Reproductive biomedicine online最新文献

{"title":"SEVERE MALE FACTOR; IS THERE ANY RELATIONSHIP AMONG MALE AMH, SERUM MARKERS AND SEMEN PARAMETERS?","authors":"Fatma Aktulum Tunç ,&nbsp;Recep Onur Karabacak ,&nbsp;İsmail Güler","doi":"10.1016/j.rbmo.2024.104537","DOIUrl":"10.1016/j.rbmo.2024.104537","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate relationship between, male AMH, serum markers, and semen parameters in severe male factor in vitro fertilization (IVF) treatment.</div></div><div><h3>Methods</h3><div>Between July 2022-June 2023, sixty-nine azopermia(n=44), severe oligospermia (n=25) and thirthy-two normospermia control patients (n=32) who met the inclusion criteria who underwent IVF treatment is analyzed. A prospective normal distributed epidemiological study, analyzed retrospectively.</div></div><div><h3>Results</h3><div>The mean AMH levels in all 3 groups azoospermia (n=44), severe oligospermia (n=25), combined of two (n=69), by comparing control group (n=32) were similar 5,3±3,8SD, 5,3±3,8SD, 5,3±3,5SD, 6,5±3,2SD ng/ml respectively. AMH distribution over the years by age were in all male factor infertility cases were already elevated and do not changed by years, only normal cases AMH decreased at trend by years (p=0,07). At ROC analyses of AMH in azospermia by controls; significant threshold value is ≤4,58 ng/ml (p=0,02). Also in combined group same threshold value was significant for AMH≤3,81 ng/ml (p=0,02). Mean FSH mIU/ml levels were in all 3 groups significantly higher than controls 15.1 ±11.8 SD, 7.08±5.9SD, 12.2±10.7SD and 3.6±1.5SD (p=0,001). FSH distribution over the years by age were in severe oligospermic, combined and control group significantly decreased by age. Azospermics FSH were already elevated, didn't changed by time. At ROC analyses of FSH by controls revealed 3 groups thereshold value &gt;5,59 mIU/ml (p=0,001).</div></div><div><h3>Conclusion</h3><div>AMH can not be used to predict a man's reproductive potential and is not associated with abnormal semen analysis results. The distrubituon of AMH over the years is found to be meaningless. Conversely FSH is closely related to abnormal semen. Linear increase of FSH levels over the years is observed significantly in men with azoospermia, severe oligospermia, combined group compared to normozoospermia. But when ROC curve analysis is performed AMH and FSH significantly predicts at thereshold levels the azospermia compared to normals.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104537"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE EFFECT OF CALCIUM IONOPHORE IN ICSI CYCLES APPLIED TO PATIENTS WITH LOW OVARIAN RESERVE","authors":"Çiğdem Çelik ,&nbsp;Ayşe Altun ,&nbsp;Ömer Demir ,&nbsp;Burçin Karamustafaoğlu Balcı","doi":"10.1016/j.rbmo.2024.104573","DOIUrl":"10.1016/j.rbmo.2024.104573","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;Several chemical, mechanical, or physical stimuli can be used to promote oocyte activation during ICSI cycles. Calcium ionophore is the most commun method for chemical oocyte activation and activation may be beneficial for cases of globozoospermia, low oocyte count, total fertilization failure, recurrent implantation failure (1,2). In what concern low ovarian reserve cases, a subgroup of infertile couples with relatively poor prognosis, artificial oocyte activation with calcium ionophore may improve fertilization rates, embryo number, embryo quality and pregnancy rates. This study aimed to find out whether Ca&lt;sup&gt;2+&lt;/sup&gt; ionophore improves fertilization, embryo development and pregnancy out comes in patients with low ovarian reserve.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material - Method&lt;/h3&gt;&lt;div&gt;This study is conducted at Istanbul University, Istanbul Faculty of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Unit. All IVF-ICSI cycles performed because of female factor, low ovarian reserve between November 2023 and July 2024 are included.Patients with DOR indication, who were administered calcium ionophore(GROUP I/Experimental Group, n:30) and patients who were not administered calcium ionophore (GROUP II/Control Group, n:30) were included. These patients were compared in terms of fertilization, embryo quality and pregnancy rates.Oocytes at the MII stage obtained from patients were subjected to ICSI approximately 4 hours after oocyte retrieval(OPU). After ICSI, the oocytes were incubated in a calcium ionophore solution for 20 minutes and then transferred to culture media. On the following days, fertilization rates, embryo development, and pregnancy statuses were assessed. The results were statistically evaluated using independent samples t-test and chi-square test. Statistical significance was considered as