A​B ST​R ACTS
   201
enough information and explanation about the time frames
involved in this process.
Conclusions: Analysis of the results helped us to develop
cost-­effective solutions: a RAG system to help prioritisa-
tion of inductions; creating an IOL working party group, a
visual aid proforma, an updated patient information leaflet
and a video to improve the dissemination of information
and communication between professionals and women.
Following implementation and re-­ evaluation, we aim to
continue to improve women's and staff's experiences and the
quality of service provided at Lister maternity. We aim to
share our learning within local maternity networks for the
wider benefit of NHS maternity services.
EP.0305  |  Optimising dalteparin prescribing post-­
elective caesarean section
Camilla Massardi; Adam Jakes; Gabrielle Bambridge; Carl
Chow
Kingston Hospital NHS Trust, London, UK
Objective: To reduce unwarranted clinical variation in
dalteparin prescribing post-­elective caesarean section.
Design: A quality improvement project was designed to
reduce inappropriate outpatient prescribing of dalteparin
post-­elective caesarean section in women with no other risk
factors for venous thromboembolism (VTE score of 1). This
would be consistent with national guidance and reduce un-
necessary cost to the Trust. Additionally, for patients who
are eligible for outpatient dalteparin (VTE score >1), comple-
tion of the outpatient prescription should be performed on
the day of surgery by the obstetrician to reduce the workload
of the postnatal junior doctor.
Method: The leads for the labour ward, elective section
pathway and postnatal care were approached to participate
in the project. All women who underwent an elective caesar-
ean section over an initial one month period were identified.
Their risk of venous thromboembolism was calculated, and
their outpatient prescriptions were reviewed for dalteparin
and timing of completion. Educational posters were devel-
oped, and staff were briefed about appropriate prescribing.
A repeat data collection post-­intervention was undertaken.
Results: Baseline data collection for November 2022 iden-
tified 69 women who underwent an elective caesarean sec-
tion. 22 women had no additional risk factors (VTE score
of 1), all of which were prescribed daltaparin for 10 days
postnatally despite no indication. Only 2 women (4%) had
their discharge medications prescribed on the day of sur-
gery by the obstetrician. Following the intervention, repeat
data collection for January 2023 identified 68 women who
underwent an elective Caesarean section. 20 women had a
no additional risk factors, of which 6 (30%) women were pre-
scribed dalteparin inappropriately. This amounted to a re-
duction of unnecessary daltaparin prescribing by 70%, and
an estimated cost saving of £395.22 following the interven-
tion. 22 (46%) women who required daltaparin postnatally
   |
had their prescriptions completed on the day of elective cae-
sarean section.
Conclusions: Following education and staff buy-­in, we have
managed to reduce inappropriate prescribing of dalteparin
post-­elective caesarean section. This has saved money and
increased the efficiency of the work for the postnatal doctor.
Further intervention is required to further reduce inappro-
priate dalteparin prescribing and improve timely prescrib-
ing of discharge medications. A repeat data collection at 6
months will be undertaken to demonstrate sustainability.
Post-­caesarean section champions will be recruited, and the
theatre sign-­out will be amended to encourage appropriate
outpatient prescriptions of dalteparin.
R E PRODUC T I V E M E DICI N E /
A S SIST E D R E PRODUC T ION
OP.0007  |  Spatial transcriptomics identifies region/
cell-­type specific endometrial abnormalities in recurrent
implantation failure
Nicola Tempest1,2,3; Jamie Soul1; Eva Caamano Gutierrez1;
Dharani Hapangama1,2
1
University of Liverpool, Liverpool, UK; 2Liverpool Women's
Hospital, Liverpool, UK; 3Hewitt Fertility Centre,
Liverpool, UK
Objective: Determine region and cell-­type specific abnor-
malities relevant to the endometrium of women with recur-
rent implantation failure (RIF).
Design: This is a prospective observational study analys-
ing pipelle human endometrial samples collected from
consented women in the window of implantation (n = 16) at-
tending a specialist Women's hospital.
Method: GeoMx spatial transcriptomics was used to cap-
ture the whole transcriptome of individual endometrial cells
within their spatio-­morphological context in endometrial
samples, collected in the window of implantation; 8 RIF vs 8
fertile controls (FC).
Differentially expressed genes (DEGs) and altered pathways
between segmented regions and the 2 groups were inter-
rogated using GeoMXTools and functionality within the
statistical software R. In silico drug screening was used to
identify putative drug targets.
Results: Transcriptomics fingerprint can be used to dis-
criminate endometrial regional and cellular differences
within patients and between RIF and FC.
Known region-­ specific marker expression in the luminal
epithelium (LE) and glandular epithelium (GE) validated
our spatial-­transcriptomics data. e.g. PTGS1 (FC 12.13 FDR
8.65-­10) LRG5 (FC 7.46 FDR 1.93E-­15), AGR3 (FC 4.29 FDR
2.07E-­07) BCAM (FC 2.38 FDR 1.69E-­05) MUC1 (FC 2.04
FDR 3E-­3) corresponding with single-­cell reproductive atlas
data. Large numbers of DEGs were identified comparing dif-
ferent regions of the endometrium between controls and RIF
 |
202       ABSTR​ACTS​
(eg. 685 panCK+ LE, 1125 LE CD45+, 1049 glandular CD56+).
Unique region-­specific pathway activity was observed in RIF
endometrium, for example, oestradiol response and WNT
signalling in the LE. ULBP1, an activating ligand for NK
cells, and DEG in all regions of RIF endometrium suggests
a pathogenic mechanism and common drug target may exist
between regions. In silico drug screening identified potential
drugs that can reverse observed RIF disease expression.
Conclusions: Our work highlights, for the first time, spatial
transcriptomic differences in LE and GE, subluminal and
deeper functionalis stroma, uNK cells and other immune
cells of women with RIF versus FC. This data supports the
importance of considering the functionality of different re-
gions and cell types separately in the endometrium, to im-
prove our understanding of RIF pathogenesis. Aberrations
found will be directly targeted in future pre-­clinical and
eventually clinical trials with novel personalised treatment
strategies proposed for this poorly understood, highly prev-
alent and distressing condition.
