bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can laboratory HIV and infectious syphilis data inform future pre-exposure prophylaxis use in women in Ontario, Canada?
Authors: Sadeghi Yasamin , Nelson Paul , Sullivan Ashleigh , Allen Vanessa , Hasso Maan , Liu Juan , Tran Vanessa , Tan Darrell H S 
Published: January 2024

ObjectivesInfectious syphilis has been proposed as an indication for HIV pre-exposure prophylaxis (PrEP) in women. We explored how many women experienced HIV seroconversion after being diagnosed with syphilis in Ontario between 20 April 2010 and 31 December 2021.MethodsThrough deterministic linkage of laboratory data at the Public Health Ontario laboratory, which conducts the vast majority of syphilis and HIV testing in Ontario, we quantified the number of females with positive syphilis diagnoses who subsequently exhibited HIV seroconversion between April 2010 and December 2021. New HIV cases were identified by diagnostic serology or HIV viral load test result of ≥20 copies/mL at least 60 days after the positive syphilis test. We report aggregate numbers of women with new laboratory evidence of HIV infection after their first positive syphilis test.ResultsAmong 7957 women with positive syphilis tests during the study period, 6554 (82.4%) had linkable HIV serology tests and 133 (1.7%) ever tested HIV positive. With further linkage to viral load data, the number of women who ever had laboratory evidence of HIV infection increased to 184 (2.3%). However, when restricting to women whose first positive HIV test or HIV viral load occurred after their first positive syphilis test, this number decreased to 34 (0.4%). The median (IQR) time between the positive syphilis test and the first laboratory evidence of HIV was 551 (IQR=226–1159) days.ConclusionAlthough it is clinically appropriate to recommend HIV PrEP to women with syphilis, Ontario surveillance data suggest that the population-level impact of this strategy on the HIV epidemic in Ontario would have been modest during this 11-year period. Future studies should explore additional ways of prioritising women for PrEP.
Optimising IVF Outcomes
Authors: Vuong Lan N 
Published: January 2024

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women, with an overall prevalence of 5% to 15%, and a frequent cause of infertility. Ovulation disorders are the main cause of infertility for the couples. A range of endocrine and metabolic traits are also associated with PCOS and these include obesity, dyslipidemia, insulin resistance, hyperinsulinism and an increased risk of type 2 diabetes mellitus and cardiovascular disease. Studies have found that women with PCOS had a higher live birth rate, clinical pregnancy rate and implantation rate, as well as an increased risk of ovarian hyperstimulation syndrome (OHSS), pregnancy complications including miscarriage, preterm delivery, gestational diabetes mellitus and pregnancy-induced hypertension in their first IVF treatment when compared with non-PCOS controls. During the past three decades, applying IVF for infertility treatment PCOS women has increased significantly, and the landscape of treatment strategies has changed dramatically. GnRH agonist triggering oocyte maturation combined with freeze-all embryos is an effective and commonly used protocol nowadays to achieve good success rate as well as to minimize the risk of OHSS in women with PCOS. Recently, there has been an increasing use of oocyte in-vitro maturation (IVM) for treating infertility in women with PCOS. IVM technique could be considered as an alternative to IVF in centers where it is available. However, strategies to minimize pregnancy complications in women with PCOS remain further studied.
Can AI Improve Imaging Diagnostics?
Authors: Hull Mary Louise 
Published: January 2024

The 2016 Cochrane Review identified Magnetic Resonance Imaging (MRI) and Transvaginal Ultrasound scans (TVUS) as the most diagnostic non-invasive test for endometriosis. This led to IMAGENDO, which uses Artificial Intelligence (AI) to model digital data from these two imaging modalities to improve the accuracy of endometriosis non-invasive diagnostics. The IMAGENDO team have developed a novel, award winning, multimodal approach to improve the sensitivity and specificity of endometriosis imaging. The talk will describe some of the methods used, the impact AI has had on diagnostic accuracy and the challenges faced and yet to be overcome. The likely role of AI in future endometriosis diagnostics will be speculated upon.
Biopsy Procedure and Preparation (Including Biopsy Medium and Biopsy Dish)
Authors: Chang Tiencheng Arthur 
Published: January 2024

