OBJECTIVE:To investigate the association of autologous platelet-rich plasma (PRP) treatment with functional ovarian reserve parameters and in vitro fertilization (IVF) outcomes of poor ovarian responders and women with primary ovarian insufficiency (POI) who refused oocyte donation. DESIGN:Observational, retrospective, multicentric cohort study SUBJECTS: Three hundred fifty-three women who underwent PRP treatment, including 207 poor responders and 146 diagnosed with POI. EXPOSURE:Intraovarian PRP injection. MAIN OUTCOME MEASURES:Main outcomes were antral follicular counts (AFCs) and serum antimüllerian hormone (AMH). Secondary outcomes were IVF parameters and reproductive outcomes. RESULTS:In the poor responders' cohort (40.0 ± 3.8 years old, AMH0 = 0.43±0.54 ng/mL; AFC0 = 2.6 ± 2.4), intraovarian PRP was associated with significantly improved AFCs at each follow-up visit (AFC0 = 2.6 ± 2.4 vs. AFC1 = 5.3 ± 3.6; AFC2 = 4.5 ± 3.5; AFC3 = 4.0 ± 2.4; AFC4 = 3.6 ± 2.7) compared with the pretreatment levels. There were 100 pretreatment and 231 posttreatment ovarian stimulation cycles initiated in 111 poor responders with similar yields of metaphase II oocytes (Pre-PRP: 2.4 ± 3.0 vs. Post-PRP: 3.0 ± 3.4) and blastocysts obtained (Pre-PRP: 0.5 ± 0.7 vs. Post-PRP: 0.6 ± 1.1). However, we found novel positive associations between PRP and oocyte quality-related parameters such as maturation (Pre-PRP: 65.8% vs. Post-PRP: 80.8%) and fertilization rates (Pre-PRP: 61.6% vs. Post-PRP: 75.8%), although statistically significant differences were not reached for implantation (Pre-PRP: 9.4% vs. Post-PRP: 35.1%), and biochemical pregnancy rates (Pre-PRP: 12.5% vs. Post-PRP: 41.5%). We identified 23 clinical pregnancies (17 after embryo transfer and six natural conceptions) with seven live births in poor responders who received PRP. In the POI cohort (38.7 ± 4.3 years old, AMH0 = 0.1 ± 0.1 ng/mL; AFC0= 1 ± 1.2), PRP treatment was only related to higher AFCs (AFC1 = 2.1 ± 1.9; AFC2= 1.9 ± 1.9; AFC3= 1.9 ± 1.8, AFC4= 1.9 ± 1.7), but improvements in IVF or reproductive outcomes were not detected. CONCLUSION:Our results suggest that PRP did not induce quantitative effects on the ovaries, as oocyte and embryo yields were not increased. However, in poor responders, retrieved oocytes seemed more capable of maturing and being fertilized. For POI patients, intraovarian PRP treatment did not improve IVF or reproductive outcomes, and thus, alternatives are still required. Prospective randomized clinical trials are recommended to validate these retrospective findings and elucidate potential mechanisms for PRP-induced ovarian reactivation.

The study assesses the effectiveness and safety of the Stem Cell Regenera Treatment for oocyte activation in women with ovarian failure, including conditions such as Poor Ovarian Response (POR), Diminished Ovarian Reserve (DOR), and Premature Ovarian Insufficiency (POI). This retrospective observational study was conducted from January 2023 to December 2024 at the IVIRMA Alicante Clinics in Spain. Women diagnosed with ovarian failure participated in the study, which involved mobilizing Hematopoietic Stem Cells from bone marrow into peripheral blood using granulocyte colony- stimulating factor (G-CSF). This was followed by an intraovarian injection of Stem Cell Factor- enriched Platelet Rich Plasma (SCFE-PRP). The primary outcome measures were the rate of oocyte activation, leukocytes and stem cell count, and pregnancy rates. Oocyte activation was defined as an increase in total Antral Follicle Count of three or more follicles after treatment and/or at least a 20% rise in Anti-Müllerian Hormone levels. Safety was assessed based on adverse effects. Pregnancy rates were evaluated for both spontaneous gestation and following in vitro fertilization (IVF) treatment. A total of 145 women participated: the overall activation rate was 68.28%, with 7.07% achieving spontaneous gestation and 14.14% achieving pregnancy following IVF. Mobilization of CD34+ cells was successful in all participants, with an average collection of 32.96 CD34+ cells/μl. No severe adverse effects were observed. The study concluded that the Stem Cell Regenera Treatment is effective and safe for oocyte activation in women with ovarian failure in real-world practice.

