Total Fertility Research Articles

Estimation of couple fecundity in the general population and the association with monthly time-varying ambient particulate matter exposure in low- and middle-income countries: A population-based multi-center epidemiological study

BackgroundDeclining total fertility rates have been observed in low- and middle-income countries (LMICs). However, it remains unclear if this trend is related to a reduction in fecundity of general population. Research evidence on contributing factors to fecundity reduction is also limited. We aimed to first estimate couple fecundity in LMICs and then investigate its association with ambient particulate matter (PM) exposure. MethodsUsing the information from Demographic and Health Surveys between 2003 and 2019, we estimated median time to pregnancy (TTP) and infertility prevalence across 30 LMICs, by employing a current duration approach. Individual PM (PM1, PM2.5, and PM10) exposure during the period of ‘at risk’ of pregnancy was assessed by months. An accelerated failure model was used to elucidate the association between monthly time-varying PM exposure and TTP. Subsequently, we estimated the prolonged TTP attributable to PM exposures above the World Health Organization (WHO)’s recommended air quality level in 2021. ResultsWithin the study regions, median TTP ranged from 6.90 (95 % CI 6.02–7.87) months in Latin America & Caribbean to 10.29 (95 % CI 9.28–11.36) months in East Asia & Pacific, with corresponding infertility prevalence varying from 33 % (95 % CI 29 %–36 %) to 44 % (95 % CI 41 %–48 %). Our estimations indicated that TTP was 1.08 (95 % CI: 0.99–1.18), 1.12 (95 % CI 1.06–1.19), and 1.05 (95 % CI 1.03–1.07) times longer for every 10 μg/m3 increment in PM1, PM2.5, and PM10, respectively. The prolonged TTP attributable to PM exposures surpassing the WHO guideline ranged from 0.11 to 2.81 months across the studied regions. DiscussionAmbient particulate matter is identified as a potential contributing factor to impaired fecundity in general population of LMICs. The findings underscore the importance of coordinated efforts to control ambient air pollution to mitigate the risk of fecundity reduction among the general population.

The Reliability of Contraceptive Discontinuation Reporting in Burkina Faso, Kenya, and Uganda.

Family planning researchers have been studying the discontinuation of contraception-the prevalence and reasons for it-for decades, as it has implications for contraceptive prevalence, total fertility, and unintended fertility. However little is known about the reliability of contraceptive discontinuation reporting: only two studies have examined the reliability of reported discontinuation in low-resource contexts. We use longitudinal and overlapping data from reproductive calendars to test the reliability of women's reporting of contraceptive discontinuation in Burkina Faso, Kenya, and Uganda. We test whether recent discontinuations reported at baseline are reported one year later, and if the same reason for discontinuation is reported. Results reveal moderate reliability at the aggregate level of reporting of the index discontinuation; however, reliability is low when the timing of discontinuation is considered. There is variability across the reliability of reasons for discontinuation; discontinuation due to desired pregnancy is reported reliably while other reasons are less reliably reported. Our findings have important implications for the field, particularly in how the data are used and interpreted; we urge caution around event-level analyses of contraceptive discontinuation and reasons for discontinuation, given low reliability.

Factors Related To Family Planning After Birth In The Working Way Of Dadok Tunggul Hitam Public Health Centre In 2023

Indonesia is the fourth most populous country in the world with a population of 273,879,750. To overcome population problems and reduce TFR (Total Fertility Rate) with contraceptive services and spacing of pregnancies through post-coital family planning. One of the behavioral determinants associated with the use of post-saline family planning includes maternal knowledge, attitudes and husband support. The purpose of this study was to determine the factors associated with the use of postpartum family planning in the working area of Dadok Tunggul Hitam Public Health Centre Padang City. This study is an analytic study with a cross sectional study approach with a sample size of 49 postpartum mothers using total sampling. Data analysis used univariate and bivariate with Chi-Square test. The results of the bivariate analysis showed that there was a relationship between the number of children, (p-value 0.006), knowledge (p-value 0.002), attitudes (p-value 0.007), and husband support (p-value 0.001) to the use of postpartum family planning.

Impact of Luteinizing Hormone on IVF/ICSI Assisted Reproduction on the Initiation Day of Gonadotropin-releasing Hormone Antagonist Protocol.

