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Purpose: To investigate the occurrence of idiopathic secondary azoospermia (ISA) in men with oligospermia over time and identify risk factors for ISA in this population. Methods: This was a retrospective cohort study conducted in a university-affiliated male infertility clinic. A total of 1056 oligospermic men (concentration < 15 million/ml (M/ml) and no azoospermia) with at least two SA done between 2000 and 2019 were included. The primary outcome was the occurrence of ISA by oligospermia severity. Results: In the entire cohort, 31 patients (2.9%) eventually became azoospermic with time. The ≤ 1 M/ml extremely severe oligospermia (ESO) group (283 patients) had significantly higher rates of ISA in each time period compared to the 1–5 M/ml severe oligospermia (SO) (310 patients) and 5–15 M/ml mild oligospermia (MO) (463 patients) groups (p < 0.05 for all comparisons), with rates of 21.1% in the ESO, 4.8% in the SO, and 0% in the MO group (p = 0.02) after 3–5 years, reaching 32% after 5 years in the ESO group compared to no cases in the other two groups (p = 0.006). Parameters shown to predict ISA were initial concentration < 1 M/ml (OR 22.12, p < 0.001) and time interval of > 3 and 5 years (OR 4.83 and 6.84, p = 0.009 and < 0.001, respectively), whereas testosterone levels were negatively associated with ISA (OR 0.88, p = 0.03). Conclusions: Men with ≤ 1 M/ml, especially those with low testosterone levels, have a dramatically increased chance of becoming azoospermic with time. Therefore, sperm banking should be recommended in these cases. Men with a sperm concentration above 1 M/ml have low chances of becoming azoospermic, even after 3 or more years. [ABSTRACT FROM AUTHOR]

Purpose: To assess factors associated with embryo donation among individuals interested in donation in the United States. Methods: An invitation to complete the 123-item survey was emailed from June to September 2022 to patients at a private practice fertility clinic with interest in donation at the time of IVF. Survey questions included disposition decision, attitudes about embryo status and genetic relatedness, donation disclosure, ideal donation arrangement, and decision satisfaction. Results: Three hundred thirty-seven completed the survey. Two hundred thirty donated to another person(s), 75 discarded embryos, 25 remained undecided, and disposition was unknown for 7 respondents. There were no demographic differences between groups based on final disposition or use of donor gametes. Few gamete recipients were interested in donation due to biological attachment to embryos. Final embryo disposition was associated with religious factors, not wanting to waste embryos, and storage fee concerns. Final disposition was also significantly associated with concern about donor-conceived children's (DCP) welfare, being denied the ability to complete donation, personal IVF outcomes, financial or legal issues, future contact with DCP, cognitive appraisal of disposition, beliefs about embryos, someone else raising their genetic child, anonymity, and beliefs about DCP not knowing genetic relationships (p <.001). Donation to others was associated with less regret and greater satisfaction with the emotional/medical aspects of donation and counseling compared to those who discarded embryos (p <.001). Conclusion: The decision to donate embryos to another person(s) is complex. Counseling that considers individual circumstances, values, and evolving dynamics may facilitate informed decision-making for those navigating infertility treatment, family building, and embryo disposition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of a single-step (SS) warming versus standard warming (SW) protocol on the survival/expansion of vitrified blastocysts and their clinical outcomes post-frozen embryo transfer (FET). Methods: Retrospective analysis was performed on 200 vitrified/warmed research blastocysts equally divided amongst two thawing protocols utilizing the Fujifilm Warming NX kits (Fujifilm, CA). SW utilized the standard 14-minute manufacturer's guidelines. SS protocol required only a one-minute immersion in thaw solution (TS) before the embryos were transferred to culture media. A time-interrupted study was performed evaluating 752 FETs (SW: 376 FETs, SS 376 FETs) between April 2021-December 2022 at a single academic fertility clinic in Boston, Massachusetts. Embryologic, clinical pregnancy, and live birth outcomes were assessed using generalized estimated equation (GEE) models, which accounted for potential confounders. Results: There was 100% survival for all blastocysts (n = 952 embryos) with no differences in blastocyst re-expansion regardless of PGT status. Adjusted analysis showed no differences in implantation, clinical pregnancy, spontaneous abortion, or biochemical pregnancy rate. A higher odds of multiple gestation [AdjOR(95%CI) 1.06 (1.01, 1.11), p = 0.019] were noted, even when adjusting for number of embryos transferred [AdjOR(95%CI) 1.05 (1.01, 1.10)]. Live birth outcomes showed no differences in live birth rates or birthweight at delivery. Conclusions: The study found equivalent outcomes for SS and SW in all parameters except for a slight rise in the rate of multiple gestations. The results suggest that SS warming is an efficient, viable alternative to SW, reducing thaw times without adverse effects on live birth rates or neonatal birth weights. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether the New York State (NYS) mandate expanding Medicaid coverage of fertility diagnostic testing and treatment is successfully increasing patient access to and utilization of fertility care. Methods: A retrospective chart review was performed of NYS Medicaid patients who presented for fertility services to a large academic reproductive endocrinology and infertility (REI) clinic. Information on patient demographics, medical history, diagnostic testing, treatments, and outcomes was collected. Patients presenting to the clinic in the 1 year prior to the mandate (October 1, 2018–September 30, 2019) were compared to patients presenting in the 1 year after the mandate (October 1, 2019–September 30, 2020). Primary outcomes of the study were differences in presentation to the clinic between the two cohorts and differences in utilization of infertility diagnostic testing and treatment. Secondary outcomes were differences in treatment outcomes. Results: A significantly larger percentage of Medicaid patients presented to the clinic for fertility assessment post-mandate (22%) as compared to pre-mandate (9%, p < 0.05). There were no demographic differences between the pre- and post-mandate patient groups. A similar percentage of patients completed diagnostic testing pre- vs. post-mandate. Post-mandate patients underwent more treatment cycles with ovulation induction medications compared to natural treatment cycles. There was no significant difference in pregnancy rates pre- vs. post-mandate. Conclusion: The NYS Medicaid mandate allowed a significantly larger percentage of Medicaid patients to present for fertility evaluation. The patients in the post-mandate cohort underwent more treatment cycles with ovulation induction medications compared to natural cycles. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the visibility of embryologists on fertility clinic websites among Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member clinics. Methods: During a 1-month interval (March 2022), all Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member fertility clinic websites were evaluated. The professional representation of the primary care team was examined including specialties, the presence of headshots, and biographies. Results: A total of 446 fertility clinic websites were scanned in the search. The embryology team has the least common professional identification by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001). This trend also applies to other types of professional identifiers, such as headshots and biographies. Professional headshots of embryologists (50.34%) were less prominent than those of gynecology clinicians (93.51%, p < 0.001). A similar trend was observed in the biographies of the embryology team (47.20%) compared to gynecology clinicians (95.08%, p < 0.001). Conclusion: The present study revealed that embryologists have low professional visibility on fertility clinic websites. Fertility clinics may prioritize enhancing the online visibility of their embryology laboratory team. This approach could potentially enhance the recognition of their team, foster transparency, and provide accessible information about the skills and expertise of healthcare professionals involved in the treatment process. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate which factors are involved in the increased rate of mosaicism in embryos. Methods: A systematic review and meta-analysis was performed. After an exhaustive search of the literature, a total of seven papers were included in the analysis. In addition, data collected from IVF cycles performed in our fertility clinic were also analysed. Day of biopsy, embryo quality, maternal and paternal age and seminal quality were the chosen factors to be studied. Results: The results of the meta-analysis show that neither embryo quality nor seminal quality were related to mosaic embryo rate (OR: 1.09; 95% CI: 0.94–1.28 and OR: 1.10; 95% CI: 0.87–1.37, respectively). A positive association was observed for the variable "biopsy day" with embryos biopsied at day 6 or 7 having the highest rate of mosaicism (OR: 1.06; 95% CI: 1.01–1.11). In opposite to what happens with aneuploidy rate, which increases with maternal age, embryo mosaicism is higher in younger women (<34 years) rather than in older ones (≥34 years) (OR: 0.95; 95% CI: 0.92–0.98). However, for the "paternal age" factor, no association with mosaicism was found (OR: 1.04; 95% CI: 0.90–1.21). Conclusions: With the present study, we can conclude that the factors related to the presence of mosaicism in embryos are the embryo biopsy day and maternal age. The rest of the studied factors showed no significant relationship with mosaicism. These results are of great importance as knowing the possible causes leading to mosaicism helps to improve the clinical results of reproductive treatments. [ABSTRACT FROM AUTHOR]

The increasing demand for fertility treatments has led to the rise of private clinics offering complementary and alternative medicine (CAM) treatments. The most frequently offered CAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility. This study evaluates the scope of information provided by CAM fertility clinics in the UK. A content analysis was conducted on 200 websites of CAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on the efficacy, risks and success rates of acupuncture for infertility. This has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment. [ABSTRACT FROM AUTHOR]