This lecture is a concise introduction designed to equip participants with essential knowledge and practical skills in performing embryo biopsy for PGT. The workshop emphasizes the significance of procedure and preparation which may impact the blastocyst biopsy and its role in selecting embryos. During the lecture, attendees are introduced to the fundamental steps of the blastocyst biopsy, starting with the optimal time frame for performing the biopsy, followed by techniques for safe and accurate zona drilling without compromising the embryo’s viability, as well as the importance of using a suitable biopsy medium that provides the necessary nutrients and support for the embryo during the biopsy. This lecture also delves into the selection and preparation of the biopsy dish, outlining the key factors to consider and practical tips on maintaining optimal conditions for the embryo within the biopsy dish and minimizing potential stress, to ensure successful outcomes. The instructor will share experiences and provide valuable insights into troubleshooting potential challenges that may arise during the biopsy process. Participants are encouraged to engage in interactive discussions and following hands-on sessions, allowing for a comprehensive understanding of the procedure, and fostering a collaborative learning environment. In conclusion, this lecture offers a valuable platform for embryologists to enhance their knowledge and skills in performing blastocyst biopsies with precision and confidence.
Micromanipulator Set-up - Taking Control of This System
Authors: Rose Ryan 
Published: January 2024

Embryo biopsy is a precise procedure, demanding adept manipulation skills and the finest instruments to ensure high-quality results. One of the most crucial elements to gain mastery over is the micromanipulator system. In this session attendees will delve into the practical facets of setting up and controlling a micromanipulator within the context of a blastocyst biopsy. The session will also cover the important aspects of system set-up, instrument alignment, and objective positioning, aimed to maximize control, precision, and stability during the biopsy procedure. Moreover, the discussion will touch on the common challenges faced during the set-up process, offering practical solutions, and troubleshooting tips to manage these effectively.
The Future of Genetic Testing of Embryos
Authors: Handyside Alan 
Published: January 2024

It is now over 30 years since the first pregnancies and live births following IVF, embryo biopsy and preimplantation genetic testing (PGT) were reported in 1990, in several couples at risk of having children affected by X-linked diseases (Handyside et al., 1990). Since then, methods for genetic analysis at the single-cell level have evolved alongside the rapid advances in human genetics and sequencing of the human genome. The range of applications has also expanded beyond monogenic diseases to chromosome aneuploidy, structural chromosome rearrangements and other genetic abnormalities. PGT is now practiced world-wide and remains a valuable alternative for at risk couples. With the development of methods for whole genome amplification, such as multiple displacement amplification (MDA), genome-wide analysis became possible. This has led to the development of microarray or next generation sequencing (NGS) based methods for genome-wide haplotyping of parental chromosomes in embryo samples and enabled universal linkage-based testing for monogenic diseases combined with molecular cytogenetic analysis of chromosome abnormalities. In the future, these methods will become increasingly informative and accurate, and it may be possible to use cell-free DNA in spent culture medium to avoid embryo biopsy. Handyside AH, Kontogianni EH, Hardy K and Winston RML (1990) Pregnancies from biopsied human preimplantation embryos sexed by Y-specific DNA amplification. Nature 344, 768
Surgical Management of Intrauterine Adhesions
Authors: Huang Xiaowu 
Published: January 2024

