Fertility Center Research Articles

A Grounded Theory Approach to Understanding Men Confronting Infertility.

Purpose: This study aims to delve into the process of men confronting infertility. Design: This research employed the Straussian grounded theory approach. Methods: The study encompassed interviews with 16 participants from a private fertility center in Isfahan, Iran, between March 2023 and March 2024. The interviews were semistructured. Data analysis was carried out concurrently using constant comparative methods and standard grounded theory techniques. the participants' main concerns were identified, culminating in developing a substantive theory centered around a core category. Findings: The primary category for men struggling with infertility was "forced concealment." This was exhibited through the suppression of emotions, maintaining secrecy about infertility, hiding treatment, and attributing infertility to their wives to counteract threats to their masculinity. Factors such as partners, family, societal surroundings, care providers, and beliefs influenced the adopting of the "forced concealment" strategy. Conclusions: The "forced concealment" theory offers insights into the experiences of men struggling with infertility. The study highlights the necessity of formulating culturally sensitive strategies that enable healthcare providers, nurses, and health system managers to effectively fulfill their roles and address the challenges and needs of couples confronting male infertility. This can be realized through a comprehensive approach that integrates nursing skills and competencies.

Status of Prenatal Nutrition Knowledge and Fertility Awareness in Women Seeking Treatment in a Tertiary Care Fertility Centre at Index Visit- An Opportunity for Education and Intervention

Status of Prenatal Nutrition Knowledge and Fertility Awareness in Women Seeking Treatment in a Tertiary Care Fertility Centre at Index Visit- An Opportunity for Education and Intervention

Efficacy and safety of Shen Que (RN8) moxibustion on reproductive outcomes in unexpected poor ovarian responders: a randomized controlled trial

BackgroundManaging infertility patients with poor ovarian response (POR) to ovarian stimulation remains unmet clinically. Besides economic burdens, patients with POR have a poor prognosis during in vitro fertilization and embryo transfer (IVF-ET). In this study, we assessed the efficacy and safety of Shen Que (RN8) moxibustion on reproductive outcomes in POSEIDON patients (Group 2a).MethodsWomen eligible for IVF were invited to participate in this randomized, open-label, superiority trial at an academic fertility center from January 2022 to December 2023. One hundred patients ≤ 44 years old equally divided between Shen Que moxibustion (SQM) and control groups were randomized. These patients must meet the POSEIDON criteria, Group 2a, which requires antral follicle count (AFC) ≥ 5 or anti-müllerian hormone (AMH) ≥ 1.2ng/ml, and a previous unexpected POR (< 4 oocytes). Twelve moxibustion sessions were conducted in the SQM group prior to oocyte retrieval, while only IVF treatment was performed in the control group. The primary outcome was the number of oocytes retrieved.ResultsAs compared with the IVF treatment alone, the SQM + IVF treatment significantly increased the number of retrieved oocytes (4.7 vs. 5.8, p = 0.012), mature oocytes (3.0 vs. 5.0, p = 0.008), and available embryos (2.0 vs. 4.0, p = 0.014) in unexpected poor ovarian responders aged more than 35 years. In the SQM group, the cumulative live birth rate was 27.3% (9/33) in comparison to 13.3% (4/30) in the control group, whereas no statistical significance was detected (p = 0.172). During the study, no significant adverse effects were observed.ConclusionsWomen with unexpected POR who meet POSEIDON Group 2a can benefit from Shen Que (RN8) moxibustion treatment.Trial registrationClinicalTrials.gov, NCT05653557.

Association of HOMA-IR with unexpected poor ovarian response in non-obese women in poseidon 1: a retrospective cohort study

