Clinical Assisted Reproduction Research Articles

‘Like going to get a facial’: Heterotopic spaces and gendered aesthetics of commercial Australian reproductive clinics

The ethical effect of aesthetics is underexplored in literatures on healthcare, especially reproductive services. Healthcare aesthetics play a particular role in influencing patient choice, and in so doing, mediates who is – and is not – welcomed into certain medical spaces. This is particularly pertinent in the context of assisted reproductive clinics, which are often seeking competitive advantage in a market where patients purportedly have a choice amongst providers, and where providers have the capital to invest in clinic design and social media presence to attract patients. Interrogating aesthetic and spatial dimensions of reproductive clinics is especially critical in uncovering gendered, class, and racial assumptions of reproductive futures. As such, ethical inquiry would benefit from examining the aesthetic qualities of ART and its implications on the reproduction of commercialized, gendered, and racialized health settings. In this paper, we draw on reflections made by participants about aesthetics during qualitative interviews on commercial influences on ART services. We expand on these initial reflections by engaging with feminist literature on the image in reproductive ethics and broader scholarship regarding health environments. In doing so, we examine the normative assumptions and effects held within clinic aesthetics to discuss the construction and influence of ‘pink’ reproductive spaces.

P-207 Analysis of oocyte morphology: differences between rescued and non-rescued metaphase II oocytes after conventional ovarian hyperstimulation

Abstract Study question Are there morphological differences between rescued and non-rescued metaphase II oocytes after conventional ovarian hyperstimulation (COH)? Summary answer Rescued metaphase II oocytes have a smaller diameter and a higher zona pellucida/perivitelline space ratio than non-rescued metaphase II oocytes. What is known already The rescue of germinal vesicles and metaphase I in assisted reproduction clinics has increased in recent years, but it is still not widely used because these oocytes have a lower developmental potential compared to oocytes matured in the follicular environment. Recent studies focus on the different strategies for the oocyte maturation process in the laboratory, one of them showed that rescued metaphase II oocytes have a smaller diameter than oocytes matured within the follicular environment. To our knowledge, this is the first study to analyze in detail the morphological differences between in vivo and in vitro matured oocytes. Study design, size, duration This retrospective study includes the analysis of 144 non-rescued metaphase II oocytes images and 181 rescued metaphase II oocytes images obtained after decumulation, or decumulation and in vitro maturation. Images were acquired over four months using Embryoscope TimeLapse systems. Morphological parameters were manually annotated by one single operator, to reduce the discrepancy of measurements, using the drawing tools of the EmbryoViewer software: oocyte area (μm2), polar body area (PBA)(μm2), zona pellucida (μm), perivitelline space (PVS)(μm). Participants/materials, setting, methods First, the different variables measured were analyzed to see if they were related to each other. Then, measurements obtained from images of non-rescued metaphase II oocytes were compared with those of the rescued. In addition, relationships between the different morphological parameters (oocyte area/PBA ratio, oocyte area/zona pellucida ratio, oocyte area/PVS ratio, zona pellucida/PVS ratio, PBA/PVS ratio and PBA/zona pellucida ratio) were calculated and their values were compared between oocytes from different maturation origins. Main results and the role of chance In both rescued and non-rescued metaphase II oocytes, a significantly positive correlation was detected between oocyte area and PBA*, and zona pellucida thickness*. It was also found a significant negative correlation between PVS size and PBA*. For rescued oocytes, a significantly negative correlation was also found between oocyte area and PVS*. Comparison of the means of age, BMI, AMH and all the morphological parameters analyzed between the two groups showed significant differences in age*, oocyte área*, PVS*, oocyte area-zona pellucida ratio*, oocyte area -PVS ratio*, zona pellucida -PVS ratio*, PBA -PVS ratio *. The average of these variables in the rescued oocytes group were: 28.77 ± 6.25, 9734.70 ± 681.28, 8.79 ± 4.43, 628.10 ± 116.29, 1391.86 ± 689.13, 2.24 ± 1.11, 50.84 ± 40.81; while their mean in the non-rescued oocytes group were: 24.41 ± 4.15, 10152.63 ± 711.3, 11.73 ± 5.62, 675,08 ± 111.48, 1063.32 ± 554.35, 1.60 ± 0.82, 37.65 ± 24.55. In addition, multivariable logistic regression showed that the differences in oocyte area size and zona pellucida/PVS ratio remained statistically different between the two groups despite the difference in patient age*. (p<.05*) Limitations, reasons for caution This study is limited by its descriptive and single-center nature. A multicenter study that also evaluates the developmental potential of oocytes would be needed. Wider implications of the findings Our study shows morphological differences between rescued and non-rescued metaphase II oocytes. It could be studied whether these differences are associated with the lower developmental competence of rescued metaphase II oocytes that has been observed in previous studies. Trial registration number Not applicable

