Shenoy, Chandra C.

Objectives The effect of ovarian reserve on expected in vitro fertilisation (IVF) attrition remains controversial. This study analyses IVF attrition rates based on ovarian reserve and stimulation protocol to create customised pre-treatment counselling tools for assisting clinicians in setting accurate patient expectations. Material and Methods We completed a retrospective chart review of 18–44-year-old patients who underwent IVF treatment at a single academic institution between January 1, 2013, and March 23, 2023. Cycle outcomes, number of retrieved oocytes, mature oocytes, fertilised embryos, and blastocysts were analysed for patients with polycystic ovary syndrome (PCOS), unexplained infertility, and diminished ovarian reserve (DOR). A Poisson regression model was used to compare oocyte maturation, fertilisation, and blastulation rates among groups, adjusted for age, body mass index, race, and insemination method. Results Three hundred and thirteen couples underwent a total of 385 IVF cycles analysed in this study. There were 109 patients who underwent 120 cycles in the unexplained infertility group (31% cycles), 133 patients with 143 cycles in the PCOS group (37% cycles), 40 patients with 45 cycles in the DOR antagonist stimulation group (12% cycles), and 39 patients with 77 cycles in the DOR minimal stimulation group (20% cycles). No differences in oocyte maturation, fertilisation, or blastulation rate were seen among PCOS or DOR antagonist cycle groups when compared to unexplained infertility. After adjusting for confounders, blastulation rate was higher for the DOR minimal stimulation group compared to unexplained infertility (1.37-fold change, p = 0.04). Conclusion Rates of oocyte maturation, fertilisation, and blastulation were similar among all antagonist protocol cycles regardless of ovarian reserve. However, patients with DOR who undergo minimal stimulation may have modestly higher blastulation rates compared to DOR patients who undergo the antagonist protocol.

Objective: Obesity is thought to negatively affect outcomes of in-vitro fertilization (IVF), however its impact on minimal stimulation (MiST) cycles is unclear. This study aims to explore the effect of elevated body mass index (BMI) on blastulation rate (BR) and clinical pregnancy rate (CPR) in patients undergoing MiST. Design: Retrospective cohort analysis of patients who underwent MiST at a single academic fertility center over four years. Patients were grouped by BMI to assess associations between BR and CPR. Materials and Methods: Patients aged 18-44 were identified who underwent MiST at Mayo Clinic between 10/1/2020, and 12/1/2024. BR was calculated as each patient’s total blastocysts divided by total 2PN embryos; embryos and blastocysts were pooled in those with multiple cycles. CPR was calculated as each patient’s total number of clinical pregnancies divided by total embryo transfers. Patients were stratified into two BMI groups: underweight/normal (BMI <25, n=58) and overweight/obese (BMI ≥25, n=76). Quasibinomial logistic regression evaluated the association between BMI (per 5-unit increase) and both BR and CPR. Results: 134 patients were identified. 58 patients in the normal BMI group underwent 117 stimulation cycles and 67 transfers. 76 patients in the elevated BMI group underwent 139 stimulation cycles and 81 transfers. Age and anti-mullerian hormone levels were similar between groups. In the normal BMI group, BR 59.6%, CPR 45.6%, and cumulative pregnancy rate 45.6%. In the elevated BMI group, BR 62.3%, CPR 45.8%, and cumulative pregnancy rate 58.8%. BR and CPR did not differ significantly between BMI groups (BR p=0.652; CPR p=0.982). Per logistic regression, increasing BMI was not significantly associated with BR (95% CI: 0.77-1.07, p = 0.25) or CPR (95% CI: 0.76-1.30, p = 0.94). Conclusions: In this cohort, high BMI was not associated with significantly lower BR or CPR in patients undergoing MiST. Support: Institutional research funding.

Abstract Introduction Microdissection testicular sperm extraction (microTESE) is performed in men with nonobstructive azoospermia who desire sperm retrieval for use in IVF. This procedure can be performed in the operating room or in the clinic with local analgesic. Objective To report office-based microTESE sperm retrieval, fertilization, and livebirth rates. Methods A review was conducted of all patients who underwent office-based microTESE for nonobstructive azoospermia with a partner that who underwent concurrent oocyte retrieval for an intended in-vitro fertilization (IVF) intracytoplasmic injection (ICSI) cycle 2022-2024. All male partners underwent Y chromosome microdeletion testing, karyotype analysis, and hormonal testing preoperatively. Patients with a diagnosis of hypogonadism were offered medical therapy and those diagnosed with a varicocele were offered varicocelectomy prior to microTESE. Office-based microTESE was performed using a surgical operating microscope, spermatic cord block, and oral anxiolytic. Female partners underwent oocyte retrieval with oocyte cryopreservation prior to microTESE. Oocyte warming and ICSI was performed only following the collection of motile sperm from the fresh microTESE samples. Relevant demographic and clinical data were collected for patients and their partners. Descriptive data analysis was performed and reported as mean ± standard deviation. Results Ten patients underwent 11 office-based microTESE procedures. One patient had repeat microTESE following an unsuccessful IVF/ICSI cycle. Overall sperm retrieval rate was 70% for first time microTESE with mean search time 197.2 ± 96.5 min. Amongst couples with successful sperm retrieval, normal fertilization rate was 42%. Early cleavage arrest was seen in 84% of normally fertilized oocytes with a 16% blastocyst rate. Embryo development arrested entirely in two couples, while the remaining five couples had at least one blastocyst on day 5 and underwent embryo transfer. Of these, four resulted in a clinical pregnancy (36%). Three couples had a successful live birth and one has an ongoing pregnancy with ultrasound-confirmed fetal heartbeat. Conclusions Our small series demonstrates high sperm retrieval rates from office-based microTESE. Fertilization rates, clinical pregnancies and live birth rates are comparable with those reported in the literature. Given the financial cost associated with microTESE and IVF/ICSI for nonobstructive azoospermia patients, office-based microTESE may be a solution to make the process more financially accessible for couples. Disclosure No.

