Efficacy and safety of ultra-low-dose estradiol and norethisterone in postmenopausal Brazilian women

OBJECTIVE

This study aimed to evaluate the efficacy and safety of oral ultra-low-dose continuous combination of 17β-estradiol (17β-E2) and norethisterone acetate (NETA) in postmenopausal Brazilian women.

METHODS

Postmenopausal women (age 45-60 years) with amenorrhea >12 months and intact uterus, with moderate to severe vasomotor symptoms, were included. The vasomotor symptoms and endometrial bleeding were evaluated by a daily diary for 24 weeks, and the women were assessed at baseline and endpoint.

RESULTS

A total of 118 women were included. The group treated with 0.5 mg 17β-E2/0.1 mg NETA (n = 58) showed a percentage reduction of 77.1% in the frequency of vasomotor symptoms versus 49.9% in the placebo group (n = 60) (p = 0.0001). The severity score showed a reduction in the treatment group when compared to the placebo (p < 0.0001). The adverse events were comparable between the groups; however, in the 0.5 mg 17β-E2/0.1 mg NETA group there were more complaints of vaginal bleeding; despite that, in most cycles in both treatment groups, more than 80% of women experienced amenorrhea.

CONCLUSIONS

The combination of 0.5 mg 17β-E2/0.1 mg NETA in a continuous combination regimen was shown to be effective in reducing the frequency and severity of vasomotor symptoms in Brazilian postmenopausal women.

P-289 KIDscore and PGT-A: Is there a relationship between the findings?

Study question

Is there a correlation between Preimplantation Genetic Tests (PGT) results and Embryoscope’s KIDscore?

Summary answer

It seems that the higher the KIDscore, the higher the percentage of euploid embryos.

What is known already

Time lapse technology is bringing new perspectives in the relationship of embryos' morphokinetics and implantation rates after assisted reproduction techniques. However, it seems that only the embryo morphokinetics could be insufficient to predict euploidy. The KIDscoreTM D5 (KS5) algorithm, thus, is used for improving the implantation rates after a single euploid embryo transfer in its blastocyst stage and is related to higher rates of euploid embryos the higher the KS5, which could lead to higher implantation rates.

Study design, size, duration

Retrospective, observational study performed at a reproductive medicine center, using data collected between 2019 and 2021. A total of 802 embryos were included for analysis.

Participants/materials, setting, methods

All the embryos were biopsied for PGT (A, SR, and M), after being cultured for five or six days in an Embryoscope® time-lapse incubator (Vitrolife®, Canada). The embryos were then divided into three groups according to the KS5 evaluation: G1 (1-4), G2 (4.1-7), G3 (7.1-9.9) and the percentage of euploidy was evaluated in each group. For statistical analysis, Chi-square, and ANOVA tests, and Pearson correlation were used, considering p &lt; 0.05.

Main results and the role of chance

The women’s mean age among groups G1 vs. G2 vs. G3 was, respectively: 39.1±3.5 vs. 38.7±3.3 vs. 37.6±3.8, p &lt; 0.001; the mean KS5 of each group was: 2.9±0.7 vs. 5.4±0.8 vs. 8.0±0.7, p &lt; 0.001 and finally, the euploidy rates comparing the G1 vs. G2 vs. G3 were, respectively: 98/341, 28.7% vs. 124/340, 36.5% vs. 63/121, 52.1%, p &lt; 0.001. A weak correlation between women's age and KIDScore was also observed (-0.173, p &lt; 0.001).

Limitations, reasons for caution

Although there is a positive correlation between embryomorphokinetics and euploidy, and the euploidy rate increases with higher KIDscore, only 50% of the high score embryos are euploids. Therefore, it is still important to perform embryo biopsy.

Wider implications of the findings

The findings suggest that better embryo morphokinetics provide greater chances of euploidy. Moreover, a weak negative correlation between women's age and KIDScore, possibly due to age-related aneuploidy, was observed. These results highlight time-lapse technology’s importance and the future perspective of morphokinetics evaluation improving implantation rates through euploidy identification.

Trial registration number

Not Applicable

P-121 Azoospermia: are there neonatal differences regarding the source of sperm for ICSI?

Study question

In couples with azoospermia undergoing intracytoplasmic sperm injection (ICSI), are neonatal outcomes different depending on sperm origin (epididymal-PESA, testicular-TESA or donor sperm)?

