Seeking Fertility Treatment Research Articles

P-163 Three-year follow-up of babies born derived from mono-pronuclear zygotes

Abstract Study question Are neonatal outcomes normal up to 3 years of ages from the transfer of blastocysts derived from mono-pronuclear(1PN) zygotes? Summary answer There was no effect on growth up to 3 years of ages in babies born from 1PN-implanted blastocysts. What is known already In human ART, 1PN zygotes are observed at low rates. We have previously reported that 80.7% of 1PN zygotes had a biparental chromosome using a Live-Cell imaging technique, and some of these developed to the blastocyst stage (Tokoro et al. ASRM 2013). Furthermore, we have reported that these blastocysts can result in a viable pregnancy and healthy live birth (Tsuji et al. ASRM 2020), and there was no effect on growth up to 18-months (Tsuji et al. ESHRE 2021). However, there is no information on the long-term prognosis of babies derived from1PN-zygotes. Study design, size, duration This was a retrospective study which included 86 cases where there was a live birth after single embryo transfer of a blastocyst derived from 1PN zygote. The incidence of birth defects, birth weight were recorded as well as a physical development survey of 19 children who responded to a 3-years follow-up survey. The time period was 108 months (January 2013 to December 2021). Participants/materials, setting, methods Patients seeking fertility treatment at an established private IVF clinic. We compared the birth weight, 3-years old height and weight of children born from 1PN zygotes with data from a control, 2PN group. Statistical significance was determined using the t-test (level of P < 0.05). Main results and the role of chance The incidence of birth defects in 1PN embryo-derived infants was 1.2% (1/86). The average birth weight of boys in the 1PN group was 3147.6+/-408.7 g, which was not significantly different from 3070.5+/-479.5 g in the 2PN group. In girls, the average birth weight was 3048.1+/-510.7 g in the 1PN group, which was not significantly different from the 2PN group (2966.2+/-462.7 g). The average height at 18-months, was 81.3+/-2.5 cm vs 80.9+/-3.4 cm for boys; 79.5+/-2.2 cm vs 79.5+/-3.0 cm for girls in the 1PN and 2PN groups, respectively. The average body weights of the 1PN and 2PN groups were 11.0+/-1.2 kg vs 10.8+/-1.1 kg for boys; 9.8+/-1.0 kg vs 10.2+/-1.1 kg for girls, respectively. The average height at 3-years, was 95.2+/-3.1 cm vs 93.8+/-4.5 cm for boys; 91.5+/-2.9 cm vs 92.5+/-4.9 cm for girls in the 1PN and 2PN groups, respectively. The average body weights of the 1PN and 2PN groups were 14.7+/-1.2 kg vs 14.1+/-1.5 kg for boys; 13.2+/-1.9 kg vs 13.6+/-1.5 kg for girls, respectively. There was no significant difference in average height and weight up-to the 3-years follow-up survey. Limitations, reasons for caution The incidence of 1PN- zygotes that develop to blastocysts resulting in births is low and the study was limited to cases of single blastocyst embryo transfer. Wider implications of the findings The incidence of congenital anomalies in Japan is around 1.7 to 2%, and the incidence was similar in the 1PN group. Also, there was no difference in 3-years follow-up survey of the 1PN compared with the 2PN. These data are reassuring for the clinical utility of 1PN derived embryos. Trial registration number not applicable

Comparison of Female Ovarian Reserve Before vs After COVID-19 Vaccination

This cohort study examines the association of COVID-19 vaccination with levels of anti-Mullerian hormone and antral follicle count in women seeking fertility treatment.

Prevalence of Low and High BMI in Patients with Infertility

Background: The number of individuals who are underweight as well as overweight is increasing worldwide and is known to lead to menstrual disorders and subfertility. Data regarding the prevalence of infertility in Austrian women are lacking. This study aimed to determine the prevalence of a pathologically low and high body mass index (BMI) in Austrian patients with infertility and to evaluate the live birth rate (LBR) after assisted reproductive technologies (ARTs) compared with normal weight patients. Methods: A total of 585 couples with infertility who sought treatment at a single center between April 2017 and April 2019 were included in this retrospective study. The patients were categorized into study group 1 (BMI <19 kg/m2, n = 35), study group 2 (BMI >30 kg/m2, n = 40), and control group (BMI 19–30 kg/m2, n = 95. They were randomly selected from the n = 522 women within these BMI values). Results: The prevalence rates of BMI <19 kg/m2 and BMI >30 kg/m2 were 5.9% and 6.7%, respectively. Baseline clinical and laboratory characteristics as well as the prevalence of pathospermia in their male partners were similar in all study groups. In women undergoing ART (n = 112), LBR was comparable between the study groups (27.3% vs. 31.9% and 22.2%, p = 0.4). Conclusions: The prevalence of low and high BMI in Austrian patients seeking fertility treatment was almost 13%. Although LBR was not reduced, physicians should be more attentive to the BMI values of patients with infertility because pregnancy-related complications are linked to being underweight and obese.

