Fertility Treatment Outcomes Research Articles

Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study.

To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting. This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement. Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5days, p < 0.001). Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.

Clinical Applicability of Microbiota Sampling in a Subfertile Population: Urine versus Vagina.

The urogenital microbiota is increasingly gaining recognition as a significant contributor to reproductive health. Recent studies suggest that microbiota can serve as predictors for fertility treatment outcomes. Our objective was to investigate the degree of similarity in microbial composition between patient-collected urine and vaginal samples in a subfertile population. We enrolled women of reproductive age (20-44 years) diagnosed with subfertility and requiring in vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (IVF-ICSI) treatment. They self-collected both mid-stream urine samples and vaginal swabs before commencing the IVF or IVF-ICSI procedure. All samples were analysed using the intergenic spacer profiling (IS-pro) technique, a rapid clinical microbiota analysis tool. The main outcome measures were the degree of similarity of microbial composition between the two different, but simultaneously collected, samples. Our findings revealed a high correlation (R squared of 0.78) in microbiota profiles between paired urine and vaginal samples from individual patients. Nevertheless, the urinary microbiota profiles contained fewer species compared to the vaginal microbiota, resulting in minor but distinguishable differences. Furthermore, different subfertility diagnoses appeared to be associated with differences in microbial profiles. A noteworthy observation was the exclusive presence of Escherichia coli (E. coli) in both samples of women diagnosed with male factor subfertility. In conclusion, since urinary microbiota profiles seem to represent a diluted version of the vaginal microbiota, vaginal microbiome sampling to predict fertility treatment outcome seems preferable. To enhance the success of fertility treatments, further research is needed to gain deeper insights into a putative causal role of microbiota in the mechanisms of subfertility.

Association of ambient PM2.5 and its components with in vitro fertilization outcomes: The modifying role of maternal dietary patterns

Despite the associations of dietary patterns and air pollution with human reproductive health have been demonstrated, the interaction of maternal preconception diet and PM2.5 and its components exposure on in vitro fertilization (IVF) treatment outcomes has not been investigated. A total of 2688 couples from an ongoing prospective cohort were included. Principle component analysis with varimax rotation was performed to determine dietary patterns. One-year and 85-day average PM2.5 and its components exposure levels before oocyte retrieval were estimated. Generalized linear regression models were conducted to assess the association of dietary patterns and PM2.5 and its components exposure with IVF outcomes. Interactive effects of dietary patterns on the association between PM2.5 and its components and IVF outcomes were evaluated by stratified analyses based on different dietary patterns. A positive association between the “Fruits-Vegetables-Dairy” pattern and normal fertilization (p-trend = 0.009), Day 3 available embryos (p-trend = 0.048), and top-quality embryos (p-trend = 0.041) was detected. Conversely, women with higher adherence to the “Puffed food-Bakery-Candy” pattern were less likely to achieve Day 3 available embryos (p-trend = 0.042) and top-quality embryos (p-trend = 0.030), clinical pregnancy (p-trend = 0.049), and live birth (p-trend = 0.020). Additionally, increased intake of animal organs and seafood improved the odds of live birth (p-trend = 0.048). Exposure to PM2.5, SO42-, organic matter (OM), and black carbon (BC) had adverse effects on embryo development and pregnancy outcomes. Furthermore, our findings indicated that the effects of PM2.5 components exposure on normal fertilization and embryo quality were modified by the “Grains-Tubers-Legumes”. Moreover, moderate intake of animal organs and seafood appeared to attenuate the effect of NO3- and NH4+ on the risk of early abortion. Our findings provide human evidence of the interaction between dietary patterns and PM2.5 exposure on IVF outcomes during preconception, implicating the potential for dietary interventions in infertile women to improve reproductive outcomes under conditions of unavoidable ambient air-pollutant exposure.

