Do Acoustic Characteristics of Dysarthria in People With Parkinson's Disease Differ Across Languages?

PURPOSE

Cross-language studies suggest more similarities than differences in how dysarthria affects the speech of people with Parkinson's disease (PwPD) who speak different languages. In this study, we aimed to identify the relative contribution of acoustic variables to distinguish PwPD from controls who spoke varieties of two Romance languages, French and Portuguese.

METHOD

This bi-national, cross-sectional, and case-controlled study included 129 PwPD and 124 healthy controls who spoke French or Portuguese. All participants underwent the same clinical examinations, voice/speech recordings, and self-assessment questionnaires. PwPD were evaluated off and on optimal medication. Inferential analyses included Disease (controls vs. PwPD) and Language (French vs. Portuguese) as factors, and random decision forest algorithms identified relevant acoustic variables able to distinguish participants: (a) by language (French vs. Portuguese) and (b) by clinical status (PwPD on and off medication vs. controls).

RESULTS

French-speaking and Portuguese-speaking individuals were distinguished from each other with over 90% accuracy by five acoustic variables (the mean fundamental frequency and the shimmer of the sustained vowel /a/ production, the oral diadochokinesis performance index, the relative sound level pressure and the relative sound pressure level standard deviation of the text reading). A distinct set of parameters discriminated between controls and PwPD: for men, maximum phonation time and the oral diadochokinesis speech proportion were the most significant variables; for women, variables calculated from the oral diadochokinesis were the most discriminative.

CONCLUSIONS

Acoustic variables related to phonation and voice quality distinguished between speakers of the two languages. Variables related to pneumophonic coordination and articulation rate were the more effective in distinguishing PwPD from controls. Thus, our research findings support that respiration and diadochokinesis tasks appear to be the most appropriate to pinpoint signs of dysarthria, which are largely homogeneous and language-universal. In contrast, identifying language-specific variables with the speech tasks and acoustic variables studied was less conclusive.

Prospective clinical validation of the Empatica EmbracePlus wristband as a reflective pulse oximeter

Introduction

Respiratory diseases such as chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, and COVID-19 may cause a decrease in arterial oxygen saturation (SaO2). The continuous monitoring of oxygen levels may be beneficial for the early detection of hypoxemia and timely intervention. Wearable non-invasive pulse oximetry devices measuring peripheral oxygen saturation (SpO2) have been garnering increasing popularity. However, there is still a strong need for extended and robust clinical validation of such devices, especially to address topical concerns about disparities in performances across racial groups. This prospective clinical validation aimed to assess the accuracy of the reflective pulse oximeter function of the EmbracePlus wristband during a controlled hypoxia study in accordance with the ISO 80601-2-61:2017 standard and the Food & Drug Administration (FDA) guidance.

Methods

Healthy adult participants were recruited in a controlled desaturation protocol to reproduce mild, moderate, and severe hypoxic conditions with SaO2 ranging from 100% to 70% (ClinicalTrials.gov registration #NCT04964609). The SpO2 level was estimated with an EmbracePlus device placed on the participant's wrist and the reference SaO2 was obtained from blood samples analyzed with a multiwavelength co-oximeter.

Results

The controlled hypoxia study yielded 373 conclusive measurements on 15 subjects, including 30% of participants with dark skin pigmentation (V-VI on the Fitzpatrick scale). The accuracy root mean square (Arms) error was found to be 2.4%, within the 3.5% limit recommended by the FDA. A strong positive correlation between the wristband SpO2 and the reference SaO2 was observed (r = 0.96, P < 0.001), and a good concordance was found with Bland-Altman analysis (bias, 0.05%; standard deviation, 1.66; lower limit, -4.7%; and upper limit, 4.8%). Moreover, acceptable accuracy was observed when stratifying data points by skin pigmentation (Arms 2.2% in Fitzpatrick V-VI, 2.5% in Fitzpatrick I-IV), and sex (Arms 1.9% in females, and 2.9% in males).

Discussion

This study demonstrates that the EmbracePlus wristband could be used to assess SpO2 with clinically acceptable accuracy under no-motion and high perfusion conditions for individuals of different ethnicities across the claimed range. This study paves the way for further accuracy evaluations on unhealthy subjects and during prolonged use in ambulatory settings.

Identification and Management of Thyroid Dysfunction Using At-Home Sample Collection and Telehealth Services: Retrospective Analysis of Real-World Data

BACKGROUND

Programs aimed at modernizing thyroid care by pairing at-home sample collection methods with telehealth options may serve an important and emerging role in thyroid care.

OBJECTIVE

The primary objective of this analysis was to evaluate telehealth use, demographics, and clinical characteristics of a cohort of consumer-initiated at-home laboratory thyroid test users who were also offered the option of follow-up telehealth consultations.

METHODS

This was a retrospective analysis of real-world data from a deidentified consumer database of home-collected, mail-in thyroid tests used from March to May 2021 (N=8152). The mean age was 38.6 (range 18-85) years, and 86.6% (n=7061) of individuals identified as female.

RESULTS

In total, 7% (n=587) of test takers fell into a thyroid dysfunction category (overt hypothyroidism: n=75, 0.9%; subclinical hypothyroidism: n=236, 2.9%; overt hyperthyroidism: n=5, 0.1%; and subclinical hyperthyroidism: n=271, 3.3%). Overall, 12% (n=984) of the overall sample opted into a telehealth consultation, with 91.8% (n=903) receiving a nontreatment telehealth consultation and 8.2% (n=81) receiving a treatment telemedicine consultation. Furthermore, 16% (n=96) of individuals with overt or subclinical thyroid dysfunction engaged in telehealth consultations. The majority of treatment consultations (59.3%, n=48) were conducted with people reporting a history of thyroid issues, with 55.6% (n=45) of people indicating wanting to discuss their current thyroid medication and 48% (n=39) receiving a prescription medication.

CONCLUSIONS

The combination of at-home sample collection and telehealth is an innovative model for screening thyroid disorders, monitoring thyroid function, and increasing access to care, which can be implemented at a large scale and across a wide range of age groups.

Measurement of changes in uterine and fibroid volume during treatment of heavy menstrual bleeding (HMB)

STUDY QUESTION

Does application of an unbiased method for analysis of magnetic resonance (MR) images reveal any effect on uterine or fibroid volume from treatment of heavy menstrual bleeding (HMB) with three 12-week courses of the selective progesterone receptor modulator ulipristal acetate (SPRM-UPA)?

SUMMARY ANSWER

Application of an unbiased method for analysis of MR images showed that treatment of HMB with SPRM-UPA was not associated with a significant reduction in the volume of the uterus or in the volume of uterine fibroids.

WHAT IS KNOWN ALREADY

SPRM-UPA shows therapeutic efficacy for treating HMB. However, the mechanism of action (MoA) is not well understood and there have been mixed reports, using potentially biased methodology, regarding whether SPRM-UPA has an effect on the volume of the uterus and fibroids.