The aim of this guide is to describe different scenarios when remote IVF would be needed, considerations around how to plan for the procedure, proper equipment in the procedure room, and proper transportation of oocytes from the procedure room. There are two different scenarios for remote IVF: (1) IVF clinics designed knowing the embryology laboratory is nonadjacent and (2) IVF clinics that routinely provide care to patients in their clinic and want to provide care to those who are ineligible for a retrieval under anesthesia in an outpatient facility. This guide will focus on both scenarios. Much of the advice can be used for IVF clinics that routinely perform oocyte retrievals nonadjacent to their embryology laboratories. Special considerations are needed when patients with complex comorbidities require high-level of care and hospital-level monitoring while under anesthesia and/or post-oocyte retrieval, and are thus unable to be treated in the standard facility. For these reasons we have created a comprehensive guide to nonadjacent, or off-site, oocyte retrievals for reproductive endocrinology and infertility (REI) physicians, nurses, and embryologists to use when planning care for IVF patients. Going forward, we will refer to both these scenarios as remote IVF. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to assess how differences in maternal age distributions between IVF clinics affect the performance of an artificial intelligence model for embryo viability prediction and proposes a method to account for such differences. Methods: Using retrospectively collected data from 4805 fresh and frozen single blastocyst transfers of embryos incubated for 5 to 6 days, the discriminative performance was assessed based on fetal heartbeat outcomes. The data was collected from 4 clinics, and the discrimination was measured in terms of the area under ROC curves (AUC) for each clinic. To account for the different age distributions between clinics, a method for age-standardizing the AUCs was developed in which the clinic-specific AUCs were standardized using weights for each embryo according to the relative frequency of the maternal age in the relevant clinic compared to the age distribution in a common reference population. Results: There was substantial variation in the clinic-specific AUCs with estimates ranging from 0.58 to 0.69 before standardization. The age-standardization of the AUCs reduced the between-clinic variance by 16%. Most notably, three of the clinics had quite similar AUCs after standardization, while the last clinic had a markedly lower AUC both with and without standardization. Conclusion: The method of using age-standardization of the AUCs that is proposed in this article mitigates some of the variability between clinics. This enables a comparison of clinic-specific AUCs where the difference in age distributions is accounted for. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and quantify the character and amount of lesbian, gay, bisexual, transgender, and queer (LGBTQ +) content on sperm, oocyte, and embryo provider websites in the USA. Methods: Websites with LGBTQ + information were categorized into "minimal," "moderate," and "significant" content. The presence and type (category) of LGBTQ + content were assessed in its relationship to geographic regions, in vitro fertilization (IVF) cycles/year, and website types. Interobserver reliability was assessed for the categorization system created. Results: Out of 373 unique websites, 191 (51.2%) had LGBTQ + content of any kind. Regarding the amount of content, websites were categorized as "none" (48.8%), "minimal" (8.0%), "moderate" (28.4%), and "significant" (14.8%). "Private fertility clinic" websites were more likely to have LGBTQ + content and a significantly increased amount of content compared to other website types ("academic hospital" and "sole sperm, oocyte, and embryo provider" websites) (p < 0.0001). Fertility clinics with more IVF cycles/year were more likely to have increased amount of LGBTQ + content compared to those with fewer IVF cycles/year (OR = 4.280; 95% CI, 1.952–9.388). Northeast, West, South, and Midwest regions showed no statistically significant difference in presence and type of content (p = 0.06 and p = 0.13, respectively). Conclusion: Approximately half of websites had LGBTQ + content. Private fertility clinics and fertility clinics with increased IVF cycles/year show a positive relationship to the presence and type of LGBTQ + content, while LGBTQ + website content was similar across four geographic regions. [ABSTRACT FROM AUTHOR]

Cryopreservation, for many reasons, has assumed a central role in IVF treatment cycles, which has resulted in rapidly expanding cryopreserved oocyte and embryo inventory of IVF clinics. We aspire to consider how and with what resources and tools "deep" technology can offer solutions to these cryobiology programs. "Deep tech" has been applied as a global term to encompass the most advanced application of big data analysis for the most informed construction of algorithms and most sophisticated instrument design, utilizing, when appropriate and possible, models of automation and robotics to realize all opportunities for highest efficacy, efficiency, and consistency in a process. [ABSTRACT FROM AUTHOR]

Objective: To determine factors associated with a positive male patient experience (PMPE) at fertility clinics among male patients. Design: Cross-sectional study Setting: Not applicable Patients: Male respondents to the FertilityIQ questionnaire (www.fertilityiq.com) reviewing the first or only US clinic visited between June 2015 and August 2020. Interventions: None Main outcome measures: PMPE was defined as a score of 9 or 10 out of 10 to the question, "Would you recommend this fertility clinic to a best friend?". Examined predictors included demographics, payment details, infertility diagnoses, treatment, and outcomes, physician traits, and clinic operations and resources. Multiple imputation was used for missing variables and logistic regression was used to calculate adjusted odds ratios (aORs) for factors associated with PMPE. Results: Of the 657 men included, 60.9% reported a PMPE. Men who felt their doctor was trustworthy (aOR 5.01, 95% CI 0.97–25.93), set realistic expectations (aOR 2.73, 95% CI 1.10–6.80), and was responsive to setbacks (aOR 2.43, 95% CI 1.14–5.18) were more likely to report PMPE. Those who achieved pregnancy after treatment were more likely to report PMPE; however, this was no longer significant on multivariate analysis (aOR 1.30, 95% CI 0.68–2.47). Clinic-related factors, including ease of scheduling appointments (aOR 4.03, 95% CI 1.63–9.97) and availability of same-day appointments (aOR 4.93, 95% CI 1.75–13.86), were associated with PMPE on both univariate and multivariate analysis. LGBTQ respondents were more likely to report PMPE, whereas men with a college degree or higher were less likely to report PMPE; however, sexual orientation (aOR 3.09, 95% CI 0.86–11.06) and higher educational level (aOR 0.54, 95% CI 0.30–1.10) were not associated with PMPE on multivariate analysis. Conclusion: Physician characteristics and clinic characteristics indicative of well-run administration were the most highly predictive of PMPE. By identifying factors that are associated with a PMPE, clinics may be able to optimize the patient experience and improve the quality of infertility care that they provide for both men and women. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate self-reported survey data provided by US oocyte donors on their experiences with ovarian hyperstimulation syndrome and possible correlations between OHSS severity and number of oocytes retrieved, trigger type, and prior OHSS history. Methods: An 85-question retrospective survey was administered online. Survey questions included demographic information, reasons for donating, immediate per-cycle experiences and outcomes, perceptions of informed consent, and perceived impact of donation on long-term health. Quantitative Data for this study was collected between February 2019 and September 2020 via QualtricsXM (January 2019), an online survey platform. Follow-up interviews were also conducted. Participants were recruited via fertility clinics, egg donation agencies, and online forum. The research was approved by the University of California, San Francisco Institutional Review Board (#14-14765). Results: Of 420 initiated US oocyte donor online surveys, 289 (68%) respondents provided detailed information on per cycle experiences with ovarian hyperstimulation syndrome, number of oocytes retrieved, and trigger type over a total of 801 cycles. On cycles where donors reported receiving GnRH agonist triggers (n = 337), they reported milder OHSS compared to cycles with hCG or dual triggers. Among donors undergoing multiple retrieval cycles, the severity of OHSS in second cycles was strongly associated with OHSS severity in first cycles. Conclusion: Self-reported OHSS in oocyte donors is lower in GnRH antagonist stimulation protocols combined with GnRHa trigger and in cycles where donors reported fewer than 30 oocytes retrieved. Donors who reported severe OHSS on a prior cycle were significantly more likely to experience severe OHSS on a subsequent cycle. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to design an automated deep learning model that extracts the morphokinetic events of embryos that were recorded by time-lapse incubators. Using automated annotation, we set out to characterize the temporal heterogeneity of preimplantation development across a large number of embryos. Methods: To perform a retrospective study, we used a dataset of video files of 67,707 embryos from four IVF clinics. A convolutional neural network (CNN) model was trained to assess the developmental states that appear in single frames from 20,253 manually-annotated embryos. Probability-weighted superposition of multiple predicted states was permitted, thus accounting for visual uncertainties. Superimposed embryo states were collapsed onto discrete series of morphokinetic events via monotonic regression of whole-embryo profiles. Unsupervised K-means clustering was applied to define subpopulations of embryos of distinctive morphokinetic profiles. Results: We perform automated assessment of single-frame embryo states with 97% accuracy and demonstrate whole-embryo morphokinetic annotation with R-square 0.994. High quality embryos that had been valid candidates for transfer were clustered into nine subpopulations, as characterized by distinctive developmental dynamics. Retrospective comparative analysis of transfer versus implantation rates reveals differences between embryo clusters as marked by poor synchronization of the third mitotic cell-cleavage cycle. Conclusions: By demonstrating fully automated, accurate, and standardized morphokinetic annotation of time-lapse embryo recordings from IVF clinics, we provide practical means to overcome current limitations that hinder the implementation of morphokinetic decision-support tools within clinical IVF settings due to inter-observer and intra-observer manual annotation variations and workload constrains. Furthermore, our work provides a platform to address embryo heterogeneity using dimensionality-reduced morphokinetic descriptions of preimplantation development. [ABSTRACT FROM AUTHOR]

Purpose: Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information. Methods: An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method. Results: Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53). Conclusion: Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support. [ABSTRACT FROM AUTHOR]

