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PubMed1987

Follicle-stimulating hormone is the main determinant of follicular recruitment and development in ovulation induction with human menopausal gonadotropin.

The early hormonal changes that lead to follicular maturation and/or hyperstimulation in women requiring ovulation induction with either human menopausal gonadotropin or gonadotropin-releasing hormone have not been elucidated. This study was undertaken to assess the relative contribution of follicle-stimulating hormone and luteinizing hormone to estradiol secretion and follicular maturation in patients receiving human menopausal gonadotropin or gonadotropin-releasing hormone. The study group consisted of 10 women (26 to 38 years of age) with secondary amenorrhea as a result of hypothalamic dysfunction who had failed to ovulate when given clomiphene citrate. The patients were randomly assigned to either human menopausal gonadotropin (n = 5) or gonadotropin-releasing hormone (n = 5) treatment. On day 5 after the onset of induced menses, all women had baseline blood samples obtained at 10-minute intervals for 4 hours. At this time either 150 U of human menopausal gonadotropin or 75 ng/kg of gonadotropin-releasing hormone administered hourly was given, and blood sampling every 10 minutes was continued for an additional 6 hours. Thereafter, patients were evaluated daily until ovulation. A significant and sustained increase in the mean plasma follicle-stimulating hormone level was first measured during the third hour after human menopausal gonadotropin administration (p less than 0.05. The area under the curve of the mean plasma follicle-stimulating hormone value after this initial increase was significantly greater than its baseline (2119 +/- 240 versus 1425 +/- 188 mlU/ml; p less than 0.01). This rise in mean follicle-stimulating hormone level was followed in less than 2 hours by a significant and uniform rise in mean plasma estradiol concentration (p less than 0.05). In contrast, no immediate change in the mean levels of luteinizing hormone, follicle-stimulating hormone, or estradiol occurred after gonadotropin-releasing hormone administration. The mean daily levels of luteinizing hormone were similar in both groups; however, mean daily follicle-stimulating hormone (20.0 +/- 1.1 versus 9.2 +/- 1.4 mlU/ml) and estradiol (1004 +/- 174 versus 495 +/- 83 pg/ml) levels were significantly higher in patients treated with human menopausal gonadotropin than in those treated with gonadotropin-releasing hormone (p less than 0.001 and p less than 0.05, respectively). In addition, only in patients receiving human menopausal gonadotropin was a positive correlation found between mean daily plasma estradiol and follicle-stimulating hormone (r = 0.685, p less than 0.05) levels and between mean daily plasma estradiol and prolactin (r = 0.94, p less than 0.001) levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Combined intra-uterine and extra-uterine pregnancy associated with mild hyperstimulation syndrome after clomiphene ovulation induction.

We report a combined intra-uterine and tubal pregnancy associated with mild ovarian hyperstimulation syndrome (OHSS) following ovulation induction by clomiphene. The diagnosis of ectopic pregnancy was originally missed until rupture occurred. OHSS confused the clinical picture, the important diagnostic feature being the fall in the haemoglobin concentration. The patient had a left partial salpingectomy and the uterine pregnancy progresses normally.

Adult↗
PubMed1984

The recovery of pre-ovulatory oocytes using a fixed schedule of ovulation induction and follicle aspiration.

Thirty-two volunteer women, scheduled for laparoscopy, were subjected to a fixed regimen of ovulation induction and ovarian follicle aspiration, following manipulation of the previous menstrual cycle with oral contraceptive pills or norethisterone. This allowed the time of oocyte recovery to be planned several weeks in advance. The recovery rate of mature oocytes (loosely dispersed cumulus) in the patients who had their cycles adjusted with norethisterone was comparable to that in a group of women treated in an embryo-transfer programme who were being individually monitored, although there was evidence from cleavage rates and concentration of sex steroids in follicular fluid that further follicular maturation could have occurred. It is suggested that a modification of this schedule could provide an acceptable recovery rate of pre-ovulatory oocytes for research purposes, and possibly by simplifying the monitoring technique could be applicable to a wider range of patients seeking embryo transfer.

Androgens↗
PubMed1990

A comparative study of single-dose growth hormone therapy as an adjuvant to gonadotrophin treatment for ovulation induction.

One intramuscular injection of biosynthetic human growth hormone (24 IU), administered on the first day of gonadotrophin treatment for ovulation induction, significantly augmented the ovarian response to gonadotrophic stimulation in seven patients. Compared with a protocol involving six injections of 24 IU of GH given on alternate days to the same patients, the smaller dose had an intermediate but highly significant effect in reducing the amount, duration of treatment and daily effective dose of hMG needed to induce ovulation. The difference between the effect of the one-dose and six-dose protocols was small. The action of growth hormone on the human ovary, probably mediated by insulin-like growth factor-1 (IGF-1), appears effective in enhancing the response to gonadotrophin therapy even when given in a single dose.

