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PubMed1987

The impact of dosage on ovulation induction by pulsatile gonadotropin-releasing hormone (Gn-RH) in hypothalamic amenorrhea.

Ten patients with hypothalamic amenorrhea (HA) were treated to induce ovulation with i.v. pulsatile Gn-RH. Twentysix cycles were administered with doses ranging from 2.5 (A; no. = 10) to 5 (B; no. = 13) to 10-12.5 micrograms/90 min (C; no. = 3). Ovulation rate was 80% in A, 92.3% in B and 100% in C and pregnancy rate 25% in A and 41.6% in B. Furthermore, both the onset of ovarian response and follicular growth were found to be more suitable in groups B and C with respect to group A. Estradiol pattern as well as mid-luteal progesterone plasma levels were superimposable in the different groups. It is concluded that all doses used are effective in inducing ovulation in HA patients. However, small pulsatile doses (2.5 micrograms/90 min) might constitute a critical threshold for adequate ovarian response.

Amenorrhea↗
PubMed1995

Gonadotropin control of follicle and oocyte maturation: implications for ovulation induction.

Development and maturation of follicles and oocytes during the menstrual cycle are complex processes that are poorly understood. Current gonadotropin therapy for ovulation induction/IVF may result in the production of suboptimal oocytes. As we learn more about the interdependency of follicle and oocyte in natural cycles, we should enhance our ability to produce better quality oocytes in artificial cycles. This will lead to improved success in the treatment of infertility.

Female↗
PubMed1989

Induction of ovulation with gonadotrophin-releasing hormone--life-table analysis of 50 courses of treatment.

Ovulation induction by means of the pulsatile subcutaneous administration of gonadotrophin-releasing hormone by way of an infusion pump is described. The clinical outcome in 50 courses of treatment, which totalled 116 treatment cycles, was analysed and was compared with the pregnancy rates that were obtained with the administration of human pituitary gonadotrophins. We found that the pregnancy rates for these two treatments were similar. We also have shown that for those women who ovulated as a result of such treatment the conception rates were similar to those in ovulatory women who had discontinued contraception. We conclude that gonadotrophin-releasing hormone has an important place among the ovulation-induction agents.

Actuarial Analysis↗
PubMedDate not supplied

Induction of ovulation with pulsatile gonadotropin releasing hormone (GnRH) in anovulatory women.

In this study we employed pulsatile GnRH therapy in different anovulatory disorders to test its real efficacy on ovulation induction. Ten adult women, 25-35 years old with primary or secondary infertility, underwent our study; all women showed anovulatory disorders such as Secondary Amenorrhea (n. 4), PCOD (n. 3) or Oligomenorrhea resistant to Clomiphene Citrate (n. 3). Pulsatile gonadotropin releasing hormone (GnRH) was given intravenously via automatic micropump, with a pulse interval of 90' and a pulse dose of 5 mcg/day. Ovulation was achieved in 7 cases (70%), whereas the failure of therapy was observed in 3 patients (30%), all affected by PCOD. The mean duration of follicular phase was 15 days and the ovulatory cycles did not need the luteal phase support. The maximum length of infusional therapy was 20 days with a low incidence of adverse side effects such as phlebitis; only in one patient a mild ovarian hyperstimulation was observed. Our results confirm that infusional pulsatile GnRH therapy is a very important tool to ovulation induction and it is more successful in primary or secondary amenorrhea and in hypothalamic disorders than in PCOD.

Adult↗
PubMed2001

Induction of ovulation in World Health Organization group II anovulatory women undergoing follicular stimulation with recombinant human follicle-stimulating hormone: a comparison of recombinant human chorionic gonadotropin (rhCG) and urinary hCG.

OBJECTIVE: To compare the safety and efficacy of 250 microg recombinant hCG (rhCG) and 5,000 IU urinary hCG (uhCG), both administered s.c., for ovulation induction in anovulatory/oligo-ovulatory patients after follicular stimulation with recombinant hFSH (rhFSH). DESIGN: Phase III, double-blind, double-dummy, randomized, parallel-group, multicenter study. SETTING: Nineteen academic and private tertiary care infertility centers in Europe, Israel, Canada, and Australia. PATIENT(S): One hundred ninety-eight WHO group II anovulatory women, aged 20 to 38 years. INTERVENTION(S): Women were randomized to receive rhCG or uhCG after follicular stimulation with rhFSH in a chronic low-dose protocol. Blood samples were collected and ultrasound examinations performed during stimulation and after hCG administration. MAIN OUTCOME MEASURE(S): Ovulation (midluteal serum progesterone > or =30 nmol/L), serum progesterone, hCG levels after hCG, pregnancy, adverse events, local tolerability, and ovarian hyperstimulation syndrome (OHSS) incidence. RESULT(S): Ovulation rates did not differ between groups: 95.3% for rhCG (n = 85) and 88.0% for uhCG (n = 92). The one-sided 95% confidence interval for the observed difference fell above the predefined limit of -20%, indicating equivalence. Treatment was well tolerated, but more uhCG patients reported local reactions (particularly inflammation and pain) (P=.0001; logistic regression). CONCLUSION(S): Subcutaneous rhCG and uhCG show equivalent efficacy in ovulation induction; however, rhCG is better tolerated.

