Objective: To compare two different blastocyst biopsy protocols. Design: Retrospective single-center cohort study. Settings: Private in vitro fertilization center. Patient(s): The study included 1,670 frozen-thawed embryo transfers (FETs) with preimplantation genetic testing for aneuploidy (PGT-A). Intervention: None. Main Outcome Measure(s): Survival rate (SR) after thawing, clinical pregnancy rate (CPR), ongoing implantation rate (IR), and live birth rate (LBR). Result(s): Eight hundred thirty-five FETs with PGT-A cycles including only embryos biopsied in the sequential blastocyst hatching and biopsy protocol paired with the ablation of one-fourth of the zona pellucida (ZP) were matched with 835 FETs with PGT-A cycles including only embryos biopsied in the day 3 prehatching protocol by female age (AE1 year), number of embryos transferred, use of gestational carrier or egg donor, and day of blastocyst transfer. Only FETs with euploid blastocysts graded no lower than 4BB were included, and cycles with fewer than five oocytes were excluded. SR after thawing, CPR, ongoing IR, and LBR were significantly higher in the FET cycles with the embryos biopsied in the sequential hatching and biopsy protocol. Four cases of monozygotic twin pregnancies were reported with the day 3 prehatching protocol and none with the sequential hatching and biopsy protocol. Conclusion(s):Our results show, for the first time, that using different blastocyst biopsy protocols can affect clinical outcomes. Because the study was retrospective, our findings should be validated in a prospective trial. (Fertil Steril Ò 2020;113:981-89. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

BACKGROUND: Failure of implantation and conception may result from the inability or decreased capability of blastocyst hatching from the zona pellucida. Hardening of the zona pellucida is known to occur in several scenarios including advancing maternal age, culture conditions and oocyte/embryo cryopreservation. There is conflicting evidence regarding the benefit of assisted hatching in the general IVF population, however, there is an increasing use of assisted hatching clinically, particularly for blastocyst frozen embryo transfers. 1 OBJECTIVE: To determine if routine assisted hatching (AH) in blastocyst frozen embryo transfers (FET) improves clinical outcomes.MATERIALS AND METHODS: A retrospective study was performed utilizing an IRB-approved registry database of 236 female patients who underwent a blastocyst FET with or without AH from 1/1/2015 to 10/31/2016 at the Center for Fertility and Reproductive Endocrinology at Magee Womens Hospital. Demographic information and clinical outcomes were collected including biochemical pregnancy rate and clinical pregnancy rate for each embryo transfer. Implantation rate per embryo transferred was also calculated. The use of AH was at the discretion of the physician. Transfer cycles were excluded if AH was not performed on each embryo transferred, if the embryos underwent prior preimplantation diagnosis/screening or if the embryos were hatching spontaneously. Proportion tests and 2 sample T-tests were used for statistical analysis.RESULTS: Two hundred thirty six patients underwent a total of 266 blastocyst transfers. AH was used in 40.2% of transfers (n¼107). Patient demographics were collected including patient age at the time of transfer, ovarian reserve, body mass index, obstetric history, infertility diagnosis, and cycle day 15 endometrial lining thickness. There were no statistical differences in patient demographics between FETs with AH versus no AH. Embryos resulted from conventional fertilization in 27.4% of transfers (n¼73), while intracytoplasmic sperm injection (ICSI) was used in 72.6% of transfers (n¼193). Number of embryos transferred was slightly higher in the group with AH at 1.56 embryos/ transfer, compared to 1.26 embryos/transfer (P<0.001). Biochemical pregnancy rate for all ages was not statistically different when AH was utilized (AH 55.0%, no AH 46.0%; P¼0.92). Clinical pregnancy rate was also not statistically different (AH 45.0%, no AH 38.0%; P¼0.93). Implantation rate was calculated to control for differences in the number of embryos transferred, and there was no statistical difference for patients of all ages (AH 28.8%, no AH 30.2%; P¼0.98). When stratified by age, a slightly higher number of embryos were transferred in women less than age 35 who underwent AH (AH 1.63 embryos/transfer vs. no AH 1.22 embryos/transfer; P<0.001), though there was no difference in the implantation rate for women less than age 35 (AH 30.1%, no AH 28.6%; P¼0.99).

DESIGN: A retrospective study carried out in men undergoing routine semen analysis and CASA at LAR (8/2014LAR (8/ -12/2016. MATERIALS AND METHODS: Semen samples were obtained from men for semen evaluation as part of routine andrology work-up and CASA. Statistical analyses were done using GraphPad-InStat software. Results were compared by means of Mann-Whitney or Kruskal-Wallis tests.RESULTS: The analysis done on 4,897 semen samples revealed a negative correlation between age and routine semen parameters (p<0.0001) and several CASA (p<0.005) variables (Table). When semen samples were distributed in 4 age-groups (G1¼18-29; G2¼30-39; G3¼40-49; G4R50 yr), G1 samples had higher (p<0.05) values for those parameters than G4, as expected. Moreover, significant differences were also observed in several parameters between G2 and G3 samples. These results led us to use 40 yr as a cut-off value, an analysis that revealed decreased (p<0.0005) parameters in the older (R40 yr; n¼1,285) group compared to the younger one (<40 yr; n¼1,285). Taking into account the negative impact of diverse clinical and lifestyle conditions upon semen quality, the same evaluations were performed in samples from a selected 'not-exposed' population. As a result, some parameters were still decreased (p<0.05) in the older group.CONCLUSIONS: A negative effect of age upon routine semen parameters was found in a large cohort of samples assessed under same laboratory standards. The negative impact of age upon sperm motility was further supported by reporting, for the first time, a negative correlation between age and sperm kinematics. These parameters were found decreased in older (R40 yr) men.(Estofan and Veron, equal contribution) Supported by: LAR and CONICET

