menotropins and Infertility

None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.

Topics: Adolescent; Adult; Biomarkers; Drug Administration Schedule; Drug Therapy, Combination; Embryo Transfer; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Male; Menotropins; Middle Aged; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome; Young Adult

To determine the predictive factors for pregnancy after IUI.. Retrospective study.. A single university medical center.. One thousand thirty-eight IUI cycles in 353 couples were studied between 2002 and 2005.. Ovarian stimulation via SC injection of FSH or hMG was performed daily; IUI was then performed 36 hours after triggering ovulation if at least one follicle measuring >16 mm and an endometrial thickness of >7 mm (with triple-line development) were obtained.. Clinical pregnancy rates were analyzed according to the woman's age, the type of infertility, the spermogram characteristics, the total motile spermatozoa (TMS) count, the E(2) level before hCG injection, and the number of mature follicles.. The couple with the best chance of pregnancy can be described as follows: an under 30 woman with cervical or anovulatory infertility and a man with a TMS >or=5 million spermatozoa. The "ideal" stimulation cycle enables the recruitment of two follicles measuring >16 mm with an E(2) concentration >500 pg/mL on the day of hCG administration. The best results are obtained when IUI is performed using a soft catheter.. This study enabled the characterization of many prognostic factors for pregnancy and particularly those for women at risk of multiple pregnancies after IUI.

Topics: Adult; Age Factors; Biomarkers; Chorionic Gonadotropin; Equipment Design; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Injections, Subcutaneous; Insemination, Artificial; Logistic Models; Male; Menotropins; Odds Ratio; Ovulation Induction; Predictive Value of Tests; Pregnancy; Pregnancy Rate; Retrospective Studies; Risk Assessment; Risk Factors; Sperm Count; Sperm Motility; Spermatozoa; Treatment Outcome; Twins

Human menopausal gonadotrophins and recombinant human follicle stimulating hormone are the two main gonadotrophin products utilized for controlled ovarian stimulation in assisted reproductive technologies. In this meta-analysis, the number of oocytes was designated as the most relevant endpoint directly resulting from ovarian stimulation, and therefore where the drug effect may be estimated with the best sensitivity.. All published randomized controlled trials on ovarian stimulation comparing the two gonadotrophin products were evaluated. Internal validity was determined using Chalmers' validated scale. If trials did not meet the established quality criteria, a sensitivity analysis assessed the stability of the results. The comparison of continuous variables was conducted following the weighted mean difference and the standardized mean difference (Cohen's effect size) with the random model. Given the known relationship of baseline conditions on treatment endpoints, results were adjusted for age, body mass index and type of infertility.. Sixteen studies involving 4040 patients were included. Treatment with human menopausal gonadotrophins resulted in fewer oocytes (-1.54; 95% CI: -2.53 to -0.56; P < 0.0001) compared to recombinant human follicle-stimulating hormone. When adjusting for baseline conditions, the mean difference estimate was -2.10 (95% CI: -2.83 to -1.36; P < 0.001). A higher total dose of human menopausal gonadotrophin was necessary (mean difference, 235.46 IU [95% CI: 16.62 to 454.30; P = 0.03]; standardized mean difference, 0.33 [95% CI: 0.08 to 0.58; P = 0.01]). The pregnancy absolute risk difference (RD [hMG-r-hFSH]) for fresh transfers was 3% (P = 0.051), and the relative risk 1.10 (P = 0.06). When adjusted for baseline conditions, the relative risk was 1.04 (P = 0.49) and absolute difference was 0.01 (P = 0.34), respectively.. Because baseline conditions are predictive of outcome, meta-analytic results are more sensitive when these variables are considered. Using an endpoint closely associated with the stimulation period, sufficient sensitivity is achieved to compare gonadotrophin treatments. As the largest meta-analysis published to date on this subject, treatment with human menopausal gonadotrophins is characterized by fewer oocytes and a higher total dose. When considering only fresh transfers, pregnancy rates were similar.

Topics: Cell Count; Dose-Response Relationship, Drug; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility; Menotropins; Menstrual Cycle; Oocytes; Ovulation Induction; Pregnancy; Recombinant Proteins; Reproductive Techniques, Assisted; Treatment Outcome

The risks of menotropin therapy (ovarian hyperstimulation syndrome, multiple gestation, adnexal torsion) are well known and have been previously described. Superovulation should not be considered for the indications described herein until more traditional therapies for infertility have been tried and found unsuccessful and sufficient time has elapsed for conception to occur. The cost of superovulation is high: the medications are expensive, frequent E2 monitoring and US studies are costly, and pregnancy complications relating to the higher rate of pregnancy loss and multiple gestation may add substantially to the overall cost. Yet, compared with IVF and GIFT, superovulation cycles combined with IUI cost between one third to one sixth that of an IVF cycle. Protocols involving combined CC/hMG/hCG, which reduce the total number of ampules of Pergonal needed per cycle and still provide multiple follicular development, may further reduce costs. There is a growing consensus that superovulation-IUI protocols should be attempted before GIFT and IVF in couples with normal pelvic viscera. There is little doubt that IVF and GIFT cycles are more costly, stressful, and complex. No comparative data have clearly shown IVF and GIFT to be superior to superovulation protocols in ovulatory women with normal pelvic anatomy. In the only study examining this issue published to date, Kaplan et al. retrospectively analyzed all GIFT and superovulation/IUI cycles at a single university center and found GIFT to be three times more efficient. However, the inherent limitations of a nonrandomized, nonprospective study of this kind are obvious as these authors have suggested. Therefore, it may be wise to consider the use of superovulation before assisted reproductive technologies until this issue is settled. It would be interesting to determine if the high PRs reported for couples with unexplained infertility or mild endometriosis in IVF and GIFT cycles in some centers not incorporating superovulation/IUI protocols would hold up if such an approach was routinely followed. Despite the increasing acceptance of superovulation protocols, we must be aware that many of the studies suggesting a role of hMG in treating ovulatory infertile women with normal pelvic anatomy suffer from deficiencies in experimental design. In a payor-driven system, such as in the United States, the difficulties in designing and carrying out scientifically sound clinical studies examining infertility therapies are

Topics: Female; Humans; Infertility; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Superovulation

Based on preliminary reports by others and by us of a potentiating effect of growth hormone (GH) on human menopausal gonadotropin (hMG)-induced ovulation, a study using a randomized, prospective, cross-over protocol between GH + hMG/human chorionic gonadotropin (hCG) and hMG/hCG was undertaken. The study included patients with long-standing (2-11 years) unexplained infertility with a negative or reduced GH response to clonidine (up to 150 micrograms of clonidine orally). The first cycle was randomly assigned between GH/hMG/hCG (study cycle) and hMG/hCG alone (control cycle), and after an interval cycle the patient's treatment was crossed over. All patients who completed the study had previously undergone 1-20 attempts at ovulation induction for in vitro fertilization (IVF) and 5-40 cycles of ovulation induction for in vivo fertilization at three different medical centers. Three patients conceived on the combined GH/hMG cycle, with diminution in the hMG consumption needed for ovulation induction in the study cycles. Another patient with long-standing mechanical infertility underwent 11 abortive attempts at ovulation induction with hMG for IVF but has never achieved egg retrieval. On the GH/hMG/hCG ovulation induction cycle, three mature ova were retrieved as opposed to no response and cancellation of the "hMG only" cycle. Another patient with 11 years of primary infertility who had undergone 21 previous attempts at ovulation induction and had reached follicular aspiration in only three of those cycles conceived spontaneously on the first cycle after the GH/hMG/hCG IVF/ET cycle. All four pregnancies that have been achieved by now in seven GH/hMG-treated patients ended in cesarean deliveries of four normal male neonates. No correlation was found between the follicular fluid levels of insulin-like growth factor I (IGF-I) and the fertilization rate in vitro. The peripheral IGF-I levels were significantly higher during the follicular phase of the study cycles than during the respective stage of the control cycles or the luteal phase of either cycle. A study of serum GH-binding protein (GH-BP) levels revealed gradual increases in the late follicular phase, in the luteal phase, and in early pregnancy. On the basis of this study and in keeping with earlier reports, we conclude that the addition of GH to hMG/hCG may serve as a contributory adjunct in selected patients. However, in contrast to others who could not find a correlation between the response to acute tes

Topics: Adult; Carrier Proteins; Chorionic Gonadotropin; Clonidine; Drug Synergism; Female; Fertilization; Gonadotropins; Growth Hormone; Humans; Infertility; Insulin-Like Growth Factor I; Menotropins; Pregnancy

Fecundity rates were measured for 302 patient-couples in 991 cycles of intrauterine insemination (IUI) between January 1984 and December 1986 in terms of the diagnoses and whether human menopausal gonadotropin (hMG) was also employed. Those rates were compared with the fecundity rates in 255 of the couples followed in 2,668 untreated cycles. IUI was most beneficial for cervical factor infertility, with a monthly yield of 0.11 in conjunction with hMG and for poor postcoital tests in general but was less impressive when seminal parameters were abnormal. The addition of hMG when ovulation was normal (as an independent variable) did not yield results statistically superior to those of IUI alone (fecundity = 0.06 versus 0.03), but the addition of hMG to the regimen gave an improvement over IUI alone when endometriosis had been diagnosed and in the presence of cervical factor infertility. One serious side effect of therapy was a pelvic abscess, which required hospitalization but not surgery.

Topics: Adult; Clomiphene; Female; Fertility; Humans; Infertility; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins

Topics: Chorionic Gonadotropin; Clomiphene; Fertilization in Vitro; Follicle Stimulating Hormone; Hormones; Humans; Infertility; Luteinizing Hormone; Menotropins

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

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

Progress in vitrification techniques has allowed reproductive physicians to consider new strategies for using progestin as an alternative to a GnRH analogue to improve in vitro fertilisation (IVF). However, the role of progestin in blocking luteinising hormone (LH) surges and its potential in clinical practice are unclear, especially for poor responders. We designed a prospective randomised controlled trial (RCT) to compare the efficacy of a gonadotropin-releasing hormone (GnRH) antagonist and progestin in blocking LH surges and premature ovulation in poor responders.. Poor responders who meet the Bologna criteria will be randomised to one of two stimulation regimens-gonadotropin-releasing hormone (GnRH) antagonist or progestin-primed ovarian stimulation (PPOS)-using a computer-generated random number. Fresh embryos were transferred in the GnRH antagonist group and frozen embryos were transferred in the PPOS group. The primary outcome is the incidence of premature LH surges. Secondary outcomes include the number of oocytes retrieved, the number of embryos available for transfer, implantation rates and clinical pregnancy. The sample size for this trial is estimated as 340 participants, with 170 participants in each group. The data analysis will be by intention to treat.. To our knowledge, this is the first RCT to examine the efficacy of administering progestin orally to block LH surges and premature ovulation compared with the GnRH antagonist protocols in poor responders undergoing IVF treatment.. www.chictr.org.cn . ChiCTR-IPR-17010906 . Registered on 18 March 2017.

Topics: Administration, Oral; Adult; Biomarkers; China; Clinical Protocols; Cryopreservation; Embryo Implantation; Embryo Transfer; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Luteinizing Hormone; Male; Medroxyprogesterone Acetate; Menotropins; Oocyte Retrieval; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Progesterone Congeners; Prospective Studies; Research Design; Sperm Injections, Intracytoplasmic; Treatment Outcome; Young Adult

To evaluate endocrine characteristics and clinical outcomes in normal ovulatory patients undergoing controlled ovarian hyperstimulation (COH) with the use of a Duphaston and hMG protocol during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments in combination with frozen-thawed embryo transfer (FET) compared with the characteristics and outcomes of patients undergoing an Utrogestan and hMG protocol.. Prospective controlled study.. Tertiary care academic medical center.. A total of 250 infertile patients undergoing IVF/ICSI treatments.. Duphaston (20 mg/d) or Utrogestan (100 mg/d) was taken orally from cycle day 3 until the trigger day, with hMG (150-225 IU) administered when appropriate. When the dominant follicles reached maturity, 0.1 mg GnRH agonist was used as the trigger. Viable embryos were cryopreserved in both protocols for transfer at a later time.. The primary outcome was the number of oocytes retrieved. Secondary outcomes included the incidence of premature LH surge, the number of viable embryos, and clinical pregnancy outcomes from FET cycles.. Consistent LH suppression was achieved during COH. None of the participants experienced a premature LH surge. The number of oocytes retrieved (8.22 ± 5.46 vs. 8.8 ± 5.62) was similar between the two groups. No between-group significant differences were observed in the number of mature oocytes (7.2 ± 4.72 vs. 6.98 ± 4.68), fertilized oocytes (6.16 ± 4.34 vs. 6.32 ± 4.23), and viable embryos (2.96 ± 2.22 vs. 3.4 ± 2.54). Furthermore, the clinical pregnancy rates (53.04% vs. 51.7%), early miscarriage rates (8.2% vs. 11.84%), implantation rates (38.68% vs. 35.71%), and cumulative pregnancy rates per woman (66.67% vs. 69.47%) were also similar.. Duphaston administration during COH was similar to Utrogestan in the prevention of LH surge, embryonic characteristics, and pregnancy outcomes.. ChiCTR-IOR-15007265.

Topics: Adult; China; Combined Modality Therapy; Cryopreservation; Drug Therapy, Combination; Dydrogesterone; Female; Fertilization in Vitro; Humans; Infertility; Luteinizing Hormone; Menotropins; Oocyte Retrieval; Ovulation Induction; Pregnancy; Pregnancy Outcome; Sperm Injections, Intracytoplasmic; Young Adult

To compare the clinical characteristics in a Utrogestan and hMG protocol with the use of different doses of Utrogestan in normally ovulating women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments.. Prospective controlled study.. Tertiary-care academic medical center.. A total of 150 infertile patients undergoing IVF/ICSI treatments.. Utrogestan and hMG were administered simultaneously beginning on cycle day 3. The dose of Utrogestan was 100 mg/d in the study group and 200 mg/d in the control group. When the dominant follicles reached mature, 0.1 mg GnRH agonist was used for trigger. Viable embryos were cryopreserved in both protocols for later transfer.. The primary outcome measure was the incidence of premature LH surge. Secondary outcomes included the embryo results and clinical pregnancy outcomes.. Consistent LH suppression was achieved during controlled ovarian hyperstimulation with Utrogestan at 100 mg, and the number of patients with profound LH suppression (LH <1.2 IU/L) in the low-dose group was significantly less than that in the high-dose group. The number of oocytes retrieved in the low-dose group was similar to that in the high-dose group (9.87 ± 5.77 vs. 10.25 ± 5.43). No significant differences were observed in the number of mature oocytes, viable embryos, clinical pregnancy rate, or implantation rate.. Utrogestan at 100 mg is as effective as Utrogestan at 200 mg in reducing premature LH surge during controlled ovarian hyperstimulation.. ChiCTR-OOC-14005277.

Topics: Adult; Biomarkers; Cryopreservation; Drug Administration Schedule; Drug Therapy, Combination; Embryo Transfer; Female; Fertility; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility; Luteinizing Hormone; Menotropins; Oocyte Retrieval; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Progesterone; Prospective Studies; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome

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

To compare the outcomes of controlled ovarian stimulation/in vitro fertilization cycles using 450 IU and 600 IU gonadotropin per day in women at risk of poor ovarian response.. Prospective randomized controlled nonblinded study.. University-affiliated private IVF center.. Women considered to be at risk of poor ovarian response: aged <41 years with basal FSH >10 IU/L, antimüllerian hormone <1 ng/mL, antral follicle count ≤ 8, or a previous IVF cycle with ≥ 300 IU/d gonadotropin that resulted in a cancellation, <8 follicles, or <5 oocytes.. A total of 356 patients underwent a microdose GnRH agonist flare-up IVF/intracytoplasmic sperm injection protocol with a fixed daily dose of either 450 IU FSH (n = 176) or 600 IU FSH (n = 180) equally divided between Menopur and Bravelle.. Number of mature oocytes retrieved.. The two groups were similar in terms of age, ovarian reserve, cause of infertility, duration of stimulation, and cycle cancellation rate. There were no significant differences in the number of metaphase II oocytes retrieved (4 [range 0-6] vs. 4 [range 2-7]), fertilization rate (62.4% vs. 57.0%), biochemical pregnancy rate (20.5% vs. 22.9%), clinical pregnancy rate (16.4% vs. 18.3%), and implantation rate (29.8% vs. 30.4%) between the 450 IU and 600 IU groups, respectively.. Gonadotropin of 600 IU/d does not improve outcome of IVF cycles compared with 450 IU/d in women at risk of poor ovarian response.. NCT00971152.

Topics: Adult; Embryo Implantation; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Oocyte Retrieval; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Quebec; Sperm Injections, Intracytoplasmic; Treatment Outcome; Urofollitropin

To evaluate whether pretreatment dehydroepiandrosterone (DHEA) supplementation improves ovarian response markers, ovarian response to standard low-dose gonadotropin stimulation, and in vitro fertilization (IVF) outcomes in poor responders.. Randomized, double-blind, placebo-controlled pilot study.. Tertiary reproductive medicine unit.. Thirty-two women with anticipated poor ovarian response.. Randomization into DHEA group (n=16) receiving GNC (25 mg three times a day) or placebo (n=16) starting from at least 12 weeks before the scheduled IVF treatment according to a computer-generated randomization list.. Measurement of monthly ovarian response markers, including antral follicle count (AFC), serum antimüllerian hormone (AMH), and follicle-stimulating hormone (FSH) levels; comparison of ovarian response to a standard dose of gonadotropin stimulation at week 8 and IVF outcomes; and AFC after 12 weeks (primary outcome).. The DHEA supplementation resulted in statistically significantly higher serum DHEA-S, free androgen index, and follicular DHEA-S levels. No statistically significant differences in the ovarian response markers (AFC, AMH, or FSH), the ovarian response to standard-dose gonadotropin stimulation, or IVF outcomes were found between the two groups.. No statistically significant improvement in ovarian response markers, ovarian response to standard dose gonadotropin stimulation, or IVF outcomes was found in poor responders receiving pretreatment DHEA.. HKCTR-1149 (www.hkclinicaltrials.com) and NCT01915186 (www.ClinicalTrials.org).

Topics: Adult; Anti-Mullerian Hormone; Biomarkers; Chorionic Gonadotropin; Dehydroepiandrosterone; Double-Blind Method; Drug Administration Schedule; Female; Fertility; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Hong Kong; Humans; Infertility; Menotropins; Ovary; Ovulation Induction; Pilot Projects; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Tertiary Care Centers; Time Factors; Treatment Outcome

Unexplained infertility affects 30% of infertile couples. Management depends on duration of infertility and age of female partner. Ovulation induction, together with intrauterine insemination, is commonly offered to couples with infertility of unknown origin. Intrauterine insemination gained its popularity because it is simple, non-invasive and cost-effective technique. The association with pharmacological stimulation is suitable to induce follicular maturation. The most used drugs to induce ovulation are clomiphene citrate and menopausal or recombinant gonodotropins. The aim of this paper was to evaluate the success rate after homologous intrauterine insemination (IUI) combined with menopausal gonadotropins stimulation.. A total of 90 couples were evaluated. Twelve couples (13.3%) were excluded from the treatment (6 vaginal infections, 4 tubal occlusions and 2 male infertility). Informed consent was applied for every couple. The remaining 78 couples were divided in two groups: group A (39 couples) were inducted with menopausal gonadotropins, while group B (39 couples) underwent placebo (multivitamin).. In group A (gonadotropins) 25 (64.1%) pregnancies and 2 (5.1%) abortion were registered, while in group B (placebo) there were 7 (17.9%). pregnancies and 1 (2.5%) abortion.. Ovulation inductions with menopausal gonadotropins, together with intrauterine insemination, improves fecundity in patients with infertility of unknown origin without recur to more invasive techniques.

