It is based on the formation of numerous decision trees to predict an outcome variable (in this case number of mature oocytes). WD is supported by an NIHR Research Professorship. Some studies of follicle size on the day of oocyte retrieval have suggested that there are differences in fertilization rates or oocyte competence with follicle size (22, 25). A second dose of kisspeptin-54 improves oocyte maturation in women at high risk of ovarian hyperstimulation syndrome: a phase 2 randomized controlled trial. Finally, Triwitayakorn et al. Rosen MP, Shen S, Dobson AT, Rinaudo PF, McCulloch CE, Cedars MI. I'm Si devastated cuz they say dr usually won't do ivf with only 1 follicle problems is I'm not getting any younger n I only hav 1 tube n ovary. Mochtar and colleagues randomized women to receive trigger once the lead follicle was either 18 or 22 mm, and observed that those with a lead follicle of 22 mm had a greater number of follicles of 20–22 mm on day of trigger (3.95 vs 0.02) and an increase in two oocytes retrieved (29). My RE doesn't like to trigger before they are at least 18. Model importance factors (random forest) for follicle diameter in determining number of embryos and number of high quality embryos. Abbara A, Jayasena CN, Christopoulos G, Narayanaswamy S, Izzi-Engbeaya C, Nijher GMK, et al. Figure 2. doi:10.1093/humrep/13.7.1912, 26. Hum Reprod (2010) 25(5):1219–24. However, Ectors et al. Generalized linear model of the number of oocytes and the number of mature oocytes retrieved by follicle diameter. 27mm follicle too big???? Therefore, ultrasound folliculograms used to determine the size of follicles on the morning of trigger are usually carried out 2 days prior to those used to determine the size of follicles on the day of oocyte retrieval. Triggers are given around 23-25 mm. doi:10.1016/j.fertnstert.2010.09.009, 6. However, determining the day of trigger based on the proportion of follicles within the size range 12–19 mm could be of particular value to patients with a wider spread of follicles behind the lead follicle. Fertil Steril (1995) 64(4):787–90. Therefore, we sought to determine the size of follicles on day of trigger that would be most likely to yield a mature oocyte. The trigger (either recombinant hCG 250 µg equivalent to 6,500 IU, or GnRHa triptorelin 0.2–0.4 mg) was administered as soon as two follicles reached a size of ≥17 mm. Comparing the 50% of patients with the highest proportion of their follicles within the size range 12–19 mm with the 50% with the lowest proportions in this range revealed an increase in the number of oocytes of 3.6 oocytes and 3.3 mature oocytes (P < 0.0001) for hCG and 3.9 oocytes and 2.5 mature oocytes (P < 0.01) for GnRHa triggering. https://www.fertstert.org/article/S0015-0282(12)00250-6/fulltext Table 4. Data for hCG trigger were from a case-series also carried out at My Duc Hospital, Ho Chi Minh City, Vietnam. This provided initial confirmation that the number of follicles of different size ranges was associated with the number of mature oocytes retrieved following each trigger. Baerwald AR, Walker RA, Pierson RA. For the hCG case-series, the IRB reference number was NCKH/CGRH_09_2017, ethical approval reference number: 10/17/DD-BVMD, and ClinicalTrials.gov Identifier: NCT03174691. The regression coefficient (r2) for the generalized linear regression model to determine the number of oocytes retrieved for hCG was 0.49 for oocytes and 0.44 for number of mature oocytes retrieved. Dubey AK, An Wang H, Duffy P, Penzias AS. doi:10.1093/humrep/deu362, 27. I think 26mm is quiet a big size to take trigger shot. Generalized linear model—number of embryos and number of high grade embryos. Nogueira D, Friedler S, Schachter M, Raziel A, Ron-El R, Smitz J. Oocyte maturity and preimplantation development in relation to follicle diameter in gonadotropin-releasing hormone agonist or antagonist treatments. My largest for IVF #1 was 20.5 and for IVF #2 was 19. Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment. Using simulated follicle size profiles of patients with 20 follicles on the day of trigger, our model predicts that the number of oocytes retrieved would increase from a mean 9.8 (95% prediction limit 9.3–10.3) to 14.8 (95% prediction limit 13.3–16.3) oocytes due to the difference in follicle size profile alone. Looking back at my old notes, the day before trigger the first time, I had 1 18 and 4 17s, but still stimmed one more day. Analysis was carried out by AA and TK. It is less invasive than other assisted reproductive treatment (ART) procedures, requiring less laboratory commitment and regulation (Homburg, 2003; van Santbrink and Fauser, 2003). Inclusion criteria: age 18–38 years, BMI < 28 kg/m2, normal ovarian reserve: AMH > 1.25 ng/ml (8.93 pmol/l) or AFC ≥6 (13). Further randomized studies are required to determine whether triggering of oocyte maturation once most follicles are within the size range 12–19 mm can lead to improved oocyte yields compared with traditional determination of day of triggering. For these patients, the highest coefficient of determination for the number of oocytes retrieved was for follicle size category 9–14 mm r2 0.478 (P < 0.0001), and for the number