Two-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Mullerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150-300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients' comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment. IMPACT STATEMENT What is already known on this subject? There is currently no consensus on the optimal treatment for controlled ovarian stimulation for patients undergoing IVF which leads to highly variable clinical practices. What the results of this study add? This study's strong point is that, since it is a consensus, it has been possible to include more topics than would normally be dealt with in a systematic review or guidelines, which are generally based on a strict method that restricts the scope of the research. Experts have reached a consensus on most of the statements and based on these they have issued consensus statements that will enable the optimal use of gonadotropins in IVF. What the implications are of these findings for clinical practice and/or further research? This Delphi consensus provides a real-life clinical perspective on gonadotropin usage in IVF.

The purpose of this study was to investigate the efficacy of the intraovarian PRP treatment to increase the ovarian reserve parameters anti-mullerian hormone (AMH) and antral follicle count (AFC) in POR women under 40 years old. Secondary aim was to describe in vitro fertilization (IVF) outcomes and reproductive results of these patients. We performed a retrospective study on 98 POR patients (Bologna Criteria), age <40 years, who refused oocyte donation and opted for autologous PRP intraovarian injection from January 2021 to December 2022 at IVI Alicante Clinic (Spain). This cohort belongs to a larger group, in which the analysis was limited to POR women under 40 years old. For PRP preparation, a standard protocol was followed as described (Endoret kit; BTI, Biotechnology Institute). The total amount of PRP sample was injected, transvaginally and under sedation in the surgery room, equally in both ovaries. After treatment, three follow up visits were performed within the first 3 days of the menstrual cycle. Ovarian reserve biomarkers (AMH and AFC) were measured the day of the procedure and during the monthly follow-ups. In case of a positive response (increase in AFC and/or AMH), ovarian stimulation was started. A descriptive analysis of AFC and AMH during the study period, including IVF outcome, was performed. Wilcoxon test wasused where appropriate. 98 POR women (mean age 35.8 ± 3.3y; range 25-39; mean FSH 9.3 mIU/l ± 5.5) underwent intraovarian PRP injection (6.9 ml ± 1.1). 93 patients completed the follow up visits. An improvement in both AMH (0.17 ng/ml, IQR 0.28 vs 0.34, IQR 0.43; p= 0.004) and AFC (2, IQR 2 vs 5, IQR 4; p < 0.001) was observed. The number of patients who showed some kind of improvement in both AMH and AFC were 55 (59.1 %), while patients who showed improvement just in AMH or AFC were 64 and 76 respectively (68.8% and 81.7 %). Compared to the baseline measurement, we arbitrarily considered a positive response an increase in the AFC of three or more follicles, which was reached in 51 women (54.8 %). Therefore, 51 patients started IVF treatments and 29 of them reached oocyte retrieval (56.8 %). Among them, 17 women obtained at least 1 blastocyst (58.6 %), and 21 embryo-transfers were performed resulting in 7 pregnancies (pregnancy rates per transfer, per pick-up and per IVF treatment were respectively 33.3%, 24.1% and 13.7%). Mean number of MII was 3 ± 1.9 (median 3, IQR 3), and mean number of blastocysts was1.7 ± 1.8 (median 1.5, IQR 3). In total 12 pregnancies were obtained (12.9% of treated with PRP and fulfilled follow up), 5 spontaneously and 7 after IVF. Autologous intraovarian PRP injection seems to be effective in increasing ovarian reserve biomarkers (AMH and AFC) giving the chance, to POR women under 40 years old to access IVF treatment.

