Ovary and ovulation: Flow cytometric analysis of granulosa cells from follicular fluid after follicular stimulation

Granulosa cells are not easily accessible, unless they are examinedin follicular fluid after oocyte retrieval. These samples areusually contaminated with blood. We have set up a general techniquefor analysis of granulosa cells without physically separatingthem from blood cells. The sample is stained with CD45, whichis a pan-leukocyte marker, and granulosa cells are consecutivelyselected as CD45 negative during flow cytometric analysis. Analysisof forward scatter of the granulosa cells, which is correlatedto cell size, shows a wide size range throughout the whole populationrather than two distinct populations as previously suggested.     

Ovary and ovulation: A model conforming the decline in follicle numbers to the age of menopause in women

The store of primordial follicles in the ovary is fixed beforebirth and dwindles with age until it is unable to provide enoughGraafian stages to sustain menstrual cyclicity. According toa simple bi-exponential model of ageing, the rate of follicledisappearance increases at age 37.5 years (or when 25 000 folliclesremain) so that the numbers fall to approximately 1000 at 51years, the median age of menopause in the population. This studyattempts to produce a biologically more realistic model of fofficledisappearance and harmonizes follicle dynamics with the distributionof menopausal ages from an American survey. The step-changein the rate of fofficle attrition was replaced by a model whichassumed that this rate changes more gradually with the sizeof the follicle store. This produced a distribution of predictedmenopausal ages (based on an assumed threshold of 1000 follicles)which was closer to observed data. The fit further improvedwhen the model was modified by having a threshold that variedacross the population. Using such a stochastic threshold modelfor menopause, the number of fertile years remaining could beforecast with an acceptable margin of uncertainty if it everbecomes possible to estimate the size of the follicle storein vivo.     

Ovary and ovulation: Application of image analysis cytometry in fofficular fluid cells obtained from in-vitro fertilization cycles: relationships to patient's age, oocyte maturity, fertilizability and in-vitro fertilization outcome

In an in-vitro fertilization (LVF)/embryo transfer pro grammegranulosa cells obtained from 59 individual preovulatory follicleswere analysed using multiparameter image analysis cytometry,in an attempt to determine whether their morphometric and DNA-cytometricparameters could prove useful in assessing follicle and oncytematurity and in predicting fertilizabifity and outcome of theseIVF cycles. Almost all morphometric and DNA- cytometric parameterswere not correlated with either the patient's age or oocytematurity, and did not predict oocyte fertilization or occurrenceof a clinical pregnancy. The only possible relevant parameterwhich, despite its inverse correlation to total luteinizinghormone administration, also proved to be inversely correlatedto pregnancy outcome (in the seven cases in which a pregnancyoccurred), was the percentage of granulosa cell nuclei withincreased DNA content (>5c). Finally, if granulosa cellsdo not reveal euploid polyploidization in spontaneous or inducedovulatory cycles, the detected cells with increased DNA contentshould be interpreted as aneuploid, i.e. with chromosomal aberrations,and so their presence could also be discussed in connectionwith the hypothetical risk of prospective neoplastic transformationof the tissue.     

Primordial and pre-antral follicles are not commonly observed in IVF aspirates

BACKGROUND: Follicular fluid recovered from IVF patients has been proposed to be a valuable source of pre-antral and primary follicles for patient therapy and research. We evaluated the recovery of immature follicles in follicular fluid from 54 patients undergoing IVF using several techniques. METHODS: Fluid from each patient underwent several methods of follicle recovery including: filtration through a cell strainer, Ficoll-Paque density gradient, isolate density gradient, histological slide preparation, and enzymatic digestion with collagenase and DNase. RESULTS: 34 primordial and primary follicles, mean 0.63 +/- 0.27/patient, and 14 pre-antral follicles, mean 0.26 +/- 0.14/patient, were found in this study. The serum estradiol level on the day of HCG injection was significantly lower (P < 0.05) in patients in which immature follicles were recovered, compared with those without immature follicles in the follicular fluid (1779.9 +/- 167.6 versus 2246.6 +/- 153.2 pg/ml). There were no women with advanced maternal age (>39 years) who had immature follicles in the follicular fluid. CONCLUSIONS: Follicular fluid cannot be considered an efficient or reliable source of immature follicles. The presence of any immature follicles appears to be associated with cause of infertility, the random placement of the aspirating needle and may be related to the age of patient.     

