Role Of Assisted Reproductive Technologies Research Articles

The role of inositol in improving fertility in patients with PCOS

Introduction and purpose
 Polycystic ovary syndrome is a common reproductive disorder, accompanied primarily by hyperandrogenism and insulin resistance. Myo-inositol (MI) and D-chiro-inositol (DCI), have emerged as potential therapeutic agents due to their role as insulin sensitizers. This article examines the effects of inositol therapy on fertility in women with PCOS and its role in assisted reproductive technology (ART). Studies suggest that inositols alleviate irregular menstruation, reduce androgen levels and positively affect ovulation rates. MI supplementation has also shown positive effects during controlled ovarian hyperstimulation and IVF procedures, reducing the required FSH dose and cycle length. However, despite positive results on ovulation and menstrual regularity, the article indicates the need for further studies to establish inositol as standard ART therapy in patients with PCOS.
 Material and methods
 The following review was based on articles from the PubMed and Google Scholar databases. Key search terms included polycystic ovary syndrome; assisted reproductive treatment, insulin resistance, inositols, Myo-inositol, D-chiro-inositol.
 Conclusions 
 Inositols are a promising therapeutic option for women with PCOS. They have been shown to have positive effects on improving insulin sensitivity and fertility. However, despite inositol's safety and easy availability, the ideal dose and timing of use, the appropriate MI/DCI ratio, as well as the potential side effects of excess DCI and the problem of inositol resistance, require further comprehensive studies.

(375) Assessing Infertility Literacy and Knowledge Gaps Amongst Patients with Cystic Fibrosis

Abstract Introduction As patients with cystic fibrosis live longer into their reproductive years, fertility concerns are rising. We hypothesized that while patients with CF may be informed of the impact of their disease on their reproductive potential, they remain unaware of the promising role of assisted reproductive technology (ART) in helping them conceive biological children. Objective Employ a cross-sectional survey to understand experiences, preferences, and current concerns in the CF community around infertility education and infertility healthcare access. Methods This study was reviewed and approved as exempt status by the Institutional Review Board (IRB) exemption as non-human research. We distributed a voluntary and anonymous Qualtrics survey to CF patients and CF advocacy organizations to assess patient understanding of infertility within CF. The survey consisted of 21 questions and aimed to capture demographics, reproductive education specific to CF, preferences on infertility education, current conception practices, and any infertility treatment. Preference questions were assessed using the Likert Scale, and personal experiences questions were answered through free text. Results Forty-one respondents completed the survey (median age of 36 ± 14 years). The median age reported for learning about CF-associated infertility was 18 years. Respondents preferred that reproductive and infertility education be provided early; 43% reported the optimal age of education was younger than 18 years while 50% reported between 18-24 years. Of the respondents trying to conceive, 43% of patients have been trying to conceive for 1-3 years qualifying for infertility. Yet, the majority of those patients (69%) have not been offered semen analysis and 90% have not had previous fertility treatments. Conclusions Patients with CF are highly educated and empowered regarding the chronic treatment of their disease. Historically, issues regarding infertility and conception have been cast to the side, given the severity of other issues, such as lung function and survival. As CF patients live longer and healthier lives, they seek healthcare in other facets, including reproduction and infertility. The findings in our study highlight the importance of discussing reproduction and its limitation in CF at a young age to preemptively empower and prepare patients and their future partners. Furthermore, our study demonstrates a strong need to strengthen the communication between CF care teams and fertility specialists. Both men and women with CF would benefit from receiving respective guidance from embryologists and andrologists to maximize their chances of conception. Disclosure Yes, this is sponsored by industry/sponsor: Cystic Fibrosis Foundation. Clarification: No industry support in study design or execution.

