Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

25 results

Page 1 of 2

  • Live birth rate of gonadotropin-releasing hormone antagonist versus luteal phase gonadotropin-releasing hormone agonist protocol in IVF/ICSI: a systematic review and meta-analysis

  • Chenhong Liu, Tian Tian, Yanru Lou, Jia Li, Ping Liu, Rong Li, Jie Qiao, Yuanyuan Wang, Rui Yang
  • Journal:
    Expert Reviews in Molecular Medicine / Volume 26 / 2024
    Published online by Cambridge University Press:
    14 December 2023, e2
    • Article
      • You have access
      • Open access
    • PDF
    • HTML
    • Export citation

  • In vitro fertilization (IVF) and embryo transfer and intracytoplasmic sperm injection (ICSI) have allowed millions of infertile couples to achieve pregnancy. As an essential part of IVF/ICSI enabling the retrieval of a high number of oocytes in one cycle, controlled ovarian stimulation (COS) treatment mainly composes of the standard long gonadotrophin-releasing hormone agonist (GnRH-a) protocol and the gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol. However, the effectiveness of GnRH-ant protocol is still debated because of inconsistent conclusions and insufficient subgroup analyses. This systematic review and meta-analysis included a total of 52 studies, encompassing 5193 participants in the GnRH-ant group and 4757 in the GnRH-a group. The findings of this study revealed that the GnRH-ant protocol is comparable with the long GnRH-a protocol when considering live birth as the primary outcome, and it is a favourable protocol with evidence reducing the incidence of ovarian hyperstimulation syndrome in women undergoing IVF/ICSI, especially in women with polycystic ovary syndrome. Further research is needed to compare the subsequent cumulative live birth rate between the two protocols among the general and poor ovarian response patients since those patients have a lower clinical pregnancy rate, fewer oocytes retrieved or fewer high-grade embryos in the GnRH-ant protocol.

  • Chapter 17 - Ovarian Hyperstimulation Syndrome

  • from Section 3 - Reproductive Endocrinology and Infertility
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 139-145

  • Summary

    Ovarian hyperstimulation syndrome (OHSS) mostly occurs due to excessive FSH stimulation, with final follicle maturation by hCG for IVF. Symptoms usually start 2–4 days after oocyte retrieval; alternatively, endogenous hCG from an implanting embryo can initiate OHSS some days later. Luteinized follicles synthesize vascular endothelial growth factor (VEGF) which induces angiogenesis and increased capillary permeability by inhibition of the cell adhesion molecule vascular endothelial-cadherin (VE-cadherin). This causes fluid leakage from the vascular bed to the third space, resulting in enlarged lutein cysts and ascites. Initial symptoms are bloated abdomen with pain, and in more severe cases dyspnoea, decreased renal and hepatic function and thromboembolism. There is no causal treatment of established OHSS, but there are several prophylactic strategies based on risk evaluation of each patient. In established OHSS, treatment is mainly supportive, by correcting fluid, salt and protein deficits, and low molecular weight heparin for thrombosis prophylaxis.

  • 9 - Assisted reproduction – clinical and laboratory procedures

  • Edited by Siladitya Bhattacharya, University of Aberdeen, Mark Hamilton
  • Book:
    Management of Infertility for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    30 January 2014, pp 97-112

  • Summary

    This chapter focuses on in vitro fertilisation (IVF), the most common assisted reproductive technology (ART) procedure. The use of IVF has radically transformed the way in which we approach the management of infertility, irrespective of the diagnosis, and it is integral to the infrastructure of a modern fertility service. Monitoring of treatment includes follicle tracking with ultrasound and ovarian steroid measurement. In the early days of IVF, oocyte collection procedures were done under laparoscopic guidance. After oocyte retrieval, freshly ejaculated seminal fluid is prepared to concentrate motile spermatozoa in a fraction that is free of seminal plasma and debris. Embryologists then have to decide whether they are going to perform conventional IVF or need to inject sperm directly into the oocyte (intracytoplasmic sperm injection (ICSI)). Two major complications of ART to consider are multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).

