Omics sciences and precision medicine in pancreas cancer

Abstract

Pancreatic cancer is a leading cause of death worldwide, associated with poor prognosis outcomes and late treatment interventions. The pathological nature and extreme tissue heterogeneity of this disease has hampered all efforts to correctly diagnose and treat it. Omics sciences and precision medicine have revolutionized our understanding of pan-creatic cancer, providing a new hope for patients suffering from this devastating disease. By analyzing large-scale biological data sets and developing personalized treatment strategies, researchers and clinicians are working together to improve patient outcomes and ultimately find a cure for pancreatic cancer.

Nutrigenomics: SNPs correlated to physical activity, response to chiropractic treatment, mood and sleep

Abstract

Nutrigenomics, a rapidly evolving field that bridges genetics and nutrition, explores the intricate interactions between an individual's genetic makeup and how they respond to nutrients. At its core, this discipline focuses on investigating Single Nucleotide Polymorphisms (SNPs), the most common genetic variations, which significantly influence a person's physiological status, mood regulation, and sleep patterns, thus playing a pivotal role in a wide range of health out-comes. Through decoding their functional implications, researchers are able to uncover genetic factors that impact physical fitness, pain perception, and susceptibility to mood disorders and sleep disruptions. The integration of nutrigenomics into healthcare holds the promise of transformative interventions that cater to individual well-being. Notable studies shed light on the connection between SNPs and personalized responses to exercise, as well as vulnerability to mood disorders and sleep disturbances. Understanding the intricate interplay between genetics and nutrition informs targeted dietary approaches, molding individual health trajectories. As research advances, the convergence of genetics and nourishment is on the brink of reshaping healthcare, ushering in an era of personalized health management that enhances overall life quality. Nutrigenomics charts a path toward tailored nutritional strategies, fundamentally reshaping our approach to health preservation and preventive measures.

Nutrigenomics: SNPs correlated to minerals' deficiencies

Abstract

Nutrigenetics and nutrigenomics are two interrelated fields that explore the influence of genetic diversity on nutrient responses and function. While nutrigenetics investigates the effects of hereditary ge-netic variations on micronutrient metabolism, nutrigenomics examines the intricate relationship between diet and the genome, studying how genetic variants impact nutrient intake and gene expression. These disciplines offer valuable insights into predicting and managing chronic diseases through personalized nutritional approaches. Nutrigenomics employs cutting-edge genomics technologies to study nutrient-genome interactions. Key principles involve genetic variability among ethnic groups, affecting nutrient bioavailability and metabolism, and the influence of dietary choices based on cultural, geographic, and socioeconomic factors. Polymorphisms, particularly single-nucleotide polymorphisms (SNPs), significantly influence gene activity and are associated with specific phenotypes that are related to micronutrient deficiencies. Minerals are inorganic elements, vital for various physiological functions. Understanding the SNPs associated with mineral deficien-cies is crucial for assessing disease risk and developing personalized treatment plans. This knowledge can inform public health interventions, targeted screening programs, educational campaigns, and fortified food products to address deficiencies effectively. Nutrigenomics research has the potential to revolutionize clinical and nutritional practices, providing personalized recommendations, enhancing illness risk assessment, and advancing public health initiatives. Despite the need for further research, harnessing nutrigenomics' potential can lead to more focused and efficient methods for preventing and treating mineral deficiencies.

Nutrigenomics: SNPs Correlated to Lipid and Carbohydrate Metabolism

Background

Nutrigenomics - the study of the interactions between genetics and nutrition - has emerged as a pivotal field in personalized nutrition. Among various genetic variations, single-nucleotide polymorphisms (SNPs) have been extensively studied for their probable relationship with metabolic traits.

Methods

Throughout this review, we have employed a targeted research approach, carefully handpicking the most representative and relevant articles on the subject. Our methodology involved a systematic review of the scientific literature to ensure a comprehensive and accurate overview of the available sources.

Results

SNPs have demonstrated a significant influence on lipid metabolism, by impacting genes that encode for enzymes involved in lipid synthesis, transport, and storage. Furthermore, they have the ability to affect enzymes in glycolysis and insulin signaling pathways: in a way, they can influence the risk of type 2 diabetes. Thanks to recent advances in genotyping technologies, we now know numerous SNPs linked to lipid and carbohydrate metabolism. The large-scale studies on this topic have unveiled the potential of personalized dietary recommendations based on an individual's genetic makeup. Personalized nutritional interventions hold promise to mitigate the risk of various chronic diseases; however, translating these scientific insights into actionable dietary guidelines is still challenging.

Conclusions

As the field of nutrigenomics continues to evolve, collaborations between geneticists, nutritionists, and healthcare providers are essential to harness the power of genetic information for improving metabolic health. By unraveling the genetic basis of metabolic responses to diet, this field holds the potential to revolutionize how we approach dietary recommendations and preventive healthcare practices.

Nutrigenomics: SNPs correlated to Food Preferences and Susceptibilities

Background

Nutrigenomics explores the intricate interplay between single nucleotide polymorphisms (SNPs), food preferences, and susceptibilities.

Methods

This study delves into the influence of SNPs on food sensitivities, allergies, tyramine intolerance, and taste preferences. Genetic factors intricately shape physiological reactions to dietary elements, with polymorphisms contributing to diverse sensitivities and immune responses.

Results

Tyramine intolerance, arising from metabolic inefficiencies, unveils genetic markers exerting influence on enzyme function. SNPs transcend genetic diversity by exerting substantial impact on food sensitivities/allergies, with specific variants correlating to heightened susceptibilities. Genes accountable for digesting food components play pivotal roles. Given the rising prevalence of food sensitivities/allergies, understanding genetic foundations becomes paramount. In the realm of taste and food preferences, SNPs sculpt perception and choice, yielding variances in taste perception and preferences for sweetness, bitterness, and umami. This genetic medley extends its reach to encompass wider health implications.

Conclusions

In this review article, we have focused on how polymorphisms wield significant sway over physiological responses, sensitivities, and dietary inclinations. Unraveling these intricate relationships illuminates the path to personalized nutrition, potentially revolutionizing tailored recommendations and interventions.

Unraveling the Role of Prickly Pear Extract as a Potent Nutraceutical Agent Against Metabolic Syndromes

Background

Prickly pear (Opuntia) extracts have garnered con-siderable attention in recent years due to their promising medicinal and nutritional properties. This comprehensive review explores the multifaceted potential of prickly pear extracts in mitigating various chronic diseases, including cardiovascular diseases (CVDs), diabetes, obesity, cancer, neuronal diseases, and renal diseases.

