menotropins and Ovarian-Cysts

Induction of ovulation has its own risks. Since this treatment is elective the physician should be convinced that it is really indicated for the specific patient. Multiple pregnancies still occur in 4 to 15% in in vivo treatment and in 15 to 20% in assisted reproduction. Abortions occur in 20% of the pregnancies achieved. These numbers demonstrate the complexity of induction of ovulation. In recent years the average age of the treated patient has increased, but it is too early to see whether this influences the frequency of complications. The physician should be aware of the possible complications and should remain in contact with the patients at risk after completion of the treatment. The patient should be well informed about the possible complications before starting treatment. At the end of the treatment she should be able to recognize any clinical warning signs of OHSS and inform her physician, in order to be treated appropriately. Further studies of the pathogenesis of OHSS in the future will hopefully lead to more specific treatments or even prevention of this phenomenon. The increasing experience in selective fetal reduction seems to be a practical solution to high rank multifetal gestation, preventing extreme prematurity and its sequelae.

Topics: Female; Fertilization in Vitro; Follicular Cyst; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Cysts; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Risk Factors

Topics: Chorionic Gonadotropin; Estrogens; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Risk Factors; Syndrome

Topics: Adult; Animals; Body Temperature; Cell Separation; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Inhalation; Luteinizing Hormone; Menotropins; Menstruation; Menstruation Disturbances; Ovarian Cysts; Ovarian Follicle; Ovary; Ovulation; Ovum; Pregnancy; Pregnancy, Multiple; Sheep; Time Factors; Twins; Ultrasonography

Topics: Amenorrhea; Ascites; Chorionic Gonadotropin; Female; Gonadotropins; Gonadotropins, Equine; Gonadotropins, Pituitary; Humans; Hydrothorax; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation; Pregnancy; Pregnancy, Multiple; Thrombosis

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

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

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

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

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

A protocol utilizing both leuprolide acetate (LA) and norethindrone acetate (NETA) in subjects undergoing ovarian suppression prior to follicle aspiration proved more effective than LA alone in reducing the incidence of ovarian cyst formation without affecting clinical outcome. Patients (n = 105) undergoing ovarian stimulation followed by follicle aspiration and in-vitro fertilization (IVF) were prospectively randomized and studied. Study measures included ovarian suppression days, days of human menopausal gonadotrophin (HMG) stimulation, serum oestradiol concentrations, number of cycles developing de novo cysts (>15 mm), number of induced flare responses (day 8 oestradiol >=50 pg/ml), number of office visits, total dose exogenous gonadotrophins, number oocytes retrieved, and clinical pregnancy and delivery rates per retrieval. Patients undergoing IVF received either LA alone (n = 58; controls) or LA and NETA (n = 47; study group) for the first 8 days of their cycle. Results comparing NETA/LA versus LA demonstrated: serum oestradiol 20.7 +/- 3.9 versus 57.3 +/- 9.4 pg/ml respectively on day 8 of ovarian suppression (P P < 0.01); and only three individuals (6.4%) using NETA/LA developed ovarian cysts >15 mm compared to 15 (25.9%) controls (P < 0.01). No differences were observed for days of stimulation, peak oestradiol attained, total dosage of exogenous gonadotrophins, or number of aspirated oocytes. Neither were there differences in the clinical pregnancy (26.8 versus 22.6%) nor in delivery rates (19.5 versus 20. 8%). We conclude that the addition of NETA to LA enhances ovarian suppression and lessens ovarian cyst formation, thereby significantly decreasing the overall cost per cycle.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Humans; Leuprolide; Menotropins; Norethindrone; Norethindrone Acetate; Ovarian Cysts; Ovulation Induction; Pregnancy; Prospective Studies

This study was designed to ascertain whether any benefit would be derived from aspirating ovarian cysts identified before ovarian stimulation in patients undergoing in vitro fertilization. Thirty-seven patients who had ovarian cysts were categorized into two groups: group A (n = 14) with baseline ovarian cysts and group B (n = 23) with ovarian cysts that developed during pituitary suppression with the gonadotropin-releasing hormone analog. Each group was prospectively randomized into two subgroups depending on whether the ovarian cysts were aspirated or not. In group A, there was a significantly greater number of follicles and oocytes in the ovaries in which cysts were aspirated. However, there was no significant difference in the total number of follicles, oocytes retrieved and fertilized, or in the final outcome. In group B, there was no significant difference in folliculogenesis between the aspirated and nonaspirated subgroups. These observations suggest that the presence of a baseline ovarian cyst may reduce folliculogenesis but do not support routine cyst aspiration if the patient has two functional ovaries.