Topics: Adult; Female; Fertility Agents, Female; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Rate; Treatment Outcome

To assess the effectiveness of tamoxifen administration with letrozole in the context of intrauterine insemination (IUI) cycles.. This prospective double-blinded study included 130 patients. After randomization, 65 patients in group A received letrozole + tamoxifen and human menopausal gonadotropin (HMG), whereas 65 patients in group B received placebo instead of tamoxifen. In both groups, the parameters recorded were total number of follicles with ≥16 and 18 mm diameter, endometrial thickness and appearance, and total HMG administered. The results were compared between groups after single-stage IUI was performed.. Total dominant follicles in both groups were similar (mean number of follicles with diameter ≥16 and 18 mm was 1.5 ± 1.4 and 1.6 ± 1.1, respectively, in group A and 1.5 ± 1.1 and 1.6 ± 1, respectively, in group B; at the same time with less HMG usage in group A (255 ± 167 vs. 313 ± 174 IU), and higher pregnancy rate in group A (18.7 vs. 11.7 %); but none of them was statistically significant). Surprisingly, endometrial thickness was significantly higher in group A (7.7 ± 1.5 vs. 7 ± 1.3 mm; P value 0.008).. In addition to the efficacy of tamoxifen in co-administration with clomiphene citrate, it has promising effects with letrozole in induction of ovulation cycles with or without IUI.

Topics: Adult; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Infertility; Insemination, Artificial; Letrozole; Menotropins; Nitriles; Ovulation Induction; Pregnancy; Prospective Studies; Tamoxifen; Treatment Outcome; Triazoles

To compare the efficacy and safety of highly purified menotropin (hphMG) and recombinant FSH (rFSH) for controlled ovarian stimulation in a GnRH antagonist cycle with compulsory single-blastocyst transfer.. Randomized, open-label, assessor-blind, parallel groups, multicenter, noninferiority trial.. Twenty-five infertility centers in seven countries.. Seven hundred forty-nine women.. Controlled ovarian stimulation with hphMG or rFSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer on day 5 in one fresh or subsequent frozen blastocyst replacement in natural cycles initiated within 1 year of each patient's start of treatment.. Ongoing pregnancy (primary end point) and live birth rates, as well as pharmacodynamic parameters.. The ongoing pregnancy rate after a fresh cycle was 30% with hphMG versus 27% with rFSH for the per-protocol (PP) population and 29% versus 27% for the intention-to-treat (ITT) population. Noninferiority of hphMG compared to rFSH was established. Considering frozen cycles initiated within 1 year, the cumulative live birth rate for a single stimulation cycle was 40% and 38% for women treated with hphMG and rFSH, respectively (both PP and ITT). Significant differences in pharmacodynamic end points were found between the two gonadotropin preparations.. Highly purified hMG is at least as effective as rFSH in GnRH antagonist cycles with compulsory single-blastocyst transfer.. NCT00884221.

Topics: Adult; Biomarkers; Birth Rate; Drug Therapy, Combination; Europe; Female; Fertility Agents, Female; Follicle Stimulating Hormone, beta Subunit; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility; Menotropins; Oocyte Retrieval; Ovulation Induction; Pregnancy; Pregnancy Rate; Progesterone; Recombinant Proteins; Single Embryo Transfer; Time Factors; Treatment Outcome; Turkey

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 demonstrate the noninferiority of highly purified menotropin (HP-hMG) compared with recombinant FSH (rFSH) regarding clinical pregnancy rate (PR) in intrauterine insemination (IUI) cycles.. Prospective randomized noninferiority trial.. Unit of physiopathology of human reproduction, university hospital.. Five hundred twenty-three patients with unexplained infertility or mild male infertility undergoing controlled ovarian hyperstimulation for IUI.. Patients were randomized for treatment with rFSH (262 patients) or HP-hMG (261 patients). Insemination was performed 34-36 hours after hCG injection.. The primary outcome was clinical pregnancy rate (PR). The secondary outcome was the number of interrupted cycles for high risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.. The clinical PR was 19.7% (95% confidence interval [CI] 15.3%-25.1%) in the HP-hMG group and 21.4% (95% CI 16.9%-26.8%) in the rFSH group [absolute difference -1.7% (95% CI -8.6%-5.2%)]; therefore, the noninferiority was demonstrated. The number of interrupted cycles for OHSS risk and multiple pregnancy was significantLy higher in the rFSH group, 8.4% (95% CI 5.6%-12.4%) than in the HP-hMG group 1.2% (95% CI 0.4%-3.3%) [absolute difference -7.27% (95% CI -11.3 to -3.7)].. HP-hMG is not inferior compared with rFSH regarding clinical PR.

Topics: Adult; Algorithms; Family Characteristics; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial; Male; Menotropins; Menstrual Cycle; Pregnancy; Pregnancy Rate; Recombinant Proteins; Severity of Illness Index; Uterus

The study was designed to test the hypothesis that granulosa cell (GC) gene expression response differs between recombinant FSH and human menopausal gonadotropin (hMG) stimulation regimens.. Females < 35 years-old undergoing IVF for tubal or male factor infertility were prospectively randomized to one of two stimulation protocols, GnRH agonist long protocol plus individualized dosages of (1) recombinant (r)FSH (Gonal-F) or (2) purified human menopausal gonadotropin (hMG; Menopur). Oocytes were retrieved 35 h post-hCG, and GC were collected. Total RNA was extracted from each GC sample, biotinylated cRNA was synthesized, and each sample was run on Human Genome Bioarrays (Applied Microarrays). Unnamed genes and genes with <2-fold difference in expression were excluded.. After exclusions, 1736 genes exhibited differential expression between groups. Over 400 were categorized as signal transduction genes, approximately 180 as transcriptional regulators, and approximately 175 as enzymes/metabolic genes. Expression of selected genes was confirmed by RT-PCR. Differentially expressed genes included A kinase anchor protein 11 (AKAP11), bone morphogenetic protein receptor II (BMPR2), epidermal growth factor (EGF), insulin-like growth factor binding protein (IGFBP)-4, IGFBP-5, and hypoxia-inducible factor (HIF)-1 alpha.. Results suggest that major differences exist in the mechanism by which pure FSH alone versus FSH/LH regulate gene expression in preovulatory GC that could impact oocyte maturity and developmental competence.

Topics: Adult; Female; Follicle Stimulating Hormone; Gene Expression Profiling; Gene Expression Regulation; Granulosa Cells; Humans; Infertility; Male; Menotropins; Oligonucleotide Array Sequence Analysis; Ovulation Induction; Recombinant Proteins; Young Adult

To compare IVF outcome in ovarian stimulation protocols with recombinant FSH plus recombinant LH versus hMG, 122 patients were randomized into two study groups: group A, patients treated with urinary hMG, and group B, patients treated with rFSH plus rLH. The two groups proved to be comparable to the main IVF outcome (pregnancy rate, implantation rate, oocytes, and embryos quality), with an increasing risk of ovarian hyperstimulation in the Pergoveris group.

Topics: Drug Combinations; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins

To evaluate the benefit of colony-stimulating factor-1 (CSF-1) adjuvant therapy to poor responders during a controlled ovarian hyperstimulation (COH) cycle.. Prospective clinical study.. University hospital, general hospital, and private IVF clinic in Japan.. Thirty normogonadotropic patients who did not respond to conventional COH protocols.. Eight million units of recombinant human CSF-1 were administered IV every other day during ovarian stimulation using FSH or hMG to 30 normogonadotropic poor responders. Serum CSF-1 concentrations were assayed on day 3. Additional studies were performed in a private IVF clinic on 27 poor responders with low serum CSF-1 levels.. Pregnancy rates (PR). In addition, number of mature follicles, cycle cancellations, amount of required gonadotropins were documented.. Significantly more mature follicles, fewer cycle cancellations, and lower amounts of required gonadotropins were seen in the group treated with CSF-1. Five (16.7%) pregnancies were achieved. The CSF-1-effective patients displayed significantly lower serum CSF-1 concentrations. In a private IVF clinic, CSF-1 treatment increased the number of mature oocytes, fertilized eggs, and transferred embryos. Cycle cancellations decreased from 18.5%-3.7%; 11 pregnancies (40.7%) resulted from treatment.. Concomitant administration of CSF-1 and hMG improved follicle developments, especially in patients with low serum CSF-1 levels in the early follicular phase.

Topics: Adult; Drug Therapy, Combination; Embryo Implantation; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility; Macrophage Colony-Stimulating Factor; Menotropins; Oocyte Retrieval; Ovulation Induction; Pilot Projects; Pregnancy; Pregnancy Rate; Prospective Studies; Recombinant Proteins; Time Factors; Treatment Outcome; Young Adult

A low-cost stimulation protocol that includes letrozole and hMG in normal responders for assisted reproductive technologies resulted in a satisfactory ongoing pregnancy rate.

Topics: Adult; Chemotherapy, Adjuvant; Drug Combinations; Female; Humans; Infertility; Letrozole; Menotropins; Nitriles; Ovulation Induction; Pilot Projects; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted; Treatment Outcome; Triazoles

To compare the result of IUI in infertile couples with different protocols of induction ovulation.. In a retrospective study, 209 infertile couples with different diagnosis (unexplained, male factor, endometriosis, tubal disease, ovulatory dysfunction and multifactorial infertility) were subjected to different protocol of induction ovulation: 50-100 mg CC in day 2-6, 50 mg CC in day 2-6 + 2 amp HMG in day 5, 7, 9, 11, and 2 amp HMG per day. Natural ovulatory cycle + IUI was used for sperm stored patients. 441 consecutive cycles of IUI was performed 36-40 hours after HCG injection. The data were analysed with student T-test and Mann-Whitney test. The significance was defined as P<0.005.. Thirty one pregnancies (7% per cycle, 15% per patient) occurred. One pregnancy occurred (pregnancy per cycle was 2% and per patient was 12%) in 8 patients undergoing 37 cycles of IUI with natural ovulation. The result with CC in 27 patients undergoing 41 cycles IUI was 2 pregnancies (4% per cycle, 7% per patient). In 129 patients receiving 283 cycles of IUI with CC+HMG 21 pregnancies occurred (7% per cycle, 16% per patient). In 35 patients receiving 80 cycles of IUI with HMG 8 pregnancies occurred (9% per cycle, 23% per patient).. The method chosen for ovulation induction had a critical bearing on the success of IUI. The result of IUI will be better by using induction ovulation compared to natural ovulatory cycle. In our programme the combined use of HMG+IUI yielded a higher rate of pregnancy rate compared with CC+IUI, CC+HMG+IUI and natural ovulatory cycle+IUI.

Topics: Clomiphene; Drug Therapy, Combination; Female; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies

To determine the effect of urinary versus recombinant FSH on platelet function and hemostatic variables in women undergoing controlled ovarian hyperstimulation cycles.. Randomized clinical study.. Major university-based infertility and in vitro fertilization unit and hemostasis laboratory.. Ten healthy women (in vitro study), and 24 women undergoing routine controlled ovarian hyperstimulation cycles (in vivo study), randomly assigned to receive either urinary (u-FSH) or recombinant gonadotropin (r-FSH).. In vitro study: effect of preincubation of plasma with u-FSH or r-FSH, in the presence or absence of estradiol, on platelet function and coagulation parameters. In vivo study: Changes in platelet function and coagulation parameters after treatment with u-FSH or r-FSH during controlled ovarian hyperstimulation cycles.. Platelet aggregation and ATP release, activated protein C resistance ratio, free protein S.. In vitro study: Platelet aggregation and ATP release were significantly inhibited by u-FSH relative to r-FSH in both the presence and absence of estradiol (P=.047). In vivo study: Platelet function was significantly inhibited after treatment with u-FSH (P=.05) but not with r-FSH. In both studies, small changes of minor clinical significance were noted in activated protein C resistance and free protein S levels.. The different platelet response to u-FSH and r-FSH may have clinical implications in selected patients, especially those at risk of thromboembolic complications, in decisions regarding the appropriate medication for controlled ovarian hyperstimulation cycles.

Topics: Activated Protein C Resistance; Adenosine Triphosphate; Adult; Blood Platelets; Drug Therapy, Combination; Estradiol; Female; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Hemostasis; Humans; Infertility; Menotropins; Ovulation Induction; Platelet Aggregation; Protein S; Recombinant Proteins

To evaluate the clinical efficacy of a combined regimen of follicle stimulating hormone (FSH) and low dose human menopausal gonadotropin (hMG) following GnRH agonist ultralong protocol in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET).. IVF-ET was performed on 45 patients who had uterine or peritoneal factors, such as moderate to severe endometriosis, adenomyosis, or uterine myoma. The patients were randomized into two groups after the administration of long-acting GnRH agonist 2-4 times within a 4-week interval; highly purified FSH (FSH-HP) and hMG (Group A, n=26), FSH-HP only (Group B, n=19). hMG was administered at a fixed-dose of 75IU per day and the dose of FSH-HP was adjusted according to the patient's individual response. The results of COH and IVF-ET were assessed and compared between the two groups.. Serum estradiol (E2) level on hCG day was significantly higher in Group A (1418.2+/-920.2 pg/ml, mean+/-S.D.) than in Group B (678.4+/-457.8 pg/ml) (P<0.05). The clinical pregnancy rate and implantation rate tended to be higher in Group A than in Group B; 23.1% (6/26) versus 10.5% (2/19), 11.0% (9/82) versus 4.6% (3/65).. In COH for IVF-ET using GnRH agonist ultralong protocol, the combined treatment of FSH-HP and low dose hMG showed a higher serum E2 level when compared with treatment with FSH-HP alone.

Topics: Adult; Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovulation Induction; Parity; Pilot Projects; Pregnancy

To investigate possible differences between using recombinant FSH (rFSH) and hMG for ovarian stimulation in IVF/intracytoplasmic sperm injection (ICSI) cycles.. Parallel group design. Prospective, randomized clinical study.. A tertiary care infertility clinic.. A total of 578 patients of our IVF/ICSI routine were recruited.. Treatment with hMG was used for 282 patients (282 cycles), whereas 296 patients (296 cycles) were treated with rFSH. The number of cycles leading to an embryo transfer were 248 and 259, respectively.. Primary: clinical pregnancy rate. Secondary: treatment days, total dose of gonadotropin administered, number of oocytes retrieved, number of mature oocytes, and embryo quality.. Of the cycles with embryo transfer, the pregnancy rates were 30.1% and 32.3% in the rFSH and the hMG groups, respectively. This difference is not statistically significant (P=0.798). Treatment with rFSH resulted in a significantly higher number of recovered oocytes compared with the hMG group but was also associated with a higher number of ampoules needed to reach the criterion for hCG administration. No significant differences were found with regard to the number of mature oocytes, the number of treatment days, and the embryo quality.. In terms of the clinical pregnancy rate, no significant differences between the two stimulation regimens can be stated.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Pregnancy; Prospective Studies; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome

Although the role that LH plays in folliculogenesis is still controversial, recent evidence points toward facilitatory actions of LH activity in ovulation induction. Thus, we compared the response to either highly purified FSH (75 IU FSH/ampoule; group A, 25 subjects) or human menopausal gonadotropin (75 IU FSH and 75 IU LH/ampoule; group B, 25 subjects) in normoovulatory GnRH agonist-suppressed women, candidates for intrauterine insemination. A fixed regimen of 2 daily ampoules of highly purified FSH or human menopausal gonadotropin was administered in the initial 14 days of treatment; menotropin dose adjustments were allowed thereafter. Treatment was monitored with daily blood samples for the measurement of LH, FSH, 17beta-estradiol (E(2)), progesterone, testosterone, hCG, inhibin A, and inhibin B, and transvaginal pelvic ultrasound was performed at 2-day intervals. Although preovulatory E(2) levels were similar, both the duration of treatment (16.1 +/- 0.8 vs. 12.6 +/- 0.5 days; P< 0.005) and the per cycle menotropin dose (33.6 +/- 2.4 vs. 23.6 +/- 1.1 ampoules; P < 0.005) were lower in group B. In the initial 14 treatment days the area under the curve of FSH, progesterone, testosterone, inhibin A, and inhibin B did not differ between the 2 groups, whereas LH, hCG, and E(2) areas under the curve were higher in group B. The occurrence of small follicles (<10 mm) and the inhibin B/A ratio in the late follicular phase were significantly reduced in group B. A nonsignificant trend toward a higher multiple gestation rate was present in group A (60% vs. 17%). We conclude that ovulation induction with LH activity-containing menotropins is associated with 1) shorter treatment duration, 2) lower menotropin consumption, and 3) reduced development of small ovarian follicles. These features can be exploited to develop regimens that optimize treatment outcome, lower costs, and reduce occurrence of complications such as multiple gestation and ovarian hyperstimulation.

Topics: Adult; Female; Follicle Stimulating Hormone; Humans; Infertility; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation; Ovulation Induction; Pregnancy; Treatment Outcome; Triptorelin Pamoate

Most ovarian cysts in women of reproductive age are physiological (functional) and patients have been treated for years with oral contraceptives to obtain the resolution of these cysts. Expectant management has been suggested to have the same effectiveness as hormonal treatment but such suggestions come from studies including all kinds of cysts. The objective of the present study was to assess the resolution of functional ovarian cysts, observed after ovulation induction, with expectant management and hormonal treatment and also to determine the period of time necessary for the resolution of the cysts. For this purpose, 53 patients with ovarian cysts, observed by transvaginal ultrasound within the first 5 days of a cycle after ovulation induction, were randomized to have expectant management (group A) or to receive oral contraception (group B) for one cycle. If the cyst persisted, the patient was followed for another cycle, without any treatment. Within the 50 women who completed the trial, a complete resolution of the cysts was observed in 19/25 (76%) and 18/25 (72%) in groups A and B respectively. On the other hand, all the persistent cysts disappeared after a second cycle without any treatment. In conclusion, expectant management is as effective as oral contraceptives for the resolution of functional ovarian cysts induced by ovarian stimulation. However, studies with a larger number of cases are needed to increase the power of the results and to obtain a firm conclusion.

Topics: Adult; Clomiphene; Contraceptives, Oral; Ethinyl Estradiol; Female; Humans; Infertility; Levonorgestrel; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Prospective Studies; Time Factors; Ultrasonography

To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples.. A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups.. The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40x10(6)) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (> or =40x10(6)) (25.7% versus 22.7%, P=0.671).. In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.

