Couples Seeking Fertility Treatment Research Articles

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women’s and men’s attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner’s lower QoL. Adaptive coping in men and women were associated with women’s higher QoL. Non-adaptive coping was associated with men and women’s lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

(107) “Can Sexual Dysfunction and Stress in Couples Attempting Conception Be Explained by the Ovulation Calculator?” An Evaluation Study

Abstract Introduction Stress and sexual dysfunction affect a significant portion of couples seeking conception, leading to emotional strain. We hypothesized that ovulation calculators, widely used as a tool to predict fertile days, may play a role in the stress experienced by couples undergoing fertility treatments. We evaluated the impact of ovulation calculators on stress levels in couples seeking fertility treatment and explored the associations with sexual dysfunction and mental health implications due to the stress of infertility. Objective The objective of this study is to evaluate the impact of ovulation calculators on stress levels in couples seeking fertility treatment and to explore the associations with sexual dysfunction and mental health implications due to the stress of infertility. Methods Participants were recruited from the University of Miami Health System Clinics. Fifty couples consulting for infertility were included in the study. Both partners were asked to complete anonymous self-reported surveys consisting of validated questions related to stress levels, sexual function, and the use of ovulation calculators. The surveys included the Female Sexual Function Index (FSFI) for females and the International Index of Erectile Function (IIEF) for males to assess sexual function. Additionally, the Fertility Problem Inventory (FPI) was used to measure fertility-related stress and distress. The data collected included age, duration of attempts to conceive, and responses to stress-related questions. Results A total of 50 couples who we reattempting conception completed the cross-sectional study with all the questionnaires were included in the study. Whether or not they were using ovulation calculators, women scored similarly in the 4 variables of the FSFI, including Arousal, Orgasm, Satisfaction, and Lubrication. When evaluating IIEF scores for Male Erectile Function, the average score of men tracking ovulation was 12.0 ± 4.8, compared to 11.5 ± 5.4 in male patients who were not (P-Value: 0.81). The results showed no statistically significant difference in stress levels between couples who used ovulation calculators and those who did not. However, both male and female participants reported higher levels of sexual dysfunction in couples experiencing higher stress levels due to infertility. Fertility-related stress was also found to be significantly associated with mental health implications, with increased anxiety and depression reported by couples undergoing fertility treatments. Conclusions The findings suggest that the use of ovulation calculators did not significantly influence the stress experienced by couples seeking fertility treatment. However, the study highlights the significant impact of infertility-related stress on sexual function and mental health in both male and female partners. These results emphasize the importance of addressing the psychological aspects of infertility and providing comprehensive support to couples undergoing fertility treatments. Further research is warranted to explore the complex interplay between ovulation calculator usage, infertility-related stress, sexual dysfunction, and mental health implications in couples seeking to conceive. Healthcare providers should consider incorporating mental health support into fertility treatment programs to optimize patient outcomes and overall well-being. Disclosure No.

Maternal and Paternal Preconception Serum Concentrations of Per and Polyfluoroalkyl Substances in Relation to Birth Outcomes.

Prenatal per and polyfluoroalkyl substances (PFAS) exposure is associated with adverse birth outcomes. There is an absence of evidence on the relationship between maternal and paternal preconception PFAS exposure and birth outcomes. This study included 312 mothers and 145 fathers with a singleton live birth from a preconception cohort of subfertile couples seeking fertility treatment at a U.S. clinic. PFAS were quantified in serum samples collected before conception. Gestational age (GA) and birthweight (BW) were abstracted from delivery records. We also assessed low birthweight (BW < 2500 g) and preterm birth (GA < 37 completed weeks). We utilized multivariable linear regression, logistic regression, and quantile-based g computation to examine maternal or paternal serum concentrations of individual PFAS and mixture with birth outcomes. Maternal serum concentrations of perfluorooctanesulfonate (PFOS), perfluorohexanesulfonate (PFHxS), and the total PFAS mixture were inversely associated with birthweight. Maternal PFOS concentration was associated with a higher risk of low birthweight. Conversely, paternal PFOS and PFHxS concentrations were imprecisely associated with higher birthweight. No associations were found for gestational age or preterm birth. The findings have important implications for preconception care. Future research with larger sample sizes would assist in validating these findings.