Summary answer

Newborns from PESA or TESA had similar neonatal outcomes. Comparing to donor cases, PESA/TESA cycles didn’t present increased levels of malformation or stillbirth.

What is known already

Since the introduction of ICSI and the demonstration that the spermatozoa derived either from the epididymis or the testis were capable of normal fertilization and pregnancy, it was possible for azoospermic men to father their own children. However, it raised concerns that the quality of spermatozoa in terms of DNA damage or maturation when collected from non-ejaculated semen could differ from that collected from ejaculated and whether sperm of different origins will affect the neonatal outcome and safety of ICSI.

Study design, size, duration

Retrospective cohort study performed at a reproductive medicine center, using data from 359 deliveries from 945 cycles of ICSI of couples with infertility due to azoospermia, performed between 1995 and 2021. Data were collected from electronic records.

Participants/materials, setting, methods

A total of 359 deliveries were divided in 3 groups, according to the sperm source: PESA (n = 138), TESA (n = 139) and DONOR (n = 82). A total of 402 newborns were evaluated: PESA (n = 162); TESA (n = 156); DONOR (n = 84). Neonatal outcomes and congenital malformations were analyzed for singletons, twins and triplets separately. Statistical analysis: Anova, chi-square and Fischer test, considering p &lt; 0.05.

Main results and the role of chance

Comparing the 3 groups (PESA, TESA, and donor sperm), the following results were found: The mean birth weight (BW), length and Apgar score &gt; 7 for singletons and twins did not differ between groups; neither did prematurity or extreme prematurity. According to birth percentile, there was a lower rate of small for gestational age (SGA) newborn in the epididymal group (PESA, 1.5% vs. TESA, 8.5% vs. sperm donor, 5.5%, p = 0.004). Also, in 158 twin births, the number of newborns with low birth weight (&lt;2500g) was significantly smaller in the epididymal group (PESA, 32.9% vs. TESA, 62.5%; donor sperm, 73.1%, p = 0.001). There were three stillbirths in triplets (PESA group). We also found six cases of neonatal mortality (one in singleton pregnancy in TESA group, 3 in twins (two in PESA group and one donor sperm group), and two in triplets (one in TESA and one in PESA groups). The total number of congenital malformations was 8 (2.48%) (PESA n = 1, 0.62%; TESA, n = 2, 1.28%, and donor sperm, n = 5, 5.95%, p = 0.02).

Limitations, reasons for caution

The possibility of incomplete medical records is an important limitation to be considered in retrospective studies. Larger studies are important to better assess the risk of malformation in this population.

Wider implications of the findings

In this study, there were no differences on neonatal outcomes regarding the source of sperm used for ICSI, with PESA, TESA and donor groups, as well as congenital malformation. It showed equally safe options with testis, epididymal or ejaculated sperm for azoospermia treatments.

Trial registration number

not applicable

P-281 A multi-centre evaluation of a novel 4-cell embryo classification system based on intercellular contact points

Study question

Is there any prognostic value to classifying 4-cell embryos according to intercellular contact points (ICPs)?

Summary answer

A significant association was found between the new blastomere arrangement classifications and blastulation, as well as blastocyst quality. No significant association was found for pregnancy.

What is known already

Current literature states that the geometric arrangement of blastomeres in 4-cell embryos is usually classified as either “tetrahedral” or “non-tetrahedral/planar”. Though tetrahedral embryos have been associated with greater developmental capacity, their prevalence has varied between studies. At ESHRE 2021, Hickman et al. proposed a more fine-grained classification system; each class was associated with a 4-digit code, where the Nth digit in said code gave the number of cells with N-1 ICPs. This gave rise to 6 classes: tetrahedral (0004), pseudotetrahedral (0022), planar (0040), closed-Y (0121), open-Y (0301) and linear (0220). In our study, we evaluate this new system.

Study design, size, duration

This study was a retrospective analysis of 844 4-cell embryos across 3 clinics in 3 countries. Focal stacks of the embryos were captured on Embryoscope/MIRI time-lapse incubators between 2018 and 2020. Embryos were annotated by their respective clinics using the original “tetrahedral/planar” system. Additionally, data on blastulation, blastocyst grade (Gardner scale) and biochemical pregnancy rates were obtained for each embryo.

