In Vitro Fertilization Patients Research Articles

Expression of mRNAs for pro-and anti-apoptotic factors in granulosa cells and follicular fluid of women undergoing in vitro fertilization. A pilot study

BackgroundThis observational clinical study evaluated the expression levels and predictive values of some apoptosis-related genes in granulosa cells (GCs) and follicular fluid (FF) of women undergoing in vitro fertilization (IVF).MethodsGCs and FF were obtained at oocyte retrieval from 31 consecutive patients with heterogeneous infertility diagnosis (age: 34.3 ± 5.8 years, body mass index: 24.02 ± 3.12 kg/m2, duration of infertility: 4.2 ± 2.1 years). mRNA expression of pro-apoptotic (BAX, CASP3, CASP8) and anti-apoptotic (BCL2, AMH, AMHR, FSHR, LHR, CYP19A1) factors was determined by quantitative RT-PCR using ROCHE LightCycler 480.ResultsNo significant difference in GC or FF mRNA expression of pro- and anti-apoptotic factors could be demonstrated between IVF patients with (9 patients) or without (22 patients) clinical pregnancy. Each transcript investigated was detected in FF, but their levels were markedly reduced and independent of those in GCs. The number of retrieved oocytes was positively associated with GC AMHR (r = 0.393, p = 0.029), but the day of embryo transfer was negatively associated with GC LHR (r = − 0.414, p = 0.020) and GC FSHR transcripts (r = − 0.535, p = 0.002). When pregnancy positive group was analysed separately the impact of apoptosis- related gene expressions on some selected measures of IVF success could be observed. Strong positive relationship was found between gene expression levels of pro- and anti-apoptotic factors in GCs.ConclusionOur study provides only marginal evidences for the apoptosis dependence of IVF outcome and suggests that the apoptosis process induces adaptive increases of the anti-apoptotic gene expression to attenuate apoptosis and to protect cell survival.

Oxidative stress and DNA damage status in couples undergoing in vitro fertilization treatment.

SummaryThis study examined the status of oxidative stress in 599 couples undertaking in vitro fertilization (IVF) treatment and its association with reproductive hormones, smoking, and outcomes. Oxidative stress biomarkers such as malondialdehyde, 8-hydroxy-2-deoxyguanosine, hydrogen peroxide (H2O2), catalase (CAT), and total antioxidant capacity (TAC) were determined in follicular fluid and seminal plasma. Tail moment (TM) was used to evaluate DNA damage in the sperm and granulosa cells. Reproductive hormones in serum and cotinine (COT) in urine, follicular fluid, and seminal plasma samples were determined. Separate multivariate linear regression was used to assess associations between levels of each oxidative stress biomarker and each hormone and smoking parameter (modeled as natural log-transformed). The findings indicate that some oxidative stress and DNA damage biomarkers played a role in disrupting certain reproductive hormones in women and their male partners either by overproducing reactive oxygen species or reducing antioxidant defense capacity. Although women were nonsmokers, COT levels > 50 and 10 µg/L in urine and follicular were observed in 5.7 and 1.7%, respectively. Levels of follicular fluid COT were positively associated with H2O2 and TM. We used log-binomial multivariate regression to estimate relative risks for the association between oxidative stress/DNA damage and IVF binary outcomes (fertilization rate > 50%, biochemical pregnancy, clinical pregnancy, and live birth). An increase in the CAT levels of follicular fluid was associated with a 48 and 41% decrease in the risk of poor fertilization rate (≤50%) and unsuccessful live birth, respectively. After the models were adjusted for hormonal factors, the associations remained the same, except that the elevated TAC in follicular fluid became significantly associated with a decrease of 42% in the risk of poor fertilization rate (≤50%). The higher antioxidant activity (CAT and TAC) in follicular fluid might positively impact specific IVF outcomes.Lay summaryOxidative stress occurs when antioxidant molecules are insufficient in the body to destroy free radicals that can damage the cells, proteins and DNA, causing different health conditions, including infertility. The role of oxidative stress in female infertility has not received as much attention as male infertility, and research is still limited. This study explored whether the overproduction of free radicals can impact the success of in vitro fertilization (IVF) treatment using several biological markers such as hydrogen peroxide, catalase, and total antioxidant capacity. Our findings revealed that the high antioxidant levels in the fluid surrounding the egg were linked with a high fertilization rate. Additionally, oxidative stress status in couples was associated negatively with several reproductive hormones and smoking status. Biomarkers of oxidative stress and DNA damage might have potential applications in evaluating IVF patients’ clinical characteristics such as causes of infertility, hormonal profile, fertilization rate, implantation and live birth.

