Abortion Rate Research Articles

P-125 Day 5 endometrium, Is the pregnancy rate following day 5 or day 6 vitrified/thawed blastocysts transfer affected?

Abstract Study question Are ongoing pregnancy rates of embryos vitrified on day 5 and day 6 when transferred into a day 5 endometrium comparable? Summary answer Day 5 blastocysts implant better in day 5.5 endometrium than day 6, whether they were vitrified on day 6 or 5 and cultured 24 hours. What is known already Preparation of the endometrium for transfer of cryopreserved embryos is usually done so that transfer takes place on endometrial day 5, although embryos may be at day 5 or 6 of development, so there may be asynchrony between the endometrium and the embryo if a day 6 embryo is transferred. Fresh transfer of day 5 blastocysts has been reported to have better results than day 6 blastocysts, predictably due to this endometrial asynchrony. However, data from frozen blastocyst transfers are less clear, possibly due to heterogeneity of the patient population and/or embryo quality. Study design, size, duration In this study we aim to analyse whether ongoing pregnancy after vitrified/thawed embryo transfers is affected if day 5 or day 6 embryos are transferred into day 5 endometrium. For this purpose, we examined 2266 cryotransfers performed in three Next Fertility clinics in Spain between 2016 and 2022. Day 5 (n = 1583) and 6 (n = 519) blastocyst transfers and day 5 embryos that devitrified one day before transfer (n = 164) were retrospectively compared. Participants/materials, setting, methods In this work blastocyst transfers were performed from donor or autologous oocytes, with or without PGT-A. Embryos were vitrified on day 5 or 6. Endometria were prepared with hormone replacement therapy or in natural cycle. All FET were performed after 5.5 days of progesterone exposure, regardless of embryo stage (day 5 or 6). The results were analysed considering all the above groups. Main results and the role of chance Ongoing pregnancy are superior with day 5 blastocysts versus day 6 and day 5 cultured for 24 hours prior to transfer. However, day 6 blastocysts were similar to cultured ones. Own oocytes: Day 5 44.98% (n = 538) vs Day 6 35.75% (n = 207) (p < 0.03); Day 5 44.98% vs Day 5 cultured 32.58% (n = 89) (p < 0.03); Day 6 35.75% vs Day 5 cultured 32.58% (p > 0.05). Donated Oocytes: Day 5 45.86% (n = 726) vs Day 6 28.51% (n = 221) (p < 0.00001); Day 5 44.98% vs Day 5 cultured 39.34% (n = 61) (p > 0.05); Day 6 28.51% vs Day 5 cultured 39.34% (p > 0.05). PGT-A Own oocytes: Day 5 51.72% (n = 203) vs Day 6 25.39% (n = 63) (p < 0.003); Day 5 51.72% vs Day 5 cultured 40.00% (n = 10) (p > 0.05); Day 6 25.39% vs Day 5 cultured 40.00% (p > 0.05). PGT-A Donated Oocytes: Day 5 42.24% (n = 116) vs Day 6 35.71% (n = 28) (p > 0,05); Day 5 42.24% vs Day 5 cultured 40.00% (n = 4) (p > 0.05); Day 6 35.71% vs Day 5 cultured 50.00% (p > 0.05). Miscarriage rates were similar across all groups. Limitations, reasons for caution Not all cohorts in the study were equally large, so some results have less statistical power, especially in abortion rates. Wider implications of the findings Day 5 blastocysts should always be transferred into a 5.5-day endometrium on the day they are devitrified, as this is when they are most synchronous with the endometrium. Further studies are needed to assess whether day 6 embryos implant better in a 6.5-day endometrium than in a 5.5-day endometrium. Trial registration number not applicable

P-212 βhCG concentration in peripherical maternal blood after single embryo transfer, ongoing pregnancy rates and morphokinetics

