Artificial Insemination Research Articles

P-753 Obstetric and neonatal risks in 7,378 singletons following fresh and frozen-thawed embryo transfers in Japan: An analysis utilizing doubly robust estimation

Abstract Study question How do obstetric and neonatal risks differ between frozen-thawed embryo transfer (FET) and fresh embryo transfer (FreshET), as well as other non-assisted-reproductive-technology (non-ART) infertility treatments? Summary answer FET demonstrated a significantly higher incidence of obstetric complications, with a discernable but not statistically significant trend toward increased neonatal anomalies. What is known already Several studies indicate that FET is associated with an increased incidence of obstetric complications, encompassing gestational hypertension, placenta accreta, and gestational diabetes. Additionally, reports suggest that ART may elevate the risk of neonatal anomalies, although discerning whether this risk is more prevalent in FET or FreshET remains uncertain. Study design, size, duration This single-center, retrospective cohort analysis was conducted, encompassing 7,378 singletons delivered between January 2013 and December 2022 following fertility treatment within our institution. Within this cohort, cases conceived through controlled ovarian stimulation, timed intercourse, intrauterine insemination, or routine infertility checkups were categorized as the non-ART group. We compared the obstetric complications and neonatal outcomes between the FET and FreshET groups, using the non-ART group as the control. Participants/materials, setting, methods The evaluated outcomes included placenta accreta, placenta previa, postpartum hemorrhage, gestational hypertension, gestational diabetes, preterm birth, placental abruption, neonatal anomalies, high birth weight (≥4,000 g), and low birth weight (<2,500 g). For the statistical analysis, we employed inverse probability weighted regression adjustment (IPWRA). IPWRA integrates outcome regression with a model for exposure (propensity score), ensuring unbiased estimates even if one of the models is misspecified (a doubly robust property). Main results and the role of chance Among the 7,378 singleton births, 2,643 were in the non-ART group, 4,219 in the FET group, and 516 in the FreshET group. Comparative analysis with the non-ART group revealed that the FET group exhibited a higher risk across various obstetric complications, including placenta accreta (adjusted risk difference [ARD] 3.61%, 95% confidence interval [CI] 2.95 to 4.28), placenta previa (ARD 0.55%, 95% CI 0.14 to 0.96), postpartum hemorrhage (ARD 7.08%, 95% CI 6.03 to 8.13), gestational hypertension (ARD 3.57%, 95% CI 2.47 to 4.68), gestational diabetes (ARD 0.96%, 95% CI 0.17 to 1.75), preterm birth (ARD 2.13%, 95% CI 1.23 to 3.02), and high birth weight (ARD 0.97%, 95% CI 0.42 to 1.52). The analysis of neonatal anomalies initially showed a significant risk difference between the FET and non-ART groups in the crude analysis (crude risk difference 0.74%, 95% CI 0.09 to 1.38), although this significance diminished after adjustment (ARD 0.68%, 95% CI -0.02 to 1.39). The FreshET group did not demonstrate an increased risk of obstetric complications or neonatal anomalies. Limitations, reasons for caution The retrospective design of this study, conducted at a single institution, limits the generalizability of its findings to a broader population. Factors inherent to the specific facility, practices, and patient demographics may introduce variability in outcomes. Moreover, the potential for bias from unmeasured confounders cannot be entirely ruled out. Wider implications of the findings The mitigation of the risk of obstetric complications may be achieved through careful selection for FreshET, as opposed to a predominant inclination towards FET. It is crucial to develop a collaborative framework that enables the seamless exchange of information on maternal and neonatal prognoses between ART and perinatal facilities. Trial registration number not applicable

O-149 The Endometriosis Longitudinal Fertility Study (ELFS): Outcomes for women with moderate or severe endometriosis who are trying to conceive

Abstract Study question What are the pregnancy outcomes for women with moderate or severe endometriosis who are trying to conceive? Summary answer Preliminary pregnancy rates in women with moderate/severe endometriosis are 11% for natural conception cycles and 22% for ART cycles. This is consistent with previous literature. What is known already Endometriosis is associated with reduced pregnancy rates in women attempting both spontaneous and assisted conception. Monthly fecundity is approximately half that of women without endometriosis and reduces further with increasing severity of disease. At present, the effect of surgery on the fertility outcomes of women with moderate or severe endometriosis remains unanswered. Treatment decisions are complex, particularly in those without pain symptoms seeking to optimise fertility outcomes. Study design, size, duration ELFS is a prospective multi-site longitudinal cohort study being conducted over 5-years. This interim report summarises data from August 2021-January 2024 in participants <38 years with evidence of in-situ moderate or severe endometriosis desiring fertility immediately or in the future. ELFS prospectively measures and compares monthly clinical pregnancy and live birth rates in women having either surgical or conservative management of endometriosis. This report assesses outcomes for those trying to conceive naturally or with ART. Participants/materials, setting, methods Following consent and baseline questionnaire completion, participants install the purpose-built ELFS App to their mobile phone or use a web-based option to complete cyclical surveys. The timing of surveys is dependent on a learned logic within the App and based on menstrual cycle length and pregnancy status. Participants report attempted conception cycles and any ART treatments undertaken with IVF or intrauterine insemination (IUI). Pregnancy outcomes are recorded as well as surgery during the study period. Main results and the role of chance There are 124 participants enrolled in ELFS, 86 (69%) are in the surgical cohort and 38 (31%) in the conservative cohort. There are 45 participants (36%) who have indicated they are actively trying to conceive during the study and a total of 171 cycles have been recorded from these participants. Of those trying to conceive, 24 (53%) have elected to have surgery during the study period, compared to 23 (29%) who were not trying to conceive. The study has captured 126 cycles with attempted conception. Of these, 42 cycles (33%) utilised ART compared to 84 cycles (67%) of natural conception attempts. Of the ART cycles, 27 (75%) involved IVF with fresh or frozen embryo transfer and there were 9 (15%) IUI cycles. To date, there are 25 reported pregnancies. The pregnancy rate for ART cycles was 22% (8/36) compared to 11% (9/87) in the natural conception cycles. Of those who conceived following surgery, 47% (8/17) of pregnancies were following ART and 53% (9/17) were natural conceptions. There are 2 live births recorded, both from the cohort who had surgery during the study. A total of 5 miscarriages (20%) have been reported, 4 (80%) from the surgical cohort. Limitations, reasons for caution In the absence of data to guide management in this area, clinician scope of practice and concurrent pain symptoms are likely to influence recommendations for ART or surgery in those trying to conceive with moderate or severe endometriosis. Wider implications of the findings This preliminary data is consistent with the current literature showing reduced natural and assisted conception rates in women with moderate or severe endometriosis. Long-term data will be required to determine if fertility and pregnancy outcomes are influenced by surgical management of endometriosis. Trial registration number ACTRN12621000431820 (ANZCTR)

