Natural Cycle Research Articles

An amplicon-based sequencing approach for Usutu virus characterization

Usutu virus (USUV), an arbovirus from the Flaviviridae family, genus Flavivirus, has recently gained increasing attention because of its potential for emergence. After his discovery in South Africa, USUV spread to other African countries, then emerged in Europe where it was responsible for epizootics. The virus has recently been found in Asia. USUV infection in humans is considered to be most often asymptomatic or to cause mild clinical signs. However, a few cases of neurological complications such as encephalitis or meningo-encephalitis have been reported in both immunocompromised and immunocompetent patients. USUV natural life cycle involves Culex mosquitoes as its main vector, and multiple bird species as natural viral reservoirs or amplifying hosts, humans and horses can be incidental hosts. Phylogenetic studies carried out showed eight lineages, showing an increasing genetic diversity for USUV. This work describes the development and validation of a novel whole-genome amplicon-based sequencing approach to Usutu virus. This study was carried out on different strains from Senegal and Italy. The new approach showed good coverage using samples derived from several vertebrate hosts and may be valuable for Usutu virus genomic surveillance to better understand the dynamics of evolution and transmission of the virus.

The natural menstrual cycle revisited – can natural cycle be trusted

BackgroundThe serum progesterone (P4) level during the luteal phase (LP) plays a crucial role in the initiation and maintenance of pregnancy. However, it is unclear whether the natural cycle consistently provides the best endocrine profile and whether mid-luteal serum P4 levels are always sufficient to support implantation and early pregnancy. The question has become more relevant in relation to fertility treatment, as more frozen embryo transfer cycles are performed in the natural cycle. Moreover, can serum hormone levels and covariates measured during the follicular phase (FP), such as Follicle Stimulation Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Anti-Mullerian Hormone (AMH) and Antral Follicle Count (AFC), be used to predict P4 levels during the luteal phase (LP)?ResultsThis observational prospective cohort study analysed 26 healthy women with a cycle length between 21–35 days and a body mass index (BMI) < 30 kg/m2. Blood sampling started on the fifth day of the menstrual cycle and continued every fifth day until the next cycle. The procedure was repeated for a total of three cycles. The study found that only ten women had a P4 level greater than 30 nmol/L on cycle day 20 or 25 in all three cycles. In total, only 45 cycles out of 77 cycles had serum P4 levels ≥ 30 nmol/L.The E2 level ≥ 345 pmol/L on cycle day 10 proved to be predictive of a P4 level of ≥ 30 nmol/L on either day 20 or day 25 with a sensitivity of 57% and a specificity of 89%. No other covariates, including the FSH level cycle day 5, LH levels during the follicular phase, age, weight, AFC and AMH cycle day 5 correlated with LP P4 levels.ConclusionsA significant correlation between FP E2 levels cycle day 5 (> 131pmol/L) and cycle day 10 (> 345pmol/L) and a LP P4 level ≥ 30 nmol/l was found; thus, the FP E2 level is a predictor of corpus luteum competence. Our findings highlight the existence of suboptimal P4 levels during the LP and a significant inter-individual and intra-cycle variation in P4 levels during the LP in regular menstruating women.

Dog ectoparasites as sentinels for pathogenic Rickettsia and Bartonella in rural Guatemala.

