Sperm Source Research Articles

Pregnancy outcomes after superovulation-intrauterine insemination (SO-IUI) using gonadotropins versus letrozole in the obese population.

To compare fertilityoutcomes of obese patients (body mass index [BMI] ≥ 30kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole. A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates. Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72-2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42-5.08), multiple pregnancy (aOR1.33, 95%CI 0.20-8.88) or cancellation rates (OR0.89, 95%CI 0.55-1.45) between the two groups. The rates of multifollicular development were also comparablebetweenthe two groups (aOR0.51, 95% CI 0.19-1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001). After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.

Preimplantation Genetic Testing for HLA Matching (PGT-HLA) When Only Partial Embryo Matches are Identified

Introduction: Preimplantation Genetic Testing (PGT) is an option for couples to select embryos that have a matching Human Leukocyte Antigen (HLA) type to a child that is in need of hematopoietic stem cell transplant (HSCT). Families in search of HLA-matched donors for HSCT may have a difficult time finding publicly available optimal donors or donors within their families. The likelihood of a family finding an optimal donor can vary from 16% to 75%, depending on ethnic and racial groups. Previously, PGT-HLA has been used to identify potential future siblings who would be an HLA match to an affected child through embryo testing as early as 2001 for conditions like Fanconi Anemia. PGT-HLA can be complicated by the presence of recombination within the HLA complex on chromosome 6 in the affected individual. If an affected child is found to be recombinant within the HLA complex (6-7% of PGT-HLA cases), the chances of finding a full sibling-matched donor can be extremely low. PGT for partial HLA matching can be used when the affected child is found to be recombinant or if a full parental match is not possible. When a child is identified as recombinant in the HLA region, consultation with their transplant team can determine whether a partial sibling match would be a good therapeutic candidate. PGT-HLA is performed by linkage analysis which requires DNA samples from the oocyte source, sperm source, and the affected child. These results will determine shared parental regions of the HLA complex genes so that partial matches can be identified. Case Reviews: We present two cases of PGT-HLA where only partial matches were identified during embryo testing. Of these 2 cases, both families completed one testing cycle for PGT-M and PGT-HLA and both had partial matches that were recommended for transfer per patient consent. One family had 3 partial match embryos, but they did not have a successful pregnancy following frozen embryo transfer. However, during the period of their transfers, they were able to find an adequate publicly-matched donor for HSCT therapy for their child. In one family, only a paternal HLA match was sought due to advanced maternal age of the mother. Consultation with the family’s transplant team indicated that a paternal-only match would be sufficient for a therapeutic effect. Conclusions: Despite the complexity of testing for PGT-HLA matching for a child where a full sibling match is not available embryo testing can still provide a therapeutic benefit. Interdisciplinary consultation in these cases would optimally include the couple, the affected child’s transplant team, the couple’s reproductive endocrinologist, and genetic counseling available at the PGT laboratory or the REI office. As accessibility to PGT continues to grow and as guidelines for PGT acceptability continue to be written, PGT-HLA should similarly find more usage. Inevitably, partial embryo matches will be seen and we will continue to learn how these can be used in clinical practice.

Association between embryo morphokinetic development and intracytoplasmic sperm injection with epididymal sperm via time-lapse imaging.

The objective of this study was to investigate the impact of sperm source on embryo morphokinetics and the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles by considering the clustering of data (multiple embryos per patient that share a comparable developmental timing). This matched cohort study was performed at a private university-affiliated in vitro fertilization center. Women who underwent ICSI with epididymal sperm between January 2019 and December 2020 (the percutaneous epididymal sperm aspiration group, n = 32 cycles) were matched with women who underwent ICSI with ejaculated sperm because of idiopathic male factor infertility (the male factor infertility [MFI] group, n = 32 cycles) or female infertility (the control group, n = 32 cycles). Embryos were cultured in a time-lapse imaging incubator, and morphokinetic development was recorded and compared among the groups. Significantly slower divisions were observed in embryos derived from epididymal sperm than in those derived from the MFI and control groups. Embryos derived from epididymal sperm had a significantly lower KIDScore (3.1 ± 0.2) than did those derived from ejaculated spermatozoa from the MFI (5.4 ± 0.1) and control (5.6 ± 0.2, p < 0.001) groups. Epididymal sperm-derived embryos showed a significantly greater occurrence of multinucleation (23.2%) than did those derived from ejaculated sperm from the MFI and control groups (2.8% and 3.7%, p < 0.001, respectively). Epididymal sperm-derived embryos were significantly more likely to undergo direct or reverse cleavage (11.1%) than ejaculated sperm-derived embryos in the control group (4.3%, p = 0.001). In conclusion, delayed cell cleavage and increased incidences of blastomere multinucleation and abnormal cleavage patterns are observed when epididymal-derived sperm are used for ICSI.

Cumulative live birth rates following intrauterine insemination using donor and husband sperm in different age groups: Acohort study of 10 415 insemination cycles.

