Efficacy and safety of human chorionic gonadotropin combined with human menopausal gonadotropin and a gonadotropin-releasing hormone pump for male adolescents with congenital hypogonadotropic hypogonadism / 中华医学杂志(英文版)

BACKGROUND@#Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH.@*METHODS@#Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0-3 months) and a follow-up phase (3-12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance).@*RESULTS@#Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P  0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference.@*CONCLUSIONS@#The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.

Trigger effect of hMG and hCG in the treatment of unexplainable non-obstructive azoospermia / 中华男科学杂志

Objective@#To investigate whether the trigger effect of human menopausal gonadotropins (hMG) and human chorionic gonadotropins (hCG) attributes to the treatment of unexplainable non-obstructive azoospermia (NOA).@*METHODS@#We retrospectively analyzed the clinical data about 282 cases of unexplainable NOA treated in the Maternity and Child Health Hospital of Guizhou Province from January 2010 to May 2017. All the patients underwent trigger treatment by intramuscular injection of hMG at 75 IU 3 times a week for 2 weeks, followed by hCG at 2 000 IU twice a week for another 2 weeks, and meanwhile took vitamin E, Levocarnitine and Tamoxifen as an adjunctive therapy. The treatment lasted 3－12 months.@*RESULTS@#Fifty-eight of the 255 patients that completed the treatment were found with sperm in the semen after treatment, all with severe oligoasthenospermia. Forty-seven of the 58 cases received assisted reproductive technology (ART), of which 18 achieved clinical pregnancy. Semen centrifugation revealed no sperm in the other cases, of which 6 were found with epididymal sperm at epididymal and testicular biopsy after treatment and 3 of them achieved clinical pregnancy after ART. Sperm was found in the semen or at epididymal or testicular biopsy in 64 of the patients after treatment, with an effectiveness rate of 25.1%.@*CONCLUSIONS@#Trigger treatment by injection of hMG and hCG combined with adjunctive oral medication has a certain effect on unexplainable NOA.

Controlled ovarian stimulation with r-FSH plus r-LH vs. HMG plus r-FSH in patients candidate for IVF/ICSI cycles: an RCT

Background: Different combination of gonadotropin preparation has been introduced with no definite superiority of one over others in vitro fertilization [IVF], but individualized regimens for each patient are needed

Objective: The aim of the present study was to investigate the effect of controlled ovarian stimulation with recombinant- follicle stimulating hormone [r-FSH] plus recombinant-luteinizing hormone [rLH] versus human menopausal gonadotropin [HMG] plus r-FSH on fertility outcomes in IVF patients

Materials and Methods: This is a randomized clinical trial study that was performed from October 2014-April 2016 on 140 infertile patients with a set of inclusion criteria that referred to infertility clinics in Vali- asr and Gandhi Hospital in Tehran. The women were randomly divided into two treatment groups. The first group [n=70] received rFSH from the second day of cycle and was added HMG in 6[th] day and the 2[nd] group [n=70], received rFSH from the second day of cycle and was added recombinant-LH in 6[th] day. Then ovum Pick-Up and embryo transfer were performed. In this study, we assessed the outcomes such as; chemical and clinical pregnancy rate, live birth and abortion rate

Results: Number of follicles in ovaries, total number of oocytes or M[2] oocytes and quality of fetuses has no significant differences between two groups [p>0.05]. Total number of fetuses were significantly higher in patients who received rFSH + HMG [p=0.02]. Fertility outcomes consisted of: live birth rate, chemical pregnancy and clinical pregnancy rate were higher in rFSH + HMG group in comparison to rFSH +r-LH group [p<0.05]

Conclusion: It seems that in IVF patients, HMG + rFSH used for controlled ovarian hyperstimulation have better effects on fertility outcomes, but in order to verify the results, it is recommended to implement studies on more patients

Diverticulitis perforada en seis mujeres posmenopáusicas / Perforated diverticulitis six postmenopausal women