  • Complications of triple pregnancy following intracytoplasmic sperm injection: a case report

  • DC Nkemayim, ME Hammadeh, M Hippach, P Rosenbaum, W Schmidt
  • Journal:
    Twin Research / Volume 3 / Issue 2 / 01 April 2000
    Published online by Cambridge University Press:
    21 February 2012, pp. 76-79
    • Article
      • You have access
    • PDF
    • Export citation

  • A case is presented of pregnancy and delivery of triplets following intracytoplasmic sperm injection (ICSI) therapy. Although the outcome was satisfactory, with the birth of normal children free from any malformation, most of the obstetric and particularly the neonatal complications that can be associated with this therapy are illustrated in this case. In addition, from point of view of medical costs, concerns are raised about the current policy of multiple embryo transfer which is directly responsible for the high rate of multiple gestations observed in the IVF/ICSI programme. The authors consequently recommend a policy of transferring not more than two embryos per treatment cycle. Twin Research (2000) 3, 76–79.

  • 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 19 - Granulosa cells and their impact on human ART

  • 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 209-222

  • Summary

    The majority of women with anovulation or oligoovulation due to polycystic ovary syndrome (PCOS) often have clinical and/or biochemical evidence of hyperandrogenism. This chapter describes the treatment with clomiphene citrate (CC), aromatase inhibitors (AIs), gonadotropins, and metformin followed by a discussion on the management of women with PCOS undergoing in vitro fertilization (IVF). It deals with the combined treatment of clomiphene with metformin. In women with PCOS, metformin is said to lower fasting insulin concentrations but also probably acts directly on theca cells and attenuates androgen production. The aim of the chronic low-dose step-up protocol is to obtain the ovulation of a single follicle. While results of IVF for women with PCOS are generally satisfactory compared with those with normal ovaries, ovarian stimulation protocols must be adapted accordingly to avoid the major pitfall of ovarian hyperstimulation syndrome (OHSS) in these women.

  • Chapter 21 - Embryo culture in the twenty-first century

  • 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 232-247

  • Summary

    This chapter deals with the classification, pathophysiology, prediction, prevention, and treatment of ovarian hyperstimulation syndrome (OHSS). OHSS is characterized by bilateral cystic ovarian enlargement and third-space fluid shift resulting in ascites and pleural effusion. It may be moderate or severe in severity, early or late in onset, spontaneous or iatrogenic in etiology. Prediction of OHSS is the cornerstone of prevention. It is based on identifying the characteristics of the patients who would be high responders as well as the use of ultrasonography and estradiol assessment. The pathophysiology of OHSS suggests the involvement of an inflammatory mechanism during the development of the fluid leakage associated with OHSS. Therefore, investigators hypothesized that glucocorticoids could possibly prevent OHSS in patients at high risk. Laparoscopic ovarian drilling has been used successfully for prevention of OHSS in patients with polycystic ovaries. The medical treatment of OHSS consists of correction of circulatory volume and electrolyte imbalance.

  • Chapter 15 - Three-dimensional in vitro ovarian follicle culture

  • 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 167-176

  • Summary

    The availability of gonadotropin releasing hormone (GnRH) antagonists did not only offer clinicians an alternative to GnRH agonists but, more importantly, has led to the development of new concepts aiming to increase safety and simplicity in ovarian stimulation. These include the modified natural cycle, mild in vitro fertilization (IVF), the use of GnRH agonist for triggering of final oocyte maturation with elective cryopreservation in patients at risk of developing ovarian hyperstimulation syndrome (OHSS), the administration of antagonists during the luteal phase for management of severe OHSS, as well as control of endogenous luteinizing hormone (LH) with GnRH antagonists in intrauterine insemination (IUI) cycles. Administration of GnRH antagonists can be performed by either a single dose or by using a daily scheme. The need to simplify ovarian stimulation led to the development of long-acting follicle stimulating hormone (FSH).

