Comparative analysis of long versus short co-incubation of gametes on post-insemination outcomes and embryo morphokinetics.

Research Question: Does a short co-incubation of gametes in conventional IVF affect post-insemination outcomes and embryo morphokinetics?

Design: Sibling oocyte randomized pilot study conducted between December 2020 and March 2023. Eligible couples (n = 55) were women aged 18-43 years with BMI 35 km/m or lower and male normal semen parameters. Cumulus oocyte complexes (COC) (six to 12) were randomized in a 1:1:2 proportion in long (16-18 h) or short (2 h) co-incubation IVF exposure and ICSI, respectively.

FSH/LH co-stimulation in Advanced Maternal Age (AMA) and hypo-responder patients - Arabian gulf delphi consensus group.

Background: In a global effort to assess expert perspectives on the use of recombinant gonadotropins, recombinant human luteinizing hormone (r-hLH) and recombinant human follicle-stimulating hormone (r-hFSH), a consensus meeting was held in Dubai. The key aim was to address three critical questions: What are the factors that influence follicle response to gonadotropins? Which categories of patients are most likely to benefit from LH supplementation? And what are the optimal management strategies for these patients?

Methods: A panel of thirty-six experts reviewed and refined the initial statements and references proposed by the Scientific Coordinator. Consensus was defined as agreement or disagreement by more than two-thirds (66%) of the panel members for each statement.

The regulatory interplay between miRNA and DNA methylation orchestrates vital ovarian functions and associated traits in PCOS.

Polycystic ovary syndrome (PCOS) is the leading cause of amenorrhea and anovulatory infertility in women of reproductive age. Both gene polymorphisms and tissue-specific epigenetic alterations, which determine gene transcription and translation dynamics in disease-states, strongly influence PCOS development. Particularly, promoter-proximal DNA methylation and microRNA expression changes show strong associations with follicular defects, suggesting post-transcriptional dysregulation of localized gene networks.

Private versus funded infertility care: not a challenge but a call for cooperation.

Private medical care has significantly contributed to the advancement of various medical fields. The birth of private IVF groups in the 1990s led to improvements in stimulation protocols, embryo culture, intracytoplasmic sperm injection, vitrification and preimplantation genetic testing. However, infertility is often misunderstood as a disease, leading to low birth rates and a lack of awareness among the general population.

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.

Steady morphokinetic progression is an independent predictor of live birth: a descriptive reference for euploid embryos.

Study Question: Can modelling the longitudinal morphokinetic pattern of euploid embryos during time-lapse monitoring (TLM) be helpful for selecting embryos with the highest live birth potential?

Summary Answer: Longitudinal reference ranges of morphokinetic development of euploid embryos have been identified, and embryos with steadier progression during TLM are associated with higher chances of live birth.

What Is Known Already: TLM imaging is increasingly adopted by fertility clinics as an attempt to improve the ability of selecting embryos with the highest potential for implantation. Many markers of embryonic morphokinetics have been incorporated into decision algorithms for embryo (de)selection.

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.

A novel antimüllerian gene mutation in a woman with high antral follicle count and extremely low serum antimüllerian hormone levels.

Objective: To report a case with a distinct difference between the ovarian reserve parameters of antimüllerian hormone (AMH) levels, antral follicle count (AFC), and follicle-stimulating hormone levels caused by a novel homozygous missense variant in the exon 1 of the gene [NM_000479.4:c259G>A, p.(Val87Met)].

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.

Artificial intelligence-powered assisted ranking of sibling embryos to increase first cycle pregnancy rate.

Research Question: Could EMBRYOLY, an artificial intelligence embryo evaluation tool, assist embryologists to increase first cycle pregnancy rate and reduce cycles to pregnancy for patients?

Design: Data from 11,988 embryos were collected via EMBRYOLY from 2666 egg retrievals (2019-2022) across 11 centres in France, Spain and Morocco using three time-lapse systems (TLS). Data from two independent clinics were also examined. EMBRYOLY's transformer-based model was applied to transferred embryos to evaluate ranking performances against pregnancy and birth outcomes.

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.

Avoiding weekend frozen embryo transfer in modified natural cycles: is it possible?

In this era of the freeze-all strategy, the prevalence of frozen embryo transfer (FET) cycles is increasing rapidly. Although still quite often used, the hormone replacement therapy cycle to prepare a FET should now belong to the past, unless strictly necessary. This raises questions about possible flexible protocols for the preparation of an FET cycle in a (modified) natural cycle.

Primary sex ratio in euploid embryos of consanguine couples after IVF/ICSI.

Purpose: To assess the primary sex ratio (males-to-females at time of conception) in blastocysts from consanguine couples undergoing IVF/ICSI treatments and its correlation with chromosomal constitution.

Method: A total of 5135 blastocysts were analyzed by preimplantation-genetic testing for aneuploidy (PGT-A) with next-generation sequencing (NGS) from November 2016 to December 2020. From those, a total of 1138 blastocysts were from consanguine couples (CS) and 3997 from non-consanguine couples (NCS).