Quantum Dynamics of Oblique Vibrational States in the Hénon-Heiles System

In this paper, we study the quantum time evolution of oblique nonstationary vibrational states in a Hénon-Heiles oscillator system with two dissociation channels, which models the stretching vibrational motions of triatomic molecules. The oblique nonstationary states we are interested in are the eigenfunctions of the anharmonic zero-order Hamiltonian operator resulting from the transformation to oblique coordinates, which are defined as those coming from nonorthogonal coordinate rotations that express the matrix representation of the second-order Hamiltonian in a block diagonal form characterized by the polyadic quantum number n = n1 + n2. The survival probabilities calculated show that the oblique nonstationary states evolve within their polyadic group with a high degree of coherence up to the dissociation limits on the short time scale. The degree of coherence is certainly much higher than that exhibited by the local nonstationary states extracted from the conventional orthogonal rotation of the original normal coordinates. We also show that energy exchange between the oblique vibrational modes occurs in a much more regular way than the exchange between the local modes.

Human root dentin microhardness and degradation by triple antibiotic paste and calcium hydroxide

PURPOSE

To investigate and compare the effects of the two widely used regenerative endodontics medicaments: Triple antibiotic paste (ciprofloxacine-metronidazole-clindamycin) and calcium hydroxide on the microhardness and degradation of human root dentin.

METHODS

Following ethical approval and subject consent to use teeth in this research study, 60 singled-rooted permanent human teeth were randomly divided into six groups:(1) Tri-antibiotic paste with distilled water, or with (2) propylene glycol, (3) calcium hydroxide with distilled water, (4) calcium hydroxide propylene glycol, (5) untreated extracted teeth as negative controls, or (6) teeth instrumented and filled with calcium hydroxide or tri-antibiotic paste as positive controls. The microhardness tests were conducted after 1 and 2 months of exposure to the medicaments using a Vickers microhardness tester. Raman spectroscopy and energy dispersive x-ray spectroscopy were used to evaluate the chemistry and structure of the root dentin.

RESULTS

There were differences in the dentin microhardness following treatment with the medicaments or controls (P< 0.05). The time of root dentin exposure to the medicaments was similar (P> 0.05). The root dentin microhardness was lower in the teeth treated with the triple antibiotic paste or calcium hydroxide when combined with propylene glycol. The root dentin collagen in these treated teeth were also significantly degraded when viewed with Raman spectroscopy and energy dispersive x-ray spectroscopy, whereas the inorganic phase (dentin) remained unaltered. Samples exposed to the antimicrobial agents with water as a vehicle exhibited stronger microhardness and less degradation.

CLINICAL SIGNIFICANCE

These ex vivo results suggest that the triple antibiotic paste and calcium hydroxide should be used with propylene glycol if a fast diffusion is desired or with water to avoid degrading the collagen and weakening the microhardness of the teeth. Clinical trials are needed of new formulations of medicaments with propylene glycol to disinfect teeth for regenerative endodontic procedures, to help strengthen the teeth to prevent the loss of children's permanent immature teeth by fracture following caries or trauma.

P-641 Physicians’ practices towards hormone monitoring during ovarian stimulation in context of treatment with Assisted Reproductive Technology (ART). A global Survey conducted through IVFworldwide.com

Study question

What is the practice of routine hormone monitoring (HM) during ovarian stimulation (OS) in the context of ART treatment?

Summary answer

The majority of ART specialists (∼80%) use HM, along with ultrasound, for monitoring OS, especially for the prevention of ovarian hyperstimulation syndrome (OHSS).

What is known already

Ovarian stimulation (OS) is an essential part of ART and optimal monitoring is essential in order to optimize final outcome and ensure safety. Monitoring of OS can be either done with ultrasound (US) and/or hormonal monitoring in order to adjust gonadotropin dose, to trigger ovulation and to maximize success while avoiding the risk of OHSS. Clinical practice guidelines typically propose US monitoring as the cornerstone of OS monitoring during ART treatment. Although HM is practiced widely, the current attitude and practice of clinicians regarding HM has not been evaluated on a global scale.

Study design, size, duration

In a cross-sectional study carried out using a survey on current practice of blood HM, we evaluated physicians’ attitudes towards blood HM during OS in context of ART treatment. An open-access questionnaire was accessible to the members of IVF-Worldwide.com, from September 8 to October 13,2021 on IVF-Worldwide.com and was completed by 528 participants. Data analysis was performed using Excel (Microsoft Inc., USA), statistics were calculated once giving all survey entries an equal representation.

