menotropins and Abortion--Spontaneous

Ovulation induction with follicle stimulating hormone (FSH) is a second-line treatment in women with polycystic ovary syndrome (PCOS) who do not ovulate or conceive on clomiphene citrate.. To compare the effectiveness and safety of gonadotrophins as a second-line treatment for ovulation induction in women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS), and women who do not ovulate or conceive after clomiphene citrate.. In January 2018, we searched the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, the World Health Organisation clinical trials register, Clinicaltrials.gov, LILACs, and PubMed databases, and Google Scholar. We checked references of in all obtained studies. We had no language restrictions.. All randomised controlled trials reporting data on clinical outcomes in women with PCOS who did not ovulate or conceive on clomiphene citrate, and undergoing ovulation induction with urinary-derived gonadotrophins, including urofollitropin (uFSH) in purified FSH (FSH-P) or highly purified FSH (FSH-HP) form, human menopausal gonadotropin (HMG) and highly purified human menopausal gonadotrophin (HP-HMG), or recombinant FSH (rFSH), or continuing clomiphene citrate. We included trials reporting on ovulation induction followed by intercourse or intrauterine insemination. We excluded studies that described co-treatment with clomiphene citrate, metformin, luteinizing hormone, or letrozole.. Three review authors (NW, EK, and MvW) independently selected studies for inclusion, assessed risk of bias, and extracted study data. Primary outcomes were live birth rate per woman and multiple pregnancy per woman. Secondary outcomes were clinical pregnancy, miscarriage, incidence of ovarian hyperstimulation syndrome (OHSS) per woman, total gonadotrophin dose, and total duration of stimulation per woman. We combined data using a fixed-effect model to calculate the risk ratio (RR). We summarised the overall quality of evidence for the main outcomes using GRADE criteria.. The review included 15 trials with 2387 women. Ten trials compared rFSH with urinary-derived gonadotrophins (three compared rFSH with human menopausal gonadotrophin, and seven compared rFSH with FSH-HP), four trials compared FSH-P with HMG. We found no trials that compared FSH-HP with FSH-P. One trial compared FSH with continued clomiphene citrate.Recombinant FSH (rFSH) versus urinary-derived gonadotrophinsThere may be little or no difference in the birth rate between rFSH and urinary-derived gonadotrophins (RR 1.21, 95% confidence interval (CI) 0.83 to 1.78; five trials, N = 505; I² = 9%; low-quality evidence). This suggests that for the observed average live birth per woman who used urinary-derived FSH of 16%, the chance of live birth with rFSH is between 13% and 28%. There may also be little or no difference between groups in incidence of multiple pregnancy (RR 0.86, 95% CI 0.46 to 1.61; eight trials, N = 1368; I² = 0%; low-quality evidence), clinical pregnancy rate (RR 1.05, 95% CI 0.88 to 1.27; eight trials, N = 1330; I² = 0; low-quality evidence), or miscarriage rate (RR 1.20, 95% CI 0.71 to 2.04; seven trials, N = 970; I² = 0; low-quality evidence). We are uncertain whether rFSH reduces the incidence of OHSS (RR 1.48, 95% CI 0.82 to 2.65, ten trials, n=1565, I² = 0%, very low-quality evidence).Human menopausal gonadotrophin (HMG) or HP-HMG versus uFSHWhen compared to uFSH, we are uncertain whether HMG or HP-HMG improves live birth rate (RR 1.28, 95% CI 0.65 to 2.52; three trials, N = 138; I² = 0%; very low quality evidence), or reduces multiple pregnancy rate (RR 2.13, 95% CI 0.51 to 8.91; four trials, N = 161; I² = 0%; very low quality evidence). We are also uncertain whether HMG or HP-HMG improves clinical pregnancy rate (RR 1.31, 95% CI 0.66 to 2.59; three trials, N = 102; I² = 0; very low quality evidence), reduces miscarriage rate (RR 0.33, 95% CI 0.06 to 1.97; two trials, N = 98; I² = 0%; very low quality evidence), or reduces the incidence of OHSS (RR 7.07, 95% CI 0.42 to 117.81; two trials, N = 53; very low quality evidence) when compared to uFSH.Gonadotrophins versus continued clomiphene citrateGonadotrophins resulted in more live births than continued clomiphene citrate (RR 1.24, 95% CI 1.05 to 1.46; one trial, N = 661; I² = 0%; moderate-quality evidence). This suggests that for a woman with a live birth rate of 41% with continued clomiphene citrate, the live birth rate with FSH was between 43% and 60%. There is probably little or no diff. There may be little or no difference in live birth, incidence of multiple pregnancy, clinical pregnancy rate, or miscarriage rate between urinary-derived gonadotrophins and recombinant follicle stimulating hormone in women with polycystic ovary syndrome. For human menopausal gonadotropin or highly purified human menopausal gonadotrophin versus urinary follicle stimulating hormone we are uncertain whether one or the other improves or lowers live birth, incidence of multiple pregnancy, clinical pregnancy rate, or miscarriage rate. We are uncertain whether any of the interventions reduce the incidence of ovarian hyperstimulation syndrome. We suggest weighing costs and convenience in the decision to use one or the other gonadotrophin. In women with clomiphene citrate failure, gonadotrophins resulted in more live births than continued clomiphene citrate without increasing multiple pregnancies.

Topics: Abortion, Spontaneous; Birth Rate; Clomiphene; Drug Resistance; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Live Birth; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Randomized Controlled Trials as Topic

To determine the relative efficacy of recombinant FSH (rFSH) and urinary FSH (uFSH) for ovarian stimulation in assisted reproductive techniques (ART).. Systematic review and meta-analysis of randomized, controlled trials comparing rFSH and uFSH.. Infertility centers providing treatment with ART.. Patients undergoing IVF with or without ICSI.. Controlled ovarian stimulation using uFSH or rFSH (follitropin alpha or follitropin beta).. Primary: rate of clinical pregnancy per cycle. Secondary: rates of spontaneous abortion, multiple pregnancy, and severe ovarian hyperstimulation syndrome (OHSS); total gonadotropin dose; serum E(2) level and number of follicles at hCG administration; number of oocytes retrieved.. Eighteen trials were included in the meta-analysis. Subgroup analyses demonstrated higher pregnancy rates with both follitropins compared with uFSH. However, statistical significance was reached only in the follitropin alpha versus uFSH comparison in IVF cycles, with an additional pregnancy for every 19 patients treated. Fewer units of rFSH than uFSH achieved the same E(2) level and oocyte yield. No differences were found between treatments in rates of spontaneous abortion, OHSS, and multiple gestation.. rFSH produced higher pregnancy rates per cycle than uFSH when follitropin alpha was used in IVF, and the total gonadotropin dose required was lower.

Topics: Abortion, Spontaneous; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Recombinant Proteins; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic; Treatment Outcome

Topics: Abortion, Spontaneous; Albumins; Antineoplastic Agents, Hormonal; Buserelin; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Luteinizing Hormone; Menotropins; Oocytes; Ovarian Hyperstimulation Syndrome; Polycystic Ovary Syndrome; Pregnancy

To conduct a systematic overview of available data comparing FSH with hMG in IVF treatment cycles.. A meta-analysis of randomized trials of FSH versus hMG use in ovarian stimulation protocols, with or without GnRH agonists, in IVF treatment cycles. Search strategies included on-line searching of the National Library of Medicine MEDLINE data base from 1975 to 1993 and hand searching of bibliographies of relevant publications and reviews and abstracts of scientific meetings. Common odds ratio (OR) and overall absolute treatment effect were calculated after demonstrating homogeneity of treatment effect across all trials.. Clinical pregnancy rates per cycle start, per cycle reaching oocyte retrieval, and per cycle reaching ET.. Eight trials met the inclusion criteria. The overall OR in favor of FSH for cycle start, oocyte retrieval, and ET were 1.71, 1.69 and 1.70, respectively, and represented an overall absolute treatment effect of 8.5%, 8.0% and 8.3%, respectively.. This meta-analysis demonstrates that in IVF cycles the use of FSH is associated with a significantly higher clinical pregnancy rate than hMG.

Topics: Abortion, Spontaneous; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Pregnancy; Pregnancy, Multiple

Although the use of luteinizing hormone-releasing hormone (LHRH) agonists and human menopausal gonadotropin (hMG) for ovarian stimulation in assisted reproduction has gained widespread popularity, a number of major issues regarding their use remain unresolved. Some of these issues are examined in the light of recent developments. The routine use of LHRH agonists produces significantly higher pregnancy and livebirth rates compared with conventional methods of ovarian stimulation. A number of prospective, randomized studies have shown that the long protocol of LHRH agonist administration is superior to the short and ultrashort protocols, and it appears that early follicular phase initiation of the long protocol may be particularly beneficial. Another major advantage of the long protocol of LHRH agonist administration is that, with its use, precise timing of human chorionic gonadotropin (hCG) administration is not important. It would, therefore, appear that the routine use of LHRH agonists has both medical as well as practical advantages.

Topics: Abortion, Spontaneous; Clinical Protocols; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prospective Studies; Randomized Controlled Trials as Topic; Time Factors

A case is presented of a twin gestation comprising a grossly normal fetus and placenta coexisting with a separate hydatidiform mole which ended in an abortion. Both developed following ovulation induction with human menopausal gonadotrophin and human chorionic gonadotrophin. The literature is reviewed and clinical aspects of this rare entity are discussed.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Female; Humans; Hydatidiform Mole; Menotropins; Ovulation Induction; Pregnancy; Twins

From the reviewed data, it appears that CC, hMG-hCG, or the association of these drugs with IVF-ET and GIFT programs do not carry an increased risk for congenital malformations as a whole, nor is there any specific malformation that has an increased incidence or is related in any way with the use of these drugs. Table 7 represents the specific malformation rate per 1,000 births in the general population and in newborns delivered after treatment with CC, hMG-hCG, or IVF-ET and GIFT. The malformation rate in the treated groups does not differ from that of the general population. However, as shown by McIntosh et al., the incidence of congenital malformations often rises with a longer follow-up. Most of the reports about babies born after ovulation induction are based on the initial examination done shortly after birth. Thus, studies including examination of these infants up to at least 12 months of age will be undoubtedly of value. Also, data concerning the reproductive capability of women born after ovulation induction is lacking. With regard to the abortion rate in pregnancies achieved after such treatments and procedures, it can be concluded that it does not appear to be higher than that of the general population, particularly when early pregnancy loss, advanced maternal age, the infertility status, and the increased incidence of multiple pregnancies occurring in these patients are taken into consideration.

Topics: Abortion, Spontaneous; Clomiphene; Congenital Abnormalities; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Menotropins; Ovulation Induction; Pregnancy

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

To compare the effects of letrozole and human menopausal gonadotropin (HMG) in the treatment of patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC).. A total of 96 clomiphene resistance polycystic ovary syndrome patients infertility were randomly divided into an LE group, and HMG group (n = 48). LE group orally received letrozole at 5.0 mg/d on the 3rd-5th days of menstrual cycle for 5 consecutive days, and 75 U/d HMG was given through intramuscular injection for 5 days starting from the third day of menstrual cycle in HMG group. Number of growing and mature follicles, serum E2 (pg/mL), serum P (ng/mL), endometrial thickness, occurrence of pregnancy and miscarriage were observed.. There was no significant difference in the number of ovulation cycles between the 2 groups (53.6% vs 64.7%, P > .05). The number of mature follicular cycles in the HMG group was higher than that of the letrozole group (P < .01). There were no significant differences in the clinical pregnancy rate (22.9% vs 27.1%, P > .05) and abortion rate (6.2% vs 10.4%, P > .05). There was no significant difference in the endometrial thickness between the 2 groups on the day of HCG injection [(9.1 ± 0.2) mm vs (10.7 ± 1.6) mm, P > .05]; the serum estradiol (E2) was lower in the letrozole group. The incidence of ovarian cysts was lower than that of HMG group (P < .05). There was2 ovarian hyperstimulation syndrome in the letrozole group; the incidence of ovarian hyperstimulation syndrome in the HMG group was 12.5%.. Letrozole-induced ovulation can obtain ovulation rate and pregnancy rate similar to gonadotropin, but reduce the risk associated with treatment. It can be used as an effective ovulation option for patients with polycystic ovary syndrome who are resistant to clomiphene.

