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PubMed1995

Preserved pituitary response under ovarian stimulation with HMG and GnRH antagonists (Cetrorelix) in women with tubal infertility.

OBJECTIVE: To examine the pituitary response in patients undergoing short-term application of the GnRH antagonist Cetrorelix in the mid-cycle phase for hypophysial suppression of premature LH surges within an IVF-program. DESIGN: Twenty patients suffering from primary or secondary tubal infertility were stimulated with hMG from cycle day 2. From day 7 till ovulation induction Cetrorelix was administered in two different dose regimens (15 patients 3 mg s.c. daily; 5 patients 1 mg s.c. daily). Three hours before ovulation induction a GnRH test was performed using 25 micrograms of native GnRH and the pituitary response examined by measurement of the serum LH concentration after 30 min. RESULTS: Premature LH surges could be avoided in the 3-mg group and in the 1-mg group, respectively. Due to this, none of the cycles had to be cancelled. Oestradiol profiles and ultrasound demonstrated a satisfactory follicular maturation. All patients showed pronounced suppression of the serum LH levels before ovulation induction. The mean increase of serum LH due to the performed GnRH test was 10 mIU/ml for the 3-mg group, while the average maximum in the 1-mg group was about 32.5 mIU/ml. CONCLUSIONS: The pituitary response is preserved by the treatment with the GnRH antagonist Cetrorelix. The extent of suppression of the adenohypophysis, as expressed by the different reactions on GnRH test, can be modulated by the dosage administered. This should allow ovulation induction by GnRH or one of its agonists instead of hCG, which could be beneficial in patients at high risk of Ovarian Hyperstimulation Syndrome (OHSS) and those suffering from Polycystic Ovary Disease (PCOD).

Adult↗
PubMed1977

[Critical evaluation of clinical and hormonal parameters for the optimal timing of induction of ovulation with gonadotropins (author's transl)].

In 9 hypogonadotrophic, normoprolactinemic women with primary or secondary amenorrhea, who were infertile, 16 treatment cycles with menopausal gonadotropin and chorionic gonadotropin (HMG-HCG) were carried out. Nine treatment cycles were monitored indirectly with the cervical factor and hormonal cytology. The concomitant serum estradiol and progesterone values were later determined by radioimmunoassays. The other 7 treatment cycles were monitored by daily serum estradiol determinations. There were 4 pregnancies. Successful induction of ovulation with subsequent pregnancies was only obtained in the treatment cycles monitored by serum estradiol determinations (pregnancy rate 60%). Classical signs of overstimulation with ascites and hydrothorax occurred twice in treatment cycles which were monitored by clinical means only. Neither the maturation index nor the cervical factor reflected a quantitative overstimulation of the ovaries. The daily radioimmunological determination of estradiol prevented overstimulation of the ovaries, and permitted optimal timing of the induction of ovulation with HCG. In our experience, the maturation index determined from vaginal cytology and the clinical determination of the cervical factor are inappropriate parameters to monitor individually a successful induction of ovulation with HMG-HCG.

Adult↗
PubMed1975

Plasma oestradiol and progesterone estimation for the monitoring of induction of ovulation with clomiphene and chorionic gonadotrophin.

Two hundred and thirty-five courses of treatment with clomiphene and human chorionic gonadotrophin (HCG) were administered for the induction of ovulation in 75 infertile women (three with primary amenorrhoea, 45 with secondary amenorrhoea and 27 with oligomenorrhoea) of whom 61 had previously been unsuccessfully treated with clomiphene alone. The treatment was monitored by plasma oestradiol estimations on day 15 and day 22 in 103 cycles and by plasma progesterone estimations on day 22 in all 235 cycles. Injections of HCG were given on day 15 and 22. Twenty patients failed to respond to treatment (43 courses). The remaining 55 patients showed no response in 32 courses, deficient responses in 55 cycles and adequate responses in 105 cycles (plasma progesterone level exceeding 10 ng per ml on day 22). The mean values (+/- SD) of plasma oestradiol on day 15, reflecting follicular development, were: 73 +/- 30 pg per ml for cycles with no response; 255 +/- 182 for deficient cycles and 366 +/- 226 pg per ml for adequate cycles. There was a positive correlation (r = 0-57) between day 15 plasma oestradiol and day 22 plasma progesterone values. Increased clomiphene dosage resulted in higher plasma oestradiol and progesterone levels. Thirty-nine pregnancies occurred in 34 out of 55 patients capable of response (62 per cent). The plasma progesterone levels during conception cycles were higher than those in non-conception cycles in the same patients. Monitoring of induction of ovulation by plasma hormone estimations allows detection and correction of inadequate response.

