Undergoing Fertility Treatment Research Articles

Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study.

To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting. This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement. Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5days, p < 0.001). Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.

7061 Incidence of Adrenal Crisis In Congenital Adrenal Hyperplasia (CAH) Patients During A Prospective Monitored Long-Term Study Of Modified-Release Hydrocortisone (MRHC) Capsules, (Efmody)

Abstract Disclosure: R.J. Ross: Consulting Fee; Self; Diurnal. D.P. Merke: Research Investigator; Self; Diurnal. A. Mallappa: Research Investigator; Self; Diurnal. W. Arlt: Research Investigator; Self; Diurnal. A. Brac de la Perriere: Research Investigator; Self; Diurnal. A.L. Hirschberg: Research Investigator; Self; Diurnal. J.D. Newell-Price: Research Investigator; Self; Diurnal. A. Prete: Research Investigator; Self; Diurnal. A. Rees: Research Investigator; Self; Diurnal. N. Reisch: Research Investigator; Self; Diurnal. M. Quinkler: Research Investigator; Self; Diurnal. P.A. Touraine: Research Investigator; Self; Diurnal. K. Maltby: Employee; Self; Diurnal. J. Quirke: Employee; Self; Diurnal. N. Aslam: Employee; Self; Diurnal. H. Coope: Employee; Self; Diurnal. J. Porter: Employee; Self; Diurnal. Background: Adrenal crisis is the leading cause of excess mortality in patients with CAH[1]. Retrospective studies report an adrenal crisis incidence of 5-10/100 patient years (PY), with mortality 0.5/100 PY2. Modified-release hydrocortisone (MRHC) capsules, (Efmody), replicate cortisol diurnal rhythm and improve androgen control in CAH compared to standard glucocorticoid therapy2. Here, we report the incidence of adrenal crisis in CAH patients from a prospective study of MRHC in CAH patients. Methods: Patients completing MRHC Ph2 and Ph3 studies were eligible to enter a single-arm, open-label extension study. Study visits occurred at baseline, weeks 4, 12, 24 and 6-monthly thereafter. The primary endpoint was the safety of MRHC over time. Adrenal crisis was defined according to Allolio 20153. MRHC doses were adjusted on the basis of an adrenal insufficiency checklist, and measurement of androstenedione (A4) and 17-hydroxyprogesterone (17-OHP) at 9am and 1pm. Results: 91 patients entered the study, mean age 37 years, 68% female, 32% male. 22 discontinued; 11 at patient request, 5 due to pregnancy, 2 undergoing fertility treatment, 2 at physician/sponsor request, 1 due to an AE (carpal tunnel syndrome), and 1 due to death (myocardial infarction). Median treatment duration was 1500 days, range 0.2 to 5.8 years. Median MRHC dose at study entry was 30mg/day, reducing to 20mg/day from 24-weeks until end of study. Signs and symptoms of adrenal insufficiency due to under-treatment were reported for 41 (45.1%) participants, most frequently fatigue which was reported at some point by 41.8% of all participants. Signs and symptoms of overtreatment were reported for 25 (27.5%) participants, most frequently sudden weight gain which was reported at some point by 16.5% of all participants. Signs and symptoms of both over- and undertreatment occurred predominantly during the first 24 weeks. The study encompassed 357 participant years, and 18 adverse events considered indicative of adrenal crisis occurred in 7 participants, giving an incidence rate of 5.043 adrenal crises / 100 PY. Conclusions: Data from this longest prospectively monitored study in CAH suggest that the incidence of adrenal crisis on MRHC is at the low end of that reported in retrospective studies and the safety profile of MRHC is otherwise similar to immediate release hydrocortisone.

Analysis of the Predictive Factors for Chronic Endometritis Recurrence in Infertile Women.

To identify the predictive factors for the recurrence of chronic endometritis (CE) in infertile women. In this case-control study, 1170 infertile women recovered from CE and underwent fertility treatment between December 2018 and August 2021. Among the 146 women (12.5%) who did not conceive or experienced pregnancy loss in 18 months after CE recovery, 105 consecutive women who underwent repeat endometrial biopsy for CD138 immunostaining and endometrial bacterial culturing were recruited. Thereafter, patients with and without CE recurrence were compared. The total recurrence rate of CE was 29.5% (31 women). Multivariable logistic regression analysis to determine predictive factors for CE recurrence revealed that hysteroscopic surgery (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02-0.56; p=0.0009) and pregnancy loss (OR, 4.13; 95% CI, 1.31-13.05; p=0.016) were significantly associated with decreased and increased CE recurrence rates, respectively. Also, reexamination with CD138 immunostaining after 16-18 months (OR, 9.75; 95% CI, 1.47-64.64; p=0.024) was significantly associated with increased CE recurrence rates. Among 49 patients without a history of pregnancy loss, the cumulative CE recurrence rates after 6, 12, and 18 months were 5.6%, 13.5%, and 20.4%, respectively. We recommend reexamination with endometrial CD138 immunostaining in patients with pregnancy loss or long-term infertility during fertility treatment. Hysteroscopic surgery without antibiotic therapy for CE associated with intrauterine abnormalities is also recommended.

The landscape of assisted reproductive technology access in India.

