bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-305 Detection of GSTM1 polymorphism in women undergoing IVF protocols
Authors: Petsavas A , Stavros S , Mavrogianni D , Drakaki E , Domali E , Drakakis P 
Published: June 2023

Abstract

Study question
Is GSTM1 polymorphism related to infertility and IVF parameters?

Summary answer
Possible correlation between the absence of GSTM1 gene and estradiol levels as well as the fertilized oocytes number, the number of COCs and their quality.

What is known already
Glutathione S-transferase (GST) M1 belongs to a family of detoxification enzymes. GSTM1 detoxifies reactive chemical species, by catalyzing their conjugation to glutathione. Deficiency in enzyme activity is caused by homozygous deletion of the GSTM1 gene. It is known that oxidative stress is a condition that leads to pathophysiological mechanisms related to female infertility Additionally several studies have addressed the possible correlation between female infertility and GSTM1 polymorphisms

Study design, size, duration
One hundred and seventy four samples were collected and divided into 2 groups. The study group was consisted of blood samples from 125 women classified as infertile according to WHO. Blood samples from 49 women classified as fertile with at least one successful pregnancy and nomiscarriages were used for the control group

Participants/materials, setting, methods
For all samples, genetic material(DNA) was extracted. Polymerase chain reaction with specific GSTM1 gene primers followed by agarose electrophoresis was applied to detect the presence of polymorphism.

Main results and the role of chance
Our study showed a significant difference between the presence of GSTM1 gene in the control group when compared with the study group. The results showed for a subgroup of the infertile women,(n = 54), that the estradiol levels were significantly higher, in women who had the GSTM1 gene compared to those who lacked the gene. The fertilized oocytes as well as the number of COCs were significantly higher in women in which the GSTM1 was detected, compared to the women in which the GSTM1 gene was not detected.

Limitations, reasons for caution
Detailed data from all infertile women could further confirm our results.

Wider implications of the findings
The results of the current study may be used for further research related to female infertility and oxidative stress and may clarify the possible interactions between the microenvironment of oocytes and the free radicals. Additionally GSTM1 may be a useful biomarker for predicting IVF results.

Trial registration number
not applicable
P-306 Generalizable AI model for microscopic and timelapse multifocal embryo images
Authors: Lee H J , Kim H M , Choi S , Jung J Y , Park J H , Koo J S K , Min S H , Chung M K , Kim J , Ko T 
Published: June 2023

Abstract

Study question
Can an AI model be applied to datasets with different characteristics?

Summary answer
The AI model predicting pregnancy developed on microscope images can be generally applied to multifocal images from time-lapse system.

What is known already
AI models require large datasets to be able to generalize and handle various scenarios, but it can be challenging to gather enough data for each case. Embryologists evaluate embryos using multiple focal planes and add color filters as needed, and timelapse images have varying features. AI models in past studies were trained using both microscopic and timelapse images, and embryologists question if images must be captured at a specific focal plane for AI to work effectively. In this study, the AI model trained on over 2,000 microscopic embryonic images was validated using timelapse images taken at multiple focal planes.

Study design, size, duration
We collected 2,555 microscopic images from 7 IVF clinics and 1299 timelapse images from 433 embryos from a single IVF clinic between July 2016 and December 2020. The timelapse images were divided into 3 groups, with Group 1 being the best visualized ICM images, Group 2 being 20 µm higher or lower than Group 1, and Group 3 being 20 µm higher or lower than Group 2.

Participants/materials, setting, methods
We built 2 CNN models. The “Microscopic model” and “Timelapse model” were trained and validated using 3-fold cross validation with 2,555 microscopic images, 433 timelapse Group 1 images, respectively. To examine whether the Timelapse model was able to infer well for images taken at different focal points, Group 1, 2, and 3 images were used to test the Microscopic model.

