Form Of Assisted Reproductive Technology Research Articles

"Modeling Diffusive Search by Non-Adaptive Sperm: Empirical and Computational Insights".

During fertilization, mammalian sperm undergo a winnowing selection process that reduces the candidate pool of potential fertilizers from ~106-1011 cells to 101-102 cells (depending on the species). Classical sperm competition theory addresses the positive or 'stabilizing' selection that acts on sperm phenotypes within populations of organisms but does not strictly address the developmental consequences of sperm traits among individual organisms that are under purifying selection during fertilization. It is the latter that is of utmost concern for improving assisted reproductive technologies (ART) because 'low fitness' sperm may be inadvertently used for fertilization during interventions that rely heavily on artificial sperm selection, such as intracytoplasmic sperm injection (ICSI). Importantly, some form of sperm selection is used in nearly all forms of ART (e.g., differential centrifugation, swim-up, or hyaluronan binding assays, etc.). To date, there is no unifying quantitative framework (i.e., theory of sperm selection) that synthesizes causal mechanisms of selection with observed natural variation in individual sperm traits. In this report, we reframe the physiological function of sperm as a collective diffusive search process and develop multi-scale computational models to explore the causal dynamics that constrain sperm 'fitness' during fertilization. Several experimentally useful concepts are developed, including a probabilistic measure of sperm 'fitness' as well as an information theoretic measure of the magnitude of sperm selection, each of which are assessed under systematic increases in microenvironmental selective pressure acting on sperm motility patterns.

Exploring perceptions and knowledge of assisted reproductive techniques in Al-Ahsa, Saudi Arabia

Objective: This study aimed to evaluate the awareness and attitude towards the use of assisted reproductive technology among adults in Al-Ahsa, Saudi Arabia. Methods: This cross-sectional study was conducted in Al-Ahsa, Saudi Arabia, between March 24, 2022, and May 17, 2022. A self-administered questionnaire was distributed through social media platforms to adult residents of Al-Ahsa province. Results: The study revealed that most participants (79%) were aware of assisted reproductive technologies (ART). Around 58% participants had proper knowledge of Islamic regulations related to ART, as confirmed by 77% participants recognizing the prohibition of some forms of ART in Islam. Over half (60%) expressed the awareness gap regarding the risks of ART for conceived children and women. Most participants (62%) had a positive attitude towards ART, and 45% believed that physicians can be pivotal in reshaping perceptions of ART. Females exhibited a higher understanding of ART than males (p = 0.024). There was no significant correlation between knowledge and other demographic characteristics. Conclusions: The Al-Ahsa population was generally aware of ART and had a positive attitude towards it. Awareness and attitude were significantly associated. Awareness was associated with gender, while attitude was associated with gender and education. Religion plays an important role in regulating ART. The internet and academic curricula were the main reported sources of knowledge.

Social Egg Freezing for Single Women in China: Legal and Ethical Controversies.

Social egg freezing is an emerging topic in China, where single women currently face restrictions in accessing this service at medical facilities. Administrative regulations prohibit single women from accessing all forms of assisted reproductive technologies. Both the first lawsuit filed by a single woman seeking to freeze her eggs and a legislative proposal aiming to protect single women's rights to access assisted reproductive technologies were denied. This has sparked controversy and discussion about the reproductive rights of single women and the legitimacy of their access to medical and technical assistance. Laws and family planning policies related to women's reproductive rights in China have undergone dramatic changes in recent years, owing to shifts in population growth trends and societal attitudes toward marriage and childbirth, subsequently leading to a notable enhancement in women's reproductive autonomy. Meanwhile, factors such as marital status and career considerations have led to a delay in childbearing, triggering a growing need and advocacy for fertility preservation among single women. In China, the pursuit of social egg freezing by single women comes into conflict with the strict regulatory restrictions on assisted reproductive technologies. This study delves into the profound impacts of demographic changes, marital trends, fertility culture, and other social factors on female fertility in China. It also discusses the legislative issues and medical-social ethical concerns associated with the application of social egg freezing for single women. Additionally, this study offers regulatory suggestions aimed at enhancing women's reproductive health and autonomy, as well as the avoidance of potential ethical risks.