A trans-vaginal endoscopic extraperitoneal myomectomy

Trans-vaginal endoscopic extraperitoneal myomectomy is an uncommon minimally invasive surgical procedure. When accessible, a vaginal myomectomy is an interesting approach for patients with para-cervical or cervical fibroids that want a fertility-sparing surgery. A 37-year-old woman nulliparous presents with deep dyspareunia and voiding dysfunction due to a 4 cm para-cervical fibroid. Patient desires to conceive as soon as possible and would like the least invasive surgical approach. After proper counseling, the patient was admitted for trans-vaginal endoscopic myomectomy. A successful vaginal myomectomy was performed with no peri- or post-operative complications. The patient was seen 6 weeks later. Her complaints resolved and she was pleased with the surgical results. She is now seeking fertility treatment. This video shows a trans-vaginal endoscopic extraperitoneal myomectomy. It is a safe and novel surgical technique that can be considered in patients with low lying uterine fibroids accessible vaginally.

Perinatal outcomes in lesbian couples employing shared motherhood IVF compared with those performing artificial insemination with donor sperm.

In lesbian couples, is shared motherhood IVF (SMI) associated with an increase in perinatal complications compared with artificial insemination with donor sperm (AID)? Singleton pregnancies in SMI and AID had very similar outcomes, except for a non-significant increase in the rate of preeclampsia/hypertension (PE/HT) in SMI (recipient's age-adjusted odds ratio (OR) = 1.9, 95% CI = 0.7-5.2; P = 0.19), but twin SMI pregnancies had a much higher frequency of PE/HT than AID twins (recipient's age-adjusted OR = 21.7, 95% CI = 2.8-289.4; P = 0.01). Oocyte donation (OD) pregnancies are associated with an increase in perinatal complications, in particular, preterm delivery and low birth weight, and PE/HT. However, it is unclear to what extent these complications are due to OD process or to the conditions why OD was performed, such as advanced age and underlying health conditions. Unfortunately, the literature concerning perinatal outcomes in SMI is scarce. Retrospective study involving 660 SMI cycles (299 pregnancies) and 4349 AID cycles (949 pregnancies) assisted over a 10-year period. All cycles fulfilling the inclusion criteria performed in lesbian couples seeking fertility treatment in 17 Spanish clinics of the same group. Pregnancy rates of SMI and AID cycles were compared. Perinatal outcomes were compared: gestational length, newborn weight, preterm and low birth rates, PE/HT rates, cesarean section rates, perinatal mortality, and newborn malformations. Pregnancy rates were higher in SMI than in AID (45.3% versus 21.8%, P < 0.001). There was a non-significant trend to higher multiple rate in AID (4.7% versus 8.5%, P = 0.08). In single pregnancies, there were no differences between SMI and AID in gestational age (278 days (268-285) versus 279 (272-284), P = 0.24), preterm rate (8.3% versus 7.3%, P = 0.80), preterm <28 weeks (0.6% versus 0.4%, P = 1.00), newborn weight (3195 g (2915-3620) versus 3270 g (2980-3600), P = 0.296), low birth rate (6.4% versus 6.4%, P = 1.00), extremely low birth weight (0.6% versus 0.5%, P = 1.00), and the distribution of newborns by weight groups. Cesarean section rate, newborn malformation rate, and perinatal mortality were also similar in SMI and AID. Additionally, there was non-significant trend in hypertensive disorders to an increase in PE/HT among SMI (recipient's age-adjusted OR = 1.9, 95% CI = 0.7-5.2). Overall, perinatal data are consistent with what is reported in the general population. In twin pregnancies, the aforementioned perinatal parameters were also very similar in SMI and AID. However, SMI twin pregnancies had a very high risk of PE/HT when compared with AID (recipient's age-adjusted OR = 21.7, 95% CI = 2.8-289.4, P = 0.01). Our data regarding the pregnancy course were obtained from information registered in the delivery report as well as from what was reported by the patients themselves, so a certain degree of inaccuracy cannot be ruled out. Additionally, in some parameters, there was up to 10% of data missing. However, since the methodology of reporting was the same in SMI and AID groups, one should not expect a differential reporting bias. It cannot be ruled out that the risk of PE/HT in simple gestations would be significant in a larger study. Additionally, in the SMI group allocation to the transfer of 2 embryos was not randomized so some bias is possible. SMI, if single embryo transfer is performed, seems to be is a safe procedure. Double embryo transfer should not be performed in SMI. Our data suggest that the majority of complications in OD could be related more with recipient status than with OD itself, since with SMI (performed in women without fertility problems) the perinatal complications were much lower than usually described in OD. No external funding was received. The authors declare that they have no conflict of interest. N/A.

