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Rodríguez-Fuentes A, Hernández J, Rouleau JP, Martín-Vasallo P, Palumbo A. A follicular volume of >0.56 cm 3 at trigger is the cutoff to predict oocyte maturity: a starting point for novel volume-based triggering criteria. Fertil Steril 2024; 121:991-999. [PMID: 38295896 DOI: 10.1016/j.fertnstert.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To determine the minimum follicular volume on the day of trigger that will correspond to a mature oocyte at egg retrieval by individualized follicular puncture and to calculate the mean follicular growth from ovulation induction to egg retrieval using SonoAVCfollicle. DESIGN A prospective observational study of 53 women undergoing in vitro fertilization, in which it was possible to identify unequivocally one or more follicles at trigger and egg retrieval using three-dimensional ultrasound. SETTING University-affiliated private in vitro fertilization center. PATIENTS The final sample included 206 follicles from 14 oocyte donors and 39 patients. INTERVENTIONS A three-dimensional ultrasound with SonoAVCfollicle was performed at trigger and egg retrieval. The same operator selected follicles that were identified easily on both scans and verified that they were apt to be aspirated individually. Follicles were punctured individually, recording the real aspirated volume and the maturity stage of the oocyte. MAIN OUTCOME MEASURES The primary outcome was the relationship between follicular volume on the day of the trigger and the oocyte maturity stage. The secondary outcome was the rate of follicular growth from the day of trigger to the day of oocyte retrieval, as measured using SonoAVCfollicle. RESULTS On the day of trigger 206, follicles were selected. Of these, 5 could not be identified on the day of oocyte retrieval, probably because of follicular rupture (mean volume: 4 cm3, range: 2-7 cm3), and in 48, an oocyte was not obtained. The relationship between follicular volume and oocyte maturity was studied in 153 follicles: 125 (82%) contained mature and 28 (18%) contained immature oocytes. Receiver operating characteristic curves showed an area under the curve value of 0.73 (95% confidence interval: 0.65-0.80). A follicular volume of >0.56 cm3 is the cutoff point, with the highest Youden index having a sensitivity of 85% and a specificity of 64% to predict oocyte maturity. The mean follicular growth from trigger to egg retrieval was 26%-50% in 53% of cases. CONCLUSION A follicular volume of >0.56 cm3 at trigger is the cutoff point with the optimal balance between sensitivity and specificity for oocyte maturity. Follicles of >2-3 cm3 may undergo spontaneous rupture before egg retrieval. Given these findings, we propose new volume-based criteria for trigger: 70% of follicles of >0.6 cm3 and dominant follicles between 2 and 3 cm3. These findings need validation by randomized controlled trials.
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Affiliation(s)
- Adela Rodríguez-Fuentes
- Department of Reproductive Endocrinology, Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jairo Hernández
- Department of Reproductive Endocrinology, Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jean Paul Rouleau
- Department of Reproductive Endocrinology, Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Pablo Martín-Vasallo
- Department of Reproductive Endocrinology, Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; UD de Bioquímica y Biología Molecular and Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
| | - Angela Palumbo
- Department of Reproductive Endocrinology, Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
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Hirshfeld-Cytron J. Three-dimensional follicle measurements: coming soon to a clinic near you? Fertil Steril 2024; 121:964-965. [PMID: 38554763 DOI: 10.1016/j.fertnstert.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
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Rodrigues ARDO, de Sá RAM, Velarde GC, Valle MP, Nóbrega BN, Roque M, Júnior EA. Comparing Two- and Three-dimensional Antral Follicle Count in Patients with Endometriosis. J Med Ultrasound 2022; 30:282-286. [PMID: 36844767 PMCID: PMC9944808 DOI: 10.4103/jmu.jmu_204_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background The purpose of the study was to compare three-dimensional (3D) ultrasound semiautomatic antral follicle count (AFC) with two-dimensional (2D) ultrasound real-time AFC to evaluate patients with deep endometriosis and/or endometrioma submitted to ovarian stimulation (OS). Methods This was a retrospective cohort study assessing all women with documented diagnosis of deep endometriosis who underwent OS for assisted reproduction treatment. The primary outcome was the difference between AFC by semiautomatic 3D follicle count using 3D volume datasets and 2D ultrasound count with the number of oocytes retrieved at the end of the cycle. The 3D ultrasound AFC was obtained using sonography-based automated volume count (SonoAVC), and the 2D ultrasound AFC data was collected from the electronic medical record. Results Total of 36 women had deep endometriosis documented by magnetic resonance imaging, laparoscopy, or ultrasonography and 3D ovarian volume datasets stored from their first exam. The differences between the 2D and 3D AFC and the number of oocytes retrieved at the end of the stimulation were compared, showing no significant statistical difference between both methods (P = 0.59). Correlations were similar using both methods when compared to the number of oocytes retrieved (2D [r = 0.83, confidence interval (CI) = 0.68-0.9, P < 0.001]); (3D [r = 0.81, CI = 0.46-0.83, P < 0.001]). Conclusion 3D semiautomatic AFC can be used to access the ovarian reserve in patients with endometriosis.