Objective: To evaluate the reproductive experiences of physicians across gender and specialty. Patients and Methods: Between November and December 2021, we surveyed nontrainee physicians of all genders at a single quaternary institution using a modified version of an existing survey instrument. Experiences with family planning, fertility, pregnancy, and parental leave were assessed. Results: There were 422 completed responses. Respondents reported a higher prevalence of infertility as compared to the general U.S. population (26% versus 19%), with no difference in infertility or obstetrical complications by specialty. Most respondents (75%) reported stigma regarding having children in medicine, and 71% reported delaying childbearing. These trends were strongest in the subanalysis of female respondents. Forty-five percent of respondents reported that their work increased the risk for subfertility, infertility, or pregnancy complications. Surgeons were significantly more likely to report physically demanding work conditions (75% versus 30%, p < 0.001), radiation exposure (39% versus 14%, p < 0.001), and bloodborne pathogen exposure (25% versus 12%, p = 0.03) as occupational reproductive hazards. Only 55% of respondents with a pregnancy history reported ever taking parental leave. Among those who took less than the full amount offered, 63% cited concerns about falling behind educationally or professionally as significantly influencing this decision. Conclusions: These results support previous trends showing delayed childbearing and increased infertility among physicians while shedding new light on stigma associated with childbearing and parental leave. A better understanding of the reproductive experiences of physicians is critical to recruiting and retaining a skilled workforce and fostering career and life satisfaction in this profession.

Background: Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional information to aid in embryo selection for transfer. Time-lapse incubators can also utilise morphokinetic models to rank embryos based on morphokinetic parameters. We sought to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Aims: The aim of the study is to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Settings and Design: This is a retrospective cohort design. Materials and Methods: Embryos cultured in a time-lapse culture system that had traditional morphologic evaluation, morphokinetic modelling and known live birth outcomes were included in this study. Embryos with unknown competence were excluded, including when two embryos were transferred with a single live birth resulted. Statistical Analysis Used: Receiver operating characteristic (ROC) curves were determined for both the morphologic analysis and the morphokinetic model on culture day 3 and day 5. Using the ROC-determined cutoff that optimised both sensitivity and specificity, a binary outcome for each test was analysed using agreement statistics to determine if one method of embryo evaluation was superior to the other. Results: Morphological and morphokinetic grading were both predictive of embryo competence on days 3 and 5. However, on day 3, morphologic grading was superior to morphokinetic grading with area under the curve (AUC) of 0.66 ( P < 0.001) and 0.58 ( P = 0.009), respectively. Contrarily, on day 5, the morphokinetic model had a higher AUC of 0.65 ( P = 0.03) compared to the morphologic grading, AUC 0.56 ( P = 0.02). Conclusion: Traditional morphology was noted to be a better diagnostic tool (higher AUC) on culture day 3 while a morphokinetic model was superior on day 5.

AbstractThe objective of this study was to determine seizure control in women with epilepsy (WWE) undergoing assisted reproductive technology (ART). Through retrospective chart review, WWE undergoing ART were identified. Demographics and details regarding epilepsy type, seizure control, and ART procedures were extracted. Seizure frequency prior to and during ART were compared. We identified 12 WWE, who underwent 29 embryo transfers, resulting in 16 pregnancies and 10 live births. Nine women were seizure‐free at least 2 years before fertility treatment, including three with resolved epilepsy. Seven were on antiseizure medications throughout fertility treatment and pregnancy, with only one on polytherapy. Eleven (all with controlled epilepsy or epilepsy in remission) remained seizure‐free throughout fertility treatment. One woman with drug‐resistant epilepsy continued to have seizures throughout fertility treatment and pregnancy without an exacerbation of seizure frequency. There was no increased seizure frequency associated with fertility treatment and subsequent pregnancy in this small series of WWE. Although this study was statistically underpowered, our results provide some preliminary evidence that ART might not pose a threat to seizure control, but larger, confirmatory studies are necessary.