To assess the age-specific cumulative live birth rates (CLBRs) in intrauterine insemination (IUI) cycles using either donor or husband sperm, and to investigate the impact of sperm sources on IUI success among women within the same age group. This retrospective cohort study comprised women who underwent IUI with donor sperm (IUI-D) or husband sperm (IUI-H) from 2017 to 2021. The women were stratified based on their age at the initiation of insemination into four categories: <35, 35-37, 38-39 and ≥40 years. A total of 5253 women undergoing 10 415 insemination cycles (3354 with IUI-D and 7061 with IUI-H) were included. The CLBRs decreased significantly with increasing maternal age within donor and husband insemination groups (P < 0.001). In the IUI-D group, the crude CLBRs were 61.50% in women aged <35, 48.91% in 35-37, 24.14% in 38-39 and 11.76% in the ≥40-year age category, respectively. The corresponding rates in the IUI-H group were 27.62%, 22.96%, 13.73% and 6.90%, respectively. Within the <35 and 35-37-year age categories, the CLBRs were significantly higher following IUI-D cycles compared to IUI-H cycles, with hazard ratios (HR) of 1.85 (1.68-2.04) and 1.69 (1.16-2.47), respectively. However, within the 38-39 and ≥40-year age categories, both IUI-D and IUI-H resulted in comparable low CLBRs, with HRs of 1.91 (0.77-4.76) and 1.80 (0.33-9.86), respectively. Advanced maternal age affects the whole process of fertility. Therefore, it could be reasonable to limit the number of IUI performed in women aged 40 years and older, even in couple using donor sperm for reproduction.

#49 : Does Percutaneous Epididymal Sperm Aspiration (PESA)-Sperm Attribute as the Game Changer in High-Risk Male Factor Fertility for Intracytoplasmic Sperm Injection (ICSI)?

Background and Aims: The surgically retrieved sperms either from PESA, TESA and microTESA are considered to contribute satisfactory outcome in ICSI cycles in male factor infertility especially in Azospermia. Although the different sources of sperm for ICSI don’t affect the fertilisation rates in ICSI cycles, but the sperm obtained from fresh PESA may become game changer with higher implantation rates, resulting in better clinical pregnancy and live birth outcomes. Method: This comparative study was based at single reproductive center and evaluated 344 PESA-ICSI patients with high-risk male factors from July 2021 to Dec 2022 henceforth were compared with ejaculated-ICSI. The following high-risk male infertility patients were included - 1. No blastocyst formation in two stimulation cycles with ejaculated sperm, 2. If &gt;2 IVF failure (with/o &gt; 4 blastocyst transfer), 3. Severe OAT/azoospermia, 4. Sperm morphology &lt;2% (and/or DFI &gt;25%) even after 6 week of lifestyle n antioxidant therapy and 5. Miscellaneous factor like morbid obesity BMI&gt;40, age &gt;45 with/o history of chronic smoking and alcoholic. The embryo quality was assessed from good blastocyst rate and pregnancy outcome was recorded as implantation and clinical pregnancy rate. Results: As per the inclusion criteria 344 high-risk infertile male (21%) underwent PESA-ICSI and compared with 1346 ejaculated-ICSI patients. The average no of M2 oocytes were takes for ICSI purpose is similar in both group (9.2 and 9.4 per oocyte retrieval). The blastocyst rate in PESA-ICSI group was 51% as compare 48% in ejaculated-ICSI but there was outstanding good-blastocyst rate (34% compared to 24%, P&lt;0.01). Both the group showed nearly equal implantation rate (83% compare to 80.4%) but ongoing pregnancy up to 12 weeks was significantly high as compare to ejaculated-ICSI group (77% vs 62% P &lt;0.01) Conclusion: The high-risk male infertility must be addressed with timely evaluation and decision. PESA offers safe, simple, daycare and promising results in terms of sperm yield and pregnancy outcome, must be offered as first line approach.

Comparing the clinical and singleton neonatal outcomes in male infertility patients with Oligoasthenospermia, OA, or NOA following fresh ICSI-ET using different sources of sperm.

To investigate clinical and singleton newborn outcomes in fresh cycles of embryo transfer after intracytoplasmic sperm injection (ICSI-ET) with diverse sperm sources (ejaculate, epididymis, and testis) in patients with Oligoasthenospermia, obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). Patients who received fresh ICSI-ET for the first time at the First Affiliated Hospital of Zhengzhou University Reproductive Medicine Center between June 2011 and June 2021 were selected for this 10-year retrospective cohort analysis. After propensity score matching, only 1630 cycles were included in the investigation of ICS-ET clinical and singleton newborn outcomes in patients with Oligoasthenospermia, OA, and NOA using sperm from diverse sperm sources. After propensity score matching, our data revealed a negligible difference in baseline and cycle parameters among groups. In patients with Oligoasthenospermia and OA, different sperm sources do not appear to influence clinical pregnancy rates and live birth rates, nor do they influence newborn outcomes, such as newborn weight, premature birth rate, and neonatal sex ratio in singleton births, except for OA patients who use epididymal sperm having higher low birth weight (LBW) rates in singleton pregnancies than those who use testicular sperm. In addition, clinical pregnancy rates, live birth rates, singleton gestation birth weights, premature birth rates, and neonatal sex ratios were similar between patients with Oligoasthenospermia, OA, and NOA using testicular sperm. Regardless of the type of male infertility (Oligoasthenospermia, OA, NOA) or sperm sources (ejaculate, epididymis, testis), a successful ICSI-ET procedure can result in similar clinical and neonatal outcomes, such as clinical pregnancy rate, live birth rate, abortion rate, neonatal birth weight and sex ratio of singleton pregnancies.

The Cation/Calcium Channel of Sperm (CatSper): A Common Role Played Despite Inter-Species Variation?

