A New Perspective for the Future of Male Infertility Treatment and Research 2 1 2 Fertility and childbirth have been one of the basic needs throughout the human life, which in some cases are failed despite the couple's long efforts. Infertility is defined as the disability of childbearing following one year of unprotected intercourse. Infertility has a prevalence of 10-15% among couples at the reproductive age and therefore it is one of the almost common illnesses for individuals. According to evidence based clinical data, the female and male partners’ role in causes of infertility are approximately equivalent. But the male’s and female’s role in infertility has been unrealistically underestimated or overemphasized in different communities. In fact, the common practice is ignoring the men's role in the causes of infertility and to highlight the role of women in infertility. But over the time and advancement of infertility diagnosis and treatment, the insights into the causes and role of male and female in infertility have become more realistic (1). A quick review on number of researches in each area of male factor and female factor infertility over the past 50 years is also evidence of this fact. Although the researches on male and female infertility are increasing with equal rate, but recently, most interventions, surgeries and assisted reproductive technologies (ARTs) for infertility treatments are performed on women, even in cases of a normal female with male factor infertility. However, introduction of Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Testicular Sperm Aspiration (TESA), Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Extraction (TESE), and Microdissection Testicular Sperm Extraction (Micro-TESE) have revolutionized treatment of infertility, especially in patients with a male factor. However, in all of these treatments, a woman who is fertile should be superovulated and ovum pick-up under anesthesia needs to be done and followed by a wide range of hormonal and non-hormonal medications to prepare the uterus for embryo transfer. Taking these hormones will continue for several months following successful pregnancy which causes a lot of suffering and pain for the woman, and this situation will be much worse if ovarian hyperstimulation syndrome (OHSS) or multiple pregnancy occurs. Another problem is the low success rate of ART cycles which will require repeating treatment cycles that may result in more physical and psychological damages for women (2). Therefore, isn’t it necessary to seek new therapies for male factor infertility that do not harm women? There is so many researches currently underway to increase the success rate of ART cycles. Introducing and applying different technologies such as Time-lapse Incubators (TL) and Preimplantation Genetic Testing for Aneuploidies (PGT-A) have improved selection of best embryos, which in part leads to increased success of IVF cycles and reduced rate of multi-pregnancy (3). In addition to the above technologies, natural IVF cycle was introduced to reduce the harm in women, but it also needs regular sonographic monitoring of ovary, ovulation triggering, surgical ovum pick-up, in vitro fertilization, embryo culture and also low success rate of natural cycle is similar to routine IVF cycles (2). Therefore, it seems that all efforts to minimize the harm and inconvenience for women and increasing success rate of IVF cycles have not been successful so far. Therefore, in such conditions, serious changes in direction of diagnostic methods and treatment procedures of male infertility are more crucial than ever. Though it is conceivable that future research on male infertility will lead to the development of new approaches to infertility treatment that no longer require multiple medications and surgery on women with nearly 100% success rate, the idea is so far-fetched and fanciful at present and is more like a science fiction. But historical experience has shown that everything that has once been human imagination and legend has become reality over time and is now available for us as common and routine technologies. Therefore, whatever we conceive as a way to improve infertility treatments with a high success rate without harm to women will certainly be achieved with efforts of scientists and support of clinicians in future. 01 3 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@ari.ir No Keyword 60072.pdf Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015;21(4):411-26.##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.##Reignier A, Lammers J, Barriere P, Freour T. Can time-lapse parameters predict embryo ploidy? a systematic review. Reprod Biomed Online. 2018;36(4):380-7.##

The Beneficial Role of Intra Cytoplasmic Morphologically Selected Sperm Injection (IMSI) in Assisted Reproduction 2 1 2 Since the introduction of intracytoplasmic sperm injection (ICSI), the importance of sperm morphology assessment has been given attention in the assisted reproduction field. It is important to select a good-quality motile spermatozoon for giving a better embryo quality in assisted reproduction technique (ART). In ICSI, sperm morphology evaluation is limited due to its low magnification. However, by using intracytoplasmic morphologically selected sperm injection (IMSI), the selection is done at high magnification of ×6600 using motile sperm organelle morphology examination (MSOME). Therefore, it becomes possible to select a good quality spermatozoon with an intact nucleus that may enhance the pregnancy outcomes. Although all patients can benefit from IMSI, it is important to standardize which techniques (IMSI or ICSI) could be used or which group of patients benefit from IMSI to maximize the efficiency of this advanced technology. 03 11 Esmat E Mangoli Research and Clinical Center for Infertility, Reproductive Science Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Reproductive Science Institute, Shahid Sadoughi University of Medical Sciences Iran Mohammad Ali MA Khalili محمد علی خلیلی Research and Clinical Center for Infertility, Reproductive Science Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Reproductive Science Institute, Shahid Sadoughi University of Medical Sciences Iran khalili59@hotmail.com ICSIIMSIMale infertilitySperm morphology 60070.pdf Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;340(8810):17-8.##De Vos A, Polyzos NP, Verheyen G, Tournaye H. Intracytoplasmic morphologically selected sperm injection (IMSI): a critical and evidence-based review. Basic Clin Androl. 2013;23:10.##Mangoli E, Khalili MA, Talebi AR, Ghasemi-Esmailabad S, Hosseini A. Is there any correlation between sperm parameters and chromatin quality with embryo morphokinetics in patients with male infertility? Andrologia. 2018;50(5):e12997.##Bartoov B, Berkovitz A, Eltes F, Kogosowski A, Menezo Y, Barak Y. Real-time fine morphology of motile human sperm cells is associated with IVF-ICSI outcome. J Androl. 2002;23(1):1-8.##Kohn TP, Kohn JR, Lamb DJ. Role of sperm morphology in deciding between various assisted reproduction technologies. Eur Urol Focus. 2018;4(3):311-3.##Bartoov B, Berkovitz A, Eltes F. Selection of spermatozoa with normal nuclei to improve the pregnancy rate with intracytoplasmic sperm injection. N Engl J Med. 2001;345(14):1067-8.##Ghazali S, Talebi AR, Khalili MA, Aflatoonian A, Esfandiari N. Large nuclear vacuoles in spermatozoa negatively affect pregnancy rate in IVF cycles. Iran J Reprod Med. 2015;13(7):425-32.##Lo Monte G, Murisier F, Piva I, Germond M, Marci R. Focus on intracytoplasmic morphologically selected sperm injection (IMSI): a mini-review. Asian J Androl. 2013;15(5):608-15.##Bartoov B, Berkovitz A, Eltes F, Kogosovsky A, Yagoda A, Lederman H, et al. Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection. Fertil Steril. 2003;80(6):1413-9.##Delaroche L, Yazbeck C, Gout C, Kahn V, Oger P, Rougier N. Intracytoplasmic morphologically selected sperm injection (IMSI) after repeated IVF or ICSI failures: a prospective comparative study. Eur J Obstet Gynecol Reprod Biol. 2013;167(1):76-80.##Hazout A, Dumont-Hassan M, Junca AM, Cohen Bacrie P, Tesarik J. High-magnification ICSI overcomes paternal effect resistant to conventional ICSI. Reprod Biomed Online. 2006;12(1):19-25.##Setti AS, Braga DP, Figueira RC, Iaconelli A Jr, Borges E. Intracytoplasmic morphologically selected sperm injection results in improved clinical outcomes in couples with previous ICSI failures or male factor infertility: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;183:96-103.##McDowell S, Kroon B, Ford E, Hook Y, Glujovsky D, Yazdani A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev. 2014;(10):CD010461.##Watanabe S, Tanaka A, Fujii S, Mizunuma H, Fukui A, Fukuhara R, et al. An investigation of the potential effect of vacuoles in human sperm on DNA damage using a chromosome assay and the TUNEL assay. Hum Reprod. 2011;26(5):978-86.##Ebner T, Shebl O, Oppelt P, Mayer RB. Some reflections on intracytoplasmic morphologically selected sperm injection. Int J Fertil Steril. 2014;8(2):105-12.##Garolla A, Fortini D, Menegazzo M, De Toni L, Nicoletti V, Moretti A, et al. High-power microscopy for selecting spermatozoa for ICSI by physiological status. Reprod Biomed Online. 