In Vitro Fertilization Program Research Articles

Multifetal Pregnancy After Implementation of a Publicly Funded Fertility Program

A publicly funded fertility program was introduced in Ontario, Canada, in 2015 to increase access to fertility treatment. For in vitro fertilization (IVF), the program mandated an elective single-embryo transfer (eSET) policy. However, ovulation induction and intrauterine insemination (OI/IUI)-2 other common forms of fertility treatment-were more difficult to regulate in this manner. Furthermore, prior epidemiologic studies only assessed fetuses at birth and did not account for potential fetal reductions that may have been performed earlier in pregnancy. To examine the association between fertility treatment and the risk of multifetal pregnancy in a publicly funded fertility program, accounting for both fetal reductions and all live births and stillbirths. This population-based, retrospective cohort study used linked administrative health databases at ICES to examine all births and fetal reductions in Ontario, Canada, from April 1, 2006, to March 31, 2021. Mode of conception: (1) unassisted conception, (2) OI/IUI, or (3) IVF. The main outcome was multifetal pregnancy (ie, a twin or higher-order pregnancy). Modified Poisson regression generated adjusted relative risks (ARRs) and derived population attributable fractions (PAFs) for multifetal pregnancies attributable to fertility treatment. Absolute rate differences (ARDs) were used to compare the era before eSET was promoted (2006-2011) with the era after the introduction of the eSET mandate (2016-2021). Of all 1 724 899 pregnancies, 1 670 825 (96.9%) were by unassisted conception (mean [SD] maternal age, 30.6 [5.2] years), 24 395 (1.4%) by OI/IUI (mean [SD] maternal age, 33.1 [4.4] years), and 29 679 (1.7%) by IVF (mean [SD] maternal age, 35.8 [4.7] years). In contrast to unassisted conception, individuals who received OI/IUI or IVF tended to be older, reside in a high-income quintile neighborhood, or have preexisting health conditions. Multifetal pregnancy rates were 1.4% (95% CI, 1.4%-1.4%) for unassisted conception, 10.5% (95% CI, 10.2%-10.9%) after OI/IUI, and 15.5% (95% CI, 15.1%-15.9%) after IVF. Compared with unassisted conception, the ARR of any multifetal pregnancy was 7.0 (95% CI, 6.7-7.3) after OI/IUI and 9.9 (95% CI, 9.6-10.3) after IVF, with corresponding PAFs of 7.1% (95% CI, 7.1%-7.2%) and 13.4% (95% CI, 13.3%-13.4%). Between the eras of 2006 to 2011 and 2016 to 2021, multifetal pregnancy rates decreased from 12.9% to 9.1% with OI/IUI (ARD, -3.8%; 95% CI, -4.2% to -3.4%) and from 29.4% to 7.1% with IVF (ARD, -22.3%; 95% CI, -23.2% to -21.6%). In this cohort study of more than 1.7 million pregnancies in Ontario, Canada, a publicly funded IVF program mandating an eSET policy was associated with a reduction in multifetal pregnancy rates. Nevertheless, ongoing strategies are needed to decrease multifetal pregnancy, especially in those undergoing OI/IUI.

What is the impact of endometriosis and the AFS stage on cumulative pregnancy rates in IVF programs?

BackgroundEndometriosis is commonly observed in infertile women and can be staged with regard to severity [e.g. according to the American Fertility Society (AFS) classification]. This condition can cause infertility through impaired oocyte quality, fertilization disorders, tubal lesions, adhesions, deep infiltration, and adenomyosis. Although women with endometriosis often turn to in vitro fertilization (IVF) programs, the literature data on IVF outcomes are sometimes contradictory (i.e. the same as in other etiologies of infertility, or worse). The objective of the present study was to assess and compare pregnancy rates in women with and without endometriosis and according to the endometriosis stage.MethodsWe retrospectively studied clinical and ongoing pregnancy rates in IVF and the cumulative pregnancy rates after frozen/thawed embryo transfers, in women without endometriosis (group A) or with endometriosis (group B). We further compared groups in which endometriosis was staged according to the revised AFS classification: stage 1/2 (group C), stage 3/4 (group D, without endometrioma), and endometrioma alone (group E).ResultsWe documented 430 cycles in group A and 460 in group B (including 56 in group C, 88 in group D and 316 in group E). After fresh or frozen/thawed embryo transfers, the differences in ongoing pregnancy rates between groups A and B were not significant. However the cumulative rates per couple were significantly lower (p < 0.05) in group D.ConclusionsWe recommend IVF for women with endometriosis because the pregnancy rates are similar to those observed for women with other types of infertility. This approach is in line with the international guidelines issued by assisted reproductive technology societies. These results again raise the question of whether surgical resection of deep infiltrating endometriosis (stage 3/4) should be recommended before admission to an IVF program.Trial registration This study was approved by an institutional review board (CPP Ouest VI, Brest, France): reference: B2020CE.43