The Health Services Legal Problems of In Vitro Fertilization (IVF) Program Patients in Indonesia

Introduction to The Problem: Every married couple expects children that the Constitution guarantees. However, the difficulty of having a child tends to be a problem in maintaining married life. Some couples decide to have a child by undergoing In Vitro Fertilization (IVF) Program. The arising problems are on how the current regulation of the IVF program and how to fulfil the rights of IVF program patients from consumer protection law. Purpose/Objective Study: This article focus on the problem of health services for IVF program patients based on the values of justice on the ground of consumer protection law in Indonesia. Design/Methodology/Approach: This study is socio-legal research. However, to support the validity of research, an empirical approach is critical to do-furthermore, where data obtained through interviews based on the researcher’s own experience. Findings: IVF program agreement between the IVF clinic and patients is a law based on Article 1338 of the Indonesian Civil Code. Even so, the research validation was still carried out with the support of an empirical approach. The results of this research are that the current IVF program has not been able to protect its patients’ rights. Patients’ position tends to be weak compared to the clinic or IVF hospital; the concept of the IVF program implementation agreement does not protect patient rights. In the future, attempts to protect IVF patients’ rights need an integrated and comprehensive regulation from the philosophical, juridical, and sociological basis to its practical implementation. Paper Type: Research Article

Perinatal outcomes of pregnancies resulting from assisted reproduction technology in SARS-CoV-2-infected women: a prospective observational study

ObjectiveTo evaluate the perinatal and maternal outcomes of pregnancies in women infected with SARS-CoV-2, comparing spontaneous and in vitro fertilization (IVF) pregnancies (with either own or donor oocytes).DesignMulticenter, prospective, observational study.Setting78 centers participating in the Spanish COVID19 Registry.Patient(s)1,347 pregnant women with SARS-CoV-2 positive results registered consecutively between February 26 and November 5, 2020.Intervention(s)The patients’ information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of the infection.Main Outcome Measure(s)Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need, and medical conditions.Result(s)The IVF group included 74 (5.5%) women whereas the spontaneous pregnancy group included 1,275 (94.5%) women. The operative delivery rate was high in all patients, especially in the IVF group, where cesarean section became the most frequent method of delivery (55.4%, compared with 26.1% of the spontaneous pregnancy group). The reason for cesarean section was induction failure in 56.1% of the IVF patients. IVF women had more gestational hypertensive disorders (16.2% vs. 4.5% among spontaneous pregnancy women, adjusted odds ratio [aOR] 5.31, 95% confidence interval [CI] 2.45–10.93) irrespective of oocyte origin. The higher rate of intensive care unit admittance observed in the IVF group (8.1% vs. 2.4% in the spontaneous pregnancy group) was attributed to preeclampsia (aOR 11.82, 95% CI 5.25–25.87), not to the type of conception.Conclusion(s)A high rate of operative delivery was observed in pregnant women infected with SARS-CoV-2, especially in those with IVF pregnancies; method of conception did not affect fetal or maternal outcomes, except for preeclampsia.Clinical Trial Registration NumberNCT04558996.

