Background The use of gonadotrophins as a first‐line treatment for anovulatory infertility has been limited by a perception of a risk of multi‐fetal gestation and ovarian hyperstimulation syndrome (OHSS). However, it has recently been recognised as an acceptable first‐line treatment if appropriate monitoring is performed. Aims To determine the cumulative live birth rate, incidence of multiple gestation, cycle cancellation rate and incidence of OHSS for therapy‐naïve anovulatory women undergoing ovulation induction with gonadotrophins. Materials and Methods A prospective observational study of 258 patients undergoing ovulation induction with a ‘low‐dose step‐up’ protocol was performed over a three‐year period across two fertility centres (40% of patients were currently or recently prescribed metformin). Results Twenty‐six percent of patients required concurrent use of luteinising hormone. The cumulative pregnancy and live birth rates were 22.5% and 18.2%, 40.3% and 34.5%, 47.7% and 41.1% after completion of the first, second and third cycles of stimulation, respectively, with a median duration of stimulation of 15 days. No patients developed OHSS and 10.5% of cycles were cancelled due to an excessive or no follicular response. The multiple pregnancy rate was 2%. The cumulative pregnancy rate was reduced for women over 35 years of age (23.8 vs 55.3%, P = 0.006) and for women with a body mass index greater than 25 kg/m2 (40.6 vs 56.7%, P = 0.027). Conclusions This study demonstrated that ovulation induction with gonadotrophin therapy, in the context of appropriate monitoring, is a safe and effective treatment for young therapy‐naïve patients with anovulatory infertility.
Polycystic ovarian syndrome is the commonest cause of anovulatory infertility. This chapter will explore fertility treatment options for this condition including the risks, benefits and success rates for different treatment methods. The importance of close patient monitoring with hormone levels and pelvic ultrasounds to ensure mono-ovulation and to avoid ovarian hyperstimulation syndrome will be highlighted.
Pregnancies resulting from fertility treatment are associated with higher rates of multiple pregnancy and have higher rates of pregnancy complications than spontaneously conceived pregnancies. Methods exist to make fertility treatment safer and less likely to result in multiple pregnancy and practitioners should be practicing fertility treatment with the aim to produce a healthy, term, singleton pregnancy. Approaches to minimising the risk of multiple pregnancy include carefully monitoring ovulation induction (OI) cycles to produce mono-follicular ovulation. Identifying patients at risk of excessive response to ovulation induction and treating them with low dose therapies and close monitoring is a critical step in practicing safe OI treatment. Performing single embryo transfer in all but exceptional cases of in-vitro fertilisation (IVF), and never transferring more than two embryos, is the single, most successful way to reduce the multiple pregnancy rate with IVF. An appreciation of the increased risk of mono-chorionic twinning with IVF is also important. This chapter will explore ways to minimise the risk of multiple pregnancy with a variety of fertility treatments.
Objectives: To improve counselling on omphalocele, by determining parent-reported motor function, cognition, health status, quality of life and behaviour in school-aged children. Methods: We sent paper questionnaires to all parents of children born with omphalocele between 2000-2012. Motor function (MABC-2 checklist) and emotional and behavioural problems (SDQ) were compared with reference data; health status (PedsQL), quality of life (DUX-25) and cognition (PedsPCF) were compared with that of controls (two per child) matched for age, gender and socio-economic status.Results: Thirty-one of 54 (57%) eligible participants returned the questionnaires. Nineteen (61%) children had been diagnosed prenatally and 10 (32%) had giant omphalocele. Of 26 children with MABC-2 checklist scores, 21 (81%) scored within normal range, and 5 (19%) -of whom 2 had giant omphalocele -scored borderline or were highly likely to have motor problems. The total difficulties SDQ score was normal in 17 (55%) children; 14 (45%) scored within the borderline or abnormal range (vs. 20% expected, p=0.001). Health status, quality of life and cognition scores were comparable with those of matched controls (table 1). Conclusions: Parents of children treated for omphalocele reported normal motor function, cognition, health status and quality of life, but more behavioural problems than healthy children. This is subject to further study.
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