Likelihood Of Pregnancy Research Articles

195 Effect of selection for growth and maternal influence on crossbred Angus heifer development

Abstract This multiyear experiment was designed to determine the effects of sire yearling weight (YW) and maternal influence (MILK) expected progeny differences (EPD) on production and fertility of beef replacement heifers. Sires were classified as moderate (< 50th percentile) or high for YW EPD (122 ± 29; from 79 to 172) and as low (< 50th percentile) or high for MILK EPD (27 ± 8; from 5 to 40). Fall-born (n = 214) and spring-born (n = 207) heifers were enrolled in the study. Birth weight (BW), weaning weight (WW), and YW of the heifers were measured. In addition, reproductive tract score (RTS), dry matter intake (DMI), and average daily gain (ADG) while consuming an unprocessed grass hay diet were determined in a subsample of enrolled heifers. Neogen Igenity Beef scores (NIBS) were also run on this subset. Pregnancy rate and conception rate at fixed timed artificial insemination (FTAI) were also determined. Adjusted BW, WW and YW and RTS were analyzed using the GLIMMIX procedure of SAS (9.4, SAS Institute Inc., Cary, NC), with YW and MILK EPD as fixed effects and year of birth as random effect. Effects of sire YW and MILK classification on the likelihood of pregnancy and successful FTAI were also analyzed using the GLIMMIX procedure of SAS. Pearson correlation coefficients between independent and dependent variables were obtained using the CORR procedure of SAS. Sire MILK EPD had no effect (P ≥ 0.13) on the body weight of fall- or spring-born heifers. However, fall-born heifers were 0.12 kg and 0.34 kg heavier (P = 0.06 and 0.001, respectively) per unit increase in sire YW EPD at weaning and yearling time, respectively. There was no effect of sire YW EPD on fall-born heifer DMI as percentage of body weight (DMI % BOW; P = 0.74) nor ADG (P = 0.90) while consuming the low-energy diet. Spring-born heifers had significantly greater (all, P ≤ 0.001) adjusted BW, WW, and YW (0.02, 0.23 and 0.37 kg per unit increase in sire YW EPD, respectively. Reproductive tract score was strong and negatively correlated (P ≤ 0.001) with DMI % BOW. Heifer YW NIBS were moderate and positively correlated (P < 0.001) with ADG. There was a tendency (P = 0.09) for a weak and negative correlation between residual feed intake genetic scores and DMI % BOW. Sire genetic merit for yearling growth was transmitted to replacement heifers. However, neither ADG, nor unprocessed forage DMI % BOW was influenced by genetic potential for growth during this study. Further research is needed to assess the benefits of using genomic profile of heifers for maternal, performance and carcass traits, alongside sire EPDs, when selecting and developing beef replacement heifers.

Embryo retention and live birth in frozen embryo transfer cycles: a cohort study

To study the effect of embryo retention in the transfer catheter on pregnancy outcomes in frozen embryo transfer (FET) cycles. Retrospective cohort study. Tertiary-care academic medical center. This retrospective study involved a total of 39,118 women who underwent FET cycles at a tertiary-care academic medical from January 2016 to December 2022. Women were divided into a control group (n = 38,933) and embryo retention group (n = 185). The women in the embryo retention group had been propensity scores matched with those in the control group at a 1:4 ratio. The primary outcome was live birth (LB). The secondary outcomes were biochemical pregnancy, clinical pregnancy (CP), miscarriage, and ectopic pregnancy. The overall incidence of embryo retention in the transfer catheter was 0.47% (185/39,118). The pregnancy outcome in the embryo retention group after propensity score matching (PSM) was comparable to that before PSM, with a reduced likelihood of biochemical pregnancy (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.72-0.95), CP (OR, 0.81; 95% CI, 0.69-0.96), and LB (OR, 0.80; 95% CI, 0.66-0.97). In addition, the birth weight in the embryo retention group was higher compared with the control group. However, no differences were observed in terms of miscarriage, ectopic pregnancy, cesarean delivery, as well as gestational age both before and after PSM. Embryo retention in the transfer catheter decreases the chance of biochemical pregnancy, CP, and LB in FET cycles.

Gender differences in sleep behaviors under China’s universal two-child policy

Since 2016, China has progressively relaxed family planning policies to stimulate birth rates. This paper examines the behavioral health repercussions of China’s 2016 universal two-child policy (UTCP) by analyzing sleep pattern data from China Family Panel Studies. Napping is a composite indicator that denotes health outcomes, job quality, and personal well-being. It reveals work conditions and environments to some extent. UTCP may lead to heightened social expectations regarding pregnancy likelihood, and changes in social expectations within the workplace may make work environments less equitable and more stressful for females. Leveraging a difference-in-difference model, this paper explores how napping behaviors among the working-age cohort have responded to the policy shifts. Our analysis reveals a gender discrepancy in response to the policy, specifically, females exhibit a discernible reduction in the likelihood of napping, as well as in the duration of both daytime naps and daily sleep. Conversely, such effects are not significant among males. These results suggest policy consequences extend beyond individuals directly impacted by childbirth or contemplating parenthood. Hence, while promoting fertility is still the government’s goal, policymakers are encouraged to consider the broader challenges the female population faces from social and workplace environment factors.