Fleas and ticks serve as vectors of multiple pathogens in the genera Rickettsia and Bartonellathat cause diseases in humans and other animals. Although human rickettsiosis and bartonellosis have been reported in all countries in Central America, limited research has been conducted to investigate the natural cycles of flea- and tick-borne rickettsiosis and bartonellosis, especially in Guatemala. We evaluated dog parasites as sentinels for zoonotic disease risk in rural Guatemala by sampling ticks and fleas from dogs, which were then identified and individually screened for Rickettsia and Bartonella. A total of 77 households were surveyed and 80.52% of them had dogs. Overall, 133 dogs were examined for fleas and ticks, of which 68.42% had fleas and 35.34% had ticks. A total of 433 fleas and 181 ticks were collected from the infested dogs, with an additional 33 ticks collected from house walls. Three flea species were identified: Ctenocephalides felis (70%), Echidnophaga gallinacea(11.8%), and Pulex sp. (17.8%). Among the collected ticks, 97% were Rhipicephalus sanguineus with the rest being Amyblyomma cajennense, A. auricularium, and A. ovale. Rickettsia felis were detected in six C. felis, in one Pulex sp., and in two R. sanguineus, while Candidatus R. senegalensis was detected in one C. felis. Bartonella was detected only in fleas, including three Pulexsp. infected with B. vinsonii subsp. Berkhoffii, B. henselae, and Bartonella sp., respectively, and 11 C. felis infected with B. henselae. This study reports Candidatus R. senegalensis and B. vinsonii subsp. Berkhoffiiin Guatemala for the first time, and indicates the potential risk of human and dog exposure to Rickettsia and Bartonella species. These results show that dogs provide critical information relevant to managing human potential exposure to flea- and tick-borne pathogens in rural Guatemala.

Estimation-based model predictive control with objective prioritization for mutually exclusive objectives: Application to a power plant

This work presents an algorithm for estimation-based model predictive control with objective prioritization such that distinct objectives may be defined for mutually exclusive operational regions. The objective prioritization algorithm is built by using logical conditions that define regions of operation which are incorporated into the objective function, thus allowing smooth transitions between a bank of objectives. The control objective prioritization is cast in the framework of model predictive control that is coupled with an extended Kalman filter for estimation of critical yet unmeasured state variables. The algorithm is applied to the challenging control problem of an industrial superheater (SH)-reheater (RH) system of a natural gas combined cycle plant under load following operation where smooth transitions among various control objectives is desired – operation under nominal conditions, avoidance of spraying to saturation at the inlet of the SH and RH systems, and avoidance of main steam temperature excursions. The results from the estimator framework are compared with the industrial data from an operating power plant. The control algorithm is evaluated by simulating a servo control problem and disturbance rejection scenarios as expected under load-following operation of the power plant. This algorithm is generic and can be applied to accomplish local control policies for safety, economics, quality control, state constraints, and others. Topical HeadingProcess Systems Engineering

Evaluating the Impact of CO2 Capture on the Operation of Combined Cycles with Different Configurations

In order to reduce greenhouse gas emissions associated with power generation, the replacement of fossil fuels with renewables must be accompanied by the availability of dispatchable sources needed to balance electricity demand and production. Combined cycle (CC) power plants adopting post-combustion capture (PCC) can serve this purpose, ensuring near-zero CO2 emissions at the stack, as well as high efficiency and load flexibility. In particular, the chemical absorption process is the most established approach for industrial-scale applications, although widespread implementation is lacking. In this study, different natural gas combined cycle (NGCC) configurations were modeled to estimate the burden of retrofitting the capture process to existing power plants on thermodynamic performance. Simulations under steady-state conditions covered the widest possible load range, depending on the gas turbine (GT) model. Attention was paid to the net power loss and net efficiency penalty attributable to PCC. The former can be mitigated by lowering the GT air–fuel ratio to increase the CO2 concentration (XCO2) in the exhaust, thus decreasing the regeneration energy. The latter is reduced when the topping cycle is more efficient than the bottoming cycle for a given GT load. This is likely to be the case in the less-complex heat recovery units.

Closing Kok’s cycle of nature’s water oxidation catalysis

The Mn4CaO5(6) cluster in photosystem II catalyzes water splitting through the Si state cycle (i = 0–4). Molecular O2 is formed and the natural catalyst is reset during the final S3 → (S4) → S0 transition. Only recently experimental breakthroughs have emerged for this transition but without explicit information on the S0-state reconstitution, thus the progression after O2 release remains elusive. In this report, our molecular dynamics simulations combined with density functional calculations suggest a likely missing link for closing the cycle, i.e., restoring the first catalytic state. Specifically, the formation of closed-cubane intermediates with all hexa-coordinate Mn is observed, which would undergo proton release, water dissociation, and ligand transfer to produce the open-cubane structure of the S0 state. Thereby, we theoretically identify the previously unknown structural isomerism in the S0 state that acts as the origin of the proposed structural flexibility prevailing in the cycle, which may be functionally important for nature’s water oxidation catalysis.