P-633 Impact of insulin resistance on reproductive medicine outcomes

Abstract Study question Does Homeostasis Model Assessment for insulin resistance (HOMA-IR) have an influence in reproductive medicine outcomes? Summary answer HOMA-IR is associated with fertility treatment parameters and has a significant influence on reproductive medicine outcomes. What is known already The HOMA model is used to yield an estimate of insulin sensitivity from basal (fasting) plasma insulin and glucose concentrations. Currently, the model has become a widely used clinical tool to evaluate glucose metabolism. Regarding fertility, the relation between polycystic ovary syndrome (PCOS) and insulin resistance (IR) has been studied. Insulin resistance may be potential contributor to impaired treatment outcomes in artificial reproductive technology (ART). Although a few studies have recently been published on the topic the association of HOMA-IR with fertility treatment parameters remains a black box in reproductive medicine research. Study design, size, duration The observational study was designed and conducted at the Kinderwunsch Institut Schenk GmbH (Dobl, Austria). The study included 175 patients (25 men and 150 women), aged 18-45. HOMA-IR was determined for each patient and then correlated with patient’s medical history, fertility treatment parameters and outcomes. Participants/materials, setting, methods HOMA-IR was determined by taking a blood sample during fasting state and measuring plasma values of glucose (mg/dl) and insulin (mU/ml). A HOMA-IR of ≥ 2 was considered as insulin resistance. HOMA-IR was correlated with medical history (polycystic ovarian syndrome (PCOS), endometriosis, Body-Mass-Index (BMI), nicotine abuse) and fertility treatment parameters (sperm quality, number of retrieved oocytes after controlled ovarian stimulation, number of mature and fertilized oocytes, embryo quality and pregnancy rate). Main results and the role of chance An increased HOMA-IR (³2) was observed in 90 patients (51.4%). They suffered from obesity (n = 36; 80%), PCOS (n = 22; 70.97%), ovarian hyperstimulation syndrome (n = 17; 77.27%) and experienced poor embryo quality (n = 249; 91.54%). A significant positive correlation was found between HOMA-IR and PCOS (p &amp;lt; 0.001), obesity (p &amp;lt; 0.001) and number of retrieved oocytes (p &amp;lt; 0.05). The pregnancy rate correlated negatively with the HOMA-IR (p &amp;lt; 0.001). Furthermore, trends of positive correlations of high HOMA-IR in endometriosis, BMI, pathological spermiogram, nicotine abuse and increased number of mature oocytes were determined. The relation between HOMA-IR and the number of retrieved and mature oocytes is consistent with its relation to PCOS. The data show that HOMA-IR is associated with fertility treatment parameters and has a significant influence on ART outcome. Limitations, reasons for caution The number of patients may be seen as a study limitation. Results should be confirmed with a bigger sample size. An interventional study should confirm the role of HOMA-IR in IVF outcomes. Wider implications of the findings These findings may help to better understand the importance of glucose and insulin metabolism in reproduction and suggest that evaluation of HOMA-IR may be a valuable parameter to be considered when collecting patients’ anamnesis prior to starting ART treatment. Trial registration number not applicable

P-720 Ethnic diversity in fertility treatment in 2017-2021 using national register data, United Kingdom

Abstract Study question Are there any differences in fertility treatment use and outcomes across ethnic groups in the UK? Summary answer There are clear ethnic disparities – Black patients had lower IVF birth rates and started treatment later than White patients. What is known already Previous studies in US and UK have shown disparities in IVF outcomes, differences in perceptions around fertility treatment usage and prevalence of infertility across ethnicities. The mechanism in differences recorded in IVF outcomes by ethnicity is not fully understood due to the complexity influenced by existing social and economic inequalities, pre-existing diseases and other societal factors. Study design, size, duration The study used data from the UK national register held by the Human Fertilisation and Embryology Authority (HFEA), where all licensed clinics in the UK are required to submit treatment data. Participants/materials, setting, methods All treatment cycles recorded on the HFEA Register with a focus on cycles undertaken in 2017-2021 were analysed. This includes over 232,000 patients who had treatment between 2017 and 2021 and their partners. Five aggregated ethnic categories were used in most of the analyses (Asian, Black, Mixed, White and Other). Main results and the role of chance IVF pregnancy and birth rates have increased in all major ethnic groups since ethnicity data started being collected in 2008. However, Black and Asian patients consistently had lower pregnancy and birth rates compared with White patients. For Black patients aged 18-37, the average IVF birth rate per embryo transferred using fresh embryo transfers was on average 23%, compared to 32% for White patients in 2020-21. Among heterosexual couples, IVF cycles funded by the National Health Service (NHS) declined most among Black patients, decreasing from 60% in 2019 to 41% in 2021, compared to a decrease from 66% to 53% among White patients. Average age at starting treatment was higher among Black patients in heterosexual couples at 36.0 years of age, compared to the national average of 35.0 in 2021. Partner type varied by ethnicity and Black patients were more commonly single compared to other ethnic groups, with 6% of Black IVF patients and 62% of Black DI patients being single in 2017-21. Multiple birth rates have decreased across all ethnic groups, with disparities narrowing in recent years. Limitations, reasons for caution Due to the COVID-19 pandemic and large-scale work to upgrade the HFEA data submission system and migrate data to a new database, data on treatments and pregnancies from 2020-21 and outcomes from 2019-21 have not yet been validated. Around 13% of patients excluded due to unreported ethnicity data. Wider implications of the findings The HFEA and key stakeholders in UK have agreed a call to action to reduce the ethnic disparities through improving in development of clinical policy, information and awareness, NHS commissioning, and research to tackle the ethnic disparities in fertility treatment. Trial registration number NA

P-719 The fertility clinic landscape in England 2012-2017: a study of the impact of clinic size and environment on success rates

