TITLE: ENDOMETRIAL CAVITY FLUID Amongst OOCYTE RECIPIENTS: NOVEL INTERVENTIONS AND SUCCESSES; A DIFF HOSPITAL APPROACH DR ESE WILLIAMS O.

OUTLINE BACKGROUND: BRIEF OVERVIEW OF ECF, PREVALENCE IN IVF OBJECTIVES SETTING METHODOLOGY RESULTS/DISCUSSION CONCLUSION REFERENCES

BACKGROUND Endometrial cavity fluid affects approximately 2-5% of patients undergoing IVF (He et al, 2010) However, report largely on Stimulated cycles Measurement of fluid in endometrium on day of OCR (akman et al) Between 1 to <3.5mm in AP diameter (He et al, 2010) Outcome usually not encouraging, without intervention With interventions, pregnancy rates quite low < 15 - 20% (he et al 2010, akman et al 2005, mansour et al 1991, chien et al 2002) Very few studies on oocyte recipients, no meta-analysis This study, a retrospective study

OBJECTIVE TO EVALUATE LIFE BIRTH RATES AMONGST OOCYTE RECIPIENTS WHO HAD RECURRENT ENDOMETRIAL CAVITY FLUID WITH VARYING INTERVENTIONS

METHODOLOGY/SETTING A Retrospective Study Data Collected From Patients On Art Treatment From 2014 To 2016 Exclusion Criteria: All Hydrosalpinx, Endometriosis, Bulky Uterus With Fibroids Or Adenomyosis, And Evidence Of Endometritis. Diagnosis Of Fluid During Endometrial Regeneration At Scan Sessions From Days 10 Of Cycle To Day 14 Of Cycle. Interventions Include: Drainage Of Fluid Alone, Drainage +Insertion Of Intrauterine Contraceptive Devices (IUCD) And Instillation Of HAC +- Drainage/ IUCD At least 48 Hours Prior To Embryo Transfer (ET). Cycle cancellations when multiple interventions failed Statistical analysis: Analyse-it® version 4.6 software for Microsoft excel SETTING; DIFF HOSPITAL. A private hospital in Abuja, FCT of Nigeria.

RESULTS/ DISCUSSION Of the 821 available data from oocyte recipients, 475 (57.8%) had ECF at scans in one or more cycles. Only 20 (2.4%) of these patients met the inclusion criteria. Life birth rate was highest amongst the HAC intervention group (33%), followed by Drainage alone (27%), then Drainage + IUCD (25%) Overall life birth in patients with ECF was 20%, largely age dependent. Age group ≥ 42 years had the least outcome following interventions

Data presentation

Successes by intervention table Interventions No Life birth Life birth Total %age success Drainage alone 8 3 11 27% Drainage + HAC 2 1 33% Drainage + IUCD 5 6 17% Grand Total 15 20 77%

Successes by age group Age Group No life birth Life birth Total %age ≤32 2 1 3 33% 33-36 14% 37-41 5 7 29% ≥42 6

Conclusion Limitations: Drainage + HAC intervention strategy in patients with ECF has shown to improve life birth rate as compared to other forms of intervention, though this was not statistically significant. Limitations: Retrospective study Final study population after exclusion Incomplete data entries Lack of available robust studies on this work

Acknowledgements The Medical Director and Director of Admin The Head of Embryology & Secretary IVF Research Assistant All IVF team members All staff of DIFF Hospital Medical statistician

References Rong-Huan He, Hui-Juan Gao, Ya-Qiong Li, Xiao-Ming Zhu: The associated factors to endometrial cavity fluid and the relevant impact on the IVF outcome. Reproductive Biology and Endocrinology (RBE), 2010, 8: 46 Akman MA, Erden HF, Bahceci M: Endometrial fluid visualized through ultrasonography during ovarian stimulation in IVF cycles impairs the outcome in tubal factor, but not PCOS, patients. Hum Reprod 2005, 20: 906- 909. Mansour RT, Aboulghar MA, Serour GI, Riad R: Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation. J In Vitro Fert Embryo Transf 1991, 8:157-159. Chien LW, Au HK, Xiao J, Tzeng CR: Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF. Hum Reprod 2002, 17:351-356.

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