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To Flush Follicles during Egg Collection or Not
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
The first approach to ovum pickup (OPU) for IVF was taken using transabdominal laparoscopy (1). This approach was followed by the use of transabdominal, ultrasound-guided, oocyte retrieval (2). Suzan Lenz was the first physician to perform ultrasound-guided OPU in IVF in December 1980. She chose to use the transvesical follicle aspiration technique and conducted it at Rigs Hospital, Copenhagen, Denmark. Information about transvaginal oocyte retrieval with transvaginal aspiration under transabdominal ultrasound guidance was published in 1984 (3). Transvaginal OPU under transvaginal ultrasound guidance was introduced and reported in 1985 by Wikland and Hamberger (4) and has remained a standard of care for OPU since that time.
Fertility preservation in pediatric and adolescent girls
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Reproductive researchers continue to explore fertility preservation techniques that can both reduce patient risk and minimize treatment delays. One experimental technique, in vitro oocyte maturation (IVM), involves removal of immature oocytes either via transvaginal oocyte retrieval or from surgically resected ovarian tissue, then maturing these oocytes in the laboratory so they can be cryopreserved as mature oocytes or fertilized for embryo cryopreservation. Compared to conventional ovarian stimulation for oocyte cryopreservation, IVM results in less cost and time for patients because it obviates the need for stimulation medications and multiple monitoring visits, in addition to avoiding exposure to large doses of gonadotropins and resultant elevated estradiol levels.52 Research is also being conducted to advance methods of isolating and maturing oocytes at all stages of development from both fresh and cryopreserved–thawed ovarian tissue.7 To date, there have not been any live births reported from IVM of immature oocytes obtained at the time of harvesting ovarian tissue for cryopreservation, although this is an area of ongoing investigation, as is cryopreservation of immature oocytes for later IVM.42,57 Development of techniques to successfully grow and mature oocytes in vitro would be particularly pertinent to cancer patients, as it could mitigate the potential risks associated with autotransplantation of cryopreserved ovarian tissue, such as reintroduction of malignant cells and need for multiple surgeries due to shortened graft life.
Anesthesia for in vitro fertilization
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Alexander Izakson, Tiberiu Ezri
Sedation alone or combined with analgesia, as well as different anesthetic techniques including general anesthesia (GA), regional anesthesia, and alternative medicine approaches, have all been used for these procedures. All of the above techniques demand the active involvement of an anesthesiologist to make transvaginal oocyte retrieval a safe procedure.
Impact of trophoectoderm biopsy for preimplantation genetic testing on serum β-hCG levels, time of delivery and birthweight following frozen embryo transfer cycles
Published in Gynecological Endocrinology, 2023
Özkan Özdamar, F. Kübra Boynukalin, Meral Gültomruk, Zalihe Yarkiner, Necati Findikli, Mustafa Bahceci
Patients underwent ovarian stimulation using recombinant follicular stimulating hormone (FSH) (rFSH) (150–300 IU, Gonal-F; Meck Serono) or human menopausal gonadotropin (HMG) (75–150 IU; Merional; IBSA) in an antagonist protocol, starting on the second or the third day of the menstrual cycle. Gonadotropin doses were individually adjusted according to the patient’s age, body mass index (BMI), medical history and anti-Müllerian Hormone (AMH) values. Pituitary downregulation was performed with daily administration of a gonadotropin-releasing hormone (GnRH antagonist) (Cetrorelix acetate) (Cetrotide; Merck Serono) starting from day 5 or 6 of stimulation. Together with serum estradiol level, periodic transvaginal ultrasound scans were performed to monitor the development of the growing follicles. rFSH/HMG doses were adjusted according to the ovarian response, when necessary. Final oocyte maturation was triggered with 250 mcg of recombinant hCG and/or 0.2 mg of triptorelin, according to physician discretion, when at least two follicles reached 18–20 mm in diameter. Transvaginal oocyte retrieval was performed 35 h after trigger.
Does egg-sharing negatively impact on the chance of the donor or recipient achieving a live birth?
Published in Human Fertility, 2023
Timothy Bracewell-Milnes, Aleena Hossain, Benjamin P. Jones, Raef Faris, Jaya Parikh, James Nicopoullos, Mark Johnson, Meen-Yau Thum
The demand for donor eggs has been rising globally, with a 49% increase in DEPS cycles since 2011 in the UK (HFEA, 2018); however the annual numbers of newly registered oocyte donors has plateaued and remained stable at 1,600 (HFEA, 2019b). In contrast to the straight-forward process of sperm donation, egg donation involves high dose ovarian stimulation and invasive procedures, such as transvaginal oocyte retrieval under sedation, or general anaesthesia. Additionally, the donor must endure the inconvenience of multiple appointments at the fertility clinic to plan the IVF cycle, ultrasound scans and counselling sessions, resulting in missing work and significant travel time. Understandably, few women are willing to donate their eggs on a purely altruistic basis, and therefore supply is falling short of demand in many countries worldwide, including the UK (Dyer, 2011). This has resulted in long waiting lists and limited choices, especially among ethnic groups seeking egg donation (Brulliard, 2006). This has driven some patients abroad to destinations where donor eggs are more readily available, but where regulations may be less strict (Culley et al., 2011), a process known as cross-border reproductive care (CBRC). Identifying this, the HFEA implemented changes aimed at improving the numbers of new donors registering and maximising the use of their gametes (BIONEWS, 2011). A significant change was providing £750 as a compensatory payment per cycle, replacing the previous payment of £250 (Bracewell-Milnes et al., 2018).
Investigation of the role of serum telomerase levels in patients with occult primary ovarian insufficiency: a prospective cross-sectional study
Published in Journal of Obstetrics and Gynaecology, 2022
Duygu Tugrul Ersak, Nafiye Yilmaz, Sabri Cavkaytar, Burak Ersak, Yaprak Ustun
The ovarian stimulation for all occult POI patients was a flexible regimen of gonadotropin-releasing hormone (GnRH)-antagonist protocol. Patients were administered recombinant FSH or human menopausal gonadotropin on cycle day 2 subcutaneously, and later 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter until the human chorionic gonadotropin (HCG) injection. Final oocyte maturation was triggered with HCG 10,000 IU when the three larger follicles reached a mean diameter of 17 mm. Serum E2 and endometrial thickness were measured on triggering day. Ultrasound-guided transvaginal oocyte retrieval was performed 36 h later. All patients had been previously underwent an infertility evaluation that included serum basal hormone levels (E2, FSH, luteinizing hormone [LH], thyroid-stimulating hormone [TSH]), and prolactin levels on menstrual cycle days 2 or 3, as well as a hysterosalphingogram. Karyotype, Fragile X mental retardation 1 premutation testing and 21-hydroxylase antibodies measurement were also performed as a part of the evaluation for all patients with POI. All patients had normal menstrual cycles with a range of 24–35 d, normal serum TSH and prolactin levels and had no other factors of infertility except for poor ovarian response. In addition, anti-mullerian hormone (AMH) levels, ovarian hyperstimulation protocols and induction parameters, peak E2 levels, IVF cycle results and total motile progressive sperm count (TMPSC) of spouses were recorded.