Methods Of Ovulation Induction Research Articles

Optimization of a protocol for fertilized egg production in Japanese eel using recombinant gonadotropins, LHRHa, pimozide, and 17α-hydroxyprogesterone

Recently, two types of Japanese eel recombinant gonadotropins (rGths), recombinant follicle-stimulating hormone (rFsh) and luteinizing hormone (rLh), have been successfully produced. However, the protocol for obtaining fertilized eggs using rGths has not yet been optimized. In this study, to establish a new protocol for obtaining fertilized eggs from Japanese eel, we decided to use rFsh as an inducer of vitellogenesis and focused on optimizing the final oocyte maturation (FOM) and ovulation induction method using rLh, 17α-hydroxyprogesterone (OHP), Lh-releasing hormone analog (LHRHa), and pimozide. Our findings indicates that OHP injection is crucial for stable ovulation induction. Quality evaluations revealed that the FOM and ovulation induction methods using LHRHa, pimozide, and OHP significantly improved the egg quality (fertility, hatchability, and larval survival) better than the methods using rLh and OHP (P < 0.05). Furthermore, effects of different doses of LHRHa and pimozide on egg quality were examined. We found that 0.5 mg/kg BW LHRHa, 10 mg/kg BW pimozide, and 2.0 mg/kg BW OHP injections was an effective and economical induction method, and this method was defined as the rGths method. When comparing the quality and quantity of eggs and larvae obtained by the rGths method with those obtained by the conventional method, the former displayed superior quality. In addition, the number of eggs, fertilized eggs, and normal larvae at 6 days post hatch was significantly higher in broodstock matured by the rGths method compared to the conventional method (P < 0.05). These results suggest that the new rGths method is a promising alternative for the artificial sexual maturation Japanese eel, potentially leading to a higher yield of larvae.

O-189 Letrozole-resistant PCOS: prevalence, further options and course of fertility treatment

Abstract Study question What is the prevalence of letrozole-resistance in infertile women with polycystic ovary syndrome (PCOS) and what is the course of clinical management for such women? Summary answer Even after 10 mg/day dose of letrozole, 2.7% women did not ovulate. Clomiphene citrate (CC) should be tried first in these women, followed by gonadotrophins What is known already Letrozole is the preferred drug for ovulation induction (OI) in infertility associated with PCOS because it results in better pregnancy and live birth rates than CC. Women not responding to conventional dose of letrozole, may require alternate regimens like two-step, higher and extended dose. But some women may remain refractory even to the maximum dose of letrozole. While CC-resistance and its management are well established, clinical management of women with PCOS resistant to the maximum dose of letrozole remains largely undocumented. Study design, size, duration A prospective observational study was conducted in a Fertility Centre between April 2018 and March 2023 after obtaining Institutional Ethics Committee approval and informed written consent from all the participants. Out of total 1851 women with PCOS and infertility, 1522 were included in the study, of which 50 were found to be resistant to letrozole. Participants/materials, setting, methods Infertile women with PCOS (defined by Rotterdam criteria), age 21-35 years, with patent fallopian tubes and normal semen reports of partner, who received no previous OI were recruited. Women who failed to ovulate (confirmed with transvaginal ultrasound) after 3 consecutive cycles of incremental (5, 7.5 and 10 mg/day) doses of letrozole were switched to CC. In case of CC-resistance, options of laparoscopic ovarian drilling (LOD) or gonadotrophins were offered. Clinical and pregnancy-associated parameters were assessed. Main results and the role of chance Out of 50 letrozole-resistant women, 19 (38%) ovulated after subsequent OI with CC, of which seven (36.8%) conceived and two (28.8%) had twin pregnancy. Out of 31 CC-resistant women, seven were lost to follow up. The singlet woman who opted for LOD did not have subsequent spontaneous ovulation and therefore, required gonadotrophins later on. All 24 women who received gonadotrophins ovulated. Most of them developed one (11, 45.83%) or two (12, 50%) follicles. However, one woman developed 10 follicles leading to ovarian hyperstimulation syndrome, for which the OI cycle was converted to in-vitro fertilization (IVF). With gonadotrophins, nine (37.5%) women conceived and one (11.1%) had triplet pregnancy that miscarried in the first trimester. The remaining 16 women who failed to conceive were offered three cycles of intrauterine insemination followed by IVF. The mean time to pregnancy from the start of treatment was 10.81 (±7.71) months. The live birth rate was similar (P = 0.0416) between gonadotrophins (6, 27.2%) and CC (5, 22.7%), Between CC-resistant and CC-responsive women, all clinical, biochemical and biophysical parameters were similar except the mean levels of luteinizing hormone, which were significantly higher in CC-resistant group (16.3 ±5.3 versus 13.2 ±4.7 mU/ml, P = 0.036). Limitations, reasons for caution The study was conducted in a single center and the results may be difficult to extrapolate on women belonging to other ethnicities. The sample size was small. Wider implications of the findings Some women with PCOS may not respond even to the maximum dose (10 mg/day) of letrozole. Correct identification of letrozole-resistance and choosing the subsequent appropriate methods of OI are of paramount importance in timely management of infertility in these couples. Trial registration number NA

