Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 17 , ISSUE 3 ( July-September, 2023 ) > List of Articles

Original Article

Evaluation of Baseline Scoring System in In Vitro Fertilization Cycles

Mohini Sethi, Sonal Panchal, Chaitanya Nagori

Keywords : Assisted reproductive technology cycles, Controlled ovarian stimulation, Ultrasound score

Citation Information : Sethi M, Panchal S, Nagori C. Evaluation of Baseline Scoring System in In Vitro Fertilization Cycles. Donald School J Ultrasound Obstet Gynecol 2023; 17 (3):184-196.

DOI: 10.5005/jp-journals-10009-1980

License: CC BY-NC 4.0

Published Online: 30-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aims and Background: In vitro fertilization (IVF) is a method of assisted reproductive technology (ART) in which the ovary is stimulated using gonadotropins. The purpose of this study is to decide the optimum gonadotropin dose that would adequately stimulate the ovaries without leading to hyperstimulation syndrome or cycle cancelation due to understimulation. In this study along with the age and body mass index (BMI) of the patient, various ultrasound parameters have been used for tailoring the appropriate gonadotropin dose for every individual based on a baseline scoring system. Materials and methods: It was a retrospective study of 61 patients. All consenting patients between the age of 22 and 40 years and BMI between 18 and 34 who were taken for IVF/intracytoplasmic sperm injection (ICSI) cycles by virtue of tubal factor infertility, male factor infertility, dysovulatory infertility (including polycystic ovarian syndrome (PCOS)] and unexplained infertility were included in the study. The baseline scoring system parameters were assessed in relation to the dose of recombinant follicle- stimulating hormone (rFSH) given, luteinizing hormone (LH) supplementation dose added at different times in the cycle, the need to change the dose of gonadotropins, various size ranges of follicles on the day of trigger and their ultimate relation with M2 oocytes retrieved. Results: Only one patient required a change of dose of gonadotropins. There was no ovarian hyperstimulation or cycle cancelation. There was a significantly higher number of M2 oocytes retrieved in patients where LH supplementation was not done, irrespective of dose or day of addition of LH. There was also a strong positive correlation between follicles 10–15 mm on the day of trigger and the number of prophase oocytes retrieved. Conclusion: The baseline scoring system is an accurate and reliable method for deciding the dose of gonadotropins in IVF stimulation protocols. The addition of human menopausal gonadotropin (HMG) to rFSH anytime in the cycle at any dose does not show improvement in the number of M2 oocytes retrieved and its use should be judicial. Retrieval of follicles <15 mm may not result in M2 oocytes and so may not be beneficial. Clinical significance: To individualize the stimulation dose in IVF cycles, other than age and BMI, other ultrasound parameters like antral follicle count (AFC), ovarian volume, and ovarian stromal Doppler studies should be used. This can avoid hyperresponse and cycle cancelation.

