Successful Live Birth Research Articles

Exploring the knowledge, attitudes, and perceptions of women of reproductive age towards fertility and elective oocyte cryopreservation for age-related fertility decline in the UK: a cross-sectional survey.

What are the knowledge, perceptions and attitudes towards fertility and elective oocyte cryopreservation (OC) for age-related fertility decline (ARFD) in women in the UK? Awareness of OC for ARFD has reportedly improved compared to studies carried out almost a decade ago, but inconsistencies in knowledge remain regarding the rate of miscarriage amongst specific age groups, the financial costs and optimal age to undergo OC for ARFD. The age of first-time motherhood has increased amongst western societies, with many women of reproductive age underestimating the impact of age on fertility. Further understanding of women's awareness of their fertility, the options available to preserve it and the barriers for seeking treatment earlier are required in order to prevent the risk of involuntary childlessness. A hyperlink to a cross-sectional survey was posted on social media (Instagram) between 25 February 2021 and 11 March 2021. Women from the general population aged 18-50 years were invited to complete the survey. In total, 5482 women fulfilled the inclusion criteria and completed the survey. The mean age of participants was 35.0 years (SD 10.25; range 16-52). Three quarters (74.1%; n = 4055) disagreed or strongly disagreed they felt well informed regarding the options available to preserve their fertility, in case of a health-related problem or ARFD. The majority overestimated the risk of miscarriage in women aged ≥30 years old, with 14.5% correctly answering 20%, but underestimated the risks in women ≥40, as 20.1% correctly answered 40-50%. Three quarters (73.2%; n = 4007) reported an awareness of OC for ARFD and 65.8% (n = 3605) reported that they would consider undergoing the procedure. The number of women who considered OC for ARFD across age groups were as follows: 18-25 (8.3%; n = 300), 26-30 (35.8%; n = 1289), 31-35 (45.9%; n = 1654), 36-40 (9.6%; n = 347), 41-45 (0.3%; n = 13), and 46-50 (0.1%; n = 2). The majority of women (81.3%; n = 4443) underestimated the cost of a single cycle of OC for ARFD (<£5000). Furthermore, 10.4% (n = 566) believed a single cycle would be adequate enough to retrieve sufficient oocytes for cryopreservation. Approximately 11.0% (n = 599) believed OC for ARFD may pose significant health risks and affect future fertility. Less than half agreed or strongly agreed that the lack of awareness regarding OC for ARFD has impacted the likelihood of pursuing this method of fertility preservation further (41.4%; n = 2259). Results from cross-sectional studies are limited as interpretations made are merely associations and not of causal relationships. The online nature of participant recruitment is subject to selection bias, considering women with access to social media are often from higher socioeconomic and education backgrounds, thus limiting generalizability of the findings. Further education regarding the financial costs and optimal age to undergo elective OC to increase the chances of successful livebirth are required. Clinicians should encourage earlier fertility counselling to ensure that OC is deemed a preventative measure of ARFD, rather than an ultimate recourse to saving declining fertility. No funding was required for this article. There are no conflicts of interests to declare. N/A.

Assessing the Impact of High Body Mass Index (BMI) on the Efficacy of Assisted Reproductive Technologies (ART) in Saudi Women: A Cross-Sectional Study Examining Ovarian Reserve and Treatment Outcomes.

