Empty follicle syndrome prevalence and management in oocyte donors.

STUDY QUESTION: Is the drug used for final oocyte maturation a factor in determining the prevalence of empty follicle syndrome (EFS)? SUMMARY ANSWER: The drug used for final oocyte maturation is not a factor in determining the prevalence of EFS among women unaffected by infertility. WHAT IS KNOWN ALREADY: Despite satisfactory follicular stimulation and adequate follicular development, cases of EFS, i.e. failure to recover any cumulus oocyte complex, have been reported both with hCG and GnRH agonist triggering. No standard management protocol has been proposed so far. STUDY DESIGN, SIZE, DURATION: Retrospective analysis of oocyte donation cycles performed between August 2006 and April 2013 in a large private fertility centre. PARTICIPANTS/MATERIALS, SETTING, METHODS: The analysis included 12 483 oocyte donation cycles of which 74 were EFS cycles. All cycles were triggered with either hCG or GnRH agonists. MAIN RESULTS AND THE ROLE OF CHANCE: There were no differences in the gonadotropic stimulation, pituitary suppression and triggering drug between cycles where oocytes were recovered successfully and EFS cycles. The total prevalence of EFS was 0.59%. Given the rarity of the syndrome, caution is advised when interpreting the analysis. LIMITATIONS, REASONS FOR CAUTION: The main limitation of this study is its retrospective nature. Although this is the largest analysis of EFS in donors reported so far, its statistical power is limited because the syndrome has a low incidence. In some cycles of EFS from 2006 to 2007 there is a lack of hormone data. WIDER IMPLICATIONS OF THE FINDINGS: Our findings may be generalized to oocyte donors and IVF patients younger than 35 years old, with cycles undergoing final maturation triggering with either hCG or GnRH agonists. The generalization cannot be extended to patients with an ovarian factor as the cause of their reproductive pathology. The theoretical aetiology of a temporary hypothalamic-pituitary hyposensitivity can explain the cycles where a rescue protocol with hCG has been successful. STUDY FUNDING/COMPETING INTERESTS: This work was supported in part by funding from Fundaciò EUGIN. The authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: NA.

Learning curves in 3-dimensional sonographic follicle monitoring during controlled ovarian stimulation.

OBJECTIVES: Three-dimensional (3D) sonographically based automated volume calculation (SonoAVC; GE Healthcare, Zipf, Austria) is being introduced in folliculometry during ovarian stimulation; however, clear training assessments in this technique are lacking. The learning curve-cumulative summation (LC-CUSUM) test provides a quantitative tool to determine when a trainee has learned a procedure. The aim of this prospective study was to assess 3D SonoAVC LC-CUSUM curves in folliculometry. METHODS: Analyses were performed on 98 oocyte donors by capturing the ovarian image in 3D and applying the 3D SonoAVC software during ovarian stimulation cycles. Each patient was scanned by an expert operator and by a trainee. Independent LC-CUSUM tests for 4 follicular diameters tracked the competency of 3 trainees in 3D SonoAVC. RESULTS: We found that the numbers of sonographic examinations required by the 3 trainees to identify the correct number of follicles of 10 mm or larger were 38, 32, and 28, respectively; for follicles of 14 mm or larger, they were 29, 28, and 28; for follicles of 18 mm or larger, they were 24, 19, and 27; and for follicles of 21 mm or larger, they were 29, 19, and 24. CONCLUSIONS: A variable number of procedures are needed to reach proficiency in 3D SonoAVC, even for trained 2-dimensional sonographers. Assessment of learning curves should be implemented when incorporating 3D SonoAVC in reproduction units.

Racial disparity in oocyte donation outcome: a multiethnic, matched cohort study.

BACKGROUND: Race and ethnicity are one of the newly investigated patient-related prognostic factors that might affect the outcome of assisted reproduction techniques. To our knowledge no data currently are available on the effect of race on oocyte donation outcome. MATERIALS: A retrospective, matched cohort study was performed in a private infertility centre evaluating 1012 Black, South-East Asian and Caucasian recipients undergoing their first oocyte donation cycles. RESULTS: A significantly lower ongoing pregnancy rate (24.6 versus 36.8%, OR: 0.56 95% CI: 0.40-0.77, P = 0.01) was observed among Black recipients compared with their matched Caucasian counterparts. The prevalence of uterine fibroids (49.6 versus 17.1%, P < 0.0001) and previous history of tubal infertility (53.2 versus 16.5%, P < 0.0001) was significantly higher among Black women. Multiple logistic regression analysis showed that, after adjusting for confounding variables, Black race was an independent risk factor for not achieving an ongoing pregnancy (for ongoing pregnancy, adjusted OR: 0.62 95% CI: 0.43-0.89, P = 0.009). Ongoing pregnancy rate (37.2 versus 37.2%, OR: 1.0 95% CI: 0.49-2.04, P = 1.0) was not significantly different between South-East Asian and matched Caucasian patients. CONCLUSIONS: Black race was an independent risk factor for not achieving an ongoing pregnancy after oocyte donation. Although yellow race does not seem to adversely affect oocyte donation, larger studies are still warranted to draw more solid conclusions. Race should be considered as an independent prognostic factor in oocyte donation.