P-298 The use of propensity score matching to assess the effectiveness of the endometrial receptivity analysis in patients with recurrent implantation failure

Abstract Study question The purpose of this study was to investigate the effect of ERA on pregnancy outcomes in patients with RIF. Summary answer The results of the study showed no significant difference in pregnancy outcomes in patients who received ERA compared to those who did not. What is known already One potential cause of implantation failure is abnormal endometrial receptivity, and how to objectively evaluate endometrial receptivity has been a matter of great concern. Endometrial receptivity analysis (ERA), a microarray-based test that assesses endometrial gene expression, may be valuable in predicting endometrial receptivity, but whether ERA improves pregnancy outcomes in patients with recurrent implantation failure (RIF) is currently controversial. Study design, size, duration We performed a retrospective cohort study analysis for a population of patients with RIF undergoing frozen embryo transfer (FET) cycles in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022(n = 1598). Participants/materials, setting, methods FET cycles with personalized embryo transfer (PET) under ERA guidance were included in the ERA group (n = 43); after using propensity score matching (PSM), a total of 120 FET cycles were included as a control group. Pregnancy outcomes were compared between the two groups. Further, the relationship between the number of previous implant failures and the rate of implant window displacement was discussed. The factors affecting the window of implantation (WOI) displacement were also assessed. Main results and the role of chance There was no statistically significant difference in embryo implantation rate, clinical pregnancy rate, spontaneous abortion rate, and live birth rate between the ERA group and the matched control patients (P > 0.05). Limitations, reasons for caution Our study is a non-large sample size retrospective study, because ERA is not a routine test in assisted reproductive technology clinics. Wider implications of the findings In our study, PET did not significantly improve pregnancy outcomes in patients with RIF, no significant differences in pregnancy outcomes were found between patients with moderate and severe RIF after PET, and no underlying etiology affecting WOI displacement was identified. Trial registration number not applicable

P-552 Unveiling associated factors to in vitro embryonic ploidy: Insights from 8194 blastocysts by Next Generation Sequencing

Abstract Study question What factors are associated with an increased probability of having aneuploid or mosaic embryos in vitro? Summary answer Maternal age and biopsy day significantly influence aneuploidy, while trophectoderm quality impacts both aneuploidy and embryo mosaicism. What is known already Embryonic aneuploidy and mosaicism are critical factors affecting the success of in vitro fertilization. Several studies have demonstrated that advanced maternal age is the most important variable associated with chromosomal abnormalities. However, the influence of other factors, including the day of the blastocyst biopsy and the quality of specific embryonic components, such as the trophectoderm, on the likelihood of aneuploidy and mosaicism is less understood. Study design, size, duration This retrospective study involved the analysis of 8,194 blastocyst embryos derived from 2,180 IVF/ICSI cycles at a specialized assisted reproduction clinic. The study spanned 7 years, from 2017 to 2023, focusing on identifying factors influencing embryonic ploidy Participants/materials, setting, methods Retrospective analysis of 8194 blastocysts from 2180 IVF/ICSI cycles at a single fertility center. Evaluated maternal age, paternal age, day of embryo biopsy, inner cell mass and trophectoderm quality, embryo biopsy operator, fertilization technique, using logistic regression to assess impact on ploidy (euploid, aneuploid, mosaic). Analysis identified significant factors influencing ploidy, adjusting for confounders. Statistical significance at p < 0.05. Main results and the role of chance The analysis of 8,194 blastocyst embryos highlighted significant findings. Maternal age showed a considerable impact on aneuploidy with a p-value <0.001 and an odds ratio (OR) of 1.74, indicating a strong association. Similarly, the day of embryo biopsy was a significant factor (p < 0.001, OR = 1.51) emphasizing its influence on embryo aneuploidy. The quality of the trophectoderm was a crucial factor, with a notable correlation with both aneuploidy (p < 0.001, OR = 1.78) and mosaicism (p < 0.001, OR = 1.28). Further analysis was also performed to find the variables associated with mosaicism, and the only significant variable was quality of trophectoderm increasing the probability of mosaicism by 28%. These statistical values underscore the robustness of the study’s conclusions. The large sample size and the application of logistic regression models further minimized the role of chance, enhancing the reliability of these findings. The research provides significant insights into the factors influencing embryonic ploidy, extending beyond the well-recognized impact of maternal age. It underscores the importance of considering these variables in clinical assessments during fertility treatments, particularly in evaluating the risk of chromosomal abnormalities. Limitations, reasons for caution The study’s retrospective nature limits causal inferences. The findings need validation in prospective, multicenter studies to establish broader applicability and account for potential biases. Wider implications of the findings These results contribute to the understanding of the factors associated with aneuploidy and embryonic mosaicism, beyond maternal age. Integrating the day of embryo biopsy and trophectoderm quality as key factors into clinical evaluation that could improve clinical decision-making in fertility treatments, especially in assessing the risk of chromosomal abnormalities. Trial registration number Non-Clinical trials

