Fertility Experts Research Articles

P-458 Development and validation of the fertility lifestyle assessment scale

Abstract Study question Can the development of the “Fertility Lifestyle Assessment Scale” contribute to the evaluation of person lifestyle habits related to fertility? Summary answer The development of the Fertility Healthy Lifestyle Assessment Scale will contribute to the evaluation of person lifestyle habits related to fertility. What is known already Healthy lifestyle habits are important for preparing the body and reproductive hormones for the demands of conception. Malnutrition, overeating, smoking, sedentary life, stress, sleep deprivation etc., situations all represent unhealthy lifestyles. The individuals may also preserve and increase fertility potential by modifying their lifestyles. Despite wide evidence about the benefits of healthy lifestyle for individuals with fertility problems, lifestyle is not systematically evaluated in generally fertility clinics. Current in study aimed to develop a valid and reliable measurement tool in order to determine risky lifestyle behaviors that may contribute to the development of fertility problems of individuals. Study design, size, duration A methodological study was conducted between July 2020- December 2021. An item pool (123 items) was prepared by reviewing the literature and the opinions of researchers and fertility experts. A multidisciplinary team of doctor, nurses and patient collaborated to asses suitability of each item of Fertility Lifestyle Assesment Scale. The Item Content Validity Index varied between .80 and 1.00. As a result a final 46-item Fertility Lifestyle Assessment Scale was developed. Participants/materials, setting, methods Participants (a) who can speak, read and write Turkish; (b) 18 years of age or older; married/single women or men, (c) who have not yet had children, and (d) who are considering having children in the future were included. The sample of this study consisted of 526 participants who met the inclusion criteria and agreed to be a part of the present study. Main results and the role of chance In the exploratory factor analysis (EFA), the Kaiser-Meyer-Olkin (KMO) coefficient of 46 items was .865 and the result of Bartlett’s sphericity test was χ2 = 15265.707, p < .001. As a result of EFA, it was determined that the scale consisted of seven subscale. Also, seven subscales were exposed to explanatory analysis: “emotional well-being”, “physical activity”, “sleep quality”, “nutrition”, “clothing/hygiene”, “use of technology”, “spiritual dimension”. These seven subscales explained 71.25% of the total variance, which shows the power of the factor structure of the scale. The total Cronbach’s alpha was .87. The item-total score correlation coefficients ranged between .19 and .57. The Pearson correlation coefficients between subscale scores and scale total scores were between .21 and .98. The Cronbach’s alpha coefficients of the subscales ranged from .60 to .98. According to the Spearman–Brown analysis, the split-half correlation coefficient was .898. Item scores were different from each other (Hotelling’s T2 = 1189.347, p= .000). This scale is valid and reliable for measuring the healthy lifestyle for improving fertility of women and man who unmaried. Limitations, reasons for caution The limitation of the study was that only 3/1 of the sample to which the scale was applied was composed of men. Wider implications of the findings This scale can be used to evaluate fertility-related lifestyle factors in individuals who are considering getting pregnant starting from the preconceptional period or who have fertility problems and apply for treatment. The scale may be easily performed by healthcare professionals and may contribute to improve fertility. Trial registration number Not applicable

P-071 The dichotomy of micronutrients in male fertility: doses matter - striking the right balance for optimal reproductive health

