ABSTRACT
Background: The objective of this retrospective cohort study was to evaluate whether the length of pituitary blockage with gonadotrophin-releasing hormone [GnRH] antagonists or the stimulation period influence intracytoplasmic sperm injection [ICSI] outcomes in patients older than 36 years of age
Materials and Methods: In this retrospective study, a total of 138 couples with maternal age >36 years undergoing ICSI with an antagonist protocol were included. The influences of stimulation and suppression length on the response to ovarian stimulation and ICSI outcomes were investigated. Receiver operating characteristic curve [ROC] analysis was performed to assess the predictive value of the stimulation period for achievement of implantation and pregnancy
Results: The gonadotrophin stimulation length negatively influenced the implantation rate [RC: -4.200; p=0.023]. The area under ROC curve [AUC] could distinguish between women with positive and negative implantation [AUC: 0.611; CI: 0.546-0.673] and pregnancy [AUC: 0.593; CI: 0.528-0.656]. The threshold value demonstrated a high negative predictive value on likelihood of implantation [p=0.0032, 90% sensitivity] and pregnancy [p=0.0147, 87.1% sensitivity] when patients underwent more than 10 days of stimulation
Conclusion: The stimulation period negatively influences the implantation rate in women older than 36 years. A stimulation interval greater than 10 days is associated with a negative predictive value for the chance of implantation and pregnancy
ABSTRACT
This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection [ICSI]. After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group [n=96] comprised oocytes derived from the leading follicle of the cohort and the small follicle group [n=920] consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of top quality embryos were compared between groups by Chi-square or Fisher's exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II [MII] stage [100 vs. 70.0%, p<0.001]. However we observed no significant differences regarding the percentage of degenerated oocytes between the large [6.25%] and small follicle [5.0%] groups [p=0.550]. Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort [OR: 1.81, p=0.046]. The fertilization rate [50.0 vs. 38.8%, p=0.038] and the percentage of top quality embryos [84.7 vs. 76.4%, p=0.040] were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle [15.0%] and small follicle [12. 8%] groups [p=0.550]. Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities