Abstract Study question Does the choice of insemination method between conventional IVF (cIVF) and ICSI impact blastocyst euploidy outcomes in relation to cycle characteristics? Summary answer Both cIVF and ICSI yield similar euploidy outcomes regardless of cycle characteristics, suggesting no procedural impact in this cohort. What is known already In non-male factor cases, ICSI has not proven to improve fertilization or live birth rates compared to cIVF, as existing evidence remains conflicting. Moreover, the widespread use of ICSI in non-PGT cycles raises concerns about long-term implications for offspring. Evaluation of euploid rates may help elucidate the relative efficacy of cIVF and ICSI, yet direct sibling oocyte comparisons in PGT scenarios remain particularly limited and relying on small sample sizes (<120 cycles). A large-scale study comparing both methods of insemination in relation to cycle characteristics could provide valuable insights. Study design, size, duration This observational study was performed in a single IVF clinic between October 2017 to December 2024 including 27694 cumulus-oocyte complexes (COCs) across 2161 PGT-A cycles. These COCs were allocated as sibling oocytes to either cIVF or ICSI. The groups are categorized based on the proportion of ICSI inseminated oocytes as follows: 50% (n = 728 cycles), >50-60% (n = 914 cycles), and >60-70% (n = 519 cycles). Participants/materials, setting, methods Couples with female age between 18-49 (mean:36.1 years), and non-severe male factor sperm parameters with a progressive motility ≥65% after capacitation were included. A total of 9132 blastocysts (≥Bl3BCC) were subjected to trophectoderm biopsy on day 5-7 and next generation sequencing (NGS). Cycle characteristics such as female and male age, number of COCs and rate of mature oocytes were analyzed as potential factors associated with fertilization, usable blastocyst formation, and euploidy rates. Main results and the role of chance When comparing outcomes between MIIs following insemination by cIVF (n = 9282) or ICSI (n = 13931) in the different groups, ICSI was not superior to cIVF in terms of fertilization (RR: 1.06 [0.96–1.18], p = 0.235), blastocyst biopsied per inseminated MII (RR: 1.00 [0.80–1.25], p = 0.996) or per 2PN (RR: 0.95 [0.78–1.15], p = 0.581). Similarly, ICSI showed no significant difference compared to cIVF for euploidy per inseminated MII (RR: 1.22, [0.85–1.74], p = 0.285), per 2PN (RR: 1.12 [0.80–1.58], p = 0.499), or per biopsy (RR: 1.09, [0.84–1.43], p = 0.513). Cycle characteristics were independently associated with fertilization, usable blastocyst, and euploidy outcomes, regardless of insemination method. Limitations, reasons for caution The non-random allocation of oocytes between insemination techniques limits the ability to establish causal conclusions. Wider implications of the findings cIVF results in comparable euploidy outcomes to ICSI, making it a viable option for couples in PGT-A cycles, maintaining a balance between efficacy and resource utilization. Trial registration number No

Abstract Study question How much value do men and young men give to andrological prevention and when do they consider it important? Summary answer Our study reveals a significant lack of preventive measures among men, with only 3.5% undergoing an andrological check-up solely for prevention, not fertility issues. What is known already Male infertility affects approximately 20% of infertile couples, typically caused by sperm production issues, hormonal imbalances, or structural abnormalities. Despite the well-documented global decline in sperm quality, male prevention remains marginal compared to its female counterpart. Adolescents and young men are significantly less likely than women to have regular medical checkups, partly due to social norms. It is important not to delay action, as age is a critical factor that affects almost all semen parameters. Regular andrological evaluations can detect issues such as varicocele or early signs of more severe conditions, including testicular or prostate cancer. Study design, size, duration This prospective observational study included 931 male patients attending Humanitas Fertility Center from November 2023 to January 2025. The patients were stratified into groups and subgroups based on their medical history, including previous sperm analyses and andrological examinations, as well as the reasons leading them to undergo the check-up. Additionally, they were classified according to their family planning desire. Participants/materials, setting, methods The research analyzed data from 931 men with an average age of 37,2 years. Participants completed a questionnaire prior to undergoing semen analysis. It investigated preventive healthcare behaviors, lifestyle factors, seminal parameters and previous andrological examination. Semen quality metrics were assessed according WHO (2021) guidelines with parameters, such as sperm concentration, motility, and viability were considered as key outcomes. Age was also evaluated as a determinant of seminal