Main results and the role of chance
The AUROCs and accuracies in mean (SD) for the Microscopic model were 0.738 (0.003) and 0.705 (0.011) after 3-fold cross-validation. The AUROC and accuracy for the Timelapse model were 0.627 and 0.583. The AUROCs for Group 1,2, and 3 were 0.699 (0.014), 0.705 (0.001) and 0.701 (0.064), respectively. The accuracies for Group 1,2, and 3 were 0.655. (0.013), 0.647 (0.007), and 0.651 (0.007). The predictive power of the Microscopic model applied to the time-lapse images was better than that of the Timelapse model, although it was not as accurate as the Microscopic model applied to the microscope images.

Limitations, reasons for caution
The limitations of the study include its retrospective nature and a small dataset. Transfer learning of timelapse images to a microscopic model may be beneficial for analyzing timelapse images.

Wider implications of the findings
The study found that timelapse images with multifocal planes can be applied to an AI model built based on a large dataset of microscopic images collected from multiple centers. It may be prudent for a small IVF clinic to apply a generalizable model rather than building its own.

Trial registration number
not applicable
P-341 Endometrial compaction and its impact on reproductive outcome
Authors: Durugkar K , Balkawade N 
Published: June 2023

Abstract

Study question
Is there a relationship between endometrial compaction and clinical pregnancy rate in frozen embryo transfer (FET) cycles?

Summary answer
Clinical pregnancy rate (CPR) were similar in both patients that demonstrated endometrial compaction or no compaction in FETs cycles.

What is known already
There has been increasing interest in the correlation between endometrial compaction and clinical outcomes but there has been conflicting evidence from prior investigations.

Study design, size, duration
Retrospective Observational data Analysis of (n-350) patients undergoing Embryo Transfer during January 2022 to December 2022 at our clinic.

Participants/materials, setting, methods
This study was performed at a single, academically affiliated fertility center in which patients who had an FET using programmed/modified natural cycle protocol were included. Endometrial thickness at time start of progesterone(T1)(TVS) & at time of Embryo transfer (T2)(TAS)was measured, and percentage on ET compaction in both HRT cycle and modified natural cycle was studied. The primary outcome (CPR) was based on proportion of compaction (percentage difference in EMT between T1 and T2).

Main results and the role of chance
Of the 350 participants included, 64%, 38% and10%, of women exhibited &gt;0%, &gt;5% and &gt;10% endometrial compaction, respectively. Endometrial compaction was not predictive of Clinical Pregnancy Rate (CPR) at any of the defined cutoffs .Primary outcomes included CPR (defined as the presence of at least one gestational sac with a fetal pole with cardiac activity on transvaginal ultrasound between 6 and 9 weeks gestation), biochemical pregnancy rate and spontaneous abortion rate. Patients were discharged to their obstetrician when a clinical pregnancy was confirmed between 6 and 9 weeks gestation.

Limitations, reasons for caution
There was the potential for measurement error in the recorded EMTs. The T2 measurement was performed transabdominally, which may cause potential measurement error, as it is generally accepted that transvaginal measurements of EMT are more accurate, though, any bias is expected to be non-differential

Wider implications of the findings
Assessing endometrial compaction may lead to unnecessary cycle cancellation. However, further studies are needed to determine if routine screening for endometrial compaction would improve clinical outcomes.

Trial registration number
not applicable
P-348 Correlation between cesarean scar defect and chronic endometritis and its effect on the pregnancy outcomes of in vitro fertilization
Authors: Xiang R , Li M , Huijun L , Zhi Z , Haitao Z , Jintao P 
Published: June 2023

Abstract

Study question
Do patients with symptomatic cesarean scar defect (CSD) have a higher risk of chronic endometritis (CE) and worse early pregnancy outcomes after hysteroscopic reconstruction for CSD?

Summary answer
Symptomatic CSD has a positive correlation with CE. Antibiotic administration is a promising option for patients with CE to obtain better early pregnancy outcomes.

What is known already
Cesarean scar defect (CSD), a niche-shaped myometrium defect, can be noticed after cesarean sections (CS). Studies about the impact of CSD on fertility are limited. The uterine isthmic region is a sperm reservoir, and CSD may negatively affect natural fertility. CE could reduce endometrial receptivity and thus leads to a lower clinical pregnancy rate. Secondary infertile patients with a history of CS are quite common in the department of reproductive medicine. However, there was still limited data to determine whether CSD correlates with CE, especially in cases suffering from symptomatic CSD with postmenstrual spotting.

