Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI: a randomised controlled trial

Abstract

BackgroundThe negative impact of rising progesterone levels on pregnancy rates is well known, but data on mature oocyte yield are conflicting. We examined whether delaying the oocyte maturation trigger in IVF/ICSI affected the number of mature oocytes and investigated the potential influence of serum progesterone levels in this process.MethodsBetween January 31, 2011, and December 31, 2011, 262 consecutive patients were monitored using ultrasound plus hormonal evaluation. Those with > =3 follicles with a mean diameter of > =18 mm were divided into 2 groups depending on their serum progesterone levels. In cases with a progesterone level < = 1 ng/ml, which was observed in 59 patients, 30-50% of their total number of follicles (only counting those larger than 10 mm) were at least 18 mm in diameter. These patients were randomised into 2 groups: in one group, final oocyte maturation was triggered the same day; for the other, maturation was triggered 24 hours later. Seventy-two patients with progesterone levels > 1 ng/ml were randomised in the same manner, irrespective of the percentage of larger follicles (> = 18 mm). The number of metaphase II oocytes was our primary outcome variable. Because some patients were included more than once, correction for duplicate patients was performed.ResultsIn the study arm with low progesterone (<= 1 ng/ml), the mean number of metaphase II oocytes (+/-SD) was 10.29 (+/-6.35) in the group with delayed administration of the oocyte maturation trigger versus 7.64 (+/-3.26) in the control group. After adjusting for age, the mean difference was 2.41 (95% CI: 0.22-4.61; p = 0.031). In the study arm with elevated progesterone (>1 ng/ml), the mean numbers of metaphase II oocytes (+/-SD) were 11.81 (+/-9.91) and 12.03 (+/-7.09) for the delayed and control groups, respectively. After adjusting for PCOS (polycystic ovary syndrome) and female pathology, the mean difference was -0.44 (95% CI: -3.65-2.78; p = 0.79).ConclusionsDelaying oocyte maturation in patients with low progesterone levels yields greater numbers of mature oocytes.Trial registrationB67020108975 (Belgian registration) and NCT01980563 (ClinicalTrials.gov).

The effect of 24 hours delay in oocyte maturation triggering in IVF/ICSI cycles with antagonist protocol and not-elevated progesterone: A randomized control trial

“…Vandekerckhove et al showed that in patients with low serum progesterone level (≤1 ng/ml) 24 hr delaying in the oocyte maturation trigger could cause to more total oocytes and mainly more mature oocytes (MII) in contrast with those triggered on the same day. Although, no meaningful differences were seen in the pregnancy rates and pregnancy outcomes between two groups ( 10 ). But in the patients with higher serum progesterone level (>1 ng/ml) delaying the oocyte maturation trigger by 24 hr accompanied with no difference in IVF cycle characteristics ( 10 ).…”

“…Elevated serum progesterone levels on the day of HCG administration (p>1.5 ng/ml) decreased ongoing pregnancy and delivery rates ( 7 , 9 ). Vandekerckhove et al showed, if the progesterone level is higher than 1 ng/ml, delaying the administration of HCG by 24 hr has no effect on the number of mature oocytes ( 10 ).…”

Shallow whole genome sequencing is well suited for the detection of chromosomal aberrations in human blastocysts

“…The course of stimulation was check by ultrasound monitoring. As soon as 50% of the follicles were >10-18 mm in diameter, oocyte maturation and retrieval was performed according to Vandekerckhove et al (13).…”

Preimplantation genetic diagnosis for chromosomal rearrangements with the use of array comparative genomic hybridization at the blastocyst stage

“…Ultrasound monitoring was done to check the course of stimulation. As soon as 50% of the follicles >10 mm reached a diameter of R18 mm, oocyte maturation and retrieval was performed according to Vandekerckhove et al (47).…”