oocyte retrieval

Progesterone levels are critical for endometrial receptivity and implantation success in assisted reproductive technology (ART). The purpose of the current study was to determine whether serum progesterone levels on oocyte retrieval day predict pregnancy success in fresh embryo transfers.

This prospective cross-sectional study was conducted at a university-affiliated infertility clinic in Tehran, Iran, in 2024. Blood samples were collected to analyze serum levels of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) using standardized methods. Student’s t-test and the Mann-Whitney U test were conducted for primary comparisons. Logistic regression was applied to adjust for covariates. The optimal progesterone cutoff was calculated by receiver operating characteristic (ROC) curve. The level of statistical significance was 0.05.

Ninety-one infertile women participated in the study, with a mean age of 35.56±4.45 years and a mean BMI of 25.98±2.2. Among those who under-went fresh embryo transfer (n=63), 21 had positive serum β-hCG results, and fetal heart rate was detected via ultrasound in 17 patients at six weeks. Proges-terone levels were significantly higher in the pregnancy-confirmed group (8.46 ng/ml) in comparison to the non-pregnant group (5.95 ng/ml, p=0.005). Similarly, patients with clinically confirmed pregnancies (detection of fetal heart rate) had significantly higher progesterone levels (8.38 ng/ml) compared to those without clinical pregnancy (6.19 ng/ml, p=0.02). A cutoff of 7.1 ng/ml predicted chemical pregnancy with 76.2% sensitivity and a cutoff of 7.55 ng/ml predicted clinical pregnancy with 71% sensitivity.

Elevated serum progesterone levels on the day of oocyte retrieval may predict positive pregnancy outcomes, highlighting the importance of moni-toring progesterone to optimize the success rate of ART.

Superovulation is a crucial component of assisted reproductive technology. Inducing superovulation with Gonadotropin-releasing hormone (GnRH) can lead to ovarian hyperstimulation, potentially affecting reproductive outcomes.

This study aimed to examine the effects of GnRH treatment on superovulation response and embryo recovery in Holstein heifers.

Twenty-one Holstein heifers (age: 135.15 months; weight: 361.05 kg) were selected based on their general health status and ovarian function. All heifers received two consecutive doses of prostaglandin F2α and underwent superovulation. The heifers were inseminated twice: Once at the onset of standing estrus and again 12 hours later. In the treatment group (13 heifers), a single dose of GnRH was administered simultaneously with the second insemination. The superovulation response was evaluated based on the number of corpus luteum (CL), unovulated follicles (UoF), total recovered embryos/ova, and the number of transferable embryos, using logistic regression with the GENMOD procedure in SAS.

The mean number of CL was not significantly greater in the control group (13.6) compared to the GnRH group (11.4). The average number of UoF was similar between the two groups (P = 0.1853). However, the control group had a significantly higher average total number of recovered embryos/ova (7.7) compared to the GnRH group (2.1). Additionally, the control group progesterone more transferable embryos, with an average of 2.5, while the GnRH group averaged 0.7 (P < 0.0062).

Gonadotropin-releasing hormone likely deactivated the oviduct by disrupting the balance of estradiol and estrogen, leading to a reduction in both the total number of embryos and the number of transferable embryos in heifers.

COVID-19 can have potential pathogenic effects on the oocyte and embryos, but there is limited data about its impact. This study aimed to investigate the COVID-19 impact on the outcome of Assisted Reproduction Techniques (ART) methods.

This case-control study was conducted on 190 infertile women who underwent oocyte retrieval at Yas Hospital in vitro fertilization (IVF) department affiliated to Tehran University of Medical Sciences, from October 2021 to October 2022. The case group was defined as women whose PCR test was positive on puncture day and the control group was women with COVID-19 negative tests on puncture day. The study outcome measurements included the number of oocytes retrieved and the number and quality of embryos. Finally, the data were analyzed by SPSS 24.

The mean age of the participants was 32.89 ± 5.58 years with an age range of 18-49 years. No significant difference was observed between the two groups regarding baseline variables.  The mean number of oocytes was significantly (p =0.001) lower in the case (6.68±4.25) group versus the control (9.07±4.10) group. While there was no statistically significant difference regarding the mean number of embryos in the study groups, No grade A embryos were observed in more than half (57.5%) of the women in the case group. Furthermore, the frequency of grade C embryos on average was 1.08±1.11 in the case group and 0.57±0.75 in the control group, with a statistically significant difference (p =0.010).