The global surge in high body mass index (BMI) and obesity has led to various health complications. While numerous studies have shown that obesity disrupts female fertility, the specific effects of obesity on the success rate of assisted reproductive technology (ART) treatments in Saudi women have been less explored. This study aimed to delve into this gap, especially focusing on the correlation between BMI, ovarian reserve parameters, and ART outcomes among Saudi women. A cross-sectional study was carried out from January to August 2023, concentrating on Saudi women aged 18 and above who underwent ART treatments for infertility. A total of 1071 women participated, with 155 completing an online survey and 916 responding through a hard copy from several Saudi hospitals. The data encompassed demographics, medical history, anthropometric details, ovarian reserve parameters, and ART results. For the analysis, StatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 28.0, Armonk,NY) was utilized, applying descriptive statistics, the Chi-square test, and a linear regression model to discern connections between BMI, participant characteristics, and ART outcomes. A p-value of less than 0.05 was considered statistically significant. Most participants were aged 25-34 (406) years and held a bachelor's degree (707). Over half (560) received fertility treatments in the past, with 37.9% (406) having polycystic ovary syndrome (PCOS) and 23.5% (252) with other fertility-impacting medical conditions. Interestingly, 62.1% (665) had not undergone any ART cycles. Of those who did, 51.6% (553) had clinical pregnancies leading to live births. About 23.8% (308) of those with clinical pregnancies faced miscarriages without successful live births. Furthermore, 17.6% (189) reported complications or side effects from past ART procedures, and 31.4% (336) were on ART-related medications or supplements. The linear regression highlighted that individuals with normal weight tended to undergo more ART cycles. However, those with a higher BMI exhibited increased chances of achieving clinical pregnancies and live births. The study underscores the crucial relationship between BMI and ART efficacy in Saudi women. The data reveals that BMI can significantly influence ART treatment outcomes, especially concerning the number of cycles, clinical pregnancies, and live births. Consequently, BMI should be an essential consideration when evaluating and optimizing the success rates of ART procedures.

Fertility preservation in patients with gynaecologic malignancy: Response to ovarian stimulation and long-term outcomes

ObjectiveTo the best of our knowledge, the available evidence on the effect and efficacy of controlled ovarian stimulation (COS) in this group of patients remains poorly reported. Concerns related to the impact of stimulation to cancer progression and recurrence, as well as the risk of disease dissemination during egg collection, might explain the aforementioned trend. MethodsOverall, our FP Service received 192 gynaecological referrals, between 2005 and 2021, regarding gynaecologic conditions mainly cancer related. A total of 68 (35.4%) patients underwent COS. These patients were diagnosed with the following gynaecologic pathologies: 33 cases (48,5%) of cervical cancer were noted (stage 1b1-2b), 25 ovarian pathology (36.7%), 9 cases (13.2%) of endometrial cancer, and a single case of vaginal cancer (1.5%). ResultsThe mean age of patients attending the fertility preservation service was 31.5 (std 5.8). The patients presenting to their initial appointment with a mean BMI 24.5 (IQR 6.9) and a median AFC of 12 (IQR 13). The mean duration of COS was 11 days (IQR 3), and the median dose of gonadotrophins was calculated at 300 IU (IQR 75 IU). In 95.4% of the cases, GnRH agonist was used as a trigger for final maturation. The median number of follicles measuring more than 14 mm at the time of trigger was 11 (IQR 8), whereas the median number of oocytes collected was 11 (IQR 9). The complication rate was reported at less than 2%. So far, one in four women of this FP group (17/68, 25% of the overall group) returned to our service to claim their cryopreserved eggs/embryos and successful livebirths were reported in 58.8% of this sample (10/17 cases). The mean time to return to use their oocytes/embryos was 36 months (min value 16 months – max value 85 months). There was no significant difference in mortality rate between patients who received FP vs those who did not (hazard ratio of mortality was estimated at 0.91 (p-value 0.88)). ConclusionBased on our findings, ovarian stimulation for patients presenting with gynaecologic malignancy is a safe and efficient method of fertility preservation. Undoubtedly, the sample size is limited, however our results are reassuring and highlight the efficacy of COS for the purpose of FP based on data coming from the largest Assisted Conception Unit of the South-East of the UK.

Successful Pregnancy and Live Birth after Uterine Artery Embolization for Uterine AV Malformation—A Rare Entity: A Case Report

Successful Pregnancy and Live Birth after Uterine Artery Embolization for Uterine AV Malformation—A Rare Entity: A Case Report

Associations between Urinary Concentrations of Disinfection Byproducts and in Vitro Fertilization Outcomes: A Prospective Cohort Study in China.

