Fertility Center Research Articles

#58 : Relationship Between E-Cigarettes (Vaping) Habits and Semen Parameters Among Patient Attending Sabahcare Fertility Centre

Background and Aims: Exposure to nicotine is known to reduce sperm count and motility as well as increasing abnormal parameters. This study aimed to determine the differences of Seminal Fluid Analysis (SFA) between e-cigarettes users (vaping) and non-vaping patients attending SabahCare Fertility Centre. This study is still on-going, more samples are to be expected before the 12[Formula: see text] Congress of ASPIRE Method: Data is collected by handing out questionnaire to male patient doing SFA in the centre. Samples are examined according to WHO laboratory manual for the examination and processing of human semen, sixth edition (WHO, 2021) criteria. Sperm parameters we applied are normozoospermia, oligozoospermia (sperm concentration <14 × 106/ml), azoospermia (no spermatozoa in the ejaculate), asthenozoospermia (sperm motility and/or progressive motility are below the reference value). Chi-Square test analysis will be performed to determine the significance level of the results. Results: Currently, a total of 38 sample sizes are collected. 60.5% are in the normal SFA quality and 39.5% are in the abnormal SFA quality. Conclusion: Sample collection to determine if using e-cigarettes (vaping) affects semen quality among SabahCare Fertility Centre are still ongoing.

Preconception Stress and Pregnancy Serum Glucose Levels Among Women Attending a Fertility Center.

The association between women's stress and pregnancy glucose levels remain unclear, specifically when considering the preconception period as a sensitive window of exposure. We investigated whether preconception perceived stress was associated with glucose levels during pregnancy among women attending a fertility center (2004-2019). Before conception, women completed a psychological stress survey using the short version of the validated Perceived Stress Scale 4 (PSS-4), and blood glucose was measured using a 50-gram glucose load test during late pregnancy as a part of screening for gestational diabetes. Linear and log-binomial regression models were used to assess associations of total PSS-4 scores with mean glucose levels and abnormal glucose levels ( ≥ 140 mg/dL), adjusting for age, body mass index, race, smoking, education, physical activity, primary infertility diagnosis, number of babies, and mode of conception. Psychological stress was positively associated with mean abnormal glucose levels. The adjusted marginal means (95% CI) of mean glucose levels for women in the first, second, and third tertiles of psychological stress were 115 (110, 119), 119 (115, 123), and 124 (119, 128), and mg/dL, respectively (P for trend = .007). Also, women in the second and third tertiles of psychological stress had 4% and 13% higher probabilities of having abnormal glucose compared with women in the first tertile of psychological stress (P trend = .01). These results highlight the importance of considering preconception when evaluating the relationship between women's stress and pregnancy glucose levels.

#21 : Letrozole Can Be a Good Adjuvant for In Vitro Fertilization (IVF) Procedure in Patient with Ovarian Endometriosis

Background and Aims: To evaluation the pregnancy rate in IVF procedure with letrozole in patient with ovarian endometrioma. Method: Prospective study performed by single physician at primary fertility center. From August 2016 to November 2019, 109 cycles of IVF were performed from couples who were diagnosed as endometrioma. 40 women were diagnosed during ovarian cystectomy, 69 were by transvaginal ultrasonography. In 64 cycles, gonadotrophic releasing hormone (GnRH) antagonist protocol was used, and in another 45 cycles, gonadotrophin releasing hormone agonist (GnRHa) protocol were applied. In every cycle, 10 mg of letrozole was added from the start of gonadotrophin till the end of ovarian stimulation. Results: Women’s age was 36.10±3.67, and the number of their previous IVF cycle was 2.66±1.63. AMH was 2.30±2.31, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) on the third day of menstruation were 9.40±5.26, 7.81±4.60 and 54.1±44.2. Start dosages and total dosages of recombinant FSH were 314.32±74.99 and 2541.37±992.77, and serum E2 and progesterone on trigger day were 1220.06±1072.49 and 0.92±0.79. The endometrial thickness was 9.20±1.46. The number of obtained oocytes was 9.05±5.94 and metaphase II(M2) oocytes were 6.71±4.12. 1.91±0.42 embryos were transferred to the uterine cavity and 2.68±2.58 surplus embryos were cryopreserved. Pregnancy rate was diagnosed if serum beta human chorionic gonadotrophin (hCG) level was above 5 ng/ml on 14th day after oocyte retrieval, and the result was 44.95% (49/109). Clinical pregnancy rate which was defined if gestational sac was visualized by transvaginal ultrasonography after at least 21st days after oocyte retrieval, and the result was 24.77% (27/109). Conclusion: In IVF procedure for the patients with ovarian endometrioma, just adding letrozole to conventional controlled ovarian hyperstimulation protocol can reduce serum peak E2 level without make harmful effect on uterine endometrium, and result in comparable pregnancy rate.

