Assisted Reproductive Technology Clinics Research Articles

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.

Guidelines for Best Practice for Staffing of ART Laboratories and Professional Development of IVF Scientists

Research Question: To establish recommendations for optimal staffing levels, training, and professional development in assisted reproductive technology (ART) laboratories in Australia and New Zealand. Design: Exploration by Scientists in Reproductive Technology (SIRT) subcommittee representing 10 different ART centers of the time requirements and complexity of ART procedures and to define training and continuing professional development (CPD) requirements. Results: The Staffing Model for ART (smART) “plug and play” calculator was developed by the SIRT subcommittee. Twelve routine procedures were examined IVF, ICSI, ICSI + PGT, ICSI + TESE, FET, FET from PGT, oocyte vitrification, oocyte warming, intrauterine insemination (IUI), semen freeze, TESE with semen freeze, and semen analysis. Based on a cycle with 10 eggs, the average time taken to do each procedure was considered as well as the complexity of the task. Laboratory quality control (QC), other administrative tasks, and leave days are reflected in the calculator. Recommendations for years of experience were determined as a trained scientist (24 months), a senior scientist (5 years), and Scientific Director (10 years). CPD is strongly recommended to improve the skills, knowledge, and ability of scientific staff. Conclusions: The risks in the IVF laboratory primarily associated with lower staffing levels have been reviewed, and the smART calculator is designed to assist clinics to tailor adequate staffing levels for their specific needs. The smART calculator is an invaluable tool for clinics to use going forward. Key Message We have reviewed the risks in the IVF laboratory primarily associated with lower staffing levels, and created the smART calculator designed to assist clinics in being able to tailor adequate staffing levels for their specific needs. We believe the smART calculator will be an invaluable tool moving forward for all ART clinics and accreditors.

Experiences of female clients in the assisted reproductive technology process in Nigeria.

Though assisted reproductive technology (ART) has been a source of hope for many infertile couples, it is known to be associated with physical, social, psychological, and ethical challenges in different settings. The study objective was to explore the experiences of female clients who accessed services in ART clinics in Nigeria. An exploratory qualitative design, using snowballing technique was employed. It involved in-depth interviews of eight women who had gone through the assisted conception process, using an interview guide. Data collection was from November 2019 to January 2020. Results: The age range of the participants was 30 - 52 years with a mean of 41.88 years. Majority of the clients presented at advanced age to their ART providers because of lack of funds and ignorance. Other challenges were suboptimal risk disclosure, high cost of services, feelings of shame and stigmatization during and after the process. Cost of ART remain unaffordable to most Nigerians hence the need for government subsidization and in-corporation of ART services into the National Health Insurance Scheme. Additionally, lack of adequate information disclosure, shared decision-making and gendered suffering are areas of great concern among the study participants. A national regulatory guideline will ensure uniform international standard of care.

REI clinics and fellowship training-a national snapshot to improve access to reproductive care.

To analyze the geographic distribution of REI fellowships and clinics across the USA and to strategize ways to improve patient access to care. Cross-sectional study using population data obtained from publicly available United States Census Bureau, Society for Assisted Reproductive Technology (SART), and National Resident Matching Program websites. Outcomes include the number of REI clinics, REI fellowship-trained physicians, and REI fellowship programs. In 2020, there were 643 assisted reproductive technology (ART) clinics reporting to SART and 1351 fellowship-trained REI physicians. Most clinics are located in the south (n = 209); however, the northeast has the highest density of REI clinics. Out of 301,316 in vitro fertilization (IVF) cycles in the USA in 2020, northeastern states initiated the most cycles (n = 93,565), and Midwestern states initiated the fewest cycles (n = 50,000). The northeast has the most REI physicians per million women aged 20-44 years (42.4) while the Midwest has the lowest ratio (19.5). There are fewer REI physicians per million women aged 20-44 years in states with a lower proportion of patients with health insurance (r = 0.56, 95% confidence interval ([CI] 0.34-0.73) and in states with a lower average income per resident (r = 0.65, 95% CI 0.46-0.79). Most of the 49 accredited REI fellowship programs in the USA are in the northeast (n = 18), and there are fewest in the south (n = 10) and west (n = 10). Access to REI care has large geographic disparities from a clinic, physician, and training program perspective. Creative solutions are needed to remedy this problem.

