Reproductive Outcomes In Women Research Articles

Quantitative Label-Free Proteomic Analysis of Mouse Ovarian Antral Follicles Following Oral Exposure to a Human Relevant Mixture of Three Phthalates.

Dibutyl phthalate (DBP), di-2-ethylhexyl phthalate (DEHP), and benzyl butyl phthalate (BBP) are used in personal and medical care products. In the ovary, antral follicles are essential for steroidogenesis and ovulation. DBP, BBP, and DEHP are known to inhibit mouse antral follicle growth and ovulation in vitro, and associate with decreased antral follicle counts in women. Given that the in vivo effects of a three-phthalate mixture on antral follicles are unknown, we evaluated the effects of a human relevant mixture of DBP, BBP, and DEHP on ovarian follicles through proteome profiling analysis. Adult CD-1 female mice were fed corn oil (vehicle), or two dose levels of a phthalate mixture based on estimated exposures in general (32 µg/kg/day; PHT 32) and occupationally exposed (500 µg/kg/day; PHT 500) populations for 10 days. Antral follicles (>250 µm) were isolated and subjected to proteome profiling via label-free tandem mass spectrometry. A total of 5,417 antral follicle proteins were detected, of which 194 were differentially abundant between vehicle and PHT 32, and 136 between vehicle and PHT 500. Bioinformatic analysis revealed significantly different responses between the two phthalate doses. Protein abundance differences in the PHT 32 exposure mapped to cytoplasm, mitochondria, and lipid metabolism; while those in the PHT 500 exposure mapped to cytoplasm, nucleus, and phosphorylation. When both doses altered proteins mapped to common processes, the associated predicted transcription factors were different. These findings provide novel mechanistic insight into phthalate-associated, ovary-driven reproductive outcomes in women.

Resveratrol ameliorates mitochondrial biogenesis and reproductive outcomes in women with polycystic ovary syndrome undergoing assisted reproduction: a randomized, triple-blind, placebo-controlled clinical trial

BackgroundThis study was designed to examine the effect of resveratrol on mitochondrial biogenesis, oxidative stress (OS), and assisted reproductive technology (ART) outcomes in individuals with polycystic ovary syndrome (PCOS).MethodsFifty-six patients with PCOS were randomly assigned to receive 800 mg/day of resveratrol or placebo for 60 days. The primary outcome was OS in follicular fluid (FF). The secondary outcome involved assessing gene and protein expression related to mitochondrial biogenesis, mitochondrial DNA (mtDNA) copy number, and adenosine triphosphate (ATP) content in granulosa cells (GCs). ART outcomes were evaluated at the end of the trial.ResultsResveratrol significantly reduced the total oxidant status (TOS) and oxidative stress index (OSI) in FF (P = 0.0142 and P = 0.0039, respectively) while increasing the total antioxidant capacity (TAC) (P < 0.0009). Resveratrol consumption also led to significant increases in the expression of critical genes involved in mitochondrial biogenesis, including peroxisome proliferator-activated receptor gamma coactivator (PGC-1α) and mitochondrial transcription factor A (TFAM) (P = 0.0032 and P = 0.0003, respectively). However, the effect on nuclear respiratory factor 1 (Nrf-1) expression was not statistically significant (P = 0.0611). Resveratrol significantly affected sirtuin1 (SIRT1) and PGC-1α protein levels (P < 0.0001 and P = 0.0036, respectively). Resveratrol treatment improved the mtDNA copy number (P < 0.0001) and ATP content in GCs (P = 0.0014). Clinically, the resveratrol group exhibited higher rates of oocyte maturity (P = 0.0012) and high-quality embryos (P = 0.0013) than did the placebo group. There were no significant differences between the groups in terms of chemical or clinical pregnancy rates (P > 0.05).ConclusionsThese findings indicate that resveratrol may be a promising therapeutic agent for patients with PCOS undergoing assisted reproduction.Trial registration numberhttp://www.irct.ir; IRCT20221106056417N1; 2023 February 09.

P-803 Intra-ovarian injection of plasma rich in stem cell-secreted and platelet-enclosed factors to promote follicle rescue and reproductive outcomes in women with very low ovarian reserve

