ART Outcomes Research Articles

P-445 High serum estradiol on the day of frozen blastocyst transfer is associated with higher early miscarriage rates in hormonal replacement therapy cycles using transdermal estrogens

Abstract Study question Do serum estradiol(E2) levels on the day of frozen blastocyst transfer(FBT) affect the live birth rate (LBR) in hormonal replacement therapy(HRT) cycles using transdermal estrogens? Summary answer E2 levels ≥ 313 pg/mL on the day of FBT are associated with increased early miscarriage rates, but no significant impact on LBR. What is known already E2 plays a crucial role in endometrial receptivity during the periconceptional period and a massive role in placentation. However, the impact of serum E2 levels measured around the time of a FBT in HRT cycles outcomes remains controversial, with some studies showing a detrimental impact of high levels, and others underlining no difference. To this date, there is no study focusing on HRT cycles with transdermal estrogens only, though it is the safest way of estrogen administration regarding thrombo-embolic complications. Study design, size, duration Observational cohort study with 2364 patients undergoing HRT-FBT cycles at a university hospital, between January 2019 and December 2022. Women were only included once during the study period. Participants/materials, setting, methods Patients undergoing single autologous FBT under HRT using transdermal estrogens and vaginal micronized progesterone. The serum E2 level was measured in the morning of the FBT, in a single laboratory. The primary outcome was the LBR, secondary outcomes included clinical pregnancy rates, early miscarriage rates(EMR), and obstetrical outcomes. Patients were divided into three groups based on the 25th and the 75th percentiles of E2 levels and compared using univariate and multivariate logistic regression models. Main results and the role of chance A total of 2364 patients were divided into 3 groups: group A < 122 pg/mL (n = 590), group B 122-312 pg/mL (n = 1184), and group C ≥ 313 pg/mL (n = 590). Mean serum E2 level on the day of FBT was 247.8 pg/mL ± 209.01 pg/ml. The LBR was 32.0% (756/2364), and the early miscarriage rate was 26.3% (280/1075) in the overall population. Multivariate logistic regression showed a negative impact of high E2 levels (≥ 313 pg/mL) on EMR: an increase in the EMR was noted between group C and referent group B (30.3% versus 24.6%, OR 1.5 95%CI (1.06-2.17)). However, no significant impact of E2 levels was noted regarding the LBR (group C vs group B, adjusted OR 0.9 95%CI (0.69-1.10)), the clinical pregnancy rates, or the obstetrical outcomes (birthweight and term of delivery Limitations, reasons for caution The main limitation of our study is linked to its observational design. Extrapolation of our results to other laboratories, or other routes and/or doses of administering estrogens also needs to be validated. Wider implications of the findings Limiting high serum E2 levels on the day of FBT in HRT cycles may improve ART outcomes. Further studies are needed to evaluate if modifications of estrogen doses may improve pregnancy chances, in an approach to individualize the management of ART patients. Trial registration number not applicable

O-056 Can we tailor ART to endometriosis patients?