Amenorrhea↗
PubMed1977

[Attempts at biotechnical induction of puberty in female young pigs. 1. Estrus and ovulation induction with Suigonan (Vemie) or FSH plus HCG mixtures in animals at the age of approximately 200 days].

64 prepuberal gilts in 4 groups were treated with 400 PMS + 200 HCG (Suigonan - Vemie) (I), 100 FSH + 100 HCG) (II), 200 FSH + 200 HCG (III) ("international units") or served as untreated controls (IV). One halve of the groups laparotomized at the 12th day p.i. had ovulated 100, 25, 75 and 12,5% resp., the other halve slaughtered at the 36th day p.i. had ovulated to 83, 43, 88 and 50% resp. Sexual cycle was registered in 50, 29, 43 and 12.5% of the animals. Zystic ovaries (greater than or equal to 11 mm) developed only in a few cases in I and III.

Animals↗
PubMed1984

A randomized study of dexamethasone in ovulation induction with clomiphene citrate.

Improved understanding of follicular dynamics has led to a reevaluation of suppression of adrenal androgens in ovulation induction. To test whether adrenal suppression during clomiphene citrate (CC) therapy would improve ovulation/pregnancy rates, 64 anovulatory patients who had not previously received CC were randomly assigned to receive either 50 mg CC on days 5 to 9 alone or with 0.5 mg dexamethasone (CC + DEX). Patients were then screened for dehydroepiandrosterone sulfate (DHEA-S) (normal range, 80 to 320 micrograms/dl), prolactin, testosterone, and semen analysis of the partner. Nine patients discontinued participation prior to completing the first treatment cycle, and ten patients were found to have either elevated prolactin (4), severe male factors (3), or tubal disease (3) and were discontinued. CC was increased 50 mg/day per cycle through 150 mg/day until ovulation occurred. Once the patient was ovulatory on therapy, a properly timed postcoital test and endometrial biopsy for luteal phase defect were performed. If anovulatory at 150 mg/day of CC or demonstrating abnormal postcoital test or endometrial biopsy at 150 mg/day of CC, patients were crossed to the other arm of the treatment protocol. The results revealed a significantly higher rate of ovulation (P less than 0.01) and conception (P less than 0.05) in the CC + DEX-treated group. When correlated with DHEA-S levels, this improvement occurred in patients with DHEA-S greater than 200 micrograms/dl (P less than 0.05).

Adrenal Glands↗
PubMed1989

Low multiple pregnancy rate in combined clomiphene citrate--human menopausal gonadotrophin treatment for ovulation induction or enhancement.

Sixty-five infertile women, 37 with anovulation, eight with ovulatory disturbances and 20 with unexplained infertility were treated by a combination of clomiphene citrate (CC) from cycle day 5 (or 3) and human menopausal gonadotrophin (HMG) begun 3 days later for induction or enhancement of ovulation. Monitoring was carried out by measuring preovulatory 17-beta-oestradiol (E2) and progesterone (P) concentrations in blood samples and by follicle measurements using ultrasound. Forty-seven pregnancies resulted with a multiple pregnancy rate of 7.7% for those completed. This incidence is very low and within the range found for CC induction and might result from the later commencement of stimulation compared with many other protocols. These results were achieved with a low incidence of ovarian hyperstimulation syndrome (2.6% per cycle). The HMG doses given were low in comparison with those found in other forms of induction. The deleterious effects of this combined mode of induction on cervical mucus and the occurrence of premature spontaneous ovulation were much less than in the sequential mode of treatment. These results suggest that combined induction treatment by CC and HMG as described offers a means of achieving low rates of multiple pregnancies a known complication in the induction of ovulation.

Adult↗
PubMed1988

The theory and practice of ovulation induction with gonadotropin-releasing hormone.

Gonadotropin-releasing hormone therapy has undergone sufficient basic and clinical investigation as a tool for ovulation induction that it should now be considered a safe and effective infertility therapy for office practice. Nevertheless, there remains sufficient mystique about patient selection, optimal dosage and route of delivery, and apprehension on the part of both physicians and patients about cost and inconvenience of medication pumps that gonadotropin-releasing hormone therapy has not enjoyed the widespread acceptance it deserves. This article presents straightforward guidelines for therapy that are based on a detailed review of current literature, together with new information about evolving pump technologic characteristics, that should offer reassurance to the practitioner considering use of gonadotropin-releasing hormone therapy in her/his practice.

Female↗
PubMed1997

Successful in vitro maturation of human oocytes not exposed to human chorionic gonadotropin during ovulation induction, resulting in pregnancy.