Purpose: Many countries prohibit payment for gamete donation, which means fertility clinics do not have to compensate donors. However, acquiring and utilizing donor sperm can still be expensive for fertility clinics. This study evaluates international fertility workers' views on charging patients for altruistically donated sperm. Methods: Using social media and email, we disseminated a SurveyMonkey survey with a question that was specifically focused on opinions about charging patients for altruistically donated sperm. Clinicians were able to select multiple pre-populated answer choices as well as write answers that reflected their views as an open-ended response. Snowball sampling was utilized to reach international fertility clinicians. Results: Of 112 respondents from 14 countries, 88% believe it is acceptable to charge for altruistically donated sperm based on one or more of four different assenting categories: so patients appreciate that sperm is valuable, because it generates funds for the running of the clinic, to cover specific costs associated with sperm, and to make a profit for the clinic. Conclusions: The consensus that charging for altruistically donated sperm is acceptable was not surprising since recruiting and processing donor sperm can be expensive for clinics. However, there were geographical differences for specific assenting answer choices which may be based on countries' income, and healthcare system, as well as religious and cultural beliefs. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of self-compassion training using videos (SCV) versus self-compassion training using digital stories (SC-DS) as compared to a control group (CG) on reducing anxiety and depression symptoms among women pursuing fertility treatment. Methods: A three-armed, randomised controlled trial randomly assigned 200 eligible women to SCV(n = 65), SC-DS (n = 67), and CG (n = 68). All three randomised groups completed questionnaires immediately after randomisation (T1), after completing the interventions (T2), and 10 weeks after the interventions (T3). A generalised estimation equation was used with the intention-to-treat analysis. The primary outcomes were anxiety and depression, and secondary outcomes were self-compassion, infertility self-efficacy, and pregnancy rates. Results: SCV and SC-DS participants experienced a significant reduction in anxiety and depression from T1 to T2 and from T1 to T3 (p < 0.001; d > 0.8). SCV and SC-DS participants experienced a significant increase in self-compassion and infertility self-efficacy from T1 to T2 and from T1 to T3 (p < 0.001; d > 0.8). SC-DS seemed to be superior to SCV and CG. No significant differences were found among the three groups in pregnancy rates. SCV and SC-DS participants rated self-compassion training programs positively and said they would highly recommend them to others. Conclusion: These findings suggest that SCV and SC-DS were effective in reducing anxiety and depression and increasing self-compassion and infertility self-efficacy. Online flexible self-compassion interventions could make psychological support more accessible for women undergoing fertility treatment in resource-poor settings. Trial registration: (ChiCTR2100046065) [12/04/2021]. [ABSTRACT FROM AUTHOR]

This letter, titled "Addressing disparities and enhancing accessibility in fertility preservation for male cancer patients in China," commends an article for highlighting the importance of fertility preservation for male cancer patients in China. The article emphasizes the negative impact of cancer treatments on male fertility and the effectiveness of sperm cryopreservation in safeguarding future fertility. It reveals regional disparities in the development of fertility preservation services in China and suggests the need for policy intervention and resource allocation to ensure equitable access. The study also identifies gaps in awareness and accessibility of these services, particularly among adolescent and young adult cancer patients. The letter concludes by emphasizing the importance of addressing these disparities and improving referral and follow-up systems to enhance the quality of life for cancer survivors. [Extracted from the article]

Frameshift now to the issue of fertility benefits and the finances and out-of-pocket expenditures attendant to this care (a conversation all too familiar to those in the ART/IVF space) and the coverage patchwork is even more bewildering for patient and provider alike. What is the status of insurance coverage for fertility services in the United States by large insurers? Benefits are variable and inconsistent, the result of several factors intrinsic to the system of purchasing healthcare plans but also driven by an against-the-tide struggle to have infertility understood as a disease by insurers. These questions include: how dated and static are fertility benefits and requirements to access these benefits by major insurers; how far are we from adequate, universal, and effective fertility and family building benefits; and finally, are there more effective models that could better inform and guide coverage?. [Extracted from the article]

Purpose: To assess public support for insurance coverage of infertility treatment among marginalized patient groups. Methods: A cross-sectional, web survey-based study using a national sample of 1226 US adults. Participants responded to questions measuring their beliefs and attitudes towards support for infertility treatment insurance coverage among specific patient populations. We then evaluated the opinions of only the participants who supported infertility treatment insurance coverage for patients meeting the standard definition of infertility. Associations between demographic data of participants and support for infertility treatment insurance coverage among these marginalized groups were queried. Results: Of the total responses, 61.9% of the respondents generally supported insurance coverage for infertility. Of the total responses, 54.5% did not support any insurance coverage for lesbian, gay, or transgender patients. Of those who generally supported the insurance coverage for infertility, 53.0% supported coverage for gay patients requiring infertility services, 54.6% supported coverage for lesbian patients, and 42.5% supported coverage for transgender patients. Of the total responses, 47.6% did not support insurance for green card holders, undocumented immigrants, or refugees. Of those who supported the insurance coverage for infertility in general, 63.6% supported insurance coverage for patients with green cards, 29.8% for refugees, and 20.7% for undocumented patients. For disability and genetic conditions, 39.5% did not support coverage for any groups. Of those who support the insurance coverage for infertility in general, there was most support for patients with physical disabilities (60.2%) followed by genetic disease (47.9%), then mental disabilities (31.4%). Conclusion: Even among those who support insurance coverage for infertility in general, approximately less than half of them supported these same treatments for marginalized groups, including the diverse sexuality and gender (DSG), immigrant, and disabled populations. Increased education and awareness of infertility is needed among the general population to garner acceptance of infertility as a disease and support insurance coverage of infertility treatment for all persons. [ABSTRACT FROM AUTHOR]

Purpose : The aim of this study is to identify what proportion of mosaic embryo diagnoses should be considered for transfer, and thereby assess the impact on patient cases. Methods: We categorised mosaic embryos into 3 groups; high, medium and low priority for transfer based on the percentage of biopsy sample being aneuploid and the chromosomes involved. The categories were applied to those patients that had no euploid embryo diagnoses but 1 or more mosaic embryos identified as mosaic available after PGT-A. Results: In total, 6614 PGT-A cases from 115 clinics and a single diagnostic laboratory were reviewed. Further, 1384 [20.9%] cases only had aneuploid embryos, 4538 [68.6%] cases had one or more euploid embryos and 692 [10.5%] cases had no euploid and one or more mosaic embryo. The mosaic embryos in the no euploid, one or more mosaic group, when reviewed using priorities, resulted in: 111 [1.7%] of cases having at least one high priority mosaic available. 184 [2.8%] of cases having no high priority but at least one medium priority mosaic available. 397 [6.0%] of cases only having low priority mosaic embryos available. Conclusion: Based on this data, embryos identified as mosaic will only be considered for transfer in the first instance for around 4.5% (when taking high and medium priority and excluding low priority cases) of all PGT-A cases. [ABSTRACT FROM AUTHOR]

Human infertility is a major global public health issue estimated to affect one out of six couples, while the number of assisted reproduction cycles grows impressively year over year. Efforts to alleviate infertility using advanced technology are gaining traction rapidly as infertility has an enormous impact on couples and the potential to destabilize entire societies if replacement birthrates are not achieved. Artificial intelligence (AI) technologies, leveraged by the highly advanced assisted reproductive technology (ART) industry, are a promising addition to the armamentarium of tools available to combat global infertility. This review provides a background for current methodologies in embryo selection, which is a manual, time-consuming, and poorly reproducible task. AI has the potential to improve this process (among many others) in both the clinician's office and the IVF laboratory. Embryo selection is evolving through digital methodologies into an automated procedure, with superior reliability and reproducibility, that is likely to result in higher pregnancy rates for patients. There is an emerging body of data demonstrating the utility of AI applications in multiple areas in the IVF laboratory. AI platforms have been developed to evaluate individual embryologist performance; to provide quality assurance for culture systems; to correlate embryologist's assessments and AI systems; to predict embryo ploidy, implantation, fetal heartbeat, and live birth outcome; and to replace the current "analogue" system of embryo selection with a digital paradigm. AI capability will distinguish high performing, high profit margin, low-cost, and highly successful IVF clinic business models. We think it will become the standard, "new normal" in IVF labs, as rapidly and thoroughly as vitrification, blastocyst culture, and intracytoplasmic sperm injection replaced their predecessor technologies. At the time of this review, the AI technology to automate embryo evaluation and selection has robustly matured, and therefore, it is the main focus of this review. [ABSTRACT FROM AUTHOR]

Purpose: Staff management is the most cited ART/IVF laboratory inspection deficiency. Small ART/IVF clinics may be challenged to perform these activities by low staff volume; similarly, large ART/IVF networks may be challenged by high staff volume and large datasets. Here, we sought to investigate the performance of an automated, digital platform solution to manage this necessary task. Methods: The ART Compass (ARTC) digital staff management platform was used to assess the clinical decision-making of ART laboratory staff. The survey modules presented standardized instructions to technologists and measured inter- and intra-technologist variability for subjective "clinical decision-making" type questions. Internal and external comparisons were achieved by providing technologists two answers: (1) a comparison to their own lab director and (2) to the most popular response collectively provided by all lab director level accounts. The platform is hosted on HIPAA compliant Amazon web servers, accessible via web browser and mobile applications for iOS (Apple) and Android mobile devices. Results: Here, we investigated the performance of a digital staff management platform for single embryologist IVF practices and for three IVF lab networks (sites A, B, C) from 2020 to 2022. Embryology dish preparation survey results show variance among respondents in the following: PPE use, media volume, timing of oil overlay, and timing of moving prepared dishes to incubators. Surveying the perceived Gardner score and terms in use for early blastocysts reveals a lack of standardization of terminology and fair to poor agreement. We observed moderate inter-technologist agreement for ICM and TE grade (0.47 and 0.52, respectively). Lastly, the clinical decision of choice to freeze or discard an embryo revealed that agreement to freeze was highest for the top-quality embryos, and that some embryos can be highly contested, evenly split between choice to freeze or discard. Conclusions: We conclude that a digital platform is a novel and effective tool to automate, routinely monitor, and assure quality for staff-related parameters in ART and IVF laboratories. Use of a digital platform can increase regulatory compliance and provide actionable insight for quality assurance in both single embryologist practices and for large networks. Furthermore, clinical decision-making can be augmented with artificial intelligence integration. [ABSTRACT FROM AUTHOR]

