Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Ovulation Induction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources
PubMed1999

Induction of ovulation with clomiphene citrate in combination with metoclopramide in patients with amenorrhea of hypothalamic origin.

Literature data have demonstrated that the chronic use of metoclopramide (MCP), a dopamine antagonist, causes increased gonadotropin secretion in patients with hypothalamic amenorrhea but without triggering ovulation. It has also been observed that women with hypothalamic amenorrhea respond poorly to ovulation induction with clomiphene citrate (CC). On this basis, the objective of the present study was to determine the effect of MCP on the response to CC in patients with hypothalamic amenorrhea in order to evaluate the validity of the simultaneous use of these drugs as ovulation inducers in this type of chronic anovulation. Twenty-two patients with amenorrhea of hypothalamic origin were submitted to a randomized double blind study in which one tablet of 5 mg MCP or placebo was administered every 8 hours for 2 months. After the 30th day of medication (MCP or placebo), CC, 100 mg orally, was additionally administered to both groups for 5 days. Blood samples were collected on days 1, 15 and 30 during the first month of the study and on days 7, 14 and 21 after the last CC tablet during the second month, for later measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol and progesterone by radioimmunoassay. The group that received MCP showed a significant increase in LH and FSH during the first month of the study, as well as a slighter increase in estradiol. Prolactin increased only during the second stage of treatment. No significant increases in gonadotropins, prolactin or estradiol occurred in the placebo group. In the group treated with MCP, 40% of the patients ovulated after CC, with menstruation occurring in 60% of them. In the placebo group, 33.3% of the women ovulated after CC and 44.4% menstruated at the end of the study. We conclude that MCP increases the circulating levels of LH, FSH, estradiol and prolactin in patients with hypothalamic amenorrhea and low estrogen levels, supporting the hypothesis that an increase in hypothalamic dopaminergic tonus occurs in these patients. On the other hand, the combination of MCP and CC does not improve the rate of ovulation compared to placebo.

Adult↗
PubMed1983

First demonstration of induction of ovulation with a hybrid human chorionic gonadotropin compound (AB1ER-CR-2XY).

This study presents the first demonstration of the ability of a hybrid human chorionic gonadotropin (hCG) compound, AB1ER-CR-2XY, to induce ovulation in humans. Thirteen patients with primary infertility were treated for 16 cycles with varying dosages of human menopausal gonadotropin (hMG), and 10,000, 5000, and 2500 IU of the hybrid hCG. Presumptive occurrence of ovulation was recorded in 15 courses of medication. Echographic studies did not indicate overt follicular or ovarian enlargement. Two singleton pregnancies occurred, one during the first treatment course and the other following the second course of hMG/hybrid hCG therapy. Due to its specific characteristics, the hybrid hCG may provide equal or greater effectiveness and a better margin of safety than commercial hCG used for ovulation induction in patients pretreated with hMG.

Adult↗
PubMed1999

Hormone patterns after induction of ovulation with clomiphene citrate: an age-related phenomenon.

Since the introduction of clomiphene citrate (CC), more than three decades ago, a discrepancy has been observed between ovulation and pregnancy rates for which as yet no explanation exists. To investigate if ovulation disorders or abnormal hormonal patterns occur more often in CC-stimulated seemingly ovulatory cycles, we performed hormonal and sonographic monitoring in first cycles of oligo- or amenorrheic patients who were stimulated with 50 mg CC, and compared the hormonal patterns to those in natural cycles of age-matched proven fertile women. Twenty-four first CC cycles were monitored. Twelve cycles appeared to be ovulatory, eleven showed no follicle development and one cycle exhibited the luteinized unruptured follicle (LUF) phenomenon. Ten ovulatory cycles were compared with 27 unstimulated control cycles. In four cycles stimulated by CC, a temporary decline in estradiol levels was apparent. In these cycles, estradiol reached a higher level on cycle day (CD) 7 or 8 compared to cycles without a decline. Such an estradiol decline was seen in only one control cycle. Furthermore, the estradiol levels on CD 7 or 8 appeared to be age-related. We conclude that the estradiol decline in CC-stimulated ovulatory cycles may be a consequence of a sharp rise after CC stimulation, and such a rise may be age-related and coincide with a diminished follicle quality. If this phenomenon is associated with a suboptimal cycle, and so contributes to the suboptimal pregnancy rates after ovulation-induction treatment with clomiphene citrate, is still unknown.

