Random antral follicle count performed on any day of the menstrual cycle has the same predictive value as AMH for good ovarian response in IVF cycles.

OBJECTIVE: To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed. METHODS: 410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase. RESULTS: Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively). CONCLUSION: AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle.

A meta-analysis of the efficacy of progestin-primed ovarian stimulation with medroxyprogesterone acetate in ovulation induction in poor ovarian responders.

PURPOSE: To systematically evaluate the effect of progestin-primed ovarian stimulation (PPOS) in in vitro fertilization (IVF)/oocyte intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in patients with poor ovarian response and to find an optimal ovulation induction protocol for such patients. METHOD: A literature search of PubMed, Medline, EBSCO, Cochrane Library, Vip.com, CNKI, and the Wanfang database was conducted to find case-control studies of PPOS with medroxyprogesterone acetate and other traditional stimulation regimens for ovulation induction in patients with poor ovarian response. The period of time searched was from the database establishment to August 2020. Patients in the experimental group underwent PPOS and those in the control group underwent another program (e.g., the gonadotropin-releasing hormone antagonist protocol). RevMan 5.3 software was used for meta-analysis. RESULTS: A total of sixteen case-control studies (one of them is randomized controlled trial), with 4422 induction cycles, were included. All the included patients met the 2011 Bologna diagnostic criteria for poor ovarian response. The numbers of mature eggs, available embryos, optimal embryos, and the rate of cumulative pregnancies in the PPOS group were all better than those in the control group (P<0.05). There was a lower Serum luteinizing hormone on the day of human chorionic gonadotropin (HCG) injection and a lower rate of cycle cancellation in the PPOS group (P<0.05). No other differences between PPOS and other treatments were statistically significant. CONCLUSION: PPOS can reduce the need for cycle cancellation, improve the follicles and embryos, and improve the pregnancy rate and thus, can present an effective choice for IVF/ICSI-ET in patients with poor ovarian response.

Ultrasound-guided follicle aspiration at time of laparotomy in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To demonstrate a unique case of direct ultrasound-guided follicle aspiration at time of a laparotomy in a patient with Mayer-Rokitansky-Küster-Hauser Syndrome. DESIGN: Video presentation. SETTING: Academic fertility center PATIENT(S): A 32-year-old gravida 0 with Mayer-Rokitansky-Küster-Hauser Syndrome and bilateral ovarian masses presented as a fertility preservation consult from gynecologic oncology due to the possibility of bilateral oophorectomy. Due to the appearance and size of the left ovary oncology planned to perform an exploratory laparotomy and left oophorectomy, with possible right oophorectomy. The patient and her partner desired embryo cryopreservation with plans for future use in a gestational carrier. She had previously undergone vaginal dilator therapy, however her ovaries were inaccessible transvaginally due to their cephalad location and small caliber of the vaginal pouch. The plan was made to proceed with controlled ovarian stimulation and concurrent ultrasound-guided follicle aspiration of the right ovary at the time of laparotomy following left oophorectomy. INTERVENTION(S): Ultrasound-guided follicle aspiration in vivo at time of laparotomy. MAIN OUTCOME MEASURE(S): Successful controlled ovarian stimulation, oocyte retrieval and embryo cryopreservation. RESULT(S): The patient underwent a long agonist protocol and received a total of 2,525 units of gonadotropin with a peak estradiol of 3,264 pg/ml. She required a total of 9 days of stimulation. The normal right ovary responded as expected, and the left ovary remained unchanged. Following laparotomy and left oophorectomy, direct application of the transvaginal ultrasound probe was used to aspirate all visible follicles on the right side in vivo. Twenty-four oocytes were retrieved, 15 were mature and 5 blastocysts were cryopreserved. Final pathology of left ovary returned as serous cystadenoma. The right ovary was examined by gynecologic oncology prior to and following retrieval and was thought to be normal and remained in situ. CONCLUSION(S): Although the approach described here is not feasible in most cases, this video demonstrates a unique and successful fertility preservation technique by direct ultrasound-guided follicle aspiration in vivo at the time of laparotomy in a Mayer-Rokitansky-Küster-Hauser Syndrome patient and to our knowledge, is the first description of its kind. This retrieval would have otherwise been limited by lack of access transvaginally and limited visualization transabdominally. This combined approach should be considered in future patients with müllerian anomalies and similar complicating factors necessitating laparotomy.

