In a nutshell
This study created a model to predict how well eggs (oocytes) develop embryos during in vitro fertilization (IVF). It found that patients with lower doses of gonadotropin (GN) hormones had better fertilization rates (FR). It also found that patients with diminished ovarian reserve (DOR) could have a high FR.
The infertility treatment IVF involves using GN hormones to stimulate the ovaries. Ovulation is then triggered so the oocytes can be collected. This trigger also reactivates the oocytes, which readies them for fertilization. However, less than half of the oocytes typically form embryos.
How well the ovaries respond to GN differs between women. Patients who produce fewer than 12 mature ovarian follicles are said to have a DOR. For women with DOR, it is particularly important to have a good FR.
Diagnostic tests are used to predict IVF outcomes and plan care. Follicle-stimulating hormone (FSH) is a natural GN. Anti-Mullerian hormone (AMH) is released by the ovaries and is related to how many oocytes are remaining. These tests can predict how well the ovaries will respond to GN. However, it is not clear whether these tests can also predict how successful fertilization will be.
Methods & findings
This study used records from 106 women undergoing IVF to create a mathematical model. This model was 86.5% successful at determining whether a patient had good FR (over 40%).
Patients with good ovarian reserve had better FR when GN was given for fewer than 10 days. Having a lower peak estrogen level (less than 3350 pg/ml) was also a predictor of good FR. The authors suggest using oral contraception prior to IVF for these patients, to reduce the body’s own hormones.
Patients with DOR who used low GN (less than 2748 pg/ml) had a 90% FR. If the patient had both DOR and low AMH (under 3.15 ng/ml), even high doses of GN led to good FR.
The bottom line
This study found that patients with lower GN had higher FRs. It also found that the AMH level was connected to FR.
The fine print
It is not clear whether the GN dose causes the difference in FR. It is possible that oocytes which require more GN to mature are less receptive to fertilization.
Talk to your doctor about the right dose of GN for your IVF cycle. If you have a high ovarian reserve, ask your doctor about using hormonal contraception to prepare for IVF.
Published By :
Oct 13, 2020