The aim of the study was to explore the optimal timing of gonadotropin initiation and the reasonable interval of luteinizing hormone (LH) levels in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol. A retrospective cohort study was conducted to analyze the data concerning the oocyte retrieval cycles from 1,361 cases with the GnRH-A protocol implemented. The ovarian responses (including AMH, AFC) in these patients were divided into the poor ovarian response group (an antral follicle count [AFC] ≤ 6, n = 394), the normal ovarian response group (an AFC > 6 and < 15, n = 570), and the high ovarian response group (an AFC ≥ 15, n = 397), according to the AFC. The patients were sub-grouped according to LH levels on the protocol initiation day, and the clinical outcomes (including dose of Gn initiation, Gn administration days, GnRH-ant administration days, P levels on the HCG day, E2 levels on the HCG day, LH levels on the HCG day, number of embryos transferred, total fertilization rate, embryo implantation rate(%), proportion of 2PN, proportion of good-quality embryos, endometrial thickness on the hCG injection day(mm), moderate to severe OHSS, AFC on the initiation day, proportion of type A endometrium on the hCG injection day, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate) were compared. On the GnRH-A protocol initiation day, among all patients with different ovarian responses, the body mass index (BMI) in those with an LH ≥ 5 IU/L was lower. The differences in pregnancy outcomes between the LH < 5 IU/L group and the LH ≥ 5 IU/L group were not statistically significant across the different ovarian response groups, but the LH < 5 IU/L group had a higher proportion of good-quality embryos (80.3±24.9 vs. 74.8±26.9, P =0.035) than the LH≥5IU/Lgroup in those with poor ovarian response. The total fertilization rate (82.2±18.1 vs 85.4±15.1, P =0.021) and proportion of two pronuclei (2PN) (69.0±20.9 vs 72.7±19.9, P =0.035) were higher in the LH ≥ 5 IU/L group than the LH<5 IU/L group for those with normal ovarian responses. The embryo implantation rate (41.4±41.3 vs 52.6±43.4, P =0.012) was higher in the LH ≥ 5 IU/L group than in the LH<5 IU/L group in those with high ovarian response. The results of the multivariate logistic analysis showed that the age of the female partner, number of embryos transferred, proportion of good-quality embryos, endometrial thickness on the hCG injection day, and moderate- to-severe ovarian hyperstimulation syndrome (OHSS) were independent factors correlated with the outcome of live births (P < 0.05). The LH levels on the gonadotropins (Gn) initiation day in the GnRH-A protocol will not affect pregnancy outcomes.

Life history traits of the gastropod-associated bacterivorous nematode Caenorhabditis brenneri (Nematoda: Rhabditida)

Abstract. Dalan L, Tañan V, Diano MA, Demayo C, Tabelin M, Sumaya NH. 2024. Life history traits of the gastropod-associated bacterivorous nematode Caenorhabditis brenneri (Nematoda: Rhabditida). Biodiversitas 25: 3106-3113. Caenorhabditis species are associated with decaying plant materials and invertebrates such as terrestrial gastropods. Few Caenorhabditis species have been studied regarding their ecology, genetics, development, and essential life history traits (LHT). In this study, we describe the life cycle of a free-living, wild-type, bacterivorous nematode, Caenorhabditis brenneri Sudhaus and Kiontke 2007, associated with the terrestrial slug Philippinella moellendorffi Collinge 1899 and account for the effects of food density and temperature on its population dynamics by employing the hanging drop technique. The bacterial food supply was sourced from the slug cadaver and identified as Alcaligenes faecalis (MT012081). C. brenneri was fed with varying bacterial densities (109 and 5×109 cells mL-1) and incubated at 20 and 25°C. The bacterial food density-temperature interaction was found to have no significant influence on the offspring production of C. brenneri. Moreover, the total fertility rate (TFR) and net reproductive rate (Ro) are higher in 109 cells mL-1 in both temperatures (TFR at 20°C: 139; 25°C: 169 and Ro at 20°C: 134; 25°C: 156). Whereas the alternative generation time (To, T1, T) and population doubling time (PDT) are faster at 25°C in both bacterial densities, the intrinsic rate of natural increase (rm) is faster at lower temperatures (20°C) in both bacterial densities. The average lifespan of C. brenneri is seven days when fed with A. faecalis. Offspring somatic growth (body length and width) was influenced by bacterial food density-temperature interaction with increased length and girth observed in higher bacterial density and temperature in our knowledge. This study is the first attempt to use A. faecalis, a wild-type bacterium from the terrestrial slug P. moellendorffi cadaver, as the bacterial food source for a Caenorhabditis LHT analysis.

Effects of extreme climate events and child mortality on total fertility rate in Bangladesh

Floods, storms, and temperature extremes are examples of extreme weather events that have a substantial influence on a country's demographic dynamics, including migration, fertility, and mortality. Changes in population size, composition, and distribution may result from these occurrences. This study, which spans the years 1966–2018, looks at how Bangladesh's total fertility rate (TFR) is affected by extreme weather events and child mortality, including neonatal, infant, male infant, and under-five mortality. We use data from secondary publicly accessible sources, such as the World Bank and The Emergency Events Database (EM-DAT), and we investigate the correlations using the autoregressive integrated moving average model (ARIMA), complemented by bivariate and multivariable analyses.Our findings from the univariate analysis are noteworthy. Total extreme climate events (β = −0.345, 95 % CI: 0.510, −0.180), as well as individual extreme climate events, such as extreme temperatures (β = −1.176, 95 % CI: 1.88, −0.47), floods (β = −0.644, 95 % CI: 1.0729, −0.216), and storms (β = −0.351, 95 % CI: 0.63159, −0.07154), exhibited negative associations with the TFR. Additionally, factors such as contraceptive prevalence rate (CPR) (β = −0.085, 95 % CI: 0.09072, −0.07954) and gross national income (GNI) per capita (β = −0.003, 95 % CI: 0.0041123, −0.0024234) were negatively correlated with the TFR. Conversely, various categories of child mortality, namely, infants (β = 0.041, 95 % CI: 0.040474, 0.042748), males (β = 0.038, 95 % CI:0.037719, 0.039891), and under-five (β = 0.026, 95 % CI:0.025684, 0.026979) – are positively associated with TFR. Controlling for two pivotal confounding factors, time and GNI per capita, yielded consistent results in the multivariate analysis. These findings provide insight on the dual impact of extreme weather events, which can reduce TFR while also raising it through infant mortality. This phenomena may be due to the increased vulnerability of younger children in climate-event-prone areas, prompting parents to seek additional children as both a replacement for lost offspring and an insurance mechanism against future child loss.