Participants/materials, setting, methods

An initial invitation and one reminder were sent to all 3845 registered members of IVF-Worldwide.com by email. In total, 528 participants answered the survey (13.7%). The survey was composed of 25 multiple-choice questions with mainly single answers. These questions asked about tests performed during any cycle monitoring visits during OS for ART treatment (blood hormone monitoring, ultrasound, timing, and frequency of prescribed tests), about monitoring to prevent OHSS as well as to adjust gonadotropin dose.

Main results and the role of chance

A total of 528 members from 88 countries responded to this web-based survey.

Most participants (87.9%) were clinicians and practiced reproductive medicine for more than 15 years (56.7%). Nearly half (46.2%) performed more than 500 oocyte aspiration cycles in their clinic annually.

Of the 528 respondents, the vast majority (98.9%) used US to monitor OS cycles during ART treatment. Hormone monitoring (HM) was widely accepted and performed by 420 (79.5%) of participants during any of the cycle monitoring visits for OS (from stimulation day 1 until the day before ovulation triggering (OT)).

Among different visits, participants most frequently monitored hormones on the day on or before the final oocyte maturation (71%) as compared with 57% on the first visit and 61% on the second and third visit during OS. The most frequent reason for HM was for prediction of OHSS (74%) and for adjusting gonadotropin dose (50%), whereas 45% of physicians considered HM for timing of OT.

Most respondents (60.7%) considered that hormones play an important role in monitoring ovarian response during OS and a 58% considered that blood hormone tests are important to guiding decision-making in preventing OHSS.

Limitations, reasons for caution

The survey was designed to represent self-reported statistics and opinions from experts in the field. It did not capture actual clinician performance or patient data.

Wider implications of the findings

Although several guidelines consider US monitoring as the cornerstone for monitoring ovarian response during OS for ART, the majority of ART specialists consider HM as essential. Good quality studies are needed to document the value of HM during OS, with respect to dose adjustment, ovulation triggering and prevention of OHSS.

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

O-070 Double stimulation in egg donors: is an adequate strategy to optimize the gamete donation program?

Study question

Is double stimulation (DuoStim) a viable strategy to optimize the performance of the egg donation program?

Summary answer

Carrying out two consecutive stimulations in the gamete donation program allows the number of donations to be increased, optimizing its efficiency while maintaining donor safety.

What is known already

DouStim (double stimulation) consists of two successive ovarian stimulations in the follicular and ensuing luteal phase with two oocyte retrievals at the end of both ovarian stimulations. This non-conventional strategy, developed to retrieve the greatest number of oocytes in the shortest possible time, was designed initially to optimize clinical outcomes in poor ovarian response, but double stimulation could be useful in patients with a good prognosis such as oocyte donors to optimize the program efficacy.

Study design, size, duration

Prospective and observational analysis performed in IVI Madrid between September and December 2019. Participants underwent the same stimulation protocol in the follicular phase and for luteal phase stimulation. The study was approved by an Institutional Review Board (1903-MADR-034-AR) and all women provided written informed consent.

Participants/materials, setting, methods

Follicular and luteal-phase stimulation was the same for all the donors; daily tablet of 10 mg of acetate of medroxyprogesterone (AMP) from first day of stimulation, 225 IU/day recombinant FSH and triggering with 0.1 mg GnRH agonist. To analyze the differences in clinical results between both phases of the cycle, independent donations were made after each oocyte retrieval. 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 60 egg donors for a total of 88 recipients who received oocytes retrieved in both the follicular and luteal phases. Although the number of oocytes and metaphase II was significantly higher in the follicular phase compared to the luteal one, 19.8 ± 2.0 vs. 13.3 ± 2.2 oocytes, p &lt; 0.001 and 16.4 ± 1.8 vs. 11.5 ± 2.1 MII, p &lt; 0.001, then this disparity in the results disappears since the rate of usable blastocyst is similar with the same proportion of frozen embryos in both stimulation phases (4.0 ± 0.6 vs. 4.4 ± 0.8, p = 0.451). According to the clinical results, we did not observe significant differences between the follicular and the luteal phase neither for the implantation rate (69.8% vs. 66.1%, p = 0.783), nor for the clinical pregnancy rate (71.2% vs. 66.7%), confirming the possibility of being able to make independent donations of each of the stimulated phases without affecting the chances of success.