Experimental studies show that disinfection byproducts (DBPs) can inhibit oocyte maturation, decrease fertilization capacity, and impair embryo development, but human evidence is lacking. We aimed to evaluate the associations between exposure to drinking water DBPs and in vitro fertilization (IVF) outcomes. The study included 1,048 women undergoing assisted reproductive technology (ART) treatment between December 2018 and January 2020 from a prospective cohort study, the Tongji Reproductive and Environmental study in Wuhan, China. Exposure to DBPs was assessed by dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) in up to four urine samples, which were collected on the day of both enrollment and oocyte retrieval. Multivariable generalized linear mixed models, accounting for multiple IVF cycles per woman, were applied to evaluate the associations between urinary biomarkers of DBP exposures and IVF outcomes. Stratified analyses were used to explore the potential effect modifiers. The included 1,048 women underwent 1,136 IVF cycles, with 960 (91.6%), 84 (8.0%), and 4 (0.4%) women contributing one cycle, two cycles, and three cycles, respectively. We found that elevated quartiles of urinary DCAA and TCAA concentrations were associated with reduced numbers of total oocytes and metaphase II oocytes and that urinary DCAA concentrations with a lower proportion of best-quality embryos (all p for ). Moreover, elevated quartiles of urinary DCAA concentrations were associated with decreased proportions of successful implantation, clinical pregnancy, and live birth (14%, 15%, and 15% decreases in adjusted means comparing the extreme quartiles, respectively; all p for ). Stratification analyses showed that the inverse associations of urinary TCAA concentrations with multiple IVF outcomes were stronger among women y of age (p for ). Exposure to drinking water DBPs was inversely associated with some IVF outcomes among women undergoing ART treatment. Further study is necessary to confirm our findings. https://doi.org/10.1289/EHP12447.

Long-Term Effects of ART on the Health of the Offspring.

Assisted reproductive technologies (ART) significantly increase the chance of successful pregnancy and live birth in infertile couples. The different procedures for ART, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and gamete intrafallopian tube transfer (GIFT), are widely used to overcome infertility-related problems. In spite of its inarguable usefulness, concerns about the health consequences of ART-conceived babies have been raised. There are reports about the association of ART with birth defects and health complications, e.g., malignancies, high blood pressure, generalized vascular functional disorders, asthma and metabolic disorders in later life. It has been suggested that hormonal treatment of the mother, and the artificial environment during the manipulation of gametes and embryos may cause genomic and epigenetic alterations and subsequent complications in the health status of ART-conceived babies. In the current study, we aimed to review the possible long-term consequences of different ART procedures on the subsequent health status of ART-conceived offspring, considering the confounding factors that might account for/contribute to the long-term consequences.

Novel biallelic ASTL variants are associated with polyspermy and female infertility: A successful live birth following ICSI treatment

Fertilization of the egg by the sperm is the first vital stage of embryogenesis. In mammals, only one sperm is incorporated into the oocyte. Polyspermy is a key anomaly of fertilization that is generally lethal to the embryo. To date, only a few causative genes for polyspermy have been reported. In a recent study, a homozygous variant in astacin-like metalloendopeptidase (ASTL), which encodes the ovastacin enzyme that cleaves ZP2 to prevent polyspermy, was found to be associated with female infertility characterized by polyspermy in vitro. Herein, we identified two ASTL variants in a Chinese woman likely responsible for her primary infertility and polyspermy in in vitro fertilization. Both variants were located within the key catalytic domain and predicted to alter hydrogen bonds, potentially impairing protein stability. Moreover, expression and immunoblot analyses in CHO-K1 cells indicated abnormal ovastacin zymogen activation or decreased enzyme stability. Intracytoplasmic sperm injection treatment successfully bypassed the defect in polyspermy blocking and resulted in a live birth. Our study associates ASTL variants with human infertility and further supports the contribution of this gene to blocking polyspermy in humans. Our findings expand the spectrum of ASTL mutations and should facilitate the diagnosis of oocyte-borne polyspermy.

Non-coding RNAs from seminal plasma extracellular vesicles and success of live birth among couples undergoing fertility treatment.

Background: Infertility remains a global health problem with male-factor infertility accounting for around 50% of cases. Understanding the molecular markers for the male contribution of live birth success has been limited. Here, we evaluated the expression levels of seminal plasma extracellular vesicle (spEV) non-coding RNAs (ncRNAs) in men of couples in relation with those with and without a successful live birth after infertility treatment. Method: Sperm-free spEV small RNA profiles were generated from 91 semen samples collected from male participants of couples undergoing assisted reproductive technology (ART) treatment. Couples were classified into two groups based on successful live birth (yes, n = 28) and (no, n = 63). Mapping of reads to human transcriptomes followed the order: miRNA > tRNA > piRNA > rRNA> "other" RNA > circRNA > lncRNA. Differential expression analysis of biotype-specific normalized read counts between groups were assessed using EdgeR (FDR<0.05). Result: We found a total of 12 differentially expressed spEV ncRNAs which included 10 circRNAs and two piRNAs between the live birth groups. Most (n = 8) of the identified circRNAs were downregulated in the no live birth group and targeted genes related to ontology terms such as negative reproductive system and head development, tissue morphogenesis, embryo development ending in birth or egg hatching, and vesicle-mediated transport. The differentially upregulated piRNAs overlapped with genomic regions including coding PID1 genes previously known to play a role in mitochondrion morphogenesis, signal transduction and cellular proliferation. Conclusion: This study identified novel ncRNAs profiles of spEVs differentiating men of couples with and without live birth and emphasizes the role of the male partner for ART success.

