bluuebunny/crossref_metadata_2025_split huggingface dataset:
Freezing Low Numbers of Sperm
Authors: Latif Haroon Khan 
Published: January 2024

Azoospermia, a condition defined by a complete lack of sperm in the ejaculate, presents a significant reproductive challenge for many infertile men worldwide. In recent years, Microsurgical Sperm Extraction (Micro-TESE) has emerged as an innovative surgical technique, allowing clinicians to retrieve viable sperm directly from the testicular tissues of patients diagnosed with this condition. A crucial aspect of optimizing the reproductive potential of the extracted sperm lies in the subsequent preservation techniques employed. This study delves deep into one such technique, sperm vitrification. As opposed to the traditional slow freezing methods, vitrification offers a rapid-cooling approach that effectively sidesteps the formation of potentially damaging ice crystals, thereby maintaining the structural and functional integrity of the sperm. The survival rates of sperm post-thawing, when subjected to vitrification, have been found to be commendably high, with figures often exceeding 60%. This is a promising statistic, particularly when dealing with minuscule sperm quantities as retrieved in Micro-TESE. However, the importance of sperm freezing transcends azoospermic scenarios. A broader and crucial indication for sperm freezing is fertility preservation, particularly poignant for cancer patients on the brink of undergoing treatments like chemotherapy or radiation, which could jeopardize their reproductive future. For these individuals, the opportunity to freeze their sperm offers a chance to father biological offspring post-recovery. By allowing multiple in vitro fertilization (IVF) attempts without necessitating recurrent surgical interventions, sperm cryopreservation, especially using vitrification, amplifies the chances of achieving biological parenthood. This is pivotal for both azoospermic individuals and cancer patients, safeguarding their dreams of family amidst medical adversities. In conclusion, the efficacy of vitrification, especially in the context of limited sperm counts, has the potential to reshape the landscape of male infertility treatments, offering a glimmer of hope for numerous affected individuals and their partners.
Lean Management in an IVF Laboratory
Authors: Tuong Ho Manh 
Published: January 2024

The early spread of Lean started in the auto industry. Toyota gained knowledge from others and developed its own management system by employing and inventing methods that fit its needs and situation. It developed the Toyota Production System, called “LEAN”. In healthcare, Lean transformation is a process of changing old mindsets and organizational cultures. It is a long-term process that takes time and effort from the whole organization. Lean management is not to solve major problems of the organization, it is about hundreds or thousands of small problems that occur in the system every day. We have to learn together, think together, and start taking action to improve every day, and continue doing so as long as we can. The ultimate goal of Lean is to provide products/services at a lower cost and higher quality, to increase the value of our products/services to our customers. IVF demand has been increasing worldwide, yet competition has been fiercer. The IVF cost has been increasing. Lean management in IVF laboratories that aims to improve IVF lab procedure flow, reducing risks/errors, adding value to IVF lab services. As the IVF business has developed very fast, IVF staff shortages are a big issue. Overworked conditions in IVF laboratories can harm procedure quality, patient safety, service quality and lead to losing staff and patients. Lean management can help us to improve the lab flow and efficiency and reduce the pressure of staff shortages. By improving efficiency, reducing errors, and adding value to the service, it will accumulatively provide a better-quality service with less costs. The presentation describes how our system in Vietnam approached and applied Lean management in IVF laboratories to reduce waste, improve laboratory quality with staff involvement and satisfaction.
What Medically Assisted Reproduction Should Be Offered in Unexplained Infertility?
Authors: Mol Ben 
Published: January 2024

