bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cumulus Cell Analysis for Prediction of Oocyte Quality in IVF and IVM
Authors: SMITZ Johan E.J. 
Published: November 2022

Background: In order to promote single embryo transfer (SET) in in vitro fertilization (ICSI) and In Vitro Maturation (IVM) supplementary analysis beyond morphological scoring is needed. The symbiosis between oocyte and cumulus during different stages of follicle development suggests the cumulus as an obvious specimen for molecular analysis. Over the last decade several studies have shown the potential of quantitative RT-PCR to measure predictive genes in ART. However, few prospective studies have validated this potential in routine embryology. Aim: Summarize the potential clinical use of cumulus gene testing from studies in routine human IVF and IVM. Methods: Pubmed search and own unpublished data. Results: So far few prospective studies (Adriaenssens et al., 2019; Van Vaerenbergh et al., 2021) have validated the approach for SET on Day 3 in a selected group of IVF (ICSI) patients in an interventional, non-randomized, assessor-blinded cohort study, by using normalized values of three predictive genes. The outcome demonstrated a significant increase in live birth when selecting single day 3 embryo in the first ICSI fresh transfer cycle based on cumulus gene-expression (of transferable embryos) versus SET based on morphology-only (from 27% to 50%; p<0.0001). A similar non-invasive approach could be developed for the decision making in IVM culture-type (depending on GV maturity grade) and to pinpoint the single IVM embryo to transfer. Conclusion: Cumulus analysis proves to be a reliable non-invasive technology with promising applications for the routine embryology laboratory.
Addressing Anxiety Using Music and Music Therapy for Women Undergoing Gynaecological and Fertility Treatments
Authors: ANDREADIS Natasha , SHORT Alison , CHEUNG Geena 
Published: November 2022

Background: The significant anxiety experienced by women undergoing fertility treatments typically relates to the nature of procedures and examinations, concerns around invasiveness of the procedures, uncertainty around what to expect, and exposing intimate parts of the body. The physiological and psychological consequences of this anxiety may affect the outcomes of fertility procedures. However, music is known to be effective in distracting from worries and concerns, allowing for relaxation and the release of mood-altering chemicals via the parasympathetic nervous system. Based on numerous applications of music therapy, it has been demonstrated that the use of music can effectively address the stress and anxiety associated with medical treatments. However, scant evidence exists about the efficacy of music in reducing anxiety experienced by women undergoing fertility and gynaecological procedures. Aim: This presentation outlines a funded collaborative research project investigating uses of music and music therapy by women attending a fertility specialist, specifically examining the effects of music listening on anxiety before and during gynaecology and fertility procedures, and a further role for facilitated music therapy sessions. Method: Women attending office, day surgery and other hospital procedures completed validated self-report surveys before and after procedures and listened to specific music via devices including the Music Star (Lund, Bertelsen & Bonde, 2016). Measures included the State Trait Anxiety Inventory (STAI-6) and the Strategies Used by People to Promote Health questionnaire (SUPPH), supported by additional questions and field notes. Results: Results indicated that the very high anxiety baseline levels for the 43 participants were significantly reduced by the use of music, and many positive comments were documented. Conclusion: Additional pilot music therapy sessions indicated a need for further research to understand the way that carefully selected and applied music can assist with the complex needs of women undergoing fertility treatments and support patients during their fertility journey.
Demographics and Cycle Outcomes of Transgender Patients Accessing Gamete Services at Monash IVF Victoria
Authors: CLEMENTS Phillippa , GREEN Mark P , ZANDER-FOX Deirdre , WESTON Gareth , ALESI Rita 
Published: November 2022

