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Background: Oocyte diameter is crucial for initiating meiosis and supporting the maturation capability, a prerequisite for successful fertilisation and high-quality embryo development. While numerous studies have explored the correlation between oocyte diameter and embryo development capacity in animal models, limited research appears concerning human oocytes. Aim: This study aims to ascertain whether oocyte diameter can serve as a reliable predictor of oocyte and embryo quality, achieved through its correlation with protein kinase B (Akt) protein levels on cumulus–granulosa cells and blastocyst morphokinetics. Setting and Design: Prospective cohort study included cumulus–granulosa cells collected from 228 mature oocytes of 32 infertile women undergoing in vitro fertilisation treatment. The diameter of the oocytes was measured using the Image J software, and the samples were categorised into three groups based on their diameter: 118.97 µm. Quantification of pAkt and Akt protein total of cumulus–granulosa cells exploited the ELISA method. Embryo morphokinetics and anomaly development events were observed at the blastocyst stage to evaluate embryo quality relative to oocyte diameter. Statistical Analysis Used: The Kruskal–Wallis test and Chi-square test were used. P 0.05). Likewise, there were no significant differences in morphokinetics and anomaly development except for the S2 parameter and reverse cleavage. Conclusion: Reflecting on the molecular profile including pAkt, total Akt protein, morphokinetics and anomaly development, it was observed that oocyte diameter does not correlate with its competency and the quality of the resulting embryo. In addition, oocytes with a diameter below 105.95 µm may have an equal potential to develop into top-quality embryos.

Abstract Purpose This study aimed to evaluate the effects of immature oocyte proportion in a cohort on both IVF laboratory and clinical outcomes. Materials and methods This retrospective cohort study took place at Morula IVF Jakarta Clinic from January 2016 to July 2020. A total of 1.826 couples undergoing IVF-ICSI/IMSI were included and classified into four groups according to the proportion of immature oocytes retrieved during OPU as follows: (1) immature ≤ 15% (n = 1.064), (2) immature 16–25% (n = 369), (3) immature 26–50% (n = 331), and (4) immature > 50% (n = 62). Primary outcomes were clinical pregnancy and miscarriage. Embryology laboratory results were assessed as the secondary outcomes. Statistical analyses were carried out utilizing Kruskal–Wallis or chi-square tests. p-value

This study aims to evaluate the certainty of anti-Müllerian hormone (AMH) levels in dried blood spots (DBS) compared to serum AMH. A total of 109 infertile women who planned to undergo their controlled ovarian stimulation cycle were recruited. Serum and DBS samples were collected from each patient for the quantification of AMH levels. Serum AMH was measured with an automated clinical chemistry assay (Roche) while DBS AMH was measured using the Ansh Labs DBS AMH ELISA reagent kit. Mean AMH level in DBS was [Formula: see text][Formula: see text]ng/mL, which ranged from 0.01 to 17.3[Formula: see text]ng/mL, while the mean AMH in serum samples was [Formula: see text][Formula: see text]ng/mL (0.01–10.8[Formula: see text]ng/mL). Comparable accuracy for low AMH quantification was observed between the two methods over basal antral follicle counts (AFC) as a clinical comparator (AUC 86%, cutoff [Formula: see text][Formula: see text]ng/mL, [Formula: see text], [Formula: see text] vs. 85%, cutoff [Formula: see text][Formula: see text]ng/mL, [Formula: see text], [Formula: see text], respectively for DBS and serum sample). Likewise, DBS AMH achieved high concordance for low AMH discrimination in comparison to serum AMH method (AUC 99% vs. 93%, respectively). A strong linear Spearman regression ([Formula: see text], [Formula: see text]) and sufficient agreement (94.5%, mean difference of −1.6, 2.7 to −5.9) was demonstrated among studied groups with mathematical Passing and Bablok regression equation of [Formula: see text]. The confidence interval of intercept (−0.12, 95% CI [−0.29 to −0.01]) and slope (1.80, 95% CI [1.66–1.94]) indicated a constant and proportional difference between the two methods but it was not significant ([Formula: see text]). AMH measurement in DBS could be useful as an alternative approach to screening ovarian reserve through a more convenient remote sample collection.

