1
|
He L, Xu Q, Wan F, Hao L, Qiu Y, Ran X, Lin J, Chen W. The usefulness of peri-trigger female reproductive hormones (delta-FRH) in predicting oocyte maturation in normal ovarian reserve patients who received in vitro fertilization-embryo transfer: a retrospective study. PeerJ 2024; 12:e17706. [PMID: 39006021 PMCID: PMC11246619 DOI: 10.7717/peerj.17706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
Objectives To evaluate the efficacy of peri-trigger female reproductive hormones (FRHs) in the prediction of oocyte maturation in normal ovarian reserve patients during the in vitro fertilization-embryo transfer (IVF-ET) procedure. Materials and Methods A hospital database was used to extract data on IVF-ET cases from January 2020 to September 2021. The levels of female reproductive hormones, including estradiol (E2), luteinizing hormone (LH), progesterone (P), and follicle-stimulating hormone (FSH), were initially evaluated at baseline, the day of the trigger, the day after the trigger, and the day of oocyte retrieval. The relative change in E2, LH, P, FSH between time point 1 (the day of trigger and baseline) and time point 2 (the day after the trigger and day on the trigger) was defined as E2_RoV1/2, LH_RoV1/2, P_RoV1/2, and FSH_RoV1/2, respectively. Univariable and multivariable regression were performed to screen the peri-trigger FRHs for the prediction of oocyte maturation. Results A total of 118 patients were enrolled in our study. Univariable analysis revealed significant associations between E2_RoV1 and the rate of MII oocytes in the GnRH-agonist protocol group (p < 0.05), but not in the GnRH-antagonist protocol group. Conversely, P_RoV2 emerged as a potential predictor for the rate of MII oocytes in both protocol groups (p < 0.05). Multivariable analysis confirmed the significance of P_RoV2 in predicting oocyte maturation rate in both groups (p < 0.05), while the association of E2_RoV1 was not significant in either group. However, within the subgroup of high P_RoV2 in the GnRH-agonist protocol group, association was not observed to be significant. The C-index was 0.83 (95% CI [0.73-0.92]) for the GnRH-agonist protocol group and 0.77 (95% CI [0.63-0.90]) for the GnRH-antagonist protocol group. The ROC curve analysis further supported the satisfactory performance of the models, with area under the curve (AUC) values of 0.79 for the GnRH-agonist protocol group and 0.81 for the GnRH-antagonist protocol group. Conclusions P_RoV2 showed significant predictive value for oocyte maturation in both GnRH-agonist and GnRH-antagonist protocol groups, which enhances the understanding of evaluating oocyte maturation and inform individualized treatment protocols in controlled ovarian hyperstimulation during IVF-ET for normal ovarian reserve patients.
Collapse
Affiliation(s)
- Lina He
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Qing Xu
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Fuming Wan
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Li Hao
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Yamin Qiu
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Xu Ran
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Jie Lin
- Department of Reproductive Medicine, Zigong Hospital of Women and Children Health Care, Zigong, Sichuan, China
| | - Wei Chen
- Department of Urology, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
- Institute of Precision Medicine, Zigong Academy of Big Data and Artificial Intelligence for Medical Science, Zigong, Sichuan, China
| |
Collapse
|
2
|
Chen Z, Li W, Ma S, Li Y, Lv L, Huang K, Gong A. Evaluative effectiveness of follicular output rate, ovarian sensitivity index, and ovarian response prediction index for the ovarian reserve and response of low-prognosis patients according to the POSEIDON criteria: a retrospective study. ZYGOTE 2023; 31:557-569. [PMID: 37737063 DOI: 10.1017/s0967199423000382] [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] [Indexed: 09/23/2023]
Abstract
The aim was to explore the implications of follicular output rate (FORT), ovarian sensitivity index (OSI), ovarian response prediction index (ORPI), and follicle-to-oocyte index (FOI) in low-prognosis patients defined by POSEIDON criteria. In total, 4030 fresh in vitro fertilization (IVF) cycles from January 2013 to October 2021 were included in this retrospective cohort analysis and were categorized into four groups based on the POSEIDON criteria. The FORT between Groups 1 and 2 (0.61 ± 0.34 vs. 0.65 ± 0.35, P = 0.081) and Groups 3 and 4 (1.08 ± 0.82 vs. 1.09 ± 0.94, P = 0.899) were similar. The OSI in the order from the highest to the lowest were 3.01 ± 1.46 in Group 1, 2.28 ± 1.09 in Group 2, 1.54 ± 1.04 in Group 3, and 1.34 ± 0.96 in Group 4 (P < 0.001). The trend in the ORPI values was consistent with that in the OSI. FORT, OSI, ORPI, and FOI complemented each other and offered excellent effectiveness in reflecting ovarian reserve and response, but they were not good predictors of clinical pregnancy rate (CPR) from IVF.
Collapse
Affiliation(s)
- Zhilan Chen
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Wei Li
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Shufang Ma
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Yanmin Li
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Liqun Lv
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| | - Kecheng Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aidong Gong
- Centre for Reproductive Medicine, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, China
| |
Collapse
|
3
|
Hu F, Wang X, Ren H, Lv Y, Li H, Liu S, Zhou W. Ovarian sensitivity index can be used as a more sensitive indicator than follicular output rate to predict IVF/ICSI outcomes in patients of normal expected ovarian response stimulated with GnRH antagonist protocol. HUM FERTIL 2023; 26:1264-1270. [PMID: 36650952 DOI: 10.1080/14647273.2023.2164869] [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: 09/27/2021] [Accepted: 09/27/2022] [Indexed: 01/19/2023]
Abstract
This retrospective study was performed to investigate the predictive power of the Ovarian Sensitivity Index (OSI) for IVF/ICSI outcomes in infertile patients who were of normal expected ovarian response. A total of 912 infertile patients who underwent GnRH antagonist protocol between January 2017 to August 2019 at the Medical Center for Human Reproduction, Beijing Chao-Yang Hospital were included. All patients completed the full oocyte retrieval cycle and either had a live birth or had no embryos left. OSI was significantly lower in patients with a live birth (196.0 ± 120.4 in the live birth group vs 276.4 ± 235.7 in the non-live birth group, p < 0.001) while follicular output rate (FORT, defined as the ratio of pre-ovulatory follicle count on hCG day x 100/small antral follicle count at baseline) showed no significant difference. Patients were divided into low, average and high OSI groups and analysed in tertiles. From the low to the high OSI group, the cumulative live birth rate (CLBR) decreased dramatically (72.7 vs 67.2 vs 54.8%, p < 0.001). Multivariate regression analysis showed that OSI was an independent factor affecting CLBR (OR: 0.996, 95%CI: 0.995-0.998, p < 0.001) in our study population. In conclusion, OSI can be used as an independent indicator to distinguish fecundity in infertile patients with normal expected ovarian response and is probably more sensitive than FORT.
