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PubMed1984

The use of ovarian ultrasonography in monitoring ovulation induction.

Ovarian ultrasonography is a new diagnostic technique which has become almost essential in monitoring ovulation. Recent improvements in ultrasound technology have allowed for accurate assessment of the number and size of the developing follicles and their rate of growth, as well as ovulation and postovulatory events. In the nonstimulated cycle follicular size correlates well with optimal maturation and there is a linear correlation between follicular diameter and plasma estradiol (E2 levels). In stimulated cycles, because of asynchrony of various recruited cohorts of follicles, these rules are not as steadfast. These observations indicate that when there is endogenous gonadotropic activity, follicular growth stimulated by human menopausal gonadotropins (hMG) does not develop synchronously. The aim should be, therefore, not only to improve the monitoring system but mainly to synchronize the cohorts of follicles recruited for development in any one cycle by a better regimen for ovulation induction. In view of the high success rate of hMG treatment in patients without endogenous gonadotropin secretion, it is tempting to speculate that inducing similar conditions in women with endogenous gonadotropin production may have a significant change in the pattern of follicular development in their conception rate.

Clomiphene↗
PubMed1989

Multiple consecutive cycles of ovulation induction with human menopausal gonadotropins.

Human menopausal gonadotropins were administered in multiple repetitive cycles for ovulation induction. Ovarian response, as judged by peak E2 levels and the day of hCG administration, remained similar in 3-12 immediately successive cycles. We conclude that hMG can be administered in multiple successive cycles without clinically impairing ovarian response.

Clomiphene↗
PubMed1996

The effect of ovulation induction on the concentration of maternal serum relaxin in twin pregnancies.

OBJECTIVE: Our purpose was to determine the effects of fetal number, various ovulation induction treatments, and placental hormones on the concentration of maternal serum relaxin. STUDY DESIGN: The concentrations of relaxin, human chorionic gonadotropin, estriol, and alpha-fetoprotein were determined in blood samples drawn at 16 to 18 weeks for prenatal diagnosis in 72 singleton and 115 twin pregnancies and analyzed by one-way analysis of variance, correlation analysis, and stepwise multiple linear regression of the log-transformed data. RESULTS: The maternal serum concentrations of each of the four measured hormones were significantly higher in the twin pregnancies than in the singleton pregnancies: 1.4-fold for relaxin, 1.9-fold for human chorionic gonadotropin, 1.9-fold for estriol, and 2.2-fold for alpha-fetoprotein (all p < 0.01). The concentrations of each of the four hormones were significantly correlated with each of the others and with the number of fetuses (p < 0.01), except that estriol was not significantly correlated with human chorionic gonadotropin. The serum relaxin concentration in twin pregnancies after treatment with follicle-stimulating hormone and luteinizing hormone (menotropins) (n = 10) was 3.3-fold that in twins resulting from spontaneous ovulation (n = 89, p < 0.01). In twins resulting from in vitro fertilization or gamete intrafallopian transfer (n = 9) the serum relaxin concentration was 2.6-fold higher than in twins resulting from spontaneous ovulation (p < 0.01). The effect of clomiphene citrate (1.2-fold, n = 7) failed to reach statistical significance. CONCLUSIONS: The second fetus causes a 1.4-fold increase in the concentration of maternal serum relaxin in twin pregnancies. Induction of ovulation with menotropins causes an additional 3.3-fold increase, whereas in vitro fertilization or gamete intrafallopian transfer treatment causes an additional 2.6-fold increase over that seen in twin pregnancies that followed spontaneous ovulation.

Chorionic Gonadotropin↗
PubMed1993

Embryonal reduction using transvaginal saline injection in a sextuplet pregnancy after ovulation induction with human menopausal gonadotropin.

A sextuplet pregnancy occurred in a first treatment cycle of ovulation induction with human menopausal gonadotropins. The serum 17-beta-estradiol concentration was 1245 pg/ml on the day of human chorionic gonadotropin administration. Embryonal reduction of four fetuses was carried out at nine weeks gestation using a transvaginal ultrasound-guided approach. Under general anesthesia, a 16-gauge in vitro fertilization needle was introduced through the posterior fornix and uterine wall, into the nearest gestational sac. The embryo was penetrated and 0.9% saline solution was injected until disintegration was noted, and confirmed by a lack of pulse for more than two minutes. The same procedure was applied to the three embryos in closest proximity to the needle. The patient delivered healthy twins in the 34th week of gestation after having had pre-term contractions for two weeks.

