P-124 Impact of Iron Levels on Embryo Quality in IVF: Quantitative and Qualitative Analysis

Abstract Study question How does iron deficiency and its correction with iron supplementation impact embryo quality and fertilization rates in women undergoing in vitro fertilization (IVF)? Summary answer Iron deficiency reduces embryo quality and fertilization rates in IVF, while iron supplementation with a two-month pause restores these parameters to control group levels. What is known already Iron deficiency negatively impacts embryo quality and fertilization rates in IVF. This study shows that immediate iron supplementation before ovarian stimulation does not significantly improve outcomes. However, iron therapy followed by a two-month pause before stimulation restores embryo quality and fertilization rates to levels comparable to the control group. These findings highlight the importance of pre-treatment timing in IVF success. Study design, size, duration This was a prospective cohort study including 106 women undergoing IVF, divided into four groups based on iron levels and treatment. The study assessed embryo quality and fertilization rates after iron supplementation with or without a two-month pause before ovarian stimulation. Data were collected over a period of 12 months, analyzing quantitative and qualitative embryo characteristics to determine the impact of iron deficiency and its correction on IVF outcomes. Participants/materials, setting, methods • Control group (CG) (n = 21) – Healthy women with normal iron levels. • Group 1 (n = 20) – Women with low ferritin levels (11.1±0.98 µg/L). • Group 2a (n = 29) – Patients with low iron levels who received iron supplements without a delay before ovarian stimulation in the IVF cycle. • Group 2b (n = 36) – Patients with low ferritin levels who underwent iron therapy followed by a two-month pause before ovarian stimulation. Main results and the role of chance • In Group 1, a significant decrease was observed in the number of fertilized oocytes (85 vs. 261 in CG), total embryos (61.4% vs. 90.4%), and the percentage of excellent-quality embryos (23.5% vs. 62.3%) (p < 0.001). • In Group 2a, which received iron before ovarian stimulation, fertilization rates and embryo quality remained significantly lower than in the control group (p < 0.01). • In Group 2b, which received iron supplementation followed by a two-month delay before stimulation, embryo parameters improved significantly, reaching levels comparable to the control group: number of fertilized oocytes (317), percentage of excellent embryos (60.9%), and a decrease in poor-quality embryos (p < 0.01). Iron deficiency significantly reduces embryo quality and fertilization rates in IVF. Immediate iron supplementation before ovarian stimulation does not yield substantial improvements. However, iron supplementation followed by a two-month pause before stimulation restores embryo parameters to levels comparable to the control group. This finding highlights the critical role of iron levels in reproductive outcomes and suggests that pre-treatment timing plays a crucial role in optimizing embryo development and fertilization success in IVF. Limitations, reasons for caution This study is limited by its sample size and short-term focus on embryo quality, without assessing pregnancy or live birth rates. Individual variations in iron metabolism and other influencing factors were not analyzed. Larger, multi-center studies are needed to confirm findings and determine optimal iron supplementation strategies for IVF success. Wider implications of the findings These findings suggest that iron levels play a crucial role in IVF success, highlighting the need for pre-treatment iron assessment and supplementation strategies. Optimizing iron status before ovarian stimulation may improve embryo quality and fertilization rates, potentially enhancing pregnancy outcomes and live birth rates in women undergoing assisted reproductive technologies. Trial registration number Yes

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