The findings of this research highlighted that women infected with COVID-19 on the puncture day have a lower number of oocytes and also good-quality embryos.

The occurrence of ovarian hematoma during controlled ovarian stimulation (COS) is very rare. Until now, there is no such case reported in the literature. In this study, an attempt was made to discuss the possible mechanisms for the development of hematoma in such patients, the clinical presentation, monitoring, and management of these cases.

A rare case of periovarian hematoma was reported in a patient with a history of endometriosis undergoing ovarian stimulation for in vitro fertilization. On the seventh day of stimulation, the patient complained of severe pain in the abdomen. Her vitals and blood investigations were within normal limits. On abdominal examination, mild tenderness was noted in the left iliac fossa. On vaginal examination, fullness and tenderness were noted in the left fornix. On ultrasound, probe tenderness was present and a left ovarian hematoma measuring 2.0x1.81x1.55 cm was observed. She was managed conservatively. The hematoma exhibited a gradual reduction following the pick-up procedure and eventually resolved completely within a month.

Underlying endometriosis could be one of the possible causes of this periovarian hematoma. A conservative approach with close monitoring forms the first-line management in hemodynamically stable patients.

The presence of anesthetic drugs in the serum with potential negative effects on hormone concentration and pregnancy rate has been shown in a number of human research. To assess the effects on blood hormone concentration and pregnancy rate of two different medications (remifentanil vs. fentanyl) used for general anesthesia during oocyte retrieval.

the present prospective comparative study was conducted at Iraq's "High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/Al-Nahrain University/Baghdad/Iraq" infertility center and was approved by Mansoura University for its validity. Sixty infertile women who were having (ICSI) for a range of infertility-related reasons that entered the study. The women's ages varied from 20 to 45 years. The study's length was extended from September 2022 to September 2023. According to the general anesthetic protocol for oocyte retrieval, those patients were divided into two groups. Midazolam, propofol, and fentanyl were given to the group one, while remifentanil, midazolam, and propofol were given to the group two.

Compare the hormone levels before and after fentanyl anesthesia. The current study's findings indicated that remifentanil led to a greater pregnancy rate (40.0%) than fentanyl (36.7%). According to the results, there were significantly higher LH levels after fentanyl anesthesia (P = 0.014). However, insignificantly higher FSH (P = 0.481) and prolactin (P = 0.076) levels post-fentanyl anesthesia. Also, significantly higher LH levels after remifentanil anesthesia (P = 0.046), insignificantly higher FSH levels (P = 0.383) and prolactin levels (P = 0.16) after remifentanil anesthesia. In the fentanyl group, the recovery time was substantially longer (P<0.001).

Because of its quicker recovery time and much greater pregnancy rate, remifentanil is preferred over fentanyl in normal general anesthetic treatments for egg harvest in ICSI operations.

Various protocols have been approved to improve the response rate leading to successful fertilizationin poor ovarian responders (PORs). The application of double ovarian stimulation (DuoStim) in the follicular andluteal phases of the same ovarian cycle has been shown as an intriguing option to achieve more oocyte retrievals inthe shortest time. The aim of the current study, is to compare the outcomes of different protocols, minimal stimulation(MS) and Duostim. This randomized clinical trial was performed on 42 in vitro fertilization (IVF) candidateswith POR diagnosis. Patients were classified into two equal groups and treated with the DuoStim protocol and MSprotocol. The IVF outcomes, including retrieved follicles, oocytes, metaphase II (MII) oocytes and embryos, werecompared between these groups. The patients’ characteristics including age, anti-mullerian hormone (AMH), follicle-stimulating hormone(FSH), luteinizing hormone (LH), and antral follicle count (AFC) were collected and compared. It showed there wasno significant difference between the two groups' baseline characteristics (P>0.05). We observed that the DuoStimprotocol resulted in a significantly higher score in comparison with the MS protocols, including the number of follicles(6.23 ± 2.93 vs. 1.77 ± 1.66, P<0.001), retrieved oocytes (3.86 ± 2.57 vs. 1.68 ± 1.58, P=0.002), MII oocytes (3.36 ±2.42 vs. 1.27 ± 1.27, P=0.001) and obtained embryos (2.04 ± 1.64 vs. 0.77 ± 0.86, P=0.003). The DuoStim protocol is a favourable and time saving plan that is associated with more oocytes in a singlestimulation cycle. The DuoStim protocol significantly can result in more frequent MII oocytes and embryos. We figuredthat the higher number of oocytes and embryos might have led to a higher rate of pregnancy (registration number:IRCT20200804048303N1).