OP.0008  |  Fertility preservation outcomes are
comparable in luteal and follicular phase oncology
patients
James Morris1; Tulay Karasu2; Alka Prakash2
1
University of Cambridge School Of Clinical Medicine,
Cambridge University Hospitals NHS Foundation Trust,
Cambridge, UK; 2Cambridge IVF, Cambridge University
Hospitals NHS Foundation Trust, Trumpington, UK
Objective: Women should be referred for fertility preser-
vation immediately upon cancer diagnosis so many begin
treatment, unconventionally, during their luteal phase. Does
this affect fertility outcomes?
Design: Retrospective analysis of fertility outcomes in rou-
tine and oncology patients undergoing ovarian stimulation
(OS) and oocyte collection. Main outcomes were the folli-
cle count, mature oocytes collected (both total count and
proportion of follicles) and oocytes vitrified. Two pairs of
cohorts were compared: follicular versus luteal oncology pa-
tients and oncology versus routine patients.
Method: 114 patients were identified from an internal da-
tabase of patients undergoing fertility preservation between
July 2016 and November 2022 at one British IVF clinic.
Patient healthcare records stored on EPIC® (Epic Systems
Corporation, Verona) and IDEAS® (Mellowood Medical,
Toronto) were used to record data including demographics,
biochemistry, referral-­ treatment delay, ultrasound appear-
ance, drug regime and fertility outcomes. Disparities between
cohorts were assessed using independent T-­tests and Fisher's
exact tests within Microsoft® Excel's® Data Analysis tool.
Linear regression analyses between continuous variables and
all four fertility outcomes quantified their effect sizes.
Results: All four main outcomes were comparable in luteal
and follicular phase oncology patients, strengthening the
reproducibility of the conclusions from all three existing
papers. Luteal phase patients required 3.7 further days of
OS compared to follicular phase patients, which conferred
an additional treatment-­referral delay of 2.8 days. They also
required a 32% higher total stimulation dose. Compared to
routine patients, oncology patients exhibited 25% more folli-
cles on pre-­oocyte collection ultrasound and had 32% more
oocytes ultimately vitrified, corresponding to an additional
2.7 oocytes. This was likely due to the oncology patients
being 6.7 years younger on average. Five covariates were
significantly correlated with the final oocyte vitrification
count; final follicle count, baseline anti-­Müllerian hormone,
antral follicle count, total stimulation dose and age at oocyte
collection. Their respective effect sizes, given as R 2 values,
were 71.6%, 12.2%, 8.4%, 6.4% and 3.8%, although these
covariates exhibited significant multicollinearity, limiting
their predictive value when combined. Prospective multi-­
centre studies with larger cohorts are required to determine
by precisely how much luteal phase OS prolongs the duration
of fertility preservation treatment.
Conclusions: Deferring fertility preservation until the folli-
cular phase does not improve fertility outcomes in oncology
patients. Luteal phase patients must wait 7 days on average
before reaching the follicular phase, overshadowing the 1–­4
day reduction in OS duration. Clinicians should reassure
cancer patients that their diagnosis should not impair oo-
cyte yield.
PP.0071  |  The impact of BMI on fertility: A systematic
review and meta-­analysis
Florence Turner1,2; Nicola Tempest1; Simon Powell1;
Dharani Hapangama1
1
Department of Women's and Children's Health, Liverpool,
UK; 2University of Liverpool, Liverpool, UK
Objective: Consolidate published data on the association be-
tween increased BMI and fertility in patients with no other
diagnosed medical co-­morbidities.
Design: Systematic review was conducted following PRISMA
guidelines and prospectively registered with PROSPERO
(CRD42022293631). A systematic search was performed
using online databases to identify all primary studies re-
porting the effects of raised BMI on fertility in women with
no other medical co-­morbidities. Data from eligible stud-
ies were extracted and meta-­analysis was performed where
possible.
Method: A systematic search was performed using EMBASE,
MEDLINE and the Cochrane CENTRAL Library. Initial
title and abstract screening was performed using Rayyan.
After full-­text retrieval and forward/backward chaining,
data were extracted before statistical analysis was performed
using Review Manager (RevMan) software. The Modified
Newcastle Ottawa scale was used to assess risk of bias.
Results: This systematic search identified nine eligible stud-
ies; only one explored natural conception, leaving eight
ART studies. A total of 4,108 cycles from 3,770 women were
A​B ST​R ACTS
included in the meta-­analyses. Women with a BMI ≥ 25 kg/
m2 are significantly less likely to have a clinical pregnancy
when compared to women with a healthy BMI (OR:0.76,
p = 0.007). In addition, women with a raised BMI required
a longer duration of stimulation (Standard Mean differ-
ence= 0.20, 95% CIs 0.07–­0.34, p = 0.002) and had reduced
oocyte harvest (Standard Mean Difference = −0.11, 95% CIs
−0.18 to −0.04, p = 0.002).
Conclusions: This review provides a unique summary of
the effects of isolated increased BMI on fertility in women
with no other medical co-­ morbidities. A meta-­ a nalysis
of eight ART studies demonstrated overweight and obese
BMI to have significant adverse effects on ART parameters
and outcomes. Being overweight or obese has significant
adverse effects on conceiving through ART even when no
other co-­morbidities are present. Women need to be made
aware of the facts, counselled appropriately and assisted
with optimisation of their weight to ensure best pregnancy
outcomes.
PP.0164  |  Does PCOS increase Cardiovascular
morbidity/mortality? A cohort study from the UK-­biobank
Triada Doulgeraki1; Annie Wright2; Frederick Ho3; Carlos
A Celis-­Morales4; Jill P Pell3; Naveed Sattar4; Stamatina
Iliodromiti5
1
Department of Obstetrics and Gynaecology, Royal London
Hospital, Barts Health NHS Trust, London, UK; 2School
of Public Health, Imperial College London, London, UK;
3
Institute of Health and Wellbeing, University of Glasgow,
Glasgow, UK; 4Institute of Cardiovascular and Medical
Sciences, University of Glasgow, Glasgow, UK; 5Women's
Health Research Unit, Wolfson Institute of Population
Health, Barts and The London School of Medicine and
Dentistry, Queen Mary University of London, London, UK
Objective: Polycystic ovary syndrome (PCOS) has been
associated with cardiovascular risk factors, however, it re-
mains unclear whether it is associated with greater risk of
cardiovascular disease (CVD).
Methods: We conducted a cohort study including a total of
75142 participants from the UK biobank, of whom 15747 had
PCOS. The primary outcome was morbidity and mortality
from ischemic heart disease and stroke. We constructed Cox
regression analysis adjusted for confounders and risk factors
to quantify the risk of cardiovascular morbidity and mortal-
ity in women with PCOS.