BackgroundInsulin resistance (IR) is related with adverse outcomes of in vitro fertilization (IVF) in women with obesity, but little is known about the relationship between IR and unexpected poor ovarian response (uPOR) in non-obese subjects with sufficient ovarian parameters (classified as POSEIDON group 1). This research aims to explore the association between the homeostasis model assessment of insulin resistance (HOMA-IR) and uPOR in non-obese women with normal biomarkers of ovarian reserve.MethodsThe retrospective cohort study was conducted at a fertility center. The main inclusion criteria were age < 35 years, body mass index (BMI) < 28 kg/m2, normal ovarian reserve (anti-Mullerian hormone ≥ 1.2 ng/ml, antral follicle count ≥ 5). Women undergoing the first oocyte retrieval cycle were included consecutively between 2018 until 2023. Patients who have ≤ 9 oocytes retrieved were defined as uPOR. The multivariable logistic model and subgroup analysis were conducted after adjusting confounders.ResultsA total of 6977 cycles were included. The adjusted odds ratio was 1.25 (95% confidence interval [CI], 1.12–1.39) for the increment of Ln HOMA-IR which was taken as a continuous variable. Meanwhile, as a sensitivity analysis, elevated tertile of HOMA-IR exhibited an increase in risk of uPOR for the third tertile (≥ 2.75) when compared with the first tertile (< 1.75) with OR of 1.33 (95%CI, 1.15–1.54). In the subgroup analysis, the positive association remained consistent.ConclusionElevated HOMA-IR values is significantly associated with increased risk of uPOR in non-obese women classified as POSEIDON group 1. Our study provided evidence for the adverse influence of IR on the ovarian response during IVF and shed light on the importance of IR measurement at the time of pre-stimulation among non-obese women.

The Smoky Impact of Nicotinic Acetylcholine Receptors on Testicular Function.

Smoking habits (from classic cigarettes to e-cigarettes and heated tobacco) are a relatively common finding in the medical histories of couples referred to fertility centers. Tobacco smoke and e-cigarettes may deliver many substances with known harmful effects on both general and reproductive health, including nicotine. Nicotinic Acetylcholine receptors (nAChRs) form a heterogeneous family of ion channels that are differently expressed in different tissues. According to the homomeric or heteromeric combination of at least five different subunits (named from α to ε), they have peculiar pharmacological and biophysical properties. nAChRs respond to the neurotransmitter acetylcholine, which influences a number of physiological functions not restricted to neurons and plays an important role in the structure and function of non-neuronal tissues such as the testis. nAChRs are also the target of Nicotine, the active element responsible for tobacco addiction. This review summarizes recent findings on the involvement of nAChRs in testicular physiology, highlighting the effects of nicotine exposure observed in animal studies and clinical settings. We will discuss the latest data on fertility outcomes and the implications for understanding nAChR functions in reproductive health.

Effect of Waiting Period on Initial Adverse Vaginal Microbiome Composition in IVF-ICSI Patients.

Background/Objectives: In this observational prospective cohort study, conducted at the Fertility Centre of the University Hospital, Duesseldorf Germany, the spontaneous reversal capacity and the effect of waiting time on an adverse vaginal microbiome profile in subfertile patients were investigated. Methods: Vaginal swabs of 76 patients were obtained before starting a fertility treatment using a commercially available test to perform a microbiome analysis. Patients with a favorable microbiome profile ("medium" or "high profile") according to the manufacturer's algorithm proceeded with the fertility treatment. Patients with an unfavorable microbiome profile ("low profile") postponed their fertility treatment and were sampled up to four times in each successive cycle or until a shift to a more favorable profile was detected. Results: Initially, 54/76 subjects had a high or medium profile and 23/76 had a low profile. Within 3 months, 75% of patients with an initial low profile shifted to a more favorable profile (7/23 dropouts). The presence of Lactobacillus crispatus in the initial sample was associated with a higher likelihood of a spontaneous shift to a more favorable profile. Conclusions: The vaginal microbiome is subject to strong fluctuations. Even an unfavorable microbiome profile can develop into a favorable microbiome profile within a few months without treatment.