Historically, infertility has been stigmatized in the Indian society, primarily due to societal norms that equate marriage with procreation. In twentieth century, India focused primarily on over-fertility in its family planning programs, with little attention given to the complexities of infertility. The introduction of Assisted Reproductive Technology (ART) in the late 1970s made a global revolution, including in India, offering hope to infertile couples. Despite a significant rise in ART clinics offering a wide range of treatment options in the recent years, challenges remain, particularly regarding the affordability. In India, ART is typically dominated by the private sector as government support remains limited. Efforts to standardize ART practices, including the establishment of the National ART & Surrogacy Registry and ART act aim to regulate, improve outcomes and curb unethical practice. Despite these advancements, the high cost of treatment cycles and lack of insurance coverage limit many couples' ability to undergo fertility treatment. Addressing these issues requires a multifaceted approach, including policy reform, increased public awareness, and the development of affordable treatment options to ensure broader access to reproductive care across India.

Barriers and facilitators experienced by South Korean women undergoing fertility treatment: A qualitative socioecological study

The purpose of this qualitative study was to use interview data to identify and describe the intrapersonal, interpersonal, community, and policy barriers and facilitators experienced by South Korean women undergoing fertility treatment. The researchers conducted one-on-one interviews with 14 women who had undergone fertility treatment and then completed a thematic content analysis on the collected interview data. Guided by the socioecological model, the researchers explored the barriers and facilitators women experienced during fertility treatment. The participants described their struggles and ­emotional distress as well as their coping mechanisms: addressing their physical and emotional stress; soliciting support from their husband, personal network, online peers, and healthcare team; and seeking government financial assistance. The information gained from this study can help healthcare providers and government agencies design effective psychosocial and national policies and interventions for this population.

Incidence of Natural Conception in Fertility Couples Delayed Treatment in the COVID-19 Shutdown in Australia

Background: In vitro fertilization (IVF) is the most widely applied fertility treatment. While the indication for IVF is not disputed in couples where natural conception chances are close to zero (blocked fallopian tubes or severe male infertility), it is less clear when IVF should be started in other couples. Natural conception occurs frequently and has been reported in patients pre- and post-IVF treatment. The outbreak of COVID-19 in the early months of 2020, resulted in Australian fertility clinics stopping treatment. This enabled the opportunity for fertility patients to try and conceive naturally. Methods: We studied couples who were scheduled to start IVF in March 2020 but who faced delayed treatment due to COVID-19 shutdowns. Outcomes were recorded as couples returned for treatment or were contacted via phone and asked why they did not return. We collected baseline characteristics including maternal age, day of next Day 1, and type of infertility, as well as the pregnancy outcome or reason for not returning. Results: We studied 533 couples who were delayed IVF treatment for a total of 1,204 observation months. From the initial cohort of 533 couples delayed treatment, 16 couples achieved pregnancy (3%) with 12 resulting in live birth (2.3%). When analyzed by indication, patients with ovulatory disorders (4 of 55 [7.2%]) or reduced ovarian reserve (7 of 141 [5%]) proved to have higher rates of natural conception compared to other diagnostic categories. There were 39 couples who did not return to treatment and did not achieve natural conception. Conclusion: There is a significant emotional toll that patients experience when undergoing fertility treatment. Natural conception is evident within cohorts scheduled for IVF treatment, and this study indicates that the chance per cycle of live birth in couples waiting to undergo medically assisted reproduction during the COVID pandemic was 2.3%.

Release: The acupuncture clinic as a therapeutic, health-enabling place

This paper critically reappraises the work of Wilbert Gesler (1992) on ‘therapeutic landscapes’ to explore the dual role of the acupuncture clinic as experienced by couples undergoing fertility treatment. Drawing on qualitative research in Ireland, I argue that the acupuncture clinic acts as a therapeutic space in two senses. First, the patient-acupuncturist relationship contributes to patient emotional support and wellbeing, with the clinic providing emotional sanctuary. Second, the clinic provides a therapeutic complement to allopathic approaches to fertility treatment, with the acupuncturist providing informational support which informs patient decision-making and, in some cases, arguably contributing to the treatment itself. In exploring the therapeutic and health-enabling importance of the acupuncture clinic, this paper adds important qualitative depth to an aspect of assisted reproduction that has become an essential complement to the medical process to many couples, but has arguably remained neglected in academic research.

P-471 Anxiety, depression, and body image among infertile women with and without polycystic ovary syndrome

