menotropins and Infertility--Female

Human menopausal gonadotropin (hMG) was demonstrated to be superior to recombinant FSH (rFSH) regarding clinical outcomes. It is not clear whether this change in the evidence was due to the introduction of highly purified (HP) hMG.. Systematic review of properly randomised trials comparing HP-hMG vs. rFSH in women undergoing in vitro fertilisation (IVF) and/or intracytoplasmic sperm injection (ICSI). A meticulous search was performed using electronic databases and hand searches of the literature.. Six trials (2371 participants) were included. Pooling of the trials demonstrated that the probability of clinical pregnancy following HP-hMG administration was higher than rFSH and reached borderline significance (odd ratio (O.R) = 1.21, 95% confidence interval (CI) = 1.00 to 1.45), but the ongoing pregnancy/live-birth rate was not statistically different between the two drugs, although it showed strong trends towards improvement with HP-hMG (O.R = 1.19, 95% CI = 0.98 to 1.44). Subgroup analysis comparing both drugs in IVF cycles demonstrated a statistically significant better ongoing pregnancy/live-birth rate in favour of HP-hMG (O.R = 1.31, 95% CI = 1.02 to 1.68). On the other hand, there was almost an equal ongoing pregnancy/live-birth rate in ICSI cycles (OR = 0.98, 95% CI = 0.7 to 1.36).. HP-hMG should be preferred over rFSH in women undergoing assisted reproduction, especially if IVF is the intended method of fertilisation.

Topics: Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Recombinant Proteins; Sperm Injections, Intracytoplasmic

The success of in vitro fertilization (IVF) treatment depends on adequate follicle recruitment following controlled ovarian hyperstimulation (COH). Women aged 40 years or older have a reduced ovarian reserve and various treatment protocols have been proposed that aim to increase their ovarian response.. To compare the effectiveness of different COH treatment interventions in women undergoing IVF aged 40 years or older.. MEDLINE, the Cochrane Library, and the Chinese Biomedical database were searched for randomized controlled trials (RCTs).. Only RCTs comparing one type of COH intervention with another in women undergoing IVF aged 40 years or older were included.. Two authors independently searched the abstracts, identified relevant papers, assessed inclusion and trial quality, and extracted the relevant data.. Four trials involving 4 different comparison groups were included in the review and enrolled a total of 611 randomized subjects.. There was insufficient evidence to support the routine use of any particular COH intervention to manage infertile women aged 40 years or older undergoing IVF. More robust data from good quality RCTs with relevant outcomes are needed.

Topics: Adult; Age Factors; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Superovulation

This review aims to evaluate whether severe endometriosis has an impact on the outcome of in vitro fertilisation (IVF), whether IVF is associated with specific complications in this context, whether a specific ovarian stimulation protocol is most appropriate, whether the endometrial condition progresses following ovarian stimulation, and whether endometrial cysts pose a specific problem for IVF. In patients with severe endometriosis, IVF represents an effective treatment option for infertility, as a complement to surgery. The prognostic parameters of IVF are identical to those of other patients. However, the risks related to the severity of endometriosis, particularly the risk of ovarian deficiency, need to be considered. Because of this issue, to which endometriosis-related pain often adds, IVF treatment should be initiated as early as possible, using appropriate protocols and after having fully informed the patient about the specific oocytes retrieval-related risks.

Topics: Cysts; Endometriosis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pain; Treatment Outcome; Uterine Diseases

Follicle-stimulating hormone (FSH) and luteinising hormone (LH) act in concert in the stimulation of folliculogenesis and ovulation. However, high levels of LH promote follicular atresia and early miscarriage, and this has led to the concept of a 'therapeutic window' of LH for successful conception in assisted reproductive technology (ART) and ovulation induction. Until now, urinary-derived human menopausal gonadotropin (hMG) has been the only available source of exogenous LH activity. hMG preparations contain highly variable levels of LH, and are often augmented with human chorionic gonadotropin (hCG), which mimics LH activity. Accumulation of hCG bioactivity, however, may have detrimental effects on follicular development and oocyte quality. Recombinant human LH (r-hLH) (Luveris) is the only pure source of LH activity. r-hLH is well characterised and production is tightly controlled, resulting in a highly consistent product. Clinical studies in hypogonadotropic hypogonadal women have demonstrated the efficacy of r-hLH, 75 IU/day, together with r-hFSH, 150 IU/day, in promoting optimal follicular development, oestrogen secretion and endometrial thickness. r-hLH therefore provides the clinician with the opportunity for precise and consistent dosing within the therapeutic window for patients requiring exogenous LH, without the risk of LH overexposure that is associated with hCG.

Topics: Dose-Response Relationship, Drug; Female; Fertility Agents, Female; Gonadotropins; Humans; Infertility, Female; Luteinizing Hormone; Menopause; Menotropins; Ovary; Recombinant Proteins; Reproductive Techniques, Assisted

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

The recent introduction of recombinant FSH into the clinical management of patients suffering from infertility appears to be associated with several treatment benefits when compared with urinary human menopausal gonadotrophin. However, from the perspective of the developing world the associated increase in cost is a cause for concern--particularly if the "cheaper" urinary gonadotrophins are no longer marketed. The need for infertility care in Africa is significant, but health resources are very limited. The commonest cause of infertility in Africa is tubal disease, so that assisted reproductive techniques, and therefore exogenous gonadotrophins, are central to effective management. The conflict between affordable and effective health care is addressed.

Topics: Africa; Developing Countries; Drug Costs; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Hormones; Humans; Infertility, Female; Menotropins; Quality of Health Care; Recombinant Proteins

To reanalyze the results of using FSH alone and hMG during IVF treatment, taking into account the different protocols of administration of superactive GnRH agonist analogs.. Meta-analysis.. The London Women's Clinic.. Women undergoing IVF treatment.. A meta-analysis of published randomized controlled trials from 1985 to 1999 of the use of FSH versus hMG for ovarian stimulation during IVF treatment. The common Peto odds ratio was calculated with use of a fixed effect model. The overall log odds ratio was estimated after demonstrating the consistency or homogeneity of the study results.. Clinical pregnancy rate per cycle of IVF.. The results suggested that in the "long and short GnRH agonists protocol" of IVF, FSH, and hMG were equally effective in achieving ovarian stimulation, and there were no differences in the clinical pregnancy rates per cycle of IVF. However, in protocols where no pituitary desensitization was used, FSH alone was more efficacious.. The optimum choice of gonadotropin preparation for ovarian stimulation during IVF treatment is influenced by the regimen of pituitary desensitization used. The optimum gonadotropin to be used when GnRH antagonists are used has yet to be determined.

Topics: Clinical Protocols; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Statistics as Topic

We report a case of activated protein C (APC) resistance and deep calf vein thrombosis under controlled ovarian stimulation for in vitro fertilization. The thrombosis occurred before administration of human chorionic gonadotrophin for ovulation induction on the 8th day of hMG (human menopausal gonadotrophin). The patient was stimulated according to the long luteal protocol. Cases of arterial and venous thrombosis as a result of ovarian stimulations are reviewed.

Topics: Activated Protein C Resistance; Adult; Factor V; Female; Genetic Carrier Screening; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Point Mutation; Risk Factors; Thrombophlebitis

Female poor responders are represented by normovulatory women showing a 'gonadal failure' in term of inadequate number of recruited follicles under conventional controlled ovarian hyperstimulation (COH) for assisted reproductive technologies (ART). ARTs offers today a high chance of pregnancy to infertile couples when a normal ovarian response provides a large choice of embryos for transfer. On the contrary, failure of the ovary to produce enough oocyte for treatment, reduces significantly the likelihood of conceiving in ART, not only in the treatment cycle, but also predicting a poor prognosis in subsequent cycles. Up to date, poor response remains one of the most frequent problems in the field of assisted reproduction. First described in 1981, poor response has been investigated by several authors, but many aspects are still controversial. In this paper definition, pathophysiology and management of poor response are revised and discussed.

Topics: Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovarian Function Tests; Pregnancy; Reproductive Techniques

The risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) are increased in women with clomiphene resistance WHO group 2 dysfunction undergoing ovulation induction as well as the risk of spontaneous abortion if conception takes place. Semi-purified preparations of FSH have been developed in an effort to reduce the impact of exogenous LH, relatively high levels of which are present in human menopausal gonadotropin (hMG). Ovulation induction in women with clomiphene resistant WHO group 2 dysfunction who often have clinical features of polycystic ovarian syndrome (PCOS), is a major challenge. The risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) are increased in this population. There also appears to be an increased risk of spontaneous abortion in those who conceive, perhaps associated with elevated LH levels. Semi-purified preparations of FSH have been developed in an effort to reduce the impact of exogenous LH, relatively high levels of which are present in human menopausal gonadotrophins.. To determine the effectiveness of daily FSH versus daily hMG in women with clomiphene-resistant polycystic ovary syndrome (PCOS), in terms of rates of pregnancy and moderate to severe ovarian hyperstimulation syndrome (OHSS).. The Cochrane Subfertility Review Group specialised register of controlled trials was searched.. All RCTs relevant to the clinical question were selected.. A diverse search strategy was employed, including hand-search of 43 core journals from 1966 to the present, bibliographies of relevant trials, MEDLINE database, abstracts from North American and European meetings and contact with authors of relevant papers. Relevant data were extracted independently by two reviewers using the standardized data extraction sheet. Validity was assessed in terms of method of randomisation, completeness of follow-up, presence or absence of crossover and co-intervention.. 2x2 tables were generated for all relevant outcomes. Odds ratios were generated using the Peto modified Mantel-Haenszel technique. Statistical heterogeneity was assessed using x2.. No significant benefit was demonstrated from semi-purified FSH versus hMG in terms of pregnancy rate: common odds ratio per patient 0.66 (95% CI 0.35-1.24) and per cycle 0.89 (95% CI 0.51-1.53). FSH appeared to be associated with a reduction in moderate to severe OHSS: common odds ratios 0.2 (95% CI 0.09-0.46).. In women with PCOS, no significant difference could be demonstrated between FSH and hMG, in terms of pregnancy rate. However, given similar cost, potential advantages in terms of purity and a possible reduction in OHSS risk, highly purified or recombinant FSH are likely to be widely adopted in the future. Further research should consider live birth as a primary clinical outcome, given concerns over the association between high androgen and LH levels with spontaneous abortion risk.

Topics: Clomiphene; Estrogen Antagonists; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

Suppression of endogenous hormone production by gonadotrophin-releasing hormone (GnRH) agonists followed by controlled ovarian hyperstimulation (COH) with human gonadotrophins, especially the so-called 'long protocol' has developed from second-line into first-line therapy. Due to this attitude premature luteinization can be safely avoided, enhancing therapeutic efficacy. Recombinant preparations of human follicle stimulating hormone (FSH) have been proven to be effective within COH according to the long protocol. The high purity of these compounds may have clinical advantages. GnRH antagonists could be successfully introduced in COH protocols. Also, daily injections in the midcycle phase according to the 'Lübeck protocol', as single or only dual administrations around day 9 seem to abolish any premature LH rises. Due to their different pharmacological mode of action, based on a classic competitive receptor blockage GnRH antagonists avoid any flare-up period and allow ovarian stimulation to start within the spontaneous cycle. Pregnancy rates are comparable to those after long protocol stimulation. Combination of softer stimulation regimes like clomiphene citrate and low dose HMG with midcycle administration of GnRH antagonists may be the way to a cheap, safe and efficient ovarian stimulation. It seems to be high time for modest forms of ovarian stimulation, lowering burden and risk for our patients.

Topics: Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins

The risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) are increased in women with clomiphene resistance WHO group 2 dysfunction undergoing ovulation induction as well as the risk of spontaneous abortion if conception takes place. Semi-purified preparations of FSH have been developed in an effort to reduce the impact of exogenous LH, relatively high levels of which are present in human menopausal gonadotropin (hMG). Ovulation induction in women with clomiphene resistant WHO group 2 dysfunction who often have clinical features of polycystic ovarian syndrome (PCOS), is a major challenge. The risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) are increased in this population. There also appears to be an increased risk of spontaneous abortion in those who conceive, perhaps associated with elevated LH levels. Semi-purified preparations of FSH have been developed in an effort to reduce the impact of exogenous LH, relatively high levels of which are present in human menopausal gonadotrophins.. To determine the effectiveness of daily FSH versus daily hMG in women with clomiphene-resistant polycystic ovary syndrome (PCOS), in terms of rates of pregnancy and moderate to severe ovarian hyperstimulation syndrome (OHSS).. The Cochrane Subfertility Review Group specialised register of controlled trials was searched.. All RCTs relevant to the clinical question were selected.. A diverse search strategy was employed, including hand-search of 43 core journals from 1966 to the present, bibliographies of relevant trials, MEDLINE database, abstracts from North American and European meetings and contact with authors of relevant papers. Relevant data were extracted independently by two reviewers using the standardized data extraction sheet. Validity was assessed in terms of method of randomisation, completeness of follow-up, presence or absence of crossover and co-intervention.. 2x2 tables were generated for all relevant outcomes. Odds ratios were generated using the Peto modified Mantel-Haenszel technique. Statistical heterogeneity was assessed using x2.. No significant benefit was demonstrated from semi-purified FSH versus hMG in terms of pregnancy rate: common odds ratio per patient 0.66 (95% CI 0.35-1.24) and per cycle 0.89 (95% CI 0.51-1.53). FSH appeared to be associated with a reduction in moderate to severe OHSS: common odds ratios 0.2 (95% CI 0.09-0.46).. In women with PCOS, no significant difference could be demonstrated between FSH and hMG, in terms of pregnancy rate. However, given similar cost, potential advantages in terms of purity and a possible reduction in OHSS risk, highly purified or recombinant FSH are likely to be widely adopted in the future. Further research should consider live birth as a primary clinical outcome, given concerns over the association between high androgen and LH levels with spontaneous abortion risk.

Topics: Clomiphene; Estrogen Antagonists; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

Case reports of ovarian tumors in women undergoing fertility treatment have raised questions about the potential neoplastic effects of ovulation-induction agents used in the treatment of infertility. This has been the subject of much debate, media coverage and patient alarm. An increased risk of malignant epithelial ovarian cancer, borderline epithelial ovarian tumors, and nonepithelial ovarian cancer have been reported in association with the use of fertility drugs. Further review of the literature reveals that there are limitations to the studies reporting this association and indicates that further research is needed before a causal relationship can be established.

Topics: Adult; Age Factors; Aged; Case-Control Studies; Clomiphene; Female; Fertility Agents, Female; Humans; Incidence; Infertility, Female; Menotropins; Middle Aged; Ovulation Induction; Parity; Pregnancy; Research; Risk Factors; Uterine Neoplasms

Currently two types of gonadotropin preparations are commercially available for ovulation induction: menotropins and follicle-stimulating hormone (FSH). Proper use of these agents is directed by many factors. Concern about the FSH-luteinizing hormone ratio and the bioconsistency of the preparations suggests the use of FSH in most situations. Regimens based on short-term incremental increases in gonadotropin dose (based on frequent sonographic and biochemical monitoring) seem to produce the highest pregnancy rates. Individualization of the patient's ovulation induction course on the basis of history of medication use and the reasons for ovulation induction therapy are also essential to optimize outcomes.

Topics: Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

During hMG therapy for ovarian stimulation, the common criteria used to appreciate both follicular growth and granulosa cells maturity are the simultaneous determination of plasma oestradiol levels and ultrasound measurement of the size of the follicles. However such an approach does not take into account that, when administered at pharmacological doses, hMG stimulate the growth of secondary and tertiary follicules and therefore create an extraphysiological hormonal environment. Although the rate of growth is identical between the follicles stimulated by hMG, their development is initiated at different periods of time during the follicular phase. For that reason, it is usual to observe a degree of asynergy in the size and maturation of the different follicles. Moreover, from IVF practice, it becomes evident that, in cycles stimulated by hMG, a dissociation between granulosa cells and oocyte maturation may be present and decreases the predictive value of the hormonal index of granulosa cell maturation. In fact, if the role of the hormones on the follicular growth and on the granulosa cells differentiation is well understood, their implication on growth and meiotic competence of the oocyte is still unknown, at last in human beings.

Topics: Estradiol; Evaluation Studies as Topic; Female; Follicular Phase; Granulosa Cells; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Predictive Value of Tests; Time Factors; Treatment Outcome; Ultrasonography

This study reviews the various types of treatment used in infertility due to hyperandrogenism, with the aim of answering the following three questions: How should these drugs be prescribed? What are their side-effects? What are the best diagnostic indications? Possibilities include ovulation inducers but also all types of treatment capable of improving the fertility of these women. The treatment of infertility due to adrenal hyperandrogenism is based upon glucocorticoids. This treatment must be continued for 3 months after conception, to attempt to avoid early spontaneous abortion. The first-line inducer in ovarian hyperandrogenism is clomiphene citrate. The good results obtained using the combination of dexamethasone and clomiphene citrate are explained by an adrenal participation in this type of hyperandrogenism. In case of failure, and in addition to classical menotrophins:--pre-treatment using LHRH agonists avoids the onset of premature luteinisation but does not prevent the possibility of multiple pregnancies;--use of purified FSH reduces, though not sufficiently, the risks of multifollicular maturation but does not greatly increase the overall pregnancy rate;--the "slow" protocol with purified FSH reduces the incidence of multifollicular maturation. Should this fail, prior treatment with an LHRH agonist and if not the pulsed administration of LHRH in non-obese women can be suggested. Surgical treatment provides useful results in severe forms of sterility due to polycystic ovaries syndrome, with new per-celioscopic techniques.

Topics: Clinical Protocols; Clomiphene; Dexamethasone; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Hyperandrogenism; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

The use of purified FSH versus classical hMG for normo-ovulatory women superovulation in an IVF programme could reduce the spontaneous LH surges incidence and/or increase the numbers of retrieved oocytes and transfers. In poor responders the advantage of high FSH doses is very discussed. Because of possible adverse effects of LH excess, high responders remain theoretically the best indication. Nevertheless only few prospective studies showed a significant reduction of multiple pregnancies and hyperstimulations by pure FSH. Most effective seems to be using low gonadotropins doses.

Topics: Adult; Clinical Trials as Topic; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies

Sterility related to ovarian dystrophy is currently treated by means of standard inductors of ovulation such as Clomid and HMG. In case of failure, patients are recommended in vitro fertilization. In our study of 30 cases of ovarian dystrophy, 9 pregnancies occurred after in vitro fertilization. Slow injections of purified FSH appear to produce similar results but the method is still under evaluation. Our results suggest that after say, two years of failure with classical methods in patients with a long history of sterility, in vitro fertilization may be expected to give good results.

Topics: Adult; Anovulation; Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome

Ovarian failure is heterogeneous in etiology and may occur at various points in a woman's life. As such, it may interfere with fertility. Clinical presentation ranges from complete cessation of menses to oligomenorrhea to the continuation of menses with elevated gonadotropins. Various therapies have been used in an attempt to induce fertility, including sex steroids and gonadotropin-releasing hormone agonists to suppress circulating gonadotropin alone or in combination with estrogen or gonadotropin-releasing hormone agonists to induce ovulation. Corticosteroids are also used to overcome autoimmunity. Randomized therapeutic trials are rare and fail to demonstrate any significant improvement in ovulation and pregnancy rates. Donor oocytes have demonstrated high success rates and have proven to be useful in patients with both premature ovarian failure and natural menopause. Pregnancies have been initiated and maintained in women through 60 years of age. Thus, for those accepting of the technique, oocyte donation appears to be the treatment of choice for hypergonadotropic hypogonadism.

Topics: Adrenal Cortex Hormones; Biopsy; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Gonadal Steroid Hormones; Gonadotropins; Humans; Infertility, Female; Menopause; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Outcome; Primary Ovarian Insufficiency

Evaluation of gonadotropins, prolactin, and thyroid function in anovulatory women directs subsequent therapy. Treatment should be initiated with the agent that is the safest and least costly for the specific indication. Except in cases of FSH elevation, pregnancy rates should approximate those of normally ovulating women. Bromocriptine, the drug of choice for hyperprolactinemia, restores ovulation in greater than 90% of women treated. Clomiphene citrate remains the drug of choice for normoestrogenic anovulation. Although drug-resistant women may respond to extended regimens, failure to ovulate or to conceive within six ovulatory cycles with clomiphene is an indication for menotropin therapy. Menotropins and pulsatile GnRH should be considered first line therapy for women with hypogonadotropic anovulation. When using hMG or pulsatile GnRH in clomiphene-resistant patients, pretreatment with GnRH analogs may normalize their response and result in higher pregnancy rates. GnRH analogs prevent premature luteinization in hMG-induced in vitro fertilization and gamete intrafallopian transfer cycles, resulting in lower cancellation rates and improved oocyte quality. Superovulation with clomiphene citrate should be attempted in patients with unexplained infertility prior to using menotropin therapy.

Topics: Bromocriptine; Clomiphene; Estrogens; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Superovulation

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

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

Topics: Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction

In order to evaluate the possibilities for induction of ovulation, the functional competence of the pituitary gland of a woman with Kallmann syndrome was examined by two consecutive dynamic GnRH tests. The second test was conducted after 1 week's treatment by a GnRH pump. The results, which showed some rise of LH but no response of FSH, favored induction by hMG/hCG therapy. Three treatment cycles resulted in a twin pregnancy which was normal and was carried to term. Review of the literature shows only six previously reported pregnancies in women with Kallmann syndrome. Five of them were treated by hMG/hCG, and one by pulsatile GnRH. The two methods of induction are discussed in relation to the heterogeneity of the pituitary and ovarian function in Kallmann syndrome. We show that this heterogeneity dictates that the treatment for induction of ovulation should be individually adjusted according to the pituitary and ovarian competence.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Hypogonadism; Infertility, Female; Menotropins; Olfaction Disorders; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Twins

GnRH analogues suppress LH fluctuations and produce a condition of hypogonadotropic hypogonadism. This action combined with treatment with human menopausal gonadotropins (hMG) has been exploited in programmes of induction of follicular growth in infertile women for both in vivo and in vitro fertilisation. There is improved clinical control over the process of ovulation and the phenomenon of premature luteinization in women with polycystic ovary disease has been eliminated.

Topics: Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Oocytes; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

Methods to induce ovulation in anovulatory women have blossomed over the last three decades. The introduction of clomiphene citrate in 1960 allowed us for the first time to provoke follicle development in patients with normo or hyperestrogenic forms of anovulation. The development of human menopausal gonadotropins in the early 1960s gave us a much more powerful tool with which to influence ovulation in all forms of ovulatory disturbances. Elucidation of the pulsatile secretion of gonadotropin-releasing hormone together with its isolation and synthesis has allowed us to streamline our methods of inducing ovulation in hypothalamic amenorrheic patients by using endogenous control mechanisms to maximize both safety and effectiveness. However, there are problems yet to solve. Polycystic ovarian disease has long eluded our efforts to resolve its pathophysiology as well as to devise a consistently effective and safe means of treatment. Methods to restore ovulation in patients with polycystic ovarian disease refractory to clomiphene citrate is the quest of future investigations.

Topics: Animals; Clomiphene; Female; Humans; Infant, Newborn; Infertility, Female; Male; Menotropins; Ovulation Induction; Pituitary Hormone-Releasing Hormones; 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

Topics: Adult; Cell Separation; Chorionic Gonadotropin; Cleavage Stage, Ovum; Clomiphene; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Oocytes; Ovulation Detection; Suction

With the use of pelvic ultrasound imaging we have found that more than half of the women presenting to our clinic with ovulatory disturbances have polycystic ovaries. As a group hirsutism is common, the serum LH, the LH:FSH ratio and serum androgen levels are higher than in other groups of patients with anovulation, but many of the women we studied were non-hirsute and had normal levels of these hormones. The aetiology of PCOS remains obscure and there is probably more than one cause. Disturbance of hypothalamic/pituitary, ovarian or adrenal function could all result in the development of polycystic ovaries. Our own data, based on pelvic ultrasound and measurement of serum androgen levels, suggest that an ovarian abnormality, other than the obvious morphological one, may be identified in most women although this does not prove (except perhaps in those women with unilateral PCOS) that the ovary is the primary site of the disturbance. Management of ovulatory disturbances includes symptomatic treatment of dysfunctional uterine bleeding and induction of ovulation. Although the ovulation rate following clomiphene is quoted as about 75%, this is probably an overestimate; less than half the 'ovulators' become pregnant and in those who do there is a high risk of early pregnancy loss. Induction of ovulation in clomiphene non-responders remains a difficult problem. The results of ovarian wedge resection are variable and any beneficial effect is short-lived with the risk of long-term infertility due to pelvic adhesions. Laparoscopic electrocautery may be a useful alternative, but it is too early to assess this form of treatment. Of the medical methods of ovulation induction in clomiphene non-responders, two methods have emerged as being highly promising: the first is administration of HMG following suppression of the pituitary by an LH-RH analogue; so far only a very small number of patients have been treated. The second is low-dose FSH. Initial studies, including our own, have shown a high incidence of ovulation and a pregnancy rate of 50%.

Topics: Androgens; Anovulation; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Diagnosis, Differential; Estrogens; Female; Follicle Stimulating Hormone; Glucocorticoids; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Hirsutism; Humans; Hyperprolactinemia; Infertility, Female; Menotropins; Menstruation Disturbances; Obesity; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Ultrasonography

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Time Factors

Topics: 17-Ketosteroids; Animals; Anovulation; Chorionic Gonadotropin; Clomiphene; Estradiol Congeners; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypothalamus; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Neurotransmitter Agents; Ovary; Ovulation; Pregnancy; Progestins; Psychology; Psychotherapy; Rabbits; Testosterone; Thyroid Hormones

The causes of puerperal infertility in lactating women are poorly understood. The controlling centres may be either the hypothalamic-pituitary axis or the ovary (or both). We studied the secretory dynamics of prolactin and gonadotropins in healthy, normal, lactating and non-lactating women after administering either gonadoliberin to assess pituitary responsiveness or human menopausal gonadotropins to assess ovarian responsiveness during the puerperium. A reciprocal relationship was observed between the secretion of gonadotropins and the secretion of prolactin after the nipples of mothers who were breast-feeding had been stimulated for 30 min. The absence of a short-loop negative feedback control by prolactin for gonadotropin secretion was not confirmed because cyclic secretion of gonadotropin was not necessarily impaired by hyperprolactinaemia. Hyperprolactinaemia did, however, appear to impair the function of the corpus luteum in women suffering from non-puerperal galactorrhoea. We postulate a multifactorial mechanism for puerperal infertility based initially on the peripheral concentration of prolactin and gonadotropins and, in some poorly defined way, on the cerebral concentration of catecholamines.

Topics: Amenorrhea; Breast Feeding; Bromocriptine; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Lactation; Luteinizing Hormone; Menotropins; Menstruation; Nipples; Ovary; Postpartum Period; Pregnancy; Prolactin; Sucking Behavior; Time Factors

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Cresols; Cyclofenil; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation

Recent methods for induction of ovulation in the woman are described. The only indication for use of these medications is induction of ovulation and pregnancy. In properly selected patients, the success rate is quite high, but treatment has undesirable side effects which occasionally may be severe.

Topics: Affective Symptoms; Animals; Anovulation; Blood Coagulation Disorders; Body Temperature; Castration; Chorionic Gonadotropin; Clomiphene; Depression, Chemical; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Pregnancy, Multiple; Thrombosis

Topics: Adrenal Cortex Hormones; Bromine; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Ergolines; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Levodopa; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Progesterone

Topics: Amenorrhea; Ascites; Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Estrogens; Female; Follicle Stimulating Hormone; Humans; Hypertrophy; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Menstruation; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple; Time Factors

Is sequential letrozole/human menopausal gonadotrophin (HMG) superior to letrozole alone in ovulation induction and pregnancy promotion among infertile women with polycystic ovary syndrome (PCOS)?. This open-label randomized controlled trial comparing sequential letrozole/HMG and letrozole alone included 174 participants enrolled from August 2019 to January 2020 at the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Infertile women aged between 18 and 40 years who met Rotterdam criteria for PCOS and without other known causes of infertility were selected for this study. Patients were randomly assigned at a 1:1 ratio to receive 2.5 mg letrozole on cycle days 3-7 (n = 87) or 2.5 mg letrozole on cycle days 3-7 with a sequential injection of 75 IU HMG on cycle days 8-10 for one treatment cycle (n = 87). The pregnancy outcome was recorded after one treatment cycle.. Women receiving sequential treatment achieved a significantly higher ovulation rate than those in the letrozole group (90.8% versus 70.1%, P = 0.001) and the live birth rate of the sequential group was significantly higher than that of the letrozole protocol (23.0% versus 10.3%, P = 0.025); there was no statistical variation with respect to adverse events.. The data suggest that the sequential letrozole/HMG protocol may be superior to the letrozole alone protocol in terms of ovulation induction and pregnancy promotion among infertile women with PCOS.

Topics: Adolescent; Adult; Clomiphene; Female; Fertility Agents, Female; Gonadotropins; Humans; Infertility, Female; Letrozole; Menotropins; Ovulation; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Young Adult

The purpose of this research was to evaluate the efficacy of 3 ovulation induction therapies for treating infertility in patients with polycystic ovary syndrome (PCOS). In this retrospective study, we compared the success rates of 90 patients who underwent intrauterine insemination, who were randomly assigned to 1 of 3 treatment groups: letrozole (LE) + urinary gonadotropin (human menopausal gonadotropin [HMG]), clomiphene (CC) + HMG, or HMG alone. Using ultrasound scanning, we examined the number of mature follicles, ovulation rate, clinical pregnancy rate, endometrial thickness, and blood flow. When compared to the other 2 groups, the LE + HMG group had significantly higher levels of mature follicles, ovulation rate, clinical pregnancy rate, estradiol, and luteinizing hormone on the day of the human chorionic gonadotropin injection and endometrial receptivity (P < .05). There was no statistically significant difference between the 3 groups in terms of abortion rate, ectopic pregnancy rate, or adverse reactions. In this research, we found that infertility in patients with PCOS could be effectively treated by combining LE with HMG. This protocol increased ovulation, boosted fertility, and enhanced endometrial receptivity with no increase in adverse reactions. Therefore, it may be a useful clinical approach for inducing ovulation and treating infertility in patients with PCOS.

Topics: Female; Fertility Agents, Female; Humans; Infertility, Female; Letrozole; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies

To evaluate the safety profile and the number of usable blastocysts on day 5 and on day 6 after treatment with an individualized dosing regimen of a follitropin delta and highly purified human menopausal gonadotropin (HP-hMG) for controlled ovarian stimulation.. Multicenter, open label, exploratory study.. Reproductive medicine clinics.. A total of 110 patients (aged 18-40 years).. Follitropin delta coadministered with HP-hMG, with follitropin delta dose fixed according to an established algorithm and HP-hMG dose at 75 IU when the follitropin delta starting dosage was <12 μg; 150 IU when follitropin delta dosage was 12 μg and weight <100 kg, and 225 IU when follitropin delta dosage was 12 μg and weight ≥100 kg (dosage adjustments confined to HP-hMG only).. Mean number of good-quality blastocysts obtained at day 5 and day 6 as well as the proportion of women with ovarian hyperstimulation syndrome (OHSS).. A cohort study was compared with the follitropin delta group from the Evidence-based Stimulation Trial with Human Recombinant Follicle-Stimulating Hormone in Europe and Rest of World 1 (ESTHER-1) study. Even when stratified by age, a statistically significantly higher mean in the number of oocytes retrieved and number of good-quality blastocysts was observed in this study compared with the ESTHER-1 trial in which follitropin delta was used alone. The rate of patients triggered with a gonadotropin-releasing hormone agonist was statistically significantly higher in our Menopur and Rekovelle Combined Study (MARCS) cohort (43%) when compared with the rates reported in the follitropin delta cohort in the ESTHER-1 study (2.3%). Incidence of any grade of OHSS was 9.3% in the present study compared to 2.6% in follitropin delta group from ESTHER-1 trial. No cases of moderate or severe OHSS were observed in our study compared with 1.4% in the follitropin delta group of ESTHER-1.. Optimizing the ovarian response during in vitro fertilization employing a mixed protocol of individualized dosing of follitropin delta and HP-hMG resulted in a statistically significant number of usable blastocysts on days 5 and 6 with an increased risk of mild OHSS, which did not require medical intervention or hospitalization.. NCT03483545.

Topics: Adolescent; Adult; Cohort Studies; Drug Therapy, Combination; Embryo Culture Techniques; Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Menotropins; Oocyte Retrieval; Ovulation Induction; Recombinant Proteins; Young Adult

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

Can dydrogesterone (DYG) be used as an alternative progestin in a progesterone primed ovarian stimulation (PPOS) protocol?. DYG can be used as an appropriate alternative progestin in a PPOS protocol.. PPOS is a new ovarian stimulation regimen based on a freeze-all strategy that uses progestin as an alternative to a GnRH analog for suppressing a premature LH surge during the follicular phase. Medroxyprogesterone acetate (MPA) has been successfully used as an adjuvant to gonadotrophin in the PPOS protocol. However, the use of MPA may lead to stronger pituitary suppression and thus may require a higher dosage of hMG and a longer duration of ovarian stimulation than that of conventional ovarian stimulation protocol.. A prospective RCT including 516 patients was performed between November 2015 and November 2016. Computerized randomization was conducted to assign participants at a 1:1 ratio into two treatment groups: an hMG + DYG group (260 patients) or an hMG + MPA group (256 patients) followed by IVF or ICSI with the freeze-all strategy. One cycle per patient was included. The primary outcome of the trial was the number of oocytes retrieved. The sample size was chosen to detect a difference of two oocytes with a power of 90%.. Patients under 36 years of age with normal ovarian reserve who were undergoing their first IVF/ICSI procedure due to tubal factor infertility were randomized into two groups based on the oral progestin protocol used: hMG co-treatment with DYG (hMG + DYG) or hMG co-treatment with MPA (hMG + MPA). The different progestin was simultaneously administered at the beginning of menstrual cycle 3 (MC3). Oocyte maturation was co-triggered by administration of a GnRH agonist and hCG. All viable embryos from both protocols were cryopreserved for later transfer. Only the first frozen embryo transfer (FET) cycle was included in our study. The embryological and clinical outcomes were measured.. Basic characteristics, such as age, BMI and infertility duration, in both groups were comparable. There was no significant difference in the number (mean ± SD) of oocytes retrieved [10.8 ± 6.3 for the hMG + DYG group versus 11.1 ± 5.8 for the hMG + MPA group, P = 0.33] or the oocyte retrieval rate [74.3 ± 19.6% for the hMG + DYG group versus 75.0 ± 19.5% for the hMG + MPA group, P = 0.69] between the groups. The viable embryo rate per oocyte retrieved did not differ between the two groups [odds ratio (OR): 1.08, 95% CI: 0.97-1.21, P = 0.16]: 37.4% (1052/2815) for the hMG + DYG group versus 35.6% (1009/2837) for the hMG + MPA group. During the whole process of ovarian stimulation, the mean LH level in the hMG + DYG group was always higher than that in the hMG + MPA group (P < 0.001); however, no patient from either group experienced a premature LH surge. In addition, no patients experienced moderate or severe ovarian hyperstimulation syndrome during the ovarian stimulation. No significant difference was found in the clinical pregnancy rate of the first FET cycle between the two groups (OR: 0.82, 95% CI: 0.56-1.21, P = 0.33): 57.6% for the hMG + DYG group (125/217) versus 62.3% for the hMG + MPA group (132/212).. The patients and physician were not blinded to the study. Further, a large proportion of patients were still pregnant at the end of the clinical trial, therefore live birth rates were not observed in the follow-up period. The dose-effectiveness of DYG administration was not addressed in the trial design.. DYG, which exhibits no or only weak inhibition of ovulation in normal dosage, can serve as an hMG adjuvant during ovarian stimulation. This finding suggests the possibility of a new application of DYG: as an appropriate alternative progestin for a PPOS protocol in IVF.. This work was supported by The National Nature Science Foundation of China (Grant no. 81503603), Shanghai Three-year Plan on Promoting TCM Development (Grant no. ZY3-LCPT-2-2006) and the Natural Science Foundation of Shanghai (Grant nos. 15401932700 and 15ZR1424900). None of the authors declare any conflict of interest.. Chictr.org.cn: ChiCTR-IPR-15007251.. Chictr.org.cn: 22 October 2015.. 1 November 2015.

Topics: Adult; Dydrogesterone; Embryo Transfer; Female; Fertilization in Vitro; Hormones; Humans; Infertility, Female; Medroxyprogesterone Acetate; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progestins; Prospective Studies; Sperm Injections, Intracytoplasmic

Does administration of corifollitropin alfa followed by highly purified (hp) HMG result in higher ongoing pregnancy rates compared with daily recombinant FSH (rFSH) in young poor responders?. Corifollitropin alfa followed by hp-HMG does not increase ongoing pregnancy rates compared with rFSH in young poor responders, although more supernumerary cryopreserved embryos were obtained with corifollitropin alfa and hp-HMG.. Poor ovarian response remains one of the main therapeutic challenges in women undergoing ovarian stimulation, given that very low live birth rates of 6% have been reported in this particular group of infertile patients. Nevertheless, concerns have been raised that a degree of heterogeneity remains, as the prognostic effect of individual factors is still unclear, particularly for the young poor responder group. The rationale for conducting the current randomized trial was based on the results of a previous pilot study demonstrating promising results with the administration of hp-HMG following corifollitropin alpha in women younger than 40 years of age, fulfilling the 'Bologna' criteria.. A multicenter, phase III, superiority, randomized trial was conducted using a parallel two-arm design. The study included 152 patients younger than 40 years old and fulfilling the 'Bologna' criteria for poor ovarian response, from one tertiary referral centre in Europe and one tertiary referral centre in Asia. Enrolment was performed from March 2013 to May 2016.. Eligible patients were randomized to either administration of 150 μg corifollitropin alfa followed by 300 IU hp-HMG (Group A) or to 300 IU of daily recombinant FSH (Group B) in a fixed GnRH antagonist protocol. The randomization sequence was created using a computer generated randomization list stratified by centre, using 1:1 allocation. The primary outcome was ongoing pregnancy rate (defined as the presence of an intrauterine gestational sac with an embryonic pole demonstrating cardiac activity at 9-10 weeks of gestation). Secondary outcomes included embryo cryopreservation rates, clinical and biochemical pregnancy rates and number of oocytes retrieved.. Overall, 152 poor ovarian responders defined by the 'Bologna' criteria were included in the study. Using an intention-to treat analysis, the ongoing pregnancy rates did not differ significantly between Group A 11/77 (14.3%) and Group B 11/70 (15.7%), absolute difference: -0.4 (-11.5 to 10.8), OR = 0.9 (0.4-2.4). Biochemical and clinical pregnancy rates, live birth rates and the number of oocytes retrieved were also comparable between the two groups. Nevertheless, more patients in the corifollitropin alfa group had cryopreserved embryos compared to the rFSH group [22 (28.6%) versus 10 (14.3%), OR = 2.4 (1.01-5.5)]. Incidentally, Asian patients had significantly lower cancellation rates compared to European poor responders [2/64 (3.1%) versus 17/83 (20.4%), OR = 0.12 (0.03-0.5)]. This discrepancy could be explained by the fact that Asian women were better prognosis patients than European patients, with significantly lower FSH [9.8 (5.3) versus 11.5 (5.4), P = 0.017] and significantly higher AMH [1.1 (0.9) versus 0.4 (0.3), P-value <0.001] levels.. Ongoing pregnancy rates close to 14% for both treatment groups differ significantly from the hypothesized primary outcome rates used in the power calculation. Therefore, our randomized trial might have been underpowered to detect smaller differences. The use of multiple secondary outcomes and multiple comparisons could have increased a Type 1 error. Finally, although the chance of selection biases remains low given the nature of the infertile population, the open-label design could have been a limitation.. Poor ovarian response represents a challenge and although a specific protocol may have increased the number of cryopreserved embryos, no difference was observed in ongoing pregnancy rates. Our study, being one of the largest RCTs in 'Bologna' criteria poor responders, highlights that baseline characteristics may play a crucial role in clinical prognosis of this population. Given that ovarian stimulation using novel protocols does not seem to significantly increase pregnancy rates even in young women, we suggest that future clinical research should focus on increasing the number of recruitable follicles and on oocyte quality rather than evaluating different stimulation protocols.. No external funding was used for this study. P.D., N.L.V., N.A.V.H., A.V., M.T.H., M.C., A.T.L. and A.V.V. have no conflict of interest to report. C.B. has received unrestricted research grants from MSD and Ferring as well as honoraria for lectures from Abbott, MSD, Merck and Ferring. P.H has received unrestricted research grants from MSD, Merck and Ferring as well as honoraria for lectures from Merck, MSD and IBSA. H.T. has received unrestricted research grants from MSD, Merck, Ferring, Cook, Roche Diagnostics, Besins International and Goodlife as well as consultation fees for research project in female infertility from Merck Finox, Abbott and ObsEva. N.P.P. has received unrestricted research grants from MSD, Ferring, Roche Diagnostics and Besins International as well as honoraria for lectures from MSD, Merck and Ferring.. The EUDRACT number of the trial was 2013-000583-29 and the study was registered at clinicaltrials.gov (NCT01816321).. 19 February 2013.. 28 February 2013.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Live Birth; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Injections, Intracytoplasmic; Treatment Outcome

Studies testing the effectiveness of GnRH antagonists in controlled ovarian stimulation (COS) for intrauterine insemination (IUI) have provided controversial results. The present study was undertaken to evaluate, whether the use of a half of the conventional dose of the GnRH antagonist cetrorelix can be effective in increasing the successful rate of IUI cycles. Patients started COS with human menopausal gonadotropin (hMG) on day three of the menstrual cycle. Cetrorelix was started when at least one follicle of ≥14 mm, was detected at the ultrasound scan, according to the flexible multiple daily dose protocol, and continued until the trigger day with recombinant hCG. Patients adopting GnRH antagonist at low dose had a pregnancy rate (21.7%) that was significantly higher (p < 0.05) in comparison to women receiving hMG only (8.7%). These results suggest that adding a reduced dose of GnRH antagonist to the COS for IUI cycles significantly improves the outcome of the procedure.

Topics: Adult; Chorionic Gonadotropin; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Hospitals, University; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Italy; Male; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins

To investigate the optimal ovulation induction with the combination of combining letrozole(LE),clomiphene citrate (CC),and human menopausal gonadotropin (HMG) in polycystic ovary syndrome(PCOS) patients resistant to CC or LE.. Two hundreds nine PCOS patients (209 cycles) resistant to CC or LE were randomly divided into three groups: CC+HMG group (59 cycles),LE+HMG group (72 cycles) and LE+CC group (78 cycles).The patients in LE+CC group unable to form the dominant follicle after 54 cycles were enrolled into LE+CC+HMG group.Maximum follicle diameter (MFD),endometrial thickness,number of follicles (diameter>1.4 cm),the level of serum estradiol (E2) were measured on the day of HMG administration.Also these results were observed and compared including the duration of treatment,dosage of HMG,number of ovulated follicles,clinical pregnancy rate,biochemical pregnancy rate,early abortion rate,twinning rate,and ectopic pregnancy rate.. The ovulation rate was significantly lower in LE+CC group (30.77%) (. Combintion of LE with CC could achieve 1/3 ovulation induction in PCOS resistant to CC or LE alone.When both combined with HMG,the induction of ovulation could be significantly higher than LE+HMG and CC+HMG,while the risk of multiple pregnancy and OHSS was reduced.

Topics: Clomiphene; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Infertility, Female; Letrozole; Menotropins; Nitriles; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Triazoles

To assess the effect of dehydroepiandrosterone (DHEA) on antral follicle count (AFC), ovarian response to a standard low dose of gonadotrophin stimulation and number of oocytes in anticipated normal responders undergoing in vitro fertilisation (IVF).. Randomised, double-blind, placebo-controlled study.. Tertiary reproductive unit.. Seventy-two subfertile women with AFC of 5-15 scheduled for IVF.. Eligible women were randomised into the DHEA group (n = 36), who received DHEA (GNC(®) , 25 mg three times a day), or the placebo group (n = 36), who received placebo, starting from 12 weeks before the scheduled IVF treatment according to a computer-generated randomisation list. Monthly assessment of AFC, serum anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) levels, ovarian response to a standard dose of gonadotrophin stimulation at week 8 and the number of oocytes obtained were compared.. The primary outcome was AFC after 12 weeks of DHEA or placebo.. DHEA for 12 weeks prior to IVF treatment in anticipated normal responders leads to significantly higher serum and follicular DHEA-S and testosterone relative to placebo. However, no significant differences in AFC, AMH and FSH, ovarian response to standard-dose ovarian stimulation and IVF cycle outcomes can be detected.. No significant differences in AFC, ovarian response to a standard low dose of gonadotrophin stimulation and number of oocytes obtained were detected in anticipated normal responders receiving 12 weeks of DHEA prior to IVF treatment relative to placebo.. No difference in ovarian response markers in normal responders receiving 12 weeks of DHEA.

Topics: Adult; Anti-Mullerian Hormone; Dehydroepiandrosterone; Double-Blind Method; Drug Administration Schedule; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Oocytes; Ovarian Follicle; Ovarian Reserve; Ovulation Induction; Testosterone; Treatment Outcome

The aim of this randomized controlled trial (RCT) was to investigate whether IVF outcomes would differ between patients with POR who received three different gonadotropin doses with or without the addition of letrozole during ovulation stimulation.. Only those who fulfilled two of the three Bologna criteria were included to the study. 95 patients met the inclusion criteria and agreed to participate in the study. In the first group, 31 patients were treated with 450IU gonadotropins. In the second group, 31 patients were treated with 300IU gonadotropins. The third group comprised 33 patients and was treated with 150IU gonadotropins in combination with letrozole.. The results indicate that differences in doses of hMG and rFSH in patients with POR result in a similar number of retrieved MII and fertilized oocytes, similar fertilization rates, number of transferred embryos, implantation, cancelation, chemical, clinical, and ongoing pregnancy rates.. Increasing the dose of gonadotropins during ovulation stimulation is an intuitively appealing approach when the patient is a poor responder. However, increasing the dose does not necessarily improve the reproductive outcome. Using a mild stimulation with addition of letrozole was as effective as stimulation with higher doses of gonadotropins alone in this patient population.

Topics: Adolescent; Adult; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embryo Transfer; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Letrozole; Menotropins; Nitriles; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Single-Blind Method; Treatment Outcome; Triazoles; Young Adult

The primary purpose of this randomized controlled trial study was to compare clinical pregnancy rates and ovulation parameters in female patients of unexplained infertility undergoing intrauterine insemination (IUI) using an antagonist protocol versus a conventional clomiphene citrate protocol.. This was a multicenter parallel randomized controlled, open-label trial. A central randomization center used computer generated tables to allocate treatments. We conducted the study in two centers: Saudi Center and Samir Abbas and Assisted Reproductive Techniques Center of Cairo University, Cairo, Egypt between January 2011 and January 2014. Six hundred and twenty-two couples with unexplained infertility were randomized into two equal groups with 27 excluded after randomization: the antagonist protocol group and the clomiphene group. Antagonist protocol: human menopausal gonadotropins were given to 298 patients from Day 2 to reach a dominant follicle of 18-22 mm, intramuscularly. Then, orgalutrone (0.25 mg) was subcutaneously started from Day 6 or Day 7 until the day of human chorionic gonadotropins (hCG; that was given in the dose of 10,000 IU, intramuscularly) when follicles reached 18-22 mm. Afterward, the IUI of 0.5 mL was done from 34 hours to 36 hours using IUI catheter without guidance of ultrasonography and with an empty urinary bladder. The clomiphene citrate protocol was clomiphene citrate given 100 mg/d to 297 patients from Day 2 to Day 6 and follow up until day of hCG. The clinical pregnancy rate detected with ultrasound confirmed fetal heart pulsations at 6-weeks' gestation (4 weeks after IUI). The number of dominant follicles, level of serum estradiol, and luteinizing hormone at the day of hCG injection and the incidence of twin or triplet pregnancies in both groups were secondary outcome measures.. The clinical pregnancy rate in the antagonist protocol group was significantly (p < 0.001) higher than in the clomiphene group. It was 80 patients (27%) in the antagonist protocol group versus 41 patients (14%) in the clomiphene group. The mean number of dominant follicles was significantly (p < 0.001) greater in the antagonist protocol group (4.36 ± 1.36 dominant follicles) compared with the clomiphene group (2.71 ± 0.96 dominant follicles). In addition, the rate of twin pregnancies was 15 cases in the antagonist protocol group versus six cases only in the clomiphene group (p = 0.047). The luteinizing hormone also was significantly lower in the antagonist group (2.1 ± 1.3) compared with that in the clomiphene group (9.5 ± 3.6).. IUI clinical pregnancy rates were significantly higher by antagonist protocol.

Topics: Adult; Clomiphene; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Insemination, Artificial; Luteinizing Hormone; Menotropins; Ovarian Follicle; Pregnancy; Pregnancy Rate; Pregnancy, Twin; Young Adult

Can controlled ovarian stimulation with low-dose human menopausal gonadotrophin (hMG) improve the clinical pregnancy rate when compared with ovarian stimulation with clomiphene citrate (CC) in an intrauterine insemination (IUI) programme for subfertile couples?. Ovarian stimulation with low-dose hMG is superior to CC in IUI cycles with respect to clinical pregnancy rate.. IUI after ovarian stimulation is an effective treatment for mild male subfertility, unexplained subfertility and minimal-mild endometriosis, but it is unclear which medication for ovarian stimulation is more effective.. A total of 330 women scheduled for IUI during 657 cycles (September 2004-December 2011) were enrolled in an open-label randomized clinical trial to ovarian stimulation with low-dose hMG subcutaneous (n = 334, 37.5-75 IU per day) or CC per oral (n = 323, 50 mg/day from Day 3-7). Assuming a difference of 10% in 'clinical pregnancy with positive fetal heart beat', we needed 219 cycles per group (alpha-error 0.05, power 0.80).. We studied subfertile couples with mild male subfertility, unexplained subfertility or minimal-mild endometriosis. Further inclusion criteria were failure to conceive for ≥12 months, female age ≤42 years, at least one patent Fallopian tube and a total motility count (TMC) ≥5.0 million spermatozoa after capacitation. The primary end-point was clinical pregnancy. Analysis was by intention to treat and controlled for the presence of multiple measures, as one couple could have more randomizations in multiple cycles. Linear mixed models were used for continuous measures. For binary outcomes we estimated the relative risk using a Poisson model with log link and using generalized estimating equations.. When compared with ovarian stimulation with CC, hMG stimulation was characterized by a higher clinical pregnancy rate (hMG 48/334 (14.4%) versus CC 29/323 (9.0%), relative risk (RR) 1.6 (95% confidence interval (CI) 1.1-2.4)), higher live birth rate (hMG 46/334 (13.8%) versus CC 28/323 (8.7%), RR 1.6 (95% CI 1.0-2.4)), low and comparable multiple live birth rate (hMG 3/46 (6.5%) versus CC 1/28 (3.6%), P > 0.99), lower number of preovulatory follicles (hMG 1.2 versus CC 1.5, P < 0.001), increased endometrial thickness (hMG 8.5 mm versus CC 7.5 mm, P < 0.001), and a lower cancellation rate per started cycle (hMG 15/322 (4.7%) versus CC 46/298 (15.4%), P < 0.001).. We randomized patients at a cycle level, and not at a strategy over multiple cycles.. This study showed better reproductive outcome after ovarian stimulation with low-dose gonadotrophins. A health economic analysis of our data is planned to test the hypothesis that ovarian stimulation with low-dose hMG combined with IUI is associated with increased cost-effectiveness when compared with ovarian stimulation with CC.. T.M.D. and K.P. were supported by the Clinical Research Foundation of UZ Leuven, Belgium. This study was also supported by the Ferring company (Copenhagen, Denmark) which provide free medication (Menopur) required for the group of patients who were randomized in the hMG COS group. The Ferring company was not involved in the study design, data analysis, writing and submission of the paper.. NCT01569945 (ClinicalTrials.gov).

Topics: Adult; Clomiphene; Endometriosis; Female; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Motility

Gonadotropin has been used to stimulate ovulation in clomiphene-resistant infertile women with polycystic ovary syndrome (PCOS), but it is associated with overstimulated cycles with the development of many follicles. The aim of the study was to evaluate the effectiveness and efficacy of letrozole and clomiphene citrate (CC) combined with human menopausal gonadotropin (HMG) in CC-resistant infertile women with PCOS.. Ninety-four women received the letrozole + HMG, 90 women received CC + HMG, and 71 women received HMG only. All women received one treatment regimen in one treatment cycle. All patients were given HMG 75 IU on alternate days daily starting on day 3 or day 7 until the day of administration of human chorionic gonadotropin.. The rate of monofollicular development was 80.2% in the letrozole + HMG group, 65.3% in the CC + HMG group, and 54.7% in the HMG-only group (P<0.05 for letrozole + HMG vs the other two groups). The number of developing follicles (≥14 mm follicles) and the cycle cancellation rate due to ovarian hyperresponse were the lowest in the letrozole + HMG group, but the difference was not significant. The ovulation and pregnancy rate were similar among the three protocols. The HMG dose needed and the mean duration of treatment were significantly lower in the letrozole + HMG and CC + HMG groups compared with the HMG-only group.. Letrozole in combination with HMG is an effective protocol for reducing the risks of hyperstimulation for ovarian induction in CC-resistant women with PCOS. This combination may be more appropriate in patients who are particularly sensitive to gonadotropin.

Topics: Adult; Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Infertility, Female; Letrozole; Menotropins; Nitriles; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Prospective Studies; Treatment Outcome; Triazoles; Young Adult

The aim was to compare ovarian response and clinical outcome of potential high-responders after stimulation with highly purified menotropin (HP-hMG) or recombinant follicle-stimulating hormone (rFSH) for in vitro fertilisation/intracytoplasmic sperm injection. Retrospective analysis was performed on data collected in two randomized controlled trials, one conducted following a long GnRH agonist protocol and the other with an antagonist protocol. Potential high-responders (n = 155 and n = 188 in the agonist and antagonist protocol, respectively) were defined as having an initial anti-Müllerian hormone (AMH) value >75th percentile (5.2 ng/ml). In both protocols, HP-hMG stimulation in women in the high AMH category was associated with a significantly lower occurrence of high response (≥15 oocytes retrieved) than rFSH stimulation; 33% versus 51% (p = 0.025) and 31% versus 49% (p = 0.015) in the long agonist and antagonist protocol, respectively. In the potential high-responder women, trends for improved live birth rate were observed with HP-hMG compared with rFSH (long agonist protocol: 33% versus 20%, p = 0.074; antagonist protocol: 34% versus 23%, p = 0.075; overall population: 34% versus 22%, p = 0.012). In conclusion, the type of gonadotropin used for ovarian stimulation influences high-response rates and potentially clinical outcome in women identified as potential high-responders.

Topics: Adult; Anti-Mullerian Hormone; Biomarkers; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Live Birth; Menotropins; Ovarian Hyperstimulation Syndrome; Ovary; Ovulation Induction; Pregnancy; Recombinant Proteins; Retrospective Studies; Risk; Sperm Injections, Intracytoplasmic; Up-Regulation

Administration of exogenous progesterone for luteal phase support has become a standard of practice. Intramuscular (IM) injections of progesterone in oil (PIO) and vaginal administration of progesterone are the primary routes of administration. This report describes the administration preferences expressed by women with infertility that were given progesterone vaginal insert (PVI) or progesterone in oil injections (PIO) for luteal phase support during fresh IVF cycles.. A questionnaire to assess the tolerability, convenience, and ease of administration of PVI and PIO given for luteal phase support was completed by infertile women diagnosed with PCOS and planning to undergo IVF. The women participated in an open-label study of highly purified human menopausal gonadotropins (HP-hMG) compared with recombinant FSH (rFSH) given for stimulation of ovulation.. Most women commented on the convenience and ease of administration of PVI, while a majority of women who administered IM PIO described experiencing pain. In addition, their partners often indicated that they had experienced at least some anxiety regarding the administration of PIO. The most distinguishing difference between PVI and PIO in this study was the overall patient preference for PVI. Despite the need to administer PVI either twice a day or three times a day, 82.6% of the patients in the PVI group found it "very" or "somewhat convenient" compared with 44.9% of women in the PIO group.. The results of this comprehensive, prospective patient survey, along with findings from other similar reports, suggest that PVI provides an easy-to-use and convenient method for providing the necessary luteal phase support for IVF cycles without the pain and inconvenience of daily IM PIO. Moreover, ongoing pregnancy rates with the well-tolerated PVI were as good as the pregnancy rates with PIO.. ClinicalTrial.gov, NCT00805935.

Topics: Administration, Intravaginal; Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections, Intramuscular; Luteal Phase; Menotropins; Patient Preference; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Progesterone; Prospective Studies; Recombinant Proteins; Surveys and Questionnaires; Treatment Outcome; Young Adult

To compare two different gonadotropin preparations, human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (rFSH), combined with clomiphene citrate (CC) in women with unexplained infertility undergoing intrauterine insemination (IUI).. In this prospective clinical trial, couples prepared for IUI cycles were randomly allocated to two groups either to receive CC and hMG (group A, n=127) or CC and rFSH (group B, n=132) for ovarian stimulation. Outcomes including rates of clinical pregnancy, miscarriage, OHSS, multiple pregnancy, cancellation, and live birth were compared between groups.. Duration of gonadotropin therapy was significantly shorter in group B (5.1±0.84 vs. 4.7±0.8 days, CI=95%, P<0.001). The total dose of administered gonadotropin was also significantly lower in group B (386.9±68.2 vs. 348.2±56.3IU, CI=95%, P<0.001). Dominant follicle number (>17mm), mean follicular diameter, and endometrial thickness on the day of hCG injection were similar. Clinical pregnancy, multiple pregnancies, abortion, live birth, ovarian hyperstimulation syndrome (OHSS), and cancellation rates were not statistically different between the groups.. IUI cycles in which rFSH had been administered may require shorter duration and a lower total gonadotropin dose.

Topics: Adult; Clomiphene; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Recombinant Proteins

The aim of this multicentre, prospective, randomised, investigator blind, controlled clinical trial was to evaluate the clinical efficacy and tolerability of a highly purified human menopausal gonadotrophin (hMG) preparation (Merional-HG) when administered to patients undergoing controlled ovarian stimulation (COS) for in-vitro fertilisation (IVF) procedure enrolled in hospital departments. One hundred fifty-seven patients were randomised in two parallel groups: 78 started COS with Merional-HG and 79 with Menopur. Results of the study showed that both highly purified hMG preparations were equivalent in terms of number of oocytes retrieved (primary endpoint: 8.8 ± 3.9 versus 8.4 ± 3.8, p = 0.54). In the patients treated with Merional-HG, we observed a higher occurrence of mature oocytes (78.3% versus 71.4%, p = 0.005) and a reduced quantity of gonadotrophins administered per cycle (2.556 ± 636 IU versus 2.969 ± 855 IU, p < 0.001). Fertilisation, cleavage, implantation rates and the number of positive β-human chorionic gonadotrophin (hCG; pregnancy) tests and the clinical pregnancy rate were comparable in the two groups. Both treatments were well tolerated. In conclusion, the results of this study support the efficacy and safety of Merional-HG administered subcutaneously for assisted reproduction techniques. Efficiency of Merional-HG appears to be higher due to reduced quantity of drug used and the higher yield of mature oocytes retrieved.

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Injections, Subcutaneous; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Single-Blind Method; Treatment Outcome

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.. A comparative prospective study.. Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10-14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.. There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].. The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.

Topics: Adult; Clomiphene; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies; Treatment Outcome; Young Adult

To compare the IVF outcomes of letrozole/antagonist and microdose GnRH agonist flare up protocols in poor ovarian responders undergoing intracytoplasmic sperm injection.. A randomized controlled trial was performed in patients with one or more previous failed IVF cycles in which four or less oocytes were retrieved when the gonadotrophin starting dose was at least 300 IU/day. Sixty patients were randomized by computer-generated list to receive either letrozole/antagonist (mild stimulation) n = 30 or GnRH-a protocol (microdose flare) n = 30.. Both groups were similar with respect to background and hormonal characteristics (age, duration of infertility, BMI, FSH, LH and E2). The clinical pregnancy rate per cycle was similar in both groups (13.3 vs. 16.6%; OR = 0.769; 95% CI = 0.185, 3.198). The doses of used gonadotropins and the number of stimulation days were significantly lower in the letrozole/antagonist protocol. The peak E2 level on the day of hCG, the endometrial thickness, the retrieved oocytes, the number of fertilized oocytes, the number of transferred embryos and the cancellation rate were statistically similar in both groups.. The letrozole/antagonist protocol is a cost-effective and patient-friendly protocol that may be used in poor ovarian responders for IVF/ICSI.

Topics: Adult; Aromatase Inhibitors; Drug Resistance; Egypt; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Letrozole; Leuprolide; Menotropins; Nitriles; Ovary; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Injections, Intracytoplasmic; Triazoles

To compare highly purified human menopausal gonadotropin (HP-hMG) with recombinant follicle-stimulating hormone (rFSH) on ovarian response and pregnancy outcome in downregulated women of advanced reproductive age.. A prospective, randomized and controlled study of 127 consecutive normogonadotropic infertile women ≥ 35 years old undergoing their first in vitro fertilization/intracytoplasmic sperm injection cycles received ovarian stimulation with HP-hMG (n = 63) or with rFSH (n = 64) in a long gonadotropin-releasing hormone agonist protocol.. More leading (≥ 18 mm) follicles and oocytes were obtained in rFSH group (p = 0.008 and p < 0.001, respectively). The proportion of top-quality embryo from oocyte retrieval and live birth rate per started cycle trended towards improvement with HP-hMG (OR 1.3, 95% CI 0.9-1.8; OR 1.9, 95% CI 0.9-3.9; respectively), although they were not significant difference between two groups. At end of stimulation, higher serum progesterone level was found in rFSH group (p < 0.001).. Following downregulated women of advanced reproductive age, superiority of HP-hMG over rFSH in live birth rate could not be concluded from this study, but noninferiority was established. Pharmacodynamic differences in follicular development, oocyte/embryo quality and endocrine response exist between HP-hMG and rFSH, which may be relevant to treatment outcome.

Topics: Adult; Aging; Birth Rate; Ectogenesis; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oogenesis; Ovulation Induction; Pituitary Gland; Pregnancy; Progesterone; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Triptorelin Pamoate

To verify non-inferiority of the clinical pregnancy rate of Early hCG administration (leading follicle sizes within 16.0-16.9 mm in diameter) compared to Late hCG administration (leading follicle sizes within 18.0-18.9 mm in diameter).. Prospective randomized trial. Six hundred and twelve infertile women candidates for intrauterine insemination (IUI) received HP-hMG 75 IU/day SC from cycle days 4 to 8 and then as per ovarian response. Ovulation was randomly triggered (hCG 5000 IU, IM) when the leading follicle diameter ranged between either 16.0 and 16.9 mm (Early hCG group, n=227) or 18.0 and 18.9 mm (Late hCG group, n=207) and IUI was performed approximately 36 h later.. Whereas population and sperm characteristics were comparable in both groups, the number of follicles ≥ 14 mm in diameter (P<0.007) and serum estradiol levels (P<0.001) on the day of hCG were lower in the Early versus the Late hCG groups. Clinical (11.9% versus 12.1%) and ongoing (11.0% versus 8.6%) pregnancy rates per randomized women were similar in the two groups and statistical non-inferiority of clinical and ongoing pregnancy rates was demonstrated.. These results suggest that hCG administered when the largest follicle size reaches 16.0-16.9 mm leads to similar clinical and ongoing pregnancy rates as when it reaches 18.0-18.9 mm in IUI cycles.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Fertility Agents, Female; Humans; Infertility; Infertility, Female; Insemination, Artificial; Male; Menotropins; Oogenesis; Organ Size; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Rate; Therapeutic Equivalency; Ultrasonography; Young Adult

To assess the psychological impact (Hospital Anxiety and Depression Scale) of an investigational ovarian stimulation protocol in women with premature ovarian failure (POF).. Prospective longitudinal study.. Ten women with POF.. Women with idiopathic POF were placed on three consecutive treatment cycles consisting of gonadotropin ovarian stimulation after estrogen priming, gonadotropin-releasing hormone agonist pituitary desensitization, and corticosteroid immune suppression.. Median anxiety and depression scores increased significantly from baseline following three consecutive treatment cycles from 4.0 (range 2.0-8.0) to 11.0 (range 10.0-14.0) (p-value 0.041) and from 1.5 (range 0-6.0) to 9.0 (range 7.0-10.0) (p-value 0.039), respectively. There were nine "probable" anxiety (90%) and three "probable" depression (30%) cases on the final treatment cycle compared with none (0%) on baseline (p-value 0.004 and 0.250, respectively).. The use of investigational ovarian stimulation protocols in women with idiopathic POF was associated with excessive psychological strain. Women with POF should be cautioned against the potentially harmful aspect of similar treatments of unproven benefit.

Topics: Adolescent; Adult; Anxiety; Buserelin; Chorionic Gonadotropin; Depression; Estrogens; Estrogens, Conjugated (USP); Female; Glucocorticoids; Humans; Infertility, Female; Insemination, Artificial; Longitudinal Studies; Medroxyprogesterone Acetate; Menotropins; Ovary; Ovulation Induction; Prednisone; Primary Ovarian Insufficiency; Prospective Studies; Psychiatric Status Rating Scales; Reproductive Control Agents; Ultrasonography; Young Adult

To evaluate, retrospectively, the roles of endogenous and exogenous luteinising hormone (LH) activity on live birth rate in ovulation induction cycles.. Associations between LH activity at baseline, end of stimulation and live birth rate were analysed in relation to patient characteristics, baseline and end of stimulation variables in WHO group II anovulatory women (n = 155) stimulated with recombinant follicle-stimulating hormone (rFSH) or highly purified human menopausal gonadotrophin (HP-hMG). HP-hMG provides FSH and exogenous LH activity mainly in the form of human chorionic gonadotrophin (hCG).. Serum LH concentrations at baseline or end of stimulation were not predictive of live birth rate in the rFSH group (n = 79) or HP-hMG group (n = 76). Serum hCG concentration at end of stimulation was a significant positive predictor in HP-hMG-treated women. Other variables were not independently predictive of live birth in either of the groups, except for a negative association between serum FSH concentrations at the start of stimulation and live birth in the rFSH-treated group.. Endogenous LH concentrations are not predictive of live birth in anovulatory WHO group II patients undergoing ovulation induction with rFSH or HP-hMG. On the other hand, exogenous hCG activity during HP-hMG stimulation is positively associated with treatment outcome.

Topics: Adult; Anovulation; Birth Rate; Chorionic Gonadotropin; Cohort Studies; Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Live Birth; Luteinizing Hormone; Menotropins; Ovulation Induction; Recombinant Proteins; Reproductive Control Agents; Retrospective Studies

To compare the efficacy of lyophilised urinary hMG (HP-hMG) with recombinant FSH (rFSH) in women with unexplained infertility undergoing a controlled ovarian hyperstimulation with intrauterine insemination (IUI).. Forty-nine consecutively seen women with unexplained infertility were randomised to a controlled ovarian hyperstimulation with IUI cycle either with rFSH or HP-hMG. The outcome was compared by independent samples t-test.. The mean patient age and duration of infertility were not different (29.5 +/- 5.7 and 4.9 +/- 2.7 years in rFSH; 28.8 +/- 3.2 and 6 +/- 4.2 in HP-hMG group) (p = 0.6 and p = 0.2). The mean body mass index (BMI) and basal hormones were similar. Total dose of gonadotropin used (710 +/- 236 vs. 636 +/- 185 IU) and duration of the cycles (9 +/- 2.1 vs. 8.3 +/- 2.3 days) showed no significant difference (p = 0.2). Number of follicles, serum oestradiol (E2), and the endometrial thickness on the day of hCG were comparable. Two singletons in each group were obtained.. These data suggest that HP-hMG and rFSH may be equally suitable in mild ovarian stimulation for unexplained infertility. Further data derived from larger study population are needed to determine whether higher amounts of two gonadotropins in this subgroup might produce any benefits or unfavourable effects.

Topics: Adult; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Prospective Studies; Treatment Outcome

To evaluate the efficacy of GnRH antagonist in comparison with the GnRH agonist protocol in OCP pretreated polycystic ovary syndrome (PCOs) patients undergoing their first ART cycle.. Prospective randomized controlled trial. University-based tertiary fertility center. Ninety-five PCOs patients under 35 years of age, with primary infertility were randomized to an ovarian stimulation protocol consisting of either. GnRh antagonist (study group) or GnRH agonist (control group) after pretreatment with OCP. Coasting or GnRH agonist Trigger was used when estradiol level > or =3,000 pgr/ml in the control and study group, respectively. Both groups received 800 mg vaginal progesterone and 4 mg oral estradiol valerate for luteal phase support.. There was no statistically significant difference in the age, body mass index, basal FSH, duration of infertility, the number of oocytes retrieved, the number of embryos transferred, Serum E2 levels on day of trigger, fertilization rate, chemical and clinical pregnancy rates between the two groups. None of the patients in the study group developed ovarian hyperstimulation syndrome (OHSS) compared with 22.2% of patients in the control group. Total duration of treatment and the number of HMG ampoules used were lower in the study group.. Antagonist protocol and GnRH agonist trigger for ovulation whenever necessary has a similar cycle outcome to the GnRH-agonist protocol in OCP pretreated PCOs patients, with significantly reduced risk of OHSS.

Topics: Adult; Buserelin; Contraceptives, Oral, Combined; Drug Administration Schedule; Drug Therapy, Combination; Ethinyl Estradiol-Norgestrel Combination; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Young Adult

To assess if the luteinizing hormone/human chorionic gonadotropin present in some gonadotropin formulations may be of benefit in protocols with GnRH antagonists.. Open, quasi-experimental, multicenter, prospective, parallel-controlled study compared 136 women undergoing in vitro fertilization--intracytoplasmic sperm injection after stimulation with highly purified human menopausal gonadotropin (hp-hMG) (n = 44), recombinant-follicle stimulating hormone (r-FSH) (n = 46), or a combination of both (r FSH + hp-hMG) (n = 46) following an antagonist protocol. Blood determinations were made on day 6 of stimulation and on the day of ovulation induction, with centralized analysis.. No differences were found in the ongoing pregnancy rates between groups [37.0% versus 29.5% (hp-hMG) and 23.9% (r-FSH); p = 0.688]. However, the ratio top-quality embryos/retrieved oocytes (TQE/RO) was higher in the combined therapy group (19.6%)--reaching significance versus the r-FSH group (6.5%) (p = 0.008), but not versus hp-hMG (12.3%) (p = 0.137).. An improved TQE/RO ratio was obtained together with a greater percentage of frozen embryos in the patients that incorporated hp-hMG to their stimulation protocol. Despite good results of adding hp-hMG, non statistical differences were found in terms of ongoing pregnancy rate.

Topics: Adult; Analysis of Variance; Chi-Square Distribution; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocyte Retrieval; Ovulation Induction; Patient Selection; Pregnancy; Pregnancy Rate; Prospective Studies; Regression Analysis; Sperm Injections, Intracytoplasmic; Treatment Outcome

In a prospective randomized controlled trial, 119 patients were randomized to receive either recombinant hCG (250 μg) or urinary-derived hCG (10,000 IU) for final oocyte maturation in an antagonist protocol with a fixed dose of recombinant FSH (187.5 IU) and predefined single blastocyst transfer. The delivery rate was improved in the recombinant hCG group compared with the urinary-derived hCG group (44.1 vs. 25.7, respectively); however, adequately powered randomized controlled trials are justified to ascertain whether this difference is true.

Topics: Adult; Birth Rate; Chorionic Gonadotropin; Drug Administration Schedule; Female; Fertility Agents, Female; Fertilization in Vitro; Hormone Antagonists; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins; Single Embryo Transfer

To compare two flexible protocols of GnRHant in OH plus IUI vs a control group without GnRHant.. Randomized controlled trial 90 infertile patients were analyzed in 116 cycles of IUI. Cycles were randomized in 3 groups; group 1: started GnRHant when the leading follicle reached 14mm, group 2: when it reached 16mm and group 3: without GnRHant hormonal determinations were done during OH. Main outcomes were: premature LH raise incidence, premature luteinization (PL) and pregnancy rate per cycle.. Premature LH rise incidence was 2.6% (3 cycles) and PL 6% (7 cycles). Group 1 didn't present cycles with LH rise or PL, groups 2 and 3 presented LH rise in 3.1% and 1.8% and PL in 12.5% and 5.4% respectively. Pregnancy rate with GnRHant was 16.4% (95% IC 8.1-28.1) vs. 7.2% (95% le 2.0-17.5%) without GnRHant (group 3) (p = 0.16): groups 1 and 2 represented a pregnancy rate of 20.6% (95% IC 7.9-39.7) and 12.5% (95% IC 3.5-28.9%) respectively (p = 0.49). Mature follicles number reached meaning difference between all groups (p = 0.04) specially between groups 1 and 2 (p = 0.02).. A trend to elevate pregnancy rates was observed with GnRHant specially with when it was started when leading follicle reached 14 mm (p > 0.05). Starting GnRHant with 16 mm was not totally usefully to prevent PL.

Topics: Adult; Awards and Prizes; Drug Administration Schedule; Female; Fertility Agents, Female; Glycoprotein Hormones, alpha Subunit; Gonadotropin-Releasing Hormone; Gynecology; Humans; Infertility, Female; Insemination, Artificial, Homologous; Luteinization; Luteinizing Hormone; Male; Menotropins; Mexico; Obstetrics; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Sperm Capacitation; Young Adult

The effect of low-dose human chorionic gonadotropin (hCG) administration in the proliferative phase of oocyte recipients was investigated in a prospective randomized trial. Sibling oocytes from the same donor were shared at random among two different recipients. In group I oocyte recipients received 750 IU of hCG every three days concomitant to endometrial preparation with estradiol until hCG injection to the donor, whereas in group II recipients received no hCG during endometrial priming with estradiol. Endometrial thickness was significantly lower in group I compared with group II, although similar endometrial thickness was detected during the mock cycle. Pregnancy rates were significantly lower in group I than in group II (13.6% vs. 45.4%, p<0.05). Implantation rates were also significantly lower in group I (1.7% vs. 22.4%, p<0.01). The study was discontinued prematurely for ethical reasons when 22 cycles were completed, as pregnancy rates were very low in group I. In conclusion, hCG administration in the proliferative phase might directly affect endometrial proliferation and receptivity.

Topics: Adult; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Embryo Implantation; Endometrium; Female; Fertility Agents, Female; Fertilization in Vitro; Follicular Phase; Humans; Infertility, Female; Menotropins; Oocytes; Pregnancy; Pregnancy Rate

A comparison of the effectiveness of different gonadotrophin preparations in intrauterine insemination (IUI) cycles for patients with unexplained infertility was performed.. Two hundred and forty-one patients were prospectively randomized using computer-generated random numbers into three groups: 81 in the Follitropin alpha (Group I), 80 in the urinary FSH (uFSH) (Group II) and 80 in the hMG (Group III). The primary outcome was clinical pregnancy rate with duration of stimulation, total gonadotrophin dose, number of dominant follicles, clinical pregnancy rate, multiple pregnancy, miscarriage rate and ovarian hyperstimulation syndrome (OHSS) rate being secondary outcomes.. Clinical pregnancy rate was significantly higher in the rFSH group (25.9% in Follitropin alpha, 13.8% in uFSH and 12.5% in HMG groups; P = 0.04). There was no significant difference in terms of duration of stimulation, but mean FSH dose consumed per cycle was significantly lower in the recombinant FSH (rFSH) group compared with others (825 IU in Follitropin alpha, 1107 IU in uFSH and 1197 IU in HMG groups; P = 0.001). The number of follicles > or =16 mm diameter was significantly higher in the rFSH group compared with the uFSH and HMG groups (2.6 in Follitropin alpha, 1.3 in uFSH and 1.4 in HMG groups; P = 0.001).. rFSH may result in a better outcome in IUI cycles for unexplained infertility.

Topics: Adult; Female; Follicle Stimulating Hormone; Glycoprotein Hormones, alpha Subunit; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies

Public funding for IVF is increasingly being challenged by health authorities in an attempt to minimize health service costs. In light of treatment rationing, the need to consider costs in relation to outcomes is paramount. To assess the cost implications of gonadotrophin treatment options, an economic evaluation comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) has been conducted. The analysis is based on individual patient data from a large randomized controlled trial (n = 731) in a long agonist IVF protocol. The economic evaluation uses a discrete event simulation model to assess treatment costs in relation to live births for both treatments based on published UK costs. After one cycle the mean costs per IVF treatment for HP-HMG and rFSH were pound2396 (95% CI pound2383-2414) and pound2633 ( pound2615-2652), respectively. The average cost-saving of pound237 per IVF cycle using HP-HMG allows one additional cycle to be delivered for every 10 cycles. With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound8893 compared with pound11,741 for rFSH (P < 0.001). The cost-saving potential of HP-HMG in IVF was still apparent after varying critical cost parameters in the probabilistic sensitivity analysis.

Topics: Adult; Birth Rate; Cost-Benefit Analysis; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Recombinant Proteins

The contribution of the LH activity in menotrophin preparations for ovulation induction has been investigated in small trials conducted versus FSH preparations. The objective of this study was to demonstrate non-inferiority of highly purified urinary menotrophin (HP-HMG) versus recombinant FSH (rFSH) with respect to the primary outcome measure, ovulation rate.. This was a randomized, open-label, assessor-blind, multinational study. Women with anovulatory infertility WHO Group II and resistant to clomiphene citrate were randomized (computer-generated list) to stimulation with HP-HMG (n=91) or rFSH (n=93) using a low-dose step-up protocol.. The ovulation rate was 85.7% with HP-HMG and 85.5% with rFSH (per-protocol population), and non-inferiority was demonstrated. Significantly fewer intermediate-sized follicles were observed in the HP-HMG group (P<0.05). The singleton live birth rate was comparable between the two groups. The frequency of ovarian hyperstimulation syndrome and/or cancellation due to excessive response was 2.2% with HP-HMG and 9.8% with rFSH (P=0.058).. Stimulation with HP-HMG is associated with ovulation rates at least as good as a rFSH in anovulatory WHO Group II women. LH activity modifies follicular development so that fewer intermediate-sized follicles develop. This could have a positive impact on the safety of ovulation induction protocols.

Topics: Adolescent; Adult; Anovulation; Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation; Recombinant Proteins

To determine if the combination of leuprolide acetate (LA) and human menopausal gonadotropin (hMG) results in luteal phase dysfunction.. A prospective, randomized clinical trial.. A tertiary care university fertility center.. One hundred thirty-five couples with various etiologies of infertility.. Patients were prospectively randomized to receive either hMG and intrauterine insemination (IUI) or luteal phase down-regulation with LA, hMG, and IUI.. Serum luteal phase progesterone (P) and luteal phase estradiol (E2) were obtained 9 days after hCG administration. Twenty-four-hour urinary P and luteinizing hormone (LH) were analyzed 9 days after human chorionic gonadotropin (hCG). Endometrial biopsies were performed 11 days after hCG and evaluated for luteal phase defects (LPD) using Noyes' criteria.. No significant differences in the incidence of LPD (11.9% vs. 13.9%), cycle fecundity (16.6% vs. 16.3%), or luteal phase hormone profiles were observed between the groups receiving and not receiving LA. A significant difference in E2 levels (on the day of hCG administration) between cycles with a luteal phase defect (967 pg/mL +/- 106) and without a luteal phase defect (1,422 pg/mL +/- 83) was observed (P<.05).. Pituitary down-regulation with LA combined with hMG did not result in luteal phase dysfunction. The E2 levels on the day of hCG administration in both groups were lower in women with documented luteal phase defects.