The main cation/calcium channel of spermatozoa (CatSper), first identified in 2001, has been thoroughly studied to elucidate its composition and function, while its distribution among species and sperm sources is yet incomplete. CatSper is composed of several subunits that build a pore-forming calcium channel, mainly activated in vivo in ejaculated sperm cells by intracellular alkalinization and progesterone, as suggested by the in vitro examinations. The CatSper channel relevance is dual: to maintain sperm homeostasis (alongside the plethora of membrane channels present) as well as being involved in pre-fertilization events, such as sperm capacitation, hyperactivation of sperm motility and the acrosome reaction, with remarkable species differences. Interestingly, the observed variations in CatSper localization in the plasma membrane seem to depend on the source of the sperm cells explored (i.e., epididymal or ejaculated, immature or mature, processed or not), the method used for examination and, particularly, on the specificity of the antibodies employed. In addition, despite multiple findings showing the relevance of CatSper in fertilization, few studies have studied CatSper as a biomarker to fine-tune diagnosis of sub-fertility in livestock or even consider its potential to control fertilization in plague animals, a more ethically defensible strategy than implicating CatSper to pharmacologically modify male-related fertility control in humans, pets or wild animals. This review describes inter- and intra-species differences in the localization, structure and function of the CatSper channel, calling for caution when considering its potential manipulation for fertility control or improvement.

P-398 Elective Oocyte Cryopreservation – a viable alternative as a means of fertility preservation

Abstract Study question What are the trends in women accessing elective oocyte cryopreservation (EOC) across a multi-site clinic in Sydney, Australia, thaw rates, utilisation and live birth rates Summary answer Over 9 years, there was a significant increase in women having EOC. 2.7% returned to use. Oocyte thaw survival rates were 89.5% with LBR 35.5%. What is known already Data from Australia/New Zealand and USA demonstrated a 3 to 8-fold increase in EOC cycles, with a reduction in mean age of women accessing treatment. &amp;lt;5% of women returned to use their frozen gametes and live birth rates were better in women aged &amp;lt; 35 years. HFEA data demonstrated the use of frozen oocytes did not appear to increase risk of adverse perinatal outcomes. Research has shown that almost half of the women who returned to use their frozen oocytes used donor sperm with an overall LBR of 20.9%. 91% of women had no regrets over their decision for EOC. Study design, size, duration This was a retrospective cohort study performed at a multi-site large private fertility clinic in Sydney, Australia. This clinic was the first in Sydney to offer EOC to women. All women accessing EOC from 2014 – September 2022 were included. Ethics approval was obtained. Participants/materials, setting, methods Data was collected from women undergoing EOC; including demographic information, controlled ovarian stimulation parameters, return to use, oocyte thaw survival rates, source of sperm used for fertilization, embryo biopsy rates, aneuploidy rates, as well as pregnancy rates. Main results and the role of chance There was a 17.5-fold increase in cycles of EOC over the 8-year study period; with a reduction in average age from 38.13 to 35.85 years. Overall the mean age was 36.6 of the 2278 women who underwent EOC, of which 30% were aged &amp;gt;38 years. The mean oocyte yield was 8.85. Of the 62 (2.7%) women who returned to use their frozen oocytes, 54.8% were &amp;lt; 38 years of age. Oocyte thaw survival rates were 89.5%. The majority of women who returned to use their frozen oocytes, used donor sperm for conception. Fertilization rates with intra-cytoplasmic sperm injection (ICSI) was 65.3%; with 8.3% of oocytes degenerating post ICSI. 41.6% of embryos developed into blastocysts with 27.8% utilization rate (good quality blastocyst formation rate). Overall LBR was 35.5% for all women. Clinical pregnancy rates (CPR) from warmed oocytes were 46.2% from women aged &amp;lt;38 years old and 22.2% from women &amp;gt;38 years old. Of women who returned for a frozen embryo transfer, LBR was 25%; all occurring in women who froze their oocytes prior to age 38. Limitations, reasons for caution In parallel to international studies, very few women returned to use their oocytes; results need to be interpreted with care when counselling women considering EOC. Lifestyle factors were unable to be accounted for. Most women have opted to continue storing and not dispose/donate their oocytes at the time of publication. Wider implications of the findings EOC proves to be a viable and useful option for fertility preservation. Due to the small proportion of women who return to use their oocytes; and paucity of data; it would be prudent to improve standardisation of data collection and outcome measure reporting. Trial registration number Not Applicable

O-149 Endometrial thickness as a predictor of live birth and perinatal outcomes following oocyte donation