Adult↗
PubMed2000

Successful induction of ovulation using highly purified follicle-stimulating hormone in a woman with Kallmann's syndrome.

OBJECTIVE: To describe a woman with Kallmann's syndrome who was treated successfully with highly purified FSH to achieve ovulation induction and pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 32-year-old woman with Kallmann's syndrome who had been treated with oral contraceptives to prime secondary sex characteristics and genital organs since the age of 16 years. INTERVENTION(S): Highly purified FSH was administered intramuscularly for a total dose of 3,825 IU. MAIN OUTCOME MEASURE(S): Follicle number and diameter. RESULT(S): Three follicles with a diameter of > 1.7 cm and an endometrial thickness of 8 mm were observed. A clinical pregnancy, which subsequently was spontaneously aborted, was obtained. CONCLUSION(S): In primed patients with Kallmann's syndrome, highly purified FSH may be a useful alternative to pulsatile GnRH or menopausal gonadotropins to achieve ovulation induction and pregnancy.

Abortion, Spontaneous↗
PubMed1995

Extended induction of ovulation by human menopausal gonadotropins and a gonadotropin-releasing hormone analog in high responders for in vitro fertilization and oocyte donation.

OBJECTIVE: To examine the efficacy of extending ovulation induction for the in vivo maturation of oocytes. STUDY DESIGN: Fifty-nine high responders underwent 72 in vitro fertilization (IVF) cycles with a conventional protocol of human menopausal gonadotropin and a gonadotropin-releasing hormone analog. These patients donated oocytes to 81 recipients. The same 59 patients underwent 90 subsequent cycles in which the duration of induction was extended by two to three days. The oocytes were also donated to 138 patients. RESULTS: With the extended protocol, significantly more oocytes were retrieved (29.1 vs. 20.6), and a greater proportion of them were mature. Fertilization rates were significantly higher for both donors (67.7% vs. 36.2%) and recipients (67.5% vs. 47.1%). Conception rates were also significantly higher for both donors (24.4% vs. 11.1%) and recipients (38.4% vs. 24.7%). CONCLUSION: Extending the duration of ovulation induction in high responders is associated with in vivo maturation of oocytes and improved success rates in IVF and ovum-donation programs.

Administration, Intranasal↗
PubMedDate not supplied

Modern use of clomiphene citrate in induction of ovulation.

Clomiphene citrate is the treatment of first choice in the management of infertility in normally oestrogenized, anovulatory women (WHO group II). The majority of women with 'pure' anovulatory infertility respond to treatment with clomiphene citrate. The rates of pregnancy and miscarriage are close to those expected in a normal fertile population. Basal hormone concentrations do not predict outcome. An increased body mass index is the only factor which is consistently associated with a decreased response to clomiphene citrate; it follows therefore, that weight reduction should be an important part of therapy in anovulatory women. According to our data, only an increased luteinizing hormone value immediately post clomiphene citrate predicted an adverse pregnancy outcome in women who conceived. Clomiphene citrate, along with other ovulation induction therapies, can cause multiple follicular development, with a risk of ovarian hyperstimulation and multiple pregnancy. Ultrasound monitoring of treatment is important in order to choose the appropriate dose of clomiphene citrate in subsequent cycles and to minimize the risks of hyperstimulation and multiple pregnancy. When couples with other factors contributing to subfertility are excluded, the cumulative conception rate continues to rise after 6 months of treatment with clomiphene citrate, reaches a plateau by treatment cycle 12 and approaches that of the normal population. It has been reported that prolonged use of clomiphene citrate may be associated with an increased risk of a borderline or invasive ovarian tumour. Taking into consideration these observations, we recommend that anovulatory women responsive to clomiphene citrate should be treated for at least 6 cycles before considering more complex or invasive methods of ovulation induction, and that treatment should probably be limited to a maximum of 12 cycles.

Adult↗
PubMed1994

Biochemical and immunohistochemical multiparametric analysis of steroid receptors and growth factor receptors in human normal endometrium in spontaneous cycles and after the induction of ovulation.