P-798 Comprehensive evaluation of autologous Platelet-Rich Plasma infusion in ovarian rejuvenation

Abstract Study question This study aimed to the evaluation of PRP injection in women with ovarian dysfunction (with POR, POI, perimenopause and menopause) to promote the ovarian rejuvenation. Summary answer Intraovarian infusion of autologous PRP exhibited remarkable evidence and promising results to restore ovarian insufficiency. What is known already Ovarian dysfunctions, such as premature ovarian insufficiency (POI) and poor ovarian response (POR) are conditions, characterized by the collapse of ovarian function and are considered currently as a global public health issue. Primary factors that are associated with female infertility include endocrine dysfunction, failure of embryo implantation, endometriosis, and other related pathologies such as polycystic ovary syndrome (PCOS), various environmental factors and inflammatory disease. For this purpose, the rejuvenation of the ovaries using the intraovarian PRP injections may result in increased release of follicles from the available reservoir, and can potentially increase the possibility of a successful pregnancy. Study design, size, duration This study was designed as a randomized prospective observational pilot study. A number of 582 participants were interested to participate. The whole study was performed between May 2018 and December 2021. The patients were subdivided into 5 groups, followeeed by autologous blood collection, PRP preparation and intraovarian injection. The follow-up of the patients lasted for 2 months. Participants/materials, setting, methods The classification of the participants was performed into the following groups: Group A (22-38 years), Group B (39-44 years), Group C (45-57 years), Group D (48-50 years) and Group E (51-56 years). 60 ml of autologous blood was collected from each patient, followed by the preparation of PRP. Intraovarian PRP injection was performed and monitoring of the ovarian function including the quantification of FSH, LH, AMH and E2 for two constitutive menstrual cycles, was performed. Main results and the role of chance For group A, decrease of more than 50% was detected for the FSH and LH whereas, the levels of E2 and AMH were elevated by more than 44% and 31%, respectively in all participants Moreover, statistically significant differences regarding the levels of FSH (p = 0.001), LH (p = 0.046) , E2 (p = 0.035) and AMH (p = 0.012), were observed after the 1st and 2nd month of follow-up. In group B, a statistically significant decrease in FSH (p &amp;lt; 0.001) and LH (p = 0.001) levels were observed in all participants. In parallel, the elevation of E2 and AMH levels was observed. Moreover, 28% of the participants with diagnosed POI, after the PRP infusion, achieved successful pregnancies and live births. In group C, after the PRP infusion, a reduction in FSH and LH levels with a parallel increase of E2 and AMH levels was detected. In group D, the levels of FSH and LH slightly declined after the PRP infusion. Also, the levels of E2 and AMH were increased. In group E, the levels of FSH and LH declin Limitations, reasons for caution No classifications between responders and no responders after the PRP administration were performed. Additionally, no presence of control groups in each category nor the determination of the growth factor content of the produced PRP was performed. The relatively limited time for the follow-up can also be considered a further limitation. Wider implications of the findings The administration of autologous PRP can be considered a safe and tolerable alternative approach to the classical ones for ovarian rejuvenation. This in turn could result to better conceiving rates, thus may beneficially improve the social impact of women with ovarian dysfunction. Trial registration number 10/10/19

P-239 Comparison of reproductive outcomes for cleavage- and blastocyst-stage frozen embryo transfer: A retrospective study

