bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Different Biopsy Techniques
Authors: Malhotra Keshav 
Published: January 2024

Preimplantation genetic testing needs access to genomic DNA in order to execute a genetic test on a preimplantation embryo. Normally a few cells must be extracted or ‘biopsied’ from the embryo to achieve this. Embryo biopsy evolved from attempts in the 1960s and early 1970s to sex farm animal embryos to now utilizing it to screen and select human embryos based on Ploidy, or avoid monogenic disorders. In October 1989, the first clinical cleavage stage biopsies and single cell PGT to determine the sex of the embryos were conducted. It has now evolved to utilize Trophectoderm cells. The advent of Laser has allowed the biopsy process to shift away from mechanical and chemical hatching and techniques also now involve Laser to separate the cells from the blastocyst. Here is a short summary of the different biopsy stages. Polar Body Biopsy : — Polar bodies are small cells produced during the process of oogenesis (egg development) in females. — Since polar bodies contain genetic material from the egg, they can be biopsied to indirectly infer the genetic status of the egg. — This technique is less common and has limitations, but it can be used in certain situations. Blastomere Biopsy (Day 3 Biopsy) : — Performed on the third day after fertilization when the embryo has around 8 cells. — A single cell (blastomere) is removed from the embryo for genetic testing. — Mosaicism cannot be ruled out thus questioning the efficacy of this technique. Trophectoderm Biopsy (Day 5-7 Biopsy) : — Performed at the blastocyst stage, typically on the fifth or sixth day of embryonic development. — Usually, 5-10 cells from the trophectoderm are removed for genetic testing. — This technique is now gold standard and allows determination of mosaicism. The embryo biopsy revolution’s 30-year saga is still unfolding, and non-invasive genetic testing holds potential to revolutionize the way embryos are tested for genetic disorders.
How Many Cells Should Be Biopsied? - Perspectives From Embryologist and Genetic Testing Lab
Authors: Cheng Ching-Wen 
Published: January 2024

The biopsy process for PGT-A involves picking up a few cells from the outer layer of the embryo trophectoderm, when the embryo has developed into blastocyst stage. The biopsy procedure of PGT-A has been refined over years, but it could potentially have a slight impact on embryo implantation. Theoretically, removal of a few cells from the outer layer of the embryo might disrupt its natural processes to some extent. Besides, a few research results indicated that the number of biopsied cells may have slight influence on the clinical outcomes of PGT-A. Meanwhile, others show no significant differences in implantation rate between biopsied and non-biopsied groups. Therefore, in this presentation, we will discuss which is the appropriate number of cells to pick up for PGT-A, and share the clinical statistical results of the number of cells we have biopsied in our center.
MitoHOPE: Introduction to the Australian Mitochondrial Donation Project
Authors: Carroll John 
Published: January 2024

Mitochondrial Donation provides a means of reducing the risk of transmitting mitochondrial genetic disease. If successful, families who have suffered in many cases across generations, will be freed from the risks of inheriting mitochondrial genetic disease in their future children. In response to mito community advocacy led by the Mito Foundation, Maeve’s Law, was passed in March 2022 to allow the introduction of mitochondrial donation in Australia. The mitochondrial donation procedure involves removing the nuclear DNA from the egg or zygote of from a woman with a mitochondrial DNA (mtDNA) mutation and transferring it to an enucleated egg or zygote from a donor with healthy mtDNA. Although this technique has been used in animal models for many years and has undergone significant preclinical testing in humans, it is use in the clinic remains at an early stage and, to date, only a small number of babies have been born. To introduce mitochondrial donation in Australia, an extensive regulatory and licensing procedure has been established and the MRFF has funded a Mitochondrial Donation Pilot Program, including a clinical trial. The mitoHOPE (Healthy Outcomes Pilot and Evaluation) Program integrates expertise in clinical genetics, oocyte and embryo development, mitochondrial disease, reproductive technologies, ethics, law, and health economics. The program was developed in conjunction with the mito community and this engagement will inform all steps of the implementation. Our partners include Monash IVF, the Mito Foundation and Newcastle University (UK). Progress is now underway to establish our governance arrangements, an oocyte donation program, clinical pathways into the clinical trial and an underpinning research program to ensure the safety and efficacy of mitochondrial donation as it is being introduced into the clinic.
Ovarian Rejuvenation for Diminished Ovarian Reserve
Authors: Kim Ji Hyang 
Published: January 2024

Addressing fertility challenges, particularly those stemming from advancing maternal age, requires innovative and effective solutions. This presentation navigates the frontier of ovarian rejuvenation for diminished ovarian reserve, examining whether it remains a myth or emerges as a promising reality. The lecture offers a comprehensive review of various ovarian rejuvenation technologies available today. It will investigate the clinical studies, accumulated evidence, and overall clinical utility, creating a foundation for understanding the effectiveness and limitations of each approach. A significant portion will be dedicated to the role and potential of Platelet-Rich Plasma (PRP) treatments in ovarian rejuvenation. This segment will include clinical study data and firsthand experiences, providing a practical perspective on PRP application. Further, an exploration into the basic research that supports PRP usage will be presented. This knowledge illuminates how PRP might influence the ovarian environment and potentially restore ovarian function. In conclusion, the lecture aims to initiate dialogue on ovarian rejuvenation and rehabilitation as alternative treatment strategies for patients contending with diminished ovarian reserve. Through this exploration, the presentation hopes to offer insights into the current landscape of fertility treatments in women with diminished ovarian reserve.
Single Step, Two-Steps, and Microfluidics in Embryo Culture. How Do They Measure up in Improving Embryo Quality?
Authors: Gardner David K. 
Published: January 2024

The issues surrounding the culture of the preimplantation human embryo are distinct from those associated with the propagation of somatic cells, given that the starting point of culture, the pronucleate oocyte, and the final stage of development, the blastocyst, are as distinct as any two cell types can be with regards to their nutrient requirements and metabolism. Furthermore, the cleavage stage period of embryo development is exquisitely sensitive to its environment and has limited capacity to regulate against disruptions in its surroundings, especially changes in pH. Historically the media used in human IVF, such as Human Tubal Fluid medium, were based on simple salt solutions but lacked key regulators of blastomere function, specifically amino acids. A resurgence of research in embryo metabolism and physiology in the 1980s paved the way for the development of Sequential media, designed not only to accommodate the changing requirements of the embryo itself (both in terms of carbohydrates and amino acids), but which were also based on available data on the dynamic/differing composition of the Fallopian tube and uterus. Sequential media, especially when used in combination with isolettes, were shown to be highly effective in supporting blastocyst development and significantly increased implantation rates, thereby facilitating the worldwide movement to single embryo transfer. However, while this approach partially satisfied the changing nutrient requirements of the embryo, and further facilitated the removal of toxins built up in the culture drop over 48h, such as ammonium, it necessitated moving embryos. Unless undertaken using warmed gassed isolettes, moving embryos inevitably resulted in shifts in temperature and pH. With the advent of time-lapse, there began a growing movement towards the use of one-step media in order to keep the embryo within an imaging incubator. To facilitate this, hybrid type media were formulated, and while they do not accommodate the dynamic requirements of the preimplantation period, their use meant embryos were not exposed to changes in either temperature or pH. To date, clinical data have reported similar outcomes using both media approaches, plausibly due to a trade-off of the inherent limitations of either approach. An alternative approach proposed decades ago, is to provide the embryo with a gradient of nutrients within a perfusion system, thereby facilitating a dynamic culture environment without the need to move embryos. Unfortunately, until recently, the technology to support this concept has not been available. However, the recent development of 3D printing using 2-photo lithography, has made it possible to create embryo-specific perfusion systems. Hence, we are now able to evaluate the potential of such dynamic systems and could find ourselves on the verge of a new era in embryo culture.
Basic Research on Oncofertility for Further Technological Innovation
Authors: Suzuki Nao 
Published: January 2024

Background: As a result of “advances in Oncology” and “advances in Reproductive Medicine” in recent years, some cancer survivors have achieved live births after cancer treatment. The world’s first report on ovarian tissue cryopreservation (OTC) and thawed-ovarian tissue transplantation in young patients with Hodgkin’s lymphoma by Professor Donnez and colleagues in Belgium in 2004 was a breakthrough in this research field. On the other hand, the report on ovarian transplantation in humans by Dr. Morris in the United States in 1906, the success of frozen ovarian thawing and transplantation in rodents by Dr. Parrott in the United Kingdom in 1960, and the success of Dr. Gosden in England in OTC using the slow freezing method in large animals in 1994 were important research results that led to Professor Donnez’s success. The current standard technique for OTC is slow freezing, and many reports of live births have been obtained. However, further technological innovation is needed for further progress in Oncofertility. I will give a talk titled “Basic Research on Oncofertility for Further Technological Innovation” focusing on the research results of our institution. Methods: I report on the following research topics: 1) the establishment of the ovarian vitrification freezing method, 2) the ovarian toxicity of new molecularly targeted drugs, and 3) the detection of minimal residual disease (MRD). Results: 1) the establishment of the ovarian vitrification freezing method, 2) the ovarian toxicity of new molecularly targeted drugs, and 3) the detection of minimal residual disease (MRD). Results: The following research topics will be reported: 1) Successful establishment of ovarian vitrification freezing method, 2) Results on ovarian toxicity of molecularly targeted drugs (PARP Inhibitor), 3) Results on detection of MRD (minimal residual disease). Conclusions: Further technological innovation should be needed for further progress in Oncofertility for the CAYA cancer patients.
Preserving Fertility for Patients Who are Gender Diverse and Transitioning
Authors: Sukcharoen Nares 
Published: January 2024