Preovulatory follicle diameter, growth rate and time of ovulation during induced oestrus using a CIDR® in trypanotolerant female Bos taurus N'Dama cattle.

The aim of this study was to assess the dose (300 to 600 IU) effects of equine chorionic gonadotropin (eCG) on the preovulatory follicle diameter, growth rate and time of ovulation characterized by echography. The eCG was injected at the end (D0) of the 7-day treatment with a controlled internal device release (CIDR®) and a PGF2α being injected 2 days before the removal of the CIDR® (d-2). The 120 N'Dama female were distributed into five experimental groups. The control group (n = 26) was treated with physiological saline at the removal of the CIDR®, while the animals in the four treated groups received, respectively, 300 IU (n = 25), 400 IU (n = 24), 500 IU (n = 22) and 600 IU (n = 23) of eCG. The diameter of the preovulatory follicle was significantly higher (P < 0.05) in the animals treated with 300 IU (10.1 ± 1.4 mm) than in untreated animals (9.3 ± 1.2 mm). Follicle growth rate was significantly (P < 0.05) higher in treated animals (1.0 ± 0.4 mm/day) than in the control group (0.9 ± 0.4 mm/day). The average interval between the time of eCG injection and ovulation was similar in the non-treated (83.7 ± 14.4 h) and treated animals (79.7 ± 11.9). Treated animals showed a significant increase in the percentage of ovulation (94.7 % compared to 73.1 %) (P < 0.01). Use of eCG contributed towards synchronising the time of ovulation between 72 to 96 h, which would facilitate the use of systematic insemination.

Autoclaved, previously used intravaginal progesterone devices induces estrus and ovulation in anestrous Toggenburg goats.

Intravaginal progesterone devices are used worldwide for estrus induction in goats. Reused devices are able to induce estrus; however, this can be a health risk within a flock. The objective was to compare new and previously used (and autoclaved) progesterone-releasing intravaginal devices for induction of estrus and ovulation in seasonally anestrous Toggenburg goats. Anestrous goats (n=42) received new intravaginal devices containing 0.3g progesterone (CONTROL), or similar devices previously used for either 6 (USED6) or 12d (USED12) and subsequently autoclaved. All goats received 5mg dinoprost at device insertion and 200 IU eCG 5d later, and all devices were removed after 6d. After device removal, estrus was monitored and females displaying signs of estrus were mated by fertile bucks. Transrectal ovarian ultrasonography was performed after device removal until detection of ovulation. Blood samples were collected for determination of plasma progesterone concentration at different times. There was no difference (P>0.05) among groups CONTROL, USED6 or USED12 for: estrus response (87, 100 or 100%, respectively); duration of estrus (32.3±2.3, 25.2±3.4 or 27.3±4.1h); ovulation rate (100, 88 or 100%); number of ovulations (1.5±0.2, 1.9±0.3 or 1.7±0.3); and pregnancy rate (60, 58 or 67%). Plasma progesterone (P4) concentrations were greater (P<0.05) in CONTROL than in USED6-treated and USED12-treated goats (7.2±1.2, 4.7±0.7 and 4.3±0.6 ng/mL, respectively) at 6h after device insertion; these differences were maintained until 4d after device insertion (3.4±0.4, 2.3±0.2, and 2.5±0.2 ng/mL). Overall, plasma progesterone concentrations were greater (P<0.05) in nulliparous than in lactating goats (3.1±0.8 compared to 2.4±0.6 ng/mL, respectively). In conclusion, autoclaved, previously used intravaginal progesterone-releasing devices resulted in significant lesser plasma progesterone concentrations than new devices, but were similarly effective in inducing estrus and ovulation in anestrous goats.

The redesigned follitropin α pen injector for infertility treatment.

INTRODUCTION: Treatment for infertility may require multiple drugs and complex dosing schedules. Available injection devices for patients who require regular injections during treatment are reviewed in this article, focusing on pen injectors used to self-administer recombinant human follicle-stimulating hormone (follitropin α). Following the introduction of the first and second follitropin α pen injectors in the last decade, a third pen injector with improved design for the administration of follitropin α has been developed for use in fertility treatment cycles. AREAS COVERED: This paper presents the results of the dose accuracy testing with this pen injector that was performed in accordance with international standards (EN ISO 11608-1:2000). This overview also provides an understanding of the key features of the redesigned pen injector that are of interest to healthcare professionals. EXPERT OPINION: The availability of an improved injection device for the delivery of follitropin α used during infertility treatment cycles of ovulation induction and assisted reproductive technology offers patients and healthcare professionals new treatment administration options. As fertility treatment cycles involve the use of several injectable gonadotropins, a standard device that could be used for all such treatments would simplify both the administration and the teaching of administration considerably.

