Outcome Of Ovulation Induction Research Articles

Outcomes of Ovulation Induction Aimed to Pregnancy in Eight Hypopituitarism Patients.

Female sex hormones work in concert. Gonadotropin-releasing hormone and ovulation-inducing agents are required in female patients with infertility owing to hormone dysregulation. Although drug-induced follicular development can be expected in patients with endogenous female hormone deficiency, data are lacking on the protocols and drugs used. We retrospectively examined the success rates of ovulation induction, assisted reproductive technology, and pregnancy outcomes in 66 cycles of eight patients with pituitary insufficiency at our hospital. Ovulation occurred in 75.4% (49/66); 82.6% (38/46) of patients <40 years and 57.9% (11/19) of patients ≥40 years of age. Five of the eight patients became pregnant, and three delivered babies. The fertilization rate was 78% with in vitro fertilization, and the recombinant follicle-stimulating hormone usage was 3,717.1 ± 1,528.9 International Unit in hypopituitarism patients. Hypopituitarism patients can achieve ovulation, pregnancy, and delivery after optimal gonadotropin administration. Further studies are needed to determine the effects of gonadotropins on other pituitary hormones, such as growth hormones.

Investigating Ovulation Induction Outcomes in Patients with Decreased Ovarian Reserve Treated with Double Stimulation during The Follicular and Luteal Phases Compared to The Conventional Antagonist Cycle: A Randomized Clinical Trial.

It is difficult to obtain healthy oocytes in poor ovarian responders with conventional treatment methods. Thus, the need to investigate new methods is essential. This study aims to investigate ovulation induction outcomes in patients with decreased ovarian reserve (DOR) in two groups treated with double stimulation (DuoStim) during the follicular and luteal phases in comparison with the antagonist cycle. This was a randomised clinical trial that enrolled the patients with reduced ovarian reserve. The patients referred for in vitro fertilization (IVF) at Molud Infertility Clinic, Ali Ebn Abitalib (AS) Hospital, Zahedan, Iran from 2020 to 2021. Participants were randomly divided into two groups, those who underwent treatment with DuoStim during the follicular and luteal phase (case group) and those who received the conventional antagonist cycle (control group). The mean number of metaphase II (MII) eggs was 7.7 ± 3.1 in the case group and 6.1 ± 3.9 in the control group (P=0.063). The mean total number of retrieved eggs in the case group was 9.2 ± 3.7 and in the control group, it was 6.9 ± 4.4 (P=0.023). The mean number of embryos obtained in the case group was 6.5 ± 3.9; in the control group, it was 4.7 ± 2.8 (P=0.016). The DuoStim method can effectively play a role in increasing the total number of retrieved eggs and embryos (registration number: IRCT20120817010617N8).

Analysis of use of different rFSHs during IVF/ICSI-assisted conception in elderly population and effect of double trigger on clinical outcomes

Objective To compare the number of oocytes retrieved and clinical outcomes of ovulation induction in an older population treated with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) (IVF/ICSI) using different rFSH options and the effectiveness of antagonist treatment to induce ovulation using gonadotropin-releasing hormone agonists (GnRH-a) in combination with an human chorionic gonadotropin (HCG) trigger. Methods A total of 132 fresh cycles were selected for this study, which were treated with IVF/ICSI in our hospital from March 2022 to December 2022. Observations were made according to different subgroups and the effects of different triggering methods on the number of oocytes obtained, embryo quality, and clinical outcomes. Results The initial gonadotropin (Gn) dose, the number of oocytes, and the number of MII oocytes were higher in group A than in group B (p < .05), and the clinical pregnancy rate was 29.41% in group A. Group B had a clinical pregnancy rate of 27.5%. The double-trigger group was superior to the HCG-trigger group in terms of the number of 2PN, the number of viable embryos, and the number of high-quality embryos (p < .05). The use of a double-trigger regimen (OR = 0.667, 95%CI (0.375, 1.706), p = .024) was a protective factor for the clinical pregnancy rate, whereas AFC (OR = 0.925, 95%CI (0.867, 0.986), p = .017) was an independent factor for the clinical pregnancy rate. Conclusions The use of a dual-trigger regimen of GnRH-a in combination with HCG using an appropriate antagonist improves pregnancy outcomes in fresh embryo transfer cycles in older patients.

