bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-087 Embryos with higher mitochondrial DNA ratios show better clinical outcomes in single euploid embryo transfer
Authors: Chen D , Kao C W 
Published: August 2021

Abstract

Study question
To assess whether there is a relationship between mitochondrial DNA content and implantation result.

Summary answer
The embryos with a higher mitochondrial DNA ratio increase pregnancy rate and implantation rate in single euploid embryo transfer.

What is known already
Mitochondria is an important organelle that generates energy during embryonic development. Recent literature points out that mitochondrial content and function may be related to implantation success and embryo viability. Some studies have linked increased ratios of mitochondrial DNA to aneuploidy, advanced maternal age, and euploid blastocyst with implantation failure, while others have failed to demonstrate similar findings.

Study design, size, duration
This study is a retrospective cohort study from 2016 to 2019, including 1465 single embryo transfer cycles.

Participants/materials, setting, methods
The involved embryos were biopsied on Day 5 or 6 and the mitochondrial DNA ratio of 1465 embryos was examined undergoing PGS/NGS. The mitochondrial DNA ratios were normalized for technical batch-to-batch variation. The mitochondrial DNA ratio between the implantation group and non-implantation group was statistically analyzed. Data were analyzed by the student’s t-test for continuous variables and Chi-square test for categorical variables.

Main results and the role of chance
The mitochondrial DNA ratio of embryos was no significant difference between different age spans ( p = 0.772) and ploidy (p = 0.224). D5 biopsied embryos, however, contained a significantly higher mitochondrial DNA ratio than D6 biopsied embryos (p &lt; 0.0001). All of the single embryo transferred embryos were classified into two groups; implanted and non-implanted embryos. Results from 1465 transferred embryos show that the mitochondrial DNA ratio of implanted embryos was statistically significantly higher than non-implanted embryos (p = 0.0053). Besides, the cut-off values were established, dividing the transferred embryos into high and low mitochondrial DNA ratio groups. The pregnancy rate and implantation rate of the high mitochondrial DNA ratio group was higher than the low mitochondrial DNA ratio group: [Pregnancy rate] 74% vs. 63.5% (p = 0.0209); [Implantation rate] 57.3% vs. 50.8% (p = 0.1907).

Limitations, reasons for caution
The mitochondrial DNA ratios were analyzed by bioinformatics processing in Miseq reporter software (Illumina) files in the BAM and FASTQ format. Not sure if there is reproducibility in different sequencing platforms.

Wider implications of the findings
There still remains a lack of clarity regarding the relationship between mitochondrial function and transfer outcome. This retrospective study links an association between increased mtDNA content and increased implantation.

Trial registration number
not applicable
P-718 Paternal smoking in the preconception period is associated with an increased risk of spontaneous miscarriage in a dose-dependent manner: a systematic review and meta-analysis
Authors: Du Fossé N , Van der Hoorn M L , Buisman N , Van Lith J , Le Cessie S , Lashley L 
Published: August 2021

Abstract

Study question
What is the association between paternal lifestyle ­factors in the preconception period and the risk of spontaneous miscarriage?

Summary answer
Preconception paternal cigarette smoking is associated with an increased risk of spontaneous miscarriage, while no associations were found with paternal alcohol consumption and obesity.

What is known already
Although maternal lifestyle risk factors for miscarriage are well-established, studies on potentially contributing paternal factors remain sparse. Recently, a significant association was found between advanced paternal age and spontaneous miscarriage. Biological evidence indicates that smoking, excessive alcohol consumption and obesity may lead to sperm oxidative DNA damage, being a known risk factor for miscarriage.

Study design, size, duration
Systematic review and meta-analysis.

Participants/materials, setting, methods
PubMed and Embase databases were searched in August 2020. Paternal factors examined were: cigarette smoking, alcohol consumption and Body Mass Index (BMI). A qualitative risk of bias assessment was performed for all included studies. Meta-analysis was performed if sufficient data was available from studies that controlled for maternal factors. PRISMA guidelines for systematic reviews were followed.