Analysis of in vitro fertilization programs in patients with functual ovarian cysts and anovulatory infertility

Background. There are different opinions about the effect of functional ovarian cysts on the duration of controlled ovarian hyperstimulation, the dose of gonadotropins, the number and quality of collected oocytes and produced embryos, and the frequency of pregnancy.Aim. To analyze in vitro fertilization (IVF) programs in women with anovulatory infertility and ovarian retention.Materials and methods. A prospective study included 71 women aged 18–44 years. The main group (I) included patients (n = 38) with anovulatory infertility and functional ovarian cysts (FOC) diagnosed by ultrasound before enrollment in the IFV program. Patients of this group underwent ultrasound-guided transvaginal puncture of ovarian cyst followed by cytology. The comparison group (II) (n = 33) encompassed patients with anovulatory infertility without FOC, who went through the IVF program. The control group (III) included apparently healthy individuals (n = 15). The study algorithm included collection of clinical and anamnestic data of the patients, data of laboratory and instrumental studies, parameters of a stimulated IVF cycle, characteristics of oogenesis and early embryogenesis, and assessment of IVF program effectiveness.Conclusion. It was established that in FOC and anovulatory infertility, the number of collected oocytes was smaller; however, the number of the best quality embryos and the frequency of pregnancy did not differ.

Recurrent failure of ART, thrombosis and thrombophilia

In recent years, the number of risk factors for thrombosis associated with pregnancy has increased substantially due to the active introduction of new medical technologies not used 30 years ago or because their role in emerging thrombosis has not been studied, e.g., during pregnancy after assisted reproductive technologies (ART) particularly in vitro fertilization (IVF). The risk of venous thromboembolic complications (VTEС) related to ovarian hyperstimulation during ART is often overlooked. We present the case of a 37-year-old woman who developed thrombosis of the right internal jugular vein 3 weeks after embryo transfer within the IVF protocol. Ovarian hyperstimulation during hormonal IVF protocols provokes procoagulant changes in the hemostasis and fibrinolysis system able to result in venous and arterial thrombosis. The localization of VTEС typical to ART is more often located in the internal jugular vein being accompanied by neck pain and edema. Thrombosis risk factors should be assessed in all women in the IVF program, and appropriate thromboprophylaxis should be carried out to all high risk subjects.

Real clinical practice of infertility treatment in Russia: a collective opinion of 425 reproductologists