2008;17(5):610-6.##Omidi M, Faramarzi A, Agharahimi A, Khalili MA. Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review. J Microsc. 2017;267(3):253-64.##Berkovitz A, Dekel Y, Goldstein R, Bsoul S, Machluf Y, Bercovich D. The significance of human spermatozoa vacuoles can be elucidated by a novel procedure of array comparative genomic hybridization. Hum Reprod. 2018;33(4):563-71.##Berkovitz A, Eltes F, Yaari S, Katz N, Barr I, Fishman A, et al. The morphological normalcy of the sperm nucleus and pregnancy rate of intracytoplasmic injection with morphologically selected sperm. Hum Reprod. 2005;20(1):185-90.##Boitrelle F, Guthauser B, Alter L, Bailly M, Bergere M, Wainer R, et al. High-magnification selection of spermatozoa prior to oocyte injection: confirmed and potential indications. Reprod Biomed Online. 2014;28(1):6-13.##Souza Setti A, Ferreira RC, Paes de Almeida Ferreira Braga D, de Cassia Savio Figueira R, Iaconelli A Jr, Borges E Jr. Intracytoplasmic sperm injection outcome versus intracytoplasmic morphologically selected sperm injection outcome: a meta-analysis. Reprod Biomed Online. 2010;21(4):450-5.##El Khattabi L, Dupont C, Sermondade N, Hugues JN, Poncelet C, Porcher R, et al. Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure? Fertil Steril. 2013;100(1):62-8.##Balaban B, Yakin K, Alatas C, Oktem O, Isiklar A, Urman B. Clinical outcome of intracytoplasmic injection of spermatozoa morphologically selected under high magnification: a prospective randomized study. Reprod Biomed Online. 2011;22(5):472-6.##Oliveira JB, Cavagna M, Petersen CG, Mauri AL, Massaro FC, Silva LF, et al. Pregnancy outcomes in women with repeated implantation failures after intracytoplasmic morphologically selected sperm injection (IMSI). Reprod Biol Endocrinol. 2011;9:99.##Antinori M, Licata E, Dani G, Cerusico F, Versaci C, d'Angelo D, et al. Intracytoplasmic morphologically selected sperm injection: a prospective randomized trial. Reprod Biomed Online. 2008;16(6):835-41.##Goswami G, Sharma M, Jugga D, Gouri DM. Can intracytoplasmic morphologically selected spermatozoa injection be used as first choice of treatment for severe male factor infertility patients? J Hum Reprod Sci. 2018;11(1):40-4.##Mangoli E, Khalili MA, Talebi AR, Agha-Rahimi A, Soleimani M, Faramarzi A, et al. IMSI procedure improves clinical outcomes and embryo morphokinetics in patients with different aetiologies of male infertility. Andrologia. 2019;51(8):e13340.##Shalom-Paz E, Anabusi S, Michaeli M, Karchovsky-Shoshan E, Rothfarb N, Shavit T, et al. Can intra cytoplasmatic morphologically selected sperm injection (IMSI) technique improve outcome in patients with repeated IVF-ICSI failure? a comparative study. Gynecol Endocrinol. 2015;31(3):247-51.##Mangoli E, Khalili MA, Eftekhar M, Macchiarelli G, Palmerini MG. First successful live birth following the use of MSOME and time lapse for sperm and embryo selections in a patient with severe male factor infertility: a case report. J Gynecol Obstet Hum Reprod. 2019;48(10):883-5.##Gatimel N, Parinaud J, Leandri RD. Intracytoplasmic morphologically selected sperm injection (IMSI) does not improve outcome in patients with two successive IVF-ICSI failures. J Assist Reprod Genet. 2016;33(3):349-55.##Marci R, Murisier F, Lo Monte G, Soave I, Chanson A, Urner F, et al. Clinical outcome after IMSI procedure in an unselected infertile population: a pilot study. Reprod Health. 2013;10:16.##Setti AS, Braga DP, Figueira RC, Iaconelli A Jr, Borges E Jr. Poor-responder patients do not benefit from intracytoplasmic morphologically selected sperm injection. J Assist Reprod Genet. 2015;32(3):445-50.##Knez K, Tomazevic T, Vrtacnik-Bokal E, Virant-Klun I. Developmental dynamics of IMSI-derived embryos: a time-lapse prospective study. Reprod Biomed Online. 2013;27(2):161-71.##Knez K, Zorn B, Tomazevic T, Vrtacnik-Bokal E, Virant-Klun I. The IMSI procedure improves poor embryo development in the same infertile couples with poor semen quality: a comparative prospective randomized study. Reprod Biol Endocrinol. 2011;9:123.##Leandri RD, Gachet A, Pfeffer J, Celebi C, Rives N, Carre-Pigeon F, et al. Is intracytoplasmic morphologically selected sperm injection (IMSI) beneficial in the first ART cycle? a multicentric randomized controlled trial. Andrology. 2013;1(5):692-7.##Zanetti BF, Braga DPAF, Provenza RR, Figueira RCS, Iaconelli A Jr, Borges E Jr. Sperm morphological normality under high magnification is correlated to male infertility and predicts embryo development. Andrology. 2018 Feb 18. [Epub ahead of print].##Kim HJ, Yoon HJ, Jang JM, Oh HS, Lee YJ, Lee WD, et al. Comparison between intracytoplasmic sperm injection and intracytoplasmic morphologically selected sperm injection in oligo-astheno-teratozoospermia patients. Clin Exp Reprod Med. 2014;41(1):9-14.##de Almeida Ferreira Braga DP, Setti AS, Figueira RC, Nichi M, Martinhago CD, Iaconelli A Jr, Borges E Jr. Sperm organelle morphologic abnormalities: contributing factors and effects on intracytoplasmic sperm injection cycles outcomes. Urology. 2011;78(4):786-91.##Cassuto NG, Hazout A, Hammoud I, Balet R, Bouret D, Barak Y, et al. Correlation between DNA defect and sperm-head morphology. Reprod Biomed Online. 2012;24(2):211-8.##Cassuto NG, Montjean D, Siffroi JP, Bouret D, Marzouk F, Copin H, et al. Different levels of DNA methylation detected in human sperms after morphological selection using high magnification microscopy. Biomed Res Int. 2016;2016:6372171.##De Vos A, Van de Velde H, Bocken G, Eylenbosch G, Franceus N, Meersdom G, et al. Does intracytoplasmic morphologically selected sperm injection improve embryo development? a randomized sibling-oocyte study. Hum Reprod. 2013;28(3):617-26.##Maettner R, Sterzik K, Isachenko V, Strehler E, Rahimi G, Alabart JL, et al. Quality of human spermatozoa: relationship between high-magnification sperm morphology and DNA integrity. Andrologia. 2014;46(5):547-55.##Hammoud I, Boitrelle F, Ferfouri F, Vialard F, Bergere M, Wainer B, et al. Selection of normal spermatozoa with a vacuole-free head (x6300) improves selection of spermatozoa with intact DNA in patients with high sperm DNA fragmentation rates. Andrologia. 2013;45(3):163-70.##Cassuto NG, Bouret D, Plouchart JM, Jellad S, Vanderzwalmen P, Balet R, et al. A new real-time morphology classification for human spermatozoa: a link for fertilization and improved embryo quality. Fertil Steril. 2009;92(5):1616-25.##Figueira Rde C, Braga DP, Setti AS, Iaconelli A Jr, Borges E Jr. Morphological nuclear integrity of sperm cells is associated with preimplantation genetic aneuploidy screening cycle outcomes. Fertil Steril. 2011;95(3):990-3.##Setti AS, Figueira RC, Braga DP, Iaconelli A Jr, Borges E Jr. Gender incidence of intracytoplasmic morphologically selected sperm injection-derived embryos: a prospective randomized study. Reprod Biomed Online. 2012;24(4):420-3.##Luna D, Hilario R, Duenas-Chacon J, Romero R, Zavala P, Villegas L, et al. The IMSI procedure improves laboratory and clinical outcomes without compromising the aneuploidy rate when compared to the classical ICSI procedure. Clin Med Insights Reprod Health. 2015;9:29-37.##Kidd SA, Eskenazi B, Wyrobek AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril. 2001;75(2):237-48.##Petersen CG, Mauri AL, Vagnini LD, Renzi A, Petersen B, Mattila M, et al. The effects of male age on sperm DNA damage: an evaluation of 2,178 semen samples. JBRA Assist Reprod. 2018;22(4):323-30.##Silva LF, Oliveira JB, Petersen CG, Mauri AL, Massaro FC, Cavagna M, et al. The effects of male age on sperm analysis by motile sperm organelle morphology examination (MSOME). Reprod Biol Endocrinol. 2012;10:19.##Ai L, Liu SY, Huang J, Chen SW, Liu J, Zhong Y. [Intracytoplasmic morphologically selected sperm injection of testicular sperm: clinical outcome in azoospermia patients]. Zhonghua Nan Ke Xue. 2010;16(9):826-9.##Gong Y, Meng XQ, Liu M, Wang J, Xiong F, Zhong Y, et al. [Intracytoplasmic injection of morphologically selected spermatozoa from patients with male factor infertility: clinical and embryo development outcomes]. Nan Fang Yi Ke Da Xue Xue Bao. 2015;35(10):1428-33.##Ghasemzadeh J, Talebi AR, Khalili MA, Fesahat F, Halvaei I, Nabi A, et al. Sperm parameters, protamine deficiency, and apoptosis in total globozoospermia. Iran J Reprod Med. 2015;13(8):495-502.##Talebi AR, Ghasemzadeh J, Khalili MA, Halvaei I, Fesahat F. Sperm chromatin quality and DNA integrity in partial versus total globozoospermia. Andrologia. 2018;50(1).##Khalili MA, Kalantar SM, Vahidi S, Ghafour-Zadeh M. Failure of fertilization following intracytoplasmic injection of round-headed sperm. Ann Saudi Med. 1998;18(5):408-11.##Khalili MA, Aflatoonian A, Zavos PM. Intracytoplasmic injection using spermatids and subsequent pregnancies: round versus elongated spermatids. J Assist Reprod Genet. 2002;19(2):84-6.##Sermondade N, Hafhouf E, Dupont C, Bechoua S, Palacios C, Eustache F, et al. Successful childbirth after intracytoplasmic morphologically selected sperm injection without assisted oocyte activation in a patient with globozoospermia. Hum Reprod. 2011;26(11):2944-9.##Chelli MH, Albert M, Ray PF, Guthauser B, Izard V, Hammoud I, et al. Can intracytoplasmic morphologically selected sperm injection be used to select normal-sized sperm heads in infertile patients with macrocephalic sperm head syndrome? Fertil Steril. 2010;93(4):1347.e1-5.##Cassuto NG, Hazout A, Bouret D, Balet R, Larue L, Benifla JL, et al. Low birth defects by deselecting abnormal spermatozoa before ICSI. Reprod Biomed Online. 2014;28(1):47-53.##Hershko-Klement A, Sukenik-Halevy R, Biron Shental T, Miller N, Berkovitz A. Intracytoplasmic morphologically selected sperm injection and congenital birth defects: a retrospective cohort study. Andrology. 2016;4(5):887-93.##Gaspard O, Vanderzwalmen P, Wirleitner B, Ravet S, Wenders F, Eichel V, et al. Impact of high magnification sperm selection on neonatal outcomes: a retrospective study. J Assist Reprod Genet. 2018;35(6):1113-21.##