Topics: Adult; Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Leuprolide; Luteal Phase; Male; Menotropins; Ovulation Induction

LH activity may influence treatment response and outcome in IVF cycles.. A randomized, assessor-blind, multinational trial compared ongoing pregnancy rates (primary end-point) in 731 women undergoing IVF after stimulation with highly purified menotrophin (HP-hMG) (n = 363) or recombinant FSH (rFSH) (n = 368) following a long GnRH agonist protocol. Patients received identical pre- and post-randomization interventions. One or two embryos were transferred on day 3.. More oocytes were retrieved (P < 0.001) after rFSH treatment (11.8) compared with HP-hMG treatment (10.0), but a higher proportion developed into top-quality embryos (P = 0.044) with HP-hMG (11.3%) than with rFSH (9.0%). At the end of stimulation, lower estradiol (E(2)) (P = 0.031) and higher progesterone (P < 0.001) levels were found with rFSH, even after adjusting for follicular response. The distribution of hypo-, iso- and hyper-echogenic endometrium showed a significant (P = 0.023) shift towards the hyperechogenic pattern after rFSH treatment. The ongoing pregnancy rate per cycle was 27% with HP-hMG and 22% with rFSH [odds ratio (95% confidence interval): 1.25 (0.89-1.75)].. Superiority of HP-hMG over rFSH in ongoing pregnancy rate could not be concluded from this study, but non-inferiority was established. Pharmacodynamic differences in follicular development, oocyte/embryo quality, endocrine response and endometrial echogenicity exist between HP-hMG and rFSH preparations, which may be relevant for treatment outcome.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Infertility, Female; Menotropins; Oocyte Donation; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Recombinant Proteins; Treatment Outcome

This pilot study was conducted to compare the results of intrauterine insemination (IUI) under ovarian stimulation with either letrozole (Femara) or human menopausal gonadotrophin (HMG). A randomized controlled trial was conducted. Eighty women aged 20-35 years with unexplained infertility of at least 2 years' duration were randomized according to a computer-generated randomization list into the letrozole group and the HMG group. Letrozole was administered at 5 mg/day from day 3 to day 7 of the IUI cycle. HMG injections were started on day 3 at a dose of 75 IU for women under 30 years old and 150 IU for women over 30 years old and monitored periodically by vaginal ultrasound and oestradiol concentrations. The variables selected for analysis were clinical pregnancy rate, endometrial thickness, length of follicular phase and number of preovulatory follicles. No statistically significant difference in clinical pregnancy rates per cycle was found for patients in the letrozole or HMG group (18.4 versus 15.7%). Cost was significantly higher in the HMG stimulation cases (P < 0.001) and no injections were required in the letrozole group. In conclusion, letrozole offers a new treatment regimen in ovarian stimulation regimens for IUI that is cost effective, simple and convenient for the patients.

Topics: Adult; Aromatase Inhibitors; Endometrium; Female; Follicular Phase; Humans; Infertility, Female; Insemination, Artificial, Homologous; Letrozole; Luteinization; Male; Menotropins; Nitriles; Ovarian Hyperstimulation Syndrome; Pilot Projects; Pregnancy; Pregnancy Rate; Triazoles

To compare double homologous versus only one intrauterine insemination (IUI) by stimulated cycle.. In a prospective, comparative study 138 patients were included, who underwent to intrauterine insemination; not inclusion parameters were: patients with cancelled cycles by poor response or by ovarian hyperestimulation syndrome risk. Patients were divided in two groups: Group 1 (N = 69) one insemination at 36 hours after human gonadotrophin chorionic hormone (hCG) and group 2 (N = 69) two inseminations 24 and 48 hours after hCG. Sperm separation was done with swim up, wash and resuspended or isolate techiques, and ovarian stimulation was done with recombinant FSH, menotrophins or clomiphene citrate. Statistical analysis was made by T Student and chi2 tests.. The overall pregnancy rate was 13.04% per cycle; and seminal characteristics after seminal preparation were similar. We observed better pregnancy rates in the patients with ovulatory dysfunction and endometriosis (14.9% and 18.2%). No differences were established in pregnancy rates when patients were compared in function to seminal preparation.. Double IUI at 24 and 48 hours after hCG has the same results in pregnancy rates than only one IUI correctly indicated 36 hours after hCG, but the costs increases in double insemination.

Topics: Adult; Clomiphene; Drug Synergism; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Sperm Capacitation; Sperm Motility; Uterus

To compare the efficacy of two early cessation protocols of triptorelin treatment in controlled ovarian hyperstimulation with the conventional long protocol in in vitro fertilization/intracytoplasmic sperm injection.. A double-blind, randomized, multicenter study.. Three Dutch hospitals.. One hundred seventy-eight women randomized to one of three treatment groups at the start of stimulation.. Midluteally started triptorelin administration was continued until the first day of hMG treatment (group S), or up to and including the fourth day of hMG treatment (group M) or the day of hCG injection (group L).. Occurrence of a premature LH surge.. One premature LH surge was observed in group M but not in groups S and L. Both early cessation protocols (S and M) are at least as effective as the long protocol (L) with regard to the number of oocytes (11.1 and 10.3 vs. 9.3), number of embryos (7.3 and 6.5 vs. 5.5), and ongoing pregnancy rate (28% and 24% vs. 21%).. Early cessation of triptorelin on day 1 of hMG treatment in a midluteally started IVF protocol is as effective as the traditional long protocol in preventing a premature LH surge and results in similar fertility effects.

Topics: Adolescent; Adult; Double-Blind Method; Drug Therapy, Combination; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Luteolytic Agents; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Sperm Injections, Intracytoplasmic; Triptorelin Pamoate

Although the capacity of recombinant FSH alone to induce folliculogenesis is undisputed, many believe that follicular recruitment in women over 38 years old could be improved by supplementing rFSH with human menopausal gonadotrophin (HMG). The present study sought to determine whether recombinant LH could reproduce the effect of HMG in women over 38 years during ovulation induction. Fifty-eight patients received rFSH (225 IU/day) supplemented with one ampoule of HMG (75 IU of FSH/75 IU of LH/HCG per day) for 5 days. Another 36 patients received rFSH (300 IU/day) supplemented with one ampoule of rLH (75 IU/day), also for 5 days. Both groups of patients received similar amounts of rFSH (1500 IU), LH/HCG (375 IU) and rLH (375 IU) and recruited a similar number of follicles as counted on day 6 (4.07 +/- 3.1 in the HMG group versus 3.7 +/- 3.2 in the LH group respectively) or on the day that human chorionic gonadotrophin (HCG) was indicated (6.5 +/- 2.7 versus 5.8 +/- 2.5 respectively). Ovarian stimulation was shorter, but not significantly so, in the group of patients receiving rFSH + HMG (10.5 +/- 1.7 days) than in the group of patients treated with rFSH +/- rLH (12 +/- 1.8 days). Significantly more MII oocytes were seen in the group treated with rFSH + rLH than in the group treated with rFSH + HMG (93.1 versus 75.3%, P < 0.05). With respect to pregnancy rates, 14/54 (26%) patients receiving rFSH + HMG and 16/34 (47%) patients receiving rFSH + rLH had a positive serum HCG. No significant difference in the number of miscarriages was observed between the two groups. In conclusion, the present results seem to indicate that rLH could be the HMG component that aids early follicular recruitment.

Topics: Adult; Age Factors; Cohort Studies; Embryo Transfer; Female; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Maternal Age; Menotropins; Oocytes; Ovarian Follicle; Ovary; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome

Patients with polycystic ovary syndrome (PCOS) may need a longer period of pituitary downregulation to suppress the elevated serum LH and androgen levels effectively during IVF treatment using the GnRH agonist long protocol. We proposed a stimulation protocol incorporating Diane-35 and GnRH antagonist (Diane/cetrorelix protocol) and compared it with the GnRH agonist long protocol for PCOS patients.. Part I of the study was an observational pilot study to evaluate the hormonal change as a result of the Diane/cetrorelix protocol (n = 26). Part II of the study was a prospective randomized study comparing the Diane/cetrorelix protocol (n = 25) and the GnRH agonist long protocol (n = 24). In the Diane/cetrorelix protocol, patients were pre-treated with three cycles of Diane-35, followed by 0.25 mg of cetrorelix on cycle day 3. From day 4, cetrorelix and gonadotrophin were administered concomitantly until the day of HCG injection.. Serum LH, estradiol and testosterone levels were suppressed comparably in both protocols at the start of gonadotrophin administration. Serum LH was suppressed at constant levels without a premature LH surge in the Diane/cetrorelix protocol. The clinical results for both protocols were comparable, with significantly fewer days of injection, lower amounts of gonadotrophin used and lower estradiol levels on the day of HCG injection following the Diane/cetrorelix protocol. Furthermore, there was no significant difference in clinical pregnancy outcome between the two stimulation protocols.. The Diane/cetrorelix protocol has a similar pregnancy outcome to the GnRH agonist long protocol for women with PCOS undergoing IVF treatment.

Topics: Adult; Androgen Antagonists; Cyproterone Acetate; Drug Combinations; Drug Therapy, Combination; Ethinyl Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Hormones; Humans; Incidence; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pilot Projects; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Premedication

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

To evaluate the role of ketoconazole in prevention of ovarian hyperstimulation syndrome (OHSS) in women with the polycystic ovary syndrome (PCOS) undergoing ovarian stimulation with gonadotropins.. Prospective, randomized, double-blind, placebo-controlled study.. University hospitals. One hundred nine women with PCOS who were referred for treatment with gonadotropins.. Fifty patients were randomly assigned to receive two ampoules of hMG beginning on day 2 or 3 of the cycle and ketoconazole (50 mg every 48 hours) starting on the first day of hMG treatment. Fifty-one patients received the same amount of hMG plus one tablet of placebo every 48 hours.. Follicular development, E(2) level, and pregnancy rate.. The total number of hMG ampoules and duration of treatment to attain ovarian stimulation were higher among ketoconazole recipients. The serum E(2) level and number of patients with dominant follicles on day 9 of the cycle were greater in placebo recipients. Serum E(2) level and total number of follicles at the time of hCG administration did not differ between the two groups. The cancellation rate and OHSS rate were similar in the two groups.. Ketoconazole does not prevent OHSS in patients with PCOS who are undergoing ovarian stimulation. It may reduce the rate of folliculogenesis and steroidogenesis.

Topics: Adult; Androgen Antagonists; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Estradiol; Female; Fertility Agents, Female; Humans; Incidence; Infertility, Female; Ketoconazole; Menotropins; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Placebos; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Treatment Failure

In compare the use of purified follicle-stimulating hormone with that of a preparation containing follicle-stimulating hormone and luteinizing hormone in infertile females undergoing IVF.. Open-labelled prospective controlled single-center study.. Nile Badrawy IVF unit.. 153 infertile females undergoing their first cycle of IVF divided into 2 groups.. Ovarian stimulation was done with either highly purified FSH for group 1 (n = 75) or human menopausal gonadotrophin group 2 (n = 78) after pituitary desensitization commenced in the midluteal phase of the preceding cycle. Monitoring was performed by ultrasound transvaginal oocyte retrieval followed by IVF and transfer of three embryos.. Number of oocytes >18 mm at day of hCG, fertilization rate, embryo transfer rate, clinical pregnancy rate and incidence of ovarian hyperstimulation syndrome.. The response to ovarian hyperstimulation was similar in both groups. The number of follicles >18 mm achieved at day of hCG was 12.3 +/- 0.9 (mean +/- SEM) following stimulation with 38.3 +/- 0.9 ampoules of Fostimon The Menogon-treated group needed 39.1 +/- 0.8 ampoules to produce 11.6 +/- 0.7 follicles. Fertilization rate (2PN/cell) was 58.6 vs. 64.2% in the Fostimon and Menogon group, respectively (p > 0.05). The number of embryos transferred per woman was 3.1 +/- 0.1 in the Fostimon group and 3.6 +/- 0.1 in the Menogon group. The pregnancy rate per woman was 33.3 vs. 25.6% in the Fostimon- and Menogon-treated groups, respectively (p > 0.05). Miscarriage rate was 16 vs 20%, respectively. However, the incidence of multiple pregnancies was significantly higher in the Fostimon-treated group (32%) vs. 10% only in the Menogon-treated group (p < 0.01).. Purified FSH yields similar clinical outcome to hMG in terms of oocytes retrieved and clinical pregnancies in a standard IVF regimen.

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Infertility, Female; Injections, Intramuscular; Menotropins; Ovulation Induction; Pregnancy; Probability; Prospective Studies; Single-Blind Method; Treatment Outcome

The objective of this study was to compare, in infertile women suffering from severe hypogonadotropic amenorrhea, the therapeutic utility and the incidence of complications arising from fertility treatment by the conventional human menopausal gonadotropin/human chorionic gonadotropin (hMG-hCG) method, the hMG step-down method, the sequential hMG/gonadotropin-releasing hormone (GnRH) method and a new, modified hMG-GnRH method that has been developed by us. In the step-down method, the daily dose of hMG was decreased from 150 IU to 75 IU when the follicle diameter reached 11-13 mm. In the sequential hMG-GnRH, hMG injection was switched to pulsatile GnRH administration (20 microg/120 min SC), when the follicle diameter reached 11-13 mm. In our new modified hMG-GnRH, pulsatile GnRH was injected together with hMG. Daily hMG was stopped and the GnRH dosage was changed from 10 microg to 20 microg when the follicle diameter reached 11-13 mm. Initially, the three established methods were applied randomly to treat 34 cycles in 20 women; and subsequently, five patients who failed to conceive following treatment by sequential hMG-GnRH were then treated by the modified hMG-GnRH method. More than eight growing follicles and multiple pregnancies were observed during treatment by the conventional method. The incidence of ovarian hyperstimulation syndrome (OHSS) was 25.7% with the conventional method, 20.0% with the step-down method and 0% with the sequential hMG-GnRH method; however, the rate of ovulation was only 50% with the sequential hMG-GnRH method. By contrast, with the modified hMG-GnRH method, less than three growing follicles occurred in 81.8% of patients, there was a 100% rate of ovulation, and neither OHSS nor multiple pregnancies were observed. Moreover, the modified hMG-GnRH method induced pregnancy in 3 out of 5 patients. These data indicate that this new method is favorable for the treatment of severe hypogonadotropic amenorrhea.

Topics: Adult; Amenorrhea; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Prolactin

To determine the relationship of follicle numbers and estradiol (E(2)) levels to multiple implantations in human menopausal gonadotropin (hMG) and clomiphene citrate (CC) cycles.. Fifteen-year prospective study.. Private infertility clinic.. Women who underwent 3608 cycles of husband or donor intrauterine insemination (IUI).. Ovulation induction (OI) with CC, hMG, or CC+hMG.. Pregnancy and multiple implantations.. Triplet and higher-order implantations-but not twin implantations-were related to age, E(2) levels, and number of follicles > or = 12 mm and > or = 15 mm, but not number of follicles > or = 18 mm, in hMG and CC+hMG cycles. For patients less than 35 years old, three or more implantations tripled when six or more follicles were > or = 12 mm, in CC, hMG, and CC+hMG cycles, and when E(2) was > or = 1000 pg mL in hMG and CC+hMG cycles. For patients 35 or older, pregnancy rates in hMG and CC+hMG cycles doubled when six or more follicles were > or = 12 mm, or E(2) levels were >1000 pg mL, whereas 3 or more implantations were not significantly increased.. Withholding hCG or IUI in CC, hMG, and CC+hMG cycles when six or more follicles are > or = 12 mm may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.

Topics: Adult; Age Factors; Clomiphene; Drug Implants; Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Multiple Birth Offspring; Ovarian Follicle; Ovulation; Pregnancy; Prospective Studies; Triplets; Twins

To evaluate the efficacy of various treatments in abolishing premature luteinization in infertile women over 37 years old who are undergoing ovulation induction.. Prospective, nonrandomized study.. Tertiary care medical clinic.. Seventeen infertile women >37 years old in whom premature luteinization was detected during their evaluation (pretreatment) cycle.. The patients underwent three consecutive treatment cycles with clomiphene citrate (group A), hMG (group B), and a GnRH agonist plus hMG (group C).. Premature luteinization, defined as a progesterone/E2 ratio of >1 on the day of hCG administration.. Fifteen (88%) of the 17 patients in group A and 13 (76%) of the 17 patients in group B demonstrated premature luteinization. In contrast, only 1 (6%) of the 17 patients in group C had a progesterone/E2 ratio of >1 on the day of hCG administration. The mean (+/-SD) E2 level on the day of hCG administration was significantly higher in group C (1.236 +/- 772.7 pg/mL) than in group A (214.02 +/- 104.46 pg/mL) or group B (412.5 +/- 337 pg/mL).. Pituitary desensitization with a GnRH agonist in conjunction with hMG may be of benefit for older infertile women who demonstrate early luteinization in their first evaluation cycle.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Maternal Age; Menotropins; Middle Aged; Ovarian Follicle; Ovulation Induction; Pregnancy, High-Risk; Progesterone; Prospective Studies; Treatment Outcome

Our purpose was to determine if pregnancy rates (PRs) for hMG (human menopausal gonadotropin)-stimulated IVF-ET (in vitro fertilization--embryo transfer) can be increased by estradiol (E2) supplementation from the early proliferative phase to the late secretory phase of the endometrium.. Eighty-one infertile women with pure tubal factor were randomized into two groups. One group received no E2 supplementation (control group) and the other received oral E2 supplementation (2 mg two times daily) from the early proliferative phase starting on the third day of the menstrual cycle to the late secretory phase of the endometrium, with hMG stimulation for ovulation induction starting on the sixth day of the menstrual cycle.. In 85 cycles, at least one embryo was transferred. Compared with the control group (n = 27 cycles), the E2 supplementation group (n = 58 cycles) had a significantly higher PR (control, 25.9%, versus E2 supplementation, 48.3%) and IR per ET (control, 10%, versus E2 supplementation, 26%), but FRs per retrieved oocytes were not statistically different between the two groups (control, 74%, versus E2 supplementation group, 73%). Four spontaneous abortions occurred in the E2 supplementation group, and one case in the control group. Ectopic pregnancy occurred in one case in the control group.. Clinical PRs and IRs in the E2 supplementation group were significantly higher than in the control group, while FRs in the control group did not differ statistically from the E2 supplementation group. This suggests that E2 supplementation from the early proliferative phase to the late secretory phase of the endometrium in hMG-stimulated IVF-ET increases the receptivity of the endometrium for transferred embryos and clinical PRs.

Topics: Adult; Embryo Implantation; Embryo Transfer; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate

To evaluate the impact of salpingectomy on the rates of embryo implantation and pregnancy in patients with severe, irreversible tubal factor sterility.. A retrospective study of patients with repeated failure of in vitro fertilization due to nonimplantation of the embryo. Seventy-two patients with severe and irreversible tubal factor sterility were selected following repeated failure of in vitro fertilization (IVF) due to assumed nonimplantation of the embryo: 35 underwent a salpingectomy before continuing IVF cycles and 37 continued IVF cycles without salpingectomy.. After the first IVF cycle consecutive to diagnosis of embryo nonimplantation, the implantation rate was 10.2% in the salpingectomy group and 6.1% in the group without the procedure (P = 0.5). After all IVF cycles, the rate was, respectively, 6.9% and 4.5% (P = 0.2). Salpingectomy improved the pregnancy rate (PR) per transfer (23.5% vs. 9.9%; P = 0.01). The curves of the cumulative probability of becoming pregnant show that salpingectomy resulted in pregnancy more rapidly.. Salpingectomy improves the PR per transfer in patients with severe and irreversible tubal factor sterility who have experienced repeated failure of IVF due to embryo nonimplantation. This procedure also reduces the number of IVF attempts needed to obtain pregnancy.

Topics: Adult; Embryo Implantation; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Male; Menotropins; Pregnancy; Pregnancy Rate; Retrospective Studies

To evaluate the efficacy of the GnRH agonist (GnRHa) administered in conjunction with human menopausal gonadotropin/human chorionic gonadotropin hMG/hCG and direct intraperitoneal insemination (DIPI) in women with long-standing unexplained infertility.. A prospective, randomized, non-blind analysis. During the period May 1995-December 1996, couples with unexplained infertility who failed to conceive following superovulation combined with IUI for at least seven cycles were prospectively enrolled and followed. Pregnancy rates per cycle and per patient of DIPI were compared between groups of hMG/hCG with (GnRHa[+] controlled ovarian hyperstimulation [COH] group) or without (GnRHa[-] COH group) GnRHa.. Thirty-four women (59 cycles) underwent COH with hMG and GnRHa, and 31 women (49 cycles) received hyperstimulation with hMG alone. The pregnancy rates for the women administered GnRHa significantly exceeded those of the patients who did not receive GnRHa both per treatment cycle (35.6% versus 14.3%) and per couple (55.9% versus 22.5%).. The use of GnRHa with hMG/hCG and DIPI treatment significantly increased the pregnancy rate in women with long-standing infertility.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Luteinizing Hormone; Menotropins; Pregnancy; Pregnancy Rate; Progesterone; Prospective Studies

Oestrogen plays an important role in follicular formation and oocyte maturation via its receptor (ER). Many studies have shown association of the ER gene polymorphisms with a variety of pathological conditions. In this study we have examined the relationship of a common PvuII and a rare BstUI polymorphism in the ER gene to the mean numbers of follicles and oocytes, their mean ratios, mean number of embryos, mean oestrogen concentrations, mean size of the follicles and pregnancy rates. Analyses were carried out in 200 local Chinese patients undergoing in-vitro fertilization (IVF) and embryo transfer in three consecutive cycles. The mean follicular number, oocyte number, embryo number, follicular size and pregnancy rate were significantly smaller in patients homozygous for PvuII polymorphism (P < 0.001). These results indicate that PvuII polymorphism may be associated with ovarian follicular development and subsequently with the pregnancy rate. This study supports the view that genetic variability in the ER gene may have a role in the quality of the ovarian follicles in stimulation, which may affect implantation. However BstUI polymorphism was not found in either the IVF or control groups, suggesting that it has no role in the local Chinese population.

Topics: Adult; Animals; Asian People; Buserelin; Cell Size; Deoxyribonucleases, Type II Site-Specific; Drug Administration Schedule; Embryo Transfer; Estradiol; Estrogen Receptor alpha; Female; Fertility Agents, Female; Fertilization in Vitro; Homozygote; Humans; Infertility, Female; Menotropins; Oocytes; Ovarian Follicle; Ovary; Ovulation Induction; Polymorphism, Genetic; Pregnancy; Pregnancy Rate; Progesterone; Receptors, Estrogen; Singapore; Treatment Outcome

The purpose of this study was to compare the efficacy of highly purified follicle-stimulating hormone (FSH-HP) alone versus the combination of FSH-HP + human menopausal gonadotropin (hMG) treatment during pituitary suppression with gonadotropin-releasing hormone (GnRH) analog on the clinical outcome and endocrine parameters in 120 randomized women undergoing gamete intra-Fallopian transfer (GIFT) for unexplained infertility. Our data did not show any significant difference between the two groups as regards dose of administered gonadotropins, duration of treatment, estradiol 17 beta 17 beta increase curves, number of follicles > 16 mm, number of recruited and transferred oocytes, and endometrial thickness. The percentages of clinical pregnancies (33.3% with FSH-HP and 31.6% with FSH-HP + hMG), of miscarriages and twin gestations were also similar in the two groups. It is concluded that, during GnRH analog suppression, FSH-HP treatment alone is effective in inducing normal follicular steroidogenesis and adequate oocyte maturation, but no detrimental effect of luteinizing hormone (LH) activity of hMG on the outcome of the outcome of ovarian stimulation was found.

Topics: Adult; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome

To describe endometrial wavelike activity, endometrial thickness, and texture in controlled ovarian hyperstimulation (COH) cycles.. Prospective observational ultrasound study.. University hospital-based infertility clinic.. Thirty-five COH cycles in 19 women with unexplained infertility.. Transvaginal ultrasound examination was performed throughout COH cycles. Intrauterine insemination was performed after hCG administration.. Endometrial wavelike activity, wave frequency, wave velocity, endometrial thickness, and endometrial texture.. Endometrial wavelike activity increased from menstruation to ovulation and decreased in the luteal phase. On day hCG+2, endometrial wave-like activity was observed in all cycles. Waves from cervix to fundus prevailed in the periovulatory phase. Endometrial wavelike activity was related significantly to endometrial thickness at the start of ovarian stimulation and in the luteal phase. Endometrial thickness increased throughout the cycle. Endometrial texture showed periovulatory a triple-line aspect.. In COH cycles, endometrial wavelike activity is more pronounced than in spontaneous cycles. The number of follicles and endometrial wavelike activity were not correlated significantly. This is the first prospective study to provide longitudinal observational evidence that endometrial thickness increases throughout the COH cycle and that a triple line pattern develops.

Topics: Adult; Endometrium; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Prospective Studies; Ultrasonography

The aim of this study was to evaluate the ovarian cysts appearing during GnRH-a/hMG treatment in patients with polycystic ovarian syndrome (PCOS). A total of 35 women with PCOS were included in the study. All women received 3.75 mg IM of long-acting leuprolide acetate on the first day of the menstrual cycle. On the 15th day of the menstrual cycle, transvaginal ultrasound examination (US) and determination of serum E2 were done. A total of 90 cycles were studied in this way and during these cycles, 14 (15.5%) ovarian cysts with a diameter of >/= 20 mm developed. According to the serum E2 levels, 11 cases (group A) had E2 concentrations > 35 pg/ml and 3 (group B) had serum E2 levels < 35 pg/ml. Group A patients attained a significantly larger mean size of ovarian cyst than group B patients (42 +/- 7.3 vs. 24.2 +/- 3.2 mm, p < 0.001). When the serum E2 concentrations were < 35 pg/ml, the ovarian cysts were disregarded and ovarian stimulation with gonadotropins was initiated. In case that serum E2 levels were > 35 pg/ml, the initiation of the ovarian stimulation with hMG was postponed until serum E2 levels indicated down-regulation, which was achieved after 5.8 +/- 2.9 days. In both groups the ovarian stimulation resulted in ovulatory cycles, while four pregnancies in group A and one in group B were achieved. In conclusion, our results indicate that in patients with PCOS the GnRH-a administration may cause follicular cysts at an incidence of 15.5%. These cysts do not constitute a contraindication for ovarian stimulation provided that serum E2 levels are low.

Topics: Adult; Estradiol; Female; Humans; Infertility, Female; Leuprolide; Menotropins; Ovarian Cysts; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

A randomized clinical trial was performed comparing recombinant follicle stimulating hormone (rFSH, Puregon, n = 54) and human menopausal gonadotrophin (HMG, Humegon, n = 35) in infertile women undergoing in-vitro fertilization without the use of a gonadotrophin-releasing hormone (GnRH) agonist. Most patients had a tubal or idiopathic infertility, the latter always longer than 4 years' duration. Patients with sperm abnormalities were excluded. None of the between-group differences in treatment outcome was statistically significant. In the rFSH group, a mean number of 11.2 oocytes was retrieved compared with 8.3 in the HMG group. Ongoing pregnancy rates per started cycle were higher in the rFSH group (22.2%) than in the HMG group (17.1%). Implantation rates were 27.5% in the rFSH group in comparison with 16.7% in the HMG group. In the rFSH group, a mean total dose of 1410 IU during 6.2 days was administered compared with 1365 IU in 6.0 days in the HMG group. Oestradiol concentrations on the day of human chorionic gonadotrophin administration were 3889 pmol/l in the rFSH group and 3145 pmol/l in the HMG group. In 15 subjects (rFSH: n = 9, 16.7%; HMG: n = 6, 17.1%) luteinizing hormone concentrations higher than 10 IU/l were seen during stimulation. In two of them, both from the rFSH group, ongoing pregnancies were achieved. The results indicate that rFSH (Puregon) is at least as efficacious as HMG and that acceptable pregnancy rates can be achieved without the use of a GnRH agonist.

Topics: Adult; Embryo Implantation; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Pregnancy; Prospective Studies; Recombinant Proteins

The aim of this work was to compare the efficiency of standard intrauterine insemination (IUI) and Fallopian tube sperm perfusion (FSP) in the treatment of infertility. Ninety-six consecutive patients with infertility in 100 cycles were included in the study. Those randomized to standard IUI included 48 patients in 50 cycles [25 clomiphene citrate only and 25 clomiphene citrate/human menopausal gonadotrophin (HMG) cycles] (group I). Patients subjected to FSP included 48 patients in 50 cycles (18 clomiphene citrate only and 32 clomiphene citrate/HMG cycles) (group II). The overall pregnancy rate per cycle (16% versus 18%) was not significantly different in the two groups. The pregnancy rates were also similar in the two groups when compared for the cause of infertility: ovulatory disorder 16.7% versus 16%, tubal impairment 10% versus 9.1%, cervical hostility (no pregnancy occurred in this group) and unexplained infertility 21.4 % versus 25 %. The overall pregnancy rate (for the two groups) appeared higher when clomiphene citrate/HMG was used for ovulation induction (21.1%) than when clomiphene citrate only was used (11.6%).

Topics: Adolescent; Adult; Clomiphene; Fallopian Tubes; Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Perfusion; Pregnancy; Treatment Outcome; Uterus

A randomized, nonplacebo controlled study was conducted to determine the effect of dexamethasone supplementation to a protocol of gonadotropin therapy in 42 "low-responder patients" aged 32 to 43 years.. All underwent at least two previous cycles treated by gonadotropins for unexplained infertility, or anovulation. Human menopausal gonadotropin was started on day 4 of the menstrual cycle combined with dexamethasone 0.5 mg administered nightly, as an adjuvant. A group of "low responders" who did not receive dexamethasone served as the controls. The number of follicles, total amount of gonadotropins used, time required for stimulation, fertilization, peak estradiol levels and pregnancy rate were evaluated.. The number of developing follicles, estradiol levels, fertilization rate and pregnancy rate did not differ significantly.. Although certain beneficial effects were observed in the literature in some of the infertile patients treated with corticosteroids, the overall results did not support daily, low-dose dexamethasone (long-acting corticosteroid) as a clinically useful adjuvant therapy for "low responders" during gonadotropin therapy.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Drug Resistance; Drug Therapy, Combination; Estradiol; Female; Fertilization; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Rate; Treatment Outcome

We present the results of a prospective randomized trial comparing the issue of IVF-ET and of ICSI when either highly purified human folliculostimulin (FSH-HP) or human menopausal gonadotrophin (hMG) is used. There seems to be a trend to a better rate of ongoing pregnancies when FSH-HP is used although not statistically significant. The study has been stopped due to the lack of hMG.

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Prospective Studies

Forty normally ovulating women aged 25-38 years from one private and two university in vitro fertilization (IVF) centres were used in this randomized, double-blind, parallel, placebo-controlled study to explore the effect of recombinant human growth hormone (GH) on follicular fluid (FF) levels of steroid hormones, particularly androgens. All the women had tubal factor infertility and were classified as poor responders with at least two previously performed and failed IVF treatments in which less than five oocytes had been retrieved following ovarian hyperstimulation. Growth hormone (GH 0.1 IU/kg body wt per day) or placebo was given as pretreatment during down-regulation with gonadotropin-releasing hormone agonist and during stimulation with human menopausal gonadotropin (hMG) according to the randomized protocol. Follicular fluid concentrations of steroids were measured and changes related to the levels of insulin-like growth factor I (IGF-I) and IGF binding proteins 1 and 3 and to the mode of GH administration. Pretreatment with GH, i.e. administration of GH before hMG stimulation only, caused significantly elevated follicular fluid concentrations of estrone, testosterone and dehydroepiandrosterone (DHEA) and higher values for markers of aromatase activity (ratios between estrone and androstenedione and between estradiol-17 beta and androstenedione) than in the placebo group, as well as in the two groups receiving GH during hMG stimulation. The highest values for markers of steroid sulfatase activity (ratios between DHA and DHEA sulfate and between unconjugated and conjugated estrone) were found in the patients pretreated with GH. Positive correlations were found between follicular fluid IGF-I and IGF binding protein 3 on the one hand and androgens on the other. This study showed that the administration of adjuvant GH to women who were poor responders to gonadotropins alters the endocrine/paracrine ovarian response to gonadotropins.

Topics: Adult; Androgens; Androstenedione; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Double-Blind Method; Estradiol; Estrone; Female; Fertilization in Vitro; Follicular Fluid; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor Binding Protein 3; Menotropins; Placebos; Recombinant Proteins; Testosterone

To analyze the effect of high dose human FSH in combination with hMG with a flare-up leuprolide acetate (LA) protocol in patients undergoing IVF at risk for a poor response.. Prospective.. Free-standing ambulatory IVF center.. Two hundred eighty-four patients underwent a LA screening test for IVF. Patients with a lack of flare response were considered at risk for a poor response and underwent ovarian stimulation with the flare-up LA protocol in combination with high dose human FSH and hMG.. The poor responder group was compared with the good responders on the flare-up LA protocol and to patients undergoing ovulation induction with a luteal phase LA protocol. There were 53 poor responder flare-up LA cycles, 177 good responder flare-up LA cycles, and 54 luteal phase LA cycles. The cancellation rate was higher in poor flare-up LA responders (11.3 percent) compared with good flare-up LA responders (1.1 percent) and luteal phase LA cycles (1.8 percent). Peak E2 levels, number of oocytes, and number of embryos were significantly higher in the good flare-up LA responders. Fertilization rate was similar in all groups. Ongoing pregnancy rate per retrieval was 28 percent in good responders, 29 percent in poor responders, and 33 percent in luteal phase LA patients. Only one patient (0.4 percent) was hospitalized for severe ovarian hyperstimulation.. The flare-up protocol with high-dose human FSH and hMG is a very good alternative for patients who are at high risk for a poor response. Although peak E2 and number of oocytes were significantly lower in this group, the patients who responded had the same fertilization and pregnancy rate as the good responders. Cancellation rate remains high in poor responders.

Topics: Adult; Clinical Protocols; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Male; Menotropins; Pregnancy; Prospective Studies

Three women with hypogonadotrophic hypogonadism, all desiring pregnancy, participated in a prospective open study attempting to assess the ability of the human corpus luteum to recover after 7 days of deprivation from gonadotrophin stimulation. Follicular growth was induced by gonadotrophins. An endogenous luteinizing hormone (LH) surge was induced by the s.c. injection of a gonadotrophin-releasing hormone agonist. For luteal support, 10 mg/day oral medroxyprogesterone acetate were given for 7 days, after which a single i.m. injection of human chorionic gonadotrophin (HCG) was administered. Monitoring during the follicular phase consisted of daily measurements of serum oestradiol, LH and follicle stimulating hormone (FSH) concentrations, and of follicular growth by transvaginal ultrasonography. During the luteal phase, monitoring consisted of measurements of serum concentrations of LH, FSH, oestradiol, progesterone, 17-hydroxyprogesterone and beta-HCG. Ovulation and luteinization occurred in two patients, demonstrated by transient marked increases in serum progesterone and 17-hydroxyprogesterone concentrations which decreased to basal preovulatory values and increased again following the administration of HCG 7 days later. In the third patient, ovulation and luteinization did not occur, and the subsequent administration of HCG did not result in an increase in progesterone concentration. Of the two patients who ovulated, one conceived and the second had a luteal phase of 15 days duration. Our preliminary results suggest that the human corpus luteum can be 'rescued' and can function normally after 7 days of deprivation from gonadotrophin stimulation in patients with hypogonadotrophic hypogonadism.

Topics: 17-alpha-Hydroxyprogesterone; Adult; Buserelin; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Corpus Luteum; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hydroxyprogesterones; Hypogonadism; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Progesterone

It has been suggested that the luteinizing hormone (LH) activity of human menopausal gonadotrophin (HMG) preparations used for ovarian stimulation in in-vitro fertilization (IVF) may have adverse effects on reproductive outcome. In the present prospective, randomized trial of 218 infertile couples this notion was investigated. A total of 114 women were treated with Pergonal (HMG group) and 104 with Fertinorm HP (HP-FSH group). The two groups were comparable with regard to duration of infertility, cause of infertility, age and number of previous IVF attempts and all had normal basal gonadotrophin concentrations before treatment was started. A standard hormonal treatment consisting of pituitary down-regulation with gonadotrophin-releasing hormone analogue (GnRHa) for 14 days starting on cycle day 21, followed by either HMG or highly purified follicle stimulating hormone (HP-FSH), three ampoules (225 IU) per day for 7 days, was used in all cases. The daily hormone dose was thereafter individualized according to the ovarian response. A maximum of two pre-embryos were transferred after 3 days of culture. Luteal support with progesterone (300 mg per day intravaginally) was used in all cases. Serum concentrations of oestradiol, FSH and LH were measured on days 1 and 8 of stimulation and on the day of oocyte retrieval. The mean number of days of stimulation, mean number of ampoules of HMG or HP-FSH used, mean total motile sperm count on the day of oocyte retrieval and mean numbers of oocytes retrieved (13.4 versus 13.7) or pre-embryos transferred (1.8 versus 1.8) were similar for both groups. Significantly (P < 0.05) more cycles in the HP-FSH group (17 = 16%) were cancelled due to complete failure of fertilization than in the HMG group (7 = 6%). The mean fertilization rate was significantly (P < 0.05) higher in the HMG group (56%) than in the HP-FSH group (50%), and significantly more transferable pre-embryos were obtained in the HMG than in the HP-FSH group (mean: 4.0 versus 3.2; P < 0.01). Serum hormone concentrations were similar to the two groups on stimulation day 1, but differed significantly with regard to FSH, LH and oestradiol on stimulation day 8. The clinical outcome was similar in the two groups, with an ongoing pregnancy rate (> 12 weeks of gestation) per started cycle of 33% in the HMG group and 29% in the HP-FSH group. The clinical abortion rates were similar (10 and 14%), and the implantation rate was 30% in each group. In conclusion, no detriment

Topics: Adult; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies; Sperm Motility; Treatment Outcome; Triptorelin Pamoate

To analyze sonographically the endometrium in patients undergoing controlled ovarian stimulation with menotropins in order to determine the significance of endometrial pattern and thickness on pregnancy rate.. This is a prospective, nonrandomized study comparing pregnancy rates in patients with hyperechoic homogeneous patterns with those in patients with isoechoic or hypoechoic trilaminar patterns.. Tertiary infertility center.. All patients receiving menotropin therapy at a tertiary infertility center.. All patients received individualized dosing of hMG starting on cycle day 3. Transvaginal sonography was performed 15 hours before hCG administration and the endometrium was assessed.. Occurrence of pregnancy as determined by serially rising beta-hCG titers and sonographic confirmation.. During the study period, 175 patients were evaluated. Thirty-four (19%) patients had a homogeneous endometrium, whereas 141 (81%) patients had a trilaminar pattern. There was 1 pregnancy (2.9%) among women with a homogeneous endometrial pattern and 33 pregnancies (23%) among those with a trilaminar pattern. No significant differences were found in mean E2 level, follicle numbers, parity, and diagnosis between the two groups.. In patients receiving menotropins, a homogeneous pattern is a bad prognostic sign, regardless of endometrial thickness.

Topics: Adult; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Endometrium; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Rate; Prospective Studies; Ultrasonography

To assess whether intrauterine insemination (IUI) improves the fertility rates in women with unexplained infertility.. We recruited 68 women with unexplained infertility and allocated them randomly to treatment with three to five cycles of superovulation plus IUI (36 patients) or superovulation alone (32 patients). Superovulation was obtained with clomiphene citrate, human menopausal gonadotropins and human chorionic gonadotropins.. The cycle fecundity rate was 10% in patients who underwent superovulation alone and 19% in those treated with superovulation plus IUI (P < .05).. Our results demonstrate that superovulation plus IUI is more effective than superovulation alone in the treatment of unexplained infertility.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Superovulation

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

Topics: Adult; Chorionic Gonadotropin; Estradiol; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Kinetics; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Gland

To study ovarian stimulation and response patterns during a gonadotropin step-down dose regimen for induction of ovulation by applying a decremental dose regimen in polycystic ovary syndrome (PCOS) patients.. The present prospective study involves 28 infertile clomiphene citrate-resistant PCOS patients during gonadotropin-induced cycles using a modified step-down dose regimen (and adjuvant GnRH agonist medication). Applied gonadotropin doses included initial daily doses of 150 IU IM followed by two reducing steps (37.5 IU each) based on sonographic criteria to a final daily dose of 75 IU IM.. Anovulatory infertile women in an academic referral center.. Daily blood withdrawal and transvaginal pelvic ultrasound.. Serum FSH and E2 concentration and follicle growth were investigated daily during gonadotropin administration.. An initial 2.1-fold increase in serum FSH levels was observed followed by a subsequent decrease of 10% (median) per day for 4 days. Growth of ovarian follicles was sustained and ovulation achieved (midluteal P, 11.7 +/- 1.3 ng/mL; conversion factor to SI unit, 3.180; mean +/- SD) in 22 patients. Major variability in day 3 E2 increase (range, 67 to 866 pg/mL; conversion factor to SI unit, 3.671)--not related to differences in FSH serum concentrations and without changes in follicle number and size--suggests differences in ovarian sensitivity for FSH stimulation. A strong correlation (r = 0.82) was found between day 3 E2 increase and the chance of ovulation. Moreover, E2 levels on the day of gonadotropin dose reduction predict (r = 0.68) chances of late follicular phase E2 levels exceeding 871 pg/mL (conversion factor to SI value, 3.671).. These findings provide the endocrine basis for the concept of gonadotropin induction of ovulation using a step-down dose regimen. Initial E2 increase (before initiation of follicle growth) represent differences in ovarian sensitivity to gonadotropins and predict treatment outcome.

Topics: Buserelin; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies

To examine the null hypothesis that women with polycystic ovary syndrome (PCOS) produce similar levels of prorenin and other components of the ovarian-derived prorenin to angiotensin cascade (ODPAC) at baseline and after stimulation with clomiphene citrate (CC) or hMG when compared with normal age- and weight-matched ovulatory controls.. Prospective controlled clinical trial.. Infertility clinic in a university-based county hospital and a hospital-based private infertility practice.. Twenty-eight infertile women aged 18 to 35 years. Thirteen patients were diagnosed with PCOS. Fifteen normal ovulatory patients who were matched for age and weight served as controls.. Twenty patients were stimulated with CC and eight were stimulated with hMG.. Serum E2, P, T, androstenedione (A), DHEAS, LH, FSH, and plasma prorenin, active renin, and angiotensin II (Ang II) were measured at baseline and during the preovulatory and midluteal phases of the stimulation cycles.. Baseline plasma prorenin in PCOS was higher than that of follicular phase controls. Plasma prorenin correlated significantly with peripheral androgen levels. Prorenin, active renin, and Ang II increased in response to gonadotropins with the largest increases occurring in control patients receiving CC. An association was seen between ovulation with CC and lower baseline levels of active renin.. The null hypothesis was rejected. Infertile women with PCOS have higher baseline prorenin levels when compared with age- and weight-matched ovulatory controls. There is a significant correlation between prorenin and the peripheral levels of androgens produced during ovarian stimulation. Baseline active renin levels may be predictive of ovulation with CC.

Topics: Adolescent; Adult; Androstenedione; Angiotensin II; Clomiphene; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Enzyme Precursors; Female; Humans; Hyperandrogenism; Infertility, Female; Matched-Pair Analysis; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Renin; Testosterone

To evaluate the efficacy and tolerability of treatment with goserelin + HMG vs bromocriptine + FSH + HMG in the induction of ovulation in patients with ovarian polycystosis.. A randomized prospective study.. Sterile women with ovarian polycystosis of the first type not responding to clomiphene citrate.. Group A: bomocriptine + FSH + HMG (10 patients); Group B: goserelin depot (Zoladex) + HMG (18 patients).. A greater percentage of ovulations, pregnancies and a higher success rate were obtained in Group B. The percentage of hyperstimulation was similar in both groups; there was a higher percentage of abortion in Group A. Cycle duration and the number of phials of gonadotropin were greater in Group B.. Treatment with bromocriptine + gonadotropin remains the simplest; the treatment protocol based on geserelin depot + gonadotropin proved to be more efficacious.

Topics: Adult; Bromocriptine; Clinical Protocols; Dose-Response Relationship, Drug; Female; Follicle Stimulating Hormone; Goserelin; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome

To evaluate the relative efficacy of a new system for fallopian tube sperm perfusion in comparison with standard IUI in controlled ovarian hyperstimulation (COH) cycles.. Prospective randomized trial.. Ovulation induction program of a tertiary outpatient care center, Hôpital Antoine Béclère, Clamart, France.. We studied 74 infertile women aged 20 to 38 years undergoing 100 cycles of COH from December 1993 to May 1994 only excluding cases of age > 38 years, obstructed or severely damaged fallopian tubes, E2 levels per mature follicle < 250 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration, spontaneous LH surge, and cases of marked sperm abnormalities.. Controlled ovarian hyperstimulation was achieved using three types of ovarian stimulation protocols: clomiphene citrate (CC) and hMG (n = 35). hMG alone (n = 35) or GnRH agonist and FSH and hMG (n = 30). Thirty-six hours after hCG administration, patients were assigned randomly to either IUI (group A, n = 50) or fallopian tube sperm perfusion (group B, n = 50). Intrauterine insemination was performed with 0.2 mL of sperm suspension according to a standard technique. Fallopian tube sperm perfusion was performed using a simple and reliable system that ensures a good cervical seal and allows to a pressurized injection of 4 mL of sperm suspension.. Feasibility of the fallopian tube sperm perfusion method, clinical pregnancy (presence of gestational sac with heart beats at 6 weeks of amenorrhea), and ongoing pregnancy rates (PRs) (> 12 weeks of amenorrhea), incidence of complications (multiple pregnancies and ovarian hyperstimulation syndrome [OHSS]).. Overall, the new fallopian tube sperm perfusion system was simple to handle and well tolerated by patients. In group A, we observed 10 clinical pregnancies (20% per cycle) of which 7 were ongoing (14%). In group B, 20 clinical pregnancies (40% per cycle) of which 17 ongoing pregnancies (34%) were obtained. These differences were statistically significant. The prevalence of twin and three or more sac pregnancies was similar in the two groups (3/10 and 0/10, respectively, in group A, and 5/20 and 2/20, respectively, in group B). No case of moderate or severe OHSS was observed in this series.. Our results indicate that the new system for fallopian tube sperm perfusion is not only simple and reliable but also may lead to PRs twice as high as standard IUI in COH cycles.

Topics: Adult; Clomiphene; Fallopian Tubes; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies; Triptorelin Pamoate; Uterus

To evaluate the outcome of oocytes donated by women with polycystic ovarian syndrome (PCOS) compared with oocytes donated by women with mechanical infertility.. A retrospective study.. The outcome of 159 oocyte donation cycles with oocyte donated by PCOS patients were compared with 69 oocyte donation cycles with oocytes donated by patients with mechanical infertility. We compared the stimulation protocols in the donors to assess if the combination of GnRH analogue (GnRH-a), FSH, and hMG has an advantage over FSH and hMG alone with respect to their effect on fertilization and implantation rates in oocyte donation cycles.. When treated with GnRH-a, pregnancy rates in PCOS and mechanical infertility donors were higher than those treated with FSH and hMG alone. The comparison between PCOS and mechanical factor oocyte recipients revealed no significant difference in the pregnancy and abortion rates, but the oocytes of patients with PCOS that were exposed to GnRH-a had a significantly higher implantation rate than those not exposed to GnRH-a.. Oocytes obtained from PCOS patients had a fertilization potential equal to oocytes obtained from mechanical infertility donors. Furthermore, because the oocytes of patients with PCOS exposed to GnRH-a had a significantly higher implantation rate, a detrimental role of high LH on oocyte quality seems probable. However, because PCOS has a high familial prevalence, some reservations may arise due to a possible propagation of the problem in the next generation of oocyte donation programs.

Topics: Embryo Implantation; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Oocyte Donation; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies; Triptorelin Pamoate

A total of 82 normogonadotrophic clomiphene-resistant anovulatory patients were treated with exogenous gonadotrophins according to a step-down dose regimen during 234 cycles. In 43 (18%) cycles co-treatment with gonadotrophin-releasing hormone analogues was applied. The initial dose was between 1.5 and 2.5 ampoules (75 IU follicle-stimulating hormone each) per day (dependent on body weight), and decreasing steps of 0.5 ampoules/day were based on sonographic findings. The overall ovulation rate was 91% (213 cycles). The median treatment period was 11 days and a total of 14 ampoules of gonadotrophin were needed. In 131 (62%) of the ovulatory cycles not more than one, and in 208 (98%) cycles not more than two, follicles > or = 16 mm were present on the day human chorionic gonadotrophin was given. A total of 37 pregnancies occurred of which two were twins and one was a triplet (multiple pregnancy rate 8%). The pregnancy rate per cycle was 17% and the cumulative pregnancy rate after 7 months was 47%. The abortion rate was 19%. There were four (1.7%) cases of mild ovarian hyperstimulation, of which none became pregnant. In conclusion, this study shows that the applied step-down regimen for gonadotrophin induction of ovulation can be a safe and effective treatment alternative for patients with clomiphene-resistant anovulation. The duration of ovarian stimulation and the amount of exogenous gonadotrophin required is limited. Pregnancy rates are comparable with those reported for step-up regimens, and a low incidence of complications (i.e. multiple gestation and ovarian hyperstimulation) was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Buserelin; Chorionic Gonadotropin; Clomiphene; Drug Resistance; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Time Factors

Our objective was to assess the effects of subtle increases in serum progesterone concentration (1.0-2.0 ng/ml) on the outcome of in-vitro fertilization (IVF), particularly on the quality of embryos, during the follicular phase of cycles stimulated with gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG). A total of 97 patients underwent 116 cycles of IVF and were stimulated with a combination of HMG and GnRHa. They were divided into two groups: those with a subtle progesterone rise and those with no progesterone rise. The two groups were compared with respect to serum oestradiol, progesterone, immunoreactive luteinizing hormone (I-LH), bioactive LH (B-LH), and results of IVF. The groups did not differ significantly in mean age or in total dose of HMG received. On the day that human chorionic gonadotrophin was administered, concentrations of oestradiol and progesterone were significantly higher in the subtle progesterone rise cycles than in the no progesterone rise cycles. In the no progesterone rise cycles, the percentages for embryos beyond the 4-cell stage, grade 1 embryos, and implantation rates were significantly higher than those in subtle progesterone rise cycles. The combination of GnRHa and HMG eliminated any significant rise in serum I-LH or B-LH concentration during the follicular phase, but did not suppress the subtle rise in progesterone. These results confirm our previous finding that a subtle progesterone rise adversely affects the outcome of IVF. It is also suggested that a reduction in embryo quality may influence the lower rate of implantation in subtle progesterone rise cycles.

Topics: Adult; Buserelin; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Follicular Phase; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Pregnancy; Progesterone

This study was undertaken to investigate a possible relationship between endogenous secretion of growth hormone (GH) during ovarian stimulation and treatment outcome in patients undergoing in-vitro fertilization (IVF) and embryo transfer. Plasma samples obtained from 19 women who had successfully completed all stages of IVF/embryo transfer were analysed retrospectively. Based on the increase in GH during treatment, 11 GH responders and eight GH non-responders were identified. Mean daily GH concentrations for the GH responders and GH non-responders were 3.5 +/- 1.8 and 1.8 +/- 0.8, 5.4 +/- 2.3 and 0.5 +/- 0.2, and 9.0 +/- 1.9 and 0.7 +/- 0.1 ng/ml (P < 0.05) for days 10, 11 and 12 respectively. Plasma insulin-like growth factor-I slightly increased with treatment in both groups. No significant difference between these groups was found in relation to treatment duration, number of human menopausal gonadotrophin ampoules used, oestradiol peak values, and number of oocytes retrieved or fertilization rate. Seven of the 11 GH responder women conceived in comparison with one pregnancy among eight GH non-responder patients (P < 0.05). In view of the absence of differences in the clinical and laboratory parameters, we suggest that the occurrence of pregnancies among GH responder patients might be related to a positive local effect of GH or its mediators on uterine receptivity at the time of nidation.

Topics: Adult; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor I; Menotropins; Ovulation Induction; Pregnancy; Reproductive Techniques; Retrospective Studies

The elevated luteinizing hormone (LH) and androgen concentrations characteristic of women with polycystic ovaries (PCO) are considered crucial factors in their infertility. The somatostatin analogue octreotide lowers LH and androgen concentrations in women with PCO. The effects of octreotide given concurrently with human menopausal gonadotrophin (HMG) were therefore compared with that of HMG alone in 28 infertile women with PCO resistant to clomiphene. In 56 cycles of combined HMG and octreotide therapy there was more orderly follicular growth compared with the multiple follicular development observed in 29 cycles in which HMG was given alone (mean number of follicles > 15 mm diameter on the day of human chorionic gonadotrophin (HCG) administration: 2.5 +/- 0.2 and 3.6 +/- 0.4 respectively; P = 0.026). There was a significantly reduced number of cycles abandoned (> 4 follicles > 15 mm diameter on day of HCG) in patients treated with octreotide+HMG, so that HCG had to be withheld in only 5.4% of cycles compared to 24.1% with HMG alone (P < 0.05). The incidence of hyperstimulation was also lower on combined treatment. Octreotide therapy resulted in a more 'appropriate' hormonal milieu at the time of HCG injection, with lower LH, oestradiol, androstenedione and insulin concentrations. Although growth hormone concentration was similar on both regimens, significantly higher insulin growth factor-I concentrations were observed on the day of HCG in women on combined therapy than on HMG alone.

Topics: Adult; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadal Steroid Hormones; Humans; Infertility, Female; Insulin; Luteinizing Hormone; Menotropins; Octreotide; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

We studied the peri-ovulatory and luteal phases in 38 human menopausal gonadotrophin (HMG)-stimulated cycles, in which ovulation was triggered with four different i.v. bolus ovulation triggers: 100 micrograms gonadotrophin-releasing hormone (GnRH; group A, n = 9), 500 micrograms GnRH agonist (GnRHa; group B, n = 10), 10,000 IU human chorionic gonadotrophin (HCG; group C, n = 10) and 500 micrograms GnRH (group D, n = 9). Endogenous luteinizing hormone (LH) surges occurred in all cycles of groups A, B and D. The rise was slowest but highest in group B (P < 0.0001) and lowest in group A. Although the t0 serum oestradiol values were similar in all groups, day +8 oestradiol and day +4 and +8 progesterone concentrations were higher in group C (P < 0.05). At day +4 and +8, serum LH concentrations were lowest (P < 0.01) but follicle stimulating hormone (FSH) concentrations were higher. Clinically, day +8 luteal scores showed a more conspicuous degree of ovarian hyperstimulation in the HCG group (P = 0.0292). Luteal insufficiency, defined as cycles with progesterone concentrations of < 8 ng/ml, occurred much more frequently in groups A, B and D than in group C (day +4: P < 0.0003; day +8: P < 0.0001), despite progesterone supplementation. Three pregnancies (one in group C and two in group D) and one moderate case of ovarian hyperstimulation syndrome (OHSS) (in a non-conceptional group D cycle) occurred. These findings show that (i) ovulation occurs and pregnancy can be achieved following an endogenous LH surge induced by GnRH and its agonists, (ii) a high frequency of luteal insufficiency occurs in such cycles even with luteal supplementation and (iii) OHSS cannot be totally prevented by this approach, although cycles with an endogenous LH surge in general result in fewer subclinical signs of ovarian hyperstimulation.

Topics: Buserelin; Chorionic Gonadotropin; Corpus Luteum Maintenance; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections, Intravenous; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Pregnancy; Progesterone

A randomized, assessor-blind, group-comparative study was performed to compare the efficacy of Normegon [75 IU follicle stimulating hormone (FSH) and 25 IU luteinizing hormone (LH) and Metrodin (75 IU FSH and < 1.25 IU LH) in infertile women undergoing in-vitro fertilization (IVF) and embryo transfer. None of the patients were pituitary-suppressed by means of gonadotrophin-releasing hormone (GnRH)-agonist treatment. They were randomized in blocks of five with a ratio between treatment with Normegon and with Metrodin of 3:2. A total of 158 patients started hormonal treatment, i.e. 93 patients with Normegon and 65 patients with Metrodin and a total of 248 cycles were performed. Evaluation of first treatment cycles included statistical analysis of the total number of ampoules, number of follicles (> or = 14 mm), serum oestradiol concentrations on the day of HCG (10,000 IU) administration, the number of oocytes retrieved and the ongoing pregnancy rate per attempt and per transfer. For none of these parameters were significant differences revealed. In both groups the median duration of stimulation was 7 days and the median number of ampoules used was 21. Overall, the duration of treatment was short in order to prevent as much as possible endogenous LH rises. The overall ongoing pregnancy rate per transfer of all cycles was 21% in the Normegon group and 19% in the Metrodin group. Analysis of completed treatment cycles (n = 90) with premature rises of LH > 10.0 IU/l and/or progesterone > 1.0 ng/l revealed a relatively high incidence (23%) of fertilization failure and poor embryo quality, but the ongoing pregnancy rate per transfer was still 22%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Pregnancy; Pregnancy Outcome; Time Factors; Treatment Outcome

Ovarian stimulation combined with intra-uterine insemination (IUI) is an effective treatment of non-tubal infertility but most women undergo several cycles of treatment to achieve a pregnancy. This prospective study was designed to assess the consistency (or variation) of ovarian responses and the effect of various ovarian stimulation protocols on this consistency in consecutive cycles of ovarian stimulation and IUI in women with non-ovulatory infertility. A total of 86 regularly menstruating ovulating patients each completed three to six cycles of ovarian stimulation and IUI (n = 347 cycles). Ovarian stimulation was achieved by sequential clomiphene citrate/human menopausal gonadotrophin (HMG), HMG-only or combined gonadotrophin-releasing hormone analogue--HMG protocols in 33, 29 and 24 patients respectively, and each patient used the same protocol consistently throughout the study. Standard methods were used to monitor ovarian response and to perform IUI. Using each patient as her own control, repeated measurements analysis of variance revealed consistency of ovarian response in consecutive ovarian stimulation cycles, as shown by the number and mean diameter of maturing pre-ovulatory follicles, peak plasma oestradiol, duration of stimulation and mean HMG requirements. This consistency existed using any of the ovarian stimulation protocols. We conclude that regularly menstruating and ovulating women are likely to have similar ovarian responses in consecutive cycles of ovarian stimulation and IUI if the same ovarian stimulation protocol is used consistently.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Endometriosis; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

To evaluate the impact of a short GnRH agonist (GnRH-a) protocol on follicular and luteal characteristics and treatment outcome in women undergoing IVF for isolated pure tubal occlusion.. A prospective randomized study.. Eighty patients with pure tubal occlusion undergoing IVF for the first time.. Patients in group 1 (control group) were administered hMG from day 3 of the menstrual cycle. Patients in group 2 were administered 900 micrograms/d buserelin acetate intranasally from day 1 of the menstrual cycle, followed by hMG administration from day 3. Buserelin acetate was discontinued on the day of hCG administration.. Information collected included E2 levels and follicular growth throughout cycle, amount of hMG required for stimulation, number of oocytes retrieved, fertilization, pregnancy, and cancellation rates.. The short GnRH-a protocol resulted in significantly higher E2 levels and required less hMG for stimulation. However, the number of follicles aspirated, number of oocytes retrieved, fertilization rate, number of embryos transferred, pregnancy rate, and cancellation rate in both groups were comparable.. The findings suggest that administration of a short protocol of GnRH-a to patients with pure tubal occlusion has no obvious superiority in comparison with hMG alone, except for the lower amount of hMG required for ovarian stimulation.

Topics: Administration, Intranasal; Buserelin; Chorionic Gonadotropin; Estradiol; Fallopian Tube Diseases; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Prospective Studies

To evaluate coagulation parameters during IVF cycles with elevated E2.. Prospective clinical study.. Human volunteers in an IVF clinic.. Infertile women undergoing IVF procedures.. Coagulation factors were measured in blood along with E2 and P after singular hMG or leuprolide acetate (LA) plus hMG up to 14 days after hCG.. Plasma coagulation factors.. Some coagulation factors were statistically but not clinically elevated after LA-hMG-induced hyperestrogenism. For the most part, this was not correlated with E2.. This study suggests that endogenous E2 increases due to fertility drugs cause a molecular activation of some coagulation factors, which do not result in an increased thrombosis.

Topics: Adult; Analysis of Variance; Blood Coagulation Factors; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Fibrinogen; Humans; Infertility, Female; Leuprolide; Menotropins; Partial Thromboplastin Time; Progesterone; Protein C; Prothrombin Time

The objective of this study was to explore the effect of cotreatment with recombinant human growth hormone (GH), gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) for induction of ovulation in women with clomiphene resistant polycystic ovary syndrome (PCOS). It was designed as a randomized, double-blind, placebo controlled trial in which 30 women with anovulation associated with PCOS who were resistant to clomiphene all received DTRP6-LHRH (Decapeptyl microcapsules, 3.75 mg, i.m.) and, 2 weeks later, HMG in a standard, conventional, individually adjusted dose regimen until human chorionic gonadotrophin (HCG) and then luteal phase support could be given. From day 1 of HMG therapy, patients were randomized to receive either human GH (Norditropin, 12 IU/day, i.m., for 7 days) or placebo. The number of ampoules, duration of treatment and daily effective dose of HMG required to achieve ovulation, serum oestradiol concentrations and number of follicles induced, ovulation and pregnancy rates, serum insulin and insulin-like growth factor-I (IGF-I) concentrations were measured. There were no significant differences between growth hormone and placebo groups in any of the outcomes measured, other than a growth hormone induced increase in serum insulin and IGF-I levels. We conclude that although GH kinetics are abnormal and GH pituitary reserves generally low in women with PCOS, adjuvant GH treatment to GnRHa/HMG does not influence follicular development or sensitivity in response to gonadotrophins and that it does not seem likely to be of any potential clinical benefit for the treatment of PCOS.

Topics: Adult; Chorionic Gonadotropin; Double-Blind Method; Female; Gonadotropins, Pituitary; Growth Hormone; Humans; Infertility, Female; Insulin; Insulin-Like Growth Factor I; Menotropins; Ovulation Induction; Placebos; Polycystic Ovary Syndrome; Pregnancy; Recombinant Proteins; Triptorelin Pamoate

To determine if oestradiol and progesterone concentrations are related to uterine blood flow in early pregnancy, we measured these hormones at the time of vaginal Doppler ultrasound before and after the beginning of intervillous circulation in spontaneous pregnancy (group I), after clomiphene citrate administration (group II), and after clomiphene citrate plus human menopausal gonadotrophin (HMG) administration (group III). Despite large increases of oestradiol concentration in group II (60%) and III (300%) and of progesterone in groups II (100%) and III (300%), compared with group I, increases in blood flow were modest during the first 9 weeks of gestation. Uterine artery flow volume increased by 20% in group II and 33% in group III (P < or = 0.02); average velocity increased by 37% in group III (P < or = 0.003) compared with groups I and II; vessel diameter increased by 15% in groups II (P < 0.025) and III (P < 0.001) compared with group I; and the uterine artery resistance index decreased by 3 to 5% in group III (P = 0.004) compared with groups I and II. Serum oestradiol and progesterone concentrations were unrelated to the uterine artery resistance index or volume by an analysis of covariance. We conclude that uterine artery blood flow is significantly increased during early pregnancy following HMG administration, and that the increase is unrelated to increases in oestradiol and progesterone concentrations.

Topics: Blood Flow Velocity; Clomiphene; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Trimester, First; Progesterone; Uterus

A randomized prospective study was undertaken to compare low and standard luteinizing hormone-releasing hormone agonist (LHRHa) dosage used in combination with gonadotrophins in ovarian stimulation for in-vitro fertilization (IVF). A total of 42 ovulatory patients with mechanical infertility were administered 0.5 mg/day LHRHa (Decapeptyl) from day 21 of their cycles for 14 days. Following down-regulation, patients were randomly allocated to continue with the same dose of LHRHa (22 patients, group A) or to receive a lower dose of 0.1 mg/day LHRHa (20 patients, group B) during folliculogenesis. Luteal phase was supported by daily i.m. progesterone (50 mg) injections and human chorionic gonadotrophin (HCG; 1500 IU) every 4 days. Ovarian response, human menopausal gonadotrophin (HMG) dosage used for induction of ovulation, evidence of premature luteinization, and clinical and laboratory IVF outcome, were compared between groups A and B. The two groups were comparable in respect of: age (32.6 +/- 0.7 and 33.0 +/- 0.9 years), HMG dosage (33.0 +/- 1.6 and 36.0 +/- 2.5 ampoules), day of HCG (11.2 +/- 0.3 and 12.2 +/- 0.4), oocytes/patient (13.3 +/- 1.0 and 12.9 +/- 1.3), fertilization rate (68.5 and 65.2%), cleavage rate (95% for both), pregnancy/embryo transfer (32 and 35%) and implantation rate (10.8 and 10.5%), for groups A and B respectively. There was no evidence of premature luteinization or luteolysis in either group. It was concluded that lowering the dose of LHRHa to 0.1 mg/day during folliculogenesis had no adverse effect on ovarian response or clinical results. However, it had no advantage in reducing the HMG dose used for ovulation induction.

Topics: Adult; Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Gland; Pregnancy; Progesterone; Prospective Studies; Triptorelin Pamoate

Immunosuppression by exogenous corticosteroids has been used to improve the rates of embryo implantation and pregnancy in in-vitro fertilization (IVF) patients who have micromanipulated embryos replaced. The present study was conducted, in a prospective design, to evaluate effects of corticosteroid on the pregnancy rate in IVF/embryo transfer patients who have non-micromanipulated embryos replaced. Infertile women < 40 years old with tubal factor were included in this study. Patients were grouped according to the different follicle stimulation protocols, and received various doses of 16 beta-methylprednisolone (0, 16 or 60 mg/day) for 4 days from the day of oocyte retrieval. The mean age, duration of infertility, length of folliculogenesis and serum oestradiol concentrations at the time of human chorionic gonadotrophin (HCG) injection were not significantly different between control and corticosteroid-treated groups of patients. Short-term immunosuppression by 16 beta-methylprednisolone administration did not show any effects on the pregnancy and miscarriage rates in IVF/embryo transfer patients. Also, immunosuppression showed no dose effects in any groups. There was no relationship between the types of follicle stimulation protocols and the effect of 16 beta-methylprednisolone. Therefore, we concluded that short-term immunosuppression by exogenous corticosteroids in IVF/embryo transfer patients who have embryos with intact zona pellucida replaced has neither positive nor negative effects on pregnancy rates.

Topics: Adrenal Cortex Hormones; Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Immunosuppression Therapy; Infertility, Female; Menotropins; Methylprednisolone; Pregnancy; Pregnancy Outcome; Prospective Studies

The use of gonadotrophin-releasing hormone agonist (GnRHa) in combination with human menopausal gonadotrophin (HMG) for ovulation induction has been advocated for the treatment, particularly by in-vitro fertilization (IVF) of various types of infertility. The present study was designed to compare the clinical efficacy of HMG alone with a short protocol of GnRHa/HMG for treatment of unexplained infertility. A total of 91 couples with unexplained infertility were randomly assigned to one of two treatments; either HMG with intra-uterine insemination (IUI) (45 patients, 62 cycles) or GnRHa/HMG with IUI (46 patients, 69 cycles) treatments. Progesterone concentrations on the day of human chorionic gonadotrophin (HCG) administration were significantly higher in HMG (1.5 +/- 0.9 ng/ml) versus GnRHa/HMG (0.8 +/- 0.6 ng/ml; P < 0.05) cycles. Furthermore, GnRHa suppressed the occurrences of premature luteinization (GnRHa/HMG 5.8% and HMG 24.2% respectively). However, there were no significant differences in HMG dose requirements, plasma oestradiol concentrations or follicular development on the day of HCG administration between the two groups. Nor were any significant differences found in the pregnancy rates between the two treatment protocols (GnRHa/HMG 13.0% and HMG 11.3% respectively). Our results suggest no beneficial effect of GnRHa/HMG compared to HMG alone for the treatment of unexplained infertility, based on pregnancy rates.

Topics: Adult; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Infant; Infertility, Female; Male; Menotropins; Prospective Studies

To compare the classic clomiphene citrate (CC) and hMG regime for ovarian stimulation before IVF in women who received hMG post-long protocol down-regulation with either 3 mg triptorelin [INN] IM or 150 mg buserelin acetate four times daily intranasally. Furthermore, if possible, to determine the preferred method of down-regulation.. A prospective study of 150 women randomized blind to the clinician to one of three alternative ovarian stimulation regimes when passing for the first time through an IVF program during 1992.. Triptorelin [INN] down-regulated significantly more quickly than buserelin acetate. The non-down-regulated group CC and hMG used significantly less hMG in a shorter time. In these women LH levels at hCG administration were significantly higher. No other intergroup differences were found. Pregnancy and take-home baby rates for the overall study were, respectively, 32%:25% (per cycle) and 42%:33%; (per ET) for the triptorelin [INN] group 28%:22% and 39%:31%; the CC group 32%:24% and 46%:34%; and the buserelin acetate group 34%:28% and 42%:34%.. Triptorelin [INN] and buserelin acetate were comparable in all parameters except down-regulation. The former was significantly quicker and more sure. In none of the clinical end points measured, however, was the classic CC and hMG non-down-regulation regime significantly less effective or troublesome than where down-regulation was used. These results therefore show that although indications for down-regulation before IVF exist, it should not be used on all patients.

Topics: Adult; Buserelin; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prospective Studies; Triptorelin Pamoate

Endometrial and follicular development were investigated by ultrasound in 25 normally cycling women who received clomiphene citrate and human menopausal gonadotrophin to induce multiple follicular development for in vitro fertilization. Ultrasonic determination of endometrial thickness and reflectivity grading and follicular number were correlated with daily concentrations of estradiol (E2) and progesterone (p) in peripheral serum. Serum E2 showed a better positive correlation with endometrial thickness than with total number of developing follicles. There was a significant inverse correlation between endometrial thickness and plasma p concentration. The E2 value per follicle and E2/p ratio were both weakly correlated respectively with endometrial thickness. These data indicate that ultrasound determination of endometrial thickness is a useful ultrasonic parameter for monitoring ovarian function for in vitro fertilization. However, endometrial thickness should always be combined with total number of developing follicles, in order to reach decisions concerning timing of oocyte recovery.

Topics: Adult; Clomiphene; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Detection; Ovulation Induction; Progesterone; Superovulation; Ultrasonography

To determine whether a new ovarian stimulation protocol termed "minimal stimulation" provides pregnancy rates (PRs) comparable with those in a conventional full stimulation protocol for patients undergoing assisted reproductive technologies (ART).. Prospective, nonrandomized study of patients in minimal stimulation or full stimulation, followed by standard IVF and zygote intrafallopian transfer or uterine-ET.. The ART program of the Mayo Clinic, Rochester, Minnesota.. Women (n = 120) 42 years of age or younger with serum day 3 FSH level < or = 15.0 mIU/mL (conversion factor to SI unit, 1.0), normal thyroid-stimulating hormone and PRL levels, normal endometrial cavity as observed on hysterosalpingogram, and partners with a normal semen analysis.. Oral clomiphene citrate, hMG, oocyte retrieval, IVF-ET.. Cancellations, implantation, pregnancy.. The cancellation rate was not significantly higher in minimal stimulation (25.8%) than in full stimulation (14.1%). Minimal stimulation cycles yielded fewer oocytes per aspiration (3.4 +/- 1.6) than full stimulation (10.1 +/- 5.4). There was no difference in the implantation rates per ET (minimal stimulation, 16.4%; full stimulation, 13.3%) or overall clinical PRs per retrieval (minimal stimulation, 31%; full stimulation, 42%).. Minimal stimulation for IVF is less expensive than full stimulation and minimizes monitoring and patient discomfort. In addition, it produces acceptable PRs and represents an attractive alternative to select patients undergoing ART.

Topics: Adult; Clomiphene; Embryo Implantation; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Infertility, Male; Male; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Prolactin; Prospective Studies; Reproductive Techniques; Sperm-Ovum Interactions; Thyrotropin; Treatment Outcome

In ovulation induction with hMG for IVF, clinical advantage has been taken of the agonistic ability of GnRH-a and its hypothalamic downregulating effect. This allows a better follicular synchronization, which represents an increase in the number and quality of oocytes and a decrease in the number of cancelled IVF cycles. Furthermore, according to the E2 response during the first 5 days of stimulation, the leuprolide screening test allows us to individualize ovarian stimulation for IVF and helps to prevent the potential risk of multiple pregnancy. In our experience, the majority of patients undergoing IVF benefit from the flare-up protocol, with the exception of the patients with an E2 pattern C response who benefit from the LPL protocol.

Topics: Clinical Protocols; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Leuprolide; Luteal Phase; Luteinizing Hormone; Mass Screening; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Progesterone; Prospective Studies; Retrospective Studies; Ultrasonography

To study in a randomized and longitudinal manner the efficacy of human menopausal gonadotropin (hMG) superovulation combined with intrauterine insemination (IUI) versus IUI alone in the treatment of various causes of infertility in the presence of normal ovulation.. An initially randomized and subsequently longitudinal study of infertile couples was performed at a university-based clinical research center. One hundred nineteen couples with longstanding infertility (average duration 3.7 years) associated with male factor infertility, unexplained infertility, and/or endometriosis were enrolled. All patients were randomized in the initial cycle to treatment with either hMG/IUI or urine LH-timed IUI alone. They were then followed longitudinally as they alternated subsequent cycles between the two modalities. Outcome indices measured were cycle fecundity, pregnancy outcome, and cumulative pregnancy rates evaluated by life-table analysis.. Human menopausal gonadotropin/IUI therapy was consistently more effective than IUI alone in the treatment of endometriosis, male factor infertility, and unexplained infertility, with cycle fecundities ranging from 7.1-19.0% versus 0-6.7%, respectively, during the first seven cycles.. Human menopausal gonadotropin/IUI is a more effective therapy for enhancing fertility than is IUI alone for the treatment of endometriosis, male factor infertility, and unexplained infertility.

Topics: Adult; Female; Follow-Up Studies; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Longitudinal Studies; Male; Menotropins; Pregnancy; Proportional Hazards Models; Risk

To compare two treatment regimens associating a gonadotropin-releasing hormone agonist (GnRH-a) and human menopausal gonadotropin (hMG) for controlled ovarian hyperstimulation (COH).. A prospective randomized trial.. The outpatient fertility clinic of a university tertiary care center, the Hôpital A. Béclère, Clamart, France.. One hundred eighty-two in vitro fertilization (IVF) candidates undergoing new or repeat IVF cycles at Hôpital A. Béclère over a 4-month period.. Group 1 (7-day protocol): A short-acting preparation of GnRH-a (Tripteriline 0.1) was administered daily for 7 days, starting on cycle day 2. Ovarian stimulation with hMG was started on cycle day 4. Group 2 (long protocol): A timed release preparation of GnRH-a (Tripteriline 3.75 mg) was administered on cycle day 2. Ovarian stimulation with hMG was started after documented ovarian suppression.. Response to COH, pregnancy rate (PR), tolerance.. In the 7-day protocol, the amount of hMG required was markedly lower at 24 +/- 7 than in the long protocol group requiring 42.5 +/- 9.75 vials (75 IU) (mean +/- SD). No elevation of plasma LH occurred in either group. The number of oocytes retrieved was 7.3 +/- 1 and 10.7 +/- 1.2 (mean +/- SD) in the 7-day and long protocols, respectively. Yet, the number of embryos obtained and the PRs were similar in the two treatment groups.. We observed that in COH, GnRH-a treatment could be interrupted safely several days before human chorionic gonadotropin administration without risking a premature increase of plasma luteinizing hormone. Moreover, the number of embryos available for fresh transfer and the ongoing PRs were similar in the new 7-day and in the classic long GnRH-a/hMG protocols, despite the smaller number of oocytes suggesting a greater efficiency of the 7-day protocol. The peak estradiol level and the hMG requirement were also lower in the 7-day GnRH-a/hMG protocol.

Topics: Adult; Delayed-Action Preparations; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Prospective Studies; Time Factors; Triptorelin Pamoate

To evaluate the effects of synthetic growth hormone-releasing factor (GRF) in women with idiopathic infertility who were treated with human menopausal gonadotrophin (HMG), 13 women with this condition were randomly assigned to undergo treatment with HMG-GRF (500 micrograms twice daily) or HMG-placebo. Conception occurred in four of six women (14 cycles) who received HMG-GRF and in one of seven women (22 cycles) who received HMG-placebo. No difference was found in the amount of HMG and the duration of HMG required to induce ovulation between the two groups of patients. The overall serum growth hormone and insulin-like growth factor I concentrations were higher in the GRF than in the placebo group. No difference was found in serum oestradiol or inhibin concentrations between the two groups. Our results suggest that in women with idiopathic infertility, administration of GRF does not decrease the duration or the amount of HMG required to induce ovulation. However, it appears that in this small group concomitant treatment with GRF increases the pregnancy rates in women who are treated with HMG (4/14 cycles compared with 1/22 cycles).

Topics: Adult; Chorionic Gonadotropin; Female; Growth Hormone-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction

We have explored the use of growth hormone (GH) for ovulation induction and ovarian stimulation for in vitro fertilization and embryo transfer (IVF-ET). We first compared the effects of co-treatment with GH and placebo on the dose of gonadotrophins required to induce ovulation. The patients were gonadotrophin deficient and, for the main part, hypopituitary. We found a significant reduction in the dose of gonadotrophins and the duration of treatment needed to induce ovulation. The dose of GH used in these studies was substantial, and we await the results of a multi-centre trial attempting to establish a dose-response relationship. We then explored the role of GH in patients undergoing IVF-ET. The end-point measured was an increase in the number of follicles developing during standard treatment with gonadotrophins. In the first randomized controlled clinical trial we found a suggestion only of an enhanced ovarian response to co-treatment with GH. Specifically selected patients with ultrasound-diagnosed polycystic ovaries were then treated. All were receiving treatment with luteinizing hormone-releasing hormone analogue as part of their ovarian stimulation protocol. The results showed clearly that in this group of patients, co-treatment with GH augmented the ovarian response to treatment with gonadotrophins. We also found an increase in serum and follicular-fluid insulin-like growth factor I (IGF-I) concentrations, but since the serum concentrations always exceeded those in follicular fluid, the results were consistent with the notion that follicular-fluid growth factor was predominantly derived from serum IGF-I rather than being synthesized locally.

Topics: Adult; Anovulation; Double-Blind Method; Embryo Transfer; Female; Fertilization in Vitro; Growth Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prospective Studies

To determine the effect of growth hormone (GH) supplementation to a long gonadotropin-releasing hormone agonist (GnRH-a)/human menopausal gonadotropin (hMG) treatment protocol, on ovarian response, embryo quality, and clinical outcome in in vitro fertilization (IVF).. Growth hormone or placebo were administered in a prospective randomized double-blind manner.. Forty-two normal ovulatory, women who were 38 years of age or less with mechanical factor infertility and a normal male factor were selected for this study.. Gonadotropin-releasing hormone agonist, 0.5 mg/d, was initiated in the midluteal phase of the preceding cycle and continued until the day of human chorionic gonadotropin (hCG) administration. Ovulation induction with hMG was started 14 days after pituitary down regulation (17 beta-estradiol [E2] serum level less than 30 pg/mL). Growth hormone (12 IU/d) or placebo were administered on days 1, 3, 5, and 7 of hMG treatment.. Breaking the code at the completion of the study revealed that 20 women received GH and 22 placebo. The age and duration of infertility did not differ between the two groups. Follicular phase duration, hMG ampules used, serum E2, and number of follicles (greater than or equal to 14 mm) on day of hCG as well as number of oocytes and embryos achieved were similar in both groups. Embryo morphology and rate of cleavage were also similar. Insulin-like growth factor-I (IGF-I) serum levels did not change after pituitary down regulation and increased significantly both after GH/hMG and placebo/hMG ovulation induction treatment. Clinical pregnancy rate (PR) per embryo transfer and implantation rate were 40% versus 32% and 17.9% versus 11.3% in the GH and placebo groups, respectively, and were not statistically different.. In normo-ovulatory women undergoing ovulation induction for IVF, GH supplementation to hMG after GnRH-a pituitary down regulation does not seem to augment ovarian response or improve embryo quality. The effect of this regimen on actual PRs and implantation rates needs further clarification.