Topics: Abortion, Spontaneous; Adult; Clomiphene; Endometrium; Estradiol; Female; Humans; Infertility, Female; Letrozole; Menotropins; Ovarian Cysts; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Young Adult

To evaluate the efficacy and safety of highly purified human menotropin (HP-hMG) and recombinant follicle-stimulating hormone (rFSH) for controlled ovarian stimulation in a population of patients predicted to be high responders.. Randomized, open-label, assessor-blinded, parallel-group, noninferiority trial.. Fertility centers.. A total of 620 women with serum antimüllerian hormone (AMH) ≥5 ng/mL.. Controlled ovarian stimulation with HP-hMG or rFSH in a GnRH antagonist assisted reproductive technology (ART) cycle. Fresh transfer of a single blastocyst was performed unless ovarian response was excessive, in which all embryos were cryopreserved. Subjects could undergo subsequent frozen blastocyst transfer within 6 months of randomization.. Ongoing pregnancy rate (OPR) after fresh transfer (primary endpoint), as well as cumulative live birth, ovarian hyperstimulation syndrome (OHSS), and pregnancy loss rates.. OPR/cycle start after fresh transfer was 35.5% with HP-hMG and 30.7% with rFSH (difference: 4.7%, 95% CI -2.7%, 12.1%); noninferiority was established. Compared to rFSH, HP-hMG was associated with significantly lower OHSS (21.4% vs. 9.7% respectively; difference: -11.7%, 95% CI -17.3%, -6.1%) and cumulative early pregnancy loss rates (25.5% vs. 14.5% respectively; difference: -11.0%, 95% CI -18.8%, -3.14%). Despite 43 more transfers in the rFSH group, cumulative live birth rates were similar with HP-hMG and rFSH at 50.6% and 51.5% respectively (difference: -0.8%, 95% CI -8.7%, 7.1%).. In high responders, HP-hMG provided comparable efficacy to rFSH with fewer adverse events, including pregnancy loss, suggesting its optimized risk/benefit profile in this population.. NCT02554279 (clinicaltrials.gov).

Topics: Abortion, Spontaneous; Adult; Anti-Mullerian Hormone; Biomarkers; Female; Fertility; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility; Live Birth; Male; Menotropins; Ovarian Hyperstimulation Syndrome; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Recombinant Proteins; Single Embryo Transfer; Sperm Injections, Intracytoplasmic; Treatment Outcome; United States; Young Adult

The strategy of in vitro fertilization (IVF) procedures relies on the increasing pregnancy rate and decreasing the risk of premature ovulation and ovarian hyperstimulation syndrome. They are also designed to avoid weekend oocyte retrievals. Combined oral contraceptive (OC) pills are among the medicines used to accomplish these objectives. Alternatively, estradiol can be used instead of OC to obtain similar results. The aim of our study was to compare the differences in pregnancy rates (PRs), implantation rates, and miscarriage rates between a short agonist protocol with estradiol priming and a long protocol with combined OC. Of the 298 women who participated in this study, 134 achieved clinical pregnancies (45.0%). A higher PR (58.4%, n = 80, compared to 40.3%, n = 54) was achieved in the long protocol after OC pretreatment group. The implantation rate was also higher for this group (37.8% versus 28.0%; P = 0.03). The miscarriage rate was 15.0% (n = 12) for the long protocol after OC pretreatment group and 20.4% (n = 11) for the short agonist group (P = 0.81). The short agonist protocol required a 5.7% lower human menopausal gonadotropin (hMG) dosage than the long protocol but surprisingly the number of oocytes retrieved was also smaller.

Topics: Abortion, Spontaneous; Contraceptives, Oral, Combined; Estradiol; Female; Fertilization in Vitro; Humans; Menotropins; Oocytes; Pregnancy; Pregnancy Rate

To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-derived highly purified (HP) menotropin, we compared HP hMG and recombinant (r) FSHalpha use in ICSI within a prospective, randomized, controlled study.. 100 infertile women were treated with HP hMG (50 patients) or rFSHalpha (50 patients). All patients received the same daily gonadotrophin dose (150 IU) following GnRH agonist suppression (long regimen) until more than three follicles >17 mm and estradiol (E(2)) levels >600 pg/ml were reached. Patients were monitored with daily LH, FSH, hCG, estradiol (E(2)), progesterone, and testosterone measurements; and alternate day pelvic ultrasound.. Treatment duration (11.1 +/- 0.4 versus 12.9 +/- 0.5 days, P < 0.05) and gonadotrophin dose (22.4 +/- 1.0 versus 27.0 +/- 1.5 ampoules, P < 0.05) were lower in the HP hMG group. Conversely, peak pre-ovulatory E(2) (1342 +/- 127 versus 933 +/- 109 pg/ml, P < 0.005); and area under the curve of E(2) (3491 +/- 350 versus 2602 +/- 349 pg/ml.day, P < 0.05), immunoreactive serum FSH (65.9 +/- 2.1 versus 48.8 +/- 1.8 IU/l.day, P < 0.001). and hCG (1.7 +/- 0.3 versus 0.0 +/- 0.0 IU/l/day, P < 0.001) during treatment were higher in the HP hMG group. Cycle cancellation rates, transferred embryo number, pregnancy rates per started cycle (30 versus 28%) and per embryo transfer (35 versus 35%) and miscarriage rates (6 versus 6%) were not significantly different.. HP hMG treatment was associated with: (i) a more efficient patient response, as reflected by reduced treatment duration and gonadotrophin requirements; (ii) increased serum levels of hCG, E(2), and immunoreactive FSH during treatment; (iii) an ICSI outcome indistinguishable from rFSHalpha.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Follicle Stimulating Hormone; Glycoprotein Hormones, alpha Subunit; Humans; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Prospective Studies; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Testosterone; Treatment Outcome

To carefully examine the features of controlled ovarian stimulation performed with recombinant FSH-alpha or hMG.. Controlled, prospective, randomized comparison of fixed gonadotropin regimens.. Academic research institution.. Fifty infertile patients who were candidates for IUI.. Patients were randomized to receive a fixed regimen of recombinant FSH-alpha (150 IU/day, 25 patients) or hMG (150 IU/day, 25 patients), after GnRH-agonist suppression (long regimen).. Daily measurements of serum LH, immunoreactive FSH, hCG, E(2), P, and T. Transvaginal pelvic ultrasound every 2 days. Pregnancy and abortion rates. Cost of medications. Two recombinant FSH-alpha-treated patients did not respond. Despite matched daily FSH dose, duration of treatment (hMG 10.8 +/- 0.4 vs. recombinant FSH-alpha 12.4 +/- 0.5 days), gonadotropin dose (21.7 +/- 0.8 vs. 25.3 +/- 1.3 ampoules), gonadotropin cost (288 +/- 10 vs. 1,299 +/- 66 /cycle), serum P levels, and small preovulatory follicle number were significantly lower, and LH, hCG, immunoreactive FSH levels, and larger follicles on day 8 were significantly higher in hMG-treated patients. The pregnancy, abortion, and twin pregnancy rates did not differ.. The hMG administration was associated with: [1]. increased serum LH activity and immunoreactive FSH levels during treatment; [2]. reduced signs of premature luteinization; [3]. differential modulation of folliculogenesis; [4]. lower treatment duration, gonadotropin dose, and cost; and [5]. clinical outcome comparable to recombinant FSH-alpha.

Topics: Abortion, Spontaneous; Adult; Corpus Luteum; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Costs; Female; Fertility Agents, Female; Glycoprotein Hormones, alpha Subunit; Gonadotropin-Releasing Hormone; Humans; Incidence; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins

Clinical application of vitrification for the cryopreservation of human blastocysts.. Clinical trial of vitrification of human blastocysts.. Private assisted reproductive technology clinic.. Supernumerary blastocysts after fresh blastocyst transfer were vitrified for subsequent transfer.. Culture of pronuclear embryos to the blastocyst stage in sequential media and subsequent vitrification of supernumerary blastocysts using a cryoloop technique.. Clinical outcome after transfer of vitrified blastocysts.. A total of 60 vitrified blastocysts from 21 patients were warmed, and the survival rate at 2 hours after warming was 63%. Six clinical pregnancies were achieved after 19 transfers. One healthy baby was born, four pregnancies are ongoing, and one ended in miscarriage.. Human blastocysts can be successfully vitrified by suspension on a small nylon loop and a direct plunge into liquid nitrogen. A delivery and ongoing pregnancies prove the safety of this method. This report documents the first successful pregnancy and delivery achieved by blastocyst vitrification using the cryoloop containerless technique.

Topics: Abortion, Spontaneous; Adult; Blastocyst; Chorionic Gonadotropin; Cryopreservation; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infant, Newborn; Menotropins; Pregnancy; Pregnancy Outcome; Sperm Injections, Intracytoplasmic

To determine whether hMG offers an advantage over clomiphene citrate (CC) in achieving pregnancy after IUI with husband's sperm.. Randomized prospective trial.. Infertility patients in a university teaching hospital.. Fifty-eight women under 39 years old undergoing ovulation induction before IUI.. The women were assigned randomly to one of two treatment groups. Patients in group I (CCHH) received CC for the first two cycles and hMG for the last two cycles. Patients in group II (HHCC) received hMG for the first two cycles and CC for the last two cycles.. Cycle fecundity rates for the two treatment modalities were compared statistically with use of life-table analysis.. Of the 174 cycles studied, overall cycle fecundity rate was 11.11 (9 of 81 cycles) in the CCHH group and 10.75 (10 of 93 cycles) in the HHCC group. The difference was not statistically significant. The cycle fecundity rate was 14.44% (13 of 90 cycles) for cycles with CC and 7.14% (6 of 84) with hMG. The difference was not statistically significant.. These data suggest that CC is an effective alternative to hMG in the population examined.

Topics: Abortion, Spontaneous; Adult; Clomiphene; Female; Humans; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

Fifty women with polycystic ovaries took part in a prospective randomized study. All women required treatment by in-vitro fertilization (IVF) for reasons other than anovulation. They had all previously undergone ovarian stimulation with gonadotrophin therapy which had failed to result in pregnancy or had been abandoned due to high risk of developing ovarian hyperstimulation syndrome (OHSS). Twenty-five women were treated by long-term pituitary desensitization followed by gonadotrophin therapy, oocyte retrieval and embryo transfer (group 1). Twenty-five women underwent laparoscopic ovarian electrocautery after pituitary desensitization followed by gonadotrophin therapy, oocyte retrieval and embryo transfer (group 2). A significantly higher number of women in group 1 had to have the treatment cycle abandoned due to impending or actual OHSS, determined by endocrine and clinical findings. In addition, the development of moderate or severe OHSS in completed cycles was higher in group 1. The pregnancy rate and miscarriage rates in the two treatment groups were similar. The authors propose that laparoscopic ovarian electrocautery is a potentially useful treatment for women who have previously had an IVF treatment cycle cancelled due to risk of OHSS or who have suffered OHSS in a previous treatment cycle.

Topics: Abortion, Spontaneous; Adult; Electrocoagulation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Laparoscopy; Menotropins; Ovarian Hyperstimulation Syndrome; Ovary; Polycystic Ovary Syndrome; Pregnancy; Prospective Studies

Based on data suggesting that higher serum LH levels during the follicular phase may decrease subsequent pregnancy rates and increase spontaneous abortion rates, the study presented herein was designed to compare the pregnancy and abortion rates in patients treated with gonadotrophin preparations with and without LH content. Infertile patients with luteal phase defects related to releasing eggs prior to complete follicular maturation were randomized into two treatment arcs: ultra-low-dose (75IU) human menopausal gonadotrophin (hMG) versus pure FSH. However, they were given the right to refuse the recommended treatment and use the other one if they preferred. Pregnancy and spontaneous abortion rates were determined for first cycle of therapy. The pregnancy rates for hMG versus pure FSH was 22.7 percent and 20.3 percent, respectively. The spontaneous abortion rates were also similar (8 percent and 9.1 percent). There were no multiple births resulting from these 36 pregnancies. Ovarian hyperstimulation syndrome was not observed in any of the 164 stimulation cycles. These data demonstrate that the use of an ultra-low-dose gonadotrophin stimulation regimen is an effective method of correcting infertility related to luteal phase defects related to follicular maturation defects since the overall pregnancy rate per first cycle of treatment was 22 percent despite a minimum of 10 months of infertility duration. Furthermore, an ultra-low-dose gonadotrophin regimen is safe for treating luteal phase defects in that there was no ovarian hyperstimulation or multiple births demonstrated. These results also show no advantage of choosing a preparation devoid of LH, thus giving the patient the opportunity to purchase the least expensive medication that is available.

Topics: Abortion, Spontaneous; Adult; Chi-Square Distribution; Female; Follicle Stimulating Hormone; Humans; Infertility; Luteal Phase; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy Rate

To compare the low-dose recombinant FSH and hMG protocols in treatment of patients with history of severe ovarian hyperstimulation syndrome (OHSS).. A prospective study on 22 patients with history of severe OHSS. Group A (n = 14) was treated with low-dose recombinant FSH 40 cycles and group B (n = 8) was treated with low-dose hMG in 26 cycles.. The Egyptian IVF-ET Center, Cairo, Egypt.. Twenty-two patients with a history of severe OHSS.. Ovulation induction.. Estradiol, number of follicles, number of hMG ampules, pregnancy rate (PR), and the development of OHSS.. The cancellation rate, mean E2 level on day of hCG, mean number of days of stimulation, and the mean number of ampules per cycle were 10%, 523 +/- 166 pg/mL (conversion factor to SI unit, 3.671), 17.8 +/- 5.4, and 19 +/- 6.5 in group A and 19.2%, 554 +/- 152 pg/mL, 14.6 +/- 2.5, and 16.1 +/- 3.6 in group B, respectively. Treatment resulted in eight pregnancies (20% per cycle) and two abortions (25%) in group A. In group B, four pregnancies resulted (15.4% per cycle) and two patients aborted (50%). No cases of OHSS developed in both groups. There were no significant differences in all parameters between the two groups.. Recombinant FSH low-dose protocol proved to be as effective as low-dose hMG in producing reasonable ovulation and PRS in polycystic ovary syndrome patients with a history of severe OHSS and the protocol was safe concerning the risk of development of OHSS.

