IVF Outcome Research Articles

Meiotic Spindle View improves the Outcome of IVF in Poor Responders: A Retrospective Analytical Study from an Indonesian IVF Center.

Previous studies have shown that the meiotic spindle is not always aligned with the first polar body (PB) in metaphase II human oocytes. Polarized Light Microscopy (PLM) has been used to observe and locate the meiotic spindle to avoid disrupting it while injecting oocytes. The aim of this study is to evaluate the relationship between meiotic spindle view and IVF-ICSI outcomes in poor responder women. This study was a retrospective analytical study, carried out from January to November 2019; involving 115 poor responder women who underwent IVF-ICSI cycles at the Halim Fertility Center, Indonesia. The patients were divided into two groups: group I without meiotic spindle viewing (non-MSV) as control group, and group II with meiotic spindle viewing (MSV) as the case group. The meiotic spindles were imaged before ICSI with Oosight microscopy. Baseline characteristics and IVF-ICSI outcomes of both groups were compared. Our study included 115 poor responder women with non-MSV group (71 women), and an MSV group (44 women). The results showed that there was no significant difference in the fertilization rate between the two groups (p>0.05), but the embryo cleavage rate was higher in the MSV group when compared to the non-MSV group; and there was a significant difference between the two groups (p<0.05). The fertilization rate was higher in aligned than misaligned spindle and there was a significant difference between the two groups (p<0.05). Good quality embryo was higher in MSV group than non-MSV group (59.05% vs. 63.95%). Meiotic spindle view might improve the outcome of IVF in poor responder women.

Intraovarian platelet-rich plasma injection in poor responders.

To evaluate if it possible to improve ovarian reserve parameters and oocyte retrieval in poor responders who undergo intraovarian injection of platelet-rich plasma (PRP). Prospective cohort study. We included 148 poor responders who underwent PRP injection between October 2021 and December 2022 in our institution, comparing pre and post PRP ovarian function. In addition, the IVF outcomes of a subgroup of patients was studied after the intervention in contrast with the previous treatment. An improvement in ovarian reserve was observed in relation to previous values: FSH (13.57 vs. 11.32, p=0.11), AMH (0.39 vs. 0.48, p=0.06), antral follicle count (3.98 vs. 5.75, p<0.001); as well as a higher number of oocytes retrieved (2.63 vs. 3.65, p=0.01) and produced embryos (1.64 vs. 2.22, p=0.03); without a great impact on pregnancy rates. Although experimental, intraovarian PRP could restore ovarian function and be postulated as an alternative to oocyte donation in patients with low ovarian reserve who do not accept this treatment. There is a lack of randomized controlled trials to support these findings.

Markers of Oocyte Quality to Enhance Human IVF Outcomes: A Bibliographic Review

Markers of Oocyte Quality to Enhance Human IVF Outcomes: A Bibliographic Review

Factors associated with successful In-Vitro Fertilization Treatment at Lusaka IVF and Fertility Clinic in Zambia

Background: The considerable emotional, physical and financial burden associated with infertility and its treatment in general, demands that factors strongly associated with the outcome should be identified and regulated prior to embryo transfer. This will improve the outcome of IVF and provide a patient centered approach to treatment.&#x0D; Methods: This was a cross sectional study at the Lusaka IVF and fertility clinic. The study aimed to identify factors associated with successful IVF treatment. 414 women had undergone IVF treatment and were eligible. The data was collected from patients’ files and entered in excel then exported to Stata V13.1.for analysis. The participant’s characteristics were compared using the Chi square. The success rate was calculated and associations measured using univariate and multivariate logistic regression.&#x0D; Results: The success rate of IVF treatment was 31% in the study period. Factors associated with successful IVF treatment include age, number of embryos transferred and the sperm factor. These were statistically significant. It was noted that post-menopausal women were 3 times more likely to have a successful IVF than those less than 35 years.&#x0D; Conclusion: The success rate of IVF treatment at LIVF clinic was 31%. The factors associated with successful IVF treatment were age of the woman, order of embryos transferred and use of donor sperm. There is need to engage the law makers to come up with a legal framework that will guide on the handling of gametes which will include sperm and oocyte donation and receiving, freezing, transportation and surrogacy.

