Abstract Study question Is live birth rate of autologous versus donor cycles similar after a euploid embryo transfer? Summary answer The live birth rate was significantly higher in autologous cycles after a euploid embryo transfer. What is known already Advanced maternal age (AMA) is a detrimental factor for patients to achieve a successful outcome in ART. Physiological ovarian aging negatively affects oocyte quality and quantity. Thus, the number of cycles with donated oocytes is increasing for AMA patients worldwide, with the perspective of surpass the oocyte factor and achieve a live birth in similar rates as younger patients. The goal of this study was to compare the live birth rates of autologous versus donor cycles after a euploid embryo transfer. Study design, size, duration Observational cohort study including all patients of IVF cycles with a euploid embryo transfer after PGT-A (NGS technology), according to medical referral between Jan/2016 and Dec/2020 (n = 3623 patients and 4025 cycles) in a private ART center. Participants/materials, setting, methods Reproductive outcomes between autologous and egg donation cycles were compared and data were analyzed in the follow subgroups: cycles with a fresh oocyte and fresh embryo transfer (FRESH), frozen embryo transfer (FET) and fresh embryo transfer from frozen oocytes (FOT). Positive pregnancy test (PPT), clinical pregnancy (CP), clinical miscarriage (CM) and live birth (LB) rates were compared. Kruskal-Wallis and Fisher test were applied for statistical analysis, significance was considered if p < 0,05. Main results and the role of chance In total, 3623 patients – 88.9% autologous and 11.1% with donated oocytes – were included. They performed 4025 ETs (3591/434) with 5313 biopsied blastocysts (4736/577) in a mean of 1,32/1,33 blastocysts per transfer in autologous/donated cycles respectively. The majority of patients using autologous and donated oocytes underwent a FET (97,2% and 63,1%), followed by FOT (1,5% and 34,7%) and FRESH (1,3% and 2,2%, respectively). Mean maternal age in autologous and donor cycles was 37,76±3,9yo and 43,47±4,26yo and oocyte donors were 24,99±3,86yo. In subgroups, autologous patients in FRESH were 38,33±2,69 yo, similar in FET (37,73±3,93 yo) and older in FOT, 39,25±3,93 yo (p = 0,03). Patients in donor cycles showed no difference in age. PPT and CP were similar in autologous and donated cycles (PPT: 59,2% vs 54,8%, p = 0.08; CP: 52,2% vs 48,2%, p = 0.11). In subgroup analysis, PPT and CP were higher in donated cycles vs autologous cycles for FOT (PPT: 50,7% vs 33,3%, p = 0.004; CP: 40,7% vs 20,8%, p = 0.01). Overall, CM were higher in donated cycles (15,5% vs 10,6%, p = 0.03), especially after FET (16,8% vs 10,6%, p = 0.025). LB rates were higher in autologous compared to donated cycles (37,8% vs 29,5%, p = 0.0007). There was no significant difference in LB rates in subgroup analysis. Limitations, reasons for caution This is a large cohort study; however, we cannot exclude potential bias due its retrospective nature. Including only euploid embryos, we excluded bias on ploidy status when comparing autologous versus donated oocytes cycles, yet the potential harmful of embryo biopsy may not be neglect. Wider implications of the findings Live birth rate was significantly higher in autologous cycles after a euploid embryo transfer, regardless of subgroups. AMA patients that choose to undergo an IVF treatment with donated oocytes should be aware that there are other important factors related to a successful reproductive outcome, including immunological adaptation and endometrial aging. Trial registration number Not applicable.

