Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism"

Transcription

1 RBMOnline - Vol 15. No Reproductive BioMedicine Online; on web 14 June 2007 Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism M Emre Bakircioglu received his MD degree from Cerrahpasa Medical School, Istanbul University. He concluded his urology residency in Haydarpasa Numune Hospital and then completed a research fellowship in neuro-urology and erectile dysfunction under supervision of Dr Tom Lue at the Department of Urology, University of California San Francisco. He is currently working at the German Hospital Urology Department, and is also a consulting urologist at the German Hospital IVF Centre and Bahçeci Women Healthcare Center. He is member of American Urology Association, American Society for Reproductive Medicine and Society for Male Reproduction and Urology. Dr Emre Bakircioglu Mustafa Emre Bakircioglu 1,3, Halit Firat Erden 2, H Nadir Çiray 2, Numan Bayazit 2, Mustafa Bahçeci 2 1 German Hospital Urology Department; 2 German Hospital IVF Centre and Bahçeci Women Healthcare Centre, Istanbul, Turkey 3 Correspondence: Cesmebasi Cad. Caliskan Sok. Kemerhill Sitesi, Madra 1/9, Kemerburgaz, Eyup, Istanbul, Turkey, Tel: ; Fax: ; Abstract The aim of this study was to evaluate the impact of gonadotrophin therapy in combination with intracytoplasmic sperm injection (ICSI) in men with hypogonadotrophic hypogonadism (HH). Twenty-five azoospermic men were diagnosed with HH due to low FSH, LH and total testosterone concentrations. These patients were treated with human chorionic gonadotrophin for 1 month plus recombinant FSH the following month. Total testosterone concentrations were measured in the first and third months. Semen analyses were performed monthly after the third month of treatment. ICSI was performed when sperm production commenced. Total testosterone concentration and testicular volume were significantly increased after gonadotrophin therapy (P < 0.001). On average, spermatozoa were detected in the ejaculate after 10 months. Spontaneous pregnancies were achieved in four couples. Twenty-two ICSI cycles were performed in 18 couples using ejaculated or testicular spermatozoa, and 12 pregnancies (54.5% per cycle) were achieved. These results showed that HH could be treated successfully with hormonal therapy combined with ICSI using ejaculated spermatozoa. The use of ICSI made it possible to achieve pregnancy when spermatozoa appeared in the ejaculate, and shortened the duration of gonadotrophin therapy. Keywords: azoospermia, gonadotrophin therapy, hypogonadotrophic hypogonadism, intracytoplasmic sperm injection, testicular sperm extraction Introduction 156 Azoospermia due to hypogonadotrophic hypogonadism (HH) is an uncommon cause of male infertility. HH is categorized as primary or secondary. Primary HH is also known as idiopathic HH (IHH), and is a disorder that selectively affects the secretion or function of gonadotrophin-releasing hormone (GnRH). As a result, LH and FSH are not produced by the hypophysis and therefore neither androgen production nor spermatogenesis is stimulated in the testes. Secondary HH may indicate the presence of various underlying diseases such as brain tumour, infiltrative disorders (sarcoidosis, haemochromatosis, infection) or head trauma. The stimulation of spermatogenesis can be successfully achieved either with pulsatile administration of GnRH or a combination of human chorionic gonadotrophin (HCG)/human menopausal gonadotrophin (HMG) in the infertility treatment of HH (Buchter et al., 1998). Continuous HCG alone may result in the presence of spermatozoa in the ejaculate (Vicari et al., 1992). Instead of using urinary menotropin preparations, the recombinant human FSH (r-hfsh) has been successfully used for the induction of spermatogenesis and fertility in gonadotrophin-deficient men (Liu et al., 1999) Published by Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB3 8DB, UK

