bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-230 Does laser-assisted hatching improve pregnancy rates : a retrospective analysis
Authors: Kanoi R , Ramakrishnan S , Mondal S , Gutgutia R 
Published: June 2023

Abstract

Study question
Is there any effect of laser-assisted zona drilling in improving pregnancy outcomes in women undergoing vitrified-warmed embryo transfers?

Summary answer
Our data suggests that there is evidence of possible improvement in pregnancy rates with laser-assisted hatching of embryos among women &gt;40 years of age.

What is known already
Mammalian embryo is surrounded by a glycoprotein shell called zona pellucida. The embryo must hatch out of this shell for it to implant in the uterus. However, certain factors such as sub-optimal in vitro culture conditions, advanced maternal age, zona-hardening due to vitrification and warming, among others, negatively impact the ability of the embryo to escape from the matrix surrounding it. Laser-assisted hatching is the safest and easiest technique available to overcome the problem of hatching by artificially disrupting the zona, though there isn’t sufficient data available on whether this has any actual benefit or is just a fancy add-on.

Study design, size, duration
Retrospective cohort study comparing embryo transfer results of 88 women whose embryos underwent LAH prior to transfer with that of a control group of women. Data was collected from embryo transfers that took place between March 2021 to December 2022.

Participants/materials, setting, methods
Beta-hCG results of women (N = 88) whose embryos underwent LAH prior to transfer was compared with the results of transfer without LAH in women (N = 88) of similar age and clinical history. Patient age, clinical indications and embryo grades were comparable across both groups. LAH was performed immediately post-warming of blastocysts using a 1.48 µm diode to drill the zona at a point opposite the ICM. Data was analyzed using independent t test and chi square test.

Main results and the role of chance
Women from both test and control groups were further stratified into the following sub-groups based on age – A (25-29 years), B (30-34 years), C (35-39) and D ( &gt;40 years). Beta-hCG results were assessed and was found to be lower in sub-groups A (57.1% vs. 78.5%) and B (46.4% vs. 67.7%) of the test group as compared to control. It was marginally higher in test group C as compared to that of control (50% vs. 47.3%). However, we found an increase in pregnancy outcomes of test sub-group D in comparison to control (83.3% vs. 20%).

Limitations, reasons for caution
This is a retrospective, preliminary study to assess initial results of effect of LAH on vitrified-warmed embryo transfer outcomes. A prospective study with a larger sample size is needed to confirm our results in both frozen and fresh embryos.

Wider implications of the findings
Our results indicate that laser-assisted hatching does not provide any advantage except possibly in older women above the age of 40 years. Thus we can select the exact group of patients who would benefit with this add-on and offer it to them routinely to improve their pregnancy rates.

Trial registration number
Not applicable
P-271 How much should you tolerate? The tolerance level of gas mixtures percentage in premixed gases
Authors: Seow Pei Yin E 
Published: June 2023

Abstract

Study question
Does the percentage of tolerance level of gas mixtures for premixed gas affect blastocyst formation rate?

Summary answer
A lower percentage of gas tolerance level can improve the blastocyst formation rate by providing a more optimal pH in the culture microenviroment.

What is known already
Benchtop incubators that use premixed gases are regarded as one of the most common incubators used in many IVF setups. The level of CO2 in the mixture has a direct impact on the media’s pH whereby an increase in the CO2 level will result in a lower pH and vice versa. Most media companies require a percentage of 6.0-6.5% to achieve an acceptable pH range of 7.2-7.4 for optimal culture microenvironment. However, it is often taken for granted that the CO2 and pH of the medium is within the acceptable range due to the “certificate” provided by these gas companies.

Study design, size, duration
This is a retrospective study looking at the average blastocyst formation rate from January 2018-December 2022 on 1665 cycles.