Physiology: Healthy and atretic follicles: vaginosonographic detection and follicular fluid hormone profiles

The health status of human preovulatory follicles was prospectivelystudied by non-invasive transvaginal ultrasound. Daily ultrasoundscans were performed from the time when the follicle measured15 mm in diameter until formation of corpus luteum or oocyteretrieval. Based on the ultrasound scans two types of follicleswere defined: type A follicles showed a cloud visualized asa cone projecting into the follicular fluid with the base ofthe cone positioned on the follicle wall. A light spot seenat the tip of the cloud in the majority of scans was presumedto be the oocyte-cumulus complex. Type B follicles showed anecho free space without a cloud. Two groups of infertility patientswere studied: Group I received intrauterine insemination; 106patients undergoing a total of 263 cycles (188 spontaneous cyclesand 75 clomiphene citrate cycles). Group II received in-vitrofertilization (IVF); 22 patients undergoing a total of 52 cycles(31 spontaneous cycles and 21 clomiphene cycles). In the firstgroup, the ovulatory potential of the follicle is associatedwith the ultrasound characteristics. From the IVF patients thefollicular fluid was harvested and assessed for the free concentrationof the following steroids: oestradiol, progesterone, testosteroneand androstendione. The endocrine health status of the folliclewas associated with the ultrasound characteristics of the follicle.In patients of group 1, 288 type A follicles ovulated out ofa total of 298 follicles (97%). None of the type B folliclesovulated (0/14). In patients of group II, oocytes were obtainedin 79% of the type A follicles (50/63), whereas 7% of the typeB follicles yielded an oocyte (1/14). The follicular fluid hormoneprofile showed significantly lower free oestradiol, free oestradiol/testosteroneratio and oestradiol/androstenedione ratio and higher free testosteroneand free androstenedione in type B follicles compared to typeA follicles. The hormone status and the high oocyte recoveryrate suggest that type A follicles are healthier than type Bfollicles, which seem to have undergone atretic changes. Itis concluded that non-invasive transvaginal ultrasound witha good degree of accuracy predicts the health status of preovulatoryfollicles. Healthy follicles have a cloud with a light spotat the tip, whereas almost all atretic follicles lack this characteristic.     

Ovary and ovulation: Prediction of ovarian cycle outcome by follicular characteristics, stage 1

Both dominant and subdominant follicles have been identifiedand individually monitored over the follicular phases of 54natural cycles in 36 women. Population dynamics of all antralfollicles, visible by ultrasonography, in the ovary over theentire cycle have also been characterized for the first time.This has been accomplished by developing a new system of mappingand monitoring follicles, including a three-dimensional computerimaging model and correlation program. The different dominantfollicle types were characterized by their ultrasonographicproperties. Ovulatory follicles were rounded in shape and mid-rangeechogenic, with a smooth antral edge by late follicular phase.Luteinized unruptured follicles were round, had low echogenicityand a very smooth antral edge. Atretic follicles were irregularin shape and antral edge and had mid-range echogenicity. A furtherimportant finding was that follicle success appears to be relatedto timing of growth and to the subdominant follicle populationpresent in the ovary. An analysis of follicle population dynamicsin ovulatory cycles showed a drastic decrease in number at theend of the luteal phase, followed by a sharp increase at thebeginning of the follicular phase. This study has demonstratedthat characteristics of individual follicles and populationdynamics of both dominant and subdominant follicles are stronglyassociated with cycle outcome. These findings will contributetowards a predictive model of dominant follicle status and cycleoutcome. A new hypothesis of follicle competition has also beenproposed.     

