Introduction: In vitro fertilization (IVF) can be used as alternative treatment for patients with polycystic ovarian syndrome (PCOS) or for patients who exhibit a very high responses (VHR) to the ovarian stimulation. Pituitary desensitization and urinary gonadotrophins are used to achieve multifollicular growth. Some cases caracterised by >20 follicles and plasma estradiol levels > 15nmol/l can lead to a life threatening condition therefore those cases require an adequate stimulation protocol. The aim of this study was to evaluate if a step-up ovarian stimulation with low gonadotrophin doses may achieve in patients at risk of VHR: 1) a better controlled ovarian responses; 2) a good oocyte quality and fertilization rate; 3) a high pregnancy rate; Material and Methods: A total of seventyone patients with polycystic ovaries and at risk of VHR (mean age ±SD: 32,2±3.6; min=24; max=41) were studied. GnRH- analog (Decapeptyl 0.1 mg/24h, Ferring, Switzerland) was started on day 23. From day 3 of the next menstrual cycle, a starting dose of 75 IU highly purified FSH ( Metrodin-HP, Serono; Switzerland) was administered. Estradiol (E2) and vaginal ultrasound were performed to evaluate the ovarian response. We have adapted the FSH-HP doses by 37.5 IU increments only when E2 was not significantly increased after 3 days of stimulation. In case of severe male factor, IVF was performed by intracytoplasmatic sperm injection (ICSI). Excess zygotes (2PN) were frozen the day before embryo transfer (ET). Results: Of the ninty stimulated cycles we obtained the following results: 1) Mean stimulation duration was 18.9±3.0 days, 2) 218 fresh (2.56/ET) and 52 frozen-thawed (2.42/ET) were transferred in 85 and 21 cycles respectively, 3) clinical pregnancy were 30 (33.3%/ET) in fresh cycles and 9 (50%/ET) in frozen thawed cycles, 4) of this 39 pregnancies we had 4 abortions (%) and 34 deliveries. No severe hyperstimulation syndrome was observed. Conclusions: We believe that an appropriate ovarian stimulation protocol (low dose step-up) in IVF cycles can acheive good results in term of oocyte quality which are confirmed by a normal fertilization rate (75.1%), and a high pregnancy rate with a low incidence of hyperstimulation syndrome.
A low dose step-up stimulation protocol can achive high pregnancy rates in IVF patients with polycystic ovaries at risk of a very high ovarian response to gonadotropin.
MARCI, Roberto;
1998
Abstract
Introduction: In vitro fertilization (IVF) can be used as alternative treatment for patients with polycystic ovarian syndrome (PCOS) or for patients who exhibit a very high responses (VHR) to the ovarian stimulation. Pituitary desensitization and urinary gonadotrophins are used to achieve multifollicular growth. Some cases caracterised by >20 follicles and plasma estradiol levels > 15nmol/l can lead to a life threatening condition therefore those cases require an adequate stimulation protocol. The aim of this study was to evaluate if a step-up ovarian stimulation with low gonadotrophin doses may achieve in patients at risk of VHR: 1) a better controlled ovarian responses; 2) a good oocyte quality and fertilization rate; 3) a high pregnancy rate; Material and Methods: A total of seventyone patients with polycystic ovaries and at risk of VHR (mean age ±SD: 32,2±3.6; min=24; max=41) were studied. GnRH- analog (Decapeptyl 0.1 mg/24h, Ferring, Switzerland) was started on day 23. From day 3 of the next menstrual cycle, a starting dose of 75 IU highly purified FSH ( Metrodin-HP, Serono; Switzerland) was administered. Estradiol (E2) and vaginal ultrasound were performed to evaluate the ovarian response. We have adapted the FSH-HP doses by 37.5 IU increments only when E2 was not significantly increased after 3 days of stimulation. In case of severe male factor, IVF was performed by intracytoplasmatic sperm injection (ICSI). Excess zygotes (2PN) were frozen the day before embryo transfer (ET). Results: Of the ninty stimulated cycles we obtained the following results: 1) Mean stimulation duration was 18.9±3.0 days, 2) 218 fresh (2.56/ET) and 52 frozen-thawed (2.42/ET) were transferred in 85 and 21 cycles respectively, 3) clinical pregnancy were 30 (33.3%/ET) in fresh cycles and 9 (50%/ET) in frozen thawed cycles, 4) of this 39 pregnancies we had 4 abortions (%) and 34 deliveries. No severe hyperstimulation syndrome was observed. Conclusions: We believe that an appropriate ovarian stimulation protocol (low dose step-up) in IVF cycles can acheive good results in term of oocyte quality which are confirmed by a normal fertilization rate (75.1%), and a high pregnancy rate with a low incidence of hyperstimulation syndrome.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
