The Culprit of Increased Complaints in IVF Clinics: New Technologies or the Growing IVF Popularity? 2 1 2 In the field of medical services, there are few treatment procedures with failure rate of more than 60-70%. Although infertile couples, as recipients of the service, are educated about the low odds of IVF success, many accept to undergo this practice. The success of infertility treatment and live birth depends on numerous factors including cause of infertility, couple’s age, duration of infertility, number of previous treatment cycles, etc. Despite many advances in the diagnosis and treatment of infertility and use of various medical and surgical methods plus add-ons, there is no definitive procedure to guarantee the success of IVF due to unexplained causes of infertility in some couples. Considering the psychological burden and high costs of repeated treat-ment cycles, sometimes couples attribute recurrent failures to recklessness, negligence, and malpractice of the physician and the medical team, so that the development of negative mindset makes the couples determined to file medical malpractice lawsuits against the health professionals. However, in other cases, the couples might make complaints following the successful treatment and birth of their babies. These cases often occur due to some unwanted mistakes such as gamete and embryo mix-ups or the presence of some preventable defects and neonatal disorders and diseases, especially after using preimplantation genetic testing (PGT) technique which has recently become more popular in most IVF clinics (1). During the last two decades, significant improvement has been made in the field of reproductive medicine, especially the clinical embryology and IVF lab, which has completely revolutionized the diagnosis and treat-ment of infertility. In addition, similar advances have been made in the field of medical genetics, performed in IVF centers, that enabled the physicians to prevent the birth of offspring with genetic defects through preim-plantation embryo evaluation. These techniques provide an opportunity for couples who cannot deliver a healthy child despite their fertility. Although the advancement of these techniques has opened new horizons in the field of reproductive medicine and increased the quality of services in IVF clinics, many ethical and legal challenges have also been emerged in applying the new techniques (2). Now, a significant question arises as to whether the number of complaints in IVF clinics is different from other specialized fields of medicine. Is the increase in the number of patients' complaints ahead of the develop-ment in diagnosis and treatment methods in different societies? Is the number of complaints the same or different in all specialized areas in ART, and whether the differences are the result of controversies in using ARTs in specific cases. Finally, is it ever possible to reduce the number of complaints against doctors and treatment teams by changing and modifying the existing approaches in the diagnosis and treatment of inferti-lity? Sometimes the treatment team is sued for refusing to provide medical care that is professionally inappropriate. The medical team involved in the treatment of infertility may not suggest certain techniques for some couples as they are aware of the subsequent medical problems and complications in the future. Physicians are legally and ethically entitled to exercise a conscientious objection to providing services that they have assessed as not being clinically appropriate or not of overall benefit to the health of the mother or the resulting fetus. As an enacted legislation in many countries, physicians may choose to opt out of providing ineffective treatments. In the context of assisted reproductive technologies (ARTs), there is no obligation to exercise a certain practice when the risk of treatment is too high and it potentially puts the patient's health and life at serious risk. For example, it is prohibited to transfer embryo to aged women (over 50) or transfer embryo to women with serious cardiovascular and pulmonary diseases, women with a family history of cancer or treated cancer with the risk of recurrence, and many other cases for whom the probability of adverse health effects is estimated to be high. Therefore, the physician is legally responsible in case of providing above services. While the infertile couple may sometimes be very insistent on undergoing the treatment and waive any future claims for these services, they may deny full responsibilities for the consequences in the future which might jeopardize the physician’s condition. In addition, some treatments would not lead to physical or life-threatening harm to the patient, such as the transfer of aneuploid embryos or the transfer of in vitro arrested embryos to uterus. Yet, the practice is contrary to scientific standards and common moral values and principles (3). Another example of these lawsuits is the damage to the embryos in the process of freezing, failure of embryo storage, and loss of all embryos for many couples. Although the development and improvement of cryo-preservation and storage of gametes and embryos, especially the vitrification, has fundamentally increased the success of ART, management of legal concerns for service providers is still a vexing challenge. In spite of the fact that few cases of above examples have been reported so far, the profound impact of such disastrous events has attracted the media coverage and led to serious financial crimes and even closure of the IVF clinic. Therefore, such concern requires a review of strategies in providing these services, the use of more reliable and precise tools and equipment, comprehensive consultation with the couples about the entire process, obtaining the essential informed consent, and using sufficient insurance coverage, which will, to some extent, eliminate the problems and concerns of the medical team and couples who own the embryos (4). Review of complaints in IVF clinics around the world provides insight into areas of practice that may require modifications in procedures or patients’ consultation. The medical team and managers of IVF clinics should actively involve in quality improvement activities to facilitate the identification of high-risk areas. Total quality management, risk assessment, and root cause analysis (RCA) are ideal tools for reducing errors, shortcomings or unfortunate events that endanger the patients’ health and safety. Unlike specialties and fields such as anesthesia, surgery, obstetrics and gynecology, the number and rates of risk profiles, claims, and court out-comes are not precisely reported in reproductive endocrinology and infertility (REI) and clinical embryology field which are helpful tools in risk reduction and improvement of patient care. A better understanding of past and emerging trends in claims in IVF practices can identify areas of vulnerability to malpractice. This strategy would culminate in a smart change in diagnostic approaches, counseling and selection of treatment plan, thereby addressing the interests of both the patients and service providers. For example, if PGT or embryology lab errors are the reasons for many claims or serious financial burdens, these services must be scrutinized more meticulously to identify high-risk areas and subsequently opt for the best preventive actions or change of protocols (5). IVF clinics, like other medical centers, have the responsibility to provide standard and professional care and efficient services to their patients. They must assure their patients that the operations will not damage their gametes, embryos, or child. Infertility specialists are also responsible for providing accurate and complete information to patients in choosing the best treatment plan and also giving advice when discontinuation of treatment is to their benefit. Clinicians should provide counseling to couples about the option of preim-plantation genetic testing because if the IVF center and physician do not provide PGT services to a carrier couple and subsequently deliver a baby with a detectable genetic defect, both the physician and the IVF center will be responsible for the malpractice. Conversely, if patients request for genetic testing of their embryos but the medical team and clinic fail to perform successful PGT and transfer genetically abnormal embryo resulting in a child with birth defects, the clinicians will definitely be liable for malpractice. This is just an example of the extraordinary sensitivity of the critical practice of IVF. Since numerous services at IVF clinics are offered as available alternatives for the couples, legal and moral responsibilities of IVF clinics reach significance and negligence in addressing the challenges increases the number of patients’ complaints. Therefore, IVF clinics and the medical teams can be held accountable for all mistakes, negligence or failure in treatment, and possible injuries to the patients or their future child. 067 69 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 140180.pdf Nesbit C, Porter MB, Esfandiari N. Catastrophic human error in assisted reproductive technologies: a systematic review. J Patient Saf. 2022;18(1):e267-e74.##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.##Daar J. Physician autonomy or discrimination: the risks and limits of saying "no". Fertil Steril. 2021;115(2):263-7.##Letterie G, Fox D. Lawsuit frequency and claims basis over lost, damaged, and destroyed frozen embryos over a 10-year period. Fertil Steril Rep. 2020;1(2):78-82.##Letterie G. Outcomes of medical malpractice claims in assisted reproductive technology over a 10-year period from a single carrier. J Assist Reprod Genet. 2017;34(4):459-63.##