  • Chapter 20 - Ultrasound monitoring for ovulation induction: pitfalls and problems

  • from Section 6: - Procedures before, during, and after ovarian stimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 217-232

  • Summary

    Ovarian hyperstimulation syndrome (OHSS) is the most serious iatrogenic complication of ovulation induction. The ovaries are noted to have a significant degree of stromal edema, interspersed with multiple hemorrhagic follicular and theca-lutein cysts, areas of cortical necrosis, and neovascularization. Mutations in follicle-stimulating hormone (FSH) receptors could be activating, resulting in OHSS, or inactivating, resulting in sterility. Bone morphogenic protein-15 (BMP-15) appears to be associated with mechanisms of infertility and superfertility in a dosage-sensitive manner. Human chorionic gonadotropin increases vascular endothelial growth factor (VEGF) production by granulosa cells and endothelial cells, which results in increased vascular permeability. Increased intraovarian blood flow and low intravascular ovarian resistance are correlated with the severity of OHSS in patients who develop the syndrome. The medical treatment of OHSS consists of correction of circulatory volume and electrolyte imbalance. Ultrasonographic guidance of transvaginal or transabdominal aspiration of ascites improves the symptoms of patients with OHSS.

  • Chapter 15 - Ovulation induction for hypogonadotropic hypogonadism

  • from Section 4: - Non-conventional forms used during ovarian stimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 162-172

  • Summary

    This chapter deals with different gonadotropin molecules in ovarian stimulation. Human menopausal gonadotropins consist of a purified preparation of gonadotropins extracted from the urine of postmenopausal women. In the natural cycle both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are required for normal follicular growth and maturation. The main risk associated with the use of FSH-containing gonadotropin products is the development of ovarian hyperstimulation syndrome (OHSS). OHSS can be easily prevented by starting with a relatively low dose of gonadotropin, especially in high-risk women like young patients, those with polycystic ovary syndrome (PCOS), and those with a low body mass index (BMI). From the many randomized trials that have been performed it appears that all available gonadotropins are comparably effective and safe. The differences in isoform profile did not appear to have significant clinically significant effects in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles.

  • Chapter 19 - Ovarian cautery for polycystic ovary syndrome

  • 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 209-216

  • Summary

    Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrinopathies, affecting 5-10% of women of reproductive age. PCOS is one of the commonest causes of anovulatory infertility. The characteristic clinical features of PCOS include menstrual irregularity such as oligomenorrhoea and signs of hyperandrogenaemia including hirsutism, acne, and/or obesity. A recent study observed a significant and progressive correlation between body mass index (BMI) and both blood pressure and clinical features in women with PCOS. Clomifene citrate has been the standard treatment for induction of ovulation in women with anovulatory infertility for many years. The beneficial endocrinologic and morphologic effects of laparoscopic ovarian diathermy appear to be sustained for up to 9 years in most patients with PCOS. In vitro maturation (IVM) protocols are now a valuable alternative to conventional in vitro fertilization (IVF) as a strategy to prevent ovarian hyperstimulation syndrome (OHSS).

  • 16 - The role of in vitro maturation of oocytes for anovulatory polycystic ovary syndrome

  • Edited by Adam Balen, University of Leeds, Stephen Franks, Roy Homburg, Sean Kehoe
  • Book:
    Current Management of Polycystic Ovary Syndrome
    Published online:
    05 July 2014
    Print publication:
    01 October 2010, pp 185-194

  • Summary

    A number of studies have shown that the presence of ovaries of polycystic morphology, regardless of whether there are additional features of the full polycystic ovary syndrome (PCOS), significantly increase the risk of developing moderate to severe ovarian hyperstimulation syndrome (OHSS). in vitro maturation (IVM) is an approach with the potential to increase both the simplicity and safety of assisted reproductive technology (ART) treatment through the absence of the need for ovarian stimulation. IVM is a promising technique for women with anovulatory PCOS. The success rates are currently lower than those achieved with in vitro fertilisation (IVF) but IVM is safer and easier to undertake for the woman and it avoids gonadotrophin stimulation and the attendant risk of OHSS. While IVM is apparently safer for the woman, long-term paediatric studies are required before IVM can be fully assessed, which is also the case for other ART treatments.

  • 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 30 - First-trimester pregnancy failure

  • 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 251-258

  • Summary

    Acute pelvic pain is a common reason for women to seek urgent gynecologic evaluation. Although the classic clinical presentation is dysmenorrhea with premenstrual intensification, dyspareunia, and chronic pelvic pain, some patients, who may or may not know they have the condition, experience acute pelvic pain. Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of superovulation induction therapy with a varied spectrum of clinical and laboratory manifestations. Crampy pelvic pain due to hormonal changes, rapid growth of the uterus, and increased blood flow is a common sign of early pregnancy. If a patient fails a single course of methotrexate or has pelvic pain that is increasing, ultrasound can be helpful. If a patient continues to have pain after a presumed miscarriage, even if products of conception were confirmed cytologically, a heterotopic pregnancy should be a considered.

