JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):179
Poster Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263909
P-167. Oocyte Quality vs. Competence: Unraveling the Influence of Female Factors in Assisted Reproduction
Maite Del Collado1, Amanda Setti2, Daniela Braga1, Jullin Fjeldstad3, Natalie Mercuri3, Edson Borges Jr4
1 Science For Everymind - São Paulo – SP- Brasil
2 Associação Instituto Sapientae - São Paulo – SP- Brasil
3 Future Fertility - Canada
4 Fertility Medical Group / FertGroup - São Paulo – SP- Brasil
Objective: In addition to the established impact of female age, the literature presents conflicting evidence regarding the influence of other female factors, such as polycystic ovary syndrome, endometriosis, and body weight, on oocyte quality and competence. This study aims to assess the impact of these conditions on oocyte quality and competence in assisted reproduction cycles.
Methods: In this retrospective cohort study, ICSI cycles in woman under 39 years, performed between January 2020 and May 2024 were collected and analyzed, and categorized into four female factor groups: polycystic ovary syndrome (PCOS; 31 cycles, 376 oocytes), endometriosis (END; 177 cycles, 1199 oocytes), overweight (OV; 522 cycles, 3384 oocytes), and obesity (OB; 202 cycles, 1338 oocytes). The control group (CTR; 1128 cycles, 6695 oocytes) consisted of cycles without any of the aforementioned female factors. For outcomes assessed from the ICSI stage onward, cycles involving men over 45 years of age or with severe male factor infertility were excluded. The artificial intelligence tool MAGENTA™ Score (MS) was used as a marker of oocyte quality, while the KIDScore™ was used to assess embryo quality. In addition, embryonic morphokinetic parameters, as well as laboratory and clinical outcomes, were also evaluated. Statistical analyses were conducted through pairwise comparisons between the control group and each of the female factor groups. For the analysis, a series of generalized linear models (GLMs) were performed using RStudio version 2024.12.1 (Posit Software, PBC, Boston, MA, USA). Models were adjusted for potential confounders: female and male age, gonadotropin dose, and estradiol levels on the trigger day for laboratory outcome analysis; and additionally for endometrial thickness and PGT-A performance (yes/no) for clinical outcome analysis. P-values<0.05 were considered statistically significant.
Results: Related oocyte quality, only PCOS differed significantly from the control group, showing a reduction in MS (4.84±0.19 vs. 6.11±0.06, p<0.0001). No significant differences were observed for the END (6.00±0.12), OV (6.29±0.09), or OB (6.31± 0.16) groups. Laboratory outcomes, including mature oocyte, fertilization, and blastulation rates, did not differ between any of the groups and the control. When comparing embryonic morphokinetics between the control group and the female factor groups, no or only slight differences in cleavage timings and synchronized cell divisions, cc2 and cc3 were observed, except in the PCOS group. Compared to the control, the PCOS group exhibited faster morphokinetics, particularly during the early stages of embryonic development up to the morula stage, as reflected by shorter timings for tPNa (5.87±0.14 vs. 6.47±0.05), tPNf (21.60±0.27 vs. 23.72±0.09), t2 (24.03±0.28 vs. 26.49±0.10), t3 (34.81±0.36 vs. 37.32±0.12), t4 (35.95±0.39 vs. 38.91±0.13), and tM (85.53±0.77 vs. 88.67±0.27). No significant differences were observed for tB or tSB. Similarly, no differences were detected in synchronized cell divisions (s1, s2, or s3) or in CC3, although CC2 was significantly shorter in the PCOS group (8.02±0.36 vs. 9.22±0.14). Despite these differences, no significant differences were observed in the KIDScore between the control group (4.56±0.07) and the PCOS (4.97±0.20), END (4.47±0.14), OV (4.27±0.10), or OB (4.48±0.20) groups. Finally, preliminary clinical outcomes indicated that none of the female factors differed from the control group in implantation, miscarriage, or pregnancy rates.
Conclusion: The findings of the present study suggest that, although PCOS could be associated with reduced oocyte quality as assessed by AI, it did not compromise oocyte competence or embryonic quality and competence. Similarly, endometriosis, obesity, and overweight did not appear to have a detrimental impact on oocyte or embryo quality and competence. These results highlight the importance of using multiple and complementary assessment tools to more accurately determine oocyte and embryo quality and competence.