Objetivo: Comunicar la perforación diverticular del colon ocurrida en 6 mujeres menopáusicas en una consulta privada de ginecología durante el período de 1980 a 2005 en la Policlínica Maracaibo, Maracaibo. Venezuela. Casos clínicos. Seis mujeres posmenopáusicas con antecedentes de cirugía previa abdominal que acudieron por dolor pélvico, secreción vaginal y signos inflamatorios a quienes se les realizó el diagnóstico de enfermedad diverticular del colon perforada. No hubo obstrucción o hemorragias, pero sí la formación de abscesos y fistulas. Resultados: De las 6 pacientes, 5 que recibieron tratamiento médico, quirúrgico o combinados, evolucionaron satisfactoriamente. En una se desconoce el curso de la enfermedad. Conclusión: La enfermedad diverticular del colon, sintomática o asintomática (diverticulosis) y sus formas de complicaciones (diverticulitis, hemorragia, absceso, perforación, plastrón) son frecuentes en la mujer que envejece y no parece existir relación con el déficit estrogénico que acompaña a la menopáusica, del momento de su aparición o del uso de terapia de reemplazo hormonal; sin embargo, en esta serie todas tenían antecedentes de cirugía previa y adherencias que pudieran haber facilitado la perforación intestinal. El diagnóstico a menudo es clínico, radiológico o endoscópico. El tratamiento inicial es medicamentoso pero a menudo puede llegar a ser quirúrgico, realizándose colectomía parcial en su mayoría.

Objective: To report the diverticular perforation of the colon in 6 menopausal women in a private gynecology clinic for a period of 1980 to 2005 in the Policlinica Maracaibo, Maracaibo. Venezuela. Clinical cases. Six postmenopausal women with a history of prior abdominal surgery who have had pelvic pain, vaginal discharge and signs of abdomino-pelvic inflammation who underwent diagnosis of perforated diverticular disease of the colon. There was no obstruction or bleeding, but the formation of abscesses and fistulas . Results: Of the 6 patients, 5 were receiving medical, surgical or combined treatment evolved satisfactorily. In a patient the course of the disease is unknown. Conclusion: Diverticular disease of the colon in asintomatic or sintomatic forms (diverticulosis) and it´s complications (diverticulitis, bleeding, abscess, perforation and plastron) are common in aging women and no relationships with estrogen deficiency accompanying menopause, the time of onset or the use of hormone replacement therapy, but in this series all had previous surgery and adhesions that may have facilitated the intestinal perforation. The diagnosis is often clinical, radiological and endoscopic. The initial treatment is medical, but often should be surgical: partial colectomy performed mostly.

Pregnancy rate following luteal phase support in Iranian women with polycystic ovarian syndrome

To assess the efficacy of luteal phase support [LPS] using intravaginal progesterone [P] on pregnancy rate in Iranian women with polycystic ovarian syndrome [PCOS] who used a combination for ovulation induction consisting of letrozole or clomiphene citrate [CC] and human menopausal gonadotropin [HMG]. This was a randomized clinical trial undertaken in a fertility clinic in Kashan, Isfahan Province, Iran. A total of 198 patients completed treatment and follow up. Base on chosen ovulation induction programs, they were divided into two following groups: i. CC group [n=98] used a combination consisting of CC [100 mg x 5 day] and HMG [150 IU x 5 day] and ii. letrozole group [n=100] used a combination consisting of letrozole [5 mg x 5 day] and HMG [150 IU × 5 day]. After human chorionic gonadotropin [hCG] administration [5000 IU], the patients [n=122] who randomly received intravaginal P [Cyclogest, 400 mg daily] were included in LPS group, while the rest [n=123] were included in non-P cycles group. The outcome was the comparison of chemical pregnancy rate between the groups. Our findings showed that LPS was associated with a 10% higher pregnancy rate than in non-P cycles, although this difference did not reach statistical significant [p=0.08]. LPS improved pregnancy rate in both CC [4%] and letrozole [6%] groups. In addition, patients who used letrozole for ovulation induction along with intravaginal P showed higher pregnancy rates than CC group. Administration of vaginal P for LPS may improve the pregnancy rate in women with PCOS using letrozole or CC in combination with HMG for ovulation induction [Registration Number: IRCT201206072967N4]