Topics: Abortion, Spontaneous; Egypt; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Ovarian Hyperstimulation Syndrome; Pregnancy; Prospective Studies; Recombinant Proteins; Risk Factors

The objective of our study was to explore the effect of dexamethasone (DEX), a highly potent, long-acting glucocorticoid, on the treatment outcome of 74 anovulatory women aged 21 to 29 years, with normal gonadotropins, androgen, and prolactin (PRL) serum levels who failed to conceive on antiestrogen therapy.. The patients received human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) for ovulation induction. Starting on day 4 of the induced menstruation, hMG was administered in combination with DEX, 0.5 mg at night, or without DEX as an adjuvant treatment. The total amount of gonadotropins used, time required for stimulation, percentage of fertilization, serum estradiol levels, pregnancy rate, cumulative pregnancy rate, and abortions were recorded.. There were no differences in either the cumulative pregnancy rate (54.1% in the DEX group and 52.7% in the untreated group) or the abortion rates (21.7% in the DEX group compared to 20.8% in the untreated group). The other parameters investigated also did not differ significantly between the groups.. The overall results did not support DEX as a clinically useful adjuvant therapy for anovulatory, normoandrogenic patients.

Topics: Abortion, Spontaneous; Adrenal Cortex; Adult; Androgens; Anovulation; Chemotherapy, Adjuvant; Chorionic Gonadotropin; Dexamethasone; Drug Therapy, Combination; Estradiol; Female; Fertility Agents, Female; Gonadotropins, Pituitary; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Prolactin; Treatment Failure

To evaluate the effect of luteal support with vaginal P suppositories in hMG- and hCG-induced cycles.. Between March 1988 and February 1989 patients did not receive luteal support, while between March 1989 and January 1990 P was given routinely in the luteal phase. Induction protocol and patient selection remained otherwise unchanged.. Infertility clinic of a tertiary care hospital.. Twenty-seven patients with hypogonadotropic amenorrhea (World Health Organization [WHO] group I) (11 women with luteal support, 16 women without) and 102 patients with euprolactinemic clomiphene citrate (CC)-resistant anovulation (WHO group II) (52 women with luteal support, 50 women without).. Vaginal P suppositories 200 mg/d in the luteal support group.. Pregnancy rate (PR), pregnancy outcome.. The overall PR in 118 cycles with luteal support was 26.3% whereas 10.4% pregnancies were achieved in 115 cycles of the control group. The influence of luteal support was more pronounced in patients with CC-resistant anovulation (25.2% versus 6.9%) than in patients with hypogonadotropic amenorrhea (33.3% versus 21.4%, not significant). The abortion rate was not significantly changed.. Luteal support with P increases the PR after hMG and hCG induction. The need for supplementary P seems to be related to the underlying cause of ovarian disturbance.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Corpus Luteum; Estradiol; Female; Humans; Menotropins; Ovulation Induction; Pessaries; Pregnancy; Pregnancy Outcome; Progesterone; Retrospective Studies

To examine the effect of GnRH analogue (GnRH-a) on the quality of frozen-thawed embryos and the pregnancy rate (PR) resulting from transfer.. A retrospective study of two groups of women undergoing transfers of frozen-thawed embryos. In group 1 ovulation induction with hMG was begun after hypophyseal desensitization with GnRH-a for 2 weeks. In group 2 ovulation was induced with hMG only. The freezing and thawing techniques were identical for both groups.. In vitro fertilization unit at a university hospital.. The study group (group 1) included 108 women who underwent 137 transfer cycles of frozen-thawed embryos, and the control group (group 2) included 44 women in 51 cycles of thawed ETs.. Ovum pick-up and ET techniques were the same for both groups. Methods of embryo freezing and thawing were identical, as were the morphological criteria for grading the embryos.. The morphology of embryos was similar in both groups, as was the number of embryos that had at least 50% intact blastomeres (83% +/- 23% and 78% +/- 30% for group 1 and group 2, respectively). The PR (16 of 137 [11.7%] and 6 of 51 [11.8%], respectively) as well as the abortion rate (30%) were similar for both groups.. The use of GnRH-a does not affect the quality of embryos nor the pregnancy outcome. Because the yield of frozen embryos per ovum pick-up is higher in cycles stimulated by GnRH-a/hMG, the PR per pick-up cycle is thus anticipated to be higher.

Topics: Abortion, Spontaneous; Adult; Blastomeres; Cryopreservation; Delayed-Action Preparations; Embryo Transfer; Embryo, Mammalian; Female; Fertilization; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Pregnancy; Pregnancy Outcome; Retrospective Studies; Triptorelin Pamoate

To determine if the routine use of gonadotropin-releasing hormone agonists (GnRH-a) for all patients undergoing in vitro fertilization (IVF) produces any significant medical advantage.. Prospective randomized study.. Three hundred eight patients having their first ever IVF attempt.. Patients were randomly divided into four groups and received either human menopausal gonadotropin (hMG) alone for ovarian simulation (group A, n = 81); clomiphene citrate and hMG (group B, n = 77); a 3-day ultrashort course of GnRH-a and hMG (group C, n = 74); or pituitary desensitization with GnRH-a followed by hMG (group D, n = 76).. The indications for IVF and mean age of all four groups of patients were comparable. There was a significant difference in the number of embryos cleaved and transferred among the groups, but there were no significant differences in the cancellation rate, mean number of oocytes collected or fertilized, and number of cases of failed fertilization. There were also no significant differences in the pregnancy and live birth rates per cycle commenced or per embryo transfer.. The routine use of GnRH-a for all patients undergoing IVF has practical but no significant medical advantages.

Topics: Abortion, Spontaneous; Clomiphene; Delayed-Action Preparations; Drug Administration Schedule; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Prospective Studies; Triptorelin Pamoate

Treatment with low-dose follicle-stimulating hormone (FSH) is associated with a high rate of ovulation in anovulatory women with polycystic ovarian syndrome (PCOS), but it is not clear whether the success of treatment is because of the use of pure FSH or the low dose of gonadotropin. We undertook a randomized controlled study to compare the effects of urinary FSH and human menopausal gonadotropin (hMG) using a low-dose regimen in 30 women with PCOS. Each subject received a maximum of three cycles of either FSH or hMG. Ovulation occurred in 75% of subjects and in 77% of cycles induced with FSH and in 94% of women, 85% of cycles of those treated with hMG. A single dominant follicle developed in 70% (FSH) and 65% (hMG) of cycles, respectively. Five singleton pregnancies occurred in each group. This study shows that low-dose FSH and hMG are equally successful in inducing ovulation, suggesting that the success of treatment depends on the low dose of gonadotropin used rather than the presence or absence of luteinizing hormone in the preparation.

Topics: Abortion, Spontaneous; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Polycystic Ovary Syndrome; Pregnancy; Random Allocation

Leuprolide acetate was used in 189 in vitro fertilization (IVF) cycles. Patients were allocated prospectively into two groups: In group A (96 cycles), leuprolide acetate was started on the 2nd menstrual cycle day of the actual IVF attempt. In group B (93 cycles), leuprolide acetate was started on the 3rd luteal phase day of the preceding IVF cycle. Ovulation was induced with a combination of pure follicle-stimulating hormone (FSH) and human menopausal gonadotropins (hMG), starting on or before the 5th cycle day, respectively. Leuprolide acetate and gonadotropins were continued until the day of human chorionic gonadotropin (hCG) administration. Follicular aspiration was carried out either by laparoscopy or by transvaginal ultrasound guidance. Group A required a lower number of FSH and hMG ampules than group B; nevertheless, there was no difference in the number of follicles, percentage of preovulatory oocytes or fertilization rate between the groups. The number of embryos transferred was 3.3 and 3.4, respectively. A significantly higher pregnancy rate was observed in group A (40.6% versus 27.7%) and a lower miscarriage rate (22.8% versus 36%) than in group B. In short, this study suggests that there is no need to administer leuprolide acetate routinely during the luteal phase of the preceding IVF cycle.

Topics: Abortion, Spontaneous; Adult; Clinical Trials as Topic; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Phase; Gonadotropin-Releasing Hormone; Hormones; Humans; Leuprolide; Luteal Phase; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Progesterone; Prospective Studies

GnRHa and hCG are both used for oocyte maturation and ovulation triggering. However, GnRHa have a shorter half-life than hCG, which leads to luteal phase deficiency. Letrozole (LE) has been found to improve the luteal function. Thus, the choice of triggering strategy can be different in intrauterine insemination (IUI) cycles using LE and human menopausal gonadotropin (HMG). The aim of this study was to compare the pregnancy and neonatal outcomes of patients triggered with GnRHa versus hCG versus dual trigger in LE-IUI cycles.. This retrospective cohort study included 6,075 LE-HMG IUI cycles between January 2010 and May 2021 at a tertiary-care academic medical center in China. All cycles were divided into three groups according to different trigger strategies as hCG trigger group, GnRHa trigger group and dual trigger group. The primary outcome was clinical pregnancy rate. Logistic regression analysis was performed to explore other risk factors for clinical pregnancy rate.. No significant difference was observed in clinical pregnancy rate between hCG, GnRHa and dual trigger cycles in LE-HMG IUI cycles (P = 0.964). The miscarriage rate was significantly lower in the GnRHa trigger group, and higher in the dual trigger group, compared with the hCG group (P = 0.045). Logistic analysis confirmed that triggering strategy was associated with miscarriage (aOR:0.427, 95%CI: 0.183-0.996, P = 0.049; aOR:0.298, 95%CI: 0.128-0.693, P = 0.005). No significant differences were observed regarding neonatal outcomes between the three groups.. Our findings suggested that both GnRHa and dual trigger can be used to trigger ovulation in LE-HMG IUI cycles, but dual trigger must be used with caution.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infant, Newborn; Insemination, Artificial; Letrozole; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies

Hormone replacement therapy (HRT) regimen was suggested to be associated with a decreased rate of livebirth and a higher risk of hypertensive disorders of pregnancy (HDP) after frozen cleavage stage embryo transfer in women with polycystic ovary syndrome (PCOS). With the dramatically increased use of elective single embryo transfer, there is great need to explore the impacts of different endometrial preparation regimens on frozen single-blastocyst transfer in women with PCOS.. In this study, a total of 3941 women who diagnosed with PCOS and underwent single-blastocyst transfer during their first cycles of frozen embryo transfer (FET) between March 2012 and December 2020 were included. We retrospectively compared the pregnancy and neonatal outcomes after frozen single-blastocyst transfer with endometrial preparation by HRT regimen (n = 3540), ovulation induction by human menopausal gonadotropin (hMG) regimen (n = 226), and ovulation induction by letrozole regimen (n = 175).. After adjustment for confounders with multivariable logistic regression, the hMG regimen group [(58.4% vs. 49.6%; adjusted odds ratio (aOR): 1.43; 95% confidence interval (CI): 1.09-1.89)] and letrozole regimen group (58.9% vs. 49.6%; aOR: 1.42; 95% CI: 1.04-1.93) were associated with a higher rate of livebirth (primary outcome), compared with the group with HRT regimen. As to the secondary outcomes, the rate of pregnancy loss in the hMG regimen group (22.8% vs. 30.3%; aOR: 0.69; 95% CI: 0.48-1.00) and letrozole regimen group (16.9% vs. 30.3%; aOR: 0.48; 95% CI: 0.30-0.78) was also lower than that in the HRT regimen group. The pregnancy outcomes between the hMG regimen group and the letrozole regimen group were similar. We did not observe significant difference in the incidences of maternal and neonatal complications among these three groups.. Ovulation induction regimen with letrozole or hMG for endometrial preparation was associated with a higher livebirth rate and a lower pregnancy loss rate in frozen single-blastocyst transfer cycles among women with PCOS.

Topics: Abortion, Spontaneous; Embryo Transfer; Female; Humans; Infant, Newborn; Letrozole; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies

The role of LH during controlled ovarian stimulation (COS) in the general population remains contentious. There is no consensus on the indications for LH supplementation during COS. The purpose of this study is to determine whether menotropin supplement is associated with decreases in early pregnancy loss rates in patients exhibiting low endogenous LH during COS.. This is a single-center, retrospective cohort from a university-affiliated hospital. Patients were enrolled from the in-vitro fertilization center from January, 2011 to December, 2014. Patients who experienced a LH level ≦ 0.8 mIU/mL during stimulation were identified, and patients that received menotropin supplementation were compared to those without menotropin supplementation. Outcome variables, including the number of oocytes retrieved, embryos obtained, implantation rates, pregnancy rates and early pregnancy loss rates, were compared.. Patients that experienced low LH during GnRH antagonist protocol and were supplemented with menotropin were associated with lower early pregnancy loss when compared with patients without menotropin supplementation (26.7% vs. 11.5%, p = 0.045). More specifically, in patients who exhibited early-onset low LH, before the use of GnRH antagonists, menotropin supplementation was associated with significantly lower early pregnancy loss compared with non-supplemented patients (3.3% vs. 29.0%, OR: 0.08, p = 0.012). Beneficial effects persisted after adjusting for confounders (aOR: 0.103, 95% CI: 0.011-0.933).. Menotropin supplementation is associated with decreased early pregnancy loss in patient who exhibited low LH during GnRH antagonist cycles. This effect is especially prominent in patients who experience low LH before the start of GnRH antagonists.

