bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-155 What strategies help patients cope with endometriosis in everyday life: a doctor's perspective
Authors: Seeber B 
Published: June 2022

Abstract
Endometriosis is an enigmatic disease characterized by chronic pain and infertility and associated with a diminished quality of life. While surgery, pain medications and hormonal treatments are the mainstays of treating endometriosis, patients are increasing seeking complementary therapies to help them cope with their symptoms in everyday life.  Too often, clinicians caring for women with endometriosis are at a loss when it comes to discussing or recommending such alternative therapies, as they are not part of typical western medical training.
This lecture will review the evidence behind –or lack thereof—for many commonly sought therapies for endometriosis to enable physicians and clinicians to better counsel their patients. Topics to be addressed include: is there any benefit to special diets for endometriosis and endometriosis-associated pain? ; is there a role for physical activity or specific exercises in improving symptoms?; are yoga and meditation effective in helping women cope with endometriosis? ; are there specific phytotherapies that improve symptoms? ; has acupuncture been shown to help women cope with endometriosis symptoms? ; are there complementary therapies that improve fertility?
In addition, based on clinical experience in treating with women with endometriosis, the importance of setting shared goals and expectations for treatment and supporting patients in their plans for attempting pregnancy and fulfilling the wish for a child will be discussed.
O-164 Contraceptive and endocrine treatment for endometriosis
Authors: Thomas M.A. 
Published: June 2022

Abstract
Endometriosis-associated pain can be incapacitating for many patients who suffer with this condition. Contraceptive agents and endocrine preparations have been proven to be a better choice for pain relief in these individuals compared to analgesics alone. In this lecture, we will discuss evidence-based recommendations for the hormonal options that are available to treat endometriosis-associated pain.
O-165 Impact of endometriosis on the oocyte
Authors: Racowsky C 
Published: June 2022

Abstract
Available evidence indicates that women with endometriosis tend to have lower implantation rates following IVF than those without endometriosis. Whether this reduction in implantation rate is due to compromised endometrial receptivity or reduced embryo quality remains controversial. However, studies with the oocyte donor model in which reciprocal transfers are performed involving oocytes/embryos from women with or without endometriosis support the conclusion that oocyte quality is the main factor compromising implantation rate. This conclusion is consistent with documented elevations of inflammatory cytokines, reactive oxygen species and growth- and angiogenic factors in follicular fluid and peritoneal fluid of women diagnosed with endometriosis.
In this lecture, we will review evidence in support of negative effects of endometriosis on oocyte quality. We will discuss the results of studies directly assessing oocyte quality through gross morphological analyses and transmission electron microscopy assessments on human oocytes. Given the paucity of human oocytes available for research, we will then consider studies on animal oocytes matured in vitro in medium supplemented with either follicular fluid or peritoneal fluid from women with endometriosis. We will then proceed to reviewing the clinical IVF literature assessing the relationship between endometriosis and embryo quality, as the latter is predominantly driven by oocyte quality. We will specifically appraise studies investigating any association between endometriosis and 1) the proportion of good quality embryos and blastocyst formation rate, as categorized by conventional morphology assessment; and 2) risks of aneuploidy, and aberrations in embryo morphokinetics identified by time-lapse imaging. We will close by a brief discussion of the challenges that prevail in untangling negative effects of endometriosis on oocyte quality.
O-306 LINZAGOLIX FOR ENDOMETRIOSIS-ASSOCIATED PAIN: SAFETY RESULTS FROM EDELWEISS 3, A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Authors: Donnez J , Taylor H , Gemzell-Danielsson K , Catherino W , Bestel E , Gotteland J.P , Humberstone A , Moore L , Garner E 
Published: June 2022

Abstract

Study question
Is once-daily linzagolix treatment for women with moderate to severe endometriosis-associated pain (EAP) safe for use for up to 6 months of treatment?

Summary answer
Both doses of linzagolix were well-tolerated with minimal BMD decrease and few TEAEs &gt;5% in either linzagolix arm.

