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1.
Hum Fertil (Camb) ; 9(3): 175-80, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17008270

RESUMEN

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication following ovarian stimulation for in vitro fertilization (IVF). Coasting is the practice whereby the gonadotrophins are withheld and the administration of human chorionic gonadotrophin (hCG) is delayed until serum oestradiol (E2) has decreased to what is considered to be a safe level, to prevent the onset of OHSS. This study aimed to assess the length of coasting on the reproductive outcome in women at risk of developing OHSS. Coasting was undertaken when the serum E2 concentrations were > or = 17000 pmol/L but < 21000 pmol/L. Daily E2 measurements were performed and hCG was administered when hormone levels decreased to < 17000 pmol/L. Eighty-one women who had their stimulation cycles coasted were grouped according to the number of coasting days. Severe OHSS occurred in one case, which represented 1.2% of patients who underwent coasting because of an increased risk of developing the syndrome. No difference was found between cycles coasted for 1 - 3 days and cycles coasted for > or = 4 days in terms of oocyte maturity, fertilization and embryo cleavage rates. Women in whom coasting lasted for > or = 4 days had significantly fewer oocytes retrieved (P < 0.05) and decreased implantation rate (P < 0.05) compared to those coasted for 1 - 3 days. Pregnancy rate/embryo transfer and live birth rate did not differ between groups. In conclusion, coasting appears to decrease the risk of OHSS without compromising the IVF cycle pregnancy outcome. Prolonged coasting is, however, associated with reduced implantation rates, perhaps due to the deleterious effects on the endometrium rather than the oocytes.


Asunto(s)
Fertilización In Vitro/efectos adversos , Fertilización In Vitro/métodos , Síndrome de Hiperestimulación Ovárica/prevención & control , Gonadotropina Coriónica/administración & dosificación , Protocolos Clínicos , Estradiol/sangre , Femenino , Hormona Liberadora de Gonadotropina/agonistas , Humanos , Menotropinas/administración & dosificación , Síndrome de Hiperestimulación Ovárica/etiología , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de Riesgo , Inyecciones de Esperma Intracitoplasmáticas/efectos adversos , Inyecciones de Esperma Intracitoplasmáticas/métodos , Factores de Tiempo
2.
Hum Fertil (Camb) ; 6(3): 116-21, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12960443

RESUMEN

This study analysed the live birth rates in 760 couples referred in 1994 to St Mary's Hospital, Manchester, a non-fee-paying National Health Service (NHS) centre, who had waited for up to 4 years for IVF treatment. These live birth rates were compared with those of 199 couples referred at a similar time to Manchester Fertility Services, a fee-paying unit, where they received IVF treatment shortly after referral. The waiting time was advantageous in that 17.8% (135 of 760) of the couples referred to St Mary's Hospital conceived without IVF treatment, 60% within one year of referral. However, the waiting time was detrimental to women aged 30-34 in whom treatment was delayed by 3-4 years. Only 26.8% (204 of 760) of couples originally referred eventually received NHS-funded IVF treatment at St Mary's. A waiting time not exceeding 18 months would allow most spontaneous conceptions and reduce the adverse effect of prolonged waiting on the take-up rate for treatment and on the chance of success in the older women.


Asunto(s)
Fertilización In Vitro , Fertilización , Resultado del Tratamiento , Adulto , Tasa de Natalidad , Femenino , Humanos , Infertilidad/terapia , Edad Materna , Embarazo , Factores de Tiempo
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