Timed oocyte collection in an assisted conception programme using GnRH analogue

Abstract

Three-hundred-and-twenty-five patients on an assisted conception programme underwent 378 cycles of oocyte retrieval (OPU) following ovarian stimulation using a GnRH analogue and human menopausal gonadotrophins (HMG), a regimen which allows programmed cycles and delayed oocyte retrieval. Eighteen cycles were excluded (failed OPU in three and failure of fertilization in 15). In 360 cycles, patients completed their treatment with either in-vitro fertilization/embryo transfer (IVF/ET) (116) or gamete intra-Fallopian transfer (GIFT) (244), of which 241 took place at the normal time and 119 were delayed for 24 h or more to avoid weekend operating. The overall pregnancy rate per OPU was 29.5%, with the IVF group being 24.1% and the GIFT group being 32.8%. In the group of patients in whom OPU was delayed, the pregnancy rate was significantly higher in each sub-group than in the corresponding non-delayed sub-group (overall, 37.0 versus 25.7%; IVF/ET, 38.5 versus 16.9%; GIFT, 36.3 versus 31.1%). There was a significantly higher number of oocytes collected, gametes/embryos transferred in the group whose OPU had been delayed. In patients receiving GnRH analogue and HMG for ovarian stimulation, delaying oocyte retrieval is not harmful, may result in an improved outcome and allows OPU to be performed on routine operating lists. This facility, together with the improved pregnancy rates associated with this protocol of ovarian stimulation should improve the cost-effectiveness of assisted conception programmes.

The kallikrein-kinin system, but not vascular endothelial growth factor, plays a role in the increased vascular permeability associated with ovarian hyperstimulation syndrome

“…All patients underwent ovarian stimulation using combined gonadotropin-releasing hormone agonist/ human menopausal gonadotropin and/or folliclestimulating hormone, using either the long or short (flare) protocol (Abdalla et al 1989). Patients were monitored by regular transvaginal ultrasound scans until the criteria for human choriogonadotropin (hCG) administration were achieved (more than three follicles with mean diameter greater than 18 mm).…”

“…Patients received 5000 IU hCG to induce final oocyte maturation, with a peak serum estradiol level of at least 500 pg/ml (1836 pmol/l). All accessible ovarian follicles were aspirated transvaginally 34 h after the hCG dose, and in vitro fertilization was performed in the usual manner (Abdalla et al 1989). Patients were monitored closely for the onset of OHSS and were scanned 7 days after oocyte collection to assess ovarian size and to record the presence of free fluid in the pouch of Douglas.…”

Serum Inhibin as an Index of Ovarian Function in Women Undergoing Pituitary Suppression and Ovarian Stimulation in an in vitro Fertilization Program

“…An additional complication of com mencing treatment in the luteal phase is that pregnancy can arise if the couple have unprotected intercourse in that cycle [7], and this must be identified to minimize GnRH-a administration during the early stage of preg nancy. Once exogenous gonadotropins are given to stim ulate follicular growth, then monitoring is required to observe the ovarian response [8] and to time the admin istration of the ovulatory trigger for the collection of mature oocytes [9], Endocrine assessments are important in monitoring ovarian function and, coupled with ultrasonography, give accurate information during pituitary suppression with GnRH-a [4] and ovarian stimulation with exoge nous gonadotropins [10], Also, the introduction of new approaches to augment the ovarian response to exoge nous gonadotropins, for example the treatment of poor responders by and growth hormone [12], has increased the need for reliable monitoring systems.…”

Exazerbation einer schizoaffektiven Psychose nach In-vitro-Fertilisation mit Leuprorelinacetat

“…Die Hypophyse wird desensitiviert und refraktär gegenüber dem Stimulus des hypothalamischen GnRH. Die FSH-und LH-Konzentrationen im Serum fallen ab und der endogene Stimulus auf die ovarielle Sexualsteroidbiosynthese kommt zum Erliegen [1,8]. Nach etwa 14-tägiger Gabe ist die gonadale Östrogensekretion weitgehend supprimiert, was zu den nicht selten vorkommenden Nebenwirkungen wie vor allem Schlafstörungen, innerer Unruhe, Übelkeit und Schwitzen führen kann [12].…”