State of the Science and Ethical Considerations for Preimplantation Genetic Testing for Monogenic Cystic Kidney Diseases and Ciliopathies.

There is a broad phenotypic spectrum of monogenic polycystic kidney diseases (PKDs). These disorders often involve cilia-related genes and lead to the development of fluid-filled cysts and eventual kidney function decline and failure. Preimplantation genetic testing for monogenic (PGT-M) disorders has moved into the clinical realm. It allows prospective parents to avoid passing on heritable diseases to their children, including monogenic PKD. The PGT-M process involves embryo generation through in vitro fertilization, with subsequent testing of embryos and selective transfer of those that do not harbor the specific disease-causing variant(s). There is a growing body of literature supporting the success of PGT-M for autosomal-dominant and autosomal-recessive PKD, although with important technical limitations in some cases. This technology can be applied to many other types of monogenic PKD and ciliopathies despite the lack of existing reports in the literature. PGT-M for monogenic PKD, like other forms of assisted reproductive technology, raises important ethical questions. When considering PGT-M for kidney diseases, as well as the potential to avoid disease in future generations, there are regulatory and ethical considerations. These include limited government regulation and unstandardized consent processes, potential technical errors, high cost and equity concerns, risks associated with pregnancy for mothers with kidney disease, and the impact on all involved in the process, including the children who were made possible with this technology.

Experiences, Knowledge Gaps and Information Needs of Women in Australia with Transfusion Dependent Thalassaemia in Regard to Fertility and Pregnancy

ObjectivesTransfusion dependent β-thalassaemia can have significant effects on fertility and is also associated with significant risks in pregnancy. However, little is known about the perspectives of women living with the condition with regards to reproductive issues. The aim of this study was to assess the experience, knowledge and information needs of Australian women living with transfusion dependent β-thalassaemia in relation to fertility and pregnancy.MethodsA cross sectional study using an online anonymous survey, self-administered through REDCap, addressing key issues related to the experience, knowledge and information needs of women with transfusion dependent β-thalassaemia. Descriptive and inferential analysis was conducted using STATA.ResultsSixty participants were included in the analysis. Two-thirds of sexually active, pre-menopausal women were using contraception. Just under half of the participants who were sexually active had children and half had required some form of assisted reproductive technology to achieve a pregnancy. Less than half identified the importance of contraception as part of ensuring optimised pre-pregnancy care, and less than half had accessed pre-pregnancy care. Although there was good understanding of the increased risk of infertility and pregnancy complications, the specific risks and causes of these risks were poorly understood. Around half of the participants indicated they wanted more information on these medical issues.Conclusions for practiceOur study demonstrated significant concerns and knowledge gaps in Australian women with transfusion dependent β-thalassaemia with regards to disease-specific issues related to fertility and pregnancy, and a desire for related patient information.

A Reexamination ofIn Vitro Fertilization

AbstractFor the sake of consistency with settled principles from other theological and ethical questions, there is a need for a Christian reexamination of in vitro fertilization (IVF). Both Old and New Testaments demonstrate that human personal life begins at conception or fertilization. Additionally, the Bible teaches that human beings are persons in the image of God from the very beginning of their existence. Thus, it can be concluded that the embryos created via IVF are persons in God’s image. Applying this to the destruction and freezing of embryos, several limitations or restrictions present themselves—embryos should not be purposefully destroyed or wasted, all embryos ought to be implanted, and embryos should not be frozen. Ultimately, however, due to the immense quantity of embryo wastage, it is concluded that Christians should avoid this form of assisted reproductive technology and consider it a pro-life issue.

