In Vitro Fertilization (IVF) is an established treatment approach for infertility based on the developments the past quarter century. However, there are still a number of reasons which prevent both doctors and patients from embarking on this available treatment option. The current indication for IVF (including endometriosis, tubal pathology, anovulation, male factor infertility-and unexplained infertility) are reviewed considering prognosis for pregnancy using IVF as compared to no/more conventional treatment. Evidence-based data are presented. Also, maternal age as a factor for success in IVF treatment is reviewed. Local setting situations which contribute to delays in treatment are also tackled.
FERTILIZATION IN VITRO

OBJECTIVES: To determine the incidence of ectopic pregnancy after IVF at the Center for Advanced Reproductive Medicine and Infertility (CARMI) in St. Luke's Medical Center-Global City (SLMC-GC) and to describe the clinical characteristics of these patients and identity possible risk factors for ectopic pregnancy following IVF.

STUDY DESIGN: This is a descriptive cross-sectional study, with the digital database of CARMI as the source of patient information. Demographic and clinical data were obtained and tabulated. Statistical analyses were performed to identify possible risk factors for the tabulated. Statistical analyses were performed to identify possible risk factors for the development of ectopic pregnancy in IVF cases.

RESULTS: There were a total of 243 clinical pregnancies among the 929 IVF-ET cases from September 2011 to April 2015. There were five cases of ectopic pregnancy. Frozen embryo transfer was the only variable found to be significantly associated with ectopic pregnancy (p=0.003).

CONCLUSION: The ectopic pregnancy rate among IVF cycles in CARMI is 2.1%. Only frozen embryo cycle was found to be significantly associated with the development of EP. The other clinical variables that were studied showed no statistical significance.

Background: The increasing number of young survivors after cancer treatment and of patients with non-malignant conditions who are at risk for subfertility has resulted in a demand for fertility preservation services, including the Philippines. Objective: The aim of this paper is to provide an overview of the history, indications, and management principles of fertility preservation. Also, the available strategies in the Philippines in both pre-pubertal and post-pubertal men and women and future directions of the field in the country will be discussed. Materials and methods: Literature review, historical accounts Results and conclusions Fertility preservation should be a priority when treating children and adults of reproductive age with agents that have deleterious effects on the gonads. If harmful treatment will be used, the options of fertility preservation should be discussed, as early as possible by the primary physician in collaboration with the oncologist and the reproductive medicine specialist. Most of the known options for fertility preservation are available in the Philippines and are being implemented in the local IVF centers. Recent developments hint of a potentially faster progress in the field with the establishment of the Philippine Society for Fertility Preservation in collaboration with other professional societies and a linkage with the Department of Health with the signing into law of the National Integrated Cancer Control Act of 2019.
Fertility Preservation ; Cryopreservation ; Oocytes ; Ovary ; Fertility

Background: Treatments for cancer have negative impact on fertility. Presently, there are technologies available to preserve the fertility of cancer patients even before gonadotoxic treatment is given. Several clinical practice guidelines on fertility preservation interventions for cancer patients have already been released. Among developed countries, Oncofertility is already an established field of clinical practice. Objectives: This study aims to determine the knowledge, attitudes, and practices of Filipino clinical practitioners on fertility preservation in cancer patients. Methodology: This was a cross-sectional study carried out between June and September 2019 using a self- administered questionnaire. The questionnaires were sent to clinicians (medical oncologists, hematologists, surgical oncologists, and radiation oncologists) who were directly involved in the treatment patients with cancer. Results: There were 213 respondents composed of 91 surgical oncologists (varied subspecialties), 81 medical oncologists, and 41 radiation oncologists. Most of the clinical practitioners, 58-85%, have not encountered patients who have availed of any fertility preservation method. In terms of knowledge, 53-73% of respondents were aware about some fertility preservation options, but had minimal knowledge. Ninety five percent of study participants acknowledged the need for more information on fertility preservation. Majority of clinicians (57%) have never referred to a fertility specialist; and only 38% have referred a patient for fertility preservation. The following factors were cited as barriers to discussion of fertility preservation: lack of knowledge of clinicians, poor success rates of fertility preservation, poor prognosis of patients, and prohibitive costs of treatment. Conclusion There is an acute need to increase knowledge and awareness about fertility preservation methods and international fertility preservation guidelines among Filipino health practitioners treating cancer patients.
Fertility Preservation ; Comprehensive Health Care ; Neoplasms

