DOCSLIB.ORG

Comparison of the Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone in Intrauterine Insemination Cycl

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparison of the Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone in Intrauterine Insemination Cycl ORIGINAL ARTICLE East J Med 25(3):427-433, 2020 DOI: 10.5505/ejm.2020.24993 Comparison of The Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone In Intrauterine Insemination Cycles In Patients With Unexplained Infertility Süleyman Cemil Oğlak1*, Mehmet Nafi Sakar2, Serhat Ege1, Serap Mutlu Özçelik Otçu1, Mehmet Obut3, Bekir Kahveci4, İsmail Yıldız5 1Health Sciences University, Diyarbakır Gazi Yaşargil Training and Research Hospital, Department of Obstetrics and Gynaecology, Diyarbakır, Turkey 2Memorial Diyarbakır Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey 3Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey 4Çukurova University School of Medicine, Department of Obstetrics and Gynaecology, Adana, Turkey 5Dicle University School of Medicine, Department of Biostatistics, Diyarbakır, Turkey ABSTRACT This study aimed to determine the outcomes of combined treatment of letrozole (LTZ) with recombinant follicle - stimulating hormone (rFSH) in comparison with rFSH alone in intrauterine insemination (IUI) cycles. This study consisted of 86 patients who experienced 106 IUI cycles. Patients were classified into two treatment groups: group I underwent a combination of LTZ plus rFSH, and group II received rFSH alone. Ovulation was triggered with human chorionic gonadotropin (hCG), and IUI performed 36 hours later. The number of follicles ≥18 mm, endometrial thickness, required dose of FSH, duration of ovulation induction (OI), clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, and live birth rates were evaluated. The total required rFSH dose during the OI was significantly lower in the LTZ-rFSH combination group than the rFSH alone group (401.2±177.1 IU and 770.1±345.8 IU, respectively, p<0.001). The days of stimulation with rFSH were also lower in the LTZ co-treatment group than the rFSH-alone group (5.2±1.3 days and 10.1±3.0 days, respectively, p<0.001). Clinical pregnancy rate was 17.0% in LTZ-rFSH group, and 15.2% in rFSH group (p>0.05). The combined use of LTZ with rFSH resulted in a lower required dose of rFSH, a similar and ac ceptable endometrial thickness at the day of hCG administration, and comparable pregnancy rate compared with rFSH alone. Key Words: Letrozole, gonadotropin, ovulation induction, intrauterine insemination Introduction couples with infertility (1,3). Also, there are conflicts among clinicians on the appropriate Intrauterine insemination (IUI) is frequently ovarian stimulation protocol in an IUI cycle. practiced as first-line treatment for couples with Clomiphene citrate (CC) has been accepted as a unexplained or mild male-factor infertility standard treatment for ovarian hyperstimulation in worldwide because it is considered to increase the unexplained infertility for many years (4,5). pregnancy rates while simple to perform and to be Clomiphene citrate increases the release of FSH comparatively low-cost (1). It is possible to from the pituitary by blocking estrogen negative perform the IUI procedure in patients' natural feedback effect, and thus increases the follicle cycles (2). But, it was found that pregnancy and development (6). However, CC has disadvantages live birth rates in IUI cycles were significantly in treatment, and the prevalence of CC resistance higher with ovulation induction (OI) cycles using is 15-40% (7). Clomiphene citrate depletes medications compared with no stimulation for estrogen receptors and has a long half-life (2 *Corresponding Author: Süleyman Cemil Oğlak, Health Sciences University, Diyarbakır Gazi Yaşargil Training And Research Hospital, Department Of Obstetrics And Gynaecology, Diyarbakır, Turkey E-mail: [email protected], Phone: 90 (506) 402 11 57 ORCID ID: Süleyman Cemil Oğlak: 0000-0001-7634-3008, Mehmet Nafi Sakar: 0000-0002-3260-1041, Serhat Ege: 0000-0001-5430- 602X, Serap Mutlu Özçelik Otçu: 0000-0001-5124-9031, Mehmet Obut: 0000-0002-6925-4784, Bekir Kahveci: 0000-0002-8729-1669, İsmail Yıldız: 0000-0001-5505-838x Received: 12.03.2020, Accepted: 25.05.2020 Oğlak et al / rFSH vs LTZ-rFSH Combination in IUI Cycles