#275 : A Comparative Study of Hatching Methods for Biopsy Time and Ploidy Status Assessment

Background and Aims: Preimplantation genetic testing plays a crucial role in assisted reproductive technologies by aiding in the selection of embryos with optimal developmental potential. This study aims to compare the time required for biopsy and evaluate the ploidy status between Day3 and Day4 hatching-based methods and cases without assisted hatching (AH). Method: We retrospectively analyzed data from 257 embryos from 56 patients between November 2022 and March 2023. Embryos were categorized into three groups: Day3 hatching-based method (n=43), and Day4 hatching-based method (n=134), and cases without AH (n=80). We used Kruskal-Wallis tests and chi-square tests to compare the groups with R software (version 4.1.0) at a significance level of 0.05. Results: There was a significant difference in the median biopsy time per embryo between the hatching-based methods (H = 6.01, p = 0.049). The Day4 hatching-based method had a significantly shorter biopsy time per embryo than cases without AH (W = 95, p = 0.037). There were no significant differences in the percentages of euploid, aneuploid, or mosaic embryos between the hatching-based methods. The Chi-square test showed no significant differences between the observed and expected percentages of euploid ([Formula: see text] = 0.22, p = 0.893), aneuploid ([Formula: see text] = 2.35, p = 0.308), or mosaic ([Formula: see text]= 0.58, p = 0.748) embryos across all hatching-based methods. The Chi-square test of independence showed no significant differences in the percentages of euploid ([Formula: see text] = 0.56, p = 0.755), aneuploid ([Formula: see text] = 1.41, p = 0.495), or mosaic ([Formula: see text] = 0.22, p = 0.896) embryos between the hatching-based methods. Conclusion: We suggest that the Day4 hatching-based method may provide a significant advantage in terms of shorter biopsy time per embryo compared to cases without AH, but there were no significant differences in the percentages of euploid, aneuploid, or mosaic embryos between the hatching-based methods.

Assessing Infertility Literacy and Knowledge Gaps Among Patients with Cystic Fibrosis.

As patients with cystic fibrosis live longer into their reproductive years, fertility concerns are rising. We hypothesized that while patients with cystic fibrosis may be informed of the impact of their disease on their reproductive potential, they remain unaware of the promising role of assisted reproductive technology in helping them conceive biological children. We distributed a voluntary and anonymous survey to cystic fibrosis patients and organizations to assess patient understanding of cystic fibrosis-related infertility. The survey questions aimed to capture demographic information, their reproductive education regarding cystic fibrosis, and their preferences for future fertility. Forty respondents completed the survey (median age of 36 ± 14 years). The median age reported for learning about cystic fibrosis-associated infertility was 18 years. Respondents preferred that reproductive and infertility education be provided early; 43% reported the optimal age of education was younger than 18 years while 50% reported between 18 and 24 years. Of the respondents trying to conceive, 43% of patients have been trying to conceive for 1-3 years qualifying for infertility. Yet, the majority of those patients (69%) have not been offered a semen analysis and 90% have not had previous fertility treatments. Our findings highlight that cystic fibrosis patients are knowledgeable about cystic fibrosis-related impacts on their fertility, with high-rated self-confidence. A fraction of patients still desire to conceive but have not been provided with assisted reproductive services. We recommend the establishment of active partnerships between cystic fibrosis care teams and fertility specialists to maximize their chances of conception.

P-369 An innovative approach for FET that does not rely on the luteinizing hormone surge or human chorionic gonadotropin: a natural cycle with luteal support