Participants/materials, setting, methods
The total MII collected and inseminated was 21,631. The mean women’s age was 37 ± 4.2 years old. All the embryos were cultured in the same laboratory conditions using BT 37 Planer (Origio) and K-Minc (Cook) incubators. From January 2018 to July 2020, all the patient’s embryos were cultured with premixed gas of 5% tolerance level (n = 940) and from Aug 2020-December 2022, all of the embryos were cultured with premixed gas of 2% tolerance level (n = 725).

Main results and the role of chance
It was found that the average blastocyst rate was significantly increased when the gas tolerance level was 2% (57.09%) when compared to when the gas tolerance level was 5% (52.11%) (p &lt; 0.05).

Limitations, reasons for caution
Different gas companies may use different methods of measuring the gas percentage levels. Therefore, it is advisable to be cautious and impose internal QC on the gas mixture percentage on individual cylinders.

Wider implications of the findings
A lower gas tolerance level may provide a more optimal accuracy of gas percentage to achieve the desired pH for embryo culture and to improve IVF outcomes.

Trial registration number
not applicable
P-313 Dysregulation of endometrial stromal serotonin homeostasis impairs decidualization in patients with recurrent implantation failure via phosphatidylcholine metabolism
Authors: Sheng X , Tian J , Yan G , Sun H 
Published: June 2023

Abstract

Study question
Does abnormal serotonin homeostasis contribute to impaired endometrial decidualization in patients with recurrent implantation failure (RIF)?

Summary answer
Abnormal serotonin homeostasis in patients with RIF, which is accompanied by decreased expression of monoamine oxidase (MAO), affects decidualization of endometrial stromal cells.

What is known already
Previous studies have found that the expression of MAO, which metabolizes serotonin, is reduced in the endometrium of patients with RIF, and serotonin can induce disruption of implantation in rats. However, whether abnormal serotonin homeostasis leads to impaired decidualization in patients with RIF and the mechanism remains unclear.

Study design, size, duration
Endometrial samples from 31 patients with RIF and 31 fertile patients were used to investigate the expression levels of MAOA, MAOB, and serotonin. We isolated human endometrial stromal cells to investigate the role of MAOA, MAOB and serotonin in inducing decidualization in vitro and further explored the mechanism using RNA-seq and LC/MS analyses.

Participants/materials, setting, methods
The levels of serotonin in the endometrium of patients with RIF were detected by ELISA and immunohistofluorescence, and the key genes of abnormal serotonin metabolism were analyzed combined with single-cell sequencing data. The effects of MAO on the decidualization of stromal cells were investigated using human endometrial stromal cells in vitro induced decidualization model and mouse artificially induced decidualization model. The potential mechanisms of MAO regulating decidualization were explored by RNA-seq and LC/MS analysis.

Main results and the role of chance
We found that women with RIF have abnormal serotonin metabolism in the endometrium and attenuated MAO in endometrial stromal cells. Endometrial decidualization was accompanied by increased MAO in vivo and in vitro. Attenuated MAO caused increased local serotonin content in the endometrium, impairing stromal cell decidualization. RNA-seq and LC/MS analyses showed that abnormal lipid metabolism, especially phosphatidylcholine metabolism, was involved in MAO-deficiency induced defective decidualization. Furthermore, decidualization defects were rescued by phosphatidylcholine supplementation.

Limitations, reasons for caution
This study found that impaired serotonin metabolic homeostasis and abnormally reduced MAO expression were one of the reasons for repeated implantation failure. However, the source and other potential function of serotonin in the endometrium remain to be further explored.

Wider implications of the findings
This study shows new insights into the mechanisms of serotonin homeostasis in human endometrial decidualization and provides new biomarkers or targets for the treatment of patients with RIF.

Trial registration number
not applicable
P-314 PlasmaShotting: a new method of treating “thin” endometrium
Authors: Kazantsev V , Feoktistov A 
Published: June 2023

Abstract

Study question
Is a new method of subendometrial platelet-rich plasma (PRP) injection (PlasmaShotting) effective in patients with “thin” endometrium?