weeks), inducing unfavorable effects on IUI. The Ethics Committee of Gazi Yaşargil endometrial thickness and cervical mucus (8,9). Training and Research Hospital approved the This effect leads to a pregnancy rate of 8.5-10% study. per cycle with the combination of CC and IUI, Before the treatment, all couples received a despite the high ovulation rate with CC (10). regular infertility assessment that involved In gonadotropin-stimulated IUI cycles, the transvaginal ultrasonography (US), a baseline pregnancy rates were in the range of 15-17% per hormone levels that included FSH, LH, estradiol, cycle (11,12). Nevertheless, the use of PRL, and TSH in the early follicular stage, a gonadotropin significantly boosts the cost of semen analysis, and assessment of tubal patency treatment and increases the risk of ovarian by hysterosalpingogram or laparoscopy. Ovulation hyperstimulation syndrome and multiple documented by serum progesterone on day 21. pregnancies (13). With the combination of The determination of unexplained infertility was gonadotropin and CC in IUI cycles, the required based on eliminating female and male factor gonadotropin dose and treatment cost decrease infertility. The inclusion criteria were as follows: compared to gonadotropin use alone, but the aged <40 years, infertility of at least one-year pregnancy rates are low with this combination due continuance, at least one patent fallopian tube, a to the anti-estrogenic effects of CC (14). healthy uterine cavity, and at least 15 million of Letrozole (LTZ), an aromatase inhibitor, inhibits motile sperm/mL with ≥32% of progressive the conversion of androgens to estrogens in motility and ≥4% of normal morphology in the ovarian follicles, resulting in a decrease in spouses' semen analysis. The exclusion criteria circulating and local estrogens and an increase in were as follows: oligo/anovulation, bilateral tubal intraovarian androgens (9). The reduction in pathology, other endocrine disorders, and male estrogen levels causes the discharge of the factor infertility. Canceled cycles were also hypothalamic-pituitary axis from the negative excluded. feedback of estrogen. This effect leads to an Study Groups: This study consisted of 86 women increase in FSH release, which results in follicular who underwent 106 IUI cycles. None of the growth (9). Unlike CC, LTZ has no anti-estrogenic women had treated with LTZ before. Patients impact and has a short (45 hour) half-life (15). were informed entirely about the mechanism of Due to these effects, LTZ does not cause an effect and the experiential essence of LTZ. The unfavorable effect on cervical mucus and off-label indication of LTZ was wholly explained. endometrial thickness, and therefore, LTZ The use of LTZ was based on the couple's choice. correlated with higher pregnancy rates (9). Participants were classified into two treatment letrozole and gonadotropin combination can groups: group I received a combination of LTZ diminish the required dose of FSH for ovarian (Femara; Novartis, Basel, Switzerland) plus rFSH stimulation without jeopardizing the pregnancy (Gonal-F; Merck, Aubonne, Switzerland), and rate compared with FSH alone and result in a low group II received rFSH (Gonal-F; Merck, occurrence of multiple gestations and ovarian Aubonne, Switzerland) alone. Group I included 34 hyperstimulation syndrome (OHSS) (16). patients who had 47 OI cycles. Group II included This study aimed to examine the effectiveness of 52 patients who had 59 OI cycles. All women LTZ-gonadotropin combination to gonadotropins experienced a maximum of two cycles of IUI. The as an ovulation induction therapy for unexplained initial dose of gonadotropins was determined on infertility couples in IUI cycles. the clinical characteristics of women, including age, BMI, duration of infertility, and prior treatment cycles. In group I, LTZ was given 5.0 Material and Methods mg/day from day 3 to 7 of the menstrual cycle, followed by the rFSH dose beginning at 50-150 Patients: This retrospective study included 86 IU/day starting on day seven until the day of the women with unexplained infertility ranging in age hCG administration. In group II, rFSH treatment from 20 to 40 years who admitted to Gazi Yaşargil was begun on day 3 of the menstrual period with Training and Research Hospital Infertility an