bluuebunny/crossref_metadata_2025_split huggingface dataset:
#78 : Can Short-Term Insemination with Cumulus Reduction Improve IVF Success?
Authors: Morris Jessica 
Published: January 2024

Background and Aims: Short-term insemination (STI) reduces the exposure time of gametes to accumulation of cell detritus and reactive oxygen species. Thus, our study aimed to explore if the use of STI combined with cumulus reduction (CR) improves IVF success through laboratory measures. Method: A prospective randomised study was initiated in November 2021. The study group (SG) used STI with a four-hour co-incubation period of oocytes and sperm, inseminated 39 hours post trigger injection. The control group (CG) used standard insemination protocol with 18-hour co-incubation period, inseminated at least 3 hours post trigger injection. Oocytes in both groups underwent CR, were cultured in continuous culture media (Origio 1-Step), undisturbed from fertilisation check to Day 5 (370C, 5% O2, 6% CO2).Results were compared by fertilisation, blastocyst formation, day 5 utilisation, overall utilisation, and clinical pregnancy rates (Fisher exact tests). Results: A total of 152 patients were randomised into the SG while 107 patients were allocated to the CG to February 2023. The STI protocol showed a significant increase in blastocyst formation (SG 71.6% vs CG 63.6%; p<0.05), and rate of day 5 utilisation (SG 88.9% vs CG 80.9%; p<0.05). This far, no differences have been observed in fertilisation (SG 76.2% vs CG 76.5%; p>0.05), overall utilisation (SG 58.8% vs CG 54.1%; p>0.05), nor clinical pregnancy rates (SG 40.0% vs CG 40.5%; p>0.05). Conclusion: This study reports an increased number of blastocysts, and good quality utilisable day 5 blastocysts when using the STI protocol, with no negative impact to results.Future studies should include the analysis of cumulative pregnancy rates, and live birth rates.
#92 : An Artificial Intelligence Algorithm Outperforms Highly Variable Embryologist Grading for Predicting the Likelihood of Pregnancy Outcome from Embryo Images
Authors: VerMilyea Matthew , Hall Jonathan , Perugini Michelle , Nguyen Tuc , Perugini Don , Diakiw Sonya 
Published: January 2024

Background and Aims: Embryologist evaluation of embryos is critical for ensuring successful pregnancy outcomes. Standard, manual evaluation is variable, subjective, and time-consuming. The aim of this study was to evaluate whether an artificial intelligence (AI) algorithm can standardize and improve embryo evaluation during IVF. Method: 20 images of blastocyst-stage embryos on day 5 of in vitro development were selected to represent a range of morphological qualities. All embryos had been transferred and the clinical pregnancy outcome was known for each embryo based on detection of fetal heartbeat at first ultrasound scan (∼7-9 weeks gestation). 50% of embryos in the dataset resulted in pregnancy. 158 embryologists made a total of 236 attempts at providing their evaluation of the morphological quality of the 20 embryo images using the Gardner system. The embryologist-assigned grades were then used to generate their prediction of whether that embryo would lead to pregnancy or not (≥ 3BB indicated a pregnancy prediction, and <3BB indicated a non-pregnancy prediction). The same 20 embryo images were also assessed by a previously developed viability AI algorithm for evaluating the likelihood of clinical pregnancy based on embryo images. An AI score of ≥5.0/10 indicated a pregnancy prediction, and <5.0/10 indicated a non-pregnancy prediction. The AI algorithm provided the same score for each embryo image regardless of how many times the analysis was performed. Results: The AI algorithm correctly predicted pregnancy outcome for 14/20 embryo images (70%). Embryologists also correctly predicted 14/20 images in 14/236 attempts (6%), and in 1 attempt correctly predicted 15/20 images. In the remaining 221 attempts (94%) embryologists correctly predicted between 6-13 images, representing a range of accuracies from 30-75%. Conclusion: This study demonstrates the inherent variability and lack of objectivity associated with an embryologist’s evaluation of embryos. It highlights the benefits of accurate AI algorithms for standardizing embryo assessment
#148 : A Comprehensive Analysis of the Cells Originating from Tripolar Mitosis in the Preimplantation Embryo
Authors: King Tracey , Sorby Kelli 
Published: January 2024