Results: Women were followed up for 11.1 years in average.
The incidence rate of cardiovascular events was 1.92/1000
person years in the PCOS population and 1.90/1000 person
years in women without PCOS. PCOS was associated with a
higher risk of obesity (OR 1.63, 95% CI 1.56–­1.70), hyperten-
sion (OR 1.18, 95% CI 1.13–­1.23) and type 2 diabetes (OR
1.44, 95% CI 1.31–­1.58). In the adjusted cox regression model,
PCOS doesn't increase the risk of CVD morbidity and mor-
tality (HR 0.89, 95% CI 0.78–­1.01), however, the cumulative
   |
   203
hazard risk in women over 60 years old with a history of PCOS
was greater compared to women without PCOS.
Conclusion: Although PCOS is strongly associated with car-
diovascular risk factors such as obesity, high blood pressure
and type 2 diabetes, it does not increase the risk of cardiovas-
cular morbidity and mortality in women aged 40 to 60 years
when adjusted for risk factors. Further research is warranted
to include women that have been followed up for longer.
PP.0166  |  Trends in assistive reproductive technology
and foetal and maternal outcomes in pregnancy
Sowmya Prasanna Kumar Menon1; Deepthika Jeyaraman2;
Pensée Wu1
1
Keele University, Newcastle Under Lyme, UK; 2Academic
department of Obstetrics and Gynaecology, University
Hospital of North Midlands, Stoke on Trent, UK
Objective: To describe the trends in assistive reproductive
technology (ART) and adverse maternal and foetal outcomes
in the United States over the last five years.
Design: A nationwide retrospective cohort study using
Natality data from the Centers for Disease Control and
Prevention (CDC), between 2016 and 2021.
Method: Using live birth data in the United States
(n = 22,618,566) between 2016 and 2021 from the CDC, ma-
ternal and foetal outcomes were investigated. We examined
demographics, adverse maternal outcomes (e.g. mode of
delivery methods and comorbidities) and foetal outcomes
(e.g. congenital birth defects, gestation age at birth and ad-
mission to NICU). The proportion of these outcomes were
compared between women who conceived with ART and
women who conceived spontaneously. Statistical analyses
were conducted using STATA. Odds ratios (OR) were cal-
culated with 95% confidence intervals (CI) for maternal and
foetal outcomes. Results were determined significant to the
level of p < 0.05.
Results: Among 22,618,566 live births, 277,217 (1.23%) uti-
lised ART. The prevalence of ART births increased by 6.10%
between 2016 and 2021. Compared to spontaneous concep-
tion, pregnancies conceived using ART were associated with
a 2.7-­fold increase in odds of caesarean section (OR 2.72, 95%
CI 2.70–­2.74). Women who conceived with ART were asso-
ciated with a 4-­fold increased risk of blood transfusion (OR
4.23, CI 95% 4.11–­4.36) compared to pregnancies conceived
without ART. In terms of foetal outcomes, pregnancies con-
ceived with ART had an increased risk of congenital cyanotic
heart disease (OR 1.92, 95% CI 1.71–­2.15), premature birth
(OR 2.43, 95% CI 2.41–­2.45) and admission to the neonatal
intensive unit (OR 2.48, 95% CI 1.99–­2.47).
Conclusion: Our study shows a significant association be-
tween ART and adverse maternal and foetal outcomes. With
the increasing prevalence of pregnancies conceived with
ART, more research is needed to understand the underly-
ing mechanisms for this association, as well as the long-­term
implications on maternal and foetal health.
 |
204       ABSTR​ACTS​
PP.0194  |  Human chorionic gonadotropin
intrauterine instillation at blastocyst transfer: Systematic
review and meta-­analysis
Sughashini Murugesu1; Efstathios Theodorou2; Lorraine
Kasaven1; Benjamin Jones1; Srdjan Saso1; Jara Ben-­Nagi2
1
Imperial College London, London, UK; 2Centre for
Reproductive and Genetic Health, London, UK
Objective: To determine the impact of intrauterine installa-
tion (IU) of Human Chorionic Gonadotropin (hCG) at the
time of blastocyst transfer on assisted reproductive technol-
ogy (ART) outcomes.
Methods: A systematic literature search was performed
using Medline, Embase, Cochrane Library and Google
Scholar databases for relevant randomized controlled trials
(RCTs) from inception until July 2022, evaluating IU hCG
instillation versus either a placebo procedure or no inter-
vention, around the time of blastocyst-­stage embryo trans-
fer (ET).
Studies were included if they were randomized clinical tri-
als (RCTs). The primary outcome combined live birth rate
(LBR) and ongoing pregnancy rate (OPR). The secondary
outcomes were clinical pregnancy rate (CPR), implantation
rate (IR) and miscarriage rate (MR).
Results: 93 citations were identified, of which seven eligi-
ble RCTs were included. Within this meta-­analysis a total
of 2499 participants were included, of which 1331 were as-
signed to an experimental group and 1168 were assigned to
the control group. The overall effect of IU hCG instillation
on combined LBR and OPR was not significant: risk ratio
(RR) 1.00 (95% CI, 0.90–­1.12). Analysis of all the secondary
outcomes found the effect of IU hCG instillation was not
significant.
Conclusion: The meta-­analysis we conducted focused solely
on blastocyst-­stage transfer and despite the large number of
cycles, the findings demonstrated that there is insufficient
evidence at present to support the use of IU hCG instillation
prior to blastocyst-­stage ET. Analysis of the data suggests
that the studies conducted have too much heterogeneity to
identify whether a specific cohort may have a significant
benefit, further studies are required.
PP.0200  |  Predictive value of circulating AMH in
PCOS women receiving clomiphene-­citrate: A meta-­
analysis
Shaimaa Aboeldalyl1; Subul Bazmi1; Lindsay Snell1; Saad
Amer2
1
University Hospitals of Derby and Burton NHS Foundation
Trust, Derby, UK; 2University of Nottingham, Derby, UK
Objective: Elevated circulating AMH is a common feature of
polycystic ovarian syndrome (PCOS) and is known to lower
sensitivity of ovarian follicles to FSH, thereby inhibiting
ovulation. This effect may compromise ovarian response to
ovulation induction in PCOS women. The aim of this study
was to determine if PCOS-­related high AMH predicts poor
response to clomiphene citrate (CC).