In vitro fertilization-intracytoplasmic sperm injection outcomes in single- versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial.

We compared the retrieval efficiency of single- (direct follicular aspiration) and double-lumen-needle (attained with follicular flushing) procedures in normal-responder IVF-intracytoplasmic sperm injection cycles. This prospective randomized study did not demonstrate a beneficial effect of double-lumen needle retrieval compared with single-needle retrieval in normal-responder IVF-intracytoplasmic sperm injection cycles in terms of retrieved oocytes, clinical pregnancy rates, and live birth rates.

[Clinical application of prefilled pen and conventional syringe during controlled ovarian stimulation for in vitro fertilization].

OBJECTIVE: To investigate the efficacy, convenience and costs of recombinant follitropin alpha administered by a prefilled pen device and conventional syringe in Chinese women undergoing controlled ovarian stimulation for in vitro fertilization (IVF). METHODS: A total of 184 patients undergoing IVF treatment were enrolled in this study. According to a long-term recombinant follicle-stimulating hormone (rFSH) protocol, ovarian stimulation was performed with the prefilled pen and conventional syringe at random in these subjects, and the dose of follitropin, number of oocytes and embryo parameters and IVF-ET outcome were compared between the two groups. RESULTS: The total rFSH dose, cost, and frequency of hospital visits were significantly lower in the pen protocol group, but the residual rFSH amount was higher. Compared with conventional injections, the prefilled pen was associated with significantly lowered rate of local redness, high rate of local bruise, more frequent follitropin dose modulation and lower serum oestradiol levels on HCG day. No significant difference was found in the endometrial thickness, numbers of oocytes retrieved, MII oocytes, transferred embryo, or the clinical pregnancy rates between the two groups. The ratio of MII oocytes, good quality embryo rates and implantation rates was significantly higher in the pen group with lower incidences of moderate and severe ovarian hyperstimulation syndrome. CONCLUSION: The prefilled pen provides an easy, safe, effective and more patient-friendly means for controlled ovarian stimulation procedure in Chinese women, but more attention should be given to protocol optimization and patient education.

A administração de hCG incrementa a incidência de ovulações duplas e múltiplas em éguas da raça Campolina apresentando folículos codominantes? / Does hCG administration increase the incidence of double and multiple ovulations in Campolina mares with co-dominant follicles?

A gonadotrofina coriônica humana (hCG) é rotineiramente empregada na indução de ovulação em éguas. A incidência de duplas ovulações é variável, sendo comum em determinadas raças brasileiras, como Brasileiro de Hipismo e Campolina. O objetivo deste trabalho foi avaliar se a administração de hCG em éguas da raça Campolina incrementa a incidência de ovulações duplas e múltiplas. Através de palpação retal e ultrassonografia, foram avaliados dois ciclos estrais de 104 éguas, divididas em dois grupos. À detecção de um ou mais folículos ³35 mm e edema endometrial grau 2, 2.500 IU de hCG (IV) eram administrados às éguas do grupo I. O grupo II serviu como controle. Os resultados obtidos foram analisados pelo Qui-quadrado. A incidência de ovulações duplas nos grupos I e II foi de, respectivamente, 32,7% (34/104) versus 30,8% (32/ 104). Ambos os grupos obtiveram incidência semelhante de ovulações triplas (1,9% - 2/104). Apenas uma ovulação quádrupla (1,0% - 1/104) foi detectada, no grupo controle. A incidência de duplas e múltiplas ovulações foi similar entre os grupos (p > 0,05). Pelo fato das éguas da raça Campolina apresentarem, fisiologicamente, considerável incidência de ovulações duplas e múltiplas, é possível que a administração de hCG não tenha influenciado estes padrões ovulatórios.

