Length Of Infertility Research Articles

A nomogram predicting testicular sperm extraction success in men with non-obstructive azoospermia: A multi-center study

ObjectivesTo develop an efficient and easy-to-use nomogram which can predict testicular sperm extraction(TESE) success in men with non‐obstructive azoospermia(NOA) by using pre-operative parameters. Materials and MetodsData of 3093 men who underwent TESE for NOA were included in this study. Demographic data, testis volumes, presence of varicocele, length of infertility, history of previous surgeries, history of genitourinary infections, smoking status, chromosome abnormalities, presence of Y-chromosome microdeletion, family history of infertility, testis biopsy, surgical data, sperm retrieval rate, final pathology obtained at testicular sperm extraction, follicle stimulating hormone, luteinizing hormone, testosterone levels were recorded. The primary outcome was to develop an efficient nomogram which can predict the TESE success in men with NOA. The secondary outcomes were identifying the significant pre-operative parameters which are associated with success in TESE. ResultsSperm retrieval rate was 50.2%(1553/3093). Testis volume, history of varicocelectomy, chromosome abnormalities, presence of Y-chromosome microdeletion were shown to affect sperm retrieval rate significantly(p<0.05). Sperm retrieval success was higher in men with older age, higher testis volume(>10mL), lower follicle stimulating hormone level(≤ 12.92mIU/mL), lower luteinizing hormone level, and higher testosterone level(p<0.05). Only testis volume and patient’s age were associated with succesful sperm retrieval in multivariate logistic regression analysis. ConclusionIn men with NOA, high testis volume, old age, low follicle stimulating hormone level, low luteinizing hormone level, and high testosterone level are advantageous for successful sperm retrieval in TESE. Herein we present a nomogram which can predict the outcome of TESE in men with NOA with adequate success.

The relationship between duration of infertility and clinical outcomes of intrauterine insemination for younger women: a retrospective clinical study

BackgroundThe objective of this research was to elucidate the association between the length of infertility and the outcomes of intrauterine insemination (IUI) in women of varying ages - a topic that has been the subject of investigation for numerous years, yet lacks a definitive consensus.MethodsA retrospective cohort investigation involving 5268 IUI cycles was undertaken at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from 2016 to 2022. Utilizing the smooth fitting curve along with threshold and saturation effect analysis, the correlation between infertility duration and IUI clinical pregnancy rates was discerned. Moreover, patients were bifurcated into two cohorts based on their respective infertility durations. A secondary examination was also performed employing propensity-score matching to mitigate the impact of confounding variables. Subsequent threshold and saturation effect analysis was carried out across various subgroups, segmented on the basis of age differentiation.ResultsWhen the duration of infertility was more than 5 years, the clinical pregnancy rate decreased with the increase of infertility duration (aOR: 0.894, 95%CI: 0.817–0.991, p = 0.043). The multivariate regression analysis suggested that longer duration of infertility (≥ 5 years) was significantly correlated with the lower clinical pregnancy rate (aOR: 0.782, 95% CI: 0.643–0.950, p = 0.01). After the propensity-score matching, the clinical pregnancy rate of women with longer infertility duration were also higher. When the duration of infertility was more than 5 years, the clinical pregnancy rate of women younger than 35 years old decreased with the increase of infertility duration (aOR: 0.906, 95%CI: 0.800–0.998, p = 0.043).ConclusionsThe clinical pregnancy rate and live birth rate of IUI in young women (< 35 years old) who have been infertile for more than 5 years significantly decrease with the prolongation of infertility time. Therefore, for young women who have been infertile for more than 5 years, IUI may not be the best choice.

Effect of health education program on knowledge, stress, and satisfaction among infertile women undergoing in vitro fertilization injection

Abstract Background Stress and dissatisfaction are common issues among patients undergoing in vitro fertilization (IVF). The process of IVF can be emotionally and psychologically challenging, leading to stress, anxiety, and depression in patients. This can be exacerbated by factors such as the length of infertility, the uncertainty of the outcome, and the financial burden of treatment. Additionally, the physical demands of the treatment, the side effects of medication, and the fear of failure can contribute to dissatisfaction and emotional strain in IVF patients. This pre-post intervention study design aimed to evaluate the effect of a health education program on knowledge, stress, and satisfaction among 100 infertile women undergoing IVF attending the Woman’s Health Hospital’s infertility outpatient clinic and IVF unit at Assiut University. Knowledge and stress were measured by women’s knowledge about IVF and the perceived stress scale, respectively. The satisfaction was measured using the Scale of Patient Satisfaction about IVF. Results There is a marked improvement in the knowledge of infertile women, with a significant reduction in their stress levels after the health education program. Furthermore, the satisfaction scores of the women who participated in the program improved significantly. Conclusion The health education program demonstrated a positive impact on knowledge, stress levels, and satisfaction among infertile women undergoing IVF. These findings highlight the positive impact of the program on the participants and emphasize the importance of continuous educational programs regarding IVF to improve knowledge, decrease stress levels, and increase their overall satisfaction with the treatment.