Purpose: Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors’ available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor.An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors’ available genetic information and process in choosing an oocyte donor.Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers.Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.Methods: Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors’ available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor.An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors’ available genetic information and process in choosing an oocyte donor.Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers.Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.Results: Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors’ available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor.An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors’ available genetic information and process in choosing an oocyte donor.Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers.Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.Conclusions: Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors’ available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor.An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors’ available genetic information and process in choosing an oocyte donor.Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers.Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience. [ABSTRACT FROM AUTHOR]

Purpose: Currently, assisted reproduction clinics employ various sperm selection techniques to identify the best sperm for fertilization. However, these techniques may not assess crucial sperm traits that can substantially impact embryonic quality. To address this, we propose analyzing diverse histone modifications as potential markers of sperm functionality and success in assisted reproduction techniques.Cross-sectional pilot study including infertile male patients attending an infertility clinic in CABA, Argentina between April and August 2019 was performed. We used immunofluorescence techniques to evaluate post-translational modifications of histones in sperm and established correlations with in vitro fertilization outcome and embryo quality.Our findings indicate a negative correlation between H3K4me3 and H3K4me2 marks and fertilization rate and showed a positive correlation of this parameter with H3K9me mark. In addition, there was a positive correlation between H3K27me3 and good embryo quality.This pilot study proposes a non-invasive strategy to predict embryo quality by analyzing spermatozoa prior to fertilization. The assessment of histone post-translational modifications in sperm samples could provide useful information for the recognition of epigenetic marks that could predict the health of the embryo of an assisted fertilization treatment.Methods: Currently, assisted reproduction clinics employ various sperm selection techniques to identify the best sperm for fertilization. However, these techniques may not assess crucial sperm traits that can substantially impact embryonic quality. To address this, we propose analyzing diverse histone modifications as potential markers of sperm functionality and success in assisted reproduction techniques.Cross-sectional pilot study including infertile male patients attending an infertility clinic in CABA, Argentina between April and August 2019 was performed. We used immunofluorescence techniques to evaluate post-translational modifications of histones in sperm and established correlations with in vitro fertilization outcome and embryo quality.Our findings indicate a negative correlation between H3K4me3 and H3K4me2 marks and fertilization rate and showed a positive correlation of this parameter with H3K9me mark. In addition, there was a positive correlation between H3K27me3 and good embryo quality.This pilot study proposes a non-invasive strategy to predict embryo quality by analyzing spermatozoa prior to fertilization. The assessment of histone post-translational modifications in sperm samples could provide useful information for the recognition of epigenetic marks that could predict the health of the embryo of an assisted fertilization treatment.Results: Currently, assisted reproduction clinics employ various sperm selection techniques to identify the best sperm for fertilization. However, these techniques may not assess crucial sperm traits that can substantially impact embryonic quality. To address this, we propose analyzing diverse histone modifications as potential markers of sperm functionality and success in assisted reproduction techniques.Cross-sectional pilot study including infertile male patients attending an infertility clinic in CABA, Argentina between April and August 2019 was performed. We used immunofluorescence techniques to evaluate post-translational modifications of histones in sperm and established correlations with in vitro fertilization outcome and embryo quality.Our findings indicate a negative correlation between H3K4me3 and H3K4me2 marks and fertilization rate and showed a positive correlation of this parameter with H3K9me mark. In addition, there was a positive correlation between H3K27me3 and good embryo quality.This pilot study proposes a non-invasive strategy to predict embryo quality by analyzing spermatozoa prior to fertilization. The assessment of histone post-translational modifications in sperm samples could provide useful information for the recognition of epigenetic marks that could predict the health of the embryo of an assisted fertilization treatment.Conclusions: Currently, assisted reproduction clinics employ various sperm selection techniques to identify the best sperm for fertilization. However, these techniques may not assess crucial sperm traits that can substantially impact embryonic quality. To address this, we propose analyzing diverse histone modifications as potential markers of sperm functionality and success in assisted reproduction techniques.Cross-sectional pilot study including infertile male patients attending an infertility clinic in CABA, Argentina between April and August 2019 was performed. We used immunofluorescence techniques to evaluate post-translational modifications of histones in sperm and established correlations with in vitro fertilization outcome and embryo quality.Our findings indicate a negative correlation between H3K4me3 and H3K4me2 marks and fertilization rate and showed a positive correlation of this parameter with H3K9me mark. In addition, there was a positive correlation between H3K27me3 and good embryo quality.This pilot study proposes a non-invasive strategy to predict embryo quality by analyzing spermatozoa prior to fertilization. The assessment of histone post-translational modifications in sperm samples could provide useful information for the recognition of epigenetic marks that could predict the health of the embryo of an assisted fertilization treatment. [ABSTRACT FROM AUTHOR]

Purpose: To study patient satisfaction with new patient telehealth visits in a reproductive endocrinology and infertility (REI) office. Methods: A cross-sectional study in a university-based fertility clinic was completed including all new patients seen via telehealth between March 1, 2021, and August 19, 2021. Primary outcomes were perceived patient satisfaction, access, and preferences to telehealth visits. Results: A total of 351 participants were contacted, 61.8% (n = 217) agreed to participate in the study, and 28.8% (n = 101) completed the survey. There were no significant differences in age, BMI, distance from clinic, or length of infertility with response to survey. Ninety-three percent of responders would use telehealth services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 88% and travel time for 96%. The median distance from clinic was 24 miles, and there was no significance difference in preference for telehealth visits over in person visits (p = 0.696). Conclusions: In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telehealth services. Based on our survey, majority of patients were satisfied with telehealth visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telehealth depending on their distance from clinic, this is reassuring because patients are satisfied with telehealth for reasons other than distance from clinic. [ABSTRACT FROM AUTHOR]