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Affiliation(s)
- Andréia Regina de Oliveira Rodrigues
- Department of Post-Graduation in Medical Sciences, Federal Fluminense University, Rio de Janeiro-RJ, Brazil,Origen-Rio Centre for Reproductive Medicine, Rio de Janeiro-RJ, Brazil
| | | | - Guillermo Coca Velarde
- Department of Post-Graduation in Medical Sciences, Federal Fluminense University, Rio de Janeiro-RJ, Brazil
| | | | | | - Matheus Roque
- Sector of Ultrasound, Mater Prime Reproductive Medicine, São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil,Address for correspondence: Prof. Edward Araujo Júnior, Rua Belchior de Azevedo, 156 Apto. 111 Torre Vitoria, CEP 05089-030, São Paulo, Brazil. E-mail:
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Louis F, Lulla CP. Hysteroscopy is Superior to 3D Ultrasound in Gynecological Diagnosis. J Obstet Gynaecol India 2020; 70:447-461. [DOI: 10.1007/s13224-020-01384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022] Open
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Wirleitner B, Okhowat J, Vištejnová L, Králíčková M, Karlíková M, Vanderzwalmen P, Ectors F, Hradecký L, Schuff M, Murtinger M. Relationship between follicular volume and oocyte competence, blastocyst development and live-birth rate: optimal follicle size for oocyte retrieval. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:118-125. [PMID: 29134715 DOI: 10.1002/uog.18955] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To analyze oocyte competence in gonadotropin-releasing hormone agonist (GnRHa) stimulation cycles with regard to maturity, fertilization and blastocyst rate, as well as clinical outcome (pregnancy and live-birth rate), in relation to follicular volume, measured by three-dimensional transvaginal sonography (3D-TVS), and follicular fluid composition. METHODS This was a prospective single-center study conducted between June 2012 and June 2014, including 118 ovum pick-ups with subsequent embryo transfer. Ovarian stimulation was performed using the GnRHa long protocol. Of 1493 follicles aspirated individually, follicular volume was evaluated successfully in 1236 using automated 3D-TVS during oocyte retrieval. Oocyte maturity and blastocyst development were tracked according to follicular volume. Intrafollicular concentrations of estradiol, testosterone, progesterone, luteinizing hormone, follicle-stimulating hormone and granulocyte-colony stimulating factor were quantified by immunoassay. Clinical outcome, in terms of implantation rate, (clinical) pregnancy rate, miscarriage and live-birth rate (LBR), was evaluated. RESULTS Follicles were categorized, according to their volume, into three arbitrary groups, which included 196 small (8-12 mm/0.3-0.9 mL), 772 medium (13-23 mm/1-6 mL) and 268 large (≥ 24 mm/> 6 mL) follicles. Although oocyte recovery rate was significantly lower in small follicles compared with medium and large ones (63.8% vs 76.6% and 81.3%, respectively; P < 0.001), similar fertilization rates (85.1% vs 75.3% and 81.4%, respectively) and blastocyst rates (40.5% vs 40.6% and 37.2%, respectively) per mature metaphase II oocyte were observed. A trend towards higher LBR after transfer of blastocysts derived from small (< 1 mL) follicles compared with medium (1-6 mL) or large (> 6 mL) follicles (54.5% vs 42.0%, and 41.7%, respectively) was observed. No predictive value of follicular fluid biomarkers was identified. CONCLUSIONS Our data indicate that the optimal follicular volume for a high yield of good quality blastocysts with good potential to lead to a live birth is 13-23 mm/1-6 mL. However, oocytes derived from small follicles (8-12 mm/0.3-0.9 mL) still have the capacity for normal development and subsequent delivery of healthy children, suggesting that aspiration of these follicles should be encouraged as this would increase the total number of blastocysts retrieved per stimulation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B Wirleitner
- IVF Centers Prof. Zech - Bregenz, Bregenz, Austria
| | - J Okhowat
- IVF Centers Prof. Zech - Bregenz, Bregenz, Austria
| | - L Vištejnová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Králíčková
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Karlíková
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Laboratory of Immunoanalysis, Department of Nuclear Medicine, Medical School and Teaching Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - P Vanderzwalmen