Individualized assisted reproductive techniques (ART) can improve ART outcomes. Some studies suggested using insulin-like growth factor-1 (IGF-1) level on cycle day 2 for individualized ART.

To investigate the relationship between serum levels of IGF-1 on day 2 of the cycle and ART outcomes.

In this cross-sectional study, cycle day 2 serum levels of IGF-1 were measured in 175 women aged between 18-44 yr as candidates for in vitro fertilization or intracytoplasmic sperm injection. All participants received antagonist protocol, and the relationship between serum levels of IGF-1 and ART outcomes according to the number of oocytes were investigated; poor responders (oocytes < 5), normal responders (oocytes 5-15), and hyper responders (oocytes > 15).

Poor responders had higher serum level of IGF-1 when compared with normal and hyper-responders; however, this difference was not statistically significant (p = 0.41). The serum levels of IGF-1 in women with zero retrieved oocytes and those cycles that were canceled for the inappropriate ovarian response were not significantly different compared to other women in the group of poor responders. An inverse relationship was observed between the serum level of IGF-1 and anti-Mullerian hormone. Furthermore, no significant relationship between serum level of IGF-1 with age, body mass index, number of 2 pronucleus, and number of embryos was observed.

According to our results, the serum levels of IGF-1 may not be able to predict ART outcomes. It seems necessary to conduct more studies with larger sample size.

There is insufficient data on the impact of severe acute respiratory coronavirus-2 (SARS-CoV-2) on the reproductive tissues, its possible risk of cross-contamination, transmission and adverse effect on in vitro fertilization (IVF) outcome. Until today, there is no report associated with viral RNA in both follicular fluid and embryo culture medium from SARS-COV-2 positive women. In this case report, a 24-year-old woman with SARS-CoV-2 was presented. We investigated the SARS-COV-2 positivity in the follicular fluid and embryo culture medium of mildly symptomatic woman on oocyte pick up (OPU) day. We could not detect viral RNA in neither the follicular fluid nor the embryo culture medium. In addition, although the response of ovarian stimulation was normal, the number and maturity of the retrieved oocytes were low.

Several mediators play an important role in implantation. One of these mediators is human chorionic gonadotropin (HCG).

To evaluate the effects of HCG intrauterine injection on the day of oocyte retrieval on the result of assisted reproductive techniques (ART).

In this randomized clinical trial study, 126 women who were referred to Afzalipour Infertility Center between December 2018 to December 2019 undergoing in vitro fertilization/intracytoplasmic sperm injection cycles were enrolled and assigned to two groups of: a case (n = 62) and a control group (n = 64). The protocols for both groups were the same; except that the case group was injected with the protocols for both groups were the same, except that the case group was injected with 1000 IU of HCG into uterine cavity following the oocyte puncture, while no medication was administered to the control group. The implantation rate, chemical pregnancy, clinical pregnancy, and abortion rates were compared between the two groups.

Positive chemical pregnancy was seen in 15 (27.3%) cases of the case group and 14 (25.5%) of the control group. No significant difference was seen in the chemical and clinical pregnancy rates between the groups. The abortion rate was higher in the control group but that was not significant.

A 1000 IU of HCG intrauterine injection after oocyte retrieval does not improve implantation, chemical or clinical pregnancy rates in ART cycles. Further studies are needed to clearly understand the role of HCG intrauterine injection in the day of oocyte retrieval in ART outcomes.

 Anesthesia is widely used to manage pain and anxiety during oocyte retrieval in vitro fertilization (IVF), but there is probable interference with the results and success rate of IVF.

 The present study compares the effects of general anesthesia (GA) and monitored anesthesia care (MAC) applied in oocyte retrieval.

 The general anesthesia used in this study comprised a fentanyl-propofol mixture to reach hypnotic concentrations. Intravenous ketamine-midazolam were used for MAC before procedures according to prescribed doses. In sum, 180 women were recruited for research while 90 women selected for general and 90 for MAC methods.