Study design, size, duration
This is a retrospective study including 118 patients with a leading symptom of postmenstrual spotting and 224 asymptomatic patients from January 1, 2018 to May 31, 2021.

Participants/materials, setting, methods
Group A was with a leading symptom of postmenstrual spotting, and group B was asymptomatic. Office operative hysteroscopy was performed to correct the CSD for symptomatic patients in group A, and thermoablation of the endometrium in CSD was performed. Out-patient hysteroscopy was performed for asymptomatic patients in group B, and only the morphology of the endometrium was evaluated. Both groups have CD138 immunohistochemistry staining of their endometrium.

Main results and the role of chance
A higher incidence of CE was found in group A compared with group B (50/118 vs. 62/224, P=0.006, OR = 1.921, 95%CI=1.203-3.068). There were no significant differences in the comparisons of chemical pregnancy rate (26/86 vs. 75/216, P=0.455, OR = 0.815, 95%CI=0.475-1.396), ectopic pregnancy rate (1/86 vs. 1/216, P=0.489, OR = 2.529, 95%CI=0.156-40.901), miscarriage rate (6/86 vs. 22/216, P=0.368, OR = 0.661, 95%CI=0.258-1.692), preterm birth rate (2/86 vs. 4/216, P=1.000, OR = 1.262, 95%CI=0.227-7.020) or full-term pregnancy rate (12/86 vs. 35/216, P=0.626, OR = 0.839, 95%CI=0.413-1.704) between the two groups.

Limitations, reasons for caution
First, different doctors might have inconsistent judgments on the definition of postmenstrual spotting. Second, three different operators performed the hysteroscopy. It might contribute to the heterogeneity of the study findings.

Wider implications of the findings
Canalling and thermoablation during hysteroscopy are effective treatments for symptomatic CSD. CSD accompanied by CE should be given more attention before embryo transfer.

Trial registration number
No. 2020A1515110791
P-373 Low-Dose Vaginal Misoprostol Application Before Office Hysteroscopy
Authors: Sarikaya E , Guliyeva M , Kipel R 
Published: June 2023

Abstract

Study question
In gynecological interventional procedures what should be the minimum misoprostol dose for achieving cervical maturation?

Summary answer
50mcgr vaginal misoprostol before office hysteroscopy; decreases the VAS score, bleeding and the total procedure time.

What is known already
Misoprostol has been on the World Health Organization (WHO) essential drugs list since 2005 due to its uterotonic effect.FIGO (The International Federation of Gynecology and Obstetrics) published a posology table in 2017 that does not cause side effects in off-label use of misoprostol in the obstetric field.There are many publications that misoprostol facilitates interventional gynecologic procedures by allowing cervical maturation . However, no guidelines have yet been published on the dose and route of administration

Study design, size, duration
This Prospective Randomized Clinical Research was approved by Ankara City Hospital Clinical Research Ethics and Academic committee . Then, 100 women who underwent office hysteroscopy in Ankara City Hospital Gynecology and Obstetrics Clinic gynecology-infertility outpatient clinic between 01/12/2021-01/05/2022 were included in the study after their informed consent was obtained.

Participants/materials, setting, methods
50 women who self-administered 50 mcg vaginal misoprostol the night before the office hysteroscopy procedure and 50 women who did not administer the drug were compared. The primary outcome of the study was the duration of the procedure, with the pain score during the procedure used being the (VAS) score system. The secondary outcome was procedure and drug-related side effects Statistical evaluation of the data was performed using the SPSS for Windows version 20.0

Main results and the role of chance
In the medicated group the mean of VAS scores during and after the procedure, and the transition and the total time of the procedure were significantly lower than non-medicated group.