- IVF Centers Prof. Zech - Bregenz, Bregenz, Austria
- Centre Hospitalier Inter Régional Edith Cavell (CHIREC), Braine-l'Alleud, Bruxelles, Belgium
| | - F Ectors
- Transgenic Platform, FARAH and GIGA Research Centers, University of Liège, Liège, Belgium
| | - L Hradecký
- IVF Centers Prof. Zech - Pilsen, Pilsen, Czech Republic
| | - M Schuff
- IVF Centers Prof. Zech - Bregenz, Bregenz, Austria
| | - M Murtinger
- IVF Centers Prof. Zech - Bregenz, Bregenz, Austria
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Seyhan A, Urman B, Turkgeldi E, Ata B. Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation. Reprod Biomed Online 2017; 36:239-244. [PMID: 29203384 DOI: 10.1016/j.rbmo.2017.10.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
Whether endometriomas grow because of supraphysiological oestradiol levels attained during ovarian stimulation for assisted reproduction techniques is a concern. In this prospective study, 25 women with 28 endometriomas underwent three-dimensional ultrasound using sono-automated volume calculation software. Endometrioma volume was measured on the first day of gonadotrophin injection (V1) and the day of ovulation trigger (V2). Nine (36%) women were stimulated in a gonadotrophin releasing hormone antagonist protocol (GnRH), 13 (52%) in a long, and three (12%) in an ultra-long GnRH agonist protocol. Mean duration of stimulation was 10.3 days with median total gonadotrophin dose of 4500 IU/day. Median number of cumulus oocyte complexes was five, and metaphase-two oocytes was four. None of the endometriomas were punctured during oocyte retrieval. Median V1 was 22.2 ml (12-30 ml) and median V2 was 24.99 ml (11.2-37.4 ml) with P = 0.001. Twenty-three out of 28 endometriomas (82%) grew to some extent during ovarian stimulation. Endometrioma growth was positively correlated with prestimulation cyst volume (Correlation coefficient 0.664; P < 0.01). Although the 3-ml average growth was statistically significant, it could be regarded as clinically insignificant.
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Affiliation(s)
- Ayse Seyhan
- Assisted Reproduction Unit of the American Hospital of Istanbul, Güzelbahçe Sok, No:20 34365 Nişantaşı, Istanbul, Turkey
| | - Bulent Urman
- Assisted Reproduction Unit of the American Hospital of Istanbul, Güzelbahçe Sok, No:20 34365 Nişantaşı, Istanbul, Turkey; Department of Obstetrics and Gynecology, Koç University School of Medicine, Davutpaşa Caddesi No:4 34010 Topkapı, İstanbul, Turkey
| | - Engin Turkgeldi
- Department of Obstetrics and Gynecology, Koç University Hospital, Davutpaşa Caddesi No:4 34010 Topkapı, İstanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Davutpaşa Caddesi No:4 34010 Topkapı, İstanbul, Turkey.
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Faghih RT, Styer AK, Brown EN. Automated ovarian follicular monitoring: A novel real-time approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:632-635. [PMID: 29059952 DOI: 10.1109/embc.2017.8036904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ovarian follicular monitoring is an essential diagnostic tool in obstetrics and gynecology to evaluate ovarian reserve and to estimate follicular and ovarian response to fertility treatment. Given the significant time requirement, inconvenience measuring follicles and estimating follicular development during multiple examinations, and variable results of different clinicians performing monitoring, complete automation of follicular monitoring is necessary. Computerized follicle detection is currently either semi-automated or has low performance due to limiting factors: (1) noise, (2) detecting multiple follicles very close to each other as one follicle region without finding the boundary of individual follicles, and (3) not being fast enough to be used in real-time clinical practice. To overcome these limitations, we handle noise by singular value decomposition based image compression followed by an anisotropic diffusion scheme for multiplicative speckle, and detect follicles by performing different segmentation techniques depending on features of the image (such as pixel intensity level) and features of the detected follicle areas (such as roundness). This approach allows for rapid identification and measurement of individual follicles with the ability to differentiate between the borders of adjacent follicles and the boundary between the follicle and ovarian stroma.