Our bab(y)ies, your uterus—a retrospective study on surrogacy at a private fertility center in South West Nigeria

Introduction: In vitro fertilization, a form of assisted reproductive technology has evolved over the last 3–5 decades in the management of infertility and now has been expanded to include third-party reproductive solutions. There are 2 types of gestational surrogacy: (1) full surrogacy (an egg from a woman is fertilized with a sperm and the resulting embryo is implanted into another woman) or (2) partial surrogacy (sperm from a man is used to fertilize an egg from the same woman in whom the embryo will be transferred to). In Nigeria, there is a paucity of publications on the outcomes of surrogate pregnancies, even though it is being practiced. At the Medical Art Center Ikeja Lagos, we practice only full surrogacy, otherwise referred to as gestational surrogacy. Study design: This was a retrospective descriptive study of 61 cycles performed over 76 months between January 1, 2015 and April 30, 2021 at a private-run single-location fertility center in South West Nigeria. Data were extracted from the electronic medical records of the commissioning parents and the gestational carrier. Results: There were a total of 58 gestational carriers in the program. Eleven (19%) had a miscarriage and there were 63 live births, out of which were 14 twin pairs (44%), 1 set of triplets (~5%) and the rest were singletons. One (1.7%) surrogate had delivery complicated by a hysterectomy on account of postpartum hemorrhage. There was no maternal mortality. The commonest reason for choosing surrogacy was multiple failed in vitro fertilization cycles, uterine factor infertility, and advanced maternal age. Conclusion: Gestational surrogacy is a valid medically assisted reproduction option for individuals who desire to have children. This option should continue to be supported by ethical, regulatory, and legal frameworks available in Nigeria.

The challenge of assisted reproduction for conservation of wild felids - A reality check

Threats to the Earth's biodiversity are increasing exponentially, driven by human population growth and resource consumption. As many as one million wildlife species may disappear within the next few decades due to this human-induced extinction event. This represents our current reality and has profound implications for wildlife conservation. Within this context, application of assisted reproductive technology (ART) to conservation management is unlikely to mitigate broad-scale species loss, but for select species, such as wild cats, ART may determine if populations survive or disappear. In North American and European zoos, 20 of the world's 38 wild felid species are managed within structured breeding programs, but most are not sustainable with natural breeding alone. Zoo-based breeding programs are facing tenuous futures due to triage-based responses to this growing sustainability crisis. Theoretically, ART could benefit conservation management, but only by recognizing and addressing its present challenges. The application of ART to wildlife has been rarely successful, with only 62 mammal species (including 15 cat species) ever propagated by AI, and just 35 of these species (6 cats) reproduced following frozen semen AI. Even this most basic form of ART has a minimal impact on wildlife sustainability. The drivers of this deficit include lack of species-specific reproductive knowledge and limited access to animals for study, but also is exacerbated by a science-conservation disconnect that attempts to apply advanced reproductive technologies to species in which basic ART remains unproven. For a few felid species, these scientific challenges have been overcome and AI with frozen semen is becoming feasible as a practical management tool; for other felids, further research is needed. Non-scientific issues also impair our ability to use ART to implement global management plans. Political dysfunction, regulatory barriers and societal indifference create inertia that interferes with achieving meaningful progress in applying ART to wildlife. Collectively, these challenges may seem insurmountable but human resiliency is essential if we are to resolve these issues in a systematic manner. It will require expanding collaborative efforts substantially and intensifying efforts to conserve wildlife species that are literally running out of time. Our goal is to create a new reality that includes a sustainable future for wild felids and other imperiled wildlife species.

IVF und ICSI – Von den Anfängen bis zur Gegenwart

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the most frequently utilized forms of assisted reproductive technologies (ART). They are indicated if the couple or the woman without a partner has proven infertility and a strong desire to have children. While the classical indications for IVF are tubal and idiopathic infertility, ICSI should only be used in cases of andrological subfertility. As a rule, controlled ovarian stimulation is performed to obtain multiple oocytes. This is followed by follicle puncture, fertilization of the oocyte, embryo culture and embryo transfer on days 2–5. The IVF and ICSI procedures differ only concerning the laboratory procedure. In IVF the sperm has to penetrate the zona pellucida of the oocyte independently in the reproductive medicine laboratory, whereas in the ICSI procedure it is actively injected into the oocyte. To date, over 8 million children have been conceived and born worldwide through IVF and ICSI. In Germany, more than 100,000 treatment cycles are carried out every year. The pregnancy rate per treatment is about 33% and the birth rate about 25%, they decrease with increasing maternal age.