International Committee for Monitoring Assisted Reproductive Technology world report: assisted reproductive technology, 2015 and 2016

ObjectiveTo report utilization, effectiveness, and safety of assisted reproductive technologies in 2015 and 2016. DesignRetrospective, cross-sectional survey of 3103 assisted reproductive technology clinics in 74 countries in 2015 and 3249 clinics in 79 countries in 2016 that submitted cycle and pregnancy outcome data through national and regional registries. SubjectsPatients undergoing assisted reproductive technology procedures. ExposureAssisted reproductive technology. Main Outcome MeasuresOutcomes on country, regional, and global levels. ResultsReported for 2015: 2,358,239 cycles with 548,652 babies born; for 2016: 2,807,963 cycles with 647,188 babies born. Estimated in 2015, ≥2,683,677 cycles resulted in >675,134 babies; in 2016, ≥3,100,448 cycles resulted in ≥723,026 babies. Reported cycles represent approximately 80% of global utilization. In 2015 and 2016, 27.6% and 27.8%, respectively, of women undergoing fresh autologous cycles were age ≥40 years. Frozen-thawed embryo transfer cycles accounted for 47.0% and 51.9%, respectively, of all embryo transfers in 2015 and 2016. Oocyte donation cycles accounted for 6.7% and 7.1% of all embryo transfers in 2015 and 2016. Intracytoplasmic sperm injection was performed in 57.7% and 56.4% of autologous aspiration cycles in 2015 and 2016, respectively. The cumulative delivery rate per aspiration cycle for fresh and frozen-thawed embryo transfer was 32.4% in 2015 and 33.1% in 2016, respectively. The average number of transferred embryos was 1.70 in 2015 and 1.69 in 2016. The proportion of single embryo transfers in fresh autologous cycles increased from 42.1% in 2015 to 44.0% in 2016. The twin delivery rate decreased from 16.0% in 2015 to 14.7% in 2016, and the triplet rate decreased from 0.6% in 2015 to 0.4% in 2016. The proportion of single embryo transfers in frozen-thawed embryo transfer autologous cycles was 62.2% in 2015 and 64.2% in 2016, with twin and triplet rates of 10.1% and 0.3% in 2015 and 10.0% and 0.2% in 2016, respectively. ConclusionUtilization of assisted reproductive technology and births per cycle increased from 2015 to 2016 while multiple births were reduced . Increasing proportion of frozen-thawed embryo transfer cycles, continuing wide variation in use of intracytoplasmic sperm injection, and increase in single embryo transfer rates are reported.

Can Microfluidics Improve Sperm Quality? A Prospective Functional Study.

The same sperm selection techniques in assisted reproduction clinics have remained largely unchanged despite their weaknesses. Recently, microfluidic devices have emerged as a novel methodology that facilitates the sperm selection process with promising results. A prospective case-control study was conducted in two phases: 100 samples were used to compare the microfluidic device with Density Gradient, and another 100 samples were used to compare the device with the Swim-up. In the initial phase, a significant enhancement in progressive motility, total progressive motile sperm count, vitality, morphology, and sperm DNA fragmentation were obtained for the microfluidic group compared to Density Gradient. Nevertheless, no statistically significant differences were observed in sperm concentration and chromatin structure stability. In the subsequent phase, the microfluidic group exhibited significant increases in sperm concentration, total progressive motile sperm count, and vitality compared to Swim-up. However, non-significant differences were seen for progressive motility, morphology, DNA structure stability, and DNA fragmentation. Similar trends were observed when results were stratified into quartiles. In conclusion, in a comparison of microfluidics with standard techniques, an improvement in sperm quality parameters was observed for the microfluidic group. However, this improvement was not significant for all parameters.