Comparison of Clinical Outcomes in the Slow-Developing Blastocysts With or Without Preimplantation Genetic Testing-Aneuploidy on Day 6 in the Frozen–Thawed Cycle

ObjectivesThis study investigated the potential of the slow-developing blastocysts using preimplantation genetic testing-aneuploidy (PGT-A) in patients undergoing frozen–thawed embryo transfer, stratified by age. MethodsA retrospective analysis was performed including a total of 743 cycles, the first frozen embryo transfer (FET) cycle with single embryo transfer, who underwent treatment between January 2020 and July 2023 in a single fertility centre, Gangnam CHA Fertility Center. A total of 743 cycles, in which we performed intracellular sperm injection and freeze-all strategy, from 743 patients were included. The patient group was divided into 4 groups as follows: group 1 (G1), 208 FET on day 5; group 2 (G2), 177 FET with PGT-A on day 5; group 3 (G3), 220 FET on day 6; group 4 (G4), 138 FET with PGT-A on day 6. We also divided into 2 groups—under 35 years of age and over 35 years of age—and performed the analysis separately for each group. ResultsIn the under 35 years of age group, there were no significant differences in clinical pregnancy and miscarriage rates in G1 and G2 (67.2% vs. 63.8%, not statistically significantly different). Also, G4 had a higher clinical pregnancy rate than G3, but it was not significant (51.8% vs. 54.7%, not statistically significantly different). In the 35 years or older group, G2 had higher pregnancy rates than G1 and lower miscarriage rates (clinical pregnancy rate: 43.3% vs. 67.7%, P = 0.001, miscarriage rate: 22.5% vs. 3.4%, P = 0.001). In addition, G4 had a higher pregnancy rate than G3 and a lower miscarriage rate (clinical pregnancy rate: 31.8% vs. 46.9%, P = 0.003, miscarriage rate: 22.9% vs. 2.2%, P = 0.023). ConclusionsIn the under-35-year-old group, PGT-A on day 5 and day 6 showed a high pregnancy rate and a low miscarriage rate. Therefore, using PGT-A seems advantageous for patients of an advanced maternal age.

Complementary, supportive and traditional practice experiences of infertile women in Türkiye: a qualitative study

BackgroundIn many societies, infertile couples use traditional practices.ObjectiveThis study aimed to determine the complementary, supportive and traditional (CST) practices used by infertile women and their attitudes toward these practices.MethodsIn this qualitative study, data were collected through individual interviews using a semi-structured form in December 2021. A total of 25 infertile women who applied to the in-vitro fertilization center of a hospital in Türkiye participated in the study. The findings were evaluated by thematic analysis.ResultsThe ages of the participants ranged from 25 to 49 years. Three main themes were obtained by the data analysis; “Reasons for using CST practices,” “Complementary, supportive and traditional practices used” and “Opinions on the effect of CST practices.”ConclusionWomen resorted to complementary and supportive practices for economic reasons, seeking hope, and environmental pressure. Various herbal cures, dietary practices, and religious methods such as praying and prayer amulets, hacamat (cupping), leeches, and various bodily applications were identified as methods commonly used by women. Women were using these methods with the recommendations of people who are not health professionals. It is important to determine the beneficial methods and increase women’s awareness of harmful practices. Additionally, although women use many methods for infertility treatment, it should also be noted that infertility is not a female-only problem. Consequently, childless women should be empowered with healthy coping skills.

Day 3 embryo assessment does not provide a reliable prediction for blastocyst formation and designation: a retrospective cohort study.

Although many Fertility Centers have adopted day 5 or 6 embryo transfer policy, yet, 30% of embryo transfers in the US are performed on day 3. This is mainly due to concerns related to longer embryo culture effect and higher rates of embryo transfer cancellation on day 5, with no effect on cumulative pregnancy rate. We conducted a retrospective cohort study comparing individual embryo transfer order rank, best embryo for fresh transfer and intention to freeze, of day-3 and day-5 embryos based on their morphology score. Day-3 embryos of each patient were ranked by embryologists for the order of transfer and intention to freeze, based on morphological score, blinded to actual blastulation outcome. The corresponding blastocysts were similarly ranked for the order of transfer and vitrification intention. Ranking was compared to test the predictive value of day-3 morphological assessment. Sixty patients with 784 day-3 embryos were included. There was only a moderate positive significant correlation between ranks on day-3 and ranks on day-5 [r = 0.662 95% CI (0.611-0.706, p < 0.001)]. Only 25% of the best embryos for transfer on day 3 (rank = 1) were chosen for fresh transfer on day 5. A total of 441 embryos were intended to be frozen on day 3. Of those, 201 were not transferred nor vitrified on day 5-6 (45%), 3.35 embryos per patient. No significant difference was found between average day-3 rank of embryos ranked 1, 2 (3.12 vs 4.12, p = 0.074) and 3 (3.12 vs 4.08, p = 0.082) on day-5-6. To conclude, this study brings a different perspective to the comparison of day 3 and day 5 by following each embryo's putative and actual designation. Day-3 ranking of embryo morphology did not provide a reliable prediction for blastocyst formation, transfer order and vitrification intention, and may support transfer or cryopreservation of blastocysts over cleavage stage embryos.