Topics: Adult; Chorionic Gonadotropin; Double-Blind Method; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicular Phase; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor I; Menotropins; Pregnancy; Prospective Studies; Triptorelin Pamoate

Sixty-seven patients whose ovulation was stimulated following a protocol of Clomiphene Citrate/HMG in order to carry out in vitro fertilisation were divided randomly in to two groups. In the first group ovulation was provoked by giving 10,000 IU HCG IM, but in the other group ovulation was provoked by releasing endogenous LH after the administration of Triptoreline in a dose of 0.1 mg in a dose subcutaneously three times in one day at 8 hour intervals. The number of oocytes recovered, cleavage and embryo transfer were compared between the two groups over 48 cycles. The number of conceptions was statistically significantly higher in the group that had triptoreline (28%) as compared with 17.4% pregnancies in the other group (p less than 0.01). These figures confirm that the endogenous LH surge provoked by giving an LHRH agonist can cause adequate final oocyte maturation. This property which is associated with a very low risk of hyperstimulation, should make it possible to stimulate ovulation when it is not used for IVF and so replace the usual injection of chorionic gonadotrophins.

Topics: Adult; Clomiphene; Female; Humans; Infertility, Female; Injections, Subcutaneous; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Triptorelin Pamoate

This study was designed to investigate the surplus effect of gamete intra-Fallopian transfer (GIFT) over ovarian stimulation alone, in patients with unexplained infertility. A total of 50 patients with unexplained infertility of at least 3 years duration, or unexplained failure of artificial insemination by donor (AID) for at least 12 cycles, meeting strict inclusion criteria, were randomly selected for either two GIFT cycles or two ovarian stimulation cycles. Ovarian stimulation was combined with timed intercourse, or timed cervical donor insemination. In 38 completed GIFT cycles, five clinical pregnancies (13.2% per cycle) occurred and in 44 ovarian stimulation cycles four clinical pregnancies occurred (9.1% per cycle). Five remaining GIFT cycles were converted into in-vitro fertilization leading to two pregnancies. Of the 50 patients suffering from unexplained infertility, the 23 who did not have AID gave rise to four pregnancies out of 39 cycles (10.3%); from the remaining 27 patients who underwent AID, seven pregnancies were achieved out of 48 cycles (14.6%). No statistical differences between GIFT and ovarian stimulation treatment were found. Therefore, the GIFT success rates can be explained at least in part, if not fully, by the effect of ovarian stimulation alone. Consequently, ovarian stimulation should be considered in unexplained infertility before more elaborate forms of assisted reproduction are used.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Insemination, Artificial, Heterologous; Menotropins; Ovulation Induction; Treatment Outcome

The anti-oestrogenic effect of clomiphene citrate causes an increased rate of associated cervical factor problems. Theoretically, it may also cause an adverse effect on the endometrium. The hostile mucus may be completely or partially corrected by the use of additional oestrogen after stopping clomiphene, or by intrauterine insemination (IUI). The prospective randomized study presented here was designed to determine whether a higher pregnancy rate might be achieved using human menopausal gonadotrophin (HMG) compared to clomiphene citrate. Thirty-seven women treated with clomiphene citrate for 165 cycles were compared to 33 treated with HMG for 179 cycles. A pregnancy was achieved in 81.1% of clomiphene-treated women (18.2%/cycle) versus 72.7% (13.3% per cycle) of HMG-treated women. The abortion rates of 13.3 and 12.5% respectively, were similar. The data suggest no adverse effect of clomiphene compared to HMG as far as pregnancy rates are concerned. IUI seems to be an effective means of treating cervical factor problems induced by clomiphene.

Topics: Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Prospective Studies; Random Allocation

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

To assess the usefulness of a short regimen in ovulation induction in an in vitro fertilization (IVF) program.. A prospective randomized trial was set up to compare long and short regimens of gonadotropin-releasing hormone agonist administration for ovulation induction in IVF.. Aberdeen Assisted Reproduction Unit.. Eighty-seven patients undergoing IVF were randomized between the two protocols. Stimulation regimen was the only variable being tested.. Stimulation response and occurrence of luteinizing hormone (LH) surges.. There was no difference in the stimulation requirements, response to stimulation, number of follicles aspirated, or the number of oocytes obtained. The fertilization rates, number of embryos transferred, and pregnancy rates were also similar in both groups. Like the long regimen, it prevents the occurrence of a premature LH surge.. The short regimen is a useful and cheaper alternative in ovarian stimulation of patients undergoing IVF.

Topics: Adult; Drug Administration Schedule; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Prospective Studies; Triptorelin Pamoate

The luteal phase of cycles stimulated with human menopausal gonadotropins (hMG) may be characterized by aberrant hormone levels, altered endometrial development, and shortened length. Luteal phase support with supplemental progesterone or hCG has been recommended to help correct these problems and thus improve pregnancy rates, but the efficacy of such regimens is controversial. Therefore, a randomized cross-over study was performed to evaluate the effects of luteal phase hCG administration on pregnancy rates during ovulation induction with hMG. Sixty-seven infertile women were randomly assigned to either group A (N = 33) or group B (N = 34). Non-treatment cycles (no luteal phase support) were alternated with treatment cycles, in which patients received 2500 IU hCG on the third, sixth, and ninth days after the ovulatory dose of 10,000 IU hCG. Patients in group A received supplemental hCG in odd-numbered cycles, whereas group B was given luteal support in even-numbered cycles. The mean number of cycles per patient was 2.2 and 2.3 for groups A and B, respectively. Analysis of 151 cycles revealed a cycle fecundity of 0.15 for 72 hCG-supported cycles, versus 0.13 for 79 nonsupported cycles (P = not significant). Midluteal progesterone levels were significantly higher in supported (45.6 ng/mL) versus unsupported cycles (31.9 ng/mL) (P less than .001). There were no significant differences in the mean peak estradiol levels in hCG-supported versus -unsupported cycles. We conclude that hCG support of the luteal phase is not routinely warranted in hMG-stimulated cycles.

Topics: Adult; Chorionic Gonadotropin; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Progesterone

To determine the efficacy of superovulation with buserelin acetate, human menopausal gonadotropins (hMG), and human chorionic gonadotropin (hCG) in the treatment of infertility associated with minimal or mild endometriosis.. Prospective, randomized, controlled study.. Forty-nine infertile women with a laparoscopic diagnosis of endometriosis stage I (n = 29) or II (n = 20) according to the revised American Fertility Society classification, randomly assigned to three superovulation cycles (n = 24) or 6 months' expectant management (n = 25).. Cycle fecundity rates and cumulative pregnancy rates (CPR) in the two groups.. Nine pregnancies were obtained in the superovulation-treated patients and six in the nontreated ones. The cycle fecundity rates and CPR were 0.15% and 37.4% after three superovulation cycles and 0.045% and 24% after 6 months of expectant management (P less than 0.05 and P = not significant, respectively). The women who did not achieve a pregnancy after three cycles of superovulation were followed for a total of 50 months during which no therapy was given. One pregnancy started in this period (cycle fecundity rate = 0.020). One spontaneous abortion occurred in each group. Three treated patients had multiple pregnancies, and four had ovarian hyperstimulation syndrome.. Superovulation seems to be associated with a better cycle fecundity rate but not a better CPR than expectant management in infertile women with endometriosis stages I and II. The efficacy and side effects of this therapeutic approach should be evaluated in larger series.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Prospective Studies; Superovulation

To assess the deleterious effect of clomiphene citrate (CC) on the development of the endometrium and its improvement by the addition of ethinyl estradiol (E2). PARTICIPATING PATIENTS: Infertility-treated patients, monitored for induction of ovulation or timing of insemination (control group).. We studied four groups of women during an ovulatory cycle with various treatment schedules. Group 1: untreated patients; group 2: patients treated by CC; group 3: patients treated by CC + ethinyl E2; group 4: patients treated by human menopausal gonadotropin. Follow-up of the patients was done by vaginal ultrasonography and measurements of blood E2.. In the group treated by CC, both endometrial thickness and uterine volume growth during the follicular phase were lower as compared with untreated controls and menotropin-treated patients. The addition of ethinyl E2 to these patients reversed this deleterious effect of CC without interfering with ovulation.. Ethinyl E2 may reverse the deleterious effect of CC on endometrial development during the follicular phase.

Topics: Adult; Clomiphene; Drug Therapy, Combination; Endometrium; Estradiol; Ethinyl Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Induction; Uterus

The role of multiple ovulation with human menopausal gonadotropin (HMG) in the treatment of unexplained infertility is evaluated. Of a total 73 patients with unexplained infertility, 39 received four cycles of HMG, whereas, 34 were left untreated. Eight (20.5%) women conceived during HMG treatment, in comparison to only 1 (2.9%) in the control group (P less than 0.05). This study gives further credit to the value of HMG treatment for unexplained infertility.

Topics: Adult; Female; Fertilization; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prospective Studies

Hormonal alterations and pregnancy rates were compared between the clomiphene citrate (CC)-hMG combination cycle and the hMG cycle alone in an in vitro fertilization and embryo transfer program. In the CC-hMG cycle, the numbers of follicles developed, oocytes recovered and embryos transferred were higher than those in the hMG cycle (p less than 0.01, p less than 0.01 and p less than 0.05, respectively). Pregnancy rates of the CC-hMG cycle (6.7%/operation, 7.1%/embryo transfer), however, were lower than those of the hMG cycle (25%/operation, 31.6%/embryo transfer). PRL levels in the hMG cycle increased according to estradiol levels. In the CC-hMG cycle, CC might inhibit estradiol-induced hyperprolactinemia and the increase was lower even if the estradiol level was much higher than that of the hMG cycle until day 2. On day 4, the PRL level in the CC-hMG cycle further increased. The thickness of endometrium on day -2 in the hMG cycle alone was much thicker than that in the CC-hMG cycle (9.8 +/- 0.4 vs. 6.8 +/- 0.4 mm, mean +/- SEM).

Topics: Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embryo Transfer; Endometrium; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Hormones; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Pregnancy; Progesterone; Radioimmunoassay

To compare GIFT, intrauterine insemination (IUI) with, and without, ovarian hyperstimulation in the treatment of unexplained infertility.. Women randomly allocated to one of three treatment protocols.. Northern Regional Fertility Centre.. 59 couples with unexplained infertility of more than 3 years duration.. Three cycles of either GIFT, IUI after ovarian hyperstimulation or IUI in a spontaneous cycle.. Pregnancy resulting in a live birth.. Fecundabilities were 0.12 after GIFT, 0.018 after ovarian hyperstimulation and IUI, and 0.018 after IUI in a spontaneous cycle. The fecundability after IUI was no different from that which would be expected without treatment in these couples but fecundability was significantly better (P greater than 0.02) after GIFT.. This trial does not support the use of IUI in the treatment of unexplained infertility but confirms the value of GIFT.

Topics: Adult; Chorionic Gonadotropin; Female; Fertility; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy

Fifty four women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response to stimulation with human menopausal gonadotropins (hMG) participated in this study. They were randomized to receive either gonadotropin releasing hormone agonist (GNRHa), Buserelin, prior to and during induction of ovulation by hMG (Group I--long protocol), or GnRHa starting on the first day of the cycle together with induction of ovulation by hMG (Group II--short protocol). Mean follicular phase serum luteinizing hormone (LH) and progesterone (P) levels were significantly lower in Group I than in Group II (P less than 0.01). Cancellation rate was significantly lower in Group I than in Group II (P less than 0.01). The long GNRHa protocol resulted in statistically significant lower cancellation rates, more oocytes per pickup (OPU), more embryos transferred per patient, and a higher pregnancy rate. Significantly more hMG ampoules and more treatments days were required in the long GNRHa protocol. Our data demonstrate that the use of GNRHa prior to and during ovarian stimulation with hMG offers a very good alternative for patients with repetitive unsuccessful IVF cycles due to inadequate response.

Topics: Adult; Buserelin; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Progesterone; Prospective Studies; Time Factors

Since patients with polycystic ovary syndrome (PCOS) commonly have insulin resistance, albeit with normal glucose tolerance, we evaluated glucose tolerance in PCOS patients exposed to the diabetogenic effect of pregnancy. The clinical material was obtained from two centers, in Springfield, Illinois (22 patients), and New York, New York (31 patients), and the results were compared with a control population with 2,306 consecutive general pregnancies. There were no differences between PCOS patients from the two centers in regard to age or ponderal index (P greater than .1). A review of the medical records showed that the incidence of gestational diabetes in the PCOS patients was 7.5%, similar (P greater than .1) to the 6.6% frequency of gestational diabetes in the controls. The overall incidence of neonatal macrosomia (birth weight greater than 4,000 g) was 7% (4 of 57) among infants born to PCOS women. That was similar to the 12.4% incidence of neonatal macrosomia among infants born to women with normal glucose tolerance and to the 14.5% incidence among infants born to women with gestational diabetes. Preexisting PCOS does not appear to increase the risk of developing gestational diabetes or neonatal macrosomia.

Topics: Adult; Clomiphene; Dexamethasone; Female; Fetal Macrosomia; Glucose Tolerance Test; Humans; Infant, Newborn; Infertility, Female; Menotropins; Polycystic Ovary Syndrome; Pregnancy; Pregnancy in Diabetics; Retrospective Studies

Topics: Adult; Chorionic Gonadotropin; Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hypogonadism; Infertility, Female; Infertility, Male; Male; Menotropins; Ovulation Induction; Prospective Studies; Spermatogenesis

Human menopausal gonadotropin (hMG) superovulation combined with washed intrauterine insemination (IUI) has been advocated for the treatment of various forms of infertility when more traditional therapy has failed. To assess the relative efficacy of combined treatment with hMG and IUI compared with either hMG or IUI alone, pregnancy outcomes of the three treatment groups were compared in couples having infertility because of male factor, cervical factor, endometriosis, or unexplained. A total of 751 cycles were analyzed from 322 couples. The mean cycle fecundity rate associated with hMG/IUI therapy was significantly higher than either hMG or IUI therapy alone for all patients (hMG/IUI = 19.6%, hMG = 6.3%, IUI = 3.4%). The improvement in cycle fecundity rates with hMG/IUI therapy was also observed when the couples were separated by infertility diagnostic groups: male factor (hMG/IUI = 15.3%, hMG = 4.4%, IUI = 3.0%), cervical factor (hMG/IUI = 26.3%, hMG = 7.9%, IUI = 5.1%), endometriosis (hMG/IUI = 12.85%, hMG = 6.6%), and unexplained infertility (hMG/IUI = 32.6%, hMG = 5.5%, IUI = 0%). Moreover, in patients who had failed to conceive with hMG or IUI alone, the cycle fecundity rate when they were switched to hMG/IUI therapy equaled that of patients who received combined therapy from the onset. We conclude that cycle fecundity rates and cumulative pregnancy rates are significantly greater using a combination of hMG and IUI compared with either modality alone in the treatment of male factor, cervical factor, endometriosis, or unexplained infertility. Indeed, in couples with nontubal related infertility, cycle fecundity rates with hMG/IUI approach the rates seen with in vitro fertilization and gamete intrafallopian tube transfer.

Topics: Endometriosis; Female; Humans; Infertility, Female; Insemination, Artificial; Male; Menotropins; Menstrual Cycle; Pregnancy; Retrospective Studies

Seventy-two infertile women with polycystic ovary disease (PCOD) and clomiphene citrate treatment failure underwent 220 human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) treatment cycles for ovulation induction over a period of 19 months. Forty-two patients ovulated but failed to conceive on clomiphene, and the remaining 30 failed to ovulate on clomiphene. Monitoring of treatment consisted of serum 17 beta-estradiol (E2) levels and ultrasonic assessment of follicular growth. Treatment was withheld whenever the E2 levels exceeded 1,500 pg/mL and/or when more than two follicles greater than or equal to 17 mm in diameter each were encountered on ultrasonography. Twenty-nine patients conceived (40.2%), and 23 delivered viable infants. Twenty-three of the 29 pregnancies were achieved in the 42 patients who ovulated on clomiphene, while only 6 pregnancies resulted in the 32 anovulatory patients on clomiphene. Six patients (20.6%) aborted in the first trimester. Multiple pregnancies consisted of only two sets of twins (6.9%). There were only two cases of mild hyperstimulation (2.7%) and no severe hyperstimulation. Because of the low occurrence of multiple pregnancies and hyperstimulation and the reasonable success rate, all PCOD patients should be started on this protocol.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome

In a prospective study, 140 patients with infertility because of ovulatory factors (group A) were followed up for 6 months after failure to achieve pregnancy using human menopausal gonadotropin (hMG) therapy. They included cases of oligomenorrhea, polycystic ovarian disease (PCOD), and hypogonadotropic amenorrhea. They were treated with hMG alone or in combination with clomiphene citrate or gonadotropin-releasing hormone agonist analog. The control group (B) included 83 infertile patients because of similar ovulatory factors. They were followed up for 6 months not preceded by ovulation induction. The overall pregnancy rate (PR) in group A (20.7%) was significantly higher than group B (7.2%). The PR was significantly higher in oligomenorrhea and PCOD patients when compared with the control group. There was no significant difference in the hypogonadotropic group.

Topics: Anovulation; Female; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Polycystic Ovary Syndrome; Pregnancy; Prospective Studies

To evaluate the prognostic and therapeutic value of a Lupron (leuprolide acetate; Tap Pharmaceuticals, North Chicago, IL) screening test before ovarian stimulation for in vitro fertilization (IVF).. Prospective.. Outpatient IVF program.. Eighty patients exhibited four early estradiol (E2) patterns. Patients with pattern A and B remained on a flare-up ovarian stimulation protocol. Patients with pattern C were randomized to three ovarian stimulation protocols. Patients with pattern D were treated with the flare-up protocol using a high pure follicle-stimulating hormone (FSH) dose.. Patterns, A, B, C, and D occurred in 44%, 16%, 25%, and 15% of the patients, respectively. The E2 pattern recurred in 77% of subsequent IVF cycles. Pattern A and B patients achieved a 41% (23/56) and 22% (5/23) ongoing pregnancy rate (PR) per stimulated cycle. An early luteal phase Lupron protocol had the best ongoing PR per stimulated cycle (10/27, 37%) in patients with a pattern C response. Pattern D patients had a 20% (5/25) ongoing PR per stimulated cycle.. The Lupron screening test allows prospective selection of stimulation protocols in ovulatory patients undergoing IVF. Early E2 patterns A and B should be treated with the flare-up protocol. Pattern C patients benefit from the luteal phase Lupron protocol and pattern D patients benefit from a high pure FSH flare-up protocol.

Topics: Adult; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

Problems arising from controlled ovarian hyperstimulation for intrauterine insemination, such as premature luteinization and asynchronous ovarian follicular development, are identical to those encountered with controlled ovarian hyperstimulation for in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). It has been suggested that the adjunctive use of GnRH agonists for controlled ovarian hyperstimulation improves the efficiency of GIFT and IVF cycles. We hypothesized that adjunctive use of leuprolide acetate, a GnRH agonist, would have a similarly beneficial effect on cycle quality and cycle fecundity in subfertile women treated with controlled ovarian hyperstimulation and intrauterine insemination. We randomly assigned the first cycle of controlled ovarian hyperstimulation and intrauterine insemination for each of 97 subfertile women to include either human menopausal gonadotropins (hMGs) alone or hMGs following midluteal pre-treatment with leuprolide. If a pregnancy did not occur in the first cycle, the woman was given the other treatment in the second cycle. Although the cycles that included leuprolide required a larger amount of hMGs and more days of stimulation per cycle, the mean estradiol concentrations and numbers of follicles were not different. Despite prevention of premature luteinization with leuprolide, the cycle fecundity was not different between groups (0.11 with adjunctive leuprolide treatment and 0.22 with hMGs alone). We conclude that in unselected subfertile patients, the adjunctive use of leuprolide for controlled ovarian hyperstimulation and intrauterine insemination does not improve cycle fecundity compared with treatment cycles that do not include adjunctive leuprolide therapy.

Topics: Adult; Drug Therapy, Combination; Female; Fertility; Gonadotropin-Releasing Hormone; Hormones; Humans; Infertility, Female; Insemination, Artificial; Leuprolide; Menotropins; Menstrual Cycle; Ovary; Ovulation Induction

A randomized, double-blind, placebo-controlled trial of cotreatment with biosynthetic, human sequence, growth hormone (GH), and human menopausal gonadotropins (hMG) for induction of ovulation was performed in 16 women with amenorrhea and anovulatory infertility. Patients were randomly allocated to treatment with hMG + GH (24 IU on alternate days, total dose 144 IU) or hMG + placebo. Those who received placebo were given GH in a subsequent course of treatment. On cotreatment with GH compared with placebo, there was a significant reduction in the required dose of hMG, duration of treatment, and the daily effective dose of gonadotropins. Serum insulin-like growth factor-I (IGF-I) rose during treatment with GH but not with placebo. We conclude that growth hormone augments the response of the human ovary to stimulation by gonadotropins. These results suggest a role for the use of GH in induction of ovulation.

Topics: Adult; Amenorrhea; Anovulation; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Growth Hormone; Humans; Hypogonadism; Hypophysectomy; Infertility, Female; Insulin-Like Growth Factor I; Insulin-Like Growth Factor II; Menotropins; Ovulation Induction; Pituitary Neoplasms; Random Allocation

To establish the usefulness of a new drug regimen in an assisted conception program, a trial was performed comparing clomiphene citrate (CC) plus human menopausal gonadotropins (hMG) with a new regimen of intranasal luteinizing hormone-releasing hormone (LH-RH) analog plus hMG. One hundred two patient cycles received treatment with CC and hMG and 118 patient cycles received treatment with LH-RH analog and hMG. Fifteen percent of cycles were canceled in the CC group and 8% in the analog group. Four percent of cycles in the CC group were canceled due to premature ovulation. The number of oocytes collected in the analog group was significantly higher than in the CC group (8.5 versus 5.5), as was the number of mature oocytes (3.5 versus 2.7). However, the percentage of mature oocytes was higher in the CC group (54.2% versus 42.3%). The number of embryos resulting from in vitro fertilization as well as the number of cleaving embryos were significantly higher in the analog group (5.2 versus 2.8 and 4.6 versus 2.3, respectively). The pregnancy rate in the analog group was significantly higher than in the CC group (30.6% versus 16.1%), as was the live birth rate (21% versus 8%). Early pregnancy loss was significantly higher in the CC group than in the analog group (35% versus 9%); and the serum level of LH on the day of human chorionic gonadotropin (hCG) administration was also significantly elevated in the CC group when compared with the analog group (8.1 versus 4.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Intranasal; Adult; Buserelin; Clinical Trials as Topic; Clomiphene; Female; Fertilization; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocytes

This study was designed to compare the results of treatment with, firstly, exogenous gonadotrophins, with (57 cycles) and without (65 cycles) pretreatment with a superactive analogue of luteinizing hormone releasing hormone (LHRH) and, secondly, pure follicle stimulating hormone (FSH) (50 cycles) with those of human menopausal gonadotrophin (HMG) (72 cycles) in 46 women with clomiphene-citrate-resistant anovulation associated with polycystic ovaries. Patients randomly allocated to the analogue group received buserelin (Suprefact, Hoechst, UK, Ltd, Hounslow, Middlesex), 800 micrograms/day by nasal insufflation and when hypogonadism was achieved, patients were again randomly allocated for ovarian stimulation with either FSH or HMG. Controls received FSH or HMG alone. Patients pretreated with the analogue had similar pregnancy and ovulation rates, needed larger doses and more days of gonadotrophin therapy and had more ovarian overstimulation than those receiving no pretreatment. The role of superactive LHRH analogues for induction of a single ovulation for in-vivo fertilization is thus uncertain. Pure FSH had no advantages over HMG, the LH content of HMG having no deleterious effect on the ovary.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

Little data exist on the effects of adjunctive therapy with leuprolide acetate (LA) in the luteal phase of women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with human menopausal gonadotropin (hMG). Additionally, it is not known whether gonadal steroid concentrations in the luteal phase of induced cycles in PCOS are predictive of pregnancy. In this prospective, randomized study comparing cycles using hMG alone (n = 26) with cycles using hMG with LA (n = 33), no differences were noted between treatment groups in progesterone (P), estradiol (E2), and P:E2 ratios on luteal days 3, 6, and 9. When all treatment cycles were pooled, there were no differences in P, E2, or P:E2 ratios, comparing conception and nonconception cycles. We conclude that adjunctive therapy with LA in PCOS patients undergoing ovulation induction with hMG does not alter the luteal phase concentrations of P, E2, and P:E2. Furthermore, no correlation was found between the serum concentrations of these luteal phase steroids and cycle fecundity.

Topics: Drug Therapy, Combination; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Luteal Phase; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progesterone; Prospective Studies; Random Allocation

A comparison has been established retrospectively between clomiphene citrate-human menopausal gonadotropin (CC-hMG) and buserelin acetate-hMG treatments in in vitro fertilization trials performed over a 3-year period. The analysis of 466 CC-hMG and 319 buserelin acetate-hMG trials shows that buserelin acetate-hMG stimulation generates a greater ovarian response resulting in higher numbers of oocytes being retrieved (6.2 + 3.8 versus 9.3 + 5.2) and fertilized (2.8 + 2.7 versus 4.3 + 3.8). More embryos are thus obtained, allowing a wider choice for intrauterine replacement and cryopreservation. Mean embryonic vitality scores do not differ (4.33 + 1.51 versus 4.44 + 1.54), implying that the embryonic quality remains similar in both treatments. A premature demise of the corpus luteum occurs in a large proportion of buserelin acetate-hMG cycles. However, when suppletive progesterone treatment is given, there is a trend toward a better implantation rate per embryo, and a significantly higher ongoing pregnancy rate is observed in relation to buserelin acetate-hMG treatment (20%) as compared with CC-hMG cycles (14%).

Topics: Adult; Buserelin; Clinical Trials as Topic; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins

Thirty-five couples with long-term unexplained infertility were treated in 98 cycles by giving gonadotropin-releasing hormone analogue, human menopausal gonadotropin and human chorionic gonadotropin for induction of superovulation. Pregnancy occurred in 24 cycles (24.5% per cycle and 68.6% per patient). All patients had been treated previously with clomiphene citrate and human menopausal gonadotropin in 110 cycles in conjunction with artificial insemination, but failed to achieve pregnancy. Pituitary suppression with gonadotropin-releasing hormone analogue followed by ovarian stimulation with human menopausal gonadotropin may correct the subtle abnormalities at the hypothalamic hypophyseal level that could be present in cases of unexplained infertility and it should be tried first for these patients before resorting to in vitro fertilization or gamete intrafallopian transfer.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome

In 51 patients, controlled ovarian hyperstimulation with clomiphene citrate (CC)/human menopausal gonadotropin (hMG), or hMG only, in 102 IVF cycles had previously resulted in a cancellation rate of 52% and no pregnancies. In 54 subsequent cycles the women were treated with prolonged administration of a gonadotropin-releasing hormone agonist (GnRHa) followed by hMG stimulation, the GnRHa group. The results were compared with the outcome of 47 cycles in patients who came for their first IVF attempt. In this group a CC/hMG regimen was used, the CC/hMG group. In the GnRHa group, 17 pregnancies were achieved, compared with 10 in the CC/hMG group. Only four cycles were cancelled in the GnRHa group, vis-à-vis 13 in the CC/hMG group, a significant difference. The study showed that prolonged use of GnRHa as a preparatory treatment is effective following previous failures of IVF.

Topics: Adult; Buserelin; Clinical Protocols; Clomiphene; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome

Topics: Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction

In order to evaluate the exact role of GnRH agonists, we have undertaken a randomized prospective study comparing two groups of 90 normo-ovulatory patients, aged less than 38 years and with tubal infertility with no male factor. Luteinizing hormone releasing hormone analogue (DTRP6 administered in a long protocol, for at least 15 days) was associated with human menopausal gonadotrophin (HMG) induction in group I. In group II, stimulation was performed using HMG alone (three ampoules per day in general, from days 2 to 7 of the cycle). Apart from the well known results demonstrated in the literature of a reduced incidence of inadequate responses, an absence of premature luteinization and a greater number of oocytes per retrieval (8.8 +/- 4.9 versus 6.8 +/- 3.2, P less than 0.01 in group II), this study confirms the higher pregnancy rate (21.1 versus 12.2% per cycle and 24.7 versus 17.1% per oocyte retrieval, not significant) and underlines the higher plasma progesterone levels and lower E2/P ratio in group I from D - 1 to D + 5, which could explain a better maturation of the oocytes and the endometrium.

Topics: Adult; Clinical Trials as Topic; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Prospective Studies; Random Allocation; Triptorelin Pamoate

Several regimens have been developed to administer gonadotropin-releasing hormone agonists in association with human menopausal gonadotropins (hMG) during follicular growth stimulation for in vitro fertilization. The aim of this study was to characterize hormonal changes induced by short-term administration of agonist, and to evaluate a putative impact of the flare-up effect on follicular recruitment and subsequent IVF. Eighteen highly selected patients were randomely divided in two groups. Nine patients received a short-term administration of Buserelin (Hoechst, AG, Franfurt/Main, FRG) (day 1). They were compared with 9 patients who were exposed to a long-term protocol (day 21), and 13 control patients. Agonist-induced luteinizing hormone (LH) and follicle-stimulating hormone (FSH) increase, in early follicular phase, stimulated follicular growth, shortened follicular phase, and induced a transient rise in progesterone. This was followed by a phase of reduced LH secretion associated with a significant modification of LH immunoreactivity. The short-term regimen did not improve the follicular recruitment, and appeared to reduce the oocytes fertilization rate and embryo quality when compared with prolonged administration of peptide.

Topics: Buserelin; Drug Administration Schedule; Embryo Transfer; Embryo, Mammalian; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Glycoproteins; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Progesterone; Random Allocation

Topics: Adult; Chorionic Gonadotropin; Drug Administration Schedule; Female; Fertilization in Vitro; Follow-Up Studies; Gamete Intrafallopian Transfer; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic

Ovulation induction in polycystic ovary syndrome (PCOS) with human menopausal gonadotropins (hMG) results in suboptimal cycle fecundity and frequently is complicated by ovarian hyperstimulation. The use of a gonadotropin releasing-hormone agonist (Gn-RH-a) with hMG induction of ovulation may improve the therapeutic outcome. In this prospective, randomized trial, 27 women with PCOS underwent a total of 25 cycles of hMG alone and 33 cycles with adjunctive GnRH-a (leuprolide) treatment. Premature luteinization was seen less frequently in the leuprolide-treated cycles than in cycles treated with hMG alone. There were no differences between the treatments in ovarian sensitivity to hMG. Cycle fecundity was 0.16 for hMG alone cycles, and 0.27 for leuprolide with hMG cycles, which were not statistically different. We conclude that the sensitivity of the PCOS ovary to hMG is not affected by 4 weeks of leuprolide pretreatment.

Topics: Drug Therapy, Combination; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Luteinizing Hormone; Menotropins; Ovarian Cysts; Ovulation; Progesterone; Randomized Controlled Trials as Topic

To ask lots of questions and try to find the truth about the medicine-based effectiveness of letrozole (LE) combined with human menopausal gonadotropin (HMG) in the treatment of inability to have children crops patients with endocrine (things that are different from what is usually expected and the effect on ovulation-related chemicals produced by the body).. A total of 160 unable to have children crops patients with endocrine things that are different from what is usually expected who were treated in our hospital from March 2019 to March 2022 were selected as the subjects of this look at how things were in the past study and were divided into instance of watching, making a statement group was treated with human menopausal gonadotropin on the basis of the control group. The differences in serum related to the process of making children, chemical produced by the body levels, ovarian function, and ovulation induction effect between the two groups were watched and compared.. After treatment, LH, FSH, PRL, and E. Letrozole can promote the improvement of sex hormones in infertile patients. After being combined with human menopausal gonadotropin treatment, the follicle development and ovulation of patients are significantly improved, and infertility is improved to a certain extent. It has a certain reference value in the clinical treatment of endocrine abnormal infertility.

Topics: Case-Control Studies; Child; Female; Gonadotropins; Humans; Infertility, Female; Letrozole; Menotropins; Ovulation Induction; Pregnancy; Retrospective Studies

There is currently a dispute over the choice of ovulation induction treatment for infertile women with polycystic ovary syndrome (PCOS). The objective of this study is to compare the therapeutic effect of pulsed rhythmic administration protocol (PRAP) with conventional letrozole + human menopausal gonadotropin (HMG) in patients with clomiphene-resistance polycystic ovary syndrome (PCOS). A retrospective analysis of 821 intrauterine insemination (IUI) cycles between January 2015 and January 2020 was performed. Of these, 483 cycles were treated with a pulsed rhythmic administration protocol (PRAP), and 338 cycles were treated with conventional letrozole + HMG protocol (LHP). The therapeutic effect of the two protocols has been compared. The pregnancy rate was 18.07% in the LHP and 27.07% in the PRAP. The ongoing pregnancy rate in LHP was 14.46% and in PRAP was 22.73%. The research suggests that PRAP is more effective than LHP and could be an adequate ovulation induction strategy for the IUI cycle of patients with clomiphene-resistance PCOS.

Topics: Adult; Aromatase Inhibitors; Clomiphene; Drug Administration Routes; Drug Resistance; Female; Fertility Agents, Female; Follow-Up Studies; Humans; Infertility, Female; Letrozole; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Retrospective Studies; Young Adult

This study compared the effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa; GONAL-f. Data were collected from 71 German fertility centres between 01 January 2007 and 31 December 2012, for women undergoing a first stimulation cycle of ART treatment with r-hFSH-alfa or hMG HP. Primary outcomes were live birth, ongoing pregnancy and clinical pregnancy, based on cumulative data (fresh and frozen-thawed embryo transfers), analysed per patient (pP), per complete cycle (pCC) and per first complete cycle (pFC). Secondary outcomes were pregnancy loss (analysed per clinical pregnancy), cancelled cycles (analysed pCC), total drug usage per oocyte retrieved and time-to-live birth (TTLB; per calendar week and per cycle).. Twenty-eight thousand six hundred forty-one women initiated a first treatment cycle (r-hFSH-alfa: 17,725 [61.9%]; hMG HP: 10,916 [38.1%]). After adjustment for confounding variables, treatment with r-hFSH-alfa versus hMG HP was associated with a significantly higher probability of live birth (hazard ratio [HR]-pP [95% confidence interval (CI)]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; relative risk [RR]-pFC [95% CI]: 1.09 [1.05, 1.15], ongoing pregnancy (HR-pP [95% CI]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; RR-pFC [95% CI]: 1.10 [1.05, 1.15]) and clinical pregnancy (HR-pP [95% CI]: 1.10 [1.05, 1.14]; HR-pCC [95% CI]: 1.14 [1.10, 1.19]; RR-pFC [95% CI]: 1.10 [1.06, 1.14]). Women treated with r-hFSH-alfa versus hMG HP had no statistically significant difference in pregnancy loss (HR [95% CI]: 1.07 [0.98, 1.17], were less likely to have a cycle cancellation (HR [95% CI]: 0.91 [0.84, 0.99]) and had no statistically significant difference in TTLB when measured in weeks (HR [95% CI]: 1.02 [0.97, 1.07]; p = 0.548); however, r-hFSH-alfa was associated with a significantly shorter TTLB when measured in cycles versus hMG HP (HR [95% CI]: 1.07 [1.02, 1.13]; p = 0.003). There was an average of 47% less drug used per oocyte retrieved with r-hFSH-alfa versus hMG HP.. This large (> 28,000 women), real-world study demonstrated significantly higher rates of cumulative live birth, cumulative ongoing pregnancy and cumulative clinical pregnancy with r-hFSH-alfa versus hMG HP.

Topics: Adult; Databases, Factual; Female; Follicle Stimulating Hormone, Human; Germany; Glycoprotein Hormones, alpha Subunit; Humans; Infertility, Female; Live Birth; Menotropins; Pregnancy; Reproductive Techniques, Assisted; Treatment Outcome

This study aims at detecting and evaluating differences in quantitative response to controlled ovarian stimulation (COS) with high doses of gonadotropins in women with low serum anti-Müllerian hormone (AMH). About 369 first cycles in a real-life scenario in women between 21 and 43 years old and with AMH ≤0.9 ng/ml were analyzed. Older women had a significantly worse outcome with respect to young women, not only qualitatively, but also in terms of quantitative ovarian response to COS [odd ratio (OR) to obtain at least three MII oocytes with each increasing year of female age: 0.89, 95% CI: 0.85 - 0.94;

Topics: Adult; Age Factors; Anti-Mullerian Hormone; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Reserve; Ovulation Induction; Recombinant Proteins; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome; Triptorelin Pamoate; Young Adult

Turner syndrome (TS) is associated with hypergonadotropic hypogonadism due to gonadal dysgenesis, which results in premature ovarian failure and subsequent infertility. Therefore, counseling and evaluation for fertility preservation are required as early as possible for women with TS.. A 23-year-old unmarried woman with mosaic TS (45, X [4/30] 46, XX [26/30]) presented to the pediatric department of our hospital for fertility counseling; she was accompanied by her mother. She was referred to the reproduction center of our hospital for ovarian reserve assessment and counseling regarding fertility preservation. We decided to retrieve oocytes using DuoStim as the controlled ovarian stimulation protocol. During the first and second oocyte retrievals, a total of 17 (9 and 8, respectively) mature metaphase II oocytes were cryopreserved.. DuoStim may be a useful option for fertility preservation for women with TS and reduced ovarian reserve. This new strategy may obtain the required number of oocytes in the shortest time and preserve the future fertility of women with TS.

Topics: 17 alpha-Hydroxyprogesterone Caproate; Buserelin; Cryopreservation; Dydrogesterone; Female; Fertility Agents, Female; Fertility Preservation; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Mosaicism; Oocyte Retrieval; Ovarian Reserve; Ovulation Induction; Primary Ovarian Insufficiency; Turner Syndrome; Young Adult

Some of the common side effects of the injectable gonadotropins, used during fertility treatments, are pain at the injection site, skin erythema, muscle pain, and rarely vasovagal reflex. These side effects cause inconvenience and lower patient's tolerance for fertility treatments.The purpose of this study was to evaluate the safety and efficacy of an FDA-approved dose of nasal human menopausal gonadotropins (Menopur) in women undergoing fertility treatment. Healthy regularly cycling reproductive-aged women (n=4) with infertility were enrolled. A total of 75 IU of each Menopur bottle was dissolved and placed in a nasal pump spray device (concentration of 3.75 IU/spray). Each participant was allowed to inhale a total of 2 sprays daily after which ovarian response during the follicular phase was monitored by transvaginal ultrasound and serum hormone measurement. None of the participants reported any side effects at the nasal site of drug administration. No known common side effects of the Menopur drug were reported by any of the participants. Despite adequate absorption of the nasal Menopur, as confirmed by elevated serum FSH levels while taking the nasal medication, 3 out of 4 participants did not show any follicular growth until cycle day 13 while only one participant who agreed to continue taking the medication until cycle day 20 developed one dominant follicle and had elevated serum estradiol levels. This FDA approved case series suggest that nasal route of Menopur administration seems to be safe at a very low doses and it constitutes a potential novel approach for ovarian stimulation.

Topics: Administration, Intranasal; Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Nasal Sprays; Ovarian Follicle; Ovulation Induction

We assessed the outcome of pregnancy in women with a history of recurrent pregnancy loss (RPL) following treatment with low-dose human menopausal gonadotropin (HMG)+progesterone or progesterone alone. This single-center retrospective cohort study included data from women diagnosed with RPL and treated between February 2005 and December 2012 with one cycle of HMG + progesterone or progesterone alone. Primary endpoint was the rate of ongoing pregnancies and losses by treatment, age (<38 vs. ≥38 years) and in the subgroup with unexplained RPL. Of 169 RPL patients, 35.5% (n = 60) received HMG + progesterone and 64.5% (n = 109) progesterone alone. Compared to progesterone alone, HMG + progesterone led to a lower, although not significant, frequency of losses (3.3% vs. 11.9%, p = .09) and a twofold higher rate of ongoing pregnancies (41.7% vs. 19.3%, p = .002). Similar results were obtained in the subgroup of patients with unexplained RPL (ongoing pregnancies: 48.1% upon HMG + progesterone vs. 21.3% upon progesterone, p = .03; losses: 0% vs. 8.5%, respectively, p = .29) and in those <38 years (ongoing pregnancies: 47.4% vs. 18.8%, respectively, p = .003; losses: 5.3% vs. 10.9% respectively, p = .47). These findings suggest that HMG in women with RPL may reduce the rate of miscarriages and increase that of live births regardless of RPL cause and in women aged <38 years.

Topics: Abortion, Habitual; Adolescent; Adult; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Retrospective Studies; Young Adult

Human menopausal gonadotropin (HMG) is one of the commonest drugs used for ovarian stimulation with no reports on the audio-vestibular system. This study aims to examine HMG on the hearing profile of patients planning intracytoplasmic sperm injection (ICSI).. This prospective study was conducted from June 2016 to June 2017 in a tertiary referral hospital. The audio-vestibular system of a total of 30 patients was evaluated using pure tone audiometry, distortion product otoacoustic emissions (DPOAEs in the form of a DP-gram) and Vestibular-evoked myogenic potential (VEMP) immediately before therapy and at the day 10 after therapy. Audio-vestibular adverse effects including hearing loss, tinnitus, vertigo, and otalgia were also considered.. Significant elevations in hearing thresholds were found on comparing thresholds at the day 10 at the onset of the study. The elevations were mostly at frequencies (1000, 2000 and 8000Hz) and did not affect speech perception. For DPOAE, significant differences were observed at all F2 frequencies on comparing both amplitudes and signal to noise ratios. Otologic complaints were significant for tinnitus and hearing loss.. Significant auditory and vestibular adverse effects may result from HMG therapy, indicating the importance of prompt monitoring of auditory functions in these patients.

Topics: Adult; Audiometry, Pure-Tone; Auditory Threshold; Earache; Female; Fertility Agents, Female; Hearing Loss; Humans; Infertility, Female; Menotropins; Otoacoustic Emissions, Spontaneous; Ovulation Induction; Prospective Studies; Signal-To-Noise Ratio; Speech Perception; Tinnitus; Vertigo; Vestibular Evoked Myogenic Potentials; Young Adult

The potential effects of high basal luteinizing hormone (LH) levels on human reproduction were controversial. To demonstrate the effects of elevated basal LH levels on the outcome of patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles, we performed a retrospective data analysis of 1011 polycystic ovarian syndrome (PCOS) patients treated with human menopausal gonadotropin and medroxyprogesterone acetate (hMG + MPA) protocol at our center between Nov. 2013 and Jun. 2017. PCOS patients with elevated basal LH levels had significantly higher LH exposure during the stimulation period. The group with LH ≥ 10 mIU/mL showed a lower mean total hMG dose used but higher numbers of oocytes retrieved, metaphase II oocytes, embryos and top-quality embryos developed than the groups with lower basal LH levels. Moreover, partial correlation analysis showed that the basal LH level was negatively correlated with the total hMG dose but positively correlated with the numbers of oocytes retrieved, metaphase II oocytes, embryos, and top-quality embryos. There were no significant differences in the rates of oocyte retrieval, fertilization, implantation, clinical pregnancy and miscarriage between the groups based on frozen embryo transfer (FET). We concluded that elevated basal LH level does not impair the final outcome of hMG + MPA-treated IVF/ICSI cycles in PCOS women.

Topics: Adult; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Gonadotropins; Humans; Infertility, Female; Luteinizing Hormone; Medroxyprogesterone Acetate; Menotropins; Middle Aged; Oocyte Retrieval; Oocytes; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies; Sperm Injections, Intracytoplasmic

To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.. AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.. The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026).. PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.

Topics: Adult; Anti-Mullerian Hormone; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Sperm Injections, Intracytoplasmic; Young Adult

Topics: Adult; Chorionic Gonadotropin; Combined Modality Therapy; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Leuprolide; Living Donors; Menotropins; Nephrectomy; Oocyte Retrieval; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Recombinant Proteins; Renal Insufficiency; Severity of Illness Index; Treatment Outcome

The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975-4800) vs 2025 (1350-3300) IU, P = 2.038E-4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0-30) vs 13 (0-42), P = 6.333E-5; 2 (0-14) vs 3.5 (0-15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.

Topics: Academic Medical Centers; Adult; Clomiphene; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Medroxyprogesterone Acetate; Menotropins; Obesity; Oocytes; Ovulation Induction; Polycystic Ovary Syndrome; Retrospective Studies

To evaluate anti-Müllerian hormone (AMH) concentrations and antral follicle counts (AFCs) in the prediction of pregnancy outcomes after controlled ovarian stimulation among women undergoing intrauterine insemination.. A retrospective study included women with unexplained infertility aged 41years or younger who attended a fertility clinic in Italy between December 2009 and May 2014. Ovarian stimulation was achieved with recombinant follicle-stimulating hormone or highly purified human menopausal gonadotropin. Receiver operating characteristic curves were generated to predict ongoing pregnancy. The primary outcome was the association between AMH/AFC and ongoing pregnancy, and was assessed by logistic regression.. Overall, 276 women were included, of whom 43 (15.6%) achieved ongoing pregnancy. Multivariate analysis showed that women with a serum day-3 concentration of AMH higher than 2.3ng/mL were more likely to have ongoing pregnancy than were those with a concentration lower than 2.3ng/mL (odds ratio 5.84, 95% confidence interval 2.38-14.31; P<0.001). No associations were recorded for AFCs.. AMH should be used to predict the pregnancy outcome of intrauterine insemination.

Topics: Adult; Anti-Mullerian Hormone; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Italy; Logistic Models; Menotropins; Multivariate Analysis; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

Highly purified Human Menopausal Gonadotropins (hp-hMG) and recombinant FSH (rFSH) are widely used in assisted reproductive technology (ART). The aim of this study was to compare ART results of the two preparations in GnRH antagonist cycles.. In this retrospective cohort study, IVF antagonist cycles performed from 2011 through 2013 were reviewed. There were 508 antagonist cycles: 320 stimulated with rFSH and 188 with hp-hMG. For every hp-hMG, two rFSH were matched for patient's age and infertility diagnosis. Subgroup analysis of patients younger and older than 35 was done as well.. Both treatments were resulted in comparable pregnancy and live birth rates. However, cumulative pregnancy rates were higher for the rFSH group. In the matching analysis, the rFSH group had more mature oocytes and more embryos while using lower doses of gonadotropins. Pregnancy, cumulative pregnancy rates, and live birth rates were comparable. In the subgroup analysis, young patients in the rFSH group had better cycle outcomes compared with those in the hp-hMG group.. In antagonist protocol, different gonadotropin products are equally effective. The choice of one or the other should depend on the availability, convenience of use, and cost.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Menotropins; Outcome Assessment, Health Care; Pregnancy; Pregnancy Rate; Recombinant Proteins; Retrospective Studies

To investigate flexibility in starting controlled ovarian stimulation at any phase of the menstrual cycle in infertile women undergoing treatment with assisted reproduction.. Retrospective cohort study.. Academic tertiary-care medical center.. At total of 150 infertile patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Ninety of the women also underwent frozen embryo transfer (FET) procedures.. Depending on the phase of the menstrual cycle when ovarian stimulation was started, three groups of patients were identified, namely: conventional group (ovarian stimulation started in the early follicular phase), late follicular phase group, and luteal phase group. When dominant follicles were observed, final oocyte maturation was triggered with the use of GnRH agonist and hCG. In all three groups, viable embryos were cryopreserved for subsequent transfer.. number of mature oocytes retrieved.. fertilization rate, viable embryo rate per oocyte retrieved, cancellation rate, and clinical pregnancy outcomes from FET cycles.. There were no differences in the mean number of mature oocytes retrieved in the conventional group, late follicular phase group, and luteal phase group (5.7 ± 3.6, 5.2 ± 3.7, and 5.2 ± 3.9, respectively). Similarly, no significant differences were observed in the viable embryo rate per oocyte retrieved (37.9%, 38.5%, and 43.6%), clinical pregnancy rates (41.5%, 45.5%, and 38.9%), and implantation rates (30.7%, 30.2%, and 27.1%) in the three groups.. All three ovarian stimulation protocols were observed to be equally effective. These results demonstrate that ovarian stimulation can be commenced on any day of the menstrual cycle.. ChiCTR-OPN-15007332.

Topics: Adult; China; Chorionic Gonadotropin; Cryopreservation; Drug Administration Schedule; Embryo Implantation; Embryo Transfer; Female; Fertility; Fertility Agents, Female; Fertilization in Vitro; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteal Phase; Medroxyprogesterone Acetate; Menotropins; Oocyte Retrieval; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic; Tertiary Care Centers; Treatment Outcome; Triptorelin Pamoate

To present a case of twin pregnancy obtained by in vitro fertilization and embryo transfer (IVF-ET) with variable dose letrozole-FSH protocol of lower peak estradiol level, after treatment of carcinoma of the breast.. A 34-year-old patient diagnosed with mucinous breast carcinoma undergoing assisted fertilization treatment after breast cancer operation and treatment including controlled ovarian stimulation (COS), oocyte retrieval, IVF, and embryo culture and transfer.. Four oocytes were obtained in three COS procedures in the three IVF cycle. All oocytes were fertilized. In the third cycle, two fresh embryos were transferred, and two healthy girls were born at 37 gestational weeks.. Variable dose letrozole-FSH protocol can maintain lower peak estradiol levels and reduce estrogen exposure after breast cancer operation and chemotherapy.

Topics: Adenocarcinoma, Mucinous; Adult; Aromatase Inhibitors; Breast Neoplasms; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Letrozole; Menotropins; Nitriles; Ovulation Induction; Pregnancy; Pregnancy, Twin; Triazoles

Poor oocyte quality is a main concern for decreased reproductive outcomes in women with polycystic ovarian syndrome (PCOS) during controlled ovarian hyperstimulation (COH). A primary way to improve oocyte quality is to optimize the COH protocol. It was demonstrated that the viable embryo rate per oocyte retrieved in the Utrogestan and hMG protocol, a novel regimen based on frozen-thawed embryo transfer (FET), is statistically higher than that in the short protocol. Thus, a retrospective study was conducted to evaluate the endocrine characteristics and clinical outcomes in PCOS patients subjected to the Utrogestan and hMG protocol compared with those subjected to the short protocol.One hundred twenty three PCOS patients enrolled in the study group and were simultaneously administered Utrogestan and human menopausal gonadotropin (hMG) from cycle day 3 until the trigger day. When the dominant follicles matured, gonadotropin-releasing hormone agonist (GnRH-a) 0.1 mg was used as the trigger. A short protocol was applied in the control group including 77 PCOS women. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the viable embryo rate per oocyte retrieved. The secondary outcomes included the number of oocytes retrieved, fertilization rate, and clinical pregnancy outcomes from FET cycles.The pituitary luteinizing hormone (LH) level was suppressed in most patients; however, the LH level in 13 women, whose basic LH level was more than 10 IU/L, surpassed 10 IU/L on menstruation cycle day (MC)9-11 and decreased subsequently. No significant between-group differences were observed in the number of oocytes retrieved (13.27 ± 7.46 vs 13.1 ± 7.98), number of viable embryos (5.57 ± 3.27 vs 5 ± 2.79), mature oocyte rate (90.14 ± 11.81% vs 93.02 ± 8.95%), and cleavage rate (97.69 ± 6.22% vs 95.89 ± 9.57%). The fertilization rate (76.11 ± 19.04% vs 69.34 ± 21.81%; P < 0.05), viable embryo rate per oocyte retrieved (39.85% vs 34.68%; P < 0.05), biochemical pregnancy rate (71.72% vs 56.67%; P < 0.05), clinical pregnancy rate (64.65% vs 51.65%; P < 0.05), and implantation rate (46.46% vs 31.35%; P < 0.05) in the study group were significant higher than those in the control group.This study shows that the Utrogestan and hMG protocol was feasible to improve the oocyte quality, possibly providing a new choice for PCOS patients undergoing IVF/ICSI treatments in combination with embryo cryopreservation.

Topics: Adult; Estrogen Replacement Therapy; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progesterone; Retrospective Studies

Subfertility represents a multidimensional problem associated with significant distress and impaired social well-being. In the Netherlands, an estimated 50,000 couples visit their general practitioner and 30,000 couples seek medical specialist care for subfertility. We conducted an economic evaluation comparing recombinant human follicle-stimulating hormone (follitropin alfa, r-hFSH, Gonal-F. A pharmacoeconomic model was developed, simulating each step in the IVF protocol from the start of therapy until either a live birth, a new IVF treatment cycle or cessation of IVF, following a long down-regulation protocol. A decision tree combined with a Markov model details progress through each health state, including ovum pickup, fresh embryo transfer, up to two subsequent cryo-preserved embryo transfers, and (ongoing) pregnancy or miscarriage. A health insurer perspective was chosen, and the time horizon was set at a maximum of three consecutive treatment cycles, in accordance with Dutch reimbursement policy. Transition probabilities and costing data were derived from a real-world observational outcomes database (from Germany) and official tariff lists (from the Netherlands). Adverse events were considered equal among the comparators and were therefore excluded from the economic analysis. A Monte Carlo simulation of 5000 iterations was undertaken for each strategy to explore uncertainty and to construct uncertainty intervals (UIs). All cost data were valued in 2013 Euros. The model's structure, parameters and assumptions were assessed and confirmed by an external clinician with experience in health economics modelling, to inform on the appropriateness of the outcomes and the applicability of the model in the chosen setting.. The mean total treatment costs were estimated as €5664 for follitropin alfa (95 % UI €5167-6151), €5990 for hp-HMG (95 % UI €5498-6488) and €5760 for uFSH (95 % UI €5256-6246). The probability of a live birth was estimated at 36.1 % (95 % UI 27.4-44.3 %), 33.9 % (95 % UI 26.2-41.5 %) and 34.1 % (95 % UI 25.9-41.8 %) for follitropin alfa, hp-HMG and uFSH, respectively. The costs per live birth estimates were €15,674 for follitropin alfa, €17,636 for hp-HMG and €16,878 for uFSH. Probabilistic sensitivity analysis indicated a probability of 72.5 % that follitropin alfa is cost effective at a willingness to pay of €20,000 per live birth. The probabilistic results remained constant under several analyses.. The present analysis shows that follitropin alfa may represent a cost-effective option in comparison with uFSH and hp-HMG for IVF treatment in the Netherlands healthcare system.

Topics: Cost-Benefit Analysis; Economics, Pharmaceutical; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Germany; Glycoprotein Hormones, alpha Subunit; Humans; Infertility, Female; Menotropins; Models, Economic; Netherlands; Pregnancy; Recombinant Proteins

Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives.. A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children.. The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967).. This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

Topics: Adult; Anovulation; Clomiphene; Cost-Benefit Analysis; Female; Fertility Agents, Female; Humans; Infertility, Female; Laparoscopy; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Retrospective Studies; Treatment Failure; Young Adult

To examine whether patients with poor ovarian response (POR) during conventional IVF/intracytoplasmic sperm injection (ICSI) treatment cycle may benefit from a modified natural cycle (MNC)-IVF.. Cohort historic study.. Tertiary, university-affiliated medical center.. One hundred eleven patients with POR, defined according to the Bologna criteria, who underwent a subsequent MNC-IVF within 3 months of the previous failed conventional IVF/ICSI cycle. The elimination of bias in this selection, for the purposes of this study, was achieved by including only a subgroup of "genuine" poor responder patients, those who yielded up to three oocytes after controlled ovarian hyperstimulation (COH) with a minimal gonadotropin daily dose of 300 IU.. Modified natural cycle IVF protocol with GnRH antagonist (GnRH-a) supplementation. Gonadotropin-releasing hormone antagonist treatment was started when a follicle of 13 mm was present. Two to three ampules of hMG were coadministered daily during the GnRH-a treatment.. Live birth rate, pregnancy rate (PR), number of oocytes retrieved, and number of embryos transferred.. Live birth rate in "genuine" poor ovarian responders was <1%. Furthermore, in the subgroup of patients with POR who underwent a previous conventional IVF/ICSI cycle with a yield of only one oocyte, no pregnancies were achieved during the MNC-IVF cycle.. Modified natural cycle-IVF is of no benefit for genuine poor ovarian responders and the option of egg donation should be seriously considered for this population.

Topics: Adult; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Live Birth; Menotropins; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome

This study compares the cycle characteristics of clomiphene (CC) with CC+HMG (Human Menopausal Gonadotropin or Menotropins) in Polycystic Ovary Syndrome (PCOS) and non-PCOS infertile patients.. Patients were treated by CC + minimal HMg protocol. The cancellation rate, the mean number of different follicle sizes and endometrial thickness and pattern were compared.. The cancelled cycles due to non-responsiveness were significantly higher in CC compared to CC+ minimal HMg protocol. PCOS patients are significantly nonresponsive in CC cycle and hyperresponsive in CC+ minimal HMg cycles. The mean number of different sizes of follicles and the endometrial thickness were significantly higher in CC+ minimal HMg. PCOS patients were significantly different from non-PCOS regarding the number of mature follicle and endometrial thickness. The pregnancy rate was 11% (10.2% in non-PCOS and 12.2% in PCOS).. CC+ minimal HMg is a viable alternative to HMg /FSH only protocol in CC failure or resistant patients, and its efficacy can be mostly attributed to improvement of endometrial quality and increase in follicle number. Moreover, due to high cancellation of PCOS patients treated by this protocol, seemingly other alternatives should be found; perhaps sequential letrozole+HMg/FSH that have been shown to improve the ovarian response in this group of patients.

Topics: Adult; Case-Control Studies; Clomiphene; Drug Resistance; Endometrium; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Rate; Prospective Studies; Treatment Failure; Treatment Outcome; Young Adult

Topics: Anovulation; Body Mass Index; Exercise; Feeding and Eating Disorders; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hypogonadism; Hypopituitarism; Hypothalamic Diseases; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; World Health Organization

Women with polycystic ovarian syndrome (PCOS) are known to have elevated circulating Anti-Müllerian hormone (AMH), which has been found to desensitize ovarian follicles to follicle stimulating hormone (FSH). The purpose of this study was to investigate the impact of high circulating AMH on ovarian responsiveness to ovulation induction with gonadotrophins in PCOS women.. This prospective observational pilot study was conducted in two collaborating Fertility Centres in the UK and Egypt. The study included 20 consecutive anovulatory women with PCOS who underwent 34 cycles of human menopausal gonadotrophin (hMG) ovarian stimulation using chronic low-dose step up protocol. Blood samples were collected for the measurement of serum AMH concentrations in the early follicular (day 2-3) phase in all cycles of hMG treatment. The serum levels of AMH were compared between cycles with good vs. poor response. The good response rates and the total dose and duration of hMG treatment were compared between cycles with high vs. low serum AMH concentrations.. Cycles with poor response (no or delayed ovulation requiring >20 days of hMG treatment) had significantly (p = .007) higher median{range} serum AMH concentration (6.5{3.2-13.4}ng/ml) compared to that (4.0{2.2-10.2}ng/ml) of cycles with good response (ovulation within 20 days of hMG treatment). ROC curve showed AMH to be a useful predictor of poor response to hMG stimulation (AUC, 0.772; P = 0.007). Using a cut-off level of 4.7 ng/ml, AMH had a sensitivity of 100% and specificity of 58% in predicting poor response. The good response rate was significantly (p < .001) greater in cycles with lower AMH (<4.7 ng/ml) compared to that in those with AMH > = 4.7 ng/ml (100% vs. 35%, respectively). All cycles with markedly raised serum AMH levels (> 10.2 ng/ml) were associated with poor response. Cycles with high AMH (> = 4.7 ng/ml) required significantly (p < .001) greater amounts (median {range}, 1087{450-1650}IU) and longer duration (20 {12-30}days) of hMG stimulation than cycles with lower AMH (525 {225-900}IU and 8{6-14}days).. PCOS women with markedly raised circulating AMH seem to be resistant to hMG ovulation induction and may require a higher starting dose.

Topics: Anti-Mullerian Hormone; Biomarkers; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pilot Projects; Polycystic Ovary Syndrome; Treatment Outcome

The aim of this retrospective study was to investigate the impact of endogenous and exogenous luteinizing hormone (LH) activity on treatment outcome, when taking into consideration potential confounding variables. Data were derived from IVF patients (n = 358) stimulated with highly purified menotrophin (HP-hMG) in a long gonadotrophin-releasing hormone (GnRH) agonist protocol. Simple retrospective logistic regression analysis showed that the mid-follicular exogenous concentrations of human chorionic gonadotrophin (hCG) (p = 0.027), provided by the HP-hMG preparation, and female age (p = 0.009) were significantly associated with live-birth rate, while the mid-follicular progesterone concentration (p = 0.075), the estradiol concentration on last stimulation day (p = 0.075) and number of embryos transferred (p = 0.071) were borderline significant. Endogenous LH was not associated with live-birth rate; neither at start of stimulation (p = 0.123), nor in the mid-follicular phase (p = 0.933) or on the last day of stimulation (p = 0.589). In the multiple regression analysis of life birth, mid-follicular hCG (p = 0.016) was identified as a positive predictor, and age (p = 0.004) and mid-follicular progesterone (p = 0.029) as negative predictors. In conclusion, mid-follicular concentrations of exogenous hCG and progesterone, but not endogenous LH, are associated with live-birth rate in IVF patients treated with HP-hMG in a long GnRH agonist cycle.

Topics: Adult; Chorionic Gonadotropin; Female; Fertility Agents, Female; Fertilization in Vitro; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Logistic Models; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Progesterone; Retrospective Studies; Young Adult

A cohort of patients addressed to a mild stimulation protocol was retrospectively analysed aiming at evaluating the effect of a luteinizing hormone (LH) activity containing stimulation compared to a pure follicle-stimulating hormone (FSH) drive in absence of any pituitary suppression. Due to a referral bias, the two groups (human FSH (hFSH) n = 210; hMG n = 105) were imbalanced for age with the hFSH group (mean age 38.4) being significantly older than the hMG group (mean age 36.8). But the clinical pregnancy rates (20%) did not differ between the groups. Secondary outcome variables showed a higher number of oocytes retrieved (3.02 vs. 2.31) and higher estradiol levels (1148 vs. 820) in the hMG/younger group whereas the fertilization rate (FR) was higher (54.8 vs. 63.8) in the FSH older/group. In spite of the LH content in the hMG product (~10 IU per vial), the LH concentration on the day of human chorionic gonadotropin (hCG) was higher, although non-significantly, in the hFSH group. We suppose hCG contained in hMG inhibited to some extent the natural release of LH from the non-suppressed pituitary. Concluding, the mild stimulation clinical pregnancy rates are satisfactory independently of the treatment choice. The hMG group showed a trend for a lower efficacy. This phenomenon might be limited to non suppressed cycles, but should be taken in due account also when designing full dose controlled ovarian hyperstimulation (COH) treatments.

Topics: Adult; Chorionic Gonadotropin; Cohort Studies; Drug Combinations; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Italy; Luteinizing Hormone; Menotropins; Oocyte Donation; Oocyte Retrieval; Ovary; Ovulation Induction; Pituitary Gland; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic

We report the first case, to the best of our knowledge, of successful conception following ovarian induction in a patient with premature ovarian failure and undetectable serum anti-Müllerian hormone. A 34-year-old woman was referred because of ovarian amenorrhea. After endogenous gonadotrophins were normalized by hormone-replacement therapy and gonadotrophin-releasing hormone agonist, ovarian induction was performed using exogenous gonadotrophins. On ovarian induction day 8, one follicle had reached a mean diameter of 19.6 mm, the serum estradiol level had increased to 516 pg/mL, and human chorionic gonadotrophin (HCG) was injected. On HCG injection day 7, ultrasonography was unable to detect the follicle, and serum progesterone levels had increased to 6.1 ng/mL. One month after HCG injection, ultrasonography detected an intrauterine fetus with beating heart. Even with serum anti-Müllerian hormone levels below the threshold of detection, there is a chance for patients with premature ovarian failure.

Topics: Adult; Anti-Mullerian Hormone; Embryo Implantation; Estrogen Replacement Therapy; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency; Severity of Illness Index

We describe successful ovulation induction with low-dose hCG administration in addition to hMG in a patient with refractory hypothalamic amenorrhea. A 24-year-old woman with weight loss-related amenorrhea underwent ovulation induction and intracytoplasmic sperm injection (ICSI). Administration of exogenous gonadotropins was ineffective in ovulation induction. Supplementation with low-dose hCG in order to increase luteinizing hormone (LH) activity in the late follicular phase produced late folliculogenesis and steroidogenesis, and ovulation was then successfully induced. This report reacknowledges the critical role that LH plays cooperatively with follicle-stimulating hormone in both folliculogenesis and steroidogenesis.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Drug Combinations; Female; Humans; Hypothalamic Diseases; Infertility, Female; Menotropins; Pregnancy; Treatment Outcome; Weight Loss; Young Adult

Fertility decreases with advancing age. This study retrospectively reviewed the results of ovarian stimulation and intrauterine insemination (IUI) in women 40 years old with diminished ovarian reserve or unexplained infertility who underwent treatment with ovarian stimulation/IUI with clomiphene citrate or gonadotrophin and compared them with the results of IVF and in-vitro maturation (IVM) treatments. The main outcome measures were pregnancy and live-birth rates. The profiles of the patients in ovarian stimulation, IVM and IVF groups were comparable. There were no clinical pregnancies in the clomiphene citrate and IVM groups. The clinical-pregnancy rates in the gonadotrophin and IVF groups were 2.6% and 16.9% and the live-birth rates were 2.6% and 13.7%, respectively. Compared with ovarian stimulation, IVF is most effective for women aged 40 years or more. Attempting success with ovarian stimulation or IVM will delay conception unnecessarily.

Topics: Adult; Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Maternal Age; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Retrospective Studies

We here report the first investigation of exclusively elective in vitro fertilization (IVF) cycles in women with no apparent history of infertility. Since IVF outcome in women with infertility are always influenced by underlying causes of infertility, a study on non-infertile women may offer new insights.. We investigated 88 females without history of infertility in 109 consecutive elective IVF cycles, almost exclusively performed for purposes of preimplantation genetic screening (PGS; i.e., elective gender selection). The following questions were addressed: (i) impact of PGS on IVF pregnancy chances; (ii) impact of transfer of 1 vs. ≥2 embryos on IVF pregnancy chances; (iii) correlation of anti-Müllerian hormone (AMH) levels to embryo ploidy (iv) effect of gonadotropin dosage used in stimulation on available embryos for transfer; and (v) in form of a 1:1 case control study, compared 33 elective PGS cycles with matched control cycles without PGS, performed in couples with either prior tubal ligations and/or severe male factor infertility as indication of IVF.. The overall clinical pregnancy rate for the group was 36.7%; pregnancy was associated with number of euploid (P = 0.009) and number of embryos transferred (P = 0.001). Odds of pregnancy were 3.4-times higher if ≥4 euploid embryos were produced in comparison to <4 (95% CI 1.2 to 9.2; P = 0.019), and odds of pregnancy were 6.6-times higher if greater than or equal to 2 rather than <1 euploid embryos were transferred (95% CI 2.0 to 21.7; P = 0.002). Increasing AMH (P = 0.001) and gonadotropin dosage used in ovarian stimulation (P = 0.024), was, independently, associated with number of available euploid embryos. Increasing AMH, but not follicle stimulating hormone (FSH), was associated with number of embryos available for biopsy and PGS (P = 0.0001). Implantation rates were 26.4% with PGS and 9.5% without (P = 0.008). Women undergoing PGS, demonstrated 4.58-times higher odds of pregnancy than matched controls (95% CI 1.102 to 19.060, Exp 4.584, P = 0.036).. This study suggests that outcomes of elective IVF cycles may significantly deviate from infertility-associated cycles. Affirming proof of concept for PGS, utilizing day-3 embryo biopsy and fluorescence in-situ hybridization (FISH), both widely held responsible for earlier failures to establish such proof, suggests that the principal cause of prior failures were likely not insufficient laboratory techniques but poor patient selection for PGS. Such a conclusion questions the current reintroduction of PGS with improved techniques and technologies in absence of prior determination of suited patient populations.

Topics: Adult; Anti-Mullerian Hormone; Embryo Transfer; Embryo, Mammalian; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Female; Male; Menotropins; Ploidies; Pregnancy; Pregnancy Rate; Preimplantation Diagnosis; Sex Preselection; Single Embryo Transfer; Treatment Outcome

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Follicular Phase; Humans; Infertility, Female; Kallmann Syndrome; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Twin

We compared modified repeated intracyclic clomiphene citrate therapy (RICCT) to gonadotropin therapy to determine whether this modified regimen was an effective alternative after conventional clomiphene therapy.. Patients with ovulation disorder received treatment with modified RICCT and gonadotropin, and ovulation, pregnancy, total drug cost, and adverse effects were compared.. Among a total of 16 patients, 14 successfully ovulated after modified RICCT and 11 ovulated after gonadotropin therapy; two did not respond to either therapy. The total drug cost was US $36.3+/-17.9 for modified RICCT, which was significantly lower than the cost of gonadotropin therapy, US $213.9+/-100.4 (p=0.0001).. Because modified RICCT does not require the discomfort of daily injection and has excellent ovulation-inducing effects, it is a useful treatment after conventional clomiphene therapy.

Topics: Clomiphene; Drug Costs; Female; Fertility Agents, Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

To examine and compare the effect of the two commercially available menotropins (highly purified-human menopausal gonadotropin (HP-hMG) and the traditional human menopausal gonadotropin (hMG)) on ovarian stimulation characteristics and in-vitro fertilisation (IVF) cycle outcome.. We studied 36 patients undergoing at least two controlled ovarian hyperstimulation cycles for IVF, with the same GnRH-analogue protocols, where one included HP-hMG and the other included hMG. Ovarian stimulation characteristics and outcome were compared between the two groups.. Patients in the HP-hMG group achieved significantly higher implantation (20.0% vs. 8.1%, p < 0.03; respectively) and pregnancy rates (47.2% vs. 19.4%, p < 0.009; respectively) compared to the hMG group. Although no in-between group difference was observed in the number of top-quality embryos per patient, the proportion of the total number of top-quality embryos per total number of generated embryos was significantly higher in the HP-hMG group (88/196 vs. 72/204, p < 0.049; respectively) as compared to the hMG group.. Patients undergoing controlled ovarian hyperstimulation for IVF that includes HP-hMG preparations produce significantly higher implantation and pregnancy rates, as compared to the traditional hMG.

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Young Adult

The relationship between fibroids and infertility remains an unsolved question, and management of intramural fibroids is controversial. During the implantation phase, uterine peristalsis is dramatically reduced, which is thought to facilitate embryo implantation. Our aims were to evaluate (i) the occurrence and frequency of uterine peristalsis in infertile women with intramural fibroids and (ii) whether the presence of uterine peristalsis decreases the pregnancy rate.. Ninety-five infertile patients with uterine fibroids were examined using magnetic resonance imaging (MRI). Inclusion criteria were as follows: (i) presence of intramural fibroids, excluding submucosal type; (ii) no other significant infertility factors (excluding endometriosis); and (iii) regular menstrual cycles, and MRI performed at the time of implantation (luteal phase day 5-9). The frequency of junctional zone movement was evaluated using cine-mode-display MRI. After MRI, patients underwent infertility treatment for up to 4 months, and the pregnancy rate was evaluated prospectively.. Fifty-one patients fulfilled the inclusion criteria, and 29 (57%) and 22 (43%) patients were assigned to the low (0 or 1 time/3 min) or high frequency (≥ 2 times/3 min) uterine peristalsis group, respectively. Endometriosis incidence was the same in both groups. Ten out of the 29 patients (34%) in the low-frequency group achieved pregnancy, compared with none of the 22 patients (0%) in the high-frequency group (P< 0.005). Comparing pregnant and non-pregnant cases, 4 of 10 patients (40%) and 9 of 41 patients (22%), respectively, had endometriosis (not significant).. A higher frequency of uterine peristalsis during the mid-luteal phase might be one of the causes of infertility associated with intramural-type fibroids.

Topics: Adult; Clomiphene; Endometriosis; Female; Fertility Agents, Female; Humans; Infertility, Female; Leiomyoma; Magnetic Resonance Imaging; Menotropins; Ovulation Induction; Peristalsis; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Rate; Prospective Studies; Retrospective Studies; Uterine Neoplasms

To evaluate the in vitro fertilization and intracytoplasmic sperm injection outcomes after high initial doses of follicle-stimulating hormone (FSH) in patients with poor ovarian reserve.. For in vitro fertilization/intracytoplasmic sperm injection patients younger than 40 years of age, 345 cycles were examined from April 2003 to April 2007. As a control, 218 cycles received gonadotropin-releasing hormone agonist and regular initial doses of FSH from day 3 of the treated cycle. The remaining 127 cycles were treated with high initial doses of FSH with an antagonist or low doses of gonadotropin-releasing hormone because of poor ovarian reserve.. When higher initial doses of FSH were used, lower estradiol levels on the day of human chorionic gonadotropin injection and less mature oocytes were retrieved from the group with poor ovarian reserve. Clinical pregnancy rates per embryo transfer were similar (45.7%vs. 48.2%, p = 0.686). There was a trend of lower ongoing pregnancy rate per cycle (28.3%vs. 38.5%, p = 0.05) in the study compared with the control group. In the subgroups with high doses of FSH, neither protocol was superior in terms of clinical (45.5%vs. 46.2%, p=0.952) or ongoing pregnancy rates per embryo transfer (37.9%vs. 42.3%, p=0.695).. There was no significant difference in clinical pregnancy rate of the two groups when good embryos were obtained. The group with poor ovarian reserve had lower ongoing pregnancy rates per cycle. For patients with expected poor ovarian response, treatment with high doses of FSH initially is an option.

Topics: Adult; Chi-Square Distribution; Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Oocytes; Ovarian Follicle; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome

Examinations of the cervical mucus for determining its quantity and physical characteristics are used to provide a clinical marker for the timing of ovulation. We propose that transvaginal ultrasound, which is routinely used as a tool for monitoring follicular growth in patients undergoing ovulation induction, might also be used simultaneously for estimating cervical mucus measurements. With no additional effort or expense, these data may help to optimize individual patient management.

Topics: Cervix Mucus; Cervix Uteri; Clomiphene; Female; Fertilization in Vitro; Follow-Up Studies; Humans; Infertility, Female; Menotropins; Predictive Value of Tests; Selective Estrogen Receptor Modulators; Sensitivity and Specificity; Ultrasonography

To investigate the outcome of in vitro fertilization and embryo transfer (IVF-ET) in special infertile patients following modified super-long down-regulation protocol combined with human menopausal gonadotropin (HMG) stimulation.. Ninety-nine special patients (42 with endometriosis, 35 with PCOS, and 22 with insufficient down-regulation) who underwent modified super-long down-regulation protocol in 2008 were retrospectively analyzed. Gonadotropin releasing hormone analogues (GnRHa, 1.5 mg) was injected intramuscularly in mid-luteal phase twice and HMG was started 25 days later after the second GnRHa injection. Conventional IVF-ET was performed as routine procedure. The clinical outcomes were compared with those of 122 similar patients in the same period.. After modified super-long down-regulation, (1) in endometriosis patients, the average gonadotropin (Gn) used was (32.33 +/- 15.11) ampoules, duration of medication was (10.57 +/- 1.88) days, the progesterone (P) level on hCG day was (0.78 +/- 0.44) microg/L, and the clinical pregnancy rate (CPR) was 73.8%; (2) in PCOS patients, the average Gn used was (28.57 +/- 12.07) ampoules, the duration of medication was (11.71 +/- 2.07) days, the P level at hCG day was (0.65 +/- 0.39) microg/L, and the clinical pregnancy rate was 65.7%; (3) in insufficient down-regulation patients, the average Gn used was (26.22 +/- 12.07) ampoules, the duration of medication was (10.01 +/- 1.77) days, the P level at hCG day was (0.71 +/- 0.50) microg/L, and the clinical pregnancy rate was 72.7%. Compared with patients using regular down-regulation protocol, the clinical pregnancy rate was improved significantly and the cost decreased obviously. The clinical pregnancy rate significantly improved compared with that of routine long down-regulation groups.. Revised super-long protocol plus HMG is a cost-effective controlled ovary hyperstimulation (COH) regimen for infertile patients with endometriosis, PCOS and insufficient down-regulation.

Topics: Adult; Embryo Transfer; Endometriosis; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies; Treatment Outcome

In a selected group of patients with >20% oocyte immaturity during an IVF cycle with FSH alone, the addition of hMG to the stimulation protocol results in a higher yield of mature oocytes and excellent-quality embryos.

Topics: Adult; Cohort Studies; Drug Therapy, Combination; Embryo, Mammalian; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Hormones; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Oocytes; Ovulation Induction; Retrospective Studies; Treatment Outcome

To study effect of drug treatment in polycystic ovary syndrome patients with hyperprolactinemia.. We retrospectively studied 63 women with polycystic ovary syndrome and hyperprolactinemia from the Reproductive Medicine Center, Provincial Hospital between January 2005 and March 2007. According to the beginning time of bromocriptine, all women were divided into two groups. Group I was composed of 48 cases who received bromocriptine administration before induction of ovulation cycles, and the dose of bromocriptine was modulated depending on the level of serum prolactin. When serum prolactin was controlled at normal levels, we decreased the dosage of bromocriptine step by step (1.25 mg once), and then continued the treatment at maintenance dosage for no less than 3 weeks. After a baseline ultrasonographic examination on day 3, patients were treated with clomiphene citrate at a dosage of 100 mg (2 tablets/day) for 5 days of a normal cycle or progesterone-induced bleeding. On day 9, we monitored the growth conditions of follicles routinely with trans-vaginal ultrasound. If there was no dominant follicle, we added human menopausal hormone (hMG, 75 U/d) to the protocol. Human chorionic gonadotropin (hCG, 6000-10,000 IU) was given intramuscularly when the mean diameter of a follicle reached at least 18 mm. At the same time we instructed the patients to have sexual intercourses or carried out artificial inseminations before and after ovulation. Group II were 15 cases in which induction of ovulations were commenced almost simultaneously with beginning of bromocriptine. The same protocol was given to patients in group II. The procedures of ovulation induction and the outcomes of treatment were analyzed and compared.. Compared with group II , the days of using hMG in Group I was shorter by instructing the time of sexual intercourse. The difference was significant (P = 0.004). And there were similar results in the artificial insemination cycles (P = 0.009). The rate of pregnancy in group I (40%, 19/48) was higher than that in group II (27%, 4/15), but the difference was not obvious (P = 0.525 ).. Bromocriptine administration before the stimulated ovulation therapy can decrease the total dosage and treatment course of ovulating drugs. Induction of ovulations simultaneously with start of bromocriptine therapy can shorten the treatment time of infertility.