Effects of Different Methods of Ovulation Induction on Sex Hormones in Serum, and Meat of Rabbit Does

Effects of Different Methods of Ovulation Induction on Sex Hormones in Serum, and Meat of Rabbit Does

Provision of fertility services to women in same-sex relationships at Catholic and non-Catholic clinics in the United States.

This study addressed deficient information on the provision of infertility care in obstetrics and gynecology clinics. We additionally evaluated the availability of these services based on clinic affiliations or stated sexual orientation. We performed a national cross-sectional "mystery caller" survey of 293 general obstetrics and gynecology clinics in 2017-2018. We matched clinics identified by web-based search engine in a 1:1 ratio by Catholic hospital affiliation, after determining number of clinics based on state-population densities. A standard call script included questions regarding provision of infertility services, ovulation induction methods, and information about the caller's sexual orientation. We performed descriptive frequencies and compared responses based on hospital affiliations. Of the 293 clinics included, 49% were affiliated with Catholic and 17% with academic hospitals. The majority offered infertility care (85%, 248/293), and of these 97% (240/248) offered ovulation induction. Only 3% (6/240) reported they would not provide to women in same-sex relationships. Most clinics not offering infertility evaluations (43/45, 96%) cited it was outside of their scope of care and of these 33% (15/45) did not provide information for self-referral. Clinics affiliated with academic (aOR 0.23) or Catholic (aOR 0.34) hospitals were less likely to provide evaluations. Those with academic affiliation were more likely to provide information for self-referral (aOR 19.2). Most general obstetrics and gynecology practices offered appointments for infertility evaluation and ovulation induction. Clinics rarely denied services to women reporting a same-sex partnership, regardless of hospital affiliation. These findings provide reassurance to same-sex couples seeking fertility care.

Trial design and protocol of randomized controlled trial comparing the efficacy of combined letrozole and clomiphene versus only letrozole as a method of ovulation induction in women with polycystic ovarian syndrome (CCLOP trial)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Both clomiphene (CC) and letrozole are commonly used oral ovulation induction agents, with different mechanism of action. Apart from letrozole or CC, options for ovulation induction in polycystic ovarian syndrome (PCOS) patients are limited and thus leaving the use of gonadotropin injections as the only option of ovulation induction in these patients. The objective of this study is to evaluate the efficacy of combined therapy of letrozole and CC compared to the use of letrozole alone to achieve ovulation in infertile women with PCOS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This will be a single-centre, double arm, triple-blind randomized controlled trial. The study was conducted after taking approval from institutional ethics committee and was prospectively registered with the clinical trials registry- India. Women were randomly assigned to receive a combination of 2.5 mg letrozole and placebo daily or a combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3–7 for one treatment cycle.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;If combination of clomiphene and letrozole is proved to be more efficacious than letrozole alone, there will be several breaks through advantages in the management of infertility. The novel method of ovulation induction with combined letrozole and clomiphene will bring down overall cost of infertility treatment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial registration:&lt;/strong&gt; The study is prospectively registered with the clinical trials registry- India CTRI/2020/09/028012.&lt;/p&gt;