Purpose: To assess telehealth services offered by reproductive endocrinology and infertility specialists and to gauge provider experiences with incorporating telehealth into their practices. Methods: A 16-question web-based survey on use of telehealth was distributed to Society for Assisted Reproductive Technology (SART) clinics and to Society for Reproductive Endocrinology and Infertility (SREI) members. Clinic demographic data, telehealth descriptive data, and provider satisfaction with use of telehealth were assessed. Results were collected via Survey Monkey. Results: A total of 1160 individuals (330 SART clinic contacts and 830 SREI members) were reached via email with an 18.6% (216) survey response rate. All respondents indicated that they offer telehealth visits. Several telehealth platforms were used, with Zoom (62.7%) and telehealth through the clinic's electronic medical record platform (34.8%) being the most common. The majority of participants (87.0%) anticipate they will offer telehealth visits after the COVID-19 pandemic. Roughly two-thirds (64.4%) of respondents anticipate fewer telehealth visits after the pandemic because of logistics, cost, and patient/provider preference. Nearly all providers are either "very satisfied" (66.2%) or "somewhat satisfied" (31.0%) with telehealth overall. Conclusion: Telehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic. While only one-third of survey respondents offered telehealth services before the pandemic, nearly all providers express satisfaction with telehealth and anticipate they will offer telehealth services henceforth. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the main psychosocial motivational factors behind the increased adoption of IVF during the COVID-19 pandemic.This prospective, multicenter, observational case–control study assessed the factors motivating infertile couples to pursue their first IVF treatment during the pandemic across various IVF clinics in Spain, Portugal, Italy, the USA, and Panama. A pre-pandemic control group and a post-pandemic participant group were surveyed. The study was conducted between November 2021 and January 2023. The increase in IVF cycles was analyzed, and an ad hoc survey was developed to explore the motivational factors driving IVF engagement.Most clinics reported a significant increase in IVF demand (5.5–8.7%) for all indicators, including the number of started ovarian stimulations, oocyte pickups, and embryo transfers, following the declaration of the pandemic. The extra time spent and the reduced workload were the most important motivations prompting women to pursue their first fertility treatment during the pandemic (time to spend in the couple’s relationship—OR, 1.53; 95% CI, 1.06–2.20; p < 0.05; decreased workload—OR, 2.63; 95% CI, 1.11–6.24; p < 0.05).This study highlights that infertility remains a significant stressor for individuals, and the desire to resolve it is not hindered by catastrophic events like COVID-19. Open communication between partners about reproductive intentions, combined with reduced work-related stress, is a key factor influencing the initiation of fertility treatment. It is crucial to encourage couples to take timely action in facing infertility.Methods: To evaluate the main psychosocial motivational factors behind the increased adoption of IVF during the COVID-19 pandemic.This prospective, multicenter, observational case–control study assessed the factors motivating infertile couples to pursue their first IVF treatment during the pandemic across various IVF clinics in Spain, Portugal, Italy, the USA, and Panama. A pre-pandemic control group and a post-pandemic participant group were surveyed. The study was conducted between November 2021 and January 2023. The increase in IVF cycles was analyzed, and an ad hoc survey was developed to explore the motivational factors driving IVF engagement.Most clinics reported a significant increase in IVF demand (5.5–8.7%) for all indicators, including the number of started ovarian stimulations, oocyte pickups, and embryo transfers, following the declaration of the pandemic. The extra time spent and the reduced workload were the most important motivations prompting women to pursue their first fertility treatment during the pandemic (time to spend in the couple’s relationship—OR, 1.53; 95% CI, 1.06–2.20; p < 0.05; decreased workload—OR, 2.63; 95% CI, 1.11–6.24; p < 0.05).This study highlights that infertility remains a significant stressor for individuals, and the desire to resolve it is not hindered by catastrophic events like COVID-19. Open communication between partners about reproductive intentions, combined with reduced work-related stress, is a key factor influencing the initiation of fertility treatment. It is crucial to encourage couples to take timely action in facing infertility.Results: To evaluate the main psychosocial motivational factors behind the increased adoption of IVF during the COVID-19 pandemic.This prospective, multicenter, observational case–control study assessed the factors motivating infertile couples to pursue their first IVF treatment during the pandemic across various IVF clinics in Spain, Portugal, Italy, the USA, and Panama. A pre-pandemic control group and a post-pandemic participant group were surveyed. The study was conducted between November 2021 and January 2023. The increase in IVF cycles was analyzed, and an ad hoc survey was developed to explore the motivational factors driving IVF engagement.Most clinics reported a significant increase in IVF demand (5.5–8.7%) for all indicators, including the number of started ovarian stimulations, oocyte pickups, and embryo transfers, following the declaration of the pandemic. The extra time spent and the reduced workload were the most important motivations prompting women to pursue their first fertility treatment during the pandemic (time to spend in the couple’s relationship—OR, 1.53; 95% CI, 1.06–2.20; p < 0.05; decreased workload—OR, 2.63; 95% CI, 1.11–6.24; p < 0.05).This study highlights that infertility remains a significant stressor for individuals, and the desire to resolve it is not hindered by catastrophic events like COVID-19. Open communication between partners about reproductive intentions, combined with reduced work-related stress, is a key factor influencing the initiation of fertility treatment. It is crucial to encourage couples to take timely action in facing infertility.Conclusion: To evaluate the main psychosocial motivational factors behind the increased adoption of IVF during the COVID-19 pandemic.This prospective, multicenter, observational case–control study assessed the factors motivating infertile couples to pursue their first IVF treatment during the pandemic across various IVF clinics in Spain, Portugal, Italy, the USA, and Panama. A pre-pandemic control group and a post-pandemic participant group were surveyed. The study was conducted between November 2021 and January 2023. The increase in IVF cycles was analyzed, and an ad hoc survey was developed to explore the motivational factors driving IVF engagement.Most clinics reported a significant increase in IVF demand (5.5–8.7%) for all indicators, including the number of started ovarian stimulations, oocyte pickups, and embryo transfers, following the declaration of the pandemic. The extra time spent and the reduced workload were the most important motivations prompting women to pursue their first fertility treatment during the pandemic (time to spend in the couple’s relationship—OR, 1.53; 95% CI, 1.06–2.20; p < 0.05; decreased workload—OR, 2.63; 95% CI, 1.11–6.24; p < 0.05).This study highlights that infertility remains a significant stressor for individuals, and the desire to resolve it is not hindered by catastrophic events like COVID-19. Open communication between partners about reproductive intentions, combined with reduced work-related stress, is a key factor influencing the initiation of fertility treatment. It is crucial to encourage couples to take timely action in facing infertility. [ABSTRACT FROM AUTHOR]

Purpose: To investigate small RNA profiles in sperm, identify stable miRNA patterns unique to sperm, and assess the behavior of consistently expressed miRNAs in sperm from subfertile men compared to fertile controls.The small RNA profiles of single sperm from four proven fertile men were analyzed using Small RNA next-generation sequencing (NGS). Subsequently, a specific set of miRNAs was validated using RT-qPCR on additional sperm samples from 65 subfertile men from an infertility clinic and 30 proven fertile men.Small RNA sequencing revealed a diverse range of sperm small RNA biotypes, including miRNAs. The mapped read percentage ranged from 22.19% for single sperm to 83.29% for enriched sperm samples used at different RNA concentrations. In single sperm, a smaller proportion of sequences were attributed to piRNAs (2.79%), miRNA (0.94%), tRNA (0.82%), and rRNA (0.47%) compared to enriched sperm samples, where piRNA (41.68%), tRNA (20.31%), miRNA (11.11%), and rRNA (6.54%) were observed. Distinct detection rates and a higher number of detected miRNAs were noted with enriched sperm samples compared to single sperm obtained using either a micromanipulator or microdissection systems. Among the identified miRNAs, 110 were consistently present in all samples. RT-qPCR revealed 15 miRNAs with increased expression and 5 miRNAs with decreased expression in sperm samples from subfertile men compared to proven fertile men. These differentially validated miRNAs were significantly correlated, either positively or negatively, with sperm count, motility, and morphology.The study extensively examines small RNAs in single sperm, identifying sperm-specific miRNAs that could serve as molecular markers to distinguish between subfertile and fertile men in clinical settings.Methods: To investigate small RNA profiles in sperm, identify stable miRNA patterns unique to sperm, and assess the behavior of consistently expressed miRNAs in sperm from subfertile men compared to fertile controls.The small RNA profiles of single sperm from four proven fertile men were analyzed using Small RNA next-generation sequencing (NGS). Subsequently, a specific set of miRNAs was validated using RT-qPCR on additional sperm samples from 65 subfertile men from an infertility clinic and 30 proven fertile men.Small RNA sequencing revealed a diverse range of sperm small RNA biotypes, including miRNAs. The mapped read percentage ranged from 22.19% for single sperm to 83.29% for enriched sperm samples used at different RNA concentrations. In single sperm, a smaller proportion of sequences were attributed to piRNAs (2.79%), miRNA (0.94%), tRNA (0.82%), and rRNA (0.47%) compared to enriched sperm samples, where piRNA (41.68%), tRNA (20.31%), miRNA (11.11%), and rRNA (6.54%) were observed. Distinct detection rates and a higher number of detected miRNAs were noted with enriched sperm samples compared to single sperm obtained using either a micromanipulator or microdissection systems. Among the identified miRNAs, 110 were consistently present in all samples. RT-qPCR revealed 15 miRNAs with increased expression and 5 miRNAs with decreased expression in sperm samples from subfertile men compared to proven fertile men. These differentially validated miRNAs were significantly correlated, either positively or negatively, with sperm count, motility, and morphology.The study extensively examines small RNAs in single sperm, identifying sperm-specific miRNAs that could serve as molecular markers to distinguish between subfertile and fertile men in clinical settings.Results: To investigate small RNA profiles in sperm, identify stable miRNA patterns unique to sperm, and assess the behavior of consistently expressed miRNAs in sperm from subfertile men compared to fertile controls.The small RNA profiles of single sperm from four proven fertile men were analyzed using Small RNA next-generation sequencing (NGS). Subsequently, a specific set of miRNAs was validated using RT-qPCR on additional sperm samples from 65 subfertile men from an infertility clinic and 30 proven fertile men.Small RNA sequencing revealed a diverse range of sperm small RNA biotypes, including miRNAs. The mapped read percentage ranged from 22.19% for single sperm to 83.29% for enriched sperm samples used at different RNA concentrations. In single sperm, a smaller proportion of sequences were attributed to piRNAs (2.79%), miRNA (0.94%), tRNA (0.82%), and rRNA (0.47%) compared to enriched sperm samples, where piRNA (41.68%), tRNA (20.31%), miRNA (11.11%), and rRNA (6.54%) were observed. Distinct detection rates and a higher number of detected miRNAs were noted with enriched sperm samples compared to single sperm obtained using either a micromanipulator or microdissection systems. Among the identified miRNAs, 110 were consistently present in all samples. RT-qPCR revealed 15 miRNAs with increased expression and 5 miRNAs with decreased expression in sperm samples from subfertile men compared to proven fertile men. These differentially validated miRNAs were significantly correlated, either positively or negatively, with sperm count, motility, and morphology.The study extensively examines small RNAs in single sperm, identifying sperm-specific miRNAs that could serve as molecular markers to distinguish between subfertile and fertile men in clinical settings.Conclusion: To investigate small RNA profiles in sperm, identify stable miRNA patterns unique to sperm, and assess the behavior of consistently expressed miRNAs in sperm from subfertile men compared to fertile controls.The small RNA profiles of single sperm from four proven fertile men were analyzed using Small RNA next-generation sequencing (NGS). Subsequently, a specific set of miRNAs was validated using RT-qPCR on additional sperm samples from 65 subfertile men from an infertility clinic and 30 proven fertile men.Small RNA sequencing revealed a diverse range of sperm small RNA biotypes, including miRNAs. The mapped read percentage ranged from 22.19% for single sperm to 83.29% for enriched sperm samples used at different RNA concentrations. In single sperm, a smaller proportion of sequences were attributed to piRNAs (2.79%), miRNA (0.94%), tRNA (0.82%), and rRNA (0.47%) compared to enriched sperm samples, where piRNA (41.68%), tRNA (20.31%), miRNA (11.11%), and rRNA (6.54%) were observed. Distinct detection rates and a higher number of detected miRNAs were noted with enriched sperm samples compared to single sperm obtained using either a micromanipulator or microdissection systems. Among the identified miRNAs, 110 were consistently present in all samples. RT-qPCR revealed 15 miRNAs with increased expression and 5 miRNAs with decreased expression in sperm samples from subfertile men compared to proven fertile men. These differentially validated miRNAs were significantly correlated, either positively or negatively, with sperm count, motility, and morphology.The study extensively examines small RNAs in single sperm, identifying sperm-specific miRNAs that could serve as molecular markers to distinguish between subfertile and fertile men in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of increasing estrogen doses during hormone therapy frozen embryo transfer (HT-FET) cycles on endometrial thickness and success rates compared to patients who received fixed estrogen dose. Materials and methods: A retrospective study from a university-based fertility clinic during the years 2008–2021. We compared two groups: the fixed-dose group (i.e., received 6 mg estradiol dose daily until embryo transfer) and the increased-dose group (i.e., the initial estradiol dose was 6 mg daily, and was increased during the cycle). Primary outcome: clinical pregnancy rate. Results: The study included 5452 cycles of HT-FET: 4774 cycles in the fixed-dose group and 678 cycles in the increased-dose group. Ultrasound scan on days 2–3 of the cycle showed endometrial thickness slightly different between the two groups (4.2 mm in the fixed-dose and 4.0 mm in the increased-dose group, P = 0.003). The total estrogen dose was higher, and the treatment duration was longer in the increased than the fixed-dose group (122 mg vs. 66 mg and 17 days vs. 11 days, respectively; P < 0.001). The last ultrasound scan done before the addition of progesterone showed that the endometrial thickness was significantly thicker in the fixed than the increased-dose group (9.5 mm vs. 8.3 mm; P < 0.001). The clinical pregnancy rates were 35.8% in the increased-group vs. 34.1% in the fixed-dose group; P = 0.401. Conclusions: The increased-dose group had thinner endometrium despite the higher doses of estrogen and longer treatment duration than the fixed-dose group. However, the pregnancy rates were similar between the two groups. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. Methods: All women ages 15–45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. Results: Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. Conclusions: In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status. [ABSTRACT FROM AUTHOR]