Analysis of the difference in metabolites and gene expressions between pre-receptive and receptive endometria

To analyze the difference in the gene expression, amino acid and carnitine levels in the cervical secretions between the endometria of pre-receptive and receptive stages, with an aim to provide clues for identifying new molecular markers for endometrial receptivity. Fifty nine infertile women treated at the Department of Reproductive Medicine of Linyi People's Hospital from January 6, 2020 to January 31, 2022 were selected as as the study subjects, which were matched with 3 pairs (6 cases) of infertile women preparing for embryo transfer based on factors such as age, body mass index, and length of infertility. Endometrial tissue samples were collected for gene transcription and expression analysis. Twenty five women who had become pregnant through assisted reproductive technology were selected as the control group, and 28 non-pregnant women receiving ovulation monitoring at the Outpatient Department were enrolled as the case group. Status of endometrial receptivity was determined by ultrasonography. In the former group, endometrial tissues were sampled for sequencing, and GO and KEGG database enrichment analysis of differentially expressed genes was carried out. In the latter group, cervical secretions were collected, and amino acid and carnitine levels were measured by mass spectrometry. Statistical analysis was carried out using rank sum test, t test and chi-square test with SPSS v25.0 software. No difference was found in the clinical data of the patients with regard to age, body mass index, infertility years, AMH, FSH, LH, E2, and type of infertility. Compared with the receptive endometrial tissues, there were 100 significantly up-regulated genes and 191 significantly down-regulated genes in the pre-receptive endometrial tissue, with the most significantly altered ones being HLA-DRB5 and MMP10. The biological processes, molecular functions and pathways enriched by more differentially expressed genes in GO and KEGG were mainly immune regulation, cell adhesion and tryptophan metabolism. Analysis of secretion metabolism also revealed a significant difference in the levels of amino acids and carnitine metabolites between the two groups (P < 0.05), in particular those of Alanine, Valine, 3-hydroxybutyrylcarnitine (C4OH) + malonylcarnitine (C3DC)/captoylcarnitine (C10). A significant difference has been discovered in the levels of gene transcription and protein expression in the endometrial tissues from the pre-receptive and receptive stages. The levels of amino acids and carnitine, such as Alanine, Valine, 3-hydroxybutyryl carnitine (C4OH)+malonyl carnitine (C3DC)/caproyl carnitine (C10), may be associated with the receptive status of the endometrium, though this need to be verified with larger samples.

MP30-16 THE ADDITIONAL EFFECT OF THE SPERM DNA FRAGMENTATION INDEX TO PREDICT PREGNANCY IN PRIMARY INFERTILE COUPLE UNDERGOING MEDICALLY ASSISTED REPRODUCTION

You have accessJournal of UrologyCME1 Apr 2023MP30-16 THE ADDITIONAL EFFECT OF THE SPERM DNA FRAGMENTATION INDEX TO PREDICT PREGNANCY IN PRIMARY INFERTILE COUPLE UNDERGOING MEDICALLY ASSISTED REPRODUCTION Giuseppe Fallara, Paolo Capogrosso, Edoardo Pozzi, Federico Belladelli, Simone Cilio, Christian Corsini, Alessandro Bertini, Francesco Lanzaro, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Luigi Candela, Luca Boeri, Alessia d'Arma, Luca Pagliardini, Federico Dehò, Francesco Montorsi, and Andrea Salonia Giuseppe FallaraGiuseppe Fallara More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Simone CilioSimone Cilio More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Luca BoeriLuca Boeri More articles by this author , Alessia d'Arma Alessia d'Arma More articles by this author , Luca PagliardiniLuca Pagliardini More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To contextualize the role of sperm DNA fragmentation index (SDF) in primary infertile couple undergoing medically assisted reproduction (ART) METHODS: Clinical and laboratory data, including semen analysis, SDF (pathological for SDF>30% according to SCSA) and serum hormones, from 442 white-European primary infertile couples associated with pure male factors and undergoing ART at a single tertiary-referral center were analyzed. Male infertile men were stratified in those having no alteration at seminal analysis, those having semen alterations, altered SDF only or both. Descriptive statistic was used to assess differences in baseline characteristics and cumulative incidence curves to show the probability of pregnancy with ART over time among the groups starting from the date at first presentation. Multivariable Cox regression analysis tested the effect of DFI alteration on pregnancy probability with ART RESULTS: Of 442 patients, 14 (3.2%) had semen abnormalities, 130 (29.4%) semen abnormalities only, 24 (5.4%) had pathologic SDF only and 274 (62%) both semen and SDF abnormalities. No differences were found in terms of age at presentation, comorbidities, BMI and length of infertility (overall 18 months [12-32]) among the groups (p>0.05). The median number of cycles of ART before pregnancy or loss to follow-up was similar among group (overall 1 [1-2]). The most used ART approach was ICSI in 404 couples (91.4%). Overall, 189 couples obtained pregnancy in a median follow-up of 24 months (95% CI 23-30). Patients with no semen alteration and those with macroscopic seminal abnormalities had a higher probability of achieving pregnancy compared to those with SDF only or both parameters altered (p<0.001) (Figure 1). At multivariable cox regression analysis, the hazard ratios (HR) for pathologic SDF only and for the combination of macroscopic semen abnormalities and pathologic SDF were 0.37 (95% CI 0.16-0.83; p=0.02) and 0.31 (0.20-0.67; p=0.001), respectively, after adjusting for age of male and female age, comorbidities, testosterone levels and BMI CONCLUSIONS: SDF emerged as a relevant clinical predictor throughout the male diagnostic work-up in primary infertile couples undergoing ART. Altered SDF increases of 60-70% the risk of unsuccessful ART cycles. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e397 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Fallara More articles by this author Paolo Capogrosso More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Simone Cilio More articles by this author Christian Corsini More articles by this author Alessandro Bertini More articles by this author Francesco Lanzaro More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Luigi Candela More articles by this author Luca Boeri More articles by this author Alessia d'Arma More articles by this author Luca Pagliardini More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