Pathways to motherhood: A single-center retrospective study on fertility preservation and reproductive outcomes in patients with breast cancer

BackgroundBreast cancer treatments often have negative effects on fertility, which pose challenges among patients who want to be parents in the future. This study aimed to examine the efficacy of oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation in patients with breast cancer. MethodsThis retrospective review evaluated 42 patients with breast cancer who underwent fertility preservation at our center from January 2012 to December 2022. This review encompassed the demographic characteristics of the patients, cancer stages, treatment details, and types of fertility preservation procedures and their outcomes. ResultsThe average age at disease diagnosis was 33.4 years. Approximately 90.4% of patients presented with early-stage cancer (≤2). Of 42 patients, 26 underwent oocyte cryopreservation; 17, embryo cryopreservation; and 2, ovarian tissue cryopreservation. Further, three patients received mixed treatment. The overall live birth rate was 63.2%. There are more live births in embryo cryopreservation group. The successful pregnancy group was significantly younger and had a remarkably higher quantity of preserved oocytes/embryos than the nonsuccessful pregnancy group. The oocyte and embryo utilization rates in cryopreservation were 7.69% and 52.94%, respectively. These findings underscored the importance of prompt, informed discussions about fertility preservation options. ConclusionFertility preservation in patients with breast cancer have promising reproductive outcomes, with embryo cryopreservation being particularly effective. Prompt counseling and individualized fertility preservation strategies are important for improving the likelihood of posttreatment pregnancy. Nevertheless, future research on the long-term psychological and emotional effects of different fertility preservation methods must be performed.

Cumulative costs of reproduction in a long-lived ungulate

Abstract Cumulative costs of reproduction are predicted by life-history theories of aging, but empirical support for cumulative costs of reproduction in ungulates is limited. Examinations of the relationship between previous reproductive effort and future reproductive output are often limited to successive years. We analyzed pregnancy status, lactation duration, and age class of Elk (Cervus canadensis) in Utah, United States, from 2019 to 2022 to better understand the relationship between previous reproductive effort and future reproductive output, particularly in nonsuccessive years. Pregnancy status 1 year prior, pregnancy status 2 years prior, and age had no effect on the likelihood of pregnancy in Elk. However, lactation duration 1 year prior and lactation duration 2 years prior had a negative effect on the likelihood of pregnancy. The best-fitting model to explain the relationship between pregnancy status and previous lactation was the positive interaction between lactation duration 1 year prior and lactation duration 2 years prior. The results of our study suggest long-lasting (i.e., multiple-year), cumulative costs of reproduction can influence reproductive output in female Elk, but differences in individual quality may have an even greater influence. High-quality individuals may be able to override the costs of reproduction and minimize reproductive trade-offs.

Hope for motherhood: pregnancy after allogeneic hematopoietic cell transplantation (a national multicenter study)

AbstractImproved long-term survival rates after allogeneic hematopoietic cell transplantation (alloHCT) make family planning for young adult cancer survivors an important topic. However, treatment-related infertility risk poses challenges. To assess pregnancy and birth rates in a contemporary cohort, we conducted a national multicenter study using data from the German Transplant Registry, focusing on adult women aged 18 to 40 years who underwent alloHCT between 2003 and 2018. Of 2654 women who underwent transplantation, 50 women experienced 74 pregnancies, occurring at a median of 4.7 years after transplant. Fifty-seven of these resulted in live births (77%). The annual first birth rate among HCT recipients was 0.45%, which is >6 times lower than in the general population. The probability of a live birth 10 years after HCT was 3.4%. Factors associated with an increased likelihood of pregnancy were younger age at alloHCT, nonmalignant transplant indications, no total body irradiation or a cumulative dose of <8 Gy, and nonmyeloablative/reduced-intensity conditioning. Notably, 72% of pregnancies occurred spontaneously, with assisted reproductive technologies used in the remaining cases. Preterm delivery and low birth weight were more common than in the general population. This study represents the largest data set reporting pregnancies in a cohort of adult female alloHCT recipients. Our findings underscore a meaningful chance of pregnancy in alloHCT recipients. Assisted reproductive technologies techniques are important and funding should be made available. However, the potential for spontaneous pregnancies should not be underestimated, and patients should be informed of the possibility of unexpected pregnancy despite reduced fertility. Further research is warranted to understand the impact of conditioning decisions on fertility preservation.

Harnessing Artificial Intelligence to Predict Ovarian Stimulation Outcomes in In Vitro Fertilization: Scoping Review.

In the realm of in vitro fertilization (IVF), artificial intelligence (AI) models serve as invaluable tools for clinicians, offering predictive insights into ovarian stimulation outcomes. Predicting and understanding a patient's response to ovarian stimulation can help in personalizing doses of drugs, preventing adverse outcomes (eg, hyperstimulation), and improving the likelihood of successful fertilization and pregnancy. Given the pivotal role of accurate predictions in IVF procedures, it becomes important to investigate the landscape of AI models that are being used to predict the outcomes of ovarian stimulation. The objective of this review is to comprehensively examine the literature to explore the characteristics of AI models used for predicting ovarian stimulation outcomes in the context of IVF. A total of 6 electronic databases were searched for peer-reviewed literature published before August 2023, using the concepts of IVF and AI, along with their related terms. Records were independently screened by 2 reviewers against the eligibility criteria. The extracted data were then consolidated and presented through narrative synthesis. Upon reviewing 1348 articles, 30 met the predetermined inclusion criteria. The literature primarily focused on the number of oocytes retrieved as the main predicted outcome. Microscopy images stood out as the primary ground truth reference. The reviewed studies also highlighted that the most frequently adopted stimulation protocol was the gonadotropin-releasing hormone (GnRH) antagonist. In terms of using trigger medication, human chorionic gonadotropin (hCG) was the most commonly selected option. Among the machine learning techniques, the favored choice was the support vector machine. As for the validation of AI algorithms, the hold-out cross-validation method was the most prevalent. The area under the curve was highlighted as the primary evaluation metric. The literature exhibited a wide variation in the number of features used for AI algorithm development, ranging from 2 to 28,054 features. Data were mostly sourced from patient demographics, followed by laboratory data, specifically hormonal levels. Notably, the vast majority of studies were restricted to a single infertility clinic and exclusively relied on nonpublic data sets. These insights highlight an urgent need to diversify data sources and explore varied AI techniques for improved prediction accuracy and generalizability of AI models for the prediction of ovarian stimulation outcomes. Future research should prioritize multiclinic collaborations and consider leveraging public data sets, aiming for more precise AI-driven predictions that ultimately boost patient care and IVF success rates.