LH on GnRH-ant day to basal LH affects the IVF/ICSI outcome of PCOS women undergoing GnRH-antagonist protocol.

The aim of this study was to investigate the influence of ratio of serum luteinizing hormone (LH) on gonadotropin-releasing hormone antagonist (GnRH-ant) day to basal LH (hLH/bLH) on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) outcome in polycystic ovary syndrome (PCOS) women who received GnRH-ant protocol for controlled ovarian hyperstimulation (COH). This retrospective study was conducted in women with PCOS (n = 1116) who underwent the GnRH-ant protocol for COH between 2015 and 2022 and were stratified as group A (hLH/bLH < 1, n = 489) and group B (hLH/bLH ≥ 1, n = 627) according to the variation of serum LH. The outcomes of COH and the first frozen embryo transfer (FET) cycle were compared between group A, B and the linear relationship between hLH/bLH ratio and IVF/ICSI outcomes were studied by multivariate linear regression analysis and restricted cubic spline (RCS) models. There were significant differences in baseline characteristics and outcomes between group A and B. Group A had higher levels of bLH, AMH, estradiol (E2) on GnRH-ant start day and lower levels of LH on GnRH-ant start day. Group B has better ovulation induction outcomes: more retrieved oocytes, normally fertilized oocytes (2PN), cleavage embryos, available embryos and high-quality blastocysts. Multivariate linear regression analysis found no statistically significant connection between hLH/bLH and clinical outcomes. RCS models showed hLH/bLH had nonlinear association with outcomes, including number of oocytes retrieved, 2PN, available embryos, incidence of OHSS, chemical pregnancy, clinical pregnancy, abortion and live birth. hLH/bLH ratio could be a more forward-looking indicator of clinical outcome in women with PCOS undergoing GnRH-ant protocols than LH on trigger day and the ratio of LH level on trigger day to basal LH. hLH/bLH = 1 may be the best condition for higher live birth rate and lower OHSS rate.

Melatonin enhances ovarian response in infertile women with polycystic ovary syndrome: A randomized controlled trial.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Anovulation, decreased Oocyte quality and low endometrial receptivity are the cause of infertility in women with PCOS. Anovulation is the consequence of hyperandrogenism, insulin resistance. Furthermore, the reactive oxygen species (ROS) induce oxidative stress which may be responsible for poor Oocyte quality. Melatonin is a documented powerful free radical scavenger and broad-spectrum antioxidant. Current evidence suggests that melatonin involves in ovarian physiology including follicular development, ovulation, and oocyte maturation. Present study was tried to evaluate the effects of melatonin on biochemical parameters as well as outcomes of ovulation induction by letrozole in infertile women with polycystic ovary syndrome. Method: This is a randomized controlled trial including 74 women of Polycystic Ovary Syndrome (PCOS) with infertility. Intervention group received melatonin 3 mg at bed time for 8 weeks as pretreatment. Serum luteinizing hormone (LH), testosterone, anti mullerian hormone (AMH), fasting insulin, oral glucose tolerance test (OGTT) were measured at baseline and after 8 weeks. Both intervention and controlled group were received ovulation induction for 3 cycles by Letrozole (5 mg from cycle days 2 to 6). Intervention group continued melatonin until mature follicle achieved. The primary outcomes were biochemical changes by serum luteinizing hormone (LH), testosterone, anti mullerian hormone (AMH), fasting insulin, oral glucose tolerance test (OGTT) and ovarian responses by number of mature follicles, endometrial thickness and ovulation rate. Secondary outcome was pregnancy rate. Result: Melatonin treatment for 8 weeks significantly decreased testosterone (P &lt;0.01) serum luteinizing hormone (&lt;P.001), HOMA IR (P&lt;0.01) and glucose tolerance (P&lt;0.01). The change of anti mullerian hormone was not significant (&gt;0.05). There was significant difference in number of mature follicles (&lt; 0.01), mean endometrial thickness (P&lt;0.01). The risk ratio (RR) of ovulation rate was 1.34(0.09-1.68) and pregnancy rate was 2.55 (.37-3.51). The risk ratio (RR) of pregnancy rate in relation to AMH level was 1.12(0.05-1.79) in ≤8ng/ ml group and 8.65(0.25-9.59) in ≥8ng/ml group which was significant. Conclusion: After 8 weeks pretreatment and 3 cycle’s co treatment with ovulation induction by letrozole, melatonin seems to provide improved biochemical and ovarian response. Based on these results, melatonin could be considered as a potential therapeutic agent for infertile women with polycystic ovary syndrome. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 850-858