Abstract Study question Do women with PCOS undergoing fertility treatment experience higher anxiety and depression symptoms, along with lower body appreciation, compared to those without PCOS? Summary answer Having PCOS was not associated with symptoms of anxiety and depression, but was associated with somewhat lower body appreciation. What is known already PCOS has been associated with a higher chance to develop mental health problems, like anxiety, and body image concerns. The International Guidelines on PCOS recommend that all women with PCOS should routinely be screened for anxiety and depressive disorders. In most studies in this field, the comparison group included healthy women without fertility problems. Study design, size, duration We conducted a cross-sectional survey study between May 2021 and July 2023, using an online questionnaire. We informed women about this study at fertility clinics in the Netherlands through posters and leaflets and on the websites of the Dutch patient organizations Freya and Stichting PCOS. Participants/materials, setting, methods This study included women with infertility, with and without PCOS, undergoing fertility treatment. Women completed the Hospital Anxiety and Depression Scale and the Body Appreciation Scale-2. Primary outcomes were clinically relevant symptoms of anxiety and depression (scores&amp;gt;11), and BAS-2 scores. Secondary outcomes were mean anxiety and depression scores, along with scores of 8 and higher. Dichotomous and continuous outcomes were analysed using logistic and linear regression analyses adjusted for age, BMI, and duration of infertility. Main results and the role of chance A total of 1025 women currently undergoing infertility treatment participated, of whom 502 (49.0%) had PCOS and 523 (51.0%) had other infertility diagnoses. We found self-reported clinically relevant symptoms of anxiety in 33.1% of women with PCOS and in 31.0% of women with other infertility diagnoses (adjusted OR: 0.99, 95% CI 0.74 – 1.31). Clinically relevant symptoms of depression were reported in 15.5% of women with PCOS versus 14.5% of women with other infertility diagnoses (adjusted OR: 1.04, 95% CI 0.71 – 1.50). Women with PCOS reported slightly less body appreciation (adjusted mean difference: -1.34, 95% CI -2.32 to -0.36). Limitations, reasons for caution Results are based on self-report and may have been affected by sampling bias. Wider implications of the findings Although guidelines recommend screening women with PCOS, feelings of anxiety and depression can be present in any woman undergoing fertility treatments. We advise fertility clinics to be aware of women’s mental health issues and to offer support accordingly, as a part of routine care. Trial registration number not applicable

O-197 Correlation of intracellular pH of non-normozoospermic men with fertilization rates in assisted reproduction procedures (Pilot study)

Abstract Study question Does measuring qualitative changes in the sperm pHi could predict the fertilizing potential of a non-normozoospermic patients under fertility treatment? Summary answer The increase of pHi correlates with fertilization rates. What is known already The intracellular pHi (pHi) is of great importance for a wide variety of sperm physiological processes, including its motility. The pHi regulates several key sperm proteins, such as the Ca2+ channel, CatSper (sperm cation channel) which is involved in sperm hyperactivation and the K+ channel SLO3.The latter participates in the regulation of membrane potential during capacitation. Interestingly, human sperm pHi has been found to positively correlate with both hyperactivated motility and in vitro fertilization (IVF) success in normozoospermic patients. Study design, size, duration This prospective study employed unidentified semen samples from 62 non-normozoospermic men (patients, age 38 ± 4 years old) undergoing fertility treatment from January to November 2023 at CITMER Reproductive Medicine, Mexico City. Frozen semen samples and procedures with less than 4 oocytes were excluded. The pHi of sperm samples was evaluated by time-lapse flow cytometry. For comparison, the pHi of 13 normozoospermic men (donors, age 28 + 6 years old) were also analyzed. Participants/materials, setting, methods Sperm were separated by density gradient and incubated in capacitating HTF media to be used for conventional IVF or ICSI. Cells were stained with vitality (propidium iodide) and pHi (BCECF-AM) sensitive fluorescent dyes. Fluorescence changes were evaluated using an AccuriC6 flow cytometer. For each pHi recording, 10 mM NH4Cl were used as an alkalinization positive control and for data normalization. Basal levels of sperm pHi and its correlation with fertilization rates, were performed using R. Main results and the role of chance The changes in pHi were recorded as changes in the BCECF fluorescence. The increase in fluorescence is proportional to an increase in pHi and vice versa. Interestingly, we observed that the increase in pHi in sperm used for ICSI but not for IVF procedures, which were paired with oocytes from female donors, are positively and significantly correlated with higher fertilization rates (R = 0.68; *p=0.02). This seems to be the same for ICSI treatment pairing sperm with oocyte from the female partner, although the correlation is not yet statistically significant (R = 0.44; p = 0.12). We did not find significant differences in the basal pHi values between sperm from donors and patients; however, we observed that sperm from patients, had higher pHi values (0.57 + 0.15 a.u.f) compared to sperm from donors (0.48 + 0.24 a.u.f). Our results suggest that sperm pHi may be an important regulator for the process of fusion and not only for fertilization. Qualitative sperm pHi values can contribute to predicting fertilization success in patients undergoing ICSI treatment. Limitations, reasons for caution The preliminary nature of the results implies a necessity to increase the number of analyzed semen samples. Physiological responses may vary even among the same patient or cell’s donor. Our population-based analysis could be underestimating such single cell variations. Wider implications of the findings Current protocols for sperm analysis fail to successfully predict the fertilizing capacity of semen samplest.Measuring pHi in capacitated sperm, could be a promising tool to help clinicians choose the best fertilization technique for each couple. This protocol is easy to perform in a laboratory that has a flow cytometer. Trial registration number Not applicable

P-467 Fertility preparedness and influencing factors in women undergoing fertility treatment: Turkish sample