Background: Since 2003 an increasing number of transgender patients are electing to store gametes prior to transitioning and/or utilising ART services at Monash IVF Victoria. Aim: The aim of this study was to determine the number of transgender patients accessing gamete storage and utilisation services, as well as their cycle outcomes. Methodology: A retrospective study of frozen gamete usage of 48 patients collected between 2003-2021 was undertaken. Results: Trans-female patients were the most common cohort, with 37 patients (16-49yrs, mean age 25.9± 7.7) undertaking semen freezing and two (13yrs and 17yrs) surgical sperm retrieval prior to transitioning. Between 2003-2010 and 2011-2021 six (15.4%) and 33 (84.6%) patients respectively used this treatment. On average 2.3± 2.0 ejaculates/patient were frozen. At freezing 13 (35.1%) patients had >1 ejaculate with a low sperm count and 23 patients (62%) low sperm motility compared to WHO criteria; data were unavailable if patients had already commenced hormonal therapy. Four patients (10.8%) elected to register as sperm donors and their sperm used, while only four (10.8%) trans -female patients have returned, 2-7 years later (mean 5.3± 2.2 years) with a cis -female partner to utilise their gametes; two achieving a live birth. In contrast, nine trans -male patients (20-29yrs, mean age 23.9± 2.6yrs) undertook oocyte collection; one (11.1%) had treatment in 2003-2010 and eight (88.9%) between 2011-2021. On average 1.4± 0.7 egg freezing cycles/patient were conducted, with 4-30 eggs frozen/collection (mean 14.4± 7.1). One patient donated their oocytes to their cis- female partner in an ICSI cycle 7 years after freezing and achieved one live birth. Conclusion: Gamete cryopreservation is a valuable service for transitioning patients wishing to preserve fertility; numbers are increasing, with low utilisation to date and successful outcomes recorded. Exploring transgender patient experiences and ART service uptake will provide vital feedback to tailor an inclusive fertility journey at our clinics.
Anti-Mullerian Hormone (AMH) Test Information on Australian and New Zealand Fertility Clinic Websites: A Content Analysis
Authors: COPP Tessa , NICKEL Brooke , LENSEN Sarah , HAMMARBERG Karin , LIEBERMAN Devora , DOUST Jenny , MOL Ben W. , MCCAFFERY Kirsten J. 
Published: November 2022

Background: The Anti-Mullerian hormone (AMH) test is promoted to women as a way to find out how long they have left to have children. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility clinic websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. Aim: To systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites. Method: Data were extracted from accredited Australian and New Zealand fertility clinic websites between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, were analysed and the content categorised. Results: 25 clinic websites included information about the AMH test. The available information embodied four overarching categories; 1) the utility of the AMH test, 2) who the test is suitable for, 3) possible actions in response to the test, and 4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not supported by evidence (e.g. “a good snapshot of current fertility”). Whilst some websites were transparent regarding the test’s limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances (e.g. “women who would like to conceive in the future”). Conclusion: The quality of information about the AMH test varied considerably. Several websites had statements about the AMH test that are not supported by evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their current or future fertility.
COVID 19- The Rise of Telehealth Within the Specialist Practice: Is it Here to Stay?
Authors: COSTA Samantha , GUINESS Tarryn , YAZDANI Anusch 
Published: November 2022

Background: The World Health Organization declared COVID-19 a global pandemic on March 11, 2020 and the world as we knew it came to a stop as Australia entered “Lock Down”, forcing a change in how consultation was delivered to patient. Forcing the rise of Telehealth into Private Specialist practice. Aim: To investigate the impact of COVID-19 and Telehealth on patient access to care in the Specialist Private Practice Sector. Method: A retrospective single unit cross sectional analysis of patient consultation type, to compare patient access to telehealth pre pandemic (FY19) and subsequent pandemic financial years (FY20/21, 21/22). Results: Results showed an increase in initial telehealth appointments by 72% in the 20/21 Financial year and 288% increase during the 21/22 Financial year. Follow up appointments via Telehealth also increase by 106% and 160% respectively. Access to telehealth appointments has also shown a decreasing trend in face-to-face appointments both with initial consultations and follow up appointments. Conclusion: The use of telehealth appointments rose significantly during the timeframes where access to the clinic was reduced due to lockdown but continues to now be an important modality of access to care for both clinicians and patients. Further research needs to address the enablers and detractors for Telehealth and the translation of traditional face to face consultations and this modality.
Prediction of Progression from Oocyte to Useable Blastocyst Using Deep Radiomic Signatures: Preliminary Results
Authors: HABIBALAHI Abbas , CULLINAN Rosemarie , TILLIA Liza , DALATI Sarah , MAHBUB Saabah B. , CAMPBELL Jared M. , RIEPSAMEN Angelique , GILCHRIST Robert B. , LEDGER William L. , GOLDYS Ewa M. 
Published: November 2022