What is known already
Linzagolix (LGX) is an investigational once-daily oral GnRH receptor antagonist that reduces serum estradiol in a dose-dependent manner and is being developed in two dosages for the treatment of endometriosis-associated pain (EAP): 75 mg, and 200 mg dose with hormonal add-back therapy (ABT).

Study design, size, duration
EDELWEISS 3 is a randomized, double-blind, placebo-controlled, multicenter Phase 3 trial of linzagolix in women with moderate to severe EAP. The trial includes 3 treatment arms: 75 mg LGX, 200 mg LGX with ABT (E2 1 mg/ NETA 0.5 mg), or placebo. Here we present safety results up to 6 months (24 weeks) of treatment.

Participants/materials, setting, methods
Eligible reproductive-aged women with moderate-to-severe EAP were randomized and treated (n = 484) for 6 months with 75 mg LGX, 200 mg LGX with ABT (E2 1 mg/ NETA 0.5 mg), or placebo. Safety and tolerability objectives reported here include 6-month results for treatment emergent adverse events (TEAEs), assessment of mean percent change from baseline (CfB) in lumbar spine (LS) bone mineral density (BMD) and Z-scores.
The safety analysis set included 484 subjects across the 3 treatment groups.

Main results and the role of chance
The overall incidence of TEAEs was similar between the placebo and LGX 75 mg group (46.9%) and slightly higher (56.8%) in the LGX 200 mg + ABT group. There were few (3) serious TEAEs, and none were related to LGX. TEAEs that occurred in over 5% of patients in either active treatment arm included headache (10.5%, 8.1%, and 8.0%), hot flush (6.8%, 7.5%, and 2.5%), and fatigue (6.8%, 3.8%, and 2.5%) for the 200 mg LGX with ABT, 75 mg LGX, and placebo groups, respectively. Mean percent CfB (95% CI) in LS BMD was -0.79% (-1.15,  -0.43%), -0.89% (-1.31, -0.47%), and +0.78% (0.41, 1.15%) for the 200 mg LGX with ABT, 75 mg LGX, and placebo groups, respectively. Z-scores at 6 months remained within the same range as baseline in all groups.

Limitations, reasons for caution
Additional efficacy and safety results from the trial's 24 weeks (6 mo) extension phase are pending. (Edelweiss 6 protocol: NCT04335591)

Wider implications of the findings
These results support further development of ABT and non-ABT doses of linzagolix that have potential to provide flexibility and choice for women seeking treatment for EAP. A non-ABT option is important for women who have a contraindication to, are at increased risk for complications, or prefer not to use ABT.

Trial registration number
ClinicalTrials.gov: NCT02778399
O-225 Endometrioma and fertility preservation: how can we save the oocytes?
Authors: Donnez J 
Published: June 2022

Abstract
Endometriosis is a benign estrogen-dependent disease
In the ovary, endometrioma formation may cause local inflammation, giving rise to structural alterations to the ovarian cortexwhich manifest as massive fibrosis and loss of cortex-specific stroma that maintains follicular nests.
Subsequent dysregulation of folliculogenesis results in “burn out” of the stockpile of dormant follicles. Moreover, endometriomas contain much higher concentrations of free iron, reactive oxygen species (ROS) and proteolytic enzymzes which could reach adjacent ovarian tissue and lead to follicular loss and intraovarian vascular injury.
Fertility preservation is a major challenge when therapeutic approaches of ovarian endometrioma are contemplated.
Surgery is often proposed in cases of endometrioma more than 3 cm in size but there are two main risks associated with the surgical treatmant of endometrioma :
1. the risk of excessive surgery (removal or destruction of normal ovarian cortex together with the endometrioma pseudocapsula).Close the ovarian hilus, ovarian tissue removed with the endometrioma wall contained follicles in more than 60% of cases in a study of Muzii and some meta-analyses have revealed significant decreases in AMH after excision.
2. The risk of incomplete surgery with subsequent early recurrence.
A correct surgical approach is therefore the first step to preserve oocytes and several techniques are discussed.
How to preserve fertility in women at risk of premature ovatian insufficiency (POI) due to severe and/or recurrent ovarian endometriosis?
Two main options are currently available :
1. COS,ovum pick-up and vitrification of oocytes is an important fertility preservation approach. Cobo et all published several series and reported high cumulative live birth rates in women less than 35 years, suggesting that patients with endometrioma should be encouraged to freeze oocytes at a younger age.
2. In some circonstances, orthotopic autotransplantation of cryopreserved ovarian cortex (which has led to more than 200 live births ) could be proposed to maintain the follicular pool.
O-228 How to introduce time-lapse technology in the IVF lab
Authors: Ebner T 
Published: June 2022