P-392 Luteal phase support for women trying to conceive by intrauterine insemination or sexual intercourse

Abstract Study question Is luteal phase support (LPS) necessary for intrauterine insemination or sexual intercourse? Summary answer Vaginal progesterone supplementation during luteal phase may increase live birth (LBR)/ongoing pregnancy rate (OPR), however, its effect on miscarriage per pregnancy (MPP) is uncertain. What is known already Ovulation induction may impact endometrial receptivity due to insufficient progesterone secretion. Low progesterone is associated with poor pregnancy outcomes. Study design, size, duration Systematic reviews and meta-analysis were conducted. We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, LILACS, trial registries for ongoing trials, and reference lists of articles (from inception to 25 August 2021). Participants/materials, setting, methods Randomised controlled trials (RCTs) of LPS using progestogen, human chorionic gonadotropin (hCG), or gonadotropin-releasing hormone (GnRH) agonist supplementation in IUI or natural cycle. We used the standard methodological procedures expected by Cochrane. Main results and the role of chance We included 25 RCTs (5111 participants). Progesterone supplementation versus placebo or no treatment Vaginal progesterone does not significantly increase the LBR/ OPR (RR 1.10, 95% confidence interval (CI) 0.81 to 1.48; 7 RCTs; 1792 participants;) or decrease MPP (RR 0.70, 95% CI 0.40 to 1.25; 5 RCTs; 261 participants). Subgroup analysis revealed that progesterone may not increase LBR/OPR in women with gonadotropin stimulation (RR 1.24, 95% CI 0.80 to 1.92; 4 RCTs; 1054 participants) and oral stimulation (clomiphene citrate or letrozole) (RR 0.97, 95% CI 0.58 to 1.64; 2 RCTs; 485 participants). In addition, progesterone may not reduce MPP regardless of stimulation protocol (RR 0.68, 95% CI 0.24 to 1.91; 2 RCTs; 102 participants, with gonadotropin; RR 0.67, 95% CI 0.30 to 1.50; 2 RCTs; 123 participants, with gonadotropin plus oral stimulation; and RR 0.53, 95% CI 0.25 to 1.14; 2 RCTs; 119 participants, with oral stimulation). Different routes of progesterone administration versus vaginal route There is no difference in terms of LBR, OPR, and MPP when comparing intramuscular (IM), oral, or subcutaneous progesterone to vaginal progesterone. Very low-certainty evidence suggests that intramuscular progesterone may lead to a substantial increase in adverse events, particularly pain at the site of injection. Limitations, reasons for caution Most studies were at unclear or high risk of bias. The main limitations of the evidence were poor reporting and imprecision. Wider implications of the findings Vaginal progesterone does not significantly increase in LBR/OPR or decrease miscarriage rate. In comparison to vaginal progesterone, there is insufficient data to evaluate whether progesterone supplementation via an alternative route has an impact on pregnancy outcomes. Trial registration number PROSPERO2017 CRD42017055106

P-099 The development of a novel sperm washing medium, enriched with serotonin as the active constituent, with the objective of enhancing sperm motility and viability

Abstract Study question Is it possible to develop a novel product that increases the success rate of treating male infertility through assisted reproductive techniques? Summary answer Sperm washing media, aiming to improve sperm quality, enhance sperm motility, and generally support male reproductive health in the field of assisted reproductive techniques. What is known already Infertility impacts 15% of all couples globally, with 50% of infertility cases attributed solely to male factors. Reduced semen motility is identified as a primary factor directly associated with infertility. The utilization of supplementation to enhance overall sperm quality has gained increasing popularity worldwide. The sperm preparation process in Assisted Reproductive Technology (ART) is crucial for successful fertilization, with sperm washing mediums playing a critical role in enhancing efficiency. Sperm-washing media is a specialized solution utilized in assisted reproductive technologies such as intrauterine insemination and in vitro fertilization to remove the seminal fluid and debris for sperm to undergo capacitation. Study design, size, duration In this study, 200 normozoospermic men were included, and their semen samples were analyzed over an 18-month period following the guidelines outlined by the World Health Organization (2010) to assess the efficacy of serotonin, selenium, zinc, L-Carnitine, and Coenzyme Q10 supplementation on sperm motility, viability, ROS and DNA damage. Participants/materials, setting, methods Sperm samples obtained from 200 volunteer men undergoing infertility assessments were subdivided into three samples.The sperm samples underwent preparation using the swim-up technique. The study involved the examination of samples in three distinct washing media: (1) Origio, (2) Irvine Scientific, (3) a prototype (serotonin, selenium, zinc, L-carnitine, and Coenzyme Q10). Each medium was analyzed for motility, apoptosis, reactive oxygen species (ROS), and DNA damage. Main results and the role of chance It is found that mean basal total sperm counts are 38 million. After sperm washing, mean total sperm counts of Origio®, Irvine® and Prototype are 15 million respectively (p > 0.05). As total progressive motility is % 40 before washing, it is increased to 62%,56% and 64% after washing with Origio®, Irvine® and Prototype, respectively (p > 0.05). Annexin V staining is used for detection of apoptosis in sperm samples. On average, early apoptosis over the total sperm count(TSC) per subgroups are 34.67% for Prototype, 33.17% for Origio® and 30.96% for Irvine®, whereas late apoptosis ratios are found significantly lower in Prototype compared to Origio and Irvine; 8.7%, 28.26% and 27.74%, respectively. Ratio of necrosis over TSC per subgroups is 3.15% for Prototype, 13.49% for Origio® and 18.78% for Irvine® whereas viability ratios are as 53.48%, 25.08%, 22.52%, respectively.(p < 0.05). ROS levels in semen after washing are significantly lower for Prototype (5.9%, 10.29%, and 18.22%, Prototype, Origio® and Irvine®, respectively) (p < 0.05). Limitations, reasons for caution Semen samples from males aged 28 to 45, who are unable to conceive, do not smoke, and have not undergone any surgical interventions, are collected from patients after a sexual abstinence period of 3-4 days. Wider implications of the findings We propose that our serotonin-activated washing media for sperm preparation can serve as a suitable choice for selecting high-quality sperm in assisted reproductive technology programs. These molecules may enhance the success of assisted reproduction techniques when present in sperm preparation media. Trial registration number SerotoneX

