Follicle Size and Oocyte Development
Condition: IVF Treatment
Study type: Interventional

Summary: 
      Studies have shown that the follicles greater in diameter was most likely to have a mature
      oocyte that was capable of fertilization and best suited for development into a high-quality
      embryo. Smaller follicles showed lower rates ( 60%).

      Lately new triggering protocols have emerged aiming to improve the proportion of mature
      oocytes at the time of retrieval. The aim of this study is to learn the effects of the dual
      triggering compared to the standard hCG triggering on the oocyte development and quality as a
      function of the follicle size
    

Detailed description: 
      Controlled ovarian hyperstimulation is critical to assisted reproduction because it increases
      the number of oocytes undergoing development. The medications, designed to override the
      selection of a single dominant follicle, drive multiple antral follicles into the growth
      phase. These follicles grow at different rates, and management is guided by their size rather
      than their competence. Human chorionic gonadotropin (hCG) is usually used as a surrogate LH
      surge to induce luteinization of the granulosa cells, final oocyte maturation and resumption
      of meiosis. This treatment is therefore based on an assumption that follicular size predicts
      the developmental competence of the oocyte. The outcome, is that only a portion of the
      oocytes will be competent for fertilization and development into viable embryos.

      Studies have shown that the follicles greater in diameter was most likely to have a mature
      oocyte that was capable of fertilization and best suited for development into a high-quality
      embryo. Smaller follicles showed lower rates ( 60%).

      Lately new triggering protocols have emerged aiming to improve the proportion of mature
      oocytes at the time of retrieval. Following the observations demonstrating comparable or even
      better oocyte\embryos quality following GnRHa, compared to hCG trigger, and the different
      effects of LH and hCG on the downstream signaling of the LH receptor, GnRHa is now offered
      concomitant to the standard hCG trigger dose to improve oocyte/embryo yield and quality. To
      the best of our knowledge, no studies have been done comparing the effect of the dual
      triggering on the amount of larger follicles per cycle and its effect on oocyte maturation.

      The aim of this study is to learn the effects of the dual triggering compared to the standard
      hCG triggering on the oocyte development and quality as a function of the follicle size

      Material and Methods A prospective cohort study including all women on antagonist protocol
      for controlled ovarian hyper stimulation with triggering using Ovitrelle ( hCG 250 mcg) or
      dual triggering - Ovitrelle ( Hcg 250 mcg) + Decapeptyl ( GnRH Agonist 0.1 mg*2 ).

      As practiced at the IVF clinic, individuals will be monitored with transvaginal ultrasound
      and blood samples for hormonal profile ( including Estradiol, Progesteron, FSH). The decision
      to administer hCG or Dual triggering will be based on physician judgment, and the timing will
      be based on the lead follicular cohort, usually with at least two follicles measuring 18 mm
      for maximal diameter. A transvaginal, ultrasound-guided follicular aspiration will be
      conducted 36 hours after triggering administration. At retrieval, each follicle will be
      measured before aspiration. Follicles will be divided into five arbitrary follicular groups
      according to their maximal dimensional size: >18 mm, 16 to 18 mm, 13 to 15 mm, 10 to 12 mm,
      and <10 mm. Following identification, the follicles will be aspirated. Microscopic
      examination of the follicular aspirates will be performed by the embryologist. Once the
      oocytes will be identified, they will be collected and organized according to follicle size.
      Oocytes will be fertilized using conventional insemination or intracytoplasmic sperm
      injection (ICSI) . Each embryo will be cultured and evaluated after 72 hours.

      Day-3 embryo grading, based on cellular cleavage and fragmentation, will be recorded
      separately. Fragmentation will be scored by the degree of fragmentation proportional to the
      whole embryo volume: 1, no fragmentation; 2, <10%; 3, 10% to 25%; 4, 25% to 50%; 5, >50%. The
      information for each oocyte, starting from the follicular size, will be followed through all
      laboratory procedures including insemination, oocyte stripping for ICSI, ICSI, pronuclear
      assessment, embryo culture, and embryo transfer.

      Data will be collected from the medical file of each patient.
    

Intervention name(s): Follicle measurment; Ovitrelle ( Hcg 250 mcg); Decapeptyl ( GnRH Agonist 0.1 mg*2 )
Intervention type(s): Diagnostic Test; Drug; Drug
Intervention description(s): Follicle will be measured before aspiration; Drug used for triggering; Drug used for triggering
Intervention MeSH terms: Triptorelin Pamoate
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: oocyte, double triggering, follicle size