COMPARISON OF FOLLICLE

STEROIDOGENESIS FROM NORMAL AND

POLYCYSTIC OVARIES IN WOMEN
UNDERGOING IVF: RELATIONSHIP
BETWEEN STEROID CONCENTRATION,
FOLLICLE SIZE, OOCYTE QUALITY AND
FECUNDABILITY

M.P Teissier, H.Chable,

S.Paulhac,Y.Aubard
Human Reproduction vol 15 no 12
pp2471-77,2000
 Introduction
Previous literature:
• Follicular endocrine environment is related to
oocyte quality in women.(MacNatty et al.,1976; Van
Dessel et al.,1996)

• A correlation between follicle size and oocyte

maturity has been shown. (Nilsson et al.,1985;
Simonetti et al.,1985; Nayudu et al.,1989; Bergh et al.,1998)

• A relationship between follicle size and

pregnancy rates following IVF induction
(Nilsson et al.,1985; Dubey et al.,1995; Bergh et al.,1998)
However, no consensus has been reached:
•Concerning maturity
•Fecundability of oocytes contained in small follicles
All data were obtained from women with:
•Normal ovaries, and
•From follicles collected under different ovarian
conditions:
 spontaneous cycles (Mason et al.,1994; Van Dessel et al.,1996)
 stimulated cycles following several induction
protocol
(Ben Rafael et al.,1987; Yding Andersen,1990,1993;Suchanek et
al.,1994; Wittmaack et al.,1994)
 The aim of this study
• To verify the concept that a relationship
exists between follicular steroid content,
follicular size and oocyte maturity which
could influence oocyte fertilization
outcome in normal patients and
polycystic ovarian syndrome following
recombinant human FSH (rhFSH)
treatment in follicles collected during a
conventional IVF programme
 Materials and methods

- tubal factor
Normal (40 patients)
- anovulatory infertility
- endometriosis (-)
- normal semen quality PCOS (35 pasients)

IVF programmed

D-Trip analougue 0,1 mg s.c

GnRHa protocol
H1 - HCG administration

Down regulation pituitary-ovary axis

rh FSH induction 150~225 IU/daily

TV USG & [E2]

5 follicles Ø > 16 mm 10.000 IU HCG

35 hours

Ovum pick-up 150 oocytes & 118

follicular fluid
Table I. Relationship between follicular steroid concentrations and follicle size from
PCOS and normal women

PCOS Normal
Small Large P Small Large P
(n=13) (n=43) (n=13) (n=43)

E2 345 371 NS 348 393 0.01

(ng/ml) (197-762) (189-1138) (131-1195) (102-1310)
T 7.2 7.9 NS 5.8 6.2 NS
(ng/ml) (3.7-25.3) (3.7-35) (2.6-13.8) (1.7-23)
Pr 4204 5363 NS 3470 5749 0.001
(ng/ml) (2116-6247) (2127-8448) (1086-9828) (2116-14484)
 Table II. Steroid concentrations from follicles according to nuclear oocyte
maturity in both ovulation groups

Class A (MCO-F)(n=80) Class B (MIO-F)(n=38) Class B

versus class
A
PCOS Normal P PCOS Normal P PCOS N

E2 473 399 NS 318 288 NS 0.003 0.001

(ng/ml) (189-1138) (211-1310) (190-477) (102-395)

NS
T 6.3 5.8 9.2 8.5 0.01 NS
0.04
(ng/ml) (3.7-26) (2.7-15) NS (4.8-35) (1.6-23)
Pr 5961 5951 2804 2111 0.001 <0.001 <0.001
(ng/ml) (4199-14484 (3054-9828) (2116-6078) (915-3916)
Table III. Comparison of steroid concentrations between PCOS and
normal women according to oocyte quality and follicle size

Size PCOS Normal

ClassA ClassB A vs ClassA ClassB A vs B
(n=37) (n=37) B (n=37) (n=19) p
p
E2 S 426 325 NS 363 347 NS
ng/ml (242-763) (197-477) (211-392) (131-395)
L 503 310 0.001 412 286 0.001
(189-1138) 190-471) (220-1310) (102-356)
T S 6.2 7.9 0.05 4.4 9.8 0.02
ng/ml 93.7-17) (4.8-25) (2.7-8) (3.1-13.8)
L 6.6 10.4 0.02 6.2 5 NS
(3.7-26) (4.9-35) (3.3-15) (1.7-23)
Pr S 5870 3290 0.009 5114 2481 0.001
ng/ml (4204-8448) (2127-6078) (3440-6247) (915-3501)
L 6622 2791 0.001 6567 2036 0.001
4199-14484) (2116-4143) (3054-9828) (1086-3916)

S = small follicle Ø 8-13 mm L = large follicle Ø >14 mm

Table IV. Relationship between follicle size, oocyte nuclear maturity
and oocyte fertilization outcome

Size Follicles Oocyte breakdown Embryo positive Embryo negative

(mm) (n) according to
maturity
ClassA ClassB ClassA ClassB ClassA ClassB
< 10 6 4 2 0 0 4 2
10 8 1 7 0 0 1 7
11 3 - 3 - 0 - 3
12 6 3 3 1 0 2 3
13 7 3 4 2 0 1 4
14 9 8 1 8 0 0 1
15 13 10 3 10 0 0 3
16 10 8 2 6 0 0 2
17-22 50 36 14 36 0 0 14
>22 7 5 2 1 0 4 2
 Table V. Pregnancy and implantation rate for embryos derived rom oocyte of only
large, only small or large & small follicles (Bergh C et al, 1998)

IVF (n = 167) ICSI (n = 156)

Large Small L+ S Large Small L+ S
Ø> 16mm Ø<14mm Ø> 16mm Ø<14mm
Age (years, mean,SD) 33.1±3.7 32.3±4.5 33.4±3.4 33.0±3.6 33.1±3.8 33.1±3.7
No.of oocytes (mean,SD) 11.9±5.1 14.2±3.4 10.6±4.8 11.4±4.8 10.0±4.8 11.9±5.1
No of embryo (mean,SD) 8.1±4.0 9.4±3.7 6.8±3.3 7.8±3.7 6.5±3.5 8.1±4.0
No of transfer 127 13 27 113 12 31
No of embryos transferred 2.0±0.2 1.9±0.3 2.0±0 2.0±0.3 1.8±0.4 2.0±0
(mean,SD)
No of pregnancies 60 2 9 46 5 14
Pregnancy rate embryo 47 15 33 41 42 45
transfer,%
No of gestational sacs 76 3 10 62 6 18
Implantation rates,% 29 12 19 28 27 29
No of deliveries 46 2 8 34 3 11
Delivery rate embryo 36 15 30 30 25 35
transfer,%
Embryo transfer day2/ day3 106/21 12/1 18/9 96/17 11/1 28/3
Back
 The relationship between follicle diameter, fertilization rate, and microscopic
Embryo quality (Christopher J.haines in fertility and sterility,vol 55,No.1, January 1991;205-207)

Table 6. Relationship between follicular diameter and oocyte fertilization rate

Follicular No. of No. fertilized Fertilized

diameter oocytes %
mm
Group A >20 28 27 96
Group B 15-19 46 39 84
Group C 10-14 26 20 76
Table 7. Relationship between follicular diameter and embryo quality

Follicular Grade 4 Grade 3 Grade 2 Grade 1 Not

diameter fertilized
mm

Group A >20 14(52) 11(41) 2(7) - 1

Group B 15-19 19(49) 16(41) 4(10) - 7
Group C 10-14 6(30) 7(35) 5(25) 2(10) 6