ovulation induction Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):36-41
DOI 10.1590/S0100-72032008000100007
PURPOSE: to establish whether there is a predictive relationship between the antral follicle count (AFC) on the second day of the cycle and the response pattern in controlled ovarian hyperstimulation cycles for intracytoplasmic sperm injection (ICSI). METHODS: a prospective study developed from May 2004 to May 2005, in which 51 patients aged <37 years old were submitted to assisted reproduction/ICSI in ovarian hyperstimulation protocol with gonadotropin recombinant and gonadotropin-releasing hormone (GnRH) antagonist. A transvaginal ultrasonography was performed on the second day of the cycle, to count the number of follicles measuring 2 to 10 mm, at the beginning of stimulus, data compared with the number of follicles with >15 mm on the day of ovulation triggering, the total number of oocytes retrieved and in metaphases II, the number of good quality embryos transferred and pregnancy rate. The statistical analysis was performed by the t-Student test and the Mann-Whitney test, with statistical significance of 5% (p<0.05). RESULTS: the mean age in the study group was 32.4 years. The AFC average was 7.1, minimum of 1 and maximum of 16. Considering AFC as a main variable, a significant direct correlation was observed with the number of follicles >15 mm on the day of ovulation triggering (p=0.0001), the total number of oocytes retrieved (p=0.0001) and those in metaphases II (p=0.0001). Such correlation between AFC and pregnancy was not observed (p=0.43). There was no significant correlation between AFC and the number of good quality embryos transferred (p=0.081). CONCLUSIONS: AFC on the second day of the stimulated cycle can be used to predict the quality of ovarian stimulation, the number of oocytes retrieved and the number of mature oocytes in in vitro fertilization cycles using GnRH antagonist.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):36-41
DOI 10.1590/S0100-72032008000100007
PURPOSE: to establish whether there is a predictive relationship between the antral follicle count (AFC) on the second day of the cycle and the response pattern in controlled ovarian hyperstimulation cycles for intracytoplasmic sperm injection (ICSI). METHODS: a prospective study developed from May 2004 to May 2005, in which 51 patients aged <37 years old were submitted to assisted reproduction/ICSI in ovarian hyperstimulation protocol with gonadotropin recombinant and gonadotropin-releasing hormone (GnRH) antagonist. A transvaginal ultrasonography was performed on the second day of the cycle, to count the number of follicles measuring 2 to 10 mm, at the beginning of stimulus, data compared with the number of follicles with >15 mm on the day of ovulation triggering, the total number of oocytes retrieved and in metaphases II, the number of good quality embryos transferred and pregnancy rate. The statistical analysis was performed by the t-Student test and the Mann-Whitney test, with statistical significance of 5% (p<0.05). RESULTS: the mean age in the study group was 32.4 years. The AFC average was 7.1, minimum of 1 and maximum of 16. Considering AFC as a main variable, a significant direct correlation was observed with the number of follicles >15 mm on the day of ovulation triggering (p=0.0001), the total number of oocytes retrieved (p=0.0001) and those in metaphases II (p=0.0001). Such correlation between AFC and pregnancy was not observed (p=0.43). There was no significant correlation between AFC and the number of good quality embryos transferred (p=0.081). CONCLUSIONS: AFC on the second day of the stimulated cycle can be used to predict the quality of ovarian stimulation, the number of oocytes retrieved and the number of mature oocytes in in vitro fertilization cycles using GnRH antagonist.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):715-720
DOI 10.1590/S0100-72032006001200005
PURPOSE: to investigate the effects of previous bilateral tubal sterilization on the outcome of in vitro fertilization. METHODS: retrospective study of 98 consecutive in vitro fertilization cycles. Fifty-five women with previous tubal sterilization without any other infertility factor (TL group) were compared with 43 women with infertility due only to mild male factor (MI group. Age, cancellation rate per induction cycle, response to ovulation induction (number of days of ovulation induction, total amount of gonadotrophin units used, number of follicles and oocytes retrieved), fertilization and cleavage rates, number of transferred embryos and clinical pregnancy per transfer cycle were the variables considered. RESULTS: the cycle discontinuation rate due to poor response, results of ovulation