Significant Difference In Pregnancy Rate Research Articles

P-250 Only euploidy does not ensure optimal chances for successful live birth through single blastocyst cryotransfer

Abstract Study question What does a euploid blastocyst require to provide the greatest probability of successful birth? Summary answer Morphokinetic and morphological features of the inner cell mass (ICM) and trophectoderm (TE) are crucial for optimizing live birth chances in cryo-transferred euploid blastocysts. What is known already Embryo selection through preimplantation genetic testing for aneuploidy (PGT-A) alongside frozen embryo transfer strategy enhances outcomes of single-embryo transfer cycles. While euploidy is a crucial indicator, investigations on the identification of additional criteria influencing implantation and live birth rates remain imperative. Studies suggest morphokinetic and morphological quality may supplement predictive factors for euploid embryo success, with varying correlations. The impact of factors like age or gamete origin on euploid blastocyst success remains uncertain, differentiating it from clear effects on non-diagnosed embryos. Optimizing selection criteria involves navigating the intricate interplay of these variables. Study design, size, duration This retrospective study analyses the pregnancy rate (PR) in 596 single embryo cryotransfers of full euploid blastocysts (without detected mosaicism) between February 2019 and September 2023. From these, 437 had a known outcome, and the live birth rate (LBR) was calculated. The study explored the potential impact of gamete origin, oocyte provider age, recipient age, morphokinetics, and morphological quality of ICM or TE (Gardner score) on the reproductive success of the transferred embryo. Participants/materials, setting, methods All embryos were biopsied at the blastocyst stage and successively vitrified. High-resolution next-generation sequencing was used for PGT-A. Only deferred transferences of single post-thawing intact embryos were included. Morphokinetic was assessed using the KIDscoreD5 3.1. Quantitative variables (oocyte provider age, recipient age, and morphokinetic score) were compared using the t-student test, while qualitative variables (gamete origin, morphological quality of ICM and TE) were assessed using the chi-square test. Main results and the role of chance Oocytes leading to pregnancies and live births were derived from women with ages comparable to those without success (Pregnancy: 30.0±7.1 vs. 30.8±6.8, p = 0.174; Live Birth: 30.1±7.1 vs. 30.5±6.9, p = 0.499). Similar age was also observed among recipients achieving pregnancy (41.5±5.4) and live births (41.1±5.1) compared to those who did not (Pregnancy: 41.8±5.1, p = 0.506; Live Birth: 41.5±5.3, p = 0.411). The origin of oocytes and semen (own or donor) did not significantly affect PR (Oocytes: 199/273 vs. 217/323, p = 0.130; Semen: 328/473 vs. 88/123, p = 0.224) or LBR (Oocytes: 113/205 vs. 116/232, p = 0.285; Semen: 183/347 vs. 46/90, p = 0.783). Morphokinetics played a crucial role, with euploid embryos resulting in pregnancy (7.5±1.7) and live births (7.6±1.6) exhibiting significantly higher scores than those without success (6.9±1.7; 7.1±1.7; p < 0.05).199 ICM quality did not significantly impact PR (A:211/296, B:190/275, C:15/25; p = 0.469). However, higher miscarriage rates in C-quality ICM blastocysts significantly reduced the LBR (A:116/211, B:107/205, C:6/21; p < 0.05). TE quality exhibited significant differences in PR (A:221/289, B:184/289, C:11/18; p < 0.05). Since the miscarriage rate was similar among groups (p = 0.787), LBR remained higher in A-quality TE blastocysts (A:124/209, B:98/213, C:7/17; p < 0.05). Limitations, reasons for caution As a retrospective analysis, this study is inherently limited. The influence of expansion grade on success rates remains unexplored, given the use of assisted hatching on day 3 of culture. Performing assisted hatching at the time of biopsy could potentially overcome this limitation. Wider implications of the findings The pursuit of a euploid embryo often becomes the priority in IVF laboratories. However, once the milestone is achieved, morphokinetics and embryonic morphological quality must continue to be considered. This study provides valuable insights for conveying a detailed message to patients with euploid embryos about their prospects for homebirth success. Trial registration number not applicable

The Effects of Puberty Blocking Treatment (Gonadotropin Releasing Hormone Agonist) on Reproductive Function in Young Female Rats

The number of adolescents identifying as transgender has been increasing with many transgender youth receiving treatment with a gonadotropin releasing hormone agonist (GnRHa) that suppresses sex hormone production (i.e., puberty blocker). Transgender individuals taking a GnRHa to block puberty have reported improved mental wellbeing, but the physiological impact on reproductive function needs to be examined. Objective: To investigate the effects of puberty blocking treatment using GnRHa on reproductive morphology and function in young female rats. It was hypothesized that puberty blocking treatment would decrease fertility. Methods: Four-week old female Sprague Dawley rats were given daily subcutaneous injections of the GnRHa triptorelin or saline as control. After four weeks of treatment a group of rats were euthanized and the uterus and ovaries were removed for H&E staining to assess morphology. An additional group was taken off GnRHa treatment for 4-weeks to examine recovery of reproductive organ morphology. The final group was taken off GnRHa treatment and housed with fertile males to determine reproductive performance. Results: GnRHa treatment led to a reduction in the mass of uteri and ovaries which recovered after 4-weeks of drug withdrawal. The myometrial and endometrial thickness of the uterus was reduced in GnRHa treated animals. The ovaries of puberty blocked animals exhibited a disruption in follicle development and corpora lutea health. The morphology of the uterus and ovaries recuperated after 4-weeks of drug withdrawal. No significant difference in pregnancy rate was detected; however, both the number of days until pregnancy detection and number of days until giving birth were considerably longer in GnRHa rats following withdrawal. The number of pups per litter was also significantly reduced by puberty blocking treatment but no abnormalities were observed in the pups. Conclusion: Young female rats treated with a GnRHa had significantly delayed development of the reproductive organs. After 4 weeks of GnRHa withdrawal reproductive organ mass and morphology recovered. A minor disruption in reproductive function was detected immediately following GnRHa withdrawal. These physiological effects on reproductive health should be considered when administering a GnRHa to block puberty. No external funding was used to support this research. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