Methods

This review provides a comprehensive overview of the diverse therapeutic applications of Opuntia extracts in managing chronic diseases. The collective evidence underscores the potential of prickly pear as a valuable natural resource for addressing global health challenges. Further research and clinical investigations are warranted to unlock the full potential of Opuntia in the prevention and treatment of chronic diseases.

Results

Studies have suggested that the bioactive compounds within prickly pear may influence glucose metabolism by improving insulin sensitivity, reducing insulin resistance, and modulating gut microbiota composition. These pathways exhibit potential in the reduction of hyperglycemia, which is a fundamental aspect of metabolic syndromes. Opuntia extracts demonstrate also antioxidant, anti-inflammatory capabilities that can contribute to improving health in various conditions.

Conclusion

Further research and clinical investigations are warranted to unlock the full potential of Opuntia in the prevention and treatment of chronic diseases.

Omics sciences and precision medicine in colon cancer

Abstract

Colon cancer presents a complex pathophysiological landscape, which poses a significant challenge to the precise prediction of patient prognosis and treatment response. However, the emergence of omics sciences such as genomics, transcriptomics, proteomics, and metabolomics has provided powerful tools to identify molecular alterations and pathways involved in colon cancer development and progression. To address the lack of literature exploring the intersection of omics sciences, precision medicine, and colon cancer, we conducted a comprehensive search in ScienceDirect and PubMed databases. We included systematic reviews, reviews, case studies, clinical studies, and randomized controlled trials that were published between 2015-2023. To refine our search, we excluded abstracts and non-English studies. This review provides a comprehensive summary of the current understanding of the latest developments in precision medicine and omics sciences in the context of colon cancer. Studies have identified molecular subtypes of colon cancer based on genomic and transcrip-tomic profiles, which have implications for prognosis and treatment selection. Furthermore, precision medicine (which involves tailoring treatments, based on the unique molecular characteristics of each patient's tumor) has shown promise in improving outcomes for colon cancer patients. Omics sciences and precision medicine hold great promise for identifying new therapeutic targets and developing more effective treatments for colon cancer. Although not strictly designed as a systematic review, this review provides a readily accessible and up-to-date summary of the latest developments in the field, highlighting the challenges and opportunities for future research.

Effects of Carob Extract on the Intestinal Microbiome and Glucose Metabolism: A Systematic Review and Meta-Analysis

Abstract

The legume tree known as carob (Ceratonia siliqua L.) is indigenous to the Mediterranean area and over the centuries its pods had been traditionally used mostly as animal feed. However, it has gained great attention in human nutrition due to the molecular compounds it contains, which could offer many potential health benefits: for example, carob is renowned for its high content of fiber, vitamins, and minerals. Moreover, in traditional medicine it is credited with the ability to control glucose metabolism and gut microbiome. Modern science has also extensively acknowledged the numerous health advantages deriving from its consumption, including its anti-diabetic, anti-inflammatory, and antioxidant properties. Due to its abundant contents of pectin, gums, and polyphenols (such as pinitol), carob has garnered significant attention as a well-researched plant with remarkable therapeutic properties. Notably, carob is extensively used in the production of semi-finished pastry products, particularly in ice cream and other creams (especially as a substitute for cocoa/chocolate): these applications indeed facilitate the exploration of its positive effects on glucose metabolism. Our study aimed at examining the effects of carob extract on intestinal microbiota and glucose metabolism. In this review, we conducted a thorough examination, comprising in vitro, in vivo, and clinical trials to appraise the consequences on human health of polyphenols and pectin from different carob species, including recently discovered ones with high polyphenol contents. Our goal was to learn more about the mechanisms through which carob extract can support a balanced gut flora and improve one's glucose metabolism. These results could influence the creation of novel functional foods and dietary supplements, to help with the management and prevention of chronic illnesses like diabetes and obesity.

Nutrigenomics: SNPs correlated to vitamins' deficiencies

Abstract

Nutrients can influence the physiological processes in the body by interacting with molecular systems. Including nutrigenetics and nutrigenomics, nutritional genomics focuses on how bio-active food components interact with the genome. The purpose of this study is to clarify how nutrigenomics and vitamin dietary deficits relate to one another. Food tolerances among human sub-populations are known to vary due to genetic variation, which may also affect dietary needs. This raises the prospect of tailoring a person's nutritional intake for optimum health and illness prevention, based on their unique genome. To better understand the interplay between genes and nutrients and to plan tailored weight loss, nutrigenetic testing may soon become a key approach.

Olive tree polyphenols as effective and sustainable grain preservatives

Abstract

Whole grains play a crucial role in the human diet. Despite being cultivated in distinct regions, they are shipped everywhere, therefore making biosafety and security essential throughout the grain industry, from harvest to distribution. Phytopathogens, which have an impact on crop yield, induce grain spoiling and reduce grain quality in a number of ways, providing a constant danger to crop storage and distribution. Chemical control approaches, such as the use of pesticides and fungicides, are detrimental to the environment and hazardous to human health. The development of alternative, environmentally friendly, and generally acceptable solutions to ensure increased grain yield, biosafety, and quality during storage is crucial in order to guarantee sufficient food and feed supplies. As a means of self-defense against microbial infection and spoilage, plant matrices feature antimicrobial natural chemicals, which have led to their widespread usage as food preservatives in recent decades. Olive tree extracts, known for their high polyphenol content, have been widely used in the food preservation industry with great success, and are highly welcomed by people all over the world. In addition to their well-known health advantages, polyphenols are a valuable plant secondary metabolite because of their great antibacterial capabilities as natural preservatives. This article discusses the promising usage of polyphenols from olive trees as a natural alternative preservative, while also highlighting the future of olive eaves in the food industry.

Nutrigenomics: SNPs correlated to detoxification, antioxidant capacity and longevity

Abstract

Nutritional genomics, also known as nutrigenomics, is the study of how a person's diet and genes interact with each other. The field of nutrigenomics aims to explain how common nutrients, food additives and preservatives can change the body's genetic balance towards either health or sickness. This study reviews the effects of SNPs on detoxification, antioxidant capacity, and longevity. SNPs are mutations that only change one nucleotide at a specific site in the DNA. Specific SNPs have been associated to a variety of biological processes, including detoxification, antioxidant capacity, and longevity. This article mainly focuses on the following genes: SOD2, AS3MT, CYP1A2, and ADO-RA2A (detoxification); LEPR, TCF7L2, KCNJ11, AMY1, and UCP3 (antioxidant capacity); FOXO3 and BPIFB4 (longevity). This review underlines that many genes-among which FOXO3, TCF7L2, LEPR, CYP1A2, ADORA2A, and SOD2-have a unique effect on a person's health, susceptibility to disease, and general well-being. Due to their important roles in numerous biological processes and their implications for health, these genes have undergone intensive research. Examining the SNPs in these genes can provide insight into how genetic variants affect individuals' responses to their environment, their likelihood of developing certain diseases, and their general state of health.