Long-term performance of magnesium phosphate cement concrete prepared in the winter

Previous studies have established the strength development of magnesium ammonium phosphate cement (MAPC) concrete and magnesium potassium phosphate cement (MKPC) concrete at sub-zero temperatures. However, the long-term performance of these magnesium phosphate cement (MPC) concrete, prepared at low temperatures and exposed to complex environmental effects of cold regions, remains underexplored. This study monitored the mechanical properties and durability of MAPC concrete at different ages for 520 d, which fully demonstrated the feasibility of MAPC concrete for winter construction in cold regions. At the age of 520 d, MAPC concrete had a compressive strength of over 65 MPa and excellent resistance to chloride ion penetration with a measured charge of 129.1 C, and could endure more than 250 rapid freeze-thaw cycles. In contrast, MKPC concrete exhibited significant disadvantages in terms of freeze-thaw resistance during natural freeze-thaw cycles. No expansive substances or damage were found in MKPC concrete that was prepared at low temperatures and subsequently experienced temperature increases along with accelerated hydration. The relatively poor freeze-thaw resistance of MKPC concrete could be attributed to a combination of factors including larger capillary size and volume, reduced air content, greater air-void spacing factor, wider and weaker interface zone between cement mortar and coarse aggregate.

Deep learning systems for forecasting the prices of crude oil and precious metals

Commodity markets, such as crude oil and precious metals, play a strategic role in the economic development of nations, with crude oil prices influencing geopolitical relations and the global economy. Moreover, gold and silver are argued to hedge the stock and cryptocurrency markets during market downsides. Therefore, accurate forecasting of crude oil and precious metals prices is critical. Nevertheless, due to the nonlinear nature, substantial fluctuations, and irregular cycles of crude oil and precious metals, predicting their prices is a challenging task. Our study contributes to the commodity market price forecasting literature by implementing and comparing advanced deep-learning models. We address this gap by including silver alongside gold in our analysis, offering a more comprehensive understanding of the precious metal markets. This research expands existing knowledge and provides valuable insights into predicting commodity prices. In this study, we implemented 16 deep- and machine-learning models to forecast the daily price of the West Texas Intermediate (WTI), Brent, gold, and silver markets. The employed deep-learning models are long short-term memory (LSTM), BiLSTM, gated recurrent unit (GRU), bidirectional gated recurrent units (BiGRU), T2V-BiLSTM, T2V-BiGRU, convolutional neural networks (CNN), CNN-BiLSTM, CNN-BiGRU, temporal convolutional network (TCN), TCN-BiLSTM, and TCN-BiGRU. We compared the forecasting performance of deep-learning models with the baseline random forest, LightGBM, support vector regression, and k-nearest neighborhood models using mean absolute error (MAE), mean absolute percentage error, and root mean squared error as evaluation criteria. By considering different sliding window lengths, we examine the forecasting performance of our models. Our results reveal that the TCN model outperforms the others for WTI, Brent, and silver, achieving the lowest MAE values of 1.444, 1.295, and 0.346, respectively. The BiGRU model performs best for gold, with an MAE of 15.188 using a 30-day input sequence. Furthermore, LightGBM exhibits comparable performance to TCN and is the best-performing machine-learning model overall. These findings are critical for investors, policymakers, mining companies, and governmental agencies to effectively anticipate market trends, mitigate risk, manage uncertainty, and make timely decisions and strategies regarding crude oil, gold, and silver markets.

