Ovulation Induction Program Research Articles

Effect of Hyaluronic Acid Vaginal Pessary on Endometrial Receptivity and Pregnancy Outcome through assessment of Serum and Follicular fluid Lymphatic Vessel Endothelial Hyaluronan Receptor 1 (LYVE1) in Women Undergoing ICSI

Successful implantation needs a receptive endometrium, a functional and normal embryo at the stage of blastocyst developmental and a synchronized dialogue between embryonic tissues and maternal tissues. Local angiogenesis is an essential pre-requisite for implantation and pregnancy. This study included 63 infertile women (32 women as study group receiving hyaluronic acid and 31 control group) who were subjected to ovulation induction programs with GnRH antagonist protocols for IVF/ICSI procedures. Blood samples were taken by Vacutainer tubes and centrifuged according to the manufacturer’s instructions for the preparation of serum samples. Serum samples for LYVE1 were obtained from each patient when the basal hormonal status was determined. The second time point when the samples were obtained on the day of ova pickup, after that the G1 embryos will be transferred inside uterine cavity. Then performance of endometrial receptivity parameters or patterns evaluation and patients were followed up to do pregnancy test after 14 days after embryo transfer. At day of hCG, there was no significant difference in mean serum LYVE1 between hyaluronic acid group and reference group, respectively (p=0.824). There was no significant difference in mean follicular fluid LYVE1 between hyaluronic acid group and reference group, 0.92±0.36 pg/ml versus 0.82±0.22 pg/ml, respectively (p=0.223). Treatment with hyaluronic acid resulted in not significant increase in serum and follicular fluid LYVE1, and this increment not related to LYVE1 improvement in local blood endometrial blood flow as reflected by reduction in resistive index and pulsatility index with eventual improvement in pregnancy outcome.

Pregnancy Outcomes in Patients with Anovulatory Infertility in Different Ovulation Induction Programs

This study aims to explore the treatment effect of different ovulation induction programs on patients with ovulatory infertility, for which 82 infertility patients who visiting our hospital from January 2013 to December 2018 were elected for sampling. All patients were divided into an experimental group and a control group according to the random number table method, with 41 cases in each group. The experimental group was treated with letrozole and clomiphene therapy; the control group was only treated with letrozole. The clinical comprehensive efficacy, ovulation rate and pregnancy rate of the two groups were compared in the study. The result shows that after the treatment, the ovulation rate and pregnancy rate of the two groups were significantly higher than those before treatment, and the experimental group was significantly better than the control group (p<0.05). It is found that, for patients with ovulatory infertility who were treated with both letrozole and clomiphene therapy, their endometrial thickness on Human chorionic gonadotropin injection days is more suitable for implantation of germ cell, and their pregnancy rate, serum hormone levels, follicular development, ovulation and endometrial growth were superior to than those who only treated with letrozole. Moreover, this method can also take advantage of the respective advantages of Chinese and Western medicine, make the best of each other’s strengths, treat both the symptoms and the root causes, and improve the clinical pregnancy rate. In the future research, it is necessary to combine the physiology, pathology and other multidisciplinary discussions to propose a more effective treatment plan.

Relation of Endometrial Hyaluronic Acid with Female Infertility in Women Undergoing Ovarian Stimulation Protocol

A comparative prospective study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, from September 2019 to March 2020. The aim of the study was to evaluate the level of hyaluronic acid (HA) in endometrial fluid at day of trigger in infertile women whom undergoing ovarian stimulation protocol. The study included a total of 60 women who were selected from those attended the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies. All couples subjected to a full history taking, complete general examination, complete gynecologic examination and infertility workup including: husband’s semen analysis, hormonal analysis, uterine cavity and tubal patency was performed. Different ovulation induction programs were used evaluation of endometrial thickness, pattern, size and number of mature follicles was performed by transvaginal sonography in the 2nd of menstrual cycle and cycle day 11-14 before HCG injection. In this study basal hormonal analysis were performed to the female in the 2nd or 3rd day of the menstrual cycle and study included aspiration of endometrial fluid for determination of hyaluronic acid level by ELISA technique. The study showed that mean of hyaluronic acid was elevated significantly in women received letrozole plus FSH (158.7±19.7 pg/ ml) followed by women received Clomid plus FSH (160.8±13.5 pg/ml) and the lowest mean was recorded in the control group (146.1±26.2 pg/ml). The study showedpositive correlation betweenhyaluronic acid and LH at day of triggering of ovulation in women received Clomid plus FSH (group B). The study showed positive correlation betweenhyaluronic acid and progesterone at day of triggering of ovulation in women received letrozole plus FSH. The study showed positive correlation betweenhyaluronic acid and number of follicles in women after receiving letrozole plus FSH. The study revealed that HA mean was elevated significantly (P&lt; 0.05) in women who became pregnant after stimulation protocol compared with women who failed to be pregnant (164.2 vs. 152.1 pg/ml) as shown in Figure 4). The study also revealed that HA was significantly elevated in women who became pregnant after receiving letrozole + FSH (164.2 pg/ ml) as compared with non pregnant women (152.1 pg/ml) while HA level was non significantly related with pregnancy occurrence after administration of Clomid+FSH. It was concluded that, hyaluronic acid was elevated significantly in women received ovulation simulation drugs and letrozolewas superior to clomiphene as a treatment foranovulatory infertility in women

