Background: Assisted oocyte activation (AOA) has been used to improve fertilization rates after intracytoplasmic sperm injection (ICSI) by artificially increasing oocyte calcium concentration. However, concerns remain about its potential long-term impact on child development. Limited data exist on developmental outcomes in children born after ICSI with AOA. This study investigated psychomotor development at 12 months of age in children born after ICSI with or without AOA. Methods: This prospective cohort study included 55 children born after frozen embryo transfer: 29 in the AOA group and 26 in the non-AOA group. At 12 months, parents completed the Ages and Stages Questionnaire, Third Edition (ASQ-3), and the Developmental Milestones Red Flags checklist, validated for assessing psychomotor development. Parents also reported their child’s physical characteristics (e.g., height and weight) and medical history, including hospital admissions and chronic illnesses. Outcomes included proportions of children with abnormal ASQ-3 scores, Red Flag signs, and adverse medical/growth outcomes. Results: Baseline parental and perinatal characteristics were comparable between groups. At 12 months, no significant differences were observed in the proportion of children with abnormal ASQ-3 scores across five developmental domains (communication, gross motor, fine motor, personal-social, and problem-solving skills). The prevalence of Red Flag signs and rates of illnesses, hospitalizations, and chronic conditions were also similar. However, children in the non-AOA group were significantly taller than those in the AOA group (77.1 ± 2.2 cm vs. 74.6 ± 4.0 cm; [Formula: see text] = 0.02). Conclusions: Children in the AOA group showed similar psychomotor development at 12 months compared to those in the non-AOA group.

Aims: We examined the data of women diagnosed with placenta accreta spectrum and studied the risk factors, diagnosis, management, and complications associated with this condition. Study Design: A retrospective review of case records of women with a diagnosis of PAS diagnosed antenatally or intraoperatively for 2 years from 2021 to 2023 at a tertiary care obstetric hospital in Srinagar, India. Results: A total of 80 patients were identified in the study period. The incidence was 2.227 per 1,000 live births. None of the PAS patients contracted coronavirus infection. An antenatal diagnosis was made in 87.5% cases. Nearly 69% patients had a placenta previa. Elective delivery occurred in 67.5% women while 31.25% needed an emergency caesarean section. The gestational age at delivery was <34 weeks in 27.5%, 34 [Formula: see text] to 36 [Formula: see text] weeks in 27.5%, and 37 weeks in 43.75% women. Caesarean hysterectomy was required in 53 women (66.25%). The estimated blood loss was <2,000 mL in 40%, 2,000 to 5,000 mL in 53.75%, and >5,000 mL in 5% patients. Almost 99% women needed blood transfusion, while 23.75% women needed inotropic support intra- and postoperatively and intensive care unit (ICU) management. Twelve percent of women had urological complications. One (1.25%) patient died of uterine rupture with massive hemoperitoneum and irreversible shock. On histopathological examination, 47 (58.75%) patients were diagnosed as placenta accreta while 32 (40%) were diagnosed as either increta or percreta. Conclusions: The present audit highlights the incidence and profile of PAS in a tertiary care referral obstetric institute. PAS is a complicated high-risk pregnancy and a surgical challenge that should be managed in a tertiary care setting with multidisciplinary team management and intensive care facilities to reduce maternal morbidity and mortality.

