Is bigger better: The association between follicle size and livebirth rate following IVF?

Jaime M. Knopman, James A. Grifo, Akiva P. Novetsky, Meghan B. Smith, Alan S. Berkeley

NYU Fertility Center, NYU Langone School of Medicine, New York, USA.

DOI: 10.4236/ojog.2012.24075                

Abstract

Purpose: To analyze the correlation between lead follicle size at hCG trigger and IVF outcome. Methods: A review of all patients undergoing their first IVF cycle between 1/2005-12/2009 was performed. Four groups were evaluated (<18 mm, 18 - 18.9mm, 19 - 19.9 mm and ≥20 mm), based on the mean diameter of the two largest follicles on day of ovulation trigger (OT); cycle parameters and outcomes were analyzed. Results: 1577 cycles were reviewed. There were no significant differences noted for cycle parameters or outcomes for the 4 groups. However, although LBR was not significantly different, there was a decline noted as lead follicle size increased. Conclusions: Delaying the administration of OT to enhance follicular growth does not appear to improve IVF outcome. Larger lead follicles do not yield a higher percentage of mature oocytes, embryos available for transfer or LBR. A misguided zest to achieve a higher quantity of fertilizable oocytes may impair oocyte and embryo quality.

Keywords

Folliculogenesis; Oocyte Maturity; Timing of Ovulation Trigger; Follicular Size and IVF Outcome