Premature Luteinization May Impact In Vitro Fertilization Outcomes Through Dual Action on Both Uterus and Embryos

This review aims to provide the up-to-date knowledge of potential mechanisms behind the putative impact of premature luteinization (PL) on the in vitro fertilization (IVF) cycle outcomes and to examine whether PL can affect embryo/oocyte quality. There is growing evidence supporting the possible negative effect of PL on the oocyte/embryo quality in various ovarian response categories of IVF cycles. It is generally accepted based on prior research that PL could affect pregnancy potential in fresh IVF cycles by impacting endometrial receptivity. PL is usually defined as serum progesterone (P) level equal or greater than 1.5 ng/ml on the day of ovulation triggering. Unfortunately, a way to prevent PL is still lacking. Embryo cryopreservation with deferred transfer in a subsequent cycle is so far the most widely practiced strategy to bypass the PL-induced harm on endometrial receptivity. However, embryo freezing carries an extra burden for both the IVF laboratory and patients and increases IVF cost. Moreover, there are recent reports showing that PL may adversely impact oocyte and embryo quality. It is thus of utmost importance to understand if PL adversely influences eggs and embryos; if this hypothesis is proven to be true, embryo freezing for a subsequent transfer may not improve outcomes and the management of PL may be reconsidered.

TGFβ1 induces in-vitro and ex-vivo angiogenesis through VEGF production in human ovarian follicular fluid-derived granulosa cells during in-vitro fertilization cycle

A growing body of evidence indicates that angiogenesis in folliculogenesis contributes to oocyte developmental competence in natural and in-vitro fertilization (IVF) cycle of animals. Among the known angiogenic factors, vascular endothelial growth factor (VEGF) has an important role involved in angiogenesis. However, its expression level and regulatory mechanism in ovarian follicular fluid (FF) in patients undergoing IVF with controlled ovarian stimulation (COS) remains to be explored. In this study, the primary cultured human ovarian follicular granulosa cells (GCs) were prepared from FF and their identity was characterized by the presence of the GC specific markers. The transforming growth factor β1 (TGFβ1) was found to induce a significant increase in VEGF mRNA level and protein expression/secretion in GCs. In line with these observations, TGFβ1 could be detected in the ovarian FF, ranging from about 400 to 2000 pg/mL among three IVF patient groups with different patient’s serum Anti-Müllerian hormone level. The cellular signaling analysis revealed that TGFβ1 induced VEGF production through TGFβ receptor (TGFβR), Smad2/3, PI3 K/AKT, and JNK1/2-related signaling pathways. Finally, in a functional study, the TGFβ1-primed GC VEGF secretion promoted in-vitro angiogenesis in vascular endothelial cells and ex-vivo vessel sprouting in aortic ring. Taken together, we demonstrated here that TGFβ1 expressed in ovarian FF is an inducer for promoting VEGF production in follicular GCs through TGFβR-mediated signaling pathways and the released VEGF subsequently leads to angiogenesis. This possibly contributes to oocyte developmental competence in folliculogenesis of IVF patients with a COS protocol.

Effectiveness of elective single versus double frozen embryo transfer in good prognosis IVF patients

Objective: This study aimed to evaluate the effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) in frozen embryo transfer cycles following in vitro fertilization (IVF) treatment in good prognosis patients. The outcome would provide medical data for the multiple pregnancy rate reduction in IVF treatment.
 Methods: This multicenter retrospective cohort study was performed in patients undergoing the first frozen embryo transfer (FET) cycles at IVF centers which belonged to the IVFMD Group, Vietnam, from January 2018 to May 2020. Patients were divided into four groups, based on the number of embryos transferred, as follows: Group 1: one good quality day-3 embryo (eSET D3), Group 2: one good quality day-5 embryo (eSET D5), Group 3: two good quality day-3 embryos (DET D3), and Group 4: two good quality day-5 embryos (DET D5). The primary outcome of the study was live birth rates (LBR) after the first FET. Secondary outcomes were also analyzed, including pregnancy outcomes (β-hCG positive, clinical pregnancy, miscarriage < 12 weeks, ongoing pregnancy 12 weeks, miscarriage < 20 weeks, and multiple birth rates [MBR]), as well as neonatal outcomes (birth weight and gestational age at birth).
 Results: There were 819 patients, of which 819 FET cycles were analyzed, including 132 eSET D3, 278 eSET D5, 140 DET D3, and 269 DET D5. LBR and MBR values were significantly lower in the eSET D3 group than in the DET D3 group (LBR: 22.7% vs 39.3%, p = 0.002; MBR: 3.3% vs 29.1%, p < 0.001, respectively). MBR was also significantly lower in eSET D5 compared with DET D5 (9.6% vs 38.3%, p < 0.001), while LBR was comparable between the two groups (41.4% vs 42.8%, p < 0.74). Birth weight and gestational age at birth were similar between eSET and DET, regardless of day-3 or day-5 embryo transfer.
 Conclusions: Among infertile, good prognosis women undergoing FET, the eSET significantly decreased multiple birth rates compared with double embryo transfer, while still sustaining an acceptable rate of live birth as well as pregnancy and neonatal outcomes.

