Fertility work‐up and fertility preservation
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Abstract
Objectives:To determine the cumulative live birth rate (CLBR) under three consecutive in vitro fertilisation (IVF) treatments in women with endometriosis and/or adenomyosis.Methods:A prospective cohort study of 1035 women aged 25–≤39 years undergoing up to three consecutive IVF treatments between January 2019 and April 2024. All women underwent an advanced transvaginal ultrasound examination prior to starting their treatments. Endometriosis/adenomyosis were diagnosed using the International Deep Endometriosis Analysis and the revised Morphological Uterus Sonographic Assessment group definitions. The aRR for cumulative live birth (CLB) after three IVF cycles was calculated using a modified Poisson regression analysis adjusting for antimüllerian hormone. In total 293 (28.3%) women had endometriosis and/or direct features of adenomyosis. All 1035 women underwent the first treatment, and 817 (78.9%) women underwent all eligible treatments.Results:The CLBR in the total cohort was 666/817 (81.5%). Women with endometriosis and/or adenomyosis had a lower CLBR of 156/223 (70.0%) compared to women without, 510/593 (86.0%), p < 0.001. The aRR for CLB for women with endometriosis and/or adenomyosis was 0.85 (95% CI, 0.78–0.91), p < 0.001. Stratified per treatment, the CLBR for women with endometriosis and/or adenomyosis in the first cycle was 90/293 (30.7%), aRR0.69 (95% CI, 0.57–0.84), in the second 44/154 (28.6%), aRR 0.72 (95% CI, 0.54–0.96) and in the third cycle 22/84 (26.2%), aRR 0.83 (95% CI, 0.54–1.28). For women without the disease, the CLBR was 335/742 (45.1%) in the first cycle, 132/319 (41.4%) in the second and 43/133 (32.3%) in the third.Conclusions:The presence of endometriosis and/or adenomyosis is associated with a reduced chance of live birth under three consecutive IVF treatments. However, the proportion of women achieving a live birth remained stable over three treatment cycles, suggesting that an unsuccessful first attempt should not be a reason to withhold further treatments.
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Objectives
To assess the prevalence and the reproductive outcome of non-obstructive corporeal congenital uterine anomalies (CUA) in an unselected population.
Methods
Premenopausal women self-presenting/referred to our unit January 2015 and December 2024 who underwent a routine/targeted gynecological examination were included. Each woman underwent three-dimensional transvaginal ultrasound. Corpus morphology was classified using a modified American Fertility Society classification of CUA. We excluded arcuate uterus cases. Septate uterus was subclassified minor vs major, depending on the internal cavity/septum surface ratio. Reproductive outcomes (infertility requiring reproductive assisted techniques, live birth, preterm birth) were compared between women with a normal uterus and those with a distorted corpus.
Results
7842 women with interpretable volume datasets were included in the study. 157 (2%) cases had a corpus CUA, 104 being major. The most common anomalies were septate and unicornuate uterus. After adjustment for confounders, all reproductive outcome parameters were similar between women with non-obstructive corporeal CUA and those with a normal uterus, except infertility. Among the 88 patients desiring it, 68 had spontaneous pregnancies, and 48 (54.5%) had a favourable perinatal outcome. Women with bicornuate uteri, didelphys and unicornuate had a lower risk of small for gestational age (p = .03) when compared to septate uteri (p = .0001), but a higher risk of preterm premature rupture of membranes (p = .0001) and preterm delivery before 34 weeks (p = .0001). The rate of live birth was similar between women with a uterine anomaly and those with a normal uterus (p = .47).
Conclusions
Supporting information can be found in the online version of this abstract
OC16.02: Impact of endometriosis and/or adenomyosis on cumulative live birth rates under three consecutive in vitro fertilisation treatments
S. Alson1,2, P. Sladkevicius1,2
1Obstetrics and Gynecology, Lund University, Lund, Sweden; 2Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden
Objectives
To determine the cumulative live birth rate (CLBR) under three consecutive in vitro fertilisation (IVF) treatments in women with endometriosis and/or adenomyosis.