Summary answer
PlasmaShotting showed higher efficiency in the group of patients with “thin” endometrium compared to conventional intrauterine infusion of platelet-rich plasma

What is known already
The problem of “thin” endometrium is one of the urgent challenges of modern reproductive medicine. In patients suffering from this condition, there is a decrease in the pregnancy rate and an increase in miscarriage rates.
“Thin” endometrium is less than 7 mm according to ultrasound. To correct this condition, many methods have been proposed: hormone replacement therapy with high doses of estrogens, aspirin, GnRH agonists, vitamin E, pentoxifylline, sildenafil, intrauterine infusion of colony-stimulating factors (G-CSF) and PRP, but none of the proposed methods has shown enough effectiveness.

Study design, size, duration
To evaluate the effectiveness of PlasmaShotting we organized a study that included 72 people. Inclusion criteria were age less than 40 years, endometrial thickness less than 6.5 mm on days 8-10 of hormone replacement therapy, and 3 or more unsuccessful embryo transfers of excellent quality embryos before.

Participants/materials, setting, methods
The patients were divided into 2 groups:
Group 1 (23 patients) underwent hysteroscopy with submucosal injections of platelet-rich plasma (PRP - PlasmaShotting) on days 10-12 of the cycle.
Group 2 (49 patients) underwent intrauterine infusion of platelet-rich plasma (PRP) on days 10-12 of the cycle

Main results and the role of chance
The clinical pregnancy rate in group 1 was 47.8% (n = 11), and in group 2 was 34.6% (n = 17).
The live births rate in group 1 was 34.7% (n = 8), and in group 2 was 20.4% (n = 10).
The miscarriage rate was in group 1 was 13.1% (n = 3), and in group 2 was 14.2% (n = 7)

Limitations, reasons for caution
The research on the effectiveness of PlasmaShotting should be continued

Wider implications of the findings
PlasmaShotting as a new method of treating “thin” endometrium can be used in patients who can't achieve pregnancy

Trial registration number
not applicable
P-327 Intrauterine fluid in patients with cesarean section defects in association with ivf outcomes
Authors: Le Duc T , Le H , Nguyen P H , Tham C D , Nguyen T L H 
Published: June 2023

Abstract

Study question
This study evaluate the effect of cesarean section scar defects associated with intrauterine fluid during endometrial preparation on pregnancy outcomes.

Summary answer
Patients with Cesarean section scar defect and intrauterine fluid during endometrial preparation had a substantially lower pregnancy outcome compared to those without uterine fluid.

What is known already
The Cesarean section rate in developed countries has increased continuously, leaving many short-term and long-term consequences. Intrauterine fluid, which reported incidence may reach 40% in patients who have had a previous caesarean section, may play an important role in reducing endometrial receptivity and further impair pregnancy outcomes.

Study design, size, duration
This is a retrospective cohort study performed on patients who had undergone frozen embryo transfer at an Assisted Reproductive Technology Center from January 2019 to December 2019.

Participants/materials, setting, methods
2,350 patients without intrauterine fluid and 74 patients with Cesarean section scar defect who had intrauterine fluid during endometrial preparation but none at progesterone supplementation were analyzed. Multiple logistic regression was performed for the probability of the pregnancy outcome of embryo transfer and measured the association with the status of intrauterine fluid, age, endometrial thickness, number of previous transfer, number of embryos, type of infertility, and difficult embryo transfer at the alpha level of 0.05%.

Main results and the role of chance
The outcomes among 2,424 patients undergoing cryopreserved embryo transfer were 59.45% for pregnancy rate, 8.7% for biochemical pregnancy rate, 50.33% for clinical pregnancy rate, and 43.15% for ongoing pregnancy rate. The analysis of multiple logistic regression indicated that the presence of intrauterine fluid during endometrial preparation did not affect the pregnancy rate. However, in patients with intrauterine fluid, there was an increased rate of biochemical pregnancy (OR 2.46, 95%CI 1.35-4.50) and a reduced rate of ongoing pregnancy (OR 0.54, 95%CI 0.32-0.89).