Adult↗
PubMed1992

Effects of gonadotropin releasing hormone agonist addition to gonadotropin induction of ovulation in polycystic ovary syndrome patients.

Meta-analysis of all randomised trials published so far, was performed to compare the effect of additional gonadotropin releasing hormone (GnRH)-agonist treatment to exogenous gonadotropins for ovulation induction in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. Five clinical studies were included, of which only one showed significant differences in pregnancy rate. In addition, pretreatment with GnRH-agonist was once reported to lead more often to cancellation of medication. Combining the results of all five trials, a significant difference in favour of additional GnRH-agonist administration could only be observed for pregnancy rate. No significant differences in ovulation rate could be found. Due to the relative small number of patients in each separate group, no conclusions could be drawn concerning the influence of GnRH-agonist treatment on gonadotropin doses necessary to induce ovulation, and the incidence of multiple pregnancy, abortion and ovarian hyperstimulation.

Female↗
PubMed1998

Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.

The diagnostic criteria used to identify patients suffering from polycystic ovary syndrome remain controversial. The present prospective longitudinal follow-up study was designed to identify whether certain criteria assessed during standardized initial screening could predict the response to ovulation induction with clomiphene citrate (CC) in 201 patients presenting with oligomenorrhea or amenorrhea and infertility. Serum FSH levels were within the normal range (1-10 IU/L), and all patients underwent spontaneous or progestin-induced withdrawal bleeding. Initial CC doses were 50 mg daily for 5 days starting on cycle day 3. In the case of an absent response, doses were increased to 100 and 150 mg daily in subsequent cycles. First ovulation with CC was used as the end point. After a complete follow-up (in the case of a nonresponse, at least 3 treatment cycles with daily CC doses up to 150 mg), 156 patients (78%) ovulated. The free androgen index (FAI = testosterone/sex hormone-binding globulin ratio), body mass index (BMI), cycle history (oligomenorrhea vs. amenorrhea), serum androgen (testosterone and/or androstenedione) levels, and mean ovarian volume assessed by transvaginal sonography were all significantly different (P < 0.01) in responders from those in nonresponders. FAI was chosen to be the best predictor in univariate analysis. The area under the receiver operating characteristics curve in a multivariate prediction model including FAI, BMI, cycle history, and mean ovarian volume was 0.82. Patients whose ovaries are less likely to respond to stimulation by FSH due to CC treatment can be predicted on the basis of initial screening characteristics, such as FAI, BMI, cycle history (oligomenorrhea or amenorrhea), and mean ovarian volume. These observations may add to ongoing discussion regarding etiological factors involved in ovarian dysfunction in these patients and classification of normogonadotropic anovulatory infertile women.

Adult↗
PubMed1985

[Gonadotrophin induction of ovulation monitored by ultrasonic studies of the ovary].

In this study the parameters of normal ovarian cycles were prospectively applied in a programme of ovulation induction with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG). Hypo-oestrogenism and failure of clomiphene administration were the main indications for treating 42 patients during 128 cycles with gonadotrophins. The initial HMG dosage was 1 ampoule per day. The dosage was adjusted daily in accordance with serum oestradiol response and ultrasound findings. HCG was administered under the following conditions: average follicle size of at least 18 mm, not more than 2 follicles present, optimal cervical mucus, and serum oestradiol levels between 1 000 and 3 000 pmol/l. Ovulation was successfully induced in 90% of treated cycles and 20 pregnancies ensued. If anovulatory patients with additional causes for infertility were excluded, the pregnancy rate per treated cycle was 30%. Two twin pregnancies developed and no cases of clinical ovarian hyperstimulation syndrome occurred. The maximum follicle size and cervical mucus score did not differ significantly from these parameters in spontaneous ovulatory cycles. Preovulatory serum oestradiol levels and mid-luteal progesterone levels, however, were significantly higher in the gonadotrophin-stimulated cycles.

Chorionic Gonadotropin↗
PubMed1987

The effect of progesterone supplementation prior to the induction of ovulation in women treated for in-vitro fertilization.