Topics: Adult; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Hyperprolactinemia; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Prolactin; Retrospective Studies; Treatment Outcome

The use of controlled ovarian hyperstimulation (COH) to recruit multiple oocytes is now common practice worldwide in most clinical programs of in vitro fertilization (IVF). It was not always so. This is the story of the first successful use of exogenous gonadotropins in a clinical program of IVF.

Topics: Chorionic Gonadotropin; Female; Fertility Agents, Female; Fertilization in Vitro; History, 20th Century; Humans; Infertility, Female; Menotropins; Narration; Ovulation Induction; Pregnancy; Reproductive Medicine; Virginia

To investigate whether menstrual cycle length correlates with success rates at IVF/intracytoplasmic sperm injection (ICSI) and could be used as a marker of ovarian reserve.. Prospective observational study.. Private infertility centre.. A total of 6271 IVF/ICSI treatment cycles.. Self-reported mean number of menstrual days during the last year was recorded before initiation of IVF/ICSI treatment.. Relations between menstrual cycle length and pregnancy and delivery rates.. Increasing age was associated with a subtle shortening of mean menstrual cycle length. Menstrual cycle length correlated linearly with pregnancy and delivery rates, even after age adjustment. The chance of delivery after IVF/ICSI was almost doubled for women with a menstrual cycle length >34 days compared with women with a menstrual cycle length <26 days. Menstrual cycle length was also significantly associated with ovarian response to FSH/hMG stimulation and embryo quality.. Mean menstrual cycle length is highly related to success rates in assisted reproduction, independently of age. A precise menstrual cycle history could be used as a simple marker of ovarian reserve.

Topics: Adult; Age Factors; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Live Birth; Menotropins; Menstrual Cycle; Ovary; Pregnancy; Pregnancy Rate; Prospective Studies; Time Factors

As there is no consensus concerning the variation of serum cortisol level during in vitro fertilization (IVF), we studied it prospectively by frequent evaluation throughout the course of an IVF cycle and compared the value, as control, of cortisol concentration obtained in the previous month (M-1) with the concentration obtained on the first day (D1) of ovarian stimulation.. In 23 IVF cycles using gonadotropin-releasing hormone agonist/human menopausal gonadotropins (hMG)/human chorionic gonadotropin, cortisol and estradiol were measured at M-1, D1, day 14 (D14, before beginning hMG), day 16 (D16), day 19 (D19), day 22 (D22), day 24 (D24), the day before (T-1) and the day after triggering ovulation (T+1), the day of oocyte retrieval (OR), 15 days after embryo transfer (ET+15) and the next month (M2). Statistical analysis used tests of linear tendency, the Pearson chi(2) test, analysis of variance, Student's t test and Spearman correlation.. Cortisol was non-significantly lower at M-1 compared with D1; although remaining in the normal range, mean cortisol increased progressively after D1, in a manner unrelated to estradiol, with non-significant differences between different time points but a significant linear tendency and a maximum value at T+1. All mean cortisol values were significantly higher than that at M-1 and, except for D19 and T-1, D1. Mean cortisol decreased at ET+15 and significantly at M2, the value at M2 being lower than that at M-1.. Cortisol showed a progressive increase beginning from D1, especially after ovulation triggering, and returned to pre-treatment level next month. Cortisol variation was not related to the changes in the E(2) values. Cortisol values at both M-1 and D1 could be used as controls.

Topics: Adult; Cohort Studies; Female; Fertility Agents, Female; Fertilization; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Stress, Physiological

Endometriosis befalls in one of the most frequent gynecologic diseases. It manifests itself by the presence and growth of focus of endometrium out of the uterus cavum that reacts to hormonal stimulations as the normal uterus endometrium does. Hyperstimulation and induction of ovulation together with intrauterine insemination (IUI) are the most frequently used treatments of unexplained infertility in patients with mild type endometriosis. The aim of this study was to compare the effects of stimulation using human meno pausal gonadotrophine (hMG) in the patients with mild type endometriosis to the patients with infertility of unknown ethiology.. The study included 50 patients with unexplained infertility (group N), as well as 50 patients with mild type endometriosis (group E) confirmed by laparoscopy. Within the same therapeutic protocole hIMG stimulation and horionic gonadotrophine induction (hCG) were used.. In the group E ovulation occurred in 74% of the pa tients during the first stimulation, in 77.78% during the second cycle, and in 75% of the patients during the third one. Regarding the group N, ovulation appeared in 82% of the patients during the first stimulation. Stimulation was performed two times more in 38 patients with unknown couse of infertil ity, and ovulation appeared in 84.21 percent of them. In the group N stimulation was performed three times in 28 women resulting in ovulation in 85.71% of them.. Con sidering the obtained results it can be concluded that hMG stimulation and hCG induction are efficient in the treatment of infertility, particularly in mild type endometriosis.

Topics: Adult; Chorionic Gonadotropin; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

To compare the early-cleavage rates and the implantation potential of embryos between the GnRH antagonist and agonist long stimulation protocols in women older than 35 years.. Retrospective analysis.. Academic medical center.. Two hundred twenty patients older than 35 years old underwent IVF.. Sixty-eight patients received GnRH antagonist protocol (GnRH antagonist group) and 152 patients received GnRH agonist long stimulation protocol (GnRH agonist group).. Early-cleavage rate of zygotes, implantation rate, and pregnancy rate.. Early-cleavage rate of zygotes was significantly lower in the GnRH antagonist group than agonist group (21.8% vs. 32.6%, P<.0001). In the GnRH antagonist group, the pregnancy rate was not significantly different between the early-cleavage and late-cleavage subgroups (40.0% vs. 47.4%). In the GnRH agonist group, the pregnancy rate was significantly higher in the early-cleavage subgroup than in the late-cleavage subgroup (61.0% vs. 29.8%, P<.0001).. In women older than 35 years, the early-cleavage rate of zygotes is significantly lower in the GnRH antagonist group than the agonist group. Early-cleavage status of zygotes is not a reliable predictor for embryo implantation in patients receiving the GnRH antagonist protocol.

Topics: Adult; Age Factors; Cell Survival; Cleavage Stage, Ovum; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Rate; Prognosis; Retrospective Studies; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome

A subtle rise in serum progesterone during the late follicular phase in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles is a frequent event that can decrease implantation and pregnancy rates in controlled ovarian hyperstimulation (COH) protocols that use a gonadotropin-releasing hormone (GnRH) antagonist. The aim of the present study was to evaluate the prevalence and effect of the subtle progesterone rise during COH with single-dose GnRH antagonist in combination with clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in IVF or ICSI cycles. Ninety-five women undergoing COH with CC, hMG and a single 2.5 mg dose of the GnRH antagonist, cetrorelix, were enrolled in the study. Patients were grouped according to serum progesterone level on the day of human chorionic gonadotropin (hCG) administration (P < 1.2 ng/ml or P >/= 1.2 ng/ml). The incidence of a subtle progesterone rise was 54.7% (52/95). The group with P >/= 1.2 ng/ml had significantly higher serum levels of luteinizing hormone (p = 0.002) and estradiol (p < 0.001) on the day of hCG injection than the group with P < 1.2 ng/ml, and more oocytes were retrieved (p = 0.001). However, there was no significant difference in fertilization, clinical pregnancy or implantation rate between the two groups. In conclusion, a subtle progesterone rise during the late follicular phase is common but not associated with pregnancy outcome.

Topics: Adult; Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Menotropins; Ovulation Induction; Progesterone; Sperm Injections, Intracytoplasmic

Enclomiphene, an isomeric component of clomiphene citrate, acts antagonistically to the oestradiol receptor at the hypothalamus level, inhibiting both negative and positive feedback, and resulting in the induction of ovarian stimulation and suppression of ovulation. The minimal ovarian stimulation protocol takes full advantage of these characteristics of clomiphene citrate. Administration of 50 mg clomiphene citrate is initiated on cycle day 3, and from day 8 patients receive 150 IU of FSH every other day. When the size of the dominant follicle and the oestradiol concentration reach the predefined values, gonadotrophin-releasing hormone agonist is administered to induce follicular maturation. Oocytes are then retrieved 32-35 h later. Because the short half-life of enclomiphene (24 h) is of critical importance in this protocol, it is necessary to continue oral administration of clomiphene citrate until the day before maturation is triggered. Of all 43,433 cycles initiated, the rates for oocyte retrieval and embryo cleavage were 83 and 64% respectively. The mean number of oocytes retrieved was 2.2. The rates for live births, miscarriages, and ectopic pregnancies, in relation to initiated cycles, including cases of frozen-thawed transfer, were 11.1, 3.4 and 0.2% respectively.

Topics: Adult; Clomiphene; Embryo Transfer; Enclomiphene; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Middle Aged; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Selective Estrogen Receptor Modulators

The objective of this retrospective analysis was to compare the clinical outcomes of recombinant FSH (r-FSH) with combination r-FSH plus human menopausal gonadotrophin (HMG) protocols in a large private practice using a single IVF laboratory, from 2001 to 2003. Patients underwent ovarian stimulation by standard gonadotrophin-releasing hormone (GnRH) antagonist protocol using r-FSH or combination r-FSH plus HMG. When two or more follicles had attained a minimum mean diameter of 20 mm, follicular triggering was achieved with either recombinant HCG (r-HCG; Ovidrel, 250 microg s.c.) or urinary HCG (u-HCG; 10,000 IU i.m.). The main outcome measures were number of oocytes retrieved and clinical pregnancy rate. There was a lower percentage of cancelled cycles and an increased number of oocytes retrieved, mature oocytes, oocytes that fertilized, embryo that cleaved and a tendency towards higher clinical pregnancy rates in patients treated with r-FSH alone compared with those treated with r-FSH plus HMG. Patients treated with r-FSH plus HMG had lower miscarriage rates and the live birth rate was similar in both treatment groups. In conclusion, irrespective of age, using a treatment regimen consisting of a combination of HMG plus r-FSH was not beneficial compared with r-FSH alone in patients using a GnRH antagonist protocol.

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Treatment Outcome

Topics: Adenocarcinoma, Clear Cell; Adult; Clomiphene; Endometriosis; Female; Fertility Agents, Female; Humans; Hysterectomy; Infertility, Female; Menotropins; Neoplasm Staging; Ovarian Diseases; Ovarian Neoplasms; Ovariectomy; Ovulation Induction; Treatment Outcome

Published cases of non-traumatic avascular necrosis of the femoral head associated with pregnancy are rare. We report a case of a 41-year-old woman who suddenly complained of bilateral hip pain 3 weeks after delivery by Caesarean section. For a problem of sterility, she had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG). Initial radiographs of both hip joints were considered regular. After 4 years' evolution, radiographs of the hip joint showed collapse of both femoral heads. Bilaterally, osteonecrosis of the femoral heads was confirmed by MRI. MRI revealed a band pattern of low signal intensity for both hips on T1- and T2-weighted images. She had no history of steroid therapy or alcohol abuse. Osteonecrosis was related to pretentaine. A bilateral total hip arthroplasty was performed. The literature about avascular necrosis of the femoral head associated with pregnancy in previous cases is reviewed.

Topics: Adult; Arthroplasty, Replacement, Hip; Chorionic Gonadotropin; Female; Femur Head Necrosis; Fertility Agents, Female; Hip Joint; Humans; Infertility, Female; Menotropins; Pain; Postpartum Period; Pregnancy

A 25-year-old woman, diagnosed with Kallmann's syndrome and wanting to become pregnant, visited our hospital. Because her serum gonadotropin levels indicated hypogonadotropic hypogonadism, a main symptom of Kallmann's syndrome, we attempted to induce ovulation using a low-dose human menopausal gonadotropin (hMG) step-up protocol. In this protocol, 75 IU of hMG was used as an initial dose and this was continued for the first 14 days because adequate follicular development was not achieved. The dose of hMG was subsequently increased to 150 IU for the next 7 days. After 22 days from the start of stimulation, two follicles had developed, and were ovulated using an injection of human chorionic gonadotropin. She became pregnant, and her pregnancy was uneventful during the first trimester; however, in the second trimester both uterine contractions and blood pressure could not be controlled, and at 27 weeks' gestation she delivered a male infant weighing 830 g by cesarean section.

Topics: Adult; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infertility, Female; Kallmann Syndrome; Male; Menotropins; Obstetric Labor, Premature; Ovulation Induction; Pregnancy

To demonstrate that folliculogenesis can be sustained with 200 IU human chorionic gonadotropins (hCG) after FSH-priming and result in pregnancy in women with estrogenic ovulatory dysfunction and risk factors for severe ovarian hyperstimulation syndrome (OHSS).. Three women with infertility associated with estrogenic ovulatory dysfunction and hyperinsulinemia who appeared to be at high risk for severe OHSS during gonadotropin therapy.. After 10 days of receiving either 150 IU hMG or recombinant FSH, patients were switched to 200 IU hCG/day alone for 2-3 days. 5,000 IU of hCG was then administered followed by either home intercourse, intrauterine insemination or transvaginal oocyte retrieval-embryo transfer.. Endovaginal ultrasound measurement of follicle number and size, serum estradiol levels, symptoms of ovarian hyperstimulation, pregnancy test, and evaluation of pregnancy by transvaginal ultrasound.. After discontinuation of hMG or recombinant FSH, serum estradiol concentrations continued to rise, and follicles >14 mm continued to grow during low-dose hCG administration. All women conceived without developing symptoms of OHSS. Pregnancy outcomes achieved include a term singleton delivery, a term twin delivery, and triplets delivered at 31 weeks gestation.. The use of low-dose hCG alone is sufficient for supporting the late stages of folliculogenesis in women with estrogenic ovulatory dysfunction. This ovulation induction regimen appears to support the follicular growth of larger follicles while decreasing the number of smaller preovulatory follicles, thereby reducing a known risk factor for OHSS. We report on the positive pregnancy outcomes in 3 women with estrogenic ovulatory dysfunction and clinically appeared to be at high risk for developing severe OHSS who safely underwent this protocol.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Male; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome

The aim of this study was to investigate the relationship of serum FSH and LH levels at the commencement of stimulation to ovarian follicular development in women undergoing pituitary down-regulation and controlled ovarian hyperstimulation with gonadotropins in IVF or intracytoplasmic sperm injection (ICSI) cycles.. Retrospective analysis.. An IVF program in a tertiary medical center.. A total of 245 women proven to be pituitary down-regulated by their serum E(2) levels.. Patients treated with a GnRH agonist and FSH and hMG underwent assisted reproductive technique (ART).. Mature oocyte yield, pregnancy rate (PR), and live birth rate.. The serum FSH levels and the FSH-to-LH ratio at the commencement of gonadotropin stimulation were inversely correlated to the number of mature oocytes (r = -0.193 and r = -0.224, respectively). When assessed with receiver-operating characteristic (ROC) analysis, there was statistically significant ability for the FSH/LH ratio to differentiate between the "poor response" cycles (with mature oocyte yield < or =4) and the normal response cycles. Using the cutoff value derived from ROC analysis, cycles with the FSH-to-LH ratio > or =3 produced less mature oocytes (8.25 vs. 11.74), lower peak E(2) levels (1,975.3 pg/mL vs. 3,324.8 pg/mL), and higher percentage of poor ovarian response cycles (32.5% vs. 14.3%).. The serum FSH-to-LH ratio at the start of gonadotropin stimulation after pituitary down-regulation provided a practical method for early prediction of mature oocyte yield.

Topics: Adult; Biomarkers; Down-Regulation; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Oocytes; Ovary; Ovulation Induction; Pituitary Gland; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Retrospective Studies

The aim of the present study was to evaluate the clinical efficacy of half-dose (50 mug) and further reduced dose (33 or 25 mug) gonadotropin-releasing hormone agonist (GnRH-a; triptorelin) long protocols for multifollicular ovarian stimulation (MFOS) for patients with high basal serum follicle-stimulating hormone (FSH) level undergoing in vitro fertilization and embryo transfer (IVF-ET). One hundred and two IVF-ET cycles performed in 84 infertile patients with high basal serum FSH (>10.0 mIU/ml) were included in this retrospective study. Study subjects were assigned to two groups: continuous half-dose GnRH-a long protocol (group A, n = 63) vs. further reduced dose GnRH-a long protocol (group B, n = 39) from half-dose at the start of GnRH-a to one-third or one-quarter dose after pituitary downregulation. Exogenous FSH or human menopausal gonadotropin was administered for MFOS in step-down mode, four or fewer embryos were transferred, and the outcomes of MFOS were compared between the two groups. Serum estradiol (E(2)) level on the day of human chorionic gonadotropin administration was significantly higher in group B (mean +/- standard deviation (SD): 1318.3 +/- 1120.4 vs. 2054.9 +/- 1773.5 pg/ml, p = 0.015). The number of transferable and good-quality embryos was also significantly higher in group B (mean +/- SD: 2.9 +/- 1.7 vs. 3.7 +/- 2.0, p = 0.027; 1.8 +/- 1.4 vs. 2.7 +/- 2.0, p = 0.020). No statistically significant difference in the outcomes was observed with respect to the dose of gonadotropins administered, the number of oocytes retrieved or the clinical pregnancy rate. In conclusion, GnRH-a long protocol with a reduced dose, tapered from the starting half-dose to a third or a quarter of the normal dose after pituitary suppression, may be beneficial for MFOS in IVF-ET patients with a high basal serum FSH level. A further prospective randomized controlled study on a larger scale is needed to confirm these findings.

Topics: Adult; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Retrospective Studies; Triptorelin Pamoate

This is a retrospective analysis of 89 patients who were undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in the Fertility Management Unit of the Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies. Twenty-eight patients (Group A), who did not receive oral contraceptive pills prior to controlled ovarian hyperstimulation (COH) were compared with 61 patients in Group B treated with oral contraceptive pills for two months prior to undergoing COH assisted reproduction using the long protocol. The number of follicles, oocytes, estimated oestradiol levels on the day of administration of human chorionic gonadotrophin (hCG), pregnancy rates, miscarriage rates and the incidence of patients who developed ovarian hyperstimulation syndrome (OHSS) were the main outcome measures. The mean age and haematocrit were the same in each group. The number of follicles retrieved tended to be higher in Group A than in Group B (median 8 versus 6, p = 0.06) with significantly more oocytes being retrieved in Group A than Group B (p < 0.05). There were no statistically significant differences between the two groups in oestradiol levels, the proportion of patients with polycystic ovarian disease, the proportion of women who developed ovarian hyper-stimulation syndrome or pregnancy outcomes. There was no difference between the groups in measures of clinical severity of OHSS. In a logistic regression model the significant predictors of OHSS were haematocrit and oestradiol levels. There appeared to be no significant clinical benefit in administering oral contraceptive pills for two months to patients prior to COH.

Topics: Adult; Contraceptives, Oral, Hormonal; Embryo Transfer; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Retrospective Studies; Treatment Outcome

We aimed to compare the effects of two different gonadotropins on steroid production in patients with polycystic ovary syndrome (PCOS). The study group comprised 20 infertile patients diagnosed with PCOS who were accepted into in vitro fertilization-embryo transfer and gamete intra-Fallopian transfer programs. Ten patients were consecutively allocated to a purified urinary follicle stimulating hormone (FSH) administration group while the other ten received human menopausal gonadotropin (hMG). All patients were pretreated with a gonadotropin releasing hormone-agonist. The patients were followed by daily vaginal ultrasonography until at least two follicles reached a diameter of 17 mm or an estradiol value of at least 100 pg/ml per follicle. To induce ovulation, human chorionic gonadotropin was given. On the 3rd day of menstruation, serum estradiol, luteinizing hormone (LH), FSH, total testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), insulin-like growth factor-I and insulin were measured. These same parameters were measured again on the day of follicle aspiration in both serum and follicular fluid. In both groups, the serum levels of estradiol and androstenedione were raised significantly, and on aspiration day the serum level of DHEAS was significantly raised in the FSH group but not in the hMG group. Our findings suggest that in PCOS patients exogenous hMG induces a different steroid synthesis pattern compared to pure FSH, hypothetically by reduction of the delta-5 steroid synthesis pathway in the adrenals and/or in the ovary.

Topics: Adult; Androstenedione; Chorionic Gonadotropin; Dehydroepiandrosterone Sulfate; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Insulin; Insulin-Like Growth Factor I; Menotropins; Ovulation Induction; Pilot Projects; Polycystic Ovary Syndrome

The study aim was to investigate possible changes in serum anti-Müllerian hormone (AMH) levels during controlled ovarian hyperstimulation (COH), and their possible relationship with follicular development and other ovarian hormones.. A total of 93 women undergoing COH with GnRH agonist and FSH was studied prospectively. Serum levels of AMH, inhibin B, estradiol (E(2)), progesterone, testosterone and Delta(4)-androstenedione were measured when pituitary suppression was achieved (baseline), on days 6 and 8 of FSH treatment, and on the day of hCG. The number of small (<12 mm) and large (>/=12 mm) antral follicles were estimated using ultrasound.. Serum AMH levels declined progressively (baseline, 1.21 +/- 0.11 ng/ml; day 6, 0.91 +/- 0.09 ng/ml; day 8, 0.77 +/- 0.08 ng/ml; and day of hCG, 0.53 +/- 0.06 ng/ml), whereas-as expected-the other hormone levels increased during FSH treatment. Throughout COH, serum AMH levels correlated positively with the number of small but not large antral follicles, and with inhibin B serum levels. No correlation between AMH and the other hormones was observed.. Serum AMH levels decline gradually during multiple follicular maturation, probably reflecting the dramatic reduction in the number of small antral follicles due to COH, and confirming the scarce AMH expression by larger follicles.

Topics: Adult; Anti-Mullerian Hormone; Female; Follicle Stimulating Hormone; Glycoproteins; Gonadotropin-Releasing Hormone; Growth Inhibitors; Hormones; Humans; Infertility, Female; Inhibins; Menotropins; Ovarian Follicle; Ovulation Induction; Prospective Studies; Testicular Hormones; Time Factors; Ultrasonography

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

All cycles of IVF with pituitary down-regulation (n = 57) done at the Damansara Fertility Centre in the year 2000 were studied. All the 57 patients had controlled ovarian hyperstimulation, either using Metrodin HP (n = 27) or Gonal-F (n = 30). Of these, 53 patients reached oocyte pick-up, 26 patients in Metrodin HP group and 27 patients in Gonal-F group. Gonal-F resulted in a higher clinical pregnancy rate of 66.6% compared to Metrodin HP 38.5% (p < 0.05). The live birth rate tends to be higher in Gonal-F group (40.7%) compared to Metrodin HP (30.8%), (p > 0.05).

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Malaysia; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

To evaluate how endometriosis affects expression of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in granulosa cells.. Prospective study.. IVF-ET program at Osaka Medical College.. Seventeen patients with revised American Fertility Society stage IV endometriosis and 17 patients with tubal infertility and no endometriosis.. Granulosa cells obtained at oocyte retrieval were examined for VEGF and IL-6 gene expression.. Serum E(2) and P levels at hCG administration, number of oocytes, fertilization rate, high-quality embryo rate, and pregnancy rate, and expression of VEGF and IL-6 genes.. Total hMG and FSH levels were statistically significantly higher in patients with endometriosis; however, the number of retrieved oocytes and the fertilization rate were lower compared with patients with tubal infertility. Serum E(2) levels and expression of VEGF in patients with tubal infertility were statistically significantly higher than those in patients with endometriosis. Interleukin-6 gene expression did not differ between the groups.. In severe endometriosis, lower VEGF gene expression in granulosa cells may adversely affect oocyte development and maturation.

Topics: Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Endothelial Growth Factors; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gene Expression; Granulosa Cells; Humans; Infertility, Female; Intercellular Signaling Peptides and Proteins; Interleukin-6; Lymphokines; Menotropins; Oocytes; Ovulation Induction; Polymerase Chain Reaction; Pregnancy; Progesterone; Prospective Studies; Reproductive Techniques, Assisted; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factors

To determine whether minimal stimulation with clomiphene and one injection of 150 IU of human menopausal gonadotrophin (hMG) provides pregnancy rates comparable with those in a conventional full hMG stimulation protocol for infertile patients undergoing intrauterine insemination (IUI).. A prospective study was carried out at the Infertility Clinic of a teaching institute and tertiary care referral center in Chandigarh, India. Two hundred couples with either unexplained infertility or ovulatory dysfunction cases who ovulated with clomiphene citrate (CC) but failed to conceive were offered ovarian stimulation with CC and hMG along with IUI for 420 cycles. Pregnancy rate, medication and monitoring cost were compared between minimal and conventional stimulation protocols.. There was no difference in the couples of the two stimulation protocols regarding their age, duration and type of infertility as well as cause of infertility. Number of ampoules of hMG and monitoring costs were significantly higher in the full hMG stimulation cases whereas pregnancy rate was comparable in both protocols.. Minimal stimulation appears to be an effective protocol in cases of unexplained infertility undergoing intrauterine insemination. Reduced cost and minimal monitoring is appealing to patients and the clinician.

Topics: Adult; Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Prospective Studies

The present retrospective study evaluated the outcome of frozen-thaw cycles with oocytes obtained either during a multiple dose protocol of cetrorelix, or after the use of a gonadotrophin-releasing hormone (GnRH) agonist. A total of 101 subfertile couples were included. These couples had a total of 222 transfers of frozen-thawed pronuclear oocytes after IVF/intracytoplasmic sperm injection (ICSI) treatment. According to the stimulation protocol during various cycles, four groups were established: cetrorelix/recombinant FSH (recFSH) (69 cycles), cetrorelix/human menopausal gonadotrophin (HMG) (10 cycles), GnRH-agonist/recFSH (71 cycles) and GnRH-agonist/HMG (72 cycles). The transfer cycles were mildly stimulated with transdermal oestradiol. No statistically significant difference was seen among the four groups regarding post-thaw survival rate, cumulative embryo score, implantation rate and pregnancies. Frozen-thawed pronuclear oocytes obtained with the use of cetrorelix give satisfactory implantation and pregnancy rates, similar to those obtained with a GnRH-agonist. These results do not depend on the gonadotrophins (HMG or recFSH) used in the collecting cycle.

Topics: Cryopreservation; Embryo Implantation; Estradiol; Estrogens; Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Male; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Outcome; Recombinant Proteins; Retrospective Studies; Sperm Injections, Intracytoplasmic

Topics: Adult; Diagnosis, Differential; Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Pelvic Pain; Pregnancy; Ultrasonography, Prenatal

To determine whether an elevated serum P:E2 ratio on the day of hCG administration during gonadotropin stimulation for intrauterine insemination (IUI) or IVF is associated with diminished ovarian reserve.. Retrospective chart review.. Tertiary fertility center.. Two hundred eighty-six women undergoing a fertility evaluation.. Clomiphene citrate challenge test (CCCT).. E2 and P concentrations on the day of hCG administration.. For the IUI group (n = 98), 74 women had a normal CCCT, while 24 had an abnormal CCCT. For women undergoing IVF (n = 188), 171 had a normal CCCT and 17 had an abnormal CCCT. For women undergoing IUI with a normal CCCT, 33 (44%) had a [(P/E2) x 1000] ratio <1 on the day of hCG, while 12 (50%) (abnormal CCCT) had a [(P/E2) x 1000] ratio <1. Similarly, for women doing IVF with a normal CCCT, 96 (56%) had a [(P/E2) x 1000] ratio <1 on the day of hCG, and 9 (44%) (abnormal CCCT) had a [(P/E2) x 1000] ratio <1 on the day of hCG. The frequencies were similar for all comparable groups. For both groups, there was no association between serum (P/E2) x 1000 on the day of hCG administration and day 3 or 10 FSH during the CCCT. For women with a normal CCCT, there were no differences in delivery rates based on the (P/E2) x 1000 ratio.. In women stimulated with hMG for IUI or IVF, the serum P:E2 ratio on the day of hCG administration is not associated with diminished ovarian reserve, as demonstrated by the CCCT, or pregnancy outcome.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Retrospective Studies

To determine the impact of a cryopreservation program on pregnancy rates and multiple-pregnancy rates in ART cycles.. Retrospective study.. University teaching hospital.. Women who underwent stimulation for in vitro fertilization at the Jones Institute for Reproductive Medicine between October 1987 and June 1999.. Analysis of pregnancy and multiple-pregnancy rates based on the number of embryos transferred.. Implantation; pregnancy and multiple-pregnancy rates.. Pregnancy rates per transfer increased from 9% when one embryo was transferred to 20% with two embryos, 35% with three embryos, 40% with four embryos, and 41% with five embryos. The rate of twin pregnancies increased to 21% with two embryos, 23% with three embryos, 21% with four embryos, and 22% with five embryos. The triplet pregnancy rates were 8% with three embryos, 9% with four embryos, and 2% with five embryos. A theoretical model limiting the number of embryos transferred to two with cryopreservation and subsequent transfer yields a cumulative pregnancy rate of 77%, a twin rate of less than 20%, and no triplet or higher-order pregnancies.. The use of a cryopreservation program can help maximize pregnancy rates while minimizing multiple-pregnancy rates. Cryopreservation should be considered in all assisted reproductive technology cycles.

Topics: Adult; Cryopreservation; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Models, Theoretical; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Recombinant Proteins; Reproductive Techniques; Retrospective Studies

This study aimed to evaluate the prognostic value of the baseline serum oestradiol E2 level on the cycle pregnancy rate (PR) in women with unexplained infertility (UI) undergoing controlled ovarian hyperstimulation (COH). This study is unique in that it evaluates the effect of cycle day 1 (rather than day 3) E2 levels on cycle PR in a COH setting (without IVF) in women with UI (rather than multiple causes of infertility). Structured as a retrospective cohort study, the setting was the Ovulation Induction Clinic at an academic tertiary care hospital. One hundred and forty-five patients with UI underwent 374 cycles of COH with either human menopausal gonadotrophin (hMG) alone or hMG and clomiphene citrate. Outcome was measured as cycle pregnancy rate (PR) according to the cycle day 1 level of E2. Patients with an E2 level > 150 pmol/l on cycle day 1 of COH achieved a significantly lower PR (4%) compared with those with E2 levels < or = 150 pmol/l (13%). Logistic regression analysis demonstrated that women with day 1 E2 levels below 150 pmol/l were 3.2 times more likely to conceive than those with day 1 E2 levels above 150 pmol/l. Also, the impact of day 1 E2 levels on the chance of pregnancy was independent of day 1 serum FSH levels. Women with UI undergoing COH in our unit with an elevated baseline serum E2 > 150 pmol/l have a significantly lower PR and should be counselled regarding the decreased likelihood of pregnancy.

Topics: Adult; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Logistic Models; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Induction; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prognosis; Radioimmunoassay; Time Factors; Treatment Outcome

Urine-derived gonadotropins have been used to treat infertility but may cause allergic reactions. IgE-mediated hypersensitivity reactions can be treated with desensitization, especially when new therapies such as recombinant human gonadotropins are unavailable.. This case is described to highlight a successful intervention with desensitization in a woman with a complicated history of secondary infertility. She had been treated with ovulation-induction regimens, such as IVF-M (in vitro fertilization-human menopausal gonadotropin [hMG]) and IVF-C (human chorionic gonadotropin [hCG]), for intrauterine insemination. During treatment, however, she experienced reactions to IVF-M and IVF-C. Because she strongly wanted a baby and no alternative preparation was available, desensitization was attempted.. Intradermal tests with IVF-M and IVF-C using both negative and positive controls were performed on the patient and four normal control subjects. Immediate wheal-and-flare reactions occurred only in the patient. ELISA and ELISA inhibition tests showed positive responses to IVF-M and IVF-C, but not to highly purified hMG, hCG, or D-mannitol, a preservative in IVF-M and IVF-C. Desensitization to IVF-M and IVF-C was done with a protocol used for parenteral desensitization to penicillin.. During the IVF-M desensitization, the intramuscular injections were well tolerated. For the next 2 days, daily administration of IVF-M was uneventful. Thirty-six hours later, desensitization to IVF-C was performed successfully. The patient had two intrauterine inseminations and became pregnant.. Nongonadotropin proteins in urine-derived gonadotropins cause IgE-mediated hypersensitivity reactions. Acute desensitization to urine-derived gonadotropins can be performed effectively, as shown in our current case.

Topics: Adult; Binding, Competitive; Chorionic Gonadotropin; Desensitization, Immunologic; Dose-Response Relationship, Drug; Female; Humans; Hypersensitivity, Immediate; Immunization Schedule; Immunoglobulin E; Infertility, Female; Menotropins

We report a successful pregnancy in a woman with severe ovarian dysfunction and infertility associated with a variant beta-subunit of luteinizing hormone (LH).. A 35-year-old woman consulted our unit for infertility. Laparoscopy and ultrasonography showed obstruction of the right tube and ovulation from the right ovary only. Human menopausal gonadotrophin (hMG) therapy was used for six subsequent cycles, but did not result in conception. Subsequently, marked elevation of follicle-stimulating hormone (FSH) and testosterone, together with polycystic ovary (PCO) were noted. The patient failed to respond to ovarian stimulation by hMG. Severe ovarian dysfunction such as premature ovarian failure (POF) was strongly suspected. Sequence analysis of the LH beta-subunit gene indicated heterozygosity for point mutations Trp(8) to Arg(8) and Ile(15) to Thr(15) in the coding sequence. LH hypersecretion resembling that seen in PCO syndrome was observed. Induction of ovulation by hMG was successful in the first cycle in which the basal LH and FSH were well controlled with gonadotrophin-releasing hormone analog following estrogen-progesterone replacement. She conceived and delivered a healthy male infant at term.. Clinicians should be clinically aware of patients with immunologically anomalous LH variant who might be at risk of developing ovarian failure within a relatively short time span. Pertinent treatment should be applied without delay in such cases.

Topics: Adult; Female; Follicle Stimulating Hormone; Humans; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Mutation; Ovulation Induction; Pregnancy; Primary Ovarian Insufficiency

In-vitro fertilization (IVF) is an effective infertility treatment for women with endometriosis, but most women need to undergo several cycles of treatment to become pregnant. This case-control study was designed to assess how consistently women with ovarian endometriosis respond to ovarian stimulation in consecutive treatment cycles compared to women with tubal infertility. We compared outcome measures in 40 women with a history of surgically confirmed ovarian endometriosis and 80 women with tubal infertility, all of whom had at least three IVF treatment cycles. The groups were matched for age and early follicular follicle stimulating hormone (FSH) concentration at their first IVF cycle. Outcome measures included number of follicles, number of oocytes, peak oestradiol concentration and number of FSH ampoules required per follicle. Cumulative pregnancy and live birth rates were calculated in both groups. The ovarian endometriosis group had a significantly poorer ovarian response and required significantly more ampoules of FSH per cycle, a difference that became greater with each subsequent cycle. However, cumulative pregnancy (63.3 versus 62.6% by fifth cycle) and live birth (46.8 versus 50.9% by fifth cycle) rates were similar in both groups. In conclusion, despite decreased ovarian response to FSH, ovarian endometriosis does not decrease the chances of successful IVF treatment.

Topics: Adult; Case-Control Studies; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Nafarelin; Oocytes; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Pregnancy; Prospective Studies

To assess serum leptin levels based on body habitus and ovarian morphology during controlled ovarian hyperstimulation.. Prospective analysis.. University IVF program.. Women undergoing IVF-ET were divided into two groups, obese ovulatory women (n = 6; mean (+/-SD) body mass index, 30.1 +/- 0.6 kg/m(2)) and lean ovulatory women (n = 20); mean (+/- SD) body mass index 22.0 +/- 0.2 kg/m(2)). Lean women were categorized further according to whether they had polycystic-appearing ovaries (n = 8) or normal-appearing ovaries (n = 12).. Controlled ovarian hyperstimulation and IVF.. Serum estradiol, testosterone, and leptin.. Mean (+/- SD) leptin levels were significantly higher before and after GnRH agonist down-regulation in obese women (41.7 +/- 5.2 pg/mL and 36.1 +/- 5.8 pg/mL, respectively) compared with lean women (8.4 +/- 1.0 pg/mL and 6.9 +/- 1.1 pg/mL, respectively). Mean (+/- SD) leptin levels increased significantly in both groups (54.5 +/- 5.1 pg/mL and 11.7 +/- 1.2 pg/mL, respectively), and the mean (+/-SD) percentage increase was similar (55% +/- 18% and 54.8% +/- 17%, respectively). Mean (+/-SD) leptin levels were similar in women with polycystic-appearing and normal-appearing ovaries before controlled ovarian hyperstimulation, but increased significantly in women with polycystic-appearing ovaries afterward (14.7 +/- 1.8 pg/mL and 9.3 +/- 1.0 pg/mL, respectively).. Significant increases in leptin levels occur during controlled ovarian hyperstimulation, suggesting that leptin plays a role in follicular growth and maturation. The exaggerated response in women with polycystic-appearing ovaries reflects either a greater number of recruited follicles or a predisposition of adipocytes to leptin production.

Topics: Adult; Body Weight; Case-Control Studies; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leptin; Menotropins; Obesity; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Testosterone

To compare ovarian response and pregnancy rate between women with one and two ovaries undergoing in vitro fertilization and embryo transfer (IVF/ET).. 20 IVF/ET treatment cycles in ten women with a single ovary were compared with 60 IVF/ET cycles in 47 women with two ovaries. Both groups were matched for age and treated for mechanical infertility. In both groups treatment protocol included gonadotropin releasing hormone/human menopausal gonadotropin/human chorionic gonadotropin (GnRH/hMG/hCG).. Effective daily dose of gonadotropins (3.7+/-0.7 vs. 3.6+/-1.0), mean 17beta-estradiol levels on day of hCG administration (1136+/-467 vs. 1343+/-776), number of retrieved oocytes (6.4+/-3.7 vs. 8.3+/-4.2) and number of embryos per transfer (3.0+/-0.7 vs 2.9+/-1.2) were not statistically different between the groups. A significantly higher pregnancy rate was observed among women with one ovary (52.9%) as compared with those with two ovaries (20.8%), (P=0.015). Multivariate logistic regression analysis demonstrated an odds ratio of 5.73 for patients with a single ovary.. Treatment outcome in patients with a single ovary undergoing IVF/ET is comparable to those with two ovaries. The unexpected significantly higher pregnancy rate observed among these patients need to be further evaluated.

Topics: Adult; Chorionic Gonadotropin; Corpus Luteum; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Logistic Models; Menotropins; Ovariectomy; Pregnancy; Progesterone; Treatment Outcome

In-vitro fertilization (IVF) and ovarian stimulation are frequently performed in patients with endometriosis. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low. We report four cases of severe digestive complications due to the rapid growth of sigmoid endometriosis under ovarian stimulation. In three patients, sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowel resection was performed before ovarian stimulation. All patients experienced severe digestive symptoms during ovarian stimulation, and a segmental sigmoid resection had to be performed. Analysis of endoscopic and radiological data demonstrated that bowel lesions of small size may rapidly enlarge and become highly symptomatic under ovarian stimulation. At immunohistochemistry, these infiltrating lesions displayed high populations of steroid receptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aware of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months of morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulation.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Digestive System Diseases; Endometriosis; Female; Fertilization in Vitro; Humans; Immunohistochemistry; Infertility, Female; Ki-67 Antigen; Menotropins; Ovulation Induction; Receptors, Steroid; Sigmoid Diseases

Our purpose was to determine prospectively, using receiver-operating characteristic (ROC) analysis, whether the ovarian reserve test with hMG could improve the predictive value of a woman's age and basal levels of follicle stimulating hormone (FSH), E2, and inhibin or any combination of them regarding ovarian response and pregnancy rate in IVF treatment following pituitary desensitization.. The hMG test was performed within 3 months of IVF treatment in 80 women undergoing the first cycle of IVF and consisted of 2 ampoules of hMG daily for 5 days starting on cycle days 2 to 3. Hormone and ultrasound evaluation was performed on cycle days 2 to 3 and 7 to 8.. The mean age and basal FSH levels were significantly higher in the canceled (n = 28) than in the control (n = 52) group, whereas the basal inhibin level was significantly higher in the latter. Regarding ovarian response, the combination FSH plus inhibin had the better diagnostic accuracy (predictive value of 70%) among basal variables. When post-hMG parameters (alone or in combination) were analyzed, E2 alone, with a 77% diagnostic accuracy, emerged as the best predictive variable of cancellation in IVF cycles. When ROC analysis was used, the area under the ROC curve for E2 post-hMG (diagnostic accuracy of 84.5%) was significantly higher than that for the estimates based on the combination of basal FSH and inhibin (diagnostic accuracy of 71.3%). However, woman's age was the only variable independently associated with pregnancy rate.. The predictive power of the hMG test of ovarian reserve is better than that of age and basal hormone values (FSH and inhibin) and it is based mainly on the E2 response to hMG treatment. However, given that age is the only predictor of pregnancy and considering the cost and discomfort of the hMG test, the usefulness, if any, of the test in predicting IVF performance in the daily clinical setting remains to be established.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Inhibins; Maternal Age; Menotropins; Ovary; Ovulation Induction; Predictive Value of Tests; Pregnancy; Pregnancy Rate; Regression Analysis; ROC Curve; Treatment Outcome; Ultrasonography

The ovarian hyperstimulation treatment increases results of in vitro fertilization. However, the risk of ovarian hyperstimulation syndrome must be carefully evaluated for each patient. An excessive response increases complication and cancellation rates. Coasting could be applied when an excessive response occurred. This method requires stopping gonadotropin administration while GnRH agonist is continued. When the estradiol rate decreases, the hCG administration is allowed. In the literature, results shows adequate pregnancy rates, between 26 and 64%. It seems oocyte quality was not spoiled. However, coasting does not eliminate definitively the risk of ovarian hyperstimulation syndrome. Coasting method could be a safe and efficient method to treat an excessive ovarian response during in vitro fertilization protocol. Pregnancy rates seem to be preserved.

Topics: Chorionic Gonadotropin; Clinical Protocols; Drug Monitoring; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Follicular Atresia; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome; Risk Factors; 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 case of general hypersensitivity-like allergic reactions to intramuscular injections of highly purified urinary follicle stimulating hormone (uFSH-HP) successfully managed by using intramuscular recombinant FSH (rFSH). The patient underwent a first cycle of in vitro fertilization (IVF) and controlled ovarian hyperstimulation (COH) was achieved with a combination of gonadotropin releasing hormone against (GnRH-a) and uFSH-HP. Because, after oocyte recovery, no fertilization occurred, the couple subsequently entered an intracytoplasmic sperm injection (ICSI) program. During the COH, the woman developed general hypersensitivity-like allergic reactions with itching, redness and swelling. Although there was regular follicular growth, the allergic symptoms worsened and, on day 8 of COH, the stimulation cycle was suspended. A few months later, the patient entered a new ICSI cycle. COH was achieved by using a combination of GnRH-a and rFSH. The cycle was completed and the patient did not report any allergic reaction. To avoid allergic reaction to the protein components of the urine-derived FSH preparations, the use of rFSH is suggested in those patients who present local and/or general hypersensitivity-like allergic reactions.

Topics: Adult; Chorionic Gonadotropin; Drug Hypersensitivity; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Infertility, Female; Injections, Intramuscular; Leuprolide; Menotropins; Ovulation Induction; Recombinant Proteins; Sperm Injections, Intracytoplasmic

Topics: Adult; Female; Fertilization in Vitro; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Twins

Multiple follicular development plays a major role in the successful outcome of IVF and embryo transfer treatment. Prediction of ovarian responses prior to stimulation is useful in counselling patients and helpful in tailoring the dosage of gonadotrophin to individual patients. The objective of this study was to compare age of women, body mass index (BMI), basal FSH concentration, volume of both ovaries and the number of antral follicles of both ovaries in predicting the number of oocytes obtained. A total of 128 consecutive women, who had no history of ovarian surgery, were non-smokers and undergoing the first cycle using a standard regimen of ovarian stimulation were examined. The total number of antral follicles achieved the best predictive value, followed by basal FSH, BMI and age of women. In those women with fewer antral follicles, a longer duration and higher dosage of human menopausal gonadotrophin were required but the number of eggs obtained was significantly less than for those with more antral follicles. Significantly more cycles were cancelled before egg collection in women with < or =6 antral follicles while more cycles of embryo transfer were postponed in order to reduce the risk of ovarian hyperstimulation syndrome in women with >9 antral follicles.

Topics: Adult; Aging; Body Mass Index; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Treatment Outcome; Ultrasonography

To verify the correlation of basal 17beta-E(2) with ovarian response to stimulation and outcome of in vitro fertilization (IVF).. Retrospective observational study.. The Assisted Conception Unit, University College London Hospitals.. Three hundred five women undergoing IVF and IVF with intracytoplasmic sperm injection.. Basal follicle-stimulating hormone (FSH) and 17beta-E(2) were assessed. The cutoff level for day 2 E(2) established was 250 pmol/L. Each patient was noted for below (group A) or above (group B) the cutoff point according to her basal E(2) level.. Basal E(2), age, duration of infertility, cycle day 2 FSH, number of ampules of gonadotropin used, number of days of stimulation, number of retrieved oocytes, fertilization rate, number of embryos transferred, number of cycles with embryo freezing, cancellation rate, clinical pregnancy rate, and implantation rate were compared between the two groups.. No differences were found between group A and group B in the number of oocytes retrieved (8.8 +/- 4.2 vs. 9.3 +/- 4.8), embryos transferred (2.5 +/- 0.8 vs. 2.7 +/- 0.7), cancellation (9.1% vs. 6.9%), pregnancy (24.8% vs. 30%), and implantation rate (12.3% vs. 15.6%). Correlation coefficient and coefficient of determination showed no significant correlation between basal E(2) and the number of oocytes retrieved, age, and basal FSH.. In our study population, basal E(2) was not a sensitive predictor of ovarian response to stimulation and did not correlate with IVF outcome.

Topics: Adult; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovary; Pregnancy; Pregnancy Rate; Prognosis; Recombinant Proteins; Retrospective Studies; Treatment Outcome

To report a successful pregnancy in a woman with panhypopituitarism who received 3 months of pretreatment with growth hormone (GH) before ovulation induction. Prior attempts at ovulation induction had failed for this patient.. Case report.. Department of Endocrinology.. A 32-year-old woman with panhypopituitarism and secondary infertility.. GH (1 IU/day) alone for 3 months; during the next cycle, 1 IU/day of GH; 3 ampules of hMG per day during days 1-21; 1 ampule of hCG on day 21. GH was discontinued on day 35 when a pregnancy test was positive.. Pregnancy and delivery.. Pregnancy and birth of a normal child after a single ovulation stimulation using GH and gonadotropins.. This case report suggests interest in a new protocol for follicular stimulation in women with hypopituitarism who are responding poorly to gonadotropin therapy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Human Growth Hormone; Humans; Hypopituitarism; Infant, Newborn; Infertility, Female; Labor, Obstetric; Male; Menotropins; Pregnancy

Our report concerns a patient with a climacterium praecox and an X-chromosomal anomaly (86% 46, XX; 7% 47, XXX; 7% 45, X0) desiring to give birth. She conceived once after down-regulation of the gonadotrophins by means of a cyclical hormone replacement therapy followed by gonadotrophin stimulation, as well as a second time under down-regulation with a GnRH-analogue and gonadotrophin stimulation. On the basis of the case report and of the literature, a possible interval therapy in such a patient, especially one even with increasing ovarian insufficiency, will be portrayed and discussed.

Topics: Adult; Down-Regulation; Estradiol; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Primary Ovarian Insufficiency; Sex Chromosome Aberrations; X Chromosome

Insulin-like growth factors (IGFs) in the intraovarian autocrine control mechanism may serve as a central signal, and the granulosa cell is their site of production, reception, and action. In addition, various IGF-binding proteins (IGFBPs) are thought to modulate and regulate the actions of IGFs and in turn influence the growth and maturation of ovarian follicles.. To further investigate the follicular growth and maturation regulated by IGFs and IGFBPs in the ovary of low responders, 14 cases of low responders cotreated with growth hormone (GH) were studied. Another 14 normal responders without GH treatment were also recruited as controls.. Serum levels of estradiol on day 6 and day 9 of the cycle and on the day of HCG administration, and the numbers of oocytes retrieved and follicles on the day of oocyte retrieval were significantly lower in low responders before growth hormone (GH) treatment than those in low responders after GH treatment as well as those in normal responders. Expression of both IGF-II and IGFBP-1 mRNA was elevated (by 23% and 35%, respectively) in granulosa cells from low responders after GH treatment as compared to that in low responders before GH treatment. In contrast, there was a substantial decrease (16%) in expression of IGFBP-3 mRNA in granulosa cells from low responders after GH treatment. Clinically, the pregnancy rate was lower in low responders after GH treatment as compared to controls (7% vs. 29%).. Cotreatment with growth hormone in low responders might not increase the pregnancy rate.

Topics: Anovulation; Drug Therapy, Combination; Female; Fertility Agents, Female; Granulosa Cells; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor Binding Proteins; Leuprolide; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; RNA, Messenger; Somatomedins; Treatment Outcome

The objective was to explore whether body mass index (BMI) of women related to the different parameters of the in vitro fertilization (IVF) procedure and outcome.. This retrospective study on 398 couples analyzed epidemiological features, characteristics of ovarian stimulation, number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: BMI < 20, 20 < or = BMI < 25 and BMI > or = 25 kg/m2.. The prevalence of underweight and overweight women was 21.8% and 22.3%, respectively. The mean ratio follicle-stimulating hormone-luteinizing hormone increased significantly according to BMI. An increase in the mean number of consummated gonadotropin ampoules together with a decrease in the number of collected oocytes was observed in long stimulating protocol cycles when BMI > or = 25 kg/m2. The same observations were made in short stimulation protocol cycles of BMI < 20 and > or = 25 kg/m2. No significant difference could be found in clinical pregnancy and miscarriage rates between underweight, normal weight, and overweight patients.. Both underweight and overweight have negative effects on IVF parameters and outcome leading to decreased chances of pregnancy.

Topics: Adult; Body Mass Index; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Oocytes; Ovary; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Retrospective Studies

To determine if a woman over age 45 with elevated serum follicle stimulating hormone (FSH) levels in the early follicular phase could still successfully conceive.. Female partner was treated with guaifenesin to improve cervical mucus quality and vaginal progesterone in the luteal phase. Careful monitoring of follicular maturation was performed.. A successful pregnancy after 14 months of progesterone therapy was achieved.. It is possible for a 46-year-old infertile woman with elevated serum FSH to achieve a pregnancy even when the male partner is taking calcium channel blockers for heart problems.

Topics: Aging; Calcium Channel Blockers; Clomiphene; Estradiol; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Guaifenesin; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Middle Aged; Pregnancy; Pregnancy Outcome; Progesterone; Vagina

To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates.. Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008).. In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

Topics: Adult; Anticoagulants; Female; Fluid Therapy; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome; Risk Factors; Ultrasonography; Venous Thrombosis

To explore the influences of macrophage colony-stimulating factor (M-CSF) on follicle development, ovulation, fertilization and embryo quality during in-vitro fertilization and embryo transfer (IVF-ET) cycles.. 36 patients underwent 54 cycles of controlled ovarian hyperstimulation by gonadotropin-releasing hormone agonist-human menopausal goudotropin-human chorionic gonadotropin for IVF-ET program. M-CSF concentrations in serum were measured at early follicular phase, mid-follicular phase and the day of oocyte retrieval by enzyme-linked immunosorbent assay. Follicular fluid (FF) on the day of egg retrieval was also measured for M-CSF concentration.. M-CSF concentration in serum gradually increased throughout ovarian hyperstimulation and reached a peak on the day of oocyte retrieval. M-CSF concentration in FF was significantly higher than that in serum on the same day (P < 0.01). The M-CSF concentration in FF from follicles where oocytes could be retrieved, fertilized or with a diameter > or 16 mm, volume > or 2 ml, was significantly higher than those from follicles where oocyte could not be retrieved, fertilized or with a diameter < 16 mm, volume < 2 ml, respectively (P < 0.01). However, there was no significant difference in M-CSF concentration of FF between high and low embryo grade groups (P > 0.05).. M-CSF may play an important role as an intraovarian regulator in the process of follicle development, maturation and ovulation. Therefore, M-CSF may exert an effect on fertilization process but not on the embryo quality.

Topics: Embryo Transfer; Enzyme-Linked Immunosorbent Assay; Female; Fertilization in Vitro; Follicular Fluid; Humans; Infertility, Female; Macrophage Colony-Stimulating Factor; Menotropins; Middle Aged; Oocytes; Ovarian Follicle; Ovulation

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

There is an increasing interest in retrieving immature oocytes in the absence of or with limited gonadotrophin exposure, with the aim of maturing them in vitro for embryo transfer purposes. The aim of this report is to present our experience of fertilization, embryonic development and pregnancies from in-vitro maturation cycles. A total of 18 patients underwent 21 cycles in which an average of 8.1 immature oocytes was retrieved after limited exposure to human menopausal gonadotrophin (HMG) and no exposure to human chorionic gonadotrophin (HCG). In one cycle, no oocytes were recovered. The oocytes were cultured for 44 h and 121 oocytes which reached MII were injected with a single spermatozoon. A total of 71 oocytes showed two pronuclei and 53 zygotes cleaved. Forty-four embryos were transferred in 17 cycles. Five weeks after embryo transfer, ultrasound examination indicated the presence of one gestational sac and one fetal heart beat in two patients. The results suggest that in-vitro matured oocytes can undergo fertilization and the resulting embryos may result in pregnancies. However, the success rate was not sufficient to recommend widespread use of the technique without further research.

Topics: Cytoplasm; Embryo Transfer; Embryonic and Fetal Development; Female; Fertilization in Vitro; Humans; Infertility, Female; Male; Menotropins; Microinjections; Oocytes; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Spermatozoa

A 26-year-old woman on human menopausal gonadotrophin-human chorionic gonadotrophin therapy for sterility showed multiple cerebral infarctions associated with ovarian hyperstimulation syndrome. A hypercoagulable state (hemoconcentration, increased plasma levels of D-dimer and thrombin-antithrombin III complex, and decreased protein S activity) was associated with her thromboembolic events. Cerebral infarction associated with mild neurologic deficits may be overlooked in patients with ovarian hyperstimulation syndrome.

Topics: Adult; Antithrombin III; Brain; Cerebral Angiography; Cerebral Infarction; Chorionic Gonadotropin; Female; Fertility Agents, Female; Humans; Infertility, Female; Magnetic Resonance Imaging; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Peptide Hydrolases; Protein S; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To assess the diffusion of gonadotropin into the follicular fluid (FF) and its relation to the results achieved in a human IVF-ET program.. Retrospective pharmacokinetic study.. Fukuoka University Hospital, Japan.. Eighty-seven infertile patients underwent 137 cycles of IVF-ET.. Serum and FF were collected at the time of oocyte recovery. The hCG ratio (between follicular hCG and serum hCG concentrations, measured by time-resolved fluoroimmunoassay) was evaluated as an index of the diffusion of exogenous gonadotropin.. Relation between hCG ratio and the results and outcome of the IVF-ET program.. The hCG ratio decreased with the total dosage of hMG and increased with the serum E2 level, the number of oocytes recovered, and the number of oocytes fertilized. Patients with a poor response showed a low hCG ratio, which was associated with a complete lack of fertilization. The mean hCG ratio in the pregnant cycles was significantly higher than that in the nonpregnant cycles. An hCG ratio > 0.46 was seen in all pregnant cycles.. The diffusion of exogenous gonadotropin into the FF may be an important predictor of IVF outcome.

Topics: Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Fluoroimmunoassay; Follicular Fluid; Humans; Infertility, Female; Male; Menotropins; Menstrual Cycle; Oocytes; Ovarian Follicle; Ovary; Pregnancy; Retrospective Studies; Spermatozoa; Treatment Outcome

To investigate follicular effects of recombinant human follicle stimulating hormone (rhFSH) induction on women with polycystic ovary syndrome (PCOS), steroid content was compared in mature follicles obtained using a long luteinizing hormone-releasing hormone agonist plus rhFSH or human menopausal gonadotrophin (HMG) in PCOS women and controls participating in an in-vitro fertilization programme. Follicular fluids (144 samples) were collected at oocyte retrieval by individual selective aspiration. Oocyte maturity and fecundability were assessed. Plasma and intrafollicular 17beta-oestradiol, progesterone, testosterone concentrations were assayed individually. No significant difference was seen in oocyte maturity and fecundability between PCOS and controls following rhFSH, or between PCOS rhFSH and HMG group. 17beta-oestradiol, testosterone and progesterone concentrations were lower in PCOS follicular fluid following rhFSH than HMG but the difference was not significant. Progesterone concentration, 17beta-oestradiol/progesterone, 17beta-oestradiol/testosterone were significantly different between the two induction groups, for PCOS fertilized oocyte follicles (P = 0.01, P < 0.05 and P < 0.05 respectively). Steroidogenic enzymatic activity seems to be regulated in healthy follicular cells in PCOS as well as in normal patients upon ovarian induction. Following rhFSH, higher PCOS follicular progesterone concentrations leading to a theoretically increased fecundability could suggest that recombinant FSH is a better inducer which needs to be confirmed.

Topics: Adult; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Humans; Infertility, Female; Male; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone; Recombinant Proteins; Testosterone

To investigate serum and follicular fluid (FF) insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) behavior in superstimulated cycles in patients with polycystic ovary syndrome (PCOS).. Controlled clinical study.. Department of Obstetrics and Gynecology, University of Naples.. Thirty-two patients with regular menses and tubal and/or male factor infertility and 21 patients with PCOS undergoing IVF.. The IVF program used leuprolide acetate suppression followed by sequential hMG in the subsequent cycle. After follicular development, hCG administration was followed 34-36 hours later by oocyte retrieval.. E2, GH, IGF-I, and IGFBP-3 assayed by RIA and immunoradiometric assay.. The controls and patients with PCOS showed similar increases in E2 and GH titers in response to FSH stimulation. Serum IGF-I did not change in either group and was equivalent in the FF. Patients with PCOS had a higher FF IGFBP-3 titer and did not show the decrease in serum IGFBP-3 levels of the control group after FSH stimulation.. The apparent failure of IGFBP-3 reduction in patients with PCOS alters IGF-I bioavailability. Increased sequestration of IGF-I affects ovarian steroidogenesis and may explain the poor response to gonadotropin stimulation.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Human Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor Binding Protein 3; Insulin-Like Growth Factor I; Leuprolide; Male; Menotropins; Polycystic Ovary Syndrome

Our purpose was to find the differences in granulosa-luteal cells obtained from gonadotropin-versus gonadotropin-releasing hormone (GnRH) agonist/gonadotropin-treated follicles in in vitro fertilization-embryo transfer (IVF-ET) cycles.. Granulosa-luteal cells were obtained from 45 follicles of women undergoing IVF-ET with gonadotropin releasing hormone (GnRH) agonist and human menopausal gonadotropin (hMG) and from 45 follicles of women with hMG IVF-ET cycles. Subpopulations of granulosa-luteal cells were observed by computerized image analysis in which human chorionic gonadotropin (hCG) was localized using immunoperoxidase staining.. The luteinized granulosa-luteal cells from hMG-treated follicles were larger than those from GnRH agonist/hMG-treated follicles. The hMG-treated follicles contained more hCG-stained cells, particularly those with cytoplasmic hCG localization.. We found differences in morphometric characteristics and hCG localization in granulosa-luteal cells obtained from hMG-versus GnRH agonist/hMG-treated follicles. We presume that the results indicate the influence and importance of luteal-phase support on the clinical pregnancy rate in GnRH agonist/hMG-treated IVF-ET cycles.

Topics: Adult; Drug Interactions; Embryo Transfer; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Granulosa Cells; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction

The aim of the study was to investigate the process of glycolysis in gonadotropic, hyperstimulated, human ovarian follicles.. Follicular fluid (FF) lactate and glucose concentrations were measured in 26 patients with tubal factor infertility undergoing in vitro fertilization treatment.. The mean FF lactate and glucose concentrations were 3.17+/-0.90 mM with positive, and 3.39+/-0.91 mM with negative correlations to follicular size. FF lactate concentration correlated negatively to glucose levels.. Our study confirms in vivo the anaerobic glycolysis in gonadotropic, hyperstimulated human ovarian follicles.

Topics: Anaerobiosis; Buserelin; Chorionic Gonadotropin; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Glucose; Glycolysis; Humans; Infertility, Female; Lactic Acid; Luteinizing Hormone; Menotropins; Oocytes; Ovarian Follicle; Ovulation; Prospective Studies

Embryo quality evaluated by the embryo morphology is a critical parameter in human in-vitro fertilization (IVF) and embryo transfer. It determines which and how many embryos will be replaced, as pregnancy rates are directly related to number and quality of transferred embryos. This retrospective analysis included 1301 IVF and embryo transfer cycles to identify which factors influenced embryo quality. Embryo quality did not correlate with maternal age, causes of infertility, ovarian stimulation parameters or embryo cohort size. However, the mean score of transferred embryos was significantly higher for patients with more than five embryos compared to fewer than five embryos (P < 0.001), irrespective of maternal age. Patients tended to produce a similar embryo quality from cycle to cycle, r = 0.33 (P < 0.001) for the embryo cohort and r= 0.47 (P < 0.001) for the transferred embryos. Poor embryo morphology probably reflects oocytes with compromised development competence and could be an independent factor of infertility. Furthermore, a large embryo cohort was the main factor increasing the chances of at least one good embryo in the cohort.

Topics: Adult; Cell Count; Cohort Studies; Embryo Transfer; Embryo, Mammalian; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Maternal Age; Menotropins; Oocytes; Ovary; Pregnancy; Retrospective Studies; Sperm Injections, Intracytoplasmic

A prospective study was undertaken to evaluate the efficacy of stimulated in vitro fertilization (SIVF) using Clomiphene Citrate and hMG in different infertilities. The analysis was applied to the first 81 cycles over a period of 9 months in the years 1994-1996 in Sheffield Fertility Centre (SFC). The female patients included in this study were under 40 years of age, and their FSH and LH values were < 10IU/L. Mild and moderate male factor infertilities were included. For tubal factor infertility 16 cases were included with an implantation rate of 0%. The unexplained factor infertility included 33 cases with an implantation rate per embryo transfer (ET) of 41%. For male factor infertility there were 18 cases with an implantation rate per ET of 42%. Out of 3 cases in the ovulatory factor group none reached ET with 0% implantation. For multiple factor infertility 11 cases were included with a 0% implantation rate. The overall implantation per embryo transfer was 27%, while the implantation per cycle started was 15%. We conclude that there are certain infertility factors, i.e. unexplained infertility and mild male factor, which can have good results in IVF using CC/hMG only.

Topics: Adult; Clomiphene; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Infertility, Male; Male; Menotropins

We demonstrate that antitestosterone autoantibody is produced in a 24-yr-old woman with hypergonadotropic hypogonadism. The serum testosterone level measured by RIA was extremely elevated (5.80 ng/mL); after elution, serum testosterone had returned to a normal female value (0.21 ng/mL). The clinical features were suggestive of no androgen activity. Primary follicles were present in the patent's ovary. After gonadotropin treatment, conception was achieved, and a normal female infant was delivered. A gel filtration study showed that the testosterone-binding activity was eluted at the position of 15,000-kDa Ig. Scatchard analysis revealed a low affinity antibody; the association constant was 0.034 x 10(3) mol-1, and the maximal binding capacity was 162 mumol/mL. An immunoprecipitation study the chain-specific antibodies showed that the antitestosterone autoantibody belonged to kappa-type IgG. This subject is the first reported case with an endocrine disorder who possessed autoantibodies against testosterone.

Topics: Adult; Autoantibodies; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Infant, Newborn; Infertility, Female; Karyotyping; Luteinizing Hormone; Male; Menotropins; Ovarian Follicle; Ovulation; Pregnancy; Pregnancy Outcome; Radioimmunoassay; Testosterone

To examine the efficacy of IUI on fecundity and baby-take-home rates in cases of infertility attributable to a male factor with and without a woman's hormone factor.. Retrospective analysis.. Department of Gynecology and Obstetrics at the General Public Hospital, Horn, Austria.. Seventy-eight long-standing involuntarily childless couples.. After a follicular phase GnRH analog (buserelin) protocol with hMG stimulation of the woman and a Percoll gradient preparation and capacitation of the man's semen, an IUI was performed.. Fecundity and baby-take-home rates.. One hundred nine inseminations were followed by 53 pregnancies (48.6%; 95% confidence intervals (CI) 38.9%-58.4%) and 38 deliveries (34.9%; 95% CI 26.0%-44.6%). Forty-nine children were born and 47 are alive (43.1%).. Intrauterine insemination combined with buserelin gonadotropin stimulation, Percoll semen preparation, and sperm capacitation is a feasible solution to the problem of sterility attributable to a male factor with and without a woman's hormone factor.

Topics: Adolescent; Adult; Birth Rate; Buserelin; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Retrospective Studies; Sperm Capacitation

To gain insight into the physiologic significance of premature luteinization and to evaluate whether it could be a manifestation of low ovarian reserve.. Retrospective evaluation.. Reproductive medicine unit.. Thirty-one consecutively seen women with normal ovulation and unexplained infertility.. Induction of superovulation with hMG coupled with synchronized IUI. A GnRH agonist was not used during the study.. Premature luteinization was defined as a progesterone/estradiol ratio of > 1 on the day of hCG administration. Patients were evaluated during their first cycles of hMG treatment and then were divided into those with (study group) and those without (control group) premature luteinization. The ovarian reserve parameters were compared between the two groups.. Nineteen of the 31 patients with unexplained infertility demonstrated premature luteinization. Patient characteristics were similar between the study and control groups. Mean (+/- SD) day 3 FSH levels were 8.2 +/- 3.3 and 6.6 +/- 1.7 mIU/mL in the study and control groups, respectively. Mean (+/- SD) day 3 estradiol levels were significantly higher in the study than in the control group (74 +/- 49 pg/mL vs. 30 +/- 17 pg/mL, respectively). Mean (+/- SD) estradiol levels on the day of hCG administration also differed significantly between the study and control groups (760 +/- 539 pg/mL vs. 1,568 +/- 675 pg/mL, respectively). Likewise, the number of follicles that were > or = 15 mm on the day of hCG administration was significantly lower in the study than in the control group (2.9 +/- 1.5 vs. 4.3 +/- 1.3, respectively). The total dose of hMG and duration of administration were similar in the two groups. The clinical pregnancy rates after four cycles of treatment were 15.8% and 41.7% in the study and control groups, respectively.. This preliminary work suggests that, in cycles that are not treated with a GnRH agonist, signs of premature luteinization in patients with unexplained infertility could be an early manifestation of low ovarian reserve. It appears that hMG treatment in this group of patients could uncover the pathogenesis of their infertility.

Topics: Adult; Chorionic Gonadotropin; Corpus Luteum; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovarian Follicle; Ovary; Pregnancy; Progesterone; Superovulation

The patterns of plasma melatonin, gonadotropins, sex steroids and prolactin were studied in anovulatory infertile females undergoing ovulation induction with hMG/hCG. Melatonin levels were found to fluctuate during the menstrual cycle of these subjects with a nadir at mid-cycle and peak occurring at the early follicular/late luteal phases of the cycle (p < 0.05). Melatonin correlated negatively with estradiol during the follicular phase (r=-0.5180, p < 0.05) and positively with LH (5 + 0.6321, p < 0.05) in the luteal phase, respectively. Correlational analyses by partial and multiple correlations suggest that the effects of estradiol and LH on melatonin in the follicular phase are interdependent whereas the effect of LH on melatonin in the luteal phase is independent of the effects of other hormones. The results suggest that hormonal interactions and phases of the cycle are important variables contributing to the fluctuations in melatonin levels during the menstrual cycle.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Melatonin; Menotropins; Menstrual Cycle; Ovulation Induction; Progesterone; Prolactin

We describe our experience with in vitro fertilization (IVF) treatment in 13 women with histologically proven genital tuberculosis.. For IVF treatment the above patients had to meet two criteria: normal uterine cavity and functional ovaries.. Six intrauterine pregnancies (28.6% success rate) were achieved after 21 IVF treatment cycles in 13 patients with histologically proven diagnoses of genital tuberculosis. This series represents a comparatively encouraging success rate, but these patients were selected carefully before committing them to IVF treatment.. IVF represents a useful treatment and improves the chances of fertility, in what was considered a desperate situation.

Topics: Adult; Buserelin; Clomiphene; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Retrospective Studies; Salpingitis; Superovulation; Tuberculosis, Female Genital; Uterus

To compare the efficacy of IUI husband in natural versus FSH stimulated cycles.. Prospective, controlled study.. IUI were performed in 57 infertile couples with natural cycles, and in 16 under FSH and GnRH stimulation (Short protocol). In stimulated patients also hCG and hydrogesteron were given. Indication in both groups was idiopathic infertility. Duration of infertility and the age were comparable. Semen preparation and ovarian monitoring were the same in 2 groups.. Three pregnancies in 57 natural IUI cycles (5.3%) and 5 out of 16 cycles in stimulated women (31.2% per cycle-with one triple pregnancy).. In couples with idiopathic infertility FSH stimulation significantly increases rate of pregnancy and multiple gestation.

Topics: Adult; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Menstrual Cycle; Pregnancy

Our purpose was to analyze factors for their predictability of multiple pregnancies in patients treated with a combination of human menopausal gonadotropins (hMG) and intrauterine insemination (IUI).. The records of all patients conceiving through treatment with hMG/IUI were reviewed for factors predictive of multiple pregnancy.. Ninety-one pregnancies reviewed included 78 singleton (86%), 8 twin (9%), and 5 higher-order pregnancies (5%). The total number of follicles > 10 mm was greater in the multiple-pregnancy group and there was a decreased number of postwash sperm in the multiple-pregnancy group. Otherwise there was no significant difference in the factors analyzed.. No factor or combination of factors predicts multiple pregnancies to a degree that it would be helpful in managing or counseling patients.

Topics: Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Risk

The most important aspect of diminished ovarian reserve is the associated decline in reproductive potential. Assessment of ovarian reserve is mainly based on measurement of early follicular phase follicle stimulating hormone (FSH) concentration. The objective of this study was to report the identification of a group of 12 infertile women initially diagnosed as having unexplained or anovulatory infertility, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins. All developed ovarian failure within a relatively short time span. Non-response to ovarian stimulation was defined by failure to achieve development of follicles >12 mm and failure to raise oestradiol concentration >350 pmol/l in two successive cycles of human menopausal gonadotrophin (HMG) doses of up to five ampoules per day for 5-8 days. Within a mean of 9 months following the failed attempts of ovarian stimulation the mean day 3 FSH concentrations rose from 5.4 +/- 2.7 IU/l to 53.5 +/- 19.7 IU/l. In these patients, day 3 FSH concentration failed to indicate the low ovarian reserve manifested only by lack of clinical response to treatment with gonadotrophins which was the first sign of impending ovarian failure. We conclude that women with normal early follicular phase serum FSH concentrations who do not respond to ovarian stimulation by HMG are at risk of developing ovarian failure within several months.

Topics: Adult; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Ovulation; Primary Ovarian Insufficiency

To report a rare case of sequential bilateral adnexal torsion in a pregnant woman after a single cycle of gonadotropin ovulation induction with IUI. To review the literature with regards to the causation and aspects of the management of adnexal torsion, particularly after assisted conception.. Case report.. Fertility department within a teaching hospital.. A 35-year-old woman with a twin pregnancy after a cycle of gonadotropin ovulation induction and IUI.. Gonadotropin ovulation induction with IUI; two laparotomies, salpingo-oophorectomy, stabilization of adnexa with stay suture.. Continuation of pregnancy until 37 weeks gestation with the abdominal delivery of healthy twins.. The case of a woman with a multiple pregnancy and ovarian hyperstimulation syndrome after ovulation induction and IUI who developed sequential bilateral adnexal torsion is used to illustrate the risk factors and management options for adnexal torsion. Physicians should be aware of the increased incidence of adnexal torsion in the rising number of women undergoing ovulation induction in order to effect early surgical intervention and adnexal salvage. Consideration should be given to the anchoring of bulky adnexae to prevent torsion recurrence.

Topics: Adnexal Diseases; Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Ovulation Induction; Pregnancy; Torsion Abnormality; Uterus

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 determine the cost-effectiveness of infertility treatments.. Retrospective cohort study.. Academic medical center infertility practice.. All patients treated for infertility in a 1-year time span.. Intrauterine inseminations, clomiphene citrate and IUI (CC-IUI), hMG and IUI (hMG-IUI), assisted reproductive techniques (ART), and neosalpingostomy by laparotomy.. All medical charges and pregnancy outcomes associated with the treatments were obtained. Cost-effectiveness ratios defined as cost per delivery were determined for each procedure. The effects of a woman's age and the number of spermatozoa inseminated on cost-effectiveness of the procedures was also determined.. Intrauterine inseminations, CC-IUI, and hMG-IUI have a similar cost per delivery of between $7,800 and $10,300. All of these were more cost-effective than ART, which had a cost per delivery of $37,000. Assisted reproductive techniques in women with blocked fallopian tubes was more cost-effective than tubal surgery performed by laparotomy, which had a cost per delivery of $76,000. Increasing age in women and lower numbers of spermatozoa inseminated were factors leading to higher costs per delivery for IUI, CC-IUI, hMG-IUI, and ART. Use of donor oocytes reduced the cost per delivery of older women to the range seen in younger women with ART.. Our analysis supports, in general, the use of IUI, CC-IUI, and hMG-IUI before ART in women with open fallopian tubes. For women with blocked fallopian tubes, IVF-ET appears to be the best treatment from a cost-effectiveness standpoint.

Topics: Clomiphene; Cohort Studies; Cost-Benefit Analysis; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Reproductive Techniques

To investigate the incidence of meiotic abnormalities, aneuploidy, and prematurely condensed sperm chromosomes in failed fertilized oocytes after controlled ovarian hyperstimulation (COH).. Retrospective analysis of air-dried preparations of unfertilized oocytes.. University hospital-based infertility clinic.. Thirty-three patients undergoing IVF having only tubal factor as the cause of infertility. Twelve patients (13 cycles) underwent treatment with hMG alone (-GnRH agonist [GnRH-a]), and 21 patients (24 cycles) underwent treatment with leuprolide acetate (LA) and hMG (+GnRH-a group).. Standard IVF-ET treatment cycle for ovarian stimulation using hMG with or without LA.. The meiotic stage, ploidy, and the presence of prematurely condensed sperm chromosomes were determined in 161 air-dried preparations of unfertilized oocytes.. Significantly more unfertilized oocytes were at metaphase II in the -GnRH-a group as compared with the +GnRH-a group, with significantly fewer exhibiting meiotic aberrations. Aneuploidy rates did not differ between groups. However, significantly more oocytes in the +GnRH-a group revealed prematurely condensed sperm chromosomes than in the -GnRH-a group.. The use of GnRH-a for COH does not have an impact on aneuploidy rates in failed fertilized oocytes. However, the higher incidence of meiotic aberrations and prematurely condensed sperm chromosomes in the unfertilized population indicates that some retrieved oocytes exhibit incomplete nuclear and cytoplasmic maturation after the use of this agonist.

Topics: Adult; Chromosomes; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Male; Meiosis; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Retrospective Studies; Spermatozoa

To determine Müllerian inhibiting substance (MIS) levels in follicular fluid (FF) and sera of IVF patients.. Prospective study.. Fertility center.. Sixty-six patients: 20 with tubal factor infertility, 17 with polycystic ovary syndrome (PCOS), and 29 with endometriosis.. All patients underwent ovarian stimulation with hMG and/or FSH, as well as oocyte retrieval for IVF.. Follicular fluid and serum MIS levels and oocyte fertilization rates.. Levels of MIS in FF and sera of PCOS patients were significantly higher than those in tubal factor patients: 7.01 +/- 1.52 versus 1.65 +/- 0.23 ng/mL (mean +/- SE) and 2.97 +/- 0.52 versus 0.92 +/- 0.19 ng/mL, respectively. In endometriosis patients, follicular fluid and serum MIS levels were not significantly different from those in tubal factor patients. In PCOS patients, the percentage of immature oocytes retrieved (17.9% +/- 5.0%) was significantly higher compared with tubal factor (1.5% +/- 1.0%) and endometriosis (9.2% +/- 2.3%) patients. The percentage of oocytes fertilize was significantly lower in PCOS patients (30.2% +/- 5.3%) compared with tubal factor (62.2% +/- 5.5%) and endometriosis (37.5% +/- 5.7%) patients.. Women with PCOS had higher serum and follicular fluid MIS levels, a higher percentage of immature oocytes, and lower fertilization rates than women with endometriosis or pelvic adhesions.

Topics: Adult; Anti-Mullerian Hormone; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Glycoproteins; Growth Inhibitors; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Testicular Hormones

A 32-year-old female presented with a dural arteriovenous fistula in the transverse-sigmoid sinus caused by stenosis of the left internal jugular vein. The feeding arteries were embolized, resulting in nearly complete disappearance of the fistula. This case supports the idea that dural arteriovenous fistula is an acquired lesion caused by intravenous hypertension.

Topics: Adult; Arteriovenous Fistula; Cerebral Angiography; Constriction, Pathologic; Cranial Sinuses; Dura Mater; Female; Fertility Agents, Female; Humans; Infertility, Female; Jugular Veins; Menotropins; Venous Pressure

To compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) after laparoscopic surgery in women with endometriosis with that of patients with tubal factor infertility.. Retrospective survey of hospital and office charts using a computerized worksheet.. Lin-Kou medical center of Chang Gung Memorial Hospital.. Sixty-seven women with minimal to mild or moderate to severe endometriosis. Women with tubal factor infertility without other associated disorders (60 cycles) made up the control group.. Seventy-five consecutive cycles of IVF-ET were performed in these patients who failed to conceive after laparoscopic conservative surgery.. The concentration of serum estradiol on the day of human chorionic gonadotropin (hCG) injection, the day of hCG injection, clinical pregnancy rates per transfer, number of follicles larger than 14 mm, number of embryos transferred, and implantation rate were not significantly different between women with endometriosis and those with tubal factor infertility. The number of oocytes retrieved and number fertilized were decreased, and the basal level of follicle-stimulating hormone on cycle day 3 was higher in women with both degrees of endometriosis. Women in both endometriosis groups received more follicle-stimulating hormone and human menopausal gonadotropin than those with tubal factor infertility.. The outcome of IVF-ET in patients with endometriosis after laparoscopic surgery did not differ from that in the group with tubal factor infertility, but the former required more ampules of gonadotropin to achieve the same response. The advantages of laparoscopic surgery in women with endometriosis should be probably correlated with success of IVF-ET.

Topics: Adult; Case-Control Studies; Chorionic Gonadotropin; Danazol; Embryo Transfer; Endometriosis; Estrogen Antagonists; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Laparoscopy; Leuprolide; Menotropins; Pregnancy; Retrospective Studies; Treatment Outcome

A 36 year-old infertile female developed a stage IV (FIGO) ovarian carcinoma consisting of a poorly differentiated Sertoli-Leydig cell tumour after receiving one course of ovulation induction with follicle stimulating hormone (FSH), human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) followed by gonadotrophin-releasing hormone analogue (GnRHa). The patient died of liver metastasis and hepatic failure 4 1/2 months after first diagnosis, despite aggressive treatment consisting of debulking surgery and aggressive adjuvant chemotherapy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Fatal Outcome; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Liver Failure; Liver Neoplasms; Menotropins; Ovarian Neoplasms; Ovulation Induction; Sertoli-Leydig Cell Tumor

In an effort to understand the mechanism underlying the improved pregnancy rate observed in IVF cycles when gonadotropin-releasing hormone analogues (GnRH-a) are applied, we investigated a possible relationship between treatment variables and oocyte nuclear maturity.. Nuclear maturity was retrospectively assessed in cumulus-free, denuded oocytes, obtained from women undergoing micromanipulation-assisted IVF treatment following controlled ovarian hyperstimulation with GnRH-a and menotropins.. The setting was the infertility and IVF unit of a tertiary academic medical center.. Two hundred twenty-one patients underwent 435 treatment cycles.. This was the proportion of germinal vesicle-intact immature (GVII) oocytes.. One hundred fifty-four of the 3520 oocytes studied (4.4%) were in the GVII stage. These oocytes were found in 66 of the treatment cycles (15.2%) and in 54 of the patients (24.4%). Cycles in which GVII oocytes were detected did not differ from those in which all the aspirated oocytes were mature in the following respects: patient age, type and duration of infertility, controlled ovarian hyperstimulation protocol and time of ovum pickup. However, the GVII group was characterized by a significantly higher peak estradiol level, as well as a higher number of mature follicles visualized sonographically (diameter, > 14 mm) and oocytes retrieved.. Comparing the present findings with previously published data, it appears that the inclusion of GnRH-a in the stimulation regimen is associated with a lower proportion of immature oocytes. A higher occurrence of oocyte-nuclear immaturity is apparently associated with a significantly better ovarian response to stimulation. The high incidence of immature oocytes observed in patients with normospermic partners and low fertilization rates in previous cycles may suggest that the fertilization failure in some of these cases is due to oocyte, rather than sperm, dysfunction.