p&lt;0.05&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;No differences were observed between the two groups in terms of female age, BMI, duration of infertility, AMH, FSH, LH, estradiol, oocyte count, oocyte maturation, and fertilization rate factors.However, the transfer of medium-quality embryos was found to be significantly higher in the DOR group without calcium ionophore application(p=0.035).The number of embryos frozen in Group I was significantly higher compared to Group II (p=0.020) (Table).No significant difference was found between the two groups in terms of clinical pregnancy and ongoing pregnancy rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Alternative laboratory treatments applied to patients with low ovarian reserve may yield positive results in terms of increasing the likelihood of success. Our study has shown that the application of calcium ionophore in these cases leads to better-quality embryo development and consequently an increased number of frozen embryos. Although no significant difference was observed in clinical pregnancy and ongoing pregnancy rates, increasing the n","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104573"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMPARISON OF TIME LAPSE AND CONVENTIONAL INCUBATORS WITH LABORATORY PERFORMANCE INDICATORS AND EUPLOIDY RATES: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS","authors":"Can Benlioglu ,&nbsp;Erkan Kalafat ,&nbsp;Ipek Keles ,&nbsp;Baris Ata","doi":"10.1016/j.rbmo.2024.104576","DOIUrl":"10.1016/j.rbmo.2024.104576","url":null,"abstract":"<div><h3>Objectives</h3><div>We aim to investigate whether time-lapse incubation systems have a favorable euploidy yield and day 5 embryo performances compared to conventional incubation.</div></div><div><h3>Material and Methods</h3><div>MEDLINE and Scopus databases were searched electronically till January 2024, using combinations of the relevant MeSH terms, keywords, and word variants for “time-lapse” AND “assisted reproductive technology”. The risk of bias in the included studies was assessed using the Cochrane RoB v2.0 for randomized trials. Only RCTs reporting the results of d5 embryos were included in the final analysis. The primary outcomes were blastulation and high-quality d5 embryo rates. The secondary outcome was the euploidy rate per biopsied embryo. After all abstracts and full texts (n=35) were reviewed independently by two authors (C.B., E.K.), 17 studies were selected for the final analysis. Analysis of the extracted data was performed with RStudio. A random-effects model with the Mantel-Haenszel method for pooling studies was used. ORs with 95% CIs were obtained, and variance between studies was tested using the I-squared statistic. Publication bias was explored using funnel plots and asymmetry tests (i.e. rank correlation).</div></div><div><h3>Results</h3><div>Random effect model in meta-analysis demonstrates favorable blastulation rates per embryo for TLS compared to conventional incubators [RR = 1.088, 95%CI = 1.01 to 1.17; 4 studies, 4923 fertilized eggs observed; p= 0.0189]. <em>High embryo quality</em> (HEQ) was defined as a higher grade than 3BB based on the Gardner classification system in all included studies. HEQ rate per fertilized embryo shows a positive trend for TLS compared to conventional incubators (CI), but there was no significance [RR = 1.10, 95%CI = 0.96 to 1.25; 6 studies, 5339 high-quality embryos in 11382 fertilized eggs, p= 0.178]. Only two sibling studies were found for the euploidy rate per biopsied embryo outcome, and a significant favorable tendency was found in TLS compared to CI [RR = 1.17, 95%CI = 1.02 to 1.35; 2 studies, 450 euploid embryos with 914 biopsies, p= 0.02]. Except for HQB rates, moderate heterogeneity was found in the other two outcomes. Risk of Bias assessment showed that in each study, there was at least one high-risk domain (e.g., assignment to intervention) in all included studies.</div></div><div><h3>Conclusion</h3><div>Time-lapse incubation systems may improve euploidy and blastulation rates compared to conventional ones, but the evidence is limited and inconclusive regarding significant overall benefits in embryo development. The low-to-moderate quality of evidence requires cautious interpretation. The scarcity of studies randomizing women in ploidy status assessment, relying predominantly on sibling oocyte randomization, significantly limits our understanding of these assessments' broader applicability and effectiveness.