EFFICACY OF USING THE DRUG BASED ON GM-CSF FOR POSTPARTUM OVARIAN HYPOFUNCTION IN COWS

The article presents the results of studying the efficacy of the drug based on granulocyte-macrophage colony-stimulating factor (GM-CSF) in cows with postpartum ovarian hypofunction. It has been established that its twofold administration at a dose of 10.0 ml/animal with a 7-day interval ensures the restoration of sexual cyclicity in 90.0% of cows with a reduction in the length of infertility by 18.0-30.1 days and the fertilization coefficient – by 0.56-0.78. A twofold use of the drug based on GM-CSF at a dose of 10.0 ml is accompanied by the development of dominant follicles, the diameter of which is by 46.6% larger compared to saline, an increase in the level of DHEA-S by 2.0 times, estradiol-17β – by 29.3%, which ensures a full manifestation of sexual cyclicity.

Long-Term Pregnancy Outcomes of Patients with Diffuse Adenomyosis after Double-Flap Adenomyomectomy.

Although many studies show that patients with diffuse adenomyosis who underwent fertility-sparing surgery can have a successful pregnancy, their pregnancy outcomes are still controversial. The objective of this study was to determine long-term pregnancy outcomes and possible influencing factors after double-flap adenomyomectomy for patients with diffuse adenomyosis. A total of 137 patients with diffuse adenomyosis who underwent double-flap adenomyomectomy between January 2011 and December 2019 were studied, and correlations between pregnancy outcomes and clinical data, including age and junctional zone measured by magnetic resonance imaging (JZmax-A), were analyzed. The results show that 56 patients (40.9%, 56/137) had 62 pregnancies, including 35 natural pregnancies and 27 assisted reproduction pregnancies, after operation. A univariate regression analysis showed that the pregnancy outcomes were related to age at surgery, visual analog scale (VAS) score of preoperative dysmenorrhea, parity experience, length of infertility, and postoperative JZmax-A. A multivariate regression analysis showed that age at surgery, VAS score of preoperative dysmenorrhea, and postoperative JZmax-A were the independent indicators correlated with pregnancy outcomes. A receiver operating characteristic curve analysis showed that postoperative JZmax-A was the most valuable indicator for predicting pregnancy outcomes. Cumulative pregnancy rates during the first 3 years were 70.1% and 20.9% in the postoperative JZmax-A ≤ 8.5 mm and the postoperative JZmax-A > 8.5 mm groups, respectively. In conclusion, double-flap adenomyomectomy could improve fertility for diffuse adenomyosis, and postoperative JZmax-A might be a promising indicator for predicting pregnancy outcomes.

Satisfaction with new patient telehealth visits for reproductive endocrinology patients in the era of COVID-19.

PurposeTo study patient satisfaction with new patient telehealth visits in a reproductive endocrinology and infertility (REI) office.MethodsA cross-sectional study in a university-based fertility clinic was completed including all new patients seen via telehealth between March 1, 2021, and August 19, 2021. Primary outcomes were perceived patient satisfaction, access, and preferences to telehealth visits.ResultsA total of 351 participants were contacted, 61.8% (n = 217) agreed to participate in the study, and 28.8% (n = 101) completed the survey. There were no significant differences in age, BMI, distance from clinic, or length of infertility with response to survey. Ninety-three percent of responders would use telehealth services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 88% and travel time for 96%. The median distance from clinic was 24 miles, and there was no significance difference in preference for telehealth visits over in person visits (p = 0.696).ConclusionsIn the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telehealth services. Based on our survey, majority of patients were satisfied with telehealth visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telehealth depending on their distance from clinic, this is reassuring because patients are satisfied with telehealth for reasons other than distance from clinic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-022-02539-4.