Topics: Adult; Buserelin; Cell Count; Cell Nucleus; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Micromanipulation; Oocytes; Oogenesis; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies

In-vitro fertilization patients (n = 15) at risk of ovarian hyperstimulation syndrome (OHSS) (oestradiol > or =4500 pg/ml on the day of human chorionic gonadotrophin administration and 25 or more follicles of intermediate or large size) underwent aspiration of all follicles and cryopreservation of all fertilized oocytes at the pronuclear stage. Patients were monitored for up to 2 weeks post-retrieval. Subsequent transfer of cryopreserved-thawed embryos was performed in programmed cycles using exogenous oestrogen and progesterone for endometrial preparation. Two patients (13%) developed OHSS necessitating hospitalization and vaginal aspiration of ascitic fluid. Two other patients (13%) developed moderate OHSS requiring ascitic fluid vaginal aspiration in the office setting, with dramatic improvement of the condition. Subsequent transfer of cryopreserved-thawed embryos yielded a clinical pregnancy rate of 58% per transfer and ongoing or delivery rates of 42 and 67% per transfer and per patient respectively. By eliminating pregnancy potential with cryopreservation of all prezygotes and examining the pregnancy potential with subsequent cryopreserved-thawed transfers, it is concluded that OHSS is reduced, but not eliminated for patients at risk. Subsequent transfer of cryopreserved-thawed prezygotes in a programmed cycle with exogenous steroids yields an excellent pregnancy rate.

Topics: Adult; Chorionic Gonadotropin; Cryopreservation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Hot Temperature; Humans; Infertility, Female; Leuprolide; Menotropins; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Pregnancy; Risk Factors

To evaluate the complications and outcome of pregnancy in women with polycystic ovary disease (PCOD).. The course and outcome of 47 singleton pregnancies in women with well-documented PCOD were compared with those in 100 healthy controls.. Women with PCOD had a significantly higher body mass index as compared to the control group (P < .05); however, the proportion of lean versus obese subjects in the two groups was similar. The incidence of an abnormal glucose challenge test, gestational diabetes mellitus and pregnancy-induced hypertension was significantly increased in pregnant women with PCOD (P < .05). When lean PCOD subjects were compared with lean control subjects, the difference in the incidence of the above complications was still significant (P < .05). The incidence of pregnancy complications was similar when obese PCOD subjects were compared with obese controls.. Women with PCOD were at increased risk of gestational diabetes and pregnancy-induced hypertension, and this risk appeared to be independent of body mass index.

Topics: Adult; Body Mass Index; Clomiphene; Dexamethasone; Diabetes, Gestational; Embryo Transfer; Female; Fertilization in Vitro; Glucose Tolerance Test; Humans; Hypertension; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome

A prospective study in patients undergoing in vitro fertilization treatment was conducted to assess whether any difference may be present in uterine blood flow between unexplained and mechanical infertility, before and during ovulation induction. The ascending branch of the uterine artery, the arcuate arteries, and the radial arteries were examined by transvaginal, color pulsed Doppler sonography on day 3 and on the day of human chorionic gonadotropin administration. Patients with mechanical factor demonstrated a decrease in resistance to blood flow in all the examined vessels during ovulation induction. Patients with unexplained infertility showed a contrasting trend in changes of uterine blood flow (e.g., as the cycle progressed, the resistance index increased). Moreover, the resistive index values on the day of human chorionic gonadotropin administration were significantly higher in patients with unexplained infertility. It is quite possible that the rise in impedance to uterine blood flow during ovulation induction and the higher impedance on the day of human chorionic gonadotropin administration in patients with unexplained infertility may be one of the factors responsible for the lower conception rate in these patients.

Topics: Arteries; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prospective Studies; Radial Artery; Regional Blood Flow; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Uterus

Our goal was to evaluate the effect of intrauterine diethylstilbestrol exposure on ovarian reserve.. Four hundred two women underwent ovarian reserve screening. Twenty had intrauterine diethylstilbestrol exposure, and 382 women did not have exposure. The groups were compared regarding age, the incidence of diminished ovarian reserve, and cycle length. Nine women with and 204 women without diethylstilbestrol exposure underwent comparison of the total human menopausal gonadotropin dose, the day of human chorionic gonadotropin administration, the peak estradiol level, and the number of mature follicles.. The diethylstilbestrol-exposed women were similar in age (37 +/- 3.4 years) to the non-diethylstilbestrol-exposed women (35 +/- 4.4 years, p > 0.05). Three of 20 exposed women (15.8%) and 57 of 382 nonexposed women (15.3%) had diminished ovarian reserve (p = 0.41). When the exposed women were compared with the nonexposed subjects, the amounts of human menopausal gonadotropin (30 +/- 10 vs 33.7 +/- 10.6 ampules) required to achieve peak estradiol levels (633 +/- 323 vs 817 +/- 518 pg/ ml) with comparable numbers of follicles (5.7 +/- 2.7 vs 5.4 +/- 2.8) on the day of human chorionic gonadotropin administration were similar (p > 0.05).. The diethylstilbestrol-exposed and nonexposed women had a similar incidence of diminished ovarian reserve and a similar follicular response to gonadotropins.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Diethylstilbestrol; Estradiol; Estrogens, Non-Steroidal; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Incidence; Infertility, Female; Mass Screening; Menotropins; Middle Aged; Oocytes; Ovarian Follicle; Ovary; Prognosis

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

To investigate whether the consequences of premature P elevation on IVF-ET outcome are modulated by the quality of the ovarian response to controlled ovarian hyperstimulation (COH).. Retrospective analysis.. Assisted Reproduction Unit, Clamart, France.. One thousand twelve women undergoing 1,189 IVF-ET cycles.. Patients underwent COH with a time-released GnRH agonist and hMG. The ovarian response to COH was classified as strong (< or = 50 hMG ampules, peak E2 levels > 2,500 pg/mL, and > or = 10 mature oocytes; n = 340), weak (> 50 hMG ampules, peak E2 levels < or = 1,500 pg/mL, and < or = 5 mature oocytes; n = 285), or intermediate (remaining cases; n = 564). The IVF-ET outcome in each group was analyzed according to whether or not plasma P levels exceeded 0.9 ng/mL.. Pregnancy rates (PRs).. Clinical PRs were similar irrespective of low or high P levels in the strong (30% and 34%, respectively) and intermediate (31% and 30%, respectively) groups. However, in the weak group, P levels > 0.9 ng/mL were associated with lower PRs (3.2% and 23%, respectively).. In the presence of an adequate response to COH, P levels > 0.9 ng/mL were not associated with lower PRs, indicating that good embryo quality may compensate for the adverse endometrial effects of P. Conversely, when the response to COH was weak, premature P elevation led to drastically reduced PRs.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Retrospective Studies

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

Follicular development in the primordial and preantral stages is almost completely independent of gonadotrophins or steroids and is mainly dependent on growth factors and local regulators. Since human growth hormone (hGH) was found to facilitate ovarian response to gonadotrophin stimulation, we hypothesized that the administration of hGH in an hypogonadotrophic state and prior to ovarian stimulation with menotropins, may initiate or facilitate the propagation of the primordial and preantral follicles to the gonadotrophin-dependent stages. We suggest that treatment with hGH prior to menotropin administration may be useful to improve results for poor responders to gonadotrophins.

Topics: Clinical Protocols; Female; Fertilization in Vitro; Human Growth Hormone; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

Direct intraperitoneal insemination (DIPI) is one of the least invasive strategies of assisted reproduction. Unexplained infertility, cervical factors and male sub-fertility are major indications for DIPI. This is a report of pregnancy that occurred as a result of a novel trial of DIPI, in which ovarian stimulation took place using a long gonadotropin-releasing hormone (GnRH) analogue and human menopausal gonadotropin (HMG) protocol in a patient who had been unsuccessfully treated with intrauterine insemination.

Topics: Adult; Buserelin; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Superovulation; Treatment Outcome

Ovarian stimulation is used to treat female infertility, especially in Black Africa where infertility is considered as shameful. Ovarian stimulation can lead not only to multiple pregnancies but also to severe systemic complications such as the one described in this report. Ovarian stimulation using human menopausal gonadotropin led to ovarian hyperstimulation and multiple organ failure in a 28-year-old Senegalese woman. Symptomatic treatment using corticosteroids, abdominal paracentesis to relieve ascites, and fluid expansion failed. Bilateral ovariectomy was performed resulting in permanent sterility. Ovarian stimulation requires close monitoring by ultrasound visualization and measurement of 17 beta-estradiol to allow early detection of complications.

Topics: Adrenal Cortex Hormones; Adult; Ascites; Drug Monitoring; Estradiol; Female; Fertility Agents, Female; Fluid Therapy; Humans; Infertility, Female; Menotropins; Multiple Organ Failure; Ovarian Hyperstimulation Syndrome; Ovariectomy; Ovulation Induction; Paracentesis

To study the effect of the ultra-short protocol of gonadotropin releasing hormone agonist (GnRH-a) combined with human menopausal gonadotropin (hMG) regimen for ovarian hyperstimulation.. Setting clomiphene (CC)/human chronic gonadotropin (hCG) (50 cycles, 31 patients) and CC/hmg/hCG regimens (16 cycles, 16 patients who had failed in CC/hCG) as control groups, the ultra-short GnRH-a/hMG/hCG regimen (15 cycles, 15 patients who had failed in CC alone or CC/hMG regimens) as study group, the number of leading follicles, endometrial thickness, cervical mucus scores and hormone levels on the day of hCG administration, and the pregnancy rates were compared among of these three groups.. There was no premature luteotropic hormone (LH) surge in the ultra-short GnRH-a/hMG/hCG regimen group while there were three cycles in the CC/hMg/hCG group. The LH and progesterone (P) levels of ultra-short GnRH-a/hMG group on the day of hCG administration were lower than those of CC alone and CC/hMG groups. There were more leading follicles, greater endometrial thickness and cervical mucus score in the ultra-short GnRH-a/hMG group than those in CC alone and CC/hMG groups. The pregnancy rates per cycles in the three groups were similar.. The ultra-short GnRH-a/hMG regimen is a fairly good ovarian hyperstimulation regimen, especially for poor responders in CC alone or CC/hMG regimens.

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Superovulation

Previous studies in animal models indicated an autocrine/paracrine action of endothelin-1 (ET-1) in the ovary. We now report evidence on the presence of ET-1 in human ovary during reproductive life. Immunohistochemical and in situ hybridization studies demonstrated a positive signal into cytoplasm of granulosa cells (GC) of follicles at different growth stages. The concentration of ET-1-like immunoreactivity (ET-1-LI) was also measured by a specific RIA in human follicular fluid (FF). FF samples were obtained from women in an in vitro fertilization program undergoing gonadotropin stimulation (group A; n = 24) or no treatment (group B; n = 7). The mean (+/-SD) ET-1-LI FF level in group A (4.85 +/- 2.06 pg/mL) was significantly higher than that in group B (1.29 +/- 0.43 pg/mL; P < 0.01), whereas the corresponding mean plasma levels were not significantly different and were not correlated to respective FF values. Our results indicate for the first time the presence of ET-1 and its messenger ribonucleic acid in the GC of the human ovary. The higher ET-1-LI levels found in the FF from women undergoing gonadotropin treatment suggest a modulation by gonadotropins and/or ovarian steroids of ET-1 production by GC.

Topics: Adult; Antisense Elements (Genetics); Blotting, Northern; Chromatography, High Pressure Liquid; Endothelins; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Granulosa Cells; Humans; Immunohistochemistry; In Situ Hybridization; Infertility, Female; Menotropins; Protein Biosynthesis; RNA Probes; RNA, Messenger; Transcription, Genetic

The human uterine glandular epithelium undergoes a sequence of well characterized changes during the menstrual cycle that presumably play an important role in preparation for blastocyst implantation. The aim of this study was to measure objectively glandular volume over the entire menstrual cycle and compare the results with eight different clinical superovulation or hormone replacement therapy (HRT) subject groups. Endometrial biopsies were taken from control normal menstrual cycle subjects (n = 96), and eight other smaller groups of women who had received different in-vitro fertilization (IVF) related treatments. The total area of glandular epithelium was objectively measured from routine histological slides using computerized image analysis. Control menstrual cycle results showed a significantly greater gland area in the early secretory stage of the cycle than at any time between the early proliferative through to the mid-late proliferative stages (P < 0.05). IVF patients receiving clomiphene citrate and human menopausal gonadotrophin had a significantly smaller glandular area than those in the control groups at equivalent stages of the menstrual cycle. The use of progesterone supplementation removed this significant difference. Patients on the ¿Flare' regime had the highest gland area, although this was not significantly different from controls. Buserelin down-regulation gave a gland area that was closest to the normal cycle controls. The three HRT groups showed high variability in gland volume between patients. The results from this study demonstrate that superovulation can cause significant alterations in endometrial gland volume, but that these do not necessarily preclude implantation.

Topics: Biopsy; Clomiphene; Epithelium; Estrogen Replacement Therapy; Female; Fertilization in Vitro; Hormones; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Uterus

Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.

Topics: Buserelin; Catheterization; Fallopian Tube Diseases; Fallopian Tube Patency Tests; False Positive Reactions; Female; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Laparoscopy; Menotropins; Microsurgery; Pregnancy; Prospective Studies

Topics: Drug Therapy, Combination; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Infertility, Female; Male; Menotropins; Ovary; Ovulation Induction

To examine selection criteria for ovarian reserve screening.. Retrospective study.. Two hundred nineteen women underwent testing for ovarian reserve for woman's age > 35 years, any age with unexplained infertility, one ovary, or a poor response to hMG.. Clomiphene citrate challenge test.. Frequency of abnormal ovarian reserve screening, menstrual cycle parameters, response to hMG, and pregnancy outcome by screening criteria.. One hundred eighty-four (84.0%) women had a normal ovarian reserve screening test; 35 (16.0%) had an abnormal ovarian reserve screening test. Twenty-six had abnormal ovarian reserve screening when screened by age, 14 for unexplained infertility, 5 for poor response to hMG, and 6 for one ovary. Fifteen women with abnormal ovarian reserve screening had more than one indication for screening. For women attempting pregnancy (n = 182), 49 of 148 (33.1%) with normal ovarian reserve screening became pregnant compared with 2 of 34 (5.9%) with abnormal ovarian reserve screening. Within each screening category, women with abnormal ovarian reserve had menstrual cycle parameters associated with a short follicular phase, required more hMG, and responded poorly to hMG.. One of six women undergoing ovarian reserve screening had an abnormal test, which was associated a poor reproductive outcome. Age was the most important single criteria. Selected ovarian reserve screening is simple and inexpensive and should be offered to all fertility patients meeting the specific screening criteria listed above.

Topics: Adult; Age Factors; Ambulatory Care Facilities; Clomiphene; Female; Fertility; Follicular Phase; Hormones; Humans; Infertility, Female; Mass Screening; Menotropins; Menstrual Cycle; Ovary; Patient Selection; Pregnancy; Pregnancy Rate; Retrospective Studies

To examine the effectiveness of a novel clomiphene citrate (CC) and hMG combination protocol ("minimal stimulation") for controlled ovarian hyperstimulation. Minimal stimulation consists of administering 100 mg/d CC for 5 days followed by a single dose of 150 IU hMG. The results of this analysis are compared with those of an hMG-alone protocol. In vitro fertilization-embryo transfer and donor insemination patients are excluded from this analysis.. Retrospective review of minimal stimulation and hMG cycles from January 1, 1989 to December 31, 1992.. Tertiary care center reproductive endocrinology and infertility clinic.. Two hundred thirty-two women who underwent 549 treatment cycles.. Clinical and multiple pregnancy rates (PRs) and medication costs.. Sixty-one women received 106 cycles of minimal stimulation and 183 received 443 cycles of hMG. Although subject groups were not assigned randomly, multivariate analysis detected no significant differences between the treatment groups. The total ampules of hMG required differed significantly (2.0 for minimal stimulation versus 16.8 +/- 8.5 [mean +/- SD] for hMG). Pregnancy rates and multiple gestation rates were similar. Medication expense of minimal stimulation is 21% that of the hMG protocol.. Minimal stimulation is as effective as hMG in the population examined. The comparable PRs and decreased medication costs of minimal stimulation justifies further evaluation of its role in the treatment of infertility.

Topics: Adult; Clomiphene; Dose-Response Relationship, Drug; Drug Costs; Female; Humans; Infertility, Female; Menotropins; Multivariate Analysis; Pregnancy; Pregnancy Rate; Retrospective Studies

To determine if an elevated FSH:LH ratio predicts response in infertile patients undergoing controlled ovarian hyperstimulation (COH) for IVF-ET.. Retrospective study.. The Division of Reproductive Endocrinology at the Mount Sinai Medical Center, New York, New York.. Seventy-four patients undergoing IVF-ET using similar protocols for COH with day 3 FSH, LH, and E2 testing available for analysis. All patients were < 41 years of age and had day 3 serum FSH < 15 mIU/mL (conversion to SI unit, 1.00).. Follicle-stimulating hormone:LH ratio, day 8 serum E2, peak serum E2, cancellation rate, pregnancy rate, and number and size of follicles.. An FSH:LH ratio > or = 3.6 (group I) predicted a poor response to COH (sensitivity 85.7% and specificity 95%). There were no significant differences regarding day 3 serum FSH and ampules of gonadotropins used for COH. Group I (ratio > or = 3.6) patients responded to COH with lower day 8 E2 (97 +/- 18 versus 319 +/- 36 pg/mL; conversion factor to SI unit, 3.671), peak E2 (422 +/- 115 versus 2,368 +/- 183 pg/mL), and fewer follicles > 15 mm (1.3 +/- 0.5 versus 17.1 +/- 1.0). In group I the cycle cancellation rate (12/14) was significantly higher than the group II cycle cancellation rate (2/60) and pregnancy rate in group II (ratio < 3.6) was 25%.. The FSH:LH ratio may increase before a dramatic increase in serum FSH is observed and appears to be a useful marker of ovarian reserve.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Forecasting; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Predictive Value of Tests; Reference Values; Retrospective Studies

The effect of pretreatment with the gonadotropin releasing hormone (GnRH) agonist D-Trp6-LHRH (Decapeptyl) on platelet serotonin transporter in women undergoing assisted reproductive treatment (ART) was investigated and compared with women treated with human menopausal gonadotropin (Pergonal). The study group (n = 10) was exposed for 12 days to 3.2 mg Decapeptyl C.R. while a comparison group (n = 9) was exposed to 11 days of human meno-pausal gonadotropin (Pergonal). All patients were assessed with the Hamilton depression and anxiety scales before and after treatment, and platelet and plasma samples were collected at the same time points. Plasma levels of estradiol, progesterone. FSH and LH were determined by radioimmunoassay (RIA). Platelet serotonin transporter was labeled using high affinity [3H]imipramine binding. The GnRH analogue induced ovarian suppression as reflected by low plasma estradiol levels, while Pergonal administration induced ovarian stimulation. An elevation in the Hamilton depression and anxiety scale scores was observed in the Decapeptyl treated group; this mood alteration was associated with a significant decrease (19%, P < 0.05) in the density (Bmax) of platelet [3H]imipramine binding sites. No significant change was observed in the Bmax of the Pergonal treated group. These results indicate that ovarian suppression (menopausal-like state) in young women is associated with depressed and anxious mood and decreased serotonin transporter density.

Topics: Adult; Anxiety; Blood Platelets; Carrier Proteins; Depression; Female; Fertility Agents, Female; Gonadotropins; Humans; Infertility, Female; Luteolytic Agents; Membrane Glycoproteins; Membrane Transport Proteins; Menotropins; Nerve Tissue Proteins; Serotonin Plasma Membrane Transport Proteins; Triptorelin Pamoate

The aim of the study was to assess the values of serum estradiol (E2) in women undergoing ovarian stimulation with five direct commercial assays (IMX, Amerlite, Spectria, Vidas, CA) and to compare them with the results of an E2 direct method used in our laboratory. The study included 12 infertile women. Thirteen cycles were monitored daily during ovarian stimulation with transvaginal ultrasound and serum E2. Large differences were found between the E2 concentrations measured on the same sample with the different methods. In general the IMX and Amerlite assays gave the highest and CA the lowest results. The results of our own RIA and Spectria assay agreed more closely. The median ratio of the highest E2 value (IMX assay) and the lowest E2 value (CA value) was 1.75 (1.30-3.15). Values of E2 measured in serum depend on the method used. It is not possible to apply criteria from other studies directly to one's own patients. Close collaboration between the laboratories and the clinical staff is essential.

Topics: Adult; Clomiphene; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Reagent Kits, Diagnostic; Reference Values

To determine the measurable factors that correlated with a higher conception ratio in one of our subpopulations of infertility patients.. We analyzed 58 menstrual cycles in 24 consecutive infertility patients treated only with human menopausal gonadotropin (hMG) and intrauterine insemination between January 1992 and February 1993 to compare those cycles leading to conception with those that did not with regard to certain factors: endometrial thickness, endometrial layering, number of follicles > or = 15 mm in diameter, peak estradiol level and number of cycles prior to conception.. All conceptions occurred in cycles that showed endometrial layering. No patient conceived if the endometrial thickness was < 8 mm. The incidence of conception increased with the number of follicles (one to three) measuring > 15 mm in average diameter. No patient conceived if the serum estradiol was < 192 pg/mL. No conceptions occurred after three successive cycles of treatment.. Endometrial layering, endometrial thickness of at least 8 mm, a higher number of follicles (up to three) with an average of 15 mm and a serum estradiol level of at least 192 pg/mL correlated with a higher rate of conception.

Topics: Adult; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Middle Aged; Ovarian Follicle; Ovary; Ovulation; Pregnancy; Pregnancy Rate; Ultrasonography

To determine the effectiveness of human menopausal gonadotropin (hMG) with intrauterine insemination (IUI) for the treatment of various causes of infertility and to identify prognostic factors for the success of this treatment.. Retrospective chart analysis.. Of the 271 cycles initiated, 247 were completed in 104 couples, and analysis of these cycles showed that the overall cycle fecundity rate was 10% and the pregnancy rate 22%. The miscarriage rate was 8% and the ectopic pregnancy rate 4%. The multiple pregnancy rate was 29%. For the various causes of infertility, we found that the cycle fecundity rate was 7% for male factor, 11% for oligoovulation, 8% for tubal/pelvic factor, 13% for minimal endometriosis, 18% for mild endometriosis, 17% for moderate endometriosis, 3% for women aged > or = 40 years, 75% for myoma, and 7% for idiopathic infertility. We also found that one IUI timed at 36-48 hours was as effective as two IUIs timed at 18-24 and 36-48 hours after human chorionic gonadotropin (hCG) administration. Poor prognostic factors that were elicited from this study were: (1) failure of pregnancy in three cycles of treatment, (2) female age > or = 40 years, (3) requirement of > 300 IU of hMG daily, and (4) presence of more than eight mature follicles at the time of hCG administration.. HMC and IUI are effective treatment of some causes of infertility.

Topics: Adult; Combined Modality Therapy; Estrogens; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Male; Menotropins; Middle Aged; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; Time Factors

To determine a simple predictive test for empty follicle syndrome before oocyte retrieval.. Retrospective correlation analysis.. Patients attending Nottingham University Research and Treatment Unit, a tertiary, university-based assisted reproductive technologies (ART) program between April 1, 1994 and March 31, 1995.. Six women in whom no oocytes were retrieved after superovulation for ART (empty follicle syndrome) were compared with 11 women with successful oocyte retrieval.. Subcutaneous buserelin acetate plus IM hMG and hCG were used for superovulation. Oocyte retrieval was transvaginal and ultrasound guided.. Ultrasound measurement of follicular growth and serum E2 levels during superovulation. Serum beta-hCG levels before and 36 hours after hCG administration IM. Number of oocytes retrieved.. Before hCG administration, beta-hCG was not detectable in the serum. The serum beta-hCG 36 hours after hCG was 209 +/- 16.7 mIU/mL (conversion factor to SI units, 1.0; mean +/- SEM, range 106 to 290 mIU/mL) in women with successful oocyte retrieval and 4 +/- 1.8 mIU/mL (range 0 to 9 mIU/mL) in empty follicle syndrome. This difference was significant.. Empty follicle syndrome is associated with very low bioavailability of beta-hCG and can be predicted by measuring serum beta-hCG level 36 hours after IM hCG administration.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Retrospective Studies; Superovulation; Syndrome

Our purpose was to determine whether elevated progesterone (P) during ovulation induction in IVF-ET cycles is a poor prognostic factor for achieving pregnancy.. We retrospectively reviewed 672 consecutive IVF-ET cycles in which ovulation was performed using luteal LA downregulation and hMG.. The ART program at the Brigham & Women's Hospital, a tertiary care institution, was the study setting.. Patients were divided into groups by serum P levels at baseline, on stimulation day 5, on the day of hCG injection, and, on the day after hCG injection and the following parameters were compared: duration of luteal LA treatment, number of ampoules of hMG used, estradiol (E2) levels, number of follicles > or = 12 mm, number of follicles > or = 15 mm, number of oocytes, number of normal embryos, number of polyspermic embryos, fertilization rate, implantation rate, and clinical and ongoing/live birth pregnancy rates.. Based on serum P level, patients were divided into three groups: Group I, < or = 0.31 ng/ml (conversion factor to SIU, 3.180); Group II, and > 0.3 and < 1.0 ng/ml and Group III, > or = 1.0 ng/ml. Measureable P at baseline was associated with a higher cancellation rate, but no difference in other cycle outcome parameters. Progesterone > 0.31 ng/ml on stimulation day 5 was associated with a higher fertilization rate in Groups II and III, but there was no difference in the clinical pregnancy or ongoing/live birth rates among the three groups. Based on P on the day of hCG administration, Groups II and III had significantly more oocytes and higher fertilization rates than did Group I, however, clinical pregnancy and ongoing/live birth rates were not significantly different. On the day after hCG, there was a trend toward a higher clinical pregnancy rate in Group III, which had younger patients, better follicular recruitment, and more embryos than Groups I or II, but these differences did not reach statistical significance.. Serum P > 0.31 ng/ml during ovulation induction reflects good follicular recruitment, and is not a predictor of IVF outcome.

Topics: Adult; Birth Rate; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Progesterone; Prognosis; Retrospective Studies

A retrospective analysis of 260 completed intrauterine insemination (IUI) cycles was used in an attempt to identify significant variables predictive of treatment success. Couples received a maximum of three IUI cycles for the treatment of anovulation, cervical factors or unexplained infertility. Male factor problems were largely excluded by pretreatment screening. The overall pregnancy rate was 19.6% per completed cycle, the miscarriage rate 15.6%, the multiple pregnancy rate 23.5% and the cancellation rate 19%. Logistic regression identified four significant IUI variables [follicle number (P < 0.005), endometrial thickness (P < 0.005), duration of infertility (P < 0.01) and progressive motility (P < 0.05)] which were the most predictive of IUI success. The chance of conceiving when only one follicle was produced was only 7.6%, whereas with two follicles this chance increased to 26%. These variables were incorporated into a statistical model to allow the prediction of the chance of success in subsequent cycles. We conclude that careful patient selection criteria coupled with successful ovarian stimulation is the model for IUI success.

Topics: Adult; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Models, Theoretical; Ovary; Pregnancy; Pregnancy Rate; Probability; Prognosis; Regression Analysis

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

Severe ovarian hyperstimulation syndrome (OHSS) leads to changes in laboratory analyte concentrations. Whereas elevated aminotransferase activity is often observed, a cholestatic course with hyperbilirubinaemia and icterus seldom occurs. In this report, the case of a 33 year old patient with polycystic ovary syndrome (PCOS) is described who, after stimulation with human menopausal gonadotrophin (HMG), developed severe OHSS with haemoconcentration, ascites, hydrothorax, elevated aminotransferases, hyperbilirubinaemia and icterus. The patient did not become pregnant and the OHSS regressed, together with the normalization of laboratory and clinical parameters and disappearance of the icterus. During the course of an OHSS cholestasis with icterus may occur, which could be explained by a reactive cholestatic hepatosis as a reaction to the hormonal changes induced by the stimulation therapy.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Humans; Hyperbilirubinemia; Infertility, Female; Jaundice; Menotropins; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Polycystic Ovary Syndrome

As several studies report that transvaginal ultrasound of endometrial thickness may help distinguish fertile from infertile cycles, we assessed endometrial growth and morphology in 124 infertile women. The patients underwent different ovulation induction treatments: clomiphene citrate (CC), human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), analogous Gn-RH and hMG (aGn-RH+hMG). CC administration is followed by a slackening of endometrial maturation. The US pattern H (typical of the ovulatory phase) appears on day 13 (76.9% of the cases) in spontaneous cycles and on day 16 (75% of the cases) in CC-induced cycles. The H pattern on day 20 in CC-induced cycles persisted in the patients who did not conceive. In aGn-RH-stimulated cycles the endometrial pattern H appears on days 13 (41.66%) and 16 (83.33%), not preceded by a Hi image. The endometrial pattern Hi was always observed in the patients who did not conceive. Our retrospective study of endometrial US morphology shows that the different ovulation induction treatments may affect the day of appearance of the various endometrial patterns. These results, which need further confirmation, can allow the changes of conceiving to be investigated during the stimulation protocol of every single stimulated cycle.

Topics: Adult; Chi-Square Distribution; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Endometrium; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction; Retrospective Studies; Time Factors; Ultrasonography

To investigate the effect of ovarian steroids on the brain stem during changes of estrogen and progesterone blood levels, we recorded brain stem auditory evoked potentials with increased stimulus rates from 26 women treated for sterility by menotropins (Pergonal and Metrodin). These women were divided into three groups according to their estrogen and progesterone blood levels. The brain stem auditory evoked potential results revealed a significant delay of peak III only, with an increased stimulus rate in the group with the highest estrogen level. Estrogen may cause a brain stem synaptic impairment, presumably because of ischemic changes, and thus also may be responsible for a higher incidence of Bell's palsy during pregnancy.

Topics: Adult; Evoked Potentials, Auditory, Brain Stem; Facial Paralysis; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Complications

The increasing use of drugs for ovarian stimulation and the possibility of long-term risks has actualized a quantitative assessment of the use of such therapy. The aim of the study was to analyze the development in the sale of different types of drugs used for ovarian stimulation in Denmark during the last two decades.. Sale statistics of clomiphene citrate, cyclophenile, human menopausal gonadotropin (hMG), mare menopausal gonadotropin (mMG) and human chorionic gonadotropin (hCG) in Denmark 1973-1993.. The number of defined daily doses (DDD) was calculated for each product group. On given assumptions the number of cycles of different treatment regimens and the number of treated women was calculated.. The sale has increased almost exponentially throughout the last two decades: Clomiphene citrate 11 fold, hMG 30 fold, and hCG 5 fold. Today, among women 15-44 years old, the estimated incidence rate of women treated with clomiphene alone is about 2.7/1,000/year, and the incidence rate of women treated with clomiphene/hCG and hMG/hCG account for about 3.1/1,000/year and 1.9/1,000/year, respectively.. Any study concerning short- and long-term effects of ovarian stimulation have to consider this secular trend.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Clomiphene; Denmark; Drug Industry; Drug Utilization; Female; Fertility Agents, Female; Gonadotropins, Equine; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction

Fourty seven women with infertility with controlled ovarian hyperstimulation with menotropins, were studied to corroborate the evidence of the luteotropic activity after the administration of human chorionic gonadotropin (hCG). They were divided in two groups: Group 1; 23 patients with (hCG). Group 2; 24 patients without (hCG). Seric progesterone level was determined at the 21 day of the cycle in both groups, with a significant difference (P < 0.05). We report 7 pregnancies; 5 in Group 1, and 2 in Group 2.

Topics: Adult; Chorionic Gonadotropin; Corpus Luteum; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Prospective Studies

To describe a patient with severe ovarian hyperstimulation syndrome (OHSS) demonstrating a beneficial result of reduction in abdominal ascites with a chest tube placed for bilateral pleural effusions.. Case report.. Academic hospital.. A 28-year-old white female with primary infertility on hMG (Pergonal; Serono Laboratories, Randolph, MA) therapy.. Intravenous fluids, lasix, and albumin were administered for correction of laboratory abnormalities, including hemoconcentration, hypoalbuminemia, and leukocytosis. A chest tube was placed for treatment of pleural effusions.. Laboratory values of hematologic measures and electrolytes. Resolution of pleural effusions and abdominal ascites as determined by chest roentgenogram and physical examination.. Treatment of OHSS with intravenous fluids, lasix, and albumin corrected the hemoconcentration, hypoalbuminemia, and leukocytosis associated with OHSS. Placement of a chest tube corrected the pleural effusions and abdominal ascites.. This case report demonstrates a beneficial result of reduction in abdominal ascites by a chest tube placed for pleural effusions.

Topics: Adult; Ascites; Chest Tubes; Drainage; Female; Fluid Therapy; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Pleural Effusion

Post coital sperm penetration tests performed in 66 women under study for infertility, the purpose was to evaluate the ovulation induction effect over mucus quality and over sperm penetration. They were divided in three groups: 1) 28 women with evidence of spontaneous ovulation (control group), 2) 26 patients in which ovulation was induced with comiphene citrate and 3) 12 patients in which ovulation was induced with menotropins. The results showed that CC had an adverse effect over cervical mucus (p < 0.001), while in patients treated with menotropins the cervical mucus quality was not modified. Sperm penetration in patients under CC had a tendency to lower values than those in women of the control group, but these were statistically lower than those in patients under menotropins (p < 0.05). These results show the adverse effect of CC and the benefit of menotropins over cervical mucus and sperm penetration.

Topics: Adult; Cervix Mucus; Clomiphene; Female; Humans; Infertility, Female; Male; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Sperm Transport; Uterine Cervical Incompetence

Concerns have been raised recently about the possible association between superovulation and ovarian cancer. In order to contribute to the limited literature on this important issue, two cases of ovarian tumours in women who had undergone multiple ovulation inductions are presented. In the first case, the patient had secondary anovulatory infertility. She was treated with human menopausal gonadotrophin (HMG) alone and in combination with clomiphene citrate or buserelin for six cycles. She then underwent ovarian stimulation with buserelin/HMG in the long protocol for in-vitro fertilization (IVF) and embryo transfer. In preparation for a new IVF/embryo transfer attempt, 8 months later, the screening ultrasound revealed a cystic formation of the left ovary and an enlargement of the right. During laparotomy, both ovaries were found to bear large tumours (approximately 6 x 5 x 4 cm) which were removed. Histological examination showed that they were epithelial tumours (serous-papillary cystadenomas) of borderline malignancy. The patient conceived spontaneously 1.5 years after the operation. In the second case, the patient presented with secondary anovulatory infertility. She underwent ovulation induction with clomiphene/HMG and with buserelin/HMG in the long protocol, and intra-uterine insemination with husband's spermatozoa and conceived (singleton pregnancy). She was delivered by Caesarean section, during which a cystic tumour of the left ovary was removed. Histological examination revealed a benign mucous cystadenoma of the ovary.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Anovulation; Buserelin; Clomiphene; Cystadenoma, Mucinous; Cystadenoma, Papillary; Cystadenoma, Serous; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Neoplasms; Ovulation Induction

Numerous anecdotal reports but few scientific approaches have suggested an increase in androgens in early pregnancy. In this study we have compared the concentration of serum androgens, testosterone and androstenedione in early pregnancy, starting within the cycle of conception. We have taken the opportunity to study women with premature ovarian failure where pregnancy develops in the virtual absence of ovarian functions. This study demonstrates that the concentration of testosterone (0.29 +/- 0.04 ng/ml) and androstenedione (1.770 +/- 0.136 ng/ml) in these subjects is as low as, if not lower than, non-pregnant women (0.39 +/- 0.02 and 2.170 +/- 0.025 ng/ml), significantly increased in normal pregnancies (1.190 +/- 0.118 and 3.920 +/- 0.297 ng/ml; P < 0.05) and even further increased in human menopausal gonadotrophin-treated cycles (1.990 +/- 0.230 and 8.19 +/- 0.72 ng/ml; P < 0.05). These studies demonstrate that the ovary is a contributor to the circulating concentrations of testosterone and androstenedione starting within the cycle of conception.

Topics: Androstenedione; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovary; Pregnancy; Primary Ovarian Insufficiency; Testosterone

The present study was undertaken to evaluate a possible relationship between the endometrial concentrations of oestrogen receptor (ER) or progesterone receptor (PR), and the sonographic appearance of human endometrium. Sonographic assessments and aspirations of the endometrium at the time of or prior to ovulation were made in 48 cycles of 45 infertile women. Endometrial patterns were classified as A, triple line pattern, or B, not triple line, on the basis of echogenicity. We did not find a correlation between ER or PR and serum oestradiol or endometrial thickness. Furthermore, serum oestradiol concentrations were not correlated with endometrial pattern or thickness. The only significant correlations were found between the concentrations of ER and PR in the pattern A endometrium (r = 0.80, P < 0.01) and in the pattern B endometrium (r = 0.49, P < 0.05). There were no differences in the mean concentrations of ER and PR despite differences in endometrial pattern and thickness. However, PR was measured at > 800 fmol/mg protein in 12 out of 38 pattern A endometria, while PR was < 800 fmol/mg protein in all pattern B endometria. These data suggest that high PR expression in the pre-ovulatory period is related to an adequate endometrial growth and thereby increases the responsiveness of the endometrium to progesterone stimulation after ovulation.

Topics: Buserelin; Endometrium; Estradiol; Female; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Receptors, Estrogen; Receptors, Progesterone; Ultrasonography

To examine the influence of polycystic ovarian disease (PCOD) on the levels of total renin in plasma and follicular fluid (FF) after stimulation with hMG.. Comparative study of the plasma and FF concentrations of total renin in women with and without PCOD after stimulation with hMG.. In vitro fertilization-embryo transfer program at the Department of Obstetrics and Gynecology, the University Central Hospital of Turku, Finland.. Thirty-six women undergoing IVF-ET for infertility with (n = 10) or without (n = 26) ultrasonographically diagnosed PCOD. Of the latter group, 15 women had tubal infertility, and the rest suffered from an anovulatory infertility and reacted with PCO-like ovarian response to stimulation.. The concentrations of total renin in plasma and FF, serum E2, and protein in FF.. The concentrations of plasma total renin after the gonadotropin stimulation were significantly higher in the PCOD and PCO-like groups when compared with the tubal group. The concentration of total renin in FF and the ratio of total renin per protein in FF were higher in the PCOD and PCO-like groups than in the tubal group, but the differences did not reach statistical significance. Positive correlations were found between the plasma total renin and serum E2 concentrations in the PCO-like and in the tubal group and between plasma total renin concentrations and the number of mature follicles in all groups. Follicular fluid total renin did not correlate with FF protein in any group. All findings were independent of the total hMG dosage used and the body mass index of the patients.. In the present study the concentrations of total renin in plasma were enhanced markedly after gonadotropin stimulation in women with PCOD compared with women having tubal infertility. The pattern of the hormonal secretions revealed a group of infertile patients reacting biochemically like women with PCOD.

Topics: Adult; Embryo Transfer; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicular Fluid; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Renin; Ultrasonography

To confirm successful implantation of IVF, cryopreserved human embryos after assisted hatching with acidic Tyrode's solution.. Case report.. In vitro fertilization-ET facility of a university-based practice.. A 28-year-old female with nonoperable bilateral tubal occlusion and > 1 1/2 years of primary infertility.. The patient was stimulated for egg retrieval after an hMG-controlled ovarian hyperstimulation regime. Luteal phase leuprolide acetate (1 mg) was administered SC for 10 days. The dose was then reduced to 0.5 mg, and she was given hMG and FSH IM twice daily until two lead follicles reached 20 mm average diameter. The patient was administered 10,000 IU hCG 36 hours before retrieval.. Viable pregnancy documented by ultrasound (US).. After the transfer of five cryopreserved-thawed human embryos that were subjected to assisted hatching using acidic Tyrode's solution, the patient established a triplet gestation as documented by US.. This case report demonstrates that zona drilling can be successfully applied to frozen-thawed pronuclear stage embryos that were cultured to 72 hours without damaging them, as evidenced by continued cleavage and resulting implantation.

Topics: Adult; Chorionic Gonadotropin; Cryopreservation; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Zona Pellucida

Cases of coexisting ovarian hyperstimulation and ectopic pregnancy are rare, and pose a difficult diagnostic problem. The routine attempts at laparoscopic diagnosis and treatment of these pregnancies may prove to be hazardous. Such cases may be better managed nonsurgically either by methotrexate or, in selected cases, by expectant management while monitoring the beta-hCG level and clinical status.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Ovarian Cysts; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy, Ectopic; Ultrasonography

The objective of our study was to establish the most adequate ovarian stimulation regimen for assisted procreation in endometriotic patients. It consisted of a retrospective analysis comparing the use of the gonadotrophin-releasing hormone analogue (GnRHa) buserelin either for 3 months or for 3 weeks and continued with ovarian stimulation with human menopausal gonadotrophin (HMG), and the use of clomiphene citrate in association with HMG for in-vitro fertilization (IVF) and embryo transfer, gamete intra-Fallopian transfer (GIFT) and zygote intra-Fallopian transfer (ZIFT). A total of 145 patients with endometriosis in 174 cycles were divided into two groups according to the revised American Fertility Society staging of the disease (group A, stages 1 and 2; group B, stages 3 and 4). The use of GnRHa significantly increased the number of oocytes retrieved. GnRH analogues for 3 months gave the highest fertilization rate for groups A and B. The cleavage, pregnancy and delivery rates, although higher in the groups treated with analogues, did not reach statistical significance. A higher number of patients had an embryo transfer in the groups treated with GnRHa (P < 0.05). Treatment with GnRHa for either 3 months or for 3 weeks proved to be more efficient than clomiphene citrate-HMG for assisted procreation procedures in patients with endometriosis.

Topics: Adult; Buserelin; Cleavage Stage, Ovum; Clomiphene; Cryopreservation; Embryo Implantation; Endometriosis; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Retrospective Studies; Zygote Intrafallopian Transfer

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

Exogenous estradiol (E2) has a well-recognized interceptive action when administered shortly after ovulation. The influence of extremely elevated levels of endogenous E2 on human oocyte fertilization and implantation are unclear. The purpose of this study was to evaluate a potential antinidatory role of extremely high endogenous E2 concentrations on implantation and pregnancy during in vitro fertilization-embryo transfer (IVF-ET).. Twenty-five patients receiving human menopausal gonadotropins (hMG) following midluteal GnRHa administration for IVF-ET, in which the maximal E2 concentration was > 5000 pg/ml (range 5358-16,344 pg/ml) were studied. Cycle parameters including oocyte and embryo characteristics, fertilization, cleavage, and implantation rates as well as pregnancy outcomes were compared to those of 25 patients treated contemporaneously whose treatment cycles had peak E2 values < 3500 pg/ml. Patients groups were matched for age, infertility diagnoses, duration of infertility and stimulation protocol.. Cycles characterized by very high endogenous E2 levels resulted in significantly more oocytes per retrieval (21.4 +/- 1.7 versus 8.4 +/- 0.6; P < 0.0001), fewer postmature oocytes (1.6% +/- 1.0% versus 14% +/- 5.0%; P < 0.03), and a decreased fertilization rate (63% +/- 4.0% versus 73% +/- 3.0%; P < 0.04) compared to control cycles. There were no differences in the overall mean morphologic grade or cleavage rates between groups. However, high E2 cycles were associated with a significantly increased implantation rate (14% +/- 4.0% versus 8.0% +/- 4.0%; P < 0.01) and pregnancy rate per embryo transfer (62% +/- 16% versus 36% +/- 16%; P < 0.01) compared to controls. The incidence of spontaneous abortion did not differ between groups. CONCLUSIONS; Extremely high endogenous E2 levels do not appear to adversely affect implantation or overall cycle pregnancy rates in IVF-ET cycles. However, impaired fertilization rates in such cycles support a potential adverse effect on oocyte quality.

Topics: Adult; Embryo Implantation; Embryo Transfer; Endometriosis; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Radioimmunoassay

To compare the presence in levels of antiovarian antibodies (AOAb) in the pre- and postovulatory stage from serum of infertile patients undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF) with outcome of the procedures.. Serum from 36 women undergoing IUI, 36 women undergoing IVF and 25 fertile, healthy controls were assayed for the presence of AOAb by a commercially available ELISA kit. AOAb was positive in 59.7% of infertile women, while none of the fertile controls were positive for AOAb. The levels of these antibodies increased as the patient age and the number of treatment attempts increased. Though the presence of AOAb did not affect oocyte recovery rate, it resulted in decreased fertilization rate, cleavage rate, and pregnancy rate in infertile women.. Our studies suggest that AOAb may be a cause of infertility and presence of these antibodies could have adverse effects on the outcome of assisted reproductive techniques.

Topics: Adult; Autoantibodies; Enzyme-Linked Immunosorbent Assay; Female; Fertility; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovary; Pregnancy; Pregnancy Rate

In a retrospective study of 813 oocyte retrieval-embryo transfer cycles in women with normal follicle stimulating hormone and luteinizing hormone concentrations, we sought to investigate the relationship between the amount of human menopausal gonadotrophin (HMG) used for ovarian stimulation and treatment outcome. Patients were divided into three groups: group A patients (495 cycles) required < 40 ampoules of HMG and had a predicted probability for pregnancy of 25% per embryo transfer; group B patients (165 cycles) required 41-77 ampoules per cycle, with a predicted probability rate for pregnancy of 5-25% per embryo transfer; and group C patients (153 cycles) required > 77 ampoules of HMG and the predicted probability for pregnancy was < 5% per embryo transfer. Groups C and A differed significantly (P < 0.005). The mean oestradiol concentration on the day of HCG administration in group C was 6412 pmol/l, and the mean number of eggs retrieved was seven. The highest success rates were found when up to 2.5 ampoules of HMG were required for each egg or 4.4 ampoules for each embryo. The lowest rates were obtained when > 4.8 ampoules of HMG were necessary for each oocyte or > 9.6 ampoules for each embryo (P < 0.005). We identified a group of infertile patients who required excessive amounts of HMG to achieve a fair degree of steroidogenesis, number of eggs and number of embryos but who had very low pregnancy rates. Although all other relevant parameters were normal, this may highlight the beginning of ovarian-gamete insufficiency before the basic hormonal status is affected. In cases of repeated failure, oocyte donation should be considered.

Topics: Drug Resistance; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Male; Menotropins; Ovary; Ovulation Induction; Pregnancy; Retrospective Studies; Treatment Outcome

Serum insulin-like growth factor binding protein-1 (IGFBP-1) concentrations were measured at the end of the proliferative phase in infertility patients undergoing normal menstrual cycle frozen embryo transfer, exogenous hormone-supported frozen embryo transfer and in-vitro fertilization (IVF) treatment cycles. These patients were divided into five groups according to their ovarian follicular activity. The exogenous hormone-supported frozen embryo transfer group, who had no ovarian follicles, and the IVF groups (number of follicles ranging from 4-38) showed statistically higher serum IGFBP-1 concentrations when compared to the normal menstrual cycle group (P < or = 0.01). There was no significant difference in the serum IGFBP-1 concentrations between the exogenous hormone support frozen embryo transfer group and the poor or normal response IVF groups (number of follicles ranging from 4 to 16). An IVF group that displayed an excessive response to our standard human menopausal gonadotrophin stimulation (> 20 mature follicles or oestradiol > 10,000 pmol/l) showed a significantly higher serum IGFBP-1 concentration when compared with the other groups (P = 0.001). This subgroup was subsequently given a modified (follicle-stimulating hormone) stimulation regime which resulted in a significant reduction in serum IGFBP-1 concentrations (P < 0.05). There was no correlation between serum oestradiol and IGFBP-1 overall or within the patient groups. We conclude that serum IGFBP-1 concentrations in our down-regulated assisted conception cycles did not increase in line with ovarian follicular activity, unless an excessive response was displayed.

Topics: Adult; Carrier Proteins; Cryopreservation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor Binding Protein 1; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovarian Follicle; Pregnancy

Topics: Administration, Intravaginal; Clinical Protocols; Cryopreservation; Drug Administration Schedule; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Hormones; Humans; Infertility, Female; Leuprolide; Menotropins; Menstrual Cycle; Oocyte Donation; Ovulation Induction; Pregnancy; Progesterone; Retrospective Studies

Changes in serum immunoreactive (IR)-inhibin were measured by RIA in two studies, in order to elucidate, firstly whether the pattern of IR-inhibin secretion is similar to that of estradiol (E2), and secondly, whether inhibin suppresses endogenous FSH release. Study 1: Purified urinary FSH (pFSH) or human menopausal gonadotropin (hMG) were daily injected intramuscularly into women with hypogonadotropic amenorrhea at 12 to 14 week intervals. PFSH and hMG stimulated IR-inhibin release in a similar fashion in the ovulatory cycles, but the increase in estradiol (E2) during pFSH administration was delayed and lower than that during the hMG cycles. This suggests that E2 and IR-inhibin are secreted independently from the granulosa cells. Study 2: Ovulation induction was performed in 18 cycles of 9 women with polycystic ovarian disease (PCOD) by the step-down administration of pFSH. The serum FSH concentration in cycles with premature LH release increased even after the dose of pFSH was reduced, and were significantly higher than those of cycles without premature LH release. It was also found that the serum IR-inhibin concentration in cycles with the premature LH release was 2 to 4 times as high as in cycles without premature LH release. This suggests that IR-inhibin does not suppress endogenous FSH release associated with premature LH release.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Inhibins; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

Topics: Clomiphene; Electrocoagulation; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Laser Coagulation; Menotropins; Ovary; Ovulation Induction; Progesterone

Topics: Clomiphene; Contraceptives, Oral; Drug Therapy, Combination; Female; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Polycystic Ovary Syndrome; Spironolactone

Topics: Altitude; Female; Follicular Phase; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

We performed direct intraperitoneal insemination in combination with superovulation and washed husband's spermatozoa as the treatment of infertility caused by oligospermia, cervical subfertility, or ovulatory dysfunction or idiopathic infertility in 162 couples during 360 cycles.. The pregnancy rate per couple was 21.9% in the cervical-factor group, 20.9% in the idiopathic group, 4.9% in the oligospermia group, and 15.5% in the ovulatory dysfunction group.. The pregnancy rate was 33.3% for all couples and 15.0% for all cycles.

Topics: Adult; Cervix Uteri; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Infertility, Male; Injections, Intraperitoneal; Insemination, Artificial, Homologous; Male; Menotropins; Oligospermia; Ovulation; Ovulation Induction; Superovulation

Five patients with a unicornuate uterus and primary infertility underwent ovulation induction with human menopausal gonadotrophins. Four conceived within the third cycle of treatment and one spontaneously immediately after the second cycle. Ovulation induction appears to be a valid treatment option for primary infertility associated with a unicornuate uterus.

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Uterus

In 23 women treated for sterility by the in vitro fertilization method the gonadotropins ovulatory surge was stimulated by applying a GnRH analogue (Buserelin). The authors showed that a single injection of GnRH analogue in the cycles stimulated with clomiphene citrate and menopausal gonadotropin causes pituitary output of both LH and FSH which is sufficient for morphological and functional maturity of the oocytes. After such treatment two patients conceived and delivered healthy babies.

Topics: Adult; Buserelin; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Outcome

A case of advanced ectopic pregnancy after in vitro fertilization complicated by an ovarian hyperstimulation syndrome is presented. Methotrexate was given in spite of high levels of hCG and appeared to be successful. Difficulties in the choice between surgical and conservative treatment are discussed.

Topics: Adult; Embryo Transfer; Fallopian Tubes; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Methotrexate; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Tissue Adhesions

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

A recently described two-site enzyme immunoassay incorporating a pre-assay oxidation step was validated and used to measure serum concentrations of dimeric inhibin in five normally cycling women and in 13 women undergoing gonadotrophin therapy. Recombinant human inhibin A (standard) gave an assay response curve which was parallel to those for human serum samples and recovery of exogenous inhibin added to serum samples before assay was quantitative (109 +/- 8%, n = 11). During the normal menstrual cycle dimeric inhibin concentration increased from 9.0 +/- 2.0 pg/ml during the early follicular phase to reach a mid-cycle peak of 55.3 +/- 11.1 pg/ml coincident with the pre-ovulatory gonadotrophin surge. After falling to 27.9 +/- 5.7 pg/ml 1 day after the luteinizing hormone surge, inhibin then rose in parallel with serum progesterone to reach a peak value of 115.6 +/- 19.3 pg/ml during the mid-luteal phase, before falling to 14.1 +/- 4.9 pg/ml by the onset of next menses. During the follicular phase, dimeric inhibin concentrations were closely correlated with those of serum oestradiol (r = 0.69; P < 0.001), whereas during the luteal phase they were most closely correlated with serum progesterone concentrations (r = 0.73; P < 0.001). Daily treatment with human menopausal gonadotrophin promoted a progressive increase in serum dimeric inhibin concentration which increased approximately 20-fold in 6 days. In the same period total alpha-inhibin (measured by radioimmunoassay) increased approximately 5-fold, while serum oestradiol increased approximately 30-fold.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Estradiol; Female; Follicle Stimulating Hormone; Follicular Fluid; Humans; Immunoenzyme Techniques; Infertility, Female; Inhibins; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Induction; Progesterone; Protein Conformation; Reproducibility of Results

Several authors have suggested that growth hormone may augment ovarian responses to follicle stimulating hormone in women (Homburg et al., Clin. Endocrinol., 29, 1988; Ibrahim et al., Fertil. Steril., 55, 1991), and that this effect may be mediated by insulin-like growth factor I (IGF-I) (Davoren and Hsueh, Endocrinology, 118, 1986). Menashe et al. (Hum. Reprod., 6, 1991) reported spontaneous pregnancies in women with a deficiency in growth hormone receptors and, consequently, low serum concentrations of IGF-I. In this report, we present the case of a patient with a rare syndrome first described by Oliver and Mcfarlane (Arch. Ophthalmol., 74, 1965). The patient was shown to be growth hormone deficient, with hypopituitarism as part of the syndrome. Adjuvant growth hormone did not influence her ovarian responses to exogenous gonadotrophins during assisted conception treatment, as reflected by the required total number of ampoules of human menopausal gonadotrophin, the number of developing follicles, the rate of follicular growth and the serum oestradiol concentrations.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Growth Hormone; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Puberty, Delayed; Syndrome

In two women (36 and 30 years old) during infertility evaluation by ultrasound, an ovarian cyst was found on the left side (5 x 7 and 6 x 9 cm respectively). In both cases, it was decided to perform a unilateral salpingo-oophorectomy, keeping the other ovary (after a negative biopsy) for a future in-vitro fertilization (IVF) procedure with their own oocytes. The histology report for each patient showed the cyst was an epithelial borderline tumour. The first woman achieved a pregnancy and delivered a healthy baby after the first IVF attempt, while the second is currently undergoing her third attempt. This paper reports on a follow-up 5 years after the first IVF attempt.

Topics: Adult; Chorionic Gonadotropin; Epithelium; Fallopian Tubes; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovariectomy; Pregnancy

Three cases including two sisters and one brother with blepharophimosis are described. Their father also had blepharophimosis. Moreover, the elder sister initially presented with resistant ovary syndrome and thereafter true premature menopause, while the younger one presented with resistant ovary syndrome. The explanation for the association of blepharophimosis with primary ovarian dysfunction is unknown, but the possibility of a microdeletion of genetic material containing two geographically associated, but independent genes could not be confirmed or excluded. All families affected by blepharophimosis should be counselled about the high incidence of ovarian dysfunction and female infertility, at least in one form of the syndrome.

Topics: Adult; Blepharophimosis; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Karyotyping; Luteinizing Hormone; Male; Menopause, Premature; Menotropins; Ovarian Diseases

Topics: Adult; Anaphylaxis; Dose-Response Relationship, Drug; Drug Hypersensitivity; Female; Fertilization in Vitro; Humans; Incidence; Infertility, Female; Menotropins

An analysis was performed on the cumulative conception rates, cumulative live birth rates and adverse effects of ovulation induction in patients with anovulatory infertility attending a single unit over an 11-year period. A total of 200 patients were included, 103 with clomiphene-resistant polycystic ovary syndrome (PCOS), 77 with hypogonadotrophic hypogonadism (HH) and 20 with weight-related amenorrhoea (WRA). Ovulation induction was performed using a number of protocols in which pulsatile luteinizing hormone-releasing hormone was administered s.c. or i.v. and gonadotrophins (human menopausal gonadotrophins or follicle-stimulating hormone) were administered i.m. The cumulative conception and live birth rates in the first course of therapy and after 12 cycles of treatment were, respectively, 73.2 and 62.4% in PCOS patients, 82.1 and 65.4% in the HH group and 95.0 and 85.3% in the WRA group. The miscarriage rates for all courses of treatment were 15.5% in PCOS patients, 22.9% in HH patients and 32.3% in WRA patients which resulted in cumulative live birth rates that were not significantly different. The median number of cycles and ovulations to achieve a pregnancy was 2 in all groups. The multiple pregnancy rate was significantly greater in women with PCOS (17.9%) than in women with HH (3.6%, P = 0.0052, 95% CI 5.12-23.36%) but not WRA (3.2%, P = 0.07, 95% CI 4.35-24.92%). The rate of multiple pregnancy fell after the introduction of monitoring by transvaginal ultrasound. Correction of anovulatory infertility by appropriately selected ovulation induction regimens results in cumulative conception and live birth rates indistinguishable from normal.

Topics: Amenorrhea; Anovulation; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

A retrospective analysis was undertaken in 160 intrauterine insemination with husband's sperm (IUIH) cycles, performed in 45 couples. The male factor represented the main indication (80%). Women who conceived had a lower duration of infertility (4.4 years +/- 3.0 vs 7.7 +/- 2.98). A significantly and pardoxically lower motility (3+ and 2+) was observed in raw specimens within conceptional cycles. However in prepared specimens in conceptional cycles the percentage of motility 3+ and 2+ was significantly increased (80.6% +/- 8.1 versus 70.7% +/- 20.2). The most significant difference was found in regard to a better response to preparation among conceptional cycles, expressed as the percentual increase in motility 3+ and 2+ (55.6% +/- 3.9 vs 41.3% +/- 19.4).

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Menstrual Cycle; Pregnancy; Semen; Sperm Motility; Treatment Outcome

We examined the possible contribution of human chorionic gonadotrophin (HCG) in Pergonal to the serum luteinizing hormone (LH)-like bioactivity in 10 patients (median age 32 years, range 28-38) with tubal infertility who were undergoing in-vitro fertilization (IVF), together with 19 controls (median age 30 years, range 21-43). IVF patients were treated with clomiphene (50 mg twice daily) over days 2-6 and Pergonal (150 IU i.m.) daily from day 5 until at least day 10. Serum LH was measured by fluoro-immunometric assay (I-LH) and in-vitro Leydig cell bioassay (B-LH). Serum HCG was measured by fluoro-immunometric assay. The data were analysed by paired two-tailed t-test, following logarithmic transformation. From days 1-5, there was an increase in serum B-LH (mean, 95% confidence intervals given in parentheses) from 8.3 (6.8, 10.2) IU/l to 11.7 (9.8, 13.9) IU/l [P = 0.004], and in serum I-LH from 4.5 (3.7, 5.4) IU/l to 5.4 (4.6, 6.3) IU/l [P = 0.002]. From days 5-8, there was a rise in B-LH to 16.6 (12.6, 21.9) IU/l [P = 0.023]. The rise in I-LH to 6.3 (5.1, 7.8) IU/l [P = 0.081] failed to reach significance. Furthermore, serum HCG was < 0.75 IU/l until after Pergonal was administered on day 5, then rose to a plateau on day 8 at 1.2 (0.8, 1.6) IU/l. Serum HCG in the controls remained < 0.75 IU/l throughout.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Animals; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Mice; Progesterone

A retrospective study was designed to assess the presence of antizona pellucida autoantibodies in in-vitro fertilization (IVF) patients in relation to low ovarian response, multiple IVF attempts and unexplained infertility. Antizona pellucida and antisperm antibodies were determined in serum samples obtained from 37 women undergoing IVF-embryo transfer and 20 fertile women. Antizona pellucida antibodies were measured using enzyme immunoabsorbent assay. Antisperm antibodies were evaluated by the immunobead binding method. Three of 10 patients with low response to ovarian stimulation had antizona pellucida antibodies in serum and one patient had antisperm antibodies. None of the other participants in the study and the control groups demonstrated measurable levels of serum antigamete antibodies. The results in this small group suggest an association between antizona pellucida antibodies and suboptimal response to gonadotrophins. It is indicated that repeated stimulation and puncture of ovaries in IVF procedures do not elicit autoimmunity to gametes.

Topics: Adult; Autoantibodies; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Retrospective Studies; Zona Pellucida

In an attempt to evaluate the risks and benefits of human menopausal gonadotrophin (hMG) therapy for patients with unexplained infertility, the response and outcome of hMG therapy for anovulatory patients and ovulatory patients with unexplained infertility were analyzed in a group of successful cases of pregnancy. The number of follicles grown and the total doses of hMG were not significantly different in the two groups. The rate of spontaneous abortion in unexplained cases was twice as high (13.2%) as in anovulatory cases. However, the rate of multiple pregnancy was 8.8% for unexplained cases which was significantly lower than that for anovulatory cases (39.0%). In addition, ovarian hyperstimulation syndrome (OHSS) occurred in 11.8% of unexplained cases and that was much lower than that for anovulatory cases (25.8%). This study justifies the application of gonadotrophin therapy to ovulatory patients with unexplained infertility in terms of the risks and benefits of the therapy in achieving pregnancy.

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Prognosis; Risk; Treatment Outcome

To compare the pregnancy outcomes during IVF-ET when different dosages of hMG are used after follicular phase suppression with leuprolide acetate (LA).. Retrospective chart review.. Hospital-based IVF-ET program.. From January 1990 to December 1992, 264 cycles reached ET after LA downregulation and gonadotropin stimulation.. Higher doses of gonadotropins, as measured by both average daily dose and total dose per cycle, were associated with lower clinical pregnancy rates. This effect was independent of age, basal FSH level, endometrial thickness, maximal E2 levels, number of eggs retrieved, and embryos transferred.. High dosages of exogenous gonadotropins are associated with lower pregnancy rates in IVF-ET.

Topics: Adult; Dose-Response Relationship, Drug; Embryo Transfer; Endometrium; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropins; Humans; Incidence; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Retrospective Studies

To analyze cumulative conception rates and the prognostic factors influencing them during exogenous human menopausal gonadotropin (hMG) therapy for World Health Organization (WHO) group I or II ovulatory disorders.. A retrospective review was conducted of 468 treatment cycles in 146 women with ovulatory disorders refractory to conventional therapy. Cumulative conception rates were calculated, and the effects of diagnostic group, age, gravidity, and duration of infertility were examined using the Cox proportional hazards model.. The cumulative proportion pregnant following six hMG cycles in WHO group I (0.89) was significantly greater than in the hyperandrogenic subgroup of WHO group II (0.30) (95% confidence interval [CI] 0.2-0.7, P = .006) or the luteal phase defect subgroup (0.35) (95% CI 0.07-0.6, P = .02). Conception rates in WHO group I did not differ significantly from those in the normoandrogenic oligo-ovulatory subgroup of WHO group II (0.63) (95% CI 0.3-1.3, P = .6). Conception rates were not influenced by duration of infertility or primary versus secondary infertility. Women 35 years or older had significantly lower conception rates than those aged 27 years or less (P = .04, hazard ratio 0.3, 95% CI 0.1-0.8).. Cumulative conception rates following exogenous gonadotropin therapy for women with refractory ovulatory disorders were both diagnosis- and age-dependent. Treatment with hMG approximated or surpassed normal fertility rates in women with WHO group I and normoandrogenic WHO group II oligo-ovulation, but was significantly less successful at correcting the underlying defect in women with hyperandrogenic anovulation and luteal phase defects.

Topics: Adult; Age Factors; Anovulation; Female; Fertilization; Humans; Infertility, Female; Menotropins; Menstruation Disturbances; Ovulation Induction; Prognosis; Proportional Hazards Models; Retrospective Studies; World Health Organization

Topics: Animals; Chorionic Gonadotropin; Chromosomes, Human, Pair 4; Drug Contamination; Female; Fertility; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Sheep

To compare the cumulative probability of pregnancy after multiple IVF cycles by age and cause of infertility.. A prospective study was done in which patients were followed from the time they registered for their first IVF cycle until they achieved a clinical pregnancy, withdrew from treatment, or study was terminated. PATIENTS, SETTING, TREATMENTS: Infertile women undergoing IVF-ET at the Cooper Institute for In Vitro Fertilization were enrolled in this study if the luteal phase leuprolide acetate (LA) and hMG controlled ovarian hyperstimulation (COH) regimen was used.. Clinical pregnancy, as determined by a positive beta-hCG level and ultrasonographic confirmation of a gestational sac, and delivery rates based on number of women with live births were compared by infertility factor and age.. The 3-month cumulative probability of pregnancy based on life table analysis was 33% in women with tubal factor who were < or = 35 years of age, 25% in women with tubal factor who were > 35 years of age, 30% for women with multiple factors who were < or = 35 years of age, and 14% for women with multiple factors who were > 35 years of age. The rate for the older women with multiple factors was significantly lower than that for the other groups. The delivery rates were lower for the women with multiple factors than for women under 35 with tubal factor only.. There is a significant effect of age and infertility factor on pregnancy and delivery rates. Physicians should consider these factors in evaluating their patients' prospects for success in IVF-ET.

Topics: Adult; Aging; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Menotropins; Pregnancy; Probability

To determine if serum beta-hCG levels are higher in multiple gestation than in singleton pregnancy at the time of intrauterine sac visualization and the first appearance of fetal heart activity as documented by serial transvaginal ultrasound (US).. Prospective analysis of serial transvaginal US findings in 19 pregnancies correlated with serum hCG levels during early gestation.. Reproductive endocrinology division of the University of Arkansas for Medical Sciences, Little Rock, Arkansas.. Nineteen infertility patients were studied after conceiving. Thirteen underwent IVF or GIFT, 4 received hMG therapy, 1 was treated with clomiphene citrate, and 1 pregnancy followed spontaneous ovulation.. Transvaginal US and hCG levels were obtained every Monday, Wednesday, and Friday from 20 to 22 days after ovulation until the appearance of fetal heart activity.. Initial sac visualization occurred at lower serum hCG levels in singleton versus multiple pregnancies (2,180 +/- 1,170 versus 7,028 +/- 4,280 mIU/mL, mean +/- SD). Sacs were always seen when the serum hCG level (mIU/mL) was > or = 1,161 in singleton, 1,556 in twin, 3,372 in triplet, and 9,399 in quadruplet pregnancies.. Failure to observe an intrauterine sac by transvaginal US in the presence of serum hCG levels in the 1,000 to 2,000 mIU/mL range is not pathognomonic for an ectopic gestation. Clinical symptomatology, risk of multiple pregnancies, and gestational age must also be considered.

Topics: Analysis of Variance; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Enzyme-Linked Immunosorbent Assay; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovulation; Peptide Fragments; Pregnancy; Pregnancy, Multiple; Ultrasonography; Uterus; Vagina

Progesterone (P4) is considered vital to the maintenance of human pregnancy, but the minimal concentration of P4 necessary to sustain human pregnancy remains unclear. The aim of this study was to examine endocrine profiles for serum P4, 17 beta-estradiol (E2), and human (h) beta-CG in early pregnancy from a group of assisted reproductive technologies (ART) patients. These subjects delivered normally but had P4 concentrations below the fifth percentile of the normal singleton pregnancy range from 2 weeks after ART. Normal ranges of these hormones were determined from 118 consecutive ART pregnancies which resulted in singleton births. Values below the fifth percentile (P4 < 35.9 nmol/L at 4 weeks gestation) were considered abnormal. Eight patients who subsequently delivered normally, with serum P4 values below this criterion at 4 weeks gestation, were found. They had serum P4 values at 4 weeks gestation ranging from 1.9-29.9 nmol/L, and their mean P4 values at 5 weeks (30.2 +/- 9.2 nmol/L; mean +/- SE) and 6 weeks gestation (48.0 +/- 10.2 nmol/L) remained below the fifth percentile. No statistically significant increase in serum P4 concentrations occurred between 7 and 11 weeks gestation in these women. Their mean E2 value in serum at 4 weeks gestation (382 +/- 73 pmol/L) was also below the fifth percentile but their mean beta-hCG concentration was within the normal range. We conclude that successful human pregnancy is possible with serum P4 values within the anovulatory range in early gestation and that, in individual patients, serum P4 concentration of 2 nmol/L can be sufficient to maintain human pregnancy.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Corpus Luteum; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Peptide Fragments; Placenta; Pregnancy; Progesterone; Reference Values; Reproductive Techniques

The effect of Clostilbegyt + Humegon + Pregnyl ovulation inductive combination therapy was examined in the woman members of 20 sterile couples appearing at the Outpatient Department of Cryospermatology, Department of Obstetrics and Gynaecology Postgraduate Medical School. In 18 of the 20 cases follicle maturation and ovulation could be induced. In the male members of the couples therapy-resistant sterility existed at the same. By using artificial insemination by donors with cryopreserved sperms, gravidity could be obtained in 14 cases. The importance of the optimal timing of AID has been emphasized. In the course of transvaginal ultrasonography folliculometry was completed with the control of the pre-ovulatory changes of the endometrium. The appearance of the pre-ovulatory ring preceded the occurrence of pregnancy in all cases, being a sign of predictive value considering conception.

Topics: Body Temperature; Chorionic Gonadotropin; Clomiphene; Drug Evaluation; Drug Therapy, Combination; Endometrium; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Prolactin; Ultrasonography

Relationships between immune and endocrine systems seem to occur in ovarian follicular fluids (FF). Lymphomonocytes have been found in preovulatory follicles and their specific products, cytokines [interleukin-1 (IL1), IL2], were demonstrated to inhibit steroidogenesis. Ovarian steroids, in turn, reduce the cytokine production from immune-competent cells. In the present study we evaluated whether lymphomonocytes are present in FF, and if both their subset distribution and their IL1 alpha and IL2 secretions, after activation with phytohemagglutinin (PHA), are similar to those of peripheral blood. Interferences of IL1 alpha and IL2 production by FF lymphomonocytes caused by isolated granulosa cells were also evaluated.. The study was performed on 86 FFs obtained from follicles containing mature oocytes that were aspirated at the time of ovum pickup from 27 women undergoing controlled ovarian hyperstimulation with exogenous gonadotropins for an in vitro fertilization (IVF) program [IVF-embryo transfer (IVF-ET) or gamete intrafallopian transfer (GIFT)].. Lymphocytes were found in FF. The distribution of CD8+ and CD3+ lymphocyte subsets is equal to that in peripheral blood, but the percentage of CD11b+, CD16+, and CD4+ cells (its trend) is higher in FF than in peripheral blood. The amount of IL2 and IL1 alpha deriving from PHA-activated FF lymphomonocytes is similar to that of peripheral blood PHA-activated lymphomonocytes. Granulosa cells significantly blunt IL2 and IL1 alpha production by FF lymphomonocytes.. These results suggest that preovulation, a migration of lymphomonocytes from the peripheral compartment to the follicle occurs. However, unfavorable effects of IL2 and IL1 alpha, cytotoxic and antisteroidogenetic activities, are counteracted by the products of granulosa cells. The higher amounts of CD11b+, CD16+, and CD4+ in FF suggest that they could be involved in other immune processes.

Topics: Adult; Female; Fertilization in Vitro; Follicular Fluid; Gamete Intrafallopian Transfer; Granulosa Cells; Humans; Infertility, Female; Interleukin-1; Interleukin-2; Leukocytes, Mononuclear; Lymphocyte Activation; Lymphocyte Subsets; Menotropins; Ovary

Topics: Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Multiple

Topics: Drug and Narcotic Control; Female; Health Services Accessibility; Humans; Infertility, Female; Menotropins; United Kingdom

We conducted a prospective study of blood levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) following daily intramuscular injection of human menopausal gonadotropin (hMG) containing equal proportions of FSH and LH. Blood samples were collected on alternate days and the resulting changes in the blood levels of the ovarian hormone estradiol were also monitored. Twenty-eight consecutive patients with polycystic ovary syndrome who were between the ages of 25 and 35 years and attending our infertility clinic for ovulation induction therapy and assisted pregnancy were studied. Polycystic ovary syndrome was diagnosed on laparoscopy and as evidenced by high serum LH which was three times greater than FSH in the follicular phase of the menstrual cycle. A male factor for infertility was excluded. Twenty-five out of 28 women (89.3%) receiving hMG responded to therapy by a rise in serum estradiol level (> 1200 pmol/l on day 9). Of the 25 women who responded to hMG, four had live single babies (16%). All four women showed a cumulative rise in mean serum FSH with treatment when measured by standard radioimmunoassay, reaching statistical significance on day 5 (p < 0.05). The remaining 21 who failed to become pregnant showed variable changes in mean serum FSH with a sharp rise on day 3 (p < 0.02) and a significant fall on day 7 (p < 0.02). However, mean serum LH measured by standard radioimmunoassay in all women remained unchanged throughout the period of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Prospective Studies

Ten women with unexplained infertility, who conceived by intrauterine insemination (IUI) or timed intercourse under controlled ovarian hyperstimulation, were analyzed to investigate the difference of hormonal environment at the periovulatory phase. Forty-two cycles were divided into three groups: the pregnant cycle group, the high luteinizing hormone (LH) group (LH > or = 60 mIU/ml on day -1: the day of human chorionic gonadotropin administration) of nonpregnant cycles and the low LH group (LH < 60 mIU/ml on day -1) of nonpregnant cycles. Progesterone (P4)/estradiol (E2) ratios of the high LH group on day -1 and day 0 were significantly higher than those of each corresponding day in the pregnant cycle. On the other hand, P4/E2 ratio of the low LH group on day +1 was significantly lower. P4/E2 ratio but absolute level of each hormone showed a high indicative value for the estimation of abnormal hormonal environment. It is concluded that the P4/E2 ratio at the periovulatory phase is a good parameter to estimate the efficacy of the method for ovulation induction.

Topics: Adult; Clomiphene; Estradiol; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Progesterone

It may sometimes be necessary to regulate cycles in assisted reproduction. Cycles can be regulated with gonadotropin releasing hormone (GnRHa) agonist but other methods can also be used. The aim of this study was to compare the pregnancy rate in a gamete intrafallopian transfer (GIFT) program in patients receiving a contraceptive pill/Clomid/human menopausal gonadotropin (hMG) regimen (study group), with the standard Clomid/hMG regime (control group). Fifty one patients in the study group were carefully matched for patient age, infertility diagnosis (female), semen parameters, number of follicles, and number of oocytes transferred into consideration with a control group.. The overall pregnancy rate was 21.6% (11/51) in the study group and 47% (24/51) in the control group (P = 0.01). However, the ongoing pregnancy rate in the two groups did not differ significantly, 11.8% (6/51) vs 27.5% (14/51) (P = 0.08). In the study group, 7.8% of patients had to be seen over a weekend, compared to 13.7% in the control group (not significant).. From the findings we conclude that, although this method of controlling cycles can be useful in selected patients, it is not the ultimate method.

Topics: Adult; Clomiphene; Desogestrel; Drug Therapy, Combination; Female; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Pregnancy; Retrospective Studies

To assess the clinical relevance of daily hormonal changes for achieving a successful pregnancy in anovulatory infertile women.. A comparative study of hormonal dynamics in pregnant and nonpregnant cycles during the pulsatile subcutaneous administration of hMG. Subjects received subcutaneous injection of either 9.375 IU or 14.0625 IU of hMG diluted in 50-microL physiological saline (total daily dose, 150 or 225 IU) at 90-minute intervals by means of a portable peristaltic pump.. Kyorin University Hospital and Ichikawa General Hospital.. We analyzed 18 pregnant and 42 nonpregnant cycles in 17 patients with secondary hypothalamic/pituitary amenorrhea who conceived after receiving pulsatile hMG treatment. Another 14 women with normal spontaneous ovulation, including 14 pregnant and 15 nonpregnant cycles, served as controls.. Serum concentrations of LH, FSH, E2, and P were measured, and the P:E2 ratio was determined.. Serum concentrations of LH and FSH did not differ significantly between the pregnant and nonpregnant cycles. Serum levels of P and E2 were significantly higher during the hMG treatments than those of the spontaneous ovulatory cycles throughout the follicular and luteal phases. Up to the midluteal phase, the P and E2 values in the nonpregnant cycles during the hMG treatments did not differ significantly from those in the pregnant cycles. The P:E2 ratios were comparable between the pulsatile stimulatory cycles and the normal spontaneous ovulatory cycles. However, the P:E2 ratio in the early and midluteal phases was significantly greater in the pregnant cycles than in the nonpregnant cycles.. The P:E2 ratio in the early and midluteal phases is a more important indicator of hormonal function for implantation than the absolute levels of either P or E2.

Topics: Adult; Anovulation; Female; Gonadal Steroid Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Menotropins; Pregnancy; Pulsatile Flow

In a retrospective study (1985-1989) based on data from the Centre for Reproductive Medicine in Brussels, a total of 23 ectopic pregnancies (2.24%) occurred after 3800 embryo, zygote or gamete transfers. This number was low compared with the data published elsewhere. Tubal damage was a major risk factor towards developing an ectopic pregnancy after in-vitro fertilization and embryo transfer. The number of ectopic pregnancies after the association of clomiphene citrate and human menopausal gonadotrophin (HMG) was significantly higher in patients with tubal (7.8%) and non-tubal indications (2.1%) compared with those stimulated with gonadotrophin-releasing hormone (GnRH) and HMG (2.18% and 0.84%, respectively). The number of replaced embryos was not associated with the rate of ectopic pregnancy and neither did transfer technique (intra-uterine or intra-Fallopian transfer) influence the ectopic pregnancy rate.