Thirty-one patients superovulated with clomiphene citrate (CC) and human menopausal gonadotrophin (HMG) were given a single injection of 25 mg progesterone (P group) 6 h prior to injection of human chorionic gonadotrophin (HCG). Levels of urinary and plasma luteinizing hormone (LH) were significantly higher (P less than 0.001) immediately prior to HCG in the P group compared with thirty-one control patients who had HCG on the same night. Plasma levels of progesterone remained significantly elevated (P less than 0.02) for 80 h after injection in the P group, thereafter the level was similar to controls. The number of oocytes recovered, fertilized and replaced per patient was identical in both groups. However, four control patients had no embryos replaced due to failed fertilization. It is concluded that in the majority of P patients the timing of ovulation induction by HCG injection was appropriate as an LH surge was elicited thus reflecting a physiological stage of readiness, and elevated plasma progesterone levels around the time of oocyte recovery and in the early luteal phase do not increase the likelihood of the establishment of pregnancy in patients stimulated for in-vitro fertilization and embryo replacement (IVF/ER) with CC and HMG.

Clomiphene↗
PubMed1991

[Induction of ovulation by pulsatile gonadoliberin administration. Indications and limits].

With its simplicity, innocuity and efficacy, pulsatile GnRH administration constitutes a considerable advance in ovulation induction techniques. Its purpose is not to replace classic methods like Clomiphene Citrate, gonadotropins or dopaminergic agonists, but to complement them. While the choice of administration route, IV vs SC is still controversial, the efficacy depends mainly on the selection of the patients susceptible of benefiting from this therapy. Low gonadotropic activity hypothalamic amenorrhea remains the best indication for pulsatile GnRH, as substantiated by the results published over the last 10 years. The other anovulation causes, including PCO-S, are more disputable indications, and prospective studies involving homogeneous populations are necessary to assess the true standing of GnRH in such indications.

Amenorrhea↗
PubMed1977

[Obstetric results and problems after induction of ovulation].

Ovulation induction has been used regularly in our department for several years to treat functional sterility. 4. various preparations and methods have been applied. The success rate is 31.3%. Altogether there have been 400 pregnancies, 274 of them have come to term, 126 patients are still pregnant. In 50% of the cases the pregnancy was uncomplicated and in 48.7% labour was normal. The number of abortions and premature labour is high and the prophylactic gestagene therapy has been successful in protecting the pregnancy. There have been more pathologies during labour, so the frequency of interventions is higher. The perinatal mortality of the mature newborn is 2.3%, but the perinatal mortality in premature labour is very high (14.7%). The total perinatal loss is 9.8%. The frequency of malformations is not higher as was previously suspected.

Abortion, Spontaneous↗
PubMed1994

ACOG technical bulletin. Managing the anovulatory state: medical induction of ovulation. Number 197--September 1994 (replaces no. 120, September 1988). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists.

With proper diagnosis and selection of treatment, ovulation induction is an option for anovulatory women. Specialized skills, knowledge, and resources, as well as patient and physician commitment, are requisite to the appropriate application of these modalities. Patients should be provided with information, support, and access to the health care team to maximize success. Current therapeutic options include the use of clomiphene citrate, bromocriptine, gonadotropins, and GnRH. Importantly, each and every one of these agents is best applied only in the appropriate clinical circumstances in keeping with the patient's individual needs. Whereas clomiphene citrate is particularly suited for the management of women with normal levels of FSH and prolactin and adequate levels of estrogen, gonadotropin therapy may be applied to both women with low levels of estrogen and gonadotropins as well as those with normal levels. Bromocriptine is only applicable for hyperprolactinemic women. Gonadotropin-releasing hormone therapy is best suited for circumstances characterized by low gonadotropin and estrogen levels as an alternative to gonadotropin therapy (assuming intact pituitary gonadotropin reserve).

Anovulation↗
PubMed1993

Comparison of exogenous gonadotropins and pulsatile gonadotropin-releasing hormone for induction of ovulation in hypogonadotropic amenorrhea.