Abstract Study question Does endometrial thickness (EMT) predict the occurrence of live birth following oocyte donation? Summary answer Our study found that EMT is predictive of live birth in oocyte donation. What is known already EMT is a widely used surrogate marker of endometrial receptivity and is believed to be associated with in vitro fertilization pregnancy outcomes. However, the evidence thus far is mixed, with many studies (and even meta-analyses) suggesting that EMT may have little/no predictive value. One potential reason for the heterogeneity in results may be that most studies assessed mostly fresh autologous embryo transfers, without accounting for embryo quality nor the effect exogenous ovarian stimulation may have on endometrial receptivity and subsequent pregnancy/perinatal outcomes. Moreover, most subcategorized EMT to facilitate interpretation, which may have inadvertently introduced bias to the analyses. Study design, size, duration This retrospective, multicentre, cohort study analyzed all single blastocyst embryo transfers following oocyte donation from 2010-2019 subdivided into regular intervals of EMT (&amp;lt;7.0 mm, 7.0-8.9 mm, 9.0-10.9 mm, ≥11.0 mm). EMT was also evaluated as a continuous variable, comparing the best-fitting fractional polynomial against the linear function, to minimize bias due to residual confounding that may occur following the categorization of continuous variables. Confounder adjustment was performed using multivariable generalized estimating equations regression analysis. Participants/materials, setting, methods The oocyte donation model was chosen to minimize the influence of potential confounding factors such as poor embryo quality and the effect of ovarian stimulation on endometrial receptivity. The main objective of the study was to compare live birth rates (LBR). Our secondary outcomes included other surrogate pregnancy (hCG-positive pregnancy, clinical pregnancy, and miscarriage rates) and perinatal (gestational age at birth, preterm birth under 37 weeks, birthweight z-score, small and large for gestational age) outcomes. Main results and the role of chance In total, 33915 embryo transfers were analyzed. Confounder variables included were female donor and recipient age, recipient BMI, female factor infertility, male factor infertility, number of mature oocytes donated, oocyte status (fresh versus vitrified), sperm source (partner or donor), embryo status (fresh versus vitrified), embryo quality, endometrial preparation (natural or artificial cycle) and year of transfer. When compared to the reference EMT of 9.0-11.0 mm, EMT &amp;lt;7.0 mm was associated with lower hCG positive pregnancy rates (51.3% vs 57.6%; aOR 0.82 CI 0.75-0.89), lower clinical pregnancy (41.9% vs 49.1%; aOR 0.79 CI 0.73-0.86), higher miscarriage rates per hCG positive pregnancy (37.5% vs 31.4%; aOR 1.31 CI 1.16-1.47) and lower LBRs per transfer (32.1% vs 39.5%; aOR 0.76 CI 0.69-0.83). Regarding perinatal outcomes, we found significantly higher preterm delivery rates following an EMT &amp;lt;7.0 mm (14.1% vs 9.9%; aOR 1.54 CI 1.21-1.96) and higher large for gestational age rates associated with EMT ≥11.0 mm (16.4% vs 12.2%; aOR 1.40 CI 1.07-1.83). The fractional polynomial analysis revealed that the subcategorization of EMT caused clinically-relevant residual confounding. Specifically, LBRs assumed an approximate bell-shaped relationship with EMT, with LBR rates decreasing for both thinner EMTs (&amp;lt;7 mm subgroup) and thicker EMTs (≥11.0 mm subgroup). Limitations, reasons for caution The retrospective nature of the study and the inherent risk of bias related to unmeasured confounding may have impacted the results. Another potential limitation is the lack of perinatal outcome data due to loss of follow-up, which should be considered when interpreting these results. Wider implications of the findings Our results support the use of EMT as a predictor of live birth and as a marker of endometrial receptivity and competence. Moreover, it stresses the potential danger of subcategorizing all EMT &amp;lt;7.0 mm and &amp;gt;11.0 mm as equivalent, as the study found that these subgroups have varying LBR. Trial registration number not applicable

O-122 The first study to assess the clinical efficacy of CHLOE-EQ on the assessment of embryo viability of embryos cultured in a GERI time-lapse incubator

Abstract Study question Can an automatic AI scoring system predict ploidy, live birth and utilization? Are there differences in AI scoring between donor and own gametes? Summary answer CHLOE-EQ Score is directly associated with oocyte quality, ploidy, utilization, live birth, embryo quality, direct uneven cleavage (DUC), blastulation, utilization and selection for transfer. What is known already The integration of AI algorithms, such as CHLOE-EQ, into different Time-lapse systems requires clinical and biological validation. Geri Time-lapse videos have given the embryologists more insight into embryo development. Analyzing this information manually requires time and introduces risk of error. To tackle this issue, AI solutions like CHLOE-EQ (Fairtility) can be used to automatically assess video datapoints. CHLOE-EQ provides an embryo quality score that has been shown to predict embryo viability and ploidy, providing clarity on the underlying biological factors. Before introducing AI tools in clinical practice, it is crucial to confirm their efficacy and validate with clinical data. Study design, size, duration A retrospective cohort analysis was conducted at a private clinic in Spain from April 2021 to November 2022, involving the review of 3196 Geri time-lapse videos with a subset of known ploidy and live birth outcomes. The correlation of CHLOE-EQ score with ASEBIR clinic grading was evaluated. As well as with DUCs, oocyte quality, sperm source, blastulation, utilization, selection for transfer, ploidy and live birth. Participants/materials, setting, methods Geri time-lapse videos were automatically analyzed by CHLOE-EQ (Fairtility). CHLOE-EQ score was assessed in relation to laboratory (ploidy, clinic ASEBIR embryo scoring, utilization, selection for transfer) and clinical outcomes (live birth), as well as between own vs donor gametes (own eggs &amp;gt;40y vs donor eggs and testicular sperm vs donor sperm) using descriptive statistics and t-test. The accuracy of prediction was measured using binary logistic regression (AUC). Main results and the role of chance CHLOE-EQ score was positively correlated with ASEBIR embryo quality (A:8.7±1.9, n = 349 &amp;gt;B:6.8±2.9, n = 470 &amp;gt; C: 5.1±3.0, n = 124 &amp;gt; D:1.3±2.1, n=751; p &amp;lt; 0.05). Non-DUCs had higher CHLOE-EQ Score than DUCs [5.3±3.8, n=1798 vs 1.9±0.38, n=643, p&amp;lt;0.001]. CHLOE-EQ Score was unaffected by the quality of the sperm sample, with similar CHLOE-EQ scores between donor sperm and testicular derived sperm (4.1±3.9, n=335 vs 3.4±4.2, n=56, respectively, NS). Embryos that blastulated (yes vs no: 5.4±3.7, n=1996 vs 0.6±2.1, n=309, p &amp;lt; 0.001), were utilized (7.4±0.28, n=911, vs 1.0±2.1, n = 1309, p &amp;lt; 0.001), selected for transfer (8.7±2.4, n=153 vs 3.3±3.7, n = 2067, p &amp;lt; 0.001), were euploid (7.5±2.5, n=72 vs 6.3±3, n=152, p = 0.001) and resulted in live births (4.4±4.1, n = 332 vs 3.8±4, n = 499, p = 0.02) had a higher CHLOE-EQ score than embryos that did not. CHLOE-EQ Score is higher in embryos derived from oocytes from donors than own eggs, suggesting that oocyte quality affects CHLOE-EQ score (4.0±4, n = 1189 vs 2.7±3.4, n = 356). CHLOE-EQ Score is predictive of utilization (AUC=0.95, n=2220, baseline=41%, p&amp;lt;0.001), euploidy (AUC=0.63, n=224, baseline=32.1%, p=0.003), blastulation (AUC=0.94, n = 2305, baseline=86.6%, p &amp;lt; 0.001) and selection for transfer (AUC=0.89, n = 2220, baseline=41%, p&amp;lt;0.001). Limitations, reasons for caution This is a retrospective single-center study in which embryos for transfer were selected by human embryologists, and forms part of program to validate the responsible integration of AI into clinical practice in each individual clinic. Wider implications of the findings This is the first study presenting the efficacy of prediction of CHLOE-EQ with GERI data. AI tools have the potential to improve consistency, efficiency, and accuracy of embryo assessment and selection. CHLOE-EQ predicts through quantitative and qualitative morphological and morphokinetics information, resulting in more personalized care for each individual embryo. Trial registration number not applicable