Limitations, reasons for caution
In Turkey, there is only one misoprostol product (CYTOTEC Ali Raif İlaç Sanayi A.Ş) with the 200 mcg posology Off label use of misoporostol in obstetrics is legal since 2021 but not for gynecological practice. We do not have country guidelines on misoprostol posology in obstetrics and gynecology usage also

Wider implications of the findings
In gynecological interventional procedures especially before office hysteroscopy, it is important to apply a minimum dose of misoprostol for cervical maturation due to its bleeding-increasing effect in patients whith endometrial polyps or hyperplasia .Because bleeding is the most important factor affecting image quality and procedure efficacy during hysteroscopy.

Trial registration number
E2-21-1068 dated 24.11.2021
P-381 "An Analysis of the Legal Gaps and Jurisprudential Paradigms Surrounding Supernumerary Embryos in Italy: A Comparative Law Approach to Propose Practical Solutions"
Authors: Dalla Costa S 
Published: June 2023

Abstract

Study question
What is the current state of resolving the issue of surplus embryos in Italy, in the absence of clear legislation?

Summary answer
This paper proposes organic reform of Italian law and European harmonization for informed and conscious patient decision-making on excess embryos.

What is known already
According to Italian law, embryos obtained through in-vitro fertilization for assisted reproduction that have not reached the transfer phase (including unsuitable ones) cannot be destroyed, resulting in significant resource allocation for indefinite preservation in biobanks. This stems from the legal and ethical recognition of the human embryo as a subject of rights that in turn prohibits destruction, donation to other couples, or use for scientific research.

Study design, size, duration
My study compares European legal systems and analyzes the evolution of Italian law on medically assisted fertilization (L. 40/2004) since its implementation, with a focus on legal and ethical issues that have been subject of ongoing debate.
It also examines the Italian Ministerial Guidelines, the only text where the legislator has dealt with the issue of surplus embryos.

Participants/materials, setting, methods
Not applicable.

Main results and the role of chance
The present study examines the various approaches taken by countries to address the issue of surplus embryos. Regulations in countries such as Spain, France were taken into consideration. The British legal system is also examined for its regulations on the donation of embryos and reproductive cells. The Spanish regulation of embryo-sharing (L. 14/2006) is the most organic approach. It grants three options to couples with respect to their remaining embryos: preservation for personal use, donation to other couples, or donation for research. In the United States, the increase in cryopreserved and abandoned blastocysts has led to the spread of conditional embryo adoption and Snowflakes adoption. The Italian provision, however, fails to adequately balance the constitutionally protected interests of couples' self-determination and scientific research for the protection of individual and collective health.
Role of chance not applicable here.

Limitations, reasons for caution
Not applicable.

Wider implications of the findings
Italian legislation neglecting to intervene has caused numerous issues, such as increased costs for fertility centers and poor practices. Clinics advertising embryo adoption, despite regulatory uncertainty, have created unfair competition leading to psychological distress for couples with cells in limbo and fears of financial obligations.

Trial registration number
NOT APPLICABLE
P-397 The effect of letrozole overlapped with gonadotropin on IVF outcomes in women with DOR or aged over 40 years old
Authors: Xiaomiao Z , Li X , Li L , He F , Zeng M , Chen X , Ji X , Qiu Q , Yang G , Huang J , Pan P , Guan G 
Published: June 2023

Abstract

Study question
Evaluating the efficacy of modified letrozole protocol (mLP) for diminished ovarian reserve (DOR) or advanced age women.

Summary answer
The modified letrozole protocol provides another option for women with DOR or advanced age, especially those who experienced ovarian stimulation previously.

What is known already
For years, numerous methods have been conducted to obtain better outcomes in women with advanced age or DOR. Increasing doses of gonadotropin (Gn), exogenous luteinizing hormone (LH) or growth factor (GH) supplementation, and various kinds of controlled ovarian stimulation (COS) protocols were reported. However, there is still no consensus due to the contradictory reports of comparable reproductive outcomes. During ovarian stimulation, estrogen and androgen are important in the recruitment of primordial follicles and promotion of follicular growth at the preantral and antral stages across different species.

Study design, size, duration
This is a paired-match study including 243 women with DOR and 249 women aged over 40 years old who received in vitro fertilization (IVF) treatment.

