An aggressive philosophy in controlled ovarian stimulation cycles increases pregnancy rates |
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Authors: | Gratton RJ; Nisker JA; Daniel S; Toth S; Gunter J; Kaplan BR; Tummon IS; Yuzpe AA |
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Institution: | Department of Gynaecology and Reproductive Medicine, University Hospital, University of Western Ontario London, Canada N6A 5A5 |
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Abstract: | To assess the effect of timing of human chorionic gonadotrophin(HCG) administration in ovarian stimulation cycles, the serumoestradiol concentration and follicle profile were comparedwith the clinical pregnancy rate in 582 ovarian stimulation intra-uterine insemination (OSIUI) cycles and3917 in-vitro fertilizationembryo transfer (IVFET)cycles. The pregnancy rates increased exponentially with increasingoestradiol in both OSIUI and IVFET cycles (R2= 0.720, P < 0.001) but then decreased in OS-IUI cycles whenthe oestradiol concentration exceeded 5000 pmol/l (R2 = 0.936,P < 0.004) at HCG administration. In OSIUI cyclesthe percentage of cycles with three or more mature follicles( 18 mm diameter) increased up to an oestradiol concentrationof 5000 pmol/l then declined, mirroring the pregnancy rate (R2= 0.900, P = 0.01). The exponential increase in pregnancy ratewith increasing oestradiol concentration in IVFET cyclessuggests that high oestradiol concentration does not have adeleterious effect on endometrial receptivity. The decreasein pregnancy rate in OS-IUI cycles when oestradiol concentrationexceeded 5000 pmol/l reflected fewer mature follicles, resultingfrom premature administration of HCG to avoid severe ovarianhyperstimulation syndrome (OHSS). We recommend that HCG administrationbe delayed until multiple follicles have reached maturity, andreducing the risk of severe OHSS by converting high risk OSIUIcycles to IVFET, or if funds or facilities are unavailable,transvaginally draining all but four or five mature follicles. |
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Keywords: | human chorionic gonadotrophin/intra-uterine insemination/in-vitro fertilization/pregnancy rate/ovarian stimulation |
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