Collapse
Affiliation(s)
- Fen Hu
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, China
| | - Xiaocheng Wang
- Department of Medical Record and Statistics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Haiying Ren
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yasu Lv
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huanhuan Li
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shan Liu
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenhui Zhou
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Wei J, Xiong D, Zhang Y, Zeng J, Liu W, Ye F. Predicting ovarian responses to the controlled ovarian hyperstimulation in elderly infertile women using clinical measurements and random forest regression. Eur J Obstet Gynecol Reprod Biol 2023; 288:153-159. [PMID: 37544248 DOI: 10.1016/j.ejogrb.2023.07.012] [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: 01/03/2023] [Revised: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
During the past decades, the number of elderly infertile women is obviously increasing in China, and more and more of them are likely to seek medical assisted reproductive technologies. As the in vitro fertilization/embryo transfer (IVF/ET) treatment presents special medical and psychological challenges to elderly infertile women, it is extremely helpful to perform the clinical evaluation and outcome prediction regarding IVF/ET outcomes. In this study, we retrospectively collected 12 clinical measurements in prior to the oocyte recovery for 689 elderly infertile patients (≥35 years of old), and used for predicting ovarian responses to the controlled ovarian hyperstimulation based on random forest regression models. Using different predictor sets and 10-fold cross validation approach, the Mean Square Error (±standard deviation) of prediction models varied from 7.56 ± 0.31 to 13.90 ± 0.37 in the training datasets, and the correlation coefficients between observed and predicted values ranged from 0.86 ± 0.02 to 0.72 ± 0.05 in the testing datasets. Among all clinical measurements involved in this study, the preovulatory follicle count (PFC), antral follicle count (AFC), and anti-Müllerian hormone (AMH) were revealed to be the most important features in prediction models. In conclusion, we successfully established the machine learning approach that could help the elderly infertile patients to better understand the most possible outcomes in subjecting to the controlled ovarian hyperstimulation.
Collapse
Affiliation(s)
- Jiajing Wei
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China
| | - Dongsheng Xiong
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China
| | - Yanan Zhang
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China
| | - Jiuzhi Zeng
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China
| | - Weixin Liu
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China.
| | - Fei Ye
- Reproductive Medicine Center, Sichuan Provincial Women's and Children's Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, 290 Shayan West Second Street, Wuhou District, Chengdu 610045, Sichuan, China.
| |
Collapse
|
5
|
Donato R, Bessow C, Genro V, Chapon R, Oliveira de Souza T, Cunha-Filho JSLD. Corifollitropin alpha was not detrimental to follicular ovarian responsiveness measured by follicular output rate (FORT). HUM FERTIL 2023; 26:557-563. [PMID: 34412562 DOI: 10.1080/14647273.2021.1968044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Corifollitropin alpha has been demonstrated to be non-inferior to other gonadotropins in reproductive outcomes. However, its impact on follicular ovarian responsiveness has never been evaluated. Follicular Output Rate (FORT) is an option for objective assessment of the follicular responsiveness. A prospective study was conducted with 306 infertile patients undergoing in vitro fertilisation. Ovarian stimulation protocol was performed with a single dose of 100 μg (<60kg) or 150 μg (≥60kg) corifollitropin alpha in group 1 (n = 147), and 150-300 IU/day human menopausal gonadotropin in group 2 (n = 150). Comparing ovarian stimulation between corifollitropin alpha and human menopausal gonadotropin, no differences regarding FORT were found (40.0% for group 1 versus 40.83% for group 2; p = 0.930). Patients treated with corifollitropin alpha had a higher number of embryos when compared with human menopausal gonadotropin group (3.0 for group 1 versus 2.0 for group 2; p = 0.04). Other secondary outcomes preset were similar between groups. Therefore, corifollitropin alpha can be an excellent option to simplify in vitro fertilisation treatment due to the "patient-friendly" protocol.
Collapse
Affiliation(s)
- Rafaela Donato
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Camila Bessow
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Vanessa Genro
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | - Rita Chapon
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| | | | - João Sabino Lahorgue da Cunha-Filho
- Postgradute Program in Heath Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Reprodução Humana Insemine, Porto Alegre, Brazil
| |
Collapse
|
6
|
Vaiarelli A, Zacà C, Spadoni V, Cimadomo D, Conforti A, Alviggi C, Palermo R, Bulletti C, De Santis L, Pisaturo V, Vigiliano V, Scaravelli G, Ubaldi FM, Borini A. Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR). J Assist Reprod Genet 2023:10.1007/s10815-023-02792-1. [PMID: 37093443 DOI: 10.1007/s10815-023-02792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. METHODS An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. RESULTS The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneuploidies (PGT-A). Each indicator was scored with a value from 1 to 5 and a weighted average formula - considering all the suggested parameters-was defined. This formula generates a center performance score, indicating low, average, good, or excellent performance. CONCLUSION This study is intended to provide KPIs, PIs and RIs that encompass several essential aspects of a modern IVF clinic, including quality control and constant monitoring of clinical and embryological features. These indicators could be used to assess the quality of each center with the aim of improving efficacy and efficiency in IVF.
Collapse
Affiliation(s)
- Alberto Vaiarelli
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy.
| | | | | | - Danilo Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
| | - Roberto Palermo
- Unità Di Procreazione Medicalmente Assistita, Centro A.M.B.R.A., Palermo, Italy
| | - Carlo Bulletti
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University, New Haven, CT, USA
- Scientific Partner of Incintas Therapeutics, New Haven, CT, USA
| | - Lucia De Santis
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Valerio Pisaturo
- Fondazione IRCCS, Ca' Granda, Ospedale Maggiore, Policlinico Di Milano, Milan, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Giulia Scaravelli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | | | | |
Collapse
|
7
|
Mardanian F, Dehghani-Mohammadabadi R, Tehrani HG, Naghshineh E, Mehrabian F. Evaluation of correlation between antral follicle diameters with Follicular Output Rate (FORT) in women under controlled ovarian hyperstimulation for assisted reproductive techniques. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
This study aimed to determine the association of diametrical antral follicles with the ovarian response by Follicular Output Rate (FORT) ratio in 100 females undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). This study selected 100 women undergoing controlled ovarian hyperstimulation (COH). The number of antral follicles (diameter of 3–10 mm) was calculated with two-dimensional vaginal sonography on days 1–3 of the cycle. Then, on a triggering day with human chorionic gonadotropin (HCG), the number of follicles (with a diameter of 16–22 mm) and the ratio of FORT were determined. The correlation among FORT with age, antral follicle count (AFC), AFC ≤ 5, AFC > 5, number of preovulatory follicles (16–20 mm), number of metaphase II (MII) oocytes, body mass index (BMI), infertility period, and anti-Mullerian hormone (AMH) was assessed.
Results
There was a significant correlation between FORT and total AFC, AFC > 5, number of preovulatory follicles (16–20 mm), and number of MII oocytes retrieved. There is no significant relationship between FORT and examined two variables (AMH and AFC ≤ 5). Multiple linear regression analysis showed no significant relationship between FORT and examined two variables (AMH and AFC > 5). There was a significant correlation between MII oocytes retrieved and age, total AFC, AFC ≤ 5, AFC > 5, number of preovulatory follicles (16–20 mm), and AMH. A significant positive relationship existed between MII oocytes retrieved and examined two variables (AFC ≤ 5 and AFC > 5).