P-740 Septoplasty versus expectant management in women with septate uterus and a previous history of a live birth

Abstract Study question Does hysteroscopic septoplasty improve reproductive outcome in patients who were diagnosed to have a septate uterus (SU) after a previous live birth? Summary answer This study suggests that hysteroscopic septoplasty improves the chance of a live birth in patients with both SU and a history of previous live birth. What is known already SU accounts for 50% of uterine anomalies and can be associated with adverse pregnancy outcomes. Many observational studies reported significant improvement in pregnancy outcomes following hysteroscopic septoplasty. However, some investigators have reported good reproductive outcome among women with SU without surgical interventions. A recent randomized controlled trial, albeit with a small sample size, reported no difference in reproductive outcomes between patients who underwent hysteroscopic septoplasty and those who had no surgery (Rikken 2021). Therefore, more studies are needed to be able to counsel patients with SU presenting with reproductive failure, especially those with a history of a previous live birth. Study design, size, duration This retrospective study included 114 patients who had a previous live birth and subsequently complained of reproductive failure. A SU was diagnosed during their work up between 2005-2022. Patients presented with secondary infertility (98.3%) or with recurrent pregnancy loss (RPL) [1.7%]. Forty-two patients presented with both secondary infertility and RPL (36.8%). Participants/materials, setting, methods Diagnosis of SU was suspected on transvaginal 3D ultrasound scan and was confirmed on a diagnostic hysteroscopy at an infertility clinic affiliated with an academic hospital. Patients were offered the option of hysteroscopic septoplasty or expectant management. Infertility treatment options depended on the underlying etiology and included spontaneous conception, oral fertility medications, intrauterine insemination, and in-vitro fertilization/embryo transfer. Eighty-two patients underwent hysteroscopic septoplasty (Group 1), while 32 patients declined surgery (Group 2). Main results and the role of chance There were no significant differences in mean age (years), BMI (Kg/m2), infertility duration, baseline FSH levels (mIU/mL), number of miscarriages, and gestational age at delivery before treatment between the two groups. There were no significant differences in incidence of ≤ 3 or ≥ 3 pregnancies, nor incidence of one live birth or > 1 live birth between the two groups. There were no significant differences in the underlying etiology, except for a significantly higher incidence of endometriosis (P = 0.004) and diminished ovarian reserve (P = 0.04) in Group 1 compared to Group 2. There were no significant differences in the incidence of partial septate uterus (PSU) [angle of indentation <90 degrees] and complete septate uterus between the two groups. However, there was significantly lower incidence of PSU with angle of indentation > 90 degrees (P = 0.028) and higher mean septum length in mm (18.9±1.0 vs 13.8±1.1, P = 0.024) on hysteroscopy in Group 1 compared to Group 2. After treatment, there were significantly higher pregnancy (68.3% vs 37.5%, p = 0.003) and live birth (61.7% vs 25%, P = 0.000) rates, but no significant difference in miscarriages (4.9% vs 6.3%), preterm birth (14% vs 25%) rates, or method of pregnancy in Group 1 compared to Group 2. Limitations, reasons for caution Our study has limitations being retrospective in nature with a small sample size. Therefore, more studies are required to support our findings. However, our pilot study explored management options in a particular group of patients with SU who initially proved their fertility and subsequently presented with reproductive failure. Wider implications of the findings Our data support the notion that patients with SU can have a normal reproductive outcome, although those who undergo septoplasty are expected to have a better chance of conception and live birth. During counselling of patients with SU, both surgical and expectant management can be offered. Trial registration number not applicable

O-181 It takes more than genes to build a family

Abstract Sperm donation has been known to mankind possibly for a very long time, although first medical reports come from the late 18th century. Initially, most inseminations in married couples were homologous, involving the husband’s semen. The first publicized breakthrough that came in 1884 would today be considered unethical, as an anesthetized woman was subjected to an injection of semen from a handsome (as duly reported) student of medicine, without any consent of both her and her spouse. The veil of secrecy that covered heterologous insemination was finally lifted when Dr Mary Barton openly acknowledged the practice in her clinic and published the first manual on “artificial insemination.” It set the ethical standards for such procedures—including mutual anonymity of donors and recipients and maintaining absolute secrecy of the fact of donor insemination—for decades to come. The cost was of course the lost identity of the conceived children and the often reported emotional detachment of the fathers from their social, but not genetical, offspring. The grave consequences of the limited pool of donors were yet to be discovered with the advent of DNA testing. In the UK, Barton’s husband and another collaborator were confirmed to father at least 100 children each. In the Netherlands, the country was shaken by the case of Jan Karbaat who used the sperm of an anonymous donor—who probably should not have even passed psychological screening—to bring more than 200 babies to the world. Suddenly, lots of adults learnt of the existence of their never expected siblings. Concomitantly, more and more parents revealed the fact of donor conception to their children motivated by openness. The secrets could not be held any longer and Joanna Rose was the first British woman that won a court case in 2002 against her own country that was wilfully breaking her right to respect for private and family life guaranteed by European Convention on Human Rights. The proponents of open donation found support also in Convention on the Rights of the Child. More and more countries started enforcing either open or at least double-track donation from then on. However, even more legislations blissfully ignore these ethical developments and maintain complete anonymity of the donor insemination procedures. This is where my personal story begins, as a father of twins born in 2012 from in vitro fertilization thanks to the semen of an anonymous donor. At that time, Poland even did not have an actual law on fertility treatment. The ART centres adopted their own policies on anonymous donation and signed contracts with their patients on a case by case basis. The legal status in my country was further cemented with the long overdue adoption in 2015 of Act on Fertility Treatment that forbids non-anonymous donation and even excludes the prospective parents from the decision process on the choice of the donor. The burden of partially lost identity of my kids will be with me possibly my entire life. But I don’t want it to cast a shadow on our family relations. We have to deal with my non-genetic fatherhood one way or another. We maintain our family ties in full knowledge of the fact of the existence of some unnamed benefactor that made this possible. Maybe one day my children will find some unsuspected genetic relatives via increasingly popular public DNA banks if they choose so, thus sticking together parts of their identity. Only time will tell.