Background: Oocyte cryopreservation is increasingly used for fertility preservation by young women with cancer prior to chemo/radiotherapy and by single women wishing to defer pregnancy beyond their mid-30’s, thereby avoiding the increased risks of infertility, miscarriage and chromosomally abnormal pregnancy seen as consequences of female ageing. Oocyte cryopreservation is inefficient, with a large number of oocytes being required to give a realistic possibility of even a single pregnancy. We report preliminary data that demonstrate the ability of deep radiomic imaging to predict progression from oocyte to useable blastocyst as a first step towards improving the efficiency of oocyte cryopreservation. Aim: To develop and apply a deep radiomic signature (DRS) based on an artificial intelligence model to identify oocytes that progressed to useable blastocysts. Method: 40× brightfield images (n = 45) of human oocytes from 6 patients, taken prior to ICSI using an Olympus DP27 camera and IX73 inverted microscope. An unsupervised deep learning approach was applied to extract informative DRS of oocyte morphology. Unsupervised analysis by a fully blinded operator was conducted to identify data clusters. The data were colour-coded to identify useable (suitable for cryopreservation or transfer) blastocyst formation and a classifier was developed to separate useable blastocysts. This study was approved by the South Eastern Sydney Human Research Ethics Committee (2020/ETH01767). Results: Blinded analysis identified an effective DRS signature with two separate clusters of oocytes. Oocytes that led to useable blastocysts formed a single cluster which was denser than that from oocytes with no good blastocyst outcome, implying less morphological heterogeneity of the higher quality oocytes. The classifier could successfully distinguish oocytes which did/did not lead to useable blastocysts with strong performance (AUC=0.86). Conclusion: Our preliminary data demonstrate that non-invasive DRS can be applied to human oocytes, identifying morphological features that predict useable blastocyst formation with high accuracy.
Serum GDF9 and BMP15 as Markers of Ovarian Function in Healthy Women and Women with Polycystic Ovary Syndrome
Authors: RIEPSAMEN Angelique H. , DONOGHOE Mark W. , INDRAN Inthrani R. , LIEN Shelly , HECHTMAN Leah , ROBERTSON David M. , GILCHRIST Robert B. , YONG Eu-Leong , LEDGER William L. 
Published: November 2022