Safety and efficacy of in vitro fertilisation in patients with chronic liver disease and liver transplantation recipients

Chronic liver disease and liver transplantation (LT) can delay both timing and ability of women to conceive. With increased awareness and availability of invitro fertilisation (IVF), the need for accurate counselling is paramount. To date, minimal data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF in women with liver-related subfertility (LRSF). A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and2019. Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 in patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n= 3, 7%). One patient with AIH-related cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted in premature deliveries (range 27-36 weeks). In selected cases, IVF in women with LRSF can be successful. However, patients should be counselled on the potential increased risks of OHSS, OC, and prematurity. Women with liver disease or those who have had a liver transplant can experience difficulties getting pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful in these women. Overall, there were no significant issues with the use of invitro fertilisation in women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.

Machine-learning algorithm incorporating capacitated sperm intracellular pH predicts conventional in vitro fertilization success in normospermic patients

To measure human sperm intracellular pH (pHi) and develop a machine-learning algorithm to predict successful conventional invitro fertilization (IVF) in normospermic patients. Spermatozoa from 76 IVF patients were capacitated invitro. Flow cytometry was used to measure sperm pHi, and computer-assisted semen analysis was used to measure hyperactivated motility. A gradient-boosted machine-learning algorithm was trained on clinical data and sperm pHi and membrane potential from 58 patients to predict successful conventional IVF, defined as a fertilization ratio (number of fertilized oocytes [2 pronuclei]/number of mature oocytes) greater than 0.66. The algorithm was validated on an independent set of data from 18 patients. Academic medical center. Normospermic men undergoing IVF. Patients were excluded if they used frozen sperm, had known male factor infertility, or used intracytoplasmic sperm injection only. None. Successful conventional IVF. Sperm pHi positively correlated with hyperactivated motility and with conventional IVF ratio (n = 76) but not with intracytoplasmic sperm injection fertilization ratio (n = 38). In receiver operating curve analysis of data from the test set (n = 58), the machine-learning algorithm predicted successful conventional IVF with a mean accuracy of 0.72 (n = 18), a mean area under the curve of 0.81, a mean sensitivity of 0.65, and a mean specificity of 0.80. Sperm pHi correlates with conventional fertilization outcomes in normospermic patients undergoing IVF. A machine-learning algorithm can use clinical parameters and markers of capacitation to accurately predict successful fertilization in normospermic men undergoing conventional IVF.

The virtual infertility community: a qualitative analysis of patient experiences shared on Instagram.

To characterize the experiences of patients undergoing in vitro fertilization (IVF) through a qualitative analysis of content shared on Instagram. We analyzed Instagram posts from five randomly selected days in February 2020. The hashtag, #ivfcommunity, was selected to identify public posts authored by Instagram's IVF community members from multiple treatment centers. Text, photos, hashtags, and emojis were collected from 452 included posts and entered into a study-specific database. Using thematic coding, a four-member team initially coded the first day in February. Common themes were agreed upon by all team members, and a preliminary codebook was created for further analysis. The remaining posts were coded by two-member teams who reached a consensus on the multiple themes assigned to each individual post. Analysis of posts led to the identification of five major themes: documentation of the medical and physical experience of IVF (76.1%), the emotional spectrum (43.1%), social support (49.2%), coping mechanisms (29.9%), and education (receipt, provision) (11.1%). Our findings suggest that women undergoing IVF often utilize social media to document daily experiences, offer and recognize sources of community support, and provide and receive education regarding their treatments. Given the increased prevalence of mental health conditions, medical providers should explore challenges discussed on online platforms and consider harnessing the supportive nature of online communities to supplement care for IVF patients.