P-224 Efficiency of MI oocytes matured in MII on the egg retrieval day

Abstract Study question Are the clinical outcomes of matured MI-eggs (MMI) comparable to MII oocytes? Summary answer The fertilisation and blastocyst rates are lower in MMI, but the proportion of good quality embryos and live birth outcomes are similar in both groups What is known already Controlled ovarian stimulation, combined with conventional in vitro fertilisation or intracytoplasmic sperm injection (ICSI), is considered to be the most effective combination of assisted human reproduction treatment. During gonadotropin stimulation and trigger medication, a large proportion of oocytes complete meiosis in the ovary and are extracted as metaphase II (MII). Oocytes that do not complete maturation are retrieved as germinal vesicles (GV) or metaphase I (MI) oocytes, often discarded in oocyte donation cycles due to their suboptimal quality. Study design, size, duration This retrospective study from January 2021 to December 2023 includes 1074 cycles with 7590 donor oocytes, where 7399 MII and 191 MMI oocytes were microinjected. For pregnancy outcomes, data were collected between January 2021 to December 2022. Clinical pregnancy, defined with a positive b-HCG and fetal heartbeat in 12 week of gestation ssw (FHB), and live birth rates (LB) of 752 transfers were recorded (747 for MII group and 5 for MMI group). Participants/materials, setting, methods Oocytes were denuded at 2h post retrieval and ICSI was performed 2h post denudation. Male factor was not taken into account. Embryos were cultured under the same conditions. Data were collected on fertilisation rates and the quality of obtained blastocyst, grouped into better quality(BQ) (AA, AB, BA, BB) and poorer quality(PQ) (BC, CB, AC and CA). The pregnancy outcomes were calculated with respect to the number of embryos transferred. Data were analysed using chi-square (SPSS26) Main results and the role of chance The obtained results showed significant differences in fertilization rate between MII (72.1%) and MMI (44.5%)(p < 0.001). Likewise, the blastocyst rate was notably higher in MII (54.4%) compared to MMI (22.4%) (p < 0.001). Concerning the distribution between day 5 and day 6, there were no significant differences in both groups (D5: 72.0%MII vs 73.7%MMI and D6: 28.0%MII vs 26.3%MMI; p = 0.870), as well as no differences in the distribution of quality (BQ: 82.0%MII vs 68.4%MMI and PQ: 18.0%MII vs 31.6%MMI; p = 0.124). Regarding transfer outcomes, PR was similar in both groups (63.6% MII and 60.0% MMI, p = 0.870). No significant difference was observed in the FHB rate (50.6% MII vs 60.0% MMI; p = 0.674) or LB rate (33.1% MII vs 40.0% MMI, p = 0.746). Limitations, reasons for caution Although the data suggest that IMM should be used, it should be noted that the number of transfers performed with embryos from IMM oocytes is low. Therefore, the number of embryos from this group should be increased for a more comprehensive evaluation. Wider implications of the findings The results obtained from this study show that MMI oocytes have lower fertilisation and blastocyst rates, but similar qualities and comparable transfer performance; therefore, the results obtained suggest its use Trial registration number Not applicable

P-112 Magnetic resonance spectroscopy at the micro scale (Micro-MRS) for non-invasively assessing individual mammalian embryos’ metabolism

Abstract Study question Can Micro-Magnetic Resonance Spectroscopy (micro-MRS) reveal the metabolic fingerprint of mammalian pre-implantation embryo? Summary answer Our research demonstrates that rapid, non-invasive analysis of embryos using Micro-Magnetic Resonance Spectroscopy (micro-MRS) can effectively uncover the significance of embryonic metabolites during development. What is known already Non-invasive selection of optimal embryos for transfer is a crucial challenge in assisted reproduction for both humans and animals. Magnetic Resonance Spectroscopy (MRS) emerges as a promising solution due to its chemical sensitivity and non-invasive nature. Despite its effectiveness in analysing large organisms, MRS faces obstacles in small sample handling and sensitivity, particularly with embryos, limiting its clinical and research applications. Our study overcomes these challenges using innovative microchip-based MRS sensors. This approach enabled successful MRS at the embryo scale, revealing metabolic biomarker linked to developmental potential in pre-implantation bovine embryos and opening new possibilities in assisted reproduction technology. Study design, size, duration Multiple MRS measuring sessions were conducted on two distinct embryo cohorts. The first cohort involved naturally arrested IVP embryos at early (8-cell) and late (morula/blastocyst) stages, establishing metabolic biomarkers in mammalian pre-implantation embryos. The second cohort involved 8-cell embryos which were further cultured over 10 days post-MRS with imaging at specific intervals (3 hours post-thawing, days 5, 8, and 10). This step was crucial to back-correlate biomarkers with in-vitro development based on bright field microscopy. Participants/materials, setting, methods Both studies involved vitrified samples that were subjected to a 50-minute MRS measurement following a 3-hour post-warming culture period. Single bovine embryo analysis was performed using our 1nL micro-MRS probe. Pre-implantation bovine embryos were obtained through IVF (n = 32 samples for cohort one and, n = 61 for cohort two). Post-MRS, the embryos were cultured in equilibrated IVC medium in a humidified incubator with 5% CO2 and 6% O2 at 38 °C. Statistical significance was set at p < 0.05. Main results and the role of chance Micro-Magnetic Resonance Spectroscopy (Micro-MRS) was utilized to identify metabolic markers in single bovine embryos, providing insights into their pre-implantation developmental stages. The spectroscopy data revealed distinct peak regions in the spectra of both cohorts, indicative of essential life-supporting fatty acids. Notably, up to six lipid markers were identified in the first cohort, five of which displayed statistically significant differences (p < 0.05). However, the majority of these biomarkers in the first cohort did not show significant expression differences in the groups of embryos assigned to the second cohort. An exception was noted in the case of the Principal Lipid Component (PLC) marker, which was significantly less prevalent in the arrested embryos than in those progressing to the blastocyst stage (p = 0.0016). Further data analysis based on AI-classification algorithms revealed up to 80% precision in predicting the development to the blastocyst stage solely based on their metabolic profiles at the 8-cell stage. Limitations, reasons for caution Magnetic Resonance Spectroscopy (MRS) shows promise for clinical and research use, requiring reliable signal detection from cellular components. While suitable for research, clinical deployment demands further safety assessments and protocol refinement. Additionally, larger sample sizes and data on post-MRS implantation and pregnancy rates are needed to validate AI-classification algorithms. Wider implications of the findings Micro-Magnetic Resonance Spectroscopy (Micro-MRS) holds potential as a reliable and non-invasive method for embryo screening prior to transfer. This innovative tool can shed light on the role of embryonic metabolites during development making Micro-MRS a key instrument in advancing both embryology research and human assisted reproduction techniques. Trial registration number not applicable

