Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 14 , ISSUE 2 ( April-June, 2020 ) > List of Articles

Original Article

Relationship between Follicular Volume, Oocyte Competence, and Blastocyst Development in ART

Sudha Agrawal, Sonal Panchal, Chaitanya Nagori

Keywords : 2 pronuclear, 3D Ultrasonography, ART, Blastocyst, Cumulus oophorus complex, Follicular volume, ICSI, Medium and large follicles, Oocytes, Small, SonoAVC

Citation Information : Agrawal S, Panchal S, Nagori C. Relationship between Follicular Volume, Oocyte Competence, and Blastocyst Development in ART. Donald School J Ultrasound Obstet Gynecol 2020; 14 (2):136-143.

DOI: 10.5005/jp-journals-10009-1636

License: CC BY-NC 4.0

Published Online: 30-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: To analyze oocyte competence in assisted reproductive technology (ART) using gonadotrophin releasing hormone (GNRH) antagonist stimulation protocol with regard to maturity, fertilization, and blastocyst development in relation to follicular volume (FV), measured by three-dimensional (3D) ultrasonography (USG) using SonoAVC software. Materials and methods: This was a prospective observational single-center study conducted at our center from April 2019 to September 2019 in which 30 cases of ovum pickup were evaluated. A single cycle of in vitro fertilization (IVF) per patient was considered. A controlled ovarian stimulation was done by GNRH antagonist induction protocol. Gonadotropin dose calculation was based on the scoring system designed on the basis of parameters which included age, body mass index (BMI), and USG parameters on baseline scan which included antral follicle count, ovarian volume, stromal resistance index (RI), and stromal peak systolic velocity (PSV). Stimulation was started on day 2 of the cycle. Scans at regular interval commencing from day 5 or day 6 of the stimulation were done to track follicular and endometrial development. Multiple follicular development due to controlled ovarian hyperstimulation in ART causes growth of follicles of different sizes and functional activity that will contain oocyte at different maturation status. So, this multiple follicular development results in polygonal shape of the follicles where two-dimensional (2D) measurements are not accurate of its size. Total number of follicles and volume of each follicle were evaluated on the day of trigger using SonoAVC software by 3D USG. Oocyte retrieval was done 35 hours after trigger, and metaphase 2 (M2) oocytes, fertilization, and blastocyst development were tracked according to 3D follicular volume (FV) with the help of our embryologist. Follicles were grouped according to FV, into three arbitrary groups, which included 313 small (0.3–0.9 mL, 8–12 mm), 414 medium (1–6 mL, 13–23 mm), and 11 large (>6 mL, ≥24 mm) follicles, all of which were aspirated and evaluated. The cumulus oophorus complex (COC) recovery rate was statistically significant (p < 0.0001) in small follicles (63%) compared with medium (86.4%) and large (63.6%) follicles. However, fertilization rate did not differ when calculating the 2PN/M2 between the three follicle groups (2 pronuclear (PN)/M2: 76.9% in small, 81.9% in medium, 60% in large, p > 0.2). Additionally, blastocyst rate per retrieved M2 oocyte was observed in all three groups (36.5% vs 46.2% vs 40%), respectively, but the difference was not statistically significant. Results: Our data indicate that the optimal follicular size for a high yield of good quality blastocysts is 13–23 mm/1–6 mL. However, oocytes derived from small follicles (8–12 mm/0.3–0.9 mL) still have the capacity for normal development and fertilization. Conclusion: Earlier clinical practice suggests aspiration of follicles of only 1–6 mL volume, but based on our results, aspiration of small follicles (0.3–0.9 mL/8–12 mm) should be a routine procedure, which would help for better oocyte yield and blastocyst rate.