Abstract Study question What is the impact of escalating doses of common water-soluble antioxidant nutrients on semen parameters and fertility in healthy (CD1) and stressed (Gpx5-/-) mice? Summary answer High-dose supplementation of previously “thought-to-be-safe” common water-soluble antioxidant nutrients can cause significant DNA damage/impaired fertility in healthy mice. What is known already In assisted conception, men increasingly take preconceptual antioxidant supplements (even if they are generally healthy) to enhance the likelihood of a successful pregnancy. Recent published reviews suggest 79% of male fertility supplements include ingredients at dosages exceeding Food Safety Authorities’ Recommended Dietary Allowances (RDAs). While many fertility experts question the efficacy of such supplements, most still carry the notion that “dietary ingredients”, regardless of the doses given, pose little safety concerns. Moreover, without established RDAs for many natural substances such as carnitines, supplement makers often subscribe to the “more is better” philosophy, potentially compromising safety in their product formulations. Study design, size, duration This study evaluates escalating doses of common water-soluble antioxidant nutrients (Vitamin C, Zinc, Folate, and Carnitines) on redox status, semen parameters, genetic integrity, and fertility in healthy (CD1) and stressed (Gpx5 -/-) mice over 28 days. The treated groups (n = 6) were compared against pooled controls (n = 24). We analyzed the doses of these ingredients in commercial fertility supplements against our new “safety profiles” to highlight potential overdosing risks and asses the broader safety implications. Participants/materials, setting, methods Experimental ingredient exposure dosages were based on current US-FDA RDA/I declarations, commercial popularity, and/or use in clinical fertility settings. Animal dosage conversion calculations were based on standard pharmaceutical methodologies. Assessments of male mouse redox status and reproductive function included general sperm parameters (count, motility, viability, acrosome integrity), DNA parameters [oxidation (8-OHdG staining), fragmentation (TUNEL), decondensation (Toluidine Blue)], and blood analysis (total antioxidant capacity, glutathione, malondialdehyde). Pregnancy outcomes were assessed in Carnitine fed, CD1 mice. Main results and the role of chance In CD1 mice, escalating doses of individual micronutrients had minimal effect on semen parameters, except for a significant sperm count increase at the highest Carnitine dose. However, there were considerable adverse effects on sperm DNA integrity and blood plasma redox state. The high-dose Carnitine group notably exhibited reduced pregnancy rates, in terms of both impregnation and total pups born, compared to controls. Yet, there were no differences in the number of pups born or resorptions, per pregnant female, between the high-dose Carnitine group and controls. In GPX5-/- mice, general semen parameters were mostly unaffected. Intriguingly, Carnitine positively influenced sperm DNA integrity in this model, underscoring the established link between micronutrient deficiency, oxidative stress, and semen quality. In the analysis of 34 random male fertility supplements, almost every product contained at least one ingredient at a dose that was harmful according to our study. Alarmingly, 88% had at least two such ingredients, 68% had three or more, and roughly 33% contained four or more at doses considered unsafe. Limitations, reasons for caution Carnitines’ pungent odor may have affected the mating efficiency of carnitine exposed CD1 males. Due to synergy of action, antioxidants administered individually, even at the same dose, may exert a different biochemical profile than when in combination with other ingredients (as in most commercial formulations). Wider implications of the findings The majority of male fertility supplements often combine aggressive doses of antioxidant nutrients. Our results highlight the potential dangers that may arise from their use and provide a clear warning to fertility experts against routinely recommending random, unsubstantiated supplements, especially in the absence of prior oxidative stress assessment. Trial registration number not applicable

Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?

Fertility preservation techniques, such as cryopreservation of ovarian tissue, embryos, and oocytes, offer hope for future reproduction to individuals facing conditions like cancer or severe haematologic disorders. While the scientific evidence supporting fertility preservation is limited, it shows promise, and there is a growing trend among fertility experts to extend its application to patients with benign conditions that can cause fertility issues, such as endometriosis. Some forms of endometriosis may have a negative impact on fertility, affecting the ovarian reserve, oocyte quality, and the tubo-ovarian interface. Evaluating fertility preservation in endometriosis patients reveals several key considerations. The diverse nature of endometriosis calls for tailored approaches and distinguishing between the disease and treatment effects on ovarian reserve is crucial. Fertility preservation in endometriosis is complex, demanding consideration of disease variability, treatment effects, accurate assessment, and a clear distinction between ovarian reserve and conception ability. A personalised approach is essential for optimal outcomes in this field.

Artificial intelligence in the service of intrauterine insemination and timed intercourse in spontaneous cycles