Abstract Study question What is the level of fertility preparedness among women undergoing fertility treatment and what factors influence this preparedness? Summary answer The readiness of the participants to undergo fertility treatment was found to be high. Factors that increase and decrease women’s prepareadiness were also identified. What is known already It is a common problem in practice to stop and not continue infertility treatment, which has a long physical, emotional and financial burden. Although there are many reasons for this, it has been found that couples move from one treatment process to another without feeling ready. In addition to the stress of infertility and treatment, couples drop out of treatment due to low readiness. Therefore, measuring the readiness of couples prior to fertility treatment and determining the factors that influence readiness may be effective in the continuation and success of treatment. Study design, size, duration It was a descriptive and cross-sectional study conducted on 375 Turkish-speaking women in a virtual environment using the Google survey technique. Infertile women who received treatment in fertility clinics of any hospital or private IVF centers worldwide and spoke Turkish constituted the population of the research. The data were collected between February 2021 and January 2022. Participants/materials, setting, methods A total of 375 women with primary infertility who agreed to be part of the study were included. Data were collected by ‘Descriptive Information Form’, ‘Fertility History Form’ and ‘Fertility Preparedness Scale for Women Receiving Fertility Support’ measurement tools. The cut-off value of the Fertility Preparedness Scale (FPS) is 56 points (min 23 - max 115) and a score of less than 56 points indicates that the participant was not sufficiently prepared for fertility treatment. Main results and the role of chance In the present study, the mean score was X¯ = 83.01 (min 39-max115). Most of the participants (94.67%) were above the cut-off value. This showed us that 94.67% of the women had a high level of prepareadiness. Factors such as advancing age, prolongation of infertility, increase in number of treatments, female factor of infertility were negative factors related to fertility preparedness. Besides increased education level, increased income, secondary infertility, feel less pressure from their families and being able to share with the social circle about the treatment were positive factors that increased the woman’s prepareadiness for treatment.According to the results fertility prepareadiness it has a very important place in starting and continuing fertility treatment. There are many factors that influence fertility prepareadiness. If a woman/couple starts well prepared in this expensive and stressful treatment process, financial loss can be prevented, treatment success can be improved and treatment discontinuation can be reduced. Limitations, reasons for caution The fact that the study was conducted online and the possibility of participation of people at different stages of treatment (beginning, while waiting for a pregnancy test, etc.) may have affected the fertility prepareadiness results. Wider implications of the findings There is a need for an experimental randomized controlled trial with objective assessment of fertility prepareadiness. It would also be useful for health professionals to measure the prepareadiness of women/couples through pre-treatment assessment in clinics. Assessment of prepareadiness and identification of influencing factors is important to provide appropriate support. Trial registration number non-clinical trials

P-473 Assessing patient perceptions: emotional support and clinic culture in fertility care. Examining changes in emotional support and clinic culture over 4 years

Abstract Study question How do patients perceive emotional support and clinic culture in the context of fertility care, what factors contribute to their overall experiences within fertility clinics? Summary answer Patients find clinic support lacking, rated 4.8/10, with &amp;lt;45% perceiving a supportive clinic culture. Despite increased awareness, emotional support perception declined from 2019 to 2023. What is known already Despite abundant research emphasising the necessity of psychosocial care in fertility treatment, notably by ESHRE, patients’ experiences indicate clinics are not consistently following these guidelines or offering sufficient emotional support. UK studies by the Human Fertilisation and Embryology Authority and Fertility Network emphasise the genuine emotional toll of fertility treatment, revealing that 40% of women undergoing treatment have experienced suicidal thoughts. These findings underscore the critical need for robust emotional support throughout the treatment journey. Study design, size, duration This study involved surveying 210 respondents undergoing fertility treatment. Employing an online survey format, disseminated within my online support communities (approx. 7,000 individuals), the study incorporated both qualitative and quantitative questions. Responses were collected across two distinct periods, 2019 and 2023, providing a comprehensive understanding of patients’ emotional experiences over the 4-year interval. Participants/materials, setting, methods The study gathered insights from 210 global respondents (97% receiving treatment in the UK, 3% in Europe and the USA), all participants were fertility patients undergoing treatment. Cohorts were surveyed in 2019 and 2023, responding to a 10-question online survey. This design enabled a comprehensive exploration of diverse perspectives on emotional support within fertility care over the specified 4-year period. Main results and the role of chance The study reveals a significant disparity between perceived and actual emotional support in fertility clinics. Despite clinics asserting excellence in support, patients rated the emotional support they received at 4.8 out of 10. An alarming 58% expressed scepticism about their clinic fostering a culture of support embraced by all staff, showcasing a disconnect between clinic claims and patient experiences. The study determined a decline in perceived support levels from 2019 to 2023, from 5.3/10 in 2019 to 4.6/10 in 2023. This downward trend raises concerns about the efficacy of efforts to enhance emotional support over the years despite an escalating focus and awareness surrounding the emotional challenges of fertility treatment. The participants’ qualitative responses unveiled a recurring theme across 2019 and 2023, indicating a persistent lack of improvement in emotional support. Patients felt like part of a production line, reduced to mere numbers in the clinic during their treatment journey. A resounding 66% of respondents expressed a desire for more accessible support services within their clinics. This study’s comprehensive findings shed light on the critical need for clinics to re-evaluate and fortify their emotional support infrastructure, ensuring it aligns with patient expectations and contributes positively to their overall experience. Limitations, reasons for caution Differences in participant demographics over study years may influence individual perspectives. Feedback could be influenced by participants’ mood on the survey day, and the global online distribution encompassing diverse clinics adds variability to responses. Wider implications of the findings The study reveals a gap in emotional support provision despite extensive research on IVF’s emotional impact. Patients hesitate to voice concerns, contributing to treatment dropout rates. Addressing this, the study suggests guidelines to help clinics establish a supportive culture from initial contact, potentially reducing dropout rates and improving patient experiences. Trial registration number not applicable