Abortion, Induced↗
PubMed1992

Ovulation induction in women with premature ovarian failure: a prospective, crossover study.

A prospective crossover study comparing ovulation induction techniques in eight women with premature ovarian failure is presented. These patients were treated with FSH rebound techniques using the GnRH-a, LA, alone in one treatment cycle and the same plus menopausal gonadotropins in the other treatment cycle. Two women ovulated in each group. We conclude that ovulation does occur in women with premature ovarian failure, but that luteal P may be inadequately secreted.

Adult↗
PubMed1996

Is multiple pregnancy an unavoidable complication of ovulation induction? The case for pulsatile GnRH.

Ovarian hyperstimulation (OHS) and multiple pregnancy are dreaded complications of ovulation induction. The use of pulsatile GnRH permits to prevent the occurrence of OHS and results in few multiple pregnancies. Low-dose GnRH administration, avoidance of preovulatory hCG, patient selection, and the use of GnRH agonist pituitary desensitization in selected patients permits to limit multiple conceptions to a level comparable with the occurrence of this complication in normal unstimulated women.

Chorionic Gonadotropin↗
PubMed1998

Simplifying ovulation induction for surrogacy in women with Mayer-Rokitansky-Kuster-Hauser syndrome.

A simple approach for ovulation induction in women with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH-S) during in-vitro fertilization (IVF)/freezing/surrogacy cycles was evaluated. Weekly progesterone plasma concentrations were measured in order to accurately establish the luteal phase in MRKH-S women. When a rising titre was detected, a gonadotrophin-releasing hormone analogue (GnRHa) was administered as part of a long protocol. Two weeks later human menopausal gonadotrophin (HMG) therapy was started. Ten treatment cycles in four women with MRKH-S were carried out. In all cases, three or less progesterone estimations were needed. Three of the four women are now, through surrogacy, genetic mothers; one of them has two children. We concluded that weekly determination of progesterone plasma concentration is a convenient, efficient and inexpensive simple approach to identify the luteal phase, and therefore suitable to the start of a GnRHa/HMG protocol in MRKH-S women enrolled in an assisted reproduction technology programme.

Amenorrhea↗
PubMed1997

Serum FSH levels in women with polycystic ovary syndrome during ovulation induction using down-regulation and urofollitropin.

OBJECTIVE: To evaluate retrospectively the use of serum FSH levels and to correlate them with follicular growth in a clinical ovulation induction program. METHODS: Twenty women with infertility due to anovulation associated with polycystic ovary syndrome (PCOS) were studied. The patients were down-regulated with a long GnRH agonist protocol and stimulated with purified urofollitropin, using a low-dose step-up regimen. Repeated serum samples were drawn and transvaginal ultrasound scans were-performed. During the exogenous FSH therapy serum FSH levels resulting in continuous follicular growth were analyzed, as well as the rates of ovulation, pregnancy, cancellation and conversion to in vitro fertilization (JVF). RESULTS: Thirty-two out of fifty treatment cycles led to ovulation, resulting in five term pregnancies. Eight cycles were converted to IVF/embryo transfer due to multiple follicular growth. They resulted in two pregnancies. Ten cycles were cancelled because of impaired follicular growth. The serum FSH levels (median 6 IU/I) resulting in continuous growth of the follicles were relatively stable within patients (variation 15%) but varied considerably between patients (45%). The relationship between FSH dose and serum level was different for lean and obese PCOS patients after subcutaneously injected urofollitropin CONCLUSIONS: There seems to be a difference in resorption/metabolism between lean and obese PCOS patients with regard to s.c. injected FSH. The intra-patient coefficient of variation (C.V.) of the serum FSH response level was quite low, as was the C.V. of the FSH dose at the response level. This allowed a more rapid dose adjustment in subsequent cycles. Analysis of serum FSH during induction of ovulation with gonadotropins seems to be of limited value in clinical programs.

Adult↗
PubMed1985

In vitro fertilization and embryo transfer: an individualized approach to ovulation induction.