Early ovarian hyperstimulation syndrome is completely prevented by gonadotropin releasing-hormone agonist triggering in high-risk oocyte donor cycles: a prospective, luteal-phase follow-up study.

In this prospective, follow-up study of 102 high-risk oocyte donors in their luteal phase, we found a complete absence of ovarian hyperstimulation syndrome (no signs of hemoconcentration or ascites) after the donors were triggered with a gonadotropin releasing-hormone (GnRH) agonist. Due to its powerful preventive effect, the GnRH antagonist protocol combined with a GnRH agonist trigger should preferentially be used in egg donors; in conjunction with an effective luteal support or embryo cryopreservation, the protocol could also be applied to high-risk in vitro fertilization patients.

Triggering with HCG or GnRH agonist in GnRH antagonist treated oocyte donation cycles: a randomised clinical trial.

AIM: To compare donor and recipient outcome after inducing the final oocyte maturation with hCG or GnRH agonist in GnRH-antagonist treated oocyte donation (OD) cycles. METHODS: Two-hundred fifty-seven oocyte donors were enrolled to participate in a clinical trial in a private fertility centre. After stimulation with 225 IU rFSH and Cetrorelix 0.25 mg/day, 212 oocyte donors were randomised with sealed envelopes for triggering with recombinant hCG (Ovitrelle 250 microgr, n = 106) or a GnRH agonist (triptorelin 0.2 mg, n = 106). RESULTS: The number of retrieved COCs (12 +/- 6.3 vs 11.4 +/- 6.4), mature oocytes (8 +/- 4.6 vs 7.5 +/- 4.1), the proportion of mature oocytes (67.2 +/- 20.4% vs 67.1 +/- 20.9%) and fertilisation rates (67.8 +/- 23.5% vs 71.1 +/- 22.1%) were comparable. Clinical, ongoing pregnancy and live birth rates were not statistically different in the corresponding recipient groups. Nine cases of mild and one case of severe OHSS occurred in hCG group, whereas no cases were detected in GnRH agonist group. CONCLUSIONS: The findings of our RCT suggest that donor and recipient outcome are comparable in OD cycles triggered with hCG or a GnRH agonist. Furthermore, the risk of OHSS seems to be reduced considerably, therefore the combination of a GnRH antagonist protocol with GnRH agonist triggering constitutes a safe treatment option for egg-donors.

Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist in gonadotropin-releasing hormone antagonist-treated oocyte donor cycles: findings of a large retrospective cohort study.

OBJECTIVE: To compare pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS) in donor stimulation cycles where final maturation of oocytes was induced with recombinant hCG or GnRH agonist. DESIGN: Retrospective, cohort study. SETTING: Private infertility clinic. PATIENT(S): A total of 1171 egg donors performing 2077 stimulation cycles. INTERVENTION(S): Controlled ovarian hyperstimulation of egg donors with GnRH antagonist protocol triggered with recombinant hCG (rhCG; 250 microg) or GnRH agonist (triptorelin 0.2 mg) based on the physician's decision. MAIN OUTCOME MEASURE(S): Proportion of mature and fertilized oocytes per donor cycle; clinical, ongoing pregnancy and implantation rate in recipients; and incidence of moderate/severe OHSS in oocyte donors. RESULT(S): The proportion of mature oocytes was comparable, whereas the difference in the fertilization rate reached statistical significance (65% vs. 69%). No significant differences were observed in the implantation rate or clinical and ongoing pregnancy rates per ET. The incidence of moderate/severe OHSS was 1.26% (13/1031; 95% confidence interval [CI], 0.74-2.15) and 0% (0/1046; 95% CI, 0.00-0.37) in the rhCG and GnRH agonist groups, respectively. CONCLUSION(S): Recipient outcome was not significantly different when using oocytes from GnRH antagonist-treated donor cycles triggered with hCG or GnRH agonist. However, GnRH agonist triggering was associated with a lower incidence of moderate/severe OHSS in egg donors.

Poor outcome in oocyte donation after elective transfer of a single cleavage-stage embryo in Turner syndrome patients.

In this retrospective, matched study we evaluated the outcome of 31 oocyte donation (OD) cycles performed in 29 Turner syndrome (TS) patients involving the elective transfer of a single, fresh cleavage-stage (day 2 to 3) embryo. Due to the fact that ongoing pregnancy rate was statistically significantly lower (3.2% versus 22.5%) in TS patients when compared with matched, non-TS recipients, other strategies (such as single blastocyst transfer) should be evaluated that could enable better outcomes and at the same time avoid potential complications related to multiple pregnancies in this particularly high obstetric-risk group.

Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles.

