الفهرس 
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Abstract
The time from hCG administration to OPU is the period of oocyte maturation in vivo, and it has a predominant effect on the success of IVF, either by in vitro insemination or ICSI. The standard recommended interval from hCG administration to oocyte pickup (OPU) is 34–38 hours. This ensures the completion of follicular development and oocyte maturation in most cases and significantly reduces the risk of spontaneous ovulation (Bokal et al., 2005).
The scientific literature varies regarding the ideal time interval between oocyte maturation trigger and aspiration. Some studies have found that longer lag times do not lead to more mature oocytes or better clinical results, whereas other studies have found that longer lag times may produce more mature oocyt or improve other clinical parameters (Griffin et al., 2012).
The current study aimed to find the relationship between the time from ovulation trigger to oocyte retrieval and the pregnancy outcome in a total of 12,472 women who underwent IVF/ICSI cycle during the interval between January 2016 and December 2017.
Type of the study: Retrospective study.
Study settings: Ain Shams university IVF and Infertility Center
Inclusion criteria:
1. Women who underwent oocyte retrieval after controlled ovarian hyperstimulation, and fresh embryo transfer at the same stimulation cycle.
2. Women who received urinary human chorionic gonadotropin (u-hCG) to trigger ovulation.
Exclusion criteria:
1. Women who had embryo transfer cancelled for any reason (e.g. no fertilized oocytes, severe early-onset ovarian hyperstimulation syndrome [OHSS]).
2. Women who received recombinant hCG (r-hCG) or gonadotropin releasing hormone agonist (GnRHa) to trigger ovulation.
The study did not include any intervention. Data were retrieved from patient electronic databases and files. Demographic data, hormone treatments, ovarian response, as well as from direct phone calls, and the time of ovulation trigger and oocyte aspiration were recorded.
All IVF/ICSI cycles during the assigned time interval were checked for eligibility. All eligible cycles are to be included in the study.
1. Files of the eligible cycles were revised and the following data were retrieved and noted:
a. Age.
b. Parity.
c. Body mass index [calculated as the weight (kg) divided by the squared height (m2)].
d. Indication for IVF/ICSI.
e. Husband’s semen parameters.
f. Ovarian reserve parameters (basal serum FSH, serum AMH, and antral follicular counbt [AFC]).
g. Protocol for ovarian stimulation.
h. Total dose of gonadotropin used.
i. Total duration of ovarian stimulation.
j. Expected no. of retrieved oocytes.
k. Peak serum E2 level.
l. Dose of u-hCG given.
m. Duration between the time of u-hCG injection and the time of oocyte retrieval.
n. No. of retrieved oocytes.
o. Notes regarding signs suggestive of ovulation (free pelvic fluid and collapsed follicles).
p. Pre-insemination incubation period.
q. No. of mature oocytes (MII).
r. No. of oocytes subjected to conventional IVF.
s. No. of fertilized oocytes.
t. No. of available embryos.
u. No. of embryos which reached blastocyst stage.
v. Day of embryo transfer (2, 3, 4, 5 or 6).
w. No. of transferred embryos.
2. Eligible women were contacted through phone calls to retrieve the following data:
a. Biochemical pregnancy outcome.
b. Clinical and ongoing clinical pregnancy outcome.
c. No. of gestational sacs.
The results of this study showed that, there were no significant differences between women who received long GnRHa protocol, women who received short GnRHa protocol and those who received GnRHant protocol for peak serum E2 level, % of MII oocytes or fertilization rate. The duration of COH was and total dose of gonadotropins, no. of oocytes retrieved, were, however, significantly higher among women who received long GnRHa protocol.
The rate of premature ovulation was significantly higher in GnRHant protocol when compared to long and short GnRHa protocols [16.7% vs. 2.2% vs. 12.4%, respectively, p<0.001].The rate of blastocyst-stage ET were significantly higher in long GnRHa protocol when compared to short GnRHa and GnRHant protocol [88.1% vs. 86.1% vs. 83.9%, respectively, p<0.001].The clinical pregnancy rate was significantly higher in women who received long GnRHa protocol when compared to those who received short GnRHa and GnRHant protocols [62.1% vs. 60.5% vs. 57.1%, respectively, p=0.003].
There were no significant difference between women who had cleavage-stage ET and women who had blastocyst-stage ET as regard the duration of COH, total dose of gonadotropins, % of MII oocytes or fertilization rate.The peak serum E2, no. of retrieved oocytes and clinical pregnancy rate were, however, significantly higher in women who had blastocyst-stage ET.
There was significant yet poor negative correlation between age and each of no. of retrieved oocytes and % of MII oocytes in included women.There were no significant correlations between each of duration of COH and total dose of gonadotropins and each of no. of retrieved oocytes and % of MII oocytes in included women.There was a significant and good positive correlation between peak serum E2 level and no. of retrieved oocytes (rs=0.854 p<0.001), but no significant correlation between peak serum E2 level and % of MII oocytes.
There was significant yet poor correlation between hCG-to-OR interval and no. of retrieved oocytes. There was significant and good positive correlation between hCG-to-OR interval and each of % of MII oocytes (rs=0.568, p<0.001) and fertilization rate (rs=0.550, p<0.001).
An hCG-to-OR interval ≥ 37.6 hours was significantly associated with premature ovulation with a sensitivity of 100%, a specificity of 84.9%, an LR+ of 6.62 and an LR- of 0.
An hCG-to-OR interval ≥ 35.99 hours was significantly associated with retrieval of ≥ 70% MII oocytes with a sensitivity of 92%, a specificity of 100%, an infinite LR+ and an LR- of 0.08.
An hCG-to-OR interval ≥ 36.47 hours was significantly associated with positive clinical pregnancy with a sensitivity of 70.1%, a specificity of 63.7%, an LR+ of 1.92 and an LR- of 0.82.