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Optimal lead follicle size in microdose flare IVF cycles depends on female age

Advanced Fertility Center of Chicago
IVF and Infertility Specialists
Gurnee & Crystal Lake, Illinois

Research presentation by Dr. Richard Sherbahn at the Annual Meeting of the American Society for Reproductive Medicine, New Orleans, LA, October, 2006.


Author:

R. Sherbahn; Advanced Fertility Center of Chicago, Gurnee, IL

Objective:

To determine the ideal lead follicle size for timing of the HCG trigger in microdose flare IVF cycles.

Design:

Retrospective analysis of 167 consecutive microdose flare IVF cycles that proceeded to egg retrieval in women under age 43.

Materials and Methods:

All microdose flare IVF cycles from January 2002 through December 2004 were analyzed. Patients stimulated with this protocol were believed to have reduced ovarian reserve based on day 3 FSH levels and/or antral follicle counts, or they previously had a poor response to ovarian stimulation with gonadotropins. A total of 167 microdose flare cycles were performed and studied. The cases were separated into 2 groups for analysis based on female age under 35, and age 35-42. The mean diameter of the 2 largest follicles was calculated. Live birth rates per egg retrieval were compared according to mean lead follicle diameters. Clinical and laboratory parameters were also assessed, including means for female age, days of stimulation, antral follicle counts, total number of follicles 12 mm diameter and larger on day of HCG, peak serum progesterone before HCG, number of eggs retrieved, and whether or not there were at least 3 8-cell embryos on day 3. Statistical analysis was performed by the t-test and chi-square analysis when appropriate.

Results:

For women under 35, live birth rates were higher with larger mean follicle diameters on the day of HCG. In this age group, the live birth rate per retrieval was 56.5% with mean follicle diameters of 19mm or greater vs. 35.4% for cases with mean diameters under 19mm (p = 0.10). For women 35-42 years old, live birth rates were lower with larger mean follicle diameters on the day of HCG. In this age group, the live birth rate per retrieval was 17.5% with mean follicle diameters of 18mm or greater vs. 45.5% for cases with mean diameters under 18mm (p = 0.004). Women under 35 with average size of the 2 leading follicles of 19mm or more had significantly more eggs retrieved (9.2 vs. 7.1, p = 0.05) compared to the same age group with smaller lead follicles. Otherwise, within each age group, there were no significant differences between the 2 follicle size groups for the other parameters assessed.

Conclusion:

Using a microdose flare ovarian stimulation protocol, live birth rates per egg retrieval were higher with larger follicles for women under 35, but lower with larger follicles for women 35-42. Although the difference was not statistically significant for the women under 35, it was highly significant for the 35-42 age group. When using a microdose flare ovarian stimulation protocol for IVF there could be a negative effect on either the eggs or the endometrium if the HCG trigger is given when the mean diameter of the 2 leading follicles is 18mm or more for women 35-42 years old. Larger and prospective studies are needed to further investigate the optimal timing of HCG in microdose flare IVF cycles.

Financial Support:

None


Author Disclosure:

R. Sherbahn, None.

Table 1

Live Birth Rates by Average Size of 2 Lead follicles

Female Age Under 35

Means +/- SD

Lead Follicle
Size < l9mm

Lead Follicle
Size 19mm or >

p value

Age

30.9

31.0

NS

Size of 2 Lead Follicles

17.3 +/- 0.8mm

20.9 +/- 2.1mm

p < 0.001

Days of Stimulation

9.9

9.6

NS

Antral Follicles

9.0

10.0

NS

Number of Follicles 12mm or Larger

8.7 +/- 3.9

10.3 +/- 3.4

NS

Peak P4

1.6 +/- 0.5

1.7 +/- 0.6

NS

Number of Eggs

7.1 +/- 4.3

9.2 +/- 3.9

p = 0.05

Number of Embryos Transferred

2.0

2.0

NS

Cases with 3 or More

8-Cell Embryos

18/48

(37.5%)

12/23

(52.2%)

NS

Live Birth Rate Per Retrieval

17/48

(35.4%)

13/23

(56.5%)

NS

p = 0.10

IVF success by lead follicle size with flare stimulation

_____________________________________________________________________

Table 2

Live Birth Rates by Average Size of 2 Lead follicles

Female Age 35 - 42

Means +/- SD

Lead Follicle
Size < l9mm

Lead Follicle
Size 19mm or >

p value

Age

37.8

37.9

NS

Size of 2 Lead Follicles

17.0 +/- 0.4mm

19.4 +/- 1.6mm

p < 0.001

Days of Stimulation

9.5

9.9

NS

Antral Follicles

8.0

8.3

NS

Number of Follicles 12mm or Larger

7.9

8.4

NS

Peak P4

1.4 +/- 0.5

1.5 +/- 0.5

NS

Number of Eggs

6.7 +/- 4.4

5.8 +/- 3.3

NS

Number of Embryos Transferred

1.9

2.0

NS

Cases with 3 or More

8-Cell Embryos

12/33

(36.4%)

17/63

(26.6%)

NS

Live Birth Rate Per Retrieval

15/33

(45.5%)

11/63

(17.5%)

p = .004

Optimal follicle size with flare stim age 35-42

Related Pages
Ovarian stimulation protocols for IVF
Ovarian reserve problems
Day 3 FSH test
Antral follicle counts
Female age and fertility
Number of eggs and IVF success
In vitro fertilization
IVF success rates

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