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Maternal age-related embryo aneuploidy is considered the most significant limiting factor for a favorable outcome after assisted reproduction technology (ART) procedures. Thus, preimplantation genetic testing for aneuploidies has been proposed as a strategy to genetically evaluate embryos before transfer to the uterus. However, whether embryo ploidy justifies all the aspects of age-related fertility decline remains controversial. To investigate the effect of different maternal ages on ART success rates after transfer of euploid embryos. ScienceDirect, PubMed, Scopus, Embase, the Cochrane library, Clinicaltrials.gov , EU Clinical Trials Register, and World Health Organization International Clinical Trials Registry were searched from inception until November 2021 using combinations of relevant keywords. Observational and randomized controlled studies were included if they investigated the impact of maternal age on ART outcomes after the transfer of euploid embryos and reported frequencies of women achieving ongoing pregnancy or live birth. The ongoing pregnancy rate or live birth rate (OPR/LBR) after euploid embryo transfer comparing women <35 vs. women ≥35 years old was the primary outcome. Secondary outcomes included implantation rate and miscarriage rate. Subgroup and sensitivity analyses were also planned to explore the sources of inconsistency among studies. The quality of studies was assessed using a modified version of the Newcastle-Ottawa Scale, and body of evidence was evaluated using the Grading of Recommendations Assessment Development and Evaluation working group methodology. A total of 7 studies were included (n = 11,335 ART embryo transfers of euploid embryos). A higher OPR/LBR (odds ratio, 1.29; 95% confidence interval [CI], 1.07–1.54; I 2 = 40%) in women aged <35 years than in women ≥35 with a risk difference equal to 0.06 (95% CI, 0.02–0.09) was found. In line, implantation rate was higher in the youngest group (odds ratio, 1.22; 95% CI, 1.12–1.32; I 2 = 0%). A statistically significant higher OPR/LBR was also found comparing women aged <35 to women 35–37, 38–40, or 41–42. A gradient relationship between age and OPR/LBR could be observed in proportion meta-analysis, especially if restricted to studies with low risk of bias. Increasing maternal age is associated with a decline in ART success rates independent of embryo ploidy. This message contributes to an appropriate patient's counseling before starting preimplantation genetic testing for aneuploidies procedures. CRD42021289760. [ABSTRACT FROM AUTHOR]

Objective: To compare directly in vitro developmental competence between parthenogenetically activated and intracytoplasmic sperm injection (ICSI)-fertilized oocytes. Design: For each patient, three metaphase II oocytes were randomized to the ICSI procedure, while n−3 were allocated to parthenogenetic activation. Setting: University hospital infertility unit. Patients: Thirty-eight patients, aged 35.2 ± 3.3 years (mean ± SD) selected for ICSI. Interventions: After 1 hour from denudation, oocytes were either fertilized by ICSI (n = 114) or chemically activated (n = 104). Fertilized and activated oocytes were cultured for up to 3 and 5 days, respectively. Main Outcome Measures: Development rate, cell number, and morphological grade during culture. Results: The two groups showed no significant differences between rates of fertilization and parthenogenetic activation, development, and blastomere number on days 2 and 3 of culture. However, parthenotes showed a lower morphological grade, and a significantly lower proportion went on cleaving to day 3, when only activated rather than total numbers of oocytes were considered. On day 5 after activation, nine oocytes (8.6%) reached the blastocyst stage, representing 12.9% of parthenotes. Conclusions: Since most parameters examined in this study were similar between activated and fertilized oocytes, parthenogenetic activation may be a useful tool for the preclinical evaluation of experimental procedures. [Copyright &y& Elsevier]

