Correlation of mature mean follicle on transvaginal ultrasound and serum estradiol levels on day of trigger injection of ovulation in ovarian stimulation cycle of in vitro fertilization with retrieved oocytes

Background: Controlled ovarian hyperstimulation aims to obtain mature follicles. The present study was conducted to assess the correlation of mature follicle in transvaginal ultrasound scanning (TVS) and serum estradiol levels on day of trigger injection in ovarian stimulation cycle for IVF with the oocyte yield.Methods: In this prospective study, we evaluated oocyte donor 19 to 45 years of age who underwent oocyte retrieval at our clinic. Outcome variables like number of mature follicles visualized on TVS on the last day of stimulation was noted for all patients. On the same day, serum estradiol levels and number of mature follicles seen on TVS were noted and correlated with the number of oocytes retrieved. Ultrasound guided transvaginal oocyte retrieval was performed and total number of oocytes were noted.Results: During the study period, 20 oocytes donors were included. Mean age of the patients was 27.9±4.7 years. Mean BMI was 26.8±2.3 kg/m2. Mean FSH level was 6.89±1.79 IU/L and mean antral follicle count on day 3 was 14.06±3.56. On the day of trigger, mean mature follicle count seen on TVS was 20.4±13.8, ranging from 8 to 50. On an average, 17.2 oocytes were retrieved. On the day of trigger, mean estradiol level was 4970±203, ranging from 500 to 15,665 pg/ml. It was observed that the number of retrieved oocytes correlated significantly with the serum estradiol levels, (Pearson’s coefficient 0.94, p value<0.001) and number of mature follicles seen on TVS ((Pearson’s coefficient 0.92, p value<0.001).Conclusions: Number of retrieved oocytes correlated significantly with the serum estradiol levels and number of mature follicles seen on TVS on the day of trigger.

Early Embryo Development in Women with Endometriosis: A Retrospective Cohort Study

Background: Endometriosis is known to be detrimental to fertility in many ways. Evidence drawn from studies on oocyte recipient cycles suggests that the oocyte quality of women with endometriosis is compromised. Research that specifically examined the association between embryo quality and endometriosis/endometrioma are scarce and the question if endometriosis affects oocyte and/or embryo quality remain controversial. This study aims to evaluate embryo quality of women with endometriosis (EN) and without endometriosis (tubal factor [TF], unexplained infertility [UE]).Methods: Multi-centre retrospective study was performed. Treatment cycles and embryology records of women with and without endometriosis undergoing IVF was reviewed via IDEASTM database. Number of oocytes collected per mature follicle, fertilisation rate, pregnancy rate, morphology and morphometric assessment of embryo at all stages were evaluatedResults: Total of 678 women who had IVF treatment was analysed (EN, n=89; TF, n=214; UE, n=375). The mean age for each group was EN, 34.4±3.3; TF, 33.5±3.7 and 34.6±3.2 respectively. Number of mature follicles (>14mm) on the day of trigger injection was similar (P=0.75) between all groups. Percentage of oocytes collected per mature follicle was lower in endometriosis compared to other groups (P=0.01; EN, 65±23; TF, 76±20; UE, 71±24). Higher percentages of embryos fail to achieve 8-cell stage in EN compared to control groups (P=0.02; EN, 4.0±1.6 TF, 1.2±0.4; UE, 1.5±0.4. Percentages of embryos at all grades (Grade1-4) per women were similar between the comparison groups (P>0.05). Endometriosis did not impair (P>0.05) blastocyst development or the development of Fully Expanded Hatching Blastocysts (FEHB).Conclusions: This study finds women with endometriosis have lower number of oocyte per total number of follicle. The presence of endometriosis is associated with a higher rate of early embryo arrest, which implicates poor oocyte quality. However endometriosis has no effect on the embryo quality beyond the 8-cell-stage of embryo development

