Ultrasonographic Monitoring of Follicle Growth in Controlled Ovarian Hyperstimulation
Arianna D'Angelo, Nazar N. Amso in Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Controlled ovarian hyperstimulation (COH) is achieved by daily subcutaneous injections of recombinant or urinary gonadotropins (Gn). The dose is individualized, and the aim is to recruit 5–15 follicles. USS is used to assess the number and average diameter of the developing follicles for timing of egg retrieval. The estimated pregnancy rate per cycle using standard COH is approximately 30% [2], but when using minimal ovarian stimulation, the pregnancy rate per cycle is lower, approximately 10% [3]. This is why the accuracy of follicular ultrasound monitoring is very important for the ultimate outcome. In addition, ovaries might overrespond to the stimulation protocol, causing ovarian hyperstimulation syndrome (OHSS), which can be a life-threatening condition [4], and hence, the importance of having a reliable and secure tool to monitor superovulation. Martins et al. [5] performed a literature search up to April 2013 for randomized controlled trials (RCTs) on this topic. Studies that compared different methods for monitoring COH, including ultrasound assessment of follicles (alone or combined with hormonal assessment), in at least one group were included in the meta-analysis. The objective of the meta-analysis was to evaluate the efficacy and safety of monitoring COH using ultrasonography. Of the 1515 records found, only six studies fulfilled the inclusion criteria and were analyzed.
SBA Questions
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
A 30-year-old woman is undergoing controlled ovarian hyperstimulation for in vitro fertilization. What factor will be associated with a decreased risk of ovarian hyperstimulation syndrome (OHSS) in this woman?Her ageHigh antral follicle countLow AMHKnown case of PCOSPrevious OHSS
Oocyte retrieval and selection
David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham in Textbook of Assisted Reproductive Techniques, 2017
On the basis of these findings, the “FSH window” concept has been introduced, suggesting the importance of the duration of FSH elevation above the threshold level rather than the height of the elevation of FSH for single dominant follicle selection (6, 7, 12). The different stimulation protocols used for controlled ovarian hyperstimulation are based on the concept of widening the FSH window with the use of exogenous gonadotropins from the early follicular phase to the day of human chorionic gonadotropin (hCG) administration. Over the last 25 years different stimulation protocols have been proposed. Easier stimulation regimens such as clomiphene citrate (CC) alone or in combination with human menopausal gonadotropin (hMG) and urinary FSH were gradually abandoned in favor of protocols where GnRH agonists (GnRHas) are used in combination with gonadotropins. These lengthy protocols, which have been for decades the most widely used treatments for ovarian stimulation, allowed us to manage the activity of in vitro fertilization (IVF) centers more easily, enabled lower cancellation rates, and raised the number of preovulatory follicles, the number of oocytes retrieved, and the number of good-quality embryos for transfer, thus leading to increased pregnancy rates (13). However, these regimens are not free from complications and costs for the patients. The clinical introduction of GnRH antagonists in IVF (14–16), with their immediate suppression of pituitary function, allows the administration of low doses of gonadotropins from the mid-follicular phase, resulting in more “patient-friendly” stimulation protocols (17, 18) with fewer days of stimulation, lower amounts of gonadotropins administered, and fewer oocytes retrieved. However, if these milder protocols may improve patients compliance, reducing the burden of IVF on the couple, the question that remains to be answered is whether the reduced number of oocytes obtained after mild protocols may impair the clinical outcome when calculated cumulatively (including cryopreservation cycles).
