体外受精/卵胞浆内单精子注射治疗患者体外受精周期中获卵数和获卵率的影响因素分析

doi:10.13481/j.1671-587X.20230324

Abstract

Abstract:

Objective To discuss the influencing factors of oocytes retrieved numbers and oocytes retrieved rates during in vitro fertilization cycle in patients underwent in vitro fertilization/intracytoplasmic sperm injection（（IVF/ICSI）， and to provide the basis for the choice of the trigger time in clinical practice. Methods A total of 950 patients who received IVF/ICSI treatment were selected. The optimal scale regression model was used to analyze the effects of age， estradiol （E2） levels on the day of of human chorionic gonadotropin （HCG） administration， ovarian reserve function， percentages of different sizes of follicles on the days of oocyte retrieved and HCG administration， ovulation induction protocols of the patients， and operators on the number of oocyte retrieved and oocyte retrieved rate. Results There was a negative correlation between the age of patients and the number of oocytes retrieved（β=－0.068，P<0.01）； there was a negative correlation between the percentage of big follicles on the oocytes retrieved day and the number of oocyte retrieved（β=－0.243， P<0.01）， there was a negative correlation between the percentage of big follicles on the HCG administration day and the number of oocyte retrieved （β=－0.073，P<0.01）； there was a positive correlation between E2 levels on the HCG administration day and ovarian reserve function and the number of oocyte retrieved（β= 0.270，P<0.01；β=0.196， P<0.01）； there was a positive correlation between the percentage of middle follicles on the HCG administration day and the number of oocyte retrieved（β=0.098，P<0.01）.The numbers of oocyte retrieved of the patients in long protocol， antagonist protocol，progesterone-primed ovarian stimulation（PPOS） protocol， and natural cycle protocol were gradually decreased（β=0.227，P<0.01）. The regression analysis results showed that there were positive correlations between the percentages of big and middle follicles on the oocyte retrieved day and the rate of oocyte retrieved（β= 0.168， P<0.01；β=0.194， P<0.01）， the ovarian reserve function， ovulation induction protocol and different operators influenced the rate of oocyte retrieved（β=0.086，P=0.040；β=0.137，P<0.01； β=0.270，P<0.01）. Conclusion The percentage of follicles with diameter ≥ 18 mm on the HCG administration day should be controlled below 20%， and more oocytes should be retrieved； with the decreasing of the women’ age and ovarian reserve functions， the number of oocyte retrieved is gradually decreased； it is necessary to strengthen the standard procedures for oocyte retrieved surgery to promote the rate of oocyte retrieved.

Key words: In vitro ferilization, Intracytoplasmic sperm injection, Number of oocytes retrived, Rate of oocytes retrieved, Estradiol

CLC Number:

Yi LI,Xiaohong YAN,Youzhu LI. Analysis on influence factors of number and rate of oocytes retrieved during in vitro fertilization cycle in patients underwent in vitro fertilization/intracytoplasmic sperm injection[J].Journal of Jilin University(Medicine Edition), 2023, 49(3): 742-749.

