Study question Can non-invasive gene expression analysis of cumulus cells (CC) improve efficiency in ART by prioritizing oocytes for further culture and fresh single embryo transfer? Summary answer CC analysis can be used for the selective processing of oocytes. This may reduce culture work and improve the outcome in ICSI elective SETs (eSET). What is known already In an interventional, blinded, prospective cohort study (Van Vaerenbergh et al. 2021), 113 patients underwent a fresh Day3 eSET with embryos ranked and transferred based on morphology and CC gene expression (Aurora Test), while 520 control patients underwent a Day3 eSET without the Aurora Test. This resulted in a significant higher clinical pregnancy of 61% in the patients with eSET based on CC ranking applied on good morphology embryos, compared to 29% in the controls with eSET based on embryo morphology only. Live birth rate was also significantly increased, while time-to-pregnancy was significantly reduced with 3 transfer cycles. Study design, size, duration In a retrospective analysis, in a subset of patients with at least 6 growing follicles and at least five 2PN oocytes (n = 80), it was investigated whether the Aurora Test, used to select transferrable Day3-embryos, could also be applied to select oocytes on Day0/1. The effect of processing only the three highest ranked oocytes (based on the Aurora Test) on embryo development and clinical pregnancy was studied compared to processing all oocytes. Participants/materials, setting, methods Patients included in this single centre study had their first or second GnRH-antagonist ICSI cycle, were younger than 40y, had normal BMI, were stimulated with HP-hMG and scheduled for Day3 eSET. Two-sided statistical analysis (p < 0,05) was performed between a strategy of processing only the top 3 Aurora ranked oocytes, according to CC gene expression, and a strategy of processing all available oocytes. Main results and the role of chance On average, 8 MII oocytes were obtained per patient and the average fertilization rate was 83%. In total, 407 good quality embryos (GQE) on Day3 were generated from these 80 patients when utilising all 639 oocytes. Processing the three top-ranked oocytes only (240/639 oocytes) would have reduced the number of embryos to 169 GQE and would have resulted in 2.1 GQE on average on Day3 per patient; 75/80 (94%) patients would have had a fresh Day3 transfer resulting in a 63% clinical pregnancy rate. Processing all 639 available 2PN oocytes (standard of care) resulted in a fresh Day3 transfer in all 80 patients and a similar 64% clinical pregnancy rate (ns). However, 399 more oocytes would need to be processed. The strategy of restricting the number of oocytes to be processed would not have compromised cumulative cycle outcome. Considering all subsequent freeze/thawing cycles the cumulative clinical pregnancy rate calculated per all 80 patients would increase to 90%. Limitations, reasons for caution The limitation of this approach is that the Aurora Test requires individual oocyte denudation and individual oocyte vitrification. Secondly, this new strategy should be validated in a prospective study. Wider implications of the findings By applying this oocyte selection strategy patients would benefit from a high pregnancy rate in the fresh transfer cycle, while the lab would see reduction in embryo culture work, because freeze/thawing cycles and culture of embryos with lower competence would be prevented. Trial registration number NA

中文翻译：

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P-251 卵丘细胞分析作为一种非侵入性卵母细胞选择策略，可减少培养的卵母细胞/胚胎数量并提高妊娠率

研究问题 卵丘细胞 (CC) 的无创基因表达分析能否通过优先考虑卵母细胞进行进一步培养和新鲜单胚胎移植来提高 ART 的效率？总结答案 CC 分析可用于卵母细胞的选择性处理。这可能会减少培养工作并改善 ICSI 选修 SET (eSET) 的结果。已知情况 在一项介入性、盲法、前瞻性队列研究（Van Vaerenbergh 等人，2021）中，113 名患者接受了新的第 3 天 eSET，根据形态和 CC 基因表达（Aurora 测试）对胚胎进行排序和转移，而 520 名对照患者在没有 Aurora 测试的情况下进行了第 3 天 eSET。根据应用于良好形态胚胎的 CC 排名，这导致 eSET 患者的临床妊娠率显着提高 61%，相比之下，仅基于胚胎形态的 eSET 对照组为 29%。活产率也显着提高，而 3 个移植周期显着缩短了怀孕时间。研究设也可用于在第 0 天/第 1 天选择卵母细胞。与处理所有卵母细胞相比，研究了仅处理三个最高等级的卵母细胞（基于 Aurora 测试）对胚胎发育和临床妊娠的影响。参与者/材料、环境、方法 纳入这项单中心研究的患者进行了第一个或第二个 GnRH 拮抗剂 ICSI 周期，年龄小于 40 岁，BMI 正常，用 HP-hMG 刺激并安排在第 3 天 eSET。在根据 CC 基因表达仅处理 Aurora 排名前 3 位的卵母细胞的策略和处理所有可用卵母细胞的策略之间进行双边统计分析 (p < 0.05)。主要结果及机会的作用平均每位患者获得8个MII卵母细胞，平均受精率为83%。在使用所有 639 个卵母细胞时，这 80 名患者在第 3 天总共产生了 407 个优质胚胎 (GQE)。仅处理三个排名靠前的卵母细胞（240/639 个卵母细胞）会将胚胎数量减少到 169 个 GQE，并且在第 3 天每位患者平均会产生 2.1 个 GQE；75/80 (94%) 的患者将进行新的第 3 天转移，从而导致 63% 的临床妊娠率。处理所有 639 个可用的 2PN 卵母细胞（护理标准）导致所有 80 名患者在第 3 天进行新的移植，临床妊娠率 (ns) 相似，为 64%。然而，还需要处理 399 个以上的卵母细胞。限制待处理卵母细胞数量的策略不会损害累积周期结果。考虑到所有随后的冷冻/解冻周期，每 80 名患者计算的累积临床妊娠率将增加到 90%。限制，谨慎的原因 这种方法的限制是极光测试需要单个卵母细胞剥落和单个卵母细胞玻璃化。其次，这一新策略应在前瞻性研究中得到验证。研究结果的更广泛意义 通过应用这种卵母细胞选择策略，患者将受益于新鲜移植周期中的高妊娠率，而实验室将减少胚胎培养工作，因为冷冻/解冻周期和能力较低的胚胎培养将是阻止了。试用注册号 NA