Assisted Reproductive Technology Techniques Research Articles

First-line infertility treatment in normal or subnormal sperm: Interest of a simplified pre-IMSI test.

In the field of male infertility, when sperm is normal/subnormal, a few "add-on" routine tests can complete the basic semen examination. The aim of this study was to develop and evaluate a faster, simplified motile sperm organelle morphology examination (MSOME) technique for selected infertile patients with apparently normal/subnormal sperm and, in their background: failure of two or three intrauterine insemination (IUI) cycles, repeatedly fragmented embryos, embryonic development to blastocyst-stage failures, repeated miscarriages, a long period of infertility or 2 or more IVF attempts without pregnancy. Our test results were correlated with IUI, conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) outcomes. We validated an adapted version of the MSOME analysis called the pre-IMSI test (PIT), based on vacuole evaluation alone. 248 infertile patients from our assisted reproductive technology (ART) Center were retrospectively selected and split into three PIT score subgroups (patients with ≤8% (score I), 9 to 15% (score II) and ≥16% normal spermatozoa (score III)) based on the correlation between PIT results and each ART technique outcome. The choice of one or another of these ART techniques had been made according to the usual clinico-biological criteria. Clinical outcomes for each of the three PIT subgroups were compared individually for the different ART techniques. For ICSI, the effect of the PIT score subgroup was significant for clinical pregnancies (p = 0.0054) and presented a trend for live births (p = 0.0614). Miscarriage rates of IVF attempts were statistically different depending on the PIT score (p = 0.0348). Furthermore, the odds ratios of clinical pregnancy rates were significantly different according to PIT score subgroup when comparing ICSI vs. IMSI or IVF vs. ICSI attempts. IMSI appears to be recommended when sperm belongs to PIT score I, ICSI when it belongs to PIT score II and IVF or IUI when sperm is of PIT score III quality in selected infertile couples. The lack of statistical power in these PIT subgroups means that we must remain cautious in interpreting results. Our results support the interest of this simplified test for certain couples with normal/subnormal sperm to help choose the most efficient ART technique, even as first-line treatment.

P-130 Comparing head-first and tail-first injection techniques in guiding new embryologists for human oocyte Piezo-ICSI

Abstract Study question Which technique is more effective for new embryologists in human oocyte Piezo-ICSI: Head-first or tail-first injection? Summary answer Tail-first injection is superior as it significantly increases fertilization rates without adversely affecting embryo development compared to head-first injection in Piezo-ICSI. What is known already ICSI is an essential technique in assisted reproductive technology. Recently, some researchers have reported that Piezo-ICSI is clinically more useful than Standard-ICSI. In most papers, Piezo-ICSI has shown significantly higher fertilization rates than Standard-ICSI. This is because, in Piezo-ICSI, it eliminates the need to aspirate the cytoplasm into the ICSI needle upon membrane breakage. After membrane breakage, the sperm is injected into the cytoplasm. A few papers evaluated the effect of sperm injection direction (head-first or tail-first) on ICSI results for human oocytes. However, little information is available to guide new embryologists on whether to use head-first or tail-first injection. Study design, size, duration During their Piezo-ICSI training, new embryologists were taught either head-first or tail-first injection techniques before commencing clinical procedures. Only the head part of the sperm was injected into the cytoplasm in the head-first group, and half of the whole sperm was injected in the tail-first group. This study divided the new embryologists into two groups (head-first or tail-first) and collected and retrospectively analyzed their first 200 oocyte ICSI results between January 2017 and November 2023. Participants/materials, setting, methods This study involved five new embryologists and a total of 1,000 oocytes. Two embryologists performed head-first injection for 400 oocytes, and three performed tail-first injection for 600 oocytes. The rates of degeneration, 2PN, 0PN, 1PN, ≥3PN, good quality day-3 embryo (≥7cell, ≤15%fragmemtation) per 2PN, blastocyst, and good quality blastocyst (better than BB with Gardner criteria) were compared. Statistical analysis was performed using either a t-test, Welch’s t-test, or Fisher’s exact test as appropriate. Main results and the role of chance The average ages of women and their husbands in the head-first and tail-first injection groups were 37.8 vs. 37.2 and 40.1 vs. 39.2, respectively, with average total motile sperm counts of 52.2 x106 vs. 52.6 x106. No significant difference was observed in these comparison items between the groups. Theoretical injected medium volume into the cytoplasm with sperm of the head-first and tail-first injection groups was 104μm3 vs. 520μm3. The 2PN rate of the tail-first injection group (88.3%; 530/600) was significantly higher (P = 0.0151) than head-first (82.8%; 331/400). The 0PN rate of the tail-first group (4.0%; 24/600) was significantly lower (P = 0.0007) than the head-first (9.5%; 38/400). The degeneration rates, 1PN rates, and ≥3PN rates of head-first and tail-first injection groups were 1.5% (6/400) vs. 1.3% (8/600), 3.5% (14/400) vs. 2.3% (14/600), and 2.8% (11/400) vs. 4.0% (24/600). No significant difference was observed in these comparison items between the groups. The good quality day-3 embryo per 2PN rates, blastocyst rates, and good quality blastocyst rates of head-first and tail-first injection groups were 64.7% (214/331) vs. 64.3% (341/530), 62.1% (192/309) vs. 62.7% (289/461), 35.3% (109/309) vs. 35.6% (164/461). No significant difference was observed in these comparison items between the groups. Limitations, reasons for caution The estimated volumes of medium injected into the cytoplasm for both head-first and tail-first injections were theoretical. We calculated the length of the sperm head and whole sperm as 6μm and 60μm. Some day-3 embryos were transferred or cryopreserved, so the blastocyst and good-quality blastocyst rates were reference ranges. Wider implications of the findings Despite the larger volume of medium injected with sperm, tail-first injection increases fertilization rates without adversely impacting embryo development compared to head-first injection. Therefore, the tail-first injection is better to guide the new embryologists for human oocytes Piezo-ICSI than the head-first injection. Trial registration number 17-0450221102