Abstract Study question How are fertility clinics in England distributed and has this changed over time? Does clinic size, geography and local deprivation level influence live birth rates? Summary answer A clinic’s size, urban/rural environment and local deprivation level shows no statistically significant impact on a clinic’s live birth rates. What is known already It has been established that children born through assisted reproduction are more likely to have parents from higher socioeconomic groups compared to those conceived through natural conception. However, studies examining the relationship between socioeconomic status and fertility treatment success rates have varied outcomes and occasionally conflicting results. There has so far been little research internationally as to whether geographical, environmental and socioeconomic markers influence fertility treatment outcomes on a national scale. Study design, size, duration Publicly available HFEA data from 2012 to 2017 for all registered clinics in England was accessed. The total number of IVF/ICSI cycles for all age groups and live birth rate per embryo transferred were recorded. 56 clinics (32,091 treatment cycles) were recorded in 2012, rising to 69 clinics (36,638 treatment cycles) in 2017. Clinic postcode was used to determine Rural-Urban Classification and postcode-level and local authority-level deprivation according to the Index of Multiple Deprivation (IMD). Participants/materials, setting, methods Statistical analysis was performed using R Statistical Software and Datawrapper was used to generate map infographics. Clinic size was categorised by the number of IVF/ICSI cycles conducted per year – small (0-499), medium (500-999) and large (&amp;gt;1000). Clinic environment was classified as urban or rural and IMD was used to categorise clinics into deprivation quintiles. Weighted live birth rates were analysed to determine any difference in clinic success based on its size and environment. Main results and the role of chance The majority of clinics conducted between 0-499 IVF/ICSI cycles per year. There was no statistically significant difference in the live birth rate per embryo transferred based on clinic size with an average success rate of 31.8% in small clinics, 33.9% in medium clinics and 32.2% in large clinics (p-value 0.885). A large proportion of clinics were located in London (28-29% of clinics and 34-40% treatment cycles) between 2012 and 2017 despite only ∼16% of the population of England living in London. There were significantly fewer clinics (p-value 0.047) and treatment cycles (p-value &amp;lt;0.001) conducted in rural, compared to urban locations. There was a small, but not statistically significant, increase in success rate in clinics located in the least, compared to most deprived quintile. The difference in average live births/embryo transferred between the most and least deprived quintile across all years studied was 3.8% (31.1% in most deprived vs 34.9% in least deprived, p-value 0.227). There was also no statistical difference between the live birth rates per embryo transferred across the local-authority deprivation quintiles, although there was a trend for slightly higher success rates in the least deprived quintile compared to most deprived quintile. (30.3% compared to 33.9% (p-value 0.211)). Limitations, reasons for caution Clinic postcode only was used, therefore deprivation may not be representative of the whole population it treats. All IVF/ICSI treatments for all age groups were included, but some clinics may treat an older population of patients. Many IVF laboratories have satellite clinics in surrounding areas, whose postcodes were not included. Wider implications of the findings It is reassuring that local environment and deprivation do not significantly impact on clinic success rates. More detailed analysis of individual patient data on a nationwide level is required to understand this further either through access to primary care records or collaboration between clinics. Trial registration number not applicable

A survey study evaluating donor gamete utilization rates, patient satisfaction, and fertility treatment outcomes according to desired race and ethnicity

To evaluate donor gamete utilization, patient satisfaction, and fertility treatment outcomes of patients pursuing treatment with donor gametes stratified by the desired race as well as ethnicity of the gamete donor. Survey study. Clinic. Patients planning to undergo treatment using donor sperm and/or donor oocytes at a single academic fertility clinic in the Southeastern United States between 2015 and2020. None. Utilization rates of donor gametes, satisfaction with donor gamete selection, and fertility treatment outcomes stratified by race and ethnicity of patient, as well as that of their gamete donor. Four hundred fifty patients were eligible for inclusion and 170 (38%) responded to the survey. Among the respondents, 59% desired a non-Hispanic White gamete donor and 20% desired a non-Hispanic Black gamete donor. Patients seeking a non-Hispanic Black gamete donor had lower odds of using donor gametes (Odds ratio [OR], 0.13; 95% confidence interval [CI], 0.04-0.40) compared with individuals seeking a non-Hispanic White gamete donor. When evaluating satisfaction with donor gamete selection, patients seeking a non-Hispanic Black gamete donor reported lower satisfaction compared with individuals seeking a non-Hispanic White gamete donor (OR, 0.19; 95% CI, 0.09-0.43). When evaluating fertility outcomes, Non-Hispanic Black patients and those using non-Hispaninc Black gamete donors were found to have lower odds of successful conception compared with non-Hispanic White patients (OR, 0.18; 95% CI, 0.07-0.46) and individuals seeking non-Hispanic White gamete donors (OR, 0.26; 95% CI, 0.09-0.75), respectively. Patients seeking non-Hispanic Black donor gametes have lower utilization rates, less satisfaction with gamete donor selection, and lower odds of conception when compared with those seeking non-Hispanic White gamete donors. These findings highlight the need for more racial diversity within donor gamete banks, as well as within the donor pools available through agencies and fertility clinics.

Low and High-Normal FMR1 Triplet Cytosine, Guanine Guanine Repeats Affect Ovarian Reserve and Fertility in Women Who Underwent In Vitro Fertilization Treatment? Results from a Cross-Sectional Study.

