Peri-ovarian adhesions interfere with the diffusion of gonadotrophin into the follicular fluid.
In previous studies, patients with severe peri-ovarian adhesions have been found to show low pregnancy rates and a poor response to gonadotrophin stimulation during in-vitro fertilization (IVF) treatment. The purpose of this retrospective pharmacokinetic study was to assess the diffusion of exogenous human chorionic gonadotrophin (HCG) in patients with peri-ovarian adhesions by examining the concentration of exogenous HCG in the follicular fluid in patients undergoing down-regulation and IVF due to infertility. The patients underwent laparoscopic examination for the scoring of peri-ovarian adhesions (using the classification of adnexal adhesions adopted by the American Fertility Society, a score of 0 means no adhesions, and a score of 32 represents bilateral expanded dense adhesions). Oocytes were recovered after human menopausal gonadotrophin-human chorionic gonadotrophin (HMG-HCG) stimulation with gonadotrophin-releasing hormone agonist. Serum and follicular fluid were collected at the time of oocyte recovery for measuring the HCG ratio (the follicular HCG concentration to the serum HCG concentration; a reflection of the diffusion of exogenous gonadotrophin) by time-resolved fluoroimmunoassay. A negative correlation was found between the number of oocytes recovered and the peri-ovarian adhesion score (r = -0.62, P < 0.01). In a given patient, the follicular HCG concentration was always lower than the serum HCG at the time of oocyte recovery. The HCG ratio in all samples was 0.9 or less (0.51 +/- 0.20; range, 0.09-0.90). Significant negative correlations were found between the peri-ovarian adhesion score and both the follicular HCG concentration (r = -0.80, P < 0.01) and the HCG ratio (r = -0.75, P < 0.01). In conclusion, severe peri-ovarian adhesions interfered with the diffusion of exogenous gonadotrophin into the follicular fluid during IVF treatment. Thus, the diffusion of exogenous gonadotrophin into the follicular fluid may represent a new parameter in the assessment of ovarian blood flow and IVF outcome.
Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Japan.
Y
Y
Nagata
K
K
Honjou
M
M
Sonoda
I
I
Makino
R
R
Tamura
T
T
Kawarabayashi
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D004058:Diffusion; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000378:metabolism*; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000378:metabolism / Q000628:therapy; D010049:Ovarian Diseases / Q000378:metabolism*; D011247:Pregnancy; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000378:metabolism
D006063:Chorionic Gonadotropin