P-057 Do the reduction of sexual abstinence influence sperm DNA fragmentation? Exploring the relationship between the two parameters

Abstract Study question Is the reduction of sexual abstinence (SA) really beneficial on sperm DNA fragmentation? Summary answer Despite recent studies support short SA’s positive impact on sperm parameters, apparently a reduced SA has not a clear impact on sperm DNA fragmentation. What is known already Sperm DNA fragmentation (sDF) has been linked to male infertility, affecting the success of fertility treatments. It’s strictly associated with failure and/or no longer time to conceive, impaired embryo development or higher miscarriege rates. The exact mechanism for age-dependent patterns of sperm decline is still not fully understood. Several factors, such as the increase in free radicals in conjuction with the rising in SA, have been discussed in literature. Recent studies support short SA’s positive impact on sperm parameters, despite controversial results; hence, we decided to analyze the trend in our facility: Humanitas Fertility Center. Study design, size, duration The present retrospective analysis, performed between 2021 and 2023, aims to investigate whether or not a reduced SA is beneficial on sperm DNA fragmentation in patients undergoing IVF. In our study 828 patients (from 21 to 59 years old) underwent both sperm analysis and sDF evaluation through Sperm Chromatin Structure Assay (SCSA). A DNA fragmentation index (DFI) lower than 30% indicates a sperm population with a good chromatin integrity, according to current knowledge. Participants/materials, setting, methods Patients were split in 4 groups, based on their age (≤38 and &amp;gt;38 years) and days of SA (0-3 and 4-7 days). Group 1 (n = 111/828): ≤38 years, ≤3 days; Group 2 (n = 359/828): ≤38 years, &amp;gt;3 days; Group 3 (n = 83/828): &amp;gt;38 years, ≤3 days; Group 4 (n = 275/828): &amp;gt;38 years, &amp;gt;3 days. Statistics was performed to analyze the variance among DFI values belonging to the four groups analyzed. Main results and the role of chance The results are expressed as mean(±SD). In Group 1, DFI %: 22,5(±14,7); in Group 2, DFI %: 21,5(±14,3); in Group 3, DFI %: 22,3(±14,9); in Group 4, DFI %: 26(±16,3). Surprisingly we observed the same behavior between most of the groups analyzed, except for the one belonging to the older patients. As a matter of fact, we found no statistical difference by comparing the DFI values belonging to samples of the same age stratification (≤38 or &amp;gt; 38 years), indeed Group 1 vs. Group 2: P=0,546; Group 3 vs. Group 4: P=0,1152. Different results were observed by comparing groups with the same SA days (≤3 or &amp;gt; 3), but belonging to a different age stratification, as it follows: Group 1 vs. Group 3: P=0,6384; Group 2 vs. Group 4: P=0,0001. This leads us to think that only the mixture of advanced paternal age (&amp;gt;38 years) and the increase of SA defines a worsening of DFI, according to our patients’ stratification. Limitations, reasons for caution There’s no homogeneity in the number of patients recruited with ≤3 days of SA compared to those with &amp;gt;3 days, as expected. Men undergoing fertility treatments follow strict SA guidelines; moreover, there’s no consensus about to request a second semen sample in clinical practice, in order to eliminate SA. Wider implications of the findings Exploring the inclusion of a broader spectrum of patients with low SA, despite their age, or instructing them to undergo semen analysis with a 0-day SA, could yield interesting insights. This could lead to targeted interventions and treatments, offering further hope for individuals with sDF issues. Trial registration number Not applicable

O-079 Reflecting on the fertility journey: Insights from couples who discontinued fertility treatment without giving birth

