P-419 Does adjuvant usage in the luteal phase improve live birth rates of ICSI - ET patients with previous implantation failure?
Authors: Uncu G , Kasapoglu I , Aslan K , Cinar C , Kuspinar G , Avci B 
Published: June 2022

Abstract

Study question
Does adjuvant usage in the luteal phase improve live birth rates of ICSI-ET (intracytoplasmic sperm injection - embryo transfer) patients with previous implantation failure?

Summary answer
Combination of low molecular weight heparin, aspirin, and prednisolone in the luteal phase doesn't improve live birth rates of ICSI-ET patients with previous implantation failure.

What is known already
RIF affects around 10% of patients undergoing IVF worldwide. The exact pathology of implantation failure, although transferring a good quality embryo, is still unknown. There are numerous treatment options, However, there is no conclusive evidence that prophylactic treatment improves the pregnancy rate in infertile women during IVF.

Study design, size, duration
This retrospective study included 1095 patients with &gt; 2 failed either fresh or frozen embryo transfer cycles between 2014 Jan – 2021 Jan.

Participants/materials, setting, methods
Patients were divided into two groups. Group-A consisted of patients with only vaginal progesterone for luteal phase support. Group-B consisted of patients with triple (daily subcutaneous low molecular weight heparin, daily p.o. 150 mg aspirin, and daily p.o. 16 mg prednisolone) luteal phase supplementation to vaginal progesterone. Demographic parameters, cycle characteristics, embryology, and pregnancy outcomes were compared, and the live birth rate was the study's primary outcome.

Main results and the role of chance
There were 5910 ICSI&ET cycles between the years Jan 2014 and Jan 2021. A total of 3853 Patients with single day5-6 good quality blastocyst transfer was selected from the database, and appropriate patients for inclusion criteria with at least two previous failure implantation history were included. As a result, a total of 1095 fresh or frozen-thawed ET cycles were included in the study. There were 617 patients without (Group A) and 478 patients with adjuvant use (Group B). Demographic parameters were similar between groups. Although higher embryology outcomes (Group A vs. B, No.of oocyte; 11 (7-17) vs. 13 (8-19), No. of MII; 9(5-14) vs. 10 (6-15), No. of 2PN; 5 (3-9) vs. 6 (4-10), p &lt; 0.01), positive b-hCG rates, miscarriage rates, live birth rates were similar between groups (Group A vs. B, positive b-hCG; 30.8% (190/617) vs. 35.4% (169/478), Miscarriage rates; 4.4% (27/617) vs. 6.7%  (32/478), Live Birth Rates; 20.4% (126/617) vs. 23.8% (114/478)). When the live birth rates were stratified depending on the number of previous failed transferred cycles, the live birth rates were still comparable between the groups.

Limitations, reasons for caution
The study's retrospective design limits the power of the results. The study's main limitation is the lack of the euploidy information of transferred embryos.

Wider implications of the findings
Our findings suggest that empirical usage of adjuvants such as low molecular weight heparin, aspirin, and prednisolone does not improve live birth rates in patients with previous implantation failure. These results support the present literature.

Trial registration number
Not applicable