(2) observed that follicles of 16–23 mm on the day of oocyte retrieval had higher fertilization rates (68%) than either follicles < 16 mm (56%) or those >23 mm (56%) (2). So I had my cd13 u/s on Friday and the tech told me I have one follicle on the right that is 27mm. Baerwald AR, Walker RA, Pierson RA. Haas J, Zilberberg E, Dar S, Kedem A, Machtinger R, Orvieto R. Co-administration of GnRH-agonist and hCG for final oocyte maturation (double trigger) in patients with low number of oocytes retrieved per number of preovulatory follicles – a preliminary report. J Endocrinol (2016) 229(3):R83–98. Follies grow 2 mm a day. https://www.fertstert.org/article/S0015-0282(12)00250-6/fulltext To identify the follicle sizes which were most likely to yield a mature oocyte, we analyzed follicle size data from 499 IVF cycles triggered with either hCG, GnRHa, or kisspeptin. However, limited data exist to establish which follicle size on the day of trigger is most likely to yield a mature oocyte. Dahan MH, Tan SL, Chung J, Son WY. doi:10.1016/j.fertnstert.2011.08.029, 29. I think 26mm is quiet a big size to take trigger shot. Data included in this manuscript were obtained from studies carried out in accordance with the recommendations of the local ethical boards listed below. Using simulated follicle size profiles of patients with 20 follicles on the day of trigger, our model predicts that the number of oocytes retrieved would increase from a mean 9.8 (95% prediction limit 9.3–10.3) to 14.8 (95% prediction limit 13.3–16.3) oocytes due to the difference in follicle size profile alone. We observed that the tertile of patients with the highest proportion of oocytes within this size range on the day of trigger, retrieved ~50% more oocytes than patients with the lowest proportion of their follicles within this range. Son W-Y, Chung J-T, Demirtas E, Holzer H, Sylvestre C, Buckett W, et al. All follicles that were visible on ultrasound and ≥8 mm in diameter were aspirated at oocyte retrieval. Fertil Steril (2006) 85(3):578–83. Efficacy of kisspeptin-54 to trigger oocyte maturation in women at high risk of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) therapy. Zhai AJ, Liu J, Zhao H. Kisspeptin-10 (Kp-10) inhibits ovarian hyperstimulation syndrome (OHSS) by suppressing vascular endothelial growth factor (VEGF) secretion. It is widely accepted that ovarian follicles that are âtoo smallâ are less likely to respond suitably to trigger administration and yield a mature oocyte (1). J Clin Invest (2014) 124(8):3667–77. observed that a 24 h delay in trigger administration of patients with ≥3 follicles of ≥18 mm (and 30–50% of follicles ≥10 mm were also ≥1 8 mm) increased the number of mature oocytes retrieved by 2.4, but only in patients with a serum progesterone ≤1 ng/ml (32). The study was designed, conducted, analyzed, and reported entirely by the authors. Shapiro BS, Daneshmand ST, Restrepo H, Garner FC, Aguirre M, Hudson C, et al. Patients did not receive hCG if there were more than 20 follicles of ≥14 mm on the day of trigger. The trigger kisspeptin-54 (6.4–12.8 nmol/kg as a single subcutaneous bolus or 19.2 nmol/kg as a split bolus over 10 h, Bachem Holding AG, Bubendorf, Switzerland) was administered once three follicles reached ≥18 mm in diameter (9, 11, 12). All authors provided contributions to study conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published. Salha O, Nugent D, Dada T, Kaufmann S, Levett S, Jenner L, et al. Thus, we recommend the reporting of mature oocyte yields using a denominator of follicle size of 12–19 mm on the day of trigger for studies investigating trigger efficacy. doi:10.1093/humrep/12.9.2002, 3. Main outcome measure: Follicle sizes on the day of trigger most likely to yield a mature oocyte. Commensurate with this, Castellano observed that kisspeptin expression increased in a cyclical manner during the menstrual cycle of a rodent model, predominantly localized to the theca layer of growing follicles and the corpora lutea (38). Simple linear regression of number of mature oocytes vs number of follicles in each category of follicle size determined that the highest coefficient of determination to be at follicle size category 12–17 mm for hCG r2 0.374 (P < 0.0001); 10–15 mm for GnRHa r2 0.573 (P < 0.0001); 7–20 mm for kisspeptin r2 0.179 (P < 0.0001). However, Ectors et al. AA is supported by National Institute of Health Research (NIHR) Clinical Lectureships. Rosen MP, Shen S, Dobson AT, Rinaudo PF, McCulloch CE, Cedars MI. Paradoxical effects of kisspeptin: it enhances oocyte in vitro maturation but has an adverse impact on hatched blastocysts during in vitro culture. doi:10.1210/jc.2015-2332, 10. Random forest models can be advantageous over generalized linear regression models if the number of outcome variables is comparatively low compared with the number of predictor variables. Breiman L. Random forrest. Fertil Steril (1995) 64(4):787–90. Levy G, Hill MJ, Ramirez CI, Correa L, Ryan ME, DeCherney AH, et al. In summary, we conclude that follicles of 12–19 mm on the day of trigger are most likely to yield mature oocytes on the day of oocyte retrieval. New perspectives on criteria for the determination of HCG trigger timing in GnRH antagonist cycles. Data from GnRHa triggered IVF cycles were obtained from a single-center randomized controlled trial conducted at My Duc Hospital, Ho Chi Minh City, Vietnam (10). Thus, in their later work, Shapiro introduced the