2 Spontaneous pregnancies have been reported after prolonged durations of hormonal therapy in IHH patients (Kliesch et al., 1994; Buchter et al., 1998; Liu et al., 1999). Sperm appearance in the semen can be expected 6 months after the initiation of gonodotrophin therapy, and pregnancy can be predicted on average 8 months after sperm concentration increases to /ml (Buchter et al., 1998; Liu et al., 1999). Therefore, it was reported that if spontaneous pregnancy does not occur after 20 months, or 8 months after achieving a sperm concentration of /ml, assisted reproductive technologies may be considered time effective (Liu et al., 2002). The combination of hormonal therapy with intracytoplasmic sperm injection (ICSI) has been reported in a few studies (Liu et al., 1999; Fahmy et al., 2004; Zorn et al., 2005). Despite undergoing prolonged gonodotrophin therapy, some patients with HH remained azoospermic. It was reported that in 11 out of 15 (73%) men with HH who were still azoospermic after gonadotrophin therapy, spermatozoa were successfully retrieved from testicular tissue (Fahmy et al., 2004). Using testicular spermatozoa in 17 ICSI cycles, the pregnancy rate was 20%. The aim of this study was to evaluate the effect of the combination of HCG and r-hfsh therapy plus ICSI of ejaculated spermatozoa on the occurrence of pregnancy in the partners of men with IHH. Materials and methods Patients Between 2002 and 2005, 25 patients (who were not referred from endocrinology or other clinics) were diagnosed with HH due to azoospermia and low concentrations of FSH, LH and total testosterone. The ejaculate volumes of the patients were lower than 1 ml due to the low testosterone concentrations. The mean age of the patients and their partners were 34.5 ± 5.2 (mean ± SD) years and 31.2 ± 4.2 years respectively. The duration of infertility was 7.1 ± 4.0 years. Azoospermia was confirmed after two to three semen analyses and examination of the pellet suspension subsequent to centrifugation at 600 g. All of the patients had a history of decreased libido and sexual dysfunction. Additionally in 15 patients, facial, axillary and pubic hair was decreased and gynaecomastia was observed. Three patients had anosmia. The testicular volume was measured by a Prader orchidometer (Accurate Surgical and Scientific Instruments Corporation, NY, USA) at the beginning and after 6 months of therapy. Testicular volumes were 4 ml in 19 and >4 ml in six patients (range 5 8 ml). Medical history and pituitary imaging by magnetic resonance imaging did not show any evidence of acquired (secondary) hypogonadotrophic hypogonadism in patients with testicular volume >4 ml. One patient had right cryptorchidism at the level of the external inguinal ring. Ten patients had a history of testosterone replacement therapy (TRT) and eight patients had a history of gonadotrophin therapy (HCG alone or combination with urinary FSH-LH). These patients discontinued the therapy for 4 weeks and then testosterone concentration was measured before gonadotrophin therapy in this study was initiated. In two patients (11% of the patients who accepted ICSI therapy), testicular sperm extraction (TESE) was performed, as there were no motile spermatozoa in their thawed material and in their ejaculate on the day of oocyte retrieval. Gonadotrophin therapy Patients started gonadotrophin therapy with 5000 IU i.m. HCG (Pregnyl; Organon, Oss The Netherlands) twice weekly. The dose of HCG was adjusted to once a week according to the testosterone concentration during follow-up visits. One month after the initiation of HCG, recombinant human FSH (Gonal- F; Industria Farmaceutica Serono S.p.A., Bari, Italy) 100 IU was administered as subcutaneous injection three times a week. The serum testosterone concentrations were determined in the first and the third month of therapy and semen analyses were performed monthly after the third month of gonadotrophin therapy. Sperm preservation When motile spermatozoa were presented in the ejaculate, two or three semen samples were collected in order to cryopreserve spermatozoa before the ICSI cycle started. A semen sample was collected again on the day of oocyte retrieval and cryopreserved spermatozoa were thawed if the motile spermatozoa did not suffice to inject all metaphase II oocytes. Testicular sperm extraction (TESE) Under general anaesthesia, the scrotum was incised on the scrotal raphe. The testis was opened from the mid part with a large horizontal incision under 10 magnification using an operating microscope. Microdissection procedure and testicular sperm preparation were performed as previously described (Bakircioglu et al., 2006). Ovarian stimulation A pelvic genital examination and transvaginal ultrasonography were performed on partners of HH patients who were scheduled to undergo ICSI treatment. Routine laboratory tests, including FSH and prolactin, were carried out. The standard long protocol with agonist desensitization with leuprolide acetate (Lucrin daily; Abbott, Turkey) was started on day 21 of the previous menstrual cycle. For poor responders, flare-up protocol was performed as previously described (Akman et al., 2001). When at least two follicles reached 18 mm in diameter, 10,000 IU HCG (Pregnyl; Organon, Oss, The Netherlands) was administered intramuscularly. Oocytes were retrieved under general anaesthesia h later and were subjected to ICSI. Fertilization was assessed h after ICSI. Embryos were cultured at 37 C, in an atmosphere of 5.5% CO 2 in air in individual 30 μl drops of a human tubal fluid based medium (Sage In-Vitro Fertilization Inc., CT, USA) covered with mineral oil. The embryos were selected according to day-3 embryo quality. The luteal phase was supported by 100 mg/day progesterone in oil i.m. Clinical pregnancy was defined as a demonstrable gestational sac by transvaginal ultrasonography, subsequent to a rise in β-hcg concentrations. Statistical analysis Mann Whitney U-test was used to compare the initial testicular volume and testosterone concentrations with those after 6 months of therapy and the time of sperm appearance in the ejaculate of 157

3 men with 4 ml and >4 ml testicular volume. Fisher s exact test was performed to analyse the pregnancy rates in the partners of men with 4 ml and >4 ml testicular volume. A P-value <0.05 was considered statistically significant. Statistics Package for Social Sciences version 11.5 for windows software (serial no: ) was used for statistical analysis. Results At the beginning of therapy, the mean testicular volume of the patients was 3.7 ± 1.9 ml and the mean total testosterone concentration was 0.5 ± 0.3 ng/ml. Testosterone concentration was significantly increased to 3.0 ± 0.7 ng/ml in the first month and to 5.1 ± 1.2 ng/ml in the third month (P < 0.001). Testicular volume was significantly increased and reached 5.7 ± 2.3 ml by the sixth month (P < 0.001). Spermatozoa were detected in the ejaculate in all patients at a mean of 10.1 ± 2.6 months of therapy (range 6 18 months) (Table 1). Spermatozoa appeared in the ejaculate at 10.5 ± 1.8 months in men with testicular volume larger than 4 ml and 9.7 ± 2.9 months in men with testicular volume smaller than 4 ml (P > 0.05). Four spontaneous pregnancies occurred during gonadotrophin therapy. One pregnancy was achieved after 18 months of therapy at a sperm concentration of /ml, 6 months after unsuccessful ICSI treatment. Three pregnancies were achieved after 12 months of therapy at sperm concentrations of / ml, /ml and /ml. The volume of the testes was smaller than 4 ml in three patients and 8 ml in one patient who achieved pregnancy after an unsuccessful ICSI treatment. The pregnancy rates achieved for patients who had testicular volume larger than 4 ml and smaller than 4 ml were 66.7 and 63.2% respectively and the difference was not statistically significant. Twenty-two ICSI cycles were performed on 18 patients and in one patient transfer of frozen thawed embryos was performed. Three patients did not undergo ICSI treatment. The distribution of sperm concentrations and the duration of the gonadotrophin therapy in those patients who underwent ICSI therapy are shown in Table 2. A total of 331 oocytes were collected, of which 261 were in metaphase II. Of these, 169 (65%) were fertilized. A mean of 3.0 ± 0.8 embryos were transferred. Twelve clinical pregnancies Table 1. Clinical characteristics of patients with hypogonadotrophic hypogonadism during gonadotrophin therapy and intracytoplasmic sperm injection (ICSI) outcome. Patient Age Months of Sperm count Total testosterone (ng/ml) Testicular volume (ml) Pregnancy (years) treatment ( 10 6 /ml) Basal 1 month 3 months Pre- 6 months before sperm treatment presence Yes Yes No PP Yes PP Yes a PP No 7 d 33 6 PP Yes PP Yes 9 e 39 8 PP No PP No PP Yes Yes a Yes Yes a Yes PP Yes a 17 e PP Yes 18 e PP No 19 d PP Yes b PP No ICSI PP No ICSI PP No 23 e 42 9 PP Yes c PP No ICSI PP Yes 158 PP = pellet positive. a Spontanous pregnancy, b frozen thawed embryo transfer, c missed abortions, d sperm recovery with testicular sperm extraction, e two ICSI attempts.