Analysis of cumulative live birth rate outcomes of three ovarian stimulation protocols in patients after laparoscopic cystectomy of ovarial endometrioma: a retrospective cohort study

BackgroundPrevious studies have reported that after laparoscopic cystectomy of ovarial endometrioma, the ovarian response to gonadotropin (Gn) significantly decreased. However, for patients with diminished ovarian reserve (DOR) after ovarian surgery, how to choose the most appropriate controlled ovarian hyperstimulation protocol has not been concluded. Compared with the traditional agonist regimen, the gonadotropin (Gn)-releasing hormone (GnRH) antagonist, microstimulation, and progestin-primed ovarian stimulation (PPOS) protocols are simple to operate and have a shorter cycle, which are often used in patients with DOR. So the purpose of our study is to compare the assisted reproductive outcomes of these three controlled ovarian hyperstimulation protocols in patients with DOR following laparoscopic cystectomy of ovarial endometrioma.MethodsIn this retrospective cohort study, 89 patients with DOR who had undergone in vitro fertilisation/intracytoplasmic sperm injection at the Department of Reproductive Medicine at the Third Affiliated Hospital of Zhengzhou University from 1 to 2018 to 31 December 2020 were included. According to the controlled ovarian hyperstimulation protocols employed, the patients were divided into GnRH antagonist (38 patients), PPOS (27 patients), and microstimulation (24 patients) groups. The basic data and clinical outcomes of the three groups were compared. The main outcome measure was the cumulative live birth rate.ResultsNo significant differences in the age of the female patients and their spouses and female patients’ body mass index and basal endocrine levels (follicle-stimulating hormone and oestradiol) were noted among the three groups (P > 0.05). The GnRH antagonist group had higher antral follicle counts, greater endometrial thickness on the human chorionic Gn injection day, greater number of oocytes retrieved, and higher two pronuclear embryo counts than did the other two groups. However, the starting dosage of Gn was lower in the GnRH antagonist group than in the other two groups. The microstimulation group had a significantly higher oocyte output rate and high-quality embryo rate than did the other two groups (P < 0.05). No significant differences in the total dosage of Gn, cumulative pregnancy rate, cumulative live birth rate, viable embryo rate, and blastocyst formation rate were observed among the three groups (P > 0.05).ConclusionIn conclusion, for patients aged under 40 years who experienced DOR after laparoscopic cystectomy of ovarial endometrioma, GnRH antagonist protocol and PPOS protocol can obtain better ovulation induction outcomes and cumulative live birth rate than microstimulation protocol, and are more suitable ovulation induction protocols.

Role of luteinizing hormone elevation in outcomes of ovulation induction with letrozole for polycystic ovary syndrome.