Abstract Study question Is there a difference between IVF outcomes in patients undergoing follicular versus luteal phase ovarian stimulation in different menstrual cycles? Summary answer Number of euploid blastocyst were higher in luteal phase ovarian stimulation IVF cycles. All other outcomes were similar between follicular and luteal phase IVF cycles. What is known already It has been published that human beings can have two or three follicular recruitment waves as observed in animals studies a long time ago. From these findings, several recent studies showed that two egg retrievals at the same menstrual cycle, named as Duo Stim, optimize time and IVF outcomes in women with low ovarian reserve due to more eggs retrieved in a shorter period with consequently higher probability of having good embryos to transfer. However, there is no knowledge about diferences concerning IVF outcomes between folicular and luteal ovarian stimulation, performed at the same women in different menstrual cycles. Study design, size, duration Retrospective, case-control study in a single IVF center. One-hundred-two patients who had two IVF treatments – the first cycle initiating ovarian stimulation at follicular phase (FPS) and the second cycle initiating after a spontaneous ovulation at luteal phase (LPS) – in different menstrual cycles (until 6 months apart) between 2014 and 2020, were included. Statistical analysis was performed with Mann-Whitney test and was considered significant when p ≤ 0.05. Data is represented as mean±SD. Participants/materials, setting, methods Patients underwent two IVF treatments in different menstrual cycles; the FPS IVF treatment was initiating at D2/D3 of menstrual cycle and the LPS treatment started three or four days after spontaneous ovulation, if at least 4 antral follicles were detected. Both IVF treatments were performed with and antagonist protocol and freeze all strategy. The majority of patients presents low ovarian reserve/Ovarian age as primary infertility factor (84.3%). Main results and the role of chance Patient’s mean age was 39.30±3.15 years, BMI (22.66±3.16) and AMH levels (0.85±0.85 ng/mL). Comparison of hormonal levels at the beginning of ovarian stimulation showed differences for FPS vs LPS, as expected: E2 (39.69±31,10 pg/mL vs 177.33±214.26 pg/mL,p< 0.0001) and P4 (0.76±2.47ng/mL vs 3,00±5.00 ng/mL,p< 0.0001). However, E2 and P4 at the day of oocyte maturation trigger were not different between FPS and LPS (1355.24±895.73 pg/mL vs 1133.14±973.01 ng/mL,p=0.0883 and 1.12±1.49 ng/mL vs 2.94±6.51,p=0.0972 respectively). There was no difference for total dose of gonadotrofins (FPS 2786.43±1102.39.01UI vs LPS 2824.12±1188.87UI, p = 0,8578), FSH (FPS 9.50±4.98 vs LPS 11.90±12.99,p=0.7502) and AFC (FPS 7.13±4.25 vs LPS 6.42±4.65,p=0,0944). From 102 patients that started ovarian stimulation, 78 had 1 or more oocyte collect in FPS group and 75 in LPS group: OPU (FPS 4.78±4.93 vs LPS 4.65±5.54,p=0.7889), number of MII (FPS 3.21±3.52 vs LPS 3.40±4.53,p=0.7889). From those, 52 patients performed ICSI in both cycles; fertilization rate 64.9%±28.6% for FPS vs 62.1%±32.4% for LPS,p=0.7899) and blastocyst formation 2.15±2.15 for FPS vs 2.54±2.35,p=0.3496). Data from 25 patients who had embryo biopsy for PGT-A showed similar number of blastocyst biopsed (2.12±1.72 FPS vs 2.48±1.71 LPS,p=0.3101) and a statistically significant difference regarding number of euploid blastocyst (0,20±0,41 FPS vs 0,96±0,93 LPS,p=0,0008). Limitations, reasons for caution This is a retrospective study in a limited number of patients. Therefore, it is not possible to make a definitive conclusion that LPS proportionate higher number of euploid than FPS. More studies are necessary to investigate not only IVF outcomes but also the impact on pregnancy rates. Wider implications of the findings: In our study, LPS protocol after spontaneous ovulation, presents similar IVF outcomes compared to routinely FPS protocol. Intriguingly, the number of euploid blastocyst was significant higher in LPS, which may be further investigated. In this way, LPS is another option of IVF treatment, and may optimize time and treatment results. Trial registration number Not applicable

PCOS is the most common anovulatory dysfunction and prevalent cause of infertility. Although patients with PCOS have an enhanced response during ovarian stimulation, the clinical outcomes are poor. Previous studies have shown relevant molecules, which are speculated to be linked in the pathogenesis of PCOS. The exact mechanism affecting ovulatory process is still unclear. The aim of this study was to analyze the proteomic profile of follicular fluid in PCOS patients undergoing IVF cycles and compared to ovum-donors. This is an experimental study including FF from PCOS patients (n=8) and oocyte donors (OD: n=9) undergoing IVF cycles. Patients were submitted to pituitary down-regulation with GnRH agonist, ovarian stimulation using rFSH and follicular maturation triggered by rhCG. The FF from leading follicle was recovered and samples were combined in two pools for each group, PCOS and OD. Sample pools were submitted to albumin-IgG depletion, digestion and desalting, and tryptic peptides were analyzed by nanoliquid chromatography (nLC) on-line by positive-ion micro-electro spray with a linear Ion Trap (LTQ-XL). Data was searched against human Uniprot database with MASCOT and validated with Scaffold 3.6 with a 2% false positive rate. Pathway analysis was performed by the Metacore. Gene ontology processes were highlighted based on 107 proteins identified using a threshold of 10 for spectrum counts. Immune responses by classical and alternative complement pathways and blood coagulation pathway were the most highlighted based on proteins expressed. The inflammatory process through the cell-matrix interaction network was up-regulated in PCOS patients, while OD proteins emphasized the angiogenesis signaling due to interleucin-6 pathway. The inflammatory process through the cell-matrix interaction network up-regulated in PCOS patients could be linked to a folliculogenesis disruption. In patients with PCOS, metalloproteinases have been associated with inappropriate follicular development and may be related to an increased ovarian extra-cellular matrix remodeling and multiple cyst formation. On the other hand, OD are supposed to be fertile supporting a normal folliculogenesis and proteins emphasized the angiogenesis signaling due to interleucin-6. The IL-6 may represent a potent angiogenesis factor, which allow the satisfactory follicle vascularization and development.

The aim of this study was to evaluate different routes of estrogen (E2) administration for endometrium preparation and the correspondent clinical pregnancy rates (CPR) in frozen embryo transfer (FET) cycles. This is a retrospective cohort study including FET cycles between July 2014 and November 2015 in a private reproductive medicine center. Patients were allocated into three groups according to route of estrogen administration. This study included 280 women undergoing FET cycles with vitrified-warmed blastocysts who underwent endometrium preparation using estradiol valerate at day 02 of the menstrual cycle plus progesterone support when appropriate. Women were divided in three groups according to administration route of estrogen for endometrial preparation: oral daily (Or, n=111), oral daily + transdermal each 48 hours (Or+Tr, n=132), intramuscular twice a week (IM, n=37). We compared groups regarding to age (Or: 37.1±4.4; Or+Tr: 36.0±4.3; IM: 39.7±5.0; p=0.003), number of ET (Or: 1.8±0.7; Or+Tr: 1.7±0.6; IM: 1.9±0.7; p=0.225) and endometrial thickness (Or: 8.8±1.6; Or+Tr: 9.1±1.8; IM: 8.6±1.3; p=0.211). Clinical pregnancy rate was statistically similar among groups (Or: 47.7%; Or+Tr: 56.8%; IM: 64.9%; p=0.141), although CPR seen in women with intramuscular administration was numerically higher. Regarding to estradiol levels on the day of FET, the three groups were statistically different and the IM group presented higher levels (Or: 422.71 ng/ml; Or+Tr: 580.81 ng/ml; IM: 799.74 ng/ml; p<0,001). Multivariate logistic regression models were built to evaluate the association of IM route of E2 (OR: 1.7; p=0.162) or E2 levels on the day of FET (OR: 1.0; p=0.742) with the clinical pregnancy, adjusted for patients age, number of ET and endometrial thickness, but we did not observed any statistical significance. There are no differences between the route of estradiol valerate supplementation if compared the Oral, Oral + Transdermal or Intramuscular administration and considering the clinical pregnancy rate in FET cycles. Costs and patient’s convenience must be considered by clinicians to select an individualized protocol for endometrial preparation with estrogen administration according to specific patient’s characteristics. This is a retrospective study and the number of patients included in the IM group is small; hence, a prospective and randomized study should be carried out to investigate if the IM route of E2 in FET cycles result in better CPR.

Study question: To compare the pregnancy rate in patients submitted to FET (Frozen Embryos Transfer) of cleavage stage embryos (Group 1), or at the blastocyst stage (Group 2).Summary answer: Our data showed that the transfer of frozen blastocysts has a better pregnancy rate than cleavage embryos.What is known already: The first birth of a baby arising from a cryopreserved embryo occurred in 1983.Since then, improvements in embryo cryopreservation have occurred.However since early 90 ′ s a vitrification technique has also been developed to cryopreserve embryos in any stage of development.Study design, size, duration: Retrospective cohort study during 2012, with a total of 132 cycles.Participants/materials, setting, methods: In the group 1 the embryos had been frozen on the 2 nd , 3 rd or 4 th day after fertilization, while in the group 2 the embryos were frozen on 5 th or 6 th day at blastocyst stage.All embryos were cryopreserved by vitrification followed Kuwayama et al, 1998 protocol.The pregnancy rates were compared through the chi-square test (p , 0.05).Main results and the role of chance: The Group 1 consisted of 74 patients, which pregnancy and clinical pregnancy rate were 27.0% (20/74) and 21.6% (16/74), respectively.The Group 2 had 58 patients, and pregnancy and clinical pregnancy rate were 50.0%(29/58) and 43.1% (25/58) respectively.There was statistical difference between the groups (P¼ 0.0107).The mean age were 34.8 and years old for groups 1 and 2 respectively.Limitations, reason for caution: The study was conducted during a short period of time.Wider implications of the findings: This result suggests that the transfer of embryos at the blastocyst stage would be the best choice for IVF clinics.Study funding/competing interest(s): There were no competing interests in this study.

