Proper induction of multiple follicles or oocytes in considered to be very benificial in current in vitro fertilization. In this study the stimulation dosage in relation to the number of follicles, correlation of follicular development including
the
number or diameter and serum estradiol(E2) levels or responses, and fertilizability of the oocytes retrieved according to the serum E2 responses and the terminal E2 patterns will be analysed.
The data to be presented are based on 92 cycles in 88 ovulatory infertile patients with average age of 33 years(ranging 24~41) including 76 having tubal factors(salpingectomized, reversal failed or nonfunctioning hydrosalpinx), 5 having
endometriosis,
and 7 suspected of having unknown origin seen in Ewha Womans University Hospital, during the period from November 1988 to January 1991. In this study 4 suspected of having polycystic ovary and one having ovarian cyst with E2 level of>100 pg/ml
was
eliminated.
In summary the results in this study were as follows.
1, In combination of FSH/hMG stimulation followed by hCG the mean number of leading developing follicles (≥10mm) until day +1(one day before aspiration) was highest (p< 0.01) in high serum E2 responder patients, followed by intermediate and low
responders respectively (i.e., 9.7±3.3 >7.4±2.3>4.0±1.8). In relation to the dosage of stimulation, low E2 responder patients failed to increase the number of follicles even with increased dosage of stimulation.
2. In follicular growth, daily mean diameter of largest follicles increased or correlated significantly with increase of Serum E2 levels in all groups of high(r=0.44, p<0.001) respectively.
It was interesting to note that the daily growth rates of largest follicular diameter were all similar among 3 E2 responders including low responders, accounting for 1.5 to 3mm per day regardless the hight of E2 responses until day +1(one day
before
aspiration). It presumably suggestive of a natural survival law of minority ethnic group such as low responders mostly consisting of smaller distribution (4.3%).
3. total oocytes and preovulatory oocytes retrieved per cycle were also high in heigh E2 responders, followed by intermediate and low E2 responders respectively (i.e., 4.4±2.1.>3.2±2.2>2.3±1.5) (P<0.05).
4. The fertilized and cleaved (conceptuses) total oocytes retrieved per cycle (Woman) was slightly increased or correlated with serum E2 levels among high and intermediate E2 responders respectively (p<0.1 and P<0.1).
However, there failed to establish any statistical differences. or correlation in the rates of fetilization or cleavage of preovulatory oocyles among 3 different E2 responders or among 3 terminal E2 patterns of A, G and B.
In general, fertilized or cleaved preovulatory oocytes per woman(cycle) could be expected to retrieve usually 2 or more.
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