Participants/materials, setting, methods
123 women received stimulation with mLP. GnRH agonist (GnRH-a) long, GnRH antagonist (GnRH-anta), and mild stimulation protocol were used as controls with 123 women in each group. Clinical pregnancy rate (CPR) and cumulative clinical pregnancy rate (CCPR) were main outcomes.

Main results and the role of chance
CPR in the mLP group (38.46%) was significantly higher than mild stimulation (17.11%), but not significantly different from GnRH-a long (26.13%) and GnRH-anta (29.17%) group. CCPR showed an increasing trend in the mLP group (33.33%) although without significance when compared with controls. The CCRP of GnRH-a long, GnRH-anta, mild stimulation group were 21.68%, 29.03%, and 13.01%, respectively. In women with repeated cycles, mLP achieved higher available embryo rate and top-quality embryo rate. Further study showed positive correlation between testosterone and the number of oocytes retrieved in mLP group (r = 0.395, P&lt; 0.01).

Limitations, reasons for caution
It is a retrospective study which resulted in minor bias among mLP and the other control protocols. Although we have already paired for age and AMH, the presence of biases cannot be totally excluded. Further prospective studies need to be done to validate the effect of mLP.

Wider implications of the findings
The modified letrozole protocol may be effective for women with DOR or advanced age, especially those who have experienced previous cycle failure. An increasing serum testosterone level may play a role and reflect follicular growth during ovarian stimulation.

Trial registration number
not applicable
P-508 The adverse effect of a previous late miscarriage on the subsequent pregnancy outcomes: a retrospective cohort study across more than ten years
Authors: Yang L 
Published: June 2023

Abstract

Study question
To explore whether a previous late miscarriage (LM) has a prognostic impact on the subsequent pregnancy outcomes in in-vitro fertilization (IVF) women.

Summary answer
Women who had a LM for unexplained factor or cervical factor following first embryo transfer had a significantly poor pregnancy prognosis after the subsequent transfer.

What is known already
It has been reported that a history of early miscarriages is significantly associated with poor pregnancy outcomes. However, whether and how previous LM might influence future pregnancy outcomes still remain unclear.

Study design, size, duration
A retrospective cohort study was performed among 1072 infertile women who had a LM following the first embryo transfer from January 2008 to December 2020 at Center for Reproductive Medicine, Shandong University.

Participants/materials, setting, methods
1072 infertile women who had a late miscarriage following first embryo transfer were grouped by the causes, 458 women with unexplained factor (unLM), 146 women with fetal factor (feLM), 412 women with cervical factor (ceLM), 56 women with trauma factor (trLM). Subgroup analysis and binary logistic regression were performed to evaluate the associations between late miscarriages with different causes and subsequent pregnancy outcomes.

Main results and the role of chance
Compared with general IVF population, the early miscarriage rate was significantly higher in the unLM group [8.28% vs 13.47%, adjusted OR (95%CI): 1.596(1.119-2.276), P=0.01]. Further, women with a unLM or ceLM had a dramatically elevated risk of recurrent late miscarriage [for unLM:4.24% vs 9.43%, adjusted OR (95%CI): 1.907(1.237-2.939), P=0.003; for ceLM: 4.24% vs 15.53%, adjusted OR (95%CI): 2.682(1.820-3.952), P=0.000] and a consequently reduced frequency of live birth [for unLM: 49.96% vs 43.01%, adjusted OR (95%CI): 0.746(0.612-0.908), P=0.004; for ceLM: 49.96% vs 38.59%, adjusted OR (95%CI): 0.611(0.494-0.756), P=0.000].

Limitations, reasons for caution
This study was limited by the retrospective design from a single center and the sample size in feLM and trLM group is small. Further studies are needed to verify our results and ascertain the mechanisms underlying the reported associations.

Wider implications of the findings
Only one previous late miscarriage resulted from unexplained factor or cervical factor was significantly associated with a higher risk of miscarriage and a lower live birth rate after subsequent embryo transfer. Women with only one late miscarriage should be informed the great risk and given intense surveillance during subsequent pregnancy.

Trial registration number
not applicable