O-211 Exploring risk factors of mismatch in the ART laboratory: An analysis based on 73719 electronic witnessing points

Abstract Study question What are the risk factors associated with mismatch (MM) and genuine mismatch (GMM) in the ART laboratory? Summary answer MM is associated with individual operators, oocyte denudation (OD) and embryo transfer (ET) processes, while GMM related to OD and extended work hours (>4pm). What is known already Mix-up of gametes or embryos in the ART laboratory causes dramatic consequences to both the patients and clinics. Recent studies using electronic witnessing system (EWS) equipped with radio frequency ID (RFID) tags, have revealed that most MM events only involved empty cell culture vessels, while the true mix-up risk arose from a subgroup of GMM involving culture vessels carrying gametes or embryos belonging to different patients. Exploration of risk factors associated with MM and GMM occurrence, separately, is still currently lacking in the literature. Study design, size, duration A total of 73719 witnessing points were retrospectively extracted from an EWS database, representing 11210 consecutive treatment cycles performed at Fertility North between January 2016 and July 2023. The 11210 treatment cycles comprised 5472 fresh IVF, 3732 frozen embryo transfer, 93 oocyte freeze, and 1913 intrauterine insemination cycles. Participants/materials, setting, methods All laboratory work areas were equipped with RFID readers. A MM was triggered by detection of RFID tagged cell culture vessels (either carrying biological material or not) and/or ID cards that belong to different patients in the same work area. A GMM was defined when a MM had involved biological materials and/or patients during procedure, with a potential mix-up. Risk factors evaluated included time of the day, weekdays, weekend, public holiday, operators, and laboratory processes. Main results and the role of chance A total of 138 (0.19%) MMs and 16 (0.02%) GMMs were identified during the study period, without actual mix-up. MM rate was the highest during 12-2pm (0.28%, p < 0.001) compared to other periods of the day, whilst GMM was the highest after 4pm (0.13%, p = 0.004). Neither MM nor GMM was associated with any specific weekday, weekend or public holiday (p > 0.05, respectively). Amongst 8 laboratory processes investigated, ET (0.36%, p < 0.001) led to the highest MM rate, followed by OD (0.35%, p = 0.021), but no increase was observed in oocyte collection, sperm preparation, insemination, embryo culture, cryopreservation and Assign ID. OD was the only process associated with higher GMM (0.13%, p < 0.001). Furthermore, Two of the 20 assessed operators were identified to produce more MMs (0.59%, p < 0.001, and 0.40%, p = 0.004; respectively) while GMM rates were similar among all operators (p > 0.05). Multivariate logistic regression indicated that the OD (adjusted odds ratio or aOR=2.147, p = 0.011) and ET (aOR=2.118, p < 0.001) processes as well as 2 individual operators (aOR=3.511, p < 0.001; aOR=2.538, p = 0.002; respectively) were independent risk factors to MM, but not the 12-2pm period of the day (aOR=1.341, p > 0.05). Finally, both extended work hours beyond 4pm (aOR=8.651, p = 0.005) and OD (aOR=9.538, p < 0.001) were independent risk factors to GMM. Limitations, reasons for caution Each individual ART laboratory has a unique team of scientists and workflow arrangement so findings in our study may not be universally applicable. GMM occurs at an extremely low frequency and is often calculated based on large numbers, therefore caution ought to be taken at statistical interpretation of data. Wider implications of the findings GMMs should be separated from MMs for analysis considering the very different clinical implications. Sufficient staffing with regular break and streamlined workflow are highlighted in preventing mix-up in the ART laboratory. Using electronically logged data, EWS enables identification of site-specific risk factors, which facilitates the development of corresponding preventative protocols. Trial registration number not applicable

P-768 Is it time for a consensus on key performance indicators for cycles involving donation and surrogacy?

Abstract Study question As there are no agreed standards for bench marking in cycles involving donation and surrogacy, how do we measure performance for these treatment types? Summary answer Until an international consensus is undertaken, we must define benchmarks using both in-house and published data from the Human Fertilisation and Embryology Authority (HFEA) register. What is known already Treatment cycles involving donor gametes or surrogacy have increased exponentially in recent years (Horsey, 2023; HFEA, 2020). Key performance indicators (KPIs) are critical for monitoring treatment effectiveness and safety. The Vienna Consensus (2017) is the accepted standard against which clinics should measure performance. However, the publication does not include data on cycles involving donation and surrogacy. In the absence of agreed standards, it is difficult for clinics to measure efficacy for these patient groups. Defining benchmarks for such cohorts is particularly challenging as the gametes used in donation and surrogacy treatment types may come from both fertile and sub-fertile populations. Study design, size, duration Retrospective analysis of anonymised United Kingdom (UK) data, published by the HFEA, from 2014 to 2018, was performed. Outcomes for 26290 donor intrauterine insemination (DIUI), 12262 in vitro fertilisation (IVF), 11341 intracytoplasmic sperm injection (ICSI) and 12453 frozen embryo transfer (FET) cycles, all using donor gametes, were included in this study. In cycles where surrogacy was indicated, gamete origin could not be determined, preventing the data from being included in this study. Participants/materials, setting, methods Using the complete HFEA data set, the average live birth rate, for each treatment type (excluding surrogacy), was calculated. This average was considered the target benchmark when comparing the average live birth rates at the clinic. Each quarter, a rolling 12 months of in-house retrospective data was used to assess clinic performance. Warning and action limits were set using standard deviations calculated using the 5 averages obtained from each year of HFEA data included. Main results and the role of chance The average live birth rates determined using the HFEA data, to be used as benchmarks for performance, were as follows; DIUI (13.7%), IVF (42%), ICSI (37%) and FET (36%). It is noteworthy that live birth rates reported by the HFEA were per embryo transfer (ET), rather than per embryo, meaning more than one live birth could be reported per ET. Discrepancies in outcome reporting meant that the national clinical pregnancy rate could not be determined for all treatment types, nor could fertilisation rate. Therefore, the clinic used in-house data to set benchmarks, action, and warning limits for these donor KPIs. Our findings whilst mining the national published data were that no cycle outcomes had been published beyond 2018, meaning these data may not be reflective of current national rates. Also, the national averages calculated will have been affected by individual clinic success rates. Knowing each clinic’s average would create a larger range, from which real world standard deviations could be determined, resulting in more meaningful warning and action limits. Such data was unavailable. The result being that, whilst UK national data is publicly available, it is flawed and insufficient for creating robust benchmarks that clinics can measure themselves against. Limitations, reasons for caution No national data, beyond 2018, is available for use in bench marking. Waiting for live birth data will delay any actions prompted by under-performance. Individual clinic success rate will have impacted the national average. Both fertile and sub-fertile populations will be included in both data sets. Wider implications of the findings The available UK data cannot be used to set robust benchmarks for donor or surrogacy KPIs. Small and new clinics are therefore unable to adequately measure their performance. With the increasing uptake of treatments involving donation and surrogacy, it is time for an international consensus on expected outcomes. Trial registration number not applicable

