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Purpose: To promote nationwide dissemination and implementation of COVID-19 Risk Assessment and Safety Management Operational Guidelines, drawn up by SAMeR Task Force in ART centers in Argentina. Our objective is to prevent and mitigate the transmission of SARS-CoV-2 at an institutional level, while reducing the risk of infection among both physicians and patients in the context of a critical scenario in the local and Latin American healthcare system., Methods: SAMeR Executive Committee set up a crisis committee which was made up of specialists in reproductive medicine, embryology, and healthcare management. A critical and updated review of the advances in science, documents, and recommendations released by other societies (ASRM, ESHRE, IFFS, Red LARA, societies of anesthesiologists, infectious diseases, and Occupational Safety and Health Administration-OSHA) was carried out. Likewise, there were joint meetings with the Ministry of Health of Argentina in order to draw up the guidelines. Simultaneously, ongoing medical training was carried out, thus providing added value to them, including two status surveys of the activities of the monovalent and polyvalent centers according to the country's epidemiological mapping. Four additional recommendations were made, and online training was given to healthcare workers. The aforementioned regulations were first analyzed by the healthcare providers and their practical suggestions were then added to the guidelines., Results: The one-off collaborative work and the actions coordinated with the National ART Program of the Ministry of Health of Argentina resulted in the development and implementation of the present COVID-19 Risk Assessment and Safety Management Operational Guidelines at a national level. SAMeR gave recommendations for the implementation of the Management Guidelines for the center reopening, providing new safety criteria against the threat of viral contagion. A new organizational culture was promoted through the awareness of all the healthcare workers and teaching responsibility. We continue working on the compliance with a new "Code of Conduct and Commitment in Healthcare" and with workplace safety measures. We helped with transforming the theoretical knowledge into practical measures for the healthcare workers in different services, with the aim to prevent, mitigate, and/or handle contingencies at the centers/services and gamete banks, in line with the actions agreed upon with the Ministry of Health., Conclusions: As an extraordinary and uncertain event, the SARS-CoV-2 pandemic helped consolidate a volunteer-based and collaborative panel of SAMeR experts who developed the COVID-19 Risk Assessment and Safety Management Operational Guidelines as a new and readily available tool for physicians, patients, and gamete banks care. Their implementation has provided specific guidelines to minimize risk for professionals in ART clinics, as well as guaranteeing patient safety.

Introduction: Worldwide there is an increase in the number of assisted reproduction treatments. The developments in culture media and drugs, associated with the occurrence of rapid freezing or vitrification techniques has improved the procedures encouraging transfers of a single embryo per cycle. This generates a greater number of viable surplus embryos. An embryo disposition decision making is a complex phenomenon., Method: Method: This descriptive exploratory study investigates the perceptions and opinions of a sample of 60 participants who have started an assisted reproduction treatment in a specialized Fertility Center of the City of Buenos Aires., Results: The absence of children in the majority of the sample (70.6% still have no children) makes the prevailing option to “continue cryopreservation” (36.67%). The majority, 38.4% (23 people), considers that the option that best represents the embryo is "a child". Although there are relatively few people who have decided to donate their embryos (5 participants), several study participants report having reflected on it (35%). The vast majority (86.6%) of respondents would not be willing to face the costs of maintaining a long-term cryopreservation., Conclusion: After more than three decades of assisted reproduction, Argentinean patients still face a high degree of uncertainty regarding what to do with the surplus embryos. Gaining more in-depth knowledge regarding the decision-making process can help to improve the communication strategies. The normative absences generate that the ARTs users are "disengaged" from their embryos; this hinders the decision making, increasing the risk of accumulating more "abandoned" embryos, (niversidad Nacional de Córdoba.)

Argentina, like many other countries in the region, faces the dilemma of what to do with the increasing accumulation of frozen embryos, which are often abandoned. This report aims to address the issue of abandoned frozen embryos, following the main concerns: 1) when is an embryo considered abandoned, according to regulatory documents; 2) how can the number of cryopreserved abandoned embryos be decreased; and 3) what are the current available options for discarding these abandoned embryos. Issues concerning the fate of abandoned embryos call for a revision of the technical aspects, as well as the symbolic aspects associated with the embryos and their options for discarding. Embryo disposal is a complex and intimate decision, which depends not only, on the quality of the cryopreserved embryo, but also on the social, cultural, economic, labor and health insurance aspects. In the absence of a formal regulatory framework for such decisions in Argentina, current practices and standard procedures face significant developmental hurdles. Among future actions to be developed in the short, medium and long term by this committee are building interdisciplinary teams, fostering patient-awareness, devising guidelines, and enforcing policies regarding embryo abandonment.