Participants/materials, setting, methods

The embryos were annotated according to the new system by a panel of three researchers without knowledge of the clinics’ or each other’s classifications. Afterwards, the panelists assembled for discussion and a unanimous consensus was reached for each embryo. The cell arrangement classes were analysed with respect to blastulation rates, blastocyst grade and pregnancy rates using chi-squared tests. The distribution of classes across the clinics was also analysed, as well as agreement among the panelists.

Main results and the role of chance

Under the new system, tetrahedral and pseudotetrahedral embryos saw significantly higher rates of blastulation (P = 0.017) and good-quality blastocysts (p = 0.043; here, “good-quality” means that the grade contains no ‘C’s or numbers less than 3) compared to other arrangements. No association was found with respect to biochemical pregnancy (p = 0.77).

There was significant variation between the clinic-provided classifications (p &lt; 0.001) with tetrahedral-to-planar ratios ranging from 1 to 9. Under the new system, there was no significant difference between the proportions of each arrangement (p = 0.66). The arrangements in order of decreasing prevalence across all the data were tetrahedral (63.7%), pseudotetrahedral (25.8%), planar (8.0%), closed-Y (2.2%) and linear (0.3%). No open-Y embryos were observed. Upon comparison with the clinic-provided tetrahedral/planar classifications, there were clear differences in the treatment of pseudotetrahedral embryos - some clinics predominantly classified them as “tetrahedral” while others as “planar”.

Prior to any discussions, the panelists’ annotations unanimously agreed on the classifications of 63% of the embryos; with 33% of the embryos having 2 different classifications and 4% of embryos causing total disagreement. The majority of disagreements regarded pseudotetrahedral embryos being confused for either tetrahedral or planar embryos.

Limitations, reasons for caution

It can be at times difficult to visualise the 3D structure of embryos from focal stacks. As a result, some annotations may be erroneous, though the use of a panel-based approach helped to mitigate this. Moreover, further studies will need to take place to validate the findings in this work.

Wider implications of the findings

The findings demonstrate the prognostic utility of Hickman et al.’s ICP-based classification system. Moreover, the findings suggest that much of the variability seen in the prevalence of tetrahedral embryos under the tetrahedral/planar system came from the mislabelling of pseudotetrahedral embryos which comprised 25.8% of the study population.

Trial registration number

N/A

P–110 Does the Body Mass Index affect sperm quality?

Study question

Does the body mass index (BMI) have an impact on semen analysis results?

Summary answer

The increase in BMI has a negative impact on sperm motility.

What is known already

Obesity is an increasingly prevalent health condition worldwide and can affect male fertility in various ways. It is known that obesity can cause testicular inflammation, higher testicular temperature, hypogonadism, sperm DNA fragmentation, and erectile dysfunction. However, there are still conflicting data regarding the correlation between BMI and semen parameters in the seminal analysis.

Study design, size, duration

Observational, cross-sectional, retrospective study using data from 1147 patients seen at a private infertility clinic between 2010 and 2020. The data were collected from electronic records in a prospective database.

Participants/materials, setting, methods

Patients were divided according to BMI (healthy weight, overweight, obesity classes I, II, III), and their seminal profiles were compared, according to 2010’s World Health Organization’s parameters. Cancer, cryptorchidism, viral orchitis, altered karyotype, Y chromosome microdeletions, vasectomy reversion, and testosterone use were excluding factors. Student t-tests and multiple linear regression were used for statistical analysis. The results were adjusted for age, alcohol, tobacco, and drug use, medication intake, physical activity, comorbidities, and scrotum heat factors.

Main results and the role of chance

From a total of 1384 patients, 219 were excluded. The BMI varied between 18,9 and 50,8 kg/m². From the 1147 patients, 297 had BMI 18.5–24.9 kg/m² (healthy weight, group 1), 611 had BMI 25–29.9 kg/m² (overweight, group 2), 179 had BMI 30–34.5 kg/m² (obese, group 3), 60 had BMI ≥ 35 kg/m² (extremely obese, group 4). The mean age for groups 1 through 4 was 37.6, 38.5, 38.2, and 36.5 years old. The comparison of the groups’ seminal parameters shows a significant decrease in progressive and total motility in patients with BMI ≥ 35 kg/m².The progressive motility was 43.8% in group 1, 44.1% in group 2, 42.4% in group 3, and 35.2% in group 4 (p = 0.07) and the total motility was 54.4%, 54.1%, 53.6%, and 45.9%, respectively (p = 0.012). The complementary analysis determined BMI 29 kg/m² as the cutoff for negative impact on progressive motility (p = 0.044) and 31 kg/m² on total motility (p = 0.036). The results were still significant after age, use of cannabis, and hypertension adjustments – the other possible interfering factors were not significant.

