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PubMed2003

Bye-bye urinary gonadotrophins? Recombinant FSH: a real progress in ovulation induction and IVF?

Whether recombinant gonadotrophin products do, indeed, represent progress for routine ovulation induction and IVF cycles, in comparison with urinary products, has remained controversial. Here we review published data with regard to respective risks, outcomes and cost for both medication options. Safety considerations favour recombinant products, while overall outcome and cost considerations favour urinary gonadotrophins. Outcome, however, appears to differ, based on age and ovarian function, with younger patients benefiting from the FSH/LH combination offered by urinary products, while older women and young women with ovarian resistance, apparently benefiting from pure FSH stimulation. Young women with poor ovarian reserve may be best stimulated with a pure FSH/antagonist protocol. We conclude that under current pricing structures in the United States, recombinant gonadotrophins do not represent a major progress for the treatments of ovulation induction and IVF. They, however, allow for an improved selectivity of stimulation protocols. The creation of recombinant FSH/LH products and cost adjustments for recombinant products, may affect these conclusions in favour of recombinant products.

Drug Costs↗
PubMed1992

Effects of smoking on ovulation induction for assisted reproductive techniques.

OBJECTIVE: To determine the effects of smoking on ovulation induction for assisted reproductive techniques. DESIGN: Matched, retrospective, cohort study. SETTING: Outpatient University endocrine/infertility program. PATIENTS: Eighteen smokers and 36 nonsmokers: 2 nonsmokers matched to each smoker for age, weight, and history of ovarian surgery. MAIN OUTCOME MEASURES: During a stimulation cycle, the serum estradiol (E2) level, number of follicles, number of oocytes, number of embryos, and ampules of gonadotropins used were compared in the smoking versus the nonsmoking groups by Wilcoxon's signed rank test for paired data. Follicular fluid (FF), testosterone (T), androstenedione (A), E2, A:E2 ratios, and T:E2 ratios were measured and compared between groups by Mann-Whitney U-tests. RESULTS: Smokers had significantly lower serum E2 levels, fewer follicles, fewer oocytes retrieved, and fewer embryos per cycle than nonsmokers, despite equal amounts of gonadotropin administration. Follicular fluid obtained from mature follicles had a higher A:E2 ratio and a higher T:E2 ratio in smokers compared with nonsmokers. CONCLUSIONS: Smoking adversely affects ovulation induction parameters and alters the FF hormonal milieu.

Adult↗
PubMed1997

Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy.

OBJECTIVE: To determine the prognostic value of single basal E2 and FSH levels as predictors of fecundity in women of advanced reproductive age who are undergoing ovulation induction with IUI therapy. DESIGN: Prospective, observational. SETTING: Fertility service of university medical center. PATIENT(S): Infertile couples in which the female partner was > or = 38 years old. INTERVENTION(S): Single assessment of basal E2 and FSH levels and ovulation induction with IUI. MAIN OUTCOME MEASURE(S): Cumulative and clinical pregnancy rates and live birth rates. RESULT(S): All live births occurred in patients with a basal E2 < or = 80 pg/mL (conversion factor to SI unit, 3.671), a basal FSH < or = 13 mIU/mL (conversion factor to SI unit, 1.00), and a chronological age < or = 42 years. In women 38 to 42 years of age, 10.3% had elevated basal E2 (> 80 pg/mL) in combination with normal basal FSH (< or = 13 mIU/mL), and no live births occurred in these couples. The cumulative live birth rate after four treatment cycles in women 38 to 42 years of age with both normal basal E2 (< or = 80 pg/mL) and FSH levels (< or = 13 mIU/mL) was 43.9%. CONCLUSION(S): Basal E2 improves the ability to predict fertility potential compared with basal FSH and chronological age alone. Basal E2, in combination with basal FSH and chronological age, has useful prognostic value in prospectively counseling patients of advanced reproductive age who are considering ovulation induction and IUI therapy.

