Objective: To analyze the distribution of oocytes nuclear maturational stages and intracytoplasmic sperm injection (ICSI) outcome in relation to follicular size, after controlled ovarian hyperstimulation (COH), using ...Objective: To analyze the distribution of oocytes nuclear maturational stages and intracytoplasmic sperm injection (ICSI) outcome in relation to follicular size, after controlled ovarian hyperstimulation (COH), using gonadotropin- releasing hormone (GnRH) antagonist or agonist protocols. Design: Prospective comparative study. Setting: Fertility unit in an academic hospital. Patient(s): Normo- ovulatory patients with unexplained, male and/or tubal factor infertility undergoing ICSI treatment. Intervention(s): Oocytes were retrieved from small (7- 12 mm) and large follicles (>12 mm). Main Outcome Measure(s): Oocyte nuclear maturation stage, fertilization and preimplantation embryonic development of the mature ova evaluated. Result(s): Distribution of oocyte maturation stages from small follicles did not differ between the two COH protocols. From large follicles, a statistically significantly higher percentage of immature oocytes was retrieved after antagonist compared with agonist treatment (16 vs 11% , respectively). No statistically significant differences existed regarding ICSI outcome of mature ova within the same follicle diameter range between COH protocols. Inseminated ova from small follicles presented a significantly higher number of embryos with delayed development on day 3 after ICSI. Conclusion(s): A greater heterogeneity of maturity was found in the population of oocyte stages that were present after the antagonist protocol. Matured oocytes retrieved from small follicles generated embryos of lower developmental potential than oocytes derived from larger follicles.展开更多
To determine the impact of the peak E2 level and its midluteal decline on IVF- ET outcome in a group of normal- and highresponding patients. Retrospective analysis of IVF- ET data. Tertiary- care, university- affiliat...To determine the impact of the peak E2 level and its midluteal decline on IVF- ET outcome in a group of normal- and highresponding patients. Retrospective analysis of IVF- ET data. Tertiary- care, university- affiliated teaching hospital. A total of 100 patients aged ≤ 38 years and receiving up to three embryos per transfer who underwent a similar standard controlled ovarian hyperstimulation for IVF- ET. Morning blood was collected on days 0 (hCG day), + 9, and + 14. Treatment cycle hormonal characteristics and percent midluteal E2 decline in conception and nonconception cycles. Among all cycles, a mean decline of 95.0% in serum E2 was observed at the midluteal phase. No significant differences were found in various parameters comparing conception with nonconception cycles. Occurrence of conception did not correlate with the absolute E2 level or with percent E2 decline in good and high responders. Early spontaneous abortion occurred more frequently in high responders with >98% E2 decline; however, the difference did not reach statistical significance. Multifactorial analysis refutes the negative role of supraphysiologic levels of E2 on the day of hCG administration or its dramatic decline at the midluteal phase on the success rate after embryo transfer. A possibly increased rate of early spontaneous abortion in the high- response group warrants further verification.展开更多
文摘Objective: To analyze the distribution of oocytes nuclear maturational stages and intracytoplasmic sperm injection (ICSI) outcome in relation to follicular size, after controlled ovarian hyperstimulation (COH), using gonadotropin- releasing hormone (GnRH) antagonist or agonist protocols. Design: Prospective comparative study. Setting: Fertility unit in an academic hospital. Patient(s): Normo- ovulatory patients with unexplained, male and/or tubal factor infertility undergoing ICSI treatment. Intervention(s): Oocytes were retrieved from small (7- 12 mm) and large follicles (>12 mm). Main Outcome Measure(s): Oocyte nuclear maturation stage, fertilization and preimplantation embryonic development of the mature ova evaluated. Result(s): Distribution of oocyte maturation stages from small follicles did not differ between the two COH protocols. From large follicles, a statistically significantly higher percentage of immature oocytes was retrieved after antagonist compared with agonist treatment (16 vs 11% , respectively). No statistically significant differences existed regarding ICSI outcome of mature ova within the same follicle diameter range between COH protocols. Inseminated ova from small follicles presented a significantly higher number of embryos with delayed development on day 3 after ICSI. Conclusion(s): A greater heterogeneity of maturity was found in the population of oocyte stages that were present after the antagonist protocol. Matured oocytes retrieved from small follicles generated embryos of lower developmental potential than oocytes derived from larger follicles.
文摘To determine the impact of the peak E2 level and its midluteal decline on IVF- ET outcome in a group of normal- and highresponding patients. Retrospective analysis of IVF- ET data. Tertiary- care, university- affiliated teaching hospital. A total of 100 patients aged ≤ 38 years and receiving up to three embryos per transfer who underwent a similar standard controlled ovarian hyperstimulation for IVF- ET. Morning blood was collected on days 0 (hCG day), + 9, and + 14. Treatment cycle hormonal characteristics and percent midluteal E2 decline in conception and nonconception cycles. Among all cycles, a mean decline of 95.0% in serum E2 was observed at the midluteal phase. No significant differences were found in various parameters comparing conception with nonconception cycles. Occurrence of conception did not correlate with the absolute E2 level or with percent E2 decline in good and high responders. Early spontaneous abortion occurred more frequently in high responders with >98% E2 decline; however, the difference did not reach statistical significance. Multifactorial analysis refutes the negative role of supraphysiologic levels of E2 on the day of hCG administration or its dramatic decline at the midluteal phase on the success rate after embryo transfer. A possibly increased rate of early spontaneous abortion in the high- response group warrants further verification.
