Method Of Infertility Treatment Research Articles

#230 : The Effectiveness of Spermatid Injection (ROSI, ELSI) Versus Spermatozoa Injection (ICSI) in Infertility Treatment for Men with Non-Obstructive Azoospermia (NOA)

Background and Aims: About 1% of men suffer from azoospermia, a condition of having no sperm in the ejaculate. Non-obstructive azoospermia, which affects 60% of azoospermia patients, is the most severe form of male infertility and requires testicular sperm extraction for sperm retrieval. Despite a 50% success rate, if no mature sperm is found, NOA men have no choice become biological fathers. To overcome this, researchers have attempted to use spermatid injection techniques, such as round spermatid injection (ROSI) or elongating/elongated spermatid injection (ELSI), to give hope for pregnancy. Spermatids are immature sperm but contain a haploid genome as spermatozoa. The aim of this prospective cohort study was to evaluate the effectiveness of ROSI and ELSI in cases where spermatozoa were unavailable. Method: Ninety-nine men diagnosed with NOA were recruited for the study. When the male partners lack spermatozoa in the testicular biopsy but have normal good-looking spermatids, they are consulted to join in the research. The intervention group received ROSI and ELSI, while the control group received spermatozoa injection into oocytes (ICSI). The primary outcome measures were fertilization, embryo development, clinical pregnancy, and live birth rate. Results: The overall fertilization rate (2PN) per MII oocyte injected after ROSI was low at 31.0% compared to ELSI and ICSI at 67.7% and 77.2%, respectively. The pregnancy rate after ROSI was also low, with 3.3% per transferred cycle and 2.2% per embryo transferred. The pregnancy rate of ROSI was much lower than ELSI (42.9%) and ICSI (55.6%). Normal pregnancy and live birth resulted in three groups (Table 1). Conclusion: ROSI and ELSI can be considered alternative methods of infertility treatment in cases where spermatozoa are unavailable.

Surrogacy Contract: Legal Qualification And Individual Content Elements

As part of the study, the author proposed the concept of a surrogacy contract — this is an agreement that is a substantive element of the contract for the provision of a comprehensive medical service aimed at overcoming the reproductive dysfunction of the parents (customer) through non-invasive replacement of unhealthy reproductive organs of the parents (customer) with healthy reproductive organs of the reproductive donor assistance of medical support of a specialized medical institution accredited to carry out the relevant procedures. Taking into account the subject of this agreement, the position is argued that its regulation should relate exclusively to the civil law plane as a kind of contract for the provision of services for compensation. The essential conditions of such an agreement are indicated: the subject matter, the irrevocable consent of the reproductive donor to record the customer as parents, as well as the amount of monetary compensation equivalent to the temporary loss of health of the reproductive donor in connection with the fulfillment of the obligations assumed under the contract. The author points out that this method of infertility treatment is a kind of donation that has certain specific features, in particular, it does not require the removal and transfer of reproductive donor organs to persons suffering from reproductive dysfunction. This also determines the essence of the role performed by the reproductive donor — the temporary provision of a healthy reproductive system for carrying an implanted embryo.

Interventions promoting mental health dimensions in infertile women: a systematic review

BackgroundScientific developments have brought hope to infertile couples; however, the results are not always favorable. This makes women suffer psychological pressure. Therefore, previous studies have investigated the effectiveness of many psychological interventions but no research identified the most common psychological interventions. In this regard, the present review aimed to investigate different psychological interventions that promote mental health in infertile to identify the most frequent (common) ones.MethodsIn the present study, the search was carried out using appropriate keywords Infertility, psychological interventions, mental health, stress, anxiety, depression and women in the Google Scholar، Magiran، SID، Pubmed، Scopus، Science Direct، ProQuest، Web of Science databases and One of the leading websites in health- WHO with Persian and English languages and two operators of “AND” and “OR” between 2000 and 2021.ResultsFirst, 7319 articles were searched, 6948 articles of which were removed due to irrelevant subjects, and 31 articles were removed due to duplication. 340 abstracts were examined and the results of 60 articles were extracted. Two approaches (examining the type and content of intervention) were used to extract findings. The first approach indicated high diversity in psychological interventions, leading to the categorization of the interventions into 4 categories of cognitive behavioral therapy (CBT), mind-body interventions (MBI), stress management skills, and others. CBT and MBI and stress management skills were found as the most frequent promoting interventions for mental health in infertile women. The second approach indicated the differences in protocols (number of sessions and time of interventions).ConclusionDespite differences in protocol of interventions under study, the results of all articles revealed the effectiveness of interventions in improving infertile women’s mental health; therefore, it is suggested to apply the most common psychological interventions based on scientific evidence (CBT, MBI, and stress management skills) along with infertility treatment methods. The results will help the specialists, policy-makers, and planners to select and implement the most appropriate psychological interventions for infertile women.