Conclusion
There was not much difference in the correlation between the AFC ≤ 5 and AFC > 5, and both positively correlated with the number of MII oocytes retrieved.
Collapse
|
8
|
Rodríguez-Fuentes A, Rouleau JP, Vásquez D, Hernández J, Naftolin F, Palumbo A. Volume-based follicular output rate improves prediction of the number of mature oocytes: a prospective comparative study. Fertil Steril 2022; 118:885-892. [PMID: 36116981 DOI: 10.1016/j.fertnstert.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To test whether volume-based follicular output rate (FORT-V) is superior to diameter based follicular output rate (FORT-D) in predicting the number of mature oocytes. The follicular output rate (FORT) is the ratio between preovulatory follicle count (PFC) and antral follicle count (AFC) and has been proposed as a better predictor of the ovarian response compared with AFC alone. DESIGN A prospective observational study of 215 consecutive women (80 oocyte donors and 135 in vitro fertilization [IVF] patients) undergoing ovarian stimulation for IVF. SETTING University affiliated private IVF center. PATIENT(S) Women undergoing ovarian stimulation between May 2018 and September 2021. INTERVENTION(S) Manual two-dimensional ultrasound and computer-generated (three-dimensional ultrasound, [3D]) AFCs were performed at baseline. During ovulation induction, follicular growth was monitored in each patient using both two-dimensional and 3D ultrasound. Preovulatory follicles were defined as those with a mean diameter of 16-22 mm. The trigger was based on the follicular volume according to our standard protocol: at least 2 follicles with a volume of >2 cc with 70% of the follicles having a volume of >0.7 cc. MAIN OUTCOME MEASURE(S) The primary outcome was the difference between FORT-V and FORT-D in their ability to predict the mature oocyte output rate. RESULT(S) In both IVF patients and oocyte donors, the computer-generated AFC was greater than the manual AFC. The FORT-V was higher than the FORT-D for both computer-generated (the difference was 35 [95% CI {confidence interval}, 32-45] in oocyte donors and 21 [95% CI, 5-46] in IVF patients) and manual FORT (the difference was 38 [95% CI, 32-45] in oocyte donors and 15 [95% CI, 3-43] in IVF patients) and was closer to the mature oocyte output rate. There was a direct correlation between the computer-generated AFC and the PFC based on volume and between PFC based on volume and the number of mature oocytes in oocyte donors and IVF patients. CONCLUSION(S) In this prospective study of 215 women, the FORT based on 3D ultrasound derived follicular volume (FORT-V) was superior to the FORT-D in determining the ovarian response in both oocyte donors and IVF patients. Moreover, our results support the non-inferiority of the computer-generated method compared with the manual method for the determination of AFC. Further studies on the role of computer-generated antral follicle characteristics may be useful in evaluating follicle stimulation regimens.
Collapse
Affiliation(s)
- Adela Rodríguez-Fuentes
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jean Paul Rouleau
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Danízar Vásquez
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Jairo Hernández
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Frederick Naftolin
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Angela Palumbo
- Centro de Asistencia a la Reproducción Humana de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| |
Collapse
|
9
|
Yang J, Li Y, Li S, Zhang Y, Feng R, Huang R, Chen M, Qian Y. Metabolic signatures in human follicular fluid identify lysophosphatidylcholine as a predictor of follicular development. Commun Biol 2022; 5:763. [PMID: 35906399 PMCID: PMC9334733 DOI: 10.1038/s42003-022-03710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/12/2022] [Indexed: 12/07/2022] Open
Abstract
In order to investigate the metabolic characteristics of human follicular fluid (FF) and to reveal potential metabolic predictors of follicular development (FD) with clinical implications, we analyzed a total of 452 samples based on a two-stage study design. In the first stage, FF samples from both large follicles (LFs) and matched-small follicles (SFs) of 26 participants were analyzed with wide-spectrum targeted metabolomics. The metabolic signatures were described by multi-omics integration technology including metabolomic data and transcriptomic data. In the second stage, the potential biomarkers of FD were verified using enzyme-linked immunoassay with FF and blood serum from an independent 200 participants. We describe the FF metabolic signatures from ovarian follicles of different developmental stages. Lysophosphatidylcholine (LPC) can be used as a biomarker of FD and ovarian sensitivity, advancing the knowledge of metabolic regulation during FD and offering potential detection and therapeutic targets for follicle and oocyte health improvements in humans. A two-stage metabolomic analysis for human follicular fluid characteristics and predictors of follicular development yields metabolic signatures and proposes lysophosphatidylcholine (LPC) as a biomarker for follicular development.
Collapse
Affiliation(s)
- Jihong Yang
- Reproductive Medical Center of Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Yangbai Li
- Reproductive Medical Center of Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Suying Li
- Reproductive Medical Center of Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Yan Zhang
- Reproductive Medical Center of Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Ruizhi Feng
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Rui Huang
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Minjian Chen
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Yun Qian
- Reproductive Medical Center of Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China.
| |
Collapse
|
10
|
Aslan K, Kasapoglu I, Cakir C, Koc M, Celenk MD, Ata B, Avci B, Uncu G. Which is more predictive ovarian sensitivity marker if there is discordance between serum anti-Müllerian hormone levels and antral follicle count? A retrospective analysis. J OBSTET GYNAECOL 2022; 42:1461-1466. [PMID: 34996328 DOI: 10.1080/01443615.2021.2003309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC (n < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC (n ≥ 7) and group 3: patients with normal AMH (≥1.1 ng/dl) and low AFC (n < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66-150), group 2: 71 (57-100), group 3: 136 (96-200), p<.01 - median FOI score with quartiles: group 1: 83 (50-140), group 2: 71 (40-100), group 3: 116 (66-216), p<.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC.Impact StatementWhat is already known on this subject? Female age, serum Anti-Müllerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve.What do the results of this study add? If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC.What are the implications of these findings for clinical practice and/or further research? It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone.