Glycosylated fIbronectin, a biomarker, point‐of‐care test for management of Hypertensive disorders of pregnancy in a low resource fertility centre – A prospective observational study. GLIMPSE study

Glycosylated fIbronectin, a biomarker, point‐of‐care test for management of Hypertensive disorders of pregnancy in a low resource fertility centre – A prospective observational study. GLIMPSE study

Oligoasthenospermia is correlated with increased preeclampsia incidence in subfertile couples undergoing in vitro fertilization and embryo transfer: a secondary analysis of a randomized clinical trial

ObjectiveTo evaluate whether intergroup differences in the risk of maternal pregnancy complications following in vitro fertilization (IVF) vary with male factor. DesignA post hoc exploratory secondary analysis of data from a multicenter, randomized, controlled, non-inferiority trial (NCT03118141). SettingAcademic fertility centers. SubjectsA total of 1131 subfertile women with complete recording of their male partner's semen parameters during the trial were enrolled. All participants underwent intracytoplasmic sperm injection (ICSI) followed by frozen embryo transfer (FET) as part of their assisted reproductive technology (ART) treatment protocol. InterventionsWomen were divided into an oligoasthenospermia group (n=405) and a normospermia group (n=726) according to the quality of male sperm. Main Outcome MeasuresPregnancy complications, principally including the incidence of preeclampsia. ResultsNotably, we found that the risk of maternal preeclampsia was significantly higher in the oligoasthenospermia group than in the normospermia group (P=0.035). After adjustments for confounding factors by multivariate logistic regression analysis, the incidence of preeclampsia in the oligoasthenospermia group was still significantly higher than that in the normospermia group (6.55% vs. 3.60%; OR=0.529; 95% CI=0.282-0.992; P-adj=0.047). However, there were no significant differences in terms of embryo quality, cumulative live birth rate, other pregnancy complications or neonatal outcomes between the two groups (P>0.05). ConclusionOligoasthenospermia was associated with a higher risk of maternal preeclampsia in subfertile couples undergoing IVF-ET treatment. In clinical practice, it is essential to thoroughly evaluate the sperm quality and quantity of male partners before IVF-ET. Further research is needed to establish the causal relationships between semen quality and adverse pregnancy complications, particularly preeclampsia, and to explore potential interventions.

Live birth after transmyometrial embryo transfer in a patient with radical trachelectomy

ObjectiveTo report the successful utilization of transmyometrial embryo transfer (TMET) in a patient with a history of radical trachelectomy. DesignVideo article. SettingAcademic fertility center. Subject(s)A 39-year-old, para 1, woman with a history of radical trachelectomy and abdominal cerclage presented with secondary infertility. Her prior pregnancy was conceived naturally. Her first in vitro fertilization (IVF) cycle yielded only one day-7 euploid blastocyst. All attempts at performing mock embryo transfers, cervical dilatation and hysteroscopy were unsuccessful due to absence of clinically identifiable cervical tissue. The euploid embryo was transferred into a gestational carrier; however, this resulted in a biochemical pregnancy. She underwent a second IVF cycle that yielded one day-5 euploid blastocyst. Given her history, TMET was planned. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionTMET using the Towako® catheter. Main Outcome MeasuresImplantation, clinical pregnancy and live birth. ResultsFollowing institutional and Health Canada approval of the Towako® catheter, a transvaginal-ultrasound guided TMET was performed under sedation with intravenous midazolam and fentanyl. The day-5 euploid blastocyst from the second IVF cycle was transferred and the patient’s β-human chorionic gonadotropin (β-hCG) levels 9 and 11 days after TMET were 86 IU/L and 262 IU/L, respectively. A single intrauterine pregnancy with cardiac activity of 119 beats/min was noted at a gestational age of 7 weeks and 2 days. The patient delivered a live singleton at 35 weeks and 2 days weighing 2182 grams. ConclusionTMET is a useful clinical technique for transferring embryos in patients with acquired or congenital cervical issues in whom trans-cervical embryo transfer is either very difficult or impossible.

