Risk of repeated spontaneous luteinizing hormone surges in ovarian stimulation for in vitro fertilization.

Although spontaneous luteinizing hormone (LH) surges are preventable with gonadotropin releasing hormone agonist (GnRH-a) inclusion in ovarian stimulation protocols, GnRH-a-containing protocols are more expensive and associated with an increased risk of ovarian hyper-stimulation syndrome. The present study assessed whether spontaneous LH surges occur in predictable patterns, allowing GnRH-a to be utilized selectively. We assessed 1,103 patients receiving clomiphene citrate/human menopausal gonadotropin (CC/hMG) without GnRH-a for their first in vitro fertilization (IVF) cycle and observed spontaneous LH surges in 30.4%. When patients who demonstrated a spontaneous LH surge received a second CC/hMG stimulation protocol, 45.9% surged again. Of those patients who did not demonstrate a spontaneous LH surge in their initial CC/hMG cycle, only 23.0%, significantly less (P < .001), surged in their second cycle. Of those patients who did not surge in their first two cycles, only 15.7% had an LH surge in their third cycle (P < .001). Thus, if all patients received CC/hMG without GnRH-a as their first IVF stimulation protocol, GnRH-a could be reserved for patients who have demonstrated a spontaneous LH surge. By tailoring the treatment plan, the pregnancy rate would be optimized while decreasing cycle cancellations due to spontaneous LH surges in those patients susceptible to LH surges and limiting costs and inconvenience for patients unlikely to surge spontaneously.

Psychological assessment and follow-up after in vitro fertilization: assessing the impact of failure.

The present study was conducted to assess the immediate psychological impact of failed in vitro fertilization (IVF). Emotional status and marital functioning were also examined pre-IVF, and both demographic information and psychological test scores were evaluated as predictors of reaction to treatment failure. After a failed first cycle, both males and females showed significant increases in anxiety and depressive symptoms. Although group means were not clinically elevated and most participants were coping adequately, the prevalence of both mild and moderate depression increased substantially, particularly among women. In addition, women without children were a subgroup particularly vulnerable to the stress of failure. Predisposition towards anxiety, pre-IVF depressive symptoms, and fertility history were the most important predictors of emotional response. Treatment implications of these findings were discussed.

Assessment of experienced pain associated with transvaginal ultrasonography-guided oocyte recovery in in vitro fertilization patients.

We described a study designed to assess the pain experienced by in vitro fertilization patients undergoing transvaginal ultrasonography-guided oocyte recovery. Participants were 164 women who underwent 194 oocyte recovery procedures at a university teaching hospital. Measurements of the intensity of pain and the quality of pain were obtained immediately after the procedure and again 1 hour later. Results show that the majority of patients reported manageable levels of discomfort, and that there was a marked reduction in both intensity and qualitative complexity over time, which suggests there were minimal residual effects. Repeated measures analyses of data from participants who underwent the procedure on two occasions suggest that familiarity with the procedure has no effect on reported pain. Finally, patients' levels of pain correlated significantly with several psychological self-report measures.