Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination

Background: Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI).Methods: A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400x magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined.Results: Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.Conclusions: The present findings support the use of high-magnification microscopy both for selecting spermatozoa and as a routine method for analysing semen before performing IUI

P-757 Clinical and neonatal outcome of single vitrified-warmed blastocyst transfer with complete zona pellucida removal using laser-assisted hatching

Abstract Study question Complete zona pellucida (ZP) removal using laser assisted hatching can improve clinical and neonatal outcome in single vitrified-warmed blastocyst transfer (SVBT) cycle? Summary answer Implantation rate, clinical pregnancy rate and live birth rate can be improved by complete removal of zona pellucida, whereas no impact on neonatal outcomes. What is known already Assisted hatching (AH) technique widely used in assisted reproductive technology for improving clinical outcome in frozen embryo transfer (FET), which could impair successful embryo hatching out of the zona pellucida (ZP) due to ZP hardening during vitrification-warming. The zona thinning and drilling methods of AH doesn’t affect clinical, live births outcomes and it could increase monozygotic twin birth, risk of placenta associated diseases. But recent studies showed that the complete removal of ZP may increase the chance of blastocyst adhesion and outgrowth afterwards, which required to be proven. Study design, size, duration Retrospective study data collected from July 2015 to November 2019 included SVBT in the Ojinmed IVF center. We divided into 2 groups as follows: case group 160 (randomly selected complete removal of ZP) and control group 160. The clinical outcomes were implantation rate (IR), clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage and neonatal outcomes including monozygotic twin, birth baby sex, birth weight, height and gestational weeks. All parameters were compared between two groups. Participants/materials, setting, methods 320 vitrified blastocyst transfer cycles in 215 patients underwent a clomiphene-based minimal ovarian stimulation protocol or drug-free natural cycles. All embryos were vitrified-warmed by Cryotop method (Kitazato, Japan). Complete removal of ZP selected an survived blastocysts after warming and used an immediate laser drilling (Laser: 1.8-2.2 ms, Octax NaviLaseTM) in perivitelline space. And gently glass pipetting done for complete removal of ZP. Statistical analysis performed by Chi-square test and logistic regression analysis using STATA 12. Main results and the role of chance A total 320 SVBT cycles, including ZP completely removed 160 cycles and control 160 cycles. In analysis of the patient's age, fertility causes and fertilization methods were not significant (p &amp;lt; 0.05) between two groups. The IR (55.2 % and 66.2 %, p &amp;lt; 0.01), CPR (39.3 % and 52.5 %, p = 0.01) and LBR (29.3 % and 43.7 %, p &amp;lt; 0.01) are highly correlated between the control and the completely removal of ZP group, respectively. In multivariable logistic regression analysis showed the completely removal of ZP group had significance for IR (aOR 0.54, CI 95 % 0.31-0.93, p = 0.02), CPR (aOR 0.56, CI 95 % 0.32-0.96, p = 0.03) and LBR (aOR 0.56, CI 95 % 0.32-0.99, p = 0.048), which adjusted by patient age, blastocyst grade and vitrification day. Miscarriage rate didn’t show significance (23.8% and 21.4%, p = 0.73) between groups. The neonatal outcomes including monozygotic twin, sex of the births, average gestation week and birthweight were non significant (p &amp;lt; 0.05) between two groups (49 for control group and 66 for case group) children. Limitations, reasons for caution The result of the current retrospective study is limited to data from a single IVF center. Wider implications of the findings Our study suggests that complete removal of ZP using laser assisted can improve clinical outcomes including implantation, clinical pregnancy and live birth after SVBT. And it may doesn’t affect to miscarriage rate and neonatal outcome. Trial registration number not applicable </jats:sec

P–232 A trophectoderm morphology can predict a live birth rate and gender imbalance

Abstract Study question Which morphology parameter is the most predictable in the live birth rate and can affect the sex ratio? Summary answer The trophectoderm grade (TE) can predict the live birth rate and skewed to male gender after single vitrified-warmed blastocyst transfers (SVBT). What is known already The Gardner and Schoolcraft grading system of blastocyst evaluation with morphology is the major predictor of the clinical outcome in ART. Inner cell mass (ICM) and trophectoderm (TE) morphology are strongly correlated between clinical pregnancy, live birth, and miscarriage. A greater degree of expansion of the transferred blastocysts showed a higher implantation rate. Therefore, it is essential to clarify which parameter is more predictable in clinical outcome during elective SVBT. However, SVBT has some potential limitations, including adverse effects such as a male-biased imbalance in the sex ratio. Study design, size, duration The retrospective analysis used 1138 cycles of SVBT in the Ojinmed IVF center, Mongolia, between May 2015 to January 2019. The morphology grade and blastocyst inner diameter compared with clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage. The sex ratio was estimated for all patients, excluding those who underwent PGT-A, donor oocytes, and monozygotic twins. Blastocyst quality was evaluated with Gardner and Schoolcraft grading system and measured inner diameter of the blastocyst. Participants/materials, setting, methods All patients underwent a clomiphene-based minimal ovarian stimulation protocol or drug-free natural cycle IVF treatment. On day 5 to 6, blastocysts that reached an inner diameter &amp;gt;160μm were immediately vitrified. Blastocyst morphology evaluated by ICM and TE grade. The CPR (with a confirmed gestational sac at 6–7 weeks of pregnancy) and the LBR (live birth at 22 weeks of pregnancy over) were estimated per embryo transfer procedure, followed by miscarriage rate. Main results and the role of chance The CPR was 44.69%, 38.97%, and 25.91% for A, B, C grades of ICM, respectively. And the LBR was 39.82%, 34.62%, and 19.1% for A, B, C grades of ICM, respectively. TE was strongly related to CPR (aOR=2.47, 95% CI 1.71–3.58, p &amp;lt; 0.01) and LBR (aOR=1.77, 95% CI 1.06–2.96, p = 0.028) in univariate and multivariable logistic regression analysis (A grade vs C grade). Also, CPR and LBR were increased with blastocyst inner diameter, proportionally. The A and B grade ICM blastocysts showed 2.8 - 2.9 times less miscarriage rate than the C grade of ICM in the univariate logistic regression analysis. The result of multivariable logistic regression analysis showed B grade of ICM had 2.3 times less than C grade of ICM (aOR 2.36, CI 95% 1.20–4.61, p = 0.012) and TE, patient age and blastocyst inner diameter were not significantly associated with miscarriage rate. The gender ratio was 56.8% (204/359) for male. The result of multivariable logistic regression analysis showed that A grade TE had a 2.3 times higher probability of male than C grade (aOR 2.31, CI 95% 1.22–4.37, p = 0.01). Neither fertilization method, ICM, expiation grade, nor fertility case was significantly associated with the sex ratio. Limitations, reasons for caution The result of the current retrospective study is limited to data from a single IVF center. Wider implications of the findings: Our study suggests that TE grade is the most predictable and ICM grade was associated with miscarriage. The high grade such as A-grade TE blastocyst transfer has more live birth rate, whereas it can affects at sex ratio in favor of male embryos after SVBT. Trial registration number Not applicable </jats:sec