P-182 The impact of ethnic differences on embryo morphokinetics and clinical outcomes: the importance of racial admixture

Abstract Study question Can ethnic differences affect embryo morphokinetics and clinical outcomes in a time-lapse imaging (TLI) embryo culture system? Summary answer Embryos from Mestizos develop faster and have a higher implantation rate than those from Caucasian and Asian patients. What is known already Over the past decades, the use of assisted reproductive technology (ART) has made pregnancy possible for many infertile couples. However, certain infertile couples exhaust all forms of ART, without achieving success. Differences in treatment success have been described as varying by race and ethnicity. In fact, it has been reported that ethnicity is a major determinant of ART outcome as indicated by significantly lower live birth rates in some ethnic minority groups, however the precise reason for this fact remains unknown. TLI may allow the identification of morphokinetics events potentially affected by ethnicity, which may impact embryo development and implantation. Study design, size, duration This historical cohort study enrolled 3,304 embryos from 466 patients undergoing ICSI cycles from Feb/2019 to Ago/2021. Female patients were split into groups according to the patient’s ethnicity: (i) Caucasian (356 patients and 2556 embryos), Mestizo (82 patients and 592 embryos), and Asian (156 patients and 28 embryos). Embryos were cultured in a TLI incubation system and morphokinetics factors and clinical outcomes were compared between the groups using generalized linear models followed by Bonferroni post-hoc. Participants/materials, setting, methods Recorded kinetic markers were timing to pronuclei appearance and fading (tPNa and tPNf), timing to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), and timing to morulae (tM), start of blastulation (tSB) and blastulation (tB). Durations of second and third cell cycles (cc2 and cc3) and timing to complete synchronous divisions s1, s2, and s3 were calculated. Additionally, the known implantation data score (KIDScore) day-5 was recorded. Main results and the role of chance Embryos derived from Mestizo patients completed several key-point stages faster, followed by Caucasians, while Asiatic embryos were the slower ones. Mestizo presented shorter t6 (54.8 ± 0.92, 52.6 ± 0.20, 51.0 ± 0.42, for Asians, Caucasians, and Mestizos respectively, p < 0.001), t7 (58.4 ± 1.05, 55.4 ± 0.22, 54.1 ± 0.45, for Asians, Caucasians, and Mestizos respectively, p < 0.001), t8 (59.3 ± 1.2, 58.7 ± 0.24, 57.3 ± 0.49, for Asians, Caucasians, and Mestizos respectively, p = 0.019), tM (99.3 ± 2.1, 90.8 ± 0.37, 87.5 ± 0.79, for Asians, Caucasians, and Mestizos respectively, p < 0.001), tsB (106.4 ± 1.9, 101.4.0 ± 0.54, 98.0 ± 1.4, for Asians, Caucasians, and Mestizos respectively, p < 0.001), and tB (109.1 ± 0.31,116.2 ± 2.0, 106.0 ± 0.64, for Asians, Caucasians, and Mestizos respectively, p < 0.001). In addition, the KIDScore-D5 ranked significantly higher for Mestizos, followed by Caucasians, while Asian patients presented the lower KIDScore-D5 (2.9 ± 0.27, 5.3 ± 0.1, 6.3 ± 0.4, p < 0.001). Pregnancy (25.0 ± 4.9, 33.0 ± 13.2, 58.0 ± 11.5, p = 0.038) and implantation rates (30.0 ± 1.2, 16.3 ± 0.4, 50.0 ±1.5, p < 0.001) were also highest among Mestizos, followed by Caucasians, whereas the Asian patients had the lowest rates. Limitations, reasons for caution The retrospective nature of the study and the small sample size may have biased the results. Wider implications of the findings Despite the increasing number of studies investigating the effect of ethnicity on ART outcomes, most of the literature has focused on White, Black and Asians. However, racial admixture has markedly increased, making attempts at strict racial categorisation confusing and out-dated. Apparently, miscegenation benefits embryonic development, which may impact clinical outcomes. Trial registration number Not applicable

Infertility and Intracytoplasmic Sperm Injection (ICSI)