Collapse
Affiliation(s)
- Kiper Aslan
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Cihan Cakir
- Department of Histology and Embryology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Meltem Koc
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Murat Deniz Celenk
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Berrin Avci
- Department of Histology and Embryology, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey
| |
Collapse
|
11
|
Jiang R, Cao M, Hao H, Jia R, Chen P, Liu Y, Zhao Z. Effects of follicular output rate on cumulative clinical pregnancy rate and cumulative live birth rate in PCOS patients with different characteristics. Front Endocrinol (Lausanne) 2022; 13:1079502. [PMID: 36601009 PMCID: PMC9806261 DOI: 10.3389/fendo.2022.1079502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We aim to explore the effects of follicular output rate (FORT) on cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR) in polycystic ovary syndrome (PCOS) patients with different characteristics undergoing in vitro fertilization (IVF) treatment. METHODS This retrospective study analyzed 454 patients with PCOS undergoing their first IVF cycle at our center from January 2016 to December 2020. FORT was calculated as pre-ovulatory follicle count (PFC) × 100/antral follicle count (AFC). Multivariate regression analyses were conducted to explore the relationships between FORT and CCPR and CLBR. Curve fitting and threshold effect analyses were established to find nonlinear relationships. Effect modification in different subgroups were examined by stratification analyses. RESULTS Based on the FORT values, individuals were classified into the following three groups: low-FORT group, middle-FORT group and high-FORT group. Multivariate regression analyses revealed that FORT was an independent factor affecting the CCPR and CLBR significantly (OR = 1.015, 95% CI: 1.001, 1.030 and OR = 1.010, 95% CI:1.001, 1.020). Curve fitting and threshold effect analyses showed that the CCPR and CLBR had a positive correlation with FORT when the FORT was less than 70% (OR = 1.039, 95% CI: 1.013, 1.065 and OR = 1.024, 95% CI: 1.004, 1.044). Stratification analyses showed that the CLBR increased by 1.3% with each additional unit of FORT for patients with hyperandrogenic manifestations (OR = 1.013, 95% CI: 1.001, 1.025). Compared with the low-FORT group, in the high-FORT group, CCPR increased 1.251 times for patients with polycystic ovarian morphology, while CCPR and CLBR increased 1.891 times and 0.99 times for those with ovulation disorder, respectively (OR = 2.251, 95% CI: 1.008, 5.028 and OR = 2.891, 95% CI: 1.332, 6.323 and OR = 1.990, 95% CI: 1.133, 3.494). CONCLUSION In patients with PCOS, cumulative IVF outcomes have a positive correlation with FORT when the FORT is less than 70%. For PCOS patients with polycystic ovarian morphology, ovulation disorder or hyperandrogenic manifestations, a high FORT could be conductive to achieving better pregnancy outcomes.
Collapse
Affiliation(s)
- Rulan Jiang
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingya Cao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haomeng Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Jia
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Peipei Chen
- Department of Gynecology and Obstetrics, Handan First Hospital, Handan, China
| | - Yuanyuan Liu
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiming Zhao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Zhiming Zhao,
| |
Collapse
|
12
|
Poulain M, Younes R, Pirtea P, Trichereau J, de Ziegler D, Benammar A, Ayoubi JM. Impact of Ovarian Yield-Number of Total and Mature Oocytes Per Antral Follicular Count-On Live Birth Occurrence After IVF Treatment. Front Med (Lausanne) 2021; 8:702010. [PMID: 34504852 PMCID: PMC8421602 DOI: 10.3389/fmed.2021.702010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/28/2021] [Indexed: 01/20/2023] Open
Abstract
To assess the relation between oocytes yield including total retrieved oocytes (O)c and total mature oocytes (MII) relative to the antral follicular count (AFC) (3–9 mm in diameter) and relative to anti-müllerian hormone (AMH) ng/mL level: Oc/AFC, MII/AFC, Oc/AMH, and MII/AMH, respectively, and ART outcomes. We included retrospectively 264 IVF cycles after the first embryo transfer (ET) and after the cumulative ET (CET). The implantation rate (IR) and the live birth rate (LBR) after first ET were 31 ± 39% and 32.6%, respectively, and after CET 35 ± 38% and 45.1%, respectively. There was a significantly higher average of Oc/AFC and MII/AFC when live birth (LB) occurred after the first ET (0.82 ± 0.4 vs. 0.71 ± 0.35 and 0.57 ± 0.4 vs. 0.68 ± 0.3, respectively, P < 0.05). We reported a significantly higher average of MII/AFC when LB occurred after CET (0.66 ± 0.3 vs. 0.56 ± 0.30, P = 0.02) in comparison to the group where no LB was obtained. Increased Oc/AFC and MII/AFC ratios were associated with the occurrence of LB and increased IR after first ET (P < 0.05). Increased MII/AFC ratio was associated with the occurrence of LB and IR after CET (P = 0.02 and P = 0.04, respectively). After age-adjusted multivariate analyses, all these trends were confirmed (P < 0.05) except for the effect of MII/AFC ratio on IR after CET. In conclusion, Oc/AMH and MII/AMH ratios have no effect on the occurrence of LBR or on IR after first ET or CET at either age grouping. Ratios Oc/AFC and MII/AFC seem promising indicators to assess ovarian response.
Collapse
Affiliation(s)
- Marine Poulain
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France.,Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France.,Ecole Nationale Vétérinaire d'Alfort, BREED, Maisons-Alfort, France
| | - Rodine Younes
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France
| | - Paul Pirtea
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France
| | - Julie Trichereau
- Biometry and Data Units of the Clinical Research Department of Foch Hospital, Suresnes, France
| | - Dominique de Ziegler
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France
| | - Achraf Benammar
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France
| | - Jean Marc Ayoubi
- Gynecology Obstetric and Reproductive Medicine Department, Foch Hospital, Suresnes, France.,Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France.,Ecole Nationale Vétérinaire d'Alfort, BREED, Maisons-Alfort, France
| |
Collapse
|
13
|
Yang H, Lin J, Jin C, Meng L, Wu S, Chen Y. The Predictive Value of the Follicular Output Rate on Pregnancy Outcome of Patients with Polycystic Ovary Syndrome Undergoing In Vitro Fertilization and Embryo Transfer. Med Sci Monit 2020; 26:e916175. [PMID: 33306667 PMCID: PMC7737407 DOI: 10.12659/msm.916175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This retrospective study aimed to evaluate the predictive value of the follicular output rate (FORT) on the pregnancy outcome of patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). Material/Methods Between January 2012 and June 2016, a total of 1,541 patients with PCOS who underwent IVF-ET at our center were enrolled in the study. FORT was calculated as the pre-ovulatory follicle count (PFC)/antral follicle count (AFC)×100%. Results According to the FORT, patients were divided into low, medium, and high FORT groups. With an increase in the FORT, the PFC and serum estradiol at the day of human chorionic gonadotropin (hCG) injection, the number of retrieved oocytes, metaphase II (MII) oocytes, total number of embryos, and number of high-quality embryos significantly increased (P<0.05 and P<0.001) from the low to high FORT groups, while the AFC, gonadotropin (Gn) stimulation day, and total Gn decreased significantly (P<0.001). The live birth rate from frozen embryo transfer and the cumulative live birth rate was the lowest in middle FORT group but increased significantly in high FORT group (P<0.05). The correlation analysis between FORT and related factors showed that the FORT was negatively correlated with body mass index (BMI), Gn stimulation days, and total Gn (P<0.05). Conclusions FORT is a powerful tool for measuring ovarian reactivity. For patients with PCOS, a high FORT to obtain high-quality embryos and perform frozen embryo transplantation can achieve good pregnancy outcome.