Abstract Study question Can progestin supplementation in natural cycle, without reliance on LH surge or hCG ovulation triggering, effectively prepare the endometrium for a frozen embryo transfer (FET)? Summary answer High pregnancy rates can be achieved in natural cycle using luteal support as the main method for endometrial synchronization, without relying on the LH surge What is known already In recent years, frozen-thawed embryo transfer has become widely adopted and plays a significant role in assisted reproductive technology. To date, the evidence suggests that natural cycles result in higher pregnancy rates and fewer obstetric complications compared to hormonal replacement therapy, however, the most effective method for preparing the endometrium has not yet been determined. For transfer in the natural cycle specifically, conflicting results have been reported in terms of the outcome following spontaneous or triggered ovulation. No research is available that supports a natural cycle FET without monitoring the endogenous LH surge or using hCG trigger. Study design, size, duration This is a prospective analysis of 508 natural FET cycles between March 2019 and December 2022, including patients receiving embryos with own oocytes (339) and donated oocytes (169). Participants/materials, setting, methods All patients underwent ultrasound monitoring and serum hormone levels determination of estrogen and progesterone in 3 moments of the cycle (the day of the start of luteal support, 1 week before B-HCG and the day of B-HCG). Upon ultrasound confirmation of the endometrium's optimal thickness and appearance and the presence of the pre-ovulatory follicle, patients began progesterone supplementation and the day for FET was scheduled. Main results and the role of chance A clinical pregnancy rate of 65.48% was reported with a miscarriage rate of 9.09%. A higher rate of miscarriage (22.22%) was found to be associated with an endometrial thickness of less than 7mm at the time of progesterone initiation. The size of the dominant follicle did not affect pregnancy outcome, but a higher pregnancy rate was observed when the follicle measured 15 mm or larger (CPR of 66.83% in cycles with a follicle ≥15mm versus CPR of 60.22% in cycles with a follicle <15mm). Estrogen levels decline in the second measurement but increase again on the day of a positive beta test. This protocol requires less monitoring compared to true and modified natural cycles and is convenient to coordinate with oocyte recipients. A thin endometrial lining, measured below 7mm, increases the risk of a clinical miscarriage. A lack of increase in estrogen levels on the day of B-hCG is an unfavorable sign for a positive outcome. Limitations, reasons for caution Our analysis of data has a prospective design, although it may be limited by unmeasured factors such as the number, stage, and chromosomal testing of transferred embryos. Wider implications of the findings Supplementary luteal support does not affect the natural progression of the endometrium towards receptiveness and results in a key intervention for controlling the start, length and functionality of the window of implantation. A natural cycle, with progesterone supplementation but without monitoring the LH surge, results in high pregnancy rates. Trial registration number Not applicable

Analyzing the Differential Impact of Semen Preparation Methods on the Outcomes of Assisted Reproductive Techniques.

Sperm separation plays a critical role in assisted reproductive technology. Based on migration, density gradient centrifugation and filtration, a properly selected sperm could help in increasing assisted reproductive outcomes in teratozoospermia (TZs). The current study aimed to assess the prognostic value of four sperm selection techniques: density gradient centrifugation (DGC), swim-up (SU), DGC-SU and DGC followed by magnetic-activated cell sorting (DGC-MACS). These were evaluated using spermatozoa functional parameters. A total of 385 infertile couples underwent the procedure of intracytoplasmic sperm injection (ICSI), with an isolated teratozoospermia in the male partner. Semen samples were prepared by using one of the mentioned sperm preparation techniques. The improvements in the percentage of normal mature spermatozoa, rate of fertilization, cleavage, pregnancy and the number of live births were assessed. The normal morphology, spermatozoa DNA fragmentation (SDF) and chromatin maturity checked by using chromomycin A3 (CMA3) with DGC-MACS preparation were better compared to the other three methods. Embryo cleavage, clinical pregnancy and implantation were better improved in the DGC-MACS than in the other tested techniques. The DGC-MACS technique helped in the selection of an increased percentage of normal viable and mature sperm with intact chromatin integrity in patients with teratozoospermia.

Effect of intrauterine infusion of platelet-rich plasma for women with recurrent implantation failure: a systematic review and meta-analysis