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  1. Simonetti S, Veeck LL, Jones HW Jr. Correlation of follicular fluid volume with oocyte morphology from follicles stimulated by human menopausal gonadotropin. Fertil Steril 1985;44(2):177–180. DOI: 10.1016/s0015-0282(16)48731-5.
  2. Scott RT, Hofmann GE, Muasher SJ, et al. Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration. J In Vitro Fert Embryo Transf 1989;6(2):73–75. DOI: 10.1007/BF01130729.
  3. Dubey AK, Wang HA, Duffy P, et al. The correlation between follicular measurements, oocyte morphology, and fertilization rates in an in vitro fertilization program. Fertil Steril 1995;64(4):787–790. DOI: 10.1016/s0015-0282(16)57855-8.
  4. Miller KF, Goldberg JM, Falcone T. Follicle size and implantation of embryos from in vitro fertilization. Obstet Gynecol 1996;88(4 Pt 1):583–586. DOI: 10.1016/0029-7844(96)00241-4.
  5. Nogueira D, Friedler S, Schachter M, et al. Oocyte maturity and preimplantation development in relation to follicular diameter in gonadotropin releasing–hormone agonist or antagonist treatments. Fertil Steril 2006;85(3):578–583. DOI: 10.1016/j.fertnstert.2005.08.033.
  6. Rosen MP, Shen S, Dobson AT, et al. A quantitative assessment of follicle size on oocyte developmental competence. Fertil Steril 2008;90(3):684–690. DOI: 10.1016/j.fertnstert.2007.02.011.
  7. Raine-Fenning N, Jayaprakasan K, Clewes J. Automated follicle tracking facilitates standardization and may improve work flow. Ultrasound Obstet Gynecol 2007;30(7):1015–1018. DOI: 10.1002/uog.5222.
  8. Bergh C, Broden H, Lundin K, et al. Comparison of fertilization, cleavage and pregnancy rate of oocytes from large and small follicles. Hum Reprod 1998;13(7):1912–1915. DOI: 10.1093/humrep/13.7.1912.
  9. Salha O, Nugent D, Dada T, et al. The relationship between follicular fluid aspirate volume and oocyte maturity in in-vitro fertilization cycle. Hum Reprod 1998;13(7):1901–1916. DOI: 10.1093/humrep/13.7.1901.
  10. Nivet AL, Leveille MC, Leader A, et al. Transcriptional characteristics of different sized follicles in relation to embryo transferability: potential role of hepatocyte growth factor signaling. Mol Hum Reprod 2016;22(7):475–484. DOI: 10.1093/molehr/gaw029.
  11. Raine-Fenning N, Jayaprakasan K, Clewes J, et al. SonoAVC: a novel method of automatic volume calculation. Ultrasound Obstet Gynecol 2008;31(6):691–696. DOI: 10.1002/uog.5359.
  12. Panchal S, Nagori C. Ultrasound based decision making on stimulation protocol for superovulated IUI cycles. International Journal of Infertility and Fetal Medicine 2016;7(1):7–13. DOI: 10.5005/jp-journals-10016-1119.
  13. Olivennes F, Fanchin R, Bouchard P, et al. Scheduled administration of gonadotrophin releasing hormone antagonist (cetrorelix) on day 8 of in vitro fertilization cycles: a pilot study. Hum Reprod 1995;10(6):1382–1386.
  14. Ludwig M, Katalinic A, Banz C, et al. Tailoring the GNRH antagonist cetrorelix acetate to individual patient's needs in ovarian stimulation for IVF: results of a prospective randomized study. Hum Reprod 2002;17(11):2842–2845. DOI: 10.1093/humrep/17.11.2842.
  15. Kurjak A, Kupesic-Urek S. Infertility. In: Kurjak A. Transvaginal color Doppler. Carnforth, UK: Parthenon Publishing; 1991. pp. 33–38.
  16. Gardner DK. Schol craft WB in vitro culture of human blastocyst. In: Javen R, Mortmer D. Towards Reproductive Certainty. Fertility and Genetics beyond. London, UK: Partheron Publishers; 1999. pp. 378–388.
  17. Gardner DK. School craft WB. culture and transfer of human blastocyst. Cure Opin Obstet Gynaecol 1999;11(3):307–311. DOI: 10.1097/00001703-199906000-00013.
  18. Triwitayakorn A, Suwajanakorn S, Pruksananonda K, et al. Correlation between human follicular diameter and oocyte outcomes in an ICSI program. J Assist Reprod Genet 2003;20(4):143–147. DOI: 10.1023/a:1022977002954.
  19. Mehri S, Levi Setti PE, Greco K, et al. Correlation between follicular diameters and flushing versus no flushing on oocyte maturity, fertilization rate and embryo quality. J Assist Reprod Genet 2014;31(1):73–77. DOI: 10.1007/s10815-013-0124-9.
  20. Akbariasbagh F, Lorzadeh N, Azmodeh A, et al. Association between diameter and volume of follicles, oocyte maturity, and competence in intracytoplasmic sperm injection cycles. Minerva Ginecol 2015;67(5):397–403.
  21. Ectors FJ, Vanderzwalmen P, Van Hoeck J, et al. Relationship of human follicular diameter with oocyte fertilization and development after in vitro fertilization or intracytoplasmic sperm injection. Hum Reprod 1997;12(9):2002–2005. DOI: 10.1093/humrep/12.9.2002.
  22. Wirleitner B, Okhowat J, Vistejnova L, et al. Relationship between follicular volume and oocyte competence, blastocyst development and live birth rate:optimal follicle size for oocyte retrieval. Ultrasound Obstetrics Gynecol 2018;51(1):118–125. DOI: 10.1002/uog. 18955.
  23. Stanger JD, Yovich JL. Failure of human oocyte release at ovulation. Fertil Steril 1994;41(6):827–832. DOI: 10.1016/S0015-0282(16) 47893-3.
  24. Edwards RG. Studies on human conception. Am J Obstet Gynecol 1973;117(5):587–601. DOI: 10.1016/0002-9378(73)90202-0.
  25. Hackeoer BJ, Fleming R, Robinson HP, et al. Correlation of ultrasonic and endocrinological assessment of follicular development. Am J Obstet Gynecol 1979;135:122–128.
  26. Penzias AS, Emmi AM, Dubey AK, et al. Ultrasound prediction of follicular volume: is the mean diameter reflective? Fertilsteril 1994;62(6):1274–1276.
  27. Amer A, Hammadeh ME, Kolkailah M, et al. Three dimensional versus two –dimensional ultrasound measurement of follicular volume:are they comparable? Arch Gynecol Obstet 2003;268(3):155–157. DOI: 10.1007/s00404-002-0315-6.
  28. Revelli A, Martiny G, Delle Piane L, et al. A critical review of bi-dimensional and three dimensional ultrasound techniques to monitor follicle growth: do they help improving IVF outcome? Repreod Biol Endocrinol 2014;12(1):107. DOI: 10.1186/1477-7827-12-107.
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