THE ISSUE OF ADVERSE EFFECTS IN CASE OF VITRO FERTILIZATION

The article deals with the issues of regulation of practical activities related to the use of assisted reproductive technologies (ART). Currently, disputes about the quality and the results of in vitro fertilization, surrogacy and the use of other methods of infertility treatment are considered to be mainly in the realm of civil litigation. However, even the most high-tech medical devices are associated with a certain degree of risk to life and health. Cases of fatal outcomes among mothers or babies after the use of ART lead to the initiation of criminal cases against healthcare providers. At the same time, the forensic methodology of investigating such cases requires a commission forensic medical examination, the results of which become the major stumbling block at all stages of criminal proceedings. There are challenges in the organization and methodological support of the work of the investigation, the prosecutor's office and the courts. Especially, when several experts with opposite views clash in court over a case, where they completely or partially refute each other. In our paper we highlight an example of such a case to improve legislation and judicial practice in this area.

Awareness and perception of in vitro fertilization as an infertility treatment method among Polish women: a cross-sectional study

Background: Assisted reproductive technology (ART) as an infertility therapy remains controversial, although it has been available for more than four decades, with more than five million people estimated to have received the treatment worldwide. In Poland, the legitimacy and acceptability of in vitro fertilization (IVF) are still debated in the public and political realms, with NaProTechnology being the recommended publicly funded method of infertility treatment. Aim of the study: This paper presents the current perceptions and opinions of Polish women of reproductive age on infertility treatment, with particular reference to IVF. Material and methods: The study used an original questionnaire to survey 226 women aged 18-49 on their knowledge and attitudes toward IVF. Results: A high level of knowledge concerning IVF as a method of infertility treatment was demonstrated by 19.9% of respondents. Most women interviewed (65%) had a positive attitude toward IVF, 4.6% would use IVF regardless of the cost, and 12.4% would never use IVF. Only 5.8% of respondents thought that access to infertility treatment is guaranteed in Poland. Conclusions: This is the first study conducted in Poland in which participants professed that their Catholic faith did not influence their lack of acceptance of IVF. Most respondents held the opinion that access to infertility treatment is not guaranteed in Poland. Given the increasing scale of the infertility problem, detailed monitoring of attitudes and acceptance of IVF is needed to support those in Poland struggling with the condition.

Infertility - causes, diagnosis, preventive measures and methods of treatment

The problem of infertility affects approximately 20% of married couples, and the number of people affected by this problem is still increasing[5,6]. Developed countries are characterized by the prevalence of primary infertility, while in developing countries there is a high rate of secondary infertility[8,9]. The most common cause of marital infertility is obstruction of the fallopian tubes, which occurs in 30-35% of women and requires surgical intervention. However, both sexes are dominated by immunological and hormonal disorders (25%-30% of cases)[3,4]. The basic examination in which male fertility is determined is the semen analysis, while in women, many tests should be performed in order to make a diagnosis: anamnesis, gynecological examination, ultrasound performed repeatedly during the menstrual cycle (ovulation assessment), hormonal and immunological tests, post-coital tests, bacteriological cultures, hysterosalpingography or laparoscopy [20]. In vitro fertilization is the most effective of all methods of infertility treatment. In vitro fertilization can be performed using the classical method by adding prepared sperm to the egg cells or by microinjection of the sperm into the egg cell[21].

Репродуктологические аспекты проблемы консервативного хирургического лечения эндометриоидных кист яичников

The aim is to clarify the timing of recurrence of endometriomas removed and the dependence of the ovarian reserve status on the number of ovarian resections performed, as well as to assess the awareness of patients about the impact of surgical treatment of endometrioid ovarian cysts (EOC) on reproductive function and therapeutic effectiveness of in vitro fertilization (IVF) technology. Material and methods. In 93 infertile patients with EOC and values of anti-muller hormone (AMH) < 1.2 ng/ml, the dependence of the degree of reduction of this hormone on the number of operations performed with relapses of endometrioma was analyzed. Using standard research methods in the same patients, the prevalence of infertility factors identified in the International Classification of Diseases of the 10th revision was studied in parallel, and women's awareness of the impact of surgical treatment of EOC on reproductive potential was clarified. Results. Other forms of endometriosis were found in 71% of women with EOC, and the observed infertility, which necessitated the appointment of IVF, was mainly associated with confirmed male and tubal factors. Among the patients operated on for EOC with a reduced level of AMH, the majority underwent repeated ovarian resections due to relapses of endometriomas that occurred within two and a half years after their removal. The degree of decrease in the level of AMH was directly dependent on the number of operations performed. During surgical treatment of EOC, only 7.5% of patients received relevant information about their frequent recurrence and possible consequences for the reproductive function of ovarian resection performed (especially multiple). Conclusions. Frequent recurrence of EOC, which forces repeated resections of the ovaries, is an obvious factor that, due to the reduction of the ovarian reserve, prevents the successful use of IVF technology with its own oocytes in situations where this method of infertility treatment is in demand. When planning the removal of EOC in women of reproductive age, surgeons should necessarily refer patients to reproductologists for advice on issues related to the implementation of reproductive plans both in the near and long term

Premature Ovarian Insufficiency - diagnostic and therapeutic challenges

Introduction and purpose: Premature Ovarian Insufficiency (POI) is a rare but serious disease diagnosed in about 1% of women before the age of 40. It is characterized by hypoestrogenism and an increase in the level of the follicle-stimulating hormone, which is associated with menstrual disorders, pregnancy failures and a reduced quality of life. The main causes of POI include a genetic background and autoimmune abnormalities, as well as increasingly jatrogenic factors. Care for patients is focused on hormone replacement therapy and infertility treatment. The aim of this review is to discuss current treatment methods, the impact of early diagnosis and the prevention of premature ovarian insufficiency, which affects the ability to have one's own offspring. The article also describes new methods of infertility treatment that are under investigation.
 Materials and methods: This literature review is based on articles published in the PubMed database from 2015 to 2022 using the following phrases: premature ovarian insufficiency, premature ovarian insufficiency stem cells
 State of knowledge: The only way to treat infertility in women with POI is egg donation. Currently, research is being conducted to achieve early diagnosis, introduce new treatment methods and reduce the number of iatrogenic forms of POI.
 Conclusion: The main problem for women diagnosed with POI is the difficulty or often impossibility of having their own children. Egg donation does not allow for the transfer of the patient's genetic material, and is also not available as a treatment option in some countries. For this reason, new methods for early diagnosis, treatment, and prevention of POI are being developed.

THE LEGALITY OF SELECTIVE REDUCTION IN MULTIPLE PREGNANCIES DURING INFERTILITY TREATMENT OF COUPLES: THE CASE STUDY OF IRANIAN LAW

Even if the Medical Abortion and Embryo Donation Acts approved in 2002 by the Iranian Legal System can be exploited to treat infertility among couples in Iran, selective reduction as one of the most commonly used procedures, has been declared illegal by Shiite jurists due to the expulsion of a number of embryos. Given that physicians destroy the weak embryos in multiple pregnancies in order to help the strong one in selective reduction between the 10th and 13th gestational weeks, and the existing laws on infertility treatments are not up-to-date or do not comply with new methods, including selective reduction, infertile couples have been facing many problems. Accordingly, the rights in infertility treatments in Iran, require more comprehensive and new legislations by pointing out the restrictions and legalities in the law, without stipulating a specific method. Upon making the law in this line, judges can deal with the requests filed by couples in each case separately, and according to the legal restrictions, and then issue a verdict regarding treatments demanded, by taking account of all new infertility treatment methods. This study reflects on the arguments against the multifetal pregnancy reduction (MFPR) in Iran, before going over the Medical Abortion and Embryo Donation Acts for Iranian infertile couples. With regard to the illegality of some infertility treatments, this study provides solution that can be consider by the legislator especially in Iran, and can be reviewed by other countries as a case study.

PROBLEMS OF OPTIMIZING TREATMENT OF INFERTILITY IN PATIENTS WITH VARICOCELE

It is known that infertility of a couple is often associated with spermatogenesis disorders. The most common causes of male infertility are varicocele, inflammatory diseases of the reproductive system, hormonal disorders and cryptorchidism. Also, in many cases, it is difficult to determine the cause of male infertility. To date, there are no generally recognized methods of drug treatment of the idiopathic form of male infertility, and its therapy is often considered to be of an empirical nature. Assisted reproductive technologies are highly effective methods of infertility treatment, but they are expensive and invasive.

Assisted reproductive technology and uterine cancer risk. A systematic review and meta-analysis

BACKGROUND: The problem of infertility has not only medical, but also socio-demographic significance. To date, the global scale of the spread of various forms of infertility is beyond doubt among specialists around the world. This, in turn, causes an increase in the frequency of prescribing assisted reproductive technologies, but the question of the relationship between the prescribing of drugs used to treat infertility and the risk of developing cancer of the uterine body remains poorly understood.
 AIM: The aim of this study was to assess the possible relationship between in vitro fertilization, the use of ovulation stimulation drugs and the risk of developing uterine cancer in women with infertility.
 MATERIALS AND METHODS: This literature systematic review is based on resources from the following databases: Medline, ClinicalKey, Google Scholar, Embase, the Cochrane Library, and eLIBRARY for the period 19992022. The search for publications was carried out using keywords defined in accordance with the PICO principle (P, population or patients; I, intervention; C, comparison; O, outcomes): female, women, infertility, infertility treatment, in vitro fertilization, IVF, assisted reproductive technology, ART, ovarian stimulation, ovarian hyperstimulation, clomiphene citrate, hCG, hMG, tamoxifen, uterine, endometrial, cancer, carcinoma neoplasm, uterine neoplasm. The following SQL operators were used during the search: AND and OR.
 RESULTS: The search resulted in 37 representative publications, with eight studies selected for meta-analysis.
 CONCLUSIONS: This systematic review and meta-analysis have demonstrated the ambiguity of the design and results of studies on the possible relationship of uterine cancer and assisted reproductive technology methods published to date. The issue under review is urgent due to the high frequency of infertility and an increase in the frequency of gynecologic cancers. The conducted studies confirm that it is impossible to evaluate the carcinogenic effect of ovulation inducers or in vitro fertilization methods without adjusting for the infertility factor, as well as risk factors for uterine cancer. There is still a high need for further research, particularly for studying the safety profile of infertility treatment methods in relation to long-term cancer risks.

Mutations in Caveolin Binding Motif Alter Human Follicle Stimulating Hormone Receptor Signaling