induction, fertilization and cleavage rates, number of transferred embryos and the occurrence of clinical pregnancy were similar in both groups. Considering solely the variable age in TL group, we observed that patients older than 35 years required higher gonadotrophin doses during ovulation induction (2445 versus 2122 IU), presented lower response with fewer follicular growth (11.3 versus 15.8) and less oocytes retrieved (6.1 versus 8.5) compared to younger women (34 years old or less). CONCLUSIONS: tubal sterilization did not interfere with in vitro fertilization outcomes. We observed a worse response to ovulation induction in women older than 35 years, who had previous tubal sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):715-720
DOI 10.1590/S0100-72032006001200005
PURPOSE: to investigate the effects of previous bilateral tubal sterilization on the outcome of in vitro fertilization. METHODS: retrospective study of 98 consecutive in vitro fertilization cycles. Fifty-five women with previous tubal sterilization without any other infertility factor (TL group) were compared with 43 women with infertility due only to mild male factor (MI group. Age, cancellation rate per induction cycle, response to ovulation induction (number of days of ovulation induction, total amount of gonadotrophin units used, number of follicles and oocytes retrieved), fertilization and cleavage rates, number of transferred embryos and clinical pregnancy per transfer cycle were the variables considered. RESULTS: the cycle discontinuation rate due to poor response, results of ovulation induction, fertilization and cleavage rates, number of transferred embryos and the occurrence of clinical pregnancy were similar in both groups. Considering solely the variable age in TL group, we observed that patients older than 35 years required higher gonadotrophin doses during ovulation induction (2445 versus 2122 IU), presented lower response with fewer follicular growth (11.3 versus 15.8) and less oocytes retrieved (6.1 versus 8.5) compared to younger women (34 years old or less). CONCLUSIONS: tubal sterilization did not interfere with in vitro fertilization outcomes. We observed a worse response to ovulation induction in women older than 35 years, who had previous tubal sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):311-315
DOI 10.1590/S0100-72031999000600002
Purpose: to verify the effects of the goserelin depot as GnRH agonist for hypophysis suppression, during the controlled ovarian hyperstimulation (COH) for in vitro fertilization and intrauterine embryo transfer (IVF & ET). Method: this is a prospective study of 110 cycles of 101 women. Goserelin depot was administered subcutaneously as a single dose; for some women (87 cycles) it was administered in the first phase of the menstrual cycle, and in 23 cycles it was administered in the luteal phase. The administration of menopausal gonadotropins was daily, until the identification of at least two follicles with a diameter equal to or larger than 18 mm; at this time the chorionic gonadotropin was administered and the follicular aspiration was programmed. Results: the women's age average was 36.7 years (between 23 to 42 years). The main indications for IVF & ET were: tubo-peritoneal factor (75.2%), endometriosis (10.9%), ovulatory factor (7.9%), male factor (3.0%) and unexplained infertility (3.0%). Of the total of the cycles, 28 (25.5%) cycles were cancealed. In 7 cycles (8.04%), for which goserelin depot was administered in the first phase of the menstrual cycle, it was necessary to perform the ovarian cysts aspiration before beginning the ovulation induction. On the average, 3.3 embryos were transferred for each patient (1-5 embryos per woman). Of the total of 70 embryos transferred, 16 clinical pregnancies resulted (pregnancy rate: 22.85%). Conclusion: the goserelin depot administration is a useful alternative for pituitary suppression for IVF & ET, since its results are similar to those observed in the literature, and the patient does not need to come every day to receive medication, a fact of extreme importance in a public service.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):7-11
DOI 10.1590/S0100-72032005000100003