An Explorative Study to Assess the Suicidal Risk Amongst Infertile Patients

IntroductionThis given study was designed to qualitatively and quantitatively examine the Psychosocial – emotional consequences of infertility on female infertile patients . Suicidal risk amongst infertile patients was a incidental yet significant finding with 25 percent of the study population reporting a positive result by the MINI scale. There are very few studies conducted in the Indian context that analyses the psychosocial aspects of infertility and the impact of ART treatment on the quality of life.The finding in our study indicates that both infertility and stress associated with ART treatment contributes to psychological turmoil namely depression , anxiety, psychopathology and quality of life impairment in addition to suicidal ideation and suicidal risk.ObjectivesAimsTo assess the psychosocial impact of infertility amongst female infertile patients including suicidal risk/ suicidal ideation in the given study population.MethodsA total of 300 women attending the Obstetrics and Gynecology out patients department of a tertiary hospital in Kolkata, India were selected by simple random sampling. 100 fertile women attending the routine ante natal clinic were selected as cases and 100 infertile women seeking fertility treatment were selected as controls. 100 women didn’t follow up with the study. The following questionnaires were administered to both case and control group- BAI, BDI, SCL-90-R, SF-36, MINI and socio demographic proforma ; by trained clinic psychologist . The raw scores &amp; adjusted scores were analysed statistically by SPSS using the following tests, independent t test, chi square test and Z test.ResultsThe results of the MINI scale indicate that up to 25% of the infertile cohort suffer from suicidal risk/ suicidal ideation which is statistically significant in comparison to the control group.The other psychosocial parameters are also statistically significant in the case in comparison to the control population.Conclusions Although the psychosocial impact of infertility has been well researched and documented. Few studies have been conducted globally which assess suicidal risk amongst infertile patients. Our results corroborate earlier studies such as the Danish administrative population-based registry study by Trille Kristina Kjaer et al which found a causative link between infertility and suicidal risk.Further research is needed in this directionDisclosure of InterestNone Declared

Lived experiences and coping strategies of persons seeking infertility treatment in the Kumasi metropolis: a descriptive phenomenological study

BackgroundWomen seeking fertility treatment face myriad challenges that they must adapt and adjust to daily. This aimed at exploring the experiences and coping strategies of such persons in the Kumasi.Metropolis.MethodsA qualitative approach was employed and a purposive sampling technique was used to select 19 participants. A semi-structured interview was used to collect data. The data collected were analyzed using Colaizzi's method of data analysis.ResultsPersons living with infertility had emotional experiences of anxiety, stress, and depression. Socially, participants experienced isolation, stigma, societal pressure, and marital problems due to their inability to conceive. The key coping strategies adopted were spiritual (faith-based) and social support. Though formal child adoption can be an option, no participant preferred it as a coping strategy. Some participants also reported using herbal medicine before going to the fertility centre upon realizing that the approach was not helping in achieving their desired outcome.ConclusionInfertility is a source of suffering for most women diagnosed with it, resulting in significant negative experiences in their matrimonial homes, families, friends, and the community at large. Most participants rely on spiritual and social support as their immediate and basic coping strategies. Future research could evaluate the treatment and coping strategies and also determine the outcomes of other forms of treatment for infertility.

Physical and psychological wellbeing among Australian and New Zealand patients seeking fertility treatment during COVID-19

ABSTRACT Background Worldwide, COVID-19 has disrupted the provision of fertility treatment and patients’ reproductive plans, resulting in heightened stress for many people seeking to form or expand their families. Aims Our study explored health behaviour changes and psychosocial implications of COVID-19 in patients accessing fertility treatment in Australia and New Zealand. Materials and Methods Sixty participants (58 female; 2 male) completed an online cross-sectional survey about demographics, fertility history and treatment, changes to physical and mental health status, and perceived support. Participant responses were summarised using descriptive statistics. Results Patients indicated that COVID-19 had adversely impacted their fertility treatment experience, including interruptions to treatment owing to fertility clinic closure (70%) and fears about conceiving (68.3%). Patients reported negative health behaviour changes, including a reduction in sleep quality (40%), reduced exercise (40%), weight gain (56.7%) and increases in symptoms of depression (38.3%), anxiety (75%), stress (78.3%) and loneliness (38.3%). Whilst most participants agreed their fertility clinic clearly communicated policy about COVID-19 service changes, including information about availability and/or restrictions, approximately 55% reported being offered nil to very little professional psychological support. When provided professional support, this was most commonly via fertility doctors and nurses (48.3%) compared to counsellors (3.3%). Conclusions(s) Commensurate with findings from larger international cohorts, this study highlights the negative impact of COVID-19 on health behaviours and psychological wellbeing. Moreover, given the ever-changing landscape of COVID-19, our study underscores the importance of promoting and utilising fertility clinic counselling services to enhance patient psychological care during this unprecedented pandemic.

Female fertility treatment and adverse birth outcomes: a multistate analysis of pregnancy risk assessment monitoring system data

Objective The popularity of fertility treatments has continued to rise, however, the potential health risks of these treatments for both mother and infant are not fully known. Our objective was to determine the association between fertility treatments and adverse birth outcomes of intended pregnancies using the Pregnancy Risk Assessment Monitoring System (PRAMS) data. Methods Data from 27,018 intended pregnancies, collected from 2009 to 2018 in the United States, were included in our analysis. PRAMS data consisted of questionnaire and birth certificate data. SAS 9.4 was used for analyses accounting for complex survey weights. All analyses were conducted separately for singleton and twin births. Weighted percentages with 95% confidence intervals (CIs) were estimated for maternal characteristics and birth outcomes. Multivariable logistic regression was used to determine adjusted odds ratios (OR) and 95% CIs for associations of fertility treatment use and adverse birth outcomes. Results Close to 12% of women reported the use of any fertility treatment. Among those using fertility treatments, the most common type was assisted reproductive technology (ART) for both twin (68.7%, 95% CI: 62.3, 75.2) and singleton births (45.1%, 95% CI: 42.0, 48.1). Use of any type of fertility treatment for singleton births was associated with increased odds of a cesarean delivery (OR: 1.31, 95% CI: 1.16, 1.47), preterm birth (OR: 1.42, 95% CI: 1.20, 1.67), a small-for-gestational age infant (OR: 1.20, 95% CI: 1.00, 1.44), and an infant hospital stay >5 days (OR: 1.34, 95% CI: 1.11, 1.62). Use of fertility treatment for twin births was associated with cesarean delivery only. In analyses examining associations for specific types of treatment (medication alone, ART, insemination) with birth outcomes, results varied by treatment type. Conclusions In this large population-based sample of women who intended to become pregnant and had a live birth, fertility treatment was associated with adverse birth outcomes. Patients seeking fertility treatment should be appropriately counseled on the risks of adverse maternal and infant birth outcomes overall and by treatment type. Maternal support and resources to prevent adverse birth outcomes among women using fertility treatments are warranted.