The Determination of Estradiol to Cumulus Oocyte Complex (COC) Number Ratio: Does it Predict the Outcomes of ART Cycles? 2 1 2 Background: The aim of this study was to assess the impact of total serum E2 on the day of human chronic gonadotropin (hCG) administration and the serum E2 per oocyte ratio on the outcomes of assisted reproductive technology (ART) cycles. Methods: A total of 205 women were categorized into 3 groups according to the serum E2 levels: 1: ≤1500 pg/ml; 2: 1500-3000 pg/ml; 3: >3000 pg/ml. Another categorization included 3 groups according to E2/oocyte ratio: A: ≤150 pg/ml per oocyte; B: 150-200 pg/ml per oocyte; and C: >200 pg/ml per oocyte. The outcome compared between groups included laboratory and clinical characteristics. One-way analysis of variance (ANOVA), chi-square and Kruskal-Wallis, and multiple logistic regression model were performed, and appropriate differences were considered significant at p<0.05. Results: There was a significant difference between the groups based on the E2 levels with respect to laboratory parameters. In group C, the rates of chemical pregnancy (54.1%), clinical pregnancy (50%) and live birth (45.8%) were significantly higher, when compared to other groups. Moreover, according to E2/oocyte ratio, the rate of live birth was higher in group C compared with group A (18.3%, p=0.04), and group C (29.7%, p<0.0001). Logistic regression showed the number of good quality embryos was a positive predictor for live birth (odds ratio=2.03, 95% CI=1-4.1), but the level of E2 on day of HCG was a negative predictor (odds ratio=0.99, 95% CI=0.99-1). Conclusion: Supraphysiological levels of E2 had no adverse effects on the quality of the embryos in IVF cycles, but may have adverse effect on live birth in fresh transfer. Also, it is confirmed that both the pregnancy and live birth rates were elevated with E2/oocyte ratio ≥200 pg/ml. 11 17 Fatemeh F Taheri Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran Marjan M Omidi Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran Mohammad Ali MA Khalili محمد علی خلیلی Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran Azam A Agha-Rahimi اعظم آقارحیمی Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran 63rahimi@gmail.com Mojdeh M Sabour Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran Azita A Faramarzi Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences Iran Esmat E Mangoli Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences Iran E2/oocyte ratioEstradiol levelIVFLive birth rate 60071.pdf Leão Rde B, Esteves SC. Gonadotropin therapy in assisted reproduction: an evolutionary perspective from biologics to biotech. Clinics (Sao Paulo). 2014;69(4):279-93.##Anifandis G, Koutselini E, Louridas K, Liakopoulos V, Leivaditis K, Mantzavinos T, et al. Estradiol and leptin as conditional prognostic IVF markers. Reproduction. 2005;129(4):531-4.##Yu Ng EH, Yeung WS, Yee Lan Lau E, So WW, Ho PC. High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen–thawed embryo transfer cycles. Hum Reprod. 2000;15(2):250-5.##Ng EH. What is the threshold value for serum estradiol levels associated with adverse IVF outcomes? Fertil Steril. 2000;73(5):1071-2.##Peña JE, Chang PL, Chan LK, Zeitoun K, Thornton MH 2nd, Sauer MV. Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles. Hum Reprod. 2002;17(1):83-7.##Friedler S, Zimerman A, Schachter M, Raziel A, Strassburger D, Ron El R. The midluteal decline in serum estradiol levels is drastic but not deleterious for implantation after in vitro fertilization and embryo transfer in patients with normal or high responses. Fertil Steril. 2005;83(1):54-60.##Mitwally MF, Bhakoo HS, Crickard K, Sullivan MW, Batt RE, Yeh J. Estradiol production during controlled ovarian hyperstimulation correlates with treatment outcome in women undergoing in vitro fertilization–embryo transfer. Fertil Steril. 2006;86(3):588-96.##Kosmas IP, Kolibianakis EM, Devroey P. Association of estradiol levels on the day of hCG administration and pregnancy achievement in IVF: a systematic review. Hum Reprod. 2004;19(11):2446-53.##Simón C, Cano F, Valbuena D, Remohí J, Pellicer A. Implantation: clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Hum Reprod. 1995;10(9):2432-7.##Paulson RJ, Sauer MV, Lobo RA. Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil Steril. 1990;53(5):870-4.##Chenette PE, Sauer MV, Paulson RJ. Very high serum estradiol levels are not detrimental to clinical outcome of in vitro fertilization. Fertil Steril. 1990;54(5):858-63.##Blazar AS, Hogan JW, Frankfurter D, Hackett R, Keefe DL. Serum estradiol positively predicts outcomes in patients undergoing in vitro fertilization. Fertil Steril. 2004;81(6):1707-9.##Var T, Tonguc E, Dogan M, Mollamahmutoglu L. Relationship between the oestradiol/oocyte ratio and the outcome of assisted reproductive technology cycles with gonadotropin releasing hormone agonist. Gynecol Endocrinol. 2011;27(8):558-61.##Loumaye E, Engrand P, Howles CM, O'Dea L. Assessment of the role of serum luteinizing hormone and estradiol response to follicle-stimulating hormone on in vitro fertilization treatment outcome. Fertil Steril. 1997;67(5):889-99.##Yang JH, Chen HF, Lien YR, Chen SU, Ho HN, Yang YS. Elevated E2: oocyte ratio in women undergoing IVF and tubal ET. Correlation with a decrease in the implantation rate. J Reprod Med. 2001;46(5):434-8.##Orvieto R, Zohav E, Scharf S, Rabinson J, Meltcer S, Anteby EY, et al. The influence of estradiol/follicle and estradiol/oocyte ratios on the outcome of controlled ovarian stimulation for in vitro fertilization. Gynecol Endocrinol. 2007;23(2):72-5.##Lai Q, Zhang H, Zhu G, Li Y, Jin L, He L, et al. Comparison of the GnRH agonist and antagonist protocol on the same patients in assisted reproduction during controlled ovarian stimulation cycles. Int J Clin Exp Pathol. 2013;6(9):1903-10.##Rocha JC, Passalia F, Matos FD, Maserati MP Jr, Alves MF, Almeida TG, et al. Methods for assessing the quality of mammalian embryos: How far we are from the gold standard? JBRA Assist Reprod. 2016;20(3):150-8.##Diedrich K, Fauser BC, Devroey P, Griesinger G. The role of the endometrium and embryo in human implantation. Hum Reprod Update. 2007;13(4):365-77.##Erzincan SG, Esmer AC, Baysal B. Does the estradiol level on the day of human chorionic gonadotropin administration predict the clinical outcome of controlled ovarian hyperstimulation? Clin Exp Obstet Gynecol. 2013;41(6):709-12.##Kara M, Kutlu T, Sofuoglu K, Devranoglu B, Cetinkaya T. Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome. Int J Reprod Biomed. 2012;10(1):53-8.##Mittal S, Gupta P, Malhotra N, Singh N. Serum estradiol as a predictor of success of in vitro fertilization. J Obstet Gynaecol India. 2014;64(2):124-9.##Valbuena D, Martin J, de Pablo JL, Remohí J, Pellicer A, Simón C. Increasing levels of estradiol are deleterious to embryonic implantation because they directly affect the embryo. Fertil Steril. 2001;76(5):962-8.##Simon C, Cano F, Valbuena D, Remohí J, Pellicer A. Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Hum Reprod. 1995;10(9):2432-7.##Forman R, Fries N, Testart J, Belaisch-Allart J, Hazout A, Frydman R. Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation. Fertil Steril. 1988;49(1):118-22.##Loutradis D, Beretsos P, Arabatzi E, Anagnostou E, Drakakis P. The role of steroid hormones in ART. J Steroid Biochem Mol Biol. 2008;112(1-3):1-4.##Vaughan DA, Harrity C, Sills ES, Mocanu EV. Serum estradiol: oocyte ratio as a predictor of reproductive outcome: an analysis of data from> 9000 IVF cycles in the Republic of Ireland. J Assist Reprod Genet. 2016;33(4):481-8.##