Main results and the role of chance
The systematic search included 3386 articles of which 11 articles met the inclusion criteria. In a meta-analysis of eight studies, paternal smoking of &gt; 10 cigarettes per day in the preconception period was found to be associated with an increased risk of spontaneous miscarriage, after adjustment for maternal smoking status (1-10 cigarettes per day: 1.01, 95% CI 0.97-1.06; 11-20 cigarettes per day: 1.12, 95% CI 1.08-1.16; &gt;20 cigarettes per day: 1.23, 95% CI 1.17-1.29). Based on five available studies, no clear association was found between paternal alcohol consumption and spontaneous miscarriage. No studies were retrieved that evaluated the association between paternal BMI and spontaneous miscarriage.

Limitations, reasons for caution
Investigating the relation between paternal lifestyle factors and spontaneous miscarriage is challenging and prone to different forms of bias, especially in retrospective studies.

Wider implications of the findings
Awareness of the association between heavy paternal smoking in the preconception period and the risk of spontaneous miscarriage should be raised. More well-designed studies are needed to further investigate the effects of other paternal lifestyle factors on the risk of spontaneous miscarriage.

Trial registration number
not applicable
O-012 Diagnostic strategies
Authors: Macklon N 
Published: August 2021

Abstract text
Most discussions of the management of recurrent implantation failure (RIF) will start by expressing the criteria for ‘diagnosis’ of the condition. And here lies our first mistake. Defining RIF as a condition diagnosable in terms of a standard number of embryos transferred without achieving pregnancy suggests that is a medical diagnosis in itself, for which, like other diseases, an optimal treatment strategy exists. But the failure of our field to improve outcomes in patients who suffer RIF suggest that we have approaching the condition wrongly.
RIF is NOT medical disease diagnosed by applying simple clinical criteria. It is a personal experience suffered by patients and which can uncomfortably challenge their doctors. IN order to address the mistake we have made in our approach to RIF, we need to recognise that the condition needs to be recognized in a different way. In practical clinical terms, RIF can be considered to have occurred at the point when the patient(s) and their doctor conclude that further action is necessary beyond the standard work up and treatment approach for IVF.
Our failure to understand what constitutes RIF has also resulted in large and methodologically sound trials of interventions proposed to ‘treat’ RIF missing the target. Based as most have been on the premise that RIF is a disease for which the optimal treatment exists if we can just find it, these trials are largely destined to produce negative results, as those in whom the intervention was effective cannot be differentiated form those in whom it might have caused harm. The resulting ‘zero sum’ requires the study authors to write off the studied intervention as ‘ ineffective’ potentially depriving certain patients of a useful treatment.
So how can we address the therapeutic impasse that we have created?
The answer is surely clear. When our standard best practices fail to result in pregnancy after IVF in a particular patient, we simply need to try to understand why. This requires the classic diagnostic approach: consider RIF a symptom; look for signs that might explain it and order investigations to pin down the cause(s).
So what diagnostic approaches should be applied? In many cases, the embryo factor will already have been subject to considerable scrutiny. When treatment continues to fail, the focus will therefore tend to turn at this point to the patients.
This is where the story begins to look more positive. In recent years it has become clear how active a role the endometrium plays in embryo implantation. As these novel endometrial factors have become elucidated, clinical tests of their function have begun to emerge. While many contributory factors merit investigation when RIF is considered to have arisen, this lecture will introduce the concept of the ‘endometrial diagnostic toolkit’ that promises to enable us to treat RIF on the basis of individual rationale rather than blind hope, and to test the efficacy of targeted rather than blind interventions.
O-013 Therapeutic aspects
O-022 Pro - FET: The future of IVF
Authors: Venetis C 
Published: August 2021