Plasma rich in growth factors (PRGF) or platelets (PRP) contain up to 800 types of proteins, cytokines, hormones, and growth factors. Indeed, intraovarian PRP injection has been proposed to improve the reproductive performance in diminished ovarian reserve (DOR) and POI women with encouraging results promoting follicle growth. Thus, we aimed to evaluate if PRGF intraovarian optimizes the ovarian reserve but also the IVF outcomes in aged DOR patients. Retrospective study including 348 women (25-45 years) who received intraovarian PRGF between 2020 and 2022 at IVIRMA Alicante (Spain). The study was approved by the IRB committee of La Fe University Hospital (2112-FIVI-109-SH). Patients underwent a PRGF injection (Endoret kit; Biotechnology Institute S.L, Spain) in both ovaries and a follow up for ovarian reserve biomarkers (AFC, AMH) during 4 months after treatment, to evaluate follicular reactivation. Then, reproductive and IVF outcomes were compared with previous ovarian stimulation cycles (COS) started in our clinics, when available. Study variables were compared to basal levels with a paired t-test. A total of 348 aged DOR patients (AMH: 0.29±0.46ng/ml; AFC0: 2.0±2.2) underwent PRGF intraovarian treatment, and showed statistically significant increases in AFC (AFC1: 4.1±3.6, p<0.0001; AFC2: 3.5±3.6, p<0.0001; AFC3 3.0±2.4, p<0.0001 and AFC4: 3.5±2.4, p=NS) during the entire follow up, compared to basal levels established before receiving the PRGF injection. Among all the included patients, 137 of them (39.8±3.8 y.o) initiate a total of 255 COS in our clinic, after PRGF that were compared with their previous 156 COS performed before PRGF (39.7±3.1 y.o). Although AMH and E2 levels were significantly higher in their previous attempts (AMH: 0.70± 0.94 vs. 0.46±0.56, p<0.013 and E2: 274.2±359.5 vs. 149.3±318.5, p=0.016), oocyte pick up was successfully developed in 70.2% and embryos obtained in 57.6% of started COS after treatment. With similar stimulation protocols, PRGF was able to improve the oocyte maturation (69.4% vs. 79.8% p=0.02), fertilization (64.7% vs. 75.2%,p=0.035) and implantation rates (7.1±23.9% vs. 32.4±47.47.5%, p=0.040) in these aged DOR women. Moreover, the number of vitrified embryos for future transfer (0.2±0.5 vs. 0.4±0.9, p=0.035) and the biochemical pregnancy rate (9.5% vs. 37.5%, p=0.044) were also increased. Indeed, 33.3% of the achieved pregnancies after PRGF were spontaneous. PRGF injection promoted follicle development since the first follow-up allowing the initiation of COS cycles. Moreover, PRGF showed positive effects on reproductive outcomes by improving oocyte maturation, fertilization, implantation, and biochemical pregnancy rates.