Twenty-year oncology sperm banking experience at a Canadian academic fertility centre: a retrospective study examining the usage and reproductive outcomes from oncology patients

BackgroundMany cancer treatments pose a threat to fertility for patients. Semen cryopreservation before cancer treatment is an effective method to preserve fertility. There are sparse long-term data on the usage...

Gender differences in behaviors toward acceptance of donor egg, sperm, and embryo in Northern Thai infertile couples.

This study aimed to examine the behavior towards the acceptance of donor egg, donor sperm, and donor embryo of Northern Thai infertile couples, separated between men and women. A cross-sectional study was conducted at the CMEx Fertility Center, Chiang Mai, Thailand. The questionnaires consisted of sociodemographic questions and the acceptance of couples toward donor egg, sperm and embryo. The couples filled in the answers separately. A total of 250 infertile couples were assessed. There were no differences in the acceptance rate of donor egg, sperm and embryo between the men and the women. Male acceptance rates were 25.6%, 18.8%, and 18.8%, respectively; while female acceptance rates were 24.4%, 18.4%, and 19.2%, respectively. Most couples (over 70%) concordantly rejected the donation program. Around 10% of couples had discordant answers. The concordance accepted for couples for donor egg, sperm and embryo was only 20%, 13.2%, and 14.8%. Older people and those who had been infertile for a longer period were significantly more likely to accept donation programs. There is no difference concerning the acceptance of donor gametes and embryo among men and women. Most participants reject the utilization of donor programs, the overall acceptance rate is relatively low. This may indicate the need for more adequate information and education for the community to enhance prevention programs rather than focus on the treatment with donor gametes or embryos.

Multiple collapses of blastocysts after full blastocyst formation is an independent risk factor for aneuploidy — a study based on AI and manual validation

BackgroundThe occurrence of blastocyst collapse may become an indicator of preimplantation embryo quality assessment. It has been reported that collapsing blastocysts can lead to higher rates of aneuploidy and poorer clinical outcomes, but more large-scale studies are needed to explore this relationship. This study explored the characteristics of blastocyst collapse identified and quantified by artificial intelligence and explored the associations between blastocyst collapse and embryo ploidy, morphological quality, and clinical outcomes.MethodsThis observational study included data from 3288 biopsied blastocysts in 1071 time-lapse preimplantation genetic testing cycles performed between January 2019 and February 2023 at a single academic fertility center. All transferred blastocysts are euploid blastocysts. The artificial intelligence recognized blastocyst collapse in time-lapse microscopy videos and then registered the collapsing times, and the start time, the recovery duration, the shrinkage percentage of each collapse. The effects of blastocyst collapse and embryo ploidy, pregnancy, live birth, miscarriage, and embryo quality were studied using available data from 1196 euploid embryos and 1300 aneuploid embryos.Results5.6% of blastocysts collapsed at least once only before the full blastocyst formation (tB), 19.4% collapsed at least once only after tB, and 3.1% collapsed both before and after tB. Multiple collapses of blastocysts after tB (times ≥ 2) are associated with higher aneuploid rates (54.6%, P > 0.05; 70.5%, P < 0.001; 72.5%, P = 0.004; and 71.4%, P = 0.049 in blastocysts collapsed 1, 2, 3 or ≥ 4 times), which remained significant after adjustment for confounders (OR = 2.597, 95% CI 1.464–4.607, P = 0.001). Analysis of the aneuploid embryos showed a higher ratio of collapses and multiple collapses after tB in monosomies and embryos with subchromosomal deletion of segmental nature (P < 0.001). Blastocyst collapse was associated with delayed embryonic development and declined blastocyst quality. There is no significant difference in pregnancy and live birth rates between collapsing and non-collapsing blastocysts.ConclusionsBlastocyst collapse is common during blastocyst development. This study underlined that multiple blastocyst collapses after tB may be an independent risk factor for aneuploidy which should be taken into account by clinicians and embryologists when selecting blastocysts for transfer.