[Quantitative assessment of mouse embryo development yielded from in vitro fertilization of ovulated mature oocytes after ovarian stimulation using human menopausal gonadotropin and Estradiol valerate]

Estradiol plays an important role in folliculogenesis and its developmental stages of embryo. This study was done to determine the quantitative assessment of mouse embryo development yielded from in vitro fertilization of ovulated mature oocytes after ovarian stimulation using human menopausal gonadotropin [HMG] and Estradiol valerate [E2]. In this experimental study, 40 female NMRI mice were allocated into two groups. Control and treatment groups received HMG alone [10 IU/mouse] and a combination of HMG and E2 [1microg/mouse] in single dose manner, respectively. Following the induction of ovulation by HCG, the oocytes collected and morphologically evaluated. MII oocytes for in vitro fertilization [IVF] were transferred into medium containing capacitated and incubated sperm derived from male NMRI mice. The yielded embryos subsequently transferred into developmental medium for reaching to the blastocyst stage. The difference between the mean percentage of yielded oocytes and healthy MII oocytes in the control and treatment groups was not significant. The percentages of the fertilized oocytes reached to two-cells was 34.22 +/- 21.87 and 36.83 +/- 20.68 in control and treatment groups, respectively. The percentages of the blastocys stages of embryos was 49.41 +/- 26.5 and 62.02 +/- 30.11 in control and treatment groups, respectively. The addition of estradiol to HMG as an ovarian stimulator can not increase the rates of yielded MII oocytes and embryonic development

Medicalização dos desvios de comportamento na infância: aspectos positivos e negativos / Medicalization of deviant behavior in children: positive and negative features / Medicalización de los desvíos de comportamiento en la infancia: aspectos positivos y negativos

A medicalização dos comportamentos desviantes na infância é apresentada como uma estratégia eficaz para lidar com crianças que apresentam algum tipo de dificuldade, sem que, no entanto, as dificuldades desse processo sejam claramente expostas. O processo de medicalização, porém, é complexo e apresenta muitos resultados negativos. Dentro desse contexto, nosso objetivo é refletir sobre essas dificuldades. Primeiramente, apresentamos como se dá a relação entre medicalização e infâcia. Em seguida, discutimos alguns aspectos considerados positivos e negativos da medicalização. Para finalizar, consideramos que enquadrar uma criança em um diagnóstico psiquiátrico apresenta sérias consequências indesejáveis, e acaba sendo mais útil para a sociedade e para o entorno da criança do que para a própria criança.

The medicalization of deviant behaviors during childhood is usually presented as an effective strategy to deal with troublesome children, but the problems associated with medicalization are not frequently exposed. Even so, the process of medicalization is complex and may present many negative results. In this context, our aim is to discuss these difficulties. First, we present an overview of the relationship between medication and childhood. After that, we discuss some positive and negative aspects of medicalization. Finally, we conclude that framing a child under a psychiatric diagnosis is often more beneficial for the society and the child's surroundings than it is for the child herself.

La medicalización de los comportamientos desviantes en la infancia es presentada como una estrategia eficaz para manejar niños que presentan algún tipo de dificultad, sin que, sin embargo, las dificultades de ese proceso sean claramente expuestas. El proceso de medicalización, sin embargo, es complejo y presenta muchos resultados negativos. En ese contexto, nuestro objetivo es reflexionar sobre esas dificultades. Primero, presentamos como se da la relación entre medicalización e infancia. Enseguida, discutimos algunos aspectos considerados positivos y negativos de la medicalización. Para finalizar, consideramos que encuadrar un niño en un diagnóstico psiquiátrico presenta serias consecuencias indeseables, y acaba siendo más útil para la sociedad y para el entorno del niño de lo que para el propio niño.

