Abstract
PurposeTo explore the trends of oocyte and pregnancy outcomes over the ovulation trigger–OPU (oocyte pickup) time interval in four mainly used COH protocols.MethodsThis retrospective study was conducted between January 2013 and July 2018. The IVF/ICSI cycles of the patients with normal ovarian reserve were included. The number of total patients was 4673, which consisted of long agonist protocol (n = 819), short agonist protocol (n = 1703), mild stimulation protocol (n = 1627), and GnRH antagonist protocol (n = 524). The primary outcome was mature oocyte rate.ResultsThe ovulation trigger–OPU time interval and COH protocol were related to cycles with > 80% MII oocytes. Four protocols showed apparently different trends of retrieved oocyte rate and mature oocyte rate over the ovulation trigger–OPU time interval, and the long agonist protocol had the most delayed time interval than other three COH protocols in retrieving more than 60% oocytes (35.4–39.6 h vs. 34.6–38.6 h vs. 32.5–37.5 h vs. 33.8–37.7 h) and getting more than 80% mature oocytes (35.0–39.7 h vs. 36.0–37.7 h vs. 34.1–35.5 h vs. 34.5–36.3 h). And the adjusted odds ratio (OR) of the cumulative live birth rate (CLBR) (OR 1.360, 95% Confidence Interval (CI) 1.156–1.549, P < 0.05) significantly increased with the trigger–OPU time interval in the long agonist protocol.ConclusionsFor getting more and mature oocytes, the ovulation trigger–OPU time intervals should be gradually prolonged from the mild stimulation protocol, the GnRH antagonist protocol, and the short protocol to the long agonist protocol. And the prolonged ovulation trigger–OPU time interval in the long agonist protocol brings higher live birth rate (LBR) and CLBR.
Highlights
The time interval from trigger to oocyte pickup (OPU) is vital, which consists of the luteinization start, the cumulus cell expansion, and the reduction division of the oocyte resumption [1]
The data illustrated that the factors of cycles with > 80% MII oocytes were not significantly related to age, BMI, and infertility duration (P > 0.05), nor with the oocyte trigger method [GnRH agonist as reference; human chorionic gonadotropin (hCG) group: odds ratio (OR) 1.234, 95% confidence interval (CI) 0.803–1.896, P > 0.05; dual trigger group: OR 1.082, 95% Confidence Interval (CI) 0.719–1.629, P > 0.05]
The other factor was the different controlled ovarian hyperstimulation (COH) protocols. These results indicated that the percentage of oocyte maturity was related to ovulation trigger–OPU time interval and COH protocol, which supported us to continue to explore the individual ovulation trigger–OPU time interval of four COH protocols
Summary
The time interval from trigger to oocyte pickup (OPU) is vital, which consists of the luteinization start, the cumulus cell expansion, and the reduction division of the oocyte resumption [1]. In most in vitro fertilization (IVF) cycles, the commonly practiced interval was 32–36 h, which was derived from the studies on patients who used Clomiphene Citrate (CC) and/or human menopausal gonadotropin (hMG) for ovulation induction [2, 3]. The clinical results of ART vary along with the time interval between oocyte maturation trigger and aspiration. Some studies have found that longer OPU time did not lead to more mature oocytes or better clinical results [4,5,6,7,8], whereas other studies have found that longer OPU time may produce more mature oocytes [1, 9, 10], higher fertilization. Most research focused on whether doctors should delay the OPU time in the specific controlled ovarian hyperstimulation (COH) protocol, such as the gonadotropinreleasing hormone analog (GnRHa) protocol
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