To compare the efficacy and safety of ovulation induction with exogenous gonadotropins vs. pulsatile GnRH in patients with hypogonadotropic amenorrhea, results from 30 patients in 111 cycles of gonadotropins and 41 patients in 118 cycles of pulsatile GnRH were analyzed retrospectively. Exogenous gonadotropins were administered using an individually adjusted protocol, using a starting dose of 150 IU. Pulsatile GnRH was delivered iv at a physiological frequency based upon our normative data. The doses administered ranged from 75-250 ng/kg. Preovulatory serum estradiol (E2) and luteal phase progesterone (P) levels were compared to those in normal cycling women (n = 87). The mean body mass index, age, and baseline gonadotropin levels were similar in the two groups. Overall ovulatory rates and conception rates per cycle and per patient were not significantly different between the two groups. However, the cumulative chance of conception after six cycles of treatment by life table analysis appeared to be higher with pulsatile GnRH treatment (96%) than with exogenous gonadotropins (72%). The risk of multiple gestation was also higher with exogenous gonadotropins (14.8% vs. 8.3%), although this was not statistically significant. All higher order multiple gestations (triplets or more) occurred in the gonadotropin-treated group. More than two dominant follicles were seen on ultrasound in 47.6% of gonadotropin-treated cycles compared to 18.9% of cycles with pulsatile GnRH treatment (P < 0.01). Three or more follicles were seen in 16.6% of the gonadotropin cycles compared to 5.4% with pulsatile GnRH (P < 0.05). No case of severe ovarian hyperstimulation was observed in either group, although the mean luteal phase ovarian size was significantly higher in the gonadotropin group (P < 0.05). Mean peak preovulatory E2 levels were significantly higher in the gonadotropin group (1684.5 +/- 124.4 vs. 1315.3 +/- 74.9 pmol/L; P < 0.05). The mean luteal phase P level 1 week after ovulation was significantly higher than normal in the gonadotropin group (84.9 +/- 10.8 vs. 61.1 +/- 3.2 nmol/L; P < 0.05), but was not significantly different from that in the pulsatile GnRH group (70.3 +/- 6.0 nmol/L). We conclude that pulsatile GnRH, when compared to exogenous gonadotropins, results in high rates of ovulation and conception, but a decreased risk of multiple folliculogenesis, higher order multiple gestations, and ovarian enlargement.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

Induction of ovulation in women undergoing assisted reproductive techniques: recombinant human FSH (follitropin alpha) versus highly purified urinary FSH (urofollitropin HP).

This multicentre, open, randomized, study compared the efficacy and safety of recombinant follicle stimulating hormone (rFSH; follitropin alpha) with highly purified urinary human FSH (uFSH; urofollitropin HP) in women undergoing ovulation induction for assisted reproductive techniques. Following long down-regulation with buserelin, patients received two ampoules of 75 IU (150 IU) s.c. rFSH or highly purified uFSH for 6 days, after which the dose could be increased until they fulfilled the criteria for human chorionic gonadotrophin (HCG) administration. Of 168 patients recruited, 155 received at least one dose of FSH, and 137 received HCG [68: rFSH (85%); 69: uFSH (92%)]. Following oocyte retrieval and fertilization, up to three embryos were replaced/patient and luteal support was given. The mean number of oocytes retrieved/patient was 10.2 +/- 6.0 for rFSH patients compared with 10.8 +/- 6.1 in the uFSH group (not significant). There was a trend towards fewer ampoules used (22.3 +/- 6.5 versus 24.3 +/- 6.5), higher pregnancy (44.3 versus 41.4%) and live birth rates (33.8 versus 26.7%), as well as a lower miscarriage rate (0.0 versus 16.7%) in favour of rFSH. However, no significant differences in efficacy parameters were recorded. Ovarian hyperstimulation syndrome occurred in 8.6% and 7.9% of rFSH and uFSH patients respectively. In conclusion, this protocol was effective in inducing multiple follicular development and high numbers of oocytes were retrieved with both drugs.

Adolescent↗
PubMed1987

Successful induction of ovulation and conception with combined gonadotropin-releasing hormone agonist plus highly purified follicle-stimulating hormone in patients with polycystic ovarian disease.