PD20-01 AGE AT PRESENTATION OF INFERTILE MEN HAS STABLY INCREASED OVER THE LAST TWO DECADES: ANALYSIS FROM A LONGITUDINAL STUDY

You have accessJournal of UrologyCME1 May 2022PD20-01 AGE AT PRESENTATION OF INFERTILE MEN HAS STABLY INCREASED OVER THE LAST TWO DECADES: ANALYSIS FROM A LONGITUDINAL STUDY Luca Boeri, Paolo Capogrosso, Giuseppe Fallara, Federico Belladelli, Edoardo Pozzi, Massimiliano Raffo, Christian Corsini, Luigi Candela, Antonio Costa, Daniele Cignoli, Nicolò Schifano, Alessia d'Arma, Eugenio Ventimiglia, Luca Pagliardini, Enrico Papaleo, Vincenzo Mirone, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Antonio CostaAntonio Costa More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Luca PagliardiniLuca Pagliardini More articles by this author , Enrico PapaleoEnrico Papaleo More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002558.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Population based studies have shown a significant drift towards advanced paternal age at first presentation. Similarly, length of infertility (LOI) has progressively increased over the last decade with negative impact on men’s reproductive potential. We aimed to assess trends of age at presentation over a 20-year time frame in a cohort of non-Finnish white-European men presenting for primary couple’s infertility. METHODS: Data from 3369 men who consecutively presented for primary couple’s infertility at a single academic centre between May 2003 and August 2021 were analyzed. Comorbidities were scored with the Charlson Comorbidity Index. Patients were stratified according to their educational status into a low-level (LL) (elementary or secondary school) and a high-level (HL) (high school or university). Data about the age of patients’ partners and LOI were also collected. Descriptive statistics and linear regression analyses detailed the association between demographic, clinical predictors and patient’s age at presentation. RESULTS: Throughout a 18-year time frame, median (IQR) patient’s, partner’s age and LOI were 37 (33-41) yrs, 34 (31-37) yrs and 20 (12-36) months, respectively. Patient’s (beta 0.07, p=0.03) and partner’s age at presentation (beta 0.09, p <0.001) increased over time (figure). Conversely, LOI decreased across the same time frame (beta -0.5, p <0.001). Age at presentation increased from 2003-07 to 2008-12 (p=0.02) but remained stable thereafter. On the contrary LOI significantly decreased from 2003-07 to 2008-12 (p <0.001), being stable afterwards. Partner’s age increased from 2008-2012 to 2017-2021 (all p <0.01). HL educational status was more frequently found in men presenting between 2018-21 compared to 2003-07 (50.6% vs. 31.4%; p <0.001). Multivariable linear regression analysis revealed that year of presentation (beta 0.12, p <0.001), partner’s age (beta 0.6, p <0.001), LL of education (beta -0.9, p <0.001) and LOI (beta 0.02, p <0.001) were all associated with older age at presentation. CONCLUSIONS: Both patients and partners’ age has increased over the last 18 years in primary infertile couple at first presentation. Of note, male age was almost stably high over the last 10 years while partners’ age still increased. LOI has decreased over time. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e355 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Massimiliano Raffo More articles by this author Christian Corsini More articles by this author Luigi Candela More articles by this author Antonio Costa More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Alessia d'Arma More articles by this author Eugenio Ventimiglia More articles by this author Luca Pagliardini More articles by this author Enrico Papaleo More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Biopsychosocial Analysis of Factors on COVID-19 Screening Awareness of Infertile Couples in Assisted Reproductive Technology

Background: The development of screening methods for infertility patients during the Coronavirus-2019 (COVID-19) pandemic provides new challenges in the adaptation of children's want programs in the era of the COVID-19pandemic. Several screening methods have been developed but various factors affect the awareness of couples to want to do COVID-19 screening. This study aimed to analyze biopsychosocial factors associated with awareness of COVID-19 screening in infertile couples. Subjects and Method: A cross-sectional study conducted at The Sekar Polyclinic of Dr. Moewardi Regional General Hospital during the COVID-19 pandemic. A number of 60 infertile couple of reproductive age who underwent the ART program was selected by random sampling. The dependent variable was awareness for COVID-19 screening. The independent variables were anxiety, knowledge, age, and length of infertility. The data were obtained from medical record and questionnaire and analyzed by a multiple logistic regression. Results: Anxiety (OR= 26; 95% CI; p&lt;0.001) and above-average knowledge levels (OR=16; 95% CI; p&lt;0.001) affected awareness for COVID-19 screening. While the age and length of infertility do not affect awareness for COVID-19 screening (p &gt;0.05). Conclusion: Anxiety and above-average knowledge levels affect awareness for COVID-19 screening.