Purpose: To assess oncofertility content on fertility clinic websites as indicated by eight relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and five predetermined clinic characteristics. Methods: We examined 381 fertility clinic websites that are members of the Society for Associated Reproductive Technology (SART). Extracted data included clinic location, practice type (private vs academic), size (cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and distance from the nearest NCI center. Additionally, we documented whether the clinic was located in a state mandating reproductive and infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine (ASRM). Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate. Results: Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one oncofertility-related keyword. Most frequently used terms included cancer (79%) and fertility preservation (78%), while less frequently used terms included suppression (9.4%) and shielding (5.0%). Practices that initiated ≥ 501 cycles per year were more likely to mention one of the oncofertility keywords (OR 1.2; 95% CI 1.1–1.3). The associations of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI-designated cancer center were not statistically significant. Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer. Conclusion: This is the first study correlating availability of oncofertility content on SART fertility clinic websites with consideration of geographic proximity to NCI designated cancer centers. Large clinic size was the only predictive factor for inclusion of oncofertility website content. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the perceived changes in sexual behaviour during COVID-19 lockdown, anxiety symptoms, and couple relationship of patients with infertility. Methods: We performed an observational cross-sectional study between 20 November 2020 and 15 January 2021. We used stratified analysis of different stress levels and Quality of Marriage Index (QMI) scores to compare the perceived changes in sexual behaviour, anxiety symptoms, and couple relationship. The logistic regression model was performed to assess factors correlated with couples' relationship quality during the lockdown. Furthermore, we performed pathway analyses to assess whether the changes in sexual behaviour, stress level, or psychological anxiety during the lockdown could predict the quality of couple relationship. Results: A total of 940 patients with infertility were included in this study. When we conducted a stratified analysis of the participants, significant differences were found between the changes in their sexual behaviour, stress levels, and couple relationship quality. The logistic regression model showed that sex, anxiety symptoms, decreased sexual satisfaction, sexual activity frequency, and income levels were closely related to couple relationship quality. Pathway analyses indicated that changes in their sexual behaviour, anxiety symptoms, and stress levels could all predict the quality of couple relationship. Conclusions: The perceived changes in sexual behaviour with different stress levels and couple relationship quality showed significant differences. Analysing the related factors that affect the quality of couple relationship, especially in times of crisis, is of great significance as this information can contribute to the improvement of treatment for patients with infertility. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether young women with idiopathic early ovarian aging, as defined by producing fewer oocytes than expected for a given age over multiple in vitro fertilization (IVF) cycles, have changes in telomere length and epigenetic age indicating accelerated biological aging (i.e., increased risk of morbidity and mortality). Methods: A prospective cohort study was conducted at two Danish public fertility clinics. A total of 55 young women (≤ 37 years) with at least two IVF cycles with ≤ 5 harvested oocytes despite sufficient stimulation with follicle-stimulating hormone (FSH) were included in the early ovarian aging group. As controls, 52 young women (≤ 37 years) with normal ovarian function, defined by at least eight harvested oocytes, were included. Relative telomere length (rTL) and epigenetic age acceleration (AgeAccel) were measured in white blood cells as markers of premenopausal accelerated biological aging. Results: rTL was comparable with a mean of 0.46 (± SD 0.12) in the early ovarian aging group and 0.47 (0.14) in the normal ovarian aging group. The AgeAccel of the early ovarian aging group was, insignificantly, 0.5 years older, but this difference disappeared when adjusting for chronological age. Sub-analysis using Anti-Müllerian hormone (AMH) as selection criterion for the two groups did not change the results. Conclusion: We did not find any indications of accelerated aging in whole blood from young women with idiopathic early ovarian aging. Further investigations in a similar cohort of premenopausal women or other tissues are needed to fully elucidate the potential relationship between premenopausal accelerated biological aging and early ovarian aging. [ABSTRACT FROM AUTHOR]

Purpose: To determine the frequency of and factors associated with a patient being declined from pursuing a cycle of in vitro fertilization with autologous oocytes (IVF-AO). Methods: A cross-sectional study using a nationwide cohort of female respondents aged 35 or over, who visited a US fertility clinic from 1/2015 to 3/2020, responded to the online FertilityIQ questionnaire (http://www.fertilityiq.com). All respondents were asked if they were previously declined from pursuing a cycle of IVF-AO. Examined demographic and clinical predictors included age, race/ethnicity, education, income, clinic type, care received in a mandated state, insurance coverage for fertility treatment, and self-reported infertility diagnosis. Logistic regression was used to calculate the adjusted odds ratios for factors associated with being declined from pursuing IVF-AO. Results: Of 8660 women who met inclusion criteria, 418 (4.8%) reported previously being declined a cycle of IVF-AO. In the multivariate analysis, predictors of being declined from pursuing IVF-AO included increasing age, income of less than $50,000, and diagnoses of poor oocyte quality and diminished ovarian reserve. Predictors of being less likely to report decline included some college or college degree and diagnoses of male factor, unexplained or tubal infertility. Notably, diagnosis of PCOS or residence in a state with mandated fertility coverage was not predictive of patients being declined from pursuing IVF-AO. Conclusion: Nearly 5% of patients who pursued IVF reported being declined from pursuing IVF-AO. Further studies are needed to confirm our findings and explore whether patients being declined treatment meet the criteria for futile or very poor prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Pre-implantation genetic testing for aneuploidies (PGT-A) is a technique used as part of in vitro fertilisation to improve outcomes. Despite the upward trend in women utilising PGT-A, data on women's motivations and concerns toward using the technology, and perceptions having undergone the process, remain scarce. Methods: This cross-sectional survey, based at a fertility clinic in the UK, utilised an electronic questionnaire to assess the motivations of women who undergo PGT-A and their perceptions and attitudes toward PGT-A after using it. Results: One hundred sixty-one women responded. The most significant motivating factors to undergo PGT-A were to improve the probability of having a baby per cycle (9.0 ± 2.1) and enhance the chance of implantation (8.8 ± 2.5). The least important motivations were reducing the number of embryos transferred per cycle (2.7 ± 3.3) and saving money by reducing the number of procedures required (4.6 ± 3.4). The most significant concerning factors identified included not having embryos to transfer (5.7 ± 3.4) and the potential for embryo damage (5.2 ± 3.3). The least concerning factors included religious (0.6 ± 1.7) or moral (1 ± 2.2) concerns. The majority of women were satisfied/very satisfied following treatment (n = 109; 68%). The proportion of those who were satisfied/very satisfied increased to 94.2% (n = 81) following a successful outcome, and reduced to 43.5% (n = 27) in those who had an unsuccessful outcome or had not undergone embryo transfer (p < 0.001). Conclusion: This study highlights that perceptions amongst women who use PGT-A are mostly positive. We also demonstrate a significant association between satisfaction and reproductive outcomes, with those who achieve a live birth reporting more positive perceptions toward PGT-A. [ABSTRACT FROM AUTHOR]