Globally, there are about 48 million couples and 186 million individuals of reproductive age that are affected by infertility. Some cases of infertility in both men and women have been attributed to impaired follicle stimulating hormone (FSH) signaling. Lack of proper function of the cognate receptor for FSH (FSHR) could contribute to infertility since the biochemical signal generated by FSH binding to FSHR stimulates the production of a sperm‐stabilizing protein in males and follicle maturation in females. It has been demonstrated that human FSHR (hFSHR) localizes to lipid rafts, which are rigid and detergent‐resistant microdomains in the cell membrane. Their structure is in part due to having higher concentrations of cholesterol and sphingolipids compared to the surrounding plasma membrane. Additionally, some lipid rafts are characterized by the presence of the protein caveolin. Signaling pathways for some cell surface receptors have been demonstrated to be regulated by residency in lipid raft domains either by separating the related molecules inhibiting premature signaling or by co‐localizing the related molecules to facilitate signaling. Based on evidence that FSHR forms direct protein‐protein interactions with caveolin, it was hypothesized that disruption of the caveolin binding motif (CBM), a conserved peptide sequence present in proteins associated with caveolin, would affect hFSHR signaling. In hFSHR this sequence is found in transmembrane helix 4 between amino acids 479‐489. The current study investigated the effect of mutations in the CBM on hFSHR signaling. The mutants were created via site‐directed mutagenesis and expression vectors were transfected in HEK293 cells. Cells stably expressing the mutant FSHRs underwent western blot analysis for qualitative comparison of signaling. Mutations in all four conserved phenylalanine residues of the CBM resulted in much higher signaling compared to the wild‐type and at a faster rate of activation. Elevated signaling at shorter FSH treatment times suggest that the mutated receptor might be more sensitive to FSH and may hint at the role of the caveolin interaction in regulating hFSHR signaling. Because current infertility treatments are costly, tend to have low success rates, and are not accessible to everyone, a greater understanding of FSH signaling pathways could lead to the design of more successful infertility treatment methods.

The opinion of the medical community on the legal issues of surrogate maternity

Introduction. Surrogacy is a method of infertility treatment involving the conclusion of an agreement between potential parents, a surrogate mother and a medical institution. Until now, lawyers have not been able to develop a unified approach to forming the regulatory framework for surrogacy. Whether healthcare providers have developed a standard view of this problem is not clear. The purpose is to summarise the medical community representatives’ views on the surrogacy program’s managing issues and their participants’ rights and obligations. Material and methods. The Internet survey was conducted among medical workers of various specialisations from different regions of Russia and among future specialists (students of medical universities and interns). 7504 questionnaire was analysed. The questions concerned the indications for surrogate motherhood, the sources of its funding, the citizenship of the participants in surrogacy and their contractual obligations, the rights of the surrogate mother and the ordering parents. Results. medical specialists assign a pivotal role to the surrogacy program’s legal aspects, despite being implemented using high-tech medical technologies. They give priority rights to a newborn child to the ordering parents. During pregnancy and childbirth, decisions regarding lifestyle, hospitalisation, and delivery methods should be made only in conjunction with specialists from the medical institution that signed the contract. As the level of professional responsibility of medical specialists grows, the share of answers about the inadmissibility of state funding of surrogacy, the implementation of surrogacy programs for foreign citizens and single men and women as genetic donors increases, and the share of answers about the admissibility of altruistic surrogacy decrease. Conclusion. Having decided on the legal issues of managing medical care in surrogacy programs, representatives of the medical community do not consider this type of high-tech medical care a common way to solve the problem of infertility, considering it as an exclusive method of medical care for married couples with infertility of women.

Prevalence and determinants of use of traditional methods of infertility treatment among women attending infertility clinic in Southeast Nigeria.

Infertility, an obstacle to healthy living, makes its victims patronize traditional methods of infertility treatment (TMIT) in spite of associated complications. They turn to hospitals when this method fails. This is actually a serious issue because the presence of contaminated herbal products and the relationship between the use of TMIT and noncompliance with biomedical treatment regimens constitutes a major concern in medical practice. And the use of traditional methods of infertility treatment has been correlated with severe and fatal consequences. Therefore, the study assessed prevalence/determinants of TMIT use among patients visiting the gynaecology clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). Descriptive cross-sectional design was adopted for the research. Only 263 women took part in the study. The research instrument was questionnaire. Data were analyzed using descriptive statistics. Findings revealed that 95.4% of these women have used traditional methods for infertility treatment and factors influencing infertile women's use of TMIT are demographic characteristics, infertility duration, husbands' relatives' pressure and cheap cost of traditional medical treatment. Again, inability of infertile women to disclose TMIT use to healthcare providers makes effective treatment difficult. Therefore, these impediments expose infertile women to use TMIT. The result is a guide to healthcare providers who are expected to know the extent of their parents' use of TMIT.