STUDY DESIGN SIZE DURATION

In a prospective clinical study (with no comparator), 19 women with HMB were treated over a period of 12 months with SPRM-UPA and uterine and fibroid size were assessed with high resolution structural MRI and stereology.

PARTICIPANTS/MATERIALS SETTING METHODS

A cohort of 19 women aged 38-52 years (8 with and 11 without fibroids) were treated with three 12-week courses of 5 mg SPRM-UPA given daily, with four weeks off medication in-between treatment courses. Unbiased estimates of the volume of uterus and total volume of fibroids were obtained at baseline, and after 6 and 12 months of treatment, by using the Cavalieri method of modern design-based stereology in combination with magnetic resonance imaging (MRI).

MAIN RESULTS AND THE ROLE OF CHANCE

Bland-Altman plots showed good intra-rater repeatability and good inter-rater reproducibility for measurement of the volume of both fibroids and the uterus. For the total patient cohort, two-way ANOVA did not show a significant reduction in the volume of the uterus after two or three treatment courses of SPRM-UPA (P = 0.51), which was also the case when the groups of women with and without fibroids were considered separately (P = 0.63). One-way ANOVA did not show a significant reduction in total fibroid volume in the eight patients with fibroids (P = 0.17).

LIMITATIONS REASONS FOR CAUTION

The study has been performed in a relatively small cohort of women and simulations that have subsequently been performed using the acquired data have shown that for three time points and a group size of up to 50, with alpha (Type I Error) and beta (Type II Error) set to 95% significance and 80% power, respectively, at least 35 patients would need to be recruited in order for the null hypothesis (that there is no significant reduction in total fibroid volume) to be potentially rejected.

WIDER IMPLICATIONS OF THE FINDINGS

The imaging protocol that we have developed represents a generic paradigm for measuring the volume of the uterus and uterine fibroids that can be readily incorporated in future studies of medical treatments of HMB. In the present study, SPRM-UPA failed to produce a significant reduction in the volume of the uterus or the total volume of fibroids (which were present in approximately half of the patients) after either two or three 12-week courses of treatment. This finding represents a new insight in respect of the management of HMB using treatment strategies that target hormone-dependence.

STUDY FUNDING/COMPETING INTERESTS

The UPA Versus Conventional Management of HMB (UCON) trial was funded by the EME Programme (Medical Research Council (MRC) and National Institutes of Health Research (NIHR)) (12/206/52). The views expressed in this publication are those of the authors and not necessarily those of the Medical Research Council, National Institute for Health Research, or Department of Health and Social Care.Medical Research Council (MRC) Centre grants to the Centre for Reproductive Health (CRH) (G1002033 and MR/N022556/1) are also gratefully acknowledged. H.C. has clinical research support for laboratory consumables and staff from Bayer AG and provides consultancy advice (All paid to Institution) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc., and Myovant Sciences GmbH. H.C. has received royalties from UpToDate for an article on abnormal uterine bleeding. L.W. has received grant funding from Roche Diagnostics (Paid to Institution). All other authors have no conflicts to declare.

TRIAL REGISTRATION NUMBER

The study reported here is an embedded mechanism of action study (no comparator) within the UCON clinical trial (registration ISRCTN: 20426843).

Virulence Factors of the Gut Microbiome Are Associated with BMI and Metabolic Blood Parameters in Children with Obesity

The development of metabolic diseases is linked to the gut microbiota. A cross-sectional study involving 45 children (6 to 12 years old) was conducted to investigate the relationship between gut microbiota and childhood obesity. Anthropometric and metabolic measurements, food-frequency questionnaires (FFQs), and feces samples were obtained. Using the body mass index (BMI) z-score, we categorized each participant as normal weight (NW), or overweight and obese (OWOB). We determined 2 dietary profiles: one with complex carbohydrates and proteins (pattern 1), and the other with saturated fat and simple carbohydrates (pattern 2). The microbial taxonomic diversity and metabolic capacity were determined using shotgun metagenomics. We found differences between both BMI groups diversity. Taxa contributing to this difference, included Eubacterium sp., Faecalibacterium prausnitzii, Dialister, Monoglobus pectinilyticus, Bifidobacterium pseudocatenulatum, Intestinibacter bartlettii, Bacteroides intestinalis, Bacteroides uniformis, and Methanobrevibacter smithii. Metabolic capacity differences found between NW and OWOB, included the amino acid biosynthesis pathway, the cofactor, carrier, and vitamin biosynthesis pathway, the nucleoside and nucleotide biosynthesis and degradation pathways, the carbohydrate-sugar degradation pathway, and the amine and polyamine biosynthesis pathway. We found significant associations between taxa such as Ruminococcus, Mitsuokella multacida, Klebsiella variicola, and Citrobacter spp., metabolic pathways with the anthropometric, metabolic, and dietary data. We also found the microbiome's lipooligosaccharide (LOS) category as differentially abundant between BMI groups. Metabolic variations emerge during childhood as a result of complex nutritional and microbial interactions, which should be explained in order to prevent metabolic illnesses in adolescence and maturity. IMPORTANCE The alteration of gut microbiome composition has been commonly observed in diseases involving inflammation, such as obesity and metabolic impairment. Inflammatory host response in the gut can be a consequence of dietary driven dysbiosis. This response is conducive to blooms of particular bacterial species, adequate to survive in an inflammatory environment by means of genetical capability of utilizing alternative nutrients. Understanding the genomic and metabolic contribution of microbiota to inflammation, including virulence factor prevalence and functional potential, will contribute to identifying modifiable early life exposures and preventive strategies associated with obesity risk in childhood.

P18 Audit on compliance with the preventive measures on Clostridioides difficile

Background

Clostridioides (Clostridium) difficile persists to be a significant pathogen for healthcare acquired infections. Antibiotic usage is the main cause for the overgrowth of this organism and resulting in C. difficile infections (CDI). Other factors that are known to contribute are usage of proton pump inhibitors, laxatives usage and poor compliance with infection prevention control guidance in health care settings. The audit was carried out to analyse if the local guidance is followed on recognition of new onset of diarrhoea in an inpatient.

Objectives

Analyse compliance rate with our local guidance in Mayo University Hospital to be followed when inpatient has a new onset of diarrhoea. This to include reviewing of medications; such as laxatives, proton pump inhibitor (PPI) and antibiotics; prompt isolation and CDI precautions were commenced, samples sent for testing and commencing stool chart.

Methods

The data of patients was collected by reviewing the chart and collected data was stored and analysed using excel spreadsheet.