Topics: Adult; Clomiphene; Coitus; Female; Follicle Stimulating Hormone; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Pregnancy; Sperm Motility; Time Factors

To compare the efficacy of fallopian tube sperm perfusion utilizing a Foley catheter technique with standard IUI.. Randomized controlled study.. The infertility units of the University Central Hospital and the Family Federation of Finland, Oulu, Finland.. One hundred infertile women with unexplained factor, minimal to mild endometriosis, mild male factor, or ovarian dysfunction, undergoing 50 IUI and 50 fallopian tube sperm perfusion cycles stimulated by clomiphene citrate and hMG.. Thirty-six hours after hCG administration, patients were randomized to either the IUI group (group 1, 50 patients and cycles) or the fallopian tube sperm perfusion group (group 2, 50 patients and cycles). Intrauterine insemination was performed using a standard method and fallopian tube sperm perfusion with a pediatric Foley catheter, which prevents the reflux of sperm suspension.. Number of clinical pregnancies.. The fallopian tube sperm perfusion method using a Foley catheter technique was easy to perform and convenient for the patients. The overall pregnancy rate per cycle was 8% for fallopian tube sperm perfusion and 20% for IUI, a difference that was not significant.. The fallopian tube sperm perfusion method using a Foley catheter offers no advantage in comparison with the conventional IUI technique.

Topics: Adult; Clomiphene; Fallopian Tubes; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Perfusion; Pregnancy

The aim of this randomized cross-over study was to determine whether direct intraperitoneal insemination (DIPI) is superior to intrauterine insemination (IUI) in hyperstimulated cycles. The treatment cycles were stimulated with either clomiphene citrate and human menopausal gonadotrophins, or buserelin and human menopausal gonadotrophins. 207 subfertile couples with a cervical factor, a male factor, a combined cervical and male factor, or an unexplained subfertility were randomly assigned to the first treatment cycle. IUI and DIPI were performed in alternate cycles to a maximum of 6 cycles per couple. Every treatment cycle was followed by a nontreatment cycle. The pregnancy rate per completed cycle was 24% for IUI and 16% for DIPI (p = 0.018), whereas the cumulative pregnancy rates for IUI and DIPI were 53 and 40%, respectively (p = 0.002). There were no significant differences between pregnancy rates for IUI and DIPI in the different categories of subfertility. We conclude that DIPI does not offer better pregnancy chances than IUI in superovulated cycles.

Topics: Adult; Antineoplastic Agents, Hormonal; Buserelin; Clomiphene; Cross-Over Studies; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Pregnancy; Pregnancy Rate; Superovulation; Treatment Outcome; Ultrasonography

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

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

To examine the difference in efficacy between two protocols of superovulation induction with IUI among infertile couples.. A prospective randomized trial.. Normal human volunteers in an infertility clinic.. Consecutively treated patients attending our infertility clinic for superovulation induction with IUI who had been unsuccessfully treated by clomiphene citrate (CC).. Infertile couples were randomized to undergo one of two controlled ovarian hyperstimulation protocols. Group A patients received daily hMG beginning on cycle day 3, whereas group B patients were administered CC days 3 through 7, followed by hMG from day 7 onward. Randomization was performed using a random numbers table. In both groups, ovulation was triggered by 5,000 IU hCG and IUI was performed by 36 hours.. Studied cycle performance parameters included peak E2, number of dominant and intermediate-sized follicles recruited, endometrial thickness and pattern, and frequency of monitoring.. Data analysis demonstrated no significant difference between the two groups with respect to patient age, parity, weight, indication for superovulation and IUI, number of dominant follicles recruited, peak E2, or mean number of total motile sperm inseminated. Endometrial thickness and pattern differed between treatments, however, with group A demonstrating relatively thicker and proportionately more trilaminar patterns than group B. Group A had significantly more serum E2 measurements, as well as transvaginal sonograms performed, when compared with group B. Pregnancy rates for groups A and B were 0.192 and 0.091, respectively. Of 25 pregnancies in group A, 7 (0.28) were multiples, whereas there were no multiple gestations in group B.. For patients undergoing superovulation with IUI, a menotropin-alone protocol yields significantly higher pregnancy rates than one using a combination of menotropin with CC. These differences could not be explained by patient characteristics. Among cycle performance parameters, endometrial thickness and pattern differed significantly between the two groups.

Topics: Adult; Clomiphene; Estradiol; Female; Humans; Infertility; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prospective Studies; Superovulation

Sperm preparations for intrauterine insemination (IUI) generally do not include seminal fluid, and it is not known whether the absence of this component affects pregnancy rates. Therefore we evaluated the effect of high intravaginal seminal fluid deposition on clinical pregnancy rates in patients undergoing ovulation induction and IUI therapy. A prospective, randomized, double-blind study was designed for an infertile population in a university-based infertility practice. Patients were randomized to receive high vaginal deposition of either seminal fluid separated from the husband's ejaculate (study group) or normal saline solution (control group). Intercourse was restricted. A comparison of clinical pregnancy rates per cycle between study and control groups showed no significant difference between them [22/164 (13.4%) and 19/155 (12.3%) respectively]. Furthermore, in non-participants with unregulated intercourse, the pregnancy rate per cycle was not significantly different (40/307; 13.0%). Miscarriage rates between the study and control groups were similar. As high intravaginal deposition of seminal fluid at the time of IUI does not improve the clinical pregnancy rate in patients undergoing ovulation induction and IUI therapy, our study suggests that, after ejaculation, clinically significant biological contributions of seminal fluid to the achievement of pregnancy are bypassed by well-timed IUI.

Topics: Adult; Clomiphene; Coitus; Double-Blind Method; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prospective Studies; Semen

The efficacy of three protocols of endometrial preparation (spontaneous cycles, A: artificial preparation, B; ovarian stimulation, C) for cryopreserved-thawed human embryo transfer (CT-ET). The implantation and clinical pregnancy rates per cycle in 236 women undergoing 381 consecutive CT-ETs were evaluated according to the endometrial preparation protocol. No statistically significant difference was found in implantation rates per embryo transfer (A = 5.6%, B = 5.6%, C = 4.6%) and clinical pregnancy rates per cycle (A = 16.9%, B = 16.5%, C = 15.6%) between the three endometrial preparation protocols used. In conclusion, the specific method of endometrial preparation for CT-ET had no significant impact upon the implantation rate.

Topics: Adult; Chorionic Gonadotropin; Cryopreservation; Embryo Implantation; Embryo Transfer; Endometrium; Estradiol; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Parity; Pregnancy; Progesterone

In this prospective randomized study we treated 60 couples with unexplained infertility with a combination of ovarian stimulation and either intrauterine insemination (IUI) or fallopian sperm perfusion (FSP). In the IUI we used a volume of 0.5 ml of inseminate and in the FSP a volume of 4 ml. The demographic characteristics of the patients, the stimulation parameters and the sperm data were not statistically different between the two groups. The pregnancy rate per cycle was 16.2% in the IUI group and 14.5% in the FSP group and the pregnancy rate per woman was 40 and 36.7%, respectively (not statistically different). We conclude that IUI and FSP are equally effective in the treatment of couples with unexplained infertility.

Topics: Adult; Chorionic Gonadotropin; Fallopian Tubes; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies; Uterus

To evaluate whether there are any benefits from intrauterine insemination (IUI) as opposed to timed intercourse (TI) in stimulated ovarian cycles in couples with longstanding, unexplained infertility.. Forty-six couples with diagnoses of unexplained infertility were evaluated in a crossover study after a total of 141 cycles. Sixty-seven cycles were with IUI after controlled ovarian hyperstimulation (COH) while 74 cycles were after COH and TI.. The pregnancy rate after COH/TI was 16.7% and after COH/IUI 45.2%. Cycle fecundity however was 8.9% after COH/TI and 25.7% after COH/IUI, which is a statistically significant difference (P < 0.05).. A trial of human menopausal gonadotropin and IUI is justified in couples with prolonged infertility of unknown cause.

Topics: Adult; Coitus; Cross-Over Studies; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Treatment Outcome

We examined the influence of human chorionic gonadotrophin (HCG), used as an ovulation inducer and/or for supporting the luteal phase, on the next ovarian cycle. Four women received 10,000 IU of HCG at mid-cycle and another four received the same dose plus 1500 IU on the 17th, 19th and 21st days of the cycle. In the menstrual cycle prior to our experiments, venous blood samples were collected and vaginal ultrasound of the ovaries was performed every other day from day 21-28; the same data were also collected on days 1-10 of the experiment cycle. In such a way, control values were obtained. After the administration of HCG, venous blood samples were collected and ultrasound was performed in the same way and on the same days as in the controls. Follicle stimulating hormone (FSH) and luteinizing hormone were determined by radioimmunoassay in all blood samples, and HCG only in samples collected after the experiment. The results showed that only FSH was lower in the late luteal phase after the administration of 10,000 IU of HCG. Follicular diameters were higher during the follicular phase than during the previous cycle only in women who received the low dose of HCG. In addition, one woman presented with detectable HCG in the following ovarian cycle. The use of HCG in the preceding cycle may reduce FSH and develop persistent follicles in the subsequent cycle. We suggest that an ultrasound of the ovaries should be performed before starting a new ovulation induction cycle in a woman who has received HCG in the previous cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Clomiphene; Estradiol; Female; Humans; Infertility; Insemination, Artificial; Menotropins; Ovarian Follicle; Ovary; Ovulation Induction; Prospective Studies

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

The objective of this work was to evaluate the results obtained with a protocol of semi-programmed ovarian stimulation (low-dose contraceptive pill+clomiphene citrate+human menopausal gonadotrophin+dexamethasone) used as the first-choice method for in-vitro fertilization (IVF). A total of 207 punctures was performed for oocyte collection from 168 patients (mean age 31.0 +/- 4.0 years); mean infertility duration was 5.81 +/- 3.30 years. The infertility factors indicating IVF for this population were as follows: tubo-peritoneal factor, 68%; pure or associated male factor, 9.2%; endometriosis, 11.1%; ovulatory factor, 4.3%; idiopathic factor, 11.6%; others, 2.4%. No oocyte was found on aspiration in five procedures (2.4%), with the mean number of oocytes collected per cycle being 5.87 +/- 3.3 (range 0-18). The cancellation rate per puncture was 5%. The mean embryo cleavage rate was 60.2 +/- 36.8%, with transfer of at least one embryo occurring in 82.6% of all punctures. The mean number of transferred embryos was 2.52 +/- 1.60 (range 1-5). The clinical pregnancy rates per started cycle and per puncture were 22.4 (218 ovarian stimulation cycles) and 23.6% (a total of 49 clinical pregnancies, 36 single, nine twins and four triplets) respectively. The clinical pregnancy rate per embryo transfer was 28.6%. The embryo implantation rate was 12.6%. The abortion rate was 16.3%. The index of deliveries per puncture was 19.8%. There were no cases of moderate or severe ovarian hyperstimulation syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Clomiphene; Contraceptives, Oral; Dexamethasone; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple

The luteal phase of in vitro fertilization-embryo transfer (IVF-ET) cycles has come under great scrutiny as the cause for the discrepancy between fertilization rates (> 70%) and pregnancy rates (around 20%) in most IVF programs is sought. The effects of the various stimulation protocols on the subsequent hormonal events of the luteal phase are both important and controversial but information regarding cycles where ovarian stimulation has been carried out with gonadotropins under pituitary suppression is scanty. The effect of high levels of estrogen in the late follicular phase and around the time of implantation is a matter of concern. As combined gonadotropin-releasing hormone analog (GnRH-a) gonadotropin treatment for superovulation is associated with supraphysiological ovarian steroid levels, both in the follicular and luteal phase of IVF cycles, we compared preovulatory (estradiol), midluteal (estradiol, progesterone and prolactin) and late luteal (estradiol and progesterone) hormone levels in on-going pregnancies, abortions and non-conception cycles in 222 patients accomplishing their first IVF-ET attempt who received such ovarian stimulation therapy. For both successful and unsuccessful implantation cycles, estradiol on the day of human chorionic gonadotropin (hCG) administration correlated positively with progesterone and estradiol levels and negatively with the progesterone/estradiol ratio in the midluteal phase. Mean peak follicular estradiol, midluteal estradiol and progesterone levels, mean mid- and late luteal progesterone/estradiol ratio, and mean midluteal prolactin concentration, were similar in the three groups studied. The mean late luteal estradiol and progesterone in the on-going pregnancy group were significantly higher than in non-conception cycles (p < 0.005 and p < 0.001, respectively) as a reflection of trophoblastic hCG production. Forty-eight patients (21.6%) had hyperprolactinemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Buserelin; Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Hormones; Humans; Infertility; Luteal Phase; Menotropins; Pregnancy; Progesterone; Prolactin; Prospective Studies; Superovulation

The adverse effect of raised luteinizing hormone (LH) concentrations on reproductive outcome suggests that exogenous LH administration for ovarian stimulation may not be desirable. The aim of this study was to compare the clinical pregnancy rates between follicle stimulating hormone (FSH) and human menopausal gonadotrophin (HMG) used in in-vitro fertilization (IVF) cycles. A total of 232 infertile patients, with a mean duration of infertility of 67.1 +/- 32.9 months, were selected for IVF (female age < 38 years, FSH < 15 IU/l, and total motile sperm count > 5 x 10(6). A short (flare-up) protocol with daily leuprolide acetate was followed randomly from day 3 with FSH (n = 115) or human menopausal gonadotrophin (HMG; n = 117), at an initial dose of two ampoules per day. A maximum of three embryos was transferred, and the luteal phase was supported with four doses of HCG (2,500 IU). No differences were observed between the two groups in any of the cycle response variables except fertilization rates per oocyte and per patient, both of which were significantly higher with FSH. Clinical pregnancy rates per cycle initiated, per oocyte retrieval and per embryo transfer were 19.1, 21.0 and 22.7% respectively for FSH, and 12.0, 12.8 and 15.4% respectively for HMG. Whilst these differences were not statistically significant, the results of this interim analysis suggest that HMG may be associated with a lower clinical pregnancy rate than FSH.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Leuprolide; Luteal Phase; Luteinizing Hormone; Male; Menotropins; Pregnancy; Pregnancy Rate; Sperm Count; Sperm Motility

A total of 100 women undergoing ovarian stimulation with gonadotrophin-releasing hormone agonist (GnRHa) and a human menopausal gonadotrophin (HMG) for in-vitro fertilization (IVF) participated in this randomized comparative study. Leuprolide acetate at a dose of 0.5 mg/day s.c. (n = 52, group I), or low-dose leuprolide acetate depot at a dose of 1.88 mg s.c. (n = 48, group II), was started on days 21-23 of the cycle. Stimulation with 225 IU/day HMG was started after pituitary desensitization had been achieved. The luteal phase was supported by human chorionic gonadotrophin (HCG) i.m. injection. There were no statistical differences in baseline oestradiol (24.5 +/- 4.8 versus 21.9 +/- 4.5 pg/ml) and follicle stimulating hormone (FSH) concentrations (3.9 +/- 1.9 versus 3.2 +/- 1.8 mIU/ml), and concentrations on the day of HCG administration of oestradiol (1657 +/- 245 versus 1512 +/- 165 pg/ml), luteinizing hormone (LH; 6.2 +/- 4.8 versus 5.6 +/- 4.3 mIU/ml) and FSH (10.6 +/- 2.8 versus 10.8 +/- 3.6 mIU/ml). There were also no statistical differences in the HMG dosage (26.8 +/- 1.8 versus 28.5 +/- 1.5), the number of oocytes retrieved (7.6 +/- 3.0 versus 8.1 +/- 4.3), the number of oocytes fertilized (5.3 +/- 2.1 versus 5.6 +/- 3.0) and the number of embryos transferred (3.5 +/- 1.3 versus 3.4 +/- 1.6). There was no evidence of a premature LH surge in either group, but two patients appeared to have a poor response in the leuprolide acetate group (group I). There were 11 pregnancies (21.2%) after the use of leuprolide acetate and 12 pregnancies (25.0%) in those given leuprolide acetate depot; no statistical difference existed between these two groups. Thus, a s.c. low-dose leuprolide acetate depot injection may offer a useful alternative for pituitary suppression in ovarian stimulation for IVF.

Topics: Adult; Chorionic Gonadotropin; Clinical Protocols; Delayed-Action Preparations; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Injections, Subcutaneous; Leuprolide; Menotropins; Ovulation Induction; Pituitary Gland; Pregnancy

During the last few years the potential importance of intraovarian regulators of follicular development has been recognized, and the effects of various growth factors on granulosa cell responses to gonadotrophins have been extensively investigated. Ovarian responses to exogenous gonadotrophins were improved by adjuvant growth hormone (GH) treatment of GH-deficient patients, and responses to hMG were apparently predicted by estimated GH reserve. However, the results of different studies of GH/hMG cotreatment were equivocal. Therefore, a randomized, prospective, cross-over study protocol between GH/hMG/hCG versus hMG/hCG was undertaken. Whereas 16 pregnancies were achieved in the 26 Clonidine-negative patients (61.5%) either in the GH/hMG cycle (11) or in the succeeding one (5), no benefit was detected in 8 Clonidine-positive patients from the GH/hMG combination. The recently described GH-binding protein (BP) may reflect the GH-receptor. GH-BP levels were evaluated in the sera and follicular fluids (FF) of patients undergoing ovulation induction with either hMG/hCG or GH/hMG/hCG. GH-BP increase in serum correlated with E2, and progesterone (P4) concentrations. The FF GH-BP correlated with serum GH-BP levels. Lower FF GH-BP levels were measured in older compared to younger women, while increased values were obtained both in patients with elevated E2 concentrations in serum and in FF, or when more than five oocytes were retrieved. Primary increased GH-BP in unexplained infertility may suggest a new mechanism whereby excessive GH-BP levels may deprive GH from its receptor and thus decrease the introavarian IGF-I production.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Age Factors; Carrier Proteins; Chorionic Gonadotropin; Clonidine; Drug Therapy, Combination; Estradiol; Female; Growth Hormone; Humans; Infertility; Insulin-Like Growth Factor I; Menotropins; Oogenesis; Ovulation Induction; Pregnancy; Prospective Studies; Receptors, Somatotropin; Treatment Outcome

In gonadotropin-releasing hormone analogue-pretreated in vitro fertilization-embryo transfer cycles, pregnancy rates are inversely related to serum progesterone levels on the day of administration of human chorionic gonadotropin. The relationship of the progesterone concentration on other days in the periovulatory period to pregnancy rates in such cycles is little studied. We therefore retrospectively analyzed the relationship between progesterone concentrations on the day after human chorionic gonadotropin and pregnancy in 114 cycles, 28 and 23 of which produced clinical and ongoing/delivered pregnancies, respectively. To assess the effect of the extent of follicular luteinization on success, we also studied the relationship between the progesterone concentration per oocyte retrieved and pregnancy for the day of and day after human chorionic gonadotropin.. Progesterone concentrations on the day after human chorionic gonadotropin were inversely associated with clinical pregnancy by multiple logistic regression analysis (P < 0.05). Progesterone/oocyte ratios were inversely associated with clinical pregnancy (P < 0.05) and ongoing/delivered pregnancy (P < 0.02) for both the day of and the day after human chorionic gonadotropin.. The study results extend the window of time during which elevated progesterone concentration is associated with poor outcome to at least 2 days. This finding is consistent with hypothetical mechanisms attributing the link between progesterone concentration and outcome to either endometrial or follicle/oocyte events. The association of lack of follicular luteinization (low progesterone per oocyte ratios) and favorable outcome suggests a predominant effect of progesterone on follicle/oocyte quality. Further studies are needed to clarify the mechanisms underlying the association between progesterone and in vitro fertilization-embryo transfer outcome.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Infertility; Injections, Intramuscular; Leuprolide; Male; Menotropins; Oocytes; Predictive Value of Tests; Pregnancy; Progesterone; Radioimmunoassay; Regression Analysis; Reproductive Techniques; Retrospective Studies

This work investigates the relationship of basal follicle stimulating hormone (FSH) measurements and age to ovarian responsiveness and pregnancy occurrence following controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI).. Basal FSH was measured retrospectively in sera from infertility patients obtained on cycle day 2, 3, or 4 of a COH-IUI treatment cycle. Basal FSH was then correlated with COH response parameters and treatment outcome in ovulatory (n = 98) and anovulatory (n = 33) patients. Clinical data were collected from retrospective chart review. In the ovulatory group, increasing basal FSH was associated with fewer follicles (P = 0.01) and lower peak estradiol (P = 0.0001).. No age related effects were detected in the anovulatory group. Also, there were no pregnancies in this group when basal FSH was > 22.1 mIU/ml. Increasing age in the ovulatory group was associated with fewer follicles (P = 0.0001), lower peak estradiol (P = 0.0001), and fewer pregnancies (P = 0.04). In the anovulatory group, basal FSH did not correlate with follicle numbers or peak estradiol, although more ampoules of hMG were used for stimulation (P = 0.03).. Increasing basal FSH and patient age both correlated inversely with ovarian responsiveness to COH in ovulatory patients. Basal FSH can be used in clinically to identify patients undergoing COH who are unlikely to respond to superovulatory drugs and unlikely to become pregnant.