Limitations, reasons for caution

This is an observational study and thus possible confounders cannot be completely excluded. 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

As far as we know, this is the first study in which a double stimulation protocol is applied in oocyte donors. The fact of being able to increase the number of donations in the same stimulation cycle allows us to improve the efficiency of the egg donation program.

Trial registration number

Not apply

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

Ab Initio Partition Functions and Thermodynamic Quantities for the Molecular Hydrogen Isotopologues

In this work, we calculate the partition functions and thermodynamic quantities of molecular hydrogen isotopologues using the rovibrational energy levels provided by the highly accurate ab initio adiabatic potential energy functions recently determined by Pachucki and Komasa (Pachucki, K.; Komasa, J. J. Chem. Phys.2014, 141, 224103). The partition functions are calculated by including all bound energy levels of the isotopologues, up to their dissociation limits, plus the quasi-bound levels lying below the centrifugal potential barriers. For the homonuclear isotopologues, H₂, D₂, and T₂, we also determine the partition functions and thermodynamic quantities of the normal mixtures using the statistical treatment recently proposed by Colonna et al. (Colonna, G.; D’Angola, A.; Capitelli, M. Int. J. Hydrogen Energy2012, 37, 9656) based on the definition of the partition function of the mixture, which avoids inconsistencies in the values of the thermodynamic quantities depending directly on the internal partition function, in the high-temperature limit.

O-079 Could ovarian reserve be affected after SARS-CoV-2 infection?

Study question

Is there a variation in ovarian reserve in women who have passed the disease?

Summary answer

The fact of having passed SARS-CoV-2 does not affect the ovarian reserve status

What is known already

Despite the overwhelming magnitude of this pandemic and its worldwide prevalence, information regarding the effects of the novel coronavirus on human reproduction are currently limited. As the assisted reproductive technology programs resumed operations, it was important to gather information regarding the status of individuals infected with the novel coronavirus, and to assess gametes and reproductive outcomes for those who had SARS-CoV-2 virus. Since it was described the presence of receptors of the virus in the ovary, studies on the reproductive involvement of coronavirus infection are warranted, particularly within recovered patients

Study design, size, duration

During the period May-June 2020, women performing an Assisted Reproductive treatment in any of the 11 clinics belonging to the IVIRMA group in Spain and who had a positive IgG for SARS-CoV-2 were invited to participate in the study; this group of women had a previous AMH determination of no more than 6 months. The study was approved by an Institutional Review Board (2007-MADR-052-AR) and all women provided written informed consent.

Participants/materials, setting, methods

A new AMH determination was made (Elecsys^® AMH, Roche Diagnostics) to detect possible variations in the hormone levels. Women were stratified in two groups, according their previous AMH levels: low responders (AMH < 1 ng/ml) or normo-high responders (AMH ≥ 1 ng/ml) 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

After filtering by the inclusion criteria described above, we included 46 patients in this phase of the study; 16 women were diagnosed as having low ovarian reserve (AMH < 1 ng/ml), with an average age of 38.6 years, whereas 30 were classified as having normal ovarian reserve (AMH ≥ 1 ng/ml), with an average age of 34.7 years. Generally, the data show no variation in AMH levels before and after SARS-CoV-2 infection (1.73 ng/ml vs. 1.61 ng/ml, respectively). However, when we analyzed these differences according to the study groups, we observed that, in women with normal ovarian reserve, average AMH level before infection was 4.6 ng/ml, whereas after infection AMH decreased to 3.1 ng/ml. For women with low ovarian reserve, AMH was 0.8 ng/ml before infection and remained at a similar value after infection (AMH = 0.7 ng/ml).

Limitations, reasons for caution

This is an observational study and thus possible confounders cannot be completely excluded. More data are needed to draw firm conclusions 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

The fact of having passed the disease does not affect the ovarian reserve status but the degree of the variation of AMH levels depending on the patient were low or high responder. Nevertheless, we could assume that the chances of success of the Assisted Reproductive treatment remain intact.