Introduction. Approaches to treatment of infertility have been progressively updated because the field of assisted reproductive technologies (ART) is a science-based symbiosis of the latest knowledge and advances in medicine, biology, and genetics. Today, a real-world clinical practice of a reproductive specialist needs to be assessed in the Russian Federation (RF) both in terms of a retrospectively analyzed development of RF in vitro fertilization (IVF) technologies and identifying promising approaches for infertility treatment in the future.Aim: analysis of current therapeutic tendencies and promising trends in real clinical practice of infertility in the Russian Federation.Materials and Methods. In 2022–2023 under the auspices of the Institute for Preventive and Social Medicine and the National Alliance for Public Health Advancement, a survey of reproductive doctors practicing at commercial and government ART centers was carried out. The questionnaire contained questions regarding describing a RF female patient’s portrait with an expected ovarian reserve and response to ovarian stimulation to propose a choice of ovarian stimulation protocol as well as basic and concomitant pharmacotherapy.Results. The opinion of 425 fertility doctors from 156 ART centers in 42 cities of the Russian Federation was assessed. A portrait of a female patient with infertility in the Russian Federation was determined in accordance with the ovarian reserve, expected response to gonadotropin-based stimulation (normal response – 40 %, hyporesponse – 40 %, hyperresponse – 20 % of patients). The basic pharmacotherapy in the stimulation protocol in the IVF program based on agonists and antagonists of gonadotropinreleasing hormone (GnRH), various gonadotropin-containing drugs in female patients with expected normal, hypo- and hyperresponse to ovarian stimulation was assessed. The dominant protocol consists of using GnRH antagonist most often observed in patients with hyper- (95 % of cases), normal (75 % of cases) and hypo-response (45.5 %). Preferences in the basic and concomitant pharmacotherapy in IVF programs were identified as well as current trends in embryo transfer in fresh and cryoprotocols (a tendency to freeze all obtained embryos - “freeze-all” strategy), preimplantation genetic testing methods (used in 30 % of protocols in normal responders, 60 % in hyporesponders and 10 % in hyperresponders) were described.Conclusion. Our study provides the most large-scale analysis of the real-world clinical practice of RF reproductive specialists. A portrait of a RF female patient with infertility, expected ovarian reserve and response to ovarian stimulation was described. Contemporary approaches to select stimulation protocol, basic and concomitant pharmacotherapy in real-world clinical practice were identified. The data obtained represent an important significant cross-section for current practical approaches in real-world practice of RF fertility doctors and can serve as the basis for assessing developing ART methods in the Russian Federation as well as be used to create an evidence base for analyzing future clinical and economic effectiveness of IVF programs in the Russian Federation.

Molecular-genetic study of &lt;i&gt;SMN1&lt;/i&gt; and &lt;i&gt;SMN2&lt;/i&gt; genes associated with spinal muscular atrophy in individuals with infertility prior to in vitro fertilization

Introduction. The rate of infertile couples comprises 17–24 % and tends to increase, with more of them turning to assisted reproductive technologies (ART). In case a required result is achieved, future parents-to-be prepare for birth of a healthy child in the family, but each couple may face a birth of offspring with severe genetic disorders including spinal muscular atrophy (SMA).Aim: to access a carriage rate for SMN1 gene exon 7 deletion associated with SMA and SMN2 gene copy number in married couples planning childbirth using in vitro fertilization (IVF).Materials and Methods. There were enrolled 170 couples (340 subjects) suffering from infertility and referred for IVF in the Sverdlovsk region (SR) of Russia. The search for deletions/duplications in the SMN1 and SMN2 genes was carried out by quantitatively analyzing number of gene copies using the SALSA MLPA Probemix P460 commercial kit (MRC-Holland, the Netherlands). The Hardy–Weinberg ratio was used to calculate estimated rate of homozygous carriers with SMN1 deletions in the next generation.Results. Among 340 patients, a deletion of exon 7 in the SMN1 gene (one copy out of two) was found in 9 individuals (3 males and 6 females) unrelated to marital relations. Thus, only 9 out of 340 examined subjects carry such gene mutation associated with SMA, with total rate of carriage comprised 2.65 % (1/38). Given the number of IVF procedures performed in SR, it may be assumed that the probability for birth of a sick child in such couple comprises at least 1:6410. A number of patients had SMN1 gene duplications – 9 (5.29 %) males and 4 (2.35 %) females baring 3 copies of the SMN1 gene. In addition, the majority of study participants (54 %) turned out to have 3 copies of the SMN2 gene.Conclusion. The rate of SMA carriage in married couples planning a pregnancy with aid of ART corresponds to the general population reaching 1:38 level. It is believed necessary that all couples entering the IVF program should be examined for carriage of SMN1 gene mutations to assess SMA risk in offspring.