Topics: Adult; Aging; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility; Insemination, Artificial; Menotropins; Ovary; Ovulation; Predictive Value of Tests; Pregnancy; Radioimmunoassay; Retrospective Studies

Microfertilization technics as SUZI (sub-zonal insemination) can be indicated in cases of repeated in vitro fertilization (IVF) failure. Feminine parameters seem to play however an important role in optimalization of results. We studied 27 couples (32 IVF-SUZI cycles) who had previously presented 2 to 4 in vitro fertilization failures. These 32 cycles were divided in 2 groups according to women's age: group A < or = 35 and group B > 35 years.. basal FSH levels were higher in group B (6.6 +/- 3.1 mIU/ml) in comparison to group A (3.7 +/- 1.5 mIU/ml). The amount of hMG necessary to accomplish ovarian stimulation was also higher in group B (39 +/- 21 ampules) than in group A (26 +/- 11 ampules). Maximal plasma estradiol levels were higher in group A (2,775 +/- 872 pg/ml) than in group B (1,824 +/- 559 pg/ml) such as the mean number of oocytes collected and micro-injected: 11.6 +/- 4.5 versus 4.7 +/- 2.2 in groups A and B, respectively. Eight pregnancies (44%), of which 7 were ongoing pregnancies, were obtained in group A. No pregnancy was obtained in group B.. SUZI seems to be an available technic for treatment of repeated IVF failures; our results seem to indicate a decrease in SUZI results with age of the women (> 35 years old); they suggest the opportunity of a complete investigation of feminine parameters prior to each SUZI-IVF cycle.

Topics: Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Insemination, Artificial; Maternal Age; Menotropins; Micromanipulation; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Prognosis; Sex Factors; Treatment Failure; Zona Pellucida

To compare the pregnancy rates (PRs) between intrauterine insemination (IUI) and intraperitoneal insemination (IPI) in women receiving comparable ovarian stimulation in couples who were infertile for various infertility conditions.. Fifty-four couples were treated. Of these, 25 were diagnosed as having unexplained infertility, 21 as having male infertility and 8 as having cervical mucus hostility.. Nine pregnancies occurred with 89 cycles of IUI and 6 pregnancies with 85 cycles of IPI, giving an overall PR of 28%. Twelve of the 15 pregnancies occurred during the first treatment cycle and three during the second treatment cycle. There was no significant difference in the (PRs) between the IUI and IPI (P > 0.25).. Both procedures combined with superovulation proved to be simple, inexpensive safe and worthwhile for infertile couples with unexplained infertility, male infertility and cervical mucus hostility.

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

To determine the relative efficacy of intrauterine insemination (IUI), direct intraperitoneal insemination, and intercourse in cycles stimulated with clomiphene citrate (CC) or human menopausal gonadotropins (hMG).. A prospective randomized trial with a 2(3) factorial design with eight different treatment alternatives. Only one cycle per couple was performed.. The Departments of Obstetrics and Gynecology, Central Hospital, Västerås and Akademiska Hospital, Uppsala University, Uppsala, Sweden.. Of 157 randomized couples with unexplained infertility including 51 cases with minimal or mild endometriosis, 148 were selected for comparison.. Pregnancy rate (PR).. Follicular stimulation with hMG gave a higher PR than with CC in the insemination cycles, 19% (10/52) and 4% (2/49), respectively, but the PRs in intercourse cycles were not significantly different for hMG and CC, 13% (3/24) and 17% (4/23), respectively. Insemination cycles and intercourse cycles had a similar overall PR, 12% (12/101) and 13% (7/47), respectively. Furthermore, IUI and direct intraperitoneal insemination did not differ in efficacy.. Follicular stimulation with hMG is more effective than CC in insemination cycles, but insemination as such seems to have no beneficial effect on the PR in stimulated cycles for treatment of unexplained infertility.

Topics: Adult; Clomiphene; Coitus; Female; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Menstrual Cycle; Pregnancy; Pregnancy Outcome; Prospective Studies

Based on preliminary reports by others and by us of a potentiating effect of growth hormone (GH) on human menopausal gonadotropin (hMG)-induced ovulation, a study using a randomized, prospective, cross-over protocol between GH + hMG/human chorionic gonadotropin (hCG) and hMG/hCG was undertaken. The study included patients with long-standing (2-11 years) unexplained infertility with a negative or reduced GH response to clonidine (up to 150 micrograms of clonidine orally). The first cycle was randomly assigned between GH/hMG/hCG (study cycle) and hMG/hCG alone (control cycle), and after an interval cycle the patient's treatment was crossed over. All patients who completed the study had previously undergone 1-20 attempts at ovulation induction for in vitro fertilization (IVF) and 5-40 cycles of ovulation induction for in vivo fertilization at three different medical centers. Three patients conceived on the combined GH/hMG cycle, with diminution in the hMG consumption needed for ovulation induction in the study cycles. Another patient with long-standing mechanical infertility underwent 11 abortive attempts at ovulation induction with hMG for IVF but has never achieved egg retrieval. On the GH/hMG/hCG ovulation induction cycle, three mature ova were retrieved as opposed to no response and cancellation of the "hMG only" cycle. Another patient with 11 years of primary infertility who had undergone 21 previous attempts at ovulation induction and had reached follicular aspiration in only three of those cycles conceived spontaneously on the first cycle after the GH/hMG/hCG IVF/ET cycle. All four pregnancies that have been achieved by now in seven GH/hMG-treated patients ended in cesarean deliveries of four normal male neonates. No correlation was found between the follicular fluid levels of insulin-like growth factor I (IGF-I) and the fertilization rate in vitro. The peripheral IGF-I levels were significantly higher during the follicular phase of the study cycles than during the respective stage of the control cycles or the luteal phase of either cycle. A study of serum GH-binding protein (GH-BP) levels revealed gradual increases in the late follicular phase, in the luteal phase, and in early pregnancy. On the basis of this study and in keeping with earlier reports, we conclude that the addition of GH to hMG/hCG may serve as a contributory adjunct in selected patients. However, in contrast to others who could not find a correlation between the response to acute tes

Topics: Adult; Carrier Proteins; Chorionic Gonadotropin; Clonidine; Drug Synergism; Female; Fertilization; Gonadotropins; Growth Hormone; Humans; Infertility; Insulin-Like Growth Factor I; Menotropins; Pregnancy

Over a period of 4 months, 262 infertile couples participated in a prospective pseudorandom trial of a novel short-term luteinizing hormone-releasing hormone/human menopausal gonadotropin (LH-RH/hMG) treatment; the short-Buserelin-gonadotropin (Hoechst, Hounslow, United Kingdom) regimen. Patients treated with the short-Buserelin-gonadotropin regimen had a significantly higher likelihood of achieving pregnancy than patients treated with the standard clomiphene citrate (CC)/hMG regimen (respectively, 35.5% and 18% per treatment cycle). A significantly higher number of eggs were collected after short-Buserelin-gonadotropin treatment than CC/hMG, but the proportion of patients having a given number of embryos replaced was similar in the two groups. The short-Buserelin-gonadotropin-treated patients were distinguished from the CC/hMG-treated group by significantly lower levels of LH in the late follicular phase and a lower plasma level of estradiol. A detrimental relationship between elevated endogenous LH secretion and failure of implantation has been established. The nature of the short-Buserelin-gonadotropin regimen provokes high levels of endogenous gonadotropin secretion in the early follicular phase and induces a suppression of gonadotropin secretion in the late follicular phase. This may be the physiologic basis of the greater implantation rate after short-Buserelin-gonadotropin treatment than is seen with conventional CC/hMG treatment.

Topics: Adult; Buserelin; Clinical Trials as Topic; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility; Luteinizing Hormone; Menotropins; Ovary; Pregnancy; Prospective Studies; Stimulation, Chemical

Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artificial insemination with donor semen (AID), three women with mild endometriosis, three with periadnexal adhesions, one with hostile (not immunologic) cervical mucus, and one couple in which the male partner was affected by asthenospermia were treated by the gamete intrafallopian transfer (GIFT) technique. Three different protocols for controlled ovarian hyperstimulation were used, and an adequate follicular growth and oocyte maturation were achieved in all cases. Seventeen pregnancies were obtained, for a global pregnancy rate of 38.6%. Two pregnancies (11.7%) ended in clinical abortions, and one (5.8%) was a tubal pregnancy. Of the ongoing pregnancies, one is twin and two are triplets. Seven pregnancies (six ongoing, one abortion) were obtained in the UI group (26%), six (all ongoing) in the failed AID group (66.6%), two continuing pregnancies in the three patients with endometriosis (66.6%); the tubal pregnancy and one clinical abortion occurred in the group with adnexal adhesions. No pregnancies were obtained in the patient with hostile cervical mucus and in the couple with infertility presumably due to poor semen. These encouraging results and the simplicity of the technique suggest that GIFT could be an effective approach that could be programmed during a well-timed laparoscopy where persistent infertility exists in association with apparently normal fallopian tubes.

Topics: Chorionic Gonadotropin; Clinical Trials as Topic; Clomiphene; Fallopian Tubes; Female; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Middle Aged; Oocytes; Ovulation Induction; Spermatozoa

What is the optimal lead follicle size in letrozole, human menopausal gonadotrophin and intrauterine insemination (IUI) cycles with and without spontaneous LH surges?. This retrospective cohort study included 3797 letrozole HMG IUI cycles between January 2010 and May 2021. All cycles were divided into two groups: the HCG trigger group (trigger day LH ≤15 mIU/ml) and the spontaneous LH surge group (trigger day LH >15 mIU/ml). These two groups were subdivided into smaller groups based on the diameter of the follicles. The primary outcome measure was clinical pregnancy rate. Logistic regression analysis was conducted to explore other risk factors.. In the HCG trigger group, the clinical pregnancy rate varied significantly, with rates of 20.8%, 14.9% and 11.8% for the 16.1-18.0, 18.1-20.0 and 20.1-22.0 mm groups, respectively (P = 0.005). In the spontaneous LH surge group, the pregnancy rate of follicles within 14.1-16.0 mm was significantly higher than that of follicles within 20.1-22.0 mm (adjusted OR 0.533, 95% CI 0.308 to 0.923, P = 0.025). Also, patients with two lead follicles were 2.569 times more likely to achieve a clinical pregnancy than those with only one lead follicle (adjusted OR 2.569, 95% CI 1.258 to 5.246, P = 0.010). The duration of infertility was also found to be a common influencing factor in both groups.. The optimal lead follicle size was between 16.1 and 18.0 mm in HCG-triggered letrozole HMG IUI cycles. If the lead follicle size is relatively small (14.1-18.0 mm) when a spontaneous LH surge occurs, there is no need to cancel the IUI cycle.

Topics: Female; Humans; Infertility; Insemination, Artificial; Letrozole; Menopause; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies

The aim of the study was to evaluate dosing of recombinant human luteinizing hormone (r-hLH) or human menopausal gonadotrophin (hMG)-derived medications with LH activity in ovarian stimulation (OS) cycles for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).. A non-interventional study was performed to analyse data from the German RecDate database (January 2007-December 2011).. Starting/total r-hLH/hMG dose, OS duration/cycle number, r-hLH/hMG initiation day (first day of administration), and population/cycle characteristics were assessed in women (≥18 years) undergoing OS for IVF/ICSI using r-hLH or hMG-derived medications (excluding corifollitropin alfa, clomiphene citrate, letrozole, mini/micro-dose human chorionic gonadotrophin, and urofollitropin alone). Data were summarized descriptively.. 67,858 identified cycles utilized medications containing r-hLH (10,749), hMG (56,432), or both (677). Mean (standard deviation) OS duration with r-hLH and hMG was 10.1 (4.43) and 9.8 (6.16) days, respectively. Median (25th-75th percentile) r-hLH starting dose (75.0 [75.0-150.0] IU) was consistent across patients regardless of age, infertility diagnosis, or gonadotrophin-releasing hormone (GnRH) protocol. Median (25th-75th percentile) hMG-derived LH activity starting dose was 225.0 (150.0-300.0) IU, regardless of GnRH protocol, but was lower in women aged <35 years and those with ovulation disorders/polycystic ovary syndrome. Median (25th-75th percentile) total dose for r-hLH (750.0 [337.5-1,125.0] IU) and hMG-derived LH activity (1,575.0 [750.0-2,625.0] IU) varied according to patients' age, infertility diagnosis, cycle number, and r-hLH/hMG initiation day. GnRH antagonist use resulted in a numerically higher median total hMG-derived LH activity dose than GnRH agonist use.. The data used in this study were taken from electronic medical records relating to a specific timeframe (2007-2011) and therefore may not accurately reflect current clinical practice; however, it is likely that the differences between the two compounds would be maintained. Additionally, secondary data sources may suffer from uniformity and quality issues.. The standard of care for OS cycles is described with respect to IVF/ICSI treatment including an LH component in Germany during the specified timeframe.

Topics: Female; Fertility; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Luteinizing Hormone; Male; Menopause; Menotropins; Ovulation Induction; Semen

To compare the effects of human menopausal gonadotropin (HMG) combined with letrozole (LE) to HMG only for ovarian stimulation on pregnancy outcome of infertile patients undergoing artificial insemination by husband (AIH) due to unexplained or mild male factors.. Infertile patients with unexplained or mild male factors treated from July 2015 to December 2021 were selected as subjects. The patients were divided into two groups according to the ovarian stimulation schemes they received, namely HMG combined with LE or HMG only. We analyzed the laboratory examination results before drug treatment (baseline) and during ovarian stimulation and compared the pregnancy outcomes of the two groups using univariable analysis and multivariable logistic regression analysis.. In total, 526 cycles of 372 couples were included. The univariate analysis showed that the clinical pregnancy rate of the HMG combined with LE group was 24.8%, significantly higher than that of the HMG group (14.8%, P = 0.007). The live birth rate (19.9%) of the HMG combined with LE group were also significantly higher than those of the HMG group (11.2%, respectively). In multivariate logistic analysis, the age of males was negatively associated with the clinical pregnancy rate (OR 0.874, 95% CI 0.793~0.963, P=0.006) and live birth (OR0.875, 95% CI 0.783~0.977, P=0.018). Moreover, ovarian stimulation with HMG+LE was the only beneficial factor significantly associated with clinical pregnancy (OR 1.929, 95% CI 1.068~3.485, P=0.029) and live birth (OR 2.255, 95% CI 1.188~4.282, P=0.013).. Ovarian stimulation using HMG combined with LE can increase the clinical outcomes (live birth and clinical pregnancy) among infertile patients undergoing AIH due to explained or mild male factors.

Topics: Female; Humans; Infertility; Insemination, Artificial; Letrozole; Male; Menotropins; Pregnancy; Retrospective Studies; Spouses

Human menopausal gonadotropin (hMG) has LH activity, and it may have beneficial effects in terms of oocyte quality and endometrial receptivity similar to recombinant LH supplementation. The aim of this study was to assess the effects of hMG, and its commencement time on the outcome of assisted reproductive technology (ART) cycles of POSEIDON group 3 and 4 poor responders. Data of 558 POSEIDON group 3 and 4 poor responders who underwent ART treatment following a GnRH antagonist cycle at a university-based infertility clinic between January 2014 and December 2019 were reviewed. hMG was commenced at the early follicular phase or mid-follicular phase in the study groups. The control group did not receive hMG stimulation. Live birth rate (LBR) was the main outcome measure. The mean duration of stimulation was significantly shorter in early follicular hMG group than in mid-follicular hMG group (11.9 ± 3.6 days vs. 12.8 ± 4 days, respectively; P = 0.027). The mean numbers of oocytes retrieved and MII oocytes were comparable between the groups. The LBRs per embryo transfer in early follicular hMG, mid-follicular hMG, and control groups were 21.9%, 11.7%, and 11.6%, respectively (P = 0.035). In conclusion, there is a significant association between the commencement time of hMG and live birth chance in ART cycles of POSEIDON group 3 and 4 poor responders. Early initiation of hMG together with rFSH seems to be beneficial in this specific population.

Topics: Adult; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Live Birth; Menotropins; Ovary; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome

Topics: Endocrinology; Fertility Agents, Female; History, 20th Century; History, 21st Century; Infertility; Menotropins; Reproductive Medicine

To determine the impact of sperm morphology on success of intrauterine insemination (IUI) in unexplained and male subfertility.. Basal and post-wash normal percentage of sperm with normal morphology was assessed prospectively in 412 couples with 530 IUI cycles who underwent ovarian hyperstimulation with gonadotropins. The primary outcome was live birth per cycle. Receiver operating characteristics (ROC) curves were used to determine the effectiveness of sperm morphology to predict live birth in IUI cycles.. Normal sperm morphology (%) after preparation was higher in patients with live birth (5.4 ± 4.5 vs 4.3 ± 4.1; respectively, p<.05) in study population. In male subfertile group, normal sperm morphology before and after sperm preparation was higher in patients with live birth (1.3 ± 1.4 vs 0.6 ± 0.9; p<0.001 and 4.6 ± 4.4 vs 1.9 ± 2.2; p<0.01, respectively). However, both basal and post-wash normal sperm morphology (%) were similar in patients with and without live birth in unexplained group. The best cut-off value for normal sperm morphology (%) to predict live birth was 4.5% in male subfertile group with a sensitivity of 50.6% and specificity of 61.7%.. Morphological evaluation is not a reliable parameter alone for predicting pregnancy outcome in unexplained infertility. In male subfertility, post-wash normal sperm morphology percentage higher than 4.5 increases the probability of live birth.