Analysis of a Preimplantation Genetic Test for Aneuploidies in Embryos from Colombian Couples: A Report of Cases 2 1 2 Background: Assisted reproduction techniques (ARTs) and the preimplantation genetic test for aneuploidies (PGT-A) help couples with fertility problems to achieve a healthy live birth around the world. The aim of this study was to determine the rate of whole chromosomal copy number variations in embryos from couples undergoing ART and PGT-A, associations of chromosomal variations with embryo morphological parameters, and their relationship to maternal age. Methods: This study included a retrospective analysis of the number of whole chromosomal copies identified by aCGH in embryos from couples undergoing ART. Results: Seventy-six embryos from 29 couples using their own gametes were analyzed, of which 25 (32.9%) were chromosomally normal, and 51 (67.1%) were abnormal. Eleven embryos were evaluated from the group of couples with donated gametes, of which 5 (45.4%) embryos were chromosomally normal, and 6 (54.5%) embryos were abnormal. The main aneuploidies observed were trisomy X (7.8%), trisomy 21 (5.9%), trisomy 9 (3.9%), monosomy 11 (3.9%), monosomy 13 (3.9%) and monosomy X (3.9%), and the principal chromosomes affected were 19, X and 13. A significant association was found between the quality of the embryo and the genetic condition: embryos with euploidy and aneuploidy (p=0.046). Conclusion: The rate of aneuploidies from couples with their own gametes was 67.1% (51/76) and from couples with donated eggs and / or sperm was 54.5% (6/11). The quality of the embryo determinated by the morphological parameters was not associated with the embryo genetic status, and also there was no association between maternal age and aneuploidy rate. 17 34 Diana D Cárdenas-Nieto Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Colombia Maribel M Forero-Castro Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Colombia Harold H Moreno-Ortiz Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Colombia Elkin E Lucena-Quevedo Fertility and Sterility Colombian Center (CECOLFES) Fertility and Sterility Colombian Center (CECOLFES) Colombia Juliana J Cuzzi Genesis Genetics Brasil, Laboratory PGD Genesis Genetics Brasil, Laboratory PGD Brazil Clara C Esteban-Pérez Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Biological Sciences Department, Biomedical Sciences Research Group, Universidad Pedagógica y Tecnológica de Colombia Colombia ciesteban@hotmail.com aCGHAssisted reproduction techniques (ARTs)Copy number variationsPreimplantation genetic test for aneuploidies (PGT-A)Preimplantation genetic test for aneuploidies (PGT-A) 60073.pdf Vanneste E, Voet T, Le Caignec C, Ampe M, Konings P, Melotte C, et al. Chromosome instability is common in human cleavage-stage embryos. Nat Med. 2009;15(5):577-83.##Yao G, Xu J, Xin Z, Niu W, Shi S, Jin H, et al. Developmental potential of clinically discarded human embryos and associated chromosomal analysis. Sci Rep. 2016;6:23995.##Oromendia AB, Amon A. Aneuploidy: implications for protein homeostasis and disease. Dis Model Mech. 2014;7(1):15-20.##Williams BR, Amon A. Aneuploidy: cancer’s Fatal Flaw? Cancer Res. 2009;69(13):5289-91.##Su Y, Li JJ, Wang C, Haddad G, Wang WH. Aneuploidy analysis in day 7 human blastocysts produced by in vitro fertilization. Reprod Biol Endocrinol. 2016;14:20.##Fiorentino F, Bono S, Biricik A, Nuccitelli A, Cotroneo E, Cottone G, et al. Application of next-generation sequencing technology for comprehensive aneuploidy screening of blastocysts in clinical preimplantation genetic screening cycles. Hum Reprod. 2014;29(12):2802-13.##Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, et al. Assited reproductive technology surveillance-United States, 2013. MMWR Surveill Summ. 2015;64(11):1-25.##Sullivan-Pyke C, Dokras A. Preimplantation genetic screening and preimplantation genetic diagnosis. Obstet Gynecol Clin North Am. 2018;45(1):113-25.##Zheng Z, Chen L, Yang T, Yu H, Wang H, Qin J. Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies. Reprod Biomed Online. 2018;36(4):472-82.##Kissin DM, Jamieson DJ, Barfield WD. Monitoring health outcomes of assisted reproductive technology. New Eng J Med. 2014;371(1):91-3.##Kang HJ, Melnick AP, Stewart JD, Xu K, Rosenwaks Z. Preimplantation genetic screening: who benefits? Fertil Steril. 2016;106(3):597-602.##Friedenthal J, Maxwell SM, Munne S, Kramer Y, McCulloh DH, McCaffrey C, et al. Next generation sequencing for preimplantation genetic screening improves pregnancy outcomes compared with array comparative genomic hybridization in single thawed euploid embryo transfer cycles. Fertil Steril. 2018;109(4):627-32.##Weissman A, Shoham G, Shoham Z, Fishel S, Leong M, Yaron Y. Preimplantation genetic screening: results of a worldwide web-based survey. Reprod Biomed Online. 2017;35(6):693-700.##Dahdouh EM, Balayla J, Garcia-Velasco JA. Comprehensive chromosome screening improves embryo selection: a meta-analysis. Fertil Steril. 2015;104(6):1503-12.##Minasi MG, Colasante A, Riccio T, Ruberti A, Casciani V, Scarselli F, et al. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Hum Reprod. 2016;31(10):2245-54.##Treff NR, Zimmerman RS. Advances in preimplantation genetic testing for monogenic disease and aneuploidy. Annu Rev Genomics Hum Genet. 2017;18:189-200.##Kaing A, Kroener LL, Tassin R, Li M, Liu L, Buyalos R, et al. Earlier day of blastocyst development is predictive of embryonic euploidy across all ages: essential data for physician decision-making and counseling patients. J Assist Reprod Genet. 2018;35(1):119-25.##Scott RT Jr, Upham KM, Forman EJ, Hong KH, Scott KL, Taylor D, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100(3):697-703.##Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656-63.e1.##Minasi MG, Fiorentino F, Ruberti A, Biricik A, Cursio E, Cotroneo E, et al. Genetic diseases and aneuploidies can be detected with a single blastocyst biopsy: a successful clinical approach. Hum Reprod. 2017;32(8):1770-7.##Fragouli E, Alfarawati S, Daphnis DD, Goodall NN, Mania A, Griffiths T, et al. Cytogenetic analysis of human blastocysts with the use of FISH, CGH and aCGH: scientific data and technical evaluation. Hum Reprod. 2011;26(2):480-90.##Petracchi F, Colaci DS, Igarzabal L, Gadow E. Cytogenetic analysis of first trimester pregnancy loss. Int J Gynaecol Obstet. 2009;104(3):243-4.##Gada Saxena S, Desai K, Shewale L, Ranjan P. Pre-implantation genetic screening using fluorescence in situ hybridization in couples of Indian ethnicity: is there a scope? J Hum Reprod Sci. 2014;7(1):25-9.##Aleksandrova N, Shubina E, Ekimov A, Kodyleva T, Mukosey I, Makarova N, et al. Comparison of the results of preimplantation genetic screening obtained by a-CGH and NGS methods from the same embryos. Gynecol Endocrinol. 2016;32(sup2):1-4.##Brezina PR, Anchan R, Kearns WG. Preimplantation genetic testing for aneuploidy: what technology should you use and what are the differences? J Assist Reprod Genet. 2016;33(7):823-32.##Garcia-Herrero S, Cervero A, Mateu E, Mir P, Poo ME, Rodrigo L, et al. Genetic analysis of human preimplantation embryos. Curr Top Dev Biol. 2016;120:421-47.##Liu J, Wang W, Sun X, Liu L, Jin H, Li M, et al. DNA microarray reveals that high proportions of human blastocysts from women of advanced maternal age are aneuploid and mosaic1. Biol Reprod. 2012;87(6):148.##Al-Asmar N, Peinado V, Vera M, Remohí J, Pellicer A, Simón C, et al. Chromosomal abnormalities in embryos from couples with a previous aneuploid miscarriage. Fertil Steril. 2012;98(1):145-50.##Goldman KN, Nazem T, Berkeley A, Palter S, Grifo JA. Preimplantation genetic diagnosis (PGD) for monogenic disorders: the value of concurrent aneuploidy screening. J Genet Couns. 2016;25(6):1327-37.##Whitney JB, Schiewe MC, Anderson RE. Single center validation of routine blastocyst biopsy implementation. J Assist Reprod Genet. 2016;33(11):1507-13.##Lai HH, Chuang TH, Wong LK, Lee MJ, Hsieh CL, Wang HL, et al. Identification of mosaic and segmental aneuploidies by next-generation sequencing in preimplantation genetic screening can improve clinical outcomes compared to array-comparative genomic hybridization. Mol Cytogenet. 2017;10:14.##Harton G, Braude P, Lashwood A, Schmutzler A, Traeger-Synodinos J, Wilton L, et al. ESHRE PGD consortium best practice guidelines for organization of a PGD centre for PGD/preimplantation genetic screening. Hum Reprod. 2011;26(1):14-24.##van Echten-Arends J, Mastenbroek S, Sikkema-Raddatz B, Korevaar JC, Heineman MJ, van der Veen F, et al. Chromosomal mosaicism in human preimplantation embryos: a systematic review. Hum Reprod Update. 2011;17(5):620-7.##Forman EJ, Tao X, Ferry KM, Taylor D, Treff NR, Scott RT. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27(4):1217-22.##Mir P, Mateu E, Mercader A, Herrer R, Rodrigo L, Vera M, et al. Confirmation rates of array-CGH in day-3 embryo and blastocyst biopsies for preimplantation genetic screening. J Assist Reprod Genet. 2016;33(1):59-66.##Kotdawala A, Patel D, Herrero J, Khajuria R, Mahajan N, Banker M. Aneuploidy screening by array comparative genomic hybridization improves success rates of in vitro fertilization: a multicenter Indian study. J Hum Reprod Sci. 2016;9(4):223-9.##Webster A, Schuh M. Mechanisms of aneuploidy in human eggs. Trends Cell Biol. 2017;27(1):55-68.##Bazrgar M, Gourabi H, Eftekhari-Yazdi P, Vazirinasab H, Fakhri M, Hassani F, et al. The effect of prolonged culture of chromosomally abnormal human embryos on the rate of diploid cells. Int J Fertil Steril. 2016;9(4):563-73.##Huang J, Zhao N, Wang X, Qiao J, Liu P. Chromosomal characteristics at cleavage and blastocyst stages from the same embryos. J Assist Reprod Genet. 2015;32(5):781-7.##Lee A, Kiessling AA. Early human embryos are naturally aneuploid-can that be corrected? J Assist Reprod Genet. 2017;34(1):15-21.##Goodrich D, Xing T, Tao X, Lonczak A, Zhan Y, Landis J, et al. Evaluation of comprehensive chromosome screening platforms for the detection of mosaic segmental aneuploidy. J Assist Reprod Genet. 2017;34(8):975-81.