Topics: Abortion, Spontaneous; Adult; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Logistic Models; Luteinizing Hormone; Menotropins; Multivariate Analysis; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Taiwan

To use patient-specific and cycle-specific characteristics to predict clinical pregnancy, multiple pregnancy, and spontaneous abortion rates after gonadotropin ovulation induction (OI)/IUI.. Retrospective chart review.. Academic fertility center.. A total of 1,438 women who underwent 3,375 gonadotropin OI/IUI cycles.. Individual and cycle-specific characteristics were evaluated to determine predictors of the rates of clinical pregnancy, multiple pregnancy, and spontaneous abortion. Logistic regression using individual parameters was used to create predictive models.. Clinical pregnancy (CPR), multiple pregnancy (MPR), and spontaneous abortion rates (SABR).. Multiple predictors were identified for CPR, MPR, and SABR. The presence of at least two follicles ≥ 13 mm at ovulation trigger significantly increased CPR (odds ratio [OR], 95% confidence interval [CI] = 1.45, 1.18-1.78) and MPR (OR, 95% CI = 5.17, 2.16-12.41). An E2 level >400 pg/mL significantly increased MPR (OR, 95% CI = 9.54, 2.31-39.42). Logistic regression models were developed for individualized predictions of outcome.. Regression analysis reveals the patient and cycle-specific characteristics that are significant predictors of CPR, MPR, and SABR after OI/IUI. Logistic models using significant or nearly significant predictors for CPR, MPR, and SABR offer improved predictive power relative to simpler models, and allow for the development of a risk calculator for personalized patient counseling.

Topics: Abortion, Spontaneous; Academic Medical Centers; Adult; Decision Support Techniques; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Insemination, Artificial; Logistic Models; Menotropins; Odds Ratio; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Outcome

To evaluate effects of luteinizing hormone (LH)-containing gonadotropins (human menopausal gonadotropin, hMG) on ploidy of human cleavage-stage embryos in gonadotropin releasing hormone (GnRH) antagonist cycles.. Retrospective matched cohort study.. Two academically affiliated private fertility centers, private preimplantation genetics laboratory, and medical school.. One hundred four consecutive in vitro fertilization cycles (IVF) with preimplantation genetic diagnosis in women aged 30 to 45 years.. Antagonist cycles with ovarian stimulation by either recombinant follicle stimulating hormone (FSH) alone, or in combination with human menopausal gonadotropin (FSH/hMG).. After matching patients for age and gonadotropin dosage, embryo ploidy, pregnancy, and miscarriage rates were evaluated.. Euploidy rates (FSH, 29.4% vs. FSH/hMG, 25.7%) and number of euploid embryos (FSH, 2.1 +/- 1.6 vs. FSH/hMG, 1.9 +/- 1.5) were similar between both groups, although trended in favor of FSH-only stimulation. FSH-only stimulation, however, demonstrated significantly higher clinical pregnancy rates per cycle start (FSH: 34.6% vs. FSH/hMG: 11.5%) and per embryo transfer (FSH: 40% vs. FSH/hMG: 15%).. Because this study involved mostly women of advanced reproductive age, at least in such an age category, LH-containing stimulation causes adverse effects on pregnancy rates, although whether such an adverse effect on ploidy exists in parallel requires further investigation. These observations point toward embryo-independent adverse effects on implantation (luteal phase) in antagonist cycles with hMG costimulation.

Topics: Abortion, Spontaneous; Adult; Blastocyst; Cohort Studies; Embryo Implantation; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Menotropins; Middle Aged; Ovulation Induction; Ploidies; Pregnancy; Pregnancy Rate; Retrospective Studies

The goal of the treatment of infertility is to apply therapeutic techniques to patients in a safe manner and at the same time increase the chances for conceiving and delivering healthy babies: basic and clinical research is more and more finalized directed to these goals. The conference "Advances in Infertility Treatment" held in Fort Lauderdale, Florida on January 24-26, 2002 covered many clinical and research aspects of this important therapeutic area. Important discussed issues included the impact of age, lifestyle, and the genetic set-up of patients in the pathogenesis and development of infertility-causing disorders such as male reproductive dysfunction, polycystic ovary syndrome, and ovarian failure. New ovulation induction regimens that may optimize, reduce complications, and lower costs of ovarian stimulation procedures and of assisted reproduction in general were presented. This was the 5th Ferring Pharmaceuticals Conference in the area of reproductive medicine held in Florida.

Topics: Abortion, Spontaneous; Costs and Cost Analysis; Female; Florida; Humans; Infertility; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Oocytes; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Preimplantation Diagnosis; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic

In this study, we sought to evaluate characteristics of couples with spontaneous conceptions after treatment with assisted reproductive technologies (ART).. Data from 254 couples who underwent 1127 therapy cycles between November 1987 and February 1997, were analyzed. Chi-Square (chi(2)) test and Student's t-test were used. P<0.05 was considered significant.. Spontaneous pregnancies occurred in 14% of all treated couples. Psychological counselling only was performed in 21% but was observed significantly more frequently among patients without later spontaneous conception. Ten percent of all treated couples applied for adoption. The miscarriage rate was significantly higher in the group of treatment dependent pregnancies compared to the group of patients with later spontaneous conception (27% versus 9%). The spontaneous conception rate differed significantly depending on women's age and normal semen analysis.. Appearance of spontaneous conception after ART-procedures should be taken into account in the first patient's interview. Depending on women's age and andrological parameters, treatment-success will differ. The positive impact of psychological counselling for stress relief during and after therapy should also be noted, even though a statistically significant impact could not be demonstrated in the present study. Adoption should be discussed as an alternative to overcome infertility.

Topics: Abortion, Spontaneous; Adoption; Adult; Clomiphene; Counseling; Female; Fertilization; Fertilization in Vitro; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic; Stress, Psychological; Treatment Outcome

During the menstrual cycle the endometrium undergoes cyclic proliferative and secretory changes in preparation for implantation. If this preparation is not sufficient, then implantation will fail. The impact of endometrial thickness on the day of embryo transfer on IVF outcome was investigated in the present study.. A retrospective analysis was conducted of 1228 IVF/ICSI cycles. Stimulation was with clomiphene citrate (CC) + hMG in one-third of the cycles, and ultrashort GnRH agonist stimulation in two-thirds. Cycle parameters were compared between pregnant and non-pregnant patients. A similar comparison was made between ongoing pregnancies and those that resulted in a loss.. There were more follicles, oocytes and embryos, the endometrium was thicker and the embryo quality was higher among women who became pregnant when compared with non-pregnant women after assisted reproduction. The pregnancy rate improved as endometrial thickness increased. No difference in cycle parameters and endometrial thickness was found between ongoing pregnancies and pregnancies that resulted in a first-trimester loss. CC had no measurable adverse endometrial effect, but the pregnancy rate was lower in CC+hMG cycles.. Increased endometrial thickness is associated with higher pregnancy rates. However, neither attainment of pregnancy nor pregnancy outcome was predicted by endometrial thickness alone.

Topics: Abortion, Spontaneous; Adult; Clomiphene; Drug Therapy, Combination; Embryo Transfer; Endometrium; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Logistic Models; Menotropins; Ovulation Induction; Predictive Value of Tests; Pregnancy; Pregnancy Rate; Pregnancy Trimester, First; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome; Ultrasonography

There has been much debate about the role of luteinizing hormone (LH) during follicle stimulating hormone (FSH)-treated ovarian stimulation for assisted reproduction, where the endogenous LH is suppressed using a gonadotrophin-releasing hormone analogue. The requirement for LH in oestradiol biosynthesis is established, but other effects of 'insufficiency' are less clear, and little attention has been paid to the specific origin of the FSH used. The aim of this study was to examine the roles of profoundly suppressed circulating LH concentrations in cycles of ovarian stimulation for IVF, which were affected in two large separate cohorts of patients undergoing assisted reproduction. They were stimulated by either purified urinary FSH (MHP) or recombinant human FSH (rFSH). Within each dataset, outcomes were examined with respect to the circulating concentrations of LH in the mid-follicular phase, as plasma samples were stored prospectively, and assayed retrospectively. Patients with profoundly suppressed LH showed much reduced oestradiol concentrations at mid-follicular phase and at human chorionic gonadotrophin administration in cycles treated with either MHP or rFSH. However, gross ovarian response, as became evident by FSH dose demands, duration of stimulation, and also oocyte and embryo yields and embryo cryopreservation were influenced only in cycles treated with MHP. Furthermore, no effect upon pregnancy survival was observed. Thus, it is concluded that there is a demand for additional exogenous LH treatment only in cycles treated with purified urinary FSH where the LH is profoundly suppressed.

Topics: Abortion, Spontaneous; Adult; Cohort Studies; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Incidence; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovary; Pregnancy; Recombinant Proteins; Retrospective Studies

We report a 34-year-old woman with sequentially occurring autoimmune diseases that are possibly triggered by numerous ovulation inductions. At the ages of 26-32 years, she experienced 27 uncontrolled ovulation induction cycles using clomiphene citrate (CC) or CC plus human menopausal gonadotropin plus human chorionic gonadotropin. She became pregnant at the ages of 27, 30 and 31 with subsequent pregnancy loss in the 28th, 8th and 10th week of gestation, respectively. Insulin-dependent diabetes mellitus (IDDM) developed at the age of 28. During the second year of ovulation induction, at the age of 27, she developed arthralgia that worsened and became migratory from the age of 31. Thrombocytopenia appeared at the age of 33. The diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) was established at the age of 34. To the best of our knowledge, this is the first case of concurrent IDDM, SLE and APS in a patient associated with ovulation inductions. Excessive levels of estradiol achieved during the ovulation inductions could play a role in the expression of multiple autoimmune diseases in the susceptible woman.

Topics: Abortion, Spontaneous; Adult; Antiphospholipid Syndrome; Arthralgia; Autoimmune Diseases; Chorionic Gonadotropin; Clomiphene; Diabetes Mellitus, Type 1; Female; Humans; Lupus Erythematosus, Systemic; Menotropins; Ovulation Induction; Pregnancy

This retrospective study was performed to examine the implantation and pregnancy rates of frozen-thawed pronuclear stage oocytes obtained with the use of a GnRH antagonist, Cetrorelix (Cetrotide((R)) ASTA-Medica, Frankfurt/M, Germany) used in a multidose protocol with hMG, and to compare these results with those obtained after a conventional long GnRH analogue protocol (Decapeptyl-Depot, Ferring, Kiel, Germany). The study population consisted of 31 infertile couples with frozen-thawed pronuclear stage oocytes after ICSI treatment using the GnRH antagonist Cetrorelix (Cetrorelix((R))) and 31 infertile couples with frozen-thawed pronuclear stage oocytes after ICSI treatment using the long GnRH analogue protocol. Patients underwent ICSI after down regulation with a GnRH agonist (Decapeptyl) and stimulation with hMG, or a GnRH antagonist (Cetrorelix) and hMG. The supernumerary pronuclear stage oocytes were cryopreserved and transferred in a later mildly stimulated cycle. The implantation and pregnancy rates for frozen-thawed pronuclear stage oocytes derived from the GnRH antagonist compared with the GnRH agonist were 3.26% versus 3.73% (P=1.0000) and 8.33% versus 10.25% (P=1.0000), respectively. To our knowledge we report here the first pregnancies obtained by the transfer of cryopreserved pronuclear stage embryos generated from ICSI using a GnRH antagonist in the collecting cycle. The use of Cetrorelix in a multiple dose protocol in combination with hMG does not demonstrate a negative effect on viability, implantation potential or pregnancy outcome as compared to 2PN conceptuses obtained from a long GnRH agonist-hMG protocol.

Topics: Abortion, Spontaneous; Cryopreservation; Embryo Implantation; Embryo Transfer; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility; Menotropins; Oocytes; Pregnancy; Pregnancy Outcome; Retrospective Studies; Sperm Injections, Intracytoplasmic; Triptorelin Pamoate

To determine reference values for the midluteal plasma progesterone concentration.. Retrospective analysis.. Infertility clinic at an academic medical center.. One hundred ninety-two infertile women who became pregnant after induction of ovulation with hMG.. The plasma progesterone level was measured during the midluteal phase of the hMG treatment cycle.. The midluteal plasma progesterone concentration was correlated with the outcome of the pregnancy.. In this cohort of 192 women in whom ovulation was induced with hMG and 5,000 IU of hCG, the mean midluteal plasma progesterone concentrations were 29.07 ng/mL, 25.85 ng/mL, 31.49 ng/mL, 41.39 ng/mL, and 28.64 ng/mL in all cycles that resulted in pregnancy, cycles that resulted in full-term singleton pregnancy, cycles that resulted in full-term multiple pregnancy, cycles that resulted in preterm pregnancy, and cycles that ended in miscarriage, respectively. There was no statistically significant difference in the progesterone concentration between the cycles that resulted in full-term pregnancy and those that ended in miscarriage, but there was a statistically significant difference between the cycles that resulted in singleton pregnancy and those that resulted in multiple pregnancy. The minimum value that was compatible with a full-term pregnancy in this cohort of women was 10.83 ng/mL.. In a cohort of 192 women, the minimum plasma progesterone concentration on day 7 in women who attained a full-term pregnancy after induction of ovulation with 5,000 IU of hCG was 10.83 ng/mL.