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104576"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DECODING TOTAL FERTILIZATION FAILURE IN INTRACYTOPLASMIC SPERM INJECTION CYCLES: A COMPARATIVE ANALYSIS OF SPERM AND OOCYTE PARAMETERS","authors":"Selahattin Emiroglu ,&nbsp;Havva Yesilleme ,&nbsp;Miray Berber ,&nbsp;Cihan Cakir ,&nbsp;Gurkan Uncu","doi":"10.1016/j.rbmo.2024.104579","DOIUrl":"10.1016/j.rbmo.2024.104579","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;This&lt;/strong&gt; study aimed to identify parameters associated with total fertilization failure in ICSI cycles. Specifically, we investigated which male and female factors contribute to total fertilization failure. Additionally, we sought to identify patient populations at risk for total fertilization failure to develop preventive strategies for future cases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;This retrospective study was conducted at the Bursa Uludağ University ART Center between 2011 and 2024. ICSI was performed on all retrieved oocytes. The study group included patients who had at least three oocytes retrieved and experienced total fertilization failure(n=98). The control group comprised patients with a fertilization rate above 80%(n=937). Comparative evaluations were made between the two groups regarding patients' baseline characteristics, basal hormonal parameters, ovarian stimulation profiles, semen parameters, and oocyte quality scores. Additionally, ovarian response was assessed using the Follicular Output Rate(FORT) and Follicle-to-Oocyte Index(FOI) in both groups. Logistic regression analysis was performed to examine the relationship between significant variables and fertilization failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline parameters between the study and control groups were statistically similar, indicating no significant differences in initial characteristics except for infertility duration&lt;em&gt;(p=0.002)&lt;/em&gt; and etiology&lt;em&gt;(p&lt;0.001)&lt;/em&gt;. Semen analysis, however, revealed that the study group had significantly lower sperm concentration(&lt;em&gt;p=0.002)&lt;/em&gt; and motility&lt;em&gt;(p&lt;0.001)&lt;/em&gt; compared to the control group, while sperm morphology&lt;em&gt;(p=0.492)&lt;/em&gt; percentages were similar between the groups. The rate of azoospermia was also higher in the fertilization failure group. Concerning oocyte parameters, the study group showed a significantly lower FOI&lt;em&gt;(p=0.007)&lt;/em&gt; compared to the control group, while oocyte maturation rates&lt;em&gt;(p=0.166)&lt;/em&gt; were similar between the groups. Despite these differences, oocyte quality scores were comparable&lt;em&gt;(p=0.272)&lt;/em&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Our study highlights that total fertilization failure in ICSI cycles is significantly associated with lower sperm concentration, reduced motility, and azoospermia. Despite similar baseline parameters and oocyte quality scores between the study and control groups, the study group experienced no successful fertilization. These findings suggest that sperm factors are more crucial than oocyte quality in predicting fertilization success.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In conclusion, semen parameters, including lower sperm concentration and reduced motility, are key factors associated with total fertilization failure in ICSI cycles. These parameters should be closely monitored to identify patients at higher risk for total fertilization failure. Addressing these factors ","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104579"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADENOMYOSIS AND INFERTILITY: ARE WE READY FOR PERSONALIZED TREATMENT?","authors":"Ludovico Muzii","doi":"10.1016/j.rbmo.2024.104518","DOIUrl":"10.1016/j.rbmo.2024.104518","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Adenomyosis, i.e., the presence of endometrial tissue within the uterine muscle, is increasingly recognized in its association with infertility. Due to refinements in non-invasive diagnostic techniques, adenomyosis is being diagnosed in a significant proportion of women, with an increase particularly significant in those of reproductive age. Clinical manifestations of this condition range from dysmenorrhea to abnormal uterine bleeding, with implications for fertility that have garnered attention in recent years. Diagnostic advancements, new available therapeutic options, growing body of literature on the topic, and the importance of individualized patient management in improving reproductive outcomes, especially in assisted reproductive technologies (ART), all underscore the potential for personalized treatment strategies in infertile patients. The increasing prevalence of adenomyosis in women seeking fertility treatments necessitates a closer examination of its role in infertility, emphasizing the need for tailored approaches.