Abstract ART remains an effective treatment for endometriosis-associated infertility, although there is evidence that pregnancy rates are diminished in women with endometriosis compared with other etiologies of infertility. In this lecture, the literature relating to endometriosis-associated infertility will be evaluated and recommendations will be made on the management of patients both pre-ART and during ART in order to improve ART outcomes in women with endometriosis. Surgery as an adjuvant to ART appears to have a favorable effect in patients with minimal to mild endometriosis prior to IVF. However, this evidence is based on only one study and more research is needed. As deep endometriosis (DE) is usually accompanied by advanced intra-abdominal disease resulting in distortion of the pelvic anatomy and tubal dysfunction, it is not surprising that IVF is considered as first line treatment. Observational data are available on the outcomes of DE surgery regarding conception rates in infertile patients with endometriosis suggesting that surgery may increase natural pregnancy rates as well as improve IVF outcomes. However, randomized trials comparing IVF to DE surgery are non-existent, as DE surgery is still mainly performed for pain and reduced quality of life rather than for treating infertility. In order to improve IVF success rates in endometriosis, various pre-ART treatments have been suggested. The oldest one relates to the use of gonadotropin releasing hormone (GnRH) agonist prior to IVF. Currently there is uncertainty as to whether long-term GnRH agonist therapy is beneficial when compared to standard IVF/ICSI in endometriosis. In addition, there is no evidence to support the use of oral GnRH antagonists and oral contraceptives as pre-treatment prior to ART, but results of ongoing studies will determine further. More recent studies support defects in endometrial receptivity as a cause of IVF failure. In recent years a new marker for endometrial receptivity in endometriosis emerged: BCL6, a biomarker for endometrial inflammation as it stimulates endometrial cytokine expression. Prospective cohort data provide a proof of concept that high BCL6 expression is associated with adverse IVF outcomes in women with endometriosis and that patients with high BCL6 expression may benefit from medical and surgical treatment prior to IVF. In order to improve IVF success rates in endometriosis, various pre-ART treatments have been suggested. The oldest one relates to the use of gonadotropin releasing hormone (GnRH) agonist prior to IVF. Contrary to previous findings, there is currently uncertainty as to whether long-term GnRH agonist therapy is beneficial when compared to standard IVF in endometriosis. In addition, there is also no evidence to support the use of oral GnRH antagonists and oral contraceptives as pre-treatment prior to ART in endometriosis, but results of ongoing studies will determine further. It has been hypothesized that applying local endometrial injury might induce a beneficial effect on endometrial receptivity prior to ART. However, scratching the endometrium as well as infusing fluids (Lipiodol and ExEm gel) into the uterine cavity (uterine bathing) in endometriosis patients prior to ART did not improve IVF success. During ART, a specific protocol for ART in women with endometriosis cannot be recommended. Both GnRH agonist and antagonist protocols can be used. For ovarian stimulation, a higher dose of gonadotropins may be required in stage III-IV endometriosis due to a poorer ovarian response. There is insufficient evidence for the routine use of prophylactic antibiotics at the time of oocyte retrieval in patients with endometriosis, but their use is recommended in patients with endometrioma. Considering fertilization, there appears no added benefit in using ICSI over IVF in endometriosis unless male-factor infertility is present. Finally, there is insufficient evidence to recommend any particular luteal support in women with endometriosis undergoing ART.

O-287 Body composition analysis and metabolic monitoring before fertility treatment: hype or hope?

Abstract The effect of body mass index on both spontaneous and assisted fertility is well known: both lower and high indexes are correlated with negative outcome including live birth rate. Asides the dysmetabolic infertility that can develop by inflammation, insulin resistance and hyperandrogenemia, psychological and social factors deserve attention: a sexual self-image dysfunction is present in up to 20% of obese people with lower sexual desire and arousal. A positive note is that ART patients want to know about the impact of diet on fertility and ART success, asides the safety of the treatment and coping strategies, when asked about research priorities. Nevertheless, research in the field of preconception weight loss in the case of obesity in non-conclusive. The difference may lay in the strategy followed: lifestyle interventions may differ in approach, new weight-losing drugs might be involved or avoided, and targets and endpoints differ between studies. A first statement is to be made: body weight is a parameter of the past. In the world of nutrition, BMI is used to describe populations but fails to give accurate information about a single person. Body composition is more refined and can be used in follow-up. Asides dual energy X-ray absorptiometry (DXA), Bio Electrical Impedance Vector Analysis (BIVA) is used to endotype patients. Magnetic Resonance Imaging can, in a whole-body approach, provides very detailed information. In general, fat mass, fat free mass, phase angle (quantitative information) and fat infiltration of muscle (qualitative aspect) are considered ‘the kg of the future’. Associations between higher amounts of fat and poorer ART outcomes are published. As body composition is the result of food intake balanced to total energy expenditure (composed from basal energy expenditure, diet induced thermogenesis and physical activity level), the knowledge of these aspects can form a basis for a personalized approach. Techniques used in clinical practice relevant to this topic are food diary analysis by specialized dietitians (quantitative and qualitative analysis of food intake) and indirect calorimetry. This device will measure oxygen consumption and carbon dioxide production and calculate the basal metabolic rate in kcal/day. The concept of nutrition intake balanced to energy expenditure is validated in critically ill patients where it reduces mortality. It also showed benefit in a cancer population during active treatment. In a tertiary, university hospital in Brussels, Belgium, the forces of the fertility clinic and the nutrition department were combined: FerMet (Fertility-Metabolism). Patients seeking ART with a BMI <18;5 or higher than 30 are directed. Biophysical endotyping is performed by both metabolic screening, food intake analysis and baseline testing: body composition by BIVA and metabolic measurement by indirect calorimetry. A personalized intervention plan is developed in co-operation with the patient(s) by the dietitian and the supervising MD. Psychological reference or physical activity coaching is initiated if needed. Interim results: a total of 3793 men and woman in 3,5 years. In the population with a BMI below 20, which is only 6.4% of the entire group, body composition analysis reveals: only 9% are confirmed with alarmingly low body fat mass, such as seen in eating disorders. 23% has a fat mass percentage comparable to the general population and 66% represents what is known as ‘constitutional lean’. This might open opportunities to refine criteria to withhold ART based on body weight. In the overweight population, interventions can be tailored on individual metabolic rates and eating patterns, which is unique in the setting of ART. Whole Body MRi can be used in research settings. Benefits of this Biophysical Endotype based interventions to increase fertility outcomes need to be proven by further research.

