bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-769 fertility treatments and the risk for long-term respiratory morbidity of the offspring; a sibling analysis
Authors: Lavi T , Pariente G , Sheiner E , Gutvirtz G , Zeadna A , Steiner N , Wainstock T 
Published: June 2023

Abstract

Study question
Is the risk of long-term respiratory morbidity increased among children born following fertility treatments (in-vitro fertilization and ovulation induction)? Sibling analysis to maximize confounder control.

Summary answer
Fertility treatments do not appear to be an independent risk factor for long-term respiratory morbidity of the offspring up to 18 years of age.

What is known already
Studies have found an association between fertility treatments and long-term respiratory morbidity of the offspring, specifically obstructive sleep apnea (OSA).

Study design, size, duration
A retrospective population-based cohort analysis was performed, including all sibling deliveries occurring between 1991 and 2021 at a tertiary medical center. Offspring were followed-up until the age of 18 years.

Participants/materials, setting, methods
The study population included 10,691 siblings of women who had at least one spontaneous pregnancy and at least one pregnancy following fertility treatments. A Kaplan–Meier survival curve was used to compare the cumulative respiratory morbidity incidence, and a multivariable Cox survival hazards regression model was used to control for confounders.

Main results and the role of chance
There were 5,869 siblings (54.9%) conceived following fertility treatment and 4,822 spontaneously conceived siblings (45.1%). Using a univariable analysis, respiratory morbidity was higher among siblings born following fertility treatments as compared with those conceived spontaneously (9.6% vs. 8.4%; p = 0.023), in particular, OSA (2.6% vs. 1.8%; p = 0.005). However, using a Kaplan-Meier survival curve, being born following fertility treatments did not have a higher cumulative incidence rate of long-term respiratory morbidity (Log-Rank, p = 0.339). Likewise, when using a Cox regression model, controlling for confounders such as maternal age, diabetes mellitus, preterm delivery, and hypertensive disorders, the association between being born following fertility treatments was no longer associated with long-term respiratory morbidity (adjusted HR = 1.0, 95% CI 0.88-1.14, p = 0.957).

Limitations, reasons for caution
This retrospective cohort study can only provide evidence of association but not causation. Also, our study results are hospital-based diagnoses of respiratory morbidity which most likely represent acute and severe disease.

Wider implications of the findings
In this large retrospective cohort study of siblings, we showed that, in contrary to current literary findings, and after matching for siblings, fertility treatments are not associated with long-term respiratory morbidity of the offspring. These findings raise questions about the existence of certain maternal predispositions that may associate the two.

Trial registration number
Not applicable
P-770 Risk factors for placenta accreta spectrum among pregnant women conceived with assisted reproductive technology
Authors: Li C , Li T , Wu Y T , Huang H F 
Published: June 2023

Abstract

Study question
What are the risk factors for placenta accreta spectrum (PAS) among women conceived with assisted reproductive technology (ART)?

Summary answer
The risk of PAS was associated with elevated estradiol and progesterone levels during COH, and HRT protocol, and abnormal endometrial thickness when preforming FET.

What is known already
Increasing evidence suggests an association between ART and PAS. Some studies have reported a high rate of diagnosis of PAS after embryo transfer compared to those with spontaneous conception. Despite this, little is known about the detailed risk factors for PAS during the procedures of ART.

Study design, size, duration
This retrospective case-control study included 1541 pregnant women with live birth conceived ART between 2013 and 2019 in a university hospital.

Participants/materials, setting, methods
Pregnant women were categorized into case and control group according to the postpartum diagnosis of PAS. The associations between PAS and ART procedures were estimated using multivariate logistic regression, and represented as adjusted odds ratio (aOR) and 95% confidential interval (CI).

Main results and the role of chance
Among all pregnant women in this study, 118 were delivered with PAS, and 1423 were delivered without PAS. During the procedures of COH and oocytes retrieval, elevated levels of estradiol (aOR=1.03, 95% CI: 1.01-1.06) and progesterone (aOR=1.02, 95% CI: 1.00-1.04) were found to be associated with the risk of PAS. The number of oocytes retrieved over 10 were also found to have an association with PAS (aOR=1.58, 95% CI: 1.05-2.37). Additionally, FET was another risk factor forPAS (aOR=1.93, 95% CI: 1.06-3.51). Among pregnant women with FET, preparing the endometrium using HRT protocol increased the risk of PAS (aOR=2.46, 95% CI: 1.57-3.84). Notably, PAS was also found to have an association with abnormal endometrial thickness after preparing the endometrium, whether too thin (&lt;7mm: aOR=15.90, 95% CI: 4.42-57.21) or too thick (&gt;14mm: aOR=6.56, 95% CI: 1.84-23.45).