Topics: Abortion, Spontaneous; Female; Gestational Age; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Pregnancy, Multiple; Progesterone; Reference Values; Retrospective Studies

The luteal phase hormonal profile and the clinical outcome of 69 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) after ovarian stimulation with human menopausal gonadotrophin (HMG) and the gonadotrophin-releasing hormone (GnRH) antagonist Cetrorelix were analysed. Twenty-four patients received Cetrorelix 0.5 mg (group I) while in 45 patients Cetrorelix 0.25 mg was administered (group II). Human chorionic gonadotrophin (HCG) was used as luteal support. Nine clinical pregnancies were obtained in group I (37.5%) and 12 in group II (26. 6%). These results were not significantly different. Serum progesterone and oestradiol concentrations did not differ between the two groups either in pregnant or non-pregnant patients. An expected decrease of the same hormones was observed 8 days after the pre-ovulatory HCG injection in non-pregnant women. With regard to serum luteinizing hormone concentrations, a decrease was observed 2 days after the pre-ovulatory HCG injection and was maintained at almost undetectable levels throughout the entire luteal phase in both conception and non-conception cycles of group I and group II. This study demonstrates that different doses of GnRH antagonist do not have any impact on the luteal phase of IVF/ICSI cycles when hormonal support is given.

Topics: Abortion, Spontaneous; Adult; Embryo Transfer; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Luteal Phase; Luteinizing Hormone; Menotropins; Microinjections; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Pregnancy, Tubal; Retrospective Studies; Twins

A 26-year-old married woman was admitted to our hospital because of massive ascites and hepatic injury. The patient had been treated with human menopausal gonadotropin and clomiphene citrate to prevent recurrence of spontaneous abortions. About 1 month later, she developed upper abdominal pain and noticed dark urine. On admission, she had elevated concentrations of serum transaminases with an asparate aminotransferase of 127 IU/L and alanine aminotransferase of 194 IU/L. An abdominal ultrasound showed massive ascites. Her serum concentration of estradiol was high at 12,100 pg/mL, which was much greater than the value of early stage of pregnancy (2,279-7,353 pg/mL). She was thus diagnosed as having ovarian hyperstimulation syndrome. Following a period of bed rest, her liver function normalized and the ascites disappeared. Based on the above findings, the patient was considered to have suffered from ovarian hyperstimulation syndrome, complicated by hepatic injury.

Topics: Abortion, Spontaneous; Adult; Bed Rest; Capillary Permeability; Chemical and Drug Induced Liver Injury; Clomiphene; Female; Fertility Agents, Female; Humans; Liver; Liver Diseases; Menotropins; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy Trimester, First

The study presented herewith was designed to compare the pregnancy and abortion rates in patients treated with gonadotropin preparations with and without LH content based on data suggesting that higher serum LH levels during the follicular phase may reduce subsequent pregnancy rates and increase spontaneous abortion rates. Infertile patients with luteal phase defects related to releasing eggs prior to complete follicular maturation were treated with either ultra-low dose (75 IU) hMG or pure FSH. The pregnancy rates for first treatment cycles for hMG versus pure FSH was 22.7% and 20.3%, respectively. The spontaneous abortion rates were also similar (8.0% and 9.1%). There were no multiple births resulting from these 36 pregnancies. Ovarian hyperstimulation syndrome was not observed in any of the 164 stimulation cycles. Thus these results show no advantage in choosing a preparation devoid of LH therefore giving the patient the opportunity to purchase the least expensive medication that is available.

Topics: Abortion, Spontaneous; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Pregnancy; Progesterone

To evaluate the effects of hydrosalpinx on the outcome of in vitro fertilization (IVF) treatment, a retrospective study was undertaken at a tertiary referral center for infertility.. Results of the first IVF treatment cycles in 144 patients from 1 January 1993 to 31 December 1995, who had tubal infertility only and were less than 38 years old, were reviewed. The duration/dosage of hMG used, serum estradiol level on the day of hCG, number of oocytes aspirated and fertilized, number of embryos replaced, implantation rate, clinical pregnancy rate, and pregnancy outcome were compared in patients with and without hydrosalpinx.. The mean implantation rate and clinical pregnancy rate were similar in patients with or without hydrosalpinx. Both groups had similar ovarian responses and fertilization rates. There was no increase in clinical abortion in the hydrosalpinx group but ectopic pregnancies were more common in patients with hydrosalpinx.. The presence of hydrosalpinx did not adversely affect the implantation and pregnancy rates in in vitro fertilization treatment when the results of the first cycle were compared. However, it can lead to a higher incidence of ectopic pregnancies.

Topics: Abortion, Spontaneous; Adult; Dose-Response Relationship, Drug; Embryo Implantation; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Incidence; Infertility, Female; Menotropins; Pregnancy; Pregnancy Rate; Pregnancy, Ectopic; Retrospective Studies; Treatment Outcome

The objective was to evaluate the utility of the ovarian hyperstimulation with menotropins as treatment of unexplained infertility. One hundred couples with unexplained infertility were treated. Ovarian stimulation was started with 150 IU of menotropins on day 3 of the menstrual cycle, monitoring the follicular growth with transvaginal ultrasonography, additional doses of menotropins were administered accordingly. Human chorionic gonadotropin (10000 IU) was administered when the dominant follicle reached a diameter > or = 16 mm. The pregnancy rate per cycle was 12.0%, on the other hand the cumulate rate of pregnancy was 48.0%. The age under 30 years and the antecedent of previous pregnancies were correlated with the likelihood of conception. The spontaneous abortion rate was 35.4%. As conclusion, it therefore appears appropriate, to offer a treatment with menotropins to that specific group of couples with unexplained infertility with good prognostic factor as age < 30 years and infertility duration < 5 years. The increase on the spontaneous abortion rate was probably induced for the luteal insufficiency produced by the ovarian hyperstimulation with menotropins.

Topics: Abortion, Spontaneous; Adult; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Prognosis

The purpose of this study was to determine whether the use of clomiphene results in a higher incidence of spontaneous abortion than occurs naturally in subfertile patients. Reproductive outcomes of 1744 clomiphene pregnancies were compared to outcomes of 3245 spontaneous pregnancies in a prospective study. Abortion was classified as clinical if a sac was seen on ultrasound or if it occurred after 6 gestational weeks, and as preclinical if a quantitative human chorionic gonadotrophin (HCG) was > or = 25 mIU and no sac was seen or abortion occurred earlier. The overall incidence of abortion was higher for clomiphene pregnancies (23.7%), compared with spontaneous pregnancies (20.4%) (P < 0.01). Preclinical abortions were increased by clomiphene for all ages (5.8 versus 3.9%, P < 0.01) and for age > or = 30 years (8.0 versus 4.9%, P < 0.001), but not for age < 30 years (3.7 versus 3.0%). Clinical abortions were increased by clomiphene for age < 30 years (15.9 versus 11.2%) (P < 0.01), but not for age > or = 30 years (20.1 versus 22.3%) or all ages (18.0 versus 16.4%). Clinical abortions occurred 22% less often following clomiphene compared with spontaneous pregnancies for patients with luteal insufficiency (18.3 versus 23.6%, P < 0.05). We conclude that the increase in abortion due to clomiphene is small and may be related to different causes for women aged < 30 and > or = 30 years, and also that clomiphene may decrease clinical abortions in patients with luteal insufficiency.

Topics: Abortion, Spontaneous; Adult; Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Gestational Age; Humans; Menotropins; Pregnancy; Pregnancy Outcome; Prospective Studies

To correlate luteal estradiol (E2) levels with pregnancy outcome, 36 consecutive conceptions resulting from gamete intrafallopian transfer in gonadotropin releasing hormone agonist/human menopausal gonadotropin (GnRH-a/hMG) cycles were analyzed. GnRH-a was initiated during the preceding luteal phase. HMG was adjusted individually. Human chorionic gonadotropin (hCG), 5,000 IU, was administered when E2 was > 500 pg/mL and the leading follicle > 17 mm (day 0). The luteal phase was supported by (1) hCG, 1,500 IU in three doses from day 5 and (2) progesterone (P) from day 7. E2 and P levels were analyzed in three groups of patients: normally progressing pregnancy (NPP), abortion (AB) and preclinical abortion (PAB). No significant differences in mean E2 levels were seen between the groups from day 0 through day 5 after hCG. Midluteal E2 levels were significantly different between the groups (P < .05). Late luteal E2 values were significantly higher for NPP than for either AB or PAB (P < .05). There were no significant differences in luteal P values between the NPP, AB and PAB groups. Decreased luteal E2 appears to be associated with early pregnancy wastage; this may be due to inadequate endometrial support.

Topics: Abortion, Spontaneous; Adult; Clinical Protocols; Estradiol; Female; Follicular Phase; Gamete Intrafallopian Transfer; Gonadotropin-Releasing Hormone; Humans; Luteal Phase; Menotropins; Pregnancy; Pregnancy Outcome

To examine the incidence of premature luteinization in individuals undergoing hMG with IUI therapy, the association between premature luteinization, cycle fecundity, and pregnancy outcome, and to determine if the selective use of leuprolide acetate (LA) in women demonstrating premature luteinization improves pregnancy outcome in subsequent hMG with IUI cycles.. Retrospective analysis of superovulation cycles from January 1990 until December 1991 at the University of Connecticut Health Center.. All women with ovulatory function undergoing hMG superovulation with IUI.. All patients were tested for evidence of premature luteinization. Those demonstrating premature luteinization were started on LA in the luteal phase in their subsequent hMG with IUI cycle.. Peak serum E2, the number of mature preovulatory follicles, the number of ampules of hMG, days of hMG therapy, cycle fecundity, and spontaneous abortion rate.. Thirty-three percent of all hMG with IUI patients showed evidence of premature luteinization, with premature luteinization occurring in 22.2% of conception cycles and 37.4% of nonconception cycles. For those women who demonstrated premature luteinization in their conception cycle, 90.0% of the pregnancies ended with either spontaneous abortion or were biochemical in nature compared with 44.3% in the cycles without evidence of premature luteinization. Cycle fecundity was 11.1% in patients demonstrating premature luteinization compared with 26.3% for patients without premature luteinization. All women demonstrating premature luteinization and not conceiving were placed on LA in the luteal phase and had a subsequent cycle fecundity of 18.9% with the percent pregnancy wastage being significantly less (33.3% versus 90.0%) when LA was used.. Premature luteinization is a common occurrence during hMG therapy and is associated with decreased cycle fecundity and an increased incidence of spontaneous abortion and biochemical pregnancies. The selective use of LA in those individuals demonstrating premature luteinization results in a significant increase in the percent of women conceiving a viable pregnancy.

Topics: Abortion, Spontaneous; Adult; Corpus Luteum; Female; Fertilization; Humans; Incidence; Insemination, Artificial, Homologous; Leuprolide; Luteal Phase; Male; Menotropins; Pregnancy; Retrospective Studies; Superovulation; Time Factors

One of the main endocrinological disturbances in patients with polycystic ovarian syndrome (PCOS) is the increased baseline concentrations of luteinizing hormone (LH) and consequently a high LH:follicle-stimulating hormone (FSH) ratio. The aim of this study was to assess the relationship between the baseline LH:FSH ratio with the stimulation response and the miscarriage risk in PCOS women stimulated for assisted reproduction techniques (ART) with and without gonadotrophin-releasing hormone analogue (GnRHa). Two groups of PCOS patients were analysed retrospectively. Group A (n = 20, 20 cycles) consisted of women stimulated with human menopausal gonadotrophin (HMG), and group B (n = 128, 162 cycles) comprised women stimulated with buserelin-long/HMG. LH and FSH concentrations were measured during the early follicular phase (days 4-6) in a preceding spontaneous or progestin-induced cycle. The following parameters were assessed: number of follicles developed, number of oocytes obtained and percentage of mature oocytes, as well as number of abortions and live births. In group A, the baseline LH:FSH ratio was correlated inversely with the number of follicles developed (P < 0.05), the number of oocytes obtained (P < 0.05) and the percentage of mature oocytes (P < 0.05). In group B, no correlation was found between the LH:FSH ratio and the number of follicles and oocytes, because their numbers were relatively constant irrespective of the baseline LH:FSH ratio, but a significant inverse correlation was noted with the percentage of mature oocytes (P < 0.001). However, a comparison of the slopes of the curve indicated a better correlation between the LH:FSH ratio and the percentage of mature oocytes in group A than in group B (P < 0.05). These findings were also confirmed when patients were subdivided according to the LH:FSH ratio (< 3 or > or = 3). Furthermore, in women who miscarried, the mean LH:FSH ratio was significantly higher than in women having a live birth. In conclusion, in PCOS patients stimulated with HMG, a high basal LH:FSH ratio appears to have an adverse effect on the number of follicles and oocytes, as well as on oocyte maturity. On the other hand, the administration of GnRHa in the long protocol seems to reverse this detrimental effect on follicle and oocyte development. Furthermore, a higher LH:FSH ratio seems to predict a greater possibility for miscarriage, despite the use of GnRHa.