Correlation between aneuploidy pregnancy and the concentration of various hormones and vascular endothelial factor in follicular fluid as well as the number of acquired oocytes.

Objective To investigate the correlation between aneuploidy pregnancy and the concentration of various hormones and vascular endothelial factor in follicular fluid as well as the number of acquired oocytes and to provide a scientific basis for improving ovulation induction programs. Methods In total, we collected 277 follicular fluid specimens from patients undergoing in vitro fertilization (IVF) treatment in our hospital. Eighteen cases of aneuploidy embryos were identified. The follicular fluid of these aneuploidy embryos was used for the study. According to the case and control 1:5 paired design, we selected five age-matched controls with healthy births following IVF for each aneuploidy case. Concentrations of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2) and vascular endothelial growth factor (VEGF) in the follicular fluid were measured. Conditional logistic regression was used to analyze the relationship between aneuploidy pregnancy and the concentrations of various hormones and VEGF in the follicular fluid as well as the number of acquired oocytes. Results Multivariate conditional logistic regression showed that of all the factors analyzed, only FSH [odds ratio (OR) = 1.300, 95% confidence interval (CI), 1.091-1.548, P = 0.003] level in the follicular fluid and the number of acquired oocytes (OR = 1.179, 95% CI, 1.070-1.299, P = 0.001) were closely related to aneuploidy pregnancy. No other factors were found to be associated with aneuploidy pregnancy. Conclusion FSH concentrations in the follicular fluid are risk factors for aneuploidy pregnancies. The higher the number of eggs, the higher the risk of aneuploidy. These findings may help improve ovulation induction programs.

Effect of ovulation induction programs on the hormonal and lipid profile of mares maintained on pastures in the Brazilian Caatinga

Effect of ovulation induction programs on the hormonal and lipid profile of mares maintained on pastures in the Brazilian Caatinga

Effect of thyroid dysfunction on hemoglobin A1c in polycystic ovary patients during ovulation induction trials.

Background: Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders leading to infertility. Majority of women with PCOS have insulin resistance and elevated hemoglobin A1c.The presence of thyroid dysfunction may affect the levels of HbA1c and the results of ovulation induction programs. &#x0D; Objectives: To evaluate the level of serum hemoglobin A1c according to the type of thyroid dysfunction in polycystic ovary patients during ovarian stimulation trials. &#x0D; Patients and Methods: Eighty three polycystic ovary patients were enrolled in this study, attending the infertility clinic in Al-Yarmouk Teaching Hospital, in the period between November 2012 and May 2013. After thorough history and examination blood samples were withdrawn for the estimation of LH, FSH, testosterone, prolactin, TSH, T3, T4 and A1C in day 2 or 3 of the menstrual cycle, Progesterone was determined in day 21 of the cycle. Ultrasound was done also at cycle day 3 for antral follicles measurements. After diagnosing PCOS the patients were divided into 3 groups, euthyroid group (control), hypothyroid and hyperthyroid groups. Ovulation induction treatment was given and ultrasound was done at the day of hCG injection. &#x0D; Results: There was no significant difference between control and patients groups regarding age (26.31 ± 5.04 Vs 27.17 ± 5.76) and BMI (31.7 ± 5.69Vs 29.25 ± 6.28).HbA1c level was significantly different between the control and patients group with a significant positive correlation between HbA1c and TSH. In clomiphene citrate treated groups, Hb A1c level, the number of antral follicles and the size of follicles at day of hCG injection were not significantly different between the patients and control groups. &#x0D; Conclusions: HbA1c level is significantly affected by thyroid dysfunction in PCOS patients as it is higher in the Hypothyroid group and lower in the Hyperthyroid group. Using Clomiphene citrate in PCOS does not significantly increase the mean size of follicles after ovarian stimulation in patients with thyroid dysfunction from that in Euthyroid ones.