Evaluation of L-Carnitine Potential in Improvement of Male Fertility 2 1 2 L-carnitine, through its antioxidant potential, plays a significant role in reducing ROS production in male genital tract; therefore, fundamental improvements in spermatogenesis process and sperm structural and functional parameters in seminal plasma can be observed by treatment with L-carnitine. A literature search was performed using PubMed (including Medline) from the database earliest inception to 2021. Eligibility criteria included studies on protective effects of L-carnitine against damages to the male reproductive system. Based on the findings of the current study, L-carnitine has an effective potential to protect testis and improve conventional and functional sperm parameters against ROS-induced damages by sperm cryopreservation, busulfan treatment, and radiation. 069 85 Leila L Kooshesh Department of Genetics, Fars Academic Center for Education, Culture and Research, ACECR Department of Genetics, Fars Academic Center for Education, Culture and Research, ACECR Iran Zohre Z Nateghian Islamic Azad University of Isfahan (Khorasgan) Branch Islamic Azad University of Isfahan (Khorasgan) Branch Iran Elham E Aliabadi Elham Aliabadi Department of Anatomy, Faculty of Medicine, Shiraz University of Medical Sciences Department of Anatomy, Faculty of Medicine, Shiraz University of Medical Sciences Iran aliabade@sums.ac.ir BusulfanL-carnitineMale fertilityRadiationSperm cryopreservation 140181.pdf D’Antona G, Nabavi SM, Micheletti P, Di Lorenzo A, Aquilani R, Nisoli E, et al. Creatine, L-carnitine, and ω 3 polyunsaturated fatty acid supplementation from healthy to diseased skeletal muscle. Biomed Res Int. 2014;2014:613890.##Li LY, Lu DL, Jiang ZY, Limbu SM, Qiao F, Chen LQ, et al. Dietary L-carnitine improves glycogen and protein accumulation in Nile tilapia via increasing lipid-sourced energy supply: an isotope-based metabolic tracking. Aquac Rep. 2020;17:100302. ##Talenezhad N, Mohammadi M, Ramezani-Jolfaie N, Mozaffari-Khosravi H, Salehi-Abargouei A. Effects of L-carnitine supplementation on weight loss and body composition: a systematic review and meta-analysis of 37 randomized controlled clinical trials with dose-response analysis. Clin Nutr ESPEN. 2020;37:9-23.##Askarpour M, Hadi A, Symonds ME, Miraghajani M, Sadeghi O, Sheikhi A, et al. Efficacy of L-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2019;29(11):1151-67.##Fielding R, Riede L, Lugo JP, Bellamine A. L-carnitine supplementation in recovery after exercise. Nutrients. 2018;10(3):349. ##AbuMoh’d MF, Obeidat G, Alsababha W. Effect of oral supplementation with L-carnitine on performance time in a 5000 m race and responses of free fatty acid and carnitine concentrations in trained-endurance athletes. Montenegrin J Sport Sci Med. 2021;10(2):5-11.##Sawicka AK, Renzi G, Olek RA. The bright and the dark sides of L-carnitine supplementation: A systematic review. J Int Soc Sports Nutr. 2020;17(1):49. ##Mardanshahi T, Rezaei N, Zare Z, Shafaroudi MM, Mohammadi H. Effects of l-carnitine on the sperm parameters disorders, apoptosis of spermatogenic cells and testis histopathology in diabetic rats. Int J Reprod Biomed. 2019;17(5):325-36.##Odo S, Tanabe K, Yamauchi M. A pilot clinical trial on L-carnitine supplementation in combination with motivation training: effects on weight management in healthy volunteers. Food Nutr Sci. 2013;04(02):222-31. ##Agarwal A, Said TM. Carnitines and male infertility. Reprod Biomed Online. 2004;8(4):376-84.##Omar MI, Pal RP, Kelly BD, Bruins HM, Yuan Y, Diemer T, et al. Benefits of empiric nutritional and medical therapy for semen parameters and pregnancy and live birth rates in couples with idiopathic infertility: a systematic review and meta-analysis. Eur Urol. 2019;75(4):615-25.##Micic S, Lalic N, Djordjevic D, Bojanic N, Bogavac-Stanojevic N, Busetto GM, et al. Double-blind, randomised, placebo-controlled trial on the effect of L-carnitine and L-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia. Andrologia. 2019;51(6):e13267. ##Mongioi L, Calogero AE, Vicari E, Condorelli RA, Russo GI, Privitera S, et al. The role of carnitine in male infertility. Andrology. 2016;4(5):800-7. ##Lenzi A, Sgrò P, Salacone P, Paoli D, Gilio B, Lombardo F, et al. A placebo-controlled double-blind randomized trial of the use of combined L-carnitine and L-acetyl-carnitine treatment in men with asthenozoospermia. Fertil Steril. 2004;81(6):1578-84. ##Aboul-Naga AM, Hamam ET, Awadalla A, Shokeir AA. The protective role of L-carnitine on spermatogenesis after cisplatin treatment during prepubertal period in rats: a pathophysiological study. Life Sci. 2020;258:118242.##Chiu MN, Blackman MR, Wang C, Swerdloff RS. The role of carnitine in the male reproductive system. Ann N Y Acad Sci. 2004;1033:177-88. ##Cabral REL, Mendes TB, Vendramini V, Miraglia SM. Carnitine partially improves oxidative stress, acrosome integrity, and reproductive competence in doxorubicin-treated rats. Andrology. 2018;6(1):236-46. ##Tsunoda S, Kimura N, Fujii J. Oxidative stress and redox regulation of gametogenesis, fertilization, and embryonic development. Reprod Med Biol. 2013;13(2):71-9. ##Ahmed SDH, Ahsan S, Iqbal T, Burney SIA. Relationship of seminal free L-carnitine with functional spermatozoal characteristics: Results from an observational study conducted in a tertiary care hospital of Karachi, Pakistan. J Pak Med Assoc. 2017;67(2):280-4.##Khaw SC, Wong ZZ, Anderson R, Martins da Silva S. L-carnitine and L-acetylcarnitine supplementation for idiopathic male infertility. Reprod Fertil. 2020;1(1):67-81. ##De Luca MN, Colone M, Gambioli R, Stringaro A, Unfer V. Oxidative stress and male fertility: Role of antioxidants and inositols. Antioxidants (Basel). 2021;10(8):1283. ##Majzoub A, Agarwal A. Systematic review of antioxidant types and doses in male infertility: Benefits on semen parameters, advanced sperm function, assisted reproduction and live-birth rate. Arab J Urol. 2018;16(1):113-24.##Kobori Y, Suzuki K, Iwahata T, Shin T, Sadaoka Y, Sato R, et al. Improvement of seminal quality and sexual function of men with oligoasthenoteratozoospermia syndrome following supplementation with L-Arginine and Pycnogenol®. Arch Ital Urol Androl. 2015;87(3):190-3. ##Jiang XH, Jiang C, Yu L, Li XL, Zuo T, Gu PF, et al. Supplementation with l-carnitine rescues sperm epigenetic changes in asthenospermic male semen with altered acetyl-l-carnitine levels. Reprod Dev Med. 2020;4(3):146-55. ##Choucair F, Saliba E, Jaoude IA, Hazzouri M. Antioxidants modulation of sperm genome and epigenome damage: Fact or fad? Converging evidence from animal and human studies. Middle East Fertil Soc J. 2018;23(2):85-90.##Modanloo M, Shokrzadeh M. Analyzing mitochondrial dysfunction, oxidative stress, and apoptosis: potential role of L-carnitine. Iran J Kidney Dis. 2019;13(2):74-86. ##Wei G, Zhou Z, Cui Y, Huang Y, Wan Z, Che X, et al. A meta-analysis of the efficacy of L-carnitine/L-acetyl-carnitine or N-acetyl-cysteine in men with idiopathic asthenozoospermia. Am J Mens Health. 2021;15(2):15579883211011371. ##Jihad Manssor1 AR, Al–Mahdawi1 ZMM, Hadi2 AM. The effect of L-Arginine of treatment for infertile men on semen parameters. Tikrit J Pure Sci. 2019;24(5):1-4.##Zhang X, Cui Y, Dong L, Sun M, Zhang Y. The efficacy of combined l-carnitine and l-acetyl carnitine in men with idiopathic oligoasthenoteratozoospermia: a systematic review and meta-analysis. Andrologia. 2020;52(2):e13470.##Haje M, Naoom K. Combined tamoxifen and L-carnitine therapies for the treatment of idiopathic male infertility attending intracytoplasmic sperm injection: a randomized controlled trial. Int J Infertil Fetal Med. 2015;6(1):20-4. ##Aliabadi E, Mehranjani MS, Borzoei Z, Talaei-Khozani T, Mirkhani H, Tabesh H. Effects of L-carnitine and L-acetyl-carnitine on testicular sperm motility and chromatin quality. Iran J Reprod Med. 2012;10(2):77-82. ##Poveda C, Rodriguez R, Chu EE, Aparicio LE, Gonzales IG, Moreno CJ. A placebo-controlled double-blind randomized trial of the effect of oral supplementation with spermotrend, maca extract (lepidium meyenii) or L-carnitine in semen parameters of infertile men. Fertil Steril. 2013;100(3):S440.##Patel JN, Hamadeh I, Zhang Q, Brown T, Steuerwald NM, Hamilton A, et al. Busulfan pharmacogenetics and drug exposure in cancer patients undergoing hematopoietic stem cell transplantation. Blood. 2017;130(Suppl 1):3215.##Zangoie R, Eshraghi H, Shirian S, Kadivar A, Nazari H, Aali E. Melatonin synergistically enhances protective effect of atorvastatin against busulfan-induced spermatogenesis injuries in a rat model. Comp Clin Path. 2020;29(1):161-6. ##Houot M, Poinsignon V, Mercier L, Valade C, Desmaris R, Lemare F, et al. Physico-chemical stability of busulfan in injectable solutions in various administration packages. Drugs R D. 2013;13(1):87-94. ##Jung SW, Kim HJ, Lee BH, Choi SH, Kim HS, Choi YK, et al. Effects of Korean red ginseng extract on busulfan-induced dysfunction of the male reproductive system. J Ginseng Res. 2015;39(3):243-9.##Salehinezhad F, Eshraghi H, Kadivar A, Shirian S, Asghari A, Aali E, et al. Amelioration effects of vitamin E, melatonin, L-carnitine, and atorvastatin, on destructive effects of busulfan in the testes of male rats: A gene expression evaluation. Kafkas Univ Vet Fak Derg. 2019;25(5):709-16. ##Xu J, Zhang X, Sun X, Lv Q, Zhang Y. Red-fleshed apple anthocyanin extracts attenuate male reproductive system dysfunction caused by busulfan in mice. Front Nutr. 2021;8:632483. ##Li B, He X, Zhuang M, Niu B, Wu C, Mu H, et al. Melatonin ameliorates busulfan-induced spermatogonial stem cell oxidative apoptosis in mouse testes. Antioxid Redox Signal. 2018;28(5):385-400.##Vahdati A. Busulfan induces apoptotic and cytotoxic effects on testis and epididymal sperm of adult male mouse following low dose treatment. Int J Biosci. 2015;6(5):70-8.##Moloody-tappe M, Shahrooz R, Razi M, Zarei L. The effect of CoQ10 on testicular tissue in rats treating with busulfan: sperm quality and histological changes histological analyses. Iran J Veterin Surg. 2018;13(1):29-38. ##Bahmanpour S, Namavar Jahromi B, Koohpeyma F, Keshavarz M, Bakhtari A. Effects of different doses and time-dependency of busulfan on testes parameters and spermatogenesis in a rat model: a quantitative stereological study. J Adv Med Sci Appl Technol. 