Abstract Background: Spinal muscular atrophy (SMA) is characterized by the homozygous deletion of the survival motor neuron-1 gene. Pre-implantation genetic testing for monogenic diseases through in-vitrofertilization program was developed to provide a reliable genetic diagnostic method for SMA. Case presentation: The couple who was confirmed as carriers of SMA visited the Morula IVF Clinic, Jakarta, Indenesia seeking for an in-vitro fertilization expert opinion in relation to the pre-implantation genetic testing for SMA. Utilizing polymerase chain reaction-restriction fragment length polymorphism, we have successfully screened for unaffected embryos that were characterized by a normal presence of the survival motor neuron-1 exon 7-8 and survival motor neuron-2 exon 7-8. The frozen embryo was subsequently transferred and a healthy unaffected female baby was born with undetected deletion of the survival motor neuron-1 gene. Conclusion: This successful embryo pre-implantation screening case could potentially accommodate the demands of genetically at-risk couples who are apprehensive about conceiving a child who might inherit monogenic disorders such as SMA.

BACKGROUND: Preimplantation genetic testing for aneuploidy has been proven to be effective in determining the embryo's chromosomal or ploidy status. The test requires a biopsy of embryonic cells on day 3, 5, or 6 from which complete information on the chromosomes would be obtained. The main drawbacks of preimplantation genetic testing for aneuploidy include its relatively invasive approach and the lack of research studies on the long-term effects of preimplantation genetic testing for aneuploidy. OBJECTIVE: Computer-assisted predictive modeling through machine learning and deep learning algorithms has been proposed to minimize the use of invasive preimplantation genetic testing for aneuploidy. The capability to predict morphologic characteristics of embryo ploidy status creates a meaningful support system for decision-making before further treatment. STUDY DESIGN: Image processing is a component in developing a predictive model specialized in image classification through which a model is able to differentiate images based on unique features. Image processing is obtained through image augmentation to capture segmented embryos and perform feature extraction. Furthermore, multiple machine learning and deep learning algorithms were used to create prediction-based modeling, and all of the prediction models undergo similar model performance assessments to determine the best model prediction algorithm. RESULTS: An efficient artificial intelligence model that can predict embryo ploidy status was developed using image processing through a histogram of oriented gradient and then followed by principal component analysis. The gradient boosting algorithm showed an advantage against other algorithms and yielded an accuracy of 0.74, an aneuploid precision of 0.83, and an aneuploid predictive value (recall) of 0.84. CONCLUSION: This research study proved that machine-assisted technology perceives the embryo differently than human observation and determined that further research on in vitro fertilization is needed. The study finding serves as a basis for developing a better computer-assisted prediction model.

Objective: Hidden knowledge could be discovered within a large practical data of in vitro fertilization (IVF) practice. In this study, Machine learning-based data mining techniques were utilized to construct a reliable prediction model for clinical pregnancy in IVF. Study Design: A retrospective cohort multicenter study involving 4.570 IVF cycles. All patients underwent fresh embryo transfer at either the cleavage or blastocyst stage between January 2015 and December 2019. The experiment focused on utilizing tree-based classifiers to generate and compare the most effective prediction model that could predict a clinical pregnancy through clinical data. Additionally, each classifier is optimized via a genetic algorithm technique, along with the selection of variables. Results: Both the decision tree and random forest showed similar performance that was much better than the gradient boost. The two superior classifiers achieved a balanced accuracy of roughly 0.62. Additionally, each prediction model was shown to work optimally with different combinations of variables, with some variables being consistently included, such as female age, and some consistently excluded, which provides an insight into the relationship between the variables and each prediction model. Conclusion: Machine learning algorithm remains effective for the purpose of data mining and knowledge extraction in IVF clinical datasets through which a relatively reliable prediction system for clinical pregnancy could be constructed, provided the available data is sufficient.

Fertility preservation through gamete vitrification has become one of the critical strategies to secure a childbearing potential in patients who are diagnosed with cancer or risks of infertility. Preserving the gametes would prevent the deleterious effects of cancer drugs or radiotherapy exposure on the quality of the gametes. Furthermore, in vitro fertilisation of vitrified mature human oocytes has lately demonstrated promising results that are reflected in the increased survival rate of thawed oocytes and the resultant clinical pregnancy rate. However, limitations in the cryopreservation of mature oocytes of cancer patients persist. Ovarian stimulation protocols which comprise administering gonadotrophin-releasing hormones could aggravate cancer or delay essential cancer therapy. Considering such circumstances, vitrification of immature oocytes would become a rational option. While the vitrification procedure of mature oocytes has been established, the vitrification of immature oocytes remains controversial due to a low post-thaw in vitro maturation and fertilisation rate. Apparent cryoinjuries to the immature oocytes post thawing or warming have been observed in both human and animal model oocytes. An alternative strategy was therefore proposed to improve the effectiveness of utilising immature oocytes for fertility preservation by conducting the in vitro oocyte maturation process first before vitrification. This method has prevailed, especially in oncofertility patients. Although the success rate of the clinical outcomes remains low, this approach, in conjugation with proper counselling, might provide oncofertility patients with an opportunity to preserve their reproductive potential.