Embryonic, genetic and clinical outcomes of fresh versus vitrified oocyte: A retrospective cohort study

Objective: To compare embryonic development, ploidy status and clinical outcomes between fresh and frozen-thawed oocytes. Methods: This retrospective cohort study evaluated 83 fertilization cycles including both fresh and frozen oocytes from 79 patients at the HP Fertility Center of Hai Phong International Hospital of Obstetrics and Pediatrics in Vietnam. The patient underwent several ovarian stimulation cycles to accumulate a certain number of oocytes that would be vitrified. In the last oocyte retrieval, all patient's oocytes including both frozen and fresh would be fertilized. The outcomes included the rates of oocyte survival, cleavage embryo, blastocyst, ploidy status, pregnancy, biochemical pregnancy and clinical pregnancy. Results: The oocyte survival rate after thawing was 96.5%. No statistically significant difference was found when comparing fresh and frozen oocytes regarding fertilization rate (78.1% vs. 75.5%, P=0.461), usable cleavage embryo rate (86.9% vs. 87.2%, P=0.916) but usable blastocyst rate was found higher statistically in the frozen oocyte group (44.4% vs. 54.0%, P=0.049). The percentages of euploid, aneuploid and mosaic embryos between the fresh group and the vitrified group had no significant differences (33.8% vs. 31.6%, P=0.682; 51.0% vs. 54.2%, P=0.569; 15.2% vs. 12.4%, P=0.787; respectively). The rates of pregnancy, biochemical pregnancy and clinical pregnancy had no statistical difference (68.8% vs. 64.8%, P=0.764; 12.5% vs. 3.6%, P=0.258; 37.5% vs. 46.4%, P=0.565). 17 Mature oocytes are the minimum to have at least one euploid embryo. Conclusions: Oocyte vitrification does not affect embryonic, genetic and clinical results. The number of mature oocytes should be considered for fertilization in some cases.

Fresh vs. frozen embryo transfers in patients with KIR Bx haplotype: impact on reproductive outcomes.

A controversy persists over whether or not the type of embryo transfer (ET) influences reproductive outcomes. This study aimed to evaluate the reproductive outcomes of pregnant patients undergoing their first in vitro fertilization procedure and explore the influence of various KIR genotypes on these reproductive outcomes. Prospective enrollment of patients with infertility who sought treatment at Origyn Fertility Center in Iasi, Romania, was conducted between January 2019 and March 2023. Descriptive statistics and average treatment effects (ATE) using propensity-score matching were employed to analyze our data. Our results indicated that both groups were homogenous regarding baseline characteristics. When we evaluated the ATE of fresh vs. frozen ET on the main outcomes, we discovered that only frozen ET significantly improved the pregnancy rates (ATE: 0.17, 95% CI: 0.04-0.30, p=0.011) and live birth rates (ATE: 0.36, 95% CI: 0.02-1.19, p=0.03). The miscarriage rates were similar between the two groups. None of the evaluated KIR genotypes had a significant influence on the ATE corresponding to fresh and frozen ET. KIR screening is not necessary before an IVF cycle, except for specific situations such as recurrent pregnancy loss or recurrent implantation failure.

Fatores que afetam o sucesso profissional de enfermeiros que atuam na área de tecnologia de reprodução assistida

Objective: to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. Method: a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. Results: 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. Conclusion: attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Factors that affect career success of nurses who practice in assisted reproductive technology.