OBJECTIVE: To report a case of successful in vitro maturation of human oocytes not exposed to hCG during ovulation induction, resulting in pregnancy after transfer of a frozen-thawed embryo resulting from intracytoplasmic sperm injection (ICSI) of the in vitro-matured human oocytes. DESIGN: Clinical study. SETTING: Hospital-based private IVF center. PATIENT(S): A couple with infertility due to severe oligospermia. INTERVENTION(S): Five immature oocytes were retrieved from a patient who failed to use hCG during ovarian stimulation and were cultured for 48 hours in B2 medium containing FSH and hCG. Five oocytes extruded the first polar body and underwent ICSI with frozen-thawed husband spermatozoa. MAIN OUTCOME MEASURE(S): In vitro maturation, fertilization after ICSI, embryo development, and pregnancy. RESULT(S): All five oocytes extruded the first polar body and were injected using ICSI. Three oocytes were fertilized, but two showed three pronuclei. The remainder, a two-pronuclei embryo subsequently cleaved and was cryopreserved. An ongoing pregnancy was obtained after-the transfer of this frozen-thawed embryo. CONCLUSION(S): Immature human oocytes at the germinal-vesicle stage that have not been exposed to hCG during ovarian stimulation can be matured in vitro and a normal pregnancy can result from ICSI of the in vitro-matured oocytes.

Adult↗
PubMed1996

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993.

OBJECTIVE: To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies. DATA IDENTIFICATION: Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993. CONCLUSIONS: The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future.

Female↗
PubMed1996

Spontaneous pregnancies despite failed attempts at ovulation induction in a woman with latrogenic premature ovarian failure.

BACKGROUND: Women with premature ovarian failure may conceive spontaneously or following different regimens of ovulation induction. CASE: A 29-year-old woman with eight years of hypergonadotropic hypogonadism following chemotherapy and radiotherapy for Hodgkin's disease conceived spontaneously and spontaneously aborted after discontinuation of estrogen replacement. Subsequently she underwent pituitary gonadotrope downregulation and attempted controlled ovarian hyperstimulation without an ovarian response or follicular development. Despite this failure, she conceived spontaneously on two occasions, resulting in a live-born infant and an ongoing pregnancy. CONCLUSION: Cases of hypergonadotropic hypogonadism may not be permanent or irreversible. Interventional regimens may fail to induce ovulation despite the presence of residual oocytes capable of recruitment and fertilization.

Adult↗
PubMedDate not supplied

Ovulation induction by human menopausal gonadotropin with ultrasonic monitoring of the ovarian follicles.

One hundred sixteen cycles of human menopausal gonadotropin (hMG) treatment for ovulation induction were studied. The ovarian response to hMG treatment was monitored by the daily determination of serum estradiol (E2) or by daily serum E2 and repeated ultrasonic examination of the ovaries. There were more follicles 18 mm in diameter or larger at the time of human chorionic gonadotropin (hCG) administration in the pregnancy than in the non-pregnancy cycles, and in the hyperstimulated than in the nonhyperstimulated cycles. The ovulatory rate and the pregnancy rate per cycle did not improve with the use of ultrasound. The number of treatment cycles required to achieve pregnancy was less in patients who had ultrasonic examination of the ovarian follicles. These results suggest that ultrasonic examination of the ovarian follicle helps to reduce the number of hMG cycles required to achieve pregnancy. The development of multiple follicles results in more pregnancies. However, the use of ultrasound does not improve the pregnancy rate.

Adult↗
PubMed1991

Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients.

OBJECTIVE: To compare ovarian performance and hormonal levels, after ovulation induction, in patients with isolated hypogonadotropic hypogonadism, using two different gonadotropin drugs. DESIGN: Patients were treated during consecutive cycles, using the same stimulation protocol, with human menopausal gonadotropin (hMG) in the first treatment cycle and purified follicle-stimulating hormone (FSH) in the second one. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS, PARTICIPANTS: Nine patients with isolated hypogonadotropic hypogonadism. MAIN OUTCOME MEASURE: Duration of stimulation, number of leading follicles, serum estradiol (E2) concentration and endometrial thickness at the time of human chorionic gonadotropin administration, and the occurrence of ovulation. RESULTS: Compared with hMG, treatment with purified FSH required significantly more ampules of drug (P less than 0.04) but resulted in a significant reduction in the number of leading follicles (P less than 0.05), serum E2 concentrations (P less than 0.002), endometrial thickness (P less than 0.02) and the occurrence of ovulation (P less than 0.05). CONCLUSION: This study in isolated hypogonadotropic hypogonadism patients is consistent with the two-cell two-gonadotropin hypothesis, that both gonadotropins are required to accommodate their synergistic action for appropriate steroidogenesis. In treating this group of patients, the superior efficacy of hMG compared with purified FSH preparation is beyond question.

Adult↗
PubMed1994

Native gonadotropin-releasing hormone for triggering follicular maturation in polycystic ovary syndrome patients undergoing human menopausal gonadotropin ovulation induction.