Design: Systematic review and meta-­analysis.
Methods: An extensive electronic search was conducted
up to September 2021 to identify available research articles
investigating the predictive value of serum AMH levels in
PCOS women receiving CC. All cohort, cross-­ sectional,
and randomized studies were considered. Risk of bias and
quality of included articles were assessed using modified
Newcastle-­Ottawa scale. Outcomes included serum AMH
levels in responders versus responders (ovulation and preg-
nancy). Other outcomes included sensitivity, specificity, and
area under the receiver operator characteristic curve (AUC)
of AMH for predicting response to CC. Data were extracted
and entered into RevMan 5.1 for meta-­analysis. Standardized
mean difference (SMD, 95%CI) in AMH between respond-
ers versus non-­responders was calculated.
Results: The review included nine eligible articles (n = 1097),
of which, eight were prospective cohort studies (n = 721)
and one randomised trial (n = 376). Pooled analysis of all
studies revealed significantly higher circulating AMH in
women failing to ovulate on CC (non-­ responders) ver-
sus CC-­ responders (SMD 1.01 ng/mL, 95%CI 0.42, 1.61;
p = 0.0009; I2=94%). Three studies (n = 204) reported a sig-
nificantly higher circulating AMH in women who did not
conceive with CC versus those who did (SMD 1.45 ng/mL,
95%CI 1.22, 1.67; p < 0.00001; I2=52%). All studies scored
high on the modified Newcastle-­Ottawa scale. Eight stud-
ies (n = 1012) used receiver operator characteristic curve to
evaluate the predictive ability of AMH. They reported areas
under the curve (AUC) ranging between 0.58 and 0.79, with
three studies reporting p < 0.05 and one study p>0.05. Seven
studies reported AMH threshold values between 3.2 and
12.4 ng/mL that can predict CC-­resistance. Meta-­analysis of
these threshold values was not possible due to high heteroge-
neity between studies.
Conclusion: High circulating AMH could be as a useful
predictor of CC-­resistance. Women with markedly elevated
AMH could either be started on high CC dose or offered
other treatments.
EP.0027  |  Visceral Adiposity Index (VAI) and Lipid
Accumulation Products (LAP) in PCOS Women
Reeta Mahey; Shreenidhi Ravichandran; Rohitha
Cheluvaraju; Monika Rajput; Garima Kachhawa; Jai B
Sharma; Neerja Bhatla
All India Institute of Medical Sciences, New Delhi, India
Objective: Visceral adipocity index (VAI) and Lipid accu-
mulation products (LAP) are simple tools proposed to screen
PCOS women for insulin resistance (IR) related comorbidi-
ties like diabetes and also cardiovascular disease. The pre-
sent study evaluated VAI and LAP in PCOS women and
evaluated their correlation with different PCOS markers.
A​B ST​R ACTS
The study also evaluated these parameters across different
PCOS phenotypes and determined their usefulness to de-
fine metabolically healthy (MH-­PCOS) and metabolically
unhealthy PCOS (MU-­PCOS) women.
Design-­Cross sectional study conducted at All India Institute
of Medical Sciences, New Delhi, India.
Methods: Two hundred PCOS women (aged 18–­38 years)
were recruited and were divided into MH-­ PCOS and
MU-­PCOS by modified NCEP criteria. VAI calculated as:
[WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL-­c) (both
triglyceride (TG) and high density lipid (HDL) levels ex-
pressed in mmol/L) and LAP (Lipid Accumulation Product)
calculated with formula (Waist Circumference (WC) (cm)
–­58) × TG (mmol/L). VAI and LAP were calculated and cor-
related with different PCOS parameters.
Results: Of total, 78% (156/200) were MH-­PCOS and 22%
(44/200) belonged to MU-­PCOS category. VAI and LAP were
highest in most severe PCOS phenotype (phenotype A) VAI
had strong positive correlation with HDL, TGL and VLDL.
LAP had strong positive correlation with weight, BMI, WC,
waist hip ratio, free androgen index (FAI), TGL and VLDL.
VAI and LAP had good ability to correctly discriminate MU-­
PCOS from MH-­PCOS [AUC (95%CI): 0.89 (0.82–­0.95)] and
[AUC (95% C.I.) (0.81–­0.92) = 0.86] using ROC respectively.
Sensitivity of VAI and LAP corresponding to optimal cut of
≥2.76 and ≥48.06 (Youden) were 84.09% and 79.55% respec-
tively. Similarly, specificity of VAI and LAP were 85.26%
and 79.49% respectively. VAI has a positive predictive value
of 61.7%; [95% CI (23.7%–­40.3%)] and a negative predictive
value of [95%; 95% CI (88%–­99.1%)]. LAP has a positive pre-
dictive value of 53%; [95% CI (40.3%–­65.4%)] and a negative
predictive value of 93.3%; [95% CI (87.6%–­96.9%)]. PCOS
women having VAI ≥2.76 had 19.3 times [(95%CI: 6.50–­57.70)]
more chance of developing MetS. PCOS women having LAP
(≥48.06) have 3.7 times [(95%CI: 1.35–­10.60)] more odds.
Conclusions: VAI and LAP are simple OPD based screening
tools which may help to differentiate PCOS into MH-­PCOS
and MU-­PCOS.VAI cut-­off ≥ 2.76 and LAP with cut off of
≥ 48.06 may be used as a markers for predicting MetS. Future
prospective studies among different ethnic populations may
further strengthen the utility of these markers.
EP.0039  |  Impact of cancer on reproductive outcomes
of women undergoing oocyte cryopreservation
Hannah Denbigh1,2; Rohini Parchure2; Bassel Wattar3
1
Hull York Medical School, Hull, UK; 2University College
London, London, UK; 3Warick Medical School, Coventry, UK
Objective: Cancer survivorship is increasing worldwide and
subsequently the demand for urgent fertility preservation
(FP) is growing. The aim of this study was to evaluate the re-
productive outcomes of women with breast cancer (BC) and
haematological cancer (HC) who underwent oocyte cryo-
preservation for fertility preservation compared to healthy
controls.
   |
   205
Design: This was a cross-­ sectional retrospective cohort
study.