O-189 Letrozole-resistant PCOS: prevalence, further options and course of fertility treatment

Abstract Study question What is the prevalence of letrozole-resistance in infertile women with polycystic ovary syndrome (PCOS) and what is the course of clinical management for such women? Summary answer Even after 10 mg/day dose of letrozole, 2.7% women did not ovulate. Clomiphene citrate (CC) should be tried first in these women, followed by gonadotrophins What is known already Letrozole is the preferred drug for ovulation induction (OI) in infertility associated with PCOS because it results in better pregnancy and live birth rates than CC. Women not responding to conventional dose of letrozole, may require alternate regimens like two-step, higher and extended dose. But some women may remain refractory even to the maximum dose of letrozole. While CC-resistance and its management are well established, clinical management of women with PCOS resistant to the maximum dose of letrozole remains largely undocumented. Study design, size, duration A prospective observational study was conducted in a Fertility Centre between April 2018 and March 2023 after obtaining Institutional Ethics Committee approval and informed written consent from all the participants. Out of total 1851 women with PCOS and infertility, 1522 were included in the study, of which 50 were found to be resistant to letrozole. Participants/materials, setting, methods Infertile women with PCOS (defined by Rotterdam criteria), age 21-35 years, with patent fallopian tubes and normal semen reports of partner, who received no previous OI were recruited. Women who failed to ovulate (confirmed with transvaginal ultrasound) after 3 consecutive cycles of incremental (5, 7.5 and 10 mg/day) doses of letrozole were switched to CC. In case of CC-resistance, options of laparoscopic ovarian drilling (LOD) or gonadotrophins were offered. Clinical and pregnancy-associated parameters were assessed. Main results and the role of chance Out of 50 letrozole-resistant women, 19 (38%) ovulated after subsequent OI with CC, of which seven (36.8%) conceived and two (28.8%) had twin pregnancy. Out of 31 CC-resistant women, seven were lost to follow up. The singlet woman who opted for LOD did not have subsequent spontaneous ovulation and therefore, required gonadotrophins later on. All 24 women who received gonadotrophins ovulated. Most of them developed one (11, 45.83%) or two (12, 50%) follicles. However, one woman developed 10 follicles leading to ovarian hyperstimulation syndrome, for which the OI cycle was converted to in-vitro fertilization (IVF). With gonadotrophins, nine (37.5%) women conceived and one (11.1%) had triplet pregnancy that miscarried in the first trimester. The remaining 16 women who failed to conceive were offered three cycles of intrauterine insemination followed by IVF. The mean time to pregnancy from the start of treatment was 10.81 (±7.71) months. The live birth rate was similar (P = 0.0416) between gonadotrophins (6, 27.2%) and CC (5, 22.7%), Between CC-resistant and CC-responsive women, all clinical, biochemical and biophysical parameters were similar except the mean levels of luteinizing hormone, which were significantly higher in CC-resistant group (16.3 ±5.3 versus 13.2 ±4.7 mU/ml, P = 0.036). Limitations, reasons for caution The study was conducted in a single center and the results may be difficult to extrapolate on women belonging to other ethnicities. The sample size was small. Wider implications of the findings Some women with PCOS may not respond even to the maximum dose (10 mg/day) of letrozole. Correct identification of letrozole-resistance and choosing the subsequent appropriate methods of OI are of paramount importance in timely management of infertility in these couples. Trial registration number NA

O-123 Trends and challenges in the practice of ART in China

Abstract China is a large country with a population of over 1.4 billion. In 1988, the first in-vitro fertilization-embryo transfer (IVF-ET) baby was born in Peking University Third Hospital. In the following 3 decades, assisted reproductive technology (ART) has developed rapidly in China, and the availability and accessibility of the ART service have improved markedly. In 2004 totally, only 37 institutions had passed the administrative licensing procedure to carry out ART. While in 2020, 536 institutions obtained the ART license. Since 2016, the total number of ART service cycles(Artificial insemination included)has exceeded 1 million, and the number of babies born has exceeded 300,000, accounting for about 2% of the total live births in China in 2016. At present, assisted reproductive technology has become one of the important medical interventions for the treatment of infertility in China, which has brought good news to infertile couples and their families, and has made great contributions to social harmony and family happiness. Cycles per million population (C/M) in 2009 was 120. In 2020, it has increased to 668, with more and more infertile couples having access to this technique in China. The success rate of assisted reproductive technology remained stable. In 2020, the clinical pregnancy rates (CPR)of conventional IVF and ICSI fresh embryo transfer cycles reached 52.4% and 49.4%, respectively, and the live birth rates were 43.0% and 40.6%, respectively. The clinical pregnancy rate and live birth rate of frozen-thawed embryo cycle were 51.3% and 40.5% per transfer. With the widespread application of embryo freezing technology, the cumulative live birth rate was estimated to reach 49.5% (CLBR estimate) in 2020. The safety monitoring indicators of assisted reproductive technology showed that since 2015, the multiple pregnancy rates of conventional IVF, ICSI and FET have decreased year by year, and have dropped to 22.4%, 21.4% and 17.6% in 2020, respectively. The incidence of moderate-severe ovarian hyper-stimulation syndrome (OHSS) and severe bleeding were also under control, within a reasonable range. Assisted reproductive technology, which involves many medical, social, ethical and legal issues, is a special clinical technology with limit application for medical indication. The Chinese government attaches great importance to the quality and safety management of assisted reproductive technology. A series of management documents such as the Administrative Measures for Human Assisted Reproductive Technology, the Regulations for Human Assisted Reproductive Technology and so forth, have been issued since 2001. Further improvement of key performance indicators (KPIs) correlated with ART quality and safety control is of the top priority and also challenging. In addition, the ART surveillance data in China is still aggregated data, which does not include important indicators such as age stratification, infertile factors or indications and delivery gestational age, maternal and infant outcomes, with some limitations for surveillance. Continuous improvement of data quality, and initiation of cycle-based data collection and security measures of case information are also challenging for the next step.