Abstract Study question Is there a relationship between the concentration of the βhCG hormone in maternal blood, embryo morphokinetics and clinical outcome? Summary answer βhCG concentration is related to trophoectoderm quality, abortion rate and live birth rate, but not to embryo morphokinetics What is known already Measurement of βhCG has been widely used for early pregnancy detection after assisted reproduction treatments. Shortly after embryo implantation, trophoblastic βhCG is detectable in maternal blood, However, βhCG concentration in several women showed high variability, and embryo implantation also depends on endometrial receptivity, what means that in early stages, everything affecting endometrial receptivity, may affect βhCG concentration. Early high βhCG concentration has been related with higher pregnancy rate, but there are scarce information concerning relationship between βhCG early value and ongoing pregnancy rates Study design, size, duration Retrospective biomedical research of 508 patients having single embryo transfer of fresh embryos at IVIRMA VIGO clinic between 2017 and 2021 to analyse the relation between βhCG concentration, and embryo quality, embryo morphokinetics and ongoing pregnancy rate. Patients with recurrent miscarriage, advanced maternal age, uterine pathologies and severe male factor were excluded of the study. βhCG was measured in the peripherical maternal blood 13 days after embryo transfer Participants/materials, setting, methods All the embryos were generated by ICSI and were cultured in a time-lapse incubator under a 37ºC, 6% CO2 and 5% O2 atmosphere. T-Student and Youden test between embryo kinetics and βhCG values, Pearson correlation test to compare gestational successes with kinetic embryo data, and a linear regression model with βhCG like response variable and morphokinetic data like explanation variables were employed Main results and the role of chance βhCG concentration was greater in trophoectoderm A embryos compared to B and C (ASEBIR classification), 619.53 UI/ml, IC95% (483.16-755.90), 442.24 UI/ml, IC95% (350.18-534.31), 269.95 UI/ml, IC95%(88.88-451.01) (p = 0.038) respectively and there was a trend with Inner cell mass quality, being greater also in quality A vs B and C (p = 0.053) Patients who had a clinic abortion showed lower βhCG concentration compared to those with ongoing pregnancy and live birth, 385.37 UI/ml, IC95% (268.45-502.28) vs 987.53 IU/ml, IC95% (845.03-1130.03). T-student test linear regression analysis and Youden index, with βhCG cut-off points of 10 IU/ml and 100 IU/ml were employed, to analyze relationship between βhCG concentration and embryo morphokinetics, but it was not significant in any of the parameters analyzed Limitations, reasons for caution There is a limited sample size and data were obtained from a retrospective study. Patients and donor oocytes were analyzed in this study, although no differences were found when they compared Wider implications of the findings This study shows that a top quality trophoectoderm produces more βhCG, and that could be a predictive value for ongoing pregnancy Trial registration number 1712-VGO-122-EM

P-536 The comparison of luteal phase support in modified natural cycle-frozen embryo transfer in young patients with high quality embryos -vaginal versus vaginal and subcutaneous progesterone.

Abstract Study question Does adding subcutaneous progesterone to vaginal administration affect pregnancy outcomes in young patients undergoing modified natural-frozen embryo transfer (mNC-FTET) with top-good quality, single blastocyst ? Summary answer Adding subcutaneous progesterone supplementation to vaginal administration after frozen-thawed embryo transfer in modified natural cycles does not improve live birth rates. What is known already Vaginal progesterone supplementation during frozen-thawed embryo transfer in modified natural cycles during luteal phase may increase the rate of live birth rate and decrease the rate of miscarriage. Study design, size, duration 245 participants were included in this retrospective cohort study conducted at a single IVF center between November 2020and January 2022.The primary outcome was the live birth rate; secondary outcomes included pregnancy, clinical pregnancy and biochemical and clinical abortion rates. Participants/materials, setting, methods 245 women aged 20-35 years in mNC-FTET cycles with a single top-good quality blastocyst embryo transfer were included. Patients with fibroids, synechiae, recurrent implantation failure, recurrent pregnancy loss were excluded. After thawing embryos were evaluated for quality, hCG(Ovitrelle-Merck) triggered; 129 patients received 200 mg vaginal progesterone (Lutinus-Merck)(group I), while 116 received 200 mg. vaginal and 25 mg subcutaneous progesterone (Progestan-Dex-Kocak Pharma) (group II). The main outcome was live birth rate(LBR), secondary outcome was miscarriage rate. Main results and the role of chance Baseline demographics and background characteristics were similar in the study groups. The live birth rate in group I is 86 of 106 (66.6%) compared 74 of 116 (63.7%) in group II (odds ratio 1,135, 95% confidence interval [CI]: 0.670-0.922, P = 0.637). There were 106 pregnant patients out of 129 in group I (82.17%) and 93 pregnant patients out of 116 in group II (odds ratio 0.877, 95 CI: 0.462-1,666, P = 0.68). The clinical pregnancy rate is 95 out of 129 patients (73.6%) in group I and 90 out of 116 patients in group II (odds ratio of 0.807, 95% confidence interval [CI]: 0.449-1.45, P = 0.474). The rate of biochemical abortion in group II was 10 of 129 patients (7.75%) and 4 of 116 (3.45%) (odds ratio 2.35, 95 CI: 0.717–7.718, P = 0.687). The clinical abortion rate was 6 of 129 patients (4.6%) and 6 of 116 patients (5.17%) in group II (odds ratio 2.35, 95 CI: 0.717-7.718; P = 0.687). According to primary and secondary outcomes, there were no significant differences between the groups. Limitations, reasons for caution To avoid bias, patients older than 35 years were excluded. Subcutaneous progesterone may be beneficial for older patients undergoing euploid embryo transfer. To reduce confounding factors, the number of patients was limited. Wider implications of the findings For luteal phase support, both vaginal and subcutaneous progesterone supplementation did not increase live birth rates following frozen-thawed embryo transfer in modified natural cycles in young patients. Trial registration number not applicable

P-114 Abdominal obesity in Polycystic ovary syndrome patients can increase endometrial stromal cells decidualization