Method: Data were extracted on women who underwent
oocyte cryopreservation at a tertiary fertility centre in
London between 11/2019 and 11/2021. Cases were identified
using standardised treatment codes and we extracted data
from electronic health records on participant demograph-
ics, treatment characteristics and reproductive outcomes.
All data were cleaned, coded, and pseudo-­anonymised be-
fore the analysis. The primary outcome was the number of
oocytes; mature (MII) and immature (GV). The study was
a service evaluation of routine practice and therefore ex-
empt from ethical approval. We reported using descriptive
statistics, natural frequencies, Pearson correlation and lin-
ear regression models with p < 0.05 set a priori for statistical
significance.
Results: We included data on 254 healthy controls, 33 BC
and 24 HC patients, and excluded women who had FP post-­
chemotherapy for a previous cancer diagnosis. Overall,
women with cancer had a significantly lower response fol-
lowing controlled ovarian stimulation compared to healthy
controls with an adjusted mean difference (aMD) of 4.2
(95%CI −6.6 to −1.6, p = 0.001). We compared the difference
in the number of collected oocytes following different ovu-
lation triggers (Gonadotropin-­releasing hormone (GnRH)
vs human chorionic gonadotropin (HCG) vs dual trigger)
using GnRH as reference which yielded no significant dif-
ference (aMD-­0.44, 95%CI −3.64–­2.76, p = 0.785 and aMD-­
1.92, 95%CI −4.85 to 1.01, p = 0.198) respectively. Those with
BC had similar numbers of oocytes collected compared to
controls (aMD-­1.27, 95%CI −4.48 to 1.94, p = 0.437), whereas
women with HC had significantly fewer oocytes collected
(aMD 8.4, 95% CI −13.2 to −3.8, p = 0.001).
Conclusions: Women with cancer showed less response to
controlled ovulation stimulation compared to healthy con-
trols, especially those with HC. Previous research high-
lighted concerns that using a GnRH-­ only trigger could
impact the number of mature oocytes available for cryo-
preservation. However, our study showed that it yielded
similar outcomes to an HCG or dual trigger amongst cancer
patients. This finding, alongside its reduced risk of ovarian
hyperstimulation syndrome, suggests that the GnRH-­only
trigger should be the trigger of choice. Our findings are lim-
ited by the small sample size and future randomised studies
are needed to evaluate the different types of ovulation trig-
gers used as part of FP treatments.
EP.0040  |  The use of GnRH agonists in fertility
treatment for endometriosis
Sharona Falzon; Vanessa Vella; Olivia Anne Cassar; Mark
Sant
Mater Dei Hospital, Msida, Malta
Objective: To determine the effectiveness of long-­
term
gonadotrophin-­
releasing hormone (GnRH) agonist
 |
206       ABSTR​ACTS​
therapy versus no pre-­treatment prior to frozen embryo
transfer during In-­Vitro Fertilisation (IVF) in women with
endometriosis.
Design: An audit tool was developed to collect data on pa-
tients with endometriosis who had received pre-­treatment
with a GnRH agonist prior to frozen embryo transfer until
September 2022. An age matched cohort who also suffered
from endometriosis but did not receive any pre-­treatment
with a GnRH agonist were also included in the study and the
outcomes were compared.
Method: All the patients included suffered from endome-
triosis which was diagnosed via either ultrasound, Magnetic
resonance imaging or laparoscopy. Data collected included
body mass index, maternal age at embryo transfer, reason
for infertility and the total number of GnRH agonist doses
administered. This information was compiled from medical
files at the Assisted Reproductive Technology (ART) clinic at
Mater Dei Hospital.
Results: The study included a total of 64 patients. Half of
the cases analysed had undergone treatment with GnRH
agonist prior to embryo transfer, whilst the other half did
not. Maternal age at embryo transfer ranged between 30 to
43 years for both cohorts.
In all cases, endometriosis was deemed as one of the rea-
sons for infertility. Other reasons included polycystic ovar-
ian syndrome (PCOS), adenomyosis, ovarian failure and
oligospermia. Interestingly, adenomyosis and PCOS com-
monly co-­existed with endometriosis. Half the patients had
a history of surgery related to endometriosis, which in most
cases was a laparoscopic cystectomy or adhesiolysis.
39% of patients who had pre-­treatment with GnRH agonist
achieved a pregnancy, compared with 18% of those with
no GnRH agonist. This shows a significant 21% increase in
chance of pregnancy when GnRH agonists were used. All
patients given GnRH agonists were administered at least
3 doses, with a majority being given 4 doses in total. The
maximum number administered was 6 doses. Out of the
pregnant patients who received GnRH agonists, 70% got
pregnant with the first transfer attempt whilst the rest had
one or two previous failed transfers.
Conclusions: These results suggest women with
endometriosis-­related infertility undergoing frozen embryo
transfers in IVF cycles, GnRH agonist pre-­treatment may re-
sult in increased pregnancy rates.
EP.0139  |  Role of Embryo pooling in low ovarian
reserve
Kaberi Banerjee; Bhavana Singla; Priyanka Verma
Advance Fertility & Gynaecology Center, New Delhi, India
Objective: To assess the role of embryo pooling in low ovar-
ian reserve.
Design: Retrospective analysis.
Materials and Methods: We had assessed 45 infertility patients
with low ovarian reserve measured by AMH < 1 ng/mL or
Antral follicle count (AFC) £ 4 with no other abnormal infertil-
ity factor. All patients were started on dehydroepiandrosterone
(DHEA) supplements. We had advised IVF with high dose hor-
mones with pooling of embryo for 2 to 3 cycles with the criteria
for getting at least 3 grade A embryos. First ovarian stimulation
was done with antagonist protocol using HMG 225 IU and FSH
150 IU. Second stimulation was started in immediate next cycle
with long agonist protocol. In 18 patients out of 45, third ovar-
ian stimulation was done with antagonist protocol after the
gap of 1 month. In the gap of 1-­month, topical testosterone gel
application was advised. In all the cycles, the number of total
oocytes retrieved, the number and grading of embryos, preg-
nancy rate and clinical pregnancy rate was assessed.
Results: The age of the females were between 28 and 42 years.
