Human reproduction最新文献

{"title":"P-154 Comparison of conventional embryo evaluation and AI models for predicting viability and competence of vitrified-warmed blastocysts","authors":"S Perez Albala, L Conversa, P Vercet, T Carrión, A Cobo, M Meseguer","doi":"10.1093/humrep/deaf097.463","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.463","url":null,"abstract":"Study question Can AI-based models outperform conventional embryo assessment methods in predicting embryo viability and implantation outcomes? Summary answer Conventional evaluation surpassed AI models before vitrification, while one AI algorithm outperformed the other overall, highlighting the potential of combining traditional and AI approaches. What is known already Vitrification is the safest method for cryopreserving human embryos, but abrupt temperature and osmolarity changes can damage blastocysts and deteriorate their quality. Therefore, the increasing number of frozen cycle transfers makes it necessary to optimize the way in which embryos undergoing vitrification are evaluated. Previous studies demonstrate the usefulness of AI in scoring vitrified-warmed embryos by providing objective and reproducible assessments. This study estimated the prediction errors and concordance between a conventional embryo evaluation method and two AI-based models to compare their predictive ability and to find the most accurate approach for the prediction of embryo viability and implantation. Study design, size, duration This single-center retrospective study included 846 blastocysts, 815 of them with known implantation data. They were vitrified and warmed by the Cryotop method (Kitazato, Japan) and placed in EmbryoScope (Vitrolife, Denmark) time-lapse incubators in the period between warming and transfer. Embryos were assessed before and after vitrification by experienced embryologists using ASEBIR morphological criteria (categories A, B, and C) and two different image-based AI models: Embryo Predict by Alife Health and Life Whisperer Viability (LWV). Participants/materials, setting, methods ASEBIR criteria and AI models (Alife and LWV) were compared by estimating prediction errors and concordance between them. Percentage errors in prediction of warming survival and implantation were calculated for ASEBIR categories A and C, and for upper and lower limits of the AI algorithms. These limits were defined by adjusting the percentiles of the AI scores to the frequencies of the ASEBIR categories. Concordance was analysed using the Kappa index in SPSS (IBM®). Main results and the role of chance In predicting implantation outcome, the ASEBIR assessment had total errors of 37.5% and 35.3% before vitrification and after warming, respectively. Setting the LWV score limits to < 2.5 (error means implanted) and >9.2 (error means non-implanted) for pre-vitrification images, the error was 45.9%, and 43.1% for post-warming images with score limits of < 1.8 and >8.5. For the Alife algorithm, score limits were <1.7 and >5.8, with 37.7% error for pre-vitrification, and <1.5 and >4.3, with 38.6% error for post-warming images. In the prediction of survival to warming, pre-vitrification ASEBIR scoring performed with 48.6% of error. Embryologists classified surviving embryos as A, B or C, and non-viable embryos as D after wa","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"91 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-359 Patients’ experiences with elective egg freezing (EEF) consent processes: best practices and recommendations for improving informed consent","authors":"K Hammond","doi":"10.1093/humrep/deaf097.665","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.665","url":null,"abstract":"Study question What are the consent processes for patients undergoing EEF at Canadian fertility clinics, and do these patients feel adequately informed through existing consent processes? Summary answer EEF consent processes rely on an unstandardized patchwork of sources. 18 EEF patients felt adequately informed; all patients thought that consent processes could be improved. What is known already The use of EEF is on the rise. Scholars have argued that the aggressive marketing of EEF, along with the fact that it is not medically necessary, necessitates a heightened standard for informed consent. In particular, scholars have argued that EEF patients need clear honest information that not only makes success rates clear but also provides patients with essential information about risks, costs, and options for the future uses of genetic material. Despite this, little to no research has evaluated EEF consent processes and EEF patients’ perceptions of these processes. This study sought to fill this gap. Study design, size, duration This study comprised of: (1) qualitative semi-structured interviews (average 37 minutes) with 27 participants, over the age of 18, who had undergone at least one cycle of