BACKGROUND: Successful embryo implantation is a complex process that requires the coordination of a series of events, involving both the embryo and the maternal endometrium. Key to this process is the intricate cascade of molecular mechanisms regulated by endocrine, paracrine and autocrine modulators of embryonic and maternal origin. Despite significant progress in ART, implantation failure still affects numerous infertile couples worldwide and fewer than 10% of embryos successfully implant. Improved selection of both the viable embryos and the optimal endometrial phenotype for transfer remains crucial to enhancing implantation chances. However, both classical morphological embryo selection and new strategies incorporated into clinical practice, such as embryonic genetic analysis, morphokinetics or ultrasound endometrial dating, remain insufficient to predict successful implantation. Additionally, no techniques are widely applied to analyse molecular signals involved in the embryo-uterine interaction. More reliable biological markers to predict embryo and uterine reproductive competence are needed to improve pregnancy outcomes. Recent years have seen a trend towards 'omics' methods, which enable the assessment of complete endometrial and embryonic molecular profiles during implantation. Omics have advanced our knowledge of the implantation process, identifying potential but rarely implemented biomarkers of successful implantation. OBJECTIVE AND RATIONALE: Differences between the findings of published omics studies, and perhaps because embryonic and endometrial molecular signatures were often not investigated jointly, have prevented firm conclusions being reached. A timely review summarizing omics studies on the molecular determinants of human implantation in both the embryo and the endometrium will help facilitate integrative and reliable omics approaches to enhance ART outcomes. SEARCH METHODS: In order to provide a comprehensive review of the literature published up to September 2019, Medline databases were searched using keywords pertaining to omics, including 'transcriptome', 'proteome', 'secretome', 'metabolome' and 'expression profiles', combined with terms related to implantation, such as 'endometrial receptivity', 'embryo viability' and 'embryo implantation'. No language restrictions were imposed. References from articles were also used for additional literature. OUTCOMES: Here we provide a complete summary of the major achievements in human implantation research supplied by omics approaches, highlighting their potential to improve reproductive outcomes while fully elucidating the implantation mechanism. The review highlights the existence of discrepancies among the postulated biomarkers from studies on embryo viability or endometrial receptivity, even using the same omic analysis. WIDER IMPLICATIONS: Despite the huge amount of biomarker information provided by omics, we still do not have enough evidence to link data from all omics with an implantation outcome. However, in the foreseeable future, application of minimally or non-invasive omics tools, together with a more integrative interpretation of uniformly collected data, will help to overcome the difficulties for clinical implementation of omics tools. Omics assays of the embryo and endometrium are being proposed or already being used as diagnostic tools for personalised single-embryo transfer in the most favourable endometrial environment, avoiding the risk of multiple pregnancies and ensuring better pregnancy rates.

Endometriosis, a highly frequent gynecological disease, is often associated with female infertility and poor in vitro fertilization (IVF) outcomes. Many factors have been suggested to cause the fertility problems in these patients, including poor oocyte quality and alterations in meiotic spindle that could affect embryo aneuploidy rates. Our main objective is to ascertain if endometriosis increases embryonic aneuploidy risk. Multicenter retrospective assay of cohorts to compare the embryonic aneuploidy rate between patients with endometriosis (experimental group) and those without the disease (control group). Our study involved patients aged 18-42 years old undergoing IVF with preimplantation genetic screening (PGS) in IVIRMA Clinics between 2012 and 2017. To discard the impact of non-endometriosis disorders on embryo abnormalities, severe male factors and patients with altered karyotype or with chromosomopathy in previous embryos or pregnancies were excluded. The following PGS indications were included: Implantation failure (IF), Recurrent miscarriage (RM) and advanced maternal age (AMA). Both blastocyst and developing embryos analyzed for the complete chromosome set by comparative genomic hybridization (CGH) arrays or next generation sequencing (NGS) were only considered. Presence of endometriosis was evidenced at the time of abdominal surgery or after pelvic ultrasound or NMR findings. For the statistical analysis, chi-square test for categorical variables or Student's t-test for quantitative data were applied to compare baseline characteristics between groups. χ2 test and Poisson regression model were used for comparing the proportion of aneuploid embryos in the different groups. A total of 1622 embryos from 350 patients were biopsied in the endometriosis group while 17914 biopsied embryos from 4000 patients were included in the control group. Among these embryos, 1577 and 17566 were informative after PGS in the experimental and control group, respectively. One thousand seventy-two embryos from the endometriosis patients and 11997 from control patients were abnormal. No significant differences in the aneuploidy rate were observed when compared embryos from the experimental and the control group (68,0 % versus. 68,3%, respectively; p=0.794). Poisson regression analysis was performed, adjusting for baseline patient characteristics (age and body mass index), but the proportion of aneuploid embryos were still not significant. Despite increased oocyte meiotic errors and chromosomal instabilities have been proposed as a potential cause of a lower IVF success in women with endometriosis, it does not seem to impact on their embryo aneuploidy risk. Further research is needed to determine if the embryo arrest before blastocyst PGS analysis could mask non-analyzed chromosomal anomalies. Anyway, disturbances during oocyte nuclear maturation, with subsequent less useful oocytes, could also explain the difficulties of these patients in becoming pregnant.