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Impact on Fertility&lt;/h3&gt;&lt;div&gt;The relationship between adenomyosis and infertility is complex. The exact etiology remains unclear, with factors such as hormonal influences and chronic inflammation suggested as responsible for the causal relationship. The inflammatory environment created by adenomyosis may disrupt normal implantation and embryo development, contributing to infertility. Studies indicate that women with adenomyosis have a lower probability of natural conception and poorer outcomes in ART. Recent meta-analyses report significantly lower clinical pregnancy rates, and higher miscarriage rates, at ART for infertile patients with adenomyosis compared to patients without adenomyosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Personalized Treatment Approaches&lt;/h3&gt;&lt;div&gt;Given the heterogeneity of adenomyosis presentations and their varied impact on fertility, personalized treatment strategies are warranted. Current management options range from medical therapies, to surgical interventions, to ART in infertile patients. Hormonal treatments, including combined oral contraceptives and oral or locally-released progestins, aim to reduce symptoms and may improve endometrial receptivity. However, their efficacy in enhancing fertility remains debated. For women with severe symptoms or those failing medical management, surgical excision of adenomyotic tissue may be considered. This approach has shown promise in improving pregnancy rates, particularly in those with localized adenomyosis and adenomyomas. In cases of infertility, ART may be the best option in most cases. Personalized protocols that consider adenomyosis severity and associated factors can optimize outcomes. A recent study reports that infertile patients with asymptomatic endometriosis do not perform worse at ART compared to patients without the condition, contrary to what is reported for the general population with adenomyosis. Imaging ","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104518"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EVALUATION OF SEXUAL DYSFUNCTION AND ITS RELATIONSHIP WITH INFERTILITY IN POLYCYSTIC OVARY SYNDROME, A PRELIMINARY CROSS-SECTIONAL STUDY","authors":"MUJDE CANDAY","doi":"10.1016/j.rbmo.2024.104560","DOIUrl":"10.1016/j.rbmo.2024.104560","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Polycystic Ovary Syndrome (PCOS) remains the most prevalent endocrine disorder affecting women of reproductive age,from adolescence through to menopause[1].PCOS can disrupt the normal functioning of the female reproductive system and adversely affect sexual health[2,3].The tendency to overlook non-fertility-related symptoms often leads to a delay in diagnosis and insufficient attention to enhancing overall women's well-being[4].It is crucial to evaluate the increased reproductive and health risks associated with PCOS. Assessing sexual and reproductive health challenges can lead to better management strategies for the syndrome[5].In this study, we aim to explore both the sexual function and infertility status of patients diagnosed with PCOS, particularly focusing on those who have not yet been diagnosed or informed about their condition.By evaluating these aspects prior to formal diagnosis, we can better understand the initial health status of these individuals and underscore the importance of integrated care in their treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;Methods:&lt;/strong&gt; For the diagnosis of PCOS, we applied the 2018 International Evidence-based Guideline, which enhances the earlier Rotterdam criteria from 2003[6]. Women of reproductive age who are sexually active were included in the study. While forming our patient group, those with infertility due to male factors or other female conditions and those with AMH levels inconsistent with their age were not included if they were suspected or confirmed to be part of this group.Our study group consisted of patients who had not previously been diagnosed with PCOS.Patients suspected of having PCOS underwent the FSFI survey to assess sexual function without being informed of the preliminary diagnosis,and a detailed medical history was recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;According to the FSFI classification,16% of individuals(n=12)do not have sexual dysfunction,while 84%(n=65)do have sexual dysfunction. According to the FSFI classification, among individuals without sexual dysfunction, 58.3% (n=7) do not have infertility, while 41.7%(n=5) do. On the other hand, among individuals with sexual dysfunction,26.2%(n=17) do not have infertility, whereas 73.8%(n=48)do. A statistically significant difference in the presence of infertility was observed according to the FSFI classification(p=0.034).