Maternal mRNA deadenylation is defective in in vitro matured mouse and human oocytes

Oocyte in vitro maturation is a technique in assisted reproductive technology. Thousands of genes show abnormally high expression in in vitro maturated metaphase II (MII) oocytes compared to those matured in vivo in bovines, mice, and humans. The mechanisms underlying this phenomenon are poorly understood. Here, we use poly(A) inclusive RNA isoform sequencing (PAIso-seq) for profiling the transcriptome-wide poly(A) tails in both in vivo and in vitro matured mouse and human oocytes. Our results demonstrate that the observed increase in maternal mRNA abundance is caused by impaired deadenylation in in vitro MII oocytes. Moreover, the cytoplasmic polyadenylation of dormant Btg4 and Cnot7 mRNAs, which encode key components of deadenylation machinery, is impaired in in vitro MII oocytes, contributing to reduced translation of these deadenylase machinery components and subsequently impaired global maternal mRNA deadenylation. Our findings highlight impaired maternal mRNA deadenylation as a distinct molecular defect in in vitro MII oocytes.

A RETROSPECTIVE STUDY ON MATERNAL AND FETAL OUTCOMES ASSOCIATED WITH ASSISTED REPRODUCTIVE TECHNOLOGIES

Assisted Reproductive Technologies (ART) have revolutionized the landscape of reproductive medicine, offering hope to couples facing infertility challenges. The study's main objective is to find the maternal and fetal outcomes associated with assisted reproductive technologies. This retrospective cohort study was conducted in Lady Reading Hospital Peshawar from July 2019 to June 2023. The study includes 850 participants who underwent ART procedures between 2021 and 2022. Details of the ART procedures, such as the technique employed, the number of embryos transferred, and the utilization of preimplantation genetic testing, were meticulously documented. Maternal outcomes were a focal point, with a comprehensive assessment of pregnancy-related hypertensive disorders, gestational diabetes, mode of delivery, and any postpartum complications. Data was collected from 850 participants. The mean maternal age was 33.5 years (SD = 4.2), and the mean BMI was 25.8 (SD = 3.5). The primary causes of infertility varied, with male factor infertility being the most prevalent at 40%, followed by ovulatory dysfunction at 30% and unexplained infertility at 20%. The ART procedures in the study cohort comprised In Vitro Fertilization (IVF) at 60%, followed by Intracytoplasmic Sperm Injection (ICSI) at 25%, and other ART techniques at 15%. Regarding the number of embryos transferred, the majority received a single source (70%), with 20% receiving two starts and 10% receiving three or more. It is concluded that pregnancies conceived through Assisted Reproductive Technologies (ART) exhibit a higher prevalence of pregnancy-related hypertensive disorders and gestational diabetes compared to naturally conceived pregnancies.

