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.

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.

It has been recognized that, to help ensure research caters to the needs of society, a research agenda must be set.[1–3] When a health research agenda is set, it will help prioritize the implementation of health researches that will in turn help improve society’s public health system. This way, evidence is provided to help guide policy decisions on health development.[1,4] Such was the context by which the National Unified Health Research Agenda (NUHRA) was created and has evolved in its three editions. In NUHRA 2017–2022, six themes of priority research were identified. These included responsive health systems, research to enhance and extend healthy lives, holistic approaches to health and wellness, health resiliency, global competitiveness and innovation in health, and research in equity and health.

Objective: To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.

Methods: A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.

Results: There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).

Conclusion: There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.

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.

INTRODUCTION: To evaluate the sperm retrieval rate and factors influencing its success among patients who undergo conventional or microsurgical testicular sperm extraction (TESE) for non-obstructive azoospermia. METHODS: Data were from 223 consecutive patients who underwent conventional or microsurgical TESE from August 2011 to January 2021 under two urologists of the center. Data regarding age, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, testicular size, histopathology, surgical technique, and sperm retrieval were collected. Patients with obstructive azoospermia, repeated TESE procedure, and those who underwent TESE for oncofertility were excluded. Using simple logistic regression analysis, the relationship of the different factors to successful sperm retrieval was computed as odds ratio. RESULTS: The overall surgical sperm retrieval rate was found to be 65.71%. The odds ratio of successful sperm retrieval were 1.04 (95% CI 1.00-1.09) for age, 0.94 (95% CI 0.91-0.97) for FSH, 0.93 (95% CI 0.87-0.99) for LH, 1.24 (95% CI 0.99-1.55) for testosterone, and 0.93 (95% CI 0.88-0.98) for estradiol. Decreased testicular size was also associated significantly with lower sperm retrieval rate (OR 0.22, 95% CI 0.09-0.56). Histopathologic pattern and surgical technique were also significantly associated with successful sperm retrieval. CONCLUSION The surgical sperm retrieval rate in this institution is comparable to the global surgical sperm retrieval rate. Age, FSH, LH, estradiol, testicular size, histopathologic pattern and surgical technique were found to have significant association to successful surgical sperm retrieval.

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

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)

Objective: The aim of the study was to determine the impact of the COVID – 19 pandemic on fertility centers in the Philippines as reflected in the change in caseload for the different types of fertility procedures and modifications in the physical set up of laboratories, staff and patient screening. Methods: A descriptive cross-sectional study using a questionnaire was administered to all Philippine Society for Reproductive Medicine (PSRM) accredited fertility centers on November 2020. The study underwent ethics and technical review approval. The medical director or manager of the centers was requested to answer the questionnaire. All data were collated, summarized and analyzed. Results: All seven PSRM accredited fertility centers participated in the study. There was an overall decrease in fertility procedures performed in all the centers with most of the centers reporting a less than 50% decrease in oocyte pick up, less than 75% decrease in frozen embryo transfer and around 50 – 75% decrease in intrauterine insemination cases. All fertility centers implemented social distancing, triaging of patients by symptoms, use of personal protective equipment for doctors and staff, placing alcohol dispensers at the reception area and limiting the number of people allowed inside the center. Clinical visits were now scheduled and revisions in informed consent were done. Conclusion The majority of local fertility centers experienced a significant decline in fertility procedures. Modifications to the conduct of their clinic for safety of their staff and patients were compliant with local and international guidelines.
COVID-19 ; Safety

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