Abstract：
OBJECTIVE: To determine the minimum follicular volume on the day of trigger that will correspond to a mature oocyte at egg retrieval by individualized follicular puncture and to calculate the mean follicular growth from ovulation induction to egg retrieval using SonoAVCfollicle.
METHODS: A prospective observational study of 53 women undergoing in vitro fertilization, in which it was possible to identify unequivocally one or more follicles at trigger and egg retrieval using three-dimensional ultrasound.
METHODS: University-affiliated private in vitro fertilization center.
METHODS: The final sample included 206 follicles from 14 oocyte donors and 39 patients.
METHODS: A three-dimensional ultrasound with SonoAVCfollicle was performed at trigger and egg retrieval. The same operator selected follicles that were identified easily on both scans and verified that they were apt to be aspirated individually. Follicles were punctured individually, recording the real aspirated volume and the maturity stage of the oocyte.
METHODS: The primary outcome was the relationship between follicular volume on the day of the trigger and the oocyte maturity stage. The secondary outcome was the rate of follicular growth from the day of trigger to the day of oocyte retrieval, as measured using SonoAVCfollicle.
RESULTS: On the day of trigger 206, follicles were selected. Of these, 5 could not be identified on the day of oocyte retrieval, probably because of follicular rupture (mean volume: 4 cm3, range: 2-7 cm3), and in 48, an oocyte was not obtained. The relationship between follicular volume and oocyte maturity was studied in 153 follicles: 125 (82%) contained mature and 28 (18%) contained immature oocytes. Receiver operating characteristic curves showed an area under the curve value of 0.73 (95% confidence interval: 0.65-0.80). A follicular volume of >0.56 cm3 is the cutoff point, with the highest Youden index having a sensitivity of 85% and a specificity of 64% to predict oocyte maturity. The mean follicular growth from trigger to egg retrieval was 26%-50% in 53% of cases.
CONCLUSIONS: A follicular volume of >0.56 cm3 at trigger is the cutoff point with the optimal balance between sensitivity and specificity for oocyte maturity. Follicles of >2-3 cm3 may undergo spontaneous rupture before egg retrieval. Given these findings, we propose new volume-based criteria for trigger: 70% of follicles of >0.6 cm3 and dominant follicles between 2 and 3 cm3. These findings need validation by randomized controlled trials.
METHODS: A prospective observational study of 53 women undergoing in vitro fertilization, in which it was possible to identify unequivocally one or more follicles at trigger and egg retrieval using three-dimensional ultrasound.
METHODS: University-affiliated private in vitro fertilization center.
METHODS: The final sample included 206 follicles from 14 oocyte donors and 39 patients.
METHODS: A three-dimensional ultrasound with SonoAVCfollicle was performed at trigger and egg retrieval. The same operator selected follicles that were identified easily on both scans and verified that they were apt to be aspirated individually. Follicles were punctured individually, recording the real aspirated volume and the maturity stage of the oocyte.
METHODS: The primary outcome was the relationship between follicular volume on the day of the trigger and the oocyte maturity stage. The secondary outcome was the rate of follicular growth from the day of trigger to the day of oocyte retrieval, as measured using SonoAVCfollicle.
RESULTS: On the day of trigger 206, follicles were selected. Of these, 5 could not be identified on the day of oocyte retrieval, probably because of follicular rupture (mean volume: 4 cm3, range: 2-7 cm3), and in 48, an oocyte was not obtained. The relationship between follicular volume and oocyte maturity was studied in 153 follicles: 125 (82%) contained mature and 28 (18%) contained immature oocytes. Receiver operating characteristic curves showed an area under the curve value of 0.73 (95% confidence interval: 0.65-0.80). A follicular volume of >0.56 cm3 is the cutoff point, with the highest Youden index having a sensitivity of 85% and a specificity of 64% to predict oocyte maturity. The mean follicular growth from trigger to egg retrieval was 26%-50% in 53% of cases.