Limitations, reasons for caution

Besides the fact that this was a retrospective study, it also has a smaller sample size of patients with extreme obesity. This is probably related to the fact that the patients seeking reproductive treatment in a private clinic have a greater purchasing power and lower prevalence of obesity.

Wider implications of the findings: In this study, sperm quality is negatively affected by BMI, with impairment since 29 kg/m² for progressive and 31 kg/m² for total motility. Our data support the potential deleterious role of obesity on semen parameters, reinforcing the importance of weight control in infertility prevention.

Trial registration number

Not applicable

P–463 Patients undergoing elective and onco-fertility preservation respond similarly to controlled ovarian stimulation for fertility preservation

Study question

Is the oocyte vitrification response different in patients undergoing elective and onco-fertility preservation?

Summary answer

Patients undergoing elective and onco-fertility preservation seem to respond similarly to controlled ovarian stimulation for fertility preservation.

What is known already

Age persists as the factor with the most significant impact on the prognosis of female fertility. The ovarian reserve can also be threatened by surgical, radiotherapy or chemotherapy procedures. Thus, maternity delay and the increased incidence of malignant diseases are the most jeopardizing conditions for reproductive potential in women. Studies are still conflicting about oocyte freezing results in patients with and without cancer. Some studies suggest worse outcomes in patients with cancer regarding the number of mature vitrified oocytes when compared to healthy patients whether others show similar response to the ovarian stimulation for fertility preservation in both groups.

Study design, size, duration

Observational, cross-sectional, and historical study using data from 367 who underwent oocyte vitrification from a Reproductive Medicine Center, between 2009 and 2018.

Participants/materials, setting, methods

Patients were divided into an elective group (EG; n = 327) and an onco-fertility group (OFG; n = 40). Data were presented as mean ± standard deviation or median and interquartile range (IQR) and absolute and relative frequencies. Chi-square test, Student’s t-test, or Mann-Whitney test were applied. Generalized linear models were used to control confounding factors. Data were adjusted by women age, FSH, and GnRH protocol. The null hypothesis was rejected when p &lt; 0.05. Main results and the role of chance: Patients age in OFG was significantly lower compared to EG (31.3±5.8 vs. 37.0 ±2.9 years; p &lt; 0.01) and also FSH measurement (4.0 [3.3 – 6.2] vs. 9.0 (5.4 – 9.9) mIU/mL; p &lt; 0.01). The presence of a partner was significantly higher in OFG (25 [62.5%] vs. [19.9%]; p &lt; 0.001). GnRH antagonist protocol was used in 80.1% of cycles, and FSH-r was used in 80.4% of cycles. Letrozole was added for 20 breast cancer patients (74%). When adjusting data for age, FSH and Gonadotropin-releasing Hormone (GnRH) protocols, no significant difference in the number of vitrified mature oocytes between the two groups were observed (6.0 [3.0–11.0] vs. 7.0 [3.0–12.0]; p = 0.11). Limitations, reasons for caution: The number of women in the OFG was lower than the EG group. The OFG was composed of different types of tumors in different locations and stages. Thus, it can be questioned whether any patient with a more aggressive tumor might have had a negative impact on the results.

Wider implications of the findings: Healthy patients and patients with cancer seem to respond similarly to ovarian stimulation for fertility preservation. The extensive number of cycles performed for EG in contrast to OFG leads to a reflection on patients who are still not referred for reproductive counseling after a cancer diagnosis.

Trial registration number

Not applicable

P–334 CT virtual Histerotomography: a new method for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy

Study question

Can computerized virtual histerotomography (CT-HSG) be used for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy? Summary answer: CT-HSG seems to be an adequate test for the evaluation of fallopian tube patency, pelvic organs, and the uterine cavity.

What is known already

CT-HSG is a minimally invasive exam, which diagnoses variations in the female reproductive system, uses low radiation doses and is well tolerated by patients. It simultaneously evaluates the uterine wall, cavity and cervix, tubes, and adjacent pelvic structures. The exam enables virtual navigation, which consists of the endoluminal view of the cervical canal and uterine cavity and allows 3D reconstruction of images. The exam remains underused to assess infertility, but previous studies have shown potential and its use may be widespread.

