day 6 (D6), and embryo quality have been suggested as influential factors in determining the clinical outcomes of single euploid blastocyst transfers. However, evidence supporting the superiority of D5 over D6 blastocysts remains inconclusive. This study aims to compare clinical outcomes following transfer of euploid blastocysts of varying quality biopsied on day 5 versus day 6.

Methods: A retrospective cohort study was conducted at an Assisted Reproductive Center, analyzing 774 patients with Day 5 biopsies and 155 patients with Day 6 biopsies who underwent embryo transfer between January 2019 and February 2022.

Results: The live birth rate was significantly lower in the euploid D6 group than in the euploid D5 group (38.71% vs. 55.04%, RR=0.70, 95% CI=0.57-0.87). The outcomes were significantly influenced by the quality of the embryos. Excellent embryos yielded live birth rates of 62.14% and 53.61% for D5 and D6 biopsies, respectively, while good embryos demonstrated live birth rates of 45.18% (D5) and 32.21% (D6). For fair embryos, the live birth rates were 28.64% (D5) and 19.32% (D6). The outcome difference was statistically significant across embryo quality categories (p<0.05). The adjusted risk ratios of clinical outcomes indicated that excellent euploid Day 5 embryos consistently outperformed other types of embryos.

Conclusions: Our study supports that the biopsy day and embryo quality are crucial factors in determining the success of single euploid blastocyst transfers. Excellent euploid Day 5 transfers yielded superior outcomes, providing valuable insights for clinicians and patients when selecting embryos for transfer in IVF cycles.
#127 : Case Series of 26 Pregnant Women with Tuberculosis Recurrence After IVF-ET
Authors: Li Hongwei , Gao Mingxia
Published: January 2024

Background and Aims: There is limited data on the outcomes of pregnancies complicated by tuberculosis (TB) recurrence following in vitro fertilization-embryo transfer (IVF-ET). This study aims to describe the diagnosis, treatment, and pregnancy prognosis of pregnant women with TB recurrence after IVF-ET.

Methods: A review of 26 patients with TB recurrence after IVF-ET or during the gestation period was conducted.

Results: Pregnancy with TB after IVF-ET was common in women with twin pregnancies and a history of TB, often presenting as fever and vaginal bleeding. Miliary nodules were the primary manifestation on chest imaging, indicating a serious condition. Some patients with extrapulmonary TB exhibited atypical symptoms, leading to missed or misdiagnoses. Among the 26 patients, 22 terminated their pregnancies, and one with tuberculous meningitis underwent a cesarean section 123 days after ET but died 28 days post-operation. Four patients had live births, but three neonates (including two twins) ultimately died after birth due to TB infection or dysplasia.

Conclusion: The prognosis of pregnancies complicated by TB recurrence after IVF-ET is poor. For patients presenting with fever and TB-related symptoms, TB recurrence should be suspected, and multidisciplinary cooperation is advised to confirm the diagnosis and provide timely treatment. If acute miliary TB is diagnosed, pregnancy termination should be considered when necessary. Single embryo transfer is suggested for patients with a history of TB, and frozen embryo transfer may benefit patients at high-risk of TB.
#144 : Randomized Controlled Trial Evaluating Efficacy of Autologous Platelet-Rich Plasma Therapy for Patients with Recurrent Implantation Failure in Frozen-Thawed Embryo Transfer After PGT-A
Authors: Obidniak Diana , Gzgzyan Alexander , Niauri Dariko , Kogan Igor
Published: January 2024

Background and Aims: Despite keen development of ART, recurrent implantation failure (RIF) remains a challenging dilemma for fertility specialists. As it contains significant growth factors involved in delicate process of implantation, platelet–rich plasma (PRP) therapy should promote endometrial receptivity and improve ART.

Objective: To evaluate if the intrauterine perfusion with autologous PRP enhances frozen-thawed embryo transfer effectiveness in patients with RIF after PGT-A.

Methods: Study type: Interventional.