Infertility is generally defined as a Time to pregnancy (TTP) of longer than 12 months among couples who engage in unprotected intercourse in the fertile days of the menstrual cycle, any specific threshold is arbitrary. The prevalence of infertility differs greatly from one country to another, being 15% globally, >30% in some developing countries, and 17-28% in industrialized countries. The term ‘implantation failure’ can be used to describe both patients who have never shown quantifiable signs of implantation such as increased levels of hCG, and those who have increased hCG production without later ultrasound evidence of a gestational sac. Intracytoplasmic sperm injection (ICSI) is a form of assisted reproductive technology in which a single sperm is injected into the cytoplasm of an egg in order to fertilize it. Complete fertilization failure following ICSI is an uncommon occurrence (1–3 percent), although it does occur even when spermatozoa appear to be normal. Furthermore, in some individuals, low to moderate fertilization (30 percent) has been reported in repeated ICSI cycles. Fertilization failure with ICSI is not the same as it is with traditional IVF technique. 60–90 percent of oocytes which showed a fertilization failure in traditional IVF are devoid of sperm nuclei, assuming that sperm ejection or penetration failure is the most common reason for the failure in fertilization process.

Parthenogenesis: New Conflicts and Opportunities for Fecundity and Reproductive Freedom

This Monograph examines, critically, a phenomenon of nature termed parthenogenesis, or asexual reproduction. The potential for adapting this occurrence to humans, especially transsexual women, is not only intriguing as a form of assisted reproductive technology, but holds great promise as a source for human embryo research and regenerative medicine. Parthenogenetic embryos would be derived from unfertilized human eggs and, thus, blunt – if not resolve – ethical concerns over experimentation of human embryos. These research embryos would, in turn, be a valuable source for producing stem cells which could then be used to facilitate growth of tissues for organ transplants. As a tool for expanding human fecundity, however, uses of this nature would be little more than a vainglorious and dangerous scientific achievement.

Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer.

The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62IU/L vs. 28.74 ± 23.52, p= 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05IU/L, p= 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23pg/L, p< 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.

O04 Fetal Outcome following Dydrogesterone Exposure in Pregnancy

BackgroundThe progestin dydrogesterone (DYD) is widely used for threatened and recurrent miscarriages, as well as for dysfunctional bleeding, infertility and other obstetric and gynecological indications. While its apparent efficacy has been compared to other progestins, its fetal safety has not been investigated.ObjectivesTo follow up fetal outcome after gestational exposure to DYD.Patients and methodsUsing a 2.5 million patients´ database, we compared congenital malformations among babies exposed in utero to DYD between 1999 and 2016, to a control group not receiving this medication. We adjusted for concomitant exposure to in vitro fertilization (IVF) and to other forms of assisted reproductive technology (ART).ResultsThere were 8508 children exposed in uteo to DYD (4417 males, 4091 females) out of 777,422 live births. After excluding cases with concomitant exposure to IVF and other forms of ART, DYD was associated with increased risk for hypospadias [OR 1.28(95% confidence interval 1.06–1.55)], overall cardiovascular malformations [OR 1.18 (1.06–1.33)], spina bifida [OR 2.29(1.32–3.97] and hydrpcephalus [OR 2.04(1.28–3.25]. In additional analysis, including also those exposed to IVF and other forms of ART, there was also increased risk for cryptorchidism [1.37(1.19–1.58)] and congenital dislocation of the hip [OR 1.58(1.42–1.78)].ConclusionsDYD confers teratogenic effects after exposure to the recommended doses in pregnant women. Some of these adverse fetal effects are further augmented by concomitant use of IVF and other forms of ART. These independent teratogenic effects may have important implication for the child and family.Disclosure(s)Nothing to disclose

"Age is Just a Number": How Celebrity-Driven Magazines Misrepresent Fertility at Advanced Reproductive Ages.