P-176 A novel electrophoretic sperm isolation system achieves equivalent ICSI outcomes to the combined density gradient centrifugation and swim-up method in a significantly shorter processing time

Abstract Study question Does an electrophoretically sperm isolation method, the Felix™ system, have clinical or operational advantages over the combined density gradient centrifugation and swim-up (DGCS) method? Summary answer The Felix™ system produces results that are comparable to the DGCS method, however, Felix™ has the ability to isolate spermatozoa more efficiently. What is known already The isolation of healthy spermatozoa to improve ART outcomes has received enormous attention in the literature recently. Although swim-up and density gradient centrifugation are the most common sperm separation methods, the optimal technique is still unclear. Recently, good sperm selection approaches using various non-centrifugal devices have emerged. Previous reports have shown that a quick and simple sperm separation device, the Felix™ system, can isolate high-quality spermatozoa and improve the results of ART. The Felix™ system combines electrophoresis and separation membranes to collect negatively charged mature normal sperm. Study design, size, duration A prospective oocyte sibling study was conducted between March 2023 and December 2023. The study involved infertile couples (n = 45) with a semen volume of 2.3 mL or more, a motile sperm concentration of 2 million/mL or more, maternal age under 43 years, and at least four mature oocytes at the time of oocyte retrieval. Ejaculated semen was prepared separately using DGCS and Felix™ on the day of oocyte retrieval and subsequent ICSI results were analyzed. Participants/materials, setting, methods In the DGCS group, semen was layered on a 45/90% of sperm grad and centrifuged for 15 minutes, followed by a 30 min swim-up. Subsequently, 0.3 mL of supernatant was collected. In the Felix™ group, 0.3 mL of sperm was collected following six minutes of membrane hydration and electrophoresis. Sperm concentration, total motility, progressive motility and DNA fragmentation (SDFR) were measured. Fertilization, blastocyst development, good-quality blastocyst development, and embryo utilisation rates were also assessed. Main results and the role of chance The average female age at the time of oocyte retrieval was 36.5±4.0 years, and the average male age was 38.1±5.9 years. Of 401 oocytes, 200 and 201 oocytes underwent ICSI using sperm prepared by DGCS and Felix™, respectively. The average processing time of Felix™ was significantly shorter than that of DGCS (54.0±4.3 vs. 7.4±0.2 minutes, p < 0.001, respectively). No significant difference was observed between the DGCS and Felix™ groups for sperm concentration (p = 0.49), motility (p = 0.05), progressive motility (p = 0.34), and SDFR (p = 0.09). Furthermore, there were no significant differences between the two groups with regards to fertilization rate (81.0% vs. 80.6%, p = 0.92), blastocyst development rate (52.9% vs. 58.4%, p = 0.60), good-quality blastocyst development rate (26.1% vs. 35.7%, p = 0.06), and embryo utilisation rate (54.3% vs 58.0%, p = 0.50). Limitations, reasons for caution Although the DGCS method was used as a comparison group, it is necessary to compare the Felix™ system with DGC alone, swim-up alone, or other sperm isolation methods. Larger, more powered studies are required to determine the impact on pregnancy and live birth outcomes. Wider implications of the findings The Felix™ system is a viable option for sperm isolation. While DGCS requires complicated procedures and time-consuming process including centrifugation and incubation; Felix™ requires six minutes only. The Felix™ system reduces processing times significantly and therefore can improve laboratory operations and workflow. Trial registration number Not Applicable

Mixed effects of ambient air pollutants on oocyte-related outcomes: A novel insight from women undergoing assisted reproductive technology