Topics: Adult; Drainage; Female; Fertilization in Vitro; Follicular Phase; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Cysts; Ovarian Follicle; Time Factors

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

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

Our purpose was to assess the effect of pretreatment with oral contraceptives (OCs) on the formation of functional ovarian cysts during pituitary suppression with gonadotropin-releasing hormone (GnRH) agonists, subsequent follicular development, and pregnancy rates.. A retrospective case-controlled study of 31 in vitro fertilization (IVF) patients, all of whom in a previous cycle had commenced the long protocol of GnRH-agonist (Buserelin) in the early follicular phase and were pretreated in a subsequent cycle with 2 weeks of an OC containing 30 micrograms of ethinyl estradiol and 150 micrograms of desogestrel prior to GnRH-agonist administration, was undertaken. Follow-up visits were arranged after a minimum of 11 days of GnRH-agonist administration and weekly thereafter until pituitary suppression was achieved.. Cysts were detected in 16 (51.6%) of the 31 patients not pretreated with OCs, and in 0 (0%) of the 31 patients pretreated with OCs (odds ratio = 67.1; 95% confidence interval = 5.6-350.7). Patients pretreated with OCs achieved pituitary suppression more rapidly (median difference = 4 days; 95% confidence interval = 2-7) and had comparable gonadotropin requirements and pregnancy rates.. Pretreatment with OCs prior to pituitary suppression in the early follicular phase decreases ovarian cyst formation, without an apparent effect on subsequent follicular recruitment or pregnancy rates.. A retrospective case-controlled study was undertaken to assess the effects of pretreatment with oral contraceptive (OC) on the formation of functional ovarian cysts during pituitary suppression with gonadotropin-releasing hormone (GnRH) agonists, subsequently follicular development, and pregnancy rates. In the period between January 1997 and December 1997, 31 in vitro fertilizations, all of which in a previous cycle, had commenced the long protocol of GnRH agonists in the early follicular phase and were pretreated in a subsequent cycle with an OC containing 30 mcg ethinyl estradiol and 150 mcg desogestrel for 2 weeks prior GnRH agonist administration and then weekly until pituitary suppression was achieved. After data collection and analysis, findings revealed that functional ovarian cysts were detected in 16 (51.6%) of 31 patients not pretreated with an OC and in 0 (0%) of 31 patients pretreated with an OC. Satisfactory pituitary suppression was achieved more rapidly with patients pretreated with an OC. Further, comparable gonadotroph requirements and pregnancy rates were detected among patients pretreated with an OC. In conclusion, pretreating patients with an OC prior to pituitary suppression in the early follicular phase decreases ovarian cyst formation, without an apparent effect on subsequent follicular recruitment or pregnancy rates.

Topics: Adult; Buserelin; Case-Control Studies; Desogestrel; Estradiol Congeners; Ethinyl Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Ovarian Cysts; Ovarian Follicle; Ovulation Induction; Pituitary Gland, Anterior; Pregnancy; Pregnancy Rate; Premedication; Progesterone Congeners; Retrospective Studies; Secretory Rate

To assess whether the ovarian response to exogenous gonadotropins and cycle performance is affected by different timing of an agonist administration in long down-regulation protocols.. An agonist was administered irrespective of cycle phase, with exogenous gonadotropin beginning 15 days later.. Five hundred fifty-seven normovulatory infertile patients, aged < or = 38 years, were classified into seven study groups, depending on the phase of the cycle in which agonist was started.. Endocrine profile, amount of exogenous stimulation, occurrence of ovarian cysts, mean number of oocytes recovered and embryos transferred, pregnancy rate, implantation rate, and live-birth rate of the seven groups.. The ovarian response of the groups did not show any statistically significant differences in relation to the initiation of the agonist. The only effect was a different incidence of ovarian cyst formation, but this phenomenon did not affect cycle performance. The pregnancy, implantation, and live-birth rates showed differences that did not reach statistical significance.. Agonists initiation can be programmed in advance irrespective of the phase of the cycle. This approach can be of help for the logistics of assisted reproduction programs.