In first cycle, average number of oocytes were 2.6 and in sec-
ond cycle, average number of oocytes were 3.2. In 18 patients
out of 45, third cycle was performed. The average number of
oocytes were 3.67 in third cycle. In first cycle, 65 embryos
(grade A, AB, B) were formed out of 117 oocytes. In second
cycle, 97 embryos (grade A, AB, B) were formed out of 144
oocytes. In third cycle, 44 embryos (grade A, AB, B) were
formed out of 66 oocytes. In 2 patients, the embryo transfer
was not done as the response was not good. The overall preg-
nancy rate was 44.1% (19 out of 43 patients) and the clinical
pregnancy rate was 30.2% (13 out of 43 patients).
Conclusions: Fertility treatment of patients with low ovarian
reserve is challenging for fertility experts and assisted repro-
duction technologies are the best option for these patients.
Embryo pooling is the best option in these cases and the cou-
ples should be properly counselled for the whole process, du-
ration of treatment and the success rate of procedure. Further
well-­designed studies are required to predict the pregnancy
rate and the clinical pregnancy rate more precisely.
EP.0246  |  How do women in the UK feel about Uterus
transplantation and donation?
Saaliha Vali1,2; Benjamin Jones3,4; Sairah Sheikh5; Srdjan
Saso3,4; Isabel Quiroga6; J. Richard Smith3,4
1
Department of Surgery and Cancer, Hammersmith
Hospital, Imperial College London, Du Cane Road, London
W12 0NN, UK, London, UK; 2Cutrale Perioperative
and Ageing Research Group, Imperial College London,
London, UK; 3West London Gynaecological Cancer Centre,
Hammersmith Hospital, Imperial College NHS Trust,
London, W12 OHS London, UK., London, UK; 4Department
of Metabolism, Digestion and Reproduction, Imperial
College London, Du Cane Road, London W12 0NN, UK.,
London, UK; 5Queen Mary University of London, Bethnal
Green, London, UK, 6The Oxford Transplant Centre, The
Churchill Hospital, Oxford University Hospitals NHS Trust,
Old Road, Oxford, OX3 7LE, london, UK
Objective: To assess the motivations, perceptions and num-
ber of the general public in the UK toward donating their
uterus for Uterus Transplantation after death (UTx).
A​B ST​R ACTS
Design: A cross sectional survey-­based study consisting of
a 32-­item electronic questionnaire was conducted over a
four-­month period. The themes explored the motivations
and perceptions towards UTx amongst the general public in
the UK including the willingness to donate and barriers pre-
venting donation.
Method: 159 participants over the age of 16, living in the UK
consented and took part in the study.
Results: A total of 159 women completed the questionnaire.
The majority of respondents had never heard of UTx (n = 107,
71%) and most of the participants were not aware the uterus
could be donated after death (n = 130, 92%). Almost half of
the cohort were willing to donate their uterus after death
(n = 57, 43%). Only a minority stated they wished to donate
their organs but not their uterus (n = 10.8%). Approximately a
third of women (n = 42; 30%) believed the child born follow-
ing UTx would have genetic links to the donor. Over half of
the respondents (n = 65, 51%) strongly agreed or agreed they
would feel joy in the knowledge that donation would lead to
bringing a new life into the world. A quarter of respondents
strongly agreed or agreed (n = 45, 25%) that the use of their
uterus by another woman would feel like an extension of life.
Conclusions: The findings indicate a favourable opinion to-
wards UTx and a positive attitude towards donation of the
uterus after death amongst the general public in the UK. The
findings also highlight the need for education around UTx
now the option is available.
EP.0251  |  Clinical utility of Serum anti-­Mullerian
hormone in Polycystic Ovarian syndrome (PCOS) women
Rohitha Cheluvaraju; Reeta Mahey; Neena Malhotra;
Monika Rajput
All India Institute of Medical Sciences, New Delhi, India
Objectives: The present study evaluated the clinical utility
of serum AMH levels in the diagnosis of PCOS women and
correlated the AMH levels with clinical, hormonal and met-
abolic parameters among Indian PCOS women.
Design: Single-­center retrospective case-­control study in a
tertiary care center
Methods: The data was taken from a prospectively main-
tained database of women attending outpatient gynecology
clinic and infertility clinic. Inclusion criteria for the study
group were: (i) diagnosis of PCOS based on Rotterdam cri-
teria (ii) with complete data. Exclusion criteria for the study
group were: (i) patients with incomplete data; (ii) women
with ovarian surgery, associated endometriosis and those
on any hormonal medications, including oral contraceptive
pills. Inclusion criteria for the control group were: (i) women
with tubal or male factor infertility; (ii) complete data.
Exclusion criteria for the control group: (i) history of ovarian
surgery; (ii) women with endometriosis; on any hormonal
medications (iii) women with serum AMH < 1.5 ng/mL or
AFC < 7. (iv) women with isolated polycystic ovarian mor-
phology (i.e AFC > 12). A total of 1300 women were screened,
   |
   207
out of which 1146 women were eligible and recruited for the
study. Among them, 608 were diagnosed PCOS who were
subgrouped into five AMH groups and 538 as non-­PCOS.
Results: Mean serum AMH was 12.39 ± 5.3 ng/mL in
PCOS cohort and 3.83 ± 1.5 ng/mL in non-­PCOS cohort (p
< 0.01). Out of 608 PCOS women, 273 (44.9%) women be-
longed to phenotype A, 230 (37.8%) women were phenotype
D. Phenotype C and B were 12.17% and 5.10% respectively.
Among those with the highest AMH group (AMH > 20 ng/
mL; 8.05%), majority belonged to phenotype A. Menstrual
cycle length, serum testosterone, fasting total cholesterol
levels, follicle number per ovary had positive correlation
with serum Anti-­Mullerian levels (p < 0.05). AMH cut-­off
for the diagnosis of PCOS was calculated as 6.06 ng/mL on
ROC analysis with sensitivity and specificity of 91.45% and
90.71% respectively.
Conclusions: The role of serum AMH as a surrogate marker
of PCOM is highly promising as it correlates with FNPO and
ovarian volume. AMH cut-­off for the diagnosis of PCOS
6.06 ng/mL with sensitivity and specificity of 91.45% and
90.71% respectively. High serum AMH levels in PCOS are
associated with worse clinical, endocrinological and meta-
bolic parameters. These levels may be used to counsel pa-
tients regarding treatment response, help in individualised
management and prediction of reproductive and long-­term
metabolic outcomes.
