Assisted Reproduction Program Research Articles

Management strategies for POSEIDON patients with poor ovarian response to ovarian stimulation: а literature review

A poor ovarian response to ovarian stimulation is a factor that significantly reduces the effectiveness of in vitro fertilization programs. Managing these patients remains an unresolved issue in assisted reproductive technology programs. The difficulties are largely determined by the heterogeneity of groups of patients with a poor ovarian response and the need for a personalized approach to ovarian stimulation. This review covers the data from the global literature on the management tactics of patients with a poor ovarian response according to the POSEIDON classification, with the aim of increasing the quantity and quality of retrieved oocytes and clinical pregnancy rates.

On the issue of repeated implantation failures with assisted reproductive technologies

Embryo implantation is the first key step of a successful pregnancy, but implantation failures in patients undergoing assisted reproductive technology (ART) programs remains quite common. The main known factors of repeated implantation failures (RIF) in patients undergoing ART are unhealthy lifestyle, genetic factor, uterus pathology, endometriosis and adenomyosis, thrombophilia, and also male factor and embryonic factors. RIF factors and ways to overcome them receive much attention from researchers. However, although many possible RIF causes have been identified, much remains unknown regarding the etiology and management of this condition. In clinical practice, studies and interventions are often used without clear scientific rationale or convincing evidence of their effectiveness due to the lack of standardization of diagnostic and treatment methods. An effective strategy for treating RIF risk factors is necessary to increase the chances of successful pregnancy in assisted reproductive technology programs.

Gonadotropins in assisted reproductive technology programs: A review

Reproductive medicine is actively developing, and new methods, drugs, and protocols are being developed and introduced for the treatment of infertility. Assisted reproductive technologies (ART) are the most effective methods. In ART protocols, ovarian stimulation (OS) is based on gonadotropin use. The choice of the starting dose of gonadotropin is a critical factor in the successful OS and the effectiveness of ART programs. The article describes the development history of gonadotropins and provides current data on their use in ART programs. The use of biosimilars of follitropin alfa in OS is discussed, and the effectiveness of its Russian biosimilar is also addressed. TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back

Reproductive Activity of Socorro Island Merino Ewes and Their Crosses with Pelibuey under Heat Stress Conditions.

An experiment was carried out to evaluate the effect of spring and autumn seasons on the reproductive activity of Merino Socorro Island ewes and their crosses with Pelibuey under heat stress (HS) conditions in the tropics. All ewes (n = 80) were randomly assigned to one of two breeds during the first and second periods, respectively: (1) Twenty Socorro Island Merino ewes (SIM) and (2) 20 Pelibuey Crossbred ewes (PBC). Animals were fed the same diet and given water ad libitum. All statistical analyses were performed using SAS statistical software 9.12 procedures. In both seasons, a mean of more than 80 U of maximum THI was obtained, while in spring and autumn, the minimum THI exceeded 30 and 40 U, respectively. All animals were in oestrus and ovulated in both seasons. The frequency of animals in spring during the first 48 h of oestrus expression was greater (p < 0.05) than 48-55 h but similar (p > 0.05) than 55-65 h; in autumn during the first 48 h and 48-55 h were similar (p > 0.05), but different (p < 0.05) than 55-65 h. The duration of oestrus expression was longer in the spring than in the autumn (p < 0.05). The frequency of animals was higher (p < 0.05) in SIM than in PBC ewes during the first oestrus cycle (1-17 d) and was also higher (p < 0.05) in PBC than in SIM ewes during the second oestrus cycle (18-35 d). The SIM ewes produced more (p < 0.05) progesterone (P4) than the PBC ewes. During the sampling days of the oestrus cycle, more P4 was created in autumn than in spring (p < 0.05). Both breeds showed severe HS. In the future, ewes treated under assisted reproductive programs in the tropics may improve reproductive efficiency.

