Two Paths to Discovery: Bridging Outside-in High Throughput Technologies and Inside-Out Artificial Intelligence for Biological Decoding of Women Reproductive Failure 2 1 140243 2 "The scientific literature is a treasure trove of untapped knowledge, where answers to complex questions lie dormant, fragmented, and obscured. Finding the pieces of this puzzle and putting them together to reveal the true picture require a creative synthesis that surpasses human cognitive abilities. A super-intelligent mind, with its ability to process vast amounts of information and identify non-obvious connections, is needed to revolutionize scientific discovery by illuminating these hidden patterns". Amir-Hassan Zarnani Embryo implantation involves a close interaction between a competent blastocyst and a receptive endometrium, occurring within a specific timeframe known as the window of implantation. Disruptions in the early stages of implantation can lead to infertility or pregnancy loss, underscoring the critical importance of this event for pregnancy success. While numerous cellular processes and molecular pathways involved in embryo-uterine cross-talk during implantation have been identified through gene expression studies and genetically modified mouse models, a complete understanding of the full nature of embryo implantation remains lacking. To prepare for implantation, the endometrium undergoes extensive remodeling, known as decidualization. Once initiated, the decidual process progresses through distinct phenotypic stages that support endometrial receptivity, embryo selection, and, ultimately, the successful resolution of pregnancy. Decidualization is regulated by intricate interactions between ovarian steroid hormones, transcription factors, cytokines, and signaling pathways. Local autocrine and paracrine factors change throughout the process of decidualization, and are believed to have various roles in endometrial function. Decidualized endometrial stromal cells (ESCs) contribute to the endometrial microenvironment and have both direct and indirect effects on extracellular matrix (ECM) remodeling, immune response regulation, antioxidant defense, and angiogenesis. Disruptions in the decidualization process are linked to infertility, recurrent miscarriage, and uteroplacental disorders (1). Oocyte fertilization, decidualization, and embryo implantation are intricately regulated by a diverse array of cytokines across multiple species. Efforts to define the role of these key molecules have involved examining receptor localization, determining the influence of steroid hormones on their regulation, and conducting functional assays both in vivo and in vitro. However, due to their complex and redundant nature, pinpointing the specific cytokines crucial for implantation has proven challenging. Chemokines are involved in the recruitment, activation, and migration of immune cells and trophoblasts to the site of implantation. They contribute to the establishment of a receptive uterine environment by regulating immune cell infiltration, tissue remodeling, and the formation of the decidua. Furthermore, chemokines influence the synchronization of embryo development with maternal endometrial receptivity. Homotypic and heterotypic interactions of several adhesion molecules take part in the trophectoderm attachment to the apical surface of uterine luminal epithelial cells, which mediate spatio-temporal regulation of embryo implantation (2). Feto-maternal immune cross-talk is a critical aspect of successful pregnancy, enabling maternal immune tolerance to the semi-allogeneic fetus. This dynamic interaction during decidualization and initial steps of pregnancy involves the exchange of signals between maternal immune cells and fetal trophoblasts, ensuring a balance between immune defense and tolerance. Maternal immune cells, such as uterine natural killer cells, regulatory T cells, dendritic cells, and macrophages play key roles in modulating immune responses at the maternal-fetal interface. Trophoblast cells, in turn, release immunomodulatory factors that prevent the maternal immune system from rejecting the fetus. Disruptions in this delicate immune communication can result in pregnancy complications such as preeclampsia, infertility, spontaneous abortion, or intrauterine growth restriction (3). While it is well-known that the uterine immune system must be carefully regulated to allow for successful embryo implantation and fetal development, the role of the systemic immunity is equally crucial. A balanced immune response throughout the entire body helps prevent maternal immune rejection of the fetus. There are numerous autoimmune diseases that can significantly impact reproductive health, particularly during embryo implantation and pregnancy. The presence of autoantibodies and dysregulated immune responses may interfere with the delicate balance required for successful implantation and fetal development, leading to impaired trophoblast invasion, reduced uterine receptivity, and increased inflammation at the implantation site (4). The information provided above underscores the complex yet well-coordinated physiological and molecular processes that begin during implantation and are essential for a successful pregnancy. These processes involve the participation of numerous genes, transcripts, noncoding RNAs, proteins, signaling pathways, and metabolites. Deficiencies in any of these components manifest as abnormalities in embryo spacing, decidualization, placentation, and intrauterine embryonic development. A more comprehensive understanding of the molecular signaling networks that regulate successful implantation and decidualization may offer new strategies to enhance the outcomes of both natural pregnancies and those resulting from in vitro fertilization. While a limited number of these regulatory genes and molecules have been studied in the past decades, many others are still yet to be explored. Despite this, current guidelines for diagnostic work-up in women with reproductive failure remain quite conservative, primarily emphasizing established and widely accepted diagnostic methods. These guidelines often overlook the importance of genes and molecules involved in the progression of a successful pregnancy. While this approach may provide reasonable specificity, it lacks the necessary sensitivity for effectively approaching to the etiology of reproductive failure in women. Large-scale data analysis and omics techniques, such as genomics, transcriptomics, proteomics, and metabolomics have revolutionized the study of female infertility and recurrent miscarriage by enabling comprehensive analysis of