Limitations, reasons for caution
The major limitations of the present study are the retrospective design and small number of patients with uterine fluid. Additionally, the composition of the uterine fluid (eg, blood, mucus, purulent, or transparent) cannot be classified by an ultrasound exam.

Wider implications of the findings
Intrauterine fluid may be an innovative and controllable factor that should be considered in patients who have a history of caesarean section in order to improve pregnancy outcomes.

Trial registration number
Not Applicable
P-355 Thin endometrium is associated to higher risk of having a displaced window of implantation (WOI)
Authors: Valbuena Perilla D , Castellón J A , Gómez M , García I , Simón C , Ruiz-Alonso M 
Published: June 2023

Abstract

Study question
Is thin endometrium (&lt;6 mm) associated to an abnormal receptivity status?

Summary answer
Thin endometrium (&lt;6 mm) is significantly associated with a displaced WOI.

What is known already
The measurement of endometrial thickness by 2D vaginal ultrasound (US) is a routine practice in Assisted Reproduction Techniques (ART). Thin endometrium (&lt;6 mm) is associated with poor reproductive outcome; however, the potential reason is unknown.

Study design, size, duration
Retrospective cohorts study including 25,888 patients in which endometrial lining was measured by 2D US the day before progesterone supplementation in HRT cycles for frozen embryo transfers and Endometrial Receptivity Analysis (ERA) was performed after 5 days of progesterone administration.
Endometrial thickness was classified as &lt; 6 mm, 6-12 mm, or &gt; 12 mm; ERA results were considered as receptive or displaced WOI (Pre-receptive, post-receptive, proliferative, and late-receptive) that needs a personalized embryo transfer (pET).

Participants/materials, setting, methods
Endometrial thickness was measured from one endometrial layer to the other on a longitudinal transvaginal scan at the site of maximum thickness evidenced by 2D US. For ERA analysis, RNA was extracted and sequenced by NGS. Then, the ERA computational predictor obtained the diagnosis as standard or displaced WOI.

Main results and the role of chance
RA results reveal that women with thin endometrium (&lt;6mm) present significantly higher incidence of displaced WOI (47.49%) than 6-12mm (38.20%) (p = 0.0038), and &gt;12mm (39.75%) (p = 0.026). No other differences were found.
*Significant different against other two groups.
Global Chi-square test for association P = 0.002.

Limitations, reasons for caution
This is a retrospective study, having innate limitations of its nature.

Wider implications of the findings
Thin endometrium (&lt;6mm) is associated to a higher displaced WOI compared to normal lining or hypertrophic endometrium. Normal endometrial thickness (6-12 mm) considered as “receptive” does not preclude a transcriptomic receptivity status in 38.20% of the cases. This finding should be considered when embryo transfer is planned.

Trial registration number
Not applicable
P-384 Advanced paternal age: a mapping of the ethical issues
Authors: Couture V 
Published: June 2023

Abstract

Study question
What are the ethical issues raised by advanced paternal age?

Summary answer
Advanced paternal age is an ethically challenging phenomenon at the intersection of perinatal ethics, public health ethics, research ethics and policymaking.

What is known already
Although there is no clear indication on when begins advanced paternal age (APA), there is a tendency to consider 40 years old and over as a turning point in male reproduction. APA is now associated with several risks for male fertility, miscarriages, future child health and psychological development. Clinicians, scientists, social science researchers and ethicists have pointed several ethical issues raised by APA. For the moment, the scope of this discussion has not been fully assessed in a systematic way.

Study design, size, duration
To support a comprehensive evaluation of APA, we propose a mapping of the ethical issues of APA.

Participants/materials, setting, methods
First, we conducted a systematic literature review to identify ethical issues pointed by researchers and clinicians. Second, this first list of issues was discussed by a panel of experts (N = 23) through a web survey. The results from both data collections were triangulated by qualitative analysis into an integrated list of issues.