PATIENT SATISFACTION WITH TELEMEDICINE VISITS FOR REPRODUCTIVE ENDOCRINOLOGY PATIENTS IN THE ERA OF COVID-19

Due to the COVID-19 pandemic, video-based telemedicine visits have become the standard in many clinical practices. Many reproductive endocrinology consultations do not require a physical exam, allowing for integration of telemedicine. The purpose of this study is to evaluate patient satisfaction with telemedicine visits in the Reproductive Endocrinology and Infertility (REI) office. This is a prospective cross-sectional study that includes any person undergoing a new patient visit at Washington University’s Reproductive Endocrinology clinic from March 1st-April 20th 2021. After the visit, patients were contacted via telephone to obtain consent to participate in an online one-time research survey. A link was sent to their email with the survey through RedCap secure web application. The survey is 25 questions which includes the telehealth usability questionnaire (TUQ) survey, a previously published tool to evaluate usability and quality of telehealth interaction, along with questions specific to the REI clinic and the participation of learners during visits. Baseline patient demographics including age, race/ethnicity, BMI, distance from clinic, and recommended treatment were collected. 117 participants were contacted, 78% (n=91) agreed to participate in the study, and 45% (n=41) completed the survey. There were no significant differences in age, BMI, distance from clinic or length of infertility with response to survey. 92.5% responders would use telemedicine services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 82.5% and travel time for 95%. The mean distance from clinic was 76 miles, and there was no significance difference in satisfaction with telemedicine services (p=0.46) or perceived access to healthcare services (p= 0.43) between those living closer or further than 76 miles. Those living further also had no preference for telemedicine visits over in person visits (p=0.134). In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telemedicine services. Based on our survey, majority of patients were satisfied with telemedicine visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telemedicine depending on their distance from clinic, this finding is reassuring because patients are satisfied with telemedicine for reasons other than distance from clinic.

RACIAL DISPARITIES IN ACCESS TO INFERTILITY CARE IN A STATE WITH MANDATED INFERTILITY COVERAGE

To investigate how race affects access to infertility care in a state with comprehensive, mandated insurance coverage for infertility services. All women seen in consult with a diagnosis of infertility at a large, academic affiliated center from January 2010 to December 2020 were included in the study. Patient age, partner age, marital status, and length of infertility at the time of initial consult were collected. Treatment utilization was determined by whether a patient underwent one or more intrauterine insemination (IUI) and/or in vitro fertilization (IVF) cycles. Race was categorized according to the U.S. Census Bureau standards which requires five minimum categories for race: “American Indian or Alaskan Native”, “Asian”, “Black”, “Native Hawaiian or Other Pacific Islander”, and “White”. Patients selecting more than one race were classified as “Two or more races”. Missing racial demographics were imputed from parental ancestry when available and patients were excluded if direct imputation was not possible. Access to care variables were compared between the racial groups using chi-square and t-test for parametric categorical and continuous variables, respectively. A total of 20,774 women met the study criteria of which 964 (4.6%) were Black, 26 (0.1%) American Indian or Alaskan Native, 2,491 (12.0%) Asian, 13 (0.1%) Native Hawaiian or other Pacific Islander, 17,098 (82.3%) White and 182 (0.9%) Two or more races. At the time of initial consult, Black women were older (36.3 vs. 34.9 years old, p<0.001) and had a longer duration of infertility (21.8 months vs. 18.2 months, p<0.001) as compared to White women. Additionally, Black women were more likely to self-pay for services (relative risk [RR] 3.0, 95% CI 2.3-3.9) and they pursued infertility treatment less frequently (RR 0.73, 95%CI 0.67-0.80 for IVF). There was no significant increase in consults among Black women over the study period (p=0.903). In contrast, the proportion of women presenting to care who identify as two or more races has increased over time (p<0.001). This group is still less likely to pursue infertility treatment compared to White women (RR 0.77, 95%CI 0.63-0.95 for IVF). The proportion of Asian women presenting to care has increased over time (p=0.003) however there remains a greater delay to infertility consult as compared to White women (19.9 vs. 18.2 months trying to conceive, p<0.001). Race impacts patient age and infertility duration at the time of initial infertility consult, as well as access to consults and infertility treatment utilization. These inequities are particularly pronounced in Black women and in women who identify with two or more races. The collection of accurate, standardized race and ethnicity data is an essential step in identifying and addressing the root causes of these health inequities.