To analyze the abilities of DANA automatic embryo selection software to interpret embryo morphokinetic parameters by massive comparison with a database of embryos with known implantation potential and generate a transfer order ranking in a single embryo transfer policy. DANA compares each cohort of embryos with a data cloud of KID (Known Implantation Data). This data cloud was performed from a retrospective analysis of 1021 KID embryos. For that, timings of embryo cleavage and cell cycle lengths were included in the DANA software. Morphokinetic parameters were arranged on a 2D graph and the software analysed the unit average distance (UAD) of the embryos to the centre of the cloud. We defined a category of TOP embryos with an UAD ≤ 0.5. The percentage of twin gestation was calculated in our double embryo transfer cases comparing whether 1 or 2 of the transferred embryos had a high score in the Dana ranking. A total of 357 fresh cycles from infertile couples undergoing oocyte donation were included; 1562 embryos were analyzed from which 536 were transferred, and 371 embryos achieved the status of KID embryos. Therefore, we compared cases in which the two blastocysts transferred were TOP, compared to those cases in which only 1 being TOP. The twin gestation rate was significantly higher in those cases in which the number of TOP embryos (UAD ≤ 0.5) transferred was two 52% vs. 25% in one top group (P < .001). In cases in which a double embryo transfer was performed, the twin gestation rate was significantly higher when the two embryos were classified as TOP by the software, reaching very high values. In consequence, the selection method here presented, is a relevant strategy, to encourage single embryo transfer at least when two TOP blastocyst are available.

Objective: To develop a noninvasive embryo selection algorithm consisting of time-lapse morphokinetics and the oxidative status of the spent embryo culture medium determined using the Thermochemiluminescence (TCL) Analyzer. Design: Retrospective cohort. Setting: Not applicable. Patient(s): From women participating in the oocyte donation program, data from 505 samples of spent embryo culture media samples from 292 intracytoplasmic sperm injection cycles. Intervention(s): None. Main Outcome Measure(s): Morphokinetic parameters assessed during incubation in the time-lapse system Embryoscope. Oxidative parameters (H-1sm, H-2sm, and H-3sm) from the spent culture medium on day 5 of incubation measured using the TCL assay; and a combined assessment algorithm, including morphology, morphokinetics, and the embryo's culture medium oxidative status, developed as a tool for embryo selection, based on implantation success and confirmed ongoing pregnancy. Result(s): The levels of the oxidative parameters H-1sm, H-2sm, and H-3sm on day 5 of incubation were statistically significantly higher in transferred and vitrified embryos compared with discarded embryos and in successfully implanted embryos compared with those that did not result in pregnancy. The assessment algorithm resulted in a hierarchical classification with six embryo quality categories (A to F), associated with implantation rates of between 76.5% and 29.2%. Conclusion(s): An assessment algorithm combining morphology, morphokinetics and the embryo's culture medium oxidative status may help to improve current embryo selection methods criteria and in vitro fertilization success. (C) 2019 by American Society for Reproductive Medicine.