Objective: To compare the efficiency of equilibrium cooling and vitrification for cryopreservation of human ovarian tissue and to determine the best experimental model for developing new protocols.Design: Experimental prospective study.Setting: An academic research environment.Patient(s) and Animal(s): Human ovarian biopsy specimens were obtained from three women undergoing operative laparoscopy for ovarian cyst enucleation. Adult cow and pig ovaries, collected at the abattoir.Intervention(s): Ovarian tissue fragments of three individuals for each species were cryopreserved by using two protocols, either for equilibrium cooling or vitrification.Main Outcome Measure(s): Comparison between fresh and cryopreserved tissue of primordial, primary, and secondary follicle morphology, graded in three classes.Result(s): Human and bovine follicles responded in the same way to the two equilibrium cooling protocols, whereas pig tissue was more cryoresistant. Both vitrification protocols caused extensive damage to the tissue of all species. Human tissue showed a response to vitrification that was different from that of both animal species.Conclusion(s): Bovine is a good animal model for the development of human ovarian tissue cryopreservation protocols by equilibrium cooling procedures. Vitrification is less efficient than equilibrium cooling, and at present, neither bovine nor pig can be considered relevant animal models for human tissue. [ABSTRACT FROM AUTHOR]

To evaluate whether laser-mediated assisted hatching (AH) performed on vitrified/warmed blastocysts before embryo transfer can improve live birth rate. The "pArtiaL zonA pelluciDa removal by assisteD hatchINg of blastocysts (ALADDIN)" is a 2-center comparative study with a parallel randomized controlled design. University hospital. Participants were recruited between September 2018 and November 2021. They were aged 18–39 years, underwent nondonor in vitro fertilization cycles, and were scheduled for elective single embryo transfer with vitrified/warmed blastocysts. Those with uterine abnormalities, body mass index of >35 kg/m2, severe male factor infertility, or performing preimplantation genetic testing were excluded. Assisted hatching was performed using a 1,480 nm diode laser, removing approximately one-third of the zona pellucida with continuous 0.2 ms pulses applied from the 1–5 o'clock positions. The primary outcome was the live birth rate. Secondary end points included clinical pregnancy, miscarriage, multiple pregnancies, preterm births, obstetric and neonatal complications, and congenital anomalies. Overall, 698 participants met the inclusion criteria and were randomized: 352 patients were assigned to the AH arm and 346 to the control arm. Of the participants, 105 (29.8%) and 101 (29.2%), respectively, achieved a live birth after treatment. The relative risk of live birth in patients with vitrified/warmed blastocysts treated with AH was 1.02 (95% confidence interval, 0.86–1.19). Exploratory subgroup analyses for women's age, recruiting centers, indications for in vitro fertilization, method of insemination, blastocyst quality, and days of blastocyst development failed to highlight any clinical situation that could benefit from AH in thawed blastocysts. In patients undergoing frozen embryo transfer with vitrified/warmed blastocysts, laser AH does not improve the live birth rate. Further studies are required to rule out milder but potentially interesting benefits in specific subgroups of patients. ClinicalTrials.gov: NCT03623659. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the economical benefit of preimplantation genetic testing of aneuploidies (PGT-A) when applied in an extended culture and stringent elective single ET framework.Design: Theoretical cost-effectiveness study.Setting: Not applicable.Patients/animal(s): None.Intervention(s): Comparison of the cost-effectiveness between two IVF treatment strategies: serial transfer of all available blastocysts without genetic testing (first fresh transfer and subsequent frozen-thawed transfer); and systematic use of genetic testing (trophectoderm biopsy, freeze-all, and frozen-thawed transfers of euploid blastocysts). The costs considered for this analysis are based on regional public health system provider.Main Outcome Measure(s): Costs per live birth.Result(s): Cost-effectiveness profile of PGT-A improves with female age and number of available blastocysts. Sensitivity analyses varying the costs of ET, the costs of genetic analyses, the magnitude of the detrimental impact of PGT-A on live birth rate, and the crude live birth rates change to some extent the thresholds for effectiveness but generally confirm the notion that PGT-A can be economically advantageous in some specific subgroups.Conclusion(s): PGT-A can be cost-effective in specific clinical settings and population groups. Economic considerations deserve attention in the debate regarding the clinical utility of PGT-A. [ABSTRACT FROM AUTHOR]