Hepatitis B virus in oocytes and embryos: pregnancy outcomes and children’s health

To investigate whether the presence of hepatitis B virus (HBV) in oocytes and embryos affects pregnancy outcomes for invitro fertilization and embryo transfer (ET) as well as is related to the vertical transmission of HBV to children. Retrospective cohort study. A university-affiliated fertility center. This study included 167 couples with at least 1 hepatitis B surface antigen-seropositive partner. These couples underwent invitro fertilization-ET, and the discarded oocytes and embryos had been tested for HBV. Couples with HBV-positive oocytes or embryos were categorized as the positive group, whereas those couples with HBV-negative oocytes and embryos served as the negative group. None. Pregnancy outcomes and the rate of children's HBV infection. The pregnancy outcomes of fresh and frozen ETs were not associated with the presence of HBV in the oocytes and embryos. Of the 106 infants born, 1 child whose mother tested positive for hepatitis B surface antigen but had negative oocytes and embryos was infected with HBV. Additionally, 26.09% of children who had been administered passive immunization and active vaccinations did not reach protective levels of anti-HBV antibodies (hepatitis B surface antibodies) and became nonresponders. The negative rate of children's hepatitis B surface antibody was associated with the presence of HBV in oocytes and embryos (odds ratio, 3.01; 95% confidence interval, 1.04-9.25). The presence of HBV in oocytes and embryos did not affect pregnancy outcomes or result in the vertical transmission of HBV to the offspring of HBV carriers. Follow-up is needed for HBV-vaccinated children with an HBV-infected parent. Booster vaccinations are necessary for continued protection.

Trophectoderm grade as a predictor of beta human-chorionic gonadotropin rise in early pregnancy.

To evaluate the association, if any, between the grade of the trophectoderm (TE) and the rate at which β-human-chorionic gonadotropin (β-HCG) rises in early pregnancy. This is a retrospective cohort study including 1116 singleton clinical pregnancies resulting from in vitro fertilization with single day 5 blastocyst transfer at an academic fertility center. TE quality was assessed by trained embryologists employing standard criteria. Three groups were formed based on the TE grade: grade A (n = 358), grade B (n = 628), and grade C (n = 130). Main outcome measure was the rise (%) in serum levels of β-HCG (days 12 to 14 post embryo transfer), using the following formula [(β-HCG D14 - β-HCG D12) * 100/β-HCG D12]. Fresh embryo transfers accounted for 64.1% of the population. Overall, in adjusted models there were no significant differences in the β-HCG% rise when comparing the TE grade C group to TE grade A [adjβ (95%CI): 10.09 (- 0.05, 20.22)] or when comparing TE grade Β group to TE grade A [4.46 (- 2.97, 11.88)]. When the analysis was restricted to fresh embryo transfers, significant differences were observed in the % rise of β-HCG when comparing the TE grade C group to TE grade A [adjβ (95%CI): 21.71 (5.67, 37.74)], but not when comparing the TE grade B group to TE grade A [2.68 (- 5.59, 10.95)]. In frozen transfers, there were no significant differences. TE grade appears to impact early pregnancy serum β-HCG levels in the setting of a fresh day 5 embryo transfer, even after adjusting for potential confounders.