genetic, epigenetic, and molecular biomarkers. These advanced technologies allow for the simultaneous examination of large numbers of genes, proteins, and metabolites involved in reproductive health, providing unprecedented insights into the underlying causes of infertility and pregnancy loss. High-throughput techniques have facilitated the identification of novel genetic mutations, gene expression patterns, and immune responses that may contribute to implantation failure, chromosomal abnormalities, and endometrial dysfunction. Additionally, these technologies have proven invaluable in identifying potential biomarkers for early diagnosis and personalized treatment strategies (5, 6). The application of multi-omics techniques has provided access to vast amounts of complex data. While these datasets yield valuable perspectives, they often present challenges in terms of interpretation and integration, as the sheer volume of information can be overwhelming and seemingly disjointed. Artificial intelligence (AI) has emerged as a powerful tool in addressing these challenges by enabling the summarization, organization, and simplification of multi-omics data. Through machine learning algorithms and advanced data analysis, AI can identify relevant patterns, molecular interactions, and hidden relationships within large datasets, thereby offering novel understandings into disease etiology. By uncovering significant connections within seemingly unrelated data points, AI can accelerate the discovery of biomarkers, therapeutic targets, and personalized treatment strategies, ultimately enhancing our knowledge of complex diseases and improving clinical outcomes. For centuries, scientists have embarked on a journey of discovery, delving progressively deeper into the intricacies of reproductive biology. From the macroscopic realm of organs and tissues, they ventured into the microscopic world of cells, and ultimately, into the astonishing universe within. Now, armed with a wealth of knowledge, they turn their gaze outward, seeking to apply this understanding to the macroscopic level. With the aid of powerful tools like AI, they can redefine the reproductive phenotype, deciphering the biological codes that distinguish health from disease. 242 245 Amir Hassan AH Zarnani امیرحسن زرنانی Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Reproductive Immunology Research Center, Avicenna Research Institute, ACECR Iran zarnania@gmail.com No Keyword 140243.pdf Gellersen B, Brosens JJ. Cyclic decidualization of the human endometrium in reproductive health and failure. Endocr Rev. 2024;35(6):851-905. ##Yockey LJ, Iwasak A. Interferons and proinflammatory cytokines in pregnancy and fetal development. Immunity. 2018;49(3):397-412.##Arck PC, Hecher K. Fetomaternal immune cross-talk and its consequences for maternal and offspring's health. Nat Med. 2013;19(5):548-56.##Carp HJ, Selmi C, Shoenfeld Y. The autoimmune bases of infertility and pregnancy loss. J Autoimmun. 2012;38(2-3):J266-74. ##Egea RR, Puchalt NG, Escrivá MM, Varghese AC. OMICS: current and future perspectives in reproductive medicine and technology. J Hum Reprod Sci. 2014;7(2):73-92. ##. Oskotsky TT, Yin O, Khan U, Arnaout L, Sirota M. Data-driven insights can transform women’s reproductive health. NPJ Womens Health. 2024;2(1):14.##

Impact of Time-Lapse Incubator Systems on Fertilization, Blastocyst Development, and Clinical Pregnancy Outcomes 2 1 140251 2 Background: The use of the time-lapse (TL) technology in infertility treatment centers has expanded, and the findings indicate its positive effect on embryo development, selection and increased pregnancy success rates. The purpose of the current study was to compare TL culture system and conventional incubator (CI) on IVF outcomes. Methods: A total of 4,769 infertile couples undergoing IVF programs were enrolled in the study. The participants were categorized into two groups according to the embryo culture system, with 2,184 patients assigned to TL incubator and 2,585 to CI group. The outcomes measured included fertilization rate, proportion of top-quality embryos on day 3 and 5, and clinical pregnancy rate. Statistical analyses were conducted utilizing the Mann-Whitney U test and chi-square test. A p<0.05 indicated significance. Results: This study revealed significantly higher fertilization rates and top-quality blastocysts in the TL group in comparison to CI group (p<0.001). Despite these differences, a comparable clinical pregnancy rate was observed between the two culture systems, with rates of 45.7% for TL and 41.1% for CI (p=0.169). These findings remained consistent in the good prognosis group, but not in the poor prognosis group. In the poor prognosis group, the TL culture system significantly improved fertilization rates (p<0.001), while the rates of top-quality cleavage and blastocyst formation were comparable between the two systems (p=0.075). Conclusion: Based on the findings of the study, time-lapse culture system demonstrated superior performance compared to the conventional incubator system in generating top-quality blastocysts. 245 253 Muhammad M Rizal Morula IVF Clinic Morula IVF Clinic Indonesia drhrizal@gmail.com Nining N Handayan IRSI Research and Training Center IRSI Research and Training Center Indonesia Pitra P Rahmawati Morula IVF Clinic Morula IVF Clinic Indonesia Wahyu WI Sari Morula IVF Clinic Morula IVF Clinic Indonesia Arif A Sofyan Morula IVF Clinic Morula IVF Clinic Indonesia Reza RT Raharjo Morula IVF Clinic Morula IVF Clinic Indonesia Tria T Ningsih Morula IVF Clinic Morula IVF Clinic Indonesia Sally SK Sugianto Morula IVF Clinic Morula IVF Clinic Indonesia Tri T Aprilliana IRSI Research and Training Center IRSI Research and Training Center Indonesia Szeifoul S Afadlal Morula IVF Clinic Morula IVF Clinic Indonesia Ivan I Sini Morula IVF Clinic Morula IVF Clinic Indonesia Arie AP Polim Morula IVF Clinic Morula IVF Clinic Indonesia Arief A Boediono Morula IVF Clinic Morula IVF Clinic Indonesia Embryonic developmentIn-vitro fertilizationPregnancyTime-lapse 140251.pdf Gardner DK, Kelley RL. Impact of the IVF laboratory environment on human preimplantation embryo phenotype. J Dev Orig Health Dis. 2017;8(4):418-35. ##Simopoulou M, Sfakianoudis K, Rapani A, Giannelou P, Anifandis G, Bolaris S, et al. Considerations regarding embryo culture conditions: from media to epigenetics. In Vivo. 2018;32(3):451-60.##Sciorio R, Smith GD. Embryo culture at a reduced oxygen concentration of 5%: a mini review. Zygote. 2019;27(6):355-61. ##Park H, Bergh C, Selleskog U, Thurin-Kjellberg A, Lundin K. No benefit of culturing embryos in a closed system compared with a conventional incubator in terms of number of good quality embryos: results from an RCT. Hum Reprod. 