Novel PLCZ1 compound heterozygous mutations indicate gene dosage effect involved in total fertilisation failure after ICSI.

PLCZ1 mutations are related to total fertilisation failure (TFF) after intracytoplasmic sperm injection (ICSI), characterised by abnormal oocyte oscillations. The novel PLCZ1 compound heterozygous mutations reported by this study were associated with TFF after ICSI, with one of the mutations indicating a gene dosage effect. Oocyte activation failure is thought to be one of the main factors for total fertilisation failure (TFF) after intracytoplasmic sperm injection (ICSI), which could be induced by abnormal calcium oscillations. Phospholipase C zeta (PLCZ), a sperm factor, is associated with Ca2+ oscillations in mammalian oocytes. To date, some mutations in PLCZ1 (the gene that encodes PLCZ) have been linked to TFF, as demonstrated by the observed reduction in protein levels or activity to induce Ca2+ oscillations. In this study, normozoospermic males whose sperms exhibited TFF after ICSI and their families were recruited. First, mutations in the PLCZ1 sequence were identified by whole exome sequencing and validated using Sanger sequencing. Then, the locations of PLCZ1/PLCZ and the transcript and protein levels in the sperm of the patients were studied. Subsequently, in vitro function analysis and in silico analysis were performed to investigate the function-structure correlation of mutations identified in PLCZ1 using western blotting, immunofluorescence, RT-qPCR, and molecular simulation. Ca2+ oscillations were detected after cRNA microinjection into MII mouse oocytes to investigate calcium oscillations induced by abnormal PLCZ. Five variants with compound heterozygosity were identified, consisting of five new mutations and three previously reported mutations distributed across the main domains of PLCZ, except the EF hands domain. The transcript and protein levels decreased to varying degrees among all detected mutations in PLCZ1 when transfected in HEK293T cells. Among these, mutations in M138V and R391* of PLCZ were unable to trigger typical Ca2+ oscillations. In case 5, aberrant localisation of PLCZ in the sperm head and an increased expression of PLCZ in the sperm were observed. In conclusion, this study enhances the potential for genetic diagnosis of TFF in clinics and elucidates the possible relationship between the function and structure of PLCZ in novel mutations.

Contraceptive use in the Gaza Strip: A systematic review

Background: Between 2017-2019, the average total fertility rate in Gaza was 3.9 births per woman, which is significantly higher than the average global total fertility rate at 2.4 births per woman in 2018. Reliable family planning methods allow women and men to avoid unintended pregnancies and reduce maternal mortality. The purpose of this systematic review was to examine what is known about contraceptive use in the Gaza Strip, including: 1) common contraceptive methods used, 2) access to contraceptive services, and 3) barriers impacting family planning services.Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published in the English language within the last 10 years (2013 to 2023) were screened from the following databases: CINAHL, PubMed, and Google Scholar.Results: Seven articles were included in the final analysis. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was found to be the main family planning service provider in the Gaza Strip (61%). Intrauterine devices (35.4%) were found to be the main method of contraception. Factors identified that impact contraceptive use included: 1) access to contraceptives, 2) cultural beliefs, 3) demographic characteristics (e.g., occupation and education), and 4) healthcare provider (HCP) and system influence. The restriction of goods into the Gaza Strip continues to impact contraceptive accessibility. Educational interventions should focus on addressing contraceptive misconceptions among Gazan women and HCPs while giving special attention to cultural beliefs (e.g., desire for several children) and demographic characteristics, specifically relating to occupation and education status.Conclusion: Unintended pregnancies are preventable through the effective use of contraceptives. Future studies should prioritize interventions aimed at overcoming barriers to contraceptive use in the Gaza Strip, thereby promoting and safeguarding Gazan individuals' ability to exercise their reproductive health rights freely.

Характеристики демографічної резильєнтності населення України у період пандемії Covid-19

The full-scale military invasion of Ukraine by the Russian Federation came at a time when our country had been weakened by a series of shocks in a relatively short historical period. Shocks such as a prolonged pandemic and war can disrupt and, in some cases, halt demographic development. In this context, the study of demographic resilience on the eve of a full-scale war, which became a new powerful shock for Ukraine, is relevant and necessary. The complexity of this issue does not allow us to provide all the answers in one article. The purpose of our paper is to determine the main parameters of the demographic resilience of the population of Ukraine in the Covid-19 period and to compare them with the characteristics of resilience in other periods of the greatest shocks experienced by our country, as well as with the indicators of other countries. In our study the main indicators of transient dynamics (convergence time, reactivity, population inertia, damping ratio) were calculated for the first time for the population of Ukraine. The influence of the contribution of different age groups of women to total fertility on the age structure of the population (with the same total fertility rate) was also determined for the first time. The calculations were based on the stable population model, the Leslie matrix, fertility tables, and life tables. The resilience indicators were calculated using the popdemo package. Methods of comparison, generalisation, and analogy were also used. Among the characteristics of demographic resilience, the half-life indicator stands out for its simplicity of calculation and interpretation. In Ukraine, the halving time for the population is decreasing, but it is still higher for the real population than for its stable equivalent. The age structure of the real population, formed under more favourable conditions, mitigates the negative consequences of shock periods, but the long-term preservation of the current regime of mortality and fertility will inevitably worsen the characteristics of the population. In Ukraine, advanced motherhood is an element of the adaptive cycle and requires a rethinking of its meaning and role, as it can be one of the internal mechanisms aimed at the resilience of the system in shock periods. In the conditions of the lowest-low fertility and mortality regime in Ukraine in 2021, advanced maternal age contributed to some increase in the number of births and a certain rejuvenation of the age structure of the population.

