Pre-ovulation prediction and clinical value evaluate for emergency oocyte retrieval in natural cycle
Objective:To investigate the factors related to premature ovulation in natural cycles,and to compare the clinical parameters and pregnancy outcomes of diminished ovarian reserve(DOR)patients with or without emergency oocyte retrieval,and to analyze the clinical value for emergency oocyte retrieval on natural cycle in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods:This was a retrospective cohort study.A total of 815 DOR patients who underwent natural cycle protocol of in IVF/ICSI-ET in Center of Reproductive Medicine of The First Affiliated Hospital,Nanjing Medical University between January 2020 to April 2023 were divided into group A(n=712)and group B(n=103)according to whether the oocytes were ovulated prematurely on the day of retrieval.According to the time of oocyte retrieval after the trigger,groups A and B were further divided into two groups:oocyte retrieval at 36 hours after the trigger(A1 and B1 groups,luteinizing hormone(LH)＜20 U/L on the trigger day)and egg retrieval at 24 hours after the trigger(A2 and B2 groups,LH≥20 U/L on the trigger day).The general data and pregnancy outcomes were compared among these four groups.Results:There were no significant differences in the age,body mass index(BMI),serum level of anti-Mullerian hormone and menstrual status among all groups(P＞0).05).As for the ovulation induction,when the time of oocyte retrieval was the same,there were no statistically significant differences in the maximum follicle diameter,levels of follicle-stimulating hormone(FSH),LH as well as estradiol(E2),and trigger drug types on the third day of the oocyte retrieval cycle when A1 group compared with B1 group and A2 group compared with B2 group(P＞0.05).The average levels of E2,LH and progesterone(P)on the trigger day in group A1 were significantly lower than those in group B1(P＜0.05).The results of the comparison of laboratory and clinical outcomes between group A1 and group A2 showed that the fertilization rate and the cleavage rate of group A1 with normal oocyte retrieval were significantly higher than those of group A2 with early oocyte retrieval,while the rate of no transferable embryos in group A2 was significantly higher than that in group A1(P＜0.05),and there were no statistically significant differences in the rates of unacquired oocyte,embryo formation,high-quality embryo,blastocyst formation,high-quality blastocyst,fresh embryo transfer,and whole embryo freezing between the two groups(P＞0.05).In the fresh embryo transfer cycle,there were no statistically significant differences with regard to human chorionic gonadotropin(hCG)positive rate,clinical pregnancy rate,miscarriage rate,and live birth rate between group A1 and group A2(P＞0.05),but the cumulative hCG positive rate,cumulative clinical pregnancy rate,and cumulative live birth rate in Group A1 were significantly higher than those in Group A2(P＜0.05).Conclusions:For patients with elevated LH on trigger day,emergency oocyte retrieval could only increase the retrieved oocyte number,and has no advantage for the final pregnancy outcomes according to the cumulative pregnancy results.There are no effective indicators to predict the risk of pre-ovulation,especially at the beginning of the natural cycle.
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