2015;30(2):268-75. ##Leung AS, Son WY, Dahan MH. Time-lapse imaging of embryos: current evidence supporting its use. Expert Rev Med Devices. 2016;13(10):881-3. ##ESHRE working group on time-lapse technology, Apter S, Ebner T, Freour T, Guns Y, Kovacic B, et al. Good practice recommendations for the use of time-lapse technology. Hum Reprod Open. 2020;2020(2):hoaa008.##Zhang JQ, Li XL, Peng Y, Guo X, Heng BC, Tong GQ. Reduction in exposure of human embryos outside the incubator enhances embryo quality and blastulation rate. Reprod Biomed Online. 2010;20(4):510-5. ##Meseguer M, Rubio I, Cruz M, Basile N, Marcos J, Requena A. Embryo incubation and selection in a time-lapse monitoring system improves pregnancy outcome compared with a standard incubator: a retrospective cohort study. Fertil Steril. 2012;98(6):1481-9.e10. ##Rubio I, Kuhlmann R, Agerholm I, Kirk J, Herrero J, Escribá MJ, et al. Limited implantation success of direct-cleaved human zygotes: a time-lapse study. Fertil Steril. 2012;98(6):1458-63. ##Desai N, Ploskonka S, Goodman LR, Austin C, Goldberg J, Falcone T. Analysis of embryo morphokinetics, multinucleation and cleavage anomalies using continuous time-lapse monitoring in blastocyst transfer cycles. Reprod Biol Endocrinol. 2014;12:54. ##Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, et al. Different effectiveness of closed embryo culture system with time-lapse imaging (EmbryoScopeTM) in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol. 2016;14(1):49. ##Racowsky C, Kovacs P, Martins WP. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go? Assist Reprod Genet. 2015;32(7):1025-30. ##Armstrong S, Bhide P, Jordan V, Pacey A, Marjoribanks J, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database of Syst Rev. 2019;5(5):CD011320. ##Chen M, Wei S, Hu J, Yuan J, Liu F. Does time-lapse imaging have favorable results for embryo incubation and selection compared with conventional methods in clinical in vitro fertilization? a meta-analysis and systematic review of randomized controlled trials. PLoS One. 2017;12(6):e0178720. ##Guo YH, Liu Y, Qi L, Song WY, Jin HX. Can time-lapse incubation and monitoring be beneficial to assisted reproduction technology outcomes? a randomized controlled trial using day 3 double embryo transfer. Front Physiol. 2022;12:794601. ##Pribenszky C, Nilselid AM, Montag M. Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis. Reprod Biomed Online. 2017;35(5):511-20. ##Boediono A, Handayani N, Sari HN, Yusup N, Indrasari W, Polim AA, et al. Morphokinetics of embryos after IMSI versus ICSI in couples with sub-optimal sperm quality: a time-lapse study. Andrologia. 2021;53(4):e14002. ##Liu J, Wang XL, Zhang X, Shen CY, Zhang Z. Live births resulting from 0PN-derived embryos in conventional IVF cycles. J Assist Reprod Genet. 2016;33(3):373-8. ##Nicolielo M, Jacobs C, Belo A, Reis AP, Erberelli R, Mendez F, et al. Embryo culture in time-lapse system provides better rates of blastocyst formation, decreases embryo development arrest rate compared to traditional triple-gas culture system. Fertil Steril. 2019;112(3):e125-6. ##Walker MW, Butler JM, Higdon HL, Boone WR. Temperature variations within and between incubators - a prospective, observational study. J Assist Reprod Genet. 2013;30(12):1583-5. ##Wale PL, Gardner DK. Time-lapse analysis of mouse embryo development in oxygen gradients. Reprod Biomed Online. 2010;21(3):402-10. ##Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, et al. Different effectiveness of closed embryo culture system with time-lapse imaging (EmbryoScopeTM) in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol. 2016;14(1):49. ##Sini I, Handayani N, Harahap A, Boediono A, Wiweko B, Hadisaputra W, et al. Role of three-dimensional Doppler ultrasonography and leukemia inhibitory factor from endometrial secretion in predicting endometrial receptivit in IVF treatment: a pilot study. Arch Gynecol Obstet. 2022;306(1):259-65.##

Determining Factors Affecting the Successful Outcome of Fresh Embryo Transfer During In Vitro Fertilization: A Retrospective Cohort Study 2 1 140252 2 Background: Fresh embryo transfer has been decreasing because of advancements in vitrification techniques and safety concerns related to ovarian hyperresponse. However, in normal responders, clinical outcomes appear to be comparable with those with frozen embryo transfer. This study aimed to determine factors that influence successful fresh embryo transfer. Methods: This retrospective cohort study included 521 women who underwent in vitro fertilization (IVF) and fresh embryo transfer at King Chulalongkorn Memorial Hospital, Thailand. Patients’ clinical data, embryo details, endometrial characteristics (thickness and pattern), and embryo transfer procedures (tip and flow during transfer, embryo placement location, difficulty of the procedure, and presence of blood and mucous at catheter) were analyzed. Chi-square test, Fisher’s exact test, Student’s t-test, and logistic regression were performed for data analysis. A p-value of <0.05 was considered statistically significant. Results: The overall clinical pregnancy rate was 17.1%. Women aged >40 years were less likely to have a clinical pregnancy than those aged <35 years (adjusted odds ratio [aOR] 0.422; 95% confidence intervals [CI] 0.196-0.908, p=0.027). Day 3 embryo transfer showed a significant decrease in clinical pregnancy compared with blastocyst transfer (aOR 0.514; 95%CI 0.287-0.923, p=0.026). In the subgroup analysis for blastocyst transfer, women with good-quality blastocyst (≥322) were 2.439 times more likely to have a clinical pregnancy than those with poor-quality blastocysts (aOR 2.439; 95%CI 1.199-4.962, p=0.014). Conclusion: Advanced age and day 3 embryo transfer were significantly associated with low clinical pregnancy rates in fresh embryo transfer. 253 264 Chanakarn C Suebthawinkul Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand chanakarn.su@chula.ac.th Pranee P Numchaisrika Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Akarawin A Chaengsawang King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society Thailand Vijakhana V Pilaisangsuree King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society Thailand Sadanan S Summat Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Araya A Peawdang Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Konkanok K Patchima Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Punkavee P Tuntiviriyapun Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Paweena P Thuwanut Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Porntip P Sirayapiwat Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Wisan W Sereepapong Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Thailand Embryo transferInfertilityIn vitro fertilizationIntracytoplasmic sperm injectionPregnancy outcomes 140252.pdf Practice committee of the american society for re-productive medicine. Performing the embryo transfer: a guideline. Fertil Steril. 