Abstract Study question How can we enhance the experience of individuals pursuing fertility treatment, from the standpoint of those who have faced unsuccessful outcomes in their treatments? Summary answer The current study identified ways to improve couples’ experience by addressing their unmet needs within the context of fertility care. What is known already Couples seeking fertility treatment face many challenges. Previous studies reported that 20% to 30% of couples decide to discontinue treatment before achieving pregnancy. Exploring ways to improve the experience of individuals seeking fertility treatment is therefore important to reduce treatment dropout. Previous studies have addressed the needs of individuals seeking fertility care, particularly in terms of information and psychosocial support. These studies were predominantely quantitative, limiting the exploration of couples’ subjective perspective. The present study addressed this limitation by using a qualitative research design, allowing for the emergence of other unmet needs and a more nuanced description of couples’ experiences. Study design, size, duration Eleven Canadian couples (n = 22 participants) who stopped fertility treatment without giving birth took part in a qualitative study in Quebec, which was approved by the researchers’ institutional review board. Data were collected between December 2022 and August 2023 as part of a larger qualitative study examining the individual and relational experiences of couples who stopped fertility treatment as well as the clinical context that may have contributed to their decision of discontinuing treatment. Participants/materials, setting, methods Couples who experienced at least one unsuccessful fertility treatment cycle and decided to stop without giving birth were eligible to participate. Ten mixed-gender/sex and one same-gender/sex couples participated in a dyadic online semi-structured interview. Participants were aged between 28 and 47 years old. Four couples were childless. Each interview lasted between 40 and 65 minutes. Interviews were transcribed and verbatims were analyzed by two independent coders using the NVivo software through thematic analysis. Main results and the role of chance During the interviews, partners discussed unmet needs and suggested ways in which these needs could be addressed. Eight themes regarding ways to improve the experience of individuals seeking fertility treatment emerged as as result of the thematic analysis. Namely, (1) providing more information to set realistic expectations (e.g., discussing the demands of fertility treatment and the possibility of treatment not working), (2) improving the physical environment within fertility clinics (e.g., providing a room for couples to gather their thoughts after a difficult announcement), (3) enhancing the sensitivity and availability of healthcare professionals (e.g., showing empathy towards the challenges that couples may face), (4) supplying reliable and accessible information that are expressed in simple non-medical terms (e.g., taking the time to explain medical terms and procedures), (5) promoting patient autonomy regarding fertility care (e.g., suggesting treatment options that take their context into account), (6) providing psychological support (e.g., increasing access to mental health professionals), (7) making patient-centered fertility care more accessible (e.g., offering low-cost psychosocial support), and (8) normalizing the experience of infertility and fertility treatment (e.g., encouraging couples to talk about their experience, offering support groups). Limitations, reasons for caution Participants discontinued fertility treatment without giving birth, making them more likely to have had negative experiences in fertility clinics. Individuals undergoing treatment or who have had successful treatment outcomes might have different perspectives. Additionally, couples came from only four fertility clinics in Quebec, Canada, limiting the heterogeneity of the sample. Wider implications of the findings The present study highlighted areas where services for couples undergoing fertility treatment could be enhanced. Findings may help healthcare providers gain a deeper understanding of the needs of their patients, and inform the development of sensible and reliable resources, which might ultimately help reduce treatment discontinuation. Trial registration number not applicable

O-061 Ovarian cancer and fertility - current understanding

Abstract Introduction Ovarian cancer is a significant health concern worldwide and is the leading cause of death from gynecologic malignancies. While fertility preservation is essential for many young women diagnosed with cancer, concerns have been raised regarding the potential impact of fertility treatments on the risk of ovarian cancer development. 1. Ovarian Cancer Risk Factors Ovarian cancer is a multifactorial disease with various risk factors contributing to its development. A woman has a risk of 1 in 78 of having ovarian cancer in her life time, risk factors include: • Age: Ovarian cancer risk increases with age, with the highest incidence observed in women over 50 years old. About 12.1% of Ovarian Cancer patients are younger than 44 years old. • Family History: Women with a family history of ovarian or breast cancer, especially first-degree relatives, have an increased risk. • BRCA Mutations: Inherited mutations in BRCA1 and BRCA2 genes significantly elevate the risk of ovarian cancer. • Reproductive Factors: Factors such as nulliparity, early menarche, late menopause, and infertility have been associated with an increased risk of ovarian cancer. 2. Fertility Treatments and Ovarian Cancer Risk Understanding the mechanisms underlying ovarian cancer development is crucial for assessing the potential impact of fertility treatments : • Ovulation Hypothesis: The repeated ovulation theory suggests that each ovulatory cycle increases the risk of DNA damage to ovarian epithelial cells, potentially leading to cancer development. The use of fertility drugs to stimulate ovulation, such as clomiphene citrate and gonadotropins, has been studied , the early studies suggested a potential increased risk, more recent evidence has been conflicting, with some studies reporting no association. • In Vitro Fertilization (IVF): Several large-scale studies have investigated the relationship between IVF and ovarian cancer risk found no significant increase in ovarian cancer risk . • Hormonal Influence: Fertility drugs alter hormonal levels, particularly estrogen and progesterone, which may influence ovarian cancer risk. • Selection Bias: Some studies have suggested that the ovarian cancer risk may be confounded by underlying infertility factors rather than the treatments themselves. 3. Clinical Implications and Recommendations • Individual Risk Assessment: Clinicians should assess each patient's individual risk factors for ovarian cancer, including age, family history, and reproductive history, before initiating fertility treatments. • Informed Consent: Patients should be provided with comprehensive information regarding the potential risks and benefits of fertility treatments • Regular Surveillance: Women undergoing fertility treatments should receive regular gynecologic screenings and follow-up care to monitor for any signs or symptoms of ovarian cancer. • Shared Decision Making: Shared decision making between patients and healthcare providers is essential to ensure that treatment decisions align with patients' preferences and values. 4. Fertility Preservation Options • Most therapeutic options for Ovarian Cancer cause infertility, either by premature ovarian failure caused by cytotoxic agents in chemotherapy or surgical approaches that include unilateral or bilateral oophorectomy • In ovarian cancer patients, Oocyte cryopreservation is still the best option and the only one established along with embryo cryopreservation. Fertility preservation surgery can be suggested depending on histology, stage of disease and pre-existing ovarian reserve. • Ovarian tissue cryopreservation will not be an option as long as the risk of reseeding cancer cells is not fully eliminated. 5. Future Directions Advancements in molecular biology and genetics may shed light on the underlying mechanisms of ovarian cancer development and its potential association with fertility treatments. The artificial ovary and in vitro maturation of oocytes is a very attractive option in these patients, but further milestones have to be achieved

O-312 Home semen freezing for fertility patients at the time of global travel restrictions due to COVID-19 pandemic

Abstract Study question Can an alternative process for freezing semen be utilized for patients in need of fertility care during the coronavirus disease 2019 (COVID-19) pandemic travel restrictions? Summary answer At-home sperm freezing was developed during COVID-19 to offer fertility care for travel restricted patients, which provided similar IVF outcomes compared to laboratory frozen sperm. What is known already Cases of COVID-19 were first detected in December 2019 spreading rapidly across the world leading to declaration of a pandemic on March 11, 2020 and resulting in international border closures and global travel restrictions lasting into 2023. Sperm freezing by trained laboratory personnel is well established and safe clinical practice. While home semen collection kits existed to extend sperm survival for hours allowing sufficient time for the sample to reach facility to be frozen in the laboratory, there were no home semen freezing methods for longer time constraints available for our patients. Study design, size, duration A specialized home semen freezing process has been developed and validated in-house on research samples. Retrospective analysis was performed to assess home sperm freezing efficiency in patients undergoing fertility treatment. IVF outcomes were compared between home sperm freezing to the samples frozen in our laboratory (control) from 2020 to 2023. Participants/materials, setting, methods In total 508 semen samples frozen at home have been received at the clinic, with 495 (98%) of samples arriving within set time of 18 days in optimal frozen condition. Delivery of 12 samples were delayed causing sample thawing during transportation that required a new at home freezing. Only IVF with ova donors were included to compare outcomes of 448 IVF with semen frozen at home to 421 IVF with semen frozen in the laboratory. Main results and the role of chance Only 17 (3%) of home semen samples arrived from patients within Canada, while 491 (97%) were from patients of 27 different countries of several regions: Europe 346 (68%), Australia 73 (15%), Middle East 36 (7%), USA 26 (5%), Asia 7 (1.5%), and Latin America 3 (0.5%). Men from the study group were similar to control in terms of age (36 ± 5.2 versus 36.8 ± 5.8). Post thaw test was performed on all home freezing samples as a quality control to ensure that sufficient sample was available for IVF: mean sperm concentration was 25.3 M/ml ± 14.8 and motility of 21% ± 10. IVF outcomes between samples frozen at home or in the lab were compared; fertilization (80.3% ± 14.6 v. 79.6 ± 19.3), blastulation (66.5% ± 20.7 v. 66.6% ± 19.3%), clinical pregnancy (39.1% v. 38.8%), miscarriage (14.6% v.6.7%) or life birth (30.9% v. 31.6%), respectively, were not statistically different. PGT-A was performed on 7224 blastocysts with results controlled by the age of ova donors and were not statistically different for embryos derived from sperm frozen at home and in the laboratory with euploidy (65.3% v. 64.6%), mosaic (14.8% v.13.8%) and aneuploidy (19.9% v. 21.6%), respectively. Limitations, reasons for caution Pre-freezing semen analysis was only available for laboratory frozen samples. Post-thaw results were not compared between home and laboratory frozen sample as different freezing protocols with two dilution factor (1:1 v. 3:1) and different sample volume per frozen unit (0.1-1.2 ml in vial v. 0.5 ml in straw) were used. Wider implications of the findings In cases where it is logistically difficult or impossible for sperm providers to travel to the clinic for IVF treatment, home semen freezing performed by the patient is a viable and safe method. Trial registration number not applicable

Attitudes, concerns, and perceptions of patients undergoing fertility treatments in an abortion restrictive state in the aftermath of the Roe v. Wade reversal.

To investigate the abortion views and reproductive concerns of current in vitro fertilization patients after the US Supreme Court Dobbs v. Jackson decision, which overturned the Roe v. Wade decision guaranteeing abortion access. This is a cross-sectional survey of English-speaking patients undergoing in vitro fertilization from January to November 2022 at a large academic institution in a state with restricted abortion care. Participants completed a 43-question electronic survey which measured feelings about abortion, future fertility treatments, and embryo disposition both quantitatively and qualitatively. Of 543 eligible patients, 267 (49%) consented to participate when called and were sent the survey. Of those, 180 (67%) completed it, resulting in a total completion rate of 33%. The majority believe abortion should be legal in the case of birth defects (90.8%) or rape or incest (90.3%). A significant proportion (91.4%) expressed concerns about abortion being illegal in the state that they receive infertility care. They reported some concern about making embryos (89.6%), controlling what happens to them (95.4%), and discarding them (94.4%). Patients wrote about their concerns with pursuing fertility treatments, fear of not having access to needed medical care, and the desire to remain close to states with less restrictive abortion laws. The evolving political landscape surrounding access to reproductive care has created significant concerns regarding legal regulation of these treatments and the disposition of embryos. By understanding patients' concerns, health care providers can more effectively advocate for the protection of fertility treatments and patients' autonomy in embryo disposition.