Results

The audit was carried out over a 4 month period from 10.06.22 until 14.10.22 in 7 wards. 31 patients were recorded as having diarrhoea with 69% (n=19) female and 39% (n=12) males during their inpatient stay. Majority of the recorded patients, which is 29% (n=9) were in medical male ward. The age of the patients ranged from 24 to 92 years of age with a median of 68 years. The median number of days from the admission until onset of diarrhoea was 5. On identifying new onset of diarrhoea, 32% (n=10) had recorded documentation of medications review. Out of 31 patients, 90% (n=28) were on PPI and only 21% (n=6) of them were held, while 7% (n=2) of them had their medication reviewed and was advised to continue the PPI as for clinical indication. Ninety percent (n=28) of patients were on regular laxatives and after the onset of diarrhoea only 39% (n=11) had the laxatives held. Of all the recorded patients, 32% (n=10) of patients had documentation of medication review and 19% (n=6) were continued on antibiotics for organisms other than CDI after discussion with clinical microbiology team. Fifty-five percent (n=17) of patients were isolated after the onset of new diarrhoea while the rest remained in a shared bay as per the discussion with clinical teams, while awaiting the stool results. Sixty-five percent (n=20) had a stool culture sent for CDI testing after the onset of new diarrhoea. Of these patients, 25% (n=5) tested positive for C. difficile.

Conclusions

Compliance to local guidance should be followed more strictly to avoid development of hospital acquired CDI and to prevent outbreaks in the healthcare setting.

Interests and preferences towards technology-based cardiac rehabilitation in men and women with coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have demonstrated the effectiveness of telemedicine programmes in patients with coronary artery disease (CAD). However, the development of these programmes is driven from a technical point of view and does not usually take into account the needs and expectations of patients. Thus, we found a need to study the interests and preferences towards technology-based cardiac rehabilitation (CR) in patients with CAD.

Purpose

The aim of this study was to compare the interests and preferences towards technology-based CR in men and women with CAD.

Method

A cross-sectional study was conducted. A total of 70 subjects with CAD (84.28% male) were included. Participants' interests and preferences were measured using the Technology Usage Questionnaire, which includes items on digital health and technology usage.

Results

On the one hand, men showed a greater interest in receiving CR counselling via mobile phone (p=0.022), would sign up for a free technology-based CR programme (p=0.034) and would like to receive less than 1-2 messages a week (p=0.010). On the other hand, women showed greater interest in receiving information about the different components included in the CR programme (receiving healthy meal/recipe ideas (p=0.002), reminders to take medication (p=0.039) and showed greater interest in meeting other people with heart disease (p=0.034). No differences were found by gender in type of communication that participants would like to receive through their mobile phone (p=0.154) or through the Internet (p=0.648), interest in receiving treatment through the Internet (p=0.454), interest in receiving an exercise-based CR program using virtual reality (p=0.810), nor usefulness of a virtual CR session (p=0.801).

Conclusions

In subjects with CAD, gender appears to be a determinant of interest. Men showed a greater interest in receiving CR counselling via mobile phone, would sign up for a technology-based CR programme and would like to receive fewer notifications. Women were more interested in receiving information about different components of the CR programme.

Physical activity and technology usage performed by patients with coronary artery disease: a gender approach

Funding Acknowledgements

Type of funding sources: None.

Background

Recent studies show that cardiac telerehabilitation, including exercise and lifestyle modification, is effective in reducing cardiovascular risk factors in patients with coronary artery disease (CAD). Thus, physical activity and technology usage of patients with CAD are important key points in order to create technology-based cardiac rehabilitation programs to improve physical patients´ condition and reduce cardiovascular risk.

Purpose

The aim of this study was to compare the physical activity and the technological usage of women and men with CAD.

Methods

A cross-sectional study in patients with CAD was performed. Sociodemographic data, physical activity (measured with the International Physical Activity Questionnaire, IPAQ) and the technology usage (measured with the Technology use subscale of the Technology Usage Questionnaire) were collected. Descriptive and inferential analyzes were performed to explore the differences between men and women with CAD.

Results

A total of 70 participants were included (84.28% men, mean age=59±8.54 years). Regarding the IPAQ, men significantly reported higher walking time (99.31±95.22 METS vs. 33.28±37.42 METS, p=0.001, respectively) and higher total physical activity (4164.91±4164.91 METS vs. 1390.68±1609.05 METS, p&lt;0.001, respectively) than women. In relation to technology usage, the entire sample used a mobile phone, whilst there were no significant gender differences in the functions/applications used (phone calls, text messages, camera, receive videos/photos, internet searches, apps, instant messages, social media, games) (p=0.068). Although the majority of the participants (85.71%) had regular access to internet, men used their phone more frequently than women (81.10% vs. 37.50%, p=0.005, respectively). Comparison by gender showed no significant differences in the type of device used for internet searches (computer, tablet, mobile phone) (p=0.169), familiarization with technology-based physical activity games (p=0.801), use of heart rate monitors (p=0.193), preference to monitor heart rate when exercising (p=0.664), nor use of other devices to monitor physical activity (pedometer, etc.) (p=0.193).

Conclusion

Based on the results obtained, we conclude that men with CAD were more physical active and used the Internet more often than women, whilst there were no differences by gender in the rest of variables. Assessment of physical activity and technology usage should be implemented in patients with CAD, in order to adapt and improve the design of technology-based telerehabilitation programs

P-374 Serum progesterone levels on the of embryo transfer in replacement cycles (HRT-ET): soft capsules vs suppositories may make a difference

Study question

Are there differences in serum progesterone levels when vaginal progesterone is administered in soft capsules vs suppositories in HRT-ET?

Summary answer

Mean serum levels of progesterone in embryo replacement cycles are higher when progesterone suppositories are used instead of soft capsules.

What is known already

Serum levels of progesterone on the day of the embryo transfer has captured recent attention, as it may vary among patients and different vaginal progesterone formulations. Previous studies have suggested that natural micronized vaginal progesterone induces a comparable decidual transformation and clinical pregnancy rates to vaginal progesterone gel. However, no data exists comparing suppositories versus soft capsules.

Study design, size, duration

Prospective, observational, single center study to compare serum progesterone levels on the day of the embryo transfer in women undergoing HRT-ET and being treated with vaginal progesterone in capsules or suppositories. Also, a patient satisfaction questionnaire was given to women participating in the study to investigate patient experience. Sample size calculation estimated 50 patients per group needed for a = 0.05 and power 90%, considering standard deviation of 5.1.

Participants/materials, setting, methods

From April to October 2021, 100 patients undergoing HRT-ET were recruited. Only one type of progesterone was administered. 50 patients received soft capsules (Progeffik©, Utrogestan©) and the other half suppositories (Cyclogest©). After estradiol priming for 10-12 days and once confirmed that endometrial thickness was &gt;7mm, 400 mg vaginal progesterone was started b.i.d. Blood was drawn on the day of embryo transfer by venipuncture and progesterone levels in blood were evaluated.