P–512 When COVID–19 pandemic seems to be a never-ending story: Fear and anxiety do not discourage infertility patients to seek for the treatment

Study questionDo fear, anxiety and perceptions related to COVID–19 infection significantly impact infertility patients in seeking and continuing the treatment?Summary answerDespite fear and anxiety related to COVID–19 pandemic, 94.4% of infertility patients still decided to proceed with the infertility treatment. What is known already: It has been commonly acknowledged that infertility has a momentous impact on the psychological well-being of both partners. COVID–19 pandemic might significantly exacerbate the feeling of stress, anxiety and depression in patients with infertility problem. However, the concern that delaying the treatment may negatively impact the outcome has led to the continuation of infertility management during the pandemic era. In this context, social distancing and loss of social support could possibly be deepened, contributing to higher levels of distress. The patients may face a high level of uncertainty due to the inability to conceive and the spread of COVID–19 infection.Study design, size, durationThis is a cross-sectional study utilising a questionnaire distributed to infertility patient in Jakarta. All the women gave their informed consent to collect and use their data for conducting this study. An anonymous electronic survey on Google Forms web application was e-mailed to infertile couples. The purpose of this survey was explained to all participants with a brief introduction. Survey participation was voluntary.Participants/materials, setting, methodsThis study utilising a questionnaire distributed to infertility patient in Jakarta. Patients were identified, and demographic data were collected between 1 September 2020 and 25 January 2021. The survey was distributed to a total of 178 patients with phone and email reminders.Main results and the role of chanceA total of 178 patients were replied and filled the google form completely. The average age of the patients and the length of infertility were 32.6 ± 1.4 years and 60 ± 2.9 months, respectively. Most of the patients were University graduated (71.8%). Among all participants, 94.4% decided to proceed with the infertility treatment despite the COVID–19 pandemic. Ovulatory dysfunction was the most common type of infertility in women (46%). However, the percentage of the treatment delay due to hospital protocol or the patient’s decision was 39.5%. The age and the length of infertility were significantly associated with higher anxiety levels (p < 0.05). Patients knowledge regarding the COVID–19 infection was not significantly impact the level of anxiety (p > 0.05). It was demonstrated that 37.3% of the patients preferred fresh compared to frozen embryo transfer despite COVID–19 pandemic, and 33.4% of the participants admitted that they had a financial problem during the COVID–19 pandemic. However, 25.9% of the patients decided to continue the treatment during the pandemic regardless of this financial problem.Limitations, reasons for cautionThe use of a cross-sectional study may lead to limited information regarding patients’ characteristics prior to the COVID–19 pandemic. The length and implications of this pandemic are unpredictable that the outcomes of this study may not reflect sustained consequences of COVID–19 pandemic on psychological well being of women with infertility.Wider implications of the findings: It is imperative to offer emotional support to reduce stress and concerns in women with infertility. As the willingness of infertility patients to continue the treatment despite pandemic COVID–19, the risks and consequences of COVID–19 infection should be addressed in managing patients with infertility during the pandemic era.Trial registration numberNot applicable

O-076 Neurodevelopmental morbidity in children born after ART: a Nordic register study from the Committee of Nordic ART and Safety (CoNARTaS) group