Hybrid of Smart System Model to Support the Service of Fertility Doctors in Handling In-Vitro Fertilization Patient Complaints

The majority of In-Vitro Fertilization (IVF) patients immediately call a fertility doctor when they experience different symptoms than usual. However, the high workload makes fertility doctors unable to immediately provide recommendations to handle complaints of IVF patients, while the longer wait for recommendations from fertility doctors will increase the anxiety of IVF patients and high levels of anxiety affect the success rate of IVF programs. The Case-Based Reasoning (CBR) model has lower performance than the modified CBR model, and the CBR model adds to the workload of fertility doctors, namely having to handle the revision stage. To overcome these problems, the CBR model was modified by applying the Chris Case-Based Reasoning (CCBR) similarity formula and combining it with the Rule-Based Reasoning model. The results of performance measurements showed that the accuracy score increased to 47\% and the precision score remained 100\%, so the results of this modification of the CBR model are worthy of being recommended for application to a smart system for handling complaints of IVF patients.

The Consequence of Short Insemination Strategy on Sperm Biological Characteristics, Embryo Morphokinetics, and Clinical Outcomes in the IVF Program

Overnight coincubation of the cumulus–oocyte complexes (COCs) with spermatozoa may be accompanied by overproduction of reactive oxygen species (ROS) and possible determinant effects on sperm cellular status in the in vitro fertilization (IVF) program. The COCs from 100 cases were divided into two groups of short (2 hr) and long (18 hr) inseminations. The malondialdehyde (MDA) level as by-product of ROS was assessed in the insemination medium. The sperm DNA integrity, the mitochondrial membrane potential (MMP), and acrosome reaction (AR) were evaluated using sperm chromatin dispersion (SCD), fluorescence stain of JC-1, and double staining, respectively. Normally, fertilized oocytes (n = 525) were assessed via time-lapse monitoring (TLM) for assessment of the time of fading (tPNF), 2 until 8 timing (t2-t8), s1 (t2-tPNF), s2 (t4-t3), s3 (t8-t5), and duration of cell cycles. Finally, the best embryos were transferred, and clinical outcomes were assessed. Higher rates of MDA concentration, DNA fragmentation, and AR and low rate of MMP were noticed in long compared to short insemination groups ( p ≤ 0.0001 ). The morphokinetic parameters showed five-cell stage (t5) and cell cycle 3 (cc3) that were significantly different between the groups ( p = 0.04 and p = 0.03 , respectively). A high level of ROS observed in the long insemination group might have a detrimental effect on sperm status. Although, similar embryo quality and clinical outcomes were noticed in two insemination groups, but the trend was toward the short insemination.

Прогнозирование исходов программ экстракорпорального оплодотворения с использованием модели машинного обучения «Случайный лес»

Currently, in vitro fertilization (IVF) with embryo transfer is the main method of treatment of all forms of infertility, but successful cases ending in pregnancy still account for only a third of all cycles performed. It is necessary to take into account many parameters and investigate the connections between them in order to properly evaluate the results of IVF. Over the past decades, a number of IVF prediction models have been developed with the aim at assessing the outcomes in individual cases, but, given the generally poor prognostic capacity, only a few of them have proven to be clinically significant. This study aimed to create nonlinear IVF outcomes prediction models and identify the most significant factors affecting the said outcomes. Using a database containing information on more than 700 indicators of 7004 women aged 18 to 45 years who participated in the IVF program in Russia from 2010 to 2020, we trained a random forest model that predicted pregnancy in the IVF cycle with ROC-AUC = 0.69. This paper describes 20 most successful predictors of the resulting model and interprets their contribution to the prognosis. Of these, body mass index (BMI) and the number of received and fertilized oocytes have been covered in the scientific literature previously as predictors of IVF outcomes, but other parameters, such as anamnestic data, previous participation in an IVF program (number of cases and their results), as well as serum concentration of AMH, rarely appear in foreign prognostic models.