Amenorrhea↗
PubMed1975

Studies on extrahypophyseal sites of estrogen action in the induction of ovulation in rats.

To discover possible extrahypophyseal sites of estrogen action in the induction of ovulation, the influence of a s.c. injection of estradiol benzoate (EB) on cell nuclear sizes in the limbic-medial preoptic continuum of progesterone-pretreated cyclic rats was evaluated. The ovulatory dose of 5 mug EB caused a significant increase of nuclear volumes in the medial preoptic nucleus and the anterior and posterior parts of the medial amygdaloid nucleus. Precocious ovulation was induced in prepuberal female rats by unilateral implantation of a molten EB: cholesterol mixture into the posterior part of the mediocortical amygdala (PMCA), but not by implantation into the anterior part of this region (AMCA) or the medial preoptic area (MPA). In adult females injected s.c. with 2.0 mg progesterone on the day post estrus, bilateral implantation of 0.1 or 0.2 mug crystalline EB on the following day did not abolish the delaying effect of progesterone on the preovulatory LH increase and ovulation, when the implants were located in the MPA, lateral septum (LS), bed nucleus of the stria terminalis (BST), AMCA, PMCA or dorsal hippocampus (DHPC), whereas intrapituitary implants were highly effective. However, the bilateral introduction of large tallow pellets containing 0.1 mug EB each, into the LS, BST, AMCA or PMCA advanced ovulation in rats with progesterone-induced 5-day cycles. Equal pellets did neither induced ovulation nor an LH increase after implantation into the MPA or the DHPC. The results suggest that the anterior pituitary, mediocortical amygdala, BST and LS, but not the MPA or DHPC, are sites of the stimulatory feedback of estrogen on gonadotropin secretion in female rats, and that the amygdaloid response to estrogen differs between prepuberal and cyclic females.

Age Factors↗
PubMed1976

Plasma testosterone and androstenedione levels during monitored induction of ovulation in infertile women with 'simple' amenorrhoea and with the polycystic ovary syndrome.

Twenty-seven infertile patients with 'simple' amenorrhoea-oligomenorrhoea and eighteen with the polycystic ovary (PCO) syndrome were treated for induction of ovulation with clomiphene, human menopausal gonadotrophin and human chorionic gonadotrophin. The treatment was monitored by plasma oestradiol, testosterone, androstenedione and progesterone estimation. Women with PCO had significantly higher plasma androgen levels than women with 'simple' amenorrhoea (P less than 0--1 to P less than 0-001) both before treatment and during induction of ovulation. When ovulation was induced the pregnancy rate for women with the PCO syndrome with elevated androgens was 21% while for those with uncomplicated amenorrhoea it was 75%. It is concluded that high levels of circulating androgens might be a factor preventing conception in some patients in whom ovulation is apparently successfully induced.

Adolescent↗
PubMed2000

Intrauterine insemination before transfer of frozen-thawed embryos may improve the pregnancy rate for couples with unexplained infertility: preliminary results of a randomized prospective study.

OBJECTIVE: To evaluate whether a combination of IUI and frozen-thawed embryo transfer (FT-ET) with ovulation induction would improve the PR in couples with unexplained infertility. DESIGN: Prospective, randomized study. SETTING: In Vitro Fertilization Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. PATIENT(S): Sixty-two patients with unexplained infertility were assigned into two groups. The study group was composed of 32 women (38 cycles) who received ovulation induction followed by IUI and FT-ET. The control group was composed of 30 women (33 cycles) who received ovulation induction followed by FT-ET. INTERVENTION(S): Clomiphene citrate (CC) and hCG, IUI, and FT-ET. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR) per cycle, PR per ET. RESULT(S): In the study group, the PR per cycle and per ET were 36.8% (14 of 38) and 40.6% (13 of 32), respectively. In the control group, the PR per cycle and per ET were 12.1% (4 of 33) and 14.3% (4 of 28), respectively. Statistically significant differences were found between the two groups in the PR per cycle (P=.02) and PR per ET (P=.03). No statistically significant difference was found between the groups for the stage in which the embryos were cryopreserved, the survival cleavage rates after thawing, grading of thawed embryos, and number of embryos transferred. CONCLUSION(S): In couples with unexplained infertility, the PR may be improved by combining IUI and FT-ET with ovulation induction. Performing IUI before thawing may prevent treatment cancellation in cycles with no surviving embryos.