Fertility preservation is the process of storing eggs, sperm, or embryos for future use. It can be an option for transgender people who want to have biological children in the future. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition showed the detrimental impact on the gonadal function and the future fertility, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. Early and regular counselling regarding future fertility, the treatment approach for fertility preservation and/or family-building in transgender and gender nonbinary individuals are very important. Fertility preservation should be offered to all transgender patients ideally prior to medical or surgical treatment. Fertility preservation options for transgender men are oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation with in vitro maturation (IVM). Semen cryopreservation or testicular tissue cryopreservation is one of the fertility preservation options for transwomen. However, there is relatively limited data and clinical information regarding fertility preservation for transgender individuals. Recently, there is a growing awareness of fertility preservation counselling prior to initiation of gender-affirming care. However, numerous studies have reported a limited standard of care with many transgender patients who are experiencing inadequate fertility counselling. Further prospective studies are needed for better quality fertility services and parenting options for transgender and nonbinary individuals. In conclusion, the denial of access to fertility services to transgender individuals and nonbinary persons is not justified.
Management of PCOS IVF Cycle
Authors: Shah Duru 
Published: January 2024

PCOS is the most common Endocrine and Metabolic disorder in reproductive age women, being the most common cause of anovulatory Infertility. PCOS is a vicious circle of Insulin Resistance, Hyperandrogenism and improper LH secretions. This leads to ovulatory dysfunction, anovulation and hence infertility. Studies have observed impaired oocyte maturation and sub optimal and endometrial receptivity in women with PCOS. Hence management in such patients is aimed to enhance pretreatment and stimulation protocols for better pregnancy outcomes. Pretreatment with insulin sensitizers, antiandrogens and achieving optimization of weight before a stimulation cycle helps achieve optimum cycle outcomes. Multiple ovarian stimulation protocols have been used to prevent LH surge during controlled ovarian stimulation including GnRh agonist, antagonist, or progestin primed protocol. Similar pregnancy rates have been observed using both agonist or antagonist protocols, while the prevalence of OHSS is considerably lower with antagonist and progestin protocols. The type of protocol utilized for ovarian stimulation, the trigger used or the type of Gonadotropin ideal for PCOS women is still debatable. In order to avoid complications due to ovarian hyperstimulation, a freeze all strategy has been adopted worldwide as the optimum protocol for PCOS women, giving superior success rates, especially in PCOS women due to the disparity in endometrial receptivity. Various studies done on the Preparation of the Endometrium for a thaw cycle, have shown no difference in live birth rates following different methods. The route and type of progesterone luteal phase support and optimum progesterone values prior to embryo transfer also need further evaluation. Recent metanalysis have proved that hormone replacement cycles are associated with a lower risk of Preterm birth, but a higher risk of larger babies and pre-eclampsia. Further studies are needed to establish whether there is any long-term effect on the metabolic and growth parameters of children born out of frozen embryos.
Innovative Medical Treatments for Endometriosis
Authors: Johnson Neil 
Published: January 2024