Collapse
Affiliation(s)
- Haiyan Yang
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Jia Lin
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Congcong Jin
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Lvhe Meng
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Suichun Wu
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Ya Chen
- Reproductive Medicine Center of The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| |
Collapse
|
14
|
Merviel P, Menard M, Cabry R, Scheffler F, Lourdel E, Le Martelot MT, Roche S, Chabaud JJ, Copin H, Drapier H, Benkhalifa M, Beauvillard D. Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH/hMG Protocol? An Assessment of 2421 Embryo Transfers, and a Review of the Literature. Reprod Sci 2020; 28:495-509. [PMID: 32886340 DOI: 10.1007/s43032-020-00307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.
Collapse
Affiliation(s)
- Philippe Merviel
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France. .,Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France.
| | - Michel Menard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Rosalie Cabry
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Florence Scheffler
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Emmanuelle Lourdel
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | | | - Sylvie Roche
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | | | - Henri Copin
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Hortense Drapier
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Moncef Benkhalifa
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Damien Beauvillard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| |
Collapse
|
15
|
Shcherbyna VY. BIOETHICS AND TECHNOLOGIES OF REPRODUCTIVE MEDICINE. BIOTECHNOLOGIA ACTA 2020. [DOI: 10.15407/biotech13.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
16
|
Role of the proportion of dominant follicles in patients with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer. Chin Med J (Engl) 2019; 132:1448-1453. [PMID: 31205103 PMCID: PMC6629341 DOI: 10.1097/cm9.0000000000000246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: There is no absolute consensus for the best time for triggering. The aim of this study was to investigate the effect of different proportion of dominant follicles (PDF) on the human chorionic gonadotropin (HCG) day for the clinical outcomes in patients with polycystic ovary syndrome (PCOS) of different ovarian stimulation protocols. Methods: A total of 371 cycles of the gonadotropin-releasing hormone (GnRH) agonist long protocol and 347 cycles of GnRH antagonist protocol from January 2014 to December 2016 were included in this retrospective study. Based on the PDF on the day of the HCG administration, the included patients were divided into three groups: Group A (low PDF), PDF <20%; Group B (medium PDF), 20%≤ PDF ≤40%; Group C (high PDF), PDF >40%. The measurements regarding ovarian stimulation characteristics, fertilization rate, top quality embryo rate, clinical pregnancy rate, and ovarian hyperstimualtion syndrome (OHSS) rate were compared in different PDF groups with different protocols. Results: In both the GnRH antagonist protocol and GnRH agonist long protocol, the characteristics such as mean age, anti-Mullerian hormone, antral follicle count (AFC), and body mass index were comparable between groups. The number of oocytes retrieved decreased statistically significantly as the PDF and rate of matured oocytes increased. In the GnRH agonist long protocol, the rate of normally fertilized oocytes was highest in Group A (59.74 ± 31.21 vs. 49.70 ± 37.95, 49.67 ± 36.62; F = 3.743, P = 0.025). There were no significant differences in the rate of top-quality embryos and the clinical pregnancy rate between the groups. The clinical pregnancy rate was similar in the three groups (63.6%, 62.5%, 67.5%, respectively, χ2 = 0.989, P = 0.911). The moderate and severe OHSS rate increased statistically significantly when the PDF increased, which was highest in group C (1.4%, 3.1%, 6.7%, respectively, χ2 = 12.014, P = 0.017). In the GnRH antagonist protocol, there were no significant differences in the rate of top-quality embryos, the rate of normally fertilized oocytes, the clinical pregnancy rate, and the moderate and severe OHSS rate between the groups. The clinical pregnancy rate in Group C was higher than that in Group A (57.9% vs. 46.6%, χ2 = 10.850, P = 0.093). Conclusions: In the GnRH antagonist protocol, PDF on the HCG day of less than 20% may be unfavorable to the clinical pregnancy rate in PCOS. In the GnRH agonist long protocol, delaying the HCG trigger timing has no good effect on clinical pregnancy and the risk of OHSS might increase in patients with PCOS.
Collapse
|
17
|
Liao S, Xiong J, Tu H, Hu C, Pan W, Geng Y, Pan W, Lu T, Jin L. Prediction of in vitro fertilization outcome at different antral follicle count thresholds combined with female age, female cause of infertility, and ovarian response in a prospective cohort of 8269 women. Medicine (Baltimore) 2019; 98:e17470. [PMID: 31593108 PMCID: PMC6799863 DOI: 10.1097/md.0000000000017470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Antral follicle count (AFC) has been widely investigated for the prediction of clinical pregnancy or live birth. This study discussed the effects of AFC quartile levels on pregnancy outcomes combined with female age, female cause of infertility, and ovarian response undergoing in vitro fertilization (IVF) treatment. At present, many research about AFC mainly discuss its impact on clinical practice at different thresholds, or the analyses of AFC with respect to assisted reproductive technology outcomes under using different ovarian stimulation protocols. Factors that include ovarian sensitivity index, female age, and infertility cause are all independent predictors of live birth undergoing IVF/intracytoplasmic sperm injection, while few researchers discussed influence of female-related factors for clinical outcomes in different AFC fields.A total of 8269 infertile women who were stimulated with a long protocol with normal menstrual cycles were enrolled in the study, and patients were categorized into 4 groups based on AFC quartiles (1-8, 9-12, 13-17, and ≥18 antral follicles).The clinical pregnancy rates increased in the 4 AFC groups (28.25% vs 35.38% vs 37.38% vs 40.13%), and there was a negative association between age and the 4 AFC groups. In addition, female cause of infertility like polycystic ovary syndrome, Tubal factor, and other causes had great significance on clinical outcome, and ovarian response in medium (9-16 oocytes retrieved) had the highest clinical pregnancy rate at AFC quartiles of 1 to 8, 9 to 12, 13 to 17, and ≥18 antral follicles.This study concludes that the female-related parameters (female cause of infertility, female age, and ovarian response) combined with AFC can be useful to estimate the probability of clinical pregnancy.
Collapse
Affiliation(s)
- ShuJie Liao
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jianwu Xiong
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Haiting Tu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Cheng Hu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Wulin Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Yudi Geng
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Tingjuan Lu
- 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Lei Jin
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| |
Collapse
|
18
|
Tan X, Wen Y, Chen H, Zhang L, Wang B, Wen H, Zhang F, Wu Q, Du J. Follicular output rate tends to improve clinical pregnancy outcomes in patients with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer treatment. J Int Med Res 2019; 47:5146-5154. [PMID: 31379237 PMCID: PMC6833430 DOI: 10.1177/0300060519860680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to examine the relationship between the follicular output rate (FORT) and clinical outcomes in patients with polycystic ovarian syndrome (PCOS). Methods A total of 841 patients with PCOS undergoing in vitro fertilization-embryo transfer (IVF-ET) were divided into three groups according to their FORT (low, middle, and high). Controlled ovarian hyperstimulation and clinical outcomes were compared retrospectively. Results Serum estradiol levels on the day of human chorionic gonadotropin (3780.5, 3599.9, and 3375.7 pg/mL) and the number of retrieved oocytes (17.5, 16.1, and 14.8) decreased from the high to low FORT groups. Pre-ovulatory follicle counts were significantly higher in the high FORT group than in the middle and low FORT groups. The number of retrieved oocytes, high-quality embryo rate, and clinical pregnancy rate decreased from the high to low FORT groups. The incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) in the middle FORT group was significantly lower than that in the high and low FORT groups. Conclusions FORT may be used to predict clinical outcomes of IVF/intracytoplasmic sperm injection-embryo transfer in patients with PCOS. Efforts should be made to prevent OHSS in patients with PCOS and a high or low FORT in controlled ovarian hyperstimulation cycles.