ObjectiveTo determine whether a TVSBP performed before and after 3-6 months subsequently a thorough LSC for removal of endometriomas (OMAS) and DIE lesions could validate the conservation of ovarian reserve (OR) using ovarian volume (OVol), antral follicle count (AFC), number of OMAS and firm adnexal adhesions.DesignProspective, observational ongoing.Materials and MethodsAll women were referred to a radiologist (LPC) who counseled about DIE mapping by TVSBP before and 3 to 6 months after LSC. The patients were also counseled regarding reproductive potential by 2 reproductive endocrinologists and the effects of surgical removal of DIE lesions and OMAS by 2 experienced reproductive surgeons. TVSBP is highly sensitive (>85%) and specific (>90%) for the evaluation of OMAS and DIE. Paired t and Wilcoxon tests were used; P< 0.05 considered significant.ResultsFrom 146 women fulfilling the study criteria, 96 concluded the 6 months interval and data computed. Pre-and-post LSC of the right(R) and left(L) sides OVol were 10.3±13.3vs.9.4±5.8 (95%CI:-1.8; 3.5, p=0.514) and 7.0±5.5 vs.12.6±16.1 (95%CI:-8.9;-2.2, p=0.002). OMAS were identified in R and L ovaries pre-LSC 19(19.8%) and 22(24.2%), respectively. The average OMAS in R and L OV were 1.7±1 and 1.4±0.6/patient with 1.6±0.7 and 1.4±0.6. After LSC, OMAS persisted in 3 women at R (3.1%; p<0.01) and 5 in the L (5.5%; p<0.01). The # AFC in the R and L OV were 7.6±4.0 and 6.8±4.2 before (P=0.985) and after LSC measuring 7.5±4.5 and 6.9±4.3 (p=0.871), respectively. Finally, extensive adhesions impairing OV mobility in the R and L in 46(48%) and 56(61%) were lowered to 16(17%, p<0.001) and 21(23%, p<0.001).ConclusionPre-and-postoperative TVSBP mapping of ovarian endometriomas and DIE lesions followed by meticulous LSC resection of DIE, endometriomas and firm adnexal adhesions were accurately appraised by a contemporary noninvasive ultrassonographic imaging of the female pelvis. ObjectiveTo determine whether a TVSBP performed before and after 3-6 months subsequently a thorough LSC for removal of endometriomas (OMAS) and DIE lesions could validate the conservation of ovarian reserve (OR) using ovarian volume (OVol), antral follicle count (AFC), number of OMAS and firm adnexal adhesions. To determine whether a TVSBP performed before and after 3-6 months subsequently a thorough LSC for removal of endometriomas (OMAS) and DIE lesions could validate the conservation of ovarian reserve (OR) using ovarian volume (OVol), antral follicle count (AFC), number of OMAS and firm adnexal adhesions. DesignProspective, observational ongoing. Prospective, observational ongoing. Materials and MethodsAll women were referred to a radiologist (LPC) who counseled about DIE mapping by TVSBP before and 3 to 6 months after LSC. The patients were also counseled regarding reproductive potential by 2 reproductive endocrinologists and the effects of surgical removal of DIE lesions and OMAS by 2 experienced reproductive surgeons. TVSBP is highly sensitive (>85%) and specific (>90%) for the evaluation of OMAS and DIE. Paired t and Wilcoxon tests were used; P< 0.05 considered significant. All women were referred to a radiologist (LPC) who counseled about DIE mapping by TVSBP before and 3 to 6 months after LSC. The patients were also counseled regarding reproductive potential by 2 reproductive endocrinologists and the effects of surgical removal of DIE lesions and OMAS by 2 experienced reproductive surgeons. TVSBP is highly sensitive (>85%) and specific (>90%) for the evaluation of OMAS and DIE. Paired t and Wilcoxon tests were used; P< 0.05 considered significant. ResultsFrom 146 women fulfilling the study criteria, 96 concluded the 6 months interval and data computed. Pre-and-post LSC of the right(R) and left(L) sides OVol were 10.3±13.3vs.9.4±5.8 (95%CI:-1.8; 3.5, p=0.514) and 7.0±5.5 vs.12.6±16.1 (95%CI:-8.9;-2.2, p=0.002). OMAS were identified in R and L ovaries pre-LSC 19(19.8%) and 22(24.2%), respectively. The average OMAS in R and L OV were 1.7±1 and 1.4±0.6/patient with 1.6±0.7 and 1.4±0.6. After LSC, OMAS persisted in 3 women at R (3.1%; p<0.01) and 5 in the L (5.5%; p<0.01). The # AFC in the R and L OV were 7.6±4.0 and 6.8±4.2 before (P=0.985) and after LSC measuring 7.5±4.5 and 6.9±4.3 (p=0.871), respectively. Finally, extensive adhesions impairing OV mobility in the R and L in 46(48%) and 56(61%) were lowered to 16(17%, p<0.001) and 21(23%, p<0.001). From 146 women fulfilling the study criteria, 96 concluded the 6 months interval and data computed. Pre-and-post LSC of the right(R) and left(L) sides OVol were 