Association between the systemic immune-inflammation index and GnRH antagonist protocol IVF outcomes: a cohort study

Research questionWhat is the relationship between the systemic immune-inflammation index (SII) and IVF outcomes in women undergoing a gonadotrophin-releasing hormone (GnRH) antagonist protocol? DesignThis retrospective cohort study analysed clinical data and blood samples collected before oocyte retrieval from participants undergoing IVF with the GnRH antagonist protocol. Logistic regression and generalized additive models were used to examine the association between SII quartiles and continuous SII values and IVF outcomes. ResultsHigher SII values correlated negatively with biochemical pregnancy, clinical pregnancy, live birth and implantation rates, and positively with early pregnancy loss, independent of age, body mass index, anti-Müllerian hormone and stimulation parameters. The most significant adverse outcomes were observed in the highest SII quartile. A non-linear relationship was identified between log-transformed SII and IVF outcomes, with an inflection point at an SII of approximately 6.72, indicating a threshold effect. ConclusionsElevated SII is associated with poorer IVF outcomes in women after the GnRH antagonist protocol, suggesting its potential as a predictive marker in IVF treatments. Further research is needed to confirm these findings and explore the underlying mechanisms.

Intraovarian platelet-rich plasma injection in poor responders

Objective:&#x0D; To evaluate if it possible to improve ovarian reserve parameters and oocyte retrieval in poor responders who undergo intraovarian injection of platelet-rich plasma (PRP).&#x0D; Design:&#x0D; Prospective cohort study. We included 148 poor responders who underwent PRP injection between October 2021 and December 2022 in our institution, comparing pre and post PRP ovarian function. In addition, the IVF outcomes of a subgroup of patients was studied after the intervention in contrast with the previous treatment.&#x0D; Results:&#x0D; An improvement in ovarian reserve was observed in relation to previous values: FSH (13,57 vs. 11,32, p=0,11), AMH (0,39 vs. 0,48, p=0,06), antral follicle count (3,98 vs. 5,75, p&lt;0,001); as well as a higher number of oocytes retrieved (2,63 vs. 3,65, p=0,01) and produced embryos (1,64 vs. 2,22, p=0,03); without a great impact on pregnancy rates.&#x0D; Conclusions:&#x0D; Although experimental, intraovarian PRP could restore ovarian function and be postulated as an alternative to oocyte donation in patients with low ovarian reserve who do not accept this treatment. There is a lack of randomized controlled trials to support these findings.

Endometrial Compaction and its Impact on IVF Outcomes

Endometrial Compaction and its Impact on IVF Outcomes

#383 : The Correlation Between Serum Estradiol, Luteinizing Hormone (LH), and Progesterone on Day Human Chronic Gonadotropin (hCG) with In Vitro Fertilisation (IVF) Outcome

Background and Aims: Serum estradiol, LH, and progesterone have been studied for many years as they were considered to have relation with the pregnancy outcome in IVF procedure. The aim of this study is to determine the serum estradiol, LH, progesterone, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy distribution of IVF patients; and to determine the correlation between serum estradiol, LH, and progesterone on day hCG with IVF outcome. Method: This is an observational study that was conducted in Yasmin IVF Clinic from 2013 until 2021. There were 416 samples. The serum estradiol, LH, and progesterone were collected from the IVF patient on day hCG. The IVF outcomes were collected by hCG blood test (biochemical pregnancy), USG (clinical pregnancy), and being checked after several months (ongoing pregnancy). The statistical analysis used IBM SPSS Statistics 26. Results: The serum estradiol, LH, progesterone, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy were distributed abnormally. There is no significant difference between serum estradiol on hCG day with biochemical pregnancy (p=0.81), clinical pregnancy (p=0.205), and ongoing pregnancy (p=0.117). There is no significant difference between serum LH on hCG day with biochemical pregnancy (p=0.606), clinical pregnancy (p=0.45), and ongoing pregnancy (p=0.396). There is no significant difference between serum progesterone on hCG day with biochemical pregnancy (p=0.363), clinical pregnancy (p=0.942), and ongoing pregnancy (p=0.352). Conclusion: There is no significant difference between serum estradiol, LH, and progesterone on day hCG with IVF outcome.