Effects of Environmental EDCs on Oocyte Quality, Embryo Development, and the Outcome in Human IVF Process.

In our daily life, people are inevitably exposed to potentially hazardous chemical contaminants. More and more evidences indicate that environmental endocrine-disrupting chemicals (EDCs) negatively affect human reproductive health and are related to many diseases including infertility. Environmental reproductive health focuses on exposure to ubiquitous and persistent EDCs. This chapter mainly discusses the effects of EDCs on the outcome of human in vitro fertilization (IVF), including oocyte quality, fertilization, embryo quality, implantation, and live births. It may be useful for doctors to advise IVF patients to avoid these adverse environmental factors as much as possible. In addition, it is important for clinical embryologists to bear in mind that adverse IVF outcome may result from such undesirable environmental exposure, and quality management and quality control in the IVF laboratory should be strengthened.

Predicting the chances of live birth for couples undergoing IVF-ICSI: a novel instrument to advise patients and physicians before treatment

Background: The prevalence of infertility ranges from 3.5% to 16.7% in more developed countries. For this reason, the number of In Vitro Fertilization(IVF) technique and Intracytoplasmic Sperm Injection (ICSI) treatments has been significantly increasing. Several factors affect the success rate of in vitro treatments, which can be used to calculate the probability of success for each couple. As these treatments are complicated, expensive and with a variable probability of success, the most common question asked by IVF patients is “What are my chances of conceiving before starting an IVF/ICSI treatment?”. The main aim of this study is to develop a validated model that estimates the chance of a live birth before the start of an IVF/ICSI non-donor cycle. Methods: A logistic regression model was developed based on the retrospective study of 737 IVF/ICSI cycles. Overall 14 pre-treatment variables were evaluated (woman’s and man’s age, duration of infertility, cause of infertility, woman’s and man’s Body Mass Index (BMI), Anti-Müllerian Hormone (AMH), Antral Follicle Count (AFC), woman’s and man’s ethnicity, woman’s and man’s smoking status and woman’s and man’s previous live children) and the outcome of the treatment was discriminated as "live birth" or "no live birth". Results: From the 14 variables acquired before starting the IVF/ICSI procedures, only male factor, man’s BMI, man's mixed ethnicity and level of AMH were statistically significant. The interactions between infertility duration and woman’s age, infertility duration and man’s BMI, AFC and AMH, AFC and woman’s age, AFC and woman’s BMI, and AFC and disovulation were also statistically significant. The Area Under the Receiver Operating Characteristic (AUROC) curve test for the discriminatory ability of the final prediction model was 0.700 (95% Confidence Interval (CI) 0.660–0.741). Conclusions: This model might result in a new validated decision support system to help physicians to manage couples’ pre-treatment expectations.

Activin A increases human trophoblast invasion by upregulating integrin β1 through ALK4.

Activin A promotes human trophoblast invasion during the first trimester of pregnancy and is associated with preeclampsia and pregnancy-induced hypertension (PE/PIH) in naturally conceived pregnancies. However, whether integrin β1 mediates activin A-increased trophoblast invasion remains unknown and the evidence is limited regarding the predictive value of activin A for PE/PIH in women receiving in vitro fertilization (IVF) treatment. Here, we studied the role and underlying molecular mechanisms of integrin β1 in activin A-promoted invasion in immortalized (HTR8/SVneo) and primary human extravillous trophoblast (EVT) cells. A nest case-control study was designed to investigate the predictive/diagnostic value of activin A in IVF pregnancies. Results showed that integrin β1 expression increased after activin A treatment and knockdown of integrin β1 significantly decreased both basal and activin A-increased HTR8/SVneo cell invasion. SB431542 (TGF-β type I receptors inhibitor) abolished activin A-induced SMAD2/SMAD3 phosphorylation and integrin β1 overexpression. Activin A-upregulated integrin β1 expression was attenuated after the depletion of ALK4 or SMAD4 in both HTR8/SVneo and primary EVT cells. Furthermore, we found similar first-trimester activin A levels in IVF patients with or without subsequent PE/PIH. These results reveal that integrin β1 mediates activin A-promoted trophoblast invasion through ALK4-activated SMAD2/3-SMAD4 pathway, and the predictive/diagnostic value of first-trimester maternal serum activin A for hypertensive disorders of pregnancy might be different in IVF population.