Conflict of Interest: BWM is supported by a NHMRC Investigatorgrant (GNT1176437). BWM reports consultancy and travel support from Merck, Guerbet and Organon and research funding from Merck. In up to half of all couples who seek medical assistance for infertility a direct cause for their inability to conceive cannot be identified and they are therefore labelled as having unexplained infertility. Unexplained infertility is characterized by normal ovulation, tubal patency, and a normal (or slightly deviant) semen analysis in the male partner according to WHO-criteria. The causes of unexplained infertility remain, as determined by its definition, largely unknown. Available treatments for unexplained infertility include intrauterine insemination (IUI) with ovarian hyperstimulation, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), but also tubal flushing or lifestyle interventions. Treatments like IUI and IVF might on one hand be effective because they increase the number of possible conceptions, for example by creating multiple follicles or embryos, but they also might overcome an unknown barrier for conception. Since, in couples labelled with unexplained infertility natural conception by definition never can be excluded, the prognostic profile of couples for such natural conception is instrumental. I will argue that understanding of prognosis for natural conception should be one of the cornerstones for the management of infertility. If the prognosis for a ‘spontaneous pregnancy’ within a reasonable time frame is high enough, it might be justified to delay treatment in these couples for some time. After that, IUI should be the treatment of first choice.
Implications of Cardiometabolic Changes in Menopausal Medicine
Authors: Robins Jared 
Published: January 2024

This lecture will describe the impact of menopause on cardiovascular and metabolic health. Menopause represents a significant transition in a woman’s life, marked by hormonal fluctuations that contribute to various physiological changes. This lecture will explore the underlying mechanisms behind these alterations and their potential health consequences. Ultimately, this lecture aims to provide healthcare professionals with the knowledge to implement effective strategies for risk assessment, prevention, and management to promote better cardiovascular and metabolic health in menopausal women. At the conclusion of this lecture the attendee will: 1. Understand menopausal associated hormonal changes and their associated cardiovascular risk factors 2. Understand how menopause can lead increased risks for type-2 diabetes and metabolic syndrome. 3. Understand how metabolic changes in menopause leads to increased risk for osteoporosis 4. Develop personalized approaches to mitigate the cardiometabolic risks associated with menopause
Management of PCOS in Adolescence - Can We Improve Future Fertility by Treating Before and in Adolescence
Authors: Shah Duru 
Published: January 2024

PCOS is a multifunctional disorder with an evolving concept. Various studies have shown that this condition affects 8-13% of women of Reproductive age with 5-15% of them being adolescent girls. The physiological pubertal changes can mask the features of PCOS, hence leading to a challenging and a delayed diagnosis during adolescence mainly due to overlapping of symptoms which are mixed with menstrual irregularities, cosmetic issues and anxiety dominating affected girls. Various causative factors have been implicated to cause PCOS, with interaction between genetics, intrauterine maternal environment, and lifestyle. A strong family history in first degree relatives in addition to epigenetic changes and obesity can influence the early onset of PCOS in adolescents. It is important to achieve a timely diagnosis & appropriate management during adolescence in order to tackle co-morbidities associated with PCOS and ensure a smooth transition to adulthood. Identifying at-risk adolescents can prevent PCOS in future and make patients aware of seeking timely treatment. As the adolescent matures into the phase of life when she would like to have children, she can be efficiently managed with lifestyle changes, oral contraceptive pills, androgens, and insulin sensitizers. Pre and Periconceptual management are of crucial importance in a woman having PCOS, as adverse influences on fetal development can cause diseases in the affected fetus due to epigenetic changes. Maternal factors like under/ over nutrition, obesity and Insulin Resistance can contribute to Impaired fetal nutrition and metabolic dysfunction. Hence correction of maternal insulin resistance and hyperandrogenism is important before conception, stressing the need of correct Nutrition during pregnancy to avoid transmission of PCOS to the fetus. There is an increased risk of PCOS in overweight girls between 7-13 yrs. of age, while being overweight after age 13, further worsens the chance of developing PCOS. Adolescents with BMI > 40 are known to have 23-fold increased risk of developing PCOS. Hence being mindful of weight during childhood and adolescence can go a long way in preventing the onset of PCOS across future generations.
Debate 2: Cross Border Reproductive Care Should Be Banned
Authors: Kovacs Gab , Patel Nayana 
Published: January 2024