10.3±13.3vs.9.4±5.8 (95%CI:-1.8; 3.5, p=0.514) and 7.0±5.5 vs.12.6±16.1 (95%CI:-8.9;-2.2, p=0.002). OMAS were identified in R and L ovaries pre-LSC 19(19.8%) and 22(24.2%), respectively. The average OMAS in R and L OV were 1.7±1 and 1.4±0.6/patient with 1.6±0.7 and 1.4±0.6. After LSC, OMAS persisted in 3 women at R (3.1%; p<0.01) and 5 in the L (5.5%; p<0.01). The # AFC in the R and L OV were 7.6±4.0 and 6.8±4.2 before (P=0.985) and after LSC measuring 7.5±4.5 and 6.9±4.3 (p=0.871), respectively. Finally, extensive adhesions impairing OV mobility in the R and L in 46(48%) and 56(61%) were lowered to 16(17%, p<0.001) and 21(23%, p<0.001). ConclusionPre-and-postoperative TVSBP mapping of ovarian endometriomas and DIE lesions followed by meticulous LSC resection of DIE, endometriomas and firm adnexal adhesions were accurately appraised by a contemporary noninvasive ultrassonographic imaging of the female pelvis. Pre-and-postoperative TVSBP mapping of ovarian endometriomas and DIE lesions followed by meticulous LSC resection of DIE, endometriomas and firm adnexal adhesions were accurately appraised by a contemporary noninvasive ultrassonographic imaging of the female pelvis.

Study question: Can inappropriate expression of Boris gene (Brother of the Regulator of Imprinted Sites) lead to embryonic or postnatal developmental abnormalities such as human vascular malformations?Summary answer: We observed that essentially all Boris/rtTA transgenic mice die on the first day of life (P0) and that some of the offspring displayed severe vascular abnormalities and hemorrhages in the brain and eye.What is known already: BORIS is originally found only in spermatocytes within normal tissues and aberrantly expressed in many tumors.Thus, it is defined within the cancer-testis group of genes.More recently, it has been detected in human oocytes, ovary, embryonic stem cells and skin samples.Although the biological data have suggested roles for BORIS in epigenetic reprogramming in testis and in the proliferation of cancercells,littleisknownaboutthemechanismselicitingthesefunctions.Study design, size, duration: Tetracycline inducible triple transgenic mice expressing Boris, testis specific-Cre and a floxed rtTA were generated.Females bred to such males and who were on doxycycline during the pregnancy were followed, and embryonic defects in the offspring were analyzed (n ¼ 10).BORIS expression was also evaluated in human cavernous malformations (n ¼ 6).Participants/materials, setting, methods: The Tet-On tetracycline-inducible Boris gene expression system in mice was studied.Breeding experiments, PCR and quantitative RT-PCR protocols were carried out for further characterization of the transgenes.The histopathological analysis of the human and mouse tissues, immunohistochemistry and Western Blot procedures for Boris were also performed.Main results and the role of chance: We previously described that doxycycline induced transgene expression of Boris throughout embryogenesis results in widespread defects in organogenesis including eye malformations, reduced body size, Abstracts i291 Downloaded from https:

ObjectiveTo evaluate the incidence and distribution of deep infiltrating endometriosis (DIE) in infertile women at the initial evaluation in a tertiary infertility center.DesignProspective observational.Materials and methodsTransvaginal ultrasound after bowel preparation (TVSBP) is included at the initial work-up irrespective of women's age, symptoms and previous laparoscopy (LSC). From 08/11to03/12, TVSBP was used for screening and mapping of endometriomas(omas) and DIE. These lesions present as hypoechogenic nod¬ules with regular or irregular margins; nodules infiltrating the bowel wall; and hypoechogenic thickening with regular and irregular margins near the retrocervical uterosacral ligaments (USL) insertion. Data are shown as the absence/presence of omas, DIE in the anterior compartment (AntC) comprising round ligaments, bladder, vesicouterine peritoneum, uterine infiltration; posterior compartment (PostC) as retrocervical space, USLs, paracervical space, ureteral, ileum, cecum, sigmoid and rectosigmoid.Results334 women aged 35.8±5.2 year old with infertility ranging from 1-4 years (2.4±1.1) were studied. In 161 women (48.2%) there was no evidence of DIE; whereas DIE was demonstrated in 173 patients (61.8%). Endometriomas were found in 26 women (7.8%). From 585 DIE found, 120 (20.5%) were seen in the AntC as round ligaments (71); bladder and vesicouterine peritoneum (40) and 9 lesions infiltrating into the uterus. At the PostC 465 (79.5%) DIE were found