Figures/Tables 14

Tab. 1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

Tab.8

Tab.9

Tab.10

Tab.11

Tab.12

Tab.13

Tab.14

References 24

1	TRIWITAYAKORN A， SUWAJANAKORM S， PRUKSANANONDA K， et al. Correlation Between Human Follicular Diameter and Oocyte Outcomes in an ICSI Program［J］. J Assist Reprod Genet， 2003， 20（4）：143-147.
2	REVELLI A， MARTINY G， DELLE P L， et al. A critical review of bi-dimensional and three-dimensional ultrasound techniques to monitor follicle growth： do they help improving IVF outcome？［J］. Reprod Biol Endocrinol， 2014， 12（1）：1-9.
3	BRAGA D， BONETTI T， SILVAI D， et al. The developmental competence of oocytes retrieved from the leading follicle in controlled ovarian stimulated cycles［J］. Int J Fertil Steril， 2013， 6（4）：272-277.
4	ABBARA A， VUONGL N， HOVN A， et al. Follicle size on day of trigger most likely to yield a mature oocyte［J］. Front Endocrinol， 2018， 9（193）：1-11.
5	BALEN A H， MORLEY L C， MISSO M， et al. The management of anovulatory infertility in women with polycystic ovary syndrome： an analysis of the evidence to support the development of global WHO guidance［J］. Hum Reprod Update， 2016， 22（6）：687-708.
6	WANG Y， CHEN Q， WANG N， et al. Controlled ovarian stimulation using medroxyprogesterone acetate and hmg in patients with polycystic ovary syndrome treated for ivf： a double-blind randomized crossover clinical trial［J］. Medicine， 2016， 95（9）：e2939.
7	PELINCK M J， VOGEL N E A， HOEK A， et al. Minimal stimulation IVF with late follicular phase administration of the GnRH antagonist cetrorelix and concomitant substitution with recombinant FSH： a pilot study［J］. Hum Reprod， 2005， 20（3）：642-648.
8	CHRISTIANSON M S， SHOHAM G， TOBLER K J， et al. Measurement of antral follicle count in patients undergoing in vitro fertilization treatment： results of a worldwide web-based survey［J］.J Assist Reprod Genet， 2015， 32（10）：1435-1440.
9	ECTORS F J， VANDERZWALMEN P， VAN H J， et al. Relationship of human follicular diameter with oocyte fertilization and development after in-vitro fertilization or intracytoplasmic sperm injection ［J］. Hum Reprod， 1997， 12（9）： 2002-2005.
10	HU X， LUO Y， HUANG K， et al. New perspectives on criteria for the determination of HCG trigger timing in GnRH antagonist cycles［J］. Medicine，2016，95（20）：e3691.
11	GONEN Y， BALAKIER H， POWELL W， et al. Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization［J］. J Clin Endocrinol Metab， 1990， 71：918-922.
12	LIN M H， WU F S， LEE R K， et al. Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles［J］. Fertil Steril，2013， 100（5）：1296-1302.
13	MIN K K， MIN K K， TAE H K. Association between different dual trigger dosages and in vitro fertilization results in patients with patient-oriented strategies encompassing individualized oocyte number group Ⅳ［J］. Obstet Gynecol Sci，2022，65（2）：215-222.
14	ZHANG N， HAO C F， ZHUANG L L，et al. Prediction of IVF/ICSI outcome based on the follicular output rate［J］. Reprod Biomed Online， 2013， 27（2）：147-153.
15	GENRO V K， GRYNBERG M， SCHEFFER J B，et al. Serum anti -Müllerian hormone levels are negatively related to Follicular Output RaTe （FORT） in normol-cycling women undergoing controlled ovarian hyperstimulation［J］.Hum Reprod，2011，26（3）：671-677.
16	GENRO V K， MATTE U， DE C E，et al. Frequent polymorphisms of FSH receptor do not influence antral follicle responsiveness to follicle-stimulating hormone administration as assessed by the Follicular Output RaTe （FORT）［J］. J Assist Reprod Genet， 2012， 29（7）：657-663.
17	HILL M J， LEVY G， LEBENS E D. Does exogenous LH in ovarian stimulation improve assisted reproduction success？ An appraisal of the literature［J］. Reprod Biomed Online， 2012， 24 （3）：261-271.
18	NIELSEN M E， RASMUSSEN I A， KRISTENSEN S G，et al. In human granulosa cells from small antral follicles，androgen receptor mRNA and androgen levels in follicular fluid correlate with FSH receptor mRNA［J］. Mol Hum Reprod， 2011， 17（1）：63-70.
19	VAN L A C， HUIRNE J A， SCHATS R， et al. GnRH agonists， antagonists， and assisted conception［J］. Semin Reprod Med， 2002， 20（4）：349-364.
20	HE W， LI X， ADEKUNBI D， et al. Hypothalamic effects of progesterone on regulation of the pulsatile and surge release of luteinizing hormone in female rats［J］. Sci Rep， 2017， 7（1）： 80-96.
21	NEUMANN K， GRIESINGER G. Follicular flushing in patients with poor ovarian response： a systematic review and meta-analysis［J］. Reprod Biomed Online， 2018， 36（4）：408-415.
22	LEVY G， HILL M J， RAMIREZ C I， et al. The use of follicle flushing during oocyte retrieval in assisted reproductive technologies： a systematic review and meta-analysis［J］. Hum Reprod， 2012， 27（8）：2373-2379.
23	EG A， ARSLANCA T， UCAR U， et al. Follicular Flushing Using Double Lumen Needle Yields More Oocytes in Mono-follicular Poor Responders［J］. J Gynecol Obstet and Human Reprod，2021， 50（11）：102150.
24	ERTA S， BALABAN B， URMAN B， et al. What is the optimum number of follicular flushing in mono-follicular IVF cycles in poor responder women population？［J］. J Turk Ger Gynecol Assoc，2022，23： 33-37.

