Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.

Investment in Community Health Worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia.

The ART-ET screening tool: an easy-to-use non-invasive screening method to predict difficult embryo transfers in advance.

Study Question: What is the diagnostic performance of the ART-ET screening tool, an easy-to-use non-invasive screening tool for prediction of difficult embryo transfers?

Summary Answer: A simple scoring of transvaginal ultrasound examination of the cervical canal can predict difficult embryo transfers with high specificity, positive likelihood ratio, and accuracy; the inclusion of cervical position and history of cesarean without a vaginal delivery improved predictive performance.

What Is Known Already: Difficult embryo transfer procedures are associated with significantly lower clinical pregnancy and live birth rates, and some interventions may facilitate an anticipated difficult embryo transfer.

Study Design, Size, Duration: A diagnostic test study prospectively conducted on 239 single euploid blastocyst transfer procedures between March and December 2023.

Reproductive Outcomes in Infertile Women with Endometriosis Undergoing Assisted Reproductive Technology.

Background: Endometriosis-related infertility and its treatment with assisted reproductive technologies (ART) have been broadly researched. Yet, underlying mechanisms of infertility, particularly in the absence of tubal dysfunction, remain unclear. While the impact of inflammatory milieu on the ovary and/or endometrium has been indicated as a contributing factor, recent evidence from euploid transfers and donor cycles questions the extent of these effects.

Effect of overweight and obesity on live birth rate in single euploid frozen embryo transfers.

Research Question: Does endometrial preparation using a natural cycle lead to higher live birth rates (LBR) in single euploid frozen embryo transfers (FET) compared with programmed cycles, for women who are normal weight, overweight and obese.

Design: Retrospective study of 845 single euploid FETs from 688 couples. Patients were stratified by body mass index (BMI) into normal weight, overweight and obesity class I/II categories.

Assessing the clinical value of day 7 blastocysts: a predictive model for preimplantation genetic testing for aneuploidy (PGT-A) cycles.

Purpose: To identify the benefit of extending embryo culture until day (D)7 based on patients and cycle characteristics.

Methods: A retrospective cohort study was conducted including 25,120 blastocysts from 5278 PGT-A autologous cycles between 2017 and 2022. A theoretical cumulative live birth rate (CLBR) was calculated by binomial density function.

A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A.

Purpose: This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist.

Methods: Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (average maternal age: 40 years, average cumulus-oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.

Good laboratory practice for PGT-M: Turkish Society of Reproductive Medicine guidelines.

This guideline was prepared by the Turkish Society of Reproductive Medicine to define the conditions and requirements for an outsourced preimplantation genetic testing (PGT) programme in line with the experience and needs of practitioners. This guideline is intended to be a reference document for assisted reproductive technology centres, genetic diagnosis centres, non-governmental organizations working on reproductive health, legal experts, consultants working on laboratory accreditation, academicians specializing in ethical issues, and policy makers. The Consortium aims to provide recommendations addressing the challenges of genetic testing, especially PGT for monogenic diseases (PGT-M) due to the high rate of consanguineous marriage in Turkey.

Exposure of antral follicles to medroxyprogesterone acetate during stimulation does not cause molecular perturbations in gonadotropin-responsiveness and steroidogenic function of granulosa cells in progestin-primed cycles.

Study Question: Does medroxyprogesterone acetate (MPA) exposure in progestin-primed ovarian stimulation (PPOS) cycles cause molecular perturbations in the steroidogenic function and gonadotropin responsiveness of the granulosa cells?

Summary Answer: PPOS cycles are identical to traditional GnRH antagonist cycles not only for clinical IVF characteristics but also for gonadotropin receptor expression, response to gonadotropins, and steroidogenic function at the molecular level.

What Is Known Already: PPOS is increasingly used as an alternative to GnRH antagonists due to the inhibitory effect of progesterone on LH release by reducing GnRH pulsatility at the hypothalamic level. Although a growing body of evidence from clinical studies did not indicate significant differences between PPOS and antagonist protocols for IVF cycle characteristics and obstetrical outcomes, it is still unknown whether exposure of the antral follicle cohort to progesterone or its synthetic derivatives during ovarian stimulation causes any subtle molecular aberrations in terms of steroidogenesis and gonadotropin responsiveness.

Preimplantation genetic testing for aneuploidy in unexplained recurrent pregnancy loss: a systematic review and meta-analysis.

Importance: Preimplantation genetic testing for aneuploidy (PGT-A) to deselect aneuploid embryos in assisted reproductive technology (ART) treatment cycles may hold promise by augmenting pregnancy rates per transfer and reducing pregnancy loss rates for patients with unexplained recurrent pregnancy loss (RPL).

Objective: To explore effectiveness of PGT-A in managing unexplained RPL by evaluating several key aspects: the likelihood of live birth in a subsequent spontaneous pregnancy, whether women with unexplained RPL have a higher rate of aneuploidy, whether euploid blastocysts offer comparable live birth rate (LBR) in patients with unexplained RPL, whether the endometrium is less selective in unexplained RPL loss, and whether PGT-A increases the LBR or reduces pregnancy losses until delivery.

Data Sources: PubMed and Cochrane Library databases were searched from inception until June 2024.

Endometriosis, staging, infertility and assisted reproductive technology: time for a rethink.

How endometriosis causes infertility, with the exception of tubal dysfunction caused by adhesions, is unclear. The inflammatory milieu in the pelvis and impaired receptivity of the eutopic endometrium are considered to be possible factors. Anatomical staging systems fail to predict the fertility status of endometriosis patients.

Walking on thin endometrium.

Purpose Of Review: Endometrial thickness has been regarded a predictor of success in assisted reproductive technology cycles and it seems a common practice to cancel embryo transfer when it is below a cut-off. However, various cut-offs have been proposed without a causal relationship between endometrial thickness and embryo implantation being established, casting doubt on the current dogma.

Recent Findings: Methodological limitations of the available studies on endometrial thickness are increasingly recognized and better designed studies do not demonstrate a cut-off value which requires cancelling an embryo transfer.

Demographic distributions and clinical results of assisted reproduction techniques in Turkey in 2019: a descriptive survey.

Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey.

Material And Methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™.

Association of 'normal' early follicular FSH concentrations with unexpected poor or suboptimal response when ovarian reserve markers are reassuring: a retrospective cohort study.

Research Question: Are basal FSH measurements, when elevated within its normal range, useful for assessing overall ovarian response and predicting unexpected poor or suboptimal ovarian response?

Design: Retrospective cohort study of ovarian stimulation cycles.

Results: A total of 1058 ovarian stimulation cycles (891 first, 167 repeated) were included. Anti-Müllerian hormone (AMH) values were categorized into four (0 to ≤0.