DETERMINATION OF IL-1β mRNA GENE EXPRESSION AND HMGB-1 mRNA GENE EXPRESSION IN WOMEN WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH INFERTILITY AT THE STAGE OF PREPARATION FOR ASSISTED REPRODUCTIVE TECHNOLOGIES

Despite the large number of studies on the identification and search for noninvasive early diagnostic markers of genital endometriosis, this problem remains relevant today. It is important to introduce early diagnosis of genital endometriosis for the purpose of timely prevention and treatment.Objective: to study the expression levels of IL-1β and HMGB-1 mRNA genes in women with genital endometriosis associated with infertility, and to evaluate the effect of our proposed preparation for assisted reproductive technologies on the level of IL-1β and HMGB-1 mRNA gene expression.Material and methods. To analyze gene expression IL-1β and HMGB-1 and determine relative normalized mRNA expression IL-1β and HMGB-1, the polymerase chain reaction method was used with real-time reverse transcription(RT-PCR. The object of molecular genetic studies using the RT-PCR method was the fraction of mononuclear cells isolated from the whole blood of patients with endometriosis. In this study, we performed a retrospective analysis of the medical records of 30 women with infertility undergoing an assisted reproductive technology program. The main group consisted of 20 women diagnosed with external genital endometriosis who underwent assisted reproductive technologies. Women in the main group, in addition to standard training for assisted reproductive technologies, received a probiotic containing Lactobacilli 1010 manufactured by Unic Biotech Ltd, India. They took one pill twice a day for one month as part of a general treatment before undergoing assisted reproductive technologies. We determined the expression level of IL-1β and HMGB-1 before and after this preparation stage. The control group consisted of 10 women who had tubal infertility due to a previous inflammatory disease, but according to the results of a comprehensive clinical and laboratory examination, they were compared to healthy women. These women, aged 21 to 42 years, with a mean age of 29,75 years, did not receive our proposed preparation with the inclusion of a probiotic. This study was conducted at the Bukovyna State Medical University and the clinic "Yuzko medical center".Results. In the main group, the IL-1β mRNA gene expression level before training was (26,7877±0,01), which was significantly higher than the level after training (0,1610±0,01*). Consequently, the use of the probiotic led to a dramatic reduction in elevated mesothelin levels, underscoring its efficacy and potential application in assisted reproductive technology training programs. Also, a high level of expression of mRNA genes can be noted HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies (table 2). Expression level of mRNA genes HMGB-1in whole blood of women of the main group before preparation for assisted reproductive technologies was (11,9198±0,01). After our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic, the mRNA gene expression level HMGB-1in the whole blood of women of the main group was (0,2821±0,01*). Therefore, our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic is quite effective, since the expression levels of IL-1β mRNA genes and HMGB-1sharply decreased.Conclusions. Extremely high expression of mRNA genes IL-1β and HMGB-1 indicates a close connection between the pathogenesis of endometriosis and inflammation. The inclusion of probiotics in the complex scheme of preparation for assisted reproductive technologies leads to a noticeable improvement in the well-being of the patient and a significant decrease in the expression of IL-1β and HMGB-1 mRNA genes. Therefore, we recommend our proposed preparation for assisted reproductive technologies with the inclusion of a probiotic.

Evaluation of renal function in patients with type 1 diabetes mellitus implementing reproductive function in assisted reproductive technology protocols

The prevalence of type 1 diabetes mellitus has increased significantly among women of reproductive age over the past two decades. Despite improved glycemic control and intensified insulin therapy, patients with diabetes still suffer from many reproductive problems, which often makes this group of patients potential participants in assisted reproductive technology programs under certain conditions. Diabetic nephropathy is one of the most serious complications of type 1 diabetes mellitus. It ranks first in the structure of chronic kidney disease and is a common cause of end-stage renal failure, disability, and mortality. Early diagnosis and identification of specific markers of diabetic nephropathy will allow for timely initiation of nephroprotective therapy to slow the progression of diabetic kidney damage.&#x0D; This review article is based on the results of the PubMed, Frontiers, and ResearchGate search queries from 2016 to 2023. We analyzed worldwide and domestic data on the impact of type 1 diabetes mellitus on kidney function, the influence of sex hormones on diabetic nephropathy, and the importance of the personalized approach to this group of patients at the pre-pregnancy stage, especially those planning treatment within assisted reproductive technology programs.