Air pollution is widely acknowledged as a significant risk factor for human health, especially reproductive health. Nevertheless, many studies have disregarded the potentially mixed effects of air pollutants on reproductive outcomes. We performed a retrospective cohort study involving 8048 women with 9445 cycles undergoing In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) in China, from 2017 to 2021. A land-use random forest model was applied to estimate daily residential exposure to air pollutants, including sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and fine particulate matter (PM2.5). Individual and joint associations between air pollutants and oocyte-related outcomes of ART were evaluated. In 90 days prior to oocyte pick-up to oocyte pick-up (period A), NO2, O3 and CO was negatively associated with total oocyte yield. In the 90 days prior to oocyte pick-up to start of gonadotropin medication (Gn start, period B), there was a negative dose-dependent association of exposure to five air pollutants with total oocyte yield and mature oocyte yield. In Qgcomp analysis, increasing the multiple air pollutants mixtures by one quartile was related to reducing the number of oocyte pick-ups by −2.00 % (95 %CI: −2.78 %, −1.22 %) in period A, −2.62 % (95 %CI: −3.40 %, −1.84 %) in period B, and −0.98 % (95 %CI: −1.75 %, −0.21 %) in period C. During period B, a 1-unit increase in the WQS index of multiple air pollutants exposure was associated with fewer number of total oocyte (−1.27 %, 95 %CI: −2.16 %, −0.36 %) and mature oocyte (−1.42 %, 95 %CI: −2.41 %, −0.43 %). O3 and NO2 were major contributors with adverse effects on the mixed associations. Additionally, period B appears to be the susceptible window. Our study implies that exposure to air pollution adversely affects oocyte-related outcomes, which raises concerns about the potential adverse impact of air pollution on women’s reproductive health.

Oocyte collection and outcome following oncologic treatment: a retrospective multicentre study

PurposeThis study assesses fertility treatment outcomes in female patients who had undergone successful oocyte retrieval following cancer therapy.MethodsBetween January 2020 and December 2022, we collected fertility treatment data from six participating centres in Spain and Germany. All patients associated with this data had undergone successful oocyte retrieval following cancer treatment.ResultsWomen had most frequently been diagnosed with a haematological (41.9%), breast (22.6%) or gynaecological malignancy (12.9%); two thirds (67.7%) had previously received a chemotherapy, half a radiotherapy (53.3%) and 45.2% had undergone surgery. On average, 7 years (range 0–28) had passed between cancer treatment and first ovarian stimulation cycle. Forty-nine ovarian stimulation cycles had been conducted on these 31 women between 2004 and 2021 (mean age at first oocyte collection following treatment: 34.8 ± 5.7 years). On average, 7 oocytes were collected per cycle (range 0–26) and 11 were collected per patient (range 0–51). Out of the 190 oocytes collected for immediate use of artificial reproductive technique, 139 were fertilised at a rate of 73%. Live birth rate per fresh transfer was 45% (9/20); no births were reported following cryotransfer (0/10). Mean values of anti-Mullerian hormone (AMH) before stimulation declined with time since treatment; however, oocytes were successfully collected from four women with an AMH of <0.5 ng/ml, although no pregnancies were reported. Ten pregnancies were documented; 3 ended in miscarriage. Two twin and 5 single pregnancies resulted in nine live births. On average, children were carried to term.ConclusionIn this small cohort, oocytes were successfully collected after chemotherapy and radiotherapy, despite—in individual cases—low AMH values. Further studies are needed to enrich the database and ultimately provide appropriate counselling to female cancer patients regarding expectations and ART outcome following cancer therapy.

The Factors of Religious Architecture Influencing Students' Perception of Beauty and Art: Evidence from Hanoi, Vietnam

This study explores the impact of religious architecture on the aesthetic perceptions of elementary school students in Hanoi, Vietnam, focusing on students majoring in fine arts. Employing regression analysis, the research assesses the influence of six key dimensions: architectural design and details, cultural and historical context, spiritual symbolism, emotional impact, context and setting, and students' perceptions of beauty and art. Data were collected through a structured questionnaire developed from a thorough literature review and expert consultations and administered to a randomly selected sample during Vietnam's Lunar New Year in January 2024. The results revealed that each dimension significantly contributes to students' perceptions of beauty, with context and setting having the most pronounced effect. The reliability of the questionnaire was confirmed via Cronbach's alpha, indicating high internal consistency across all scales. The regression analysis validated the theoretical framework, establishing that religious buildings' architectural and contextual elements significantly shape students' aesthetic judgments. These findings underscore the importance of integrating architectural aesthetics into educational curricula, highlighting how environmental and cultural contexts influence educational outcomes in art and aesthetics. This research contributes to filling a significant gap in understanding the academic impact of cultural heritage, offering significant implications for educational practices and policies in culturally diverse settings.

