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Principles of Pathophysiology of Infertility Assessment and Treatment*
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
Recent advances in understanding the pathophysiology of ovulation and the development of potent pharmacological agents have made it possible to induce ovulation in the majority of anovulatory females. At present, the majority of women whose infertility is caused by anovulation can be treated successfully.
Ovulation, Hemorrhagic Cyst, and Hyperstimulation Syndrome
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
María Ángela Pascual, Jean L. Browne
The ovarian hyperstimulation syndrome (OHS) may occur in women receiving gonadotropins, or less frequently clomiphene citrate, to induce ovulation during assisted reproduction treatment. This exaggerated ovarian response may give rise to serious complications such as thromboembolic phenomena, kidney failure, liver dysfunction, or bleeding due to a ruptured ovary. An endogenous rise of gonadotropins is also rarely a cause of OHS.
Alternative, non-IVF therapies
Published in Elisabeth Hildt, Dietmar Mieth, In Vitro Fertilisation in the 1990s, 2018
Ovulatory disorders account for about 15 per cent of all infertility factors (Speroff et al. 1994). In some cases it is possible to treat the cause of the disorder and in this way restore the normal ovulatory cycle (see table 2). These disorders may originate outside the hypothalamic pituitary axis and therefore may require the correction of other associated endocrinologic problems, behavioural changes, or surgery. After ruling out or treating other problems, a pharmacologic treatment is indicated to induce ovulation. The choice of hormone therapy depends on the underlying cause of the disorder or imbalance (table 3). Clomiphene citrate is the most commonly used drug to induce ovulation and acts by stimulating the hypothalamic release of GnRH (Gonadotrophin releasing hormone). In some cases, clomiphene is not effective in inducing ovulation and other drugs have to be considered. Gonadotrophins are often the next line of therapy and directly stimulate ovarian function. All of these treatments have important side-effects, but the most important complication, at least for clomiphene and gonadotrophin therapy, is the risk of multiple pregnancy: This risk is about 5 per cent for clomiphene, and 10 to 40 per cent for gonadotrophin therapy, depending on the quality of the monitoring and good medical judgment (Sperofif et al. 1994).
Incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders after gonadotropin-releasing hormone (GnRH) agonist trigger in “freeze-all” approach
Published in Gynecological Endocrinology, 2023
M. Fernández-Sánchez, H. Fatemi, J. A. García-Velasco, P. W. Heiser, G. S. Daftary, B. Mannaerts
Due to its half life, human chorionic gonadotropin (hCG) has a sustained luteotrophic effect contributing to OHSS by inducing granulosa-lutein cells to produce vascular endothelial growth factor (VEGF) and increasing ovarian vascular permeability [6]. A single high-dose of hCG applied to induce ovulation or to trigger final follicular maturation may cause early onset OHSS. The higher the ovulatory serum hCG levels, the higher the risk of developing OHSS, especially when ≥25 follicles are observed on the day of triggering [7]. Thus, lowering or withholding the dose of hCG for triggering, may prevent early OHSS [2, 8]. However, endogenous hCG produced by the trophoblast in early pregnancy may accelerate early OHSS or induce late-onset OHSS. When the ovarian response is too high, most IVF clinics freeze all embryos to eliminate the risk of late-onset OHSS [9, 10].
Vasomotor tone-associated factors and pregnancy outcomes of women who undergo in vitro fertilization
Published in Growth Factors, 2021
Yonglian Lan, Xiaokui Yang, Yu Liang, Lingling Lei, Ying Li, Shuyu Wang
A standard mid-luteal long protocol was used to induce ovulation. Before menstruation, triptorelin acetate (Ferring GmbH, Germany) was subcutaneously injected at a dose of 0.1 mg/day for 7 days. When the ovarian function was inhibited (E2 level, <50 pg/ml; follicle diameter in both ovaries, <5 mm; endometrial thickness, <5 mm), recombinant human follicle-stimulating hormone (Merck Serono, Switzerland) was injected at a dose of 150–225 IU/day to induce ovulation. The ovarian follicle was monitored until suitable ovarian follicles (one dominant follicle ≥18 mm or three dominant follicles ≥17 mm) were observed. After injection of 250 µg of recombinant human chorionic gonadotropin (Merck Serono) for 36 h, the oocytes were collected and immediately fertilized. At 72 h post-fertilization, two embryos at the cleavage stage were implanted. Starting from the day of oocyte retrieval, oral dydrogesterone at a dose of 10 mg twice a day and vaginal utrogestan at a dose of 0.2 g thrice a day were administered for luteal support.
She’s got nerve: roles of octopamine in insect female reproduction
Published in Journal of Neurogenetics, 2021
Melissa A. White, Dawn S. Chen, Mariana F. Wolfner
In D. melanogaster, both mated and virgin females are able to ovulate. Tbh mutant females are sterile due to defects in ovulation, causing accumulation of mature oocytes in their ovaries (Monastirioti, 2003; Monastirioti et al., 1996). Sterility in these females can be rescued with OA feeding (Cole et al., 2005; Monastirioti et al., 1996). Additionally, simply injecting wild-type virgin females with OA is sufficient to induce ovulation (Meiselman et al., 2018). Interestingly, Tdc2 mutant females lacking both OA and TA also exhibit egg retention, but not due to an ovulation defect (Cole et al., 2005). This suggests that TA may also play a role in egg movement. The OA required for ovulation comes from OA neurons innervating the RT. Silencing the female RT OA neurons causes egg retention (Rodríguez-Valentín et al., 2006), and expressing Tbh specifically in these neurons can rescue the sterility of Tbh mutant females (Monastirioti, 2003).