The effect of elevated luteinizing hormone (LH) on the clinical outcomes of ovulation induction (OI) in infertile anovulatory patients with polycystic ovary syndrome (PCOS) remains controversial. This retrospective study included PCOS patients undergoing intrauterine insemination (IUI) following letrozole (LE) stimulation without OC pretreatment. A retrospective cohort analysis was conducted in a single, academic ART center from January 2013 to May 2019. In total, 835 IUI cycles of PCOS patients treated with letrozole were collected for the analysis. Cohorts were separated based on the level of basal LH (bLH) and LH level after letrozole administration (LHle) during OI. OI response and reproductive outcomes were evaluated for each cohort. No adverse effects of dysregulated levels of either bLH or LHle on ovulation rate or reproductive outcomes were observed. Furthermore, the cohort of individuals with normal bLH and high LHle levels, exclusive of LH surge, exhibited significantly higher rates of clinical pregnancy (30.3% vs. 17.3%, p = 0.002) and live birth (24.2% vs. 15.2%, p = 0.024) than those with normal bLH and normal LHle. These results indicated that high LH levels in PCOS are not solid evidence of poor prognosis of letrozole-induced ovulation, while elevated LHle may be a prospective predictor for better OI outcomes. It seems that preinhibition of LH secretion is not needed.

Ovulation Induction Outcome with Different Phenotypes Of PCOS

Ovulation Induction Outcome with Different Phenotypes Of PCOS

Strategies to Improve Outcomes of Ovulation Induction and Assisted Reproductive Technology (ART): The Iraqi Consensus

The ESHRE 2019 Guidelines provide clinicians with valuable evidence-based recommendations to optimize ovarian induction and ovarian stimulation in in vitro fertilization (IVF). However, data from such guidelines are primarily based on randomized controlled trials with highly selected populations that are conducted under very controlled conditions. To complement evidence from clinical guidelines and further improve treatment outcomes, seven Iraqi experts gathered to evaluate opinions on the specific approaches during an IVF cycle in Iraq and developed 15 statements agreed upon: The Iraqi Consensus. A Delphi consensus was conducted to formulate expert opinion on how assisted reproductive technology outcomes could be improved. Step 1 involved the scientific Board, comprising the scientific coordinator, who developed the initial statements and supporting references, which were discussed/amended by seven experts, and refined the final statements and references. Step 2 involved 30 Iraqi experts voted on their level of agreement/disagreement with each statement. Consensus was reached if the proportion of participants agreeing/disagreeing with a statement was &gt;66%. Step 3 data was collected and analyzed then communicated to participating experts. Consensus was achieved for 15 statements with high level of agreement in &gt;85% of statements, tackling follicular development/gonadotropins; pituitary suppression; final oocyte maturation triggering; luteal-phase support. This represents the collective point of view of the experts that took part in the consensus development and are based on local practice. This Delphi consensus provides a real-world clinical perspective from Iraqi experts and complements the international guidelines, and may help to further improve treatment outcomes in Iraq and the region.

Letrozole Compared With Clomiphene Citrate for Polycystic Ovarian Syndrome: A Systematic Review and Meta-analysis.

To estimate the effect of letrozole and clomiphene citrate in women with infertility and polycystic ovarian syndrome (PCOS). MEDLINE through PubMed, Web of Science, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for relevant studies from inception to February 1, 2022. Two reviewers retrieved, filtered, and extracted data independently using the bibliographic software EndNote X9 and Excel workbook. We included randomized controlled trials (RCTs) reporting ovulation induction outcomes in women with infertility and PCOS treated with either letrozole or clomiphene citrate followed by timed intercourse or intrauterine insemination. The data were merged into a mean difference or risk ratio (RR) with 95% CI, depending on variable types. Data collection and organization were conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Twenty-nine RCTs were eligible, which included 3,952 women and 7,633 ovulation induction cycles. We acquired evidence from 22 RCTs for the ovulation rate, 28 RCTs for the clinical pregnancy rate, and eight RCTs for live-birth rate. Pooled analysis indicated that letrozole treatment prevailed against clomiphene citrate in ovulation rate (RR 1.14, 95% CI 1.06-1.21, P<.001), clinical pregnancy rate (RR 1.48, 95% CI 1.34-1.63, P<.001), and live-birth rate (RR 1.49, 95% CI 1.27-1.74, P<.001). Letrozole was associated with improved ovulation, pregnancy, and live-birth rates compared with clomiphene citrate. We recommend letrozole over clomiphene citrate as an ovulation induction drug in women with infertility and PCOS, although the quality of the evidence is mixed. PROSPERO, CRD42022308777.

