Mono-ovulatory cycles: a key goal in profertility programmes

Baird, D. T.; Collins, John J.; Crosignani, Pier Giorgio; Evers, Johannes L.H.; Fanchin, Rénato; Fauser, Bart C.J.M.; Filicori, Marco; Jacobs, Howard S.; Tarlatzis, Basil C.; Cohen, Jean-David; Diczfalusy, E.; Diedrich, K.; Fraser, Lynn R.; Frigerio, G. C.; Gianaroli, Luca; Harlin, Joakim; Persson, Jan; Rojas-Rìos, A.; Sunde, Arne; Steirteghem, A. Van

doi:10.1093/humupd/dmg020

Cited by 34 publications

(7 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cost of CC is low, the oral route of administration is patient-friendly, and its safety is well established when properly utilized. The goal of treatment is to mimic a physiological ovulatory cycle with monofollicular development and ovulation from a single follicle, while minimizing the risks of ovarian hyperstimulation syndrome (OHSS) and multiple gestations [ 22 ].…”

Section: Medical Strategies For Achieving Ovulationmentioning

confidence: 99%

Managing PCOS-Related Infertility: Ovulation Induction, In Vitro Fertilization, and In Vitro Maturation

Torrealday

Patrizio

2013

Polycystic Ovary Syndrome

View full text Add to dashboard Cite

Key Points• PCOS accounts for approximately 80 % of women with ovulatory infertility.• Lifestyle modifi cation with caloric restriction and physical exercise should be considered as fi rst-line intervention when managing infertile women with an overweight/obese PCOS phenotype.• Clomiphene citrate (CC) remains the fi rst-line treatment for ovulation induction in anovulatory women with PCOS, although aromatase inhibitors have shown promise as an alternative method for ovulation induction.• Gonadotropin use is an option for CC-resistant and CC-failure patients, although treatment-related risks of ovarian hyperstimulation and multiple pregnancies may be exaggerated in the PCOS population. Gonadotropin therapy should therefore be reserved as a second-line strategy for women with PCOS and approached with caution.• In vitro fertilization (IVF) is a reasonable option for women with PCOS who have additional factors for infertility (tubal occlusion, male factor) or for those who have failed prior treatment with CC or gonadotropins.• In theory, in vitro maturation (IVM) is a potentially useful strategy for the management of PCOS-related infertility; in reality however, the reported pregnancy rates with IVF and IVM are signifi cantly lower than seen with conventional IVF. More research is needed before IVM can be offered as a reliable treatment option for women with PCOS.

show abstract

Section: Medical Strategies For Achieving Ovulationmentioning

confidence: 99%

Managing PCOS-Related Infertility: Ovulation Induction, In Vitro Fertilization, and In Vitro Maturation

Torrealday

Patrizio

2013

Polycystic Ovary Syndrome

View full text Add to dashboard Cite

show abstract

“…Because many women with PCOS are very sensitive to the use of ovulation induction agents, careful monitoring is essential to reduce the risk of OHSS and multiple pregnancies (147), also in combination with IUI. An additional approach is to perform transvaginal ultrasound-guided aspiration of the supernumerary follicles (148).…”

Section: Protocolmentioning

confidence: 99%

Consensus on infertility treatment related to polycystic ovary syndrome

Thessaloniki¹,

Greece²

2008

Fertility and Sterility

620

View full text Add to dashboard Cite

“…However, a substantial proportion (approximately 40%) of women with WHO Group II anovulatory infertility fail to conceive following CC therapy [5]. Such patients may benefit from gonadotrophin therapy to stimulate follicle development and induce ovulation [1,4,6-9].…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly important for women with WHO Group II anovulatory infertility and polycystic ovarian morphology [5], as the ovaries are extremely sensitive to gonadotrophin stimulation [8]. …”

Section: Introductionmentioning

confidence: 99%

“…Chronic low-dose (CLD) step-up FSH protocols have been developed so that the lowest effective dose of FSH can be used to achieve the objective of mono-follicular development [5,16,17]. The classic CLD regimen involves a low daily starting dose (usually 75 IU) for 14 days and, if necessary, the FSH dose is increased in small increments (37.5 IU), at intervals of no fewer than 7 days, until follicular development is initiated [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Phase IV, open-label, randomized study of low-dose recombinant human follicle-stimulating hormone protocols for ovulation induction

Serour

Aboulghar

Bahar³

et al. 2014

Reprod Biol Endocrinol

View full text Add to dashboard Cite

BackgroundThis Phase IV, open-label, multicentre, randomized study (MEnTOR) compared two low-dose recombinant human follicle-stimulating hormone (r-hFSH) protocols for ovulation induction.MethodsThis study was conducted in six Middle Eastern countries between March 2009 and March 2011. Eligible women (18–37 years), with World Health Organization Group II anovulatory infertility, were randomized to receive r-hFSH (starting daily dose: 75 IU) as a chronic low-dose (CLD) (37.5 IU dose increase on Day 14) or low-dose (LD) (37.5 IU dose increase on Day 7) protocol if no follicles were ≥10 mm. The maximum r-hFSH daily dose permitted was 225 IU/day. The total length of ovarian stimulation could not exceed 35 days, unless ultrasound assessment suggested imminent follicular growth and maturation. Patients underwent only one treatment cycle. Primary endpoint: incidence of mono-follicular development. Secondary endpoints included: stimulation duration and rates of bi-follicular development; human chorionic gonadotrophin administration rate; clinical pregnancy; and cycle cancellation (owing to inadequate response). Adverse events (AEs) were recorded. The primary efficacy analysis was performed using data from all patients who received at least one dose of correct study medication, had at least one efficacy assessment, and no protocol violations at treatment start (CLD group, n = 122; LD group, n = 125).ResultsMono-follicular development rates (primary endpoint) were similar in both groups (CLD: 56.6% [69/122] versus LD: 55.2% [69/125], p = 0.93; primary efficacy analysis population). Similarly, there were no significant differences between groups in bi-follicular development, clinical pregnancy or cycle cancellation (inadequate response) rates. In patients who received human chorionic gonadotrophin injections, the mean duration of stimulation was 13.7 days in the CLD group and 12.9 days in the LD group. Clinical pregnancy rates for those patients who received an hCG injection were similar in both groups (CLD: 20.2% [19/94] versus LD: 19.8% [18/91], p = 0.94; primary efficacy analysis population). Most AEs were mild in severity. Only one case of ovarian hyperstimulation syndrome was reported (mild; CLD group).ConclusionsEfficacy and safety outcomes were similar for the two protocols.Trial registrationClinicaltrials.gov NCT01081626.

show abstract

Mono-ovulatory cycles: a key goal in profertility programmes

Cited by 34 publications

References 6 publications

Managing PCOS-Related Infertility: Ovulation Induction, In Vitro Fertilization, and In Vitro Maturation

Managing PCOS-Related Infertility: Ovulation Induction, In Vitro Fertilization, and In Vitro Maturation

Consensus on infertility treatment related to polycystic ovary syndrome

Phase IV, open-label, randomized study of low-dose recombinant human follicle-stimulating hormone protocols for ovulation induction

Contact Info

Product

Resources

About