Methods
A prospective cohort study of 1035 women aged 25–≤39 years undergoing up to three consecutive IVF treatments between January 2019 and April 2024. All women underwent an advanced transvaginal ultrasound examination prior to starting their treatments. Endometriosis/adenomyosis were diagnosed using the International Deep Endometriosis Analysis and the revised Morphological Uterus Sonographic Assessment group definitions. The aRR for cumulative live birth (CLB) after three IVF cycles was calculated using a modified Poisson regression analysis adjusting for antimüllerian hormone. In total 293 (28.3%) women had endometriosis and/or direct features of adenomyosis. All 1035 women underwent the first treatment, and 817 (78.9%) women underwent all eligible treatments.
Results
The CLBR in the total cohort was 666/817 (81.5%). Women with endometriosis and/or adenomyosis had a lower CLBR of 156/223 (70.0%) compared to women without, 510/593 (86.0%), p < 0.001. The aRR for CLB for women with endometriosis and/or adenomyosis was 0.85 (95% CI, 0.78–0.91), p < 0.001. Stratified per treatment, the CLBR for women with endometriosis and/or adenomyosis in the first cycle was 90/293 (30.7%), aRR0.69 (95% CI, 0.57–0.84), in the second 44/154 (28.6%), aRR 0.72 (95% CI, 0.54–0.96) and in the third cycle 22/84 (26.2%), aRR 0.83 (95% CI, 0.54–1.28). For women without the disease, the CLBR was 335/742 (45.1%) in the first cycle, 132/319 (41.4%) in the second and 43/133 (32.3%) in the third.
Conclusions
The presence of endometriosis and/or adenomyosis is associated with a reduced chance of live birth under three consecutive IVF treatments. However, the proportion of women achieving a live birth remained stable over three treatment cycles, suggesting that an unsuccessful first attempt should not be a reason to withhold further treatments.
OC16.03: Intraoperative ultrasound-guided laparoscopic ovarian cystectomy for the management of benign ovarian cysts: randomised controlled trial
L. Kasaven2,1, N.P. Anson2,1, B. Jones2,1, S. Ghaem-Maghami2,1, J.Y. Verbakel3, M. El-Bahrawy2,1, S. Saso2,1, J. Yazbek4
1Imperial College Healthcare NHS Trust, London, United Kingdom; 2Cancer and Surgery, Imperial College London, London, United Kingdom; 3Public Health and Primary Care, KU Leuven, Leuven, Belgium; 4Gynecological Oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
Objectives
To compare the ovarian reserve following intraoperative ultrasound-guided laparoscopic ovarian cystectomy (UGLOC) to laparoscopic ovarian cystectomy (LOC).
Methods
Women aged between 18–45 diagnosed with a benign ovarian cyst (dermoid, simple, serous cystadenoma) requiring surgical management were randomised to either LOC or UGLOC. The change in ovarian reserve markers, including anti-Müllerian hormone (AMH) and antral follicle count (AFC) were assessed preoperatively and at 3 and 6 months postoperatively.
Results
Twenty-seven patients have been recruited to the study, of which n = 13 (48.1%) underwent LOC and n = 14 (51.9%) underwent UGLOC. There was no significant difference in rate of intraoperative cyst rupture (P = 0.82) or duration of surgery (P = 0.85) between the two groups. A significant difference was observed in the amount of ovarian tissue excised with the specimen (P = 0.02), although no significant difference was found in the grade of follicles excised (P = 0.69). The odds ratio (OR) for significant ovarian reserve decline (AMH 6 months' postoperatively) in the LOC group compared to UGLOC is (OR 0.47; CI 95%, 0.09–2.34, P = 0.36), with no significance demonstrated when adjusting for age (OR 1.00; CI 95%, 0.90–1.13, P = 0.87). The odds ratio for significant ovarian reserve decline (AFC 6 months' postoperatively) in the LOC group compared to UGLOC is (OR 0.44; CI 95%, 0.08–2.24, P = 0.32), with no significance demonstrated when adjusting for age (OR 0.97; CI 95%, 0.87–1.09, P = 0.67).
Conclusions
UGLOC does not reduce the odds of significant ovarian reserve decline when compared to LOC. However, as there is a significant difference in whether ovarian tissue is excised with the specimen, UGLOC may be beneficial for particular cohorts of patients, such as older women with a baseline diminished ovarian reserve to prevent further loss of healthy follicles.
