Oocyte and Sperm Cryopreservation In Oncological Patients During Covid-19 Pandemic

During the pandemic, most infertility and IVF Units decided to keep fertility preservation active as an urgent procedure. It is well established that chemotherapy is gonadotoxic and impact negatively on quality of life. The American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) recommend to offer fertility preservation before cancer treatment. Oocyte cryopreservation and sperm cryopreservation are the best treatments of the choices to preserve fertility in cancer patients. This is a prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from February 2020 to January 2021. 149 cancer patients underwent gamete cryopreservation to preserve their fertility. All patients tested for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2 48 hours before cryopreservation. The viral RNA detection was provided only in case of positive swab and no treatment was interrupted. 59 women underwent ovarian stimulation with gonadotropins followed by oocyte retrieval. Women’s basal characteristics were: Age (m±sd) 31.0 ± 7.0 years, FSH (m±sd) 14 ±9IU/l, AMH (m±sd) 2.4 ± 1.3 ng±ml, AFC (m±sd) 9 ±5. 90 men underwent spermatozoa rapid cryopreservation. Men’s basal characteristics were: Age (m±sd) 34±7 years;Total Sperm count x 106 (m±sd) 52.3±49.6, Sperm x 106/ml 28.1±25.5, Total motility (m±sd) 48.0±26.7 %, Progressive motility (m±sd) 22.2±20.5 %, normal morphology (m±sd) 22.3±11.1 %. 296 oocyte were cryopreserved: 5.5±4.3 (mean±sd per patient). Vitrification with closed devices (High-Security Vitrification™ - HSV) was used for oocyte cryopreservation to minimize the risk of viral contamination. 403 Sperm samples were frozen with slow freezing: 5.7±2.1 (m±sd) per patient. All patients tested negative for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2. The oncofertility activity must be maintained even in pandemic periods by implementing adequate safety measures to protect the health of patients and healthcare professionals. Funding: Supported by Italian Ministry of Health "Fertility Preservation in gonadotoxic treatments” project code RF-2011-02348826 Conflict of Interest: None to disclose

Effects of different dialysis techniques on inflammation in maintenance hemodialysis patients with covid-19: A randomized study

BACKGROUND AND AIMS: Uncontrolled inflammation plays a relevant role in the pathogenesis of Coronavirus Disease-19 (COVID-19) and has been related to disease severity and unfavorable outcomes. Here, we studied the time trend of pro-and antiinflammatory markers in a population of patients undergoing hemodialysis (HD) affected by COVID-19, evaluating the potential modulating effects of two different dialysis approaches. METHOD: For this prospective randomized study, we recruited maintenance hemodialysis patients with confirmed COVID-19 infection. After diagnosis, the patients were randomized to two different dialysis modalities, expanded HD (HDx), performed by use of a medium cut-off membrane, and standard treatment based on the use of a protein-leaking dialyzer (PLD). Clinical and laboratory data were collected, including circulating pre and post-dialysis levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-g). Samples were collected at diagnosis (T0), one and two weeks after the diagnosis (T7 and T14, respectively). RESULTS: Twenty-seven HD patients with COVID-19 (69.7 616.6 years, 14 males) were compared with 14 non-infected HD patients, as the control group. COVID-19 patients presented a significantly reduced number of lymphocytes, including CD4 andCD8 subpopulations, and higher levels of ferritin and lactate dehydrogenase. Moreover, COVID-19 patients had higher levels of IL-6 [35.5 (59.4) vs 12 (43) pg/ml, p=0.048] and IL-10 [9.3 (20.8) vs 1.2 (1.4) pg/ml, p=0.02], while the levels of IL-8 and sTLR4 were comparable. Then, twenty-five patients were randomized to undergo HDx (n.15) or PLD (n.10). Basal characteristics and cytokine levels were not significantly different between the two groups. All over the study, no significant modifications of circulating cytokine levels were observed. Similarly, no significant differences were found between patients on HDx or PLD evaluated at different time points. After a single HD treatment, IL-8 showed a significant reduction compared to pre-dialysis levels in both groups. IL-8 reduction rate resulted significantly correlated with IL-8 pre-dialysis levels. Finally, there were no correlations between cytokine levels and clinical characteristics and outcomes. CONCLUSION: In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Modulation of the inflammation is not a suitable therapeutic target in this specific population. Other mechanisms could be involved in the pathogenesis of COVID-19 in HD patients. MO905 Figure 1: Time trends of pro-and anti-inflammatory cytokines in HD patients with COVID-19. A) IL-6 showed a trend to decrease in the first week after the diagnosis of COVID-19, reaching statistical significance in PLD group. B) IL-10 presented a significant increase in the first week after the diagnosis of COVID-19 in HDx group. C) IL-8 circulating levels, as well as D) sTLR4 levels, did not present significant modifications during the study. Expanded hemodialysis (HDx): black lines;Protein-leaking dialysis (PLD): red lines.

HIGH SECURITY CLOSED DEVICES ARE EFFICIENT AND SAFE FOR VITRIFICATION TO PROTECT HUMAN OOCYTES FROM THE RISK OF VIRAL CONTAMINATION ESPECIALLY DURING THE COVID-19 PANDEMIC

Objective: To compare the efficacy of high security versus open devices for human oocytes vitrification. Design: Prospective study. Between October 2015 and April 2020, 737 patients (775 oocytes cryopreservation cycles) were randomly assigned to two Groups: Group 1: 368 patients (389 vitrification cycles) by High Security Vitrification™ (HSV) Group 2: 369 patients (386 vitrification cycles) by Cryotop® open system. Vitrification was performed in case of Ovarian Hyper Stimulation Syndrome, failure semen production and supernumerary oocytes. Materials and Methods: All patients attending IVF and Infertility Center, University Hospital S.Orsola (Italy), were stimulated with recombinant-follicle stimulating hormone and gonadotropin releasing hormone analogues. Oocyte retrieval by transvaginal needle aspiration was performed 36 hours after ovulation triggering with recombinant Human chorionic gonadotropin injection. Metafase II oocytes were vitrified by Kuwayama’s protocol (2005) and microinjected after warming. Results: Results are shown in Table 1. [Formula presented] Conclusions: The efficacy of vitrification was assessed in vitro using survival, fertilization and cleavage rates and in vivo after embryo transfer by pregnancy, implantation and miscarriage rates. Results shows no statistically significant differences using HSV or Cryotop® for oocytes vitrification. Therefore, in order to ensure safety, especially during the current COVID-19 pandemic, the use of the closed device eliminates the potential sample contamination during vitrification and storage without compromising its in vitro and in vivo survival and development.