Advances in the study of genetic factors and clinical interventions for fertilization failure.

Fertilization failure refers to the failure in the pronucleus formation, evaluating 16-18 h post in vitro fertilization or intracytoplasmic sperm injection. It can be caused by sperm, oocytes, and sperm-oocyte interaction and lead to great financial and physical stress to the patients. Recent advancements in genetics, molecular biology, and clinical-assisted reproductive technology have greatly enhanced research into the causes and treatment of fertilization failure. Here, we review the causes that have been reported to lead to fertilization failure in fertilization processes, including the sperm acrosome reaction, penetration of the cumulus and zona pellucida, recognition and fusion of the sperm and oocyte membranes, oocyte activation, and pronucleus formation. Additionally, we summarize the progress of corresponding treatment methods of fertilization failure. This review will provide the latest research advances in the genetic aspects of fertilization failure and will benefit both researchers and clinical practitioners in reproduction and genetics.

Natural cycle frozen embryo transfer: a survey of current assisted reproductive technology practices in the U.S.

Emerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.). In this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers' perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses. The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1-2 physicians in their practice. Common reasons for not offering NC-FET included "lack of timing predictability for transfer" (81%) and "increased burden on staff/laboratory personnel on holidays and weekends" (54%). Of clinics offering NC-FET, 76% reported < 25% of cycles used the NC for endometrial preparation. Over half (52%) of clinics that offered NC-FET reported having eligibility restrictions for NC-FET. Reported benefits of NC-FET were "patient satisfaction" (18%), "decreased cost of medications" (18%), and "avoidance of intramuscular progesterone" (17%). The attitude towards NC-FET in their clinics was reported as positive by 65% of respondents. NC-FETs are offered by most U.S. ART clinics but are used only in the minority of FET cycles for endometrial preparation, and use is often restricted.

The Assisted Reproductive Technology (Regulation) Act, 2021: A Step in the Right Direction.

The Assisted Reproductive Technology (Regulation) Act, 2021, was passed on December 20, 2021 by an act of Parliament to regulate the functioning of assisted reproductive technology (ART) clinics and ART banks in the country. Since the dawn of in vitro fertilization (IVF), there has been a mushrooming of ART clinics in the country. There was need to supervise and regulate the functioning of these clinics and to safeguard the rights of women undergoing fertility treatment at these centers. The passing of this Act will go a long way in the better supervision, regulation, licensing, and smooth functioning of ART clinics and ART banks. The Act also brings into its ambit the controversial treatment of surrogacy and hence ensures protection of the rights of surrogate mothers. Moreover, strict implementation of the act will guarantee the success of the treatment within the legal and ethical framework.

Assisted Reproductive Technology: Gaps in young adults’ perceptions and information from clinics

Abstract Background Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics. Methods A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out. Results In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous. Conclusions Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health. Key messages • Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young. • ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.

EMOTIONAL ASPECTS ASSESSED BY THE DASS-21 SCALE IN PREGNANT WOMEN CONCEIVED BY IN VITRO FERTILIZATION DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has brought new challenges to infertile couples: the fear and uncertainty of potential SARS-CoV-2 infection effects during pregnancy. The present study aims to evaluate depression, anxiety and stress parameters in pregnant women conceived by IVF, during the coronavirus outbreak. This prospective cohort study included 109 clinical pregnant women (fetal heart beat) that consecutively underwent embryo transfer after an IVF treatment during the coronavirus outbreak between Jun/20 to Feb/21 in a private ART (assisted reproductive technology) clinic. Patients were evaluated through telephonic interview at the end of each trimester of pregnancy (12, 24 and 34 weeks) by the DASS-21 questionnaire, an internationally validated scale to track the severity of depression, anxiety and stress symptoms. Clinical variables such as age, obstetric history, clinical comorbities and years of infertility were also included. Comparison statistical tests were applied accordingly to normal distribution of values. A p value <0,05 was considered significant. The mean age was 38,97±5,02 years old. The majority of patients had never been pregnant before (67%) and had no other comorbid associated (75,2%). The mean infertility time was 3,76±2,38 years. Singleton pregnancies represented 83,5%. During the follow-up, two patients had late miscarriage at 21 weeks of singleton pregnancies (1,8%) and one had a fetal demise at 26 weeks of a singleton pregnancy (0,9%). Four patients (3,7%) had very preterm labor (between 28-32 weeks), seven (6,4%) had moderate preterm labor (between 33-35 weeks) and one (0,9%) had a late preterm labor (36th week). In general, there were no difference in any of the emotional aspects evaluated (depression, anxiety and stress) along first, 2nd and 3rd trimesters (p=0.13, p=0.93 and p=0.55, respectively). However, when participants were separated by groups of age (<38 yo and ≥38 yo, means 34,84±2,90 and 42,35±3,69, p=0.007), older patients presented higher levels of stress (p=0.017) compared to the youngers. Furthermore, patients with history of previous pregnancy loss presented higher levels of anxiety and stress (p=0.037 and 0.036 respectively) compared to the nulliparous. In addition, when comorbidities were associated with infertility, patients also presented higher levels of anxiety and stress (p=0.03 and 0.002, respectively). Years of infertility (≤3 or ˃3 years) was not associated with aggravation in DASS scores during pregnancy. Our data demonstrated that patients who conceived during the pandemic by IVF showed higher levels of anxiety and stress throughout their pregnancy, as assessed by the DASS-21 scale, mainly if they are greater than 38yo, had previous pregnancy loss or presented other comorbity associated.