##Demko ZP, Simon AL, McCoy RC, Petrov DA, Rabinowitz M. Effects of maternal age on euploidy rates in a large cohort of embryos analyzed with 24-chromosome single-nucleotide polymorphism-based preimplantation genetic screening. Fertil Steril. 2016;105(5):1307-13.##Majumdar G, Majumdar A, Verma IC, Upadhyaya KC. Relationship between morphology, euploidy and implantation potential of cleavage and blastocyst stage embryos. J Hum Reprod Sci. 2017;10(1):49-57.##Fesahat F, Montazeri F, Sheikhha MH, Saeedi H, Dehghani Firouzabadi R, Kalantar SM. Frequency of chromosomal aneuploidy in high quality embryos from young couples using preimplantation genetic screening. Int J Reprod Biomed (Yazd). 2017;15(5):297-304.##Alfarawati S, Fragouli E, Colls P, Stevens J, Gutierrez-Mateo C, Schoolcraft WB, et al. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril. 2011;95(2):520-4.##Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. Aneuploidy across individual chromosomes at the embryonic level in trophectoderm biopsies: changes with patient age and chromosome structure. J Assist Reprod Genet. 2014;31(11):1501-9.##Eaton JL, Hacker MR, Barrett CB, Thornton KL, Penzias AS. Influence of patient age on the association between euploidy and day-3 embryo morphology. Fertil Steril. 2010;94(1):365-7.##Ubaldi FM, Cimadomo D, Capalbo A, Vaiarelli A, Buffo L, Trabucco E, et al. Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience. Fertil Steril. 2017;107(5):1173-80.##Capalbo A, Rienzi L, Cimadomo D, Maggiulli R, Elliott T, Wright G, et al. Correlation between standard blastocyst morphology, euploidy and implantation: an observational study in two centers involving 956 screened blastocysts. Hum Reprod. 2014;29(6):1173-81.##Mazzilli R, Cimadomo D, Vaiarelli A, Capalbo A, Dovere L, Alviggi E, et al. Effect of the male factor on the clinical outcome of intracytoplasmic sperm injection combined with preimplantation aneuploidy testing: observational longitudinal cohort study of 1,219 consecutive cycles. Fertil Steril. 2017;108(6):961-72.e3.##Soler A, Morales C, Mademont-Soler I, Margarit E, Borrell A, Borobio V, et al. Overview of chromosome abnormalities in first trimester miscarriages: a series of 1,011 consecutive chorionic villi sample karyotypes. Cytogenet Genome Res. 2017;152(2):81-9.##Freed D, Stevens EL, Pevsner J. Somatic mosaicism in the human genome. Genes (Basel). 2014;5(4):1064-94.##

Obesity and Infertility: A Metabolic Assessment Strategy to Improve Pregnancy Rate 2 1 2 Background: The metabolic global approach is a multidisciplinary intervention for obese women before undergoing assisted reproductive techniques, with the goal of improving fertility and decreasing adverse pregnancy outcomes. The objective of this study was to evaluate the impact of the metabolic global approach on pregnancy rate. Methods: This retrospective cohort study included 127 women and was conducted at the Centre hospitalier de l’Université de Montréal fertility center. Eligibility included BMI at initial consultation of ≥30 kg/m2. Fertility treatments were considered when a weight loss of minimum 5% and normal metabolic indices were achieved. The p<0.05 was considered statistically significant. Results: Median baseline and last clinical assessment BMIs were 38.2 kg/m² and 35.8 kg/m² respectively (p<0.001), representing a median weight loss of 5.1%. At baseline, at least one metabolic parameter was abnormal in 66% of women. Total pregnancy rate was 53%. The majority of women (63%) who achieved pregnancy did so with weight loss and metabolic stabilization alone (11%) or combined with metformin (36%) and/or oral ovulation drugs (16%). Normal vitamin D (p<0.001) and triglyceride levels (p<0.05) as well as lower BMI after weight loss (p<0.05) were associated with an increased relative risk of pregnancy. Conclusion: Replete vitamin D status, weight loss of 5% and lower BMI as well as normal triglyceride level are significant and independent predictors of pregnancy in obese women presenting to our fertility center. The metabolic global approach is an effective program to detect metabolic abnormalities and improve obese women’s pregnancy rate. 34 42 Rachel RR Bond Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Canada Alexandra A Nachef Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Canada Catherine C Adam Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Canada Marielle M Couturier Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Canada Isaac-Jacques IJ Kadoc Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Canada Louise L Lapensée Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Canada Gilles G Bleau Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Clinique de Procréation Assistée du Centre Hospitalier de l'Université de Montréal (CHUM), Department of Obstetrics and Gynecology, Montreal Canada Ariane A Godbout Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal Canada ariane.godbout.1@umontreal.ca Assisted reproductive technologyInfertilityMetabolic syndromeObesityVitamin D deficiency 60069.pdf Body mass index, overweight or obese, self-reported, adult, by age group and sex [Internet]. Canada: Statistics Canada; c2014-2017. Proportion of Overweight and Obese Women in Reproductive Age, Table 13-10-0096-20 (number of persons: 1,854,600); 2017 Nov 30 [cited December 21, 2017]; [about 1 screen]. Available from: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health81a-eng.htm##Bellver J, Ayllón Y, Ferrando M, Melo M, Goyri E, Pellicer A, et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertil Steril. 2010;93(2):447-54.##Luke B, Brown MB, Stern JE, Missmer SA, Fujimoto VY, Leach R. Female obesity adversely affects assisted reproductive technology (ART) pregnancy and live birth rates. Hum Reprod. 2011;26(1):245-52.##Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103(2):219-24.##Pinborg A, Gaarslev C, Hougaard C, Andersen AN, Andersen P, Boivin J, et al. Influence of female bodyweight on IVF outcome: a longitudinal multicentre cohort study of 487 infertile couples. Reprod Biomed Online. 2011;23(4):490-9.##Metwally M, Cutting R, Tipton A, Skull J, Ledger WL, Li TC. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online. 2007;15(5):532-8.##Sobaleva S, El-Toukhy T. The impact of raised BMI on the outcome of assisted reproduction: current concepts. J Obstet Gynaecol. 2011;31(7):561-5.##Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? a meta-analysis of the evidence. Fertil Steril. 2008;90(3):714-26.##Hollmann M, Runnebaum B, Gerhard I. Effects of weight loss on the hormonal profile in obese, infertile women. Hum Reprod. 1996;11(9):1884-91.##Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. Improving reproductive performance in overweight/obese women with effective weight management. Hum Reprod Update. 2004;10(3):267-80.##Chavarro JE, Ehrlich S, Colaci DS, Wright DL, Toth TL, Petrozza JC, et al. Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction. Fertil Steril. 2012;98(1):109-16.##Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13(6):1502-5.##Moran L, Tsagareli V, Norman R, Noakes M. Diet and IVF pilot study: short-term weight loss improves pregnancy rates in overweight/obese women undertaking IVF. Aust N Z J Obstet Gynaecol. 2011;51(5):455-9.##Yu CKH, Teoh TG, Robinson S. Obesity in pregnancy. BJOG An Int J Obstet Gynaecol. 2006;113:1117-25.##American college of obstetricians and gynecologists. ACOG committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013;121(1):213-7.##Al Awlaqi A, Alkhayat K, Hammadeh ME. Metabolic syndrome and infertility in women. Int J Women Health Reprod Sci. 2016;4(3):89-95.##Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690-3.##Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril. 2014;102(2):460-8.e3.##Paffoni A, Ferrari S, Viganò P, Pagliardini L, Papaleo E, Candiani M, et al. Vitamin D deficiency and infertility: Insights from in vitro fertilization cycles. J Clin Endocrinol Metab. 2014;99(11):E2372-6.##Aflatoonian A, Arabjahvani F, Eftekhar M, Sayadi M. Effect of vitamin D insufficiency treatment on fertility outcomes in frozen-thawed embryo transfer cycles: a randomized clinical trial. Iran J Reprod Med. 2014;12(9):595-600.##Lv SS, Wang JY, Wang XQ, Wang Y, Xu Y. Serum vitamin D status and in vitro fertilization outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet. 2016;293(6):1339-45.##Institude of medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino Acids. 1st ed. Washington, D.C.: National academies press; 2005. 1358 p.##Canadian society of exercise physiology. Canadian physical activity and sedentary behaviour guidelines. 2011. 32 p.##Wilson RD, Désilets V, Wyatt P, Langlosis S, Gagnon A, Allen V, et al. Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2007;29(12):1003-13.##Royal college of obstetricians and gynaecologists. Management of women with obesity in pregnancy. 2010. 31 p.##Canadian diabetes association clinical practice guidelines expert committee, Cheng AY. Canadian diabetes association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes. 2013; Suppl 1:S1-3.##Gallagher JC, Sai AJ. Vitamin D insufficiency, deficiency, and bone health. J Clin Endocrinol Metab. 2010;95(6):2630-3.##Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81.