Topics: Adult; Cohort Studies; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility; Infertility, Male; Insemination, Artificial; Live Birth; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Prognosis; Prospective Studies; Recombinant Proteins; ROC Curve; Spermatozoa; Treatment Outcome; Young Adult

To provide the best available evidence on the role of dehydroepiandrosterone (DHEA) treatment in improving the outcome of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in women with poor ovarian response (POR).. A randomized controlled trial conducted in Cairo University hospitals and Dar Al-Teb subfertility and assisted conception centre, Giza, Egypt. 140 women undergoing IVF/ICSI with POR according to the Bologna criteria were randomly divided into 2 equal groups. The study group received DHEA 25mg three times daily for 12 weeks before the IVF/ICSI cycles and the control group did not receive DHEA. Controlled ovarian stimulation (COH) was started on the second day of menstruation using human menopausal gonadotropins, cetrotide 0.25mg was started when the leading follicle reached 14mm. The main outcome measures were the clinical pregnancy rate, ongoing pregnancy rate, retrieved oocytes, fertilization rate, gonadotropins doses and COH days.. The DHEA group had significantly higher clinical pregnancy rate (32.8% vs 15.7%, p=0.029), ongoing pregnancy rate (28.5% vs 12.8%), retrieved oocytes (6.9±3 vs 5.8±3.1, p=0.03), fertilization rate (62.3±27.4 vs 52.2±29.8, p=0.039), significantly less gonadotropins doses (3383±717.5IU vs 3653.5±856IU, p=0.045) and COH days (11.6±1.8 vs 12.6±1.06, p=0.001).. DHEA increases the number of oocytes, fertilization rate, fertilized oocytes, and clinical pregnancy rate and ongoing pregnancy rate in women with POR according to the Bologna criteria. DHEA was well tolerated by the patients and was associated with less COH days and gonadotropins doses.. www.clinicaltrials.govNCT02151006.

Topics: Adult; Dehydroepiandrosterone; Egypt; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Oocyte Retrieval; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Injections, Intracytoplasmic

To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa.. Retrospective cohort study.. Private fertility clinic.. Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyperstimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated.. Intranasal GnRHa for luteal-phase support.. The primary outcome was ongoing clinical pregnancy rate.. High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS.. Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients triggered with GnRHa and avoiding OHSS.

Topics: Administration, Intranasal; Adult; Drug Administration Schedule; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility; Menotropins; Nafarelin; Oocyte Retrieval; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins; Retrospective Studies; Risk Factors; Treatment Outcome

To identify the risk factors for suboptimal response to GnRH agonist (GnRH-a) trigger and evaluate the effect of hCG on the outcome of patients with suboptimal response to GnRH-a.. A retrospective data analysis.. A tertiary-care academic medical center.. A total of 8,092 women undergoing 8,970 IVF/intracytoplasmic sperm injection (ICSI) treatment cycles.. All women underwent hMG + medroxyprogesterone acetate (MPA)/P treatment cycles during IVF/ICSI, which were triggered using a GnRH-a alone or in combination with hCG (1,000, 2,000, or 5,000 IU). Viable embryos were cryopreserved for later transfer.. The rates of oocyte retrieval, mature oocytes, fertilization, and the number of oocytes retrieved, mature oocytes, and embryos frozen.. In total, 2.71% (243/8,970) of patients exhibited a suboptimal response to GnRH-a. The suboptimal responders (LH ≤15 mIU/mL) had a significantly lower oocyte retrieval rate (48.16% vs. 68.26%), fewer mature oocytes (4.10 vs. 8.29), and fewer frozen embryos (2.32 vs. 3.54) than the appropriate responders. Basal LH levels served as the single most valuable marker for differentiating suboptimal responders with the areas under the receiver operating curve of 0.805. Administering dual trigger (GnRH-a and hCG 1,000, 2,000, 5,000 IU) significantly increased oocyte retrieval rates (60.04% vs. 48.16%; 68.13% vs. 48.16%; and 65.76% vs. 48.16%, respectively) in patients with a suboptimal response.. Basal LH level was useful predictor of the suboptimal response to GnRH-a trigger. Administrating dual trigger including 1,000 IU hCG for final oocyte maturation could improve the oocytes retrieval rate of GnRH-a suboptimal responder.

Topics: Adult; Area Under Curve; Biomarkers; Chorionic Gonadotropin; Cryopreservation; Drug Therapy, Combination; Female; Fertility; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Luteinizing Hormone; Medroxyprogesterone Acetate; Menotropins; Oocyte Retrieval; Oocytes; Ovulation; Ovulation Induction; Predictive Value of Tests; Progesterone; Retrospective Studies; ROC Curve; Sperm Injections, Intracytoplasmic; Treatment Outcome

The objective of this study was to assess the relationship between BMI and oocyte number and maturity in participants who underwent minimal stimulation (mini-) or conventional IVF.. Participants who underwent their first autologous cycle of either conventional (n = 219) or mini-IVF (n = 220) were divided according to their BMI to analyze IVF outcome parameters. The main outcome measure was the number of oocytes in metaphase II (MII). Secondary outcomes included the number of total oocytes retrieved, fertilized (2PN) oocytes, cleavage and blastocyst stage embryos, clinical pregnancy (CP), and live birth (LB) rates.. In conventional IVF, but not in mini-IVF, the number of total oocytes retrieved (14.5  ±  0.8 versus 8.8  ±  1.3) and MII oocytes (11.2 ± 0.7 versus 7.1 ± 1.1) were significantly lower in obese compared with normal BMI women. Multivariable linear regression adjusting for age, day 3 FSH, days of stimulation, and total gonadotropin dose demonstrated that BMI was an independent predictor of the number of MII oocytes in conventional IVF (p = 0.0004). Additionally, only in conventional IVF, BMI was negatively correlated with the total number of 2PN oocytes, as well as the number of cleavage stage embryos.. Female adiposity might impair oocyte number and maturity in conventional IVF but not in mini-IVF. These data suggest that mild ovarian stimulation might yield healthier oocytes in obese women.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility; Leuprolide; Linear Models; Menotropins; Metaphase; Obesity; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Rate

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

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

To determine whether dendritic cells (DCs), innate immune cells that specialize in initiation and modulation of immune responses, are present in ovarian follicular fluid (FF) and whether their abundance and maturation state correlate with ovarian response to gonadotropins.. Observational study.. IVF unit and laboratory for reproductive immunology.. Patients undergoing IVF.. None.. FF was collected from the first follicle aspirated in each patient, and cellular content was analyzed by flow cytometry. DCs were defined as CD45(+)CD11c(+)HLADR(+)-cells, and the intensity of HLADR expression indicated DC maturity.. The CD45(+)-hematopoietic cell compartment in FFs (n = 30) contained a significant fraction of CD11c(+)HLADR(+) DCs (15.4% ± 2.9%). The mean fluorescence intensity (MFI) of HLADR expression, which reflects DC maturity, correlated positively with ovarian response to gondotropins, as determined by serum levels of E(2) on the day of hCG administration (r = 0.38).. DCs make up a significant fraction of hematopoietic cells in the FF. Furthermore, DC maturation correlates positively with the ovarian response to gonadotropins. It is therefore conceivable that DCs contribute to the sterile inflammatory process in the follicle that leads to ovulation.

Topics: Adult; Biomarkers; CD11c Antigen; Chorionic Gonadotropin; Dendritic Cells; Drug Therapy, Combination; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Flow Cytometry; Follicle Stimulating Hormone; Follicular Fluid; Gonadotropins; HLA-DR Antigens; Humans; Infertility; Israel; Leukocyte Common Antigens; Menotropins; Ovulation Induction

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

To compare a US clinical trial of gonadotropin therapy for IVF with a similar European trial to determine what factors may explain the higher clinical pregnancy rate in the US trial.. Comparison of baseline, treatment, and outcome variables in the United States (US) and European trials.. IVF practices in the US (n=4) and Europe (n=6).. 297 women undergoing IVF.. None.. Clinical pregnancy rate.. Clinical pregnancy rates were 43.4% in the US compared with 29.7% in Europe (p=0.016), with a live birth rate of 38.2% versus 27.6% (p=0.064). This difference in clinical pregnancy rate could not be explained by differences in the US versus Europe for number of embryos transferred (2.3 vs. 2.6) or female age (34.6 vs. 30.4). Although the starting dose of gonadotropin was higher in the US trial compared with the European trial (300 versus 225 IU), the total dose of gonadotropin was only slightly higher in the US. In multiple logistic regression analysis of 81 pretransfer variables on clinical pregnancy, the only two found to be significant predictors of outcome were baseline endometrial thickness following down-regulation and number of days of gonadotropin treatment.. This study suggests the possibility that US pregnancy rates may be higher in part because of differences in down-regulation or gonadotropin dosing. Other factors not assessed in these studies or in national datasets likely also contribute to the difference in pregnancy rates.

Topics: Adolescent; Adult; Clinical Trials as Topic; Embryo Transfer; Epidemiologic Factors; Europe; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropins; Humans; Infertility; Menotropins; Pregnancy; Pregnancy Rate; Prognosis; Recombinant Proteins; Treatment Outcome; United States; Young Adult

Topics: Anti-Mullerian Hormone; Coitus; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Ovulation Induction; Pregnancy; Time Factors

In an attempt to examine the role of human menopausal gonadotrophin (HMG) administration in patients with high basal FSH/LH ratio, patients undergoing at least two IVF cycles, where one included HMG (HMG group) and the other included recombinant FSH (rFSH) only (FSH group), were studied. The use of HMG, in this specific group of patients, produced significantly higher number of top-quality embryos (3.9 +/- 3.1 versus 2.5 +/- 1.7, respectively; P < 0.05), higher implantation (27.9% versus 5.3%, respectively; P +/- 0.003) and clinical pregnancy rates (44.4% versus 11.1%, respectively; P < 0.02), as compared with rFSH. Moreover, while the HMG group achieved a significantly higher peak oestradiol concentration (P = 0.04), no differences were observed between the groups in the other ovarian stimulation variables. In conclusion, the use of HMG in patients with high basal FSH/LH ratio, produced significantly higher number of top-quality embryos, and higher implantation and clinical pregnancy rates, compared with rFSH.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Luteinizing Hormone; Menotropins; Pregnancy; Recombinant Proteins; Retrospective Studies; Treatment Outcome; Young Adult

Women with a breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2) mutation are at increased risk for developing breast and ovarian cancer. Various reproductive and hormonal factors have been shown to modify the risk of breast cancer. These studies suggest that estrogen exposure and deprivation are important in the etiology of hereditary cancer. Many patients are interested in the possibility of an adverse effect of fertility treatment on breast cancer risk. It is important to evaluate whether or not infertility per se or exposure to fertility medications increase the risk of breast cancer in genetically predisposed women.. We conducted a matched case-control study of 1,380 pairs of women with a BRCA1 or BRCA2 mutation to determine if a history of infertility, the use of fertility medications, or undergoing in vitro fertilization (IVF) were associated with and increased the risk of breast cancer.. Sixteen percent of the study subjects reported having experienced a fertility problem and 4% had used a fertility medication. Women who had used a fertility medication were not at significantly increased risk of breast cancer (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 0.81-1.82) compared to non-users. Furthermore, there was no risk associated with a history of use of a fertility medication when the subjects were stratified by parity: (OR = 1.29; 95% CI = 0.83-2.01 for nulliparous women and OR = 0.81; 95% CI = 0.30-2.22 for parous women).. The results of this study suggest that the use of fertility medications does not adversely affect the risk of breast cancer among BRCA mutation carriers. Given the small sizes of the exposed subgroups, these findings should be interpreted with caution and confirmatory studies are required.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Bromocriptine; Case-Control Studies; Clomiphene; Estrogens; Female; Fertility Agents, Female; Genes, BRCA1; Genes, BRCA2; Humans; Infertility; Menotropins; Middle Aged; Multivariate Analysis; Mutation; Risk Factors; Young Adult

Topics: Drug Administration Routes; Female; Follicle Stimulating Hormone; Humans; Infertility; Luteal Phase; Menotropins; Meta-Analysis as Topic; Pregnancy; Pregnancy Rate; Recombinant Proteins; Time Factors; Treatment Outcome

To compare the efficacy and cost-effectiveness of different induction protocols involving gonadotropins with intrauterine insemination (IUI).. We performed a retrospective chart review of 648 IUI cycles. Some patients had gonadotropin injections alone before human chorionic gonadotropin (hCG) and IUI (human menopausal gonadotropin protocol); others were given oral medications, then gonadotropins before hCG and IUI (combination protocol). Outcomes included pregnancy rates, multiple birth rates, endometrial thickness, number of ovarian follicles, injection days, ampules of gonadotropins and cost.. The combination protocol was more cost-effective. In first cycles, pregnancy rates, multiple birth rates, number of large follicles produced and cancellation rates were similar. The combination group had fewer days of injections and fewer ampules used. When all cycles were analyzed, the multiple birth rate was lower in the combination group. Comparing the different oral medications in the combination protocols, letrozole yielded higher pregnancy rates than tamoxifen or clomiphene. Multiple birth rates were similar for all oral medications.. Combination protocols are less costly and equally effective, with potentially fewer multiple births than with gonadotropins alone. Letrozole may be more effective than clomiphene and tamoxifen in a combination protocol.

Topics: Administration, Oral; Adult; Analysis of Variance; Clomiphene; Cost-Benefit Analysis; Female; Fertility Agents, Female; Humans; Infertility; Injections; Insemination, Artificial; Letrozole; Menotropins; Nitriles; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Tamoxifen; Triazoles

To determine whether IUI pregnancy was affected by [1] place of semen collection (home vs. clinic), and [2] intervals from collection to sperm wash (C-SW), from sperm wash to IUI (SW-IUI), and from collection to IUI (C-IUI).. Retrospective study.. Infertility clinic.. Sixty-two couples in 132 cycles.. Clomiphene citrate (CC) or hMG, plus hCG, and IUI.. Ultrasonographic detection of fetal heart beat(s).. Semen collection at clinic resulted in a higher pregnancy rate than collection at home in hMG-treated (44% vs. 18%; P=.03) but not in CC-treated women (9% vs. 9%; P=.93). Intervals of C-SW, SW-IUI, and C-IUI were shorter in pregnant than in nonpregnant hMG-treated women (27 vs. 41 minutes, 42 vs. 85 minutes, and 99 vs. 156 minutes, respectively; P< or =.01) but not in CC-treated women (28 vs. 38 minutes, 51 vs. 63 minutes, and 109 vs. 131 minutes, respectively; P> or =.19). Semen processed within 30 minutes after collection resulted in a higher pregnancy rate than that processed 31-60 minutes after collection in hMG-treated (48% vs. 18%; P=.02) but not in CC-treated women (10% vs. 8%; P=.81). Intrauterine insemination performed within 90 minutes of collection resulted in a higher pregnancy rate than IUI performed at 91-120 minutes or >120 minutes after collection in hMG-treated (99% vs. 22% and 7%, respectively; P<.0001) but not in CC-treated women (11%, 4%, and 10%, respectively; P> or =.46).. For i.u.i. with hMG but not CC, semen collection at the clinic is more effective than, and should be chosen over, collection at home. Delaying semen processing from 30 minutes up to 1 hour and/or delaying IUI from 90 minutes up to 2 hours after collection compromises the pregnancy outcome in hMG-IUI cycles. Semen specimens should be processed as soon as just after liquefaction and within 30 minutes of collection, and IUI performed as soon as just after processing and within 90 minutes of collection.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Fertility Agents, Female; Fetal Heart; Humans; Infertility; Insemination, Artificial, Homologous; Linear Models; Menotropins; Middle Aged; Pregnancy; Pregnancy Rate; Retrospective Studies; Semen; Specimen Handling; Therapeutic Irrigation; Time Factors; Tissue and Organ Harvesting; Ultrasonography, Prenatal

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

Ferring Pharmaceuticals (US) is developing a highly purified form of urofollitropin [human follicle-stimulating hormone, hFSH, FERRING hFSH, Bravelle] for use in ovarian stimulation in fertility treatments. The highly purified human-derived follicle-stimulating hormone (HP-FSH), administered by either intramuscular (IM) or subcutaneous (SC) injection, was in phase III trials in the US and in May 2002 the product received US FDA approval for use in conjunction with human chorionic gonadotropin for infertility patients undergoing ovulation induction. The product will be marketed as Bravelle. Ferring Pharmaceuticals has also submitted a New Drug Application for additional indications for Bravelle in infertility treatment, which is currently under review by the US FDA. Bravelle is produced from the urine of menopausal women and has been shown to be as effective as Organon's recombinant FSH product, Follistam. Preclinical studies have shown that Ferring Pharmaceuticals' hFSH can be mixed in the same syringe as purified human menopausal gonadotropin (hMG) to reduce the number of daily injections required in ovarian stimulation protocols without altering the bioactivity of FSH or luteinising hormone. In addition, Ferring Pharmaceuticals' hFSH administered SC or IM showed positive results compared with SC Repronex in a randomised, open-label study in patients undergoing in vitro fertilisation.Ferring Pharmaceuticals has teamed up with the American Infertility Association and RESOLVE: the National Infertility Association to improve access to infertility treatment in the US, with the recent launch of the 'Bravelle' HEART (Helping Expand Access to Reproductive Therapy) Programme. The programme is intended to provide urofollitropin treatment at significant cost savings to patients and their physicians. Serono is also developing a highly purified urofollitropin product.

Topics: Adolescent; Adult; Clinical Trials, Phase II as Topic; Drug Administration Schedule; Drug Approval; Drug Combinations; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Injections, Intramuscular; Injections, Subcutaneous; Menotropins; Ovary; Pregnancy; Pregnancy Rate; Premenopause; United States; United States Food and Drug Administration

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

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

To evaluate the results of the use of GnRH antagonist (GnRHant) and GnRH analog (GnRHa) in two matched groups of unselected IVF/ICSI patients in a retrospective matched pair analysis.. Patients (n=52) were stimulated with human menopausal gonadotropin (hMG) and/or recombinant FSH (rFSH). In Group I (n=26) a daily dose of 0.25mg of Cetrorelix (GnRHant) was administered when follicles reached a diameter of > or = 14 mm. Patients in Group II (n=26) were first desensitized with GnRHa triptorelin long protocol, which was continued during the gonadotropins treatment until the induction of ovulation.. In both groups, serum LH levels remained low during the stimulation. The mean length of stimulation, and the dose of FSH required per patient were similar in both groups. The mean E2 level on day of hCG administration was significantly higher in the patients of Group II (2076+/-1430 versus 1145+/-605 pg/ml), however, a progressive increase in serum E2 concentration during the cycle was noted in both groups. A median of 5.38 and 6.34 mature oocytes per patient was obtained, and the fertilization rate was 59.3% in Group I and 63.6% in Group II. Pregnancy rate (PR) were better in Group II (15 versus 5%), and no severe or moderate ovarian hyperstimulation syndrome (OHSS) occurred.. GnRHant and GnRHa provide comparable results in unselected patients, while GnRHant allows a higher flexibility in the treatment.

Topics: Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Luteinizing Hormone; Menotropins; Ovarian Follicle; Ovulation Induction; Recombinant Proteins; Retrospective Studies; Sperm Injections, Intracytoplasmic

This report describes a patient who experienced a generalized allergic reaction to Pergonal during controlled ovarian hyperstimulation in preparation for an intracytoplasmic sperm injection procedure for treatment of severe male factor infertility. The report describes a successful desensitization protocol which allowed the patient to complete her treatment cycle despite the allergic reaction to Pergonal. Subsequently recombinant follicle stimulating hormone was used successfully in inducing follicular growth in the absence of any allergic reactions. Therefore, this report confirms other studies which have suggested that an allergic reaction to human menopausal gonadotropins is due to impurities in such urine-derived products.

