337 J Contemp Med Sci | Vol. 8, No. 5, September-October 2022: 337–342 Original Relation of Serum and Follicular Level of BMP15 with Oocyte Quality, Embryo Grading and Pregnancy Rate Zainab Hassan Hashim 1* , Lubna Amer 2 , Estabraq A. Al-Wasiti 3 1 Department of Clinical Reproductive Physiology, High Institution for Infertility Diagnosis and Assisted Reproductive Technologies, University of Al-Nahrain, Baghdad, Iraq. 2 Institution for Infertility Diagnosis and Assisted Reproductive Technologies, University of Al-Nahrain, Baghdad, Iraq. 3 Department of Biochemistry, College of Medicine, University of Al-Nahrain, Baghdad, Iraq. *Correspondence to: Zainab Hassan Hashim (E-mail: zainab.hassan@ierit.nahrainuniv.edu.iq) (Submitted: 03 March 2022 – Revised version received: 21 March 2022 – Accepted: 07 April 2022 – Published Online: 26 October 2022) Abstract Objectives: Use of serum and follicular fuid concentration of oocyte secreted factors BMP15 as biomarkers of oocyte quality, embryo quality and it’s relation to pregnancy rate. Methods: Eighty eight women were included in this study; they were selected from those undergoing intra-cytoplasmic sperm injection. Results: Positive pregnancy was achieved by 14 women accounting for 19.0% (total number of women that reach embryo transfer was 72). No signifcant diference in mean serum BMP15 between pregnant and non-pregnant women, but the level of follicular fuid BMP15 was signifcantly higher in pregnant women. MI oocyte count was not signifcantly correlated to serum or follicular fuid BMP15 (P > 0.05). MII oocyte count showed highly signifcant positive correlation to serum and follicular fuid BMP15 (P < 0.01). Grade 1 embryo count showed highly signifcant positive correlation to serum and follicular fuid BMP15 (P < 0.01), Grade 2 embryo count showed signifcant positive correlation to serum BMP15 (P = 0.032), but the grade 2 embryo count showed non-signifcant correlation to follicular BMP15 (P > 0.05). Also grade 3 embryo count showed non-signifcant correlation to serum and follicular BMP15 (P > 0.05). Conclusion: The current study revealed that serum and follicular BMP15 could be used as indicator for oocyte maturity, and serum BMP15 could be used as indicator of good quality embryos. Keywords: Follicular level, BMP15, oocyte, embryo grading, pregnancy rate ISSN 2413-0516 Introduction Infertility is defned as the inability, of a couple to have preg- nancy afer a period of one year, in those women under 35 years of age or afer 6 months in those women above 35 years of age, in spite of regular (3 to 4 times/week), adequate and unprotected sexual intercourse. Te key limiting factor in female fertility is the oocyte quality, and till now there is poor understanding of what factors that determine the oocyte quality or the mechanisms that governing it. 1,2 About 35% of infertility cases are caused by female fac- tors, 35% related to male factors, 20% caused by both male and female factors, and 10% by unknown causes. 3 Te key limiting factor in female fertility is the oocyte quality; the quality of oocyte greatly afects early embryonic survival, also establishment with maintenance of pregnancy, devel- opment of the fetus, and even causes some adult diseases. 1 Bone morphogenetic protein 15 (BMP15) and growth dif- ferentiation factor 9 (GDF9), have a unique feature, within the transforming growth factors-b super-family is that the expression of the protein is essentially restricted to the gam- etes (oocyte). BMP15 and GDF9 are expressed in the oocyte during folliculogenesis, from the earliest stages. 4 Tey are expressed in high levels by the oocyte throughout follicu- logenesis, so they are could be regarded a good indicator for oocyte quality, and measuring them in the serum which is rapid, non-invasive and easy test could give a great clue to female fertility. 5 Tis study aimed to use serum and follicular fuid concen- tration of oocyte secreted factors BMP15 as biomarkers of oocyte quality, embryo quality and then to study it’s relation with the pregnancy rate. Materials and Methods A prospective study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technolo- gies, Al-Nahrain University, from Nov., 2020 to July 2021. One hundred and seventy six women were included in this study. Te study subjects involved eighty eight women who were selected from those attended the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, they were enrolled in IVF program. Inclusion Criteria • All couples undergoing IVF/ICSI protocols. • Women at any age from 18 to 47 years old. • Infertility due to female factors: tubal blockage, unovula- tory cycles, and mild-moderate cases of endometriosis that diagnosed laproscopically. • Couples with male factor infertility. • Unexplained infertility. Exclusion Criteria • All types of congenital anomalies of the reproductive system. • Uncontrolled systemic and endocrine disorders. • Women with BMI more than 30 kg/m 2 Methods and Study Design A total of eighty eight patients undergoing IVF/ICSI cycle were evaluated: • Taking full obstetrical, medical, surgical history with assessment of weight and height to obtain (BMI).