initial dose of 50-150 IU/day until the day of policlinic between February 2017 and March 2018. the hCG treatment. Both of the groups, the dose The clinical data were recorded from our clinical of rFSH was adjusted depending on the ovarian database. All the patients had unexplained response to achieve mature follicle (≥18 mm). infertility and experienced ovarian Follicle growth (the number and the diameter of hyperstimulation with recombinant FSH (rFSH) follicles) was monitored with transvaginal alone or combined with LTZ (5.0 mg/day) for East J Med Volume:25, Number:3, July-September/2020 428 Oğlak et al / rFSH vs LTZ-rFSH Combination in IUI Cycles ultrasound by gynecologists from day 7 to day 10 Results of the cycle, and then performed every two days based on the follicle growth. When the diameter A total of 86 patients experienced 106 IUI cycles. of at least one follicle had reached 18mm, a All participants diagnosed with unexplained subcutaneous injection of 6500 IU of hCG infertility. There were no statistically significant (Ovitrelle; Merck, Modugno, Italy) was used to differences
Load more

Recommended publications
  • Artificial Insemination
    Ch36-A03309.qxd 1/23/07 5:16 PM Page 539 Section 6 Infertility and Recurrent Pregnancy Loss Chapter Artificial Insemination 36 Ashok Agarwal and Shyam S. R. Allamaneni INTRODUCTION widely available, the terms homologous artificial insemination and heterologous artificial insemination were used to differentiate Artificial insemination is an assisted conception method that can these two alternative sources. However, the use of these bio- be used to alleviate infertility in selected couples. The rationale medical terms in this manner is at variance with their scientific behind the use of artificial insemination is to increase the gamete meaning, where they denote different species or organisms (as in, density near the site of fertilization.1 The effectiveness of artificial e.g., homologous and heterologous tissue grafts). insemination has been clearly established in specific subsets of In the latter half of the 20th century, the terms artificial infertile patients such as those with idiopathic infertility, infertility insemination, donor (AID) and artificial insemination, husband related to a cervical factor, or a mild male factor infertility (AIH) found common use. However, the widespread use of the (Table 36-1).2,3 An accepted advantage of artificial insemination acronym AIDS for acquired immunodeficiency syndrome resulted is that it is generally less expensive and invasive than other in the replacement of AID with therapeutic donor insemination assisted reproductive technology (ART) procedures.4 (TDI). An analogous alternative term for AIH has not evolved, This chapter provides a comprehensive description of probably in part because of the increasingly common situation indications for artificial insemination, issues to consider before where the woman’s partner is not her legal husband.
    [Show full text]
  • Unexplained Infertility
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, University of Helsinki, Finland UNEXPLAINED INFERTILITY Studies on aetiology, treatment options and obstetric outcome RITA ISAKSSON ACADEMIC DISSERTATION To be presented by permission of the Medical Faculty of the University of Helsinki for public criticism in the Auditorium of the Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Haartmaninkatu 2, Helsinki, on October 18th, 2002, at 12 noon. Helsinki 2002 1 Supervised by Docent Aila Tiitinen, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Docent Bruno Cacciatore, M.D., Ph.D. Department of Obstetrics and Gynaecology Helsinki University Central Hospital Reviewed by Docent Anne-Maria Suikkari, M.D., Ph.D. The Family Federation of Finland, Infertility Clinic, Helsinki Docent Aydin Tekay, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital Offi cial opponent Docent Hannu Martikainen, M.D., Ph.D. Department of Obstetrics and Gynaecology Oulu University Central Hospital ISBN 952-91-5071-7 (print) ISBN 952-10-0712-5 (PDF) Yliopistopaino Helsinki 2002 2 To my family 3 CONTENTS LIST OF ORIGINAL PUBLICATIONS ....................................................................7 ABBREVIATIONS .................................................................................................