##Kort JD, Winget C, Kim SH, Lathi RB. A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril. 2014;101(5):1400-3.##Einarsson S, Bergh C, Friberg B, Pinborg A, Klajnbard A, Karlström PO, et al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod. 2017;32(8):1621-30.##Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50(12):1499-504.##Gower BA, Weinsier RL, Jordan JM, Hunter GR, Desmond R. Effects of weight loss on changes in insulin sensitivity and lipid concentrations in premenopausal African American and white women. Am J Clin Nutr. 2002;76(5):923-7.##Miglio C, Peluso I, Raguzzini A, Villaño D V, Cesqui E, Catasta G, et al. Antioxidant and inflammatory response following high-fat meal consumption inoverweight subjects. Eur J Nutr. 2013;52(3):1107-14.##Calabrò P, Golia E, Maddaloni V, Malvezzi M, Casillo B, Marotta C, et al. Adipose tissue-mediated inflammation: the missing link between obesity and cardiovascular disease? Intern Emerg Med. 2009;4(1):25-34.##Wlazlo N, van Greevenbroek MM, Ferreira I, Jansen EJ, Feskens EJ, van der Kallen CJ, et al. Low-grade inflammation and insulin resistance independently explain substantial parts of the association between body fat and serum C3: the CODAM study. Metabolism. 2012;61(12):1787-96.##Markert UR, Morales-Prieto DM, Fitzgerald JS. Understanding the link between the IL-6 cytokine family and pregnancy: implications for future therapeutics. Expert Rev Clin Immunol. 2011;7(5):603-9.##Chu J, Gallos I, Tobias A, Tan B, Eapen A, Coomarasamy A. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis. Hum Reprod. 2018;33(1):65-80.##Rabenberg M, Scheidt-Nave C, Busch MA, Rieckmann N, Hintzpeter B, Mensink GB. Vitamin D status among adults in Germany--results from the German health interview and examination survey for adults (DEGS1). BMC Public Health. 2010;15:641.##Kinuta K, Tanaka H, Moriwake T, Aya K, Kato S, Seino Y. Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads. Endocrinology. 2000;141(4):1317-24.##Johnson LE, DeLuca HF. Vitamin D receptor null mutant mice fed high levels of calcium are fertile. J Nutr. 2001;131(6):1787-91.##Dennis NA, Houghton LA, Pankhurst MW, Harper MJ, McLennan IS. Acute supplementation with high dose vitamin D3 increases serum anti-müllerian hormone in young women. Nutrients. 2017;9(7). pii: E719.##

Comparison of Continuous Epidural Infusion of Bupivacaine and Fentanyl Versus Patient Controlled Analgesia Techniques for Labor Analgesia: A Randomized Controlled Trial (RCT) 2 1 2 Background: To diminish labor pain, several techniques have been used in developed countries. In the current randomized controlled trial, the use of epidural analgesia via PCEA pump with and without background infusion of analgesic was studied. Methods: In this double-blinded controlled trial, 60 women were enrolled and randomly assigned to study groups for receiving epidural analgesia during labor. All patients received initial bullous dose including 125 mg bupivacaine and 3 mg/ml fentanyl, and the first group patient (CI) received background infusion of 8 ml/hr and the second group (PCEA) received 10 ml bullous dose of 125 mg bupivacaine combined with 100 mcg fentanyl (2 ml) via epidural catheter. The Visual Analogue Scale (VAS) of 0-10 was measured 20 min after drug injection. The chi-square and student T-test were used for comparing variables between groups, and 0.05 was considered as the level of significance. Results: There was no significant difference in terms of demographic variables. Mean duration of the second stage of labor was significantly lower in patients received continuous infusion (CI) (p<0.0001). However, the total administered fentanyl dose was significantly higher in patients who underwent PCEA (p<0.0001). Besides, the CI group had a significantly lower rate of patient-controlled injection compared to PCEA patients (p<0.0001). However, there was no significant difference between patients’ satisfaction and VAS in study groups. Conclusion: Epidural analgesia using PCEA combined with continuous infusion did not provide higher analgesia or patients’ satisfaction compared to PCEA alone; however, it led to a decreased rate of drug injection and total administered dosage. 42 49 Raha R Khaneshi Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Iran Sousan S Rasooli Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Iran Farnaz F Moslemi Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Department of Anesthesiology, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Iran Sanam S Fakour Department of Cardiothoracic Surgery, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Department of Cardiothoracic Surgery, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences Iran Sanam.fakour@gmail.com BupivacaineEpidural analgesiaFentanylLabor pain 60066.pdf Mousa WF, Al-Metwalli R, Mostafa M. Epidural analgesia during labor vs no analgesia: A comparative study. Saudi J Anaesth. 2012;6(1):36-40.##Chestnut DH, Wong CA, Tsen LC, Kee WDN, Beilin Y, Mhyre J. Chestnut's obstetric anesthesia: principles and practice. 5th ed. US: Elsevier Health Sciences; 2014. 1328 p.##Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's anesthesia. 8th ed. California: Elsevier Health Sciences; 2014. 3312 p.##Siddik-Sayyid SM, Taha S, Azar M, Hakki M, Yaman R, Baraka A, et al. Comparison of three doses of epidural fentanyl followed by bupivacaine and fentanyl for labor analgesia. Acta Anaesthesiol Scand. 2008;52(9):1285-90.##Kalra S, Saraswat N, Agnihotri G. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia. Saudi J Anaesth. 2010;4(3):178-81.##Gambling DR, Cole PYC, McMorland GH, Palmer L. A comparative study of patient controlled epidural analgesia (PCEA) and continuous infusion epidural analgesia (CIEA) during labour. Can J Anaesth. 1988;35(3 (Pt 1)):249-54.##Taylor HJ. Clinical experience with continuous epidural infusion of bupivacaine at 6 ml per hour in obstetrics. Can J Anesth J. 1983;30(3 Pt 1):277-85.##Lim Y, Ocampo CE, Supandji M, Teoh WH, Sia AT. A randomized controlled trial of three patient-controlled epidural analgesia regimens for labor. Anesth Analg. 2008;107(6):1968-72.##Ferrante FM, Rosinia FA, Gordon C, Datta S. The role of continuous background infusions in patient-controlled epidural analgesia for labor and delivery. Anesth Analg. 1994;79(1):80-4.##Petry J, Vercauteren M, Van Mol I, Van Houwe P, Adriaensen H. Epidural PCA with bupivacaine 0.125%, sufentanil 0.75 microgram and epinephrine 1/800.000 for labor analgesia: is a background infusion beneficial? Acta Anaesthesiol Belg. 2000;51(3):163-6.##Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S160-72.##Slade P, MacPherson S, Hume A, Maresh M. Expectations, experiences and satisfaction with labour. Br J Clin Psychol. 1993;32(Pt 4):469-83.##Hasanein R, El-sayed W, Khalil M. The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia. Egypt J Anaesth. 2013;29(3):219-24.##Srivastava U, Gupta A, Saxena S, Kumar A, Singh S, Saraswat N, et al. Patient controlled epidural analgesia during labour: effect of addition of background infusion on quality of analgesia & maternal satisfaction. Indian J Anaesth. 2009;53(6):649-53.##Bolukbasi D, Sener E, Sarihasan B, Kocamanoglu S, Tur A. Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia. Int J Obstet Anesth. 2005;14(4):288-93.##Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. 2005;103(6):1211-7.##Thorp JA, Breedlove G. Epidural analgesia in labor: an evaluation of risks and benefits. Birth. 1996;23(2):63-83.##De Tommaso O, Caporuscio A, Tagariello V. Neurological complications following central neuraxial blocks: are there predictive factors? Eur J Anaesthesiol. 2002;19(10):705-16.##Horlocker TT. Complications of spinal and epidural anesthesia. Anesthesiol Clin North Am. 2000;18(2):461-85.##Bremerich DH, Waibel HJ, Mierdl S, Meininger D, Byhahn C, Zwissler B, et al. Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia (PCEA) using ropivacaine combined with sufentanil for labor and delivery. Int J Obstet Anesth. 2005;14(2):114-20.##Okutomi T, Saito M, Mochizuki J, Amano K, Hoka S. A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain. Int J Obstet Anesth. 2009;18(1):28-32.##Halpern SH, Carvalho B. Patient-controlled epidural analgesia for labor. Anesth Analg. 2009;108(3):921-8.##Vallejo MC, Ramesh V, Phelps AL, Sah N. Epidural labor analgesia: continuous infusion versus patient-controlled epidural analgesia with background infusion versus without a background infusion. J Pain. 2007;8(12):970-5.##