Intrauterine adhesions, also known as Asherman’s syndrome, can have an impact on both reproductive outcomes and gynaecologic symptoms. Surgical management with hysteroscopic lysis of adhesions is the gold standard for treatment. The following techniques are described in this presentation for cases with severe occlusive cavity and should be performed by experienced surgeons. 1. The use of 3D ultrasound played an important role in the preoperative workup of the patient, it could be used to evaluate the severity of intrauterine adhesion and predict the complexity of the cases. 2. Transabdominal 2D ultrasound guidance can help to delineate the location and extent of the adhesions and reduce the risk of uterine perforation and the formation of false passage. Laparoscopic guidance for severe cases has been advocated for immediate treatment of uterine perforation and minimizing extrauterine trauma. 3. In patients with severe intrauterine adhesion, a “myometrial scoring technique” could be used by bipolar electrode need with score 6 to 8, 4-mm-deep incisions from the fundus to the cervix and a transverse incision at the uterine fundus. Or the “ploughing technique” could be used by scissors, both methods aim to remove the fibrotic tissue, expose any underlying healthy basal endometrial tissue capable of regeneration. It remains to be seen whether “ploughing technique” using cold scissors or a “myometrial scoring technique” by bipolar electrode produces similar or different results, which could only be resolved by RCT in the future. 4. Surgical management offers favourable fertility outcomes and is often successful in restoring menstruation. Endometrial thickness and volume assessed by 3D-TVUS may have important predictive value for pregnancy after hysteroscopic adhesiolysis. 5. Prevention of reformation of adhesions remains challenging and no single method for preventing recurrence has shown superiority.
Genetic Diagnosis in Male Infertility
Authors: Rehman Khaleeq 
Published: January 2024

The male factor is responsible for more than half of infertile couples. It is caused by diverse factors. Amongst them, genetic and epigenetic abnormalities are important disorders. Appropriate genetic diagnosis is the key to understanding male factor infertility. It is interesting to note that genetic abnormalities of any disease vary from one region to another due to ethnic, geographic, and other differences. Our experience with the Pakistani population is similar. We have found novel genetic mutations in familial Idiopathic hypogonadotropic hypogonadism (IHH) specific to our patients. Familial IHH of Pakistan were studied through whole genome sequencing and we found novel mutations in GnRHR, KISS1R, and ANOS1 genes. We have found IHH families with X linked mode of inheritance and novel deletions in the ANOS1 gene that could be prevented by avoiding cousin marriages that are common in Pakistan. Similar results were found for our patients suffering from congenital absent vas deferens. This is why every region needs indigenous research to understand the genetic and epigenetic abnormalities of its population. The current presentation will highlight and discuss further research updates in this area. Today we have high hopes for the future of genetic medicine, but any developments in treatment strategies would require an understanding of the genetic patterns of different populations. It is an uphill task, especially for developing countries, so broadly-based collaborative studies are required with the facilitation of global organisations like “ASPIRE”.
Investing in Future Fertility: Where is the Best Place to Put Your Country’s Money?
Authors: Tiemann Emily 
Published: January 2024

Fertility rates continue to fall across the Asia Pacific Region (APAC), placing pressure on the economy, healthcare systems, and society as a whole. It is not just a question of population size; increasing old-age dependency ratios beg the question of how a diminishing workforce will be able to pay for the services necessary to serve an ageing population. In many countries, it is the women who are expected to shoulder the burden of homecare and childcare duties, even if they are working full time themselves. What can policymakers in APAC countries do in order to help couples achieve the family size they desire and perhaps turn the falling fertility rate around, or at least slow the rate of population decline? And importantly, where should investment be placed to make the biggest impact? Economist Impact has authored a series of papers, sponsored by Merck, on the issue of low fertility rates in APAC countries. We explored the evidence base and cost-effectiveness for interventions such as workplace policies, parental leave, childcare provision, financial incentives and assisted reproductive technology, and discussed wider cultural and economic issues that may be impeding action. This presentation will describe the main findings from our previous work, including a recent policy prioritisation “Toolkit” that was designed to be used by policymakers in the region to help inspire the development of policy ideas to address falling fertility rates, and support discussions on where funding should best be targeted. We shall also describe our current research project on the development of a policy “Scorecard”, which compares and contrasts the fertility and family-friendly landscape in countries across APAC, to explore what policies are being implemented in practice in the region, and provide local suggestions for improvement and where funding should be allocated.
Debate 1: All Childless Women Age 32-34 Should Be Offered Egg Freezing
Authors: Boothroyd Clare , Kar Sujata 
Published: January 2024