Ovary and ovulation: Nitric oxide concentrations in the follicular fluid and apoptosis of granulosa cells in human follicles

To study the relationship between follicular atresia, apoptosis,and nitric oxide (NO) generation in follicular development,steroidogenesis, NO levels in follicular fluid and apoptosiswere analysed in the various sized follicles of women receivingovarian stimulation with human meno-pausal gonadotrophin (HMG)—humanchorionic gonado-trophin (HCG) treatments for in-vitro fertilization(IVF)-embryo transfer. The follicles were divided into threegroups by diameter: large follicle, 18 mm; medium follicle,12 and 15 mm; small follicle, 10 mm. Follicular fluid was obtainedfrom 20 women 34 h after HCG administration, and the concentrationsof oestradiol, progesterone and testosterone, and nitrite, nitrate,arginine and citrulline were measured. Granulosa cells obtainedfrom each group of follicular fluid were stained with Hoechstdye, and nuclear morphology was examined by a fluorescence microscopy.Oestradiol and progesterone concentrations in large follicleswere significantly (P < 0.01) higher than those in mediumor small follicles, and testosterone concentrations in smallfollicles were significantly (P < 0.01) higher than thosein large follicles. There were no significant differences inthe concentrations of nitrite, nitrate, arginine and citrullineamong three groups. The percentage of apoptotic cells with nuclearfragmentation was significantly (P < 0.01) higher in smallfollicles than in large follicles. The present results suggestedthat small follicles with poor response to HMG may undergo atresiathrough apoptosis. No significant difference in the follicularNO level between large and small follicles led us to speculateon a different responsiveness to NO in these two types of follicles.     

Correlation between 21 amino acid endothelin, intrafollicular steroids and follicle size in stimulated cycles.

Several in-vitro studies have shown that endothelins (ET) may inhibit synthesis of progesterone and prevent luteinization of granulosa cells. In the present study, a specific radioimmunoassay was used to evaluate the correlation between concentrations of active (21 residue) ET and ovarian steroids in 47 samples of human follicular fluid (FF) following gonadotrophin stimulation for in-vitro fertilization (IVF) protocols. An isoform non-selective antibody was used in the radioimmunoassay, which recognized the C-terminal structure of the 21 residue ET, and therefore did not crossreact with their weakly active precursors - big ET. In pooled samples of follicular fluid (FF), the concentration of 21 amino acid ET correlated negatively with diameter of the follicles (r = -0.31, P < 0.05) and progesterone concentrations in FF (r = -0.56, P < 0. 001). A positive relationship (non-significant) was found between ET and testosterone concentrations. No correlation between ET and oestradiol was observed. The within-patient correlation coefficients were also evaluated in women from whom three or more samples of FF were obtained. ET were markedly inversely correlated with follicle size in all cases, and with progesterone in five of seven women. Five of seven patients also showed significant positive correlation of ET with testosterone. The results demonstrate clinical evidence that active ET play an important role in regulation of follicle development, especially in the inhibition of premature luteinization of granulosa cells.     

Ovary and ovulation: Cell-specific localization of nitric oxide synthases (NOS) in the rat ovary during follicular development, ovulation and luteal formation