Steroid signaling in mature follicles is important for Drosophila ovulation

Although ecdysteroid signaling regulates multiple steps in oogenesis, it is not known whether it regulates Drosophila ovulation, a process involving a matrix metalloproteinase-dependent follicle rupture. In this study, we demonstrated that ecdysteroid signaling is operating in mature follicle cells to control ovulation. Moreover, knocking down shade (shd), encoding the monooxygenase that converts ecdysone (E) to the more active 20-hydroxyecdysone (20E), specifically in mature follicle cells, blocked follicle rupture, which was rescued by ectopic expression of shd or exogenous 20E. In addition, disruption of the Ecdysone receptor (EcR) in mature follicle cells mimicked shd-knockdown defects, which were reversed by ectopic expression of EcR.B2 but not by EcR.A or EcR.B1 isoforms. Furthermore, we showed that ecdysteroid signaling is essential for the proper activation of matrix metalloproteinase 2 (Mmp2) for follicle rupture. Our data strongly suggest that 20E produced in follicle cells before ovulation activates EcR.B2 to prime mature follicles to be responsive to neuronal ovulatory stimuli, thus providing mechanistic insights into steroid signaling in Drosophila ovulation.

The Correlation of Basal Serum FSH, Antral Follicle Count with Ovarian Response in Women with Advanced Reproductive Age

Objective (s): The aim of this study was to find out the correlation between basal serum Follicle Stimulating Hormone (FSH) level, antral follicle count and number of oocytes retrieved during IVF cycle in women with advanced reproductive age.Method: It was a cross sectional observational study which was done between January 2015 and December 2015 in Infertility Management Center, a tertiary center in Dhaka where assisted reproductive technologies are being offered. Eighty nine (89) infertile patients who were between 35 to 45 years of age and have come for IVF treatment for the first time were included in this study. The selected patients had undergone estimation of basal serum FSH by automated immuno assay analyzer and counting of the antral follicles by transvaginal sonography on day two or three. In total sixty nine (69) patients started IVF treatment according to GnRH long agonist protocol. Controlled ovarian stimulation started with 225 IU rFSH. Follicle monitoring was done on day 5 and day 9 and the dosage was kept same or changed according to the patient’s response. After day nine of stimulation, ten women were excluded as they had no mature follicle of 18 mm or more and cycle was cancelled. So in fifty nine (59) cases ovulation was triggered with hCG 5000 IU on the day when at least one mature follicle measuring 18mm was observed. The ovum pickup was done 32 hours after the trigger and the number of collected oocytes was counted under microscope. Outcome measures of this study was to compare basal FSH and antral follicle count as predictors of ovarian reserve by correlating with the number of oocytes retrieved and to correlate the age of the female partner with the number of oocytes retrieved.Results: Most couples in this study (68.33%) have been suffering from primary infertility and majority of them had six to ten years of infertility. Higher proportion of the female partners (75%) was between 35 to 37 years. The majority of infertile couples have male factor infertility (32%). The second commonest cause found was tubal factor in female partner (20%).Stepwise multiple regression analysis was done. Significant positive correlation was noticed between AFC and number of oocytes (b = 0.2413).There was negative correlation between the basal FSH level and the number of oocytes (b= -0.5083). Age of female partner had weak correlation with ovarian reserve.Conclusion: Measurement of antral follicle number in the follicular phase is a better predictor of ovarian reserve in comparison to basal FSH and age of the women.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 20-24

Perbandingan hasil stimulasi ovarium dengan kombinasi klomifen sitrat gonadotropin dan klomifen sitrat pada inseminasi intra uteri