Motion: For NIL Motion: Against In my opinion this is a very radical approach to managing women’s fertility. Women need ethical, scientific, practical, and doable advice from us as fertility consultants. We shall fail in our duties if we do not give them evidence based yet socially and personally relevant information. My points against egg freezing as a universal policy are as follows: 1. False sense of security. This by far is the most important reason. Women cannot and should not consider frozen eggs like an insurance policy, which they can use when and where they need. 2. Ethical reasoning suggests such a policy might put pressure on women affected reproductive autonomy. They must plan themselves when, where, how and with whom they wish to bear a child. 3. Such a policy may bring about socioeconomic disparities in the society as not all will have access or afford the cost of egg freezing. 4. Cost of the procedure, long-term freezing then IVF/ET will be very substantial and will put burden on a young upcoming struggling with career woman. 5. Healthcare resource diversion/allocation will be significant, with so many other more important women’s healthcare issues at hand. 6. Normalizing delayed childbirth by way of egg freezing could have massive changes in the demography of the society, also psychological pressure in women in follow this principle leading to regrets later in life. In the face of these issues, it might be more beneficial to focus on policies that support women to have children when they feel ready–whether that is at a younger or older age—rather than encouraging them to delay childbearing via egg freezing. This could include parental leave policies, affordable childcare, flexible work arrangements, and ensuring access to fertility treatments for those who need them. Not only policy, but research targeting assisted reproductive technologies aimed towards improving IVF success rates, ovarian rejuvenation, stem cell treatment etc. Will go a long way to satisfy reproductive needs of women of all age groups.
Debate 5: All Women with Recurrent Implantation Failure Should Be Offered PGT-A
Authors: Hardy Tristan , Legro Richard 
Published: January 2024

Motion: For Preimplantation genetic testing for aneuploidy (PGT-A) remains one of the most controversial aspects of reproductive medicine. The benefits of deselection of embryos using PGT-A must be considered according to the clinical situation. Although PGT-A is not the solution for recurrent implantation failure, it remains part of the armamentarium available to ensure patient care is optimised in other aspects. Motion: Against NIL
#225 : miR-135b Expression Correlated with Aneuploidy in Trophectoderm from IVF Patients: An Approach to NIR-Invasive Screening for Embryo Quality Assessment
Authors: Mutia Kresna , Bowolaksono Anom , Febri Ririn Rahmala , Iffanolida Pritta Ameilia , Pratama Gita , Harzif Achmad Kemal , Maidarti Mila , Sumapraja Kanadi , Muharam R. , Hestiantoro Andon , Wiweko Budi 
Published: January 2024

Background and Aims: MicroRNAs (miRNAs) are abundantly expressed in rapidly growing and undifferentiated cells, for example, embryonic stem cells. This led to the discovery that miRNAs are significantly expressed in human embryos and that intracellular miRNAs expression patterns differ between euploidy and aneuploid embryos. Our study aims to determine the correlation between miR-35b and embryo chromosomal status. Methods: Thirty-six blastocyst culture media were collected from patients who underwent the In Vito Fertilization (IVF) program followed by Preimplantation Genetic Testing for Aneuploidy (PGT-A) at Dr. Ciptomangunkusumo General Hospital, Jakarta. The trophectoderm cells were biopsied, and half of the spent media culture was evaluated for aneuploidy detection using Next Generation Sequencing (NGS). While the rest of the spent media on day five were analyzed for miR-135b expression using quantitative Real-Time Polymerase Chain Reaction (RT-qPCR). All the data were analyzed using SPSS, and the sensitivity and specificity of the miR-135b were analyzed using the ROC curve. Results: miR-135b relative expression was detected in blastocyst spent blastocyst media culture and not in culture media without embryo. Based on the average of miR-135b, expression was higher in aneuploidy embryos (7.9(0.01-1-45.57)) than embryos with no aneuploidy detected (0.7(0.003-9.65)) and statistically different with p¡0.05. miR-135 relative expression in spent culture media was 10.72-fold higher in aneuploidy compared with an embryo with a normal chromosome. Based on the validation, the sensitivity value was 71.4%, and the specificity was 68.2%, with a cut-off of the relative expression of miR-135b was 1.185-fold. Conclusion: miR-135b detected in IVF spent culture media from blastocyst media culture. The significant expression of miR-135b in an aneuploidy embryo makes miR-135b a potential biomarker for predicting the chromosomal quality of blastocyst embryos.
#44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure
Authors: Kuroda Keiji , Horikawa Takashi , Moriyama Azusa , Shiobara Keisuke , Takamizawa Satoru , Kuribayashi Yasushi , Nakagawa Koji , Sugiyama Rikikazu 
Published: January 2024