Adult↗
PubMed2006

Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction and achievement of pregnancy in 154 women with polycystic ovary syndrome.

OBJECTIVE: To determine which first-line medication is more effective in polycystic ovary syndrome (PCOS) patients for ovulation induction and pregnancy achievement and to verify whether any patient characteristic is associated with a better response to therapy. DESIGN: Observational comparative study. SETTING: Fertility clinic. PATIENT(S): One hundred fifty-four infertile women with oligomenorrhea and hyperandrogenism. INTERVENTION(S): Group 1 (56 patients) received clomiphene citrate (CC) 50 mg from days 5-9 of the cycle. Group 2 (57 patients) received 500 mg of metformin 3 times a day. Group 3 (41 patients) received both medications. MAIN OUTCOME MEASURE(S): Ovulation and pregnancy. RESULT(S): Patients receiving metformin alone had an increased ovulation rate compared with those receiving CC alone (75.4% vs. 50%). Patients on metformin had similar ovulation rates compared with those in the combination group (75.4% vs. 63.4%). Pregnancy rates were equivalent in the 3 groups. Response to metformin was independent of body weight and dose. Finally, nonsmoking predicted better ovulatory response overall as well as lower fasting glucose for CC and lower androgens for metformin. CONCLUSION(S): Metformin is better for ovulation induction than CC alone and equivalent for pregnancy achievement. We suggest that metformin can be used first for ovulation induction in patients with PCOS regardless of their weight and insulin levels because of its efficacy and known safety profile.

Adult↗
PubMed1996

Elevated serum progesterone values at the time of ovulation induction in luteal leuprolide acetate-down-regulated GIFT cycles are associated with decreased clinical pregnancy rates.

PURPOSE: The effects of premature luteinization of ovarian follicles as detected by elevated progesterone values on the day of human chorionic gonadotropin induction of ovulation were evaluated in 38 consecutive gamete intrafallopian transfer (GIFT) retrieval cycles. MATERIALS AND METHODS: All patients received leuprolide acetate beginning in the midluteal phase of their prior menstrual cycle, followed by gonadotropin stimulation of folliculogenesis. At least four oocytes were transferred in each cycle. RESULTS: No significant differences in gonadotropin dosage, total number of days of gonadotropins, age, number of prior pregnancies, years of infertility since last pregnancy, total number of eggs retrieved, mature residual oocytes, fertilization of mature residual oocytes, or primary etiology of infertility were observed between groups; however, estradiol concentrations were significantly higher in the group with elevated progesterone values (2573 +/- 216 pg/ml) compared to the lower progesterone group (1925 +/- 202 pg/ml, P = 0.035) and the total number of oocytes transferred was greater in the high progesterone group (7.5 +/- 0.5) vs the low progesterone group (6.3 +/- 0.3, P < 0.038). P4 concentrations < or = 0.8 ng/ml were associated with significantly higher pregnancy rates (11/19; 57.9%) compared to progesterone concentrations > 0.8 ng/ml (5/19, 26.3%; P = 0.050). CONCLUSIONS: Premature luteinization may occur in luteal leuprolide acetate-down-regulated patients and progesterone values > 0.8 ng/ml are associated with significantly lower pregnancy rates in GIFT cycles.

Chorionic Gonadotropin↗
PubMed1997

Ovulation induction and gamete transport in the female tract of the musk shrew, Suncus murinus.