#176 : The Relationship Between Blastocyst Morphology and PGD Result

Background and Aims: Blastocyst morphology has been clinically assessed during the selection of blastocyst for transfer and cryopreservation, and the morphological grading scheme has gained wide acceptance. Blastocyst grading according to Gardner et al. (20) early blastocyst, blastocoel less than half of the blastocyst (1AA), blastocyst with blastocoel more than half of the blastocyst (2AA), blastocyst with blastocoel fill the blastocyst (3AA), and Expanded Blastocyst (4AA/4BB/4CC). Morphology blastocyst with good quality determining the success of PGD. Preimplantation genetic diagnosis (PGD) are routine procedures performed in many in vitro fertilization (IVF) clinics. In patients with genetic or chromosomal abnormalities, PGD is an integral part of the IVF program. This study aims to determine whether embryos with normal blastocyst morphology have euploidy result on the PGD test. Method: Observational research study. Results: Dari 22 embryo blastocyst yang di PGD, 59% embryo euploidy 4AA/4BB, 22,7% embryo low level mosaicism 4AA/4BB, 13% embryo aneuploidy 2AA/3AA and 4,5% embryo multiple aneuploidy 3AA. The result suggested that the euploidy rate of blastocyst grade 4AA was the highest. Conclusion: Based on data, embryo morphology with quality 4AA/4BB show PGD result Euploidy was the highest. Euploidy of embryo is one of the important factors affecting embryo implantation and development. Euploidy of blastocyst during PGD treatment was found to be correlated with morphological assessment (Gardner grade)

#279 : The Relationship Between Maternal Age and the Chromosomal Status of the Embryo

Background and Aims: Maternal age is one of the success factors of in vitro fertilization (IVF). Specifically, advanced maternal age (AMA; defined as [Formula: see text]35 years) shows just a negligible impact upon fertilization rate and a mild impact upon embryo development to the blastocyst stage, but results in a dramatic impact upon blastocyst aneuploidy rate. This is also associated with a progressive decrease in ovarian stimulation so that the number of oocytes and embryos produced from an older maternal age becomes less and the implantation rate decreases. However, the high incidence of embryonic chromosomal abnormalities in young women does not exclusively prove that maternal age is related to the quality of the resulting embryos. This study aims to analyze the relationship between maternal age and the chromosomal status of the embryo. Method: This cross-sectional research was done on 30 embryos from 12 patients aged 28-40 years old who underwent an IVF program in three clinics. Embryos were cultured until blastocyst stage. Preimplantation genetic testing for aneuploidy (PGT-A) was done after blastocyst biopsy on day 5 or 6, and chromosomal analysis was done using the next generation testing (NGS) method. Then the relationship between maternal age with embryo chromosomal status was analysed. Results: There is no difference in subjects’ characteristics between the euploid and aneuploid embryo groups (p&gt;0.05). There is no significant difference in maternal age of the euploid and aneuploid embryo groups. (With p=0.690). Conclusion: Maternal age has no relationship with embryo chromosomal status. There is no specific pattern in the relationship between age and chromosomal status, except in the age range of 36 to 40 years, it is found that increasing age increases the number of aneuploid embryos and decreases the number of euploid embryos.

A Markov-model simulation of IVF programs for PCOS patients indicates that coupling myo-Inositol with rFSH is cost-effective for the Italian Health System

Accumulating evidence suggests that oral supplementation with myo-Inositol (myo-Ins) is able to reduce the amount of gonadotropins and days of controlled ovarian hyperstimulation (COS) necessary to achieve adequate oocyte maturation in assisted reproduction technology (ART) protocols, particularly in women affected by polycystic ovary syndrome (PCOS). We used computational calculations based on simulation modellings. We simulated in vitro fertilization (IVF) procedures—with or without intracytoplasmic sperm injection (ICSI)—with 100,000 virtual patients, accounting for all the stages of the entire IVF procedure. A Monte Carlo technique was used to account for data uncertainty and to generate the outcome distribution at each stage. We considered virtual patients with PCOS undergoing IVF cycles to achieve pregnancy. Computational data were retrieved from clinical experience and published data. We investigated three parameters related to ART protocols: cost of single procedure; efficacy to achieve ongoing pregnancy at 12 gestational weeks; overall cost per single pregnancy. The administration of oral myo-Ins during COH protocols, compared to the standard COH with recombinant Follicle Stimulating Hormone (rFSH) only, may be considered a potential strategy to reduce costs of ART for the Italian Health System.

The ethics of using body mass index in in-vitro fertilization risk assessment.

