Background: Ultrasound-guided manual vacuum aspiration (USG-MVA) has been shown to be safe and effective alternative to traditional surgical evacuation in managing first trimester pregnancy loss. This study aims to determine patient satisfaction and acceptability of USG-MVA for the management of their first-trimester miscarriage. Methods: This was a single-center cross-sectional study conducted in a university-affiliated tertiary hospital. Patients with delayed miscarriage of [Formula: see text]12 weeks of gestation or incomplete miscarriage who underwent USG-MVA were invited to complete a questionnaire 2-hour post-procedure to evaluate their experience. The Client Satisfaction Questionnaire-8 (CSQ-8) was used to assess patient satisfaction and acceptability to USG-MVA in addition to questions evaluating patient’s perception to the procedure. Results: From 2018 to 2023, a total of 137 patients were recruited and all of which completed the questionnaire. Results indicate that patients were highly satisfied with the procedure, with CSQ-8 mean scores of 27 (SD 3.3, range 14-32). 135 (98.5%) patients were satisfied with the procedure, 129 (94.2%) of patients would wish to choose USG-MVA if they required surgical evacuation again and 128 (93.4%) patients would recommend USG-MVA to a friend. Conclusions: USG-MVA is a feasible, effective, safe and highly acceptable alternative to surgical treatment for the management of first-trimester miscarriage. The option of USG-MVA can be presented as a treatment option when counselling for the management of first trimester miscarriage.

The line between abnormal and normal fertilized oocyte is typically determined by the presence or absence of genetic or chromosomal abnormalities. In general, a normal fertilized oocyte refers to one that is euploid and has undergone successful fertilization resulting in a viable embryo. On the other hand, an abnormal fertilized oocyte is generally aneuploid and may have genetic abnormalities. These abnormalities can occur due to errors during fertilization or genetic mutations inherited from the parents. Preimplantation genetic testing (PGT) can help to identify abnormal embryos, allowing selection of healthy embryos for transfer. It is important to note that the line between normal and abnormal fertilized oocytes can be complex and may not always be clear-cut, as some abnormalities may have varying degrees of impact on development.

Ovarian tissue cryopreservation (OTC) and subsequent grafting (OTG) is an innovative fertility preservation option, particularly for those patients who cannot delay treatment or are pre-pubertal. Unlike mature oocyte cryopreservation, OTC provides potential multiple opportunities for conception given the large supply of oocytes at immature stage. OTG is increasingly recognised as being successful in re-establishing fertility for women who have had gonadotoxic treatment, with over 200 live births documented worldwide from either spontaneous or assisted conception. However, establishing accurate clinical pregnancy rates and livebirth rates associated with IVF treatment after grafting is somewhat difficult as most studies publish pregnancy rates per patient rather than per transfer. Accurate information is important to assist patients with expectation management of numbers of cycles required to conceive and with outcomes, given this type of treatment is more labour-intensive than straightforward IVF. For patients with haematological cancers and with ovarian cancer there is a risk of tumour cell transmission and therefore strategies are required to allow use of the tissue and/or the gametes without conferring this risk. In-vitro-maturation offers the potential for healthy pregnancy and livebirth without the risk of grafting, and development of this technology will allow a robust and realistic fertility treatment strategy. However, how to successfully effect the initial phase of follicle development from primordial phase, termed the in-vitro-growth phase, is still eluding researchers. Mastery of this will allow substantial expansion of the follicle pool.

Background and Aims: The spindle is an essential cellular organelle that plays an important role in the oocyte during chromosome alignment and separation at meiosis. To examine the effect of presence or location of spindle on the fertilization rate and the morphokinetic parameter of embryo in patients over 40 years. Methods: This was a retrospective study based on data collected between January and December 2022. A total of 394 matured oocytes retrieved from 155 patients over 40 years undergoing ICSI cycles were imaged for meiotic spindle using PolScope. Oocytes were subdivided into two groups. Group A: oocytes had the spindle forming 0 to 15[Formula: see text] angles, group B: oocytes had the spindle forming 15[Formula: see text] or more. Morphokinetic analysis; Embryoscope+ using guided semi-automatic annotation. Results: Meiotic spindles were visualized in 369 oocytes (93.65%, 369/394) and were not visualized in 25 oocytes (6.35%, 25/394). The fertilization rate (73.98% and 44.00%; P=0.0012) and good quality embryo rate (41.39% and 27.27%; P=0.365) were significantly higher in oocyte with spindle, compared with in oocyte without spindle. Divided by spindle angle, group A was significantly higher fertilization rate, good quality rate compared to group B. There was no signicant difference in KID3 score (mean, 3.91±1.46 and 4.00±1.22; P=0.39) and the D3 morphokinerics parameter among the different groups. However, the D5 morphokinetics parameter (tSC; 81.56±7.48 vs 85.73±8.29, tM; 87.22±7.89 vs 94.00±11.60, tSB; 96.05±8.03 vs 102.18±9.15, tB; 106.39±10.04 vs 113.06±10.88, P<0.05) showed a significant association with spindle location. Conclusions: Visible spindle or location close to polar body showed higher fertilization rate and good quality embryo as well as differed in morphokinetic parameters on day 5. This study confirmed a positive relationship between the spindle and fertilization rate. A significant difference of morphokinetics was found in day 5, but not in day 3.