Background and Aims: Tripolar mitosis (TM) is cellular division resulting in three daughter cells instead of the typical identical two. Historically studies have grouped all types of aberrant mitosis together providing insufficient evidence to make clinical decisions. This study examined the fate of tripolar mitosis daughter cells and their impact on embryo development and clinical outcomes. Method: A retrospective analysis of 14,450 embryos cultured in EmbryoScope+ was conducted. Embryos were assessed for cleavage stage TM events; mitosis with two concurrent cleavage furrows. TM embryos were categorised by the mitotic cycle of the TM event; Mitosis 1 (TM1), Mitosis 2 (TM2), Mitosis 3 (TM3) or multiple TM (MTM). TM embryo clinical outcomes were compared to embryos from the same IVF cycles. Timelapse footage was used to assess TM daughter cells outcomes. Results: The incidence of TM embryos (n=448) was 3.1% (TM1 n=118, TM2 n=206, TM3 n=98, MTM n=26). TM1 embryos displayed significantly later pronuclei fade times than control embryos (26.7 vs 25.0 HPI, p<0.001) and first cleavage time (29.7 vs 28.1 HPI, p<0.001). Utilisation rate for TM1 (6.6%), TM2 (39.3%) and MTM (11.6%) was significantly reduced compared to control embryos (53.4%, n=2,432, p<0.001). TM3 embryos showed no reduction in utilisation (59.2%). TM embryos demonstrated significantly lower clinical pregnancy and live birth rate (26.8% & 19.6% respectively, n=56) compared to control embryos (45.7% & 34.5%, p<0.01). TM1 embryos had no clinical pregnancies (n=5). At the compaction stage 98.1% of TM embryos had excluded cells. In 97.0% of cases excluded cells originated from TM daughter cells. Trophectoderm biopsy yielded no significant difference in euploidy rate between TM (46.1%) and control (40.1%) embryos. Conclusion: TM1, TM2 and MTM embryos displayed significantly reduced developmental potential. TM3 did not appear to be detrimental to embryo development. Despite TM not affecting euploidy, TM embryos demonstrated lower implantation potential and live birth rate.
#159 : Aneuploidy Embryos Rate in Good Prognosis Patients After Fertilization Using ICSI and IMSI Methods
Authors: Raharjo Reza , Boediono Arief , Sini Ivan , Indrasari Wahyu 
Published: January 2024

Background and Aims: Embryo aneuploidy is caused by many factors, including patient age, sperm quality and sperm selection method. There are several methods for selecting sperm, ICSI (intracytoplasmic sperm injection) and IMSI (intracytoplasmic morphologically selected sperm injection). Previous study related to the effect of sperm selection methods on aneuploidy embryos rate is still very rare. This study aims to determine the effect of selecting sperm methods on the aneuploidy embryos rate, especially in the good prognosis patient group. Method: A total of 67 patients with a good prognosis (AFCs[Formula: see text]6; AMH[Formula: see text]1,2) were grouped based on the method of selecting sperm. Furthermore, the fertilized oocytes that become blastocyst embryos were biopsied in the trophectoderm of the cell and compared between the two treatments. Results: The results of the study showed that the sperm selection method did not significantly affect the aneuploidy embryos rate (P>0.05). The percentage of aneuploidy embryos in the ICSI method was 28.1%, while in the IMSI method it was 24.3%. Conclusion: The conclusion of this study is that the sperm selection method does not affect the aneuploidy embryos rate in patients with a good prognosis.
#181 : The Importance of Inner Cell Mass Ratio for Embryo Grade Prediction Using Artificial Intelligence
Authors: Lee Chae Yoon , Lee Chae Yoon , Heo Jin , Kim Hyung Min , Park Jong Hyuk , Chung Mi Kyung 
Published: January 2024