Herpes simplex virus type 2 seroprevalence and associated factors in fertility-treatment-seeking population: A cross-sectional survey in the United Arab Emirates.

Herpes simplex virus type 2 (HSV-2) is a common genitally-transmitted viral infection affecting more than 400 million individuals globally. In the United Arab Emirates (UAE), in specific at-risk population groups, the burden of HSV-2 has not been reported. This study investigated the prevalence of HSV-2 IgG antibodies in patients seeking fertility treatment and characterized patients with seropositivity to HSV-2 IgG antibodies. A cross-sectional sample of patients seeking fertility treatment in a major fertility clinic in Abu Dhabi, UAE was surveyed from April to May 2021. Patients were consecutively invited to complete self-administered questionnaires and provide blood for HSV-2 testing. Information on sociodemographics, medical history, and infertility was collected. Serum specimens were screened using an enzyme-linked immunosorbent assay for HSV-2 IgG antibodies detection. Two hundred and ninety-nine patients were surveyed and provided blood samples. The mean age of the patients was 35.9 ± 6.8 [mean ± standard deviation (SD)] years with 89.3% being women. Sixty-six percent were overweight or obese, 25.0% had at least one chronic comorbidity, and 19.6% reported ever-had genital infection. More than two-thirds (68.3%) of the patients were infertile for ≥ 6 months. Of the 42 infertile males, 69.0% had an abnormal semen analysis. HSV-2 IgG antibodies was detected in 12.4% of patients. The HSV-2 IgG seropositive patients had a higher mean age (39.5 vs. 35.4 years; p < 0.001) compared to seronegative patients. HSV-2 IgG antibodies seropositivity was more common in males (15.6%) than females (12.0%), in patients with secondary (14.1%) vs. primary (9.2%) infertility, or in males with abnormal (10.3%) vs. normal (7.7%) semen. Exposure to HSV-2 at any time in patients seeking fertility treatment in the UAE was found to be slightly common in more than one out of 10 patients. Tailored health campaigns on HSV-2 prevention are warranted.

ODP617 An interdisciplinary intervention improves lifestyle behaviours in women living with obesity and infertility: a randomized controlled trial

Abstract Introduction Lifestyle modifications should be the first-line treatment for improving reproductive function and preconception weight in women living with obesity who are seeking fertility treatments. Evidence is however scarce regarding the effectiveness of lifestyle programs in supporting these women. The study's objective was therefore to determine whether the Obesity-Fertility program leads to healthier lifestyle behaviours in women living with obesity and consulting at a fertility clinic. Methods Women with obesity and infertility were randomized to the control (CG=65) or intervention (IG=65) group. Based on the participant's medical record, randomization was stratified according to the polycystic ovarian syndrome status. The CG followed the usual fertility clinic approach while the IG participated in individual and group sessions with a registered dietician, a kinesiologist, and a psychologist. Before the intervention (baseline) and 6 months after (V6), frequency of food and beverages intakes, physical activity levels, sedentary time, daily sleep duration, alcohol consumption and smoking use were collected via a lifestyle behaviour questionnaire adapted from the 2009 Canadian Community Health Survey (Statistics Canada). Functional capacity was evaluated with a 6-minute walk test. Descriptive statistics, two-sample tests of means or proportions, generalized linear models and logistic regressions were performed. Results At baseline, women who had a research visit at 6±1 months (n=85) were 30±5 years old and had a BMI of 39.8±7.7 kg/m2. Most of them held no university degree (81.2%) and were primiparous (56.5%). Both groups (CG=43 and IG=42) had similar sociodemographic and anthropometric characteristics as well as lifestyle behaviours at baseline except for smokers’ proportion that was higher in CG (CG: 34.9% vs IG: 9.5%, p&amp;lt;0. 01). From baseline to 6 months, whole fruit and vegetable frequency intakes increased more in the IG vs CG (fruits: +1.1 vs +0.4/day, p&amp;lt;0. 01; vegetables: +0.7 vs +0.4/day, p&amp;lt;0. 01). Significant differences (IG vs CG) were also observed for frequency intakes of whole grain products (+1. 0 vs +0. 04/day, p&amp;lt;0. 01) and dairy products (+0.5 vs -0.2/day, p&amp;lt;0. 01) as well as in the percentage of active women (&amp;gt;3 kcal/kg/day: +14.2% vs +2.3%, p=0. 03) and the time spent in sedentary behaviours (-6.7 vs -0.1 h/week, p&amp;lt;0. 01). Distance covered during the 6-minute walk test tended to increase more in IG vs CG (+28.8 vs +5.5 metres, p=0. 05). Sleep duration decreased by 19 and 12 minutes per day in the IG and CG, respectively (p=0.25). No significant difference was found between IG and CG for changes in sleep duration, alcohol consumption and smoking use. Conclusion The Obesity-Fertility program significantly improved components of diet, physical activity levels and sedentary behaviours in women living with obesity and seeking fertility treatments. Such programs can therefore support these women to adopt healthier lifestyle behaviours and may improve their fertility as well as decrease risks of complications during pregnancy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ATM AND INFERTILITY: ARE THERE ADDITIONAL BARRIERS TO PREGNANCY IN ATAXIA-TELANGIECTASIA MUTATION CARRIERS?