In-vitro fertilization clinics across the world currently use the body mass index (BMI) to assess risk for and determine access to in-vitro fertilization (IVF); however, clinics vary widely in both setting specific BMI limits for access to IVF and articulating the reasons for their policies. Given that scholars have begun to question the usefulness of BMI for individual health risk assessment, it is striking that ethicists have not yet systematically evaluated the reasons given for using BMI in assessing individuals' risk in IVF treatments. In this paper, I provide the first systematic analysis of the chief arguments currently offered by IVF programs for using BMI as a criterion for risk assessment. Specifically, I articulate empirical concerns about the success of IVF in high-BMI patients, practical concerns about the ability of high-BMI patients to safely undergo procedures associated with IVF, and ethical concerns about the risk-to-reward ratio for high-BMI patients and their potential children. I advance a series of objections to those arguments, using empirical data regarding IVF procedures and analogies with other high-risk conditions including systemic lupus erythematosus, and science regarding the diagnosis of BMI-correlated comorbidities such as high blood pressure or diabetes to argue that BMI alone is not a reasonable criterion for risk assessment in IVF; moreover, the usage of BMI may involve unacceptable violations of the bioethical principles of justice and respect for autonomy. Instead, I hold that IVF programs should rely on more precise laboratory and clinical measurements to evaluate risk in IVF.

Neonatal outcomes from in vitro fertilization-conceived pregnancies

Background In vitro fertilization (IVF) shows potential to improve pregnancy success, especially for infertile couples. This technique has some risks for neonates in the perinatal period and may affect their future health.&#x0D; Objective To investigate the characteristics and clinical outcomes of neonates from IVF-conceived pregnancies.&#x0D; Methods This retrospective study was conducted in neonates from IVF-conceived pregnancies from January to December 2021 at Bunda Women’s and Children’s Hospital, Jakarta. We gathered data from medical records about maternal age and morbidity, gravidity, gestational age, method of delivery, multiple gestation, also neonates’ significant profiles like prematurity, birth weight, Apgar score, and morbidities in perinatal period. We would like to investigate the characteristics and clinical outcomes of neonates born from IVF-conceived pregnancies program.&#x0D; Results There were 361 neonates whose mothers underwent IVF included in this study. Most mothers were ?35 years (70.9%) and on their first pregnancy (69.2%). Maternal complicating factors were premature contractions (16.6%), premature rupture of membranes (8.3%), and twin pregnancy (31.5%). About 98.6% of deliveries were performed by caesarean section and from IVF-conceived pregnancies program most 61.2% neonates were born at full term gestation (61.2%). Preterm deliveries occurred at a mean gestational age of 34.4 (SD 2.4) weeks. Subjects’ mean birth weight was 2,800.2 (SD 640.3) grams, with 26.3% in the low-birth-weight category. Most neonates (93.0%) were appropriate weight for gestational age and had good Apgar scores in the first minute (92.2%) and fifth minute (99.7%). However, 24.3% of neonates needed intensive care (NICU) with morbidities. The longest length of NICU stay was 100 days, with mortality of 7.9% of NICU-treated infants.&#x0D; Conclusion In our setting, most neonates from the IVF program were born with good outcomes, although preterm birth rate, low birth weight, need for NICU care, and mortality rate were quite high. Further study is needed to evaluate long-term outcomes of IVF neonates.

Current Applications and Controversies in Preimplantation Genetic Testing for Aneuploidies (PGT-A) in In Vitro Fertilization.

Preimplantation genetic testing for aneuploidy (PGT-A) has evolved over recent years, including improvements in embryo culture, biopsy, transfer, and genetic testing. The application of new comprehensive chromosome screening analysis has improved the accuracy in determining the chromosomal status of the analyzed sample, but it has brought new challenges such as the management of partial aneuploidies and mosaicisms. For the past two decades, PGT-A has been involved in a controversy regarding its efficiency in improving IVF outcomes, despite its widespread worldwide implementation. Understanding the impact of embryo aneuploidy in IVF (in vitro fertilization) should theoretically allow improving reproductive outcomes. This review of the literature aims to describe the impact of aneuploidy in human reproduction and how PGT-A was introduced to overcome this obstacle in IVF (in vitro fertilization). The article will try to analyze and summarize the evolution of the PGT-A in the recent years, and its current applications and limitations, as well as the controversy it generates. Conflicting published data could indicate the lacking value of a single biopsied sample to determine embryo chromosomal status and/or the lack of standardized methods for embryo culture and management and genetic analysis among other factors. It has to be considered that PGT-A may not be a universal test to improve the reproductive potential in IVF patients, rather each clinic should evaluate the efficacy of PGT-A in their IVF program based on their population, skills, and limitations.