A retrospective study was conducted in a private infertility centre to evaluate the rate of complications in a large oocyte donation programme. A total of 4052 oocyte retrievals were performed between January 2001 and October 2007. Altogether, 1238 cycles (30.6%) were stimulated with the use of gonadotrophin-releasing hormone (GnRH) agonists and in 2814 cycles (69.4%) the GnRH antagonist protocol was used. The GnRH antagonist treated cycles were triggered with human chorionic gonadotrophin (HCG) or a GnRH agonist in 1295 and 1519 cycles, respectively. Complications related to oocyte retrieval occurred in 17 patients (0.42%) (intra-abdominal bleeding: n = 14, severe pain: n = 2, ovarian torsion: n = 1). Fourteen of these were hospitalized (0.35%) and six donors (0.15%) required surgical intervention. Pelvic infections, injury to pelvic structures or anaesthesiological complications were not observed in this series. Moderate/severe ovarian hyperstimulation syndrome (OHSS) occurred in 22 donors; 11 required hospital admission and 11 were managed on an outpatient basis. All cases were related to HCG triggering (0.87%). Serious complications related to oocyte retrieval occurred at a low rate in healthy young donors. The risk of OHSS can be substantially reduced by specific stimulation protocols, which include GnRH agonist triggering. Prospective oocyte donors should be adequately counselled about the risks related to egg donation.

[Prevalence of hepatitis C virus in pregnant women and vertical transmission]. / Prevalencia de la infección por el virus de la hepatitis C en mujeres embarazadas y transmisión vertical de este virus.

BACKGROUND: The objectives of this study were to know the seroprevalence of HCV in pregnant women and to determine its vertical transmission rate as well as the viremia evolution in infected children. PATIENTS AND METHOD: Two different populations were studied: a) all pregnant women (n = 2,615) controlled in our hospital during 1999, and b) newborns (n = 228) to mothers with HCV antibodies (Ab) who were referred to our hospital from January 1995 to September 2000. Eighty of these infants were born to mothers coinfected with HIV-1. HCV Ab were determined by ELISA and RIBA techniques and viral ARN was studied by PCR. Risk factors in infected pregnant women were reviewed. RESULTS: HCV Ab were detected in 37 women using RIBA or PCR, hence meaning a seroprevalence rate of 1.4%. Usual risk factors were not identified in 35% of cases. Median viral load was 3.5 * 105 IU/ml. ARN HCV was detected in 15 infants, 9 out of them being born to mothers coinfected with HIV-1 (vertical transmission rate: 11.25%) and the remaining 6 being born to mothers without HIV-1 coinfection (vertical transmission rate: 4%). The difference in the transmission rate had statistical significance (p < 0.05). CONCLUSIONS: Seroprevalence of HCV infection in our population of pregnant women was relatively high. HCV screening in pregnant women is useful in order to identify this infection not only in this population but also in newborns and, consequently, to follow-up the vertical transmission cases.

Prevalencia de la infección por el virus de la hepatitis C en mujeres embarazadas y transmisión vertical de este virus / Prevalence of hepatitis C virus in pregnant women and vertical transmission

FUNDAMENTO: Los objetivos de este estudio fueron conocer la tasa de seroprevalencia del virus de la hepatitis C (VHC) en mujeres embarazadas y determinar la tasa de transmisión vertical, así como la evolución de la viremia en los niños tras la primoinfección. PACIENTES Y MÉTODO: Se estudiaron dos poblaciones diferentes: a) todas las gestantes (n = 2.615) controladas en el Hospital Sant Joan de Déu durante 1999, y b) los recién nacidos (n = 228) hijos de madres con anticuerpos para el VHC, nacidos entre enero de 1995 y septiembre de 2000 que fueron remitidos a este hospital para control. Ochenta de estos niños eran hijos de madres coinfectadas con virus de la inmunodeficiencia humana (VIH). Los métodos utilizados fueron: detección de anticuerpos del VHC por técnicas de ELISA y RIBA, estudio de la presencia de ARN viral por técnica de PCR y revisión de los factores de riesgo en las gestantes infectadas. RESULTADOS: En 37 gestantes se detectaron anticuerpos del VHC, confirmados por PCR o RIBA (tasa de seroprevalencia 1,4 por ciento). En el 35 por ciento de estas gestantes no se encontró factores de riesgo conocidos. La media de la carga viral fue de 335.524 copias/ml. Se detectó ARN VHC en 15 niños, 9 hijos de madres coinfectadas con VIH-1 (tasa de transmisión vertical: 11,25 por ciento) y 6 hijos de madres no coinfectadas (tasa de transmisión vertical: 4 por ciento). La diferencia en la tasa de transmisión fue estadísticamente significativa (p < 0,05).CONCLUSIONES: En este estudio la prevalencia de la infección VHC fue relativamente elevada (1,4 por ciento). El cribado del VHC en gestantes es útil para identificar la infección en esta población y poder realizar en sus recién nacidos el diagnóstico y control de la posible infección VHC por transmisión vertical (AU)