Effect of lay theory of climate change on coping strategies: Stability and variability of information-induced results

Individuals' explanations for the cause of global climate change are based on their life experiences and acquired climate knowledge, namely the lay theories of climate change by this study. This explanation could related with their coping on climate change, but previous research has paid less attention to this issue. Study 1 conducted two national surveys (1a: n = 978, 1b: n = 933) to explore Chinese people’s lay theories of climate change and their relationship to coping strategies. In Study 2, three sub-studies were conducted to investigate the variability of lay theories of climate change and its impact on coping strategies, respectively, using the priming experiment (2a: n = 150) and the daily experience method (2b: n = 76, 2c: n = 138). The results suggest that lay theories of climate change can be divided into natural cycle theory and human-made acceleration theory. Human-made acceleration theory positively predicts problem- and meaning-focused coping strategies, and negatively predicts emotion-focused coping strategies. Participants' lay theories of climate change, while stable, are subject to change, which in turn affects their coping strategies. It is harder to get participants to switch to natural cycle theory than to human-made acceleration theory. This study puts forward the viewpoint of lay theories of climate change, which enriches the research on coping strategies of climate change.

Indigenous Accounts of Spiraling Time

Abstract Time has often been understood as either linear or cyclical, sometimes in Eurocentric ways that enclose Indigenous peoples in natural cycles with little or no historical development. This article explores an alternative to the line and the circle. In the context of environmental destruction, Indigenous scholars have suggested that traditional Indigenous accounts of spiraling time, from the Anishinaabe and Māori to the Aztecs and Muskoke, better connect nature with human history as well as more appropriately link human generations, including ancestors and descendants. Exploring its connection with the hermeneutic circle and other notions, I will propose the spiral as indeed a promising way to grasp these important connections. In conclusion, I will discuss the question of whether Indigenous spiral ontologies can be proposed for all of humanity beyond knowledge extractivism.

Unlocking the potential of Spirulina microalgae: Cultivating in wastewater treatment for sustainable biofuel production

Municipal wastewater, known for its high nitrogen and phosphorus levels, disrupts natural biogeochemical cycles. However, these nutrients are vital for cultivating green algae, which show potential as a sustainable energy source. In this study, Spirulina microalgae biomass was cultivated from diluted municipal wastewater and converted into biofuel to assess its compatibility with conventional diesel applications. Algae growth rate, nutrient removal from wastewater, and proximate and ultimate analyses of the biomass were conducted. Elemental, functional group, and chemical analyses of the biodiesel were also performed using an elemental analyzer, Fourier-transform infrared (FTIR) spectroscopy, and Gas Chromatography-Mass Spectrometry (GC-MS), respectively. Results showed effective removal of calcium, magnesium, potassium, and nitrogen nutrients by 44.7%, 71.7%, 50%, and 55.6%, respectively, through algae cultivation. Proximate and ultimate analyses confirmed the biomass's energy content and efficiency for energy production. Elemental analysis of biodiesel revealed significant contributions of carbon, hydrogen, and oxygen, while FTIR and GC-MS analyses identified carbon-based components and methyl esters as major constituents, respectively. Physicochemical properties of algae biodiesel met ASTM D6751 limits. This comprehensive assessment suggests that Spirulina algae from wastewater treatment holds promise as a viable energy source for diesel applications.

Do women with severely diminished ovarian reserve undergoing modified natural-cycle in-vitro fertilization benefit from earlier trigger at smaller follicle size?

To evaluate whether trigger and oocyte collection at a smaller follicle size decreases the risk of premature ovulation while maintaining the reproductive potential of oocytes in women with a severely diminished ovarian reserve undergoing modified natural-cycle in-vitro fertilization. This was a retrospective cohort study including women who had at least one unsuccessful cycle (due to no response) of conventional ovarian stimulation with a high dosage of gonadotropins and subsequently underwent a modified natural cycle with a solitary growing follicle (i.e. only one follicle > 10 mm at the time of trigger). The association between follicle size at trigger and various cycle outcomes was tested using regression analyses. A total of 160 ovarian stimulation cycles from 110 patients were included in the analysis. Oocyte pick-up (OPU) was performed in 153 cycles and 7 cycles were canceled due to premature ovulation. Patients who received their trigger at smaller follicle sizes (≤ 15 mm) had significantly lower rates of premature ovulation and thus higher rates of OPU (98.9% vs 90.8%; odds ratio, 9.56 (95% CI, 1.58-182.9); P = 0.039) compared with those who received their trigger at larger follicle sizes (> 15 mm). On multivariable analysis, smaller follicle sizes at trigger (> 10 to 13 mm, > 13 to 15 mm, > 15 mm to 17 mm) were not associated significantly with a lower rate of cumulus-oocyte complex (COC) retrieval, metaphase-II (MII) oocytes or blastulation when compared to the > 17-mm group. On sensitivity analysis including only the first cycle of each couple, the maturity rate among those with COC retrieval was highest in follicle sizes > 15 to 17 mm (92.3%) and > 13 to 15 mm (91.7%), followed by > 10 to 13 mm (85.7%) and lowest in the > 17-mm group (58.8%). During the study period, five euploid blastocysts developed from 48 fertilized MII oocytes with follicle sizes of 12 mm (n = 3), 14 mm (n = 1) and 16 mm (n = 1) at trigger. Of those, four were transferred and resulted in two live births, both of which developed from follicles with a size at trigger of 12 mm. The ideal follicle size for triggering oocyte maturation may be smaller in women with a severely diminished ovarian reserve managed on a modified natural cycle when compared to conventional cut-offs. The risk of OPU cancellation was significantly higher in women triggered at follicle size > 15 mm and the yield of mature oocytes was not adversely affected in women triggered at follicle size > 13 to 15 mm compared with > 15 to 17 mm. Waiting for follicles to reach sizes > 17mm may be detrimental to achieving optimal outcome. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study.

To evaluate the optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) following hysteroscopic polypectomy. This was a retrospective clinical cohort study involving 464 patients who underwent their first FET after polyp resection between January 2021 and July 2023. The cohorts were categorized into three groups: the natural cycle (NC) group (n = 139), the ovarian induction (OI) group (n = 117), and the hormone replacement therapy (HRT) group (n = 208). In the initial unadjusted analysis, both NC and OI cycles exhibited similar pregnancy rates but were associated with significantly higher implantation rate (56.5%, 57.1% vs 42.0%, P < 0.001), clinical pregnancy rate (73.4%, 74.4% vs 57.2%, P = 0.001), and ongoing pregnancy rate (OPR; 67.6%, 63.2% vs 51.0%, P = 0.005) compared to the HRT group. Additionally, the three groups demonstrated comparable abortion rate (7.8%, 14.9% vs 10.9%, P = 0.299). After adjusting for potential confounders in the multiple logistic regression model, the HRT protocol resulted in a 54% significantly lower OPR compared to the NC protocol (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI]: 0.28-0.77; P = 0.003). Meanwhile, the OPR difference between the OI protocol and the NC protocol remained insignificant (OI vs NC: aOR = 0.62, 95% CI: 0.35-1.12; P = 0.112). The ovulatory-FET scheme (NC and OI) following hysteroscopic polyp resection displayed promising clinical outcomes compared with HRT-FET scheme. The regimen without exogenous estrogen administration should be prioritized for endometrial preparation protocol after polypectomy.

Sustainable rural economy and food security: An integrated approach to the circular agricultural model

The lack of resources and increasing damage are major obstacles to sustainable economic progress. Conventional farming methods, known for their energy consumption and resulting pollution, need changes. This study focuses on agriculture, an approach inspired by natural ecological cycles that aim to promote sustainable development in rural areas through efficient resource reuse. The connection between agriculture and rural economies, along with strategies for their combined advancement, is an area that requires more exploration and thorough empirical analysis. The research involves an energy analysis methodology tailored for use in regions to assess the benefits and environmental impacts of implementing circular agriculture for sustainable rural economic growth. A multi-objective decision-making approach using TOPSIS is employed to enhance agricultural policy formulation and decision-making processes. The study concludes by developing a model that considers production, processing, recycling, and socioeconomic aspects to delve into the development of circular agriculture within rural communities and propose relevant strategies. The uniqueness of this research lies in its combination of agriculture and the coordinated advancement of rural economies, which offers a fresh viewpoint and approach to sustainable farming methods and robust rural economic development. The results contribute to the circular agriculture literature body and provide practical guidance for policymakers and farmers.