Nitric oxide (NO) has emerged as one of several important intraovarianregulatory factors. In particular, NO has been implicated inthe processes of ovulation and atresia-related apoptosis. Theaim of the present study was to investigate the presence anddistribution of the NO-generating nitric oxide synthase (NOS)enzymes in the ovary during follicular development, ovulationand luteal formation of the equine chorionic gonadotrophin (ECG)/humanchorionic gonado-trophin (HCG)-primed rat NADPH diaphorase activitywas used as a histochemical marker for NOS within the ovary.Diaphorase reactivity was most abundant in the stroma (S) ofthe ovary and in the theca (T) layer of the follicle. In luteinizedovaries, weaker diaphorase reactivity was present within thecorpora lutea (CL). Two different isoforms of NOS, the constitutivelyexpressed endothelial NOS (eNOS) and the inducible isoform ofNOS (iNOS), were immunolocalized in ovaries of immature ratsand in ECG/HCG-primed rats during the periovulatory period fromHCG injection until 2 days after ovulation. In addition, ovarianconcentrations of eNOS and iNOS were quantified by immunoblotting.Immunoblotting with a monoclonal anti-eNOS antibody demonstratedthe presence of eNOS mainly in the residual ovary (ROV) duringthe periovulatory period. In luteinized ovaries, higher concentrationsof eNOS were seen in CL, while those in the ROV at this stagewere lower than in the periovulatory ovary. Immature ovariescontained diminutive amounts of eNOS, detectable mostly in theROV compartment. In contrast, iNOS was barely detectable duringfollicular development to the preovulatory stage. A slight elevationof iNOS was observed in the granulosa cells at 6 h after theHCG injection. The levels of iNOS during the luteal phase werealso low. Immunohistochemical analysis using polyclonal eNOSand iNOS antibodies revealed the localization of these two isoformsprimarily in the S and the T of the periovulatory ovary. Inluteinized ovaries, positive immunoreactivity was also seenwithin the CL. With a monoclonal antibody against eNOS, intenseimmunoreactivity was observed in the S, T and within CL. Therewas a particularly strong staining in blood vessels. These datademonstrate the presence of an intraovarian NO-generating system.The localization of this system to the S, T and CL suggestsa role for NO in the ovulatory process and in the regulationof CL function.     

Ovary: Follistatin concentrations in follicular fluid of normal and polycystic ovaries

Follistatin (FS) is an activin/inhibin binding protein whichis believed to act in an autocrine/paracrine manner to regulategrowth and differentiation. Although FS has been identifiedin human follicular fluid, it remains unclear how its concentrationchanges during selection and atresia, and what the concentrationsof FS are in follicles of women with polycystic ovary syndrome(PCOS). Towards this goal, we have measured by radioimmunoassaythe concentrations of FS in follicular fluid obtained from dominantand atretic cohort follicles of normal cycling women, preovulatoryfollicles of in-vitro fertilization (IVF) patients, and smallGraafian follicles of patients with PCOS. In all cases, thefollicular fluid concentration of FS was much higher (100-fold)than that reported in serum. The FS concentrations (ng/ml) were203 ± 42 (normal dominant), 185 ± 17 (atreticcohort), 185 ± 5 (IVF), and 250 ± 14 (PCOS). Therewas no statistical difference between these mean values of FS.Further, there were no significant correlations between thefollicular fluid concentrations of FS and the concentrationsof oestradiol, progesterone, or androstenedione. These resultsindicate that human Graafian follicles, regardless of whetherthey are healthy or atretic, normal or PCOS, contain high steady-stateconcentrations of FS in the micro-environment. Collectively,these data fit with the hypothesis that major increases anddecreases in the concentration of FS in the micro-environmentmay not play a key role in the mechanisms of selection, atresia,and PCOS in women. The possibility of regulation of intrinsicactivin and inhibin activity through FS binding is discussed.     