Abstract Study question Whether abdominal obesity can change the decidualization induction potential in PCOS patients? Summary answer We hypothesized that considering the inflammatory origin of abdominal obesity, it may affect decidualization potential of endometrial stromal cells (ESCs). What is known already Polycystic ovary syndrome (PCOS) as a chronic inflammatory disease is the most common hormonal disorder in women of reproductive age, which is often associated with subfertility or infertility due to ovulation disorders and subsequently low pregnancy rate, live birth rate and a high miscarriage rate. Inflammatory Abdominal obesity (AO) is the most common phenotype in PCOS patients, which has a high association with PCOS pathogenesis. Embryo-endometrium cross-talk has a key role in successful embryo implantation, which contains inflammatory phase (decidualization induction). Followed by inflammatory phase for pregnancy support. Study design, size, duration Our study population were consisting of 53 infertile women including PCOS diagnosed according to Rotterdam criteria (n = 25) and normal oogenesis women (male factor infertility) (n = 28) with in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) and frozen embryo transfer (FET) indication. All patients were aged 25-35 referred to Royan Institute between 1st May until 1st December in 2021 for infertility treatments. Participants/materials, setting, methods The embryos were subdivided into four groups: PCOS with AO, PCOS without AO, nonPCOS with AO, and nonPCOS without AO patients. The embryos from each group were single cultured up to the blastocyst stage. Their embryo condition media (ECM) were pooled and added to the culture media of healthy ESCs monolayer to investigate their effects on decidualization potential via gene and protein expression analysis and ESCs migration assay. Main results and the role of chance Results showed that ECM generally can improved decidualization capacity in ESCs. Morphological analysis, migration assay, protein and gene expressional analysis showed PCOS with AO had the highest decidualization potential and revealed by higher expression of decidualization markers (P ≤ 0.05). NonPCOS individuals without AO had the lowest level of both gene and protein decidualization markers (P ≤ 0.05). Limitations, reasons for caution Due to small sample population and the ECM volume limitation, the present study remained focused on the some main decidualization markers rather than extended study. Wider implications of the findings Inflammation may increase endometrial receptivity, allowing more suboptimal embryos to implant; this could explain the high rate of abortion in these cases. Controlling the inflammation in PCOS patients with AO may correct the decidualization profile of these patients. Trial registration number Not applicable

P-499 Individualization of the mean luteal phase after frozen embryo transfer with hormone replacement therapy

Abstract Study question Objective: To determine in embryo cryotransfer cycles with hormone replacement therapy whether progesterone levels five days after transfer < 15.7 ng/mL correlate with reproductive outcomes. Summary answer Conclusion: We cannot affirm that low levels of progesterone in the mid luteal phase after cryotransfer are an independent factor of evolutionary gestation. What is known already n the transfer of frozen embryos with hormone replacement therapy after a period of endometrial preparation with estrogens for 10-12 days, luteal phase support with vaginal progesterone is administered as many days as the embryo to be transferred, as reported by Van de Vijver et al 2001. After reporting that low progesterone levels on the day of transfer were associated with worse outcomes, our purpose is to evaluate progesterone levels after transfer with the first prospective study monitoring post-transfer progesterone levels to see if its supplementation correlates with better reproductive outcomes. Study design, size, duration Study desing: Analytical, observational, longitudinal, prospective study conducted at the Assisted Reproduction Unit of Hospital Quironsalud Barcelona between December 2021 and May 2022. 159 patients aged 18-42 years who have undergone a cycle of frozen embryo transfer (CT) of their own or donated embryos with hormone replacement therapy. Participants/materials, setting, methods Material and methods: Determine in embryo cryotransfer cycles with hormone replacement therapy with estradiol, luteal phase support of micronized natural progesterone five full days prior to the transfer of a blastocyst.Determination of progesterone levels five days after transfer, if levels > = 15.7ng (group C) we followed the same guideline, if < 15.7 ng one group was supplemented with 25 mg Psc (group A), and another group of patients (group B) was not supplemented. Main results and the role of chance Results: Total of 159 patients with mean age of 37.86 years, mean antimuleriana value 2.95 ng/ml, antral follicle count of 11.54 and mean endometrial thickness of 8.93mm. 55.97%(n = 89) TC had P4D+10 <15.7ng. Pregnancy rate (BHCG>5mIUI/mL) was higher in the group with progesterone 5 days after transfer ( P4D+10) > =15.7ng with 65.71% CI95%[53.31,76.38] p = 0.65, and in the group of P4D+10 < 15.7 ng became pregnant 53.57% CI95%[34. 21,71.99] p = 0.53 of group A with respect to 45.90% IC95%[33.26,59.06] p = 0.45 group B. Clinical evolutionary pregnancy rate was higher in group A 80% vs 67.86% of group B, p-value=0.06. Abortion rate lower in group A 20% vs 32.14% group B, p = 0.01. Limitations, reasons for caution Limitations. There are few previous studies that allow us to support our arguments, the variability of progesterone levels in blood throughout the day can alter the results,nevertheless, and the sample size is small and it is difficult to find significant differences. Wider implications of the findings We did observe that >50% (55.97%) of the patients presented low values of progesterone after the embryo frozen transfer, with an improvement in pregnancy rate 53.57% vs 45.90% when these were rescued with subcutaneous progesterone. About 7% of pregnancies would be lost without this monitoring and supplementation. Trial registration number not applicable

P-341 Endometrial compaction and its impact on reproductive outcome

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 >0%, >5% and >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

O-161 Performance of IDAScore prediction models on clinical, obstetric and neonatal outcomes of single vitrified-thawed blastocyst transfer

Abstract Study question Does a free-annotation embryo scoring system (IDAScore) prediction model effective in clinical assisted embryo selection? Summary answer iDAScore could be used to predict the clinical pregnancy and live birth. What is known already iDAScore model, as a free-annotation and deep learning-based embryo scoring system, was created according to deep learning model by training 115,832 embryos and 14,644 known implantation embryos from 18 reproductive medical center. Then, every blastocyst was scored without any manipulation and intervention by embryologists. Although iDAScore's performance was validated by a few reproductive centers, it has not yet been verified in a sizable cohort study. As a result, the effectiveness of iDAScore should be assessed in more reproductive clinics. Study design, size, duration A total of 6,291 vitrified-thawed single blastocyst transfer (SBT) cycles from 2018 to 2021 at the Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, were analyzed a free-annotation and deep learning-based embryo scoring system (IDAScore) (EmbryoScope Plus, Vitrolife, Sweden). Participants/materials, setting, methods All blastocysts undergoing SBT were scored from 1 to 9.9 with ida system. Blastocyst scores were grouped according to quartile.The effectiveness of ida system was evaluated according to clinical outcomes, perinatal and neonatal outcomes of different groups (1.0-8.0, 8.1-8.9, 9.0-9.3, 9.4-9.9). Main results and the role of chance The iDA scores decreased with increasing maternal age. Clinical pregnancy rate and live birth rate increased with iDAScores, and there was a significant correlation (p < 0.001). The abortion rate decreased slightly with the increase of iDAScores, but there was no significant difference (p > 0.05). Ectopic pregnancy rate did not change significantly with iDAScores. No statistically significant difference were observed between single and twin live birth among different iDAScore groups (p > 0.05). For perinatal and neonatal outcomes, no significant difference was shown in four iDAScore group (p > 0.05). Among them, gestational age and premature birth rate were similar (p > 0.05). Besides, no significant difference was shown in types and rate of pregnancy complication (p > 0.05). For newborn babies, the birth weight and sex were statistically similar across all groups (p > 0.05). The birth defect outcome was also evaluated. No significant difference were shown on different types of birth defect in all groups (p > 0.05). The uni-variate and multi-variate logistic regression for live birth was also analyzed. iDAScore were significantly correlated with a positive live birth probability (OR: 1.200, 95% CI: 1.148-1.253, p < 0.05). Limitations, reasons for caution The experimental samples in this study are all blastocyst transfer cycles. There is no guiding significance for other centers using the cleavage embryo transfer cycle. Wider implications of the findings iDAScore could be used to predict the clinical pregnancy and live birth. For the blastocyst that has obtained live birth, different iDAScore did not cause significant differences in obstetric and neonatal outcomes. Therefore, iDAScore determined blastocyst implantation more than fetal development. Trial registration number not applicable

P-253 Clinical efficacy of PGT-A according to maternal age and embryo quality in blastocyst stage

Abstract Study question To establish the usefulness of PGT-A as an embryo selection tool based on the quality of the blastocyst and the age of the patient. Summary answer The euploidy rate of good quality blastocysts decreases dramatically with increasing maternal age. What is known already One of the fundamental objectives to achieve an optimal gestation rate is the selection of the embryo with the highest implantation potential. For this purpose, morphokinetics and aneuploidy detection are used. Most aneuploidies arise in maternal meiosis, and increase exponentially in women over the age of 35 years, coinciding with the rapid decline in IVF success and live birth rates in patients of advanced maternal age. Study design, size, duration In the present retrospective study, embryo quality of 321 blastocysts was evaluated from June 2020 to January 2023. They were analyzed according to the ASEBIR (2015) classification and using preimplantation genetic testing for aneuploidy (PGT-A) with next-generation sequencing (NGS). Participants/materials, setting, methods A total of 321 blastocysts were analyzed using PGT-A from which 101 were euploid. This 101 blastocysts were classified according to the morphokinetic (A or B (good quality) and C (medium quality)) and the maternal age (<35, 35-36, 37-38, 39-40, 41-42, 43-44 and 45 -46 years). Out of the 101 euploid blastocysts, 78 embryos were classified as A or B (good quality) and 23 as C (medium quality) according to the ASEBIR classification. Main results and the role of chance The euploidy rate of the embryos decreases as the age of the patient increases, being 73% for good quality embryos in patients under 35, 54% in patients between 35-36, 37% in patients between 37- 38, 31% in patients between 39-40, 23% in patients between 41-42, 5% in patients between 43- 44 and 0 % in patients between 45-46 years. For medium quality embryos, the euploidy rate is 58% in patients under 35, 38% in patients between 35-36, 30% in patients between 37-38, 26% in patients between 39-40, 0% in patients between 41-42, 0% in patients between 43-44 and 0% in patients between 45- 46 years. In patients under 35 years, PGT-A will improve pregnancy rates considering that it is an invasive and costly technique. In patients between 35-36 years, PGT-A is a very useful tool when embryos have C quality as well as, in patients between 37- 40, regardless of embryo quality. Furthermore, patients between 41-42 years with good quality embryos, PGT-A will decrease the abortion rates and increase the pregnancy rates. In contrast, patients with C-quality embryos should not start new cycles, as well as patients with over than 43 years due to the low probability of euploidy. Limitations, reasons for caution Studies of larger sample size and study period are required to validate our current findings. Furthermore, more information about fertilization, pregnancy, birth rate and perinatal outcomes could improve the current results. Wider implications of the findings Making the decision whether or not to use PGT-A on the day of blastocyst formation helps to choose the best strategy by individualizing each case according to the maternal age and the quality of the blastocysts. Decreasing cycle times will always be beneficial to patients and their outcomes. Trial registration number Does not apply

P-650 Follicular extracellular vesicles of older women inhibit oocyte maturation

Abstract Study question Whether follicular extracellular vesicles of older women interfere with the quality of oocytes. Summary answer OLD-EVs induced the oxidative stress in the oocytes and inhibited oocyte maturation by increasing the abnormal mitochondria distribution and abnormal spindle rates. What is known already Ovary is a critical regulator of female fertility and the source of oocytes. With the modern tendency of delaying childbearing, ovarian aging has become an age-related disease. Ovarian aging is generally characterized by a gradual decrease in both the quantity and quality of oocytes. The pregnancy outcomes of older women were far from satisfying with higher abortion rates, birth defects rates, and lower live birth rates even after the assistance of IVF. However, the detailed mechanisms of decreased oocyte quality of aging women have not been clarified. Study design, size, duration Extracellular vesicles (EVs) were isolated from follicular fluid of older women (aged 40-50, n = 7, OLD-EVs) and younger women (aged 25-30, n = 6, YOUNG-EVs) via ultracentrifugation. Germinal vesicle (GV) oocytes from female ICR mice were co-cultured with OLD-EVs, YOUNG-EVs, or PBS (blank control), respectively. GV breakdown (GVBD) rate and maturation rate were calculated at two-hour and fourteen-hour of co-culture, respectively. Besides, oocyte mitochondria distribution, meiosis spindle morphology, and oxidative status were assessed in different groups. Participants/materials, setting, methods EVs were determined by western blotting, nanoparticle tracking analysis, and transmission electron microscopy. Fluorescence labeled EVs were used to visualize internalization by oocytes. Oocytes mitochondria and mitosis spindles were stained with fluorescence, and abnormal mitochondria rate or abnormal spindle rate was calculated. Reactive oxygen species (ROS) level was detected in the differently treated oocytes. Moreover, the expression of CAT, GSS, and SOD was determined in the oocytes using quantitative reverse transcription polymerase chain reaction. Main results and the role of chance Both OLD-EVs and YOUNG-EVs are bilayered vesicles, ranging from 100 to 150 nm and enriched in Alix, TSG101, and CD9. EVs could be internalized by oocytes within one hour. After coculture, GVBD rate was similar among the three groups; whereas maturation rate was significantly decreased in the OLD-EV group compared with YOUNG-EV group or PBS group. In addition, the abnormal mitochondria distribution rate or abnormal spindle rate were significantly increased in the OLD-EV group compared with PBS or YOUNG-EV group. The ROS level was increased in the PCOS-EV group compared with YOUNG-EV group, and the expression of CAT, GSS, and SOD was increased in the OLD-EV-treated oocytes. Limitations, reasons for caution Our study did not identify the contents of OLD-EVs and YOUNG-EVs, and the molecular mechanisms of dysregulations induced by OLD-EVs need further researches to investigate. Wider implications of the findings This work confirmed that EV-conducted cellular communication played an important role in oocyte maturation. The dysregulation of oocytes induced by OLD-EVs might be related to the poor oocyte quality of aging women, which provide a novel target to improve pregnancy outcomes of these patients. Trial registration number not applicable

Hydroxychloroquine improves pregnancy outcomes in patients undergoing frozen embryo transfer with positive serum autoantibodies.

Does hydroxychloroquine (HCQ) improve pregnancy outcomes after frozen embryo transfer (FET) cycles in patients who are positive for autoantibodies？ METHOD OF STUDY: This was a retrospective clinical study involving 128 patients who were positive for autoantibodies undergoing FET cycles between October 2017 and December 2022. Subjects were divided into two groups: a study group of 65 cycles with HCQ (HCQ was administered orally over 2 months before transplantation and continued during the first trimester) and a control group consisting of 63 cycles without HCQ (no HCQ was used throughout the FET cycle). Each patient was enrolled in the cohort only once. Then, we analyzed the clinical pregnancy outcomes between the two groups. Analysis showed that HCQ was a factor that independently associated with clinical pregnancy rate (CPR) OR (Odds Ratio): 3.106; 95% confidence interval (CI): 1.458-6.616; p=.003. Furthermore, the implantation rate (IR), CPR and ongoing pregnancy rate (OPR) of the treatment group were significantly higher than those in the control group. The biochemical pregnancy rate (BPR) and early miscarriage rate (EMR) were significantly lower than that in the control group (p=.029, p<.001). We found that HCQ improved clinical pregnancy outcomes and reduced the rate of first-trimester abortion in patients who were positive for autoantibodies during FET cycles.