Topics: Adult; Drug Hypersensitivity; Embryo Transfer; Female; Follicle Stimulating Hormone; Follicle Stimulating Hormone, Human; Humans; Infertility; Leuprolide; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Tubal; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Ultrasonography

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

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

A total of 811 intrauterine insemination (IUI) cycles in which clomiphene citrate/human menopausal gonadotrophin (HMG) was used for ovarian stimulation were analysed retrospectively to identify prognostic factors regarding treatment outcome. The overall pregnancy rate was 12.6% per cycle, the multiple pregnancy rate 13.7%, and the miscarriage rate 23.5%. Logistic regression analysis revealed five predictive variables as regards pregnancy: number of the treatment cycle (P = 0.009), duration of infertility (P = 0.017), age (P = 0.028), number of follicles (P = 0.031) and infertility aetiology (P = 0.045). The odds ratios for age < 40 years, unexplained infertility aetiology (versus endometriosis) and duration of infertility < or = 6 years were 3.24, 2.79 and 2.33, respectively. A multifollicular ovarian response to clomiphene citrate/HMG resulted in better treatment success than a monofollicular response, and 97% of the pregnancies were obtained in the first four treatment cycles. The results indicate that clomiphene citrate/HMG/IUI is a useful and cost-effective treatment option in women < 40 years of age with infertility duration < or = 6 years, who do not suffer from endometriosis.

Topics: Clomiphene; Cost-Benefit Analysis; Female; Health Care Costs; Humans; Infertility; Insemination, Artificial, Homologous; Logistic Models; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Prognosis; Retrospective Studies

To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI.. Retrospective analysis.. The Center for Reproductive Medicine at the Brigham and Women's Hospital, a tertiary care academic medical center.. Two hundred seventy-four women who underwent controlled ovarian hyperstimulation with gonadotropins and IUI.. Infertility treatment with gonadotropins and IUI.. Pregnancy rates according to patient age, infertility diagnosis, and number of treatment cycles.. Pregnancy rates decreased with increasing patient age. The cumulative pregnancy rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.. There is a clear age-related decline in fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. Patients <40 years of age and those with male factor infertility or tubal factor infertility have a particularly poor prognosis.

Topics: Adult; Aging; Anovulation; Endometriosis; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Retrospective Studies

A retrospective (1987-1995), single-center study was conducted to evaluate the IVF success rate in women who were 40 years and over. Controls were randomly selected patients who were 35 years or younger from the same center. The main evaluation criterion was the number of pregnancies initiated in each group and especially the number of full-term deliveries (take-home baby rate). Differences were considered as statistically significant for P < or = 0.05: A total of 194 IVF attempts in women 40 years or over were compared to 209 attempts in the control group. The mean ages of the two groups was 40.9 vs. 29.3 years (P < 0.001). The duration of follicle stimulation was 12.9 vs. 13.1 days (not significant, NS). The number of ampules was 29.6 vs. 29.2 (NS). Serum estradiol levels were 1435.8 vs. 2020.8 pg/ml (P < 0.001). Oocytes: 4.6 vs. 7.3 (P < 0.001). Embryos: 1.7 vs. 2.8 (P < 0.0001). Full-term deliveries: 3.6 vs. 13.4% (P < 0.05). Better oocyte retrieval was achieved (5.3 vs. 3.3; P = 0.001) in the group that was 40 years or over, but there were no differences in the rate of embryo transfer (1.9 vs. 1.3; NS) and full-term deliveries (4.2 vs. 2.9%) in a long protocol compared to a short one. The results of the study are similar to those found in the literature. Indications for standard IVF without oocyte donation should be carefully thought out and couples should be warned of the low success rate.

Topics: Adult; Clomiphene; Embryo Implantation; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Pregnancy; Pregnancy Outcome; Retrospective Studies

The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program.. Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/ mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed.. The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0.004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups.. The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis.

Topics: Adult; Embryo Implantation; Embryo Transfer; Endometriosis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Oocytes; Outcome Assessment, Health Care; Ovarian Hyperstimulation Syndrome; Pregnancy; Retrospective Studies

To determine the efficiency and comparison of two different protocols, human menopausal gonadotropin (hMG) plus gonadotropin-releasing hormone analog (GnRH-a) and low-dose hMG to reduce multifollicular development in clomiphene-resistant polycystic ovary syndrome (PCOS) patients.. Prospective comparative and pilot study in 20 patients for 31 cycles. The first group (n = 10) was treated with buserelin acetate, 600 micrograms/d, for six weeks before ovulation induction with hMG in conventional doses for 14 cycles. The other group (n = 10) was treated only with low-dose hMG for 17 cycles. All cycles were compared in terms of the number of follicles per cycle, cycles human chorionic gonadotropin withheld, estradiol level on ovulation day, treatment duration and number of ampules used per cycle. In addition, the outcome of cycles and complications of multifollicular development, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy were determined.. As compared with the GnRH-a + hMG protocol, the low-dose hMG protocol yielded less multifollicular (57.1% vs. 17.6%) and more monofollicular (35.7% vs. 70.6%) development. Consequently, less OHSS (21.4% vs. 0%) and multiple pregnancy (10% vs. 0%) occurred in the low-dose group.. Low-dose hMG therapy has distinct advantages in eliminating multifollicular development and related complications in clomiphene citrate-resistant PCOS patients. The addition of GnRH-a to gonadotropins does not change the incidence of multifollicular development.

Topics: Adult; Anovulation; Clomiphene; Dose-Response Relationship, Drug; Drug Resistance; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovarian Follicle; Ovulation Induction; Pilot Projects; Polycystic Ovary Syndrome; Prospective Studies

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

The role of transvaginal pulsed colour Doppler ultrasound in the assessment of ovarian vascularity was studied in 196 in-vitro fertilization (IVF) cycles. The changes in ovarian blood flow after gonadotrophin-releasing hormone agonist (GnRHa) down-regulation and human menopausal gonadotrophin (HMG) stimulation were determined. The data obtained showed that the ovarian blood flow was significantly improved by oestradiol secretion (P = 0.05) and human chorionic gonadotrophin (HCG) administration (P = 0.003). Folliculogenesis was affected by blood flow supply. The resistance index (RI) value was significantly different (P = 0.05) according to the duration of ovarian stimulation. Patients with a mean RI value >0.56 had a longer stimulation with a significantly lower mean number of oocytes retrieved (P = 0.01) despite the administration of a standard dose of HMG. The RI value is a good indicator of modifications in ovarian vascularization during stimulation. Doppler blood flow measurement could be used to determine the optimal timing for the beginning of HMG administration in patients undergoing ovarian stimulation after down-regulation for IVF treatment.

Topics: Adult; Blood Flow Velocity; Chorionic Gonadotropin; Drug Resistance; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovary; Ovulation Induction; Pregnancy; Time Factors; Triptorelin Pamoate; Ultrasonography

To present a successful transfer of microhatched embryos to the fallopian tubes via microlaparoscopy.. Case report.. Private practice affiliated with a medical university.. A 40-year-old woman with primary infertility, mildly elevated baseline FSH levels, and a history of poor ovarian response to ovulation induction. Her husband had severe oligoospermia after vasectomy reversal.. Late luteal leuprolide acetate to pituitary down-regulation followed by pure FSH, 300 IU, and hMG, 300 IU, daily for ovulation induction. Transvaginal oocyte retrieval, intracytoplasmic sperm injection, assisted embryo hatching, microlaparoscopic intrafallopian ET.. Amniocentesis at the 14th week of gestation revealed a normal karyotype (46,XX), birth of a normal female infant (3700 g).. Establishment of a single, viable intrauterine gestation followed by a vaginal delivery at term.. This case shows the possibility of using assisted-hatched embryos for laparoscopic intrafallopian tube transfer.

Topics: Adult; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Male; Menotropins; Microinjections; Oligospermia; Ovulation Induction; Pregnancy; Pregnancy Outcome; Zygote Intrafallopian Transfer

This prospective study was undertaken to examine the usefulness of a long gonadotrophin releasing hormone agonist (GnRH-a)/human menopausal gonadotrophin (hMG) protocol in intrauterine insemination (IUI) treatment. The results were compared to those of clomiphene citrate (CC)/hMG/IUI.. Seventy-five patients were recruited to a GnRH-a/hMG group (group 1) while 88 patients underwent CC/hMG stimulation and served as controls (group 2). The study subjects were stimulated with a long GnRH-a/hMG regimen. IUI was performed 36 h after the administration of human chorionic gonadotrophin.. The number of preovulatory follicles, the thickness of endometrium and sperm parameters were similar in both groups. The hMG requirements were significantly higher in group 1 than in group 2 (21.2 +/- 5.1 vs. 8.1 +/- 3.1 ampoules). The pregnancy rate was 20% in group 1 and 12.5% in group 2, the difference being not significant.. The pregnancy rates were not significantly different between the GnRH-a/hMG/ IUI and CC/hMG/IUI groups. In addition, GnRH-a/hMG stimulation is notably more expensive than CC/hMG, and for these reasons, GnRH-a/hMG stimulation is not cost-effective in routine IUI therapy.

Topics: Adult; Buserelin; Clomiphene; Female; Fertilization in Vitro; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies

To evaluate the diagnostic usefulness of color Doppler velocimetry for infertility treatment.. Sixty-one women undergoing controlled ovarian hyperstimulation and intrauterine insemination with their husbands' semen due to unexplained infertility were enrolled in the study. The Doppler waveforms of the uterine artery, subendome-trial radial artery and intraovarian artery were analyzed around ovulation, and the calculated pulsatility indices (PIs) were correlated with subsequent pregnancy results.. Those women who conceived exhibited a significantly lower uterine artery PI and higher frequency of positive diastolic blood flow in the subendometrial arteries shortly after ovulation. The PI of the intraovarian arteries prior to ovulation was also significantly lower in conception cycles than in nonconception cycles. Uterine artery PIs between different cycles correlated well in the same individual. Lower uterine artery impedance was noted in women receiving supplementation with human menopausal gonadotropins as compared to clomiphene citrate alone.. Doppler velocimetry is a useful tool for evaluating uterine receptiveness in infertility treatment. Intrinsically poor uterine perfusion should be investigated in cases of unexplained infertility.

Topics: Adult; Clomiphene; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pulsatile Flow; Ultrasonography, Doppler, Color; Uterus

This study aimed to standardize the clomiphene citrate test (CC-t) in our laboratory while comparing two different protocols of controlled ovarian stimulation in poor responders. One hundred and forty-four patients scheduled for assisted reproductive techniques were submitted to the CC-t within 3 months before starting stimulation; 133 underwent controlled ovarian stimulation with a blocking protocol. Poor responders in the first cycle (n = 30) were subsequently treated with a flare-up protocol. Although it was not statistically significant, more patients reached oocyte retrieval with the flare-up protocol. In the completed cycles, more gonadotropin ampules (55 +/- 15 vs. 34 +/- 13; p < 0.001) and more stimulation days (12.6 +/- 1 vs. 11.6 +/- 1.2; p < 0.005) were needed in the blocking than in the flare-up protocol. No difference was observed in peak 17 beta-estradiol levels, preovulatory follicles, oocytes retrieved or pregnancy rate between the two protocols. According to the threshold values, established on CC-t of patients who obtained a clinical pregnancy (n = 44), the incidence of abnormal results was 10%. All but one patient with abnormal CC-t were poor responders during the first stimulation cycle. The flare-up protocol did not improve the ovarian response in these patients.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Clomiphene; Desogestrel; Embryo Transfer; Estradiol; Ethinyl Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility; Menotropins; Ovulation Induction; Pregnancy; Triptorelin Pamoate

During a retrospective study on 152 singles pregnancies obtained by in vitro fecondation at Tenon hospital, and followed in this department between January 1990 and December 1994, we have studied the influence of the IVF (tubal origin, masculine or idiopathic) and the type of stimulation (human menopausal gonadotrophin: hMG or follicle stimulating hormone: FSH) on the weight of the newborn and the pathologies that occurred during the pregnancy. No difference in the antecedents has been found in the different group of patients. This study shows a significative difference (p < 0.001) of the newborn's weight when the indication of IVF is tubal origin or masculine. Also, in all IVF indications, the weight is significantly (p < 0.01) higher after a follicular stimulation by FSH versus hMG. For the pregnancy pathologies, no significative difference has been noted, although arterial hypertension, fetal growth retardation and gestational diabetes appear to be more frequent in the group of women who had stimulation by hMG.

Topics: Adult; Birth Weight; Clinical Protocols; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

The use of ovulation induction combined with intrauterine insemination (IUI) as a treatment for subfertility in women with patent Fallopian tubes has increased in recent years. Little is known regarding the efficacy of this treatment in women aged >/=40 years. We reviewed our data in our ovulation induction with IUI programme for 168 consecutive patients aged >/=40 years undergoing a total of 469 cycles of treatment. Either sequential clomiphene citrate and human menopausal gonadotrophins or daily gonadotrophins were utilized along with timed IUI insemination. In 402 completed cycles, 28 clinical pregnancies occurred. The pregnancy loss rate was 34.4%. The overall ongoing/viable pregnancy rates per initiated and completed cycles were 4.47 and 5.22% respectively. No viable pregnancies occurred in 136 cycles in women aged >/=43 years. The ongoing/variable cycle fecundity rates for women aged 40, 41, and 42 years were 9.6, 5.2, and 2.4% per cycle respectively. When utilized in women aged >=40 years, ovulation induction with IUI is most likely to result in successful pregnancy in women 40-42 years of age. Women >/=43 years should consider other alternatives such as adoption or egg donation.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Maternal Age; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Retrospective Studies

A gonadotrophin-releasing hormone agonist stimulation test determination of follicle stimulating hormone (FSH) concentrations before and 2 h after buserelin injection was carried out in 78 in-vitro fertilization cycles, and compared with basal FSH concentrations to predict ovarian response. Ovarian response was quantified by the ratio of peak oestradiol concentration divided by the total dose of human menopausal gonadotrophin (HMG) administered, the most reproducible parameter in 11 patients who underwent two treatment cycles. Stimulation outcome was highly related to the buserelin test, the best prognostic indicator being the sum of FSH concentrations. However, basal FSH concentration achieved similar correlations, even in those patients aged > 35 years. Sensitivity, specificity, positive and negative predictive values of basal FSH concentration and sum of FSH concentrations were similar. Low basal concentration and sum of FSH concentrations were both associated with a better ovarian response. Construction of receiver operator characteristic curves demonstrated that basal FSH concentration was more informative than the sum of FSH concentrations. Finally, the sum of FSH concentrations did not increase the prediction of ovarian response variability. We conclude that the buserelin test is strongly predictive of stimulation outcome, but is no more informative than the usual screening. We suggest that the performance of other stimulation tests should be clearly compared with that of basal FSH concentration.

Topics: Adult; Buserelin; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovarian Function Tests; Ovulation Induction; ROC Curve; Sensitivity and Specificity; Treatment Outcome

The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population.. When 939 couples underwent 1375 cycles of IUI with varying etiologies of infertility which included male factor, endometriosis, tubal factor, ovulatory dysfunction, uterine factor, cervical factor, and unexplained infertility, the results were 207 pregnancies.. The overall pregnancy rate per cycle was 15.1% (207/1375). The total motile sperm count were significantly increased in the pregnant group than the nonpregnant group (38.7 x 10(6) versus 28.6 x 10(6); P < 0.001). There was a trend toward an increased success rate with increased total motile sperm count. Significance was reached when the total motile sperm count exceeded 5 x 10(6). Life table analysis was performed and the curve representing a cumulative chance of pregnancy calculated from our data reached 72%.. Our findings suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy and allow couples to be informed of the chances of success.

Topics: Female; Fertility Agents, Female; Humans; Infertility; Insemination, Artificial; Male; Menotropins; Ovulation; Pregnancy; Sperm Count; Sperm Motility; Spermatozoa

The premature LH surge in ART programs seems to be avoided by daily administration of the GnRH-antagonist Cetrorelix during the midcycle phase in controlled ovarian hyperstimulation with hMG. The dosage necessary for sufficient suppression of the pituitary gland is not yet defined.. To elucidate this question three daily dosages (3, 1, 0.5 mg) were administered and the hormone profiles obtained as well as the number of oocytes retrieved, the fertilization rate, and the consumption of HMG were compared.. No premature LH surge could be observed at any of the three dosages administered. Both gonadotropins were deeply suppressed. The fertilization rates of the oocytes obtained were 45.3% in the 3-mg group, 53.1% in the 1-mg group, and 67.7% in the 0.5-mg group. The average uses of hMG ampoules were 30 in the 3-mg group, 27 in the 1-mg group, and 26 in the 0.5-mg group.. Cetrolix, 0.5 mg/day, administered during the midcycle phase of controlled ovarian hyperstimulation with hMG is enough to prevent completely the premature LH surge. Perhaps even lower dosages would be sufficient. Regarding fertilization rates and use of hMG, the lower dosage seems to be the most favorable.

Topics: Adolescent; Adult; Estradiol; Female; Fertility; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility; Luteinizing Hormone; Menotropins; Ovary; Progesterone

Topics: Clomiphene; Female; Fertility Agents; Humans; Infertility; Menotropins; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Retrospective Studies

To evaluate the prognostic value of day 3 E2 levels, independent of day 3 FSH levels, on responses to ovulation induction and subsequent pregnancy rates (PRs) in IVF-ET patients.. Prospective, observational.. University-based tertiary care and private reproductive endocrine-infertility units.. A total of 225 patients underwent 292 IVF cycles with luteal phase GnRH agonist suppression and hMG stimulation.. We evaluated response and outcome data including age, day 3 FSH and E2 levels from a menstrual cycle before IVF, ampules of hMG used, maximum E2 level, cancellation rates, and clinical PR.. Despite similar age, number of ampules of hMG, and peak E2 levels, patients with an elevated E2 level (E2 > or = 80 pg/mL) (conversion factor to SI unit, 3.671) on day 3 of a cycle before IVF-ET achieved a lower PR per initiated cycle (14.8% versus 37.0%) and had a higher cancellation rate (18.5% versus 0.4%) compared with those with E2 levels < 80 pg/mL. Even when patients with elevated FSH levels (FSH > or = 15 mIU/mL) (conversion factor to SI unit, 1.00) were excluded (leaving 279 cycles), those with an elevated day 3 E2 still had a lower PR per initiated cycle (14.8% versus 38.9%) and maintained a higher cancellation rate (18.5% versus 0.4%). When the day 3 E2 was > or = 100 pg/mL there was a 33.3% cancellation rate and no pregnancies were achieved.. Patients who presented with an elevated day 3 E2 (> or = 80 pg/mL) in a cycle before IVF-ET had a higher cancellation rate and achieved a lower PR independent of FSH level. A day 3 E2 level, in addition to a day 3 FSH level, appears very helpful in prospectively counseling patients regarding cancellation risk and ultimate IVF-ET success.