Anxiety (DASS21) and the Quality of Life (FertiQol) of Infertile Women Underwent In Vitro Fertilization

Infertility affects physical and mental health and has various consequences. In vitro fertilization (IVF) is one of the Assisted Reproductive Technology (ART) programs that include several phases, requiring longer time, more patience, and is expensive. This may make women who undergo the ART program to have higher stress level, especially anxiety. This study aimed to determine the relationship between anxiety and quality of life in infertile patients undergoing assisted reproductive technology programs. This was a cross-sectional observational analytic study performed at Aster Fertility Clinic, Dr. Hasan Sadikin General Hospital and Bandung Fertility Center, Limijati Hospital Bandung, Indonesia, from February until April 2020. The analysis was performed using the DASS21 scale and FertiQol count on 27 subjects undergoing the IVF program and 30 control subjects who were pregnant without IVF program. The statistical analyses used to determine the condition of anxiety and the condition of quality of life were the Chi-square and the Mann-Whitney tests, while the relationship between anxiety and quality of life as the main subject was measured using the Spearman correlation test. The anxiety level as measured with the DASS21 instrument in the subject and control groups was 6.2 vs 0.7 with p&lt;0.001. From the analysis of the FertiQol instrument in the subject and control groups, the scores were 79.6 vs. 98.9 for the mind-body domain (p&lt;0.001); 68.8 vs 98.5 for the emotional domain (p &lt; 0.001); 83.2 vs 95.7 for the relational domain (p&lt;0.001); and 77.6 vs 97.6 for the social domain (p&lt;0.001). For the overall FertiQol core domains, the score was 77.3 vs 97.7 (p&lt;0.001). The correlation between anxiety and the FertiQol total core domains were evident from the results of the Spearman correlation test, with an r-value of -0.479 (p&lt;0.001). Therefore, there is a significant negative correlation between anxiety and quality of life.

Artificial intelligence algorithms for optimizing assisted reproductive technology programs: A systematic review

Artificial intelligence (AI) has been experiencing rapid growth in recent years, and numerous applications are improving the single-step efficiency of the whole assisted reproductive technology (ART) procedure. In this review, we collected all the algorithms supplying ART and selected those supporting the clinical assistance to the procedure up to the successful attempt. Those with a clear role in improving ART performances were further selected. We found a questionnaire-based algorithm identifying patients at risk for endometriosis with early management and better fertility outcome. An algorithm can detect the values of simple gamete production (male) and reservoir (female) according to gradual scale allocation, and display themas normal or abnormal, spontaneousor stimulated gamete production. This can provide significant benefits for infertile couples undergoing diagnostic and therapeutic journeys. The calculators for the starting dose of gonadotropins and the trigger timing during controlled ovarian stimulation make clinical management more efficient. With the application of AI in ART, the ability to determine the optimal number of metaphase II oocytes required for blastocyst formation and number of oocytes needed for embryo production has been significantly improved. The calculation of the implantation rate as proposed in different calculators, using the ultrasound of endometrial vascularization or the age and euploidy of the embryo transferred, may provide further advancement in managing the ART procedure with more participation from the couples to increase the efficacy of the procedures. Finally, the calculator of presumptive success with an ART program based on couples or medical center profiling and efficiency is of tremendous comfort to couples. In conclusion, algorithms and machine learning development in human reproduction are growing daily with evident benefits. Infertility treatments by in vitro fertilization (IVF) are assisted by several algorithms that improve the efficiency of each procedure step, making IVF program’s management more effortless.