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 ability of minipigs as surrogates for somatic cell nuclear transfer.

Pigs are genetically, anatomically, and physiologically similar to humans. Recently, pigs are in the spotlight as a suitable source animal for xenotransplantation. However, to use pigs as source animals, pigs should be raised in designated pathogen-free facilities. There is abundant data from embryo transfer (ET) experiments using farm pigs as surrogates, but data on ET experiments using minipigs are scarce. Eighty minipigs were used for ET experiments and after transplantation, the implantation and delivery rates were investigated. It was also confirmed whether the pregnancy rate could be increased by changing the condition or surgical method of the surrogate. In the case of minipigs that gave birth, the size of the fetal sac on the 28th day of ET was also measured. The factors that can affect the pregnancy rate such as estrus synchronization program, ovulation status at the time of ET, the number of repeated ET surgeries, and the ET sites, were changed, and the differences on the pregnancy rate were observed. However there were no significant differences in pregnancy rate in minipigs. The diameter of the implanted fetal sac on the 28th day after ET in the minipigs whose delivery was confirmed was calculated to be 4.7 ± 0.5 cm. In conclusion, there were no significant differences in pregnancy rate of minipigs in the comparative experiment on various factors affecting the pregnancy rate. However, additional experiments and analyses are needed due to the large individual differences of the minipigs.

A review of the optimization of thyroid function, thrombophilia, immunity and uterine milieu treatment strategy for recurrent implantation failure and recurrent pregnancy loss.

Aside from embryonic factors, various factors can intricately interfere with embryo implantation and maintenance of pregnancy, causing recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL). This review focuses the optimization of thyroid function, thrombophilia, immunity, and uterine milieu (OPTIMUM) treatment strategy on RIF and RPL. Three studies employing the OPTIMUM treatment strategy for patients with RIF and/or RPL were reviewed. The OPTIMUM improved pregnancy rates in women with RIF aged <40 years. Among advanced age women, however, no significant differences in pregnancy rates were observed between the control, OPTIMUM, and preimplantation genetic testing for aneuploidy (PGT-A) groups, although pregnancy rates were highest after OPTIMUM + PGT-A. The OPTIMUM reduced miscarriage rates in women with RPL aged <40 years. Among advanced age women, PGT-A, but not the OPTIMUM, contributed to miscarriage prevention. Factors predicting pregnancy success in women with RIF who received the OPTIMUM included thrombophilia and young age. Risk factors for an unsuccessful live birth among women with RPL who received the OPTIMUM included advanced age, infertility, diminished ovarian reserve, and non-ART treatment. The OPTIMUM can improve pregnancy outcomes in women with RIF/RPL, except for advanced age women with embryonic factor-induced reproductive failure.

Pregnancy Rate In Non-Azoospermia With Normal Or Suboptimal Semen Parameter Versus Azoospermic Male Treated By IVF-ICSI Cycle

Background: Intracytoplasmic sperm injection (ICSI) opens the gate for many cases of male factor infertility to be the biological fathers of their sibling since 1992. Most of cases were non-obstructive azoospermia and different levels of oligoastheno-teratozoospermia. Nowadays many cases of reduced semen parameter or female factor infertility are treated by IVF-ICSI Cycle for better pregnancy rate, biochemical and clinical, and live birth rate. Aim of the study: The study aims to compare biochemical, clinical pregnancy rate and outcome of pregnancies in the group with ejaculated sperm with normal or suboptimal semen parameter and group with non-obstructive azoospermia in whom sperm retrieved by TESE, using ICSI. Method: A retrospective cohort study was conducted between January, 2016 and February, 2023 in the fertility center of Al-Sader Medical City, a total of 372 couple, 90 of the males gave semen sample by masturbation and 282 of the males were non-obstructive azoospermia and their sperms were retrieved by TESE; all are treated by ICSI, all of their female partner were under age of 37 year, the maternal medical condition and obstetric history were not included in this study. Simple random sampling was depended, SPSS version 26 was used to perform the statistical analysis processes. Results: There was a highly significant difference in pregnancy rate by β.HCG between ejaculate group (43.3 %) and azoospermia (26.6 %) with p. value =0.003. A significant difference in clinical pregnancy rate by ultrasound between the ejaculate group (31.1%) and azoospermia (20.9%) with p. value =0.047. There was no statistically significant difference in live birth rate between ejaculate group as (24.4 %) and azoospermia as (17.4 %) with p.value=0.137. Conclusion: Freshly ejaculated sperm with normal or suboptimal semen parameter gave a better biochemical and clinical pregnancy rate than obtained from NOA by TESE, while live birth rate was not largely different in both groups

P-218 Does Artificial Oocyte Activation (AOA) improve the outcome beyond fertilization rate in ICSI cycles?