Topics: Abortion, Spontaneous; Buserelin; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Polycystic Ovary Syndrome; Pregnancy; Prognosis; Reproductive Techniques; Retrospective Studies

Our purpose was to evaluate the effect of age on endometrial receptivity and to compare success rates for oocyte donation among groups with differing primary diagnoses.. This was a retrospective analysis of 300 consecutively attempted oocyte donation cycles.. The setting was the in vitro fertilization program at the University of Southern California.. Recipients were divided into groups according to age: Group I, < 30 years (n = 8); Group II, 30-39 years (n = 59); Group III, 40-49 years (n = 107); and Group IV, 50-59 years (n = 18). Additionally, indications for treatment were divided into Classes A-G according to a primary diagnosis given to each patient and included premature ovarian failure (n = 44), surgical castration (n = 9), genetic disease carrier (n = 12), transitional menopause (n = 27), natural menopause (n = 30), multiple IVF failures (n = 62), and postchemotherapy (n = 8). Recipients received oral micronized estradiol and intramuscular progesterone. Oocytes were donated by fertile young women utilizing ovarian hyperstimulation with menopausal gonadotropins.. There were no significant differences among groups or classes related to either the number of oocytes received or the number of embryos transferred per cycle. Rates for embryo implantation and resorption and the clinical and ongoing or delivered pregnancy rates were similarly not different among patients except for women who previously received chemotherapy, where a significantly elevated rate of spontaneous abortion was noted P < 0.05).. The establishment of pregnancy utilizing oocyte donation is not adversely affected by the chronological age of the recipient, inferring that the age-related decline in fertility is due primarily to oocyte aging, and not to loss of endometrial receptivity. Also, prior exposure to chemotherapy may alter endometrial integrity and lead to greater pregnancy wastage in women receiving donated embryos.

Topics: Abortion, Spontaneous; Administration, Oral; Adult; Age Factors; Antineoplastic Agents; California; Drug Administration Schedule; Embryo Implantation; Estradiol; Female; Fertilization in Vitro; Fetal Resorption; Genetic Diseases, Inborn; Humans; Infertility, Female; Injections, Intramuscular; Injections, Subcutaneous; Leuprolide; Maternal Age; Menopause; Menotropins; Middle Aged; Oocyte Donation; Ovariectomy; Pregnancy; Pregnancy, High-Risk; Primary Ovarian Insufficiency; Progesterone; Retrospective Studies; Universities

To assess the risk of miscarriage after in-vitro fertilization (IVF) with respect to age, cause of infertility, ovarian morphology and treatment regimen, a retrospective analysis was performed of the first 1060 pregnancies conceived between June 1984 and July 1990 as a result of 7623 IVF cycles. Superovulation induction was achieved with human menopausal gonadotrophin (HMG) and/or purified follicle stimulating hormone (FSH) together with either clomiphene citrate or the gonadotrophin hormone-releasing hormone (GnRH) agonist buserelin, the latter either as a short 'flare' regimen or as a 'long' regimen to induce pituitary desensitization. There were 282 spontaneous abortions (26.6%) and 54 ectopic pregnancies (5.1%). The mean age of women with ongoing pregnancies was 32.2 (SD 3.9) years compared with 33.2 (SD 4.1) years in those who miscarried, which were significantly different (P = 0.008). There was no relation between the miscarriage rate and the indication for IVF. The miscarriage rate was 23.6% in women with normal ovaries compared with 35.8% in those with polycystic ovaries [P = 0.0038, 95% confidence interval (CI) 4.68-23.10%]. There was no difference in the miscarriage rate between treatment with HMG or FSH. Women whose ovaries were normal on ultrasound were just as likely to miscarry if they were treated with clomiphene or with the long buserelin protocol. Those with polycystic ovaries, however, had a significant reduction in the rate of miscarriage when treated with the long buserelin protocol, 20.3% (15/74), compared with clomiphene citrate, 47.2% (51/108) (P = 0.0003, 95% CI 13.82-40.09%).

Topics: Abortion, Spontaneous; Adult; Buserelin; Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Pituitary Gland; Polycystic Ovary Syndrome; Pregnancy; Prevalence; Reference Values; Retrospective Studies

Over the last 20 years, the frequency of multiple pregnancy has increased mainly because of the introduction of exogenous pituitary gonadotropins in the treatment of sterility. The incidence of ectopic pregnancies also increased during the same period of time. This paper describes the first reported case of a simultaneous bilateral tubal and multiple intra-uterine pregnancy after ovulation induction with human gonadotropins.

Topics: Abortion, Induced; Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Diagnostic Errors; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Pregnancy, Tubal; Ultrasonography

To compare the effect of treatment with gonadotropin-releasing hormone agonist (GnRH-a) and human menopausal gonadotropins (hMG) with that of gonadotropins only, on the cumulative livebirth rate and miscarriage rate of pregnancies achieved in women with polycystic ovarian syndrome (PCOS).. Retrospective analysis of the outcome of 97 pregnancies according to the treatment protocol, with or without GnRH-a. Calculation of miscarriage rate and cumulative livebirth rate by life-table analysis.. Infertility clinic and in vitro fertilization (IVF) unit.. Women with polycystic ovaries (n = 239) who were clomiphene citrate failures and received either GnRH-a/hMG (n = 110) or gonadotropins only (n = 129) for ovulation induction (n = 138) or superovulation for IVF (n = 101).. For ovulation induction, hMG was given in a step-up, individually adjusted dose scheme. For IVF, three ampules of pure follicle-stimulating hormone were given for 3 days followed by three ampules per day hMG and then individual dose adjustment. Gonadotropin-releasing hormone agonist (Decapeptyl, D-Trp6, microcapsules, 3.75 mg) was given in a single dose 2 weeks before gonadotropin treatment.. The rate of early miscarriages (< 12 weeks) per pregnancies achieved was analyzed, and the cumulative livebirth rate for each treatment group was calculated by life-table analysis.. Miscarriage rates after treatment in ovulation induction with (16.7%) and without GnRH-a (39.4%) and in IVF with (18.2%) and without GnRH-a (38.5%) were almost identical and were therefore analyzed together. Of pregnancies achieved with GnRH-a, 17.6% miscarried compared with 39.1% of those achieved with gonadotropins alone. Cumulative livebirth rate after four cycles for GnRH-a was 64% compared with 26% for gonadotropins only.. Cotreatment with GnRH-a/hMG for anovulatory women with PCOS reduces the miscarriage rate and improves the livebirth rate compared with treatment with gonadotropins alone.

Topics: Abortion, Spontaneous; Adult; Female; Fertilization in Vitro; Humans; Luteinizing Hormone; Menotropins; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications; Retrospective Studies; Triptorelin Pamoate

To assess the reportedly higher miscarriage rate during menotropin-induced cycle pregnancies as compared with natural cycle.. Prospective cohort groups were selected, and pregnancies were identified 16 to 18 days after insemination and followed through to outcome.. Three hundred twelve patients were studied: 251 women receiving human menopausal gonadotropin and 61 requiring donor insemination without medication.. A significant difference between the spontaneous abortion rate of gonadotropin-treated women (28.5%) and women conceiving during natural cycles (11.7%) was demonstrated.. The opinion that higher miscarriage rates in menotropin-treated women are related to a surveillance bias compared with natural cycle conceptions should be reconsidered.

Topics: Abortion, Spontaneous; Adult; Female; Humans; Male; Maternal Age; Menotropins; Menstrual Cycle; Pregnancy

To examine the relationship of baseline and preovulatory serum E2, P, and LH levels and age with pregnancy outcome in polycystic ovarian syndrome (PCOS) patients undergoing hMG ovulation induction.. Retrospective analysis of all available data over 2 years.. Tertiary referral ovulation induction clinic.. Forty-four anovulatory PCOS patients with 25 ovulatory nonconception and 50 conception cycles after hMG ovulation induction.. Ovulation (midluteal serum P > 25 nmol/L [7.86 ng/mL]); pregnancy (serum beta-hCG > 30 mIU/mL 16 days after ovulating injection); pregnancy outcome: pregnancy termination < 20 weeks' or > or = 20 weeks' amenorrhea.. Of the endocrine parameters considered, none was significantly different in nonconceptive and conceptive ovulatory cycles. Miscarriage was associated with low basal serum E2: median value for pregnancies ending < 20 weeks, 105 pmol/L (28.6 pg/mL) and for > or = 20 weeks 150 pmol/L (40.9 pg/mL). It was also significantly associated with age. For patients > 29.5 years of age, (29.5 years, population mean age) a baseline E2 < or = 140 pmol/L (38.2 pg/mL) had sensitivity 92%, specificity 54%, positive predictive value 65%, and negative predictive value 87% for the prediction of miscarriage. The nature of the previous cycle, the day of the cycle on which therapy commenced, and a past history of miscarriage were not related either to pregnancy outcome or to basal serum E2.

Topics: Abortion, Spontaneous; Adult; Estradiol; Female; Follicular Phase; Humans; Luteinizing Hormone; Maternal Age; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies

To assess the effect of moderate obesity on the outcome of induction of ovulation with low dose gonadotrophin in women with polycystic ovary syndrome (PCOS).. Retrospective analysis of women with PCOS treated consecutively. An analysis of the impact of obesity on outcome of pregnancy using data from the North West Thames Regional (NWTR) obstetric database was included for comparison.. Induction of ovulation clinic at the Samaritan Hospital for Women (St. Mary's Hospital Group).. 100 women with clomiphene-resistant anovulation associated with PCOS. 75 were of normal weight (BMI 19-24.9 kg/m2, lean group) and 25 were moderately overweight (BMI 25-27.9 kg/m2, obese group).. Induction of ovulation using low doses of gonadotrophins with small, stepwise increments in dosage as required.. Rates of ovulation, pregnancy and miscarriage; daily and total doses of gonadotrophin required for induction of ovulation.. The proportion of ovulatory cycles was significantly greater in the lean group (77%) compared with the obese group (57%) (chi 2 9.8, P less than 0.001). Obese women required larger doses of gonadotrophin to achieve ovulation (P less than 0.001). The proportion of women who achieved at least one pregnancy was similar in the two groups (39% vs 48%) but miscarriage was more frequent in the obese group (60% vs 27%; P less than 0.05). This difference was independent of the baseline and/or mid-follicular luteinizing hormone (LH) concentration either before or during treatment. Analysis of data from the North West Thames Health Region obstetric database confirmed an increased risk of miscarriage in moderately obese women which was independent of maternal age.. Moderate obesity in women with PCOS, treated with low dose gonadotrophin, is associated with an increased risk of miscarriage. This is reflected in the results of analysis of the effect of obesity on outcome of pregnancy in the general population. It is therefore important to encourage weight reduction in obese women with PCOS before considering therapy to induce ovulation.

Topics: Abortion, Spontaneous; Adult; Drug Administration Schedule; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Maternal Age; Menotropins; Obesity; Odds Ratio; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications

One hundred eighty-one stimulation cycles in which gonadotropin suppression with oral contraceptives (OCs) preceded induction of follicle stimulation (study group) and 113 stimulation cycles without pituitary suppression (control group) were compared. The mean length of ovarian suppression was 35.3 +/- 0.9 days. No spontaneous luteinizing hormone (LH) surges occurred when the use of OC preceded ovarian hyperstimulation, whereas in the control group the incidence of LH surges was 19.5%. The mean amount of human menopausal gonadotropin required was significantly lower in the study group than in the control group (8.9 +/- 0.4 and 10.9 +/- 0.4 ampules, respectively). Significantly more follicles greater than or equal to 1.5 cm in diameter were seen on the day before oocyte retrieval and significantly more oocytes were retrieved per attempt in the group with OC pretreatment. Our data clearly demonstrate that OCs are useful in vitro fertilization stimulation protocols to facilitate scheduling of cycles and to prevent spontaneous LH surges.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Contraceptives, Oral; Estradiol; Female; Fertilization in Vitro; Humans; Luteinizing Hormone; Menotropins; Oocytes; Pregnancy; Pregnancy Outcome

It is generally recognized that a spontaneous abortion rate of approximately 25% exists in human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced pregnancies. Despite this, little is known regarding the prognosis of future menotropin-induced pregnancies in women who abort in their first hMG pregnancy. We retrospectively reviewed the obstetrical outcome of women who achieved two or more menotropin pregnancies between the years 1980 and 1987. Nineteen of 40 patients (48%) whose first hMG pregnancy ended in an early spontaneous abortion went on to abort in a second hMG pregnancy, as compared with only 1 of 15 women (6.7%) whose first hMG pregnancy was successful. Age, parity, weight, height, and plasma estradiol levels at hCG administration did not differ between the two groups. From this data we conclude that women whose first hMG pregnancy results in a spontaneous abortion are at high risk for another spontaneous abortion in a subsequent menotropin conception.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Medical Records; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Retrospective Studies; Risk Factors

Pregnancy-associated endometrial alpha 2-globulin (alpha 2-PEG) is the major secretory protein of the endometrium in the late luteal phase. Serum levels were measured during the implantation period in successful and unsuccessful cycles of assisted conception. The effects of two different treatment regimens were also compared. All patients who underwent ovulation induction therapy showed an endometrial response as measured by a rise in serum levels of alpha 2-PEG. This rise was the same regardless of either implantation or the method of ovulation induction used. Higher levels were seen at oocyte recovery in those cycles treated with clomiphene citrate and may reflect a disordered endometrial response involving a direct effect of the drug on the endometrium. This may explain the difference in success rates in assisted conception when an alternative treatment initially involving down-regulation of endogenous gonadotrophin activity and subsequent administration of gonadotrophins is used. The rise in serum levels seen in pregnancy did not differ statistically according to whether the pregnancy progressed normally or subsequently aborted. Considerably reduced alpha 2-PEG production by the endometrium was identified in one patient who subsequently aborted. The measurement of serum levels of alpha 2-PEG during the implantation phase is unlikely to provide a clinical tool either for early detection of pregnancy or as a prognostic factor of successful implantation.