To develop a machine learning model designed to predict the time of ovulation and optimal fertilization window for performing intrauterine insemination or timed intercourse (TI) in natural cycles. A retrospective cohort study. A large invitro fertilization unit. Patients who underwent 2,467 natural cycle-frozen embryo transfer cycles between 2018 and2022. None. Prediction accuracy of the optimal day for performing insemination or TI. The data set was split into a training set including 1,864 cycles and 2 test sets. In the test sets, ovulation was determined according to either expert opinion, with 2 independent fertility experts determining ovulation day ("expert") (496 cycles), or according to the disappearance of the leading follicle between 2 consecutive days' ultrasound examinations ("certain ovulation") (107 cycles). Two algorithms were trained: an NGBoost machine learning model estimating the probability of ovulation occurring on each cycle day and a treatment management algorithm using the learning model to determine an optimal insemination day or whether another blood test should be performed. The estradiol progesterone and luteinizing hormone levels on the last test performed were the most influential features used by the model. The mean numbers of tests were 2.78 and 2.85 for the "certain ovulation" and "expert" test sets, respectively. In the "expert" set, the algorithm correctly predicted ovulation and suggested day 1 or 2 for performing insemination in 92.9% of the cases. In 2.9%, the algorithm predicted a "miss," meaning that the last test day was already ovulation day or beyond, suggesting avoiding performing insemination. In 4.2%, the algorithm predicted an "error," suggesting performing insemination when in fact it would have been performed on a nonoptimal day (0 or -3). The "certain ovulation" set had similar results. To our knowledge, this is the first study to implement a machine learning model, on the basis of the blood tests only, for scheduling insemination or TI with high accuracy, attributed to the capability of the algorithm to integrate multiple factors and not rely solely on the luteinizing hormone surge. Introducing the capabilities of the model may improve the accuracy and efficiency of ovulation prediction and increase the chance of conception. HMC-0008-21.

Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation?

One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.

Fertility preservation in women with cancer in Brazil: Infertility specialists' perceptions and attitudes.

e13676 Background: Oncofertility is a universal right and a global oncology priority. However, there is a lack of communication between infertility specialists and their clinical oncologists on topics relating to fertility preservation. The present study aims to evaluate the perceptions and attitudes of infertility specialists regarding fertility preservation in women with cancer in Brazil. Methods: An online questionnaire was sent to infertility specialists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). Results: A total of 100 (30.9%) of 323 FEBRASGO infertility specialists responded, most located in the southern and southeastern Brazilian states. Experience in Human Reproduction ranged from one to 40 years (mean ± standard deviation: 15.5 ±10.2 years). Considering women with cancer in reproductive age in whom fertility preservation was indicated, 60.3% ±28.8% of them performed the procedure (ranging from 10 to 100%). Three main barriers to fertility preservation were appointed: cost (41%), knowledge and acceptance of medical oncologists (35%) and accessibility (9%). Most infertility specialists (58%) considered age above 40 years as the limit for fertility preservation in women with cancer. Breast and ovarian cancers, leukemia, and lymphoma were considered the most relevant types to be considered for fertility preservation, while lung, thyroid, gastric and brain. Conclusions: This is the first Brazilian study on specialists' impressions on cancer patient's access to fertility preservation. While most Brazilian cancer patients are treated in the public health system, most fertility specialists are in the private sector. Currently, the model of care is fragmented and a more integrated workflow between cancer and fertility experts is fundamental to improve fertility sparing access. Further studies are needed on the topic, also including clinical oncologists, hematologists, breast cancer specialists, and patients.

Evidence in reproductive medicine

Evidence in reproductive medicine

Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience

Research questionToday, women can plan for parenthood and family life, but delaying pregnancy is often associated with anxiety regarding the question of future fertility. We aim to evaluate if there is a benefit to offering fertility evaluation to all women, including those who have no immediate plans for pregnancy. DesignWe developed in our reproductive center a new concept of an all-in-one ultrasound open to all women of reproductive age. Fertility Check Up (FCU) is a medical and ultrasound exam followed by an interview with a fertility expert, accessible to all women of childbearing age whether or not they are planning a pregnancy. The FCU provides an anatomical and functional evaluation of the reproductive system and indicates the theoretical likelihood of conception, along with advice from fertility experts. ResultsIn the first year, 440 women between 24 and 48 were screened, 56% of whom had never attempted to conceive. An anatomical abnormality was found in 58.5% of women, the examination concluded to a low-for-age ovarian reserve in 14% of the cases. 37.5% of the women in our study were referred either for ART treatment, fertility preservation or oocyte donation. Six months after, 50% of the women who had no immediate pregnancy plans stated that the FCU had modified their personal or professional plans regarding a possible future pregnancy. ConclusionsFertility assessment for all women, whether infertile or not, with or without immediate pregnancy plans, allows for information, advice, and treatment if necessary.

Gynecological co-morbidity, chronic illnesses and infectious diseases among black African women with primary or secondary infertility: should we be worried about hepatitis?