Main results and the role of chance

Mean serum levels of progesterone were significantly higher when suppositories were compared with soft capsules (16.2 ± 7 vs 12.5 ± 5.2 ng/ml, p = 0.0034). According to our previous studies we considered an adequate cut-off of progesterone of 8.8 ng/ml, and patients with a suboptimal serum level of progesterone were supplemented with subcutaneous progesterone. Of those patients receiving suppositories, only 6 out 50 (12%) required subcutaneous supplementation, whereas it was needed in 12 out of 50 (24%) women receiving soft capsules. No differences were observed in pregnancy rate (70% vs 50%) or ongoing pregnancy rate (48% vs 36%).

Regarding patient satisfaction, no differences were observed in the frequency of itching, burning, leakage of medication or drowsiness between groups.

Limitations, reasons for caution

We should consider the limited sample size and the study design, not randomized, before generalizing the results observed.

Wider implications of the findings

In luteal support of frozen embryo replacement cycles, vaginal progesterone suppositories yields superior progesterone serum levels than soft capsules.

Trial registration number

Not applicable

P-624 The type of vaccine received against SARS-CoV-2 does not affect ovarian function in an Assisted Reproduction cycle

Study question

Do the different types of vaccines against SARS-CoV-2 influence the results of an Assisted Reproduction treatment?

Summary answer

The type of vaccine administered against SARS-CoV-2 does not affect the results in women performing an Assisted Reproduction treatment.

What is known already

Since the COVID-19 pandemic was declared, the search for vaccines has become the priority, so its development has represented a step towards herd immunity in a short period of time. Despite this encouraging advance, vaccine hesitancy in reproductive-aged women has been heightened because of the spread of misinformation stating that COVID-19 vaccines will cause sterility. Due to the lack of information and the clinical relevance, the objective of this work was to evaluate the impact of the different types of vaccines on women’s fertility.

Study design, size, duration

Retrospective and observational study during January-October 2021 in women vaccinated against SARS-CoV-2 and performing an Assisted Reproductive treatment in any of the 11 clinics belonging to the IVIRMA group in Spain. The Control group included patients performing a treatment during the same study period but who had not yet been vaccinated. The study was approved by an Institutional Review Board (2109-MADR-084-AR)

Participants/materials, setting, methods

All women, those who had received the complete vaccination schedule, regardless of the type of vaccine administered mRNA or viral vector, and women from the control group underwent the same ovarian stimulation protocol. The Assisted Reproduction treatment was performed with their own oocytes in all cases. Statistical analyses were performed using the Statistical Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA).

Main results and the role of chance

We included 510 patients distributed as follows: 13.5% (n = 69) received a viral vector vaccine either the adenovirus serotype 26 vector vaccine (Ad26.CoV2.S; Johnson & Johnson; n = 31) or the chimpanzee adenovirus vector vaccine (ChAdOx; AstraZeneca; n = 38). The remaining 86.5% (n = 441) received an mRNA vaccine from either Pfizer-BioNTech (n = 336) or Moderna (n = 105). Sample size for control group was n = 1190

Our results showed that women vaccinated with Johnson & Johnson have a higher average age (39.7 ± 4.3) than the other groups, although no statistical difference was observed (p = 0.072); that is, AstraZeneca (36.8 ± 1.7), Moderna (35.7 ± 1.5), Pfizer (34.6 ± 1.6) and the control group (37.8 ± 2.7). This circumstance did not affect other parameters such as the days of stimulation (p = 0.336) or the doses of FSH administered (p = 0.392), where no statistical differences were recorded between the vaccinated and the control group. Finally, the number of oocytes were as follows, Johnson & Johnson (9.2 ± 2.6), AstraZeneca (7.7 ± 1.2), Moderna (11.3 ± 1.8), Pfizer (12.6 ± 1.0), and the control group (10.2 ± 1.5), p = 0.06.

Limitations, reasons for caution

This is an observational study, and thus possible confounders cannot be excluded entirely. More data are needed to draw firm conclusions, and it will be critical to increase the sample size to check if the results observed in this work remains in the general population

Wider implications of the findings

This is the first study to assess whether the type of vaccine administered against SARS-CoV-2, mRNA, or viral vector, affects ovarian function in ART. These early findings suggest no measurable detrimental on ovarian response regardless of vaccine received.

Trial registration number

not applicable

P-796 Intraovarian injection of plasma rich in growth factors improves ovarian reserve and reproductive outcomes in women with diminished ovarian reserve

Study question

Does Plasma rich in growth factors (PRGF) ovarian injection increase the ovarian reserve biomarkers in women with diminished ovarian reserve?

Summary answer

PRGF injection increased Antimüllerian hormone (AMH) levels and antral follicular count (AFC) since the first follow-up after treatment allowing the initiation of ovarian stimulation cycles.

What is known already

Several techniques based on in vitro activation, ovarian fragmentation and stem cell ovarian transplantation have been proposed to reactivate ovarian function and increase IVF success in women with premature ovarian insufficiency and poor ovarian response. However, less invasive and feasible approaches are still required for those patients where egg donation is the only practical option.

Platelet rich plasma (PRP) and PRGF contain a high concentration of platelets, which carry more than 800 types of proteins, cytokines, hormones, and chemoattractants. Indeed, intraovarian PRP injection has recently been used in different case series and cohort studies of POI women with encouraging results.

Study design, size, duration

Retrospective study with 104 women aging 23-45 years who received a PRGF intraovarian injection (REGENERA-Ovario) was conducted between 2020 and 2021 at IVIRMA Alicante (Spain). Study was approved by the IRB committee of La Fe University Hospital (2112-FIVI-109-SH).

Participants/materials, setting, methods

Patients underwent a PRGF injection (Endoret kit; B.T.I. Biotechnology Institute S.L, Spain) in both ovaries and a follow up of ovarian reserve biomarkers (AFC, AMH) and follicle stimulating hormone (FSH) to evaluate follicular reactivation seeking IVF or spontaneous pregnancy. The follow up visits ranged from 1 to 5 months and were developed on a monthly basis after treatment or after menses recovery in POI. Study variables were compared to basal levels with a paired t-test.

Main results and the role of chance

Overall, 104 women (age: 38.7±2.0 years; BMI: 22.1±2.9) with diminished ovarian reserves underwent a PRGF intraovarian injection (3.3±0.8ml PRGF/each ovary). Prior to treatment, our cohort was characterized high serum FSH (21.8±4.1mIU/mL), low AMH levels (0.25±0.37ng/ml), and an ovarian volume of 6.3±2.3cm3.

Eighty-eight of them fulfilled the 1st follow up visit and showed an increase of serum AMH (0.25±0.37ng/ml vs. 0.32±0.36ng/ml, p = 0.008), and AFC in both ovaries (2.1±1.9 vs. 3.2±2.4, p &lt; 0.0001) compared to basal levels, achieving ovarian reactivation in 55.9% of them and IVF cycle initiation in 19.3%. These improvements were higher 2 months after treatment (55 patients), with increased antral follicles (AFC-2: 2.9±2.5, p = 0.0001) and ovarian activation in 58.2%, and IVF start in 43.9% of patients. Similar results were observed during the 3rd follow up accomplished by 30 women and lasted until the 5th visit (n = 8), although the reduced patient number at this point.