2017;107(4):882-96.##Reshef EA, Robles A, Hynes JS, Turocy JM, Forman EJ. A review of factors influencing the implantation of euploid blastocysts after in vitro fertilization. F&S Rev. 2022;3(2):105-20.##Venetis CA. Pro: fresh versus frozen embryo transfer. Is frozen embryo transfer the future? Hum Reprod. 2022;37(7):1379-87.##Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021;2021(2):CD011184.##Roque M, Haahr T, Geber S, Esteves SC, Humaidan P. Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and metaanalysis of reproductive outcomes. Hum Reprod Update. 2018;25(1):2-14.##Maheshwari A, Bell JL, Bhide P, Brison D, Child T, Chong HY, et al. Elective freezing of embryos versus fresh embryo transfer in IVF: a multicentre randomized controlled trial in the UK (E-Freeze). Hum Reprod. 2022;37(3):476-87.##Vuong LN, Dang VQ, Ho TM, Huynh BG, Ha DT, Pham TD, et al. IVF transfer of fresh or frozen embryos in women without polycystic ovaries. N Engl J Med. 2018;378(2):137-47.##Niederberger C, Pellicer A, Cohen J, Gardner DK, Palermo GD, O'Neill CL, et al. Forty years of IVF. Fertil Steril. 2018;110(2):185-324.e5.##Suebthawinkul C, Numchaisrika P, Chaengsawang A, Pilaisangsuree V, Summat S, Sereepapong W. Determining factors influencing the successful embryo transfer and Pregnancy during the frozen cycle of in vitro fertilization: a retrospective cohort study. Int J Fertil Steril. 2024;18(4):352-61.##Suebthawinkul C, Thaweepolcharoen C, Thuwanut P, Tuntiviriyapun P, Sirayapiwat P, Sereepapong W. Prevalence of empty follicle syndrome in king chulalongkorn memorial hospital. J Med Assoc Thai. 2021;104(6):1005-9.##Magli MC, Jones GM, Lundin K, van den Abbeel E. Atlas of human embryology: from oocytes to preimplantation embryos. Preface. Hum Reprod. 2012;27 Suppl 1:i1.##Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, et al. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393(10178):1310-8.##Çelik S, Turgut NE, Yağmur E, Boynukalın K, Çelik DC, Fındıklı N, et al. The effects of fresh embryo transfers and elective frozen/thawed embryo transfers on pregancy outcomes in poor ovarian responders as defined by the Bologna criteria. Turk J Obstet Gynecol. 2015;12(3):132-8.##Fang R, Cai L, Xiong F, Chen J, Yang W, Zhao X. The effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the first fresh IVF/ICSI cycle. Gynaecol Endocrinol. 2016;32(6):473-6.##Xu J, Zhang S, Jin L, Mao Y, Shi J, Huang R, et al. The effects of endometrial thickness on pregnancy outcomes of fresh IVF/ICSI embryo transfer cycles: an analysis of over 40,000 cycles among five reproductive centers in China. Front Endocrinol (Lausanne). 2022;12:788706.##Chua SJ, Danhof NA, Mochtar MH, van Wely M, McLernon DJ, Custers I, et al. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis. Hum Reprod. 2020;35(8):1808-20.##Suebthawinkul C, Babayev E, Lee HC, Duncan FE. Morphokinetic parameters of mouse oocyte meiotic maturation and cumulus expansion are not affected by reproductive age or ploidy status. J Assist Reprod Genet. 2023;40(5):1197-213.##Katagiri Y, Jwa SC, Kuwahara A, Iwasa T, Ono M, Kato K, et al. Assisted reproductive technology in Japan: a summary report for 2020 by the ethics committee of the Japan society of obstetrics and gynecology. Reprod Med Biol. 2023;22(1):e12494.##Geng L, Lu S, Li S, Chen ZJ, Wei D, Liu P. An appraisal of current embryo transfer strategies. Hum Fertil (Camb). 2023;26(4):815-23.##Li Y, Liu S, Lv Q. Single blastocyst stage versus single cleavage stage embryo transfer following fresh transfer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;267:11-7.##Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, Ciapponi A, Cornelisse S, Blake D. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2022;5(5):CD002118.##Matsumoto H. Molecular and cellular events during blastocyst implantation in the receptive uterus: clues from mouse models. J Reprod Dev. 2017;63(5):445-54.##Neblett 2nd MF, Kim T, Jones TL, Baumgarten SC, Coddington CC, Zhao Y, et al. Is there still a role for a cleavage-stage embryo transfer? F S Rep. 2021;2(3):269-74.##Thompson SM, Onwubalili N, Brown K, Jindal SK, McGovern PG. Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer (eSET): a national study. J Assist Reprod Genet. 2013;30(12):1577-81.##Bakkensen JB, Brady P, Carusi D, Romanski P, Thomas AM, Racowsky C. Association between blastocyst morphology and pregnancy and perinatal outcomes following fresh and cryopreserved embryo transfer. J Assist Reprod Genet. 2019;36 (11):2315-24.##Zhan Q, Sierra ET, Malmsten J, Ye Z, Rosenwaks Z, Zaninovic N. Blastocyst score, a blastocyst quality ranking tool, is a predictor of blastocyst ploidy and implantation potential. F S Rep. 2020;1(2):133-41.##Comstock IA, Diaz-Gimeno P, Cabanillas S, Bellver J, Sebastian-Leon P, Shah M, et al. Does an increased body mass index affect endometrial gene expression patterns in infertile patients? a functional genomics analysis. Fertil Steril. 2017;107(3):740-8.e2.##Snider AP, Wood JR. Obesity induces ovarian inflammation and reduces oocyte quality. Reproduction. 2019;158(3):R79-90.##Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and metaanalysis. Hum Reprod Update. 2019;25(4):439-51.##Tao P, Yan X, Yao Y, Wang Z, Li Y. Pre-pregnancy obesity is not associated with poor outcomes in fresh transfer in vitro fertilization cycles: a retrospective study. BMC Pregnancy Childbirth. 2023;23(1):633.##Romanski PA, Bortoletto P, Magaoay B, Chung A, Rosenwaks Z, Spandorfer SD. Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer. J Assist Reprod Genet. 2021;38(2):347-55.##Peng Y, Ma S, Hu L, Wang X, Xiong Y, Yao M, et al. Effectiveness and safety of two consecutivecycles of single embryo transfer compared with one cycle of double embryo transfer: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:920973.##Mullin CM, Fino ME, Talebian S, Krey LC, Licciardi F, Grifo JA. Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age. Fertil Steril. 2010;93(6):1837-43.##Eum JH, Park JK, Kim SY, Paek SK, Seok HH, Chang EM, et al. Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles. Clin Exp Reprod Med. 2016;43(3):164-8.##Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40000 embryo transfers. Hum Reprod. 2018;33 (10):1883-8.##

