Induction of final follicle maturation with a gonadotropin-releasing hormone agonist in women at risk of ovarian hyperstimulation syndrome undergoing gonadotropin stimulation and intrauterine insemination: proof-of-concept study.

OBJECTIVE: To evaluate the reproductive performance and safety of gonadotropin-stimulated intrauterine insemination (IUI) cycles in women at risk for ovarian hyperstimulation syndrome (OHSS) when final follicle maturation was induced using a gonadotropin-releasing hormone (GnRH) agonist. MATERIALS AND METHODS: Thirty-three women presenting with a history of cancelled ovarian stimulation for fear of OHSS, underwent repeat gonadotropin ovarian stimulation for IUI. They were all found to be at high-risk for OHSS once more, and were counseled to receive a GnRH agonist to trigger final follicle maturation before insemination. GnRH agonist trigger of ovulation (triptorelin) was given subcutaneously every 12 hours in three repeated doses: 0.3, 0.2, 0.2 mg, respectively. RESULTS: Induction with the agonist was associated with a 30.3% take-home pregnancy rate and 20% miscarriage rate. Multiple pregnancy rates were 26.7%. There were no reported cases of clinically significant moderate/severe ovarian hyperstimulation syndrome. CONCLUSIONS: The use of a GnRH agonist to trigger final follicle maturation in stimulated cycles of hyper responders was associated with a favorable reproductive outcome and no incidence of OHSS. The rate of multiple pregnancies nevertheless was found to be uncontrollably elevated, raising serious concerns regarding the safety of this protocol in standard clinical practice in the context of IUI.

Immunological testing and treatment in reproduction: frequency assessment of practice patterns at assisted reproduction clinics in the USA and Australia.

BACKGROUND: The roles that alloimmunity and autoimmunity may play in reproductive failure, including recurrent pregnancy loss and failed IVF, have not been clearly established. To help define practice patterns, we investigated what tests clinicians in the USA and Australia were offering, to which patients (diagnostic groups) the tests were recommended, and in what situations immunological/anticoagulation treatment was advised. METHODS: A five section survey was completed by senior physicians attending the annual national fertility society meetings in the USA and Australia. Results were tabulated and analysed. RESULTS: Antiphospholipid antibody testing was offered to patients with recurrent pregnancy loss by almost all physicians surveyed. Patients with previous failure of IVF were tested much less often. Other immune tests (embryotoxic assay, natural killer cells and leukocyte antibodies) were ordered by none of the Australian participants and approximately 25% of the American participants. The use of immunotherapy and anticoagulation therapy for patients who tested positive for various immunological tests was also evaluated for frequency of use and reported secondary complications. CONCLUSIONS: Large, well-structured studies examining the benefits of immunological evaluation and treatment are necessary before definite recommendations can be made.

Autoimmune factors in reproductive failure.

The present review highlights recent studies that investigated the possible influences of autoimmune factors in reproductive success or failure. These factors include antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, antisperm antibodies, and antiovarian antibodies. The majority of recent work has focused on these potential autoimmune factors; however, controversy still exists over indicated testing and treatment options. An association of antiphospholipid antibodies and recurrent pregnancy loss has been established, and treatment with subcutaneous heparin appears most efficacious. Other autoimmune factors are under investigation as markers of in-vitro fertilization failure. Limited data from treatment trials are presented.

The predictive value of five different urinary LH kits in detecting the LH surge in regularly menstruating women.

OBJECTIVES: To compare the predictive value of five different urinary LH kits at detecting the LH surge in regularly menstruating, reproductive-age women. DESIGN: Single center, prospective study. SETTING: University of Tennessee, Obstetrics and Gynecology department. INTERVENTION: Eleven regularly menstruating women collected urine daily from cycle days 10 through 18. Urinary LH was quantitated by radioimmunoassay. Transvaginal sonography was performed to document ovulation. Three different lots of Clear Plan Easy, OvuKit, OvuQuick, Sure Step, and EZ LH were evaluated. MAIN OUTCOME MEASURE: Correlation of urinary LH test kit results with urine LH value determined by RIA. RESULTS: Peak urinary LH values by RIA ranged from 13.5 mIU/mL to 73.0 mIU/mL. The lowest level detected as positive by LH kits ranged from 25.5 mIU/mL to 48.7 mIU/mL. Lot-to-lot variations were rare. Follicular collapse occurred within 24 hours of the urinary LH peak in 8 of 10 (80%) and by 48 hours in the remaining 2 subjects. CONCLUSIONS: The percentage of LH surges detected by urinary LH kits ranged from 50% to 100%. The lowest LH value detected as positive varied almost twofold between different kits. Manufacturers should indicate the detection limit of their kits in mIU/mL.