P-583 PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level on hCG day: a retrospective study of Ten years data

Study question

We aimed to investigate whether serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict the IVF/ICSI outcomes in PCOS patients.

Summary answer

PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L).

What is known already

There were several studies suggesting serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict IVF outcomes, and to decide fresh cycle embryo transfer or frozen all. But there was few study focus on PCOS patients.

Study design, size, duration

This is a single-center retrospective cohort study in PCOS women undergoing the first transfer of an IVF cycle between January 1st 2010 and December 31th 2019. There were 141,539 oocyte retrieval cycles during the study period, and 97,189 cycles were their first IVF cycle. PCOS was diagnosed according to the Rotterdam criteria. Among them, 3,146 cycles full filled the inclusion and exclusion criteria, and all with two embryos transferred on Day 3.

Participants/materials, setting, methods

We compared the live birth rate of fresh embryo transfer, stratified for serum P level. We looked for interaction between serum P level and live birth rate of fresh cycles. The serum P level within normal range (< 6nmol/L) on the day of hCG trigger day was divided into 4 quartiles. The four quartiles were defined as ≤ 1.35 nmol/L (Q1), >1.35-1.93 nmol/L (Q2), >1.93-2.7 nmol/L (Q3), >2.7 nmol/L (Q4).

Main results and the role of chance

The baseline characteristics with no different between groups, except BMI. The patients in Q4 group with lowest BMI, significantly higher number of oocytes retrieved and live birth rate (P < 0.05) . The Logistic regression analysis of the relative factors on live birth rate including BMI, basal LH and number of oocytes retrieved [P = 0.003, 0.030, 0.037 respectively, 95%CI (1.022, 1.111), (1.004, 1.076), (1.002, 1.082)].

Limitations, reasons for caution

Due to the retrospective nature of this study, a well-designed and matched large sample prospective study is needed. The definition of elevated P level and the method of hormonal assessments were different between studies, this limiting the comprehensive analysis of researches and the further verification of existing results.

Wider implications of the findings

PCOS patients who with normal range P level on hCG day, got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L). Weight control is important for PCOS patients accepting IVF treatment.

Trial registration number

NOT APPLICABLE

P-511 Measuring patient-centredness in publicly funded fertility care and private funded fertility care in China

Study question

Does the Patient-Centred Questionnaire-Infertility (PCQ-Infertility) validate in China? Do patients experience different on patient-centredness in public fertility care compared to that in private fertility care?

Summary answer

PCQ-Infertility is valid in China. The patients in private fertility care have better experiences on patient-centredness than that in publicly fertility from results of PCQ-Infertility.

What is known already

Patient-centredness is one of the most important elements of quality of care. The PCQ-Infertility has validated to be a reliable tool to assess the extent of patient-centredness of fertility care in many countries, cross European counties to New Zealand. In China, physicians in many hospitals have recognized the importance of patient-centred infertility care, but lack of using instrument to measure it and then to improve it.

Study design, size, duration

This is a cross-sectional study. A survey with written questionnaire was performed among patients who diagnosed with infertility in Reproductive Medical Center of the First Affiliated Hospital of Hainan Medical University (publicly funded fertility care and Reproductive Medical Center of Hainan Modern Women and Children’s Hospital (private funded fertility care) between July and December 2021.

Participants/materials, setting, methods

In this study, 315 patients and 189 patients completed the survey at two reproductive medical centers. We used patient’s questionnaires to collect data on the patients’ experience with the quality of care. The PCQ-Infertility content, besides background questions, the questionnaire included 46 care aspects. Psychometric tests included inter-item and reliability analyses. An elaborate multivariate multilevel regression analysis was performed to assess the PCQs ability to measure differences in patient-centredness between reproductive medical centers.

Main results and the role of chance

The questionnaire was completed by 315 and 189 patients from the two hospitals. Patients’ mean scores on overall patient-centredness and the eight subscales (possible range 0–3) were calculated. High scores represent positive experiences with care. Both private and public hospitals scored high on care organization and communication. The lowest scores for both hospitals were the subscale, namely,‘information’. The significant differences between two hospitals were in “accessibility, respect for patient’s values, continuity and transition”.

Limitations, reasons for caution

This study is cross-sectional, the sample size is small, and enrolled fertility care centers are only two.