Background: Frozen embryo transfer (FET) has been a routine assisted reproductive technology (ART) procedure since the first FET by slow freezing. It is estimated that more than 2 million FET cycles are performed worldwide each year. The stepwise removal of cytotoxic cryoprotectants and rehydration in serial osmotic solutions has been a fundamental principle, but the entire process is time-consuming and labor-intensive. Methods: A two-phase study was performed. In Phase 1 (technical validation), four culture media and phosphate-buffered saline (PBS)-only control with specific osmolality (270 ± 10 mOsm/KG) were used. Survival rates were determined by embryo movement and re-expansion under time-lapse imaging. The technical compatibility of repeated direct warming and repeated biopsies for preimplantation genetic tests was investigated. In Phase 2 (clinical application), 20 and 76 patients were recruited for direct and conventional warming. Cost-effectiveness analyses were performed. Results: In Phase 1, all culture media supported 100% survival rates ([Formula: see text] = 52), even in PBS ([Formula: see text] = 11). Revived blastocysts could re-expand as a conventional method. Directly rehydrated and warmed blastocysts in culture medium also survived from direct warming, trophectoderm biopsy, second vitrification, and second direct warming with the second biopsy, indicating compatibilities with conventional PGT procedures ([Formula: see text] = 13). In Phase 2, nonsignificant but higher implantation rates and clinical pregnancy rates were obtained from direct warming compared with conventional warming (61.9% vs. 38.5%, 60.0% vs. 39.5%), leading to healthy live births (LBs) (45% vs. 36.8%). Miscarriage rates were also comparable (three vs. two incidences). Cost-effectiveness analyses showed that direct warming could save 42% in consumable costs and 90% in labor hours. Conclusions: Current results showed that direct warming/rehydration is a feasible way, and gradual cryoprotectant removal and rehydration were unnecessary for human blastocyst warming survival. In this small sample-size pilot study, direct-warmed blastocysts supported all clinical outcomes equivalent to conventional procedures with saved time and money. Further multicenter clinical trials are needed to provide convincing resolutions on the direct warming and rehydration of human blastocysts.

This Invited Editorial considers the significance of three recent articles in Fertility and Reproduction on quality management, especially vital human resources management aspects, in the ART laboratory within the Asia-Pacific region. It highlights the growing need for regional education in all aspects of total quality management and accreditation-compliant practices that will allow clinics to improve their operational efficiency and safety, along with preparedness for managing and mitigating the impacts of emergencies and disasters. Adopting such practices will also improve both the work experience and work-life balance of its staff and the efficacy of its clinical services measured in terms of both pregnancy rate and patient satisfaction.

Among female subjects of reproductive age, polycystic ovarian syndrome (PCOS) is a common endocrine disorder that may be linked to a number of health risks for cardiovascular diseases (CVDs). The study aims to determine some CVD risk variables and how they relate to body mass index (BMI) in female subjects with PCOS. Fifty healthy women without PCOS (controls) and 90 women with PCOS between the ages of 18 and 45 were enrolled in the study. Standard methods were used to evaluate the serum sex hormones, lipid profile, troponin-I, highly sensitive C-reactive protein (hs-CRP), fasting blood glucose, and atherogenic indices. Compared to controls, the mean age of women with PCOS was substantially lower ([Formula: see text]). The mean values of BMI, waist circumference, and hip were not significantly different from one another. While the cardiometabolic variables were higher in women with PCOS than in healthy subjects, no significant difference between obese/overweight and nonobese women with PCOS in terms of mean BMI, fasting blood glucose, insulin, atherogenic index of plasma (AIP), troponin-I, hs-CRP, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol were observed. In PCOS-affected women, AIP ([Formula: see text], [Formula: see text]), lipid accumulation product (LAP) ([Formula: see text], [Formula: see text]), and hs-CRP ([Formula: see text], [Formula: see text]) all showed positive correlations with BMI. Regardless of BMI status, there was an independent correlation between cardiovascular risk factors (CVRFs) and PCOS. This implies that regardless of a woman’s BMI, PCOS may increase her risk of CVD. Treatment combined with lifestyle modifications may be useful in lowering the risk of CVD in PCOS-afflicted Nigerian women. The finding suggests that PCOS itself, independent of weight, may increase the risk of heart disease. Nigerian women with PCOS are at increased risk of CVD, regardless of their BMI, and early detection, prevention, and treatment of CVRFs in women with PCOS is desirable.

