P-252 Impact of endometriosis on early embryo development and age-related decline in ART patients: an objective evaluation using automated time-lapse image analysis

Abstract Study question Does endometriosis affect oocyte quality and subsequently embryonic development in ART? Summary answer Endometriosis did not affect embryonic development until the mid-30s, but in the late 30s, it further exacerbated the age-related decline in embryonic development. What is known already ART is often considered a treatment option for infertile women with endometriosis, but lower oocyte retrieval and fertilisation rates have been observed compared to other infertility factors. On the other hand, there are conflicting reports on the impact of endometriosis on preimplantation embryo development, including morphokinetic analysis with different data algorithms. Study design, size, duration We conducted a retrospective cohort study of embryos, cultured using the Geri™ time-lapse incubator with (n = 1477)/without (n = 2728) automated algorithm analysis (Eeva™) from 744 oocyte retrieval cycles at our ART Centre from 2018 to 2024, with patients aged between 23 and 52. The indication for the Eeva™ test was determined by non-medical reasons such as insurance coverage, and there was no bias or impact on analyses unrelated to the Eeva™ test. Participants/materials, setting, methods Data from numerous time-lapse images, including 74 non-linear evaluation items, were analysed in the Eeva™ test. The automated algorithm scored embryos on a 5-point scale (1 being the best). Embryos were classified into the endometriosis group (n = 328) or control group (n = 1149) based on patient history. Statistical analysis was performed using the Pearson’s chi-square test, Mann-Whitney U test, and other appropriate methods. Main results and the role of chance In the endometriosis group, AMH levels were lower, and even with the use of more FSH/HMG, the number of embryos reaching time-lapse culture was fewer compared to the control group. Additionally, this number decreased further in the late 30s compared to the control group. The endometriosis group aged 37 and older (n = 83) showed a trend toward lower overall Eeva™ scores (P = 0.00006) and a significantly lower proportion of embryos scored 1 or 2 (favourable for live birth) compared to age-matched controls (n = 682) (18.1% vs. 39.1%; P = 0.0002). The endometriosis group aged 35 and younger (n = 214) showed a similar distribution of scores (P = 0.18) and a similar proportion of embryos scored 1 or 2 compared to age-matched controls (n = 805) (43.9% vs. 49.8%; P = 0.13). The overall live-birth rate per transfer in the endometriosis cohort was 25.7% (9/35) for ages 36-39, which was comparable to 22.9% (27/118) for those aged 35 and under. However, there were no embryos from individuals aged 40 and above (42 embryos, 14 transfers) that resulted in live birth in this cohort. Limitations, reasons for caution This study is based on data from a single institution, and the endometriosis group includes both patients who have undergone surgery and those who have not. The number of embryos in the endometriosis group is limited due to lower fertilisation rates and decreasing oocyte retrieval with age. Wider implications of the findings Data from automated algorithm time-lapse assessment demonstrated that the presence of endometriosis significantly exacerbates age-related decline in embryo development. These findings need to be further studied and validated. Trial registration number No