The impact of hyperandrogenism on the outcomes of ovulation induction using gonadotropin and intrauterine insemination in women with polycystic ovary syndrome.

ObjectiveThis study aimed to investigate the impact of hyperandrogenism (HA) on the outcomes of ovulation induction (OI) using gonadotropin and intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS).MethodsThis was a retrospective cohort study including 415 patients undergoing OI using gonadotropin and IUI treatment between January 2018 and December 2020 at a single infertility center. Baseline characteristics, clinical and laboratory parameters, and pregnancy outcomes were investigated.ResultsAmong the study population, there were 105 hyperandrogenic (25.3%) and 310 non-hyperandrogenic patients (74.7%). The live birth rate was lower in the HA group than in the non-HA group, but this difference did not reach statistical significance due to the limited sample size (14.3% vs. 21.0%, relative risk=0.68; 95% CI, 0.41–1.14, p=0.153). No predictive factors for live birth were identified through logistic regression analysis. ConclusionHA did not negatively affect the outcomes of OI using gonadotropin and IUI cycles in Vietnamese women with PCOS. The result may not be applicable elsewhere due to the large variation in the characteristics of women with PCOS across races and populations.

The influence of ethnicity on outcomes of ovulation induction with clomifene citrate in women with PCOS

Research questionWhat is the influence of ethnicity on the outcome of ovulation induction with clomifene citrate in women with polycystic ovary syndrome (PCOS)? DesignThis was a retrospective cohort study. In total, 420 women diagnosed with PCOS who were of Northern European, Mediterranean, African, South-East Asian or South American descent, and who started ovulation induction treatment with clomifene citrate, were included. All women were treated with clomifene citrate according to a standardized treatment regimen. The minimal effective dose of clomifene citrate and prevalence of clomifene resistance (CRA) were assessed, and the chance of becoming ovulatory was predicted. ResultsDifferences were observed in body mass index (P = 0.008), waist circumference (P = 0.036) and serum LH, insulin and androgen concentrations (all P < 0.001) in women of different ethnicities with PCOS. Compared with women of Northern European descent, the minimal effective dose of clomifene citrate in women of other ethnic groups was not significantly different. The prevalence of CRA (P = 0.574) was similar in all ethnic groups A similar chance of ovulation (P = 0.504) was predicted for the different ethnic groups. ConclusionsThis is the first study aiming to link ethnicity to ovulation induction outcome in PCOS. Although women of different ethnicities who have PCOS exhibit a variation in phenotypic expression, there do not appear to be differences in the prevalence of clomifene-resistant anovulation or the minimal effective dose of clomifene citrate. Furthermore, a prediction model revealed no significant differences in the predicted chance of ovulation. A larger cohort is needed to validate these findings.

Does Asymptomatic Leukocytospermia Affect Ovulation Induction's Outcome?

Does Asymptomatic Leukocytospermia Affect Ovulation Induction's Outcome?

Letrozole is superior to clomiphene citrate in ovulation induction in patients with polycystic ovary syndrome.

Objective:This study was aimed to compare the clinical outcomes of ovulation induction (OI) by timed intercourse with letrozole (LTZ) and clomiphene citrate (CC).Methods:Three hundred and twenty-three patients with polycystic ovary syndrome (PCOS) who underwent OI with LTZ or CC between February 2017 and November 2018 were included in this retrospective study. The patients were divided into two groups as the CC group (n=148) and the LTZ group (n=175). Endometrial thickness, follicular development, ovulation, clinical pregnancy, abortion, and live birth rates of the groups were analyzed.Results:The mean endometrium thickness of the CC group was 7.1±1.7 mm, and the LTZ group was 8.6±1.8 mm (p<0.001). The ovulation rate per cycle was higher in the LTZ group (93.1%) in comparison with the CC group (83.8%) (p=0.013). Clinical pregnancy rates were 52% in the LTZ group, and 41.2% in the CC group (p=0.047). LTZ with 44% of live birth rate was superior to CC with a 33% live birth rate (p=0.029).Conclusions:LTZ is an effective OI agent in PCOS patients. LTZ is superior to CC in terms of pregnancy rates and live birth rates. As a result, we recommend that LTZ should be the first-line treatment agent in patients with PCOS.