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  1. Panchal S, Nagori C. Ultrasound based decision making on stimulation protocol for IVF cycles. Donald Sch Ultrasound Obstet Gynecol 2016;10(3):330–337. DOI: 10.5005/jp-journals-10009-1481
  2. Ng EH, Yeung WS, Fong DY, et al. Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum Reprod 2003;18(10):2169–2174. DOI: 10.1093/humrep/deg404
  3. Klinkert ER, Broekmans FJ, Looman CW, et al. The antral follicle count is a better marker than basal follicle-stimulating hormone for the selection of older patients with acceptable pregnancy prospects after in vitro fertilization. Fertil Steril 2005;83(3):811–814. DOI: 10.1016/j.fertnstert.2004.11.005
  4. Saleh A, Ayoub H, Faqeera F, et al. The number of basal antral follicles may predict ovarian responsiveness and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection treatment cycles. Fertil Steril 2006;86(2):473–476. DOI: 10.1016/j.fertnstert.2005.12.060
  5. La Marca A, D'Ippolito G. Ovarian response markers lead to appropriate and effective use of corifollitropin alpha in assisted reproduction. Reprod Biomed Online 2014;28(2):183–190. DOI: 10.1016/j.rbmo.2013.10.012
  6. Hashish NM, Shaeer EK. Choosing the optimal dose of human menopausal gonadotropins for ovarian stimulation in ICSI cycles. Middle East Fertil Soc J 2014;19(2):124–128. DOI: 10.1016/j.mefs.2013.06.004
  7. Magnusson Å, Nilsson L, Oleröd G, et al. The addition of anti-Müllerian hormone in an algorithm for individualized hormone dosage did not improve the prediction of ovarian response-a randomized, controlled trial. Hum Reprod 2017;32(4):811–819. DOI: 10.1093/humrep/dex012
  8. Zaidi J, Barber J, Kyei-Mensah A, et al. Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program. Obstet Gynecol 1996;88(5):779–784. DOI: 10.1016/0029-7844(96)00316-X
  9. Engmann L, Sladkevicius P, Agrawal R, et al. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999;71(1):22–29. DOI: 10.1016/s0015-0282(98)00406-3
  10. Kupesic S, Kurjak A. Predictors of IVF outcome by three-dimensional ultrasound. Human Reprod 2002;17(4):950–955. DOI: 10.1093/humrep/17.4.950
  11. Popovic-Todorovic B, Loft A, Lindhard A, et al. A prospective study of predictive factors of ovarian response in ‘standard’ IVF/ICSI patients treated with recombinant FSH. A suggestion for a recombinant FSH dosage normogram. Hum Reprod 2003;18(4):781–787. DOI: 10.1093/humrep/deg181
  12. Mercé LT, Barco MJ, Bau S, et al. Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography. Eur J Obstet Gynecol Reprod Biol 2007;132(1):93–100. DOI: 10.1016/j.ejogrb.2006.07.051
  13. Arora A, Gainder S, Dhaliwal L, et al. Clinical significance of ovarian stromal blood flow in assessment of ovarian response in stimulated cycle for in vitro fertilization. Int J Reprod Contracept Obstet Gynecol 2015;4(5):1380–1383. DOI: 10.18203/2320-1770.ijrcog20150715
  14. Shahrokh Tehraninejad E, Farshbaf Taghinejad M, Hossein Rashidi B, et al. Controlled ovarian stimulation with r-FSH plus r-LH vs. HMG plus r-FSH in patients candidate for IVF/ICSI cycles: an RCT. Int J Reprod Biomed 2017;15(7):435–440. PMID: 29177245.
  15. Marchiani S, Tamburrino L, Benini F, et al. LH supplementation of ovarian stimulation protocols influences follicular fluid steroid composition contributing to the improvement of ovarian response in poor responder women. Sci Rep 2020;10(1):12907. DOI: 10.1038/s41598-020-69325-z
  16. Eftekhar M, Tabibnejad N. Recombinant luteinizing hormone supplementation in assisted reproductive technology: a review of literature. Middle East Fertil Soc J 2021;37(26). DOI: 10.1186/s43043-021-00083-2
  17. Wang M, Huang R, Liang X, et al. Recombinant LH supplementation improves cumulative live birth rates in the GnRH antagonist protocol: a multicentre retrospective study using a propensity score-matching analysis. Reprod Biol Endocrinol 2022;20(1):114. DOI: 10.1186/s12958-022-00985-4
  18. Nayar KD, Gupta S, Singh M, et al. Adjuvant recombinant LH (rLH) or Growth hormone (GH) to the antagonist protocol in poor responders undergoing IVF. Fertil Steril 2018;110(4):e101–e102. DOI: 10.1016/j.fertnstert.2018.07.306
  19. Conforti A, Esteves S, Humaidan PS, et al. Recombinant human luteinizing hormone co-treatment in ovarian stimulation for assisted reproductive technology in women of advanced reproductive age: a systematic review and meta-analysis of randomized controlled trials. Reprod Biol Endocrinol 2021;19(1):91. DOI: 10.1186/s12958-021-00759-4
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