This study evaluated the effect of intrauterine perfusion of autologous platelet-rich plasma (PRP) on pregnancy outcomes in women with recurrent implantation failure (RIF). Key biomedical databases were searched to identify relevant clinical trials and observational studies. Outcomes included clinical pregnancy rate, chemical pregnancy rate, implantation rate, live birth rate, and abortion rate. Data was extracted from ten studies (six randomised controlled trials, four cohort studies) involving 1555 patients. Pregnancy outcomes were improved in women treated with PRP compared to controls: clinical pregnancy rate (RR = 1.96, 95% CI [1.67, 2.31], p < 0.00001, I 2 = 46%), chemical pregnancy rate (RR = 1.79, 95% CI [1.54, 2.08], p < 0.00001, I 2 = 29%), implantation rate (RR = 1.90, CI [1.50, 2.41], p < 0.00001, I 2 = 0%), live birth rate (RR = 2.83, CI [1.45, 5.52], p = 0.0007, I 2 = 83%), abortion rate (RR = 0.40, 95% CI [0.18, 0.90], p = 0.03, I 2 = 59%). These data imply PRP has potential to improve pregnancy outcomes in women with RIF, suggesting a promising role in assisted reproductive technology. IMPACT STATEMENT What is already known on this subject? Platelet-rich plasma (PRP) is an autologous blood product that contains platelets, various growth factors, and cytokines at concentrations above the normal baseline level. Recent studies have shown that intrauterine infusion of autologous PRP can improve pregnancy outcomes in infertile women. What do the results of this study add? This systematic review and meta-analysis of data from ten studies (n = 1555; 775 cases and 780 controls) investigated the effect of intrauterine perfusion of autologous PRP on pregnancy outcomes in women with recurrent implantation failure (RIF). Findings suggest that pregnancy outcomes, including clinical pregnancy rate, chemical pregnancy rate, implantation rate, live birth rate and abortion rate were improved in women treated with PRP compared to controls. What are the implications of these findings for clinical practice and/or further research? RIF remains a challenge for researchers, clinicians, and patients. Our study identified PRP as a potential intervention in assisted reproduction. As an autologous blood preparation, PRP eliminates the risk of an immune response and transmission of disease. PRP is low cost and effective and may represent a new approach to the treatment of patients with RIF.

The making of ‘old eggs’: the science of reproductive ageing between fertility and anti-ageing technologies

This article proposes going back in the history of reproductive medicine to shed light on the role of assisted reproductive technology (ART) in the making of ‘old eggs’. Focusing on two key technologies – egg donation and cytoplasmic transfer – both of which contributed significantly to the production of scientific knowledge about reproductive ageing, the article suggests that ART can be analysed as ‘in-vivo models’ playing a pivotal role in the shift from age as a demographic variable to ageing understood in biological terms. It will shed light on the role of ART in locating age in the eggs and producing a cellular understanding of fertility decline. It argues that ART not only offers new means of reconfiguring the biological clock by extending fertility, but also reconfigures the biology of reproductive ageing itself. This becomes both the target and the means for new technological interventions, imaginaries and norms, anchored in women’s bodies and a more plastic biology, and thereby illuminates hitherto underexplored aspects of the encounter between the science and technology of reproduction and anti-ageing.

Warrants of cryopreservation in assisted reproductive technology amidst COVID-19 pandemic

Cryopreservation plays a central role in assisted reproductive technology (ART) by allowing in vitro fertilization (IVF) cycle segmentation, banking of supernumerary gametes, embryos, and fertility preservation. The identification of viral receptors on gametes and embryos raises serious concerns for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who are interested in preserving fertility. The complications caused by the SARS-CoV-2 on IVF and embryo safety are yet to be explored. Scanty information is available so far regarding the risk of cryopreservation of biological materials used in ART. Here, we highlight the risks of cryopreservation in ART and safety measures to follow amidst the COVID-19 pandemic.

The impact of congenital uterine abnormalities on pregnancy and fertility: a literature review.

Congenital abnormalities of the uterus result primarily from embryological maldevelopment of the paramesonephric ducts and have been associated with pregnancy complications, reduced fertility, and other adverse fetal outcomes. While such abnormalities are rare, affected patients should be correctly managed to improve psychological, sexual, and reproductive outcomes. This review intends to elucidate the impact of congenital uterine abnormalities on fertility and pregnancy outcomes. We also present the available management methods and discuss the role of assisted reproductive technologies (ART) to benefit affected women. This review clearly shows that although these disorders are generally not lethal, they critically impact the patient’s reproductive health. The fertility rate of patients with uterine congenital abnormalities depends on the severity of the condition. Reproductive endocrinologists and infertility specialists must be considered as active parts of the interdisciplinary treatment team for such patients. ART practices are reasonably successful at managing fertility problems of women with these abnormalities.