Evaluation of ovarian reserve in women with thyroid autoimmunity.

To compare the ovarian reserve of women of reproductive age with and without thyroid autoimmunity (TAI). We performed a retrospective analysis of medical records from an assisted reproduction clinic from February 2017 to December 2021. Women aged between18 and 47 years with data on antithyroperoxidase and antithyroglobulin (anti-Tg) antibodies and assessment of ovarian reserve by anti-müllerian hormone (AMH) and antral follicle count (AFC) were included. Among the 188 participants included, 63 were diagnosed with TAI, and 125 had both antibodies negative. AMH and AFC were compared between groups. Subanalysis based on age, types of antibodies, and thyroid function markers were performed. In addition, bivariate analysis and regression models were used. Overall, there was no difference in the median levels of AMH or AFC between the two groups. However, in the subgroup analysis by age, we observed a trend towards lower median levels of AMH in women over 39 years with TAI (0.9 ng/mL vs. 1.5 ng/mL, p=0.08). In a subanalysis according to antibodies, we found a significantly lower median AFC in the group with anti-Tg than in the group without this antibody (8.0 follicles vs. 11.5 follicles, p=0.036). We also found a significantly higher prevalence of anti-Tg in patients with low ovarian reserve compared to those with normal reserve (60.7% vs. 39.3%, p=0.038). The ovarian reserve of women with TAI appears to be insidiously compromised over the years, with a decreased ovarian reserve in women with anti-Tg.

A Discrete Event Simulation of Patient Flow in an Assisted Reproduction Clinic With the Integration of a Smart Health Monitoring System

A Discrete Event Simulation of Patient Flow in an Assisted Reproduction Clinic With the Integration of a Smart Health Monitoring System

Comparison of biochemical and clinical pregnancy rate and first outcomes with or without non-invasive preimplantation genetic testing for aneuploidies: a retrospective cohort study.

Evaluation of embryos’ genetic status is an increasingly widespread practice in assisted reproduction clinics. The existence of limitations with PGT-A, such as the invasive nature of the biopsy procedure and the need for the technical ability of embryologists, added with the knowledge that a determinate number of cells in trophectoderm might not be representative of the entire embryo genetics, is leading to increase the use of non-invasive PGT-A (niPGT-A) using spent cultured medium (SMCs) by embryos analyzed. This retrospective cohort study from May 2022 to August 2023 analyzed first experiences with niPGT-A, setting characteristics of patients—first, results obtained comparing pregnancy outcomes with frozen embryo transfer (FET) without niPGT-A. A total of 56 SCMs were collected. The average age of women in the study was 37.4±4.2 in the niPGT-A group and 36.0±5.9 in the FET group (p= 0.2953). The main reasons why couples decided to undergo niPGT-A were women’s age (46.7%), male factor (20.0%), and RIF (16.7%). No significant differences were seen between niPGT-A (n=14) and elective FET (n=18) groups in terms of biochemical pregnancy rate (35.7% vs 38.8%; p=0.4298) and clinical pregnancy rate (35.7% vs 33.3% p=0.4462) (CI 95%). Based on the results obtained, niPGT-A is an excellent alternative to assess the chromosomal status of cultured embryos. Comparing groups, no significant differences were found in biochemical and clinical pregnancy rates. A small number of samples represent a limitation; large-scale randomized studies will be necessary.