of mature oocytes also for follicle size category 9–14 mm r2 0.444 (P < 0.0001). Studies evaluating kisspeptin as a trigger of oocyte maturation used a denominator of follicles ≥14 mm on day of trigger to compare trigger efficacy following different doses and demonstrated a reasonable dose-response (9). Vuong TNL, Ho MT, Ha TD, Phung HT, Huynh GB, Humaidan P. Gonadotropin-releasing hormone agonist trigger in oocyte donors co-treated with a gonadotropin-releasing hormone antagonist: a dose-finding study. doi:10.1210/jc.2015-2332, 10. Byri P, Gangineni A, Reddy KR, Raghavender KBP. Fresh embryo transfer was not carried out in GnRHa- or hCG-triggered cycles. Inclusion criteria: aged 18–34 years, BMI 18–29 kg/m2, early follicular FSH ≤12 IU/l, serum AMH ≥10 pmol/l (≥1.4 ng/ml), both ovaries intact. Venetis CA, Kolibianakis EM, Bosdou JK, Lainas GT, Sfontouris IA, Tarlatzis BC, et al. doi:10.1016/j.fertnstert.2007.11.054, 25. Data from GnRHa triggered IVF cycles were obtained from a single-center randomized controlled trial conducted at My Duc Hospital, Ho Chi Minh City, Vietnam (11). doi:10.1007/s10815-013-0124-9, 20. Baseline characteristics are presented in Table 1, which have in part previously been reported (9–12). GnRHa data were from a randomized controlled trial and hCG data from a case-series conducted at My Duc Hospital, Ho Chi Minh City, Vietnam (10). Wittmaack et al. Hum Reprod (2016) 31:1383–6. Here are the most important contributions of each author: AA, LV, RS, TK, GT, PH, and WD designed the study. Abbara A, Islam R, Clarke SA, Jeffers L, Christopoulos G, Comninos AN, et al. J Clin Invest (2014) 124(8):3667–77. It is widely accepted that the maturity and competence of oocytes change with the size of follicles during controlled ovarian stimulation (1). Levy G, Hill MJ, Ramirez CI, Correa L, Ryan ME, DeCherney AH, et al. Results: Follicles 12–19 mm on the day of trigger contributed the most to the number of oocytes and mature oocytes retrieved. Scattergram (median and interquartile range) of the number of oocytes (A), mature oocytes (B), and zygotes (C) by the proportion of follicles on the day of trigger within the size range 12–19 mm in patients triggered with either hCG or GnRH agonist. doi:10.1093/humrep/13.7.1901, 19. 17mm and above means mature follicle means u can ovulate next 24-36 hours or so. Ideal size for a follicle is between 18mm and 24mm. Reprod Biol Endocrinol (2014) 12(1):31. doi:10.1186/1477-7827-12-31, 33. observed that the odds of retrieving mature oocytes from follicles of 13–15 mm on the day of oocyte retrieval were 70% less compared with follicles > 18 mm (23). Objective: To determine the optimal size of the leading follicle before human chorionic gonadotropin (hCG) administration in cycles with clomiphene citrate (CC) and letrozole, and to examine any differences in the optimal leading follicle size between cycles with CC and letrozole. A further subset of patients triggered with kisspeptin had their final follicle monitoring scan on the day prior to the day of trigger administration (n = 62). Collectively, data from both animal models and humans have demonstrated that exogenous kisspeptin administration stimulates endogenous GnRH release from the hypothalamus (7). The Institutional Review Board (IRB) reference number was NCKH/CGRH_01_2014, and ClinicalTrials.gov registration was NCT02208986. Repeating this analysis comparing patients with the upper tertile for proportion of their follicles within the range 12–19 mm with the lowest tertile revealed an increase in the number of oocytes of 5.4 oocytes and 4.7 mature oocytes (P < 0.0001) for hCG and 4.8 oocytes and 4.9 mature oocytes (P < 0.01) for GnRHa triggering. Your doctor will monitor your ovaries via ultrasound and give you the green light to do the trigger shot when your follicles are of a size that your clinic specifies. Recently, kisspeptin has been used to induce oocyte maturation during IVF cycles with low rates of OHSS even in high risk women (8). Ovarian kisspeptin expression was undetectable in immature oocytes, but increased at ovulation (38). Go by ur RE advise but do BD from day 10 u know ? Hum Reprod (2011) 26(5):1091–6. Thus, while similar results were observed for kisspeptin as for other triggers, it is interesting to note that some smaller follicles could also contribute to the number of oocytes retrieved for kisspeptin more so than for other triggers (see Tables 2 and 3). Women were aged 18–38 years with a body mass index (BMI) 18–29 kg/m2 and had antral follicle counts 4–87. Hum Reprod (1998) 13(7):1912–5. The editor and reviewers' affiliations are the latest provided on their Loop research profiles and may not reflect their situation at the time of review. Conversely, Tan and colleagues randomized patients to trigger either once the lead follicle was 18 mm, or 1 day later, or 2 days later and observed no differences in the number of oocytes retrieved (30). (2) observed that follicles of 16–23 mm on the day of oocyte retrieval had higher fertilization rates (68%) than either follicles < 16 mm (56%) or those >23 mm (56%) (2). Thus, one could hypothesize that while all follicles of sizes between 12 and 19 mm contributed to the number of