Hafizi, Ezanaton Nisar Omar
(2022)
The predictors for high-quality embryos for advanced age women undergoing intracytoplasmic sperm injection cycles in Hospital USM Fertility Unit.
Masters thesis, Universiti Sains Malaysia.
Abstract
Advanced age women associated with fertility decline as a result of ovarian reserve
depletion and declining oocyte and embryo quality. Determining the predictor factor of
oocytes and embryo quality may assist in stimulation target and cycle prediction. The study
is to determine the oocyte and embryo quality among advanced age woman receiving
Intracytoplasmic Sperm Injection cycles in Hospital USM Fertility Unit. Predictors for highquality
oocytes and embryos were identified. This prospective observational study was
performed over a period of 24 months in Hospital USM Fertility Unit, on 941 oocytes
retrieved from 124 women of advanced age receiving ICSI. Oocytes grading by means of its
morphological appearances and the SARTCORS grading system for embryo grading were
used to determine their qualities. Fertilization rate and cleavage rate were expressed as
percentage per cycle, while pregnancy rate was expressed as percentage per transfer.
Possible predictors of good-quality oocytes and high-quality embryos were evaluated using
single and multiple regression tests, with p < 0.05 considered as significant. From 941
retrieved oocytes, 291 oocytes (39.64%, mean 2.35 SD=1.79 per cycle) were Grade 1
oocytes, while 272 oocytes (37.06%, mean 2.19 SD=1.27) were Grade 2 oocytes and the rest
(n=171, 23.30% mean 1.38 SD=1.22) were Grade 3 oocytes. Among 586 available embryos,
500 (85.32%, mean 4.03 SD=3.22) high-quality embryos were obtained. The fertilization
and cleavage rates were 81.6% and 97.8%, per cycle respectively. Seventy-six embryo
transfers were conducted, with 17 successful conceptions (pregnancy rate = 22.37% per transfer). There were no miscarriages among the pregnancies. This study has proved that
increasing the number of collecting mature oocytes and cleavage rate could increase the
chance of obtaining high-grade embryos. This could increase the success of ICSI among
women of advanced age. Therefore, efforts to find ways to increase oocytes quantity and
quality among advanced aged women must be made.
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