Inferior vena cava diameter adds information to pulmonary artery systolic pressure in outpatients with heart failure

Background

Evaluation of pulmonary arterial pressure (PAP) is recommended by guidelines to diagnose and monitor congestion in patients with heart failure (HF). However, the high compliance of the venous system might buffer the effects of a large increase in intravascular volume and delay an elevation in PAP. Therefore, measuring inferior vena cava (IVC) diameter by ultrasounds might add important information in patients with HF, regardless of PAP.

Aim

To evaluate the relationship between the IVC diameter and systolic PAP (PAsP) assessed by echocardiography with mortality in outpatients with HF.

Methods

We enrolled consenting out-patients attending a community HF clinic for initial diagnosis or follow-up in Kingston upon Hull, UK between 2009–2012. HF was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either a left ventricular systolic function (LVEF) <50% or elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥125 pg/ml. IVC was considered dilated when >2.0 cm, PAsP elevated when >35 mmHg.

Results

Amongst the 874 patients enrolled, median age was 75 years, 68% were men, median LVEF was 44% and median NT-proBNP was 1125 pg/ml. 468 patients (54%) had normal IVC and PAsP, 117 (13%) had normal IVC but elevated PAsP, 75 (8%) had dilated IVC but normal PAsP and 214 (25%) had both dilated IVC and elevated PAsP. Compared to those with normal IVC and PAsP, those with elevated PAsP but normal IVC were older, more likely to be women, and had higher LVEF and NT-proBNP, whilst those with dilated IVC but normal PAsP had similar age and LVEF, but more signs of congestion and higher NT-proBNP. Compared to those with both normal IVC and PAsP (reference), those with dilated IVC but normal PAsP (HR: 1.83; CI: 1.04–3.25; P=0.037) or elevated PAsP but normal IVC (HR: 1.88; CI: 1.25–2.85; P=0.003) had a similarly increased risk of death but those with a dilated IVC and elevated PAsP had the greatest risk (HR: 4.16; CI: 3.10–5.57; P<0.001).

Conclusion

A dilated IVC is associated with mortality even when PAsP is not elevated. Tailoring treatments to reduce IVC diameter is a strategy worth exploring to improve outcomes in outpatients with heart failure.

Funding Acknowledgement

Type of funding sources: None.

O-208 Use of epididymal spermatozoa in in vitro fertilization cycles impacts the morphokinetics of embryos cultured in a time-lapse imaging incubator system

Study question

Does sperm origin impact embryo morphokinetics (the moments at which an embryo reaches a developmental milestone) and clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles?

Summary answer

The use of epididymal sperm correlates with late cell cleavages, and higher multinucleation and abnormal cleavage rates compared to those from men without infertility factor.

What is known already

ICSI with sperm surgically retrieved from the epididymis (PESA) dramatically altered the pregnancy prognosis in couples with severe male factor infertility, including obstructive azoospermia. The integration of time-lapse imaging (TLI) into the in vitro fertilization (IVF) laboratory allowed for an in-depth analysis of embryonic development. However, the impact of the use of epididymal sperm on embryonic morphokinetics has been poorly studied. We hypothesized that factors related to sperm origin may interfere with the speed and pattern of cell divisions.

Study design, size, duration

Women undergoing ICSI with epididymal sperm between Jan/2019 and Dec/2020 in a private university-affiliated IVF center were included (PESA group, n = 32 cycles/276 embryos). A matching was performed to form two groups of women undergoing ICSI using ejaculated sperm from partners with idiopathic male factor infertility (IMF group, n = 32 cycles/284 embryos) or without male factor infertility (Control group, n = 32 cycles/246 embryos). Generalized linear models followed by Bonferroni post hoc were used to compare morphokinetics between groups.

Participants/materials, setting, methods

Embryos were cultured in the EmbryoScope incubator, which recorded the following kinetic markers: timing to pronuclei appearance and fading (tPNa and tPNf), two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), morulae (tM), start of blastulation (tSB) and blastulation (tB). Durations of second and third cell cycles (cc2 and cc3) and timing to complete synchronous divisions s1, s2, and s3 were calculated. The KIDScore ranking was recorded.

Main results and the role of chance

Embryos derived from epididymal sperm showed significantly slower divisions compared to those from ejaculated sperm (Table 1).  The KIDScore rank was significantly lower for embryos deriving from epididymal sperm (3,1 ± 0.2) compared to those deriving from ejaculated sperm from IMF and control groups (5.4 ± 0.1 and 5.6 ± 0.2, p < 0.001, respectively). The incidence of multinucleation was significantly higher in embryos deriving from epididymal sperm (23.2%) compared to those deriving from ejaculated sperm from IMF and control groups (2.8% and 3.7%, p < 0.001, respectively). The incidence of abnormal cleavage patterns (direct or reverse) was significantly higher in embryos deriving from epididymal sperm (11.1%) compared to those deriving from ejaculated sperm from control group (4.3%, p = 0.001). Similar clinical outcomes were observed between the groups.

Limitations, reasons for caution

Retrospective nature of this study and the small sample size may be a reason for caution.

Wider implications of the findings

The use of epididymal sperm for ICSI correlates with delayed cell cleavage, and increased incidences of multinucleation and abnormal cleavage patterns. This finding highlights the importance of TLI for the identification and de-selection of slow-growing embryos for transfer, in ICSI cycles with surgical sperm retrieval.

Trial registration number

not applicable

P-182 The impact of ethnic differences on embryo morphokinetics and clinical outcomes: the importance of racial admixture

Study question

Can ethnic differences affect embryo morphokinetics and clinical outcomes in a time-lapse imaging (TLI) embryo culture system?

Summary answer

Embryos from Mestizos develop faster and have a higher implantation rate than those from Caucasian and Asian patients.