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing WorkEnvironment Scale. Descriptive and inferential statistics were applied. 597assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75[standard deviation (SD) = 1.01] and 3.42(SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

#20 : Follitropin Delta Can Play a Good Role in Both Patients with High Serum AMH Level and Patients with Low Serum AMH Level in IVF

Background and Aims: To evaluation clinical efficacy of follitropin delta in IVF procedure for Korean. Method: This is a prospective study performed by single physician at primary fertility center. From December 2020 to November 2021, total 82 cycles of IVF were performed. 70% of total cycles was performed using gonadotrophic releasing hormone (GnRH) antagonist protocol, and another 30% of cycles were gonadotrophin releasing hormone agonist (GnRHa) protocol. Results: Average duration of infertility was 2.2± 1.5 years. AMH levels were 2.4± 2.4 ng/ml. The number of obtained oocytes were 8.9± 5.0. Mean daily dose of follitropin delta were 10.3± 2.5 mcg, and total dosage were 121.8± 25.5 mcg. Duration of stimulation were 9.9± 2.0 days. Biochemical pregnancy rate was 38% and clinical pregnancy rate was 27%. No cases of severe ovarian hyperstimulation syndrome were developed. Conclusion: For both patients with good ovarian reserve, and the patients with poor ovarian reserve, follitropin delta can play a good role. With its discriminative fixed dosing protocol, follitropin delta gives more convenient way for both physicians and patients with minimal risk of OHSS, without having detrimental effect on pregnancy rate.

#172 : The Comparison of Intra-Cytoplasmic Sperm Injection (ICSI) Treatment Outcome for Patient Stimulated with Progestine-Primed Ovarian Stimulation (PPOS) and Gonadotrophin-Releasing Hormone Agonist (GnRHa) Long Protocol

Background and Aims: GnRHa long protocol is a traditional method with benefits such as synchronisation of follicular development, higher oocytes recovery, and improved endometrial thickness but it possesses higher fees with long injection timeline. However, PPOS is an ovarian stimulation protocol that can block the surge of luteinizing hormone (LH) through progesterone instead of the traditional method. This prospective randomized trial is to investigate whether PPOS can be as effective as GnRHa long protocol in ICSI treatment for patients. Method: A total of 55 patients with mean age 36.67 who underwent ICSI cycle in TMC Fertility Centre Ipoh, Malaysia from Jan 2015 to December 2022 was analysed between PPOS and GnRHa long protocol. The embryological and clinical outcomes were measured using statistical analysis T-test with a significant value at p&lt;0.05. Patients above 42-years-old was excluded in this study. Results: Basic characteristics such as infertility duration, age, anti-mullerian hormone (AMH), antra-follicle count (AFC) and body mass index (BMI) were comparable in both groups. There was no significant difference found between PPOS and GnRHa long protocol in the number (mean± SD) oocytes retrieved [9.33±7.38 vs 8.55±7.44, p=0.352]; fertilized oocytes [5.79±4.92 vs 4.03±4.12, p=0.081]; number of blastocysts formed [4.35±2.82 vs 3.11±3.23, p=0.147] and utilized blastocysts [2.79±1.42 vs 2.35±2.66, p=0.300]. There was also no significant difference in clinical pregnancy rate (p=0.456) in both groups. No patient from either group experienced cycle cancellation due to the low number of oocytes expected. No ovarian hyperstimulation (OHSS) syndrome was reported from both groups as well. Conclusion: PPOS in combination with embryo cryopreservation as an ovarian stimulation regimen was as effective as GnRHa long protocol during controlled ovarian stimulation (COH) under different endocrinal mechanisms as it can achieve comparable embryological and clinical outcome. Hence, it can be an alternative treatment for infertile patients in ART in terms of cost and treatment timeline.

#345 : Progestin-Primed Ovarian Stimulation Protocol Slightly Improves the IVF Funnel in Patients with Poor Ovarian Response