A compact, high-throughput semi-automated embryo vitrification system based on hydrogel

Research questionWhat is the efficiency and efficacy of the novel Biorocks semi-automated vitrification system, which is based on a hydrogel? DesignThis comparative experimental laboratory study used mouse model and human day 6 blastocysts. Mouse oocytes and embryos were quality assessed post-vitrification. ResultsThe Biorocks system successfully automated the solution exchanges during the vitrification process, achieving a significantly improved throughput of up to 36 embryos/oocytes per hour. Using hydrogel for cryoprotective agent delivery, 12 vessels could be processed simultaneously, fitting comfortably within an assisted reproductive technology (ART) workstation. In tests involving the cryopreservation of oocytes and embryos, the system yielded outcomes equivalent to the manual Cryotop method. For example, the survival rate for mouse oocytes was 98% with the Biorocks vitrification system (n = 46) and 95% for the manual Cryotop method (n = 39), of which 46% and 41%, respectively, progressed to blastocysts on day 5 after IVF. CC-grade day 6 human blastocysts processed with the Biorocks system (n = 39) were associated with a 92% 2 h re-expansion rate, equivalent to the 90% with Cryotop (n = 30). The cooling/warming rates achieved by the Biorocks system were 31,900°C/minute and 24,700°C/minute, respectively. Oocyte quality was comparable or better post-vitrification for Biorocks than Cryotop. ConclusionsThe Biorocks semi-automated vitrification system offers enhanced throughput without compromising the survival and developmental potential of oocytes and embryos. This innovative system may help to increase the efficiency and standardization of vitrification in ART clinics. Further investigations are needed to confirm its efficacy in a broader clinical context.

Islamic Perspectives on Polygenic Testing and Selection of IVF Embryos (PGT-P) for Optimal Intelligence and Other Non-Disease-Related Socially Desirable Traits.

In recent years, the genetic testing and selection of IVF embryos, known as preimplantation genetic testing (PGT), has gained much traction in clinical assisted reproduction for preventing transmission of genetic defects. However, a more recent ethically and morally controversial development in PGT is its possible use in selecting IVF embryos for optimal intelligence quotient (IQ) and other non-disease-related socially desirable traits, such as tallness, fair complexion, athletic ability, and eye and hair colour, based on polygenic risk scores (PRS), in what is referred to as PGT-P. Artificial intelligence (AI) and machine learning-based analysis of big data sets collated from genome sequencing of specific human ethnic populations can be used to estimate an individual embryo's likelihood of developing such multifactorial traits by analysing the combination of specific genetic variants within its genome. Superficially, this technique appears compliant with Islamic principles and ethics. Because there is no modification of the human genome, there is no tampering with Allah's creation (taghyīr khalq Allah). Nevertheless, a more critical analysis based on the five maxims of Islamic jurisprudence (qawa'id fiqhiyyah) that are often utilized in discourses on Islamic bioethics, namely qaṣd (intention), yaqın̄ (certainty), ḍarar (injury), ḍarūra (necessity), and `urf (custom), would instead reveal some major ethical and moral flaws of this new medical technology in the selection of non-disease-related socially desirable traits, and its non-compliance with the spirit and essence of Islamic law (shariah). Muslim scholars, jurists, doctors, and biomedical scientists should debate this further and issue a fatwa on this new medical technology platform.

Islamic Viewpoints on Opportunistic Sex Selection of IVF Embryos upon doing Preimplantation Genetic Testing for Preventing Genetic Diseases.

In recent years, preimplantation genetic testing (PGT) of IVF embryos have gained much traction in clinical assisted reproduction for preventing various genetic defects, including Down syndrome. However, such genetic tests inevitably reveal the sex of IVF embryos by identifying the sex (X and Y) chromosomes. In many countries with less stringent IVF regulations, information on the sex of embryos that are tested to be genetically normal is readily shared with patients. This would thus present Muslim patients with unintended opportunities for sex selection based on personal or social biases without any pressing need or valid medical reason. Additionally, there are other patients who claim using PGT for preventing genetic defects as a pretext or "convenient excuse," with a secret intention to do sex selection when it is banned in their home country. Currently, non-medicalsex selection is a highly-controversial and hotly debated issue in Islam, because there is generally a strong preference for having sons over daughters due to widespread cultural norms of elderly parents depending on their sons for financial support, as well as the need for male heirs to continue the family lineage within the backdrop of local patriarchal cultures. There is a risk of gender imbalance and social disequilibrium occurring in Islamic societies due to prevalent sex selection. Hence, the question is whether opportunistic sex selection with PGT would contravene Islamic ethics and principles, which will thus be discussed here.

