P-201 Identifying patients benefiting from delayed-matured oocytes insemination. (30th June 2022)

• Record Type: Journal Article
• Authors: Elkhatib, I; Bayram, A; Abdala, A; Arnanz, A; Melado, L; Eldamen, A; Lawrenz, B; Fatemi, H
• Is Part Of: Human reproduction. Volume 37(2022)Supplement 1
• Publication Date: 2022-06-30
• Subjects: Human reproduction -- Periodicals; 618
• DOI: 10.1093/humrep/deac107.194
• Languages: English
• ISSNs: 0268-1161

Abstract

Abstract: Study question: Are there any predictive factors supporting the decision of inseminating delayed-matured oocytes? Summary answer: Patients with ≤59% mature oocytes at retrieval and/or Anti-Mullerian-Hormone (AMH) >2.52 ng/ml have increased chances of obtaining a euploid embryo from delayed-matured oocytes. What is known already: Approximately 15% of oocytes retrieved after ovarian stimulation are immature, at metaphase I (MI) or germinal-vesicle (GV) stages at the time of oocyte denudation. Performing IVM in those oocytes could permit an increase on the number of usable embryos. Nevertheless, the utility of delayed-matured oocytes varies greatly among IVF laboratories with relatively low success rates, hence its practice in daily routine might be counter-productive. Determining which patient population could benefit from such strategy is valuable thereof to the clinical practice. Moreover, data comparing euploid rates of embryos derived from delayed-matured oocytes with its mature sibling oocytes are needed. Study design, size, duration: This observational study was performed at ART Fertility Clinics, Abu Dhabi, UAE, between January 2019 and June 2021. A total of 5454 cumulus oocytes complexes (COC) were retrieved from 469 ovarian stimulation cycles. Out of the retrieved COCs, 3473 oocytes were immediate at metaphase II (MII-D0), and 915 were delayed-metaphase II oocytes (MII-D1). Participants/materials, setting, methods: Patients with primary and secondary infertility undergoing Controlled ovarian stimulation (COS) in standardized protocols for IVF/ICSI treatment were included. Ovum pick up performed 34-36h post final oocyte maturation trigger shot (TS). Insemination was done 39-41h post TS for the MII-D0, while MII-D1 ICSI was performed 63-68h post TS. All cycles were planned for Preimplantation Genetic Testing for Aneuploidies (PGT-A) at blastocyst stage using Next Generation Sequencing (NGS). Main results and the role of chance: Fertilization rates significantly differed between MII-D0 and MII-D1 oocytes (69.54% vs 55.96%, p < 0.001, respectively). Blastocyst utilization rates were significantly higher in MII-D0 group compared to MII-D1 group (59.47% vs 18.52%, p < 0.001). However, no difference was observed in the rate of euploid blastocysts between MII-D0 and MII-D1 (46.3% vs 39.0%, p = 0.163). As identified by univariant logistic regression analysis, the following parameters augmented the chances of obtaining at least 1 blastocyst for biopsy when MII-D1 were injected: AMH (OR 1.15, p < 0.001), number of COCs collected (OR: 1.03, P = 0.005), maturation rate on day0 (OR: 0.19, P = 0.001). When the multivariant analysis model was applied, AMH and maturation rate on day0 remained significant factors predicting the success of inseminating delayed-matured oocytes (OR:1.15, [CI:1.00-1.32], p = 0.045); OR:0.06, [CI:0.03-0.31], p < 0.001, respectively), with cut off values of AMH >2.52 ng/ml and maturity rate of ≤ 59%, being identified by ROC analysis. Limitations, reasons for caution: ICSI of MII-D1 was performed with the fresh or frozen sperm samples from the previous day. Exact timing of polar body extrusion of delayed-matured MI/GV was not identified. Wider implications of the findings: The results of this study might provide guidance to the IVF laboratories for targeting the patient population who would benefit from MII-D1 ICSI without adhering to unnecessary costs and workload. Trial registration number: not applicable