Trial registration number

Not apply

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

On the Role of Entropy in the Stabilization of α-Helices

Protein folding evolves by exploring the conformational space with a subtle balance between enthalpy and entropy changes which eventually leads to a decrease of free energy upon reaching the folded structure. A complete understanding of this process requires, therefore, a deep insight into both contributions to free energy. In this work, we clarify the role of entropy in favoring the stabilization of folded structures in polyalanine peptides with up to 12 residues. We use a novel method referred to as K2V that allows us to obtain the potential-energy landscapes in terms of residue conformations extracted from molecular dynamics simulations at conformational equilibrium and yields folding thermodynamic magnitudes, which are in agreement with the experimental data available. Our results demonstrate that the folded structures of the larger polyalanine chains are stabilized with respect to the folded structures of the shorter chains by both an energetic contribution coming from the formation of the intramolecular hydrogen bonds and an entropic contribution coming from an increase of the entropy of the solvent with approximate weights of 60 and 40%, respectively, thus unveiling a key piece in the puzzle of protein folding. In addition, the ability of the K2V method to provide the enthalpic and entropic contributions for individual residues along the peptide chain makes it clear that the energetic and entropic stabilizations are basically governed by the nearest neighbor residue conformations, with the folding propensity being rationalized in terms of triads of residues.

ALWAYS ICSI? A SWOT analysis

PURPOSE

Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI.

METHODS

A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication.

RESULTS

The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out.

CONCLUSION

Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.

Intraresidual Correlated Motions in Peptide Chains

We investigate the interresidual and intraresidual correlations between dihedral displacements of adjacent residues within model polyalanine peptides by analyzing extensive molecular dynamics trajectories. Correlations are evaluated individually at different residue conformations covering the whole (ϕ_i,ψ_i)-space. From these, we draw maps that unveil an unprecedented strong intramolecular correlation displaying opposite (correlated/anticorrelated) behaviors at different conformations. Both interresidual and intraresidual correlations arise from the propensity of the peptide to minimize the overall atomic displacements.

Tuning the Optical Properties of Novel Antitumoral Drugs Based on Cyclometalated Iridium(III) Complexes

Most of the current efforts in drug discovery are devoted to the design of molecules able to mitigate side effects by concentrating the biological action in the targeted tissue. One promising strategy is photodynamic therapy, which is based on the in situ generation of reactive singlet oxygen upon radiation exposure. However, such an approach requires the use of an efficient photosensitizer. This contribution deals with the optical properties of an Ir(III) complex, [Ir(pbz)₂(N^N)] (pbz = 2-phenylbenzimidazole; N^N = methyl 1-butyl-2-pyridyl-benzimidazole-5-carboxylate), which has recently been shown to exhort a strong photoactivity, but still needs further improvements to reach clinical applications. We performed density functional theory calculations at the M06, PBE0, ωB97xD, and CAM-B3LYP levels to predict the impact of introducing electron donor-acceptor groups into the nature of the lowest excited states. The simulations performed demonstrate that the presence of a NH₂ at the pbz ligand and a NO₂ group at the N^N ligand yield a bathochromic shift of absorption spectrum. We report the most sensitive positions to tune the optical signatures of this family of complexes.

Energetic Self-Folding Mechanism in α-Helices

A novel energetic route driving the folding of a polyalanine peptide from an extended conformation to its α-helix native conformation is described, supported by a new method to compute mean potential energy surfaces accurately in terms of the dihedral angles of the peptide chain from extensive molecular dynamics simulations. The energetic self-folding (ESF) route arises specifically from the balance between the intrinsic propensity of alanine residues toward the α_R conformation and two, opposite, effects: the destabilizing interaction with neighbor residues and the stabilizing formation of native hydrogen bonds, with the latter being dominant for large peptide lengths. The ESF mechanism provides simple but robust support to the nucleation-elongation or zipper models and offers a quantitative energetic funnel picture of the folding process. The mechanism is validated by the reasonable agreement between the computed folding energies and the experimental values.

Small-sized follicles could contribute to high-order multiple pregnancies: outcomes of 6552 intrauterine insemination cycles

RESEARCH QUESTION

Can predictors of twin and high-order multiple pregnancy among women with multiple cycles of ovarian stimulation intrauterine insemination (IUI) be identified?

DESIGN

Retrospective cohort study of IUI cycles carried out between January 2014 and December 2015 in a private clinic in Spain. The 4879 women and 6552 cycles analysed in this study include single IUI with ovarian stimulation using recombinant FSH.