quality. Main results and the role of chance The survey of patients' reasons for undergoing semen analysis reveals that the majority (88,5%) did it with the intent to have children. Another 7% tested because of varicocele, while only 3,5% did so for purely preventive reasons. The remaining 1% cited other reasons. Regarding prevention, 32% of the patients performed their first spermiogram during the observation period, while 68% had previously been tested. In the first group, the following results were observed: 22,7% were oligozoospermic, 30,4% had asthenozoospermia, and 3,7% had necrozoospermia. In addition, it was found that 50,7% of the patients had never undergone an andrological examination. The mean age of this group was 37.8 years, indicating a lack of prevention among both young and adult men. In this group, 79,7% trying to have their first child, while 3,8% were tested because of varicocele. Additionally, 13,7% was actually seeking for the second child and 0,8% cited other reasons. Only 2% (n = 9) underwent fertility check for purely preventive reasons, with no intention to have children, no ongoing medical conditions, and no previous andrological examination. This highlights a significant gap in awareness about male reproductive health. Limitations, reasons for caution Since the study was conducted at a fertility-specialized center, it may have influenced the sample by selecting men who already had reproductive concerns. The cross-sectional nature of the study limits the ability to establish causal relationships. However, the results highlight significant gaps in preventive practices related to male infertility. Wider implications of the findings Promoting early andrological consultations is essential, as age negatively impacts seminal parameters such as motility, volume, and concentration. Public health initiatives should be targeted at young men to reduce preventable causes of infertility and avoidable health risks, ensuring reproductive and overall well-being. Trial registration number No

Abstract Adenomyosis, a condition characterized by the infiltration of endometrial tissue into the myometrium, poses significant challenges in reproductive medicine, particularly regarding its impact on fertility (Moawad, 2022). We present a novel robotic-assisted surgical approach for uterine-sparing management of adenomyosis (Moawad 2024), aimed at preserving reproductive potential while alleviating symptomatic burdens. We perform a minimally invasive technique, which demonstrated significant symptomatic relief and improved reproductive outcomes, that is evidenced by a 75% pregnancy rate in patients post-operatively (Smith et al., 2023). The robotic approach offers enhanced precision in tissue resection, reducing intraoperative complications and postoperative recovery time compared to traditional methods (Jones & Lee, 2022). These findings underscore the potential of robotic surgery as a pivotal intervention for managing adenomyosis, warranting further investigation into long-term reproductive outcomes and quality of life.

Abstract Study question What are the reproductive patterns, utilisation of assisted reproductive technologies (ART), pregnancy-related risks and genetic implications for offspring in women with Turner syndrome (TS)? Summary answer More women with TS give birth, while adoption rates decline. TS is associated with increased obstetrical risks and a higher prevalence of TS in offspring. What is known already TS affects approximately 1 in 2000 live-born girls and is associated with cardiovascular risks, including aortic dilation and hypertension. Historically, pregnancies in women with TS have been discouraged due to these risks, but current guidelines recommend thorough cardiac evaluation and specialist counseling before attempting pregnancy. Increased access to ART, particularly oocyte donation, has led to more women with TS pursuing pregnancy. Studies indicate a higher risk of perinatal complications, especially with ART. An increased risk of abnormal genetic karyotype in offspring of women with TS remains controversial, with some studies suggesting no significant difference in birth defect rates. Study design, size, duration Swedish nationwide population-based cohort study including all women born 1950-1999 and registered as Swedish residents, followed until 2017. Participants/materials, setting, methods Women with TS were identified by diagnosis codes, and their reproductive patterns and perinatal outcomes were analysed using data from Swedish population-based registers. The proportion of women with and without TS who had at least one child was calculated by women’s year of birth and parenthood method. Logistic regression estimated odds ratios for binary outcomes, while multinomial logistic regression assessed relative risk ratios for categorical outcomes, adjusting for confounders. Main results and the role of chance Among the 3,410,210 women born in Sweden 1950-1999, the prevalence of TS was 3.6 per 10,000 women. Over time, the proportion of women with TS who had given birth increased