EEF at a Canadian fertility clinic. Interviews occurred between April 2023 and September 2024. (2) Consent materials were collected from 11 Canadian fertility clinics. In February 2024 all Canadian fertility clinics were contacted by email with a request for samples of consent forms and accompanying materials. Participants/materials, setting, methods Average participant age, at time of freezing eggs, was 35 (range: 21-40). Interviews took place over Zoom and were recorded, transcribed and analyzed through NVivo. Consent materials came from clinics across Canada. In addition to the 11 consent forms, accompanying materials included information packages, brochures, online materials, and videos. All consent materials were analyzed by the principal investigator and a research assistant according to seven elements of ethical standards of disclosure. Main results and the role of chance Consent processes vary significantly from clinic to clinic and rely on an unstandardized patchwork of materials. Some consent materials are very thorough, but most did not adhere to minimum standards of disclosure. There were 8 areas that were recurringly mentioned by participants (5+) as areas where they did not feel as though they were given adequate information. These were: (1) administration of hormone injections, (2) logistics of the egg retrieval, (3) subsequent procedures to use frozen eggs (e.g. IVF), (4) emotional risks and inconveniences, (5) egg storage (cost and location) (6) success rates at the clinic where they pursued EEF, (7) options for any unused eggs, and (8) possibility to freeze embryos. In terms of how information was given, best practices noted by participants included: thorough meeting with the physician, opportunity to ask questions after initial meeting, in","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"40 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-063 Effect of age on semen parameters, sperm DNA fragmentation and hormones of 1500 men attending a tertiary medical center in Qatar","authors":"A Al Saeedi, M Arafa, H Elbardisi, K AlKubaisi, A AlMalki, M Mahdi, K Khalafalla, N Fadol, S AlSaid, A Majzoub","doi":"10.1093/humrep/deaf097.372","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.372","url":null,"abstract":"Study question Does advancing age impact semen parameters, sperm DNA fragmentation (SDF), and reproductive hormone levels among patients in Qatar? Summary answer Advancing age is linked to decreased semen quality, increased SDF, and hormonal changes, with the strongest association observed between age and SDF. What is known already Aging is associated with declines in semen quality, including reduced sperm concentration, motility, and normal morphology, alongside increased SDF and altered reproductive hormone levels. While these age-related changes have been documented globally, limited data exist on how these trends manifest in the Qatari population, underscoring the need for further investigation. Study design, size, duration This was a retrospective study of 1500 patients presenting to male fertility unit in a tertiary hospital over a period of 5 years. Exclusion criteria were presence of azoospermia, genetic abnormalities, cryptorchidism, chemo- or radiotherapy, clinical varicocele, endocrine abnormalities, and history of infectious or inflammatory genital condition. Participants/materials, setting, methods The medical charts were reviewed retrospectively to collect demographic and clinical data, including age, marital status, semen analysis (WHO 5th edition), SDF (sperm chromatin dispersion, cutoff 30%), and hormone levels (FSH, LH, Prolactin, Testosterone, Estradiol). Participants were grouped by age (<30, 30-40, 40-50, >50 years). Spearman’s correlation and Kruskal-Wallis test analyzed numerical data. A p-value <0.05 was considered statistically significant. Main results and the role of chance The median age of all participants was 35 years (IQR: 31–35). Of the 1500 participants, 297 (19.6%) were <30 , 778 (51.9%) 30–40, 332 (22.1%) 40–50, and 97 (6.4%) >60 years of age. Age was found to be significantly positively correlated with BMI (r = 0.11, p < 0.001), FSH (r = 0.12, p = 0.001), and SDF (r = 0.31, p < 0.001), while it was significantly negatively correlated with serum testosterone (r=-0.11, p = 0.005), prolactin (r=-0.12, p = 0.001), total (r=-0.13, p < 0.001) and progressive motility (r=-0.11, p < 0.001), normal morphology (r=-0.1, p = 0.001), and viability (r=-0.15, p = 0.01). The strongest relationship was observed between age and SDF with the median SDF found in men >50 years =32 (19-53). Limitations, reasons for caution Retrospective study, single center experience. Inclusion of additional variables could have benefited the results and their interpretation. Wider implications of the findings These findings highlight the negative impact of aging on semen quality and reproductive hormones, emphasizing the need for early fertility assessment and counseling. The strong association between age and SDF suggests potential implications for natural conception and assisted reproduction, reinforcing the importance of considering paternal age in reproductive planning. Tria","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"9 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O-249 Surgery versus IVF for the treatment of infertility associated to ovarian and deep endometriosis (SVIDOE). Preliminary results from a multicenter randomized controlled trial","authors":"L Benaglia, M Reschini, J Ottolina, I La Vecchia, R Villanacci, V Liprandi, L Buggio, G Belloni, E Papaleo, M Candiani, V Michele, P Viganò, P Vercellini, E Somigliana","doi":"10.1093/humrep/deaf097.249","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.249","url":null,"abstract":"Study question Is IVF more effective than surgery for treating infertility associated to ovarian and deep endometriosis detected at ultrasound? Summary answer The live birth rate within a year from the study’s beginning was significantly higher in IVF group compared to that obtained in the surgery group What is known already The management of endometriosis-associated infertility is still controversial. To date, no randomized controlled trials (RCTs) have definitively clarified the potential benefits of surgery versus assisted reproductive techniques in women with advanced endometriosis, particularly those with ovarian endometriomas or deep peritoneal lesions. Currently, the choice between surgery and IVF is individualized, considering the advantages and limitations of each approach alongside the patient’s clinical profile. Due to the absence of RCTs or robust prospective studies, treatment strategies for women with endometriosis vary significantly across centers. Study design, size, duration This is a multicentric, not blinded, RCT comparing pregnancy chances between infertile women with sonographically identified endometriosis undergoing surgery and those treated with IVF. All participants underwent infertility treatments or surgery at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, IRCCS San Raffaele Scientific Institute or Macedonio Melloni Hospital (Milan-Italy), between April 2021 and September 2024. Participants/materials, setting, methods Endometriosis women who had been seeking pregnancy for over 12 months with a partner with normal semen were randomized to either surgery followed by natural pregnancy attempts or a three-cycle IVF program. Women who declined randomization were monitored in a patient-preference trial (PPT). Previous surgery for endometriosis was an exclusion criterion. The primary outcome included only live births achieved within 12 months from the study’s starting point. Main results and the role of chance A total of 130 women were recruited. Among them, 55 were randomized (28 to IVF and 27 to surgery), while 75 chose their preferred treatment (50 opted for IVF and 25 for surgery). Baseline characteristics were comparable between the two groups. In the intention-to-treat analysis, the live birth rate (LBR) was significantly higher in the IVF group compared to the surgery group (46% vs. 23%, p = 0.009). Additionally, 12 pregnancies are still ongoing, with an ongoing pregnancy rate (>20 weeks) of 60% in the IVF group and 27% in the surgery group (p < 0.001). Kaplan-Meier survival analysis of time to LBR further demonstrated a significant advantage for IVF (p = 0.004). Six patients conceived naturally before treatment, and six withdrew from the trial, leading to a per-protocol analysis including 118 patients. The results remained consistent, with LBR still significantly higher in the IVF group compared to surgery (47% vs. 20%, p = 0.005). The ongoing pregnancy rate was also significantly greater in t","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"22 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-605 The predictive role of follicle-stimulating hormone receptor polymorphism on letrozole resistance in women with polycystic ovary syndrome","authors":"Q Wang, Z Xiuxian, L Jingwen, Z Yunqing, B Shihua, F Yonglun","doi":"10.1093/humrep/deaf097.911","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.911","url":null,"abstract":"Study question Whether follicle stimulating hormone receptor (FSHR) polymorphism can predict letrozole resistance in women with polycystic ovarian syndrome (PCOS) during ovulation induction therapy. Summary answer The Asn/Asn polymorphism at FSHR 680 position and Thr/Thr polymorphism at FSHR 307 position were potential predictors for letrozole resistance in women with PCOS. What is known already Letrozole is an oral medication for ovulation induction, which gradually becomes an essential first-line treatment for anovulatory infertility. However, there are still a proportion of non-responsive cycles during letrozole