Infertile Women Undergoing Ovulation Induction Research Articles

The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination

In this study, we aimed to evaluate the effect of infertility duration and dominant follicle size measured on the day of human chorionic gonadotropin (HCG) administration on pregnancy rates in infertile women undergoing ovulation induction (OI) with gonadotropin (GND). A total of 352 patients aged 20 to 41 years who were diagnosed with unexplained infertility or polycystic ovary syndrome (PCOS) were included in this study. Patients with a history of multifollicular development or follicle stimulating hormone (FSH) value more than 12 IU/ml were excluded from the study. The demographic and clinical features of the patients were obtained from the patients’ files and hospital automation system and recorded for each woman. The demographic and clinical features of the patients were recorded. Patients were divided into two groups as live birth (group 1, n = 47) and non-live birth groups (group 2, n = 305). There were no statistically significant differences in regard to age, infertility type, follicle stimulating hormone (FSH) level, oestradiol (E2) level, antral follicle count (AFC), cycle characteristics, GND type, number of follicles, E2 level and endometrial thickness on HCG day, total GND dose, dominant follicle size (p > 0.05). Infertility duration in group 1 was 3.5 ± 2.1; in group 2, 4.7 ± 3.9 years. This difference was statistically significant (p = .014). According to this study, live birth rates after GND + IUIs(intrauterine insemination) were significantly affected by the duration of infertility. But the dominant follicle size and endometrial thickness measured on HCG day in GND and IUI cycles did not have a significant effect on pregnancy rates. IMPACT STATEMENT What is already known on the subject? It is thought that the timing of the ovarian triggering is vital for the success of intrauterine insemmination (IUI) treatment. What do the results of this study add? According to our results live birth rates after GND + IUIs were significantly affected by the duration of infertility. What are the implications of these findings for clinical practice and/or further research? It is determined that the duration of infertility is significant and patients should be encouraged to the treatment as soon as possible.

Deep Learning Based Two-Dimensional Ultrasound for Follicle Monitoring in Infertility Patients

Abstract Background: A two-dimensional (2D) ultrasound examination is the primary technique for follicle monitoring, but 2D ultrasound follicle monitoring has significant inter- and intra-observer variability in the measurement of follicle diameter. The aim of this study was to propose a novel deep learning-based automated model for accurate 2D ultrasound follicle monitoring and validate the reliability and repeatability in clinical practice. Methods: A prospective trial including 300 infertile women undergoing ovulation induction (single follicle cycles) or controlled ovarian hyperstimulation (multiple follicle cycles) was conducted in the reproductive center. After 2D ultrasound image acquisition, the mean diameter of each targeted follicle was measured using an automated model, experts, and a novice. Designating the expert assessment as the gold standard, the reliability and repeatability of the automated model for single and multiple follicle cycles were evaluated using the intraclass correlation coefficient and Bland-Altman plots. Results: A total of 228 and 1065 follicles from single and multiple follicle cycles, respectively, were included. The accurate recognition rate of follicle boundaries using the automated model was 0.931. The inter-observer variability of follicle mean diameter measurements in single and multiple follicle cycles were 0.970 and 0.984 for the automated model and experts, and 0.965 and 0.978 for a novice and experts, respectively. Bland-Altman plots showed that 95% limits of agreement for follicle diameter measurement between the automated model and experts (−2.02 to 2.39 mm and −0.68 to 1.50 mm) was lower than a novice and experts (−1.69 to 2.74 mm and −0.58 to 1.73 mm) for both single and multiple follicle cycles. The intraclass correlation (ICC) of follicle diameters ≥10 mm calculated by the automated model was significantly higher than follicle diameters <10 mm in multiple follicle cycles (0.834 vs. 0.609). There were no significant differences between the two groups in single follicle cycles (0.967 vs. 0.970). Conclusion: A deep learning-based automated model provides an accurate and fast approach for novices to improve the reliability and receptivity of 2D ultrasound follicle monitoring, especially in multiple follicle cycles and for follicles with a mean diameter ≥ 10 mm.

Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: A comparison of drugs

ObjectiveTo study the effectiveness of different ovulation induction protocols in infertile women with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI). DesignRetrospective cohort study. PatientsInfertile women with PCOS undergoing IUI had ovulation induced with clomiphene citrate (CC), letrozole, or gonadotropins. Main Outcome MeasureLive birth and multiple pregnancy rates. ResultsWe performed 1068 IUI cycles in 765 couples. Live birth rates were comparable in CC-stimulated cycles (13.9%), letrozole-stimulated cycles (13.5%, OR 0.96 [95% CI, 0.63, 1.47]), and gonadotropins-stimulated cycles (13.2%, OR 0.94[95% CI, 0.62, 1.43]). Multiple pregnancy rates were 8.3%, 4.1% (OR 0.47 [95% CI, 0.09, 2.42]), and 3.3% (OR 0.34 [95% CI, 0.07, 1.95]) in CC, letrozole and gonadotropins stimulated cycles, respectively.Compared to CC, letrozole generated more often mono-follicular growth (75.9% versus 67.0%; OR 1.55 [95% CI, 1.11, 2.15]) but not more often after gonadotropins (72.9%, OR 1.17 [95% CI, 0.82, 1.66]. Cycles with multi-follicular growth did not result in statistically higher live birth rates than cycles with mono-follicular growth (15.8% vs. 12.7%, OR 1.29 [95% CI 0.89, 1.89]), but more often in multiple pregnancies (15.5% versus 0.8%, OR 22.4 [95% CI, 2.8, 181.6]). ConclusionIn women with PCOS undergoing stimulated IUI, CC, letrozole and gonadotropins were equally effective and safe. Since multi-follicular growth increased the multiple pregnancy rates without increasing the overall live birth rate, ovulation induction would strictly aim for mono-follicular growth. Since letrozole had the highest mono-follicular growth rate, we recommend this drug as the treatment of first choice in infertile women undergoing ovulation induction and IUI.

Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET.

Objective:Pretreatment of myoinositol is a very new method that was evaluated in multiple small studies to manage poor ovarian response in assisted reproduction. This study was to determine the efficacy of myoinositol supplement in infertile women undergoing ovulation induction for intracytoplasmic sperm injection (ICSI) or in vitro fertilization embryo transfer (IVF-ET).Methods:A meta-analysis and systematic review of published articles evaluating the efficacy of myo-inositol in patients undergoing ovulation induction for ICSI or IVF-ET was performed.Results:Seven trials with 935 women were included. Myoinositol supplement was associated with significantly improved clinical pregnancy rate [95% confidence interval (CI), 1.04–1.96; P = .03] and abortion rate (95% CI, 0.08–0.50; P = .0006). Meanwhile, Grade 1 embryos proportion (95% CI, 1.10–2.74; P = .02), germinal vescicle and degenerated oocytes retrieved (95% CI, 0.11–0.86; P = .02), and total amount of ovulation drugs (95% CI, –591.69 to –210.39; P = .001) were also improved in favor of myo-inositol. There were no significant difference in total oocytes retrieved, MII stage oocytes retrieved, stimulation days, and E2 peak level.Conclusions:Myoinositol supplement increase clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. It may improve the quality of embryos, and reduce the unsuitable oocytes and required amount of stimulation drugs.

EFFECT OF INSULIN RESISTANCE ON THE OCCURRENCE OF PREGNANCY IN WOMEN TREATED EMPIRICALLY FOR UNEXPLAINED INFERTILITY.

The detrimental effects of hyperinsulinemia on human ovaries during follicular development process have been shown in various studies, particularly in women with polycystic ovary syndrome. To our knowledge there is no study regarding the effect of insulin resistance (IR) on the intrauterine insemination (IUI) success in women with unexplained infertility (UEI). To evaluate the effects of IR on the occurrence of pregnancy among infertile women undergoing ovulation induction (OI) with IUI for UEI. Prospective cohort study. 173 patients who met the criteria for UEI and under the age of 35 were included in this study. All women underwent OI with IUI and, subsequently, they were divided into two groups based on the presence of pregnancy. Data reviewed for analysis were demographic, clinical, and laboratory features. There were 37 (21.4%) cycles with pregnancy and 136 (78.6%) cycles without pregnancy. Median infertility duration was significantly lower in the pregnant group when compared with non-pregnants (p=0.018). The mean number of previous cycles per patient was also lower in this group (p=0.028). No significant differences were found between the groups in terms of other variables. Levels of insulin, fasting glucose and HOMA-IR were also similar between the two groups. IR calculated by using HOMA-IR index has no positive or negative effect on the occurrence of pregnancy in women undergoing OI therapy with IUI for UEI.

