Comparison of the Number of Oocytes Obtained Between Chinese and Caucasian Women in IVF Treatment
Condition: Subfertility
MeSH terms: Infertility
Study type: Observational

Summary: 
      IVF is a well-established method to treat various causes of infertility. Some studies have
      suggested that ethnicity affects the success of IVF. This is a prospective study involving
      two tertiary IVF units in Hong Kong and Australia. The IVF outcome between Chinese and
      Caucasians will be compared.
    

Detailed description: 
      This is a prospective study conducted in two tertiary IVF units in Hong Kong and Australia.

      The target population for the trial will be women undergoing IVF or intracytoplasmic sperm
      injection (ICSI) treatment in two IVF Units.

      Intervention:

      Patients recruited in this study will undergo IVF+/-ICSI treatment. They will undergo an
      ultrasound scan on the second or third day (day 2 or 3) of a period to exclude the presence
      of ovarian cyst and have the antral follicle count determined, which includes all follicles
      of 2-10 mm measured with a 5.5-7.5mHz transvaginal ultrasound probe. Blood will be checked
      for anti-mullerian hormone (AMH) measured by Beckman-Coulter Diagnostics.

      Ovarian stimulation will be started if there are no ovarian cysts on ultrasound scan. They
      will receive one long acting gonadotrophin injection Elonva 150 microgram subcutaneously
      followed by daily gonadotrophin injections (Puregon) 200 IU in an antagonist protocol.
      Antagonist (orgalutran 0.25 mg) will be started on day 5 of ovarian stimulation. Transvaginal
      ultrasound will be performed for follicular tracking 7 days after the Elonva injection and
      every 1-3 days thereafter. No adjustment in FSH dose is allowed. Cycles will be cancelled if
      there are less than 3 follicles larger than 18mm after one week of 200 IU Puregon or there no
      developing follicle (i.e. larger than 11mm) after one week of 200 IU Puregon.

      Recombinant hCG (Ovidrel, Serono, Bari, Italy) 0.25mg will be given if there are 2 follicles
      >18 mm in diameter. Gonadotrophin injection will not be given on the day of hCG. Agonist
      trigger will be used if oestradiol concentration on the day of trigger is greater than 15,000
      pmol/L or there are more than 15 follicles >16mm on transvaginal scanning. All embryos or
      blastocysts will be frozen for transfer later following agonist trigger or when the number of
      oocytes aspirated is 20 or more. Serum FSH, oestradiol, LH and progesterone concentrations
      are taken 7 days after the Elonva injection and hCG trigger day. Transvaginal
      ultrasound-guided oocyte retrieval (TUGOR) will be scheduled on Mondays, Wednesdays and
      Fridays, 34-36 hours after the hCG injection. Flushing of follicles will not be performed.
      Follicular fluid not contaminated with blood will be collected from the first and largest
      follicle on each side for estradiol and progesterone level.

      The retrieved oocyte will be inseminated conventionally or by ICSI, depending on the semen
      parameters. ICSI is advised if the total motile sperm number after sperm preparation < 0.2
      million, sperm morphology by strict criteria < 3% or fertilization rate < 30% in previous IVF
      cycles with conventional insemination. One to two embryos will be replaced on day 2-5 after
      oocyte retrieval. Luteal phase support will be started according to the standard protocol of
      the centre. Patients will be followed up for urinary pregnancy test 16 days after embryo
      transfer. Patients with a positive pregnancy test will have transvaginal ultrasound scan
      performed 10-14 days later and are referred for antenatal care at 8-10 weeks gestation. The
      remaining embryos will be frozen. Pregnancy outcome will be monitored.
    

Intervention name(s): Transvaginal ultrasound-guided oocyte retrieval; Embryo transfer
Intervention type(s): Procedure; Procedure
Intervention description(s): Transvaginal ultrasound-guided oocyte retrieval will be performed 34-36 hours after hCG injection.; One or two embryos will be replaced on day 2-5 after oocyte retrieval.
Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment in the two study
        sites.
      
Biospecimen description: 
      Blood will be saved for genetic study if there is significant difference in the number of
      oocytes obtained between Chinese and Caucasian women.
    
Keywords: subfertility; In-vitro fertilization