Comparison of the Number of Oocytes Obtained Between Chinese and Caucasian Women in IVF Treatment

Comparison of the Number of Oocytes Obtained Between Chinese and Caucasian Women Undergoing in Vitro Fertilization Treatment With a Standard Ovarian Stimulation Regimen

IVF is a well-established method to treat various causes of infertility. Some studies have suggested that ethnicity affects the success of IVF. This is a prospective study involving two tertiary IVF units in Hong Kong and Australia. The IVF outcome between Chinese and Caucasians will be compared.

Study Overview

• Status: Completed
• Conditions: Subfertility
• Intervention / Treatment: Procedure: Transvaginal ultrasound-guided oocyte retrieval; Procedure: Embryo transfer

Detailed Description

This is a prospective study conducted in two tertiary IVF units in Hong Kong and Australia.

The target population for the trial will be women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment in two IVF Units.

Intervention:

Patients recruited in this study will undergo IVF+/-ICSI treatment. They will undergo an ultrasound scan on the second or third day (day 2 or 3) of a period to exclude the presence of ovarian cyst and have the antral follicle count determined, which includes all follicles of 2-10 mm measured with a 5.5-7.5mHz transvaginal ultrasound probe. Blood will be checked for anti-mullerian hormone (AMH) measured by Beckman-Coulter Diagnostics.

Ovarian stimulation will be started if there are no ovarian cysts on ultrasound scan. They will receive one long acting gonadotrophin injection Elonva 150 microgram subcutaneously followed by daily gonadotrophin injections (Puregon) 200 IU in an antagonist protocol. Antagonist (orgalutran 0.25 mg) will be started on day 5 of ovarian stimulation. Transvaginal ultrasound will be performed for follicular tracking 7 days after the Elonva injection and every 1-3 days thereafter. No adjustment in FSH dose is allowed. Cycles will be cancelled if there are less than 3 follicles larger than 18mm after one week of 200 IU Puregon or there no developing follicle (i.e. larger than 11mm) after one week of 200 IU Puregon.

Recombinant hCG (Ovidrel, Serono, Bari, Italy) 0.25mg will be given if there are 2 follicles >18 mm in diameter. Gonadotrophin injection will not be given on the day of hCG. Agonist trigger will be used if oestradiol concentration on the day of trigger is greater than 15,000 pmol/L or there are more than 15 follicles >16mm on transvaginal scanning. All embryos or blastocysts will be frozen for transfer later following agonist trigger or when the number of oocytes aspirated is 20 or more. Serum FSH, oestradiol, LH and progesterone concentrations are taken 7 days after the Elonva injection and hCG trigger day. Transvaginal ultrasound-guided oocyte retrieval (TUGOR) will be scheduled on Mondays, Wednesdays and Fridays, 34-36 hours after the hCG injection. Flushing of follicles will not be performed. Follicular fluid not contaminated with blood will be collected from the first and largest follicle on each side for estradiol and progesterone level.

The retrieved oocyte will be inseminated conventionally or by ICSI, depending on the semen parameters. ICSI is advised if the total motile sperm number after sperm preparation < 0.2 million, sperm morphology by strict criteria < 3% or fertilization rate < 30% in previous IVF cycles with conventional insemination. One to two embryos will be replaced on day 2-5 after oocyte retrieval. Luteal phase support will be started according to the standard protocol of the centre. Patients will be followed up for urinary pregnancy test 16 days after embryo transfer. Patients with a positive pregnancy test will have transvaginal ultrasound scan performed 10-14 days later and are referred for antenatal care at 8-10 weeks gestation. The remaining embryos will be frozen. Pregnancy outcome will be monitored.

• Study Type: Observational
• Enrollment (Actual): 192

Contacts and Locations

Study Locations

• China
  • Hong Kong
    • Hong Kong, Hong Kong, China
      • Department of Obstetrics and Gynaecology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment in the two study sites.

Description

Inclusion Criteria:

• Women age 18-36 years old
• Body weight >60Kg
• Total antral follicle count >=7 and ≤ 20 i.e. not poor ovarian reserve based on Bologna criteria
• Chinese women in the HK centre and Caucasian women (defined as originating from the United Kingdom, Europe or United States of America, excluding the Middle East) in the Australian centre
• Written informed consent

Exclusion Criteria:

• Mixed race/ ethnicity
• History of ovarian surgery
• Body mass index >35 kg/m2
• >2 previous stimulated IVF cycles
• History of ovarian hyperstimulation syndrome in previous stimulated IVF cycles
• Polycystic ovary syndrome or total antral follicle count >20

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of oocytes obtained	Number of oocytes obtained	17 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of follicles smaller than 14, 16mm and larger than 18mm in diameter on day 8 and day of hCG	Number of follicles smaller than 14, 16mm and larger than 18mm in diameter on day 8 and day of hCG	8 and day of hCG
Duration of recombinant FSH	Duration of recombinant FSH	15 days
Dosage of recombinant FSH	Dosage of recombinant FSH	15 days
Serum estradiol levels on day 9 and day of hCG	Serum estradiol levels on day 9 and day of hCG	9 and day of hCG
Serum FSH levels on day 9 and day of hCG	Serum FSH levels on day 9 and day of hCG	9 and day of hCG
Serum LH levels on day 9 and day of hCG	Serum LH levels on day 9 and day of hCG	9 and day of hCG
Serum progesterone levels on day 9 and day of hCG	Serum progesterone levels on day 9 and day of hCG	9 and day of hCG
Miscarriage rate	Miscarriage rate	24 weeks
Clinical pregnancy rate	Clinical pregnancy rate: presence of intrauterine gestational sac at 6 weeks	6 weeks
Ongoing pregnancy rate	Ongoing pregnancy rate: presence of fetal heart pulsation on transvaginal scan at 12 weeks	12 weeks
Live birth rate	Live birth rate	44 weeks
Ovarian hyperstimulation rate	Ovarian hyperstimulation rate (according to RCOG guideline)	8 weeks

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: The University of New South Wales
• Investigators: Principal Investigator: Ernest HY Ng, Department of Obstetrics and Gynaecology, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong

Publications and helpful links

General Publications

• Ko JKY, Kan A, Leung P, Lee VCY, Li RHW, Ledger W, Ng EHY. Comparison of the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing in vitro fertilization using a standardized stimulation regime. J Ovarian Res. 2021 Dec 11;14(1):175. doi: 10.1186/s13048-021-00928-4.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2016
• Primary Completion (Actual): April 30, 2020
• Study Completion (Actual): December 30, 2020

Study Registration Dates

• First Submitted: April 13, 2016
• First Submitted That Met QC Criteria: April 19, 2016
• First Posted (Estimate): April 22, 2016

Study Record Updates

• Last Update Posted (Actual): April 29, 2021
• Last Update Submitted That Met QC Criteria: April 27, 2021
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: In-vitro fertilization; subfertility
• Additional Relevant MeSH Terms: Infertility
• Other Study ID Numbers: UW 15-547

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED