Stanger, J. D., & Yovich, J. L. (1984). Failure of human oocyte release at ovulation. Fertility and Sterility, 41(6), 827-832. https://doi.org/10.1016/s0015-0282(16)47893-3
Stanger JD, Yovich JL. Failure of human oocyte release at ovulation. Fertil Steril. 1984;41(6):827-832. doi:10.1016/s0015-0282(16)47893-3
Stanger, James D., and John L. Yovich. "Failure of human oocyte release at ovulation." Fertility and Sterility, vol. 41, no. 6, 1984, pp. 827-832.
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Ruptured follicles may still hold an egg in stimulated cycles
In 14 women at one IVF laboratory, flushing ruptured follicles found an egg in about 6 out of 10 of them after ovarian stimulation. The authors suggest that in such cycles a follicle may rupture yet keep its egg.
Key Findings
Of 150 patients admitted for egg collection, 14 had at least one ruptured follicle when the surgeons looked with the laparoscope.
Flushing the ruptured follicles recovered an oocyte from 13 of 22.
Of those 13 oocytes, 12 fertilized in the laboratory and 11 reached the 4-cell stage before transfer.
Follicles of 1.7 cm or greater on the previous day's ultrasound had ruptured in 16 of 19 cases, against 6 of 22 smaller follicles.
Oocytes came from 6 of 11 patients given clomiphene alone and from all 3 patients given clomiphene plus human menopausal gonadotropin.
Interpretation
This case series followed 14 women with ruptured follicles among 150 patients undergoing egg collection after ovarian stimulation. The authors ruled out the possibility that a flushed egg came from a neighboring follicle entered by the needle. The authors note that some retained eggs may have gone uncollected, so the true retention rate could run higher than the reported 60%. The findings support larger studies of follicle rupture and oocyte retention across stimulation protocols.
RRM Context
Fertility awareness methods detect an ovulatory event, such as a temperature shift. The authors write that only pregnancy confirms the egg was released. They name retained eggs as a second ovulation disorder next to the luteinized unruptured follicle, a follicle that answers the trigger without rupturing.
Our editorial summary of this paper, not the article's abstract.
Abstract
Among 150 patients admitted for ovum aspiration, in vitro fertilization, and embryo transfer in Perth, Western Australia, 14 were found to have had at least one ovulated follicle at the time of laparoscopy. Based upon ultrasound estimation of follicle diameter 24 hours previously, ovulation occurred in 6 of 22 follicles less than 1.7 cm in mean diameter and in 16 of 19 follicles greater than 1.7 cm in mean diameter. When the ruptured follicles were flushed with heparinized fertilization medium, oocytes were collected in 13 of the 22 dispersed follicles. Twelve oocytes developed pronuclei 16 hours after the addition of spermatozoa, and 11 cleaved to the 4-cell stage within 44 hours of insemination. Oocytes were recovered from 6 of 11 patients stimulated with clomiphene alone and from all 3 patients stimulated with clomiphene supplemented with human menopausal gonadotropin. These observations suggest that oocyte release and follicle rupture are not necessarily synonymous events and that the incidence of retained oocytes in ovulated follicles following stimulation with clomiphene or clomiphene plus human menopausal gonadotropin could be on the order of 60%.
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