Exploring the Factors Influencing Premenstrual Syndrome and Its Severity: The Role of Lifestyle Determinants 2 1 140247 2 Background: Women experience at least one of the Symptoms of Premenstrual Syndrome (PMS) during the menstrual cycle. The present study aimed to determine the factors that influence PMS occurrence and its severity in the medical students. Methods: This cross-sectional study was carried out on 369 undergraduate female students of Maragheh University of Medical Sciences, Iran, between September 2021 and April 2022. The sampling method was random and participants were recruited through public announcements. The collected data included the provisional diagnosis of premenstrual syndrome, the Iranian version of Premenstrual Syndrome Screening Tool (PSST), the International Physical Activity Questionnaire (IPAQ), Food Frequency Questionnaire (FFQ), and the self-reported measurement of weight and height. All data and questionnaires were designed and then completed online by participants. The multivariable logistic regression analysis determined the potential predictors of PMS, and p-values less than 0.05 were considered significant. Results: About 70% of participants had PMS. According to the PSST, 69% of them were positive in terms of the severity of PMS. There was a significant correlation between PMS and the severity of PMS symptoms (p<0.001), BMI (p=0.031), and dietary fat (p=0.013). The odds ratio for PMS, BMI, and dietary fat was 10.314, 1.073, and 1.008, respectively. Conclusion: The present study demonstrated that among lifestyle factors, dietary fat and BMI play a significant role in premenstrual syndrome. Future studies are needed to identify other factors influencing its occurrence and to propose approaches for improving the quality of life of female medical students during their lifespan. 264 272 Haniyeh H Azadi Student Research Committee, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences Student Research Committee, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences Iran Sadra S Madani Student Research Committee, Maragheh University of Medical Sciences Student Research Committee, Maragheh University of Medical Sciences Iran Laleh L Payahoo Medicinal Plants Research Center, Department of Nutrition, Maragheh University of Medical Sciences Medicinal Plants Research Center, Department of Nutrition, Maragheh University of Medical Sciences Iran llllpayahoo44@gmail.com Mohammad Taghi MT Khodayari Research Center for Evidence Based Health Management, Maragheh University of Medical Sciences Research Center for Evidence Based Health Management, Maragheh University of Medical Sciences Iran Body mass indexExerciseFeeding behaviorMedical studentsPremenstrual syndrome 140247.pdf Rapkin AJ, Winer SA. Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Rev Pharm Outcomes Res. 2009;9(2):157-70.##Leila Amiri F, Tooba H, Fereshteh N, Mohammad Asghari J, Vahideh S. Relationship between pre menstrual syndrome with body mass index among university students. J Hayat. 2012;17(4):85-95.##Chauhan SP, Berghella V, Sanderson M, Magann EF, Morrison JC. American college of obstetricians and gynecologists practice bulletins: an overview. Am J Obstet Gynecol. 2006;194(6):1564-72.##Ranjbaran M, Samani RO, Almasi-Hashiani A, Matourypour P, Moini A. Prevalence of premenstrual syndrome in Iran: A systematic review and meta-analysis. Int J Reprod Biomed. 2017;15(11):679-86.##Farrokh-Eslamlou H, Oshnouei S, Heshmatian B, Akbari E. Premenstrual syndrome and quality of life in Iranian medical students. Sex Reprod Healthc. 2015;6(1):23-7.##Mohammadi V, Shidfar F, Keshtkar Aghababaee S, Mokhtari P, Mohammadi R, Gohari MR. 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Serum Progesterone Levels on the Day of Oocyte Retrieval as a Predictor of Pregnancy Outcomes in Fresh Embryo Transfer Cycles 2 1 140250 2 Background: Progesterone levels are critical for endometrial receptivity and implantation success in assisted reproductive technology (ART). The purpose of the current study was to determine whether serum progesterone levels on oocyte retrieval day predict pregnancy success in fresh embryo transfers. Methods: This prospective cross-sectional study was conducted at a university-affiliated infertility clinic in Tehran, Iran, in 2024. Blood samples were collected to analyze serum levels of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) using standardized methods. Student’s t-test and the Mann-Whitney U test were conducted for primary comparisons. Logistic regression was applied to adjust for covariates. The optimal progesterone cutoff was calculated by receiver operating characteristic (ROC) curve. The level of statistical significance was 0.05. Results: Ninety-one infertile women participated in the study, with a mean age of 35.56±4.45 years and a mean BMI of 25.98±2.2. Among those who under-went fresh embryo transfer (n=63), 21 had positive serum β-hCG results, and fetal heart rate was detected via ultrasound in 17 patients at six weeks. Proges-terone levels were significantly higher in the pregnancy-confirmed group (8.46 ng/ml) in comparison to the non-pregnant group (5.95 ng/ml, p=0.005). Similarly, patients with clinically confirmed pregnancies (detection of fetal heart rate) had significantly higher progesterone levels (8.38 ng/ml) compared to those without clinical pregnancy (6.19 ng/ml, p=0.02). A cutoff of 7.1 ng/ml predicted chemical pregnancy with 76.2% sensitivity and a cutoff of 7.55 ng/ml predicted clinical pregnancy with 71% sensitivity. Conclusion: Elevated serum progesterone levels on the day of oocyte retrieval may predict positive pregnancy outcomes, highlighting the importance of moni-toring progesterone to optimize the success rate of ART. 272 281 Farahnaz F Farzaneh Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences Iran Mahnaz M Ashrafi مهناز اشرفی Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Iran Robabeh R Mohammad Beigi Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences Iran Tayebeh T Azadbakht Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Iran Arash A Mohazzab Epidemiology Department, School of Public Health, Iran University of Medical Sciences Epidemiology Department, School of Public Health, Iran University of Medical Sciences Iran amohazzab@yahoo.com Eva E Esmael Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Department of Obstetrics and Gynecology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Shahid Akbarabadi Hospital, School of Medicine, Iran University of Medical Sciences Iran drevaeva15@gmail.com Assisted reproductive technologyOocyte retrievalProgesterone 140250.pdf Silverberg KM, Burns WN, Olive DL, Riehl RM, Schenken RS. Serum progesterone levels predict success of in vitro fertilization/embryo transfer in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab. 1991;73(4):797-803.##Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010;25(8):2092-100.##Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC. Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles. Hum Reprod Update. 2013;19(5):433-57.##Benmachiche A, Benbouhedja S, Zoghmar A, Al Humaidan PSH. The impact of preovulatory versus midluteal serum progesterone level on live birth rates during fresh embryo transfer. PloS One. 2021;16(2):e0246440.##Nayak S, Ochalski ME, Fu B, Wakim KM, Chu TJ, Dong X, et al. Progesterone level at oocyte retrieval predicts in vitro fertilization success in a short-antagonist protocol: a prospective cohort study. Fertil Steril. 2014;101(3):676-82.##Thomsen LH, Kesmodel US, Erb K, Bungum L, Pedersen D, Hauge B, et al. The impact of luteal serum progesterone levels on live birth rates-a prospective study of 602 IVF/ICSI cycles. Hum Reprod. 2018;33(8):1506-16.##Uyanik E, Mumusoglu S, Polat M, Yarali Ozbek I, Esteves SC, Humaidan P, et al. A drop in serum progesterone from oocyte pick-up 3 days to 5 days in fresh blastocyst transfer, using hCG-trigger and standard luteal support, is associated with lower ongoing pregnancy rates. Hum Reprod. 2023;38(2):225-36.##Neves AR, Santos-Ribeiro S, García-Martínez S, Devesa M, Soares SR, García-Velasco JA, et al. The effect of late-follicular phase progesterone elevation on embryo ploidy and cumulative live birth rates. Reprod Biomed Online. 2021;43(6):1063-9.##Xu J, Zhang C, Wang S, Zhang S. Impact of progesterone concentration on human chorionic gonadotropin trigger day on clinical outcomes with one top-quality cleavage-stage embryo or blastocyst transfer in fresh in vitro fertilization cycles. Front Endocrinol (Lausanne). 2023;14:1085287.##Burks HR, Peck JD, Gavrizi S, Anderson ZS, Diamond MP, Hansen KR. Effect of prematurely elevated late follicular progesterone on pregnancy outcomes following ovarian stimulation-intrauterine insemination for unexplained infertility: secondary analysis of the AMIGOS trial. Hum Reprod. 2024;39(8):1684-91.##Alyasin A, Agha-Hosseini M, Kabirinasab M, Saeidi H, Nashtaei MS. Serum progesterone levels greater than 32.5 ng/ml on the day of embryo transfer are associated with lower live birth rate after artificial endometrial preparation: a prospective study. Reprod Biol Endocrinol. 2021;19(1):24.##Kofinas JD, Blakemore J, McCulloh DH, Grifo J. Serum progesterone levels greater than 20 ng/dl on day of embryo transfer are associated with lower live birth and higher pregnancy loss rates. J Assist Reprod Genet. 2015;32(9):1395-9.##Tsai YR, Lin YJ, Lin YC, Hsu TY, Lan KC. Factors associated with extremely high progesterone concentrations on the day of HCG administration. J Gynecol Obstet Hum Reprod. 2020;49(8):101720.##Xu B, Li Z, Zhang H, Jin L, Li Y, Ai J, et al. Serum progesterone level effects on the outcome of in vitro fertilization in patients with different ovarian response: an analysis of more than 10,000 cycles. Fertil Steril. 2012;97(6):1321-7.e1-4.##Yang J, He Y, Wu Y, Zhang D, Huang H. Association between abnormal body mass index and pregnancy outcomes in patients following frozen embryo transfer: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2021;19(1):140.##Supramaniam PR, Mittal M, McVeigh E, Lim LN. 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Enhancing Sperm Quality Through Consecutive Ejaculation After Short Abstinence in Men with Low Semen Parameters Undergoing ICSI 2 1 140244 2 Background: Longer abstinence time is believed to be associated with the production of reactive oxygen species (ROS), which in excessive amounts may be detrimental to the sperm. To enhance sperm quality, multiple research studies have proposed reducing the duration of abstinence by encouraging consecutive ejaculations. This approach has been shown to improve sperm motility and morphology, which are associated with better ICSI and IUI outcomes. The purpose of the current study was to evaluate sperm quality and fertilization rate, cleavage rate, as well as embryo quality in severe oligoasthenozoospermic men using the consecutive ejaculate collected within an hour of abstinence. Methods: A prospective study was conducted at Halim Fertility Center from August 2020–April 2022, involving male partners undergoing ICSI treatment who presented with severe oligoasthenozoospermia on their previous semen analysis. The non-parametric Mann-Whitney and Wilcoxon tests were used to analyze the parameters of the groups, including characteristics of the study participants, oocytes and sperm samples, as well as the ICSI outcomes, using a significance level of 5%. Results: A statistically significant improvement in the sperm total motility was recorded in the consecutive ejaculate compared to the first (31.53±11.73% vs. 22.52±8.85%; p<0.001). Both fertilization and cleavage rates were higher in the consecutive ejaculate group, although they were not statistically significant (61.41±28.04% vs. 55.45±31.76%; p=0.081 and 88.10±28.63% vs. 81.07±36.34%; p=0.262). Conclusion: Consecutive ejaculates collected within an hour of the first may enhance sperm total motility, fertility, and cleavage rates in male partners with low sperm count and quality undergoing ICSI treatment. 281 290 Binarwan B Halim Faculty of Medicine, Universitas Prima Indonesia Faculty of Medicine, Universitas Prima Indonesia Indonesia Jesselyn J Angell Halim Fertility Center, Stella Maris Women’s and Children’s Hospital Halim Fertility Center, Stella Maris Women’s and Children’s Hospital Indonesia Agustinus A Agustinus Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga Indonesia agustinus27@fk.unair.ac.id Cennikon C Pakpahan Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga Indonesia Hilma HP Lubis Department of Obstetrics and Gynecology, Division of Reproductive, Endocrinology and Infertility, Faculty of Medicine, Universitas Sumatera Utara, Medan Department of Obstetrics and Gynecology, Division of Reproductive, Endocrinology and Infertility, Faculty of Medicine, Universitas Sumatera Utara, Medan Indonesia AbstinenceConsecutive ejaculateEmbryo developmentSemen qualitySperm motility 140244.pdf Agarwal A, Gupta S, Du Plessis S, Sharma R, Esteves SC, Cirenza C, et al. 