Cumulative live birth rates of patients in the Peruvian Andes according to the POSEIDON criteria: a single-center retrospective analysis

Objective:To identify low prognosis in-vitro fertilization (IVF) patients treated at Centro de Fertilidad y Ginecología del Sur (CFGS) based on the POSEIDON criteria.Methods:This retrospective study included 412 IVF patients and assessed them based on the POSEIDON criteria to describe the cumulative live birth rates seen in each group.Results:13.1% of patients met the POSEIDON criteria, and the proportion of cases in POSEIDON groups 1, 2, 3 and 4 were 20.4%, 31.5%, 14.8%, and 33.3%, respectively. The cumulative live birth rate for the individuals meeting the POSEIDON criteria was 25.9%, while for patients in POSEIDON groups 1, 2, 3, and 4 the rates were 45.5%, 29.4%, 25.0%, and 11%, respectively. The differences were not statistically significant due to the small number of cases.Conclusions:Patients belonging to the four POSEIDON groups were described at CFGS. Age and number of retrieved mature oocytes were determining parameters in the prognosis of pregnancy in IVF/ICSI patients.

Tryptophan catabolism to serotonin and kynurenine in women undergoing in-vitro fertilization.

This cross-sectional clinical study was designed to explore the impact of tryptophan-kynurenine and tryptophan-serotonin (5 HT) pathways on reproductive performance during in vitro fertilization (IVF). Paired serum and follicular fluid (FF) samples were obtained from 64 consecutive IVF patients. The analysis was done by using LC-MS/MS. Ovarian hyperstimulation resulted in decreased serum tryptophan (p<0.004), 5-HT (p<0.049) and kynurenine (p<0.001). FF levels of tryptophan (R=0.245, p<0.051), kynurenine (R=0.556, p<0.001) and 5-HT (R=0.523, p<0.001) were positively related to their respective serum levels. Clinical pregnancy was associated with higher serum 5-HT (p<0.045) and FF 5-HT (p<0.020) and lower kynurenine to 5-HT ratio (p<0.024). Chemical pregnancy was also positively related to FF 5-HT (R=0.362, p<0.024). Moreover, there was a direct relationship of the number of mature oocytes to the FF 5-HT (R=0.363, p<0.020) but it was inversely related to FF tryptophan to 5-HT and FF kynurenine to 5-HT ratios (R=-0.389, p<0.016 and R=-0.337, p<0.036, respectively). Multivariate logistic regression revealed that the number of mature oocytes was significantly influenced by FF 5-HT (?=0.473, p<0.001). In IVF patients ovarian hyperstimulation results in a reduction of the availability of tryptophan to catabolic pathways to kynurenine and 5-HT. Outcome measures improved significantly when 5-HT predominated over kynurenine.

(Not) wanting to choose: outside agencies at work in assisted reproductive technology.

Human choice and interventions that could seem to threaten the course of ‘nature’ or ‘chance’ are at the heart of controversies over assisted reproductive technology across Western countries. These debates focus predominately on so-called ‘selective reproductive technology’. While today, the technique of in-vitro fertilization (IVF) raises few political and bioethical debates in France and other Western countries, concerns remain that human intervention might replace ‘natural’ processes, threatening human procreation. These polemics focus on situations that require a decision, notably embryo selection and the fate of spare frozen embryos. The choices involved are induced by the technology and organized by the law. In the French legal system, IVF patients and professionals have the opportunity and, to a certain extent, the responsibility to decide on the status of in-vitro embryos. This article shows that, in these situations, both IVF patients and professionals invoke outside agencies (‘instances tierces’), both to avoid making decisions and to recover a world order in which procreation is not entirely subject to human decision. In short, there is a need to feel that procreation is not entirely dependent on human intervention; that individuals do not decide everything. It appears that the choices that are made, their nature and the type of outside agency that is invoked are highly situated.