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Liang Y, Cao Q, Gao X, Du H. Increased bone morphogenetic protein-6 in follicular fluid and granulosa cells may correlate with fertilization and embryo quality in humans. Exp Ther Med 2017; 14:1171-1176. [PMID: 28810575 DOI: 10.3892/etm.2017.4603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 03/31/2017] [Indexed: 12/30/2022] Open
Abstract
Bone morphogenetic protein-6 (BMP-6), which is a member of the transforming growth factor-β superfamily, is associated with the regulation of bone development and various physiological processes. In the present study, the expression of BMP-6 in follicular fluid and granulosa cells (GCs) from pregnant and non-pregnant patients was explored. A total of 44 pregnant patients (pregnant group) and 36 non-pregnant patients (non-pregnant group) were recruited for the present study. The expression of BMP-6 was detected using western blotting and reverse transcription-quantitative polymerase chain reaction. The expression of BMP-6 was significantly higher at the protein level (P<0.01) in follicular fluid obtained from the pregnant group compared with that from the non-pregnant group. The mRNA and protein expression of BMP-6 in GCs were significantly upregulated in the pregnant group compared with the non-pregnant group (both P<0.01). These results suggest that high expression of BMP-6 in pregnant women may be a novel biomarker for the fertility process.
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Affiliation(s)
- Ying Liang
- Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Qinying Cao
- Prenatal Diagnosis Center, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Xing Gao
- Reproductive Medicine Center, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, Hebei 050011, P.R. China
| | - Huilan Du
- Department of Integrated Traditional and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, P.R. China
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Hernández J, Rodríguez-Fuentes A, Puopolo M, Palumbo A. Follicular Volume Predicts Oocyte Maturity: A Prospective Cohort Study Using Three-Dimensional Ultrasound and SonoAVC. Reprod Sci 2016; 23:1639-1643. [PMID: 27688243 DOI: 10.1177/1933719116671003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate whether the automatic measurement of follicular volume by three-dimensional (3D) ultrasound can predict the number of mature oocytes retrieved. A prospective cohort study including 47 women undergoing in vitro fertilization was conducted in a private fertility center. Follicular growth was monitored both manually and automatically using 3D scanning with SonoAVC on the day of human chorionic gonadotropin (hCG) administration. Regression analysis showed that under a standard protocol for hCG administration, the count of mature oocytes is well predicted by a multivariate model including the counts of follicles in the volume classes 2.00 to 5.00 cm3, 1.50 to 1.99 cm3, 1.00 to 1.49 cm3, and 0.60 to 0.99 cm3 In conclusion, this study shows that follicular volume as measured by SonoAVC on the day of hCG administration can be useful to predict oocyte maturity. Specifically, larger follicles and smaller size follicles (class 0.60-0.99 cm3) contribute to the mature oocyte count. This finding warrants the design of clinical trials to establish new criteria for hCG administration based on follicular volume.