Abortion, Spontaneous↗
PubMed1994

Insulin-like growth factor binding proteins in serum and follicular fluid from women undergoing ovarian stimulation with and without growth hormone.

The effects of supplementary growth hormone (GH) upon insulin-like growth factor binding proteins (IGFBP) in serum and ovarian follicular fluid were investigated in women undergoing buserelin-human menopausal gonadotrophin (HMG) ovulation induction for in-vitro fertilization. IGFBPs were detected by Western ligand blotting (WLB) or radioimmunoassay (IGFBP-3) and were shown in the present study to increase and decrease in patients with diseases of GH excess or deficiency. In the women undergoing treatment for ovulation induction, radioimmunoassay of IGFBP-3 gave results which were consistent with the well-documented GH dependency of this protein, increasing in the serum when GH was administered at the same time as buserelin-HMG. In contrast there were no consistent patterns in the abundance of the IGFBPs in serum and follicular fluid examined by WLB whether or not the patient was receiving GH, and the IGFBPs varied independently of the result obtained by radioimmunoassay. Other studies have shown that during pregnancy a serum protease can dramatically decrease the detection of the IGFBPs on the WLB. However, there was no evidence for a protease in the serum or follicular fluid from these nonpregnant women undergoing ovulation induction. Tissue availability of IGFs is probably regulated by the BPs, so that data would suggest that in normal women, neither ovarian activity nor GH at pharmacological concentrations is the primary regulator of the IGFBPs, which are likely to be regulated by some other factor(s), e.g. nutrition. These data may account for the lack of consistent clinical improvement in studies investigating the hypothesis that supplementary GH during ovulation induction with gonadotrophins would be beneficial.

Blotting, Western↗
PubMed1990

Induction of ovulation with pulsatile subcutaneous administration of human menopausal gonadotropin in patients with polycystic ovary syndrome.

The present study was undertaken to determine whether ovulation can be induced in patients with polycystic ovary syndrome (PCOS) by pulsatile subcutaneous administration of hMG after the pituitary secretion of LH and FSH was suppressed with a gonadotropin releasing hormone (GnRH) analogue. The results of the combined regimen cycles (group II) were compared with those of hMG (group I) or FSH (group III) pulsatile administration in the same PCOS patients. The ovulation rate (89.1% of 46 cycles) in group I was significantly greater (p less than 0.01) than that found in group II (65.9% of 41 cycles). In group III, ovulation occurred in 89.5% of the 19 treatment cycles. Ovarian hyperstimulation syndrome (OHSS) occurred in 28.3% of cycles in group I, 7.3% in group II, and 26.3% in group III, respectively. The incidence of OHSS in group II was significantly lower than that found in group I or III. The rates of pregnancy were 10.9% of cycles in group I, 4.9% in group II, and 21.1% in group III, respectively. All 10 fetuses were singleton conceptions, and the pregnancies continued successfully to term. The present data demonstrate that pulsatile subcutaneous administration of hMG or FSH is effective in the induction of successful ovulation and the establishment of singleton pregnancy in patients with PCOS.

Adult↗
PubMed1990

Polycystic ovary syndrome: abnormalities and management with pulsatile gonadotropin-releasing hormone and gonadotropin-releasing hormone analogs.

Ovulation induction with pulsatile gonadotropin-releasing hormone achieves high ovulatory and pregnancy rates in hypogonadotropic hypogonadism while limiting the occurrence of ovarian hyperstimulation and multiple pregnancy. However, this form of therapy is apparently less effective in polycystic ovary syndrome. The administration of a gonadotropin-releasing hormone analog for 4 to 8 weeks before the initiation of pulsatile gonadotropin-releasing hormone ovulation induction can temporarily correct endocrine abnormalities of polycystic ovary syndrome, such as excessive luteinizing hormone and androgen secretion, and improve ovulatory and pregnancy rates in these patients. For optimal results, this pretreatment should probably be repeated before each pulsatile gonadotropin-releasing hormone ovulation induction cycle. Obesity is associated with a lower success rate, and spontaneous abortion remains a prominent complication in polycystic ovary syndrome even after gonadotropin-releasing hormone analog suppression. With this regimen the risks of ovarian hyperstimulation and multiple pregnancy are virtually abolished. Thus, pulsatile gonadotropin-releasing hormone appears to be highly effective and safe for ovulation induction in patients with polycystic ovary syndrome also, provided that this treatment is preceded by pituitary-ovarian suppression with a gonadotropin-releasing hormone analog.