Debate 4: Morphological Assessment of Embryos is Outdated

Motion: For The Outdated Significance of Morphological Assessment in Embryo Selection and the Rise of Advanced Technologies in Reproductive Medicine This symposium lecture presents a compelling debate, shedding light on the diminishing relevance of traditional static morphological assessment as a primary criterion for embryo. The speaker aims to challenge the long-standing reliance on morphological evaluation and advocate for the integration of cutting-edge technologies as a more reliable and objective means of embryo quality assessment. During the debate, the speaker will examine the limitations of morphological assessment, acknowledging its subjective nature, potential bias, and lack of comprehensive insight into embryonic development. The traditional morphological assessment based solely on visual appearance may not adequately predict an embryo’s true potential for successful implantation and healthy pregnancy. A variety of available new technologies will be highlighted during the lecture, showcasing alternatives to morphological embryo assessment. Attendees will gain insight into how these innovative methods can offer more objective and precise measures of embryo quality, enhancing the success rates of assisted reproductive procedures. The symposium will foster an engaging environment, encouraging active participation and thoughtful discussions among attendees from the reproductive medicine community. Participants will have the opportunity to challenge prevailing notions and explore the implications of adopting new technologies in clinical practice. In summary, this debate aims to catalyze a paradigm shift in embryo evaluation, emphasizing the need to move beyond traditional morphological assessment towards embracing advanced technologies, to optimize embryo selection and lead to improved outcomes in IVF. Motion: Against Morphological Assessment of Embryos is Not Outdated In the era of new technologies and artificial intelligence, looking good has never been more important! On-time progression through specific events is requisite for human preimplantation development and provides important visual insights into the health and physiology of the embryo. The formation of 2 distinct pronuclei, the times and patterns of cleavage, and how the cells compact are all key markers of development. Following compaction, the formation of the blastocyst is not only a temporally regulated event, but also an energetically demanding process, one that reflects the metabolic activity (a biomarker of viability) of the embryo. Further, at the blastocyst stage it is possible to visualise and quantitate the formation of both the inner cell mass (ICM) and trophectoderm, with all parameters of blastocyst development linked to transfer outcomes. The development of time-lapse incubation, which can be described as embryo morphology over time, has led to the incorporation of several key morphological features to support embryo selection, further reflecting the significance of embryo morphology. Interestingly, AI algorithms used for embryo selection reflect predominantly those morphological parameters that are known to affect transfer outcomes, such as blastocyst quality. While only specific molecular tests can accurately determine the precise chromosomal composition of an embryo, key morphological features and events can also be used to tag those embryos at greatest risk of being genetically abnormal. In conclusion, key morphological developmental events indirectly inform us of the physiology of the embryo (degree of blastocyst expansion reflects metabolic activity for example), and hence this is why morphological grading systems (such as the Gardner Grade for blastocysts) have been shown to be effective in embryo selection for over the past 25 years, and further have proven to be as useful as AI or biomarker analysis for the majority of patients.

#281 : IVF Outcome of Good Prognosis Patients Based on Sperm Morphology Grading Using Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Technique