THE INFLUENCE OF THE MNEMONIC LEARNING MODEL ON THE LEARNING OUTCOMES OF ARTS, CULTURE, AND CRAFTS (SBDP) IN CLASS IV SDN PANNARA, MAKASSAR CITY

ABSTRACTThis study aims to determine whether the mnemonic learning model influences the learning outcomes of arts and crafts (SBdP) for fourth grade students at SDN Pannara, Makassar City. The research method employed was quantitative experimental research with a one-group pretest-posttest design, and the subjects were fourth-grade elementary school students with collage-related two-dimensional expression work material. This study employs research test instruments, observation sheets, and documentation. In this study, descriptive statistical analysis and inferential statistical analysis were used to analyze the data. Fourth-grade students of SDN Pannara Makassar City whose learning outcomes were enhanced by the application of the mnemonic learning model, as demonstrated by the study's findings. This is demonstrated by testing the hypothesis with the t-test and the test results, namely a significance of 0.000 0,000 &lt; α 0,05 which means that H1 is accepted and H0 is rejected. Where H1 asserts that SBdP learning outcomes for fourth-grade students at SDN Pannara have improved because of the use of the mnemonic learning model. While H0 claimed there was no improvement in SBdP learning outcomes for fourth-grade students at SDN Pannara because of the use of the mnemonic learning model, this study found otherwise. The average student score, which ranges from 30.67 on the pre-test to 90.95 on the post-test, further demonstrates this point. The use of the mnemonic learning model improved the learning outcomes of fourth grade students of SDN Pannara in Makassar City. Therefore, it is recommended that teachers, especially of SBdP subjects, consider using the mnemonic learning model in SBdP learning to make the teaching and learning process more effective, enjoyable, and engaging.

Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes.

Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes.

Prevalence of FSH-R Asn680Ser and Ala307Thr receptor polymorphism and their correlation with ART outcomes among infertile Indian-Asian women-a prospective cohort study.

The present prospective cohort study evaluated the prevalence of FSH-R receptor Asn680Ser and Ala307Thr among infertile Indian women and the correlation of these polymorphisms with ART outcomes. Total 804 infertile and 209 fertile controls were enrolled for FSH-R analysis. Correlation of different genotypes with ovarian reserve markers, IVF parameters, and cumulative live birth rates (CLBR) was done among women undergoing IVF. In fertile controls, at 680 position GG (Ser/Ser) was the most common genotype; but among infertile women, all the genotypes were equally distributed. There was no significant difference in ovarian response parameters, oocyte yield, and CLBR among the three genotype groups. Empty follicle syndrome (EFS) was highest in women with AA or AG type at both positions. On categorisation of unexpected poor responders according to POSEIDON stratification; GG genotype at both positions had the lowest risk ratio of low-oocyte yield in ART cycles, but these differences were not statistically significant. This is the largest study from Indian ethnicity showing GG (Ser/Ser) genotype is most common among fertile women. The effect of FSH-R genotypes is very marginal on IVF parameters and is not reflected in CLBR. More prospective data may be required on the correlation of these genotypes with genuine EFS, thus stratifying the next cycles with self or donor oocytes. Routine genetic testing of FSH-R polymorphism should not be done except in a research setting. As both 680 and 307 positions are in linkage disequilibrium, only 680 position analysis may be done in a research setting.

Sperm Chromatin Dispersion Test Detects Sperm DNA Fragmentation Mainly Associated with Unviable Spermatozoa and Underestimates the Values with Respect to TUNEL Assay.

Several clinical laboratories assess sperm DNA fragmentation (sDF) in addition to semen analysis in male infertility diagnosis. Among tests evaluating sDF, TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) and SCD (Sperm Chromatin Dispersion) are widely used. Our lab developed a modified version of TUNEL (TUNEL/PI) able to distinguish two sperm populations (PI Brighter and PI Dimmer) differently associated with sperm viability and reproductive outcomes. The aim of this study was to compare sDF levels detected by SCD and TUNEL/PI in the semen samples from 71 male subjects attending our Andrology Laboratory. Our results demonstrate that SCD is less sensitive in determining sDF compared to TUNEL/PI. The statistically significant positive correlation found between sDF evaluated by SCD and PI Dimmer (consisting of all dead spermatozoa) suggests that SCD mainly detects sDF in unviable spermatozoa. We confirmed that most spermatozoa detected by SCD are unviable by performing SCD after incubation in hypo-osmotic medium to discriminate viable and unviable cells in 52 samples. Such results might explain the lower ability of this test in discriminating couples having successful ART outcomes demonstrated in published metanalyses. Overall, our results indicate that SCD is less sensitive in evaluating sDF for diagnostic purposes.