Letrozole versus tamoxifen for ovulation induction in non-polycystic ovarian syndrome anovulatory infertile females

Background: Anovulation is the most common cause for infertility, different oral agents are used for induction of ovulation, tamoxifen may be effective as letrozole in this era.Objective: The aim of this study was to compare the effectiveness of tamoxifen and letrozole in terms of ovulation induction outcomes in non PCOS anovulatory patients.Patients and Methods: This randomized single blinded clinical trial was conducted among a total of 120 patients with anovulatory infertility that were randomized to one of two treatment arms: Letrozole group and Tamoxifen group. The treatment was continued for three consecutive cycles. Main outcome measures were number of follicles ≥ 18mm, endometrial thickness and ovulation rate. Secondary outcomes measures were cumulative pregnancy rate and spontaneous abortion rates.Results: Mean number of mature of follicles ≥ 18 mm was statistically significantly higher in Tamoxifen group (1.9 ± 1.1) when compared to Letrozole group (1.5 ± 0.9) with p-value=0.03. Also, endometrial thickness was significantly different between both groups; as it was higher in Tamoxifen group (8.2 ± 1.6 mm versus 7.08 ± 2.4 mm) in Letrozole group (p-value=0.02). No significant difference was reported between both groups as regarding ovulation rate, pregnancy rate and spontaneous abortion rate, ovulation rate was 73.3% with Letrozole and 63.3% with Tamoxifen (P =0.3), cumulative pregnancy rate was 30% with Letrozole group and 23.3% with Tamoxifen group (p=0.5) and spontaneous abortion rate was 3.3% in Letrozole group and 5% in Tamoxifen group (p=0.9).Conclusion: Tamoxifen drug has comparable ovulation induction outcomes to letrozole with very low costs and side effects. Tamoxifen could be considered suitable for ovulation induction in developing countries

SAT-194 Correlation of Capillary and Venous Plasma Measurements of Anti-Müllerian Hormone

Anti-Müllerian Hormone (AMH) is a member of the transforming growth factor β superfamily which regulates gonadal development and differentiation. AMH is a biomarker for ovarian age and reserve used to assess fertility and predict ovulation induction outcome. It is also a marker for diagnosis and treatment of polycystic ovarian syndrome (PCOS), menopausal transition, and gonadal function. As diagnostic testing begins to expand into self-collection and point-of-care capabilities, there is a need to minimize sample volume requirements and include additional sample types. The TAP device, manufactured by Seventh Sense Biosystems (Medford, MA), is a small, easy to use, single push device that collects approximately 100 µL whole blood from the upper arm. As the blood travels through the channels of the device it is mixed with lithium heparin anticoagulant. The device collects capillary blood and is FDA approved for use in hemoglobin A1c measurements. In this study, AMH levels in venous and capillary plasma were compared. AMH was measured by an electrochemiluminescent immunoassay requiring only 40 µL plasma. The performance characteristics of the assay including accuracy, precision, linearity, and limits of quantitation were assessed. The stability of samples stored in the TAP device was also evaluated. Twenty-one female volunteers ages 24 to 67 donated paired venous and capillary blood samples. Venous plasma from donors with undetectable AMH levels was used as a matrix for spike and recovery studies to verify acceptable accuracy and precision across the analytical measurement range (AMR) and establish the lower (LLOQ) and upper (ULOQ) limits of quantitation. The ULOQ and LLOQ were 15 and 0.15 ng/mL, respectively. Accuracy was within 20% and precision within 15% across the AMR. Linearity was evaluated by serially diluting samples with high levels of AMH in AMH-negative pooled plasma. The maximum acceptable dilution was 8-fold. Correlation of venous and capillary results was excellent. A linear least square model resulted in a coefficient of determination (R2) of 0.998. Four capillary blood samples were collected from each of three donors for stability analysis. One was processed immediately and used as the baseline. The remaining three samples were stored at 2-8°C in the TAP device for 3, 5 and 7 days before processing. Plasma collected after 5 and 7-day storage in the TAP device was moderately hemolyzed and smaller volumes were retrieved. The hemolysis did not impact AMH measurement. AMH was stable at all time points tested with mean recovery of 104% compared to baseline values. This study shows that very small volumes of venous and capillary plasma can be used to accurately measure AMH levels. The ability to measure AMH in capillary blood via the TAP device allows for quick and reproducible blood collection, potentially outside the healthcare setting, improving access to diagnostic information.