Design: randomized controlled study

Intervention Model: Parallel Assignment

Masking: open label

After obtaining institutional review board approval, 232 women aged 28-42 years were involved. Matching criteria: RIF, normal karyotype, absence of uterine factors of infertility, availability of euploid embryos after PGT-A (NGS). 2 groups of patients: study group (N = 118): single IP with 2.0 ml of autologous PRP on day 10-11 of menstrual cycle; Control group: no therapy (N = 114). Endometrium preparation was carried out according to standardized protocol. Primary outcome measure was clinical pregnancy rate. Secondary outcome measures were pregnancy loss rate, endometrial thickness and adverse event.

Results: The clinical pregnancy rate was higher in the study group (63.55% vs 38.59%) ([Formula: see text]2=14.462, OR=2.775, 95% CI 1.630 - 4.722, p<0,001). The endometrium thickness before intervention didn’t between groups (7.3 vs 7.4 mm), however, endometrium thickness measured just before embryo transfer was significantly higher in the study group (10.5 vs 8.4 mm, Student’s t-test value: 11.87; number of degrees of freedom f=230; Critical value of Student’s t-test=1.972, at significance level [Formula: see text]= 0.05). The pregnancy rate loss did not differ between groups ([Formula: see text]2=0.033, OR=0.908, 95% CI 0.324 – 2.546, p>0,05).

No adverse event was noted.

Conclusions : – The PRP intrauterine perfusion should be considered perspective, safe and cost-effective therapy method for patients with RIF. – PRP does not influence on pregnancy loss rate – Meta-analysis is required.

Support: None
#150 : Do Women with a History of Recurrent Miscarriage Have a Higher Risk of Obstetric and Perinatal Complications in a Subsequent Pregnancy? A Cohort Study
Authors: Chen Xiaoyan , Li Tin Chiu
Published: January 2024

Background and Aims: To examine if there are any adverse obstetric and perinatal outcomes associated with a history of recurrent miscarriage (RM) among a large cohort of Chinese women in Hong Kong.

Method: It is a retrospective study using prospectively collected data from 2000 to 2019.

Data of obstetric and perinatal outcomes from 3112 women with history of recurrent miscarriage was collected from the Clinical Data Analysis and Reporting System database and compared to 108,012 deliveries within the same time period. Logistic regression analyses were performed, adjusting for potential confounding factors.

Results: For obstetric outcomes, women with RM had significantly increased odds of gestational hypertension (OR 1.28, 95% CI 1.09-1.51) and Caesarean section (OR 1.47, 95% CI 1.36-1.60). After adjusting confounding factors, there was significantly increased odds for only Caesarean section (adjusted OR 1.55, 95% CI 1.32-1.77). For perinatal outcomes, women with a history of RM were more likely to deliver preterm (OR 1.67, 95% CI 1.47-1.91; adjusted OR 1.72, 95% CI 1.50-1.99). The incidence of small for gestational age was also significantly higher in women with a history of RM (OR 1.64, 95% CI 1.39-1.94; adjusted OR 1.70, 95% CI 1.41-1.98). There was a significant difference in the incidence of perinatal death from all causes (OR 1.48, 95% CI 1.03-2.12; adjusted OR 1.52; 95% CI, 1.11-2.32).

Conclusion: An increased risk of several obstetric and perinatal complications was found in a large cohort of Chinese women with a history of two or more miscarriages, who should be offered specialist obstetric care from the start of pregnancy with an emphasis on strategies to manage the increased risk of preterm birth small for gestational age and perinatal death.
#153 : Sperm Motility: Effect on Fertilization Rate and Embryo Quality in Patients Undergo Intracytoplasmic Sperm Injection in Indonesia
Authors: Laurus Geraldo , Margiana Ria , Wen Maitra Djiang , Wibowo Suwaspodo Henry , Kamaroekmi Maya Sri , Supardi Supardi
Published: January 2024

Background and Aims: Progressive motility may be an indicator of adequate metabolic activity of the sperm; it is important in ICSI as it helps embryologists in picking a viable and best spermatozoa for injection. Studies evaluating the relationship between sperm motility and fertilization rate and embryo quality in ICSI showed inconclusive results. This study aimed to assess the correlation between sperm motility and fertilization rate and embryo quality in patients undergo ICSI in Indonesia.