The Potential of Infrared Thermography for Early Pregnancy Diagnosis in Nili-Ravi Buffaloes.

This study was designed to explore the potential of infrared thermography (IRT) as an alternate approach for early pregnancy diagnosis in buffaloes. The surface temperature (ST) of different regions (eyes, muzzle, flanks, and vulva) was determined in 27 buffaloes using IRT from the day of artificial insemination (AI; Day 0), and measurement was repeated every fourth day until Day 24 post-AI. From all regions, the ST in each thermograph was recorded at three temperature values (maximum, average, minimum). Pregnancy status was confirmed through ultrasonography on Day 30, and animals were retrospectively grouped as pregnant or non-pregnant for analysis of thermographic data. In pregnant buffaloes, all three values of ST were significantly greater (p ≤ 0.05) for the left flank, while, in the left eye and vulva, only the maximum and average values were significantly greater. By contrast, the maximum ST of the muzzle was significantly lower (p ≤ 0.05) in pregnant buffaloes compared to non-pregnant buffaloes. However, the ST of the right eye and right flank did not show significant temperature variation at any value. These findings suggest that IRT has the potential to identify thermal changes associated with pregnancy in buffaloes at an early stage.

Predictive Value of Teratospermia During Initial Sperm Analysis on the Success of Intrauterine Insemination Cycles

ObjectiveTo evaluate the predictive value of sperm morphology, specifically teratospermia, seen during initial semen analysis on the success of intrauterine insemination (IUI) cycles and pregnancy outcomes. MethodsA retrospective cohort analysis on patients undergoing IUI at a large US fertility network. Baseline demographic characteristics, primary infertility diagnoses, and pregnancy outcomes were recorded. A total of 27,925 IUI cycles in 16,169 unique patients were analyzed. IUI cycles were grouped by a sperm morphology of 1% (n=3,799), 2% (n=5,506), 3% (n=4,857), or 4% or greater (n=13,763). The outcome measures were pregnancy rate (positive pregnancy test), clinical pregnancy rate (ultrasound confirmation of a gestational sac with a yolk sac around 5-6 weeks), live birth rate, and miscarriage rate. ResultsSperm morphology is a significant predictor of pregnancy rate (p= <0.001), clinical pregnancy rate (p=0.011), and live birth rate (p=0.026) following IUI. In each of these outcome measures, patients with 1% normal forms had the lowest percentage of success, and patients with 4% or greater normal forms had the most success. Relative outcome percentages, however, were similar in each group. Live birth rates in the 1%, 2%, 3% and > 4% group were 12.3%, 13.1%, 12.7% and 13.9%, respectively. Sperm morphology is not a significant predictor of miscarriage rate per clinical pregnancy post IUI (p=0.054). ConclusionsSperm morphology was a statistically significant predictor of pregnancy, clinical pregnancy, and live birth but not miscarriage rate after an IUI cycle. Higher morphology percentages were associated with increasingly favorable outcomes. However, the small observed differences did not demonstrate clinical significance.

Pregnancy and calving rate of artificial insemination with sexed semen in swamp buffaloes under field conditions

Abstract Artificial Insemination (AI) with sexed semen in buffaloes has been applied for increased calf sex ratio as well as genetic improvement. A field study was conducted to evaluate conception and calving rates following artificial insemination (AI) with sexed semen in swamp buffaloes from different agroecosystems. The study was carried out in different agroecosystems: riverside (Brebes Regency) and oil palm plantations (Pandeglang Regency). A total of 72 buffalo cows aged 5–9 years old had normal body conditions. All buffalo cows were given estrus synchronization treatment using prostaglandin hormone (PGF) twice at 11-day intervals. The sexed semen was inseminated at a fixed time, 72 hours after the second PGF injection. A conception check was done 60 days after AI using ultrasonography and rectal palpation. The parameters observed were conception and calving rate. The data were analysed descriptively. The results showed the mean conception rate and calving rate were 50.7% and 46.2%, respectively. The differences in conception (43.3 vs. 57.1%) and calving rate (40.0 vs. 52.3%) between the agroecosystems of riverside and palm oil plantations, respectively. The use of sexed semen resulted in moderate conception and calving rates. This research indicated that sexed semen can be applied in an AI program for buffaloes at farm levels.

Ultrasound Imaging and Ovarian Follicles Growth of Mares at Nirwana Equestrian Club

Mares in the estrus cycle by the form of reproductive determine the precision of ovulating time so that efficient to the appropriate time of artificial insemination for breeding. The determination requires supporting medical equipment such as Ultrasonography during the ovulation. This research was conducted to know the ovarian follicle imaging of mares during estrus with Ultrasonography that helps through presume ovulation and the appropriate time to proceed with artificial insemination. This observation was conducted at Nirwana Equestrian Club Semarang, from October until December 2023. The sampling is collected by purposive sampling method where the sample is specifically the mares while in their estrus symptom. The collected data and information are processed descriptively using laboratory equipment such as Ultrasonography. The observation collected the mares physical estrus symptoms such as urination, vulvar pulsination, and vaginal fluid discharge. Significant development was observed from the initial follicle size of 5.34 cm to 5.61 cm in one of the samples with the examination interval within 18 hours before the occurrence of the corpus luteum. The results were proved by 9 samples of mares that had been measured with ultrasound during their estrus, and undergoing pregnancy by one attempt of artificial insemination. The optimum time for artificial insemination for mare is during ovulation where the effective precision is supported by ultrasonography.

Multiple births from medically assisted reproduction: contribution of different types of procedures and trends over time

ObjectiveTo evaluate the relative impact of different strategies of medically assisted reproduction (MAR), i.e. first line treatment (ovarian stimulation with or without intrauterine insemination) and in vitro fertilization (IVF) procedures (conventional IVF or intracytoplasmic sperm injection), on the risk of multiple births. Study designWe utilized the health care utilization databases of the Lombardy region to identify births resulting from MAR between 2007 and 2022. We gathered data on the total number of multiple births and calculated the prevalence rate by dividing the number of multiples by the total number of births. To examine the temporal trend in the proportion of multiple births after MAR over time, a linear regression model was employed separately for different types of techniques and in strata of maternal age. ResultsA total of 30,900 births after MAR were included; 4485 (14.5 %) first line treatments and 26,415 (85.5 %) IVF techniques. Overall, 4823 (15.6 %) multiple births were identified. The frequency of multiple births over the study period decreased from 22.0 % in 2007 to 8.7 % in 2022 (p < 0.01). Multiple births from first line treatments were stable ranging from 13.5 % in 2007–2008 to 12.0 % in 2021–2022 (p = 0.29). Multiple births from IVF procedures decreased from 23.8 % in 2007–2008 to 8.4 % in 2021–2022 (p < 0.01). Stratifying for maternal age (i.e. < 35 and ≥ 35 years), the trends remained consistent. ConclusionsThe reduction in multiple births has been influenced by changes in IVF strategy and procedures. The decline has been gradual but steady since 2009, when a law restricting embryo freezing was repealed in Italy. In contrast, the proportion of multiple births resulting from first line treatments has remained constant over time. Despite declining, multiple births from MAR remained about one order of magnitude higher than those from spontaneous pregnancies.