The role of partner support in infertility-related quality of life in couples seeking fertility treatment

Infertility is a common issue, with significant impacts on couples’ lives. Infertility and its treatments can place considerable stress on both partners and lead to relationship insecurity. Several researchers have shown that infertility can reduce the quality of life of both members of the couple. Since partners represent the main source of support for each other in the context of infertility, examining partner support as a potential protective factor for these couples seems highly justified. The objective of this study was to examine the association between partner support and infertility-related quality of life assessed 3 months later among 83 couples using medically assisted reproduction. Partners individually completed online questionnaires at baseline and 3 months later. Path analyses using the actor-partner interdependence model revealed that a person’s perception of greater emotional, informational, and tangible partner support was associated with their own higher emotional and relational infertility-related quality of life 3 months later. Women’s perception of greater physical support was also associated with their partner’s higher relational quality of life. The findings suggest that interventions targeting partner support could reduce the negative effects of infertility and its treatments on infertile couples’ quality of life.

Attachment and Sexual Functioning in Couples Seeking Fertility Treatment: The Role of Infertility-Specific Coping Strategies

Couples facing infertility often experience sexual difficulties. Yet, little is known about the factors associated with these difficulties. We examined whether infertility-related coping strategies explain the associations between attachment insecurities (anxiety, avoidance) and sexual function and satisfaction in 97 couples seeking fertility treatment. Anxiety was associated with one’s lower sexual satisfaction and function via self-neglect coping strategies. Anxiety was also associated with the partner’s lower sexual satisfaction via self-blame coping. Avoidance was associated with lower partner support-seeking and sexual satisfaction. These findings support the roles of attachment and coping in the experience of sexual difficulties among couples seeking fertility treatment.

The Impact of Ovulation Calculators on the Stress Levels of Fertility-Seeking Couples: An Evaluation Study.

Introduction Infertility affects a significant portion of couples seeking pregnancy, leading to stress and emotional strain. Ovulation calculators, widely used as a tool to predict fertile days, may play a role in the stress experienced by couples undergoing fertility treatments. The aim of this study was to evaluate the impact of ovulation calculators on the stress levels of couples seeking fertility. Methods Participants were recruited from the University of Miami Health System Clinics. Fifty couples consulting for infertility were asked to participate in the study and complete anonymous self-reported surveys. The surveys consisted of validated questions related to stress levels and the use of ovulation calculators. The completed surveys were collected and analyzed using descriptive statistics. The data collected included age, number of years trying to conceive, and answers to questions related to stress levels and the use of ovulation calculators. Responses from 50 couples who met the inclusion criteria were included in the final analysis. Results A total of 50 couples who wereattempting conception and who completed all the questionnaires were included in the study. Whether or not they were using ovulation calculators, females scored similarly in the four variables of the Female Sexual Function Index (FSFI), including arousal, orgasm, satisfaction, and lubrication. When evaluating International Index of Erectile Function (IIEF)scores for male erectile function, the average score of males tracking ovulation was 12.0 ± 4.8, compared to 11.5 ± 5.4 in male patients who were not (P = 0.81). The results showed no statistically significant difference in stress levels between couples who used ovulation calculators and those who did not. However, in couples experiencing higher stress levels due to infertility, both male and female participants reported higher levels of sexual dysfunction. Fertility-related stress was also found to be significantly associated with mental health implications, with increased anxiety and depression reported by couples undergoing fertility treatments. Conclusion The findings suggest that the use of ovulation calculators did not significantly influence the stress experienced by couples seeking fertility treatment. However, the study highlights the significant impact of infertility-related stress on sexual function and mental health in both male and female partners. These results emphasize the importance of addressing the psychological aspects of infertility and providing comprehensive support to couples undergoing fertility treatments. Further research is warranted to explore the complex interplay between ovulation calculator usage, infertility-related stress, sexual dysfunction, and mental health implications in couples seeking to conceive. Healthcare providers should consider incorporating mental health support into fertility treatment programs to optimize patient outcomes and overall well-being.

Perinatal outcomes in lesbian couples employing shared motherhood IVF compared with those performing artificial insemination with donor sperm.

In lesbian couples, is shared motherhood IVF (SMI) associated with an increase in perinatal complications compared with artificial insemination with donor sperm (AID)? Singleton pregnancies in SMI and AID had very similar outcomes, except for a non-significant increase in the rate of preeclampsia/hypertension (PE/HT) in SMI (recipient's age-adjusted odds ratio (OR) = 1.9, 95% CI = 0.7-5.2; P = 0.19), but twin SMI pregnancies had a much higher frequency of PE/HT than AID twins (recipient's age-adjusted OR = 21.7, 95% CI = 2.8-289.4; P = 0.01). Oocyte donation (OD) pregnancies are associated with an increase in perinatal complications, in particular, preterm delivery and low birth weight, and PE/HT. However, it is unclear to what extent these complications are due to OD process or to the conditions why OD was performed, such as advanced age and underlying health conditions. Unfortunately, the literature concerning perinatal outcomes in SMI is scarce. Retrospective study involving 660 SMI cycles (299 pregnancies) and 4349 AID cycles (949 pregnancies) assisted over a 10-year period. All cycles fulfilling the inclusion criteria performed in lesbian couples seeking fertility treatment in 17 Spanish clinics of the same group. Pregnancy rates of SMI and AID cycles were compared. Perinatal outcomes were compared: gestational length, newborn weight, preterm and low birth rates, PE/HT rates, cesarean section rates, perinatal mortality, and newborn malformations. Pregnancy rates were higher in SMI than in AID (45.3% versus 21.8%, P < 0.001). There was a non-significant trend to higher multiple rate in AID (4.7% versus 8.5%, P = 0.08). In single pregnancies, there were no differences between SMI and AID in gestational age (278 days (268-285) versus 279 (272-284), P = 0.24), preterm rate (8.3% versus 7.3%, P = 0.80), preterm <28 weeks (0.6% versus 0.4%, P = 1.00), newborn weight (3195 g (2915-3620) versus 3270 g (2980-3600), P = 0.296), low birth rate (6.4% versus 6.4%, P = 1.00), extremely low birth weight (0.6% versus 0.5%, P = 1.00), and the distribution of newborns by weight groups. Cesarean section rate, newborn malformation rate, and perinatal mortality were also similar in SMI and AID. Additionally, there was non-significant trend in hypertensive disorders to an increase in PE/HT among SMI (recipient's age-adjusted OR = 1.9, 95% CI = 0.7-5.2). Overall, perinatal data are consistent with what is reported in the general population. In twin pregnancies, the aforementioned perinatal parameters were also very similar in SMI and AID. However, SMI twin pregnancies had a very high risk of PE/HT when compared with AID (recipient's age-adjusted OR = 21.7, 95% CI = 2.8-289.4, P = 0.01). Our data regarding the pregnancy course were obtained from information registered in the delivery report as well as from what was reported by the patients themselves, so a certain degree of inaccuracy cannot be ruled out. Additionally, in some parameters, there was up to 10% of data missing. However, since the methodology of reporting was the same in SMI and AID groups, one should not expect a differential reporting bias. It cannot be ruled out that the risk of PE/HT in simple gestations would be significant in a larger study. Additionally, in the SMI group allocation to the transfer of 2 embryos was not randomized so some bias is possible. SMI, if single embryo transfer is performed, seems to be is a safe procedure. Double embryo transfer should not be performed in SMI. Our data suggest that the majority of complications in OD could be related more with recipient status than with OD itself, since with SMI (performed in women without fertility problems) the perinatal complications were much lower than usually described in OD. No external funding was received. The authors declare that they have no conflict of interest. N/A.

Occupational factors and markers of testicular function among men attending a fertility center.

Are occupational factors associated with markers of testicular function among men attending a fertility center? Men working non-daytime/rotating shifts and those with physically demanding jobs have higher sperm concentration and total sperm count as well as higher estradiol and total testosterone concentrations. Semen quality has declined during recent decades and has been negatively correlated with higher risks of common chronic diseases and mortality, highlighting its public health importance beyond fertility and reproduction. While most of the previous epidemiology literature on male fertility has focused on environmental exposures, dietary factors, and other related variables, little attention has been paid to occupational factors. This observational study included 377 men who were male partners in couples seeking infertility treatment at a fertility center, who enrolled in the Environment and Reproductive Health (EARTH) study between 2005 and 2019. Self-reported information on lifting/moving heavy objects, typical shift, and physical level of exertion at work was collected from a take-home questionnaire. Semen samples were analyzed following World Health Organization guidelines. Enzyme immunoassays were used to assess reproductive hormone concentrations. Linear regression models were used to evaluate the association between occupational factors and measures of testicular function, while adjusting for covariates such as age, BMI, education, race, smoking, and abstinence time, and accounting for multiple semen samples (mean = 2, min-max = 1-9) in analyses for semen parameters. Men had a median (interquartile range) age of 36 (33, 39) years and were predominantly Caucasian (87%). Of the men who completed the survey, 12% reported often lifting or moving heavy objects at work, 6% reported heavy physical exertion at work, and 9% reported evening or rotating shifts. Men who reported often lifting or moving heavy objects at work had 46% higher sperm concentrations (P = 0.01) and 44% higher total counts (P = 0.01) compared with men who reported never lifting or moving heavy objects at work. Similar results were found for men working in rotating shifts compared to those in day shifts, as well as for men involved in heavy levels of physical exertion compared to those with light levels at work. We also found that men involved in heavy/moderate levels of physical exertion at work had higher circulating testosterone concentrations compared to those with lighter exertion (adjusted means of 515 and 427 ng/dl, respectively, P = 0.08), and men who often moved/lifted heavy objects at work had higher estradiol concentrations, compared to those who never did (adjusted means of 36.8 and 27.1 pg/ml, respectively, P = 0.07). Men working evening/rotating shifts had 24% higher testosterone (P = 0.04) and 45% higher estradiol concentrations (P = 0.01), compared to men working day shifts. No associations were observed for ejaculated volume, total motility, morphologically normal sperm, or serum FSH and LH concentrations. Due to our study design which recruited men from couples seeking fertility treatment, it may not be possible to generalize our findings to men from the general population. Also, as is the case of all studies based on self-reported questionnaires, measurement error and misclassification of the exposure are potential concerns. Physically demanding jobs and rotating or evening shift occupations may be associated with higher testicular function in men measured as higher sperm concentrations and counts as well as higher serum testosterone and estradiol levels. Confirmation of these findings in other non-fertility clinic study populations is warranted. NIH grants R01ES022955, R01ES009718, R01ES033651, and R01ES000002 from the National Institute of Environmental Health Sciences (NIEHS) and Legacy, Inc. R.A.G. works part time for Legacy, Inc., which provided funds to perform this analysis. There are no other conflicts of interest. N/A.