Pretreatment with oral contraceptives in infertile anovulatory patients with polycystic ovary syndrome who receive gonadotropins for controlled ovarian stimulation

This study was intended to assess the effects of oral contraceptives given before treatment in infertile anovulatory patients with polycystic ovary syndrome who receive gonadotropins for controlled ovarian stimulation. Pretreatment with oral contraceptives increased the mono-ovulatory cycles, the duration of stimulation for noncanceled cycles, and the number of vials of gonadotropins used. It also reduced the number of dominant follicles and the peak E(2) levels for dominant follicles. No effect was observed in rates of cycle cancellation, pregnancy, abortion, live birth, multiple pregnancies, and ovarian hyperstimulation syndrome.

Modified Moghissi Cervical Mucus (Cm) Score and Body Mass Index (BMI) in Spontaneous and Clomiphene Citrate Ovulation Induction Program

A comparative study was performed to determine the effect of clomiphene citrate (CC) on cervical&#x0D; mucus (CM) sampled in the preovulatory period in ovulatory cycle patients (control) and CC treated&#x0D; patients, moreover the correlation between CM score and body mass index (BMI) was studied in these&#x0D; two groups. One hundred-three infertile women were evaluated in outpatient clinic attending Institute for&#x0D; Embryo Research and Infertility/University of Al-Nahrain/Baghdad from February to August 2005, these&#x0D; patients were divided into two groups, the first group (number= 45) was ovulatory (control) group, this&#x0D; group took no treatment and the second group(number= 58)was CC-treated group, they were given dose&#x0D; of CC 100 mg/day orally for 5 days starting from cycle day 2 .Follicular growth was monitored in both&#x0D; groups starting from cycle day 10 using transvaginal ultrasound when the dominant follicle size was&#x0D; 1620 mm, the CC score was done to all patient. Body mass index (kg/m2) was measured for the all&#x0D; patients and its effect on CM score was evaluated. There was highly significant reduction in volume,&#x0D; consistency, spinnbarkeit, cellularity, and total CM score in treated CC cycles compared to control cycle,&#x0D; whereas there was no statistically significant difference in regard to ferning test between two groups. The&#x0D; PH of CM of patients in the CC treated cycle increased but not to a significant level as compared to&#x0D; control cycle. This study also demonstrate a negative linear correlation with CM and BMI in controls&#x0D; cycle, whereas there is no correlation in CC treated cycle .It was concluded from these results that, CC&#x0D; cause a marked reduction in the quality and quantity of cervical mucus.

Relationship Between Cytokines in Ascites and the Severity of Ovarian Hyperstimulation Syndrome: A Case Report

Objective: Determination of the correlation of interleukin-‘ (I L-‘), IL-6, IL-8, tumor necrosis facto r (TNF), and vaseular endothelial growth factar (VEGF) levels in serum and ascites with the severity of ovarian hyperstimulation syndrome (OHSS). Case Report: We present the ca se of a woman with primary infertility who was enrolled in an ovulation induction program. OHSS developed 6 days after artificial insemination with the husband’s sperm. We performed continuous paracentesis and recorded daily concentrations of Il-‘ , IL-6, I L-8, TNF, and VEGF in serum and ascites in an attempt to determine their correlation with the severity of OHSS. Conclusions: Improvement in symptoms and a decreasing amount of ascites were correlated with a decreasing serum concentration of VEGF. [Taiwanese j Obstet Gyneco/2004;43(2):107-109]

Prevention of Multiple Pregnancy During Ovulation Induction

Gonadotrophin ovulation induction is currently used for a heterogeneous group of ovulation disorders and unexplained infertility. In the United States it is reported that multiple pregnancy rates of greater than 30% occur as a result of ovulation induction, most commonly after controlled ovarian hyperstimulation and intrauterine insemination. Treatment strategies to reduce the incidence of multiple pregnancies on ovulation induction programs can be targeted to reducing multiple follicular development and subsequent ovulation by a more aggressive cancellation policy, follicle reduction by fine needle aspiration or conversion to IVF; or dealing with the problem of multiple gestation after it has occurred (i.e., multifetal pregnancy reduction). The procedures and abilities exist to resolve this problem. What is needed are appropriate treatment guidelines and well constructed trials to demonstrate that higher order multiple pregnancies can be substantially reduced and/or eliminated without compromising a couple's chances to conceive.