Purpose: To study how SART-member fertility clinics communicated via clinic websites during the first wave of the COVID-19 pandemic following publication of ASRM COVID-19 Task Force recommendations. Methods: SART-member fertility clinic websites were systematically surveyed for the presence of an REI-specific COVID-19 message (REI-CM) and analyzed for their adherence to ASRM guidance. Results: Of the 381 active clinic websites, 249 (65.3%) had REI-specific COVID messaging. The presence of REI-CM was more common in private than in academic practices (73% vs 38%, p < 0.001) and with increasing practice volume: 38% of clinics with < 200 annual cycles vs 91% of clinics with > 1000 cycles (p < 0.001). Adherence to ASRM guidance was more common in academic than in private practices (54% vs 31%, p = 0.02). Additionally, 9% of REI-CM (n = 23) announced continued treatment regardless of a patient's clinical urgency. This messaging was more common in groups doing > 1000 cycles a year (18%, p = 0.009). Clinics treating all-comers were less likely to cite ASRM than other clinics (41% vs 62%, p = 0.045). However, 75% (n = 14) cited COVID-19 guidance from WHO, CDC, and state and local governments. Conclusions: Clinic response to ASRM recommendations during the first wave of COVID-19 pandemic was heterogeneous. Although academic practices were more likely to follow ASRM guidance, there was a lower extent of patient-facing messaging among academic practices than private clinics. In event of further escalations of this and future pandemics, clinics can learn from experiences to provide clear messaging to patients. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the demographic differences between infertile/sub-fertile women who utilized infertility services vs. those that do not. Methods: A retrospective analysis of cross-sectional data obtained during the 2011–2013, 2013–2015, and 2015–2017 cycles of National Survey for Family Growth from interviews administered in home for randomly selected participants by a National Center of Health Statistics (NCHS) surveyor was used to analyze married, divorced, or women with long-term partners who reported difficulty having biological children (sub-fertile/infertile women). Demographic differences such as formal marital status, education, race, and religion were compared between women who presented for infertility care vs. those that did not. The primary outcome measure was presenting for infertility evaluation and subsequently utilizing infertility services. Healthcare utilization trends such as having a usual place of care and insurance status were also included as exposures of interest in the analysis. Results: Of the 12,456 women included in the analysis 1770 (15.3%) had used infertility services and 1011 (8.3%) said it would be difficult for them to have a child but had not accessed infertility services. On univariate analysis, compared to women who used infertility services, untreated women had lower average household incomes (295.3 vs. 229.8% of the federal poverty line respectively). Untreated women also had lower levels of education and were more likely to be divorced or never have married. In terms of health status, unevaluated women were less likely to have a usual place for healthcare (87.3%) as compared to women presenting for fertility care (91.9%) (p = 0.004). When examining insurance status, 23.3% of unevaluated women were uninsured as compared to 8.3% of evaluated women. On multivariate analysis, infertile women without insurance were at 0.37 odds of utilizing infertility care compared to women with insurance. Conclusions: Demographic factors are associated with the utilization of infertility care. Insurance status is a significant predictor of whether or not infertile women will access treatment. Data from the three most recent NSFG surveys along with prior analyses demonstrate the need for expanded insurance coverage in order to address the socioeconomic disparities between infertile women who are accessing services vs. those that are not. [ABSTRACT FROM AUTHOR]

Purpose: To study recent legal cases involving the transfer of the incorrect embryo into patients and learn how fertility clinics can better serve clients, protect themselves financially, and safeguard their physicians' personal assets. Methods: The Nexis Uni database was used to review legal cases, news, and business publications of previous cases of embryo mix-ups. County and district courthouse dockets were also queried for filings and court documents related to lawsuits involving embryo mix-ups using Public Access to Court Electronic Records (PACER). Emphasis was placed on court decisions, awarded damages, and legal and media coverage related to embryo mix-up events. Results: A case law review of US legal databases and courthouse dockets was conducted for cases between 2000 and 2020, focusing on lawsuits against reproductive endocrinologists and in vitro fertilization (IVF) facilities offering embryo transfer (ET). Improper labeling and ineffective communication led to errors in the cases reviewed. Conclusion: It is prudent for clinics to protect themselves from embryo mix-ups, which can subsequently lead to undesirable clinical outcomes, as well as lawsuits stemming from these errors. This article emphasizes following labeling guidelines when storing embryos, employing a two-step read back method prior to ET, and offering genetic testing when a discrepancy is found in the record. In the case an embryo mix-up does occur, it is recommended to protect personal assets through business organizing procedures and consider settlement offers for policy limits. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation between the DNA Fragmentation Index (DFI) and sperm morphology in patients undergoing ICSI, as a predictive parameter in reproductive outcomes. Methods: A retrospective study was conducted on 125 infertile patients enrolled in a fertility clinic. Seminal characteristics were measured following the WHO guidelines (2010) for the examination of the seminal fluid. After collecting motile sperm population by pellet swim up, DFI was calculated and simultaneously associated with sperm morphology using in situ TUNEL assay and an image analyzer software in at least 250 spermatozoa for each patient. Results: All subjects were divided into two groups according to a cutoff established, by choice, of the sperm DFI (15%): group A (< 15%) consisting of 65 patients and group B (≥ 15%) of 60 patients. Data were analyzed using non-parametric statistical methods. The results demonstrate that there is no statistical difference between the two groups in seminal characteristics. The collective data show a high significant correlation, suggesting that spermatozoa with abnormal morphology are the best candidates to contain DNA damage (p < 0.001). Also, when group A is compared with group B, an increased percentage of morphologically normal spermatozoa with fragmented DNA was observed in patients, with DFI values ≥ 15% (p < 0.001). Conclusion: These results are aimed at providing an exact value of DFI in morphologically normal spermatozoa, which will be helpful to the embryologist in evaluating the risk of transferring, during the ICSI procedure, a spermatozoon whit normal morphology but fragmented DNA. [ABSTRACT FROM AUTHOR]

Purpose: To review cases of couples presented to our PGT-unit with copy number variants (CNVs) classified as variants of uncertain significance (VUS) in order to better understand their needs. Methods: Retrospective cohort study conducted in a tertiary medical-center, 2014–2019. We reviewed files of all couples applying for genetic counseling with CNVs classified as VUS. The main outcomes measured: number of VUS findings and their description, PGT-M procedures planned and performed, IVF cycles, clinical pregnancy, and live birth rates (LBR). VUS were classified according to the American-College of Medical-Genetics and Genomics classification at time of first consultation, and updated—December 2018. Results: Twenty-four couples presented with a total of 30 VUS. Twelve couples (50%) had isolated VUS and 12 (50%) had VUS diagnosed in addition to a pathogenic mutation. Initially, nine findings (30%) were defined as VUS; eight (27%) as likely benign (b-VUS); and 13 (43%) as likely pathogenic (p-VUS). PGT-M was recommended for 17/30 CNVs (56.6%), 12 (70%) of which, isolated VUS. No couple had other indications for IVF. To date, nine couples performed PGT-M for isolated VUS; LBR per-couple—55.5%. Five couples performed PGT-M for both pathogenic findings and VUS, LBR—80%. After reviewing VUS classifications, 30% remained unchanged, 20% were more severely defined, and 50% less severely defined. Conclusion: The genomic era enables detection of VUS whose definition is subject to change as additional information becomes available. The uncertainty of variants' clinical significance and changes in VUS definition over time complicates genetic counseling. Revised guidelines for VUS interpretation and reevaluation of patient counseling before each pregnancy must be practiced when counseling them regarding the justification of PGT-M for their diagnosed VUS. [ABSTRACT FROM AUTHOR]

Purpose: To compare patient and provider satisfaction with saline ultrasound (SIS) versus office hysteroscopy for cavity evaluation prior to in vitro fertilization (IVF) and to assess the capability of hysteroscopy to manage pathology at time of diagnosis to reduce delays and supernumerary procedures. Methods: This was a randomized, controlled trial in a university fertility clinic. One hundred enrolled subjects undergoing routine uterine cavity evaluation prior to planned embryo transfer were randomized to SIS or office hysteroscopy without anesthesia. Subjects and providers completed surveys about their experience. Subjects with findings on SIS had a hysteroscopy performed or scheduled for further evaluation. Those with hysteroscopy findings had management attempted within the same procedure. Results: Overall patient satisfaction was high and did not differ between groups, while providers indicated that hysteroscopy provided a better cavity evaluation. There was no difference in time to complete procedures between groups. Pain score on a ten-scale was slightly higher in the hysteroscopy group compared to the SIS group (3.38 ± 1.85 vs. 2.44 ± 1.64, p < 0.01), but this did not impact satisfaction scores. Although pathology was found in a similar rate (22% vs. 36% for SIS and HSC groups, respectively), those in the SIS group all required secondary procedures, while only 1/17 did in the HSC group (p < 0.01). Conclusion: Although the hysteroscopy group exhibited slightly higher pain scores, overall patient and provider satisfaction was high and similar between groups. There were significantly fewer secondary procedures and delays in the hysteroscopy group. Hysteroscopy is a reasonable first line screening tool for patients requiring cavity evaluation. Trial registration: ClinicalTrials.gov, NCT04415489 [ABSTRACT FROM AUTHOR]