O-105 Contribution of ART to fertility rates and family size

Abstract In the last three decades declining fertility has become an increasing global trend. One-half of the global population today lives in countries where the period Total Fertility Rate is below 2.1 births per woman. Many countries in Europe and Asia are experiencing “ultra-low” fertility rates of 1.0-1.4 births per woman. This decline in births creates both social and economic challenges. In addition, most countries have gone through a long period of increasing average age at birth. The shift in births at older ages has been accompanied by a concomitant decline in completed family size. As the average age at having children has increased over time, the proportion of women experiencing difficulty in achieving a pregnancy has also increased, with assisted reproductive technology (ART) treatments becoming increasingly important in counteracting this decline. However, the demographic impact of ART widely varies across countries, with the proportion of babies born as a result of ART, ranging from almost 10% of birth in in some European countries to &amp;lt; 1% in Latin America and 2% in the USA. ART is increasingly being raised as a potential policy tool to increase fertility. While ART can broaden the range of possible responses to low fertility rates, there are a number of challenges in quantifying contribution to fertility rates. There are also a number of important unintended consequences that need to be taken into account when trying to estimate their effectiveness as a policy tool to increase fertility. In this presentation, the evidence for the contribution of ART to total and age-specific fertility rates in different settings will be summarized and compared with other pronatalist policies. The contribution of ART and other forms of fertility treatment to completed family size and childbearing timing will also be described and discussed. Assisted reproduction is making a modest and increasing contribution to the fertility rate of high-income countries, but its potential impact should not be overestimated.

O-188 Conventional in vitro fertilisation versus intracytoplasmic sperm injection in first cycle patients without severe male factor infertility (INVICSI): a randomised, controlled, open-label, multicentre trial

Abstract Study question Is the cumulative live birth rate (CLBR) after ICSI superior to conventional IVF (c-IVF) in first cycle fertility patients without severe male factor infertility? Summary answer In couples without severe male factor infertility, ICSI does not improve the CLBR compared to c-IVF after transfer of embryos from the first oocyte collection What is known already The ICSI procedure, originally developed for addressing severe male factor infertility, has seen expanded utilisation across various causes of infertility. Large retrospective studies and a recent randomised controlled trial (RCT) demonstrated comparable reproductive outcomes between ICSI and c-IVF in couples without male factor infertility. In approximately half of infertility cases, a male factor is involved, with about one-third attributed to male factor alone. Despite this, ICSI currently constitutes two-thirds of all assisted reproductive technology treatments worldwide Study design, size, duration Open-label, two-armed, multicentre RCT. A sample size of 784 women was required to detect a clinically relevant change of 10 percentage points with 80% power. Accounting for an expected 5% exclusion rate (dropouts and unexpected severely decreased quality sperm samples on the day of oocyte retrieval), 824 women were recruited from six public fertility clinics in Denmark between Nov 29, 2019, and Dec 14, 2022 Participants/materials, setting, methods Eligible participants were women aged 18-42 years and in their first treatment cycle with a partner/donor with normal or lightly to moderately decreased sperm quality. Randomisation was performed in a 1:1ratio between ICSI and c-IVF. The primary outcome was CLBR. Follow-up continued until the primary outcome was achieved or for a minimum of one year after the last participant’s inclusion.The primary outcome was assessed in an intention to treat (ITT) and a per protocol analysis Main results and the role of chance In total, 414 and 410 women were randomised to ICSI and c-IVF, respectively. Results include fresh as well as frozen-thawed embryo transfers from the first oocyte collection and are displayed as ITT. All transfers were elective single embryo transfers or single embryo transfers. The cumulative probability of achieving a live birth for couples/women undergoing ICSI was not different compared to those undergoing c-IVF (CLBR: ICSI 42.0% vs. c-IVF 46.6%, Risk ratio: 0.90, 95% CI: 0.77-1.05). The median time from inclusion to live birth did not differ between ICSI and c-IVF (309 days (IQR 268-378) vs 308 days (IQR 269-356); p = 0.12). Total fertilisation failure was seen in 4.9% of the ICSI group compared to 3.8% in the c-IVF group (Risk ratio: 1.29, 95% CI: 0.68-2.54) Limitations, reasons for caution This study was designed with 80% power to identify a 10% percentage point difference in CLBR between ICSI and c-IVF. We cannot dismiss the possibility of a smaller difference between the two methods Wider implications of the findings Our study, supported by prior research, shows that c-IVF rather than ICSI should be the first choice in initial cycles for patients without severe male factor infertility. Fertility staff should inform first cycle patients that ICSI does not increase the live birth rate for couples without severely decreased sperm quality Trial registration number NCT04128904

P-026 Retrospective descriptive analysis of 1300 ICSI-AOA cycles: evaluating clinical outcomes and child health in the context of artificial oocyte activation (AOA)