oocytes retrieved, perhaps only oocytes derived from larger follicles in this range (e.g., 16–19 mm) would contribute to the number of zygotes and embryos formed. Reproduction (2017) 154(4):355–62. ), estrogen 17,969 2 days before trigger … However, while it is possible to speculate that kisspeptin could enhance oocyte maturation in combination with gonadotropin exposure, it is unlikely that in vivo administration can lead to oocyte maturation in the absence of a gonadotropin-response (9). Follies grow 2 mm a day. This paper presents independent research funded by grants from the MRC, BBSRC, and NIHR and supported by the NIHR/Wellcome Trust Imperial Clinical Research Facility and Imperial Biomedical Research Centre. This was repeated from a baseline of 9 mm, then 10 mm, and so on such that every possible category of follicular size was derived. We observed that the tertile of patients with the highest proportion of oocytes within this size range on the day of trigger, retrieved ~50% more oocytes than patients with the lowest proportion of their follicles within this range. doi:10.1016/j.rbmo.2017.12.014, 15. doi:10.1016/j.rbmo.2013.07.008, 14. IVF treatment involves the administration of supra-physiological doses of follicle-stimulating hormone (FSH) to induce the growth of multiple ovarian follicles. Lessons on the size of follicle from which mature oocytes can be retrieved can also be learned from studies of in vitro maturation (IVM) (34). The study was designed, conducted, analyzed, and reported entirely by the authors. with methotrexate) was considered a prospective triggering factor for lymphoproliferative disorders [ 132 ]. That it's either a cycst (which I'm pretty sure it's not) or the egg is "over mature"?? We used a third approach termed “random forest model,” which is a type of “ensemble modeling” utilizing modern machine learning technology (17). Triwitayakorn A, Suwajanakorn S, Pruksananonda K, Sereepapong W, Ahnonkitpanit V. Correlation between human follicular diameter and oocyte outcomes in an ICSI program. Haas J, Zilberberg E, Dar S, Kedem A, Machtinger R, Orvieto R. Co-administration of GnRH-agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles – a preliminary report. All subjects gave written informed consent in accordance with the Declaration of Helsinki and Good Clinical Practice. Fertil Steril (2008) 90(3):684–90. The current method of determining the day of trigger administration once two to three lead follicles are 17–18 mm in size should lead to a similar day of trigger as most follicles will still be within the size range 12–19 mm. Figure 1. Overall, follicles of 16–22 mm on the day of oocyte retrieval are more likely to contain mature oocytes than smaller follicles, while larger follicles are more likely to contain post-mature oocytes (1). doi:10.3109/09513590.2014.895984, 34. Kisspeptin data were obtained from patients undergoing clinical trials at Hammersmith Hospital, London (9, 11, 12). Design: Retrospective analysis to determine the size of follicles on day of trigger contributing most to the number of mature oocytes retrieved using generalized linear regression and random forest models applied to data from IVF cycles (2014–2017) in which either hCG, GnRHa, or kisspeptin trigger was used. Rosen et al. All patients included had a final ultrasound scan to assess follicle sizes on the morning of trigger. It is widely accepted that ovarian follicles that are “too small” are less likely to respond suitably to trigger administration and yield a mature oocyte (1). Commensurate with this, Castellano observed that kisspeptin expression increased in a cyclical manner during the menstrual cycle of a rodent model, predominantly localized to the theca layer of growing follicles and the corpora lutea (38). Table 5. Reprod Biol Endocrinol (2014) 12:107. doi:10.1186/1477-7827-12-107, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Ross R. Comparison of human chorionic gonadotropin and gonadotropin-releasing hormone agonist for final oocyte maturation in oocyte donor cycles. a prospective randomized. Jayasena CN, Abbara A, Comninos AN, Nijher GMK, Christopoulos G, Narayanaswamy S, et al. First-pass analysis using simple linear regression of the number of oocytes retrieved vs the number of follicles on day of trigger in each category of follicle size determined that the highest coefficient of determination to be at follicle size category 12–17 mm for hCG r2 0.433 (P < 0.0001); 10–14 mm for GnRHa r2 0.512 (P < 0.0001); and 7–18 mm for kisspeptin r2 0.246 (P < 0.0001). Clinical definition paper on in vitro maturation of human oocytes. Fertil Steril (2004) 82(1):102–7. While, follicles in the center as well as the periphery, are seen in normal induced multicystic ovaries 4. Endocrinol., 25 April 2018 doi:10.1093/humrep/dew109, 35. Our model predicts that the number of oocytes retrieved from patients with 20 follicles on the day of trigger would increase from a mean of 9.8 (95% prediction limit 9.3–10.3) to 14.8 (95% prediction limit 13.3–16.3) oocytes due to the difference in follicle size profile alone (P < 0.001). , Tuong HM, Wong PC, Howles CM X, Luo Y, Xu Y, Xu,... 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