Topics: Abortion, Spontaneous; Buserelin; Clomiphene; Embryo Implantation; Endometrium; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Glycodelin; Glycoproteins; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Proteins; Pregnancy Trimester, First

A European survey was carried out in order to evaluate the incidence of chromosome anomalies in spontaneous abortions after IVF. Of the 34 abortuses analysed, 21 had a chromosome anomaly (62%), namely three with monosomy X,14 autosomal trisomies, one double trisomy, one triploidy, one tetraploidy and one translocation. These data show that IVF does not increase the incidence of chromosomal abortuses when compared with natural conceptions (60%).

Topics: Abortion, Spontaneous; Adult; Aneuploidy; Chromosome Aberrations; Clomiphene; Europe; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Maternal Age; Menotropins; Monosomy; Polyploidy; Pregnancy; Superovulation; Translocation, Genetic; Trisomy

The number of multiple pregnancies has been increasing as a result of the relatively widespread use of drugs for induction of ovulation and assisted conception techniques. This paper details the first reported cases of triplet pregnancies occurring in consecutive IVF cycles in two patients.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Triplets; Ultrasonography

Our purpose was to assess factors that are associated with an increased rate of spontaneous abortion in pregnancies initiated by in vitro fertilization. Pregnancies were diagnosed by measurement of serum human chorionic gonadotropin (hCG) 15 days after embryo transfer. Of the 64 women who conceived, 47 delivered term infants, one patient delivered a stillborn at 22 weeks, 14 aborted in the first trimester, and two had pregnancies that implanted in the tube. Abortion rates were similar for women treated with human menopausal gonadotropin (24%; 12 of 54) and those who received clomiphene citrate (12.5%; one of eight). Two patients conceived after treatment with a combination of clomiphene citrate and human menopausal gonadotropin, neither of whom aborted. In 54 patients treated with human menopausal gonadotropin, there were no significant differences in mean maternal age, number of years of infertility before the pregnancy, history of previous pregnancies, amount of human menopausal gonadotropin used to induce ovulation, serum estradiol levels on the day of hCG administration, mean number of follicles, and the mean number of transferred embryos between the group who delivered and the group who aborted. We conclude that none of these factors are associated with increased tendency for fetal loss in our in vitro fertilization program. Beta-hCG levels on day 15 after embryo transfer were significantly lower in the group who aborted than in the group who delivered, and may be predictive of implantation failure.

Topics: Abortion, Spontaneous; Adult; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy, Tubal

The purpose of this study was to determine whether basal or stimulated (or both) serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on day 3 of the cycle before administration of exogenous gonadotropins can predict stimulation response and in vitro fertilization (IVF) outcome. Eighty consecutive new patients underwent a gonadotropin-releasing hormone (GnRH) stimulation test on the morning of cycle day 3. All patients underwent the same stimulation protocol consisting of a combination of FSH and human menopausal gonadotropin (hMG). Paired discriminant analysis of FSH0 (at 0 minutes from GnRH injection) and LH0 revealed seven distinct groups of patients with statistically significant differences among the means: groups 1, 2, and 3 (26.25%) with higher means FSH0:LH0; group 4 (40%) with mean FSH0:LH0 (both levels less than 10 mIU/ml) of 1:1, and groups 5, 6, and 7 (33.75%) with higher mean LH0:FSH0. Canonical discriminant analysis of both basal and stimulated serum FSH and LH levels confirmed the seven groups and did not add to the information from analysis of FSH0 and LH0 only. Serum estradiol (E2) response during stimulation, as well as the number of preovulatory oocytes aspirated and transferred, was highest in the groups with a higher mean LH0:FSH0, intermediate in the group with mean FSH0:LH0 of 1:1, and lowest in the group with a higher mean FSH0:LH0. No pregnancy occurred in the higher FSH:LH groups. It is concluded that basal serum gonadotropin levels can distinguish different populations of IVF patients who tend to behave differently in terms of E2 response, oocytes obtained and transferred, and pregnancy rates and outcome.

Topics: Abortion, Spontaneous; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Luteinizing Hormone; Menotropins; Menstrual Cycle; Oocytes; Pituitary Hormone-Releasing Hormones; Pregnancy; Progesterone

Women who conceive with human gonadotropins have a high rate of spontaneous abortions. The causes for this poor outcome are unknown. In a retrospective analysis, the authors analyzed potential factors in 45 menotropin-treated patients with spontaneous first-trimester miscarriages. Data were compared with 119 menotropin-treated patients who conceived and delivered viable infants. Patient factors that were analyzed included the following: age, history of past miscarriages, duration of infertility, diagnostic category, weight, body surface area, duration and weight-corrected dose of menotropin administration, maximum estradiol level, estradiol pattern, human chorionic gonadotropin (hCG) dose, presence or absence of hCG support in the luteal phase, results of postcoital testing, methods of insemination, and results of husband's semen analysis. There was a significant difference between the miscarriage group and the control group in regard to age and weight distribution. All other characteristics were not significantly different. Patients over 81.8 kg as well as patients aged 35 years and older were both significantly (P less than 0.01) at increased risk to have a spontaneous first-trimester miscarriage. The data suggest that obesity and advanced age contribute to the high miscarriage rate in menotropin-treated patients. It appears reasonable to suggest that women weighing more than 81.8 kg should make every effort to lose weight before beginning menotropin therapy.

Topics: Abortion, Spontaneous; Adult; Age Factors; Body Weight; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility; Menotropins; Pregnancy; Retrospective Studies; Risk Factors

Between February 1983 and January 1985, 206 laparoscopies were performed on 172 women following controlled ovarian hyperstimulation with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Sixty-four clinical pregnancies advanced beyond the sixth week of gestation and were confirmed by ultrasound; and 37.2% of the patients conceived after in vitro fertilization and embryo transfer. The clinical pregnancy rate was 31.1% when based on the number of laparoscopies performed and 33.9% when based on the number of embryo transfers. There were 12 multiple pregnancies (18.8%), 11 miscarriages (17.2%), and one ectopic (tubal) pregnancy (1.6%). The most important factors contributing toward the success of this program were the establishment of specific criteria for patient selection, rigid adherence to clinical and laboratory protocols, and the maintenance of strict quality control.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Laparoscopy; Menotropins; Oocytes; Ovary; Parity; Pregnancy; Pregnancy, Multiple; Pregnancy, Tubal; Quality Control; Ultrasonography

Details of 767 clinical pregnancies and 500 births from Bourn Hall are reported. All treated patients included some over 40 years old, many with ovarian or uterine defects, male infertility, etc. Patients were treated during their natural cycle or stimulated with clomiphene or clomiphene and human menopausal gonadotrophin. Follicular maturation was induced by an endogenous luteinizing hormone surge or human chorionic gonadotrophin. A maximum of three embryos were replaced, except in a few patients receiving four. Twenty-eight percent of pregnancies aborted, occurring more frequently in patients who were over 40, with a complicated obstetric history, and given clomiphene alone. Approximately 18% of fetuses 'vanished' in multi-pregnancies. Seventy-one sets of binovular twins and nine sets of triplets have been born, and seven twins and three triplets are ongoing. Seventeen and a half per cent of patients aged 39 and less with one or more replaced embryos delivered one or more children, rising to almost 25% with three replaced embryos. A mean of 1.3 children were born per delivery when three embryos were replaced. Most deliveries were by Caesarean section. There were two cases of placenta praevia, one stillbirth, four major and eight minor anomalies. All the triplets, and some twins and singletons had low birth weights and were born prematurely. The sex ratio was 247 males to 253 females.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Clomiphene; Delivery, Obstetric; Embryo Transfer; Female; Fertilization in Vitro; Fetal Death; Humans; Infant, Newborn; Male; Maternal Age; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple

In 126 selected patients treated with clomiphene and human menopausal gonadotrophin, 154 embryos were transferred into the uterus 41-50 h after in-vitro insemination. Fifty per cent of embryos implanted. The rate of cleavage was inversely related to the success of embryo transfer; implantation failures occurred for 69 and 46% of embryos with more than or less than four cells, respectively (p less than 0.05). Cleavage rate was not related to the viscosity of the cumulus cell mass, serum supplementation of culture medium, nor to the age or genetic factors of the woman. There was a trend towards smaller follicles, and a significant (p less than 0.05) tendency for patients developing numerous follicles to yield faster-cleaving embryos. These relationships were not found in 50 other embryos obtained from patients treated with pure FSH.

Topics: Abortion, Spontaneous; Cell Division; Cleavage Stage, Ovum; Clomiphene; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Ovarian Follicle; Pregnancy; Retrospective Studies; Time Factors

Three hundred seventy-two patients underwent laparoscopy for in vitro fertilization and embryo transfer. Of these, 156 were treated with clomiphene citrate alone, 203 with clomiphene citrate and hMG, and 13 with hMG alone. Two-hundred seventy-two of these patients underwent embryo transfer, and 55 pregnancies resulted. Of these, 30 were ongoing, 14 biochemical, 6 ectopic, and 5 aborted. Where four embryos were transferred, the pregnancy rate was found to be significantly higher than when a lesser number were transferred. When the embryos transferred were analyzed, however, it was found that fewer than 10% of all transferred embryos implanted and it was largely a function of multiple embryo transfer per patient that led to success. When the type of hyperstimulation was compared, clomiphene citrate cycles were found to be less successful in that they produced fewer oocytes and embryos than did cycles in which hyperstimulation was achieved by supplementary hMG. It is conceded that this is an overall analysis and that individuals, especially those producing twins, had more than one good embryo transferred into a receptive uterus. The data suggest that unsuccessful cycles had somewhat poorer quality embryos, nonreceptive endometria, or a combination of these factors when compared with those of the successful embryo transfer cycles. The only predictive factor as to outcome relates to the multiplicity of embryos transferred. The fact that some IVF cycles produce multiple pregnancies indicates that a predictor of embryo health is urgently required. However, until such a reliable predictor is obtained, multiple embryo transfer remains a major advance in the success of IVF and ET.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Laparoscopy; Menotropins; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple

A study was designed to see if progesterone support of the luteal phase could reduce the increased incidence of spontaneous abortions seen in HMG-induced pregnancies. Fifty milligrams per day of progesterone suppositories beginning on the third day of the temperature rise or the demonstration of ovum release by ultrasound was employed. The incidence of spontaneous abortions in the untreated control group was 28% (28 of 100) as compared to 16% (21 of 130) of the progesterone-supported patients. The decrease in abortions cannot be attributed to losses of multiple gestations since there were larger numbers of multiples in the progesterone-supported group (1.3 babies per patient) versus the controls (1.2 babies per patient).