therapy, which is defined as “letrozole resistance”. Exploring potential markers to predict the ovarian response during ovulation induction will help women with PCOS achieve conception in a shorter time with a lower expense. Previous studies have shown that FSHR polymorphism is associated with ovarian response. However, the relationship between FSHR polymorphism and the ovarian response to letrozole has not been reported. Study design, size, duration This was a retrospective study that included 133 women with PCOS (93 with letrozole response and 40 with letrozole resistance) between January 2021 and May 2024. Participants/materials, setting, methods Data on demographics were collected, and the genotyping of the FSHR single nucleotide polymorphisms (c.2039A>G, rs6166 at position 680, and c.919A>G, rs6165 at position 307) was carried out using the predesigned TaqMan SNP assays. Binary logistic regression model was used for the prediction of FSHR polymorphisms on letrozole resistance. Main results and the role of chance The distribution rate of Asn/Asn polymorphism at position 680 was significantly higher [OR: 1.543 (95% CI, 1.046-2.278), P = 0.013] in letrozole resistance group (57.5%) compared to letrozole response group (34.41%), so as to the distribution rate of Thr/Thr polymorphism at position 307 [57.5% vs. 30.11%; OR: 1.645 (95% CI, 1.120-2.415), P = 0.003]. As a result, significantly more participants with Asn/Asn polymorphism or Thr/Thr polymorphism were resistant to letrozole compared to other polymorphisms. Logistic regression model showed that Asn/Asn polymorphism tended to be a risk factor [OR: 5.227 (95% CI, 0.994-27.490), P = 0.051] for letrozole response, while Thr/Thr polymorphism significantly influenced [OR: 7.04 (95% CI, 1.394-35.559), P = 0.018] letrozole response. Limitations, reasons for caution Our study is limited by the retrospective design and the small sample size, thus additional prospective trials with a larger sample size are needed to verify our findings. In addition, the mechanism on how FSHR genotype affects ovarian response to letrozole treatment needs to be further explored. Wider implications of the findings Our study provided evidence for making individualized ovulation induction strategies according to the FSHR genotypes, which help to better guide the selection of ovulation-induction m","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"15 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-295 Consequences of embryos transfer following fresh biopsy (single vitrification) and frozen-thaw embryo biopsy (double vitrification) after preimplantation genetic testing for aneuploidy: A retrospective cohort analysis","authors":"D D Dave, P Joshi, V Bansi, V Sisodiya, D Talwar, R Aggarwal, N Shah, V Chandra, N Murdia, K Murdia, W Mistari","doi":"10.1093/humrep/deaf097.603","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.603","url":null,"abstract":"Study question Does exposure of embryos to double vitrification and double warming affect the chances of ongoing pregnancy for patients undergoing embryo biopsy and euploid embryos transfer? Summary answer A significantly higher statistical clinical outcomes were established in fresh embryo biopsy as compared to freeze-thaw embryo biopsy cycles. What is known already In couples and clinicians, often uncertainty is observed while testing cryopreserved embryos for embryo selection via preimplantation genetic testing for aneuploidy (PGT-A). The utilization of PGT-A over the years has been augmented and leads to the lowering down of the genetic disorders in neonates. The effect of transferring euploid thaw, biopsy, refreeze (TBR) embryos is inconclusive and ESHRE PGT Consortium and SIG Embryology good practice recommendations of 2020 depicted that multiple cryopreservation and its impact on pregnancy outcomes requires further investigations. This investigation aims to uncover the effects of transferring a freeze-thaw biopsy embryos in comparison to fresh biopsy embryos. Study design, size, duration It is a single centric retrospective observational study conducted during the timeline of May 2021 to September 2024 with data of 181 frozen euploid embryo transfers (FETs). The research had two arms, embryos underwent fresh PGT-A, control group (n = 114) and embryos underwent freeze-thaw PGT-A, comparative group (n = 67). The research included a maximum of two grade 1 embryo transfers and the bias was eliminated by matching the patient’s characteristics and indications and embryo morphology. Participants/materials, setting, methods In fresh PGT-A group, the embryos were cultured till day5 or 6 using standard protocol and PGT-A was performed by aspirating 5-10 cells from trophectoderm and vitrified until transfer. In the freeze-thaw PGT-A group (previous failure) the good embryos vitrified on day5 or 6 were thawed for PGT-A and re-vitrified until transfer. The clinical outcomes in the groups were estimated. Statistical analysis was performed using chi-square and Fisher Exact test and p < 0.05 was considered significant. Main results and the role of chance Our investigation decodes that in the freeze-thaw embryo biopsy (n = 67) a reduction in clinical pregnancy rate (CPR) of 17.5% was observed compared to fresh embryo biopsy (n = 114) (59.7%, 77.2%; p = 0.018). CPR is defined as the presence of a vital fetal heart observed at 6-8 weeks scan. For biochemical pregnancy rate (BPR) a decrease of 15.9% was seen in the freeze-thaw embryo biopsy group compared with the control group (65.7%, 81.6%; p = 0.020). The pregnancy of the patients was tracked till 12 weeks (ongoing pregnancy rate) and a decline of 15.2% was observed in freeze-thaw embryo biopsy group compared with the control group (56.7%, 71.9%; p = 0.048). Simultaneously, the trimester losses were also calculated, and it was observed that biochemical loss rate was higher by 3.7% in patients underw","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"46 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-279 Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy","authors":"M Cozzolino, M G Massaro, A Capalbo, L Pellegrini, A Pellicer, D Galliano","doi":"10.1093/humrep/deaf097.587","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.587","url":null,"abstract":"Study question Do donor oocyte recipients benefit from preimplantation genetic testing for aneuploidy (PGT-A)? Summary answer The PGT-A does not improve the likelihood of live birth and time to pregnancy for recipients of vitrified donor oocytes. What is known already Oocyte vitrification has led to increased live birth from cryopreserved oocytes and has led to widespread use of this technology in donor egg IVF programs. However, oocyte cryopreservation has the potential to disrupt the meiotic spindle leading to abnormal segregation of chromosomes during meiosis II and may increase aneuploidy in the blastocyst. Therefore, PGT-A might have benefits in vitrified donor egg cycles. However, blastocysts derived from young donor oocytes are expected to be predominantly euploid, and trophectoderm biopsy may harm blastocysts compared to embryo transfer without PGT-A. Study design, size, duration Retrospective single-center study encompassing 2233 vitrified-warmed donor oocyte cycles conducted between March 2021 and August 2024 at a private Italian IVF clinic. The study included 299 donor cycles with and 1934 without PGT-A. Vitrified donor oocyte cycles were analyzed for live birth as the main outcome measure. Secondary outcomes were time to achieve pregnancy defined as the days from the egg thawing until a live birth achieved, clinical pregnancy, ongoing pregnancy miscarriage rates. Participants/materials, setting, methods The study included women aged 30-49 who underwent blastocyst single embryo transfer (SET). Trophectoderm biopsy was performed on day 5 or 6 based on embryo development. Both natural and artificial cycle SETs were considered. Exclusions were women with fibroids >3 cm, severe adenomyosis, or male partners with sperm concentration <1 million/ml. Statistical analyses included chi-square and Student’s t-tests for group comparisons. Logistic regression adjusted for confounders was used to analyze live birth rates (LBR). Main results and the role of chance The fertilization and blastulation rates were similar in both groups with PGT and no-PGT-A, respectively p = 0.24 and p = 0.49.The mean euploidy rate per recipient was 75.3% in the PGT-A group.No statistical differences were reported for age of the donor type of endometrial preparation (natural/artificial), endometrial thickness, and days of endometrial preparation.Regarding the sperm parameter in the PGT-A, the sperm concentration (mil/mL) and sperm motility was lower than no-PGT-A (p < 0.001).The live birth rate was not different in the PGT-A group 39.9% (CI95%35.31-44.74) vs no-PGT-A 42.9% (40.95-44.87), p = 0.27.The days to reach a live birth was higher in the group with PGT-A 65.5 (CI 95% 44.31-86.77) than no PGT-A 49.7 (CI95%42.52-56.95), p = 0.48.The pregnancy rate was lower in the PGT-A group 53.3% than in no-PGT-A 62.3% (p < 0.01), while no statistical differences were reported for the clinical pregnancy rate 52.33% (CI95% 47.72-56.92) vs 56.6% (CI95%54.