Impact of peak serum estradiol levels on the outcomes of hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles

With the improvised ovulation induction methods coming up, FET (Frozen Embryo Transfer) has gained preference over fresh transfers. Several strategies have been devised for preparing the endometrium for FET, out of which the hormone replacement regimen (HRT) with exogenous estrogen and progesterone supplementation still remains the most popular one. There are different clinical protocols for the transfer of frozen-thawed embryos. However, there has always been a debate about the impact of hyperestrogenism on endometrial development and implantation, particularly when controlled ovarian hyperstimulation is used in conjunction with fresh embryo transfers. We conducted this study with an objective to investigate the impact of variable serum estradiol (E2) levels achieved in the late follicular phase on implantation and pregnancy outcomes of cryopreserved/thawed embryos transferred in programmed cycles with exogenous hormonal replacement.

Evaluating the role of endometrial colour Doppler dynamic tissue perfusion measurements in in vitro fertilisation success

The role of uterine receptivity and endometrial perfusion in in vitro fertilisation (IVF) remains unclear. In our prospective pilot study, we used a new dynamic tissue perfusion measurement method to evaluate this relationship in humans. A standard ovulation induction and embryo transfer method were applied to all the volunteers. On the day of embryo transfer, dynamic images of the uterus were recorded using colour Doppler ultrasound, and these images were uploaded onto PixelFlux Chameleon Software (GmbH, Münster, Germany). After determining the region of interest (ROI), the average velocity, intensity, and area values for all coloured pixels in the ROI, the tissue resistance index (RI) and the tissue pulsatility index were calculated. Endometrial thickness, morphology and dynamic endometrial perfusion parameters were compared between the clinically pregnant and non-pregnant groups. Endometrial thickness, morphology values and endometrial dynamic tissue perfusion measurements were similar between the groups. This study compared perfusion parameters between clinically pregnant and non-pregnant patients by accurately calculating endometrial tissue perfusion using standard software to establish its relationship with implantation success in IVF treatment. IMPACT STATEMENT What is already known about this subject? The relationship between IVF success, endometrial receptivity and perfusion is known. Clear valuations of endometrial receptivity require an endometrial biopsy which may cause endometrial damage to the actual IVF cycle. This problem has led researchers to conduct non-interventional studies. Studies have revealed the value of endometrial thickness, pattern and Doppler examination of endometrial uterine arteries in predicting the success of IVF treatment. What do the results of this study add? This prospective pilot study is the first one to use this programme in humans to evaluate uterine receptivity in IVF. Successful results can be obtained by using computer programmes in tissues where perfusion parameters cannot be measured using traditional colour Doppler ultrasonography. Revealing the relationship between tissue perfusion and IVF success will be more effective and accurate with the development of software technologies. What are the implications of these findings for clinical practice and/or further research? To increase the success of IVF treatment, current and new technological developments, as well as imaging methods should continue to be tested.

P–656 Examination of the clinical significance of the two-step ovulation induction method (DuoStim)

