bluuebunny/crossref_metadata_2025_split huggingface dataset:
#101 : A Direct Healthcare Cost Analysis of Recombinant LH Versus hMG Supplementation on FSH During Controlled Ovarian Hyperstimulation in the GnRH-Antagonist Protocol
Authors: Chang Jui-Chun , Lin Wei-Szu , Chen Ming-Jer , Lin Ching-Heng 
Published: January 2024

Background and Aims: We have previous proposed a retrospective matched-case control study comparing the effect of recombinant LH versus hMG supplementation on FSH during COH in the GnRH-antagonist protocol. The result showed the cumulative live birth rate (CLBR) was significantly higher the in the LH group (53% vs. 64%, p=0.02). In this study we aim to do the cost analysis between these two groups based on our previous study. Method: The analysis consisted of 425 IVF and ICSI cycles performed in Taichung Veterans General Hospital, Taiwan between 2013 and 2018 in our previous study. They were chosen by Propensity score matching with balanced age, anti-mullerian hormone (AMH) level, and oocyte retrieval date. There were 259 cycles in hMG ± FSH group and 166 cycles in LH ± FSH group. The total cost related to treatment of each patient was recorded. Results: The treatment cost was showed in Table 1. The total treatment cost per patient was significantly higher in the LH than in the hMG group (USD 4194.93 ± 713.6 vs. $ 4466.33 ± 793.18 p=0.001). However, the mean costs per live birth in the hMG goup was higher with US $7875.42, vs. US $6928.83 in the LH group. The analysis of CLBR in the two groups in different treatment cost range results were showed in Figure 1 and Table 2. The CLBR was almost higher in the LH group in each range except for range between USD 5000-5499. When treatment cost between $4000-4499, the CLBR was significantly higher in the LH group than in the hMG group (81.8% vs. 54.3% p=0.006). Conclusions: The cost analysis showed that recombinant LH is more cost effectiveness than hMG supplementation on FSH during COH in the GnRH-antagonist protocol.
#166 : Investigating the Effect of Parental Age on Intracytoplasmic Sperm Injection Reproductive Outcomes in Indonesia: Prognostic Tools and Prediction Approaches to Maximize Human Embryo Implantation
Authors: Margiana Ria , Laurus Geraldo , Amalia Fatkhurrohmah Leo , Supardi Supardi , Abdullah Muhammad Fadhli , Wen Maitra Djiang , Wibowo Suwaspodo Henry , Kamaroekmi Maya Sri 
Published: January 2024

Background and Aims: Reproductive issues impact one in eight Indonesian married couples. Intra Cytoplasmic Sperm Injection (ICSI) is still expensive; hence many couples don’t get evaluated or enroll fertility programs. We decided to study the correlation between age, hormonal status, and ICSI embryo quality because Indonesia’s infertility rate is rising. This is the first investigation into the factors behind ICSI outcomes in Indonesia. Method: In 2022, two fertility centers in Surabaya and Tangerang, Indonesia, performed ICSI on couples. 150 couples receiving ICSI at two research sites comprise the sample. Surgically retrieved or frozen sperm cycles and incomplete medical records were excluded. The Spearman test was used to investigate the correlation between parental age, hormonal status, and ICSI embryo quality on day 1 and day 3. (D1 and D3). Results: 150 ICSI cycles were studied. The hormonal baseline varied from normal to subnormal, while paternal and maternal age ± SDs were 37.03 ± 6.08 and 34.28 ± 5.11. The Spearman test demonstrated a significant negative connection between paternal age and embryo quality D1 (p<0.005, r=-0.363) and D3 (good category: p<0.005, r=-0.172; intermediate category: p<0.005, r=-0.250; poor category: p<0.005, r=-0.221). The Spearman test showed a significant negative connection between maternal age and embryo quality D1 (p<0.005, r=-0.413) and D3 (good category: p<0.005, r=-0.231; intermediate category: p<0.005, r=-0.294; poor category: p<0.005, r=-0.291). Conclusion: This study reveals that married couples have a substantial impact on their hormonal condition, the rate of fertilization, the quality of D1 and D3 embryos, and the number of embryos generated following ICSI. To increase the success rate of ICSI procedures, it is necessary to maximize fertility at a younger age.
#266 : Heterotopic Tubal Pregnancy After Frozen Embryo Transfer: A Case Report
Authors: Susanto Cynthia Agnes , Syahbana Luky Satria , Beeleonie Beeleonie , Lie Vellyana , Wiweko Budi 
Published: January 2024