Oocyte donation program (OD) provides the ideal setting for investigate if endometrial scratching improves 10 % the ongoing implantation rate, as the recipient's endometrial priming guarantees the homogeneity of the endometrium and also the equality of quality of the transferred embryos and limiting the confounding factors. A multicentric,open-label, randomized, controlled trial has been conducted in a private setting since Oct 2013. Eligible recipients were randomly assigned in a 1:1 ratio to either ES (by pipelle biopsy in the luteal phase of the menstrual cycle prior to the embryo transfer, n=123) or no intervention (NES, n=111), through a computer-generated randomization list. At the time of interim analysis, 234 out of 600 patients were recruited (40%). Inclusion criteria: 18-44 yearsaged ovum recipients with preserved ovarian function, 19-29.9kg/m2, first or second OD fresh embryo transfer (ET), endometrial thickness >6 mms, and 1-2 optimal quality blastocysts transferred. Exclusion criteria: any adverse condition, and recurrent implantation failure with OD (>5 embryos transferred, including frozen transfers). The primary outcome measure was ongoing implantation rate: the number of ongoing sacs per embryo transferred.All the outcomes were analyzed on an intent-to-treat basis and per embryo transfer. A total number of 196 recipients underwent OD-embryo transfer, 93 in scratching arm and 103 in the NES group. No differences existed in the mean age and BMI of recipients and oocyte donors, oocytes retrieved and microinjected, fertilization rates, blastocysts transferred, endometrial thicknesses and oestradiol /progesterone levels after their endometrial priming. The clinical pregnancy rate was 55.6% 95%CI(46,1-64,7) and 52.1% 95%CI(43,1-60,9) in the ES arm and in NES arm on the ITT analysis (OR=1.13 95%CI (0.67-1.9); p=0.59), and in the per ET analysis, 67.0% 95%CI(56,7-75,9) vs 60,4% 95%CI(50,6-69,3) respectively, OR=1.14 95%CI(0.67.1.96), p=0.34. The implantation rate was in the per ET analysis, 63.6% 95%CI(52.5-70.9) vs 58.8% 95%CI(50.1-67.1) in the ES arm and in NES arm, OR=1.14 95%CI(0.67.1.96), and the ongoing implantation rate was 51,8% 95%CI(41.0-59.9) vs 45,8% 95%CI(35.9-53.1) in ES and NES respectively, OR=1.27 95%CI(0.75-2.16). There were no differences in miscarriage nor multiple pregnancy rates. The endometrial biopsy procedure was well tolerated in most women. The final decision of continuing or not the study was taken by means of applying the stochastic curtailment approach, to test the null hypothesis rejection probability given the current data available. P value of 0.7633 yielded Z=0.72, leading to keep the trial continuing. The interim analysis shows that ES in the luteal phase of the cycle preceding the OD embryo transfer in recipients without RIF would not pose a significant benefit thus its application to all OD recipients cannot be advised at this point, although the study continues. There is not enough evidence supporting scratching to increase endometrial receptivity.

Recruitment and selection of gamete donors has become during the years a challenge for doctors and psychologists due to the importance of selecting the best candidate. But, is there a donor female and male profile? The objective of this study is to investigate the socio-demographic and motivational characteristics of female and male gamete donor candidates at a fertility clinic in order to find a prediction profile for donors and to detect how their characteristics change over time. A transversal predictive design and a comparative design were used, and 1338 women and 137 men donor candidates at the Alicante IVI Center in Spain in the 2007–2013 period participated in the study. Data were obtained from semi-structured interviews. Being younger, in active employment and having a partner increases the likelihood of women becoming donors. Similarly, if women candidates have completed secondary or university education, do not smoke and have a partner, it is more likely they will be determined as suitable candidates in the psychological assessment. However, there does not appear to be a defined profile for men. The profile for a financially compensated donor candidate has shown significant changes over time; changing from being in active employment to being unemployed, but the motivations have remained the same. These findings can be a valuable tool which can lead to improvements in the selection process for financially compensated gamete donor candidates. El reclutamiento y selección de los donantes de gametos ha constituido durante años un reto para médicos y psicólogos debido a la importancia de seleccionar al mejor candidato. Pero, ¿existe un perfil de donante femenino y masculino? El objetivo de este estudio es investigar las características sociodemográficas y motivacionales de candidatos a donantes femeninos y masculinos en una clínica de fertilidad, con el propósito de encontrar un perfil predictivo para los donantes y detectar cómo sus características evolucionan con el tiempo. Se utilizó un diseño transversal predictivo y un diseño comparativo, y 1.338 mujeres y 137 hombres candidatos a donantes en el centro IVI Alicante en España en el período 2007-2013 participaron en el estudio. Los datos se obtuvieron a través de entrevistas semiestructuradas. Ser más joven, en activo laboralmente y tener pareja incrementa la probabilidad de llegar a ser donante en mujeres. De forma similar, si las candidatas han completado la educación primaria o universitaria, no fuman y tienen pareja, es más probable que sean calificadas como candidatas adecuadas en la evaluación psicológica. Sin embargo, no parece existir un perfil definido para los varones. El perfil para el candidato a donante compensado económicamente ha mostrado cambios en el tiempo significativos, pasando de ser laboralmente activo a ser desempleado, pero sus motivaciones se han mantenido. Estos hallazgos constituyen una valiosa herramienta que puede llevar a mejoras en el proceso de selección de los candidatos a donantes de gametos compensados económicamente.