from 10% for those born in the 1950s to 31% for those born in the 1970s, while adoption rates decreased from 18% to 9%. Women without TS maintained a stable birthrate of around 80%, with consistently low adoption rates of about 1%. In the most recent decade (2007-2017), 35.2% of TS births and 3.9% of comparator births were conceived using ART. At least 64.1% of ART conceptions in women with TS were achieved with donated oocytes, compared to 1.1% in comparators. Women with TS had significantly higher risk of perinatal complications compared to women without TS, including gestational diabetes (3.6% vs. 0.9%), gestational hypertension (9.2% vs. 3.5%), pre-eclampsia (6.8% vs.2.4%), placental abruption (1.6% vs 0.4%), preterm birth (10.4% vs. 5.6%), low Apgar scores in children (3.7% vs. 1.3%), low birth weight (9.0% vs. 3.4%), and congenital malformations (6.8% vs. 3.9%). The absolute risk of having a girl with TS in pregnancies with autologous oocytes was 1.6% among women with TS and <0.1% in women without TS. Limitations, reasons for caution The reliance on registry data may result in misclassification or underreporting of certain conditions. Moreover, the study could not account for all potential confounding factors, such as lifestyle variables, specific types of TS karyotype (mosaic or monosomy), and co-morbidities, all of which could influence reproductive and obstetric outcomes. Wider implications of the findings The study results provide valuable data for pre-conceptional counseling and pregnancy monitoring in women with TS, ultimately contributing to more informed clinical practice and patient care. Trial registration number No

Abstract Study question Does adding oral, sublingual or subcutaneous to vaginal progesterone supplementation during the first 10 days after FET affect the clinical pregnancy rate? Summary answer Adding oral progesterone to vaginal progesterone supplementation increases clinical pregnancy rates in patients with low serum progesterone on the day of FET. What is known already Progesterone supplementation is a critical component of Hormone Replacement Therapy-Frozen Embryo Transfer (HRT-FET) . Adequate progesterone levels are essential for successful embryo implantation. Previous studies have demonstrated lower clinical pregnancy rates in patients with serum progesterone (P4) levels below 10 ng/mL on the day of frozen embryo transfer (FET). However, there is limited evidences regarding the effectiveness of different forms of progesterone supplementation—oral, sublingual, subcutaneous, vaginal, or their combinations—in improving the clinical pregnancy rate (CPR) in this patient group. Study design, size, duration A retrospective multi-centre study including 1379 HRT single FET between 02/2019 and 12/2024. The dataset includes P4 levels on the day of FET, clinical pregnancy outcomes, patient age, BMI, embryo morphology grade, embryo freezing day, total number of transfers, preimplantation genetic testing, endometrial thickness, endometriosis status, menstrual cycle on the day of FET, types and dosages of progesterone supplementation: oral, sublingual, subcutaneous and vaginal (used in all processes) during the first 10 days post-FET. Participants/materials, setting, methods HRT-FET cycles were divided in two groups based on P4 levels on the day of FET (Group 1: P4<10 ng/ml , Group 2: P4 > =10 ng/ml) .Machine learning (ML) models were trained using the gradient boosting method to predict clinical pregnancy for each group. The model parameters were identical: 100 decision trees with a learning rate of 0.04, max depth: 4 and number of leaves: 8. Feature importances was ranked using Shapley Additive Explanation (SHAP) values. Main results and the role of chance The ML model trained on data from Group 1 (394 processes) achieved an accuracy of approximately 70% similar to the accuracy of the Group 2 model. Among the predictive features influencing the likelihood of clinical pregnancy, the addition of oral progesterone to vaginal progesterone supplementation ranked as the third most important, following embryo morphology grade and embryo freezing day. SHAP analysis demonstrated that addition of oral progesterone was significantly associated with an increased likelihood of clinical pregnancy, as indicated by positive SHAP values, whereas the absence of oral progesterone was linked to negative SHAP values (p < 0.001). In contrast, the addition of sublingual or subcutaneous progesterone to vaginal supplementation had no significant effect. Vaginal progesterone dosage also played a crucial role—patients receiving >1000 mg/day exhibited a higher probability of achieving a clinical pregnancy. For Group 2 (985 processes) ML model did not show any significant effect of oral, sublingual or subcutaneous progesterone addition. In this group, embryo morphology and embryo freezing day remained the strongest predictors of success, while increasing vaginal progesterone dosage above 1000 mg/day had only a minimal effect on clinical pregnancy outcomes. Limitations, reasons for caution The main limitation of the study is its focus on the first 10 days after FET, crucial for implantation but insufficient to assess miscarriages. Additionally, the dataset was limited only to clinical pregnancy outcomes. Wider implications of the findings For patients with P4 <10 ng/ml on FET day, adding oral progesterone to vaginal supplementation improves CPR, along with increasing the vaginal dose >1000 mg/day. However, in patients with P4 levels > =10 ng/ml on FET day, additional oral, subcutaneous, or sublingual progesterone does not improve CPR. Trial registration number No