Background and Aims: Controlled Ovarian Stimulation (COS) is a crucial first step in the In Vitro Fertilization (IVF) or Intra-Cytoplasmic Sperm Injection (ICSI) process. Progestin-primed ovarian stimulation (PPOS) has been recently introduced as an alternative to traditional COS regimens. However, the efficacy of PPOS regimen among infertile women with poor ovarian response (POR) remains unclear. This study aims to evaluate the effect of PPOS regimen on the chance of success throughout the IVF process in Vietnamese infertile women with POR. Method: This randomized controlled trial included 120 infertile women with POR (according to POSEIDON criteria) who received IVF at Tam Anh Fertility Center (Hanoi, Vietnam). PPOS and GnRH_ant regimens were randomly applied to the participants (n=60 for each group). A chain of 4 successive Binomial regression models has been applied to estimate the chance of success for 4 steps: oocyte maturation, fertilization and achieving good quality day-3 and day-5 embryos. The effect of PPOS in comparison with GnRH_ant protocol was evaluated by marginal risk-ratio (RR) from each model. Results: Chances of successfully achieving the MII oocytes, fertilization, high-quality D3 and D5 embryos were all moderately higher when using the PPOS regimen, compared with those of GnRH_ant protocol (95% confidence intervals of RR were respectively 0.88–1.07, 0.89–1.14, 0.96–1.14 and 0.74–1.73). Conclusion: Although not yet reached a statistical significance, those results indicated that using PPOS protocol may slightly improve the chance of success in 4 first critical steps of the IVF process for infertile women with POR.

#313 : The Correlation Between Ultrasound Morphological Parameters and Phenotypes of Polycystic Ovary Syndrome in Indonesian Women

Background and Aims: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects women of reproductive age. Ultrasound morphological parameters of ovarian morphology, ovarian volume, follicle number, endometrial plate thickness, and doppler analysis are necessary for the diagnosis of PCOS. The aim of this study is to evaluate the correlation between ultrasound morphological parameters and classic and nonclassic phenotypes of PCOS in Indonesian Women. Method: A single-center, observational analytic study from May 2022 until October 2022 was performed upon 50 women with PCOS at Halim Fertility Center (HFC), Indonesia. Fifty PCOS women were classified into two groups: 20 PCOS women with classic phenotype and 30 PCOS women with non-classic phenotype. Data on patient’s age, body mass index (BMI), LH level, FSH level, LH: FSH ratio, Testosterone, Free testosterone index, SHBG, HOMA-IR, Ultrasound parameters (antral follicle count, follicle size, ovarian volume, stromal volume, Stromal/total area (S/A) ratio, Pulsatility index (PI), Peak systolic velocity (PS) and follicle distribution) were assessed and compared between the two groups. Results: The antral follicle count was higher in classic phenotype of PCOS than in nonclassic phenotype and there was a significant difference between the groups (p&lt;0.05). The stromal volume and PI were higher in non-classic phenotype PCOS than in classic phenotype and there was significantly difference between the groups (p&lt;0.05). Most of the follicle distribution in the classic phenotype of PCOS was central and the follicle distribution in the non-classic phenotype was peripheral and there was significantly difference between the groups (p&lt;0.05). The number of antral follicles, stromal volume, PI, and follicle distribution were positively correlated with the PCOS phenotypes (r=0.734; r=0.594; r=0.577; r=0.196), respectively. Conclusion: Classic phenotype of PCOS in Indonesian women has high antral follicle count and central follicle distribution and nonclassic phenotype has high stromal volume, PI and peripheral follicle distribution.

Impact of adenomyosis on IVF outcomes in women undergoing donor oocyte transfers: a prospective observational study

To prospectively examine the association between adenomyosis type, location, and severity with reproductive outcomes in patients undergoing single embryo transfer (SET) with embryos derived from donor oocytes. A prospective observational cohort study. University-affiliated in-vitro fertilization center. Infertile patients with (n=114) and without (n=114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in the study. Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2D/3D transvaginal ultrasound, and classified according to type (diffuse, focal), localization (inner/outer myometrium and/or the junctional zone) and uterine extension (mild, moderate, severe). Following an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage. The primary outcome was the implantation rate. The secondary outcomes were clinical pregnancy, live birth, and miscarriage rate following SET. (s): The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate compared to those without adenomyosis (20.2% vs. 9.6 %, respectively; p=0.04). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, TVS-detection of adenomyosis in the junctional zone was associated with over three-fold higher odds of miscarriage (RR 3.28, 95% CI 1.38-7.78; p=0.004). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy (RR 0.30, 95% CI 0.13-0.72; p=0.004). Diffuse adenomyosis in the JZ and severe adenomyosis raised the odds of miscarriage four-fold (RR 2.29, 95% CI 1.22-4.30; p=0.015; and RR 2.20, 95% CI 1.19-4.04; p=0.005). (s): This study demonstrated that while adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the junctional zone and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of infertile patients.

#82 : Does Apoptotic Body Impair Pregnancy Outcome

Background: Morphologically suboptimal blastocyst is often associated with poorer pregnancy outcomes. Apoptotic body is one of the abnormal findings in blastocysts characterised by cellular shrinkage and a darker appearance. The presence of apoptotic bodies may be suggestive of ongoing cellular degeneration. Cellular degeneration in the blastocyst is part of its self-corrective mechanism. The degenerated cells will deplete through the phagocytosis process. Aims: This is a retrospective study that aims to analyse whether the presence of apoptotic body has a significant impact on pregnancy outcomes. Method: We compare the outcome of the frozen-thawed embryo transfer (FET) cycle of blastocysts with apoptotic body and without it as a control. We further divide the cases into single blastocyst transfer and double blastocyst transfer. The data was collected from Vistana Fertility Centre from January to December 2022. Results: Conclusion: Data analysis showed that there is no significant difference between the study group and the control group. Hence, the presence of dead cells did not negatively impact the pregnancy outcomes.

#336 : Improving Success of Intrauterine Insemination

Background and Aims: IUI is one of the most used methods to treat various forms of infertility. The aims were to compare the success rate of IUI with that of timed intercourse, review the methods used to time the IUI with ovulation, identify the factors to determine IUI outcome, compare the success rate of double IUI vs single IUI. Method: This is a cross-sectional prospective study conducted at a Private Fertility Centre, Chattogram, Bangladesh over a period of 40 months from 996 patients who underwent IUI. Variables such as age of women, cause of infertility, drugs used for COH, number of mature follicles, endometrial thickness post wash sperm count, type of IUI (single IUI and double IUI) were recorded and statistically analyzed. Results: The age for females and males were 18-41 and 23-52 respectively. The mean endometrial thickness was 8.9 mm ± 0.2 mm. Pregnancy rate for total motile sperm count less than 10 million was 7.2%. The successful conception rate for females were the age 28 was 9.6% compared to the whole group at 12%. Among 996 patients, 109 patients (10.94%) had successful conception. 209 patients (20.98%) underwent double IUI out of which 40 patients (19.14%) had a successful conception while 787 patients (79.01%) underwent single IUI out of which 69 patients (8.76%) had successful conception. Conclusion: IUI is currently a successful treatment modality for infertility especially as invasive treatment for couples with unexplained infertility, male factor infertility, anovulation, female less than 30 years of age. The numbers of motile sperms, appropriate endometrial thickness, have a remarkable impact on the outcome of IUI. Double IUI increases the success rate significantly. Acknowledgment: The authors are grateful to all who participated in the preparation of this manuscript.

#302 : Shorter Centrifugation Time Leads to Better Sperm Quality in Swim-Up Processing Technique

Background and Aims: Centrifugation is one of the many factors that cause sperm DNA damage in IVF semen preparation. This can occur due to the formation of reactive oxygen species (ROS) that are uncontrollable, so that the quality of sperm DNA can be damaged. This study aims to compare sperm quality results with swim-up technique under centrifugation times of 5 and 10 minutes. Method: This study involved 50 patients at the Halim Fertility Center clinic from June 2020 to October 2020. The samples obtained were processed using the swim-up method. Samples were divided into 3 groups, namely control, 5 and 10 minutes of centrifugation. Sperm quality recorded was concentration, total motility, progressive motility and DNA fragmentation index (DFI). Results: The sperm concentration after 5- and 10-min centrifugation before swim-up (27.78-39.79 and 35.36–51.09, respectively; p [Formula: see text] 0.05) was significantly higher compared to control (24.85–32.33). The total motility before and after 5- and 10-min centrifugation were 43.78–51.08, 97.66–98.20, and 97.86–98.20, respectively. The progressive motility after 5- and 10-min centrifugation (0–41 and 0–54, respectively) was significantly higher than control (0–24; p &lt; 0.05). The DFI was significantly better after 5 min centrifugation (3.82–6.98) compared to control and after 10 min centrifugation (13.48–19.04 and 1–25, respectively; p &lt; 0.05). Conclusion: Shorter centrifugation times indicate lower progressive motility than long centrifugation times, but considering the lower DFI level, shorter centrifugation times must be used in sperm preparation for IVF to produce better sperm quality.

