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Lab Attendence

Lab 1 Assessment

Article 1

PMCID: PMC4524365 Progesterone elevation on the day of human chorionic gonadotropin administration adversely affects the outcome of IVF with transferred embryos at different developmental stages

The effect progesterone evaluation (PE) during fresh invitro fertilisation (IVF) cycles after hCG administration for oocyte maturation is still unclear. To overcome the possible effect cleavage-stage embryo’s are replaced with blastocyst-stage embryos before transfer which are suggested to be unaffected by PE, however it is unclear if the results are reliable. Therefore a study was conducted to investigate the link between PE on the day hCG is administrated and the clinical pregnancy rate (CPR) following IVF/intracytoplasmic sperm injection cycles after embryo transfer at different stages. The levels at which PE had a detrimental effect on CPR was also investigated.

A retrospective study was conducted on a cohort of patients undergoing IVF with gonadotropin and GnRH agonist for ovarian stimulation at a single-centre. Patients were then spilt into two groups, one undergoing cleavage-stage embryo transfer at day 3, and the other undergoing blastocyst-stage transfer at day 5. Patients were assessed clinically to undergo the standard long GnRH protocol or a prolonged protocol.

The pituitary was suppressed by injecting Triptorelin acetate or Diphereline. This was followed by gonadotropin, FSH activity or FSH and LH activity to initiate ovarian stimulation. Oocyte retrieval was conducted and embryo quality graded. CPR was measured as well as implantation rate, fertilisation rate and cleavage rate. Statistical analysis was performed.

It was found that in the day 3 and day 5 group, serum progesterone levels are inversely related to CPR. The detrimental affect of progesterone became evident once serum progesterone reached 1.0ng/ml in the day 3 group and 1.75ng/ml in the day 5 group. The developmental stage at which embryos were transferred was not found to be statistically significant. Therefore it is concluded that on the day that hCG is administered PE was found to decrease CPR in GnRH IVF cycles despite developmental stage of transfer.

Article 2

PMCID: PMC4518483 Cut-Off Levels of Anti-Mullerian Hormone for The Prediction of Ovarian Response, In Vitro Fertilization Outcome and Ovarian Hyperstimulation Syndrome

The role of Anti-mullerian hormone (AMH) in the ovary is to inhibit the early stages of follicular development. It appears to be a reliable marker for the number of small antral follicles and as a result can help determine the plan for ovarian stimulation. AMH also decreases from adulthood onwards, and so can help indicate reduced ovarian reserve and dysfunction. Ovarian hyper stimulation syndrome (OHSS) patients have high serum AMH. A study was conducted to compare the average and cut-off AMH levels after oocyte attainment after ovarian stimulation and the association with pregnancy rates. AMH levels endocrinological and pathological risk factor patients were also compared to patients without the risk factors.

Serum and follicular fluid (FF) was collected from patients in their first or second IVF and ICSI cycles. Patients were analysed and their pathological factors compared to normal patients. The correlation between serum and FF AMH levels and the correlation between serum AMH, estradiol, number of follicles, injected dose of recombinant FSH (rFSH - used to induce ovarian stimulation after down-regulation with GnRH agonist) and patient age was analysed. The average and cut-off level of AMH was also evaluated in low, moderate or high responders to ovarian stimulation and pregnancy rates. Three analysis were conducted were AMH levels were analysed. They included one where ovary overreaction was induced (OHSS) and one for polycistic ovarian syndrome (PCOS) which were compared against the third analysis of normal endocrinological patients.

It was found that AMH levels were significantly higher in FF than serum where AMH levels increased with increasing response in both. There was a positive correlation present between AMH levels and estradiol, number of follicles, number of retrieved oocytes and number of fertilised oocytes where AMH levels increased with each factor as response increased, as well as a inverse correlation with age. The median AMH level in serum (1.76 ng/ml) and FF (2.9 ng/ml) was higher in patients who became pregnant than those who did not (1.0ng/ml in serum and 1.8 ng/ml in FF). AMH cut off level was 0.61 ng/ml in serum and 1.43 ng/ml in FF in low responders, and 1.03 ng/ml in serum and 2.23 ng/ml in FF in high responders. OHSS and PCOS patients had lower level of injected rFSH, higher follicle numbers which suggests higher estradiol than normal patients. Higher oocytes were retrieved from OHSS patients. Normal patients had the lowest AMH, PCOS the highest. In conclusion, AMH can help predict ovarian stimulation response, can be a marker for PCOS and help to avoid OHSS.

References

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