Enhanced Charge-Carrier Dynamics and Efficient Photoelectrochemical Nitrate-to-Ammonia Conversion on Antimony Sulfide-Based Photocathodes.

The photoelectrochemical reduction of nitrate to ammonia (PEC NO3RR) has emerged as a promising pathway for facilitating the natural nitrogen cycle. The PEC NO3RR can lower the reduction potential needed for ammonia synthesis through photogenerated voltage, showcasing the significant potential for merging abundant solar energy with sustainable nitrogen fixation. However, it is influenced by the selective photocathodes with poor carrier kinetics, low catalytic selectivity, and ammonia yields. There are few reports on suitable photoelectrodes owning efficient charge transport on PEC NO3RR at low overpotentials. Herein, we rationally constructed the CuSn alloy co-catalysts on the antimony sulfides with a highly selective PEC ammonia and an ultra-low onset potential (0.62 VRHE). CuSn/TiO2/Sb2S3 photoelectrodes achieved an ammonia faradic efficiency of 97.82 % at a low applied potential of 0.4 VRHE, and an ammonia yield of 16.96 μmol h-1 cm-2 at 0 VRHE under one sun illumination. Dynamics experiments and theoretical calculations have demonstrated that CuSn/TiO2/Sb2S3 has an enhanced charge separation and transfer efficiency, facilitating photogenerated electrons to participate in PEC NO3RR quickly. Meanwhile, moderate NO2* adsorption on this photocathode optimizes the catalytic activity and increases the NH4 + yield. This work opens an avenue for designing sulfide-based photocathodes for the efficient route of solar-to-ammonia conversion.

Political Economic Role in Natural Quality Management and its Impact on Plant Ecology: Why Arar-Juniper Plants Disappeared

Wadi-Arar is a unique region that has lost some of its most important natural features within 200 years, including plants, geographical lakes, and valleys. The study aimed to investigate the disappearance of the juniper plant, a vital species in Saudi Arabia, in recent decades. The research highlighted various factors influencing the quality of life for the juniper plant and its habitats. It sought to identify the primary factors causing changes in the natural conditions of the plant and those influencing its growth. The findings indicated a significant impact of the Suez Canal on the Arar region, the sole connection between Africa and Asia, and Europe. This influence extends beyond geopolitical factors in the surrounding area, as the existence of the Suez Canal disrupted the natural life cycle of many animal species over thousands of years of migrations and coexistence across Earth's continents. These animals previously provided natural organic fertilizer to the soil, supporting plant growth. However, due to low rainfall resulting in low natural nutrients and high salinity, the plants' viability has diminished, reflecting a history of administrative and geopolitical decisions.

Low Dose hCG Support in Modified Natural Frozen Embryo Transfer Cycles.

What is the effect of a single low-dose recombinant hCG injection after embryo transfer (ET) in letrozole-induced modified natural frozen embryo transfer cycles (mNC-FET)?. An observational study was conducted in the university-affiliated referral clinic between 2022 and 2024. Women aged 18-42 with at least one vitrified blastocyst obtained from the previous cycle(s) were included. Ovulation induction for endometrial preparation was initiated with oral letrozol (5mg/day) for five days. Ovulation was triggered using 6500IU rec hCG sc when the leading follicle > 17mm, endometrial thickness > 7.5mm, and serum progesterone (P) < 1.5ng/ml. All women received 30mg dydrogesterone/day po for additional five-day luteal support. On the 6th day, ET was performed. Based on a quasi-randomized design, a group of women additionally received a half single bolus of (3250IU) rec hCG (sc) on the morning of 3rd day of ET (hCG group). Women who did not receive additional hCG were assigned as controls.One hundred fifty-four women were detected to be eligible for the study among 2150 initiated FET cycles during the period.Demographic data of the groups, including mean women's age, BMI, serum AMH, and infertility etiologies, were comparable in terms of variables. Mean serum progesterone values and the number of transferred embryos were also similar. A significantly higher ongoing pregnancy/started cycle was documented in the hCG group than in controls (46.7% vs 33.6% respectively, p = 0.03*). A single low-dose hCG injection after ET may improve the OPRs of women in letrozole mNC-FET cycles.