What is known already

Over the past decades, the use of assisted reproductive technology (ART) has made pregnancy possible for many infertile couples. However, certain infertile couples exhaust all forms of ART, without achieving success. Differences in treatment success have been described as varying by race and ethnicity. In fact, it has been reported that ethnicity is a major determinant of ART outcome as indicated by significantly lower live birth rates in some ethnic minority groups, however the precise reason for this fact remains unknown. TLI may allow the identification of morphokinetics events potentially affected by ethnicity, which may impact embryo development and implantation.

Study design, size, duration

This historical cohort study enrolled 3,304 embryos from 466 patients undergoing ICSI cycles from Feb/2019 to Ago/2021. Female patients were split into groups according to the patient’s ethnicity: (i) Caucasian (356 patients and 2556 embryos), Mestizo (82 patients and 592 embryos), and Asian (156 patients and 28 embryos). Embryos were cultured in a TLI incubation system and morphokinetics factors and clinical outcomes were compared between the groups using generalized linear models followed by Bonferroni post-hoc.

Participants/materials, setting, methods

Recorded kinetic markers were timing to pronuclei appearance and fading (tPNa and tPNf), timing to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), and timing to morulae (tM), start of blastulation (tSB) and blastulation (tB). Durations of second and third cell cycles (cc2 and cc3) and timing to complete synchronous divisions s1, s2, and s3 were calculated. Additionally, the known implantation data score (KIDScore) day-5 was recorded.

Main results and the role of chance

Embryos derived from Mestizo patients completed several key-point stages faster, followed by Caucasians, while Asiatic embryos were the slower ones. Mestizo presented shorter t6 (54.8 ± 0.92, 52.6 ± 0.20, 51.0 ± 0.42, for Asians, Caucasians, and Mestizos respectively, p < 0.001), t7 (58.4 ± 1.05, 55.4 ± 0.22, 54.1 ± 0.45, for Asians, Caucasians, and Mestizos respectively, p < 0.001), t8 (59.3 ± 1.2, 58.7 ± 0.24, 57.3 ± 0.49, for Asians, Caucasians, and Mestizos respectively, p = 0.019), tM (99.3 ± 2.1, 90.8 ± 0.37, 87.5 ± 0.79, for Asians, Caucasians, and Mestizos respectively, p < 0.001), tsB (106.4 ± 1.9, 101.4.0 ± 0.54, 98.0 ± 1.4, for Asians, Caucasians, and Mestizos respectively, p < 0.001), and tB (109.1 ± 0.31,116.2 ± 2.0, 106.0 ± 0.64, for Asians, Caucasians, and Mestizos respectively, p < 0.001). In addition, the KIDScore-D5 ranked significantly higher for Mestizos, followed by Caucasians, while Asian patients presented the lower KIDScore-D5 (2.9 ± 0.27, 5.3 ± 0.1, 6.3 ± 0.4, p < 0.001). Pregnancy (25.0 ± 4.9, 33.0 ± 13.2, 58.0 ± 11.5, p = 0.038) and implantation rates (30.0 ± 1.2, 16.3 ± 0.4, 50.0 ±1.5, p < 0.001) were also highest among Mestizos, followed by Caucasians, whereas the Asian patients had the lowest rates.

Limitations, reasons for caution

The retrospective nature of the study and the small sample size may have biased the results.

Wider implications of the findings

Despite the increasing number of studies investigating the effect of ethnicity on ART outcomes, most of the literature has focused on White, Black and Asians. However, racial admixture has markedly increased, making attempts at strict racial categorisation confusing and out-dated. Apparently, miscegenation benefits embryonic development, which may impact clinical outcomes.

Trial registration number

Not applicable

O-260 Improved implantation and pregnancy rates in frozen-thawed embryo transfer using a modified-natural ovulatory regimen

Study question

Are the outcomes of pregnancy significant different between modified-natural (mN) cycle frozen-thawed embryo transfer (FET) and hormone terapy (HT) cycle FET?

Summary answer

Implantation and pregnancy rates are significantly higher in mN cycle FET as compared to HT cycle FET.

What is known already

The use of FET has dramatically increased the cumulative pregnancy rate and reduced the cost and time to pregnancy in assisted reproductive technology (ART). Three different regimens can be used to perform FET, the spontaneous ovulatory (natural) cycle; the one in which the endometrium is artificially prepared with HT; and cycles in which ovulation is induced. In our center, for the past three years, we have performed HT cycle FET as well as a modified-natural regimen, which includes the administration of 250 µg recombinant hCG (r-hCG) upon the visualization of one follicle measuring ≥ 18 mm in diameter.

Study design, size, duration

Women undergoing FET post intracytoplasmic sperm injection (ICSI), between Jan/2019 and August/2021 in a private university-affiliated IVF center were included (mN cycle FET group, n = 142 and HT cycle FET group, n = 1180). Generalized linear models adjusted for potential confounders, followed by Bonferroni post hoc were used to compare clinical outcomes between groups.

Participants/materials, setting, methods

In mN cycle FET group, after menses, the endometrial development was monitored, and patients received 250µg r-hCG upon the visualization of one follicle ≥ 18mm in diameter, and 600mg daily of micronized progesterone for five days, until embryo transfer. In HT cycle FET group, after menses the patients received 200µg of transdermal 17 β-estradiol every three days. When endometrium showed proliferative morphology and thickness of at least 7.5mm, 600mg of progesterone was daily administered.

Main results and the role of chance

Mean female age was similar between the groups (36.0 years ± 0.5 for mN cycle FET and 35.6 years ± 0.2 for HT cycle FET groups, respectively). The implantation rate was significantly higher in mN cycle FET group compared to HT cycle FET group (45.3% ± 0.76 vs. 38.6% ± 0.22, p < 0.001, respectively). The pregnancy rate was also significantly higher in mN cycle FET group compared to HT cycle FET group (66.0% vs. 52.4%, p = 0.017, respectively). No significant differences were observed between the groups in miscarriage rate (10.7% for mN cycle FET and 15.7% for HT cycle FET groups, respectively, p = 0.279).

Limitations, reasons for caution

Retrospective nature of this study and the small sample size may be a reason for caution.

Wider implications of the findings

Our study suggests use of an hCG trigger may improve outcomes in natural cycle FET. In patients undergoing FET, triggering ovulation can significantly reduce the number of visits necessary for scheduling embryo transfer without an adverse effect on outcomes. Ovulation triggering can increase both patient convenience and cycle cost effectiveness.

Trial registration number

Not applicable

P-528 Time-lapse monitoring: an adjunct tool to select embryos for preimplantation genetic testing

Study question

Does embryo aneuploidy have any impact on embryo morphokinetic events in a time-lapse imaging (TLI) culture system?