Integrated lipid metabolomics and proteomics analysis reveal the pathogenesis of polycystic ovary syndrome

BackgroundPolycystic ovary syndrome (PCOS) is an endocrinological and metabolic disorder that can lead to female infertility. Lipid metabolomics and proteomics are the new disciplines in systems biology aimed to discover metabolic pathway changes in diseases and diagnosis of biomarkers. This study aims to reveal the features of PCOS to explore its pathogenesis at the protein and metabolic level.MethodsWe collected follicular fluid samples and granulosa cells of women with PCOS and normal women who underwent in vitro fertilization(IVF) and embryo transfer were recruited. The samples were for the lipidomic study and the proteomic study based on the latest metabolomics and proteomics research platform.ResultsLipid metabolomic analysis revealed abnormal metabolism of glycerides, glycerophospholipids, and sphingomyelin in the FF of PCOS. Differential lipids were strongly linked with the rate of high-quality embryos. In total, 144 differentially expressed proteins were screened in ovarian granulosa cells in women with PCOS compared to controls. Go functional enrichment analysis showed that differential proteins were associated with blood coagulation and lead to follicular development disorders.ConclusionThe results showed that the differential lipid metabolites and proteins in PCOS were closely related to follicle quality,which can be potential biomarkers for oocyte maturation and ART outcomes.

Correlation of Glycolysis-immune-related Genes in the Follicular Microenvironment of Endometriosis Patients with ART Outcomes.

Endometriosis (EMT) -related infertility has been a challenge for clinical research. Many studies have confirmed that abnormal alterations in the immune microenvironment and glycolysis are instrumental in causing EMT-related infertility. Recently, our research team identified several key glycolysis-immune-related genes in the endometrial cells of EMT patients. This study aimed to further investigate the expression patterns of pyruvate dehydrogenase kinase 3 (PDK3), glypican-3 (GPC3), and alcohol dehydrogenase 6 (ADH6), which are related to glycolysis and immunity, in the follicular microenvironment of infertile patients with EMT using enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qRT-PCR) assays. According to the results, compared to the patients with tubal factor infertility, the concentrations of PDK3 and GPC3 were considerably increased in the follicular environment of EMT patients, while ADH6 expression was significantly reduced. The number of oocytes retrieved, the transferable embryo rate, and the cumulative clinical pregnancy rate of EMT patients were significantly reduced, and there was a correlation with the level of PDK3, GPC3, and ADH6 in Follicular Fluid (FF). The area under the receiver operating characteristic (ROC) curve for predicting clinical pregnancy in infertile patients with EMT for PDK3, GPC3, ADH6, and their combination was 0.732, 0.705, 0.855, and 0.879, respectively (P < 0.05). In conclusion, our research indicates that glycolysis-immune-related genes may contribute to infertility in EMT patients through immune infiltration, and disruption of mitochondrial and oocyte functions. The combined detection of PDK3, GPC3, and ADH6 in FF helps to predict clinical pregnancy outcomes in infertile patients with EMT.

IJCM_425A: Outcomes of Second Line Anti-Retroviral Therapy Among a cohort of people living with HIV/AIDS attending an ART Centre in Mangalore

Background: Anti-Retroviral therapy for HIV/AIDS has been effective, but the mortality rate remains to be high, resulting in the use of second line of ART treatment for better results. Objectives: 1) To estimate the number of deaths among PLHIV between the years 2011 and 2017. 2) To assess the clinical immunological and virological outcomes among these patients. 3) To find out the association of outcomes with the socio demographic characteristics. Methods: In this record-based study, medical records of PLHIV seeking treatment from an ART center associated with KMC, Attavar. between the years 2011 and 2017 were reviewed. The data was extracted using a data extraction sheet consisting of sections on demographic, clinical and treatment details of the patient. Results: The baseline median CD4 count before starting ARTs was found to be 253 (IQR 150-351). After starting second line ARTs it was found to be 461 (IQR 326-651). The correlation of CD4 count after initiation of second line ART with viral load among 34 patients measured was found to be -0.371 (P&lt;0.05). Conclusion: The study concludes that the outcomes of second line ARTs in the present study were found to be satisfactory. The average CD4 count after the initiation of ARTs was significantly high as compared to the CD4 count before the ARTs, implying that second line ARTs had a good, long-term and positive immunological outcome on PLHIV and attending a second-line ART clinic.