Conjoined oocytes are characterized by a follicle containing two oocytes surrounded by a single zona pellucida or their fusion in a zonal region. Gonadotropin stimulation, coupled with PCOS, predisposes to the occurrence of conjoined oocytes. Although a result of developmental accident, conjoined oocytes have the potential to develop into genetically normal embryos and babies. In this paper, the authors describe the aspiration of multiple conjoined oocytes in a single IVF cycle, leading to normal fertilization after selective intracytoplasmic sperm injection (ICSI). Development to blastocyst stage allowed trophectoderm biopsy resulting to a euploid embryo that was eventually transferred, and resulted to a live term birth.

Key words: conjoined oocytes, in vitro fertilization (IVF), intracytoplasmic sperm injection(ICSI)

Background: While COVID‑19 spreads rapidly around the world, innovative means to provide continuing prenatal care are being developed to monitor maternal and fetal health while minimizing disease transmission. Telemedicine is one platform by which patients are provided the necessary prenatal and postpartum care safely as the pandemic rages Aims and Objectives: To evaluate the acceptability of telemedicine in the delivery of prenatal and postnatal care in the setting of the COVID‑19 pandemic Materials and Methods: A cross‑sectional study was conducted in a tertiary hospital in Manila. A structured Likert scale‑based survey consisting of a model measuring telemedicine perception was utilized. This was a predeveloped model by Lin in 2017.[1] Descriptive statistical analysis and Chi‑square tests were done to evaluate the data Results: A total of 193 pregnant and postpartum patients participated in the study. Majority of the respondents were between 25 and 34 years old, living within Metro Manila, and normal obstetric patients who were previously seen at the outpatient department. Most of the participants considered telemedicine to be cost‑effective, reliable, easy to use, and useful Conclusion We conclude that telemedicine is an acceptable means of providing prenatal and postnatal care among pregnant patients because it allowed the necessary interaction between patient and doctor and these “users” kept on using the system. There was no association between telemedicine perceptions and patient age, place of residence, type of patient encounter, disease, and treatment. In the setting of the COVID‑19 pandemic, telemedicine is an acceptable means of providing prenatal and postnatal care regardless of patient characteristics
COVID‑19 ; Pandemics ; Postnatal Care ; Prenatal Care ; Telemedicine

Objective: This study aimed to evaluate the effect of oocyte incubation after retrieval in TFF among IVF-ICSI and identify factors affecting total fertilization failure (TFF).

Methods: This is a retrospective cohort study, involving 995 IVF cycles using the antagonist protocol that were clustered into three timings of oocyte denudation from retrieval : Group 1: <1 hour, Group 2: ?1 hour to <2hours and Group 3: ?2hours. Other variables considered were etiology of infertility, female age, days of stimulation and total number of oocytes retrieved.

Results: Overall TFF was 4.5%. TFF among groups were 4.8%, 5.8% and 3.2%, respectively. Multiple logistic regression analysis showed that oocyte incubation prior to denudation for ? 2 hours tend to decrease TFF incidence. Among factors studied, male factor infertility and a low number of oocytes adversely affect TFF.

Conclusion: Timing of incubation of oocyte did not significantly affect the occurrence of TFF. Among factors studied, male factor infertility and a low number of oocytes adversely affect TFF.