Motion: For The opinions expressed in this debate are not the personal opinions of the presenter but are points raised to provide a debate. CBRC is defined as “movement of persons from one jurisdiction to another in order to access or provide treatment. Often called “reproductive tourism” but it is “reproductive exile” Existed for many years before fertility treatment-Irish women going to England for abortion. Why? Either unavailable or more affordable. Avoid legal, religious, or ethical restrictions Do we want to encourage breaking the laws of home? Do we encourage exploitation of poor donors/surrogates? Do we want to encourage avoidance of record keeping of donors? CONCERNS Health and safety Legal difficulties, e.g., passport for child Exploitation Children as a “commodity” Children abandoned e.g., Abnormalities SAFEGUARDS Balance rights of individuals against rights of children Need global guidelines/laws- UNTIL THEN; BAN CBRC. Motion: Against Cross-border reproductive care (CBRC) has become a dynamic global phenomenon encompassing various fertility treatments and practices, including surrogacy, embryo donation, age limit, marital status, cost considerations, advanced technology, support systems, known clinician or clinic preference, frozen embryo use, international job transfers, sex selection, PGTA restrictions, and restrictions on the number of embryos transferred. This debate revolves around the motion against banning CBRC, acknowledging its multifaceted nature and the need for comprehensive evaluation of its legal, ethical, and economic implications. CBRC has emerged as a lifeline for individuals facing restrictive reproductive laws in their home countries, offering hope and expanded choices for family building. Critics express concerns over potential exploitation, inadequate regulations, and safety risks associated with CBRC. Ethical dilemmas arise regarding patient autonomy, justice, and discrimination, particularly for LGBTQI individuals seeking fertility treatments in less legally restrictive countries. International organizations such as ESHRE, ASRM, ICMART, and IFFS have initiated efforts to collect data and set guidelines for CBRC. However, more work is needed to establish standardized data registries and harmonize laws to accurately assess the magnitude and scope of CBRC worldwide. A balanced approach to CBRC involves collaborative global governance and cooperation to address challenges while upholding patient rights and ensuring responsible practices. Facilitating access to advanced fertility treatments and safeguarding against potential risks are paramount considerations in shaping the future of cross-border reproductive care. In conclusion, the complexities surrounding CBRC warrant thoughtful deliberation and international collaboration. Rather than imposing a blanket ban, an inclusive approach focusing on transparency, safety, and ethical considerations will foster a responsible and balanced implementation of cross-border reproductive care.
#289 : Mitochondrial Activator BGP-15 Protects Sperm from DNA Damage During Sperm Recovery for Assisted Reproductive Technology
Authors: Gonzalez Macarena , Connaughton Haley , Barry Michael , Robker Rebecca , Rose Ryan 
Published: January 2024

Background and Aims: The recovery of sperm by assisted reproductive technology (ART) results in significant DNA damage. Elevated levels of DNA damage in sperm have been linked to poor-quality embryos and increased pregnancy loss after ART. Therefore, in this study, we aimed to investigate potential of the new mitochondrial activator BGP-15 to prevent sperm DNA damage in an in vitroejaculate over time. Additionally, we sought to determine whether BGP-15 can preserve sperm quality during various sperm recovery techniques used in ART. Method: We incubated donated human semen specimens untreated or treated with BGP-15, then examined sperm motility and DNA damage (DNA fragmentation and oxidation). Semen samples were then processed using different clinical sperm recovery methods: simple wash (SW), swim-up (SU) and density gradient centrifugation (DGC); and the purified sperm underwent further analysis including motility, vitality, ROS levels, mitochondrial membrane integrity and mitochondrial membrane potential (MMP), and DNA damage. Results: Semen samples incubated with BGP-15 demonstrated improved sperm motility and reduced DNA damage levels. SW samples had the highest sperm count, while SU had the highest vitality and DNA integrity, but the lowest MMP. DGC sperm had increased MMP after BGP-15 Treatment. Although BGP-15 treatment only reduced sperm DNA fragmentation in SW samples, it reduced DNA oxidation in all recovery methods. Conclusion: Our findings indicate that clinical manipulation of patient semen samples can negatively impact sperm quality, and different sperm recovery methods have unique effects. However, the addition of BGP-15 to clinical processes can preserve sperm quality, potentially leading to improved embryo quality and ART success.
#362: Importance of Monitoring Progesterone(P4) Values a Day Before D5 FET and Effect of Intervention with Progesterone Supplements in Cases with Low P4 Values
Authors: Chirumamilla Lakshmi , Ambavarapu Divya Reddy , Volesingamreddy Pranitha Reshmi 
Published: January 2024