Background and Aims: Does the Optimization of Thyroid function, Thrombophilia, Immunity and Uterine Milieu (OPTIMUM) treatment strategy contribute to improving pregnancy outcomes after single euploid blastocyst transfer (SEBT) in patients with a history of repeated implantation failure (RIF) and/or recurrent pregnancy loss (RPL)? Method: Between January 2019 and May 2022, women aged ≥ 40 years with RIF after three or more embryo transfer using morphology good embryos and/or RPL after two or more clinical pregnancy losses underwent preimplantation genetic testing for aneuploidy (PGT-A) and RIF/RPL testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3, interferon-γ-producing helper-T (Th1) cell, IL-4-producing helper-T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 160 consecutive women who underwent SEBT, we compared 127 and 33 women with and without the OPTIMUM treatment strategy, respectively. Results: RIF/RPL testing identified intrauterine abnormalities in 67 (52.8%), aberrant high Th1/Th2 cell ratios in 38 (29.9%), thyroid dysfunction in 19 (15.0%), and thrombophilia in 24 (18.9%). The clinical pregnancy and live birth rates in the OPTIMUM group was significantly higher than that in the control group (73.9% and 45.5%, respectively; p = 0.005 and 64.7% and 39.4%, respectively; p = 0.01) in women with RIF (Table 1). Whereas there was no significant difference of miscarriage rate in RPL women with and without OPTIMUM (5.5% and 13.3%, respectively; p = 0.58). Conclusion: In the women aged ≥40 years with RIF who underwent PGT-A, the OPTIMUM treatment strategy improved pregnancy outcomes after SEBT. In RPL, however, both PGT-A with and without OPTIMUM resulted in low miscarriage rates and no significant difference was recognized.
#54 : Patient Tolerability of Local Anesthesia Infiltration of the Vaginal Wall and Parietal Peritoneum During Oocyte Retrieval for Minimal Simulation In-Vitro Fertilization (IVF)
Authors: Perillo Gayla , Mendiola Rudie Frederick , Ong-Jao Ednalyn , Francisco Fides Marie 
Published: January 2024

Background and Aims: Oocyte retrieval is a brief and minimally invasive procedure occasionally performed under anesthesia due to pain caused by the aspirating needle puncturing the vaginal skin and ovarian capsule during its manipulation within the ovary. Despite different techniques and regimens examined, there is no conclusion on the preferred method for anesthesia and pain relief for these procedures. The purpose of this retrospective cross-sectional study was to assess patient tolerability of local anesthesia for oocyte retrieval. Method: Patients undergoing minimal stimulation IVF were included. The average age of the women was 38.51 ± 4.402 (min. 28, max. 49). 3 ml of 2% lidocaine infiltration was done at the vaginal wall and parietal peritoneum just before oocyte retrieval. Participants rated pain levels at three events: during oocyte aspiration (“intra-op”), right after oocyte retrieval (“post-op”), and 15 minutes post-OPU. The pain scale used ranged from 0 to 10, with 0 being “No pain” and 10 being “Worst pain imaginable”. Results: The average time duration of oocyte retrieval was 7.54 ± 4.57. The average number of follicles aspirated was 4.77 ± 4.04 and the average number of eggs retrieved was 3.62 ± 3.213. Average pain ratings were as follows: Intra-op: 4.152 ± 2.757 S.D. (min. 0, max. 10); 15-min post-OPU: 2.848 ± 2.662 (min. 0, max. 9), and Discharge: 1.711 ± 2.017 (min. 0, max. 8), respectively. There was significant difference in the average pain felt by patients at the three events (p<0.001). According to 55 out of 99 participants who willingly answered the survey, 90.9% were willing to use the same sedation method again. Conclusion: Vaginal wall and parietal peritoneum local anesthesia infiltration helps in making the procedure tolerable for the patient.