Efficacy of combined clomiphene citrate and gonadotrophin therapy

To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Observational analytical study. June 2009 to June 2010. In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin [CC - hMG] regime and maximum of three treatment cycle were given. Out of 100 patients in our study, 74% [2/3 rd] patients were less than 30 years of age and 26% [1/3rd] were between 30 - 40 yrs of age. Primary infertility was seen also in 2/3rd of patients [73%] and secondary infertility in remaining 1/3rd [27%] of patients. Polycystic ovary [PCO] was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown [unexplained infertility]. on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day [12.41 day] of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8% of patients refused further treatment and 4% did not report back. Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients

Modified super-long down-regulation protocol improved the outcome of in vitro fertilization-embryo transfer in infertile patients / 中南大学学报(医学版)

OBJECTIVE@#To investigate the outcome of in vitro fertilization and embryo transfer (IVF-ET) in special infertile patients following modified super-long down-regulation protocol combined with human menopausal gonadotropin (HMG) stimulation.@*METHODS@#Ninety-nine special patients (42 with endometriosis, 35 with PCOS, and 22 with insufficient down-regulation) who underwent modified super-long down-regulation protocol in 2008 were retrospectively analyzed. Gonadotropin releasing hormone analogues (GnRHa, 1.5 mg) was injected intramuscularly in mid-luteal phase twice and HMG was started 25 days later after the second GnRHa injection. Conventional IVF-ET was performed as routine procedure. The clinical outcomes were compared with those of 122 similar patients in the same period.@*RESULTS@#After modified super-long down-regulation, (1) in endometriosis patients, the average gonadotropin (Gn) used was (32.33 +/- 15.11) ampoules, duration of medication was (10.57 +/- 1.88) days, the progesterone (P) level on hCG day was (0.78 +/- 0.44) microg/L, and the clinical pregnancy rate (CPR) was 73.8%; (2) in PCOS patients, the average Gn used was (28.57 +/- 12.07) ampoules, the duration of medication was (11.71 +/- 2.07) days, the P level at hCG day was (0.65 +/- 0.39) microg/L, and the clinical pregnancy rate was 65.7%; (3) in insufficient down-regulation patients, the average Gn used was (26.22 +/- 12.07) ampoules, the duration of medication was (10.01 +/- 1.77) days, the P level at hCG day was (0.71 +/- 0.50) microg/L, and the clinical pregnancy rate was 72.7%. Compared with patients using regular down-regulation protocol, the clinical pregnancy rate was improved significantly and the cost decreased obviously. The clinical pregnancy rate significantly improved compared with that of routine long down-regulation groups.@*CONCLUSION@#Revised super-long protocol plus HMG is a cost-effective controlled ovary hyperstimulation (COH) regimen for infertile patients with endometriosis, PCOS and insufficient down-regulation.

Depressão na mulher / Depression in women

A especial atenção que é dada à mulher quando se aborda a depressão justifica-se primordialmente pela maior prevalência deste transtorno no sexo feminino. As pacientes com transtornos depressivos habitualmente freqüentam os serviços de atendimento médico primário. Pode-se dizer, então, que a depressão na mulher faz parte do cotidiano clínico do médico em geral. Apesar disso, menos da metade dessas pacientes recebe tratamento mínimo adequado. Reconhecimento e tratamento adequados dos casos não só contribuem para a prevenção de complicações e novos episódios depressivos como para uma melhor resposta aos tratamentos clínicos e maior adesão terapêutica. Sendo assim, o estudo da depressão na mulher nos parece fundamental para a boa prática médica. Descreveremos neste artigo os aspectos clínicos particulares da mulher e as relações entre a depressão e o ciclo de vida feminino.