Background and Aims: Our study was carried out at a tertiary fertility Centre- Hyderabad, to study the importance of monitoring P4 values, day before D5FET and intervention with progesterone supplements in case of low levels and its outcome. Methods: This is a retrospective cohort study done by analyzing all D5FET cases and cases with low P4 values were given progesterone supplements and its effect on outcome were studied. Done between 1/01/22-31/03/23, a period of 15 months. Excluded donor, D3nD6 cycles. Results: In a 15 months period, there were 466 D5FET cycles which were included in our study. The age group of women were between 21-45 years and their P4 values, day before D5FET were studied. Around 290(62.2%) cases had levels between 11-20 ng/ml. Among them, 217 conceived being 74.8%. There were 79(16.9%) people who had levels between 21-30 ng/ml among whom 60 conceived with success rate being 75.9%. There were 97 cases who had levels less than 10 ng/ml. If their levels were less than 8ng/ml, they received aqueous progesterone 25 mg subcutaneously twice, 12 hours apart. If levels were between 8-10 ng/ml, they received micronized progesterone 200 mg per rectum twice, 12 hrs apart. The positive pregnancy rate came up to 76.2% among people who received supplementation. In fact, there were 4 people who had levels <5 ng/ml, all four received aqueous progesterone and conceived. Conclusion: Our study concludes that evaluating P4 values day before D5FET is of vital importance. Timely supplementation helps in positive pregnancy rate at par with people with optimum levels of P4.
#394 : The Efficacy of an Individualized Dose of Follitropin Delta on Ovary Reproductive Stimulation and Clinical Outcomes
Authors: Kesiman Dyatmika Maheswari , Cakradiningrat Kadek Dwi , Kesumadana I Wayan 
Published: January 2024

Background and Aims: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Mullerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this present manuscript, we aimed to gather all available data published between 2018–2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Therefore, all post hoc derived analyzes and subgroups of patients who participated in subsequent studies support this statement. Conclusion: Despite the relatively limited range of data in the current literature, most authors provide strong evidence to support the later use of this drug according to patient profiles and overcoming ethnic limitations. Others disagree with these observations, but this topic and this drug have great potential. As such, additional research is needed to fill existing knowledge gaps and extend this experience to a larger scale. Demonstrate overcoming all limitations.
#8 : The Effect of IVF-ET Electro-Ultrasound Therapy on the Outcome of Frozen Embryo Transfer in Patients with Thin Endometrium
Authors: Wu Qiongfang , Tian Lifeng , Zhao Yan , Xu Tao , Chen Jia , Huang Jialuv , Xu Dingfei , Xia Leizheng , Nie Ling , Li Mengxi 
Published: January 2024