Background and Aims: While reports suggest that the Inner Cell Mass (ICM) ratio may impact pregnancy rates, the Gardner criteria for grading ICM does not specify the ICM size or ratio. This study investigates the potential impact of the ICM ratio on predicting ICM grades using artificial intelligence. Methods: The study analyzed 1,963 Day 5 blastocyst images obtained from seven IVF clinics between June 2011 and May 2022. The images were matched with metadata, including ICM grade and ICM ratio. ICM ratio was computed as the ratio of the ICM area to the embryo area. ICM was graded according to the Gardner criteria and only ICM A and C grade groups were used to avoid ambiguity. Two CNN (Convolutional Neural Network) models were built: one with embryo images including ICM ratio and one without. Results: The use of ICM ratio in conjunction with the original grading model resulted in an improved model performance. Logistic regression analysis revealed the ICM ratio as a significant variable impacting embryo grade, with a p-value of less than 0.001. The coefficient for ICM ratio demonstrated an 8-fold increase in the odds ratio for grade A embryos with every 1-unit increase. Conclusions: We demonstrated that the CNN model could predict ICM grades with fair accuracy and that the inclusion of the ICM ratio significantly improved its performance. While CNNs are widely used for image analysis by extracting features from patterns, they may not effectively learn the characteristics of an area. To capture the important area-related features, measured values should be considered along with the image. Furthermore, the ICM ratio appears to be a significant feature that embryologists consider when grading embryos in clinical settings, beyond the Gardner criteria. Additional studies are warranted to investigate other features for evaluating ICM.
#307 : Establishment of an Early Blastocyst Stage Classification System and Its Implications for Clinical Pregnancy and Live Birth Outcomes
Authors: Caddy Melissa , Boekel Kym , Zander-Fox Deirdre , Green Mark 
Published: January 2024

Background and Aims: Sub-optimal embryo development on day 5 often leads to the transfer of an early blastocyst (EB) stage embryo, especially for women >38 years of age. Yet there are few studies of reported outcomes, nor an industry-wide EB classification system to identify EBs for fresh transfer with the best outcomes. Hence, this study aimed to determine clinical outcomes and whether an EB-stage classification system could be beneficial. Method: A retrospective cohort study analysed 537 cycles undertaken between 2019 and 2022 at two large clinics, in which patients had on day-5 a single fresh EB stage embryo transferred. A novel EB classification system was developed and applied to determine clinical pregnancy rate (CPR) and live birth rate (LBR) outcomes, as well as the effects of maternal age ([Formula: see text] or > 38 years of age). EB stage embryos were classified into four categories based on day-5 morphological features from highest (EB-A) to lowest (EB-D) quality. Data were analysed using Fisher’s exact and non-parametric analyses. Results: Transfer of a fresh EB embryo resulted in a 20.1% CPR and 14.7% LBR. Classification of EBs into four distinct sub-groups identified differences in CPR and LBR (LBR: EB-A 23.4%; EB-B 10.3%; EB-C 12.9%; EB-D 7.6%). Similar CPR and LBR trends were determined for patients [Formula: see text] 38 years of age (LBR:26.7%,14.2%,19.0%, 2.1%) and >38 years of age (LBR:17.5%,4.3%,5.8%,2.7%), with an overall lower LBR for women >38 years of age (8.0%) compared with [Formula: see text] 38 years old (19.5%; P<0.05). Conclusion: Whilst pregnancies and live births can result from an EB transfer, LBR varied by >15% between different morphological classifications. If required, transfer of a late-stage EB results in a higher LBR, especially for women [Formula: see text] 38 years of age. Use of an EB classification system would benefit clinical decisions around when to transfer an EB stage embryo.
#328 : Fertilization and Embryo Quality of Human Mature Oocytes with Morphological Abnormalities After Intracytoplasmic Sperm Injection (ICSI)
Authors: Sudiman Jaqueline , Adnyana IB Putra , Widianti I Gusti Ayu , Suardika Anom 
Published: January 2024

Background and Aims: The dysmorphism of oocytes either extra or intracytoplasmic could decrease viability and developmental competence of oocytes. There are several reports describing that specific dysmorphisms are related with decrease in fertilization and embryo competence. The aim of this research is to investigate fertilization and embryo quality of specific dysmorphic mature oocytes obtained from ICSI. Method: A retrospective analysis was performed in 183 patients with 1700 mature oocytes. Mature oocytes were classified as normal morphology (control), oocytes with intra-cytoplasmic dysmorphism (fragile oocytes, inclusion bodies, vacuoles, mild granularity of cytoplasm, severe granularity of cytoplasm, and central granulation), and oocytes with extra-cytoplasmic dysmorphism (granulation in perivitelline space, polar body fragmentation, large perivitelline space, and abnormal zona pellucida). All oocytes were inseminated with ICSI. Oocytes were cultured and scored on day 3 then some of them were transferred. The rest of oocytes were extended culture until day 5. Day 3 embryos were classified based on grading by Kamardi et al., 2021. Grade 1 and 2 embryos are considered good quality embryos. Day 5 embryos were classified based on modified grading by Gardner and Schoolcraft., 1999. Results: Overall, fertilization rate was significantly lower in the dysmorphic oocytes compared to control (P<0.01). Good quality embryo development on day 3 was significantly lower in oocytes with severe granularity of cytoplasm compared to control (P<0.05). Looking at embryo development on day 5, oocytes with inclusion bodies and central granulation had significantly lower on good quality blastocyst (P<0.05). Conclusion: The fertilization potential of dysmorphic oocytes in our study was lower compared to normal morphology oocytes, however, only severe granularity of cytoplasm, inclusion bodies and central granulation related with poor embryo quality on day 3 and day 5. In this study, we were able to define several specific of oocyte dimorphism related with lower fertilization and embryo quality.
#368 : Non-Invasive PGT: A Preliminary Experience
Authors: Kanoi Rashi , Ramakrishna Sujatha , Gutgutia Rohit 
Published: January 2024