Phthalate metabolites in urine and follicular fluid in relation to menstrual cycle characteristics in women seeking fertility assistance

BackgroundPhthalates have been shown to disrupt the estrous cycle in animal studies. However, epidemiological research investigating their associations with menstrual cycle characteristics is limited. ObjectiveTo explore the relationships between phthalate exposure and menstrual cycle characteristics among women seeking fertility assistance. MethodsWe determined the levels of eight phthalate metabolites in both follicular fluid (FF) and urine specimens collected from 441 women in the Tongji Reproductive and Environmental (TREE) cohort, using high-performance liquid chromatography and tandem mass spectrometry. Information about menstrual cycle parameters was obtained through a questionnaire. The impacts of individual and joint exposure to phthalates on menstrual cycle characteristics were assessed using multivariable linear regression, Poisson regression, and quantile g-computation approaches. ResultsAfter adjusting for relevant covariates, we found that per log10-unit increase in mono(2-ethylhexyl) phthalate (MEHP) level in urine specimens was associated with a decrease of 0.20 days (95 % CI: −0.37, −0.03) in bleeding duration. We also observed that mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) and the sum of di(2-ethylhexyl) phthalate (DEHP) metabolites (∑DEHP) concentrations in FF samples were inversely related to cycle length [β = −1.92 (95 % CI: −3.10, −0.75) and −1.87 (95 % CI: −3.56, −0.19), respectively]. However, we generally observed null associations between phthalate metabolites and irregular cycle, dysmenorrhea, hypomenorrhea, or cycle length variation. Furthermore, we also found that phthalate metabolite mixtures in FF and urine were generally unrelated to menstrual cycle characteristics. ConclusionOur findings suggest that some DEHP metabolites in FF and urine are inversely associated with menstrual cycle length and menstrual bleeding duration in women attending a fertility center.

Fertility Services &amp; Training: What the Future Beholds

The world of assisted reproductive technology is rapidly expanding worldwide with new improvements and constantly developed techniques. Two of the important factors affecting the success of any centre are the reproductive clinician and the embryologist. While training programme for reproductive clinician has been established, less so is said for embryologist. As the pioneer and leading fertility centre amongst universities in the country, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) is making steps towards introducing a clinical embryology programme that is hoping to set a standard for embryologist training for the country and region. Fertility preservation is an area of assisted reproduction that is fast gaining recognition. It gives hope, especially to young oncologic patients for future reproduction. International success with ovarian tissue cryopreservation and reimplantation culminating with the first birth in 2004 gives hope to these patients. With the current plans of expansion and training of our reproductive centre, an oncofertility unit with ovarian cryopreservation facilities will be soon established to cater to the needs of the country.

The Amino Acid Profile in Seminal Plasma of Normozoospermic Men: A Correlation Analysis with Spermiogram Parameters and Total Antioxidant Capacity.

Male infertility is usually determined by the manual evaluation of the semen, namely the standard semen analysis. It is currently impossible to predict sperm fertilizing ability based on the semen analysis alone. Therefore, a more sensitive and selective diagnosis tool is required. Twelve fresh semen samples were collected from fertile volunteers attending the Avicenna Fertility Center (Tehran, Iran). The seminal plasma (SP) was prepared and subjected to liquid chromatography-tandem mass spectrometry (LC-MS/MS), and the total antioxidant capacity (TAC) was analysis. Thirty-four amino acids including essential amino acids (EAA), non-essential amino acids (NEAA), and non-proteinogenic amino acids (NPAA) relative concentration were determined, and the correlation between their concentration with spermiogram parameters and TAC of the SP was analyzed. Significant positive correlations have been found between selected amino acids with the motility (Met and Gln, rs=0.92; Cys, rs=0.72; and Asn, rs=0.82), normal sperm morphology (Met, rs=0.92; Cys, rs=0.72; Glu, rs=0.92; and Asn, rs=0.82), and sperm concentration (Trp, Phe, and Ala). In contrast, several AAs, including Gly, Ser, and Ile showed negative correlations with sperm concentration (rs=-0.93, r=-0.92, and r=-0.89, respectively). Furthermore, TAC showed a positive association only with Tyr (rs=0.79). The strong positive/negative correlations between the seminal metabolic signature and spermiogram demonstrate the significance of determining metabolite levels under normal conditions for normal sperm functions. Combining the metabolome with the clinical characteristics of semen would enable clinicians to look beyond biomarkers toward the clinical interpretation of seminal parameters to explain the biological basis of sperm pathology.