Abstract Study question Could intraovarian injection of plasma rich in stem-cell and platelet growth factors optimize ovarian reserve and IVF outcomes in women with very low ovarian reserve? Summary answer Intraovarian injection of G-CSF mobilized plasma rich in grown factors improved follicle count since first follow-up and led to better fecundation, implantation and pregnancy’ rates. What is known already Autologous stem cell ovarian transplantation (ASCOT) of bone marrow derived stem cells optimized ovarian reserve and reproductive outcomes in poor responders (POR) and this effect seems to be due to the growth factors secreted by the stem cells, acting through paracrine pathways. Similarly, platelet-rich Plasma (PRP) has been also offered to promote ovarian reactivation in patients with impaired ovarian reserve by providing positive growth factors contained in platelets. Indeed, a technique that combines both the non-cellular components of ASCOT and PRP (ASCOT-1) has been proposed to optimize follicle rescue and IVF outcomes in women with very low reproductive prognosis. Study design, size, duration Retrospective observational study with 159 women (≤ 45 years) diagnosed with POR and primary ovarian insufficiency (POI) according to ESHRE criteria, who underwent the ASCOT-1 technique after refusing oocyte donation, between June 2021-October 2023 at IVIRMA Alicante, Spain (IRB approval 2310-FIVI-188-SH). The ASCOT-1 consisted in the intraovarian injection of plasma rich in both stem cell-secreted and platelet-enclosed factors obtained after granulocyte colony stimulating factor (G-CSF) mobilization and PRP obtention (Endoret Kit BTI, Biotechnology institute). Participants/materials, setting, methods Medical records of patients who underwent the ASCOT-1 as an ovarian reactivation treatment were examined. Follow up of AFC and AMH was carried out for a maximum of 4 menstrual cycles to evaluate follicular activation. Moreover, when follicle growth was detected, patients underwent a controlled ovarian stimulation (COS). IVF and reproductive outcomes were compared with previous COS cycles started in our clinics, when available. T-test was used where appropriate. Main results and the role of chance Overall 159 POR/POI women (age 38.7±4.2years, AMH0 0.22±0.41ng/ml; AFC0 1.4±1.9) underwent the ASCOT-1 technique. Mean volume of plasma injected was 6.8±0.8ml, distributed equally in both ovaries. First follow-up was done in 131 women showing statistically significant improvements in the AFC during the entire follow-up compared to the basal levels measured before the treatment (AFC1 3.3±3.4, p &amp;lt; 0.001; AFC2 3.3±3.6, p &amp;lt; 0.001; AFC3 2.9±2.6, p &amp;lt; 0.001; AFC4 2.4±2.6, p = 0.07). After ASCOT-1, 98 COS were initiated in 48 women in our clinics, which were compared to their previous 66 cycles. Although age was significantly higher in their posterior cycles (38.0±2.9 vs40.0±3.6; p &amp;lt; 0.001), after ASCOT-1 oocyte retrieval was reached in a greater amount of cases (75.5% vs87.5%, p=NS). ASCOT-1 showed a positive, but non statistically significant effect in the number of MII-oocytes (2.8±4.1 vs3.2±3.9, p=NS) and blastocysts obtained (1.8±2.8 vs2.4±3.1, p=NS), but relevant improvements were observed in quality related parameters such as oocyte maturation (61.5%, 95%IC 45.8-77.3, vs86.1%, 95I%IC 69.9-85.5; p 0.03), fertilization (62.6%, 95%CI 53.0-71.3, vs76.5%, 95%CI 70.0-82.0; p &amp;lt; 0.001), implantation (25.0%, 95%CI 8.3-52.5 vs41.1%, 95%CI 19.4-66.5; p &amp;lt; 0.001) and clinical pregnancy rate (25.0%, 95%CI 8.3-52.5 vs46.6%, 95%CI 22.2-72.5; p &amp;lt; 0.001). Ultimately, 14 clinical pregnancies (7 after ET and 7 by natural conception) were obtained after ASCOT-1. Limitations, reasons for caution This retrospective study involves short periods of follow up and limited amount of IVF attempts. Thus, further prospective studies with increased sample size are required to validate our results, to establish the duration of the effects, and to identify which subgroups of patients could benefit the most from this treatment. Wider implications of the findings Growth factors contained in the G-CSF mobilized PRP could play a role in follicular development, providing a new tool to increase the reproductive potential of women with very low ovarian reserve where oocyte donation is the only practical option, allowing them to access to homologous IVF treatment. Trial registration number 2310-FIVI-188-SH