To investigate the clinical outcomes of female and male patients who are carriers of Ataxia-Telangiectasia (ATM) variants seeking fertility treatments.

COVID-19 vaccine hesitancy and associated factors among infertile couples undergoing assisted reproductive treatment.

Although periconception vaccination is important to maternal and neonatal health, little is known about the COVID-19 vaccine hesitancy among infertile couples seeking fertility treatment. Thus, we conducted this survey among infertile patients in a reproductive medicine center, between September 2021 and December 2021, to estimate the prevalence of COVID-19 vaccine hesitancy and its influencing factors. Information was collected through face-to-face interviews among volunteers. Among the 987 included interviewees, 17.33% reported hesitancy in primary vaccination, 25.63% reported hesitancy in booster vaccination, and 32.32% delayed the primary vaccination. Hesitancy in primary vaccination was associated with unexplained infertility (OR: 1.77, 95% CI: 1.05-2.98), ongoing IVF treatment (OR: 2.17, 95% CI: 1.22-3.89), concerns for vaccine safety (OR: 4.13, 95% CI: 2.66-6.42), effectiveness (OR: 1.62, 95% CI: 1.15-2.28), and influence on pregnancy (OR: 2.80, 95% CI: 1.68-4.67). These factors were also associated with hesitancy in booster vaccination. Delay of the primary vaccination was inversely associated with a college or above degree (OR: 0.49, 95% CI: 0.27-0.87), previous history of influenza vaccination (OR: 0.67, 95% CI: 0.46-0.98), and was positively associated with concerns for the influence on pregnancy (OR: 7.78, 95% CI: 5.01-12.07). It is necessary to carry out targeted education program by health professionals to publicize the benefits of periconception vaccination, and to reduce the resistance to COVID-19 vaccine among infertile couples.

Synthetic pyrethroids exposure among women from fertility clinic and embryological outcomes- is there an association?

Introduction: Pyrethroids exposure has been associated with adverse reproductive outcome. However, there is no study that explore the effect of environmental exposure and embryological outcomes. This question was addressed in the prospective cohort of couples undergoing fertility treatment. Methods: We included 450 women aged 25-45 undergoing assisted reproductive technology (ART) cycle at Infertility Clinic in Poland. A urine sample were collected at the time of fertility procedure(s) to assess four urinary synthetic pyrethroids concentrations (3-phenoxybenzoic acid (3PBA), cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA), trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA), cis-2,2-dibromovinyl-2,2-dimethylocyclopropane-1-carboxylic acid (DBCA)) using validated gas chromatography ion-tap mass spectrometry and calculated for cycle-specific for each metabolite. To evaluate effect of environmental exposure to synthetic pyrethroids and embryological outcomes (methaphase II (MII) oocyte yield, top quality embryo, fertilization rate, implantation rate) multivariable generalized linear mixed analyses with random intercepts was prepared. Results: Urinary 3-PBA concentrations decrease MII oocyte count (p=0.007) in the four quartile (&amp;#x3e;75 percentyl) compared to women in the first quartile (&amp;#x2264; 25 percentyl). Additionally when 3-PBA was treated as continuous variable the negative association between exposure to pyrethroids and MII oocyte count was also observed (p=0.012). Exposure to other pyrethroids metabolities (CDCCA, TDCCA, DBCA) were not related to any of the examined embryological outcomes. Conclusions: The exposure to synthetic pyrethroids may be associated with poorer embryological outcome among couples seeking fertility treatments. As this is the first study on this topic, the results need to be confirmed in further studies. Keywords: embryological outcomes, urinary pyrethroids concentrations, environmental exposure, IVF treatment

Are Clinical Outcomes of Microdissection Testicular Sperm Extraction in Non-Obstructive Azoospermic Men Affected by the Use of Fresh or Frozen Gametes?