4 Table 2. Intracytoplasmic sperm injection (ICSI) results in patients with hypogonadotrophic hypogonadism according to sperm concentration. Parameter Sperm concentration Pellet + <10 5 /ml /ml /ml No. of ICSI cycles No. of pregnancies 2 a Mean duration of the 10.3 ± ± ± ± 2.8 therapy (months) a Both resulted in abortion. Two cycles in which testicular sperm extraction was applied are not included. (54.5% per cycle, 67% per patient) were achieved and two consecutive ICSI cycles were performed in four couples. In one couple, the two pregnancies resulted in missed abortions. In two couples, no pregnancy was achieved by either ICSI attempt. In the remaining couple, pregnancy was achieved at the second attempt. In addition, in one couple frozen thawed embryo transfer resulted in a pregnancy. Six pregnancies resulted in deliveries of eight boys and three girls, and five pregnancies are ongoing. Discussion The aetiology of idiopathic HH is not fully understood; however, recent studies suggest that the pathology may have a genetic and molecular basis (Wolczynski et al., 2003; Paduch et al., 2005; Pengo et al., 2006). In the treatment of men with HH, GnRH or HCG, with or without FSH, can successfully initiate spermatogenesis (Finkel et al., 1985; Schopohl et al., 1991; Buchter et al. 1998). Although different protocols have been used in the treatment of HH, prolonged continuous therapy, followup with the assessment of hormone concentrations and semen analyses are mandatory to achieve successful sperm production. Usually, the protocols start with HCG and after stabilization of the serum testosterone concentration, FSH is then included in the protocol (European Metrodin HP Study Group 1998; Liu et al., 1999; Bouloux et al., 2002). The efficacy of using recombinant or urinary FSH was reported to be similar (Liu et al., 2002). Spermiogenesis and sperm presence in the ejaculate occurred in response to HCG and r-hfsh therapy at a mean of 10 months in the present study group. This result compares with a mean of 9 months in HCG combined with highly purified urinary FSH treatment (European Metrodin HP Study Group, 1998). However, in some studies 13 53% of men with HH failed to produce any spermatozoa after treatment (Burris et al., 1988; Schopohl et al., 1991; Burgues and Calderon, 1997; European Metrodin HP Study Group, 1998; Liu et al., 2002). TESE could be an option for men with HH who still have azoospermia after a long period of therapy. In one study, it is reported that in 11 of 15 patients (73%) spermatozoa were successfully recovered after TESE (Fahmy et al., 2004). In this study, in two of 18 (11%) patients, who had occasional spermatozoa in the pellet, no spermatozoa were detected in the ejaculate on the day of oocyte retrieval. Spermatozoa were successfully recovered from testicular tissue in those patients. Several semen samples were collected and cryopreserved in order to avoid the TESE operation; however, motile spermatozoa could not be recovered on the day of oocyte retrieval. Therefore, in consultations for ICSI treatment, men who have occasional spermatozoa in the pellet should be informed of the possibility of the TESE procedure and their treatment could be postponed for several months to increase sperm concentration in the ejaculate. Gonadotrophin therapy is mandatory to induce spermatogenesis and testicular development in men with HH who seek fertility. It was shown that testicular volume was the most prominent clinical factor to predict pregnancy and spermatogenesis in those patients (Liu et al., 2002). Patients who had a testicular volume larger than 4 ml were generally agreed to have a better prognosis in terms of pregnancy (Burris et al., 1988; Vicari et al., 1992; Liu et al., 2002). In this study, the time of sperm appearance and pregnancy rates were not statistically significantly different between those patients who had larger and smaller than 4 ml testicular volume. In addition, three of the patients who had <4 ml testicular volume achieved spontaneous pregnancy. All of the patients who achieved spontaneous pregnancy had at least /ml sperm concentration after 12 months of therapy. It is reported that pregnancies mostly occurred within 8 months after achieving /ml sperm concentrations (Liu et al., 2002). In the progress of infertility treatment of patients who have had at least 1 year of therapy and sperm concentrations of < /ml, or who have > /ml sperm concentration and in whose partner a pregnancy does not occur after 20 months, assisted reproductive technologies may be suggested to the couple. In addition to the factors above, the ovarian reserve and the age of the partner should be considered. ICSI is an alternative infertility treatment in men with HH, and the results of ICSI with gonadotrophin therapy have been presented in several studies in the literature. Yong et al. (1997) reported an ICSI attempt in one patient with post-pubertal onset of HH after 9 months of gonadotrophin therapy. Another study showed an ICSI pregnancy using cryopreserved spermatozoa and frozen thawed embryo transfer that resulted in a miscarriage (Liu et al., 1999). Zorn et al. (2005) reported four men with HH who underwent ICSI after 6 23 months of gonadotrophin therapy. Ten ICSI cycles were performed and resulted in a 67% fertilization rate and 30% pregnancy rate per cycle (Zorn et al., 2005). In the present study, fertilization of the oocytes was 65% and the pregnancy rate was 54.5% in 22 ICSI attempts. So far as 159

