No abstract available.
Female ; Ovulation Induction* ; Ovulation*

The authors studied on 242 infertile cases due to an ovulation in 296 cycles of treatment by FSH-HCG from 1995 to 1997. The pregnancy rate is 28,51% of cases and 23,31% of cycles. The rate of spontaneous abortion plus embryos death in utero is high 52,7%. The rate of ovarian hyperstimulation is 8,45%. The monitoring of ovarian function by ultrasound and serum estradiol level is very important to prevent the risk of severe hyperstimulation. It is difficult to decrease the rate of abortion and embryo death in utero
Ovulation Induction ; Abortion, Spontaneous

No abstract available.
Female ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction* ; Ovulation*

No abstract available.
Calcium* ; Estrogens* ; Female ; Metabolism* ; Ovulation Induction* ; Ovulation*

No abstract available.
Female ; Growth Hormone* ; Ovulation Induction* ; Ovulation*

Unlike the GnRH agonists, which have been routinely used in ovarian stimulation protocols for almost 20 years, the GnRH-antagonist acts via a dose-dependent competetive blockade of the pituitary GnRH receptors. This results in an immediate suppression of gonadotrophin secretion (in particular LH) from the anterior pituitary. Despite the new advantages of this new class of substances, the controversial discussion about the influence of the antagonist of the implantation and embryo quality has been ongoing for the last few years. New data from recent meta analysis have demonstrated that the clinical pregnancy rate per cycle is equivalent between antagonist protocols, however there is a sugnificant reduction in the amount of FSH used and the incidence of OHSS. Recently, flexible protocols where the GnRH antagonist is applied according to leading follicle size rather than a fixed of stimulation have been developed in order to prevent a premature LH surge. A recent meta-analysis of four randomised trials comparing fixed vs flexible starting day for the GnRH antagonist concluded there was no statistically significant difference in pregnancy rates, but a significant reduction in the amount of FSH utilized in favour of the flexible protocol. A series of studies have however raised concern about late administration of the GnRH antagonist, as used in a flexible protocol. In the three studies, the implantation and pregnancy rates were higher when the antagonist was initiated on a fixed day (stimulation day 6) compared to administration in a flexible protocol according to follicle size (-15mm). Whilst Kolibianakis, et al. reported no difference in overall pregnancy rate in flexible over fixed day antagonist administration, the implantation rate was lower in the flexible protocol, when there were no follicles of -15mm on the stimulation day 6. In this group, higher concentrations of LH and oestradiol were observed to antagonist administration. In a second study, Kolibianakis, et al reported that profound suppression of LH after GnRH antagonist suppression was associated with a significantly higher ongoing pregnancy rate. They argued that exposure of the genital tract/oocyte to LH may adversely affect the implantation rate, mainly by altering endometrial receptivity. One issue here that ma have complicated the interpretation of the results is the very late administration of the GnRH antagonist (-15mm). It is generally recommended that the antagonist should administered when the leading follicle is 14mm at he very latest. Co-treatment with oral contraceptive pill (OCP) programming can also be utilized with GnRH antagonists in order to facilitate scheduling the start of FSH therapy, rather than waiting for the patient to have spontaneous menses. There are now a number of studies reporting the use of OCP pill programming with either daily 0.25mg or single dose 3mg Cetrotide in routine ART and also poor responder patients. Future studies in this area are needed to elucidate the optimal preparation protocol in GnRH antagonist cycles. However, the data that are emerging seem to support that previous cycle preparation can make a clinical contribution to the outcome of the antagonist treatment cycle.
GONADOTROPIN-RELEASING HORMONE ; OVULATION INDUCTION

OBJECTIVETo study the effect of Chinese medical herbs for Shen tonifying, blood nourishing and activating (CMHSTBNA) on the cycle of controlled ovarian hyperstimulation (COH) of assisted reproductive technique (ART).

METHODSA large sample randomized control trial was performed. Infertility women patients, younger than 42 years (infertility due to tubal factor and/or male factor) were randomly assigned to the CMHSTBNA intervention group (abbreviated as the treated group) and the control group, 184 cases in each group. All underwent COH. Those in the treated group received assist therapy of CMHSTBNA from the menstrual period day 2 -3 of COH to the day of oocytes retrieved. The serum hormone level [including estrogen (E2), progesterone(P), luteal hormone (LH) on the day of human chorionic gonadotrophin (hCG) administration], the medication days and dosage of gonadotropin (Gn), the number of oocytes retrieved, the fertilization rate, and the good-quality embryo rate were observed and compared with the control group.