Dynamic mutations in the 5' untranslated region of FMR1 are associated with infertility. Premutation alleles interfere with prenatal development and increase infertility risks. The number of CGG repeats that causes the highest decrease in ovarian reserves remains unclear. We evaluated the effect of FMR1 CGG repeat lengths on ovarian reserves and in vitro fertilization (IVF) treatment outcomes in 272 women with alleles within the normal range. FMR1 CGG repeat length was investigated via PCR and capillary electrophoresis. Alleles were classified as low-normal, normal, and high-normal. Serum levels of follicle-stimulating hormone and anti-Mullerian hormone (AMH) in the follicular phase of the menstrual cycle were measured, and antral follicles (AFC) were counted. IVF outcomes were collected from medical records. Regarding FMR1 CGG repeat length alleles, 63.2% of women presented at least one low-normal allele. Those carrying low-normal alleles had significantly lower AMH levels than women carrying normal or high-normal alleles. Low-normal/low-normal genotype was the most frequent, followed by low-normal/normal and normal/normal. A comparison of ovarian reserve markers and reproductive outcomes of the three most frequent genotypes revealed that AFC in the low-normal/normal genotype was significantly lower than the low-normal/low-normal genotype. The low number of FMR1 CGG repeats affected AMH levels and AFC but not IVF outcomes per cycle of treatment.

Oocyte collection and outcome following oncologic treatment: a retrospective multicentre study

PurposeThis study assesses fertility treatment outcomes in female patients who had undergone successful oocyte retrieval following cancer therapy.MethodsBetween January 2020 and December 2022, we collected fertility treatment data from six participating centres in Spain and Germany. All patients associated with this data had undergone successful oocyte retrieval following cancer treatment.ResultsWomen had most frequently been diagnosed with a haematological (41.9%), breast (22.6%) or gynaecological malignancy (12.9%); two thirds (67.7%) had previously received a chemotherapy, half a radiotherapy (53.3%) and 45.2% had undergone surgery. On average, 7 years (range 0–28) had passed between cancer treatment and first ovarian stimulation cycle. Forty-nine ovarian stimulation cycles had been conducted on these 31 women between 2004 and 2021 (mean age at first oocyte collection following treatment: 34.8 ± 5.7 years). On average, 7 oocytes were collected per cycle (range 0–26) and 11 were collected per patient (range 0–51). Out of the 190 oocytes collected for immediate use of artificial reproductive technique, 139 were fertilised at a rate of 73%. Live birth rate per fresh transfer was 45% (9/20); no births were reported following cryotransfer (0/10). Mean values of anti-Mullerian hormone (AMH) before stimulation declined with time since treatment; however, oocytes were successfully collected from four women with an AMH of <0.5 ng/ml, although no pregnancies were reported. Ten pregnancies were documented; 3 ended in miscarriage. Two twin and 5 single pregnancies resulted in nine live births. On average, children were carried to term.ConclusionIn this small cohort, oocytes were successfully collected after chemotherapy and radiotherapy, despite—in individual cases—low AMH values. Further studies are needed to enrich the database and ultimately provide appropriate counselling to female cancer patients regarding expectations and ART outcome following cancer therapy.

Racial and Ethnic Disparities in Adverse Neonatal Outcomes Persist With Use of Fertility Treatment [ID 2683455

INTRODUCTION: Racial/ethnic health disparities are well documented, yet little is known about the effect of fertility treatment on disparities. This study assesses the relationship between fertility treatment and adverse neonatal outcomes by race/ethnicity. METHODS: A secondary data analysis was performed using National Vital Statistics (2012–2020) including singleton, non-anomalous births from 23 to 42 weeks of gestation. The primary outcome was an adverse neonatal composite outcome (ANCO) encompassing neonatal intensive care unit admission, assisted ventilation, seizures, and Apgar scores less than 7 at 5 minutes. Multivariable logistic regression assessed whether fertility treatment was associated with ANCO by race/ethnicity after adjusting for maternal age, gestational age at delivery, maternal body mass index, education status, insurance, and delivery year. RESULTS: Of 31,975,746 births meeting inclusion criteria, 414,716 (1.3%) were conceived with fertility treatment. Across the entire cohort, fertility treatment was associated with significantly increased odds of ANCO (adjusted odds ratio [aOR] 1.44; 95% CI, 1.43–1.46). Prevalence of ANCO was highest for the non-Hispanic Black (NHB) and American Indian/Alaska Native (AIAN) populations in both nonfertility and fertility treatment groups. Without fertility treatment, the Asian/Pacific Islander (API) and Hispanic groups had the lowest rates of ANCO at 8.3% and 8.9%, respectively. With fertility treatment, ANCO odds increased the most in API (aOR 1.61; 1.56–1.66) and Hispanic populations (aOR 1.60; 1.54–1.65). CONCLUSION: Fertility treatment is associated with approximately 1.5 times the odds of adverse neonatal outcomes across all racial/ethnic groups, with the greatest increase among the API and Hispanic populations. The NHB and AIAN groups experienced the highest overall rates of ANCO, supporting the need for targeted interventions for historically marginalized populations.

Vaginal microbiota are associated with in vitro fertilization during female infertility.