Overcoming poor ovarian response in assisted reproductive technology programs in patients of late reproductive age

Objective: to increase the effectiveness of in vitro fertilization in patients of late reproductive age by optimizing prepregnancy preparation for the IVF program.Materials and methods: The study included 67 patients of late reproductive age with a history of unsuccessful IVF attempts, divided into two groups at the second stage of the study, depending on the volume of prepregnancy preparation: group 1 (33 patients), group 2 (34 patients). The control group (50 patients) were healthy women of reproductive age. Immunohistochemical examination of the endometrium and microbiological examination of the uterine cavity, hormonal status of peripheral blood, study of the concentration of melatonin in peripheral blood and follicular fluid, antioxidant status of follicular fluid, expression of leukemia inhibitory factor (LIF) in the cervical secretion were performed.Results: in patients with age-related dysregulation of the hypothalamic-pituitary-ovarian axis and impaired fertile function, a systemic and local (in follicles) decrease in melatonin levels was revealed. The studied effects of melatonin suggested that its use in patients of late reproductive age with reduced follicular reserve and a "poor" response to ovarian stimulation may increase the effectiveness of in vitro fertilization (IVF).Conclusions: The inclusion in the pre-gravidar preparation of a complex of water-soluble polypeptide fractions of the epiphysis, stimulating the production of endogenous melatonin, made it possible to increase the effectiveness of IVF in patients by an average of 3.1 times according to the criterion of "clinical pregnancy" and 4.1 times according to the criterion of "live birth".

Prediction of a poor ovarian response in assisted reproductive technology programs in patients after surgical interventions on the ovaries

Prediction of a poor ovarian response in assisted reproductive technology programs in patients after surgical interventions on the ovaries

ЗАСТОСУВАННЯ ПРОГРАМ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ В УКРАЇНІ: УПРАВЛІНСЬКІ АСПЕКТИ

The article discusses managerial aspects of the use of assisted reproductive technology programs in Ukraine. It was noted that it is now critically important for the natural recovery of the population of Ukraine to do everything possible to expand access to treatment, diagnosis and prevention of infertility, in particular with the help of programs of assisted reproductive technologies. It was determined that currently in Ukraine the most active subjects are service providers who determine the direction of development of management relations in the field of application of assisted reproductive technologies. The need to intensify the activities of the authorities regarding their role as a regulator of social relations within their competence is emphasized. Attention is focused on the development of a balanced regulatory toolkit of management, i.e. regulatory and legal acts of different legal force, follows organically from this. Attention was also drawn to the broad context of management in the field of application of assisted reproductive technologies. It is argued that within the scope of determining the priority directions for improvement of management in the field of application of assisted reproductive technology programs in Ukraine, it is expedient to develop not only medical, but also socio-humanitarian and socio-economic research on the evidence of certain reproductive health management practices. It is emphasized that in modern realities, the context of post-war reconstruction should also be taken into account in order to determine the ways of development of management in the field of application of assisted reproductive technologies. It was concluded that in order to ensure the high-quality functioning of the health care sector in the current realities, several options for solving the most acute problems are proposed: strengthening decentralization; expanding the space of freedom for autonomous work of doctors; establishment of coordination of activities between all links of medical care; introduction of new roles in the system of health care services; mental health as priorities for state funding.

Histological changes in the endometrium during intrauterine use of platelet-rich plasma (PRP) in assisted reproductive technology programs

Histological changes in the endometrium during intrauterine use of platelet-rich plasma (PRP) in assisted reproductive technology programs

ЕФЕКТИВНІСТЬ УПРАВЛІННЯ У СФЕРІ ЗАСТОСУВАННЯ ПРОГРАМ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ

The article substantiates the directions for increasing the efficiency of management in the field of application of assisted reproductive technology programs in Ukraine. It was noted that for the successful implementation of new approaches to the management of the DRT sphere, the government, all management bodies and society in general should investigate in more detail the complex of management measures in order to increase the efficiency of the functioning of this system. It is emphasized that the management of the field of DRT is closely related to the management of risks arising from globalization and modernization, which requires management participants to have the skills and ability to recognize and solve problems both in the field of health care and in other areas where risks arise. Attention is focused on the fact that in the process of studying the issues of the effectiveness of DRT management, it is worth focusing on specific Sustainable Development Goals: Goal 3 "Strong health and well-being" and Goal 17 "Partnership for sustainable development". Performance evaluation criteria are proposed, which will contribute to the improvement of the quality of management in the field of application of DRT programs at the current stage of the development of the Ukrainian state. This list of criteria can be further expanded and improved, because these proposals contain those performance indicators that are absolutely necessary at today's stage of development of management relations in the field of DRT application, when the sector is given over to self-regulation, programmatic and regulatory documents are not adopted for years. It is concluded that in order to achieve the maximum effectiveness of management in the field of application of DRT, it is advisable to implement the following principles of health management, which are combined in the general societal and national approaches: management through cooperation; management by involving citizens; management through a combination of regulation and persuasion; management through independent agencies and expert bodies; management through adaptive policies, sustainable structures and forecasting results.