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Balaban, B. and Urman, B. (2006) Effect of oocyte morphology on embryo development and implantation. Reproductive BioMedicine Online, 12, 608-615. doi:10.1016/S1472-6483(10)61187-X
[2]	Ben-Rafael, Z., Kopf, G.S., Blasco, L., Flickinger, G.L., Tureck, R.W., Strauss, J.F. and Mastroianni, L. (1986) Follicular maturation parameters associated with the failure of oocyte retrieval, fertilization and cleavage in vitro. Fertility and Sterility, 45, 51-57.
[3]	Bergh, C., Broden, H., Lundin, K. and Hamberger, L. (1998) Comparison of fertilization, cleavaage and pregnancy rates of oocytes from large and small follicles. Human Reproduction, 13, 1912-1915. doi:10.1093/humrep/13.7.1912
[4]	Ciotti, P.M., Notarangelo, L., Morselli-Labate, A.M., Felletti, V., Porcu, E. and Venturoli, S. (2004) First polar body morphology before ICSI is not related to embryo quality or pregnancy rate. Human Reproduction, 19, 2334-2339. doi:10.1093/humrep/deh433
[5]	Clark, L., Stanger, J. and Brinsmead, M. (1991) Prolonged follicular stimulation decreases pregnancy rates after in vitro fertilization. Fertility and Sterility, 55, 1192-1194.
[6]	DeCherney, A.H., Tarlatzis, B.C. and Laufer, N. (1985) Follicular development: Lessons learned from human IVF. American Journal of Obstetrics & Gynecology, 153, 911-923.
[7]	Droesch, K., Muasher, S.J., Kreiner, D., Jones, G.S., Acosta, A.A. and Rosenwaks, R. (1988) Timing of oocyte retrieval in cycles with a spontaneous luteinizing hormone surge in a large in vitro fertilization program. Fertility and Sterility, 50, 451-456.
[8]	Dubey, A.K., Wang, H.A., Duffy, P. and Penzias, A. (1995) The correlation between follicular measurements, oocyte morphology, and fertilization rates in an in vitro fertilization program. Fertility and Sterility, 64, 787-790.
[9]	Ebner, T., Moser, M., Sommergruber, M., Puchner, M., Wiesinger, R. and Tews, G. (2003) Developmental competence of oocytes showing increased cytoplasmic viscosity. Human Reproduction, 18, 1294-1298. doi:10.1093/humrep/deg232
[10]	Ebner, T., Moser, M., Sommergruber, M., Gaiswinkler, U., Shebl, O., Jesacher, K. and Tews, G. (2005) Occurrence and developmental consequences of vacuoles throughout preimplantation development. Fertility and Sterility, 83, 1635-1640. doi:10.1016/j.fertnstert.2005.02.009
[11]	Ectors, F.J., Vanderzwalmen, P., Van Hoeck, J., Nijs, M., Verhaegen, G., Delvigne, A., Schoysman, R. and Leroy, F. (1997) Relationship of human follicular diameter with oocyte fertilization and development after in-vitro fertilization of intracytoplasmic sperm injection. Human Reproduction, 12, 2002-2005.
[12]	Edwards, R.G. (1973) Physiological aspects of human ovulation, fertilization and cleavage. Journal of Reproduction and Fertility. Supplement, 18, 87-101.
[13]	Edwards, R.G. and Steptoe, P.C. (1975) Induction of follicular growth ovulation and luteinization in the human ovary. Journal of Reproduction and Fertility. Supplement, 22, 121-160.
[14]	Garcia, J., Acosta, A., Andrews, M.C., Jones, G.S., Jones, H.W., Mantzavinos, T., Mayer, J., McDowell, J., Sandow, B., Veeck, L., Whiblye, T., Wilkes, C. and Wright, G. (1984) In vitro fertilization in Norfolk, Virginia, 1980-1983. Journal of in Vitro Fertilization and Embryo Transfer, 1, 24-28. doi:10.1007/BF01129616
[15]	Johnston, I., Lopata, A., Speirs, A., Hoult, I., Kellow, G. and Plessis, Y. (1981) In vitro fertilization: The challenge of the eighties. Fertility and Sterility, 36, 699-706.
[16]	Kreiner, D., Muasher, S.J., Acosta, A.A., Jones, G.S., Liu, H.C. and Rosenwaks, Z. (1988) Monitoring gonadtropin-stimulated cycles for in vitro fertilization and embryo transfer. Journal of in Vitro Fertilization and Embryo Transfer, 5, 230-233. doi:10.1007/BF01131127
[17]	Laufer, N., DeCherney, A., Tarlatzis, Zuckerman, A.L., Polan, M.L., Dlugi, A.M., Graebe, R., Barnea, E.R. and Naftolin, F. (1984) Delaying hCG administration in human menopausal gonadotropin-induced cycles decreases successful IVF of human oocytes. Fertility and Sterility, 42, 198-203.
[18]	Miller, K.F., Goldberg, J.M. and Falcone, T. (1996) Follicle size and implantation of embryos from in vitro fertilization. Obstetrics & Gynecology, 88, 583-586. doi:10.1016/0029-7844(96)00241-4
[19]	Nogueira, D., Friedler, S., Schachter, M., Raziel, A., Ron-El, R. and Smitz, J. (2006) Oocyte maturity and preimplantation development in relation to follicular diameter in gonadotropin-releasing hormone agonist or antagonist treatments. Fertility and Sterility, 85, 578-583. doi:10.1016/j.fertnstert.2005.08.033
[20]	O’Herlihy, C., Evans, J.H., Brown, J.B., de Crespigny, L. and Robinson, H. (1982) Use of ultrasound in monitoring ovulation induction with human pituitary gonadotropins. Obstetrics & Gynecology, 60, 577-582.
[21]	Rosen, M.P., Shen, S., Dobson, A.T., Rinaudo, P.F., McCulloch, C.E. and Cedars, M.I. (2008) A quantitative assessment of follicle size on oocyte developmental competence. Fertility and Sterility, 90, 684-690. doi:10.1016/j.fertnstert.2007.02.011
[22]	Scott, R.T., Hofmann, G.E., Muasher, S.J., Acosta, A.A., Kreiner, D.K. and Rosenwaks, Z. (1989) Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration. Journal of in Vitro Fertilization and Embryo Transfer, 6, 73-75. doi:10.1007/BF01130729
[23]	Tan, S.L., Balen, A., El Hussein, E.E., Mills, C., Campbell, S., Yovich, J. and Jacobs, H.S. (1992) A prospective randomized study of the optimum timing of hCG administration after pituitary desensitization in IVF. Fertility and Sterility, 57, 1259-1264.
[24]	Wittmaack, F.M., Kreger, D.O., Blasco, L., Tureck, R.W., Mastroianni, L. and Lessey, B.A. (1994) Effect of follicular size on oocyte retrieval, fertilization, cleavage, and embryo quality in in vitro fertilization cycles: A 6-year data collection. Fertility and Sterility, 62, 1205-1210.