Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration

Objective To determine (a) the correlation between follicular sizes, oocyte maturity, normal fertilization rate, cleavage and embryo quality; and (b) to establish whether oocytes recovered with or without follicular flushing have different developmental competence. Design Prospective observational study. Setting Academic medical center. Patients Forty nine cycles (37 ICSI and 12 IVF). Interventions Measurement of 360 follicular diameters on the day of egg retrieval and classification into three groups Group A (mean diameter 12-14.5 mm.), group B (mean diameter 15-18 mm.) and group C (diameter >18.5 mm.). Main outcome measure Correlation between follicular size at the time of retrieval and oocyte maturity, fertilization and cleavage rate in 226 oocytes (163 ICSI and 63 IVF). Developmental competence of oocytes retrieved with flushing versus non flushing. Results Almost all (99 %) of the oocytes recovered from follicles of group C were in metaphase II as opposed to 80 % in group A and 81 % in group B (p <0.01). Overall there was a progressive and significant increase in fertilization rates from group A follicles to group C (47 % vs. 67 %, p 0.05). Overall 53 % of oocytes retrieved from group A follicles showed either no fertilization or abnormal fertilization versus 27 % in group C (p 0.05). The oocyte recovery rate with follicular flushing improved from group A to group B and to group C follicles (65 % vs. 49 % vs.37 % respectively p <0.01). There were no differences in rates of immature oocyte, fertilization, abnormal or not fertilization and cleavage. Conclusions The results of this study shows that: a) Follicles larger than 18 mm at retrieval have consistently mature oocytes with a higher rate of fertilization; b) Small size follicles are still capable of containing mature oocytes, but their rate of abnormal or no fertilization is high; c) Oocytes recovered with flushing are still able to produce embryos with full developmental competence.

“…In addition, the aspiration of follicles greater than 18 mm. provided the highest probability of retrieving mature oocytes (MII), confirming previous publications [2,3,6].…”

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 92%

Correlation between follicular diameters and flushing versus no flushing on oocyte maturity, fertilization rate and embryo quality

Mehri

Levi-Setti

Greco

et al. 2013

“…Many studies have demonstrated that the oocyte quality retrieved from large follicles is often better than that from small follicles [1][2][3], and those oocytes from large follicles tend to develop high quality embryos. Therefore, some clinicians argue that the timing of hCG triggering should be delayed to prolong the duration of ovarian stimulation and stimulate enough follicular growth.…”

Section: Introductionmentioning

confidence: 99%

Association between the proportion of dominant follicles and oocyte developmental competence

et al. 2014

Purpose To explore the optimal timing for hCG triggering by investigating the impact of different proportion of dominant follicles on the oocyte developmental competence. Methods One hundred ninety-eight infertile women were divided into three groups according to the proportion of dominant follicles on hCG day: (1) low: <15 % (n=66); (2) middle: 15-27 % (n=66); (3) high: >27 % (n=66). The grouping criteria were the bottom and top tertiles of the proportion of dominant follicles. Results The gonadotropin dosage, duration and maximum follicle diameter in the low proportion group were lower than those in the middle and high proportion groups. Oocyte maturation and the abnormal fertilization rate in the low proportion group were lower than those in the middle and high proportion groups. The normal fertilization rate did not differ among the three groups. The cleavage rate and number of transferable embryos in the low proportion group were significantly higher than those in the high proportion group. The high-quality embryo rate, implantation rate, and pregnancy rate in the low proportion group were significantly higher than those in the middle and high proportion groups.Conclusions A high proportion of dominant follicles are closely associated with impaired oocyte developmental competence and low pregnancy rate. These findings suggest that follicular overgrowth induced by delayed hCG triggering may undermine oocyte developmental competence and the proportion of dominant follicles may be a potential parameters for hCG triggering.

“…Therefore, the rationale for curetting the follicle to remove increased numbers of granulosa cells during retrieval to decrease the amount of VEGF release. The OHSS rate in our population was within previously reported ranges of moderate to severe OHSS of 2-5% [11,14,15]. Given these overall low OHSS rates, our study was insufficiently powered to detect a difference in the incidence of OHSS.…”

Section: Discussionmentioning

confidence: 52%

“…It is also important to note that there were no differences between the groups in the number of antral follicles or in the size of follicles on the day of hCG which are both major factors predicting oocyte yield [10] and maturity [11]. There was no difference in the number of germinal vesicles (immature oocytes) between the groups which we may expect to see with an increase total number of oocytes retrieved.…”

Section: Discussionmentioning

confidence: 90%

Follicle curetting at the time of oocyte retrieval increases the oocyte yield

Dahl

Cannon

Aubuchon

et al. 2009

Purpose To determine whether follicle curetting at the time of oocyte retrieval increases oocyte yield. Methods Retrospective review of all patients who underwent oocyte retrieval from July 1, 2003 to June 30, 2005. Main outcome measure Number of oocytes retrieved. Secondary outcome measures: retrieval time, number of cryopreserved embryos, pregnancy rates, and incidence of ovarian hyperstimulation syndrome. Results There were no differences in patient demographics, antral follicle count, cycle stimulation characteristics, fertilization rates, embryo quantity or quality, embryo cryopreservation rates, clinical pregnancy rates, live birth rates, or ovarian hyperstimulation syndrome between the groups. Retrievals that utilized curetting took three minutes longer. Follicle curetting significantly increased the number of oocytes retrieved, 13.9±0.6 compared to 11.4±0.6 oocytes without curetting (P=0.003). The quantity of mature oocytes was also increased with curetting (10.3± 0.5 versus 8. 4±0.5, P=0.006). Conclusions This study demonstrated that follicle curetting significantly increased oocyte yield. While it did not increase live birth rates, this increase in oocyte yield should lead to increased numbers of embryos for selection at transfer and increased embryos for cryopreservation.