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"35 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-456 First trimester sonographic diagnosis and management of abdominal ectopic pregnancy (AEP)","authors":"L Berg, L V De Braud, D Jurkovic","doi":"10.1093/humrep/deaf097.762","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.762","url":null,"abstract":"Study question What are clinical and ultrasound characteristics of first trimester abdominal ectopic pregnancies? Summary answer A significant proportion of AEPs occur after assisted conception. Patients are asymptomatic or have mild symptoms. Ultrasound morphology is varied and early detection is vital. What is known already AEP is rare, accounting for approximately 1% of ectopic pregnancies with a prevalence of 1/10,000 pregnancies. Early detection is critical to initiate timely treatment and decrease the risk of severe maternal morbidity. Although assisted reproductive technology (ART) has been associated with increased risk of ectopic pregnancy, risk factors specific to abdominal ectopic pregnancy are unknown. The aim of this study was to describe ultrasound features of AEP and propose sonographic criteria which could be utilised to aid diagnosis during the first trimester. Study design, size, duration This was a retrospective single-centre study of consecutive patients with a sonographic diagnosis of AEP between 2008 – 2024 at a tertiary referral centre. Participants/materials, setting, methods All patients presenting to our centre with a positive urine pregnancy test are assessed clinically followed by a transvaginal and/or transabdominal ultrasound scan using high resolution equipment. We performed a retrospective review of our database to identify all cases of AEP during the study period. We report clinical and ultrasound characteristics, management and clinical outcomes. In addition, we suggest novel criteria to assist sonographic diagnosis of AEP. Main results and the role of chance Thirteen patients were diagnosed with an abdominal ectopic pregnancy during the study period. Their median age was 35 years and median gestational age at diagnosis was 7 + 1 (range 5 + 4 to 14 + 4) weeks. 5/13 (38%) patients conceived using ART. 5/13 (38%) were asymptomatic, whilst the remaining 8/13 (62%) presented with mild vaginal bleeding and/or abdominal pain. 8/13 (62%) pregnancies were implanted within the pouch of Douglas, 3/13 (23%) within the uterovesical fold and 2/13 (15%) at the pelvic sidewall. Morphology varied from an inhomogeneous swelling in 5/13 (38%) cases to a gestational scan with live embryo in 2/13 (15%) cases. 5/13 (38%) patients opted for expectant management, which was successful in 4/5 (80%) of cases, 7/13 (54%) had laparoscopic excision and the remaining patient had transvaginal ultrasound-guided methotrexate injection because the pregnancy was inaccessible at laparoscopy. Based on our findings, we propose novel sonographic criteria for the diagnosis of AEP: 1) presence of a gestational sac or trophoblastic tissue which is separate from the uterus and ovaries and adherent to the peritoneum, 2) absence of a tissue layer overlying the pregnancy, 3) negative ‘sliding organs’ sign; 4) evidence of blood supply derived from the peritoneal surface on colour Doppler examination. Limitations, reasons for caution The main limitation of thi","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"644 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-602 Impact of recombinant LH supplementation versus FSH alone on cumulative live birth rates: a comprehensive observational study in poor ovarian responders undergoing ART","authors":"S Abbas, H Latif Khan, S Bhatti","doi":"10.1093/humrep/deaf097.908","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.908","url":null,"abstract":"Study question Does luteinizing hormone supplementation improve cumulative live birth rates in poor ovarian responders. Summary answer LH supplementation (LHS) enhances CLBR in moderate and severe poor ovarian responders (POR), with the effect becoming more pronounced as severity increases. What is known already Poor ovarian responders (POR) typically produce fewer oocytes during standard controlled ovarian stimulation (COS), leading to lower live birth rates. Various treatments, including high-dose gonadotropins, mild stimulation, and growth hormones, aim to improve ovarian response. LH supplementation (LHS) has been explored as a potential solution, but results remain conflicting. LHS may enhance follicular maturation and oocyte quality, particularly in hypogonadotropic women. While suppressed LH during GnRH agonist/antagonist COS does not negatively impact IVF outcomes, adding LH in patients with reduced LH does not always improve live birth rates. The potential benefits of LHS in POR remain uncertain and require investigation. Study design, size, duration This retrospective, multicenter controlled study utilized data from 5 ART centers in Pakistan, focusing on poor ovarian responders (POR) treated with follitropin-alfa (FSH-α), with or without lutropin-α, based on an intention-to-treat principle during 2008 to 2020. POR was defined per the ESHRE Bologna criteria and categorized as mild, moderate, or severe using the PROP score. The primary endpoint was CLBR from fresh and frozen embryos derived from the same ovarian stimulation cycle. Participants/materials, setting, methods A total of 12,000 controlled ovarian stimulation (COS) cycles were