Abstract
Although there is conflicting evidence on the actual clinical relevance of time-lapse technique (TLT) it is an add on technique that does come along with several advantages that would justify its use. However, once the decison has been made to go with TLT it has to be brought to mind that the European Tissues and Cells Directive dictates that new equipment is qualified accordingly before used routinely. This process is usually done according to GMP standards, e.g. a proper design qualification (DQ) would identify the most superior equipment which then undergoes further qualification steps such as installation (IQ), operational (OQ) and performance qualifications (PQ). The latter should involve a comparison with generally accepted laboratory KPIs, a process which would allow to establish levels of competence and aspirational benchmark. Upon proper qualification and clearance TLT can be an important tool in an existing quality management system, e.g. for evaluation of inter- and intraobserver variation, implementation of new consumables, and for testing the safety and efficacy of new lab methods.
O-231 Is there a role for medical management of fibroids in infertile patients?
Authors: Palshetkar N 
Published: June 2022

Abstract

Uterine Fibroids are one of the most common benign uterine tumors. 33% of women with fibroids will be symptomatic. Surgical treatment has usually been the treatment of choice. However, the medical management of fibroids is a less explored territory. Evidence suggests that progesterone pathways play a crucial role in the path physiology of uterine fibroids. Selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA) may be used. There have been many RCTs suggesting the use of UPA. Medical management can reduce the morbidity of surgery and also help preserve fertility as well. Therefore having a new tool in every gynecologist's bag opens up novel strategies for the management of uterine fibroids.

Trial registration number
O-278 Prenatal outcomes of mosaic embryo transfer and neonatal assessment
Authors: Viotti M 
Published: June 2022

Abstract
Ever-improving PGT-A methodologies now make it feasible to routinely detect chromosomal mosaicism. What is the appropriate clinical management of those embryos? What is the impact on pregnancies and births when such embryos are transferred? Mosaicism is the consequence of chromosome-segregation errors at mitosis, resulting in a mix of cells with different chromosomal content. The transfer of embryos with evidence of diploid-aneuploid mosaicism in their PGT-A results has become relatively common practice, and numerous clinics have published their experiences with such transfers. On average, ‘mosaic’ embryos have decreased potential to establish a pregnancy and higher risk for miscarriage compared to ‘euploid’ embryos, but pregnancies reaching term seem to produce apparently healthy babies. These findings favor an expansion of the binary ‘normal vs abnormal’ classification system of PGT-A to include ‘mosaicism’ as a third category. Further data suggest that features of mosaicism detected with PGT-A associate with different clinical outcomes, namely the mosaic level (percent aneuploid cells) and the mosaic type (nature of aneuploidy). ‘Low level’ mosaicism is preferable to ‘high level’ mosaicism, and segmental abnormalities are preferable to aneuploidies affecting whole chromosomes. Therefore, the ‘mosaic’ category can be further refined for optimal ranking purposes in the clinic. While many mosaic embryo transfers have resulted in babies, systematic and detailed follow-up studies on pregnancies from such embryos are urgently needed. The present talk will give an update on the ongoing data collection effort by an international, multicenter consortium containing 1700+ ‘mosaic’ embryo transfers, neonate information from 500+ babies born from those transfers, and 380+ associated prenatal test results. Analysis of the data reveals that late-term pregnancies and babies from ‘mosaic’ and ‘euploid’ embryos have largely equivalent health, with a few notable exceptions.
P-099 The effect of sperm DNA quality on blastocyst and euploid rates
Authors: Exeter H , Odia R , Cawood S , Haddock L , Lewis S , Srividya S , Serhal P , Saab W 
Published: June 2022

Abstract

Study question
Do sperm DNA quality measurements influence the blastocyst rate and/or euploid rates?