Background and Aims: Spermatozoa morphology is one of the factors that can influence the success of IVF. IMSI is a technique that provides various selection criteria of sperm head’s morphology and the presence of vacuoles with a total magnification of over 6,000. The purpose of this study was to compare the embryo development of good prognosis patients based on sperm morphology grading using IMSI technique. Method: This study was a retrospective analysis performed at Morula IVF Jakarta from 2019 to 2022 based on good prognosis patients (age [Formula: see text] 38 years, AFC [Formula: see text] 7, AMH [Formula: see text] 1.1). There were two groups in this study, (A) sperm grade I and II, (B) sperm grade III and IV, based on Vanderzwalden et al. (2008). The number of patients in group (A) was 1035 patients, and group (B) was 345 patients. The parameters observed in this study were fertilization rate (FR), top embryo quality rate on day 3 (D3) and day 5 (D5), blastocyst rate (BR). Results: The result study showed that (FR) were significantly increased (P=0.000) in group (A) compared to group (B), which was 77.28% and 72.90%. In addition, group (A) had significantly (D3), which was 51.37% (P=0.012) compared to group (B) 46.92%. On the other hand (D5) and (BR) were significantly increased (P=0.000) in group (A), by about 42.58% and 48.01%, contrasted to group (B), which was only 36.11% and 39.21%. Conclusion: Grade I and II sperm of IMSI technique significantly increased IVF outcome in good prognosis patient.

#287 : A Comparison of hCG Trigger Versus Dual Trigger for Final Oocyte Maturation in Poor Ovarian Responders Undergoing Minimal Stimulation

Background and Aims: Traditionally, hCG has been used for oocyte triggering. However, women with poor ovarian response manifest low oocyte yield and compromised occyte quality. More recently, a combination of hCG and GnRHa (dual trigger) has been shown to improve follcile collection yield and oocyte maturation. The aim of the study is tocompare the result of final oocyte maturation and the embryo formation between two groups of poor ovarian responders undergoing minimal stimulation after triggering by hCG alone versus dual trigger. Method: This randomized control trial was conducted at National Assisted Reproductive Center, National Hospital of Obstetrics and Gynecology. Patients defined as poor ovarian responders according to the Bologna criteria were equally divided into two groups: control (hCG trigger) and investigation (dual trigger) groups. The group received the hCG trigger (6500 IU) and the investigation group received the dual trigger (0.2 mg of Triptorelin plus 6500 IU of hCG). Minimal stimulation IVF protocols consist of 5 days of 100mg clomiphene citrate and small amounts of gonadotropin. Results: One hundred and two patients were included in the study, with 51 women in each treatment group. Dual triggering showed a significant higher number of retrieved oocytes (5.35 ± 3.13 vs 4.35 ± 2.44, P=0.038) and metaphase II oocytes (4.25 ± 3.12 vs 3.35 ± 2.02, P=0.043). Although not reaching statistical significances, increases in the number of fertilized oocytes, embryos, and number of top-quality embryos (TQE) were observed. Conclusion: Dual trigger for final oocyte maturation is associated with better IVF outcome in poor ovarian responders undergoing minimal stimulation. Acknowledgements: The authors are grateful to all physicians, administrative staff at the National Assisted Reproductive Technology Center, National Hospital of Obstetrics and Gynecology, Vietnam for allowing and supporting us to undertake this research.

#167 : Role of Endometrial Receptivity Using 3D Doppler Ultrasound on Pregnancy Outcome of IVF-FET Cycles

Background: The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends primarily on the quality of the embryo and the receptivity of the uterus. In addition to embryo quality the receptivity of the endometrium plays a role in the implantation process. Uterine receptivity is widely accepted as one of the main limiting factors in IVF outcomes. Endometrial thickness and endometrial pattern have been regarded as indicators for endometrial receptivity. Objective: To compare the ultra-sonographic endometrial characteristic in relation to blood flow on Doppler between pregnant and non-pregnant groups of FET patients in IVF/ ICSI cycles. Methods: This cross-sectional study is approved by the Institutional Ethical Committee (IEC) of Hameed Latif Hospital. Our study consists of 200 women who have come for FET cycle. On 18th day of period cycle, endometrial thickness, resistance index was obtained by transvaginal sonography. In the combined analysis, endometrial thickness groups (group 1: &lt;9 mm; group 2: [Formula: see text]9 mm) were subdivided into two endometrial patterns (triple-line and diffused). The women were divided into the [Formula: see text]-HCG positive and [Formula: see text]-HCG negative groups. For statistical analysis chi-square and Fisher’s exact tests was used. Multiple logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were applied to determine the best predictive variables. Results: The women in [Formula: see text]-HCG positive group were significantly younger as compared to [Formula: see text]-HCG negative group. Endometrial thickness was ¿ 9mm and RI was lower in group 1. A significant association was found between endometrial pattern and pregnancy outcome. (p-value = 0.01. ROC curve revealed that for ultrasound parameters the area under the curve was around 0.5. Conclusion: Endometrium pattern and thickness and resistive index on Doppler may better predictor for pregnancy; combined endometrial characteristics do not predict outcomes.