Abstract Study question Do culture results of eggs obtained by double stimulation (DuoStim), where eggs are collected twice in one cycle, differ from a conventional fertility drug method? Summary answer The culture results of eggs acquired via the DuoStim cycle versus those acquired via a widely used conventional fertility drug method did not differ significantly. What is known already For patients with reduced ovarian reserve, the random start method, in which ovarian stimulation can start at any time during the menstrual cycle, is being used. As the pituitary gland is suppressed by progesterone during the luteal phase, endogenous luteinizing hormone surges are less likely to occur and ovulation is more easily avoidable. Previous reports showed that ovarian stimulation during the follicular and luteal phases of the same menstrual cycle resulted in similar blastocyst formation rates with normal chromosome numbers, which seems to be time-consuming. The DuoStim method is considered useful in cases in which time is at a premium. Study design, size, duration Between June 2019–December 2020, 562 egg collection cycles were performed in women ≥36 years. Ovulation cycles were evaluated in the conventional ovulation induction cycle (Co) group and DuoStim cycle (DS) group (subclassified into D1 group [first egg collection in cycle] and D2 group [second egg collection]. Post-insemination culture results were evaluated. Participants/materials, setting, methods Participants were women ≥36 years. Infusion method was IVF, and blastocysts of Gardner classification 3BB or higher were designated as good blastocysts, and blastocysts of 3AA or higher were designated as the best blastocysts. Confirmation of the fetal sac was defined as clinical pregnancy for the single freeze-thaw blastocyst transplant cycle. Chi-square and t-tests were used for statistical analysis. P ≤ 0.05 indicated statistical significance. Main results and the role of chance The average number of eggs acquired per cycle was 6.9 in the Co group and 3.5 in the DS group, and the egg maturation rate was 88.0% in the Co group and 95.7% in the DS group, which showed significant differences. The 2PN rate, blastocyst arrival rate, and Day 5 good blastocyst arrival rate in the obtained mature eggs were 66.5%, 66.5%, and 38.3% in the Co group and 70.9%, 70.5%, and 34.4% in the DS group and were not significantly different. Similarly, when a comparative study was conducted between the D1 group and D2 group, rates were 67.5%, 69.0%, and 31.0% in the D1 group and 74.4%, 71.9%, and 37.5% in the D2 group, with no significant difference noted. Rates of clinical pregnancy and post-transplantation miscarriage were 41.1% and 17.8% in the Co group and 16.6% and 0% in the DS group, respectively, with no significant difference, although rates in the Co group tended to be better. Limitations, reasons for caution The fertilization method was evaluated only by IVF. The transplantation method was freeze-thaw embryo transfer by hormone replacement cycle, and the target age was 36 years or older. Wider implications of the findings: DuoStim, which increases the number of acquired eggs, is useful when eggs must be collected as soon as possible. Regarding the clinical pregnancy rate after transplantation, better results were obtained for eggs acquired by the conventional fertility method, but it was necessary to repeat the number of attempts. Trial registration number Not applicable

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Transvaginal Ultrasound Doppler

The study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Ovulation rate was taken as the gold standard for assessment of ovulation induction result Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. It can be concluded from the results of this study that combined use of transvaginal sonography& colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause.

Effects of an intravaginal GnRH analogue administration on rabbit reproductive parameters and welfare

On commercial farms, rabbit does are subjected to a reproductive rhythm that does not account for their welfare or physiology, leading to reduced longevity and consequently high annual replacement. The European Food Safety Authority (EFSA) recommends limited and infrequent use of hormone treatments, and suggests replacement with alternative methods that do not threaten animal welfare when possible. In the present study, we aimed to determine whether the GnRH analogue lecirelin acetate could be administered by inclusion in the seminal dose during insemination. Twenty 9-month-old does (Grigio del Monferrato, autochthonous Italian breed),each having two previous deliveries, were individually housed and divided into two groups at artificial insemination. The control group received 0.2 mL of intramuscular lecirelin (Dalmarelin, Fatro®, Italy) prior to insemination. The intravaginal group was inseminated with a seminal dose that included 0.3 mL Dalmarelin. The experiment was performed for six consecutive reproductive cycles at 42-day intervals, and included a total of 120 inseminations. Prior to each insemination, the heterospermic pooled semen samples were assessed for sperm motility and morphology. Each ejaculate was divided into two samples, with and without lecirelin addition. Compared to the control group, the does with intravaginal Dalmarelin administration showed equal or greater sexual receptivity, which resulted in a higher fertility rate over increasing cycles. The seminal dose volume was very low, possibly explaining the better results in the intravaginal group, which received a similar amount of hormone (0.3 mL/doe) as the control group (0.2 mL/doe). The negative performance of the control group may have also been due to anti-GnRH formation, and the more stressful method of ovulation induction. The number of live-born kits did not significantly differ between groups. Progressive motility was significantly positively correlated with motility characteristics, including VAP, VSL, ALH, BCF, STR, and LIN. Overall, our present findings supported that the incorporation of GnRH in a seminal dose could be used for ovulation induction in rabbit does. Further studies should identify the optimal dose of GnRH for intravaginal administration, taking into account that the intravaginal absorption capacity is about 10 times smaller than the intramuscular absorption capacity.