Intra-patient analysis of individual weight gain or loss between IVF cycles: cycle now and transfer later.

What is the impact of clinically significant weight change on outcomes related to IVF cycle performance? While individual weight loss did not significantly impact ovarian response to stimulation or other cycle outcome parameters in our study, some positive associations were found for individual weight gain. The role of weight-change in patients undergoing IVF has been largely studied by comparing weight loss in different cohorts of patients stratified by a static BMI. Specifically, obesity has been extensively studied in relation to its negative effects on assisted or unassisted conception outcomes and ovulatory function. Previous research has shown conflicting results, while BMI, which is commonly used as a marker of obesity, may not accurately reflect the underlying factors affecting fertility in obese patients. This study utilized a retrospective within-patient repeated measurement analysis design to assess the impact of weight change on IVF outcomes in cycles where all embryos were cryopreserved at the blastocyst stage for transfer at a later date. The study was conducted at an academically affiliated fertility center. The data included 961 women who underwent at least two IVF cycles between December 2014 and June 2020, with documented short-term weight gain (n = 607) or weight loss (n = 354) within 1year from their initial IVF cycle. Multivariable generalized estimating equations (GEE) and generalized linear mixed models (GLMM) were employed to assess associations between weight change and outcomes across cycles. The multivariable models indicated that weight loss did not show any significant associations with the numbers of oocytes retrieved, or mature oocytes, the fertilization rate or the blastulation rate. However, weight gain demonstrated a minor positive association with the number of oocytes retrieved in both GEE models (coefficient: 0.01, 95% CI: 0.00-0.01) and GLMM models (0.01, 95% CI: 0.01-0.00). There was also a potential increase in the fertilization rate with weight gain, as indicated by a positive coefficient in both GEE models (coefficient: 0.01, 95% CI: 0.00-0.02) and GLMM models (coefficient: 0.01, 95% CI: 0.00-0.01). However, the association between weight gain and the embryo blastulation rate was not statistically significant in any model. This study focused on cycle performance parameters instead of reproductive outcomes, which restricted our ability to evaluate the impact of weight change on cumulative live birth rates. Additionally, the study did not account for variables such as stimulation protocols, potentially introducing confounding factors and limiting the generalizability of the results. Although obesity is associated with adverse obstetrical risks, there is less evidence of adverse reproductive outcomes in IVF cycles. We therefore recommend that an IVF cycle should not be delayed due to weight, so that the patient is not adversely affected by increasing age. The IVF cycle should aim to freeze all embryos, so that embryo transfer can then occur after weight loss, so as to limit the recognized obstetrical risks. The study was not funded and there were no competing interests. N/A.

Strong social disparities in access to IVF/ICSI despite free cost of treatment: a French population-based nationwide cohort study

BackgroundAccess to IVF/ICSI is facilitated when the financial barrier is removed. In a national context where in vitro fertilisation (IVF)/intracytoplasmic sperm Injection (ICSI) treatment is cost-free, how many women do not access IVF/ICSI and what are the factors associated with non-access?MethodsUsing French national health insurance databases, the cohort included 20,240 women aged 18–43 years living in France who underwent unsuccessful treatment (no pregnancy) with clomiphene citrate (CC) and/or gonadotropins with treatment started between January and August 2016. The outcome measure was non-access to IVF/ICSI during the 24-month following start of infertility care. Factors associated with non-access to IVF/ICSI were explored using mixed effects logistic regression.ResultsIn the cohort, 65.4% of women did not access IVF/ICSI. In multivariable analysis, non-access to IVF/ICSI was higher in younger women (18–25 years: (OR 2.17, 95% CI: 1.85–2.54) and in older women (40–43 years: (OR=3.60, 95% CI: 3.25–3.98)). Non-access was higher among women below the poverty line (OR=3.76, 95% CI: 3.34–4.23) and showed a significant upward trend with increasing deprivation of place of residence. Distance to the nearest fertility centre was not significantly associated with non-access to IVF/ICSI.ConclusionsIn a national context of cost-free ART treatment, a large proportion of women did not access treatment, with a strong social gradient that raises important issues. We need to understand the underlying social mechanisms to develop an efficient and equitable health policy regarding infertility care.