Introduction: Female infertility may not occur alone but could be associated with other health conditions. Overlooking these health conditions during clinical assessment of women who present with primary or secondary infertility may not bring desired results of achieved pregnancy. Objective: To determine the frequency and relative risks of certain chronic illnesses such as hypertension and diabetes, infectious diseases such as hepatitis and other gynecological diseases such as uterine fibroid and endometriosis in women with primary and secondary infertility taking into consideration their age groups and body mass index. Study design: This was a retrospective study carried out at a tertiary health care facility in Lagos Nigeria. Methods: Records of patients who consulted for the management of infertility were retrieved for analysis. Result: The overall prevalence of hypertension, diabetes, cancer and asthma in all patients were 9.6%, 6.8%, 0.8% and 0.4% respectively. Among the infectious diseases, hepatitis B occurred most frequently at 19.1%, more among women with SI (28.0%) than PI (13.9%). The most prevalent gynecological diseases as co-morbidity were uterine fibroid (32.7%) and endometriosis (11.2%). Pooled analysis showed that there was a significant variation in the distribution of Polycystic ovarian syndrome (PCOS) (Pearson’s χ²=10.14, P-value=0.02) relative to age, no significant distribution of any disease relative to body mass index (BMI) in Kg/m2, significant distribution of intrauterine adhesion relative to age (years) and BMI among those with PI (Pearson’s χ²=9.80, P-value=0.04) but not in SI. Significant correlations were observed between infertility and hepatitis (r=0.17, P-value=0.006, 95% CI= 0.06, 0.36) and between infertility and fibroid (r=0.1868, P-value=0.003, 95% CI=0.07, 0.32). Conclusion: Through this study it is concluded that women with history of primary infertility are more at risk of diabetes, endometriosis and PCOS more than those with SI; conversely, those with SI are more at risk of hypertension, hepatitis, fibroid and adenomyosis. Gynecologists and fertility experts in sub-Saharan Africa should probe for these diseases in each patient who presents with infertility, after excluding male factor as contributing to female infertility. Early diagnosis of these diseases and others among infertile or sub-fertile women can minimize pain and reduce cost of hospitalization and also minimize the number of patients with unexplained infertility.

O-276 Reproductive outcomes and fertility-sparing in women with Borderline ovarian tumors

Abstract The standard treatment of BOT is defined as a total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, omentectomy and multiple peritoneal biopsies. These procedures allowed to perform an adequate staging, most of the time no adjuvant treatment is necessary except in case of associated invasive peritoneal implants. The prognosis of BOT is excellent. However, late recurrences (after 5 or 10 years) can be observed. Conservative surgery is defined as preservation of the uterus and at least part of one ovary, in order to preserve fertility. BOT arise in a young population, for whom fertility is a major issue. The global recurrence risk is estimated at 13%. The rate of recurrence is correlated with the type of conservative treatment used (salpingo-oophorectomy or cystectomy) with a higher rate of between 10 and 42% in patients undergoing cystectomy. In the case of bilateral serous BOT, if technically feasible, bilateral cystectomy should be performed to improve pregnancy rates. For serous BOT e cystectomy can be performed (tumour can be bilateral for 20% of these patients) with a close follow up by ultrasound. For mucinous BOT, salpingo-oophorectomy is recommended to avoid rare but at risk invasive recurrence, (these lesions are usually unilateral). A complete evaluation must be performed preoperatively including MRI with evaluation of possible safe functional ovarian tissue and oncofertility consultation to discuss if fertility preservation technique can be proposed before surgery. The observed pregnancy rates observed after conservative surgery are between 32 and 88%. Different factors can influence fertility rates: type of conservative treatment, age of the patient (with almost a quarter of the live birth occurring after recurrence with no more further event to date, a second fertility-sparing surgery after local borderline recurrence can be proposed in the case of pregnancy project), histologic subtype of the tumour (better with mucinous versus serous), the use of a laparoscopic approach and the use of a 2- or 3-step surgery (initial, restaging, second look). In spite of conservative management in BOT, some patients will experience infertility. In vitro fertilization (IVF) procedures have not been significantly associated with a specific increase in BOT or ovarian cancer rates. In vitro data suggest that gonadotropins and/or high dose of estrogens don’t induce a borderline cell cultures proliferation. Analyzing all series reporting IVF and BOT, the pooled estimate for pregnancy was 80% (95% CI: 68–92%). The pooled estimate for recurrence was 23% (95% CI: 6–39%). The rate of recurrence in these women is ‘low’ though this is probably due to the fact that women who are selected as eligible for ART have a better prognosis and more often early-stage BOT. However, there is a real need for fertility preservation expert centers associating oncologists and fertility experts who can evaluate conservative management of BOT along with alternative therapeutic options to preserve fertility as well as ART.