EP.0254  |  Effectiveness of Intrauterine (PRP) Before
(IUI) In Improvement of Pregnancy Outcomes
Aisha Elbareg1,2; Fathi Essadi3
1
Misrata University, Misrata, Libya; 2AlJazeera International
Hospital, Misrata, Libya; 3Misrata Medical Centre, Misrata,
Libya
Background & Objectives: Platelets contain a significant
amount of growth factors. PRP, volume of plasma, prepared
from peripheral vein fresh blood, centrifuged to increase
platelets concentration. IUI, effective treatment, to be of-
fered before starting more ART invasive options. Study aim
was to evaluate the efficacy & safety of intrauterine infusion
of Autologous PRP before IUI in improvement of reproduc-
tive outcomes: clinical pregnancy rate (CPR) & life birth rate
(LBR) in women with history of infertility.
Materials & Methods: 165 infertile patients planned for IUI,
mean age of (33.8 ± 5.1 years) were included in a prospective
controlled study for 2 years (February 2020 through January
2022). Exclusion criteria: uncontrolled chronic disease, se-
vere endometriosis, PID, uterine malformations, endome-
trial polyps, & submucous myomas. Women divided into 2
groups: (A) [PRP& IUI, n: 85], and (B): [control, IUI only,
n: 80]. On 12th day of menstrual cycle, PRP was prepared
from autologous peripheral venous blood by a two-­step cen-
trifuge process, 1 mL of PRP was infused into uterine cavity
with IUI catheter on same day in (A) group. Semen sam-
ples collected after 3 days of sexual abstinence & prepared
 |
208       ABSTR​ACTS​
by swim up technique. IUI performed with 0.5 ml in both
(A) & (B) groups on 14th day of the cycle. Luteal support by
oral dydrogestrone for 2 weeks. (CPR): +ve pregnancy test &
GS visualized by (TVS) 4 weeks after IUI and compared be-
tween the two groups. (LBR) for (A) & (B) were recorded and
compared with each other. Complications if any were docu-
mented. Statistical analysis performed using SPSS packages
for Windows. P-­value significant if (< 0.05).
Results: Among (A) group, 9/85 (10.58%) patients were lost
in follow up, (only 76 were included in final analysis), but
none in the control group (B) were lost. CPR was higher in
the [(A) group (41/76) (53.94%)] vs [(19/80) (23.75%) in group
(B)] (p < 0.05). There were 28 live births in (A) group (28/76)
and 11 in group (B) (11/80), LBR was significantly higher in
(A) group (36.84%) than in (B) group (13.75%), (p < 0.01). (A)
group had a higher implantation rate and lower spontaneous
miscarriage rate than (B) group, statistically significant, (p
< 0.05). No complications in both groups were recorded.
Conclusion: Autologous intrauterine infusion of PRP be-
fore IUI is an effective, safe, and inexpensive treatment that
could significantly increase CPR & LBR in patients with his-
tory of infertility.
EP.0301  |  Managing IVF cycles to minimise OHSS in
a public hospital fertility clinic
Isla Robertson; Aarti Umranikar; Polly Ford
Salisbury District Hospital, Salisbury, UK
Objective: How has a hospital-­based IVF setting with mostly
long protocol cycles and a fixed operating day adapted post-­
covid aiming to minimise OHSS and hospital admission?
Design: Retrospective review from 1 Jan 2017–­31 Dec 2022,
of patients undertaking IVF/ICSI cycles in a single fertil-
ity centre within an NHS hospital. Data extracted from
clinic log, electronic health record and patient notes and
anonymised for analysis. Comparison of patient, cycle, and
outcome data from two groups, 2017–­2019 and 2020–­2022 to
identify any changes in management and associated effects.
All data analysed using R studio.
Method: 1389 cycles were included. In 86 cycles, all em-
bryos were frozen due risk of OHSS. Statistical comparisons
made between the two groups comparing female age, AMH
(pmol/L), no of follicles at final scan, no of eggs collected,
starting stimulation dose, dose changes, trigger drug, num-
ber of embryos frozen, if admitted to hospital due to OHSS
and OHSS severity.
Results: The freeze-­a ll rate due to OHSS was 3.08% from
2017 to 2019 versus 10.18% from 2020 to 2022. Within this
subset of cycles, there were no observed differences in fol-
licle count, number of oocytes collected, stimulation dose,
age or AMH. Frozen embryo yields were good, and outcome
data collection is ongoing. Across the whole patient cohort,
there was a significant increase in the number of patients
with ≥18 eggs collected 14.61% 2017–­19 vs 19.54% 2020–­22
and ≥20 eggs collected 9.87% 2017–­19, 14.78% 2020–­22. The
threshold for mandatory freeze-­a ll was reduced to 20 eggs
collected at the start of the covid pandemic.
The rate of OHSS hospital admission did not change signifi-
cantly, 1.54% from 2017–­2019 and 1.97% from 2020–­2022.
This falls within the 1%–­3% admission rate with a universal
freeze-­a ll policy reported in a Cochrane review (Wong et al.,
2017). However, there were no cycles leading to OHSS hospi-
tal admissions after fresh embryo transfer since 2019, drop-
ping from 0.90% from 2017–­19 to 0% from 2020–­22. This
suggests more liberal use of freeze-­a ll may have prevented
some potential late OHSS admissions, improving patient
safety, but it is also associated with additional time to preg-
nancy and increased costs.
Conclusions: Freeze-­a ll cycles due to OHSS risk have in-
creased, reducing late OHSS but with added costs. Further
work is needed to explore the observed trend in increas-
ing higher egg yields and perform overall cost analysis.
Optimising cycle management by reassessing AMH/AFC
stimulation thresholds may reduce the need for freeze-­a ll.
EP.0308  |  Practical and cost benefits of AMH over
timed gonadotrophins for fertility assessment
Romana Cuffolo1; Fatima Husain1; Dawn Grenshaw1; Ian
Walker1; Goli Shenasan1; Bardia Azar1; Gulam Bahadur2,3
1
Wexham Park Hospital, Slough, UK; 2Homerton Fertility
Unit, London, UK; 3North Middlesex University Hospital,
london, UK
Objective: Initial fertility investigations include testing gon-
adotrophins and progesterone, both requiring precise tim-
ing in the menstrual cycle. AMH (anti-­mullerian hormone)
shows minimal inter and intra-­cycle variation and is supe-
rior to gonadotrophins in predicting ovarian reserve and
response to ovarian stimulation. This study evaluates the
cost-­effectiveness and practical aspects of performing uni-
versal AMH testing in primary and secondary care, instead
of conventional timed gonadotrophins and progesterone.