Collapse
Affiliation(s)
- Xiaoqing Tan
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Yu Wen
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Huixiao Chen
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China.,Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ling Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Bin Wang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hongwei Wen
- Department of Reproductive Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Fengli Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Qin Wu
- Department of Obstetrics and Gynecology, Chongqing General Hospital, Chongqing, China
| | - Jing Du
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| |
Collapse
|
19
|
Inheritance of imbalances in recurrent chromosomal translocation t(11;22): clarification by PGT-SR and sperm-FISH analysis. Reprod Biomed Online 2019; 39:40-48. [PMID: 31097322 DOI: 10.1016/j.rbmo.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION To analyse why unbalanced viable offspring are derived mainly from the 3:1 segregation mode in t(11;22)(q23;q11.2) reciprocal translocation. DESIGN Retrospective analysis of 24 pre-implantation genetic testing for chromosomal structural re-arrangements (PGT-SR) cycles was performed on seven male and five female carriers of t(11;22) translocation. Sperm analysis was performed on each male carrier. These patients were directed to the study centre after several years of miscarriages and/or abortions, primary infertility for male carriers or birth of an affected child. RESULTS Twenty-four PGT-SR cycles were performed to exclude imbalances in both male and female carriers. The unbalanced embryos derived from the adjacent-1 segregation mode were the most represented in both male and female carriers (68.4% and 50%, respectively). These results were positively related with meiotic segregation analysis of reciprocal translocation in spermatozoa. A thorough analysis of the unbalanced embryo karyotypes determined that the expected viable +der22 karyotype resulting from 3:1 malsegregation was less represented at 5.3%. CONCLUSIONS These findings highlight the divergence that may exist between meiotic segregation and post-zygotic selection. Post-zygotic selection would be responsible for the elimination of unbalanced embryos derived from the adjacent-1 segregation mode. The combined action of several factors occurs at the beginning of post-zygotic selection. Genetic counselling must consider the risk of a birth related to the adjacent-1 segregation mode, irrespective of the sex of the translocation carrier. These results will allow deeper understanding of the PGT results of t(11;22) carriers, which often include a high number of aneuploid embryos.
Collapse
|
20
|
Grynberg M, Labrosse J. Understanding Follicular Output Rate (FORT) and its Implications for POSEIDON Criteria. Front Endocrinol (Lausanne) 2019; 10:246. [PMID: 31040828 PMCID: PMC6476927 DOI: 10.3389/fendo.2019.00246] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/29/2019] [Indexed: 11/30/2022] Open
Abstract
The management of low prognosis patients in ART represents a challenge for reproductive specialists. Different profiles and biologic characteristics have been identified among these patients. Indeed, while poor ovarian response can be seen in patients with impaired ovarian reserve, others, identified as hypo-responders, show unexpected poor or suboptimal response to controlled ovarian stimulation despite satisfying ovarian parameters. These hypo-responders are associated during FSH stimulation to slow initial responses in terms of estradiol levels and follicle growth, longer stimulations, and/or greater cumulative FSH doses. Hence, it appears that ovarian sensitivity to gonadotropins differs from a patient to another, and plays a determinant role on ovarian response to stimulation. Although precise mechanisms remain to be elucidated, increasing evidence suggests that ovarian sensitivity to FSH could be influenced by the presence of genetic mutations or single nucleotide polymorphisms of gonadotropins and their receptors. Evaluating ovarian sensitivity to FSH therefore appears as a key element to improve IVF success rates in these low prognosis patients and open new treatment perspectives. Since the traditional ovarian markers currently used are not sufficient to accurately reflect ovarian response to FSH, a tool to assess ovarian sensitivity to gonadotropin stimulation was required. The present review aims to present Follicular Output Rate (FORT) as an efficient quantitative and qualitative marker of ovarian responsiveness to gonadotropins, discuss the underlying mechanisms of impaired sensitivity to FSH and the possible FORT implications for Poseidon criteria.
Collapse
Affiliation(s)
- Michael Grynberg
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, Clamart, France
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
- INSERM U1185, University Paris-Sud, Le Kremlin-Bicêtre, France
- INSERM U1133, University Paris Diderot, Paris, France
- *Correspondence: Michael Grynberg
| | - Julie Labrosse
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| |
Collapse
|
21
|
Antral follicle responsiveness to FSH, assessed by the follicular output rate (FORT), is altered in Hodgkin's lymphoma when compared with breast cancer candidates for fertility preservation. J Assist Reprod Genet 2017; 35:91-97. [PMID: 28986734 DOI: 10.1007/s10815-017-1059-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/25/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Oocyte and/or embryo cryopreservation after controlled ovarian hyperstimulation (COH) represents the most established method for female fertility preservation (FP) before cancer treatment. Whether patients suffering from malignancies, candidates for FP, have a normal ovarian capacity to respond to stimulation is controversial. Reduced responsiveness of antral follicle to exogenous FSH might be at play. The percentage of antral follicles that successfully respond to FSH administration may be estimated by the follicular output rate (FORT), which presumably reflects the health of granulosa cells. The present study aims at investigating whether the FORT differs between Hodgkin's lymphoma (HL) and breast cancer (BC) patients. METHODS Forty-nine BC and 33 HL patient candidates for FP using oocyte vitrification following COH were prospectively studied. FORT was calculated by the ratio between the pre-ovulatory follicle count (16-22 mm) on the day of oocyte triggering × 100/antral follicle count before initiation of the stimulation. RESULTS Overall, women in the HL group were younger in comparison with BC patients (26.4 ± 3.9 vs 33.6 ± 3.3 years, p < 0.0001, respectively). The FORT was significantly decreased in patients with HL when compared with BC group (27.0 ± 18.8 vs 39.8 ± 18.9%, p = 0.004, respectively), further leading to a comparable number of oocytes vitrified (10.8 ± 5.9 vs 10.2 ± 7.7 oocytes, p = 0.7, respectively). CONCLUSION The present findings indicate that the percentage of antral follicles that successfully respond to FSH administration is reduced in HL when compared to BC patients, supporting the hypothesis of a detrimental effect of hemopathy on follicular health. In vitro experimentations might provide additional data to confirm this hypothesis.