P-351 Reproductive outcomes in a cohort of lymphoma patients

Abstract Study question What are the reproductive outcomes in women with malignant lymphoma Hodgkins (HD) and non-Hodgkins (NH) from a single, experienced center? Summary answer 74 children were born to 43 women (28 with HD, 15 with NH) giving a live birth rate (LBR) of 81% and 72%, respectively. What is known already The risk of premature ovarian insufficiency (POI) after HD and NH is related to female age, type and dose of gonadotoxic treatment. Where ABVD regimens in HD patients and CHOEP regimens in most young NH patients, rarely results in POI and reduced fertility, treatment with BEACOPP or BEAM and stem cell transplantation seems to be associated with a much higher risk of ovarian failure. However, studies are heterogeneous and there is still a need for studies with structural follow up on repeated measurements of ovarian function markers in relation to clinical outcomes. Study design, size, duration This cohort study was conducted as a single center study at the fertility clinic in a large public Danish university hospital. Data was collected retrospectively from medical records from 1999 to 2020 and prospectively from 2020 to 2023. We included all female patients with HD (n = 63) and NH (n = 32), who were referred to our clinic for fertility preservation between 1999 and 2022. End of follow up was December 31st, 2023. Participants/materials, setting, methods Age at referral ranged from 14 to 33 years. Information about diagnoses, gonadotoxic treatment, gynecologic (including endocrine parameters) and obstetric history was retrieved from medical records. Permission to obtain retrospective data from 1999 to 2020 was given by the Danish Patient Safety Authorities (jrn 3-3013-2790/1) and prospective data collection was given by informed consent from the patients from 2020 and onwards. Main results and the role of chance 33% of patients with HD had ABVD only, and the remaining BEACOPP or other high-dose alkylating regimens. 72% of patients with NH had CHOEP, and the rest other high-dose alkylating regimens. 78/95 women had fertility preservation. Of these, 95% had ovarian tissue cryopreservation (OTC), 5% had IVF with vitrification of oocytes or embryos. Following chemotherapy 33 women (52%) with HD and 18 (56%) with NH became pregnant. Of these, 28 women with HD had 51 deliveries, and 15 with NH had 23 deliveries. The LBR was 0,81 for HD and 0,72 for NH. For HD patients, 54% of the deliveries were achieved by women who had ABVD compared to about 40% after other high-dose alkylating regimens. For NH patients, 73% of deliveries were achieved by women who had CHOEP compared to 13% after other high-dose alkylating regimens. Most pregnancies were conceived spontaneously. A total of 15/74 women had ovarian tissue transplantation (OTT). Of these, 7 women with HD became pregnant resulting in 4 deliveries, and 4 women with NH became pregnant resulting in 2 deliveries giving an overall pregnancy rate of 73% in this group of women and a LBR of 40%. Limitations, reasons for caution This study is based on information from medical records in public Danish hospitals, containing information on all deliveries. Pregnancies and deliveries outside of Denmark might therefore not be included. Furthermore, for some women the follow-up period was only one year, which could underestimate the fertility in this group of patients. Wider implications of the findings This study shows a reassuringly high rate of spontaneous pregnancies in female survivors of malignant lymphomas. Only 20% of the women have so far used their tissue stored before chemotherapy. Current results might question whether we overtreat our lymphoma patients by offering OTC to the majority Trial registration number not applicable

P-573 Reframing reproductive odds: live birth rate in women with undetectable or negligible anti-mullerian hormone (AMH) levels

Abstract Study question what is the Live birth rate in women with undetectable or negligible AMH levels ? Summary answer Based on our findings, we suggest considering IVF for twith undetectable or negligible AMH levels. What is known already The reproductive outcomes of women with undetectable or negligible AMH levels have not been well studied. Nevertheless, it is widely believed that females with extremely low AMH levels may have difficulty conceiving and may experience early menopause. An undetectable AMH value is indicative of an ovarian reserve similar to that of a 44-year-old woman. It is important to note that fertility is not solely determined by AMH levels and that other variables, such as age, can also have an impact. Study design, size, duration This study was a retrospective cohort design. Data were collected from October 2009 to April 2022, and included 81 consecutive female participants aged 24 to 43 years with undetectable or negligible levels of AMH who had previously experienced a failed in vitro fertilization (IVF) cycle due to poor ovarian response. The participants were given DHEA after at least one failed IVF cycle, The primary outcome measure was live birth rate (LBR). Participants/materials, setting, methods The study participants were divided into two groups based on AMH levels. Group A had undetectable AMH equivalent to &amp;lt; 0.14 ng/ml (For SI units &amp;lt;1 pmol/L), and group B had negligible AMH levels between 0.14 ng/ml and 0.5 ng/ml (For SI units; 1 pmol/L to 3.6 pmol/L) as defined by Tocci et al. (2009). Both groups underwent IVF, and if the cycle failed, women received DHEA before next IVF cycle. The Primary outcome was LBR. Main results and the role of chance The study, which was conducted from October 2009 to April 2022, analysed a total of 81 cycles, with 41 in Group A and 40 in Group B. There were no significant differences in patient characteristics between the two groups. The overall spontaneous pregnancy rate was 17% (7/41) for women in Group A and 7.5% (3/40) for women in Group B, who received DHEA while waiting to start their next IVF cycle. All pregnancies resulted in live births. Additionally, one case in Group A converted from IVF to IUI and also resulted in a live birth. The overall LBR per woman and per embryo transfer (ET) were 53% (43/81) and 62.3% (43/69) respectively. The LBR per started cycle for Group A and Group B was 51.2% (21/41) and 55% (22/40) (p = 0.12), respectively. The LBR per ET for Groups A and B were 60% (21/35) and 64.7% (22/34) (p = 0.16), respectively. The rate of first trimester miscarriages was similar in both groups. The sub-analysis of patient age showed that the overall LBR for women under 37 years old was 44.4% (36/81) and 55.5% (45/81) for women aged 37 years old and above. The cycle cancellation rate was 14.81% (12/81). Limitations, reasons for caution The small sample size and the study’s retrospective design may introduce bias. Additionally, during the 12 years of the study period, AMH measurement techniques have changed. These limitations should be taken into account when interpreting the results. Further research is needed to establish the cost-effectiveness of these findings. Wider implications of the findings The presence of undetectable or negligible AMH levels should not automatically exclude the use of assisted reproductive technology. Supplementation with DHEA and a tailored ovarian stimulation protocol may improve reproductive outcomes in these cases and should be considered before resorting to oocyte donation. Trial registration number Not Applicable

P-318 Reproductive ageing: the seed, the soil, or both?