square or Fisher's exact tests were used for categorical variables. P % 0.05 used to determine statistical significance.RESULTS: A total of 264 subjects who presented for DS-IUI at two affiliated medical centers from 2016-2019 were included: 146 coupled lesbian women, 45 single heterosexual women, and 73 coupled heterosexual women. Race, body mass index (BMI), and early follicular phase FSH were similar between all three groups. Lesbians were significantly younger (33.1 AE 4.5 years) than single (37.8 AE 3.5 years, p<0.001) and coupled heterosexuals (34.5 AE 3.7 years, p¼0.02). Lesbians did not have an increased prevalence of polycystic ovary syndrome (PCOS) (OR 2.12, 95% CI 1, 4.52, p¼0.6811) nor diminished ovarian reserve (DOR) (OR 2.86, 95% CI 1.44, 5.64, p¼0.0908). Fewer lesbians reported a history of sexually transmitted infection (5.5% versus 18%, p¼0.03). Lesbians also had less tubal disease (defined as an abnormal radiographic finding in at least one fallopian tube on hysterosalpingogram) (7.5% versus 16%, p¼0.04). There was no difference in the age-adjusted number of DS-IUI cycles to achieve clinical pregnancy between lesbian (4.6 cycles) and single women (4.0 cycles, p¼0.06), but coupled heterosexuals (3.0 cycles, p¼0.06) required 24% fewer DS-IUI cycles to achieve pregnancy than lesbians (OR 0.76, 95% CI 0.66-0.9, p¼0.0007).CONCLUSIONS: This study is the first in the United States to compare both the etiologies of subfertility and pregnancy outcomes of lesbian women and heterosexual women undergoing DS-IUI. When compared to their heterosexual counterparts, our data reveal less tubal disease and no increased prevalence of PCOS or DOR in lesbian women. Interestingly, lesbian women required more DS-IUI cycles to achieve clinical pregnancy than coupled heterosexual women.

BACKGROUND: Strong mentorship may improve the success of academic Obstetrics and Gynecology faculty and has the potential to decrease faculty turnover. Yet many junior faculty report that they do not have a mentor. One proposed solution is an institutional mentorship program for junior faculty, but there are few reports of successful programs in the specialty.OBJECTIVE: To evaluate the initial impact of a mentorship program curriculum developed in the Department of Gyn/OB at Johns Hopkins to enhance the training of the next generation of clinical and research scientists in Obstetrics and Gynecology.MATERIAL AND METHODS: We developed a specialty-specific departmental mentorship program tailored to obstetricians and gynecologists that was based on ranked areas of interest of junior faculty and subspecialty fellows (Gyn/OB, Reproductive Scientist). The curriculum consisted of monthly interactive workshops and seminars over a threeyear rotational schedule to coincide with the 3-year duration of fellowship training in the specialty. Themes included research, education and leadership in academic obstetrics and gynecology. There was a strong emphasis on participatory exercises for trainees in subject matter. Examples of curriculum topics include manuscript publication and review, grant writing, working with the IRB, promotion, core teaching skills, and time management. The research was IRB-approved. Pre-and postcourse questionnaires assessed participants' confidence in skills related to the course topics. Generalized linear models were used to assess change in post course response, using each question as the dependent variable and an indicator for post-course as the predictor variable. The control group was comprised of junior faculty and fellows in the Gyn/ OB department before the course was initiated for an identical threeyear duration of time. Outcome measures included the number of published papers and the impact factor of the journal in which the published manuscripts appeared. A Wilcoxon-rank-sum test was used to assess outcome measures. All tests were two sided and were performed at 0.05 level of statistical significance.RESULTS: Of the 118 attendees over the three-year course, 26 (22.0%) were junior faculty, 35 (29.66%) clinical fellows, 28 (23.7%) research fellows, other research staff or students. For each three-year course series, an average of 20 junior faculty and clinical fellows completed the post-course surveys, of which 72% were clinical fellows, 22% assistant professors and 5% instructors. The data revealed a statistically significant change in the participant's overall confidence in skills related to research, education and leadership when comparing the cumulative results from the pre-to-post course surveys (P<0.001). Specifically, participants noted improved confidence in their skills related to clinical and translation research (P<0.001) and leadership and academic career advancement (P¼0.001). Additionally, junior faculty and clinical fellows who attended the course had a higher number of publicat...