Does day-3 LH/FSH ratio influence in vitro fertilization outcome in PCOS patients undergoing controlled ovarian hyperstimulation with different GnRH-analogue?

In an attempt to evaluate whether high basal day-3 luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio affects IVF cycle outcome in polycystic ovary syndrome (PCOS) patients undergoing ovarian stimulation with either GnRH-agonist (n = 47) or antagonist (n = 104), we studied 151 IVF cycles: 119 in patients with basal LH/FSH <2 and 32 in patients with LH/FSH ≥ 2. The PCOS with high LH/FSH ratio achieved a non-significantly higher pregnancy rate using the GnRH-agonist (50% vs 17.9%, p = 0.

Human menopausal gonadotropin versus highly purified-hMG in controlled ovarian hyperstimulation for in-vitro fertilisation: does purity improve outcome?

Objectives: To examine and compare the effect of the two commercially available menotropins (highly purified-human menopausal gonadotropin (HP-hMG) and the traditional human menopausal gonadotropin (hMG)) on ovarian stimulation characteristics and in-vitro fertilisation (IVF) cycle outcome.

Study Design: We studied 36 patients undergoing at least two controlled ovarian hyperstimulation cycles for IVF, with the same GnRH-analogue protocols, where one included HP-hMG and the other included hMG. Ovarian stimulation characteristics and outcome were compared between the two groups.

A combined approach to patients with repeated IVF failures.

In an attempt to evaluate the appropriate approach in patients with repeated IVF failures, we compared the stimulation characteristics of 19 cycles. This includes the combination of diagnostic hysteroscopy and endometrial sampling during oral contraceptive pill treatment, which precedes the ultrashort GnRH-ag/GnRH-ant protocol to the patients' previous failed IVF attempt. Patients undergoing the combined approach achieved an improved outcome with reasonable implantation and clinical pregnancy rates (25 and 42%, respectively).

Ovarian stimulation in polycystic ovary syndrome patients: the role of body mass index.

In an attempt to examine whether body mass index (BMI) may influence IVF outcome in polycystic ovary syndrome (PCOS) patients undergoing ovarian stimulation with either gonadotrophin-releasing hormone (GnRH)-agonist (agonist group) or antagonist (antagonist group), 100 IVF cycles were studied: 35 in the agonist and 65 in the antagonist groups. In both agonist and antagonist groups, patients with BMI < or = 25 kg/m(2) had a significantly higher fertilization rate compared with patients with BMI > 25 kg/m(2) (P < 0.02 and P < 0.

HMG improves IVF outcome in patients with high basal FSH/LH ratio: a preliminary study.

In an attempt to examine the role of human menopausal gonadotrophin (HMG) administration in patients with high basal FSH/LH ratio, patients undergoing at least two IVF cycles, where one included HMG (HMG group) and the other included recombinant FSH (rFSH) only (FSH group), were studied. The use of HMG, in this specific group of patients, produced significantly higher number of top-quality embryos (3.9 +/- 3.

The influence of body mass index on in vitro fertilization outcome.

Objective: To examine whether body mass index (BMI) influences the outcome of in vitro fertilization (IVF).

Methods: We studied 516 IVF cycles, 438 undergone by nonobese (BMI < or = 30) and 78 by obese (BMI > 30) women who all had an a priori favorable prognosis (age < 40 years and first, second, or third IVF cycle).

Results: Pregnancy was achieved in 122 (27.

Repeated in vitro fertilization cycle attempts in patients undergoing controlled ovarian hyperstimulation with use of gonadotropin-releasing hormone antagonists.

To examine pregnancy rate in patients undergoing controlled ovarian hyperstimulation (COH) with use of multidose GnRH antagonists in multiple repeated IVF cycle attempts, we conducted a survey in 785 consecutive IVF cycles in our unit. Although pregnancy rate significantly decreased beyond the second IVF cycle attempt, no significant decrease was noted between cycle attempts 3 and 4 and 5 to 8.

Follitropin-alpha (Gonal-F) versus follitropin-beta (Puregon) in controlled ovarian hyperstimulation for in vitro fertilization: is there any difference?

In an attempt to examine and compare the effect of the two commercially available recombinant FSH on ovarian stimulation characteristics and IVF cycle outcome, we studied 264 IVF cycles in patients with a favorable prognosis a priori, 198 in patients using follitropin-alpha, and 68 in patients using follitropin-beta. Although both groups achieved a comparable number of retrieved oocytes, the use of follitropin-beta was associated with a tendency toward a lower clinical pregnancy rate (PR), and with significantly higher E(2) levels despite the use of significantly lower total gonadotropin dose.