Fresh embryo transfer in the cleavage and blastocyst stages and pregnancy outcomes: A retrospective cross-sectional study.

Advances in cell culture media have led to a trend of embryo transfer from the early cleavage stages to blastocyst stage. The study aims to compare the effects of fresh embryo transfer in cleavage and blastocyst stage on pregnancy outcomes. This cross-sectional study was conducted on 1422 cases referred to the Umm-al-Banin Infertility Clinic Center, Dezful, Iran, between July 2013 and December 2020 who were candidates for in vitro fertilization/intracytoplasmic sperm injection for fresh embryo transfer. A total of 1246 cases were divided into 4 categories on days 2-5 or 6. Chemical and clinical pregnancy, abortion, multifetal pregnancy, ongoing pregnancy, and live birth rates were analyzed. Fresh embryo transfer was performed in 28.5% of the cases on the 2 day, 45.8% on the 3, 15.3% on the 4 day, and 10.4% on days 5 or 6. The overall clinical pregnancy and live birth rates were estimated at 20.6% and 17.6% in the cleavage, and 17% and 14% in the blastocyst stages, respectively. However, no significant difference was observed in either group. In addition, there was no significant difference between groups in terms of the abortion, multifetal pregnancy, and ongoing pregnancy rate (p 0.05). According to the results, the consequences of pregnancy in fresh embryo transfer at the blastocyst stage were not superior to embryo transfer at different stages of the cleavage process.

Investigating the unaccounted ones: insights on age-dependent reproductive loss in a viviparous fly.

Most empirical and theoretical studies on reproductive senescence focus on observable attributes of offspring produced, such as size or postnatal survival. While harder to study, an important outcome of reproduction for a breeding individual is whether a viable offspring is produced at all. While prenatal mortality can sometimes be directly observed, this can also be indicated through an increase in the interval between offspring production. Both direct reproductive loss and presumed losses have been found to increase in older females across several species. Here, we study such reproductive loss (or "abortion") in tsetse, a viviparous and relatively long-lived fly with high maternal allocation. We consider how age-dependent patterns of abortion depend on the developmental stage of offspring and find that, as per previous laboratory studies, older females have higher rates of abortion at the late-larval stage, while egg-stage abortions are high both for very young and older females. We track the reproductive output of individual females and find little evidence that experiencing an abortion is an adaptive strategy to improve future reproductive outcomes. After an abortion, females do not generally take less time to produce their next offspring, these offspring are not larger, and there is no sex bias towards females, the sex with presumed higher fitness returns (being slightly larger and longer-lived than males, and with high insemination rates). Abortion rates are higher for breeding females experiencing stress, measured as nutritional deprivation, which echoes previous work in tsetse and other viviparous species, i.e., humans and baboons. We discuss our results in the context of studies on reproductive loss across taxa and argue that this is an important yet often overlooked reproductive trait which can vary with maternal age and can also depend on environmental stressors.

Changes in conception rates, not in pregnancy-related behaviour, likely caused decline in preterm births during the first year of the COVID-19 pandemic.

Changes in conception rates, not in pregnancy-related behaviour, likely caused decline in preterm births during the first year of the COVID-19 pandemic.

Early Abortions and Congenital Malformations: A Comparison Between Agricultural and Nonagricultural Areas in the State of São Paulo/Brazil.

Areas with higher agricultural production have higher rates of abortion and malformation, probable related to pesticides. To compare the rates of early abortion and fetal malformation in agricultural and nonagricultural areas. A survey was carried out on fetal deaths in children weighing less than 500 g or gestational age less than 22 weeks and fetal malformations in live births. From 1996 to 2018, there was an increase in the rates of abortion and, albeit to a lesser extent, malformation. The areas of greater agricultural production have higher rates of fetal mortality and malformation than the others. The study suggests that areas with higher use of pesticides have higher rates of abortion and fetal malformations than the others, requiring further observational studies, reducing confounders inherent to the ecological study.

Potential Impacts of Roe v. Wade repeal on Sexual and Reproductive Health in Sub‐Saharan Africa

AbstractThe United States (US) Supreme Court's decision to repeal Roe v. Wade has had significant implications for abortion care in the US, especially for emergency care. This ruling may also have an impact on sub‐Saharan Africa, where restrictive laws and policies limit women's access to safe and legal abortions. Sub‐Saharan Africa is the region with the highest rate of unwanted pregnancies and unsafe abortions, resulting in 15,000 preventable deaths annually. Although every country in sub‐Saharan Africa has at least one legal basis for abortion, they remain limited. In Nigeria, where 29% of pregnancies are unintended, 48% of these led to abortions, amounting to over 1.4 million abortions between 2015 and 2019. Unsafe abortions are prevalent in the region due to socioreligious stigma, particularly for unmarried women. Criminal charges can result from violating these limitations, with prison terms ranging from 3 to 14 years. The reversal of Roe v. Wade could have significant consequences in abortion‐related policies and politics in sub‐Saharan Africa, encouraging nations to adopt restrictive policies and legitimizing them. The landmark decision of Roe v. Wade may also impact the rate of unsafe abortions in the region, much like the US Mexico City Policy. With the high probability of foreign assistance funds for safe abortions depleted, sub‐Saharan African countries must prepare for this financial vacuum in health response. Therefore, the repeal of Roe v. Wade may lead to increased maternal morbidity and mortality in sub‐Saharan Africa, where access to safe and legal abortions is already limited.

Pregnancies in the United States by Desire for Pregnancy: Estimates for 2009, 2011, 2013, and 2015

We examine whether changes in U.S. pregnancy, birth, and abortion rates between 2009 and 2015 reflect underlying change in the incidence of pregnancies classified by retrospectively reported pregnancy desires: pregnancies reported as having occurred at about the right time, later than wanted, too soon, or not wanted at all, and those for which individuals expressed other feelings, including uncertainty, ambivalence, or indifference. We calculate the proportionate distributions of these pregnancies and rates among U.S. women aged 15–44, as well as change over time, overall and among age groups. Characterization of desires for a past pregnancy shifted in a number of ways between 2009 and 2015, and changes across age groups were not uniform. Rates of pregnancies reported as occurring later than wanted increased among older women, while rates of pregnancies reported as occurring too soon decreased among all women. These findings shed light on previous research documenting an increasing age at first birth, increasing rates of pregnancy and childbearing among the oldest age groups, and changes in patterns of contraceptive use, particularly among young women. Our analysis explores limitations and challenges of two major sources of data on pregnancies in the United States and their measures of retrospectively reported pregnancy desires.

Placentitis occurrence, treatments, pregnancy outcome and subsequent fertility on a large warmblood stud farm: a retrospective field study

Little is known about the incidence and outcome of high-risk pregnancies including placentitis. Common placentitis treatments combine antibiotics, non-steroidal anti-inflammatory drugs and progestins. However, clinical studies on spontaneous placentitis cases and treatments are missing. Therefore, the aim of this retrospective field study was to describe the occurrence and severity of placentitis, the abortion rate after placentitis diagnosis (based on udder development, combined-thickness-of-uterus-and-placenta and fetal fluid echogenicity) and treatment during pregnancy (2017-2019) on one warmblood stud farm. Furthermore gestational, placental and foal characteristics were analyzed to determine their association with the severity of placentitis, which was scored (Placentitis score (PSc) 1-3; low to high). Pregnancy day of diagnosis (PDD), placentitis treatment and subsequent fertility were recorded as well as the effects of mare's age and status (own pregnancy (OP) or embryo transfer recipient (ER)). Statistical analyses were conducted to analyze potential associations and significant effects on PSc using a Chi-Square test and a generalized linear mixed model. The proportion of pregnancies affected by placentitis was 4.2% (n=177/4192) occurring in 164 mares (3-24 years; Mean±SD= 11.8±5.10). After clinical diagnosis (PDD 256.7±50.4 days) mares were treated with one of nine different treatments (TM 1-9). Abortion occurred in 17/177 (9.6 %) pregnancies diagnosed with placentitis. The remainingplacentitis pregnancies were further characterized by decreased gestational length (330.1±10.04 days), foal birth weight (54.3±7.09 kg), foal height (103.6±4.28 cm) and placental weight (6.3±1.9 kg). Placentitis severity was scored as PSc1 (51.4%), PSc2 (32.8%) and PSc3 (15.8%). PSc was affected by mare's status (P=0.034) with ER mares having increased PSc compared with mares having their own pregnancy. PSc significantly influenced the choice of TM (χ² (16) = 161.4, P<0.0001) and duration of treatment (PSc1: 19.1a ±23.5 days, PSc2: 51.8b ±33.3 days, PSc3: 65.1b ±43.8 days). Mares with PSc1 were most commonly treated with TM1 (Ceftiofur+Flunixin; 37.4%) and TM8 (TrimSulfa+Flunixin; 33.0%). PSc2 mares predominantly received TM2 (Ceftiofur+Flunixin for 7d, followed by TrimSulfa+Altrenogest; 51.7%) and animals showing PSc3 were treated with TM5 (TrimSulfa+Altrenogest+Clenbuterol+Pentoxifylline) and TM3 (Ceftiofur+Flunixin for 7 d, followed by TrimSulfa+Altrenogest+Clenbuterol+Pentoxifylline) (both 28.6%). Overall, at the end of the next season, 61.1% of placentitis mares were pregnant, 32.0% barren, and 6.9% open (n=175). Pregnancy was established in 62/91(68.1%) of mares with PSc1, 31/58(53.4%) with PSc2 and 14/26(53.8%) with PSc3. Most pregnancies were achieved in the first 81/107(75.7%) or second 18/107(16.8%) inseminated cycle. In conclusion, early detection and treatment of placentitis can save high-risk pregnancies in > 90% of cases and mares show a satisfying subsequent fertility.