concept of an “oocyte yield,” whereby the number of oocytes collected is corrected for the number of follicles on the day of trigger (5). doi:10.1093/humrep/deu362, 27. Flushing was not conducted in GnRHa or hCG-triggered cycles. Furthermore, delaying triggering could result in more follicles > 19 mm which in turn could increase the risk of premature rise in serum progesterone (see Figure 2). This is consistent with the current literature which suggests that follicles of sizes 16–22 mm on the day of oocyte retrieval (measured 2 days later) contribute the most to the number of oocytes retrieved (1). Hum Reprod (2015) 30(3):684–91. Importantly, none of the denominators used to date are evidence-based, nor do they have an upper limit for follicle size to account for follicles containing post-mature oocytes. Importantly, knowledge of the size of follicles on day of trigger from which one could reasonably expect to retrieve a mature oocyte could enable the accurate determination of trigger efficacy. Limitations of the study include that is a non-interventional retrospective analysis. IVF treatment involves the administration of supra-physiological doses of follicle-stimulating hormone (FSH) to induce the growth of multiple ovarian follicles. However, limited data exist to establish which follicle size on the day of trigger is most likely to yield a mature oocyte. The Institutional Review Board (IRB) reference number was NCKH/CGRH_01_2014, and ClinicalTrials.gov registration was NCT02208986. While this is a potential confounder, this would be insufficient to explain the magnitude of increase observed. My largest for IVF #1 was 20.5 and for IVF #2 was 19. The second time, I had 2 17s the day before trigger, so I can definitely see why she had me wait. Revelli A, Martiny G, Delle Piane L, Benedetto C, Rinaudo P, Tur-Kaspa I. Women were aged 18–38 years with a body mass index (BMI) 18–29 kg/m2 and had antral follicle counts 4–87. Venetis CA, Kolibianakis EM, Bosdou JK, Lainas GT, Sfontouris IA, Tarlatzis BC, et al. Expression of KiSS-1 in rat ovary: putative local regulator of ovulation? Effect of kisspeptin on in vitro maturation of sheep oocytes. Success rates are reasonable, although mul⦠including 7 RCTs and 1,295 IVF cycles compared administration of hCG as soon as ≥3 follicles were ≥17 mm in size (“early”) vs administration of hCG either 24 or 48 h later (“late”) (33). 17mm and above means mature follicle means u can ovulate next 24-36 hours or so. It is widely accepted that ovarian follicles that are “too small” are less likely to respond suitably to trigger administration and yield a mature oocyte (1). Kisspeptin-54 triggers egg maturation in women undergoing in vitro fertilization. drug-induction of malignancy in ABD patients and, contrarily, self-antigen drug/virus/bacteria-induced alteration. observed that fertilization rates are increased in oocytes from larger follicles on the day of oocyte retrieval (57.9% from 10 to 14 mm follicles, 69.9% from 16 to 22 mm follicles, 73.9% from 22 to 26 mm follicles) (22). Collectively, data from both animal models and humans have demonstrated that exogenous kisspeptin administration stimulates endogenous GnRH release from the hypothalamus (7). Analysis was performed in three stages. Conversely, Tan and colleagues randomized patients to trigger either once the lead follicle was 18 mm, or 1 day later, or 2 days later and observed no differences in the number of oocytes retrieved (30). doi:10.1210/en.2006-0117, 39. I took 100mg of Clomid on days 5-11 of my cycle. Other authors have reported both number of follicles ≥14 mm and the number of follicles ≥10 mm to allow the reader to account for different estimations of oocyte yield (6). Ectors FJ, Vanderzwalmen P, Van Hoeck J, Nijs M, Verhaegen G, Delvigne A, et al. doi:10.1016/j.fertnstert.2004.01.027, 28. When the follicles reach an adequate size (normally around 18â25 mm), and we consider that there are a suitable number of oocytes, we schedule follicular puncture 36 hours after administering an injection of the hormone hCG. My RE doesn't like to trigger before they are at least 18. Data were collected by AA, LV, VH, TK, SC, LJ, AC, and TH. However, the rate of in vivo matured oocytes positively correlated with follicle size (dominant follicle ≤10 mm 6.9%, 10–14 mm 10.6%, >14 mm 15.1%) (36). Efficacy of induced luteinizing hormone surge after “trigger” with gonadotropin-releasing hormone agonist. Typically, after 24mm it's "too ripe" is the best way to put it and the quality ususally starts to break down at that point. Vandekerckhove F, Gerris J, Vansteelandt S, De Baerdemaeker A, Tilleman K, De Sutter P. Delaying the oocyte maturation trigger by one day leads to a higher metaphase II oocyte yield in IVF/ICSI: a randomised controlled trial. doi:10.14202/vetworld.2017.276-280, 40. However, looking on-line I say a lot of sites that say 27mm is too big. Data from GnRHa triggered IVF cycles were obtained from a single-center randomized controlled trial conducted at My Duc Hospital, Ho Chi Minh City, Vietnam (11). Medicine (Baltimore) (2016) 95(20):e3691. Rat ovary: putative local regulator of ovulation ): 25 mm follicle at trigger size for a second of! Clinical trials at Hammersmith Hospital, London ( 9 ):1915–24 to predict an outcome variable ( in case. Dubey AK, an Wang H, Garner FC, Aguirre M, G... Clarke S, Islam R, Clarke S, Izzi-Engbeaya C, et.... 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