Borderline form of empty follicle syndrome treated with a novel dual trigger method combined with delayed oocyte retrieval: A case report

BACKGROUND Borderline form of empty follicle syndrome is a condition in which only a few mature or immature oocytes are recovered after meticulous follicular aspiration,despite adequate ovarian response to stimulation.It is a rare phenomenon with an unclear cause.Currently,the condition still lacks effective treatment.CASE SUMMARY A patient with secondary infertility who had undergone three cycles of assisted reproductive technique(ART)is described.With regard to good follicular response,two oocytes were obtained in the first two ART cycles,but no embryo was formed.In the third ART cycle,which is the subject of this study,ovulation was induced by dual trigger of a supernormal dose of human chorionic gonadotropin(HCG)combined with a delayed oocyte retrieval approach.The method involved administration of gonadotropin-releasing hormone agonist,recombinant HCG,and urinary HCG 39 h before ovum pick-up.Ten oocytes were recovered,two out of three mature eggs were fertilized after intracytoplasmic sperm injection,resulting in two embryos that were subsequently cryopreserved.The case report guidelines have been used herein to present the first case of this novel dual trigger method.CONCLUSION This approach provides a new treatment option for patients with a similar condition in the future.This study can also inspire further investigation on the effects of variousβ-HCG serum levels 36 h after intramuscular HCG administration.

Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval:A randomized controlled trial

Background Transvaginal oocyte retrieval is frequently followed by adverse events related to anesthesia and the procedure.Some research showed that transcutaneous electrical acupoint stimulation(TEAS)can relieve intraoperative pain and postoperative nausea.Objective This study examined whether TEAS can alleviate pain and relieve adverse symptoms after oocyte retrieval.Design,setting,participants and interventions Altogether 128 patients were randomly divided into the TEAS group and the mock TEAS group.The two groups received a 30-minute-long TEAS or mock TEAS treatment that began 30 min after oocyte retrieval.Main outcome measures The primary outcome was the visual analog scale(VAS)pain score.Secondary outcomes were pressure pain threshold,McGill score,pain rating index(PRI),present pain intensity(PPI),VAS stress score,VAS anxiety score,and postoperative adverse symptoms.Results The baseline characteristics of the two groups were comparable(P>0.05).The VAS pain scores of the TEAS group were lower than those of the mock TEAS group at 60 and 90 min after oocyte retrieval(P<0.05).The McGill score,PRI and PPI in the TEAS group were significantly lower than those in the control group at 60 min after oocyte retrieval(P<0.05).However,the two groups had equivalent beneficial effects regarding the negative emotions,such as nervousness and anxiety(P>0.05).The TEAS group was superior to the mock TEAS group for relieving postoperative adverse symptoms(P<0.05).Conclusion TEAS treatment can relieve postoperative pain and postoperative adverse symptoms for patients undergoing oocyte retrieval.

Analgesic effect of acupuncture at Hegu (LI 4) on transvaginal oocyte retrieval with ultrasonography

OBJECTIVE: To observe the analgesic effect of acupuncture at Hegu (LI 4) in vitro fertilization-embryo transfer (IVF-ET) transvaginal oocyte retrieval using ultrasonography and explore its mechanism. METHODS: Ninety patients undergoing IVF-EF oocyte retrieval were randomly divided into three groups: an acupuncture group with needles inserted into bilateral Hegu (LI 4) points, a placebo group given placebo needles, and a control group with routine oocyte retrieval. Each group had an indometacin enema 30 min before the operation. We compared the pain-rated index (PRI), visual analogy scale (VAS), and present pain intensity (PPI) immediately after operation and 1 h after operation. We also determined the neuropeptide Y (NPY) level of the follicular fluid. RESULTS: PRI, VAS, and PPI after operation and 1 hafter operation in the acupuncture group were significantly lower than those in the control group (P< 0.01). No obvious difference (P>0.05) was observed in PRI,VAS, and PPI after operation and 1 h after operation between the placebo group and the control group.The NPY level of the follicular fluid in the acupuncture group was significantly higher than that in the control group (P<0.01). No obvious difference (P>0.05) was observed in the NPY level of the follicular fluid between the placebo group and the control group. CONCLUSION: The analgesic effect of acupuncture at Hegu in transvaginal oocyte retrieval using ultrasonography may be related to the increase in the NPY level of the follicular fluid.

Rupture of ovarian abscess following ultrasound-guided transvaginal oocyte retrieval for in-vitro fertilization in a patient with ovarian endometriomata:a case report

Ultrasound-guided transvaginal oocyte retrieval （TVOR） has become the gold standard for couples undergoing in-vitro fertilization （IVF）. Despite a relatively low complication rate following the procedure, here we report a rare case of a ruptured ovarian abscess presenting late after ultrasound-guided TVOR in a 32-year-old woman with ovarian endometriomata. Prompt intervention and proper choices of treatment led to rapid patient recovery with no long-term sequelae. Rupture of ovarian abscess needs to be included in the differential diagnosis of a patient presenting with abdominal pain following TVOR.

