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PubMed1983

Ovulation induction with subcutaneous pulsatile gonadotropin-releasing hormone: singleton pregnancies in patients with previous multiple pregnancies after gonadotropin therapy.

Three patients with hypothalamic amenorrhea who had previously had multiple pregnancies following gonadotropin therapy were treated with subcutaneous pulsatile gonadotropin-releasing hormone (GnRH), administered by a portable pump. After treatment with lower doses in some cases, pulses of 5 to 10 micrograms were given at 90-minute intervals, resulting in ovulation on six occasions. Ovarian steroid profiles closely resembled those of normal ovulatory cycles, and spontaneous ovulation of a single ovarian follicle was consistently demonstrated by ultrasound. Singleton pregnancy was confirmed in each patient. The results imply normal operation of the ovarian-pituitary feedback loop and suggest that subcutaneous pulsatile GnRH therapy is a safe and effective means of ovulation induction in clomiphene-resistant cases of hypothalamic amenorrhea and may possibly become the preferred method of treatment.

Adult↗
PubMed1996

The effect of various ovulation induction protocols on pregnancy rates following intracytoplasmic sperm injection.

In the last two years intracytoplasmic sperm injection (ICSI) has become frequently employed as an assisted reproductive technique primarily to treat male factor infertility.' In order to achieve high pregnancy rates, all assisted reproductive technologies including ICSI require sufficient number and quality oocytes. In our practice we use three different ovulation induction regimens (CC/hMG, GnRH-a/hMG, and GnRH-a/FSH) to maximize the number of oocytes available for fertilization. In this present report, we retrospectively com- pared pregnancy rates with ICSI following the use of these protocols.

Journal Article↗
PubMed1990

A study on follicle stimulation and ovulation induction in polycystic ovary syndrome (PCOS).

The present study was undertaken to verify the efficacy of preparations for inducing follicular maturation and ovulation in patients with polycystic ovary syndrome (PCOS). Successful induction of ovulation in patients with PCOS was observed in treatment cycles with daily injections or pulsatile subcutaneous administration of human menopausal gonadotropin (hMG), the combination of clomiphene citrate and bromocriptine, or the combination of clomiphene citrate and hMG. The incidence of ovarian hyperstimulation syndrome varied with the different clinical conditions in which ovulation was induced, the types of preparations administered, and the doses and schedules administered.

Bromocriptine↗
PubMed1987

Potential teratogenicity of gonadotropin treatment for ovulation induction in the mouse offspring.

The teratogenic effects of induced ovulation were studied in mice by using three different doses of pregnant mare's serum (PMS)/human chorionic gonadotropin (HCG) (2.5, 5, or 10 IU) at two different stages of the estrous cycle. The PMS/HCG treatment induced high incidences of external congenital anomalies in the offspring in a dose-dependent manner. This was especially so when the treatment was "out of phase" to the naturally occurring ovulation schedule. The predominant malformations were open eyelids and cleft palate. The problems of extrapolating these findings to humans are discussed.

Abnormalities, Drug-Induced↗
PubMed1986

Comparison of intermediate-dose purified urinary follicle-stimulating hormone with and without human chorionic gonadotropin for ovulation induction in polycystic ovarian disease.

Urinary FSH is capable of inducing ovulation in PCOD. The duration of treatment can be reduced by administering an intermediate dose. However, it appears that prospective monitoring with E2 assays and ultrasound, combined with hCG, is required to optimize outcome and minimize complications. Studies comparing urinary FSH with similar doses of hMG with and without hCG are needed to determine the most effective form of gonadotropin therapy in PCOD.

Chorionic Gonadotropin↗
PubMed1985

Effects of aromatizable and nonaromatizable androgen treatments on luteinizing hormone receptors and ovulation induction in immature rats.

