ABSTRACT: To review and critique the literature and our own experience regarding coasting as a strategy to prevent ovarian hyperstimulation syndrome (OHSS).
Identification of relevant clinical literature through PubMed and EMBASE databases, as well as the experience of our institution with this approach.
Coasting is a rescue procedure that can be avoided by carefully adjusting the gonadotropin dosage. It is a good alternative that can be used to avoid cycle cancellation in extremely high responders to controlled ovarian hyperstimulation, who have a high risk of developing severe OHSS. Even if OHSS develops after coasting, both its incidence and severity will be diminished. Each case should be individually counseled to determine whether the patient should be coasted, and her hypothetical risks and benefits should be evaluated. Until the multifactorial etiopathogenesis of OHSS is completely understood, absolute prevention will not be possible, but coasting is definitely of great benefit.
Fertility and sterility 04/2006; 85(3):547-54. · 3.97 Impact Factor
ABSTRACT: To investigate the factors that may be related to pregnancy in oocyte recipients who shared oocytes from the same donor and showed discordant pregnancy outcome.
Matched pair analysis.
IVF academic center.
Five hundred forty-two oocyte donation cycles that shared oocytes from 197 donors with discordant outcome.
Egg donation and embryo transfer.
Pregnancy rate and implantation rate.
Three hundred sixty-five matched-paired discordant outcome oocyte recipients were analyzed. Pregnant and nonpregnant recipients were similar in terms of age, serum E(2) levels, endometrial thickness, indications for oocyte donation, and abnormal sperm parameters. No differences were found in the number of oocytes received per patient, fertilization rate, IVF/intracytoplasmic sperm injection (ICSI) distribution, embryo quality, or on embryo transfer difficulty.
Discordant pregnancy outcome could not be explained by the different egg recipients and cycle factors studied. In addition to chance, other factors must be investigated that could explain discordant outcome in egg recipients sharing oocytes from single donors.
Fertility and Sterility 08/2003; 80(1):54-60. · 3.56 Impact Factor
ABSTRACT: To compare the results of ovulation induction in couples undergoing intrauterine insemination (IUI) with a standard daily dose of 100 IU of recombinant follicle-stimulating hormone (rFSH) vs. 150 IU of urinary follicle-stimulating hormone (uFSH).
Prospectively, 118 cycles were randomized to rFSH and 106 cycles to uFSH. Ovarian response was compared on the human chorionic gonadotropin administration day by serum estradiol (E2) levels and number of ovarian follicles produced.
In the rFSH group a significantly lower dose of FSH was administered (799.1 vs. 1,293.0 IU, P < .001), and a lower number of follicles > or = 12 mm (2.9 vs. 3.7, P < .001) and lower number of midsized follicles (12-16 mm) were observed (0.7 vs. 1.7, P < .001) as compared to the uFSH group. No difference was found between groups in the number of follicles > or = 17 mm or in serum E2 levels obtained. The E2/FSH dose ratio was significantly higher in the rFSH group (0.9 vs. 0.6, P < .001), and the ratio of E2/follicles > or = 17 mm was significantly lower in the rFSH group (308.9 vs. 406.5, P < .001).
A standard daily dose of 100 IU of rFSH is more effective than uFSH in women undergoing IUI treatment since a more symmetric response is obtained.
The Journal of reproductive medicine 02/2003; 48(2):112-8. · 0.87 Impact Factor
ABSTRACT: To determine whether transabdominal ultrasound guidance during embryo transfer (ET) is a useful tool for increasing pregnancy rates in patients undergoing oocyte donation.
Prospective, randomized, controlled trial.
In vitro fertilization academic center.
Three hundred seventy-four infertile patients undergoing oocyte donation.
Transabdominal ultrasound-guided ET.
We measured the pregnancy rate and implantation rate after transabdominal ultrasound-guided ET versus the rates in a control group who did not receive transabdominal ultrasound-guided ET.
Clear visualization at ultrasound during ET was achieved in 90.8% of the patients who had ultrasound-guided ET. A similar number of easy transfers were performed in both the ultrasound-guided and the control groups (84.5% vs. 86.6%). The pregnancy rate was comparable between the groups (59.9% ultrasound vs. 55.1% control), as was the implantation rate (30.6% ultrasound vs. 26.3% control). No differences were found in the miscarriage rate (10.7% ultrasound vs. 9.1% control) or in the multiple pregnancy rate (21.4% ultrasound vs. 22.5% control). Although all ectopic pregnancies occurred in the group that did not receive ultrasound guidance, the differences were not statistically significant (0 vs. 2.7%).
We could not show any benefit in terms of pregnancy rate in oocyte recipients for whom ET was performed under direct transabdominal ultrasound visualization of the endometrial cavity. There was a lower ectopic pregnancy rate when ultrasound guidance was used, but this rate was not statistically significant in comparison with the pregnancy rate without ultrasound guidance.
Fertility and Sterility 10/2002; 78(3):534-9. · 3.56 Impact Factor