Wider implications of the findings

The PCQ-infertility is encouraged to be used in China to measure the patient-centredness, and can be adopted for quality improvement especially for publicly funded fertility care.

Trial registration number

ChiCTR2100053616

P–422 Acylglycerol Kinase is a new novel marker in preeclampsia

Study question

What is the potential function of Acylglycerol Kinase (AGK) in the pathogenesis of preeclampsia(PE).

Summary answer

AGK plays an important role in the pathogenesis of PE by influencing the function of the trophoblast cells.

What is known already

PE is the leading cause of maternal and perinatal mortality and morbidity. The underlying mechanism is still not completely elucidated. Disorder migration, invasion and mitochondria function of trophoblast cells are one of mechanism in preeclampsia. AGK is a subunit of the mitochondrial channel protein complex TIM22, and maintain the stability of mitochondrial structure and function. Studies have shown that AGK is related to the development of various cancers by infecting the cells migration and invasion. It will be interesting to explore the potential function of AGK in the process of early trophoblast development and the pathogenesis of PE.

Study design, size, duration

Firstly, explore the expression of AGK in PE. Secondly, lentivirus systems was used to generate loss and gain of function models in trophoblast cell line-HTR8/Sneov to study the role of AGK in the pathogenesis of PE.

Participants/materials, setting, methods

We examined the expression of AGK both in placental tissues from PE patients and normal pregnant patients. Meanwhile, we generated AGK loss and gain of function models in HTR8/Sneov cells by using lentivirus systems. Transwell assays, scratch-wound assays, EDU and plate clone formation assays, cell apoptosis assays, cell cycle assays, ATP concentration, mtDNA level and transmission electron microscopy were used to examine the function of AGK in HTR8/Sneov cells model.

Main results and the role of chance

In this study, AGK was significantly decreased in the extra-villous trophoblast (EVT) cells in placental tissues of PE patients compared with that in control group by immunohistochemistry. And further confirmed the expression of AGK in placental tissues by QPCR, western blot. We demonstrated that knockdown of AGK in HTR8 dramatically decreased the cell proliferation, migration and invasion. It also showed the significantly lower plate clone formation rate in AGK knockdown -HTR8 cells compare with the WT HTR8 cells. While overexpression of AGK in HTR8 dramatically increased the cell proliferation, migration, invasion and higher plate clone formation rate. Further, we demonstrated that AGK regulated the ATP level and mtDNA level in HTR8 cells model. And we found that knockdown AGK decreased the number of mitochondria, and shown the mitochondrial crista disorder, mitochondrial swelling and dissolution and mitochondrial membrane fragmentation. While overexpression AGK increased the number of mitochondria.

Limitations, reasons for caution

Although we show that AGK played an important role in the function of HTR8, the study of working mechanism of AGK in PE is still very limited. More studies will be performed to explore its underline mechanism.

Wider implications of the findings: This study was the first time to explore the role of AGK in PE. It will help us to better understand the pathogenesis of PE, which might be helpful in future application of novel therapeutic targets in PE.

Trial registration number

Not applicable

[Longitudinal biomechanical effect on repair options of artery injury]

OBJECTIVE

To investigate the relationship between the different defect length of vessels and the options of vascular repair, and to compare the different options of repair because of the longitudinal biomechanical effect.

METHODS

A clinical analysis was undertaken to evaluate the major arterial and venous injuries in human extremities repaired by end-to-end anastomoses or venous autograft(177 cases, 185 vessels). Compared the defect length of the same kind of vessels repaired by different options (Student-t test). Evaluated the defect length to repair arterial injuries between by end-to-end anastomoses and by vein graft by means of 95% confidence interval.

RESULTS

There was significant difference between the defect length of brachial artery repaired by end-to-end anastomosis and femoral artery and popliteal artery repaired by autogenous vein graft (P < 0.01). The upper limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 3.17 cm, 2.81 cm and 2.44 cm respectively by end-to-end anastomosis by means of 95% confidence interval. The lower limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 2.82 cm, 2.41 cm and 2.17 cm respectively by vein graft by means of 95% confidence interval. The defect length of brachial artery, femoral artery and popliteal artery repaired by vein graft was linear correlation with the length of graft.

CONCLUSION

Because of the longitudinal biomechanical difference of arteries and veins in human extremities, different options of repair are necessary to different arterial injuries.