Introduction Women are postponing childbearing and preventing age‐related fertility decline with oocyte freezing for non‐medical reasons (OFNMR). The objective of this systematic evaluation was to gain an understanding of women's attitudes and knowledge of, and intentions to use OFNMR among users of OFNMR and the general public. Material and methods A systematic search of MEDLINE, EMBASE, and PyschINFO databases was undertaken, for studies that examined the psychosocial attitudes among women toward OFNMR. The search was limited to English language and no time restriction was set for publications. Extracted data were analyzed using thematic analysis and the study was performed according to PRISMA guidelines with prospective PROSPERO registration (CRD4201912578). Results Overall, 35 studies met the inclusion criteria. Studies were broadly categorized into studies investigating users or potential users of OFNMR, and studies examining the views of members of the general public. Users of OFNMR have good knowledge of age‐related fertility decline and awareness of the OFNMR procedure. Lack of partner was identified as the most common motivating factor to undertake OFNMR, with cost as a predominant concern. Knowledge among the general public of OFNMR is highly variable. Underestimation of age‐related fertility decline is common among the general public. Intentions of women to use OFNMR also varied drastically between studies. Conclusions Women are predominantly motivated to freeze eggs by the lack of a suitable partner, but cost is a significant barrier. Increasing the number of women pursuing OFNMR at an earlier stage may positively impact upon the risk of future involuntary childlessness. Better information should be made available to both women and men about their fertility and options to inform their reproductive decision‐making.

The aim of this work was to evaluate the effects of extreme body mass index (BMI) on assisted reproductive treatment outcome and pregnancy outcome. This is a descriptive cohort study that evaluated 8,145 consecutive in-vitro fertilisation/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles in which BMI were known, from July 1997 to June 2005 in an inner London major fertility clinic. The data were collected prospectively and analysed retrospectively on women undergoing IVF/ICSI and ET. Patients' weight and height were established prior to treatment. IVF/ICSI treatment was then started using either a long or an antagonist protocol. Patients were divided into five groups: Group A (BMI < 19); Group B (BMI between 19 and 25.9); Group C (BMI between 26 and 30.9); Group D (BMI between 31 and 35.9); Group E (BMI > 36). The main outcomes measured were number of eggs collected, fertilisation rate, number of embryos available for transfer, pregnancy rate (PR), live-birth rate (LBR) and miscarriage rate (MR). The results showed no significant difference in the average number of days taking follicle stimulating hormone (FSH) for ovarian stimulation, the average amount of gonadotrophin used for stimulation, number of eggs collected and fertilisation rate. The pregnancy rate, miscarriage rate and the live-birth rate were not statistically different between all groups. However, in group E the miscarriage rate was significantly higher and the LBR was statistically lower compared with group B. We concluded that extreme BMI did not affect the super-ovulation outcome fertilisation rate and pregnancy rate. Women with a BMI > 35 had a higher miscarriage rate and hence a lower live-birth rate, but a reasonable pregnancy and live-birth rate can be achieved. For women with a BMI < 20 there was no difference in assisted reproduction treatment (ART) outcome and pregnancy outcome when compared with women with a normal BMI. This information should be used to advise patients who wish to embark on ART with extreme BMI.

PurposeThe purpose of this study was to assess product-specific features for a variety of self-administered injection devices and identify key factors that patients and nurses in select European markets find most important when selecting injection devices for self-administration of recombinant human follicle-stimulating hormone and urinary human follicle-stimulating hormone for fertility/reproductive therapy.Patients and methodsPatients (N=402) in France, Italy, Spain, Germany, the UK, the Netherlands, and Belgium, as well as reproductive/fertility nurses (N=40) in Germany, Italy, France, Spain, and the Czech Republic were surveyed. All patients were previously prescribed a follicle-stimulating hormone (FSH) treatment for either in vitro fertilization or ovulation induction. Patient and nurse preferences for attributes across all injection devices in the market were obtained via an online questionnaire and evaluated using the maximum differential scaling (MaxDiff) and conjoint analyses, which captured the relative importance of the selected FSH injection device attributes to determine specific qualities in overall product preference.ResultsBoth the MaxDiff and conjoint analyses indicated that, for patients and nurses, the ideal FSH injection device would be a highly accurate, multi-use reusable pen injector with a dial-back function that would be easy for both use and education/instruction. Patients and nurses each selected attributes pertinent to their own experiences with the FSH injection device. Categorically, patients valued factors that resulted in minimal impact on daily life, including reduced injection volume to minimize injection-site pain, as well as a reusable device that would be easy to use; nurses placed greater value on a device that would be easy to teach in order to instruct the greatest number of patients while minimizing risk.ConclusionPatient and nurse preferences were aligned on certain selected attributes of the FSH products. Although this study was an unbranded examination of attributes across all injection devices currently in the market, results demonstrated that the preferred product attributes were all characteristics of the Ovaleap® Pen.

Modified TESA is done with an 18-gauge needle performing multiple passes (50-100) while applying a vacuum. The SRR from this procedure was 30%. When performing salvage mTESE after an unsuccessful modified TESA, the SRR was only 11%. Therefore, we hypothesized that modified TESA is an effective alternative to mTESE. Accordingly, we conducted the first randomized clinical trial on surgical sperm retrieval in NOA men comparing modified TESA with mTESE.METHODS: Ethical approval was obtained, and a prospective randomized clinical trial was conducted between 04/2017e10/2020. Inclusion criteria were azoospermia according to WHO, testis volume 15ml and no indication of obstructive causes of azoospermia. Exclusion criteria were previous surgical sperm retrieval or testicular biopsy, anejaculation, retrograde ejaculation, Klinefelter's Syndrome, XX male, AZF a/b microdeletion and CFTR mutation. The calculated population size was 100 (using 25% SRR for TESA and 52% for mTESE, power 80% and alpha 0.05) and with an expected drop-out rate of 10%, 110 men with NOA needed to be included. Men were randomized to mTESE or modified TESA. Patients with a failed TESA proceeded directly to mTESE while in the operating room. The primary outcome was successful sperm retrieval. SRRs were compared using Chi-square test. Statistical significance was set at p<0.05.RESULTS: 110 men were included, 10 withdrew before randomization and 100 underwent surgery. Median age was 33 years (range 22e54). Spermatozoa were retrieved in 11/51 (22%) men randomized for TESA and 21/49 (43%) men undergoing mTESE (p[0.02). SSR from salvage mTESE was 4/38 (11%). Thus, the combined SRR for men randomized to TESA was 15/51 (29%) which did not reach statistical significance compared to mTESE (p[0.16).CONCLUSIONS: In direct comparison SRR was higher in mTESE compared to modified TESA. Although not powered for such comparison, the study may indicate that combining salvage mTESE with the modified TESA is a viable alternative reducing invasiveness and cost for a proportion of patients.

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