Objective: To report a case of successful testicular sperm extraction performed during an emergency scrotal exploration for trauma in a patient with a history of previous contralateral cryptorchidism. Design: Case report. Setting: Clinica Urologica I, Università degli Studi di Milano, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico. Patient(s): A 28-year-old man with a history of right orchiopexy for cryptorchidism presenting with blunt trauma of the pelvis. Intervention(s): Seminiferous tubules extraction. Main Outcome Measure(s): Successful sperm retrieval. Result(s): Scrotal ultrasonography (US) showed a suspected rupture of the left tunica albuginea, and color Doppler examination evidenced testicular perfusion only in the region near the mediastinum testis. Twelve hours after scrotal exploration, the extracted testicular tissue was successfully processed, and seven vials of sperm were frozen. Conclusion(s): After testicular trauma in selected patients, such as individuals with a history of monorchism or cryptorchidism, emergency testicular sperm extraction (TESE) can be a useful option to preserve fertility. [ABSTRACT FROM AUTHOR]

Objectives: To establish the risk factors for monozygotic twin (MZT) and monochorionic twin (MCT) pregnancies after in vitro fertilization (IVF).Design: Systematic review and meta-analysis.Setting: Not applicable.Patient(s): Women who achieved MZT and non-MZT pregnancies through IVF.Intervention(s): Systematic search of Medline from January 1995 to October 2018 with cross-checking of references from relevant articles in English.Main Outcome Measure(s): Possible risk factors for MZT or MCT pregnancies after IVF, comprising extended embryo culture, insemination method (conventional IVF and intracytoplasmic sperm injection [ICSI]), embryo biopsy for preimplantation genetic testing for aneuploidies or for monogenic/single-gene defects (PGT-A or PGT-M) programs, assisted hatching (AH), oocytes donation, female age, and embryo cryopreservation.Result(s): A total of 40 studies were included. Blastocyst transfer compared with cleavage-stage embryo transfer, and female age <35 years were associated with a statistically significant increase in the MZT and MCT pregnancy rate after IVF: (23 studies, OR 2.16, 95% CI, 1.74-2.68, I2=78%; 4 studies, OR 1.29; 95% CI, 1.03-1.62, I2=62%; and 3 studies, OR 1.90, 95% CI, 1.21-2.98, I2=59%; 2 studies, OR 2.34; 95% CI, 1.69-3.23, I2=0, respectively). Conventional IVF compared with ICSI and assisted hatching were associated with a statistically significantly increased risk of MZT pregnancy (9 studies, OR 1.19, 95% CI, 1.04-1.35, I2=0; 16 studies, OR 1.17, 95% CI, 1.09-1.27, I2=29%, respectively). Embryo biopsy for PGT-A or PGT-M, embryo cryopreservation, and oocytes donation were not associated with MZT pregnancies after IVF.Conclusion(s): Blastocyst transfer is associated with an increased risk of both MZT and MCT pregnancies after IVF. Further evidence is needed to clarify the impact of female age, insemination method and AH on the investigated outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the presence of endometriomas affects ovarian function. Design: Prospective cohort study. Setting: Infertility unit of an academic setting. Patient(s): Twenty-nine women undergoing an IVF cycle. Intervention(s): Prospective evaluation of women with unoperated unilateral endometriomas undergoing IVF. The affected and contralateral intact gonads were compared in terms of responsiveness and oocyte quality. Main Outcome Measure(s): Oocyte developmental competence. Results: Ovarian responsiveness and oocyte quality did not significantly differ between the affected and intact gonads. The number of codominant follicles, the number of oocytes retrieved, and the number of suitable oocytes in affected and intact gonads were 3.7 ± 2.4 and 4.1 ± 1.7, 4.2 ± 3.1 and 4.7 ± 2.5, and 3.1 ± 2.6 and 3.5 ± 2.3, respectively. The number of viable embryos and the number of high-quality embryos were 1.8 ± 2.1 and 1.8 ± 1.4 and 1.0 ± 1.7 and 0.8 ± 0.7, respectively. The fertilization rate in the affected and intact gonads was 64% and 64%, respectively. The cleavage rate was 58% and 51%, respectively. The rate of high-quality embryos was 31% and 21%, respectively. Conclusion(s): In women undergoing IVF, the presence of ovarian endometriomas does not affect oocyte developmental competence. [ABSTRACT FROM AUTHOR]

