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Ovulation Induction in In-Vitro Fertilization
by Mohamed
Nabil El Tabbakh, MD, OBGYN.net Egypt
Representative
Tables and Figures |
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Mohamed Nabil El
Tabbakh, MD
Ovulation Induction in In-Vitro Fertilization
http://www.obgyn.net/infertility/articles/ovulation_induction.htm
2001 |
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| Table 1. Findings and Outcome at Laparoscopy in Patients Receiving “High Dose”
hMG Alone and Clomiphene Alone |
| Treatment Group |
Follicles
Aspirated per Patient* |
Oocytes Recovered
per Follicle Aspirated |
Oocytes Recovered
per Patient* |
| hMG |
4.7 ± 2.2 (n=18) |
82/84 97.6% (n=18) |
4.6 ± 2.7 (n=16) |
| Clomiphene |
3.2 ± 1.2 (n=16) |
27/51 52.9% (n=16) |
1.7 ± 0.9 (n=15) |
| Significance |
p<0.05 |
p<0.001 |
p<0.001 |
Data
from Quigley et al. 1984 (5)
*Mean ± standard deviation. |
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| Table 2. Length of the Menstrual Cycle and Luteal Phase in Patients Receiving “High Dose”
hMG Alone and Clomiphene Alone |
| Group |
Total Cycle
Length* |
Length of Luteal
Phase* |
| hMG |
21.1 ± 1.5 days |
11.6 ± 1.5 days |
| Clomiphene |
26.8 ± 2.3 days |
14.3 ± 2.3 days |
| Significance |
p<0.001 |
p<0.001 |
Data
from Quigley et al. 1984 (5)
*Mean ± standard deviation. |
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| Table 3. Follicular Development at hCG Administration, Oocytes Recovered at Laparoscopy, and Embryos Transferred in Patients Receiving Clomiphene Alone and a Clomiphene
hMG Combination |
| |
Total Number of
Follicles (hCG day) |
Oocytes Recovered
per Patient* |
Embryos
Transferred per Patient* |
| Clomiphene |
3.7 ± 1.2 (n=17) |
1.9 ± 0.9 (n=15) |
2.0 ± 0.4 (n=12) |
| Combination |
5.1 ± 2.0 (n=17) |
2.8 ± 1.9 (n=13) |
2.5 ± 1.2 (n=13) |
| Significance |
p<0.01 |
p<0.05 |
NS |
Modified
from Quigley et al. 1984 (5)
NS, not significant,
*Mean ± standard deviation. |
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Table 4 - Structure and relative potencies of current
GnRH-as |
| GnRH Analogue |
Substitution |
Relative Potency |
| Buserelin |
D-Ser (TBU) for
Gly-6 |
100 |
| Nafarelin |
D-(2Nal) for Gly-6 |
100 |
| Leuprorelin |
D-Leu for Gly-6 |
50 |
| acetate |
Ethylamide for
Gly-10 |
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| Goserelin |
D-Ser (TBU) for
Gly-6 |
50 |
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Az-Gly for Gly-10 |
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| Triptorelin |
D-Trp for Gly-6 |
100 |
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Figure 1
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Figure
2
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Figure
3
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Table 5. Classifications of patients in the three different stimulation protocols, 1989-1990 |
| |
Luteal
Leuprorelin Acetate (A)
(45%) |
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Follicular
Leuprorelin Acetate (B)
(26%) |
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FSH/hMG (C)
(29%) |
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| 1. Stimulation
cycles |
|
524 |
|
299 |
|
332 |
| 2. Patients |
429 |
|
243 |
|
278 |
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| 3. Retrieval
cycles |
507 |
|
268 |
|
275 |
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| 4. Cancellation
rate (%) |
3* |
|
10 |
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...
.. |
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| 5. Transfer
cycles |
492 |
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244 |
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244 |
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(94%
of 1.) |
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(82%
of 1.) |
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(73%
of 1.) |
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A<B<C,
P<0.05
(Muasher 1992) (95) |
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Table
6. Causes
of infertility in the three stimulation protocols, 1989-1990 |
| Cause |
Luteal
Leuprorelin Acetate (A)
(n=507) |
(%) |
Follicular
Leuprorelin Acetate (B)
(n=268) |
(%) |
FSH/hMG (C)
(n=275) |
(%) |
| Tubal |
269 (53) |
|
157 (59) |
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152 (55) |
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| Male |
102
(20) |
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49
(18) |
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62
(23) |
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| Endometriosis |
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57 (11) |
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38 (14) |
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38 (14) |
| Unexplained &
Other |
79
(16) |
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24
(9) |
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23
(8) |
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| (Muasher
1992) (95) |
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Table
7. Patient
and stimulation characteristics in the three stimulation
protocols, 1989-1990 |
| |
Luteal
Leuprorelin Acetate (A)
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Follicular
Leuprorelin Acetate (B)
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FSH/hMG (C)
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| Characteristic |
|
(n=524) |
|
(n=299) |
|
(n=332) |
| Age (y) |
33.6±±3.6* |
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33.5±±3.6 |
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36.1±±3.7 |
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| Basal FSH (ml
U/ml) |
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9.8±±3.3* |
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16.5±±5.0 |
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14.5±±7.1 |
| Basal LH (ml
U/ml) |
16.5±±6.3 |
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14.2±±6.0 |
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13.5±±6.7 |
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| Ampoules of FSH/hMG |
22±±6 |
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19±±5 |
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19±±4.5 |
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| E2 day of hCG (pg/ml) |
1069±±684** |
|
768±±497 |
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587±±389 |
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| Peak E2
(pg/ml) |
1430±±897** |
|
992±±597 |
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764±±510 |
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| All
values means ±± SD. *A<B,C,
P<0.05: **A>B,C,
P<0.05 |
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Table
8. Classification
of oocytes retrieved, transferred and cryopreserved in the three
stimulation protocols, 1989-1990 |
| |
Luteal
Leuprorelin Acetate (A)
(n=507) |
Follicular
Leuprorelin Acetate (B)
(n=268) |
FSH/hMG (C)
(n=275) |
| Total oocytes/cycle |
12.9±±5.2* |
6.6±±3.9 |
6.4±±4.1 |
| Preov. oocytes/cycle |
9.3±±2.0* |
4.6±±1.6 |
3.9±±1.4 |
| Preov. oocytes
transfer/cycle |
3.8±±1.0* |
2.9±±.08 |
2.6±±0.7 |
| Cycles with cryo
% |
54(274/507)* |
20(53/268) |
19(52/275) |
| Embryos cryo/cycle
with cryo |
5.5±±1.8** |
3.6±±2.0 |
2.5±±2.0 |
Preov.
= preovulatory; cryo = cryopreserved, cryopreservation
All values means ±± SD. *A>B,C P<0.05;
**A>B>C, P<0.05
(Muasher 1992) (95) |
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Table
9 - Final
IVF parameters (mean±±SD) |
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High-fixed dose
(n=23) |
Step-down
(n=21) |
| No. of FSH vials |
61.2±±8 |
38.2±±9.6 |
| Maximum
oestradiol (pg/ml) |
1459±±844 |
1223±±696 |
| Follicles >³
12mm |
6.3±±3.1 |
5.1±±2.3 |
| Total oocytes |
5.4±±2.4 |
5.6±±3.4 |
| Fertilized
oocytes |
4.1±±2.2 |
3.8±±1.9 |
| Replaced oocytes |
2.3±±0.9 |
1.9±±0.8 |
| No. of
pregnancies |
3 |
1 |
| Hugues
et al (1998) (178) |
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