National features of the new Chinese pronatalism

In 2016 the Chinese demographic policy, as a result of improving the regulation of population development, was radically reoriented to increase the birth rate. The rejection of «one-child policy» began with permission to have a second child, and soon was supplemented by second births stimulation. Taking into account the world pronatalism, socio-economic measures were applied. They showed that the most effective results can be achieved with the help of socio-economic tools that prevent deterioration of living conditions of families after childbirth. The regional diversity of China determines variability of such measures, but everywhere they begin with targeted «child» payments and the creation of conditions, which do not interrupt women’s professional career after pregnancy and delivery, then they are expanded through social help to families with children, tax relief, reduction of housing and education costs, as well as measures relevant for specific population groups (large families, single mothers, etc.). The main criterion of the assistance targeting is the number of children, but its size and forms depend on local capabilities. The importance of material factors of reproductive choice decreases with an increase of living standards, the conditions making it possible to combine parenthood and profession, large family traditions, gender of children, fertility preservation with safe contraception become more important. Measures, taking into account national specifics, include availability of assisted reproduction programs and promoting a modern three-child family among the population of reproductive age, a significant part of which belongs to the generation consciously focused on small family.

#338 : Insights into the Zona-Pellucida Mediated Selection of Fertilization-Competent Spermatozoa

Background and Aims: Human zona pellucida (ZP) selectively interacts with high-quality spermatozoa characterized by superior morphology and normal chromatin structure to achieve fertilization. Human ejaculate contains millions of spermatozoa with varying degrees of fertilization potential and genetic quality, of which only thousands of motile spermatozoa can bind to the ZP at the fertilization site. However, direct evidence for ZP-mediated sperm selection process is lacking. This study aims to demonstrate that spermatozoa-ZP interaction represents a crucial step in selecting fertilization-competent spermatozoa in humans. Method: Human spermatozoa and oocytes were obtained with written consents from the donors attending our assisted reproduction program. Acrosome intact, ZP-bound and unbound spermatozoa were recovered using the modified spermatozoa-ZP coincubation assays. ZP-binding protein expression on ZP-bound and unbound spermatozoa were examined by immunofluorescence staining. And the genetic integrity and epigenetic landscapes were evaluated by TUNEL assay, COMET assay, acridine orange staining, chromomycin A3, and immunofluorescence staining for 5-methylcytosine. Results: The time course data demonstrated that ZP interacted with a small proportion of motile spermatozoa. Heat shock 70 kDa protein 2 (HSPA2) and sperm acrosome associated 3 (SPACA 3) are two protein markers associated with the sperm ZP-binding ability. ZP-bound spermatozoa had a higher percentage of positive HSPA2 (85.8% vs. 45.9%, p&lt;0.05) and SPACA3 signals (86.3% vs. 30.5%, p&lt;0.05) than the unbound ones. The signal intensities of both markers were stronger in the ZP-bound spermatozoa than the unbound ones. ZP-bound spermatozoa had a significantly higher level of normal morphology, DNA integrity, chromatin integrity, protamination and global methylation when compared to the unbound ones. Conclusion: Our results validated the functional role of spermatozoa-ZP interaction in providing diagnostic information regarding the fertilization potential and genetic qualities of spermatozoa independent of those derived from the standard semen analysis.