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The Effect of Spiritual Health on Psychological Distress of Infertile Women: The Role of Perceived Social Support as a Mediator 2 1 140246 2 Background: The objective of this study was to evaluate the model of spiritual health in relation to psychological distress among infertile women, with perceived social support as a mediator. Method: In this study, structural equation modeling (SEM) was employed. The study population included all infertile women in Shiraz from which a sample of 250 individuals was selected using a targeted sampling method. The research data were collected by Spiritual Health questionnaire developed by Iranian Academy of Medical Sciences; Depression, Anxiety, and Stress Scale 21 (DASS-21); and Multidimensional Scale of Perceived Social Support (MSPSS). Data analysis was performed using SPSS and AMOS software. Results: The results demonstrate that the direct impact of spiritual health on psychological distress and perceived social support was statistically significant. Furthermore, a significant indirect effect of spiritual health on psychological distress was identified through perceived social support. Conclusion: According to the findings of this study, it may be beneficial to address aspects of spiritual health and social support to alleviate psychological distress among infertile women. 290 298 Faride F Ensafdaran Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences Iran f.ensafdaran@gmail.com Mahmoud M Nejabat Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences Iran Soudabeh S Sabetian سودابه ثابتیان Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences Iran Bahia B Namavar Jahromi Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences Iran Fatemeh F Hemmati Fatemieh Institute of Higher Education Fatemieh Institute of Higher Education Iran InfertilityPerceived social supportPsychological distressSpiritual health 140246.pdf Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. 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BMC Womens Health. 2017;17(1):48.##Jahromi BN, Mansouri M, Forouhari S, Poordast T, Salehi A. Quality of life and its influencing factors of couples referred to an infertility center in Shiraz, Iran. Int J Fertil Steril. 2018;11(4):293-7.##Ozturk R, Taner A, Guneri SE, Yilmaz B. Another face of violence against women: Infertility. Pak J Med Sci. 2017;33(4):909-14.##Akyuz A, Seven M, Şahiner G, Bilal B. Studying the effect of infertility on marital violence in Turkish women. Int J Fertil Steril. 2013;6(4):286-93.##Rufai AI, Grema BA, Bello MM, Michael GC. Association between family functionality, sociode-mographic factors, and severity of depression in women with infertility attending a gynecology clinic in northwest Nigeria. J Neurosci Rural Pract. 2022; 13(2):246-53.##Simionescu G, Dorfotei B, Maftei R, Obreja BE, Anton E, Grab D, et al. The complex relationship between infertility and psychological distress (Review). Exp Ther Med. 2021;21(4):306.##Chiew PW, Jan JM. 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The stress and distress of infertility: does religion help women cope? Sex Reprod Menopause. 2005;3(2):45-51.##Dadhwal V, Choudhary V, Perumal V, Bhatta-charya D. Depression, anxiety, quality of life and coping in women with infertility: a cross‐sectional study from India. Int J Gynecol Obstet. 2022;158 (3):671-8.##Fernandez-Ferrera C, Llaneza-Suarez D, Fernan-dez-Garcia D, Castañon V, Llaneza-Suarez C, Lla-neza P. Resilience, perceived stress, and depressed mood in women under in vitro fertilization treat-ment. Reprod Sci. 2022;29(3):816-22.##Ni Y, Huang L, Zhang E, Xu L, Tong C, Qian W, et al. Psychosocial correlates of fertility-related quality of life among infertile women with re-peated implantation failure: the mediating role of resilience. Front Psychiatry. 2022;13:1019922.##Hajihasani M, Ekhtiari Amiri R. Psychological dis-tress in infertile women: the role of quality of marital relationships and self-compassion. Hum Fertil. 2023;26(6):1393-9.##Truong LQ, Luong TB, Tran T, Dang NH, Nguyen LH, Nguyen TT, et al. Infertility-related stress, social support, and coping of women experiencing infertility in Vietnam. Health Psychol Rep. 2022; 10(2):129-38.##Zhong M, Li X, Tang N, Chen X, Fan T. Role of resilience in relationship between perceived social support and quality of life of breast cancer patients. Chinese Nurs Res. 2019;33(2):237-40.##Dreyer J, Schwartz-Attias I. Nursing care for ado-lescents and young adults with cancer: literature review. Acta Haematol. 2014;132(3-4):363-74.##Kong L, Fang M, Ma T, Li G, Yang F, Meng Q, et al. Positive affect mediates the relationships be-tween resilience, social support and posttraumatic growth of women with infertility. Psychol Health Med. 2018;23(6):707-16.##Khalid A, Dawood S. Social support, self-efficacy, cognitive coping and psychological distress in in-fertile women. Arch Gynecol Obstet. 2020;302(2):423-30.##Parkitny L, McAuley J. The depression anxiety stress scale (DASS). J Physiother. 2010;56(3):204.##Amiri P, Abbasi M, Gharibzadeh S, Asghari Jafar-abadi M, Hamzavi Zarghani N, Azizi F. [Desig-nation and psychometric assessment of a compre-hensive spiritual health questionnaire for Iranian populations]. Med Ethics. 2015;8(30):25-55. Persian.##Ensafdaran F, Nejabat M, Mahmoudi A, Shamsaei M. Presenting a model of nurses' psychological well-being based on the variables of spiritual health, resilience, and emotional atmosphere of the family during the corona pandemic and its effect on emotional distress tolerance of nurses. J Health System Res. 2022;18(2):120-6.##Dahlem NW, Zimet GD, Walker RR. The multi-dimensional scale of perceived social support: a confirmation study. J Clin Psychol. 1991;47(6):756-61.##Van Nieuw Amerongen‐Meeuse JC, Schaap‐Jon-ker H, Anbeek C, Braam AW. Religious/spiritual care needs and treatment alliance among clinical mental health patients. 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A New Strategy for Chronic Endometritis Treatment Using Fermented Soy Product (ImmuBalanceTM) 2 1 140248 2 Background: Chronic endometritis (CE) significantly contributes to repeated implantation failure (RIF). Although antibiotics are common treatments for CE, some patients do not achieve resolution. Therefore, the use of an alternative method involving the administration of ImmuBalanceTM (IMB), a combination of pre- and probiotics, was explored in the current study. Methods: This retrospective study was conducted between April 2021 and August 2022. A total of 819 women with CE were treated with antibiotics-1 (doxycycline, n=809) or IMB (n=10, Group 1). Following endometrial biopsies, CE was not resolved in 209 out of 819 women. Subsequently, 194 patients were treated with antibiotics-1 (n=4) or -2 (amoxicillin, azithromycin, and metronidazole, n=190), whereas 15 were treated with IMB (n=15, Group 2). After the treatment with antibiotics-2, four women underwent IMB (Group 3). Statistical analysis of the number of plasma cells with CD138 before and after treatment was conducted using Fisher’s exact test and p-values <0.05 were considered statistically significant. Results: CE was treated in 60% of patients (6/10) in Group 1; however, the reduction in CD138 count was not statistically significant (p=0.13). In Groups 2 and 3, CE was treated with a significantly reduced CD138 count (Group 2, p<0.01; Group 3, p=0.04). CE was treated in 100% of cases in Group 2 and 3 (15/15 and 4/4, respectively). Conclusion: Based on the findings of this study, administration of IMB may be effective in treating CE, especially following antibiotic treatment. 