Abstract Study question Does CultActive© improve reproductive outcomes of ICSI cycles in cases of low fertilization rate and normal fertilization rate? Summary answer The application of CultActive© after ICSI improves fertilization rates only in clinical indication of fertilization failure. What is known already Oocyte activation deficiency is attributed in the majority of cases to fertilization failure in ICSI cycles, and these can be corrected by increasing initial levels of calcium (Ca2+) using assisted oocyte activation techniques (AOA), such as the use of Ca2+ ionophores. These agents enhance intracellular calcium release and increase the membrane permeability facilitating the influx of extracellular Ca2+, which initiates the activation cascade. Previous results suggest that Ca2+ ionophore treatment can increase the live birth rate after failed ICSI cycles in couples with poor fertilization rates, embryo developmental arrest, and also increase the number of good quality embryos. Study design, size, duration This was a retrospective observational study. There were 30 patients included and the first group consisted of 30 ICSI cycles, 231 oocytes and 56 embryos (without AOA). The second group consisted of the same patients (n = 30) with 30 ICSI cycles using AOA, 219 oocytes and 47 embryos. Subgroups were defined according to clinical indications (normal fertilization rate group: ≥ 65 % and low fertilization rate group: &amp;lt;65% ). All data was collected from January-December 2022. Participants/materials, setting, methods 450 oocytes were assessed in the study. 231 oocytes belonged to the pre-AOA and 219 belonged to the AOA. The oocytes were exposed for 15 minutes after ICSI in a solution containing the Ca2+ ionophore A23187, CultActive© (Gynemed, Germany). Fertilization, good quality blastocyst formation and pregnancy rate were analyzed.Good quality blastocyst were defined as ≥ 3BB. Statistical significance was analyzed using the Paired Student T test (p &amp;lt; 0.05 was considered statistically significant). Main results and the role of chance The cohort of patients with normal fertilization rate (without clinical indications),was not significantly different. The AOA treatment gave a fertilization rate of 61% compared to 71% of the control cycles (p = 0.1398). There was no increase in the number of good quality blastocysts formation when the study group was compared to the control (p = 0.1660). In the cohort of patients with an indication of low fertilization, a significantly higher fertilization rate was recorded compared to the control (51% and 37%, respectively p = 0.0238). There were no significant difference in the quantity of good quality blastocysts compared with the control (p = 0.3328). Regardless of normal or low fertilization rates there was no significant difference in pregnancy rate when CultActive© was used in treatment (p &amp;gt; 0.05). Limitations, reasons for caution There are limitations in our study. First, the retrospective design and limited study population are major limitations. The data should be interpreted cautiously in the subgroup analyses due to potential bias, specifically the small population in the group without clinical indication. Wider implications of the findings AOA was only beneficial for couples with poor fertilization. Embryo quality and pregnancy rate did not improve with CultActiveive©. External variation was minimized by using the same patients in each cohort. This suggests AOA should not be used without clinical indication or for poor embryo quality/blastulation rate. Trial registration number not applicable

Trends and factors related to pregnancy after breast cancer treatment in young patients.

e24095 Background: In women of reproductive age who have been treated for breast cancer (BC), interest in fertility preservation (FP) is as important as treatment. Although methods for FP are already well known, sufficient information is not provided about the pregnancy results at specified BC stage or treatment. This study was designed to retrospectively analyze and provide information on fertility preservation attempts and actual pregnancy in women of childbearing age who had been diagnosed with BC for the past 10 years. Methods: We retrospectively reviewed women of childbearing age (18-40 years) with treated at single tertiary medical center from December 2010 to September 2020. The relationship between the tumor characteristics and treatments and actual pregnancy was analyzed. Time from diagnosis to pregnancy was analyzed according to tumor characteristics and treatments. During the period, intensive education on FP was offered to the patients from 2014, and whether there were any changes in the results before and after this was also analyzed. Results: A total of 1033 patients were included, representing 115 patients who were pregnant during the observation period. Overall, 519 (50.2%) patients were offered fertility counseling, 81 (7.8%) patients get oocytes or embryos preservation and 456 (44.1%) patients underwent Gonadotrophin hormone receptor analogue (GnRHa) for FP. Our analysis showed differences in pregnancy rates for age at diagnosis ( P= .002), HR (Hormone receptor) status ( P=.015), and hormonal therapy ( P= .004), among them, there was a significant difference in pregnancy timing only for HR (2.53 vs 3.42 years, P= .009) and hormonal therapy (2.39 vs 3.56 years, P&lt;.001). There were 93 patients who stopped taking tamoxifen for preparing pregnancy, and 53 patients succeeded in becoming pregnant. In this cohort there were no significant difference in pregnancy rate for age, tumor characteristics, stage and treatments. Conclusions: Tumor characteristics which required endocrine therapy was related to the pregnancy rate and time to conception. However, more than half of the women who actively consulted with their doctor for pregnancy and interrupted endocrine therapy within first five years had a successful pregnancy and also were not inferior in disease free survival. Most of FP was still predominantly underwent with concurrent GnRHa use. In young women who want to preserve fertility, it is important to provide such information and make mutual decisions for active FP.[Table: see text]

Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042

INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.