Anovulation↗
PubMed1972

Ovulation in hamster: induction by subunit of ovine interstitial cell stimulating hormone.

As little as 5 micrograms of interstitial cell stimulating hormone (ICSH) or 20 micrograms of ICSH-beta is effective for the induction of ovulation in 100 percent of hamsters treated at 0500 hours on day 4 after lordosis, whereas as much as 800 micrograms of ICSH-alpha is ineffective. Both ICSH and ICSH-beta are also effective for induction of ovulation in hypophysectomized animals. Thus, the ovulation-inducing activity of the ICSH molecule resides in its beta subunit.

Animals↗
PubMed2000

Estradiol/progesterone substitution in the luteal phase improves pregnancy rates in stimulated cycles--but only in younger women.

Innumerable studies have attempted to demonstrate that hormonal support of the luteal phase during ovulation induction cycles improves pregnancy rates. None has, however, so far been able to confirm the validity of such treatment conclusively, possibly because most studies only utilized progesterone substitution. Since luteal phase endometrium also requires estradiol support, this study attempted to investigate whether hormone substitution with progesterone and estradiol would be more successful in improving pregnancy rates. Amongst approximately 7500 consecutive ovulation induction cycles were identified prospectively which were characterized by a precipitous drop of luteal phase serum estradiol levels by more than 50% over a 48 hour period within 10 days from hCG administration. Those cycles were prospectively randomized to oral micronized estradiol substitution (Group I) or not (Group II), while both groups received routine progesterone substitution of the luteal phase. Cycles were then evaluated in regards to the occurrence of chemical, ectopic and clinical pregnancies. One hundred sixty-three Group I cycles resulted in 34 pregnancies (20.9%), which compared favorably to 21 pregnancies in 167 Group II patients (12.6%) (x2[1] = 4.06; p < 0.04). The advantage for Group I cycles (29/95 pregnancies, 31%) vs. Group II cycles (16/105, 15%) became even more pronounced when only women up to age 35 years were evaluated. Estradiol substitution maintained a significant advantage until age 38 (x2 [1] = 6.87; p < 0.009). While gravidity did not affect pregnancy success, estradiol substitution in Group I benefited nulliparous (23% pregnancy rate) over multiparous women (12% pregnancy rate) (x2 [2] = 6.86; p< 0.03). This association was, however, age-dependent. A combined estradiol and progesterone substitution of the luteal phase of ovulation induction cycles increases the overall pregnancy rate. Since estradiol substitution was initiated in this study only once a precipitous drop in serum estradiol levels had already taken place, an even larger improvement in pregnancy rates could conceivably be possible if earlier estradiol substitution of the luteal phase is initiated. A further expansion of investigations of similar protocols for routine ovulation induction and in vitro fertilization (IVF) cycles may be indicated, especially in women below age 38 years and in nulliparous females.

Administration, Oral↗
PubMed1997

Diagnosis and therapy of hyperandrogenism.

Diagnostic categories in hyperandrogenism include polycystic ovary syndrome (PCOS) and its variants, adrenal and ovarian steroidogenic enzyme deficiencies, adrenal and ovarian androgen secreting tumours and other endocrine disorders such as hyperprolactinaemia, Cushing syndrome and acromegaly. About 95% of hyperandrogenic women will have PCOS. Endometrial hyperplasia can be prevented in hyperandrogenic, anovulatory women by the oral contraceptive pill or progestins. Hirsutism is best treated by a combination of the oral contraceptive pill and an anti-androgen. The first line of therapy for ovulation induction is clomiphene citrate, with human menopausal gonadotrophins (hMG) or laparoscopic ovulation induction reserved for clomiphene failures. hMG together with gonadotrophin-releasing hormone agonist may decrease the risk of spontaneous abortion following ovulation induction in PCOS. Weight loss should be vigorously encouraged to ameliorate the metabolic consequences of PCOS.

Androgen Antagonists↗
PubMed1996

A unique case of massive ascites before ovulation associated with gonadotropin therapy.

OBJECTIVE: To describe a unique case of massive ascites associated with gonadotropin therapy. DESIGN: Case report. SETTING: Patient in a hospital-based private IVF center. INTERVENTION(S): Ovulation induction with gonadotropins for subsequent IVF. RESULT(S): Ovulation induction with gonadotropins resulted in the accumulation, before ovulation, of 1,200 and 2,000 mL of peritoneal fluid in two consecutive cycles. The stimulation yielded four and six oocytes, respectively. CONCLUSION(S): Gonadotropin therapy can result in ascites before ovulation without an exaggerated ovarian response and without interfering with follicular development.