Study design, size, duration

Retrospective cohort study, that included data from 317 women seeking pregnancy, between January/2019 and January/2021. The CT-HSG was indicated for infertility (90.3%) and RPL (0.9%) investigation, and for the evaluation of tubal stump in patients who were planning the tubal reversal surgery (8.8%). Patients filled out a questionnaire about their pain symptoms and data were collected from electronic records.

Participants/materials, setting, methods

The study analyzed patients’ clinical characteristics and image findings regarding tubes, uterine cavity, and ovaries. For the exam, a catheter was positioned in the cervix, where the contrast medium (iopromide) was injected through an infusion pump at 0.30 ml/s, for a total of 20ml. The tomographic slices were obtained at the 50th second. The CT-HSG images were interpreted by the same gynecologist and radiologist. Data were analyzed using SPSS version 20.0.

Main results and the role of chance

Women and partners’ mean age was 32.7 ± 5.6 and 34.6 ± 7.7 years, respectively, and women’s mean BMI was 28.4 ± 6.4 Kg/m². The pain scale was applied in 103 patients, who reported 5.4±3.2 pain scale scores at the end of the exam. Among the infertile patients 67% were nulliparous. Regarding the exam findings, most of the uterus findings were normal (72.6%). The variations found were uterine malformations (including unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, and arcuate uterus), synechia, fibroids, endometrial polyps, adenomyosis and retractions/lateralizations that may suggest endometriosis. The tubal findings on the right/left (%) were: 65/67.5 patent horn; 18.9/17.7 obstructed tubes; 4/41 dilatation/hydrosalpinx and 9.4/9.1 with previous history of tubal ligation or salpingectomy; 1.5% of the tubal evaluation were inconclusive. Eleven from 317 patients had to repeat the exam due to occurrences during the execution (for example, improper catheter positioning, cuff fall, stenosis of the internal cervical ostium, severe pain).The 3D analysis and virtual navigation assist in the findings assessment, in addition to being simpler for the gynecologists evaluation.

Limitations, reasons for caution

The sample size is small due to the exam being a new technique. Patient follow-up and correlation with laparoscopy and hysteroscopy, when indicated, are under studied.

Wider implications of the findings: The exam seems to be promising for assessing infertility, RPL and the tubal stump. Moreover, it may be a good option to hysterosalpingography as it seems to cause less pain and allows to evaluate the ovaries and the uterine contour, added to 3D reconstructions and to virtual uterine navigation.

Trial registration number

Not applicable

P–481 COVID–19 pandemic: the emotional impact comparing men and women on assisted reproductive treatment

Study question

How has the COVID–19 pandemic affected the psychological aspects of men and women undergoing reproductive treatments?

Summary answer

The women were more emotionally affected due to the COVID–19 pandemic than men, especially increasing anxiety and fear of not achieving pregnancy.

What is known already

COVID–19 pandemic required changes in behavior and plans of most people worldwide, including patients undergoing assisted reproductive treatment (ART). The reproductive societies recommended immediate cessation of all new fertility treatment cycles, arousing different opinions from patients and providers, concerned that a delay of months may affect clinical outcomes. The fear, social distancing and financial insecurity are enough reasons for worry and anguish, and the uncertainty of resuming plans of parenthood make the scenery even more challenging. Therefore, the psychosocial aspects’ evaluation of these patients during the pandemic is fundamental for better comprehension, management, and reception in this especially challenging moment.

Study design, size, duration

Cross-sectional study using data from a centre of reproductive medicine between June and August 2020. The sample was composed of 120 patients (54 men and 66 women), 14.16% undergoing frozen embryo transfer (FET), 77.5% in vitro fertilization (FIV), 1.6% semen freezing collection and 6.6% oocyte freezing.

Participants/materials, setting, methods

The data were extracted from an electronic questionnaire elaborated by the clinical team, which included questions about the patients’ psychological aspects, applied one day before ART. The answers were compared between men and women,and between the types of ART used by each patient. The statistical analysis was made using the program SPSS for Windows. The Chi-Square test was used to compare the study groups, considering p &lt; 0.05 statistically significant.