Limitations, reasons for caution
As a hospital-based study, several confounders related to medical procedures have been taken into consideration. However, it is not possible to rule out unknown confounders.

Wider implications of the findings
Caution is warranted when preforming COH, and endometrial preparation before FET due to the increased risk of PAS after deliveries.

Trial registration number
NA
O-092 Does embryo biosensing really determine endometrial fate decisions at implantation?
Authors: Brosens J 
Published: June 2023

Abstract

Implantation depends on bi-directional communication between the blastocyst and endometrium. Encoded in this communication is information on maternal and embryonic fitness, which in turn can lead to the activation of species-specific reproductive suppression mechanisms. For example, blastocysts in over 130 mammals, although not humans, respond to the presence or absence of specific endocrine or endometrial cues by entering or exiting diapause, a state of suspended animation that leads to postponement of implantation. By contrast, embryo biosensing and selection depend on the endometrium first receiving and decoding fitness information from the conceptus and then either promoting implantation or initiating rapid tissue breakdown, thus limiting maternal investment into a failing pregnancy. Importantly, embryo selection relies on physiological mechanisms that sense deleterious (internal/external) cues, which is fundamentally different from reproductive failure caused by disease or trauma. Nevertheless, physiological embryo selection is easily conflated with pathology. For example, repeated implantation failure of low-fitness IVF embryos can lead to the diagnosis of ‘recurrent implantation failure’, an ill-defined clinical label, which often spurs uninformative investigations and ineffective ad-hoc treatments. On the other hand, pathological relaxation of embryo selection at implantation causes early pregnancy loss, with the frequency of affected cycles determining the age-independent recurrence risk of miscarriage. In this presentation, I will elaborate on the cellular mechanisms that control embryo biosensing and selection, highlight the clinical consequences, and discuss emerging strategies for pre-pregnancy optimisation of the endometrium.

Trial registration number
XXXX
O-108 C-section scar defect: Hysteroscopic vs laparoscopic repair
Authors: Mashiach R , Burke Y Z 
Published: June 2023

Abstract
Objective: To present a systematic review of the literature on the hysteroscopic and laparoscopic repair of cesarean scar niche and offer an evidence-based approach to the treatment of cesarean scar niche.
Data sources: A thorough search of the PubMed/Medline, Embase, and Cochrane databases was performed. (PROSPERO registration number CRD42020190668).
Methods of study selection: Studies from the last 20 years that addressed cesarean scar niche repair were collected. Both authors screened for study eligibility and extracted data. All prospective and retrospective studies of more than ten women were included.
Tabulation and integration: The initial search identified 666 articles [PRISMA flow chart]. We excluded duplicates, case reports, reviews, video articles, and technique articles. We also excluded studies describing only laparotomy or vaginal repair as these were not of the scope of this review.
A total of 31 articles met the inclusion criteria, 21 for hysteroscopic resection and 13 for laparoscopic or combined repair (4 articles tested both modalities and appear in both tables).
Results: For abnormal uterine bleeding (AUB), hysteroscopic remodeling relieved symptoms in 60%-100% of cases and laparoscopy in 78%-94%. Secondary infertility was not evaluated in all studies. We found that after hysteroscopic and laparoscopic treatment, 46%-100% and 37.5%-90% of those who wished to conceive became pregnant following the procedure, respectively.
Pain and dysmenorrhea seem to be uncommon. All studies that tested improvement of pain had less than ten women. However, it would appear that between 66% and 100% of women who complain of pain or dysmenorrhea will note a marked improvement to full resolution.
Conclusion: cesarean scar niche or cesarean scar defect is usually asymptomatic. For symptomatic women, a repair is a valid option. For those with RMT (Residual Myometrial thickness) &gt;2-3 mm, hysteroscopic remodeling is the modality of choice with an improvement in AUB, secondary infertility, and pain. For women with a RMT &lt;2-3 mm, laparoscopic repair with simultaneous hysteroscopic guidance shows similar results. Since available data is limited, no cutoff for the correct choice between hysteroscopy or laparoscopy can be concluded. We recommend 2.5 mm as the cutoff value based on common practice and expert opinion, although no significance between hysteroscopic and laparoscopic treatment was shown.
O-109 Avoiding the C-section scar defect
Authors: Kalem Z , Namli Kalem M 
Published: June 2023