Cause of infertility and response to ovulation induction drugs -a hospital based study

This study was performed to investigate the most common causes of infertility and the choice of the more suitable and more easily achievable treatment. A detail history and physical examination were done for all the patients who were referred to Mahdishahr Hospital with chief complaint of infertility from October 2004 to September 2005. Patients who failed to become pregnant after unprotected intercourse for 1 year were chosen as the criteria for to this study. At first semen analysis was performed for all couples. Among the patients who were complaining of oligomenorrhea, galactorrhea or in their laboratory test hyperprolactinemia was found, the treatment started with ovulation induction drugs. In all these groups of patients endometrial thickness and the size of follicles was measured by sonography in the 13th days of their period, among the patients with two or four follicles bigger or equal to 18 mm [If they were treated with clomiphene citrate, bromocriptine or dexamethasone] or when two or four follicles were bigger or equal to 16 mm [if they were treated with Human Menopausal Gonadotropin [HMG] and endometrial thickness or equal to 6mm and Human Chorionic Gonadotropin [HCG] Ampoule [10000 unit] was injected. All these patients were followed to control their response to the treatment and during the whole period of pregnancy. In the other patients hystrosalpingography or post-coital test used for finding the cause of infertility. In 57% of the patients [40 persons] there were symptoms of oligomenorrhea, galactorrhea or hyperprolactinemia. For these patients ovulation induction is started by clomiphene citrate, bromocriptine, dexamethasone and HMG. 27 cases [67%] of them conceived. Term pregnancy with normal child in 20 cases, abortion in 5 cases and unexpected preterm birth both in 21 weeks of pregnancy happened. Twenty eight percent [20 cases] of cause of infertility was male factor. 7% [5 cases] and 1/4% [lease] of causes were tubal and cervical factors respectively. It's concluded that the most common cause of infertility in Mahdishahr is the ovulatory factor. Other causes respectively are male-factor, tubal, cervical, and other factors. Besides, in a large percent of these patients who were treated by ovulation induction pregnancy happend which is noticeable

Evaluation of spontaneous abortion and multiple gestation rates in patients undergoing ovulation induction and intrauterine insemination

Cohort analytic study to assess risks of spontaneous abortion and multiple gestations in patients undergoing induction of ovulation. In this study we compared the spontaneous abortion and multiple gestation rates of 361 cases that they were undergoing ovulation induction with clomiphene citrate alone or with human menopausal gonadotropin and they were candid for intrauterine insemination with a control group consisting of 350 cases who were conceived naturally. We matched the two groups with regard to age and weight. Abortion considered as spontaneous termination of pregnancy below 20 week of pregnancy and multiple gestation diagnosis was based on sonography in any time during pregnancy. We used chi-square test for statistical analysis and determination of differences between groups. Intrauterine insemination was performed in 361 cases and pregnancy happened in 70 cases [19/4%] of study group. The spontaneous abortion happened in 10 cases [14/2] and in control group among 350 cases spontaneous abortion happened in 50 cases [14/2]. Statistical analysis with chi-square test revealed that there isn, t Significant statistical difference between the study group and control group. In regard to multiple gestations there were 1 cases of multiple gestations in study Group. Six cases were twin and one of them was quadruplet. In control group there were 6 cases of multiple pregnancies, 5 cases were twin and one of them was triplet. Statistical analysis with chi-square test showed that there is a significant statistical difference between the study group and control group. In this study there was not significant statistical difference in abortion rate between the patients who they were undergoing ovulation induction/intrauterine insemination and normal fertile group but there was significant statistical difference in multiple gestations between two groups