Main results and the role of chance

It was observed that 23/54 (42%) of men and 42/66 (63%) of women were at least partially emotionally affected by the pandemic (p = 0.027). Comparing feelings between groups (men and women, respectively) the following results were observed: optimistic (42,1% vs 57,9% p = 0.664), hopeful (32,3% vs 67,7%, p = 0.098), anxious (22,6% vs 77,4%, p = 0.004), calm (60,7% vs 39,3%, p &lt; 0.001). Also, 27% of men and 39.3% of women felt more anguished than normal, which was mostly expressed through anxiety (36.7% vs 63.3%, p = 0.113), followed by irritability (54.5% vs 45.5%, p = 0.421), eating habit change (42.5% vs 56.5, p = 0.962) and sleep disorders (28.6% vs 56.5%, p = 0.215). Most patients (96.6%) reported having somebody to share their feelings and didn’t want to be contacted by the clinic’s psychologist (92.5%); 26.3% of couples had their relationship positively affected. Comparing feelings between patients undergoing FET vs FIV, respectively, were found: optimistic (47.0% vs 29.0%, p = 0.142) and anxious (23,5% vs 27.9%, p = 0.70).

Limitations, reasons for caution

The data was collected at one point, in the worst moment of the pandemic in Brazil, which may have influenced some of the answers. The small sample size is due to the lower number of procedures in this period.

Wider implications of the findings: The feelings were similar between groups. However, women seemed to be more fearful of not being able to realize the parenthood dream. Anxiety was the main symptom in both groups, being more prevalent in women. This study reinforces the importance of having mental health professionals in assisted reproductive clinic.

Trial registration number

Not applicable

P–702 The effect of body weight on assisted reproduction treatment: clinical and perinatal outcomes

Study question

Does body weight have any effect on clinical and perinatal outcomes in assisted reproduction techniques (ART)?

Summary answer

Obesity and overweight were associated with smaller oocytes retrieved and mature number, tendency to minor pregnancy rates, and with a greater chance of macrosomic newborns.

What is known already

The body mass index (BMI) is an international measure to categorize population regarding body weight. Overweight and obesity have an established negative impact on female fertility, especially due to chronic anovulation. However, studies are inconsistent regarding body weight and ART clinical and perinatal outcomes. Some say there is no difference, others show a little or unfavorable outcomes in overweight and obese patients.

Study design, size, duration

Retrospective cohort study performed at an assisted reproductive clinic. A total of 2296 follicle stimulation cycles were included, from 1686 patients, which resulted in 2278 embryo transfers (ET). Both fresh (1942) and vitrified (354) ET cycles were included in the study. The data refers to a period from 2013- 2020 and were collected from electronic records.

Participants/materials, setting, methods

Sample was divided into groups, according to BMI (kg/m²): Group 01 (&lt;18.5, n = 30 cycles); Group 02 (18.5–24.9, n = 1630 cycles); Group 03 (25–29.9, n = 459 cycles) and Group 04 (≥30, n = 177 cycles). Data were presented as mean±SD, median (interquartile range), or percentage. ANOVA and Chi-square tests were applied, considering p &lt; 0.05. Multiple logistic regression and generalized estimating equations were performed to consider patients and cycles.

Main results and the role of chance

The mean maternal age was 35.71±3.5 years old. A statistically significant difference was observed in retrieved oocytes and mature oocytes number (MII) when groups 01 and 02 were put together (G01+G02) and compared to groups 03 and 04: (8.8 [8.5–9.2] vs 7.9 [7.3–8.6] vs. 7.2 [5.9–8.4], p = 0.005) and (6.7 [6.4–7] vs 6 [5.5–6.5] vs. 5.3 [4.3–6.3], p = 0.003), respectively. A significant linear tendency to minor pregnancy rates with higher BMI (p = 0.038), with no significant difference in pregnancy rates was found between the four groups (52.6% vs. 47.9% vs. 46.7% vs. 36.3%, p = 0.124). There was no significant difference in cumulative pregnancy, live birth rate, fertilization and implantation rates between groups. Group 04 showed a higher, but not significant, prevalence of macrosomic newborns (p = 0.110). No statistical differences regarding any other clinical and perinatal outcomes were found (prematurity, intensive care unit admission, congenital malformations, Apgar index, newborn percentile, gestational age and birthweight.

Limitations, reasons for caution

This is a retrospective study with a limited number of patients. Also there was no information on patients’ weight gain throughout pregnancy, and others clinical pregnancy diseases that could affect perinatal outcomes.