Summary answer

Aneuploidy had a significant impact on early and late embryo morphokinetic events. Mosaic and aneuploid embryos behaved similarly in terms of morphokinetics.

What is known already

The preimplantation genetic testing (PGT) emerged as an approach to analyse embryos’ DNA for determining genetic abnormalities, distinguishing chromosomally normal embryos, considered to have high developmental potential, from their aneuploid siblings. Although shown to be efficient and clinically relevant, the invasive nature of the technique limits its success. Given the challenges associated with invasive embryo biopsy, ongoing studies are now seeking for non-invasive assessments of the embryo DNA. Timelapse imaging (TLI) may allow the identification of morphokinetics events affected by aneuploidy, which could be a powerful tool for improving embryo selection for transfer, without the detrimental effects of embryo biopsy.

Study design, size, duration

This case-control study was performed in a private university–affiliated IVF center, between 2019 March and 2020 December. Kinetic data were analyzed in 957 embryos, derived from 316 patients undergoing ICSI cycle with PGT-A. Kinetic markers from the point of insemination were recorded. Generalized linear models followed by Bonferroni post hoc were used to compare timing of specific events in euploid (n = 352), aneuploid (n = 583) and mosaic embryos (n = 22). The post hoc achieved power was > 80%.

Participants/materials, setting, methods

Embryos were cultured in the EmbryoScope incubator, which recorded the following kinetic markers: timing to pronuclei appearance and fading (tPNa and tPNf), two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), morulae (tM), start of blastulation (tSB) and blastulation (tB). Durations of second and third cell cycles (cc2 and cc3) and timing to complete synchronous divisions s1, s2, and s3 were calculated. The KIDScore ranking was recorded.

Main results and the role of chance

Aneuploid embryos showed significantly longer tPNf, t2, t3, t4, t6, t7, t8, tM, tSB, tB, s2 and s3 compared to euploid embryos. The KIDScore day 5 also rank was significantly lower in aneuploid embryos compared to euploid ones. As for mosaic embryos no significant differences were observed in the comparisons of means of morphokinetic events and KIDScore rank, but regression analyses showed an increased chance of mosaicism among embryos with longer tPNf, t2, t3, t6, t7, tM, tB, as well as a inverse association with KIDScore rank, when compared with euploid embryos. Embryos were hierarchically distributed into quartiles according to the KIDScore rank: Q1 ≤3.9, Q2 4-5.6, Q3 5.7-7.5, and Q4 ≥7.6. Euploidy incidence was significantly different among the KIDScore quartiles, in which the percentage of euploidy increased directly proportional to the kidscore rank. For patients >35 years old, the logistic regression analysis demonstrated that comparing with embryos in the Q4, embryos in the Q1, Q2, and Q3 have a decreased chance of being euploid. For patients ≤35 years old, comparing with embryos in the Q4, embryos with KIDScore D5 in the Q1 and Q2, but not in Q3, have a decreased chance of being euploid.

Limitations, reasons for caution

Our study is limited by its retrospective nature and small casuistic, despite adequate power has been achieved. The reason for the lack of consistency with some previous findings can be explained by variations in culture systems, studied population, embryo stage for biopsy and wide range of tests used for PGT.

Wider implications of the findings

Our evidence suggests that TLI monitoring may be an adjunct approach to select embryos for PGT, however, cautious investigation is still needed. The mechanism by which embryo aneuploidy may alter the cleavage timing of embryos is undefined, but disruptions of mitosis, cell-cell interactions and blastocyst differentiation are possible candidates.

Trial registration number

not applicable

P-503 The role of the duration of infertility on the of quality of life and psychological health in infertile couples

Study question

Is the quality of life (QoL) and psychological health affected by the duration of infertility in infertile women?

Summary answer

The duration of infertility negatively impacts infertile women's QoL and psychological health.

What is known already

Infertility is a deeply distressing experience. The process, from suspicion to received diagnosis and treatments often endures over a long period of time and usually involves repeated oscillations between hope and delusion, perception of loss of control, loss of self-esteem, inability to plan future, changes in identity and worldviews and difficulties in social interactions. Therefore, being infertile and undergoing fertility treatments is a condition which affects all infertile couple’s QoL. Whether QoL of these individuals is affected by the duration of infertility should be the focus of further investigation, to define psychological care interventions with patients dealing with infertility.

Study design, size, duration

This transversal study enrolled 442 female infertile patients that completed a modified non-validated Fertility Quality of Life Questionnaire (FertiQoL) between August and November 2021, containing multiple choice questions, which were evaluated in an ordinal manner (from one to five, being five the reference category associated with best QoL parameter).

Participants/materials, setting, methods

The FertiQoL questionnaire was conducted through an online-platform and consisted of 24 items derived from four subscales (mind-body, emotional, social, and relational), 10 treatment-related items, and two overall life and physical wellness items. Additionally demographic infertility-related characteristics were answered by the participants. Generalized Linear Models were performed to assess the association between FertiQoL scores and duration of infertility. Results are described by B coefficient and the p value.

Main results and the role of chance

A negative association between duration of infertility and FertiQoL scores were observed. With one unit increase in duration of infertility, the log of odds of having a positive perception about: (i) one’s own health decreases by -2.07 to -5.49, p < 0.001, (ii) one’s satisfaction with the quality of life decreases by -0.981 to -3.90, p < 0.001, (iii) ability to handle other life plans and goals while dealing with infertility decreases by -0.59 to -2.77, (iv) ability to deal with one's fertility issues decreases by-1.38 to -4.00, p < 0.001, (v) experience of envy feelings increases by 0.10 to 2.71, p < 0.001, (vi) experience oscillations of hope and hopelessness feelings increases by 0.25 to 0.97, p < 0.001, (vii) experience of social isolation due to infertility increases by 0.92 to 3.12, p < 0.001, (viii) loving to one's partner despite fertility problems decreased by -0.54 to -5.99 p < 0.001, (ix) feeling discomfort in social situations increases by 0.80 to 2.73, p < 0.001, (x) feeling of inferiority in relation to people who have children increases from 0.48 to 1.29, p < 0.001, (xi) feeling of anger due to infertility increases from -0.20 to -1.56, p < 0.001, and (xii) unpleasant effects of infertility treatment increases from 0.217 to 1.97, p < 0.001.