Background: Recognizing the pervasive impact of popular media on reproductive-aged women, we sought to characterize the depiction of age-related fertility decline in widely consumed media. Materials and Methods: We performed a quantitative and qualitative analysis of top read print magazines targeting reproductive-aged women. Primary outcome measures include celebrity age at time of pregnancy, content related to assisted reproductive technology (ART) and donor gametes, and mention of risks related to pregnancy at advanced maternal age (AMA). Results: Four hundred sixteen magazine issues published between January 2010 and January 2014 included 1,894 headlines, photos, or text passages related to fertility. Fertility was highlighted on one-third of all magazine covers. Two hundred forty celebrities received at least one fertility-related depiction. The majority (56%) were of AMA; only two mentions of AMA-related obstetrical risks were included. Three of 240 subjects (1.25%) were reported as having used ART. Forty-five celebrities (33%) were at least 40 years old at the time of mention; 7 subjects >44 years were depicted as pregnant or having delivered a healthy infant, without mention of ART. Donor gametes received no mention. All 416 magazines (100%) contained at least 1 reference to contraception; only 10 magazines (2.4%) mentioned any form of ART. Conclusions: Widely consumed popular media downplays the impact of age on fertility. Magazines promote contraception contrasted with easily reachable fertility goals at advanced reproductive ages, with rare or no mention of ART, donor gametes, or AMA-related health risks. Magazine content may be a contributing source to the public's misconceptions about age-related fertility decline.

Fertility treatment is associated with multiple meningiomas and younger age at diagnosis.

Meningiomas are more common in females and 70-80% express the progesterone receptor, raising the possibility that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female meningioma patients. A retrospective review (2015-2018) was performed of female patients with meningioma, and those with prior fertility treatment were compared to those without fertility treatment using standard statistical methods. Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). Median follow up was 1.8years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs. 57.3 years, p = 0.0135, 2-tailed T-test), and on multivariate analysis were more likely to have multiple meningiomas (OR 4.97, 95% CI 1.4-18.1, p = 0.0154) and convexity/falx meningiomas (OR 4.45, 95% CI 1.7-11.5, p = 0.0021). Patients in this cohort with a history of fertility treatment were more likely to present at a younger age and have multiple and convexity/falx meningiomas, emphasizing the importance of taking estrogen/progesterone exposure history when evaluating patients with meningioma. Future clinical studies at other centers in larger populations and laboratory investigations are needed to determine the role of fertility treatment in meningioma development.

Development of novel oocyte activation approaches using Zn2+ chelators in pigs

Artificial oocyte activation is an essential step in somatic cell nuclear transfer (SCNT) and can enhance viability of embryos as a form of assisted reproductive technology (ART) in clinics. Most artificial activation methods have been developed to increase cytosolic calcium (Ca2+) level in oocytes. Interestingly, recent studies have demonstrated that mammalian oocytes can be activated using N,N,N′,N′-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN), a Zn2+ chelator. Although effective, TPEN is also known to induce apoptosis and shows poor selectivity between free Zn2+ and protein-bound Zn2+. The aim of this study was to identify different Zn2+ chelators that can activate pig oocytes. Among five Zn2+ chelators examined, 1,10-phenanthroline (Phen), and tris(2-pyridylmethyl)amine (TPA) successfully activated pig oocytes. The level of available Zn2+ was reduced without any increase in Ca2+ in oocytes incubated with Phen or TPA, indicating that the oocyte activation occurred independently of Ca2+ signal. When various concentrations (100–500 μM) and incubation durations (10–120 min) of Phen and TPA were used to activate pig oocytes, 500 μM for 60 min and 100 μM for 60 min of Phen and TPA treatments, respectively, were found to be most effective in supporting embryo development. The frequency of blastocyst formation after the treatments was higher than 40% at day 7. When oocytes were incubated with TPEN, Phen, or TPA under their optimal treatment conditions, there was no significant difference in the frequencies of day 7 blastocyst formation among the three treatments. However, day 5 blastocyst formation was observed from the Phen- and TPA-treated oocytes, whereas no blastocyst was formed at day 5 in the TPEN-treated oocytes. The average total cell number in day 7 blastocysts was higher in the Phen treatment group than in the TPEN treatment (P < 0.05). These results suggest that Phen and TPA can be used as powerful agents to artificially activate oocytes and to increase the developmental potential of SCNT embryos or embryos going through clinical ART procedures.