Abstract
The cesarean scar defect was first described in 1961 by Poidevin et al. Cesarean delivery is one of the most common surgeries today, and millions of women give birth this way every year. The prevalence of cesarean scar defect is increasing due to increasing cesarean section rates. The cesarean scar defect is called by different names in the literatüre, such as isthmocele, niche, diverticulum, dehiscence of the cesarean scar. It was discovered that the prevalence of isthmocele varied widely. Using contrast-enhanced sonohysterography, the prevalence in a random group of women with a history of CS was between 56% and 84%, whereas the incidence in pelvic ultrasonography fluctuates between 6% and 36%.
The most common gynecological problems that may occur due to isthmocele are menstrual spotting, dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The likelihood of scar pregnancy, placentation abnormalities, and uterine rupture increases with subsequent pregnancies. Both hysteroscopic and laparoscopic isthmocele repair techniques are highly effective. Therefore, precautions against isthmocele during cesarean delivery should be made more transparent.
The development of isthmocele is influenced by the timing of the cesarean section (during pre/early or advanced labor), the position of the uterine incision (its distance or proximity to the internal os of the cervix), and the opening and closing (suturation) method of the uterine incision. Once more, both gestational diabetes and being overweight might be viewed as independent risk factors.
Understanding the risk factors for isthmocele development will aid in the development of preventative measures. The two most crucial elements in the formation of isthmocele, according to our knowledge of the literature, are the site of the uterine incision and the suture methods. In this presentation, we will discuss ways to prevent the development of isthmocele.
O-167  The good egg: on the onset of transcription in mouse and human embryos
Authors: Perry A 
Published: June 2023

Abstract

At the moment of union in fertilisation, sperm and oocyte are transcriptionally silent, but little is understood about how transcription initiates in the newly-formed embryo. In this talk, I shall suggest why this fundamental process has remained arcane for so long, and how my lab has sought to unlock its secrets in mouse and human embryos. By combining micromanipulation and single-cell RNA-sequencing, we have revealed a programme of embryonic transcription initiation beginning within four hours of fertilisation in the mouse. The talk will outline our efforts to characterise this initiating transcription, and its conservation in human one-cell embryos. Transcribed genes predict regulation by oncogenic factors, including c-Myc, whose features will be detailed, together with a model suggesting predictive parallels between the onset of embryogenesis and cancer.

Trial registration number
XXXX
O-168 The dark shadow of historical eugenics on reproductive technologies and practices
Authors: Cavaliere G 
Published: June 2023

Abstract

Eugenics is often referred to in discussions on the ethics of reproductive technologies. References to the word “eugenics” are often used to draw distinctions between ethically permissible and impermissible technologies, and permissible and impermissible uses of these technologies. While historians have long argued that 20th century eugenics cannot be reduced to a uniform set of practices, references to eugenics in discussions on the ethics of reproductive technologies have proven difficult to eradicate. Some authors stress the similarities between past eugenics and present reproductive technologies (what I define here as “the continuity view”) to condemn these technologies. Others focus instead on the differences between past and present (what I define here as “the discontinuity view”) to defend reproductive technologies.
In this talk, I canvass the meanings and uses of the word “eugenics” in relation to the permissibility of reproductive technologies and argue that disagreement concerning the value and ethical standing of these technologies originates in divergent views of condemnable and justifiable features of the past. Moreover, I suggest focusing on the reproductive preferences of those accessing fertility treatment as a starting point for any analysis concerning the permissibility of novel reproductive technologies.

Trial registration number
XXXX
O-171 Psychological support: the light in the darkness of my infertility journey
Authors: Dumont S 
Published: June 2023

Abstract
Sandrine Dumont shares her own personal patient experience : « my infertility journey started at the age of 32, when I was finally diagnosed with endometriosis after years of pain. I went through one year of natural but monitored baby trials, 4 artificial inseminations, a break-up with my then partner, and 3 IVF with my new partner : these 3 IVF took place during a short period of 5 months. First IVF was in a public hospital, who kicked us out after first IVF failed. Other two IVF took place in a private hospital in Paris, who incidentally diagnosed PCOS : both IVF were also unsuccessful. I was physically and psychologically exhausted, and then decided to take a break from fertility treatments. We expected information and guidance from both fertility centers to help us through this. It never came.
During all these years, we’ve been appalled with how very few information we were given from all the medical staff. We were never prepared for failure at all. We felt treated badly, even in a rude and sometimes brutal way, by some professionals. Patient care was almost inexistent. We felt like a mere number on a list, not worth being explained anything or just answered our legitimate and simple questions about our own case. We were left alone with our doubts and questions: how could we make an enlightened decision as whether to continue treatments or not, with no information to nurture this decision ?
It seemed an endless dark tunnel with no exit. Then came guilt, loneliness and depression. I searched for external psychological support to help us get through this: this was not easy, since psychological weakness was something to be very ashamed of at the time, in French society. Psychological support turned out to be the light in our darkness. I found a psychiatrist to whom I went weekly for almost two years. This is what it took to heal : accepting failure, accepting my own limits to what I was ready to endure to try to be a mother, accepting to be different from what is expected of a woman in our traditional French society. This therapy was a lifesaver. There also came the association Collectif Bamp, thanks to whom I met a two women in the same situation as me. Knowing I was not alone just changed everything : it was the first day of the rest of my life.
Today, 10 years later, I am now an active member of Bamp association : I try to be there for patients as Bamp was there for me. I share my experience, so people don’t feel alone. I advocate pyschological support and real patient care.
O-173 Cellular and developmental damage from oocyte cryopreservation
Authors: Comizzoli P 
Published: June 2023