  • 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.

  • Chapter 36 - Sperm banking:

  • Edited by Larry I. Lipshultz, Stuart S. Howards, University of Virginia, Craig S. Niederberger, University of Illinois, Chicago
  • Book:
    Infertility in the Male
    Published online:
    19 May 2010
    Print publication:
    24 September 2009, pp 593-602

  • Summary

    In-vitro fertilization (IVF) has rapidly become a treatment for male factor infertility. Mature oocytes are inseminated in a Petri dish and examined 18 hours later for morphologic proof of fertilization. Gamete intrafallopian transfer (GIFT) is designated for women who have at least one functioning fallopian tube. Micromanipulation procedures progressed because of discouraging results with IVF for the male-factor patient. Although application of acid solutions or enzymes, and mechanical opening of the human zona pellucida have been developed, only partial zona dissection (PZD) has been successful in humans. One of the most significant risks associated with ART is the ovarian hyperstimulation syndrome (OHSS). Preimplantation genetic screening (PGS) for aneuploidies has been performed in patients with advanced maternal age, unexplained recurrent miscarriage, recurrent implantation failure, nonobstructive and obstructive azoospermia (NOA and OA), and severe sperm morphology anomalies.

  • 7 - Fertiloscopy

  • 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 70-75

  • Summary

    Fertiloscopy is performed as an ambulatory technique. There are five steps in this procedure: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. One of the prerequisite of operative fertiloscopy was to be as effective as the same procedure practiced during laparoscopy. Compared to laparoscopy, fertiloscopy has also some advantages like the facility to perform salpingoscopy and microsalpingoscopy. Fertiloscopy was first designed to avoid diagnostic laparoscopy. Operative possibilities were developed later. The complication rate is low, almost always avoidable if contraindications are strictly respected. Endometriosis may also be treated by operative fertiloscopy, when minimal or moderate. If the lesions are extensive or severe, then laparoscopy has to be the preferred option. Some techniques like fertiloscopic ovarian drilling in polycystic ovarian syndrome (PCOS) patients have already demonstrated its interest in the pregnancy rate obtained without the risks of ovarian hyperstimulation syndrome (OHSS).

  • 62 - Complications of Assisted Reproductive Technology

  • from PART III - ASSISTED REPRODUCTION
  • 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 604-618

  • Summary

    This chapter considers each stage of assisted reproductive technology (ART) and discusses its possible complications with options for prevention. The frequency of complications of ART varies among series and depending on whether the complications are reported in single treatment cycles or all treatment cycles. The iatrogenic condition of ovarian hyperstimulation syndrome (OHSS) is the most important complication of ovulation induction and, in its severe form, is a potentially lethal disease. Ovarian cancer and breast cancer are also associated with use of ovulation stimulating drugs. Other unusual side effects of ovulation induction include bloody ascites in a woman with endometriosis and familial Mediterranean fever, pituitary hemorrhage after clomiphene citrate, and hypophyseal hypertrophy in pregnancy after bromocriptine treatment for prolactinomia. Three main groups of complications of oocyte pick up (OPU) are: hemorrhage, pelvic infection, and damage to pelvic structures such as the bowel or ureters.

  • 27 - Ovarian Hyperstimulation Syndrome

  • 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 243-257

  • Summary

    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction, which may cause serious impact on the patient's health, with 0.1-2 percent of the patients developing severe forms of the syndrome. Many substances involved in the regulation of vascular permeability (VP) have been implicated in causing OHSS. The use of low doses of dopamine may be useful in severe OHSS patients. The OHSS primary prevention is to reduce its incidence, being the most important step to identify patients at risk that will undergo in-vitro fertilization (IVF) treatment, using a softer stimulation protocol and giving these patients special attention and close monitoring than usual with frequent ultrasound and serum estradiol levels. Until recently, OHSS treatment was reduced to the management of its complications. New data as the vascular endothelial growth factor (VEGF) system studies are providing new insights for prevention and treatment of OHSS.

Page 1 of 2