Abstract Study question How does the outcomes of ICSI-AOA and child health differ from those reported in the literature? Summary answer ICSI-AOA clinical outcomes, including fertilization, embryo quality, pregnancy, live birth rates, and anomaly rates in children, align with those reported for ICSI alone. What is known already The use of AOA to artificially induce calcium rises by employing calcium ionophores has been shown as an effective approach in overcoming fertilization failure following ICSI, especially in couples facing severe male factor infertility. However, a significant gap exists in reporting live birth outcomes. On the other hand, uncertainties surrounding the health implications for children born through this method necessitate further investigation due to the limited sample sizes in previous reports. This descriptive analysis fills that gap by assessing 1300 cases, providing crucial insights into the clinical outcomes and health status of babies resulting from ICSI-AOA treatment. Study design, size, duration This retrospective study analyzes 1300 cases of ICSI-AOA between 2018 and 2020. Clinical outcomes in this study includes: fertilization, embryo quality, pregnancy, and live birth rates. Questionaries regarding the children health were included from birth to two years. Participants/materials, setting, methods The study included 1300 cases that referred to Isfahan Fertility and Infertility Center (Isfahan, Iran) and underwent ICSI-AOA due to: 1) cases with testicular biopsy (N = 458), 2) cases with 99-100% sperm head abnormal morphology and/or 3) previous low fertilization or total fertilization failure after ICSI (N = 842). In all cases, to induce AOA, oocytes were subjected to a 10-minute exposure of 10 micromolar ionomycin following ICSI. Main results and the role of chance From 1300 couples, 11,756 mature, 2,012 immatures, 193 degenerate, and 76 uninjectable oocytes were obtained. Fertilization were 59.69%, and 52.18% for mature and immature oocytes, resulting in cleavage rates of 96.93% and 93.80%, respectively. On day 3, 25.14% grade A, 31.49% grade B, and 43.36% grade C were observed. In 321 couples, 571 fresh embryos were transferred on day 3, resulting in clinical pregnancy and live birth rates of 20.82%, and 19.55%, respectively. For 32 couples with 44 fresh ET on day 5, rates were 9.38%, and 9.38% respectively. Out of 3270 vitrified embryos on day 3, 1743 were thawed (337 couples) and 1147 were transferred in 643 ET cycles. Clinical pregnancy and live birth rates were 21.61%, and 20.37%, respectively. 1527 embryos remain frozen. Out of 2,974 day 5-embryos, 2,571 did not reach blastocyst, leaving 403 vitrified embryos in 699 cases. Among them, 197 embryos remain frozen (80 cases) while 206 were transferred, with clinical pregnancy and live birth rates of 22.11%, and 21.80%, respectively. Cancellation rate, encompassing failed fertilization, cancellations on multiple days, and after freeze-thawing, was 20.16%. Among 266 live births, seven children showed anomalies, including achondroplasia, combined immunodeficiency, left eye deviation, intrauterine growth restriction, hydrocephaly, epilepsy, and umbilical hernia. Limitations, reasons for caution The main limitations of this study were the lack of comprehensive information on previous cycles, the absence of an ICSI control group, and the limited long-term follow-up on the physical and mental health of children born through the ICSI-AOA method beyond age two. Wider implications of the findings ICSI-AOA yields helpful clinical outcomes in high fertilization, pregnancy, and live birth rates in infertile couples, especially those with severe male factor infertility similar to ICSI in literature. Furthermore, presently, there seem to be no real concerns about health of babies born through this method, aligning with ICSI studies. Trial registration number IR.ACECR.ROYAN.REC.1401.038

O-242 Why do we need to act NOW?

Abstract In the early 1970s, the Report of Rome represented a powerful wake up call to the world. If the world population would continue to grow the way it did until then, catastrophe was predicted and the future of the planet would be in danger. All attempts should focus on decreasing world population growth. At that time the global total fertility rate (the number of children born per woman) was around 5. Policies were implemented worldwide aiming to reduce the number of children born, and the widespread introduction – at least in the more developed world - of various contraceptive strategies in the 1970s certainly helped to reach this goal. Especially in Western societies, the liberation in women (increased participation in higher education, more focus on work and career, and control over when to start a family if at all) was significantly enhanced, dramatically reducing the number of children born. In this context, it is no surprise that organizations like the European Union or the World Health Organization gave very low priority to fertility care, which would potentially increase the number of children born. For a population to remain stable, approximately 2.1 child needs to be born per woman. At present, in more than 50% of all countries worldwide – mainly the more prosperous ones – the number of children born is below replacement level. It is anticipated that societies below replacement will increase up to 90% of all countries worldwide during the 21th century. Hence, underpopulation - causing distinct society challenges - rapidly becomes of distinct concern to many governments, especially in European countries, China, and Japan. It is a generally recognized human right, in case individuals or couples wish to establish a family. However, historically little attention has been dedicated by policy makers to fertility care, mainly because the justified concerns for overpopulation. However, the incidence of infertility remains around 15% worldwide and treatment options have significantly improved. In addition, demand for fertility care is increasing year by year, especially by single individuals, lesbian or gay couples and other members from the LGBTQ+ community who wish to establish a family. At present, at least 10% of all children born are due to infertility therapies in some wealthy countries. However, access to fertility care varies dramatically due to high cost of treatment and lack of insurance coverage of such treatments in the great majority of countries. At present, governments increasingly introduce so called “child friendly” policies (such as financial compensations, extended pregnancy and parental leave, free child care, tax benefits, etc), aiming to decrease barriers for people who wish to have children. Unfortunately, improved access to fertility care is not yet part of this discussion. Over half a century, family planning strategies exclusively focused on the prevention of unwanted pregnancies aiming to reduce world population growth. However, at present family building strategies (helping people who wish to establish a family) should also be included in future family planning strategies.