2019;3(3):155-62.##Mirhoseini M, Saki G, Hemadi M, Khodadadi A, Asl JM. Melatonin and testicular damage in busulfan treated mice. Iran Red Crescent Med J. 2014;16(2):e14463. ##Dehghani F, Sotoude N, Bordbar H, Panjeshahin MR, Karbalay-Doust S. The use of platelet-rich plasma (PRP) to improve structural impairment of rat testis induced by busulfan. Platelets. 2019;30(4):513-20.##Vafaei A, Mohammadi S, Fazel A, Soukhtanloo M, Pour AM, Beheshti F. Effects of carob (Ceratonia siliqua) on sperm quality, testicular structure, testosterone level and oxidative stress in busulfan-induced infertile mice. Pharm Sci. 2018;24(2):104-11. ##Chen Z, Liu M, Hu JH, Gao Y, Deng C, Jiang MH. Substance P restores spermatogenesis in busulfan-treated mice: A new strategy for male infertility therapy. Biomed Pharmacother. 2021;133:110868.##Ohira T, Saito T, Ando R, Tamura K, Hoshiya T. Systemic histopathology of infant rats exposed to busulfan. J Toxicol Pathol. 2014;27(1):25-9.##Zhao X, Liu Z, Gao J, Li H, Wang X, Li Y, et al. Inhibition of ferroptosis attenuates busulfan-induced oligospermia in mice. Toxicology. 2020;440:152489. ##Ahar NH, Khaki A, Akbari G, Novin MG. The effect of Busulfan on body weight, Testis weight and MDA enzymes in male rats. Int J Women’s Heal Reprod Sci. 2014;2(5):316-9. ##Nasimi P, Tabandeh MR, Vahdati A, Khatamsaz S. Busulfan induces oxidative stress- and Bcl-2 family gene- related apoptosis in epididymal sperm and testis of adult male mice Busulfan as a representative chemotherapeutic agent. Physiol Pharmacol. 2015;19(3):208-15.##Hakemi SG, Sharififar F, Haghpanah T, Babaee A, Eftekhar-Vaghefi SH. The effects of olive leaf extract on the testis, sperm quality and testicular germ cell apoptosis in male rats exposed to busulfan. Int J Fertil Steril. 2019;13(1):57-65. ##Gülçin I. Antioxidant and antiradical activities of L-carnitine. Life Sci. 2006;78(8):803-11.##Abd-Elrazek AM, Ahmed-Farid OAH. Protective effect of L-carnitine and L-arginine against busulfan-induced oligospermia in adult rat. Andrologia. 2018;50(1). ##Fathizadeh H, Milajerdi A, Reiner Ž, Amirani E, Asemi Z, Mansournia MA, et al. The effects of L-carnitine supplementation on indicators of inflammation and oxidative stress: a systematic review and meta-analysis of randomized controlled trials. J Diabetes Metab Disord. 2020;19(2):1879-94. ##Mutomba MC, Yuan H, Konyavko M, Adachi S, Yokoyama CB, Esser V, et al. Regulation of the activity of caspases by L -carnitine and palmitoylcarnitine. FEBS Lett. 2000;478(1-2):19-25. ##Dehghani F, Hassanpour A, Poost-pasand A, Noorafshan A, Karbalay-doust S. Protective effects of L-carnitine and homogenized testis tissue on the testis and sperm parameters of busulfan- induced infertile male rats. Iran J Reprod Med. 2013;11(9):693-704.##Ozmen HK, Erdemci B, Askin S, Sezen O. Carnitine and adiponectin levels in breast cancer after radiotherapy. Open Med (Wars). 2017;12:189-94. ##Virmani A, Diedenhofen A. The possible mechanisms involved in the protection strategies against radiation-induced cellular damage by carnitines. Int J Clin Med. 2015;06(02):71-80. ##Khan HA, Alhomida AS. A review of the logistic role of l-carnitine in the management of radiation toxicity and radiotherapy side effects. J Appl Toxicol. 2011;31(8):707-13. ##Seifried HE, Anderson DE, Sorkin BC, Costello RB. Free radicals: the pros and cons of antioxidants. Executive summary report. J Nutr. 2004;134(11):3143S-63S.##Qu N, Itoh M, Sakabe K. Effects of chemotherapy and radiotherapy on spermatogenesis: the role of testicular immunology. Int J Mol Sci. 2019;20(4):957. ##Aktoz T, Caloglu M, Yurut‐Caloglu V, Yalcin O, Aydogdu NU, Nurlu D, et al. Histopathological and biochemical comparisons of the protective effects of amifostine and l‐carnitine against radiation‐induced acute testicular toxicity in rats. Andrologia. 2017;49(9).##Kanter M, Topcu-Tarladacalisir Y, Parlar S. Antiapoptotic effect of l-carnitine on testicular irradiation in rats. J Mol Histol. 2010;41(2-3):121-8.##Topcu-Tarladacalisir Y, Kanter M, Uzal MC. Role of L-carnitine in the prevention of seminiferous tubules damage induced by gamma radiation: a light and electron microscopic study. Arch Toxicol. 2009;83(8):735-46. ##Düzenli U, Altun Z, Olgun Y, Aktaş S, Pamukoğlu A, Çetinayak HO, et al. Role of N-acetyl cysteine and acetyl-l-carnitine combination treatment on DNA-damage-related genes induced by radiation in HEI-OC1 cells. Int J Radiat Biol. 2018;95(3):298-306.##Soliman MM, Elshazly SA, Aldhahrani A. Gamma‐irradiation‐induced testicular oxidative stress and apoptosis: Mitigation by L‐carnitine. J Biochem Mol Toxicol. 2020;34(11):e22565. ##Elshazly SA, Ahmed MM, Hassan HE, Ibrahim ZS. Protective effect of L-carnitine against yrays irradiation-induced tissue damage in mice. Am J Biochem Mol Biol. 2012;2(3):120-32.##Famularo G, Simone CDE, Trinchieri V. Carnitines and its congeners a metabolic pathway to the regulation of immune response and inflammation. Ann N Y Acad Sci. 2004;133:132-8. ##Ahmed MM, Ibrahim ZS, Alkafafy M, El-Shazly SA. L-carnitine protects against testicular dysfunction caused by gamma irradiation in mice. Acta Histochem. 2014;116(6):1046-55.##Dokmeci D, Akpolat M, Aydogdu N, Uzal C, Doganay L, Turan FN. The protective effect of L-carnitine on ionizing radiation-induced free oxygen radicals. Scand J Lab Anim Sci. 2006;33(2):75-83. ##Mansour HH. Protective role of carnitine ester against radiation-induced oxidative stress in rats. Pharmacol Res. 2006;54(3):165-71. ##Palomar Rios A, Molina Botella I. Description and outcomes of current clinical techniques for sperm cryopreservation. Eur Med J. 2019;5:79-92.##Rios A, Botella IM. Causes and impact of cryopreservation-associated damage on different parameters of human spermatozoa and its clinical impact. Reprod Health. 2019;5(1):100-9. ##Liu X, Xu Y, Liu F, Pan Y, Miao L, Zhu Q, et al. The feasibility of antioxidants avoiding oxidative damages from reactive oxygen species in cryopreservation. Front Chem. 2021;9:648684. ##Hezavehei M, Sharafi M, Kouchesfahani HM, Henkel R, Agarwal A, Esmaeili V, et al. Sperm cryopreservation: a review on current molecular cryobiology and advanced approaches. Reprod Biomed Online. 2018;37(3):327-39.##Makary S, Abdo M, Fekry E. Oxidative stress burden inhibits spermatogenesis in adult male rats: Testosterone protective effect. Can J Physiol Pharmacol. 2018;96(4):372-81. ##Bahmyari R, Zare M, Sharma R, Agarwal A, Halvaei I. The efficacy of antioxidants in sperm parameters and production of reactive oxygen species levels during the freeze- thaw process: a systematic review and meta-analysis. Andrologia. 2020;52(3):e13514.##Chavoshi Nezhad N, Vahabzadeh Z, Allahveisie A, Rahmani K, Raoofi A, Rezaie MJ, et al. The effect of L-carnitine and Coenzyme Q10 on the sperm motility, DNA fragmentation, chromatin structure and oxygen free radicals during, before and after freezing in oligospermia men. Urol J. 2021;18(3):330-6. ##Sariözkan S, Ozdamar S, Türk G, Cantürk F, Yay A. In vitro effects of l-carnitine and glutamine on motility, acrosomal abnormality, and plasma membrane integrity of rabbit sperm during liquid-storage. Cryobiology. 2014;68(3):349-53. ##Aliabadi E, Jahanshahi S, Talaei-Khozani T, Banaei M. Comparison and evaluation of capacitation and acrosomal reaction in freeze-thawed human ejaculated spermatozoa treated with L-carnitine and pentoxifylline. Andrologia. 2018;50(2).##Banihani S, Agarwal A, Sharma R, Bayachou M. Cryoprotective effect of l-carnitine on motility, vitality and DNA oxidation of human spermatozoa. Andrologia. 2014;46(6):637-41. ##Zhang W, Li F, Cao H, Li C, Du C, Yao L, et al. Protective effects of L-carnitine on astheno- and normozoospermic human semen samples during cryopreservation. Zygote. 2016;24(2):293-300. ##Fattah A, Sharafi M, Masoudi R, Shahverdi A, Esmaeili V, Najafi A. L-Carnitine in rooster semen cryopreservation: Flow cytometric, biochemical and motion findings for frozen-thawed sperm. Cryobiology. 2017;74:148-53. ##Manee-In S, Parmornsupornvichit S, Kraiprayoon S, Tharasanit T, Chanapiwat P, Kaeoket K. L-carnitine supplemented extender improves cryopreserved-thawed cat epididymal sperm motility. Asian-Australas J Anim Sci. 2014;27(6):791-6. ##Gibb Z, Lambourne SR, Quadrelli J, Smith ND, Aitken RJ. L-carnitine and pyruvate are prosurvival factors during the storage of stallion spermatozoa at room temperature. Biol Reprod. 2015;93(4):104. ##Khan IM, Cao Z, Liu H, Khan A, Rahman SU, Khan MZ, et al. Impact of cryopreservation on spermatozoa freeze-thawed traits and relevance OMICS to assess sperm cryo-tolerance in farm animals. Front Vet Sci. 2021;8:6091180. ##Duru NK, Morshedi M, Schuffner A, Oehninger S. Semen treatment with progesterone and/or acetyl-L-carnitine does not improve sperm motility or membrane damage after cryopreservation-thawing. Fertil Steril. 2000;74(4):715-20. ##Ghorbani F, Nasiri Z, Koohestanidehaghi Y, Lorian K. The antioxidant roles of L-carnitine and N-acetyl cysteine against oxidative stress on human sperm functional parameters during vitrification. Clin Exp Reprod Med. 2021;48(4):316-21.##

Comparison of In-House Microfluidic Device and Centrifuge-Based Method Efficacy in Sperm Preparation for Assisted Reproductive Technology 2 1 2 Background: Sperm DNA fragmentation can affect reproductive outcomes in assisted reproductive techniques (ART), and it is a concern in density gradient centrifugation (DGC). By contrast, microfluidic approaches allow the selection of highly motile sperm with low DNA fragmentation index (DFI). The purpose of current study, was to compare the efficacy of a microfluidic device designed in-house in comparison with DGC. Methods: Nineteen healthy men with normal semen profiles were included in the study. Semen samples were individually aliquoted for three sperm preparation analyses (crude and processed with to either DGC or the microfluidic method). Sperm parameters of the samples were evaluated along with DNA fragmentation using the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) method. Results: Sperm processed using the microfluidic method showed a significantly lower DFI than those obtained using DGC and in crude semen, with DFI of 1.1%, 3.5%, and 4.9%, respectively. Although the microfluidic method yielded significantly lower sperm concentrations than DGC, no significant differences were observed in total motility, progressive motility, curvilinear velocity, straight-line velocity, or normal morphology. Conclusion: Using the in-house microfluidic device, sperm with lower DFI was effectively isolated when compared with DGC. The motility and normal morphology rates were comparable among the samples. 085 94 Tonghathai T Phairatana Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University Thailand Thanaporn Th Prateepchaikul Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University Thailand Raphatphorn R Navakanittworakul Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University Thailand Chainarong Ch Choksuchat Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University Thailand chchaina@yahoo.com Assisted reproductive technologyDensity gradient centrifugationDNA fragmentationMicrofluidicsSperm 140183.pdf Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Fertil Steril. 2017;108(3):393-406.##Cui W. Mother or nothing: the agony of infertility. Bull World Health Organ. 2010;88(12):881-2.##Taylor HS, Pal L, Seli E. Speroff’s clinical gynecologic endocrinology and infertility. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2019. 1292 p.##Oseguera-López I, Ruiz-Díaz S, Ramos-Ibeas P, Pérez-Cerezales S. Novel techniques of sperm selection for improving IVF and ICSI outcomes. Front Cell Dev Biol. 2019;7:298.##Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, et al. Male infertility. Lancet. 2021;397 (10271):319-33.##Agarwal A, Said TM, Bedaiwy MA, Banerjee J, Alvarez JG. Oxidative stress in an assisted reproductive techniques setting. Fertil Steril. 2006;86(3): 503-12.##Ahelik A, Mändar R, Korrovits P, Karits P, Talving E, Rosenstein K, et al. Systemic oxidative stress could predict assisted reproductive technique outcome. J Assist Reprod Genet. 2015;32(5):699-704.##Muriel L, Garrido N, Fernández JL, Remohí J, Pellicer A, de los Santos MJ, et al. Value of the sperm deoxyribonucleic acid fragmentation level, as measured by the sperm chromatin dispersion test, in the outcome of in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril. 2006;85(2):371-83.##Velez de la Calle JF, Muller A, Walschaerts M, Clavere JL, Jimenez C, Wittemer C, et al. Sperm deoxyribonucleic acid fragmentation as assessed by the sperm chromatin dispersion test in assisted reproductive technology programs: results of a large prospective multicenter study. Fertil Steril. 2008; 90(5):1792-9.##Borini A, Tarozzi N, Bizzaro D, Bonu MA, Fava L, Flamigni C, et al. Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART. Hum Reprod. 2006;21(11): 2876-81.##Jerre E, Bungum M, Evenson D, Giwercman A. Sperm chromatin structure assay high DNA stainability sperm as a marker of early miscarriage after intracytoplasmic sperm injection. Fertil Steril. 2019;112(1):46-53.e2.##Nicopoullos J, Vicens-Morton A, Lewis SEM, Lee K, Larsen P, Ramsay J, et al. Novel use of COMET parameters of sperm DNA damage may increase its utility to diagnose male infertility and predict live births following both IVF and ICSI. Hum Reprod. 2019;34(10):1915-23.##Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, et al. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012;27(10):2908-17.##Zhao J, Zhang Q, Wang Y, Li Y. Whether sperm deoxyribonucleic acid fragmentation has an effect on pregnancy and miscarriage after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril. 2014;102(4):998-1005.e8.##Chinnasamy T, Kingsley JL, Inci F, Turek PJ, Rosen MP, Behr B, et al. Guidance and self-sorting of active swimmers: 3D periodic arrays increase persistence length of human sperm selecting for the fittest. Adv Sci (Weinh). 2017;5(2):1700531.##Gode F, Gürbüz AS, Tamer B, Pala I, Isik AZ. The effects of microfluidic sperm sorting, density gradient and swim-up methods on semen oxidation reduction potential. Urol J. 2020;17(4):397-401.##Kishi K, Ogata H, Ogata S, Mizusawa Y, Okamoto E, Matsumoto Y, et al. Frequency of sperm DNA fragmentation according to selection method: comparison and relevance of a microfluidic device and a swim-up procedure. J Clin Diagn Res. 2015;9(11):QC14-6.##Asghar W, Velasco V, Kingsley JL, Shoukat MS, Shafiee H, Anchan RM, et al. Selection of functional human sperm with higher DNA integrity and fewer reactive oxygen species. Adv Healthc Mater. 2014;3(10):1671-9.##Quinn MM, Jalalian L, Ribeiro S, Ona K, Demirci U, Cedars MI, et al. Microfluidic sorting selects sperm for clinical use with reduced DNA damage compared to density gradient centrifugation with swim-up in split semen samples. Hum Reprod. 2018;33(8):1388-93.##Shirota K, Yotsumoto F, Itoh H, Obama H, Hidaka N, Nakajima K, et al. Separation efficiency of a microfluidic sperm sorter to minimize sperm DNA damage. Fertil Steril. 2016;105(2):315-21.e1.##World Health Organization. WHO Laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010. 286 p.##Wei-Xuan LI, Liang GT, Wei YA, Zhang Q, Wei WA, Xiao-Mian ZH, et al. Artificial uterus on a microfluidic chip. Chinese J Analytical Chem. 2013;41(4):467-72.##Mancini V, Pensabene V. Organs-on-chip models of the female reproductive system. Bioengineering (Basel). 2019;6(4):103.##Ahmadkhani N, Hosseini M, Saadatmand M, Abbaspourrad A. The influence of the female reproductive tract and sperm features on the design of microfluidic sperm-sorting devices. J Assist Reprod Genet. 2022;39(1):19-36.##Barroso G, Morshedi M, Oehninger S. Analysis of DNA fragmentation, plasma membrane translocation of phosphatidylserine and oxidative stress in human spermatozoa. Hum Reprod. 2000;15(6): 1338-44.##Muratori M, Tarozzi N, Carpentiero F, Danti S, Perrone FM, Cambi M, et al. Sperm selection with density gradient centrifugation and swim up: effect on DNA fragmentation in viable spermatozoa. Sci Rep. 2019;9(1):7492.##Xue LT, Wang RX, He B, Mo WY, Huang L, Wang SK, et al. Effect of sperm DNA fragmentation on clinical outcomes for Chinese couples undergoing in vitro fertilization or intracytoplasmic sperm injection. J Int Med Res. 2016;44(6):1283-91.##Ni W, Xiao S, Qiu X, Jin J, Pan C, Li Y, et al. Effect of sperm DNA fragmentation on clinical outcome of frozen–thawed embryo transfer and on blastocyst formation. PLoS One. 2014;9(4): e94956.##Sedo CA, Bilinski M, Lorenzi D, Uriondo H, Noblía F, Longobucco V, et al. Effect of sperm DNA fragmentation on embryo development: clinical and biological aspects. JBRA Assist Reprod. 2017;21(4):343-50.##Jin J, Pan C, Fei Q, Ni W, Yang X, Zhang L, et al. Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ovarian reserves. Fertil Steril. 2015;103(4):910-6.##Lin MH, Lee RKK, Li SH, Lu CH, Sun FJ, Hwu YM. Sperm chromatin structure assay parameters are not related to fertilization rates, embryo quality, and pregnancy rates in in vitro fertilization and intracytoplasmic sperm injection, but might be related to spontaneous abortion rates. Fertil Steril. 2008;90(2):352-9.##

The Influence of Platelet-Derived Growth Factors on the Proliferation of Germinal Epithelium After Local Irradiation with Electrons 2 1 2 Background: At present, the damage of male reproductive function caused by electron irradiation, as well as the development of methods for its correction are the relevant topics for further research. In fact, the effect of leukocyte-poor platelet-rich plasma (LP-PRP) growth factors are poorly investigated on different aspects of male fertility. Methods: In this study, Wistar rats were divided into four groups; I) control which were injected with saline; II and III) groups (n=65) whose testes were locally irradiated with electrons to a dose of 2 Gy (linear accelerator "NOVAC-11"); III) the group (n=30) which received LP-PRP for 11 weeks after irradiation; and IV)¬ animals (n=30) which received only LP-PRP (conditional control). The testes were studied by histological, immunohistochemical (IHC), western blotting, and TUNEL methods using Ki-67, Bcl-2, and p53. Comparison between groups was performed and p<0.01 was set as the level of significance. Results: The results showed a decrease in the expression levels of Ki-67 and Bcl-2 besides an increase in p53-positive cells by the end of the experiment (p<0.01). After injection of LP-PRP, a gradual restoration of the proliferative activity of gametes was noted, which was confirmed by an increase in the proportion of Ki-67- and Bcl-2-positive germ cells (46.4±2.3, p<0.01 and 23.5±1.1, respectively, p<0.01). Conclusion: Ki-67 expression and TUNEL analysis in the testes revealed a modulation of the proliferative-apoptotic balance towards apoptosis of germ cells after 2 Gy local electron irradiation. A tendency to restore the proliferative-apoptotic balance was noted after LP-PRP injections as indicated by increase in Ki-67-positive germ cells. 094 101 Demyashkin D Grigory A I.M. Sechenov First Moscow State Medical University (Sechenov University) I.M. Sechenov First Moscow State Medical University (Sechenov University) Russia r.dga@mail.ru Vadyukhin V Matvey A I.M. Sechenov First Moscow State Medical University (Sechenov University) I.M. Sechenov First Moscow State Medical University (Sechenov University) Russia Shekin Sh Vladimir I I.M. Sechenov First Moscow State Medical University (Sechenov University) I.M. Sechenov First Moscow State Medical University (Sechenov University) Russia Cell cycleElectronsGrowth factorsInfertilityPlatelet-rich plasmaSpermatogenesis 140184.pdf Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018; 62:2-10.