    [Show full text]
  • Definitions and Relevance of Unexplained Infertility in Reproductive Medicine 5
    Definitions and Relevance of Unexplained Infertility 1 in Reproductive Medicine Sandro C. Esteves, Glenn L. Schattman and Ashok Agarwal Infertility is customarily defined as the inability of a sexually infertility can result from congenital or acquired urogenital active couple with no contraception to achieve natural preg- abnormalities, urogenital tract infections, increased scrotal nancy within one year [1]. The American Society for Repro- temperature such as a consequence of varicocele, endocrine ductive Medicine (ASRM) considers infertility as a disease, disturbances, genetic abnormalities, immunological factors, which by definition is ‘‘any deviation from or interruption of lifestyle habits (e.g., obesity, smoking, and use of gonado- the normal structure or function of any part, organ, or system toxins), systemic diseases, erectile dysfunction, and incor- of the body as manifested by characteristic symptoms and rect coital habitus. Unfortunately, owed to limitations in our signs; the etiology, pathology, and prognosis may be known understanding of the events that take place during natural or unknown’’ [2, 3]. conception, and in view of the crude diagnostic tests avail- It has been estimated that 15 % of couples seek medical able to identify potential abnormalities, the cause of infertil- assistance for infertility, and the origins of the problem seem ity is not determined in nearly half of the cases. Moreover, to be equally distributed between male and female partners approximately 5 % of couples remain unwillingly childless [1]. Taking into account a global perspective and a world despite multiple interventions [1, 8, 9]. population of 7 billion people, these figures indicate that ap- Infertility of unknown origin comprises both idiopathic proximately 140 million people (2.2 %) face infertility [4, 5].
    [Show full text]
  • Male Infertility Is a Women's Health Issue—Research and Clinical
    cells Review Male Infertility is a Women’s Health Issue—Research and Clinical Evaluation of Male Infertility Is Needed Katerina A. Turner 1 , Amarnath Rambhatla 2, Samantha Schon 3, Ashok Agarwal 4 , Stephen A. Krawetz 5, James M. Dupree 6 and Tomer Avidor-Reiss 1,7,* 1 Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; [email protected] 2 Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA; [email protected] 3 Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, L4000 UH-South, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; [email protected] 4 American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; [email protected] 5 Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA; [email protected] 6 Department of Urology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48019, USA; [email protected] 7 Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA * Correspondence: [email protected] Received: 25 February 2020; Accepted: 14 April 2020; Published: 16 April 2020 Abstract: Infertility is a devastating experience for both partners as they try to conceive. Historically,when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility.
    [Show full text]
  • Folate, Hormones and Infertility
    Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 987 Folate, Hormones and Infertility Different factors affecting IVF pregnancy outcome TIINA MURTO ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-554-8919-9 UPPSALA urn:nbn:se:uu:diva-220476 2014 Dissertation presented at Uppsala University to be publicly examined in Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, Thursday, 22 May 2014 at 09:15 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in Swedish. Faculty examiner: Associate Professor Sven-Eric Olsson (Institutionen för kliniska vetenskaper, Danderyds sjukhus (KI DS)). Abstract Murto, T. 2014. Folate, Hormones and Infertility. Different factors affecting IVF pregnancy outcome. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 987. 57 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-8919-9. Various hormones have been studied as regards prediction of pregnancy outcome after infertility treatment, but no ideal candidate has been found. Folate and genetic variations in folate metabolism have also been associated with infertility, but it remains unclear how these factors affect IVF pregnancy outcome. It is known that infertility is associated with active folic acid supplement use, but the effect of socioeconomic and lifestyle factors on folic acid supplement use in infertile women has not been well investigated. The overall aim of this work was to obtain information on the prediction of live birth, and to study factors affecting the role of folate and folic acid intake in relation to IVF pregnancy outcome. Infertile women with various infertility diagnoses were studied. Healthy, fertile non-pregnant women were used as controls in three of the studies.