The success rate of intrauterine insemination in sperm preparation swim-up method at room temperature compared to the incubator temperature

HIGHLIGHTS There were no significant differences in TMSC, sperm motility, sperm morphology, and DFI in sperm preparation using the swim-up method at 27°C and 37°C. However, this study provided an overview of the average improvement of DFI at 27°C compared to 37°C. There was no significant difference in the pregnancy rate of IUI in sperm preparation using the swim-up method at 27°C and 37°C. ABSTRACT Objective: This study aimed to determine the effect of temperature during sperm preparation on total sperm motile count (TMSC), sperm motility, sperm morphology, DNA fragmentation index (DFI), and pregnancy rate. Materials and Methods: A quasi-experimental laboratory study with pre- and post-test control group was conducted at Sekar Fertility Clinic, Dr. Moewardi General Hospital, Surakarta, Indonesia. A total of 20 sperm samples from infertile patients were prepared using the swim-up method at 27°C (group 1) and 37°C (group 2). TMSC, motility, morphology, and DFI examinations were performed. In addition, IUI was performed to confirm pregnancy rate. Sperm DNA fragmentation was determined using Sperm Chromatin Dispersion/SpermFunc DNAf test. Sperm DNA fragmentation was characterized by a halo &lt;30% of the volume of the sperm head. Results: Group 1 had mean TMSC of 13.77 ± 9.30, while group 2 had 14.82 ± 8.82; p=0.218. Group 1 had a motility value 82.25+12.77 and group 2 had 82.55 ± 11.69; p=0.968. The morphological value for group 1 was 11.25 ± 5.15 and group 2 was 11.6 ± 5.34; p=0.626. The mean DFI for group 1 was 17.79 ± 10.88 and group 2 was 18.18 ± 12.95; p=0.765. Pregnancy rate in group 1 was 10% and group 2 was 20%; p=1.000. Conclusion: There were no significant differences in TMSC, sperm motility, sperm morphology, DFI, and pregnancy rate in sperm preparation using the swim-up method at 27°C and 37°C.

MP43-05 TESTICULAR SPERM ASPIRATION (TESA) VS. MICROFLUIDIC SPERM SEPARATION (MSS) IN COUPLES WITH HIGH SPERM DNA FRAGMENTATION UNDERGOING ICSI: WHICH APPROACH IS BETTER?

You have accessJournal of UrologyCME1 Apr 2023MP43-05 TESTICULAR SPERM ASPIRATION (TESA) VS. MICROFLUIDIC SPERM SEPARATION (MSS) IN COUPLES WITH HIGH SPERM DNA FRAGMENTATION UNDERGOING ICSI: WHICH APPROACH IS BETTER? Rabea Akram, Karen Kteily, Michael Maalouf, Ahmad Alshammari, Simon Phillips, and Armand Zini Rabea AkramRabea Akram More articles by this author , Karen KteilyKaren Kteily More articles by this author , Michael MaaloufMichael Maalouf More articles by this author , Ahmad AlshammariAhmad Alshammari More articles by this author , Simon PhillipsSimon Phillips More articles by this author , and Armand ZiniArmand Zini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular sperm aspiration (TESA) and microfluidic sperm separation (MSS) are modalities designed to select the best sperm quality for intra-cytoplasmic sperm injection (ICSI) in men with poor sperm DNA integrity. We sought to investigate and compare reproductive outcomes in couples with a high sperm DNA fragmentation index (DFI) using TESA-ICSI or MSS-ICSI. METHODS: We conducted a retrospective study of consecutive infertile couples with high DFI who underwent ICSI using TESA, or MSS. Couples were divided into 3 subgroups based on sperm DFI results (20-29%, ≥30-39% and ≥40% DFI). Sperm DFI was determined by flow cytometry based TUNEL assay (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling). We utilized the ZyMōt® microfluidic sperm selection device. We excluded cycles with advanced maternal age (>40 years) and included cycles with transfer of day 5 blastocysts. RESULTS: After excluding cycles with advanced maternal age and those that did not proceed to day 5 blastocyst transfer, we identified 66 couples in the TESA cohort and 73 couples in the MSS cohort. Maternal age was not significantly different in the TESA vs. the MSS cycles in any of the DFI subgroups. However, paternal age was significantly higher in the TESA than in the MSS cycles within the 20-29% and 30-39% DFI subgroups (Table 1). There were no significant differences in pregnancy rates per embryo transfer in any of the DFI subgroups, However, live birth rates were higher in the MSS vs. the TESA cycles in the 20-29% DFI group. A trend toward higher live birth rates in the TESA vs. MSS cycles in the ≥40% DFI subgroup was noted (Table 1). CONCLUSIONS: TESA-ICSI and MSS-ICSI offer similar pregnancy rates per embryo transfer in couples with high DFI although MSS may be a better option than TESA in terms of live birth rates in couples with DFI in the 20-29% range. Larger studies are needed to define the optimal use of these sperm selection modalities in the treatment of couples with high DFI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e602 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rabea Akram More articles by this author Karen Kteily More articles by this author Michael Maalouf More articles by this author Ahmad Alshammari More articles by this author Simon Phillips More articles by this author Armand Zini More articles by this author Expand All Advertisement PDF downloadLoading ...

