title: Choosing GnRH Antagonist Protocol Shows Improved Oocyte and Embryo Quality, Coherent with the Perifollicular Vascularity (PFV) in Assisted Reproductive Techniques.
abstract: BACKGROUND
  The parent oocyte from which the embryo is derived, determines its quality and the perifollicular vascularity (PFV) determines the micro-environment of the developing ovum. The PFV correlates well with the follicular oxygenation, oocyte maturation and embryo viability. PFV is imaged with Power Doppler Ultrasound.
  
  
  OBJECTIVE
  To study and compare the association of the PFV of follicles with the quality of the oocytes and embryos in agonist and antagonist protocol, employed in Assisted Reproductive techniques (ART).
  
  
  METHODS
  A prospective observational study was conducted on 75 patients, who were recruited for ART cycles, out of which 25 were given the Agonist protocol and the remaining 50 received the Antagonist protocol.
  
  
  METHODS
  The patients underwent the stimulation protocol. The PFV of preovulatory follicles were studied with Transvaginal Power Doppler and graded. Each oocyte retrieved carried the same label of its parent follicle. Embryos were cultured. The embryologist was blinded. The oocyte and embryo quality were assessed and compared with the PFV of parent follicle.
  
  
  RESULTS
  Follicles with grade 1 and 2 PFV were predominantly observed. The yield of oocytes was independent of PFV. The mean yield of good quality embryos in conjunction with the PFV of the parent follicle was found to be highly significant in both the groups. The antagonist group had statistically significant yield of mature oocytes and embryos, compared to the agonist group.
  
  
  CONCLUSIONS
  Antagonist protocol had favourable outcomes compared with the agonist protocol. The retrieval of oocytes, even the mature ones and the yield of high grade embryos were found higher. As the PFV increased, the yield and overall pregnancy rates were higher. PFV as assessed by Power Doppler is a useful non-invasive biomarker of embryo quality and can be employed in conjunction with other biomarkers in ART to predict successful outcome.
authors.affiliation: Junior Resident, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India .
authors.forename: Pavithra Muraleedharan
authors.initials: PM
authors.lastname: Vengetesh
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India .
authors.forename: Amar
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India .
authors.forename: Pratap
authors.initials: P
authors.lastname: Kumar
keywords: Agonist cycle; Antagonist cycle; Embryo grade; Oocyte grade; Power Doppler