RESULTS

Number of follicles and follicle size were the only factors with a significant effect (P < 0.001) on the likelihood of achieving a twin or multifetal pregnancy. Follicles 12 mm or wider greatly increase the chances of achieving a twin or multifetal pregnancy. A total of 73 out of 127 (57.5%) twin pregnancies occurred in cycles with at least one additional follicle measuring 12 mm or wider, and 102 out of 127 twin pregnancies (80.3%) occurred in cycles with at least one additional follicle measuring 14 mm or wider. Cancellation criteria should consider the presence of follicles 12 mm or wider.

CONCLUSION

Follicles measuring 12 mm or wider increase the risk of having a twin or a high-order multiple pregnancy rate. These data may help clinicians balance decision-making between cancelling and performing the cycle within an IUI procedure.

A new fluorescence turn-on chemosensor for nanomolar detection of Al3+ constructed from a pyridine–pyrazole system

A pyridine–pyrazole based fluorescence turn-on chemosensor provides access to selective detection of Al³⁺ in solution as well as in HepG2 living cells.

Understanding the connection between conformational changes of peptides and equilibrium thermal fluctuations

Despite the increasing evidence that conformational transitions in peptides and proteins are driven by specific vibrational energy pathways along the molecule, the current experimental techniques of analysis do as yet not allow to study these biophysical processes in terms of anisotropic energy flows. Computational methods offer a complementary approach to obtain a more detailed understanding of the vibrational and conformational dynamics of these systems. Accordingly, in this work we investigate jointly the vibrational energy distribution and the conformational dynamics of trialanine peptide in water solution at room temperature by applying the Instantaneous Normal Mode analysis to the results derived from equilibrium molecular dynamics simulations. It is shown that conformational changes in trialanine are triggered by the vibrational energy accumulated in the low-frequency modes of the molecule, and that excitation is caused exclusively by thermal fluctuations of the solute-solvent system, thus excluding the possibility of an intramolecular vibrational energy redistribution process.

Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease

BACKGROUND

Adenomyosis is linked to infertility, but the mechanisms behind this relationship are not clearly established. Similarly, the impact of adenomyosis on ART outcome is not fully understood. Our main objective was to use ultrasound imaging to investigate adenomyosis prevalence and severity in a population of infertile women, as well as specifically among women experiencing recurrent miscarriages (RM) or repeated implantation failure (RIF) in ART.

METHODS

Cross-sectional study conducted in 1015 patients undergoing ART from January 2009 to December 2013 and referred for 3D ultrasound to complete study prior to initiating an ART cycle, or after ≥3 IVF failures or ≥2 miscarriages at diagnostic imaging unit at university-affiliated private IVF unit. Adenomyosis was diagnosed in presence of globular uterine configuration, myometrial anterior-posterior asymmetry, heterogeneous myometrial echotexture, poor definition of the endometrial-myometrial interface (junction zone) or subendometrial cysts. Shape of endometrial cavity was classified in three categories: 1.-normal (triangular morphology); 2.- moderate distortion of the triangular aspect and 3.- "pseudo T-shaped" morphology.

RESULTS

The prevalence of adenomyosis was 24.4 % (n = 248) [29.7 % (94/316) in women aged ≥40 y.o and 22 % (154/699) in women aged <40 y.o., p = 0.003)]. Its prevalence was higher in those cases of recurrent pregnancy loss [38.2 % (26/68) vs 22.3 % (172/769), p < 0.005] and previous ART failure [34.7 % (107/308) vs 24.4 % (248/1015), p < 0.0001]. The presence of adenomyosis has been shown to be associated to endometriosis [35.1 % (34/97)]. Adenomyosis was diagnosed as a primary finding "de novo" in 80.6 % (n = 200) of the infertile patients. The impact on the uterine cavity was mild, moderate and severe in 63.7, 22.6 and 10.1 % of the cases, respectively.

CONCLUSIONS

Our results indicate that adenomyosis is a clinical condition with a high prevalence that may affect the reproductive results. The described severity criteria may help future validating studies for better counseling of infertile couples.

High-Resolution Rotational Spectrum, Dunham Coefficients, and Potential Energy Function of NaCl

We report laboratory spectroscopy for the first time of the J = 1-0 and J = 2-1 lines of Na35Cl and Na37Cl in several vibrational states. The hyperfine structure has been resolved in both transitions for all vibrational levels, which permit us to predict with high accuracy the hyperfine splitting of the rotational transitions of the two isotopologues at higher frequencies. The new data have been merged with all previous works at microwave, millimeter, and infrared wavelengths and fitted to a series of mass-independent Dunham parameters and to a potential energy function. The obtained parameters have been used to compute a new dipole moment function, from which the dipole moment for infrared transitions up to Δv = 8 has been derived. Frequency and intensity predictions are provided for all rovibrational transitions up to J = 150 and v = 8, from which the ALMA data of evolved stars can be modeled and interpreted.

