Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients.
Hum Reprod
; 12(11): 2359-65, 1997 Nov.
Article
en En
| MEDLINE
| ID: mdl-9436663
ABSTRACT
PIP: Presented is a protocol that is effective in improving in vitro fertilization (IVF) outcome in women with a tendency for a high response to gonadotrophin therapy. High responders to exogenous gonadotrophin therapy show recruitment of large numbers of follicles, rapid estradiol responses, and a significant cycle cancellation rate due to the potential risk of hyperstimulation during IVF-embryo transfer attempts. Women with polycystic ovarian syndrome are especially sensitive to exogenous gonadotrophin therapy. The protocol entails 25 days of oral contraceptive (OC) use, followed by 1 mg/day of subcutaneous leuprolide acetate overlapped with the final 5 days of OC therapy. On the third day of withdrawal bleeding, gonadotrophin stimulation is initiated through either human menopausal gonadotrophins or purified urinary follicle-stimulating hormone (150 IU/day). This approach permits normalization of the luteinizing hormone/follicle-stimulating hormone ratio and reduces ovarian androgen concentrations, while circumventing the initial gonadotrophin flare response. This protocol was tested in a retrospective review (1990-94) of 99 cycles from 73 high-responder women treated at a US infertility center. There were only 13 cancellations (13.1%) prior to embryo transfer. The clinical and ongoing pregnancy rates per initiated cycle were 46.5% and 40.4%, respectively. Only 8 women experienced ovarian hyperstimulation syndrome after treatment. Among women who had undergone previous IVF embryo transfer cycles at the center, the present regimen was associated with significant improvements in oocyte fertilization rates, embryo implantation rates, and pregnancy rates.
Palabras clave
Americas; Biology; Clinical Research; Contraception; Contraceptive Methods--therapeutic use; Demographic Factors; Developed Countries; Endocrine System; Family Planning; Fertility; Fertility Measurements; Fertilization; Follicle Stimulating Hormone; Gonadotropins; Gonadotropins, Pituitary; Hormones; In Vitro; Infertility; Luteinizing Hormone; North America; Northern America; Oral Contraceptives--therapeutic use; Physiology; Population; Population Dynamics; Pregnancy Rate; Reproduction; Research Methodology; Research Report; Retrospective Studies; Studies; United States
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Banco de datos:
MEDLINE
Asunto principal:
Síndrome del Ovario Poliquístico
/
Fertilización In Vitro
/
Hormona Liberadora de Gonadotropina
/
Leuprolida
/
Anticonceptivos Orales
/
Transferencia de Embrión
Tipo de estudio:
Guideline
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Año:
1997
Tipo del documento:
Article