#242 : Correlation of Sperm DNA Fragmentation with Laboratory Performance in Good and Poor Prognosis Patient Groups at Morula IVF Jakarta

BACKGROUND AND AIMS: Infertility in males contributes to about 40% of cases of infertility in couples, either as the main factor or along with female factors. Fragmentation of sperm DNA is known as a cause of male infertility, which impacts the failure of couples to undergo assisted reproductive programs, such as embryo development and recurrent miscarriage. However, some literature studies are still debating this. This research aims to determine the correlation between sperm DNA fragmentation and IVF laboratory performance. METHODS: Infertile couples undergoing an in vitro fertilization program at Morula IVF Jakarta in 2022 are the samples for this study. We divided them into two groups: good prognosis (maternal age [Formula: see text]38 years, AFC[Formula: see text]7; AMH[Formula: see text]1.1) and poor prognosis (maternal age &gt; 38 years, AFC &lt;7, AMH&lt;1.1). Sperm DNA fragmentation was examined using the sperm chromatin dispersion (SCD) assay. Correlation statistical analysis using the Spearman test (p-value &lt;0.05). RESULTS: Based on receiver operating characteristic (ROC) curve analysis, it was found that the sperm DNA fragmentation rate &gt;14.9% had a significant negative correlation with IVF laboratory performance, particularly in the fifth-day embryo quality and blastocyst rate in the good prognosis group. Whereas in the group with poor prognosis, all laboratory performance parameters were not affected by high sperm DNA fragmentation values. CONCLUSIONS: Sperm DNA fragmentation rate &gt; 14.9% correlated with fifth-day embryo quality and a lower blastocyst rate in the good prognosis group.

Risk factors for the ineffectiveness of assisted reproductive technology programs after a woman’s illness with COVID-19

Purpose - to determine the risk factors for the ineffectiveness of ART programs after a woman’s illness with COVID-19. Materials and methods. In the group of 80 examined patients with symptoms of “long-COVID” who applied to the reproductive technology clinic for infertility treatment, 2 subgroups were distinguished: the Subgroup 1: 64 patients in whom assisted reproductive technologies (ART) was unsuccessful (cancellation of transfer, non-occurrence of pregnancy or its loss) and the Subgroup 2: 16 women with successful ART (live birth). Results. Significant differences were found among patients with unsuccessful use of ART in terms of the frequency of the main symptoms of “long-COVID”, the following symptoms stand out: “depression, anxiety” (54.7% vs. 18.8%, p&lt;0.05) and “sleep disturbances” (59.4% vs. 31.3%, p&lt;0.05). A significant difference was also found in social and household factors: the presence of stress (35.9% vs. 12.5%, p&lt;0.05), especially in everyday life (31.3% vs. 6.3%, p&lt;0.05), the presence of bad habits (21.9% vs. 6.3%, p&lt;0.05). A significantly higher frequency of decreased ovarian reserve (32.8% vs. 12.5%, p&lt;0.05) and corresponding hormonal disorders: increased follicle-stimulating hormone (21.9% vs. 6.3%, p&lt;0.05) and decreased anti-Müllerian hormone (25.0% vs. 6.3%, p&lt;0.05). Among somatic pathology, endocrine pathology stands out (45.3% vs. 12.5%, p&lt;0.05), in particular metabolic disorders (34.4% vs. 12.5%, p&lt;0.05). A significant difference was also established in the frequency of liver diseases (21.9% vs. 6.3%, p&lt;0.05) and gastrointestinal tract (23.4% vs. 12.5%, p&lt;0.05). There is a higher frequency of menstrual disorders, namely a decrease in the duration of menstruation (20.3% vs. 6.3%) or, conversely, prolonged menstruation (17.2% vs. 6.3%), an irregular cycle (25.0% vs. 6.3%, p&lt;0.05) and luteal phase insufficiency (21.9% vs. 6.3%, p&lt;0.05). Urogenital infections were noted in 43.8% of patients (vs. 12.5%, p&lt;0.05). Conclusions. Risk factors for the ineffectiveness of ART programs have been established, among which stress, depression and anxiety, bad habits, endocrine pathology, metabolic disorders, liver pathology, menstrual cycle disorders, and urogenital infections are especially highlighted. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

Correlation of progesterone and activin A with pregnancy outcome following IVF/ICSI cycle