Background: Non-obstructive azoospermia (NOA) is a severe form of male factor infertility, evident in approximately 5% of infertile couples seeking fertility treatment. The combination of microsurgical testicular sperm extraction (mTESE) and ICSI has become one of the treatment options, with sperm motility positively associated with outcome success rates. Few studies have investigated whether use of fresh or thawed gamete combinations affect clinical outcomes. Aim: To determine the clinical outcomes of ICSI cycles using mTESE recovered testicular sperm of NOA patients and whether these are affected by the use of fresh or thawed gametes. Method: A retrospective study of NOA patients who underwent mTESE between March 2017 and September 2020. Clinical outcomes investigated included successful surgical sperm retrieval (SSR), sperm motility, fertilisation, embryo utilisation and live-birth/ongoing pregnancy rates. Results: A total of 105 NOA patients underwent mTESE, with a 65.7% successful SSR. In total 58 patients contributed to 72 ICSI cycles, with a 37.5% 2PN fertilisation rate and 29.4% live-birth/ongoing pregnancy rate. Cycles using only motile sperm had a greater fertilisation rate than those using a motile/non-motile sperm combination (51.7% vs 31.1%, p[Formula: see text]0.05). Compared with fresh, thawed testicular spermatozoa didn’t affect clinical outcomes, including live-birth/ongoing pregnancy rates (Fresh 18.2%; Thawed 17.9%; Odds ratio (OR) 1.02 (0.34-2.86) p=0.98). In contrast, use of thawed oocytes decreased fertilisation rate [Fresh-oocytes: 45.0%; Vitrified-oocytes: 35.5%; OR 1.47(1.03-2.10), p=0.03] but had no differences for other clinical outcomes, including live-birth/ongoing pregnancy rate (p=0.74). Importantly, injection of exclusively non-motile-spermatozoa (n=26 cycles) resulted in a very low fertilisation rate (2.7%) and no live-birth/ongoing pregnancies were recorded. Conclusion: Microdissection TESE is an effective treatment for NOA patients, with no clear negative effects of using thawed spermatozoa, however, the use of vitrified oocytes requires further investigation. The use of non-motile spermatozoa in mTESE ICSI cycles is discouraged.

Perceived Injustice and Psychological Well-Being in Couples Seeking Fertility Treatment

Infertility and its treatment are associated with a host of negative emotions, including perceived injustice. However, no quantitative study has examined the link between perceived injustice and psychological difficulties in couples seeking fertility treatment. This study examined the associations between perceived injustice and both partners’ psychological well-being and investigated possible differences in perceived injustice based on sex or cause of infertility. Both partners of 103 couples seeking fertility treatment completed the Injustice Experience Questionnaire—Infertility, the Hospital Anxiety and Depression Scale, and the Fertility Quality of Life Tool. Perceived injustice was associated with one’s own and one’s partner’s higher depressive symptoms and lower infertility-related quality of life, as well as one’s own higher anxiety symptoms. Women also perceived more injustice than men. The cause of infertility was unrelated to perceived injustice. Findings suggest that perceived injustice could represent an intervention target to reduce psychological distress in infertile couples.

O-133 Association between normal-range paternal serum free thyroxine concentrations and outcomes of assisted reproductive technologies

Abstract Study question Are paternal serum free thyroxine (FT4) concentrations within the reference range associated with outcomes of assisted reproductive technologies (ART)? Summary answer Men of older reproductive age (≥ 35 years old) with low FT4 concentrations within the reference range are associated with a decreased live birth rate. What is known already The impact of maternal thyroid dysfunction on ART outcomes has been widely elucidated. However, few studies have investigated the impact of paternal thyroid dysfunction on ART outcomes. Our previous study showed a detrimental impact of paternal subclinical hypothyroidism (SCH) on the clinical outcomes of ART. Patients with SCH had relatively lower concentrations of FT4 compared to those with euthyroidism. Therefore, it remains to be determined whether the detrimental impacts of paternal SCH on ART outcomes arise from low concentrations of FT4. Study design, size, duration This retrospective cohort study included 4,066 couples who received 4,894 ART treatment cycles in our clinic between 1 April 2016 and 31 August 2021. Participants/materials, setting, methods The differences in sperm parameters and ART outcomes across the paternal FT4 tertiles were compared using generalised linear models or generalised estimation equation models. The primary outcomes were the clinical pregnancy rate (CPR) and live birth rate (LBR), and the secondary outcomes were sperm parameters, fertilisation rate, good-quality embryo rate, blastocyst formation rate, and implantation rate. Main results and the role of chance The mean ages of the males and their female partners were 33.0 and 31.0 years, respectively. No significant differences are observed in the sperm parameters and ART outcomes across the paternal FT4 tertiles in the overall population. However, stratified analysis of men aged ≥ 35 shows a non-significantly lower CPR in the lower paternal FT4 tertile (adjusted rate: 0.36, 95% CI: 0.27–0.45) relative to the middle (adjusted rate: 0.45, 95% CI: 0.38–0.53) and upper (adjusted rate: 0.43, 95% CI: 0.36–0.51) tertiles. The adjusted LBR is 0.21 (95% CI: 0.15–0.30) for men aged ≥ 35 in the lower FT4 tertile (p = 0.024, with reference to the upper tertile), 0.27 (95% CI: 0.21–0.35) for those in the middle tertile and 0.30 (95% CI: 0.23–0.38) for those in the upper tertile. No differences in these outcomes are seen among men aged &amp;lt; 35. The nonlinear smoothing curve obtained by using FT4 as a continuous variable further supports these findings. Limitations, reasons for caution Due to the retrospective design of the study, a causal relationship between paternal FT4 concentrations and ART outcomes could not be established. In addition, the study participants were patients who sought fertility treatment, which may have biased the results when we analysed the associations between FT4 concentrations and sperm parameters. Wider implications of the findings These results suggest that in older men, low paternal FT4 concentrations, although within the reference range, are associated with worse ART outcomes, especially LBR. Future prospective studies are warranted to confirm the detrimental effects of low paternal FT4 concentrations on ART outcomes. Trial registration number Not applicable