Prevention of Multiple Pregnancy During Ovulation Induction

Gonadotrophin ovulation induction is currently used for a heterogeneous group of ovulation disorders and unexplained infertility. In the United States it is reported that multiple pregnancy rates of greater than 30% occur as a result of ovulation induction, most commonly after controlled ovarian hyperstimulation and intrauterine insemination. Treatment strategies to reduce the incidence of multiple pregnancies on ovulation induction programs can be targeted to reducing multiple follicular development and subsequent ovulation by a more aggressive cancellation policy, follicle reduction by fine needle aspiration or conversion to IVF; or dealing with the problem of multiple gestation after it has occurred (i.e., multifetal pregnancy reduction). The procedures and abilities exist to resolve this problem. What is needed are appropriate treatment guidelines and well constructed trials to demonstrate that higher order multiple pregnancies can be substantially reduced and/or eliminated without compromising a couple's chances to conceive.

Serum FSH levels in women with polycystic ovary syndrome during ovulation induction using down-regulation and urofollitropin.

To evaluate retrospectively the use of serum FSH levels and to correlate them with follicular growth in a clinical ovulation induction program. Twenty women with infertility due to anovulation associated with polycystic ovary syndrome (PCOS) were studied. The patients were down-regulated with a long GnRH agonist protocol and stimulated with purified urofollitropin, using a low-dose step-up regimen. Repeated serum samples were drawn and transvaginal ultrasound scans were-performed. During the exogenous FSH therapy serum FSH levels resulting in continuous follicular growth were analyzed, as well as the rates of ovulation, pregnancy, cancellation and conversion to in vitro fertilization (JVF). Thirty-two out of fifty treatment cycles led to ovulation, resulting in five term pregnancies. Eight cycles were converted to IVF/embryo transfer due to multiple follicular growth. They resulted in two pregnancies. Ten cycles were cancelled because of impaired follicular growth. The serum FSH levels (median 6 IU/I) resulting in continuous growth of the follicles were relatively stable within patients (variation 15%) but varied considerably between patients (45%). The relationship between FSH dose and serum level was different for lean and obese PCOS patients after subcutaneously injected urofollitropin There seems to be a difference in resorption/metabolism between lean and obese PCOS patients with regard to s.c. injected FSH. The intra-patient coefficient of variation (C.V.) of the serum FSH response level was quite low, as was the C.V. of the FSH dose at the response level. This allowed a more rapid dose adjustment in subsequent cycles. Analysis of serum FSH during induction of ovulation with gonadotropins seems to be of limited value in clinical programs.

The behavior of follicle cysts formed after long-acting gonadotropin-releasing hormone analog administration in patients with polycystic ovarian syndrome

This study was conducted to examine the effect of ovarian cysts that develop after administration of a gonadotropin-releasing hormone (GnRH) analog during an ovulation induction program for patients with polycystic ovarian syndrome. Twenty-eight women received Decapeptyl Continuous Release for 10 cycles starting on day 3 of the menstrual cycle, after exclusion of any ovarian pathology by transvaginal ultrasonography. Fifteen days later ultrasonography was again performed and serum estradiol estimated. Cystic structures ≥ 20 mm in the ovaries were defined as follicle cysts. In three cycles follicle cysts developed and low estradiol levels were measured (Group 1). In another six cycles cysts developed after GnRH analog, and elevated estradiol levels were found (Group 2). In the latter, estradiol decreased 3 to 7 days later, with cyst regression in three cases. Ovulation induction with human menopausal gonadotropin (hMG) was initiated only if the estradiol level was ≤ 20 pg/ml, otherwise induction was postponed until estradiol decreased, disregarding the presence of cysts. When 2 to 3 follicles were ≥ 18 mm, and generally when estradiol levels were < 1500 pg/ml, human chorionic gonadotropin was administered. All the cycles were ovulatory and two women from Group 2 conceived. The development of follicle cysts with low serum estradiol levels after GnRH analog administration represents a benign condition and is not a contraindication for hMG stimulation. In cases with elevated estradiol levels, ovulation induction can be postponed until the estradiol has decreased. Our study revealed good ovulatory and pregnancy rates as a result.

A new system for fallopian tube sperm perfusion leads to pregnancy rates twice as high as standard intrauterine insemination