Assisted reproductive technologies in Russia: medical breakthroughs and social problems

The paper considers the role of assisted reproductive technologies in changing the qualitative and quantitative characteristics of Russian fertility. The author analyzes the quantitative and qualitative characteristics of ART in Russia in 1986-2020, their public perception and current problems based on the data of national ART registers, reviews of international professional associations of reproductive specialists, secondary sociological information and hospital statistics. The general trend is the expansion of the geography of reproductive centers and the diversification of services, but the growing demand for ART as methods of alternative conception in the absence of reproductive disorders intensifies public debate around them, especially in the context of religion and children’s health. Nevertheless, in conditions of low fertility, the state considers ART as instruments of a pronatal demographic policy and finances them even against the backdrop of the coronavirus pandemic.

Generation of cynomolgus monkey fetuses with intracytoplasmic sperm injection based on the MII-stage oocytes acquired by personalized superovulation protocol.

BackgroundMature oocytes at the metaphase II status (MII-stage oocytes) played an important role in assisted reproductive technology in non-human primates.ObjectivesIn order to improve the proportion of MII-stage oocytes retrieval, three different superovulation protocols were performed on 24 female cynomolgus monkeys.MethodsAll the monkeys received once-daily injection of follicle-stimulating hormone (25 international unit [IU]) on day 3 of the menstruation, 3-day intervals, twice daily for 8–12 days until the time of human chorionic gonadotropin (1,500 IU) injection, on the 14–17th day of menstruation collecting oocytes. The difference between protocol I and protocol II was that 0.1 mg the gonadotropin-releasing hormone agonist was injected on day 1 of the menstruation, while the difference between personalized superovulation protocol and protocol II was that oocytes could be collected on the 14–17th day of menstrual cycle according to the length of each monkey.ResultsThe total number of oocytes harvested using the personalized superovulation protocol was much higher than that using protocol I (p < 0.05), and the proportion of MII-stage oocytes was significantly greater than that from either superovulation protocol I or II (p < 0.001 and p < 0.01 respectively), while the proportion of immature oocytes at the germinal vesicle was less than that from superovulation protocol I (p < 0.05).ConclusionsThe personalized superovulation protocol could increase the rate of MII-stage oocytes acquired, and successfully develop into embryos after intracytoplasmic sperm injection, and eventually generated fetus.

Assisted conception as a potential prognostic factor predicting insulin therapy in pregnancies complicated by gestational diabetes mellitus

BackgroundAdvanced maternal age, family history of diabetes, pre-gestational obesity, increased level of HbA1c, history of gestational diabetes mellitus (GDM), and poor pregnancy consequences are considered risk factors for antenatal insulin requirement in women with GDM. However, the role of assisted reproductive technology (ART) in increasing the risk of insulin therapy in pregnancies complicated with GDM remained elusive. The current study aimed to determine the role of ART in predicting insulin therapy in GDM women and investigate the clinical and biochemical factors predicting the need for insulin therapy in pregnancies complicated with GDM.MethodsIn this prospective cohort study, 236 Iranian women with GDM were diagnosed by one-step oral glucose tolerance test (OGTT) between October 2014 and June 2017. They were mainly assigned to two groups; the first group (n = 100) was designated as ART which was further subdivided into two subgroups as follows: 60 participants who received medical nutrition therapy (MNT) and 40 participants who received MNT plus insulin therapy (MNT-IT). The second group (n = 136) was labeled as the spontaneous conception (SC), consisting of 102 participants receiving MNT and 34 participants receiving MNT in combination with IT (MNT-IT). The demographic, clinical, and biochemical data were compared between groups. Multivariate logistic regression was performed to estimate prognostic factors for insulin therapy.ResultsA higher rate of insulin therapy was observed in the ART group as compared with the SC group (40% vs. 25%; P < 0.001). Multivariate logistic regression demonstrated that maternal age ≥ 35 years [OR: 2.91, 95% CI: (1.28–6.62)], high serum FBS [1.10: (1.04–1.16)], HbA1c [1.91 (1.09–3.34)], and ART treatment [2.94: (1.24–6.96)] were independent risk factors for insulin therapy in GDM women.ConclusionsApart from risk factors mentioned earlier, ART may be a possible prognostic factor for insulin therapy in pregnancies complicated with GDM.