The effects of androgen pretreatment on follicle-stimulating hormone (FSH)-stimulated luteinizing hormone (LH) receptor induction in ovarian granulosa cells was examined. Immature female rats were treated with various doses (0.1-5 mg/rat) of testosterone (T), 5 alpha-dihydrotestosterone (DHT), 5 alpha-androstane-3 alpha,17 beta-diol (3 alpha-diol), or 5 alpha-androstane-3 beta,17 beta-diol (3 beta-diol). Subsequent follicular development was stimulated by treatment with ovine FSH. LH receptor induction in granulosa cells and ovulatory responses to 10 IU human chorionic gonadotropin (hCG) were examined. Since LH receptor induction requires the synergistic action of both FSH and estradiol, the effects of the androgen pretreatment on FSH-stimulated estradiol production were also examined. Dihydrotestosterone treatment at doses greater than 1 mg inhibited LH receptor induction by approximately 70%, which resulted in absent ovulatory responses. Treatment with 1 mg or more of T or 3 alpha-diol had no effect on LH receptor induction, yet the hCG-stimulated ovulation rate was reduced to 40% of that seen in vehicle-treated controls. 3 beta-Diol, at a dose of 1 mg/rat, did not affect LH receptor induction but did reduce hCG-stimulated ovulation responses. No significant effects of androgen treatment on ovarian or uterine weight or FSH-stimulated estradiol production were observed. These results suggest that androgens can act at multiple sites to inhibit ovarian follicular development and function. In addition these studies demonstrate that, although LH receptor induction is necessary, it may not be a sufficient condition to ensure ovulation of ovarian follicles.

Androgens↗
PubMed2004

Effects of medroxyprogesterone acetate (MAP) on ovarian antral follicle development, gonadotrophin secretion and response to ovulation induction with gonadotrophin-releasing hormone (GnRH) in seasonally anoestrous ewes.

When ovulation is induced with gonadotrophin-releasing hormone (GnRH) in anoestrous ewes, a proportion of animals fail to form normal (full-lifespan) corpora lutea (CL). Progesterone treatment before GnRH prevents luteal inadequacy. It remains uncertain whether a similar effect, achieved with medroxyprogesterone acetate (MAP) from intravaginal sponges, is mediated by influences on growing ovarian follicles and/or secretion of gonadotrophic hormones, before and after GnRH treatment. Two experiments were performed, on 13 and 11 anoestrous Western white-faced ewes, respectively. Seven and six ewes, respectively, received MAP-containing sponges (60 mg) for 14 days; the remaining ewes served as untreated controls. To test the effect of timing of GnRH administration after pre-treatment with MAP-releasing sponges, GnRH injections (250 ng every 2h for 24h followed by a bolus injection of 125 microg of GnRH i.v.) were given either immediately (Experiment 1) or 24h after sponge removal in the treated ewes (Experiment 2). Ovarian follicular dynamics (follicles reaching >or=5mm in size) and development of luteal structures were monitored using transrectal ultrasonography. In Experiment 1, the mean ovulation rate (0.7+/-0.3 and 1.0+/-0.4) and proportion of ovulating ewes (57 and 67%, respectively) did not vary (P>0.05) between MAP-treated and control ewes. Normal (full-lifespan) CL were detected in 29% of treated and 67% of control ewes (P>0.05). In Experiment 2, the mean ovulation rate (2.3+/-0.2 and 1.2+/-0.6; P<0.05) and percentage of ewes with normal (full-lifespan) CL (100 and 40%, respectively; P<0.10) were greater in the treated compared to control ewes. In Experiment 1, the mean peak concentration of the GnRH-induced LH surge was lower (P<0.05) in MAP-treated than in control ewes. There were no significant differences between MAP-treated and control ewes in the characteristics of follicular waves, mean daily serum FSH concentrations, and secretory parameters of LH/FSH, based on intensive blood sampling conducted 1 day before sponging and 1 day before sponge removal. It is concluded that treatment with MAP has no effect on the tonic secretion of LH/FSH or follicular wave development in anoestrous ewes. However, the GnRH-stimulated LH discharge was attenuated in the ewes that received MAP-impregnated sponges for 14 days and were treated with GnRH immediately after sponge withdrawal. Ovulatory response and CL formation were increased when GnRH was administered 24 h after sponge removal.

Anestrus↗
PubMed1978

Combined tubal and multiple intrauterine pregnancies following ovulation induction.

An infertile woman who conceived after human menopasual gonadotropin-induced ovulation experienced ovarian hyperstimulation and a quintuplet gestation--an ectopic and a quadruplet intrauterine pregnancy. The intrauterine pregnancy was confirmed by B-scan ultrasonography about the time that the tubal pregnancy was ruptured. Salpingectomy did not interfere with the intrauterine pregnancy, but in spite of a cervical cerclage the patient developed premature labor after about 26 weeks of gestation.