5 is known, this is the highest number of patients with HH using ejaculated spermatozoa for ICSI. These results suggest that ICSI may be considered as the choice of infertility treatment in men with HH, even though the sperm concentrations are very low in their ejaculate. Further studies need to be conducted to assess the effect of sperm concentrations on ICSI results in the treatment of men with HH. In conclusion, gonadotrophin therapy for men with HH should be for at least a year, and during the therapy patients need support and careful assessment. The results show that pregnancy rates are promising with ICSI. Hence, during the gonadotrophin therapy, ICSI can be considered as a treatment option, and therefore might be discussed with patients who have commenced sperm production. References Akman MA, Erden HF, Tosun SB et al Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial. Human Reproduction 16, Bakircioglu ME, Erden HF, Kaplancan T et al Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome. Urology 68, Bouloux P, Warne DW, Loumaye E 2002 Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism. Fertility and Sterility 77, Buchter D, Behre HM, Kliesch S et al Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases. European Journal of Endocrinology 139, Burgues S, Calderon MD 1997 Subcutaneous self-administration of highly purified follicle stimulating hormone and human chorionic gonadotrophin for the treatment of male hypogonadotrophic hypogonadism. Spanish Collaborative Group on Male Hypogonadotropic Hypogonadism. Human Reproduction 12, Burris AS, Rodbard HW, Winters SJ et al Gonadotropin therapy in men with isolated hypogonadotropic hypogonadism: the response to human chorionic gonadotropin is predicted by initial testicular size. Journal of Clinical Endocrinology and Metabolism 66, European Metrodin HP Study Group 1998 Efficacy and safety of highly purified urinary follicle-stimulating hormone with human chorionic gonadotropin for treating men with isolated hypogonadotropic hypogonadism. Fertility and Sterility 70, Fahmy I, Kamal A, Shamloul R et al ICSI using testicular sperm in male hypogonadotrophic hypogonadism unresponsive to gonadotrophin therapy. Human Reproduction 19, Finkel DM, Phillips JL, Snyder PJ 1985 Stimulation of spermatogenesis by gonadotropins in men with hypogonadotropic hypogonadism. New England Journal of Medicine 313, Kliesch S, Behre HM, Nieschlag E 1994 High efficacy of gonadotropin or pulsatile gonadotropin-releasing hormone treatment in hypogonadotropic hypogonadal men. European Journal of Endocrinology 131, Liu PY, Gebski VJ, Turner L et al Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men. Human Reproduction 17, Liu PY, Turner L, Rushford D et al Efficacy and safety of recombinant human follicle stimulating hormone (Gonal-F) with urinary human chorionic gonadotrophin for induction of spermatogenesis and fertility in gonadotrophin-deficient men. Human Reproduction 14, Paduch D A, Mielnik A, Schlegel P N 2005 Novel mutations in testisspecific ubiquitin protease 26 gene may cause male infertility and hypogonadism. Reproductive BioMedicine Online 10, Pengo M, Ferlin A, Arredi B et al FSH receptor gene polymorphisms in fertile and infertile Italian men. Reproductive BioMedicine Online 13, Schopohl J, Mehltretter G, von Zumbusch R et al Comparison of gonadotropin-releasing hormone and gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism. Fertility and Sterility 56, Vicari E, Mongioi A, Calogero AE et al Therapy with human chorionic gonadotrophin alone induces spermatogenesis in men with isolated hypogonadotrophic hypogonadism long-term follow-up. International Journal of Andrology 15, Wolczynski S, Laudanski P, Jarzabek K et al A case of complete hypogonadotropic hypogonadism with a mutation in the gonadotropin-releasing hormone receptor gene. Fertility and Sterility 79, Yong EL, Lee KO, Ng SC et al Induction of spermatogenesis in isolated hypogonadotrophic hypogonadism with gonadotrophins and early intervention with intracytoplasmic sperm injection. Human Reproduction 12, Zorn B, Pfeifer M, Virant-Klun I et al Intracytoplasmic sperm injection as a complement to gonadotrophin treatment in infertile men with hypogonadotrophic hypogonadism. International Journal of Andrology 28, Received 20 February 2007; 8 March 2007; accepted 25 May

Drug Therapy Guidelines

Drug Therapy Guidelines Drug Therapy Guidelines Applicable Injectable Fertility Medications: Bravelle, Cetrotide, Follistim AQ, Ganirelix, Gonal-F, human chorionic gonadotropin, leuprolide, Menopur, Novarel, Ovidrel, Pregnyl,

More information

Pulsatile gonadotrophin releasing hormone versus gonadotrophin treatment of hypothalamic hypogonadism in males

Pulsatile gonadotrophin releasing hormone versus gonadotrophin treatment of hypothalamic hypogonadism in males Human Reproduction vol.8 Suppl.2 pp. 175-179, 1993 Pulsatile gonadotrophin releasing hormone versus gonadotrophin treatment of hypothalamic hypogonadism in males Jochen Schopohl Medizinische Klinik, Klinikum

More information

Infertility treatment

Infertility treatment In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation

More information

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G.R. Dohle, Z. Kopa, A. Jungwirth, T.B. Hargreave. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 Definition Infertility is the

More information

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G. Dohle (chairman), A. Jungwirth and W. Weidner. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 1. Introduction Infertility is

More information

Article Conception rates following assisted reproduction in poor responder patients: a retrospective study in 300 consecutive cycles

Article Conception rates following assisted reproduction in poor responder patients: a retrospective study in 300 consecutive cycles RBMOnline - Vol 6. No 4. 439 443 Reproductive BioMedicine Online; www.rbmonline.com/article/872 on web 7 April 2003 Article Conception rates following assisted reproduction in poor responder patients:

More information

Causes of Infertility and Treatment Options

Causes of Infertility and Treatment Options Causes of Infertility and Treatment Options Dr Mrs.Kiran D. Sekhar Former vice President-FOGSI Former Chairperson- Genetics and Foetal medicine-fogsi Founder and Medical Director-Kiran Infertility centre

More information

ART Drugs. Description

ART Drugs. Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.02 Subject: ART Drugs Page: 1 of 7 Last Review Date: September 15, 2017 ART Drugs Description Bravelle

More information

Article Outcome of 1114 ICSI and embryo transfer cycles of women 40 years of age and over

Article Outcome of 1114 ICSI and embryo transfer cycles of women 40 years of age and over RBMOnline - Vol 13. No 4. 2006 516-522 Reproductive BioMedicine Online; www.rbmonline.com/article/2391 on web 15 August 2006 Article Outcome of 1114 ICSI and embryo transfer cycles of women 40 years of

More information

Understanding Infertility, Evaluations, and Treatment Options

Understanding Infertility, Evaluations, and Treatment Options Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly

More information

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various

More information

Assisted Reproductive Technology (ART) / Infertility / Synarel (nafarelin)

Assisted Reproductive Technology (ART) / Infertility / Synarel (nafarelin) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.03 Subject: Synarel Page: 1 of 5 Last Review Date: September 15, 2016 Synarel Description Assisted