RESULTSThe endometrial thickness on the day of oocytes retrieved was 10.85 +/- 1.63 mm in the treated group, larger than that in the control group (10.50 +/- 1.49 mm) (P <0.05). The good-quality embryo rate and the frozen rate were 48. 9% and 39. 7% respectively in the treated group, superior to those of the control group (45. 4% and 35. 8% respectively), showing statistical difference (P < 0.05). On the day of hCG administration, favorable tendency was shown in the serum levels of estradial (E2), progesterone (P), luteinizing hormone (LH), the medication days and dosage of Gn, the number of oocytes retrieved, the fertilization rate, and the cleavage rate, showing no statistical difference when compared with the control group (P >0.05).

CONCLUSIONThe combined application of CMHSTBNA and gonado-trophic hormones in COH cycle could elevate the embryo quality, improve the endometrial state, thus laying foundation for successful in vitro fertilization/intracytoplasmic sperm embryo transfer.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; drug therapy ; Ovulation Induction ; methods ; Pregnancy ; Pregnancy Rate ; Superovulation ; drug effects

No abstract available.
Calcium* ; Estrogens* ; Female ; Humans ; Hypogonadism* ; Metabolism* ; Ovulation Induction* ; Ovulation*

OBJECTIVE: The aim of this study was to investigate the impact of pretreatment with transdermal estradiol (E₂) compared to oral contraceptive pills (OCPs) on controlled ovarian stimulation (COS) response in normal responders undergoing fresh in vitro fertilization (IVF)-embryo transfer (ET) cycles. METHODS: A retrospective cohort study was performed of normal responders undergoing fresh IVF-ET cycles who received pretreatment with transdermal E₂ versus OCPs prior to fresh IVF-ET. The total days of ovarian stimulation, total dosage of gonadotropins, total number of oocytes, and mature oocytes retrieved were noted. Pregnancy outcomes after ET were also recorded. RESULTS: A total of 2,092 patients met the inclusion criteria: 1,057 and 1,035 patients in the transdermal E₂ and OCP groups, respectively. Patients in the OCP group had a longer duration of COS (10.7±1.63 days, p<0.01) than the E₂ group (9.92±1.94 days). Patients in the OCP group also required higher cumulative doses of gonadotropins (2,657.3±1,187.9 IU) than those in the E₂ group (2,550.1±1,270.2 IU, p=0.002). No statistically significant differences were found in the total and mature oocytes retrieved or in the rates of biochemical pregnancy, clinical pregnancy, spontaneous miscarriage, and live birth between the groups. CONCLUSION: Our findings suggest that compared to OCPs, pretreatment with transdermal E₂ is associated with a shorter duration of ovarian stimulation and lower gonadotropin utilization, without compromising the oocyte yield or pregnancy outcomes in normal-responder patients undergoing fresh IVF.
Abortion, Spontaneous ; Cohort Studies ; Contraceptives, Oral, Combined ; Estradiol* ; Female ; Fertilization in Vitro* ; Gonadotropins ; Humans ; In Vitro Techniques* ; Live Birth ; Oocytes ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Reproductive Techniques, Assisted ; Retrospective Studies ; Superovulation ; Transdermal Patch

OBJECTIVETo evaluate the influence of superovulation by GnRHa protocol and pregnant mare's serum gonadotropin (PMSG) alone on the expression of estrogen receptor (ER), progesterone receptor (PR) and leukemia inhibitory factor (LIF) mRNA on endometrium.

METHODSForty-five female ICR mice were randomly allocated into 3 groups:(1) GnRHa+PMSG group: alarelin was give first for desensitizing the pituitary, then superovulation with PMSG; (2) PMSG group: mice were injected with PMSG only; (3) Natural cycle group: mice were given with same volume of saline. Endometrium samples were taken at 48 hours after given hCG or ovulation (control group). ER and PR in glandular cells were detected with SP immunohistochemistry semiquantitatively. Expression of LIF mRNA on endometrium was detected with reverse transcriptase-polymerase chain reaction (RT-PCR) analysis.

RESULTThe positive rate(%) and expression intense (AU) of ER and PR on glandular epithelium cells were significantly lower in GnRHa+PMSG group and PMSG group than those in natural cycle group (all P <0.01). The expression of LIF mRNA was significantly lower in GnRHa+PMSG group and PMSG group than that in natural cycle group (all P <0.01); but the expressions of ER, PR and LIF in GnRHa+PMSG group were higher than those in PMSG group.

CONCLUSIONThe protocol with GnRHa down regulates the expressions of ER, PR and the LIF mRNA on the mice of secretive phase endometrium, suggesting it may have an adverse effect on the endometrial receptivity in mice, but it may still be better than PMSG alone.

Animals ; Clinical Protocols ; Endometrium ; metabolism ; Female ; Gonadotropin-Releasing Hormone ; analogs & derivatives ; pharmacology ; Gonadotropins ; pharmacology ; Leukemia Inhibitory Factor ; metabolism ; Mice ; Mice, Inbred ICR ; Ovulation Induction ; methods ; RNA, Messenger ; metabolism ; Random Allocation ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Superovulation ; metabolism