THE MORPHOLOGICAL CHARACTERISTICS OF THE OFFSPRING OF MALE RATS IRRADIATED WITH ELECTRONS AT A DOSE OF 2 GY AND TREATMENT BY PLATELET-RICH PLASMA

One of the most dangerous effects of radiation on health is reproductive dysfunction, often leading to infertility. Available studies on the effects of radiation on spermatogenesis and fertility have not considered the possibility of using restorative therapy. One of the modern methods of infertility treatment is the introduction of autologous blood plasma with an increased content of platelets and native growth factors. Currently, there are no studies on the study of offspring obtained by using this method of infertility treatment and the assessment of its teratogenicity. Purpose of the study: morphological analysis of offspring of male rats irradiated with electrons at a dose of 2 Gy and receiving platelet-rich plasma. Male Wistar rats (n=35) were once subjected to targeted ionizing radiation at a NOVAC-11 pulsed electron accelerator at a dose of 2 Gy. To half (n=15) of the irradiated animals were injected with platelet-rich plasma and insulin-like growth factor-1 for 12 weeks, after which the males of both groups were placed with intact females (n=30) to produce offspring. The state of the developing offspring was assessed by morphological analysis after the removal of pregnant females from the experiment on the 20th day of prenatal development. Pregnancy was observed only in females bred by control males and males treated with platelet-rich plasma. Classical histological methods and X-ray computed microtomography were used. As a result of the study, it was found that the weight and size of the offspring from the control and experimental groups did not have macroscopic differences; light microscopy did not reveal significant changes in their histological structure. Pathological changes in the development of the offspring of males of the experimental group who received platelet-rich plasma after electron irradiation with a dose of 2 Gy using computed microtomography were also not detected. The obtained data indicate about of effectiveness of the treatment of the infertility of irradiated male rats with platelet-rich plasma, as well as the absence of its teratogenic effects.

SEXUAL FUNCTION AND IN VITRO FERTILIZATION.

The aim of the study was to investigate the sexuality of individuals undergoing in vitro fertilization as one of the methods of infertility treatment. The focus was on sexual dysfunction, sexual satisfaction and associated risk factors. Data were collected based on a validated, standardized procedure. The sample consisted of 119 individuals who had undergone in vitro fertilization, 61 (51.3%) women and 58 (48.7%) men, average age 35 years. Most of the 119 survey participants were in the 31-35 age group (37%), married (79.8%), with high school diploma (51.3%), Catholic denomination (89.9%), childless (78.2%), with a one sexual partner in their lifetime (51.3%), and in current sexual relationship for a period of 7 to 8 years (18.5%). The survey found statistically significantly higher satisfaction among male participants, participants in the 26-30 age group, those with a higher level of education, nonreligious, without children in marriage, with four sexual partners in life, over a period of 1 to 2 years in current partner (sexual) relationship, and without a diagnosed sexual disorder. There was a correlation between infertility, associated treatment, and sexuality. Infertility and involvement in treatment procedures increased the risk of sexual dysfunction. The risk factors identified in our study could help facilitate detection and timely treatment of sexual dysfunction, which would help maintain healthy sexuality in couples participating in in vitro fertilization procedures.

Comparative efficacy of various methods of infertility treatment in patients with external genital endometriosis

With the aim of comparative examination of efficacy of different drugs and methods of endoscopic surgery in treatment of infertile women with genital endometriosis 548 patients were examined. Distinct advantages of combined treatment were revealed: surgical destruction of endometrial foci at the first stage and administration of antigonadotrophic preparations at the second stage. Maximum frequency of impregnation after such therapy was observed during first 6-8 months. By 11-12 months the index decreased to its minimum. So, it is reasonable to give up passive supervision after 12 months

Function of Follicular Cytokines: Roles Played during Maturation, Development and Implantation of Embryo.