Oocyte Donation: Three Perspectives

Background: A number of important problems remain unresolved in the field of assisted reproductive technologies (ART) using germ cells from a single donor. This study aimed to assess attitudes about the use of sex gamete donation in ART in different social groups including medical workers, oocyte recipients, and oocyte donors.&#x0D; Methods: To achieve this goal, we surveyed 286 participants from seven countries. Of them, 190 were medical workers from ART clinics (respondents from seven countries), 45 were oocyte recipients (Kazakhstan), and 51 were oocyte donors (Kazakhstan).&#x0D; Results: A survey of the three groups showed that issues related to donor health were most common in the donor selection process based on patient and doctor distrust of the health care system. The main motive for oocyte donation was financial compensation, which draws attention to the social disadvantage of the donor population. Medical workers with more than 5 years of work experience (79.7%) supported the use of programs tracking donor sex gametes and limiting the use of oocyte donors.&#x0D; Conclusions: The willingness and consent of the surveyed medical workers and oocyte recipients to use the donor material and create a unified registry of donor sex gametes demonstrates the importance of this issue.

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.

Illuminating the Artefacts of NGS Seen in PGT-A &amp; PGT-SR

Background: Advancements in next generation sequencing (NGS) based genomics over the past 10 years have allowed the routine adoption of preimplantation genetic testing for aneuploidy (PGT-A), and/or segmental rearrangements (PGT-SR) of [Formula: see text]10Mb 1 in the assisted reproductive technology (ART) clinic. However, one challenge remains within the assessment of aligned short read sequencing data, in the ability to discriminate between embryonic profiles with genuine pathological copy number variations (CNVs) from artefacts arising from erroneous DNA amplification or library preparation. Aim: To identify the common artefacts seen in next generation sequencing (NGS) based PGT to reduce inconclusive or false positive results. Method: NGS profiles generated from biopsied human embryonic trophectoderm cells were manually analysed for common genomic artefacts. Following trophectoderm biopsy within a clinical ART cycle, cell samples underwent DNA amplification (Illumina SureplexTM DNA amplification system), sequencing (VeriSeqTM PGS kit on the MiSeq[Formula: see text] System, and bioinformatic data analysis (Bluefuse Multi v4.4, Illumina). Results: Common artefacts were identified affecting chromosomes 7, 11, and 19. Artefacts imitated small CNVs typically displaying a [Formula: see text]50% increase in centromeric sequence counts on chromosomes 7 and 11, and a global increase of sequence counts of [Formula: see text]40% across the entire chromosome 19 (except at the centromere, presenting as diploid). Interestingly a technical repeat of the library preparation and sequencing of the original DNA template somewhat normalised these artefacts. Conclusion: The study found three commonly occurring artefacts involving chromosomes 7, 11, and 19 artificially introduced during suboptimal NGS library preparation. Importantly these artefacts may be normalised through technical repeat of library preparation and sequencing. The awareness of these artefacts may reduce false positive and/or inconclusive results, increasing clinical embryonic utilisation following PGT.