Failure in Identity Building as the Main Challenge of Infertility: A Qualitative Study 2 1 2 Background: The approach of considering the psychosocial consequences of infertility has become significant. Psychosocial outcomes of infertility are defined and shaped in the context of the particular social and cultural conditions. Childbearing, and raising a child are considered to be the core of "identity" in many collectivist cultures, and the status provided to individuals with children is accompanied with social acceptance and approval. In such societies, infertile people see their social identity seriously damaged. The purpose of this study was to comprehend the challenge of identity crisis of infertile people in Iran for helping to formulate support programs for policy makers. Methods: This qualitative study was conducted in 2016-2018, through semi-structured interviews conducted with 40 infertile clients of Avicenna Fertility Center. Data were analyzed by Strauss and Corbin coding paradigm. Results: The core of the phenomenon of psychosocial consequences of infertility was failure in identity building, which included the main categories of prevention from continuity and prevention of forming normative identity. Conclusion: Challenge of identity crisis based on the experience of infertile people and the social construction of infertility in their minds affects not only internal, external, personal and structural factors, but it is also a kind of identity search in individuals. Regarding this fact, providing appropriate social services and training the skills needed to rebuild identity of infertile people and their social health will be very effective. 49 59 Shaghayegh Sh Alamin Department of social work, Faculty of Social Sciences, Allameh Tabataba'i University Department of social work, Faculty of Social Sciences, Allameh Tabataba'i University Iran shaghayeghalamin@gmail.com Tallat T Allahyari Department of social work, Faculty of Social Sciences, Allameh Tabataba'i University Department of social work, Faculty of Social Sciences, Allameh Tabataba'i University Iran Behzad B Ghorbani بهزاد قربانی Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Nanobiotechnology Research Center, Avicenna Research Institute, ACECR Iran Ali A Sadeghitabar Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Avicenna Infertility Clinic, Avicenna Research Institute, ACECR Iran Mohammad Taghi MT Karami Department of Women's Studies, Faculty of Social Sciences, Allameh Tabataba'i University Department of Women's Studies, Faculty of Social Sciences, Allameh Tabataba'i University Iran Blood connectionCounselingCultureFemininityIdentityInfertilityMasculinitySocial context 60064.pdf Berek JS. Berek & Novak’s gynecology. 14th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. 1695 p.##Vayena E, Rowe PJ, Griffin PD. Current practices and controversies in assisted reproduction: report of a meeting on medical, ethical and social aspects of assisted reproduction, held at WHO Headquarters in Geneva, Switzerland. World Health Organization; 2002. 404 p.##Matsubayashi H, Hosaka T, Izumi S, Suzuki T, Ma-kino T. Emotional distress of infertile women in Japan. Hum Reprod. 2001;16(5):966-9.##Fido A, Zahid MA. Coping with infertility among Kuwaiti woman: cultural perspectives. Int J Soc Psychiatry. 2004;50(4):294-300.##van Rooji FB, Van Balen F, Hermanns JM. Emotional distress and infertility: Turkish migrant couples compared to Dutch couples in western Turkey. J Psychosom Obstet Gynaecol. 2007;28(2):87-95.##Becker G, Becker G. The elusive embryo: how women and men approach new reproductive techno-logies. 1st ed. California: University of California Press; 2000. 330 p.##Clarke LH, Martin-Matthews AN, Matthews R. The continuity and discontinuity of the embodied self in infertility. Can Rev Sociol. 2006;43(1):95-113.##Earl S, Letherby G. Conceiving time? women who do or do not conceive. Sociol Health Illn. 2007;29 (2):233-50.##Johanson M, Berg M. Women’s experience of childlessness: 2 years after the end of in vitro fertilization treatment. Scand J Caring Sci. 2005;19(1):58-63.##Redshaw M, Hockley C, Davidson LL. A qualitative study of the experience of treatment for infertility among women who successfully became pre-gnant. Hum Reprod. 2007;22(1):295-304.##Mumtaz Z, Shahid U, Levay A. Understanding the impact of gendered roles on the experience of infertility amongst men and women in Punjab. Reprod Health. 2013;10:3.##Greil AL. Not yet pregnant: infertile couples in contemporary America. 1st ed. US: New Brunswick N.J., University Press; 1991. 243 p.##Pashigian MJ. Conceiving the happy family: infertility and marital politics in northern Vietnam. In: Inhorn MC, Balen FV, editors. Infertility around the globe: new thinking on childlessness, gender and reproductive technologies. California: University of California Press; 2002. p. 134-51.##Greil AL. Infertile bodies: medicalization, metaphor, and agency. In: Inhorn MC, Balen FV, editors. Infertility around the globe: new thinking on childlessness, gender and reproductive technologies. California: University of California Press; 2002. p. 101-18.##Barden-O’Fallon J. Associates of self-reported fertility status and infertility treatment seeking in a rural district of Malawi. Hum Reprod. 2005;20(8):2229-36.##Greil AL. Not yet pregnant: infertile couples in contemporary America. 1st ed. New Brunswick NJ: Rugers University Press; 1991. 51 p.##Ahuja M. Counseling in infertility: south asian federation of obstetrics and gynecology. J SAFOG. 2009;1(2):38-43.##Gibsin DM. The relationship of infertility and death: Using the relational/cultural model of counseling in making meaning. Humanist Psychol. 2007; 35:275-89.##Inhorn MC. Sexuality, masculinity and infertility in Egypt: potent troubles in the marital and medical encounter. J Mens Stud. 2008;10(3):343-59.##Bos H, Van Balen F, Visser A. Social and cultural factors in infertility and chillessness. Patient Educ Couns. 2005;59(3):223-5.##Spannagel C, Glaser-Zikuda M, Shroeder U. Application of qualitative content analysis in user pro-gram interaction research. Forum Qual Soc Res. 2005;6(2).##Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed.Thousands Oaks, CA: Sage Publications, Inc; 2008. 358 p.##Polit DF, Beck CT. Essentials of nursing research: methods, appraisal and utilization. 6th ed. Phliade- lphia: Lippincott Williams and Wilkins; 2006. 554 p.##Lampman C, Dowling-Guyer S. Attitudes toward voluntary and involuntary childlessness. Basic Appl Soc Psych. 1995;17:213-22.##Al-e-Ahmad J. A stone on a grave. 1st ed. CA: Mazda Publishers; 2008. 122 p.##Harris D.L; Daniluk JC. The experience of spontaneous pregnancy loss for infertile women who have conceived through assisted reproduction tech-nology. Hum Reprod. 2010;25(3):714-20.##Haghighatian M, Haghighat F, Rostami Z. Social consequences of infertility on families in the city of Isfahan. Int J Arts Humanit. 2014;10(2):355-61.##Anderson KM, Sharpe M, Ratlary A, Irvine DS. Distress and concernes in couples referred to a spe-cialist infertility clinic. J Psychosom Res. 2003;54 (4):353-5.##Holter H, Anderheim L, Bergh C, Moller A. First IVF treatment- Short-term impact on Psychological well-being and the marital relationship. Hum Reprod. 2006;21(12):3295-302.##Slade P, O'Neill C, Simpson AJ, Lashen H. The re-lationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Hum Reprod. 2007;22(8):2309-17.##

Alteration in Expression of Primordial Germ Cell (PGC) Markers During Induction of Human Amniotic Mesenchymal Stem Cells (hAMSCs) 2 1 2 Background: Currently, scientists are looking for a solution to the problem of the couples who have a lack of germ cells by through cell therapy. It is found that human amniotic membrane mesenchymal stem cells (hAMSCs) could be a good candidate for solving this problem. In the present study, an attempt was made to show that hUMSCs can express the PGC markers in the presence of retinoic acid (RA). Methods: Placenta was obtained from healthy mothers and amniotic stem cells were isolated by enzymatic method from amniotic membrane. The cells were treated by retinoic acid for 14 days. Mesenchymal properties of hAMSCs were assessed by flow-cytometry and expression of PGC markers was established by Q-PCR. Results: Mesenchymal stem cell properties were confirmed by antibodies against mesenchymal stem cell markers (CD73, CD90, and CD105). After that, the expression of the C-kit, Oct4, SSEA4, VASA genes were determined as primordial germ cell markers using quantitative PCR. It was found that the use of retinoic acid led to the highest expression of C-kit, SSEA4, VASA genes and lower expression of Oct4. Conclusion: Our study indicates that retinoic acid can be used as a suitable factor for induction of hAMSCs into primordial germ cells (PGCs) and hAMSCs have enough potential to do that. 59 65 Farzane F Alifi Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences Iran Hamid Reza HR Asgari Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences Iran asgari.hr@iums.ac.ir AmnionCell differentiationGerm cellsMesenchymal stem cellsRetinoic acid 60065.pdf Hull M. Infertility treatment: relative effectiveness of conventional and assisted conception methods. Hum Reprod. 1992;7(6):785-96.##Zuba‐Surma EK, Kucia M, Ratajczak J, Ratajczak MZ. “Small stem cells” in adult tissues: very small embryonic‐like stem cells stand up! Cytometry A. 2009;75(1):4-13.##Hass R, Kasper C, Böhm S, Jacobs R. Different populations and sources of human mesenchymal stem cells (MSC): a comparison of adult and neonatal tissue-derived MSC. Cell Commun Signal. 2011;9:12.##Lodi D, Iannitti T, Palmieri B. Stem cells in clinical practice: applications and warnings. J Exp Clin Cancer Res. 2011;30:9.##Pittenger MF. Mesenchymal stem cells. In: Kadereit S, Udolph G, editors. Umbilical cord blood: a future for regenerative medicine? Singapore: World Scientific; 2011. p. 91-104.