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P-79 11:25 AM Monday, October 16, 2023
ENDOMETRIAL MACROPHAGES AND EMBRYO
IMPLANTATION. Rumiana Ganeva, MSc,
1
Dimitar Parvanov, PhD,
1
Margarita Ruseva, MSc,
1
Maria Handzhiyska, BSc,
1
Nina Vidolova, MSc,
1
Veselina Moskova-Doumanova, assoc. prof.,
2
Dimitar Metodiev, M.D.,
1
Georgi Stamenov, MD/PhD
11
Nadezhda Women’s Health Hospital, Sofia,
Bulgaria;
2
Sofia University "St. Kliment Ohridski, Sofia, Bulgaria.
OBJECTIVE: It has been suggested that macrophages have key role in
assembling the immune tolerance during the process of embryo implantation.
In the mid-secretory endometrium, however, different sets of macrophages
are present depending on their inflammatory action.
The aim was to compare the main macrophages populations’ quantity and
spatial distribution in the mid-secretory endometrium between women with
successful and failed embryo implantation.
MATERIALS AND METHODS: Endometrial tissue from 20 patients with
successful and 20 with failed embryo implantation, without inflammation
and endometrial pathologies were selected from the hospitals tissue bank.
All samples were obtained by regular diagnostic biopsy during mid-luteal
phase of the menstrual cycle (LH+7) from unstimulated IVF patients 1-
month prior embryo transfer.
All samples were immunohistochemically stained against 3 sets of mac-
rophages: pan-macrophages (CD68+, IS61330-2, Dako), anti-inflammatory
macrophages (CD163+, 2-CD353-13, Quartett) and pro-inflammatory
macrophages (CD11c+, 60258-1, Proteintech), using novolink polymer
detection system (RE7280-K, Leica) according to the manufacturer’s in-
structions.
The studied immune cells quantity and density were analysed by HALO
image analysis software (Indica Labs) using the CytoNuclear and Spatial
Analysis modules. Number of cells per mm
2
and max number of cells
per mm
2
in 50mm radius in both groups were compared by Mann-Whitney
U test.
RESULTS: Median number (range) of macrophages in the successful
and the failed embryo implantation groups are: 277/mm
2
(402) and 211/
mm
2
(297), respectively CD68+ cells; 93/mm
2
(188) and 100/mm
2
(127), respectively CD163+ cells with no significant differences between
the two groups (p>0.05). Significantly higher number of CD11c+ cells,
however, were observed in the successful embryo implantation group
when compared to the failed one – 58/mm
2
(114) and 21/mm
2
(56),
respectively, p<0.013.
In terms of spatial distribution, the density of pro- and anti-inflammatory
macrophages in 50 mm radius of each cell in both successful and failed em-
bryo implantation groups were not significantly different: 3.6x10
3
/mm
2
(3.3)
and 3.3x10
3
/mm
2
(3.2) for CD11c+ cells (p¼0.57); 2.7x10
3
/mm
2
(4.3) and
2.3x10
3
/mm
2
(3.6) for CD163+ cells (p¼0.33). While the density of
CD68+ macrophages was significantly higher in the successful embryo im-
plantation patients when compared to the failed ones: 2.2x10
3
/mm
2
(2.9)
and 1.4x10
3
/mm
2
(1.7), respectively, p¼0.015.
CONCLUSIONS: Higher number of anti-inflammatory macrophages indi-
cated for successful embryo implantation. Clusters of pro- and anti-inflam-
matory macrophages were not related to embryo implantation outcome, in
contrast to pan-macrophages density, which was higher in thesuccessful em-
bryo implantation cases.
IMPACT STATEMENT: The number of anti-inflammatory macrophages
and pan-macrophages density in 50mm radius could indicate for endometrial
receptivity and could be used as markers of immune status of ART patients.
Future studies are needed to further evaluate their importance on embryo im-
plantation.
SUPPORT: N/A
REFERENCES: N/A
P-80 11:30 AM Monday, October 16, 2023
SERUM PROGESTERONE PRIOR TO AND AFTER
FROZEN EMBRYO TRANSFER CYCLES DO NOT
CORRELATE WITH LIVE BIRTH RATES IN PRO-
GRAMMED CYCLES UTILIZING INTRAMUSCULAR
PROGESTERONE FOR LUTEAL SUPPORT. Meghan Yamasaki,
D.O.,
1
Chelsea M. Canon, MD,
2
Fernanda Murillo Armijo, B.S, M.S.,
3
Dmitry Gounko, B.S., M.A.,
4
Kevin E. Loewke, PH.D.,
5
Joseph Lee,
BA,
4
Meike L. Uhler, M.D.,
6
Micah J. Hill, DO,
1
Alan H. DeCherney,
MD,
1
Alan B. Copperman, M.D.,
7
Kathleen Devine, MD
81
National Insti-
tute of Child Health and Human Development, NIH, Bethesda, MD;
2
Icahn
School of Medicine at Mount Sinai, New York,NY;
3
Alife Health, Inc., Cam-
bridge, MA;
4
Reproductive Medicine Associates of New York, New York,
NY;
5
Alife Health, Inc., San Francisco, CA;
6
Fertility Centers of Illinois,
Chicago, IL;
7
Reproductive Medicine Associates of New York LLP, New
York, NY;
8
Shady Grove Fertility, Rockville, MD.
