menotropins and Fetal-Death

Improvement in the prognosis of SLE prognosis has led to considering infertility therapy. The earliest reports displayed complications such as SLE revealed by ovulation induction or thrombophlebitis. Fertility is known to be normal in women with SLE, excepting amenorrhea accompanying severe flare-ups, renal insufficiency-related hypofertility and ovarian failure secondary to cyclophosphamide therapy. Anti-phospholipid antibodies are suspected to cause defective nidation and placental ischemia. An exponential rise of serum estradiol is observed irrespective of the ovulation induction protocol used, leading to SLE flare-up and thrombosis. We have experience with 114 cycles in 21 women with SLE and/or APS. A complication (fetal loss, SLE flare-up, thrombophlebitis) revealed the underlying disease in 8 women. Eighteen pregnancies led to 9 live-births, 4 fetal deaths and 5 embryonic losses. Pregnancy rate was higher after ovulation induction using gonadotropins (25% per cycle), than clomiphene (4%). Pregnancy rate was similar after IVFETE, whether the protocol was planned or not. However, three-quarters of the pregnancies after unplanned IVFETE led to abortions. On the contrary, 6 out of 7 pregnancies after planned IVFETE led to live-births. Two women developed thrombophlebitis after gonadotropins therapy. A SLE flare-up appeared after 13 out of 62 cycles, with a flare-up rate higher after gonadotropins (27% per cycle) than clomiphene therapy (6%), and after an unplanned (30%) than a planned procedure (10%). In conclusion, ovulation induction therapy can reveal SLE or APS. Clomiphene complications are uncommon. When gonadotropin therapy is considered, a preventive anti-inflammatory therapy should be discussed in SLE patients, in conjunction with heparin and/or anti-aggregate therapy for those with asymptomatic anti-phospholipid antibodies or prior thrombotic events.

Topics: Adult; Antiphospholipid Syndrome; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Fetal Death; Humans; Infant, Newborn; Infertility, Female; Lupus Erythematosus, Systemic; Menotropins; Ovulation Induction; Pregnancy; Risk Factors

Using a retrospective analysis, we compared cumulative pregnancy rates, early pregnancy failure rates and multiple pregnancy rates in couples with polycystic ovarian syndrome (PCOS) (n = 148), hypogonadotrophic or eugonadotrophic hypogonadism (n = 91) and unexplained infertility (n = 117), who were treated in an ovulation induction clinic between January 1991 and December 1995. The women were treated with either human menopausal gonadotrophin (HMG) or purified follicle stimulating hormone (FSH). The cumulative pregnancy rate (derived from life-table analysis) after four ovulatory treatment cycles was 70% in the PCOS group, 74% in the hypogonadism group and 38% in the unexplained infertility group. The cumulative pregnancy rate in the unexplained infertility group was significantly lower than the other groups (P < 0.001) but there was no significant difference between PCOS and hypogonadism using the log rank test. The early pregnancy failure rate was 25% in the PCOS group, 27% in the hypogonadism group and 26% in the unexplained infertility group (chi(2) = 0.132, not significant). The multiple pregnancy rate was 20% in the PCOS group, 30% in the hypogonadism group and 17% in the unexplained infertility group (chi(2) = 2.105, not significant). Treatment of anovulatory infertility using HMG or FSH is effective irrespective of the cause. Couples with unexplained infertility are less successfully treated using HMG: correction of unexplained infertility may involve more than simple correction of possible subtle ovulatory defects.

Topics: Adult; Body Mass Index; Female; Fetal Death; Follicle Stimulating Hormone; Humans; Hypogonadism; Infertility, Female; Male; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Retrospective Studies

The case reported consists of thrombosis of the left internal jugular vein occurring on the 22nd week of amenorrhea of a pregnancy achieved by IVF. No etiological factor other than biochemical ovarian hyperstimulation was found. Maternal outcome was positive but intrauterine fetal death occurred 7 weeks later at 29 weeks of amenorrhea. The late occurrence of this thrombosis after ovarian hyperstimulation need to be stressed.