Characterizing the consistency of motion of spermatozoa through nanoscale motion tracing

To demonstrate nanoscale motion tracing of spermatozoa and present analysis of the motion traces to characterize the consistency of motion of spermatozoa as a complement to progressive motility analysis. Anonymized sperm samples were videographed under a quantitative phase microscope, followed by generating and analyzing superresolution motion traces of individual spermatozoa. Not applicable. Centrifuged human sperm samples. Not applicable. Precision of motion trace of individual sperms, presence of a helical pattern in the motion trace, mean and standard deviations of helical periods and radii of sperm motion traces, speed of progression. Spatially sensitive quantitative phase imaging with a superresolution computational technique MUltiple SIgnal Classification ALgorithm allowed achieving motion precision of 340 nm using ×10, 0.25 numerical aperture lens whereas the diffraction-limited resolution at this setting was 1,320 nm. The motion traces thus derived facilitated new kinematic features of sperm, namely the statistics of helix period and radii per sperm. Through the analysis, 47 sperms with a speed >25 μm/s were randomly selected from the same healthy donor semen sample, it is seen that the kinematic features did not correlate with the speed of the sperms. In addition, it is noted that spermatozoa may experience changes in the periodicity and radius of the helical path over time. Further, some very fast sperms (e.g., >70 μm/s) may demonstrate irregular motion and need further investigation. Presented computational analysis can be used directly for sperm samples from both fertility patients with normal and abnormal sperm cell conditions. We note that MUltiple SIgnal Classification ALgorithm is an image analysis technique that may vaguely fall under the machine learning category, but the conventional metrics for reporting found in Enhancing the QUAlity and Transparency Of health Research network do not apply. Alternative suitable metrics are reported, and bias is avoided through random selection of regions for analysis. Detailed methods are included for reproducibility. Kinematic features derived from nanoscale motion traces of spermatozoa contain information complementary to the speed of the sperms, allowing further distinction among the progressively motile sperms. Some highly progressive spermatozoa may have irregular motion patterns, and whether irregularity of motion indicates poor quality regarding artificial insemination needs further investigation. The presented technique can be generalized for sperm analysis for a variety of fertility conditions.

Surgical management of an ectopic pregnancy in the setting of an unexpected Müllerian anomaly: intraoperative and postoperative implications

ObjectiveTo describe the intraoperative and postoperative implications arising from the unexpected diagnosis of a Müllerian anomaly during the surgical management of an ectopic pregnancy. DesignVideo article. SettingAcademic Center. Subject(s)A 39-year-old nulligravid woman with anovulation and irregular menstrual cycles presented to the office. Her urine pregnancy test was incidentally positive; serum β-human chorionic gonadotropin (β-hCG) level was 5,644 mIU/mL. Outpatient transvaginal ultrasonography (TVUS) demonstrated a 2.1 x 1.7 x 2.2-cm thick-walled structure in the left adnexa without an intrauterine pregnancy. These findings were highly suspicious for a left tubal ectopic pregnancy. The patient was consented for laparoscopy with planned left salpingectomy. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionDiagnostic laparoscopy did not show an obvious left tubal ectopic pregnancy. Instead, a right unicornuate uterus with a dilated rudimentary left uterine horn was seen. Both fallopian tubes and ovaries appeared normal. These laparoscopic findings were consistent with an ectopic pregnancy in the rudimentary horn. However, in the absence of informed consent for a hemi-hysterectomy and no evidence of ectopic rupture or bleeding within the pelvis, we decided to proceed with excision of the ectopic pregnancy from the uterine horn. An incision was made over the anterior surface of the uterine horn, and the pregnancy sac was dissected from the underlying myometrium and excised in its entirety. Left salpingectomy was also performed. The patient was discharged home the same day, and her β-hCG levels decreased to <5 mIU/mL within 28 days of surgery. Main Outcome MeasuresComplete resolution of a left rudimentary uterine horn ectopic pregnancy through surgical excision of the pregnancy sac without hemi-hysterectomy. ResultsPostoperative hysterosalpingography (HSG) demonstrated a right unicornuate uterus with normal fill and spill of the right fallopian tube. Magnetic resonance imaging (MRI) of the pelvis confirmed the findings of a right unicornuate uterus with a non-communicating left rudimentary uterine horn that did not contain any endometrial tissue. Thus, the patient did not require an interval hemihysterectomy. She underwent letrozole and intrauterine insemination treatment 5 months after the initial surgery, which resulted in a clinical intrauterine pregnancy. However, this pregnancy was terminated in the early second trimester due to findings of trisomy 18. She conceived naturally one year later, and this pregnancy resulted in a full-term vaginal birth at 39 weeks gestation. ConclusionUndiagnosed or unexpected Müllerian anomalies can impact the standard intraoperative and postoperative management of ectopic pregnancies.

Association of genomic prediction for twin pregnancies with the incidence of double ovulation in primiparous dairy cows.

Twin pregnancies compromise the health and well-being of dairy cattle. A recent genomic prediction model for twin pregnancies has been developed based on twin calving or abortion. However, the incidence of double ovulation is significantly higher than that of twin births. This study aimed to evaluate whether genomic prediction values for twin pregnancies are associated with the incidence of double ovulation in primiparous dairy cows. Factors influencing the double ovulation rate were analysed using binary logistic regression on 676 cows: 475 (70.3%) inseminated at spontaneous estrus and 201 following one of two different estrus synchronization protocols for fixed-time artificial insemination (FTAI). The odds ratio for double ovulations was 0.92 (p = .002) per unit increase in prediction value and 2 (p = .01) for cows subjected to an FTAI protocol. Our findings suggest that genomic prediction values for twin pregnancies can effectively identify the risk of double ovulation at the herd level.