Assisted reproductive technologies are well-established treatments for many types of subfertility representing substantial economic and healthcare implications for patients, healthcare providers and society as a whole. In order to optimize outcomes according to the type of gonadotrophins within an oocyte donor programme, we performed an economic evaluation based on data collected in a multicentre, prospective, randomized study within three private clinics belonging to the IVI Group. Results showed no relevant between-group differences in the clinical variables. According to the economic analysis, ovarian stimulation with corifollitropin alfa increased the overall cost of the treatment as well as the cost per retrieved and effective oocyte, although the differences were not statistically significant. In conclusion, cost savings can be achieved using cheaper gonadotrophins during ovarian stimulation. The cost of corifollitropin alfa compared with recombinant FSH and highly purified human menopausal gonadotrophin should be considered when making treatment decisions.

Las microdeleciones del cromosoma Y se consideran una de las causas más comunes de la infertilidad masculina. La ausencia de algunos genes localizados en ciertas regiones del cromosoma Y, conocidas como «factor de azoospermia», conduce a fallo de la espermatogénesis, aunque en muchos casos se consigue recuperar espermatozoides del eyaculado o del testículo. Su detección puede resultar crucial en el tratamiento clínico de estos pacientes, pues permite predecir, en pacientes azoospérmicos con ciertas microdeleciones, la presencia de espermatozoides en el testículo, además de prevenir el empleo de métodos invasivos de extracción espermática en pacientes oligozoospérmicos que pudieran tener una pérdida progresiva de su producción con el tiempo.

A successful pregnancy is the greatest goal for reproductive medicine. The probability that pregnancy occurs during a cycle of assisted reproduction is a function of multiple factors, of which embryo transfer is one of the most critical steps in these treatments. This article reports a case of successful pregnancy and twin delivery by transmyometrial embryo transfer after IVF in a woman with a neocavity parallel to the uterine cavity, which prevented the transfer of embryos to the correct place. The patient first went to another fertility centre where embryo transfer was impossible to perform because the cervix could not be canalized. Subsequently in this study clinic, after considering the difficulty of inserting a catheter into the endometrial cavity, a trial transfer was performed, which discovered a false route parallel to endometrial cavity. Following a first cycle in which conventional transcervical embryo transfer was performed, a transmyometrial embryo transfer was carried out and the patient became pregnant with twins. In cases where transcervical embryo transfer is very difficult or impossible to perform, the value of transmyometrial transfer is self-evident.

