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Volume-based follicular output rate improves prediction of the number of mature oocytes: a prospective comparative study
Fertility and Sterility ( IF 6.7 ) Pub Date : 2022-09-16 , DOI: 10.1016/j.fertnstert.2022.07.017
Adela Rodríguez-Fuentes 1 , Jean Paul Rouleau 1 , Danízar Vásquez 1 , Jairo Hernández 1 , Frederick Naftolin 1 , Angela Palumbo 1
Affiliation  

Objective

To test whether volume-based follicular output rate (FORT-V) is superior to diameter based follicular output rate (FORT-D) in predicting the number of mature oocytes. The follicular output rate (FORT) is the ratio between preovulatory follicle count (PFC) and antral follicle count (AFC) and has been proposed as a better predictor of the ovarian response compared with AFC alone.

Design

A prospective observational study of 215 consecutive women (80 oocyte donors and 135 in vitro fertilization [IVF] patients) undergoing ovarian stimulation for IVF.

Setting

University affiliated private IVF center.

Patient(s)

Women undergoing ovarian stimulation between May 2018 and September 2021.

Intervention(s)

Manual two-dimensional ultrasound and computer-generated (three-dimensional ultrasound, [3D]) AFCs were performed at baseline. During ovulation induction, follicular growth was monitored in each patient using both two-dimensional and 3D ultrasound. Preovulatory follicles were defined as those with a mean diameter of 16–22 mm. The trigger was based on the follicular volume according to our standard protocol: at least 2 follicles with a volume of >2 cc with 70% of the follicles having a volume of >0.7 cc.

Main Outcome Measure(s)

The primary outcome was the difference between FORT-V and FORT-D in their ability to predict the mature oocyte output rate.

Result(s)

In both IVF patients and oocyte donors, the computer-generated AFC was greater than the manual AFC. The FORT-V was higher than the FORT-D for both computer-generated (the difference was 35 [95% CI {confidence interval}, 32–45] in oocyte donors and 21 [95% CI, 5–46] in IVF patients) and manual FORT (the difference was 38 [95% CI, 32–45] in oocyte donors and 15 [95% CI, 3–43] in IVF patients) and was closer to the mature oocyte output rate. There was a direct correlation between the computer-generated AFC and the PFC based on volume and between PFC based on volume and the number of mature oocytes in oocyte donors and IVF patients.

Conclusion(s)

In this prospective study of 215 women, the FORT based on 3D ultrasound derived follicular volume (FORT-V) was superior to the FORT-D in determining the ovarian response in both oocyte donors and IVF patients. Moreover, our results support the non–inferiority of the computer-generated method compared with the manual method for the determination of AFC. Further studies on the role of computer-generated antral follicle characteristics may be useful in evaluating follicle stimulation regimens.



中文翻译:

基于体积的卵泡输出率提高了对成熟卵母细胞数量的预测:一项前瞻性比较研究

客观的

测试基于体积的卵泡输出率 (FORT-V) 在预测成熟卵母细胞数量方面是否优于基于直径的卵泡输出率 (FORT-D)。卵泡输出率 (FORT) 是排卵前卵泡计数 (PFC) 与窦状卵泡计数 (AFC) 之间的比率,与单独使用 AFC 相比,已被提议作为更好的卵巢反应预测指标。

设计

一项对 215 名连续接受 IVF 卵巢刺激的女性(80 名卵母细胞捐献者和 135 名体外受精 [IVF] 患者)的前瞻性观察研究。

环境

大学附属私人试管婴儿中心。

病人)

2018 年 5 月至 2021 年 9 月期间接受卵巢刺激的女性。

干预措施

在基线进行手动二维超声和计算机生成的(三维超声,[3D])AFC。在诱导排卵期间,使用二维和 3D 超声监测每位患者的卵泡生长。排卵前卵泡被定义为平均直径为 16-22 毫米的卵泡。根据我们的标准方案,触发基于卵泡体积:至少 2 个卵泡体积 > 2 cc,其中 70% 的卵泡体积 > 0.7 cc。

主要观察指标)

主要结果是 FORT-V 和 FORT-D 在预测成熟卵母细胞输出率方面的差异。

结果)

在 IVF 患者和卵母细胞捐赠者中,计算机生成的 AFC 均大于手动 AFC。两种计算机生成的 FORT-V 均高于 FORT-D(在卵母细胞供体中差异为 35 [95% CI {置信区间},32-45],在 IVF 中差异为 21 [95% CI,5-46]患者)和手动 FORT(卵母细胞供体的差异为 38 [95% CI,32-45],IVF 患者的差异为 15 [95% CI,3-43])并且更接近成熟卵母细胞输出率。计算机生成的 AFC 与基于体积的 PFC 之间以及基于体积的 PFC 与卵母细胞供体和 IVF 患者的成熟卵母细胞数量之间存在直接相关性。

结论

在这项针对 215 名女性的前瞻性研究中,基于 3D 超声衍生卵泡体积 (FORT-V) 的 FORT 在确定卵母细胞供体和 IVF 患者的卵巢反应方面优于 FORT-D。此外,我们的结果支持计算机生成的方法与确定 AFC 的手动方法相比的非劣效性。进一步研究计算机生成的窦状卵泡特征的作用可能有助于评估卵泡刺激方案。

更新日期:2022-09-16
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