ABSTRACT
We report a case of a fetus diagnosed with micro-retrognathism at routine ultrasound examination in the 22nd week of gestation. The diagnosis of Pierre-Robin syndrome was made postnatally. The possible differential diagnoses and the main complications of retrognathism are reviewed.
Subject(s)
Pierre Robin Syndrome/diagnosis , Adult , Chromosome Inversion , Chromosomes, Human, Pair 9 , Diagnosis, Differential , Female , Humans , Infant, Newborn , Karyotyping , Male , Pierre Robin Syndrome/genetics , Pregnancy , Ultrasonography, PrenatalABSTRACT
In the GnRH-antagonist multiple-dose protocol, the LH level retrieved from a single measurement during ovarian stimulation and concomitant GnRH-antagonist administration can vary according to [1] the time point of sampling with respect to the GnRH-antagonist injection and [2] episodic changes in circulating LH concentration due to the pulsatile release of LH from the pituitary gland. To exemplify the size of pharmacodynamic effect of a single 0.25-mg cetrorelix administration on LH concentration profile and pulsatility, we measured endogenous LH levels every 15 minutes from 8 hours before the first cetrorelix administration until 24 hours thereafter on ovarian stimulation day 6 and 7 in a single patient.
Subject(s)
Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Hormone Antagonists/therapeutic use , Luteinizing Hormone/blood , Ovulation Induction , Adult , Dose-Response Relationship, Drug , Female , Gonadotropin-Releasing Hormone/administration & dosage , Gonadotropin-Releasing Hormone/therapeutic use , Hormone Antagonists/administration & dosage , Humans , Osmolar Concentration , Prospective Studies , Time FactorsABSTRACT
High hopes accompanied the release of gonadotrophin-releasing hormone (GnRH) antagonists onto the market at the end of the last millennium. Today, it must be admitted that not all of these hopes have been realized. According to large meta-analyses, treatment time for ovarian stimulation could be significantly shortened, and the incidence of severe ovarian hyperstimulation syndrome (OHSS) could also be reduced. However, the achieved clinical pregnancy rates seem not to be equivalent to those obtained after ovarian stimulation using GnRH agonists in the so-called long protocol. Very recent studies have demonstrated that oversuppression of LH after initiating GnRH antagonist administration seems not to be responsible for that observation. Moreover, supplementation with recombinant LH does not increase success rates. However, an analysis based on the data of the German IVF registry (DIR), scrutinizing more than 1800 cycles in so-called ideal patients (age < 35 years, first treatment cycle, pure tubal infertility, only classical IVF), did not demonstrate any differences in pregnancy rates between GnRH antagonists and GnRH agonists. These data seem to indicate that GnRH antagonists should be used as 'first choice treatment' in ovarian stimulation.