Abstract Study question Is it all about the embryo? Can a single euploid blastocyst transfer sustain reproductive outcomes in women with advanced reproductive age? Summary answer Despite euploid embryo transfer, endometrial senescence appears to play a crucial role in determining reproductive success, particularly in older patients undergoing in vitro fertilization (IVF). What is known already Advanced reproductive age significantly impairs oocyte and embryo quality. Effective crosstalk and synchronization between embryo and endometrium are pivotal for successful pregnancies, both in vivo and in vitro. Implantation failure remains a persistent challenge in IVF, exacerbated by delayed family planning trends. The transfer of euploid blastocysts through preimplantation genetic testing for aneuploidy (PGT-A) is a potential strategy to address implantation issues, decrease miscarriages, and shorten time-to-pregnancy. However, a significant proportion of IVF treatments remain unsuccessful, suggesting critical factors beyond the embryo. Study design, size, duration This retrospective study analyzed 457 single euploid blastocyst transfers performed by two doctors at a private IVF center from January to November 2023. Inclusion criteria encompassed cases with PGT-A indications (advanced maternal age, repeated implantation failure, recurrent pregnancy loss, etc.) or cases where embryo biopsy was patient-requested. The primary outcome was ongoing pregnancy rate (OPR), with secondary outcomes including pregnancy rate (PR) and clinical pregnancy rate (CPR). Participants/materials, setting, methods Participants were categorized into four groups: Group 1 (&amp;lt; 35 years old; N = 100), Group 2 (35-37 years old; N = 102), Group 3 (38-40 years old; N = 118), and Group 4 (&amp;gt; 41 years old; N = 87). A control group (oocyte donation; N = 50) with single euploid embryo transfers showed a mean recipient age of 43 years. Donors were always less than 32 years old. Endometrial preparation protocols were consistent across all groups. Chi-square test was used to compare groups. Main results and the role of chance Among the 457 transfers analyzed, with a mean female age of 37 years, the overall PR was 71.3%, CPR was 64.8%, and OPR was 60.2%. Groups showed no differences in demographic variables and cycle parameters. Group 1 demonstrated higher PR (83.3%), CPR (78.4%), and OPR (73.5%) compared to Group 2 (PR 70.9%, p = 0.034; CPR 66%, p = 0.047; OPR 62.1%, p = 0.081), Group 3 (PR 68.2%, p = 0.009; CPR 61.2%, p = 0.005; OPR 56.6%, p = 0.008), and Group 4 (PR 65%, p = 0.002; CPR 56.1%, p &amp;lt; 0.001; OPR 51.2%, p = 0.001). Furthermore, the control group (oocyte recipients) showed significantly lower PR (68%, p = 0.031), CPR (54%, p = 0.002), and OPR (46%, p &amp;lt; 0.001) compared to Group 1, but not with the other groups. These findings demonstrate that even with euploid embryos originating from young donors, older women exhibited lower pregnancy rates than young women transferring single euploid blastocysts from their own oocytes and similar rates compared to those with advanced reproductive age transferring their own euploid blastocysts, implying that endometrial ageing may disproportionately influence IVF treatment outcomes. Limitations, reasons for caution The retrospective design introduces inherent bias, notably selection bias and unmeasured confounders. This preliminary data did not account for male infertility factors and their impact on embryo quality. Wider implications of the findings Reproductive aging appears to be influenced by factors beyond the embryo itself, especially in women above 35 years. Further research is warranted to elucidate the causes and impact of reproductive aging on implantation potential, aiming to refine clinical practices and enhance the success of IVF treatments. Trial registration number not applicable

P-147 Number of autologous mature oocytes as a predictor of live birth rate in women aged over 40 who do not accept egg donation