Abstract Study question Does blastocyst-stage (day 5-6) embryo transfer improve pregnancy and live birth rates per frozen transfer compared to cleavage-stage (day 2-3) embryo transfer? Summary answer Pregnancy rate is significantly higher following frozen blastocyst-stage embryo transfer, while live birth rate does not differ. What is known already The extended culture of cleavage-stage (day 2-3) embryos to blastocyst-stage (day 5-6) embryos has been largely adopted in recent years. In fact, blastocyst culture may allow a better selection of the embryo to be transferred based on its developmental history and morphological criteria, and result in a lower number of exceeded embryos to be frozen for storage. However, the literature comparing pregnancy and live birth rates for cleavage- and blastocyst-stage transfer remains contradictory, and the benefits of frozen blastocyst transfer is still under discussion. Study design, size, duration This retrospective study investigated couples having frozen embryo transfer at the cleavage (days 2 or 3) or the blastocyst-stage (days 5 or 6) at our clinic between 2014–2021. Results from more cycles were analyzed individually. We excluded cycles based on fresh embryo transfer, oocyte or sperm donation. Cycles were further sub-classified based on the type of treatment, as natural or stimulated, and the pregnancy and live birth rates were compared. Participants/materials, setting, methods Data was obtained from patient records at our fertility clinic and sorted by two authors. Variables included female age, treatment plan, the stage of the embryo transferred, and the report of pregnancy and live birth. Statistical analysis was conducted by using MedCalc Software, and Chi-squared test applied to compare the outcomes’ frequency based on the day of frozen embryo transfer. P &amp;lt; 0.05 was considered significant. Main results and the role of chance A total of 2,922 cycles were included for analysis, with age of female patients being 37.2 ± 5.0 years at the time of transfer. Most cycles were stimulated (n = 2,217, 75.9%) compared to natural cycles (n = 705, 24.1%). In all cycles, IVF was used for fertilization. Approximately one third of the cycles (n = 954, 32.6%) underwent frozen embryo transfer at the cleavage-stage (days 2 or 3), while the remaining had transfer at the blastocyst-stage (n = 1,968, 67.4%). Pregnancy rate was significantly (P &amp;lt; 0.0001) higher for blastocyst-stage embryo transfer compared to cleavage-stage embryo transfer (36.2% vs 20.4%, respectively) when all cycles were analyzed. This significance was found when natural (23.3% vs 14.8%, P = 0.0052) or stimulated cycles (38.0% vs 25.8%, P &amp;lt; 0.0001) were sub-analyzed. While we observed 19.0% of successful live birth per embryo transferred in the entire cohort, this did not significantly vary depending on the stage of frozen embryo transferred (cleavage or blastocyst-stage, 13.6% vs 21.5%, respectively) and when patients were sub-classified based on the type of treatment chosen in natural (9.0% vs 14.2% respectively) or stimulated (18.0% vs 22.6%, respectively) cycles. With a large sample size and a very significant P-value for pregnancy rate, the role of chance is limited. Limitations, reasons for caution As a retrospective study, the non-random allocation to treatment groups might hide selection bias and limit the statistical power of the data analysis, especially for the live birth rate. Also, no adjustment for confounders was performed. Wider implications of the findings Frozen embryo transfer at blastocyst-stage may offer an improved chance of pregnancy in both natural and stimulated cycles, possibly resulting in less embryos stored and lower costs for patient treatment. Although no difference was observed, larger prospective studies are needed to clarify the impact on live birth rate. Trial registration number Not applicable

Announcement of First Successfully Pregnancy Following Abdominal Radical Trachelectomy in Viet Nam

Objectives: Abdominal radical trachelectomy (ART) is an alternative treatment for preserving fertility in selected patients with early - stage cervical cancer. This report to announce one case of successful conceive and gave birth following the abdominal radical trachelectomy. Materials and Methods: We have performed 12 cases of radical trachelectomy with pelvic lymphadenectomy in The Oncology Hospital of Ho Chi Minh city between January 2018 and December 2022. One of them has successful live birth after procedure about six months.Results: The characteristics of the 12 adult patients, who underwent radical trachelectomy, included stage IB1 disease in all cases, a mean age of 31 years (range, 29–41), and a median estimated blood loss of 100 ml (range, 70–150). No one needed adjuvant treatments after surgery, and all cases resumed normal menstruation postoperatively. There were no intraoperative complications. Transurethral Foley catheters were removed in all cases at postoperative days 02 – 04. Cervical stenosis was observed in one case. One case had successfully conceived and gave births following the abdominal radical trachelectomy. All patients remain disease-free after a median 3 - year follow-up. Conclusions: ART with pelvic lymphadenectomy is a feasible operation for selected women with early-stage cervical cancer cases who desire to preserve reproductive function. Menstruation and reproductive function might be preserved after bilateral uterine vessel ligation.