P-104 production and glucose-dependent secretion of insulin by human spermatozoa

Abstract Study question Do human spermatozoa express insulin and the enzymes responsible for the cleavage of proinsulin? Is the secretion of insulin by spermatozoa responsive to glucose stimuli? Summary answer Human spermatozoa express insulin and PC1/3 and PC2, enzymes responsible for the cleavage of proinsulin. Spermatozoa produce and release insulin in a glucose concentration-dependent manner. What is known already Spermatogenesis is dependent on a finely regulated hormonal and metabolic control. Insulin is considered one of the most important regulators in the metabolic regulation of spermatogenesis, acting directly on the differentiation of spermatogonia into primary spermatocytes or indirectly through the metabolic modulation of both Sertoli and Leydig cells. In addition, insulin is hypothesized to play a major role in human spermatozoa capacitation, although the mechanisms that regulate its production and secretion remain to be disclosed. Study design, size, duration The main objective of this study was to estimate the capacity of insulin production by human spermatozoa and if they express PC1/3 and PC2, which are enzymes responsible for the cleavage of proinsulin. In addition, we hypothesized that insulin production could respond to glucose stimuli. Seminal samples of normozoospermic men (n = 15) seeking fertility treatment were collected for these experiments. Participants/materials, setting, methods Spermatozoa were submitted to a density gradient centrifugation and two fractions were collected according to their motility (high vs low motility). The expression of insulin, PC1/3 and PC2 mRNA was evaluated by RT-qPCR. The protein expression of insulin, PC1/3 and PC2 was evaluated by immunofluorescence. High motility spermatozoa were incubated in BWW medium with increasing glucose concentrations (0, 5.5, 11, and 22 mM). After 6 h, the concentration of secreted insulin was quantified by ELISA. Main results and the role of chance We were able to identify the expression of insulin, PC1/3, and PC2 mRNA, as well as the respective proteins, in human spermatozoa. Through immunofluorescence, we observed that insulin and both enzymes are mainly expressed in the midpiece. Human spermatozoa also express insulin receptor, mainly in the midpiece and tail. The mRNA expression of insulin and PC1/3 was found to be higher in the highly motile spermatozoa. Human spermatozoa produce very small quantities of insulin (pg/mL range), which suggests an autocrine or paracrine action. The release of insulin to the medium was found to occur in a glucose concentration-dependent manner. Limitations, reasons for caution This is an in vitro study with relatively small sample size. Future studies are required to further evaluate the role of insulin and its signalling pathway on human spermatozoa capacitation and fertilization capacity. Wider implications of the findings This study shows that human spermatozoa express PC1/3 and PC2, enzymes responsible for the cleavage of proinsulin. In addition, human spermatozoa release insulin in a glucose concentration-dependent manner. The study of insulin signalling opens the path for a deeper understanding of human spermatozoa bioenergetics and the development of novel therapies. Trial registration number Not applicable

P-342 The impact of Clomiphene Citrate (CC) on the endometrium in comparison to gonadotropins (Gn) in intrauterine-insemination treatments (IUI): Is it thinner and does it matter?

Abstract Study question Utilizing patients as their own controls, does endometrial thickness (EMT) differ between CC/IUI and Gn/IUI? Does EMT differ between CC-cycles with and without associated conception? Summary answer Within-patient, CC resulted in thinner EMT compared to Gn. CC-cycles associated with conception compared to the ones without it, had thicker endometria. What is known already CC, unlike gonadotropins, may have an anti-estrogenic effect on the endometrium. Concerns exist that the thinning of the endometrium might be associated with altered endometrial development and receptivity. However, available data in CC cycles remain inconsistent, probably due to patient and protocol heterogeneity. Currently, it remains unclear whether CC treatments produce a thinner endometrium, compared to gonadotropins, in the same patient. Furthermore, it is uncertain whether such a difference, if one exists, has a consequential effect on IUI cycle outcomes. Study design, size, duration Design: retrospective. Duration: 1/2004-9/2021 Cohort 1 utilized women as their own controls to evaluate CC’s impact on the endometrium and included all cycles from women who sought fertility treatments and initially underwent CC/IUI (CC1, n = 1252) followed by Gn/IUI (Gn1, n = 1307). Cohort 2 included all cycles from women seeking fertility treatments at the same center that conceived following CC/IUI treatments (CC2, n = 686). EMT was compared between groups (CC1 vs. Gn1, CC1 vs. CC2). Participants/materials, setting, methods Outcome measures: Primary: EMT (mm). Secondary: HCG-positivity (pos-HCGR), clinical pregnancy (CPR), and spontaneous abortion rates (SABR). Statistics: Regression analysis was used to calculate Odds Ratios (OR) with associated 95% confidence intervals (95%CI), adjusting for potential confounders [maternal age, Body Mass Index (BMI), prior parity, day of EMT measurement relative to trigger). Generalized estimating equations (GEE) model were utilized to account for multiple cycles per patient. P &amp;lt; 0.05 was considered significant. Main results and the role of chance In cohort 1, despite CC1 exhibiting non-inferior ovarian response compared to Gn1 (as assessed by preovulatory follicular number), EMT was significantly thinner in CC1 compared to Gn1 [Median(IQR): 7.0(5.7-8.3) vs. 8.9(7.4-10.0), p&amp;lt;.001]. When CC1 was compared to CC2 (CC conceiving), EMT was also thinner [Median(IQR): 7.0(5.7-8.3) vs. 7.5(6.2-9.0), for CC1 vs. CC2, respectively, p&amp;lt;.001]. A higher percentage of CC1 compared to Gn1 cycles resulted in EMT≤7mm (48.9% vs. 16.7% , for CC1 vs. Gn, respectively; p&amp;lt;.001). Most subsequent Gn cycles (82.8%), in the same women, resulted in thicker EMT compared to CC1. AdjOR, in generalized linear mixed models, suggested that CC2 when compared to CC1 cycles had thicker EMT [adjOR(95%CI): 1.81, (1.41,2.35), p&amp;lt;.001]. Interestingly, clinical pregnancies were observed even when EMT was ≤4mm in both CC2 and Gn1 groups and SABR did not differ between cycles with EMT≤4mm and the ones with thicker EMT (2.5% vs. 11.5%, p=.258, in CC2; 0% and 12.3%, p=.544, in Gn1; SABR EMT ≤4 vs. 4 mm, respectively). GEE models suggested an association between EMT and CPR in CC cycles (CC1&amp;CC2), [adjOR(95%CI): 1.12(1.07,1.18), p&amp;lt;.001)] while in Gn1, no such association was observed. Limitations, reasons for caution Our study was limited by its retrospective design. Reflecting our selection criterion, in cohort 1, most CC cycles did not result in pregnancy, restricting relevant comparisons. Number of cycles resulting in EMT ≤7mm, and particularly ≤4mm, was limited, and consequently respective results should be interpreted cautiously. Wider implications of the findings Utilizing patients as their own controls, we showed that CC compared to gonadotropins resulted in thinner endometrium. Given comparable follicular response, and potentially estradiol levels, thinner endometrium might have resulted from CC’s anti-estrogenic effect. Furthermore, patients conceiving on CC had a thicker endometrium compared to the ones that did not. Trial registration number NA