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Our study, which assesses the sexual functions of patients not previously diagnosed with PCOS and not informed of their diagnosis, is valuable in correlating sexual dysfunctions with infertility. There is a need for a separate evaluation of sexual dysfunctions in PCOS patients and consideration of sexual dysfunctions in infertility treatments. The approach to PCOS-related infertility should not only focus on metabolic causes but also potential sexual dysfunctions, with some patients potentially being treatable with sex","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104560"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INDIVIDUALIZED PROGESTERONE TREATMENT PROTOCOLS FOR FROZEN THAWED EMBRYO TRANSFER PREPARATION","authors":"Gokalp Oner","doi":"10.1016/j.rbmo.2024.104589","DOIUrl":"10.1016/j.rbmo.2024.104589","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Frozen-thawed embryo transfer (FET) is a technique commonly used in assisted reproductive technology (ART) to transfer previously frozen embryos into the uterus. Progesterone usage in luteal support is a critical component of creating an optimal hormonal environment for cycles [1]. It is typically administered in the form of intramuscular injections, vaginal suppositories, or oral medications. The day before ET, the progesterone levels may be more than 10 ng/mL and if it is lower some rescue protocols has been developed [2]. To date, there has been no ideal progesterone replacement therapy for FET and no study to compare to all the forms of progesterone. We hypothesize that in women within FET in IVF, progesterone levels in the day before ET is critical to implantation of the embryo and we analyze which rescue protocol is superior than others.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and Method&lt;/h3&gt;&lt;div&gt;In this prospective randomized trial, the ethics committee approval was taken from 2022-27 Nigde University. Elective single blastocyst embryo transfer (eSET) strategy has been preferred in 200 patients with the diagnosis of unexplained infertility. After 10 days oral 6 mg/daily estradiol usage, we examined and accepted women with endometrial thickness more than 8 mm and progesterone levels lower than 1.5 ng/mL. Then 600 mg/daily vaginal progesterone was begun to all women. 6 day of progesterone administration, the best blastocyst embryo according to embryo scoring system was chosen to transfer. The day before ET, blood progesterone levels were examined and progesterone levels lower than 10 ng/mL were randomized to 5 group. These groups are Group 1 as a control group was 600 mg/daily vaginal micronized progesterone usage, group 2 800 mg/daily vaginal micronized progesterone usage, group 3 600 mg/daily micronized progesterone plus 50 mg/daily i.m. progesterone usage, group 4 600 mg/daily micronized progesterone plus 25 mg/daily s.c. progesterone usage, group 5 600 mg/daily micronized progesterone plus oral 30 mg/daily dydrogesterone usage, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;All women are under 35 years old and there has been no statistically significant difference between the groups. Also, all clinical characteristics were similar. The highest progesterone levels on the day of biochemical pregnancy day are in group 3 and 4. Although the group 3 and 4 has significantly increased clinical pregnancy rates, the other groups were similar pregnancy rates (Table 1). Early pregnancy loss rates are significantly lower in group 3 and 4. Also live birth rates of group 3 and 4 are higher than other groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion and Conclusion&lt;/h3&gt;&lt;div&gt;In this study, different progesterone administration methods were firstly compared and displayed the relation between these protocols to pregnancy rates, early pregnancy lost and live birth rates after frozen thawed eSET. Therefore, individualized luteal phase progesterone","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104589"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PLATELET-RICH PLASMA PRP AND STEM CELLS NOVELTİES IN ART: FACTS OR FADS?","authors":"Johnny Awwad MD, HCLD, FACS","doi":"10.1016/j.rbmo.2024.104511","DOIUrl":"10.1016/j.rbmo.2024.104511","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The integration of platelet-rich plasma (PRP) and stem cells novelties into assisted reproductive technology (ART) has sparked considerable interest due to their potential to enhance reproductive outcomes, especially in challenging cases such as diminished ovarian reserve (DOR), recurrent implantation failure (RIF), and thin endometrium. These regenerative therapies have been posited as innovative strategies to rejuvenate ovarian function, improve endometrial receptivity, and boost implantation success rates. While preclinical studies have shown encouraging biological effects, the translation of these therapies into routine clinical practice remains contentious.