EP27.03: Longitudinal volumetric analysis of follicular growth

Longitudinal study of follicular growth using transvaginal ultrasound images (3D TVS) targeted towards assisted reproduction. Prospective study involving 32 subjects enrolled for IVF at Vishakapatnam, India. Subjects underwent 3D-TVS (Samsung Medison WS80A with V5-9 probe) once every 2 days from initiation of stimulation to oocyte pick-up. A fixed stimulation protocol was employed for each subject with sparse fine tuning of dosage. 5DFollicle® application was used to determine the number of follicles, its diameter, minimum and maximum axis lengths, volume and average diameter in each exam. Ovarian vessels were used as anatomical landmarks to assist longitudinal tracking of individual follicles. Statistical regression was used to analyse follicular growth with respect to multiple clinical parameters (e.g. hormonal dosage, anthropometric data). A statistical model was developed to determine follicular growth rate and ovarian response. A subset (n=137) of follicles were tracked individually. Follicles that have a volume of ≥2mL (≥15mm diameter) on the day of Oocyte pickup grow at a rate of 0.04±0.04 mL/day up to the 5th day of IVF cycle, 0.2±0.12 mL/day between 6th day to 10th day of cycle and 0.38±0.4 mL/day from 10th day onwards. Follicles that have a volume between 1mL-2mL (10mm-15mm diameter) on the day of Oocyte pickup grow at a rate of 0.03±0.03 mL/day up to the 5th day of cycle, 0.17±0.08 mL/day between 6th day to 10th day of cycle and 0.2±0.2 mL/day from 10th day onwards. A first of its kind statistical model is developed that allows for accurate prediction of follicular growth rate. This limited sample analysis indicates feasibility of achieving our targeted goal of creating a normative follicular growth charts. This will enable the development of a hyperstimulation protocol in a clinical environment for a predictable ovarian response.