CONCLUSIONS: A follicular volume of >0.56 cm3 at trigger is the cutoff point with the optimal balance between sensitivity and specificity for oocyte maturity. Follicles of >2-3 cm3 may undergo spontaneous rupture before egg retrieval. Given these findings, we propose new volume-based criteria for trigger: 70% of follicles of >0.6 cm3 and dominant follicles between 2 and 3 cm3. These findings need validation by randomized controlled trials.
摘要：
目的：确定触发当天的最小卵泡体积，该最小卵泡体积对应于通过个性化卵泡穿刺取卵时的成熟卵母细胞，并计算从排卵诱导到SonoAVC™卵泡取卵的平均卵泡生长。
方法：对53名接受试管婴儿的妇女进行前瞻性观察研究，通过三维超声可以明确识别触发和取卵时的一个或多个卵泡。
方法：大学附属的私人IVF中心。
方法：最终样品包括来自14个卵母细胞供体和39名患者的206个卵泡。
方法：在触发和取卵时使用SonoAVC™卵泡进行三维超声。相同的操作者选择在两次扫描中容易识别的卵泡,并验证它们易于单独抽吸。卵泡被单独刺穿，记录卵母细胞的实际抽吸量和成熟阶段。
方法：主要结果是触发当天卵泡体积与卵母细胞成熟期之间的关系。次要结果是通过SonoAVC™卵泡测量的从触发当天到卵母细胞取出当天的卵泡生长速率。
结果：在触发当天选择206个卵泡。其中,5在取卵当天无法识别，可能是由于卵泡破裂（平均体积4cm3，范围2-7），并且在48中未获得卵母细胞。研究了153个卵泡中卵泡体积与卵母细胞成熟度的关系,125(82%)成熟和28(18%)未成熟。ROC曲线显示0.73的曲线下面积(95CI:0.65-0.80,p<0.001)。>0.56cm3的卵泡体积是具有最高Youden指数的切点,其具有85%的灵敏度和64%的特异性以预测卵母细胞成熟度。在53％的病例中，从触发到取卵的平均卵泡生长为26-50％。
结论：触发时>0.56cm3的卵泡体积是卵母细胞成熟度敏感性和特异性之间最佳平衡的临界点。>2-3cm3的卵泡在取卵前可能会自发破裂。鉴于这些发现,我们提出了新的基于体积的触发标准:70%的卵泡>0.6cm3,优势卵泡在2~3cm3之间.这些需要随机对照试验的验证。
方法：对53名接受试管婴儿的妇女进行前瞻性观察研究，通过三维超声可以明确识别触发和取卵时的一个或多个卵泡。
方法：大学附属的私人IVF中心。
方法：最终样品包括来自14个卵母细胞供体和39名患者的206个卵泡。
方法：在触发和取卵时使用SonoAVC™卵泡进行三维超声。相同的操作者选择在两次扫描中容易识别的卵泡,并验证它们易于单独抽吸。卵泡被单独刺穿，记录卵母细胞的实际抽吸量和成熟阶段。
方法：主要结果是触发当天卵泡体积与卵母细胞成熟期之间的关系。次要结果是通过SonoAVC™卵泡测量的从触发当天到卵母细胞取出当天的卵泡生长速率。
结果：在触发当天选择206个卵泡。其中,5在取卵当天无法识别，可能是由于卵泡破裂（平均体积4cm3，范围2-7），并且在48中未获得卵母细胞。研究了153个卵泡中卵泡体积与卵母细胞成熟度的关系,125(82%)成熟和28(18%)未成熟。ROC曲线显示0.73的曲线下面积(95CI:0.65-0.80,p<0.001)。>0.56cm3的卵泡体积是具有最高Youden指数的切点,其具有85%的灵敏度和64%的特异性以预测卵母细胞成熟度。在53％的病例中，从触发到取卵的平均卵泡生长为26-50％。
结论：触发时>0.56cm3的卵泡体积是卵母细胞成熟度敏感性和特异性之间最佳平衡的临界点。>2-3cm3的卵泡在取卵前可能会自发破裂。鉴于这些发现,我们提出了新的基于体积的触发标准:70%的卵泡>0.6cm3,优势卵泡在2~3cm3之间.这些需要随机对照试验的验证。