Topics: Abortion, Spontaneous; Adult; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Pregnancy; Pregnancy, Multiple; Progesterone

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

One hundred fifty-one cycles in 134 consecutive patients were stimulated with 150 IU of human urinary follicle-stimulating hormone (FSH) and 150 IU of human menopausal gonadotropin (hMG) on cycle days 3 and 4 and then with 150 IU of hMG daily for the purpose of multiple follicular development for in vitro fertilization (IVF). Seventy-three patients did not have a prior IVF attempt, and 61 patients in 78 cycles had prior IVF attempts at least once with their previous cycles stimulated with the same method and/or hMG and/or FSH. There was an average of three preovulatory oocytes retrieved per laparoscopy and a pregnancy rate of 27% per transfer cycle. The results were equally favorable in "new" and "old" patient cycles. The pregnancy rate increased with the transfer of two or more conceptuses of preovulatory origin. The multiple pregnancy rate, but not the abortion rate, increased with increased numbers of conceptuses transferred.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Drug Therapy, Combination; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Luteal Phase; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Progesterone; Time Factors

A questionnaire was sent to potential participants of the III World Congress of in Vitro Fertilization and Embryo Transfer, held in Helsinki in 1984, concerning their current practice in and results with IVF to the end of January 1984. Sixty-five teams reported information concerning 10,028 cycles. Embryo replacement was performed in 7993 cycles to yield 600 infants to date from 523 confinements; 572 continuing pregnancies; 324 clinical abortions; and 19 ectopic and 285 "biochemical" pregnancies. The best success rates were seen in couples where the woman was less than 30 years of age (13.6%) compared with those where the woman was over 40 years of age (7.2%); where normal semen was used; where higher numbers of embryos were replaced per patient (9.7% with one, 14.6% with two, 19.3% with three, and 24.1% with four or more); and where the women presented with secondary infertility. Of the 523 confinements reported, 457 were singleton deliveries; 57 twin deliveries (10.9%); 7 triplet deliveries (1.3%); and two quadruplet deliveries (one set was born after January 1984). The cesarean section rate was 49%. No infant was reported to be born with a chromosomal abnormality. Nine conceptuses from spontaneous abortions were reported to have a chromosomal abnormality, but this is likely to be an underestimate since not all underwent chromosome analysis. There were 9 other severe fetal defects, including intrauterine fetal death (1.5%). Results of this collaborative study show that in vitro fertilization is widely accepted as a method for the treatment of infertility and does not carry a higher than normal risk of fetal abnormalities.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Chromosome Aberrations; Chromosome Disorders; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Fetal Death; Follow-Up Studies; Humans; Infertility, Female; Maternal Age; Menotropins; Pregnancy; Semen

The incidence of pregnancy and abortion was analyzed in 1679 patients having embryos replaced after oocyte recovery and in vitro fertilization in order to alleviate their infertility. In these patients, 364 pregnancies were achieved and 108 abortions occurred. Patients were treated either on their natural cycle, having a spontaneous luteinizing hormone (LH) surge to induce ovulation, or after ovarian stimulation using clomiphene citrate alone or in combination with human menopausal gonadotropin (hMG). The data were assessed in relation to the numbers of embryos replaced, the follicular stimulation and ovulation induction regime used, the dose of gonadotropins and the dose of antiestrogens, and the age of the patient. The most successful treatment for the number of live births per laparoscopy was the use of clomiphene citrate in combination with human menopausal gonadotropin followed by human chorionic gonadotropin (hCG) to induce follicular maturation and ovulation. This treatment produced a significantly higher (P less than 0.001) number of patients with multiple embryos (86.5%). There was no significant effect on pregnancy or abortion with a low (less than 400-mg) or high (greater than or equal to 400-mg) dose of clomiphene. The total dose of gonadotropins used did not influence the incidence of pregnancy or abortion. The use of hCG with hMG induced a significant (P less than 0.01) positive effect on the incidence of pregnancy. The incidence of pregnancy showed a progressive decline with increasing age but there was a highly significant (P less than 0.01) increase in the incidence of abortion with increasing age. With increasing numbers of embryos replaced, up to three, the incidence of deliveries increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Abortion, Spontaneous; Adult; Age Factors; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Follicular Phase; Humans; Luteinizing Hormone; Male; Menotropins; Menstrual Cycle; Pregnancy; Prognosis

As of March 31, 1985, 100 clinical pregnancies have been achieved since the program for extracorporeal fertilization was started in Erlangen. 531 (71%) of 768 follicular punctures resulted in an embryo transfer. The overall pregnancy rate is 13% with regard to the total number of laparoscopies and 19% with regard to the number of embryo transfer. The most effective stimulation proved to be the pure hMG regimen. Employing this protocol, we have achieved a clinical pregnancy rate after IVF and ET of 32% during the last 6 months. Oocyte recovery related to the number of patients is 97%, with laparoscopy being superior to ultrasonically guided puncture. The success rate is appreciably affected by both the number of transferred embryos and the atraumatic transfer technique. We question the rationale of supporting the luteal phase.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Germany, West; Humans; Luteal Phase; Menotropins; Pregnancy; Pregnancy, Ectopic

There seems to be an association of first-trimester spontaneous abortion and untreated endometriosis. In this report, 52% of an untreated group of patients with endometriosis aborted. However, 12% of a second group of surgically treated patients and 7% of a third group of patients treated with danazol aborted. Therefore, either medical or surgical therapy for endometriosis lowers the abortion rate significantly.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Danazol; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Complications, Neoplastic; Progesterone

Despite the high incidence of fetal loss following gonadotropin therapy, the etiologic, factors that contribute to this loss remain unknown. In 203 women who conceived following gonadotropin therapy, the abortion rate was 28.5%. However, in 84 women who conceived a second time, also with gonadotropin treatment, the abortion rate was 11.9%. Second- and third-degree hyperstimulation of the ovary are accompanied by a 50% abortion rate, and the occurrence of abortion is more frequent in the first pregnancy. The contribution of multiple pregnancy, maternal age, and number of gonadotropin treatment cycles are also evaluated and discussed.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Female; Humans; Maternal Age; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical

Topics: Abortion, Spontaneous; Animals; Child Development; Chorionic Gonadotropin; Cricetinae; Embryo Implantation; Embryo Transfer; Ethics, Medical; Female; Fertilization; Fertilization in Vitro; Genetic Techniques; Humans; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Maternal Age; Meiosis; Menotropins; Mice; Oocytes; Ovarian Follicle; Pregnancy; Rabbits; Rats; Research

Twenty-four women with ovulatory infertility as a result of surgically or biochemically documented polycystic ovary syndrome (PCO) who had failed to conceive during clomiphene citrate therapy underwent a closely supervised menotropin treatment to induce ovulation. Evidence of ovulation was obtained in all patients treated, and major side effects were limited. Fourteen women conceived after an average of 2.4 treatment cycles; twin pregnancies occurred in 36% and spontaneous abortions occurred in 21%. Initial treatment cycles tended to be less successful than the subsequent treatment cycles. Serum 17 beta-estradiol (E2) levels were significantly augmented in the last 3 days before administration of chorionic gonadotropins (hCG) in treatment cycles resulting in conception compared to E2 levels in those cycles which resulted in ovulation only. A second hCG administration to trigger ovulation had to be given in 27% of the treatment cycles and seemed to be an indication of a less promising treatment cycle. Treatment cycles resulting in twin gestations did not differ from those resulting in singleton gestations; specifically, the E2 response was not increased. In summary, under a closely monitored regimen, menotropin therapy can be used in women with nonovulatory infertility as a result of PCO with considerable effectiveness and relative safety once clomiphene citrate treatment has failed.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Estradiol; Female; Fertilization; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Twins

The recovery of the ovarian response to gonadotropin stimulation after molar abortion was investigated in relation to the serum human chorionic gonadotropin (hCG) level. Thirteen women with an aborted mole were given 225 IU of human menopausal gonadotropin (hMG) per day for 3 consecutive days, and their serum levels of estradiol (E2) were determined by radioimmunoassay on days 1, 3, 5, and 7 after hMG administration. Women with serum hCG levels of less than 200 mIU/ml exhibited a normal increase in serum E2 levels in response to hMG, whereas women with serum hCG levels of 2000 mIU/ml or more did not show any change after hMG administration. These findings suggest that a serum level of hCG in excess of 2000 mIU/ml prevents normal ovarian E2 responsiveness to exogenous gonadotropin stimulation.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Estradiol; Female; Humans; Hydatidiform Mole; Menotropins; Ovary; Pregnancy; Uterine Neoplasms

The fertility in previously sterile women who conceived at least once following hMG/hCG-induced ovulation is investigated. The study comprises 141 women. The cumulative spontaneous pregnancy rate (CSPR) was calculated using life table analysis and was found to be 30.4% after 5 years. The CSPR for subsequent pregnancies reached 91.3% after 5 years. This figure is similar to that of normal parous women, although the study group (previously infertile women) requires a larger exposure period to attain the figure. The spontaneous abortion rate in the hMG/hCG-induced pregnancies was 29%; whereas in subsequent spontaneous pregnancies this rate was 8.8%. This difference in rate was found to be statistically significant, and the possible reasons are discussed.

Topics: Abortion, Spontaneous; Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Galactorrhea; Humans; Infertility, Female; Menotropins; Menstruation; Oligomenorrhea; Ovulation Induction; Postpartum Period; Pregnancy

The effect of luteal phase endometrial biopsy was studied in 33 anovulatory women treated with human menopausal gonadotropins (hMG) to induce ovulation and pregnancy. Over-all, 33 of 85 ovulatory cycles resulted in pregnancy (39%). Of 50 nonbiopsied cycles, 26 resulted in pregnancy (52%) whereas only 7 of 35 biopsied cycles resulted in pregnancy (20() (P less than 0.01). Four pregnancies terminated in spontaneous first-trimester abortions, 12% in the nonbiopsied group and 14% in the biopsied group. Luteal phase endometrial biopsy significantly lowers pregnancy rates in hMG-induced ovulatory cycles, but does not change abortion rates.

Topics: Abortion, Spontaneous; Biopsy, Needle; Body Temperature; Chorionic Gonadotropin; Endometrium; Female; Humans; Luteal Phase; Menotropins; Ovulation Detection; Ovulation Induction; Pregnancy

Some geneticists have been against induction of ovulation because there is a greater incidence of chromosome abnormalities in spontaneous abortions that occur after induced pregnancies. We have found the number of early abortions (15.6 p. 100) and of malformed fetuses (4.8 p. 100) is not greater than average when we have studied a personal prospective series of 140 pregnancies and a series of 519 pregnancies collected following an enquiry made among some of our colleagues. The number of late abortions and of premature labours is much higher (3.4 p. 100 and 14.8 p. 100 respectively) and they correspond particularly with the higher incidence of multiple pregnancies (12.3 p. 100) which have been obtained especially after the use of HMG. This has a direct repercussion on perinatal mortality (4.3 p. 100).. 519 pregnancies resulted from induction of ovulation were investigated to study the incidence of chromosome abnormalities and of spontaneous abortion. Of the 519 induced pregnancies 492 were carried to term. Of these 15.6% were early abortions, 3.4%, a rather normal incidence, were late abortions, and 14.8% were premature labors, a very high incidence which was also associated to the high number of multiple pregnancies, i.e. 12.3%. This last factor, the number of multiple pregnancies, appeared as the only real risk of stimulation of ovulation.

Topics: Abortion, Spontaneous; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Congenital Abnormalities; Dexamethasone; Estrogens; Female; Humans; Infant, Newborn; Male; Menotropins; Obstetric Labor, Premature; Ovulation; Ovulation Induction; Paris; Pregnancy; Pregnancy, Multiple; Prospective Studies; Sex Ratio

The plasma estradiol response is maximal 8--10 hours following mentropin injection. To obtain closer control, a menotropin protocol using 5 PM--8 PM injections and 8 AM blood sampling with a plasma estradiol window of 1000--2000 pg/ml was evaluated with simultaneous calibration of a urinary estriol glucuronide radioimmunoassay. One hundred twenty-eight paired urine and plasma samples were assayed in 48 cycles. In 26 cycles with paired samples on the day of human chorionic gonadotropin (hCG) injection, there were no cases of severe hyperstimulation, 2 cases of moderate hyperstimulation, and 11 pregnancies (42% of cycles given hCG). A window of between 40 and 100 micrograms/day of urinary estriol glucuronide corresponded to the 1000--2000 pg/ml plasma estradiol window by regression analysis. The pregnancy and hyperstimulation rates were compared with those observed in protocols previously published. Radioimmunoassay of urinary estriol glucuronide is faster and simpler than radioimmunoassay of plasma estradiol.

Topics: Abortion, Spontaneous; Estradiol; Estriol; Female; Humans; Menotropins; Monitoring, Physiologic; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Radioimmunoassay; Stimulation, Chemical; Twins

Topics: Abortion, Spontaneous; Anovulation; Chorionic Gonadotropin; Female; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Neoplasms; Pregnancy; Pregnancy, Multiple

We report the results obtained with a standard system of gonadotrophin therapy. Seventy-seven consecutive patients were given 322 treatment cycles. Thirty-seven patients (48 per cent) conceived, six of them on two occasions, making 43 pregnancies of which 31.6 per cent were multiple. Five per cent of all treatment cycles were complicated by mild, and 0.62 per cent by severe hyperstimulation. The factors involved in achieving a satisfactory pregnancy rate whilst avoiding complications are discussed. Most complications occurred during the first cycle in which the rise in oestrogen excretion suggested follicular development and human chorionic gonadotrophin (HCG) was given (the "first effective" treatment cycle). In such cycles the risk of hyperstimulation rose sharply when the day 6 urinary total estrogen level was above 150 mug. per 24 hours and the multiple pregnancy rate was increased by a large dose of HCG.

Topics: Abortion, Spontaneous; Adult; Amenorrhea; Chorionic Gonadotropin; Congenital Abnormalities; Estrogens; Female; Follicle Stimulating Hormone; Hernia, Umbilical; Humans; Infertility, Female; Luteinizing Hormone; Meningocele; Menotropins; Menstruation Disturbances; Pierre Robin Syndrome; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Drug Evaluation; Ethinyl Estradiol; Female; Fetal Death; Humans; Infant, Newborn; Menotropins; Obstetric Labor, Premature; Ovarian Diseases; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Progesterone; Prognosis; Triplets; Twins

Topics: Abortion, Spontaneous; Amenorrhea; Chorionic Gonadotropin; Chromosome Aberrations; Clomiphene; Female; Humans; Menotropins; Ovulation; Pregnancy

Topics: Abortion, Spontaneous; Adolescent; Adult; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Meigs Syndrome; Menotropins; Ovulation; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical

Topics: Abortion, Spontaneous; Amenorrhea; Child, Preschool; Chorionic Gonadotropin; Female; Follow-Up Studies; Gonadotropins, Pituitary; Humans; Infant; Infant, Newborn; Infertility, Female; Male; Menotropins; Ovarian Diseases; Pregnancy; Pregnancy, Multiple