P-363 Ovarian endometriosis deteriorates embryo development in ART cycles: An embryonic time-lapse study
Authors: Ho J Y P , Ho N T , Liao W J , Huang Y L , Lee Y R , Lin H H , Tzeng S Y , Chao C Y , Lin C M , Chu P L , Hsu Y C , Chen Y H , Tzeng C R 
Published: June 2023

Abstract

Study question
Does ovarian endometriosis deteriorate embryo quality in terms of morphokinetic parameters determined by time-lapse images?

Summary answer
Embryos from ovarian endometriosis patients accelerate their early developmental events but decelerate after t5. Completion of late developmental events were significantly delayed in endometriosis group.

What is known already
Endometriosis may affect the oocyte quality and consequently affect the embryo quality in terms of embryo morphology and implantation ability. Morphokinetic evaluation of embryos provided more developmental details and might be utilised as a tool to distinguish the embryo developmental ability. Only scarce studies with limited case numbers have evaluated the association between endometriosis and developments of embryo in terms morphokinetic observation. Hardly any consensus has ever been drawn.

Study design, size, duration
The morphokinetic parameters of embryos were compared between patients with or without ovarian endometriosis. A total of 52 ovarian endometriosis cases and 208 controls without endometriosis, receiving their assisted reproductive techniques from April 2020 through June 2022, were included for analysis. Propensity Score Matching with age, BMI and AMH was performed in a ratio of 1:4 in order to eliminate the confounding factors.

Participants/materials, setting, methods
We analyzed a total of 737 top quality embryos obtained from 348 oocyte retrieval cycles performed at Taipei Fertility Center. 127 embryos were obtained from women affected by ovarian endometriosis and 617 were obtained from unaffected controls. All embryos were cultured in a time-lapse incubator chamber and completed blastulation.

Main results and the role of chance
Morphokinetic data showed that embryo development is distorted in embryos obtained from women with endometriosis. The timing of early developmental events, including tPNf (22.7 +/- 2.9 hr vs 23.5 +/- 4.1 hr, p = 0.03) and t2 (25.2 +/- 3.1 hr vs 26.1 +/- 4.4 hr, p = 0.03) were significantly shortened in the endometriosis group. However, the timing of late developmental events, including tM (89.7 +/- 9.8 hr vs 86.6 +/- 11.4 hr, p = 0.006) and tB (111.0 +/- 11.0 hr vs 108.3 +/- 12.5 hr, p = 0.03) were significantly prolonged in the endometriosis group. The timing of t5 by morphokinetic observation was found to be equal both in ovarian endometriosis group and control group (50.4 +/- 8.7 hr vs 50.4 +/- 8.4 hr, p = 0.99). The average of KID score of embryos from ovarian endometriosis group was lower than that from normal control, but it did not reached statistical significance (4.07 +/- 2.11 vs 4.49 +/- 2.70, p = 0.27). The initial serum hCG levels in pregnant women from both endometriosis and non-endometriosis participants showed that hCG levels were significantly higher in non-endometriosis cases (628.8 +/- 967.7 mIU/ml vs 1581.5 +/- 1885.1 mIU/ml, p = 0.01).

Limitations, reasons for caution
This is a retrospective observational study with propensity score matching method to eliminate confounding factors such as age, BMI and AMH.

Wider implications of the findings
The effects of prolonged morphokinetic parameters on the embryo quality need further study to clarify; however, they may serve as markers in selecting embryos with implantation potential.

Trial registration number
Not applicable