    [Show full text]
  • Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in Couple with Unexplained Infertility
    J Women’s Health Dev 2020; 3 (2): 077-091 DOI: 10.26502/fjwhd.2644-28840019 Research Article Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in couple with Unexplained Infertility Nazdar Raouf1*, Roj Hikmat², Aveen Munib³, Maida Shamdeen4, Ramadhan Salahaldeen5, Hameed Abdullah6 ¹Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq ²Senior Registrar, Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq ³Infertility and IVF center, College of Pharmcy, Azadi Teaching Hospital, Duhok, Iraq 4Obstetrics and Gynecology Department, Duhok Medical College, Azadi Teaching Hospital, Iraq 5Duhok Medical College, Azadi Teaching Hospital, Kurdistan, Iraq 6Neonatal Intensive Care Unit, Hevi Pediatrics Teaching Hospital, Duhok, Iraq *Corresponding Author: Nazdar Raouf, Duhok Obstetrics and Gynecology Teaching Hospital, Kurdistan, Iraq, Tel: + (964) 7504863598; Email: [email protected] Received: 05 April 2020; Accepted: 18 April 2020; Published: 23 April 2020 Citation: Nazdar Raouf, Roj Hikmat, Aveen Munib, Maida Shamdeen, Ramadhan Salahaldeen, Hameed Abdullah. Success of Controlled Ovarian Hyperstimulation and Intrauterine Insemination in couple with Unexplained Infertility. Journal of Women’s Health and Development 3 (2020): 077-091. Abstract Background: Management of unexplained infertility remains largely empirical, the therapeutic approach should be individualized taking into account patient age and duration of infertility, treatments include expectant observation with timed intercourse
    [Show full text]
  • Effects on Follicular Diameter and Endometrial Thickness in Polycystic Ovary Syndrome
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 07, 2020 Clomiphene Citrate and Anastrozole : Effects on Follicular Diameter and Endometrial Thickness in Polycystic Ovary Syndrome Yashinta Sampeliling1, Andi Mardiah Tahir2,Eddy Hartono3, Firdaus Kasim4 1,2,3Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Hasanuddin 4Faculty of Public Health, Universitas Hasanuddin, Dr. Wahidin Sudirohusodo General Hospital, Makassar Abstract Objective: To compare the effects of clomiphene citrate and anastrozole on follicular diameter and endometrial thickness in women with polycystic ovary syndrome (PCOS). Methods: This prospective study was conducted at the private-practice setting. The study group consisted of 14 patients who received clomiphene citrate 50 mg and 14 patients received anastrozole 1 mg on day 3 of menstruation for 5 days. Follicular diameter and endometrial thickness were measured with transvaginal ultrasound on day 12 of menstruation. Results: The mean diameter of follicles in the clomiphene citrate group was not significantly differ compared with anastrozole group (13.35±4.72 mm vs 10.92±4.29 mm; p>.05, respectively). A similar effect also observed in endometrial thickness for both study groups (8.51±1.88 mm in anastrozole vs 7.49±2.09 mm in clomiphene citrate; p>.05). Conclusion: Clomiphene citrate and anastrozole were not significantly improved follicular diameter dan endometrial thickness in polycystic ovary syndrome. Keywords : Clomiphene citrate, anastrozole, PCOS 1. INTRODUCTION Polycystic ovary syndrome (PCOS) occurs in 15-20% of reproductive women according to the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). Fifty to seventy percents of PCOS cases are caused by insulin resistance.1 This syndrome is characterized by chronic anovulation with exaggerated biochemical and/or clinical of androgens and without other diseases of the adrenal gland, thyroid or pituitary in similar features.