Trends in Social Media Topics During COVID-19 Among Women Undergoing Assisted Reproductive Technology Treatments.

Patients undergoing fertility treatments, such as in-vitro fertilization (IVF), face unique challenges both physically and mentally. With the emergence of the COVID-19 global pandemic, IVF patients began to face additional obstacles as hospitals and clinics shut down in compliance with recommendations for limiting exposure risk. In order to assess the impact of COVID-19 on IVF patients, we conducted a qualitative analysis using 563 public Instagram posts collected from three randomly selected days in March 2020. After the exclusion of 354 posts, thematic coding was used to analyze 209 posts. Five major themes were identified including (1) the medical and physical experience of IVF, (2) emotional spectrum, (3) sources of social support, (4) coping mechanisms, and (5) education on social media. Posts were categorized based on whether COVID-19 was discussed and theme frequencies were compared. The majority of patients impacted by the pandemic discussed setbacks to care, such as clinic closures. In addition, posts authored by those impacted by COVID-19 contained more negative emotions and fewer positive emotions compared to unaffected users. Despite an increase in setbacks and negative emotions, posts offering support nearly tripled in frequency highlighting the resilience of the IVF community. Our thematic analysis supports the need for careful consideration of the psychological and social effects of cycle cancellations on the IVF community. Experiences and sentiments revealed by this study should be considered when a successive pandemic or global emergency threatens IVF treatment protocols.

Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial

IntroductionRecent studies in in vitro fertilisation (IVF) patients have associated abnormal vaginal microbiota (AVM) with poor clinical pregnancy rates of 6%–9% per embryo transfer. The biological plausibility for this finding...

EMOTIONAL WELL-BEING DURING FERTILITY TREATMENT: A RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE USE OF AN ONLINE LEARNING PLATFORM AS A RESOURCE

Infertility and associated therapies have been characterized as anxiety-provoking. As emotional states can be triggered by stimuli, we assessed the impact of a visual multimedia electronic (e)-learning and e-consent platform on patients’ anxiety states prior, during, and upon completion of infertility treatment cycles. Prospective randomized controlled trial Patients aged 18-43 years undergoing their first intrauterine insemination (IUI) or in-vitro fertilization (IVF) cycle were randomized to two groups receiving either: 1) standard fertility counseling with their physician and nurse team (conventional group); or 2) standard counseling plus access to an interactive multimedia e-learning platform (EngagedMD) before and during their treatment cycle (EMD group). Patients completed surveys including a modified 19-question State-Trait Anxiety Inventory (STAI) at three time points to quantitively assess their treatment experience: T1 (prior to treatment), T2 (after the MD/RN teaching session at the start of their cycle), and T3 (after cycle completion). Each STAI item is given a weighted score of 1 to 4, the instrument has a possible score from 19 to 76, and the 50th percentile for an anxious state in women aged 19-39 is 34. Student’s t-test and Chi-squared test were used as appropriate. To date, a total of 77 patients (IUI=35 and IVF=42) with a mean age of 35.2 +/- 4.4 years have been enrolled with no differences in baseline demographics (age, duration of infertility, infertility diagnosis, and education level) for both IUI and IVF and conventional and EMD groups. Overall, STAI scores at T1, T2, and T3 were 37.8 +/- 11.3, 37.0 +/- 10.6, and 37.0 +/- 11.6 respectively, with no difference in IUI and IVF patients at T1 (p=0.51). However, IVF patients scored significantly higher at T2 (40.3 +/- 9.3 vs. 33.7 +/- 11.1, p=0.03) and T3 (41.3 +/- 12.1. vs. 32.7 +/- 9.5, p=0.01) compared to IUI patients at the same timepoints. IUI patients had a significant decrease in their anxiety from T1 to T2 (mean delta -3.1; p=0.05) and T1 to T3 (mean delta -3.9 p=0.01), while patients undergoing IVF treatments had no significant change in their anxiety scores throughout. With respect to conventional and EMD groups, there were no differences in STAI scores in IUI and IVF cycles from T1 to T3. Of the patients undergoing IUI, there was a significant decrease in patients’ anxiety levels from T1 to T2 in the EMD group (35.8 +/- 9.3 vs. 31.6 +/- 10.2; p=0.02), while this difference was not seen in the conventional group (37.4 +/- 11.5 vs. 35.5 +/- 12.0; p=0.46). Anxiety levels were significantly elevated in first-time IVF patients during and after treatments compared to those undergoing IUI. The addition of an e-learning platform did not alter the level of anxiety compared to traditional teaching methods in IVF patients. In contrast to standard counseling, patients undergoing IUI experienced a decrease in their immediate anxiety level after exposure to EngagedMD. Overall, anxiety levels in this cohort of patients were high, indicating that added psychological resources may be beneficial to this population.