at the retrocervical space (129); USLs (223); vesicouterine peritoneum (14); rectovaginal and paracervical (32); ureteral (2) and ileocecum and sigmoid rectum (65).ConclusionThese findings clearly demonstrate the usefulness of a properly performed noninvasive TVSBP at the onset of infertility evaluation. The unforeseen incidence of DIE calls for immediate attention to an aggressive disease which has a negative impact on their health and infertility management. Further, DIE mapping would contribute to pa¬tient counseling, ART management and surgical planning. ObjectiveTo evaluate the incidence and distribution of deep infiltrating endometriosis (DIE) in infertile women at the initial evaluation in a tertiary infertility center. To evaluate the incidence and distribution of deep infiltrating endometriosis (DIE) in infertile women at the initial evaluation in a tertiary infertility center. DesignProspective observational. Prospective observational. Materials and methodsTransvaginal ultrasound after bowel preparation (TVSBP) is included at the initial work-up irrespective of women's age, symptoms and previous laparoscopy (LSC). From 08/11to03/12, TVSBP was used for screening and mapping of endometriomas(omas) and DIE. These lesions present as hypoechogenic nod¬ules with regular or irregular margins; nodules infiltrating the bowel wall; and hypoechogenic thickening with regular and irregular margins near the retrocervical uterosacral ligaments (USL) insertion. Data are shown as the absence/presence of omas, DIE in the anterior compartment (AntC) comprising round ligaments, bladder, vesicouterine peritoneum, uterine infiltration; posterior compartment (PostC) as retrocervical space, USLs, paracervical space, ureteral, ileum, cecum, sigmoid and rectosigmoid. Transvaginal ultrasound after bowel preparation (TVSBP) is included at the initial work-up irrespective of women's age, symptoms and previous laparoscopy (LSC). From 08/11to03/12, TVSBP was used for screening and mapping of endometriomas(omas) and DIE. These lesions present as hypoechogenic nod¬ules with regular or irregular margins; nodules infiltrating the bowel wall; and hypoechogenic thickening with regular and irregular margins near the retrocervical uterosacral ligaments (USL) insertion. Data are shown as the absence/presence of omas, DIE in the anterior compartment (AntC) comprising round ligaments, bladder, vesicouterine peritoneum, uterine infiltration; posterior compartment (PostC) as retrocervical space, USLs, paracervical space, ureteral, ileum, cecum, sigmoid and rectosigmoid. Results334 women aged 35.8±5.2 year old with infertility ranging from 1-4 years (2.4±1.1) were studied. In 161 women (48.2%) there was no evidence of DIE; whereas DIE was demonstrated in 173 patients (61.8%). Endometriomas were found in 26 women (7.8%). From 585 DIE found, 120 (20.5%) were seen in the AntC as round ligaments (71); bladder and vesicouterine peritoneum (40) and 9 lesions infiltrating into the uterus. At the PostC 465 (79.5%) DIE were found at the retrocervical space (129); USLs (223); vesicouterine peritoneum (14); rectovaginal and paracervical (32); ureteral (2) and ileocecum and sigmoid rectum (65). 334 women aged 35.8±5.2 year old with infertility ranging from 1-4 years (2.4±1.1) were studied. In 161 women (48.2%) there was no evidence of DIE; whereas DIE was demonstrated in 173 patients (61.8%). Endometriomas were found in 26 women (7.8%). From 585 DIE found, 120 (20.5%) were seen in the AntC as round ligaments (71); bladder and vesicouterine peritoneum (40) and 9 lesions infiltrating into the uterus. At the PostC 465 (79.5%) DIE were found at the retrocervical space (129); USLs (223); vesicouterine peritoneum (14); rectovaginal and paracervical (32); ureteral (2) and ileocecum and sigmoid rectum (65). ConclusionThese findings clearly demonstrate the usefulness of a properly performed noninvasive TVSBP at the onset of infertility evaluation. The unforeseen incidence of DIE calls for immediate attention to an aggressive disease which has a negative impact on their health and infertility management. Further, DIE mapping would contribute to pa¬tient counseling, ART management and surgical planning. These findings clearly demonstrate the usefulness of a properly performed noninvasive TVSBP at the onset of infertility evaluation. The unforeseen incidence of DIE calls for immediate attention to an aggressive disease which has a negative impact on their health and infertility management. Further, DIE mapping would contribute to pa¬tient counseling, ART management and surgical planning.