Wider implications of the findings: The study presented that the higher the weight, there seems to be a tendency towards worse outcomes of ART, especially regarding retrieved oocytes and mature oocytes number. Also, the study draws attention to the possible relationship between obesity and perinatal outcomes, also seen in spontaneous pregnancies.

Trial registration number

Not applicable

P–107 Does hematological cancer have the same impact on sperm quality as testicular cancer?

Study question

Does hematological cancer have the same impact on sperm quality as testicular cancer before chemo or radiotherapy? Summary answer: Hematological cancer has no impact on sperm quality before treatment.

What is known already

The deleterious effects of chemo and radiotherapy on testicular function are well known. Furthermore, testicular cancer causes a negative impact on sperm quality, even before treatment, probably due to local action. Hematological cancer, particularly Hodgkin lymphoma, seems to produce inflammatory alterations in the testis. However, it is not clear if hematological cancer can compromise spermatogenesis, as does testicular cancer.

Study design, size, duration

Observational, cross-sectional, retrospective study using data from 360 patients seen at a private infertility clinic between 1992 and 2019 for sperm cryopreservation before treatment. The data were collected from electronic records in a prospective database.

Participants/materials, setting, methods

Seminal samples from patients that cryopreserved semen due to hematological or testicular cancer were compared. Sperm analyses were performed according to the 2010’s World Health Organization (WHO)’s parameters. Seminal volume, total sperm number, sperm concentration, total and progressive motility, and vitality were analysed. In the hematological group, leukemia and lymphoma, and Hodgkin and non-Hodgkin lymphoma were compared. Student t-tests and Chi-Square were used, considering p &lt; 0.05 statistically significant.

Main results and the role of chance

This study included 295 patients with testicular cancer (TEST) and 100 with hematological cancer (HEMAT). Patients that had already started chemo or radiotherapy (4 HEMAT and 12 TEST) were excluded, and 4 HEMAT and 15 TEST were azoospermic or cryptozoospermic (41.7% vs. 53,0%, p = 0,792 ). The other parameters were analysed in 92 HEMAT and 268 TEST. The mean age of the HEMAT group was 28.2 years and 27.9 for the TEST group (p = 0,858). The TEST group had higher rates of oligozoospermia (50.7% vs 31.5%, p = 0.001) and of severe oligozoospermia (29.5% vs 15.2%, p = 0.006) than the HEMAT group. Furthermore, 69.6% HEMAT had normal concentration, compared to 45.9% TEST (p &lt; 0.001). The mean concentration of the HEMAT group was 35 mi/mL, normal according to the WHO’s standards, and the TEST group was 12 mi/mL, below the WHO’s normal standards (p &lt; 0.001). No difference was found when comparing leukemia and lymphoma, or Hodgkin and non-Hodgkin lymphoma.

Limitations, reasons for caution

Besides the fact that this study is retrospective, it also has a small sample size. Furthermore, no analyses regarding sperm morphology were made.

Wider implications of the findings: In this study, testicular cancer had a negative impact on spermatogenesis and sperm quality, whereas hematological cancer did not. However, counseling regarding fertility preservation using sperm banking prior to chemo or radiotherapy should be reinforced in all young cancer patients.

Trial registration number

Not applicable

Successful birth after injection of frozen human oocytes with frozen epididymal spermatozoa

A couple (female 31, male 42 years old) with infertility due to obstructive azoospermy returned to the clinic in order to attempt pregnancy using their frozen oocytes and epididymal sperm cells, which had been cryopreserved at the time of a previous IVF attempt. Two days before the scheduled transfer, eight oocytes were thawed; 5/8 (63%) oocytes survived and 4/5 (80%) oocytes fertilized after intracytoplasmic sperm injection (ICSI) with the previously frozen epididymal spermatozoa. All four fertilized ova cleaved (100%). On day 2 after thawing, four embryos were transferred; three with two cells (grade II) and one with three cells (grade III). Hormonal support for the established pregnancy was maintained with oestradiol and progesterone orally until 12 weeks of gestation, and the patient was delivered by Caesarean section at 40 weeks of gestation; the baby boy weighed 3025 g, and measured 51 cm, with Apgar of 10 in the 1st and 5th min. The cryopreservation and warming protocol used for this study yielded very favourable results, comparing well with reports in the literature. This case report demonstrates that it is possible to obtain high rates of oocyte survival following thawing and high rates of fertilization after ICSI, with viable development of the resulting embryos.