Follicle Size on Day of Trigger Most Likely to Yield a Mature Oocyte.

Ali Abbara,Sophie A Clarke,Geoffrey H Trew,Tom W Kelsey,Waljit S Dhillo,Alexander N Comninos,Tuong M Ho,Lan N Vuong,Vu N A Ho,Rehan Salim,Peter Humaidan,Lisa Jeffers

doi:10.3389/fendo.2018.00193

Abstract

To identify follicle sizes on the day of trigger most likely to yield a mature oocyte following hCG, GnRH agonist (GnRHa), or kisspeptin during IVF treatment. Retrospective analysis to determine the size of follicles on day of trigger contributing most to the number of mature oocytes retrieved using generalized linear regression and random forest models applied to data from IVF cycles (2014-2017) in which either hCG, GnRHa, or kisspeptin trigger was used. HCG and GnRHa data were collected at My Duc Hospital, Ho Chi Minh City, Vietnam, and kisspeptin data were collected at Hammersmith Hospital, London, UK. Four hundred and forty nine women aged 18-38 years with antral follicle counts 4-87 were triggered with hCG (n = 161), GnRHa (n = 165), or kisspeptin (n = 173). Follicle sizes on the day of trigger most likely to yield a mature oocyte. Follicles 12-19 mm on the day of trigger contributed the most to the number of oocytes and mature oocytes retrieved. Comparing the tertile of patients with the highest proportion of follicles on the day of trigger 12-19 mm, with the tertile of patients with the lowest proportion within this size range, revealed increases of 4.7 mature oocytes for hCG (P < 0.0001) and 4.9 mature oocytes for GnRHa triggering (P < 0.01). Using simulated follicle size profiles of patients with 20 follicles on the day of trigger, our model predicts that the number of oocytes retrieved would increase from a mean 9.8 (95% prediction limit 9.3-10.3) to 14.8 (95% prediction limit 13.3-16.3) oocytes due to the difference in follicle size profile alone. Follicles 12-19 mm on the morning of trigger administration were most likely to yield a mature oocyte following hCG, GnRHa, or kisspeptin.

Highlights

IVF treatment involves the administration of supra-physiological doses of follicle-stimulating hormone (FSH) to induce the growth of multiple ovarian follicles
For both hCG and GnRH agonist (GnRHa), follicle sizes of 12–19 mm had the greatest contributions to the number of oocytes and mature oocytes retrieved
The data were less clear, but significant follicle size categories were in a similar size range

Summary

Introduction

IVF treatment involves the administration of supra-physiological doses of follicle-stimulating hormone (FSH) to induce the growth of multiple ovarian follicles. Once ovarian follicles grow to an appropriate size, a trigger is administered to mature the oocytes in preparation for oocyte retrieval. It is widely accepted that ovarian follicles that are “too small” are less likely to respond. Follicle Size Prior to Trigger suitably to trigger administration and yield a mature oocyte [1]. Most IVF centers will monitor follicular size and administer the trigger of oocyte maturation once follicles are deemed to have grown to an appropriate size. Relevant data exist as to the appropriate size of follicles on the day of oocyte retrieval that are most likely to yield an oocyte in both human and animals models [1]. Limited data exist to establish which follicle size on the day of trigger is most likely to yield a mature oocyte

Methods

Results

Conclusion