Side of ovulation and cycle characteristics in normally fertile women

This study was undertaken to establish whether ovulation in humans alternates consistently from right to left ovary in successive cycles and whether the site of ovulation affects the next cycle length or the hormonal profiles. A total of 199 cycles in 80 normally fertile women were studied. The volunteers were monitored with ultrasonography to determine the day and side of ovulation and to calculate follicular and luteal phase lengths. Urinary hormone concentrations were also assayed. Right-sided ovulations occurred in 104 of the 199 cycles (52.3%; not significantly different from 50%). Alternate ovulations occurred in 61 of the 119 pairs of succeeding cycles (51.3%, not significant). The follicular phase length in contralateral ovulation (14.59 +/- 0.33 days; mean +/- SEM) did not differ significantly from that of ipsilateral ovulation (14.59 +/- 0. 37 days). There were also no significant differences in urinary concentrations of oestrone-3-glucuronide, pregnanediol-3alpha glucuronide, follicle stimulating hormone, and luteinizing hormone between ipsilateral and contralateral ovulation in either early follicular, peri-ovulatory or luteal phase of the cycle. It is concluded that in normally fertile women, the cycle length and the hormonal profile are independent of the, most probably random, site of ovulation.     

Ultrasonically guided percutaneous and transvaginal fofficle aspiration; a comparative study

In this study we compare the efficacy of ultrasonically guidedpercutaneous oocyte collection for in-vitro fertilization withultrasonically guided transvaglnal oocyte collection. Forty-sevenpatients were prospectively randomized into two groups. Twenty-fourpatients underwent percutaneous follide aspiration and 23 patientsunderwent a transvaginal puncture. The number of aspirated oocytesper patient showed a statistically significant difference inthe two groups: 2.5 for the percutaneous puncture versus 5.2for the transvaginal procedure. The number of embryos per patientwas 2.7 in the transvaginal puncture group versus 1.6 in thepercutaneous puncture group. This difference was not statisticallysignificant. The clinical pregnancy rate per patient was 12.5%with the percutaneous approach and 30.4% with the transvaginaltechnique. This difference was also not statistically significant.Since the transvaginal procedure also creates less discomfortto the patient and is less time-consuming it is concluded thatthis approach is preferable to the percutaneous puncture techniquein obtaining oocytes for in-vitro fertilization.     

Relationship between fertilization results after intracytoplasmic sperm injection, and intrafollicular steroid, pituitary hormone and cytokine concentrations

Previous studies relating hormone and cytokine concentrations in follicular fluid to oocyte fertilizability were flawed by the uncertainty about the actual oocyte maturity status at the time of recovery and by the possible contribution of the male factor to failures of conventional in-vitro fertilization. This is the first study in which oocyte maturity was assessed immediately after recovery and only mature oocytes were selected for treatment by intracytoplasmic sperm injection. Fertilization outcomes were related to follicular fluid concentrations of 17beta-oestradiol, progesterone, follicle stimulating hormone, luteinizing hormone (LH), growth hormone (GH), prolactin (PRL), interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF alpha). Those oocytes that subsequently showed normal fertilization were harvested from follicles with higher concentrations of progesterone, GH, PRL, IL-1 and TNF alpha as compared with those of oocytes that failed to fertilize. Among the normally fertilized oocytes, low GH concentrations were associated with the failure of cleavage and with poor morphology of cleaving embryos, whereas rapidly cleaving embryos developed from oocytes recovered from follicles with high concentrations of LH and IL-1. These data suggest important roles for GH, IL-1 and TNF alpha, and of residual LH after pituitary suppression, as positive regulators of the final phase of oocyte intrafollicular development.     

Few instead of many: human follicle collection from follicular aspirates at oocyte retrieval

BACKGROUND: The aim of this study was to determine if follicular aspirates obtained during oocyte retrieval for IVF were a good source of ovarian follicles for research purposes. METHODS: Follicular aspirates from 86 patients were collected and examined for the presence of follicles, and histological examination of tissue sample found was undertaken. RESULTS: Follicles were only obtained from aspirates of seven out of a total of 86 patients. From these samples a total of 14 follicles was found. The follicles were primordial, primary or secondary, 40-80 microm in diameter. Three of these recovered follicles were cultured and all degenerated within 2 days. In all aspirates some groups of granulosa cells that did not contain follicles or oocytes were found, as was vaginal epithelium that was also identified and verified by histology. CONCLUSIONS: Follicular aspirates are not a useful source of human follicles. Some structures found in the aspirates may be erroneously identified as follicles.     