Background and Aims: Trophectoderm biopsy is an invasive procedure, triggering concerns about its impact on embryo viability and implantation potential. The discovery of cell-free embryonic DNA in spent culture medium could serve as a non-invasive method to analyze the chromosomal status of embryos and provide a better representation of the entire embryo since the DNA originates from both ICM and TE. We aimed to retrospectively analyze the reliability of carrying out non-invasive PGT (niPGT) on a group of patients and see if this procedure can be offered to those undergoing IVF-PGT cycles as a safer alternative. Method: Test group embryos (N=23) underwent non-invasive PGT by spent blastocyst media analysis and were compared with control group embryos (N=25) subjected to invasive PGT. Clinical history and age of women from both groups were similar. Spent media was extracted as per the genomic partner’s instructions. Data was collected from cycles that took place from April 2022 to November 2022. Results: PGT results of embryos from both groups were compared and were as follows: euploid embryos were lower (34.7% vs. 48%); aneuploid (43.4% vs. 44%) and no DNA detected embryos (4.3% vs. 4%) were similar; non-informative embryos were higher (17.4% vs. 0%) in test group as compared to control. Conclusion: Our initial findings suggest that detection capabilities of niPGT could be limited as we are losing out on some embryos due to higher non-informative/no DNA detected results and lower number of euploid embryos. However, this is a retrospective study assessing preliminary usage of a new technology for non-invasive genomic testing and the sample size is small to draw a definitive conclusion. A prospective study with a larger sample size is needed to confirm our findings and see if this method can be a suitable alternative to PGT.
#386 : Warming Vitrified Oocytes in a Fraction of the Current Required Time Results in Superior Survival Rates
Authors: Brewer Amber , Guerrero Carlos , VerMilyea Lindsey 
Published: January 2024

Background and Aims: Oocyte vitrification and warming is very time consuming. Oocyte vitrification protocols are different from that of embryos or blastocysts, while warming protocols allow all to be warmed the same. For blastocysts, frequently only one device is warmed per patient; however, numerous devices are required in oocyte warming. We aim to evaluate whether vitrified oocytes can successfully survive a warming protocol involving only Thawing Solution (TS) with a total elapsed warming time of a mere 90 seconds. Methods: 58 vitrified donor oocytes (Treatment Group) were prospectively warmed in January 2023. 71 vitrified donor oocytes (Control Group) warmed in 2022 were retrospectively analyzed. Both groups were vitrified in Kitazato or Irvine Scientific Vit Kit with identical protocols (elapsed time approximately 17-minutes). In both groups the TS was equilibrated to 37-degrees for a minimum of 2-hours. The Control Group was warmed in Irvine Scientific Vit Kit (1-minute TS, 3-minute DS, 8-minute WS) for a total warming time of 12-minutes. Warming for the Treatment Group was in Irvine Scientific Vit Kit Warm-NX, TS only, for 90-seconds. Results: After Chi-square analysis, [Formula: see text] value < 0.05 reflected significance. The Control Group warmed with 90.1% survival. The Treatment Group resulted in 98.3% survival, ([Formula: see text] -value = 0.056). Survival at 3-hours post warm in the Control Group was 100%. At this point for the Control Group, ICSI was performed, and the oocytes placed back into the incubator for resulting embryo culture. For the Treatment Group, oocyte survival was re-assessed at 1-hour and 24-hours, and 100% survival was maintained over the course of 24-hour incubation, with little-to-no visible cryo-damage. Conclusions: Vitrified oocytes exhibit outstanding survival when warmed with a highly modified and considerably faster protocol than current practice. The extended oocyte survival of at least 24-hours shows a very favorable outcome for the accelerated warming protocol and gives credibility to the survival assessment.
#17 : Clinical Efficacy of IVIG Depending on the Peripheral Blood NK Cell Proportions in Women with Recurrent Pregnancy Loss
Authors: Hur YooJin , Lee Ji Sun , KIM Dong Ja , Lee Taek Hoo , Park Joon Cheol 
Published: January 2024

