RESUMO
Ovulation induction (OI) or ovulation enhancement (OE) with gonadotrophins can be a reasonable treatment option for patients with a variety of infertility diagnoses. It must be used with extensive monitoring and management given the risk of multiple pregnancy,especially high-order multiples. This retrospective study evaluated per cycle outcomes of a large cohort of 1452 gonadotrophin OI/OE cycles at an academic infertility centre, and the efficacy of specific guidelines in limiting multiple pregnancy. The lowest possible gonadotrophin doses were used and cycle cancellation was recommended if more than three dominant follicles were present, and/or ifserum oestradiol was above 1500 pg/ml. Overall, pregnancy rate (PR) was 12% and live birth rate was 7.7%, with an increasing trend in younger patients (P = 0.0002 and <0.0001, respectively). Multiple clinical PR was 2.6% with 1.9% twins and 0.7% triplets and above.The birthweight of a singleton from a vanishing twin pregnancy (n = 8)was significantly lower than other singletons (2882 g versus 3250 g,P = 0.013). Reducing multiple pregnancies from OI/OE cycles remains an important and challenging goal. In this large cohort, high-order multiple clinical PR was limited to 0.7% per cycle by using specific management strategies while maintaining a reasonable PR.
Assuntos
Gonadotropinas/metabolismo , Infertilidade/terapia , Indução da Ovulação/métodos , Adulto , Estudos de Coortes , Estradiol/sangue , Estradiol/metabolismo , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Taxa de Gravidez , Gravidez Múltipla , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the effect of the gonadotropin-releasing hormone antagonist Ganirelix on gonadotropin ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, controlled study. SETTING: Academic infertility center. PATIENT(S): Ninety-eight anovulatory women with PCOS undergoing 154 gonadotropin OI cycles. INTERVENTION(S): Patients were treated with recombinant FSH alone (group 1) or in conjunction with Ganirelix when the leading follicle was ≥13 mm (group 2) versus from the beginning of stimulation (group 3), followed by IUI. MAIN OUTCOME MEASURE(S): Per cycle clinical pregnancy rate (CPR), live-birth rate (LBR), total gonadotropin dose, days of stimulation, serum LH and peak E2, and premature luteinization rate. RESULT(S): Data are suggestive of improved CPR in group 2 versus group 1 (33% vs. 19%) and LBR (35% vs. 20%) but not significantly different. Premature luteinization was highest in group 1 (21% vs. 1.8% in group 2 and 2.1% in group 3). Group 3 had the highest cancellation rate and cost without improving CPR and LBR. No differences were noted in peak serum E2, total gonadotropin dose, or days of stimulation. CONCLUSION(S): Adding Ganirelix in a flexible protocol to gonadotropin OI cycles in women with PCOS may be beneficial by decreasing premature luteinization.
Assuntos
Hormônio Foliculoestimulante/administração & dosagem , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/tratamento farmacológico , Adulto , Quimioterapia Combinada , Feminino , Hormônio Liberador de Gonadotropina/administração & dosagem , Gonadotropinas/administração & dosagem , Antagonistas de Hormônios/administração & dosagem , Humanos , Infertilidade Feminina/fisiopatologia , Hormônio Luteinizante/sangue , Síndrome do Ovário Policístico/fisiopatologia , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagemRESUMO
OBJECTIVE: To evaluate the impact on the rates of clinical pregnancy and live birth of polyploidy after intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): One hundred forty-three patients undergoing their first IVF-embryo transfer cycle requiring ICSI. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patients were divided into two groups on the basis of the proportion of post-ICSI triploid fertilization that was observed at the time of fertilization assessment: group 1 included patients with