Abstract Study question Is the number of mature oocytes (M2) retrieved a reliable predictor of success for women aged over 40 with autologous oocytes? Summary answer 79.5% of live births were achieved in patients with ≥3M2 retrieved, 14.3% in women with 2M2, and 6.5% in women with 1M2. What is known already The delayed desire for parenthood has become a social phenomenon, particularly among women over 35. Reproductive outcomes in women over 40, using their own oocytes, are usually poor due to a decrease in follicle and oocyte quantity and quality, along with an increased prevalence of oocyte chromosomal abnormalities. While using donated oocytes is often recommended, it remains an unacceptable option for many couples. Furthermore, in Argentina the legislation on Assisted Reproduction Technologies endorses assisted reproductive treatments employing womeńs own oocytes up to the age of forty-four. Study design, size, duration This retrospective observational study, was performed between January 2004 and December 2022 in 5757 patients aged 40 and above undergoing autologous oocyte retrieval and fresh embryo transfer because they do not accept PGTa. Statistical analysis was performed using the InStat GraphPad statistical package. One-way ANOVA and two-tailed Student’s t-test were performed as required. Participants/materials, setting, methods Group1(G1): 40 years (N = 1600); Group 2(G2): 41years (N = 1300); Group 3(G3): 42 years (N = 1087); Group 4(G4): 43 years (N = 735); Group 5(G5): 44 years (N = 496); Group 6(G6): 45 years (N = 302); Group 7(G7): 46 years (N = 140); Group 8(G8): 47 years (N = 61); Group 9(G9): 48 years (N = 23); Group 10(G10): 49 years (N = 13). Primary outcome was relationship between number of M2 and live birth rate. Secondary outcomes were live birth rate, cancellation rate, miscarriage rate, clinical pregnancy rate. Main results and the role of chance Number of M2 retrieved: G1=3.9±3.4 [1-16]; G2=3.6±2.7 [1-14]; G3= 3.5±2.3 [1-12]; G4= 3.4±2.8 [1-14], G5=2.5±1.5 [1-7]; G6=2.3±2.2 [1-12]; G7=1.8±1.5 [1-8]; G8=1.5±0.9 [1-3]; G9=1.3±0.6 [1-3]; G10=1.0±0 [1-1]. Cancelation rate (%): G1=18.2 (292/1600); G2=20.9(272/1300), G3=22.3(243/1087); Gr4= 29.9(220/735); G5=28.0(139/496); G6=38.1 (115/302); G7= 42.8(60/140); G8= 44.3 (27/61); G9=47.8 (11/23); G10= 61.5 (8/13). Clinical pregnancy/transfer rate(%): G1=24.2 (316/1308); G2=21.7 (223/1028); G3=18.0(152/844); G4=18.0 (93/515); G5=9.2 (33/357); G6=11.2 (21/187); G7=3.7 (3/80); G8=0 (0/34); G9=8.3 (1/12); G10=0 (0/5). Live birth rate (%): G1= 11.8 (147/1250); G2= 10.0 (99/993); G3= 6.8 (57/831); G4= 6.6 (34/515); G5= 3.2 (11/348); G6= 2.1 (4/187); G7= 1.2 (1/80); G8= 0 (0/34); G9=0 (0/12); G10=0 (0/5). Miscarriage rate (%) 40 to 46 years: G1= 43.0 (111/258); G2= 47.3 (89/188); G3= 59.0 (82/139); G4= 63.4 (59/93); G5= 66.7 (22/33); G6= 80.9 (17/21); G7=66.7 (2/3) and 100 (1/1) for 48 years (G9). Cancellation rates increased with age. The number of M2 retrieved was significantly associated with clinical pregnancy, live birth and miscarriage rates. The average number of mature oocytes retrieved in cases resulting in live births was consistently higher across all age groups: G1=5.8±2.7 [1-16]***; G2= 4.8±3.5 [1-14]***; G3= 4.0±2.1 [1-9]***; G4= 5.7±2.7 [3-13]***; G5= 4.2±1.4 [2-7]***; G7= 6.0±1.4 [5-8]***; G8= 7.0±0 [7,7]*** (***= p &amp;lt; 0.0001). Limitations, reasons for caution This extensive retrospective study’s conclusions should be cautiously applied, limited to a specific group of elderly women unwilling to consider egg donation. 106 clinical pregnancies were not included because we did not have information on live births. Wider implications of the findings Identifying parameters associated with higher live birth rates in this population may aid in providing realistic expectations for achieving pregnancy with autologous oocytes. This information could guide medical advice and potentially suggest alternative options, such as egg donation or adoption. Trial registration number NOT APPLICABLE

Reproductive Outcomes for Women With Vasculitis.

There are limited data on the reproductive health of women with vasculitis. This study used a prospective, international vasculitis pregnancy registry to survey women during and after pregnancy. The Vasculitis Pregnancy Registry (VPREG) is imbedded within the Vasculitis Patient-Powered Research Network, an international online research infrastructure. Any pregnant woman with a diagnosis of vasculitis can self-enroll. After enrollment, women are invited to complete online surveys at study entry, once per trimester, and postpartum. Descriptive statistics are reported here. Between 2015 and 2022, 147 women with 149 pregnancies enrolled in VPREG from 16 countries. Data on 78 pregnancies with known outcomes were included in this analysis. During pregnancy, women on average experienced low levels of pain related to vasculitis (scale 0-10, median 2 [IQR 1-5]) and preserved feelings of wellness (scale 0-10, median 3 [IQR 1-5]). Thirty-six percent of women reported their vasculitis was active during pregnancy. Of the 14 women requiring hospitalization during pregnancy outside of delivery, 4 cited active vasculitis as the indication. Most women (54/73, 74%) were prescribed medications for vasculitis during pregnancy. Seventy-six (97%) pregnancies resulted in live births, with 64% delivering vaginally and 21% experiencing a preterm delivery. These results demonstrate that most women with vasculitis can experience pregnancies that result in live births delivered at term. During pregnancy, a minority of women reported flares of vasculitis or the need for hospitalization due to vasculitis. These data are useful to rheumatologists and patients to inform and facilitate discussions about reproductive health and vasculitis.

