#44 : Effects of Optimum (Optimization of Thyroid, Thrombophilia, Immunity, and Uterine Milieu) Treatment Strategy on Euploid Blastocyst Transfer in Advanced Aged Women with Recurrent Reproductive Failure

Abstract

Background and Aims: Does the Optimization of Thyroid function, Thrombophilia, Immunity and Uterine Milieu (OPTIMUM) treatment strategy contribute to improving pregnancy outcomes after single euploid blastocyst transfer (SEBT) in patients with a history of repeated implantation failure (RIF) and/or recurrent pregnancy loss (RPL)? Method: Between January 2019 and May 2022, women aged ≥ 40 years with RIF after three or more embryo transfer using morphology good embryos and/or RPL after two or more clinical pregnancy losses underwent preimplantation genetic testing for aneuploidy (PGT-A) and RIF/RPL testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3, interferon-γ-producing helper-T (Th1) cell, IL-4-producing helper-T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 160 consecutive women who underwent SEBT, we compared 127 and 33 women with and without the OPTIMUM treatment strategy, respectively. Results: RIF/RPL testing identified intrauterine abnormalities in 67 (52.8%), aberrant high Th1/Th2 cell ratios in 38 (29.9%), thyroid dysfunction in 19 (15.0%), and thrombophilia in 24 (18.9%). The clinical pregnancy and live birth rates in the OPTIMUM group was significantly higher than that in the control group (73.9% and 45.5%, respectively; p = 0.005 and 64.7% and 39.4%, respectively; p = 0.01) in women with RIF (Table 1). Whereas there was no significant difference of miscarriage rate in RPL women with and without OPTIMUM (5.5% and 13.3%, respectively; p = 0.58). Conclusion: In the women aged ≥40 years with RIF who underwent PGT-A, the OPTIMUM treatment strategy improved pregnancy outcomes after SEBT. In RPL, however, both PGT-A with and without OPTIMUM resulted in low miscarriage rates and no significant difference was recognized.