The association between the two hormones (progesterone and Activin A) in infertile women on the day of ova pick up and their relationship with pregnancy status in assisted reproductive programs are both poorly understood. To determine the correlation of progesterone and activin A on the day of ova pick up with pregnancy status of women undergoing IVF/ICSI cycle .The study was conducted on 80 infertile couples. The serum at day of ova pick up was collected. Serum progesterone and activin A analysis were done for all samples for activin A. Out of eighty infertile females twenty-five became pregnant (Pregnancy rate = 31%). Serum progesterone levels at days of oocytes pick up was significantly higher in pregnant females than nonpregnant (9.22 ± 0.54 vs. 4.47 ± 0.44; p &lt; 0.001). There was a significantly higher serum activin levels at day of oocytes pick up in pregnant women compared to non-pregnant (2.19 ± 0.04 vs. 1.52 ± 0.04; p &lt; 0.001). The cutoff value of serum progesterone at day of oocytes picks up was &gt; 7.5 ng/ml and the cut-off value of serum activin A at day of oocytes pick up was &gt; 1.85 ng/ml .Pregnant women had higher levels of the hormone progesterone and Activin A than non-pregnant women, which is significantly correlated. This result can be utilized to predicate the pregnancy status early in IVF Centers.

CLINICAL RESULTS IN PATIENTS WITH REDUCED OVARIAN RESERVE IN PROTOCOLS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

Introduction. The issues of infertility treatment remain relevant, even in light of significant advances in reproductive medicine. Among the primary factors contributing to reproductive function disorders in women, age stands out prominently. The trend of women delaying pregnancy planning due to their emphasis on social fulfillment and financial stability has been steadily increasing. The aim of this study is to assess the effectiveness of protocols of controlled ovarian stimulation using pre-gravid preparation in patients with reduced ovarian reserve when using assisted reproductive technologies. Participants and methods. This study involved 112 women experiencing infertility due to reduced ovarian reserve and tubal infertility factors. These women underwent a brief ovulation stimulation protocol as part of an assisted reproductive technologies program. The participants were categorized into three groups: the first group comprised 43 women with infertility due to reduced ovarian reserve; prior to controlled ovarian stimulation (COS) and follicular puncture, this group received a combined treatment, which included a vitamin complex containing inositol ("FT500 plus"), a dietary supplement based on alpha-lipoic acid and magnesium ("Pelvidol"), dehydroepiandrosterone (DHEA), and growth hormone ("Zomacton"); the second group consisted of 38 women with infertility associated with reduced ovarian reserve who did not receive any pre-conception preparation; the third group, serving as the control, consisted of 31 women with infertility resulting from tubal factors, and they did not undergo any pre-conception preparation. The clinical outcomes of the women in both research groups and the control group were analyzed based on their treatment tactics within the ovulation stimulation protocols in assisted reproductive technologies programs. Results and discussion. The average number of oocytes obtained from patients with infertility under reduced ovarian reserve who underwent pre-gravid preparation with the medications "FT500 plus" and "Pelvidol" is statistically higher compared to the group of women with reduced ovarian reserve who did not undergo pre-gravid preparation for COS. Clinical results also indicate positive dynamics regarding proper fertilization, blastulation of embryos and subsequent pregnancy in women, who underwent pre-gravid preparation with an inositol-based pharmaceutical "FT500plus" and the dietary supplement "Pelvidol", dehydroepiandrosterone (DHEA) and "Zomacton" (growth hormone).Conclusion. The results of this clinical study demonstrate the effectiveness of pre-conception preparation for patients with reduced ovarian reserve (poor response). This preparation positively impacts the number of oocytes and embryos obtained, the controlled stimulation of oocytes, and the subsequent implantation of the embryo, leading to successful pregnancies.

The importance of preconception Hcy testing: identification of a folate trap syndrome in a woman attending an assisted reproduction program.