Background: In vitro fertilization (IVF) is the most widely applied fertility treatment. While the indication for IVF is not disputed in couples where natural conception chances are close to zero (blocked fallopian tubes or severe male infertility), it is less clear when IVF should be started in other couples. Natural conception occurs frequently and has been reported in patients pre- and post-IVF treatment. The outbreak of COVID-19 in the early months of 2020, resulted in Australian fertility clinics stopping treatment. This enabled the opportunity for fertility patients to try and conceive naturally. Methods: We studied couples who were scheduled to start IVF in March 2020 but who faced delayed treatment due to COVID-19 shutdowns. Outcomes were recorded as couples returned for treatment or were contacted via phone and asked why they did not return. We collected baseline characteristics including maternal age, day of next Day 1, and type of infertility, as well as the pregnancy outcome or reason for not returning. Results: We studied 533 couples who were delayed IVF treatment for a total of 1,204 observation months. From the initial cohort of 533 couples delayed treatment, 16 couples achieved pregnancy (3%) with 12 resulting in live birth (2.3%). When analyzed by indication, patients with ovulatory disorders (4 of 55 [7.2%]) or reduced ovarian reserve (7 of 141 [5%]) proved to have higher rates of natural conception compared to other diagnostic categories. There were 39 couples who did not return to treatment and did not achieve natural conception. Conclusion: There is a significant emotional toll that patients experience when undergoing fertility treatment. Natural conception is evident within cohorts scheduled for IVF treatment, and this study indicates that the chance per cycle of live birth in couples waiting to undergo medically assisted reproduction during the COVID pandemic was 2.3%.

Background: A Delphi consensus was conducted to formulate an expert opinion on the definition of in-vitro fertilization (IVF) success, to provide a reference basis for clinical practice. Methods: Chinese experts in assisted reproductive technology (ART) were surveyed using the Delphi method. Based on the literature related to IVF success, eight experts developed a framework of statements and items. A questionnaire was then distributed to 23 experts to canvas their opinions on these statements. If consensus was not achieved, the statement was revised and revoted upon until a consensus was reached. Results: Consensus was reached for 19 statements related to the definition of IVF success, the most relevant of which are summarized as follows: (1) Goal of IVF treatment ([Formula: see text] statement): to attain a healthy live birth in the shortest possible time and with the lowest possible risks; (2) Definition of IVF success ([Formula: see text] statements): effectiveness, safety, and efficiency of IVF treatment should be included in the definition of success, with the cumulative live birth rate per ovarian stimulation cycle within 2 years being a performance indicator (PI) of success, and IVF success should be measured from a patient-centered perspective, including the patient’s burden and satisfaction. (3) Assurance of IVF success ([Formula: see text] statements): to provide evidence-based treatment and avoid the introduction of IVF add-ons into routine clinical practice without any clear evidence of benefit, optimize treatment quality by establishing and monitoring key PIs, and improving quality control systems. (4) Hurdles of IVF success ([Formula: see text] statements): cycle cancellation before oocyte pickup and treatment discontinuation after failed cycles are hurdles of success to IVF. Conclusions: Based on the Delphi method, the expert opinion on the definition of IVF success has been formed, which could complement guidelines and may help improve treatment outcomes.

Purpose: Does preimplantation genetic testing for aneuploidy (PGT-A) in embryos help women of advanced maternal age (AMA) of Indian origin to achieve better reproductive outcomes? Methods: In this retrospective study, a total of 267 patients were recruited, of which 53 patients (PGT-A group) consented to PGT-A, followed by euploid embryo transfer, whereas the remaining 214 patients (non-PGT-A group) underwent frozen embryo transfer (FET) of unscreened morphologically graded blastocysts. Results: A significant increase in the clinical pregnancy rate was observed in the PGT-A group when compared to the non-PGT-A group (71.6% vs. 51%, [Formula: see text]), while the miscarriage rate was found to be lower in the PGT-A group compared to the non-PGT-A group (11% vs. 25%, [Formula: see text]). The live birth rates were also significantly better in PGT-A group (60.3% vs. 25.6%, [Formula: see text]). In the PGT-A group, similarly, the implantation rate was found to be significantly higher than in the non-PGT-A group (53% vs. 33%, [Formula: see text]). Conclusions: The data suggest that PGT-A testing in women of AMA can improve their reproductive outcomes. Role of PGT-A seemed equally efficient in women of Indian origin and showed no difference based on ethnicity.

Background: Follicle-stimulating hormone (FSH) is widely used during assisted reproductive therapy to facilitate the development of multiple follicles. In turn, the number of oocytes retrieved has been shown to relate to the live birth rate. This retrospective study investigated the correlation between the total FSH dose used and the cumulative live birth rate in individuals who had undergone in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods: This retrospective study included women undergoing IVF/ICSI using a gonadotropin-releasing hormone antagonist protocol who had a regular menstrual cycle and an expected normal response to ovarian stimulation. Cumulative live birth rate was defined as the first live birth following the use of all fresh and frozen transfers of embryos derived from one stimulated IVF/ICSI cycle. Results: The analysis included 7,130 stimulated cycles in 6,517 individuals (9,138 transfers). The mean age, antral follicle count, and anti-Müllerian hormone level were [Formula: see text], [Formula: see text], and [Formula: see text][Formula: see text]ng/ml, respectively. The mean total FSH dose, total number of oocytes retrieved, and total FSH dose per oocyte retrieved were [Formula: see text] IU, [Formula: see text], and [Formula: see text] IU, respectively. There was a significant negative correlation between the total FSH dosage and the cumulative live birth rate in women aged [Formula: see text] years ([Formula: see text], 95% confidence interval [−0.14, −0.08]; [Formula: see text]) and in those aged [Formula: see text] years ([Formula: see text], 95% confidence interval [−0.11, −0.02]; [Formula: see text]). Conclusions: The cumulative live birth rate decreased as the total FSH dose increased. These findings suggest that physicians may wish to avoid prescribing a high dose of FSH in women undergoing IVF/ICSI who are predicted not to have a poor response.

Background and Aims: Embryologist evaluation of embryos is critical for ensuring successful pregnancy outcomes. Standard, manual evaluation is variable, subjective, and time-consuming. The aim of this study was to evaluate whether an artificial intelligence (AI) algorithm can standardize and improve embryo evaluation during IVF. Method: 20 images of blastocyst-stage embryos on day 5 of in vitro development were selected to represent a range of morphological qualities. All embryos had been transferred and the clinical pregnancy outcome was known for each embryo based on detection of fetal heartbeat at first ultrasound scan (∼7-9 weeks gestation). 50% of embryos in the dataset resulted in pregnancy. 158 embryologists made a total of 236 attempts at providing their evaluation of the morphological quality of the 20 embryo images using the Gardner system. The embryologist-assigned grades were then used to generate their prediction of whether that embryo would lead to pregnancy or not (≥ 3BB indicated a pregnancy prediction, and <3BB indicated a non-pregnancy prediction). The same 20 embryo images were also assessed by a previously developed viability AI algorithm for evaluating the likelihood of clinical pregnancy based on embryo images. An AI score of ≥5.0/10 indicated a pregnancy prediction, and <5.0/10 indicated a non-pregnancy prediction. The AI algorithm provided the same score for each embryo image regardless of how many times the analysis was performed. Results: The AI algorithm correctly predicted pregnancy outcome for 14/20 embryo images (70%). Embryologists also correctly predicted 14/20 images in 14/236 attempts (6%), and in 1 attempt correctly predicted 15/20 images. In the remaining 221 attempts (94%) embryologists correctly predicted between 6-13 images, representing a range of accuracies from 30-75%. Conclusion: This study demonstrates the inherent variability and lack of objectivity associated with an embryologist’s evaluation of embryos. It highlights the benefits of accurate AI algorithms for standardizing embryo assessment