The vaginal microbiome plays an essential role in the reproductive health of human females. As infertility increases worldwide, understanding the roles that the vaginal microbiome may have in infertility and in vitro fertilization (IVF) treatment outcomes is critical. To determine the vaginal microbiome composition of 1411 individuals (1255 undergoing embryo transplantation) and their associations with reproductive outcomes, clinical and biochemical features are measured, and vaginal samples are 16S rRNA sequenced. Our results suggest that both too high and too low abundance of Lactobacillus is not beneficial for pregnancy; a moderate abundance is more beneficial. A moderate abundance of Lactobacilluscrispatus and Lactobacillus iners (~80%) (with a pregnancy rate of I-B: 54.35% and III-B: 57.73%) is found beneficial for pregnancy outcomes compared with a higher abundance (>90%) of Lactobacillus (I-A: 44.81% and III-A: 51.06%, respectively). The community state type (CST) IV-B (contains a high to moderate relative abundance of Gardnerellavaginalis) shows a similar pregnant ratio (48.09%) with I-A and III-A,and the pregnant women in this CST have a higher abundance of Lactobacillus species. Metagenome analysis of 71 samples shows that nonpregnant women are detected with more antibiotic-resistance genes, and Proteobacteria and Firmicutes are the main hosts. The inherent differences within and between women in different infertility groups suggest that vaginal microbes might be used to detect infertility and potentially improve IVF outcomes.

The Impact of Advanced Reproductive Medicine on Female Fertility: Clinical and Technological Perspectives

Background: Infertility is defined as failure to be pregnant after 12 months of unprotected intercourse. This condition affects millions of individuals worldwide. It is not only a personal problem, causing stress and anxiety amongst individuals and couples, but it has become a community issue. One in every 6 couples will experience infertility in their lifetime. It is affecting both male and female reproductive systems, with causes ranging from hormonal imbalances to obstructive disorders. Despite its prevalence, fertility care is unequal and, for those in low and middle-income countries, virtually non-existent and a long overdue topic for global attention and action. Method: We followed a systematic approach to select articles related to recent developments in female fertility and reproductive medicine. Keywords such as “female fertility” and “advanced reproductive medicine” were used for getting targeted articles. We used only peer-reviewed articles published from 2019 to 2024. Only high-quality data was extracted for general public information. Result: Our findings show that Assisted Reproductive Technologies (ART), microfluidic devices, and innovations like CoQ10 therapies have significantly improved fertility treatment outcomes. AI-driven personalized medicine has enhanced accessibility and effectiveness, democratizing fertility care. Stem cell therapy and platelet-rich plasma techniques are another breakthrough in reproductive medicine. Conclusion: It is concluded that medical advancements have revolutionized reproductive medicine. There is now a ray of new hope for those couple who are experiencing infertility. The future promises further improvements in success rates and patient experience with continued progress.

(212) The Questionable Clinical Utility of Sperm Morphology: Rate of Isolated Teratospermia in a Population of Fertile Men

Abstract Introduction Over the last several decades, sperm morphology has represented a standard component of semen analysis. However, its clinical utility is not well-defined, despite continual efforts by the WHO to address critiques of semen morphology criteria through increasingly strict guidelines. Issues with intra- and inter-laboratory technical variability, in addition to the subjective nature of the morphology assessment, have been thoroughly discussed in existing literature. Furthermore, current literature has highlighted the low predictive value of sperm morphology abnormalities in assisted fertility treatment (ART) and natural pregnancy outcomes. As of 2020, the American Society for Reproductive Medicine (ASRM) guidelines have noted that morphology alone is not highly predictive or diagnostic of infertility. However, past survey studies have demonstrated the pervasive belief among physicians of the value of sperm morphology, potentially leading to counseling patients towards more expensive ART methods. These concerns call into question the emphasis placed on sperm morphology assessment and its value in the clinical setting. Objective To better understand the impact of sperm morphology on fertility, we assessed sperm morphology in a population of known fertile men. Methods Healthy men over 18 years of age were recruited to provide one semen sample prior to vasectomy from March 2020 through November 2022. Inclusion criteria for the study was as follows: (1) patients were required to have biological children under the age of 5 years old, with no history of difficulty achieving pregnancy, and (2) had undergone no prior fertility procedures. Sperm morphology was analyzed using Papanicolaou stain with Kruger strict criteria by two technicians in an Andrology specialty laboratory per the WHO 5th edition manual. Results There were 83 men who participated in the study, 68 of whom (81.9%) had a complete sperm morphology assessment available. On average, participants were 37 years of age and had a mean BMI of 28 (22.8, 33.2). Of those with a smoking history available (n=61), 38 (62.3%) were non-smokers, 7 (11.5%) were former smokers, and 16 (26.2%) were current smokers. Patients had an average of 3 children with a mean youngest child age of 11.5 months old. There were 38 patients (55.9%) with 3% or lower normal sperm morphology, including two patients who had 0% normal morphology (Table 1). The most common morphologic abnormalities were head shape defects (n=59, 84.3%), followed by coiled tails (n=14, 20.3). Men 3% or lower normal sperm morphology were four times as likely to have both head and tail abnormalities than men with 4% or greater normal sperm morphology (n=8 vs n=2, respectively); half of these men also had lower than normal motility, whereas none of the men with 4% or greater normal sperm morphology had lower than normal motility. Conclusions More than half of fertile male patients (65.6%) had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict. Disclosure No.