##Lacham‐Kaplan O, Chy H, Trounson A. Testicular cell conditioned medium supports differentiation of embryonic stem cells into ovarian structures containing oocytes. Stem Cells. 2006;24(2):266-73.##Nayernia K, Nolte J, Michelmann HW, Lee JH, Rathsack K, Drusenheimer N, et al. In vitro-differentiated embryonic stem cells give rise to male gametes that can generate offspring mice. Dev Cell. 2006;11(1):125-32.##In't Anker PS, Scherjon SA, Kleijburg-van der Keur C, de Groot-Swings G, Claas F, Fibbe WE, et al. Isolation of mesenchymal stem cells of fetal or maternal origin from human placenta. Stem Cells. 2004;22(7):1338-45.##Alviano F, Fossati V, Marchionni C, Arpinati M, Bonsi L, Franchina M, et al. Term amniotic membrane is a high throughput source for multipotent mesenchymal stem cells with the ability to differentiate into endothelial cells in vitro. BMC Dev Biol. 2007;7:11.##Mihu CM, Rus Ciuca D, Soritau O, Susman S, Mihu D. Isolation and characterization of mesenchymal stem cells from the amniotic membrane. Rom J Morphol Embryol. 2009;50(1):73-7.##Cai J, Li W, Su H, Qin D, Yang J, Zhu F, et al. Generation of human induced pluripotent stem cells from umbilical cord matrix and amniotic membrane mesenchymal cells. J Biol Chem. 2010;285(15):11227-34.##Whittle WL, Gibb W, Challis JR. The characterization of human amnion epithelial and mesenchymal cells: the cellular expression, activity and glucocorticoid regulation of prostaglandin output. Placenta. 2000;21(4):394-401.##Malhotra C, Jain AK. Human amniotic membrane transplantation: Different modalities of its use in ophthalmology. World J Transplant. 2014;4(2):111-21.##Song SH, Kumar BM, Kang EJ, Lee YM, Kim TH, Ock SA, et al. Characterization of porcine multipotent stem/stromal cells derived from skin, adipose, and ovarian tissues and their differentiation in vitro into putative oocyte-like cells. Stem Cells Dev. 2011;20(8):1359-70.##Bowles J, Koopman P. Retinoic acid, meiosis and germ cell fate in mammals. Development. 2007;134(19):3401-11.##Friedenstein AJ, Gorskaja J, Kulagina NN. Fibroblast precursors in normal and irradiated mouse hematopoietic organs. Exp Hematol. 1976;4(5):267-74.##Hübner K, Fuhrmann G, Christenson LK, Kehler J, Reinbold R, De La Fuente R, et al. Derivation of oocytes from mouse embryonic stem cells. Science. 2003;300(5623):1251-6.##Nayernia K, Lee JH, Drusenheimer N, Nolte J, Wulf G, Dressel R, et al. Derivation of male germ cells from bone marrow stem cells. Lab Invest. 2006;86(7):654-63.##Huang P, Lin LM, Wu XY, Tang QL, Feng XY, Lin GY, et al. Differentiation of human umbilical cord Wharton's jelly‐derived mesenchymal stem cells into germ‐like cells in vitro. J Cell Biochem. 2010;109(4):747-54.##Asgari HR, Akbari M, Abbasi M, Ai J, Korouji M, Aliakbari F, et al. Human wharton’s jelly-derived mesenchymal stem cells express oocyte developmental genes during co-culture with placental cells. Iran J Basic Med Sci. 2015;18(1):22-9.##Afsartala Z, Rezvanfar MA, Hodjat M, Tanha S, Assadollahi V, Bijangi K, et al. Amniotic membrane mesenchymal stem cells can differentiate into germ cells in vitro. In Vitro Cell Dev Biol Anim. 2016;52(10):1060-71.##Samsonraj RM, Rai B, Sathiyanathan P, Puan KJ, Rötzschke O, Hui JH, et al. Establishing criteria for human mesenchymal stem cell potency. Stem Cells. 2015;33(6):1878-91.##Kim EY, Lee KB, Kim MK. The potential of mesenchymal stem cells derived from amniotic membrane and amniotic fluid for neuronal regenerative therapy. BMB Rep. 2014;47(3):135-40.##Drusenheimer N, Wulf G, Nolte J, Lee JH, Dev A, Dressel R, et al. Putative human male germ cells from bone marrow stem cells. Soc Reprod Fertil Suppl. 2007;63:69-76.##Geijsen N, Horoschak M, Kim K, Gribnau J, Eggan K, Daley GQ. Derivation of embryonic germ cells and male gametes from embryonic stem cells. Nature. 2004;427(6970):148-54.##Ghasemzadeh‐Hasankolaei M, Eslaminejad M, Batavani R, Sedighi‐Gilani M. Comparison of the efficacy of three concentrations of retinoic acid for transdifferentiation induction in sheep marrow‐derived mesenchymal stem cells into male germ cells. Andrologia. 2014;46(1):24-35.##Asgari HR, Akbari M, Yazdekhasti H, Rajabi Z, Navid S, Aliakbari F, et al. Comparison of human amniotic, chorionic, and umbilical cord multipotent mesenchymal stem cells regarding their capacity for differentiation toward female germ cells. Cell Reprogram. 2017;19(1):44-53.##Nejad NA, Amidi F, Hoseini MA, Nia KN, Habibi M, Kajbafzadeh AM, et al. Male germ-like cell differentiation potential of human umbilical cord Wharton's jelly-derived mesenchymal stem cells in co-culture with human placenta cells in presence of BMP4 and retinoic acid. Iran J Basic Med Sci. 2015;18(4):325-33.##Shenefelt RE. morphogenesis of malformations in hamsters caused by retinoic acid: relation to dose and stage at treatment. Teratology. 1972;5(1):103-18.##Eguizabal C, Shovlin TC, Durcova-Hills G, Surani A, McLaren A. Generation of primordial germ cells from pluripotent stem cells. Differentiation. 2009;78(2-3):116-23.##Miki T, Strom SC. Amnion-derived pluripotent/multipotent stem cells. Stem Cell Rev. 2006;2(2):133-42.##Ghasemzadeh‐Hasankolaei M, Sedighi‐Gilani M, Eslaminejad M. Induction of ram bone marrow mesenchymal stem cells into germ cell lineage using transforming growth factor‐β superfamily growth factors. Reprod Domest Anim. 2014;49(4):588-98.##Gang EJ, Bosnakovski D, Figueiredo CA, Visser JW, Perlingeiro RC. SSEA-4 identifies mesenchymal stem cells from bone marrow. Blood. 2007;109(4):1743-51.##Yoshizaki G, Sakatani S, Tominaga H, Takeuchi T. Cloning and characterization of a vasa‐like gene in rainbow trout and its expression in the germ cell lineage. Mol Reprod Dev. 2000;55(4):364-71.##Hussain SR, Naqvi H, Ahmed F, Babu SG, Bansal C, Mahdi F. Identification of the c-kit gene mutations in biopsy tissues of mammary gland carcinoma tumor. J Egypt Natl Canc Inst. 2012;24(2):97-103.##

Robertsonian and Balanced Reciprocal Translocation in Both Child and Mother with a History of Recurrent Abortions 2 1 2 Background: Similar rare Robertsonian and balanced reciprocal translocation in both child and mother with a history of multiple miscarriages in the first trimester was the motive to write this case report. Cytogenetic analysis helps in genetic counselling of infertility, BOH and dysmorphology which in turn helps in pre implantation genetic testing. Although many case reports have already been published about Robertsonian and balanced translocations, this is the first case report in India which showed both types of translocation in the same patient, rob (13;14) and t (4;7). Interestingly, in the same patient, same translocations were also identified in the mother and father having no chromosomal abnormalities. Case Presentation: Proband with dysmorphology was refered first for karyotyping and later parental karyotyping was performed. Conclusion: Cytogenetic analysis plays an important role in the diagnosis and management of disease along with prenatal screening. 65 68 Subhadra S Poornima Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar India subhadrapoornima1@gmail.com Swarnalatha S Daram Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar India Rama R Krishna Department of Biochemistry, Kamineni Academy of Medical Sciences and Research Centre, LB Nagar Department of Biochemistry, Kamineni Academy of Medical Sciences and Research Centre, LB Nagar India Hasan H Qurratulain Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar Department of Genetics and Molecular Medicine, Kamineni Hospitals, L.B. Nagar India CounsellingCulturingReciprocal translocationRobertsonian translocation 60067.pdf Alfarawati S, Fragouli E, Colls P, Wells D. Embryos of robertsonian translocation carriers exhibit a mitotic interchromosomal effect that enhances genetic instability during early development. PLoS Genet. 2012;8(10):e1003025.##Arsham MS, Barch MJ, Lawce HJ, editors. The AGT cytogenetics laboratory manual. 4th ed. US: John Wiley & Sons; 2017. 1103 p.##Bowser-Riley SM, Griffiths MJ, Creasy MR, Farndon PA, Martin KE, Thomson DA, et al. Are double translocations double trouble? J Med Genet. 1988;25(5):326-31.##Crolla JA, Youings SA, Ennis S, Jacobs PA. Supernumerary marker chromosomes in man: parental origin, mosaicism and maternal age revisited. Eur J Hum Genet. 2005;13(2):154-60.##Keymolen K, Van Berkel K, Vorsselmans A, Staessen C, Liebaers I. Pregnancy outcome in carriers of Robertsonian translocations. Am J Med Genet A. 2011;155(10):2381-5.##Kochhar PK, Ghosh P. Reproductive outcome of couples with recurrent miscarriage and balanced chromosomal abnormalities. J Obstet Gynaecol Res. 2013;39(1):113-20.##Miryounesi M, Diantpour M, Motevaseli E, Ghafouri-Fard S. Homozygosity for a Robertsonian translocation (13q; 14q) in a phenotypically normal 44, xx female with a history of recurrent abortion and a normal pregnancy outcome. J Reprod Infertil. 2016;17(3):184-7.##Ogilvie CM, Braude P, Scriven PN. Successful pregnancy outcomes after preimplantation genetic diagnosis (PGD) for carriers of chromosome translocations. Hum Fertil. 20011;4(3):168-71.##Tempest HG, Cheng SY, Gillott DJ, Handyside AH, Thornhill AR, Griffin DK. Scoring of sperm chromosomal abnormalities by manual and automated approaches: qualitative and quantitative comparisons. Asian J Androl. 2010;12(2):257-62.##