Topics: Adult; Buserelin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Ovarian Cysts; Ovary; Pregnancy; Time Factors

Hyperreactio luteinalis is a non-neoplastic tumor-like ovarian lesion associated with pregnancy. Most patients are asymptomatic, with the ovarian enlargement being incidentally discovered at the time of cesarean section. It can simulate a neoplasm on clinical, gross and sometimes microscopic examination. We report a case of hyperreactio luteinalis in a patient, who was diagnosed as having polycystic ovary disease before conceiving a triplet pregnancy after three treatment cycles of human menopausal gonadotropin-human chorionic gonadotropin therapy, and discuss its pathogenesis.

Topics: Adult; Chorionic Gonadotropin; Diagnosis, Differential; Drug Therapy, Combination; Female; Fertility Agents, Female; Humans; Menotropins; Ovarian Cysts; Ovarian Neoplasms; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Triplets

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

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

The aim of this study was to examine the occurrence of ovarian cysts during the administration of three different gonadotrophin-releasing hormone analogues (GnRHa) in the long protocol as well as their characteristics, management and outcome compared with patients with no cyst formation. A total of 172 in-vitro fertilization (IVF) cycles in which GnRHa was administered at menstruation were analysed. Group B consisted of 72 cycles in which buserelin was used. Of these, 10 (13.9%) were with cysts (group B1) and 62 (86.1%) without cysts (group B2). Group T included 49 cycles in which triptorelin was injected. Of these, seven (14.2%) were with cysts (group T1) and 42 (85.7%) without cysts (group T2). Group L comprised 51 cycles in which leuprolide was administered. Of these, eight (15.7%) were with cysts (group L1) and 43 (84.3%) without cysts (group L2). All women with ovarian cysts had higher serum oestradiol concentrations and all except five underwent cyst aspiration with no complication. No differences were observed in the number of follicles and oocytes between groups B, T and L or between the groups with cysts and those without cysts. The pregnancy rate was similar in all groups. In conclusion, follicle cyst formation does not seem to be related to the use of a specific GnRHa, its short- or long-acting form or to the mode of administration. In addition, follicle cyst aspiration is a safe and successful solution to the problem of functionally active ovarian cysts.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Menotropins; Ovarian Cysts; Pregnancy; Triptorelin Pamoate

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

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

Patients undergoing COH were prospectively studied in 174 cycles for the presence of baseline ovarian cysts. In 37.4% of all cycles, a baseline cyst > 10 mm mean diameter was found, but a cyst was more common in subsequent cycles than on the first (41.5% versus 15.8%). Cycle fecundity as determined by life table analysis was significantly higher if no baseline cyst were present (0.25 versus 0.06, P > 0.01). These findings suggest that baseline ovarian cysts may adversely affect the chances for pregnancy in COH not associated with IVF or GIFT.

Topics: Estradiol; Female; Fertility; Humans; Menotropins; Menstrual Cycle; Ovarian Cysts; Ovary; Ultrasonography

In this report, the treatment by follicular aspiration was evaluated in a pregnant patient with severe ovarian cysts subsequent to ovulation induction with CC and gonadotropins. The patient had dramatic and immediate improvement of the symptoms and general condition as well as a significant shorter hospital stay. The procedure was, under meticulous US guidance, safe and effective, providing additional improvement or increased therapeutic confidence in the severe complications after ovulation induction, as an assisted option during pregnancy.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Menotropins; Ovarian Cysts; Ovulation Induction; Pregnancy; Pregnancy Complications; Suction; Ultrasonography