Background: The oocyte-secreted factors growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are key regulators of female fertility and are predominantly expressed by oocytes. Recently, methods to quantitate these proteins in serum have demonstrated diagnostic potential. It is unknown if concentrations reflect ovarian and endocrine function, particularly in women with polycystic ovary syndrome (PCOS), where GDF9/BMP15 function is suggested to be aberrant. Aim: To determine if serum GDF9/BMP15 are associated with ovarian and endocrine parameters, and the ovarian pathologies, PCOM and PCOS. Method: Women aged 21-45 years (n=381) were from a cross-sectional study at the National University Hospital, Singapore, including healthy volunteers and referrals from gynecological clinics. Transvaginal ultrasound scans, blood tests and questionnaire were performed. Serum GDF9 and BMP15 were assessed relative to ovarian (cycle regularity, ovarian volume, AFC, AMH) and androgenic (testosterone, DHT, androstenedione, DHEAS, SHBG, mFG score) characteristics. PCOM and PCOS were determined using the Rotterdam criteria. Statistical analyses used parametric survival models and Kendall’s tau correlation appropriate for data containing values below the limit of detection. Results: Serum GDF9 and BMP15 were detectable in 40% and 41% of women, respectively. Serum GDF9 positively correlated with ovarian volume (p=0.02), AFC (p=0.004), and weakly with AMH (p=0.05). Furthermore, irregular menstrual cycles were associated with high GDF9 (p=0.005), and similar, although non-significant associations were seen for BMP15. When stratified into PCOS (n=130), PCOM (n=59), and control (n=192), GDF9 and BMP15 concentrations were not significantly different, and were not associated with the majority of androgenic features of PCOS. However, the relationship between GDF9 and AFC was significantly different between PCOM, PCOS and control women (p=0.02). Conclusion: These results suggest that serum GDF9 and BMP15 reflect ovarian characteristics but not androgenic characteristics of PCOS, and that the relationships between GDF9 and AFC may be aberrant in women with PCOM/PCOS.
Higher Doses of FSH Used for Superovulation Do Not Adversely Affect Embryonic Ploidy: A Randomised Controlled Trial (Stimulation Resulting in Embryonic Aneuploidy Using Menopur (STREAM) Trial)
Authors: SHYAMSUNDER Akshara , HARDY Tristan , YAZDANI Anusch , POLYAKOV Alex , NORMAN Robert , HART Roger , AGRESTA Franca , ROMBAUTS Luk , BOOTHROYD Clare , CHAPMAN Michael , SWEETEN Prudence , SOMERVILLE Eleanor , JOSE Rachel , WAND Handan , LEDGER William L. 
Published: November 2022

Background: High dose gonadotropin stimulation protocols may increase costs, patient discomfort, likelihood of ovarian hyper stimulation syndrome (OHSS), ovarian torsion and increased bleeding after multiple ovarian punctures. In addition, it is possible that high dose stimulation may result in impaired oocyte “quality” with adverse effect of embryonic ploidy. This may negate any benefits seen from a higher oocyte yield after high dose stimulation. Aim: To determine the proportion of euploid blastocysts resulting from higher versus lower dose ovarian stimulation protocols. Method: Multicentre randomised controlled trial recruiting 57 women who were treated with ovarian stimulation using either 150 or 300 IU Menopur per day. In Vitro Fertilisation (IVF) or Intracytoplasmic Sperm Injection (ICSI) were performed according to individual unit protocol and embryos were cultured to blastocyst stage. A trophectoderm biopsy was performed for preimplant action genetic testing for aneuploidy. Results: The number of oocytes obtained from women randomised to 150 IU Menopur was between 3–17 (mean=9), whereas the number of oocytes obtained from women randomised to 300 IU Menopur was between 3–24 (mean=11). There was a positive linear relationship between serum AMH concentration and oocyte yield in both the 150 & 300 IU Menopur groups (R=0.3359, R2=0.1129 & R=0.3741, R2=0.1399). 63% of blastocysts were euploid in the 150 IU Menopur group and 75% in the 300 IU Menopur group (p=0.17). Conclusion: The higher dose ovarian stimulation protocol did not significantly increase the number of oocytes retrieved, nor did the higher dose protocol reduce the proportion of euploid embryos created. This study does not support the hypothesis that use of higher doses of gonadotropin for ovarian stimulation results in a reduction in the proportion of euploid embryos obtained after IVF.
Individualised versus Standard FSH Dosing in Predicted Poor Responders Undergoing IVF: A Randomised Controlled Trial
Authors: LIU Xitong , SHI Juanzi , MOL Ben W , LI Wentao 
Published: November 2022