P-490 Patient Care Guidance: Development of a unique tool for fertility clinics based on best practice evidence

Abstract Study question How can fertility clinics be encouraged to implement evidence-based person-centred care? Summary answer To help fertility clinics provide holistic care to their patients a multidisciplinary team developed a user-friendly, evidence based practical guidance. What is known already Despite wide evidence about the benefits of person-centred care for patients seeking fertility treatment, this is not systematically implemented in most fertility clinics. Study design, size, duration The aim was to develop evidence-based practical guidance on person-centred care for fertility clinics. A multidisciplinary team collaborated to developed person-centred care guidance for fertility clinics over a 12-month period. Participants/materials, setting, methods A group of 18 stakeholders, including:15 fertility experts, 2 patient associations and 1 quality manager reviewed and summarised evidence relating to the needs of fertility patients to guide the implementation of person-centred care in fertility clinics. It was specially designed to fulfil the needs of different countries’ legislation and cultural contexts. Main results and the role of chance This collaboration resulted in a unique and practical evidence-based tool to help fertility clinics implement best practice in person-centred care. It includes a range of topics such as: the importance of a patient care system in ART; benefits of patient-centered care for patients, staff, and the clinic; ways to communicate information to patients; informing about fertility treatment options; fertility awareness; men’s needs; emotional support; benefits of a mentor program; how to support to staff; exit strategies; needs of patients seeking cross-border care; the fertility clinic’ online communication; engaging patients in good and safe choices; and also how to care about patients undergoing a gamete donation treatment. Limitations, reasons for caution Despite the large number of topics required to support on fertility clinics, high impact topics were prioritised in the first phase of the guidance document – which will be updated periodically. Wider implications of the findings This guidance offers added value to fertility clinics and patients. The authors were able to adapt scientific evidence into a practical and user-friendly guidance that allows all staff to understand the concept of patient-centred care, the roles, responsibilities, actions that can be taken to improve patient experience, outcome and care. Trial registration number NO

Role of Stem Cells in the Ovarian Tissue Cryopreservation and Transplantation for Fertility Preservation.

Although the cancer survival rate has increased, cancer treatments, including chemotherapy and radiotherapy, can cause ovarian failure and infertility in women of reproductive age. Preserving fertility throughout cancer treatment is critical for maintaining quality of life. Fertility experts should propose individualized fertility preservation methods based on the patient’s marital status, pubertal status, partner status, and the urgency of treatment. Widely practiced fertility preservation methods, including ovarian transposition and embryo and oocyte cryopreservation, are inappropriate for prepubertal girls or those needing urgent initiation of cancer treatment. Ovarian tissue cryopreservation and transplantation, an emerging new technology, may be a solution for these cancer patients. The use of stem cells in ovarian tissue cryopreservation and transplantation increases oxygenation, angiogenesis, and follicle survival rates. This review discusses the recent advances in ovarian tissue cryopreservation and transplantation with special focus on the use of stem cells to improve fertilization techniques.

Determining the need for fertility care and the acceptability and feasibility of administering a fertility awareness tool from the user's perspective in a sample of Sudanese infertility patients.