P-111 Artificial Oocyte Activation (AOA) through piezoelectric stimulation post-Intracytoplasmic Sperm Injection (ICSI) for teratozoospermia patients

Abstract Study question Does employing piezoelectric stimulation on oocytes post-ICSI in teratozoospermia cases affect early embryonic development rates? Summary answer In a retrospective study, piezoelectric stimulation after ICSI showed increased fertilization rates and improved embryo quality in teratozoospermia cases. What is known already Fertilization can fail due to various factors. One of the causes of fertilization failure after ICSI is the inability to achieve oocyte activation, a process initiated by sperm-induced events. Piezoelectric stimulation, a method of artificial oocyte activation, involves applying specific electric currents post-ICSI, elevating Ca+2 levels. Studies suggest its efficacy in enhancing fertilization rates and improving embryo quality, particularly in cases of total fertilization failure and severe sperm abnormalities. However, available literature on the efficiency of electrical stimulation in cases of sperm abnormalities is limited. Study design, size, duration In this retrospective study conducted at our reproductive center between January 2023 and October 2023, we enrolled 122 patients diagnosed with male factor infertility. These patients were divided into two groups: the control group (n = 61) where piezoelectric stimulation was not employed post-ICSI, and the AOA group (n = 61) where piezoelectric stimulation was utilized after the ICSI procedure. Participants/materials, setting, methods The study assessed 2122 oocytes, with 1031 in the control and 1091 in the AOA group. Piezoelectric stimulation was administered oocytes approximately 20-30 minutes after ICSI. The quality of sperm samples was assessed based on Kruger’s strict criteria. Following ICSI, statistical analysis utilized Student’s t-test and chi-squared tests to assess the impact of piezoelectric stimulation on fertilization and embryo quality, considering p &amp;lt; 0.05 as significant and p &amp;lt; 0.001 as highly significant. Main results and the role of chance Clinical outcomes were compared between two groups. No significant differences were observed between the control group and AOA group regarding female age (29.93±4.9 vs. 29.93±5.11, p = 0.988) and male age (34.25±3.45 vs. 33.93±3.64, p = 0.628), the number of retrieved oocytes (16.90±11.04 vs. 17.89±9.3, p = 0.344), the number of metaphase II (11.02±6.8 vs.12.46±6.6, p = 0.162). However, a highly significant difference was noted in the distribution of fertilization rate (59.08% [397/672] vs. 66.84% [508/760], p = 0.002), high-quality embryos rate (day 3) (44.08% [175/397] vs. 54.33% [276/508], p = 0.002), blastocyst rate (40.05% [159/397] vs. 50% [254/508], p = 0.003) and the good blastocyst development rate (14.11% [56/397] vs. 24.41% [124/508], p = 0.0001). Cleavage rate was significantly higher in the AOA group (85.24% [433/508]) than control group (79.09% [314/397]), p = 0.01. Limitations, reasons for caution Constraints include the study’s retrospective, single-center design, and a limited sample size. Wider implications of the findings Piezoelectric stimulation demonstrates effectiveness in improving fertilization rates and embryo quality in teratozoospermia cases after ICSI. Trial registration number not applicable

Factors influencing male fertility in Uganda

Male fertility is an important component of population research. Against this backdrop, this paper aims to examine the factors explaining male fertility changes in Uganda. The authors applied the own-children method, as described by Schoumaker, to understand the prevailing male total fertility rate trends and to select datasets for inclusion during the multivariate analysis, using the Uganda demographic health surveys conducted from 2006 to 2016. A multivariable Poisson decomposition regression model was used to examine factors associated with male fertility changes. This model analyzed data from the 2006 and 2016 surveys only and included a total sample size of 7839 male respondents. The outcome variable for the regression model was children ever born (CEB). The regression model showed that differences related to changes in the proportional composition of characteristics contributed 113% to the change in CEB, compared with the differences due to reproductive behavior, with other factors being kept constant. The most important proportional changes that led to meaningful variability in CEB were observed among the following characteristics: occupation, number of current wives, total number of lifetime partners, type of residence, education, and age at first childbirth. Thus, interventions to delay the formation of cohabitation and marriage unions and the onset of childbirth or fatherhood among adolescents and young men below the age of 25 should be prioritized as potent fertility regulation measures. In addition, the focus on eliminating the lack of education and primary education as the highest levels attained among boys and men should be prioritized to boost a rapid male fertility transition in Uganda.

P-027 Sperm motility and calcium ionophore treatment influence fertilization and pregnancy outcomes in TESE-ICSI

Abstract Study question Are there differences in fertilization and pregnancy rates post-TESE-ICSI between motile and immotile sperm, and do these vary in treatments with and without calcium ionophore? Summary answer Post-TESE-ICSI data reveals differences in fertilization and pregnancy rates when comparing motile vs. immotile sperm and treatments with and without calcium ionophore after TESE-ICSI. What is known already Testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) poses a challenge for every IVF laboratory. This is particularly true in patients exhibiting azoospermia, where only a few and mostly immotile sperm are present in testicular tissue. In these cases, a calcium ionophore treatment for activation of the oocyte may help to overcome poor prognosis fertilization outcome, and thereby enhancing the likelihood to achieve a transfer leading to a successful pregnancy. Although both techniques, TESE-ICSI and activating substances are commonly applied, detailed analyses for individual counselling of couples are missing. Study design, size, duration This study analyzed 787 TESE-ICSI cycles (2015-2023) regarding patient age, number of attempts, oocyte maturity, fertilization and pregnancy rate after fresh embryo transfer. Cycles were split into four groups: (A) at least one motile sperm was injected (n = 493); (B) only immotile sperm were used (n = 294); (C) calcium ionophore (n = 474); (D) no calcium ionophore (n = 313). 17 cycles were excluded from the study because no sperm were found on the day of TESE-ICSI and oocytes were vitrified. Participants/materials, setting, methods In our IVF clinic, calcium ionophore treatments are only offered if a pre-screening of TESE samples reveals the absence of motile spermatozoa or if a previously conducted TESE-ICSI attempt resulted in a low fertilization rate (&amp;lt;30%) or a total fertilization failure. Statistical analyses was performed to compare the motile and immotile sperm group and the groups with or without calcium ionophore treatment. Main results and the role of chance No differences were found in all groups (A-D) regarding age of female or male patient and number of collected oocytes per group. However, our results demonstrate a difference in the mean number of ICSI attempts when comparing motile sperm and immotile sperm (2.0±1.3 vs. 2.3±1.6, p &amp;lt; 0.05), and when comparing attempts with calcium ionophore treatment and those without (2.4±1.6 vs. 1.8±1.8, p &amp;lt; 0.0005). The mean fertilization rate (2PN stage) was higher in the motile sperm group (A) compared to the immotile group (B) (57.8% vs. 28.4%, p &amp;lt; 0.0005) and also higher in attempts of group (D) in comparison to attempts of group C (56.8% vs. 40.2%, p &amp;lt; 0.0005). While fertilization failure occurred less often in group (A) (3.2%) it occurred to a higher rate in group (B) (19.4%), followed by group (C) (12.0%). Biochemical (BPR) and clinical pregnancy rates (CPR) showed a significant difference between the motile and immotile sperm group (BCR: 33.2% vs. 12.3%, p &amp;lt; 0.0005; CPR: 25.6% vs. 9.3%, p &amp;lt; 0.0005), but no differences between the two calcium ionophore groups. Limitations, reasons for caution This analysis was done retrospectively. A potential subgroup analysis of groups (A) and (B) into calcium ionophore use and of groups (C) and (D) into motile or immotile sperm will reveal the effect of calcium ionophore on success rates regardless of sperm motility. Wider implications of the findings Our data provides insight into success rates of TESE-ICSI cycles, especially if only immotile sperm were present. This will serve as a helpful guide for physicians when counseling patients about their success rates and to optimize the outcome in cases with poor prognosis by using a calcium ionophore treatment. Trial registration number not applicable

O-187 Real-word data on effectiveness of ICSI over conventional IVF according to infertility factors based on human fertilisation and embryology authority dataset

Abstract Study question Can the analysis of Human Fertilisation and Embryology Authority (HFEA) dataset provide real-word data on effectiveness of ICSI over conventional IVF according to infertility factors? Summary answer A statistically significant reduction in live birth rate was shown to be associated with ICSI use in cycles with female infertility factors. What is known already The adoption of ICSI has seen a considerable increase over the years, even in cases without an evident male-factor infertility. Available studies including large retrospective studies and meta-analyses evaluating the effectiveness of the two strategies tend to support the idea that in the absence of a male factor, ICSI does not offer a significant advantage over conventional IVF(cIVF). However, some uncertainties still exist regarding live birth rates and in relation to various infertility factors. Study design, size, duration Retrospective study of 275.825 first cycles treated with cIVF or ICSI between 2005-2018, included in the HFEA database. Infertility indications were simplified into three groups: 1) female only (endometriosis, tubal, ovulatory and cervical factors); 2) male (male only or with male and female factors together); 3) unexplained infertility. The primary outcome was live birth rate in the first fresh cycle. Secondary outcomes included fertilization, implantation, miscarriage rates, cycle cancellation rate and neonatal outcomes. Participants/materials, setting, methods Outcomes were evaluated through binomial logistic regression including the following predictors: female age, inseminated oocytes, number/stage of transferred embryos (condensed with principal component analysis), subtype of female infertility, year of treatment. A paired-analysis was also performed matching couples in a 1:1 ratio between ICSI and conventional IVF based on female age, indication, inseminated oocytes, year of treatment. Results were reported according to infertility cause using crude and adjusted Odds Ratios (OR) with 95%CI. Main results and the role of chance The study revealed a consistent balance in treatment distribution between conventional IVF and ICSI, with a slight increase in ICSI cycles in recent years. Based on logistic regression analysis, a significant reduction in live birth rate was demonstrated using ICSI compared to conventional IVF in cycles with female factors (adjusted OR = 0.95, 95%CI: 0.91-0.99). No significant differences emerged in unexplained factor cycles. With the use of conventional IVF, the overall odds of having a total fertilization failure increased by a factor of 1.84 (95%CI: 1.75-1.94). No significant differences in implantation rates between conventional VF and ICSI were seen after adjustment. The OR for male sex in newborns compared to female sex from single pregnancies was significantly influenced by ICSI use across the three groups of infertility causes and ranged between 0.84 and 0.87. The matched dataset confirmed a reduced occurrence of live birth per cycle in case of female factors (aOR=0.91, 95%CI: 0.86-0.96) and an overall significant lower proportion of cycles ending in cancellation for absence of viable embryos using ICSI compared to conventional IVF. Limitations, reasons for caution Some biases are intrinsic in the availability and quality of retrospective data obtained from registries and unmeasured confounders may influence the generalizability of the results. The study does not provide information on cumulative live birth rates. Wider implications of the findings ICSI introduces an additional, invasive step in assisted reproduction with a potential reduction in live birth rates for specific patients’ groups. These findings emphasize the importance of tailoring treatments to specific patient profile.The routine use of ICSI for all cases should not be considered an appropriate clinical practice. Trial registration number not applicable