O-025 Livebirth delivery rates after natural versus artificial cycle in women receiving donated oocytes and the impact of female age.

Abstract Study question Is female age associated with worse outcomes following embryo transfer in either a natural cycle (NC) or artificial cycle (AC) in women receiving donated oocytes? Summary answer NC embryo transfers resulted in both lower miscarriage and higher livebirth rates, and the age of the female recipient did not modify this effect. What is known already Previous studies have demonstrated that NC may result in better outcomes than AC embryo transfer. When feasible, avoiding AC in advanced maternal age and/or couples using donated oocytes could be considered, given the potential compounding effect for certain negative maternal and perinatal outcomes such as gestational hypertension. However, there is limited research on the use of NCs in women of advanced maternal age and research thus far has shown that the luteal phase of the menstrual cycle in older women may be altered, thus potentially limiting the effectiveness of NC. Study design, size, duration This retrospective, multicentre, cohort study included all single blastocyst embryo transfers following oocyte donation performed between January 2010 and December 2019, subdivided according to the type of endometrial preparation performed (NC or AC). The oocyte donation model was preferred to minimize the potential confounding effect related to both poor embryo quality in older women and the influence that ovarian stimulation performed during autologous IVF may have on endometrial receptivity prior to a fresh embryo transfer. Participants/materials, setting, methods The main objective of the study was to compare livebirth delivery rates (LBR). The secondary outcomes included hCG positive pregnancy rate, clinical pregnancy rate (CPR) and miscarriage rate. Confounder-adjustment was performed using multivariable generalized estimating equations model regression analysis, adjusting for multiple confounders. Additionally, an interaction variable was added to the final multivariable model to assess whether female recipient age may modify the effect of each type of endometrial preparation on LBRs. Main results and the role of chance In total, 38259 embryo transfers were analysed, including AC (n = 34850) and NC (n = 3409). Mean recipient age was 42 years, with a range of 20-50 years. The results showed that despite being associated with a higher hCG positive pregnancy (57.1% vs 53.5%; OR 0.91 CI 0.84-0.98), AC were also associated with a higher miscarriage rate per hCG positive pregnancy (33.5% vs 27.9%; OR 0.70 CI 0.62-0.78) when compared to NC, resulting in slightly lower LBRs per transfer with AC (38.0% vs 38.6%; OR 1.13 CI 1.05-1.21). All primary and secondary outcomes were still significant following confounder adjustment. Confounder variables included were female donor and recipient age, recipient BMI, female factor infertility, male factor infertility, number of mature oocytes donated, oocyte status (fresh versus vitrified), sperm source (partner or donor), embryo status (fresh versus vitrified), embryo quality, endometrial thickness, and year of transfer. The interaction of endometrial preparation method with female recipient age was not statistically significant (aOR 1.02, 95% CI 0.99-1.05). Limitations, reasons for caution The retrospective nature of the study and the inherent risk of bias related to confounding may have impacted the results. Another limitation is the low numbers of natural cycles (9% of all cycles), which could be related to the low uptake to the treatment and/or to selection bias. Wider implications of the findings NC seems slightly better than AC and the differences between the two are unlikely to be modified by female age. Therefore, it seems reasonable to suggest NC for older women, as they would benefit from the decreased risk of miscarriage and hypertension during pregnancy. Trial registration number not applicable

Surgical sperm extraction versus semen centrifugation: Method of spermatozoa recovery does not correlate with euploidy rates in patients with cryptozoospermia