More information

Clinical Policy: Infertility Therapy Reference Number: CP.CPA.261 Effective Date: Last Review Date: Line of Business: Medicaid Medi-Cal

Clinical Policy: Infertility Therapy Reference Number: CP.CPA.261 Effective Date: Last Review Date: Line of Business: Medicaid Medi-Cal Clinical Policy: Reference Number: CP.CPA.261 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy for important

More information

INFERTILITY. Services - Part 2

INFERTILITY. Services - Part 2 INFERTILITY Services - Part 2 1 Imprint Published in January, 2013 By Victory A.R.T. Laboratory Phils, Inc. These articles were compiled by in hopes of helping bring into light infertility questions and

More information

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE

BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation

More information

Article Aromatase inhibitors in ovarian stimulation for IVF/ICSI: a pilot study

Article Aromatase inhibitors in ovarian stimulation for IVF/ICSI: a pilot study RBMOnline - Vol 13. No 2. 2006 166-172 Reproductive BioMedicine Online; www.rbmonline.com/article/2261 on web 19 May 2006 Article Aromatase inhibitors in ovarian stimulation for IVF/ICSI: a pilot study

More information

Abstract. RBMOnline - Vol 6. No Reproductive BioMedicine Online; on web 23 December Dr Jean-Noel Hugues

Abstract. RBMOnline - Vol 6. No Reproductive BioMedicine Online;  on web 23 December Dr Jean-Noel Hugues RBMOnline - Vol 6. No 2. 185 190 Reproductive BioMedicine Online; www.rbmonline.com/article/725 on web 23 December 2002 Article Improvement in consistency of response to ovarian stimulation with recombinant

More information

Article TESE ICSI in patients with non-mosaic Klinefelter syndrome: a comparative study

Article TESE ICSI in patients with non-mosaic Klinefelter syndrome: a comparative study RBMOnline - Vol 18. No 6. 2009 756-760 Reproductive BioMedicine Online; www.rbmonline.com/article/3892 on web 17 April 2009 Article TESE ICSI in patients with non-mosaic Klinefelter syndrome: a comparative

More information

Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection

Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection Sandra L. Emmons, MD Phillip Patton, MD Source: Medical Acupuncture, A Journal For Physicians By Physicians Spring

More information

Abstract. Introduction. RBMOnline - Vol 18 No Reproductive BioMedicine Online; on web 14 November 2008

Abstract. Introduction. RBMOnline - Vol 18 No Reproductive BioMedicine Online;  on web 14 November 2008 RBMOnline - Vol 18 No 1. 2009 67-72 Reproductive BioMedicine Online; www.rbmonline.com/article/3551 on web 14 November 2008 Article Frozen thawed cleavage-stage embryo transfer cycles after previous GnRH

More information

Article Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study

Article Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study RBMOnline - Vol 15. No 2. 2007 134-148 Reproductive BioMedicine Online; www.rbmonline.com/article/2711 on web 13 June 2007 Article Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective

More information

Rafael A. Cabrera, M.D., Laurel Stadtmauer, M.D., Ph.D., Jacob F. Mayer, Ph.D., William E. Gibbons, M.D., and Sergio Oehninger, M.D., Ph.D.

Rafael A. Cabrera, M.D., Laurel Stadtmauer, M.D., Ph.D., Jacob F. Mayer, Ph.D., William E. Gibbons, M.D., and Sergio Oehninger, M.D., Ph.D. Follicular phase serum levels of luteinizing hormone do not influence delivery rates in in vitro fertilization cycles down-regulated with a gonadotropin-releasing hormone agonist and stimulated with recombinant

More information

Lars G.Westergaard 1, Karin Erb, Steen Laursen, Per E.Rasmussen and Sven Rex

Lars G.Westergaard 1, Karin Erb, Steen Laursen, Per E.Rasmussen and Sven Rex Human Reproduction vol.11 no.6 pp. 1209-1213, 19% The effect of human menopausal gonadotrophin and highly purified, urine-derived follicle stimulating hormone on the outcome of in-vitro fertuization in

More information

Different follicle stimulating hormone/luteinizing hormone ratios for ovarian stimulation

Different follicle stimulating hormone/luteinizing hormone ratios for ovarian stimulation Human Reproduction vol.8 no.9 pp. 1387-1391, 1993 Different follicle stimulating hormone/luteinizing hormone ratios for ovarian stimulation LJ.M.Duijkers 1 ' 4, H.M.Vemer 1, J.M.G.HoUanders 1, W.N.P.Willemsen

More information

Laboratory Investigation of Male Gonadal Function. Dr N Oosthuizen Dept of Chemical Pathology UP 2010

Laboratory Investigation of Male Gonadal Function. Dr N Oosthuizen Dept of Chemical Pathology UP 2010 Laboratory Investigation of Male Gonadal Function Dr N Oosthuizen Dept of Chemical Pathology UP 2010 1 Figure 1. Hypothalamic-pituitary pituitary-testicular testicular axis 2 Testosterone (T) measurement

More information

Infertility. Thomas Lloyd and Samera Dean

Infertility. Thomas Lloyd and Samera Dean Infertility Thomas Lloyd and Samera Dean Infertility Definition Causes Referral criteria Assisted reproductive techniques Complications Ethics What is infertility? Woman Reproductive age Has not conceived

More information

Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used

Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara

More information

Puerto Rico Fertility Center

Puerto Rico Fertility Center Puerto Rico Fertility Center General Information of the In-Vitro Fertilization Program Dr. Pedro J. Beauchamp First test-tube baby IN PUERTO RICO Dr. Pedro Beauchamp with Adlin Román in his arms. Paseo

More information

Orgalutran 0.25 mg/0.5 ml solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION

Orgalutran 0.25 mg/0.5 ml solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 1. NAME OF THE MEDICINAL PRODUCT 0.25 mg/0.5 ml solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each pre-filled syringe contains 0.25 mg of ganirelix (INN) in 0.5 mg aqueous solution.