The ultrastructural nature of human oocytes’ cytoplasmic abnormalities and the role of cytoskeleton dysfunction

To investigate the structural bases of human oocytes' cytoplasmic abnormalities and the causative mechanism of their emergence. Knowledge of an abnormal oocyte's intracellular organization is vital to establishing reliable criteria for clinical evaluation of oocyte morphology. Laboratory-based study on experimental material provided by a private assisted reproduction clinic. University laboratory and imaging center. A total of 105 women undergoing hormonal stimulation for invitro fertilization (IVF) donated their spare oocytes for this study. Transmission electron microscopy (TEM) was used to analyze the fine morphology of 22 dysmorphic IVF oocytes exhibiting different types of cytoplasmic irregularities, namely, refractile bodies; centrally located cytoplasmic granularity (CLCG); smooth endoplasmic reticulum (SER) disc; and vacuoles. A total of 133 immature oocytes were exposed to cytoskeleton-targeting compounds or matured in control conditions, and their morphology was examined using fluorescent and electron microscopy. The ultrastructural morphology of dysmorphic oocytes was analyzed. Drug-treated oocytes had their maturation efficiency, chromosome-microtubule configurations, and fine intracellular morphology examined. TEM revealed ultrastructural characteristics of common oocyte aberrations and indicated that excessive organelle clustering was the underlying cause of 2 of the studied morphotypes. Inhibition experiments showed that disruption of actin, not microtubules, allows for inordinate aggregation of subcellular structures, resembling the ultrastructural pattern seen in morphologically abnormal oocytes retrieved in IVF cycles. These results imply that actin serves as a regulator of organelle distribution during human oocyte maturation. The ultrastructural analogy between dysmorphic oocytes and oocytes, in which actin network integrity was perturbed, suggests that dysfunction of the actin cytoskeleton might be implicated in generating common cytoplasmic aberrations. Knowledge of human oocytes' inner workings and the origin of morphological abnormalities is a step forward to a more objective oocyte quality assessment in IVF practice.

Mapping ethical, legal, & social implications (ELSI) of assisted reproductive technologies.

A significant portion of the research on assisted reproductive technologies explores ethical, legal, and social implications. It has an impact on social perceptions, the evolution of norms of clinical practices, regulations and public funding. This paper reviews and maps the geographical distribution to test the hypothesis of geographical concentration and classifies the output by fields and topics. We queried PubMed, Scopus and the Web of Science for documents published between 1999 and 2019, excluding clinical trials and medical case reports. Documents were analyzed according to their titles, abstracts and keywords and were classified to assisted reproductive fields and by Topic Modeling. We analyzed geographic distribution. Research output increased nearly tenfold. We show a trend towards decentralization of research, although at a slower rate compared with clinical assisted reproduction research. While the U.S. and the U.K.'s share has dropped, North America and Western Europe are still responsible for more than 70%, while China and Japan had limited participation in the global discussion. Fertility preservation and surrogacy have emerged as the most researched categories, while research about genetics was less prominent. We call to enrich researchers' perspectives by addressing local issues in ways that are tailored to local cultural values, social and economic contexts, and differently structured healthcare systems. Researchers from wealthy centers should conduct international research, focusing on less explored regions and topics. More research on financial issues and access is required, especially regarding regions with limited public funding.

Comparison of microbial profiles and viral status along the vagina-cervix-endometrium continuum of infertile patients

For decades, the endometrium was considered to be a sterile environment. However, now this concept is disputed, and there is growing evidence that microbiota composition might affect endometrial receptivity. Routine clinical management of infertility is still limited to a microbiological assessment of the lower reproductive tract. The purpose of this study was to compare the abundance of various bacterial, fungal, and viral species, qualitatively and quantitatively, in vaginal, cervical, and endometrial biomaterial of infertile patients. A total of 300 samples from 100 infertile patients of a private assisted reproduction clinic were analyzed. A broad real-time polymerase chain reaction panel was used to identify 28 relevant microbial taxa as well as three members of the Herpesviridae family. All patients underwent endometrial biopsy for further histopathological evaluation. Analysis of the microbial diversity (within the boundaries of the detection panel) revealed that Shannon indexes in the cervix and vagina were similar (1.4 × 10−2 (1.6 × 10−3 – 6.5 × 10−1) vs 1.9 × 10−2 (2.3 × 10−3 – 5.3 × 10−1), respectively, p = 0.502), whereas endometrial indexes differed significantly from both regions (0 (0 – 1.4 × 10−1), p < 0.0001). Surprisingly, 17 microbial and viral taxa were detected in at least one sample. Endometrium exhibited a quite distinct microbiological profile, being different at the detection rates of 14 taxa (p < 0.05). Remarkably, 4% and 2% of endometrial samples were positive for Cytomegalovirus and Candida spp., respectively, while these were undetectable in corresponding cervical and vaginal samples. Prevalence of the Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. group in endometrium was associated with a low abundance of Lactobacillus spp. (p = 0.039). No noteworthy associations were identified between various microbiota characteristics and clinical parameters, such as chronic endometritis, uterine polyps and adhesions, endometriosis, and a history of sexually transmitted infections. These findings indicate that the microbiological profile of the endometrium is unique, and the analysis of the lower reproductive tract should supplement, rather than be a substitute for it.

