Oocyte Quantity and Quality

 Abstract

Three decades of clinical experience with assisted reproductive technologies (ART) led to an intimate intertwining between the responses to controlled ovarian stimulation (COS) and actual ART outcome.  In turn the functional testing that predicts COS responses – dubbed ‘ovarian reserve’ – was mistakenly seen as foretelling the degree of remaining fecundity.  The highly publicized ‘ovarian reserve’ concept has now sparked an emerging business of advanced or ‘provisional’ ART for the purpose of saving cryopreserved oocytes for later use in women whose ovarian reserve is diminished.

Is it ethically correct to leave 40% of eggs in the ovary by not flushing using optimal equipment?

More than 50% of colleagues worldwide are not flushing follicles during egg collection.  The primary reason for this are studies, published in the early nineties, comparing egg retrievals using two needles with the same outer diameter (Single Lumen Needles and Double Lumen Needles). All of the authors concluded that that they harvested the same number of oocytes with either needle, but the duration of egg collection procedure took 2 to 3 times longer using the double lumen needles.

Endometrial Biopsy Improves Implantation and Pregnancy Outcome

More than 50% of colleagues worldwide are not flushing follicles during egg collection.  The primary reason for this are studies, published in the early nineties, comparing egg retrievals using two needles with the same outer diameter (Single Lumen Needles and Double Lumen Needles). All of the authors concluded that that they harvested the same number of oocytes with either needle, but the duration of egg collection procedure took 2 to 3 times longer using the double lumen needles. 

Progesterone antagonism for the modulation of the mid cycle LH peak

The small amount of progesterone (P) released by human follicles at their very final stage of maturation plays a central role in the human reproduction. It may anticipate the expansion of the cumulus even before the LH peak and, once the oocyte-cumulus complex has been released into the fallopian tube, it attracts the sperms toward the oocyte 1allowing its fecundation. While facilitating the fecundation process, follicular P also plays as the main trigger of the mid-cycle gonadotropin surge. Indeed, under raising estradiol concentration, hypothalamic cells expose P receptors (PR). These P receptors are extremely sensitive and may react to the very small amounts of hormone, either synthesized within the brain or released from the end stage follicle. The activation of hypothalamic PR triggers the release of a peak of GnRH, which in turn triggers the midcycle gonadotropin surge 2.

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