Summary answer
Sperm DNA fragmentation has a negative influence on the rate of blastulation. It does not impact on euploidy rates assessed by pre-implantation genetic testing (PGT-A).

What is known already
Some studies show that sperm DNA has no influence on embryo development and that its negative influence begins following implantation. Other studies show that every step of the fertility process from fertilization onwards is impacted by the male gamete as well as the female gamete. To date, data has been confounded by different sperm DNA tests and different clinical practices and parameters measured.

Study design, size, duration
This was a retrospective study using the sensitive Comet assay to analyse whether it’s three sperm DNA fragmentation scores influence embryo development or euploidy.

Participants/materials, setting, methods
Data from 110 cycles of intracytoplasmic sperm injection (ICSI) where the blastocyst rate (number of blastocysts/number of mature oocytes injected) was obtained from the patient database of a UK single centre. Inclusion criteria: Only outcomes from the first assisted reproductive cycle after a Comet assay had been performed were included. Included cycles were within one year of the test.

Main results and the role of chance
Blastocysts were ranked in 4 groups- 0.25-0.49, 0.5-0.74, 0.75-1.00. Three Comet scores were analysed: Average Comet Score (damage across the semen sample; ACS), Low Comet Score (proportion of sperm with good DNA; LCS) and High Comet Score ( proportion of sperm with high DNA damage; HCS). Clinical thresholds were calculated by comparison with fertile donor sperm. High ACS and LCS and low HCS were all associated with higher blastocyst rates (ANOVA, p = 0.013; Kruskal Wallis, p = 0.027, Post Hoc pairwise comparisons between blastocyst groups (p = 0.016-0.024). No relationship was found between euploid rate (number of euploid embryos/total embryo number) and sperm DNA damage p = 0.761).

Limitations, reasons for caution
Retrospective design requiring more data to clarify these associations coupled with the lack of randomisation and low power analysis.

Wider implications of the findings
This study reports the negative impact of sperm DNA fragmentation on blastocyst formation rates. Male partner diagnostic assessments such as sperm DNA quality testing are useful adjuncts to semen analysis. Further research to determine if there is a relationship between sperm DNA damage and euploid embryo outcomes is ongoing.

Trial registration number
IRB-001C06-01-22
P-194 Healthy babies after intrauterine transfer of mosaic blastocysts
Authors: Fernandez Sanguino A , Oviedo O , De pablo J.L , Belmonte M , Diez Alcantara J , Martin Garcia B , Pilar L , Collazos R 
Published: June 2022

Abstract

Study question
Can mosaic blastocysts be considered a valid alternative to patients undergoing IVF with no euploid embryos?

Summary answer
We believe that mosaic embryos can be a valid alternative when no euploid embryos are obtaines, particularly in diminished ovarian reserve and advance maternal age

What is known already
Preimplantational genetic screening is used to identify chromosomal euploid embryos and select them for intrauterine transfer in order to improve clinical IVF outcome.Chromosomal mosaicism is defined as two or more distinct chromosomical cells within an embryo and is a relatively common finding in human embryos. Mosaicism arises from mitotic errors occurring after fertilization or meiotic failures in gametes. The variables for the risk stratification of mosaic embryos have been defined as the percentage of mosaicism, specific chromosomes involved, monosomy versus trisomy and inclusion of complete or segmental chromosome mosaicism. High risk mosaic embryos may decrease implantation potential and increase miscarriages.

Study design, size, duration
A retrospective observational review of our results. During the period of 2017 - 2021 we performed 532 PGT-a studies. Embryos underwent blastocyst-stage preimplantation genetic testing for aneuploidy by next-generation sequencing. We obtained 39 low risk mosaic blastocysts, and from those we transferred 8 mosaic blastocysts.