The musk shrew Suncus murinus was studied with regard to induction of ovulation, the genesis and role of the vaginal copulation plug, and the behaviour of gametes and embryos within the Fallopian tube. Ovulation occurred about 15 h after ejaculation, which required a mean of 5.2 (range 2-10) intromittent thrusts. Since ovulation occurred also after five thrusts without ejaculation, and after ejaculation without plug formation or sperm deposition, the primary stimulus for this seemed to be the thrust of the penis, the glans of which was covered by a dense field of spines. Neither vasectomized nor prostatectomized males formed a plug at ejaculation, and in the latter case the mean number of spermatozoa reaching the isthmus of the Fallopian tube, the number at the ampullary fertilization site and the rate of fertilisation were lower than in females mated to normal males. Thus both the vesicular gland on the vas deferens and the prostate are essential for formation of the copulation plug, which appears to enhance sperm transport within the female tract. At ejaculation, < or = 10(6) spermatozoa were incarcerated by the plug in the anterior vagina for 6-7 h, by which time a maximal population of several hundred had become established in posterior crypts of the isthmus of the Fallopian tube as small groups of free languidly moving spermatozoa. It remains to be established whether oviductal crypts in this and other shrews have a storage function for spermatozoa or sequester spermatozoa and so regulate the number that reach the fertilization site. Very few spermatozoa reached the ampulla of Suncus. Generally, only one or two spermatozoa had reached the ampulla by 4-5 h, and often less than ten had done so by 5-13 h after ovulation. As a probable correlate, few eggs were penetrated during the first 5 h, with a frequent delay of 10-13 h before most eggs were fertilized. Thereafter, unfertilized eggs were transported through the oviduct at the same rate as developing embryos, which entered the uterus about 85 h after ovulation at the 32-cell stage. There were highly significant differences between the larger KAT/SK strains and smaller OK strain with regard to Fallopian tube length (mean 6.9 mm versus 9.7 mm), as well as the rates of hCG-induced ovulation (5.6 versus 3.25) and of unilateral ovulation (6% versus 50%).

Animals↗
PubMed1992

Ovulation induction with a single-blind treatment regimen comparing naltrexone, placebo and clomiphene citrate in women with secondary amenorrhea.

Secondary amenorrhea is often associated with emotional stress, weight loss, eating disorders or polycystic ovary-like disease. Involvement of the endogenous opioids in the pathophysiology of hypothalamic amenorrhea, by inhibition of hypothalamic GnRH secretion, has been demonstrated in some cases. Chronic blockade of the endogenous opioids with the long-acting opioid antagonist naltrexone could result in increased gonadotropin secretion and ovulation induction in these cases. A single-blind ovulation induction protocol comparing naltrexone, placebo and clomiphene citrate was evaluated in eight patients with secondary amenorrhea. Naltrexone proved not to be more effective than placebo in our study. Only one patient ovulated on naltrexone, one on placebo and four on clomiphene citrate. The latter therapy caused a better endocrine response. In conclusion, although ovulation could be incidentally induced by naltrexone, this drug did not appear to be more successful than placebo and clomiphene citrate for ovulation induction in this population of patients.

Amenorrhea↗
PubMedDate not supplied

Ovulation induction for in vitro fertilisation using clomiphene citrate and low-dose human menopausal gonadotrophin.

Ovulation induction using a low dose of human menopausal gonadotrophins and clomiphene citrate for in vitro fertilisation and embryo transfer is described. Sixty-two cycles of ovulation induction were initiated in 37 patients. Forty-six laparoscopies were performed, yielding 116 oocytes. Of these, 90 (77.6%) cleaving embryos developed, and in 36 transfers 10 pregnancies (27.8%) were established. The use of low-dose hMG in conjunction with a programme on an outpatient basis may prove to be optimal for the purpose of in vitro fertilisation and embryo transfer.

Cleavage Stage, Ovum↗
PubMed1994

Growth hormone co-treatment for ovulation induction may enhance conception in the co-treatment and succeeding cycles, in clonidine negative but not clonidine positive patients.