Collapse
|
22
|
Follicular sensitivity index (FSI): a novel tool to predict clinical pregnancy rate in IVF/ICSI cycles. J Assist Reprod Genet 2017; 34:1317-1324. [PMID: 28674785 DOI: 10.1007/s10815-017-0984-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/16/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aims to introduce a new tool (the Follicular Sensitivity Index; FSI) for objective assessment of follicular responsiveness to exogenous gonadotropins and to evaluate its ability to predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI. METHODS FSI was calculated as preovulatory follicle count (PFC) × 100,000/[antral follicle count (AFC) × total received FSH doses]. One thousand women were included and were divided according to the FSI tertile values into three groups. The primary outcome was clinical pregnancy defined by the presence of an intrauterine gestational sac 5 weeks after embryo transfer. RESULTS There was progressive increase in the clinical pregnancy rate from the low to the high FSI groups (0.27 ± 0.4 vs 0.4 ± 0.4 and 0.58 ± 0.4; p < 0.001). Receiver operator curves showed that FSI had a greater area under the curve than those of the AFC, PFC, and the FSH dose (0.638 vs 0.509, 0.538, and 0.589 respectively). Multivariate logistic regression analysis showed that the correlation between FSI and pregnancy was independent of potential confounding factors like age and body mass index (p < 0.001). CONCLUSION FSI can predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI using GnRH agonist protocol. Higher FSI values had significantly higher oocyte yield and fertilization and clinical pregnancy rates. Wider implications of these findings include the potential use of FSI to define absolute criteria of poor/good ovarian response in IVF/ICSI cycles, guide future IVF cycle management for the same couples, and guide cycle cancelation criteria for poor ovarian response.
Collapse
|
23
|
Hassan A, Kotb M, AwadAllah A, Wahba A, Shehata N. Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study. Reprod Biomed Online 2017; 34:598-604. [PMID: 28341386 DOI: 10.1016/j.rbmo.2017.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
This study aimed to determine whether follicular output rate (FORT) can predict the clinical pregnancy rate in women with unexplained infertility undergoing IVF/ICSI. This was a prospective study conducted at Dar El Teb subfertility centre in Cairo between June 2014 and July 2016. A total of 303 women with unexplained infertility, who were undergoing IVF/ICSI, were divided into three groups according to FORT tertile values. FORT was calculated as pre-ovulatory follicle count/antral follicle count × 100. There was a progressive and significant increase from the low to the high FORT groups in the clinical pregnancy rate (29.9%, 43.3% and 57.8%; P < 0.001), number of retrieved oocytes (5.4 ± 1.5, versus 6.8 ± 2.8, and 7.4 ± 2.1; P < 0.001), and fertilization rate (48.4 ± 21.8 versus 55.3 ± 20.3 and 57.4 ± 19.2; P = 0.006). Multivariate logistic regression analysis revealed that the correlation between FORT and pregnancy was independent of potential confounding factors (P = 0.008). We concluded that FORT is an independent variable affecting the clinical pregnancy rate in IVF/ICSI cycles. Higher FORT values had better oocyte yield and clinical pregnancy rates in women with unexplained infertility undergoing IVF/ICSI with potentially normal ovarian response.
Collapse
Affiliation(s)
- A Hassan
- Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya Street, AlKasr AlAiny, Cairo 11562, Egypt.
| | - M Kotb
- Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya Street, AlKasr AlAiny, Cairo 11562, Egypt
| | - A AwadAllah
- Department of Gynecology and Obstetrics, Ain Shams University, Ramsis Street, Abassiya, Cairo 1156, Egypt
| | - A Wahba
- Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya Street, AlKasr AlAiny, Cairo 11562, Egypt
| | - N Shehata
- Department of Gynecology and Obstetrics, Beni Suef University, Beni Suef Governorate, Egypt
| |
Collapse
|
24
|
Wang M, Hao C, Bao H, Huang X, Liu Z, Zhang W, Li F. Effect of elevated estradiol levels on the hCG administration day on IVF pregnancy and birth outcomes in the long GnRH-agonist protocol: analysis of 3393 cycles. Arch Gynecol Obstet 2016; 295:407-414. [PMID: 27858152 DOI: 10.1007/s00404-016-4242-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This retrospective study aimed to evaluate the association between elevated serum estradiol (E 2) levels on the human chorionic gonadotrophin (hCG) administration day and in vitro fertilization (IVF) pregnancy and birth outcomes in the long GnRH-agonist protocol. METHODS This study analyzed the data of 3393 infertile women who underwent initial fresh IVF. The patients were categorized into high and low E 2 groups based on their serum E 2 levels on the hCG day. Pregnancy and birth outcomes were compared. RESULTS The implantation rate, clinical pregnancy rate, and live birth rate were all significantly higher in the high E 2 group than in the low E 2 group (p < 0.05). The good-quality embryo rate and abortion rate did not significantly differ between the two groups. There were no significant differences in the mode of delivery, gestational age, birth weight, and fetal gender between the two groups. Furthermore, there were no differences in the risk of preterm birth, low birth weight, and fetal malformation between the two groups in 860 single live births. Subgroup analysis of singleton pregnancies in the high E 2 (E 2 ≥ 3757 pg/mL) group revealed a significant increase in abortion rate in the age group of ≥37 years. CONCLUSIONS Elevated serum E 2 levels associated with controlled ovarian stimulation did not increase the risks of preterm birth, low birth weight, and fetal malformation. High E 2 on the hCG day had no detrimental effect on the implantation rate, clinical pregnancy rate, and live birth rate.
Collapse
Affiliation(s)
- Meimei Wang
- Shandong University School of Medicine, Jinan, People's Republic of China.,Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Cuifang Hao
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China.
| | - Hongchu Bao
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Xin Huang
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Zhenteng Liu
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Wei Zhang
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| | - Fenghua Li
- Reproductive Medicine Centre, Yuhuangding Hospital of Yantai, Affiliated Hospital of Qingdao University, 20 Yuhuangding Road East, Yantai, 264000, Shandong, People's Republic of China
| |
Collapse
|
25
|
Rehman R, Mustafa R, Baig M, Arif S, Hashmi MF. Use of Follicular Output Rate to Predict Intracytoplasmic Sperm Injection Outcome. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:169-74. [PMID: 27441049 PMCID: PMC4948068 DOI: 10.22074/ijfs.2016.4906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/02/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The measurement of follicular output rate (FORT) has been proposed as a good indicator for evaluating follicular response to the exogenous recombinant folliclestimulating hormone (rFSH). This places FORT as a promising qualitative marker for ovarian function. The objective of the study was to determine FORT as a predictor of oocyte competence, embryo quality and clinical pregnancy after intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS This prospective study was carried out on a group of infer- tile females (n=282) at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2010 till August 2013. Downregulated females were stimulated in injection gonadotropins and on ovulation induction day, pre-ovulatory follicle count (PFC) was determined using transvaginal ultrasound scan (TVUS), and FORT was determined as a ratio of PFC to antral follicle count (AFC)×100. Group I consisted of females with a negative pregnancy test, while group II had a positive pregnancy test that was confirmed with the appearance of fetal cardiac activity. Linear regression analyses of categorical variables of clinical pregnancy along with other independent variables, including FORT, were performed using SPSS version 15.0. RESULTS Pregnancy occurred in 101/282 women who were tested, recording a clinical pregnancy rate of about 35.8%. FORT values were higher in group II as compared to group I females (P=0.0001). In multiple regression analysis, 97.7, 87.1, 78.2, and 83.4% variations were explained based on the number of retrieved oocytes per patients, number of metaphase II oocytes retrieved, number of fertilized oocytes, and number of cleaved embryos, respectively, indicating FORT as an independent predictor. CONCLUSION FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. It also gives information about the number of cleaved embryos and clinical pregnancy rate.