A balance within the immune system is necessary for the proper development of ovarian follicles. Numerous cytokines were detected in follicular fluid, the role of which in reproductive physiology seems crucial. They influence the development and maturation of the follicle, ovulation, and corpus luteum formation, as well as embryo implantation and maintenance of pregnancy. The analysis of follicular fluid requires its collection by puncturing of the ovary, which is usually executed in connection with various gynaecological procedures. When interpreting such test results, clinical indications for a given procedure and the method of patient preparation should be taken into account. This review revealed the results of currently available studies on the concentration of pro-inflammatory cytokines in follicular fluid in various forms of infertility. Additionally, it presented cytokines, whose concentration has a significant impact on the size of ovarian follicles, their number, the effectiveness of in vitro fertilisation, development of the embryo, and chances of correct implantation. Despite the many recent publications, the knowledge of follicular fluid immunology in the context of reproductive pathology is superficial and further research is required to extensively understand the roles of individual cytokines in reproductive pathology. In the future, this knowledge may enable patients’ individual qualifications to individual methods of infertility treatment, as well as the possible adjustment of the treatment regimen to the patient’s immune profile.

An Intelligent Model for Prediction of In-Vitro Fertilization Success using MLP Neural Network and GA Optimization

In Vitro Fertilization (IVF) is one of the scientifically known methods of infertility treatment. This study aimed at improving the performance of predicting the success of IVF using machine learning and its optimization through evolutionary algorithms. The Multilayer Perceptron Neural Network (MLP) were proposed to classify the infertility dataset. The Genetic algorithm was used to improve the performance of the Multilayer Perceptron Neural Network model. The proposed model was applied to a dataset including 594 eggs from 94 patients undergoing IVF, of which 318 were of good quality embryos and 276 were of lower quality embryos. For performance evaluation of the MLP model, an ROC curve analysis was conducted, and 10-fold cross-validation performed. The results revealed that this intelligent model has high efficiency with an accuracy of 96% for Multi-layer Perceptron neural network, which is promising compared to counterparts methods.

ACCESS TO WORK LEAVE AND IN VITRO FERTILIZATION (IVF) OUTCOMES

BackgroundAssisted Reproductive Technology (ART) including IVF is the most expensive method of infertility treatment, at a median cost of $19,000/cycle (1). It is also the most time intensive, resulting in an average of 8.74 days taken off work per cycle (2). In 2009, only an estimated 24% of ART need was being met in the U.S. ART is responsible for 1.5% of total live births in the U.S., compared to 3% in Europe despite no difference in incidence (1). The financial burden of care has been researched extensively, and state mandated insurance coverage improves access and outcomes associated with IVF. States with mandated coverage have fewer embryos transferred and fewer multiple births per cycle (3). There is less research examining the amount of time off work that is required during treatment. Existing literature suggests that increased time off from work is associated with increased stress and early termination of care (4,5). However, to our knowledge, there is no research examining access to employment leave during IVF and how this influences outcomes.ObjectiveTo examine the current state of access to employment leave during IVF cycles, evaluate the relationship between access to employment leave during IVF treatment and IVF outcomes as measured by number of embryos transferred, live birth rate, and multiple pregnancy rate in an academic infertility clinic located in a state with no insurance mandate.Materials and MethodsWomen who underwent IVF with a fresh embryo transfer from 2016-2018 were asked to complete an email survey with questions about their access to work leave, type of work leave, ease of requesting leave, and impact of taking leave on their work. IVF outcomes were collected from the clinic’s SART data set and demographics were collected from both the SART data and clinic records.ResultsOf the 409 cycles identified during the study period, 335 had email addresses and were contacted. 69 responses were received (20.5% response rate). 46 patients reported having access to leave during IVF, 17 patients reported not having access, and 6 patients did not require leave (unemployed or self-employed). Patients without leave transferred 1.4 embryos per cycle, had a live birth rate of 52.9%, and 17.6% of cycles resulted in multiple pregnancies. In patients with leave, 1.6 embryos were transferred per cycle, the live birth rate was 50%, and the rate of multiple pregnancies was 13%. There are no statistically significant differences between the groups for any of the outcomes. There is a significant difference (0.0342) in the percentage of patients that believe time off for IVF affected their work, 65% of patients in the group without access to leave felt time off affected their work compared to 35% of the group with leave.ConclusionsThe present study found no difference in IVF outcomes based on patient access to work leave during treatment, however it suggests that limited access to leave could be a barrier, preventing people from receiving appropriate fertility treatment. Research investigating the barriers that limit access to care serves as an important tool to help address the socioeconomic discrepancies that exist with infertility treatment.