Method: This retrospective study included couples who underwent ICSI at 2 fertility clinics in Surabaya and Tangerang, Indonesia, between 1 January 2022 to 31 December 2022.

Exclusion criteria were patients with incomplete medical record and cycles using surgically retrieved or frozen sperm. Data of sperm motility (progressive and total motility) and normal fertilization rate and embryo quality on day 3 (D3) were analyzed using Spearman correlation test.

Results: 98 out of 150 ICSI cycles were analyzed in this study. The mean±SD of progressive and total motility were 36,8±18,7% and 48,6±19,5%, respectively. While the percentage of fertilization rate ranged from 0% to 100% (median 70%) and percentage of good D3 embryo quality ranged from 0% to 100%, (median 7,7%). Spearman test showed a significant correlation between progressive motility and fertilization rate (p=0.00, r=0.279), progressive motility and good D3 embryo quality (p=0.000, r=0,372), total motility and fertilization rate (p=0.00, r=0.323), and total motility and good D3 embryo quality (p=0.000, r=0.404).

Conclusion: Progressive motility has a weak positive correlation with the fertilization rate and the percentage of good D3 embryo quality. Total motility has a weak positive correlation with the fertilization rate and moderate positive correlation with good D3 embryo quality. These results allow adjusting our strategy in maximizing the sperm motility before ICSI cycle as sperm motility is correlated with fertilization rate and embryo quality.
#182 : Pharmacokinetics of Ovarian Stimulation for Projected Poor Responder Patients in IVF. A Randomised Trial Comparing a Corifollitropin Alfa Agonist Flare Protocol with a Corifollitropin Alfa Antagonist Protocol
Authors: Arulpragasam Kaushalya , O’Neil Mary , Sweeten Prudence , Lieberman Devora , Rodgers Rachael , Choi Shannon , Tan Joan , Briggs Nancy , Ledger William L.
Published: January 2024

Background & Aims: Approximately 10% of patients have a sub-optimal response to controlled ovarian stimulation. Many different protocols for superovulation have been developed for this group of patients but the optimal approach for “poor responder” patients is yet to be determined. Use of corifollitropin alfa (Elonva) in a flare (EF) protocol is a novel approach to ovarian stimulation for predicted poor responder patients. We hypothesised that the unique pharmacokinetic and pharmacodynamic profiles of corifollitropin alfa would maximise FSH exposure and follicular recruitment in the critical early follicular phase due to the initial suprathreshold release of bioactive FSH in the initial 2-3 days of exposure to Elonva, in combination with the ‘flare’ of endogenous FSH release.

Method: Twenty-one women aged 31-41 were identified as predicted poor responder patients according to the Poseidon criteria. Each participant was randomised to treatment with Elonva/Synarel flare or Elonva/Orgalutran antagonist. Serum FSH and E2 were measured daily for five days following injection of Elonva. The study was approved by the Southeastern Sydney HREC.

Results: Serum FSH concentrations were significantly higher at each time point in the EF group when compared with the antagonist group (p=0.022). Peak FSH two days after injection of Elonva, was also significantly higher 27 vs 11 IU/L. Serum E2 concentrations were also significantly higher in the EF group at each time point (p=0.039). On day seven of stimulation, E2 concentrations were 3000 vs 1850 pmol/L.