The human chorionic gonadotrophin (hCG) has been routinely used in the equine species to induce ovulations for more than four decades. The incidence of multiple ovulations in horses is variable, being double ovulations a common occurrence in some Brazilian breeds, such as Brasileiro de Hipismo and Campolina. The aim of this work was to evaluate the role of hCG administration to increase, in Campolina mares, the incidence of double and multiple ovulations, which are desirable in embryo transfer programs. One hundred and four (104) mares had their estrous cycles recorded through rectal palpation and ultrasonographic evaluation during the breeding season of 2003 - 2004, in a total of two hundred and eight (208) cycles (two cycles per mare). Animals were allocated in two groups, with fifty two (52) horses each. In Group I mares, once one or more = 35 mm follicles and grade 2 uterine edema were present, 2.500 IU of hCG were intravenously administered. The untreated mares in Group II served as control. The Chi-Square test was used to analyze obtained results. The incidence of double ovulations in groups I and II was, respectively, of 32.7% (34/104) versus 30.8% (32/104). The incidence of triple ovulations was low in both groups, of 1.9% (2/104). Only once in the control group (1.0% - 1/104) was a quadruple ovulation detected. There was no difference in the incidence of double and multiple ovulations between both groups (p > 0.05). Possibly, hCG administration did not influence ovulation patterns in this work due to the fact that Campolina breed mares physiologically show a considerable incidence of double and multiple ovulations.

The J-Tip Needle-Free Injection System in controlled ovarian hyperstimulation in in vitro fertilization: a pilot study.

OBJECTIVE: To evaluate the use of a novel needle-free system (J-Tip) in the administration of gonadotropins for controlled ovarian hyperstimulation (COH) in IVF. DESIGN: An open-label, single-center, pilot study. SETTING: Assisted conception unit of a university hospital. PATIENT(S): Twenty patients undergoing COH over a 3-month period. INTERVENTION(S): COH was carried out using a fixed dose of rFSH administered via the J-Tip System in a GnRH antagonist cycle. MAIN OUTCOME MEASURE(S): The primary endpoint was the mean number of oocytes collected per patient, and secondary endpoints were incidence of technically correct injections, clinical pregnancy, and cancellation rates. Patient diaries were kept throughout the study. RESULT(S): Sixteen patients completed the trial, four of whom became pregnant, with a high overall satisfaction rate. CONCLUSION(S): This is the first report of the use of the novel J-Tip Needle-Free Injection System for administration of gonadotropins in IVF with successful ovarian stimulation and achievement of pregnancies. This report indicates that this technique is associated with minimal pain and high patient acceptability. Large-scale multicenter studies are required to examine the reproducibility of these results and the J-Tip's cost-effectiveness as well as to compare the J-tip System with conventional needle-wise administration for COH before its introduction into routine IVF practice.

New advances in ovulation induction.

PURPOSE OF REVIEW: To review recent advances in ovulation induction. RECENT FINDINGS: Aromatase inhibitors can replace clomiphene citrate as ovulation-inducing substances. The most widely used aromatase inhibitor for this purpose is letrozole and the optimal dose is 5 mg daily for 5 days. Compared to clomiphene citrate, it is associated with a thicker endometrium and a better pregnancy rate. It is as effective as gonadotropin but yet less expensive. The overall rates of congenital malformation among newborns conceived after infertility treatment with letrozole or clomiphene citrate are similar. When letrozole is combined with gonadotropin, it leads to lower gonadotropin requirements with pregnancy rates comparable to gonadotropin treatment alone. Another promising aromatase inhibitor is anastrazole. Recent evidence suggests that luteinizing hormone activity in human menopausal gonadotropin modifies follicular development so that fewer intermediate-sized follicles develop. Compared to the use of follicular stimulating hormone only, human menopausal gonadotropin is associated with less ovarian hyperstimulation. SUMMARY: Aromatase inhibitors are alternative drugs to clomiphene or gonadotropin for ovulation induction or superovulation.

A retrospective comparison of clinical outcomes and satisfaction using reconstituted recombinant gonadotropins (rFSH) or cartridge rFSH with a pen device in donor oocyte cycles.

