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1. A 35-year-old woman with a history of endometriosis
and infertility is undergoing in vitro fertilization (IVF)
treatment. She receives daily injections of gonadotropins to
stimulate ovarian follicle development. On day 10 of her
cycle, she undergoes transvaginal ultrasound to assess the
number and size of the follicles. The ultrasound reveals that
she has 12 follicles, ranging from 15 to 20 mm in diameter.
What is the most appropriate next step in her treatment?
A) Continue gonadotropin injections until the follicles
reach 25 mm in diameter.
B) Administer human chorionic gonadotropin (hCG)
injection to trigger ovulation and schedule oocyte retrieval.
C) Reduce the dose of gonadotropins to prevent ovarian
hyperstimulation syndrome (OHSS).
D) Cancel the cycle and start a new one with a lower dose
of gonadotropins.
Answer: B) Administer human chorionic gonadotropin
(hCG) injection to trigger ovulation and schedule oocyte
retrieval.
Rationale: The optimal size of the follicles for IVF is
between 18 and 22 mm in diameter. When the majority of
the follicles reach this size, hCG injection is given to
induce final maturation and ovulation of the oocytes.
Oocyte retrieval is performed 34 to 36 hours after hCG
injection. Continuing gonadotropin injections or reducing
the dose may compromise the quality and quantity of the
oocytes. Cancelling the cycle is not necessary unless there
are signs of OHSS or other complications.
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