To determine if ovarian cysts are associated with a particular basal endocrine profile and impair follicular growth.. Retrospective study.. In Vitro Fertilization (IVF) Center.. Nine hundred fourteen stimulation cycles stimulated with a combination of luteinizing hormone-releasing hormone analogues (LH-RH-a) and human menopausal gonadotropins (hMG) in a long protocol in an IVF program.. After 15 days of LH-RH-a therapy, ovarian cysts (> or = 20 mm) were observed in 8% of cases. These cysts were not related to a particular basal endocrine profile and did not impair follicular growth and IVF results. However, puncturing these cysts enhanced the quality of subsequent follicular growth. On the contrary, cysts appearing during hMG treatment (> or = 25 mm) were related with a lower LH:follicle-stimulating hormone ratio (0.79 +/- 0.52 versus 0.92 +/- 0.74 in absence of cyst) and to a lower ovarian response as assessed by the maximal estradiol level to the total number of hMG ampules ratio (51.6 +/- 36.5 versus 65.9 +/- 47.9 in absence of cyst). However, this difference had no influence on the pregnancy per stimulation rate (18% versus 16% in absence of cyst; not significant).. Results show that the pathogens of ovarian cysts appearing during the blockage phase and during the stimulation phase are different. However, they do not impair the results of IVF, and thus it is not necessary to cancel the attempt in case of ovarian cyst.

Topics: Buserelin; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Leuprolide; Luteinizing Hormone; Menotropins; Ovarian Cysts; Ovarian Follicle; Pregnancy; Retrospective Studies; Triptorelin Pamoate

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

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

The ovarian hyperstimulation syndrome is the most serious complication following ovulation induction. It is assuming greater clinical importance now that the indication for ovulation induction is no longer limited to anovulatory women but expands to other infertility problems. In its most severe manifestation the ovarian hyperstimulation syndrome consists of massive ovarian enlargement with multiple cysts, hemoconcentration, ascites, and pleural and pericardial effusion. There is no specific treatment and a reduction in the incidence of this iatrogenic syndrome can be achieved only by preventive measures.

Topics: Adult; Ascites; Female; Humans; Hypertrophy; Iatrogenic Disease; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pleural Effusion; Syndrome

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

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

The results of both groups, the one with hMG postponement and the one without, were similar in respect to the amount of hMG needed, number of oocytes retrieved, quality of embryos, pregnancy, and abortion rates. The flexible hMG commencement lowers the cancellation rate to a minimum.

Topics: Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; Luteinizing Hormone; Menotropins; Ovarian Cysts; Ovulation; Pituitary Hormone-Releasing Hormones; Pregnancy; Progesterone

The outcome of in-vitro fertilization treatment using buserelin, an agonist of luteinizing hormone releasing hormone, given in a short stimulation regimen with human menopausal gonadotrophin (HMG), was compared with a conventional regimen including clomiphene citrate (CC). A total of 94 infertile women underwent cycles of treatment with intranasal buserelin, 500 micrograms daily from the first day of menstruation and also HMG daily from the third day. The same patients had previously undergone unsuccessful treatment cycles with CC and HMG. Overall, addition of buserelin resulted in fewer cycles being abandoned (10 versus 34%) and none of the patients ovulated prior to collection. The mean total dose of HMG required was increased by 74% in buserelin cycles. Significantly more oocytes were collected with buserelin treatment (mean 5.9 versus 4.4, P less than 0.01) and, thus, significantly more embryos were transferred (mean 2.3 versus 1.2, P less than 0.0001) although fertilization and cleavage rates were unchanged. Fifteen pregnancies were achieved, giving a clinical pregnancy rate of 22% per embryo transfer. These pregnancies resulted in 16 live births (7 singletons, 3 twins, 1 triplets). Four pregnancies failed before 14 weeks gestation. We conclude, therefore, that the substitution of buserelin for CC for ovarian stimulation in poor responders results in an improved outcome, both in terms of the number of oocytes collected and the pregnancy rate per treatment cycle.