Assessing the influence of preconception diet on female fertility: a systematic scoping review of observational studies

Preconception diet is a proposed modifiable risk factor for infertility(1). However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility. A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evidence gaps, and to provide information for nutritional recommendations for couples planning a pregnancy. In this systematic scoping review, four electronic databases (Medline and EMBASE via Ovid processing, CAB Direct, and CINAHL via EBSCO) were searched for observational studies (prospective and retrospective cohort, cross-sectional, and case–control studies) from inception to 27 September 2021. Eligible studies included women of reproductive age during the preconception period, and evaluated exposures related to preconception diet and outcomes related to fertility. Results were synthesised using a descriptive approach. A total of 36 studies were eligible for inclusion (31 prospective, 3 cross-sectional, and 2 case–control studies) and were published between 2007 and 2022. Of the assessed dietary exposures, increased adherence to the Mediterranean diet displayed the strongest and most consistent association with improved clinical pregnancy rates. Reducing trans fatty acids (TFAs), saturated fatty acids, and discretionary food intake (fast food and sugar-sweetened beverages) were associated with improvements in live birth, clinical pregnancy rates, and related ART outcomes. The dietary components of seafood, dairy, and soy demonstrated inconsistent findings across the few included studies. Due to heterogeneity and the limited available literature on most exposures, there is insufficient evidence to support any specific dietary approach for improving fertility. However, following some of the dietary approaches outlined in this review (anti-inflammatory diets, reducing TFA, and discretionary food intake) are consistent with broad healthy eating guidelines, have little to no associated risk, and offer a plausible set of possible benefits. This warrants further exploration in randomised controlled trials.

The influence of the guided inquiry method and critical thinking on the learning outcomes of culinary arts in class X high school students

The influence of the guided inquiry method and critical thinking on the learning outcomes of culinary arts in class X high school students

Efforts to Improve Motivation and Learning Outcomes with the Use of Powerpoint Media

&#x0D; &#x0D; &#x0D; The purpose of this study was to determine the use of powerpoint media to increase motivation and learning outcomes of art and culture with materials for drawing decorative flora and fauna for class VIIIA students of SMP Negeri 02 Padangsidimpuan in the second semester of the academic year 2022/2023. This research was conducted in the second semester of the academic year 2022/2023. The research subjects were 36 students of class VIIIA of SMP Negeri 02 Padangsidimpuan. With the research target is the motivation and learning outcomes of art and culture materials for drawing decorative flora and fauna. Tool to collect data by observation to determine student learning motivation, learning outcomes of art and culture carried out a performance drawing test. This study uses 3 data analyzes, namely initial conditions, cycle 1 data, and cycle 2 data analyzed using comparative description techniques followed by reflection. The method used is to form large groups, small groups using powerpoint media are carried out by drawing performance tests to determine the increase in learning outcomes. This research model uses 4 stages of action: planning, action, observation, and reflection. Based on the results of the study, it was concluded that there had been an increase in the motivation indicator data for cycle 1, indicator 1) 81%, 2) 82%, 3) 87, cycle 2 increased to indicator 1) 83%, 2) 84%, 3) 90%. While the data on learning outcomes in cycle 1, the lowest score was 70, the highest score was 87, the average value was 77, there were 2 students who had not completed, cycle 2 the lowest score was 76, the highest score was 90, the average value was 79, and all the students completed.&#x0D; &#x0D; &#x0D;

Deletion of ACTRT1 is associated with male infertility as sperm acrosomal ultrastructural defects and fertilization failure in human.