Influence factor	β	SE	P	Importance(η/%)
Age	－0.068	0.022	0.002	4.5
Type of infertility	0.002	0.011	0.830	0.1
Ovarian reserve function	0.196	0.031	<0.01	18.5
Method of trigger	0.029	0.019	0.112	1.6
Serum E2 level on trigger day	0.270	0.028	<0.01	24.6
Percentage of big follicle on oocytes retrieved day	－0.243	0.025	<0.01	22.0
Ovulation induction protocols	0.227	0.034	<0.01	20.9
Percentage of big follicle on HCG administration day	－0.073	0.034	0.010	3.7
Percentage of middle follicle on HCG administration day	0.098	0.034	<0.01	5.7
Percentage of small follicle on HCG administration day	0.012	0.017	0.571	0.2

Item	Age(year) 20	21	22	23	24	25	26	27	28	29
Frequency	3	3	5	12	23	34	40	62	83	80
Quantification value	－2.215	－2.034	－1.853	－1.672	－1.492	－1.311	－1.130	－0.949	－0.768	－0.588
Item	Age(year) 30	31	32	33	34	35	36	37	38	39
Frequency	75	62	59	55	57	60	52	30	23	17
Quantification value	－0.407	－0.226	－0.045	0.135	0.316	0.497	0.678	0.859	1.039	1.220
Item	Age(year) 40	41	42	43	44	45	46	47	48
Frequency	19	17	14	17	22	12	6	7	1
Quantification value	1.401	1.582	1.763	1.943	2.124	2.305	2.486	2.667	2.847

Group	Frequency	Quantification value
Long protocol	620	0.496
Antagonist protocol	185	－0.014
Natural cycle protocol	32	－4.049
PPOS protocol	113	－1.553

Group	Frequency	Quantification value
Ovarian reserve function
Normal	726	0.555
Low	224	1.800

Group	Frequency	Quantification value
Serum level of E2 [ρ_B/(μg·L^－1)]
114－261	8	－1.857
284－1 545	218	－1.240
1 548－2 563	197	－0.623
2 570－3 511	154	－0.006
3 533－4 546	131	0.611
4 559－5 746	191	1.228
5 832－7 968	51	1.854

Analysis on influence factors of number and rate of oocytes retrieved during in vitro fertilization cycle in patients underwent in vitro fertilization/intracytoplasmic sperm injection

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 14

References 24

Related Articles 11

Metrics

Comments

Recommended 10

Group	Frequency	Quantification value
Percentage of big follicles(η/%)
<20	371	－0.709
20－40	376	－0.321
≥40	203	1.890

Group	Frequency	Quantification value
Percentage of middle follicles(η/%)
<20	70	－3.480
20－40	72	－0.391
≥40	808	－0.336

Group	Frequency	Quantification value
Percentage of big follicles(η/%)
<20	380	－0.783
20－40	316	－0.367
≥40	254	－1.692

Influence factor	β	SE	P	Importance(η/%)
Age	0.050	0.038	0.191	4.6
Ovarian reserve function	0.086	0.042	0.040	10.0
Method of trigger	0.039	0.028	0.149	－1.9
Serum estradiol on HCG administration day	0.050	0.037	0.177	－2.8
Percentage of big follicle on oocytes retrieved day	0.168	0.040	<0.01	15.6
Percentage of middle follicle on oocytes retrieved day	0.194	0.037	<0.01	11.6
Ovulation induction protocols	0.137	0.040	<0.01	16.3
Percentage of big follicle on HCG administration day	0.076	0.051	0.137	3.9
Different operators	0.270	0.031	<0.01	38.4
Oocyte retrieval needles	0.056	0.039	0.155	5.1