Topics: Administration, Intranasal; Adult; Buserelin; Clomiphene; Female; Fertilization in Vitro; Humans; Menotropins; Oogenesis; Ovarian Cysts; Ovulation Induction

In the present paper we examined, whether the combined GnRH-agonist/hMG therapy implies an increased risk of the ovarian hyperstimulation syndrome (OHS). In a retrospective analysis, 525 GnRH-a/hMG cycles were compared with 643 cycles of hMG stimulation, which were simultaneously performed at the Department of Gynecology and Obstetrics of the University of Hamburg. Two different GnRH-agonists were used: Buserelin (Hoechst) given intranasally (410 cycles) and Triptorelin (Ferring) intramuscularly (115 cycles). The clinical results of hMG "only"-therapy revealed an OHS incidence of 7% for grade II and 0.2% for grade III. In contrast, significantly higher incidences were observed after GnRH-a/hMG treatment. In Buserelin/hMG cycles in 23% OHS grade II and in 1.0% OHS grade III occurred, in Triptorelin/hMG cycles in 40% OHS II and in 5.2% OHS III, respectively. The increased incidence of OHS correlated with higher ovarian estrogen production as well as a higher number of follicles following the GnRH-a/hMG stimulation. Furthermore, in GnRH-a/hMG cycles a prolonged duration of follicular maturation occurred due to an increase of the active phase; in addition the amount of hMG-ampoules needed for ovarian stimulation was higher. After GnRH-a/hMG treatment, an endogenous LH-surge was not detected, whereas in 34% of hMG stimulated cycles irregular LH-fluctuations were observed. There was a higher pregnancy rate in GnRH-a/hMG cycles (15%/525 cycles), as compared to hMG stimulation (8%/643 cycles), but the abortion rate was similar (23%, GnRH-a/hMG, versus 13%, hMG). The demonstration of an increased ovarian response leading to better pregnancy rates but also higher risks of OHS is well known from earlier data of hMG stimulation in patients with hypogonadotropic amenorrhoea (WHO group I). This implies that GnRH-agonist pre-treatment shows similar endocrine conditions in normogonadotropic patients.

Topics: Buserelin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pituitary Hormone-Releasing Hormones; Pregnancy; Risk Factors; Syndrome; Triptorelin Pamoate

Ovarian cysts persisting after the onset of menses were demonstrated by ultrasound (US) in 40 of 71 (56%) nonconception cycles following ovulation induction with human menopausal gonadotropins (hMG) and human chorionic gonadotropin (hCG). Persistent cysts were self-limited and all resolved spontaneously within two cycles. They developed more frequently during stimulation cycles with (1) higher mean pre-hCG serum estradiol (E2), (2) a greater number of medium and large follicles at peak pre-hCG E2, and (3) a larger leading follicle diameter at peak pre-hCG E2. Persistent ovarian cysts frequently occurred despite a peak pre-hCG E2 lower than 1000 pg/ml. Although ovarian enlargement in the presence of cysts exceeded 5 X 5 cm in 25% of cases, no patient developed clinical symptoms of ovarian hyperstimulation syndrome (OHSS). Repeated induction of ovulation with hMG/hCG in the presence of nonfunctional, persistent cysts resulted in pregnancies in 6 of 15 cases (40%). Asymptomatic persistent ovarian cysts frequently follow an hMG/hCG regimen and, when nonfunctional, are not a contraindication to repeated ovarian stimulation. Persistent ovarian cysts appear to be an attenuated form of OHSS.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Follicle; Ovulation Induction; Recurrence; Syndrome

Topics: Adult; Clomiphene; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation Induction; Syndrome