Adult↗
PubMed1995

Sex ratio in triplets.

Since the introduction of different ovulation induction regimens the incidence of triplet pregnancies increased from a spontaneous rate of about 1:10,000 to the frequency of nearly 1:1000. Sex ratio of trigemini and male/female proportion of the three newborns within the same triplet set is the amazing issue that we attempted to elucidate in the present study. Data on 36 women with triplet pregnancies delivered in our hospital and information regarding 2717 triplet pregnancies reported by 16 relevant papers were included in this study. 36 women delivered 63 (58%) male and 45 (42%) female babies. Triplet sets of same gender comprised 33% of all trigemini. Sex ratios (male/female) for the spontaneous, menotropin and clomiphene group were 2.00, 1.57 and 0.94 respectively. Homogenous male/female set ratio was 5.0, 2.0 and 0.5 in menotropin, spontaneous and clomiphene groups respectively. As the percentage of ovulation induction triplet pregnancies increased constantly from 0% to 100%, a decline in the fraction of homogenous gender triplet sets was observed--from 73% to 23%. It may be concluded that sex ratio in triplet newborns is divergent according to different publications with most of the authors reporting a male/female ratio of less than 1.00. Ovulation induction results in a lower proportion of homogenous sex triplets sets. Superovulation by menotropins cause a higher percentage of male triplet newborns when compared to ovulation induction by clomiphene.

Clomiphene↗
PubMed2006

Comparison of the effect of natural mating, LH, and GnRH on interval to ovulation and luteal function in llamas.

Gonadotropins and GnRH have been used to electively induce ovulation in llamas and alpacas, but critical evaluation of the natural interval to ovulation after mating has not been performed nor has a direct comparison of the effects of natural mating versus hormone treatments on this interval and subsequent luteal development. The objectives of this study were to compare the effects of hormonal treatments and natural mating on ovulation induction, interval to ovulation, and luteal development in llamas. The ovaries of llamas were examined by transrectal ultrasonography once daily. Llamas with a large follicle were assigned randomly to be: (1) mated with an intact male (mated; n=10); (2) given 5 mg of LH im (LH; n=11); or (3) 50 microg of GnRH im (GnRH; n=10). Ultrasound examinations were performed every 4h from treatment (day 0) to ovulation and thereafter once daily for 15 consecutive days to monitor CL growth and regression (n=5 per group). Plasma progesterone concentrations were measured at days 0, 3, 6, 9, and 12 after treatment to evaluate CL function. The size of the largest preovulatory follicle at the time of treatment did not differ among groups (11+/-0.6, 10.5+/-0.8, 11.8+/-0.9 mm, for mated, LH, and GnRH groups, respectively; P=0.6). No differences were detected among groups (mated, LH, and GnRH) in ovulation rate (80%, 91%, 80%, respectively; P=0.6), or interval from treatment to ovulation (30.0+/-0.5, 29.3+/-0.6, 29.3+/-0.7h, respectively; P=0.9). Similarly, no differences were detected among groups (mated, LH, and GnRH) in maximum CL diameter (14.2+/-0.3, 13.2+/-0.5, and 13.0+/-0.7 mm, respectively; P=0.5), the day of maximum CL diameter (7.6+/-0.2, 7.6+/-0.2, and 7.4+/-0.4 mm, respectively; P=0.6), or the day on which the CL began to regress (12.3+/-0.3 [non-pregnant, n=3], 11.8+/-0.6, 12.2+/-0.4, respectively; P=0.4). The diameter of the CL and plasma progesterone concentrations changed over days (P<0.0001) but the profiles did not differ among groups. In summary, ovulation rate, interval to ovulation, and luteal development were similar among llamas that were mated naturally or treated with LH or GnRH. We conclude that both hormonal preparations are equally reliable for inducing ovulation and suitable for synchronization for artificial insemination or embryo transfer program.

Animals↗
PubMed2001

Specific factors predict the response to pulsatile gonadotropin-releasing hormone therapy in polycystic ovarian syndrome.