Abstract text
Assisted reproductive technology (ART) represents a relatively new but extremely dynamic field of medicine. Throughout its 40 year-old history, there has been a number of paradigm changes, all of which aimed to optimise the efficacy and safety of this technology. This presentation will cover all the scientific developments of the last few years that have now build the case for yet another paradigm change; the transition to predominantly frozen embryo transfers. Emerging knowledge on the effect of the supraphysiological levels of sex steroids, usually present during a stimulated cycle, on the probability of pregnancy combined with new strategies to completely eliminate the occurrence of ovarian hyperstimulation syndrome represent strong arguments in favour of frozen embryo transfer cycles. Dissociating ovarian stimulation from the embryo transfer, also allows for more intense stimulation, which can likely increase the cumulative live birth rate of a single aspiration and therefore reduce the need for future treatment. All these, combined with the encouraging evidence regarding the obstetric and neonatal outcomes of these pregnancies, render the option of the frozen-embryo transfer cycle quite compelling and a strong candidate as the future standard of care in IVF. This presentation will elaborate on these topics and provide guidance on the optimal strategy for frozen-thawed embryo transfer cycles so that the safety and efficacy of IVF are maximised.
O-025 Value of hysteroscopy
Authors: Haimovich S 
Published: August 2021

Abstract text
The 3 main characters in any ART are the uterus, the endometrium, and the embryo. With the rutinary use of 2D US and especially 3D US in infertile patients we are able to assess most of the uterine anomalies and intrauterine pathologies.
Until recently, the assessment of the endometrial cavity with hysteroscopy was reserved only for cases of IVF failure, as a complementary evaluation to ensure that nothing was missed during the ultrasound scan.
We also need to remember how hysteroscopy was performed in the past and, unfortunately, in some cases even today. In the old days, to assess the endometrial cavity, it was required to take the patient to the operating room and under general anesthesia, dilate the cervix to then introduce a large diameter hysteroscope only for diagnostic purposes.
The prevalent working model in ART today is in close collaboration between Fertility specialists, Ultrasound and Hysteroscopy units in order to improve patient’s outcome.
In our center, a diagnostic hysteroscopy is performed as part of the diagnostic workup of the infertility patient. It is performed in office setting and without anesthesia, by the staff of the reproduction and infertility unit.
When we look at hysteroscopy as an in-office procedure and no longer as a procedure performed in operating room, we appreciate that it is something that all infertility patients can benefit from.
The right question to ask now would be “Is there a benefit in performing a hysteroscopy to all our patients?”.
Ultrasound is not perfect, especially when evaluating the endometrium. The gold standard and the only modality that we have to assess the endometrium with direct visualization is hysteroscopy. Chronic endometritis, adhesions and adenomyosis are only a few examples of what can be assessed by direct vision of the endometrial cavity.
The advantages of a simple, inexpensive, office procedure such as hysteroscopy outweigh any other consideration against it.
During my talk all these points will be presented helping to understand why hysteroscopy is becoming an indispensable tool in every assisted fertility unit.
O-071 The ovarian endometriotic cyst
Authors: Nisolle M 
Published: August 2021