Objective: To report a case of successful testicular sperm extraction performed during an emergency scrotal exploration for trauma in a patient with a history of previous contralateral cryptorchidism. Design: Case report. Setting: Clinica Urologica I, Università degli Studi di Milano, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Ca'' Granda, Ospedale Maggiore Policlinico. Patient(s): A 28-year-old man with a history of right orchiopexy for cryptorchidism presenting with blunt trauma of the pelvis. Intervention(s): Seminiferous tubules extraction. Main Outcome Measure(s): Successful sperm retrieval. Result(s): Scrotal ultrasonography (US) showed a suspected rupture of the left tunica albuginea, and color Doppler examination evidenced testicular perfusion only in the region near the mediastinum testis. Twelve hours after scrotal exploration, the extracted testicular tissue was successfully processed, and seven vials of sperm were frozen. Conclusion(s): After testicular trauma in selected patients, such as individuals with a history of monorchism or cryptorchidism, emergency testicular sperm extraction (TESE) can be a useful option to preserve fertility. [Copyright &y& Elsevier]

Objective: Fertility status evaluation in patients found azoospermic at the time of malignancy diagnosis. Design: Case series follow-up. Setting: University Hospital Sperm Banking service. Patient(s): Male cancer patients found azoospermic between 1986 and June 2000. Intervention(s): Patients were interviewed about their reproductive history and were invited for a free semen analysis. Main Outcome Measure(s): Pregnancy rate (PR) and percentage of patients with viable spermatozoa in the ejaculate. Result(s): Sixty-five patients were enrolled; 16 were lost at follow-up, 7 died, and 42 were followed to the end of the study. The median (range) time of follow-up for the 42 remaining patients was 9 years (2–14 years). Seventeen patients had wanted to father a child; 12 had a child (71%, 95% confidence interval [CI] 48%–88%). Semen analysis results were available in 11 patients. Resumption of spermatogenesis was documented in 9 cases (82%, 95% CI 53%–97%). Conclusion(s): Spontaneous fertility recovery is frequent in patients who are azoospermic at the time of cancer diagnosis. [Copyright &y& Elsevier]

To evaluate the influence of IVF on the dimension of leiomyomas, we selected 72 women with small intramural or subserosal leiomyomas and assessed the size of these lesions before and after the treatment cycle. The mean ± SD diameters of the tumors at these two time points were 20.5 ± 9.5 and 20.6 ± 10.2 mm, respectively, thus supporting the conclusion that IVF does not influence the growth of these lesions. [ABSTRACT FROM AUTHOR]

Objective To evaluate the accuracy of antral follicular count (AFC) in predicting ovarian responsiveness in ovaries with endometriomas or with a past history of surgical excision of endometriomas. Design Retrospective review. Setting Academic hospital. Patient(s) Eighty-three women for a total of 166 gonads. Intervention(s) None. Main Outcome Measure(s) Total number of developing follicles. Result(s) The ovaries were characterized as four groups: [1] unoperated gonads without endometriomas (n = 42, control group), [2] unoperated gonads with endometriomas (n = 46), [3] operated gonads without endometriomas (n = 55), and [4] operated gonads with endometriomas (n = 23). The analyses subsequently considered all ovaries with endometriomas (groups 2 + 4, n = 69) and all operated ovaries (groups 3 + 4, n = 78). The capacity of AFC to predict low response (≤2 follicles) or hyperresponsiveness (≥7 follicles) was evaluated using receiver operating characteristic curves. We used a linear regression model to calculate the adjusted B coefficients. The adjusted B coefficients in unaffected ovaries, in all ovaries with endometriomas, and in all operated ovaries were 0.55 (95% confidence interval [CI], 0.07–1.03), 0.76 (95% CI, 0.54–0.98), and 0.51 (95% CI, 0.26–0.76), respectively. The area under the curve (AUC) for the prediction of low response was 0.83 (95% CI, 0.68–0.99), 0.83 (95% CI, 0.73–0.93), and 0.74 (95% CI, 0.63–0.85), respectively. The AUC for the prediction of hyperresponse was 0.84 (95% CI, 0.70–0.97), 0.74 (95% CI, 0.63–0.85), and 0.77 (0.60–0.94), respectively. Conclusion(s) The accuracy of AFC for predicting ovarian response is similar in unaffected ovaries, ovaries with endometriomas and ovaries with a history of surgery for endometriomas. [ABSTRACT FROM AUTHOR]