##Meistrich ML. Effects of chemotherapy and radiotherapy on spermatogenesis in humans. Fertil Steril. 2013;100(5):1180-6.##Sineath RC, Mehta A. Preservation of fertility in testis cancer management. Urol Clin North Am. 2019;46(3):341-51.##Qu N, Itoh M, Sakabe K. Effects of chemotherapy and radiotherapy on spermatogenesis: the role of testicular immunology. Int J Mol Sci.2019;20(4):957.##Abd El Tawab AM, Shahin NN, AbdelMohsen MM. Protective effect of Satureja montana extract on cyclophosphamide-induced testicular injury in rats. Chem Biol Interact. 2014;224:196-205.##Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020. Int J Mol Sci. 2020;21(20):7794.##Garcia K, Wichmann A, Su TT. Cell cycle regulation. Fly (Austin). 2007;1(2):125-31.##Dehghani F, Sotoude N, Bordbar H, Panjeshahin MR, Karbalay-Doust S. The use of platelet-rich plasma (PRP) to improve structural impairment of rat testis induced by busulfan. Platelets. 2019;30 (4):513-20.##Guo M, Hay BA. Cell proliferation and apoptosis. Curr Opin Cell Biol. 1999;11(6):745-52.##Zhao WP, Wang HW, Liu J, Tan PP, Luo XL, Zhu SQ, et al. Positive PCNA and Ki-67 expression in the testis correlates with spermatogenesis dysfunction in fluoride-treated rats. Biol Trace Elem Res. 2018;186(2):489-97. ##Bagheri H, Salajegheh A, Javadi A, Amini P, Shekarchi B, Shabeeb D, et al. Radioprotective effects of zinc and selenium on mice spermatogenesis. J Biomed Phys Eng. 2020;10(6):707-12.##Wang Q, Zhou Y, Wang X, Evers BM. Glycogen synthase kinase-3 is a negative regulator of extracellular signal-regulated kinase. Oncogene. 2006;25(1):43-50.##Morel C, Carlson SM, White FM, Davis RJ. Mcl-1 integrates the opposing actions of signaling pathways that mediate survival and apoptosis. Mol Cell Biol. 2009;29(14):3845-52.##Reisz JA, Bansal N, Qian J, Zhao W, Furdui CM. Effects of ionizing radiation on biological molecules--mechanisms of damage and emerging methods of detection. Antioxid Redox Signal. 2014;21 (2):260-92. ##Demyashkin GA, Borovaya TG, Andreeva YY, Nedorubov AA, Stepanova YY, Vadyukhin MA, et al. An experimental approach to comprehend the influence of platelet rich growth factors on spermatogenesis. Int J Radiat Biol. 2022;98(8):1330-43.##Maria-Angeliki G, Alexandros-Efstratios K, Dimitris R, Konstantinos K. Platelet-rich plasma as a potential treatment for noncicatricial alopecias. Int J Trichology. 2015;7(2):54-63.##Kutluhan MA, Özsoy E, Şahin A, Ürkmez A, Topaktaş R, Toprak T, et al. Effects of platelet-rich plasma on spermatogenesis and hormone production in an experimental testicular torsion model. Andrology. 2021;9(1):407-13.##Vergara SP, Lizama C, Brouwer-Visser J, Moreno RD. Expression of BCL-2 family genes in germ cells undergoing apoptosis during the first wave of spermatogenesis in the rat. Andrologia. 2011;43 (4):242-7.##Galluzzi L, Vitale I, Aaronson SA, Abrams JM, Adam D, Agostinis P, et al. Molecular mechanisms of cell death: recommendations of the nomenclature committee on cell death 2018. Cell Death Differ. 2018;25(3):486-541.##

An Evaluation of Antibacterial Effects of Human Amniotic Fluid on Pathogenic and Probiotic Bacteria in Vitro 2 1 2 Background: Amniotic fluid in the uterus is beneficial for the fetus growth and protection due to its nutritional elements as well as its antibacterial and anti-inflammatory properties. Today, body membranes are increasingly being used in multiple fields. The purpose of the current study was evaluation of the antibacterial effects of amniotic fluid and comparison of its effects on pathogenic and probiotic bacteria. Methods: This experimental study was conducted on amniotic fluid obtained from 43 healthy mothers who gave birth by selective cesarean section. Then, antibacterial effects of amniotic fluids were investigated on 8 standard bacterial strains, including Bacillus cereus, Escherichia coli, Staphylococcus aureus, Shigella flexneri, Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus cereus, and Lactobacillus plantarum by agar well-diffusion method. Data analysis was performed by SPSS software, vs. 22 (IBM, US). Results: Amniotic fluid revealed an inhibitory effect on the growth of bacterial strains. Staphylococcus aureus and Streptococcus pyogenes strains showed growth inhibition in 39% and 17% of samples, respectively. In other bacterial strains, there was growth inhibition in less than 5% of the samples. Also, the zone of growth inhibition for Staphylococcus aureus and Streptococcus pyogenes was significantly higher than the other strains. Amniotic fluid samples had an antibacterial effect on all pathogen strains in general, but not on the Lactobacillus plantarum probiotic strain. Conclusion: Our findings suggest that the antibacterial effect of amniotic fluid on pathogenic bacteria is significantly higher than the Lactobacillus plantarum as a probiotic one. Overall, the findings support the use of natural substances as alternative therapeutic agents to combat antibiotic resistance. 101 108 Nahid N Ghanbarzade Department of Gynecology and Obstetrics, Medical Faculty, Birjand University of Medical Sciences Department of Gynecology and Obstetrics, Medical Faculty, Birjand University of Medical Sciences Iran Pouria P Mohammadparast-Tabas Student Research Committee, Birjand University of Medical Sciences Student Research Committee, Birjand University of Medical Sciences Iran Hamed H Aramjoo Student Research Committee, Birjand University of Medical Sciences Student Research Committee, Birjand University of Medical Sciences Iran Elahe E Allahyari Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences Iran Saeedeh S Ghasemi Student Research Committee, Birjand University of Medical Sciences Student Research Committee, Birjand University of Medical Sciences Iran Soheila S Erfani Assistant of Nuclear Medicine, Mashhad University of Medical Sciences Assistant of Nuclear Medicine, Mashhad University of Medical Sciences Iran Behzad B Mesbahzadeh Department of Physiology, School of Allied Medical Sciences, Birjand University of Medical Sciences Department of Physiology, School of Allied Medical Sciences, Birjand University of Medical Sciences Iran Hamideh H Dehghan Student Research Committee, Birjand University of Medical Sciences Student Research Committee, Birjand University of Medical Sciences Iran Majid M Zare-Bidaki Infectious Diseases Research Center, Medical Microbiology Department, Birjand University of Medical Sciences Infectious Diseases Research Center, Medical Microbiology Department, Birjand University of Medical Sciences Iran m.zare@live.co.uk Amniotic fluidAntibacterial effectBacteria 140188.pdf Dallal MMS, Kalafi Z, Rastegar-Lari A, Hosseini SK, Rahimi-Foroushani A, Deilami-Khiabani Z, et al. The effect of reduced bacterial dilution on human amniotic membrane antibacterial activity, in vitro. Zahedan J Res Med Sci. 2013;15(5):6-8.##Parthasarathy M, Sasikala R, Gunasekaran P, Raja J. Antimicrobial activity of human amniotic and chorionic membranes. J Acad Ind Res. 2014;2(10):545-7.##Gholipourmalekabadi M, Farhadihosseinabadi B, Faraji M, Nourani MR. How preparation and preservation procedures affect the properties of amniotic membrane? How safe are the procedures? Burns. 2020;46(6):1254-71.##Kim Y, Lee KY, Lee JJ, Tak H, Park ST, Song JE, et al. Expression of antimicrobial peptides in the amniotic fluid of women with cervical insufficiency. Am J Reprod Immunol. 2022;88(2):e13577.##Mao Y, Pierce J, Singh-Varma A, Boyer M, Kohn J, Reems J-A. Processed human amniotic fluid retains its antibacterial activity. J Transl Med. 2019;17(1):68.##Barequet IS, Habot-Wilner Z, Keller N, Smollan G, Ziv H, Belkin M, et al. Effect of amniotic membrane transplantation on the healing of bacterial keratitis. Invest Ophthalmol Vis Sci. 2008;49(1):163-7.##Chokshi A, Sifri Z, Cennimo D, Horng H. Global contributors to antibiotic resistance. J Global Infect Dis. 2019;11(1):36-42.##Ramuta TŽ, Tratnjek L, Janev A, Seme K, Starčič Erjavec M, Kreft ME. The antibacterial activity of human amniotic membrane against multidrug-resistant bacteria associated with urinary tract infections: new insights from normal and cancerous urothelial models. Biomedicines. 2021;9(2):218.##Tuon FF, Dantas LR, Suss PH, Tasca Ribeiro VS. Pathogenesis of the Pseudomonas aeruginosa biofilm: a review. Pathogens. 2022;11(3):300.##Pormohammad A, Nasiri MJ, Azimi T. Prevalence of antibiotic resistance in Escherichia coli strains simultaneously isolated from humans, animals, food, and the environment: a systematic review and meta-analysis. Infect Drug Resist. 2019;12:1181-97.##Bengoechea JA, Sa Pessoa J. Klebsiella pneumoniae infection biology: living to counteract host defences. FEMS Microbiol Rev. 2019;43(2):123-44.##Ranganathan S, Doucet M, Grassel CL, Delaine-Elias B, Zachos NC, Barry EM. Evaluating Shigella flexneri pathogenesis in the human enteroid model. Infect Immun. 2019;87(4):e00740-18.##Jespersen MG, Lacey JA, Tong SY, Davies MR. Global genomic epidemiology of Streptococcus pyogenes. Infect Genet Evol. 2020;86:104609.##Cong Y, Yang S, Rao X. Vancomycin resistant Staphylococcus aureus infections: A review of case updating and clinical features. J Adv Res. 2020;21:169-76.##Wu K, Nie L, Nusantara AC, Woudstra W, Vedelaar T, Sigaeva A, et al. Diamond relaxometry as a tool to investigate the free radical dialogue between macrophages and bacteria. ACS Nano. 2023;17(2):1100-1111.##Kjaergaard N, Hein M, Hyttel L, Helmig R, Schønheyder H, Uldbjerg N, et al. Antibacterial properties of human amnion and chorion in vitro. Eur J Obstet Gynecol Reprod Biol. 2001;94(2):224-9.##Al-Adwani S, Wallin C, Balhuizen MD, Veldhuizen EJ, Coorens M, Landreh M, et al. Studies on citrullinated LL-37: detection in human airways, antibacterial effects and biophysical properties. Sci Rep. 2020;10(1):2376.##Larsen B, Davis B, Charles D. Critical assessment of antibacterial properties of human amniotic fluid. Gynecol Obstet Invest. 