Human Reproduction vol.5 no.4 pp.431-433, 1990
Non-functional ovarian cysts do not affect ipsilateral or contralateral ovarian performance during in-vitro fertilization*
V.C.Karande1, R.T.Scott, G.S.Jones and S.J.Muasher The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Avenue, 6th Floor, Norfolk, VA 23507, USA 'To whom correspondence should be addressed
Reports on the significance of ovarian cystic structures during in-vitro fertilization (TVF) have been conflicting. This study examined the effect of such structures on ovarian performance during IVF. Twenty-one patients with one or more cystic structures of 20-50 mm in diameter, detected on day 6 of the menstrual cycle, were compared to 35 non-cystic controls. Differences (cyst versus non-cyst) included basal oestradiol (Ej) levels (40 ± 4.8 versus 29 ± 2.0 pg/ml; P < 0.01), ampoules of gonadotrophins administered (24 ± 2 versus 16 ± 1; P < 0.001) and peak E 2 concentrations (415 ± 45 versus 744 ± 88 pg/ml; P < 0.05). There were no differences in the number of follicles aspirated or oocytes retrieved. In 19 patients with unilateral structures, the ipsilateral ovary produced fewer follicles (2.5 ± 0.5 versus 3.9 ± 0.6; P < 0.05); however, there were no differences in the number or maturity of oocytes recovered. Since the numbers of oocytes recovered were equivalent in the presence or absence of ovarian cystic structures, their presence is not an indication to cancel an IVF cycle. Key words: follicles/IVF/oocytes/ovarian cysts
Introduction The primary aim of gonadotrophin-induced ovarian stimulation during in-vitro fertilization (IVF) is to obtain several mature oocytes. The presence of ovarian cystic structure is a common finding during ultrasound examinations of IVF patients. Whether or not these structures interfere with stimulation and outcome is a matter of concern; prior reports have been conflicting (Hornstein etai, 1989; Thatcher etai., 1989). Thatcher el al. (1989) demonstrated that patients widi ovarian cystic structures during IVF showed decreased responsiveness to human menopausal gonadotrophin (HMG) with lower serum oestradiol (E2) levels and fewer preovulatory oocytes recovered. They also found a higher cancellation rate due to an early decrease in E2 levels. In contrast, Hornstein et al. (1989) found no •Presented as a poster at the Thirty-Seventh Annual Clinical Meeting of The American College of Obstetricians and Gynecologists, May 1989, Atlanta, GA, USA © Oxford University Press
negative impact on parameters of ovulation induction, oocyte recovery rates or pregnancy rates. This study was designed to evaluate the impact of ovarian cysts on stimulation and outcome during FVF. In patients with unilateral cysts, oocyte recovery rates were compared for the ipsilateral and contralateral ovary. Materials and methods A retrospective analysis was done of 352 patients who underwent IVF from January 1988 to June 1988 (Norfolk series 30 and 31). All patients with ovarian cystic structures on their initial (cycle day 6) ultrasound were selected for review. Cystic structures were defined as fluid-filled structures within the ovary between 20 and 50 mm in diameter. Patients were excluded according to the following criteria: concomitant use of a gonadotrophin-releasing hormone agonist, the presence of only one ovary, the presence of a hydrosalpinx or other confounding adnexal cystic structure, a cyst size of > 50 mm or basal (cycle day 3) levels of E2 > 50 pg/ml. Of the 352 patients, all those without ovarian cystic structures and with pure tubal factor infertility served as controls. All the controls underwent stimulation protocols identical to the study group. The charts were reviewed and the following data recorded: patient age and weight, aetiology of infertility, basal (cycle day 3) FSH, E2 and progesterone (P) values, number of ampoules of gonadotrophins used during stimulation, number of follicles aspirated at retrieval, and number and maturity of oocytes recovered. Ultrasound scans were performed with a General Electric RT-3600 machine (General Electric Company, Milwaukee, WI) using a 5.0 MHz transvaginal sector probe. All patients had undergone pure gonadotrophin stimulation using established protocols (Rosenwaks and Muasher, 1986). Oocyte retrieval was performed transvaginally according to published techniques (Flood etai, 1989). The preincubation of oocytes, sperm preparation, insemination and culturing conditions and techniques, and embryology procedures were as previously described (Veeck etai., 1983; Veeck, 1986). Commercially available radioimmunoassay (RIA) kits were used to determine FSH concentrations (Leeco Diagnostics, Southfield, MI). The inter-assay and intra-assay coefficients of variation for FSH were 6.2 and 4.8% respectively. E2 levels were also determined by a commercially available RIA (Pantex, Santa Monica, CA) and had inter-assay and intra-assay coefficients of variation of 5.8 and 5.7% respectively. The basal FSH and E2 concentrations, the quantity of gonadotrophins administered, the number of follicles aspirated 431
V.C.Karande et al.