Ovary and ovulation: In-vitro maturation, fertilization and embryo development of immature oocytes from early preantral follicles from prepuberal mice in a simplified culture system

A simplified culture system was developed for the in-vitro maturationof early preantral mouse ovarian follicles. The follicles werecultured singly in 20 (µ droplets under oil in mediumsupplemented with recombinant follicle stimulating hormone (r-FSH)at 37°C and 5% CO² in air. The follicles grew and becameattached to the bottom of the dish, progressively lost theirspherical structure by outgrowth of the granulosa cells throughthe basal membrane and developed follicles with antral-likecavities. The normal three-dimensional follicular structurewas lost but all components, i.e. theca, granulosa and oocyte,remained functional, as was proven by the oestradiol, inhibinand progesterone secretion patterns. Follicle survival exceeded80% and histological analysis proved the absence of atresiaand cell death in granulosa cells up to day 16. Oocytes of 55(± 4) µm diameter on the day of isolation reached74 (± 3) µm by day 16 of culture. The optimal momentfor inducing the final meiotic maturation with human chorionicgonadotrophin was investigated: the highest absolute numbersof metaphase II oocytes were obtained on days 12 and 14 (39and 41%). The fertilizing potential of the in-vitro maturedoocytes was comparable to in-vivo matured controls. A 50% hatched-blastocystdevelopment rate was observed.     

Ovary and ovulation: Symmetry and ovulation in women

Women have cryptic ovulation, and self-observation methods ofdetermining the timing of ovulation, such as monitoring cervicalmucus symptoms or recording basal body temperature, are notreliable. It has recently become apparent that the symmetryof paired soft tissue traits, such as breast size and digitlength, changes across the menstrual cycle. This paper presentsevidence that symmetry in four paired soft tissue traits showeda marked increase on the day of ovulation. The difference (i.e.the asymmetry) between the size of the left and right traitin ears, 3rd, 4th and 5th digits was measured. The timing ofovulation was confirmed by real-time pelvic ultrasonographyand trait measurements were made without knowledge of scan results.Asymmetry was lowest on the day of ovulation (day 0), decreasingby about 30% from day –1, and significant within-subjectschanges occurred from days –2 to day –1, and day–1 to day 0. The practical and evolutionary implicationsof these findings are discussed.     

Ovary and ovulation: A morphological and functional study of the effect of slow freezing followed by complete in-vitro maturation of primary mouse ovarian follicles

Mechanically isolated intact early preantral follicles (100–130 µm diameter) from 14 day old mice were cryopreservedby a slow freezing protocol with dimethyl sulphoxide and thenmatured in vitro for 12 days after rapid thawing. Minor freezedamage observed after 1 day of in-vitro culture included ablationof the theca cell layer and granu-losa cell dehydration, resultingin disruption of intercellular contacts with the oocyte andbetween granulosa cells. Of the follicles, 24% were irreversiblydamaged and had a collapsed oocyte. The remaining majority ofthe follicles had an intact oocyte as evaluated by ultrastructuralanalysis. Follicles with an intact oocyte were cultured in vitroand, after an initial retarded development, the final numberof fully grown oocytes ovulated in vitro was not different fromthat of unfrozen controls. Cryopreserved early preantral folliclesmatured in vitro responded to stimulus with human chorionicgonadotrophin in a similar way to controls, with mucificationof the oocyte-cumulus complex, germinal vesicle breakdown andextrusion of the first polar body of the oocyte. These cryopreserved,in-vitro matured oocytes had the potential to fertilize anddevelop to hatched blastocysts.     

In-vitro fertilization in cases with severe sperm defect: use of a swim-across technique and medium supplemented with follicular fluid.