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Affiliation(s)
- Jairo Hernández
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Tenerife, Spain
| | | | - Maria Puopolo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanitá, Rome, Italy
| | - Angela Palumbo
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Tenerife, Spain .,Department of Obstetrics and Gynecology, New York University, NY, USA
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Three-dimensional sonography-based automated volume calculation (SonoAVC) versus two-dimensional manual follicular tracking in in vitro fertilization. Int J Gynaecol Obstet 2015; 131:166-9. [DOI: 10.1016/j.ijgo.2015.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 04/17/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022]
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Revelli A, Martiny G, Delle Piane L, Benedetto C, Rinaudo P, Tur-Kaspa I. A critical review of bi-dimensional and three-dimensional ultrasound techniques to monitor follicle growth: do they help improving IVF outcome? Reprod Biol Endocrinol 2014; 12:107. [PMID: 25420733 PMCID: PMC4255967 DOI: 10.1186/1477-7827-12-107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/01/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This review focuses on the possibility of improving the outcome of human IVF by studying the follicles where oocytes grow by ultrasound techniques. A comprehensive analysis of bi-dimensional (2D) and three-dimensional (3D) ultrasound (US) assessment of the follicle size and volume is presented. METHODS Published reports from the year 1999 to 2014 analyzing the relationship between oocyte competence, IVF outcome and ultrasound assessment of the follicle size and volume have been critically analyzed. RESULTS US assessment of growing follicles has been performed mainly by 2D-US, and while overall very useful, it has been found to be of limited usefulness in predicting oocyte competence, recognize which follicles will release a mature metaphase II oocytes and decide the ideal time to trigger ovulation. In fact, a quite wide follicle size range (16-22 mm) has been reported to be associated with mature oocytes with good competence toward fertilization and embryo development. It has been also shown that smaller follicles sometimes contain mature, fertilizable oocytes. However, embryos derived from smaller follicles have probably a lower implantation potential, while follicles larger than 22 mm often contain post-mature eggs. CONCLUSIONS The study of follicular size by 2D-US is of limited usefulness in helping in the identification of follicles containing the best oocytes and in choosing the best moment to trigger ovulation. Possibly the value of US in this area will be improved by large prospective studies in which automated 3D-US will be used.
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Affiliation(s)
- Alberto Revelli
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
- LIVET Infertility and IVF Clinic, Torino, Italy
| | - Giorgia Martiny
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
| | | | - Chiara Benedetto
- Gynaecology and Obstetrics, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Torino, Italy
| | - Paolo Rinaudo
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA USA
| | - Ilan Tur-Kaspa
- Institute for Human Reproduction (IHR) and the Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL USA
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Turkgeldi E, Urman B, Ata B. Role of Three-Dimensional Ultrasound in Gynecology. J Obstet Gynaecol India 2014; 65:146-54. [PMID: 26085733 DOI: 10.1007/s13224-014-0635-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.
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Affiliation(s)
- Engin Turkgeldi
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, Amerikan Hospital, Koc University School of Medicine, Rumelifeneri Yolu Sarıyer, 34450 Istanbul, Turkey
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Gerris J, Delvigne A, Dhont N, Vandekerckhove F, Madoc B, Buyle M, Neyskens J, Deschepper E, De Bacquer D, Pil L, Annemans L, Verpoest W, De Sutter P. Self-operated endovaginal telemonitoring versus traditional monitoring of ovarian stimulation in assisted reproduction: an RCT. Hum Reprod 2014; 29:1941-8. [DOI: 10.1093/humrep/deu168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vandekerckhove F, Bracke V, De Sutter P. The Value of Automated Follicle Volume Measurements in IVF/ICSI. Front Surg 2014; 1:18. [PMID: 25593942 PMCID: PMC4286967 DOI: 10.3389/fsurg.2014.00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/16/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS The objective of this literature study is to investigate the place of recent software technology sonography-based automated volume count (SonoAVC) for the automatic measurement of follicular volumes in IVF/ICSI. Its advantages and disadvantages and potential future developments are evaluated. METHODS A total of 74 articles were read via a PubMed literature study. The literature study included 53 articles, 32 of which for the systematic review. RESULTS The SonoAVC software shows excellent accuracy. Comparing the technology with the "golden standard" two-dimensional (2D) manual follicle measurements, SonoAVC leads to a significantly lower intra- and inter-observer variability. However, there is no significant difference in clinical outcome (pregnancy rate). We noted a significant advantage in the time gained, both for doctor and patient. By storing the images, the technology offers the possibility of including a quality control and continuous training and further standardization of follicular monitoring can be expected. Ovarian reserve testing by measuring the antral follicle count with SonoAVC is highly reliable. CONCLUSION This overview of previously published literature shows how SonoAVC offers advantages for clinical practice, without losing any accuracy or reliability. Doctors should be motivated to the general use of follicular volumes instead of follicular diameters.
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Affiliation(s)
| | - Victoria Bracke
- Centre for Reproductive Medicine, University Hospital Ghent , Ghent , Belgium
| | - Petra De Sutter
- Centre for Reproductive Medicine, University Hospital Ghent , Ghent , Belgium
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Abstract
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.