Topics: Adult; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Ectopic; Reproductive Techniques; Retrospective Studies; Risk Factors; Zygote Intrafallopian Transfer

We have previously presented data to show that in patients who had in-vitro fertilization (IVF)-embryo transfer using ovarian stimulation involving the luteal phase leuprolide acetate--human menopausal gonadotrophin (HMG) regimen, poor pregnancy results ensued if either the endometrial thickness was < 10 mm or a homogeneous hyperechogenic sonographic pattern was present immediately prior to taking a human chorionic gonadotrophin (HCG) injection. There were only 15 cases with this hyperechogenic type endometrium (and no pregnancies). The purpose of the present study was to evaluate the influence of a hyperechogenic endometrium when the endometrial thickness was > or = 10 mm, in a more extensive series, in women having IVF-embryo transfer using the same ovarian stimulation regimen. A total of 273 consecutive cycles, where endometrial thickness was > or = 10 mm, were evaluated (not including the 85 cycles previously reported). Of 22 patients with the hyperechogenic pattern, one achieved a chemical pregnancy (beta-HCG > 500 mIU/ml) and none achieved clinical pregnancies (ultrasound confirmation). In contrast, 67 of 251 (26.7%) patients conceived with other echo patterns (chi 2 analysis = 5.9, df = 1, P = 0.01). These data thus confirm, in a larger series, the negative influence of this type of echo pattern on subsequent pregnancy rates following the luteal phase leuprolide acetate--HMG ovarian stimulation regimen.

Topics: Embryo Transfer; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Menotropins; Pregnancy; Progesterone; Prognosis; Ultrasonography

A woman with longstanding primary infertility and progressive, symptomatic rectal endometriosis was treated with daily leuprolide acetate for nine months. All bowel symptoms subsided. The patient was treated with human menopausal gonadotropin and intrauterine insemination prior to discontinuation of the leuprolide acetate, resulting in a twin pregnancy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Endometriosis; Female; Humans; Infertility, Female; Insemination, Artificial, Heterologous; Leuprolide; Menotropins; Pregnancy; Rectal Diseases

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 investigate whether various types of ovarian stimulation induce differences in endometrial development at the midluteal phase in infertile women.. Assessment of stromal and glandular compartments in endometrial biopsies using morphometric criteria.. Institute for Hormone and Fertility Research, Hamburg, Germany.. The study included 18 women after treatment with human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) (group I), 23 women after clomiphene citrate (CC)/hMG/hCG treatment (group II), and 12 women after CC stimulation (group III).. Endometrial biopsies and blood samples were taken simultaneously in the early to midluteal phase. To assess the time of ovulation, hormone analysis and regular checks by ultrasonography were performed.. Morphometric evaluation of glandular and stromal structures revealed an impaired endometrial development after various treatment protocols.. Ovarian stimulation in infertile women results in most cases in an elevation of steroid levels; however, the occurrence of an inadequate endometrial development might have an unfavorable influence on the outcome of implantation. Therefore, these findings may be of importance to the choice of treatment for infertility.

Topics: Adult; Biopsy; Chorionic Gonadotropin; Clomiphene; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovary; Progesterone

To compare the IVF rates of oocytes retrieved from small follicles (< 2 mL in volume) with those of oocytes retrieved from large follicles and to test the effect of adding gonadotropins to the IVF medium on the fertilization rates of oocytes from small follicles.. Oocytes were retrieved with endovaginal ultrasound (US) guidance from patients undergoing infertility treatment in our IVF program. Oocytes were grouped according to the volume of the originating follicle and subjected to our routine procedure for IVF. HMG was added to the IVF medium for some of the oocytes from small follicles.. Toronto Fertility and Sterility Institute is affiliated with the University of Western Ontario and University of Toronto and is equipped for RIA, endovaginal US monitoring and oocyte retrieval, and for processing and culturing gametes and embryos.. Infertile patients admitted to our IVF program.. Patients underwent ovarian stimulation with hMG before oocyte retrieval. No other interventions were introduced to the processing and culturing the gametes and embryos except the addition of hMG to the medium of some of the small follicle-originated oocytes with the informed consent from the patients.. Rates of fertilization, cleavage of the fertilized embryos before replacement, and meiotic status of some of the oocytes from small follicles.. Most of the oocytes from small follicles did not complete the first meiotic division; they had low rates of fertilization and cleavage compared with oocytes from large follicles, and these rates were improved by the addition of hMG to the IVF medium.. Oocytes from small follicles are probably less mature and require a more physiological environment to achieve normal rates of fertilization and cleavage.

Topics: Adult; Cleavage Stage, Ovum; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Oocytes; Ovarian Follicle

Topics: Adult; Bulgaria; Chorionic Gonadotropin; Chronic Disease; Clomiphene; Female; Hospitals, Maternity; Hospitals, Urban; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Superovulation

Serum concentrations of follicle-stimulating hormone (FSH) were measured in a 33-year-old eumenorrhoeic woman with primary infertility. Postmenopausal levels were obtained. Using an alternative assay, the patient was found to have normal levels of FSH. The probable cause of the misleading result is discussed.

Topics: Adult; Antibodies, Monoclonal; Diagnostic Errors; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Radioimmunoassay

Twenty-one sterile couples, between September 1989, and August 1991, were treated for ovulation stimulation of their cycles, in order to practice in them, a in vitro fertilization and tube embryo transfer (ZIFT). Two protocols of ovulation induction were used, both with leuprolide acetate (Lupron), one in the luteal phase and the other in follicular phase and since the second or the fourth day of the cycle, respectively, gonadotropins were added (Metrodine and Pergonal). Out of all the twenty-nine initiated cycles, twenty-seven were aspirated (93.1%) and twenty-four reached an embryo transfer (82.8%). Seven clinic pregnancies were obtained (29.17% per transfer) and four deliveries (16.67% per transfer). The sterility period average was 69.64 +/- 36.6 months and the patients age average was 34.1 +/- 4.38 years. The global rate of fertilization was 63.53%. With luteal phase Lupron best results were got (pregnancy rate of 38.46% per transfer) and there were not considerable difference in the number of gonadotropins ampulla employed. When embryos were transfer to the tubes and the uteri the pregnant rate was 50% per transfer, in comparison to 18.75% when transfer was made only in the tubes.

Topics: Chile; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pregnancy; Zygote Intrafallopian Transfer

We studied 23 women with polycystic ovarian syndrome (PCOS), resistant to clomiphene citrate, who had a previous history of multifollicular ovarian development on gonadotrophin stimulation. Each woman had one cycle of gonadotrophin-stimulating hormone agonist/human menopausal gonadotrophin (GnRHa/HMG) stimulation and then one cycle of low-dose follicle stimulating hormone (FSH) stimulation. All GnRHa/HMG cycles were multifollicular. On the low-dose FSH protocol, 10 cycles were unifollicular, while two to three follicles were observed in nine cycles, and four cycles were multifollicular. The ovarian hyperstimulation syndrome ensued in one of the FSH cycles versus 13 of the GnRHa/HMG cycles. Despite decreasing luteinizing hormone (LH) levels and increasing FSH levels, androgen levels increased during stimulation on both protocols. There was one pregnancy in the GnRHa/HMG cycles versus six pregnancies following the FSH cycles. In conclusion, low-dose FSH administration seems a safe stimulation regimen with a satisfactory conception rate even in PCOS women with a previous record of multifollicular ovarian development.

Topics: Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Hyperstimulation Syndrome; Polycystic Ovary Syndrome; Pregnancy; Progesterone

To determine the effect of a spontaneous luteinizing hormone (LH) surge on the cycle fecundity during superovulation induction.. Superovulatory cycles of patients with various diagnoses are retrospectively compared.. Reproductive Endocrinology Outpatient Clinic.. A total of 1,185 superovulatory cycles from July 1, 1982 until November 1, 1991 are compared.. The probability of achieving a pregnancy per treatment cycle.. Patients with unexplained infertility and hyperprolactinemia were more likely to have a spontaneous LH surge during superovulation than patients with either endometriosis or polycystic ovarian disease. However, the cycle fecundity rate did not differ whether or not an LH surge occurred, regardless of the diagnosis.. Spontaneous onset of an LH surge during superovulation induction does not influence the chances for pregnancy.

Topics: Adult; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Retrospective Studies; Superovulation

To examine the effects of growth hormone (GH) on ovarian responses to exogenous gonadotropins after pituitary desensitization in normal and poor responder patients undergoing in vitro fertilization.. A prospective study with comparison of control and GH-treated cycles.. Poor responder patients (n = 10) required > 44 ampules of human menopausal gonadotropin (hMG) to achieve criteria for administration of human chorionic gonadotropin (hCG) on day 0 or cancellation in control cycles, and normal responder patients (n = 10) required < 45 ampules.. Ovarian responses to hMG assessed by duration of stimulation required to achieve first significant estradiol (E2) response and hCG criteria. Total doses and duration of hMG, follicular development and E2 concentrations on day 0, and embryology were also assessed.. Growth hormone showed no effect on any of the parameters studied in either patient group.. Follicular recruitment, E2 secretion by mature follicles, and oocyte yield and quality were uninfluenced by GH treatment.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Infertility, Female; Insulin-Like Growth Factor I; Menotropins; Ovarian Follicle; Ovary; Prospective Studies

To look for patterns of antisperm antibody expression in women by exploring the levels of antisperm antibodies in different body fluids. This was achieved by studying sequential serum samples from individual patients and by comparing the levels of antisperm antibodies in serum from a number of patients with the levels of antisperm antibodies in cervical mucus or peritoneal fluid (PF).. Prospective studies were performed on sequential serum samples within a menstrual cycle. Retrospective studies were done to compare antisperm antibodies in serum and mucus or PF. The immunobead assay was used to measure antisperm antibodies in these fluids.. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.. A random sample of patients undergoing evaluation for infertility.. The levels of antisperm antibodies in sera drawn from patients at different points in a menstrual cycle stimulated by the presence of exogenous hormones did not change during the follicular phase of the menstrual cycle. Also, in many samples, the antisperm antibody level in serum did not correlate with the antisperm antibody levels in mucus or PF.. The data suggest that measurement of antisperm antibodies at a single point in time or from a single fluid is not sufficient when evaluating a woman for immunological infertility. The data also suggest that numerous and complex factors contribute to the expression of antisperm antibodies in women.

Topics: Antibodies; Antigens; Ascitic Fluid; Cervix Mucus; Clomiphene; Estradiol; Ethinyl Estradiol; Female; Humans; Immunoglobulin A; Immunoglobulin G; Infertility, Female; Male; Menotropins; Ovulation Induction; Prospective Studies; Retrospective Studies; Spermatozoa

To elucidate the clinical background of the luteal-phase defect (LPD), 201 LPD cycles were studied in 753 infertile women. One hundred and twenty-one cases (62.2%) of LPD showed transient hyperprolactinemia. In transient hyperprolactinemia, there was a significant inverse correlation between serum prolactin (PRL) 30 min after the 500-micrograms intravenous loading of thyrotropin-releasing hormone TRH (PRL30) and progesterone (P4) in the luteal phase (r = -0.67, p less than 0.005). Mature follicles (diameter greater than 20 mm as determined by ultrasonography) were observed in 74 cases (61.2% of the transient hyperprolactinemia cases). On the contrary, in 25 (12.4%) of the 121 LPD cases who showed the hyper-luteinizing hormone (LH) syndrome (LH/FSH ratio greater than 1), only 9 (36%) had mature follicles. Of the remaining 55 cases who showed neither transient hyperprolactinemia nor the hyper-LH syndrome, 27 cases (49.1%) had mature follicles. Five of these patients indicated a significantly higher LH pulse amplitude despite depressed P4 secretion in the luteal phase. From these results, it was concluded that the most common cause of LPD was transient hyperprolactinemia. The second cause of LPD was suspected to be disturbed follicle development due to the inappropriate ratio of LH/FSH in the hyper-LH syndrome. Another cause was speculated to be the primary failure of a response from the corpus luteum to LH. Treatments based on the conclusions mentioned above resulted in a 48.3% pregnancy success rate.

Topics: Bromocriptine; Chorionic Gonadotropin; Clomiphene; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Hyperprolactinemia; Immunoradiometric Assay; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Follicle; Pituitary Gland; Progesterone; Prolactin; Thyrotropin-Releasing Hormone

To investigate the functional aspects of secretory-phase endometrium, hysteroscopy was performed in 61 patients for in vitro fertilization-embryo transfer (IVF-ET), and 50 women for infertility evaluation. All women had normal ovulatory cycles. The hysteroscopic assessment of secretory-phase endometrium was made by characterizing the glandular openings (GO) and vasculature. The assessments were classified as 'good': characterized by ring-type GO and well-developed vessels; and 'poor': characterized by dot and/or punctate-type GO and fine vasculature. In the 30 patients classified 'good' prior to the IVF cycle, there was a higher pregnancy rate (40%) than in 'poor' ones (13%). Thirty of 50 infertile women were classified 'good', and their average age was lower than that of the remaining 20 in the 'poor' group. Preovulatory estradiol was significantly higher in the 'good' than in the 'poor' group. From an analysis of 20 patients with a 'poor' assessment, it was demonstrated that the maturation of secretory-phase endometrium was affected by a failure of folliculogenesis, progesterone secretion, endometrial growth and menstrual shedding.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Hysteroscopy; Infertility, Female; Luteal Phase; Menotropins; Ovarian Follicle; Progesterone; Treatment Outcome; Ultrasonography

The purpose of this study was to evaluate the influence of the relationship between plasma progesterone (P4) and estradiol (E2) levels in the luteal phase for achieving pregnancy in human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG)-treated cycles. Plasma P4 and E2 levels were determined in 93 hMG-hCG-treated cycles (23 pregnant and 70 nonpregnant) of 46 patients during 3 periods of the luteal phase, using radioimmunoassay. In addition, 88 spontaneous ovulatory cycles and 100 clomiphene-treated cycles were also studied in the same manner. In hMG-hCG-treated cycles in the early luteal phase, the P4/E2 ratio in pregnant cycles was significantly higher than that in nonpregnant cycles. There was no significant difference between the P4/E2 ratios of the luteal phase of hMG-hCG-treated pregnant-group, clomiphene-treated and spontaneous ovulatory cycles. In nonpregnant cycles, however, the P4/E2 ratio in hMG-hCG-treated cycles was significantly lower than that in clomiphene-treated or spontaneous ovulatory cycles. These results suggest that in hMG-hCG-treated cycles, the P4/E2 ratio may be a more reliable index of luteal function for achieving pregnancy than P4 levels alone.

Topics: Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Progesterone; Radioimmunoassay

We retrospectively analyzed the prevalence and prognostic significance of plasma progesterone rises during in vitro fertilization (IVF) protocols including pituitary down-regulation by LHRH agonists in a long protocol and stimulation by hMG (n = 1,116: Group A) or pure FSH (n = 178: Group B). On the day of hCG injection, plasma progesterone level was in the 0.60-0.99 ng/ml range in 7.1% of group A patients and 6.2% of group B patients (NS) and above 1 ng/ml in respectively 4.0% and 3.4% of the cases (NS). On the same day, plasma progesterone was strongly correlated with plasma estradiol (r = 0.26 - p < 0.001 in group A; r = 0.21 - p < 0.01 in group B). However, increased progesterone levels were not associated with changes in plasma LH levels, falls in plasma estradiol levels after hCG injection, or significant modifications in biological and clinical results of IVF. The cause of this pattern of progesterone rise remains to be elucidated.

Topics: Buserelin; Clinical Protocols; Drug Therapy, Combination; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteolytic Agents; Menotropins; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Progesterone; Prognosis; Retrospective Studies; Triptorelin Pamoate

Topics: Adult; Clomiphene; Endometrium; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteal Phase; Menotropins; Primary Ovarian Insufficiency; Progesterone; Superovulation

Reviewing 780 in-vitro fertilization (IVF) cycles, where buserelin was commenced in the preceding luteal phase and human menopausal gonadotrophin on day 4 of the ensuing menses, 53 cycles were identified with sonolucent cysts (30-50 mm diameter). Of the latter 53 cycles, the serum oestradiol was significantly greater on day 4 in 22 cycles abandoned for poor follicular development than in 31 cycles which proceeded to oocyte retrieval (P less than 0.05). Of the 31 cycles proceeding to oocyte retrieval, nine had a day 4 serum oestradiol greater than 200 pmol/l (95th centile for day 4 oestradiol in patients without apparent cysts), and these cycles produced significantly fewer grade 1 embryos than the cycles with day 4 oestradiol levels less than or equal to 200 pmol/l (P less than 0.05). Six of the 53 cycles with cysts resulted in conception, and all of these cycles had a day 4 serum oestradiol less than 200 pmol/l. Among the 53 cycles with ovarian cysts, the serum progesterone on the day of abandonment in four cycles and on the day of human chorionic gonadotrophin administration in one non-abandoned cycle, was above the range established for 104 cycles without cysts. No significant difference was seen in day 4 serum androstenedione levels, and the day 4 serum progesterone was less than 5 nmol/l in all but one patient. Functional activity of ovarian cysts is associated with an adverse influence on IVF cycles.

Topics: Androstenedione; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovulation Induction; Progesterone

To determine hormonal and ultrasound parameters associated with pregnancies, 115 women with unexplained infertility (n = 82), endometriosis (n = 22) or cervical factor (n = 11) were treated with direct intraperitoneal insemination (DIPI) after ovarian stimulation with clomiphene citrate and human menopausal gonadotrophins (HMG). Twenty women conceived and were compared with the remaining 95 non-pregnant women during one treatment cycle. Women with basal FSH levels less than or equal to 1.25 micrograms/l responded with higher oestradiol levels (P less than 0.0001), with the development of more follicles (P less than 0.05) and higher progesterone levels (P less than 0.05) than women with basal FSH levels greater than 1.25 micrograms/l, but the conception rates were similar. Women with miscarriages or biochemical pregnancies had a higher basal FSH value than both the women with term pregnancies and the non-pregnant women. Women with at least 3 preovulatory follicles greater than or equal to 15 mm had a higher pregnancy rate than those with fewer follicles, but a further increase was not observed above that number. The endometrium was thicker on the day of ovulation induction in cycles leading to a term pregnancy than in cycles without conception or with a biochemical pregnancy. No term pregnancy was observed when the endometrium was thinner than 8 mm. Women with a short luteal phase (less than 12 days) had a higher ratio of oestradiol/progesterone in the midluteal phase than women with a luteal phase of greater than or equal to 12 days and pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Clomiphene; Endometrium; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Peritoneal Cavity; Pregnancy; Progesterone; Retrospective Studies; Ultrasonography

Theoretically, clomiphene citrate or human menopausal gonadotropins might have a higher chance of inducing pregnancy per cycle were it not for the concomitant rise in androgens induced by these follicle-maturing drugs. In the present study, mid-cycle androgen levels were evaluated in anovulatory women with normal baseline early follicular levels who were treated with either clomiphene citrate or human menopausal gonadotropins. The only mid-cycle androgen to rise above the normal range was androstenedione. However, no negative effects of elevated androstenedione levels on pregnancy rates were apparent. Thus, at least in women with normal baseline androgen levels, the use of follicle-maturing drugs does not appear to cause a rise in androgen levels except for androstenedione, and the rise in androstenedione at mid-cycle appears to have no adverse effect on conception.

Topics: Androgens; Androstenedione; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Pregnancy

In view of the association of hyperinsulinemia with elevated luteinizing hormone (LH) levels and hyperandrogenism in polycystic ovary syndrome (PCOS), the effect of octreotide was investigated in women with PCOS. Twelve amenorrheic women were treated with 100 micrograms octreotide twice a day for 7 days; 13 infertile women unresponsive to clomiphene citrate were treated either with octreotide (100 micrograms twice a day from day 1 of the menstrual cycle until corpus luteum formation) in addition to human menopausal gonadotropins (HMG) or with HMG alone. Octreotide significantly reduced the 4-hour integrated LH concentrations. LH pulse amplitude and nadir concentrations, and LH, testosterone, androstenedione, and estradiol responses to a gonadotropin-releasing hormone (GnRH) analogue in amenorrheic PCOS women. Octreotide treatment also resulted in a more "appropriate" hormonal milieu at the time of human chorionic gonadotropin (HCG) injection in the infertile women, with LH and testosterone levels being reduced while follicle-stimulating hormone (FSH) levels increased. Orderly follicular growth occurred, with one or two mature follicles being present at the time of HCG injection in cycles in which octreotide was given together with HMG. There were no cases of hyperstimulation, even in women who had previously hyperstimulated after HMG alone. Octreotide thus inhibits LH and androgen secretion and may improve ovulatory performance in infertile women with PCOS.

Topics: Adolescent; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Follicular Phase; Gonadal Steroid Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Luteinizing Hormone; Menotropins; Octreotide; Polycystic Ovary Syndrome

To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical services.. All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response.. British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles.. 156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and 1 quintuplet set). These data were compared to nationally collected OPCS data.. Method of conception, obstetric performance, neonatal outcome.. Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17 (11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively.. Assisted reproduction is the major cause of triplets and higher multiple births and ovarian stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make considerable demands on neonatal intensive care facilities.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies; Reproductive Techniques; United Kingdom

To investigate if peritoneal oocyte and sperm transfer (POST) performed transvaginally is an effective treatment for nontubal infertility.. Prospective study of 18 patients (4 with unexplained infertility, 13 with failed donor insemination, and 1 with male factor infertility) having 20 cycles of transvaginal POST in a specialist infertility unit.. Ovarian stimulation was achieved with human menopausal gonadotropin (hMG) alone, hMG and clomiphene citrate, or gonadotropin-releasing hormone agonist with hMG. Oocyte recovery was performed transvaginally under ultrasound guidance, the pouch of Douglas rinsed repeatedly and an embryo transfer catheter used to transfer 4 x 10(6) progressively motile sperm in 1 mL and up to four oocytes into the pouch of Douglas. Luteal support was provided with human chorionic gonadotropin injections given 2 and 5 days later.. The mean age of the patients was 32.65 +/- 5.0, and the mean length of infertility 5.07 +/- 2.32 years. The mean number of oocytes transferred was 3.53 +/- 0.87. Three pregnancies were achieved in the failed donor insemination group and 1 each in those with unexplained and male factor infertility, giving overall clinical pregnancy and live birth rates of 25% and 20% per initiated cycle. All pregnancies were achieved in those who had three or four oocytes transferred.. Transvaginal POST is a useful assisted conception technique for the treatment of nontubal infertility.

Topics: Adult; Buserelin; Clomiphene; Female; Humans; Infertility, Female; Male; Menotropins; Oocytes; Ovary; Pregnancy; Prospective Studies; Reproductive Techniques; Spermatozoa

Patients undergoing human menopausal gonadotropin (hMG) superovulation were reviewed retrospectively to determine whether fecundity was greater for intrauterine insemination (IUI) than timed intercourse. Forty patients with unexplained infertility, American Fertility Society I or II endometriosis, luteal phase defect and/or cervical factor were treated with hMG alone or hMG plus IUI. Twenty-eight underwent 52 cycles of hMG/IUI, and 19 underwent 31 cycles of hMG. The probability of pregnancy after four cycles was significantly better in the hMG/IUI group (.90) than the hMG group (.37, P = .049). There was a 54.5% multiple pregnancy rate, and one patient was admitted to the hospital for hyperstimulation. When traditional therapy fails, hMG/IUI significantly increases the pregnancy rates as compared to hMG with timed intercourse in a "good prognosis" group of patients.

Topics: Baltimore; Coitus; Female; Hospitals, University; Humans; Infertility, Female; Insemination, Artificial, Homologous; Life Tables; Menotropins; Pregnancy; Pregnancy Outcome; Prognosis; Proportional Hazards Models; Retrospective Studies; Superovulation; Time Factors

Data presented in this study indicate that ovulation can be induced in patients with PCOS using a GnRH analogue combined with hMG in a decreasing dose regimen. Based on the observed decline in functional, medium sized follicles in the late follicular phase, it may be speculated that the risk of ovarian hyperstimulation during gonadotropin induction of ovulation in patients with PCOS can be reduced.

Topics: Adult; Buserelin; Drug Administration Schedule; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Random Allocation; Ultrasonography

Dopamine agonist Bromocriptin tablet has been used in 102 cases, partly for the inhibition of puerperal lactation, partly for the treatment of infertility accompanied by hyperprolactinaemia. On the basis of the clinical results and the changes of PRL level the drug was found to be very effective in both indications. Side-effects necessitating the discontinuance of treatment were not observed.

Topics: Adult; Anovulation; Bromocriptine; Clomiphene; Drug Therapy, Combination; Female; Humans; Hyperprolactinemia; Infant, Newborn; Infertility, Female; Lactation; Menotropins; Postpartum Period; Pregnancy

Ninety one patients with unexplained infertility were treated with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG). The overall pregnancy rates were 29% per patient and 11% per cycle. In patients under the age of 37, the rates were 40% per patient and 15% per cycle. Many cycles (15%) were cancelled because of poor response to stimulation and by definition these women had normal cycles prior to stimulation. Within 1 year of ceasing HMG treatment, 9 patients had conceived spontaneously and another 4 conceived by GIFT.

Topics: Adult; Age Factors; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Time Factors; Treatment Outcome

Daily changes in the thickness and texture of the endometrium were assessed by transvaginal sonography in 15 natural (cycles 'cycle-A) and 24 stimulated cycles (cycle-B: hMG-hCG cycles; hCG 10,000 IU was injected on the day after the dominant follicle reached 18mm in three-directional radius, n = 7) (cycle-C: hCG 3,000 IU injections on the 5th, 9th and 13th day after hCG 10,000 injection were added to cycle-B, n = 10) (cycle-D: hCG 1,000 IU instead of 3,000 IU of cycle-C, n = 7). The duration of the luteal phase was 15, 9, 17 and 18 days in cycle-A, cycle-B, cycle-C and cycle-D, respectively. The thickness of the endometrium increased lineally until ovulation day (D +/- 0) (thickness: 10.7mm) in cycle-A, but in stimulated cycles it revealed a significantly rapid increase until D-4 (10.9mm) and then reached a plateau. The ratio of the thickness of the hyperechoic area to the total thickness of the endometrium reached 100% (D + 9) in cycle-A. The ratio reached only 72% (Max, D + 4) in cycle-B, but the effect of luteal support was shown to reach 89% and 85% (Max, D + 7) in cycle-C and cycle-D. The serum progesterone level in stimulated cycles revealed a rapid increase until D + 5, but it had an unstable pattern in cycle-C and cycle-D. It was shown that luteal support was necessary to offset the luteal phase defect caused by stimulation with hMG.

Topics: Chorionic Gonadotropin; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Induction; Progesterone; Ultrasonography

Our objective was to evaluate the effect of controlled ovarian hyperstimulation on pregnancy rates after intrauterine insemination of washed husband's sperm.. In a private practice setting at the Infertility, Gynecology, and Obstetrics Medical Group in San Diego, 79 treatment programs included intrauterine insemination during natural cycles, 195 included clomiphene stimulation, and 53 had human menopausal gonadotropin stimulation. Pregnancy rates and monthly fecundabilities were calculated by life-table analysis and compared by the Z test.. By life-table analysis the cumulative probability of pregnancy after intrauterine insemination with no ovulation induction is 21.0% after six cycles with a monthly fecundability of 3.4%. With clomiphene the pregnancy rate is 32.7% with a monthly fecundability of 6.1%, and with human menopausal gonadotropin the pregnancy rate is 60.7% with a monthly fecundability of 13.0%. The human menopausal gonadotropin group had a significantly higher pregnancy rate and monthly fecundability as compared with the other two groups. There were no differences between the no-stimulation and the clomiphene groups.. Human menopausal gonadotropin stimulation results in a significantly higher pregnancy rate and monthly fecundability after intrauterine insemination as compared with no stimulation or clomiphene use.

Topics: Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Life Tables; Male; Menotropins; Ovary; Pregnancy; Retrospective Studies

This prospective study was undertaken to evaluate the relative efficacy of three in vivo methods of assisted fertilization in 150 infertile women with patent fallopian tubes: gamete intrafallopian transfer (GIFT), combined intrauterine and direct intraperitoneal insemination (IUI+DIPI), and controlled hyperstimulation (COHS) alone. The clinical pregnancy rate was highest in the IUI/DIPI and GIFT groups: IUI/DIPI, 29.3%; GIFT, 28.6%; and COHS, 8.9%. We believe that controlled ovarian hyperstimulation combined with IUI and DIPI is a good alternative to GIFT.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Fallopian Tubes; Female; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Prospective Studies; Superovulation; Treatment Outcome

Two protocols were scheduled for in vitro fertilization and embryo transfer (IVF-ET) in patients with various stages of endometriosis who were resistant to conventional therapies. In the ultralong protocol (21 patients), gonadotropin releasing hormone agonist (Gn-RHa) was administered for at least 60 days prior to ovarian stimulation along with menotropin until human chorionic gonadotropin was injected. In the long protocol (11 patients), Gn-RHa was started at the midluteal phase and exogenous gonadotropin was commenced between the third and the seventh day of the menstrual cycle after pituitary suppression. The estradiol response and the number of retrieved oocytes, fertilized oocytes, cleaved oocytes, and transferred embryos were similar in both groups but the clinical pregnancy rate per transfer was superior in the ultralong protocol (67 vs 27%). The miscarriage rate was 14% (2/14) in the ultralong protocol. Prolonged Gn-RHa suppression of ovarian function before superovulation may overcome some causes of infertility in patients with endometriosis.

Topics: Adult; Antigens, Tumor-Associated, Carbohydrate; Buserelin; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Treatment Outcome

The difficulty in evaluating the efficacy of treatments for endometriosis in terms of sterility results from the frequent confusion between the inhibition of the natural progression of endometriosis and a beneficial effect on fertility. The authors review the supposed benefits and the drawbacks of the various medical and surgical treatments available and medically assisted fertilization (IVF) in the context of the various types of endometriosis damage. They highlight the inadequacy of the AFS score, which gives very similar scores for effects with widely differing impacts on fertility. The authors attempt to identify the therapeutic associations which seem currently to be useful in treating endometriosis and also beneficial in obtaining a pregnancy.

Topics: Adult; Clomiphene; Danazol; Endometriosis; Female; Fertilization in Vitro; Gestrinone; Gonadotropin-Releasing Hormone; Humans; Infant, Newborn; Infertility, Female; Medroxyprogesterone; Menotropins; Pregnancy; Randomized Controlled Trials as Topic

The results of IVF in cases of tubal sterility are compared with those of surgery (macro- or micro-surgery, coelio-surgery). This analysis includes a continuous series of 1051 attempted pregnancies in 640 women (with or mixed tubal sterility with or without endometriosis). After an average 1.64 attempts per patient, 220 women had achieved 241 pregnancies (pregnancy rate: 22.9% per puncture, 34.3% per woman). Of these 241 pregnancies, there were 172 (71.8%) which continued to term, 57 (23.6%) miscarriages and 11 (4.6%) ectopic pregnancies. The pregnancies carried to term were single pregnancies in 129 cases (74.6%), twin pregnancies in 37 cases (21.4%) and triple pregnancies in 7 cases (4%). The indication of coelio-surgery (or microsurgery) is justified in young women with no history of genital tuberculosis, tubal plasty or ectopic pregnancy and presenting with purely tubal sterility with a good prognosis. Restoration of patency after tubal sterilization remains a good indication for microsurgery in young women. In all other cases, indication is for IVF from the outset.

Topics: Adult; Clomiphene; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Prognosis; Retrospective Studies; Triplets

Twenty-four women with infertility caused by antisperm antibodies were treated by homologous intrauterine insemination. Initially, all the women had timed intrauterine insemination by washed spermatozoa for three cycles. The pregnancy rate per couple was 4.20%. The remaining 23 patients received a combined treatment of chlomiphene citrate and intrauterine insemination for three cycles, which did not increase the pregnancy rate per couple and per cycle (4.3% and 1.4% respectively). Thereafter, the remaining 22 patients received a combined treatment of hMG and intrauterine insemination for another three cycles which resulted in a pregnancy rate per cycle (6.1%) and per couple (18.20%) that was significantly greater (P less than 0.01). We conclude that infertile women with antisperm antibodies can benefit after a trial of induction of multiple follicular development with hMG in combination with intrauterine insemination.

Topics: Adult; Antibodies; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Spermatozoa; Uterus

This study deals with the combined therapy of GnRH-agonist (GnRH-a) and HMG for stimulation in 15 patients who failed two prior in vitro fertilization attempts. Fifty-three patients who received HMG without GnRH-agonist suppression served as controls. Comparing the HMG group with GnRH-a/HMG cycles, the cancellation rate dropped from 35.5% to 13.2%. Oocyte recovery was similar in both groups, as were the fertilization rates, 88.4% in GnRH-a and 82% in HMG cycles, respectively. The number of embryos available for transfer was virtually identical in both groups (3.7 vs. 3.6). Embryo cleavage speed was higher in GnRH-a than in HMG regimens. The E2 rise was smooth in the GnRH-a group compared to the sharp rise observed in the HMG group. The pregnancy rate per transfer was 30.5% in the GnRH-a group versus 20.5% in the HMG group. GnRH-a seems to offer a clear improvement to a number of stimulation failures.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction

Gonadotropin-releasing hormone analogues (GnRH-a) are currently used in combination with gonadotropins in ovarian stimulation for in vitro fertilization programs (IVF). The present study aims at evaluating the treatment cycles for IVF for which human menopausal gonadotropin (HMG) was initiated only when pituitary desensitization was confirmed regardless of the time of GnRH-a administration. Two groups of patients were examined. Patients in group A (n = 46) were commenced with HMG treatment on day 15 when E2 level was less than 40 pg/ml. Group B patients (n = 27) comprised the cycle treatments in which E2 levels were greater than 40 pg/ml on day 15. In these cases HMG was first given when E2 levels declined to less than 40 pg/ml. The fertilization rate was similar in both A and B groups, 71.6 and 67.7% respectively. The pregnancy rate per transfer was 27.5 and 34.6% in group A and B respectively. Multiple pregnancies were found at 18.1% in group A versus 44.4% in group B. It is concluded that postponement of HMG administration in patients with high levels of E2 on day 15 after GnRH-a administration seems to offer an improvement in embryo cleavage speed, pregnancy rate and multiple pregnancies.

Topics: Adult; Buserelin; Estradiol; Female; Fertilization in Vitro; Follicular Phase; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovarian Follicle; Ovulation Induction; Time Factors

Patients who failed to conceive after gonadotropin stimulation in in vitro fertilization treatment were classified into normal, high, or poor responders. They were routinely offered another cycle with a combination of a gonadotropin releasing hormone agonist and gonadotropin therapy (in order to evaluate whether this combined therapy could improve their response). The gonadotropin-induced cycle was compared with the combined therapy cycle. With the combination treatment, in the normal responders the phase of ovarian stimulation was significantly (P less than 0.001) prolonged, and the number of follicles and oocytes collected (5.7 +/- 0.7 vs 3.1 +/- 0.4) was increased, without any change in serum estradiol level compared to the control cycle. In high responders the number of oocytes was not modified by the combined treatment compared with the control cycle. However, serum estradiol level was significantly (P less than 0.005) decreased. The combined therapy did not modify any parameter of response in poor responders. We conclude that the response to combined agonist/gonadotropin therapy is dependent on the patient's own basal response. No improvement in response was expected in poor responders.

Topics: Delayed-Action Preparations; Drug Therapy, Combination; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteolytic Agents; Menotropins; Ovary; Triptorelin Pamoate

Platelet-activating factor-acether (PAF-acether) presence was investigated in 27 human follicular fluids (FFs).. Aggregation of washed rabbit platelets was used to measure PAF-acether. Data were compared using Student's t-test.. Follicular fluids came from the in vitro fertilization program at Antoine Béclère Hospital, and PAF-acether was assayed at Institut National de la Santé et de la Recherche Médicale, Unités 187 and 200, Clamart, France.. The study concerned five infertile women 29 to 39 years of age.. Ovaries were stimulated with human menopausal gonadotropin under gonadotropin-releasing hormone agonist (GnRH-a) action.. The height of platelet aggregation was compared between FFs and synthetic PAF-acether.. Mean FF concentration of PAF-acether was 1,367 to 3,467 pg/mL among women. Values were higher for patients in a long than in a short GnRH-a protocol (P less than 0.05). However, PAF-acether concentration was not related to fertilization rate.. Platelet-activating factor-acether is possibly involved in oocyte release from the follicle, a process occulted by follicular puncture.

Topics: Adult; Animals; Buserelin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicular Fluid; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocytes; Platelet Activating Factor; Platelet Aggregation; Rabbits; Triptorelin Pamoate

This work was undertaken in order to evaluate retrospectively the relative efficacy of ovulation induction by menotrophins and that of in-vitro fertilization and embryo transfer (IVF-ET) in the treatment of unexplained infertility. These two treatments were compared between two groups of patients: 87 couples undergoing 446 cycles of ovulation induction by menotrophins (group A) and 72 couples undergoing 108 cycles of IVF-ET (group B). A total of 30 and 20 pregnancies were achieved in groups A and B for a rate of 34 and 28% per patient, respectively. A similar cumulative pregnancy rate (CPR) was achieved for three cycles of ovulation induction (23%) and one cycle of IVF-ET (22%). The cumulative live birth rate (CLBR) in group A was 22% after three cycles and exceeded that of one IVF-ET cycle (17%). It is concluded that menotrophin treatment in unexplained infertility is highly beneficial and should precede an IVF attempt.

Topics: Adult; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Pregnancy; Retrospective Studies

In order to improve the ovarian response to exogenous gonadotropins and to reduce the risk of the ovarian hyperstimulation syndrome and of multiple pregnancies, human menopausal gonadotropin (hMG) was administered by continuous pulsatile subcutaneous (s.c.) infusion via a portable pump. The effectiveness of pulsatile hMG treatment was first demonstrated in a control group comprising 7 females with regular ovulatory cycles, who underwent gonadotropin ovarian superovulation and subsequent IVF/GIFT procedures for tubal or male factor. All pulsatile s.c. hMG cycles were ovulatory and one clinical pregnancy was achieved. In this group, ovarian response was similar following intramuscular (i.m.) and pulsatile s.c. hMG therapy, with a marked reduction of preovulatory serum levels of oestradiol in the pulsatile s.c. hMG cycles. In a prospective study, 11 patients with overt polycystic ovary syndrome (PCO) who failed to ovulate in response to clomiphene, received i.m. hMG ovarian superovulation treatment in 19 cycles and pulsatile s.c. hMG in 21 cycles. Following i.m. hMG treatment, only 10 cycles were ovulatory; 7 cycles had to be cancelled for impending ovarian hyperstimulation syndrome. Following pulsatile s.c. hMG treatment, 15 cycles were ovulatory, only 3 treatment cycles had to be disrupted for multifollicular ovarian response. Both modes of treatment were similar in terms of requirement of hMG ampoules, number of preovulatory follicles, preovulatory serum levels of oestradiol and duration of the preovulatory oestradiol rise. The total duration of hMG treatment was significantly increased following pulsatile s.c. hMG. It is concluded, that in overt PCO syndrome, continuous pulsatile s.c. administration of hMG is an effective method to induce follicular maturation and to achieve ovulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Estradiol; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Infusion Pumps; Menotropins; Polycystic Ovary Syndrome; Pulsatile Flow

Four anovulatory patients who did not respond to large doses of hMG over 18-33 days were co-treated in subsequent cycles with human growth hormone. Treatment with growth hormone markedly raised serum insulin-like growth factor concentrations. Two patients had a dramatic ovarian response within 7 days of co-treatment; two menopausal patients did not respond. This combined therapy may be of practical value for ovulation induction in non-menopausal patients with non-responsive ovaries.

Topics: Addison Disease; Adult; Drug Therapy, Combination; Female; Growth Hormone; Humans; Hypogonadism; Infertility, Female; Insulin-Like Growth Factor I; Menopause; Menotropins; Ovarian Follicle; Ovulation Induction; Uterus

The aim of human menopausal gonadotropin treatment (hMG), to simulate normal follicular development by injecting FSH and LH and induce follicular rupture with hCG, is rarely met. Multiple follicular development occurs because hypothalamic-pituitary feedback is bypassed. This, exacerbated by the long half-life of hCG, causes the principal complications of hMG therapy--multiple pregnancy and hyperstimulation. The initial use of hMG in pituitary deficiency has been widened to include failure to respond to clomiphene, polycystic ovaries, 'unexplained infertility' and in vitro fertilization. Reported pregnancy rates, incidence of hyperstimulation and of multiple pregnancy vary widely. We reviewed the results of hMG therapy from 1977 to 1989 in 260 consecutive women with clomiphene-resistant infertility. Conception and live birth rates after six treatment cycles were 45.7% and 43.3%, respectively and were influenced by the cause of infertility, age, weight and sperm parameters. The miscarriage rate was 18.6% and multiple pregnancy rate 19.3%. The conception rate fell during the 12-year period in all groups except those with regular anovulatory cycles. Over this period, age, weight and male subfertility increased in patients referred to us. hMG is an effective and safe treatment for women with clomiphene-resistant infertility and patent tubes.

Topics: Adult; Age Factors; Estradiol; Female; Fertilization; Humans; Hypogonadism; Infertility, Female; Menotropins; Obesity; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progesterone

To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF).. A retrospective study of IVF pregnancies was performed between November 1983 and December 1989.. This study was conducted in a tertiary care center, the Port-Royal University Hospital.. Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF.. Forty-six salpingectomies were performed for EP after IVF.. We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred.. Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies.. Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.

Topics: Adult; Embryo Transfer; Estradiol; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Risk Factors

To assess predisposing factors to tubal pregnancy after in vitro fertilization-embryo transfer (IVF-ET).. Retrospective analysis of 891 ET cycles.. University-based IVF program.. All ET cycles performed in the study period were included; the indication for IVF was tubal factor in 640 (72%) and other (nontubal) factors in 251 (28%) cycles.. None.. Observing a higher than expected number of tubal pregnancies in our program; we examined subgroups to determine those at highest risk.. Tubal pregnancies comprised 12% of clinical pregnancies in the tubal factor group but only 2.6% in the cycles nontubal factor group (P less than 0.05). Of 640 ET cycles in the tubal factor group, 359 were performed in patients who had prior tubal reconstructive surgery; tubal pregnancies comprised 15.6% of the clinical gestations in this subgroup. In the remainder of the tubal factor group (no prior tubal surgery), 281 ET cycles yielded a tubal pregnancy rate of only 5.5% (P less than 0.05).. Women with prior reconstructive surgery for distal tubal disease are at highest risk of developing tubal pregnancy after IVF.

Topics: Adult; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Tubal; Retrospective Studies

The progestagen-associated endometrial protein (PEP) level rises from the early to the late luteal phase. A study was performed in infertile women where late luteal phase endometrial biopsies and serum PEP levels were obtained. The objective of the study was to evaluate the correlation between the PEP levels and the endometrial biopsies and to determine if subnormal PEP levels could be improved by the same therapies used to correct endometrial defects. There was a poor correlation between PEP levels and endometrial biopsies (r = 0.17). Similarly, there was no significant correlation between PEP levels and levels of the following hormones: mid- and late-luteal phase progesterone (P) (r = 0.186 and 0.282 respectively), mid-luteal phase 17-hydroxyprogesterone (17-OHP) (r = 0.139) and mid-luteal phase oestradiol (r = 0.135). Furthermore, there was no correlation between PEP levels and the dosage of progesterone used in therapy (r = 0.07). There were no statistically significant differences in PEP values (U/ml) depending on whether any fertility drug was taken. Thus our data suggest that progesterone may only have a permissive role, with some other factor(s) controlling the actual rise and fall of PEP.

Topics: 17-alpha-Hydroxyprogesterone; Biopsy; Bromocriptine; Clomiphene; Dose-Response Relationship, Drug; Estradiol; Female; Glycodelin; Glycoproteins; Humans; Hydroxyprogesterones; Infertility, Female; Luteal Phase; Menotropins; Pregnancy Proteins; Progesterone; Radioimmunoassay

Transvaginal catheterization of the fallopian tube has gained increased popularity for transfer of embryos and gametes. Forty-five ITIs were performed on 32 patients using the novel approach of tubal transfer via tactile sensation. This group of patients had undergone an average of 5.2 IUIs before ITI. There were a total of 11 pregnancies, 6 occurring with hMG stimulation and 5 with CC-stimulated cycles (34% PR per patient). Three pregnancies ended with spontaneous abortion, and one patient developed acute salpingitis necessitating laparotomy. These data suggest ITI may be effective in assisted reproduction but, as other invasive procedures, is not without risk.

Topics: Adult; Catheterization; Clomiphene; Fallopian Tubes; Female; Humans; Infertility, Female; Insemination, Artificial; Insemination, Artificial, Heterologous; Insemination, Artificial, Homologous; Menotropins; Pregnancy; Pregnancy Outcome; Sensation; Vagina

We report a case of a twin pregnancy at term obtained after five multiple embryo transfers in a patient who presented diethylstilbestrol (DES)-associated cervical and uterine structural abnormalities, a septate uterus and bilateral tuberculous salpingitis. The suitability of in-vitro fertilization/embryo transfer in DES-exposed women is discussed.

Topics: Adult; Diethylstilbestrol; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Hysterosalpingography; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Tuberculosis, Female Genital; Twins; Uterus

This study assesses the effects of attempts to optimize human menopausal gonadotropin (hMG) dosage in 271 patients who had at least two hyperstimulation cycles for in vitro fertilization or gamete intrafallopian transfer. In the first cycle, all patients received clomiphene citrate and hMG 150 IU/d. In the second cycle, the hMG dose was increased in 45% of patients to try to increase the egg yield. In spite of the increase, the population response was practically identical in both cycles. Median numbers of eggs retrieved (6 versus 6), no eggs retrieved (0.4% versus 1%), only one or two eggs retrieved (10% versus 10%), and canceled cycles (10% versus 10.7%). This suggests that increasing the hMG dosage above 150 IU does not increase the number of eggs retrieved. A poor response may be due to inherent differences in follicular development that cannot be overcome by increases in hMG dosage.

Topics: Dose-Response Relationship, Drug; Embryo Transfer; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Oocytes; Ovary; Ovulation; Retrospective Studies

The results of ovulation induction in patients with ovulatory dysfunction were reviewed for a one year period. Eighty-six women were assigned to four groups: secondary amenorrhea, anovulation, oligo-ovulation, and luteal phase defect/short luteal phase (LPD). All patients were monitored with basal body temperature (BBT) graph, postcoital testing, and ultrasonic scanning of ovarian follicles. All patients received therapy with clomiphene citrate (CC) for a minimum of four cycles and 13 patients conceived. Fifty patients were offered additional therapy with human menopausal gonadotropins (HMG-HCG). Seventeen completed a minimum of four cycles, and 13 conceived. The number of CC-treated patients with poor mucus quality in the face of adequate follicular development was 24, or 48%. The overwhelming problem with ovulation induction when CC failed was the large number of patients who dropped out of therapy, 48%. In summary, close monitoring during ovulation induction to confirm ovulation, and assess mucus quality and luteal function allow detection and correction of inadequate response. Induction of ovulation can be highly successful if patients can follow through and complete protocols of therapy.

Topics: Adult; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

Ten endocrinologically normal women were injected subcutaneously with 500 micrograms D-Ser(TBU)6-EA10-LHRH (buserelin) on days 3,4 and 5 after the start of the menses. Two types of response were observed. Five women (group A) responded promptly and had a mean number of 13.4 oocytes retreived after 11.4 days of stimulation. In the second group (B), two to three times more HMG was needed to obtain a mean number of 7.3 oocytes after 17.2 days of stimulation. The response upon stimulation could be predicted by the serum gonadotrophin output on days 4 and 5 of the cycle. One woman from group B had a premature LH rise on day 16 and luteinization; her cycle was abandoned. In the four other patients of group B, serum and urinary LH concentrations showed that pituitary gonadotrophin secretion had recovered before the ovulatory stimulus, without signs of premature luteinization. Two women in each group became pregnant, one of whom aborted. This short-term GnRH agonist treatment could be an alternative method for ovarian stimulation, although it did not totally prevent the occurrence of an endogenous LH surge.

Topics: Adult; Buserelin; Drug Therapy, Combination; Endocrine Glands; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Progesterone; Reference Values; Stimulation, Chemical; Time Factors

Failure to respond to human menopausal gonadotropin (hMG) with adequate ovarian stimulation is associated with a poor prognosis in subsequent cycles in women participating in an in vitro fertilization/embryo transfer program. Sera from 26 menstruating women (mean age 38 +/- 4.3 years) identified as "low responders" with either tubal or male factor infertility, mean baseline FSH values of 11 mIU/mL, and peak serum estradiol levels lower than 300 pg/mL were assessed for specific antibodies to human ovary and gonadotropins. Twenty-five infertile women with tubal or male factor infertility with a good response to hMG served as controls. Ninety-two percent of low responders had antibodies to FSH and 65% had antibodies to LH when assessed by enzyme-linked immunosorbent assay. Similarly, 77% of low responders had ovarian antibodies. No hepatic antibodies were found in the sera of low responders, indicating that the positivity was not a general interaction with cell components. None of the "good responders" had antibodies to gonadotropins or to ovarian or liver tissue. The significant differences in antibodies between the groups supports a possible immunologic cause for low ovarian stimulation response to gonadotropin.

Topics: Adult; Autoantibodies; Enzyme-Linked Immunosorbent Assay; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Immunohistochemistry; Infertility, Female; Luteinizing Hormone; Menotropins; Middle Aged; Ovary

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

Different protocols using agonists of GnRH-a have been proposed for the ovarian stimulation in IVF cycles. In case of stimulation failure with the flare-up protocol, we have investigated whether an immediate switch to pituitary blockade by the long-acting analog may avoid the cycle to be canceled. This procedure allows a rescue of cycles among poor responders and does not have any deleterious effect on the recruitment of follicles, oocyte quality, fertilization, and pregnancy rates.

Topics: Adult; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Pregnancy; Stimulation, Chemical

In an attempt to identify factors that may be responsible for reproductive failure, we compared endometrial biopsies taken from infertile patients during the luteal phase of spontaneous cycles (n = 18) with those taken after ovarian stimulation (n = 18). Morphometric analyses were performed and compared with peripheral estradiol (E2) and progesterone levels at the time of supposed implantation. In stimulated cycles the number of glands per square millimeter was positively correlated to the E2 level. The morphometric data point to a measurable difference between the study groups, indicating an insufficient secretory transformation of the tissue in infertile women when compared with a group of fertile women. The observations suggest that hormonal stimulation occasionally results in impaired development of the endometrial glands.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation; Progesterone

Forty-five women suffering from unexplained infertility collected saliva for progesterone (P) measurements every morning during 1 to 3 complete cycles. A total of 27 cycles analyzed were unstimulated, 19 were stimulated by clomiphene citrate (CC), and 7 with CC, human menopausal gonadotropin (hMG), and human chorionic gonadotropin (hCG). Compared with reference profiles of salivary P from 27 normal cycles, the length and magnitude of P secretion were significantly lower in the infertility group. Luteal P concentrations were normalized during CC stimulation and significantly elevated during the CC-hMG-hCG stimulation. The other abnormalities found in the salivary P profiles of these patients included preovulatory P peaks, interruption of P secretion during luteal phase, and high P level at the beginning of menstruation. The results suggest that patients with prolonged unexplained infertility represent a heterogenous population with common luteal phase defects. The disturbance is effectively corrected with treatments stimulating gonadotropin secretion.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Menstrual Cycle; Pregnancy; Progesterone; Saliva

Thirty-one women with hypothalamic primary or protracted secondary amenorrhoea were treated with human menopausal gonadotrophin (HMG) in 89 cycles, but adequate follicular growth failed to occur. They were then treated with a gonadotrophin releasing hormone analogue (GnRHa) and HMG in 91 cycles. An adequate ovarian response occurred in 68 cycles (74.7%) and pregnancy occurred in 26 cycles (28.6%). GnRHa and HMG produced an adequate ovarian response in hypothalamic amenorrhoeic patients who failed to respond to HMG alone. The strong initial agonistic effect of GnRHa produced sudden high levels of FSH that might possibly have initiated folliculogenesis which was continued by HMG.

Topics: Adult; Amenorrhea; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypothalamus; Infertility, Female; Menotropins; Pregnancy

A 30-year-old woman with primary amenorrhea, hypothalamic hypogonadism, decreased sense of smell, and primary infertility failed to respond to pulsatile exogenous gonadotropin-releasing hormone. In addition, failure to respond to stimulation with human menopausal gonadotropins was consistent with concomitant ovarian failure. Perturbation of normal cellular migration during embryogenesis in the regions of the olfactory placode, yolk sac, hindgut, and gonadal ridge may explain both the hypothalamic defect and ovarian failure experienced by this woman. She demonstrates that gonadal failure need not be accompanied by elevated gonadotropin levels; nor do low gonadotropin levels necessarily indicate potentially responsive ovaries. These findings are consistent with the coexistence of isolated gonadotropin deficiency and ovarian failure in the same individual.

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction

Conception rates decline in the latter part of the reproductive years. To examine which ovarian parameters are altered with aging, 486 cycles from 225 ovulatory infertile women undergoing human menopausal gonadotropin (hMG) superovulation and washed intrauterine insemination were analyzed. Infertility factors included endometriosis (68%), unexplained infertility (8.4%), male factor (12.9%), and ovulatory dysfunction (10.7%). Parameters that demonstrated a linear relationship with increasing age included numbers of ampules of hMG required per cycle (r = 0.79; P less than 0.05), days of stimulation (r = 0.73; P less than 0.01), estradiol level at the time of hCG (r = -0.92; P less than 0.0001), number of follicles larger than 15 mm (r = -0.61; P less than 0.05), and rate of rise of estradiol (r = -0.92; P less than 0.0001). These same age-dependent changes were observed in women receiving a standard stimulation protocol (3 ampules hMG beginning on cycle day 2). When standard cycles were limited to the first cycle only, the preovulatory estradiol (r = -0.92; P less than 0.005), slope of estradiol rise (r = -0.92; P less than 0.005), and number of preovulatory follicles (r = -0.92; P less than 0.005) still showed a significant decrease with age. Although the mean estradiol level per preovulatory follicle showed a slight decrease with maternal age, no statistically significant trend was noted. In addition, the cycle day of hCG administration was unaffected by age. With advancing age, there appears to be a decreased ovarian response to an increased amount of stimulation, as measured by steroidogenesis and follicular recruitment; yet the estradiol/follicle remains unaltered, indicating continued health of the follicle. These observations may explain in part the observed decrease in fecundity in older women.

Topics: Adult; Aging; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Superovulation

Forty-three patients who responded poorly to previous stimulation with clomiphene citrate (CC)/human menopausal gonadotrophin (HMG) for IVF were followed during 70 further cycles. Eighteen patients had a normal FSH response to CC in the previous cycle, while 25 had an abnormal FSH response. Three stimulation protocols were used: buserelin/HMG, CC/HMG and HMG only. No difference between the two groups was observed in the dose of HMG used for any stimulation protocol. More cycles were cancelled due to a poor response in the abnormal response group compared to the normal response group. In the completed cycles, the maximum oestradiol level and number of oocytes retrieved were lower in the abnormal response group compared to the normal response group. The total pregnancy rate per patient, including spontaneous conceptions during the study period, was lower in the abnormal response group compared to the normal response group, 4 versus 33%. We conclude that poor responders with an abnormal FSH response to CC have a latent ovarian failure with a low chance of success in further IVF attempts.

Topics: Adult; Buserelin; Clomiphene; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Pregnancy

Ovarian responses to human menopausal gonadotropin (hMG) are conventionally monitored by urinary estrogen or serum estradiol (E2) concentration. E2 can also be measured in saliva but this is rarely used. With ultrasound (USS) however, follicular development is assessed directly and we have previously shown that USS is superior to urinary estrogens for monitoring. We have now compared salivary and serum E2 with USS during hMG therapy in 48 women over 101 cycles. Salivary and serum E2 correlated significantly with each other and with the number of mature follicles. The manufacturers of hMG state that hCG should be given only when E2 is between 100 and 3000 pmol/l. However, there were no mature follicles in 40% of the cycles where E2 lay within this range. USS is the most accurate method of monitoring responses to hMG and, where this is available, estrogen assay provides no additional useful information.

Topics: Estradiol; Female; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ovarian Follicle; Ovulation Induction; Regression Analysis; Saliva; Ultrasonography

The CA-125-antigen could not only be identified in the epithelium of serous ovarian carcinoma, but also in the regular surface epithelium of the endometrium, the decidua and the peritoneum. The aim of this study was, to examine the pattern of CA-125 in the serum of women at early stages of pregnancy, after hMG/hCG-stimulation and subsequent insemination, IVF or GIFT. In particular, it was differentiated between simple or twin pregnancies, ovarian hyperstimulation syndrome and mole pregnancies. 16 patients, who spontaneously became pregnant after cyclus-monitoring, served as a control group. Among the total of 77 patients, 16 women with single pregnancies without stimulation showed an increase of CA-125 values to maximum amounts of 42.9 +/- 18.8 U/ml in the 8th week. 21 patients with single pregnancies after hMG/hCG-treatment and IVF, exhibited maximums of 97.5 +/- 66.8 U/ml in the 6th week, in cases of twins (n = 10) of 216.8 +/- 85.1 U/ml in the 7th week. Considering the group with the hMG/hCG-stimulation and following insemination (n = 20), maximum values of 91.4 +/- 57.3 U/ml were found in the 6th week, just as in the IVF-group. In cases of ovarian hyperstimulation syndrome (n = 5) as well as in such of a mole pregnancy (n = 5), drastically elevated values of 9519 and 1496 U/ml respectively, have been demonstrated. The decidua is regarded as a presumable source of high antigen levels in normal pregnancy, while the peritoneum is assumed to be such as for the ovarian hyperstimulation syndrome. Concerning mole pregnancy, the antigen levels could possibly emerge from the amniotic fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Biomarkers, Tumor; Chorionic Gonadotropin; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Hydatidiform Mole; Infertility, Female; Menotropins; Pregnancy; Pregnancy Trimester, First; Pregnancy, Multiple; Prospective Studies; Radioimmunoassay; Reference Values; Uterine Neoplasms

The case history of a 35-year-old woman with a pregnancy following IVF treatment is presented. Transvaginal sonography revealed an abnormal pattern of the embryonic heart rate between 28 and 50 days following follicular aspiration. At term, a male infant with the characteristics of Down's syndrome was born. The diagnosis was confirmed by chromosome analysis. The implications of this observation are discussed.

Topics: Adult; Chorionic Gonadotropin; Down Syndrome; Embryo Transfer; Female; Fertilization in Vitro; Fetal Diseases; Follicle Stimulating Hormone; Gestational Age; Heart Rate, Fetal; Humans; Infertility, Female; Karyotyping; Male; Menotropins; Pregnancy; Ultrasonography

Twenty-eight hyperandrogenemic women suffering from infertility owing to chronic anovulation were treated with hMG. Only 7 patients exhibited the typical polycystic ovarian appearance of multiple subcortical cysts, however, a wide range (6-15 cm3) of ovarian volume was observed. The LH/FSH ratio was consistently lower than 2.5 and circulating androgens of both ovarian and adrenal origin were elevated. The 4 days dexamethasone suppression test showed more than 80% suppression of dehydroepiandrosterone-sulphate and a variable (40-60%) reduction of testosterone and androstenedione levels. Two different patterns of follicular development were observed in response to hMG. Sixteen patients exhibited polycystic ovarian reaction, whereas 12 women had a follicular growth pattern similar to that seen in hMG-stimulated normo-ovulatory subjects. Patients with polycystic ovarian reaction showed a significantly increased androstenedione response to hMG when compared with the other group. Moreover, the non-stimulated ovarian volume was found to be markedly greater than in subjects without polycystic reaction. Thus, ovarian stimulation of patients with mixed hyperandrogenemia may elucidate the presence of borderline polycystic ovaries; furthermore the increased accumulation of androstenedione may suggest an inherent ovarian failure.

Topics: Adult; Androgens; Androstenedione; Anovulation; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Polycystic Ovary Syndrome; Testosterone

In 1673 treatment cycles stimulated with buserelin and HMG, for IVF, GIFT or ZIFT, the severe ovarian hyperstimulation syndrome (OHSS) occurred in 10 cycles (0.6%). Eight patients were hyperandrogenic and showed an increased ovarian response to HMG. After replacement of a maximum of three embryos or zygotes, seven women became pregnant. Three women had a multiple gestation. All patients recovered uneventfully with conservative treatment. Support with progesterone or continuation of the agonist during the luteal phase did not prevent OHSS, confirming that the ovulatory HCG dose is the most important factor in inducing this severe complication. Luteal supplementation with HCG and/or HCG production during implantation could exacerbate OHSS.

Topics: Adult; Androgens; Buserelin; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Ovulation Induction; Retrospective Studies; Sex Hormone-Binding Globulin; Superovulation; Testosterone

To examine the usefulness of intrauterine insemination in women with various fertility factors, we retrospectively analyzed data from women treated during 1986 and 1987. Ninety-three patients underwent 1-11 cycles of single or double procedures, for a total of 423 inseminations in 263 treatment cycles. Twenty-six patients (28%) conceived, for a 10% total pregnancy rate per cycle, with 58% of the pregnancies resulting from double inseminations per cycle. An average of two treatment cycles was required to achieve pregnancy. Eight pregnancies (31%) occurred in spontaneous cycles, while 18 (69%) occurred in stimulated cycles. While clomiphene citrate therapy was useful in anovulatory patients, it was of no benefit in ovulatory patients being treated with intrauterine insemination. Human menopausal gonadotropin therapy was of benefit in both ovulatory and anovulatory patients when combined with intrauterine insemination. The live birth rate was higher (75%) in spontaneous cycles than in stimulated cycles (44%). Semen preparation was accomplished by sperm washing in 61% of the pregnancies and by Percoll preparation in 39%. The effectiveness of the discontinuous Percoll gradient for semen preparation for insemination was suggested by a pregnancy rate of 9% per cycle. While the mean sperm count in the pregnant group was 44 million, successful pregnancy was accomplished with a double insemination of 880,000 and 1.16 million rapidly progressive sperm in the first and second inseminate, respectively. The data confirm the important role of intrauterine insemination for the treatment of infertility.

Topics: Adult; Clomiphene; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Menstrual Cycle; Middle Aged; Ovulation Induction; Povidone; Pregnancy; Retrospective Studies; Silicon Dioxide; Spermatozoa; Therapeutic Irrigation; Uterus

The pulsatile subcutaneous administration of human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was used for induction of ovulation in 26 patients with hypothalamic/pituitary amenorrhea or polycystic ovary syndrome (PCO). Ovulation was observed in 116 (90.6%) of 128 treatment cycles, and 15 (16 treatment cycles) of 26 patients became pregnant. All 14 fetuses, excluding two pregnancies interrupted spontaneously at weeks 6 and 9, were singleton conceptions. Ovarian hyperstimulation was observed in 15.6% of treatment cycles. Five patients with PCO who failed to conceive on the hMG regimen also received pulsatile FSH administration. Although ovulation rates in PCO patients did not differ significantly between the hMG (88.1%) and FSH (88.2%) regimens, a significant reduction in the average dose of FSH (P less than 0.05) was observed with pulsatile FSH administration. Furthermore, the number of patients who conceived during the FSH regimen was significantly greater than that found with hMG treatment. The present data demonstrate that pulsatile subcutaneous administration of hMG or FSH is effective in induction of successful ovulation and establishment of singleton pregnancy in patients with various types of anovulatory infertility.

Topics: Adult; Amenorrhea; Drug Administration Schedule; Female; Hormones; Humans; Infertility, Female; Injections, Subcutaneous; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Radioimmunoassay

Anovulatory infertility in 134 women was treated with gonadotropins for a total of 318 cycles. The patients were classified into WHO group I, hypothalamic-pituitary failure (72 patients), and WHO group II, hypothalamic-pituitary dysfunction (62 patients). All patients in this group had failed to achieve pregnancy with clomiphene citrate therapy in repeated cycles. The pregnancy rate in group I was 72.2% vs 17.7% in group II. The 'take home' baby rate was 57.1% in group I vs 13.1% in group II. The rate of miscarriages was 14.3% without any significant difference between the groups. Multiple pregnancies occurred only in group I patients (19.2%). The conception rate was highest in the first four cycles, whereas no patient became pregnant after the sixth treatment cycle. Ovarian hyperstimulation syndrome occurred most frequently in group II patients, however, overall only 2.2% of the patients needed hospitalization because of hyperstimulation. Gonadotropin therapy must be considered an efficient and successful treatment of infertility in patients with hypothalamic-pituitary failure, whereas the success rate is rather poor in patients with hypothalamic-pituitary dysfunction.

Topics: Chorionic Gonadotropin; Drug Combinations; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Luteinizing Hormone; Menotropins; Ovary; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

In the private clinical setting the use of Pergonal or Metrodin is a safe and efficient method of inducing ovulation; however, the known risks of those agents must be kept in mind at all times. By adhering to the guidelines listed here and administering Pergonal and then human chorionic gonadotropin in the prescribed manner, an ovulation rate of greater than 90% should be achieved. A six-month course of therapy with Pergonal should yield a pregnancy rate of 60-70%, provided that the fallopian tubes are normal, the sperm count is adequate and cervical mucus function is intact. Patients who do not become pregnant in six to nine months should be referred to tertiary centers for other procedures, such as in vitro fertilization and/or gamete intrafallopian transfer.

Topics: Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Private Practice

To investigate a new treatment for so-called functional sterility, 17 out of 456 infertile patients were treated in the past three years (age: 32.7 +/- 3.6 years old, infertile period: 5.9 +/- 1.4 years, M +/- S.D.). These patients were treated with HMG-HCG. The injection of HMG (75-450iu) was started on the 5th day of the menstrual cycle, and the follicular development was observed by ultrasonography. Then, HCG (10,000-20,000iu) was injected when 3 or 4 matured follicles (with a diameter greater than 20mm) were observed. In some cases, the endometrial biopsy was done in the mid-luteal phase and the effect of the treatment was examined morphologically. Pregnancies were observed in 6 cases (35.3%) and all of them were singletons. One of them spontaneously aborted at 9 weeks of gestation, but remaining five cases delivered at full term without any complications. The total dose of HMG was 2,116.8 +/- 843.3iu, and OHSS was observed in 5 cycles out of 31 cycles (16.1%). There was no other severe complication during the treatment. The growth of the endometrium thickened in the treated cases, but no time lag in endometrial dating could be found in the morphological study. These results indicated that the intended superovulation method for the treatment of so-called functional sterility was effective through the mechanism of the improvement of the implantation ratio.

Topics: Adult; Bromocriptine; Embryo Implantation; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Induction; Progesterone

To investigate whether the provision of increased gonadotropins would enhance follicular recruitment and selection, women not responding (N = 18) to our standard clomiphene citrate (CC)-human menopausal gonadotropin (hMG) regimen were treated with increased hMG (treatment cycle II). Estradiol levels were higher in treatment cycle II and these differences were significant on days 8 and 9 (P less than or equal to 0.05 and P less than or equal to 0.03, respectively). On day 9, better follicular development was seen in cycle II (P less than or equal to 0.05). While none of the patients responded in cycle I, 10 of 18 responded in cycle II. Of the 10 responders, 2 conceived following in vitro fertilization and embryo placement. Increasing the dose of hMG improved the development of a cohort of follicles so that aspiration and possible pregnancy were achieved in women who were previously unresponsive to therapy.

Topics: Clomiphene; Dose-Response Relationship, Drug; Estradiol; Female; Fertilization in Vitro; Follicular Phase; Humans; Infertility, Female; Menotropins; Oocytes; Ovarian Follicle; Pregnancy; Pregnancy Outcome; Suction

Most invasive techniques (i.e., in-vitro fertilization, gamete intrafallopian transfer) used for the therapy of unexplained or male-related infertility involve the induction of multiple follicular development (MFD). The efficacy of MFD in conjunction with a non-invasive technique (artificial insemination with husband's semen) was evaluated in a group of 41 couples with long-lasting infertility. MFD was obtained by means of clomiphene citrate and exogenous gonadotropins. Within 6 months of treatment, pregnancy was achieved by 52.2% of couples with male-related infertility and by 54.5% of couples with unexplained infertility. Sperm parameters, age of the female partner and preovulatory estradiol peak did not show any significant difference between couples who conceived and those who did not. It is concluded that induction of MFD represents an effective therapy and might replace invasive techniques for the treatment of the above conditions.

Topics: Adult; Clomiphene; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Sperm Count; Sperm Motility

144 patients were treated by 5 different stimulation protocols in the IVF-program of the University Women's Hospital Rostock (Clomiphene/hCG, Clomiphene/Anthrogon/hCG, Pergonal/hCG, Anthrogon/hCG, Folistiman/hCG). Estradiol-17 beta and progesterone were determined during the follicular phase of 172 cycles by RIA. The results were compared between the treatment groups by means of Student's t-test or Mann-Whitney's nonparametric test. Additionally, in 37 cycles prolactin was determined. The levels of estradiol-17 beta in all treated groups were higher as compared with spontaneous cycles. Between the groups statistically significant differences were found in start and velocity of E2-rise, in the average level of E2, and in the level of preovulatory peaks. The latent phase of stimulation was significantly longer in patients treated with pergonal than in Anthrogon treated patients. Moreover, in the Anthrogon group the rate of "high responder" was higher. On average, in patients with a very fast growth rate of estradiol-17 beta (greater than 1.9 nmol/l) during the late follicular phase the percentage of less mature oocytes was increased after follicular puncture. The levels of progesterone started to rise in all groups between day-2 and -1 (day 0: day of LH-peak). On day 0, patients with Pergonal and Anthrogon had the significantly highest level. Levels above the 1s-range occurred in 12 patients during the follicular phase. This elevation of progesterone took place in 3 patients without any rise of basal LH-levels. 80.4% of 37 patients investigated were found to have prolactin levels above 500 mE/l during the late follicular phase. This transient hyperprolactinemia correlated with the rise of estradiol levels and continued during the early and mid luteal phase. Hence preventive administration of bromocryptine appears to be advisable in cycles stimulated with gonadotropins.

Topics: Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Hyperprolactinemia; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Progesterone; Prolactin

Follicular fluids from eight patients with one ovary and from ten patients with two ovaries were investigated for bioactive inhibin, total renin, oestradiol (E2) and progesterone (P4) concentrations. Four follicular fluids were pooled per patient before assessment. All women had been stimulated similarly using a protocol including a GnRH agonist, HMG and HCG. Renin levels were significantly lower and P4 significantly higher in pools of follicular fluid from patients with one ovary, whereas inhibin and E2 concentrations were similar in both patient groups. A significant negative correlation was found in the pools of follicular fluid between inhibin and E2 in both groups. These results suggest a role for inhibin and renin in the paracrine and autocrine control of stimulated follicular development.

Topics: Adult; Body Fluids; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Inhibins; Menotropins; Ovarian Follicle; Ovary; Progesterone; Renin

A hypogonadotropic patient with primary pituitary insufficiency who has been previously treated for four cycles with hMG/hCG for ovulation induction is described. The hMG consumption was 76 to 96 ampules/cycle. Addition of GH (16 to 24 units/cycle) to hMG treatment was associated with a significant diminution in hMG consumption (35 to 36 ampules/cycle). The patient conceived on the second cycle of combined hMG/GH/hCG treatment. The possible role of GH as an adjunct to gonadotropin treatment is discussed, as well as the possible mechanisms of GH effects on the ovary.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Drug Synergism; Female; Fertilization; Growth Hormone; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovarian Follicle; Stimulation, Chemical

Sixty-five infertile women, 37 with anovulation, eight with ovulatory disturbances and 20 with unexplained infertility were treated by a combination of clomiphene citrate (CC) from cycle day 5 (or 3) and human menopausal gonadotrophin (HMG) begun 3 days later for induction or enhancement of ovulation. Monitoring was carried out by measuring preovulatory 17-beta-oestradiol (E2) and progesterone (P) concentrations in blood samples and by follicle measurements using ultrasound. Forty-seven pregnancies resulted with a multiple pregnancy rate of 7.7% for those completed. This incidence is very low and within the range found for CC induction and might result from the later commencement of stimulation compared with many other protocols. These results were achieved with a low incidence of ovarian hyperstimulation syndrome (2.6% per cycle). The HMG doses given were low in comparison with those found in other forms of induction. The deleterious effects of this combined mode of induction on cervical mucus and the occurrence of premature spontaneous ovulation were much less than in the sequential mode of treatment. These results suggest that combined induction treatment by CC and HMG as described offers a means of achieving low rates of multiple pregnancies a known complication in the induction of ovulation.

Topics: Adult; Clomiphene; Drug Therapy, Combination; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Progesterone

Twenty-four women with luteal phase defects who were ovulatory on clomiphene therapy with or without human chorionic gonadotropin (hCG) at midcycle for three to eight cycles yet failed to produce a live birth were treated with a short course of menotropin (hMG-S), one to two ampules for five days in the early follicular phase followed or not followed by hCG at midcycle for three to eight cycles. The luteal phase defect was diagnosed with repeat endometrial biopsies with a lag time of three or more days prior to clomiphene therapy. A complete infertility workup revealed only eight patients (33%) with a purely endocrine factor (luteal phase defect). The rest (16 patients, or 67%) had one or two additional infertility factors. Two abortions occurred in this group during clomiphene therapy, while five pregnancies (four live births and one spontaneous abortion) occurred during hMG-S therapy. The ovulation rates were similar for hMG-S (89%) and clomiphene (91%) therapy, but the frequency of a normal ovulatory cycle was significantly greater (P = .026) for hMG-S therapy (71%) than for clomiphene therapy (57%). The midluteal mean serum progesterone level was lower and the mean luteal length shorter in the cycles with less than 130 ng/mL/d of total integrated luteal progesterone. The postcoital test results showed better cervical mucus, with increased mucus volume and better fluidity and spinnbarkeit, in hMG-S cycles than in clomiphene cycles. It appears that hMG-S treatment can improve ovarian function and achieve successful pregnancy in patients with luteal phase defects who fail to produce a live birth during clomiphene treatment.

Topics: Adult; Body Weight; Cervix Mucus; Clomiphene; Female; Humans; Infertility, Female; Luteal Phase; Menotropins

One hundred and seventy nine (179) ovarian cycles from 52 patients treated with human menopausal gonadotrophins were retrospectively analysed. Eighty one (81) cycles were monitored by serial measurements of plasma oestradiol concentrations and 98 cycles were monitored by realtime ultrasound scanning of ovarian follicles. The results suggest that realtime ultrasonography, used alone, is a safe and effective method for monitoring gonadotrophin therapy.

Topics: Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Progesterone; Retrospective Studies; Ultrasonics

Insemination of women with sperm treated by the swim-up technique resulted in 81% male offspring. This was achieved even in women taking ovulation-inducing drugs, in whom the albumin gradient separation technique not only is not effective in male preselection but in which the female sex is favored. Confirmation of these initial data is needed as well as an investigation of the swim-up's efficacy of producing male offspring in women not taking ovulation-inducing drugs.

Topics: Clomiphene; Female; Genetic Engineering; Humans; Infertility, Female; Insemination, Artificial; Male; Menotropins; Ovulation Induction; Sex Preselection; Specimen Handling; Spermatozoa

Ovulation induction was performed by the pulsatile administration of subcutaneous human menopausal gonadotropin (hMG). Treatment was started with a daily dose of 75 IU hMG (in a 90% distribution), then it was increased to 150 IU depending on the oestradiol level of the plasma and on the result of folliculometry. Of 10 cycles treated ovulation was induced in 7 cases and two pregnancies occurred. In two cases, following a previous unsuccessful intramuscular hMG treatment, ovulation was induced. Hyperstimulation did not occur. The pulsatile s.c. administration of hMG seems to be an adequate ovulation-induction method in ovulatory disorders of hypothalamo-hypophyseal origin and is a good substitute for the missing, endogenous gonadotropin secretion of inadequate pace.

Topics: Adult; Female; Humans; Infertility, Female; Infusion Pumps; Menotropins; Ovulation Induction; Progesterone; Pulsatile Flow

Topics: Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Pregnancy; Pregnancy, Multiple

Three-hundred-and-twenty-five patients on an assisted conception programme underwent 378 cycles of oocyte retrieval (OPU) following ovarian stimulation using a GnRH analogue and human menopausal gonadotrophins (HMG), a regimen which allows programmed cycles and delayed oocyte retrieval. Eighteen cycles were excluded (failed OPU in three and failure of fertilization in 15). In 360 cycles, patients completed their treatment with either in-vitro fertilization/embryo transfer (IVF/ET) (116) or gamete intra-Fallopian transfer (GIFT) (244), of which 241 took place at the normal time and 119 were delayed for 24 h or more to avoid weekend operating. The overall pregnancy rate per OPU was 29.5%, with the IVF group being 24.1% and the GIFT group being 32.8%. In the group of patients in whom OPU was delayed, the pregnancy rate was significantly higher in each sub-group than in the corresponding non-delayed sub-group (overall, 37.0 versus 25.7%; IVF/ET, 38.5 versus 16.9%; GIFT, 36.3 versus 31.1%). There was a significantly higher number of oocytes collected, gametes/embryos transferred in the group whose OPU had been delayed. In patients receiving GnRH analogue and HMG for ovarian stimulation, delaying oocyte retrieval is not harmful, may result in an improved outcome and allows OPU to be performed on routine operating lists. This facility, together with the improved pregnancy rates associated with this protocol of ovarian stimulation should improve the cost-effectiveness of assisted conception programmes.

Topics: Adult; Chorionic Gonadotropin; Female; Fertilization in Vitro; Follicular Phase; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Insemination; Male; Menotropins; Oocytes; Ovulation; Pituitary Hormone-Releasing Hormones; Pregnancy; Specimen Handling

We undertook a prospective study to compare our gamete intra-Fallopian transfer (GIFT) procedure with or without the use of human follicular fluid (FF) as a constituent for the final spermatozoal suspension and as the tubal transfer medium for both eggs and spermatozoa. We routinely perform an intrauterine and intracervical insemination (IUI and ICI) following GIFT, and FF or culture medium was used accordingly as a constituent in this spermatozoal suspension also. When FF was used (26 cycles), clear FF taken from the first egg-bearing follicle was sterilized by micropore filtration, gassed with 5% CO2 in air and warmed to 37 degrees C. This FF was then used to dilute the spermatozoal suspension (50:50, v/v) for both tubal, uterine and cervical inseminations at least 30 min before transfer, and all transferable eggs were placed into this FF before transfer. Alternatively (30 control cycles), eggs and spermatozoa were prepared and transferred in Earle's medium supplemented with 10% pooled fetal cord serum. The FF and control patient groups were relatively homogeneous, with no statistically significant differences in ovarian response, oocyte retrieval or transfer or seminal profiles. The outcome of the GIFT procedures using FF or culture medium showed no significant advantage of the use of FF. The clinical pregnancy rate was similar in both groups: 50% (15/30) control; 46.2% (12/26) FF.

Topics: Adult; Chorionic Gonadotropin; Cytological Techniques; Female; Follicle Stimulating Hormone; Follicular Fluid; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Male; Menotropins; Pregnancy; Semen

During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic gonadotropin developed hyperstimulation necessitating hospitalization in 201 cycles. Moderate ovarian hyperstimulation occurred in 116 of the patients and severe ovarian hyperstimulation in 34. Sixteen patients underwent operative procedures. Twelve patients underwent puncture of the pleura or abdomen to drain symptomatic hydrothorax or ascites, with clinical improvement of the symptoms in all of them. Three patients had coagulation abnormalities, and 1 patient had thromboembolic phenomena. Hyperstimulation seems to be associated with an increased pregnancy rate, since seventy-five pregnancies (35%) occurred in the study group. Appropriate monitoring can reduce the rate of OHSS but it should be kept in mind that death due to OHSS may occur.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction

A combination of gonadotropin-releasing hormone agonist and human menopausal gonadotropins was used for ovulation induction in a patient with premature ovarian failure. A paradoxical suppression of any ovarian response was noted despite increasing doses of human menopausal gonadotropins.