Abstract Reproductive behaviour has been changing fast around the world, with fertility rates falling to record-low levels, first births being shifted to ever later ages and more women and men remaining permanently childless. This talk reviews the changing global reproductive landscape, focusing especially on higher-income countries with a long history of low fertility rates. I sum up what is known about the main drivers of changing fertility trends in the past two decades, looking at structural factors including economic uncertainty and housing prices, changing partnerships and intimate behaviours and contraceptive use and unplanned pregnancies. I highlight the shifts in education distribution, characterised by rapidly rising share of young people with a degree and growing educational imbalances between men and women. The education expansion has had different impact on fertility in countries with higher and lower levels of gender inequality. I also look at changing reproductive preferences and views of parenthood. I highlight other relevant factors that have been suggested in many studies – including the impact of “screens” and the supposed “sperm crisis” –where we still lack more broad-based evidence on their impact. Next I focus on the intersection between delayed parenthood, reproductive plans at higher childbearing ages, and possible role of infertility and assisted reproduction as important factors determining the future fertility recovery at higher reproductive ages. We still lack representative data on age-related infertility across countries and over time. In conclusion, I sketch out the future research agenda and argue that we are heading into an era of low or very low fertility, to which most countries need to accommodate.

Abstract Study question Are de novo male gametes derived from embryonic stem cells (ESCs) capable of sustaining full pre-implantation development? Summary answer Using our three-dimensional (3D) culturing environment, we were able generate male germ-like cells capable of consistent fertilization and normal development to the blastocyst stage. What is known already In regenerative medicine, several 3D culture systems have been proposed and are capable of producing functional tissue implants. In reproductive biology, recent studies have reported preliminary success in generating functional de novo gametes through 3D bio-printed scaffold and testicular organoids from mouse embryonic stem cells. However, to achieve successful fertilization and satisfactory embryo development, a heterologous transplantation in a host seminiferous tubule is required to allow proper spermiogenesis to obtain functional gametes. Here we attempt to perform neogametogensis in a novel 3D niche to generate de novo gamete ready to be used for ICSI. Study design, size, duration Mouse ESCs were initially cultured on a gelatin-coated 6-well plate with a monolayer of fibroblasts before being encapsulated in sodium alginate spheres. These spheres were then immersed in a specially formulated medium to promote differentiation into germ-like cells. Over the course of differentiation, cells were assessed for germ cell differentiation biomarkers. Considering that a normal mouse spermatogenesis occurs in 30 days, utilization of the de novo gametes was planned for day-15, 22, 29 and 36. Participants/materials, setting, methods Mouse ESCs spheres were submerged in EpiLC medium containing Activin A, bFGF and KSR for 3 days followed by PGCLC medium containing BMP4, LIF, SCF and EGF for up to 36 days. Customized spheres were fitted in EmbryoSlide to monitor colony growth. Differentiation was assessed for markers DAZL (spermatogonium), VASA (spermatocyte), BOULE (post-meiotic) and acrosin (spermatid). Differentiated cells were then injected into oocytes and activated by calcium ionophore. Embryo development was monitored via time-lapse microscopy. Main results and the role of chance Immunofluorescence analysis revealed consistent expression patterns of spermatogenic markers throughout the differentiation process. VASA, a universal germline marker, showed consistent expression levels (9% on day-3, 16% on day-10, 18% on day-15, 14% on day-22, and 9% on day-29). DAZL, specific to spermatogonia, peaked at 29% on day-10. BOULE, expressed by secondary spermatocytes, reached its highest level of 10% on day-15 but decreased to 4% on day-22. Acrosin, a marker for spermatids, showed no positivity on day-10, but increase to 2% on day-15, 4% on day-22, and peaking at 7% on