More information

Reproductive Health and Pituitary Disease

Reproductive Health and Pituitary Disease Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives

More information

Article Male and female factors that influence ICSI outcome in azoospermia or aspermia

Article Male and female factors that influence ICSI outcome in azoospermia or aspermia RBMOnline - Vol 18. No 2. 2009 168-176 Reproductive BioMedicine Online; www.rbmonline.com/article/3515 on web 9 December 2008 Article Male and female factors that influence ICSI outcome in azoospermia

More information

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde

GUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde GUIDELINES ON Male Hypogonadism G.R. Dohle, S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely

More information

Information for Patients. Male infertility. English

Information for Patients. Male infertility. English Information for Patients Male infertility English Table of contents What is male infertility?... 3 Diagnosis... 3 Medical history... 3 Physical examination... 3 Hormone blood tests... 3 Semen analysis...

More information

Hormonal Control of Human Reproduction

Hormonal Control of Human Reproduction Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with

More information

Reproductive Endocrinology & Infertility Glossary

Reproductive Endocrinology & Infertility Glossary Reproductive Endocrinology & Infertility Glossary The following is a glossary of terms you may hear during your association with the University of Mississippi Health Care's reproductive endocrinology and

More information

A Case of Pregnancy Using Recombinant Follicle Stimulating Hormone and Gonadotropin Releasing Hormone Antagonist

A Case of Pregnancy Using Recombinant Follicle Stimulating Hormone and Gonadotropin Releasing Hormone Antagonist 1 *, ** * * * ** A Case of Pregnancy Using Recombinant Follicle Stimulating Hormone and Gonadotropin Releasing Hormone Antagonist Yoon Sung Nam, Nam Keun Kim*, Eun Kyung Kim**, Hyung Min Chung** and Kwang

More information

Article Prediction of pituitary down-regulation by evaluation of endometrial thickness in an IVF programme

Article Prediction of pituitary down-regulation by evaluation of endometrial thickness in an IVF programme RBMOnline - Vol 8. No 5. 2004 595-599 Reproductive BioMedicine Online; www.rbmonline.com/article/1065 on web 17 March 2004 Article Prediction of pituitary down-regulation by evaluation of endometrial thickness

More information

EHY Ng, WSB Yeung, PC Ho. Introduction

EHY Ng, WSB Yeung, PC Ho. Introduction Comparison of two dosages of recombinant human follicle-stimulating hormone in Chinese women undergoing controlled ovarian stimulation: prospective randomised double-blind study EHY Ng, WSB Yeung, PC Ho

More information

A Tale of Three Hormones: hcg, Progesterone and AMH

A Tale of Three Hormones: hcg, Progesterone and AMH A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,

More information

Abstract. Introduction. Materials and methods

Abstract. Introduction. Materials and methods RBMOnline - Vol 10. No 5. 2005 645 649 Reproductive BioMedicine Online; www.rbmonline.com/article/1518 on web 18 March 2005 Article Factors predicting IVF treatment outcome: a multivariate analysis of

More information

Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists

Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists

More information

Aromatase Inhibitors in Male Infertility:

Aromatase Inhibitors in Male Infertility: Aromatase Inhibitors in Male Infertility: The hype of hypogonadism? BEATRIZ UGALDE, PHARM.D. H-E-B/UNIVERSITY OF TEXAS COMMUNITY PHARMACY PGY1 03 NOVEMBER 2017 PHARMACOTHERAPY ROUNDS Disclosures No conflicts

More information

Infertility. Dafydd Ywain & Kayleigh Hansen

Infertility. Dafydd Ywain & Kayleigh Hansen Infertility Dafydd Ywain & Kayleigh Hansen Terminology Epidemiology Aetiology Male infertility Female infertility Conclusion Content Terminology Fecundability The probability of conceiving during a single

More information

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective

More information

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should

More information

Sherman J.Silber 1,3, Zsolt Nagy 2, Paul Devroey 2, Michel Camus 2 and André C.Van Steirteghem 2

Sherman J.Silber 1,3, Zsolt Nagy 2, Paul Devroey 2, Michel Camus 2 and André C.Van Steirteghem 2 Human Reproduction vol.12 no.12 pp.2693 2700, 1997 The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Fertavid 50 IU/0.5 ml solution for injection Fertavid 75 IU/0.5 ml solution for injection Fertavid 100 IU/0.5 ml solution for

More information

Duration of progesterone-in-oil support after in vitro fertilization and embryo transfer: a randomized, controlled trial

Duration of progesterone-in-oil support after in vitro fertilization and embryo transfer: a randomized, controlled trial Duration of progesterone-in-oil support after in vitro fertilization and embryo transfer: a randomized, controlled trial Christine S. Goudge, M.D., Theodore C. Nagel, M.D., and Mark A. Damario, M.D. Division

More information

Asimina Tavaniotou 1, Carola Albano 1, Johan Smitz 1 and Paul Devroey 1,2

Asimina Tavaniotou 1, Carola Albano 1, Johan Smitz 1 and Paul Devroey 1,2 Human Reproduction Vol.16, No.4 pp. 663 667, 2001 Comparison of LH concentrations in the early and midluteal phase in IVF cycles after treatment with HMG alone or in association with the GnRH antagonist

More information

Factors influencing serum progesterone level on triggering day in stimulated in vitro fertilization cycles

Factors influencing serum progesterone level on triggering day in stimulated in vitro fertilization cycles ORIGINAL ARTICLE pissn 2233-8233 eissn 2233-8241 Clin Exp Reprod Med 2015;42(2):67-71 Factors influencing serum progesterone level on triggering day in stimulated in vitro fertilization cycles Ju Hee Park

More information

Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome

Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome Original Article Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome Tahereh Modarresi, M.Sc. 1, Hani Hosseinifar, M.Sc. 1,

More information

Abstract. Introduction. RBMOnline - Vol 19. No Reproductive BioMedicine Online; on web 24 August 2009

Abstract. Introduction. RBMOnline - Vol 19. No Reproductive BioMedicine Online;  on web 24 August 2009 RBMOnline - Vol 19. No 4. 2009 599 603 Reproductive BioMedicine Online; www.rbmonline.com/article/3872 on web 24 August 2009 Article Assisted reproduction in women over 40 years of age: how old is too

More information

Article Retrospective analysis of 1217 IVF cycles in women aged 40 years and older