Electrocatalysts for Inorganic and Organic Waste Nitrogen Conversion.

Anthropogenic activities have disrupted the natural nitrogen cycle, increasing the level of nitrogen contaminants in water. Nitrogen contaminants are harmful to humans and the environment. This motivates research on advanced and decarbonized treatment technologies that are capable of removing or valorizing nitrogen waste found in water. In this context, the electrocatalytic conversion of inorganic- and organic-based nitrogen compounds has emerged as an important approach that is capable of upconverting waste nitrogen into valuable compounds. This approach differs from state-of-the-art wastewater treatment, which primarily converts inorganic nitrogen to dinitrogen, and organic nitrogen is sent to landfills. Here, we review recent efforts related to electrocatalytic conversion of inorganic- and organic-based nitrogen waste. Specifically, we detail the role that electrocatalyst design (alloys, defects, morphology, and faceting) plays in the promotion of high-activity and high-selectivity electrocatalysts. We also discuss the impact of wastewater constituents. Finally, we discuss the critical product analyses required to ensure that the reported performance is accurate.

O-206 Natural, modified natural or artificial endometrial preparation strategies for frozen embryo transfer in ovulatory women (MONART): a randomized controlled trial

Abstract Study question Are live birth rates after natural (NC), modified natural (mNC) endometrial preparation superior to artificial cycle (AC) strategies for ovulatory women undergoing frozen embryo transfer? Summary answer Live birth rates were comparable between NC, mNC, and AC. However, NC and mNC resulted in a significantly higher cycle cancellation rate. What is known already The number of frozen embryo transfer (FET) cycles has increased dramatically. In ovulatory women undergoing FET, three common strategies can be used for endometrial preparation: NC, mNC (NC + human chorionic gonadotropin trigger), and AC protocols. Previous studies comparing the effectiveness of these strategies had several drawbacks, including small sample size, lack of consistency between studies in the assessment and reporting of outcomes, and the retrospective origin, which introduced potential biases. Therefore, there is a lack of consensus on the optimal endometrial preparation protocol for FET. Study design, size, duration This single-center, open-label, randomized controlled trial was conducted at IVFMD, My Duc Hospital in Ho Chi Minh City, Vietnam. From March 2021 to March 2022, a total number of 1,428 participants were randomized (476 per group). The primary outcome of the study was live birth after one FET. Secondary outcomes were fertility outcomes, early pregnancy complications, obstetrical outcomes, perinatal and neonatal complications, and endometrial preparation cycle cancellation rates. Participants/materials, setting, methods Eligible participants were ovulatory women aged 18–45 with FET treatment, underwent no more than three IVF/intracytoplasmic sperm injection-FET cycles, had no more than two day-3 or one blastocyst transferred. Women with menopause/anovulation, contraindications for hormonal administration, uterine abnormalities who underwent in-vitro maturation, pre-implantation genetic testing, oocyte donation cycles were excluded. The FET strategies included FET after the first endometrial preparation cycles with AC, mNC, or NC, as per randomization, and the second with AC. Main results and the role of chance A total of 4,779 participants were screened, of whom 1,428 eligible individuals (476 per group) were randomized after written informed consent. The live birth rate after one FET was 36.6% (174/476) in the natural cycle strategy group, 33.4% (159/476) in the modified natural cycle strategy group, and 34.0% (162/476) in the artificial cycle strategy group (relative risk [95% confidence interval] for natural versus artificial cycle strategy: 1.07 [0.87–1.33] and for modified natural versus artificial cycle strategy: 0.98 [0.79–1.22]). Maternal and neonatal outcomes were comparable between groups, in particular,hypertensive disorders in pregnancy. For both natural and modified cycle groups, 20.08% (99/476) of the first FET cycles were canceled before subsequent successful ET versus none in the artificial cycle group. Limitations, reasons for caution Due to the nature of the intervention, blinding was not possible. The study was conducted in ovulatory women in a single center in Vietnam, which may limit the generalisability of the findings. Wider implications of the findings Live birth rates and obstetric/neonatal outcomes after the natural cycle, modified natural cycle, or artificial cycle strategies for ovulatory women undergoing FET are comparable, with higher cancellation rates in both the natural cycle and the modified natural cycle groups. Trial registration number NCT04804020