Clinical and neonatal outcomes of complete zona pellucida removal by laser-assisted hatching after single vitrified-warmed blastocyst transfer.

Laser-assisted hatching (LAH) is a widely used and unavoidable technique in assisted reproductive technology after frozen embryo transfer (FET). We aimed to investigate the safety and efficacy of completely ZP (zona pellucida) removed by an assisted laser group compared to an intact group after FET. This retrospective study involved 320 SVBT single vitrified-warmed blastocyst transfers of 213 patients who underwent clomiphene citrate (CC) based minimal stimulation protocol. This study compared 160 SVBT with ZP that were completely removed using laser-assisted (laser beams of 10-15, a wavelength of 1.48μm, and duration of 1.8-2.2ms) to 160 cases of intact SVBT. Fisher's exact test, chi-squared test, and logistic regression are used for statistical analysis. The women's age, cause of infertility, BMI, transferred embryo day, insemination methods, and blastocyst grade were not significantly different between two groups. The implantation rate (66.2% vs. 51.2%, P < 0.01), the clinical pregnancy rate (CPR, 52.5% vs. 39.3%, P = 0.01), and the live birth rate (LBR, 43.7% vs. 29.3%, P < 0.01) were significantly higher in the completely ZP removed than the intact group. In logistic regression analysis, the laser-assisted hatching group showed about 2 times higher implantation rate and CPR and LBR than the control group. But miscarriage, gestational weeks, gender, birth weight, and twin births were insignificant between two groups. Our study suggests ZP free embryo transfer by assisted laser is more effective and safer than intact embryo transfer.

Role of Artificial Intelligence in ICSI (Intra-Cytoplasmic Sperm Injection) &amp;IUI (Intra-Uterine Insemination)

In contrast to natural intelligence demonstrated by humans, AI (Artificial Intelligence) is the ability of a computer to learn and display intelligence. AI has grown in popularity quickly and gradually, and it is now a part of our personal and social lives. AI has been used in almost every field, including IT companies and many other fields that collect data. AI is also used in a large number of factories. As modern technology advances, artificial intelligence is being used in the medical field. AI technology is being used in a variety of laboratories, including IVF labs. Many treatment techniques, such as ICSI (Intra -Cytoplasm Sperm Injection) and IUI (Intra – Uterine Insemination), are used in IVF laboratories. The techniques are used in the creation of ART (Assisted Reproductive Technology). Because of its high success rate, the ICSI technique is the most commonly used technique. The review focuses on the role of artificial technologies in the IVF lab and how they can be more useful for increasing IVF treatment success rates.The article concludes that AI can be very useful for IVF laboratories and for ART techniques. The role of AI in the future of IVF can be useful and helpful in the treatment increasing rate of IVF (in- vitro fertilization). AI technologies are used in a variety of methods to select high-quality oocytes and sperm. The article discusses how AI can be used to predict the future.

#18 : Risk Factors for Placenta Accreta Spectrum in Pregnancies Conceived after Frozen-Thawed Embryo Transfer in a Hormone Replacement Cycle

Background and Aims: Assisted reproductive technology (ART), especially frozen–thawed embryo transfer (FET) in a hormone replacement cycle (HRC) is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies conceived after FET in an HRC. Method: We performed a case–control study in two tertiary perinatal centers in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centers between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed in patients 1) with histopathological findings of placenta increta/percreta, 2) those requiring manual evacuation of the placenta after delivery, or 3) those with retained placental tissue. Among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case–control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of cesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos and endometrial thickness at the initiation of progestin administration. Results: PAS was associated with [Formula: see text]2 previous uterine surgeries (adjusted odds ratio [OR], 3.57; 95% confidence interval [CI], 1.60–7.97) and the number of blastocysts transferred (adjusted OR, 2.89; 95% CI, 1.15–7.26). In patients with &lt;2 previous uterine surgeries, PAS was associated with an endometrial thickness of &lt;7.0 mm (adjusted OR, 5.18; 95% CI, 1.10–24.44). Conclusion: A history of multiple previous uterine surgeries, the number of blastocysts transferred and a thin endometrium before ET are risk factors for PAS in pregnancies conceived after FET in an HRC.