OBJECTIVE: While numerous studies have evaluated the relationship be-
tween serum progesterone concentration (P) and pregnancy outcomes in pro-
grammed frozen embryo transfer (FET) cycles with vaginal (PV)
progesterone replacement, P is higher with intramuscular progesterone
(IMP) relative to PV, and it remains unknown whether P correlates with suc-
cess following programmed FET with IMP. The current study aimed to eval-
uate the relationship between serum progesterone (P) and live birth rates
(LBR) in women receiving IMP in programmed FET cycles.
MATERIALS AND METHODS: The study included all single, euploid
FET cycles at a single academic center from 2014 to 2022. All patients un-
derwent programmed endometrial preparation cycle with IMP replacement.
IMP was started at 50mg once daily (QD) and was increased if P was <18 ng/
ml at any time during monitoring. The dose was initially increased to 75mg
QD and further increased to 100mg QD if P remained <18 ng/ml. If a patient
required a dose increase in a prior cycle, then a higher dose was started in the
subsequent cycle(s). Serum P was obtained the day prior to FET, two days
after FET and at time of pregnancy test. The primary outcome was live birth
following euploid FET. Mixed effects logistic regression model was per-
formed to account for multiple cycles in the same patient for the primary
outcome of live birth.
RESULTS: A total of 4731 cycles from 3343 unique patients were
analyzed. The mean serum P and interquartile ranges for the day prior to
FET, two days after FET and at the time of pregnancy test were 26.57 ng/
ml (19.7 - 32.1), 28.95 ng/ml (22.4 - 34.6), and 28.97 ng/ml (22.7 - 34.3),
respectively. After adjusting for patient age, body mass index, endometrial
thickness, embryo grade, embryo development, number of prior cycles and
multiple cycles within the same patient, there was no statistically significant
association between serum progesterone and live birth rate at each time inter-
val with p values of 0.617, 0.844, and 0.712 for P the day prior to FET, two
days after FET and at the time of pregnancy test, respectively.
CONCLUSIONS: To our knowledge, this is the largest study evaluating
the relationship between P and LBR in programmed FET cycles utilizing
IMP replacement. While the study was limited by the varying doses of
IMP utilized, it indicates that P with IMP was generally sufficient and was
not associated with LBR. Therefore, routine monitoring prior to and
following FET may not be indicated when IMP is used. However, given
the retrospective nature of this study, additional prospective studies should
be performed to further elucidate the relationship between P and pregnancy
outcomes in FET cycles using IMP for luteal support.
IMPACT STATEMENT: Based on these data, LBR is not likely to be asso-
ciated with serum P concentration in programmed cycles where IMP is used,
given the high P generally achieved with IMP administration for FET. Serum
P monitoring may not be necessary after initiation of IMP in programmed cy-
cles. Prospective confirmatory studies are needed to confirm these findings.
SUPPORT: None
P-81 11:35 AM Monday, October 16, 2023
ABSOLUTE UTERINE-FACTOR INFERTILITY -
GESTATIONAL CARRIER OR UTERINE
TRANSPLANT? – A COST EFFECTIVENESS
ANALYSIS. Joshua C. Combs, B.S., M.D.,
1
Meghan Yamasaki, D.O.,
2
Kiley Hunkler, M.D., MSt, MSc,
3
Jaime A. Roura-Monllor, M.D., M.S.,
4
Micah J. Hill, DO,
2
Alan H. DeCherney, MD,
2
Kathleen Devine, MD,
5
Robert J. Stillman,
M.D.,
6
Jeanne E. O’Brien, M.D., M.SC.
51
Naval Medical Center Portsmouth,
Portsmouth, VA;
2
National Instituteof Child Health and Human Development,
NIH, Bethesda, MD;
3
National Institute of Health,Bethesda, MD;
4
Uniformed
Services University of the Health Sciences, Bethesda, MD;
5
Shady Grove
Fertility, Rockville, MD;
6
Shady Grove Fertility, potomac, MD.
OBJECTIVE: To evaluate the cost effectiveness of gestational carrier
(GC) versus uterine transplant (UTx) in absolute uterine-factor infertility
(AUFI).
FERTILITY & STERILITY
Ò
e139