Topics: Adult; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Male; Menotropins; Ovulation Induction; Pregnancy; Prognosis; Prospective Studies; Time Factors

To examine the effect of high doses of gonadotropins on IVF outcome in normal (intermediate) responders.. Retrospective analysis of patients undergoing IVF therapy from 1990 to 1994 at our institution.. Academic tertiary center.. A homogeneous group of women that consisted of intermediate responders examined in their initial attempt and who received differing amounts of gonadotropins were examined.. All patients were stimulated using a combination of a GnRH-agonist and FSH and hMG and were allocated into two groups, based on the amount of gonadotropin administered initially (four or six ampules).. Implantation and pregnancy (clinical and ongoing) rates were compared.. There were no significant differences between patients receiving high doses versus those patients receiving lower doses of gonadotropins with regard to implantation and pregnancy rates.. We conclude that high doses of gonadotropins have no detrimental effect on IVF outcome in normal (intermediate) responders.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Leuprolide; Menotropins; Pregnancy; Retrospective Studies

Our purpose was to assess the changes in multifetal pregnancy generation as a function of utilization of ovulation stimulation and assisted reproductive techniques and to document the relative control of hyperstimulation between the methods.. The methods of infertility treatment, number of fetuses, and outcomes of 220 patients referred for multifetal pregnancy reduction were compared over three time periods (1986 to 1989, 1991 to 1992, and 1992 to 1993). Clomiphene, human menopausal gonadotropin, and ovulation stimulation with urofollitropin were compared against gamete intrafallopian transfer, zygote intrafallopian transfer, and in vitro fertilization (assisted reproductive techniques).. The proportion of multifetal pregnancies generated by assisted reproductive techniques has steadily risen from 26% in the first two time periods to nearly half in the last 2 years. However, the number and proportion of quintuplet and greater pregnancies from assisted reproductive techniques have steadily fallen while for ovulation stimulation the proportion has remained about one third.. Despite considerably increased use and proportionate generation of triplet and quadruplet pregnancies, the incidence of quintuplets has fallen for assisted reproductive techniques while there has been no improvement for ovulation stimulation. Continued, greater vigilance, particularly in the use of human menopausal gonadotropin and urofollitropin, must be emphasized.

Topics: Clomiphene; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques; Zygote Intrafallopian Transfer

To determine causes of "idiopathic" infertility, the IVF-ET experience of three cohorts of couples with this diagnosis was examined.. Three cohorts of idiopathic infertility couples undergoing IVF-ET: a "failed IUI" group, three previous controlled ovarian hyperstimulation (COH)-IUI cycles with no pregnancies; a "conversion" group, patients converted during a COH-IUI cycle to IVF-ET because of excess follicle numbers; and a "direct IVF" group, patients proceeding directly to IVF-ET were compared.. A tertiary referral reproductive medicine unit.. Forty-one idiopathic infertility couples.. In vitro fertilization-ET.. Number of oocytes retrieved, percent oocytes fertilized, number embryos per ET, implantation rate, percent pregnancy per cycle.. The cohorts had similar fertilization rates and mean (+/- SD) number of pre-embryos transferred. The conversion group demonstrated a higher pregnancy rate (PR) per cycle and a higher E2 concentration than the other groups. The PR of 35.0% in the direct IVF group appeared higher than the 16.7% rate observed in the failed IUI group.. Our observation of a lower PR in couples in the failed IUI group (16.7%) than in couples in the direct IVF group (35.0%) suggests pre-embryo developmental problems or implantation problems as likely important etiologies for a large proportion of idiopathic infertility couples. However, as the conversion group demonstrated both a significantly higher E2 concentration ([E2]) and per cycle PR than the other cohorts with similar fertilization and pre-embryo transfer rates. Subjects converted in a COH-IUI cycle to IVF-ET are thus either more likely to produce pre-embryos more genetically capable of continued development to implantation stage (i.e., better oocytes recruited and fertilized) or due to the higher [E2] to have endometrium more receptive to implantation. Neither undiagnosed tubal factors nor fertilization problems appear to be major etiologic contributors.

Topics: Adult; Cohort Studies; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Osmolar Concentration; Pregnancy; Treatment Failure

Serum concentrations of androstenedione, testosterone and dehypdroepiandrosterone sulfate (DHEAS) as well as estradiol and progesterone were measured throughout the in vitro fertilization (IVF) cycle and compared by conception outcome to try to determine if differing levels of androgens could help elucidate the endocrine environment conducive to successful IVF cycles. The luteal phase gonadotropin-releasing hormone agonist (GnRH-a) protocol was used for ovarian stimulation. of the 46 women enrolled in the study, 11 conceived and 35 did not conceive. Throughout the follicular phase, levels of androstenedione and DHEAS were found to rise but the same pattern of increase was found in both conception and non-conception cycles. The pattern of testosterone increase in non-conception cycles was faster than that in conception cycles. Differences in mean levels of androstenedione, testosterone, estradiol and progesterone by conception outcome in the late luteal phase can be attributed to secretion by the corpus luteum. It is possible that those women having multiple failed cycles with rapidly rising serum testosterone levels should be considered for longer use of the GnRH-a. Differences in the pattern of testosterone rise should be monitored.

Topics: Adult; Androgens; Androstenedione; Chorionic Gonadotropin; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; Fertilization in Vitro; Follicular Phase; Humans; Infertility; Leuprolide; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Progesterone; Testosterone

The timing of ovulation induction is usually decided according to estradiol plasma concentrations and follicle size. We administered human chorionic gonadotropin (hCG) when at least three follicles of 16 mm or more in diameter and adequate estradiol plasma concentrations were detected. We studied the percentage of mature oocyte-cumulus-corona radiata complexes, estradiol and progesterone concentrations in a heterogeneous sized follicle population (range 10-20 mm, n = 90) to perform a retrospective analysis of the adequacy of criteria adopted for the timing of ovulation induction. Plasma and follicular fluid were obtained from 20 normo-ovulating women (aged 28-37 years) treated with gonadotropin releasing hormone analogs (GnRH-a) and human menopausal gonadotropin (hMG) for in vitro fertilization (IVF). No correlation was found between the mean individual follicular fluid estradiol concentration (500-5640 nmol/l) and the respective maximum concentration in plasma (2-16 nmol/l). The estradiol concentration was similar in all follicles. Total follicular fluid estradiol concentration was found to be correlated with follicular fluid volume (r = 0.771, p < 0.01). On the day of hCG administration, the concentration of estradiol in the plasma but not the follicular fluid was correlated with the number of oocyte-cumulus-corona radiata complexes collected (p < 0.01) and the number of mature complexes (p < 0.01). At oocyte pick-up, the plasma concentration of progesterone was correlated (p < 0.01) with number of complexes collected and the number of mature complexes. The percentage of mature complexes collected (77.5%) was higher than suggested by the number of leading follicles. This indicates that our criteria for administering hCG were adequate and that heterogeneous follicle size does not exclude a high rate of mature oocyte-cumulus-corona radiata complexes.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Follicular Fluid; Humans; Infertility; Menotropins; Menstrual Cycle; Ovarian Follicle; Progesterone; Steroids; Triptorelin Pamoate

The objective of this study was to investigate the influence of thyroid hormone on gonadotrophin-induced oestradiol and progesterone secretion by human granulosa cells maintained in vitro. Granulosa cells were obtained by aspiration of pre-ovulatory follicles from women undergoing assisted reproductive technology. Ovulation induction was performed with gonadotrophin-releasing hormone agonist, human menopausal gonadotrophin and human chorionic gonadotrophin. Granulosa cells were maintained in vitro in a defined medium with added insulin. Between 48 and 72 h after the initiation of cell culture, oestradiol and progesterone secretion into the medium was determined for granulosa cells growing in serum-free medium with follicle-stimulating hormone (FSH)/luteinizing hormone (LH) and in serum-free medium with FSH/LH and thyroxine added in a concentration range of 10(-10)-10(-7) M. All concentrations of thyroxine used produced a statistically significant increase in oestradiol (range 1.18-1.37 times the amount with FSH/LH alone) and progesterone (range 1.29-1.51 times the amount with FSH/LH alone) secretion.

Topics: Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Granulosa Cells; Humans; In Vitro Techniques; Infertility; Luteinizing Hormone; Menotropins; Ovulation Induction; Progesterone; Thyroxine

We analysed 381 consecutive cycles of homologous intrauterine insemination (IUI) in 215 infertile couples, resulting in 48 pregnancies (12.6%/cycle, 22.3%/patient). Cycle fecundity ranged from 0.11 to 0.14 in women aged 25-39 years, falling to 0.04 beyond age 40 years. Of the 48 pregnancies, 43 occurred in the first three treatment cycles, in which fecundity was 0.14, 0.16 and 0.10 respectively. Beyond three cycles, fecundity was 0.07 (P = 0.05 versus first two cycles). The occurrence of pregnancy varied with diagnosis (P = 0.04). Fecundity was significantly greater for women with ovulatory dysfunction (0.30) than for endometriosis, male factor, tubal factor, idiopathic infertility or multifactorial (0.08-0.14). Ovulation induction using menopausal gonadotrophins offered significant advantage over natural cycles or cycles using clomiphene citrate without gonadotrophins (0.15 versus 0.03, P = 0.01). Cycles in which pre-ovulatory surges were either induced or supported with human chorionic gonadotrophin (HCG) were superior to spontaneous luteinizing hormone surges (0.13 versus 0.03, P = 0.05). Recruitment of at least two mature (> 1.6 cm) follicles was critical. Only one pregnancy occurred in 64 cycles characterized by one mature follicle, compared with a pregnancy rate of 0.15 in cycles characterized by two or more mature follicles (P = 0.006). IUI is not beneficial to women > 40 years old, and has the best chance of success within three cycles. Multiple follicle recruitment using gonadotrophin-based stimulation protocols and mid-cycle HCG are necessary to achieve an acceptable pregnancy rate.

Topics: Adult; Aging; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Retrospective Studies

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

To investigate the prevalence of endometrial inadequacy in endometrial biopsies from women undergoing superovulation with hMG and to correlate these findings with the hormonal milieu.. Controlled, retrospective analysis.. University-based, tertiary referral, outpatient infertility clinic.. Endometrial biopsies were performed during the late luteal phase in 89 women undergoing hMG superovulation combined with IUI. Results were compared with the initial biopsies obtained as part of their routine infertility evaluation.. Biopsies were dated by two different observers using standard dating criteria. Serum samples obtained during the midluteal phase were assayed in duplicate for E2 and P levels using commercially available RIAs.. Fifty-seven percent of the endometrial biopsies showed differences in the dating of the glandular epithelium that differed by > 2 days when compared with the stroma. In contrast, only 13% of endometrial biopsies obtained during a nonstimulated cycle showed gland-stroma dyssynchrony. When cycles associated with gland-stroma dyssynchrony were compared with cycles associated with coordinated development of the glands and stroma, no significant differences were observed in E2 level on the day of hCG administration, midluteal serum P, midluteal E2 level, or P:E2 ratios.. This study demonstrates that when endometrial biopsies are obtained during the late luteal phase in patients undergoing ovarian hyperstimulation there is a significant dyssynchrony in the maturation of the glandular epithelium and the stroma. This may reflect the degree of responsiveness of an individual woman's endometrium rather than a result of the hormonal milieu.

Topics: Adult; Biopsy; Endometrium; Estradiol; Female; Humans; Infertility; Luteal Phase; Menotropins; Progesterone; Retrospective Studies; Superovulation

There has been a 1.9-fold increase over nearly 20 years in the number of dispensed prescriptions for CC. Since its marketing in 1967, CC has been the major drug prescribed for infertility. In 1973, there were an estimated 390,000 prescriptions for this drug; by 1991, 731,000. From 1984 through 1991, chorionic gonadotropin, menotropins, and urofollitropin together accounted for no more than one third of the market share of the gonadotrophin class of drugs, whose primary indication is treatment of infertility. These drugs were primarily prescribed by obstetrician gynecologists to white females, 20 to 39 years of age, for treatment of infertility of unspecified origin.

Topics: Adolescent; Adult; Child; Child, Preschool; Chorionic Gonadotropin; Clomiphene; Cryptorchidism; Female; Fertility Agents; Humans; Infertility; Male; Menotropins; Middle Aged

The recent use of gonadotrophin-releasing hormone agonist in a short-term regimen has allowed the effectiveness of human menopausal gonadotrophin (HMG) stimulation to be markedly improved. It seems to be related to the flare-up effect of the agonist in the early follicular phase of the cycle. However, individual hormonal responses to the agonist are quite variable and four patterns of oestradiol secretion have been described. The present study indicates that in women pre-treated with progestogen, only two patterns of serum oestradiol are observed in the flare-up period, with a significant increase in 57% of patients. Significant correlations are observed between oestradiol values and the endogenous gonadotrophin surge (positively with luteinizing hormone, r = 0.38; P less than 0.05 and negatively with follicle stimulating hormone, r = 0.48; P less than 0.005). Furthermore, there was a significant relationship between the hormonal flare-up and the ovarian parameters following HMG stimulation. In conclusion, in progestogen-pre-treated women, the serum oestradiol level during the flare-up period is a reliable index to predict subsequent effectiveness of ovarian stimulation with HMG.

Topics: Adult; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Luteinizing Hormone; Menotropins; Norethindrone; Ovary; Triptorelin Pamoate

The first IVF-baby (in-vitro fertilization) was born in England in 1978 and was greeted enthusiastically. But, despite the enormous effort invested, pregnancy rates were disappointingly low. Although in recent years the clinical pregnancy rate has increased worldwide to 15-20% per retrieval, a vast number of people remained unaware of this improvement. To demonstrate and analyze the progress of IVF we evaluated all 196 IVF treatments effected from 1988-1991 at Zürich University Hospital. With an initial clinical pregnancy rate of only 6% per retrieval in 1988, the rate improved to 35% (p < 0.025) in 1991. The crucial factors relating to this improvement were the 1990 introduction of the programmed short-term protocol for ovarian stimulation and reevaluation of the previously used embryo freezing technique.. After a difficult start, IVF has become, if accurately indicated, a method of sterility treatment with a realistic pregnancy and delivery prospect.

Topics: Antibodies; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Punctures; Spermatozoa

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

Topics: Adult; Androstenedione; Estradiol; Female; Follicle Stimulating Hormone; Follicular Fluid; Humans; Infertility; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Pregnancy; Retrospective Studies; Smoking; Testosterone

The influence of partial zona dissection (PZD) on the fertilization rate was studied in 34 couples with a history of fertilization failure and/or severe sperm deficiency. Overall, PZD improved the rate of monospermic fertilization compared to controls (41/254 versus 6/111: P less than 0.001) and fertilization was achieved in 50% of cases. However, the results differed according to the seminal characteristics. In 10 couples with at least two in-vitro fertilization (IVF) trials entailing total fertilization failure and with semen defined as normal, PZD did not significantly improve the monospermic fertilization rate (6/44 in the PZD group versus 2/39 among controls). A benefit related to PZD was evident in 33 attempts with severe sperm deficiency. In this group, only four of 72 unmanipulated control oocytes were fertilized but the monospermic fertilization rate was 14.6% for PZD oocytes. The rates of polyspermy were 40% and 14.6% in the groups with normal and abnormal semen parameters respectively. Of 33 trials with defective spermatozoa, 20 reached the stage of embryo transfer and three pregnancies were obtained, of which one aborted at 9 weeks.

Topics: Female; Fertilization; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility; Male; Menotropins; Micromanipulation; Ovulation Induction; Sperm Count; Sperm Motility; Sperm-Ovum Interactions; Zona Pellucida

In a prospective comparison of IP, IUI, and natural intercourse following superovulation in couples diagnosed as having unexplained infertility, semen factors, or sperm antibodies, pregnancy rates were found to be significantly higher after IP. Pregnancy rates were also higher in the unexplained infertility group when compared with those with semen factors. It was concluded that IP in combination with superovulation offered a simple, inexpensive, safe alternative to GIFT.

Topics: Administration, Intravaginal; Adult; Clomiphene; Coitus; Female; Humans; Infertility; Injections, Intraperitoneal; Insemination, Artificial; Menotropins; Ovary; Pregnancy; Superovulation

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Humans; Infertility; Menotropins; Ovary; Ovulation Induction; Pregnancy; Progesterone; Superovulation

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility; Insemination, Artificial, Homologous; Menotropins; Oocytes; Ovary; Ovulation Induction; Pregnancy; Superovulation

It has previously been demonstrated that use of gonadotrophin releasing hormone analogues allows the administration of HCG to be delayed and makes it possible to avoid oocyte retrievals at weekends. In this study, we demonstrate that it is also possible to avoid embryo transfers on Sundays, by delaying transfers of Friday retrievals until Monday, without any apparent change in the results. This facility should improve the cost-effectiveness of assisted reproduction programmes.

Topics: Buserelin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility; Menotropins; Ovary; Ovulation Induction; Pregnancy; Pregnancy Outcome; Triptorelin Pamoate

Topics: Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility; Insemination, Artificial; Menotropins; Ovulation; Superovulation

Leuprolide acetate (LA) has improved the efficiency of human menopausal gonadotropins (hMG) in in vitro fertilization cycles. We hypothesized that the combination of LA/hMG/intrauterine insemination (IUI) would be more efficacious than hMG/IUI cycles.. During an 18-month period, all patients completing either a hMG/IUI cycle (group I) or a LA/hMG/IUI cycle (group II) had the characteristics and outcomes of their stimulation cycles assessed. The groups were not prospectively randomized.. Referral center at a tertiary care hospital.. One hundred twenty three patients in group I completed 219 cycles, and 64 patients in group II completed 102 cycles. Twenty-eight of the patients who failed to conceive with hMG/IUI were advanced to group II.. Pregnancy/IUI is compared between the two groups.. Group II demonstrated significantly greater clinical pregnancy/IUI than group I (26.5% and 16.0%, respectively, P less than 0.05), as well as a higher live birth/IUI (21.6% and 12.8%, respectively, P less than 0.05). No difference was present in the rate of fetal wastage or multiple births.. In our patients with recalcitrant infertility, the addition of a gonadotropin-releasing hormone agonist to hMG/IUI improved the pregnancy rate, without increasing the rate of multiple births or fetal wastage.

Topics: Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Insemination, Artificial; Leuprolide; Male; Menotropins; Ovary; Pregnancy; Pregnancy, Multiple

The purpose of this study was to evaluate the success of gamete intrafallopian transfer (GIFT) and superovulation with intra-uterine artificial insemination (S-IUI) in couples with long-term unexplained infertility. Thirty-nine couples were offered three attempts at each treatment. Sixty-three IUI cycles were completed with a pregnancy rate of 1.5% per cycle. Forty-nine GIFT procedures were carried out with a pregnancy rate of 26.5% per cycle. The cumulative conception rate after three cycles of GIFT was 0.56. GIFT appears to offer a far greater chance of pregnancy than S-IUI in unexplained infertility.

Topics: Adult; Buserelin; Clomiphene; Female; Gamete Intrafallopian Transfer; Humans; Infertility; Insemination, Artificial, Homologous; Male; Menotropins; Pregnancy; Superovulation; Uterus

Topics: Androgens; Animals; Dose-Response Relationship, Drug; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Infertility; Menotropins; Ovary; Pituitary Gland

To determine the characteristics associated with pregnancy and multiple gestation after human menopausal gonadotropin intrauterine insemination (hMG-IUI).. Prospective study of all patients undergoing hMG-IUI between January 1, 1984 and December 31, 1989.. University affiliated private clinic.. Four hundred twenty-four infertility patients undergoing 779 cycles of hMG-IUI.. The relationship between estradiol (E2), number and size of follicles, age, and initial semen quality on pregnancy and multiple gestations in hMG-IUI cycles.. The number of follicles greater than or equal to 12 mm was correlated with births and predicted all multiple births (r = 0.140, P less than 0.001). The corrected birth rate was 25.8% for age less than 35 and 14.0% for age greater than or equal to 35 when four or more follicles were greater than or equal to 12 mm. The uncorrected clinical pregnancy rate (PR) and birth rate were 12.8% and 10.5%, respectively. Decreased births were associated with tubal adhesions alone (P less than 0.03) or with endometriosis (P less than 0.002), more than four cycles of treatment (P = 0.01), initial sperm count less than 5 x 10(6) per mL (P less than 0.01), initial sperm motility less than 30% (P less than 0.002), and age greater than or equal to 35 (P less than 0.01). Estradiol was correlated with birth rate (r = 0.160, P less than 0.001), which increased from 3.6% when E2 was less than 500 pg/mL to 19.6% when E2 was greater than or equal to 2,500 pg/mL.. The outcome of hMG-IUI is related to the number of follicles greater than or equal to 12 mm, to E2, and to age. Optimal PRs from hMG-IUI require mild ovarian hyperstimulation.