Pregnancy outcomes in women with primary ovarian insufficiency in assisted reproductive technology therapy: a retrospective study.

This study aims to retrospectively estimate cumulative reproductive outcomes in women with primary ovarian insufficiency (POI) in assisted reproductive technology (ART) therapy. A total of 139 patients diagnosed with POI were reviewed in this study. Firstly, they were divided into two groups according to oocyte origin: using their own oocytes (OG group) or accepting oocyte donations (OD I group). Secondly, the patients were split depending on the pregnancy outcome. In the OG group, nine patients decided to use others' oocytes after a failure of attempting to use their own, and this population was the oocyte donation II group (OD II group). There were 88 patients who used their own oocytes, while 51 patients accepted oocyte donations. In the OG group, there are only 10 (7.2%) patients who got pregnant, and patients in the OD group had worse hormone levels (FSH 71.37 ± 4.18 vs. 43.98 ± 2.53, AMH 0.06 ± 0.04 vs. 1.15 ± 0.15, and AFC 0.10 ± 0.06 vs. 1.15 ± 0.15) and more years of infertility (5.04 ± 0.48 vs. 3.82 ± 0.30), which explained why they choose oocyte donation. In all the three groups, baseline characteristics were comparable between pregnant women and non-pregnant women. Of the 10 pregnant patients in the OG group, four of them used luteal-phase short-acting long protocol and had pregnancies successfully in their first cycles. Ovarian stimulation in POI women requires more cost and time. For those with a stronger desire to have genetic offspring, luteal-phase short-acting long protocol may help them obtain pregnancy rapidly.

How phytochemicals influence reproductive outcomes in women receiving assisted reproductive techniques: a systematic review.

Over the past few years, there has been an increasing amount of scholarly literature suggesting a connection between the nutritional status of pregnant mothers and early fetal development, as well as the long-term health consequences of their offspring. Multiple studies have documented that alterations in dietary patterns prior to conception have the potential to affect the initial stages of embryonic development. The aim of this study was to perform a comprehensive review of the research pertaining to the correlation between phytochemicals ( specifically, polyphenols, carotenoids and phytoestrogens) and assisted reproductive technology (ART). PubMed, Scopus, Web of Science, and Clinical Trials databases were searched from January 1978 to March 2023. This study comprised observational, randomized controlled, and cohort studies that examined the effects of phytochemicals on ART results. The study's outcomes encompass live birth rate, clinical pregnancy, and ongoing pregnancy. The assessment of study quality was conducted by 2 researchers, independently, using the Quality Criteria Checklist for Primary Research. A total of 13 studies were included, of which there were 5 randomized controlled studies, 1 nonrandomized controlled study, 6 prospective cohort studies, and 1 retrospective cohort study. This research focused on investigating the impact of phytochemicals on ART and has highlighted a dearth of articles addressing that topic. Collaboration among patients, physicians, and nutritionists is crucial for doing novel research. PROSPERO registration no. CRD42023426332.

Impact of insulin sensitization on metabolic and fertility outcomes in women with polycystic ovary syndrome and overweight or obesity-A systematic review, meta-analysis, and meta-regression.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. This systematic review, meta-analysis, and meta-regression aims to compare the effect of insulin sensitizer pharmacotherapy on metabolic and reproductive outcomes in women with PCOS and overweight or obesity. We searched online databases MEDLINE via OVID, EMBASE, Clinicaltrials.gov, and EudraCT for trials published from inception to November 13, 2023. Inclusion criteria were double-blind, randomized controlled trials in women diagnosed with PCOS, body mass index (BMI) ≥ 25 kg/m2, which reported metabolic or reproductive outcomes. The intervention was insulin sensitization pharmacotherapy versus placebo or other agents. The primary outcomes were changes from baseline BMI, fasting blood glucose, and menstrual frequency. Nineteen studies were included in this review. Metformin had the most significant effect on the fasting plasma glucose and body mass index. Insulin sensitizer pharmacotherapy significantly reduced fasting plasma glucose, body mass index, fasting serum insulin, HOMA-IR, sex hormone binding globulin, and total testosterone, but the effect size was small. There was a lack of menstrual frequency and live birth data. The results indicate a role for insulin sensitizers in improving the metabolic and, to a lesser degree, reproductive profile in these women. Further research should examine insulin sensitizers' effects on objective measures of fecundity.

The impact of thyroid autoimmunity on pregnancy outcomes in women with unexplained infertility undergoing intrauterine insemination: a retrospective single-center cohort study and meta-analysis.