day-29. To prove embryo developmental competence, neogametes were injected into mature oocytes. Spherified neogametes on D15, 22, 29, and 36 achieved fertilization rates of 34.7%, 61.0%, 82.7%, 72.5%, respectively, and blastulation rates of 4.7%, 18.6%, 36.0%, and 19.5%, respectively. Controls exhibited fertilization rates of 89.1% and blastulation rates of 76.3%. When embryo morphokinetics were taken in consideration, D29 embryos reached compaction at 63h and blastulation at 77h, mirroring closely the control’s timing of 62h and 76h, respectively. Conversely, D36 embryos achieved compaction and blastulation significantly later, at 68h and 88h respectively. D22 embryos displayed the most delayed embryo development, of which compaction occurred at 68h and blastulation at 105h. Limitations, reasons for caution Despite normal fertilization and successful blastulation, the efficiency rate remained below optimal levels. More critically, the capacity to produce viable offspring still remains to be assessed. Wider implications of the findings Replicating the three-dimensional seminiferous tubule environment is crucial for generating artificial gametes. This eliminates the need for allo-/xeno-genic transplantation in experimental animals. Additionally, this system is currently being applied in human stem cell models, yielding similar immunofluorescent expression in human germ cell biomarkers. Trial registration number No

Abstract Study question Could the pre-implantation genetic testing for aneuploidy (PGT-A) results and the relevant embryo transfer outcomes be related to biopsies of Day 5 low-expanded and Day 6 high-expanded blastocysts? Summary answer Embryo transfer demonstrated better outcomes with Day 5 low-expanded blastocysts, although the euploidy rate was slightly lower compared to Day 6 high-expanded blastocysts. What is known already Low-expansion grade blastocysts biopsied on day 5 are one of the factors that affect embryo quality and PGT-A accuracy rates. Conversely, prolonging the culture period to day 6, which includes the potential risk of full hatching, may negatively impact the success of embryo transfer. Regarding genetic abnormalities, patients over 35 years old are recommended to undergo PGT-A. Additionally, a rapid decline in the euploid embryo rate, as detected by PGT-A, is known to occur in individuals over 40 years old. Therefore, this study focused on the patient age group of 36–40 years old for PGT-A evaluation. Study design, size, duration A retrospective clinical study included 662 patients aged 36–40 years who underwent oocyte retrieval between 10/1/2023 and 10/31/2024. Blastocyst morphological grading was assessed on day 5 or day 6 using the Gardner and Schoolcraft system. Among 2,663 high-quality blastocysts selected for PGT-A, low-expanded blastocysts on day 5 (grade 2, n = 161; grade 3, n = 598) were compared to high-expanded blastocysts (grade 5–6) on day 6 (n = 230). Participants/materials, setting, methods The primary data included PGT-A results, focusing on the euploid ratio for each group. Secondary outcomes encompassed embryo transfer results, such as pregnancy rate, implantation rate, and ongoing pregnancy rate. The analysis included all patients who initiated an ovarian stimulation cycle and underwent their first embryo transfer. Results are presented as odds ratios (OR) with 95% confidence intervals (95% CI). Main results and the role of chance This study analyzed 2,663 trophectoderm biopsies from 662 PGT-A cycles in women aged 36–40 years. The rates of euploidy, aneuploidy, and mosaicism per cycle were 42.1%, 43.6%, and 14.3%, respectively. Embryo transfer was conducted in 437 patients (377 with euploid embryos and 60 with mosaic embryos), while 225 patients did not proceed due to a lack of suitable euploid embryos (194) or undetermined transfer timing (31). Day 5 expanded grade 5 blastocysts achieved the best outcomes, with 56.9% euploidy, a 71% pregnancy rate, 67.5% implantation rate, and 62% ongoing pregnancy rate. Conversely, day 6 expanded grade 2 blastocysts had the poorest results, with 23% euploidy, a 42.9% pregnancy rate, and 28.6% implantation and ongoing pregnancy rates. Day 5 grade 2 blastocysts (lowest expansion) had a slightly lower euploidy rate (OR 0.82 [95% CI 0.53–1.26]), while grade 3 blastocysts showed a similar euploidy rate (OR 1.02 [95% CI 0.73–1.4]) compared to day 6 high-expanded blastocysts (grades 5–6). For embryo transfer outcomes, day 5 low-expanded blastocysts (grades 2 and grade 3) achieved higher ongoing pregnancy rates than day 6 high-expanded blastocysts, with odds ratios of 2.33 [95% CI 0.67–8.17] and 2.87 [95% CI 1.14–7.19], respectively. Limitations, reasons for caution This study was limited to data from a single clinic, reflecting the specific protocols (e.g., embryo culture, biopsy) used there. The small sample size and variations in patient profiles and protocols may influence the observed rates. Nevertheless, our findings provide a valuable reference for informing biopsy decisions in PGT-A. Wider implications of the findings Biopsying day 5 blastocysts with low expansion grades may be a better option than prolonging culture to day 6. However, careful handling is essential to prevent cell breakage or unintended collection of cell fragments. Additionally, more than one time points of biopsy assessment at day 5 might be considered. Trial registration number No