Purpose: Infertility has been defined as a couple's failure to conceive after regular and unprotected coitus for 1 year or six months, depending on the age of the female counterpart. Although infertility can result from both the male and/or the female, often the female partner faces pressure since it is believed in some African cultures that a woman without children is like a tree without leaves. The aim of this study was to determine the prevalence of successful pregnancy outcomes among infertile women undergoing assisted reproductive technology (ART) treatment at the Cape Windhoek Fertility Clinic. Methods: This was a prospective and descriptive cross-sectional case reference study encompassing 178 infertile women visiting the Cape Windhoek Fertility Clinic for ART treatment. Results: The vast majority of the participants (81.5%) were married women. From the 178 infertile women, 96 (53.9%) suffered from primary and 82 (46.1%) from secondary infertility. The predominant cause of complications for infertility among the women studied was defective ovulation (28.7%) and the most common ART treatment administered was IVF/ICSI (52.2%). Only a third (33.1%) of the women who received ART treatment eventually fell pregnant. Conclusion: The outcome of this study may not give a clear indication of the prevalence of infertility among women in the entire Namibian nation due to the costs involved with ART treatment offered mainly at privately owned hospitals and/or clinics, thereby resulting in those who cannot afford treatment to be left out despite being infertile. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether endometrial compaction using sequential transvaginal ultrasound is associated with improved live birth rates in medicated single euploid frozen embryo transfer (FET) cycles. Methods: Prospective observational cohort study at a private fertility clinic. Patients who underwent FETs between January and December 2018 were assessed for inclusion. The change in endometrial thickness between the end of the estrogen phase and the day before embryo transfer, measured by sequential transvaginal ultrasound, was used to categorize cycles with compaction (≥ 5%), no change, or expansion (≥ 5%). FET cycle outcomes were then compared between groups. The primary outcome was live birth. Secondary outcomes include clinical pregnancy rate and rate of spontaneous abortion. Results: Of the 259 single euploid medicated FETs performed during the study period, only 43/259 (16.6%) of the cycles demonstrated ≥ 5% compaction, whereas 152/259 (58.7%) expanded and 64/259 (24.7%) were unchanged. Live birth rates did not differ between cycles with compaction (58.1%), no change (54.7%), or expansion (58.6%), p = 0.96. Clinical pregnancy and spontaneous abortion rates were also similar between groups. Conclusion: The vast majority of cycles did not demonstrate endometrial compaction. Endometrial compaction is not associated with live birth rate or spontaneous abortion rate in medicated single euploid FETs in this cohort. [ABSTRACT FROM AUTHOR]

Purpose: Does IDEF mapping help monitor the technical process of IUI and explore the potential improvements which might contribute to increased pregnancy and live birth rates? Method: Retrospective analysis of 1729 homologous IUI cycles of couples attending a fertility clinic in a university hospital setting. Standardized conventional semen parameters were analyzed and the semen samples prepared via discontinuous density gradient centrifugation. Results: There was no significant association between sperm concentration, motility and morphology (analysis phase), and pregnancy outcome. Only female and male ages were significantly associated with the pregnancy outcome. There was a significant difference in the odds on clinical pregnancies and live births when analysis was ≤ 21 min initiated, and < 107 min between sample production and IUI, adjusted for male and female age. Conclusions: Adjusting for the couple's age, we could show that time intervals between semen production and analysis and IUI when kept low significantly influenced clinical pregnancies and live births. [ABSTRACT FROM AUTHOR]

Purpose: (1) To test the hypothesis that under-represented minority women, including Hispanic/Latina and African American or Black women, will be more likely to report greater socioeconomic and cultural barriers to infertility care compared with white women. (2) To identify gaps in knowledge that can guide future educational interventions. Methods: A cross-sectional survey was completed by 242 women, ages 18–44, at five gynecology clinics in the greater Boston, Massachusetts area from February 27, 2018, to February 25, 2019. Results: Of the respondents, 61.4% identified as Hispanic/Latina, 24.5% as white, and 6.6% as Black or African American. Cost was the most commonly reported barrier to care (62.8%) regardless of race/ethnicity or insurance status. Only 8.9% of participants were aware of personal insurance coverage for infertility treatment. Compared with white patients, Hispanic/Latina patients were less likely to know if their own insurance covered infertility treatment: 14.3% vs 6.8%; aRR 0.36 (95% CI 0.17–0.74), after adjusting for a personal history of infertility. Conclusion: Cost was the most commonly reported barrier to care. Most women were unaware of their insurance coverage despite the state insurance mandate to cover infertility treatment in Massachusetts. Education and outreach will be instrumental in helping address disparities in access to care. [ABSTRACT FROM AUTHOR]

Purpose: To assess longitudinal trends in in vitro fertilization (IVF) patients' choices for disposing of cryopreserved embryos. Methods: This is a retrospective cohort study of embryo disposition forms submitted between January 2000 and February 2020 at a university-based fertility clinic. Primary outcome was disposition decision. Binary and multivariable logistic regression were performed to determine odds ratios (OR) for decisions according to female age, education, race, religion, state of residence, area deprivation index based on zip code, and IVF pregnancy history. We also assessed disposition year, storage duration, and number of stored embryos. Results: Forms were reviewed from 615 patients; 50.6% chose to discard embryos, 45.4% donated to research, and 4.1% chose reproductive donation. In the regression model, two factors were significantly associated with donation to research: female listing "no preference" or declining to list religious preference (OR 2.56, 95%CI 1.44–4.54) and live birth of multiples after IVF (OR 1.58, 95%CI 1.05–2.36). Before 2012, females younger than age 30 at storage were equally likely to choose to donate embryos to research as discard them. However, between 2013 and 2020, females younger than 30 were significantly more likely to discard than donate embryos for research (OR 2.87, 95%CI 1.13–7.28). Conclusion: Since 2013, the majority of patients younger than 30 at storage have chosen to discard cryopreserved embryos. Before then, patients were more likely to donate embryos for research. To ensure sufficient embryos are available for research, young patients, who are most likely to have cryopreserved embryos, should be counseled about options for donation. [ABSTRACT FROM AUTHOR]

Objective: To assess the causes of infertility and artificial reproductive technology (ART) outcomes in women of African descent living in the Caribbean and Bermuda. Design: Cross-sectional study composed of a questionnaire administered to providers who care for women undergoing ART in the Caribbean and Bermuda. Material and methods: A questionnaire from the Deerfield Institute was adapted to meet the aims of our study with their permission. Eight infertility clinics in the Caribbean and Bermuda were identified. The primary physician at each site was contacted via email and invited to participate in the study. Questionnaires were completed via interview or electronically. Responses were collected in a REDCap database for statistical analysis. Results: There were five respondents from Barbados, Bermuda (× 2), Puerto Rico, and the Bahamas. The most commonly reported etiologies of infertility among Afro-Caribbean patients were female-male factor and uterine factor. In vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI) is performed more often than conventional IVF. The cumulative live birth rates (LBR) after ART for those ages ≤ 34, 35–37, 38–42, and > 42 were 52%, 40%, 22%, and 12%, respectively. The cumulative live birth rate was 31.5% for total patients. The factors reported to be most important in hindering patients from cycling were coping emotionally with poor ovarian response and cost. The biggest restraints to infertility care were costs and a lack of local IVF centers on all islands. Conclusion: Afro-Caribbean women receiving infertility care in the Caribbean may have better ART outcomes compared to African-American women in the United States (US). [ABSTRACT FROM AUTHOR]

Purpose: Improving access to care is an issue at the forefront of reproductive medicine. We sought to describe how one academic center, set in the background of a large and diverse metropolitan city, cares for patients with extremely limited access to reproductive specialists. Methods: The NYU Reproductive Endocrinology and Infertility (REI) Fellowship program provides a "fellow-run clinic" within Manhattan's Bellevue Hospital Center, which is led by the REI fellows and supervised by the REI attendings of the NYU Langone Health system. A description of the history of the hospital as well as the logistics of the fertility clinic is provided as a logistical template for implementation. Results: The fellow-run fertility clinic at Bellevue hospital is held on two half days per month seeing approximately 150 new patients per year. The fertility workup, counseling, surgery, as well as ovulation induction, and early pregnancy management are offered within the construct of the fellowship and residency at NYU. Barriers to care and ways to circumvent those barriers are discussed in detail. Conclusion: By utilizing the ambition and construct of the OB/GYN programs, we greatly improve care for an otherwise underserved patient population by offering an efficient and optimal infertility workup and treatment in a population that would otherwise be without care. We utilize the framework of graduate medical education to provide autonomy, experience, and mentorship to both residents and fellows in our programs in an effort to provide a solution to combating inequity in infertility care. [ABSTRACT FROM AUTHOR]

Assisted reproductive technologies (ART) represent commonly utilized management strategies for infertility with multifactorial causes (including genetically predisposed diseases). Amongst ART, in vitro fertilization (IVF) is the most popular. IVF treatment may predispose the mother to increased risks and complications during pregnancy, and there may be adverse fetal outcomes. Hormonal therapies, including oral contraceptives, may impair glucose and lipid metabolism, and promote insulin resistance and inflammation. IVF treatment involves administration of reproductive hormones, similar in composition but in much higher doses than those used for oral contraception. The provision of IVF reproductive hormones to mice associates with glucose intolerance. In addition, the physiological and hormonal changes of pregnancy can trigger an inflammatory response, and metabolic and endocrine changes. There is controversy regarding the potential effects of IVF hormonal therapies in the promotion of diabetogenic and inflammatory states, additional to those that occur during pregnancy, and which may therefore predispose women with IVF-conceived pregnancies to adverse obstetric outcomes compared with women with spontaneously conceived pregnancies. This review summarizes the limited published evidence regarding the effect of IVF-based fertility therapies on glucose homeostasis, insulin resistance, cardio-metabolic profile, and markers of inflammation. [ABSTRACT FROM AUTHOR]