ObjectiveThe majority of recurrent spontaneous abortions like the recurrent failures of embryo implantation share the same cause high incidence of preimplantation embryo aneuploidy. Therefore, our objective was to compare the incidence of chromosomally normal embryos (CNE) from couples undergoing preimplantation genetic screening (PGS) with a history of previous miscarriages following natural conceptions (NC) and in couples undergoing PGS after multiple IFV treatment (MIVF).DesignRetrospective study.Materials and MethodsWomen undergoing IVF-PGS were divided into 2 groups: A-(NC) those who had CNE after natural conception and B-(MIVF) who had CNE who were undergoing PGS after multiple IFV treatment. Women's aged 37.8±5.4 year old in the two groups of contemporary patients. After embryo biopsy carried out either on in vitro day 3 or 5, the blastomeres were hybridized and submitted to array Comparative Genomic Hybridization (aCGH) (PGS-aCGS). Statistical analysis of data was performed with X2 (P>0.05).ResultsIn the NC group, 28 IVF cycles were performed in 17 couples resulting in 86 biopsied embryos while in the MT group 58 cycles were carried out in 48 couples producing 196 embryos. The observed percentage of CNE in MT group was significantly greater than those encountered in the NC group (34% vs. 26%; P<0.05). Further, 48% of NC cycles had no euploid embryo available for transfer in comparison to 38% of MT cycles (P=0.286). Detailed evaluation of the aneuploid embryos, NC and MT showed similar rates of single chromosome, multiple chromosomes or complex abnormalities descriptions.ConclusionThe aCGH-PGS results revealed that the incidence of CNE in the multiple treatment groups was significantly higher than in patients had previous miscarriages. In addition, the NC group of couples was more likely to not have viable embryo for transfer. Since maternal age was similar in both groups the presence of miscarriages after natural pregnancies is an important marker of the reproductive prognosis for these couples. ObjectiveThe majority of recurrent spontaneous abortions like the recurrent failures of embryo implantation share the same cause high incidence of preimplantation embryo aneuploidy. Therefore, our objective was to compare the incidence of chromosomally normal embryos (CNE) from couples undergoing preimplantation genetic screening (PGS) with a history of previous miscarriages following natural conceptions (NC) and in couples undergoing PGS after multiple IFV treatment (MIVF). The majority of recurrent spontaneous abortions like the recurrent failures of embryo implantation share the same cause high incidence of preimplantation embryo aneuploidy. Therefore, our objective was to compare the incidence of chromosomally normal embryos (CNE) from couples undergoing preimplantation genetic screening (PGS) with a history of previous miscarriages following natural conceptions (NC) and in couples undergoing PGS after multiple IFV treatment (MIVF). DesignRetrospective study. Retrospective study. Materials and MethodsWomen undergoing IVF-PGS were divided into 2 groups: A-(NC) those who had CNE after natural conception and B-(MIVF) who had CNE who were undergoing PGS after multiple IFV treatment. Women's aged 37.8±5.4 year old in the two groups of contemporary patients. After embryo biopsy carried out either on in vitro day 3 or 5, the blastomeres were hybridized and submitted to array Comparative Genomic Hybridization (aCGH) (PGS-aCGS). Statistical analysis of data was performed with X2 (P>0.05). Women undergoing IVF-PGS were divided into 2 groups: A-(NC) those who had CNE after natural conception and B-(MIVF) who had CNE who were undergoing PGS after multiple IFV treatment. Women's aged 37.8±5.4 year old in the two groups of contemporary patients. After embryo biopsy carried out either on in vitro day 3 or 5, the blastomeres were hybridized and submitted to array Comparative Genomic Hybridization (aCGH) (PGS-aCGS). Statistical analysis of data was performed with X2 (P>0.05). ResultsIn the NC group, 28 IVF cycles were performed in 17 couples resulting in 86 biopsied embryos while in the MT group 58 cycles were carried out in 48 couples producing 196 embryos. The observed percentage of CNE in MT group was significantly greater than those encountered in the NC group (34% vs. 26%; P<0.05). Further, 48% of NC cycles had no euploid embryo available for transfer in comparison to 38% of MT cycles (P=0.286). Detailed evaluation of the aneuploid embryos, NC and MT showed similar rates of single chromosome, multiple chromosomes or complex abnormalities descriptions. In the NC group, 28 IVF cycles were performed in 17 couples resulting in 86 biopsied embryos while in the MT group 58 cycles were carried out in 48 couples producing 196 embryos. The observed percentage of CNE in MT group was significantly greater than those encountered in the NC group (34% vs. 26%; P<0.05). Further, 48% of NC cycles had no euploid embryo available for transfer in comparison to 38% of MT cycles (P=0.286). Detailed evaluation of the aneuploid embryos, NC and MT showed similar rates of single chromosome, multiple chromosomes or complex abnormalities descriptions. ConclusionThe aCGH-PGS results revealed that the incidence of CNE in the multiple treatment groups was significantly higher than in patients had previous miscarriages. In addition, the NC group of couples was more likely to not have viable embryo for transfer. Since maternal age was similar in both groups the presence of miscarriages after natural pregnancies is an important marker of the reproductive prognosis for these couples. The aCGH-PGS results revealed that the incidence of CNE in the multiple treatment groups was significantly higher than in patients had previous miscarriages. In addition, the NC group of couples was more likely to not have viable embryo for transfer. Since maternal age was similar in both groups the presence of miscarriages after natural pregnancies is an important marker of the reproductive prognosis for these couples.