COVID-19 vaccine hesitancy and associated factors among infertile couples undergoing assisted reproductive treatment.

Although periconception vaccination is important to maternal and neonatal health, little is known about the COVID-19 vaccine hesitancy among infertile couples seeking fertility treatment. Thus, we conducted this survey among infertile patients in a reproductive medicine center, between September 2021 and December 2021, to estimate the prevalence of COVID-19 vaccine hesitancy and its influencing factors. Information was collected through face-to-face interviews among volunteers. Among the 987 included interviewees, 17.33% reported hesitancy in primary vaccination, 25.63% reported hesitancy in booster vaccination, and 32.32% delayed the primary vaccination. Hesitancy in primary vaccination was associated with unexplained infertility (OR: 1.77, 95% CI: 1.05-2.98), ongoing IVF treatment (OR: 2.17, 95% CI: 1.22-3.89), concerns for vaccine safety (OR: 4.13, 95% CI: 2.66-6.42), effectiveness (OR: 1.62, 95% CI: 1.15-2.28), and influence on pregnancy (OR: 2.80, 95% CI: 1.68-4.67). These factors were also associated with hesitancy in booster vaccination. Delay of the primary vaccination was inversely associated with a college or above degree (OR: 0.49, 95% CI: 0.27-0.87), previous history of influenza vaccination (OR: 0.67, 95% CI: 0.46-0.98), and was positively associated with concerns for the influence on pregnancy (OR: 7.78, 95% CI: 5.01-12.07). It is necessary to carry out targeted education program by health professionals to publicize the benefits of periconception vaccination, and to reduce the resistance to COVID-19 vaccine among infertile couples.

Are Clinical Outcomes of Microdissection Testicular Sperm Extraction in Non-Obstructive Azoospermic Men Affected by the Use of Fresh or Frozen Gametes?

Background: Non-obstructive azoospermia (NOA) is a severe form of male factor infertility, evident in approximately 5% of infertile couples seeking fertility treatment. The combination of microsurgical testicular sperm extraction (mTESE) and ICSI has become one of the treatment options, with sperm motility positively associated with outcome success rates. Few studies have investigated whether use of fresh or thawed gamete combinations affect clinical outcomes. Aim: To determine the clinical outcomes of ICSI cycles using mTESE recovered testicular sperm of NOA patients and whether these are affected by the use of fresh or thawed gametes. Method: A retrospective study of NOA patients who underwent mTESE between March 2017 and September 2020. Clinical outcomes investigated included successful surgical sperm retrieval (SSR), sperm motility, fertilisation, embryo utilisation and live-birth/ongoing pregnancy rates. Results: A total of 105 NOA patients underwent mTESE, with a 65.7% successful SSR. In total 58 patients contributed to 72 ICSI cycles, with a 37.5% 2PN fertilisation rate and 29.4% live-birth/ongoing pregnancy rate. Cycles using only motile sperm had a greater fertilisation rate than those using a motile/non-motile sperm combination (51.7% vs 31.1%, p[Formula: see text]0.05). Compared with fresh, thawed testicular spermatozoa didn’t affect clinical outcomes, including live-birth/ongoing pregnancy rates (Fresh 18.2%; Thawed 17.9%; Odds ratio (OR) 1.02 (0.34-2.86) p=0.98). In contrast, use of thawed oocytes decreased fertilisation rate [Fresh-oocytes: 45.0%; Vitrified-oocytes: 35.5%; OR 1.47(1.03-2.10), p=0.03] but had no differences for other clinical outcomes, including live-birth/ongoing pregnancy rate (p=0.74). Importantly, injection of exclusively non-motile-spermatozoa (n=26 cycles) resulted in a very low fertilisation rate (2.7%) and no live-birth/ongoing pregnancies were recorded. Conclusion: Microdissection TESE is an effective treatment for NOA patients, with no clear negative effects of using thawed spermatozoa, however, the use of vitrified oocytes requires further investigation. The use of non-motile spermatozoa in mTESE ICSI cycles is discouraged.