 The collected oocytes were higher in number in general group (11.25 ± 4.39) than MAC group (7.03 ± 3.84, P < 0.001), meanwhile, the analyses did not show difference between groups regarding the number of fertilized oocytes (4.52 ± 3.18 vs. 4.15 ± 3.02). The differences in successful pregnancy was not significant.

 Thus, it seems from findings that fentanyl-propofol GA without nitrous oxide is an appropriate alternative to ketamine-midazolam MAC and can be used for IVF oocyte retrieval if GA is demanded.

Many women experience oocyte retrieval during an IVF treatment as a stressful and emotionally difficult situation. Women fear the pain as associated with oocyte retrieval. Based on the existing literature, a coping intervention for oocyte retrieval (CIFOR) was developed to deal with the stress and pain during oocyte retrieval. The objective of this study was to explore the experiences of women using coping intervention for oocyte retrieval (CIFOR) while undergoing oocyte retrieval.

For this generic qualitative study, a purposeful sample of fifteen women was gathered from a university clinic in the Netherlands and each participant was interviewed. Background information about the IVF treatment was collected from medical files. Semi-structured interviews were performed approximately 15 min after the OR procedure. Data were analyzed using the Qualitative Analysis Guide of Leuven and processed using MAXQDA.

Twenty-five women were approached for this study between January and May 2018. This study identified five themes that were important in the experiences of women using CIFOR: highly valuing the CIFOR, feasible in daily practice, need for information, sense of control and partner’s involvement. 

Women highly valued the tool. They found CIFOR feasible in daily practice and it fulfilled their needs for information. In addition, women had a sense of control using the intervention. Future research will involve performing a pilot study according to the Medical Research Council framework with outcomes based on the patient’s sense of control, ability to cope, coping strategies, anxiety and pain.

Severe pelvic infections following ultrasound-guided transvaginal oocyte retrieval (TVOR) are rare but challenging. Ovarian abscess formation is one of the consequences and management of such cases as highly debated in pregnant patients. In this case report, an early fetal loss following laparoscopic management of ovarian abscess is described and possible etiologies are discussed.

Case:We discuss 3 clinical cases of tubo-ovarian abscess in women with endometriosis after oocyte retrieval despite antibiotic prophylaxis between 2004 and 2011 at our center, and discuss our experience in the context of earlier reports. It is unclear whether antibiotic prophylaxis is necessary in these women, and which antibiotic is best. Only douching with povidone-iodine appears to decrease the rate of pelvic infection. Pelvic inflammatory disease with progression to pelvic abscess is a rare complication after oocyte retrieval during in vitro fertilization cycles. However, in patients with endometriosis the risk appears to be increased. Many authors agree on the need for antibiotic prophylaxis during the oocyte retrieval in these patients, but there is no consensus regarding the best antibiotic.

This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection (ICSI). After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group (n=96) comprised oocytes derived from the leading follicle of the cohort and the small follicle group (n=920) consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of topquality embryos were compared between groups by Chi-square or Fisher’s exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II (MII) stage (100 vs. 70.0%, p<0.001). However we observed no significant differences regarding the percentage of degenerated oocytes between the large (6.25%) and small follicle (5.0%) groups (p=0.550). Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort (OR: 1.81, p=0.046). The fertilization rate (50.0 vs. 38.8%, p=0.038) and the percentage of top quality embryos (84.7 vs. 76.4%, p=0.040) were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle (15.0%) and small follicle (12. 8%) groups (p=0.550). Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities.

Pelvic inflammatory disease (PID) is a rare complication of transvaginal oocyte retrieval. Itmay result in failure of assisted reproductive techniques (ART). During a 7 years period, 5958transvaginal ultrasound-guided oocyte retrievals resulted in 10 cases of acute PID. Eight out of 10patients were diagnosed infertile because of endometriosis. Two patients had mild ovarian, 3 hadstage III, and 2 had stage IV endometriosis. One patient had a 3-4 cm ovarian endometrioma.After treatment, no mortality was encountered among the 10 patients, although none of themconceived. This observation supports the previous reports that endometriosis can raise the risk ofPID after oocyte retrieval. More vigorous antibiotic prophylaxis and better vaginal preparationare recommended when oocyte pickup is performed in patients with endometriosis.