1984;18(2):100-4.##Schlievert P, Larsen B, Johnson W, Galask RP. Bacterial growth inhibition by amniotic fluid: III. Demonstration of the variability of bacterial growth inhibition by amniotic fluid with a new plate-count technique. Am J Obstet Gynecol. 1975;122(7):809-19.##Yang SJ, Lee JE, Lim SM, Kim YJ, Lee NK, Paik HD. Antioxidant and immune-enhancing effects of probiotic Lactobacillus plantarum 200655 isolated from kimchi. Food Sci Biotechnol. 2018;28(2):491-9.##Zhou Q, Xue B, Gu R, Li P, Gu Q. Lactobacillus plantarum ZJ316 attenuates Helicobacter pylori-induced gastritis in C57BL/6 mice. J Agric Food Chem. 2021;69(23):6510-23.##Yavari M, Ahmadizadeh C. Effect of the cellular extract of co-cultured lactobacillus casei on BAX and human β-Defensin 2 genes expression in HT29 cells. Intern Med Today. 2020;26(4):364-81.##Mirtaghi SM, Torbati Nejad P, Mazandarani M, Livani F, Bagheri H. Evaluation of antibacterial activity of Urtica dioica L. leaf ethanolic extract using agar well diffusion and disc diffusion methods. Med Lab J. 2016;10(5):15-21.##Gonelimali FD, Lin J, Miao W, Xuan J, Charles F, Chen M, et al. Antimicrobial properties and mechanism of action of some plant extracts against food pathogens and spoilage microorganisms. Front Microbiol. 2018;9:1639.##Thadepalli H, Appleman MD, Maidman JE, Arce JJ, Davidson Jr EC. Antimicrobial effect of amniotic fluid against anaerobic bacteria. Am J Obstet Gynecol. 1977;127(3):250-4.##Essawi WM, El-Demerdash AS, El-Mesalamy MM, Abonorag MA. Validation of camel's fetal fluids as antimicrobial agents. Curr Microbiol. 2020;77(8):1399-404.##

Evaluation of the Utility of Seminal Plasma Resistin and Leptin in Predicting Successful Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia 2 1 2 Background: The purpose of the current study was evaluation of the utility of seminal plasma (SP) resistin and leptin in predicting successful surgical sperm retrieval (SSR) in men with non-obstructive azoospermia (NOA). Methods: This prospective comparative study was conducted in the andrology clinic of a specialized fertility center. In total, 53 NOA men as candidates for either first time micro‐testicular sperm extraction (micro-TESE) or repeat micro-TESE and 28 normozoospermic controls were included. ELISA was used for measurement of SP resistin and leptin levels in all participants. Significance level was defined as p<0.05. Results: The current study demonstrated a significant positive correlation between estradiol (E2) level in serum and SP resistin (r=0.342, p=0.025). Also, there was a highly significant positive correlation between SP leptin and SP resistin (r=0.568, p=0.001). Interestingly, SP leptin was the only variable that demonstrated a significant correlation with eventful micro-TESE outcome in men who underwent micro-TESE for the first time. Finally, ROC curve showed that SP leptin level of 4.05 ng/ml predicted successful SSR in men who underwent micro-TESE for the first time with a sensitivity of 73.3% and a specificity of 75% as 11 out of 27 (41%) cases showed eventful micro-TESE at or above this cut-off level [AUC of 0.747, 95% CI, lower bound of 0.555, and upper bound of 0.939, p=0.030]. Conclusion: SP leptin can be used as a non-invasive biomarker to predict successful SSR in NOA cases undergoing first time micro-TESE, while SP resistin failed to play the same role. 108 117 Medhat MK Amer Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Egypt Wael W Zohdy Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Egypt Sameh Fayek SF GamalEl Din Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Department of Andrology, Sexology and STDs, Faculty of Medicine, Cairo University Egypt samehfayek@kasralainy.edu.eg Hanan HH Moawad Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University Department of Clinical and Chemical Pathology, Faculty of Medicine, Beni-Suef University Egypt Dina DA Hasan El Saedy Egypt Ministry of Health and Population Egypt Ministry of Health and Population Egypt Eman EA Zaki Gamal Egypt Ministry of Health and Population Egypt Ministry of Health and Population Egypt Ahmed A Ragab Department of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University Department of Andrology, Sexology and STDs, Faculty of Medicine, Beni-Suef University Egypt LeptinMale infertilityNon-obstructive azoospermiaResistinSeminal plasma 140185.pdf Shin DH, Turek PJ. Sperm retrieval techniques. Nat Rev Urol. 2013;10(12):723-30.##Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015;104(5):1099-103.e1-3.##Budak E, Sánchez MF, Bellver J, Cerveró A, Simón C, Pellicer A. Interactions of the hormones leptin, ghrelin, adiponectin, resistin, and PYY3-36 with the reproductive system. Fertil Steril. 2006;85(6):1563-81.##Michalakis K, Mintziori G, Kaprara A, Tarlatzis BC, Goulis DG. The complex interaction between obesity, metabolic syndrome and reproductive axis: anarrative review. Metabolism. 2013;62(4):457-78.##Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl. 2018;20(1):30-6.##Zarezadeh R, Fattahi A, Nikanfar S, Oghbaei H, Ahmadi Y, Rezaei YR, et al. Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia. J Assist Reprod Genet. 2021;38(8):2049-59.##Ma Y, Chen B, Wang H, Hu K, Huang Y. Prediction of sperm retrieval in men with non-obstructive azoospermia using artificial neural networks: leptin is a good assistant diagnostic marker. Hum Reprod. 2011;26(2):294-8.##Yu WH, Kimura M, Walczewska A, Karanth S, McCann SM. Role of leptin in hypothalamic–pituitary function. Proc Natl Acad Sci USA. 1997;94(3):1023-8.##Mah PM, Wittert GA. Obesity and testicular function. Mol Cell Endocrinol. 2010;316(2):180-6.##Ishikawa T, Fujioka H, Ishimura T, Takenaka A, Fujisawa M. Expression of leptin and leptin receptor in the testis of fertile and infertile patients. Andrologia. 2007;39(1):22-7.##Grosfeld A, Zilberfarb V, Turban S, Andre J, Guerre-Millo M, Issad T. Hypoxia increases leptin expression in human PAZ6 adipose cells. Diabetologia. 2002;45(4):527-30.##Önel T, Ayla S, Keskin İ, Parlayan C, Yiğitbaşı T, Kolbaşı B, et al. Leptin in sperm analysis can be a new indicator. Acta Histochem. 2019;121(1):43-9.##Dupont J, Pollet-Villard X, Reverchon M, Mellouk N, Levy R. Adipokines in human reproduction. Horm Mol Biol Clin Investig. 2015;24(1):11-24.##Moretti E, Collodel G, Mazzi L, Campagna M, Iacoponi F, Figura N. Resistin, interleukin-6, tumor necrosis factor-alpha, and human semen parameters in the presence of leukocytospermia, smoking habit, and varicocele. Fertil Steril. 2014;102(2):354-60.##Elfassy Y, Bastard JP, McAvoy C, Fellahi S, Dupont J, Levy R. Adipokines in semen: physiopathology and effects on spermatozoas. Int J Endocrinol. 2018;2018:3906490.##Kratzsch J, Paasch U, Grunewald S, Mueller MA, Thiery J, Glander HJ. Resistin correlates with elastase and interleukin-6 in human seminal plasma. Reprod Biomed Online. 2008;16(2):283-8.##Thomas S, Kratzsch D, Schaab M, Scholz M, Grunewald S, Thiery J, et al. Seminal plasma adipokine levels are correlated with functional characteristics of spermatozoa. Fertil Steril. 2013;99(5):1256-63.##World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.##World Health Organization (WHO). WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: WHO: 2010. 271 p.##Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14(1):131-5.##Amer M, Ateyah A, Hany R, Zohdy W. Prospective comparative study between microsurgical and conventional testicular sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Hum Reprod. 2000;15(3):653-6.##McLachlan RI, Rajpert-De Meyts E, Hoei-Hansen CE, de Kretser DM, Skakkebaek NE. Histological evaluation of the human testis: approaches to optimizing the clinical value of the assessment—mini review. Hum Reprod. 2007;22(1):2-16.##Morita Y. Histological investigation of testis in infertile man. Part II. Pathological problems. Nagoya J Med Sci. 1971;34(2):113-29.##Dohle GR, Elzanaty S, van Casteren NJ. Testicular biopsy: clinical practice and interpretation. Asian J Androl. 2012;14(1):88-93.##Glander HJ, Lammert A, Paasch U, Glasow A, Kratzsch J. Leptin exists in tubuli seminiferi and in seminal plasma. Andrologia. 2002;34(4):227-33.##Jope T, Lammert A, Kratzsch J, Paasch U, Glander HJ. Leptin and leptin receptor in human seminal plasma and in human spermatozoa. Int J Androl. 2003;26(6):335-41.##Lampiao F, du Plessis SS. Insulin and leptin enhance human sperm motility, acrosome reaction and nitric oxide production. Asian J Androl. 2008;10(5):799-807.##Guo J, Zhao Y, Huang W, Hu W, Gu J, Chen C, et al. Sperm motility inversely correlates with seminal leptin levels in idiopathic asthenozoospermia. Int J Clin Exp Med. 2014;7(10):3550-5.##Ellithy MM, Shaeer OK, Gaafar KM. Correlation between leptin content and sperm retrieval in cases of functional azoospermia. J Basic Appl Zool. 2014;67(5):164-72.##Alves MG, Jesus TT, Sousa M, Goldberg E, Silva BM, Oliveira PF. Male fertility and obesity: are ghrelin, leptin and glucagon-like peptide-1 pharmacologically relevant? Curr Pharm Des. 2016;22(7):783-91.##Martins AD, Moreira AC, Sá R, Monteiro MP, Sousa M, Carvalho RA, et al. Leptin modulates human sertoli cells acetate production and glycolytic profile: a novel mechanism of obesity-induced male infertility? Biochim Biophys Acta. 2015;1852(9):1824-32.##Moretti E, Micheli L, Noto D, Fiaschi AI, Menchiari A, Cerretani D. Resistin in human seminal plasma: relationship with lipid peroxidation, CAT activity, GSH/GSSG ratio, and semen parameters. Oxid Med Cell Longev. 2019;2019:2192093.##