Infertility affects 8-12% of couples worldwide, with 15-30% classified as unexplained infertility (UI). Thyroid autoimmunity (TAI), the most common autoimmune disorder in women of reproductive age, may impact fertility and pregnancy outcomes. However, the underlying mechanism is unclear. This study focuses on intrauterine insemination (IUI) and its potential association with TAI in UI patients. It is the first meta-analysis following a comprehensive literature review to improve result accuracy and reliability. Retrospective cohort study analyzing 225 women with unexplained infertility, encompassing 542 cycles of IUI treatment. Participants were categorized into TAI+ group (N=47, N= 120 cycles) and TAI- group (N=178, N= 422 cycles). Additionally, a systematic review and meta-analyses following PRISMA guidelines were conducted, incorporating this study and two others up to June 2023, totaling 3428 IUI cycles. Analysis revealed no significant difference in independent variables affecting reproductive outcomes. However, comparison based on TAI status showed significantly lower clinical pregnancy rates (OR: 0.43, P= 0.028, 95%CI: 0.20-0.93) and live birth rate (OR: 0.20, P= 0.014, 95%CI: 0.05 ~ 0.71) were significantly lower than TAI- group. There was no significant difference in pregnancy rate between the two groups (OR: 0.61, P= 0.135, 95%CI: 0.32-1.17). However, the meta-analysis combining these findings across studies did not show statistically significant differences in clinical pregnancy rates (OR:0.77, P=0.18, 95%CI: 0.53-1.13) or live birth rates (OR: 0.68, P=0.64, 95%CI: 0.13-3.47) between the TAI+ and TAI- groups. Our retrospective cohort study found an association between TAI and reduced reproductive outcomes in women undergoing IUI for unexplained infertility. However, the meta-analysis incorporating other studies did not yield statistically significant associations. Caution is required in interpreting the relationship between thyroid autoimmunity and reproductive outcomes. Future studies should consider a broader population and a more rigorous study design to validate these findings. Clinicians dealing with women with unexplained infertility and TAI should be aware of the complexity of this field and the limitations of available evidence.

Reproductive outcomes in women opting for fertility preservation after fertility-sparing surgery for borderline ovarian tumors.

What are the reproductive outcomes of women who had fertility preservation (FP) using either oocyte or embryo vitrification after fertility-sparing surgery (FSS) for a borderline ovarian tumor (BOT)? A retrospective, single-center cohort study was conducted between January 2013 and December 2021. Patients with BOT who resorted to FP by vitrifying oocytes or embryos were included. Both clinical and reproductive parameters were reviewed. The primary outcome was live birth. In total, thirteen patients who performed 31 FP cycles were included. Of those, six patients achieved eight live births after a mean follow-up period of 79 months. Three further pregnancies are still ongoing. All pregnancies/live births were obtained without using their cryopreserved oocytes or embryos. Women who had FSS for BOT have favorable prospects of live offspring, even without the need to use their cryopreserved material. Fertility preservation in patients with BOT has to be considered as a tool to mitigate the risk of infertility that may arise in case of BOT recurrence requiring castrating surgery.

Perfusion magnetic resonance imaging in Asherman syndrome.

Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS). To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS. A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA. There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA. Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.

Prognostic and reproductive outcomes in women who had uterine myomas removed during cesarean section and sutured using different techniques

BackgroundIn this study, the prognostic and reproductive outcomes of women who underwent excision of uterine myomas and were sutured using different techniques while undergoing a cesarean section were investigated.MethodsA total of 299 females who underwent cesarean section between January 2015 and June 2022 due to a scarred uterus were enrolled in this study. These participants were segregated into two categories: the experimental group (comprising 155 cases) in which uterine myoma (single lesion) was excised during the cesarean procedure, and the control group (consisting of 144 cases) in which only the cesarean section was conducted. A comparison between the two groups was carried out based on the following parameters: volume of intraoperative bleeding (mL), additional measures taken for intraoperative hemostasis (n, %), percentage (%) of patients experiencing postoperative fever, duration required for the passage of gas (hours [h]), length of hospital stay (days [d]), weight of newborns (kg) and their Apgar scores, and the reproductive outcomes of the experimental group assessed two years after the surgical procedure.ResultsIn the experimental group, the amount of bleeding during surgery, occurrence of postoperative fever among women, time taken for patients to resume passing gas, and length of hospital stay were 540.65 ± 269.12 mL, 9.03%, 15.99 ± 4.68 h, and 5.08 ± 1.18 days, respectively. In contrast, the control group had values of 409.03 ± 93.24 mL, 2.77%, 16.24 ± 4.92, and 4.47 ± 0.70 days, respectively (P < 0.05). No notable increase was observed in the need for additional intraoperative hemostasis measures, and there was no significant difference in the time it took for patients to pass gas after the surgery. All newborns had positive health status. In the experimental group, 25 patients underwent subsequent pregnancies, and 15 of them successfully reached full-term deliveries, all of which had positive outcomes.ConclusionCombining myomectomy with various suture methods during cesarean delivery did not cause excessive bleeding and resulted in healthy newborns. This approach offers the advantage of avoiding additional surgeries under anesthesia and can be considered a viable option. Subsequent pregnancies after myomectomy were considered high-risk.