Various methods used by gynecologists in the past for hormone therapy and ovulation inducement are discussed including the administration of: 1) steroids composed mainly of estrogen, 2) clomiphene or tamoxifen (estrogen), 3) bromocriptine for high prolactin or latent (transitory) prolactin, 4) glucocorticoid for high androgen levels such as polycystic ovary or adrenogenital syndrome, 5) human menopausal gonadotropin (hMG) and human chorionic gonadotropin, and 6) hMG (pulsatile). In previous studies, another method--the administration of luteinizing hormone releasing hormone (LHRH) by drip infusion--was unsuccessful in inducing ovulation. However, experiments have been performed in which monkeys were given a pulsatile administration of LHRH every 60 minutes for 10-14 days. This new method proved successful in inducing ovulation and normalizing the ovulation cycle. Graphs showing the results of both the old method of ovulation inducement and the new method by pulsatile administration of LHRH are included. There is a brief discussion of contraception, examining, in particular, a new noncoital means of birth control involving antiprogesterone steroids which has been in the developmental stages for the past several years.

Topics: Adult; Anovulation; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Estrenes; Female; Gestrinone; Gonadotropin-Releasing Hormone; Humans; Luteinizing Hormone; Menotropins; Mifepristone; Ovarian Cysts; Ovarian Neoplasms; Ovulation Induction

Twenty-seven anovulatory women who had episode(s) of ovarian hyperstimulation during ovulation induction with hMG were studied. Twenty-nine of the total 89 treatment cycles were complicated by ovarian hyperstimulation. Twenty-four-hour urinary estrogen concentrations 3 days prior to hCG administration were significantly higher in the hyperstimulated (H) than in the nonhyperstimulated cycles (NH). Patients who had progesterone withdrawal bleeding (Group I) were more prone to be hyperstimulated in the first treatment cycle than patients who had no progesterone withdrawal bleeding (Group II). In all instances, the syndrome resolved spontaneously with time. The pregnancy rate of H was threefold NH. It is concluded that hyperstimulation in patients who had evidence of endogenous estrogen activity as demonstrated by progesterone withdrawal bleeding tend to occur in the first treatment cycle. Strict monitoring decreased the incidence of severe hyperstimulation. A minimal amount of hyperstimulation might be beneficial to improve the pregnancy rate.

Topics: Adult; Anovulation; Chorionic Gonadotropin; Estrogens; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovary; Ovulation Induction; Pregnancy; Syndrome

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Menotropins; Ovarian Cysts; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Quintuplets

Eighty cycles induced by human menopausal gonadotropins in 45 women were studied with serial ultrasound examinations. The incidence of ovarian hyperstimulation (OHS) was 44%, considerably higher than in other series using similar induction protocols. This was probably due to the superior ability of ultrasound to detect ovarian enlargement and the withholding of human chorionic gonadotropin until at least one follicle had reached a minimum size of 15 mm. No difference was found between the mean urinary estrogen levels of those in whom mild or moderate OHS developed and those in whom it did not. It is concluded that the development of OHS is a frequent but acceptable result of ovulation induction.

Topics: Amenorrhea; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovary; Ovulation; Ovulation Induction; Ultrasonography

A combined treatment of human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), and dexamethasone was administered to 27 infertile patients with polycystic ovarian disease who failed to conceive with clomiphene citrate and hMG-hCG alone. Twenty-two (81%) of the patients ovulated according to basal body temperature and progesterone values, and 20 (74%) conceived during one to four treatment cycles. Fifteen (74%) pregnancies terminated in live full-term deliveries (14 singletons and 1 set of twins), and 5 (25%) have terminated in first-trimester abortions. Only one of the treatment cycles was complicated by moderate ovarian hyperstimulation. The average hMG dose required for the induction of ovulation was significantly reduced from 25 ampules with hMG-hCG alone to 18 ampules under the combined treatment (P less than 0.01). The combination of hMG-hCG and dexamethasone is an additional, safe, and effective nonsurgical treatment for women with polycystic ovarian disease who have failed to respond to an hMG-hCG regimen alone.

