ABSTRACT
OBJECTIVE: To evaluate the rate of multiple pregnancies in intrauterine insemination cycles stimulated with a minimal dose of recombinant follicle stimulating hormone (rec-FSH). DESIGN: Retrospective study. SETTING: University Medical Center. POPULATION: A total of 1256 patients underwent 3219 consequent intrauterine insemination cycles with minimal ovarian stimulation. METHODS: Patients received 50 or 75 IU of rec-FSH from day four to day seven. The dose was adjusted according to oestradiol (E(2)) levels in order to achieve a maximum of two follicles on the day of hCG administration. MAIN OUTCOME MEASURES: Peak E(2) levels, the number of follicles >15 mm and pregnancy rates were calculated. The predictive value of E(2) levels for multiple gestations was also estimated. RESULTS: Of 3219 cycles, 334 resulted in pregnancies (10%). Of these, 238 (91%) were singletons, 28 (8%) twins and 1 (0.3%) was a triplet. The cumulative overall pregnancy rate was 43%. Patients over 40 years old had a significantly lower pregnancy rate per cycle and overall live birth rate (P < 0.05). Most pregnancies (83%) occurred during the first three cycles. Pregnancy rates per cycle varied from 8% for tubal factor to 14% for anovulation infertility. CONCLUSIONS: Minimal FSH stimulation in intrauterine insemination cycles may reduce the rates of twins and high order multiple pregnancies without affecting overall pregnancy rates.
Subject(s)
Follicle Stimulating Hormone/administration & dosage , Infertility, Female/therapy , Insemination, Artificial, Homologous/methods , Ovulation Induction/adverse effects , Pregnancy, Multiple , Adult , Female , Humans , Infertility, Female/etiology , Pregnancy , Pregnancy Rate , Prospective Studies , ROC Curve , Recombinant Proteins , Retrospective StudiesABSTRACT
BACKGROUND: High, normal and poor responders are usually defined by reference to subjectively selected estradiol E2 levels at days 4-6 and the day of hCG administration (d-hCG). The purpose of this study was to use E2 percentile curves from day 5 until d-hCG to determine high, normal and poor responders, and to predict IVF outcome. METHODS: In this retrospective study, 762 patients underwent 905 cycles with a GnRH agonist/recombinant FSH short protocol. They were divided into three groups according to their age. Percentile E2 curves according to E2 levels were plotted. High responders were those patients with E2 levels above the 90th percentile, normal responders had E2 between the 10th and 90th percentiles, and poor responders had E2 below the 10th percentile. RESULTS: IVF outcome, expressed as number of oocytes, total embryos obtained and number of high grade embryos, was significantly better for patients with E2 above the 90th percentile at d-hCG for the three age groups and at day 5 for group A (<35 years). Pregnancy rates were higher for high responders, but the difference did not reach statistical significance. CONCLUSIONS: Percentile curves can be useful in controlled ovarian stimulation cycles to define high, normal and poor responders, and also to predict IVF outcome.
Subject(s)
Estradiol/blood , Fertilization in Vitro , Follicle Stimulating Hormone/therapeutic use , Hormones/therapeutic use , Ovulation Induction , Adult , Chorionic Gonadotropin/administration & dosage , Drug Administration Schedule , Female , Humans , Pregnancy , Pregnancy Rate , Recombinant Proteins/therapeutic use , Treatment OutcomeABSTRACT
La ecografía transvaginal (ETV) fue practicada en embarazadas por fertilización asistida. Fueron seguidas con la ETV y con ß-hCG semanalmente a partir del 14§ día hasta la 7§ semana. Un saco gestacional (SG) de 1,9 fue visualizado al día 15. A partir del día 17, un SG siempre fue observado. No hay ninguna correlación individual entre la talla del saco y el ß-hCG. El primer embrión fue visto el día 21. Después del día 27 todos los SG contenían un embrión. La frecuencia cardíaca fetal (FCF) fue observada desde el día 23. Los embriones sin ritmo cardíaco visible después del día 28 no fueron viables. Se presentaron 3 embarazos extrauterinos (EEU), uno de ellos asociados a un embrazo intrauterino que fue tratado con laporoscopia operatoria el día 34 y 35