THE IMPACT OF GENETIC COUNSELORS IN ASSISTED REPRODUCTION CLINICS: A SURVEY OF PRACTICE MANAGERS

Genetics-related indications are increasingly occupying clinicians’ time in assisted reproduction clinics. Genetic counselors (GCs) are uniquely equipped to address genetic aspects of reproductive care; however, few fertility clinics employ genetic counselors, often relying on laboratory-based GCs instead. The objective of this study was to evaluate the current scope of practice and impact of genetic counselors employed by assisted reproduction clinics.

The possibilities of opportunistic cervical screening in the assisted reproductive technology clinic

Secondary prevention of cervical cancer in the conditions of opportunistic cervical screening by co-testing in 5618 women over 30 years of age allowed to identify a high-risk group of cervical cancer for further examination using viral load assessment, immunocytochemical determination of the level of cancer proteins p16INK4a and Ki-67, extended video colposcopy and cervical biopsy with histological examination of surgical material. The obtained data demonstrated the expediency of changing the testing strategy by integrating the methods tested in the framework of opportunistic screening into the nationwide population screening program for cervical cancer.

Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis.

To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.

Advances in the study of HLA class Ib in maternal-fetal immune tolerance.

The HLA class Ib molecule is an alloantigen that causes transplant rejection on behalf of individual human and plays an important role in maternal-fetal immune tolerance. Early studies on HLA class Ib focused on the mechanism of HLA-G-induced immune escape, but in recent years, studies on the mechanism of HLA-G have deepened and gradually explored the mechanism of HLA-E and HLA-F, which are also HLA class Ib molecules. In the maternal-fetal interface, trophoblast cells express HLA class Ib molecules to protect the fetus from maternal immune cells by binding to inhibitory receptors of decidual immune cells (DICs) and shifting Th1/Th2 balance toward Th2 bias. Further studies on the molecular mechanism of HLA class Ib molecules provide a reference for its application in the field of clinical assisted reproduction.

The effect of oocyte denudation time and intracytoplasmic sperm injection time on embryo quality at assisted reproductive technology clinic – A cross-sectional study

BackgroundThis study aims to determine whether there is an effect of oocyte denudation time and ICSI time on embryo quality at assisted reproductive Technology clinic. MethodsAn observational analytic retrospective study was conduct using cross-sectional study. The subject were oocytes from in-vitro fertilization procedures using the ICSI method at the assisted reproductive technology clinic in a private hospital in Bandung for the period 2017 - 2019. Three variables were oocyte denudation time, ICSI time and embryo quality collected from samples that met the research criteria. Data will be grouped based on denudation time (T1) and Intracytoplasmic Sperm Injection time (T2). ResultFrom the 5 groups of denudation time; 3–4 hours, 4–5 hours, 5–6 hours, 6–7 hours and more than 7 hours group, the denudation time of 3–4 hours group showed the highest number (66.7%) for excellent embryo quality results, while denudation time of more than 7 hours showed the lowest number (29.2%) for excellent embryo quality results with p < 0.001. From these figures, it shows that the ICSI time of 3–4 hours is superior to the ICSI time of 2–3 hours because the outcome of excellent embryo quality is higher while the outcome of poor embryo quality is lower, although the difference is not significant (p = 0.140). ConclusionThis study shows there was a significant difference in the effect of oocyte denudation time on embryo quality at assisted reproductive technology clinic. There was no significant difference in the effect of intracytoplasmic sperm injection (ICSI) time on embryo quality at assisted reproductive technology clinic.