Objective&#x0D; The aim of this study is to evaluate the rate of embryonic euploidy in blastocysts derived from testicular versus ejaculated sperm in cryptozoospermic patients.&#x0D; Design&#x0D; Retrospective cohort analysis.&#x0D; Material and methods&#x0D; The study included couples who suffer from Cryptozoospermia and underwent an autologous in vitro fertilization (IVF) with preimplantation genetic testing (PGT-A) cycle(s) from 2014 to 2019. Only cases where oocyte insemination was conducted with intra-cytoplasmic sperm injection (ICSI) were evaluated. Cohorts were separated based on the source of sperm (Ejaculated vs. Testicular (TESE)). Demographic and clinical embryology parameters were compared among cohorts. Student’s t-test, Wilcoxon’ rank test, chi-square test, and multivariate logistic regression fitted with a GEE model were used for data analysis.&#x0D; Results&#x0D; A total of 573 blastocysts derived from 87 IVF/PGT-A cases were included in the study. 74 cases (n= 474 embryos) utilized ejaculated sperm and 13 cases (n= 99 embryos) utilized testicular sperm. No significant differences were found in demographic and stimulation parameters among cohorts. (Table 1) No differences among the ejaculated and testicular cohorts were found in fertilization rate (63.2%; 61.1%, p=0.32); blastulation rate (64.5%; 66.6%, p=0.69); and rate of embryo euploidy (49.7%; 52.1%, p=0.76) respectively. No differences were found in rate of cycle cancellation due to unavailable embryos for TE biopsy (18.9% vs 7.6%, p=0.32).&#x0D; Conclusions&#x0D; There is no genomic advantage to surgical sperm retrieval in cryptozoospermic patients.

Effects of different sperm sources on the clinical outcomes of in vitro oocyte maturation cycles combined with intracytoplasmic sperm injection.

To evaluate the embryonic developments and clinical outcomes of different sperm sources with cycles of intracytoplasmic sperm injection (ICSI) and in vitro maturation (IVM). This retrospective study was approved by the hospital ethics committee and conducted in the hospital in vitro fertilization (IVF) clinic. From January 2005 to December 2018, 239 infertile couples underwent IVM-ICSI cycles and were divided into three groups according to different sperm sources. Group 1 comprised patients with percutaneous epididymal sperm aspiration (PESA; n = 62, 62 cycles), group 2 comprised patients with testicular sperm aspiration (TESA; n = 51, 51 cycles), and group 3 comprised patients with ejaculated sperm (n = 126, 126 cycles). We calculated the following outcomes: 1) outcomes per IVM-ICSI cycle: fertilization rate, cleavage rate, and embryo quality; 2) outcomes per embryo transfer cycle: endometrial thickness, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, and live birth rate. There was no difference in basic characteristics among the three groups, such as the female partner's age, basal follicle-stimulating hormone (FSH), basal luteinizing hormone (LH), and antral follicle count (p > 0.1). There were no statistically significant differences according to the IVM-ICSI cycle among the three groups in fertilization rate, cleavage rate, and rate of good-quality embryos (p > 0.05). The results were similar among cycles regarding the number of transfer embryos and endometrial thickness per embryo transfer cycle among the three groups (p > 0.05). There were also similar clinical outcomes per embryo transfer cycle among the three groups, such as the biochemical pregnancy rate, clinical pregnancy rate, and live birth rate (p > 0.05). Different sperm sources, percutaneous epididymal sperm aspiration, testicular sperm aspiration, and ejaculated sperm, do not affect the embryo and clinical outcomes after IVM-ICSI cycles.

Outcome analysis of ICSI assisted pregnancy using testicular sperm versus ejaculated sperm in man with severe oligozoospermia in the same ART cycle: A case report.

Intracytoplasmic sperm injection (ICSI) has become the most common method for couples with male factor infertility, and source of sperm for the procedure have evolved over time. but few have examined testicular sperm extraction vs. ejaculated sperm use for severe oligozoospermia in the same assisted reproductive technology (ART) cycle. Here, we evaluated the clinical outcomes after ICSI with testicular sperm or ejaculated in man with severe oligozoospermia in the same ART cycle. A couple who had failed the first ART cycle with ejaculated sperm, using the freshly ejaculated sperm and testicular sperm for ICSI during the second ART cycle by lack of enough sperm to fertilize in an ICSI attempt. The patient was diagnosed with severe oligozoospermia, and routine semen analysis revealed sperm concentration is less than 2 million/mL. The patient using testicular sperm versus ejaculated sperm with ICSI assisted pregnancy in the same ART cycle. We found that superior cleavage rate, number of embryos transferred and blastocyst rate with the use of testicular rather than ejaculated sperm-ICSI in the couple. The results described here suggest that use of testicular sperm may improve biologic outcomes, especially for couples with male-partner oligozoospermia who previous ICSI failures. Our case report supported the efficacy of testicular sperm preference over ejaculated sperm for ICSI in men with severe male factor infertility. It is a paradigm shift concerning the use of ejaculated sperm as the preferable source of sperm for ICSI, add to the small amount of literature on testicular sperm extraction vs. ejaculated sperm use for severe oligozoospermia in the same ART cycle.