BACKGROUND: A clinical pregnancy prediction model was developed by implementing machine learning technology that uses a combination of static images and medical data to calculate the outcome of an in vitro fertilization cycle.OBJECTIVE: To provide a system that can accurately and sufficiently assist with decision making that is critical to in vitro fertilization cycles, primarily embryo selection.STUDY DESIGN: Historical medical data, which consist of clinical information and a complete transferred embryo image dataset, of 697 patients who underwent unique in vitro fertilization were collected. Various techniques of machine learning were used, namely decision tree, random forest, and gradient boosting; each technique used the same data configuration for performance comparison and was subsequently optimized using genetic algorithm.RESULTS: A prediction model with a peak accuracy of approximately 65% was achieved. Significant differences in the performances of the 3 selected algorithms were apparent. Nonetheless, additional metric measurements, such as receiver operating characteristic, area under the receiver operating characteristic curve score, accuracy, and loss, suggested that the gradient boosting model performed the best in predicting clinical pregnancy.CONCLUSION: This study served as a stepping stone toward the application of in vitro fertilization prediction models that use machine learning techniques. However, additional validation steps are required to boost the model's performance for its implementation in the clinical setting.

Our study aims to assess the utilization of oocyte cryopreservation (OC) in Indonesian women. Data from 122 women who had undergone OC was retrospectively analyzed from medical records. The baseline profile, clinical characteristics, and main outcomes comprising intentions for oocyte vitrification and outcomes following oocyte warming were examined. Out of 122 women who underwent OC, 49 patients returned and use their cryopreserved oocytes with a median duration of storage was two months. Arranged from the greatest to the least, participants had undergone the cycle of OC due to sperm factor [51 (41.80%)], increased embryo availability [6 (12.1%)], postponement of marriage [6 (12.1%)], social reasons [10 (8.19%)], and other reasons [8 (6.55%)]. Meanwhile, treatment due to advanced maternal age [6 (4.91%)], poor ovarian reserve [6 (4.91%)], cancer [5 (4.09%)], PCOS [2 (1.63%)], and endometriosis [2 (1.63%)] was reported among remaining subjects. Clinical pregnancy was reported in 12 (40.0%) patients constituting of each 6 (50.0%) subjects of day-3 and day-5 embryo transfer, respectively. Our study demonstrated that sperm factor, increased embryo availability, and postponement of marriage is the main reason for women undergoing OC in Indonesia.

Objective: To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization (IVF) cycles comprising a single fresh top-quality blastocyst transfer. Methods: This was a retrospective observational study performed in Morula IVF Clinic Jakarta. Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows: 0.05). Nonetheless, the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved, mature, and fertilized oocytes, the total sum of derived embryos, and top-quality embryos at cleavage and blastocyst stage (P

Background:Luteinizing hormone (LH) supplementation may have beneficial effect on the maturity and fertilizability of oocytes in poor ovarian reserve (POR) and may influence the progesterone level, thus increasing the pregnancy rate. However, previous studies on the effect of LH activity supplementation on poor responders have shown conflicting results. This study aimed to compare the clinical effectiveness of two different forms of gonadotropin (highly purified human menopausal gonadotropin (HP-HMG) vs. recombinant human follicle-stimulating hormone (r-hFSH)-only) in Indonesian population. Methods: Women diagnosed with poor ovarian response who received gonadotropin-releasing hormone (GnRH) antagonist protocol with either HP-HMG or r-hFSH-only were investigated. Women who underwent freeze all cycles, mini stimulation, and natural stimulation were excluded. Multiple logistic regression was performed to assess the effect of follicle-stimulating hormone (FSH) + human chorionic gonadotropin (HCG)-driven LH activity combination in HP-HMG to pregnancy event adjusting for progesterone level, demographic variables, and clinical characteristic variables. Results: A total of 101 subjects in the HP-HMG treatment group and 89 subjects in r-hFSH-only treatment group were involved in the study. There was no significant difference of clinical pregnancy rate between HP-HMG group and r-hFSH-only group (adjusted OR: 0.94, 95% CI: 0.39–2.25; p-value: 0.890). Conclusion: Compared to r-hFSH-only group, combination of FSH + HCG-driven LH activity in HP-HMG group had similar effectiveness in poor responders undergoing in vitro fertilization (IVF) using the antagonist protocol.