Background and Aims: Endometriosis is a common estrogen-dependent disease that occurs mostly in women of childbearing age and is characterized by ectopic growth of endometrial glands and stroma. Endometriosis may present as malignant transformation and the two most common malignancies in this situation are ovarian clear cell carcinoma and endometrioid adenocarcinoma. Rare cases of endometriosis-associated ovarian cancer (EAOC) after in-vitro fertilization (IVF) treatment were reported before, and the relationship between the usage of ovulation induction medications and the development of ovarian cancer is controversial. This study aims to summarize the characteristics of EAOC patients with IVF treatment history. Method: All history, clinical data, imaging data, operative documents, and follow-up of 3 cases of endometriosis-associated ovarian cancer with IVF treatment history were reviewed, among the 793 patients undergoing surgeries for ovarian malignancy at the Gynecology Department, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, from 2019 to 2022. Results: 3 EAOC patients under the age of 40 who had undergone controlled ovarian hyperstimulation (COH) for IVF treatment were identified in the cases review. The 3 infertility women underwent 3, 4, and 6 cycles of ovulation induction and achieved 1, 0, and 1 time of pregnancy, respectively. Unfortunately, none of them reached a pregnancy outcome over 12 weeks. After staging surgery, the 3 patients were diagnosed with Stage IA clear cell carcinoma, Stage IIB clear cell carcinoma, and Stage IIB adenosquamous carcinoma, respectively. The latter two patients had undergone two times of needle aspiration and sclerosis for chocolate cysts, and the surgical records also showed more severe abdominal adhesion and poor prognosis. Conclusion: Patients with endometriosis cysts need to be very careful when seeking IVF treatment, especially in the order of treatment of cysts and ovulation induction. Repeated needle aspiration and sclerosis for ovarian cysts are not recommended.

Nowadays, blastocyst biopsy is widely used in preimplantation genetic tests (PGTs), especially in preimplantation genetic testing for aneuploidy (PGT-A). Compared to polar body biopsy and cleavage stage biopsy, blastocyst biopsy has a higher consistency in the genetic analysis of human embryos and has a less impact on embryo implantation potentials. However, the consistency of genetic tests and the clinical outcome of post blastocyst biopsy can vary depending on biopsy practitioners. This workshop will discuss the handling of blastocyst biopsy procedure with the purpose of helping participants further advance their blastocyst biopsy techniques. We will review the procedure step by step including post biopsy cryopreservation through formal lectures, salon talks, panel discussions and hands-on training. We will also discuss trouble shootings from the perspective of an embryology lab and that of a genetic testing lab.

The 2016 Cochrane Review identified Magnetic Resonance Imaging (MRI) and Transvaginal Ultrasound scans (TVUS) as the most diagnostic non-invasive test for endometriosis. This led to IMAGENDO, which uses Artificial Intelligence (AI) to model digital data from these two imaging modalities to improve the accuracy of endometriosis non-invasive diagnostics. The IMAGENDO team have developed a novel, award winning, multimodal approach to improve the sensitivity and specificity of endometriosis imaging. The talk will describe some of the methods used, the impact AI has had on diagnostic accuracy and the challenges faced and yet to be overcome. The likely role of AI in future endometriosis diagnostics will be speculated upon.

