Analgesic effect of acupuncture at hegu (LI 4) on transvaginal oocyte retrieval with ultrasonography.

OBJECTIVE: To observe the analgesic effect of acupuncture at Hegu (LI 4) in vitro fertilization-embryo transfer (IVF-ET) transvaginal oocyte retrieval using ultrasonography and explore its mechanism. METHODS: Ninety patients undergoing IVF-EF oocyte retrieval were randomly divided into three groups: an acupuncture group with needles inserted into bilateral Hegu (LI 4) points, a placebo group given placebo needles, and a control group with routine oocyte retrieval. Each group had an indometacin enema 30 min before the operation. We compared the pain-rated index (PRI), visual analogy scale (VAS), and present pain intensity (PPI) immediately after operation and 1 h after operation. We also determined the neuropeptide Y (NPY) level of the follicular fluid. RESULTS: PRI, VAS, and PPI after operation and 1 h after operation in the acupuncture group were significantly lower than those in the control group (P < 0.01). No obvious difference (P > 0.05) was observed in PRI, VAS, and PPI after operation and 1 h after operation between the placebo group and the control group. The NPY level of the follicular fluid in the acupuncture group was significantly higher than that in the control group (P < 0.01). No obvious difference (P > 0.05) was observed in the NPY level of the follicular fluid between the placebo group and the control group. CONCLUSION: The analgesic effect of acupuncture at Hegu in transvaginal oocyte retrieval using ultrasonography may be related to the increase in the NPY level of the follicular fluid.

Measurement of the speed of sound in follicular fluid.

BACKGROUND: Measurement of ovarian follicles by ultrasound is common practice in fertility treatment. However, the effect of the speed of sound is not taken into account. We present results from a study aimed at measuring this. METHODS: The speed of sound was measured in samples of follicular fluid aspirated from patients undergoing fertility treatment. The transmitted and received pulses from a single element ultrasound transducer were recorded using a digital oscilloscope for a pulse passed through a sample of the fluid. The distance over which the pulse travelled was known from calibration with pure water. Variation with temperature was investigated in the range 25-45 degrees C. Dependence on ultrasound frequency, patient and time from aspiration were also investigated. RESULTS: The speed of sound in follicular fluid was found to be 1550+/-3 m/s at 37.3 degrees C using 5.0 MHz ultrasound. The speed varied from 1528+/-3 m/s at 24.8 degrees C to 1561+/-3 m/s at 44.8 degrees C. Variation with patient, time and frequency were not detected. CONCLUSION: The speed of sound in follicular fluid at body temperature is 1550 m/s. This small difference from the speed assumed by the ultrasound machine corresponds to the systematic bias in volume measurement evident in previously published results.

Selection of the dominant follicle and insulin-like growth factor (IGF)-binding proteins: evidence that pregnancy-associated plasma protein A contributes to proteolysis of IGF-binding protein 5 in bovine follicular fluid.

Development of a dominant follicle is associated with decreased intrafollicular low molecular weight IGF-binding proteins (namely IGFBP-2, -4, and -5) and increased proteolysis of IGFBP-4 by pregnancy-associated plasma protein A (PAPP-A). In addition to IGFBP-4 proteolytic activity, bovine follicular fluid contains strong proteolytic activity for IGFBP-5, but not for IGFBP-2. Here we show that the IGFBP-5 protease present in bovine follicular fluid is a neutral/basic pH-favoring, Zn(2+) metalloprotease very similar to the previously described IGFBP-4 protease. We hypothesized that immunoneutralization and immunoprecipitation with anti-PAPP-A antibodies would result in abrogation of the IGFBP-4, but not the IGFBP-5, proteolytic activity in follicular fluid. As expected, anti-PAPP-A antibodies were able to neutralize and precipitate the IGFBP-4, but not the IGFBP-5, proteolytic activity of human pregnancy serum, which was used as a positive control for PAPP-A. Surprisingly, immunoneutralization and immunoprecipitation of follicular fluid from bovine preovulatory follicles with anti-PAPP-A antibodies abrogated both IGFBP-4 and IGFBP-5 proteolysis. Quantitative results derived from phosphorimaging revealed a complete inhibition of both IGFBP-4 and -5 proteolysis by follicular fluid incubated for 2 or 5 h in the presence of anti-PAPP-A antibodies. After 18 h of incubation, anti-PAPP-A antibodies still inhibited IGFBP-5 degradation, although with an efficiency lower than that for IGFBP-4 degradation. Both proteolytic activities have identical electrophoretic mobility, and a single band ( approximately 400 kDa) was detected by Western immunoblotting of bovine follicular fluid with anti-PAPP-A antibodies. Proteolysis of IGFBP-5 was readily detectable in follicular fluid from dominant follicles and was negligible in subordinate follicles from the same cohort. These results suggest that an active intrafollicular IGFBP-4/-5 proteolytic system, in which PAPP-A is the major protease involved, is an important determinant of follicular fate.

Transvaginal three-dimensional ultrasound: accuracy of follicular volume measurements.

OBJECTIVES: To evaluate the accuracy of three-dimensional (3-D) ultrasound (US) follicular volume measurements. DESIGN: Prospective clinical study. SETTING: A tertiary referral center for assisted reproduction. PATIENTS: Twenty-five patients undergoing ovarian stimulation for IVF-ET using the long protocol of GnRH agonist. INTERVENTION: Transvaginal two-dimensional (2-D) and 3-D ovarian scan performed immediately before US-directed follicle aspiration. MAIN OUTCOME MEASURES: The volume of follicular fluid aspirated was compared with the corresponding volume of the follicle measured by 3-D US and with the conventional 2-D US volume measurement calculated using the formula pi/6 (D1 x D2 x D3). Limits of agreement and 95% confidence intervals were calculated and systematic bias between the methods was analyzed. RESULTS: The limits of agreement between the volume of follicular aspirate and follicular volume determined by US were +0.96 to -0.43 mL for 3-D measurements and +3.47 to -2.42 mL for 2-D measurements. CONCLUSIONS: The true volume of ovarian follicles, within the clinically useful range for IVF-ET cycles, is measured more accurately by a 3-D US system than by 2-D US techniques.