[In vitro fertilization outcome in patients with polycystic ovary syndrome treated with GnRH analogue]

Polycystic ovarian syndrome [PCOS] is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization [IVF] protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone [GnRH] agonist protocols versus the GnRH antagonist protocol in PCOS patients. In the present study, we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression, patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol, half or one-third dose depot Decapeptyl [1.875 mg, 1.25 mg] was injected on 21[st] day of previous cycle. In GnRH antagonist cycles, cetrotide 0.25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation [COH] characteristics were analyzed. Basal characteristics including: age, FBS, prolactin, hirsutism, length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation, number of gonadotrophin ampoules and metaphase two [MII] oocytes were found in GnRH antagonist protocol [P<0.001, P<0.001 and P=0.045], while the decrease in biochemical pregnancy [P=0.083] and live birth rate [P=0.169] wasn't significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles [P=0.881]. The incidence of OHSS weren't significantly different between 3 groups [5%, 4.9% and 12.8%, P=0.308]. Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome [OHSS] as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonist.

Ovarian Hyper-Response to Administration of an GnRH-Agonist Without Gonadotropins

Several case reports have indicated that a small subgroup of patients may develop ovarian hyperstimulation following the administration of gonadotropin-releasing hormone agonists (GnRHa) without gonadotropins. However, since only few such cases have been published, it is unclear what course to follow in subsequent cycles after ovarian hyperstimulation in the first cycle using only GnRHa. A 33-yr-old woman was referred to in vitro fertilization for oocyte donation. A depot preparation (3.75 mg) of tryptorelin without gonadotropins induced ovarian multifollicular enlargement with high estradiol level, and was followed by human chorionic gonadotropin administration and oocyte retrieval. In a subsequent cycle of the same patient, a low dose of tryptorelin (0.05 mg) did not induce ovarian hyperstimulation, and resulted in clinical pregnancy. This report shows potential management of ovarian hyperstimulation following the administration of GnRHa without gonadotropins.

Aspectos clínicos e genótipo do receptor do FSH na síndrome de hiperestímulo ovariano induzida por hCG / Clinical aspects and genotype of the FSH receptor in hCG-induced ovarian hyperstimulation syndrome

A síndrome de hiperestímulo ovariano (SHO) pode ocorrer de forma espontânea na gestação ou durante indução da ovulação para fertilização in vitro. Com o objetivo de identificar fatores clínicos e hormonais de risco para a SHO iatrogênica e analisar o papel das variantes alélicas do FSHR na sua etiologia, estudamos 29 pacientes com SHO iatrogênica moderada e grave. Idade < 33,5 anos, FSH basal < 5,2 UI/L e resposta de estradiol > 1757 pg/mL durante a estimulação ovariana atuaram como preditores independentes do risco de desenvolvimento da SHO iatrogênica, sendo a associação dos três fatores capaz de predizer a síndrome com acurácia de 7 por cento. Não foram encontradas mutações nas 29 pacientes com SHO iatrogênica. Entretanto, o alelo Asn680 do polimorfismo Ser680Asn se associou às formas mais graves da SHO iatrogênica / Ovarian hyperstimulation syndrome (OHSS) can occur spontaneously during early pregnancy or as an iatrogenic complication in assisted reproductive medicine. The aim of this study was to identify clinical and hormonal risk factors for iatrogenic OHHS and to evaluate the role of allelic variants of the FSHR in the etiology of this syndrome. We studied 29 patients with moderate and severe iatrogenic OHHS. Age < 33.5 y, basal FSH < 5.2 U/L and estradiol response during ovarian stimulation > 1757 pg/mL were independent risk factors for iatrogenic OHSS and these three factors in association were able to predict the syndrome with accuracy of 78 per cent. We did not find mutations in any patient studied. However, there was a predominance of the Asn680 allele of Ser680Asn polymorphism in patients with the most severe forms of the syndrome...

effect of progesterone after ovarian hyperstimulation on the ultrastructure of mouse endometrium during preimplantation period

The aim of this study was to investigate the morphological and ultrastructural changes of mouse endometrium by daily injection of progesterone, after ovarian hyperstimulation during preimplantation period. Material and NMRI mice, 6-10 weeks old, were initially hyperstimulated using hMG and hCG injection and then daily progesterone injection was performed subcutaneously [1 mg/mouse], thereafter they were mated artificially. 3.5 days after hyperstimulation, the animals were killed by cervical dislocation and the samples were obtained from 13 middle part of uterine horns. Specimens were also obtained from naturally and artifically impregnated control groups. The samples were devided and processed for light [H and E, PAS] and electron microscopic studies. Our results indicated that, daily injection of progesterone after hyperstimulation decreased the height of the epithelium. In the experimental group several fat droplets were seen in the basal part of epithelium. Also intercellular spaces were decreased decidualization was not seen. Results show that daily injection of progesterone after hyperstimulation altered the ultrastructure of endometrial epithelium which resulted in inhibition of decidualization reaction and can affect the uterine receptivity during implantation

Ovarian hyperstimulation syndrome associated with clomiphene citrate

Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chorionic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a differential diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with avoidance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction.