comparative study of mixed urinary gonadotrophins regimens

To evaluate the value of using mixed protocol of urinary gonadotrophins for an ICSI/TESE program. Adam International Clinic. Normo-ovulatory women whose partners suffer from severe oligospermia or azospermia were divided into two groups: Group I: Received Fostimon/Merional and Group II received Fostimon/Menogon. All cases underwent ICSI/TESE program and followed-up till clinical pregnancy rate. There was a statistical significant difference in favor of Fostimon/Menogon protocol regarding the number of good quality embryos together with cryo good embryos. More importantly, there was statistically significant difference regarding clinical pregnancy rate in Favor of Fostimon/Menogon protocol. [49/120Vs 33/124]. Mixed protocols were also achieving better results than menogon alone or merional alone. Based on the available results achieved and according to the two cell theory, mixed gonadrotophins using Fostimon/Menogon has become the preferred protocol of ovarian simulation in our ICSI/TESE program

Ausência de resposta à estimulação ovariana para técnicas de reprodução assistida / Non-response to ovarian simulation for assisted reproductive techniques

Foram avaliados retrospectivamente 476 ciclos de TRA, em 476 mulheres eumenorreicas e com dosagem de FSH basal menor ou igual 15UI/mL. Em 476 ciclos, houve 33 cancelamentos (6,9%) por ausência de resposta (nenhum folículo maior que 10 mm). Todas as pacientes foram submetidas de 7 a 10 dias de estimulação ovariana antes do cancelamento. Nossos resultados mostraram que 6,9% de pacientes submetidas a TRA não apresentam resposta à estimulação ovariana com gonadotropinas.

Comparison between the effect of coasting when used with both GNRH antagonist and GNRH agonist protocols in control of serum estradiol in prevention of severe ovarian hyperstimulation syndrome

Ovarian hyper stimulation syndrome [OHSS] is an iatrogenic potentially life threatening condition resulting from excessive ovarian stimulation. Coasting has been the most commonly used technique and has become the first choice for prevention of severe OHSS in high risk patients, however, prolonged coasting was found to have adverse prognosis. Combining both the use of a GnRH antagonist protocol, and coasting, and comparing it with coasting in long GnRH agonist protocol in controlling the serum Estradiol [E2] level in patients at risk of developing OHSS. Retrospective randomized study. Private infertility Center. 61 patients were included in the study all with the risk of developing severe OHSS, in which coasting was performed once the serum E2 < 3500 pg/ml, with < 20 follicles, with the leading follicle diameter 16 mm. They were divided into 2 groups according to the stimulation protocol used. Group A [n=33] [Flexible GnRH antagonist HMG-FSH protocol], and Group B [n=28] [Long GnRH agonist HMG-FSH protocol]. Primary outcome measures were the number of stimulation days, E2 level before starting to coast, peak E2 level reached, number of days for E2 to drop to a safe level, number of coasted days, E2 level on day of HCG, and percentage of E2 drop from the peak level. Secondary measures were number of oocytes retrieved, number of high quality embryos, and pregnancy rate, and incidence of severe OHSS in both groups. Coasting is more efficient with the GnRH antagonist protocols, than with the GnRH agonist protocol, without any effect on the pregnancy outcome. This is caused by the better pituitary suppression achieved by the antagonist that ensures E2 drop to safe levels, besides its prevention of premature luteinization that is common in cases of prolonged coasting