The Impact of the Female Genital Microbiota on the Outcome of Assisted Reproduction Treatments.

The vaginal microbiota plays a critical role in the health of the female genital tract, and its composition contributes to gynecological disorders and infertility. Lactobacilli are the dominant species in the female genital tract: their production of lactic acid, hydrogen peroxide, and bacteriocins prevents the invasion and growth of pathogenic microorganisms. Several factors such as hormonal changes, age of reproduction, sexual practices, menstrual cycle, pregnancy, and antimicrobial drugs use can cause imbalance and dysbiosis of the vaginal microbiota. This review aims to highlight the impact of the vaginal microbiota in Assisted Reproductive Technology techniques (ART) and it examines the factors that influence the vaginal microbiota, the consequences of dysbiosis, and potential interventions to restore a healthy female genital tract.

Capturing sex-specific and hypofertility-linked effects of assisted reproductive technologies on the cord blood DNA methylome

BackgroundChildren conceived through assisted reproduction are at an increased risk for growth and genomic imprinting disorders, often linked to DNA methylation defects. It has been suggested that assisted reproductive technology (ART) and underlying parental infertility can induce epigenetic instability, specifically interfering with DNA methylation reprogramming events during germ cell and preimplantation development. To date, human studies exploring the association between ART and DNA methylation defects have reported inconsistent or inconclusive results, likely due to population heterogeneity and the use of technologies with limited coverage of the epigenome. In our study, we explored the epigenetic risk of ART by comprehensively profiling the DNA methylome of 73 human cord blood samples of singleton pregnancies (n = 36 control group, n = 37 ART/hypofertile group) from a human prospective longitudinal birth cohort, the 3D (Design, Develop, Discover) Study, using a high-resolution sequencing-based custom capture panel that examines over 2.4 million autosomal CpGs in the genome.ResultsWe identified evidence of sex-specific effects of ART/hypofertility on cord blood DNA methylation patterns. Our genome-wide analyses identified ~ 46% more CpGs affected by ART/hypofertility in female than in male infant cord blood. We performed a detailed analysis of three imprinted genes which have been associated with altered DNA methylation following ART (KCNQ1OT1, H19/IGF2 and GNAS) and found that female infant cord blood was associated with DNA hypomethylation. When compared to less invasive procedures such as intrauterine insemination, more invasive ARTs (in vitro fertilization, intracytoplasmic sperm injection, embryo culture) resulted in more marked and distinct effects on the cord blood DNA methylome. In the in vitro group, we found a close to fourfold higher proportion of significantly enriched Gene Ontology terms involved in development than in the in vivo group.ConclusionsOur study highlights the ability of a sensitive, targeted, sequencing-based approach to uncover DNA methylation perturbations in cord blood associated with hypofertility and ART and influenced by offspring sex and ART technique invasiveness.

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.

Assisted Reproductive Technology in Western Algeria.

Infertility is a major public health problem that Assisted reproductive technology (ART) helps remedying, allowing infertile couples realizing their parental project. In Algeria, the infertility rate is about 15%. Thereupon, several ART national centers have emerged. The aim of this study is to evaluate the ART activities, provide quantified data to understand the ART practice in western Algeria and compare our results abroad. We conducted a retrospective study on 1930 women treated for an ART at the EL MAWLOUD fertility center in Oran from January 1, 2019 to December 31, 2020. Our study showed the patients' average age as 33.42 and the ICSI as the commonest ART technique in our center with 90% frequency. The pregnancy rate equals 26.59% by insemination in IUI, and 41.25 % by puncture in IVF and ICSI, i.e. an average success rate similar in Europe and USA. This study elucidates the use of ART techniques (2019-2020) in western Algeria. They are satisfactory in our region compared to international data in the literature. However, ART remains embryonic in Algeria, regarding mainly the exorbitant prices of these techniques and the non-reimbursement of this act by the National Social Security Fund, which handicaps couples with medium and low incomes.