Topics: Adult; Delayed-Action Preparations; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Primary Ovarian Insufficiency; Triptorelin Pamoate

The introduction of luteinizing hormone-releasing hormone (LH-RH) analogs into treatment schemes for the stimulation of ovulation has enabled the authors' in vitro fertilization (IVF) team to overcome two problems; they can now suppress spontaneous LH peaks and program their activity. Two hundred and five IVF cycles were investigated. The agent used was D-Trp-6-LH-RH, either in a sustained release formulation (112 cases, group 1) or in a standard form (93 cases, group 2). The quantity of human menopausal gonadotropin (hMG) necessary for adequate ovarian stimulation was much lower when the standard form of the analog was used. The number of oocytes recovered per puncture was greater in group 1 (7.6 compared with 5.1), but the difference was not significant when considering the number of embryos (2.4 compared with 2.1). The corrected pregnancy rate (with allowance for progressive introduction of freezing from the third embryo onwards) was identical in both groups. The authors conclude that systems in which LH-RH analogs are employed have a clear advantage over the classical treatment with clomiphene citrate/hMG, and that the immediate-action formulation of D-Trp-6-LH-RH is preferable.

Topics: Adult; Cell Count; Cell Division; Delayed-Action Preparations; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocytes; Pregnancy; Triptorelin Pamoate

The effect of a combined pure follicle-stimulating hormone/human menopausal gonadotropin (pFSH/hMG) ovarian stimulation regimen and modified, sharpened laparoscopic follicular aspiration needles on the number of oocytes retrieved and the oocyte/follicle ratio in 43 consecutive cycles of in vitro fertilization (IVF) were retrospectively compared with 99 consecutive preceeding cycles stimulated with hMG alone and captured with aspiration needles that had never been sharpened. A modified laparoscopic follicular aspiration needle is described. Purified FSH/hMG ovarian stimulation significantly improved the mean serum estradiol levels, number of preovulatory follicles, and, therefore, the total number of oocytes recovered per cycle. The mean ratios of oocytes recovered per preovulatory follicle documented on ultrasound, and per aspirated follicle, increased significantly using sharpened needles. Both modifications improved the success rate of our IVF program.

Topics: Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infant; Infertility, Female; Laparoscopes; Menotropins; Needles; Ovulation Induction

To avoid cancellation of in vitro fertilization (IVF) because of early luteinization, pituitary suppression by gonadotropin-releasing hormone (GnRH) was carried out in 111 cycles. D-Trp-6-luteinizing hormone-releasing hormone (LH-RH) microcapsules were administered intramuscularly at menstruation and menotropin (hMG) stimulation was started 19 days (mean) later. In 3 cycles (2.7%), only early luteinization occurred. The mean number of oocytes per cycle was 6.7, with a fertilization and cleavage rate of 50 and 95%, respectively. A mean of 3.4 embryos were transferred per cycle. The 111 cycles resulted in 34 clinical pregnancies, 41% per cycle with embryo transfer. The early abortion, multiple pregnancy, and ovarian hyperstimulation rates were 24, 18, and 11%, respectively. It is concluded that D-Trp-6-LH-RH/hMG cycles are associated with a very low occurrence of early luteinization, high number of oocytes and embryos, and a substantial incidence of ovarian hyperstimulation syndrome.

Topics: Adult; Cell Count; Cell Division; Chorionic Gonadotropin; Delayed-Action Preparations; Embryo Transfer; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Triptorelin Pamoate

In the present paper we examined, whether the combined GnRH-agonist/hMG therapy implies an increased risk of the ovarian hyperstimulation syndrome (OHS). In a retrospective analysis, 525 GnRH-a/hMG cycles were compared with 643 cycles of hMG stimulation, which were simultaneously performed at the Department of Gynecology and Obstetrics of the University of Hamburg. Two different GnRH-agonists were used: Buserelin (Hoechst) given intranasally (410 cycles) and Triptorelin (Ferring) intramuscularly (115 cycles). The clinical results of hMG "only"-therapy revealed an OHS incidence of 7% for grade II and 0.2% for grade III. In contrast, significantly higher incidences were observed after GnRH-a/hMG treatment. In Buserelin/hMG cycles in 23% OHS grade II and in 1.0% OHS grade III occurred, in Triptorelin/hMG cycles in 40% OHS II and in 5.2% OHS III, respectively. The increased incidence of OHS correlated with higher ovarian estrogen production as well as a higher number of follicles following the GnRH-a/hMG stimulation. Furthermore, in GnRH-a/hMG cycles a prolonged duration of follicular maturation occurred due to an increase of the active phase; in addition the amount of hMG-ampoules needed for ovarian stimulation was higher. After GnRH-a/hMG treatment, an endogenous LH-surge was not detected, whereas in 34% of hMG stimulated cycles irregular LH-fluctuations were observed. There was a higher pregnancy rate in GnRH-a/hMG cycles (15%/525 cycles), as compared to hMG stimulation (8%/643 cycles), but the abortion rate was similar (23%, GnRH-a/hMG, versus 13%, hMG). The demonstration of an increased ovarian response leading to better pregnancy rates but also higher risks of OHS is well known from earlier data of hMG stimulation in patients with hypogonadotropic amenorrhoea (WHO group I). This implies that GnRH-agonist pre-treatment shows similar endocrine conditions in normogonadotropic patients.

Topics: Buserelin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy; Risk Factors; Syndrome; Triptorelin Pamoate

Ovulation induction in patients with hypergonadotropic premature ovarian failure is rarely successful. The authors have attempted to reproduce the results of recent case reports that suggest that ovulation and pregnancy can be successfully achieved when estrogen therapy precedes or coincides with ovarian stimulation with human menopausal gonadotropins (hMG). Fourteen patients with idiopathic premature ovarian failure underwent gonadotropin suppression and attempted ovulation induction with at least one of three regimens, which were as follows: 1) Group A: estrogen-induced suppression followed by hMG stimulation (n = 4). 2) Group B: estrogen-induced suppression followed by hMG stimulation with concomitant estrogen therapy (n = 10). 3) Group C: gonadotropin-releasing hormone agonist-induced gonadotropin suppression followed by concomitant hMG stimulation (n = 6). Despite complete gonadotropin suppression and high-dose hMG therapy in all three groups, ovulation occurred in only a single patient in group C. Pregnancy did not ensue. These data fail to corroborate previous case reports.

Topics: Adult; Drug Therapy, Combination; Estradiol; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Infertility, Female; Medroxyprogesterone; Medroxyprogesterone Acetate; Menotropins; Ovulation Induction

Seventy-six women with unexplained infertility, undergoing in-vitro fertilization and embryo transfer (IVF-embryo transfer), were selected for three different ovulation induction protocols. In group I, induction of ovulation was performed with pure follicle-stimulating hormone/human menopausal gonadotrophin/human chorionic gonadotrophin (pFSH/HMG/HCG). Group II patients were given a combined therapy consisting of a gonadotrophin-releasing hormone (GnRH) analogue, decapeptyl (DTRP6) followed by pFSH/HMG/HCG. In group III, patients underwent two IVF-embryo transfer cycles, serving as their own controls. The initial cycle was induced with pFSH/HMG/HCG while the second was stimulated using decapeptyl/pFSH/HMG/HCG. Significantly higher rates of fertilization, cleavage and pregnancy (P less than 0.001, P less than 0.07, P less than 0.001, respectively) were achieved in group II patients to whom combined GnRH agonists and gonadotrophins were given. Furthermore, among group III patients, no pregnancies occurred during the initial IVF-embryo transfer cycles whereas a 23% pregnancy rate (P less than 0.001) was obtained after GnRH agonist therapy. Our results indicate that the combination of GnRH agonists and gonadotrophins is of value in cases of unexplained infertility. Further, larger studies must be performed before the true efficacy of this mode of therapy can be determined in women with unexplained infertility.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Triptorelin Pamoate

Topics: Adult; Combined Modality Therapy; Dehydroepiandrosterone; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Prednisolone

Topics: Buserelin; Combined Modality Therapy; Female; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Triptorelin Pamoate

Traditional therapies for abnormal cervical mucus, other than timed intrauterine insemination, are noteworthy for being ineffectual. Patients (n = 27) with documented abnormal Insler scores in repetitive cycles and failure to conceive with traditional treatments were screened with conjugated equine estrogens (CEE) for estrogen responsiveness of the cervix. Only 5 patients were found unresponsive. Seventeen patients with CEE-responsive cervices then were treated with human gonadotropins (hMG), initially 1 ampule days 5 to 11. If the mucus failed to improve, the hMG was increased to standard doses. Eight patients responded to 1 ampule hMG with improved mucus and conception. The remainder required 2 ampules hMG. In patient cycles with corrected cervical mucus, the viable fecundibility (fv) was 0.35. This is significantly higher than predicted for this population (fv = 0.09; P less than 0.01). In all, 14 of 17 patients conceived viable pregnancies during hMG treatment. It is concluded that graduated hMG is efficacious in treating patients with abnormal cervical mucus responsive to CEE. It is preferable to either in vitro fertilization or gamete intrafallopian transfer, based on both cost and efficacy for most patients.

Topics: Cervix Mucus; Estrogens, Conjugated (USP); Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

Topics: Female; Humans; Infant, Newborn; Infertility, Female; Male; Menotropins; Pregnancy; Pregnancy, Multiple; Sex Ratio

The treatment course of a 31-year-old infertility patient due to PCO disease is presented. Because the patient failed to conceive after various treatment cycles with CC, she was subjected to a combined GnRHa/hMG/hCG therapy. After plasma E2 levels had reached 2400 pg/ml, three leading follicles, with diameters of 20 to 24 mm, were detected. Induction of ovulation was achieved by 10,000 IU hCG. The patient conceived and developed ovarian hyperstimulation. At 8 weeks of gestation, seven cystic structures were detected within the uterine cavity, five containing single embryos, and two with twin embryos. All nine embryos were vital, as evidenced by their heart beats. Embryo reduction was achieved by transabdominal puncture on three occasions. The three surviving fetuses were carried to the 34th week of gestation. After delivery by cesarean section, three healthy babies developed normally. This communication illustrates the complications that can be associated with ovulation induction in PCO disease: ovarian hyperstimulation, polyovulation, multiple conceptions, and their clinical management.

Topics: Adult; Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Triptorelin Pamoate

Topics: Administration, Cutaneous; Adult; Clinical Protocols; Drug Administration Schedule; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Gland; Reproductive Techniques; Triptorelin Pamoate

Luteinizing hormone-releasing hormone (LH-RH) agonists are being increasingly used in ovulation stimulation protocols in IVF programs. The results of two methods of utilization of LH-RH agonists are compared. In the long protocol, gonadotropin stimulation was commenced only after a preliminary period of pituitary desensitization with LH-RH agonist. In the short protocol, exogenous gonadotropins were administered shortly after the start of LH-RH agonist therapy, benefiting from the gonadotropin flare up effect. One hundred eighty-six patients were equally divided between the two treatments. There was no difference in the ovarian response on the day of human chorionic gonadotropin (hCG) or the number of mature oocytes recovered. The cleavage rate of mature oocytes was higher in the short protocol (70% versus 56% P less than 0.01). The ongoing pregnancy rate per treatment cycle was similar in both groups (18% in the long protocol and 16% in the short protocol). Analysis of the luteal phases revealed a trend for higher progesterone values in the long protocol although this was only significant on the 2nd day following oocyte retrieval. As the clinical results were similar, other factors should be taken into account when deciding therapy. These include patient convenience, cost, and side effects. Other schedules of ovulation stimulation with LH-RH agonists are discussed.

Topics: Adult; Buserelin; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Triptorelin Pamoate

A preovulatory increase in serum progesterone (P) precedes the occurrence of an endogenous luteinizing hormone (LH) surge in a majority of women. This study evaluates whether a single daily measurement of serum P could reliably identify a spontaneous LH surge in women undergoing controlled ovarian hyperstimulation. Eighty-four infertile women received either clomiphene citrate and human menopausal gonadotropin (hMG), or hMG alone. Serum P levels were increased significantly the morning of the day of an endogenous LH surge (P less than 0.01). A 2-fold rise in the serum P levels was associated with a predictability of 64.4% of a LH surge; however, a 4-fold increase in serum P could accurately predict a spontaneous endogenous LH discharge in 93.3% (P less than 0.001) of cases.

Topics: Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Pregnancy; Progesterone; Prognosis; Superovulation

Long-standing infertility of unknown etiology is currently an indication for in vitro fertilization. Because of the prolonged waiting time, expense, and operative risk, we have treated a group of women with empiric human menopausal gonadotropins/human chorionic gonadotropin before in vitro fertilization. A study group of 97 couples with well-documented, long-standing idiopathic infertility received up to four cycles of empiric human menopausal gonadotropin therapy before in vitro fertilization. This group was compared with a control group of 48 couples who did not receive human menopausal gonadotropin before in vitro fertilization. The 12 (12.4%) conceptions and eight (8.2%) term births resulting from empiric human menopausal gonadotropin therapy in the study group was significantly higher than the number of spontaneous conceptions and births (1%) in the study group (p less than 0.003) and was also greater than the spontaneous conception and birth rate (4%) in the control group (p less than 0.07). The conception rate with empiric human menopausal gonadotropin (12.4%) compared favorably with that after in vitro fertilization (7.9%) and 8 of 12 (66.7%) of empiric human menopausal gonadotropin conceptions resulted in term births, compared with two of seven (28.6%) of the in vitro fertilization conceptions. Preovulatory serum estradiol levels were similar for all study patients undergoing empiric human menopausal gonadotropin therapy, control patients undergoing in vitro fertilization, and patients receiving empiric human menopausal gonadotropin during conception cycles. It therefore appears appropriate to offer a 4-month trial of empiric human menopausal gonadotropin to that specific group of couples with long-standing idiopathic infertility.

Topics: Adult; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

Despite this good correlation supporting only four follicles, seven gestational sacs developed. The cause is unknown, but oocyte division cannot be ruled out. This case demonstrates that there are no absolute criteria for preventing high multiple pregnancies. While sophisticated cycle tracking using ultrasound and E2 values may alert the clinician to the development of multiple follicles, thus permitting discontinuation of the treatment, this report emphasizes that multiple gestations exceeding the anticipated number of follicles remains a possibility.

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ovulation Induction; Pregnancy; Pregnancy, Multiple

A patient with PCO and primary infertility had undergone numerous failed attempts of ovulation induction. She then was treated with GnRHa leuprolide 500 micrograms subcutaneously daily for 4 weeks, later combined with hMG 225 IU IM daily for 8 days and hCG 5000 IU IM. Six oocytes were retrieved for IVF, four fertilized and two were replaced. Twin pregnancy was established and delivered at term. Hyperstimulation syndrome was managed conservatively.

Topics: Adult; Chorionic Gonadotropin; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormones; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

Four women with unexplained infertility and two anovulatory oligomenorrheic women who experienced repeated premature luteinization when treated with human menopausal gonadotropin (hMG) or gonadotropin-releasing hormone (GnRH) were given the gonadotropin-releasing hormone agonist (GnRHa), luprolide acetate, in order to effect medical hypophysectomy. This was followed by hMG for induction of ovulation. Four of the six patients had hMG-only cycles, which were compared with the luprolide acetate/hMG cycles. The luprolide acetate/hMG cycles resulted in normal folliculogenesis with presumptive ovulation. In luprolide/hMG cycles, significantly more hMG was needed for induction of ovulation than in hMG-only cycles. Premature luteinization was abolished with luprolide acetate treatment.

Topics: Adult; Anovulation; Drug Administration Schedule; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Luteal Phase; Luteinizing Hormone; Menotropins; Oligomenorrhea; Ovulation Induction; Prospective Studies

Sixty-two women with unexplained infertility were studied. Fifteen (group 1) had timed intrauterine insemination (IUI), 25 (group 2) were treated by Pergonal (Serono Laboratories, Ltd., Welwyn Garden City, England) superovulation, and 22 (group 3) underwent Pergonal superovulation combined with IUI. Where Pergonal treatment was followed by insemination, a significantly greater pregnancy rate per cycle (P less than 0.05) was achieved, whether this group of patients was compared with those treated by IUI alone or with those treated with Pergonal alone. Moreover, the pregnancy rate in group 3 was comparable to that reported following gamete intrafallopian transfer (GIFT). The authors therefore suggest this form of treatment for patients with unexplained infertility prior to their referral to the more invasive procedure of GIFT.

Topics: Adult; Combined Modality Therapy; Female; Humans; Infertility, Female; Insemination, Artificial; Insemination, Artificial, Homologous; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Outcome; Superovulation; Uterus

Ovulatory dysfunction is a leading cause of female infertility in the United States. Fortunately, ovulatory dysfunction is often amenable to treatment. Thorough testing is necessary to identify the exact cause of anovulation before conventional ovulation-inducing therapy is started. Careful patient monitoring is essential to avoid risks such as the ovarian hyperstimulation syndrome. Several newer ovulation-inducing agents are available for use in special situations.

Topics: Anovulation; Bromocriptine; Clomiphene; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Menotropins; Ovulation Induction; Pituitary Hormone-Releasing Hormones

The diagnostic response toward the administration of a luteinizing hormone-releasing hormone (LH-RH) analogue in the early follicular phase has been used sequentially with conventional human menopausal gonadotropin (hMG) treatment in patients who had previously failed to develop multiple follicles in response to a combination of hMG and clomiphene citrate. Nine of fourteen patients (64%) showed an increase in the number of preovulatory follicles and five subjects reached oocyte recovery for the first time. Two patients (22%) became pregnant after in vitro fertilization and embryo transfer during the treatment cycle and had healthy babies. It is suggested that this treatment regimen may be advantageous in some patients with resistant ovaries.

Topics: Adult; Buserelin; Drug Combinations; Female; Fertilization; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Male; Menotropins; Ovary; Pituitary Gland; Pregnancy

Ovarian hyperstimulation syndrome (OHS) is one of the potential complications associated with the use of human menopausal gonadotropin therapy. We recently dealt with a case of severe OHS presenting features of liver dysfunction; such a case has not been reported on before.

Topics: Adult; Chemical and Drug Induced Liver Injury; Cytoplasm; Female; Humans; Infertility, Female; Liver Diseases; Menotropins; Mitochondria, Liver; Ovary; Ovulation Induction

Hormonal profiles were compared in 14 ovulatory women who were treated with two different doses of gonadotropins in successive in vitro fertilization cycles. All patients suffered from mechanical causes of infertility. Serum estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (P) were measured daily during the follicular phase. Women were arbitrarily classified as high responders (E2 greater than 1000 pg/ml on the day of human chorionic gonadotropin administration, n = 8) or as low responders (E2 less than 1000 pg/ml, n = 6), according to the peak E2 levels during the cycle when they received 3 ampules of human menopausal gonadotropin (hMG). When patients were treated with 3 ampules of hMG, serum FSH, LH, and P concentrations increased significantly during the follicular phase in high responders but remained unchanged in low responders. When these patients were treated with 2 ampules of hMG, the temporal profiles of the hormones were similar, but the magnitude of increases in serum levels of gonadotropins and sex steroids was significantly reduced in high responders. The authors conclude that temporal individuality of endocrine profiles cannot be altered by varying the dose of gonadotropin. Increases in hormone levels accompanying a high response to hMG can, however, be dampened by lowering the dose. In contrast, hormone concentrations are not influenced by changing the dose of hMG in low responders.

Topics: Adult; Dose-Response Relationship, Drug; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovary; Progesterone; Retrospective Studies

One hundred ten women with anovulatory infertility (World Health Organization [WHO] group I n = 50, WHO group II n = 60) were given 341 treatment courses with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Additional hCG was given as single or repeated injections during the luteal phase in 205 ovulatory cycles. In WHO group I, the incidence of luteal phase defects was lower and the pregnancy rate higher in cycles with extra hCG administration during the luteal phase than in cycles with no extra hCG. In WHO group II, there was no such difference after supplemental hCG. The abortion rate was the same after cycles with or without extra hCG administration. It is suggested that during ovulation induction with hMG/hCG in anovulatory women with no evidence of endogenous estrogen activity, the luteal phase should be supplemented with additional hCG.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Corpus Luteum; Female; Humans; Infertility, Female; Menotropins; Pregnancy

The ovarian function of infertile women with normal menstrual rhythm was investigated by daily plasma hormone (estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone) analyses throughout the menstrual cycle, and patients were diagnosed as showing a subnormal profile of progesterone in the early luteal phase or as showing no abnormality. Women with oligomenorrhea and elevated luteinizing hormone levels were diagnosed as having polycystic ovary syndrome primarily on the basis of endocrinology. All patients were treated with a gonadotropin-releasing hormone analog to suppress endogenous luteinizing hormone and follicle-stimulating hormone so that ovulation induction with exogenous gonadotropins could be undertaken as in patients with hypogonadotropic hypogonadism. Interference in the process of ovulation by endogenous luteinizing hormone fluctuations was eliminated and pregnancies were achieved. The pregnancy rate in the group with polycystic ovary syndrome was 77% per treatment course (six cycles) while that in the group with subnormal progesterone profiles was 61.5%. Patients showing no abnormality achieved no pregnancy, demonstrating the redundancy of interference with normal ovarian function.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Menstrual Cycle; Oligomenorrhea; Ovulation Induction; Polycystic Ovary Syndrome; Progesterone

Several studies have indicated that ovulation induction with human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defect. To assess the efficiency of luteal support by hCG to an infertile population undergoing ovulation induction, with CC/hCG or hMG/hCG, we have randomly administered 2500 IU hCG intramuscularly on days 3, 6, and 9 after ovulation induction by 10,000 IU of hCG to 74 patients on 265 treatment cycles. As controls served 357 ovulation induction cycles in the same 74 patients. The treatment cycles were randomly alternated with control cycles so that each patient served as her own control. However, the mean +/- standard deviation (SD) midluteal P was 38.1 +/- 10.8 ng/ml in the study group versus 15.7 +/- 10.5 ng/ml in the control group (P less than 0.001). Luteal phase length was 15.4 +/- 1.5 days in the treatment group versus 12.1 +/- 1.7 in the control group (P less than 0.01). In the treatment group, 64.8% of the patients achieved pregnancy (27% pregnancies/treatment cycle) versus 47.3% in the control group (11.5% pregnancies/control cycle) (P less than 0.01). The pregnancy wastage rates (including abortions and "chemical" pregnancies) were 30.6% in the treatment group versus 56% in the control group (P less than 0.01). We conclude that repetitive hCG administration may be an efficient luteal support in infertile patients undergoing ovulation induction.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy

This study tests the hypothesis that serial measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) are useful in identifying a subset of patients with premature ovarian failure (POF) who may respond to high-dose human menopausal gonadotropin (hMG) therapy. Nineteen patients with POF were studied with weekly measurements of serum FSH, LH, and E2 for five consecutive weeks. Nine patients (group I) showed episodic increases in E2 (greater than 50 pg/ml), seven accompanied by decreases in FSH, and an FSH/LH ratio that was periodically less than 1.0. Ten patients (group II) displayed persistent, nonvarying low E2 and high FSH and LH levels. There was no significant difference in the E2 response to high-dose hMG (48 to 100 ampules hMG/trial) in the two groups, all patients failing to respond. In conclusion, serial assays for FSH, LH, and E2 in patients with POF fail to predict ovarian responsiveness to a trial of high-dose hMG.

Topics: Adult; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Diseases; Ovary

Ninety-one women with long-standing infertility in the presence of humoral antisperm antibodies (ASA) underwent 473 cycles of intrauterine insemination of washed sperm (IUI), resulting in 26 pregnancies. Nine pregnancies were achieved in 67 women who underwent 285 IUI during unstimulated cycles (13% pregnancy rate; 3% pregnancy/cycles of treatment). Twenty women underwent 86 IUI after clomiphene citrate (CC) stimulation, resulting in 6 pregnancies (30%; 7% per cycle), while 28 underwent 102 cycles of IUI after human menopausal gonadotropins (hMG) stimulation, resulting in 11 pregnancies (39%; 11% per cycle). Twenty-one of the 26 pregnancies (81%) were achieved in the first 2 IUI cycles. During unstimulated and CC IUI cycles, all pregnancies occurred in the first two cycles of treatment, while with hMG stimulation pregnancies also occurred in the third, fourth, and fifth IUI cycles. Nine of these 91 women subsequently conceived spontaneously, and three others conceived through in vitro fertilization. Only 6 of the 38 pregnancies resulted in spontaneous abortion (16%). Thus, pregnancies achieved in women with ASA have no increased risk of abortion.

Topics: Adult; Antibodies; Clomiphene; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin Isotypes; Immunoglobulin M; Infertility, Female; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovary; Pregnancy; Spermatozoa; Uterus

Forty-four cycles with a spontaneous luteinizing hormone (LH) surge among 377 in vitro fertilization (IVF) patients were studied for outcome with different timing of oocyte retrieval. Mean number of preovulatory oocytes per retrieval and per transfer was significantly less in these cycles than in controls. Mean number of preovulatory oocytes per retrieval and per transfer was significantly higher when the human chorionic gonadotropin (hCG)-retrieval interval was greater than 35 hours, compared with less than 24 hours. In cycles with an hCG-retrieval interval of less than 24 hours, percentage of preovulatory oocytes was higher when serum estradiol (E2) decreased by greater than 15% on the morning after hCG administration compared with a plateau or an increase in serum E2. Timing oocyte retrieval after spontaneous LH surge should consider the hCG-retrieval interval and changes in E2 levels after hCG administration; this may avoid cancellation for many patients.

Topics: Adult; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Oocytes; Ovulation; Pregnancy; Time Factors

Fifty-eight patients in an in vitro fertilization program who did not have embryo transfers had endometrial biopsies performed on the second day after ovulation. The patients had been stimulated with clomiphene citrate (CC) and human chorionic gonadotropin (hCG) (group I); with CC, human menopausal gonadotropin (hMG), and hCG (group II), or with hMG and hCG (group III). Only 17 patients (30%) showed a normal luteal phase histology. The remaining 41 patients (70%) showed variety of endometrial abnormalities. Patients stimulated with hMG and hCG (group III) had a normal luteal phase at a significantly higher rate (48% versus 16%). Women below the age of 35 had a significantly higher rate of normal luteal phase histology than women older than 35 years. The study establishes abnormal endometrial histology as a possible cause of the low pregnancy rate of in vitro fertilization. The degree of endometrial histologic abnormality varies considerably with the type of ovarian stimulation used.

Topics: Adult; Aging; Atrophy; Chorionic Gonadotropin; Clomiphene; Endometrium; Epithelium; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteal Phase; Menotropins

Three-hundred-and-two unfertilized oocytes left over from successful in-vitro fertilization (IVF) attempts in 143 women (27-42 years) on a follicular stimulating hormone-human menopausal gonadotrophin (FSH-HMG) stimulation regime were subjected to chromosome analysis. Ten oocytes were degenerated with no visible chromosomes and 41 metaphases had chromosomes that were clumped together which could not be interpreted either numerically or structurally. Of the remaining oocytes, 76.6% (192/251) had a normal haploid complement (n = 23), 13% (33/251) were hypohaploid (n = 19-22), 8% (20/251) were hyperhaploid (n = 24-26), 2% (5/251) were diploid (2n = 46) and 0.4% (1/251) had structural rearrangements. The 21% aneuploidy was from 24 different patients and hypohaploid sets had chromosomes missing mainly from the A, B, C, D and G groups while the hyperhaploid sets had extra chromosomes from A, B, D, G and E groups of the human karyotype. The mean age of patients showing aneuploid oocytes was 36.7 years which was above the mean for the entire group. The aneuploidy may have been brought about by errors in oogenesis (anaphase lagging or non-disjunction) and may offer one explanation for fertilization failure and overall low pregnancy rates after IVF.

Topics: Adult; Aneuploidy; Chromosome Aberrations; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Karyotyping; Male; Menotropins; Oocytes; Pregnancy; Sperm-Ovum Interactions

Typical possibilities of abnormal development in human oocytes cultured and fertilized in vitro were studied using phase-contrast microscopy. All oocytes were checked three times for maturity, fertilization and embryo development. A total of 180 non-cleaved oocytes and 30 embryos originating from polypronuclear oocytes are described. It is concluded that an exact inspection at the fertilization check is essential to avoid the transfer of abnormally developing oocytes and embryos.

Topics: Chorionic Gonadotropin; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Oocytes; Zona Pellucida

A common problem encountered by in vitro fertilization (IVF) programs is the premature occurrence of the spontaneous luteinizing hormone (LH) surge during ovarian stimulation cycles. Administration of gonadotropin-releasing hormone agonists (GnRH-a) for 2 to 3 weeks produces a state of hypogonadotropic hypogonadism, thus allowing ovarian stimulation to proceed uncomplicated by a spontaneous LH surge. We have elected to treat seven patients with GnRH-a in a "short-term" protocol, with GnRH-a initiated on cycle day 3 along with exogenous gonadotropins. In this series, we found that the spontaneous LH surge was abolished, while ovarian responsiveness seemed to be improved. These results suggest that the initial surge of gonadotropins elicited by GnRH-a administration may enhance ovarian stimulation and that spontaneous LH surge is blocked when GnRH-a and exogenous gonadotropins are initiated concomitantly.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Leuprolide; Luteinizing Hormone; Menotropins

Ovarian hyperstimulation syndrome occurred in a 32-year-old woman who presented with symptoms from a large unilateral pleural effusion which was the predominant feature in her case. The aetiology of the effusion was initially uncertain in view of the relative absence of ascites suggesting that the effusion arose because of a primary pleural abnormality.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Pleural Effusion

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction

Six patients with a history of infertility of more than 4 years were offered in vitro fertilization (IVF) followed by translaparoscopic embryo transfer to the fallopian tubes. Three of the patients became pregnant. In one patient the oocytes did not fertilize in vitro. Intrafallopian transfer of embryos may be an alternative to gamete intrafallopian transfer (GIFT) or IVF, especially in those cases where confirmation of fertilization is wanted.

Topics: Adult; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Oocytes; Pregnancy; Progesterone

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation; Ovulation Induction; Superovulation

Eight clomiphene citrate (150 mg/day for 5 days)-resistant anovulatory women with polycystic ovary were included in this study. A luteinizing hormone-releasing hormone (LH-RH) analog, D-Trp-6-LH-RH, 100 micrograms subcutaneous-per day, induced a hypogonadotropic state within varying periods but at most within 3 weeks, after an initial flare-up effect characterized by slight increase in ovarian size in four patients and in the other four by cysts that disappeared rapidly. On the 28th day or 15 to 20 days after menstruation for subsequent cycles, during maintenance of D-Trp-6-LH-RH therapy, a usual gonadotropin regimen was carried out in 33 cycles. Human menopausal gonadotropins obtained follicular maturation in all cycles. However, there was never the growth of a single dominant follicle but always of several follicles. Human chorionic gonadotropin then induced ovulation in 31 cycles (94%). Luteal phase was normal in 28 and inadequate in 3 of the 31 ovulatory cycles. Hyperstimulation, generally mild to moderate but rather severe in 2 cycles, was constant. Five pregnancies were obtained. The overall pregnancy rate was 15% per cycle and 17.8% per normoovulatory cycle. This study showed that an associated treatment with an LH-RH analog enables gonadotropins to achieve ovulation regularly with an encouraging number of pregnancies but at a risk of hyperstimulation.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Drug Resistance; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Triptorelin Pamoate

Topics: Adrenal Cortex Hormones; Adrenocortical Hyperfunction; Clomiphene; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Drug Evaluation; Drug Synergism; Female; Fertilization in Vitro; Gonadal Steroid Hormones; Humans; Infertility, Female; Menotropins; Ovulation Induction; Random Allocation

The value of multiple parameters in the prediction of fertile cycles was prospectively evaluated in 52 menotropin-induced cycles. The periovulatory pattern of estradiol (E2) was found to correlate with conceptional cycles. E2 levels greater than 500 pg/ml on the day of human chorionic gonadotropin administration (day 0) with a further increase on day +1 (high ascending pattern--A1) were found to have a 51% predictive value for fertile cycles. Twelve of the 17 fertile cycles had an A1, type of response (71%), whereas the overall incidence of an A1 pattern was 42% (22 of 52). No pregnancies have occurred with preovulatory follicles less than or equal to 14 mm in diameter. The number of preovulatory follicles, E2 level on day 0, and midluteal progesterone had no predictive value for fertile cycles.

Topics: Anovulation; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Prospective Studies

Eight human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced cycles in four anovulatory women unresponsive to clomiphene citrate plus hCG were studied. Blood samples were obtained for baseline determinations and daily thereafter, 24 hours after the injection of hMG. Serum estradiol (E2), progesterone, follicle-stimulating hormone, and luteinizing hormone (LH) were measured by radioimmunoassay. Bioassayable LH (LH-b) was determined by the immature mice interstitial cell in vitro bioassay for testosterone with LER-907 as the reference standard. Appropriate follicular growth, assessed by pelvic ultrasonography, occurred in all cycles. During induction days mean immunoassayable LH (LH-i) and LH-b levels were suppressed until the E2 concentrations rose to a mean of 1420.5 +/- 149 pg/ml (standard error of the mean), at which time a concurrent rise in LH-b and LH-i levels was observed (130% and 34%, respectively). LH-b/LH-i ratio increased by 63% on the day E2 peaked, indicating enhanced LH bioactivity before hCG administration. Our data suggest that during hMG/hCG-induced cycles, in a high E2 milieu, endogenous or exogenous LH may show a heterogeneity in its molecular content, resulting in enhanced bioactivity relative to immunoactivity.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Time Factors

To examine the effects of transient hyperprolactinemia on in vitro fertilization and embryo transfer, 61 cycles in 50 euprolactinemic ovulatory women with irreparable tubal diseases were stimulated with clomiphene (CC) alone or CC and human menopausal gonadotropin followed by human chorionic gonadotropin (hCG). Serum prolactin (PRL) increased after hCG administration with peak values of 45.4 +/- 4.2 ng/ml on the day of laparoscopic oocyte aspiration. The highest serum estradiol (E2) concentration was found on the day before PRL peak and serum progesterone (P) began to increase after hCG injection concomitant with the PRL rise. The group having 50 ng/ml or more of PRL (34 cycles) had significantly higher levels of E2 during preovulatory and early luteal phase compared to those of the group having less than 50 ng/ml of PRL (27 cycles) but there was no significant difference between the P levels in the two groups. In the higher PRL group 72 (62.1%) of 116 collected oocytes were fertilized and 6 (20.0%) conceived. In the lower PRL group 45 oocytes (58.4%) of 77 were fertilized and 3 (12.5%) became pregnant. These data suggest that elevated serum PRL concentrations may have no effect on fertilization of oocytes in vitro or embryonic development.

Topics: Adult; Clomiphene; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation; Ovulation Induction; Pregnancy; Progesterone; Prolactin; Superovulation

The capacity of the pituitary to secrete prolactin (PRL) and gonadotropins was investigated during the luteal phase of eight normally menstruating tubal infertility patients after ovarian stimulation with clomiphene citrate, human menopausal gonadotropin, and human chorionic gonadotropin. The baseline values of PRL were significantly higher (P less than 0.025), those of luteinizing hormone unchanged, and those of follicle-stimulating hormone lower (P less than 0.025) during the treatment than in the control cycles. The maximal response of PRL to the dopamine antagonist metoclopramide was increased (P less than 0.01), whereas the maximal responses of luteinizing hormone (P less than 0.025) and follicle-stimulating hormone (P less than 0.001) to gonadotropin-releasing hormone were lowered in the treatment cycles. The current results indicate that ovarian hyperstimulation with clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin may induce luteal phase pituitary dysfunction, which may affect the luteal phase functions of the corpus luteum.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Gland, Anterior; Prolactin

The purpose of this study is to investigate the ovulatory effect of the following three methods on 40 patients with normoprolactinemic amenorrhea patients who failed to respond to clomiphene citrate (Cl) alone. Method I is the combined therapy with bromocriptine and Cl (Brc/Cl). Method II is the combined therapy with Brc/Cl and an additional small amount of HMG (less than or equal to 300 IU). Method III is the combined therapy with Brc/Cl and an increased amount of HMG (less than or equal to 1,200 IU) and HCG. The ovulation rate of method I was 57.5% (23/40) in 40 cases, and 55.6% (99/178) in 178 cycles. The pregnancy rate for this method was 23.8% (5/21). Out of the 12 nonrespondent method I cases, 5 additional cases were ovulated by method II and 3 cases were ovulated by method III. The total pregnancy rate was 42.9% (9/21) with these three methods. Seven cases were normal pregnancies, one case was a twin pregnancy and 1 case was an abortion. No other side effects were found in this study. From these results, the combined therapy with Brc/Cl or Brc/Cl + HMG had almost the same ovulatory rate as the HMG-HCG therapy, and fewer side effects.

Topics: Adolescent; Adult; Anovulation; Bromocriptine; Clomiphene; Drug Administration Schedule; Drug Resistance; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Prolactin

Monitoring of human menopausal gonadotropin (hMG) treatment for induction of ovulation according to either preovulatory estrogen levels or the presence of a dominant ovarian follicle was found insufficient to prevent ovarian hyperstimulation syndrome (OHS). In 65 infertile patients treated with hMG and human chorionic gonadotropin (hCG), a possible correlation between the number and size of all ovarian follicles on the day of assumed ovulation and the occurrence of OHS was evaluated in order to assess the value of ultrasonography in predicting OHS. It was found that patients with OHS had significantly more follicles at the time of hCG than patients without OHS. Mild OHS was characterized by the presence of eight to nine follicles, 68.7% of which were of intermediate size (9 to 15 mm). In moderate to severe OHS 95% of the preovulatory follicles were less than 16 mm, most of them (54.7%) less than 9 mm in diameter. It can be concluded that a specific preovulatory follicular configuration characterizes mild and severe hyperstimulation. This is important information before hCG administration and emphasizes the value of ovarian ultrasonography in predicting OHS.

Topics: Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovarian Follicle; Ovary; Ovulation; Ovulation Induction; Pregnancy; Prospective Studies; Stimulation, Chemical; Syndrome; Ultrasonography

Although the technique of in vitro fertilization and embryo transfer (IVF-ET) was developed for couples with untreatable tubal factor infertility, IVF-ET is now being applied to women with other causes of infertility and normal pelvic anatomy. In an effort to determine the treatment-independent pregnancy rate, we retrospectively reviewed the first 245 couples enrolled in the IVF-ET program at Duke University Medical Center. There were 19 treatment-independent pregnancies in 18 women and 3 treatment-associated pregnancies in cycles in which the oocyte retrieval was canceled (in 2 women washed intrauterine insemination was substituted for oocyte retrieval). Six pregnancies were established after an unsuccessful attempt at IVF-ET with additional non-IVF-ET therapy, including washed intrauterine insemination in three couples, and donor insemination in two couples. These observations suggest that a significant number of treatment-independent pregnancies will occur in couples clinically deemed appropriate for IVF-ET, pregnancies can be established in cycles of controlled hyperstimulation without oocyte retrieval, and additional non-IVF-ET therapy can result in pregnancy despite failure of IVF-ET in selected couples.

Topics: Adult; Clomiphene; Drug Therapy, Combination; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Menotropins; Parity; Pregnancy; Retrospective Studies

The purpose of this communication is to evaluate the results of in vitro fertilization attempts in women with infertility due to a tubal factor, with one or two ovaries. Four hundred fifteen patients (788 cycles) with two ovaries and 86 patients (162 cycles) with one ovary were stimulated with gonadotropins starting on day 3 of the cycle for multiple follicular development. Although the mean number of preovulatory oocytes per laparoscopy and per transfer was significantly higher (2.33 versus 1.67 and 2.28 versus 1.99, respectively) in patients with two ovaries than in those with one ovary, the pregnancy rates per transfer were almost identical in the two groups (24.4% with two ovaries, 23.9% with one ovary). Results are presented according to different stimulation protocols and different age groups. It is concluded that although fewer fertilizable oocytes may be recruited from patients with one ovary, the potential for achieving a pregnancy is no different from that of patients with two ovaries.

Topics: Adult; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy; Progesterone; Prognosis

Topics: Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

The treatment of infertile women by gonadotropins is more effective in hypogonadotropic than in normogonadotropic ovarian insufficiency. In order to induce a hypogonadotropic state the luteinizing hormone-releasing hormone analog (LHRHA) buserelin was administered in eight cycles of four infertile patients suffering from luteal phase defect. Buserelin was infused subcutaneously in a dosage of 400 micrograms/d for 26-44 days using a portable external osmotic minipump system. Following suppression of estradiol-17 beta below 35 pg/ml within 11 +/- 5 days, gonadotropins were injected intramuscularly to stimulate ovarian function. In all cycles treated, ovulation and formation of a functional corpus luteum were observed without signs of premature luteinization. Whereas constant administration of LHRHA by a slow release system seems very useful for long-term reversible suppression of follicular maturation, further studies should evaluate the clinical usefulness of combined LHRHA/gonadotropin treatment in cases of infertility.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Infusion Pumps; Injections, Intramuscular; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Diseases

Increasing levels of E2 in gonadotropin-treated women stimulated hepatic synthesis of SHBG and TBG, and consequently increases in T4 concentration. Nevertheless, unchanged FTI and TSH suggested that a euthyroid state was maintained. The temporal patterns for the rise in serum concentrations of TBG and SHBG during gonadotropin therapy suggest that the synthesis of these proteins by the liver has different sensitivities to E2.

Topics: Chorionic Gonadotropin; Estradiol; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation Induction; Sex Hormone-Binding Globulin; Thyroid Function Tests; Thyroxine; Thyroxine-Binding Proteins

Topics: Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Female; Humans; Hypothyroidism; Infertility, Female; Medroxyprogesterone; Menotropins; Progesterone

Topics: Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Latex Fixation Tests; Menotropins; Monitoring, Physiologic; Ovulation Induction; Ovum

Topics: Adult; Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Polycystic Ovary Syndrome

In vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT) are used to treat intractable infertility in women with no distortion of the pelvic viscera, despite the lack of controlled trials demonstrating efficacy. The mechanism of any purportedly enhanced cycle fecundity in ovulatory women without significant distortion of the pelvic viscera is unclear, but both GIFT and IVF-ET increase the number of male and female gametes at the site of fertilization. Intrauterine insemination (IUI) during human menopausal gonadotropin (hMG)-stimulated superovulatory cycles has similar potential but does not require oocyte retrieval. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET and GIFT, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles between 1983 and 1986 in women with normal pelvic anatomy. IUI during hMG-stimulated cycles yielded a cycle fecundity (f) of 0.17 for endometriosis, 0.29 for cervical factor, and 0.19 for idiopathic infertility, which approaches the fecundity of normal women and equals or exceeds that reported for IVF-ET and GIFT. The authors conclude that treatment with IUI in hMG cycles, alleviating the need for invasive oocyte retrieval, should be considered for inclusion in a randomized, controlled trial in comparison with IVF-ET and GIFT.

Topics: Cervix Mucus; Embryo Transfer; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Oocytes; Ovulation; Pelvic Inflammatory Disease; Sperm Transport; Superovulation

Topics: Adult; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Progesterone; Ultrasonics

Two cases are reported of infertile women who developed cold-induced digital vasospasm (Raynaud's phenomenon) on low-dose Parlodel (5.0 to 7.5 mg/day). The cases are reported to alert clinicians to the potential relationship between Raynaud's phenomenon and low-dose Parlodel usage in women using the drug for hyperprolactinemic or infertility indications.

Topics: Adult; Bromocriptine; Female; Humans; Infertility, Female; Menotropins; Raynaud Disease

A preparation of HMG purified to contain only FSH (FSH 75 IU/LH less than 1 IU) was used in 26 patients who had anovulatory sterility because of sclero-polycystic ovaries. It was a selected population in that all the patients had proved to be resistant to Clomiphene Citrate and at risk with HMG therapy. Purified urinary FSH was used and monitored as classical HMG treatment. 44 treatment cycles resulted in 33 ovulatory cycles (75%) and 6 pregnancies (13.6% per cycle). The number of cases of hyperstimulation (13.6%) was low when it is compared to situations at risk when HCG was administered in 2/3 of the treatment cycles. The results obtained in a population with a bad prognosis can be considered to be very encouraging and gives purified urinary FSH a specific place in our therapeutic armamentarium.

Topics: Adult; Anovulation; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Polycystic Ovary Syndrome

In 30 sterility patients with normal course of the cycle, 17 OHP already rises significantly one day before the LH-peak. It influences not only progesterone and E2 but also hypothalamic opiate activity and LHRH and LH secretion. 17 OHP is on the one hand discussed as a further trigger for the LH peak and is on the other hand regarded as an initiator for incipient luteinization.

Topics: 17-alpha-Hydroxyprogesterone; Clomiphene; Estradiol; Female; Fertilization in Vitro; Humans; Hydroxyprogesterones; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Ovulation Detection

Endometrial thickness was measured ultrasonographically in three groups of patients undergoing in-vitro fertilization (IVF) on three different ovulation induction regimens. The endometrial thickness was comparable on all three regimens and similar to that observed in a group of spontaneously ovulating, normal, fertile controls. These patterns of endometrial thickness were observed despite significantly higher levels of serum oestradiol-17 beta in all of the hyperstimulated cycles, suggesting that in the normal cycle a maximum response in terms of endometrial development may be achieved. In the three conception cycles endometrial thickness continued to increase throughout the luteal phase, whilst in non-conception cycles plateauing of thickness increase occurred in the mid-luteal phase and reduction in late luteal phase. Whether ultrasonographic evaluation of endometrium during IVF stimulation cycles has any prognostic value regarding prediction of conception has yet to be determined.

Topics: Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embryo Transfer; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Prognosis

Some patients show high output of urinary LH when superovulated with clomiphene citrate and HMG. Recent evidence has shown that this is detrimental to successful IVF. By the use of an GnRH analogue we have managed to ameliorate this condition and successfully establish pregnancy in these women. Further, the association between failure of IVF-ER and elevated levels of LH may explain the aetiology of some 'idiopathically' infertile couples.

Topics: Adult; Buserelin; Clomiphene; Drug Therapy, Combination; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy

In an attempt to prevent the loss of 'overstimulated cycles' associated with human menopausal gonadotrophin (hMG)-induced ovulation, oestradiol levels and ovarian follicular state were monitored in 12 women with 'overstimulated cycles' after withholding hMG for several days. Human chorionic gonadotrophin (hCG) was administered when oestradiol levels were less than or equal to 1700 pg/ml and the leading follicles between 17 and 22 mm in diameter. During the withholding period follicular growth continued in all patients, while oestradiol levels declined in all but three. These three patients conceived. Ovulation was observed in six additional women. Ovarian hyperstimulation did not occur in any of the 12 patients. We conclude that a rescue of 'overstimulated cycles' is sometimes possible. Conception seems to depend on a continuing rise of E2 levels and early detection of 'overstimulation'.

Topics: Chorionic Gonadotropin; Drug Administration Schedule; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction

A developing extra-uterine intra-abdominal gestation is very rare. In the literature the incidence varies from 1 : 6389 to 1 : 10,200. Our case concerns an abdominal ectopic twin gestation, exclusively in relation with the peritoneal surface, which developed normally until 13 weeks and then died.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Abdominal; Pregnancy, Ectopic; Pregnancy, Multiple

Topics: Adult; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

Between 1980 and 1985, in Monash University in vitro fertilization (IVF) program, ectopic pregnancy occurred in 10 of 256 IVF pregnancies. The incidence of ectopic pregnancy between 1983 and 1984 was 4% of the total pregnancies, or 4.2% of pregnancies excluding biochemical pregnancies. The incidence of ectopic pregnancy was distributed equally across the infertility classifications (tubal, idiopathic, male factor, and mixed). There appeared to be no relationship between superovulatory methods, endocrine changes before egg recovery, laparoscopic procedures, embryo transfer procedures, and number of embryos transferred. Nine of the ten patients were classified as having either tubal factor infertility before IVF or chronic tubal inflammation, which probably existed at the time of embryo replacement. No ectopic pregnancies were recorded in the 33 pregnancies obtained with superovulation with the use of clomiphene citrate alone. We were unable to identify a major predisposing factor for ectopic pregnancy in IVF.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Progesterone

Ultrasound has been employed in diagnosing the luteinized unruptured follicle syndrome (LUF). Eighty-nine of 333 infertility patients were found to have LUF. The patients were divided into three groups. Group 1 was on no fertility medication. Twenty-five of 39 of this group released with HCG alone. Ten of the nonreleasers to HCG did release with HMG mixed with HCG. Group 2 patients had been treated with clomiphene and found to have LUF. Thirteen of 16 patients released with HCG and one of the failures released with HMG-HCG. Group 3 patients had been treated with HMG and had failed to release the ova despite HCG. Thirty-one of 33 did release with HMG-HCG. Twenty-six of 89 patients achieved a pregnancy within six months of therapy and 20 of 36 patients with all fertility factors corrected achieved a pregnancy.

Topics: Anovulation; Chorionic Gonadotropin; Corpus Luteum; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovarian Follicle; Pregnancy; Syndrome; Ultrasonography

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

Two hundred fifty-six children were born in 195 births from 176 women that conceived after human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced ovulation. The secondary sex ratio was 50% male to 50% female births, which is not statistically different from the Israeli or Occidental population. The same trend was observed for single births and for twins. Thus, the data presented do not support the reports of increased numbers of female infants in those conceived after induction of ovulation. Factors that are expected to have been shown to affect sex ratio: maternal age at delivery, total number of ampules of hMG/hCG administered in the conceptional cycle, urinary estrogen levels on the day of hCG injection, degree of ovarian hyperstimulation syndrome, and time of insemination in relation to the basal body temperature rise were found to be insignificant. Thus, the hypothesis that a local hormonal environment (gonadotropin or estrogen levels) during hMG/hCG treatment possibly affects sex selection was not confirmed.

Topics: Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Sex Factors

A pilot program of in vitro fertilization and embryo transfer at McMaster University is described. Fourteen couples with a clinical diagnosis of infertility due to apparent tubal dysfunction, with evidence of ovulation, and with normal semen analysis underwent induction of superovulation with human menopausal gonadotropin. At laparoscopy, 82 follicles were aspirated and 19 oocytes were recovered. Eleven oocytes demonstrated cleavage and all inseminated oocytes were transferred 49 to 65 1/2 hours after insemination. In vitro fertilization therapy resulted in two pregnancies, one leading to a spontaneous abortion and the other to the birth of a healthy female infant. At 10 to 12 months after in vitro fertilization therapy in the remaining 12 patients, there were three additional pregnancies (treatment-independent), one ectopic and two intrauterine. One patient was delivered of a healthy female infant. In vitro fertilization therapy should be evaluated by a randomized controlled clinical trial.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Male; Menotropins; Oocytes; Ovulation Induction; Pilot Projects; Pregnancy

Topics: Buserelin; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy

One hundred four normally cycling women were treated with fixed low-dose human menopausal gonadotropin (hMG) (2 ampules/day) in preparation for oocyte aspiration for in vitro fertilization. The response rate was related to age, weight, and the ratios weight/height2 and weight/height. The required dose of hMG was related to total body weight, but not to age or either of the weight/height ratios. In patients who required fewer than 5 days of hMG (rapid responders), a significantly higher number (P less than 0.02) of oocytes were harvested, compared with slow responders. However, a smaller percentage of the oocytes from rapid responders fertilized (P less than 0.003) and resulted in a reduced rate of embryo transfer. The difference in pregnancy rates was not statistically significant. The results of the study suggest that patients undergoing in vitro fertilization who weigh less than 55 kg may benefit from treatment with a lower dose of hMG to prolong the stimulation cycle.

Topics: Adult; Age Factors; Body Height; Body Weight; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Time Factors

We have presented the case of a woman with unilateral occlusion of a tube ovulated permanently on the same side. The other ovary and tube were intact. To overcome this problem, we gave full menotropic treatment to induce super-ovulation, and the patient became pregnant in the second treatment cycle. We think medical treatment should be attempted before paradoxical oophorectomy is contemplated in women with unilateral occlusion who cannot become pregnant.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Fallopian Tube Diseases; Female; Humans; Infertility, Female; Menotropins; Ovulation; Superovulation

Pulsatile administration of human menopausal gonadotropin (hMG) via the subcutaneous route was evaluated in 15 patients with various ovulatory disorders. Administration of hMG was started at a dose of 4.6875 IU (75 IU/day) or 9.375 IU (150 IU/day) per pulse every 90 minutes. Ovulation was observed in 26 (92.9%) of 28 treatment cycles, and two singleton pregnancies were confirmed. Ovarian hyperstimulation was observed in 1 to 26 ovulatory cycles; however, no other side effects were observed during treatment. A regimen of 75 IU/day resulted in a significant increase (P less than 0.0001) of the total dose and prolongation of the treatment period for induction of ovulation, as compared with that of 150 IU/day. Shortened luteal phases occurred in ovulatory cycles induced by pulsatile subcutaneous treatment. Human chorionic gonadotropin administration given every other day until the midluteal phase significantly prolonged the duration of the luteal phase (P less than 0.05). This treatment in patients with the polycystic ovary syndrome was followed by a normalization of luteinizing hormone/follicle-stimulating hormone ratio and resulted in a successful induction of ovulation in 8 to 10 cycles. The present data demonstrated that pulsatile subcutaneous administration of hMG was effective in inducing follicular maturation and ovulation in patients with various types of anovulatory infertility.

Topics: Adult; Amenorrhea; Anovulation; Drug Administration Schedule; Female; Gonadal Steroid Hormones; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamic Diseases; Infertility, Female; Injections, Subcutaneous; Luteal Phase; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

In vitro fertilization and embryo transfer (IVF-ET) was performed on women with tubal disease only (28 women, 40 cycles), endometriosis grade I (15 women, 24 cycles), grade II (25 women, 37 cycles), grade III (26 women, 36 cycles), or grade IV (31 women, 52 cycles). Rates of oocyte recovery and fertilization were not affected by the presence of endometriosis. Pregnancy rates per cycle were similar to that of the tubal group (18%) for women with grade I (13%) or grade II (14%) endometriosis, lower in women with grade III endometriosis (6%) and significantly reduced in women with grade IV (2%, P less than 0.05).

Topics: Clomiphene; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

The thickness of the endometrium was compared in 15 patients who conceived and 15 who did not with an in vitro fertilization and embryo transfer (IVF-ET) protocol after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG). There was no statistically significant difference (P = 1.0) in the endometrial thickness in the conception versus the nonconception group. Average estradiol (E2) values and number of mature follicles were also not statistically different in the two groups (P = 0.78, P = 0.81). There was a slightly significant difference in the number of embryos transferred in the conception versus nonconception groups (2.5 versus 1.9, P = 0.005). However, the most significant difference between the conception and nonconception groups was the total number of oocytes retrieved (4.4 versus 2.8, P = 0.005). These findings indicate that there are no sonographically detectable differences in the endometrial thickness in patients who achieve pregnancy versus those that do not when given a similar ovulation induction regimen of hMG/hCG for IVF-ET.

Topics: Chorionic Gonadotropin; Endometrium; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Prospective Studies; Ultrasonography

Real-time ultrasound scanning of follicular development was performed during 45 cycles of 15 patients receiving gonadotropin therapy for treatment of anovulatory infertility. The amount of gonadotropins administered was based exclusively on the results of the ultrasound examinations. Fourteen pregnancies were obtained, with 10 singletons, 2 sets of twins, and 1 set of triplets, resulting in a cumulative pregnancy rate of greater than 93%. Mild hyperstimulation occurred in two cases. Ultrasound alone can be used effectively to control gonadotropin therapy in the majority of cases.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ultrasonography

A 31-year-old woman is described with PCOD associated with endometrial hyperplasia and well-differentiated adenocarcinoma. Conservative treatment with ovulation induction was pursued for a total of 3 1/2 years. After CC treatment failed to achieve conception, treatment with menotropins resulted in a twin pregnancy that aborted spontaneously and a singleton term pregnancy. Hysterectomy was performed 4 1/2 years after the initial diagnosis of well-differentiated endometrial adenocarcinoma was made. Histologic examination of the endometrium showed no progression of the disease. Ovulation induction of patients with polycystic ovaries and well-differentiated and noninvasive endometrial adenocarcinoma may be justified in properly selected cases.

Topics: Adenocarcinoma; Adult; Endometrial Hyperplasia; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Uterine Neoplasms

This study was designed to compare the efficiency of daily intramuscular human menopausal gonadotropin (hMG) therapy to an intermittent subcutaneous regimen in women with ovulatory dysfunction. Ovarian follicular development was assessed with the use of serial ultrasound scans and serum 17 beta-estradiol (E2) levels. Ovulation was based on pregnancy and/or elevated luteal progesterone values. There were no significant differences between the two treatment regimens, based on E2 levels, follicular size, and/or number of follicles greater than 1.0 cm. Pregnancy and ovulation occurred more frequently after intramuscular hMG therapy. These results indicate that daily hMG is preferred over intermittent subcutaneous administration because of convenience.

Topics: Adult; Anovulation; Estradiol; Evaluation Studies as Topic; Female; Humans; Infertility, Female; Injections, Intramuscular; Injections, Subcutaneous; Menotropins; Ovarian Follicle; Pregnancy; Progesterone; Ultrasonography

Topics: Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progesterone

Topics: Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Delayed implantation in cycles with ovarian stimulation and ovulation induction was observed in eight patients. Endocrinological evidence for ovulation during pregnancy is presented in three cases; in one of them the implantation was evidently rescued by a new active corpus luteum. All pregnancies had the following factors in common: (1) A delay in the detection of the first positive serum human chorionic gonadotrophin (HCG) by 4-5 days. (2) The corpus luteum was not rescued initially and menstruation started at low serum concentrations of 17 beta-oestradiol and progesterone between 12 to 18 days (13.8 +/- 1.9 days) after induction of ovulation. (3) Because of the negative HCG, menstrual bloodloss and low steroid hormone concentrations, a new ovarian stimulation was started and continued for some days until pregnancy was detected. On the basis of the endocrine findings, three different forms of delayed implantation could be distinguished. Two of the eight pregnancies had a normal progression until full-term delivery, two developed into echographically-confirmed clinical pregnancies, but aborted at 9 and 11 weeks after the first menstrual period had started. The remaining four ended with a preclinical abortion between 7 and 8 weeks.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Embryo Implantation; Embryo Implantation, Delayed; Estradiol; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Progesterone

Topics: Austria; Chlorobenzenes; Chorionic Gonadotropin; Clomiphene; DDT; Dieldrin; Fallopian Tubes; Female; Germany, West; Heptachlor Epoxide; Hexachlorobenzene; Hexachlorocyclohexane; Humans; Infertility, Female; Insecticides; Menotropins; Ovarian Follicle; Polychlorinated Biphenyls

Therapy with human menopausal gonadotropin (HMG) conventionally has been monitored by estrogen measurements. Pelvic sonography may offer a more accurate method of monitoring HMG therapy. In this study 67 anovulatory patients were treated with HMG until at least one follicle had a diameter of 17 mm. The serum estradiol level was noted at the time a mature follicle was achieved. There was a correlation between the ultrasound data and the serum estradiol range in 57% of the cases. However, in 24% it was necessary to push the estradiol level above the allowable maximum of 2000 pg/mL. Twenty percent of the patients attained a 17-mm follicle before reaching the minimum required estradiol level of 500 pg/mL. Sonographic monitoring should improve the efficacy of HMG therapy.

Topics: Anovulation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Detection; Pregnancy; Pregnancy, Multiple; Progesterone; Ultrasonography

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

Topics: Chorionic Gonadotropin; Chromosome Banding; Chromosomes, Human; Clomiphene; Embryo Transfer; Embryo, Mammalian; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Karyotyping; Laparoscopy; Luteal Phase; Menotropins; Oocytes; Ovulation; Pregnancy; Prognosis

In a retrospective review of 211 female infertility patients receiving ovulation induction agents, the role of sonography in infertility management is defined. Sonography is used to determine imminence of ovulation for timing of insemination and in vitro fertilization. It is also used to diagnose ovarian hyperstimulation syndrome. To identify characteristics of the ovarian follicles of women able to conceive that might differentiate them from those unable to become pregnant, patients were assigned to "pregnant" (30.8%) or "nonpregnant" subgroups. In 259 sonographically monitored cycles reviewed, follicular size and configuration were not different for the two groups. The cumulus oophorus was seen in 28% of pregnant patients (8/28) and in only two nonpregnant patients. Low-level echoes were seen in the mature follicles of 11 patients but not in the large follicles of nonpregnant patients. Low-level intrafollicular echogenicity may be a prognostic indicator of fertility and may represent a periovulatory state, optimal, in the appropriate clinical setting, for artificial insemination or in vitro fertilization.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Retrospective Studies; Stimulation, Chemical; Ultrasonography

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

Eight oligomenorrhoeic patients with increased luteinizing hormone (LH) and androgen levels who had failed to conceive during prolonged anti-oestrogen therapy received a new treatment. Large doses of an LH-releasing hormone (LHRH) analogue (HOE 766) were used to suppress circulating gonadotrophin concentrations and block the positive feedback gonadotrophin surge. Ovulation was induced during continued LHRH analogue treatment with exogenous gonadotrophins without interference from the patient's own pituitary. Seven of eight patients conceived rapidly without premature luteinization and without excessive ovarian enlargement. These complications had occurred in control treatment cycles using exogenous gonadotrophins in the absence of the LHRH analogue.

Topics: Adult; Buserelin; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Oligomenorrhea; Ovary; Ovulation Induction

A prospective longitudinal and standardized study is presented, dealing with ultrasonographic and hormonal characteristics of the luteinized unruptured follicle (LUF) syndrome. Among 600 cycles monitored in 270 infertility patients, 40 cycles in 27 patients showed no evidence of follicle rupture, in spite of signs of luteinization, as reflected by basal body temperature recordings and progesterone determinations. In this study, 20 LUF cycles in 20 infertile patients were compared with 45 ovulatory cycles in 45 control women. During the follicular phase, no substantial difference in follicle growth was found, but after the luteinizing hormone peak, LUF follicles, instead of rupturing, showed a typical accelerated growth pattern. Both mean luteinizing hormone peak levels and midluteal progesterone levels were significantly lower in LUF cycles than in the control cycles. However, the duration of the luteal phase was not affected. Both central and local factors can be held responsible for the lack of follicle rupture. Ultrasound offers new possibilities as a noninvasive method in diagnosing the LUF syndrome.

Topics: Adult; Anovulation; Body Temperature; Chorionic Gonadotropin; Female; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Progesterone; Prospective Studies; Syndrome; Ultrasonography

Human urinary FSH (HU-FSH) was administered during 25 treatment cycles to 21 infertile women with polycystic ovary syndrome (PCO) who had failed to conceive in response to clomiphene citrate. HCG was also given in 23 of the cycles. Twenty-two (88%) ovulations occurred, and eight (38.1%) conceptions resulted, two (25%) of which terminated in abortion and six (75.0%) in normal deliveries. No multiple pregnancies occurred. Ten instances (40%) of mild-moderate hyperstimulation also resulted. A spontaneous LH surge was observed in 12 treatment cycles. Ultrasound scanning revealed multiple ovarian follicles developing at various rates. We conclude that HU-FSH is an effective form of treatment for women with PCO. However, the response to exogenous FSH is unpredictable and depends on the stage of development and the number of follicles present prior to stimulation.

Topics: Chorionic Gonadotropin; Female; Gonadal Steroid Hormones; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; Polycystic Ovary Syndrome; Prolactin; Ultrasonography

Thirty-nine cycles were studied in patients with a history of endometriosis who went through in vitro fertilization. In 15 cycles, there was no evidence of endometriosis; in 10 cycles, the patients had mild or moderate disease; in 14 cycles, severe or extensive endometriosis was found. The pregnancy rates per cycle were 33%, 60%, and 7%, respectively (groups I and II, no significant difference; groups II and III, P less than 0.01). The difference was due to the different number of oocytes aspirated at laparoscopy because of technical problems in the cases with severe and extensive disease. There was also a significant difference in the number of pregnancies per transferred cycles. There was no difference in the luteal phase in the three groups. The reproductive potential, which seemed to be similar in groups I and II, was severely impaired in the group with severe endometriosis.

Topics: Adult; Embryo Transfer; Endometriosis; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteal Phase; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Progesterone

Topics: Attitude to Health; Clomiphene; Counseling; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Prednisolone; Pregnancy; Psychophysiologic Disorders; Puerperal Disorders; Self Concept

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

A high performance liquid chromatographic (HPLC) method with both electrochemical detection (ECD) and ultraviolet spectrometric detection (UVD) was developed for the rapid and simultaneous measurement of estradiol (E2), estrone (E1), testosterone (T), 17 alpha-hydroxyprogesterone (17-OHP) and progesterone (P) in serum. These hormones were extracted with diethylether, and chromatographed on an octadecyl silane-silica (ODS) column with an eluent of a phosphate buffer solution - acetonitrile mixture (volume ratio 49:51). Estrogens were detected by ECD at +1.0 V vs. Ag/AgCl, and other hormones by UVD at 242 nm. With this method, the simultaneous determination of sex steroid hormones could be performed within approximately two hours with high precision. The hormones of 34 patients (39 menstrual cycles) undergoing human menopausal gonadotropin (HMG)-human chorionic gonadotropin (HCG) therapy were measured. It was concluded that the switch from HMG to HCG should be performed when the E2 level reaches 400 pg/ml for ovulation and 800 pg/ml for pregnancy. The occurrence of ovarian hyperstimulation syndrome (OHSS) can be predicted when the P level rises above 30 ng/ml on the 7th day after the switch. Moreover, conception may be indicated when the P level does not increase from the 7th to 14th day after the switch. In this way, this method proved to be useful for the monitoring of HMG-HCG therapy.

Topics: Chorionic Gonadotropin; Chromatography, High Pressure Liquid; Electrochemistry; Female; Gonadal Steroid Hormones; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ovary; Ovulation Induction; Pregnancy; Spectrophotometry, Ultraviolet

HMG treatment is usually monitored by the evaluation of the cervical mucus, the determination of plasma 17 beta-estradiol, total urinary estrogens, ultrasonographic evaluation or a combination of these. We evaluated the daily validity of estrone-3-glucuronide excretion in urine as an indicator of follicular growth and maturation in 28 infertile women who were treated with HMG (Pergonal 500). Total urinary estrogens and estrone-3-glucuronide were measured in 24 h urine collections, and 11 of the women collected the early-morning urine separately. This allowed comparison of the concentrations and excretion of total estrogens and estrone-3-glucuronide of the 24 h urine with that found in the urine collected overnight. This comparison was made on 83 urine samples. The correlation between either the total excretion per 24 h or the concentration per liter in the 24 h urine collection of the two systems of determination was good in all determinations. Also in the urine collected on the day prior to HCG administration, total estrogens measurement was in good correlation with the estrone-3-glucuronide. However, there was statistically a significant difference in the concentrations of total estrogens and estrone-3-glucuronide between the women who ovulated and those who did not. Estrone-3-glucuronide, when calculated as a percentage of the total estrogens, was 60.86% in the women who ovulated and 33.15% in those who did not. These results demonstrate that although estrone-3-glucuronide reflects ovarian function in women treated with HMG, it may serve as a better predictor to ovulation.

Topics: Chorionic Gonadotropin; Estrogens; Estrone; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

Ovarian stimulation with hMG/hCG is most effective in hypogonadotropic patients. In normogonadotropic/estrogen-positive patients in whom gonadotropin therapy is also indicated after failure of other forms of treatment, it is much more difficult and considerably less effective. The objective of this study was to change the endocrine status in patients from a normogonadotropic and estrogen-positive status, by administration of a GNRH analogue, to a hypogonadotropic, estrogen-negative status, in order to create better conditions for gonadotropin stimulation. For this purpose Buserilin was administered either intranasally or intravenously and the endocrine reaction was observed. The endocrine changes observed were very varied. In the majority of cycles a fall in plasma FSH concentrations resulted (20 out of 28), in 2 a rise, while in 6 of the 28 there was no change. In 12 out of 28 cycles the plasma LH concentration decreased; it rose in 3 and was unchanged in 13. The LH fluctuation was suppressed or irregular in all cases. Estrogen secretion was unaffected in 16 cycles; it increased continuously in 6 cycles and temporarily in a further 6. The reaction to the hMG injections did not show the hoped-for improvement with simultaneous administration of an RH analogue. A complete and constant suppression of pituitary function, and thus the creation of a hypogonadotropic state, could not be achieved by medication with 8 X 300 micrograms Buserilin or intravenous injection of 5 and 10 micrograms every 90 minutes.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovarian Diseases; Pituitary Gland; Progesterone; Testosterone

Thirty-two infertile patients with basal FSH/LH ratios of less than 0.5 were treated with a pure human urinary FSH preparation in various doses, in 57 cycles. With initially low FSH doses and increase in the dose according to the individual reaction (analogous to hMG therapy) ovulation and a normal luteal phase were achieved in 22 out of 25 cycles, and 6 pregnancies. In one cycle there was a clinical overstimulation syndrome in early pregnancy. Treatment with high doses of FSH at the beginning of the cycle proved unsuitable: normal follicle stimulation, ovulation and luteal phase only occurred in 12 out of 23 cycles, and there was no pregnancy. The combination of FSH therapy with initially high doses and subsequent stimulation with hMG resulted in ovulation in 9 out of 10 cycles without ensuing pregnancy. The behaviour of the endogenous LH under FSH therapy varied: with an initially high dose of FSH there was a clear drop in serum LH concentrations in 8 out of 23 cycles, and with an initially low dose in 5 out of 25 cycles. In 5 cycles the serum LH concentrations rose under FSH therapy. The results of the investigation confirm earlier observations that ovarian stimulation with FSH is possible in cases with low endogenous FSH/LH ratios, and that it is best accomplished by individualized therapy with an initially low dose. However, because of the different reaction of endogenous LH secretion, a better ovarian reaction than with hMG therapy could not be achieved with regard to ovulation and pregnancy rate, course of the luteal phase and overstimulation.

Topics: Adult; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovarian Diseases; Ovarian Follicle; Stimulation, Chemical; Testosterone; Ultrasonics

The therapeutic effect of glucocorticoid therapy in infertile patients with hyperandrogenemic ovarian insufficiency was verified in a clinical study and compared with the results of other forms of therapy. Of 40 patients treated with 0.5 mg/d dexamethasone only one conceived. Of 47 patients treated with 7.5 mg/d prednisone 6 became pregnant. A combination therapy of dexamethasone and clomiphene resulted in 3 pregnancies among 20 patients; a combination of prednisone and clomiphene in 18 patients led to one pregnancy. In the majority of these patients previous treatment with clomiphene only had been unsuccessful. In the patient in whom both clomiphene and glucocorticoid therapy was unsuccessful, hMG/hCG therapy was applied. The pregnancy rate, 24% in the dexamethasone group and 36% in the prednisone group, was much higher. Plasma testosterone concentrations were not significantly suppressed under corticoid therapy. Neither at the beginning of a cycle nor at the time of ovulation were FSH and LH levels changed by the administration of corticoids. There was no significant correlation between the plasma testosterone values and the length of the cycle, the duration of the follicular phase, the duration of the rise in basal temperature or the length thereof. There was a significant correlation between testosterone and the LH/FSH quotient at the beginning of the cycle both in the spontaneous cycles and under corticoid therapy, though not under clomiphene therapy. In the control cycles there was a significant correlation between testosterone and LH; in the corticoid cycles it was not significant, and under corticoid therapy there was no correlation. A negatively significant correlation between testosterone and FSH was found in the control cycles. This correlation was not significant under glucocorticoid therapy and there was no correlation under clomiphene therapy. As testosterone concentrations increased a decrease in the percentage of biphasic cycles was observed in all groups. Regardless of the testosterone concentration, the pregnancy rate in patients showing signs of androgenization, at 22%, was higher than in patients without these symptoms. In patients who conceived under corticoid therapy there was no uniform correlation either to the pretherapeutic testosterone levels or to the degree of testosterone suppression. Neither the initial testosterone level nor the degree of its suppression is of any prognostic value for corticoid therapy. The more pronounced

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Dexamethasone; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Glucocorticoids; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Diseases; Testosterone

The sonographic appearance of the endometrium was evaluated in 97 infertile women, 51 from a fertility unit (FU) and 46 from an in vitro fertilization (IVF) program. Three groups of patients were identified: those with normal findings, those with an incomplete endometrial echo, and those without any endometrial echo. Findings were correlated with the type of ovulation induction protocol, the peak estradiol level, and the number of successful pregnancies. In the IVF group, 72% of the patients did not exhibit normal endometrial echoes but had adequate estradiol levels, compared with 62% of the FU patients with normal endometrial echoes but significantly lower estradiol. The data suggest that IVF patients have a nonresponsive endometrium rather than inadequate estrogen stimulation and therefore that an endometrial abnormality may be an important cause of their infertility. Ultrasound may be used as a screening method to identify such patients.

Topics: Clomiphene; Endometrium; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstrual Cycle; Ovulation Induction; Pregnancy; Ultrasonography

Measurement of urinary or blood oestrogen is essential for a precise monitoring of follicular development in gonadotrophin therapy. Blood oestradiol levels are considered most accurately to reflect follicular maturation. Although radioimmunoassays (RIA) for oestradiol yielding rapid results are now available, they require qualified technicians and equipment for RIA. Recently, a simple, rapid method for determining urinary total oestrogen has been developed by Mochida Pharmaceutical Co. Ltd., Japan. To determine whether this kit may be applicable to monitoring gonadotrophin therapy, urinary total oestrogen concentrations measured by the kit were compared with serum oestradiol levels determined by RIA in patients who were treated with gonadotrophin. Urinary total oestrogen concentrations in samples obtained either at 07.00 h (first morning urine specimen) or at 09.00 h significantly correlated with serum oestradiol levels. Thus, urinary total oestrogen concentrations determined by the kit appear to reflect follicular development accurately, and are considered applicable to monitoring gonadotrophin therapy. Correction of the urinary total oestrogen concentrations by the creatinine level significantly improved the correlation between urinary total oestrogen values and serum oestradiol levels. Therefore, the primary total oestrogen values should be corrected by the creatinine level.

Topics: Chorionic Gonadotropin; Clomiphene; Creatinine; Estradiol; Estrogens; Female; Hemagglutination Inhibition Tests; Humans; Infertility, Female; Menotropins; Radioimmunoassay

Three groups of women with different types of ovulatory dysfunction who had failed to conceive on conventional therapy were treated with pulsatile gonadotropin-releasing hormone (GnRH). Group A consisted of nine patients with luteal phase defect; group B included four patients with apparently normal menstrual cycles but disordered folliculogenesis seen by serial ultrasound examinations; and group C consisted of eight patients who exhibited anovulation or irregular ovulation. GnRH was administered subcutaneously or intravenously in dosages varying from 5 micrograms to 20 micrograms, with pulse frequency of 2 to 3 hours in 53 cycles. Forty-one cycles were ovulatory. Four pregnancies resulted, one ending in miscarriage at 12 weeks' gestation. Our results indicate that GnRH may be used as an alternative to the prevalent therapeutic methods for ovulatory dysfunction. Only those women who had anovulation and abnormal basal levels of serum luteinizing hormone were resistant to GnRH therapy.

Topics: Adult; Anovulation; Cervix Mucus; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteal Phase; Menotropins; Menstruation Disturbances; Pregnancy; Time Factors

Topics: Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

The use of HMG is only justified to obtain a pregnancy, and cannot be used until after an investigation which excludes other causes of sterility, and necessitates careful surveillance. The contraindications should be respected. The author discusses the present indications for the administrations of HMG.

Topics: Amenorrhea; Anovulation; Female; Fertilization in Vitro; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins

The different methods of inducing ovulation and the results which one can hope to obtain relative to the indications for each of them are discussed. It is interesting to note that the cumulative total of pregnancies over 12 months shows that the prognosis in terms of fertility is similar to that of a normal population, provided that it has been treated under optimal conditions.

Topics: Chorionic Gonadotropin; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Diseases

We are investigating the most practical parameters i.e. reliable and with a rapid response, which allow the time of insemination to be determined in women undergoing stimulation because of anovulation. We have already shown the advantage of rapid radio-immunological determinations of 17 beta-oestradiol (E2) to induce the releasing action of chorionic gonadotrophic hormone (hCG). We have carried out our investigations directed towards the rapid-immunological determination of luteotrophic hormone (LH), and have recorded a good temporal correlation between E2 and LH, the rise of E2 preceding by some hours that of LH, and the two summits succeeding each other. Inseminations are followed by fertilization in women who present with the following: a mean oestradiolaemia of about 500 pg/ml in the second part of the follicular phase, maintained after interruption of HMG administration (alone or after clomiphene citrate), which decreases only slowly after administration of hCG; a level of LH increasing from 9-14 ng/ml (mean) in the last two days preceding the summit of LH; the level of LH multiplied at least by 2 after the administration of hCG, whatever the mode of stimulation. Clomiphene citrate, not provoking a constant ovulatory discharge, does not dispense with the administration of hCG in the majority of cases. These considerations result from the study of a group of 22 anovulatory women, in whom stimulation followed by determination of E2 and LH, under echographic control, have allowed 12 pregnancies to be obtained (7 by clomiphene citrate + HMG + hCG; 5 by HMG + hCG), decreasing the mean number of inseminated cycles to 3 per woman thus studied.

Topics: Adult; Clomiphene; Estradiol; Female; Fertility; Fertilization; Humans; Infertility, Female; Insemination; Luteinizing Hormone; Menotropins; Menstrual Cycle; Ovulation Detection

Topics: Adult; Amenorrhea; Estrogens; Estrogens, Conjugated (USP); Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Syndrome

Conventional treatment of the cervical factor has proved unsuccessful, with fertility rates under 30% usually quoted. Low-dose estrogen has been one of the main therapies but carries the complication of ovulation interference. It is hypothesized that higher doses of estrogen would improve mucus but would have an even greater adverse effect on ovulation. However, the latter could be obviated by concomitant use of human menopausal gonadotropin (hMG). The hMG would then be monitored by pelvic ultrasound because the ingested estrogen would interfere with estrogen assays. Eighty-two percent of 34 infertile women with no motile sperm on baseline postcoital tests improved their levels after therapy with this high-dose estrogen hMG technique. To date, 56% of these women for whom therapy had previously failed have conceived. Nevertheless, simpler and less expensive techniques should be used initially.