Hints of a rotating spiral structure in the innermost regions around IRC +10216

The Atacama Large Millimeter/submillimeter Array (ALMA) is allowing us to study the innermost regions of the circumstellar envelopes of evolved stars with un-precedented precision and sensitivity. Key processes in the ejection of matter and dust from these objects occur in their inner zones. In this work, we present sub-arcsecond interferometric maps of transitions of metal-bearing molecules towards the prototypical C-rich evolved star IRC +10216. While Al-bearing molecules seem to be present as a roughly spherical shell, the molecular emission from the salts NaCl and KCl presents an elongation in the inner regions, with a central minimum. In order to accurately analyze the emission from the NaCl rotational lines, we present new calculations of the collisional rates for this molecule based on new spectroscopic constants. The most plausible interpretation for the spatial distribution of the salts is a spiral with a NaCl mass of 0.08M☉. Alternatively, a torus of gas and dust would result in similar structures as those observed. From the torus scenario we derive a mass of ~ 1.1 × 10-4M☉. In both cases, the spiral and the torus, the NaCl structure presents an inner minimum of 27 AU. In the case of the torus, the outer radius is 73 AU. The kinematics of both the spiral and the torus suggests that they are slowly expanding and rotating. Alternative explanations for the presence of the elongation are explored. The presence of these features only in KCl and NaCl might be a result of their comparatively high dipole moment with respect to the Al-bearing species.

Conformational Changes of Trialanine in Water Induced by Vibrational Relaxation of the Amide I Mode

Most of the protein-based diseases are caused by anomalies in the functionality and stability of these molecules. Experimental and theoretical studies of the conformational dynamics of proteins are becoming in this respect essential to understand the origin of these anomalies. However, a description of the conformational dynamics of proteins based on mechano-energetic principles still remains elusive because of the intrinsic high flexibility of the peptide chains, the participation of weak noncovalent interactions, and the role of the ubiquitous water solvent. In this work, the conformational dynamics of trialanine dissolved in water (D2O) is investigated through Molecular Dynamics (MD) simulations combined with instantaneous normal modes (INMs) analysis both at equilibrium and after the vibrational excitation of the C-terminal amide I mode. The conformational equilibrium between α and pPII conformers is found to be altered by the intramolecular relaxation of the amide I mode as a consequence of the different relaxation pathways of each conformer which modify the amount of vibrational energy stored in the torsional motions of the tripeptide, so the α → pPII and pPII → α conversion rates are increased differently. The selectivity of the process comes from the shifts of the vibrational frequencies with the conformational changes that modify the resonance conditions driving the intramolecular energy flows.

SI-BEARING MOLECULES TOWARD IRC+10216: ALMA UNVEILS THE MOLECULAR ENVELOPE OF CWLEO

We report the detection of SiS rotational lines in high-vibrational states as well as SiO and SiC2 lines in their ground vibrational state toward IRC+10216 during the Atacama Large Millimeter Array Cycle 0. The spatial distribution of these molecules shows compact emission for SiS and a more extended emission for SiO and SiC2, and also proves the existence of an increase in the SiC2 emission at the outer shells of the circumstellar envelope. We analyze the excitation conditions of the vibrationally excited SiS using the population diagram technique, and we use a large velocity gradient model to compare with the observations. We found moderate discrepancies between the observations and the models that could be explained if SiS lines detected are optically thick. Additionally, the line profiles of the detected rotational lines in the high energy vibrational states show a decreasing linewidth with increasing energy levels. This may be evidence that these lines could be excited only in the inner shells, i.e., the densest and hottest, of the circumstellar envelope of IRC+10216.