OC16.04: Incorporating three-dimensional ultrasound uterine measurements and vascularity into AI models to identify predictive factors for assisted reproductive technologies
C. Fakih1,2, A. Masri2, K. Al Haj2, G. Fakih3, B. Jreij3, A. Fakih4, Y. Mourad5, F. Fakih6
1Al Hadi IVF Center, Beirut, Lebanon; 2Faculty of Medicine, Universite Libanaise, Beirut, Lebanon; 3University of Balamand, Beirut, Lebanon; 4American University of Beirut, Beirut, Lebanon; 5Al Hadi Laboratory, Beirut, Lebanon; 6Centre Hospitalier Moulins Yzeure, Moulins, France
Objectives
Three-dimensional (3D) power Doppler indices – vascularisation index (VI), flow index (FI), and vascularization flow index (VFI) – correlate with better endometrial receptivity. Intercornual distance, cornual angles, and fundal indentations have been insufficiently studied. The main objective of this study was to identify which 3D ultrasound uterine measurements and vascularity parameters in AI models can predict assisted reproductive technique outcomes.
Methods
This prospective observational study included 628 patients. Only those undergoing a single blastocyst transfer were considered. Ultimately, 171 patients were retained. On embryo transfer day, 3D vaginal power Doppler (WS80A, Samsung) assessed vascularity indices and 3D endometrial measurements. To predict pregnancy, all these features were added to age and endometrial thickness in ten AI classifiers.
Results
No significant differences between pregnant and non-pregnant groups in uterine volume, endometrial volume, uterine vascularity index, flow index, vascular flow index, lateral and fundal indentation, cornual angles, or isthmus+fundus height. The only significant difference was the intercornual distance (p = 0.034) 31.28+/-5.56 mm in pregnant women and 26.23+/-4.98 mm in non pregnant women. Among AI models the Artificial Neural Network (ANN) performed best, achieving 82% accuracy, then Support Vector Machine (80%) and Random Forest (80%). SHAP method identified inter cornual distance as the third most predictive feature, following age and endometrial thickness.
Conclusions
Incorporating 3D measurements mainly inter cornual distance in endometrial preparation monitoring could identify better prognosis patients.
OC16.05: Safety and tolerability of sonohysterosalpingography (HyFoSy)
S. Guerriero1, F. Deiala1, A. Pisu1, D.A. Jurca1, A. Borzacchelli2, M. Boi3, S. Ajossa3
1Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; 2Presidio Ospedaliero San Giuseppe Moscati, Aversa, Italy; 3University of Cagliari, Cagliari, Italy
Objectives
To analyse the tolerability and adverse reactions associated with HyFoSy, focusing on the perception of pain and the presence of side effects.
Methods
Patients referred to our infertility centre who required tubal patency evaluation were included in the study. The presence of concomitant pathologies (tubal pathology, uterine fibromatosis, endometriosis, endometrial polyps, adenomyosis) and previous abdominal surgery were recorded. At the end of the examination, the patients' well-being was recorded and they were asked to rate their perceived pain using a visual analogue scale (VAS). The sample was divided into patients examined before 2017 (a:33 patients) or after 2017 (b:112 patients).
Results
145 women were included in the study. The mean VAS pain score was 2.02 +/- 1.6. No statistically significant difference in pain perception was found between the groups of patients with different pathologies or previous surgical procedures. The total number of complications detected at the end of the study, whether the study was completed or not, was as follows: 6 cervical stenosis, 2 vagal reactions, 1 panic attack, 1 intrauterine bleeding, 1 suspected pelvic inflammatory disease, 1 venous intravasation. Bilateral tubal patency was found in 82 cases (61.2%), unilateral tubal patency in 43 cases (32.1%) and bilateral tubal occlusion in 9 cases (6.7%). There was no statistically significant association between the finding of tubal patency and the presence of gynecological pathology. There was a significantly higher rate of pain when the examination was not completed (VAS 6.45 +/- 2.6 vs 1.66 +/- 0.7 p< 0.05). There was no statistically significant difference in the rate of pain occurrence between the two groups (before and after 2017).
Conclusions
HyFoSy is a safe method for assessing tubal patency with good patient tolerability and a low risk of complications, besides this technique has a rapid learning curve.
OC16.06: Uterine artery Doppler parameters significantly differ among infertile women during ovarian stimulation with varying perceived stress levels
F. Alawneh1, C. Fakih1,2, S. Samad3, N. Abou Assaf3, M. Trad2, N. Al Samad3, R. Ajoury3, A. Fakih4, Y. Mourad5, F. Fakih6
1Al Hadi IVF Center, Beirut, Lebanon; 2Universite Libanaise, Beirut, Beirut Governorate, Lebanon; 3University of Balamand, Beirut, Lebanon; 4American University of Beirut, Beirut, Lebanon; 5Al Hadi Laboratory, Beirut, Lebanon; 6Centre Hospitalier Moulins Yzeure, Moulins, France
Objectives
Stress increases cortisol levels and alters sympathetic nervous system activity, negatively affecting vascular tone and endothelial function. Our main objective was to investigate how uterine artery Doppler parameters differ across infertile women with varying perceived stress levels.
Methods
This is a prospective observational study conducted between January and December 2024. It involved 368 infertile women undergoing controlled ovarian stimulation with 7.5 mg of daily Letrozole. Each woman completed a questionnaire on medical history and the Arabic-validated Perceived Stress Scale (PSS-10). Participants were categorised into three groups based on their PSS-10 scores: low stress (0–13), moderate stress (14–26), and high stress (27–40). On day 9, ultrasound assessments (WS80A, Samsung) evaluated ovarian follicles and uterine artery Doppler parameters at the dominant follicle side. Statistical tests included ANOVA, Spearman's, and Pearson's correlations.
Results
A statistically significant lower time-averaged peak velocity (TAPV) (cm/s) was observed in the high stress group (5.51 ± 1.41) compared to the moderate stress group (8.47 ± 1.67) and the low stress group (14.32 ± 1.99) (p = 0.002). A significant negative correlation was found between stress levels and TAPV (Pearson's r = -0.439, p = 0.01). Furthermore, a statistically significant higher systolic/diastolic ratio was found in the high stress group (307 ± 47) compared to the low stress group (7.79 ± 2.29) and moderate stress group (33.15 ± 6.45) (p = 0.001).
Conclusions
Follow-up of infertile patients under simple stimulation using PSS-10 during ovarian stimulation could identify stress-related uterine blood flow issues and assess their impact on pregnancy chances.
OC16.07: Consistency evaluation of endometrial peristaltic wave using AI-assisted software EmPA in ultrasound videos: a single centre observational study
Y. Wang1, H. Wang1
1Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
Objectives
Endometrial peristaltic waves are playing a key role in embryo implantation and pregnancy maintenance. Traditional manual identification methods are time-consuming, lack standardisation, and show significant inter-operator variability. This study aims to evaluate the repeatability of AI-assisted software EmPA in detecting endometrial peristaltic waves.
Methods
This single centre observational diagnostic trial recruited 60 female patients undergoing assisted reproductive technology (ART) and planning for frozen embryo transfer. Two-minute transvaginal ultrasound videos were collected 1–5 days before embryo transfer and automatically analysed by EmPA software to generate endometrial peristaltic wave patterns. Simultaneously, two senior physicians with over 10 years of experience performed visual counting of peristaltic waves by watching videos at 4x speed. The consistency between EmPA and visual counting was compared, and differences between anterior and posterior endometrial peristalsis, as well as the impact of sampling line placement, were analysed.
Results
EmPA counting showed strong positive correlation with physician visual counting (r = 0.824), with a mean square error of 1.65 and mean absolute error of 0.80. Bland–Altman analysis demonstrated good overall consistency between the two methods, with most errors falling within the consistency range ( ± 1.96 SD). Significant differences were found between anterior and posterior wall endometrial peristalsis (t = -2.067, p = 0.042). Sampling line placement (at endometrial junction or within endometrium) did not significantly affect peristalsis counting results (Bhattacharyya coefficient >0.99).
Conclusions
EmPA software demonstrates good consistency and repeatability in endometrial peristaltic wave detection, making it an effective tool for clinical assessment. Differences exist between anterior and posterior wall endometrial peristalsis, but sampling line placement does not affect results, providing operational convenience for clinical application.
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