Topics: Cervix Mucus; Estrogens; Female; Humans; Infertility, Female; Menotropins; Monitoring, Physiologic; Ovulation Induction; Pregnancy; Ultrasonography

Gonadotropins are released in a pulsatile fashion at a frequency of between 1 and 2 hours in the follicular phase of the menstrual cycle. Human menopausal gonadotropins are usually administered intramuscularly. We evaluated the gonadal response to intravenous human menopausal gonadotropins administered in a pulsatile fashion over nine treatment cycles in three anovulatory infertile women. Human menopausal gonadotropin pulses in doses up to 12 IU follicle-stimulating hormone at frequencies between 2 to 3 hours over 3 to 17 days resulted in ovulation in five cycles with one pregnancy being conceived. In the ovulatory cycles (5,000 to 10,000 IU of human chorionic gonadotropin was used to induce ovulation), the 17 beta-plasma estradiol level was 961 +/- 128 versus 326 +/- 95 pg/ml (mean +/- SEM) in the anovulatory cycles (p = 0.015). The dose of human menopausal gonadotropins (in ampules of Pergonal, 75 IU of follicle-stimulating hormone and 75 IU of luteinizing hormone) in the intravenous cycles needed to induce ovulation was 12.3 +/- 1.4 versus 20.4 +/- 0.9 for intramuscular cycles (n = 80 in 23 women, p = 0.008). Treatment was well tolerated and without complications. We are continuing to explore the use of this apparently more efficient mode of administering human menopausal gonadotropins to anovulatory patients resistant to other techniques of ovulation induction therapy.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Clomiphene; Drug Resistance; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections, Intravenous; Menotropins; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy

Topics: Adult; Anovulation; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction

Premature luteinization is a frequent phenomenon observed in infertile women undergoing human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) therapy for corpus luteum insufficiency or anovulatory cycles. By inducing hyperprolactinemia in these women with sulpiride, we intended to create a dysfunctional state in these women, which supposedly induces a better reaction to hMG/hCG therapy. The rationale behind this combined treatment was the observation that hyperprolactinemic amenorrheic patients have a much higher pregnancy rate under hMG/hCG treatment than the above group. Three cases are reported in detail, illustrating the altered ovarian response to combined sulpiride-hMG/hCG treatment. Of 60 infertile women with repeated premature luteinization, 12 conceived after sulpiride-hMG/hCG therapy. Their expected pregnancy rate would have been very low (5% or less) if conventional hMG/hCG treatment had been continued.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Menstruation; Pregnancy; Sulpiride

Topics: Adult; Amenorrhea; Drug Evaluation; Female; Gonadotropins; Humans; Hypothalamic Diseases; Infertility, Female; Menotropins; Ovulation Induction; Pituitary Diseases; Pregnancy

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

The detection of pregnancy through the rise of human chorionic gonadotropin hormone secretion, on maternal plasma level, has been studied in normally developed pregnancies following in vitro fertilization and embryo transfer (IVF-ET), and compared with two other groups of pregnancies, the first group being pregnancies following artificial insemination with donor semen (AID) in spontaneous cycles ("AID group") and the second group being pregnancies following in vivo fertilization in a stimulated cycle ("stimulated group"). The day of human chorionic gonadotropin detection level significant for pregnancy (Dd) has been first defined and then determined for each pregnancy. Thereafter, mean levels for Dd (Dd) have been compared for each pregnancy group. It has been found that in pregnancies following IVF-ET, Dd is 12.05 +/- 0.8 days after ovulatory stimulus, which is delayed in comparison with spontaneous cycle pregnancies (Dd = 9.5 +/- 1.0) and with stimulated cycle pregnancies (Dd = 8.0 +/- 1.5). The hypothesis to explain this observation is then discussed.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Injections, Intramuscular; Insemination, Artificial, Heterologous; Menotropins; Ovulation Induction; Pregnancy; Radioimmunoassay; Time Factors

Statistical evaluation of 133 cycles of induction of ovulation using generalized linear models demonstrated that the occurrence and severity of ovarian hyperstimulation was influenced by the serum 17 beta-estradiol (E2) concentration (P less than 0.001), conception (P less than 0.001), and the endocrinologic diagnosis, polycystic ovary syndrome (PCO) or hypothalamic amenorrhea (HA) (P less than 0.01). When menotropins were administered between 5:00 P.M. and 8:00 P.M. and blood was drawn at 8:00 A.M., an upper limit for serum E2 in patients with HA of 2417 pg/ml or an upper limit for patients with PCO of 3778 pg/ml gave an approximate 5% risk of severe ovarian hyperstimulation in conception cycles and a 1.3% risk of severe hyperstimulation in nonconception cycles. Comparison of our E2 radioimmunoassay involving extraction and chromatography to the Pantex immunodirect Estradiol 125I kit (Pantex, Santa Monica, CA) demonstrated no detectable systematic error, allowing the use of these limits with either assay. The ovulating injection of human chorionic gonadotropin was given at 5:00 P.M. to 8:00 P.M. on the evening of blood drawing as soon as the first follicle reached an average diameter of 14 mm or greater. The ultrasound parameters allow the chance of pregnancy to be optimized and the chance of multiple gestation to be minimized. Serum E2 monitoring indicates when the risk of ovarian hyperstimulation is too great for human chorionic gonadotropin to be given.

Topics: Amenorrhea; Chorionic Gonadotropin; Chromatography; Estradiol; Female; Humans; Hypothalamic Diseases; Infertility, Female; Iodine Radioisotopes; Menotropins; Models, Biological; Ovary; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Radioimmunoassay; Time Factors

We describe the outcome of induction of ovulation with gonadotrophins (HMG/HCG) in 46 patients treated over 138 cycles. Ovulation was induced in 88 per cent of cycles and there were 43 conceptions in 33 patients with a cumulative conception rate of 96 per cent. The incidence of multiple pregnancy was 36 per cent of those reaching a gestation of 13 weeks or more and accounted for all the second and third trimester foetal losses. Overall, 61 per cent of the patients have taken home at least one healthy child. Mild symptomatic ovarian hyperstimulation complicated 9.4 per cent of courses and was more frequent among patients with normal pretreatment oestrogen levels. We found continuous biochemical monitoring of follicular growth to be a poor predictor of multiple pregnancy or hyperstimulation. We discuss our local experience with reference to published reports from other centres and in relation to recent advances in management and consider the future role of this therapy.

Topics: Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple

Total 24-hour urinary oestrogen has been used extensively and proven to be reliable in monitoring gonadotrophin therapy for induction of ovulation. However, the method is time consuming for the patient and incomplete collection, as expected, is not uncommon, hence interfering with the treatment result. Oestrone-3-glucuronide in first morning urine samples has been shown to correlate well with plasma oestradiol-17 beta levels during normal menstrual cycles. A comparative study was made to examine the correlation between the levels of 24-hour urinary oestrogen and first morning urinary oestrogen in patients on gonadotrophin therapy. Creatinine levels were also determined to exclude the factor of variable excretion of oestrogen. The correlation thus found is highly significant (p less than 0.001). Hence first morning urinary oestrogen to creatinine ratios may be used to replace 24-hour urinary oestrogen in biochemical monitoring of gonadotrophin therapy.

Topics: Creatinine; Estradiol; Estrogens; Estrone; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Time Factors

Studies on in vitro fertilization were begun at Monash University in 1970. A review is presented summarizing developments since then, culminating in pregnancy rates of 18% in 1980, 22% in 1981, and 19% in 1982.

Topics: Academic Medical Centers; Adult; Australia; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

Multiple gestations after human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) therapy were detected within 7 gestational weeks (GW) by ultrasound examinations and also by "midluteal phase" (MLP) progesterone (P) concentrations. The mean MLP-P level in nonconception cycles following hMG-hCG therapy was 25.1 +/- 2.1 ng/ml. In the pregnancies following hMG-hCG therapy, MLP-P levels were 32 ng/ml, 37 ng/ml, and 56 ng/ml. These values were associated with a singleton, twin, and triplet pregnancies, respectively. Ultrasonography revealed the number of gestational sacs within 7 GW in each instance. We suggest that assay of MLP-P is useful in women receiving regimens for induction of ovulation. Efforts may as well be made to ascertain multiple conceptions by ultrasound examinations in patients whose MLP-P levels are far above the mean MLP-P level in hMG-hCG-induced cycles.

Topics: Chorionic Gonadotropin; Clinical Laboratory Techniques; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Multiple; Prenatal Diagnosis; Progesterone; Ultrasonography

Catechol estrogens, estrogen metabolites of potential physiologic significance, were measured in infertile women undergoing ovulation induction with human menopausal gonadotropins. Urinary 2-hydroxyestrone (2-OH-E1) specimens were obtained from 12 women in one or more stimulated cycles. The actual time for the administration of human chorionic gonadotropin to induce ovulation was based on serial plasma estradiol (E2) specimens. A significant correlation between plasma E2 and urinary 2-OH-E1 was demonstrated, similar but more pronounced than that seen in normal cycling women. This confirms previous work that showed that 2-OH-E1 is the major urinary estrogen metabolite in the nonpregnant state and further suggests that urinary catechol estrogens are a useful index of ovarian function.

Topics: Estradiol; Estrogens, Catechol; Female; Humans; Hydroxyestrones; Infertility, Female; Menotropins; Ovulation Induction; Radioimmunoassay

Etiologic factors in hypergonadotropic hypogonadism are discussed. On the basis of these data a classification system is proposed for women with hypergonadotropic hypogonadism to be used in future investigations of the natural history of this disorder. The classification system can also be used in attempts at therapeutic intervention in these women. Recommendations for clinical management and future studies of women with hypergonadotropic hypogonadism are provided.

Topics: Adult; Antineoplastic Agents; Estradiol; Estrogens; Female; Humans; Hypogonadism; Infertility, Female; Karyotyping; Menopause, Premature; Menotropins; Ovarian Diseases; Radiation Dosage

The development of ovarian follicles was studied ultrasonographically in 21 cycles in eight infertile patients with the diagnosis of ovulatory dysfunction in whom conception did not occur after the defect had apparently been corrected. Pelvic ultrasound demonstrated three patterns in 20 of the 21 cycles studied: ovarian hyperstimulation in seven cycles; follicular atresia before ovulation in three cycles; persistent unruptured follicular cysts in 10 cycles. Recognition of these patterns has been helpful in modifying therapy in infertile patients.

Topics: Chorionic Gonadotropin; Clomiphene; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Ultrasonography

Topics: Adult; Bromocriptine; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

Ultrasound provides precise measurement of follicular growth and thus is important in the diagnosis and treatment of infertility in women. It is also important in in vitro fertilization and in the treatment of women undergoing ovulation induction with HMG-HCG. Plasma E2 and ultrasound are complementary techniques.

Topics: Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Detection; Ovulation Induction; Ultrasonic Therapy; Ultrasonography

Topics: Adrenal Cortex Hormones; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovary; Ovulation Induction; Pregnancy

A combined treatment of human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), and dexamethasone was administered to 27 infertile patients with polycystic ovarian disease who failed to conceive with clomiphene citrate and hMG-hCG alone. Twenty-two (81%) of the patients ovulated according to basal body temperature and progesterone values, and 20 (74%) conceived during one to four treatment cycles. Fifteen (74%) pregnancies terminated in live full-term deliveries (14 singletons and 1 set of twins), and 5 (25%) have terminated in first-trimester abortions. Only one of the treatment cycles was complicated by moderate ovarian hyperstimulation. The average hMG dose required for the induction of ovulation was significantly reduced from 25 ampules with hMG-hCG alone to 18 ampules under the combined treatment (P less than 0.01). The combination of hMG-hCG and dexamethasone is an additional, safe, and effective nonsurgical treatment for women with polycystic ovarian disease who have failed to respond to an hMG-hCG regimen alone.

Topics: Adult; Chorionic Gonadotropin; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovulation Induction

Daily estimations of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, and progesterone were made in the serum of eight infertile patients from day 1 through the follicular phase during menstrual cycles before and after tamoxifen therapy. Tamoxifen therapy was found to shorten the follicular phase from 15.4 +/- 0.8 days (mean +/- standard error of the mean) to 14.0 +/- 0.6 days (difference not significant) and to lengthen the luteal phase from 12.8 +/- 0.4 days to 14.1 +/- 0.8 days (P less than 0.05). The mean estradiol concentration in the eight patients during tamoxifen treatment cycles rose on day 8 (3 days after starting tamoxifen treatment) and increased significantly (P less than 0.05) from day 10 to midcycle. The integrated follicular phase estradiol concentration in the tamoxifen treatment cycle increased to 2450.1 +/- 208.1 pg/ml/cycle, and was significantly higher (P less than 0.025) than that in the nontreatment cycle. In contrast, the concentrations of follicle-stimulating hormone, luteinizing hormone, and prolactin during the follicular phase and at the midcycle peak of tamoxifen treatment cycles were not significantly different from those of the nontreatment cycle. These results suggest that the mechanism of tamoxifen in improving folliculogenesis may involve a direct action on the ovary without intervention of the hypothalamic-pituitary system.

Topics: Adult; Estradiol; Female; Follicular Phase; Gonadotropins, Pituitary; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Progesterone; Prolactin; Stimulation, Chemical; Tamoxifen

The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.

Topics: Adult; Estradiol; Female; Humans; Infertility, Female; Injections, Intramuscular; Menotropins; Ovulation Induction; Pregnancy

Ovarian follicular development was assessed by serial ultrasonography in infertile women being treated with human menopausal gonadotropin. Both follicular size and number of follicles correlated with serum estrogen values in most patients, and follicles increased in size 2--3 mm per day. Most patients had serum estrogen values greater than 750 pg/ml when one or more follicles larger than 18 mm were present. A comparison of conception cycles with non-conception cycles did not reveal a significant difference in size or number of follicles, or in the rate of rise or peak value of serum estrogen. When women monitored with ultrasonography were compared with patients treated with gonadotropins prior to the availability of ultrasonography, there was no significant difference in the rates of successful conception, although the number of ampules of pergonal used by the former was significantly reduced, permitting more efficient use of an expensive medication.

Topics: Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Detection; Ovulation Induction; Ultrasonography

Topics: Adolescent; Child; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Prenatal Exposure Delayed Effects; Puberty

Twenty-six daughters born to amenorrheic women after gonadotropin-induced ovulation were studied at 10 to 16 years of age. The aim of the study was to assess whether the mothers' condition, namely, amenorrhea and infertility followed by the pharmacologic induction of ovulation, had any effect on their female offspring in terms of endocrine disorders at puberty. The daughters were found to have normal onset of puberty as well as normal physical and mental development. The mean age at menarche, body weight, and height were similar to those of the general female population in Israel. A functioning hypothalamic-pituitary-ovarian axis was evidenced by the appearance of menarche followed by regular cycles. These data form a reassuring sample for the clinicians, the treated mothers, and their offspring.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Amenorrhea; Child; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menarche; Menotropins; Ovulation Induction; Pregnancy; Prenatal Exposure Delayed Effects; Puberty

Topics: Estrogen Antagonists; Fallopian Tubes; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Microsurgery

This study presents the first demonstration of the ability of a hybrid human chorionic gonadotropin (hCG) compound, AB1ER-CR-2XY, to induce ovulation in humans. Thirteen patients with primary infertility were treated for 16 cycles with varying dosages of human menopausal gonadotropin (hMG), and 10,000, 5000, and 2500 IU of the hybrid hCG. Presumptive occurrence of ovulation was recorded in 15 courses of medication. Echographic studies did not indicate overt follicular or ovarian enlargement. Two singleton pregnancies occurred, one during the first treatment course and the other following the second course of hMG/hybrid hCG therapy. Due to its specific characteristics, the hybrid hCG may provide equal or greater effectiveness and a better margin of safety than commercial hCG used for ovulation induction in patients pretreated with hMG.

Topics: Adult; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estradiol; Female; Half-Life; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation Induction; Pregnancy; Progesterone

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Corpus Luteum; Drug Evaluation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Progesterone; Time Factors

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

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Female; Menotropins; Olfaction Disorders; Ovulation Induction; Pregnancy; Syndrome

Topics: Adult; Carcinoma, Hepatocellular; Clomiphene; Female; Fetus; Humans; Infant; Infertility, Female; Liver Neoplasms; Menotropins

Five infertile women, with normal menstrual rhythm who had been investigated previously by daily hormone analyses throughout at least one complete menstrual cycle and had shown poor luteal-phase steroid-hormone profiles were treated by a new approach. They were rendered hypogonadotrophic with large doses of a luteinizing hormone releasing-hormone analogue (Hoe 766) and were then treated with exogenous gonadotrophins to induce follicular growth and ovulation. Progesterone production after ovulation in all cases was superior to that observed in the individual patients' without treatment. One patients conceived in her first conception cycle and another in her fourth. This regimen offers a systematic approach to the treatment of unexplained infertility in women with deficient luteal-phase steroid-hormone profiles.

Topics: Buserelin; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Progesterone

Serum unconjugated estradiol concentrations were measured daily in patients who ovulated spontaneously and in patients whose ovulations were induced with human menopausal gonadotropins. When the logarithm of the estradiol concentration was plotted against time (semi-log plot) for each patient, the plots were essentially linear, and the rates of estradiol production were similar during spontaneous and induced cycles. Based on two or three estradiol determinations, subsequent estradiol concentrations can be determined as long as the established rates of estradiol production falls within reasonable confidence limits. The slope of serum unconjugated estradiol concentrations of a patient known to have a multiple gestation due to multiple ovulations did not differ significantly from the slopes of estradiol concentrations with single pregnancies, suggesting that the follicular phase estradiol concentrations do not reflect number of dominant follicles.

Topics: Estradiol; Female; Humans; Infertility, Female; Mathematics; Menotropins; Ovulation Induction

Real-time ultrasound scanning of ovarian follicles was performed during 61 cycles in 22 infertile patients being treated with sequential injections of human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). Total 24-h urinary oestrogens were estimated (and in 13 cycles plasma oestradiol) but the amount of gonadotrophin given was based mainly on the ultrasound findings. A retrospective analysis of the results showed that there was a poor statistical correlation between the diameter of the largest follicle and the total urinary oestrogens (r=0.39) and with the level of plasma oestradiol (r=0.56), although similar clinical information was obtained by all methods. Ovulation was induced in 58 cycles when the leading follicle had a mean diameter of 20-25 mm (mean 21.3 mm); follicular rupture was observed in 57 cycles and in these cases there was biochemical evidence of luteinization (plasma progesterone greater than 15 nmol/1; total urinary pregnanediol greater than 8 nmol/24h). Three patients (three cycles) were not given hCG; one developed micropolycystic ovaries and two showed evidence of hyperstimulation (one follicle greater than 25 mm diameter, three or more follicles 20-25 mm diameter). Twelve patients became pregnant, all with single fetuses. Subsequently one aborted, one had an ectopic pregnancy, three gave birth to normal babies at term and seven pregnancies are continuing. Real-time ultrasound scanning of ovarian follicles is a simple, practical method for monitoring follicular growth during the administration of hMG and predicting the response to hCG.

Topics: Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation; Pregnancy; Ultrasonics

The authors were interested in determining the predictive value of postcoital testing in women who undergo human menopausal gonadotropin (hMG) therapy for the induction of ovulation. Fifty consecutive patients were studied whose husbands had acceptable semen analyses; 24 of the patients conceived. Postcoital testing was done after hMG stimulation on the day human chorionic gonadotropins (hCG) were given or the day before. All but one patient had excellent cervical mucus quality. Sperm characteristics in cervical mucus were analyzed in regard to overall motility, number of active sperm per high-power field (HPF), and quality of movement. These data were correlated with outcome in terms of conception. A linear correlation could be shown between overall motility and pregnancy outcome once at least 40% motility was present; no pregnancy occurred in patients with 20% or less sperm motility. Once five or more active sperm/HPF were noted, the chance of pregnancy was about 60%; this chance was not increased with higher density rates. In all but one patient who conceived, sperm with maximum quality (+3 motility) were noted. Data were compiled in a postcoital score (range 0 to 12). Patients with a high score had a pregnancy rate of 70%, patients with an intermediate score, 23%, and none of the seven women with low scores conceived. Because menotropin therapy is costly, demanding, and potentially risky, it is suggested that one utilize results of postcoital testing as a guide in decisions about the continuation of such therapy.

Topics: Cervix Mucus; Chorionic Gonadotropin; Coitus; Evaluation Studies as Topic; Female; Humans; Infertility, Female; Male; Menotropins; Sperm Count; Sperm Motility; Vaginal Smears

Luteinization of an unruptured ovarian follicle has been reported as a cause of infertility and has heretofore been diagnosed only by direct visualization of the ovarian surface. Four patients who demonstrated defects in ovulation requiring therapy to induce ovulation and who were not achieving desired conception despite apparently adequate treatment were studied with serial pelvic ultrasonic examinations for 17 cycles. Luteinization, characterized by the loss of a clear demarcation of the follicular cyst wall and the presence of intrafollicular echoes, was suspected in each of these cycles by the absence of ultrasonic signs of ovulation--that is, a rapid decrease in follicular size and the appearance of free fluid in the cul-de-sac. Histologic confirmation of a persistent luteinized cyst is presented.

Topics: Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation; Time Factors; Ultrasonography

Forty-nine patients in whom clomiphene citrate failed to induce ovulation were treated for 177 cycles with a fixed low dosage of menotropin. Among these 49 patients, there were 24 pregnancies. Among these pregnancies were two that were multiple and three spontaneous abortions. In only one treatment cycle was there a hyperstimulation syndrome. These patients were divided into three clinical groups: the secondary amenorrheic patient, the oligo-amenorrheic patient, and the patient with poor corpus luteum function. There was no statistically significant difference in the pregnancy rate per month among all groups during the first three treatment cycles (average value, 0.07). However, there was a statistically significant improvement in the pregnancy rate per month in the group with secondary amenorrhea and the group with poor corpus luteum in the last three treatment cycles, as compared with the first three treatment cycles (P = 0.05; average value, 0.75). The oligo-amenorrheic patients, on the other hand, during the last 3 months of treatment, had no statistically significant increase in the pregnancy rate per month. These data suggest that menotropin therapy may have a priming effect. These data do not fit the currently accepted model of a constant pregnancy rate per month for all patients. The data suggest that caution should be exercised before combining patient groups when evaluating the results of menotropin therapy.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Estradiol Congeners; Female; Humans; Infertility, Female; Male; Menotropins; Ovulation Induction; Pregnancy; Statistics as Topic; Superovulation

Topics: Adult; Coitus; Ethinyl Estradiol; Female; Humans; Infertility, Female; Menotropins

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

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prenatal Diagnosis; Sonication; Ultrasonography

Ultrasonic measurement of ovarian follicles was used in conjunction with conventional measurement of urinary oestrogen output to monitor responses in infertile women receiving gonadotrophin stimulant therapy. In the 21 women who conceived during the first 15 months, in which this combined monitoring was used, ultrasound proved superior to oestrogen measurement alone for assessing follicular maturity and hence deciding when to administer the ovulating dose fo chorionic gonadotrophin. The use of ultrasound imaging improves efficiency of treatment with gonadotrophin stimulant therapy, but is not predictive of multiple pregnancy or of hyperstimulation.

Topics: Adult; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Pregnancy; Pregnancy, Multiple; Ultrasonography

Twenty-four courses of ovulation induction with HMG-HCG were accompanied by ultrasound sector scanning. The results of cross-sectional studies did not deviate from those reported for normal cycles. Cross-sectional studies indicate smaller peak follicular volumes than repeated measurements of the same follicles. Results may, however, be influenced by frequency and time of measurements, as well as frequency and time of coitus for the patients. Peak-size follicular volumes in patients who became pregnant were relatively large. Peak volumes connected with subsequent pregnancies may therefore have another range of variation than follicles releasing oocytes which will remain unfertilized.

Topics: Amenorrhea; Anovulation; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Oligomenorrhea; Ovulation; Ovulation Detection; Pregnancy; Ultrasonography

Seventeen patients with anovulation or luteal deficiency were tested with HMG-HCG for 40 cycles. Follicular development was monitored daily by measurement of immunoreactive plasma estrogen. Ovulation was evaluated by determination of plasma progesterone. Ovulation was induced in 16 patients and 37 of 40 cycles (93%). Fourteen pregnancies occurred in 13 patients. Plasma estrogen measurements in ovulatory cycles at the time of HCG injection ranged from 315 to 1,482 pg/ml (mean 764 pg/ml). Mild hyperstimulation occurred in two cycles with preovulatory estrogen values of 720 pg/ml and 784 pg/ml. The highest preovulatory estrogen level which was followed by anovulation was 493 pg/ml. The preovulatory estrogen peak in one triplet pregnancy measured 1,356 pg/ml. Determinants of treatment failure included inadequate follicular stimulation, interruption of HMG therapy for more than 1 day, previous ovarian wedge resection, and congenital anomaly of the uterus. Increase in body weight required higher doses of drug therapy in one case. We conclude that optimal estrogen levels prior to HCG injection range from 500 to 700 pg/ml. The risks for ovarian hyperstimulation and multiple pregnancy may be reduced and ovulation accomplished by daily administration of HMG until the defined estrogen level is reached.

Topics: Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Progesterone

Ten women with hyperprolactinemic sterility, which had lasted for 2-8 years, did not conceive under bromocryptine alone or combined with clomiphene, with or without hCG. Two of the patients were anovulatory, while in eight the main problem seemed to be an unreceptive cervix. They were all treated with bromocryptine combined with menotropin (hMG) and hCG for one to four cycles. Seven became pregnant after one to two cycles. Three remained unresponsive even after four cycles of treatment. It is proposed that in hyperprolactinemic infertility a combination of bromocryptine with hMG-hCG may give good results when other regimens of treatment have failed.

Topics: Adult; Bromocriptine; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Prolactin

The dosage, duration of treatment, and plasma hormone levels were analyzed statistically between and within groups of treatment cycles with (n = 46) and without (n = 10) ovulation. A significant difference was observed in the dosage of human menopausal gonadotropins (hMG) over various days of treatment, but not in the mean dosage of hMG and human chorionic gonadotropin (hCG) administered per cycle. Follicle-stimulating hormone (FSH):luteinizing hormone (LH) ratios, prolactin (PRL) levels, and the magnitude and the duration of the estradiol response were greater in the ovulatory cycles. Additionally, in the ovulatory cycles, the dose of hMG correlated with the plasma levels of estradiol, FSH, and LH, while in the anovulatory cycles, hMG dosage correlated only with the LH concentrations. After administration of hCG, the mean plasma concentrations of its beta subunit peaked within 1 day and remained detectable for up to 10 days thereafter. In the ovulatory cycles, the mean progesterone level was maximal 6 days following hCG administration. In these cycles, luteal phase progesterone levels correlated positively with the preovulatory estradiol and inversely with concentrations of the beta subunit of hCG. The data demonstrate that, in contrast to anovulatory follicles, ovulatory follicles were exposed to a relative "dominance" of FSH over LH, with higher concentrations of estradiol and PRL for several days before hCG was administered. Apart from hMG dosage, the endogenous discharge of LH appeared to be an important determinant of the ovarian response. A single 10,000 IU dose of hCG was adequate for inducing ovulation and maintaining luteal function.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Cyclic AMP; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Peptide Fragments; Progesterone

In vitro fertilization was studied in human egg cells obtained by laparoscopy. In 1979 our studies included 65 women with long term infertility and proven tubal factor infertility. The primary diagnostic laparoscopy established disease of uterus, tubes and ovaries and was used to correct pathology. Lysis of adhesions was used to make aspiration of a spontaneous mature follicle for in vitro fertilization easier. The aspiration laparoscopy was performed after stimulation with HMG and HPG. Our prerequisite was the presence of at least one ovary with ovulatory cycles. In almost all cases the ovaries wer accessible only following lysis of ovarian and tubal adhesions. Aspiration of the follicle was successful in 55 of the patients stimulated with HMG/HCG. In 10 cases no follicle for aspiration was available. In 21 cases one egg cell was found. In 11 cases more than one egg cell was found. The maximum was 8 egg cells in one patient. In 34 patients only cumulus cells were aspirated following stimulation. Under the in vitro fertilization conditions described in this paper it was possible to obtain twice a pro-nucleus formation, twice the two cell and twice the four cell stage following conjugation with sperm of the partner. Of the 47 patients with a tubal occlusion, 30 were isthmic or utero-isthmic and 17 tubal occlusions were peripheral. In 15 patients chromo-tubation showed recanalization.

Topics: Chorionic Gonadotropin; Female; Fertilization in Vitro; Humans; Infertility, Female; Laparoscopy; Menotropins; Time Factors

Correlation coefficients for dehydroepiandrosterone sulfate (DHEAS) were determined in women on menotropin. DHEAS was significantly correlated with testosterone free index (TFI), 0.78**; percentage free testosterone (%FT), 0.66**; androstenedione (delta 4A), 0.66*; luteinizing hormone (LH), 0.55**; LH/follicle-stimulating hormone (FSH) ratio, 0.55**; 17-OH-progesterone (17-P), 0.55**; testosterone (T), 0.53**; weight (WT), 0.40**, urinary estriol glucuronide (E3G), 0.33*; and free cortisol index (FFI), 0.32*, with 43 df but not with prolactin (PRL), 0.25. Normal male DHEAS (3.5 +/- 1.2, 25) (microgram/ml; mean +/- standard deviation, n) was higher than normal female DHEAS (2.4 +/- 1.1, 27), P less than 0.01 and DHEAS in women on oral contraceptives (1.9 +/- 1.1, 17) was slightly lower than in normal females, P greater than 0.2. In the combined population (male, female, and females on oral contraceptives) DHEAS was correlated with TFI (0.56**), T (0.54**), %FT (0.52**), delta 4A (0.40**), and age (-0.40**) with 66 df and 17-P (0.30*) with 54 df. TFI appears to be one determinant of plasma DHEAS, **P less than 0.01. *P less than 0.05.

Topics: Amenorrhea; Dehydroepiandrosterone; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Polycystic Ovary Syndrome; Testosterone

Topics: Amenorrhea; Drug Evaluation; Endocrine System Diseases; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Prolactin

Results of prospective examination of follicle development under HMG-HCG-therapy by real time scanning are discussed. 1979-1980 37 patients were treated with HMG-HCG, 82 cycles of treatment were evaluated. In 93% of these cycles ovulation occurred, 17 patients became pregnant. Slight overstimulation was seen in 5% (4 of 82 cycles of treatment). Real time scan monitoring of follicular development allows a more efficient treatment with HMG-HCG, also multiple gravidity might theoretically be reduced.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Progesterone; Ultrasonography

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

Topics: Adult; Anovulation; Drug Evaluation; Female; Humans; Hypogonadism; Infertility, Female; Menotropins; Ovulation Induction

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

Sixty-nine pregnancies were observed in 57 hyperprolactinemic women (5 with pituitary macroadenoma, 20 with microadenoma, and 32 with normal tomography of the sella turcica). Ten of these pregnancies took place spontaneously in women with mild to moderate hyperprolactinemia (up to 70 ng/ml); 2 were induced by exogenous gonadotropins, 2 by clomiphene, 42 by bromocriptine, and 9 by metergoline; and 4 occurred after pituitary selective adenomectomy. The observed complications included spontaneous abortion (10 cases); headache (7 cases); sellar enlargement (5 cases); and bitemporal hemianopsia (1 subject with macroadenoma). Among 24 women in whom prolactin levels were reevaluated at least 1 month after parturition and/or lactation, 8 showed a decrease in prolactin concentration (less than 50% of pregestational levels), with actual prolactin normalization in 3 and resumption of cyclic menses in 2 previously amenorrheic women. In contrast, no changes in prolactin levels occurred after pregnancies that ended in abortion. These data suggest the following: 1) conception is not uncommon in women with moderate hyperprolactinemia; and 2) pregnancy may be safely induced without prior surgery and/or radiotherapy in hyperprolactinemic women, except those with large pituitary adenomas, and a considerable number of these patients even show a clinical and biochemical improvement after pregnancy.

Topics: Adenoma; Bromocriptine; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Metergoline; Ovary; Ovulation Induction; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin

A patient with a triplet pregnancy had one infant affected by anencephalus. This pregnancy resulted from ovulation stimulation by gonadotropins. Several cases of association between anencephalus and induction of ovulation by clomiphene have been reported. The association with gonadotropins, however, has been reported only once. The event was prenatally diagnosed by ultrasound studies in the first and second trimesters. The association of anencephalus with ovulation stimulation is discussed briefly.

Topics: Adult; Anencephaly; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Multiple; Triplets

The Authors have considered the possibility of avoiding the ovarian hyperstimulation syndrome, (O.H.S.), in women undergoing treatment with ovulation inductors, (Clomiphene citrate and gonadotropin) by means of repetitive ultrasonographic scansion beginning from the eleventh day of the cycle. They have come to the conclusion that there should be a routine use of ultrasound in order to avoid the moderate and severe forms of this syndrome.

Topics: Body Temperature; Chorionic Gonadotropin; Clomiphene; Estradiol; Estradiol Congeners; Female; Humans; Infertility, Female; Menotropins; Ovulation; Progesterone; Superovulation; Ultrasonics

Topics: Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation; Progesterone; Time Factors; Ultrasonography

The methods and results of treatment with human menopausal gonadotropins (hMG) and chorionic gonadotropin (hCG) in 26 patients (mean age 24 years, range 22-35 years) with hypogonadotropic primary amenorrhea and without chromosomal abnormalities are reported. The usual dose of hMG was 225 IU daily until the karyopycnotic index rose to 40% or more and the other clinical parameters revealed sufficient follicular maturation. A dose of hCG was then administered at the rate of 10,000 IU daily for 4 days. In 60 courses of treatment, we obtained 17 pregnancies (28.3%) in 13 patients (i.e., including some second pregnancies), 35 ovulations without pregnancy (58.3%), and seven patients did not respond (11.6%). Three patients who did not respond and who continued the treatment ovulated and became pregnant. Clinical hyperstimulation occurred in three patients on the first course of treatment. Two of them again presented this complication on repetition of treatment despite the precautions taken. Urinary estrogen and pregnanediol measurements on the 7th-11th day after hCG administration revealed considerable hormonal hypersecretion in 19 of 27 courses of treatment. In eight patients the high output of pregnanediol continued during the first 1-2 months of pregnancy and decreased thereafter. The rate of pregnancies seemed to be higher in patients with hypersecretion whereas clinical hyperstimulation did not correlate with the degree of the hormonal output. Pregnancies were all single and uneventful except for one abortion in a patient who was found to have mycoplasma infection. All patients gave birth to normal children and lactated normally. The increased dosage of hCG used in this series is considered to be a decisive factor in the induction of ovulation and the maintenance of pregnancies through the abundant steroid production it induced.

Topics: Adult; Amenorrhea; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnanediol

Topics: Adult; Amenorrhea; Cervix Mucus; Chronic Disease; Drug Evaluation; Estrogens; Female; Humans; Infertility, Female; Menotropins

During the years 1974 to 1977, a total of 77 treatment cycles of human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) were administered to 41 infertile patients with polycystic ovarian disease who failed to conceive on clomiphene. Twenty-seven patients (65.9%) conceived, two of them twice, making twenty-nine pregnancies. The abortion rate was 24.1% and the multiple pregnancy rate was 36.3%. Of the 77 treatment cycles, 7.8% were complicated by mild hyperstimulation and 3.9% by severe hyperstimulation. In six treatment cycles (7.8%), ovulation occurred spontaneously prior to the hCG injection. hMG-hCG is an additional safe and effective, nonsurgical treatment for women with polycystic ovarian disease who have failed to respond to clomiphene therapy. The reaction to exogenous gonadotropins is unpredictable and probably depends on the stage of follicular development prior to the stimulation. Therefore, daily estrogen determinations from the 1st day of treatment are mandatory in order to avoid hyperstimulation and/or multiple births.

Topics: Adult; Body Temperature; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Humans; Hypertrophy; Infertility, Female; Menotropins; Ovary; Ovulation; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple

Topics: Adult; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Insemination, Artificial, Homologous; Luteinizing Hormone; Menotropins; Menstruation; Polycystic Ovary Syndrome; Pregnancy

A patient with growth hormone deficiency and primary amenorrhoea became pregnant with the help of human menopausal gonadotrophin. Pregnancy was complicated only by abdominal discomfort due to her very small stature and by moderate oedema. She was delivered of healthy female twins by lower segment Caesarean section at the 37th week.

Topics: Adult; Amenorrhea; Female; Growth Disorders; Growth Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Complications; Pregnancy, Multiple

In treating infertile couples an understanding of the endocrine system and its relationship to reproduction is essential. The reproductive capacity in women is regulated by the hypothalamic-pituitary-ovarian axis, a system which controls hormonal synthesis, secretion, and inhibition. Unregulated positive feedback systems produce disequilibrium which can cause hormonal imbalance predisposing the individual to possible infertility. The hypothalamus receives, processes, and acts upon various signals associated with reproductive processes. At the pituitary level, short, negative feedback loops inhibit the release of gonadotropin releasing hormone once adequate levels of pituitary hormones are reached. Hypothalamic dysfunction may be attributable to abnormalities in the amount of sequence of estrogen secretion or the inability of the hypothalamus to respond to the estrogen cue. The pituitary gland responds to levels of gonadotropin releasing hormone through inhibition or secretion of follicle stimulating hormone and luteinizing hormone. A direct outcome of pituitary gonadotropin stimulation is the rhythmicity of ovarian function. The key events in the menstrual cycle are dependent on the central role of estrogen. Ovarian failure is generally attributed to the absence of follicular tissue, which presents as some type of gonadal disgenesis. During the initial interview, the infertile couple must be informed as to the time and financial considerations and statistical outcomes of treatments and the couple's psychological status must be determined to some extent as well. Clomiphene citrate is the most widely used drug in the management of anovulatory conditions related to inadequate cycle stimulation by the pituitary gonadotropins; the usual dose os 50 mg for 5 days, increased up to 200 mg for 5 days if success is not achieved. While it does not directly stimulate ovulation, this drug starts a sequence of events that are physiologically similar to a specific phase of the normal menstrual cycle. If this is not successful the couple may be treated with human menopausal gonadotropin, or Pergonal, which brings about follicular growth and menstruation. If the couple fails to achieve pregnancy, support from health professionals is crucial in discussion adoption, child-free living, and other options.

Topics: Anovulation; Clomiphene; Endocrine System Diseases; Female; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Menotropins; Pituitary Hormone-Releasing Hormones

Gonadotropin therapy for anovulation is highly successful: 58.6% of treated patients conceive. Better results are achieved in patients with galactorrhea-amenorrhea (77.1%) and hypogonadotropic hypogonadism (63.3%) than in patients with normal gonadotropin levels (45.4%). The spontaneous abortion rate (27.5%) is somewhat higher than that in spontaneous pregnancies. The multiple pregnancy rate is 31% and was slightly lower in cycles with preovulatory estrogen levels in the physiologic range. In patients treated with human menopausal and chorionic gonadotropins for 7 to 9 days per cycle, the multiple pregnancy rate is considerably less (12.9%) than in patients with longer treatment. The efficacy of treatment does not diminish with repeat-treatment cycles.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estrogens; Female; Galactorrhea; Humans; Infant, Newborn; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Time Factors

Twenty infertile, anovulatory women were treated with human menopausal gonadotropin (hMG) for a total of 61 treatment cycles. Cervical scores (all cycles) and vaginal maturation indices (23 cycles) were compared with serum concentrations of total immunoreactive estrogens to determine their clinical efficacy in monitoring hMG treatment. All courses of therapy were judged to have induced ovulation. Singleton pregnancies occurred in nine patients, and one patient conceived twice. All pregnancies were uncomplicated. There was good clinical correlation between cervical score and increasing estrogen levels in approximately one-third of the cycles. Most of these good correlations occurred in patients with low estrogen status. Very poor correlation was found with vaginal cytologic changes. Therefore, in conjunction with serum estrogen determinations, the cervical score is a safe and less expensive means of monitoring hMG therapy in selected patients.

Topics: Adult; Cervix Uteri; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Vagina

During the years 1963 to 1978, 515 patients were treated with HMG. They were divided into two groups depending upon the absence (Group I) or presence (Group II) of distinct endogenous estrogen activity. Group II patients were referred after failure of clomiphene therapy. None of the patients had mechanical or male infertility factors. The cumulative pregnancy rate (life table method) in Group I patients after six cycles of treatment was 91.2%. In 77 patients from Group I, further treatment was given for a second pregnancy after the first gonadotropin conception. In this group, the cumulative conception rate was 93.6% after eight cycles of treatment. In Group II the cumulative conception rate was 50% after 12 cycles of treatment. In both groups, the results were better in patients who were less than 35 years of age than those who were 35 or more when treated.

Topics: Adult; Age Factors; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Middle Aged; Pregnancy; Prognosis

Topics: Female; Gonadotropins; Humans; Infertility, Female; Menotropins

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Topics: Adult; Amenorrhea; Chronic Disease; Drug Evaluation; Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovarian Follicle; Pregnancy; Time Factors

Six patients with primary unexplained infertility of 2 to 9 years duration, and who failed to conceive after repeated trials of clomiphene treatment, were treated with human gonadotropins; 3 of them became pregnant following one or two courses of treatment. Three patients failed to conceive in spite of 3 courses of human gonadotropins, 2 of them had high titers of sperm-agglutinating antibodies found in their sera, which may explain their infertility. None of the 13 treatments resulted in hyperstimulation syndrome or multiple births. This preliminary result seems encouraging but awaits further study.

Topics: Adult; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Pregnancy; Sperm Agglutination

Topics: Adult; Amenorrhea; Antibodies; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

Successful treatment of primary sterility in a woman having the rare association of panhypopituitarism with Fredrickson's Type V hyperlipemia is described. Replacement therapy with l-thyroxine, prednisone and a low fat diet cleared the patient's blood of the excessive chylomicrons and very low density lipoproteins. Ovulation was induced with human gonadotrophins, and triplets (two normal girls and a boy) were born.

Topics: Adult; Chorionic Gonadotropin; Chylomicrons; Drug Therapy, Combination; Female; Humans; Hyperlipidemias; Hypopituitarism; Infertility, Female; Lipoproteins, VLDL; Menotropins; Triglycerides

Topics: Bromocriptine; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy, Multiple

Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition, intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.

Topics: Administration, Intranasal; Adult; Amenorrhea; Anovulation; Body Temperature; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Pregnancy

A group of twelve patients with a history of infertility lasting at least 2 years despite evidence of regular ovulatory cycles, were selected from an Infertility Clinic after thorough investigation had revealed no other obvious cause for their infertility. Daily plasma gonadotrophin and steroid concentrations were measured in twenty cycles from these women and the results compared with the hormonal profiles obtained from a group of eleven control 'normal' women. No significant differences were found in the concentrations of LH, FSH or oestradiol although plasma progesterone concentrations were significantly lower in the infertile women, particularly during the first half of the luteal phase. In the absence of any other demonstrable defect, it was assumed that the decreased progesterone secretion was directly or indirectly implicated in the pathogenesis of their infertility, and a number of therapeutic regimes (progesterone supplementation of the luteal phase or additional stimulation by either anti-oestrogens or exogenous gonadotrophins) were assessed for their efficacy in correcting this defect. Although plasma progesterone concentrations after most of these regimes were significantly increased, none of the patients in this series conceived.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Ovulation; Progesterone; Tamoxifen

Topics: Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation

Topics: Estradiol; Female; Humans; Infertility, Female; Menotropins; Menstruation; Prolactin

The administration of human menopausal gonadotrophin (HMG) followed by human chorionic gonadotrophin (HCG) stimulated the development of various numbers of follicles in patients treated for infertility. Graafian follicles from these patients were aspirated 32-33 h after the injection of HCG and the levels of steroids in the follicular fluid and matching serum samples were measured by radioimmunoassay. The follicles could not be grouped into two distinct clusters as found in patients given HCG during the menstrual cycle but a broad classification of follicles into four groups was indicated from the dendrogram. Two of the groups were similar to the ovulatory and non-ovulatory groups found previously, whereas the other two groups of follicles were more intermediate in nature. The use of a discriminant analysis showed that these two groups had clearly been stimulated by the HMG and HCG, although they were not yet fully ovulatory. Our data indicate that the number of developing follicles is considerably increased by treatment with HMG and HCG but there is asynchrony in follicular development because the pattern of steroid synthesis differs in many follicles. The effects of this asynchronous development on oocyte maturation and disorders of the luteal phase are discussed.

Topics: Androgens; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Follicle; Progestins

From 1964 to 1975, 320 patients with failure of ovulation were treated with human gonadotropins (human menopausal gonadotropin [HMG]/human chorionic gonadotropin [HCG]). Estimation of the pituitary and ovarian function of each patient rather than classification into clinical groups contributed positively to the selection of patients. The dosage schedules used for the patients should be considered conservative, insofar as the amount of HMG and HCG administered per treatment cycle is concerned. The response to human gonadotropins was evaluated mainly according to excretion levels of estrogen and pregnanediol. Of the 320 patients, 256 ovulated at least once during treatment with gonadotropins (80%). Ovarian hyperstimulation syndrome was encountered in 22 patients (6.8%). Pregnancy occurred in 163 patients (50.9%) and in some of them twice, so that the total number of pregnancies was 206. Fifteen pregnancies were multiple (all of them twins). Of 197 pregnancies followed, 43 ended in abortion and 36 in premature labor. Cesarian section was performed in 21 cases.

Topics: Chorionic Gonadotropin; Dose-Response Relationship, Drug; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Pregnanediol

Topics: Adult; Body Temperature; Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Diagnosis, Differential; Endometrium; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Menstruation; Pregnancy; Progesterone; Progesterone Congeners; Prolactin; Vagina

Topics: Amenorrhea; Anovulation; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

Topics: Anovulation; Female; Gonadotropins; Humans; Hypothalamus; Infertility, Female; Menotropins; Pituitary Function Tests

Topics: Anovulation; Cervix Mucus; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction

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

An infertile woman who conceived after human menopasual gonadotropin-induced ovulation experienced ovarian hyperstimulation and a quintuplet gestation--an ectopic and a quadruplet intrauterine pregnancy. The intrauterine pregnancy was confirmed by B-scan ultrasonography about the time that the tubal pregnancy was ruptured. Salpingectomy did not interfere with the intrauterine pregnancy, but in spite of a cervical cerclage the patient developed premature labor after about 26 weeks of gestation.

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Pregnancy, Tubal

Topics: Adult; Cervix Mucus; Clomiphene; Estrogens, Conjugated (USP); Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins

Topics: Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovulation

Twenty-six patients seeking advice for sterility were given courses of treatment with HMG-HCG. Ovarian maturation was followed by daily evaluation of plasma 17beta-oestradiol concentrations. HCG was administered as soon as 17beta-oestradiol levels reached 250 pg/ml. In a first group of 7 amenorrheic patients with lack of oestrogen activity, a pregnancy rate of 71.4% and an ovulation rate of 91.7% were achieved. In a second group of 5 amenorrheic patients showing evidence of oestrogen activity, a pregnancy rate of 80.0% and an ovulation rate of 100% were obtained. In a third group of 14 oligomenorrheic patients, the pregnancy rate attained 71.4% and the ovulation rate 96.9%. The overall pregnancy rate was 73.0%. With this procedure of monitoring HMG-HCG treatment by means of plasma 17beta-oestradiol levels, the multiple pregnancy rate reached only 11.7% and only one case of mild ovarian hyperstimulation was observed. Pre-ovulatory and pre-conceptional 17beta-oestradiol concentration were identical with those observed in spontaneous ovulatory cycles with or without conception.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Female; Menotropins; Oligomenorrhea; Ovulation; Pregnancy; Progesterone

Topics: Bromocriptine; Chorionic Gonadotropin; Clomiphene; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Male; Menotropins; Ovulation; Pregnancy

Ten infertile patients with polycystic ovarian disease were treated with 18 cycles of "pure" human pituitary follicle-stimulating hormone (HP-FSH) and 10 cycles of human menopausal gonadotropin (HMG) consisting of FSH and luteinizing hormone (LH) in a 1:1 ratio. Human chorionic gonadotropin was used to trigger ovulation when optimal follicular development was achieved as judged by urinary estrogen determinations. Of the 18 cycles utilizing HP-FSH, 14 were presumptively ovulatory, 2 were conceptual, and in 5 cycles ovarian enlargement was noted. Of the 10 HMG cycles, none was ovulatory, no conceptions resulted, and 6 instances of hyperstimulation were noted. Pretreatment serum LH levels were significantly higher than normal follicular phase values. These observations suggest that endogenous LH levels in patients with polycystic ovaries are quite adequate for follicular development so that the administration of exogenous LH is unwarranted. Furthermore, the data suggest that HP-FSH or low-LH-containing HMG may prove to be an additional safe and effective nonsurgical treatment modality for patients who are anovulatory because of polycystic ovaries.

Topics: Adult; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome

Ovulation induced with human menopausal gonadotropin-human chorionic gonadotropin in a 27-year-old woman who had been amenorrheic for 7 years resulted in pregnancy. Although pretreatment neurologic evaluation was normal, significant loss of vision was found at 30 weeks' gestation, and a skull x-ray revealed enlargement and erosion of the sella turcica. As an attempt to delay surgery, 12 mg of dexamethasone daily arrested further visual deterioration, and the pregnancy continued uneventful for 36 weeks, when triplets were born. Five days after delivery the visual fields were normal. Trans-sphenoidal resection of a prolactin-secreting chromophobe adenoma of the pituitary was carried out 6 months later. It is suggested that when disturbance in visual perception due to a pituitary tumor occurs during pregnancy, a course of high-dose corticosteroids with frequent monitoring of visual fields and acuity might be tried before surgical intervention. Although further rapid deterioration in vision may dictate immediate surgical decompression, conservative management may result in stabilization, allowing the patient to carry the pregnancy to term and obviating the need for emergency surgery.

Topics: Adenoma, Chromophobe; Adult; Chorionic Gonadotropin; Dexamethasone; Female; Humans; Infertility, Female; Menotropins; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Triplets; Vision Disorders; Visual Fields

A case of hyperstimulation syndrome secondary to Pergonal therapy is presented. Successful management was based principally on severe sodium and fluid restriction without the use of volume expanders. The rationale for this therapeutic approach is presented and discussed. Although this iatrogenic disease should be virtually eliminated with the monitoring of daily urinary estrogens, severe hyperstimulation may still occur as a result of laboratory error.

Topics: Adult; Anuria; Ascites; Cation Exchange Resins; Chorionic Gonadotropin; Diet, Sodium-Restricted; Estrogens; Female; Humans; Hydrothorax; Iatrogenic Disease; Infertility, Female; Menotropins; Oliguria; Ovarian Cysts; Ovarian Diseases; Pregnancy; Stimulation, Chemical; Syndrome; Water Deprivation

Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone (E1), estradiol-17beta(E2), progesterone (P), androstenedione (A), and testosterone (T) were analyzed in daily plasma samples of seven cycles of human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG) induced ovulation. Plasma FSH rose gradually and remained at a higher level (20 to 30 mlU/ml) during hMG injection while LH stayed at a low tonic level. The FSH/LH ratio of plasma gonadotropins was consistently higher than 1 in spite of injecting an hMG preparation with FSH/LH ratio of 1. A pharmacologically induced high RSH/LH ratio in the late follicular phase is contradictory to the low ratio seen in the normal ovulatory cycle. This may be one of the causes of multiple follicular maturation and ovulation frequently encountered in the hMG-hCG induced ovulation. Higher than normal levels of plasma progesterone commonly seen in the hMG-hCG induced cycle is attributed to the multiple ovulation. Plasma androgen levels, both A and T, in these therapy cycles stayed consistently within normal range. This is a strong contrast to the clomiphene induced cycle in which A and T were frequently elevated in parallel with elevated LH. No significant differences in plasma hormones were observed between the pregnant and nonpregnant patient following hMG-hCG induced ovulation. A consistent and similar ovarian response to hMG-hCG was noted in 1 individual who had 3 consecutive therapy cycles studied. The plasma hormone levels in the multiple ovulation did not show a significant difference from those in the single ovulation with the exception of a higher plasma P level in the former.

Topics: Adult; Androstenedione; Anovulation; Chorionic Gonadotropin; Estradiol; Estrone; Female; Follicle Stimulating Hormone; Gonadal Steroid Hormones; Humans; Infant, Newborn; Infertility, Female; Luteinizing Hormone; Menopause; Menotropins; Pregnancy; Pregnancy, Multiple; Progesterone; Testosterone; Triplets

In the course of sterility therapy 375 pregnancies were observed in 296 patients. 63 women conceived twice or more. At the first visite the mean age of the patients was 25,8 years, the mean duration of sterility 2,7 years. A primary sterility was observed in 207 and a secondary sterility in 98 cases. The main therapeutic procedure was the induction of ovulation with FSH/LH releasing preparations (Clomiphen, Cyclofenil, Epimestrol) (40,3%), followed by the substitution therapy with human gonadotrophins (22,7%). 78 pregnancies ended by spontaneous and 4 by artificially induced abortion. The abortion rate in this study was 20,8 %, exceeding considerably the normal abortion rate. The rate of extrauterine pregnancies was also increased, being 2,4%. There was no significant difference in the abortion rate of pregnancies with or without induction of ovulation. The age at the time of conception and the duration of therapy had no significant influence on the rate of abortions. In 293 pregnancies the duration of gestation exceeded the 28th week. However, 33,1% of these pregnancies had complications that required hospitalisation. Almost 50% of the complications consisted of threatened abortion. The mean duration of gestation was reduced by 5 days, caused by a relatively high frequency of early births (16,9%). The mode of delivery of our patients was in 68,8% spontaneous delivery, in 16,2% caesarian section, in 15,0% forceps or vacuum extractions. This corresponds to the general mode of delivery of our hospital. Only after gonadotrophin therapy a higher caesarian section rate of 26,8% was noted. Out of the 310 live born children, 9,2% had a weight below 2500 g, owing to a multiple pregnancy rate of 4,1%. 4% of the children showed the signs of dystrophia. The perinatal mortality amounted to 5,1%. However, when the gonadotrophin induced multiple pregnancies are excluded, the rate is 2,7%. Only 2 cases of malformations were observed.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Epimestrol; Evaluation Studies as Topic; Female; Humans; Infant, Newborn; Infertility, Female; Menotropins; Pregnancy

Topics: Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Infertility, Female; Luteal Phase; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovary; Pituitary Gland; Pregnancy; Pregnanediol; Progesterone; Temperature

A human embryo in transition between a morula and blastocyst after culture in vitro was reintroduced into the mother's uterus via the cervix. The resulting pregnancy was closely monitored and was found to be located in the oviduct. The ectopic embryo was removed at 13 weeks gestation.

Topics: Adult; Chorionic Gonadotropin; Culture Techniques; Embryo Implantation; Embryo, Mammalian; Ethinyl Estradiol; Female; Humans; Hydroxyprogesterones; Infertility, Female; Insemination, Artificial; Menotropins; Norethindrone; Pregnancy; Pregnancy Tests; Pregnancy, Tubal; Time Factors; Ultrasonography

To gain further insight into the mechanisms of postpartum infertility, plasma gonadotropins, prolactin, estradiol, and progesterone were measured following either iv LHRH or im menopausal gonadotropins (Pergonal) to postpartum women. Plasma estradiol and progesterone rose significantly between 24-72 hours following hMG injection. The response was similar in both nursing and non-nursing women throughout the intermediate and late postpartum study interval. No gonadotropin response was observed following LHRH injection in the early puerperium. Beyond five postpartum weeks, a significantly greater response following LHRH was observed in nursing compared with non-nursing women. A subsequent and significant rise in estradiol correlated with the magnitude of the LHRH-induced increment. Basal prolactin levels in nursing women were significantly greater than in non-nursing women but were unchanged after either hMG or LHRH. We conclude that the postpartum ovary is not refractory to either direct exogenous gonadotropin stimulation or to endogenously released gonadotropins, at least as far as estrogen production is concerned. Furthermore, the difference in the pituitary response to LHRH in nursing and non-nursing women may reflect a difference in the hypothalamic-pituitary axis. Elevated prolactin secretion in response to nursing may be involved in postpartum infertility, but the specific role remaine unclear.

Topics: Adult; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Hypothalamus; Infertility, Female; Lactation; Menotropins; Menstruation; Ovary; Pituitary Gland; Postpartum Period; Pregnancy; Progesterone

Topics: 17-Ketosteroids; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamus; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Prolactin

Topics: Adult; Amenorrhea; Anovulation; Clomiphene; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation; Ovarian Follicle; Ovary; Ovulation; Pregnancy; Progesterone

Human menopausal gonadotropin (HMG) was given to 10 patients who failed to ovulate after treatment with clomiphene citrate. Prior to one or more treatment courses, 200 mg. of clomiphene were administered daily for 5 days; at least one other treatment course was not preceded by clomiphene. Before therapy, progesterone in oil was administered and serum FSH, LH, and estrogen were measured. Those patients who had normal serum FSH levels and had withdrawal bleeding following progesterone had a reduction in amount and duration of HMG requirements for those patients with low serum FSH who did not withdraw. Thus, sequential clomiphene-HMG therapy is of benefit only for those women with normal serum FSH levels and is the treatment of choice.

Topics: Adult; Anovulation; Clomiphene; Drug Therapy, Combination; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins

To determine if elevated serum prolactin hPRL inhibits ovarian steroidogenesis and contributes to the amenorrhea associated with galactorrhea syndromes, the following study was performed. Four women with amenorrhea, galactorrhea, and elevated serum hPRL levels were treated with menopausal gonadotropins (Pergonal) for the associated infertility. Urinary estrogen response was comparable to that in normal ovulatory women in each patient. Ovulation occurred in 3 of the 4 women with resultant conception and normal pregnancies. There was no evidence to support the contention that elevated hPRL interferes with ovarian function.

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Galactorrhea; Humans; Infertility, Female; Menotropins; Ovary; Pregnancy; Prolactin

Topics: Adult; Drug Evaluation; Female; Humans; Infertility, Female; Menotropins; Pregnancy

The purpose of this study was to investigate and treat a group of patients referred for "idiopathic" infertility in whom no apparent cause for infertility, apart from inadequate cervical mucus, was found. Hormone investigations revealed that these patients could be divided into two groups: those with low sex steroid profiles despite apparent ovulation, and a second group with normal sex steroid profiles. All patients were treated with ovulation-inducing agents in an attempt to produce "controlled" ovarian hyperstimulation and an improved cervical mucus. Four of six patients conceived. The rationale behind the use of ovulation-inducing agents in this situation is discussed.. This study investigated and treated 6 women ages 24-37 years with unexplained infertility. Pretreatment investigations included basal body treatment recording, serial estradiol and progesterone assays, thyroid and adrenal function tests, cervical swab for culture, assessment of cervical mucus, a postcoital test prior to or during midcycle, laparoscopy and dye hydrotubation during the follicular phase of the cycle, and endometrial biopsy. The only abnormal features detected were the cervical mucus findings and sex steriods profiles. The cervical mucus was scant or absent at midcycle in 4 patients. All patients were treated with human menopausal gonadotropin (HMG) from day 3 of the menstrual cycle until an estradiol level of 1000-1500 pg/ml was achieved, at which point a single injection of 10,000 U of human chorionic gonadotropin (HCG) was administered. Clomiphene citrate was given to patients who did not respond to this regimen. 4 of the patients (including 1 treated with HMG alone and 3 treated with clomiphene and HMG) conceived during the treatment period. Cervical mucus improved in both quantity and quality and the postcoital tests became strongly positive, showing more than 20 motile sperm/high power field. These results suggest that treatment with ovulation-inducing agents can correct both poor follicular development and inadequate cervical stimulation in women with idiopathic infertility. HMG or a combination of clamiphene citrate and HMG is preferred to clamiphene citrate alone because the latter regimen may have an adverse effect on cervical mucus.

Topics: Adult; Cervix Mucus; Clomiphene; Estradiol; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins

Topics: Cervix Uteri; Chorionic Gonadotropin; Clomiphene; Cyclofenil; Female; Follow-Up Studies; Humans; Infertility, Female; Infertility, Male; Male; Marriage; Menotropins; Pregnancy

Seventy-nine previously infertile women were studied during the first 9 weeks of their pregnancies. Pregnancy had occurred either without any specific therapy or following treatment with clomiphene, prednisone, or human chorionic gonadotropin, singly or in various combinations. Serum levels of progesterone, 17 alpha-hydroxyprogesterone, and estradiol were measured at 2-week intervals. A profile of early pregnancy in terms of these hormones is presented and discussed with regard to its significance for corpus luteum function. Aspects of the hormonal profile predictive of the pregnancy outcome are noted. Ovarian over-stimulation was directly related to the dosage of clomiphene, and the increased levels of 17 alpha-hydroxyprogesterone thus produced persisted into the seventh week of pregnancy. This hormonal excess probably derives from multiple corpora lutea which may also account for the increased incidence of multiple pregnancy associated with clomiphene therapy.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Drug Therapy, Combination; Estradiol; Female; Humans; Hydroxyprogesterones; Infertility, Female; Menotropins; Prednisone; Pregnancy; Progesterone

Topics: Clomiphene; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation; Progesterone Congeners

In an effort to diminish the incidence of multiple pregnancy, ovarian hyper-stimulation syndrome, and the excessive cost of human menopausal gonadotropin (HMG) administration, a sequence of Clomid-HMG-human chorionic gonadotropin (HCG) was used in 80 patients with infertility due to prolonged amenorrhea. Criteria for this therapeutic regimen were: (1) normal seminal fluid analysis and postcoital test; (2) lack of withdrawal bleeding from progesterone following amenorrhea of more than 6 months' duration; (3) normal x-ray of the sella turcica and visual fields; (4) low serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels; (5) normal endoscopic examination; and (6) lack of response to clomiphene in excessive dose (200 mg daily for 5 days) or prolonged dose (100 mg daily for 10 days) with or without HCG, or apparent ovulatory response to the above sequence for five or six consecutive cycles without pregnancy. Clomiphene was administered in a dose of 100 mg daily for 7 days. HMG was then given in the following manner: two ampules daily for 4 days, then one ampule daily for 2 days (75 IU of FSH and 75 IU of LH/ampule). After a 24-hour interval without treatment, 10,000 IU of HCG were given and 2000 IU of HCG 4 days later. Twenty-three pregnancies occurred in 80 patients. However, 15 of the first 25 patients became pregnant--in these patients the only abnormality noted was lack of ovulation. Six additional pregnancies occurred subsequent to one or more unsuccessful cycles. Multiple pregnancies occurred in only two patients (twins delivered at 32 weeks in one and an abortion of five fetuses at 20 weeks in another). However, multiple pregnancy did not occur in any patient whose urinary estrogen level was monitored and in whom the level was 100 mug or less when the HCG was given. The ovarian hyperstimulation syndrome did not occur in any patient.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

Human ovarian responses to FSH- and LH-releasing hormone (FSH/LH-RH) were observed at laparotomy and studies by histologic and histochemical examination of ovarian biopsy specimens. The responses were compared to those induced by human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) singly and together. The subjects were healthy, fertile, young women rendered anovulatory by injections of depomedroxyprogesterone acetate (DMPA) or depochlormadinone acetate (CA). Supplementary studies included measurement of urinary pregnanediol, examination of the cervix and vagina for estrogenic and progestational responses, and endometrial biopsy, Both HMG and HCG induced follicular growth and proliferation of granulosa and theca cells, but neither, when given alone, induced ovulation or corpus luteum formation. When given in conjunction they induced single or multiple ovulations and corpora lutea in 11 of 18 women treated. FSH/LH-RH CONSISTENTLY STIMULATED FOLLICULAR DEVELOPMENT AND INDUCED OVULATION IN 2 OF 16 WOMEN TREATED. Preovulatory mature follicles were found in 3 more. FSH/LH-RH may prove to be useful in the treatment of some cases of anovulatory sterility of hypothalamic origin.

Topics: Adult; Biopsy; Chlormadinone Acetate; Chorionic Gonadotropin; Corpus Luteum; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Injections, Intramuscular; Laparotomy; Medroxyprogesterone; Menotropins; Ovary; Ovulation; Pregnanediol

This report provides a detailed description of a method by which mature or maturing human oocytes can safely be recovered by follicular aspiration during laparoscopy. By combining gonadotropin administration with laparoscopic recovery, oocytes which have resumed or completed meiotic division can be obtained for study without subjecting the patient to more hazardous surgical procedures. Fifteen oocytes were obtained from sixteen patients. On electron microscopic examination, four were found to have extruded polar bodies and were therefore classified as mature. Daily rather than intermittent administration of HMG, larger HMG dose, longer HCG aspiration intervals, and controlled aspiration pressures appeared to be the factors which produced the best yield of mature oocytes.

Topics: Adult; Blastocyst; Carbon Dioxide; Chorionic Gonadotropin; Chromatin; Chromosomes; Female; Follicle Stimulating Hormone; Humans; In Vitro Techniques; Infertility, Female; Laparoscopy; Luteinizing Hormone; Menotropins; Microscopy, Electron; Microtubules; Ovum; Postoperative Complications

The authors report a case of amenorrhoea with galatorrheoa due to a prolactin adenoma secondary to an inducer of ovulation (HMG and HCG) and in which pregnancy occurred. There was sudden progression of the adenoma with formation of a haematoma and the necessity for emergency surgery. In the light of this case, the risks and indications of inducers of ovulation in the sterile woman complaining of amenorrhoea with galactorrhoea are discussed.

Topics: Adenoma; Adult; Amenorrhea; Chorionic Gonadotropin; Female; Fertility Agents, Female; Galactorrhea; Humans; Hypophysectomy; Infertility, Female; Menotropins; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Prolactin; Radiography; Sella Turcica

Ovulation has been induced by clomiphene citrate and human gonadotropins in infertile women. Clomiphene should be the first choice in anovulatory women with active ovaries as indicated by basic levels of estrogens in blood or urine, in women with post-pill amenorrhea even if their ovaries are quiescent and in women with functional abnormalities of the hypothalamus or pituitary. Human gonadotrophins should be used as a second alternative when clomiphene fails. It should also be used as a first choice in women with primary amenorrhea and quiescent ovaries and in women with gross anatomical changes in the pituitary or hypothalamus. If no result is obtained after two courses of gonadotropic therapy, further treatment should be reconsidered and the infertile couple reinvestigated.

Topics: Adult; Amenorrhea; Anovulation; Clomiphene; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Infertility, Female; Menotropins; Polycystic Ovary Syndrome; Pregnancy

Ten patients with hypothalamic anovulation weretreated with a "retard" preparation of synthetic luteinizing hormone releasing hormone (LHRH) after an HMG stimulation in order to induce ovulation and pregnancy. Four of the patient ovulated after intramuscular administration of the LHRH preparation. This study suggests that is is possible to induce ovulation with LHRH in patients pretreated with HMG, and that LHRH has advantages over HCG since it does not induce hyperstimulation even in the presence of exagerated follicular growth. Nevertheless, the optimal conditions for the use and monitoring of LHRH treatment have yet to be clarified.

Topics: Adult; Amenorrhea; Anovulation; Estradiol; Female; Follicle Stimulating Hormone; Galactorrhea; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Pregnancy; Progesterone; Radioimmunoassay

The 5 general types of hormonal treatment of female and male sterility reviewed here are gonadotropins, gonatoropin-releasing hormone, clomiphine, cyclophenil, and epimestrol. One must 1st diagnose whether a woman is sterile at the ovarian, hypothalamic, or pituitary level, whether she is amenorrheic, menstruating and ovulating or not. Usually human menopausal gonadotropin (HMG) is given for 12 days, then human chorionic gonadotropin (HCG) to incude ovulation. Doses must be regulated to achieve a ratio of luteinizing hormone/follicle stimulating hormone (LH/FSH) of less than 1 in the beginning of the cycle, up to 2 at ovulation, or results can be assessed clinically by vaginal smear, cervical mucus, and ovarian size. Usually pregnancy occurs within 1-3 months, but seldom after 6 months of treatment. LH-releasing hormone (RH) has been used since 1970 after a course of HMG, with variable results. Estrogens are effective in some anovulatory women. Clomiphine is the most effective fertility drug: 50-150 mg is given for 3-5 days, followed by HCG. Cyclofenil, 3-methoxy-17-epi-estriol, and Sexovid are slightly less effective, but produce fewer side effects and cases of hyperstimulation than clomiphine. Methods used for men include gonadotr opins, clomiphine and LH-RH, with variable results depending on the caus e of their infertility.

Topics: Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Menotropins

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Ergot Alkaloids; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Tamoxifen

Topics: Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

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

Coagulation and fibrinolytic profiles have been studied in two groups of sterility patients receiving low dosage regimens of human gonadotropins for ovarian stimulation. This investigation was prompted by a report of two patients with severe episodes of intravascular coagulation associated with periods of "hyperstimulation" from these drugs. No statistically significant changes were found as a result of administration of one ampoule of human menopausal (HMG) or pituitary gonadotropins (HPG) for 8 days followed by 9000 units of human chorionic gonadotrophin (HCG). A course of 2-3 ampoules HMG on alternate days for longer periods of time prior to administration of HCG also failed to produce significant alterations of the coagulation or fibrinolytic mechanisms. In two patients with severe hyperstimulation there were elevated levels of factor V, platelets, fibrinogen, profibrinolysin, and fibrinolytic inhibitors. Generation of thromboplastin was also increased when plasma was diluted one to fifty in the thromboplastin generation test. These results suggest a possibly increased coagulation potential in patients with "hyperstimulation syndrome" but not in those receiving the low dosage regimens of human gonadotropins more commonly used for ovarian stimulation at the present time.

Topics: Blood Coagulation; Blood Coagulation Factors; Blood Coagulation Tests; Chorionic Gonadotropin; Estrogens; Factor V; Female; Fibrinogen; Fibrinolysis; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility, Female; Meigs Syndrome; Menotropins; Progestins; Thromboplastin; Thrombosis; Time Factors

Eighteen patients hospitalized for excessive ovarian hyperstimulation syndrome are reported. In 14 cases the ovarian hyperstimulation was induced by human menopausal -onadotropins and in 4 cases by combined treatment with clomiphene and HCG. In 5 patients the hyperstimulation was associated with conception, which resulted in 1 quintuplet delivery, 1 early quintuplet abortion, 1 twin abortion, 1 normal delivery, and 1 missed abortion. The regimen of treatment was a conservative one. The patients were hospitalized and treated with infusion of plasma expanders. Anticoagulant therapy was administered only in cases that showed clinical evidence of thromboembolic pheomena or laboratory evidence of severe hemoconcentration. The pathogenesis of the ovarian hyperstimulation syndrome, prevention, and management are discussed. This syndrome should be diagnosed early and treated intensively.

Topics: Abdomen, Acute; Adult; Anovulation; Ascites; Body Fluids; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Iatrogenic Disease; Infertility, Female; Menotropins; Menstruation Disturbances; Ovarian Cysts; Ovarian Diseases; Ovary; Plasma Substitutes; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Syndrome

Eight hMG-hCG therapy cycles in 6 anovulatory infertile patients are presented. Daily plasma estrogen monitoring during the therapy contributed to success in inducing ovulation in all 6, 3 of whom established pregnancies and delivered healthy babies. The duration of hMG therapy required varies among individuals. Duration and dosage can be determined on the basis of daily plasma estrogen levels. Administration hCG is recommended to trigger ovulation when these levels reach 300 to 600 pg/ml. Although success in ovulation induction and pregnancy is achievable, multiple ovulation and multiple pregnancy cannot be predicted or prevented.

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Estrogens; Female; Follicle Stimulating Hormone; Humans; Hypogonadism; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Ovulation Detection; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Progesterone

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Female; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Methods; Radioimmunoassay

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

Topics: Adult; Age Factors; Amenorrhea; Biopsy; Brain Neoplasms; Chorionic Gonadotropin; Endometrium; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovary; Pregnancy; Stimulation, Chemical

Topics: Amenorrhea; Chorionic Gonadotropin; Estradiol; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation; Periodicity; Pregnanediol; Progesterone; Time Factors

Topics: Adult; Binding, Competitive; Chorionic Gonadotropin; Estradiol; Estrone; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Injections, Intramuscular; Menotropins; Menstruation; Ovulation; Periodicity; Pregnancy; Pregnanediol; Progesterone; Protein Binding

Topics: Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy

Topics: Adult; Ascites; Female; Humans; Infant, Newborn; Infertility, Female; Male; Menotropins; Ovarian Diseases; Pregnancy; Pregnancy Complications, Hematologic; Pulmonary Embolism; Thrombophlebitis

Topics: Adult; Amenorrhea; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Topics: Body Temperature; Cervix Mucus; Estrone; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Pregnanediol; Regression Analysis; Twins

Topics: Cells, Cultured; Chorionic Gonadotropin; Embryo Implantation; Embryonic and Fetal Development; Female; Fertilization; Humans; Infertility, Female; Luteinizing Hormone; Male; Menotropins; Ovarian Follicle; Ovulation; Ovum; Pregnancy; Progesterone; Spermatozoa

Topics: Adult; Amenorrhea; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Injections, Intravenous; Luteinizing Hormone; Menotropins; Ovary; Ovulation; Pregnancy; Progesterone; Stimulation, Chemical

Topics: Basal Metabolism; Clomiphene; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation

Topics: Drug Evaluation; Drug Interactions; Drug Therapy, Combination; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intravenous; Luteinizing Hormone; Menotropins; Methods; Ovulation; Premedication; Radioimmunoassay; Stimulation, Chemical; Time Factors

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Gland; Polycystic Ovary Syndrome; Pregnancy

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Cyclofenil; Estrogens; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Gonadotropins, Equine; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Tamoxifen

Topics: Chorionic Gonadotropin; Estradiol; Estrone; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnanediol; Progesterone

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Ovulation; Radioimmunoassay; Time Factors

Topics: Chorionic Gonadotropin; Female; Humans; Hypothalamo-Hypophyseal System; Infertility, Female; Menotropins; Progesterone

Topics: Amenorrhea; Birth Weight; Cesarean Section; Chorionic Gonadotropin; Female; Gestational Age; Humans; Infant Care; Infant, Newborn; Infertility, Female; Male; Menotropins; Organ Size; Placenta; Pregnancy; Pregnancy, Multiple; Prenatal Care

Topics: Adult; Arthritis; Clomiphene; Familial Mediterranean Fever; Female; Humans; Hysterosalpingography; Infertility, Female; Intestinal Obstruction; Laparoscopy; Menotropins; Ovarian Diseases; Ovulation; Peritonitis; Physical Examination; Pregnancy; Time Factors; Uterine Diseases

Topics: Adenoma, Acidophil; Adenoma, Chromophobe; Adult; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Hydrocortisone; Infertility, Female; Injections, Intramuscular; Menotropins; Ovulation; Pituitary Neoplasms; Postoperative Complications; Pregnancy; Progesterone; Thyroid Hormones

Topics: Chorionic Gonadotropin; Clomiphene; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovulation; Prednisone; Pregnancy; Progesterone; Stimulation, Chemical

Topics: Clomiphene; Endometriosis; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Uterine Cervical Incompetence; Uterine Neoplasms

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Injections, Intravenous; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Function Tests; Pituitary Hormone-Releasing Hormones; Radioimmunoassay; Time Factors

Topics: Adult; Amenorrhea; Cervix Mucus; Clomiphene; Female; Humans; Infertility, Female; Infusions, Parenteral; Injections, Intramuscular; Injections, Subcutaneous; Luteinizing Hormone; Menotropins; Ovulation; Pituitary Hormone-Releasing Hormones; Pregnancy; Time Factors; Vaginal Smears

Topics: Administration, Oral; Animals; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hypothalamus; Infertility, Female; Luteinizing Hormone; Medroxyprogesterone; Menotropins; Menstruation Disturbances; Ovary; Ovulation; Pituitary Gland; Pituitary Hormone-Releasing Hormones; Pregnancy; Pregnancy, Multiple

Topics: Adult; Clomiphene; Cyclofenil; Epimestrol; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; Pregnenediones; Stimulation, Chemical

Topics: Amenorrhea; Ascites; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovary; Ovulation; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Triplets; Twins; Vaginal Smears

Topics: Chorionic Gonadotropin; Corpus Luteum; Female; Humans; Infertility, Female; Menotropins; Pregnanediol; Progesterone

Topics: Amenorrhea; Cervix Mucus; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Progesterone; Stimulation, Chemical

Topics: Adult; Amenorrhea; Body Temperature; Clomiphene; Contraceptives, Oral; Female; Fertilization; Follicle Stimulating Hormone; Hirsutism; Humans; Hypothalamus; Infertility, Female; Lactation Disorders; Luteinizing Hormone; Menotropins; Ovulation; Polycystic Ovary Syndrome; Pregnancy; Prognosis; Radioimmunoassay

Topics: Adult; Animals; Chorionic Gonadotropin; Estriol; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Infertility, Female; Menorrhagia; Menotropins; Menstruation Disturbances; Mice; Pregnancy; Pregnanediol; Time Factors

Out of 210 women seen at the Middlesex Hospital with secondary amenorrhoea the 63 who developed it after stopping oral contraceptives were fully investigated. Five had organic disease sufficient to account for the amenorrhoea (one had severe diabetes, one a pituitary tumour, and three premature ovarian failure); two patients had galactorrhoea (one of whom also had the pituitary tumour); two had anorexia nervosa.Of the 63 women 40 (63%) had suffered from amenorrhoea or prolonged or irregular menstrual cycles before taking the pill, and this suggested that combined oestrogen-progestogen oral contraceptives should be used with caution for women with irregular menstruation.Nineteen patients wished to become pregnant and 12 have so far done so after treatment with clomiphene or gonadotrophins.In another study 204 women recorded when their first menstrual cycle occurred after stopping the pill. Seventy-four had a cycle longer than five weeks but only five exceeded three months, and only one of the five had more than six months' amenorrhoea. These results confirm that the incidence of amenorrhoea after stopping oral contraceptives is low.

Topics: Adult; Affective Symptoms; Amenorrhea; Clomiphene; Contraceptives, Oral; Diabetes Complications; Estrogens; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovarian Diseases; Pituitary Neoplasms; Progestins; Prospective Studies; Time Factors

Topics: Cervix Mucus; Chorionic Gonadotropin; Endometrium; Epithelium; Fallopian Tubes; Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins; Ovary; Ovulation; Pregnancy; Uterus; Vagina

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Menstruation; Ovulation; Pregnadienediols; Pregnancy

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Injections; Menotropins; Methods; Ovulation; Pregnancy; Statistics as Topic

Topics: Adolescent; Adult; Amenorrhea; Capillary Permeability; Chiari-Frommel Syndrome; Female; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Hypopituitarism; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Stimulation, Chemical

The results obtained in 250 patients treated with preparations that induce ovulation are reported. 212 were treated with clomiphene citrate, obtaining ovulation in 86.3% of the cases and 32.2% pregnancies; 12 of the 68 pregnancies ended in abortion; 2 (2.9%) produced twins; all the babies delivered were normal. Success depends on the cause of the prior absence of ovulation, and specifically on the estrogen level, with very good results with high estrogen level and very poor results when it is low. The drug is very well tolerated, with slight side effects in only 10% of the cases and without need for special treatment. 27 patients were treated with gonadotropins from menopausal women (Pergonal), with ovulation in 74.1% and pregnancy in 29.6% of the cases; 2 out of 8 pregnancies were multiple (with 2 and 3 products). 11 cases were treated with corticoids, obtaining 72.7% ovulation and 27.3% pregnancy rates. The luteinizing hormone (LH) curve should be determined in order to select the proper treatment; cases with a normal LH curve should be treated with clomiphene; gonadotropins should be used when LH is absent; neither treatment is appropriate when LH is normal without ovarian response; corticoids are indicated in case of excessive excretion of male hormones.

Topics: Adrenal Cortex Hormones; Clomiphene; Drug Evaluation; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Tablets

Topics: Adult; Female; Humans; Infertility, Female; Menotropins; Middle Aged; Ovulation; Ovum

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

Topics: Abortion, Habitual; Adult; Chorionic Gonadotropin; Chromosome Aberrations; Chromosome Disorders; Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Menotropins; Pregnancy

Topics: Clomiphene; Cyclofenil; Female; Fertility Agents; Humans; Infertility, Female; Menotropins; Ovulation; Phenols; Stimulation, Chemical

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Delivery, Obstetric; Female; Humans; Infertility, Female; Menotropins; Ovulation; Pregnancy; Pregnancy, Multiple; Pregnancy, Tubal

Topics: Amenorrhea; Female; Fertilization; Humans; Infertility, Female; Menotropins; Ovulation; Polycystic Ovary Syndrome; Pregnancy; Pregnancy, Multiple; Retrospective Studies

Topics: Adult; Biopsy; Corpus Luteum; Endometrium; Female; Humans; Infertility, Female; Insemination, Artificial; Menotropins

Topics: Amenorrhea; Animals; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; Rats

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Gonadotropins; Humans; Infertility, Female; Menotropins; Ovary; Ovulation; 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

Topics: Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases

Topics: Abortion, Missed; Adult; Chorionic Gonadotropin; Clomiphene; Embryo Implantation; Female; Gestational Age; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Methods; Ovulation; Pregnancy; Pregnancy Tests; Radioimmunoassay

Topics: Adult; Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Ovulation; Pregnanediol; Time Factors

Topics: Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility; Infertility, Female; Menotropins; Ovulation

Topics: Amenorrhea; Atrophy; Endometrium; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility; Infertility, Female; Menotropins