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Platelet-rich plasma&lt;/strong&gt; effectiveness was explored in a 2023 systematic review and network meta-analysis in women with RIF. Results indicated significantly improved clinical pregnancy rates (CPR) and live birth rates (LBR) after PRP infusion compared to placebo or no intervention. The most recent Cochrane review (2024) evaluated twelve parallel-group randomized controlled trials (RCTs) involving 1,069 women with RIF. The review concluded that intrauterine PRP infusion increased live births by 2.38-fold (95% CI: 1.16 to 4.86) compared to controls. However, PRP was also associated with a higher risk of preterm delivery. The main limitations across the studies included lack of standardization in PRP preparation, absence of uniform placebo control, and the fact that most studies were conducted in a single country with a narrow patient population. This highlights the need for multi-centered trials with standardized protocols to establish PRP's therapeutic reliability in RIF management.&lt;/div&gt;&lt;div&gt;The use of PRP in women with DOR has shown limited promising preliminary results. A 2024 systematic review and meta-analysis of 38 observational studies encompassing 2,256 women reported that PRP ovarian injections led to a monthly rise in AMH serum levels and antral follicle count (AFC), in addition to an increase in oocytes retrieved and embryo counts. Despite these encouraging outcomes, a contrasting Cochrane review of a single RCT involving 73 women with poor ovarian response found no significant improvement in ongoing and clinical pregnancy rates following intra-ovarian PRP injections. This discrepancy in findings underscores the variability in study protocols, patient selection criteria, and PRP preparation techniques, which complicate conclusive clinical recommendations.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Stem cell therapies, particularly mesenchymal stem cells (MSCs),&lt;/strong&gt; have garnered attention for their regenerative potential in both ovarian and endometrial tissues. MSCs, derived from sources such as bone marrow and adipose tissue, exhibit immunomodulatory properties and secrete bioactive factors that promote tissue repair. However, misconceptions persist about MSCs ability to differentiate into oocytes. A recent clinical trial using bone marrow-derived MSCs (BM-MSCs) fo","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104511"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Ovarian Stimulation","authors":"Fernanda Pacheco,&nbsp;Nabil Arrach","doi":"10.1016/j.rbmo.2024.104513","DOIUrl":"10.1016/j.rbmo.2024.104513","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Ovarian stimulation is a critical step in assisted reproductive technologies (ART), involving numerous decisions about medication protocols, dosing, and timing, which can be tailored to each patient's unique profile. According to the 2020 ESHRE Guidelines&lt;sup&gt;1&lt;/sup&gt;, there are 84 recommendations overall, including 7 for pre-stimulation management and 40 for pituitary suppression. However, with variability in patient response, big data generated at &lt;em&gt;in vitro&lt;/em&gt; fertilization (IVF) clinics, and the complexity of decision-making, few doctors have the training and experience to make the most efficient choices consistently.&lt;/div&gt;&lt;div&gt;Artificial Intelligence (AI) offers a promising solution, enabling individualized and optimized decision-making in ovarian stimulation. By analyzing large datasets from previous IVF cycles, AI can support fertility doctors by recommending personalized treatment plans, optimizing the number of oocytes retrieved, and improving patient outcomes.&lt;/div&gt;&lt;div&gt;AI has the potential to enhance several critical areas in the ovarian stimulation process:&lt;/div&gt;&lt;div&gt;1. Gonadotropin Dosing: AI models can predict the optimal starting dose of gonadotropins based on patient characteristics such as age, ovarian reserve, and hormone levels. This reduces the risk of over- or under-stimulation, lowering the chances of ovarian hyperstimulation syndrome (OHSS) or a failed cycle.&lt;/div&gt;&lt;div&gt;2. Trigger Timing: AI can analyze follicular growth and hormone levels to recommend the best time to administer the trigger shot, ensuring the retrieval of mature oocytes at the optimal time. AI's ability to provide real-time data analysis supports more precise decisions regarding when to induce ovulation.