The association between assisted reproductive technology and cardiac remodeling in fetuses and early infants: a prospective cohort study

BackgroundLimited data exist regarding the potential impact of assisted reproductive technology (ART) on cardiac remodeling. In particular, whether different ART techniques are related to different cardiac alterations remains unclear. We aimed to evaluate cardiac changes in fetuses and infants arising from ART and fetal cardiac alterations in fetuses conceived by specific ART procedures.MethodsThis prospective and observational cohort study recruited 111 fetuses conceived by ART and 106 spontaneously conceived controls between December 2017 and April 2019. Echocardiography was performed between 28+0 and 32+6 weeks-of-gestation and at 0–2 and 6 months after birth.ResultsA total of 88 ART fetuses and 85 controls were included in the final analysis. Compared to controls, ART fetuses demonstrated a globular enlarged left ventricle (LV) (LV sphericity index of mid-section, 2.29 ± 0.34 vs. 2.45 ± 0.39, P = 0.006; LV area, 262.33 ± 45.96 mm2 vs. 244.25 ± 47.13 mm2, P = 0.002), a larger right ventricle (RV) (RV area, 236.10 ± 38.63 mm2 vs. 221.14 ± 42.60 mm2, P = 0.003) and reduced LV systolic deformation (LV global longitudinal strain (GLS), −19.56% ± 1.90% vs. −20.65% ± 1.88%, P = 0.013; LV GLS rate S, −3.32 ± 0.36 s-1 vs. −3.58 ± 0.39 s-1, P = 0.023). There were no significant differences between the ART and control groups at postnatal follow-ups. Furthermore, we found fetal cardiac morphometry and function were comparable between different ART procedures. Compared to controls, the fetuses derived from various ART procedures all exhibited impairments in the LV GLS and the LV GLS rate S.ConclusionsOur analysis demonstrated that subclinical cardiac remodeling and dysfunction were evident in ART fetuses, although these alterations did not persist in early infancy. In addition, various ART procedures may cause the same unfavorable changes in the fetal heart.Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (ChiCTR1900021672) on March 4, 2019, retrospectively registered.

Piezo-ICSI for Human Oocytes.

Since the first successful pregnancies achieved by intracytoplasmic sperm injection (ICSI) were reported, ICSI has become an essential technique in assisted reproductive technology (ART). ICSI uses micropipettes with a spiking tip to penetrate the zona pellucida and membrane. Then, the cytoplasm is usually aspirated into the micropipette for membrane breakage (conventional-ICSI). The survival and fertilization rates of mouse oocytes after conventional-ICSI were as low as 16% and 8%, respectively. Kimura and Yanagimachi applied a piezo drive unit, mercury, and a micropipette with a flat tip for mouse ICSI. The membrane breakage could be performed semi-automatically by combining these types of equipment without cytoplasmic aspiration into the micropipette (piezo-ICSI). These authors reported significantly higher survival and fertilization rates (80% and 78%) compared to those of conventional-ICSI (16% and 8%). Therefore, the piezo-ICSI may be effective not only for mouse oocytes but also for human oocyte ICSI. However, only five papers are available that assessed the effectiveness of piezo-ICSI compared to conventional-ICSI for human oocytes. All of these five papers reported significantly higher fertilization rates compared to those of conventional-ICSI. The goal of the piezo-ICSI protocol described here is to improve the clinical results of ICSI compared to the conventional-ICSI.

Intracytoplasmic sperm injection versus conventional IVF

Intracytoplasmic sperm injection is a widely used fertilisation method that involves injecting a single spermatozoon into oocyte cytoplasm using a glass micropipette.1 Although it was introduced as a modification of conventional in-vitro fertilisation (IVF) to overcome severe male factor infertility,2 intracytoplasmic sperm injection has become the most common laboratory technique in assisted reproductive technology, accounting for almost 70% of the around 2·8 million annual assisted reproductive technology cycles, according to global estimates.