Abstract
Compared to somatic or sperm cells, mammalian oocytes are much more sensitive to cryopreservation mainly because of the large volume, cytoskeleton, and presence of the zona pellucida. Connections with the surrounding cumulus cells also are challenging to preserve in immature oocytes. Besides the genetic and epigenetic information enclosed in the nucleus, oocytes contain organelles and cytoplasmic factors that are necessary for the early embryo development. Therefore, exposure to cryoprotectant and freezing temperatures can easily damage the oocyte’s complex cellular structure and developmental competence, which leads to poor success in fertilization, lower embryo quality, and reduced pregnancy rates. Using the domestic cat as a model, our laboratory has studied damages in cumulus-oocyte complexes (immature oocytes) occurring at each step of the cryopreservation process. Specifically, this included the impact of cryoprotectants on microtubules, the effect of osmotic changes on the overall structures, as well as sensitivity of the nuclear chromatin and epigenetic patterns to freezing temperatures. Based on those findings, it has been possible to design mitigating solutions like customized ultra-rapid freezing or vitrification protocols, Laser-warming methods, or post-warming reanimations. New horizons have also been explored to move away from issues and limitations related to cryopreservation. Approaches like storage of oocytes for the long-term at non-freezing temperatures are currently being developed based on encouraging data generated in preliminary studies. For instance, incorporation of trehalose into the oocyte followed by microwave-assisted dehydration can allow to remove enough water while creating a protective trehalose glass compatible with survival and storage at non-freezing temperatures. Interestingly, transcriptomic and proteomic studies have already shown that stresses and damages induced by dehydration versus cryopreservation are different and may be easier to overcome.
O-204 Treatment of unexplained infertility: IUI for all?
Authors: Bhattacharya S 
Published: June 2023

Abstract

Study question
What is the recommended management for couples presenting with unexplained infertility, based on the best available evidence in the literature?

Summary answer
The ESHRE Guideline on Unexplained infertility makes 19 recommendations on treatment of couples with unexplained infertility.

What is known already?
Unexplained infertility (UI) is diagnosed in the absence of any abnormalities of the female and/or male reproductive systems after “standard” investigations. The management of UI is traditionally empirical. The efficacy, safety, costs, and risks of treatment options have not been subjected to robust evaluation.

Study design, size, duration
The guideline was developed according to the structured methodology for the development of ESHRE guidelines. Following formulation of key questions by a group of experts, literature searches and assessments were undertaken. Papers written in English and published up until 24 October 2022 were included. Prior to publication, the guidelines were reviewed by independent international reviewers.

Participants/materials, setting, methods
Based on the available evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee.

Main results and the role of chance
This guideline aims to help clinicians provide the best care for couples with unexplained infertility. The first-line treatment for couples with unexplained infertility was deemed to be intra-uterine insemination (IUI) in combination with ovarian stimulation. This lecture will focus on the rationale behind this recommendation and the place of additional and alternative options for the treatment of unexplained infertility.
The guideline has been in stakeholder review and is prepared for submission in 2023.

Limitations, reasons for caution
Most interventions in couples with unexplained infertility have not been subjected to robust evaluation. For a large proportion of these treatments, evidence was very limited and of very low quality. More evidence is required, and the results of future studies may require the current recommendations to be revised.

Wider implications of the findings
The guideline provides clinicians with clear advice on best practices in the care of couples with unexplained infertility, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field.

Study funding/competing interest(s)
The guideline was developed by ESHRE which funded the guideline meetings, the literature searches and dissemination. The guideline group members did not receive any financial incentives; all work was provided voluntarily.