Conclusion: The corifollitropin alfa agonist flare protocol produces significantly higher FSH and E2 concentrations than a standard corifollitropin alfa antagonist protocol for projected poor responder patients, with reduced patient burden for a group who may need multiple ovarian stimulation cycles to achieve a pregnancy. A larger RCT is required to study embryology and pregnancy outcomes, costs and patient burden.
#183 : The Use of Follitropin-Delta in Indonesia: Current Evidence and Development
Authors: Siregar Fahreza Akbar , Jovito Axel , Yulinda Dafi , Regan Louis , Wiweko Budi
Published: January 2024

Background and Aims: The current success of IVF treatments was aided by the fulminant ascent of recombinant DNA technologies. Follitropin delta (FD) is used to promote ovarian follicular proliferation. This research was aimed to investigate the current evidence and development of follitropin delta in its novel in Indonesia.

Method: This prospective cohort study was conducted at the Yasmin IVF Center, Dr. Cipto Mangunkusumo General Hospital Jakarta from January 2021 to October 2022. All IVF/ICSI cycles in which follitropin delta (RekovelleⓇ, FE 999049; Ferring Pharmaceuticals, St. Prex, Switzerland) was used for ovarian stimulation. The outcome data were collected, including initial dose, and total dose of follitropin delta, retrieved oocytes, fertilized eggs, blastocyst day 3-5, embryo transfer, clinical pregnancy rates, and clinical implantation rates. The collected patients’ data (n = 20) who underwent IVF and received follitropin delta ovarian stimulation were divided into 2 groups by age (under 35 years and above 35 years).

Results: The average oocyte, blastocyst, and embryo day 3 obtained in the study sample were higher in women under 35 years old. The pregnancy rate was higher in group 1 (33,30% vs. 25,0%) which was assessed based on a positive b-HCG results and a P4 value after receiving FET. Patients who followed follitropin delta ovarian stimulation had a pregnancy rate of 30%. Follitropin delta can be used in patients to successfully obtain a pregnancy in both groups, as it achieves higher result in women under 35 years old (33.3% vs. 25%).

Conclusion: Optimizing ovarian response in IVF by using a program of follitropin delta dose achieved considerable rise in the quantity of good-quality, usable blastocysts. Assessing follitropin delta in individualized protocols and improving understanding of the dosages can help clinicians in evaluating follitropin delta in their conventional protocols.
#198 : When to Transfer Day 6 Vitrified Embryos? On Day 5 vs Day 6 of Progesterone, a Retrospective Analysis
Authors: Bhoi Nihar , Chandra Vipin , Murdia Kshitiz
Published: January 2024

Background and Aims: The age of cryopreserved embryos impacts the ART outcome of frozen embryo transfer cycles. The development potential of embryos is not uniform. Though the days of progesterone exposure before transfer of D5 blastocyst is so far standardized, there is lack of standardization on transfer of Slow growing embryo i.e. D6 blastocysts.

So, this study aims to compare the clinical outcomes of D6 blastocyst transferred on the 5th day or 6th day of progesterone supplementation.

Method: The retrospective data were collected from the central registry of Indira IVF Hospital Private Limited to analyze 62227 frozen cycles from April 2019 to July 2021, divided into two groups: D6-Frozen embryos transferred on P+5 (Group A) vs P+6 (Group B).

Results: There were 1212 cycles in Group A, and 189 cycles in the Group B arm in the final analysis). The propensity scores were calculated using binary logistic regression and the nearest neighborhood technique based on the following variables at baseline: Wife Age, Husband Age, Body max Index (BMI), Anti mullerian hormone (AMH), and Endometrial thickness. The clinical pregnancy rate was significantly higher in Group A than in Group B (CPR 70.5% vs. 63.0%, p=0.037). No significant differences were observed in the biochemical pregnancy rate (72.6% vs. 66.1%; p=0.066), biochemical loss rate (3.0% vs. 4.8%; p=0.271), clinical miscarriage rate (15.9% vs. 13.4%; p=0.485), live birth rate (59.2% vs. 54.5%; p=0.218) and multiple live birth rate (16.5% vs. 14.8%; p=0.559).

Conclusion: In this study Frozen Embryo Transfer of D-6 blastocysts on the day-5 of progesterone results in better pregnancy outcomes than the day-6 of progesterone.