A total of 44 IVF cycles were started and oocyte pick-up was successfully developed in 72.7% of them with a mean number of 3.3±4.2MII oocytes, 1.8±2.1 fertilized oocytes and 1.5±2.0 embryos per cycle. Indeed, 6 pregnancies were obtained during this period, 2 of them after embryo transfer and 4 by natural conception.

Limitations, reasons for caution

Our results are encouraging but a large cohort of patients with a longer follow up period is needed to establish the efficacy and duration of the PRGF positive ovarian effects. Moreover, a proper comparison with a control group with the same characteristics and no PRGF intervention is still required.

Wider implications of the findings

PRGF intraovarian injection reactivates follicle growth and allows IVF cycle initiation and embryo generation in a poor prognosis population of patients with diminished ovarian reserve. The effects persisted for several months after treatment.

Trial registration number

2112-FIVI-109-SH

P-601 Is Medroxiprogesterone acetate (MPA) an adequate alternative to GnRH antagonist in oocyte vitrification for non oncological fertility preservation (FP) and preimplantation genetic test (PGT-A) cycles?

Study question

Can we use MPA as a pituitary inhibitor instead of the GnRH antagonist in ovarian stimulation protocols in non-oncological fertility preservation and PGT-A cycles?

Summary answer

MPA can act as a substitute of GnRH antagonist for pituitary suppression in FP and PGT-A cycles, since the results are similar between both groups.

What is known already

Progestin-primed ovarian stimulation (PPOS) protocols using exogenous progesterone to replace GnRH analogs during the follicular phase of OS have emerged as an efficient alternative to prevent LH from peaking and have been used successfully in different types of patients.

Fertility preservation (FP) and preimplantation genetic testing (PGT-A) have become new emerging areas of assisted reproduction. FP gives women the ability to have children using their own gametes after age-related fertility decline, while PGT-A appears to improve reproductive outcomes in advanced maternal age at increased risk of aneuploid embryos. However, few data are available for both indications regarding PPOS cycle outcomes.

Study design, size, duration

Multicenter, retrospective, observational, cohort study conducted in eleven IVIRMA centers attached to private universities.

We included a total of 4,961 cycles of non-oncological fertility preservation that were distributed as follows: n = 494 were stimulated under a PPOS protocol while n = 4,467 received a GnRH antagonist. Regarding PGT-A cycles, we analyzed 12,461 treatments, of which n = 686 and n = 11,775 received MPA and GnRH antagonist, respectively. Cycles were performed from January 2017 to December 2021.

Participants/materials, setting, methods

Patients were divided according to the protocol used for preventing premature luteinization during follicular phase of OS. In the MPA group, participants received 10 mg daily administered orally, while in the control group, women received an antagonist once the main follicle reached 13 mm.

In FP cycles, ovarian response specific parameters were evaluated, such as endocrine profile and mature oocytes; in PGT-A treatments, main variables were number of biopsied and aneuploid embryos and reproductive outcomes.

Main results and the role of chance

Regarding FP's baseline characteristics, age was statistically but not clinically significant between the two groups. Length of ovarian stimulation and total dose of hMG administered were similar in both groups, despite the significantly higher total dose of FSH administered in MPA compared to the GnRH antagonist group (p = 0.008) . Number of mature oocytes retrieved (10.2 [95% CI 9.6-10.8] vs 9 [95% CI 8.8-9.2]) was significantly higher in MPA compared to antagonist group; this trend continued regardless of age (≤ 35 or &gt; 35 years).

PGT-A cycles followed the same tendency in terms of demographic characteristics. Length of OS was comparable between groups, whilst the total dose of rFSH and hp-HMG administered in the MPA were significantly higher than that in the GnRH antagonist group. Although the number of MII was comparable and despite the lower number of embryos biopsied in the MPA group (4.5±0.2 vs 4.7±0.06, p = 0.031) the number of aneuploid embryos was similar between the two groups (2.3±0.1 vs 2.4±0.04, p = 0.474), as well as implantation (56% vs. 54% p = 0.359) and clinical pregnancy rate (64.1% vs. 62.1, p = 0.316). The miscarriage rate was significantly lower in the group treated with MPA compared to GnRH antagonists (4.7% vs. 8.2%, p = 0.001).

Limitations, reasons for caution

The retrospective nature of this study may be a reason for caution and only association, not causation, can be inferred from the results. Despite being the largest sample size ever reported with PPOS in no oncological FP and PGT-A, the number of patients included is still low.

Wider implications of the findings

The administration of PPOS yielded similar or even better results than those observed with GnRH antagonists in terms of oocytes retrieved, rate of aneuploid embryos or clinical results. Therefore, PPOS could be recommended for ovarian stimulation in non-oncological FP and PGT-A cycles as it allows for a more patient-friendly approach.

Trial registration number

Not applicable

P-715 (In)fertility perceptions in a cohort of 1569 women

Study question

Which are the perceptions and knowledge regarding female fertility and infertility of Spanish women?

Summary answer

Infertility carries a social stigma that prevents women from sufficient knowledge or professional aid to take their reproductive choices adequately.

What is known already

Infertility is a pathology that remains on an invisible plane for society. It is estimated that up to a third of all IVF cycles performed due to low ovarian reserve would be avoidable if women had received sufficient information at the right time. The factors that mainly contribute to this phenomenon are the marked social stigma that it entails, the lack of knowledge regarding tools, possibilities and real expectations in fertility and the low socio-sanitary involvement regarding tasks and campaigns to increase social awareness in this specific field.

Study design, size, duration

This is a cross-sectional study carried out using a population-based survey to identify different attitudes, knowledge and opinions regarding fertility and infertility. The survey was made public on April 30, 2019 and closed on May 10, 2019.

Participants/materials, setting, methods

A total of 1569 Spanish women answered all the questions included in the survey. No response or subject participation was excluded from the study. The platform used to create the questionnaire was Google Forms, which anonymizes the responses automatically. Data processing was performed using RStudio, an integrated development for R scripting.

Main results and the role of chance

Up to 1231 women had not had children at the time of the survey and 46% (566) of these cohort were either worried or very concerned about not being able to conceive naturally in the future. Also, 71% (871) of the same cohort were willing to have children of their own. In addition, 65% (1015) among those surveyed though that infertility had an important social stigma. With respect to gynecological health, 89% (1376) of women surveyed had had at least a gynecologic check-up at the time of answering the survey. However, up to 78% (921) of this cohort had never consulted their gynecologist regarding female fertility. Women surveyed were asked to predict the age at which conceiving a child both naturally and via assisted reproductive techniques started to become difficult. Respondents predicted that age to be 36.74 (IC95% [36.52, 36.96]) years and 39.79 (IC95% [39.58, 40.01]) years, respectively. Plus, 86% (1328) of women surveyed were in favor of elective fertility preservation and up to 72% (1127) thought that the Spanish State should either cover or aid economically this process. Finally, up to 72% (1115) of them thought they lacked important information to take their reproductive choices adequately.

Limitations, reasons for caution

Participants in the survey were exclusively contacted virtually. Even with the number of responses obtained and due to the descriptive nature of this study, it might not be representative of Spanish female society regarding the topics addressed. Also, the results here presented might not be extrapolable to other populations.

Wider implications of the findings

Considering the data presented in this work, education in fertility should start as soon as possible, ideally in high school. Finally, reproductive autonomy is being able to choose whether to have or not to have children, but the key is to always be able to make that decision.

Trial registration number

Not applicable

“Dad is feeling blue”: what to know about paternal perinatal depression

Introduction

The transition into parenthood is associated with an increased psychopathological vulnerability. Most studies have focused on mothers, although recently, the role of fathers has grown more importance. Paternal perinatal depression (PPD) is an episode of major depressive disorder occurring in new or expectant fathers during the perinatal period. PPD is not widely acknowledged and research are rare.

Objectives

The authors intend to review the literature about PPD, focusing on its prevalence, risk factors, clinical features, treatment and consequences.

Methods

Non-systematic review of the literature through PubMed.

Results

A meta-analysis of PPD estimated a prevalence of 10.4%. Risk factors of PPD are multiple and complex. There are sociodemographic factors, such as marital status, monthly income and social support. Psychological factors, for instance history of depression, maternal prenatal anxiety and maternal depression. Some literature also suggests hormonal changes on men like increase estrogen and lower testosterone levels. PPD can present with symptoms of mood alterations, like irritability and restricted emotions, anxiety, fatigue, insomnia, loss of appetite. Also common are behavioural disturbances such as interpersonal conflicts, impulsivity, violence, avoidance behaviour, and substance abuse. There are no studies to specific treatments to PPD, so the treatment is the same for women, such as antidepressants and psychotherapy. If untreated, PPD can have an adverse influence on the health and wellbeing of the mother and child.

Conclusions

PPD is still underscreened, underdiagnosed and undertreated. It is fundamental identifying risk factors and the development of specific interventions. Further research on PPD is needed.

Disclosure

No significant relationships.

Challenges of ageing in prisons and forensic psychiatric settings

Introduction

There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

Objectives

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Methods

Non-systematic review of the literature.

Results

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

Conclusions

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

Disclosure

No significant relationships.

Early Word Segmentation Behind the Mask

Infants have been shown to rely both on auditory and visual cues when processing speech. We investigated the impact of COVID-related changes, in particular of face masks, in early word segmentation abilities. Following up on our previous study demonstrating that, by 4 months, infants already segmented targets presented auditorily at utterance-edge position, and, using the same visual familiarization paradigm, 7-9-month-old infants performed an auditory and an audiovisual word segmentation experiment in two conditions: without and with an FFP2 face mask. Analysis of acoustic and visual cues showed changes in face-masked speech affecting the amount, weight, and location of cues. Utterance-edge position displayed more salient cues than utterance-medial position, but the cues were attenuated in face-masked speech. Results revealed no evidence for segmentation, not even at edge position, regardless of mask condition and auditory or visual speech presentation. However, in the audiovisual experiment, infants attended more to the screen during the test trials when familiarized with without mask speech. Also, the infants attended more to the mouth and less to the eyes in without mask than with mask. In addition, evidence for an advantage of the utterance-edge position in emerging segmentation abilities was found. Thus, audiovisual information provided some support to developing word segmentation. We compared 7-9-monthers segmentation ability observed in the Butler and Frota pre-COVID study with the current auditory without mask data. Mean looking time for edge was significantly higher than unfamiliar in the pre-COVID study only. Measures of cognitive and language development obtained with the CSBS scales showed that the infants of the current study scored significantly lower than the same-age infants from the CSBS (pre-COVID) normative data. Our results suggest an overall effect of the pandemic on early segmentation abilities and language development, calling for longitudinal studies to determine how development proceeds.

Medical check-up of newly arrived unaccompanied minors: A dedicated pediatric consultation service in a hospital

BACKGROUND AND AIMS

Healthcare for the increasing number of migrants in Europe, and particularly of unaccompanied minors (UMs) seeking asylum, has become a major challenge. We aimed to describe the health issues of UMs managed in a dedicated pediatric consultation service in a care center in Paris.

METHODS

All UMs attending a dedicated migrant medical consultation service in Robert Debré Hospital, Paris, France, were included in a single-center retrospective observational study from September 1, 2017, to September 30, 2018.

RESULTS

Out of the 107 UMs who were included, 87% had a health problem (n=93) and 52% had an infectious disease (n=56). The main infectious diagnoses were schistosomiasis (22%), latent tuberculosis (22%), intestinal parasitosis (16%), and chronic hepatitis B (8%). Posttraumatic stress disorder (PTSD) and overweight were common (35% and 20%, respectively). The median age was 15 years old (IQR, 14-16), the male/female ratio was 95/12. Most of the children were from sub-Saharan Africa (n=67), 46% had crossed Libya (n=49) and, when compared to the other migration routes, faced an increasing risk of violence (69%, p=0.04), imprisonment (53%, p=0.03), and forced labor (48%, p=0.02). The median duration of the trip before reaching France was 6 months (IQR, 2-13), the median time to consultation was 2 months (0-5) and was not associated with an increased risk of health problems. A total of 43 UMs were lost to follow-up.

CONCLUSION

Health problems, particularly infectious diseases and PTSD, are common among UMs and should prompt an early medical consultation with psychiatric evaluation. Follow-up is problematic and could be improved by an on-line health book.

O-111 The DuoStim strategy shortens the time to obtain an euploid embryo in poor prognosis patients: a non-inferiority, randomized controlled trial

Study question

Is there any difference in the time to obtain euploid embryos from poor prognosis patients who performed two conventional cycles versus double stimulation (DuoStim) in the same cycle?

Summary answer

DuoStim showed similar ovarian response and in vitro fertilization (IVF) laboratory outcomes while shortening the time to obtain an euploid embryo in poor prognosis patients.

What is known already

Several waves of cyclic development of antral follicles within the same menstrual cycle have been demonstrated. Likewise, it has been shown that oocytes obtained from luteal phase ovarian stimulation (OS) have similar competence than those obtained in the follicular phase OS. Often, some patients require sequential OS in order to obtain more oocytes and increase their chances to reach embryo transfer. Thus, the DuoStim strategy could be an attractive alternative to reduce the time-to-pregnancy. However, prospective data and randomized trials that validate this strategy are lacking.