The effect of low and ultra-low oxygen tensions on mammalian embryo culture and development in experimental and clinical IVF
Published in Systems Biology in Reproductive Medicine, 2020
Manuel Belli, Sevastiani Antonouli, Maria Grazia Palmerini, Serena Bianchi, Sara Bernardi, Mohammad Ali Khalili, Orlando Donfrancesco, Stefania Annarita Nottola, Guido Macchiarelli
From this success forwards, IVF became a medical treatment for infertility. The controlled ovarian hyperstimulation usually takes place by using a combined administration of gonadotropin-releasing hormone agonists or antagonists and gonadotropins. Oocytes are aspirated through transvaginal or transabdominal ultrasound-guided aspiration of follicles and fertilized in vitro. One or more embryo(s) are then transferred into the uterus. This procedure occurs over an approximately two-week interval of time and is called the IVF cycle (Glujovsky et al. 2012). The embryos obtained are usually transferred into the uterus at the second (E2) or third (E3) day of the in vitro culture (IVC), approximately corresponding to the 4–8 cell stage, i.e., when the receiving uterus can provide the best environment for embryo development (Laverge et al. 2001). However, recent evidence indicates that human embryos at the fifth (E5) or sixth (E6) day of culture (i.e., 64-cell or blastocyst stage) are at the best biological stage to be transferred to the uterus because the extended culture may give an improved chance to select high-quality embryos (Glujovsky et al. 2012).
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
Since controlled ovarian hyperstimulation alone gives poor results in such a situation, various approaches have been used to increase pregnancy rates, including immunosuppressive therapy and DHEA supplementation, with or without IVF. Some studies showed the value of corticosteroids for improving the pregnancy success rate in a subset of patients with previous IVF failures and high serum AOA levels [33,50]. Indeed, decreasing the high, endogenous, ineffective FSH, by gonadotropin releasing hormone agonist associated to controlled ovarian hyperstimulation and corticosteroids were sometimes effective in generating conceptions in patients with POF [51]. The release of the FSH receptors occupancy from the endogenous FSH, may give way to receptor stimulation by exogenous FSH, combined with amelioration of the autoimmune disturbance by glucocorticoids cotreatment. The mechanism of action of corticosteroids is thought to involve a reduction in perifollicular inflammatory macrophages around follicles, which can then restore folliculogenesis in dormant small follicles [15]. In another study, corticosteroids did not influence ovarian responsiveness to gonadotropins in patients with POF [52]. Some studies noted higher pregnancy rates with DHEA supplementation in patients with diminished ovarian function [53,54]. Estrogens have also proven beneficial for the recovery of ovarian function via the restoration of receptor sensitivity to gonadotropins, thus promoting folliculogenesis [9]. However, to date no treatment for autoimmune oophoritis has demonstrated efficacy and safety in prospective randomized placebo-controlled studies.
Effects of oral contraceptive for different responder women before GnRH antagonists: a systematic review and meta-analysis
Published in Gynecological Endocrinology, 2021
Jie Li, Yan Sun, Sien Mo, Shujia Wang, Weiwei Luo
As an important part of assisted reproductive technology (ART), controlled ovarian hyperstimulation (COH) is of major importance in achieving a pregnancy. Hypophyseal activity suppression, multiple follicle growth stimulation, and ovulation induction are the three main purposes of current COH for ART [1]. By suppressing hypophyseal activity, untimely luteinizing hormone (LH) surge can be prevented and without affecting appropriate development of the leading follicle. For this purpose, gonadotropin-releasing hormone (GnRH) agonist (GnRH-a) and GnRH antagonist (GnRH-ant) are currently available drugs. As a valid alternative to the classical protocol, GnRH-ant protocol was introduced in clinical practice only in the last decades following the long GnRH-a protocol which has been widely used in ART [2–5]. Although the two kinds of drugs have similar clinical indications, their mechanisms of action are quite different [3]. GnRH-ant protocol is characterized by shorter length of stimulation and decreased requirements for gonadotropins as compared with the long GnRH-a protocol [6–8]. However, GnRH-ant protocol is lacking of flexibility in the starting day of gonadotropin stimulation, which is not convenient for the patients’ treatment in controlling their time of stimulation and for the ART centers in controlling their workload. Pretreatment with oral contraceptive pills (OCPs) can help to overcome this limitation in the GnRH-ant protocol [9,10].
Related Knowledge Centers
- Assisted Reproductive Technology
- Ovarian Follicle
- Ovulation
- In Vitro Fertilisation
- Fertility Medication
- Transvaginal Oocyte Retrieval
- Insemination
- Multiple Birth
- Ovulation Induction
- Pregnancy Rate