en Assisted Reproductive Technologies Original Article Original Article <div style="text-align: justify;"><span style="font-size:10pt"><span style="line-height:normal"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:12.0pt">Background: </span></b><span style="font-size:12.0pt">Declining fertility in a woman of advanced age is associated with a depletion in ovarian reserve as well as declining oocyte and embryo quality. Determining the predictors of embryo quality may assist in stimulation target and cycle prediction. </span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:normal"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:12.0pt">Objectives:</span></b><span style="font-size:12.0pt"> This study aims to identify factors affecting embryo quality among women of advanced age receiving intracytoplasmic sperm injection (ICSI) cycles.</span><span style="font-size:12.0pt"></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:normal"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:12.0pt">Materials and Methods: </span></b><span style="font-size:12.0pt">This prospective cohort study was conducted over a period of 12 months, from January until December 2018, on 734 mature oocytes retrieved from 124 women of advanced age (35-45 yr old) receiving ICSI. The Society of Assisted Reproductive Techniques system was used to determine the morphological grading of embryo quality. The fertilization rate, cleavage rate, and pregnancy rate per cycle were expressed as a percentage per cycle for a total of 76 embryo transfers. Possible predictors of high-quality embryos were evaluated using single and multiple regression tests, with p < 0.05 considered as significant.</span><span style="font-size:12.0pt"></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:normal"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:12.0pt">Results:</span></b><span style="font-size:12.0pt"> Out of the 586 available embryos, 288 (49.15%) high-quality embryos were obtained. The fertilization and cleavage rates were 86.18% and 97.83%, respectively. The total number of retrieved oocytes (R² = 0.857) and the total available embryos (R² = 0.857) were closely related to high-quality embryos. 76 embryo transfers were conducted, with 17 successful conceptions (implantation rate = 22.37% per transfer). There were no miscarriages among the pregnancies.</span><span style="font-size:12.0pt"></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:normal"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:12.0pt">Conclusion:<a name="_Hlk48926216"> </a></span></b><span style="font-size:12.0pt"> Increasing the number of collected oocytes and the cleavage rate could increase the chance of obtaining more high-grade embryos. This could increase the success of ICSI among women of advanced age</span><span style="font-size:12.0pt">.</span></span></span></span></div> Embryo development, Intracytoplasmic sperm injection, Ovarian hyperstimulation, Advanced age, Predictors. 581 590 http://ijrm.ir/browse.php?a_code=A-10-1757-1&slc_lang=en&sid=1 Ezanaton Nisar Omar Hafizi ezanaton@usm.my 0000-0001-9583-5542 No Department of Obstetrics and Gynecology, Hospital Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia. Rahimah Abdul Rahim drrahimah@usm.my 0000-0001-5858-0894 No Department of Obstetrics and Gynecology, Hospital Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia. Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Erinna Mohamad Zon erinna@usm.my 0000-0003-4240-6298 No Department of Obstetrics and Gynecology, Hospital Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia. Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Adibah Ibrahim dradibah@usm.my 0000-0001-7549-1535 Yes Department of Obstetrics and Gynecology, Hospital Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia. Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.