Design: This is a retrospective observational cohort study of
cost-­effectiveness of universal AMH screening compared to
current timed hormone testing, focusing on the interface be-
tween primary and secondary care. We included all women
aged 18–­51 who had AMH or both gonadotrophins and pro-
gesterone tested in our laboratory over a one-­year period.
We excluded progesterone tests for early pregnancy com-
plications, women on ovulation induction, samples from
emergency department and non-­fertility related requests.
The costs of were obtained from UK National Schedule of
Reference Costs. The cost of repeat clinic appointments was
estimated by the number of tests requested by fertility spe-
cialists, assuming that one additional appointment was re-
quired for each patient to review these results.
Results: In 2016, 2239 women had fertility investigations in
our lab, undergoing 4159 blood samples. 42% of gonadotro-
phin tests were incorrectly taken on the same day as proges-
terone, with 93% originating from primary care. The total
A​B ST​R ACTS
cost of lab assays with phlebotomy was £37656.40, based on
current prices. As multiple samples were missing or mis-­
timed, 472 women (21% of all) had further blood tests re-
quested by fertility consultants, increasing the expenditure
including repeat clinic appointments to £134416.40. The
universal AMH testing for this cohort would cost £54810.72
leading to a saving of £79605.68, with a spend per patient
being £24.48 for universal AMH testing as opposed to
£60.03 with standard testing regime including repeat ap-
pointments (p < 0.0001). Our proposed investigation path-
way includes a single AMH blood test prior to secondary
care referral, which does not need to be accurately timed, nor
repeated. Even though the cost of AMH is 66% more than
timed gonadotrophins and progesterone, it would allow an
overall 59% cost reduction by limiting repeat gynaecology
clinic attendance.
Conclusion: This study highlights that universal AMH test-
ing in primary care, instead of timed gonadotrophin and
progesterone assays, could provide a cost saving of 59% per
patient and reduce the number of fertility clinic appoint-
ments. This could potentially enable a one stop fertility ser-
vice, likely improving waiting times and patient satisfaction.
R ISK M A NAGE M E N T
OP.0016  |  Near-­miss audit of SGA babies not detected
during antenatal surveillance
Hanna Ellson; Emily Butler; Oliver Hugh; Jason Gardosi
Perinatal Institute, Birmingham, UK
Objective: Pregnancies with small-­for-­gestational age (SGA)
fetuses have an increased risk of stillbirth and perinatal mor-
bidity, and failure to recognise SGA antenatally increases
risk further. Improved antenatal detection is the key aim of
the Growth Assessment Protocol (GAP), and a key part of
the program is the application of an audit tool to ascertain
the reasons why babies born SGA were missed antenatally.
Design: Analysis of anonymised case note audits.
Method: GAP-­SCORE (standardised clinical outcome re-
view and evaluation) is a web-­based audit tool provided as
part of the GAP program, designed to assist review of clini-
cal care against RCOG, NHS England and GAP guidelines.
Cases for entry are selected randomly at unit level and are
fully anonymised. The entry criterion was singleton preg-
nancies with a birthweight <10th GROW centile which had
not been suspected or detected antenatally by ultrasound es-
timated fetal weight (EFW).
Results: The cohort included 3765 cases entered in 62 UK
hospitals during 2022. The largest category (46.9%) was SGA
cases missed despite serial scanning initiated according to
local protocol following first trimester risk assessment. The
median number of third trimester scans performed in these
pregnancies was 3 (interquartile range 3–­4), with a median
interval between last scan and delivery of 11 days (IQ 6-­18).
   |
   209
A further 6.5% of pregnancies had been assessed as high
risk but failed to have serial scans. 33.6% of all missed cases
were considered low risk in early pregnancy but had one or
more referrals for growth scans in the third trimester, which
nevertheless failed to detect that the fetus was SGA. The re-
maining 12.3% of cases were low risk, where fundal height
measurement failed to identify the need to refer for scan.
Conclusion: The study showed that the largest category of
missed cases were in pregnancies undergoing serial third tri-
mester scans. This may be associated with chronic shortages
in ultrasound resources and limited capacity to afford the
GAP guideline's recommendation of four 3-­weekly growth
scans in the third trimester. Quality assurance is also impor-
tant and units have started to assess accuracy of their EFWs
by using our bespoke audit tool. Less than a fifth of reviewed
cases were missed due to lack of recognition of SGA by se-
rial fundal height measurement. Frequent feedback from
clinicians was that the audit process helps to identify train-
ing needs and system failures, including hurdles in referral
pathways and adherence to protocol.
PP.0032  |  Prediction of spontaneous preterm birth
from routinely collected clinical data
Ruta Margelyte1,2; Gbenga A. Kayode1,2; Christy Burden1,2;
Dilly O. C. Anumba3,2; Basky Thilaganathan4,2; Andrew
Judge1,2; Erik Lenguerrand1,2
1
University of Bristol, Bristol, UK; 2RCM-­RCOG Tommy's
National Centre for Maternity Improvement, London,
UK; 3University of Sheffield, Sheffield, UK; 4St George's
University Hospitals NHS Foundation Trust, London, UK
Objective: To develop and validate a model using rou-
tinely collected data to predict spontaneous delivery before
37 weeks gestation in women with singleton pregnancies.
Design: Population-­based cohort study.
Method: Two data sources were obtained: (1) National
Maternity and Perinatal Audit (NMPA) patient level data
from April 2015 to March 2017 across 131 NHS Trusts in
England containing maternal characteristics, obstetric his-
tory, and care provider details; (2) Data from a single NHS
Trust from April 2018 to December 2021, containing more
detailed obstetric history, antenatal complications and med-
ication, and 1st trimester combined screening results. The
primary outcome was occurrence of spontaneous preterm
birth before 37 weeks gestation. Continuous variables asso-
ciation with preterm delivery was tested for non-­linearity
and natural splines transformations were used. Logistic re-
gression with backward selection was used to develop the
models in the training datasets and then they were inter-
nally validated in the test datasets. Model performance was
assessed for calibration across deciles of predicted risk, and
discrimination using the Area Under the Receiver Operating
Curve (AUROC).
Results: Spontaneous preterm delivery occurred in 32,093
or 3.1% of the 1,041,060 singleton pregnancies (50.3% of all