Limitations, reasons for caution

Lack of adequate opportunities to conduct face to face interview and lack of knowledge of the real state of the participants, concerning infertility or when involved in an assisted reproduction treatment (ART), knowledge of which treatment.

Wider implications of the findings

Long infertility duration is a significant risk factor affecting women's QoL and psychological health. It can be hypothesized that, besides the duration of infertility itself, repeated ART treatments related to longer infertility may compromise QoL, highlighting the importance of the psychological counseling for infertile patients, especially those with longer infertility.

Trial registration number

Not applicable

O-209 The impact of sperm DNA fragmentation on pregnancy outcomes depends on oocyte dimorphisms

Study question

Does the impact of sperm DNA fragmentation (SDF) on Intracytoplasmic sperm injection (ICSI) outcomes depend on the presence of oocyte dimorphisms?

Summary answer

There is a significant influence of oocyte quality on the impact of SDF on pregnancy outcomes.

What is known already

Sperm DNA fragmentation has been associated with ICSI outcomes. DNA damage is commonly encountered in human spermatozoa and it has been widely accepted that the oocyte assumes responsibility for the repair and remodelling of both the maternal and paternal genomes during the oocyte-embryo transition. Indeed, spermatozoa with DNA damage can fertilise oocytes and still lead to embryo development due to the oocyte DNA repair capacity. Considering the vital role played by the oocyte in the developmental process, it could be hypostatised that the oocyte quality, translated as oocyte morphology, would influence the machinery responsible for sperm DNA repair after fertilization.

Study design, size, duration

This cohort study included 3,035 oocytes from 525 patients undergoing ICSI cycles in a university-affiliated IVF-center, between June/2016 and July/2019. Oocytes were split into groups according to the SDF index of the sample used for ICSI: low-fragmentation (<30% SDF, n = 2,277) and high-fragmentation (≥30% SDF, n = 758). Oocytes were evaluated before sperm injection and the dimorphisms were recorded. The influence of SDF index on ICSI outcomes, depending on the presence of oocytes dimorphisms was evaluated.

Participants/materials, setting, methods

Data was evaluated using generalized linear models (GZLM) followed by Bonferroni post hoc. The results are expressed as mean ± standard error for continuous variables or percentages for dichotomous variables, and p-values. The sample size calculation suggested that a sample of at least 504 subjects had 95% power to detect a 20% effect with a significance level of 5% (α). The study was performed in a private university–affiliated in vitro fertilization (IVF) center.

Main results and the role of chance

The association of both factors: the presence of oocyte dimorphisms (dark cytoplasm, vacuoles in the ooplasm, and resistant membrane) and high SDF index resulted in the lowest fertilization rate among groups, while oocytes free of these dimorphisms injected with samples with <30% SDF had the highest fertilization rate (p = 0.05, p < 0.01 and p < 0.01 for dark cytoplasm, vacuoles in the ooplasm and resistant membrane respectively). The impact of SDF index on high quality embryos rate on cleavage stage was also influence by the presence smooth endoplasmic reticulum clusters and resistant membrane oocytes (p = 0.013 and p = 0.018). As for the clinical outcomes, the impact of SDF index on the implantation rate was influenced by the presence of vacuoles in the ooplasm (p < 0.01), smooth endoplasmic reticulum clusters (p < 0.01), large perivitelline space (p < 0.01), resistant membrane (p < 0.01), and non-resistant membrane (p < 0.01), while the influence of SDF index on the pregnancy rate was influenced by the presence large perivitelline space (p < 0.01), resistant membrane (p = 0.018) and non-resistant membrane (p < 0.01). The effect of SDF on the miscarriage rate was also increased in the presence of large perivitelline space (p = 0.045), non-resistant membrane (0.037) and centrally located cytoplasmic granular area (p = 0.025).

Limitations, reasons for caution

The retrospective nature is a limitation. It could be argued that using samples with high SDF index does not necessarily mean that a sperm cell with a fragmented DNA was injected, however, the higher the SDF index, the higher the chance of selecting one with fragmented DNA.

Wider implications of the findings

The findings presented here highlight the crucial role of male and female factors when facing assisted reproduction. The association of low oocyte quality and high SDF index may lead to impaired results. As the oocyte defect cannot be modified, in vivo upgrading of spermatozoa before the treatment should be encouraged.

Trial registration number

Not applicable

O-224 Paternal ageing impacts blastulation and pregnancy outcomes at different levels of maternal age: a clustering analysis of 21,960 injected oocytes and 3837 ICSI cycles

Study question

Are the morphological parameters and development of in vitro cultured embryos, and intracytoplasmic sperm injection (ICSI) outcomes influenced by maternal and paternal ageing?

Summary answer

The slopes of maternal age on blastulation, blastocyst quality, and implantation, pregnancy and miscarriage rates significantly changed (worsened) for every year increase in paternal age.

What is known already

Due to the vast literature demonstrating that female age interferes with intracytoplasmic sperm injection (ICSI) outcomes, there is an imposition, in numerous countries, regarding maternal age limit for assisted reproduction. Despite several studies have underscored the negative impact of paternal age and lifestyle factors on reproductive health, the influence of paternal age on ICSI outcomes is still a matter of debate. The aim of this study was to investigate if the effect of paternal age on embryo development differs at different values of maternal age, thus creating a rationale for the data to reach physicians, patients, and public health recommendations.

Study design, size, duration

This historical cohort study included 3837 couples undergoing their first ICSI cycle from January/2014 to October/2020. A total of 21960 oocytes were injected and embryos were evaluated until day 5 of development. The main effects of maternal and paternal ages, as well as the effect of their product (interaction term) on embryo growth and development, and on pregnancy outcomes were investigated taking into account clustering of data (multiple embryos per cycle), using generalized mixed models.

Participants/materials, setting, methods

The study was performed in a private university-affiliated in vitro fertilization center. Zygotes were morphologically evaluated 17h post ICSI. For days 2 and 3 of development, the number of blastomeres, blastomere symmetry, percentage of fragmentation and presence of multinucleation were recorded. On day 5 of development, successful blastulation, and inner cell mass and trophectoderm qualities were recorded. Pregnancy was calculated per transfer, and miscarriage was defined as pregnancy loss before 20 weeks gestation.