Reproductive outcome of Ovulation Induction for Polycystic Ovary Syndrome Patients according To Edessy Ovarian Reserve Score

Reproductive outcome of Ovulation Induction for Polycystic Ovary Syndrome Patients according To Edessy Ovarian Reserve Score

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-M ul lerian hormone (AMH) on the outcome of ovulation induction using human menopausal gonadotropin (hMG)in women with polycystic ovary syndrome (PCOS). Methods This prospective study included 63 anovulatory women with PCOS who underwent hMG ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic (ROC) curve was used to evaluate the prognostic value of circulating AMH. Results hMG responders had a significantly lower serum AMH concentration compared with non-responders (8.43±2.18 μ g/L vs 11.05±2.85 μ g/L , P g/L . Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hMG treatment in PCOS patients.

Series of 18 Cases of Clomiphene Resistant Anovulatory Women with Polycystic Ovary Syndrome and Altered Response to FSH Stimulation

The outcome of ovulation induction in anovulatory polycystic ovarian syndrome (PCOS) may depend, in part, on the pharmacologic compounds used, but also on individual patient characteristics, such as age, body mass index (BMI), hyper- androgenism, luteinizing hormone (LH), hyper-secretion, anti mullerian hormone (AMH) levels and possibly antral follicle count (AFC) with ovarian volume of these women. There exists a subset of clomiphene citrate (CC) resistant PCOS women who require stimulation of ovulation with high doses of human menopausal gonadotropin (hMG), after not having responded to chronic low dose step up regimes of recombinant follicle stimulating hormone (r-FSH).

Follicle-stimulating hormone receptor polymorphism affects the outcome of ovulation induction in normogonadotropic (World Health Organization class 2) anovulatory subfertility

To assess whether an FSH receptor polymorphism (Asn680Ser, rs6166) can affect the outcome of ovulation induction in normogonadotropic (World Health Organization class 2 [WHO2]) anovulatory subfertile women. Prospective, longitudinal, cohort study. University-based fertility unit. A total of 240 consecutive women diagnosed with WHO2 anovulatory subfertility who underwent ovulation induction therapy. Results were replicated in a retrospective cohort of 185 patients with polycystic ovary syndrome (PCOS) (Rotterdam criteria). Ovulation induction using clomiphene citrate (CC) as first-line and exogenous gonadotropins (exFSH) as second-line therapy. Clomiphene-resistant anovulation (CRA), clomiphene failure (CCF), and ongoing pregnancy rate. Genotyped patients (n = 159) were similar to nongenotyped women (n = 81) regarding clinical characteristics and outcomes of ovulation induction. The 680(Ser) allele was associated with CRA. A pooled analysis of both cohorts showed an 89% higher chance of CRA after CC treatment (odds ratio 1.9 [95% confidence interval 1.1-3.3]) in homozygous carriers of the FSH receptor variant (680(Ser/Ser)). A lower chance of ongoing pregnancy (hazard ratio 0.51 [95% confidence interval 0.27-0.98]) was observed among these patients during CC treatment in the prospective cohort. An FSH receptor polymorphism is associated with CRA during treatment with clomiphene citrate. These data may be used to design a treatment algorithm that is more efficacious and better tailored to the individual patient.