Comparison of Cumulative Live Birth Rate (CLBR) According to Patient Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Stratification Among Low Prognosis Women Undergoing IVF-ICSI Cycles 2 1 2 Background: The purpose of the current study was to evaluate patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria, validate stratification of low prognosis women, and prognosticate their reproductive potential in terms of cumulative live birth rate (CLBR) in Indian women. Methods: Out of 4048 women who underwent IVF/ICSI, 3287 women met the criteria for final evaluation of CLBR. They criteria were divided into (a) group 1a as cases with <4 oocytes retrieved and 1b with 4-9 oocytes retrieved; (b) group 2a as cases with <4 oocytes retrieved and 2b with 4-9 oocytes retrieved; (c) group 3 (<35 years, AMH <1.2 ng/ml, AFC <5); and (d) group 4 (≥35 years, AMH <1.2 ng/ml, AFC <5). Non-POSEIDON group was sub-divided into normo-responders (10-20 oocytes) and hyper-responder (>20 oocytes). Results: Overall CLBR was two-fold lower in POSEIDON group as compared to non-POSEIDON group (p<0.001). For every one-year increase in the age, the odds of CLBR decreased by 4% (OR 0.96, CI 0.93-0.99) in POSEIDON group and by 5% (OR 0.95, CI 0.92-0.98) in non-POSEIDON group. For every unit increase in number of oocytes retrieved, the odds of CLBR increased by 1.22 times (OR1.22, CI 1.16-1.28) in POSEIDON group and by 1.08 times (OR 1.08, CI 1.05-1.11) in non-POSEIDON group. Among POSEIDON groups, the highest values in CLBR belonged to group 1b followed by 3, 2b, 4, 1a, and 2a. Conclusion: POSEIDON stratification of low-prognosis women undergoing IVF may be considered valid to prognosticate and counsel women undergoing IVF. Prospective studies will strengthen its validity among different ethnic populations. 117 132 Reeta R Bansiwal Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Reeta R Mahey Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India reetamahey52@gmail.com Neena N Malhotra Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Neeta N Singh Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Monika M Saini Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Ashok A Bhatt Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Nilima N Nilima Department of Biostatistics, All India Institute of Medical Sciences (AIIMS) Department of Biostatistics, All India Institute of Medical Sciences (AIIMS) India Kalaivani Kh Mani Department of Biostatistics, All India Institute of Medical Sciences (AIIMS) Department of Biostatistics, All India Institute of Medical Sciences (AIIMS) India Rohitha R Cheluvaraju Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Monika M Rajput Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Neerja N Bhatla Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) India Cumulative live birth rateInfertilityIVFLow prognosis womenPOSEIDON criteria 140186.pdf Ferraretti AP, La Marca A, Fauser BCJM, Tarlatzis B, Nargund G, Gianaroli L, et al. ESHRE consensus on the definition of “poor response” to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26(7):1616-24.##Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder–a plea for universal definitions. J Assist Reprod Genet. 2015;32(12):1709-12.##Poseidon group (Patient-oriented strategies encompassing individualizeD oocyte number), Alviggi C, Andersen CY, Buehler K, Conforti A, De Placido G, et al. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016;105(6):1452-3. ##Esteves SC, Conforti A, Sunkara SK, Carbone L, Picarelli S, Vaiarelli A, et al. Improving reporting of clinical studies using the POSEIDON criteria: POSORT guidelines. Front Endocrinol (Lausanne). 2021;12:587051.##Esteves SC, Roque M, Sunkara SK, Conforti A, Ubaldi FM, Humaidan P, et al. Oocyte quantity, as well as oocyte quality, plays a significant role for the cumulative live birth rate of a POSEIDON criteria patient. Hum Reprod. 2019;34(12):2555-7. ##Yang R, Zhang C, Chen L, Wang Y, Li R, Liu P, et al. Cumulative live birth rate of low prognosis patients with POSEIDON stratification: a single-centre data analysis. Reprod Biomed Online. 2020;41(5):834-44.##Kotdawala AP, Mir P, Herrero J, Khajuria R, Lalit Kumar PGL, Banker MR. Embryonic aneuploidy after preimplantation genetic screening: age- and indication-matched comparative study between Indian and Spanish population. J Hum Reprod Sci. 2019;12 (2):141-9.##Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26(6):1270-83.##Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155-8.##Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. 2017. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32(9):1786-801.##Ji J, Liu Y, Tong XH, Luo L, Ma J, Chen Z. The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China. Hum Reprod. 2013;28(10):2728-34.##McLernon DJ, Steyerberg EW, Te Velde ER, Lee AJ, Bhattacharya S. Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population-based study of linked cycle data from 113,873 women. BMJ. 2016;355:i5735.##Vargas-Tominaga L, Vargas A, Alarc F, Medina A, Mez MG, Bejar K. Cumulative live birth rates of patients in the Peruvian Andes according to the POSEIDON criteria: a single-center retrospective analysis. JBRA Assist Reprod. 2021;25(3):412-6.##Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis. PLoS One. 2017;12(10):e0186287.##Shan D, Qiu PY, Wu YX, Chen Q, Li AL, Ramadoss S, et al. Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Sci Rep. 2018;8(1):12239.##Shi W, Zhou H, Tian L, Zhao Z, Zhang W, Shi J. Cumulative live birth rates of good and low prognosis patients according to POSEIDON criteria: a single center analysis of 18,455 treatment cycles. Front Endocrinol (Lausanne). 2019;10;10:409.##Leijdekkers JA, Eijkemans MJC, Tilborg TC, Oudshoorn SC, Golde RJT, Hoek A, et al. Cumulative live birth rates in low-prognosis women. Hum Reprod. 2019;34(6):1030-41.##

The Effect of Uterine Contractions on Fertility Outcomes in Frozen Embryo Transfer Cycles: A Cohort Study 2 1 2 Background: The relationship between uterine peristalsis before embryo transfer and the success of assisted reproductive techniques (ARTs) has not been properly investigated. In this study, the effect of uterine contractions on embryo implantation in frozen embryo transfer (FET) cycles was investigated to determine whether the frequency of uterine contractions can be used as a quantitative marker to assess endometrial receptivity. Methods: In this cohort study of 68 eligible FET candidates, one hour before embryo transfer (ET), frequency of uterine contractions was assessed with transvaginal ultrasonography. Patients were followed up for 20 weeks. The association between FET outcomes including clinical pregnancy, abortion, and ectopic pregnancy with uterine contractions was evaluated. Binary logistic regression was conducted to test the association between clinical pregnancy outcomes in different groups. The p<0.05 were considered statistically significant. Results: Of 68 patients, 25 (36.8%) experienced clinical pregnancy. Multiple logistic regression for omitted confounders (age, BMI, duration, type and cause of infertility) revealed that patients with uterine peristaltic wave frequency less than 2≤ wave/min had higher chance of successful pregnancy compared to those with ≥4 wave/min (odds ratio: 10.8; 95% confidence interval: 1.5-79.4, p=0.019). The Pearson's correlation showed a statistically significant relationship between the frequency of uterine contraction and endometrial thickness (r= 0.42, p=0.002). Conclusion: Patients with uterine peristalsis of <4.0 wave/min before embryo transfer had a higher chance of successful implantation and pregnancy compared with those with higher contraction frequencies. It seems that measuring uterine contraction frequency before embryo transfer might help to predict pregnancy outcomes. 132 139 Mojgan M Javedani Masroor Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Iran Ladan L Younesi Asl Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Iran Niloufar N Sarchami Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Shahid Akbar-Abadi Clinical Research Development Unit, Iran University of Medical Sciences (IUMS) Iran Sarchami_Niloo@yahoo.com Assisted reproductive technologyClinical pregnancyUterine peristalsis 140187.pdf Taylor HS, Pal L, Sell E. Speroff's clinical gyneco-logic endocrinology and infertility. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2019. 973 p.##Isaksson R, Gissler M, Tiitinen A. Obstetric outcome among women with unexplained infertility after IVF: a matched case–control study. Hum Reprod. 2002;17(7):1755-61.##Szamatowicz M. Assisted reproductive technology in reproductive medicine-possibilities and limitations. Ginekol Pol. 2016;87(12):820-3.##Lahav-Baratz S, Koifman M, Shiloh H, Ishai D, Wiener-Megnazi Z, Dirnfeld M. Analyzing factors affecting the success rate of frozen–thawed embryos. J Assist Reprod Genet. 2003;20(11):444-8.##Baker VL, Jones CE, Cometti B, Hoehler F, Salle B, Urbancsek J, et al. Factors affecting success rates in two concurrent clinical IVF trials: an examination of potential explanations for the difference in pregnancy rates between the United States and Europe. Fertil Steril. 2010;94(4):1287-91.##Younglai EV, Holloway AC, Foster WG. Environmental and occupational factors affecting fertility and IVF success. Hum Reprod Update. 2005;11(1):43-57.##Bretherick KL, Fairbrother N, Avila L, Harbord SH, Robinson WP. Fertility and aging: do reproductive-aged Canadian women know what they need to know? Fertil Steril. 2010;93(7):2162-8.##Kupka MS, Ferraretti AP, De Mouzon J, Erb K, D'Hooghe T, Castilla JA, et al. Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE. Hum Reprod. 2014;29(10):2099-113.##Shen C, Shu D, Zhao X, Gao Y. Comparison of clinical outcomes between fresh embryo transfers and frozen-thawed embryo transfers. Iran J Reprod Med. 2014;12(6):409-14.##Li M, Xie Y, Park H, Kumar A, Hubert G, Buyalos R. Frozen-thawed embryo transfer improves clinical outcomes in patients receiving IVF treatment. Fertil Steril. 2013;100(3):S177.##Ijland MM, Evers JL, Dunselman GA, van Katwijk C, Lo CR, Hoogland HJ. Endometrial wavelike movements during the menstrual cycle. Fertil Steril. 1996;65(4):746-9.##Bulletti C, de Ziegler D, Polli V, Diotallevi L, Ferro ED, Flamigni C. Uterine contractility during the menstrual cycle. Hum Reprod. 