O-091 From Family Planning to Fertility Planning - ‘FertPlan’ awareness amongst contraceptive healthcare providers and users

Abstract Study question Are women and healthcare professionals seeking or providing contraception aware of age-related decline in female fertility and information support regarding fertility awareness? Summary answer 89.9% of contraceptive users and 71% of providers stated lack of awareness regarding age and fertility emphasising website as the preferred information resource. What is known already The last 50 years has seen an upward trend in the age at which women are giving birth. The birth rate for women aged 35 to 39 has trebled since 1980 and is now at its highest ever level. Delaying childbearing may mean that some women will inevitably leave it too late and become childless involuntarily. Women are also seeking fertility treatment at older ages, however, success rates decrease dramatically with age. It is not clear whether women who delay their fertility are aware of the decline in fertility with age, and whether healthcare professionals discuss fertility planning with women. Study design, size, duration We conducted two independent anonymous questionnaire surveys of reproductive age women seeking contraception and healthcare professionals(HCP) providing contraception in the UK following research ethics approval, to determine their awareness of the age-related decline in fertility, information resource and potential barriers to provision of information. . This was a prospective study design conducted over a year period using an online questionnaire. A total of 249 participants completed the survey. Participants/materials, setting, methods 138 reproductive age women on contraception consented and participated in the study by completing the online questionnaire. Of these, 96.4% were of white origin,1.4% mixed ethnicity, 1.4% Asian origin and 0.7% Black. 111 HCP providing contraceptive advice in family planning clinics or in General practice completed the survey. Of these, 6 were allied healthcare professionals ie specialist nurses. Data was collated and analysed using percentages and descriptive statistics. Main results and the role of chance Of the total 138 female contraceptive users, 87 were aged 30-39 years whilst 35 were 40-45 years. 51.4% of women indicated no concern about their future fertility, whilst the remainder gave roughly uniformly distributed ratings of concern from unconcerned to highly concerned. However, one third of all women (31.1%) believed that age-related fertility decline occurred after 40 years. 89.9% of women felt fertility awareness and education is important. Of the total 111 HCP, ∼one in 10 HCP (11.7%) misconstrued the female age-related decline to begin from 40 years onwards. The contraceptive providers also were misinformed regarding age related decline in IVF success rate with 45% of them citing 40 years or over to be the age that contributed to decline in IVF success. Despite these figures, majority (71.2%) of HCP agreed there was lack of fertility awareness and 33.3% felt fertility education should be commenced as early as school age. 27% HCP always discussed future fertility whilst 33.3% discussed most of the times. The most commonly-stated barriers to providing information were lack of time, self-perceived lack of knowledge, and women not asking. 73.2% of reproductive age contraceptive users and 85.6% HCPs expressed website to be the most preferred option for information resource. Limitations, reasons for caution To the best of our knowledge, this is one of the first studies seeking fertility awareness amongst those practising family planning. As this was not a qualitative interview based study, the findings are open to interpretation and one must exercise caution. Wider implications of the findings This study highlights clear need for fertility education and awareness amongst contraceptive providers and users. By providing resources to inform, we may increase awareness and confidence amongst both groups thereby empowering women to make informed choices about their future fertility by integrating Fertility planning within Family Planning. Trial registration number Not applicable (IRAS 248991 and R&amp;D Ref 8999)