Background: Pre-implantation Genetic Testing for Aneuploidy (PGT-A) has enabled IVF specialists to screen embryos for abnormalities in chromosome number and structure. Subsequently, healthy embryos are selected for transfer, decreasing the rate of spontaneous miscarriages and improving pregnancy outcomes. In spite of this, almost only half of the PGTdetermined euploid embryos result in a pregnancy. Objective: This study aimed to determine what other factors among euploid embryo transfers will have an association with successful implantation and live birth. Methods: This study retrospectively analyzed 159 IVF-PGS cycles performed in CARMI SLMCGC from January 2017 to December 2019. Of these, a total of 231 euploid embryos (86 single embryo transfers and 73 double embryo transfers) were assessed. The relationship of eight predictive variables (maternal age, maternal BMI, etiology of infertility, history of failed IVF, blastocyst expansion stage, ICM grade, TE grade and endometrial thickness on transfer) with regard to the outcome of successful implantation and live birth among single or double euploid blastocyst transfers were determined via logistic regression analysis. Results: Overall, the implantation rate was significantly lower when using B-grade ICM or C-grade ICM blastocysts as compared to A-grade ICM blastocysts (OR 0.54, 95% CI 0.356- 0.815, p = 0.003). With regard to live birth rate, the success of transfer is statistically lower when using a B-grade or C-grade ICM blastocysts as compared to A-grade ICM blastocysts (OR 0.55, CI 0.354-0.863, p = 0.009). Other predictive factors such as maternal age, maternal BMI, etiology of infertility, number of previous IVF, blastocyst expansion stage, trophectoderm grade and endometrial thickness had no apparent effect on the outcome of implantation and live birth. Conclusion Present study results suggest that only the ICM grade of euploid blastocysts correlates with implantation and live birth in IVF-FET cycles. Therefore, the selection of euploid blastocysts based on the presence of a higher grade ICM is the most predictive factor that determines success among those undergoing IVF with PGT-A.
Live Birth ; Genetic Testing

BACKGROUND

In-vitro maturation (IVM) is utilized to avoid ovarian hyperstimulation syndrome and decrease the cost of IVF. However, there are different opinions regarding its utility. We evaluated outcomes of rescue IVM in polycystic ovary syndrome, diminished and normal ovarian reserve.

This retrospective cohort involves 615 immature oocytes retrieved from 221 IVF cycles. Outcomes of in-vitro matured oocytes were compared to sibling in-vivo mature oocytes. Association between stimulation an study trigger protocol were analyzed.

Laboratory outcomes of Rescue-IVM (R-IVM) matured oocytes showed no statistically significant difference among groups. In-vivo mature oocytes showed a significantly higher fertilization rate and blastocyst rate (p < 0.0001) compared to in-vitro matured oocytes. Progestin primed protocol and combination/dual trigger had significantly higher maturation rates.

Immature oocytes undergoing R-IVM can potentially undergo maturation, fertilization and even developed to blastocyst stage. However, given the low efficiency of development to blastocyst stage, higher power studies are needed to evaluate its practical use.

OBJECTIVE

To determine the threshold value for anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovarian syndrome (PCOS) in infertile Filipino women and to ascertain the correlation of AMH with age and body mass index of PCOS women.

A retrospective cross-sectional study was carried out on infertile Filipino women at the Center for Advanced Reproductive Medicine and Infertility from August 2015 to March 2020. The women were separated into the PCOS group and male factor infertility group. Serum AMH was analyzed with Access AMH chemiluminescent immunoassay by Beckman Coulter. The AMH threshold for the diagnosis of PCOS was computed using Youden’s index.

There were 585 women included in the study, 311 (53.16%) were diagnosed with PCOS by the Rotterdam criteria, while 274 (46.84%) were non PCOS women. Mean serum AMH for PCOS was 5.88 ± 3.37 (p < 0.01). A threshold value of serum AMH above 3.86 ng/ml was predictive of PCOS by Youden’s index with a sensitivity of 67.2%, specificity of 77.7%, and correct classification rate of 72.1%. There was a negative correlation of AMH level with increasing age in both PCOS and non – PCOS group but the PCOS group had a higher AMH level. There was no correlation noted with AMH and body mass index in both groups.

AMH levels were higher in the PCOS women compared to those without the diagnosis. AMH threshold level could support the diagnosis of PCOS in infertile Filipino women.