Clinical outcomes of cryptozoospermic patients undergoing surgical sperm retrieval

IntroductionCryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. Although the number of spermatozoa is usually sufficient for intracytoplasmic sperm injection (ICSI), ICSI fails due to poor sperm quality in some cases. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we will offer patients a surgical sperm retrieval via conventional or microdissection testicular sperm extraction (microTESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microTESE at our center.MethodsWe retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE between 2007- 2021 for failed ICSI with ejaculated sperm or sperm quality deemed to be of insufficient quality for ICSI (e.g., nonmotile sperm). We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR) and ICSI outcomes.Results28 cryptozoospermic patients were identified. These patients underwent 37 unique microTESE. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had ejaculated sperm with non-suitable quality for ICSI. None had genetic abnormalities. Successful retrieval of motile sperm suitable for ICSI was achieved in in 30 micro TESE procedures (SRR: 81.0%).14 out of 28 patients (50%) who underwent embryo transfer had positive pregnancy result, and 12/28 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). Fibrosis pathology was significantly higher in the negative pregnancy group. There were no postoperative complications noted.DisscussionThe use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications.

MP30-04 CLINICAL OUTCOMES OF CRYPTOZOOSPERMIC PATIENTS UNDERGOING SURGICAL SPERM RETRIEVAL

You have accessJournal of UrologyCME1 Apr 2023MP30-04 CLINICAL OUTCOMES OF CRYPTOZOOSPERMIC PATIENTS UNDERGOING SURGICAL SPERM RETRIEVAL Raneen Sawaid Kaiyal, Rossella Cannarella, Shinnosuke Kuroda, Neel V. Parekh, Sarah C. Vij, and Scott Lundy Raneen Sawaid KaiyalRaneen Sawaid Kaiyal More articles by this author , Rossella CannarellaRossella Cannarella More articles by this author , Shinnosuke KurodaShinnosuke Kuroda More articles by this author , Neel V. ParekhNeel V. Parekh More articles by this author , Sarah C. VijSarah C. Vij More articles by this author , and Scott LundyScott Lundy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. This sperm is usually sufficient for intracytoplasmic sperm injection (ICSI), but in some cases, ICSI fails due to sperm quality. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we routinely perform surgical sperm retrieval via conventional or microdissection testicular sperm extraction (TESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microsurgical testicular extraction (microTESE) at our center METHODS: We retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE performed between 2007- 2021 for failed ICSI with ejaculated sperm or who had immotile or morphologically poor sperm. We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR), and ICSI outcomes. RESULTS: 28 cryptozoospermic patients were identified and underwent 37 unique microTESE operations with demographics and outcomes listed in Table 1. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had poor quality ejaculated sperm not suitable for ICSI. None had genetic abnormalities. Motile sperm suitable for ICSI was retrieved in 30 (81.0%) of these operations. 14 out of 28 patients (50%) had positive pregnancy result and 12 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). There were no postoperative complications noted. CONCLUSIONS: The use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e392 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raneen Sawaid Kaiyal More articles by this author Rossella Cannarella More articles by this author Shinnosuke Kuroda More articles by this author Neel V. Parekh More articles by this author Sarah C. Vij More articles by this author Scott Lundy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP16-13 CYSTINURIA AND PREGNANCY: CLINICAL COURSE AND OUTCOMES FROM 2000-2020