analyzed, with 6,658 receiving luteinizing hormone supplementation (LHS) and 5,342 receiving FSH-α alone. The intent-to-treat sample included all COS cycles for POR treated with recombinant FSH-α alone or with recombinant LH. A generalized linear mixed model with logistic regression assessed cumulative live birth rate (CLBR), adjusted for PROsPeR score and severity. Random factors included center and matched sub-classes. Missing data (5.9%) were missing at random. Main results and the role of chance The total cycles were classified into Mild (32.6%), Moderate (54.5%), and Severe (12.9%) categories based on POR. A mixed logistic regression model, adjusted for matched sub-classes and baseline severity, revealed a significant improvement in CLBR with luteinizing hormone supplementation (LHS) in patients with moderate (15.7% vs. 12.4%, OR = 1.41, [1.05, 1.40], RR = 1.29, p = 0.015) and severe (9.9% vs. 3.3%, OR = 2.39 [1.34, 3.11], RR = 1.99, p < 0.001) POR. However, no significant benefit was observed in the mild category (16.6% vs. 20.5%, OR = 0.98 [0.68, 2.11], RR = 0.98, p = 0.05). Additionally, the effect of LHS appeared to increase with the severity of baseline POR. In the control group, CLBR was slightly higher for mild POR but declined significantly with increasing severity, reaching just 5.6% f","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"27 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P-115 A deep learning-based system for oocyte image assessment predicts the outcomes of intracytoplasmic sperm injection and morphokinetic fate in human preimplantation embryos","authors":"N Fujiwara, K Ezoe, T Miki, L Vanzella, N Mercuri, J Fjeldstad, P Mojiri, D Nayot, K Kato","doi":"10.1093/humrep/deaf097.424","DOIUrl":"https://doi.org/10.1093/humrep/deaf097.424","url":null,"abstract":"Study question How is the deep learning-based oocyte assessment system, Magenta, related to the outcomes of intracytoplasmic sperm injection (ICSI) and biological events during the preimplantation period? Summary answer The Magenta score is predictive of delayed fertilization events in the pronuclei (PNs) and cytoplasm, abnormal blastomere cleavage, compaction errors, and impaired blastulation and expansion. What is known already Morphological assessment of oocyte quality remains challenging because of the lack of objective criteria. Artificial intelligence (AI) has recently been implemented in assisted reproductive technologies, leading to the development of several AI-based evaluation systems for oocytes and embryos. Magenta is a deep learning-based tool that predicts the embryonic development of mature oocytes to the blastocyst stage. It provides individual oocyte scores where higher scores indicate greater likelihood of blastocyst development. However, the specific relationship between Magenta score and morphokinetic parameters is unclear. Additionally, Magenta was developed using data from controlled-ovarian stimulation cycles; therefore, its effectiveness for minimal-stimulation cycles remains uncertain. Study design, size, duration This retrospective study included 2,950 images of mature oocytes from 1,487 oocyte retrieval cycles (average cohort size=1.99±1.11; 1,231 patients; mean age 38.7±4.0 years). Patients underwent clomiphene citrate-based minimal ovarian stimulation followed by ICSI between October 2019 and December 2020. Images were obtained immediately post-ICSI. Surgical sperm retrieval and/or recurrent implantation failure cases were excluded. Oocytes unsuitable for observation (i.e. poor image quality) were excluded. Magenta analysed individual mature oocytes, providing scores from 0 to 10. Participants/materials, setting, methods The microinjected oocytes were cultured for 4–7 days in a time-lapse incubator (Embryoscope+/Flex). Fertilization and embryo development at each stage were assessed with EmbryoViewer software, and key phenomena, including meiotic resumption, PN/cytoplasmic dynamics, cleavage patterns, blastomere compaction, and embryo quality were manually annotated. The relationship between the Magenta score, embryonic and pregnancy outcomes, and morphokinetics was analysed using generalized estimating equations, adjusting for bias using covariates and confounders to verify the statistical significance. Main results and the role of chance The mean Magenta score was 5.3±2.9 (median: 5.4; quartiles: 2.6, 8.0). A lower Magenta score correlated with a higher degeneration rate (P = 0.0006) and a lower normal fertilization rate (P = 0.0004) per ICSI. Additionally, the Magenta score positively correlated with the incidence of the first cleavage, development to the 8-cell stage, compaction, blastulation, and blastocyst expansion (P < 0.0001–0.0333). Although no correlation was observed between the Magenta score and th","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"53 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}