O-199 IVF success rates: challenging the concept of recurrent implantation failure

Abstract Study question What is the likelihood of pregnancy in successive IVF attempts, and how does it relate to the concept of recurrent implantation failure? Summary answer The first two IVF transfer attempts have the highest pregnancy chances, while subsequent attempts show stability, challenging the notion of recurrent implantation failure. What is known already According to the theory of recurrent implantation failure (RIF), around 10% of patients undergoing several embryo transfers fail to implant due to certain risk factors. This should eventually enrich this subset as more transfers are performed. According to conventional thinking, this group’s IVF success rates should therefore soon start to significantly fall. Recent studies on euploid embryo transfers, however, have started to challenge this idea. They suggest that the IVF success rate drop may be less than previously believed, and that RIF may be less prevalent than previously expected. Study design, size, duration This registry study of the Danish IVF registry used historical data from 1994 to 2019, comprising a large cohort of 85,453 unique women who underwent 171,159 transfers. Participants/materials, setting, methods A participant could receive up to ten transfers in a row. The live birth rate (LBR) for every transfer cycle, as well as the cumulative LBR was calculated. After achieving a pregnancy, the woman was censored. The mean age of the patients included in the study was 33.8 (33.7-33.8) years at the time of the first ovarian stimulation with a mean BMI of 24.2 kg/m2. Main results and the role of chance The median number of stimulations was 2 and a total median number of 8 oocytes were obtained per patient. The first two transfer-attempts had the highest LBR, with 38.48% and 33.99%, respectively. Subsequent attempts showed a gradual decline but maintained relative stable: the LBR was 30.61% in the third attempt, followed by 28.00% for the fourth and 27.14% for the fifth attempt.Beyond the fifth attempt, the success rates were around 25%. Moreover,we conducted an analysis of 25,433 transfers performed from 2017-2019 transfers, predominantly involving blastocyst-transfers. Herein, the LBRs were higher: 42.31% in the first attempt and 37.81% in the second attempt. Like in the whole cohort, subsequent cycles demonstrated a gradual decline in LBR, however with the 8th attempt still yielding 28.87%. Notably, cumulative live birth rates (CLBR) revealed a steady increase for those having enough blastocysts to transfer: By the fifth attempt, the CLBR had reached 89.86%, and this trend continued to rise, culminating in 98.40% CLBR after the tenth attempt. These findings challenge the conventional notion of RIF,as they suggest that, while a slight decline in LBR is evident with additional IVF attempts, the cumulative chances of achieving a livebirth remain substantial for patients able to pursuing multiple cycles. Limitations, reasons for caution As a retrospective register study, we relied on historical data from 1994 to 2019. It does not take potential changes in clinical practices over time or patient-specific factors that may influence fertility, such as age, underlying conditions, or specific treatment protocols into account. Wider implications of the findings Our findings challenge the conventional understanding of RIF in IVF. The consistency of pregnancy rates over several transfers may have significant effects on patient counseling and clinical practice. Understanding that IVF success is possible even after multiple attempts may reduce anxiety, making informed decisions for couples pursuing reproductive treatments easier. Trial registration number not applicable

P-126 The impact of ICSI versus IVF on the reproductive outcomes of couples with non-male factor infertility and frozen-thawed embryo transfer cycles