Perceived Injustice and Psychological Well-Being in Couples Seeking Fertility Treatment

Infertility and its treatment are associated with a host of negative emotions, including perceived injustice. However, no quantitative study has examined the link between perceived injustice and psychological difficulties in couples seeking fertility treatment. This study examined the associations between perceived injustice and both partners’ psychological well-being and investigated possible differences in perceived injustice based on sex or cause of infertility. Both partners of 103 couples seeking fertility treatment completed the Injustice Experience Questionnaire—Infertility, the Hospital Anxiety and Depression Scale, and the Fertility Quality of Life Tool. Perceived injustice was associated with one’s own and one’s partner’s higher depressive symptoms and lower infertility-related quality of life, as well as one’s own higher anxiety symptoms. Women also perceived more injustice than men. The cause of infertility was unrelated to perceived injustice. Findings suggest that perceived injustice could represent an intervention target to reduce psychological distress in infertile couples.

P-399 Effect of male body mass index on miscarriage rate following fertility treatment, a systematic review and meta-analysis

Abstract Study question Is raised paternal body mass index (BMI) important for the miscarriage rate following assisted reproductive technology (ART)? Summary answer Based on the available evidence, raised male BMI is not associated with higher risk of miscarriage following ART. What is known already More than half women and men of reproductive age worldwide are overweight or obese.There is extensive literature exploring the importance of normal female BMI for reproductive outcomes. However, little attention has been given to male BMI for couples seeking fertility treatment [1] .The adverse effect of male obesity on sperm parameters including DNA damage is well documented and there is evidence suggesting that raised male BMI results in significant decrease in live birth rate following ART [2] .Furthermore, emerging evidence from human and animal studies demonstrates that paternal obesity can affect the future health of the offspring through epigenetic pathways[3]. Study design, size, duration A computerized literature search was performed using EMBASE, MEDLINE, CINAHL and the Cochrane Central register of trials from database inception to November 2021. The aim was to explore the association between male BMI on miscarriage rate following ART. Reference lists of relevant studies were cross-checked. Only articles with full manuscripts available and published in English were included. Papers not relating to human subjects were excluded. All eligible studies were included (observational, prospective and retrospective studies). Participants/materials, setting, methods Included studies reported on couples undergoing ART for any indication using partner’s fresh sperm. Outcomes of interest were miscarriage rate and clinical pregnancy rate. Outcome data from each study were pooled and expressed as odds ratio (OR) with 95% confidence interval (CI) by using a random-effect model due to statistical heterogeneity in the outcome data[4]. Heterogeneity of treatment effects was evaluated using the I2 statistic to quantify the variation across studies caused by heterogeneity. Main results and the role of chance Abstract screening identified 197 relevant studies. After excluding duplicates, reviews and studies which did not fulfill the inclusion criteria, full manuscripts were accessed for 13 studies. Six studies were identified exploring the effect of male BMI on miscarriage following ART, two prospective and four retrospective. The quality of evidence was low using the GRADE framework. Meta-analysis was possible for three studies including 6793 couples undergoing ART. Outcomes were compared for male BMI &amp;lt; 25 kg/m2 versus BMI &amp;gt;/=25 kg/m2 . The pooled results did not show a statistically significant increase in miscarriage rate when the male partner was overweight or obese compare to normoweight (OR 1.32, 95% CI 0.82–2.1, P = 0.249). There was significant heterogeneity between the included studies (I 2 = 48.7%). There was no significant effect of male BMI on clinical pregnancy rate (OR 0.90, 95% CI 0.59–1.38, P = 0.637). For two of the remaining studies which could not be included in the meta-analysis due to missing data, the authors concluded that male BMI &amp;gt;25 was not associated with increased miscarriage risk whilst the most recent prospective study showed that high male BMI was associated with increased risk of chromosomal aberration-related miscarriages. Limitations, reasons for caution The number of the included studies and significant heterogeneity are the main limitations. It was not possible to account for important confounders such as age, subfertility diagnosis, type of stimulation and laboratory parameters including embryo grade. We grouped participants in two BMI categories therefore did not distinguish between overweight/obesity/morbid obesity. Wider implications of the findings Despite increasing evidence suggestive of adverse effect of raised male BMI on reproductive outcomes, there is limited literature exploring the impact on miscarriage rate following ART. More well-designed studies are needed for sound conclusions. Paternal characteristics, general health and preconception lifestyle should not be overlooked in the fertility consultation. Trial registration number not applicable

Local and Systemic Oxidative Stress Biomarkers for Male Infertility: The ORION Study.