    [Show full text]
  • Altered Follicular Fluid Metabolic Pattern Correlates with Female Infertility and Outcome Measures of in Vitro Fertilization
    International Journal of Molecular Sciences Article Altered Follicular Fluid Metabolic Pattern Correlates with Female Infertility and Outcome Measures of In Vitro Fertilization Giacomo Lazzarino 1,† , Romina Pallisco 2,†, Gabriele Bilotta 2,†, Ilaria Listorti 2,†, Renata Mangione 3,4, Miriam Wissam Saab 5, Giuseppe Caruso 6 , Angela Maria Amorini 5 , Maria Violetta Brundo 7 , Giuseppe Lazzarino 5,8,* , Barbara Tavazzi 3,4,* and Pasquale Bilotta 9 1 UniCamillus—Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; [email protected] 2 Alma Res Fertility Center, Laboratory of Andrology and Embriology, Via Parenzo 12, 00198 Rome, Italy; [email protected] (R.P.); [email protected] (G.B.); [email protected] (I.L.) 3 Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Rome, Largo F. Vito 1, 00168 Rome, Italy; [email protected] 4 Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy 5 Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; [email protected] (M.W.S.); [email protected] (A.M.A.) 6 Department of Drug and Health Sciences, University of Catania, Viale A. Doria 6, 95125 Catania, Italy; [email protected] 7 Department of Biology, Geology and Environmental Sciences, Section of Animal Biology, University of Catania, Via Androne 81, 95124 Catania,
    [Show full text]
  • Natural Cycle In-Vitro Fertilization in Couples with Unexplained Infertility: Impact of Various Factors on Outcome
    Human Reproduction vol.12 no.ll pp.2402-2407, 1997 Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome F.Zayed1'3, E.A.Lenton1'2 and I.D.Cooke2 The first live birth following IVF occurred in 1978 and was a consequence of IVF performed in the natural cycle 'Sheffield Fertility Centre, 26 Glen Road, Sheffield S7 IRA and 2University Department of Obstetrics and Gynaecology, of a woman with tubal infertility (Edwards et al, 1980). Downloaded from https://academic.oup.com/humrep/article/12/11/2402/664697 by guest on 30 September 2021 Jessop Hospital for Women, Sheffield S3 7RE, UK This success encouraged a number of groups to attempt NIVF, but they experienced difficulties (Johnston et al, 3To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Jordan University of Science and 1981; Jones et al, 1982). NIVF was quickly abandoned in Technology, P.O. Box 962106, Amman-11196, Jordan favour of stimulated IVF (SIVF), which yielded higher pregnancy rates as a consequence of transferring several This study evaluated outcome in 117 couples with un- embryos (Wood et al, 1985; Testart et al, 1986). However, explained infertility who underwent 162 attempts at recently interest in NIVF has revived because of concerns natural cycle in-vitro fertilization (NIVF) between 1991 surrounding ovarian stimulation. These include ovarian and 1993. An egg was obtained in 138 cycles and a hyperstimulation syndrome, multiple pregnancies (Rizk single embryo was transferred in 89 cycles. There were 16 et al, 1991; Tan et al, 1992), a possible decrease in implantations (four biochemical pregnancies, three clinical endometrial receptivity (Paulson et al, 1990), the emotional abortions and nine live births).