This presentation will focus on the following innovative areas in medical treatments for endometriosis. Where were we, say, a decade ago compared to where we are now? What diagnostic techniques should we employ to define the population we should treat? Does gold standard surgical treatment help patients avoid unwanted medical treatment - or should it now be the other way round? Do we still believe that medical treatment is not indicated for infertility related to endometriosis? What are the genuinely evidence-based innovative medical treatments for endometriosis? Consensus statements and guidelines represent a clear line in the sand of what may be considered gold standard practice of the time – the World Endometriosis Society’s consensus on current management of endometriosis (2013) 1 provides a good perspective on where we were around a decade ago; the ESHRE Guideline (2022) 2 reflects best practice today. There is growing consensus that a laparoscopic (+/- histological) diagnosis is no longer practical, or indeed needed, in most cases to implement the whole gamut of medical treatment, even though the entire evidence base for treating endometriosis hinges on laparoscopic diagnosis. Hence, “in 2023, there is a strong case for treatment of endometriosis to be based on a clinical diagnosis of ‘likely endometriosis’ supported by imaging findings, when appropriate, in lieu of a traditional diagnosis by laparoscopy +/- histology”. Following laparoscopic surgery, those not intending to conceive should consider the levonorgestrel intrauterine system or combined oral contraceptive pill for at least 18-24 months to reduce the recurrence of endometriosis-related pain symptoms; 2 following surgery for either endometriomas or deep endometriosis, long term hormone therapy should be considered to reduce the chance of recurrence.2 Given the respective evidence bases, progestin hormone therapy may be preferable to the combined oral contraceptive pill to turn the tide of increasing prevalence of endometriosis. 3 While medical treatment has not been recommended to improve fertility, indeed a delaying effect on fertility through medical treatment has traditionally been highlighted, innovative analysis methods, including network meta-analysis, have raised the question whether some medical treatments (dydrogesterone and GnRH agonists) might benefit fertility – and this is merit-worthy of further investigation. GnRH antagonists and aromatase inhibitors are the innovative medical treatments that have shifted from ‘showing potential’ to ‘recommended’, so we will delve into the data supporting this to discover that, for aromatase inhibitors, this remains far from convincing, but for GnRH antagonists, these present a genuine innovative medical treatment option for those suffering from endometriosis.
Population Trends in the World and the Asia Pacific Region
Authors: Gray Edith 
Published: January 2024

This presentation explores the population trends in both the global and Asia-Pacific regions, examining the underlying factors that influence population growth and population age structure. The presentation highlights the importance of understanding fertility rates and their implications to population ageing, particularly in the context of the Asia-Pacific region. Fertility rates have declined in all regions of the world, however there is still substantial diversity across the globe. In high- and middle-income countries, fertility is now at low levels, some at extremely low levels. In low-income countries, the levels of fertility are more variable, with some countries seeing substantial decline, while others have declined, but at a slower rate. Because of low fertility, some countries have seen substantial population ageing in recent decades, and in the absence of migration, are experiencing depopulation. Other countries, buoyed by their migration policies, are ageing at a slower rate, and do not face the implications of a declining population. In the Asia-Pacific region there are substantial demographic shifts underway. The population has been declining in Japan for over 10 years, and is also declining in South Korea and most recently, China. All populations have very low fertility rates, with South Korea the lowest in the world, at 0.8 in 2021. Japan and South Korea also have very low immigration rates. In 2023, India overtook China as the world’s most populous country. While most regions of the world now have low population growth, populations in Africa are still growing rapidly, fuelled by a young population structure. This provides the region with a potential ‘demographic dividend’ which can contribute to economic opportunities. By outlining the drivers of population change, their implications, policy responses, and future challenges, this presentation will provide insights into the complexities of demographic shifts in today’s world.
How to Share Information Giving in Underprivileged Communities
Authors: Sini Ivan 
Published: January 2024

Infertility is a global disease and one of the major causes of psychosocial issues within reproductive group. This affects multilayer of socio economy strata including in developing world. Awareness and information of infertility in the community varies depending on the level of education. One of other key challenges in improving quality of reproductive care in infertility is accessibility. This implies to availability of resources and facility infrastructures. Health education generally varies in between socio economy background. Indonesia as example has different demographic layers which is stratified into upper, middle, and lower income. Although the country’s GDP continue to grow, large proportion of the community falls into the category of middle-income market. Their typical education degree are at high school level. Healthcare information are mostly delivered proactively through primary healthcare providers and social media plays significant role in as information source. Government and professional society organizations have important responsibility in how the information is delivered accurately and effectively. Reproductive campaign requires good strategy at public policy and budget associated with it. At the professional level, it is the duty of the providers to share proportional and accurate healthcare information irrespective of the patient’s background. However, to allow patients to make a well-informed decision, it is important that healthcare professionals to have good communication skills. They need to have sufficient time in delivering the message to educate the patients of proposed treatment plan. Theoretically this may not be applicable when supply of counselling time is not available due to lack of healthcare resources. For lengthy reproductive counselling, information can be provided by doctors and nurses. Empowerment of nurses and allied healthcare workers will extend the information shared by the doctors. They may be able to address other non-clinical matters to build trust and will assist patients in making decisions.