Infertility problems occur in around 10% of all couples worldwide, with male-factor infertility as the sole contributor in 20–30% of these cases. Oxidative stress (OS) is suggested to be associated with the pathophysiology of male infertility. In spermatozoa, OS can lead to damage to the cell membrane, resulting in disruption of DNA integrity and a decrease in motility. Established biomarkers for OS include free thiols and malondialdehyde (MDA), both representing different components of the reactive species interactome (RSI). This exploratory study aimed to investigate seminal plasma-free thiol and MDA levels in relation to semen parameters as defined by the World Health Organization (WHO) to determine if these markers are adequate to define local OS status. Furthermore, this study investigated if there is a relation between systemic and local OS status by comparing seminal concentrations of free thiol (R-SH, sulfhydryl groups, representing the extracellular redox status) and MDA (lipid peroxidation product) levels to those measured in serum. Free thiol and MDA measurements in both serum and semen plasma were performed in 50 males (18–55 y) of couples seeking fertility treatment. A significant positive correlation was found between seminal plasma-free thiol levels and sperm concentration and progressive motility (r = 0.383, p = 0.008 and r = 0.333, p = 0.022, respectively). In addition, a significant positive correlation was found between MDA levels in seminal plasma and sperm concentration (r = 0.314, p = 0.031). This study supports that seminal plasma-free thiols may be promising as local OS biomarkers. No associations were observed between local and systemic OS biomarker concentrations.

Associations between mixtures of urinary phthalate metabolite concentrations and oxidative stress biomarkers among couples undergoing fertility treatment

Phthalate exposure has been associated with adverse reproductive outcomes and oxidative stress is a potential mechanism by which they act. However, few human studies have explored co-exposure confounding or joint effects. Furthermore, most studies examine associations between biomarkers of exposure and oxidative stress from the same urine sample. We investigated single-exposure, co-exposure-adjusted, and joint associations between phthalate metabolites and oxidative stress in the Environment and Reproductive Health (EARTH) study among couples undergoing fertility treatment. We examined cross-sectional associations in both women and men, and longitudinal associations in women. Urine was collected in the follicular phase (women only) and at the time of fertility procedure (women and men), and analyzed for 11 phthalate metabolites. Urine from the time of fertility procedure was analyzed for oxidative stress biomarkers, including free 8-iso-prostaglandin F2α (8-iso-PGF2α), its primary metabolite (2,3-dinor-5,6-dihydro-15-F2t-isoprostane [F2-IsoP-M]), and prostaglandin F2α (PGF2α). Linear mixed effects models were used to estimate single-exposure associations. Bayesian Kernel Machine Regression (BKMR) was used to adjust for co-exposures and to estimate joint effects. Among women, we observed positive associations between all phthalate metabolites and oxidative stress biomarkers in single-exposure models, but there was clear co-exposure confounding. For instance, in a single-exposure model, we estimated a 63% (95% confidence interval: 51, 77) increase in the 8-iso-PGF2α metabolite per interquartile range (IQR) difference in mono-n-butyl phthalate (MBP) versus a 34% (95% credible interval: 12, 60) increase in co-adjusted models. However, several phthalate metabolites remained associated with oxidative stress in co-exposure models, and the joint effects of all exposures were high (e.g., an 114% increase in the 8-iso-PGF2α metabolite per IQR difference in all exposures). Longitudinal results were also attenuated compared to cross-sectional results in women; however, the joint effect of all exposures and the 8-iso-PGF2α metabolite remained positive and statistically significant (11% increase per IQR difference in all exposures, 95% credible interval: 0.2, 23). In men, associations were generally less pronounced, although the joint effect of the mixture on 8-iso-PGF2α was above the null. Because oxidative stress is related to reproductive success among couples seeking fertility treatment, mitigating phthalate exposure should be considered as a potentially beneficial measure.

