Gonadotropin therapy for the treatment of anovulation and for ovarian hyperstimulation for IVF.

Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Molecular and Cellular Endocrinology (Impact Factor: 4.24). 02/2002; 186(2):159-61. DOI: 10.1016/S0303-7207(01)00660-8
Source: PubMed

ABSTRACT Knowledge of the mechanisms of single dominant follicle selection has led to the development of a novel and effective ovulation induction regimen for anovulatory women; the step down protocol. This commences with a fixed high gonadotropin dose followed by several decremental steps. For some patients the initial dose is too high, risking ovarian hyperstimulation syndrome. A major improvement to this approach would, therefore, be the ability to use initial screening characteristics to assess the individual FSH threshold beforehand. For IVF treatment, interfering in the process of single dominant follicle selection in ovulatory women by late follicular phase administration of low doses of FSH may result in a significantly reduced duration of stimulation and amounts of exogenous FSH preparations used. Less monitoring would be required and chances for short-term complications or long term risks may be reduced.

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    ABSTRACT: The aim of this review was to summarize previously published classifications for ovarian hyperstimulation syndrome (OHSS), as well as to analyse the available methods for preventing OHSS. Withholding hCG and cycle cancellation--once the main methods of preventing OHSS--are now seldom used. There is a growing body of evidence to support the use of coasting to prevent OHSS, without cycle cancellation. However, most studies on coasting are retrospective, and well-designed prospective randomized studies are lacking. There is no current consensus as to how coasting should be carried out. A serum estradiol level of 3000 pg/ml is generally considered optimum for administration of hCG. It appears that intravenous albumin or hydroxyethyl starch at the time of oocyte retrieval is beneficial in preventing OHSS, but does not offer complete protection. There is insufficient evidence to support routine cryopreservation of all embryos for the later transfer of frozen-thawed embryos in high-risk patients. Several uncontrolled studies have reported the protective effect of GnRH agonist to trigger ovulation in preventing OHSS, though the method is applicable solely for gonadotrophin-only or GnRH antagonist cycles. A single dose of recombinant LH to trigger ovulation significantly reduced OHSS as compared with hCG. The possible role of GnRH antagonist protocols in reducing the incidence of OHSS is debatable. The above measures to prevent OHSS were successful in reducing the incidence of the syndrome, but complete prevention is not as yet possible.
    Human Reproduction Update 05/2003; 9(3):275-89. · 8.66 Impact Factor
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    ABSTRACT: Background: controlled ovarian hyper-stimulation (COH) is a crucial step of assisted reproductive technologies (ART). Thyroid dysfunction and autoimmune thyroid disease (ATD) may negatively affect the outcome of ART, but the underlying mechanisms are still poorly understood. Our aim was to evaluate the respective role of ATD and thyroid function, as assessed by serum TSH, on the early outcome of COH. Methods: 262 (202 ATD-negative and 60 ATD-positive) euthyroid sub-fertile women underwent ART. Prior to COH, serum FSH, LH, estradiol (E2) were measured at cycle day 3, and progesterone at cycle day 21. At oocyte pick-up and at embryo transfer we evaluated the performance of recombinant-FSH (r-FSH), as assessed by serum E2 concentration/total administered r-FSH units (E2/r-FSH) ratio and by oocytes quality. Results: at At both oocyte pick-up and embryo transfer, the performance of r-FSH was significantly poorer in ATD-positive than in ATD-negative women. In the ATD-positive group, women with a TSH < 2.5 mIU/L displayed a higher serum E2 concentration at oocyte pick-up, a higher E2/r-FSH ratio, and a greater number of mature metaphase II (M II) oocytes than women with a TSH > 2.5 mIU/L. When ATD-positive women were divided into quartiles according to their serum TSH level, both the ovarian response to r-FSH and the number of M II oocytes significantly decreased from the lowest to the highest quartiles of serum TSH concentration. Conclusions: ATD has a negative effect on the early outcome of COH, but this negative influence may be avoided with adequate L-levothyroxine (LT4) therapy aimed at keeping TSH < 2.5 mU/L. Thyroid antibodies and serum TSH should be checked in any woman undergoing ART.
    Thyroid: official journal of the American Thyroid Association 04/2013; DOI:10.1089/thy.2013.0022 · 2.60 Impact Factor