P-398 Lower ectopic pregnancy prevalence with natural endometrial preparation in single euploid frozen embryo transfers

Abstract Study question Does the endometrial preparation approach for an euploid-frozen embryo transfer have an impact on the incidence of an ectopic pregnancy? Summary answer The natural cycle endometrial preparation approach seems to have a lower incidence of ectopic pregnancies compared to a hormonal replacement therapy cycle. What is known already Ectopic pregnancy (EP) is an uncommon complication of pregnancy and is associated with significant morbidity. IVF pregnancies have been implicated as a risk factor, but this finding is mostly confounded by multiple embryo transfer and complicated medical history of women undergoing IVF treatment (tubal disease, surgery, endometriosis, etc.). Recent studies have suggested that frozen embryo transfer may reduce the risk of EP, but it is not yet known whether embryo ploidy status and different endometrial preparation regimens affect the risk of EP. Study design, size, duration Retrospective cohort of 1517 pregnancies from 2607 single euploid frozen embryo transfers. Comparator estimates were estimated using multiple large cohort studies in the literature including 58,203,239 pregnancies from unselected cohorts and 220,167 pregnancies from IVF-treated women with the transfer of non-tested embryos. Participants/materials, setting, methods The rate of ectopic per pregnancies were compared to ectopic rate derived from multiple cohorts of IVF-treated women and population level reports of unselected pregnancies (natural conception and IVF). Comparator estimates were obtained with proportion meta-analyses using generalized linear mixed models. Factors associated with ectopic pregnancies were investigated with mixed-effects logistic regression analyses. Main results and the role of chance EP rate in our cohort was 10/1000 pregnancies (95% CI: 5 to 16 per 1000) resulting from single euploid embryo transfers (1.1%, 16/1517). The observed prevalence of EP was 12/1000 pregnancies (95% CI: 6.8 to 21 per 1000) in unselected cohorts and 14/1000 pregnancies (95% CI: 13 to 15 per 1000) after IVF-treatment. Ectopic rate in our study was not significantly different than rates reported in the literature from unselected and IVF pregnancies (P = 0.579 and 0.223, respectively). There were no significant differences between women with ectopic pregnancies and those with clinical pregnancies in terms of age (33.6±5.5 vs. 35.1±5.2 years, P = 0.290), BMI (26.7±4.8 vs. 25.8±4.6 kg/m2, P = 0.475) and serum AMH levels (3.3±2.9 vs. 3.4±3.9 ng/mL, P = 0.854), nor between the quality of embryo transferred between top, good, fair and poor (1.8% vs 0.7% vs 1.9% vs 0.9%, p = 0.088, 0.997 and 0.508 respectively). Ectopic rates were also similar between women with history of cesarean section (1.1% vs 1.0%, P = 0.847) or isthmocele (1.0 vs 1.1%, P = 0.857). There were less ectopic pregnancies following transfers with natural endometrial preparation (0.5 vs 1.5%, natural vs programmed) and the effect showed statistical significance in multivariable analyses (OR: 0.28, 95% CI: 0.06 – 0.88, P = 0.049). Limitations, reasons for caution Small sample size as well as infrequent occurrence of the studied event reduces the power of our study to detect small but clinically meaningful effects with statistical significance. Wider implications of the findings We did not observe a lower than reported prevalence of EP among euploid embryo transfer. However, rate of EP was significantly lower in natural endometrial preparation cycles compared to preparation with exogenous hormones, indicating that a natural cycle might have a protective effect against the development of an ectopic pregnancy. Trial registration number Not applicable