Date of Presentation
5-4-2023 12:00 AM
College
School of Osteopathic Medicine
Poster Abstract
OBJECTIVE: To determine if there is value in culturing a metaphase I oocyte to metaphase II followed by intracytoplasmic sperm injection (ICSI), fertilization, then embryo transfer (ET) in women with marked DOR. MATERIALS AND METHODS: A follicle stimulating hormone (FSH) receptor up-regulation technique was used in women whose day 3 serum FSH levels were >12 mIU/mL and/or the serum anti-mullerian (AMH) level was <1ng/mL to mature antral follicle(s) to the dominant follicle stage (average diameter >18) and serum estradiol (E2) >200pg/mL when 10,000 IU human chorionic gonadotropin (hCG) would be given followed by oocyte retrieval 32 hours later. The basic tenet of this follicle maturation technique is to 1) use very little FSH for stimulation, 2) do not use any FSH if the serum FSH is >14 mIU/mL 214 mIU/mL, 3) lower serum FSH to restore down-regulated FSH receptors with 20 mcg ethinyl estradiol if there is no progressive rise in serum E2, 4) add cetrorelix or ganirelix when a 14 mm follicle is found on sonography and the serum E2 is >100 pg/mL or if luteinizing hormone (LH) is starting to rise with mild rise in serum progesterone (P) even if serum E2/mL. If there was a rise in LH before a gonadotropin releasing hormone agonist (GnRHa) could be used, then sometimes the retrieval may be scheduled detected, retrieval would be scheduled 32-33 hours later. If deemed metaphase I, the oocyte would be cultured one more day before ICSI. Similarly, the same would apply to oocytes retrieved< 45 years old. Twenty-five years of data were evaluated. RESULTS: 113 patients had a single metaphase I oocyte retrieval. Fertilization occurred in 61 (53.9%). This led to 35 transfers (31.0%). Unfortunately, there was only 1 live delivery in the 61 women whose metaphase I oocytes were cultured one more day with attempted fertilization by ICSI (2% live delivered pregnancy rate per transfer). CONCLUSION: Frequently, women with DOR have earlier rises in LH, which could cause the oocyte to release before the 32-hour mark for retrieval. In our studies for women with DOR and single embryo transfers because of only 1 oocyte retrieved and with the fertilization of a metaphase II oocyte, the live delivered pregnancy rate is about 25% for women
Keywords
Ovarian Reserve, Oocyte Retrieval, Infertility, Intracytoplasmic Sperm Injections, Pregnancy Outcome
Disciplines
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Female Urogenital Diseases and Pregnancy Complications | Medicine and Health Sciences | Obstetrics and Gynecology | Women's Health
Document Type
Poster
Included in
Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Endocrine System Diseases Commons, Endocrinology, Diabetes, and Metabolism Commons, Female Urogenital Diseases and Pregnancy Complications Commons, Obstetrics and Gynecology Commons, Women's Health Commons
Evaluation of Outcome Following Oocyte Retrieval in Women with Marked Diminished Oocyte Reserve (DOR) Where the Only Oocyte Retrieved Was in a Metaphase I State
OBJECTIVE: To determine if there is value in culturing a metaphase I oocyte to metaphase II followed by intracytoplasmic sperm injection (ICSI), fertilization, then embryo transfer (ET) in women with marked DOR. MATERIALS AND METHODS: A follicle stimulating hormone (FSH) receptor up-regulation technique was used in women whose day 3 serum FSH levels were >12 mIU/mL and/or the serum anti-mullerian (AMH) level was <1ng/mL to mature antral follicle(s) to the dominant follicle stage (average diameter >18) and serum estradiol (E2) >200pg/mL when 10,000 IU human chorionic gonadotropin (hCG) would be given followed by oocyte retrieval 32 hours later. The basic tenet of this follicle maturation technique is to 1) use very little FSH for stimulation, 2) do not use any FSH if the serum FSH is >14 mIU/mL 214 mIU/mL, 3) lower serum FSH to restore down-regulated FSH receptors with 20 mcg ethinyl estradiol if there is no progressive rise in serum E2, 4) add cetrorelix or ganirelix when a 14 mm follicle is found on sonography and the serum E2 is >100 pg/mL or if luteinizing hormone (LH) is starting to rise with mild rise in serum progesterone (P) even if serum E2/mL. If there was a rise in LH before a gonadotropin releasing hormone agonist (GnRHa) could be used, then sometimes the retrieval may be scheduled detected, retrieval would be scheduled 32-33 hours later. If deemed metaphase I, the oocyte would be cultured one more day before ICSI. Similarly, the same would apply to oocytes retrieved< 45 years old. Twenty-five years of data were evaluated. RESULTS: 113 patients had a single metaphase I oocyte retrieval. Fertilization occurred in 61 (53.9%). This led to 35 transfers (31.0%). Unfortunately, there was only 1 live delivery in the 61 women whose metaphase I oocytes were cultured one more day with attempted fertilization by ICSI (2% live delivered pregnancy rate per transfer). CONCLUSION: Frequently, women with DOR have earlier rises in LH, which could cause the oocyte to release before the 32-hour mark for retrieval. In our studies for women with DOR and single embryo transfers because of only 1 oocyte retrieved and with the fertilization of a metaphase II oocyte, the live delivered pregnancy rate is about 25% for women