Adult↗
PubMed1996

Ovulation induction and ovarian malignancy.

Many couples faced with infertility are treated with ovulation inducing medicines. Recently, concerns have been raised about the possible risk of ovarian malignancy after such ovarian stimulation. Theories of pathogenesis for ovarian cancer include incessant ovulation, elevated pituitary gonadotropins, genetic predisposition, and chemical carcinogens. Protective factors include suppression of ovulation, pregnancy, and castration. Low numbers of exposed women who develop ovarian cancer make this a difficult research subject. Research to date demonstrates conflicting results, with some investigators reporting an increased risk of ovarian cancer with fertility drugs, whereas others do not. The likely magnitude of risk, if one believes a risk exists, may be two to three times that of the general population which is at most 4-5% in a woman's lifetime. The present uncertainty makes it challenging to apply this to today's practice of medicine. With continued efforts worldwide, we hope an understanding of this will be forthcoming.

Female↗
PubMed1992

Sonographic assessment of late proliferative phase endometrium during ovulation induction.

Late proliferative phase endometrium was assessed sonographically in 400 patients undergoing ovulation monitoring or stimulation. Endometrial evaluation was classified in relation to its widest diameter (quantity) and by the presence or absence of a double-layered (outer echogenic/inner hypoechoic) pattern (quality). No patient conceived if the endometrium was totally echogenic and less than 8 mm in diameter. All patients who conceived had an endometrium that was double-layered or greater than 9 mm in diameter. Positive, double-layered patterns correlated with correction of hormonal aberrations such as hypoestrogenism, hyperprolactinemia or hyperandrogenism. Such a positive pattern was also accomplished after discontinuation of clomiphene citrate in certain low-body weight/low-body fat women and administration of human menopausal gonadotropins to those patients. Application of the principles described to ensure the development of an adequate, double-layered (follicular phase) endometrium at midcycle were found to coincide with a higher incidence of pregnancy and viable gestation.

Chorionic Gonadotropin↗
PubMed1994

Ovulation induction and risk of neural tube defects.

The relation between use of ovulation-inducing drugs and risk of neural tube defects (NTDs) was studied in a case-control surveillance programme. The frequency of any use of such drugs during the 6 months before the last menstrual period or during pregnancy was 3.0% for 1034 mothers of infants and fetuses with NTDs (cases) and 2.8% for 4081 mothers of those with other major congenital malformations (controls) (relative risk 1.1, 95% CI 0.8-1.7). Relative risks for clomiphene and for hormones were 0.8 (0.5-1.3) and 1.5 (0.7-3.4), respectively. These data suggest that use of ovulation-inducing drugs before conception does not increase the risk of NTDs.

Case-Control Studies↗
PubMed1986

Drugs used in ovulation induction. Safety of patient and offspring.

Data on the safety of agents used to induce ovulation in women are presented, with a special reference to the normality of children at birth and puberty. No overall increase in anomalies has been found after the use of clomiphene citrate. This drug has been given up to day 35 of pregnancy, and its safety in these circumstances requires further analysis. More studies will also be needed on offspring as they pass through puberty, to ensure there are no defects in their Müllerian system. No increase in anomalies has been noted after the use of human menopausal gonadotrophins (HMG). The onset of menstrual rhythms and other parameters in the offspring appear to be normal. No increase in various cancers has been identified following the use of clomiphene or HMG, although most treated women have yet to enter the high risk years.

Chorionic Gonadotropin↗
PubMed1986

Ovulation induction with human menopausal gonadotropins.

This review has summarized the evolution of hMG stimulation of ovulation in amenorrheic individuals, its monitoring, and its complications. Based on the principles learned from these individuals, use of hMG has now extended to women with cervical mucus deficiencies or luteal phase defects, as well as in vitro fertilization. Recommendations regarding the use of hMG at the current time when assessment by both serum E2 and ultrasound are available have been made. Briefly, it is suggested that an "E2 window" of at least 1000 pg/ml be achieved over the course of a 9- to 12-day follicular phase. Furthermore, assessment of these monitoring modalities should be made in combination in order that findings from one modality alone not be allowed to initiate premature hCG administration.

Amenorrhea↗