Mutagenic effects induced by the attack of NO2 radical to the guanine-cytosine base pair

We investigate the attack of the nitrogen dioxide radical (NO^•₂) to the guanine—cytosine (GC) base pair and the subsequent tautomeric reactions able to induce mutations, by means of density functional theory (DFT) calculations. The conducted simulations allow us to identify the most reactive sites of the GC base pair. Indeed, the computed relative energies demonstrate that the addition of the NO^•₂ radical to the C8 position of the guanine base forms to the most stable adduct. Although the initial adducts might evolve to non-canonical structures via inter-base hydrogen bonds rearrangements, the probability for the proton exchange to occur lies in the same range as that observed for undamaged DNA. As a result, tautomeric errors in NO₂-attacked DNA arises at the same rate as in canonical DNA, with no macroscopic impact on the overall stability of DNA. The potential mutagenic effects of the GC–NO^•₂ radical adducts likely involve side reactions, e.g., the GC deprotonation to the solvent, rather than proton exchange between guanine and cytosine basis.

Labelling Herceptin with a novel oxaliplatin derivative: a computational approach towards the selective drug delivery

The clinical use of platinum(II)-based drugs has serious side effects due to the non-specific reactions with both malignant and normal cells. To circumvent such major drawback, novel metallodrugs might be combined with suitable carrier molecules, as antibodies, to ensure selective attacks on tumours while sparing healthy tissues. In this contribution, we investigate the stability of a novel oxaliplatin derivate drug embedded in Herceptin (trastuzumab), an antibody which is able to recognise breast cancer cells, by using a wide panel of theoretical tools: docking, molecular dynamics and quantum calculations. Our calculations reveal the binding mechanism: the drug initially interacts non-covalently with the Pro40A and Asp167A residues, and the nitrogen of His171B subsequently replaces one of the water molecules coordinated to the platinum center, where the latter step reversibly fixes the drug into the antibody. These data might be used to further rationalise the synthesis of improved drugs beyond classical platinum(II) derivatives by improving the ligand-protein coupling mode.

Assessing the importance of proton transfer reactions in DNA

Although engineered by millions of years of evolution, the cellular machinery is not flawless, and errors regularly appear during DNA replication. The subsequent alteration of the stored genetic message results in a mutation and might be the starting point of important health disorders. The question therefore is what causes DNA mutations? All living organisms are constantly exposed to a number of external agents such as free radicals and to radiation, which may lead to induced mutations. There are also mutations happening without invoking the action of any exogenous element, the so-called spontaneous mutations. The former can be partially controlled by avoiding exposure to high-risk environments, while the latter are more intriguing because their origin is unclear and difficult to determine. As noted by Watson and Crick when they first discovered the DNA structure, the correct replication of DNA rests on the assumption that the base pairs remain in their most stable, canonical form. However, protons along the interbase hydrogen-bond network are not static entities. They can in fact interchange their positions in DNA bases through proton transfer (PT) reactions before strands unwind, giving rise to noncanonical structures defined as rare tautomers. The importance of these rare tautomers was also cleverly anticipated by Watson and Crick and some years later claimed by Löwdin to be a source of spontaneous mutations. In Watson and Crick's words: "It would be of interest to know the precise difference in free energy between the various tautomeric forms under physiological conditions." Unfortunately, rare tautomeric forms are very difficult to detect, so no direct and accurate free energy measure has been discerned. In contrast, theoretical chemistry is making good progress toward the quantification of PT reactions in DNA and their biological consequences. This Account touches upon the theoretical studies devoted to appraising the importance of rare tautomers as promoters of spontaneous mutations. We focus in particular on the crucial role played by the biological environment on DNA stability. It has now been demonstrated that valuable macroscopic predictions require not only highly accurate theories but also refined chemical models. Hybrid quantum mechanics/molecular mechanics (QM/MM) simulations performed on short but complete DNA sequence fragments emerge in this context as the most adequate tools. In addition, these methods can be used to quantify the effect of different external agents on the PT tautomeric equilibria and, eventually, to conveniently handle them. This is the case for the possible alteration of the naturally observed mutation rate by exposure to intense electric fields. Theoretical predictions envision in this respect promising applications of ultrashort electric pulses in medicine to selectively modify the mutated/canonical ratio in DNA.

A case of Japanese encephalitis in a 20 year-old Spanish sportsman, February 2013

We report a severe case of imported Japanese encephalitis (JE) in a healthy young Spanish traveller who developed symptoms after spending three weeks in a touristic area of Thailand. The patient was diagnosed in Thailand and subsequently transferred to Barcelona, Spain, where the Thai laboratory results were confirmed based on IgM serology. Although JE is a rare disease in travellers, this case illustrates the need for seeking travel medical advice before visiting tropical countries.