The Biochemistry of Infertility
A. S. Curry, J. V. Hewitt in Biochemistry of Women: Clinical Concepts, 1974
The two major complications of treatment are superovulation and hyperstimulation. Multiple ovulation or superovulation is most likely to occur when an excessive stimulating dose of FSH (HPG or HMG) has been given, or when repeated doses of LH (HCG) are given after the initial peak of estrogen secretion. In the former case the level of urinary total estrogen excretion will be in excess of 120 μg/24 hr on the 6th and 7th days of the treatment cycle, or will show a progressive rate of increase in which the daily estrogen excretion doubles or more than doubles each day. Under such circumstances multiple ovulation is almost certain to occur if HCG is given, and the injection should be withheld. The chances of such pregnancies proceeding to normal term are small, and the obstetric risks are high. In some centers, repeated injections of HCG have been suggested to induce ovulation, but in the author’s own experience superovulation and severe ovarian enlargement will occur.
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.
Introduction and development of IVF and its ethical regulation
Elisabeth Hildt, Dietmar Mieth in 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.
Oocyte maturation arrest produced by TUBB8 mutations: impact of genetic disorders in infertility treatment
Published in Gynecological Endocrinology, 2020
María C. Lanuza-López, Sandra G. Martínez-Garza, Jesús F. Solórzano-Vázquez, Daniela Paz-Cervantes, Claudia González-Ortega, Israel Maldonado-Rosas, Gerardo Villegas-Moreno, Lina G. Villar-Muñoz, Francisco A. Arroyo-Méndez, Antonio M. Gutiérrez-Gutiérrez, Raul E. Piña-Aguilar
Factors related to ovarian superovulation are mainly considered as the etiology, including unproper administration of hCG by the patient or untimed oocyte triggering. In 2014, a genetic etiology for oocyte maturation arrest was described for the first time [4]. Currently, oocyte maturation defects of genetic etiology comprise a group of six different Mendelian disorders: oocyte maturation defect type 1 caused by mutations in ZP1 gene [4] (OMIM 195000), type 2 produced by mutations in TUBB8 gene [5] (OMIM 616768), type 3 related to ZP3 gene [6] (OMIM 182889), type 4 by mutations in PATL2 gene [7,8] (OMIM 614661), type 5 related with WEE2 gene [9] (OMIM 614084) and type 6 produced by mutations in ZP2 gene [10] (OMIM 182888). From a clinical and laboratory point of view, some of these disorders are potentially diagnosed by the abnormal morphology of oocytes when defects affect the structure of zona pellucida but in the others the only visible abnormality is that oocytes are at MI after oocyte capture and IVF or ICSI complicating an accurate clinical diagnosis.
The role of FGF-4 and FGFR-2 on preimplantation embryo development in experimental maternal diabetes
Published in Gynecological Endocrinology, 2022
Filiz Yilmaz, Serap Cilaker Micili, Guven Erbil
The study was a prospective experimental study. The weights of the mice were measured at the beginning and end of the experiment. Female mice (weighting 25–30 g, aged 7–8 weeks) were randomly divided into two groups: control (n = 15) and diabetic (n = 13). Two diabetic female mice died and were excluded from the study. After in the diabetic group mice were confirmed to be diabetic, all mice were induced for superovulation with 10 IU PMSG (pregnant mare serum gonadotropin; Folligon, Intervet) followed by 10 IU hCG (human chorionic gonadotropin; Chorulon, Intervet) over 48 h [16]. One of the basic techniques of reproductive biotechnology in experimental animals is the induction of superovulation, increasing the number of eggs [17]. After HCG injection, females were placed in cages with males and left to copulate, and the vaginal plug was evaluated the next day. Vaginal plug means copulation, and its presence defines the first day of pregnancy. Female mice in both groups were sacrificed under ether anesthesia on the third and fourth day of pregnancy, and their uterus and fallopian tubes were removed [18]. We collected the blastocysts by flushing the oviducts and uteri with M2 medium (Sigma) supplemented with 4 mg/ml bovine serum albumin (BSA; BioVision) [19]. The recovered embryos were counted and examined under the stereomicroscope for developmental stage classification and morphological analysis [21,28].
Effect of epigallocatechin-3-gallate (EGCG) on embryos inseminated with oxidative stress-induced DNA damage sperm
Published in Systems Biology in Reproductive Medicine, 2020
Man Chen, Wanmin Liu, Zhiling Li, Wanfen Xiao
The ovulated oocytes arrested at metaphase II were collected 13 ~ 15 hours (hs) after human chorionic gonadotropin (hCG; Ningbo Second Hormone Factory, China) administration from the oviducts of 4–8 weeks old female KM mice (weighing 25–35 g, 160 mice). Prior to the oocyte collection, superovulation was induced by treating the mice with 10 IU of pregnant mare’s serum gonadotropin (PMSG; Ningbo Second Hormone Factory, China) for 48 h, followed by treatment with 10 IU of HCG. The harvested oocytes were cultured in microdrops (10 ~ 15 oocytes per microdrop) and then suspended in fertilization medium (FM, HTF medium containing 0.4% BSA) and inseminated with the three processed spermatozoan samples (range: 1–2.5 × 106/mL): fresh sperm, frozen-thawed sperm, or H2O2-treated sperm. Four to six hours post-insemination (hpi), the putative zygotes were washed thrice with HTF containing 0.4% BSA, and incubated in embryo culture medium (EM, HTF containing 0.4% BSA) at 5% CO2 and 37°C.
Related Knowledge Centers
- Assisted Reproductive Technology
- Ovarian Follicle
- Ovulation
- In Vitro Fertilisation
- Fertility Medication
- Transvaginal Oocyte Retrieval
- Insemination
- Multiple Birth
- Ovulation Induction
- Pregnancy Rate