Recuento de folículos antrales como predictor de la respuesta ovárica

Sonographic prediction of successful embryonic implantation in in-vitro fertilization and embryo transfer cycle procedures, using a multi-parameter approach

INTRODUCTION

The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depend on maternal age, embryo quality and uterine receptivity. Prediction of embryonic implantation prior to IVF has become crucial in counseling patients due to the cost of failed procedure, in terms of huge financial expenditure, time taken for the procedure, associated health risks and psychological effects following unfulfilled expectation. The objective of this study was therefore to develop a scoring protocol and consequently, a predictive model for a successful embryonic implantation in IVF-ET cycles using maternal demographic, endometrial, ovarian, and hormonal parameters as tools for clinical decision and patient counseling.

MATERIAL AND METHODS

The body mass index (BMI), age, endometrial pattern and thickness, antral follicle count, (AFC) and anti-Mullerian hormone (AMH) concentration of 295 women between the ages of 18-45 years were evaluated prior to IVF- ET at a fertility clinic in Lagos, Nigeria. The AFC, endometrial pattern and thickness were determined sonographically and the AMH assayed, using ELISA test kits. Multiple regression analysis was used to determine the contribution of each parameter to the likelihood of a successful implantation, and a 4 point rating scale was developed based on the relative contribution of each parameter. Scores were then assigned based on the strength of each predictor variable to implantation rates.

RESULTS

Eighteen women that conceived had a full score of 20, while five that failed to conceive scored below 9. Chi square test indicated that endometrial pattern, thickness, age, AFC and AMH are highly significant in predicting embryonic implantation at IVF, while BMI was insignificant (r = -1.831, p = 0.094).

CONCLUSION

The prediction model demonstrated a positive correlation between the cumulative score and implantation rate. The use of the scoring system could provide a guide to clinicians to predict the success rate of each IVF-ET procedure prior to commencement of treatment.

IMPLICATIONS FOR PRACTICE

The availability of this prediction model provides a counselling tool for physicians to IVF clients which ensures improved confidences level and reduced disappointments from failures in successful implantation and embryonic transfer including its associated financial costs and health risks.

Antral follicular count and its relationship with ovarian volume, preantral follicle population and survival, oocyte meiotic progression and ultrastructure of in vitro matured bovine cumulus-oocyte complexes

This study aimed to evaluate the relationship between antral follicular count (AFC) and ovarian volume (OV), preantral follicular population and survival, meiotic progression and ultrastructure of cumulus-oocyte complexes (COCs) after in vitro maturation. In experiment 1, the relationship between AFC and preantral follicle population and survival was evaluated by classical histology. In experiment 2, the relationship among AFC, OV, ability of oocytes to resume meiosis and ultrastructure of in vitro matured bovine COCs was studied. A positive correlation (P < 0.05) between AFC and the numbers of healthy primordial, degenerate and total follicles was observed, as well as with healthy secondary follicles and total follicles. The numbers of grades I and II oocytes in ovaries of high AFC class were higher compared with those with intermediate or lower AFC. After in vitro maturation, COCs from ovaries of high AFC had a higher percentage of oocytes in metaphase II compared with those of intermediate and low AFC (P < 0.0001). Ovaries of intermediate AFC had a higher percentage of oocytes in metaphase II compared with ovaries with low AFC (P < 0.0001). The proportion of oocytes in metaphase I, telophase I and anaphase I in COCs from ovaries of intermediate AFC (26.04%) was higher (P < 0.05) compared with that seen in COCs of ovaries with high (8.55%) and low (14.15%) AFC. No differences in the ultrastructure of oocytes were seen. In conclusion, after in vitro maturation, cow ovaries with high AFC have higher numbers of oocytes that reach in metaphase II (MII), but they also have higher numbers of degenerated primordial and primary follicles.