Backgrounds and Aims: Etiology of repeat pregnancy loss (RPL) is complex, approximately 50% of cases of RPL had been classified as unexplained. Nowadays, elevated peripheral blood NK cell proportions are supposed to be related to RPL, and IVIG could down-regulate the NK cell levels. However, the efficacy of IVIG in RPL women is still under debates. The aims of this study were to evaluate the clinical outcomes of IVIG in RPL women with elevated peripheral blood NK cell proportions (PbNK), and to analyze the efficacy depending on the levels of PbNK. Methods: In this retrospective study, 916 women suffered two more miscarriages were evaluated from Jan. 2002 to Aug. 2022. After excluding the genetic, anatomic, endocrinologic causes and antiphospholipid antibody syndrome, 383 unexplained RPL women with elevated PbNK were enrolled. IVIG were treated 400 mg/kg in every three weeks, started right after a positive pregnancy test. Clinical pregnancy outcomes and miscarriage were evaluated. Results: Mean age of enrolled women was 35.24±4.31 years old, mean parity was 0.15±0.36 and mean number of miscarriages was 2.79±1.46 (min 2–max 14). Mean PbNK was 17.74±5.82 (12.0–45.3%). During the IVIG infusion, no serious side effects were found. Among 238 pregnant women, 48 women suffered miscarriage unfortunately. Excluding the termination cases related with chromosomal abnormality and congenital anomalies, live birth rate was 80.9%. In 4 subgroups (NK<15%, 15–20%, 20–25%, <25%), the live birth rates tended to decrease as the PbNK increased, statistically insignificant (84.0%, 82.1%, 72.5%, 65.0%). Mean gestational weeks (GW), preterm birth rates under 37th GW and preterm birth rates under 34th GW were similar in each group. Conclusion: IVIG treatment in RPL women with elevated peripheral blood NK cell proportions could be beneficial without serious side effects. Even in higher elevated level of NK cell proportion, it could be effective as well.
#141 : Enhanced Luteal Support Following IVF/ICSI for Women with Two or More Good-Quality Embryo Transfer Failures Using Both Subcutaneous and Vaginal Progesterone: A Retrospective Cohort Study
Authors: Dao Viet Quoc , Da Silva Sarah Martins 
Published: January 2024

Background and Aims: Utilizing progesterone to support the luteal phase (LP) in in vitro fertilization is a well-established practice. Subcutaneous progesterone (SC-P) administration has shown pregnancy rates comparable to vaginal progesterone (Vag-P). However, data are not available regarding the efficacy of combining SC-P with Vag-P for women with multiple good-quality embryo transfer (ET) failures. Therefore, this study aims to evaluate the effectiveness of adding SC-P to Vag-P in women who had not conceived following two or more good-quality ETs. Method: A retrospective cohort analysis of data collected from a university-affiliated fertility centre in the UK between January 2020 to May 2022. A total of 224 embryo transfer cycles, including 65 fresh embryo transfer (fresh-ET) cycles and 159 frozen embryo transfer (FET) cycles in women who had not conceived or experienced miscarriages following two or more good-quality ETs, were analysed. The luteal support protocol was either micronized Vag-P (gel 90mg daily in fresh-ET cycles or pessaries 800mg daily in FET cycles) plus SC-P 25mg once daily (enhanced group) or Vag-P alone (control group). The pregnancy outcomes between the two groups were compared. Clinical pregnancy rates (CPR) represented the primary outcome. Results: In fresh-ET cycles, the enhanced group resulted in higher CPR than the control group. However, statistical significance was not achieved (40% (14/35) vs. 30% (9/30), p=0.40; multivariate analysis adjusted OR 1.54, 95% CI 0.48–4.93, p=0.468). In FET cycles, CPRs were comparable between the enhanced group and the control group (32.3% (21/65) vs. 31.9 % (30/94), p=0.958; multivariate analysis adjusted OR 0.98, 95% CI 0.47–2.03, p=0.953). In both fresh and frozen cycles, no significant difference was observed regarding the positive pregnancy test and miscarriage rates between the two groups. Conclusion: Adding SC-P to Vag-P did not improve pregnancy outcomes for women who had not conceived following two or more good-quality ETs.