Effect of traditional Chinese herbs combined with low dose human menopausal gonadotropin applied in frozen-thawed embryo transfer / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assess embryo implantation rate (IR) and pregnancy rate (PR) in women who received Bushen Wengong Decoction (BSWGD), a Chinese herbal formula, combined with low dose of human menopausal gonadotropin (hMG) prior to frozen-thawed embryo transfer (FET).</p><p><b>METHODS</b>A total of 262 subjects (674 transferred embryos) who received FET were analyzed retrospectively. In them, 122 women were under 30 years old, 106 between 30 - 35 years and 32 over 35 years. The 85 subjects with normal ovulation were assigned to Group A, the natural menstruation cycling group, on whom no pre-transfer treatment was applied. The other 177 subjects with abnormal ovulation were assigned to Group B, and subdivided, according to the pre-transfer treatment they received, into three groups, Group B1 (50 cases) received BSWGD, Group B2 (58 cases) received hMG and Group B3 (69 cases) received both BSWGD and low dose hMG. The IR and PR of FET in the four groups were compared, and the effect of the embryo cryotime on PR of FET were compared also. Besides, the influencing factors to FET were analyzed.</p><p><b>RESULTS</b>IR and PR were significantly higher in all age sects of Group B3 than those in Group A, showing significant difference (P< 0.05). IR and PR in subjects in age sects of <30 years and > 35 years in group B3 were significantly higher than those in Group B1 ( P<0.05), but no significant difference was shown in the two parameters between Group B 2 and Group B3 (P>0.05). PR in the subjects who received embryos with cryo-time of > 200 days was significantly lower than that in those with cryo-time of < 100 days ( P<0.05). Embryo cryo-time, endometrial thickness, use of BSWGD and use of hMG were of significance in FET ( P 0.05).</p><p><b>CONCLUSION</b>A programmed cycle of BSWGD combined with low dose of hMG could improve the embryo IR and PR of FET. Embryo cryo-time, endometrial thickness, and the use of BSWGD and hMG are of significance for FET.</p>

Comparação entre menotropina altamente purificada e folitropina alfa para hiperestimulação ovariana controlada após supressão hipofásica nos ciclos de ICSI / A comparison of menotropin, highly-purified menotropin and follitropin alfa for controlled ovarian stimulation after pituitary down-regulation in ICSI cycles

OBJETIVO: Comparar a eficácia clínica entre três tipos de gonadotrofinas para a estimulação ovariana após a supressão hipofisária nos ciclos de ICSI. MATERIAL E MÉTODOS: Analisou-se retrospectivamente 865 ciclos consecutivos de ICSI envolvendo supressão hipofisária previamente à hiperestimulação ovariana controlada (HOC). A HOC foi realizada com menotropina (HMG: Menogon, Ferring; n=299), menotropina altamente purificada (HMG-HP: Menopur, Ferring; n=330) e FSH recombinante (r-hFSH: Gonal-F, Serono; n=236). Os protocolos laboratoriais e clínicos permaneceram inalterados ao longo do tempo, os últimos diferindo apenas no tipo de gonadotrofina utilizada, que foram introduzidas seqüencialmente na prática clínica, iniciando com o HMG, seguido pelo HMG-HP, e finalmente o r-hFSH. Os parâmetros de interesse primário foram a taxa de nascidos vivos e as doses totais de gonadotrofina utilizadas por ciclo, por gestação e por nascido vivo. Análise comparativa foi realizada com ANOVA, Kruskal-Wallis e Chi-quadrado quando apropriado. RESULTADOS: As taxas de nascidos vivos não foram significativamente diferentes entre os grupos HMG (26,4%), HMG-HP (34,6%) e r-hFSH (32,4%; p igual a 0,09). A dose total de gonadotrofina utilizada por ciclo foi significativamente superior nos grupos HMG (2.685±720UI) e HMG-HP (2.903 mais ou menos 867UI) em comparação com o r-hFSH (2.268 mais ou menos 747UI; p menor que 0,001). Diferenças relativas de 15,7% e 45,2%, e de 11% e 19,8% foram observadas a favor do r-hFSH em comparação ao HMG e HMG-HP, respectivamente, no que se refere às quantidades de gonadotrofina necessárias para se obter cada gestação e cada nascido vivo. CONCLUSÕES: Taxas de nascidos vivos similares foram obtidas com HMG, HMG-HP e r-hFSH quando utilizadas para HOC após supressão hipofisária nos ciclos de ICSI. Doses totais significativamente menores de r-hFSH foram utilizadas por ciclo em comparação às menotropinas. Para cada nascido vivo, quantidades consideravelmente maiores d...