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth.

BackgroundThe initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied.ObjectivesTo examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.MethodsPopulation‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019.ResultsOverall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension.ConclusionsThe early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.

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.

Impact of satellite clinics on geographic access to assisted reproductive technology services in the United States

BackgroundMany assisted reproductive technology (ART) centers utilize satellite clinics to expand reach and access to clinical services, but their contribution to lowering geographic barriers in access to care has not been examined. This study’s purpose is to determine the extent to which satellite clinics impact geographic access to ART and estimate the percentage of reproductive-age women who have geographic access to ART services.MethodsA systematic web-search collected the locations of all main and satellite ART clinics in the United States (US). Driving times were calculated between satellite clinics and main clinics. The percentage of women with geographic access to care was characterized by clinic type using US Census Core Based Statistical Areas (CBSAs). Logistic regression was used to statistically model the presence of main and satellite clinics as a function of CBSA median income and female reproductive-age population.ResultsFour hundred sixty-nine main clinics with embryology labs and 583 satellite clinics were found in the US. Practices with satellite clinics tend to perform more ART cycles. Satellite clinics are located on average 66 minutes from their practice’s main clinic and 31 minutes from any main clinic. 22% of satellite clinics were in CBSAs without a main clinic. 46 M (72%) US reproductive-age women live in a CBSA with a main clinic, 5.1 M (8%) women live in a CBSA without a main clinic but at least one satellite clinic, and 13 M (20%) women live in an area with no ART clinic of either type. Female reproductive-age population was found to be a more important predictor of clinic presence than median income.ConclusionsThe majority of satellite clinics in the US are positioned in relative proximity to a main clinic. 85% of satellite clinics are located closer to the main clinic of other practices than to their own main clinic. Less than a quarter of ART satellite clinics expand geographic access to ART services by being located in areas without a main clinic, and the vast majority of practices with satellite clinics position their satellite clinics close to another practice’s main clinic.Trial registrationNot applicable.

An Online Tool Using Basal or Activated Ovarian Reserve Markers to Predict the Number of Oocytes Retrieved Following Controlled Ovarian Stimulation: A Prospective Observational Cohort Study.

BackgroundPredicting the number of oocytes retrieved (NOR) following controlled ovarian stimulation (COS) is the only way to ensure effective and safe treatment in assisted reproductive technology (ART). To date, there have been limited studies about predicting specific NOR, which hinders the development of individualized treatment in ART.ObjectiveTo establish an online tool for predicting NOR.Materials and MethodsIn total, 621 prospective routine gonadotropin releasing hormone (GnRH) antagonist COS cycles were studied. Independent variables included age, body mass index, antral follicle counts, basal FSH, basal and increment of anti-mullerian hormone, Luteinizing hormon, estradiol, testosterone, androstenedione, and inhibin B. The outcome variable was NOR. The independent variables underwent appropriate transformation to achieve a better fit for a linear relationship with NOR. Pruned forward selection with holdback validation was then used to establish predictive models. Corrected Akaike’s information criterion, Schwarz–Bayesian information criterion, scaled –log[likelihood], and the generalized coefficient of determination (R 2) were used for model evaluation.ResultsA multiple negative binomial regression model was used for predicting NOR because it fitted a negative binomial distribution. We established Model 1, using basal ovarian reserve markers, and Model 2, using both basal and early dynamic markers for predicting NOR following COS. The generalized R 2 values were 0.54 and 0.51 for Model 1 and 0.64 and 0.62 for Model 2 in the training and validation sets, respectively.ConclusionModels 1 and 2 could be applied to different scenarios. For directing the starting dose of recombinant follicle stimulation hormone (rFSH), Model 1 using basic predictors could be used prior to COS. Model 2 could be used for directing the adjustment of rFSH dosages during COS. An online tool (http://121.43.113.123:8002/) based on these two models is also developed. We anticipate that the clinical application of this tool could help the ART clinics to reduce iatrogenic ovarian under- or over-responses, and could reduce costs during COS for ART.

