Leading follicle size in modified natural cycle IVF- predictor of successful outcome?

Abstract

ObjectiveTo determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes.DesignSingle-centre retrospective cohort study.Materials and MethodsAll modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG.ResultsA total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared.ConclusionModified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes. ObjectiveTo determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes. To determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes. DesignSingle-centre retrospective cohort study. Single-centre retrospective cohort study. Materials and MethodsAll modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG. All modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG. ResultsA total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared. A total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared. ConclusionModified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes. Modified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes.