Safety and effectiveness of diclofenac sodium in assisted reproduction treatment: a randomized prospective double-blind study.

Insufficient information is available on the safety and efficacy of the potent analgesic diclofenac sodium administered following oocyte retrieval. The present study aims to address this issue. A randomized prospective double-blind study of 381 assisted conception cycles was performed. Patients included were <40 years old with early follicular FSH <10 IU/l and no medical contraindications to receiving non-steroidal anti-inflammatory drugs. Patients were randomized to either receive diclofenac sodium suppository 100 mg (Voltarol) at the end of oocyte retrieval or nothing. Effect of diclofenac sodium on outcome was assessed. A total of 187 IVF/intracytoplasmic sperm injection cycles were randomized to receive diclofenac sodium at the end of oocyte retrieval and 194 cycles did not receive diclofenac sodium. The number reaching embryo transfer in the two groups was 185 and 190 respectively. The implantation and pregnancy rates per embryo transfer were 25.3% and 38.9% in the Voltarol group and 21.6% and 32.6% in the group randomized not to receive Voltarol. Use of diclofenac sodium did not significantly compromise the implantation and pregnancy rates. Patients randomized to receive diclofenac sodium had statistically significantly reduced pain scores prior to discharge (P = 0.030). Administration of diclofenac sodium for analgesia following oocyte retrieval did not compromise treatment outcome.

Levonorgestrel hormone releasing intrauterine system (Mirena) as a contraceptive in egg donors: case report.

We report the safe use of levonorgestrel hormone releasing intra uterine system (Mirena) as a contraceptive in egg donors during a treatment cycle. In the first case report, a 29-year-old egg donor using the Mirena coil for contraception and two egg recipients, aged 41 years and 32 years respectively underwent standard IVF treatment, oocyte retrieval in the egg donor and in vitro fertilization followed by embryo transfer in the recipient. The outcome of IVF cycle using donor eggs was satisfactory with successful pregnancy in the egg recipient. The second case involved a 34-year-old egg donor using the Mirena coil and a 44-year-old recipient. Our findings suggest that egg donors can safely use the (Mirena) as a contraceptive device during treatment, without compromising follicular development and oocyte quality.

A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome.

OBJECTIVE: To determine the effect of exogenous LH dosage on IVF outcome. DESIGN: Single-blinded (assessor-blinded) study with random assignment of treatment groups. SETTING: Human Assisted Reproduction Unit, Rotunda Hospital, Dublin, Ireland. PATIENT(S): Infertile normogonadotropic women undergoing their first cycle of IVF were studied. INTERVENTION(S): Patients were randomized to gonadotropin drugs with varying doses of LH per ampule: recombinant FSH containing no LH (group 0, n = 39), urinary FSH containing <1 IU of LH per ampule (group 1, n = 30), hMG containing 25 IU of LH per ampule (group 25, n = 30), and hMG containing 75 IU of LH per ampule (group 75, n = 29). The FSH dose was kept constant at 75 IU per ampule. A long-protocol GnRH-analog regimen was used. MAIN OUTCOME MEASURE(S): Dose and duration of gonadotropin stimulation, follicle and oocyte numbers, implantation rate, and pregnancy rate. RESULT(S): The median duration of ovarian stimulation; median number of gonadotropin ampules used; serum E2 levels; and numbers of follicles, oocytes, and embryos were similar among the four groups. Median LH levels on the day of hCG administration, however, differed significantly. Live birth rates per cycle differed markedly, but statistical significance was not achieved (23%, 7%, 20%, and 31% for groups 0, 1, 25, and 75, respectively). A significant trend in implantation rates was noted with increasing LH dosage of the urinary preparations (19%, 10%, 18%, and 28% for groups 0, 1, 25, and 75, respectively). CONCLUSION(S): In the present study, although the residual endogenous LH after down-regulation was adequate for ovarian response and E2 synthesis, the addition of exogenous LH improved implantation. An FSH/LH ratio of 75/75 IU per ampule appeared to be the optimum dose.