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The total number of retrieved oocytes, the number of retrieved mature oocytes, the fertilization rate, the number of good quality embryos, the pregnancy rate and the live birth rate were compared among the three groups.
The results of this study suggests that, no matter GnRH antagonist or agonist treatment, if administration of hCG switch is needed, it is better to delay hCG timing rather than to advance it. The delayed administration of hCG may not favor IVF outcome in a single cycle, but the cumulative pregnancy rate is likely to be improved with consideration of higher yield of mature oocytes, fertilized oocytes and good quality embryos per IVF cycle.
In principle, delayed hCG timing yields a greater amount of larger follicles, which in turn yields more mature oocytes with better developmental competence, according to a number of earlier studies [9-16]. The relationship between the follicle sizes and the developmental competence of the oocytes has been investigated by different research groups. They found that oocytes from larger follicles have higher fertilization rate, cleavage rate, and implantation/pregnancy rate [9-16]. The mechanism is not yet clear; it may be due to better cytoplasm maturation in the oocytes from the larger follicles. In our study, we did not follow follicles/oocytes one by one, so it is difficult to say if the good quality embryos are from those oocytes within larger follicles or not. However, we found that the number of good quality embryos had good correlation with the number of follicles larger than 15 mm at the hCG administration. This suggests that follicle size could be used as one of the predictors for IVF outcome. The emergency of 3D measurement of oocytes could help doctors make better predictions [17].
Among most of the IVF cycles, we notice a big drop from fertilized oocytes to good quality embryos, no matter it is on day 2 or day 3. It seems that a majority (83% - 89%) of retrieved oocytes are mature and most (68% - 72%) of these mature oocytes can be fertilized, but only half (52% - 58%) of them develop further to embryos with good quality. To improve the final IVF outcome, more efforts are needed to optimize the development of the embryo after fertilization, for example, by changing the culture medium or lowering the osmolarity [18]. If we can achieve better development of embryo in vitro, we will have a much higher IVF success rate in the future. 041b061a72