Background: Infertile couple with the cause of unexplained infertility and male factor can follow intrauterine insemination (IUI) program as a cheap and easy method for infertility therapy. Ovarian stimulation by combination of clomiphene citrate and gonadotropin and also clomiphene citrate alone was done as a superovulation mode to get higher number of mature follicle to gain higher pregnancy rate. Objective : To compare the amount of mature follicles and endometrial thickness as an outcome of ovarian stimulation between combination drug of clomiphene citrate and gonadotrophin with clomiphene citrate alone.Methods: Observational retrospective cohort. Subject is one cycle intrauterine insemination stimulated either by combination CC gonadotrophin or CC alone, eligible in inclusion criteria and exclusion criteria. Statistic test used was independent t-test, chi-square and logistic regression.Location of study: Infertility Clinic of Permata Hati, dr. Sardjito Hospital, Yogyakarta.Result: A total of 142 cycle from 98 couples followed IUI and stimulated by combination CC gonadotrophin (n=72) or CC alone (n=70). Multiple mature follicle number was different and statistically significant 77% vs 54%, RR 1,433 (IK95% 1,118-1,836), p=0,005, while endometrial thickness > 7mm was more frequent in combination group but not statistically different with percentage 81,9% vs 74,3%, RR 1,103 (CI95% 0,926-1,315), p=0,367.Conclusion: Ovarian stimulation by combination CC gonadotropin resulting of more multiple mature follicle number while good endometrial thickness was more in combination group but not statistically significant.Keywords: ovarian stimulation, clomiphene citrate, gonadotrophin, multifollicular, endometrial thickness

Benign Hematologic Disorders

The menstrual cycle is composed of the follicular (proliferative), periovulatory, and luteal (secretory) phases. At periovulation, the mature follicle triggers a surge in luteinizing hormone level, causing ovum release and stimulating the residual ovarian follicle to transform into a corpus luteum. Circulating estrogen and progestin levels increase. A thickened, enriched endometrium develops owing to progestin secretion from the corpus luteum. Without fertilization, the corpus luteum atrophies, estrogen and progestin levels decline, follicle-stimulating hormone release is stimulated, and the endometrium sloughs.

218 THE EFFECT OF OVULATING AGENTS ON MATURE FOLLICLES IN BACTRIAN CAMEL (CAMELUS BACTRIANUS)

Mature follicle response and CL formation following induction of ovulation using GnRH analogues and LH were investigated in Bactrian camel. Bactriancamels (n = 58) withamature follicle (12-25 mm)received 1) alarelin (Vetaroline®, Aburaihan,Tehran, Iran; 25 μg, i.m. 37/58); 2) buserelin (Receptal®, Intervet, Boxmeer, the Netherlands; 20 μg i.v. 16/58); or 3) LH (Lutropin®-V, Bioniche, Belleville, Ontario, Canada; 25 mg i.v. 5/58; Day 0 of experiment = day of inducing ovulation). Ovarian follicles were considered mature according to previous definition in Bactrian camel (Nikjou D et al. 2008 Theriogenology 69 491-500). Daily ultrasonography was conducted between Days -5 and 15 of the experiment using a real-time ultrasound scanner (Aloka 500, Tokyo, Japan) equipped with a 5-MHz linear array transrectal transducer. The day after inducing ovulation, the size of the mature follicle increased in 89.7% (52/58; 0.72 mm ± 0.11) or decreased in 10.3% (6/58; 0.75 mm ± 0.13) of observations. All mature follicles ovulated by 48 h after treatment. Corpus luteum was detected on Day 4.9 ± 0.13 at the diameter of 14.0 mm ± 0.31 and reached the maximum diameter of 20.2 mm ± 0.58 on Day 9.0 ± 0.13 after treatment. Vacuolated CL was detected in 14% of observations. Corpuralutea started to regress 1 to 2 days after reaching the maximum diameter. In conclusion, mature follicles, at the diameter of 12 to 25 mm, ovulated and normal CL with the short life span (about 10 days) formed consistently in response to the use of ovulating agent in Bactrian camel. Table 1.Changes in ovarian structures following injection of different GnRH analogues and LH Research was funded by the Deputy of Research, University of Tehran. The authors thank the companies Bioniche (Canada), Aburaihan (Iran) and Intervet (the Netherlands) for kind provision of pharmaceuticals.