Could actin-related protein T1 (ACTRT1) deficiency be a potential pathogenic factor of human male infertility? A 110-kb microdeletion of the X chromosome, only including the ACTRT1 gene, was identified as responsible for infertility in two Chinese males with sperm showing acrosomal ultrastructural defects and fertilization failure. The actin-related proteins (e.g. ACTRT1, ACTRT2, ACTL7A, and ACTL9) interact with each other to form a multimeric complex in the subacrosomal region of spermatids, which is crucial for the acrosome-nucleus junction. Actrt1-knockout (KO) mice are severely subfertile owing to malformed sperm heads with detached acrosomes and partial fertilization failure. There are currently no reports on the association between ACTRT1 deletion and male infertility in humans. We recruited a cohort of 120 infertile males with sperm head deformations at a large tertiary hospital from August 2019 to August 2023. Genomic DNA extracted from the affected individuals underwent whole exome sequencing (WES), and in silico analyses were performed to identify genetic variants. Morphological analysis, functional assays, and ART were performed in 2022 and 2023. The ACTRT1 deficiency was identified by WES and confirmed by whole genome sequencing, PCR, and quantitative PCR. Genomic DNA of all family members was collected to define the hereditary mode. Papanicolaou staining and electronic microscopy were performed to reveal sperm morphological changes. Western blotting and immunostaining were performed to explore the pathological mechanism of ACTRT1 deficiency. ICSI combined with artificial oocyte activation (AOA) was applied for one proband. We identified a whole-gene deletion variant of ACTRT1 in two infertile males, which was inherited from their mothers, respectively. The probands exhibited sperm head deformations owing to acrosomal detachment, which is consistent with our previous observations on Actrt1-KO mice. Decreased expression and ectopic distribution of ACTL7A and phospholipase C zeta were observed in sperm samples from the probands. ICSI combined with AOA effectively solved the fertilization problem in Actrt1-KO mice and in one of the two probands. Additional cases are needed to further confirm the genetic contribution of ACTRT1 variants to male infertility. Our results reveal a gene-disease relation between the ACTRT1 deletion described here and human male infertility owing to acrosomal detachment and fertilization failure. This report also describes a good reproductive outcome of ART with ICSI-AOA for a proband. This work was supported by the Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau, 2023MSXM008 and 2023MSXM054). There are no competing interests to declare. N/A.

Non-invasive cumulus cell analysis can be applied for oocyte ranking and is useful for countries with legal restrictions on embryo generation or freezing.

Can a strategy for scoring oocyte quality, based on cumulus cell (CC) gene expression, prioritize oocytes with the highest implantation potential, while limiting the number of embryos to be processed in culture and the number of supernumerary embryos to be vitrified? An interventional, blinded, prospective cohort study was retrospectively analyzed. In the original study, patients underwent a fresh Day3 single embryo transfer with embryos ranked based on morphology and CC gene expression (Aurora Test). The additional ranking of the embryos with the Aurora Test resulted in significant higher clinical pregnancy and live birth rates. Now it is investigated if the Aurora Test ranking could be applied to select oocytes. The effect of an Aurora Test based restriction to 2 and 3 2PN or MII oocytes on clinical pregnancy and other outcomes, was analyzed in two subsets of patients with all 2PN (n = 83) or all MII oocytes (n = 45) ranked. Considering only the top three ranked 2PN oocytes, 95% of the patients would have received a fresh SET on Day3 resulting in 65% clinical pregnancies. This was not different from the pregnancy rate obtained in a strategy using all oocytes but significantly reduced the need for vitrification of supernumerary embryos by 3-fold. Considering only top-ranked MII oocytes gave similar results. In countries with legal restrictions on freezing of embryos, gene expression of CC can be used for the selective processing of oocytes and would thus decrease the twin pregnancy rate and workload, especially for embryo morphology scoring and transfers as the handling and processing of lower competence oocytes is prevented, while improving the ART outcome.

Ndarboy Genk Music Performing Arts Management on the 2022 Cidro Asmoro Album Tour

Music is a form of artistic expression, serving as a manifestation of the creator's emotions through attention to melody, rhythm, expression, and harmony. The accompanying music can act as a balance for both the left and right hemispheres of the listener's brain. Each singer is supported by a management team to present and achieve the best outcomes in a performance art that involves task distribution from general to functional areas. This study aims to investigate the management of Ndarboy Genk's music performances during the 2022 Cidro Asmoro album tour, aiming to identify weaknesses and obstacles in the management of their musical performances. The research employs a qualitative descriptive approach. The management of the music group Ndarboy Genk encompasses elements and functions that are interconnected. Additionally, the underlying factors in the artistic management of the Cidro Asmoro album tour by Ndarboy Genk include implementing organizational arts management, the second factor being production management by Ndarboy Genk, and the third factor being Ndarboy Genk's execution of performance arts management.