Topics: Adult; Age Factors; Estradiol; Female; Humans; Infertility; Insemination, Artificial; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Prospective Studies

Direct intraperitoneal insemination (DIPI) and superovulation are simple procedures which may together represent a good alternative to gamete intra-Fallopian transfer (GIFT) in infertile women with patent Fallopian tubes. In the present study, pregnancy occurred in 25 of 96 couples (26%) and six (24%) of these aborted. The pregnancy rate for all cycles was 19.6% and multiple pregnancies were found in six of 25 (24%) patients. We observed no ectopic pregnancy. The combination of these techniques is concluded to be useful in achieving pregnancy in infertile women with patient Fallopian tubes.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility; Insemination, Artificial, Homologous; Menotropins; Ovary; Ovulation Induction; Pregnancy; Superovulation

Sextuplet pregnancy occurred after human menopausal gonadotropin ovulation induction, intrauterine insemination and human chorionic gonadotropin support in the luteal phase. The patient's peak serum estradiol concentration was 861 pg/mL, and ultrasound monitoring demonstrated only one follicle greater than 11 mm in diameter. The possibility of high-order multiple birth exists despite intensive monitoring efforts for this therapy.

Topics: Adult; Female; Humans; Infertility; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Superovulation; Uterus

The efficacy of a technique of gonadotropin suppression and human menopausal gonadotropins (hMG) to induce ovulation in women with hypergonadotropic amenorrhea was evaluated in 100 consecutive women. Ovulation was achieved in 19% of cycles (68/361), the pregnancy rate per cycle was 5.2% (19/361), and the viable pregnancy rate was 2.2% (8/361). In the majority of the successful cases, estrogen was used to decrease the elevated luteinizing hormone and follicle-stimulating hormone levels, especially where the ethinyl estradiol therapy alone induced a rise in endogenous 17 beta-estradiol levels with hMG used to boost the follicle to maturation. Although the success rate is low, this technique can result in some successes in otherwise almost hopeless cases.

Topics: Adult; Amenorrhea; Estrogens; Ethinyl Estradiol; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Hormones; Humans; Infertility; Leuprolide; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Outcome; Time Factors

Gamete intra-Fallopian transfer (GIFT) was performed in 130 treatment cycles over a 17-month period. In 91% (118/130) of the cycles one or more oocytes were available for insemination in vitro and only GIFT cycles with supernumerary oocytes were included in the present study. Pituitary and ovarian suppression was achieved with buserelin followed by stimulation of multifollicular development by human menopausal gonadotrophin (HMG). Failure of supernumerary oocytes to fertilize was associated with a significantly reduced pregnancy rate (3/23; 13%) compared to cycles where fertilization occurred in vitro (35/95; 37%). These findings demonstrate that the outcome of IVF of supernumerary oocytes may be of particular diagnostic value in couples where the female partner has not conceived following treatment by GIFT after pituitary down-regulation with buserelin and ovarian stimulation with HMG.

Topics: Adult; Buserelin; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility; Male; Menotropins; Oocytes; Ovary; Pituitary Gland; Pregnancy

The survival of cleaving embryos after freezing and thawing has been assessed. First, comparisons were made of the proportions of embryos in which all blastomeres were viable cells after thawing, following various forms of ovarian stimulation. A flare-up protocol using a GnRH-agonist (buserelin) produced significantly higher numbers of these embryos than a pituitary down-regulation protocol (P less than 0.05), though neither was significantly different from clomiphene citrate/HMG stimulation. Secondly, other parameters of embryo survival e.g. proportions with one or more surviving cells and pregnancy rates were assessed and were similar among stimulation protocols and treatments in the embryo replacement cycle. Survival of blastomeres in 2- to 8-cell embryos was inversely related to the theoretical total surface area of all blastomeres in the embryo. Thawed embryos with one or more blastomeres damaged during freezing had the same capacity to produce pregnancies as did those with all blastomeres intact. The survival of individual cells was clearly related to the stage at which the cleaving embryo is frozen, but moderate loss of cells does not significantly influence implantation.

Topics: Blastomeres; Buserelin; Cell Survival; Cleavage Stage, Ovum; Clomiphene; Cryopreservation; Embryo Transfer; Female; Fertilization in Vitro; Freezing; Humans; Infertility; Menotropins; Pregnancy; Tissue Preservation; Tissue Survival

This report concerns the development of in-vitro fertilization (IVF) in the Nordic countries from the start of 1981 to January 1, 1988. All the 24 clinics in the Nordic countries which treat infertile couples with IVF participated in the study. The number of IVF clinics in the Nordic countries has increased from four in 1981 to 24 in 1987. In the same period, the number of people who spent some of their professional time as a part of an IVF team increased from 17 to 150. The majority of the clinics (19) based their activity mainly on governmental funding, while five of the clinics were private. During the period from 1981 to 1987, the Nordic clinic changed their methods of oocyte retrieval. In 1981, all oocyte retrievals were done using laparoscopy. Transvesical, ultrasound-guided follicular punctures domainated in 1985 and transvaginal ultrasound-guided punctures were used in 81.5% of the retrievals in 1987. A total of 852 pregnancies were reported. Of these, 313 (36.8%) were miscarriages, including 66 (7.7%) ectopic pregnancies. At January 1, 1988, 433 babies had been born, including 48 sets of twins, 14 sets of triplets and two sets of quadruplets. This gave a multiple birth rate of 18.2%. Premature births (less than 36 weeks of gestation) were reported in 14.6% of the births. Five babies (1.1%) died in the neonatal period and five (1.1%) were born with various types of malformation. One hundred and eight-eight pregnancies were in progress at January 1, 1988.

Topics: Adult; Clomiphene; Denmark; Embryo Transfer; Female; Fertilization in Vitro; Finland; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Norway; Ovulation; Ovulation Induction; Surveys and Questionnaires; Sweden

From January 1986 to July 1987, 143 patients with unexplained infertility (UI) following 217 IVF attempts were studied and randomly assigned for statistical analysis to be compared with 434 tubal infertility (TI) patients undergoing 748 IVF attempts. The age of patients, previous pregnancy history and stimulation protocols were identical in both groups. In comparison with tubal patients, IVF attempts on the UI group were characterized by the same rates of cycle failure, mean number of oocytes retrieved per cycle, a lower fertilization rate (45.7% UI/59.8% TI) (P less than 0.01) and no difference in cleavage and nidation rates. However, a decrease in the pregnancy rate/attempt (13.8% UI/19.5% TI) tended towards a significant value (P = 0.06). Although the semen parameters were found to be in the normal range during the previous fertility screening in both groups, the incidence of at least one abnormality (count less than 20 X 10(6)/ml, and/or total motility less than 30% and/or abnormal forms greater than 75%) on the day of insemination was found to be significantly higher in UI (20%) than in TI (11%) patients. Moreover, 25% of UI patients did not fertilize any oocytes inseminated, whatever the number of oocytes retrieved. This rate of failed fertilization was significantly lower (9%) in tubal patients. The oestrogen response profiles were similar in both groups, analyzed according to the stimulation protocols.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Buserelin; Chorionic Gonadotropin; Clomiphene; Embryo Implantation; Estrogens; Female; Fertilization in Vitro; Humans; Infertility; Male; Menotropins; Menstrual Cycle; Ovulation Detection; Semen; Sperm Agglutination

Gamete intra-Fallopian transfer (GIFT) was combined with a diagnostic laparoscopy on a routine operating list in a district general hospital. The equipment used was entirely portable. Operations were programmed 6-12 weeks in advance using a fixed ovarian stimulation regimen. Of 47 patients treated, 38 (81%) responded appropriately to stimulation. Of these, 23 had partners with normal semen parameters and 5 of 21 (24%) who had GIFT conceived. Two others were found to have tubal damage. Their eggs were transported to an in-vitro fertilization unit at another hospital. Both conceived after embryo transfer. In 15 couples, the semen was found to be sub-optimal and none of these became pregnant. GIFT can be performed in a district hospital, on a fixed schedule in conjunction with a diagnostic laparoscopy. The technique appears unsuitable for patients with suboptimal semen and the backing of an in-vitro fertilization unit increases pregnancy rates.

Topics: Clomiphene; Female; Gamete Intrafallopian Transfer; Hospitals, District; Humans; Infertility; Laparoscopy; Menotropins; Norethindrone; Ovulation Induction

Over a 27-month period, the authors observed 70 pregnancies in 66 women following intrauterine insemination (IUI) in conjunction with human menopausal gonadotropins/human chorionic gonadotropin (hMG/hCG) stimulation. Excluding ectopic pregnancies (n = 3) and spontaneous miscarriages (n = 15) during the first 10 weeks of gestation, 14 of the 52 pregnancies (27%) included multiple fetuses: nine twins, four triplets, and one quadruplet. Analysis of patient characteristics and clinical management, as well as semen characteristics of the conception cycle, revealed a significant correlation between gestation type (multiple versus singleton) and the total number of motile sperm in the IUI inseminate (P less than 0.01, Fisher's exact test). General linear models procedures did not identify additional significant relationships between various combinations of parameters examined and the gestation type. The authors conclude that IUI with high numbers of motile sperm constitutes a risk factor in the genesis of multiple gestation. The risk of multiple gestation rises significantly when the inseminate contains more than 20 million motile sperm.

Topics: Adult; Female; Humans; Infertility; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Risk Factors; Sperm Count; Sperm Motility

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

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

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Estradiol; Female; Humans; Infertility; Menotropins; Peptide Fragments; Pregnancy; Pregnancy, Multiple; Progesterone; Ultrasonography

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

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

The effect of the dose of human chorionic gonadotropin (hCG) on oocyte retrieval in an in vitro fertilization (IVF) program was studied. Following ovulation induction using clomiphene citrate and either pure follicle-stimulating hormone (FSH) or human menopausal gonadotropin (hMG), hCG was administered at a dose of 2000 IU (n = 88), 5000 IU (n = 110), and 10,000 IU (n = 104). There was a significantly lower successful oocyte recovery in patients who received 2000 IU of hCG (77.3%) compared with patients who received either 5000 IU of hCG (95.5%) or 10,000 IU of hCG (98.1%; P less than 0.001). There was no significant difference between 5000 or 10,000 IU of hCG. In patients who received 2000 IU of hCG, successful oocyte recovery was significantly lower when pure FSH was used (60%) compared with those who received hMG (84.1%; P less than 0.03). Patients have different thresholds for follicular response to hCG and the recommended minimum dose of hCG should be at least 5000 IU.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Dose-Response Relationship, Drug; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction

This study compares outcomes of in vitro fertilization (IVF) in two groups of 57 patients when either 2 (group 1) or 3 (group 2) ampules of human menopausal gonadotropin (hMG) were administered daily. Treatment began on day 3 of the cycle and was discontinued when at least 2 follicles attained diameters greater than or equal to 1.5 cm. Human chorionic gonadotropin (hCG) was given either 24 or 48 hours after the last dose of hMG. Although serum estradiol levels were lower in group 1, the average number of oocytes retrieved (3.2 versus 2.9), fertilized (1.9 versus 2.0), and cleaved (1.7 versus 1.8) per completed cycle did not differ between groups 1 and 2. Likewise, the number of oocytes that fertilized abnormally was similar in both groups (0.5 versus 0.3/cycle). However, the number of atretic oocytes (0.03 versus 0.5/cycle) and the percent of oocytes recovered from the cul-de-sac (0 versus 7.2%) were significantly (P less than 0.05) lower in group 1. In group 1, administration of hCG 48 hours after the last dose of hMG was associated with a higher number of cleaving embryos (2.1 versus 1.5/cycle) and a higher pregnancy rate (34.8 versus 14.7%; P less than 0.05) when compared with injection at 24 hours. In group 2, the interval between hMG and hCG did not influence these results. Together, the associations between fewer oocytes that were atretic or recovered from the cul-de-sac, and a trend toward a higher pregnancy rate, suggest that follicular recruitment with 2 ampules of hMG is more appropriate than 3 ampules in an IVF program.

Topics: Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Humans; Infertility; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Pregnancy; Retrospective Studies

The clomiphene or hMG to stimulate ovarian follicle maturation which we call "controlled ovarian stimulation (COS)", in vitro capacitation (IVC) of spermatozoa and artificial insemination of husband's sperm (AIH) were simultaneously given to refractory infertile couples. The following couples were studied in 5 groups, 1 male subfertility 27 cases, 2 functional infertility 25 cases, 3 ovulatory dysfunction due to central mechanism 8 cases, 4 cervical mucous insufficiency 3 cases, 5 endometriosis 6 cases. The pregnancy rate was 21.7% in total (15 of 69 cases): 25.9% in group 1, 16.0% in group 2, 25.0% in group 3, 33.3% in group 4 and 16.7% in group 5. The follicle size and serum estradiol were measured every day during the periovulatory phase to evaluate follicle maturation. The Percoll centrifugation method was compared with the washing-centrifugation method with respect to the recovery rate and the concentration rate of motile spermatozoa. The recovery rate was 67.9% with the Percoll centrifugation method, and 40.0% with the washing-centrifugation method. The concentration rate was 1.81 times in the Percoll centrifugation method, and 1.19 times in the washing-centrifugation method. The present studies indicated that the combination of COS and IVC methods for AIH in refractory infertile couples was very effective.

Topics: Clomiphene; Combined Modality Therapy; Evaluation Studies as Topic; Female; Humans; Infertility; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Menstrual Cycle; Pregnancy; Sperm Capacitation; Stimulation, Chemical

Blodgett Memorial Medical Center began developing an IVF program in September of 1982. It took 10 months to establish animal and human IVF laboratories and an andrology laboratory. All personnel were recruited from within the hospital. From August 1983 through March 1985, 49 patients went through 58 complete IVF laparoscopy cycles. hMG and hCG were used to stimulate folliculogenesis and ovum maturation. An average of 5.2 oocytes was obtained by laparoscopic follicular aspiration. Eighty-four percent were either mature or intermediate oocytes. The fertilization rate per oocyte was 67%. Eighty percent underwent cleavage. Forty-seven patients (81%) received 1 or more embryos, with an average of 2.8 embryos each. There have been 12 pregnancies, including 3 abortions and 3 multiple pregnancies. Eight healthy infants have been born to date. The pregnancy rate per laparoscopy cycle was 21% and per transfer cycle was 26%. As a result of the IVF program, other services for infertile couples have been developed.

Topics: Chorionic Gonadotropin; Costs and Cost Analysis; Drug Administration Schedule; Female; Fertilization in Vitro; Hospitals, Community; Humans; Infertility; Male; Menotropins; Pregnancy

Fourteen couples with long-standing infertility, associated with cervical mucus insufficiency, male subfertility, or unexplained infertility, participated in a therapeutic trial. The female partners, who were all ovulatory, were given human menopausal gonadotropin from day 2 of the menstrual cycle (controlled ovarian hyperstimulation). When plasma estradiol concentrations reached 1000 to 2000 pg/ml, human chorionic gonadotropin was given. Approximately 32 hours and again 70 hours thereafter, a masturbation specimen of the husband's sperm was capacitated in vitro and inseminated transcervically into the uterine cavity. Five women (35%) conceived following a single cycle of treatment. Four of the pregnancies are currently progressing normally; one ended in a spontaneous miscarriage in the early first trimester. The potential role of in vitro sperm capacitation and transcervical intrauterine insemination in the treatment of refractory infertility unrelated to female organic pelvic disease is discussed.

Topics: Chorionic Gonadotropin; Female; Humans; Infertility; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation; Sperm Capacitation

Topics: Adnexa Uteri; Adnexal Diseases; Adult; Anovulation; Chorionic Gonadotropin; Danazol; Endometriosis; Female; Humans; Infertility; Laparoscopy; Laparotomy; Male; Menotropins; Ovarian Neoplasms; Pregnancy; Pregnancy, Tubal; Preoperative Care; Urinary Bladder Neoplasms

A case report of a quadruplet pregnancy that followed the induction of ovulation by human chorionic gonadotropin and human menopausal gonadotropin is presented. Examination revealed 4 separate placentas, indicating development from 4 different ova. The infants all did well at term, with no signs of respiratory distress syndrome, and have developed normally. Early diagnosis by ultrasonography and complete early bedrest are important for fetal survival. Hospitalization at Week 27-28 of pregnancy is essential, and a complete, competent staff able to handle high-risk patients should be available. Intravenous ethanol infusion is useful during early labor. The patient must be carefully observed for postpartum hemorrhage and should be followed in the recovery room for 24 hours.

Topics: Adult; Chorionic Gonadotropin; Delivery, Obstetric; Estriol; Extraction, Obstetrical; Female; Humans; Infertility; Labor Presentation; Male; Menotropins; Pregnancy; Pregnancy, Multiple; Quadruplets

A study of human menopausal gonadotropin (HMG) in the induction of ovulation in 14 infertile, anovulatory women is presented. All of the women had failed to ovulate following clomiphene therapy. The dose of HMG administered in each of the 43 treatment cycles was determined by measuring the estrogen levels by either fluorimetric tests of total urinary estrogen, radioimmunoassay of serum estradiol, or a rapid 4-hour radioimmunoassay of immunoreactive serum estrogen. A significant correlation among the methods in establishing estrogen production obtained (r=.935; p less than .001). 38 of the 43 treatment cycles were presumed to be ovulatory, based on serum progesterone levels and basal body temperature. 7 of the 14 patients became pregnant (11 of the 38 ovulatory cycles). There were 5 instances of mild ovarian hyperstimulation during the study. The results demonstrate that the rapid radioimmunoassay technique for measuring serum estrogens, without chromatography, is capable of determining the extent of follicular maturation during HMG therapy.

Topics: Adult; Chorionic Gonadotropin; Chromatography, Gel; Estradiol; Estrogens; Female; Fluorometry; Follicle Stimulating Hormone; Humans; Infertility; Male; Menotropins; Ovulation; Progesterone; Radioimmunoassay; Tritium

Topics: Animals; Chorionic Gonadotropin; Chromatography, Gel; Drug Stability; Estradiol; Estriol; Estrone; Female; Humans; Hydrogen-Ion Concentration; Infertility; Male; Menotropins; Menstruation; Pregnancy; Rabbits; Radioimmunoassay; Time Factors; Tritium

Topics: Amenorrhea; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility; Infertility, Female; Menotropins; Ovulation

Topics: Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility; Infertility, Male; Male; Menopause; Menotropins; Spermatozoa

Topics: Amenorrhea; Atrophy; Endometrium; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Infertility; Infertility, Female; Menotropins