This study was carried out with three aims: to assess the variations of receptors for beta-oestradiol and progesterone, and for epidermal growth factor (EGF), alpha-fibroblast growth factor (FGF) and beta-FGF, during a spontaneous cycle in normo-ovulatory patients, 2 days before, and 2 and 7 days after the day of ovulation; to compare the control group of patients with those given ovulation induction using a multiparametric approach; and to study the role of luteal supplementation with progesterone in two groups of patients treated by a luteinizing hormone-releasing hormone agonist plus human menopausal gonadotrophin. The results were assessed by biochemical analyses and by immunohistochemistry. In spontaneous cycles, a decrease in steroid receptors occurred during the luteal phase. There was an increase in EGF and EGF receptors which was induced by oestradiol secretion, and an increase during the luteal phase of alpha-FGF and beta-FGF, which are considered to be angiogenic factors. Comparisons between spontaneous and induced cycles showed a few variations in the endometrium but no differences were related to the type of ovulation induction.

Adult↗
PubMed1996

Circulating immunoreactive and bioactive follicle stimulating hormone concentrations in anovulatory infertile women and during gonadotrophin induction of ovulation using a decremental dose regimen.

Our purpose was to determine whether decreased follicle stimulating hormone (FSH) activity, either systemic or at the follicular level, is involved in impaired follicle growth associated with normogonadotrophic anovulation. To differentiate between the possible levels of disturbance, bioactive (BIO-FSH; using the in-vitro rat granulosa cell aromatase bioassay) and immunoreactive (IRMA-FSH) FSH serum concentrations of three groups of subjects were compared: (i) 172 normogonadotrophic anovulatory infertile women during baseline conditions, (ii) 22 clomiphene-resistant polycystic ovary syndrome patients undergoing ovulation induction by exogenous gonadotrophins using a decremental dose regimen, and (iii) nine regularly cycling controls. BIO-FSH [13.2 (range 0.8-29.5) IU/l] and IRMA-FSH [4.4 (range 1.2-9.3) IU/l] concentrations in anovulatory women during baseline conditions were significantly lower than maximum concentrations reached during the follicular phase in controls [18.7 (13.2-23.4) and 6.4 (5.7-10.0) IU/l respectively], but were not significantly different from initial concentrations in controls [10.4 (7.2-19.6) and 4.8 (2.8-8.2) IU/l respectively]. Moreover, concentrations of IRMA-FSH and BIO-FSH were negatively correlated (r = -0.25, P = 0.01, and r = -0.24, P = 0.02 respectively) with the interval between last vaginal bleeding and blood sampling. Maximum concentrations of IRMA-FSH [7.6 (3.9-10.9) IU/l] during ovulation induction by gonadotrophins were not significantly different from maximum [6.4 (5.7-10.0) IU/l] concentrations in controls, whereas maximum BIO-FSH concentrations [13.5 (8.7-17.4) versus 18.7 (13.2-23.4) IU/l] were significantly lower. Our findings suggest that (i) circulating FSH does not reach concentrations that are sufficient to induce normal follicle development in anovulatory women during baseline conditions, and (ii) the FSH threshold for ovarian stimulation of this patient group is not different from normal.

Adult↗
PubMed1977

[Increasing the effectiveness degree of ovulation induction using clomiphene in combination with HCG in cases of functional sterility].

The authors gave functionally infertile women a combined treatment, of Clomiphen + HCG whom 19 had already been treated with Clomiphenor Epimestrol without success. If the number of ovulations considerably increase in consequence of Clomiphen + HCG treatment or the periods of ovulations, aphysiological periods, are of physiological duration the treatment may be successful. In these cases the effectiveness of Clomiphene induction can be intensified with HCG administration

Adult↗
PubMed1975

Ovulation induction and antifertility effects of an LH-RH analogue (AY 25,205) in cyclic rats.

Pro-oestrous rats, treated with fluphenazine dihydrochloride to block ovulation, were used to compare the ovulation-inducing activity of synthetic LH-RH with one of its analogues, [D-Ala-6, des-Gly-NH2-10]-LH-RH ethylamide (AY-25,205). The lowest dose of LH-RH which produced a significant response was 125 ng compared with 2.9 ng AY-25,205. Statistical analysis of the data showed that AY-25,205 was approximately thirty-six times more potent than LH-RH. Treatment with AY-25,205 also induced partial ovulation in metoestrous rats (80 or 160 ng/rat) and apparently normal ovulation in dioestrous rats (10 to 160 ng/rat). The compound (160 ng) failed to induce further ovulation in oestrous rats which ovulated during the previous night. Advancement of premature ovulation in dioestrous rats with AY-25,205 prevented mating behaviour and pregnancy during the treatment cycle. The antifertility effect of the compound disappeared during the following cycle.

Animals↗