Ovulation induction is particularly challenging in patients with polycystic ovarian syndrome (PCOS) and may be complicated by multifollicular development. Pulsatile GnRH stimulates monofollicular development in women with anovulatory infertility; however, ovulation rates are considerably lower in the subgroup of patients with PCOS. The aim of this retrospective study was to determine specific hormonal, metabolic, and ovarian morphological characteristics that predict an ovulatory response to pulsatile GnRH therapy in patients with PCOS. Subjects with PCOS were defined by chronic amenorrhea or oligomenorrhea and clinical and/or biochemical hyperandrogenism in the absence of an adrenal or pituitary disorder. At baseline, gonadotropin dynamics were assessed by 10-min blood sampling, insulin resistance by fasting insulin levels, ovarian morphology by transvaginal ultrasound, and androgen production by total testosterone levels. Intravenous pulsatile GnRH was then administered. During GnRH stimulation, daily blood samples were analyzed for gonadotropins, estradiol (E(2)), progesterone, inhibin B, and androgen levels, and serial ultrasounds were performed. Forty-one women with PCOS underwent a total of 144 ovulation induction cycles with pulsatile GnRH. Fifty-six percent of patients ovulated with 40% of ovulatory patients achieving pregnancy. Among the baseline characteristics, ovulatory cycles were associated with lower body mass index (P < 0.05), lower fasting insulin (P = 0.02), lower 17-hydroxyprogesterone and testosterone responses to hCG (P < 0.03) and higher FSH (P < 0.05). In the first week of pulsatile GnRH treatment, E(2) and the size of the largest follicle were higher (P < 0.03), whereas androstenedione was lower (P < 0.01) in ovulatory compared with anovulatory patients. Estradiol levels of 230 pg/mL (844 pmol/L) or more and androstenedione levels of 2.5 ng/mL (8.7 nmol/L) or less on day 4 and follicle diameter of 11 mm or more by day 7 of pulsatile GnRH treatment had positive predictive values for ovulation of 86.4%, 88.4%, and 99.6%, respectively. Ovulatory patients who conceived had lower free testosterone levels at baseline (P < 0.04). In conclusion, pulsatile GnRH is an effective and safe method of ovulation induction in a subset of patients with PCOS. Patient characteristics associated with successful ovulation in response to pulsatile GnRH include lower body mass index and fasting insulin levels, lower androgen response to hCG, and higher baseline FSH. In ovulatory patients, high free testosterone is negatively associated with pregnancy. A trial of pulsatile GnRH therapy may be useful in all PCOS patients, as E(2) and androstenedione levels on day 4 or follicle diameter on day 7 of therapy are highly predictive of the ovulatory response in this group of patients.

Adult↗
PubMed1999

Grief, depression, and coping in women undergoing infertility treatment.

OBJECTIVE: To identify the levels of grief and depression and the coping mechanisms of women with infertility problems who participated in in vitro fertilization (IVF) or ovulation-induction medication. METHODS: Pretest and post-test data were obtained from 50 IVF and 50 ovulation-induction medication patients receiving treatment at two urban infertility centers. RESULTS: Both groups of women experienced measurable levels of grief and depression before, during, and after treatment. Higher scores on the Grief Experience Inventory were found for both groups of women when pregnancy did not occur. Age, reproductive problems, years infertile, financial impact, and number of past IVF cycles were not found to influence the reported grief or depression levels. Women in the IVF and ovulation-induction medication groups used isolation coping behaviors such as self-talk and sleep. CONCLUSION: Because of moderate to high levels of grief and depression, therapeutic counseling may be more effective if initiated before the infertility treatment. Women's present levels of distress and coping strategies should be assessed prior to initiating infertility treatment to provide the patients with opportunities to learn and practice new adaptive behaviors that could enhance their ability to cope with infertility and the associated medical procedures.

Adaptation, Psychological↗
PubMed2003

[Pleural effusion due to the ovarian hyperstimulation syndrome].

Ovulation induction is a treatment that aimed to increase the pregnancy probability by increasing the follicular grow up and maturation. The most frequent complication is ovarian hyperstimulation syndrome (OHSS). Pleural effusion and abdominal ascites accumulation is frequently accompany this syndrome. A young patient receiving ovulation induction therapy was admitted to our department with sudden chest pain and dyspnea. Exudative pleural effusion was determined in the right and we suggest that pleural effusion was accumulated due to OHSS because of the presence of abdominal ascites, hemoconcentration, recent application of ovulation induction therapy and elimination of other causative factors for pleural effusion. The disappearance of pleural effusion spontaneously in a week support our idea. We reviewed the literature about the pleural effusion due to ovarian hyperstimulation syndrome. In the differential diagnosis of pleural effusion in young female patients, the accumulation of pleural effusion due to the recent ovulation induction story should be kept in mind which is especially important in the differential diagnosis of pulmonary embolism.

Female↗