Main results and the role of chance
Six groups of issues emerged from data analysis. The first group relates to issues associated with the family project. In other words, how to balance the risks of APA with the benefits of the family project. The second group looks at the issues for healthcare professionals, i.e., how to support the family project while respecting the professional duty to protect their patients’ wellbeing. The third group refers to the gender justice issues and how APA generates inequities between gendered reproductive roles. The fourth group covers the public health dimension of APA and the justification to create intervention to respond to a collective and potentially intergenerational phenomenon. The fifth group is concerned about ways to develop sound and fair policies to respond to the challenges of APA. The sixth group encompasses research ethics issues on how to respectfully develop the field of research on APA.

Limitations, reasons for caution
APA is a burgeoning field of research, and it faces two principal limitations: (1) there is no clear understanding of the molecular mechanism of APA effect, and (2) data on the psychosocial dimension of APA is scarce. For these reasons, the ethical reflection is still speculative.

Wider implications of the findings
These findings offer a roadmap for future research on the ethics of APA. They provide a comprehensive understanding of issues that can be discussed during preconception counselling. At last, they suggest indications for the development of public health interventions or policies dedicated to address the most challenging aspects of APA.

Trial registration number
not applicable
P-487 Preimplantation genetic testing for aneuploidy for recurrent pregnancy loss: a systematic review and meta-analysis
Authors: Zhao S 
Published: June 2023

Abstract

Study question
Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live rate of recurrent pregnancy loss(RPL)?

Summary answer
PGT-A can improve the live birth rate and reduce the rate of miscarriages in women with RPL following in vitro fertilization-embryo transfer (IVF-ET).

What is known already
PGT-A has been widely used in women with RPL over the past decade. However, there is no consensus supporting this approach to the management of RPL.

Study design, size, duration
Systematic review and meta-analysis according to PRISMA guidelines. The research population was focused on RPL women. The intervention was PGT-A. The comparator was IVF/ICSI without PGT-A or expectant management. The primary outcome was the live birth rate per woman, and the secondary outcomes were the miscarriage rate and clinical pregnancy rate.

Participants/materials, setting, methods
PubMed, EMBASE, The Cochrane Library, and trial registers were searched for studies on PGT-A and RPL up to October 2022. There were no limitations regarding the year of publication or duration of follow-up but to the English language. The primary outcome was the live birth rate per woman, and the secondary outcomes were the miscarriage rate and clinical pregnancy rate.

Main results and the role of chance
Out of 1466 search results, 9 studies (including one RCT, one prospective pilot study, and seven retrospective cohort studies) were included in the review. Seven of these studies compared the live birth rate of RPL with PGT-A versus without PGT-A following in vitro fertilization-embryo transfer (IVF-ET). PGT-A signiﬁcantly increased live birth rate (odds ratio(OR): 2.07; 95% conﬁdence interval: 1.88 to 2.27) and lowered miscarriage rate (OR: 0.21; 95% conﬁdence interval: 0.13 to 0.34). However, PGT-A did not improve the clinical pregnancy rate. In two studies comparing the live birth rate/ongoing pregnancy of RPL with PGT-A versus expectant management, the result shows that PGT-A did not improve the live birth rate (OR: 1.11; 95% conﬁdence interval: 0.74 to 1.67).

Limitations, reasons for caution
Limitations include the retrospective design and heterogeneity of studies included, limiting comparison and pooling of data. Some studies have limited sample sizes. The data collected in the database could not exclude anatomic or chromosomal abnormalities in women with RPL.

Wider implications of the findings
PGT-A can improve the live birth rate and reduce the rate of miscarriages in women with RPL following IVF-ET. However, there is no evidence of a beneficial effect of PGT-A if compared with expectant management. It is important to evaluate carefully the application of PGT-A in clinical practice.

Trial registration number
not applicable