Abstract Study question Does the risk of neurodevelopmental disorders differ between singletons born after various assisted reproductive techniques (ART) and spontaneous conception (SC) until young adulthood? Summary answer ART children had a slightly increased rate of learning and motor functioning disorders, autism spectrum disorders (ASD), and ADHD and conduct disorders. What is known already Studies on the impact of ART on offspring have reported both increased risk and comparable incidences of neurodevelopmental disorders between ART and SC offspring. The most studied neurodevelopmental disorders with ART are autism spectrum disorders (ASD.) There is, however, no consensus on the risk of ASD for ART children. The risk for other neurodevelopmental disorders, like attention-deficit hyperactivity disorders (ADHD) or tic disorder among ART children, is also a debated issue, as studies are scarce. Study design, size, duration A Nordic register-based cohort study including all singleton live births (N = 5 076 444) after ART (n = 116 909) or SC (n = 4 959 535) between 1995 and 2014 in Denmark and Finland, 1995 and 2015 in Sweden; and 2005 and 2015 in Norway. Children with intellectual disability (ICD-10: F70-F79) are excluded. The children are followed up to young adulthood (the year 2014 in Denmark and Finland, and 2015 in Norway and Sweden). Participants/materials, setting, methods Offspring outcomes were defined as following ICD-10 diagnoses: learning and motor functioning disorders (F80-83), ASD (F84), ADHD and conduct disorders (F90-F92), and tic disorders/Tourette (F95). We calculated crude and adjusted hazard ratios (HR) for neurodevelopmental diagnoses using Cox regression. Adjustments were made for the country, maternal age at the delivery, parity, smoking, and maternal psychiatric morbidity. Main results and the role of chance The cumulative incidences of neurodevelopmental disorders in the cohort were 1.74% for F90-F92, 1.40% for F80-83, 0.66% for F84, and 0.22% for F95. In crude Cox-regression ART children had an increased likelihood during the follow-up of being diagnosed with F84 (HR 1.12 [95% CI 1.04-1.21]) and F95 (HR 1.21 [95% CI 1.06-1.38]), but not with F80-83 (HR 1.01 [95% CI 0.96-1.07]) or F90-92 (HR 0.82 [95% CI 0.77-0.86]). After adjustments the likelihood was increased for F80-83 (HR 1.20 [95% CI 1.13-1.27]), F84 (HR 1.12 [95% CI 1.03-1.24]), and F90-92 (HR 1.09 [95% CI 1.04-1.19]), but nor for F95 (HR 1.13 [95% CI 0.99-1.30]). After adjustments, intracytoplasmic sperm injection children compared with in vitro fertilization children had similar likelihood during follow-up for F80-83 (1.06 [95% CI 0.89–1.25]), for F84 (HR 0.92 [95% CI 0.76–1.11]), for F90-92 (HR 0.96 [95% CI 0.83–1.12]), and for F95 (HR 1.16 [95% CI 0.83–1.63]). After adjustments, frozen embryo transfer children compared with fresh embryo transfer children had similar likelihood during follow-up for F80-83 (HR 1.11 [95% CI 0.90–1.37]), F84 (HR 0.98 [95% CI 0.76–1.27]), F90-92 (HR 0.96 [95% CI 0.78–1.19]), and F95 (HR 0.83 [95% CI 0.51–1.35]). Limitations, reasons for caution There may be residual confounding by unknown or unmeasured confounders. We lack information on possible confounders like the reason and length of infertility, maternal substance use other than self-reported smoking status, paternal age, and parental somatic morbidity. Additional limitations are differences in registration practice and data availability between study countries. Wider implications of the findings This is the largest singleton cohort and the first multinational study on the risk for neurodevelopmental disorders among ART children. While the rate of some neurodevelopmental disorders was increased among ART children, the absolute risk was moderate. The type of ART did not associate with the incidence of neurodevelopmental disorders. Trial registration number ISRCTN11780826

Pro-caspase-3 is constitutively expressed in luteinized granulosa cells from women undergoing controlled ovarian stimulation for in vitro fertilization

Apoptosis regulation in luteinized granulosa cells (LGC) during assisted reproduction procedures is still controversial. Caspase-3 is a major apoptosis mediator encoded by CASP3 and formed through cleavage of its precursor pro-caspase-3. The aim of this study was to investigate the expression patterns of pro-caspase-3 (mRNA and protein) and cleaved caspase-3 in human LGC. Thirty-five women undergoing controlled ovarian stimulation for in vitro fertilization were prospectively enrolled in the study. LGC were isolated from follicular fluid during oocyte pickup and evaluated by immunocytochemistry for pro-caspase-3 and cleaved caspase-3, and by real-time PCR for CASP3 mRNA expression. We found a positive staining of pro-caspase-3 in 77 % of the LGC (95 % confidence interval [CI] 60%–84%), whereas cleaved caspase-3 was found in only 4% of the cells (95 % CI 3%–6%). The abundance of cells expressing pro-caspase-3 was independent from CASP3 mRNA levels (r = 0.24, p = 0.255) and did not correlate with the amount of cleaved caspase-3 (r = -0.24, p = 0.186). Multivariable logistic regression showed that pro-caspase-3 positivity was not influenced by clinical characteristics such as age, cause or length of infertility, antral follicle count or hormonal drugs used to induce ovulation. These findings suggest that pro-caspase-3 is constitutively expressed in LGC, allowing quick cleavage into active caspase-3 and apoptosis triggering whenever needed in the course of gonadotropin-induced follicular development.

Procena zadovoljstva podrškom od strane medicinskog osoblja u procesu suočavanja sa neplodnošću

Regardless of the trend of using the patient-centred approach in (in)fertility clinics, there has been no research on satisfaction with medical staff care in Serbia yet. Accordingly, the main aim of this study is to examine the metric characteristics of the first quantitative instrument for measuring satisfaction with this type of support in Serbia - the Medical Support Assessment Questionnaire. A total of 87 women, currently facing the problem of infertility, participated in the study. The reliability of the Questionnaire is high and amounts to .96, expressed through the Kronbach's Alpha coefficient.. Using the Principal Components Method, the one-factor solution is obtained. An additional aim of the study is to examine satisfaction levels with different aspects of support. The best rated aspect of the medical staff support refers to technical skills and competencies for treatment implementation, while the worst rated aspects include emotional support by the medical staff and patient education about the emotional effects of treatment. Furthermore, the results indicate that there is no statistically significant difference in these estimates depending on the length of infertility or age of participants. The findings show that medical staff is still focused on the medical aspects of the treatment and its effectiveness instead of focusing on a holistic, patient-centred approach. These open up the space for working on integrating a holistic approach into fertility clinics in Serbia. In addition, the results highlight the importance of having an effective and reliable instrument for measuring satisfaction with medical support for the purposes of monitoring and improving the ART clinics service.