The influence of embryo culture technologies using traditional and TLT incubators on reproductive outcomes in women with different prognoses for the success of in vitro fertilization

The influence of embryo culture technologies using traditional and TLT incubators on reproductive outcomes in women with different prognoses for the success of in vitro fertilization

Hysteroscopic hysteroplasty for the treatment of T-shaped uteri in women with reproductive failure.

To evaluate the efficacy of hysteroscopic hysteroplasty in the treatment of uterine malformation complicated by primary reproductive disorders. Women with unexplained primary infertility, repeated in vitro fertilization (IVF) failure or repeated spontaneous abortion, and uterine malformations unrelated to diethylstilbestrol who visited the obstetrics and gynecology department of our hospital from January 2019 to December 2022 were included in the prospective cohort study. Uterine malformation in the patients was confirmed by three-dimensional ultrasound and diagnostic hysteroscopy. Hysteroscopic hysteroplasty was performed using a 5-mm diameter hysteroscope and 5-FR surgical scissors, and after 3 months, palliative care was proposed for patients with unexplained infertility or repeated spontaneous abortion, and after 6 months, IVF treatment was recommended for patients with repeated in vitro fertilization (IVF) failures, with a planned minimum follow-up time of 1 year. A total of 83 women enrolled in the study, including 33 cases of primary infertility, 29 cases of repeated spontaneous abortion, and 21 cases of repeated IVF failure. No complications occurred during the hysteroscopic surgery. During the follow-up period, the clinical pregnancy rate of the women enrolled in the study increased to 77.1%, the live birth rate went up to 79.7%, the fetus delivered at full term accounted for 64.1%, and the cesarean section rate was 27.5%. The miscarriage rate was 9.4%. Hysteroscopic hysteroplasty can improve the reproductive outcomes in women with primary reproductive disorders and uterine malformations.

Epigenetic age acceleration and reproductive outcomes in women

Life history theory applied to human development stipulates that humans have evolved to detect and encode information from the early developmental environment that entrain coordinated development pathways. One possible mechanism is epigenetic age acceleration but few studies have prospectively examined associations between epigenetic aging and life-history related phenotypes. The purpose of this study was to examine the relations between epigenetic age acceleration when children were age 7 years and indices of reproductive development during adolescence using a sample of N = 512 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC). A path model was used to test direct and indirect associations between epigenetic age acceleration and age at menarche (AAM), age at first sex, and lifetime and past year sexual partner number. Results showed epigenetic age acceleration was directly associated with earlier age at first sex and increased sexual partner number. There were further indirect associations with sexual partner number via age at first sex. Epigenetic age acceleration was not associated with AAM. Follow-up analyses to determine if aspects of the early developmental environment were associated with age acceleration were null. Implications for life history theory and the need for additional research are discussed.

The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus.

Women with systemic lupus erythematosus (SLE) who get pregnant while SLE is active or while on teratogens have higher risk of poor pregnancy outcomes. The American College of Rheumatology (ACR) Reproductive Health Guidelines recommend women conceive when SLE is well controlled and treated with pregnancy-compatible medications. The Healthy Outcomes in Pregnancy with SLE Through Education of Providers (HOP-STEP) Intervention was created to ascertain pregnancy interest and contraceptive use followed by a personalized pregnancy prevention and/or planning discussion (https://www.LupusPregnancy.org). All study participants were adult females enrolled in a prospective registry who met ACR or SLICC criteria. Women were defined as "not medically ready for pregnancy" if they were currently prescribed a teratogen, had proteinuria ≥500mg, or had elevated SLE activity according to the physician's global assessment. Two time periods were assessed: 2/2018-12/2019 and 10/2020-4/2021 to evaluate pre- and post-pandemic periods, with some post-pandemic visits taking place via telehealth. The interest in pregnancy was similar between the first time period (17%) and the second time period, whether in-person (18%) or virtual (18%). Pregnancy interest was assessed significantly more frequently during in-person visits (90%) compared to virtual encounters (67%) (p = .02). Contraceptive use was not significantly different during either time period with use of a teratogen or increased SLE activity. Of the 52 women in both time periods who were not medically ready for pregnancy and were not on effective contraception, three women (5.8%) conceived. None of the women who were using moderate or highly effective contraception became pregnant. Pregnancy outcomes were similar between unintended or high-risk and well-timed pregnancies. The HOP-STEP Intervention effectively identified pregnancy interest, giving rheumatologists the opportunity to address patient reproductive goals, optimize disease activity, and adjust medication regimens prior to conception.

9888 Effects of Early Second-Look Hysteroscopy Combined with Intrauterine Balloon Dilatation on Reproductive Outcomes for Women with IUAs

9888 Effects of Early Second-Look Hysteroscopy Combined with Intrauterine Balloon Dilatation on Reproductive Outcomes for Women with IUAs