Background: Heterotopic pregnancy is a serious complication in vitro fertilization and embryo transfer (IVF-FET). The incidence of heterotopic pregnancy in assisted reproductive technique is 1-3%. The most common site of ectopic pregnancy both in spontaneous and ART is in tubal fallopian. This case can increase morbidity and mortality both in mother and intrauterine gestation, when delayed diagnosis happened. Case report: A 31-year-old woman presented to regular control after 14 days of frozen embryo transfer. The patient was transferred one good and one moderate blastocyst, and the [Formula: see text]-human chorionic gonadotropin ([Formula: see text]-hCG) level was 1960,6 mIU/mL and progesterone level were 54.04 ng/mL. The first transvaginal ultrasound found only one fifth weeks gestational sac. Two weeks after that, we found the same seventh weeks gestational sac. The patient then came on her 11[Formula: see text] week pregnant, and ultrasound revealed another gestational sac was implanted within the right fallopian tube and one more gestational sac was within intrauterine. Both babies were alive. Emergency Laparoscopy was performed, and it was found the gestational sac indeed was being implanted in the fallopian tube and some part of the placenta was implanted within the right ovary. We then performed the right salpingectomy. The other intrauterine pregnancy was then closely monitored, and until today, the mother and other baby is in good condition. Conclusion: Heterotropic pregnancy incidence increases greatly, especially in ART. Thus, as clinicians, closely monitoring ultrasound is needed in order to prevent late diagnosis of heterotropic pregnancy.
#292 : Combination of Hormone Replacement Therapy and Ovarian Stimulation as Endometrial Preparation Strategy for Refractory Thin Endometrium
Authors: Mariappen Uma 
Published: January 2024

Background and Aims: The aim of the case study is to demonstrate that combination of hormone replacement therapy with controlled ovarian stimulation is effective to improve endometrial thickness (ET) in difficult cases of thin endometrium. Method: The patient is a 35-year-old, nulliparous with primary subfertility for six years. She had PCOS with history of right salphingo-oophorectomy done for benign serous papillary cystadenoma. The male partner had severe oligoasthenoteratozoospermia. He started on FSH injections for three months with slight improvement in sperm parameters. She then underwent an IVF cycle and obtained five blastocysts. We struggled with thin ET with one failed frozen embryo transfer (FET) and two abandoned cycles. The patient was started with hormone replacement therapy on day one menses with tablet progynova 4 mg six hourly together with estrogel 3 g eight hourly transdermally. A scan was performed on day one menses and endometrial thickness was 4.5 mm. The serum progesterone and luteinizing hormone was baseline. A repeat scan for ET was done on day seven menses and was noted to be 6.4 mm. She was given another four days of oral and transdermal estrogen and the ET remained 6.4 mm at day eleven menses. We decided to perform low dose ovarian stimulation with recombinant FSH 150 IU daily. She was then seen on day fourteen menses for repeat scan. The ET only marginally increased to 6.7 mm. We increased the injection to 225 IU daily. On day eighteen menses, her ET was 7.8 mm and we triggered with HCG 5000 IU. She had her FET done on day twenty-five menses. Results: Her BHCG two weeks later was 948.3 U/L. The pregnancy is currently ongoing at 18 weeks. Conclusion: A combination of hormone replacement therapy and ovarian stimulation enables the exogenous and endogenous estrogen to act synchronously on the endometrium to achieve better endometrial thickness for implantation.
#360 : Twin Pregnancy After Step-Wise Cryopreservation and Thawing of Oocytes, Sperm and Blastocysts in the Case of Azoospermia: Case Report
Authors: Kang Hee Jung , Song Seul Ki , Jo Su Vin , Lee You Jung , Lee Gyoung Hoon 
Published: January 2024