Main results and the role of chance

The coefficients for the interaction term were statistically significant for blastocyst development (B: - 0.005, OR: 0.995, CI: 0.994 – 0.996, p < 0.001), top-quality blastocyst (B: - 0.003, OR: 0.997, CI: 0.996 – 0.999, p < 0.001), implantation rate (B: - 0.041, OR: 0.960, CI: 0.947 – 0.973, p < 0.001), pregnancy rate (B: - 0.004, OR: 0.996, CI: 0.995 – 0.997, p < 0.001), and miscarriage rate (B: 0.011, OR: 1.012, CI: 1.005 – 1.018, p = 0.001). These values describe the changes in slopes such that, the slope of one independent variable (e.g. maternal age) on the dependent variable (e.g. implantation rate) changes by the value of B (- 0.041) for every unit change on the other independent variable (e.g. paternal age). No significant results were observed for the influence of the interaction term on embryo morphological features on days 1, 2 and 3 of development. Two post hoc power analyses were calculated, given α of 5%, sample size of 21960 zygotes and 3315 ICSI cycles with embryo transfer and effect sizes for blastulation and pregnancy outcomes, respectively. The achieved power was superior to 99% in both analyses.

Limitations, reasons for caution

The retrospective and monocentric nature of the study are its major limitations.

Wider implications of the findings

Our results underscore the importance of both maternal and paternal ages for blastulation and successful pregnancy. Main effects of paternal and maternal ages should no longer be interpreted as the relationship between each independent variable and a given outcome, but rather be conditional on the values of the interaction term.

Trial registration number

Not applicable

Influence of Biliopancreatic Diversion on Pregnancy Outcomes in Comparison to Other Bariatric Surgery Procedures

BACKGROUND

Pregnancy after bariatric surgery (BS) has an increased risk for small-for-gestational-age infants (SGA), shorter length of gestation, and probably perinatal mortality. The aim of this study was to investigate if biliopancreatic diversion could impair pregnancy outcomes in comparison to other bariatric surgery procedures.

METHODS

We conducted a cohort retrospective single-center study in 65 women before and after BS. Thirty-one pregnancies occurred before BS, while 109 after BS, amongst which n = 51 after biliopancreatic diversion (BPD) and n = 58 after non-malabsorptive procedures.

RESULTS

The pregnancy outcomes after BS in comparison with those before BS resulted less affected by diabetes, hypertensive disorders, macrosomia, and large-for-gestational-age (LGA), but more complicated by preterm births (14.5 versus 4.0%) and low birth weight (LBW) infants (28.9 versus 0%). Moreover, mean birth weight resulted lower after BS than before BS (p < 0.001). In pregnancies after BPD in comparison to those before BS, the LBW rate (42.5%) resulted a drastic increase (p < 0.001), and mean birth weight (p < 0.001) and mean birth weight centile (p < 0.001) were lower after BPD. When pregnancy outcomes after BPD were compared with those after non-malabsorptive procedures, the rate of congenital anomalies, preterm births, LBW, and SGA resulted an increase (p = 0.002, 0.008, 0.032, and < 0.001, respectively).

CONCLUSIONS

BPD drastically reduced diabetes, hypertensive disorders, macrosomia, and LGA; however, it was associated with the poorest pregnancy outcomes in comparison to those observed after other BS procedures. On the basis of the present study, we recommend a cautious multidisciplinary selection of severely obese patients for BPD during the fertile age.

Sperm morphological normality under high magnification is correlated to male infertility and predicts embryo development

Human sperm morphology has been described as an essential parameter for the diagnosis of male infertility and a prognostic indicator of natural or assisted pregnancies. Nevertheless, standard morphological assessment remains a subjective analysis and its impact on intracytoplasmic sperm injection (ICSI) is also of limited value. The objective of this prospective cohort study was to investigate whether motile sperm organelle morphology examination (MSOME) can improve semen analysis by better defining male infertility and providing a better prognosis for ICSI up to a year later. Data were obtained from 483 patients undergoing conventional semen analysis from June 2015 to June 2017 in a private university-affiliated in vitro fertilization (IVF) center. The correlation of MSOME with seminal parameters was evaluated. One hundred and thirty patients underwent ICSI up to a year later, and the correlation between MSOME and ICSI outcomes was established. Except for volume, all seminal parameters were positively correlated with MSOME I+II. MSOME was also distinct between World Health Organization (WHO) classification groups, with normozoospermic and oligoasthenoteratozoospermic presenting the higher and the lower proportion of MSOME I+II, respectively. MSOME I+II was prognostic for fertilization rate, high-quality cleavage-stage embryos rate, and blastocyst rate. The normality cutoff value based on blastocyst rate was MSOME I+II≥ 5.5%. MSOME could be a useful tool for the diagnosis of infertility severity as it is correlated with sperm morphology, motility, and concentration. Men who had higher MSOME I+II had better ICSI outcomes. The future use of MSOME as a routine method for semen analysis may be a reliable form of assessing male infertility.

Intensive lifestyle modifications with or without liraglutide 3mg vs. sleeve gastrectomy: A three-arm non-randomised, controlled, pilot study

BACKGROUND/OBJECTIVES

As only 1% of clinically eligible subjects choose to undergo surgical treatment for obesity, other options should be investigated. This study aimed to assess the effects of intensive lifestyle modification (ILM) with or without 3-mg liraglutide daily vs. sleeve gastrectomy (SG) on BMI after 1 year.

SUBJECTS/METHODS

In this study performed at an Italian university hospital, non-diabetic patients eligible for bariatric surgery were recruited from a weight-loss clinic and had the option to choose from three possible weight-loss programmes up to an allocation of 25 subjects in each arm matched by BMI and age. ILM consisted in 813kcal of a very low-calorie diet (VLCD) for 1 month, followed by a diet of 12kcal/kg body weight of high protein and high fat for 11 months plus 30min of brisk walking daily and at least 3h of aerobic exercise weekly. SG patients followed a VLCD for 1 month and a free diet thereafter. Patients were evaluated at baseline and at 1, 3, 6, 9 and 12 months.

RESULTS

A total of 75 patients were enrolled; retention was 100% in the SG and 85% in the two medical arms. SG reduced BMI by 32% (P<0.001 vs. medical arm), while ILM+liraglutide and ILM led to BMI reductions of 24% and 14%, respectively (P<0.001). More women allocated themselves to the ILM+liraglutide group. Weight loss was 43kg with SG, 26kg with ILM+liraglutide and 15kg with ILM alone. Lean body mass reductions were -11.6kg with SG, -6.3kg with ILM and -8.3kg with ILM+liraglutide. Prevalence of prediabetes was significantly lower with ILM+liraglutide, and insulin resistance was reduced by about 70% by both ILM+liraglutide and SG vs. 39% by ILM alone. Cardiometabolic risk factors were greatly reduced in all three groups.