PURPOSE: to compare pregnancy rates and mean endometrial thickness obtained with three protocols for induction of ovulation in cycles of intrauterine insemination (IUI). METHODS: one hundred and ten IUI cycles were retrospectively evaluated in the study, divided into three groups, according to the used ovulation induction protocols: 100 mg clomiphene citrate (CC) on days 3 to 7 of the cycle (CC group, n=24), 100 mg/day CC on days 3 to 7 of the cycle + 75 IU/day of human menopausal gonadotrophin (hMG) on days 3, 5 and 7 of the cycle (CC+hMG group, n=29), and 75 IU/day of hMG on days 3 to 8 of the cycle (hMG group, n=57). Statistical analysis was performed using Student's t test to compare the means and the c² test to compare the rates. Results were considered statistically significant at p<0.05. RESULTS: the patients' average age at the onset of the first cycle was 2340 years (mean age, 33.3 years). There were no statistically significant differences between groups. The mean endometrial thickness on the day of the human chorionic gonadotrophin (hCG) administration was significantly higher in the hMG group (10.2±0.2 mm), as compared with the CC and CC+hMG group (7.9±0.4 and 8.7±0.2 mm, respectively, p<0.001). The overall clinical pregnancy rate was 18.2%, and there were no statistically significant differences between the groups (CC group=12.5%; CC+hMG group=24.1% and hMG group=19.3%). CONCLUSION: the results indicate higher mean endometrial thickness in the hMG group as compared with the CC group and the CC+hMG group. There were no significant differences between clinical pregnancy rates obtained with each protocol (CC, CC+hMG and hMG).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):7-11
DOI 10.1590/S0100-72032005000100003
PURPOSE: to compare pregnancy rates and mean endometrial thickness obtained with three protocols for induction of ovulation in cycles of intrauterine insemination (IUI). METHODS: one hundred and ten IUI cycles were retrospectively evaluated in the study, divided into three groups, according to the used ovulation induction protocols: 100 mg clomiphene citrate (CC) on days 3 to 7 of the cycle (CC group, n=24), 100 mg/day CC on days 3 to 7 of the cycle + 75 IU/day of human menopausal gonadotrophin (hMG) on days 3, 5 and 7 of the cycle (CC+hMG group, n=29), and 75 IU/day of hMG on days 3 to 8 of the cycle (hMG group, n=57). Statistical analysis was performed using Student's t test to compare the means and the c² test to compare the rates. Results were considered statistically significant at p<0.05. RESULTS: the patients' average age at the onset of the first cycle was 2340 years (mean age, 33.3 years). There were no statistically significant differences between groups. The mean endometrial thickness on the day of the human chorionic gonadotrophin (hCG) administration was significantly higher in the hMG group (10.2±0.2 mm), as compared with the CC and CC+hMG group (7.9±0.4 and 8.7±0.2 mm, respectively, p<0.001). The overall clinical pregnancy rate was 18.2%, and there were no statistically significant differences between the groups (CC group=12.5%; CC+hMG group=24.1% and hMG group=19.3%). CONCLUSION: the results indicate higher mean endometrial thickness in the hMG group as compared with the CC group and the CC+hMG group. There were no significant differences between clinical pregnancy rates obtained with each protocol (CC, CC+hMG and hMG).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):727-733
DOI 10.1590/S0100-72032004000900009
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):727-733
DOI 10.1590/S0100-72032004000900009
PURPOSE: to evaluate the results of ovulation hyperinduction followed by in vitro fertilization (IVF) in women with polycystic ovary syndrome (POS), as compared to normal cycle women. METHODS: a controlled retrospective study conducted on 36 women with POS (POS group) and on 44 women with infertility due to mild male factor (control group), submitted to IVF from 1997 to 2003. Subject ages ranged from 18 to 36 years. Ovulation hyperinduction was obtained with recombinant follicle-stimulating hormone and a gonadotrophin-releasing hormone agonist. The analyzed variables were the follicles with a mean diameter of 14 to 17 mm and the follicles with diameters of 18 mm or above on the day of human chorionic gonadotrophin administration, percentage of follicles >18 mm, the number of retrieved oocytes, fertilization rate, cleavage rate, incidence of ovarian hyperstimulation syndrome (OHS), clinical pregnancy rate, and abortion rate. The variables were analyzed by the unpaired t test, Fisher exact test and Mann-Whitney test, with level of significance set at p<0.05. RESULTS: the POS group presented a larger number of retrieved follicles, most of them measuring 14 to 17 mm in diameter, compared to the control group (64.8 vs 53.9%), a lower fertilization rate (59.43 vs 79.57%) and a higher incidence of OHS (38.9 vs 9.1%). The number of retrieved oocytes, cleavage rates, pregnancy rates per embryo transfer, abortion rates and live born rates did not differ between groups. CONCLUSION: the success of IVF is impaired in women with POS due to their larger number of retrieved follicles of reduced diameter, reduced fertilization rate and high OHS rates.