Objective: To compare the effectiveness of blastocyst elective single embryo transfer (eSET) and double embryo transfer (DET) in reducing low birth weight, preterm birth, and perinatal mortality in in vitro fertilization (IVF) cycles of Indonesian women. Methods: A retrospective observational study was conducted at Morula IVF Clinic, Jakarta, Indonesia. A total of 179 women who underwent either eSET or DET and had met the eligibility criteria were included. Seventy-six women underwent eSET while 103 underwent DET in their IVF cycles. Low birth-weight rate, preterm birth rate, and perinatal mortality rate of both groups were measured as the primary study outcomes. Neonatal intensive care unit (NICU) admission rate, Apgar score, multiple pregnancy, and maternal complications during pregnancy were also evaluated. Results: The risk of low birth weight [odds ratio (OR)=0.21, 95% confidential interval (CI): 0.10-0.45, P< 0.001] and preterm birth (0R=0.25, 95% CI: 0.13-0.49, P< 0.001) was significantly lower in the eSET group compared with the DET group. Furthermore, eSET efficiently reduced the incidence of NICU admission and multiple pregnancy (P=0.01 and P< 0.001, respectively). No significant difference was observed in terms of perinatal mortality rate, Apgar score, and maternal complications including gestational diabetes, preeclampsia as well as pregnancy-induced hypertension (P>0.05). However, a lower incidence of antepartum hemorrhage was noticed in the eSET group than in the DET group (P=0.03). Conclusions: Compared with DET, infants conceived through IVF cycles with eSET have a significantly lower risk of low birth weight, preterm birth, and NICU admissions. Moreover, eSET is shown to reduce multiple pregnancy rate, yet no significant differences are observed in the perinatal mortality rates, Apgar score and maternal complications (except for the incidence of antepartum hemorrhage) between both groups.

Background: Ca2+ signaling pathway is suggested to play an essential role in mediating oocyte maturation. Aims: The aim of this study was to evaluate intracellular Ca2+ of resistant immature oocytes that failed to resume meiosis following subsequent in vitro culture reach metaphase II after calcium ionophore A23187 activation. Settings and Design: This in vitro analytical experimental study was conducted at Animal Science Laboratory of Indonesian Medical Education and Research Institute (IMERI), Human Reproductive Infertility and Family Planning of IMERI, and Electrophysiology Imaging of Terpadu Laboratory, Faculty of Medicine, University of Indonesia. Methods: A total of 308 oocytes classed as resistant immature following in vitro culture were randomly allocated to control (n = 113) and treatment groups (n = 195). The oocyte activation group was exposed to A23187 solution for 15 min and then washed extensively. Maturation was evaluated by observing the first polar body extrusion 20‒24 h after A23187 exposure. Ca2+ imaging was conducted using a confocal laser scanning microscope to identify the dynamic of Ca2+ response. Statistical Analysis: SPSS 20, Chi-square, and Mann–Whitney U-test were used in this study. Results: Activation of resistant immature oocytes with A23187 significantly increased the number of oocyte maturation compared with the control group (P

Urinary retention in non-pregnant reproductive age women is a very rare condition. Hereby, we reported a rare case of acute urinary retention in a non-pregnant reproductive-age woman with hydronephrosis and hydroureter due to a large fibroid. The fibroid had resulted in constant pressure to the urethral sphincter, which causes urinary retention. Robotic myomectomy was performed after insertion of ureteric catheters. To our knowledge, this is the first case report of a robotic surgery being utilised to manage acute urinary retention in a non-pregnant individual due to large fibroid.

Cryopreservation is an ultra rapid freezing process to preserve tissue or organ. The studywas conducted to identify the effectiveness of cryoloop vitrification method and the viability ofembryos following vitrification. Embryos at blastocyst stage were vitrified by placing them inequilibration medium containing 10% ethylene glycol (EG) and phosphate buffer saline (PBS) wichsupplemented with 20% new born calf serum for 8-10 minutes. The blastocysts were then removedand put in vitrification medium (15% dimethyl sulfoxide, 15% EG, and 0.5M sucrose), and theprocess in the vitrifivcation medium not longer than 25-30 seconds. The blastocysts were immediatelytransferred to the vitrification medium film in the cryoloop and plunged into 100 ml liquid nitrogen.The warming process was done by immersing the cryoloop which carried the vitrified blastocstsinto PBS supplemented with 20% serum and 0.5M sucrose for 1 minute, and then removed to samesolution supplemented with 0.25M sucrose and 0.1M sucrose for 2 minutes respectively. Theblastocysts were washed 4 times in kalium simplex optimized medium (KSOM) and cultured indrops of KSOM in 5% CO2 incubator at 370C. The observations were done every 6 hours for 48hours using inverted microscope ( Olympus IX70 Japan). The viability of embryos was assessed onthe basis of the intact morphology, reexpansion of the blastosul, and the development of embryosinto advance stage. The results showed that 85.71% of vitrified embryos, developed into advancestages and 19% of them hatched. In conclusion the cryoloop can be used to vitrify the embryos.