You have accessJournal of UrologyCME1 Apr 2023MP16-13 CYSTINURIA AND PREGNANCY: CLINICAL COURSE AND OUTCOMES FROM 2000-2020 Amy Reed and Nicole Miller Amy ReedAmy Reed More articles by this author and Nicole MillerNicole Miller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystinuria is a rare disease which limits the understanding of its impact on pregnancy. We sought to characterize stone disease and management of patients with cystinuria during pregnancy at a single institution. METHODS: We completed a retrospective chart review of cystinuria patients at a single institution from 2000-2022. Patients were identified by ICD-10 codes (E72.01) and then included for childbearing potential. Charts were reviewed for urologic history as well as baseline medical and surgical treatment history. We evaluated imaging studies, stone episodes, stone surgeries and complications during pregnancy. This was then compared to the reported historic incidence of renal colic, stone diagnosis and surgical intervention during pregnancy. RESULTS: 44 female patients with cystinuria were identified and 40 were included based on child bearing potential. Patient age ranged from 16-68 years. Nine patients had a total of 27 pregnancies and 20 successful live births. Patients were treated with Thiola (3), urinary alkalinization (4) or fluid alone (5) and all medications were discontinued during pregnancy. Patients had an average of 6 stone surgeries prior to pregnancy. Comorbidities included chronic pain (2), chronic kidney disease (1) and multiple sclerosis (1). Renal colic occurred in 27% of pregnancies requiring an average of 1 renal ultrasound in addition to routine prenatal assessment. Of these, only one patient had confirmed stone events in 2 out of her 4 pregnancies (8.3% of symptomatic patients) which required a total of six surgeries (stent placement, ureteroscopy). The remaining 8 patients did not have any confirmed stone events. Comparatively, the reported incidence of renal colic in all pregnancies is 0.12% with 71% of these patients having confirmed stone events and 28% of them undergoing surgical intervention. Comparing pre- and post-partum imaging, 4 patients had radiographic evidence of stone growth during pregnancy. Pregnancies were complicated by 4 (15%) spontaneous abortions in the first trimester and one patient developed a ureteral stricture after ureteroscopy during pregnancy that required delayed reconstruction. CONCLUSIONS: Patients with cystinuria are at an increased risk of renal colic episodes during pregnancy but these symptomatic patients do not have a higher rate of stone diagnosis or surgical intervention. Cystinuria patients do not seem to increased complications during pregnancy. However, given a high rate of new stone formation, close follow up of these patients in the post-partum period is necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e207 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Reed More articles by this author Nicole Miller More articles by this author Expand All Advertisement PDF downloadLoading ...

Live birth in woman with premature ovarian insufficiency and 46, XY karyotype after chemotherapy and bone marrow transplant: a case report

BackgroundPremature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian function before the age of 40 years, characterized by elevated serum gonadotropin levels and decreased estrogen levels with menstrual disturbance. POI can be natural or iatrogenic such as after chemotherapy, radiotherapy and surgery.Case presentationIn this study, we describe a successful live birth in a 31-year-old woman with POI and 46, XY Karyotype after being treated with chemotherapy and bone marrow transplant (BMT) for acute non-lymphocytic leukemia when she was 17 years old. With amenorrhea or oligomenorrhea for 11 years, her serum level of FSH was up to 35.0 IU/L and 53.0 IU/L taken 4 weeks apart, which can be diagnosed as POI. After controlled ovarian stimulation treatment for three cycles with different protocols and frozen-thawed embryo transfer (FET), she finally got a successful pregnancy and had a live birth later.ConclusionsThis case report serves as a reminder that karyotype of peripheral blood may mislead the diagnosis as disorders of sex development (DSD). It also demonstrates that it is possible for a woman with chemotherapy and bone marrow transplant induced POI can have successful pregnancy and live birth with appropriate therapy. Furthermore, as age may plays a predominant role in fertility rather than residual ovarian reserve, active treatment may be concerned for women with POI at younger age.

Pregnancy outcomes in in vitro fertilization in 17-alpha-hydroxylase deficiency

Since the first case of 17-alpha-hydroxylase-deficiency (17-OHD) was described in 1966, a number of cases have been reported with a clinical picture of hypertension, hypokalemia, and hypogonadism. Infertility is a major concern for some of these individuals. This mini-review aims to detail the components of this disorder that affect fertility and focus on the recent acceleration in the success of achieving live births, as well as highlight the unsuccessful attempts. The data supporting successful live births remains limited, but existing evidence suggests that invitro fertilization can be used in conjunction with hormone replacement therapy and steroid suppression to achieve live birth in patients with infertility from 17-OHD.

MicroRNAs, small regulatory elements with significant effects on human implantation: a review.