A comparison on the Intrauterine Insemination Outcomes of Infertile Women Undergoing Ovulation Induction with Clomiphene Citrate and rFSH

A comparison on the Intrauterine Insemination Outcomes of Infertile Women Undergoing Ovulation Induction with Clomiphene Citrate and rFSH

Quantitative insulin-sensitivity check index (QUICKI) predicts pregnancy outcomes in PCOS

Poor insulin sensitivity is associated with poor pregnancy outcomes. The optimal strategy to identify insulin sensitivity's association with pregnancy and live birth rates in infertile women undergoing ovulation induction has not been identified. In a randomized trial of ovulation induction in women with PCOS, we compared two validated surrogates (QUICKI and HOMA-IR) of insulin sensitivity and odds of pregnancy and live birth.

Body mass index–associated differences in response to ovulation induction with letrozole

To compare occurrence of pregnancy among obese (body mass index [BMI] ≥30) and nonobese (BMI <30), infertile women undergoing ovulation induction with the aromatase inhibitor letrozole followed by intrauterine insemination (IUI). Retrospective cohort study. Academic reproductive endocrinology and infertility clinic. Ninety women with a variety of infertility diagnoses. Letrozole (5 mg) on menstrual cycle days 3-7, followed by intrauterine insemination (IUI). Occurrence of pregnancy and pregnancy outcomes. Ninety women underwent 180 letrozole-IUI cycles. Conception of pregnancy occurred in 10.4% and 18.2% of the BMI <30 and BMI ≥30 groups, respectively. Using BMI as a continuous variable showed a pregnancy odds ratio of 1.093 (confidence interval 1.008-1.184) for each unit increase in BMI. Incidence of miscarriage, multiple births, number of mature follicles, and presence of LH surge were similar between groups. Our study of 90 women undergoing letrozole-IUI treatment showed greater likelihood of pregnancy in higher-BMI women, although the difference was not significant. Letrozole is an effective ovulation induction agent in higher-BMI women.

Comparison of the effect of tamoxifen on endometrial thickness in women with thin endometrium (

Infertile women undergoing ovulation induction (OI) with clomiphene citrate (CC) who have adequate follicular recruitment and an endometrial thickness of <7 mm as determined by transvaginal sonography in the late follicular phase were switched to tamoxifen for OI in a subsequent cycle. A comparison between the endometrial thickness on CC and tamoxifen was made with by paired analysis. For women undergoing OI with CC who have adequate follicular recruitment and thin endometrium (<7 mm), switching to tamoxifen in subsequent cycles improves endometrial thickness.

Is Infertility Treatment Linked to Breast Cancer Risk

Infertile women undergoing ovulation induction often are concerned about the risk for breast cancer. To assess both ovulatory infertility and its

Follicular response and pregnancy among infertile women undergoing ovulation induction and intrauterine insemination

Objective To determine the relationship between ovarian follicular response (number and diameter of follicles) to ovulation induction agents and pregnancy. Design Retrospective cohort study. Setting Hospital-based center of reproductive medicine. Patient(s) Three hundred twenty-two clinically diagnosed infertile couples undergoing 1,483 cycles of ovulation induction and IUI. Intervention(s) Oral and injectable fertility drugs were administered for 2–10 cycles; ultrasound follicular measurements were recorded around time of ovulation; hCG was administered when follicles were 18–20 mm or more in diameter; IUI was performed 36–40 hours after administration of hCG. Main outcome measure(s) A first positive pregnancy test as indicative for conception. Result(s) Women with follicular diameters ≥20 mm were less likely to become pregnant as compared to women with diameters between 15.00 and 19.99 mm (risk ratio [RR] = 0.58, 95% confidence interval [CI] = 0.35, 0.97). Women ≥30 years of age were half as likely to become pregnant as compared to women <30 years (RR = 0.51, 95% CI = 0.30, 0.85). Likelihood of pregnancy increased by 21% for each prior pregnancy (RR = 1.21, 95% CI = 1.00, 1.47). Conclusion(s) Maternal age, gravidity, and follicular diameters around the time of insemination are prognostic factors in the likelihood of pregnancy.

Urinary catechol estrogens in cycles stimulated by human menopausal gonadotropin

Catechol estrogens, estrogen metabolites of potential physiologic significance, were measured in infertile women undergoing ovulation induction with human menopausal gonadotropins. Urinary 2-hydroxyestrone (2-OH-E1) specimens were obtained from 12 women in one or more stimulated cycles. The actual time for the administration of human chorionic gonadotropin to induce ovulation was based on serial plasma estradiol (E2) specimens. A significant correlation between plasma E2 and urinary 2-OH-E1 was demonstrated, similar but more pronounced than that seen in normal cycling women. This confirms previous work that showed that 2-OH-E1 is the major urinary estrogen metabolite in the nonpregnant state and further suggests that urinary catechol estrogens are a useful index of ovarian function.