Automated human sperm tracking using mean shift - collision detection and modified covariance matrix method

In vitro fertilisation (IVF) is a popular technique in assisted reproductive technology. The success of IVF mainly depends on the selection of the correct sperm in human semen sample. Sperm tracking plays an important role in selecting the active-moving sperm. One of the major challenges in sperm tracking is the collision of sperm cases during tracking. To solve this issue, mean shift–collision detection and modified covariance matrix (MS–CDMCM) is proposed. Specifically, MS–CDMCM detects collision and generates a new covariance matrix based on the collision condition. Then, this new covariance matrix will form a new tracked region to continue the tracking process. Results show that the proposed method is a more accurate and robust tracking method than other state-of-the-art sperm tracking methods. The proposed method produces significantly low error values, such as MAE, MSE and RMSE, according to the quantitative analysis when compared with ground truth images. The proposed method is expected to be implemented in sperm motility assessment in the future.

AMH-based ovarian stimulation versus conventional ovarian stimulation for IVF/ICSI: a systematic review and meta-analysis.

Anti-Müllerian hormone (AMH) used to establish patient profiles and predict ovarian response to stimulation, its role in assisted reproductive technology techniques is crucial. To evaluate the evidence from published RCTs about the efficacy and safety of AMH-based ovarian stimulation versus conventional ovarian stimulation. Search strategy: electronic databases were searched using the following MeSH terms (Anti-Müllerian hormone OR AMH) AND (IVF OR ICSI) and (tailored OR based). only RCTs were included. Four studies were included in the quantitative synthesis. the extracted data were entered into RevMan software, the relative risk (RR) and 95% confidence interval (CI) were used for data analysis. Primary outcomes: ongoing pregnancy: test for overall effect was in favor of AMH-based group, but there was no statistically significant difference [RR = 0.95, 95%CI (0.84-1.08), P = 0.44]. Severe ovarian hyperstimulation syndrome (OHSS) test or overall effect was in favor of AMH-based group, but there was still no statistically significant difference [RR = 0.68, 95%CI (0.43-1.06), P = 0.09]. Secondary outcomes were dose of rFSH, the number of oocytes retrieved, fertilized oocytes, embryos (day 3), blastocysts (day 5), and duration of stimulation. Only the dose of rFSH and duration of stimulation were in the favor of AMH-based group, with statistically significant difference. The other four secondary outcomes were in the favor of the conventional group but with no statistically significant difference. AMH-based stimulation has the same results of pregnancy rate and risk of OHSS and can reduce the dose of rFSH and duration of stimulation.

Comparing different sperm separation techniques for ART, through quantitative evaluation of p53 protein

Context:In the last 10 years, assisted reproductive technologies (ARTs) have offered infertile couples an opportunity to complete their reproductive project. However, the high failure rate could be explained with the complex human reproduction system. In ART, the decrease of the success is due to the conditions far from the natural ones.Aims:The aim of this study is to evaluate deoxyribonucleic acid (DNA) damage of spermatozoa before and after selection procedures, using a new technique able to quantize sperm DNA damage.Settings and Design:They were involved 43 males domiciled permanently in two areas with different Environmental Impact, HEI (high environmental impact) and LEI (Low environmental impact), they are aged between 24 and 31 years with various degrees of dyspermia.Subjects and Methods:The 43 males were divided into two groups: 21 in Group A (EIL) and 22 in Group B (EIH). The samples must be aliquoted into parts of 0.5 mL: Group (a) Control, no processing; Group (b) Swim-up (SUP) from semen; Group (c) classic SUP; Group (d) density gradient centrifugation (DGC). All samples were subjected to a quantitative dosage of p53 protein, before and after processing.Statistical Analysis Used:For the development of the probability and significance of the data, the Student's t-test was used.Results:From our data, it emerges that Groups D and B provide a superior quality about motility, vitality, and apoptosis indexes compared to other conventional techniques. In Group B, apoptosis is comparable to Group D, but they have slightly lower about motility and vitality. Group C is the one that has lower parameters than the other techniques. Regarding the evaluation of p53 protein, the results are conflicting with the evaluation of apoptosis; in fact, in Group D, the values are significantly higher than the other techniques.Conclusions:Sperm separation is an important moment in ART techniques. From our data, it emerges a greater fragility of DNA in the male spermatozoa who reside permanently in areas with high environmental impact.