DISCUSSION

At least in the short-term, liraglutide 3.0mg once daily associated with drastic calorie-intake restriction and intensive physical activity promoted a 24% weight loss, which was almost two times greater than ILM alone and only about 25% less than with SG, while preserving lean body mass. Although this study was non-randomised, it was designed to explore the efficacy of medical treatments for obesity in everyday clinical practice.

Total motile sperm count has a superior predictive value over the WHO 2010 cut-off values for the outcomes of intracytoplasmic sperm injection cycles

The objective of this study was to compare (i) the intracytoplasmic sperm injection outcomes among groups with different total motile sperm count ranges, (ii) the intracytoplasmic sperm injection outcomes between groups with normal and abnormal total motile sperm count, and (iii) the predictive values of WHO 2010 cut-off values and pre-wash total motile sperm count for the intracytoplasmic sperm injection outcomes, in couples with male infertility. This study included data from 518 patients undergoing their first intracytoplasmic sperm injection cycle as a result of male infertility. Couples were divided into five groups according to their total motile sperm count: Group I, total motile sperm count <1 × 10(6) ; group II, total motile sperm count 1-5 × 10(6) ; group III, total motile sperm count 5-10 × 10(6) ; group IV, total motile sperm count 10-20 × 10(6) ; and group V, total motile sperm count >20 × 10(6) (which was considered a normal total motile sperm count value). Then, couples were grouped into an abnormal and normal total motile sperm count group. The groups were compared regarding intracytoplasmic sperm injection outcomes. The predictive values of WHO 2010 cut-off values and total motile sperm count for the intracytoplasmic sperm injection outcomes were also investigated. The fertilization rate was lower in total motile sperm count group I compared to total motile sperm count group V (72.5 ± 17.6 vs. 84.9 ± 14.4, p = 0.011). The normal total motile sperm count group had a higher fertilization rate (84.9 ± 14.4 vs. 81.1 ± 15.8, p = 0.016) and lower miscarriage rate (17.9% vs. 29.5%, p = 0.041) compared to the abnormal total motile sperm count group. The total motile sperm count was the only parameter that demonstrated a predictive value for the formation of high-quality embryos on D2 (OR: 1.18, p = 0.013), formation of high-quality embryos on D3 (OR: 1.12, p = 0.037), formation of blastocysts on D5 (OR: 1.16, p = 0.011), blastocyst expansion grade on D5 (OR: 1.27, p = 0.042), and the odds of miscarriage (OR: 0.52, p < 0.045). The total motile sperm count has a greater predictive value than the WHO 2010 cut-off values for laboratory results and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection as a result of male infertility.

Effects of biliopancreatic diversion on diurnal leptin, insulin and free fatty acid levels

Background

Free fatty acid (FFA) levels are raised in obesity as a consequence of increased production and reduced clearance. They may link obesity with insulin resistance. Bariatric surgery can result in considerable weight loss and reduced insulin resistance, but the mechanism of action is not well understood. Although drugs such as metformin that lower insulin resistance can contribute to weight loss, a better understanding of the links between obesity, weight loss and changes in insulin resistance might lead to new approaches to patient management.

Methods

Variations in circulating levels of leptin, insulin and FFAs over 24 h were studied in severely obese (body mass index over 40 kg/m2) women before and 6 months after biliopancreatic diversion (BPD). Body composition was measured by dual-energy X-ray absorptiometry. A euglycaemic–hyperinsulinaemic clamp was used to assess insulin sensitivity. Levels of insulin, leptin and FFAs were measured every 20 min for 24 h. Pulsatile hormone and FFA analyses were performed.

Results

Among eight patients studied, insulin sensitivity more than doubled after BPD, from mean(s.d.) 39·78(7·74) to 96·66(27·01) mmol per kg fat-free mass per min, under plasma insulin concentrations of 102·29(9·60) and 93·61(9·95) µunits/ml respectively. The secretory patterns of leptin were significantly different from random but not statistically different before and after BPD, with the exception of the pulse height which was reduced after surgery. Both plasma insulin and FFA levels were significantly higher throughout the study day before BPD. Based on Granger statistical modelling, lowering of daily FFA levels was linked to decreased circulating leptin concentrations, which in turn were related to the lowering of daily insulin excursions. Multiple regression analysis indicated that FFA level was the only predictor of leptin level.

Conclusion

Lowering of circulating levels of FFAs after BPD may be responsible for the reduction in leptin secretion, which in turn can decrease circulating insulin levels. Surgical relevanceInsulin resistance is a common feature of obesity and type II diabetes. These patients are also relatively insensitive to the biological effects of leptin, a satiety hormone produced mainly in subcutaneous fat.Biliopancreatic diversion, a malabsorptive bariatric operation that drastically reduces circulating lipid levels, improves insulin resistance independently of weight loss. The mechanism of action, however, has still to be elucidated.This study demonstrated that normalization of insulin sensitivity after bariatric surgery was associated with a reduction in 24-h free fatty acid concentrations and changes in the pattern of leptin peaks in plasma. Bariatric surgery improves the metabolic dysfunction of obesity, and this may be through a reduction in circulating free fatty acids and modification of leptin metabolism.

The male factor of infertility should not be an issue for the selection of patients for extended embryo culture programmes

This study evaluated the influence of sperm origin and basic sperm parameters on blastocyst implantation competence. The study included 2912 embryos obtained from 370 patients undergoing intracytoplasmic sperm injection cycles, with embryo transfer on day 5 of development. The embryos were divided into experimental groups according to their origin: (i) embryos originated from ejaculated-derived spermatozoa (Ejaculated group, n = 2093), from epididymal-derived spermatozoa (Epididymal group, n = 463) and from testicular-derived spermatozoa (Testicular group, n = 356). The groups were compared in relation to their blastocyst implantation competence. In addition, the influence of sperm parameters on blastocyst implantation was investigated. The sperm origin was determinant to the success of implantation. When blastocysts originating from testicle-derived spermatozoa were transferred, 66.4% implanted, while only 35.8 and 48.6% of blastocysts originated from epididymis- and ejaculate-derived spermatozoa implanted respectively (p = 0.001). The sperm volume and concentration were increased in cycles in which the implantation rate was 100 compared to the 0% implantation rate cases; however, the sperm motility and morphology did not differ among the groups. These results suggest that, with the exception of sperm volume and concentration, the male factor of infertility should not be an issue for the selection of patients for extended embryo culture programmes, even when azoospermic patients are considered.