Pregnancy Achievement by Medical Assisted Reproduction Is Correlated to the G Protein-Coupled Receptor 30 mRNA Abundance in Human Spermatozoa

Estrogens, specifically 17β-estradiol (E2), play an important role in male health, including male fertility. The G protein-coupled receptor for estrogen 30 (GPR30) is essential for mediating the rapid non-genomic effects of E2 on a variety of testicular cells, including spermatozoa, although its molecular effects remain largely unknown. In this work, we hypothesized that the GPR30 mRNA abundance in spermatozoa could be correlated to sperm quality. Sperm GPR30 mRNA could also be carried into the oocyte, potentially impacting embryo development and the success of a pregnancy. For this study, 81 sperm samples were collected from couples seeking fertility treatment and undergoing medically assisted reproduction treatments (ART), following the World Health Organization guidelines. GPR30 mRNA abundance in spermatozoa was assessed with a quantitative polymerase chain reaction. The resulting data show that there is no correlation between the abundance of the GPR30 transcript with paternal BMI, age, or sperm quality parameters. Interestingly, we observed that higher levels of GPR30 mRNA abundance in spermatozoa were related to the achievement of biochemical pregnancy and clinical pregnancy (p &lt; 0.05) by couples undergoing treatment. These results highlight the role of the sperm’s RNA cargo in offspring development, suggesting that spermatozoa mRNA content can influence ART success.

CLINICAL IMPLICATIONS OF AN EXPANDED PAN-ETHNIC CARRIER SCREENING PANEL

To describe what proportion of patients complete the recommended expanded carrier screening prior to initiating fertility treatment and what proportion of those patients had actionable screening results. This was a retrospective cohort study of all new patient visits from January to April 2016 where at least one partner underwent expanded pan-ethnic genetic carrier screening at our university affiliated center. The primary outcome of this study was the number of couples who completed screening prior to initiating fertility treatment. The secondary outcome was the number of actionable genetic disorders screened positive for individual patients and couples. A total of 1,320 new patient visits were screened for inclusion, of which 911 couples pursued fertility treatment at our center. Of the 911 couples, 648 (71.1%) couples completed screening where at least one partner was screened, and 263 (28.9%) couples declined or were not screened. Of those screened, 317 (49.0%) couples were screened together on the same day. For couples who were not screened together, the female partner was screened an average of 35.7 ± 131 days before their partner underwent screening. Of the 612 female partners who completed screening, 402 (65.7%) females screened positive for a genetic disorder. There were 31 couples where both partners screened positive for at least one actionable genetic disorder. Of these 31 couples, 12 pursued in-vitro fertilization (IVF) only, eight pursued IVF with preimplantation genetic testing for monogenic disorder, three pursued intrauterine insemination, two conceived spontaneously, one used an egg donor, one pursued ovulation induction, and six did not return for treatment at our center. Of the 457 females who became pregnant, 53 (11.6%) couples did not complete any screening before pregnancy. The findings of this descriptive study suggest that the majority of couples seeking fertility treatment completed the expanded pan-ethnic genetic carrier screening and many of these couples are screened before becoming pregnant, indicating that many couples are interested in knowing their risk of having a child with a genetic disorder. This expanded pan-ethnic carrier screening has a high positivity rate thus providing valuable information to help couples decide what type of fertility treatment to pursue.

P–716 The relationship of men’s adherence to the Mediterranean diet with sperm parameters and outcomes of assisted reproductive technologies

Abstract Study question Is men’s adherence to the Mediterranean diet (MD) associated with sperm parameters and couples’ outcomes of assisted reproductive technologies (ART)? Summary answer Higher men’s adherence to the MD was associated with an increased probability of clinical pregnancy and live birth among couples undergoing ART. What is known already There is growing literature supporting the hypothesis that some nutrients, foods, and dietary patterns may be related to sperm quality and fertility. However, no previous studies analyzed the relationship of men’s adherence to the Mediterranean diet with sperm parameters and ART outcomes in the same cohort. Study design, size, duration The Environmental and Reproductive Health (EARTH) Study is a prospective preconception cohort of couples seeking fertility treatment at the Massachusetts General Hospital Fertility Center (Boston, USA). This analysis includes 314 men and their female partner, who underwent 791 ART cycles (2007–2020). Diet intake was measured by a validated semi-quantitative food frequency questionnaire completed prior to ART. Men’s adherence to the MD was estimated using the Trichopoulou score. Participants/materials, setting, methods Primary outcomes included: conventional sperm parameters (volume, sperm count, concentration, motility, and morphology), and ART outcomes (implantation, clinical pregnancy, and live birth). We estimated the marginal means and 95% confidence interval (95%CI) for semen parameters and the probability of ART (95%CI) by employing generalized linear mixed models while adjusting for several potential confounders. Sensitivity analyses by changing the cut-off points of adherence to the MD were tested. Main results and the role of chance At baseline, men had a median (IQR) age of 35.6 (32.6, 38.8) years and a BMI of 26.7 (24.0, 29.4) kg/m2. Female partner age median (IQR) was 35.0 years (32.0, 38.0) and BMI 23.3 (21.3, 26.6) kg/m2. Couples were mostly white and had never smoked. Men’s adherence to the MD was not associated with seminal parameters in the multivariable-adjusted models but it was related to a higher probability of clinical pregnancy and live birth. The predicted marginal proportions and confidence intervals among men in the lowest compared with the highest quartile of adherence to the MD were 0.25 (0.14, 0.40), 0.55 (0.41, 0.68) for clinical pregnancy (P-trend=0.005), and 0.19 (0.10, 0.32), 0.42 (0.30, 0.55) for live birth (P-trend=0.014). Male partner MD dietary pattern scores were unrelated to the probability of implantation. Sensitivity analyses using tertiles and quintiles of men’s adherence to the MD showed similar associations. Limitations, reasons for caution Although we have adjusted our models by several potential confounding factors, residual confounding cannot be ruled out, and therefore our results should be interpreted with caution. The findings may not be generalizable to other populations or couples attempting conception without ART. Wider implications of the findings: According to our knowledge, this is the first study suggesting that adherence to MD could be suitable dietary guidance for men whose partners are undergoing infertility treatment. Trial registration number Not applicable