Pro caspase-3 and cleaved caspase-3 gene and protein expression in human granulosa cells correlate with cos duration, length of infertility and proportion of mature oocytes retrieved

Pro caspase-3 and cleaved caspase-3 gene and protein expression in human granulosa cells correlate with cos duration, length of infertility and proportion of mature oocytes retrieved

Ovulation induction: comparing success rates between anovulatory and ovulatory cycles using different treatment protocols

The management of patients with sub-fertility, particularly unexplained sub-fertility, is a sensitive and complex matter. This was a prospective observational study conducted from October 2016 to March 2017 in Galway, Ireland, the aim of which was to identify the clinical pregnancy rates (CPR) in women undergoing ovulation induction (OI) with timed sexual intercourse (TSI) or intrauterine insemination (IUI) and to compare them across two groups: (1) Anovulatory women and (2) ovulatory women with unexplained subfertility. Patients undergoing OI were recruited consecutively and OI regimens were prescribed as per local clinical protocol. The main observation was a higher CPR in the anovulatory group (18%) compared with the ovulatory group (CPR = 10%) (p < 0.05). No difference was observed in the CPR between the TSI and IUI groups. There are many studies to support the use of OI in the treatment of women with anovulatory subfertility, though the use of OI in ovulatory women is a more controversial issue. The treatment options offered to these patients need to be individualized to each couple and should consider their length of infertility, age, and financial means. Due to the lower cost and the less invasive nature of OI-treatment we conclude that a short treatment course could be offered as an acceptable alternative prior to IVF.

The prognostic factors for pregnancy after gonadotropin-induced controlled ovarian stimulation therapy with intrauterine insemination cycles

To identify the predictive determinants for pregnancy in patients who underwent controlled ovarian stimulation (COS) /intrauterine insemination (IUI). A total 458 gonadotropin-induced controlled ovarian stimulation and intrauterine insemination cycles in 361 couples using were studied between February 2014 and January 2018. The main outcome was clinical pregnancy rate, which has been analyzed according to baseline clinical characteristics (women age, length of infertility, day 3. follicle stimulating hormone, estradiol level) and variables related to intrauterine insemination cycle (number of preovulatory follicles, endometrial thickness), and sperm parameters (sperm concentration, sperm motility, sperm morphology and total motile sperm count (TMSC). The overall clinical pregnancy rate was 11.6% (53/458) per cycle. Clinical pregnancy rate per cycle was 12.0% (43/361) in the first cycle; 10.3% (9/87) in the second cycle, and 10% (1/10) in the third cycle. Among the predictive factors evaluated, more than 25x106 TMSC was also good predictor for clinical pregnancy. The TMSC in ejaculate proved to be a useful predictor of the chance for pregnancy after IUI treatment.

Impact of Body Mass Index on In Vitro Fertilization-Embryo Transfer Outcomes in Xinjiang, China

Background: To investigate the effect of body mass index (BMI) on the outcomes of in vitro fertilization–embryo transfer (IVF- ET) treatment, and to provide evidence for future clinical studies of infertile women with different body mass indices. Methods: The relationship between pregnancy outcome and BMI in 717 infertile women who underwent IVF- ET was analyzed. Results: A total of 531 out of 717 patients were classified as having a standard body weight, and 20 patients were classified as obese. We found a significant difference in the basal follicle-stimulating hormone (FSH) level among the groups; the basal FSH level was lower in the obese group (6.80 ± 2.20 IU/L) than in the standard weight group (7.56 ± 2.25 IU/L). However, there were no significant differences in the age of females, the age of males, basal estradiol (E2) and luteinizing hormone (LH) levels, length of infertility, and history of dysmenorrhea. Although the pregnancy rate was highest (54.6%) in the standard weight group and lowest (45.0%) in the obese group, there was no significant difference among these groups by Chi-square test analysis. Furthermore, there were no significant differences in gonadotropin-releasing hormone agonist days, number of 2PN, and the LH level on the day of human chorionic gonadotropin treatment among the groups. Conclusions: Obese women can improve a successful pregnancy rate after undergoing IVF–ET treatment by controlling weight. Key words: Body Mass Index; In vitro Fertilization–Embryo Transfer; Xinjiang Area