Food, nutrition, and fertility: from soil to fork

Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University’s Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting.Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations.Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.

Ovarian follicular fluid levels of phthalates and benzophenones in relation to fertility outcomes

BackgroundMany endocrine disrupting chemicals (EDCs), for instance phthalates and benzophenones, are associated with adverse fertility outcomes and semen quality parameters. ObjectiveTo evaluate if concentrations of selected phthalate metabolites and benzophenones measured in follicular fluid are associated with fertility outcomes (i.e., reproductive hormones, antral follicle count, detected heartbeat at gestational week 7, and live birth) and, in a supplementary study, if measured concentrations of chemicals in follicular fluid can exert biological effects on human spermatozoa. MethodsOverall, 111 couples from a fertility clinic in Denmark contributed with 155 follicular fluid samples. Concentrations of 43 metabolites from 19 phthalates and phthalate substitutes and six benzophenones were measured in follicular fluid using liquid chromatography-tandem mass spectrometry. Multiple linear and logistic regression with an applied generalized estimating equation model allowing more than one measurement per woman assessed the association between follicular EDC levels and fertility outcomes. The assessment of biological effects of individual and mixtures of EDCs on human spermatozoa was conducted through a human sperm cell based Ca2+-fluorimetric assay. ResultsBenzophenone-3 (BP-3) and seven metabolites of five phthalates were detectable in follicular fluid. Women with metabolites of dibutyl phthalate isomers in the highest tertiles had lower antral follicle count (MiBP: β = −5.35 [95 % CI: −9.06; −2.00], MnBP: β = −5.25 [95 % CI: −9.00; −2.00]) and lower odds for detecting a heartbeat at gestational week 7 (MiBP: OR = 0.35 [95 % CI: 0.14; 0.91], MnBP: OR = 0.39 [95 % CI: 0.13; 1.15]). Mixtures of the measured concentrations of BP-3 and the seven phthalate metabolites induced a small significant increase in the intracellular calcium ion concentration in human spermatozoa from healthy donors (n = 3). DiscussionPhthalate metabolites and BP-3 were detectable in follicular fluid and high concentrations of some phthalate metabolites were linked with lower chance of successful fertility treatment outcomes. Chemical mixture concentrations in follicular fluid induced a calcium response in human spermatozoa highlighting possible biological effects at physiologically relevant concentrations.

Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35–0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4–0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31–0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.

Fertility treatment outcomes in transgender men with a history of testosterone therapy

To evaluate fertility treatment outcomes among transgender (TG) men with a history of gender-affirming hormone therapy with exogenous testosterone. Descriptive, retrospective cohort study. Transgender men with a history of gender-affirming hormone therapy with exogenous testosterone underwent fertility treatments, including embryo cryopreservation, invitro fertilization (IVF), co-IVF, oocyte cryopreservation, and intrauterine insemination (IUI), between 2013 and 2021. Gender-affirming hormone therapy with testosterone. Live births (LBs), number of frozen embryos, and number of frozen oocytes. Other outcome measures included total gonadotropin used, peak estradiol levels, oocytes retrieved, oocyte maturity rate, fertilization rate, and embryo grade. A total of 77 TG men self-presented or were referred to care at a single academic fertility center, of which 46 (59.7%) TG men underwent fertility preservation and/or family-building counseling, with 16 (20.8%) patients proceeding to fertility treatment. Of those patients who underwent treatment, 11 (68.8%) had a history of gender-affirming hormone therapy with exogenous testosterone use. Cohort 1 included IVF (n = 1), co-IVF (n = 1), embryo cryopreservation (n = 2), cohort 2 included oocyte cryopreservation (n = 4), and cohort 3 included IUI (n = 3). In cohort 1, both the patients who underwent IVF and the patients who underwent co-IVF achieved LBs. All embryo cryopreservation cycles froze three or more embryos. In cohort 2, the average number of frozen mature oocytes was 19.3 ± 16.2 (range 6-43). All patients who underwent IUI cycles achieved LB. In this study, no correlation existed between patient age, time on or off gender-affirming hormone therapy with exogenous testosterone, total gonadotropin used, and number of oocytes retrieved. All patients who completed IVF or embryo cryopreservation produced high-quality blastocytes, and this is the first study to show successful IUI cycles in patients with a history of gender-affirming hormone therapy with exogenous testosterone. This study demonstrates that TG men who have used gender-affirming hormone therapy previously can successfully undergo fertility treatments to attain oocyte and embryo cryopreservation, pregnancy, and LBs.

