Sonographically monitored ovarian stimulation for assisted reproduction: a prospective, blind study.

OBJECTIVE: To assess prospectively the appropriateness of follicular sonography alone for monitoring ovarian stimulation and to compare it to ovarian monitoring with both follicular sonography and hormone level determinations. STUDY DESIGN: Prospective, blind, clinical study in which the investigator made cycle management decisions based on follicular sonography only. RESULTS: Follicular sonography alone predicted 88% of the decisions made by the combination of follicular sonography, luteinizing hormone (LH), estradiol (E2) and progesterone measurements. Follicular sonography was unable to predict abnormal E2 patterns in eight (8%) of the patients' scans. Follicular sonography did not detect three (3%) patients with a premature LH surge. CONCLUSION: Follicular sonograms alone performed during ovarian stimulation predicted 88% of cycle decisions. One could argue that hormone measurements could be either reduced or eliminated during ovarian stimulation for assisted reproductive technology and that follicular sonography only would be a cost-effective compromise. The effect of such simplified monitoring on pregnancy rates would require further prospective evaluation.

Incidence of fetal loss in infertility patients after detection of fetal heart activity with early transvaginal ultrasound.

A study was conducted to determine the incidence of fetal loss after fetal heart activity (FH) had been detected with vaginal ultrasound. One hundred sixty patients with serum beta-human chorionic gonadotropin greater than 25 mIU/mL were studied. Patients underwent serial vaginal ultrasound evaluations every one to two weeks beginning the 5th week from the last menstrual period (LMP), through 12 weeks. One hundred fourteen (71%) patients had confirmation of FH (mean days from LMP, 48.1 +/- 2.9 SD). Of these, 106 (93%) patients had normally progressing pregnancy, while 8 (7%) experienced a fetal loss in the first trimester. There were no significant differences in fetal wastage after unstimulated cycles (n = 30), clomiphene citrate cycles (n = 24), human menopausal gonadotropin (hMG) cycles (n = 27) and gonadotropin releasing hormone agonist/hMG cycles (n = 33). Although mean gestational age at which post-FH fetal loss was diagnosed was 67.2 +/- 7.2 days, only two of the losses occurred after 65 days (1.7%). The probability of a pregnancy loss after the detection of FH is approximately 7%, and fewer than 2% of pregnancies with previously documented FH may have a fetal loss after nine weeks.