Effect of vitamin D on apoptotic marker, reactive oxygen species and human sperm parameters during the process of cryopreservation.

Objective(s):Sperm cryopreservation plays an undeniable role in assisted reproductive technology. However, this process significantly reduces the motility, viability, morphology and nuclear integrity of sperm. Reasons of these changes were oxidative stress and apoptosis. The aim of this study was to evaluate the influence of vitamin D on the survival and integrity of fertile sperm after cryopreservation.Materials and Methods:Semen sample of 18 males with normal parameters was used. After swimming up, each sample was divided into two parts. 20 µmol vitamin D was added to one part as experimental group and the other part was left untreated as control group. The samples in all groups were frozen for 14 days. Post-thawing, the groups were evaluated for sperm motility, and viability using eosin staining, morphology using the Diff-Quick staining and apoptosis by TUNEL, Annexin-V and caspase-3 activity assay. By using nitrobluetetraxolium test and thiobarbituric acid, the reactive oxygen species (ROS) and lipid peroxidation of sperms were measured, respectively.Results:In comparison with control groups, motile and viable sperm concentration was substantially higher in treated groups (P-value<0.05); however, morphological analysis did not show any remarkable changes. Also, ROS and lipid peroxidation values were dramatically reduced by vitamin D (P-value<0.05). TUNEL and Annexin assay for apoptosis were considerably lower in treated groups (P-value<0.05), but caspase activity assay revealed no significant difference between groups.Conclusion:The results have shown that the addition of vitamin D to a freezing medium leads to higher quality and function of human sperm.

Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction.

Over the past 40years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.

ID: 1064 Effects of FSH, cumulus cell morphology and follicular fluid from different follicular sizes on the in vitro maturation of bovine oocytes

The quality of mature oocyte plays a vital role in assisted reproductive technology, as well as animal cloning. Therefore, optimization of the in vitro maturation procedure for oocytes has long been of interests for researchers in the fields of reproduction. In this study, we investigated the effect of different supplement culture factors on in vitro maturation of bovine oocytes such as follicular-stimulating hormone (FSH) (experiment 1), different layers of cumulus cells (CCs) (experiment 2), and follicular fluid (FF) collected from different follicle sizes (experiment 3). With result from experiment 1, bovine oocytes cultured in in vitro maturation (IVM) medium supplemented with FSH reached to higher maturation rate than cultured in the basic one (85.9% and 69.3% respectively). In addition, experiment 2 suggested that, the groups of 3-4 layers and 2-3 layers achieve higher rate of oocyte maturity than group of &lt;1 layers (84.38%; 82.46%; 47.83% respectively). However, the result of experiment 3 show that FF collected from different follicle size did not affect to the maturation rate. In conclusion, FSH and layers of CCs affect to the maturation of bovine oocytes.