Reproductive outcomes after surgical sperm retrieval in couples with male factor subfertility: a 10-year retrospective national cohort

To determine any significant differences in the reproductive outcome from intracytoplasmic sperm injection (ICSI) with surgical sperm retrieval (SSR) between cycles using fresh and cryopreserved sperm and between cycles using epididymal and testicular sperm. A retrospective national cohort study using data from the UK Human Fertilisation and Embryology Authority, including all ICSI cycles performed in the United Kingdom over a 10-year period. Hospital. All nondonor ICSI cycles from 2008 to 2017 categorized by sperm source and cryopreservation status. Intracytoplasmic sperm injection with SSR using fresh or cryopreserved sperm and using ejaculated, testicular, and epididymal sperm. Live birth rate, pregnancy rate, and implantation rate. We analyzed data from 214,649 ICSI cycles, including 199,818 cycles of ejaculated sperm, 5,646 cycles of epididymal sperm, and 9,185 cycles of testicular sperm. Live births rates per ICSI cycle were 28.5%, 30.6%, and 28.7% for ejaculated, epididymal, and testicular sperm cycles, respectively. Epididymal sperm cycles had a higher live birth rate than that of testicular sperm cycles (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.014-1.123). This was despite a higher mean male age (42.5 vs. 40.6 years; 95% CI of difference, 1.81-1.85 years) and female age (34.3 vs. 34.0 years; 95% CI of difference, 0.32-0.34 years) in epididymal cycles than in testicular cycles. Implantation (61.2% vs. 58.0%; OR, 1.086; 95% CI, 1.041-1.133) and clinical pregnancy rates (34.3% vs. 31.3%; OR, 1.085; 95% CI, 1.039-1.132) were also higher in epididymal cycles than in testicular cycles. There were no statistically significant differences in outcomes between cycles using fresh sperm and those using cryopreserved sperm for SSR-ICSI. Our study indicates that reproductive outcomes of SSR-ICSI are at least comparable with those of ICSI using ejaculated sperm and does not support the preferential use of fresh sperm over cryopreserved sperm in SSR-ICSI. Births per SSR-ICSI cycle were higher for cycles using epididymal sperm than for cycles using testicular sperm; however, the differences were small, which may provide reassurance to patients undergoing these procedures. The results must be interpreted with caution because multivariable analysis was not possible because of aggregation of data.

COMPARISON OF LABORATORY OUTCOMES FROM DIFFERENT SPERM SOURCES USING FRESH AND FROZEN DONOR EGGS IN A SINGLE HIGH VOLUME LABORATORY

Use of frozen donor eggs for ART has increased substantially. The convenience of using frozen donor eggs in advantageous and addresses limitations present with fresh donor egg cycles. However, compared to fresh donor cycles, the number of frozen eggs provided per cycle is low. Thus, high developmental competence of frozen eggs is critical to ensure success, especially with certain sperm sources. Fertilization and blastocyst development from fresh and frozen donor eggs following injection with varying sperm sources were compared.

Effect of inactivated COVID-19 vaccination on intrauterine insemination cycle success: A retrospective cohort study.

BackgroundVaccine hesitancy was found in couples seeking artificial reproductive technology (ART) services. As the main vaccine used in China, investigations into the influence of inactivated coronavirus disease 2019 (COVID-19) vaccines on human fertility is needed.MethodsThis retrospective cohort study included data on COVID-19 vaccination, clinical characteristics, and reproductive outcome of 1,000 intrauterine insemination (IUI) cycles in 653 couples from March 2021 to March 2022 in a single university hospital-based center for reproductive medicine. The IUI cycles were divided into two categories based on sperm source, including 725 cycles in 492 women undergoing artificial insemination with their husband's sperm (AIH) and 275 cycles in 161 women undergoing artificial insemination with donor sperm (AID). Women were then divided into two groups. The vaccine exposed group included women vaccinated prior to insemination and the unexposed group included women who were not vaccinated or vaccinated after insemination. Reproductive outcomes including ongoing pregnancy rate, clinical pregnancy rate, and miscarriage rate were assessed.ResultsInactivated COVID-19 vaccinated women prior to intrauterine insemination in AIH cycles have comparable ongoing pregnancy rate (11.1 vs. 10.3%, P = 0.73), clinical pregnancy rate (12.5 vs. 11.3%, P = 0.60) as compared with unvaccinated counterparts. Similarly, there were no significant differences in ongoing pregnancy rate (20.9 vs. 28.1%, P = 0.17), clinical pregnancy rate (21.7 vs. 28.8%, P = 0.19) between vaccine exposed and unexposed groups in AID cycles. Multivariable logistic regression analyses showed that inactivated COVID-19 vaccination status cannot independently influence the reproductive outcomes of AIH and AID cycles. Subgroup analysis of vaccine exposed cycles showed that doses of vaccination and Interval between the last dose of vaccination and insemination have no influence on the reproductive outcomes of AIH cycles.ConclusionsNo negative effects were found on female fertility in IUI cycles following exposure to the inactivated COVID-19 vaccine. These findings indirectly reflect the safety of inactivated COVID-19 vaccine toward reproductive health and help to mitigate vaccine hesitancy among people planning to conceive.