MNGI-09. FERTILITY TREATMENT AND MENINGIOMA INCIDENCE

Meningiomas are more common in females and 70–80% express the progesterone receptor. They have been reported after gender reassignment therapy, suggesting that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female patients presenting with meningioma. A retrospective review of patients presenting with meningioma from 2015–2018 was conducted. Female patients with prior fertility treatments were compared to those who did not receive fertility treatment using standard statistical methods. Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (3.8%). One patient (3.8%) received supplemental progesterone during her treatment. The most common presenting symptoms were incidental (57.7%) and headache (26.9%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs 57.3 yrs, p = 0.0135, 2-tailed T-test) and were more likely to have multifocal (OR: 4.5, 95% CI: 1.4–14.8, p = 0.0196) and non-skull base meningiomas (OR: 4.4, 95% CI: 1.7–11.4, p = 0.0012). A history of fertility treatment is common in female patients presenting with meningioma. Patients with meningioma and a history of fertility treatment were more likely to present at a younger age and have multifocal and non-skull base tumors. These findings stress the importance of assessing for prior estrogen/progesterone exposure in patients presenting with meningioma. Future large prospective series and laboratory investigations are needed to determine the impact of fertility treatment on meningioma development.

Varicocelectomy to “upgrade” semen quality to allow couples to use less invasive forms of assisted reproductive technology

To determine the magnitude of improvement in semen parameters after a varicocelectomy and the fraction that have improvements such that couples needing IVF or IUI are "upgraded" to needing less invasive assisted reproductive technology (ART). Retrospective review of prospectively collected data. Academic medical centers. Men presenting for a fertility evaluation with a clinical varicocele. Varicocele repair (surgical or embolization). Total motile sperm count (TMSC) before and after repair, and the proportion of men considered candidates for: natural pregnancy (NP) >9 million, IUI 5-9 million, or IVF < 5 million. A total of 373 men underwent varicocele repair. The TMSC increased from 18.22 ± 38.32 to 46.72 ± 210.92 (P=.007). The most pronounced increase was with baseline TMSC <5 million, from 2.32 ± 1.50 to 15.97 ± 32.92 (P=.0000002); 58.8% of men were upgraded from IVF candidacy to IUI or NP. For baseline TMSC 5-9 million, the mean TMSC increased from 6.96 ± 1.16 to 24.29 ± 37.17 (P=.0004), allowing 64.9% of men to become candidates for NP. For baseline TMSC of >9 million, TMSC increased from 36.26 ± 52.08 to 81.80 ± 310.83 (P=.05). Varicocele repair has an important role in the treatment of infertility. Even for low TMSCs, a varicocelectomy may reduce the need for IVF. Varicocele repair (by embolization or microsurgery) potentially reduces the need for IVF and IUI.

Assisted Reproductive Technologies and the Right to Reproduce Under South African Law

Reproductive rights in South Africa have traditionally focused on the rights of individuals to avoid reproduction. However, with an increase in the use of assisted reproductive technologies (ART), there has been a shift in the focus on reproductive rights from the rights of individuals to avoid reproduction to the rights of individuals to reproduce noncoitally.&#x0D; With the emergence of new technologies, reproduction by noncoital means and the right to engage in these new technologies is becoming more prevalent. This raises two questions. The first question is whether such a right exists. The recent Constitutional Court decision in AB v Minister of Social Development 2017 3 BCLR 267 (CC) suggests that it does, but only if the person claiming this right is physically involved in the reproductive process. Ostensibly this excludes those who cannot contribute to the reproduction of a child.&#x0D; The second question raised pertains to the impact of this right on specific forms of ART, namely mitochondrial transfer, posthumous reproduction and embryo donation. While the first two forms of ART would meet the criteria set down in AB, embryo donation would not. Individuals denied access to embryo donation could thus not rely on either the right to reproductive autonomy or the right to privacy to aid them. Fortunately the existing legal framework provides some assistance to these individuals, although sadly the same legislative framework does not support the use of mitochondrial transfer and posthumous reproduction. In this respect there is incongruence between rights and legislation, which has only been exacerbated by the recent Constitutional Court decision. What is thus needed is clarity on the meaning of certain rights in respect of certain forms of ART as well as legislative reform to reflect the clarified position.&#x0D; &#x0D;