298 304 Fumio F Suyama Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan fumiwo.may.2nd@gmail.com Koji K Nakagawa Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Keisuke K Shiobara Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Takashi T Horikawa Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Keiji K Kuroda Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi Japan Hisayo H Kataoka Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Yuko Y Ojiro Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Satoru S Takamizawa Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan Rikikazu R Sugiyama Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku Japan AntibioticsEndometritisPlasma cells 140248.pdf Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immnol. 2011;66(5):410-5.##Kuroda K, Matsumura Y, Ikemoto Y, Segawa T, Hashimoto t, Fukuda J, et al. Analysis of the risk factors and treatment for repeated implantation failure: optimizing of thyroid function, IMmumnity, and uterine milieu (OPTIMUM) treatment strategy. Am J Reprod Immunol. 2021;85(5):e13376.##Kitaya K, Matsubayashi H, Takaya Y, Nishimura R, Yamaguchi K, Takeuchi T, et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. Am J Reprod Immunol. 2017;78(5).##McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 2014;101(4):1026-30.##Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640-7. ##Kuroda K, Ikemoto Y, Horikawa T, Moriyama A, Ojiro Y, Takamizawa S, et al. Novel approaches to the management of recurrent pregnancy loss: the OPTIMUM (optimization of thyroid function, thrombophilia, immunity, and uterine milieu) treatment strategy. Reprod Med Biol. 2021;20(4):524-36.##Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010;93(2):437-41.##Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune, et al. Review: chronic endometritis and its effect on reproduction. J Obstet Gynaecol Res. 2019;45(5):951-60.##Chen C, Song X, Wei W, Zhong H, Dai J, Lan Z, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun. 2017;8(1):875.##Hu B, Dong Y, Zhou W, Ma Y, Li L, Fu X, et al. Effect of Inonotus obliquus polysaccharide on composition of the intestinal flora in mice with acute endometritis. PLoS One. 2021;16(11):e0259570.##Kadotani H, Asai K, Miyamoto A, Iwasaki K, Kawai T, Nishimura M, et al. The fermented soy product immuBalanceTM suppresses airway inflammation in a murine model of asthma. Nutrients. 2021;13(10):3380.##Matsuda A, Tanaka A, Pan W, Okamoto N, Oida K, Kingyo N, et al. Supplementation of the fermented soy product ImmuBalanceTM effectively reduces itching behavior of atopic NC/Tnd mice. J Dermatol Sci. 2012;67(2):130-9.##He LX, Abdolmaleky HM, Yin S, Wang Y, Zhou JR. Dietary fermented soy extract and oligo-lactic acid alleviate chronic kidney disease in mice via inhibition of inflammation and modulation of gut microbiota. Nutrients. 2020;12(8):2376.##Kuroda K, Ishiyama S, Shiobara S, Nakao K, Moriyama A, Kataoka H, et al. Therapeutic efficacy of genetle endometrial curettage on antibiotic-resistant chronic endometritis in infertile women. Reprod Med Biol. 2023;22(1):e12525.##Kadogami D, Nakaoka Y, Morimoto Y. Use of a vaginal probiotic suppository and antibiotics to influence the composition of the endometrial microbiota. Reprod Biol. 2020;20(3):307-14.##

Cytogenetic Evaluation and Clinical Correlation: A Retrospective Analysis of East Indian Patients with Diverse Amenorrhea Profiles 2 1 140245 2 Background: Amenorrhea is defined as the absence of menstruation in women at reproductive age, caused by imbalanced hormonal interactions. The genes located on X chromosome are linked to the physiology of menstruation and reproduction, and early detection of major chromosomal conditions can be facilitated through cytogenetic testing. This study aimed to determine the frequency and spectrum of chromosomal anomalies in amenorrhea patients from Eastern India and correlate clinical features with cytogenetic findings. Methods: From September 2022 to September 2024, 231 women with confirmed amenorrhea were included in a study conducted at inDNA Life Sciences Private Limited, India. Clinical features of women with a history of amenorrhea were recorded and cytogenetic investigation was carried out for all women. Results: Study revealed that 20.35% of amenorrhea cases exhibited chromosomal anomalies. Among them, 38.30% were classified as numerical anomalies, 25.53% as sex reversal, 19.15% as structural anomalies, and 17.02% as mosaic karyotypes, with X-monosomy identified as the most prevalent anomaly. Conclusion: The findings emphasizes the importance of karyotyping in diagnosis, highlighting its role in early detection and management of female infertility. Karyotyping has a resolution limit of 4-5 Mb, which disables identification of submicroscopic chromosomal abnormalities. In contrast, chromosomal microarray (CMA) analysis can examine the entire genome at higher resolutions, allowing for the identification of genetic abnormalities that may not be detected by karyotyping. While CMA was excluded from this investigation, it could serve as a valuable technique for future research aimed at identifying submicroscopic chromosomal abnormalities in cytogenetically normal women with amenorrhea. 304 316 Sunny SKJK Patel Molecular Stress and Stem Cell Biology Group, School of Biotechnology, Kalinga Institute of Industrial Technology Molecular Stress and Stem Cell Biology Group, School of Biotechnology, Kalinga Institute of Industrial Technology India Birendranath B Banerjee inDNA Center for Research and Innovation in Molecular Diagnostics, inDNA Life Sciences Pvt. Ltd. inDNA Center for Research and Innovation in Molecular Diagnostics, inDNA Life Sciences Pvt. Ltd. India biren.banerjee@indnalife.com AmenorrheaChromosomal anomaliesConventional cytogenetic analysisIsochromosome 140245.pdf Ivalla AP. Prospective study of primary amenorrhoea and its management in a rural tertiary centre. 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