Alkaline semen diluent combined with R848 for separation and enrichment of dairy goat X-sperm.

A large number of female goats are needed for the dairy goat industry; therefore, the development of a method to ensure the birth of more females than males in a single pregnancy will lead to economic benefits. Increasing the number of X-sperm would be an effective way to increase the proportion of female offspring. In this study, goat semen was incubated at pH 7.4 in alkaline diluent combined with resiquimod (R848) and the number of X-sperm was enriched by the swim-up method. The percentage of X-sperm was determined using the double TaqMan qPCR method. Sperm total motility, progressive motility, average path velocity, straight-line velocity, and curvilinear velocity were measured using a computer-aided sperm analysis system, and the functional parameters of the sperm plasma membrane, the acrosome, mitochondrial activity, ATP content, and reactive oxygen species levels were also measured. Lastly, the ratio of female embryos was determined by in vitro fertilization, and the number of female kids and the pregnancy rate of does was assessed by artificial insemination. The results showed that dilution of semen in an alkaline buffer containing R848 could enrich the number of X-sperm to 85.57% ± 3.27%. The progressive motility, average path velocity, straight-line velocity, curvilinear velocity, mitochondrial activity, and ATP level of the collected X-sperm-enriched semen were significantly reduced, but its total motility, plasma membrane, and acrosome were not affected. The in vitro fertilization experiments showed that the rate of female embryo production using X-sperm-rich seminal fluid could reach 83.25% (174/209), which was significantly higher than the proportion of female embryos in the control group, 47.71% ± 1.80% (104/218). As determined by artificial insemination, the number of female kids in the test group increased by 62.79% (243/387), which was significantly higher than that in the control group (47.65%, 193/405). There was no significant difference in pregnancy rate between the test group and the control group (71.71% vs. 78.48%). Therefore, this study demonstrated that use of a pH 7.4 diluent containing R848 is a simple and effective method of X-sperm enrichment for dairy goat production. Its application would allow does to produce more female offspring for herd expansion and milk production.

609P Effect of lymphadenectomy on fertility and prognostic outcomes in adult patients with clinically early-stage malignant ovarian germ cell tumours during fertility-sparing surgery: A retrospective multicenter study

Malignant ovarian germ cell tumors(MOGCT), as a rare type of the ovarian malignancies, have an excellent prognosis when treated by surgery followed by platinum-based chemotherapy. Based on the current clinical practice guidelines, systematic lymphadenectomy (LND) can be omitted for child and adolescent patients with early-stage MOGCT. However the clinical role of LND for adult patients with early-stage MOGCT remains ambiguous. The purpose of this retrospective multicenter study was to evaluate the effect of systematic LND on prognostic and fertility outcomes in adult patients with clinically stage I malignant ovarian germ cell tumors MOGCTs who received fertility-sparing surgery (FSS) treatment. This study included 168 adult MOGCTs patients who underwent FSS and were deemed to have disease clinically confined to the ovary during surgery (stage I) between 2005 to 2020 from four major university-teaching hospitals. The Propensity score matching (PSM) algorithm was adopted to reduce the bias resulting from differences of clinical characteristics. Of the 168 patients, 92 (54·8%) underwent LND and 76 (45·2%) did not. Sixty patients attempted pregnancy, with the pregnancy rate of 81·7% and live birth rate of 66·7%. In the before PSM cohort, no-LND patients showed a better pregnancy rate than LND patients (93.3% versus 70.0%, P=0.020). However, in the after PSM cohort, there were no significant differences in pregnancy rates (92.9% versus 76.9%, P=0.326). Univariate logistic regression analysis showed that age ≤25 years (OR 3.50, 95%CI 1.11-11·01, P=0.032) correlated with better live birth. Regarding the prognosis, only 3 (0.18%) patients had recurrence and no patient died after a median follow-up of 65 months. Disease-free survival (DFS) was similar between patients treated with LND and no-LND in the before and after PSM cohorts(P>0.05). LND provided no significant benefit on both prognostic and fertility outcomes for adult patients with clinically early-stage (stage I) MOGCTs who underwent FSS in our study. Meanwhile, age ≤25 years was associated with a better live birth rate.

Effect of lymphadenectomy on fertility and prognostic outcome in adult patients with clinically early-stage malignant ovarian germ cell tumors during fertility-sparing surgery: A retrospective multicenter study (178)