Topics: Adult; Female; Fertilization in Vitro; Fetal Death; Humans; Jugular Veins; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Thrombosis

To compare the effect of fertility drugs and IVF on the outcome of triplet pregnancies.. Prospective clinical study.. A single university medical center.. One hundred six consecutive triplet pregnancies treated from 1984 through 1992.. The frequency of pregnancy loss, livebirths, and antenatal and neonatal complications was compared in spontaneous, clomiphene citrate (CC), menotropins, and IVF triplet pregnancies.. Eighty-one of the 106 (76.4%) triplet pregnancies progressed beyond 25 weeks, comprising 6 of 7 (85.7%) spontaneous pregnancies, 13 of 16 (81.2%) CC induced, 44 of 56 (78.6%) menotropin induced, and 18 of 27 (66.6%) IVF gestations. There were no significant differences in the stillbirth and neonatal mortality rates according to the mode of conception. The mean gestational ages and the mean birth weights were similar in the four groups. The frequency of premature contractions, premature rupture of membranes, cesarean section, and neonatal complications were similar in the ovulation induction and IVF pregnancies.. Triplet pregnancies after ovulation induction and IVF have a similar outcome.

Topics: Adult; Birth Weight; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Fetal Death; Gestational Age; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies; Triplets

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

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

This report is based on 416 infertile female patients who were treated for 1,033 cycles with gonadotropins. 28.6% of the patients conceived after hMG/hCG treatment in 79.8% of these pregnancies, healthy children were born. Spontaneous abortion or premature birth occurred in 20.2% of the cases. The twin rate was 28.6%, the triplet rate 5.5%. Most of the abortions occurred in the first trimester (52.2%). No malformations were seen. The pregnancy rate showed striking differences in the various diagnostic groups: hypogonadotropic amenorrhea 44.4%, normogonadotropic amenorrhea 50%, anovulatory cycles 22%, corpus luteum insufficiency 14.8%. The abortion rates for these four groups were as follows: hypogonadotropic amenorrhea 25%, normogonadotropic amenorrhea 14.7%, anovulatory cycles 4.8%, corpus luteum insufficiency 36.3%. A detailed analysis of the treatment cycles is given for the four groups: the number of ampoules of hMG/hCG increased from 21.4 ampoules in patients with corpus luteum insufficiency to 47.7 ampoules in patients with hypogonadotropic amenorrhea. The inactive phase increased from 5.6 days in patients with corpus luteum insufficiency to 8.5 days in patients with hypogonadotropic amenorrhea. Estrogen values around the time of ovulation and in the corpus luteum phase were much lower in patients with spontaneous uterine bleedings. Hyperstimulation syndrome occurred less frequently in these patients. The percentage of pregnancies decreased in patients with corpus luteum insufficiency from 8.1% in the first treatment cycle to 4.8% in the following treatment cycles, whereas it increased from the first to the following cycles in the other diagnostic groups. Patients with anovulatory cycles and corpus luteum insufficiency respond differently to hMG/hCG treatment than patients with normogonadotropic amenorrhea. The inactive and active phase are important parameters for the evaluation of ovulation induction with hMG/hCG, hMG/hCG treatment is of little value in patients with corpus luteum insufficiency.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Corpus Luteum; Drug Therapy, Combination; Female; Fertility Agents, Female; Fetal Death; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Pregnancy

A follow-up of 78 twin pregnancies diagnosed in the first trimester indicated that early ovular resorption occurred in 63% of spontaneous and 64% of Clomiphene-induced gestations, so that singletons were born. No failure was observed in the 12 twin conceptions following administration of gonadotropins or Cyclofenil.

Topics: Chorionic Gonadotropin; Clomiphene; Cyclofenil; Female; Fertility Agents, Female; Fetal Death; Fetal Resorption; Humans; Infant, Newborn; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Trimester, First; Pregnancy, Multiple; Twins; Twins, Dizygotic

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