CASE: Although twins born from freeze-thawed mature oocytes were first reported in Australia in 1986, oocyte cryopreservation was experimental before 2012. The success of oocyte cryopreservation was uncertain compared to sperm freezing. Since then, many studies have been conducted on preserving female fertility, but data on the results of oocyte cryopreservation in the case of male infertility are limited. Thus, we aimed to report a twin pregnancy after three steps of cryopreservation, freezing, and thawing of oocytes, sperm, and blastocysts. At 40 years of age, a woman returned to our center, where donated sperm can be used by women with the desire to get pregnant. As her partner was diagnosed with severe oligospermia, she had already undergone eight cycles of OPU (Oocyte Pick Up), three times with fresh ET (Embryo Transfer), and three with thawed ET, but failed to get pregnant. With a diagnosis of recurrent implantation failure, she decided to cryopreserve oocytes for fertility preservation while waiting for her partner to improve his gamete condition. A total of 20 oocytes cryopreserved at three clinics were stored for that purpose. However, she decided to use sperm cryopreserved for donation after getting a urologic recommendation as a candidate for receiving donor sperm. Fourteen of 20 thawed oocytes survived (70%) and were inseminated by ICSI (Intracytoplasmic Sperm Injection) using thawed sperm. Twelve were fertilized (75%) and had started their development to become good embryos at three days (50%). Among five cryopreserved embryos, three were at the cleavage, and two were at the blastocyst stage. Two blastocyst embryos were thawed on the sixth day of progesterone treatment after pretreatment with estradiol valerate. Two gestational sacs were confirmed via ultrasound. This case is the first report of a successful pregnancy using cryopreserved oocytes, sperm, and blastocysts in Korea.
#146 : Low-Lactate Culture Medium Increases the Percentage of Usable Blastocysts from Advanced Maternal Age Patients: A Sibling-Oocyte, Monocentric Study
Authors: Hattori Hiromitsu , Takahashi Mizuho , Toya Mayumi , Igarashi Hideki , Kyono Koichi 
Published: January 2024

Background and Aims: Excess lactate in culture medium accumulates may adversely affect the embryo as metabolic stress. The purpose of this study is to investigate whether culture media with a low-lactate concentration have an effect on embryonic development in IVF. Method: A split sibling study was performed on 8313 oocytes from 1,312 ICSI cycles from which at least two matured oocytes were retrieved from January 2020 through August 2022. Sperm-injected oocytes were allocated to Continuous Single Culture-NX (NX, N=4352) which contains a low concentration of lactate (1mM) and GlobalⓇ totalⓇ LP (GL, N=3961), which contains 5mM concentration of lactate. Patients were classified into subgroups of <40 years (854 cycles) and [Formula: see text]40 years (458 cycles). Single frozen embryo transfers were performed in 859 cycles (NX; N = 500, GL; N = 359). Embryo development up to Day 6, clinical pregnancy and miscarriage rates were compared. Usable blastocysts were defined as any blastocyst cryopreserved on day 5 or day 6. P<0.05 was considered statistically significant. Results: The mean patient age was 37.1 ± 4.4 years. Overall fertilization rates and the blastocyst development rate were significantly higher in NX than GL (80.7% vs. 78.9% and 62.3% vs. 59.8% respectively). There was no significant difference in blastocyst utilization rate on day 5 with all ages considered (36.2% NX vs. 34.2% GL). There was no significant difference in blastocyst development rate for patients [Formula: see text]40 years, but for patients [Formula: see text]40 years, blastocyst development rate and day 5 usable blastocyst rate were significantly increased in NX (51.2% vs. 46.4% and 26.2% vs. 22.4% respectively). There were no significant differences in the clinical pregnancy or miscarriage rates (48.8% vs. 49.9% and 22.1% vs. 21.8% respectively). Conclusion: Our results suggest that the lower concentration of lactate in culture medium is effective for late embryonic development in advanced maternal age patients.
#283 : Fertilization Rate and Embryonic Morphokinetic Parameters According to the Spindle Pattern in the Oocyte in Patients Over 40 Years of Age Who Underwent Polscope-Based ICSI
Authors: Kim Su Hyeon , Jeong Seong Hee , Kim Jae Won , Jeong Hyeon Jeong , Kim Myung Hee , Lee Hee Sun , Chung Mi Kyung 
Published: January 2024