Management of Ectopic Ovary in the Setting of Mullerian Agenesis [35P

INTRODUCTION: Mullerian agenesis can be associated with a complex array of other congenital anomalies, including ectopic ovaries. As a rare finding, clinical recommendations are not clear cut, therefore we present a case report and literature review to develop recommendations for clinical management of an ectopic ovary in the setting of complete Mullerian agenesis. METHODS: An adolescent female with primary amenorrhea underwent complete evaluation at an academic reproductive endocrinology clinic. Clinical management recommendations were developed based on literature review. RESULTS: Physical examination of the 16-year-old amenorrheic female revealed a short blind vagina, fullness of the left inguinal canal, normal sexual hair distribution and breast development. Further evaluation with pelvic MRI demonstrated absence of the uterus, normal right ovary, and ectopic ovarian gonad located in the left inguinal canal. She was additionally found to have absence of the left kidney and a hypertrophic right kidney with a single ureter. We performed extensive literature review to develop clinical recommendation on ectopic ovary in patients with complete Mullerian agenesis, also known as Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The considerations of gonadal conservation, risk of malignancy, and indications of ovarian transposition were evaluated in preparation of management recommendations. CONCLUSION: Ovarian conservation without ovarian transposition is an optimal clinical management in the case of unilateral ectopic ovary in patients with Mullerian agenesis. Absence of significant increase of malignant transformation should be discussed with these patients. A review of possible oocyte recovery from an ectopic ovary and role of assisted reproductive technology is highly recommended to diminish patient anxiety about future fertility.

An Introduction to Epigenetics.

Epigenetics refers to the heritable information that is exclusive of DNA. Several syndromes have been found to occur as the result of the process of epigenetics. This process causes changes in the expression of genes, without changing the actual DNA sequence. The factors influencing this process include both internal and external triggers, leading to modulation of the epigenome through different mechanisms. This article aims to describe how the process of epigenetics gives rise to the multitude of possible syndromes seen in neonates. The article will also discuss the role of assisted reproductive technology may play in epigenetic changes when compared with the naturally conceived embryo.

Potential Influence of the Microbiome on Infertility and Assisted Reproductive Technology

Although an altered vaginal microbiota has been demonstrated to affect parturition, its role in assisted reproductive technologies is uncertain. Nevertheless, the effect of known pathogens such as Mycoplasma tuberculosis, Chlamydia trachomatis, and Neisseria gonorrhoeae is clear, causing subclinical changes thought to be risk factors in subfertility. The Human Microbiome Project (HMP) has allowed for metagenomic studies to aid in characterizing normal vaginal flora. Recent findings from the HMP demonstrate that many different species of Lactobacillus are present in the vaginal tract, with a few that predominate. Studies that characterize the vaginal microbiome in assisted reproductive technology support the hypothesis that colonizing the transfer-catheter tip with Lactobacillus crispatus at the time of embryo transfer may increase the rates of implantation and live birth rate while decreasing the rate of infection. In addition, there is some evidence that a progesterone-resistant endometrium might increase the risk of an abnormal vaginal microbiome.

Deformational plagiocephaly at birth: an observational study on the role of assisted reproductive technologies

ABSTRACTBackground: Following the “back to sleep” recommendations, a striking rise in deformational plagiocephaly (DP) occurred. However, additional maternal, pregnancy and infant conditions may play a role.Objectives: We aimed to evaluate the prevalence of and risk factors for DP at birth. Additionally, given the association between assisted reproductive technologies (ART) use and unfavorable pregnancy events, we explored the association between ART and DP.Patients and Methods: A total of 413 neonates >33 weeks born at L. Sacco Hospital (Milan, Italy) from May 2011 through to January 2012 were enrolled. Data regarding parental, conceivement, pregnancy and delivery characteristics were recorded. Infants’ skull measurements, including the oblique cranial length ratio (OCLR) were taken within 72 h after birth. Plagiocephaly was defined for OCLR > 105.9.Results: The prevalence of DP was 20.3%. It was associated with twinning (OR 5.0; 95%CI 2.22–11.1), pregnancy complications (OR 2.86; 95%CI 1.49–5.26), prematurity (OR 2.13; 95%CI 0.98–4.54), ART use (OR 2.00; 95%CI 0.90–4.35) and male gender (OR 1.79; 95%CI 0.94–2.50). Adjusting for multiple pregnancies however, the association between ART and DP disappeared.Conclusion: Results show that offspring of pregnancies conceived through ART do not have increased risk of DP. However, our numbers are small thus larger studies are needed for definitive conclusions.