Regional fertility predictors based on socioeconomic determinants in Slovakia

The study's primary purpose was to recognise the effects of determinants on the level of fertility and thereby explain the differences in trends in the regions of Slovakia. At the turn of the century, the differences in fertility in regions increased, but the total fertility rate decreased. Multivariate statistical methods clarified the regional effects of the level and nature of fertility. Initial regression surveys indicated weak effects between regions, which led to applying factor and cluster analysis to establish regional types. Comprehensive regression analysis was then applied. The strength and nature of regional relationships differed at the inter- and intra-regional levels. Research has demonstrated significant differences in fertility rates dependent on the socioeconomic environment, as regional types uniquely link to determinants. Moreover, each determinant has specific spatial patterns with unequal regression coefficients at different regional levels, which cannot be evaluated constantly. Knowing how spatial variation in fecundity occurs will enable future studies to elucidate the processes involved. Finally, fertility is vital for social assessment and policy formulation, the study’s findings could inform local decision-makers and planners in identifying the socioeconomic conditions underlying fertility at the regional level and planning appropriate intervention strategies.

Dietary supplementing South African indigenous rams with flaxseed oil and ascorbic acid improves cryopreserved semen quality and in vitro fertility

The purpose of this study was to evaluate how ascorbic acid with dietary flaxseed oil affects the quality and fertility of cryopreserved ram sperm in South African indigenous rams. Treatment diets were supplemented 60 days before semen collection to afford proper spermatogenesis, adaptation to the feed formulated and fed throughout the study. Semen was collected with the use of artificial vagina following dietary supplementation with five treatment diets (neg. cont. – negative control, pos. cont. – positive control, FLO – 5% Flaxseed oil, ASA – 4% Ascorbic acid, and FLO + ASA). Semen was then extended using tris-based extender and cryopreserved using the programmable freezer (CBS Freezer 2100 series, Laboratory consumables & chemical suppliers, America). Ovaries were collected from a neighbouring slaughter house and conveyed to the lab in 0.9% saline at 37 °C. Data (sperm parameters and in vitro fertility) was then exposed to the GLM (General Linear Model) in Minitab 17. Pearson’s correlation coefficient was utilized to investigate the relationship between cryopreserved sperm quality and in vitro fertility. The student Least Significant Difference Test was used to separate the treatment means, and differences were accepted when the p-value was less than 0.05. The FLO + ASA group had higher (p < 0.05) progressive (36.33 ± 1.87), total (88.24 ± 2.24), rapid motility (27.52 ± 1.74), intact plasma membrane (75.67 ± 2.08), total fertilization (65.98 ± 7.39), and total cleavage (66.19 ± 6.50) when compared to other treatment groups. Total fertilization rate had a medium significant (p < 0.001) medium correlation with the progressive motility (r2 = 0.435), total motility (r2 = 0.447) and rapid motility (r2 = 0.409). In conclusion, dietary flaxseed and ascorbic acid (FLO + ASA) improves cryopreserved semen quality, in vitro fertilization rate, and the total cleavage rate. Noteworthy, the progressive, total and rapid motility play a crucial in the in vitro fertilization rate.

The nursing-midwifery workforce size significantly influences the reduction of neonatal mortality rate

PurposeThis study aimed to quantify the confounded and independent role of nursing-midwifery workforce size (NMWS) in protecting against neonatal mortality (NMR) globally and regionally. MethodsScatter plots, bivariate correlation, partial correlation, and multiple linear regression analyses were conducted to assess the correlations between NMWS and NMR. This cross-sectional study fully accounted for potential confounding effects of economic affluence, total fertility rate, and urbanization on this relationship. Countries were categorized to explore regional variations in the protective role of NMWS in reducing NMR. ResultsExplaining 55.76% of NMR variance worldwide, NMWS correlated to NMR negatively and significantly. NMWS still significantly correlated to NMR, but only explained 9.12% of NMR variance when the confounding effects of economic affluence, total fertility rate and urbanization were removed in partial correlation. Linear stepwise regression identified NMWS as the third most significant variable influencing NMR variance worldwide. NMWS correlated to NMR significantly and consistently in different country groupings, especially in developing countries. This suggested that nursing shortage is a significant global issue, but worse in developing countries. ConclusionsNMWS appears to have been a protective factor against NMR globally, particularly in developing nations. This protective effect remained significant even after adjusting for economic affluence, total fertility rate, and urbanization. The consistent negative correlations observed between NMWS and NMR, both globally and regionally, highlight the importance of addressing the chronic shortage of nursing and midwifery personnel, prompting healthcare authorities to prioritize this issue.