Study design, size, duration

We conducted a prospective, randomized controlled trial at our institution from[MCM1] [JAGV2] January 2017 to December 2020. A total of 80 poor prognosis patients aged over 38 years undergoing PGT-A were enrolled in two groups: 39 patients did two OS in consecutive cycles (control) whereas 41 women underwent two OS in the same menstrual cycle (DuoStim).

Participants/materials, setting, methods

Poor prognosis was defined as suboptimal responders. The primary outcome was the time needed to obtain an euploid embryo. The secondary outcomes were duration of stimulation, dose of gonadotropins, oocyte maturity rate, fertilization and blastocyst formation rates. Variables were expressed as mean ± standard deviation. Statistical analyses was performed by ANOVA and Chi-square tests, as appropriate. Differences were considered significant when p-value &lt; 0.05.

Main results and the role of chance

The patients’ baseline characteristics were similar between groups. We did not find any difference in the mean days of stimulation between the control and the DuoStim group (21.3 ± 1.6 vs. 23 ± 1.4, p = 0.105), nor in the amount of gonadotropin required (4005 ± 450 vs. 4245 ± 430, p = 0.43), number of MII oocyte (8.7 ± 1.8 vs. 6.8 ± 1.7, p = 0.159), blastocyst rate (51.4% vs. 34.8%, p = 0.113) and the number of euploid embryos (0.8 ± 0.4 vs. 0.6 ± 0.4, p = 0.45). However, there was a significant difference in the average number of days until reaching an euploid blastocyst, favoring the DuoStim group (44.1 ± 2 vs. 23.3 ± 2.8, p &lt; 0.001). Comparing the follicular versus the luteal phase within the DuoStim group, the only difference detected concerns to the mean days of stimulation (10.3 ± 0.8 vs. 12.7 ± 0.9, p &lt; 0.001). We also observed a trend towards a higher fertilization (38.1% vs. 61.8%, p = 0.02) and blastulation rate (23% vs. 53%, p = 0.03) in the luteal phase of the DuoStim cycle.

Limitations, reasons for caution

The major limitation is related to the limited sample size, as it limits our power analysis (70%). On the other hand, it is one of the first randomized prospective pilot trial that compared the efficiency of performing two consecutive ovarian stimulation in different menstrual cycles with the DuoStim strategy.

Wider implications of the findings

This study clearly showed that the DuoStim protocol is not inferior to the conventional stimulation in terms of ovarian response and laboratory outcomes. Moreover, the DuoStim reduces the time to obtain an euploid embryo in poor prognosis patients, which is of great clinical utility.

Trial registration number

NCT03291821

P–415 Clinical and In Vitro Fertilization laboratory parameters that contribute to clinical miscarriage after single euploid embryo transfer

Study question

To investigate which factors, excluding embryo aneuploidies, are associated with miscarriage in patients who have undergone a single euploid blastocyst transfer.

Summary answer

Miscarriage was related to the body mass index (BMI), the type of cycle and the thickness of the endometrium.

What is known already

Preimplantation genetic testing for aneuploidies (PGT-A) is widely used in-vitro fertilization (IVF) to select euploid embryos. Several studies have shown that embryo aneuploidy is the main contributing factor for IVF failure, reinforcing the relevance of PGT-A as a method to select chromosomally normal embryos.

A recent meta-analysis confirmed that patients undergoing PGT-A have a lower miscarriage rate than women that conceived naturally (9% vs 28%, respectively).

Even though most of the studies show that PGT-A significantly reduces miscarriage rate, still some women do lose their pregnancies. We investigated which other reasons may be related to this early pregnancy loss.

Study design, size, duration

Retrospective, observational, and multicenter study of 6910 patients undergoing single euploid blastocyst transfer after PGT-A from January 2017 to December 2019 in our institution. Several laboratory and clinic variables were analyzed to study the effect of these variables on the miscarriage rate

Participants/materials, setting, methods

Indications for PGT-A were advanced maternal age, implantation failure, recurrent pregnancy loss and male factor. Embryos were cultured 5% O2 concentration and 6.5% CO2 concentration. Trophectoderm biopsy was performed on day 5/6 of development and analyzed through Next Generation Sequencing (NGS); embryos were vitrified until transfer was performed. Single euploid embryo transfer was performed in all cases.

We performed a multivariate regression analysis to compare the different variables and search for there are significant differences.

Main results and the role of chance

We studied a total of 6910 patients undergoing PGT-A to describe which factors, excluding embryo aneuploidies, were correlated with miscarriage in patients who underwent single thawed euploid embryo transfer.

When considering embryo morphology (embryo grading, quality of inner cell and quality of trophectoderm), we did not find differences in miscarriage rate among groups (high quality= 15.9%; normal quality= 14.3%; low quality= 15.0%; poor quality= 14.8%) p = 0.833.

BMI was significantly associated with miscarriage rate (odds ratio [OD] 1.04; 95% confidence interval [CI], 1.012–1–076 p = 0.006) and miscarriage rate.

We observed a weak association between endometrial thickness and miscarriage rate ([OD] 0.65; 95%, 0.528–0.778 p = 0.04) and also between type of endometrial preparation (natural cycle or hormone replacement cycle) ([OD] 0.77; 95%, 0.528–0.778) p = 0.04.

Body mass index, according to our findings, was the main variable correlated with miscarriage rate. We did not find any association with the other variables studied (biopsy day, maternal age, male age, duration infertility, cycle length, previous miscarriage, previous live birth, previous cycles IVF, endometrial pattern and diagnosis).

Limitations, reasons for caution

The retrospective study design limits the generalization of our results but offers a good insight to be validated in prospective trials.

Wider implications of the findings: According to our findings, BMI, endometrial thickness the day of the embryo transfer, and the type of endometrial preparation should be considered when transferring an euploid blastocyst.

Trial registration number

NO APLICA

P–287 Uterine adenomyosis does not affect perinatal outcomes in ART treatments

Study question

Is adenomyosis associated with worse clinical and perinatal outcomes in ovum donation cycles?

Summary answer

Adenomyosis was associated with reduced live birth rate per embryo transfer but not with increased risk of miscarriage or worse perinatal outcomes than controls.

What is known already

The effect of adenomyosis on IVF/ICSI outcomes are controversial as studies addressing this issue are limited in number and heterogeneous. Conclusions withdrawn from previous works differ regarding the prospective or retrospective design of the study. Two different metanalysis conducted showed that adenomyosis reduced implantation and clinical pregnancy rate and increased miscarriage risk. However, current data regarding perinatal outcomes of assisted reproduction techniques cycles in patients diagnosed with uterine adenomyosis is scarce.

Study design, size, duration

A retrospective cohort study in which 3307 patients undergoing ovum donation cycles were included. Patients who underwent single embryo transfer (SET) between years 2018 and 2019 were included and divided into two groups: adenomyosis (n = 179) and controls (n = 3218).