Endometriosis consists of major five features including inflammation, angiogenesis, MMP activation, adhesion formation and anti-apoptosis which all exhibit adverse effects and severely interfere with embryo implantation. Meta-analysis also shows decreased mean number of eggs retrieved, compromised clinical pregnancy rates and live birth rates in women with endometriosis. Endometriosis impacts on human oocytes by decreased mitochondrial number, reduced mitochondria DNA copy number, and increased the abnormal mitochondrial ultrastructure. The embryo morphokinetics research by time-lapse observation in patients with ovarian endometriosis illustrates delay tM and tB around 2-3 hours compared with the controls. Medical treatment by GnRHa or Dienogest before ET or FET both can induce apoptosis and autophagy of endometriotic tissues and lead to diminished endometriosis related biomarkers Tensin1 etc.) and restores the implantation markers (HOXA 10). Translational clinical studies in IUI or IVF also demonstrated beneficial effects on pregnancy outcomes and decreasing miscarriage rate following GnRHa pretreatment.

Background and Aims: We have previously shown that GM-CSF can improve embryo development when added during in vitro oocyte maturation (IVM) as well as increase pregnancy and birth rates following embryo transfer in mice. The aim of the present study was to determine whether GM-CSF during IVM can improve embryo development in a mouse model of advanced maternal age (AMA) Method: 12–14-month-old CBAF1 female mice were injected with 5IU of PMSG and cumulus-oocyte complexes (COCs) aspirated 46–48 h post-injection. Ten COCs were cultured per 50 [Formula: see text]L drop in bicarbonate-buffered [Formula: see text]-MEM containing 3 mg/ml BSA, 1 mg/ml Fetuin and 5 mIU/mL FSH plus 0 or 10 ng/ml of GM-CSF. Zygotes were cultured in Cleave Media and cleavage and blastocyst rates were determined. Blastocysts were differentially stained on Day 5 to determine cell numbers. To determine mitochondrial membrane potential (MMP) COCs were incubated for 15 minutes in HEPES buffered alpha-MEM media with JC-1 dye for 15 minutes. To examine spindle formation and chromosomal alignment, MII oocytes were fixed and then incubated with FITC conjugated mouse anti-[Formula: see text]-tubulin for 40 minutes at 25°C and chromosomes stained using Hoechst. Fluorescence was visualised using Cell Voyager CV1000 Confocal Scanner and Z-stack images were analysed using Fiji Image J software. Data were analysed using a univariate general liner model in IBM SPSS. Results: GM-CSF during IVM increased Day 5 blastocyst rate by 21% (P<0.01) and the proportion of expanded blastocysts by 75% (P<0.05). Blastocyst inner cell mass was increased by 23% (P<0.05) and total cell number by 14% (P<0.05). MMP was increased across all fields by three-fold (P<0.05). GM-CSF did not affect spindle formation but tended to reduce chromosomal misalignment by 17% (P>0.05). Conclusion: We have shown that the addition of GM-CSF during IVM can improve embryo development and mitochondrial activity in a mouse of AMA.

Background and Aims: Hydrosalpinx is a severe manifestation of tubal disease-causing infertility in women. It has an adverse effect on the outcome of in vitro fertilization (IVF), reducing live birth rate (LBR) by 50% compared to other tubal factors. Laparoscopic salpingectomy can effectively improve IVF outcome but is contraindicated in some women. It can also be expensive and is not without complications. Ultrasound-guided hydrosalpinx aspiration is a cheaper, less invasive procedure alternative to salpingectomy. It has been shown to improve clinical and ongoing pregnancy rates compared to patients with no aspiration. However, the published literature on the effectiveness of hydrosalpinx aspiration is equivocal. Method: This retrospective study aimed to evaluate the outcome of minimal stimulation (mild) IVF cycles wherein the women underwent hydrosalpinx aspiration prior to embryo transfer at a private fertility clinic in the Philippines. Results: A total of 98 IVF cycles satisfied the inclusion criteria. The average patient age was 35.22 ± 4.57 and average duration of infertility was 5.87 ± 3.70 years. The biochemical pregnancy rate was 48% and the clinical pregnancy rate was 39.8%. Live birth rate was 35.7%, which is comparable to that of mild IVF patients without hydrosalpinx. There was a negative correlation between patient age and biochemical pregnancy rate, clinical pregnancy rate, and LBR, however, the correlations were statistically insignificant (Pearson correlation, P = 0.081, 0.197, and 0.344, respectively). Binary logistic regression analyses showed that age, infertility type, infertility factor, basal hormone levels, and number of eggs retrieved were not predictive of the success of IVF among the women in the study. Conclusion: Our results show that hydrosalpinx aspiration is a safe and effective option in improving pregnancy and live birth rates in women undergoing mild IVF.