P-731 Into a green (r)evolution in fertility centers: a forerunner experience

Abstract Study question Is it possible to redefine an everyday clinical routine at the fertility centers in order to reduce the environmental impact? Summary answer A fundamental improvement in the reduction of waste is the elimination of all unnecessary disposable tools, especially during embryo transfer. What is known already Pollution and related climate changes have a major impact on global health. While the mission of healthcare systems is to guarantee health among people, emissions from the health care setting significantly contribute to climate change. Recent publications have called for an emergency action to reduce the healthcare environmental footprint. The International Federation of Gynaecology and Obstetrics (FIGO) states that the current climate crisis implies an imminent health risk even to reproductive health. An immediately reduceable source of greenhouse emissions could reside in inappropriate and avoidable tests, procedures, tools and treatments used in clinical practice. Study design, size, duration This is a retrospective observational study in which all outpatient, surgical and laboratory procedures, that are part of the daily clinical routine at our fertility center, were analysed during a one-week period and evaluated to be strictly necessary or not. In particular, as for surgical activity, in the mentioned week, all embryo transfer (ET) and oocyte retrieval (OR) waste production was analysed. Participants/materials, setting, methods During the week of 18-24 September 2023, waste production from 80 ETs and 56 ORs procedures was analysed. The environmental impact of all unnecessary tests, procedures and tools was assessed in terms of energy-, time- and money-saving, waste production and potential harm to the patients. In particular, the amount of packaging unnecessarily produced each week was weighed. Main results and the role of chance In consideration of the high number of procedures performed at our fertility center, the amount of waste related to the surgical activity was estimated as too high. Regarding ETs, the estimated total waste for a single procedure is 0.6692 kg, 0.5749 kg being product waste, 0.0943 kg being packaging waste. Concerning ORs, the estimated total waste for a single procedure is 0.7563 kg, 0.6495 kg being product waste, 0.1068 kg being packaging waste. This waste can be reduced by eliminating extra-packaging for the ET and OR set (from «one pack for each item» to «all in one»). A significant role in environmental pollution is also played by plastic surgical drapes and physician’s coats, used to cover patients and operators to guarantee both protection and comfort. These plastic garments have several drawbacks, including difficult or unfeasible sterilisation as well as their disposable use, huge environmental impact and cost in their manufacture. A proposed solution is to avoid the use of unnecessary disposable tools, such as the plastic sterile physician’s coat, 2 out of 3 plastic sterile cloths to cover the patients and the plastic syringe during the embryo transfer. Limitations, reasons for caution The main limitation of the proposed solution is healthcare workers’ compliance. In fact, their willingness to participate in eventual future educational events and procedural changes is unknown. Another limitation is that it is not clear whether the removal of unnecessary facilities will lead to a real reduction in environmental damage. Wider implications of the findings Eliminating unnecessary materials during surgery seems to have a huge positive impact on waste reduction. Our future plan is to lead a prospective study to compare waste management, production and recycling differentiation of a selected week after the procedural changes and awareness-raising events with the already assessed week. Trial registration number Not applicable

O-085 Oocyte cryopreservation: a comprehensive analysis of live birth rate by age and indication of treatment provides reassurance for young cancer patients

Abstract Study question Does the outcome of oocyte cryopreservation vary across different age groups and treatment indications, i.e. cancer diagnosis, other medical conditions or non medical fertility preservation? Summary answer Live birth rate (LBR) is significantly influenced by a woman's age, although not by indication of treatment. What is known already OC is increasingly applied in assisted reproduction, although little is about the outcomes, including livebirth according to indication. Study design, size, duration Retrospective cohort study analyzing all OC and subsequent warmed oocyte cycles in two fertility centers - Melbourne IVF and the Royal Women’s Hospital, Melbourne, Australia, between the years 2014 to 2022. Participants/materials, setting, methods Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Outcome of stimulation cycles and warmed oocyte cycles were assessed according to women’s age at OCP (≤ 35 years, 35-40 years and ≥ 40 years) and treatment indication- cancer diagnosis, other medical conditions and non medical. Main results and the role of chance 2689 women underwent a total of 3801 cycles of OC, comprising 702 cycles for cancer diagnosis (18.6%), 1146 cycles for other medical (30.5%), and 1953 cycles for non-medical (50.9%). Regardless of indication, younger age groups exhibited a higher median number of mature oocytes: &amp;lt;35 (11, 8-17), 35-40 (9, 6-11), and &amp;gt;40 (6, 3-9) (H(2)=15.1, p &amp;lt; 0.05). Among 582 warmed oocytes cycles, the &amp;gt;40 group demonstrated lower rate cycles with at least one good-quality blastocyst (76.7%) compared to 35-40 (87.1%) and &amp;lt;35 (87.2%), p &amp;lt; 0.05. Cumulative live birth rates (cLBR) were also lower in the &amp;gt;40 age group (14.9%) compared to 35-40 (34.9%) and &amp;lt;35 (46.5%), p &amp;lt; 0.01. When analyzing cycles by indication, patients with cancer had lower oocyte survival rate (80.8% vs 84.8% in other medical and 82.1% in non medical, p &amp;lt; 0.01). Nonetheless, no differences in rate of cycles with at least one good quality embryo rates (cancer diagnosis 87.2%, other medical 82.1% and non medical 89.3%, p = 0.06). Patients with cancer diagnosis had higher clinical miscarriage rate (25%) compared with other medical (7%) and non medical (10.5%), p &amp;lt; 0.01. However, cLBR did not differ between the indication groups (29.7% in cancer diagnosis, 35% in other medical and 38.1% in non medical, p = 0.5. Limitations, reasons for caution Retrospective data collection. Wider implications of the findings Our study offers comprehensive data that may assist patients desiring OC, and provides reassurance that even with a cancer diagnosis, outcomes are as favorable as those having non-medical OC. Given the substantial impact of age, health care providers should, when possible, advise to complete this procedure at a young age. Trial registration number Not applicable