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Vandekerckhove F, Vansteelandt S, Gerris J, De Sutter P. Follicle measurements using sonography-based automated volume count accurately predict the yield of mature oocytes in in vitro fertilization/intracytoplasmic sperm injection cycles. Gynecol Obstet Invest 2013; 76:107-12. [PMID: 23868029 DOI: 10.1159/000353432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/30/2013] [Indexed: 11/19/2022]
Abstract
AIMS We define criteria to predict the number of mature oocytes using automated three-dimensional (3D) ultrasound follicle measurements. METHODS Fifty in vitro fertilization/intracytoplasmic sperm injection patients underwent automated 3D echographic monitoring by a single researcher following the stimulation procedure. Classic criteria for triggering oocyte maturation as defined in the literature were utilized. 3D parameters, including the follicular volume and follicle diameter calculated from the volume measurement, were related to the oocyte count, mature oocyte count and the number of observed fertilized oocytes. RESULTS We found that when oocyte maturation was induced, 55% of the total follicles with a diameter of at least 10 mm had a volume of at least 1.5 cm³. The number of mature eggs that were retrieved was correlated with the number of follicles observed with a volume of at least 1 cm³ or a calculated follicle diameter of at least 12 mm. CONCLUSION Sonography-based automated volume count measurements of follicle volume and reconstructed follicle diameter can be used to reliably predict the number of mature oocytes.
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Jokubkiene L, Sladkevicius P, Valentin L. Number of antral follicles, ovarian volume, and vascular indices in asymptomatic women 20 to 39 years old as assessed by 3-dimensional sonography: a prospective cross-sectional study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1635-1649. [PMID: 23011627 DOI: 10.7863/jum.2012.31.10.1635] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our aim was to elicit data representative of normal findings on 3-dimensional (3D) transvaginal gray-scale and power Doppler sonography of ovaries in women of fertile age. METHODS A total of 303 gynecologically asymptomatic white women 20 to 39 years old with spontaneous regular menstrual cycles were examined with transvaginal 3D gray-scale and power Doppler sonography on cycle days 4 to 8. We used a 6- to 12-MHz transducer. The ovarian volume, number and volume of antral follicles of 2 mm or larger, vascularization index, flow index, and vascularization-flow index were calculated using dedicated software. Results are presented separately for women with follicles of 2.0 to 10.0 mm and for those with at least 1 follicle larger than 10.0 mm for 3 age groups: 20 to 29, 30 to 34, and 35 to 39 years. RESULTS There were 214 women (71%) with follicles of 2.0 to 10.0 mm and 89 (29%) with follicles larger than 10.0 mm. In women with follicles of 2.0 to 10.0 mm, the right ovary was on average 0.8 cm3 larger and contained on average 1.2 more follicles than the left one. The ovarian volume, number of follicles, and total follicular volume decreased significantly with age in both ovaries (P = .000-.029): for the right ovary ovarian volume, the median (range) decreased from 8.4 (3.7-17.3) cm3 at 20 to 29 years to 6.5 (2.4-12.7) cm(3) at 35 to 39 years, the number of follicles from 14 (1-32) at 20 to 29 years to 8 (1-21) at 35 to 39 years, and the total follicular volume from 1.08 (0.01-3.10) cm3 at 20 to 29 years to 0.84 (0.03-2.00) cm3 at 35 to 39 years. The size of the largest follicle and the vascular indices manifested no clear changes with age in any ovary. In women with follicles larger than 10 mm, the number of follicles decreased with age in both ovaries. CONCLUSIONS We have elicited data representative of normal findings on 3D trans-vaginal sonography of ovaries in gynecologically asymptomatic white women of fertile age. Our gray-scale sonographic results may be used as reference values for general gynecology in populations similar to ours. Vascular indices must be interpreted with caution because of difficulties with standardization.
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Affiliation(s)
- Ligita Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, S-20502 Malmö, Sweden.
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Ovarian size and vascularization as assessed by three-dimensional grayscale and power Doppler ultrasound in asymptomatic women 20–39 years old using combined oral contraceptives. Contraception 2012; 86:257-67. [DOI: 10.1016/j.contraception.2011.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/21/2011] [Accepted: 12/21/2011] [Indexed: 11/22/2022]
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