Abstract Study question Does Intracytoplasmic Sperm Injection (ICSI) improve reproductive outcomes in patients with non-male factor infertility undergoing Frozen-Thawed Embryo Transfer (FET) treatment? Summary answer ICSI showed slightly improved clinical outcomes compared to IVF, but was associated with higher preterm birth rates and low birthweight when twins were born. What is known already The use of ICSI has seen a significant surge globally, particularly in Europe and the USA, as a solution for fertilization failure resulting from male factor infertility. FET presents a viable option for those considering additional children. Numerous studies have investigated the effectiveness of ICSI in couples with non-male factor infertility undergoing fresh embryo transfer in ovarian stimulation cycles. However, there is a dearth of evidence demonstrating whether ICSI, compared to conventional IVF (cIVF), could influence reproductive outcomes in couples with non-male factor infertility undergoing FET treatment. Study design, size, duration This retrospective cohort study included 10,143 cycles from 6,206 couples who underwent FET at the Third Affiliated Hospital of Zhengzhou University between January 2016 and September 2022. Participants/materials, setting, methods Patients were categorized into two groups based on the insemination methods used for the transferred embryos. Patients were excluded if : 1) Embryos were biopsied and tested; 2) Oocytes had been vitrified; 3) Embryos were derived from donor oocytes, AOA treatment, or rescue ICSI; 4) Embryos that were not transferred; and 5) They had undergone fresh embryo transfer. PSM at a ratio of 1:1 was utilized to ensure comparability of reproductive outcomes. Main results and the role of chance Post-PSM, the general characteristics were comparable across both groups. The clinical pregnancy rates (37.6% vs 40.0%, P = 0.311), miscarriage rates (21.4% vs 23.1%, P = 0.597), and live birth rates (28.2% vs 30.4%, P = 0.329) exhibited no significant disparity post-PSM between the two groups. Notably, a marginally elevated live birth rate was observed in the ICSI group when blastocysts were transferred to the women (39.8% vs 48.3%, P = 0.050). However, the GEE models indicated that ICSI did not enhance the likelihood of clinical pregnancy, miscarriage, and live birth relative to IVF in women with non-male factor infertility. Following adjustments for variables, ICSI yielded consistent OR values [1.14(0.92-1.42), P = 0.241; 1.08(0.72-1.61), P = 0.703; and 1.16(0.92-1.46), P = 0.220, respectively]. The perinatal outcomes were similar between the two grousps. However, a significantly higher incidence of preterm birth was observed in the ICSI group compared to the cIVF group (20.0% vs 12.5%, P = 0.026). While pregnancy complications were comparable between the two groups, neonates born as twins in the ICSI group exhibited significantly reduced live birth-weight [2520.8(572.9) vs 2691.9(423.7), P = 0.043] and birth length [47.5(2.8) vs 48.5(2.3), P = 0.031]. Correspondingly, the rate of low birthweight was significantly higher in the ICSI group (38.9% vs 21.0%, P = 0.025). Limitations, reasons for caution The retrospective design may lead to selection bias among the included patients. The use of ICSI in ART has been strictly regulated in our country, limiting the sample size and potentially reducing the statistical power. Wider implications of the findings The value of ICSI should be thoroughly discussed with patients with non-male factor infertility before ovarian stimulation. Further research is needed to better understand the impact of ICSI on reproductive and neonatal outcomes in this population. Trial registration number 2021YFC2700602

O-296 The benefits of higher concentrations of synthetic serum substitutes in post-warming embryo culture and transfer media: a retrospective study of 864 frozen blastocyst transfer cycles

Abstract Study question Does a higher concentration of synthetic serum substitutes (SSS) in post-warming embryo culture and transfer media improve clinical outcomes in frozen blastocyst transfer (FBT) cycles? Summary answer Increased SSS concentration in post-warming embryo culture and transfer media reduces miscarriage rate in FBT cycles and improves ongoing pregnancy rate in euploid blastocyst transfer. What is known already Several studies showed increased clinical pregnancy rates with the use of complex protein supplementation such as SSS in embryo culture media. Nevertheless, there is a lack of standardization on their concentrations. The range of concentrations employed is strikingly wide, spanning from 5% to 50%. Moreover, no studies investigating different SSS supplement concentrations in post-warming embryo culture and transfer media in FBT cycles are available. These uncertainties warrant further investigation in this field. Study design, size, duration This retrospective study included 864 patients undergoing vitrified-warmed euploid (n = 102) and untested (n = 762) blastocyst transfers between September 2022 and August 2023. The cohort was divided based on the concentration of SSS used in post-warming embryo culture and transfer media: 10% (n = 415) and 20% (n = 449). The exclusion criteria were ICSI-cycles performed with surgically retrieved or frozen sperm, gamete donation and vitrified-warmed oocyte cycles. Prior to embryo transfer, warmed blastocysts were cultured for 2-3 hours. Participants/materials, setting, methods Treatment allocation to 10% or 20% SSS groups followed an alternating regimen. To reduce any pre-existing differences between the two groups, a propensity-score (PS) analysis was performed, targeting unbiased treatment effect estimates. Variables included in the PS were: maternal age, maternal BMI, infertility type, transfer day, endometrial preparation, blastocyst quality, and the operators for biopsy, warming, and transfer. Main results and the role of chance Patient baseline characteristics were evenly distributed in the two study groups. After the PS-based analysis, no statistically significant differences in ongoing pregnancy rates for both overall and untested blastocyst transfers were observed between 10% and 20% SSS groups. However, the 20% SSS group exhibited a significantly lower miscarriage rate in overall FBTs [OR = 0.61, 95% CI (0.37-1.00), p-value=0.050] and a higher ongoing pregnancy rate in euploid blastocyst transfers [OR = 3.48, 95% CI (1.30-9.35), p-value=0.013]. A mild trend of an increased miscarriage rate was also observed in both euploid and untested blastocyst transfers in the 10% SSS group compared to the 20% SSS group [OR = 2.834, 95% CI (0.651-12.337), p-value=0.165; OR = 1.558, 95% CI (0.897-2.705), p-value=0.115 respectively]. Limitations, reasons for caution The study is limited by its retrospective design and a lack of randomization, although a PS-based analysis may mitigate such a weakness. Not considering live birth rate as outcome and protein concentrations higher than 20% and lower than 10% might represent other study limitations. Wider implications of the findings To our knowledge, this is the first study investigating the impact of varying protein supplementation concentrations in post-warming embryo culture and transfer media on clinical outcomes in FBTs. Our findings suggest that higher serum concentrations improve the likelihood of ongoing pregnancy, especially in blastocysts undergoing stressful manipulations such as biopsy. Trial registration number not applicable

P-413 Retrospective observational study: evaluating progesterone levels on the day prior to euploid embryo transfer and its impact on pregnancy rate

Abstract Study question What significance does progesterone levels hold on the day prior to the transfer of euploid embryos, and how is this correlated with pregnancy rates? Summary answer Progesterone levels prior to embryo transfer play a crucial role in endometrial receptivity What is known already In the realm of assisted reproductive technology, creating optimal conditions for embryo transfer is crucial for successful pregnancies. Progesterone, a key hormone for endometrial receptivity, plays a pivotal role in this process. This retrospective observational study aims to evaluate the importance of progesterone levels the day before euploid embryo transfer and their correlation with pregnancy rates. For this reason, we study patients with low progesterone levels prior to transfer and the effectiveness of “rescue protocols”. Study design, size, duration This was a Retrospective Observational Study, that covers 121 women who underwent embryo transfer (euploid embryos and oocyte donation) who had their progesterone measured the day before the transfer, from January 1st 2023– December 31st 2023. The primary endpoint was pregnancy rate. Participants/materials, setting, methods During the study period, endometrial preparation was carried out by administration of progesterone, both orally or vaginally. The patients were divided into three groups based on the level of progesterone the day before the embryo transfer. • &amp;gt;10ng/mL • 8-10 ng/mL • &amp;lt;8ng/mL. These participants were treated with the daily administration of 1 or 2 doses of injectable Prolutex until confirmation of pregnancy by ultrasound. Eligible patients were aged ≤50 years with adequate endometrium thickness after receiving estrogen. Main results and the role of chance Preliminary findings underscore a significant correlation between progesterone levels exceeding 10 ng/ml the day before embryo transfer and elevated pregnancy rates. Conversely, in cases with lower progesterone levels, a personalized supplementation approach involving Prolutex demonstrates positive impacts on pregnancy outcomes. This highlights the pivotal role of tailored progesterone supplementation, utilizing Prolutex, in enhancing endometrial receptivity and, consequently, elevating the likelihood of successful pregnancies. The study emphasizes the need for personalized strategies, shedding light on the nuanced interplay between progesterone levels, supplementation methods, and the potential influence on reproductive success. As we explore these results, it becomes evident that chance alone does not govern outcomes; rather, strategic interventions hold the key to optimizing the path to successful pregnancies. Limitations, reasons for caution The main limitation of the study is the lack of randomized control studies. Furthermore, in this study, we are not including as the main group those who with low progesterone do not undergo rescue intervention with Prolutex. Wider implications of the findings Preliminary findings reveal a substantial link between progesterone levels exceeding 10 ng/ml before embryo transfer and heightened pregnancy rates. Conversely, in cases of lower progesterone, personalized Prolutex supplementation positively influences outcomes, emphasizing the pivotal role of tailored progesterone strategies in optimizing endometrial receptivity for successful pregnancies. Trial registration number not applicable

O-250 Never a lost cause: can artificial intelligence (AI)-powered ranking help decrease time to pregnancy when only poor-quality embryos are available?

Abstract Study question Can an objectively trained AI system complement embryologists in their ranking of embryos and minimize time to pregnancy, when only poor-quality embryos are available? Summary answer An objective AI algorithm could have decreased cycle to pregnancy by 18% in cohorts of embryos where only poor-quality embryos were available. What is known already Morphokinetics is a key criterion for embryologists to rank embryos as good, fair, or poor quality, with the latter frequently being discarded. Although poor-quality embryos can still lead to a pregnancy, selection of a viable embryo remains challenging to embryologists due to their depleted morphological characteristics. Unlike embryologists, an AI can be trained to see beyond embryo morphological quality, on data that includes many poor-quality embryos that resulted in a pregnancy. As such, AI has the potential to recognize viable poor-quality embryos, which becomes especially crucial in cases where good or fair embryos are unavailable from the embryo pool. Study design, size, duration Data from a French center was acquired through a MIRI® (ESCO) time-lapse system and uploaded on EMBRYOLY, between January 2022 and March 2023. For a total of 204 patients (women’s average age 35 y.o.), embryologists were faced with having to choose an embryo to transfer among 4.3 ± 1.7 poor-quality embryos either because the cohort was composed of only poor-quality embryos or because higher quality embryos had already been transferred. Participants/materials, setting, methods A previously described deep learning algorithm trained on videos of developing embryos with known pregnancy outcome was used to score embryos according to their chances of leading to a clinical pregnancy (fetal heartbeat between 6-9 weeks). A 2D ResNet model was trained, validated and tested on 8138 images of day 5 embryos annotated by senior embryologists to identify those of poor-quality (Gardner grade ICM and/or TE = C, corresponding to 44.7% of the dataset). Main results and the role of chance The association between video predictions and pregnancy was assessed with a logistic regression. A McNemar test was used to compare cycle to pregnancy (CTP) with and without EMBRYOLY’s hypothetical impact. EMBRYOLY’s AI was able to rank poor-quality embryos, as illustrated by a 2-7% relative increase in likelihood of clinical pregnancy observed with an increase in the video score (logistic regression with unit level +0.02, OR = 1.04, 95CI = [1.02-1.07], N = 261 transferred embryos, p &amp;lt; 0.05). EMBRYOLY’s first choice was concordant with the embryologists’ first choice in 74% of the cases that led to a pregnancy (N = 42 embryos). For patients who had two poor-quality embryos transferred with at least one pregnancy (N = 14 cycles), the results show that if the embryologist had first transferred the highest EMBRYOLY-ranked embryo, the number of cycles to pregnancy would have been reduced by 18% (from 1.7 to 1.4, McNemar, p &amp;lt; 0.05), corresponding to a median of 2.3 months. Limitations, reasons for caution The endpoint used was clinical pregnancy as measured by fetal heartbeat, and does not indicate the probability of live birth. The current investigation was performed with retrospective data from a single center. In the future, a multi-centre evaluation should be performed to generalize our findings. Wider implications of the findings Our findings support that an objectively trained AI can help embryologists not miss out on poor-quality embryos that can lead to a pregnancy, which is all the more important to target when good or fair embryos are unavailable from the embryo pool. Trial registration number not applicable

