Evaluating the ratio of mature oocytes to immature oocytes in oocyte cohorts aspirated from HIV seropositive and HIV seronegative females post-controlled ovarian hyperstimulation

Abstract

A woman’s reproductive potential can be threatened by disrupting normal oocyte development, often associated with advancing maternal age, chronic viral infections, medical conditions/interventions, pharmaceutical and recreational drugs, and an individual’s Body Mass Index (BMI). Often, these factors affect the outcomes of assisted reproductive techniques (ART); however, they are not always addressed well, especially in developing countries such as South Africa. Research Aim and Objectives: This study aimed to provide a comparative analysis of the mature and immature oocyte yields in oocyte cohorts obtained from HIV-infected females against HIV-uninfected women of reproductive age, post-controlled ovarian hyperstimulation (COH). Additionally, the study examined the potential influence of factors associated with HIV infection, infertility, and ART, such as age, BMI, viral load, CD4+ lymphocyte counts, antiretroviral medication intake, ovarian stimulation protocols, and ovulation trigger injections on oocyte maturation outcomes. Methodology: This study evaluated n=80 women aged between 18-39 years attending ART between 2021 and 2023. GnRH-Antagonist protocol (Cetrotide® antagonist) for COH was used on all patients, and the exogenous gonadotropins for follicular stimulation were initiated on day 2/3 of the menstrual cycle. Ovitrelle® at 250mcg or Lucrin® at 40IU or 80IU were the ovulation triggers used. The oocytes were aspirated 36 hours after administration of the ovulation trigger. Oocyte denudation and assessment were done 2 hours after the TVOA, after which insemination using the ICSI technique was conducted 2 hours after incubation. Only the mature (MII) oocytes were inseminated at Day 0/Day 1, the appearance of 2 pronuclei (PN) and 2-Polar bodies (PB) at 16-18hours signified successful fertilisation, and single embryo culture in one-step media (under oil) was carried out for the next 3-5 days in a benchtop incubator. Results: The means for MII oocytes (p-value= 0,264), MI oocytes (p-value= 0,352), and GV oocytes (p-value= 0,258) between the HIV-infected population and HIV uninfected controls showed no statistical differences (all p-values> 0.05). Furthermore, when the total population was matched by age, BMI, ovarian stimulation protocol, ovulation trigger injection, and serum AMH, outcomes (follicle number, oocyte retrieval rates, and MII oocyte number) were comparable (all p-values> 0.05). Age was, however, positively associated with the relationship between AMH, follicle number, and MII oocyte number in the entire population. In this study, the quantities of mature (MII) oocytes in oocyte cohorts from the HIV positive females against the HIV negative females were similar. Furthermore, there were no significant differences in ART outcomes between the two groups after matching patients by age, BMI, ovarian stimulation protocol, and ovulation trigger.