2000;15 Suppl 1:81-9.##Fanchin R, Ayoubi JM, Righini C, Olivennes F, Schönauer LM, Frydman R. Uterine contractility decreases at the time of blastocyst transfers. Hum Reprod. 2001;16(6):1115-9.##Zhu L, Xiao L, Che H, Li Y, Liao J. Uterine peristalsis exerts control over fluid migration after mock embryo transfer. Hum Reprod. 2014;29(2):279-85.##Kuijsters NPM, Methorst WG, Kortenhorst MSQ, Rabotti C, Mischi M, Schoot BC. Uterine peristalsis and fertility: current knowledge and future perspectives: a review and meta-analysis. Reprod Biomed Online. 2017;35(1):50-71.##Hunt S, Abdallah KS, Ng E, Rombauts L, Vollenhoven B, Mol BW. Impairment of uterine contractility is associated with unexplained infertility. Semin Reprod Med. 2020;38(1):61-73.##Zhu L, Che H, Xiao L, Li Y. Uterine peristalsis before embryo transfer affects the chance of clinical pregnancy in fresh and frozen-thawed embryo transfer cycles. Hum Reprod. 2014;29(6):1238-43.##Lesny P, Killick S, Tetlow R, Robinson J, Maguiness S. Embryo transfer--can we learn anything new from the observation of junctional zone contractions? Hum Reprod. 1998;13(6):1540-6.##Fanchin R, Righini C, Olivennes F, Taylor S, de Ziegler D, Frydman R. Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization. Hum Reprod. 1998;13(7):1968-74.##Chung CHS, Wong AWY, Chan CPS, Saravelos SH, Kong GWS, Cheung LP, et al. The changing pattern of uterine contractions before and after fresh embryo transfer and its relation to clinical outcome. Reprod Biomed Online. 2017;34(3):240-7.##Blank C, Sammali F, Kuijsters N, Huang Y, Rabotti C, de Sutter P, et al. Assessment of uterine activity during IVF by quantitative ultrasound imaging: a pilot study. Reprod Biomed Online. 2020;41(6):1045-53.##Kim A, Lee JY, Ji YI, Lee HH, Lee ES, Kim HY, et al. Do endometrial movements affect the achievement of pregnancy during intrauterine insemination? Int J Fertil Steril. 2015;8(4):399-408.##Check JH, Dietterich C, Graziano V, Lurie D, Choe JK. Effect of maximal endometrial thickness on outcome after frozen embryo transfer. Fertil Steril. 2004;81(5):1399-400.##Groenewoud ER, Cohlen BJ, Al‐Oraiby A, Brinkhuis EA, Broekmans FJ, de Bruin JP, et al. Influence of endometrial thickness on pregnancy rates in modified natural cycle frozen‐thawed embryo transfer. Acta Obstet Gynecol Scand. 2018;97(7):808-15.##Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007;87(1):53-9.##Bu Z, Sun Y. The impact of endometrial thickness on the day of human chorionic gonadotrophin (hCG) administration on ongoing pregnancy rate in patients with different ovarian response. PLoS One. 2015;10(12):e0145703.##Wang Y, Zhu Y, Sun Y, Di W, Qiu M, Kuang Y, et al. Ideal embryo transfer position and endometrial thickness in IVF embryo transfer treatment. Int J Gynaecol Obstet. 2018;143(3):282-8.##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.##

The Effect of Follitropin Alfa in Controlled Ovarian Stimulation Protocol for In Vitro Fertilization Cycles 2 1 2 Background: Follitropin alfa (FA) is one of the most widely used exogenous gonadotropins in both agonist and antagonist protocols for controlled ovarian stimulation (COS) and in vitro fertilization (IVF). However, reports of its effectiveness are limited, particularly in terms of its impact on overall IVF outcomes and ovarian hyperstimulation syndrome (OHSS). Therefore, in this study, FA competency was investigated by evaluating its effect on IVF outcomes and OHSS, administering agonist and antagonist COS protocols. Methods: A retrospective study with 120 subjects was conducted. Outcomes comprising the number of retrieved and fertilized oocytes, quality of embryos, and clinical pregnancies were assessed. Statistical correlation between FA dose, IVF outcomes, and the incidence of OHSS was also analyzed. All statistical analyses were performed at 95% confidence level. Results: There was no significant difference in both protocols regarding retrieved oocytes (p=0.604), fertilized oocytes (p=0.761), embryo quality including good, average, poor embryo (p=0.875, p=0.565, p=0.785), and clinical pregnancy (p=0.844). However, FA doses in the agonist protocol were shown notably higher (p=0.001). Negative correlations were also observed between FA dose and the number of retrieved oocytes (r=-0.255, p<0.01), fertilized oocytes (r=-0.296, p<0.01), and good quality embryos (r=-0.231, p<0.05). Conclusion: Our study suggested that FA yields similar outcomes in both COS protocols, but agonist protocols require higher doses of FA and evaluation of its effect on OHSS is an important area of research for further investigation. 139 145 Novitai N Prasetiawati Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Indonesia Ayu AM Sundari Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Indonesia Agus A Supriyadi Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Hadi H Sjarbaini Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Sudirmanto S Tarigan Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Gde G Suardana Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Gangsar G Pariyanti Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Deana DR Indah Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Euis E Purwatyningsih Melati Infertility Clinic, Harapan Kita Women and Children Hospital Melati Infertility Clinic, Harapan Kita Women and Children Hospital Indonesia Anom A Bowolaks Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Graduate School of Biology, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia Indonesia alaksono@sci.ui.ac.id AgonistAntagonistFollitropin alfaGonadotropin releasing hormone (GnRH)In vitro fertilizationOHSS 140182.pdf Lindenberg S, Almind GJ, Lindenberg FB. Is gonadotropin stimulation bad for oocytes? Curr Opin Obstet Gynecol. 2018;30(3):151-4.##Wang H, May J, Butnev V, Shuai B, May JV, Bousfield GR, et al. Evaluation of in vivo bioactivities of recombinant hypo- (FSH21/18) and fully- (FSH24) glycosylated human FSH glycoforms in Fshb null mice. Mol Cell Endocrinol. 2016;437:224-36.##Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22(4):980-8.##Friedler S, Meltzer S, Saar-Ryss B, Rabinson J, Lazer T, Liberty G. An upper limit of gonadotropin dose in patients undergoing ART should be advocated. Gynecol Endocrinol. 2016;32(12):965-9.##Xu GF, Zhang JY, Pan HT, Tian S, Liu ME, Yu TT, et al. Cardiovascular dysfunction in offspring of ovarian-hyperstimulated women and effects of estradiol and progesterone: a retrospective cohort study and proteomics analysis. J Clin Endocrinol Metab. 2014;99(12):E2494-503.##Huirne JA, van Loenen AC, Schats R, McDonnell J, Hompes PG, Schoemaker J, et al. Dose-finding study of daily gonadotropin-releasing hormone (GnRH) antagonist for the prevention of premature luteinizing hormone surges in IVF/ICSI patients: antide and hormone levels. Hum Reprod. 2004;19(10):2206-15.##Newton CL, Riekert C, Millar RP. Gonadotropin-releasing hormone analog therapeutics. Minerva Ginecol. 2018;70(5):497-515.##Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4(4):CD001750.##Lambalk CB, Banga FR, Huirne JA, Toftager M, Pinborg A, Homburg R, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560-79.##Gay LR, Mills GE, Airasian P. Educational research: Competencies for analysis and application. United State of America: Pearson education; 2012. p. 145.##ESHRE special interest group of embryology and alpha scientists in reproductive medicine. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reprod Biomed Online. 2017;35(5):494-510.##Golan A, Weissman A. Symposium: update on prediction and management of OHSS. a modern classification of OHSS. Reprod Biomed Online. 2009;19(1):28-32.##Lunenfeld B, Bilger W, Longobardi S, Alam V, D'Hooghe T, Sunkara SK. The development of gonadotropins for clinical use in the treatment of infertility. Front Endocrinol (Lausanne). 2019;10:429.##Mochtar MH, Dutch Ganirelix Study Group. The effect of an individualized GnRH antagonist protocol on folliculogenesis in IVF/ICSI. Hum Reprod. 2004;19(8):1713-8.##Stimpfel M, Vrtacnik-Bokal E, Pozlep B, Virant-Klun I. Comparison of GnRH agonist, GnRH antagonist, and GnRH antagonist mild protocol of controlled ovarian hyperstimulation in good prognosis patients. Int J Endocrinol. 2015;2015:385049.##Hsieh YY, Chang CC, Tsai HD. Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization. Taiwan J Obstet Gynecol. 2008;47(1):66-74.##Velthuis E, Hubbard J, Longobardi S, D'Hooghe T. The frequency of ovarian hyperstimulation syndrome and thromboembolism with originator recombinant human follitropin alfa (GONALl-f) for medically assisted reproduction: a systematic review. Adv Ther. 2020;37(12):4831-47.##Xiao JS, Su CM, Zeng XT. Comparisons of GnRH antagonist versus GnRH agonist protocol in supposed normal ovarian responders undergoing IVF: a systematic review and meta-analysis. PLoS One. 2014;9(9):e106854.##Sydow P, Gmeinwieser N, Pribbernow K, Keck C, Wiegratz I. Effectiveness and safety of follitropin alfa (Ovaleap®) for ovarian stimulation using a GnRH antagonist protocol in real-world clinical practice: a multicenter, prospective, open, non-interventional assisted reproductive technology study. Reprod Biol Endocrinol. 2020;18(1):54.##Lunenfeld B, Bilger W, Longobardi S, Kirsten J, D'Hooghe T, Sunkara SK. Decision points for individualized hormonal stimulation with recombinant gonadotropins for treatment of women with infertility. Gynecol Endocrinol. 2019;35(12):1027-36.##Iaconelli CAR, Setti AS, Braga DPAF, Maldonado LGL, Iaconelli A Jr, Borges E Jr, et al. Concomitant use of FSH and low-dose recombinant hCG during the late follicular phase versus conventional controlled ovarian stimulation for intracytoplasmic sperm injection cycles. Hum Fertil (Camb). 2017;20(4):285-92.##Hovatta O, McVeigh E, Lass A, Homburg R. A large Northern European observational study of follitropin alpha filled-by-mass pre-filled pen. Reprod Biomed Online. 2009;18(4):502-8.##