menotropins and Abnormalities--Drug-Induced

Ovulation is the result of a perfectly balanced and coordinated function of endocrine, paracrine, and autocrine systems. Any disruption in the delicately coordinated interaction between the integrated components of the hypothalamic-pituitary-ovarian axis may lead to ovulatory dysfunction, a multifactorial entity. The widening scope of knowledge regarding physiology of the reproductive processes as well as rapid development of new diagnostic methods and therapeutic procedures necessitates the continued reassessment and identification of factors leading to ovulatory dysfunction and the design of safe therapy for this condition. The combined use of serial ultrasonography and estradiol measurements should be the standard method of ovulation induction monitoring. The identification of high-risk groups prior to the initiation of ovulation induction regimens must also be taken into consideration if we want to improve pregnancy rate and reduce the incidence of hyperstimulation to a minimal level.

Topics: Abnormalities, Drug-Induced; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Bromocriptine; Clomiphene; Female; Humans; Infant, Newborn; Infertility, Female; Luteal Phase; Menotropins; Neural Tube Defects; Ovulation Induction; Pregnancy; Pregnancy Complications; Pregnancy, Multiple

The effects of HMG (Humegon)-HCG therapy in 6096 cycles in 2166 Japanese women with anovulatory infertility were examined. The rates of ovulation, pregnancy, the ovarian hyperstimulation syndrome, multiple pregnancy, abortion, and malformations in the newborn were recorded, and the possible factors of multiple pregnancies were analyzed. Ovulation occurred in 73.2% of the cases and 64.5% of the treatment cycles. Pregnancy occurred in 23.0% of the cases and 8.6% of the cycles. Ovarian hyperstimulation syndrome with grade I of WHO definition or more was observed in 10.3% of the cases and 5.3% of the cycles. The incidence of the ovarian hyperstimulation syndrome was high in amenorrheic patients, who respond to progestin with bleeding. The multiple pregnancy rate was 20.5%, of which 13.0% was twins and 7.5% triplets or more. The abortion rate was 22.0%, and the abortion rate in multiple pregnancy was significantly higher (P less than 0.05) than that in singleton pregnancy. The external malformation rate was 1.68% in the 594 newborn who could be examined. No significant differences were found in maternal factors, the treatment schedule, or the ovarian response to treatment in singleton and multiple pregnancy groups. This survey revealed that the efficacy and the incidence of adverse effects of Humegon-HCG therapy in a large number of Japanese women were not different from those in Caucasians except for a lower rate of multiple pregnancy, and no special causative factors for multiple pregnancy were found.

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Adult; Amenorrhea; Anovulation; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple

With proper patient selection, appropriate pretreatment studies and careful monitoring will ensure that patients ovulate safely. Table 7 is a summary of the results that may be expected following properly monitored hMG therapy. Among estrogen-deficient patients without other causes of infertility, the cumulative pregnancy rate after six cycles will exceed 90%. However, among normoestrogenic patients with no other infertility factors the cumulative conception rate has been reported to be only 50% after 12 courses of therapy, although with the use of ultrasound monitoring it is likely that this latter figure will improve. Nevertheless, these data may be used to afford couples with a realistic prognosis.

Topics: Abnormalities, Drug-Induced; Anovulation; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infant, Newborn; Medroxyprogesterone; Menotropins; Menstruation Disturbances; Ovarian Follicle; Ovulation Induction; Pregnancy; Progesterone; Ultrasonography

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adult; Amenorrhea; Down Syndrome; Drug Evaluation; Female; Follow-Up Studies; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovulation; Pregnancy; Triplets; Twins