Fertility experts have advocated addressing preventable causes of infertility and early intervention. However, awareness of risk factors is low, especially in low- and middle-income countries where the prevalence of infertility is high. To address this lack of awareness, the Fertility Awareness Tool (FertiSTAT) was adapted for use in Sudan and other low-resource countries. The aims of this study were to ascertain the need for fertility education in Sudan (Aim 1), and to gauge the acceptability and feasibility of implementing the FertiSTAT in Sudan (Aim 2), both from the patients’ perspective. Convenience sampling was used to recruit participants for semi-structured-in-depth interviews from a fertility clinic in Sudan. We collected sociodemographic information, medical and reproductive history, asked about fertility knowledge, administered the FertiSTAT and asked about the acceptability of the FertiSTAT. Thematic analysis was conducted for qualitative data. Twenty participants were included; of these, 17 were female, 13 were educated beyond secondary school, the mean age was 32.8 years, and the mean duration of infertility was 4.1 years. Ten themes emerged: of these, three themes addressed Aim 1: ‘desire for fertility information’, ‘state of fertility knowledge’ and ‘benefits of fertility education’; and seven themes addressed Aim 2: ‘specific suggestions for the tool’, ‘factors influencing the acceptability and feasibility of implementing the tool’, ‘challenges and barriers to implementation’, ‘self-disclosure’, ‘understanding of being at risk’, ‘compatibility with worldview’ and ‘cultural tailoring’. Fertility education was viewed as necessary and beneficial; however, participants thought that lack of acceptability of sensitive topics would hinder the implementation of the FertiSTAT. Acceptability and feasibility would be enhanced if challenges were addressed in a culturally sensitive manner using cultural tailoring of materials to increase compatibility with individual worldviews.

What do Sunni Muslims think about religiously forbidden reproductive options?

This study explored the attitudes of Sunni Muslims towards religiously forbidden reproductive options: gamete donation, sex selection, surrogacy, and adoption. A total of 824 married Sunni Muslim people read 12 hypothetical vignettes depicting five types of assisted reproductive technologies: (i) sperm donation; (ii) egg donation, (iii) surrogacy; (iv) sex selection of a male foetus; and (v) and sex selection of a female foetus. They also related to the option of adopting a baby. Each vignette was presented twice: once depicting a relatively younger couple and once again describing a relatively older couple. The respondents were asked to state the level of their objection or acceptance for each of the twelve vignettes. In accord with the Islamic ruling, respondents reported objections to sex selection, egg and sperm donation, and surrogacy. However, they expressed a moderate level of acceptance of adoption of a baby. The greatest objection was directed at sperm donation, followed by objection to egg donation. Our study shows that the Sunni Muslims do not support the provision of fertility care for reproductive options that clearly contravene Islamic religious ruling. The findings may help fertility experts understand the cultural and religious complexities in treating Sunni Muslim couples.

“Mix or Match?”: Transnational Fertility Industry and White Desirability

ABSTRACT Does the transnational process of gamete selection challenge ways of mobilizing race and whiteness? Based on a mobile ethnography of the transnational fertility industry, I argue that fertility experts and intended parents (IP) co-produce the desirability of whiteness through “racial matching” for white, heterosexual IP, and “strategic hybridization”, or strategic mixing of gametes, for some same-sex IP who do not identify as white. Although disruptive of notions of racial purity of whiteness and the heteronormative focus on resemblance match, the transnational legitimizing of such desires as intimate and innocuous choices depoliticizes conversations around race, racialization and whiteness as privilege.

Current Awareness and Attitude toward Fertility Preservation in Indonesia: A Nationwide Survey Among Health-care Providers.

Context:Fertility preservation (FP) is necessary for cancer patients who develop infertility due to chemotherapy and radiotherapy. In Indonesia, many systematic steps and long-term continued actions must be taken to establish FP units since there has been an increasing incidence of cancer among people under 45 years old.Aims:This study aimed at a comprehensive evaluation on the awareness and practices of health-care providers (HCPs) toward FP.Settings and Design:This was a descriptive cross-sectional study.Subjects and Methods:A validated nationwide online survey was completed by 160 HCPs as a representative sample from 11 provinces in 2017 that provide medical care to cancer patients at hospitals or clinics.Statistical Analysis Used:Descriptive statistics, analysis of variance, logistic regression, and Pearson correlation tests were used for the statistical analysis.Results:Respondents were specialists (59.4%) and other HCPs (40.6%). Around 60% of the HCPs who performed cancer therapies already discussed the fertility issues with their patients. Meanwhile, the HCPs (60.7%) also tended not to consult and refer their patients to fertility experts (P < 0.05). However, those who discussed the risk of infertility with patients tended to consult with and refer them to a fertility consultant for further FP procedure as the follow-up for their discussions (odds ratio = 8.98, confidence interval 95%, P < 0.05).Conclusions:In Indonesia, FP awareness of the HCPs who performed cancer therapy was high. Nevertheless, attitudes to refer patients to fertility experts for possible FP management still need to be improved.

