Abstract
Background: Understanding the complex dialogue between the oocyte and its surrounding follicular cell in the ovarian follicle has been crucial in developing clinical protocols for assisted reproductive technology for infertile women. Folliculation and oocyte maturation need GDF-9 and BMP-15. These traits must predict ovarian response in intracytoplasmic sperm injection (ICSI) for assisted reproductive technologies to work. In women having ICSI, blood and follicular fluid GDF-9 and BMP-15 levels were used to predict ovarian response, oocyte quality, and pregnancy outcomes. Method: From January 2022 to September 2023, Al-Nahrain University's High Institute of Infertility Diagnosis and Assisted Reproductive Technologies conducted a prospective study on 84 female ICSI patients. Aged 18–44, their BMI was 18–30 Kg/m 2. All were determined on menstruation day two. GDF-9 and BMP-15 were measured in blood using ELISA. Follicular fluid was obtained for GDF-9 and BMP-15 assays after oocyte extraction. Standardized hormonal testing, ovarian stimulation, and embryo transfer were performed. Results: 42.9% of volunteers conceived. Positive pregnancy outcomes were associated with greater total oocyte, metaphase II oocyte, and embryo counts (p = 0.003, 0.002, and 0.002). Despite not being statistically significant, pregnant women exhibited higher GDF-9 and BMP-15 levels. Biomarkers predicted pregnancy outcomes with low sensitivity (58%) and specificity (61–67%). Conclusion: Successful conception was clearly linked to higher oocyte and embryo quality; GDF-9 and BMP-15 levels showed promise as predictive indicators but lacked significant statistical significance. More study is required to improve prediction models by include other biomarkers.

Key words: GDF-9, BMP-15, ovarian response, ICSI, assisted reproduction, folliculogenesis, pregnancy outcomes.