Five women (group A) with polycystic ovarian disease (PCOD) and sterility for at least 3 yr were treated for 1 cycle for ovulation induction with a combined regimen of GnRH agonist (GnRH-A) plus highly purified FSH. The patients received GnRH-A (Buserelin; 200 micrograms, sc, twice a day) for 6 weeks and then GnRH-A combined with FSH highly purified (2 ampules a day; 75 IU FSH and less than 0.11 IU LH in each ampule). Ovarian response was evaluated by plasma estradiol (E2) assay and ultrasound examination, performed daily. Furthermore, plasma FSH and LH levels were assayed 3 times a week. Once a follicle was considered sufficiently developed, the combined regimen was withheld, and 24-48 h later hCG (5000 IU, im) was given. The results are compared with those of 31 ovulatory cycles induced by im FSH highly purified (group B) in PCOD patients with the same FSH administration, clinical, and monitoring protocols. Ovulation was achieved in all cycles treated by GnRH-A plus FSH. Two singleton and a twin pregnancy resulted. Multiple follicular development occurred in all cycles. Plasma E2 levels were generally in the normal range. Echographic and endocrine features in the 2 groups were as follows. 1) basal ovarian volume and ovarian enlargement were similar. 2) Group A had a greater number of follicles than did group B (P less than 0.01), while E2 to number of follicles and E2 to ovarian volume ratios were greater (P less than 0.01) in group B. 3) The linear correlations between plasma E2 levels and ovarian volume were markedly different in groups A and B (P less than 0.01). The regression line for group B had a steeper slope than that for group A. This finding indicates that at a fixed ovarian volume plasma E2 levels were significantly lower in group A than in group B. We conclude that the combined GnRH-A and FSH regimen may constitute an alternative and promising tool for the induction of ovulation in patients with PCOD.

Adult↗
PubMed1999

[From theory to clinical practice: recombinant FSH in daily practice].

The purpose of the present study is to determine the efficacy of induction ovulation with recombinant FSH in patients treated with in vitro fertilization and embryo transfer (IVF-ET) and basic assisted reproductive techniques (ART). One hundred seven cycles were analyzed. The patients were divided in two groups: Group 1, treated with IVF (n = 12) and group 2, treated with basic ART (n = 95). Only recombinant FSH was utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, were administered when one or more dominant follicles with diameter > or = 18 mm were presents; oocyte retrieval was performed 34 hour, while intrauterine insemination was practiced at 36 hours after the hCG injection. The pregnancy rate per IVF cycle was 25.0%, and 16.4% for basic ART. It is concluded that ovulation induction with recombinant FSH is a good and efficient alternative for both variations of ART.

Female↗
PubMed1999

Predictors of chances to conceive in ovulatory patients during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.

The present prospective follow-up study was designed to identify whether clinical, endocrine, or ultrasound characteristics assessed by standardized initial screening of normogonadotropic oligo/amenorrheic infertile patients could predict conception in 160 women who reached ovulation after clomiphene citrate (CC) medication. Additional inclusion criteria were total motile sperm count of the partner above 1 million and a negative history for any tubal disease. Daily CC doses of 50 mg (increasing up to 150 mg in case of absent ovarian response) from cycle days 3-7 were used. First conception (defined as a positive urinary pregnancy test) was the end point for this study. A cumulative conception rate of 73% was reached within 9 CC-induced ovulatory cycles. Patients who did conceive presented more frequently with lower age (P < 0.0001) and amenorrhea (P < 0.05) upon initial screening. In a univariate analysis, patients with elevated initial serum LH concentrations (>7.0 IU/L) had a higher probability of conceiving (P < 0.01). In a multivariate analysis, age and cycle history (oligomenorrhea vs. amenorrhea) were identified as the only significant parameters for prediction of conception. These observations suggest that there is more to be gained from CC ovulation induction in younger women presenting with profound oligomenorrhea or amenorrhea. Screening characteristics involved in the prediction of ovulation after CC medication in normogonadotropic oligo/amenorrheic patients (body weight and hyperandrogenemia, as shown previously) are distinctly different from predictors of conception in ovulatory CC patients (age and the severity of cycle abnormality). This disparity suggests that the FSH threshold (magnitude of FSH required for stimulation of ongoing follicle growth and ovulation) and oocyte quality (chances for conception in ovulatory cycles) may be differentially regulated.

Adult↗
PubMed1977

Induction of ovulation with clomiphene citrate.

There are specific indications for the use of clomiphene. When used with the simple precautions that have been outlined, it is a safe, relatively inexpensive and convenient method of ovulation induction. Clomiphene certainly deserves its prominent place in the treatment of the infertile woman.

Amenorrhea↗