Embryo implantation is a critical process for achieving a successful pregnancy and live birth. The proper implantation must have a synchronized interaction between blastocyst and a receptive endometrium. Many genes are involved in the modulation of precise molecular events during implantation. MicroRNAs (miRNAs) have been extensively reported as gene regulatory molecules on post-transcriptional levels involved in various biological processes such as gametogenesis, embryogenesis, and the quality of sperm, oocyte, and embryos. A plethora of evidence has demonstrated critical roles for miRNAs in regulating genes involved in the implantation process; hence, dysregulation of miRNAs could be associated with significant impairments in implantation, such as recurrent implantation failure. In addition to the indispensable role of miRNAs in the intracellular control of gene expression, they can also be secreted into extracellular fluid and circulation. Therefore, miRNAs in body fluids and blood may be exploited as non-invasive diagnostic biomarkers for different pathological and physiological conditions. Recently, several studies have focused on the discovery of miRNAs function in the implantation process by appraising miRNAs and their target genes in human embryos, endometrial tissue, and cell culture models. Moreover, it was revealed that there could be a significant association between endometrial receptivity or implantation status and the expression of miRNAs in human body fluids, reinforcing their role as non-invasive biomarkers. In the current work, we reviewed the studies concerning the role of intracellular and extracellular miRNAs in human implantation and the influence of their dysregulation on implantation disorders.

Sperm selection by the oviduct: perspectives for male fertility and assisted reproductive technologies†.

The contribution of sperm to embryogenesis is gaining attention with up to 50% of infertility cases being attributed to a paternal factor. The traditional methods used in assisted reproductive technologies for selecting and assessing sperm quality are mainly based on motility and viability parameters. However, other sperm characteristics, including deoxyribonucleic acid integrity, have major consequences for successful live birth. In natural reproduction, sperm navigate the male and female reproductive tract to reach and fertilize the egg. During transport, sperm encounter many obstacles that dramatically reduce the number arriving at the fertilization site. In humans, the number of sperm is reduced from tens of millions in the ejaculate to hundreds in the Fallopian tube (oviduct). Whether this sperm population has higher fertilization potential is not fully understood, but several studies in animals indicate that many defective sperm do not advance to the site of fertilization. Moreover, the oviduct plays a key role in fertility by modulating sperm transport, viability, and maturation, providing sperm that are ready to fertilize at the appropriate time. Here we present evidence of sperm selection by the oviduct with emphasis on the mechanisms of selection and the sperm characteristics selected. Considering the sperm parameters that are essential for healthy embryonic development, we discuss the use of novel in vitro sperm selection methods that mimic physiological conditions. We propose that insight gained from understanding how the oviduct selects sperm can be translated to assisted reproductive technologies to yield high fertilization, embryonic development, and pregnancy rates.

Selectively targeted blastocyst embryo transfer: optimizing ivf pregnancy results while minimizing risks and side effects

Research Question: Is single embryo transfer a reasonable option. Design: Material and methods: This is a retrospective cohort study conducted in a single IVF center. These patients consisted of 96 patients using egg donors and 92 patients using their own eggs for a total of 188 patients undergoing IVF-ICSI. Results: Among 96 patients who received donor eggs, 59 women (61%) were positive for pregnancy tests, resulting in 40 live births (68% per Pregnancy). On the other hand, of 92 patients who received their own egg, 34 patients (37%) were positive in terms of pregnancy tests, resulting in 15 live births (44% per pregnancy). Overall, of all 55 live births, 24 were multiple pregnancies. Interestingly, all multiple pregnancies occured in patients &lt;35 years of age. All of these multiples resulted from the transfer of two blastocysts of grade A. Conclusion: These results corroborate and enhance the various reproductive society recommendations that a selective single embryo transfer at the blastocyst stage and above would be a feasible option in patients less than 38 years of age, especially in patients using egg donors younger than 33 years of age, while resulting in a reasonably high successful singleton live birth rate. This is based on the predicted calculation of a 42.5% singleton live birth per egg donor pregnancy, and a 28% singleton live birth per pregnancy for patients using their own eggs. Summary: Patients who had Blastocyst or above grade A had a 63.7% biochemical or clinical positive pregnancy test result and a 40.7% Live birth. Whilst, patients with blastocysts of other grades or lower stages of development, resulted in 30.7% positive biochemical or clinical pregnancy with 10.7% live birth.

Successful twin live birth following a two-step embryo transfer in a patient with poor ovarian reserve: a case report

Successful twin live birth following a two-step embryo transfer in a patient with poor ovarian reserve: a case report