To investigate the effect of co-treatment with growth hormone (GH) for ovulation induction with human menopausal gonadotrophins (HMG) on conception, we compared the pregnancy rate and response to co-treatment with GH versus HMG/human chorionic gonadotrophin (HCG) alone in a prospective, randomized, cross-over protocol of ovulation induction for either in-vivo or in-vitro fertilization (IVF). The main outcome measures were the amount of gonadotrophin used and conception. Co-treatment with GH was associated with a reduction of approximately 30% in gonadotrophin requirement. In 24 clonidine negative patients 14 pregnancies were achieved (58.3%) either in the GH/HMG/HCG cycle or in the succeeding one. GH co-treatment did not generate any pregnancy in eight clonidine positive patients. We conclude that growth hormone may increase the pregnancy rate when combined with HMG/HCG for ovulation induction, not only in the co-treatment cycle but also in the succeeding one. The beneficial, synergistic effect of GH co-treatment was detected in clonidine negative but not in clonidine positive infertile patients.

Adult↗
PubMed2004

[Effect of rosiglitazone on ovulation induction in women with polycystic ovary syndrome].

OBJECTIVE: To investigate the effect of rosiglitazone on ovulation induction in women with polycystic ovary syndrome (PCOS). METHODS: Ninety-six PCOS women with insulin resistance (IR) were randomly divided into three groups. Group A (28 cases) received clomiphene citrate (CC) alone. Group B (32 cases) received rosiglitazone alone. And group C (36 cases) received CC and rosiglitazone in combination. All were treated for three menstrual cycles. Homeostasis model assessment insulin resistance (HOMA IR) and ovulation before and after treatment were compared among the 3 groups. RESULTS: After the treatment, HOMA IR in group B and C decreased from 1.2 +/- 0.6 to 0.6 +/- 0.2 and from 1.1 +/- 0.5 to 0.6 +/- 0.4, respectively (P < 0.05). Success rate of ovulation after treatment in group C (80%) was higher than that in group A (59%) and group B (35%, P < 0.05). CONCLUSION: Rosiglitazone therapy improves insulin sensitivity and ovulation induction.

Adult↗
PubMed2000

Ovulation induction.

In the woman with anovulation and polycystic ovarian syndrome, there are many options for ovulation induction. Treatment should be individualized, but clomiphene citrate is an excellent first-line agent. In the woman resistant to clomiphene citrate, combination therapy often results in pregnancy. Some women with PCOS only respond to gonadotropin therapy. These women are at a higher risk for multiple pregnancy and ovarian hyperstimulation syndrome. In the woman with anovulation and hypothalamic amenorrhea, the options for ovulation induction are limited. The luteal phase must be supported. The hypothalamus is unable to support the corpus luteum or early pregnancy.

Clomiphene↗
PubMed1991

Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements.

OBJECTIVE: To attempt the monitoring of ovulation induction solely with ultrasound (US). DESIGN: Using serial US measurements to monitor ovulation induction using human menopausal gonadotropin and human chorionic gonadotropin (hCG), in comparison with estradiol (E2) concentrations that became available at the end of each cycle. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS, PARTICIPANTS: Twenty hypogonadotropic and 29 ultrasonically diagnosed polycystic ovary patients. MAIN OUTCOME MEASURE: Follicular growth, uterine measurements, endometrial thickness, and serum E2 concentrations. RESULTS: Follicular growth, uterine measurements, and endometrial thickness correlated strongly with E2 concentrations (P less than 0.0001). The endometrium on the day of hCG administration was significantly thicker (P less than 0.01) in the conception (n = 27) compared with the nonconception cycles (n = 87), whereas no significant difference were observed in serum E2 concentrations. No pregnancy was observed when hCG had been administered when the endometrial thickness was less than or equal to 7 mm. Midluteal endometrial thickness of greater than or equal to 11 mm was found to be a good prognostic factor for detecting early pregnancy (P less than 0.008). CONCLUSIONS: Serial US examinations used alone have proven to be safe and highly efficient. It also has a unique ability to detect pregnancy in the midluteal phase.

Adult↗
PubMed1989

Luteal phase hyperprolactinemia during ovulation induction with human menopausal gonadotropins: incidence, recurrence, and effect on pregnancy rates.