Objectives: To evaluate motivations to perform an elective single embryo transfer (e-SET)., Methods: Cross-sectional surveys to reproductive medicine specialists and to infertile patients undergoing assisted reproductive treatments., Results: In the physician's survey (n = 278), we found that the main reasons for not offering e-SET were the physicians' belief that patients prefer optimizing the pregnancy rates regardless of the potential complications (57.1%). Regarding the decision making process, 76.7% of physicians thought that patients and doctors should make these decisions together and 93.3% would like to have a more formal decision-aid to help with counseling. In the patients' survey (n = 100), 21.3% chose e-SET, while 33% mentioned that complications associated to multiple pregnancies were insufficiently discussed. Among those patients, none chose to have e-SET, while 30% of those who had a full discussion selected e-SET (p = 0.05)., Conclusions: Most physicians did not offer e-SET based on potential patients' negative feelings. Also, almost 30% take important decisions without the patient's participation. Patients that discussed more thoroughly this topic, more frequently selected e-SET. Almost all the physicians surveyed agreed that decision-aids could help in this important shared-decision process., Practice Implications: Decision aids about e-SET vs DET are needed to help patients in the decision making process., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The effect of pentoxifylline on the spontaneous and follicular fluid (hFF)-induced acrosome reaction (AR) was studied in an attempt to identify those patients who would benefit from the use of pentoxifylline as an AR-stimulating agent. Pentoxifylline (1 mg/ml) produced no significant increase over spontaneous AR at any of the time points studied (60 min: 6.2% +/- 2.0 spontaneous AR vs 7.4% +/- 2.0 pentoxifylline AR; 120 min: 7.1% +/- 1.6 spontaneous vs 9.0% +/- 2.5 pentoxifylline; 180 min: 7.0% +/- 1.8 spontaneous vs 10.9% +/- 4.0 pentoxifylline, n = 6). On the other hand, hFF produced a significant increase in AR (6.9% spontaneous AR vs 11.2% hFF AR, p < 0.001, n = 39) and this effect was enhanced by pre-incubation with pentoxifylline (15.0% pentoxifylline + hFF AR vs 11.2% hFF AR, p < 0.001). There were no differences in percentage AR induced by hFF or pentoxifylline + hFF between patients with normal (n = 16) and abnormal (n = 25) semen samples. Individual analysis of the effects of hFF and pentoxifylline + hFF on AR showed great variability between patients and enabled us to classify them into four categories: inducible-responder (15%), non-inducible-responder (23%), inducible-non-responder (41%) and non-inducible-non-responder (21%). An induction index (II) (induction produced by hFF divided by spontaneous AR) and a response index (RI) (induction produced by pentoxifylline + hFF divided by hFF) were calculated for each sample. Patients previously classified as inducible exhibited an II > 0.30 and patients previously classified as responders showed an RI > 0.26. There was no correlation between II and RI values (Spearman, r = -0.185, p = 1). Our results show that pentoxifylline is an enhancer of the induced AR only in some patients. We propose an 'AR response assay' to identify responder patients and thus enable rational use of this drug.

A prospective non-randomized study was undertaken to test whether immunosuppression improves implantation and pregnancy rates in an in-vitro fertilization-embryo transfer (IVF-ET) programme in patients with tubal factor infertility. Treatment involved ovarian stimulation, transvaginal oocyte retrieval, IVF-ET, and assessment of short-term administration of large doses of corticosteroids (60 mg of methyl-prednisone x 4 days). When compared to the group that did not receive immunosuppressive doses of methylprednisone (group A; mean age 31.85 +/- 4.09 years), those subjects who were treated (group A2) showed a statistically significant increase in pregnancy (P < 0.01) and take home baby rate (P < 0.01). Similar results were observed in subjects who received corticosteroids in their first IVF-ET attempt (group B; mean age 34.32 +/- 4.98 years). Our results suggest that immunosuppressive doses of corticosteroids administered for a short period of time to patients undergoing IVF-ET could significantly improve the implantation and pregnancy rates. Possible mechanisms of action of corticosteroids are proposed.