The objective of the present study was to examine the association between follicular fluid (FF) steroid concentration and oocyte maturity and fertilization rates. Seventeen infertile patients were submitted to ovulation induction with urinary human follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (hCG). A total of 107 follicles were aspirated after hCG administration, the oocytes were analyzed for maturity and 81 of them were incubated and inseminated in vitro. Progesterone, estradiol (E2), estrone, androstenedione, and testosterone were measured in the FF. E2 and testosterone levels were significantly higher in FF containing immature oocytes (median = 618.2 and 16 ng/ml, respectively) than in FF containing mature oocytes (median = 368 and 5.7 ng/ml, respectively; P < 0.05). Progesterone, androstenedione and estrone levels were not significantly different between mature and immature oocytes. The application of the receiver-operating characteristic curve statistical approach to determine the best cut-off point for the discrimination between mature and immature oocytes indicated levels of 505.8 ng/ml for E2 (81.0% sensitivity and 81.8% specificity) and of 10.4 ng/ ml for testosterone (90.9% sensitivity and 82.4% specificity). Follicular diameter was associated negatively with E2 and testosterone levels in FF. There was a significant increase in progesterone/testosterone, progesterone/E2 and E2/testosterone ratios in FF containing mature oocytes, suggesting a reduction in conversion of C21 to C19, but not in aromatase activity. The overall fertility rate was 61% but there was no correlation between the steroid levels or their ratios and the fertilization rates. E2 and testosterone levels in FF may be used as a predictive parameter of oocyte maturity, but not for the in vitro fertilization rate.

were taken into account, together with resulting costs and (dis)utilities. Results were specified for subgroups in scenario analyses: NVAF + VTE patients (base case); NVAF and VTE patients separately; unstable NVAF patients with TTR (time in therapeutic range) < 60%. A probabilistic sensitivity analysis (PSA) was performed to investigate the influence of parameter uncertainty on the incremental cost-effectiveness ratio (ICER). Results: For the analyzed subgroups the use of rivaroxaban was cost saving and provided health gains compared to treatment with VKAs. Cost savings were highest for VTE patients, followed by unstable NVAF patients. Health gains were approximately the same for each subgroup at 0.023-0.026 quality adjusted life-years (QALY) per patient. ConClusions: From a healthcare payers perspective in the Dutch setting, rivaroxaban treatment is likely to be dominant over current standard therapy with VKAs, for the prevention of stroke in patients with (unstable) NVAF and treatment of (r)VTE.