The impact of increasing body mass index on in vitro fertilization treatment, obstetrical, and neonatal outcomes

BackgroundCiting the risks of administering anesthesia to patients with obesity, few fertility centers offer IVF as a treatment modality for patients with BMIs ≥ 40 kg/m2. Although previous studies have assessed clinical pregnancy and cumulative live birth rates in patients who spontaneously conceive with BMIs ≥ 50 kg/m2, there is a paucity of IVF, obstetric, and neonatal outcome data in patients with severe obesity who conceive after IVF. ObjectiveTo evaluate the impact of increasing BMI on IVF, obstetrical, and neonatal outcomes in patients with obesity undergoing IVF. Study DesignThis was a retrospective cohort study within an academic fertility center including 2,069 fresh IVF/ICSI and frozen embryo transfer cycles from January 1, 2012 to April 30, 2020: this cohort was utilized to determine IVF treatment outcomes. A second embedded cohort of 867 fresh IVF/ICSI and frozen embryo transfer cycles which resulted in ongoing clinical pregnancies and deliveries within a single tertiary hospital system was utilized to determine pregnancy, maternal, and neonatal outcomes. All patients with a BMI ≥ 40 kg/m2 underwent consultation with a maternal fetal medicine specialist prior to starting treatment and a preoperative evaluation with an anesthesiologist prior to oocyte retrieval. Cycles were grouped by body mass index at cycle start: BMI 30-34.9 kg/m2, BMI 35-39.9 kg/m2, BMI 40-44.9 kg/m2, BMI 45-49.9 kg/m2, and BMI > 50 kg/m2. Log-binomial Poisson regression and Poisson regression with an offset models were performed with BMI 30-34.9 kg/m2 as the reference group, adjusting for potential confounders including oocyte age, patient age, embryo quality, transfer type, and coexisting comorbidities. The primary outcome was live birth rate. Secondary outcomes included fertilization rate, blastulation rate, miscarriage rate, incidence of preeclampsia with severe features, gestational diabetes, labor induction, cesarean section, preterm delivery, and birth weight. ResultsThere were 2,069 fresh IVF/ICSI and frozen embryo transfer cycle starts from January 1, 2012 to April 30, 2020. Of these, 1008 cycles were in the BMI 30-34.9 kg/m2 group, 547 in the BMI 35-39.9 kg/m2 group, 277 in the BMI 40-44.9 kg/m2 group, 161 in the BMI 45-49.9 kg/m2 group, and 76 in the BMI > 50 kg/m2 group. Live birth rate was not significantly different between groups. The BMI > 50 kg/m2 group was significantly more likely to experience preeclampsia with severe features when compared to the BMI 30-34.9 kg/m2 group (aRR 2.75, 95% CI 1.13-6.67). Fertilization rate, blastulation rate, miscarriage rate, incidence of gestational diabetes, labor induction, cesarean section, preterm delivery, and neonatal birth weights were not significantly different between groups. Conclusion(s): Among patients with BMIs 30-60 kg/m2 who conceived via IVF and received comprehensive prenatal care at a tertiary care hospital, IVF, obstetrical, and neonatal outcomes were largely comparable. These data support a collaborative care approach with maternal fetal medicine specialists and skilled anesthesiologists, reinforcing the notion that IVF should not be withheld as a treatment modality from patients with obesity.

P-479 Prognosis for ongoing pregnancy after recurrent implantation failure (RIF) following IVF/ICSI treatment

Abstract Study question What is the cumulative ongoing pregnancy rate within one year after visiting the RIF outpatient clinic in patients with RIF after IVF/ICSI treatment? Summary answer The cumulative ongoing pregnancy rate was 42.9% with a mean time to pregnancy of 8.8 months (95% CI 7.5-10.1 months). What is known already An estimated portion of 10-15% of IVF patients experience RIF. Multiple add-on treatments have been proposed, however, evidence for effective clinical therapeutic options still remain scarce. Although it is described that RIF patients might eventually benefit most from a ‘keep calm and carry on’ approach, in practice patients often seek clearer answers on their pregnancy chance and request further investigations/interventions. It would be helpful to give patients insight in their chances of achieving pregnancy after RIF, but at this moment little is known about their prognosis. This is further complicated by the lack of consistency in the definition of RIF. Study design, size, duration A prospective cohort study on 42 RIF patients after one-year follow-up was performed, as part of the MURIM (Multidisciplinary Research on Repeated Implantation Failure and Recurrent Miscarriages) study. Baseline characteristics including an endometrial assessment and ReceptIVFity (vaginal microbiome) test were collected at the RIF outpatient clinic. After a follow-up duration of minimal one year participants were asked to complete a questionnaire regarding fertility treatment and pregnancy outcome. Missing information was received via medical files. Participants/materials, setting, methods RIF patients aged 18 to 38 years old visiting the RIF outpatient clinic at Maastricht University Medical Centre+ between April 2019 until September 2021 were included. RIF was defined as consecutive implantation failure of three high quality embryos or ten embryos without a quality criterion. Clinical characteristics, pregnancy outcome and time to pregnancy was analyzed by survival analysis and cox hazard regression analysis via SPSS version 20.0. A p-value of &amp;lt; 0.05 was considered statistically significant. Main results and the role of chance Forty-two out of 44 contacted patients responded to the questionnaire (response rate = 95.5%). The ongoing pregnancy rate was 42.9% (Standard Deviation (SD): 0.50%) during the first year after visiting the RIF outpatient clinic. Mean time to ongoing pregnancy was 8.8 months (95%-CI: 7.5-10.1 months). The mean amount of embryo transfers (ETs) during this year was 2 (SD: 1.78). The ongoing pregnancy rate per ET (by survival analysis) for the first, third and sixth ET was 33.1%, 49.3% and 63.8%, respectively. To correct for a possible overestimation of the cumulative ongoing pregnancy rate per ET by normal survival analysis, pregnancy rates were calculated again using the number at risk of the total group during the first ET (pessimistic cumulative pregnancy rate). The pessimistic cumulative ongoing pregnancy rates were 33.1%, 42.9% and 48.6%, respectively. When comparing baseline characteristics by univariable cox hazard regression between women with and without ongoing pregnancy, no significant differences were found. Nineteen pregnancies were reported during the one-year follow-up, one conceived spontaneously (5.3%); four via fresh ET (IVF=15.8% and ICSI=5.3%); and 14 by frozen ET (IVF=26.4% and ICSI=47.4%). The pregnancies resulted in 14 livebirths (73.7%); one miscarriage (5.3%); one stillbirth (5.3%); and three ongoing pregnancies (15.8%). Limitations, reasons for caution Although this is the first study that prospectively describes pregnancy prognosis after RIF, it is limited by the short follow-up period and relatively small sample size. The RIF outpatient clinic consultation might have contributed to the obtained pregnancy results but the proportionality is unclear as there is no control group. Wider implications of the findings The obtained ongoing pregnancy prognosis after RIF is encouraging and justifies a conservative approach after three failed ETs. Furthermore, the high pregnancy rate indicates the need of well-defined, individualized diagnostic criteria to define RIF and to be able to deviate between couples with 'bad luck' and an underlying (treatable) cause. Trial registration number NL66835.068.18/METC18-040