P-170 Clinical evaluation of an image-based artificial intelligence model for embryo selection: a double-blinded randomized comparative reader study

Abstract Study question What is the performance of an image-based artificial intelligence (AI) model for ranking blastocyst stage embryos compared to embryologists using traditional morphology? Summary answer The AI was non-inferior to manual embryo selection. The AI showed significant improvement in clinical pregnancy when there was disagreement between AI and manual selection. What is known already In previous work, we developed an image-based AI model that predicts the likelihood of clinical pregnancy by analyzing a single static image of a blastocyst captured prior to biopsy or freeze. This model was trained on data from over 8,000 single-blastocyst transfer cycles from multiple U.S. IVF clinics performed between 2014 to 2021. Study design, size, duration We performed a retrospective, double-blinded, comparative reader study. The study included data from 438 single-blastocyst transfers from 10 different IVF clinics in U.S. that were not part of previous model development or testing. Using this data, a set of 1,257 virtual patient panels were created. Each virtual patient panel included between 2-5 embryos that were matched by age (18 - 29, 30 - 34, 35 - 37, ≥38), race (white, non-white, and unknown) and PGT-status. Participants/materials, setting, methods A group of 5 embryologists (readers) with varying levels of experience were asked to select their top embryo for transfer for each virtual patient panel (control arm) based on morphology grades. The AI model was also used to select a top embryo for transfer from each patient panel (treatment arm). The clinical pregnancy rates of the top-selected embryos were calculated and compared. Main results and the role of chance There was disagreement on the top pick embryo amongst the five embryologists 34.6% of the time, which increased to 43.9% when there were 3 or more embryos to choose from, supporting the need for a tool to standardize this decision. The clinical pregnancy rate of the control arm (average of embryologist readers) was 61.0% (individual rates of 58.9%, 59.6%, 61.5%, 61.6%, and 63.3%), and the clinical pregnancy rate of the treatment arm (AI model) was 62.3% (demonstrating non-inferiority with p&amp;lt;.001). The pregnancy rate of random embryo selection was 53.2%. All 5 of the embryologist readers agreed on the top-pick embryo 65% of the time. When all 5 readers agreed, the AI model disagreed with that consensus 31% of the time, and in these cases the AI model pregnancy rate was significantly higher by 8.6% (AI: 63.1%, Embryologist Consensus: 54.5% (p &amp;lt; 0.05)). Limitations, reasons for caution While data for this study was collected prospectively, the analysis was done retrospectively. Furthermore, readers were provided morphology grades from retrospective data rather than grading the embryos themselves. However, it is common for an embryologist to make an embryo selection based on morphology grades previously assigned by a different embryologist. Wider implications of the findings The AI model was able to select the top embryo for transfer with performance comparable to experienced embryologists. Such a model could allow for automated and objective embryo selection using a single static image of blastocyst stage embryos. Trial registration number NA

P-140 Does assessment of time-lapse videos result in improved prediction of clinical pregnancy compared to assessment of single images of blastocysts?

Abstract Study question Is there a difference in performance between artificial intelligence(AI) algorithms that predict the likelihood of pregnancy from a single blastocyst image compared to time-lapse videos? Summary answer The performance of AI to predict pregnancy from a single blastocyst image was similar to the performance of an AI using time-lapse video. What is known already Vitrolife’s “iDAScore (iDA)” and Presagen’s Life Whisperer Viability (LW) are AI systems trained on videos (iDA) or images (LW) of blastocysts, with corresponding pregnancy outcomes (fetal heartbeat). iDA requires a dedicated time-lapse incubator and uses multiple images to predict pregnancy. LW requires only one image taken with a camera that meets image quality requirements. However, as tools for selecting viable embryos for transfer, these methods adopt different approaches: iDA relying on multiple morphokinetic timepoints to achieve prediction based on past embryo development, and LW relying on predictive analytics from morphological assessment at the decision point prior to transfer. Study design, size, duration 359 embryos cultured in EmbryoScope +/8 that reached blastocyst stage (Gardner classification ≥1) on Day 5 were utilised for first single vitrified blastocyst transfer (between 2018-2021). Pregnancy prediction was scored from EmbryoScope’s embryo images using iDA and LW, and a dataset was created with fetal heartbeat as the outcome. Participants/materials, setting, methods iDA data was classified into quartiles (Low, Medium, High, Very High) and LW into the manufacturers’ recommended four categories (Low, Medium, High, Very High). The trend of pregnancy outcome and respective scores were evaluated using a trend test (Cochran-Armitage test). Additionally, the Quadratic Weighted Kappa coefficient was used to evaluate the concordance of the categories. The Area Under the Roc Curve (AUC) for each prediction accuracy was also determined and compared using Delong’s test. Main results and the role of chance A trend of increasing pregnancy rate was observed for both methods as the score category increased (iDA: Low 35.2%, Medium 46.9%, High 52.1%, Very High 65.4%; LW: Low 36.0%, Medium 46.3%, High 60.5%, Very High 63.4%). The respective AUCs were iDA: 0.635 LW: 0.627, (not significantly different; P = 0.732). The Quadratic Weighted Kappa coefficient was 0.622, indicating that the categories of evaluation were consistent. Limitations, reasons for caution This is a retrospective study performed in a single clinic. In addition, the study was limited to transfer cycles of embryos where blastocyst formation was reached on day 5 of culture. Wider implications of the findings These results indicate that an AI that predicts pregnancy from a single blastocyst image can perform equally well compared to AI that predicts pregnancy from time-lapse videos. This suggests that tracking of morphokinetic timepoints during embryo development may be less important than end-point morphology for predicting pregnancy at blastocyst stage. Trial registration number not applicable

Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study

BackgroundRecent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders.MethodsUtilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes “Shadow of the past,” reflecting past experiences, and “Shadow of the future,” reflecting future imaginaries, building upon the existing “Narrative Framework.”ResultsThe Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The “Shadow of the present” was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future.ConclusionsThis study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.

Predicting the Outcomes of In Vitro Fertilization Using Baseline Maternal Serum Inflammatory Markers: A Retrospective Cohort Study.

Achieving pregnancy through in vitro fertilization (IVF) remains a challenge, with less than one-third of women succeeding. There is a pressing need for reliable predictive tools to assess the likelihood of post-IVF pregnancy. While some serum inflammatory biomarkers have been investigated for their predictive potential, substantial knowledge gaps persist. This study examined the utility of different inflammatory markers in predicting IVF outcomes. Inflammatory markers including the white blood cell count, neutrophil-to-lymphocyte ratio (NLR), platelet count, mean platelet volume, platelet distribution width, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate, and vitamin D3 were assessed. Study outcomes were chemical pregnancy (positive serum beta-human chorionic gonadotropin 2 weeks post-embryo transfer), clinical pregnancy (detection of pregnancy sac via transvaginal ultrasonography), and viable pregnancy (detection of fetal heart rate). Univariate and multivariate logistic regression analyses were conducted, with multivariate analysis incorporating age, body mass index, infertility duration, type, and etiology, as well as all studied serum inflammatory markers, embryo count, stage, quality, and endometrial thickness. Lower NLR (p<0.001, odds ratio [OR]=0.372 [0.247-0.559]) and CRP (p=0.035, odds ratio=0.956 [0.916-0.997]) predicted chemical pregnancy in univariate analysis, with NLR maintaining significance in multivariate analysis (p=0.022, OR=0.319 [0.120-0.848]). Lower NLR (p<0.001, OR=0.309 [0.198-0.482]) and PLR (p=0.013, OR =0.994 [0.990-0.999]) predicted clinical pregnancy, with NLR surviving multivariate analysis (p=0.005, OR = 0.217 [0.075-0.626]). Lower NLR (p<0.001, OR = 0.320 [0.198-0.516]) also predicted viable pregnancy, maintaining statistical significance in multivariate analysis (p = 0.002, OR = 0.177 [0.058-0.541]). Other studied inflammatory markers did not predict IVF outcomes. NLR emerged as a robust independent predictor of pregnancy attainment after IVF.

Uterine tone: A neglected criterion for the selection of bovine embryo transfer recipients.

This study evaluated the relationship between CL features assessed by ultrasound (luteal tissue area and blood flow, BF) or rectal palpation (size), uterine tone (UT), plasma progesterone (P4) concentration on Day 7 (D7) and subsequent pregnancy outcomes in bovine embryo recipients. A total of 163 cows and heifers were included in this study. The expected day of ovulation after the synchronization protocol was designated as D0. On D7, ovaries and uterus were examined by ultrasonography and rectal palpation, and subjective scores (1-3 scale) were assigned for CL size, area and BF, and for UT. Blood samples were collected for further P4 analysis. Each embryo recipient then received a grade I frozen-thawed invivo-produced blastocyst, which was transferred to the uterine horn ipsilateral to the CL. Pregnancy diagnosis was performed on D35, and the results were retrospectively compared with the assigned scores for CL and UT. We observed a significant (p < .02) interaction between CL size and UT, with a progressive increase in the likelihood of pregnancy for recipients bearing a large CL among those with turgid UT. Ultrasound scoring of the CL using B-mode and Doppler-mode did not significantly predict pregnancy rates on D35 (p < .6 and p < .5, respectively). However, logistic regression analysis revealed a trend towards a quadratic effect (p < .08 and p < .06) indicating that the probability of pregnancy varied according to the area of luteal tissue and P4 concentrations, respectively. No significant (p > .05) association was found between the probability of pregnancy and the BF area of the CL. In summary, UT before embryo transfer may reflect successful recipient synchronization. Elevated P4 levels, assessed by CL size, may offset uterine contractility, mitigating adverse effects. Additionally, the CL area may be more important than its vascularization area when evaluating recipients D7 after ovulation.

Impact of varicocele repair on semen parameters and spontaneous pregnancy: An endless debate put to rest

ABSTRACT There has been much controversy about the true value of varicocele repair for improving fertility and the chances of natural conception. This review summarizes the latest research findings, current professional societies’ recommendations, and the conclusions of recent systematic reviews and meta-analyses. The current evidence suggests a positive role for varicocele repair in improving basic sperm parameters and increasing the likelihood of natural pregnancy.