BACKGROUND: Use of recombinant follicle stimulating hormone (rFSH) in a cartridge pen device offers obvious benefits for donor oocyte cycles including the administration of fewer and more patient-friendly injectable medications. METHODS: In a University-based IVF program, a total of 98 oocyte donor cycles using rFSH either reconstituted or as a pen device given to 118 recipients (eight split cycles) were retrospectively reviewed. Following discontinuation of oral contraceptive, controlled ovarian hyperstimulation was begun using either reconstituted rFSH (n = 19) or rFSH with a cartridge pen device (n = 79) (150-300 IU qd). GnRH-antagonists (Ganirelix, Organon) and an additional 75 IU of rFSH/day were begun when lead follicles were 13-14 mm in greatest diameter. The primary endpoints analyzed included cycle stimulation characteristics for each donor group and donor medication tolerance assessment with respect to each rFSH formulation, while secondary outcome measures included clinical pregnancy and implantation rates. RESULTS: Oocyte donors using the pen required significantly less rFSH (2734 IU vs. 3276 IU, p < 0.05) and scored significantly higher medication tolerance scores (3.9 +/- 0.4 vs. 3.1 +/- 0.6, p < 0.05). No other differences in cycle stimulation for oocyte donors and clinical outcomes for recipients were seen including pregnancy rates (pen, 77% vs. reconstituted, 55%, p - NS) and clinical pregnancy rates (61% vs. 45%, p - NS). However, significantly greater implantation rates (57% vs. 31%, p < 0.01) occurred in the pen group. CONCLUSION: Compared to reconstituted formulations, the pen device results in lower gonadotropin requirements and provides a simplified dosing method with better tolerance.

Applicability of a progesterone-based timed artificilal insemination protocol after follicular fluid aspiration using the ovum pick-up technique in suckled beef cows.

We conducted a progesterone-based timed AI protocol after follicular fluid aspiration using the ovum pick-up (OPU) technique to examine its applicability to the suckled beef cow. A total of 19 beef cows were randomly allocated to one of the following three groups based on the number of days postpartum: 13 to 60 days (Group A: suckled; early postpartum period, n=9), 61 to 150 days (Group B: suckled; mid postpartum period, n=6), or 151 to 281 days (Group C: non-suckled; prolonged open period, n=4) postpartum. These cows were treated with follicular fluid aspiration and insertion of a progesterone-releasing intravaginal device (PRID) on day 0. The PRID was removed and 500 microg of cloprostenol was intramuscularly administered on day 7. A dose (100 microg) of fertirelin acetate was injected intramuscularly 48 hours later, and this was followed by a timed AI (TAI) after another 18 hours (day 10). Serum samples were taken on days 0, 7, 9, 10, 12, 17, 24 and 31 for determination of the estradiol-17beta (E(2)) and progesterone concentrations. Pregnancy diagnosis was made by rectal palpation approximately 60 days after TAI. There was no significant difference in the peripheral E(2) concentrations among the three groups during the period of the hormonal treatment. The average progesterone concentrations in Group A on day 17 were significantly higher than those in Group B and exceeded 1.0 ng/ml on day 17 and thereafter. There was no significant difference in the numbers of collected immature oocytes among the three groups. The pregnancy rates in Groups A, B, and C were 77.8% (7/9), 83.3% (5/6) and 50.0% (2/4), respectively. In conclusion, this timed AI protocol is applicable to suckled beef cows within the period of 60 days postpartum.

A pen injection device for self-administration of recombinant follicle-stimulating hormone for fertility treatments.

A pen injection device modeled on the insulin pen used by diabetic patients has been introduced to deliver recombinant follicle-stimulating hormone to women undergoing controlled ovarian stimulation for in vitro fertilization or other forms of assisted reproductive technology. The pen device makes it easier and less painful for women to self-administer daily injections. The high precision and accuracy of the device enables physicians to fine-tune dosage. The woman simply inserts the multidose cartridge into the Puregon (Follistim) Pen, attaches a BD Micro-Fine Pen Needle, selects the prescribed dose on the dial at the base of the pen, inserts the needle subcutaneously and pushes the injection button to administer the injection. A fresh needle is used for each injection.

[A murine model of polycystic ovaries: its use in the evaluation of effects of endoscopic ovulation induction]. / Un modelo murino de síndrome de ovarios poliquísticos: su utilidad para evaluar los efectos de la inducción endoscópica de la ovulación.

The objective was to evaluate the effect of the endoscopic treatment of the polycystic ovary syndrome (PCOS) in a murine model induced with depot estrogen. Three groups with PCOS were studied: group 1 (n = 22) evaluated exclusively using laparoscopy; group 2 (n = 11) one fulguration on both ovaries was performed during laparoscopy; and group 3 (n = 10) three fulgurations were performed. One month after laparoscopy the animal were sacrificed and was carried surgical microscopic examination of the intraabdominal organs, moreover histological evaluation of the gonads was practiced. All the animals showed PCOS. No adhesions were observed in the animals of group 1, while the frequency of adhesion in group 2 was 36.3%, 18.1% of the animals of group 2 showed gonadal atrophy. The frequency of adhesions in the group 3 was 66.6%. The adhesion score was significantly higher in groups 2 and 3 than in group 1. Is concluded that the use of estrogen is useful to induce PCOS in animal models. The procedure can be employed to study the effects of the surgical induction of ovulation, it's utility in other conditions seems promissary.