The purpose of this study was to evaluate a new method of in-vitro fertilization (IVF) in patients with severe sperm defects. Unlike the conventional swim-up method, spermatozoa and oocytes are placed in opposite corners of the bottom of the incubation dish so that sperm swimming is horizontal instead of vertical. Another difference between the swim-across and swim-up techniques is that the incubation medium is supplemented with 20% follicular fluid. After a randomized series (protocol I) of 15 IVF attempts had demonstrated that swim-across was more effective than swim-up in terms of fertilization and cleavage, we began a second series (protocol II) using only swim-across. A total of 124 couples with motile sperm counts less than 1 x 10(6) spermatozoa/ml of semen were included in protocol II. Clinical parameters (age, tubal damage) and number of recovered oocytes were recorded and compared in patients who did (group A: n = 94) and did not (group B: n = 74) achieve fertilization. In group A the fertilization rate was 36.7% and, out of the 94 transfers that were made, there were 21 clinical pregnancies and 12 full-term pregnancies with 16 live births. The number of oocytes collected (12 versus 7.7, P less than 0.001) and the incidence of tubal damage (50% versus 24.3%, P less than 0.001) was significantly higher in group A than in group B. Using logistic regression analysis, we showed a significant correlation between fertilization and progressive motility, percentage normal spermatozoa, number of recovered oocytes and tubal damage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ovary and ovulation: Ovarian tissue cryopreservation for patients

For patients about to receive chemotherapy, radiotherapy orto undergo a surgical procedure, loss or impairment of fertilityis a major issue. For males, sperm banking is a standard acceptedprocedure to circumvent loss or damage to spermatozoa and thishas been undertaken in this unit since 1975 (Steele et al, 1995).For women there is no established procedure for gamete storage.Embryo preser vation is not an option for single women or evenfor those In a stable relationship, as treatment would haveto be delayed while ovarian stimulation and oocyte retrievaltook place. With the general shortage of donor oocytes, thepossibility of maturing primordial follides from fetal ovaries has become a subject for debate (HFEA 1995: Recent deliberations).In animals, the use of frozen ovarian tissue has been encouragingwith a report of a live birth in lamb after orthotopic transplantation(Gosden et al, 1994). Media attention to the future prospectfor freezing ovarian tissue has meant that pressure from patientsis likely to increase either for information or as requeststo freeze the ovarian tissue which could irretrievably be lostas a result of surgery and/r treatment. In the absence of welldefined procedures and technologies, should women be given thechance to preserve ovarian tissue prior to receiving intensive chemotherapy or radiotherapy?     

Ovary and Ovulation: Home ovulation testing In a donor insemination service

The use of home ovulation testing kits in donor insemination(DI) has been proposed to increase patient and clinic conveniencewhile not compromising fecundity rates. Such a system was introducedinto our Dl service in December 1994, and we here report anaudit of experience over 6 months. Patients were offered homeor laboratory luteinizing hormone (LH) testmg, and those requestinghome testing were asked to store an aliquot of tested urinefor subsequent assay in the laboratory allowing retrospectiveanalysis of the accuracy of cycle timing. Insemination usingcryopreserved semen was performed on the day home testing predictedovulation, or on the day an LH surge was detected in the laboratory,and on the following day. Pregnancy rates were significantlyreduced in home testers: 3.4% per cycle (174 cycles, 64 women)versus 12.7% (110 cycles, 53 women) over the same time period(P<0.005, 95% confidence interval 6.5–18.9). Urinesamples from 140 cycles from 51 women using home testing wereanalysed. There were insufficient data in nine to allocate thecycle. Of home tested cycles, 37 (28%) were inseminated on aday other than the first day of the LH surge. In 13 of theseinsemination was performed after the first day of the LH surge.Incorrect treatment was associated with high baseline LH, butthose with ‘late’ treatment had low basal LH concentrations,similar to those correctly treated. Analysis of individual urinesamples showed that the positive predictive value of home testingwas 72%. These results suggest that home ovulation testing resultsin reduced chance of pregnancy, with increased frustration forboth patients and clinic staff. This may be particularly soin women with high baseline LH concentrations.