GnRH antagonist ganirelix prevents premature luteinization in IUI cycles: rationale for its use.

This study evaluated the efficacy of a gonadotrophin-releasing hormone antagonist (GnRHa) to prevent premature luteinization (PL) and examined its impact on intrauterine insemination (IUI) cycle outcome. A total of 662 patients who were undergoing IUI were evaluated. Ovarian stimulation was started on day 3 with recombinant (r)FSH, followed by the GnRHa and recombinant human chorionic gonadotrophin (rHCG). The overall incidence of PL was 11.5%. In patients with and without PL, the pregnancy rates (PR) were 22.4 (17/76) and 17.7% (104/586) respectively. Patients with PL were divided into two groups: (i) those with increased serum progesterone [PR was 10.7% (3/28) in this group]; and (ii) patients with elevated serum LH but normal progesterone concentrations [PR was 29.2% (14/48) in this group]. Patients in the first group who did not become pregnant (n = 22) were administered GnRHa in a second IUI cycle, and the PR was 18.1%; however, some patients (n = 6; 27.3%) in this group still had high serum progesterone concentrations. In the second group, patients (n = 26) with elevated serum LH in the previous cycle were administered GnRHa in another IUI and the PR was 23.1%. Use of a GnRHa in patients with PL who have had a previous unsuccessful IUI may be an alternative in future attempts.

Extended embryo culture to increase implantation rate.

Multiple pregnancies are a serious adverse event of IVF treatment. Several strategies have been developed to improve embryo selection and embryo developmental potential to increase pregnancy rates without increasing the risk of multiple pregnancies. The only way to effectively solve this problem is to reduce the number of embryos transferred to one. The introduction of extended embryo culture has provided IVF programmes with a valuable tool to select more accurately those embryos with a higher implantation potential. The concept of single embryo transfer presents a clinical dilemma with seemingly opposing sides: one seeking to maintain acceptable pregnancy rates and the other seeking to reduce the number of twin births or high order multiple pregnancies. The present review addresses the potential benefits and drawbacks of blastocyst transfer.

Extended embryo culture to increase implantation rate.

Multiple pregnancies are a serious adverse event of IVF treatment. Several strategies have been developed to improve embryo selection and embryo developmental potential to increase pregnancy rates without increasing the risk of multiple pregnancies. The only way to effectively solve this problem is to reduce the number of embryos transferred to one. The introduction of extended embryo culture has provided IVF programmes with a valuable tool to select more accurately those embryos with a higher implantation potential. The concept of single embryo transfer presents a clinical dilemma with seemingly opposing sides: one seeking to maintain acceptable pregnancy rates and the other seeking to reduce the number of twin births or high order multiple pregnancies. The present review addresses the potential benefits and drawbacks of blastocyst transfer.

Medical treatment of endometriosis.

The medical treatment of endometriosis is a critical aspect of the therapeutic approach to this disease. This review will present an overview of current literature about the medical treatment of endometriosis, without referring to the surgical treatment or a combination of both. The main purpose of the current medical treatment of endometriosis is to create an amenorrheic state, in other words, to create a hypoestrogenic environment by suppressing estrogen secretion of the ovary. Current research has focused upon medications designed to attack specific aspects of the development and maintenance of endometriosis. This includes progesterone receptor modulators, gonadotropin releasing hormone (GnRH) analogs, aromatase inhibitors and, tumor necrosis factor alpha (TNFalpha) inhibitors, angiogenesis inhibitors, matrix metalloproteinase inhibitors and estrogen receptor beta agonists like inmunomodulators. These drugs show decreased spreading of lesions and reduced disease related symptoms. Medical treatment is moderately effective in reducing pain but ineffective in improving fertility; a combination of medical treatment with assisted reproductive technology may be beneficial in improving fertility.