Collapse
Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Rozina Mustafa
- Department of Obstetrics and Gynecology, United Medical and Dental College, Karachi, Pakistan
| | - Mukhtiar Baig
- Department of Biochemistry, Faculty of Medicine, Rabigh, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Sara Arif
- House Officer Civil Hospital, Karachi, Pakistan
| | | |
Collapse
|
26
|
Ferfouri F, Bernicot I, Schneider A, Haquet E, Hédon B, Anahory T. Is the resulting phenotype of an embryo with balanced X-autosome translocation, obtained by means of preimplantation genetic diagnosis, linked to the X inactivation pattern? Fertil Steril 2016; 105:1035-46. [PMID: 26772789 DOI: 10.1016/j.fertnstert.2015.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 11/07/2015] [Accepted: 12/08/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine if a balanced female embryo with X-autosome translocation could, during its subsequent development, express an abnormal phenotype. DESIGN Preimplantation genetic diagnosis (PGD) analysis on two female carriers with maternal inherited X-autosome translocations. SETTING Infertility center and genetic laboratory in a public hospital. PATIENT(S) Two female patients carriers undergoing PGD for a balanced X-autosome translocations: patient 1 with 46,X,t(X;2)(q27;p15) and patient 2 with 46,X,t(X;22)(q28;q12.3). INTERVENTION(S) PGD for balanced X-autosome translocations. MAIN OUTCOME MEASURE(S) PGD outcomes, fluorescence in situ hybridization in biopsied embryos and meiotic segregation patterns analysis of embryos providing from X-autosome translocation carriers. RESULT(S) Controlled ovarian stimulation facilitated retrieval of a correct number of oocytes. One balanced embryo per patient was transferred and one developed, but the patient miscarried after 6 weeks of amenorrhea. In X-autosome translocation carriers, balanced Y-bearing embryos are most often phenotypically normal and viable. An ambiguous phenotype exists in balanced X-bearing embryos owing to the X inactivation mechanism. In 46,XX embryos issued from an alternate segregation, der(X) may be inactivated and partially spread transcriptional silencing into a translocated autosomal segment. Thus, the structural unbalanced genotype could be turned into a viable functional balanced one. It is relevant that a discontinuous silencing is observed with a partial and unpredictable inactivation of autosomal regions. Consequently, the resulting phenotype remains a mystery and is considered to be at risk of being an abnormal phenotype in the field of PGD. CONCLUSION(S) It is necessary to be cautious regarding to PGD management for this type of translocation, particularly in transferred female embryos.
Collapse
Affiliation(s)
- Fatma Ferfouri
- Cytogenetic PGD Department, CHU Montpellier University Hospital, Montpellier, France
| | - Izabel Bernicot
- Cytogenetic PGD Department, CHU Montpellier University Hospital, Montpellier, France
| | - Anouck Schneider
- Cytogenetic PGD Department, CHU Montpellier University Hospital, Montpellier, France
| | - Emmanuelle Haquet
- ART-PGD Department, CHU Montpellier University Hospital, Montpellier, France
| | - Bernard Hédon
- ART-PGD Department, CHU Montpellier University Hospital, Montpellier, France
| | - Tal Anahory
- Cytogenetic PGD Department, CHU Montpellier University Hospital, Montpellier, France; ART-PGD Department, CHU Montpellier University Hospital, Montpellier, France; INSERM U487, Saint Eloi Hospital, Montpellier, France.
| |
Collapse
|
27
|
Dahan MH, Ata B, Rosenberg R, Chung JT, Son WY, Tan SL. Collection of 125 oocytes in an in vitro maturation cycle using a new oocyte collection technique: a case report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 36:900-903. [PMID: 25375303 DOI: 10.1016/s1701-2163(15)30439-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have developed a new oocyte collection technique applicable to use in women with "string-of-pearls" polycystic ovaries undergoing in vitro maturation (IVM) of oocytes for in vitro fertilization. CASE A 34-year-old woman with polycystic ovary syndrome and infertility underwent IVM. Her ovaries had the string-of-pearls appearance on ultrasound, and antral follicle counts were consistently less than 60. An IVM cycle was performed using a new "rapid-pass" oocyte collection technique. We retrieved 125 germinal vesicle oocytes. A total of 44 oocytes reached the metaphase II stage after 48 hours in culture. After fertilization, four embryos were transferred to the uterus, resulting in a live birth. CONCLUSION We believe this to be the largest number of oocytes retrieved from a single individual at one time. This was done using a newly developed aspiration technique.
Collapse
Affiliation(s)
- Michael H Dahan
- McGill University Health Centre Reproductive Centre, Royal Victoria Hospital, Montreal QC
| | - Baris Ata
- McGill University Health Centre Reproductive Centre, Royal Victoria Hospital, Montreal QC; Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Uludag University, Bursa, Turkey
| | | | - Jin Tae Chung
- McGill University Health Centre Reproductive Centre, Royal Victoria Hospital, Montreal QC
| | - Weon Young Son
- McGill University Health Centre Reproductive Centre, Royal Victoria Hospital, Montreal QC
| | - Seang Lin Tan
- McGill University Health Centre Reproductive Centre, Royal Victoria Hospital, Montreal QC
| |
Collapse
|
28
|
Li Y, Li T, Mai Q, Long L, Ou J. Comparison of fertilization outcome between microdrop and open insemination methods in non-male factor IVF patients. Syst Biol Reprod Med 2014; 60:165-70. [PMID: 24499510 DOI: 10.3109/19396368.2013.872707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both microdrop and open methods are commonly used for in vitro fertilization (IVF) protocols for embryo culture as well as oocyte insemination. However, few comparative studies evaluating the microdrop or open method of insemination on the fertilization outcome and subsequent embryo development have been performed. A randomized study was conducted to compare microdrop and open fertilization with respect to fertilization rate and embryo development among non-male factor patients undergoing in vitro fertilization and embryo transfer (IVF-ET). The results presented in this study demonstrate that the fertilization failure rate [total fertilization failure rate (TFF) plus low fertilization rate (<25% oocytes fertilized)] in the microdrop insemination group was higher than in the open insemination group (11.9% versus 3.3%, p < 0.001), while the good quality embryo rate and pregnancy rate did not differ significantly between the groups. As a highly complicated process involving many extrinsic and intrinsic factors, further studies are needed to confirm the effects of these insemination methods on the rate of fertilization failure.
Collapse
Affiliation(s)
- Yubin Li
- The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | | | | | | | | |
Collapse
|