Impact of Prestimulation Treatment

Polycystic ovarian syndrome (PCOS) is one of the commonest endocrine disorders encountered in women of reproductive age. It is characterised by an altered Androgen metabolism which leads to irregular menses, anovulation and hyperandrogenism (HA). It is associated with hyperinsulinaemia and obesity which aggravate the HA status. Ovulation induction and controlled ovarian stimulation pose a unique challenge in these patients. The endocrine disturbance leads to arrest of follicular growth and patients may either not respond to OI drugs are may hyper-respond leading to a risk of OHSS. The best strategy to improve outcome of IVF in PCOS patients is still under consideration. This lecture will address pre-treatment (IVF) drugs and strategies that ameliorate HA, decrease the risk of OHSS and improve cycle outcome. Selection of the safest and most effective OS protocols will be discussed. Use of segmental IVF in PCOS patients has almost eliminated OHSS- it involves using an antagonist protocol with a GnRH agonist trigger and a freeze all strategy. The pros and cons of this strategy will be discussed. We will also look at the current status of Metformin Inositols, Vit D in PCOS patients and their role in improving IVF outcome. Use of pre-treatment hormones/OCP’s and their effect on IVF outcome will be deliberated. Lifestyle change and weight reduction are important to improve the HI &amp; HA status and have become a fundamental requirement in these young women. The challenge patients face in achieving weight reduction goals due to the inherent metabolic disturbances needs to be recognised. At the end of the lecture the delegate would be able to have a better understanding of the current status of various pre-treatment strategies used in PCOS patients undergoing IVF.

#186 : Ultra-Long Protocol During IVF Outcome in Infertile Women with Endometriosis

Background and Aim: Endometriosis issue with infertility may require ART and long-term GnRH agonist therapy prior to frozen embryo transfer was associated with a greater rate of clinical pregnancy. The aim of the study is to assess pregnancy outcomes in endometriosis patients who have received GnRH-a ultra-long protocol prior to IVF. Method: A retrospective cohort study was conducted at the Yasmin IVF Center, Dr. Cipto Mangunkusumo General Hospital in Jakarta. The study included all Patients diagnosed with endometriosis and underwent IVF procedure with GnRH-a ultra-long protocol was used for ovarian stimulation from July 2021 to January 2023. Parameters observed were maternal age, body mass index, oocytes retrieved, fertilization rate, blastocyst rate, and pregnancy rate. Result: There were 12 patients who underwent IVF and received ovarian stimulation with ultra long protocol. The average oocyte retrieved in this study was 12 ± 5,3 with the average fertilization rate was 66,2 ± 18,2. We found a pregnancy rate was 58,3% and total live born child was 3 out of 7 patients (42,8%). We assessed based on the presence of intrauterine gestational sac with fetal heartbeat at ultrasound examination. Conclusion: Ultra long protocol for stimulations in patients with endometriosis have a chance to improve oocytes retrieval, fertilization rate, and pregnancy rate.