LIKELIHOOD FOR REACHING EMBRYO TRANSFER FOLLOWING EXCLUSION-BASED NON-DISCLOSURE PREIMPLANTATION GENETIC TESTING FOR MONOGENIC CONDITIONS (PGT-M)

Non-disclosure (ND) preimplantation genetic testing (PGT) for monogenic disorders (PGT-M) via in vitro fertilization (IVF) is an option for individuals at risk for having a late-onset dominant condition. One method involves testing the patient for a familial mutation without disclosing the results, and blinding them to whether their embryos are tested via PGT-M with concurrent PGT for aneuploidy (PGT-A) if they have the mutation, or via PGT-A only if they do not. Exclusion-based testing is an alternate method which does not require the patient’s mutation status to be known. Rather, by determining which of the patient’s chromosome homologs with the gene of interest was inherited from their affected parent, embryos that inherit that copy of the chromosome are excluded from transfer due to the potential risk for inheriting the mutation. Exclusion-based testing eliminates the risk for accidental disclosure of the patient’s mutation status but may exclude unaffected embryos from transfer if the patient does not have the familial mutation. Patients may consider cryopreservation of potentially at-risk embryos in case they pursue testing for themselves at a later time. In this study, we review the likelihood of unaffected and euploid embryo results using exclusion-based ND testing. Retrospective analysis of trophectoderm (TE) biopsy results from IVF patients referred for exclusion-based ND PGT-M with concurrent PGT-A. For each case, a mutation/clinical diagnosis report for the affected relative and samples from the couple and the at-risk patient’s parent(s) were required. TE biopsies were shipped to a lab for genotyping using Illumina Cyto12 SNP-based microarrays with informatics. Twenty-five patients underwent exclusion-based ND PGT-M for 7 disorders (Huntington’s Disease (HD), n=19; Spinocerebellar ataxia (SCA) type 3, n=1; SCA type 6, n=1; Polycystic kidney disease, n=1; Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), n=1; Familial TTR amyloidosis, n=1; Creutzfeldt-Jakob disease, n=1). A total of 273 TE samples from 46 IVF cycles were tested (average of 5.9 embryos/cycle, range 1-21). Average maternal age was 33.1 years (range 26.2–41.9 years). 73.9% (34/46) of cycles had at least one euploid and unaffected embryo. Analysis by maternal age groups indicated that the chance of having at least one euploid and unaffected embryo was 83.3% (5/6) for <30 years, 76.7% (23/30) for 30-34 years, and 60% (6/10) for women ≥35 years. Exclusion-based ND testing avoids the risk of accidental disclosure of a patient’s mutation status, while allowing a relatively high rate of having an embryo for transfer after a single IVF cycle. This information may be useful for counseling patients considering ND exclusion-based PGT-M and discussing the potential need for additional IVF cycles in order to reach transfer, especially for women of advanced maternal age. Although ND exclusion-based testing is most commonly performed for HD, here we demonstrate that this method can be utilized for other dominant late-onset conditions.