Background: Poor responders usually lead to detrimental effects on IVF outcomes due to low oocyte number and quality which further result in low pregnancy outcomes and increased chance of cycle cancellation. Clinicians often individualise the FSH dose using ovarian reserve tests (ORT), including antral follicle count (AFC). However, it is unclear whether individualised FSH dosing improves clinical outcomes. Aim: To understand if there is a difference in live birth rates between individualised or standard FSH dosing in poor responders? Method: Between March 2019 and April 2020, we performed a single center, parallel, open-label randomised controlled trial. Women referred for their first IVF/ICSI cycle, [Formula: see text]43 years of age, AFC[Formula: see text]10 were approached. Eligible women were randomised either to individualised or standard FSH dosing. In the individualised group, women with AFC 1-6 were assigned to 300IU/day, while women with AFC 7-9 were assigned to 225IU/day. In the standard group, women were assigned 150IU/day. The primary outcome was live birth attributable to the first ART cycle within 18 months of randomization. Results: A total of 661 women were randomised, 328 to the individualised group and 333 to the standard group. The live birth rate (follow up still ongoing) was not significantly different between the two groups [49.1% (161/328) vs 42.3% (141/333), RR: 1.16 (95%CI, 0.98-1.37), P=0.082]. The cumulative ongoing pregnancy rate for individualised versus standard dosing was 53.0% (174/328) versus 47.4% (158/333), respectively [RR: 1.12 (95%CI, 0.96-1.30), p=0.150]. The multiple pregnancy rate also did not differ between individualised and standard dosing [5.49% vs 5.71%, RR: 0.96 (95%CI, 0.51-1.80), p=0.903]. Individualised dosing reduced the occurrence of poor response compared to standard dosing [31.1% vs 48.6%, RR: 0.64 (95%CI, 0.53-0.78), p[Formula: see text]0.001]. Conclusion: The individualised dosing strategy led to lower rates of poor response, but it did not result in significantly higher ongoing pregnancy rates.
Can We Identify Subgroups in Which ICSI is Cost-Effective Over IVF: A Secondary Analysis of a Randomised Clinical Trial
Authors: MOL Ben W. , VUONG Lan N. , LUU Tam M. , PHAM Toan D. , HO Tuong M. , HA Anh N. , TRUONG Binh T. , PHAN Anh K. , NGUYEN Dung P. , PHAM Thanh N. , PHAM Quan T. , WANG Rui , NORMAN Robert J. , DANG Vinh Q. 
Published: November 2022

Background: The use of intracytoplasmic sperm injection (ICSI) has increased substantially worldwide, primarily in couples with non-male factor infertility. We recently published the results of a large randomised controlled trial (RCT) comparing ICSI and IVF showing no significant improvement of ICSI over IVF in couples with normal semen concentration and motility. Here, we assess the cost-effectiveness of ICSI in these couples, with additional attention for subgroups. Aim: To assess the effectiveness and cost-effectiveness of ICSI versus IVF in relation to sperm morphology. Method: We performed a cost-effectiveness alongside a randomised clinical trial comparing ICSI and IVF. Between 16th March 2018 and 12th August 2019, we had randomized 1,064 couples (532 to ICSI vs 532 to IVF) in two centres in VietNam. After comparing the difference in life birth rate, we calculated the incremental cost-effectiveness ratio as the additional cost to establish one live birth. We also looked at (cost-)effectiveness in subgroups by the baseline characteristics treatment-indication, ovarian response, total-motile-count and sperm-morphology. Results: In the base case, there were per 100 women 3.4 more babies born for an extra cost of €65,600. This translates to €19,294 per extra life birth, which is comparable to the benchmark of €15,000 per live birth. We did not find significant interaction with any of the baseline characteristics (all P-values for interaction [Formula: see text] 0.05). However, for sperm morphology, in the 458 couples with [Formula: see text]=4% normoform cells, live birth rates were 32.1% versus 32.9% (RR 0.97 (0.75 to 1.27)), while in 201 women with [Formula: see text]4% normoform cells this was 36.2% versus 29.7% (RR 1.22 (0.97, 1.54)). While this would implicate no effectiveness of ICSI in couples with completely normal sperm, in couples with normal total sperm count and motility, those with sperm morphology [Formula: see text]4% would have 6.5 additional babies per 100 women, resulting in a cost-effectiveness of €10,076 per extra life birth. Conclusion: In couples with completely normal sperm (normal total sperm count, motility and morphology) ICSI does not add anything to the chances obtained with IVF. In couples with a normal total sperm count and motility with abnormal morphology, ICSI could be considered as it seems cost-effective.