    [Show full text]
  • The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement
    The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement Panel Members: AUA Staff: Jonathan Jarow, MD, Chairman Heddy Hubbard, PhD, MPH, FAAN, Mark Sigman, MD, Facilitator Cynthia Janus, MLS, Michael Folmer, Kebe Kadiatu Peter N. Kolettis, MD, Larry R. Lipshultz, MD, Consultant: R. Dale McClure, MD, Joan Hurley, JD, MHS Ajay K. Nangia, MD, Cathy Kim Naughton, MD, Gail S. Prins, PhD, Jay I. Sandlow, MD, Peter N. Schlegel, MD Table of Contents Abbreviations and Acronyms ...................................................................................................... 2 Introduction ................................................................................................................................... 3 Methodology .................................................................................................................................. 4 Evaluation goals ............................................................................................................................ 6 When to do a full evaluation for infertility ................................................................................. 7 Components of a full evaluation for male infertility .................................................................. 7 Required evaluation components for every patient ..................................................................... 7 Medical history ------------------------------------------------------------------------------------------ 7 Physical examination -----------------------------------------------------------------------------------
    [Show full text]
  • Unexplained Infertility
    Unexplained Infertility Kaylen M. Silverberg, M.D. Thomas C. Vaughn, M.D. Texas Fertility Center Austin, Texas Introduction Infertility is generally defined as the inability to conceive following one year of unprotected intercourse. This definition is often modified in couples where the female partner is 35 years of age or older, such that an infertility evaluation may be encouraged following only 6 months of unsuccessful attempted conception. Up to 30% of couples presenting with this chief complaint are eventually diagnosed as having unexplained infertility.1 Couples with unexplained infertility are thought to represent either a subpopulation of patients in the lower extreme end of the normal distribution of fertility, or a group of patients with a defect in fecundity not detected by the routine infertility evaluation.2 When compared to “normal, fertile” patients, couples with unexplained infertility demonstrate both diminished and delayed fecundity. Untreated, their pregnancy rates have been reported to be 34% within 6 months, 76% within 2 years, and 87% within 5 years.3 In a review of previously published prospective, randomized trials, Guzick et al determined the cycle fecundity rate with expectant management in couples with unexplained infertility to be 1.3-4.1% - compared to the generally accepted cycle fecundity of 20% in proven fertile couples. 4 This chapter will provide a critical, evidence based review of both the diagnosis and treatment of unexplained infertility. Diagnosis Traditionally, a diagnosis of unexplained infertility is made only when the basic infertility evaluation fails to reveal an obvious abnormality. This diagnosis therefore implies that a couple has evidence of normal, timely ovulation, adequate sperm production, fallopian tube patency, normal integrity of the endometrial cavity, adequate cervical mucus production, timely development of endometrial secretory change, and no evidence of pelvic endometriosis.
    [Show full text]
  • CER 217 Management of Infertility Evidence Summary
    Comparative Effectiveness Review Number 217 R Management of Infertility Evidence Summary Background Purpose of Review Condition and Therapeutic Strategies Evaluate the comparative effectiveness and safety of “Infertility” has traditionally been defined treatments for common causes of infertility. as failure to achieve pregnancy after 12 Key Messages months of regular unprotected intercourse with the same partner (or after 6 months • The ability to compare the effectiveness of for women greater than 35 years of age). treatments would be enhanced by greater However, as many as half of such couples consistency in reporting of outcomes, particularly will conceive without intervention over the live birth rates, as well as reporting of diagnosis- next 12-24 months. Because of this, the term specific outcomes for treatments, such as assisted “subfertility” is preferred by many.1 From a reproductive technology, that are used for population perspective, couples who meet the multiple diagnoses. dichotomous criteria for “infertility” include • Letrozole most likely results in more live births couples who are “normal” but who are in with lower multiple births than clomiphene alone the upper end of the population distribution in women with polycystic ovary syndrome. for “time to pregnancy,” and couples who have a physiological or anatomical cause for • For women with unexplained infertility, there is a prolonged time to pregnancy. However, to most likely shorter time to pregnancy for women be concise, we will use the term “infertility” with immediate in vitro fertilization (IVF) throughout this report. than for those who undergo other treatments prior to IVF. For the outcomes of live birth, Self-reported infertility in the United States, multiple births, ectopic pregnancy, miscarriage, using the 12-month definition, affected low birthweight, and ovarian hyperstimulation approximately 6 percent of married women syndrome however, there may be no difference aged 15-44 in the 2006-2010 National Survey between the two groups.
    [Show full text]