Abstract text
"The ovarian endometriotic cyst”
Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility.
Patients suffering from endometriosis frequently present an already reduced ovarian reserve, assessed by AMH dosage or by antral follicular count during TVS.
Pain and infertility are the main indications for endometrioma surgery which is a complex procedure as endometriosis leads to inflammation around the lesions, causing fibrosis.
Three main surgical procedures have been described: the ovarian cystectomy, the endometrioma ablation or the combined technique.
During the cystectomy, after ovarian mobilization and adhesions lifting, an incision of the cortex is realized to find a cleavage plane between the cyst wall and the ovarian cortex. Traction and countertraction movements are performed to carefuly dissociate the cyst from the ovarian cortex. It is crucial to handle the ovarian tissue as atraumatically as possible. With this technique, the cyst wall as well as the surrounding fibrosis are excised with the risk of oocytes removal responsible for decreased ovarian reserve.
The ablative surgery is defined by the fenestration and vaporization of the endometrioma cyst. The ablation is carried out using a laser or plasma energy or electrocoagulation. Once the endometrial cyst has been emptied of its contents, the entire internal surface of the endometrioma must be sprayed or evaporated using the different chosen techniques. Where feasible, the cyst may be turned inside out to facilitate further treatment.
The combined technique associates partial cystectomy (80-90%) and ablation of the 10-20% remaining endometrioma. This method is especially useful while operating large endometriomas. It prevents excessive bleeding or damage to the ovarian tissue.
In cases of large ovarian endometrioma, the three-step approach has been proposed, consisting on an opening and drainage of the cyst followed by a 3 months’ administration of Gn-RH agonists in order to reduce its diameter and vascularization. A second surgical procedure is then scheduled to ablate the remaining cyst wall.
In conclusion, it is crucial to keep in mind that endometriosis and especially the presence of endometrioma reduce fertility whereas in the majority of cases, the ovarian reserve is already diminished in relation to the patient's age. Ovarian preservation must be one of our priorities in young patients of childbearing age and it is therefore really important to carry out surgeries that are as atraumatic as possible.
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O-064 Artificial intelligence in embryo selection of IVF
Authors: Zhang X 
Published: August 2021

Abstract
Abstract text
Some studies have discussed the use of artificial intelligence and machine learning in the assessment and selection of embryos for in vitro fertilization. Complete artificial intelligence acquired using CNN’s dark box algorithm could be highly useful in assessing in embryos, though it could be difficult to perform the external validation necessary to confirm its value. But due to the inherent drawbacks in complete artificial intelligence assessing in vitro developmental embryos, such as lacking results of discard embryos, dislocations between computer scientist and embryologist, low explanatory values in dark box algorithm, here, we suggest training computers to recognize the target region (internal pellucid zone region) and the features of embryos, then continuously score the embryos starting at in vitro fertilization through the zygote to the blastocyst stage. Parameters suitable for use with various endpoints in treatment sequence could be found by AI. Further clinical studies should be performed to validate the parameters and AI needed.
Trial registration number:
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O-242 Metabolic coupling and spermatogenesis
Authors: Bing Y 
Published: August 2021

Abstract
Abstract text
The microenvironment of spermatogenesis mainly consists of Sertoli cells, Leydig cells, and peritubular cells. The traditional theory considers that spermatogenesis is regulated by hypothalamus-pituitary gland- gonadal axis. In the hypothalamus-pituitary gland- gonadal axis, the microenvironmental cells are mainly regulated by the hormones, which are secreted by the hypothalamus or/and pituitary gland. Meanwhile, Sertoli cells and Leydig cells also secrete related factors to feedback the functions of the hypothalamus and pituitary gland. With the development of research, it has found that metabolic disorders are closely related to the spermatogenesis. Some components involving in lipid metabolism pathways, including saturated fatty acids, cholesterol, and triglycerides, etc. affect the functions of Sertoli and Leydig cells through metabolic coupling pathway. The disorder function of Sertoli and Leydig impairs the microenvironment of spermatogenesis, which finally leads to spermatogenic failure. Current studies have found that the imbalance of lipid metabolism can affect the intestinal flora, which induces the changes of related metabolites, and finally leads to the occurrence of male infertility. Based on the current research, we regulated the lipid metabolism by Omega-3 and metformin in clinic, the activity of spermatogenesis can be remolded.
Trial registration number:
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O-170 Predictive value of cytoplasmic granulation patterns during IVF in MII oocytes from young donors
Authors: Hu J , Molinari E , Darmon S , Albertini D F , Barad D H , Gleicher N 
Published: August 2021

Abstract

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

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

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

Study design, size, duration
A retrospective cohort study during 2017-2020.

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

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

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

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

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

Abstract

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

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

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

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

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

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

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

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

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

Trial registration number
ChiCTR1800014590