Hyperprolactinemia may develop during ovulation induction with human menopausal gonadotropins and hCG (hMG/hCG). Because elevated serum prolactin (PRL) has several adverse effects on female reproductive function, this event has been implicated as a factor to explain the difference between ovulation and pregnancy rates in hMG/hCG treatment cycles. The incidence and severity of hyperprolactinemia in the luteal phase of hMG/hCG-stimulated cycles was investigated in a large series of patients. We analyzed 240 consecutive, ovulatory hMG/hCG cycles in 96 women from July 1984 to January 1986. All women had failed to conceive with clomiphene citrate, and had normal luteal phase PRL levels during unstimulated cycles. Daily serum total estrogens were determined during hMG administration. Serum progesterone and PRL were determined in the mid-luteal phase (7 days post-hCG administration). In 7.5% of the cycles, luteal phase PRL elevations were greater than 25 ng/mL. Only 2.5% of cycles had levels of PRL greater than 35 ng/mL. Hyperprolactinemia infrequently recurred in different cycles of the same patient (two of 16 patients, 12.5%). Cycles with hyperprolactinemia were found to have significantly higher preovulatory estrogen levels. Serum progesterone levels were not significantly decreased in cycles with elevated PRL. Pregnancy rates in cycles with and without hyperprolactinemia were similar (7.7 versus 11.1%, respectively; P greater than .05). We conclude that the development of luteal phase hyperprolactinemia during ovulation induction with hMG/hCG is an isolated event. High preovulatory estrogen levels may predispose to its development. Because hyperprolactinemia is uncommon and is usually mild, other factors must be responsible for the difference between ovulation and pregnancy rates using hMG/hCG.

Chorionic Gonadotropin↗
PubMed2006

Infertility, ovulation induction treatments and the incidence of breast cancer--a historical prospective cohort of Israeli women.

CONTEXT: Ovulation induction drugs may be associated with increased breast cancer risk. Results so far have been inconclusive. OBJECTIVE: To evaluate the association between infertility, exposure to ovulation induction drugs and the incidence of breast cancer. DESIGN: Historical prospective cohort and nested case-control study. SETTING: Institutional practice PATIENTS: About 5,788 women attending five infertility centers in Israel between 1964 and 1984. INTENTION: Abstracting of medical records and telephone interviews. MAIN OUTCOME MEASURE: Breast cancer incidence was determined through linkage with the National Cancer Registry database. Standardized incidence ratios (SIRs) and 95% confidence intervals were computed by comparing the observed to the expected cancer rates in the general population. In addition, a nested case-control study within the cohort was performed with interviews of breast cancer cases and two matched controls. RESULTS: The study cohort included 120,895 women years of follow-up. Compared to 115.2 expected breast cancer cases, 131 cases were observed (SIR = 1.1; 95% CI 0.9-1.4). Risk for breast cancer was significantly higher for women treated with clomiphene citrate (SIR = 1.4; 95% CI 1.0-1.8). Similar results were noted when comparisons were carried out between treated and untreated women, and when multivariate models were applied. In the nested case-control study, higher cycle index (OR = 2.2; 95% CI 1.0-4.8) and treatment with clomiphene citrate (OR=2.7; 95% CI 1.3-5.7) were associated with higher risk for breast cancer. CONCLUSION: Infertility and usage of infertility drugs in general are not associated with increased risk for breast cancer. However, for infertile women treated with clomiphene citrate, breast cancer risk is elevated.

Adult↗
PubMedDate not supplied

Naltrexone effect on pulsatile GnRH therapy for ovulation induction in polycystic ovary syndrome: a pilot prospective study.

