Changing clinical significance of oocyte maturity grades with advancing female age advances precision medicine in IVF

Comparative Analysis of Rescue-In Vitro-Maturation (r-IVM) Outcomes in Women with Diminished Ovarian Reserve (DOR) Versus Normal Ovarian Reserve (NOR)

Background/Objectives: Diminished ovarian reserve (DOR) poses significant challenges in the reproductive field, resulting in fewer mature and more low-quality eggs. Methods: We studied r-IVM in addition to standard in vitro fertilization (IVF) and compared the embryological outcomes between both DOR and NOR women. Results: We recruited 90 women (45 NOR; 45 DOR) with a younger age seen in NOR (35.2 vs. 36.5 years old) women. Otherwise, DOR women had lower levels of AMH and AFC, thus fewer retrieved follicles and collected oocytes. Most of the group presented with primary subfertility, with 55.6% in the NOR group diagnosed with polycystic ovary syndrome (PCOS), while 37.8% in the DOR group presented with aging and cancer survivorship issues. Most women in the NOR group used hCG as a trigger (82.2%), while 17.8% of the DOR group opted for a decapeptide. A total of 719 oocytes were retrieved, with 72.3% of eggs being mature in the NOR group compared to 64.9% in the DOR group. Following r-IVM, 47.69% of NOR eggs were matured compared to 60% in DOR eggs. The fertilization rates (FRs) following r-IVM were higher in the DOR group (66.7% vs. 37.8%). Overall, higher numbers and quality of D3 embryos were seen in the DOR group. Our analysis revealed that the trigger type, hCG, was the only significant factor linked to successful oocyte maturation rates. Conclusions: Our study suggests that r-IVM may enhance outcomes for women with DOR, including better egg maturity, FR, and embryo quality than NOR women.

Automated detection and recognition of oocyte toxicity by fusion of latent and observable features

Oocyte quality is essential for successful pregnancy, yet no discriminant criterion exists to assess the effects of environmental pollutants on oocyte abnormalities. We developed a stepwise framework integrating deep learning-extracted latent features with observable human-concept features focused on toxicity detection, subtype and strength classification. Based on 2126 murine oocyte images, this method achieves performance surpassing human capabilities with ROC-AUC of 0.9087 for toxicity detection, 0.7956-0.9034 for subtype classification with Perfluorohexanesulfonic Acid(PFHxS) achieving highest score of 0.9034 and 0.6434-0.9062 for toxicity strength classification with PFHxS achieving highest score of 0.9062. Notably, Ablation studies confirmed feature fusion improved performance by 18.7-23.4 % over single-domain models, highlighting their complementary relationship. Personalized heatmaps and feature importance revealed biomarker regions such as polar body and cortical areas aligning with clinical knowledge. AI-driven oocyte selection predicts embryo competence under pollutants, bridging computational toxicology to mitigate infertility.

Why the hypothesis of embryo selection in IVF/ICSI must finally be reconsidered

Embryo selection (ES) during IVF is expected to select the 'best' embryo(s) from among a cycle's embryo cohort and has been a core concept of IVF for over 40 years. However, among 36 492 articles on ES in a recent PubMed search, we were unable to locate even a single one questioning the concept that, beyond standard oocyte and embryo morphology, ES has remained an unproven hypothesis. In unselected patient populations, attempts at ES have universally, indeed, failed to improve cumulative pregnancy and live birth rates. The only benefit ES appears to offer is a marginal shortening in time to pregnancy, and even this benefit manifests only in best-prognosis patients with large oocyte and embryo numbers. Excluding in vitro maturation efforts, oocytes, once retrieved, and their resulting embryos have predetermined finite cumulative pregnancy and live birth chances that cannot be further improved. The hypothesis of ES has, however, remained a driving force for research and the introduction of a multitude of 'add-ons' to IVF. Enormous investments over decades in ES, therefore, should be better redirected from post- to pre-retrieval efforts.

The quality of human eggs and its pre-IVF incubation

Background

Multi-factors influence the success rate of infertility treatments, and one of the important points is to obtain good quality eggs.

Methods

Based on the literatures and unpublished data, the factors affecting egg quality were summarized.

Main Findings Results

Egg quality is an important determinant in successful infertility treatment. In addition to maternal age, controlled ovarian hyperstimulation (COH) protocols also play a key role in affecting the quality of the egg. After egg retrieval, the insemination occurs 3-6 h after collection, with a pre-IVF incubation time by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (39-42 h post-HCG injection). The pre-IVF incubation refers to the short period time of 3 to 6 h after oocyte retrieval and before the insemination by IVF or ICSI. The pre-IVF incubation of collected eggs in the designed culture medium improves egg quality in terms of maturation and early embryonic development.

Conclusions

Pre-IVF incubation of the collected eggs contributes to the improvement of the quality of eggs; therefore, it may increase subsequent pregnancy and implantation rates following embryo transfer.

In vitro matured oocytes have a higher developmental potential than in vivo matured oocytes after hormonal ovarian stimulation in Callithrix jacchus

BACKGROUND

The common marmoset, Callithrix jacchus, is an invaluable model in biomedical research. Its use includes genetic engineering applications, which require manipulations of oocytes and production of embryos in vitro. To maximize the recovery of oocytes suitable for embryo production and to fulfil the requirements of the 3R principles to the highest degree possible, optimization of ovarian stimulation protocols is crucial. Here, we compared the efficacy of two hormonal ovarian stimulation approaches: 1) stimulation of follicular growth with hFSH followed by triggering of oocyte maturation with hCG (FSH + hCG) and 2) stimulation with hFSH only (FSH-priming).

METHODS

In total, 14 female marmosets were used as oocyte donors in this study. Each animal underwent up to four surgical interventions, with the first three performed as ovum pick-up (OPU) procedures and the last one being an ovariohysterectomy (OvH). In total, 20 experiments were carried out with FSH + hCG stimulation and 18 with FSH-priming. Efficacy of each stimulation protocol was assessed through in vitro maturation (IVM), in vitro fertilization (IVF) and embryo production rates.

RESULTS

Each study group consisted of two subgroups: the in vivo matured oocytes and the oocytes that underwent IVM. Surprisingly, in the absence of hCG triggering some of the oocytes recovered were at the MII stage, moreover, their number was not significantly lower compared to FSH + hCG stimulation (2.8 vs. 3.9, respectively (ns)). While the IVM and IVF rates did not differ between the two stimulation groups, the IVF rates of in vivo matured oocytes were significantly lower compared to in vitro matured ones in both FSH-priming and FSH + hCG groups. In total, 1.7 eight-cell embryos/experiment (OPU) and 2.1 eight-cell embryos/experiment (OvH) were obtained after FSH + hCG stimulation vs. 1.8 eight-cell embryos/experiment (OPU) and 5.0 eight-cell embryos/experiment (OvH) following FSH-priming. These numbers include embryos obtained from both in vivo and in vitro matured oocytes.

CONCLUSION

A significantly lower developmental competence of the in vivo matured oocytes renders triggering of the in vivo maturation with hCG as a part of the currently used FSH-stimulation protocol unnecessary. In actual numbers, between 1 and 7 blastocysts were obtained following each FSH-priming. In the absence of further studies, FSH-priming appears superior to FSH + hCG stimulation in the common marmoset under current experimental settings.

COVID-19 Vaccination and Reproductive Health: a Comprehensive Review for Healthcare Providers

With all the current misinformation on social media platforms about the COVID-19 vaccine and its potential effects on fertility, it is essential for healthcare providers to have evidenced-based research to educate their patients, especially those who are trying to conceive, of the risks to mothers and fetuses of being unvaccinated. It is well known that COVID-19 infection puts pregnant women at higher risk of complications, including ICU admission, placentitis, stillbirth, and death. In February of 2021, the American College of Obstetricians and Gynecologists (ACOG), the American Society for Reproductive Medicine (ASRM), and the Society for Maternal-Fetal Medicine (SMFM) released a statement denying any link between COVID vaccination and infertility. ASRM later confirmed and stated that "everyone, including pregnant women and those seeking to become pregnant, should get a COVID-19 vaccine". In this review, we aim to provide a compilation of data that denies any link between vaccination and infertility for healthcare providers to be able to educate their patients based on evidence-based medicine. We also reviewed the effect of COVID-19 virus and vaccination on various parameters and processes that are essential to obtaining a successful pregnancy.

Leukocyte telomere length and DNA methylome as biomarkers of ovarian reserve and embryo aneuploidy: the intricate relationship between somatic and reproductive aging

The average childbearing age among women continues to rise, leading to an increased prevalence of infertility and a subsequent increased use of assisted reproductive technologies (ARTs). Ovarian aging, especially diminished ovarian reserve and poor ovarian response, have been implicated as common causes of infertility. Telomere length and DNA methylation-based epigenetic clocks are established hallmarks of cellular aging; however, the interplay between somatic and ovarian aging remains unclear. There appears to be a lack of correlation between leukocyte telomere length and the DNA methylation age of somatic and ovarian cells. Both the telomere length and methylome of follicular somatic cells (granulosa and cumulus) appear to be unaffected by chronologic age, infertility, or processes that result in diminished ovarian reserve and poor ovarian response. As such, they are unlikely candidates as surrogate biomarkers of reproductive potential, response to stimulation, or ART outcome. Meanwhile, telomere or methylome changes in leukocytes associated with aging seem to correlate with reproductive function and may have the potential to aid the characterization of women with reproductive decline; however, current data are limited and larger studies evaluating this within an ART setting are warranted.