Body Mass Index as a Factor Influencing Oocyte Competence and Implantation Potential – Distribution and Results in 4,882 Women Undergoing Fertility Treatment

Abstract Introduction The large amount of excess adipose tissue affects negatively every single step of the assisted reproductive treatment process – from the controlled ovarian hyperstimulation (COH) to obstetric complications and health consequences for the fetus. A number of scientific data show correlation between impaired clinical pregnancy rates (CPR) and obese patients maintaining high body mass index (BMI). The debate whether high proportion of body fat negatively affects oocyte quality or only impacts endometrial receptivity remains open. Aim The aim of this study is to investigate the specific effect of the different BMI range in patients undergoing assisted reproductive technology (ART) treatment with reference to oocyte quality, fertilization capacity and Implantation potential. Materials and methods We analyzed a total of 4,882 women from partner couples who underwent ART treatment. Height and weight data were entered at the start of the in vitro fertilization (IVF) procedure. According to their BMI the female patients were divided in four distinct groups: in group 1 (underweight and BMI below 18.5 kg/m2) – 498 women, group 2 (normal range from 18.5 to 24.9 kg/m2) – 3021 women, group 3 (overweight with BMI between 25 – 29.9 kg/m2) – 789 women and group 4 (obese with BMI over 30 kg/m2) - 484 women. Results Distribution of the women in different BMI groups indicates that most of the Bulgarian patients undergoing fertility treatment are in the normal range. No association between BMI and ovarian response was found. A total of 33,205 oocytes were obtained after the COH. The mean numbers of the retrieved oocytes were similar (6,85 in group 1; 6,83 in group 2, 6,77 in group 3 and 6,67 in group 4) per woman and the fertilization rate was comparable in the four groups as it varies between 74-75%. Proportional categories of good, fair and bad embryos at cleavage stage were found. On the contrary according to CPR, Statistical difference between normal weight group (34,38%) versus overweight (29,6%) and obese groups (28,80%) (p &lt; 0,05) was found. Conclusion No correlation was found between the number of the retrieved oocytes and BMI values. Statistically lower pregnancy rates were reported in overweight women with BMI ≥ 25 kg/m2 group and further onwards in the obesity group (BMI ≥ 30 kg/m2), which may be associated with impaired endometrial receptivity as a result of abnormally high levels of adipose tissue.

A comprehensive analysis of spermatozoal RNA elements in idiopathic infertile males undergoing fertility treatment

Current approaches to diagnosing male infertility inadequately assess the complexity of the male gamete. Beyond the paternal haploid genome, spermatozoa also deliver coding and non-coding RNAs to the oocyte. While sperm-borne RNAs have demonstrated potential involvement in embryo development, the underlying mechanisms remain unclear. In this study, 47 sperm samples from normozoospermic males undergoing fertility treatment using donor oocytes were sequenced and analyzed to evaluate associations between sperm RNA elements (exon-sized sequences) and blastocyst progression. A total of 366 RNA elements (REs) were significantly associated with blastocyst rate (padj < 0.05), some of which were linked to genes related to critical developmental processes, including mitotic spindle formation and both ectoderm and mesoderm specification. Of note, 27 RE-associated RNAs are predicted targets of our previously reported list of developmentally significant miRNAs. Inverse RE-miRNA expression patterns were consistent with miRNA-mediated down-regulation. This study provides a comprehensive set of REs which differ by the patient’s ability to produce blastocysts. This knowledge can be leveraged to improve clinical screening of male infertility and ultimately reduce time to pregnancy.

Determining the cost-effectiveness of follitropin alfa biosimilar compared to follitropin alfa originator in women undergoing fertility treatment in France

ObjectiveThe study assessed cost-effectiveness of follitropin alfa biosimilar versus the originator in terms of cost per cumulative live-birth (CLB) for the French healthcare system based on real-world evidence. Follitropin alfa biosimilars have been shown to have comparable clinical outcomes to the originator, in both clinical studies and real-world settings, in terms of oocyte retrieval and cumulative live-birth rate (CLBR). Previous health economic studies comparing the cost-effectiveness of follitropin alfa biosimilars against the originator utilised clinical trial data, leaving ambiguity over cost-effectiveness in real-world settings. Additionally, previous cost-effectiveness analysis has been performed for live-births following only fresh embryo transfers, whereas, fresh and frozen transfers are common in clinical practice. This study investigates the cost per CLB, which more closely models clinical practice. Study designA decision-tree cost-effectiveness model was developed based on the total costs and CLBR per ovarian stimulation (OS) for a follitropin alfa biosimilar (Bemfola®, Gedeon Richter Plc, Budapest, Hungary) and the originator (Gonal-f®, Merck KGaA, Darmstadt, Germany). A time horizon of one year from oocyte retrieval to embryo transfer was used but costs from resulting transfers were also included. Clinical inputs were taken from the REOLA real-world study or clinician insights, while acquisition costs were taken from French public databases. The output was cost per CLB following one OS. One-way sensitivity analysis was performed to determine the largest model drivers. ResultsCost per CLB was €18,147 with follitropin alfa biosimilar and €18,834 with the originator, saving €687 per CLB following OS with the biosimilar. When wastage estimates were considered the biosimilar cost saving is estimated to be between €796 and €1,155 per CLB further increasing cost savings. Irrespective of wastage, if used ubiquitously throughout France for ART, the biosimilar could save the French health system €13,994,190 or lead to 771 more births when compared to its higher-cost originator. Sensitivity analysis showed that the originator’s relative CLBR had the greatest impact on the model. ConclusionThis analysis demonstrates that the follitropin alfa biosimilar, Bemfola®, is a more cost-effective option for OS compared with the originator from a French healthcare payer perspective, in terms of cost per CLB.

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.

The mammalian sperm factor phospholipase C zeta is critical for early embryo division and pregnancy in humans and mice.