To investigate whether women with low ovarian reserve evaluated by serum levels of anti-mullerian hormone (AMH) have a higher cancelation of embryo transfer (ET) due to aneuploidies of biopsied embryos assessed by comparative genomic hybridization (CGH) array technology. Prospective observational study. Embryo biopsies were carried out with CGH-array technique and performed in both D (day) 3 and D5 of in vitro culture. Euploid embryos were transferred on D5 and D6. AMH serum levels were measured by immunoassay within 3 months of IVF treatment. Women's age, AMH levels and aneuploidies in biopsied embryos were the endpoints. Student's t test or Mann-Whitney's U test were used where appropriate. Significance was attained at P<0.05. Embryo biopsy was performed in 345 embryos derived from 122 women who had mean age of 38 ± 4 years and mean AMH levels of 1.7 ± 1.4 ng/mL. Mean number of embryos biopsied per women was 3 ± 1.4. Sixty two women had ET cancellation due to aneuploidies in all embryos. Mean AMH levels of these women were 1.3 ± 1.2ng/mL. Women who had euploid embryos had a mean AMH levels of 2.2 ± 1.5ng/mL (P=0.041).Mean age of women who had an embryo transfer was 36 ± 3.5 years versus 39 ± 3.4 years for those who had a cancellation of ET (p < 0.0001). Women under 36 years who had an AMH > 1.15ng/mL had an ET cancellation rate of 30%, which was not statically different from women above 36 years with an AMH >1.15ng/mL who had an ET cancellation rate of 50% (P=0.63). On the other hand, if AMH level was <1.15ng/mL in women above 36 years ET cancellation rate was 78%. The chance of having an embryo transfer cancellation due to chromosomal abnormalities in all embryos biopsied with CGH array technique is correlated with lower AMH levels. This fact is most likely due to a lower oocyte quality which is associated with to a reduced ovarian reserve expressed by levels of AMH under 1.15ng/mL.

OBJECTIVE: We aimed to compare in vitro fertilization (IVF) outcomes of patients ≥40 years old sorted according the levels of anti-mullerian hormone (AMH). DESIGN: prospective cross sectional study. MATERIALS AND METHODS: Patients submitted to IVF treatment by ICSI were sorted according to their AMH levels: low AMH(LAMH)(≤0.9ng/mL ; ≤2rd quartile); high(HAMH)(>0.9; >2nd quartile). In vitro fertilization outcomes were recorded for comparison between groups with Student's T test and Fischer's exact test. Significance was attained at p=0.05. RESULTS: Patients in LAMH and HMAH had significantly different AMH levels, but similar ages and basal FSH levels. Total doses of gonadotropin for controlled ovarian stimulation, yet dosage of FSH was decided on women's age alone, were similar between groups. There were more oocytes yielded in HAMH in comparison to LAMH. Fertilization rates, number of top quality and transferred embryos were similar between groups. Implantation and pregnancy rates were comparable between groups. Data were presented in the table.Tabled 1LAMH(n=12)HAMH(n=7)p-valueAMH (ng/mL)0.59 ± 0.312.6 ± 10.002Basal FSH (IU/mL)10.6 ± 10.15.9 ± 1.490.18Age (years)41 ± 241 ± 30.84Total rFSH (IU)2719 ± 17001963 ± 4800.09# of oocytes5 ± 310 ± 20.001Fertilization rate (%)92 ± 1586 ± 180.48# of top quality embryos (8cell;grade 1)1 ± 11 ± 10.70# transferred embryos3 ± 13 ± 10.1Implantation rate %23 ± 3317 ± 160.03Pregnancy rate %41(5/12)57 (4/7)0.6 Open table in a new tab CONCLUSION: Patients ≥40 years old with AMH > 0.9 ng/mL (3rd quartile) have a greater ovarian response than those with AMH levels under the 2rd quartile. Our data might indicate that AMH should be used as a prognostic tool for Patient counseling regarding to ovulation induction for older women.