Because of the inherent marked individual responsiveness to ovulatory stimulating agents, a highly individualized approach to ovulation induction for in vitro fertilization has been utilized. The starting time for medication was varied according to the previous mean cycle length. The dose of clomiphene citrate was adjusted to the body weight. The dose and duration of both clomiphene and human menopausal gonadotropin (hMG) were adjusted as early as treatment day 5 in accordance with the ultrasonic findings. The day of human chorionic gonadotropin (hCG) administration was varied according to a combination of ultrasonic findings and plasma estradiol levels. This approach resulted in a mean retrieval of four oocytes per laparoscopy, 75% of which were mature, a fertilization rate of 78%, and a pregnancy rate of 14% of laparoscopies.

Adult↗
PubMed1993

Ovulation induction in gonadotrophin-resistant women.

The patient who has gonadotrophin-resistant ovaries and who requires ovulation induction or superovulation for IVF presents a serious problem. The diagnosis is usually made in the first treatment cycle which is either abandoned due to a failure of response, requires inordinately high doses of gonadotrophins to induce a response or fails to induce satisfactory oestradiol levels and/or follicular development. This situation is often associated with advanced maternal age and high day 3 concentrations of FSH. The possible treatment strategies that we have described seem to offer only a partial solution to specific subgroups of poor responders. These include protocols of clomiphene/hMG, mini-dose GnRH agonist regimens, and cotreatment with GH, each of which may be found to be effective in individual cases. Taking into account today's increasing demand for pregnancy in older aged women, more research is needed to evolve more efficient solutions for this difficult problem.

Anovulation↗
PubMed2005

Evaluation of ovulation induction protocols for poor responders undergoing assisted reproduction techniques.

OBJECTIVE: To compare 3 stimulation protocols in poor ovulation responders undergoing in-vitro fertilization (IVF). METHODS: The study was a randomized, prospective clinical trial from June 2003 to July 2004, in Royan Institute, Tehran, Iran. One hundred and fifty-four patients, who had poor responses to ovulation induction in at least one previous IVF attempt, were randomly divided into 3 groups. In the first group, human menopausal gonadotropin (HMG) was administered from day 3 of the cycle at a dose rate of 150 IU/day. In the second group, gonadotropin-releasing hormone (GnRH) agonist was started at a dose rate of 800 microg/day by nasal spray or 500 microg/day subcutaneously in the mid-luteal phase, followed by a standard HMG dose after pituitary down regulation was confirmed. In the third group, clomiphene at a dose rate of 100 mg/day was given from day 3 and HMG from day 6. Our main outcomes were number of mature oocytes, cancellation rate, number of HMG ampoules used and incidence premature luteinizing hormone (LH) surge. RESULTS: There was a high incidence of premature LH surge in all groups except in the GnRH group (p=0.0001) and there were significant differences between groups in HMG requirements (p=0.004). There were no significant differences between groups in number of mature oocytes recovered and cancellation rate. CONCLUSION: Results showed no advantage in the use of GnRH agonist compared to the older regimens of clomiphene plus HMG and HMG alone. The cancellation rate was similar for 3 protocols and HMG requirement was higher with the use of GnRH agonist. The treatment of poor responders in assisted reproductive technologies remains a challenge.

Female↗
PubMed1995

[Evaluation of the cervical factor in ovulation induction].

Post coital sperm penetration tests performed in 66 women under study for infertility, the purpose was to evaluate the ovulation induction effect over mucus quality and over sperm penetration. They were divided in three groups: 1) 28 women with evidence of spontaneous ovulation (control group), 2) 26 patients in which ovulation was induced with comiphene citrate and 3) 12 patients in which ovulation was induced with menotropins. The results showed that CC had an adverse effect over cervical mucus (p < 0.001), while in patients treated with menotropins the cervical mucus quality was not modified. Sperm penetration in patients under CC had a tendency to lower values than those in women of the control group, but these were statistically lower than those in patients under menotropins (p < 0.05). These results show the adverse effect of CC and the benefit of menotropins over cervical mucus and sperm penetration.

Adult↗
PubMed1999

Pregnancy following the laparoscopic bipolar electrocoagulation of polycystic ovaries resistant to medicamentous ovulation induction--a case report.

The case of a primarily infertile patient with polycystic ovaries (PCOS) resistant to medicamentous ovulation induction is presented. The preoperative condition, laparoscopic ovarian drilling using an original technique of bipolar electrocoagulation and consecutive spontaneous pregnancy and delivery are described. This case suggests that bipolar forceps with jaws 1 mm wide could be a useful instrument for laparoscopic ovarian drilling.

Adult↗
PubMed1986

Ovulation induction with pulsatile gonadotropin-releasing hormone: a study of the subcutaneous route of administration.

The efficacy of ovulation induction with the use of intermittent gonadotropin-releasing hormone (GnRH) therapy was examined in seven infertile women with hypothalamic amenorrhea. GnRH was administered every 90 minutes via the subcutaneous route in doses ranging from 50 to 300 ng/kg. Analysis of the induced gonadotropin pulse pattern revealed normal to modestly increased luteinizing hormone secretory parameters (e.g., pulse amplitude) in six of the seven patients. Six of seven women and 15 of 16 treatment cycles (94%) were ovulatory. The conception rate was 43% per woman and 19% per cycle. However, detailed hormonal analysis of 13 treatment cycles revealed that only 1 cycle was entirely normal in terms of duration and/or steroid secretion.

Adult↗
PubMed1984

Ovarian hyperstimulation syndrome following ovulation induction with human menopausal gonadotropin.

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Adult↗
PubMed1992

Ovulation induction with human menopausal gonadotropin versus follicle-stimulating hormone after pituitary suppression by gonadotropin releasing hormone agonist in polycystic ovary disease. A cross-over study.

Ten patients with polycystic ovary disease (PCOD) had ovulation induction after pituitary suppression by gonadotropin releasing hormone agonist (GnRHa) with GnRHa plus pure follicle-stimulating hormone (FSH) or plus human menopausal gonadotropin (hMG). Duration of the stimulation period and gonadotropin doses were superimposable. A multifollicular response was observed in both treatments. Bioassay and radioimmunoassay of luteinizing hormone, androstanedione and testosterone plasma levels were higher in hMG cycles compared to FSH-treated cycles. No differences was found in FSH and estradiol (E2) plasma concentrations, whereas in hMG-treated cycles the E2/number of follicles and E2/ovarian volume ratios were greater than in the FSH-treated cycles. Clinical results in terms of percentages of ovulation and pregnancies were the same in the two protocols. We conclude that the presence of luteinizing hormone in induction of ovulation in patients with PCOD does not seem to influence follicular recruitment and development, but it may have a role in the enhancement of steroid production.

Adult↗
PubMed1994

Increased insulin secretion in patients with multifollicular and polycystic ovaries and its impact on ovulation induction.

OBJECTIVE: To assess the oral glucose tolerance test (OGTT)-stimulated insulin secretion and its relation to pulsatile GnRH ovulation induction outcome in patients with multifollicular or polycystic ovaries (PCOs). DESIGN: Prospective study. SETTING: Reproductive Endocrinology Center, University of Bologna, Bologna, Italy. PATIENTS: Eight normal and 29 anovulatory women (8 with multifollicular ovaries and 21 with PCOs). INTERVENTION: A standard OGTT was performed in all subjects. In all anovulatory patients, ovulation was induced with pulsatile GnRH (5 micrograms i.v. every 60 minutes). In multifollicular ovary patients, pulsatile GnRH was administered alone, whereas in PCOs it was preceded by GnRH agonist (GnRH-a) suppression. MAIN OUTCOME MEASURES: Glucose, insulin, and C-peptide response to the OGTT, expressed as area under the curve (AUC). Ovulatory rates in response to pulsatile GnRH. RESULTS: Insulin and C-peptide AUC were greater than controls in both multifollicular ovary and PCO patients. Insulin AUC was positively correlated to ovarian volume. Ovulation was achieved in 88% and 57% of multifollicular ovary and PCO patients, respectively. Body mass index and glucose AUC but not insulin and C-peptide AUC were significantly greater in the anovulatory PCO. CONCLUSIONS: [1] Insulin AUC was increased in both multifollicular ovary and PCO patients; [2] derangements of insulin secretion may be present in a greater variety of anovulatory patients than previously thought; [3] insulin levels during the OGTT did not predict a response to pulsatile GnRH in PCOs, suggesting complex insulin interactions at the ovarian level; [4] given the in vitro stimulatory properties of insulin on granulosa cells synergistic with FSH, we propose that excessive insulin levels may contribute to the ovarian enlargement often found in multifollicular ovary and PCO patients.

Adult↗