Impact of adenomyosis on IVF outcomes in women undergoing donor oocyte transfers: a prospective observational study

To prospectively examine the association between adenomyosis type, location, and severity with reproductive outcomes in patients undergoing single embryo transfer (SET) with embryos derived from donor oocytes. A prospective observational cohort study. University-affiliated in-vitro fertilization center. Infertile patients with (n=114) and without (n=114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in the study. Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2D/3D transvaginal ultrasound, and classified according to type (diffuse, focal), localization (inner/outer myometrium and/or the junctional zone) and uterine extension (mild, moderate, severe). Following an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage. The primary outcome was the implantation rate. The secondary outcomes were clinical pregnancy, live birth, and miscarriage rate following SET. (s): The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate compared to those without adenomyosis (20.2% vs. 9.6 %, respectively; p=0.04). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, TVS-detection of adenomyosis in the junctional zone was associated with over three-fold higher odds of miscarriage (RR 3.28, 95% CI 1.38-7.78; p=0.004). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy (RR 0.30, 95% CI 0.13-0.72; p=0.004). Diffuse adenomyosis in the JZ and severe adenomyosis raised the odds of miscarriage four-fold (RR 2.29, 95% CI 1.22-4.30; p=0.015; and RR 2.20, 95% CI 1.19-4.04; p=0.005). (s): This study demonstrated that while adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the junctional zone and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of infertile patients.

What is the Optimum Endometrium Needed for Implantation?

Implantation most critical step in reproduction. A complex process where blastocyst becomes intimately connected with maternal endometrium/decidua and requires; Competent embryo at blastocyst stage Receptive endometrium Synchronized dialogue between maternal and embryonic tissues Endometrial Changes for Implantation include architectural, morphological, cytochemical, molecular and genetic. These Changes Induce Endometrial receptivity, which is endometrial lining in a state of readiness for blastocyst implantation. It involves acquisition of adhesion ligands and loss of inhibitory components that may act as a barrier to an attaching embryo. Receptive endometrium is capable of selecting good quality embryos and reject the incompetent embryos. Endometrial Evaluation includes 1. Non-Invasive Assessment of Endometrial Receptivity by USG 2. Detection of abnormal Uterine cavity by 3D USG/SIS, HSG and Hysteroscopy 3. Diagnose Chronic Endometritis by hysteroscopy and Molecular tests? 4. Endometrial Microbiome by molecular tests 5. Endometrial asynchrony - Proteomics and transcriptomics 2D and 3D Ultrasound can Identify patients with poor implantation prognosis but has low predictive value in determining endometrial receptivity and IVF outcome. Ideal endometrial thickness for optimal outcome is between 7-14 mm. No Association was seen between clinical pregnancy rates (CPR) and endometrial pattern for women undergoing in IVF with fresh ET and FET. Minimum Endometrial Volume associated with pregnancy is 1.59 mL – 3D. But most pregnancies occur in volumes of 2-13 mL. Evaluation of endometrial volume is particularly useful in synechiae, adenomyosis and uterine anomalies. Vascularity demonstrated within Zone 3 or within Zones 3 and 4 prior to transfer is associated with good implantation rate. Presence of &gt;3 peristaltic contractions of the sub endometrial myometrium/2 minutes interval on Day of hCG administration associated with poor implantation. Diagnosis of chronic endometritis is based on hysteroscopy, endometrial biopsy with plasma cells being identified histologically and specific treatment is determined based on microbial culture. Existence of non-Lactobacillus bacteria in the endometrium is correlated with negative impacts on reproductive function and should be considered as an emerging cause of implantation failure and pregnancy loss. Endometrial Receptivity Array (ERA) is validated for analysing the expression of 238 genes that are intimately related to endometrial receptivity. Abnormality in endometrial receptivity is displayed a specific gene expression profile. Intrauterine secretory profile directly linked to successful implantation and evaluation of endometrial fluid for cytokine, interleukin and growth factor secretions can be used to assess the endometrium. Conclusion: Identification of one or more of endometrial parameters that definitely indicate receptivity for implantation remains an elusive goal. None of the endometrial receptivity markers have sufficient discriminatory value to act as a diagnostic test for endometrial receptivity based on their ability to predict clinical pregnancy. Due to the dynamic, cyclic nature of the endometrium it may be difficult, to reliably assess endometrial function on the basis of a single test.