Topics: Adult; Chorionic Gonadotropin; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infertility, Female; Menotropins; Ovarian Cysts; Ovulation Induction

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovulation Induction; Pregnancy; Pregnancy Complications; Syndrome; Torsion Abnormality

Nine infertile patients, suffering from polycystic ovaries, were treated with human urinary FSH and hCG (eight cases) to induce ovulation. Oestrone, oestradiol, 17 alpha-hydroxyprogesterone, testosterone and androstenedione serum levels increased during the treatment. A decrease in luteinizing hormone serum levels was noticed, and in five cases a spontaneous peak was observed. No changes were noted in 5 alpha-dihydrotestosterone serum levels. Ultrasound scanning of the ovaries often revealed multiple follicles at different speeds and stages of growth and their marked turnover was observed. The beginning of the LH spontaneous surge was precocious compared to the normal ovulating follicular sizes: it does not appear that an optimum size exists but when the LH peak occurred too prematurely, ovulation did not take place. Administration of hCG seems to be necessary as spontaneous peaks of LH are not always followed by rupture of the follicle. Ultrasound scanning plays an important role in monitoring ovulation induction, while oestradiol and 17 alpha-hydroxyprogesterone serum levels are not good indicators of follicular maturity in multifollicular growth. Ovulation occurred in eight patients; four conceptions were obtained, one of which resulted in abortion. No ovarian hyperstimulations were observed.

Topics: Adolescent; Adult; Androstenedione; Dihydrotestosterone; Estradiol; Estrone; Female; Follicle Stimulating Hormone; Humans; Hydroxyprogesterones; Luteinizing Hormone; Menotropins; Ovarian Cysts; Ovulation Induction; Testosterone; Ultrasonography

Topics: Adult; Chorionic Gonadotropin; Chromosome Aberrations; Female; Humans; Menotropins; Mosaicism; Ovarian Cysts; Ovulation; Pregnancy; Twins

A case of hyperstimulation syndrome secondary to Pergonal therapy is presented. Successful management was based principally on severe sodium and fluid restriction without the use of volume expanders. The rationale for this therapeutic approach is presented and discussed. Although this iatrogenic disease should be virtually eliminated with the monitoring of daily urinary estrogens, severe hyperstimulation may still occur as a result of laboratory error.

Topics: Adult; Anuria; Ascites; Cation Exchange Resins; Chorionic Gonadotropin; Diet, Sodium-Restricted; Estrogens; Female; Humans; Hydrothorax; Iatrogenic Disease; Infertility, Female; Menotropins; Oliguria; Ovarian Cysts; Ovarian Diseases; Pregnancy; Stimulation, Chemical; Syndrome; Water Deprivation

Eighteen patients hospitalized for excessive ovarian hyperstimulation syndrome are reported. In 14 cases the ovarian hyperstimulation was induced by human menopausal -onadotropins and in 4 cases by combined treatment with clomiphene and HCG. In 5 patients the hyperstimulation was associated with conception, which resulted in 1 quintuplet delivery, 1 early quintuplet abortion, 1 twin abortion, 1 normal delivery, and 1 missed abortion. The regimen of treatment was a conservative one. The patients were hospitalized and treated with infusion of plasma expanders. Anticoagulant therapy was administered only in cases that showed clinical evidence of thromboembolic pheomena or laboratory evidence of severe hemoconcentration. The pathogenesis of the ovarian hyperstimulation syndrome, prevention, and management are discussed. This syndrome should be diagnosed early and treated intensively.

Topics: Abdomen, Acute; Adult; Anovulation; Ascites; Body Fluids; Chorionic Gonadotropin; Clomiphene; Drug Therapy, Combination; Female; Humans; Iatrogenic Disease; Infertility, Female; Menotropins; Menstruation Disturbances; Ovarian Cysts; Ovarian Diseases; Ovary; Plasma Substitutes; Pregnancy; Pregnancy, Multiple; Stimulation, Chemical; Syndrome

Topics: Animals; Ascitic Fluid; Chlorpheniramine; Disease Models, Animal; Female; Humans; Menotropins; Ovarian Cysts; Ovarian Diseases; Ovary; Pleural Effusion; Rabbits

Topics: Adult; Amenorrhea; Body Temperature; Drug Combinations; Estrogens; Female; Gonadotropins; Gonadotropins, Pituitary; Humans; Menotropins; Ovarian Cysts; Pregnancy; Pregnanediol