and the number and maturity of the oocytes recovered were compared for the study and control groups. The fertilization and pregnancy rates for the two groups were noted. A further analysis was made of patients with unilateral ovarian cystic structures to compare ovarian performance in the ipsilateral and contralateral ovaries. Statistical analysis for comparisons of the study and control groups were done by two-tailed Student's Mests. Comparisons in the study group between the cystic and non-cystic ovaries were performed with paired Mests. A probability value
Non-functional ovarian cysts do not affect ipsilateral or contralateral ovarian performance during in-vitro fertilization*
V.C.Karande1, R.T.Scott, G.S.Jones and S.J.Muasher The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Avenue, 6th Floor, Norfolk, VA 23507, USA 'To whom correspondence should be addressed
Reports on the significance of ovarian cystic structures during in-vitro fertilization (TVF) have been conflicting. This study examined the effect of such structures on ovarian performance during IVF. Twenty-one patients with one or more cystic structures of 20-50 mm in diameter, detected on day 6 of the menstrual cycle, were compared to 35 non-cystic controls. Differences (cyst versus non-cyst) included basal oestradiol (Ej) levels (40 ± 4.8 versus 29 ± 2.0 pg/ml; P < 0.01), ampoules of gonadotrophins administered (24 ± 2 versus 16 ± 1; P < 0.001) and peak E 2 concentrations (415 ± 45 versus 744 ± 88 pg/ml; P < 0.05). There were no differences in the number of follicles aspirated or oocytes retrieved. In 19 patients with unilateral structures, the ipsilateral ovary produced fewer follicles (2.5 ± 0.5 versus 3.9 ± 0.6; P < 0.05); however, there were no differences in the number or maturity of oocytes recovered. Since the numbers of oocytes recovered were equivalent in the presence or absence of ovarian cystic structures, their presence is not an indication to cancel an IVF cycle. Key words: follicles/IVF/oocytes/ovarian cysts
Introduction The primary aim of gonadotrophin-induced ovarian stimulation during in-vitro fertilization (IVF) is to obtain several mature oocytes. The presence of ovarian cystic structure is a common finding during ultrasound examinations of IVF patients. Whether or not these structures interfere with stimulation and outcome is a matter of concern; prior reports have been conflicting (Hornstein etai, 1989; Thatcher etai., 1989). Thatcher el al. (1989) demonstrated that patients widi ovarian cystic structures during IVF showed decreased responsiveness to human menopausal gonadotrophin (HMG) with lower serum oestradiol (E2) levels and fewer preovulatory oocytes recovered. They also found a higher cancellation rate due to an early decrease in E2 levels. In contrast, Hornstein et al. (1989) found no •Presented as a poster at the Thirty-Seventh Annual Clinical Meeting of The American College of Obstetricians and Gynecologists, May 1989, Atlanta, GA, USA © Oxford University Press
negative impact on parameters of ovulation induction, oocyte recovery rates or pregnancy rates. This study was designed to evaluate the impact of ovarian cysts on stimulation and outcome during FVF. In patients with unilateral cysts, oocyte recovery rates were compared for the ipsilateral and contralateral ovary. Materials and methods A retrospective analysis was done of 352 patients who underwent IVF from January 1988 to June 1988 (Norfolk series 30 and 31). All patients with ovarian cystic structures on their initial (cycle day 6) ultrasound were selected for review. Cystic structures were defined as fluid-filled structures within the ovary between 20 and 50 mm in diameter. Patients were excluded according to the following criteria: concomitant use of a gonadotrophin-releasing hormone agonist, the presence of only one ovary, the presence of a hydrosalpinx or other confounding adnexal cystic structure, a cyst size of > 50 mm or basal (cycle day 3) levels of E2 > 50 pg/ml. Of the 352 patients, all those without ovarian cystic structures and with pure tubal factor infertility served as controls. All the controls underwent stimulation protocols identical to the study group. The charts were reviewed and the following data recorded: patient age and weight, aetiology of infertility, basal (cycle day 3) FSH, E2 and progesterone (P) values, number of ampoules of gonadotrophins used during stimulation, number of follicles aspirated at retrieval, and number and maturity of oocytes recovered. Ultrasound scans were performed with a General Electric RT-3600 machine (General Electric Company, Milwaukee, WI) using a 5.0 MHz transvaginal sector probe. All patients had undergone pure gonadotrophin stimulation using established protocols (Rosenwaks and Muasher, 1986). Oocyte retrieval was performed transvaginally according to published techniques (Flood etai, 1989). The preincubation of oocytes, sperm preparation, insemination and culturing conditions and techniques, and embryology procedures were as previously described (Veeck etai., 1983; Veeck, 1986). Commercially available radioimmunoassay (RIA) kits were used to determine FSH concentrations (Leeco Diagnostics, Southfield, MI). The inter-assay and intra-assay coefficients of variation for FSH were 6.2 and 4.8% respectively. E2 levels were also determined by a commercially available RIA (Pantex, Santa Monica, CA) and had inter-assay and intra-assay coefficients of variation of 5.8 and 5.7% respectively. The basal FSH and E2 concentrations, the quantity of gonadotrophins administered, the number of follicles aspirated 431
V.C.Karande et al.
and the number and maturity of the oocytes recovered were compared for the study and control groups. The fertilization and pregnancy rates for the two groups were noted. A further analysis was made of patients with unilateral ovarian cystic structures to compare ovarian performance in the ipsilateral and contralateral ovaries. Statistical analysis for comparisons of the study and control groups were done by two-tailed Student's Mests. Comparisons in the study group between the cystic and non-cystic ovaries were performed with paired Mests. A probability value