The aim of the present study was to analyze the opioid influence on LH pulsatility in polycystic ovary syndrome (PCOS) patients and to evaluate the effectiveness of a long-term opioid antagonist (naltrexone) treatment in improving the pulsatile GnRH therapy which is successful in this syndrome. Ten obese women affected by PCOS participated in the study. Patients were hospitalized during the early follicular phase and underwent an oral glucose tolerance test (OGTT) with 75 g of glucose and a pulse pattern study followed by a GnRH test (100 pg i.v.). All patients were then treated for ovulation induction with pulsatile administration of GnRH (5 microg/bolus every 90 min). Since pregnancies did not occurr in any patient, after spontaneous or progestin-induced menstrual cycles, all patients received naltrexone at a dose of 50 mg/day orally for 8 weeks and during treatment repeated the basal protocol study and the ovulation induction cycle with the same modalities. The naltrexone treatment significantly reduced the insulin response to OGTT and the LH response to GnRH bolus, whereas it did not affect the FSH and LH pulsatility patterns. Concerning the ovulation induction by pulsatile GnRH, naltrexone treatment was able to improve, although not significantly, the ovulation rate (60% pre-treatment vs 90% post-treatment). Furthermore, the maximum diameter of the dominant follicle and the pre-ovulatory estradiol concentration were higher after long-term opioid blockade (follicular diameter 19.5+/-1.76 mm pre-treatment vs 21.6+/-2.19 mm post-treatment, p<0.001; maximum estradiol level 728.7+/-288.5 pmol/l pre-treatment vs 986.4+/-382.1 pmol/l post-treatment, p<0.05). During the naltrexone-pulsatile GnRH co-treatment two pregnancies occurred. In conclusion, our data show that naltrexone-pulsatile GnRH co-treatment is able to improve the ovarian responsiveness to ovulation induction in obese PCOS patients when compared to pulsatile GnRH alone. This action seems to be related to a decrease of insulin secretion. Further randomized studies should be performed in order to obtain significant conclusions on the possible clinical application.

Adult↗
PubMed1995

[Hypogonadotropic form of amenorrhea. Principles of ovulation induction].

Analysis of the clinico-anamnestic and endocrine parameters of the reproductive system of 45 patients with hypogonadotropic amenorrhea helped single out three types of this condition. Drug doses and schemes of their administration to induce ovulation were selected individually with due consideration for the initial functional status of the reproductive system. The authors defined the basic principles of ovulation induction in patients with hypogonadotropic amenorrhea: the patients should be carefully selected according to WHO classification, with due regard for their clinico-anamnestic data and the function of the reproductive system (hormonal functional test); drug doses for substitution therapy and protocols of their administration should be selected individually, with consideration for the degree of hypophyseal-gonadal insufficiency; daily double (ultrasonic and hormonal) monitoring is needed for the correction of ovulation induction protocols; the choice of the optimal time of administration of the "ovulatory" dose should be based on the findings of double monitoring indicating follicle size 19-20 mm and the maximal activity of steroidogenesis (350 to 400 pmol/liter estradiol per follicle). The possibility of using lutrelef, an analog of gonadotropin releasing hormone, for ovulation induction in patients with the hypothalamic form of gonadotropic amenorrhea was studied. The drug was administered in a pulsed mode using Zykloma+ device (Ferring, Germany). The advantages of a physiological principle of substitution therapy were demonstrated, although the induction of cycles was not appreciably improved by this method as against substitution therapy with human menopausal gonadotropin.

Adolescent↗
PubMed2000

Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome.