Background and Aims: This study are to investigate the clinical indicators of the infertile population of IVF-ET thin endometrium patients after electro-ultrasound treatment, record the observational data and analyze the clinical effectiveness of this treatment method. Method: Patients undergoing IVF-ET freeze-thaw embryo transfer from March 2022 to November 2022 were screened, and those who met the entry criteria were randomly grouped by random number table method. Treatment group (n=32): patients who received electro-ultrasound therapy; patients treated with electro-ultrasound (MLD-C7000) once a day for 30 minutes for 7 days for 1-3 sessions in the context of conventional FET preparation of the endothelium. Control group (n=69): Routine FET preparation of the endometrium without. Results: There were no significant differences in basic data (P > 0.05). The endometrial thickness on the day of conversion 7.75±2.00 mm was significantly higher in the treatment group than the endometrial thickness on the day of conversion 6.39±0.67 mm in the control group (P<0.05). The biochemical pregnancy rate and clinical pregnancy rate in the treatment group were higher than those in the control group, but the differences were not statistically significant (P > 0.05). Conclusion: In IVF-ET patients with thin endometrium, electro-ultrasound therapy device can effectively improve the endometrial thickness of patients with a trend of beneficial effects on clinical outcomes and can be one of the methods to improve the success rate in patients with thin endometrium. However, further increase in sample size is needed in the future to improve the accuracy of the results.
#41 : The Effectiveness of GnRH Agonist Administration Prior to Frozen-Thawed Embryo Transfer with Artificial Cycle: A Systematic Review and Meta-Analysis of Different Protocols and Infertile Populations
Authors: Ho Nguyen Tuong , Ho Dang Khanh Ngan , Tomai Xuan Hong , Hu Yu-Ming , Ho Yen-Ping , Lin Shyr-Yeu , Wang Ruey-Sheng , Lee Yi-Xuan , Tan Shun-Jen , Kao Shu-Huei , Tzeng Chii-Ruey 
Published: January 2024

Background and Aims: We investigated the use of GnRHa pretreatment with different protocols and durations of treatment on pregnancy outcomes in women undergoing FET with artificial cycles (AC-FET). Method: A systematic search of PubMed, EMBASE, Google Scholar, and Cochrane library was performed to include only eligible peer-reviewed studies in English published before September 01, 2022. This review was registered on PROSPERO (CRD42022299259) Results: A total of 41 studies (43021 individuals) were included with low to moderate risk of bias. Overall, GnRHa pretreatment improved clinical pregnancy rate (CPR) (OR=1.27, 95%CI:1.12-1.44), implantation rate (IR) (OR=1.24, 95%CI:1.07-1.45), live birth rate (LBR) (OR=1.31, 95%CI:1.07-1.60) and endometrial thickness (MD=0.16, 95%CI:0.03-0.30). Subgroup analyses of randomized and non-randomized studies both demonstrated the benefits of GnRHa pretreatment in CPR, IR, and LBR. Protocols using depot GnRHa (OR=1.19, 95%CI:1.04-1.36) showed a better LBR than daily GnRHa (OR=1.04, 95%CI:0.93-1.16). Women administered GnRHa for more than one cycle had better CPR (OR=2.01, 95%CI:1.29-3.13) and IR (OR=2.14, 95%CI:0.98-4.67) than those treated with GnRHa within one cycle before FET ([OR=1.18, 95%CI:1.04-1.33] and [OR=1.16, 95%CI:1.01-1.32], respectively). In women with PCOS, pituitary suppression with GnRHa significantly improved CPR (OR=1.24, 95%CI:0.98-4.67), LBR (OR=1.22, 95%CI:1.05-1.42) and reduced the miscarriage rate (OR=0.75, 95%CI:0.59-0.95). In contrast, women with regular menstruation had a higher endometrial thickness (MD=0.16, 95%CI: 0.04-0.28) but no significant improvements in pregnancy outcomes. GnRHa pretreatment considerably improved IR (OR=2.21, 95%CI:1.60-3.07) in women with adenomyosis and CPR (OR=1.74, 95%CI:1.12-2.71), and LBR (OR=1.67, 95%CI:1.06-2.63) in women with endometriosis. Conclusion: GnRHa pretreatment, especially with longer suppression duration and the use of depot GnRHa, demonstrates a beneficial role during AC-FET cycles. Individuals with PCOS benefit from GnRHa pretreatment, though this FET protocol should be carefully considered in ovulatory women with regular menstruation. Albeit having the potential, effectiveness of this protocol on adenomyosis or endometriosis remains controversial and requires more rigorous investigation