Inducción del parto en embarazos de alto riesgo obstétrico: misoprostol vaginal versus ocitocina / Labor induction in high risk pregnancy: vaginal misoprostol versus oxytocin

Efectuamos ensayo clínico controlado, con 1000 ug de misoprostol intravaginal para borramiento cervical e inducción de parto, en 175 pacientes con embarazos de alto riesgo obstétrico, con score de Bishop bajo 7. Comparamos resultados con 1999 pacientes de un grupo histórico similar, sometido a inducción ocitócica. Los tiempos de lactancia y de trabajo de parto fueron significativamente menores con misoprostol (p<0,05). La polisistolia fue más frecuente con misoprostol (55 por ciento versus 1 por ciento p<0,05). El síndrome de hiperestimulación fue más frecuente con misoprostol (10,2 por ciento versus 0,05 por ciento, p<0.05) pero no representó mayor compromiso de la unidad fetoplacentaria. La cesárea fue menos frecuente con misoprostol (24,6 por ciento versus 33,6 por ciento, N.S). El éxito en 24 horas fue mayor para misoprostol (66,2 por ciento versus 43,7 por ciento p<0,05). Los resultados neonatales fueron similares. Conclusiones: misoprostol produce borramiento cervical preinducción, es más eficiente como inductor de parto y posee similar seguridad comparado con ocitocina. El análisis de riesgos relativos apoya estas conclusiones. Dosis menores de misoprostol podría ser eficientes y aún más seguras

Síndrome de hiperestimulación ovárica severa. Frecuencia, valor de los criterios de riesgo y medidas preventivas / Ovarian hyperestimulation syndrome; frequency. worth of risk criteria and preventive points

La hiperestimulación ovárica es la inducción farmacológica deliberada, de múltiples folículos, en codominancia, cuya finalidad es la de obtner un mayor número de óvulos por ciclo. Complicaciones de ésta son: embarazo múltiple y síndrome de hiperestimulación ovárica severa (SHOS). La frecuencia de SHOS es de 0.5-10 por ciento, definiéndose como condiciones aitrogénica, potencialmente letal, que involucra extravasación masiva plasmática, hemoconcentración, dolor abdominal, ascitis y oliguria a consecuencia del uso de gonadotrofinas exógenas. Análisis estadístico: prueba de chi cuadrada de Pearson. Se analizaron en el IECH del CGOMSA, de 1994-1996, 368 ciclos hiperestimulados: 3 casos de SHOS sin factores de riesgo y 28 casos con factores de riesgo sin SHOS. De los criterios de riesgo, presentaban: estradiol sérico promedio 6643.59 ñ 233320 pg/ml. Número promedio de folículos: 26.6 ñ 6.9, óvulos recuperados por aspiración: 19.32 ñ 9.1. Se formaron 5 grupos según medidas preventivas empleadas: albúmina (13 pacientes), coasting (1 paciente), albumina + coasting (11 pacientes), albúmina + congelamiento de embriones (3 pacientes), congelamiento embrionario (1 pacient). Ninguna de estas pacientes desarrolló el SHOS. Los factores de riesgo descritos permiten adoptar medidas profilácticas oportunamente. A pesar de no desarrollar factores de riesgo, puede presentarse el SHOS

Hiperestimulación ovárica / Ovarian hyperstimulation

Se relata un caso clínico de hiperestimulación ovárica, que provoca una tumoración quística ovárica multilocular por uso de tamoxífeno

Prevençäo da hiperestimulaçäo ovariana pelo uso de agonista de GnRH (leuprolide) como indutor da ruptura folicular / Prevention of the ovarian hyperestimulation by the using of GnRH (leuprolide) agosnist for the triggering ovulation

Um grupo de 12 pacientes com infertilidade e tratados com hMG em preparaçäo para inseminaçäo intra-uterina ou para correçäo de anovulaçäo, tiveram a ovulaçäo desencadeada pela descarga de LH endógeno, através da administraçäo de 2,5mg subcutâneo de acetato de leuprolide, por terem sido consideradas de alto risco para desenvolverem a síndrome de hiperestimulaçäo ovariana (SHO). Com a utilizaçäo do agonista do GnRh a rotura folicular ocorreu em 10 das 12 pacientes (83,33 por cento) e a SHO nos graus moderado e severo näo foi observada em nenhuma paciente apesar das altas taxas pré-ovulatórias de estradiol (µ = 2.078,17pg/ml), do grande número de folículos < 15mm (µ = 10,0) e da presença de um baixo fator de sincromia ovariano (µ = 0,40).