Impact of Transcutaneous Electrical Acupoint Stimulation on BDNF Expression and IVF Outcomes in Patients with Infertility

Impact of Transcutaneous Electrical Acupoint Stimulation on BDNF Expression and IVF Outcomes in Patients with Infertility

Novel Method to Improve IVF and ICSI Outcomes

Novel Method to Improve IVF and ICSI Outcomes

#243 : Comparison of IVF Outcome Following Follitropin Alfa and Follitropin Delta Utilization at Melati Clinic, Harapan Kita Women and Children Hospital

Background and Aims: Follitropin delta is the third recombinant FSH (rFSH) preparation developed with an individualized dosing regimen based on patient’s body weight and AMH level. According to the existing report, a daily dose of follitropin delta provides an equivalent ovarian response to that of follitropin alfa. However, the effect of follitropin delta on the resulting embryo and biochemical pregnancy remains to be elucidated. Hence, the present study aims to evaluate the effect of follitropin delta on embryo quality and biochemical pregnancy rates compared with that of follitropin alfa in an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle. Methods: A retrospective cohort study was conducted between January and December 2022 at Melati Clinic, Harapan Kita Women and Children Hospital. A total of 59 IVF/ICSI cycles stimulated with follitropin alfa and 26 IVF/ICSI cycles treated with follitropin delta were subsequently analyzed. Results: After analysis, no significant difference was observed regarding the embryo quality of both treatments (P&gt;0.05). The median of the good, moderate, and poor embryos in the follitropin alfa and follitropin delta group was 2 vs. 3, 1 vs. 2, and 2 vs. 2, respectively. Similarly, the biochemical pregnancy rate between the follitropin alfa and follitropin delta group was comparable (25% vs. 15%, P&gt;0.05). Conclusions: In conclusion, our study suggests that stimulation with follitropin delta in IVF/ICSI cycles yields a similar embryo quality and biochemical pregnancy rates to those of follitropin alfa.

#304 : Comparing GnRH Agonist and GnRH Antagonist Protocols for IVF-ET Outcomes in Patients with Endometriosis: A Meta-Analysis

Background and Aims: Endometriosis is known to have detrimental effects on fertility, but there is no consensus on the optimal stimulation protocol for IVF-ET in patients with endometriosis. The study aimed to compare the IVF outcomes of gonadotropin-releasing hormone (GnRH) agonist protocols versus antagonist protocols in patients diagnosed with endometriosis. Method: We performed a meta-analysis of studies that compared IVF outcomes of GnRH agonist versus antagonist protocols in patients with endometriosis. Through literature search, we retrieved 222 articles, and the last search date was April 7, 2023. Among them, six studies which met inclusion criteria were eligible for final analysis. The primary outcome was clinical pregnancy. Random effects and fixed effects models were applied according to I2 statistics. Results: The use of GnRH agonist was associated with higher clinical pregnancy rate (Odds ratio (OR) 1.61, 95% CI 1.35–1.93, 6 studies, [Formula: see text]&lt;0.00001, I2=16%), higher live birth rate (OR 1.75, 95% CI 1.32–2.33, 3 studies, [Formula: see text]&lt;0.0001, I2=12%), and similar miscarriage rate. The total dose of gonadotropin did not differ between the two methods, but the GnRH agonist protocol had a longer duration of stimulation (WMD 1.34, 95% CI 0.44–2.24, 5 studies, I2=98%), retrieved more oocytes (WMD 2.23, 95% CI 0.58–3.88, 3 studies, [Formula: see text]=0.0008, I2=97%), more MII oocytes (WMD 2.81, 95% CI 2.34–3.28, 3 studies, [Formula: see text]&lt;0.00001, I2=0), and more embryos (WMD 1.90, 95%CI 1.13–2.67, 3 studies, [Formula: see text]&lt;0.00001, I2=68%). Conclusion: Patients with endometriosis may benefit from using GnRH agonist protocol in the IVF-ET cycle, as it may be associated with a higher clinical pregnancy rate and live birth rate. Even though the stimulation duration is longer, more oocytes, mature oocytes, and embryos may be expected. Although the findings of this study may be potentially beneficial for clinicians, it is crucial to conduct additional randomized prospective trials with larger cohorts to further validate the results.