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Three Dimension Transvaginal Ultrasound & Doppler Indices

Background: the study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Objectives: Ovulation rate was taken as the gold standard for assessment of ovulation induction result. Patients and Methods: Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. Results: It can be concluded from the results of this study that combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. Conclusion: combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause.

Assessment of Different Methods of Ovulation Induction on Endometrial and Ovarian Blood Flow by Three Dimension Transvaginal Ultrasound &amp; Doppler Indices

Background: the study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Objectives: Ovulation rate was taken as the gold standard for assessment of ovulation induction result. Patients and Methods: Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. Results: It can be concluded from the results of this study that combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. Conclusion: combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause.

Prognostic factors in intrauterine insemination cycles.

ObjectiveThis study aimed to evaluate the clinical pregnancy rate of intrauterine insemination cycles in relation to patient age, cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility.MethodsThis retrospective observational study included 237 intrauterine insemination cycles performed from 2011 to 2015 at the Assisted Reproduction Service of the Hospital das Clínicas of the Ribeirão Preto Medical School, University of São Paulo. Student's t-test was used to compare quantitative variables and the chi-square test was used to compare qualitative variables.ResultsPatient age was inversely and significantly correlated with pregnancy rates (p=0.001) (Pregnant women = 32.56±5.64 years, non-pregnant women = 36.64±5.03 years). Cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility were not associated with pregnancy rates. The overall clinical pregnancy rate was 7.59%. In the subgroup of patients (n=102 cycles) considered ideal for intrauterine insemination (age ≤35 years, unexplained infertility, ovarian factor infertility or minimal endometriosis, and a partner with sperm count ≥2.5×106 retrieved on the day of insemination) the pregnancy rate was 12.74%.ConclusionIn the studied group, female patient age was the only variable significantly correlated with intrauterine insemination success rates.

LAPAROSCOPIC DRILLING OF OVARIES: PRO AND CONTRA

Laparoscopic ovarian drilling is now considered to be a safe and effective surgical method. The frequency of the onset of pregnancy is similar tothat of the therapeutic methods of ovulation induction. At the same time, a lower risk of ovarian hyperstimulation syndrome and multiple pregnancies makes drilling more preferable to gonadotropin therapy. Despite the advantages of this method of surgical treatment, the issue of possible complications still remains to be relevant.

Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome

Aim of our study was to assess the ovulation rate, with mid-luteal progesterone level and ultrasound follicles monitoring, in PCOS CC-resistant patients undergone transvaginal hydrolaparoscopy ovarian drilling. A prospective observational study was carried out in 123 PCOS, infertile, CC-resistant patients who undergone THL ovarian drilling. Each woman was evaluated by hormonal measurement, and ultrasound evaluation during 6 months follow-up. Progesterone serum levels were assessed on days 20–24 of the cycle after surgical treatment. Pg levels >3 ng/mL were considered as ovulation. Ovulation frequency and the highest mean follicular diameters during the monitoring were recorded. 117 patients complete the study, since six patients were lost to follow-up. Mean follicular diameter during ovulation monitoring was 16.37 mm. Ovulation rate at the follow up was 64.1% one month after treatment, 79.5% after three months and 82.9% after six months. 28 patients conceived during follow-up period. Pregnancy rate was 70.1%. Our study has shown that THL ovarian drilling improves ovulation and pregnancy rate in women with CC-resistant PCOS. We believe that this approach should be offered as second-line therapy at all PCOS CC-resistant women who fail the medical methods of ovulation induction.

Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis

ABSTRACTIntroductionOvulation induction in women with polycystic ovarian syndrome (PCOS) can be carried out with drugs, such as clomiphene citrate (CC), which remains the first-line treatment option, and surgery, such as laparoscopic ovarian drilling (LOD), which is usually recommended as one of the second-line treatment options. Laparoscopic ovarian drilling may avoid or reduce the need for gonadotropins and at the same time reduce ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.AimWe aimed to evaluate the effectiveness of LOD in clomiphene-resistant women and to identify the clinical factors that might predict its success.Study designRetrospective analysis in a tertiary level infertility unit.Materials and methodsAll CC-resistant PCOS women who underwent LOD over a 10-year period were included. Polycystic ovarian syndrome was defined as per the Rotterdam criteria. The follow-up period was up to 3 years post-LOD. Outcomes, such as onset of regular cycles, spontaneous pregnancies, and live births were recorded.ResultsA total of 59 PCOS women who underwent LOD and were available for follow-up were included in the study. Majority of the patients were less than 30 years of age with a body mass index (BMI) &gt; 24 kg/m2. Out of those, 12 conceived (20.3%) spontaneously and 14 (23.7%) had regular menstrual cycles after the procedure. The live birth rate was 16.9% (10/59). We did not find any association of clinical factors, such as age, BMI, type of infertility, and history of irregular cycles with LOD success.ConclusionLaparoscopic ovarian drilling can be offered as a treatment option in select group of CC-resistant women with reasonable success. Post-LOD, for those who do not have resumption of regular cycles, alternate method of ovulation induction can be initiated.How to cite this articleThomas S, Vithayathil VP, Chandy A, Aleyamma TK, Kamath MS. Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis. Int J Infertil Fetal Med 2017;8(3):93-96.

The tree analysis model as a guide for the selection of the optimum ovulation induction method to improve the quality of oocytes

The tree analysis model as a guide for the selection of the optimum ovulation induction method to improve the quality of oocytes

Does polycystic ovarian morphology influence the response to treatment with pulsatile GnRH in functional hypothalamic amenorrhea?

BackgroundPulsatile GnRH therapy is the gold standard treatment for ovulation induction in women having functional hypothalamic amenorrhea (FHA). The use of pulsatile GnRH therapy in FHA patients with polycystic ovarian morphology (PCOM), called “FHA-PCOM”, has been little studied in the literature and results remain contradictory. The aim of this study was to compare the outcomes of pulsatile GnRH therapy for ovulation induction between FHA and “FHA-PCOM” patients in order to search for an eventual impact of PCOM.MethodsRetrospective study from August 2002 to June 2015, including 27 patients with FHA and 40 “FHA-PCOM” patients (85 and 104 initiated cycles, respectively) treated by pulsatile GnRH therapy for induction ovulation.ResultsThe two groups were similar except for markers of PCOM (follicle number per ovary, serum Anti-Müllerian Hormone level and ovarian area), which were significantly higher in patients with “FHA-PCOM”. There was no significant difference between the groups concerning the ovarian response: with equivalent doses of GnRH, both groups had similar ovulation (80.8 vs 77.7 %, NS) and excessive response rates (12.5 vs 10.6 %, NS). There was no significant difference in on-going pregnancy rates (26.9 vs 20 % per initiated cycle, NS), as well as in miscarriage, multiple pregnancy or biochemical pregnancy rates.ConclusionPulsatile GnRH seems to be a successful and safe method for ovulation induction in “FHA-PCOM” patients. If results were confirmed by prospective studies, GnRH therapy could therefore become a first-line treatment for this specific population, just as it is for women with FHA without PCOM.

ALGORITHM OF OVULATION INDUCTION IN PATIENTS WITH POLYCISTIC OVARY SYNDROME.

Polycystic ovary syndrome is the most frequent endocrine disturbance in the reproductive period of women's life and the most frequent cause of anovulatory infertility. Ovulation and pregnancy in patients having polycystic ovary syndrome may be a result of a wide range of therapeutic options, and the treatment assumes a gradual approach--from simple noninvasive to expensive and demanding procedures. A systematic literature survey concerning the efficiency of particular ovulation induction methods in respect of the reproductive outcome was carried out with the aim of establishing the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome. The search was confined to clinical investigations performed on human subjects, reported in English in the period from the beginning of 2010 to June of 2014. As a conclusion of this systematic survey of the efficiency of ovulation induction methods, which confirms and supplements the knowledge in this field, it is possible to form the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome, consisting of the following subsequent steps: 1) modification of life style, 2) induction with clomiphene citrate 3) use of metformin, 4) use ofaromatase inhibitors, 5) application ofgonadotropins and laparoscopic ovarian drilling--as a second-line treatment, and 6) assisted reproductive techniques.