Impact of ovarian response on intracytoplasmic outcome.

Zafeiriou S*, Petrogiannis N·, Giannakouris A*, Triantaphilou P*, Aghani G*.

*Centre de fécondation in vitro. Centre hospitalier Universitaire Besancon,  France.

·Naval Hospital of Athens,Gynecological department

Introduction: Early follicular phase FSH and female age have been reported to be better predictors or intracytoplasmic sperm injection (ICSI) outcome than severity of sperm dysfunction. The aim of this study was to investigate the role of ovarian response. Two parameters were considered: length of stimulation and oestradiol (E2) concentration on the day of hCG administration.

Materials and methods: 231 consecutive couples undergoing ICSI were investigated. Patients with FSH values>10 U/I or less than 8 follicles assessed by ultrasonography during a non stimulated cycle were excluded before this study. Pituitary desensitization was initiated on day 1 of the cycle and stimulation started on day 15 (2-4 ampoules / day). Embryo transfer was performed 48 hours after oocyte retrieval. Embryo quality was judged by Veeck criteria.

Results were analyzed statically using a chi-square test. Mantel Haenzel test, and Student’s t-test.

Results: Fertilization implantation and clinical pregnancy (PR) rates were not influenced by length of stimulation. A wide range of E2 values from 800 to 5400 pg/ml was observed. One woman had moderate ovarian hyperstimulation syndrome. Patients with E2 concetrations between 2500 and 3500 pg/ml had significantly higher PR (37,8) than patients with lower E2 (22%, P<0,003) or higher E2 (23%, P<0,004) concentrations. The difference was even more significant (p<0,01) when only patients with more than 3 embryos were taken into account. In these conditions, PR reached 60% when E2 concentrations were optimal (2500-3500 pg/ml ), versus 27% in the other cases.

Follicle number at the beginning of a non stimulated cycle age, number of gonadotrophin ampoules, morphological grade, cleavage status did not vary in relation to E2 concentration. The transfer of at least 1 embryo, grade I or II with more than 3 blastomeres, corresponded to a predictive parameter independent of E2 concentration.

Conclusions: This study underlined the prognostic value of E2 on the day of hCG administration, already observed [ Loutradis et al., (1999) Fertil Steril, 72, 240-244]. However E2 values >3500 pg/ml were detrimental to ICSI. Stimulation length did not modify the outcome. Our own personal experience would suggest that these conclusions do not apply to standard in vitro fertilization.