Expression of obesity-related genes in human spermatozoa affects the outcomes of reproductive treatments

To study the abundance of obesity-related gene (ORG) mRNA in human spermatozoa and its association with sperm quality parameters, embryonic development, and pregnancy rates after assisted reproduction treatment (ART). Cross-sectional study of spermatozoa ORG mRNA expression, and sperm and embryonic development parameters of infertile couples attending a single ART center. University, in collaboration with a medically assisted reproduction center. One hundred six couples seeking fertility treatment and receiving ART. Expression of spermatozoa ORG mRNA was assessed by quantitative reverse transcription-polymerase chain reaction. Sperm and embryonic development parameters were measured by board-certified embryologists. Serum β-human chorionic gonadotropin levels and fetal heartbeat detection on ultrasound were used to document biochemical and clinical pregnancy, respectively. Correlations between the abundance of ORG transcripts in spermatozoa and sperm quality, embryonic development, and achievement of pregnancy. The abundance of spermatozoa FTO mRNA was positively correlated with total sperm count (r = 0.5030), fertilization rate (r = 0.4854), embryo cleavage rate (r = 0.5705), and high-quality embryo rate (r = 0.6982). The abundance of spermatozoa MC4R transcript was negatively correlated with sperm viability (r = -0.3111) and positively correlated with biochemical pregnancy (r = 0.4420). The abundance of MC4R and GNPDA2 transcripts was higher in spermatozoa of men with asthenozoospermia and teratozoospermia than in those with normozoospermia. To our knowledge, this is the first report showing that the abundance of MC4R and FTO transcripts in spermatozoa is associated with sperm and embryo quality parameters, as well as pregnancy rates. Overall, these results further support the view that male factors beyond classic sperm quality parameters, namely the abundance of ORG transcripts, also affect the outcome of ART.

Hysterosalpigography findings of female partners of infertile couple attending fertility clinic at Lagos University Teaching Hospital

IntroductionHysterosalpingography (HSG) is an outpatient fluoroscopic method for the evaluation of the uterine cavity, fallopian tubes, and the surrounding peritoneal cavity. Female fertility depends greatly on normal female reproductive organs; hence tubal abnormalities may contribute significantly to female infertility. HSG is an invaluable screening tool in the evaluation of women with suspected tubal factor infertility. This study aims to review the HSG findings of women who sought fertility treatment at the Lagos University Teaching Hospital, Lagos (LUTH).Methodsthis was a retrospective study of the pattern of HSG findings among female partners of infertile couples seeking fertility treatment at the LUTH, over a 2-year period, from January 2018 to December 2019.Resultsa total of 266 medical records and HSG results were reviewed and included in the data analysis. The mean age (± standard deviation) was 38.4 (± 0.3) years with a range of 24 to 50 years. Most (80.5%) of the participants have secondary infertility and majority (65.4%) were nulliparous. Tubal pathology was the commonest abnormality detected on HSG in 54.9% of women. About one-third (30.8%) of women had bilateral tubal occlusion on HSG. With regards to the right fallopian tube, 43.2% of the participants had tubal occlusion, which differs from 41.7% on the left fallopian tube. Similarly, 10.2% of the women had hydrosalpinx on the left tube when compared with 9% on the right tube. Age (OR 1.055; 95% CI: 1.006, 1.106, p-value 0.028), and previous salpingectomy [OR 6.151; 95% CI: 1.335, 28.349] and myomectomy [OR 4.6; 95% CI: 1.814, 11.67] were identified as risk factors for tubal pathologies on HSG.Conclusiontubal abnormalities are common findings on HSG and the identifiable risk factors for tubal pathologies include age, salpingectomy, and myomectomy. HSG remains a vital screening tool in the evaluation of tubal-factor infertility in Nigeria.