Does ICSI outcome in obstructive azoospermia differ according to the origin of retrieved spermatozoa or the cause of epididymal obstruction? A comparative study

PurposeTo determine whether ICSI outcomes are affected by sperm source or genital tract inflammatory status.MethodsA retrospective cohort study was conducted in all consecutive obstructive azoospermia patients who underwent testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) and ICSI between February 1, 2017, and December 31, 2020. Couples were excluded if they were diagnosed with monogenic disease, abnormal karyotype, or had female uterine malformation. The primary objective was to determine whether ICSI outcomes are affected by the use of testicular or epididymal spermatozoa, and the secondary objective was to explore the effect of granulocyte elastase on ICSI outcomes using epididymal spermatozoa.ResultsCompared with TESA, inflammatory and non-inflammatory PESA patients exhibited a better high-quality embryo rate, with significant differences among the three groups (49.43 vs. 55.39% and 56.03%; odds ratio, 6.345 and 6.631; 95% confidence interval, 0.340–12.350, and 1.712–11.550; P = 0.038 and P = 0.008, respectively). The fertilization rate, clinical pregnancy rate, live birth delivery rate, and congenital anomaly birth rate were similar in patients who underwent TESA or PESA (with or without inflammation).ConclusionsThe high-quality embryo rate in PESA patients was higher than that in TESA patients. After successful pregnancy, ICSI outcomes did not differ between patients with obstructive azoospermia who experienced TESA or PESA and those with or without genital tract inflammation.

Pathways to fatherhood: clinical experiences with assisted reproductive technology in single and coupled intended fathers

To explore the cycle characteristics and outcomes of single and coupled intended fathers (SCIFs) using assisted reproductive technology. Cross-sectional study. Multicenter, fertility practices from 2016 to2020. In this study, cycles among SCIFs with access to fertility coverage from 2016 to 2020 were included. None. Our primary outcome was live birth rate. The secondary outcomes included the number of embryos transferred, miscarriage rate, and incidence of multifetal birth. Five single and 39 coupled intended fathers completed an invitro fertilization cycle with a majority using egg donation and an agency-based gestational carrier (69.7%, 83/119). In most couples, both partners wanted to serve as the sperm source (64.4%, 29/45). The vast majority (97.7%, 43/44) also used preimplantation genetic testing for aneuploidy. Among the embryo transfer (ET) cycles (n = 27), most consisted of a single euploid ET (74.07%, 20/27), whereas the remaining consisted of a double euploid ET (25.92%, 7/27). The SCIFs had high rates of success, with a live birth rate of 85.19% (23/27). A mean of 1.26 ± 0.44 embryos were transferred, with a majority resulting in singleton birth (70.37%, 19/27). Our study of SCIFs using assisted reproductive technology in the United States demonstrates that this population shares similar preferences for sperm source and the use of preimplantation genetic testing. Clinical outcomes suggest that this population is successful at achieving a live birth when using egg donation and a gestational carrier.

O-045 ICSI: From ‘this cannot work' to ‘remarkably safe'

Abstract ICSI From “this cannot work” to “remarkably safe” It is now 30 years since the first child was born after ICSI treatment. Since then there has been an ongoing debate on the use and safety of the technique. Initially, ICSI was used to treat severe forms of male factor infertility but today it is also used to treat mild male factor infertility, mixed male/female infertility, unexplained infertility and fertilization failures. Both the latest European ESHRE report and the global ICMART report reveal an increasing global use of ICSI, with more than 70% of cycles using ICSI. Due to the invasiveness of the ICSI procedure as well as the arbitrary selection of the spermatozoon and genetic and epigenetic parental factors, concerns have been expressed about the health of ICSI children. While most births after ART are uncomplicated, ART is associated with potential adverse obstetric outcomes for both mothers and infants, including hypertensive disorders of pregnancy, preterm delivery, and low birth weight ART has also been associated with an increased risk of birth defects .Many of these adverse outcomes can be attributed to a higher rate of multiple pregnancies after ART. With the increasing use of single embryo transfer, the multiple pregnancy rate has been significantly reduced but is still unacceptably high in many countries. When comparing ICSI and conventional IVF, most large studies have found similar or lower risks of very preterm and preterm birth, very low birth weight, low birth weight and peri/neonatal mortality in ICSI children. A possible explanation for the better outcome in ICSI singletons may be that in ICSI the majority of the women are reproductively healthy, which could give a more favorable intrauterine environment. Most studies have found an increased rate of birth defects in ART children, ranging between 30% and 70% higher, but with no difference between conventional IVF and ICSI and the different sperm sources used in ICSI do not seem to influence the rate of birth defects negatively. However, the incidence of de novo and inherited sex chromosomal abnormalities in ICSI offspring is slightly higher, which probably relates to the genetics of the infertile couples. Although children born after IVF and ICSI have a higher risk to be born preterm and with low birth weight they usually catch up during the first years. A large systematic review from Denmark showed no differences in weigh and length up to 22 years of age, between children born after IVF and ICSI and children born after spontaneous conception. Looking at general physical health similar results are observed for ICSI and IVF-conceived children. Most large cohort studies do not show any increase in childhood cancer in general in ART children and provide no evidence of an increased risk in the ICSI group. Most studies comparing children up to eight years of age born after ICSI, conventional IVF and spontaneous conception, suggest their neurocognitive development is comparable. Sperm source or individual semen parameters do not affect neurodevelopment. Two recent large studies reporting associations between ICSI and autism and autistic disorders should be interpreted with caution, since the absolute risks of autism and autistic disorders are small. School performances in 15-16 years old adolescences have recently been studied in several large Nordic register studies. Children born after ART performed better in unadjusted analyses but after adjustment, mainly for parental education, these differences disappeared. No differences were observed between ICSI and IVF. Continuous supervision after ART is needed to ensure safety and quality, especially when new techniques are introduced. National ART registries such as those existing in the Nordic countries enable follow-up studies of ART children and should be encouraged.