Un modelo murino de síndrome de ovarios poliquísticos: su utilidad para evaluar los efectos de la inducción endoscópica de la ovulación / A murine model of polycystic ovary syndrome: its utility to evaluate the effects of endoscopic induction of ovulation

El objetivo fue evaluar el efecto del tratamiento endóscopico del síndrome de ovarios poliquísticos (SOP) en un modelo murino inducido con estrógeno de depósito. Se estudiaron tres grupos de ratas con SOP: grupo 1 (n=22) evaluadas exclusivamente por laparoscopia; grupo 2 (n=11) fue efectuada una fulguración en cada ovario durante el procedimiento endoscópico; y grupo 3 (n=10) con tres fulguraciones en cada ovario. Un mes después de la cirugía los animales fueron sacrificados y se realizó estudio de los órganos intraabdominales mediante microscopio quirúrgico y además se efectuó evaluación histológica de las gónadas. Todos los animales tuvieron SOP. Los del grupo 1 no desarrollaron adherencias, mientras que los del grupo 2 las presentaron en 36.6 por ciento de los casos y hubo atrofia gonadal en 18.1 por ciento. El 66.6 por ciento de las ratas del grupo 3 tuvieron adherencias cuando se compararon los grupos 2 y 3 con el grupo 1. Se concluye que el uso de estógeno de depósito es útil para la producción de SOP en animales de experimentación. El procedimiento puede emplearse para estudiar los efectos de la inducción quirúrgica de la ovulación, su utilización en otras condiciones tambien parece ser promisorio

Evaluación del factor cervical en la mujer con inducción de la ovulación / Evaluation of cervical factor in women with ovulation induction

Se estudiaron 66 pacientes que acudieron por esterilidad a quienes de les realizó prueba de penetración espermática poscoito (PPE) con el fin de valorar el efecto de los inductores de la ovulación en la calidad del moco cervical y la penetración espermática. Fueron divididas en tres grupos: 1) 28 mujeres con evidencias de ovulación espontánea (grupo testigo), 2) 26 pacientes a las cuales se les indujo ovulación con citrato de clomifeno (CC) y 3) 12 pacientes en quienes se indujo ovulación con menotropinas. Los resultados mostraron que el CC tiene un efecto adverso sobre el moco cervical (p< 0.001), mientras que en las pacientes tratadas con menotropinas la calidad del moco cervical no se alteró. La penetración espermática en las pacientes con CC mostró una tendencia a valores menos que en las mujeres del grupo testigo, pero fue significativamente menor que en las pacientes estimuladas con menotropinas (p< 0.05). Estos resultados ponen de manifiesto el efecto adverso del CC y el efecto benéfico de las gonadotropinas sobre el moco cervical y la penetración espermática

Inducción de la ovulación / Inductions of ovulation

El citrato de clomifeno es el principal inductor de la ovulación; su función estrogénica débil actúa por competencia con el estradiol endógeno. La bromocriptina es otro compuesto que induce la ovulación en mujeres con hiperprolactinemia puesto que las concentraciones altas de prolactina interfieren con la descarga cíclica normal de gonadotrofinas. La gonadotrofinas per se utilizan en los casos de infertilidad anovulatoria en mujeres en quienes no se logró la ovulación con los dos compuestos anteriores o en quienes reaccionan con efectos adversos a ellos. La hormona liberadora de gonadotrofina se usa en pacientes con amenorrea de origen hipotalámico

Advances in induction of ovulation.

The emphasis of this review is placed on the treatment of clomiphene-resistant women with polycystic ovary syndrome (PCOS) or with hypogonadotropic hypogonadism. There has been an increasing awareness of the need to avoid the consequences of multiple folliculogenesis, and this is reflected in the more widespread use of low-dose regimens for induction of ovulation, particularly in PCOS. The past 12 months have seen the first reports of the clinical applications of recombinant human follicle-stimulating hormone (FSH), and there is an intriguing suggestion that long-acting opiate agonists may have a part to play in the management of anovulation of hypothalamic origin.