BACKGROUND: Approximately 15% of patients with PCOS remain anovulatory despite treatment with oral anti-oestrogen medications such as clomiphene citrate. In addition, about half of women with PCOS ovulating on anti-oestrogen treatment fail to conceive. Gonadotrophin stimulation is the next step in treatment for women who are "clomiphene resistant", however, results of gonadotrophin stimulation in women with PCOS are less successful. In PCOS associated with hypersecretion of LH, purified urinary follicle-stimulating hormone (u-FSH) preparations have theoretical advantages over the use of human menopausal gonadotrophin (hMG) preparations (containing both FSH and LH), but whether this claimed advantage extends into clinical practice remains uncertain. In addition, the use of gonadotrophin-releasing hormone analogues (GnRH-a) to produce pituitary desensitisation prior to ovulation induction in PCOS has been claimed to increase the success rates of treatment as well as reduce complications such as OHSS and multiple pregnancy. Gonadotrophin preparations have also been administered via different routes (intramuscular or subcutaneous), or using different stimulation regimens and protocols (step-up or standard) in an attempt to improve efficacy. OBJECTIVES: To determine the effectiveness of urinary-derived gonadotrophins as ovulation induction agents in patients with PCOS trying to conceive. In particular, to assess the effectiveness of (1) different gonadotrophin preparations, (2) the addition of a gonadotrophin-releasing hormone agonist (GnRH-a) to gonadotrophin stimulation and (3) different modalities of gonadotrophin administration. SEARCH STRATEGY: The search strategy to identify RCTs consisted of (1) the Group's Specialised Register of Controlled Trials using the search strategy developed for the Menstrual Disorders and Subfertility Group as a whole (see the Review Group details for more information), (2) additional specific electronic Medline searches and (3) bibliographies of identified studies and narrative reviews. SELECTION CRITERIA: RCTs in which urinary-derived gonadotrophins were used for ovulation induction in patients with primary or secondary subfertility attributable to PCOS. DATA COLLECTION AND ANALYSIS: Twenty three RCTs were identified, 9 of which were excluded from analysis. The data were extracted independently by 2 authors. The following criteria were assessed: (1) the methodological characteristics of the trials, (2) the baseline characteristics of the studied groups and (3) the outcomes of interest: pregnancy rate (per cycle), ovulation rate (per cycle), miscarriage rate (per pregnancy), multiple pregnancy rate (per pregnancy), overstimulation rate (per cycle) and ovarian hyperstimulation syndrome (OHSS) rate (per cycle). Where suitable, meta-analysis was performed using Peto's OR with 95% CI with the fixed effect Mantel-Haentszel equation. MAIN RESULTS: (1) A reduction in the incidence of OHSS with FSH compared to hMG in stimulation cycles without the concomitant use of a GnRH-a (OR 0.20; 95% CI 0.08-0.46) and (2) a higher overstimulation rate when a GnRH-a is added to gonadotrophins (OR 3.15; 95% CI 1.48-6.70). REVIEWER'S CONCLUSIONS: Although 14 RCTs were included in this review, few dealt with the same comparisons, all were small to moderate size and their methodological quality was generally poor. Any conclusions, therefore, remain tentative as they are based on a limited amount of data and will require further RCTs to substantiate them. In none of the comparisons was there a significant improvement in pregnancy rate but this may be due to the lack of power (i.e. insufficient patients randomised to demonstrate a significant difference between treatments). There was a trend towards better pregnancy rates with the addition of a GnRH-a to gonadotrophin stimulation and these interventions warrant further study. Despite theoretical advantages, urinary-derived FSH preparations did not improve pregnancy rates when compared to traditional and cheaper hMG preparations; their only demonstrable benefit was a reduced risk of OHSS in cycles when administered without the concomitant use of a GnRH-a. No conclusions can be drawn on miscarriage and multiple pregnancy rates due to insufficient reporting of these outcomes in the trials.

Female↗
PubMed1976

Haematological changes during ovulation-induction by gonadotrophins.

The oestrogen response to ovulation-induction by gonadotrophins initiates a preovulation rise in total leucocytes and promotes fluid retention. In consequence of the latter, cyclic changes occur in blood haemoglobin and the haematocrit. The level of oestrone excretion in the follicular phase of induced cycles indicates that multiple follicular development probably occurs, and this also appears to affect the luteal phase. It seems likely, therefore, that the data present a rather exaggerated picture of the situation which obtains in normal menstrual cycles.

Blood↗