O-175 The Positive Reappraisal Coping Intervention: how it works in recurrent pregnancy loss

Abstract Study question How does the Positive Reappraisal Coping Intervention (PRCI) sustain coping during the early stages of a new pregnancy in women with recurrent pregnancy loss (RPL)? Summary answer The PRCI improved psychological well being by sustaining coping and providing psychological respite from the stress of uncertainty. What is known already Increased levels of maternal anxiety and uncertainty are common during the early stages of a new pregnancy following RPL when women wait for confirmatory scan of ongoing pregnancy, however psychological support is often limited. The PRCI is a self-administered coping tool developed for uncontrollable and unpredictable situations like waiting, theorised to achieve its benefits by promoting positive feelings alongside negative feelings in unrelenting stressor situations, sustaining coping. It has been shown to have benefits for those awaiting the outcome of fertility treatment and those experiencing RPL by increasing positive emotions, positive appraisals of the situation and emotional quality of life. Study design, size, duration We performed secondary analysis of qualitative data from a two-centred feasibility randomised controlled study on the effectiveness of the PRCI for psychological well being of women with RPL. Participants (n = 75) were recruited over a two-year period. Participants for the qualitative component of the study (n = 14), participated in semi-structured interviews exploring their experience of pregnancy following RPL, perception of study methods and the intervention. Participants/materials, setting, methods Participants were recruited from the Recurrent Miscarriage Clinic in two tertiary referral hospitals in the UK. Women who had experienced three or more pregnancy losses were eligible to participate. Semi-structured interviews were conducted face to face. Data for the secondary analysis were interview data from the intervention arm of the study, that received the PRCI. Interview transcripts were analysed using NVivo 12 software and the approach of Braun and Clarke (2006). Main results and the role of chance This secondary analysis focused on improving understanding of the mechanisms by which the PRCI was perceived to be effective at promoting maternal psychological well being during the challenging early stages of a new pregnancy following RPL. Inductive thematic analysis of the qualitative data identified three themes on which the main theme of ‘PRCI sustains coping’ was based, namely that PRCI: •· prevented further falling or spiralling down by stimulating questioning of negative thoughts and encouraging time out for oneself •· encouraged an ‘I can do this’ attitude, acting as a reminder of the positives and stimulating positive thinking in this experience •· was perceived a helpful coping resource to lean on The study identified that the PRCI was a ‘go to’ resource in taxing moments of need, conveying benefits to maternal psychological well being by restoring depleted coping resources, stimulating positive coping, and providing psychological respite from the stressor of uncertainty experienced during the early stages of a new pregnancy. There were no apparent downsides of use. These insights are consistent with theory of how positive reappraisal helps people carry on coping in challenging situations. Limitations, reasons for caution Since this is a secondary analysis, data was utilised from a study that was not originally designed to investigate the perceived mechanism of the PRCI, and as such the data should be interpreted cautiously. Wider implications of the findings PRCI has the potential to be made more widely available as an effective, safe, convenient, and low-cost intervention to provide emotional support in RPL clinics. It might also be a useful coping technique in other clinical contexts where patients/carers experience increased psychological strain because of prolonged periods of uncertainty. Trial registration number ISCTN43571276