Participants/materials, setting, methods

Inclusion criteria consisted of patients in an oocyte donation program who had fresh SET on day 5 blastocyst stage development. Patients diagnosed with miomas and/or severe endometriosis and those who had undergone previous uterine surgical interventions were excluded from the study. Cases consisted of patients with a history of either focal or diffuse adenomyosis diagnosed via transvaginal ultrasonography (TVUS).

Main results and the role of chance

Clinical pregnancy rate per embryo transfer was 82/179 (45.8%) in those women diagnosed with adenomyosis versus 1869/3218 (59.8%) in control group (OR = 0.57 95% CI. 0.41–0.78, p &lt; 0.001). Miscarriage rate was similar in the two study groups and differences found were not statistically significant, being 15/82 (18.3%) for adenomyosis and 309/1869 (16.5%) for control group. A lower live birth rate per embryo transfer was observed in women diagnosed with adenomyosis versus control, being 68/179 (38%) and 1560/3128 (49.9%) respectively (OR = 0.615 95% CI 0.44–0.85, p = 0.002). There were no statistically significant differences between childbirth delivery methods (vaginal versus caesarean section). Furthermore, means of gestational age at the time of delivery, newborn size and weight and incidences of low birth weight, preterm birth and admission in neonate intensive care unit (NICU) did not differ between the two groups. In addition, IVF and perinatal outcomes were similar in patients with diffuse adenomyosis compared to focal adenomyosis.

Limitations, reasons for caution

This is an observational study and thus possible confounders cannot be completely excluded. Diagnostic of adenomyosis is complex and, despite imaging via TVUS is both sensitive and specific, different criteria may be combined in order to fully assess the diagnostic.

Wider implications of the findings: Published literature has described how adenomyosis negatively impacts clinical outcomes in ART cycles; however, data regarding perinatal results is scarce. This study is of interest as it provides a first insight for clinicians showing that adenomyosis affects clinical but not perinatal outcomes in ovum donation cycle.

Trial registration number

Not applicable

P–687 Impact of medroxyprogesterone acetate (MPA) as pituitary suppression on oocyte quality and clinical outcomes in egg donation recipients

Study question

To compare the impact on oocyte quality and reproductive outcomes in patients who received oocytes from donors stimulated with MPA versus GnRH antagonist protocol.

Summary answer

Compared to GnRH antagonist, MPA does not exert a major effect on oocyte quality and yields similar reproductive outcomes in egg donation recipients.

What is known already

Conventional ovarian stimulation (OS) protocols have classically used GnRH analogues, both agonists and antagonists, to avoid premature follicular luteinization. The oral administration of MPA or micronized progesterone during the follicular phase of OS has emerged as an attractive alternative to conventional protocols in the prevention of early luteinization. Compared to progesterone, MPA is characterized by a moderate-strong progestanic action, lower androgenic properties and does not interfere with the measurement of endogenous progesterone. In our group, administration of MPA during the follicular phase of OS has been included in the routine clinical practice of our donor program since late 2019.

Study design, size, duration

Multicentre, retrospective, observational, cohort study carried out in eleven private university-affiliated IVF centers. The present study included a total of 14,282 fresh ovum donation cycles performed from October 2017 to March 2020. Oocyte donors were recruited and stimulated under either MPA (n = 4,665) or GnRHa (n = 9,617) to suppress the pituitary during the follicular phase of OS, and GnRH agonist was administered to trigger final oocyte maturation in all the participants.

Participants/materials, setting, methods

Recipients were divided according to the protocol used for premature luteinization prevention during the follicular phase of the ovum donation matched-cycle: Group 1, recipients who received oocytes from donors treated with 10 mg/day of MPA (ProgeveraÒ); Group 2, recipients who received oocytes from GnRH antagonist (FyremadelÒ) down-regulated donor cycles. All the procedures were approved by an Institutional Review Board (1910-VLC–091-JG) and complied with Spanish law on assisted reproductive technologies (14/2006).

Main results and the role of chance

Regarding donoŕs baseline characteristics, age and antral follicle count were significantly different between groups, but not clinical differences. The length of ovarian stimulation was similar in both groups (10.7 days [95% Confidence Interval (CI) 10.5–10–8] vs 10.5 days [95% CI 10.0–11.00]). Despite slightly higher mean total dose of FSH administered in Group 1 compared to Group 2 (1.841 IU [95% CI 1.813–1.868] vs 1.739 IU [95% CI 1.723–1.754]), there were no differences in the total dose of hMG administered between both groups (967 IU [95% CI 901–1.034] vs 971 IU [95% CI 944–998]). With regard to IVF data, both the number of retrieved oocytes (22.9 [95% CI 22.4–23.4] vs 24.1 [95% CI 23.8–24.3]), and mature oocytes (18.7 [95% CI 18.3–19.1] vs 19.3 [95% CI 19.1–19.6]), were slightly lower in Group 1 compared to Group 2, whereas fertilization rate was significantly higher in Group 1 compared to Group 2 (82.1% [95% CI 81.7–82.6] vs 80.8% [95% CI 80.6–81.2]),. Regarding the clinical outcomes, no differences were observed in either implantation rate (58.7% [95% CI 56.7–60.7] vs 59.3% [95% CI 57.3–61.3]) or clinical pregnancy rate (59.5% vs 59.8%, P = 0.04) between both groups.

Limitations, reasons for caution

As a consequence of being a retrospective study, only association, and not causation, can be inferred from the results. A further limitation is that donors are healthy young women and do not perfectly match other populations, as infertile patients who may be older, low or high responders to OS.

Wider implications of the findings: MPA emerges as an effective oral alternative to GnRH analogues for preventing premature luteinizing hormone surges in donors undergoing OS in ovum donation program. Compared with GnRH antagonists, MPA has advantages of being an oral administration route and providing easy access, yielding similar clinical results.

Trial registration number

1910-VLC–091-JG

How to provide fertility treatment during COVID-19 pandemic

PURPOSE OF REVIEW

The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. The objective of this review is to summarize how this pandemic has affected the activity of a Reproductive Medicine Center, which established a series of measures in parallel with governments decisions and scientific societies.

RECENT FINDINGS

The control measures adopted for restarting the healthcare activity should be equitable and inclusive. Moreover, this pandemic has implied changes in treatments and strategies to be alert regarding the daily changing information. Finally, for ensuring a safe practice both for patients and staff, it is important to detect asymptomatic patients, so Reproductive Medicine centers must take special care with screening and testing procedures.

SUMMARY

The pandemic has pushed up toward a new reality in terms of Assisted Reproductive treatments, where social distance and responsibility are protagonists. We face a new challenge of balancing between responding to the committed efforts of infertile couples to achieve pregnancy and safeguarding the health of the future parents and their children during this time of pandemic.