What is the preferred GnRH analogue for polycystic ovary syndrome patients undergoing controlled ovarian hyperstimulation for in vitro fertilization?

In an attempt to evaluate the influence of the GnRH analogue used during controlled ovarian hyperstimulation (COH) on the outcome of IVF cycles of polycystic ovary syndrome (PCOS) patients, we studied 152 IVF cycles. The PCOS patients undergoing COH using the GnRH agonist protocol (n = 50) showed a significantly higher pregnancy rate (36% vs. 19.

Ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist for patients with repeated IVF failures and poor embryo quality.

To evaluate the appropriate controlled ovarian hyperstimulation (COH) protocol in patients with repeated IVF failures and poor embryo quality we compared the stimulation characteristics of ten cycles which included ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist with the patients' earlier failed IVF attempts. The use of ultrashort GnRH agonist/GnRH antagonist COH protocol resulted in a significantly higher number and proportion of top-quality embryos, with a consequent improvement in clinical pregnancy rate (50%).

GnRH agonist versus GnRH antagonist in controlled ovarian hyperstimulation: their role in patients with an unfavorable prognosis a priori.

In an attempt to examine the influence of the type of GnRH analogue used during controlled ovarian hyperstimulation on IVF outcome in patients with an unfavorable outcome a priori, we studied 728 consecutive cycles in patients with repeated IVF failure. In patients with repeated failure, the GnRH agonist group showed significantly higher clinical pregnancy rate compared with the GnRH antagonist group (20.8% vs 14.

Is there a limit for the number of in vitro fertilization cycles for an individual patient?

To examine whether and when conception may be achieved in multiple repeated in vitro fertilization cycles, we surveyed the outcome of 2760 consecutive cycles in our unit. The pregnancy rate statistically significantly decreased after the third cycle attempt, but no statistically significant decrease was observed between cycles 4 and 20; an acceptable clinical pregnancy rate/cycle of 15% was achieved between cycles 7 and 20.

Do stimulation characteristics of the first in vitro fertilization cycle predict pregnancy in women of 40 years old and over?

The failure of tests of ovarian reserve to predict clinical pregnancy in women 40 years old and older prompted this study of the predictive value of information obtained during the first cycle of in vitro fertilization (IVF). Stimulation characteristics during the first IVF cycle attempt were unhelpful in predicting the possibility of clinical pregnancy within the first three consecutive IVF cycles.

Does day 3 luteinizing-hormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues?

To examine whether day 3 LH level or FSH-LH ratio predict IVF outcome, we studied patients with a favorable prognosis a priori undergoing controlled ovarian hyperstimulation (COH) with GnRH agonist (agonist group; n = 131) or antagonist (antagonist group; n = 137). Although LH level could not predict IVF outcome, patients undergoing COH using the GnRH antagonist or agonist protocols with FSH-LH ratios >2 or >3, respectively, achieved significantly lower pregnancy rates (11.1% vs.

GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity.

To examine whether the choice of the GnRH analogues used during controlled ovarian hyperstimulation (COH), may influence endometrial receptivity, we studied 712 IVF cycles, in patients undergoing COH with GnRH agonist or antagonist and with the transfer of at least one top-quality embryo. The GnRH agonist group showed significantly higher endometrial thickness and higher pregnancy rate, suggestive of a higher endometrial receptivity, compared with the GnRH antagonist group.

Controlled ovarian hyperstimulation using multi-dose gonadotropin-releasing hormone (GnRH) antagonist results in less systemic inflammation than the GnRH-agonist long protocol.

Objective: The aim of the study was to investigate whether controlled ovarian hyperstimulation (COH) using multi-dose gonadotropin-releasing hormone (GnRH) antagonist results in a lesser degree of systemic inflammation than the GnRH-agonist long protocol.

Design: Prospective, observational study.

Patients And Methods: Blood was drawn three times during the COH cycle from patients undergoing the long GnRH-agonist protocol (agonist group) (n = 12) or the multi-dose GnRH-antagonist protocol (antagonist group) (n = 15): the day on which adequate suppression was obtained (agonist group), or day 2 or 3 of the menstrual cycle and before gonadotropin treatment (antagonist group) (Day-0); the day of or prior to administration of human chorionic gonadotropin (Day-hCG); and the day of ovum pick-up (Day-OPU).

Ultrashort gonadotropin-releasing hormone agonist combined with flexible multidose gonadotropin-releasing hormone antagonist for poor responders in in vitro fertilization/embryo transfer programs.