The Effectiveness of using Letrozole prior Tomisoprostol Versus Misoprostol alone for Successful Induction of missed Abortion: A Randomized Controlled Trial

Objective: To evaluate the efficacy of medical abortion induction when Letrozole and misoprostol are combined vs when misoprostol is used alone. Methods: It was intended for 150 women to participate in a randomized controlled experiment. They were split into two groups at random, each with 75 people. While the control group (misoprostol alone group) only got misoprostol, the case group (letrozole group) received pretreatment letrozole 12.5mg for two days. According to American College of Obstetrics and Gynecology (ACOG) recommendations based on gestational Age, misoprostol was administered to both groups in the following dosages: 800mg sublingually in a single dose during the first trimester and 400mg sublingually every 3 hours for up to 5 doses during the second trimester. Results: 137 women in all, 69 of whom received Letrozole and 68 of whom received misoprostol alone. Complete abortions were recorded in 96 instances (70.07%), 51 of which were associated with Letrozole (73.9%) and 45(66.2%) with misoprostol alone (P=0.32). However, the case and control groups had corresponding mean expulsion start times of 7.51.8 hours and 8.31.5 hours. This suggests that the case group had an ejection that began much sooner (P=0.003). Conclusion: The current study found that a combination of misoprostol with Letrozole did not lead to a significantly higher rate of complete abortion if compared with misoprostol alone among women with missed abortion up to 20 weeks gestation. It only significantly shortened the interval to the initiation of expulsion.

MOROCCAN WOMENS EMPOWERMENT THROUGH THE USE OFAN MHEALTH SOLUTION FOR FERTILITY MANAGEMENT AND CONTRACEPTION:

In developing countries, limited access to family planning services, results in high rates of unintendedpregnancies and unsafe abortions leading to many avoidable maternal deaths.Unmet need for family planning «UMN»is one of the United NationsMillennium Development Goals Indicators? it evaluates women who are fecund and sexually active but are not using any methods of contraception, while reporting not desiring any more children or wanting to delay the next child. According to the Moroccan national survey for family planning published in 2018,the unmet need for family planningwas 29.2% which is high.The advent of new technological solutions created for family planning has the potential to address unmet needs in low- and middle-income countries.In Morocco, research studies are scarce in the field of Family planning and sexual health.To improve the access to family planning methods and to lower the perceived barriers to contraception use in Morocco, our team in Maternity les Orangers collaborated with the software research team of the national school for computer science ENSIAS in a research project to create a new mHealth solution tailored to Moroccan women, to help empower them to achieve their reproductive goals and contraceptive needs.

The impact of cryopreserved sperm on intrauterine insemination outcomes: is frozen as good as fresh?

Frozen sperm utilization might negatively impact cycle outcomes in animals, implicating cryopreservation-induced sperm damage. However, in vitro fertilization and intrauterine insemination (IUI) in human studies are inconclusive. This study is a retrospective review of 5,335 IUI [± ovarian stimulation (OS)] cycles from a large academic fertility center. Cycles were stratified based on the utilization of frozen (FROZEN, n = 1,871) instead of fresh ejaculated sperm (FRESH, n = 3,464). Main outcomes included human chorionic gonadotropin (HCG) positivity, clinical pregnancy (CP), and spontaneous abortion (SAB) rates. Secondary outcome was live birth (LB) rate. Odds ratios (OR) for all outcomes were calculated utilizing logistic regression and adjusted (adjOR) for maternal age, day-3 FSH, and OS regimen. Stratified analysis was performed based on OS subtype [gonadotropins; oral medications (OM): clomiphene citrate and letrozole; and unstimulated/natural]. Time to pregnancy and cumulative pregnancy rates were also calculated. Further subanalyses were performed limited to either the first cycle only or to the partner's sperm only, after excluding female factor infertility, and after stratification by female age (<30, 30-35, and >35 years old). Overall, HCG positivity and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p < 0.001, respectively), which persisted only among OM cycles after stratification (9.9% vs. 14.2% HCG positivity, p = 0.030; 8.1% vs. 11.8% CP, p = 0.041). Among all cycles, adjOR (95% CI) for HCG positivity and CP were 0.75 (0.56-1.02) and 0.77 (0.57-1.03), respectively, ref: FRESH. In OM cycles, adjOR (95% CI) for HCG positivity [0.55 (0.30-0.99)] and CP [0.49 (0.25-0.95), ref.: FRESH] favored the FRESH group but showed no differences among gonadotropin and natural cycles. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN group among gonadotropin cycles [adjOR (95% CI): 0.13 (0.02-0.98), ref.: FRESH]. There were no differences in CP and SAB in the performed subanalyses (limited to first cycles or partner's sperm only, after excluding female factors, or after stratification according to female age). Nevertheless, time to conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p < 0.001). No significant differences were present in LB and cumulative pregnancy results, other than in the subgroup of natural cycles, where higher LB odds [adjOR (95% CI): 1.08 (1.05-1.12)] and higher cumulative pregnancy rate (34% vs. 15%, p = 0.002) were noted in the FROZEN compared to the FRESH group. Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.