Karakteristik Keberhasilan Kehamilan Pasien Yang Menjalani Bayi Tabung Dengan Protokol Panjang Di Klinik Bayi Tabung Rumah Sakit Umum Pusat Sanglah Tahun 2014-2017

Introduction: Globally there are estimated cases of infertility in 8%-10% of couples, if from the global picture of the population then about 50-80 million couples (1 in 7 couples) or about 2 million new infertile pairs each year and this number continues to increase. In Vitro Fertilization (IVF) can be a solution for infertile patients. There are two IVF programs, namely with short protocols and long protocols, each protocol has benefits and limitations, The long protocol was the most widely used protocol prior to the introduction of GnRH antagonists (short protocols) in IVF centers around the world, but high cost constraints leads change over to the short protocol method. In its journey, the average success rate of IVF cycles ranges from 25-30%, while in Indonesia it is 29% for one cycle of long protocol. Thus, this study aims to determine characteristics of success rate patients undergoing ivf with long protocol at ivf clinic Sanglah General Hospital. Methods: This research is a descriptive study using medical record data and the sampling technique is saturation sampling. The data obtained according to the inclusion and exclusion criteria were 4 data which were analyzed descriptively for each case. Result: This study shows that out of 87 cases underwent the ivf program at RSUP Sanglah Clinic only 4 cases who underwent IVF with the long protocol, only 1 case was success, the age of the male partner was 35 years old and the female partner was 35 years old with primary infertile status for 4 years, had a total of 12 oocytes and 4 embryos and appropriate for the long protocol criteria. IVF with levels of ?-hCG 204.1 mIU / ml and get Geneli's pregnancy.Conclusion: During the 2014-2017 period, only 4 cases of patients undergoing IVF with the long protocol method were found, 3 cases with ?-hCG &lt;50,2 did not get live birth while 1 case with ?-hCG&gt; 50,2 had a viable pregnancy.

Past COVID-19: The Impact on IVF Outcomes Based on Follicular Fluid Lipid Profile

Follicular fluid is an important component of follicle growth and development. Negative effects of COVID-19 on follicular function are still open. The aim of this work was to study the features of the lipid profile of follicular fluid and evaluate the results of the in vitro fertilization (IVF) program in women after COVID-19 to identify biomarkers with prognostic potential. The study involved samples of follicular fluid collected from 237 women. Changes in the lipid composition of the follicular fluid of patients who underwent COVID-19 in mild and severe forms before entering the IVF program and women who did not have COVID-19 were studied by mass spectrometry. Several lipids were identified that significantly changed their level. On the basis of these findings, models were developed for predicting the threat of miscarriage in patients who had a severe course of COVID-19 and models for predicting the success of the IVF procedure, depending on the severity of COVID-19. Of practical interest is the possibility of using the developed predictive models in working with patients who have undergone COVID-19 before entering the IVF program. The results of the study suggest that the onset of pregnancy and its outcome after severe COVID-19 may be associated with changes in lipid metabolism in the follicular fluid.

Analysis of anti-apoptotic protein (Bcl-xl) levels and mRNA expression in infertile patients.

In assisted reproductive technology (ART), researchers have tried to predict in vitro fertilization (IVF) outcomes depending on follicular cells apoptosis. Previous reports suggested the B-cell lymphoma-extra-large (BCL-XL) as an apoptosis inhibitor in mammalian ovaries. Therefore, the present research aimed to correlate BCL-XL expression in blood and concentration in follicular fluid (FF) with some outcomes of IVF. A prospective case-control study on infertile women (n=80, mean age= 31.18± 6.04 years) who underwent an IVF program at Kamal Al-Samarai Hospital (Baghdad/Iraq), July 2021- January 2022. All women were split based on pregnancy outcome into two groups: the non-pregnant group (n=40) and the pregnant group (n=40). Samples of FF and blood were assembled at oocyte retrieval time. The BCL-XL mRNA expression was assessed with the Real-Time Quantitative Reverse Transcription-polymerase chain reaction (Real-Time qRT-PCR) technique, whereas the BCL-XL concentration in FF was investigated by sandwich enzyme-linked immunosorbent assay (ELISA). The BCL-XL concentration in FF from pregnant group (3.90 ng/ml ±1.16) raised significantly (P = 0.00) compared with non-pregnant group (1.90 ng/ml ± 0.63). Similarly, the BCL-XL mRNA expression in blood from pregnant group (0.73 ±0.31) raised significantly (P = 0.00) compared with non-pregnant group (0.34± 0.12). In addition, FF BCL-XL concentration associated significantly with fertilization rate (r= 0.399, P=0.048). The research proposed that the elevation of anti-apoptotic BCL-XL might assist in diminished apoptosis in pregnant women who underwent IVF treatment.