To evaluate the appropriate controlled ovarian hyperstimulation (COH) protocol in poor responders, we compared the stimulation characteristics of 21 cycles, which included the ultrashort gonadotropin-releasing hormone (GnRH) agonist combined with the flexible multidose GnRH antagonist, to the patients' previous failed in vitro fertilization attempts. The use of an ultrashort GnRH-agonist/GnRH-antagonist COH protocol resulted in a statistically significantly greater number of follicles larger than 14 mm on the day of hCG administration, a higher number of oocytes retrieved and embryos transferred, and a reasonable clinical pregnancy rate (14.3%).

Controlled ovarian hyperstimulation: are we monitoring the appropriate sex-steroid hormones?

We prospectively evaluated the behavior of serum 17-hydroxyprogesterone (17-OHP), sex-steroid hormones, and C-reactive protein (CRP) levels in 27 patients during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). While routine measurement of COH via serum 17-OHP may replace estradiol (E(2)) and progesterone levels, additional studies are needed to elucidate the ceiling level of serum 17-OHP beyond which intervention is required to prevent severe ovarian hyperstimulation syndrome.

GnRH agonist versus GnRH antagonist in ovarian stimulation: the influence of body mass index on in vitro fertilization outcome.

In an attempt to examine whether body mass index (BMI) may influence IVF outcome in patients undergoing COH with either GnRH-agonist (agonist group) or GnRH-antagonist (antagonist group), we studied 799 IVF cycles: 481 in the agonist group and 318 in the antagonist group. In patients with BMI >25 kg/m(2), COH with either GnRH-agonist or GnRH-antagonist achieved a comparable outcome; whereas in patients with BMI <25 kg/m(2), the use of GnRH-agonist suppressive protocol revealed significantly higher pregnancy rates.

Does physicians' experience influence in vitro fertilization success in patients undergoing controlled ovarian hyperstimulation with GnRH antagonists?

In an attempt to examine whether physicians' experience may influence IVF outcome in patients undergoing GnRH antagonist (GnRH-a) controlled ovarian hyperstimulation (COH) protocols, we studied 273 consecutive patients, with a favorable prognosis a priori, admitted to our IVF unit, of whom 88 conceived. The highest pregnancy rate (PR) (46.5%) was observed in patients achieving, on day of hCG administration, an E(2)-to-follicle ratio <100 pg/mL.

Does methotrexate treatment for ectopic pregnancy influence the patient's performance during a subsequent in vitro fertilization/embryo transfer cycle?

In a study on the influence of methotrexate (MTX) treatment on ovarian stimulation characteristics during the subsequent IVF cycle, 14 patients admitted to our department with the diagnosis of ectopic pregnancy and successfully treated with MTX were evaluated. No differences were observed in ovarian stimulation characteristics between the IVF cycle that had resulted in the ectopic pregnancy and the IVF cycle that followed MTX treatment. Treating ectopic pregnancy with MTX has no influence on patients' performance in the following IVF cycle.

The influence of estradiol/follicle and estradiol/oocyte ratios on the outcome of controlled ovarian stimulation for in vitro fertilization.

Objective: The aim of the study was to evaluate the influence of the ratios of estradiol (E2) to either the number of follicles >14 mm on the day of human chorionic gonadotropin administration (E2/follicle) or the number of oocytes retrieved (E2/oocytes) during controlled ovarian hyperstimulation (COH) with gonadotropin-releasing hormone (GnRH)-agonist (agonist group) and GnRH-antagonist (antagonist group), on the outcome of in vitro fertilization (IVF) cycles.

Patients And Methods: All consecutive women aged <35 years admitted to our IVF unit during a 6-year period with normal to high response to COH were retrospectively studied. Ovarian stimulation characteristics, number of oocytes retrieved, number of embryos transferred and pregnancy rate were assessed.

Quality of nuchal translucency measurements in multifetal pregnancies.

Objective: A prospective comparative study was conducted to investigate the effect of multifetal pregnancies on the quality of nuchal translucency measurements using an image scoring method.

Methods: The study sample included 72 consecutive multiple gestations (164 fetuses) and 195 singleton gestations (control) matched for maternal age and fetal crown-rump length. Nuchal translucency ultrasound was performed similarly in singleton and multiple pregnancies.

A simplified approach to religious infertility.

Orthodox Jewish women with a prolonged menstrual flow or short follicular phase may be unable to attend the ritual bath early enough in their cycle for conception to take place. Oral estrogen supplementation may effectively delay ovulation beyond the time of the ritual bath, when intimate relations are allowed, thereby restoring the normal (23%) fecundity rate.