OBJECTIVE: To evaluate the role of GnRH administration instead of hCG for triggering follicular maturation in patients with polycystic ovaries (PCO) undergoing hMG ovulation induction when the late follicular 17-beta-E2 levels are > 1,600 pg/mL (> 6,000 pmol/L). DESIGN: Prospective study. SETTING: Infertility outpatient clinic of Rambam Medical Center (general hospital), Haifa, Israel. PATIENTS AND INTERVENTIONS: High serum E2 concentrations from 1,600 to > 3,600 pg/mL (2,800 +/- 68, mean +/- SD [6,000 to > 13,000 pmol/L, 10,279 +/- 2,500]) were experienced in 44 hMG cycles. The number of preovulatory follicles visualized by transvaginal sonography was between 8 and 25. An IV injection of 200 micrograms GnRH was administered for triggering final follicular maturation and ovulation, instead of 10,000 IU IM hCG, usually injected for this purpose, when the E2 levels are < or = 1,600 pg/mL (6,000 pmol/L). Serum E2 and P levels were monitored in the luteal phase. In cycles where E2 decreased to < or = 1,360 pg/mL (5,000 pmol/L), 2,500 IU hCG was administered once or twice at 3-day intervals for luteal support. MAIN OUTCOME MEASURES: Pregnancy and abortion rates and the rate of ovarian hyperstimulation syndrome (OHSS). RESULTS: Ten pregnancies were generated by the hMG and GnRH co-treatment in 32 patients (31.2%), in 44 cycles (23%). Two pregnancies aborted (20%), and eight generated eight healthy neonates. Ovarian hyperstimulation syndrome occurred in two cycles of patients who were both pregnant. All but two of these PCO patients also have undergone 69 hMG and hCG cycles. Only 7 patients conceived (23%) 10 times (10/69, 14.5%); 5 of these pregnancies (50%) were multiple gestations (3 twins, 1 sextuplet, and 1 heptuplet gestation). The pregnancy wastage rate was 30% (3/10). CONCLUSION: The use of native GnRH to trigger ovulation in PCO patients with late follicular E2 levels > 1,600 pg/mL (6,000 pmol/L) appears to be comparable with prior hMG and hCG cycles in terms of pregnancy rate, pregnancy wastage, risk of multiple gestation, and incidence of severe ovarian hyperstimulation. Unlike hMG and GnRH-agonist, which is associated with luteal phase dysfunction, hMG and GnRH offers a preferable alternative due to the ability of hCG luteal support and rescue, providing the E2 levels are not dangerously increased.

Estradiol↗
PubMed2006

Hormonal characteristics of follicular fluid from women receiving either GnRH agonist or hCG for ovulation induction.

BACKGROUND: A recent prospective randomized study from our group compared GnRH agonist (0.5 mg buserelin) and hCG (10,000 IU) for triggering of ovulation following a flexible antagonist protocol. The agonist group showed a poor reproductive outcome despite luteal phase support with progesterone and estradiol (E(2)). In the present prospective observational study, the health status of follicles from the above study was monitored by analysing the hormonal content of frozen/thawed follicular fluid samples. The aim was to test whether the poor reproductive outcome could be related to a defective pre-ovulatory follicular maturation resulting in oocytes with a compromised developmental competence. METHODS: Hormone concentrations were measured in two individual follicular fluid samples from each of 32 women receiving buserelin and 37 receiving hCG, thus representing a subset of the follicles retrieved. RESULTS: Follicular fluid levels of LH in the agonist group as compared with the hCG group was 11.1 +/- 0.5 versus 3.6 +/- 0.3 IU/l (mean +/- SEM; P < 0.001); FSH, 6.3 +/- 0.6 versus 3.3 +/- 0.2 IU/l (P < 0.001); hCG, not determined versus 139+/-8 IU/l; E(2), 1.9 +/- 0.2 versus 1.8 +/- 0.2 micromol/l (P > 0.10); progesterone, 70 +/- 4 versus 93 +/- 6 micromol/l (P < 0.001); inhibin-A, 36.9 +/- 3.1 versus 37.1 +/- 2.5 ng/ml (P > 0.10) and inhibin-B, 35.6 +/- 2.8 versus 40.1 +/- 3.1 ng/ml (P > 0.10). Thus, pronounced hormonal differences exist in follicular fluid, and the collective concentration of all three gonadotropins and the follicular fluid concentration of progesterone were much higher in the group of women receiving hCG for ovulation induction. CONCLUSION: The study suggests that GnRH agonist results in proper pre-ovulatory follicular maturation, but the ovulatory signal--probably in synergy with the resulting pituitary down-regulation--is too low to support appropriate corpus luteum (CL) function.

Adult↗