P-465 Rehabilitation services and the infertility journey: a study on women’s experiences in Ethiopia

Abstract Study question How does infertility affect women in Ethiopia, and can rehabilitation service providers mitigate its impact? Summary answer Introducing rehabilitation services for women with infertility in Ethiopia could mitigate the frequent adverse psychosocial consequences and maintain women’s integration into family and community structures. What is known already Infertility is a disease that generates a disability as an impairment of function. Globally, millions of people are affected, and women bear the brunt of its consequences. In Ethiopia, infertility can cause significant distress and burden for women who are unable to meet societal expectations of motherhood. Despite this impact, no previous research has been conducted in Ethiopia to explore the role of rehabilitation services in providing support for these women. Study design, size, duration We followed a sequential mixed methods design that consisted of three parts: The national prevalence of infertility in Ethiopia was first determined using data from the 2016 Ethiopian Demographic and Health Survey (DHS); using Interpretive Phenomenology, the lived experiences of Ethiopian women living with infertility was explored; and finally, an Interpretive Description approach was applied to evaluate the role of rehabilitation services in assisting women with infertility. Data were collected between 2022 and 2023. Participants/materials, setting, methods For the first part, we performed secondary data analysis from 15,683 women in Ethiopia through the 2016 Ethiopian DHS. The data were analyzed using two approaches to infertility – the demographic and current duration. In the second part, 13 women undergoing treatment at a fertility center were interviewed. In the third part, 14 rehabilitation, medical, and policy service providers were purposefully selected from diverse institutions across three different geographical locations in Ethiopia. Main results and the role of chance Using the demographic definition, the overall prevalence of infertility was 7.6% (95% CI 6.6-8.8), with a prevalence of primary and secondary infertility of 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. The current duration approach resulted in a prevalence of overall infertility of 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5- 12.3) at 36-months. Thus, the demographic definition resulted in a lower estimate compared to the current duration approach which could be more appropriate for the early detection and management of infertility in Ethiopia. According to participants, infertility had far-reaching consequences that substantially affected women’s psychological, socio-cultural, and spiritual lives. Despite this, women developed various coping mechanisms and resilience. Women had minimal access to psychosocial and financial support and no access to rehabilitation services. Finally, interviewees recognized the potential of rehabilitation services to maximize the day-to-day functioning and overall well-being of women with infertility. Limitations, reasons for caution Using demographic proxies to determine exposure to pregnancy can make estimation unreliable. The fertility center only treated married couples; hence, single, separated, or divorced women were not included. Results are context-specific and cannot be extrapolated to all infertility cases in Ethiopia or elsewhere. Wider implications of the findings This is the first study to explore infertility in Ethiopia from a rehabilitation perspective. Based on the prevalence and impact, infertility in Ethiopia represents a major public health issue. Strengthening policies, integrating rehabilitation services into fertility care, and recognizing infertility as a disabling condition are crucial steps toward addressing infertility. Trial registration number not applicable