Personalized medicine for in vitro fertilization procedure using modeling and optimal control

In vitro fertilization (IVF) is the most common technique in assisted reproductive technology and in most cases the last resort for infertility treatment. It has four basic stages: superovulation, egg retrieval, fertilization, and embryo transfer. Superovulation is a drug-induced method to enable multiple ovulation per menstrual cycle and key component towards a successful IVF cycle. Although there are the general guidelines for dosage, the dose is not optimized for each patient, and complications, such as overstimulation, can occur. To overcome the shortcomings of this general system, a mathematical procedure is developed which can provide a customized model of this stage regarding the size distribution of eggs (follicles/ oocytes) obtained per cycle as a function of the chemical interactions of the drugs used and the conditions imposed on the patient during the cycle, which provide a basis for predicting the possible outcome. Uncertainty and risk are modeled and included in optimal drug dosage decisions. This paper describes the theory, model, and the optimal control procedure for improving outcomes of IVF treatment for one of the four protocols used in real practice. The validation of the procedure is performed using clinical data from the patients previously undergone IVF cycles. Customized patient-specific model parameters are obtained by using initial two-day data for each patient. Subsequently, this model is used to predict the FSD for the remaining days of the cycle. This procedure was conducted for 49 patients. The results of the customized models are found to be closely matching with the observed FSD. These results thus validate the modeling approach and consequently its use for predicting the customized optimal drug dosage for each patient. Using the customized model and the optimized dosage, the FSD at the end of the cycle was determined. A small double-blind clinical trial was also conducted in India. The results from the trial show that the dosage predicted by using the model is 40% less than the suggestion made by the IVF clinicians. The testing and monitoring requirements for patients using optimized drug dosage is reduced by 72%. Work on the other three protocols and for patients in the USA is started and is showing promising results.

Laser technology in the ART laboratory: a narrative review.

To improve success rates, assisted reproductive technology (ART) procedures continually undergo optimization and enhancement such that the best quality gametes and embryos can be identified and manipulated, thus improving clinical outcomes. Laser technology is now being applied across ART to reduce procedure times and increase the consistency and reproducibility of traditional ART techniques such as assisted hatching, embryo biopsy, intracytoplasmic sperm injection cryopreservation and sperm immobilization/selection. This review examines the current status of cutting-edge laser-assisted reproductive technologies, investigates experimental techniques that are increasingly being applied clinically. It highlights the benefits of lasers as a powerful technology at the forefront of both diagnostic and therapeutic treatments for general subfertility and male-factor infertility. However, it is important to note that although lasers are becoming increasingly commonplace in ART units, there is comparatively little information in the existing literature pertaining to the potential negative effects that laser application might have on the developing human embryo, thus creating the need for further investigative research.

Effects of superovulation, in vitro fertilization, and oocyte in vitro maturation on imprinted gene Grb10 in mouse blastocysts

Grb10 is a key imprinted gene that is suspected to have a role in the adverse outcomes of assisted reproductive technology (ART), but little is known about the effects of ART on it. Primary ART techniques, including superovulation, in vitro fertilization (IVF), and oocyte in vitro maturation (IVM), were analyzed in this study of the effects of ART on embryo quality and Grb10. Embryo development rates were determined. Blastocyst cell number and global methylation were analyzed at the single-embryo level, together with Grb10 methylation and mRNA expression of the imprinted genes. Lower blastocyst cell number, higher genome and Grb10 CGI1 methylation, and variable mRNA expression were observed in the ART groups compared with the control group. Whether fertilization was in vivo or in vitro, the changes in the genome and Grb10 CGI1 methylation level and Grb10 and H19 expression were similar in the groups with superovulation and more significant than the IVM group. These results suggest that superovulation had a greater impact than IVF or IVM on the genome and Grb10 DNA methylation level, and Grb10 and H19 expression.