Background and Aims: The spindle is an essential cellular organelle that plays an important role in the oocyte during chromosome alignment and separation at meiosis. To examine the effect of presence or location of spindle on the fertilization rate and the morphokinetic parameter of embryo in patients over 40 years. Methods: This was a retrospective study based on data collected between January and December 2022. A total of 394 matured oocytes retrieved from 155 patients over 40 years undergoing ICSI cycles were imaged for meiotic spindle using PolScope. Oocytes were subdivided into two groups. Group A: oocytes had the spindle forming 0 to 15[Formula: see text] angles, group B: oocytes had the spindle forming 15[Formula: see text] or more. Morphokinetic analysis; Embryoscope+ using guided semi-automatic annotation. Results: Meiotic spindles were visualized in 369 oocytes (93.65%, 369/394) and were not visualized in 25 oocytes (6.35%, 25/394). The fertilization rate (73.98% and 44.00%; P=0.0012) and good quality embryo rate (41.39% and 27.27%; P=0.365) were significantly higher in oocyte with spindle, compared with in oocyte without spindle. Divided by spindle angle, group A was significantly higher fertilization rate, good quality rate compared to group B. There was no signicant difference in KID3 score (mean, 3.91±1.46 and 4.00±1.22; P=0.39) and the D3 morphokinerics parameter among the different groups. However, the D5 morphokinetics parameter (tSC; 81.56±7.48 vs 85.73±8.29, tM; 87.22±7.89 vs 94.00±11.60, tSB; 96.05±8.03 vs 102.18±9.15, tB; 106.39±10.04 vs 113.06±10.88, P<0.05) showed a significant association with spindle location. Conclusions: Visible spindle or location close to polar body showed higher fertilization rate and good quality embryo as well as differed in morphokinetic parameters on day 5. This study confirmed a positive relationship between the spindle and fertilization rate. A significant difference of morphokinetics was found in day 5, but not in day 3.
#71 : Successful IVF Procedure on SARS-CoV-2 Positive Advance Maternal Age Woman
Authors: Prasetiawati Novita , Supriyadi Agus , Sjarbaini Hadi , Suardana Gde , Tarigan Sudirmanto , Haekal Mohammad , Indah Deana Rosaria , Pariyanti Gangsar , Bowolaksono Anom 
Published: January 2024

Background and Aims: Due to the coronavirus disease-19 (COVID-19) pandemic, assisted reproductive techniqueservices across Indonesia have been suspended. With an unpredictable duration, the suspension is affecting particular groups of women who want to achieve pregnancy, including advanced aged women whose fertility has declined significantly. Here we present a 44-year-old woman with primary infertility and nulliparous with unexplained indication who underwent an in vitro fertilization procedure while confirmed positive for COVID-19. The goal of this study was to investigate SARS-CoV-2 transmission through the embryo and its effect on the embryo survival rate. Method: The IVF procedure was carried out following standard methods. Controlled ovarian stimulation was done by giving growth hormone and exogenous gonadotropin on the first day of the cycle, gonadotropin-releasing hormone antagonist on day 7 of the cycle, and human chorionic gonadotropin 36 hours before ovum pick up. Then, ovum pick up was carried out with COVID-19 standard safety procedures and the follicles were sent to the IVF laboratory with a heating stage. The oocytes were obtained from the follicular fluid analysis, following intracytoplasmic sperm injection. The zygotes were cultured for 48 hours and tested negative for SARS-CoV-2. Afterward, the entire embryos were vitrified for 30 days until the patient’s RT-PCR test confirmed negative for SARS-CoV-2 infection. Thereafter, an endometrial thickness examination was done, followed by embryo transfer on the same day. Results: Six oocytes in metaphase-II were retrieved while the patient was confirmed positive with COVID-19. After fertilization, 6 embryos were obtained, tested negative for COVID-19, and were later vitrified. Conclusion: Two of the embryos survived vitrification and both were successfully transferred. IVF with standard procedures is safe to proceed on COVID-19 positive women.
#136 : Osteopontin Facilitates Embryo Growth, Implantation, and Cellular Metabolism via Interacting with αvβ3 and RGS2 Pathway: Evidence from Mouse Embryos and a 3D In-Vitro Implantation Model
Authors: Ho Nguyen Tuong , Liao Pei-Yu , Tzeng Chii , Kao Shu-Huei 
Published: January 2024

