Is the retrieval of high numbers of oocytes desirable in patients treated with gonadotrophin-releasing hormone analogues (GnRHa) and gonadotrophins?

Abstract

Continuous administration of gonadotrophin-releasing hormone analogues (GnRHa) in patients stimulated for the purpose of IVF might have a direct effect on the ovary. We have evaluated the IVF outcome of patients treated with Buserelin and subsequently with a combination of follicle-stimulating hormone (FSH) and human menopausal gonadotrophin (HMG). Patients were divided into three groups according to the number of oocytes obtained by transvaginal ultrasound-guided follicular aspiration: group 1 (n = 35), in which 1-5 oocytes were retrieved; group 2 (n = 30), in whom 6-10 oocytes were obtained; group 3 (n = 32), in whom greater than or equal to 11 oocytes were collected. Only couples with normal semen samples at oocyte retrieval were included in this study. The dose of Buserelin employed was not different between groups. However, the amount of FSH/HMG necessary to reach an optimal response significantly (P less than 0.01) decreased as follicular development increased. The quality of the oocytes obtained was evaluated based on the appearance of the oocyte-corona-cumulus complex, fertilization rate, morphological appearance of the embryos, and implantation rate. The fertilization rate was significantly (P less than 0.01) decreased in group 3 (57.2%) in comparison with groups 1 (77.1%) and 2 (74.2%). There was no significant difference between the groups in the quality of the embryos obtained or the quality of those replaced into the uterus. The implantation rate per embryo transferred was significantly (P less than 0.05) higher in group 1 (16.5%) in comparison with groups 2 (6.6%) and 3 (8.2%).(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of supraphysiologic serum estradiol levels on peri-implantation embryo development and early pregnancy outcome following in vitro fertilization cycles

“…Cycles in the 3rd quartile of estradiol level (1,882-2,465 pg/mL) measured on the day of hCG administration consistently appear to be associated with optimal IVF and early pregnancy outcomes when compared with cycles in other quartiles of estradiol level. This finding is in agreement with other studies that have shown a negative correlation between elevated estradiol and normal oocyte fertilization during IVF, [20,[28][29][30][31]. However, unlike previous studies, we also show that these parameters displayed an inverted U-shaped dose response, confirming a typical biphasic response.…”

Oocyte quality in polycystic ovaries revisited: Identification of a particular subgroup of women

“…In fact, PCO women behave as high responders when they undergo ovarian stimulation for IVE We have consistently found lower implantation rates in high responders (8,12,25), which are the consequence of, at least in part, high estrogen levels (25). Our patients in group II had significantly higher serum E2 levels than control subjects, suggesting that implantation failure was due to an endocrine cause.…”

“…In patients with PCOS, reduced fertilization rates have been observed compared with normal subjects (1-3), a finding similar to that observed in high responders (8,9). When the ultrasound appearance alone has been employed to analyze the outcome, controversial findings have been reported regarding oocyte quality (3,7).…”

“…Implantation was defined as the presence of a gestational sac by transvaginal ultrasound. Four types of embryos were established, ranging from type 1 to 4 (8). Type 1 embryos were the best and were defined as round and well-shaped blastomeres without fragments.…”

Preretrieval predictors of pregnancy in IVF

“…The rationale for this approach is provided by observations of a positive correlation between pregnancy rates, level of estradiol on the day of administration of hCG, number of follicles, size of leading follicles, and number of retrieved oocytes (4,5,9,10). These findings, however, contrast with other reports suggesting that fertilization rates, implantation rates, and pregnancy rates decline in cycles associated with a high number of preovulatory follicles and a high number of oocytes (11)(12)(13).…”