Abstract
BackgroundOvarian stimulation for assisted reproductive technology (ART) overcomes the physiologic process to develop a single dominant follicle. However, following stimulation, egg recovery rates are not 100%. The objective of this study is to determine if the follicular fluid hormonal environment is associated with oocyte recovery.MethodsThis is a prospective study involving patients undergoing ART by standard ovarian stimulation protocols at an urban academic medical center. A total of 143 follicular fluid aspirates were collected from 80 patients. Concentrations of FSH, hCG, estradiol, progesterone, testosterone and prolactin were determined. A multivariable regression analysis was used to investigate the relationship between the follicular fluid hormones and oocyte recovery.ResultsIntrafollicular FSH was significantly associated with oocyte recovery after adjustment for hCG (Adjusted odds ratio (AOR) = 1.21, 95%CI 1.03–1.42). The hCG concentration alone, in the range tested, did not impact the odds of oocyte recovery (AOR = 0.99, 95%CI 0.93–1.07). Estradiol was significantly associated with oocyte recovery (AOR = 0.98, 95% CI 0.96–0.99). After adjustment for progesterone, the strength of association between FSH and oocyte recovery increased (AOR = 1.84, 95%CI 1.45–2.34).ConclusionThe relationship between FSH and oocyte recovery is significant and appears to work through mechanisms independent of the sex hormones. FSH may be important for the physiologic event of separation of the cumulus-oocyte complex from the follicle wall, thereby influencing oocyte recovery. Current methods for inducing the final stages of oocyte maturation, with hCG administration alone, may not be optimal. Modifications of treatment protocols utilizing additional FSH may enhance oocyte recovery.
Highlights
Ovarian stimulation for assisted reproductive technology (ART) overcomes the physiologic process to develop a single dominant follicle
If one egg was not recovered from each aspirated follicle they were included in the negative oocyte recovery group
Analyses to determine whether these parameters were associated with oocyte recovery revealed that the total antral follicle count was inversely associated with the odds of oocyte capture (Adjusted odds ratio (AOR) = 0.94, P = 0.016, 95%CI 0.89–0.98)
Summary
Ovarian stimulation for assisted reproductive technology (ART) overcomes the physiologic process to develop a single dominant follicle. In order to maximize in vitro fertilization (IVF) success, ovarian stimulation is performed to generate multiple mature oocytes This process overrides the physiologic mechanisms that normally select a single dominant follicle. The regulation of selection, growth, and ovulation of the dominant follicle is a complex process that involves follicle stimulating hormone (FSH), luteinizing hormone (LH) and modulation by an intra-ovarian network of factors [2]. Surges in both FSH and LH precede spontaneous ovulation, characterized by detachment of the cumulusoocyte complex from the follicular wall and subsequent expulsion from the ovary [3,4]. Plasminogen activator converts plasminogen to the active protease plasmin, which is presumably involved in dissociating the oocyte from the follicular wall and weakening the wall to facilitate rupture [7,8]
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