&lt;/div&gt;&lt;div&gt;3. Predictive Models for Success: AI tools can estimate the probability of achieving live birth (LB) with each cycle, using data from thousands of previous cycles. These predictions can help doctors provide more personalized counseling, set realistic expectations, and adjust treatment plans accordingly.&lt;/div&gt;&lt;div&gt;A literature review on PubMed found 19 relevant studies on the subject. Notably, Banerjee et al.&lt;sup&gt;3&lt;/sup&gt; developed an AI tool to predict live birth (LB) in the second cycle (C2) based on data from the first cycle (C1). Their model, trained on 1,676 cycles, showed LB rates of 29% for C1, 18% for C2, and 14% for C3. Of those who did not achieve live birth in C1, 71% returned for C2, while 39% dropped out. External validation with an independent dataset (2007-2008) demonstrated that the AI model predicted LB 35.5% better than age-only models, providing valuable insights for patient counseling and treatment planning.&lt;/div&gt;&lt;div&gt;Letterie and MacDonald&lt;sup&gt;4&lt;/sup&gt; tested a decision-support system for four critical decisions in ovarian stimulation: continuing or stopping stimulation, triggering or canceling the cycle, adjusting medication, and determining follow-up intervals. Compared to experts' decisions, the system had an accu","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104513"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FERTILITY PRESERVATION: ARE WE DOING TOO MUCH OR TOO LITTLE?","authors":"Kirsten Tryde Macklon M.D., Ph.D.","doi":"10.1016/j.rbmo.2024.104502","DOIUrl":"10.1016/j.rbmo.2024.104502","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Fertility preservation (FP) has evolved over the past decades both to prevent age-related but also iatrogenic ovarian follicular depletion. For many, this represents a hope for future fertility, particularly for those faced with the possibility of acute ovarian failure due to chemotherapy or radiation therapy. In many centers FP has become standard of care, at least in cases of imminent iatrogenic ovarian failure, and various FP methods are offered to girls and women of fertile age with successful results. Increased focus on awareness, distribution of knowledge and education along with patient wishes means that many oncology and fertility clinics now discuss and offer FP to most of their younger patients newly diagnosed with cancer. Many cancer survivors, who have frozen their eggs or ovarian tissue before chemotherapy, have used these later to become pregnant, but many never come back to use their stored eggs/tissue. This raises the question of whether we, as empathic and eager healthcare professionals (HCPs), have taken our wish to help all patients a step too far and are in fact offering it to women, who might be better off not going through the effort of maturing and taking out eggs or surgical removal of their ovarian tissue.&lt;/div&gt;&lt;div&gt;Examples of such cases could be:&lt;/div&gt;&lt;div&gt;1. &lt;u&gt;The risk of ovarian failure is very small.&lt;/u&gt;&lt;/div&gt;&lt;div&gt;Some chemotherapy protocols are not very gonadotoxic or given in such small doses that the infertility risk that the patient faces is negligent. If these patients are offered in vitro fertilization (IVF) or ovarian tissue cryopreservation (OTC) the chance of them ever coming back to use their eggs/tissue is very small and the risk of the biological material staying in the freezer forever is very high.&lt;/div&gt;&lt;div&gt;2. &lt;u&gt;The ovarian reserve is already depleted&lt;/u&gt;.&lt;/div&gt;&lt;div&gt;This applies to women of advanced reproductive age or women with a known low ovarian reserve. Although we as HCPs always want to help as best we can, there are cases, in which the expected outcome after IVF or OTC is so poor that we maybe in fact do the opposite of helping by letting the patients go through IVF or surgery for collection of ovarian tissue.&lt;/div&gt;&lt;div&gt;3. &lt;u&gt;The health of the patient.&lt;/u&gt;&lt;/div&gt;&lt;div&gt;Cancer is a serious illness and can sometimes affect the patient to such a degree that is poses significant threat to her health to let her undergo hormonal stimulation and egg retrieval in case of IVF, or surgery and general anaesthesia in case of OTC. If the health (and ultimately life) of the patient is at risk, then FP should be considered contraindicated. This also applies to the situation in which no delay of treatment can be accepted due to the severity of the disease, not even a couple of days to effectuate OTC.&lt;/div&gt;&lt;div&gt;3. &lt;u&gt;Ethical considerations.&lt;/u&gt;&lt;/div&gt;&lt;div&gt;We as HCPs are obligated to take ethical issues into consideration before offering any procedure to a patient. Poor prognosis, advanced-stage disease, c","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"49 ","pages":"Article 104502"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}