Background and Aims: We conducted a study on mice to investigate how osteopontin, a mediator of cell-cell and cell-extracellular matrix (ECM) communication and invasion, influences embryonic development, metabolism, and implantation potential, with confirmation by a 3D in-vitro implantation model. Method: Embryos were collected from female mice and cultured under different conditions: HTF only, HTF supplemented with OPN at different doses, and OPN-supplemented HTF with anti-[Formula: see text]v[Formula: see text]3 Ab or RGS2 inhibitors. Embryo morphology, development, and implantation rates were evaluated. Microarrays were used to evaluate gene expression profiling. Choriocarcinoma JAR and epithelial RL95-2 cell lines were adopted for the in-vitro implantation model. Oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) were used to measure cellular metabolism levels. Results: The supplementation of OPN best enhanced the rate of embryo hatching-out and implantation onto the matrigel at 100 nM, but a higher degeneration rate was seen at a higher concentration ([Formula: see text]200 nM). In OPN-treated embryos, microarray analysis showed 51 significantly down-regulated genes and 60 up-regulated genes, including RGS2. Inhibition of [Formula: see text]v[Formula: see text]3 integrin decreased embryo implantation rates and down-regulated RGS2. Validation of the 3D implantation model using JAR spheroids and RL95-2 monolayer showed a similar effect. OPN also increased OCR and ECAR of the JAR cells, and migration assays revealed increased migration ability in OPN-overexpressed JAR cells, which was then inhibited by [Formula: see text]v[Formula: see text]3 and RGS2 inhibitors. Conclusion: Osteopontin, at a reasonable concentration, could enhance embryo development and implantation by interacting with [Formula: see text]v[Formula: see text]3 integrin, subsequently facilitating the RGS2 pathway. OPN has the potential to be a supplement during in vitro embryo culture in ART intervention.
#129 : The Ratio of Luteal Phase Serum Progesterone and Estradiol Can be Used to Predict Pregnancy in Frozen Embryo Transfer Cycles
Authors: Lee Li-Hsuan , Hsu Chao Chin 
Published: January 2024

Background and Aims: Low serum progesterone (P) levels on day of embryo transfer (ET) and luteal phase have been associated with poorer pregnancy outcome. This study aimed to know if serum estradiol (E2) and P levels during mid and late luteal phase are related with ongoing pregnancy. Method: The serum E2 and P levels from mid luteal phase (5 days after ET) to the day of the [Formula: see text]-hCG check (11 days after ET) in both fresh and frozen embryo transfer (FET) cycles was investigated between January 2019 and December 2021. Eligible patients were reproductive aged women with a normal uterus. Single blastocyst transfer cycles were included. Estradiol valerate (2 mg/bid) was started from day 3 of cycle as hormone replacement and vaginal micronized P (400 mg/bid) was started 5 days before ET in all FET cycles. The 2-degree polynomial fitted data were analysed and logistic linear model and ROC analysis were performed to assess E2 and P4 polynomial coefficients as a predictive test for ongoing pregnancy. Results: A total of 388 patients were included. The overall pregnancy rate was 43.8% and 31.3% for FET and fresh ET, respectively. On day 5 post ET, the serum P levels correlated significantly with ongoing pregnancy and live birth rates, especially in FET cycles. The ROC curve showed that there is a significant day 5 post ET predictive value of serum P4/E2 levels for pregnancy rate, being the AUC (95% CI) = 0.596 (0.539–0.653) for the combination of both fresh and FET cycles; and 0.611 (0.548–0.674) for FET cycles, with best cut-off values of 0.079 and 0.077, respectively. Conclusion: Serum P levels in mid and late luteal phase days are associated with pregnancy outcome both in fresh and frozen ET cycles. Ongoing pregnancies can be predicted using the day 5 post ET serum P4/E2 levels.
#339 : Secondary Amenorrhea Due to Sheehan’s Syndrome: A Case Report
Authors: Yuad Haviz 
Published: January 2024

Background: It is said to be secondary amenorrhoea when a woman of reproductive age who has had menstruation, suddenly her menstruation stops for at least three months in a row. Sheehan’s syndrome, also called postpartum pituitary necrosis, refers to necrosis of cells of the anterior pituitary gland after significant postpartum hemorrhage, hypovolemia, and shock. Advances in obstetric care in developed countries have reduced the incidence of this condition. Sheehan’s syndrome is the most common cause of amenorrhea due to pituitary disorders. Case presentation: A 26-years-old had complained of not having her period since 2018 (5 years) after the patient gave birth to her first child spontaneously vaginally at a midwife. At that time the patient experienced postpartum bleeding, since then the patient has no longer had menstruation. The patient had also complained of hot flushes, osteoporosis symptoms and vaginal dryness. Upon further evaluation, she was found to have decreased the pituitary hormonal profile (GH, FSH, LH, Prolactin); uterine and bilateral adnexa was hypoplasia from Ultrasonography, and the empty sella (sheehan syndrome?) from the Magnetic Resonance Examination of head. The basis of treatment for Sheehan’s syndrome is lifelong deficient hormone replacement; these patients require lifelong follow-up and close monitoring of their hormone levels. Conclusion: The medical signs and symptoms should be recognized as sheehan’s syndrome, especially for the patient with a massive postpartum hemorrhage in order to give better treatments and outcomes.