FOLLICULAR CHARACTERISTIC OF VARIOUS STIMULATION REGIMES FOR ASSISTED REPRODUCTIVE TECHNIQUES

Abstract

This thesis is an investigation of the follicular characteristics, and to assess the results of various stimulation regimes, for patients undergoing In-vitro fertilization (IVF) and Gamete intra fallopian transfer (GIFT). It is based on the IVF-ER and GIFT cycles that were initiated in 1 July 1985 to 30 September 1985 in Kandang Kerbau Hospital and from 1 October 1985 to 30 June 1986 in the National University Hospital. 94 cycles from 79 patients was recruited in this study. From 94 cycles, 50 cycles were under the IVF-ER programme and 44 were under GIFT programme (from 79 patients 45 were under the IVF-ER and 34 were under the GIFT programme). Oocytes recovery was possible in 82 cycles ( 40 cycle were under I VF-ER and 42 under GIFT). There were 68 patients (35 IVF-ER patients and 33 GIFT patients). Oocyte recoveries (OR) were done in the following: Four (out of 5 patients) with CC + hMG stimulation, 11 (out of 14 patients) with FSH stimulation, 2 (out of 5 patients) with CC + FSH stimulation, 6 (out of 8 patients) with hMG stimulation and 45 ( out of 47 patients) with FSH + hMG (2: 1) stimulation. The gonadotrophins were administered daily from day 2 until hCG administration. The follicular response of the administered stimulation regimes was monitored by ultrasound scanning and oestradiol assays. The gonadotrophins dosage was varied for each patient, depending on the results of ultrasound monitoring and oestradiol level. Mean plasma oestradiol level per follicle on the day of hCG administration in the various stimulation regimes were between 420 ± 215.6 pg/ml (Mean ±SO) and 548 ± 314.4 pg/ml, the mean number of follicles were between 4.5 ( ± 1.8 ) and 6.7 ( ± 3.1) follicles; and the mean follicular diameters were between 14.2 ( ± 3.4 ) mm and 15.1 ( ± 3.5) mm. A mean of 4.8 ( ± 0.9 ) follicles were aspirated from a mean of 5.6 ( ± 3.0 ) follicles on ultrasound, with a mean of 3.2 ( ± 2.1) oocytes recovered. Mean duration of each laparoscopy was 34.6 ( ±21.9 ) minutes. The majority of oocytes were obtained in the first three flushes (225 or 85.6% oocytes) and system flush (24 or 11.0% oocytes). The pregnant patients had a mean age of 32.3 ( ± 2.9 ) years. The age range was between 28 and 37 years (from a range of 27 and 45 years for all patients). There were a total of 15 pregnant patients with a pregnancy rate of 22.10c per patient who had OR and 18.3% per cycle with oocyte recovery (or of 19.0% of all patients and 16.0% per recruited cycle). Pregnancies were only obtained from 2 stimulation regimes. Firstly FSH stimulation: 3 pregnancies out of 17 cycles ( 170c) with 2 ( I u:s;;-) deliveries. Secondly from FSH + hMG stimulation regimes 12 pregnancies out of .S8 cycles (20.7%) with 9 (15.5%) deliveries. Total delivery rate was 11.7% per patient and 13.9% per recruited cycle.