Methylation is a ubiquitous and permanent key biochemical process playing a major role in gametogenesis and embryogenesis in relation to epigenetics and imprinting. Methylation relies on a unique cofactor S-Adenosyl Methionine: SAM. Release of the methyl group onto target molecules is followed by liberation of S-Adenosyl Homocysteine (SAH), and then homocysteine (Hcy), both potent inhibitors of the methylation process. Defective recycling of homocysteine, leading to Hyperhomocysteinemia, is mainly due to reduced activity of MTHFR (Methylene TetraHydroFolate Reductase). However, we described here, in a woman attending an ART program, arather rare syndrome: The Folate trap syndrome. Due to vitamin B12 deficiency (malabsorption), Hcy cannot be recycled to methionine by the methionine synthase. Transmethylation activity is weak and leads to Hhcy (Hyperhomocysteinhemia). Her Hhcy, over 16µM, was resistant to 5MTHF (5 Methyltetrahydrofolate) associated with a support of the one carbon cycle, a classical efficient treatment for elevated homocysteine. Treatment with Methylcobalamine (associated with adenosyl Cobalamine) allowed a Hcy drop down to 10 µM. Knowing the pleiotropic negative impact of Hcy on gametes, embryos and pregnancy in general, we strongly recommend a Hcy dosage in both members of couples seeking treatmentfor pregnancy.

Anxiety (DASS21) and the Quality of Life (FertiQol) of Infertile Women Underwent In Vitro Fertilization

Infertility affects physical and mental health and has various consequences. In vitro fertilization (IVF) is one of the Assisted Reproductive Technology (ART) programs that include several phases, requiring longer time, more patience, and is expensive. This may make women who undergo the ART program to have higher stress level, especially anxiety. This study aimed to determine the relationship between anxiety and quality of life in infertile patients undergoing assisted reproductive technology programs. This was a cross-sectional observational analytic study performed at Aster Fertility Clinic, Dr. Hasan Sadikin General Hospital and Bandung Fertility Center, Limijati Hospital Bandung, Indonesia, from February until April 2020. The analysis was performed using the DASS21 scale and FertiQol count on 27 subjects undergoing the IVF program and 30 control subjects who were pregnant without IVF program. The statistical analyses used to determine the condition of anxiety and the condition of quality of life were the Chi-square and the Mann-Whitney tests, while the relationship between anxiety and quality of life as the main subject was measured using the Spearman correlation test. The anxiety level as measured with the DASS21 instrument in the subject and control groups was 6.2 vs 0.7 with p&lt;0.001. From the analysis of the FertiQol instrument in the subject and control groups, the scores were 79.6 vs. 98.9 for the mind-body domain (p&lt;0.001); 68.8 vs 98.5 for the emotional domain (p &lt; 0.001); 83.2 vs 95.7 for the relational domain (p&lt;0.001); and 77.6 vs 97.6 for the social domain (p&lt;0.001). For the overall FertiQol core domains, the score was 77.3 vs 97.7 (p&lt;0.001). The correlation between anxiety and the FertiQol total core domains were evident from the results of the Spearman correlation test, with an r-value of -0.479 (p&lt;0.001). Therefore, there is a significant negative correlation between anxiety and quality of life.

“Tango for Two”: Women’s Interviews in Clinical Reproductive Practice

This article attempts to combine data obtained through interviews by a psychologist of female donors participating in an assisted reproductive technology program and interpret them through narrative analysis and communicative situation analysis. The article describes the structure of an oocyte-donor which has never been done before with reference to Russian-language material. An ethical platform for the study is openness to a new type of scientific knowledge that results from the interpretation of the informants’ answers who try to comprehend their motives to donate. The narrative analysis of 21 transcripts helps determine the roles of the interviewer and the informant at each stage and their contribution to the discussion-testing communicative situation. The interview includes several stages, such as “a window to the past”, at which the autobiographical narrative is recorded as comprehensively as possible; a description of the donor’s current state which focuses on strategies for solving problem situations; the interview ends with a series of thought experiments that allow the psychologist to assess the emotional stability of the potential donor and make a forecast regarding the prospects for long-term cooperation with the reproductive medicine clinic. The paper outlines the cases of participants’ cooperation and mismatches in building a credible and value-consistent autobiographical narrative that includes the donation experience. The authors seek to fit this experience into a broader value context, including a compensatory one related to the urgent problems of potential donors. Women’s answers help specify the concept of donor ‘multi-motivation’. The ambiguity of public opinion regarding donation as a reproductive medicine phenomenon is expressed in the fact that the availability of information for those who are aware of the issue co-exists with donors’ persistent reluctance to display their activity outside the inner circle. Research perspectives include the need to consider the narrative contribution of each participant in the situation of reproduction, i. e. physicians, donors, and recipient parents, and its further use in practice.