A Delayed Ovarian Hemorrhage with Severe Ovarian Hyperstimulation Syndrome after Transvaginal Ultrasound-guided Oocyte Retrieval for in vitro Fertilization-embryo Transfer

Objective To report a case of ovarian hemorrhage after transvaginal ultrasoundguided oocyte retrieval combined with severe ovarian hyperstimulation syndrome （OHSS）. Methods A 26-year-old woman who was on therapy for infertility presented with abdominal distension and a decrease of urine after transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization-embryo transfer （IVF-ET）. Initial clinical presentation, ultrasound, and lab results were consistent with the diagnosis of severe OHSS. However with 4 d conservative treatments there seemed no recovery and the patient became more serious for her hemoglobin fell from 169.0 g/L to 60.2 g/L along with more abdominal fluid and a decrease of urine. Ultrasound guided paracentesis revealed an ovarian hemorrhage, and the patient underwent emergent surgery. Results The patient underwent emergent laparotomy for oophoroplasty and preservation of ovary. She got twin pregnancy in the second frozen-thawed embryo transfer （FET） cycle and delivered two female babies. Conclusion It is important to distinguish the OHSS from ovarian hemorrhage, because the ovarian hemorrhage with hemoperitoneum requires immediate operative management, whereas OHSS is nearly always managed conservatively. Clinicians must be aware that ovarian hemorrhage may be delayed in women presenting OHSS.

Pregnancy outcomes of the first thawing cycle in"freeze-all"strategy of infertility patients with fever during oocyte recruitment:a matched-pair study

Background:It is currently unknown whether patients with a fever after controlled ovulation during egg retrieval could increase the risk of pelvic infection or not,and fever itself may affect endometrial receptivity or embryo quality with poor pregnancy outcomes.The aim of this study was to analyze the outcomes of patients with fever during oocyte retrieval after the first frozen-thawed embryo transfer(FET)cycle.Methods:This was a 1:3 retrospective paired study matched for age.In this study,58 infertility patients(Group 1)had a fever during the control ovulation,and the time of the oocyte retrieval was within 72 hours,they underwent ovum pick up and whole embryo freezing("freeze-all"strategy).The control subjects(Group 2)are 174 patients matched for age who underwent whole embryo freezing for other reasons.The baseline characteristics,clinical data of ovarian stimulation,and outcomes,such as the clinical pregnancy rate,ongoing clinical pregnancy rate were compared between the two groups in the subsequent FET cycle.Results:All patients had no pelvic inflammatory disease after oocyte retrieval.Anti-Mullerian hormone(AMH)levels(4.2 vs.2.2,P<0.001)were higher in group 2,and the number of oocytes retrieved,and fertilization rate were lower in group 1(P<0.001),but the endometrial thickness,the number of embryo transfers,and the type of luteal support supplementation were similar between the two groups.Regarding pregnancy outcomes in the subsequent FET cycle,the implantation rate,clinical pregnancy rate,early spontaneous rate,ectopic pregnancy rate,and ongoing pregnancy rate were all not significantly different.Further regression analyses showed that the clinical pregnancy rate and ongoing pregnancy rate were also not significantly different.Conclusions:Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a safe and minimally invasive method for patients with fever.Moreover,the fever had almost no effect on embryo quality.

Prediction of Cumulative Live Birth Rate in Women Aged 40 Years and Over Undergoing In vitro Fertilization/Intracytoplasmic Sperm Injection

Objective:To investigate cumulative live birth rate (cLBR) per oocyte retrieval in infertile patients aged 40 years and over undergoing their first in vitro fertilization/intracytoplasmic sperm injection cycles and to identify the possible predictors.Methods:A total of 1,613 patients at a university hospital in China from January 2013 to May 2017 were enrolled in this retrospective study.All data for fresh and subsequent frozen-thawed cycles were analyzed.Multivariate logistic regression analysis with stepwise selection of possible predictors for cLBR was performed,and Loess curve was constructed to determine the association between cLBR and the number of oocytes retrieved.Results:cLBR significantly increased with the number of oocytes retrieved and reached up to 75% when > 20 oocytes were retrieved (P<0.001).Variables of antral follicle count (AFC) and the number of oocytes retrieved were selected using multiple logistic regression analysis with stepwise selection to predict the significance of cLBR.cLBR demonstrated an obvious upward trend as the number of oocytes retrieval increased in the Loess curve.Conclusions:For patients aged 40 years and over,AFC and the number of oocytes retrieved were two key predictors for cLBR and maximization of ovarian reserve exploitation was pivotal to increase the chance of live birth.