Participants/materials, setting, methods
Patients in our clinic undergoing IVF treatment with PGT-a screening.

Main results and the role of chance
Our success pregnancy rate when transferring mosaic blastocysts was 62,5 %. From 10 mosaic embryos, 1 patient was lost in the study, 3 transferred embryos gave negative bHCG results and we obtained 5 ongoing pregnancies which resulted in 5 healthy babies. An amniocentesis was performed during the pregnancies to correlate the karyotype of the babies. The pregnancies were controlled with no pathological findings in detailed ultrasonography and the fetuses showed normal fetal growth. All pregnancies were delivered at term.

Limitations, reasons for caution
The main limitation of the study is the number of patients. A bigger size is needed in order to have full data which can support future decisions on whether to transfer mosaic embryos.

Wider implications of the findings
Our study shows that mosaic embryos can develop into healthy babies.
Our study is small, but we have achieved a high pregnancy rate. Further studies should be performed in order to be able to counsel women who undergo PGAT-a screening in IVF cycles with only mosaic embryos.

Trial registration number
not aplicable
P-323 Should We Measure Oxidative Stress Biomarkers In Follicular Fluid Of Women With Endometriosis Undergoing IVF?
Authors: Gupta P , Malhotra N , Dada R 
Published: June 2022

Abstract

Study question
Do levels of Oxidative stress (OS) biomarkers differ in the follicular fluid of women with endometriosis compared to tubal factor infertility?

Summary answer
8-Isoprostane is a promising biomarker in diagnosing oxidative stress in women with endometriosis opening a window of opportunity for improving outcomes.

What is known already
A delicate balance between oxidants and antioxidants is required for oocyte development and maturation. Any perturbation in the oocyte microenvironment which is the follicular fluid results in hampered oocyte quality and further affects the embryo development. As endometriosis causes destruction of the oocyte milieu, various OS biomarkers have been explored with inconclusive results. The present study aimed to compare these biomarkers in follicular fluid of women with endometriosis and tubal factor infertility undergoing in-vitro fertilization and correlate with ART outcomes.

Study design, size, duration
In a cross sectional study conducted at the assisted conception unit at a tertiary care hospital from 2017-2018 women undergoing their first IVF cycles for endometriosis and tubal factor infertility were recruited in the study. The study included a total of 107 patients with 50 in the endometriosis group (Group1) and 57 in the tubal group (Group 2).

Participants/materials, setting, methods
Follicular fluid from women undergoing IVF in both the groups was collected and evaluated for Oxidative stress biomarkers including Reactive Oxygen species (ROS), Total Antioxidant Capacity (TAC), 8-Isoprostane (8-IP) levels. ROS levels were detected by chemiluminescence and TAC and 8-IP using enzyme immunoassays.

Main results and the role of chance
Levels of ROS {(39.6 cpm vs 54.8 cpm) (p = 0.2)}were comparable in both the groups. Levels of 8-IP were significantly higher in group 1 as compared to the group 2 {(85.2  pg/ul vs 39.2  pg/ul) (p = 0.01)}. TAC levels were higher in endometriosis group compared to the tubal group {(5.4 mM of Trolox vs 4.1 mM of Trolox) (p = 0.005)} which could explain comparable ongoing clinical pregnancy rate in both groups (24.0% vs 24.5%, p = 0.34). There was no correlation of OS biomarkers with ART outcomes in tubal factor. Follicular fluid in Group 1 revealed a negative correlation of ROS with cleavage rate (r = - 0.42, p = 0.002) and positive correlation of TAC with fertilization rate (r = 0.44, p = 0.001) and Good grade embryos (r = 0.4, p = 0.001).

Limitations, reasons for caution
The main limitation is the inability to assess the dietary intake and blood oxidative stress biomarkers in both the groups.

Wider implications of the findings
OS biomarkers especially 8-IP could be useful in prognosticating IVF outcomes in women with endometriosis with a potential role of addition of antioxidants in culture media during IVF in these women.

Trial registration number
Not Applicable