Effect of the oral contraceptive pill on patients undergoing controlled ovarian hyperstimulation

This is a retrospective analysis of 89 patients who were undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in the Fertility Management Unit of the Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies. Twenty-eight patients (Group A), who did not receive oral contraceptive pills prior to controlled ovarian hyperstimulation (COH) were compared with 61 patients in Group B treated with oral contraceptive pills for two months prior to undergoing COH assisted reproduction using the long protocol. The number of follicles, oocytes, estimated oestradiol levels on the day of administration of human chorionic gonadotrophin (hCG), pregnancy rates, miscarriage rates and the incidence of patients who developed ovarian hyperstimulation syndrome (OHSS) were the main outcome measures. The mean age and haematocrit were the same in each group. The number of follicles retrieved tended to be higher in Group A than in Group B (median 8 versus 6, p = 0.06) with significantly more oocytes being retrieved in Group A than Group B (p < 0.05). There were no statistically significant differences between the two groups in oestradiol levels, the proportion of patients with polycystic ovarian disease, the proportion of women who developed ovarian hyper-stimulation syndrome or pregnancy outcomes. There was no difference between the groups in measures of clinical severity of OHSS. In a logistic regression model the significant predictors of OHSS were haematocrit and oestradiol levels. There appeared to be no significant clinical benefit in administering oral contraceptive pills for two months to patients prior to COH

Localization and activity of mouse endometrial alkaline phosphatase after hyperstimulation and progesterone injection at the implantation time

The activity of mouse endometrial alkaline phosphatase after hyperstimulation and progesterone injection at the implantation time Alkaline phosphatase [ALP] of endometrium may play a critical function in the development and implantation of embryo. The aim of this study was to determine the localization of endometrial ALP activity after hyperstimulation and progesterone injection. Thirty adult female NMRI mice were hyperstimulated using human menopasual gonadotropic hormone and human chorionic gonadotropic hormones [hCG]. Then, daily injections of progesterone [1 mg/mouse] were performed in one hyperstimulated group. Animals were sacrificed by cervical dislocation 4.5 day after hCG injection. Tissues were obtained from 1/3 middle part of uterine horns and used for enzyme histochemistry and morphological studies. The samples were cryosectioned at -30°C and the enzyme histochemistry was carried out by azo-coupling technique using alpha naphtol phosphate as substrate. In the control groups, the ALP activity was localized on the apical and basal border. Cytoplasm of glandular and surface epithelium was stronger than the other hyperstimulated groups on the day four of pseudoprgnancy. Our results showed that the ALP activity was decreased after ovarian hyperstimulation and progesterone injection and the defect of implantation of embryo after hyperstimulation and embryo transfer in animals may be due to the reduction of enzyme activity

Laparoscopic ovarian electrocautery versus human menopausal gonadotrophin in the management of infertility due to polycytic ovarian disease

Either of electrosurgical laparoscopic ovarian drilling [LOD]or gonadotropin [hMG] therapy is the second choice for induction of ovulation in clomiphene citrate resistance patients with polycystic ovarian disease, this study aim to compare both modalities [LOD and hMG]. Comparative study Bab El-Sharia University Hospital. Seventy five patients with anovulatory infertility due to PCOD were recruited from infertility clinic, the patients subdivided into two groups : first group [40 patients] treated with hMG, and second group [35 patients] subjected to LOD. The results of menstrual pattern, hormonal response, ovulation pattern and occurrence of pregnancy were compared between both modalities of treatment. Improved menstrual pattern 90% versus 70%, ovulation rate 79% versus 75%, pregnancy rate 40% versus 32.5% in LOD and hMG treated groups respectively. The rate of twin pregnancy was 7% in LOD treated group versus 23% in hMG treated group. No abortion occurred with LOD compared with 23% abortion rate in hMG treated group. The outcome of pregnancies in LOD was 100% healthy live birth compared with 76.9% in hMG treated group. NO hyperstimulation associated with LOD. The results with LOD are some what superior to the results with hMG