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The Use of Ovarian Markers
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Neena Malhotra, Siladitya Bhattacharya
This ovarian reserve screening method involved baseline measurement of FSH and E2, followed by administration of a standard intramuscular (IM) dose (300 IU) of purified FSH on day 3. E2 levels were rechecked 24 hours later. IVF with GnRH-a and human menopausal gonadotropin (hMG) was undertaken two menstrual cycles later, and the post-FSH E2 increment (Δ E2) and the baseline FSH values (b FSH) were evaluated and compared with the subsequent quality of the ovarian response in IVF and pregnancy outcome. This test consumes considerable time and therefore is rarely used, besides producing a high false-positive rate (12) as mentioned in a systematic review. The test is not recommended in clinical settings.
Intracytoplasmic Sperm Injection
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Emad Fakhry, Medhat Amer, Botros Rizk
According to the protocol selected, a gonadotrophin-releasing hormone (GnRH) antagonist or a GnRH agonist is prescribed to allow complete control over ovulation once the treatment cycle begins. The ovarian stimulation cycle is composed of repeated injections of purified recombinant follicle-stimulating hormone (FSH) or human menopausal gonadotrophin (HMG) with frequent folliculometry, estradiol monitoring, and triggering the last stage of oocyte maturation with human chorionic gonadotropin (hCG). Timing is vital: the hCG injection can be given when >4 follicles have reached 18–20 mm in size and estradiol levels are at least 2,000 pg/mL [17,18].
Introduction and development of IVF and its ethical regulation
Published in Elisabeth Hildt, Dietmar Mieth, In Vitro Fertilisation in the 1990s, 2018
In the 1960s, the first modern application of assisted human conception involved the use of pituitary extracts and hormone preparations to stimulate ovulation in some amenorrhoeic patients. The first studies were carried out by Gemzell (1967), using pituitary extracts for stimulation and HCG to induce ovulation. Multiple ovulation and births occurred just as in mice. Lunenfeld and Donini (1969) introduced the use of human menopausal gonadotrophins (HMG) for ovarian stimulation, and identified forms of hyperstimulation, multiple pregnancies and the standard use of HMG and HCG for inducing ovulation as a routine treatment in amenorrhoeic women. Clomiphene was also introduced some years later, and proved to be an effective and mild ovarian stimulant (Greenblatt et al. 1961). The induction of superovulation in amenorrhoeic women raised considerable ethical qualms, concerned at first with the establishment of many multiple births, some of a very high order. Recently, it has been discovered that the use of pituitary extracts to stimulate follicle growth in these women infected many of them with Jacob Creutzfeld disease. Many died from this condition several years after treatment.
What must be considered when prescribing hormonal pharmacotherapy for male infertility?
Published in Expert Opinion on Pharmacotherapy, 2022
Olivia Holtermann Entwistle, Aditi Sharma, Channa N. Jayasena
Exogenous gonadotropins such as FSH or human chorionic gonadotropin (hCG) seek to replicate the physiological action of FSH and LH, respectively. A Cochrane review of six RCTs investigating the effect of various gonadotropin preparations, such as hCG, human menopausal gonadotropin (HMG), purified and highly purified FSH and recombinant FSH, in idiopathic male infertility found a significant increase in spontaneous pregnancy rates in the treatment group [3]. One study examined the effect of a combination regimen of purified and highly purified FSH in couples undergoing IUI, starting 3 months prior to the first cycle and ending with the fifth cycle, in couples undergoing intra-uterine insemination (IUI), and another examined the effect of highly purified FSH treatment for 12 weeks on couples undergoing ICSI, both with non-significant results [3]. The authors note that gonadotropin preparations, treatment regimens, and treatment duration were heterogeneous across all the included studies. In view of this heterogeneity, and the small sample sizes of the studies, the authors conclude that although the pooled data showed a generally positive effects in terms of spontaneous pregnancy rates, there is insufficient data to draw conclusions about the superiority of any gonadotropin preparation, treatment regimen, or treatment duration [3].
Successful live birth after in vitro maturation treatment in a patient with autoimmune premature ovarian failure: a case report and review of the literature
Published in Gynecological Endocrinology, 2021
Lucie Chansel-Debordeaux, Elisabeth Rault, Chloé Depuydt, Volcy Soula, Claude Hocké, Clément Jimenez, Hélène Creux, Aline Papaxanthos-Roche
The hormonal replacement therapy was stopped 5 days before starting the ovarian stimulation. Subcutaneous injections of highly purified human menopausal gonadotropin (HP-hMG; Menopur®; Ferring Pharmaceuticals, Aalst, Belgium) were given for three consecutive days, at a daily dose of 150 IU. A pelvic ultrasound scan was performed in the morning of the third day of stimulation. In the right ovary, six follicles had reached a diameter of 8–9 mm, and five were <5 mm. In the left ovary, five follicles were 7–9 mm in diameter, and five were 5–6 mm. Blood tests showed an undetectable estradiol level of <10 pg/ml, and serum LH and progesterone levels of 28.4 IU/L and 0.2 ng/mL, respectively. The endometrial thickness was 4 mm. Ovulation was triggered on the following day by injection of 10,000 IU hCG (chorionic gonadotropin; MSD, Courbevoie, France). Vaginal ultrasound-guided retrieval of cumulus-oocyte complexes (COCs) from the small antral follicles was carried out 38 h after triggering ovulation. The oocyte retrieval was performed using a 17-gauge single lumen needle (Otrieva™, K-TIVM-172030; Cook Medical, Co. Limerick, Ireland). For endometrial preparation, the patient was given 4 mg of estradiol hemihydrate orally (Provames®; Merus Labs Luxco II S.a.R.L, Luxembourg, Luxembourg), starting on the evening of oocyte retrieval. Luteal support was provided by 600 mg of transvaginal progesterone (Estima®; Effik Pharmaceuticals, Bièvres, France) starting on the day of fertilization [18].
Follicular fat-soluble vitamins as markers of oocyte competency
Published in Systems Biology in Reproductive Medicine, 2020
Patrycja Skowrońska, Michał Kunicki, Ewa Pastuszek, Lucyna Konieczna, Tomasz Bączek, Krzysztof Łukaszuk
All patients were treated according to the agonist long protocol with contraception priming (0.15 mg desogestrel with, 0.02 mg ethynylestradiol (Ovulastan Adamed) beginning on day 1–5 of the menstrual cycle. After 17–20 days GnRH agonist (triptorelin 0.1 mg) (Gonapeptyl Daily Ferring GmbH) was started and administered every other day. In each case, ovarian stimulation began 14 days after confirmation of pituitary desensitization (E2 < 50 pg/ml, no follicles >10 mm). Dosage of human Menopausal Gonadotropin (hMG, Menopur, Ferring Pharmaceuticals) was adjusted based on the patient’s AMH and previous stimulation history. During stimulation, all patients were monitored with serum estradiol testing and transvaginal ultrasonography. Ovulation was induced with 5000 IU of hCG when at least 2 leading follicles ≥ 18 mm were visualized 36 h after the hCG injection the oocytes were retrieved by transvaginal aspiration (Lukaszuk et al. 2005).