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Regulation of Reproduction by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
Fertilized eggs showing two pronuclei are incubated in a special medium for about 48 h when the zygotes consist of six to eight cells. After additional cell divisions, embryos are transferred to the patient’s uterus by a thin transvaginal catheter. The number of embryos to be transferred depends on the number available, the age of the woman, and other health and diagnostic factors. Either freshly prepared or thawed frozen embryos can be transferred. Luteal support for the mother is then provided by treatment with progestins, hCG, or GnRH agonists, and may be accompanied by estradiol. The success rate of IVF (i.e., the percentage of IVF cycles resulting in a live birth) is from 5% to 40%, depending on the maternal age, cause of infertility, embryo status, reproductive history, lifestyle factors, and proficiency of the IVF clinic.
Human Chorionic Gonadotropin Supplementation in Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Carlo Ticconi, Adalgisa Pietropolli, C.V. Rao
Many studies have been performed to investigate the effect of hCG for luteal support in women undergoing assisted reproductive technologies (ARTs). These studies have been reviewed in a recent Cochrane review along with the use of progesterone [56]. The analysis concluded that luteal phase hCG supplementation may be associated with a higher incidence of live births compared with placebo, although the evidence was not conclusive. However, if hCG supplementation is used, there may be an increased incidence of ovarian hyperstimulation syndrome [56]. A more recent and larger Cochrane review, which included 12 randomized controlled trials (RCTs) carried out on 4038 subjects on the intrauterine administration of hCG in sub-fertile women undergoing ART, concluded that pregnancy outcome following a dose of 500 IU or greater is promising when embryo transfer was performed at cleavage stage [57]. However, due to the high risk of bias found in 9 out of 12 of the selected studies and the fact that positive results were obtained in a subgroup analysis, the authors concluded that caution should be used before recommending large-scale hCG use. Other more recent prospective studies suggest a significant beneficial effect of the intrauterine administration of hCG in women with recurrent implantation failure [58,59].
Intracytoplasmic Sperm Injection
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Emad Fakhry, Medhat Amer, Botros Rizk
Luteal support: During IVF, the administration of GnRH agonists and antagonists for downregulation may disrupt the luteal phase and lower progesterone secretion; with decreased implantation potential. Supplementation with exogenous progesterone is usually used for stimulated IVF cycles [36].
Effectiveness of gonadotrophin-releasing hormone agonist therapy to improve the outcomes of intrauterine insemination in patients suffering from stage I-II endometriosis
Published in Annals of Medicine, 2022
Kemei Zhang, Shisi Huang, Haiyan Xu, Jiaou Zhang, Ensheng Wang, Yang Li, Changling Zhu, Jing Shu
IUI was performed 36–40 h after injection by a gynaecologist in an operating room adjacent to the laboratory. After the operation, the women were advised to rest for at least 30 min. The luteal support was used routinely in all patients since the day of ovulation. It consisted of Duphaston (Dydrogesterone Tablets, 20 mg/day, Abbott, Netherlands) for 14 days. A blood test for hCG assay was performed 14 days after insemination to confirm whether pregnancy had occurred. If the patient got a positive hCG, ultrasound examination could be performed 3 weeks later to confirm foetal viability. Clinical pregnancy was confirmed when there was ultrasonographic evidence. The primary outcome was the clinical pregnancy rate calculated by dividing the numbers of clinical pregnant patients by the total number of patients who underwent IUI treatment. Other pregnancy outcomes included live birth rate, gestation weeks of delivery, preterm delivery rate and birth weight.
Luteal-phase progesterone supplementation in non-IVF treatment: a survey of physicians providing infertility treatment
Published in Human Fertility, 2020
Elizabeth Weedin, Jonathan Kort, Alexander Quaas, Valerie Baker, Robert Wild, Karl Hansen
The use of progesterone supplementation for luteal support during in vitro fertilization (IVF) cycles is well established and is effective (van der Linden, Buckingham, Farquhar, Kremer, & Metwally, 2011). Alternatively, the benefit in non-IVF cycles is unclear (Green et al., 2017). A recent meta-analysis concluded that luteal progesterone supplementation is associated with improved live-birth outcomes in gonadotropin-IUI cycles (A. Erdem, M. Erdem, Atmaca, & Guler, 2009). However, there was no benefit in clomiphene citrate-IUI cycles, although the authors recognized the limitations of the included studies, including the lack of live-birth outcomes in the clomiphene citrate investigations (Agha-Hosseini, Rahmani, Alleyassin, Safdarian, & Sarvi, 2012; Karadag et al., 2016; Kyrou, Fatemi, Tournaye, & Devroey, 2010). Additionally, there has only been one study evaluating the effectiveness of luteal progesterone supplementation in letrozole-IUI cycles (Montville, Khabbaz, Aubuchon, Williams, & Thomas, 2010). This study, while favouring the use of progesterone in letrozole-IUI cycles, was limited by small sample size, retrospective design, and lack of live birth outcome data (Montville et al., 2010). Use of progesterone supplementation in non-IVF cycles remains controversial (Green et al., 2017).
The effects of letrozole on women with endometriosis undergoing ovarian stimulation for in vitro fertilization
Published in Gynecological Endocrinology, 2020
Se Jeong Kim, Chang Woo Choo, Seul Ki Kim, Jung Ryeol Lee, Byung Chul Jee, Chang Suk Suh, Won Don Lee, Seok Hyun Kim
All patients underwent COS using gonadotropin-releasing hormone (GnRH) agonist or antagonist for pituitary suppression. For patients receiving the combination therapy, 5 mg letrozole was started from the third day of the menstrual cycle and continued until the day of triggering. The recombinant FSH (Gonal-F; Serono, Geneva, Switzerland), purified human menopausal gonadotropin (Menopur; Ferring Pharmaceuticals Inc., Kiel, Germany), or recombinant FSH plus recombinant LH (Pergoveris; Serono, Darmstadt, Germany) were initiated with the starting dose based on the age and ovarian reserve. When the leading follicle reached a mean diameter of 14 mm, GnRH antagonist (Cetrorelix, 0.25 mg; Serono, Darmstadt, Germany) was added. Recombinant human chorionic gonadotropin (hCG; Ovidrel, 250 μg; Serono, Darmstadt, Germany) was given for final oocyte maturation when at least two follicles reached a mean diameter of 18 mm. About 34–36 h after hCG triggering, the oocyte was retrieved under ultrasound guidance. Fertilization was assessed by the presence of 2pronuclei (2PN) and a second polar body. Usable embryos were defined as transferred embryos plus cryopreserved embryos for future use. Fresh embryo transfers were mostly performed 3 days following retrieval. Vaginal progesterone was given for luteal support.