12Aug 2018

FOLLICULAR OUTPUT RATE (FORT) MAY PREDICT INTRA CYTOPLASMIC SPERM INJECTION (ICSI) OUTCOME.

  • Department of Obstetrics and Gynaecology.
  • Faculty of Medicine ? Ain Shams University.
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Background: In IVF/ICSI treatment, basal (follicle stimulating hormone) FSH, antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) concentrations are used to assess the basal ovarian reserves and to predict ovarian response and IVF/ICSI outcome. AFC; a non-invasive method, may well represent functional ovarian reserves and is well correlated to the number of oocytes retrieved. However, it cannot predict the oocyte /embryo quality or outcome in IVF/ICSI treatment. Aim of the Work: The aim of the study is to assess the accuracy and usefulness of the Follicular Output Rate (FORT); which was determined as a ratio of pre-ovulatory follicle count (PFC) on day of HCG administration to (AFC)?100, as a predictor of pregnancy outcome after ICSI treatment cycles in infertile women. Patietns and Methods: This prospective cohort study was conducted on quota sampling used to recruit 100 infertile women undergoing ICSI in each of four study groups: polycyctic ovary syndrome (PCOS) group, tubal factor group, endometriosis group and unexplained infertility group, i.e. a total of 400 women were enrolled in the study in the Assisted Reproduction Unit (ART Unit) of Ain Shams University Maternity Hospital and private IVF centres in the period between February 2017 and July 2018. Results: PFC was significantly higher in the PCOS women compared to the other three groups (11.42 ? 4.54, 7.79 ? 4.12, 6.81 ? 0.81 and 7.53 ? 2.61 respectivily). PCOS women who achieved clinical pregnancy had significantly lower FORT than those who didn?t (0.56?0.21,0.66?0.19;P=0.02). Tubal-factor women who achieved clinical pregnancy had significantly higher FORT than those who didn?t (0.66 ? 0.25, 0.53 ? 0.26; P=0.01). Endometriosis women who achieved clinical pregnancy had non significantly different FORT than those who didn?t (0.46 ? 0.19, 0.46 ? 0.17; P=0.99). Unexplained infertility women who achieved clinical pregnancy had significantly higher FORT than those who didn?t (0.62 ? 0.19, 0.53 ? 0.15; P=0.01). Conclusion: FORT may be a predictor of oocyte competence in terms of number of retrieved, mature and fertilized oocytes. The indicator can be used for prediction of clinical pregnancy rate after ICSI. The FORT predictive value, sensitivity, specificity and cut-off values to define poor ovarian responders and whether FORT can be used to determine when to cancel IVF/ICSI cycles for poor ovarian response are questions to be answered by further large scale research and meta-analysis which will undoubtfullycontribute to broaden its clinical applications.

  1. Rijal B, Shrestha R, Jha B. Association of thyroid dysfunction among infertile women visiting infertility center of Om Hospital, Kathmandu, Nepal. Nepal Med Coll J. 2011;13(4):247-9.
  2. Shaheen R, Subhan F, Sultan S, SubhanKh, Tahir F. Prevalence of infertility in a cross section of Pakistani population. Pakistan J Zool. 2010; 42(4): 389-393
  3. Rehman R, Hussain Z, SiddiqAA.Role of Progesterone in human embryo implantation. Rawal Med J 2012; 37(2): 194-198
  4. Rehman R, Hussain Z, ZuberiNA.Prediction of success in intracytoplasmic sperm injection (ICSI) by estimation of serum Estradiol/Progesterone ratio on the day of embryo transfer. J Pak Med Assoc 2013; 63(5): 609-613
  5. Toner JP.Ovarian reserve, female age and the chance for successful pregnancy. Minerva Gincecol 2003; 55(5): 399-406.
  6. Hendriks DJ, Mol B-WJ, Bancsi LF, TeVelde ER, Broekmans FJ.Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. FertilSteril 2005; 83(2): 291-301
  7. Toporcerova S, Adam J, Toporcer T, Hredzak R, Ostro A. Basal concentrations of FSH (follicle stimulating hormone) as a transfer outcome. Hum Reprod. 2006;27(4):1066-72.
  8. Melo MA, Garrido N, Alvarez C, Bellver J, Meseguer M, Pellicer A, Remohı? J.Antral follicle count (AFC) can be used in the prediction of ovarian response but cannot predict the oocyte/embryo quality or the in vitro fertilization outcome in an egg donation program. FertilSteril 2009;91:148?156.
  9. Gallot V, Berwanger da Silva AL, Genro V, Grynberg M, Frydman N, Fanchin R.Antral follicle responsiveness to follicle-stimulating hormone administration assessed by the Follicular Output RaTe (FORT) may predict in vitro fertilization-embryo transfer outcome. Hum Reprod. 2012;27(4):1066-72.
  10. Gougeon A. Regulation of ovarian follicular development in primates: facts and hypotheses. Endocr Rev. 1996;17(2):121-55.
  11. Van Royen E, Mangelschots K, De Neubourg D, Valkenburg M, Van de Meerssche M, Ryckaert G, Eestermans W, Gerris J. Characterization of a top-quality embryo, a step towards single-embryo transfer. Hum Reprod1999; 14:2345?2349
  12. Zhang N, Hao CF, Zhuang LL, Liu XY, Gu HF, Liu S, Chen ZJ. Prediction of IVF/ICSI outcome based on the follicular output rate.Reproductive biomedicine online. 2013 Aug 1;27(2):147-53.
  13. Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. FertilSteril 2009;91:705?714.
  14. H. Lee, C. H. Liu, C. C. Huang, K. C. Hsieh, P. M. Lin, and M. S. Lee, Impact of female age and male infertility on ovarian reserve markers to predict outcome of assisted reproduction technology cycles, Reproductive Biology and Endocrinology, vol. 7, article 100, 2009.
  15. Genro VK, Grynberg M, Scheffer JB, Roux I, Frydman R, Fanchin R. Serum anti-Mullerian hormone levels are negatively related to Follicular Output RaTe (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation. Hum Reprod 2011;26:671?677.
  16. Aboulghar M. Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS. Hum Reprod 2003;18:1140?1141.
  17. Hassan A, Kotb M, AwadAllah A, Wahba A, Shehata N. Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study. Reproductive biomedicine online. 2017 Jun 1;34(6):598-604.
  18. Fanchin R, Schona?uer LM, Cunha-Filho JS, Me?ndez Lozano DH, Frydman R. Coordination of antral follicle growth: basis for innovative concepts of controlled ovarian hyperstimulation. SeminReprod Med 2005;23:354?362.

[Hesham M. Fathy, Sherif F. El-Mekkawi, Ahmed M. El-kotb, Azza A. Abdel-Razek, Amr A. Riad and Omar G. Mustafa. (2018); FOLLICULAR OUTPUT RATE (FORT) MAY PREDICT INTRA CYTOPLASMIC SPERM INJECTION (ICSI) OUTCOME. Int. J. of Adv. Res. 6 (Aug). 608-618] (ISSN 2320-5407). www.journalijar.com

Omar Gamal Farag Mustafa
Department of Obstetrics and Gynaecology Faculty of Medicine – Ain Shams University

DOI:

Article DOI: 10.21474/IJAR01/7559      
DOI URL: https://dx.doi.org/10.21474/IJAR01/7559

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