Recombinant human luteinizing hormone, lutropin alfa, for the induction of follicular development and pregnancy in profoundly gonadotrophin-deficient women.

OBJECTIVE: To provide evidence of efficacy and safety for use of lutropin alfa in inducing follicular development and pregnancy in hypogonadotrophic hypogonadal women with profound gonadotrophin deficiency. DESIGN: An open-label, noncomparative extension of a randomized, double-blind, placebo-controlled study PATIENTS: A total of 31 hypogonadotrophic hypogonadal women with profound gonadotrophin deficiency in 23 medical centres in four countries were studied. INTERVENTIONS: Lutropin alfa 75 IU and follitropin alfa (75-225 IU), individually based on each patient's response as is consistent with usual medical practice. MEASUREMENTS: Follicular development as defined by (i) at least one follicle >or= 17 mm; (ii) preovulatory serum oestradiol level >or= 109 pg/ml on the day of hCG administration; and (iii) midluteal phase P(4) level >or= 7.9 ng/ml. Pregnancy and over-response leading to cycle cancellation were considered treatment successes. Pregnancy rates were assessed. RESULTS: In a total of 54 cycles, 27 of 31 (87.1%) profoundly gonadotrophin-deficient patients achieved follicular development within three cycles. Twenty of 27 patients (74.1%) who achieved follicular development and received hCG became pregnant; 16 (59.3%) continued to clinical pregnancy. One patient was hospitalized for severe ovarian hyperstimulation syndrome. Lutropin alfa was well tolerated. CONCLUSIONS: Coadministration of lutropin alfa 75 IU and follitropin alfa is safe and effective in inducing follicular development and pregnancy in hypogonadotrophic hypogonadal women with profound gonadotrophin deficiency in a setting consistent with established medical practice.

Power doppler ultrasound assessment of the relationship between age and ovarian perifollicular blood flow in women undergoing in vitro fertilization treatment.

PURPOSE: To examine the relationship between age and ovarian perifollicular blood flow (PFBF) in women undergoing IVF. METHODS: Serial transvaginal power Doppler ultrasound (PDU) scans to assess ovarian PFBF were performed prospectively throughout the follicular phase of ovarian stimulation in women undergoing IVF. The ultrasound assessment days were categorized according to day of hCG trigger. RESULTS: A total of 1050 ovarian follicles from 34 women undergoing one IVF treatment cycle were used for data analysis. The median age of the women was 38.5 years, ranging from 28 years to 44 years. There was a significant negative correlation between age and ovarian PFBF on the day of hCG trigger or trigger day minus 1, but not beforehand during the follicular phase. CONCLUSIONS: There was a significant negative correlation between age and ovarian PFBF in women undergoing IVF which was only observed very late in the follicular phase of ovarian stimulation.

Power Doppler ultrasound assessment of ovarian perifollicular blood flow in women with polycystic ovaries and normal ovaries during in vitro fertilization treatment.

OBJECTIVE: To evaluate whether ovarian perifollicular blood flow (PFBF) varies by ultrasound among women with polycystic and normal ovaries undergoing in vitro fertilization (IVF). DESIGN: Prospective observational cohort study of women undergoing IVF treatment. SETTING: Department of reproductive medicine at a university teaching hospital. PATIENT(S): Thirty four women with regular spontaneous ovulatory menstrual cycles undergoing IVF divided into two groups according to findings on a baseline transvaginal ultrasound scan: group 1 consisted of 20 women with ultrasound-evident normal ovaries (USNO group), and group 2 consisted of 14 women with ultrasound-evident polycystic ovaries (USPCO group). INTERVENTION(S): Serial transvaginal power Doppler ultrasound assessments throughout the follicular phase of ovarian stimulation. MAIN OUTCOME MEASURE(S): Ovarian PFBF and ovarian stromal artery pulsatility index. RESULT(S): Women with USPCO had a significantly lower ovarian stromal artery pulsatility index at the time of the first ultrasound assessment before starting the FSH injections compared with USNO women. However, there was no difference in ovarian PFBF between women with USPCO and USNO during the follicular phase of ovarian stimulation for IVF. CONCLUSION(S): There is no difference in ovarian follicular vascularity between women with polycystic and normal ovaries during ovarian stimulation at IVF treatment.

Case series of a single centre's treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination in 2002.

The present paper reports a single department's retrospective case series of all clomiphene citrate (CC) combined with intrauterine insemination (IUI) treatment cycles for ovulatory infertility performed during 2002. Thirty-eight couples with unexplained, endometriosis, male or unilateral tubal factor infertility had undergone 71 cycles of CC and IUI. The clinical and ongoing cycle pregnancy rates were 20 and 17%, respectively. Seven percent of the clinical pregnancies were multiple pregnancies, with all multiple pregnancies being twin gestations. The current use of CC and IUI is an effective early treatment option in couples with ovulatory infertility presenting to our department.

Predictive value of mid luteal progesterone concentration before luteal support in controlled ovarian hyperstimulation with intrauterine insemination.

BACKGROUND: There is no published data assessing whether higher mid luteal serum progesterone (P4) levels are associated with a higher cycle pregnancy rate (CPR) in controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI). AIMS: To assess whether the mid luteal serum P4 level is predictive of pregnancy in COH with IUI. METHODS: A retrospective cohort study of all women with unexplained, minimal endometriosis or mild male factor infertility who underwent COH with IUI between October 1999 and December 2000 at our department was analysed. The COH was achieved with follicle stimulating hormone injections. All cycles were triggered with human chorionic gonadotropin when at least one follicle > or =15 mm was visible on ultrasound and IUI performed the following day. A serum P4 and beta human chorionic gonadotropin level was measured at 7 and 14 days post-trigger, respectively. RESULTS: There were 33 pregnancies in the 188 cycles analysed, giving a CPR of 18%. The median (range) mid luteal P4 level for all cycles was 51 nmol/L (1.8-234). This did not differ between the pregnant (55 nmol/L) and non-pregnant (50 nmol/L) cycles (P=0.282, Mann-Whitney U-test). There was also no difference in CPR between cohorts below or above the cut-off levels of 33 nmol/L (25th percentile) (13.3 vs 18.9%; P=0.39), 51 nmol/L (50th percentile) (16.0 vs 19.1%; P=0.57), or 69 nmol/L (75th percentile) (16.3 vs 21.3%; P=0.44), respectively. CONCLUSIONS: Increased mid luteal serum P4 levels are not associated with a higher CPR in women undergoing COH with IUI. However, a low mid luteal P4 level < or =25 nmol/L may help predict treatment failure.