To evaluate the relative efficacy of a new system for fallopian tube sperm perfusion in comparison with standard IUI in controlled ovarian hyperstimulation (COH) cycles. Prospective randomized trial. Ovulation induction program of a tertiary outpatient care center, Hôpital Antoine Béclère, Clamart, France. We studied 74 infertile women aged 20 to 38 years undergoing 100 cycles of COH from December 1993 to May 1994 only excluding cases of age > 38 years, obstructed or severely damaged fallopian tubes, E2 levels per mature follicle < 250 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration, spontaneous LH surge, and cases of marked sperm abnormalities. Controlled ovarian hyperstimulation was achieved using three types of ovarian stimulation protocols: clomiphene citrate (CC) and hMG (n = 35). hMG alone (n = 35) or GnRH agonist and FSH and hMG (n = 30). Thirty-six hours after hCG administration, patients were assigned randomly to either IUI (group A, n = 50) or fallopian tube sperm perfusion (group B, n = 50). Intrauterine insemination was performed with 0.2 mL of sperm suspension according to a standard technique. Fallopian tube sperm perfusion was performed using a simple and reliable system that ensures a good cervical seal and allows to a pressurized injection of 4 mL of sperm suspension. Feasibility of the fallopian tube sperm perfusion method, clinical pregnancy (presence of gestational sac with heart beats at 6 weeks of amenorrhea), and ongoing pregnancy rates (PRs) (> 12 weeks of amenorrhea), incidence of complications (multiple pregnancies and ovarian hyperstimulation syndrome [OHSS]). Overall, the new fallopian tube sperm perfusion system was simple to handle and well tolerated by patients. In group A, we observed 10 clinical pregnancies (20% per cycle) of which 7 were ongoing (14%). In group B, 20 clinical pregnancies (40% per cycle) of which 17 ongoing pregnancies (34%) were obtained. These differences were statistically significant. The prevalence of twin and three or more sac pregnancies was similar in the two groups (3/10 and 0/10, respectively, in group A, and 5/20 and 2/20, respectively, in group B). No case of moderate or severe OHSS was observed in this series. Our results indicate that the new system for fallopian tube sperm perfusion is not only simple and reliable but also may lead to PRs twice as high as standard IUI in COH cycles.

The luteal phase after ovulation induction with human menopausal gonadotropin and one versus two doses of a gonadotropin-releasing hormone agonist

To use a GnRH agonist (GnRH-a) to induce ovulation after priming with exogenous hMG. Prospective, randomized double-blind protocol using one or two doses of intranasal nafarelin. Office-based ovulation induction program. PATIENTS, INTERVENTIONS: Infertile women not conceiving after use of clomiphene citrate for at least 6 months who were given hMG and nafarelin. No luteal support was given. Serum concentrations of FSH, LH, E2, and P acutely and at 6 days after GnRH-a administration. Duration of the luteal phase was assessed. Ovulation with elevation of both FSH and LH was achieved. The two-dose regimen was more effective than one dose for sustained LH release. Luteal phase P values and luteal phase duration were both less than usually seen with gonadotropin hCG therapy in the absence of luteal phase support. Ovulation induction with GnRH-a after hMG priming produces unacceptable luteal phase cycles in the absence of hormonal support.

Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements

International Journal of Gynecology & ObstetricsVolume 38, Issue 4 p. 336-337 Citations from the literature endocrinology Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements Z Shoham, Z ShohamSearch for more papers by this authorC Di Carlo, C Di CarloSearch for more papers by this authorA Patel, A PatelSearch for more papers by this authorGS Conway, GS ConwaySearch for more papers by this authorHS Jacobs, HS JacobsSearch for more papers by this author Z Shoham, Z ShohamSearch for more papers by this authorC Di Carlo, C Di CarloSearch for more papers by this authorA Patel, A PatelSearch for more papers by this authorGS Conway, GS ConwaySearch for more papers by this authorHS Jacobs, HS JacobsSearch for more papers by this author First published: August 1992 https://doi.org/10.1016/0020-7292(92)91056-TAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume38, Issue4August 1992Pages 336-337 RelatedInformation

Is it possible to run a successful ovulation induction program based solely on ultrasound monitoring? The importance of endometrial measurements

To attempt the monitoring of ovulation induction solely with ultrasound (US). Using serial US measurements to monitor ovulation induction using human menopausal gonadotropin and human chorionic gonadotropin (hCG), in comparison with estradiol (E2) concentrations that became available at the end of each cycle. Specialist Reproductive Endocrine Unit. Twenty hypogonadotropic and 29 ultrasonically diagnosed polycystic ovary patients. Follicular growth, uterine measurements, endometrial thickness, and serum E2 concentrations. Follicular growth, uterine measurements, and endometrial thickness correlated strongly with E2 concentrations (P less than 0.0001). The endometrium on the day of hCG administration was significantly thicker (P less than 0.01) in the conception (n = 27) compared with the nonconception cycles (n = 87), whereas no significant difference were observed in serum E2 concentrations. No pregnancy was observed when hCG had been administered when the endometrial thickness was less than or equal to 7 mm. Midluteal endometrial thickness of greater than or equal to 11 mm was found to be a good prognostic factor for detecting early pregnancy (P less than 0.008). Serial US examinations used alone have proven to be safe and highly efficient. It also has a unique ability to detect pregnancy in the midluteal phase.