<b>Objectives:</b> Malignant ovarian germ cell tumors (MOGCTs), as a rare type of ovarian malignancies, are commonly present in children as well as young women and have an excellent prognosis when treated by surgery, followed by platinum-based chemotherapy. Based on the current National Comprehensive Cancer Network (NCCN) clinical practice guidelines, systematic lymphadenectomy (LND) can be omitted for child and adolescent patients with early-stage MOGCTs. However, the clinical role of LND for adult patients with early-stage MOGCTs remains ambiguous. The purpose of this retrospective multi-center study was to evaluate the effect of systematic LND on prognostic and fertility outcome in adult patients with clinically stage I MOGCTs who received fertility-sparing surgery (FSS) treatment and to investigate the clinical-pathologic factors associated with fertility outcomes. <b>Methods:</b> This study included adult MOGCTs patients who underwent fertility-sparing surgery (FSS) and were deemed to have disease clinically confined to the ovary at the time of the surgery (stage I) between January 2005 to June 2020 from four medical institutions. All patients were classified into two groups: the LND group (patients who underwent systematic pelvic and/or para-aortic lymphadenectomy) and the no-LND group (patients who did not undergo lymphadenectomy). Propensity score matching (PSM) algorithm was adopted to reduce the bias resulting from the differences in clinical characteristics between the two groups. The Chi-square test and the Kaplan-Meier analysis were used to compare the fertility outcome as well as the disease-free survival (DFS). The univariate logistic regression analysis was performed to evaluate the clinical-pathologic factors associated with fertility outcomes. <b>Results:</b> A total of 168 adult patients with clinically stage I MOGCTs who received FSS treatment were enrolled in the study. There were 92 (54.8%) patients in the LND group and 76 (45.2%) patients in the no-LND group, with a median age of 26 years (range:18-44 years). Only two (2.6%) patients had lymph nodal metastasis. Among a total of 60 patients who attempted pregnancy, 49 (81.7%) succeeded to conceive, and 40 (66.7%) delivered successfully. In the before PSM cohort, patients in the no-LND group showed a better pregnancy rate than the LND group (93.3% vs 70.0%, p=0.020). However, in the after PSM cohort, there was no significant difference in pregnancy rates between no-LND and LND groups (92.9% vs 76.9%, p=0.326). Univariate logistic regression analysis showed that age ≤25 years (OR: 3.50, 95% CI: 1.11-11.01, p=0.032) correlated with a better live birth rate. Regarding the prognostic outcome, only three (0.18%) patients had recurrence after a median follow-up of 65 months and no patient died after surgery. In the before and after PSM cohort, the 5-year DFS for patients in the LND and the no-LND groups were 97.6% versus 97.9% (p=0.707) and 89.3% versus 95.0% (p=0.335), respectively. There was no significant difference in DFS between the LND and no-LND groups in the before and after PSM cohorts. <b>Conclusions:</b> Lymphadenectomy provided no significant benefit in both prognostic and fertility outcomes for adult patients with clinically early-stage (stage I) MOGCTs who underwent FSS in our study. Moreover, age ≤25 years was associated with favorable fertility outcomes for early-stage MOGCTs patients after FSS treatment. Our study suggests that abandonment of LND seems to be a preferred choice for clinically stage I adult MOGCTs patients with FSS treatment.

O-140 The impact of past COVID-19 infection on pregnancy rates in frozen embryo transfer cycles

Study questionWhat is the effect of COVID-19 infection on pregnancy rates in frozen embryo transfer (FET) cycles?Summary answerPast COVID-19 infection decreased pregnancy rates in FET cycles, especially in patients with recent infection.What is known alreadyACE2 and TMPRSS2 are expressed in the endometrium, potentially enabling SARS-COV-2 viral invasion of the cells. Unlike with bacterial infections, the effect of viral infections in general on implantation and pregnancy rates is unclear. Some evidence suggests that early embryonic and trophoblastic infection, may result in impaired implantation or placentation. A recently published study including both recovered and vaccinated patients did not find an effect of COVID-19 immunity on FET cycle outcomes. The study did not stratify by time from infection thus the immediate consequences of infection on pregnancy rates could not be properly evaluated.Study design, size, durationA retrospective cohort study, including 41 COVID-19 recovered women, aged 20-42 years that underwent FET cycles, and 41 controls between January 1, and June 31, 2021, at a large IVF unit.Participants/materials, setting, methodsEmbryos transferred were the product of fresh cycles performed prior to infection. Maximal time from infection to transfer was defined as one year. The study group was matched by age, number of embryos transferred and day of transfer, to unvaccinated patients, with no history of past infection that underwent FET cycles during the same period. Demographics and cycle characteristics were recorded. Clinical and ongoing pregnancy rates were compared, with further stratification by time from infection.Main results and the role of chanceClinical pregnancy rates were 29.3% and 48.8% for the recovered and control patients respectively (p = 0.070). Ongoing pregnancy rates were 26.6% vs. 43.4% (p = 0.093). Mean age at ovum pickup (30.72 vs. 30.69; p = 0.929) and at transfer (31.56 vs. 31.58; p = 0.966) was similar between groups, as were the demographic characteristics and previous retrievals and transfers. The predominant transfer protocol used was different between groups with higher rates of natural cycle (NC) protocol in the COVID group (61% vs. 33.3%; p = 0.013. All other cycle characteristics including endometrial width, number of embryos transferred, day of embryo transfer and embryo grade were similar. Stratification by time from COVID-19 infection to transfer into ≤60 and >60 days revealed a significant difference in pregnancy rates, with recovered women having lower pregnancy rates if infected in proximity to the transfer (20.7% vs. 55.2%; p = 0.006). In a logistic regression model, infection was a significant variable (p = 0.05, OR 0.325, 95% CI 0.106-0.998). Logistic regression applied on the subgroup of women infected in proximity to the transfer, further strengthened the univariate results, with COVID-19 infection remaining a significant parameter (p = 0.005, OR 0.072, 95% CI 0.012-0.450).Limitations, reasons for cautionA retrospective study, with a limited sample size, but nevertheless our results showed significant differences. Wider implications of the findingsFurther studies with larger groups are warranted to support these findings. Pending further information, in cases of FET cycles with limited numbers of embryos (advanced age, embryo donation, fertility preservation, embryos following sperm extraction), postponing embryo transfer for at least 60 days following recovery might be considered, if feasible.Trial registration numberHMC-0010-21

P-312 Effect on pregnancy outcomes of depot GnRH agonist pre-treatment before frozen-thawed embryo transfer cycles in patients with adenomyosis

Abstract Study question Is there any difference between using or not using depot GnRH agonist pre-treatment on pregnancy outcomes in patients with adenomyosis before frozen-thawed embryo transfer cycles? Summary answer GnRH agonist pre-treatment before frozen-thawed embryo transfer has no effect on pregnancy outcomes in adenomyosis patients. What is known already Uterine adenomyosis negatively affects implantation and clinical pregnancy rates and also increases the risk of early pregnancy loss. Increased inflammatory markers and increased myometrial peristalsis are thought to decrease the rate of implantation. Depot GnRH agonist pre-treatment is thought to increase implantation rate by both decreasing myometrial contractility and reducing inflammatory marker production. Study design, size, duration This retrospective cohort study was conducted at ART and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey. Patients with adenomyosis undergoing a FET cycle between 2011 and 2021 were evaluated. Patients between 25-45 years old with good and top-quality blastocysts were included and preimplantation genetic diagnosis (PGD) was applied to patients who were &amp;gt;37 years old. A total of 144 frozen embryo transfer cycles were examined. Participants/materials, setting, methods Diagnosis of adenomyosis was made using transvaginal ultrasound and/or pelvic magnetic resonance imaging which revealed an asymmetrically thickening between the anterior and posterior uterine walls, focal adenomyosis, myometrial cysts and irregular/interrupted junctional zone of the endometrium. 65 patients in the study group (Group I) who received depot GnRH agonist pre-treatment for minimum 2 and maximum 6 months and 79 patients without GnRH agonist pre-treatment (Group 2) were evaluated. Main results and the role of chance There was no significant difference in patient characteristics such as age, endometrial thickness on embryo transfer day, BMI, infertility duration, and anti mullerian hormone levels between groups 1 and 2. Endometrial preparation was done using artificial cycle in the depot agonist group, whereas both artificial and modified natural cycle were used in patients without depot GnRH agonist pre-treatment.The pregnancy rate was 53.8%(n = 35) in group 1 and 54.4%(n = 43) in group 2. The clinical pregnancy loss rate was 20% (n = 9) in group 1 and 15.7% (n = 6)in group 2. The live birth rate was 40% (n = 26) in group I and 39.2. (n = 31) in group II. There were no statistically significant differences in pregnancy rates, clinical pregnancy losses, and live birth rates between the groups. Limitations, reasons for caution The limitation of the study is its retrospective nature. Wider implications of the findings The lack of any statistically significant differences in pregnancy outcomes in this study suggests the need for further evaluation of the value/effectiveness of GnRHa treatment in adenomyosis patients before embryo transfer cycles. Trial registration number not applicable

Transport of vitrified-warmed ICSI blastocysts in straws for up to 5 hours does not affect the pregnancy rate

An increasing desire from embryo owners to have embryos transferred to their recipients at their private place, instead of bringing their recipient mare to the clinic for transfer, has led to this study, investigating whether the transport of embryos in straws, can be performed without affecting the pregnancy rate. The present study aimed to determine if vitrified-warmed ICSI blastocysts could be loaded in 0,25 ml straws in a buffered, commercial media (GMOPS Plus, Vitrolife, Sweden) and transported in a versatile shipping incubator (26237, WTA), at 38°C for up to 5 hours driving by car without affecting the pregnancy rate. Blastocysts were produced by conventional ICSI with oocytes recovered from immature follicles by transvaginal ultrasound-guided oocyte pick up in a clinical commercial program in Denmark. This study was performed in the transfer season 2021 (March to August) and included 90 embryos from different breeds, mainly Warmblood mares. The blastocysts were vitrified on days 7-10 after ICSI using commercial vitrification media (VitriFreeze, FertiPro, Belgium), and an open vitrification device (VitriFit, CooperSurgical, Denmark). On the day before the transfer, blastocysts were warmed in commercial warming media (VitriThaw, FertiPro) and incubated overnight in EQ-IVC2 (IVF Bioscience, UK), 6% CO2, 38.2°C. On the day of transfer, embryos going to be transferred at the client's place were loaded in 0,25 ml straws with warm GMOPS Plus and placed in the WTA shipping incubator at 38°C. All embryos were transferred by manual and transcervical method to recipient mares being 4 to 5days after ovulation. In total 90 embryos were transferred; 39 embryos were transported in straws and 51 embryos were transferred directly at the clinic, and no significant difference in the pregnancy rate was observed between transported embryos (26/39, 67%) and directly transferred embryos (33/51, 65%) 7-10 days after transfer. When checking for the heartbeat (∼day 30 after ovulation), also no significant difference in the heartbeat pregnancy rate was observed between the transported embryos (24/39, 62%) and directly transferred embryos (29/51, 57%). In conclusion, these data show that equine ICSI blastocysts can be transported in straws at 38°C for up to 5 hours by car in a commercial medium, without affecting the heartbeat pregnancy rate. For future studies, it would be interesting to investigate if vitrified-warmed ICSI blastocysts can be transported in straws for more than 5 hours without affecting the pregnancy rate.