Group	Frequency	Quantification value
Long protocol	620	－0.506
Antagonist protocol	185	0.516
Natural cycle protocol	32	4.736
PPOS protocol	113	0.634

Group	Frequency	Quantification value
Operator
1	279	1.051
2	229	－1.372
3	131	1.053
4	40	－1.035
5	270	－0.280

Group	Frequency	Quantification value
Percentage of big follicles(η/%)
<20	380	－1.043
20－40	316	0.092
≥40	254	1.451

Group	Frequency	Quantification value
Percentage of oocytes retrieved(η/%)
<20	329	－1.016
20－40	395	－0.089
≥40	225	1.641

[1]	Hong GAO,Li LIN,Xiaohong YAN,Ping TAO,Youzhu LI. Effect of transient prematur of luteinizing hormone in gonadotropin releasing hormone antagonist flexible protocols on pregnancy outcomes of patients underwent fresh IVF/ICSI-ET cycles [J]. Journal of Jilin University(Medicine Edition), 2022, 48(6): 1566-1573.
[2]	Yuanyuan YE,Xiaohong YAN,Youzhu LI. Analysis on related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/ intra-cytoplasmic sperm injection [J]. Journal of Jilin University(Medicine Edition), 2022, 48(2): 454-461.
[3]	Xining LI,Wei WENG,Zheyuan SHEN,Xiaojie DOU,Jikang MIN. Therapeutic effect of estradiol combined with 1,25-dihydroxyvitamin D3 on postmenopausal osteoporosis in rats [J]. Journal of Jilin University(Medicine Edition), 2021, 47(4): 857-864.
[4]	YANG Lijuan, XIA Xueyi, WANG Zhenjiang, WU Dianxiu, GE He, ZHANG Ying, LIN Jiayu, ZHAO Peng, JING Qi, ZHANG Hanyuan, LIU Yanbo. Improvement effect of 17β-estradiol on intestinal mucosal microcirculation in rabbits with hemorrhagic shock and its mechanism [J]. Journal of Jilin University(Medicine Edition), 2019, 45(06): 1199-1205.
[5]	LENG Bing, WANG Dalin, ZHENG Shuyun, HAN Mei, WU Zhenyu, PEI Ying, XUE Haogang. Effect of 17β-estradiol on Ca²⁺ channels during osteogenic differentiation of rat bone marrow mesenchymal stem cells [J]. Journal of Jilin University(Medicine Edition), 2019, 45(05): 1041-1045.
[6]	LIU Jingqiao, ZHENG Yan, WANG Yujing, MENG Yali, XU Shuwen, ZHANG Hualin. Improvement effect of estradiol valerate combined with aspirin on intrauterine adhesion in rats [J]. Journal of Jilin University(Medicine Edition), 2019, 45(04): 830-835.
[7]	GUO Li, ZHANG Xiaoxia, YU Meiling, ZHAO Ting, ZHANG Liqun. Preventive effect of hydroxyethyl starch solution on ovarian hyperstimulation syndrome [J]. Journal of Jilin University Medicine Edition, 2016, 42(06): 1147-1150.
[8]	WANG Ying, XU Wenjing, GAO Zhizhuo, HU Ping, YANG Haiyan, RAO Wei, XU Shaolin. Protective effects of 17-β estradiol on apoptosis of retinal ganglion cells induced by pressure and its mechanism [J]. Journal of Jilin University Medicine Edition, 2015, 41(01): 60-63.
[9]	HUANG Min¹, XIA Wei², ZHAO Hua¹. Effects of estrogen on behavior and norepinephrine content in habenular \|nucleus of depressive rats [J]. J4, 2009, 35(3): 397-399.
[10]	HUANG Min, JIA Wei, DIAO Hua. Effects of estrogen on behavior and norepinephrine content in habenular \|nucleus of depressive rats [J]. J4, 2009, 35(3): 397-399.
[11]	SHE Miao-rong, GUO Kun-yuan, NIU Xin-qing, LU Xiao-xun, TU San-fang. 2-methoxyestradiol-induced apoptosis in U937 cells through generation of reactive oxygen species [J]. J4, 2008, 34(3): 469-473.