Objective To explore if the GnRH analogue used for controlled ovarian stimulation (COS) and the ovulation triggering factor (GnRH agonist + hCG triggering versus GnRH antagonist + GnRH agonist triggering) affect embryo development and kinetics. Study design In a retrospective cohort study in the Instituto Valenciano de Infertilidad (IVI) Alicante and the Instituto Universitario-IVI Valencia, Spain, 2817 embryos deriving from 400 couples undergoing oocyte donation were analysed. After controlled ovarian stimulation and IVF/intracytoplamic sperm injection, the timing of embryonic cleavages was assessed by a video time-lapse system. The results were analysed using Student's t test for comparison of timings (hours) and Chi-squared test for comparison of proportions. A p-value < 0.05 was considered to be statistically significant. Results Embryos from cycles co-treated with GnRH antagonist + GnRH agonist (n = 2101) cleaved faster than embryos deriving from patients co-treated with GnRH agonist + hCG (n = 716): these differences were significant at the first stages of development but they disappeared as long as the embryo developed. Assessing embryo quality in terms of morphokinetic characteristics, we did not find significant differences between the two groups. Conclusion(s) By adopting a time-lapse video system, we can suggest that the type of protocol used for controlled ovarian stimulation influences embryo kinetics of development but these variations are not reflected in embryo quality.

Because of the different intrinsic characteristics of the classic IVF and intracytoplasmic sperm injection (ICSI) techniques, the timing of zygote development can be influenced by the method of fertilization. However, there is no information about the relevance of the insemination procedure on embryo-quality parameters as measured through their developmental dynamics. The aim of this work was to determine if the insemination technique, IVF or ICSI, influences embryo developmental kinetics by examining 1203 embryos from 178 couples undergoing oocyte donation with IVF or ICSI. Using time-lapse information, this work calculated several developmental kinetic variables, from pronuclear fading (PNF) to expanded blastocyst, and also the proportion of optimal embryos in a best time range with a predicted higher implantation potential. Embryo development after ICSI was slightly faster than after IVF; however, when PNF, rather than time of insemination, was established as t0, the differences between the two procedures disappeared. The percentage of optimal embryos showed a trend towards higher values in IVF-derived embryos; however, the difference was not statistically significant. With these results and through the time-lapse monitoring system, it is concluded that it is the fertilization method which determines embryo developmental kinetics if insemination time is used as the starting point. A key step in assisted reproduction is the assessment of oocyte and embryo viability to determine the embryo(s) most likely to implant. Current embryo assessment strategies in clinical settings largely rely on embryo morphology and cleavage rates, and although these systems have been successful in improving pregnancy rates, their precision is far from ideal as they are based on visual information. In contrast, automated image analysis may add objectivity to the process of embryo selection and consequently, lead to an improvement in the implantation rates. Timing of zygote development can be influenced by the method of fertilization or by in-vitro culture conditions, so it has been suggested that the fertilization procedure influences the length of time elapsed between fertilization and the first cleavage. In this report, we show the results from using a time-lapse monitoring system to determine the timing of key events during embryo development both in IVF and ICSI. Due to the different intrinsic characteristics of the classic IVF and ICSI techniques, the selection of a critical time point is essential so as to maximize the differences between the two methods. For that reason, we searched for evidence in the data obtained from the image analysis for a link connecting embryo cleavage and the fertilization technique and also to find whether the kinetic of development derived from classic IVF or ICSI is also related to a predicted higher implantation.

Ovarian stimulation treatment is recognized as placing a physical and psychological burden on patients and oocyte donors. The introduction of sustained follicle stimulants will reduce the number of injections and may improve the overall patient experience. This study aimed to evaluate the degree of satisfaction in oocyte donors undergoing treatment with corifollitropin α, a synthetic recombinant rFSH which replaces daily FSH injections for the first week of ovarian stimulation. The results showed no significant differences in clinical parameters between the two protocols (recombinant FSH versus corifollitropin α). Implantation rates for the corifollitropin α and daily FSH protocol groups were 39.1% and 38.4%, respectively, while ongoing pregnancy rates were 45.9% and 44.4%. There were no statistical between-group differences in the responses to the questionnaires. However, donors treated with corifollitropin α who had undergone a previous cycle with daily FSH reported greater satisfaction with the corifollitropin α protocol. In conclusion, no significant differences were found in any analysed parameters between treatments. However, when donors who had undergone both treatments chose which treatment they preferred, the results clearly showed a positive trend towards choosing corifollitropin α, confirming that this protocol may reduce treatment burden and increase donor compliance.