Abstract Study question Can the integration of a digital patient management platform and a four-day workweek improve operational efficiency, nursing job satisfaction, and patient experience in ART clinics? Summary answer The combination of digitalised clinic management and a four-day workweek reduced administrative burden, improved job satisfaction and enhanced patient experience without compromising care quality. What is known already Fertility nursing is highly demanding, requiring extensive administrative tasks, cycle monitoring, patient education, and procedural support. Nurses dedicate 9–16 hours per IVF cycle, leading to workload strain, potential burnout, and operational inefficiencies. While digital patient management platforms have been introduced to streamline workflows, their impact on both nursing efficiency and well-being remains underexplored. Additionally, alternative work structures such as a four-day workweek have shown benefits in other healthcare fields but are not widely adopted in fertility. This study evaluates the combined effects of digitalisation and work schedule restructuring to enhance nursing operations, job satisfaction, and patient experience in ART clinics. Study design, size, duration This prospective, mixed-methods study was conducted over eight months at a single UK-based fertility centre. A digital clinic and patient management platform (Wawa) was implemented to automate administrative tasks, reduce manual workload, and improve patient communication. Simultaneously, a four-day workweek with 10-hour shifts was introduced. Nursing efficiency, job satisfaction, and patient experience were assessed through time-tracking analysis, structured interviews, and patient feedback, comparing pre- and post-implementation metrics to evaluate the combined impact of both interventions. Participants/materials, setting, methods Five fertility nurses participated. Key administrative tasks such as appointment scheduling, consent management, and patient communications were compared before and after the implementation of the digital platform. A four-day workweek structure was adopted to assess its effect on work-life balance. Qualitative and quantitative data were collected through structured interviews, real-time workload tracking, and patient-reported experience measures. The study aimed to identify efficiency gains, job satisfaction improvements, and potential impacts on patient care quality. Main results and the role of chance Results showed a 40% reduction in administrative workload (from 6.5h to 3.9h) following the digital platform’s integration, allowing nurses to allocate more time to direct patient care. The most significant improvement was a decrease in emails and phone calls, as patients gained real-time access to their records, medication schedules, and consent forms through the platform. This streamlined workflow improved operational consistency, reducing errors associated with manual data entry and communication breakdowns. The four-day workweek contributed to enhanced job satisfaction, with all participating nurses reporting improved work-life balance and higher engagement at work. The combination of digitalisation and structured time off resulted in lower fatigue, greater focus during patient interactions, and increased professional fulfilment. From a patient perspective, the ability to instantly access blood test results and scan reports via the digital platform significantly improved their experience, with many reporting feeling “well-informed” and “more in control of their treatment journey.” The reduction in interruptions also allowed nurses to provide longer, more meaningful consultations, further strengthening patient-nurse relationships. These findings suggest that combining technological advancements with work structure changes in ART clinics can transform fertility nursing, improving both operational efficiency and job satisfaction while maintaining high standards of patient care. Limitations, reasons for caution This study was conducted at a single fertility clinic with a small sample size. Further research with a larger cohort across multiple centres is needed to validate findings. The long-term impact of these interventions on patient outcomes and nurse retention also requires further investigation. Wider implications of the findings Integrating digital patient management platforms and alternative work structures in ART clinics has the potential to revolutionise fertility nursing. These findings support the adoption of technology-driven, nurse-centric models that enhance efficiency, reduce burnout, and improve patient engagement, paving the way for a more sustainable and effective fertility care system. Trial registration number No