優勢卵泡大小決定取卵時機與懷孕率之關連: 新關念

傳統優勢卵泡大小1.8cm以上即施打破卵針hCG

新研究顯示優勢卵泡大小2.2cm以上才施打破卵針hCG可提高懷孕率(25%-->37%)






優點:
下降不成熟卵子之比率
爭取1-3天讓子宮內膜增厚成熟有利胚胎著床

缺點:
須注意卵巢排卵反應與其它卵子老化之風險


Ref:

Hum Reprod. 2011 May;26(5):1091-6. Epub 2011 Feb 28.

Timing oocyte collection in GnRH agonists down-regulated IVF and ICSI cycles: a randomized clinical trial.

Mochtar MH, Custers IM, Koks CA, Bernardus RE, Verhoeve HR, Mol BW, van Wely M, van der Veen F.

Source

Department of Obstetrics and Gynaecology, Centre of Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands. m.h.mochtar@amc.nl

Abstract

BACKGROUND:

The evidence underpinning the timing of an oocyte collection in IVF or ICSI is limited. The aim of this study was to assess the effect of the follicle diameter size of the dominant follicle on ongoing pregnancy rates.

METHODS:

We conducted a randomized controlled trial, including women aged between 18 and 43 years who were scheduled for GnRH agonist down-regulated IVF/ICSI treatment in four assisted conception units. Women were randomized between timing oocyte collection when the leading follicle had a diameter of 22 mm or when the leading follicle had a diameter of 18 mm. The primary end-point was ongoing pregnancy, defined as a viable pregnancy at 12 weeks of gestation.

RESULTS:

The trial had major problems with recruiting patients and after the planned 2 years of recruiting only half of the aimed 400 inclusions were obtained. We allocated 97 women to the 22-mm group and 93 women to the 18-mm group. In the 22-mm group more women reached an ongoing pregnancy (37 of 97 women, 38%) compared with the 18-mm group (22 of 93 women, 24%) resulting in a relative risk of 1.6 [95% confidence interval (CI): 1.03-2.5]. In a logistic regression analysis, the timing of oocyte collection, adjusted for female age, IVF/ICSI and centre, was still associated with ongoing pregnancy, although the association was no longer statistically significant (OR: 2.0; 95% CI: 0.96-4.2)

CONCLUSIONS:

This study suggests that delaying the timing of oocyte collection in IVF or ICSI results in better ongoing pregnancy rates, however, larger studies have to be performed to prove or refute these findings. Trial registration: ISRCTN24724622.