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9 results

  • Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer

  • Junwei Zhang, Mingze Du, Lijun Sun
  • Journal:
    Journal of Developmental Origins of Health and Disease / Volume 13 / Issue 2 / April 2022
    Published online by Cambridge University Press:
    11 May 2021, pp. 244-251

  • The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16–2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10–2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05–2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03–2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.

  • Chapter 16 - Artificial gametes

  • Edited by David K. Gardner, University of Melbourne, Botros R. M. B. Rizk, University of South Alabama, Tommaso Falcone
  • Book:
    Human Assisted Reproductive Technology
    Published online:
    16 May 2011
    Print publication:
    31 March 2011, pp 177-185

  • Summary

    Discovering the genetic variants associated with ovarian response to gonadotropins is an important step towards individualized pharmacogenetic protocols of ovarian stimulation. More than 90% of the genetic variability is caused by the presence of single nucleotide polymorphisms (SNPs). Pharmacogenetics is the science that describes the relationship between genetic variability and drug response and studies how to tailor pharmacological therapy to the genetic features of the individual patient and how to improve desired actions and minimize side effects. Different genes have been studied in relation to the characteristics of the normal ovarian cycle or different individual responses to controlled ovarian hyperstimulation (COH). The follicle stimulating hormone receptor gene (FSHR) is crucial in follicular maturation: inactivating FSHR mutations almost always leads to amenorrhea and activating mutations can cause a spontaneous ovarian hyperstimulation syndrome or predispose to iatrogenic ovarian hyperstimulation syndrome (OHSS).

  • Chapter 17 - In vitro maturation of oocytes

  • from Section 5: - Alternatives to ovarian hyperstimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 181-194

  • Summary

    Management of the poor responder remains one of the greatest challenges of controlled ovarian hyperstimulation (COH) in preparation for the assisted reproductive technologies. This chapter reviews a variety of approaches which have been employed in this poorly defined patient group. The profound suppression of gonadotropins induced by traditional long luteal gonadotropin-releasing hormone agonist (GnRHa) protocols may be particularly devastating for poor responders. Decreasing the GnRHa dose during the luteal phase prior to COH would theoretically decrease the extent of endogenous gonadotropin suppression while preventing premature ovulation. The administration of estradiol in the luteal phase may induce follicle-stimulating hormone (FSH) receptor formation in more resistant follicles and result in a more coordinated gonadotropin response. The ability to enhance endogenous follicular phase gonadotropin release by the administration of either clomiphene citrate or an aromatase inhibitor would represent an attractive adjunct to GnRHant protocols in poor-responder patients.

  • Chapter 18 - Uterine septum

  • from Section 2: - Ultrasonography in infertility
  • Edited by Botros R. M. B. Rizk, University of South Alabama
  • Book:
    Ultrasonography in Reproductive Medicine and Infertility
    Published online:
    07 September 2011
    Print publication:
    25 March 2010, pp 141-154

  • Summary

    Three-dimensional (3D) ultrasound technologies are beneficial in some applications of obstetrics and gynecology and may aid in the evaluation of abnormal ovaries. Although the diagnostic criteria of polycystic ovary syndrome (PCOS) do not include 3D imaging, Allemand performed a study establishing the diagnostic threshold for 3D Ultrasonography of PCOS. The administration of gonadotropins for both insemination cycles as well as in-vitro fertilization cycles relies upon the use of serial real-time ultrasound examinations. In clinical practice, TV ultrasound monitoring during controlled ovarian hyperstimulation (COH) is performed to improve safety and precise monitoring of ovarian response to gonadotropin stimulation. PCOS patients have an increased number of preantral follicles; hence, close monitoring for ovarian hyperstimulation syndrome (OHSS) is essential. 3D ultrasound is a new imaging modality that improves the sensitivity and specificity of ultrasound. Recent advances in 3D ultrasound have the potential to better our understanding of follicular development, ovulation, and uterine receptivity.

  • Chapter 20 - Scrotal ultrasonography in male infertility

  • from Section 2: - Ultrasonography in infertility
  • Edited by Botros R. M. B. Rizk, University of South Alabama
  • Book:
    Ultrasonography in Reproductive Medicine and Infertility
    Published online:
    07 September 2011
    Print publication:
    25 March 2010, pp 163-170

  • Summary

    When clomiphene citrate (CC) is used for ovulation induction, endometrial thickness is often decreased compared with spontaneous cycles during and immediately following the days CC is taken, because of its antiestrogen effect. A triple-line pattern on the day of human chorionic gonadotropin (hCG) administration has been reported to be necessary for implantation in controlled ovarian hyperstimulation (COH) cycles, where human menopausal gonadotropin (hMG) or follicle stimulating hormone (FSH) is administered. A triple-line endometrial pattern on the day of hCG administration in in-vitro fertilization (IVF) cycles is related to serum estradiol level, the number of mature oocytes, and the number of top-quality embryos and is unrelated to serum progesterone levels. Preclinical miscarriage, also referred to as biochemical pregnancy, in which quantitative hCG levels initially indicate pregnancy but decrease before a gestational sac can be seen on ultrasound, and clinical miscarriage of embryos with karyotype is the result of inadequate endometrial development.

  • Chapter 32 - Heterotopic pregnancy and assisted reproduction

  • from Section 4: - Early pregnancy after infertility treatment
  • Edited by Botros R. M. B. Rizk, University of South Alabama
  • Book:
    Ultrasonography in Reproductive Medicine and Infertility
    Published online:
    07 September 2011
    Print publication:
    25 March 2010, pp 271-275

  • Summary

    Over the last 25 years, progress in the field of assisted reproduction has paralleled that in ultrasonography. Normal fallopian tubes are not usually seen by ultrasound, though it is sometimes possible to visualize the fimbrial end within fluid in the pouch of Douglas. The ovaries are usually seen lateral to the uterus, in close relationship to the internal iliac vessels. They can be identified by their echogenic stroma and sonolucent follicles. A variety of ovarian reserve tests are used in routine clinical practice to assess a woman's ovarian performance prior to controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). Transvaginal ultrasound-guided aspiration of ovarian follicles provides a safe and effective means of oocyte retrieval. Embryo transfer is a crucial step of IVF treatment. Ultrasound is a cornerstone of prevention and diagnosis of potential IVF complications such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies.

  • 24 - Aromatase Inhibitors for Assisted Reproduction

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 220-227

  • Summary

    This chapter discusses the potential role of the new group of medications called aromatase inhibitors in assisted reproduction. When an aromatase inhibitor is applied during controlled ovarian hyperstimulation (COO), estrogen production per growing ovarian follicle has been found to be significantly lower than when aromatase inhibitors are not used. The use of aromatase inhibitors for in vitro maturation is an exciting application that can involve a brief aromatase inhibitor-induced rise in endogenous gonadotropin secretion leading to multiple ovarian follicles, followed by retrieval of immature oocytes. Both lowering supraphysiological levels of estrogen during COH and improving response to COH by enhancing endogenous gonadotropin production and increasing the ovarian follicular sensitivity to gonadotropin stimulation could be of benefit in particular groups of patients, for example, poor responders, endometriosis-associated infertility, polycystic ovarian syndrome (PCOS), and survivors of estrogen-dependant malignancies, for example, breast cancer.