Article Retrospective analysis of 1217 IVF cycles in women aged 40 years and older RBMOnline - Vol 14. No 3. 2007 348-355 Reproductive BioMedicine Online; www.rbmonline.com/article/2623 on web 5 February 2007 Article Retrospective analysis of 1217 IVF cycles in women aged 40 years and

More information

in vitro fertilization

in vitro fertilization FERTILITY AND STERILITY VOL 69, NO. 6, JUNE 1998 Copyright (#1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Elevated levels of basal

More information

IVF Patient Information

IVF Patient Information What is IVF? IVF (In Vitro Fertilisation) is a treatment by which fertilisation of eggs by sperm takes place outside the body in a dish in an IVF laboratory. An ovary has a pool of immature eggs. In a

More information

Article Effect of cetrorelix dose on premature LH surge during ovarian stimulation

Article Effect of cetrorelix dose on premature LH surge during ovarian stimulation RBMOnline - Vol 16. No 6. 2008 772-777 Reproductive BioMedicine Online; www.rbmonline.com/article/3181 on web 18 April 2008 Article Effect of cetrorelix dose on premature LH surge during ovarian stimulation

More information

The psychological impact of IVF failure after two or more cycles of IVF with a mild versus standard treatment strategy

The psychological impact of IVF failure after two or more cycles of IVF with a mild versus standard treatment strategy Human Reproduction Vol.22, No.9 pp. 2554 2558, 2007 Advance Access publication on June 23, 2007 doi:10.1093/humrep/dem171 The psychological impact of IVF failure after two or more cycles of IVF with a

More information

Article Vaginal gel versus intramuscular progesterone for luteal phase supplementation: a prospective randomized trial

Article Vaginal gel versus intramuscular progesterone for luteal phase supplementation: a prospective randomized trial RBMOnline - Vol 16. No 3. 2008 361-367 Reproductive BioMedicine Online; www.rbmonline.com/article/3193 on web 21 January 2008 Article Vaginal gel versus intramuscular progesterone for luteal phase supplementation:

More information

SCIENTIFIC DISCUSSION

SCIENTIFIC DISCUSSION SCIENTIFIC DISCUSSION This module reflects the initial scientific discussion for the approval of GONAL-f. This scientific discussion has been updated until 1 July 2004. For information on changes after

More information

INFERTILITY. Tom Huws and Charlotte Cowling

INFERTILITY. Tom Huws and Charlotte Cowling INFERTILITY Tom Huws and Charlotte Cowling Overview Introduction Male infertility Female infertility Assisted reproductive technologies Introduction Following unprotected sex: 84% of couples conceive within

More information

Patient Price List. t: e: w:

Patient Price List. t: e: w: Patient Price List t: 0333 015 9774 e: enquires@ivi.uk w: www.ivi.uk fertility treatments Pre Treatment Medical Consultation 250 Nurse Planning 200 Baseline ultrasound scan of uterus and ovaries included

More information

Open Access. Mohamed K. Moustafa 1,2, Ahmed R. Abdelwahed 2, Ibrhium Abosekena 2, Shokry Abdelazim 2, Ahmed M. Abou-Setta 3 and Hesham G.

Open Access. Mohamed K. Moustafa 1,2, Ahmed R. Abdelwahed 2, Ibrhium Abosekena 2, Shokry Abdelazim 2, Ahmed M. Abou-Setta 3 and Hesham G. The Open Women s Health Journal, 2009, 3, 11-15 11 Open Access IVF Outcomes with Either Highly Purified FSH vs. Recombinant FSH in Down-Regulated Normogonadotrophic Women: A Prospective Comparative Study

More information

Klinefelter - An Evolving Syndrome

Klinefelter - An Evolving Syndrome Klinefelter - An Evolving Syndrome Bruce R. Gilbert, MD, PhD Professor of Urology Hofstra North Shore LIJ School of Medicine Director of Male Reproductive and Sexual Medicine Smith Institute for Urology

More information

TESE: Testis Sperm Extraction

TESE: Testis Sperm Extraction TESE: Testis Sperm Extraction Robert D. Oates, M.D., F.A.C.S. Department of Urology Boston University School of Medicine When is Microsurgical TESE indicated? Cases of Non-obstructive Azoospermia (NOA)

More information

Male Reproduction Organs. 1. Testes 2. Epididymis 3. Vas deferens 4. Urethra 5. Penis 6. Prostate 7. Seminal vesicles 8. Bulbourethral glands

Male Reproduction Organs. 1. Testes 2. Epididymis 3. Vas deferens 4. Urethra 5. Penis 6. Prostate 7. Seminal vesicles 8. Bulbourethral glands Outline Terminology Human Reproduction Biol 105 Lecture Packet 21 Chapter 17 I. Male Reproduction A. Reproductive organs B. Sperm development II. Female Reproduction A. Reproductive organs B. Egg development

More information

Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data.

Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data. Recombinant versus highly-purified, urinary follicle-stimulating hormone (r-fsh vs. HPuFSH) in ovulation induction: a prospective, randomized study with cost-minimization analysis Revelli A, Poso F, Gennarelli

More information

Poor & Hyper responders: what is the best approach?

Poor & Hyper responders: what is the best approach? Poor & Hyper responders: what is the best approach? A. La Marca ObGyn Dept University of Modena and Reggio Emilia Italy Center for Reproductive Medicine University Hospital of Modena Italy Criteria used

More information

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following hormones controls the release of anterior pituitary gonadotropins? A) LH

More information

LUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi

LUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency

More information

Study on Several Factors Involved in IVF-ET of Human Beings

Study on Several Factors Involved in IVF-ET of Human Beings Study on Several Factors Involved in IVF-ET of Human Beings Lei X 1, Zhuoran W 1, Bin L 1, Huiming L 1, Hongxiu Z 1, Yajuan Z 1, Yingbo Q 1, Guixue Z 2 1 The First Clinical College of Harbin Medical University,

More information

Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital; 2

Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital; 2 RBMOnline - Vol 16. No 5. 2008 632-639 Reproductive BioMedicine Online; www.rbmonline.com/article/3209 on web 27 March 2008 Article Prospective comparison of short and long GnRH agonist protocols using

