Because latent form of matrix metallopeptidase-9 (proMMP9) levels are positively related to blastocyst development, it was hypothesized that addition during maturation may improve development of heat-stressed oocytes. To test hypothesis, 0, 30 or 300 ng/ml human proMMP9 (hMMP9) was added at 18 h of in vitro maturation (hIVM) to cumulus-oocyte complexes matured at 38.5 or 41.0ºC (first 12 h only). Heat stress decreased 24 hIVM proMMP9 levels only in 0 and 30 ng/ml groups and increased progesterone in 0 and 300 ng/ml hMMP9 groups. Heat stress decreased cleavage and blastocyst development. Independent of maturation temperature, hMMP9 at 18 hIVM decreased blastocyst development. In a second study, cumulus-oocyte complexes were matured for 24 h at 38.5 or 41.0ºC (HS first 12 h only) with 0 or 300 ng/ml hMMP9 added at 12 hIVM. Without hMMP9, heat stress decreased 24 hIVM proMMP9 levels and increased progesterone production. Addition of 300 ng/ml of hMMP9 produced equivalent levels of proMMP9 at 24 hIVM (271 vs. 279 ± 77 for 38.5ºC and 41.0ºC treated oocytes, respectively). Heat stress did not affect ability of oocytes to cleave but reduced blastocyst development. Independent of temperature, hMMP9 decreased cleavage and blastocyst development. In summary, hMMP9 supplementation during IVM did not improve development of heat-stressed oocytes even when it was added for the entire maturation period. At doses tested, hMMP9 appeared detrimental to development when supplemented during the last 12 or 6 h of oocyte maturation.

A total of 39,643 cycles by 22,668 patients were available for analysis. Mean age for each minority group was higher than Caucasians. Mean BMI was higher for African Americans and lower for Asians. African Americans were more likely to be diagnosed with diminished ovarian reserve, tubal and uterine factors, and less likely to be diagnosed with endometriosis, male factor, or ovulatory dysfunction, and asians were more likely to be diagnosed with diminished ovarian reserve (P<0.0001 for each). The number of embryos transferred and cryopreserved were similar among all four groups. The significantly lower pregnancy and birth rates per transfer for the African American and Asian groups persisted after adjusting for age, BMI and diagnoses in the GEE analyses, as did the higher pregnancy loss rate for African Americans (p<0.0001 for each).CONCLUSIONS: This is the largest single practice study evaluating the association between race and ART outcomes. The significantly lower pregnancy and birth rates among African Americans and Asians, and the increased pregnancy loss rate among African Americans, when compared to Caucasians, could not be explained by differences in age, BMI, or infertility diagnoses that existed among these groups. Explanations for the poorer ART outcomes observed among these two groups require further study.

suggesting that low grade mosaic embryos (<50%) can have the same potential to give healthy newborn as euploid embryos and the PGDIS guidelines needs to be reconsidered. As far as we know this is the second study that provides data about the LBR of mosaic embryos (Greco et al., 2015). No deliveries were obtained from the transfer of complex mosaic embryos.

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