Efficiency of embryo biopsy and PCR for sex determination in a commercial equine embryo transfer program in Argentina

In some horse breeds, such as Argentinian Polo Horses, limiting pregnancies to the desired foal sex has both economic and welfare implications. Biopsy of equine embryos to assess embryonic sex by polymerase chain reaction (PCR) on DNA from sampled cells has been reported under research settings and in a limited number of commercial programs. We previously reported the results of embryo biopsy and PCR of biopsied trophoblast cells for sexing in our commercial equine embryo transfer program. In that study, including one season and results on biopsy of over 450 embryos, there was no significant difference in pregnancy rate between biopsied and non-biopsied embryos (72% vs 73%) or for biopsied embryos recovered at the center (73%) compared with those shipped overnight (72%). Initially, sampled cells were probed with both a genomic (confirmatory) DNA probe and a Y-specific probe, however a sizable proportion (14%) of biopsies did not provide a sex diagnosis (no signal for either probe). We later found that determination only of presence of Y DNA was equally or more effective than using the genomic DNA control; it appeared that the division of the DNA isolated from the biopsy into two aliquots (for analysis of genomic and Y-specific DNA) reduced the accuracy.Overall, the accuracy (correct foal sex) was 95% for embryos diagnosed as male and 78% for embryos diagnosed as female. In the present breeding season (2021-22), we used only Y-DNA assessment. At the time of writing, we have biopsied and assessed over 300 embryos. Embryos were recovered at the Center or shipped overnight to the Center. Biopsy was performed via micromanipulation, and the biopsied cells were evaluated for Y-chromosome specific DNA via PCR. Only embryos without a Y-DNA signal were transferred. Pregnancy rates after transfer of biopsied embryos are currently 124/163 (76%). Sexing of fetuses from transferred embryos via ultrasonographic evaluation at 60-70 days gestation is ongoing and at the time of writing, 48 fetuses have been evaluated. The proportion of female fetuses resulting from embryos with a “female” biopsy/PCR diagnosis (no Y-DNA signal) appears to have varied through the season, being 80% for the first 20 fetuses evaluated and 68% for the next 28 fetuses evaluated. We are currently examining the system to determine possible reasons for the reduction in the accuracy of the PCR diagnosis, and updated results will be presented at the time of the symposium.

Embryonic Development in Relation to Maternal Obesity Does Not Affect Pregnancy Outcomes in FET Cycles.

This retrospective cohort study examined the effect of maternal BMI on embryo morphokinetics using a time-lapse incubator (TLI) and evaluated the effect on outcomes of frozen embryo transfer (FET) cycles. The study included 641 women who underwent FET of a total of 2553 embryos from January 2017 to August 2019. The women were divided into four groups according to BMI: underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25.0–29.99 kg/m2), and obese (≥30 kg/m2). Embryos were transferred on day 3 or 5, and their development was monitored using a TLI. We found that oocytes from obese patients were slower in the extraction of the second polar body (tPB2) after fertilization and the two pronucleus stage appeared later compared to normal-weight women. The time to fading of the pronucleus (tPNf), t2, and t4 were comparable between the four groups. Oocytes from underweight and overweight women had significantly faster cleavage at t3 and t5–t8 compared to normal weight. We did not find any significant difference in pregnancy rate, clinical pregnancy rate, or miscarriage rate among groups. In conclusion, embryos from normal-weight patients had slower cleavage rates compared to obese patients, while embryo quality was similar between BMI groups. The cycle outcomes demonstrated comparable pregnancy rates among the BMI groups.

Efficacy of Yushen Tongluo Granule Combined with Clomiphene Citrate for Anovulatory Infertility: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

Objective To evaluate the efficacy and safety of Yushen Tongluo Granule (YSTLG) combined with clomiphene citrate (CC) in the treatment of anovulatory infertility. Methods This randomized, double-blinded, placebo-controlled clinical trial was carried out in the Department of Obstetrics and Gynecology and the Department of Traditional Chinese Medicine (TCM). During the 3 menstrual cycle intervention periods, all subjects received 50 mg/day CC from day 5 until day 9 of the menstruation. If no ovulation, the amount of CC per cycle increased 50 mg/day until 150 mg/day. Participants in the experimental group received YSTLG, while participants in the control group received YSTLG placebo. The granules were orally taken from the end of menstruation until ovulation. When one leading follicle attained a diameter of 18 mm or more, 5000 U human chorionic gonadotropin (hCG) was given intramuscularly. The primary outcome measure was the ovulation rate, and follicular development was monitored by transvaginal ultrasound on the 10th day of the cycles until ovulation. Secondary outcome measures including the overall curative effect, endometrial thickness, and pregnancy outcomes were also compared between the two groups. Results The ovulation rate in the experimental group was higher than that in the control group (P < 0.05). Compared with the control group, the overall curative effect of the experimental group was better than that of the control group (P < 0.05), and the endometrial thickness in the ovulation phase was significantly thicker than that in the control group (P < 0.01). There was no significant difference in pregnancy rate and miscarriage rate between the experimental group and control group (P > 0.05). Conclusion The combined YSTLG and CC used to treat anovulatory infertility can improve the ovulation rate without affecting endometrial thickness, which is efficacious and safe.