Advanced strategies for single embryo selection in assisted human reproduction: A review of clinical practice and research methods

Among the primary objectives of contemporary assisted reproductive technology research are achieving the births of healthy singletons and improving overall fertility outcomes. Substantial advances have been made in refining the selection of single embryos for transfer, with the aim of maximizing the likelihood of successful implantation. The principal criterion for this selection is embryo morphology. Morphological evaluation systems are based on traditional parameters, including cell count and fragmentation, pronuclear morphology, cleavage rate, blastocyst formation, and various sequential embryonic assessments. To reduce the incidence of multiple pregnancies and to identify the single embryo with the highest potential for growth, invasive techniques such as preimplantation genetic screening are employed in in vitro fertilization clinics. However, new approaches have been suggested for clinical application that do not harm the embryo and that provide consistent, accurate results. Noninvasive technologies, such as time-lapse imaging and omics, leverage morphokinetic parameters and the byproducts of embryo metabolism, respectively, to identify noninvasive prognostic markers for competent single embryo selection. While these technologies have garnered considerable interest in the research community, they are not incorporated into routine clinical practice and still have substantial room for improvement. Currently, the most promising strategies involve integrating multiple methodologies, which together are anticipated to increase the likelihood of successful pregnancy.

Association of ambient air pollutant mixtures with IVF/ICSI-ET clinical pregnancy rates during critical exposure periods

Abstract STUDY QUESTION Does exposure to a mixture of ambient air pollutants during specific exposure periods influence clinical pregnancy rates in women undergoing IVF/ICSI-embryo transfer (ET) cycles? SUMMARY ANSWER The specific exposure period from ET to the serum hCG test was identified as a critical exposure window as exposure to sulfur dioxide (SO2) or a combination of air pollutants was associated with a decreased likelihood of clinical pregnancy. WHAT IS KNOWN ALREADY Exposure to a single pollutant may impact pregnancy outcomes in women undergoing ART. However, in daily life, individuals often encounter mixed pollution, and limited research exists on the effects of mixed air pollutants and the specific exposure periods. STUDY DESIGN, SIZE, DURATION This retrospective cohort study involved infertile patients who underwent their initial IVF/ICSI-ET cycle at an assisted reproduction center between January 2020 and January 2023. Exclusions were applied for patients meeting specific criteria, such as no fresh ET, incomplete clinical and address information, residency outside the 17 cities in the Sichuan Basin, age over 45 years, use of donor semen, thin endometrium (&amp;lt;8 mm) and infertility factors unrelated to tubal or ovulation issues. In total, 5208 individuals were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Daily average levels of six air pollutants (fine particulate matter (PM2.5), inhalable particulate matter (PM10), SO2, nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)) were acquired from air quality monitoring stations. The cumulative average levels of various pollutants were determined using the inverse distance weighting (IDW) method across four distinct exposure periods (Period 1: 90 days before oocyte retrieval; Period 2: oocyte retrieval to ET; Period 3: ET to serum hCG test; Period 4: 90 days before oocyte retrieval to serum hCG test). Single-pollutant logistic regression, two-pollutant logistic regression, Quantile g-computation (QG-C) regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate the influence of pollutants on clinical pregnancy rates. Stratified analyses were executed to discern potentially vulnerable populations. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate for participants during the study period was 54.53%. Single-pollutant logistic models indicated that for PM2.5 during specific exposure Period 1 (adjusted odds ratio [aOR] = 0.83, 95% CI: 0.70–0.99) and specific exposure Period 4 (aOR = 0.83, 95% CI: 0.69–0.98), and SO2 in specific exposure Period 3 (aOR = 0.92, 95% CI: 0.86–0.99), each interquartile range (IQR) increment exhibited an association with a decreased probability of clinical pregnancy. Consistent results were observed with dual air pollution models. In the multi-pollution analysis, QG-C indicated a 12% reduction in clinical pregnancy rates per IQR increment of mixed pollutants during specific exposure Period 3 (aOR = 0.89, 95% CI: 0.79–0.99). Among these pollutants, SO2 (33.40%) and NO2 (33.40%) contributed the most to the negative effects. The results from BKMR and QG-C were consistent. Stratified analysis revealed increased susceptibility to ambient air pollution among individuals who underwent transfer of two embryos, those with BMI ≥ 24 kg/m2 and those under 35 years old. LIMITATIONS, REASONS FOR CAUTION Caution was advised in interpreting the results due to the retrospective nature of the study, which was prone to selection bias from non-random sampling. Smoking and alcohol, known confounding factors in IVF/ICSI-ET, were not accounted for. Only successful cycles that reached the hCG test were included, excluding a few patients who did not reach the ET stage. While IDW was used to estimate pollutant concentrations at residential addresses, data on participants’ work locations and activity patterns were not collected, potentially affecting the accuracy of exposure prediction. WIDER IMPLICATIONS OF THE FINDINGS Exposure to a mixture of pollutants, spanning from ET to the serum hCG test (Period 3), appeared to be correlated with a diminished probability of achieving clinical pregnancy. This association suggested a potential impact of mixed pollutants on the interaction between embryos and the endometrium, as well as embryo implantation during this critical stage, potentially contributing to clinical pregnancy failure. This underscored the importance of providing women undergoing ART with comprehensive information to comprehend the potential environmental influences and motivating them to adopt suitable protective measures when feasible, thereby mitigating potential adverse effects of contaminants on reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This work received support from the National Key Research and Development Program of China (No. 2023YFC2705900), the National Natural Science Foundation of China (Nos. 82171664, 81971391, 82171668), the Natural Science Foundation of Chongqing Municipality of China (Nos. CSTB2022NSCQ-LZX0062, CSTB2023TIAD-KPX0052) and the Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (No. 2021KFKT013). The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.