The impact of single-step and sequential embryo culture systems on obstetric and perinatal outcomes in singleton pregnancies: the Massachusetts Outcomes Study of Assisted Reproductive Technology

To compare the obstetric and perinatal outcomes of deliveries conceived with embryos from single-step vs. sequential culture media systems. Historical cohort of Massachusetts vital records linked to assisted reproductive technology clinic data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and laboratory embryology data from two large academic hospital fertility centers. Not applicable. Patients with singleton live birth deliveries between 2004 and 2017 conceived with autologous assisted reproductive technology cycles with fresh blastocyst transfer using either single-step (n = 1,058) or sequential (n = 474) culture media systems. None. Associations of single-step vs. sequential culture with obstetric outcomes (mode of delivery, placental abnormalities, pregnancy-induced hypertension, and gestational diabetes) and perinatal outcomes (preterm birth, low birthweight, small-for-gestational-age, and large-for-gestational-age [LGA]) were assessed with multivariate logistic modeling, adjusted for maternal age, race/ethnicity, education, parity, insurance type, protein supplementation, oxygen concentration, fertilization method, and number of transferred embryos. Compared with sequential culture, single-step culture was associated with increased odds of LGA (adjusted odds ratio 2.1, 95% confidence interval 1.04-4.22). There were no statistically significant differences between single-step and sequential culture media systems in the odds of placental abnormalities, pregnancy-induced hypertension, gestational diabetes, prematurity, small-for-gestational-age, or low birthweight. Single-step culture is associated with increased odds of LGA, indicating that embryo culture media systems may affect perinatal outcomes.

Assisted reproductive technology cycles involving male factor infertility in the United States, 2017–2018: data from the National Assisted Reproductive Technology Surveillance System

ObjectiveTo describe the prevalence and treatment characteristics of assisted reproductive technology (ART) cycles involving specific male factor infertility diagnoses in the United States.DesignCross-sectional analysis of ART cycles in the National ART Surveillance System (NASS).SettingClinics that reported patient ART cycles performed in 2017 and 2018.Patient(s)Patients who visited an ART clinic and the cycles were reported in the NASS. The ART cycles included all autologous and donor cycles that used fresh or frozen embryos.Intervention(s)Not applicable.Main Outcome MeasuresAnalyses used new, detailed reporting of male factor infertility subcategories, treatment characteristics, and male partner demographics available in the NASS.Result(s)Among 399,573 cycles started with intent to transfer an embryo, 30.4% (n = 121,287) included a male factor infertility diagnosis as a reason for using ART. Of these, male factor only was reported in 16.5% of cycles, and both male and female factors were reported in 13.9% of cycles; 21.8% of male factor cycles had >1 male factor. Abnormal sperm parameters were the most commonly reported diagnoses (79.7%), followed by medical condition (5.3%) and genetic or chromosomal abnormalities (1.0%).Males aged ≤40 years comprised 59.6% of cycles with male factor infertility. Intracytoplasmic sperm injection was the primary method of fertilization (81.7%). Preimplantation genetic testing was used in 26.8%, and single embryo transfer was used in 66.8% of cycles with male factor infertility diagnosis.Conclusion(s)Male factor infertility is a substantial contributor to infertility treatments in the United States. Continued assessment of the prevalence and characteristics of ART cycles with male factor infertility may inform treatment options and improve ART outcomes. Future studies are necessary to further evaluate male factor infertility.

High-Frequency Ultrasound Boosts Bull and Human Sperm Motility.

Sperm motility is a significant predictor of male fertility potential and is directly linked to fertilization success in both natural and some forms of assisted reproduction. Sperm motility can be impaired by both genetic and environmental factors, with asthenozoospermia being a common clinical presentation. Moreover, in the setting of assisted reproductive technology clinics, there is a distinct absence of effective and noninvasive technology to increase sperm motility without detriment to the sperm cells. Here, a new method is presented to boost sperm motility by increasing the intracellular rate of metabolic activity using high frequency ultrasound. An increase of 34% in curvilinear velocity (VCL), 10% in linearity, and 32% in the number of motile sperm cells is shown by rendering immotile sperm motile, after just 20 s exposure. A similar effect with an increase of 15% in VCL treating human sperm with the same setting is also identified. This cell level mechanotherapy approach causes no significant change in cell viability or DNA fragmentation index, and, as such, has the potential to be applied to encourage natural fertilization or less invasive treatment choices such as in vitro fertilization rather than intracytoplasmic injection.