Effectiveness of vitamin D3 in improving sperm count, motility and morphology in subfertile men

The effect of vitamin D3 in improving sperm count, motility and morphology of men was assessed using design. All men who attended OPD at a selected hospital were screened with Male Fertility Profile. Forty-six men among them were diagnosed as were chosen as study participants. A detailed explanation of the study was given to the selected participants, and the written consent was received from each study participant. They were given treatment under the guidance of our fertility experts, the oral administration of vitamin D3 supplements per oral twice a day for 72 days and the post-test semen analysis was done on 73rd day. The findings of the study revealed that there is an improvement in the semen quality (counts in the sperm /ml, progressive motility level, total progressive motility level P&amp;lt;0.00001 and morphology P &amp;lt;0.00007). In contrast, there were no changes revealed in the level of volume, and PH was slightly alkaline. Vitamin D enhances . Therefore, vitamin D supplements can be administered in men.

Fresh versus frozen embryo transfer after an in vitro fertilization cycle: Is there a difference in the ectopic pregnancy rate?

BackgroundEctopic pregnancy (EP) occurring because of an abnormal site of embryo implantation is a major cause of maternal morbidity and mortality if not timely diagnosed and intervened. To avert the increase in the rates of EP through in vitro fertilization cycles as compared to spontaneous conception, fertility experts have resorted to multiple measures, of which the most studied is shifting to frozen embryo transfer (ET) in place of fresh transfer. The aim of this study was to evaluate the difference in the risk of ectopic implantation in women undergoing fresh versus frozen-thawed ETs. MethodsIt was a retrospective single-center cohort study wherein 802 of the 853 patients who underwent ET during the study period were analyzed. These patients were further subdivided into fresh transfer group (n = 339) and frozen transfer group (n = 443). The primary outcome measure was to study the difference in EP rates in the two groups and the secondary outcome measure was to analyze the clinico-therapeutic profile of the two subgroups of EPs. ResultsOf the 802 women who underwent ETs, 19 women had an ectopic implantation with an overall incidence of 2.3%. Among the 19 EPs, there were eight EPs (2.23%) in the fresh transfer group and 11 EPs (2.48%) in the frozen transfer group, but the difference was not statistically significant (P > 0.05). The clinico-therapeutic profile of the patients was comparable in both the groups. ConclusionFrozen ET cycle does not mandatorily reduce the incidence of EP in spite of the maintenance of the intrauterine milieu compared to a stimulated cycle. Larger and more robust studies are needed for recommending frozen ET cycle as a preventive modality for EP.

Do fertility treatments affect labor induction success rate? A retrospective cohort study

Purpose To evaluate labor induction success rate by Foley catheter (FC) on patients who conceived spontaneously, as compared to those who underwent fertility treatments. Materials and methods This retrospective cohort study included all pregnant women hospitalized at a single tertiary care center between January 2011 and May 2018 for induction of labor with FC. The study groups included patients with a singleton pregnancy who conceived after fertility treatments: controlled ovarian hyperstimulation (COH) or in vitro fertilization (IVF), while control group included patients who conceived spontaneously. Our primary outcome was the rate of cesarean deliveries. Regression analysis was conducted on the following parameters: age, gravidity, parity, the gestational week, and IVF. Results The study groups included 59, 321, and 3159 patients who conceived following COH, IVF, or spontaneously, respectively. While 72.1% of patients who conceived spontaneously had a vaginal delivery, only 62.7% and 58% of patients who conceived by COH and IVF had successful labor induction (respectively, p < .01). Similarly, significantly higher cesarean section (CS) rates were demonstrated by patients who conceived by COH and IVF (28.8% and 30%, respectively), compared to the control group (18.7%, p < .01). Regression analysis demonstrated that although age, parity, and the gestational week were significantly related to cesarean sections, no statistically significant association was found regarding fertility treatments (p = .050). Conclusions The possible association between fertility treatments and cesarean delivery remains an important dilemma for obstetricians and fertility experts. While unadjusted analysis demonstrated such association among patients who undergo labor induction by FC, adjusted analysis has not supported that finding. Further studies focusing on the causes of failed vaginal delivery are needed to further expand our knowledge and to improve patient consultation.

The mitochondrial DNA copy number of cumulus granulosa cells may be related to the maturity of oocyte cytoplasm.

The mitochondrial DNA copy number of cumulus granulosa cells may be related to the maturity of oocyte cytoplasm.