More information

Minimal stimulation using recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist in women of advanced age

Minimal stimulation using recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist in women of advanced age FERTILITY AND STERILITY VOL. 81, NO. 4, APRIL 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Minimal stimulation using recombinant

More information

Advanced age, poor responders and the role of LH supplementation. C. Alviggi University Federico II, Naples, Italy

Advanced age, poor responders and the role of LH supplementation. C. Alviggi University Federico II, Naples, Italy Advanced age, poor responders and the role of LH supplementation C. Alviggi University Federico II, Naples, Italy LH serum level (IU/L) 20.0 15.0 10.0 5.0 0.0 LH levels during spontaneous and stimulated

More information

5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle

5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION

More information

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA) IN MEN WITH OBSTRUCTIVE AZOOSPERMIA

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA) IN MEN WITH OBSTRUCTIVE AZOOSPERMIA Clinical Urology PESA IN OBSTRUCTIVE AZOOSPERMIA International Braz J Urol Vol. 29 (2): 4-46, March - April, 2003 Official Journal of the Brazilian Society of Urology PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION

More information

Clinical Policy Committee

Clinical Policy Committee Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group Clinical Policy Committee Commissioning policy: Assisted Conception Fertility treatments

More information

PACKAGE INSERT PREGNYL. (chorionic gonadotropin for injection, USP) 10,000 units/vial. Human Gonadotropin

PACKAGE INSERT PREGNYL. (chorionic gonadotropin for injection, USP) 10,000 units/vial. Human Gonadotropin PACKAGE INSERT PREGNYL (chorionic gonadotropin for injection, USP) 10,000 units/vial Human Gonadotropin Merck Canada Inc. 16750 route Transcanadienne Kirkland QC Canada H9H 4M7 Date of Revision: July 26,

More information

Endometrial advancement after triggering with recombinant or urinary HCG: a randomized controlled pilot study

Endometrial advancement after triggering with recombinant or urinary HCG: a randomized controlled pilot study Reproductive BioMedicine Online (2010) 21, 50 55 www.sciencedirect.com www.rbmonline.com ARTICLE Endometrial advancement after triggering with recombinant or urinary HCG: a randomized controlled pilot

More information

Ovarian response in three consecutive in vitro fertilization cycles

Ovarian response in three consecutive in vitro fertilization cycles FERTILITY AND STERILITY VOL. 77, NO. 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Ovarian response in

More information

Chapter 28: REPRODUCTIVE SYSTEM: MALE

Chapter 28: REPRODUCTIVE SYSTEM: MALE Chapter 28: REPRODUCTIVE SYSTEM: MALE I. FUNCTIONAL ANATOMY (Fig. 28.1) A. Testes: glands which produce male gametes, as well as glands producing testosterone 2. Seminiferous tubules (Fig.28.3; 28.5) a.

More information

Influence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser

Influence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser Influence ovarian stimulation on oocyte and embryo quality Prof.Dr. Bart CJM Fauser How to balance too much vs too little? Lecture Outline Context ovarian stimulation Impact ovarian stimulation on oocyte

More information

Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156

Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156 Fertility problems: assessment and treatment Clinical guideline Published: 20 February 2013 nice.org.uk/guidance/cg156 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

HUMAN MENOPAUSAL GONADOTROPINS (hmg)

HUMAN MENOPAUSAL GONADOTROPINS (hmg) CLINICAL POLICY HUMAN MENOPAUSAL GONADOTROPINS (hmg) Policy Number: PHARMACY 288.1 T2 Effective Date: November 1, 2015 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE BENEFIT CONSIDERATIONS...

More information

Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy

Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy M.E. Coccia, F. Cammilli, L. Ginocchini, F. Borruto* and F. Rizzello Dept Gynaecology Perinatology and Human

More information

Best practices of ASRM and ESHRE

Best practices of ASRM and ESHRE Best practices of ASRM and ESHRE Late submission Cortina d Ampezzo, Italy 1-3 March 2012 A joint meeting between the American Society for Reproductive Medicine and the European Society of Human Reproduction

More information

TUE Physician Guidelines Medical Information to Support the Decisions of TUE Committees MALE HYPOGONADISM MALE HYPOGONADISM

TUE Physician Guidelines Medical Information to Support the Decisions of TUE Committees MALE HYPOGONADISM MALE HYPOGONADISM 1. Medical Condition Hypogonadism in men is a clinical syndrome that results from failure of the testes to produce physiological levels of testosterone (testosterone deficiency) and in some instances normal

More information

08036-Barcelona, Spain. Fax: ;

08036-Barcelona, Spain. Fax: ; RBMOnline - Vol 6. No 4. 427 431 Reproductive BioMedicine Online; www.rbmonline.com/article/859 on web 13 March 2003 Article Pregnancy after administration of high dose recombinant human LH alone to support

More information

(BMI)=18.0~24.9 kg/m 2 ;

(BMI)=18.0~24.9 kg/m 2 ; 33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV

More information

Spontaneous ovulation versus HCG triggering for timing natural-cycle frozen thawed embryo transfer: a randomized study

Spontaneous ovulation versus HCG triggering for timing natural-cycle frozen thawed embryo transfer: a randomized study Reproductive BioMedicine Online (2011) 23, 484 489 www.sciencedirect.com www.rbmonline.com ARTICLE Spontaneous ovulation versus HCG triggering for timing natural-cycle frozen thawed embryo transfer: a

More information

Fertility Services Commissioning Policy

Fertility Services Commissioning Policy Fertility Services Commissioning Policy NEE CCG Policy Reference: Where patients have commenced treatment in any cycle prior to this version becoming effective, they are subject to the eligibility criteria

More information

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1 CASE REPORT Cryptorchidism and its impact on male fertility: a state of art review of current literature Eric Chung, MBBS, FRACS; Gerald B. Brock, MD, FRCSC Division of Urology, University of Western Ontario,

More information

- Meta. : (rfsh); (ufsh); (IVF); : R711.6 : A : X(2015) : hmg( FSH LH) [ufsh, (ufsh-p) (ufsh-hp)] (rfsh) [1] 80, rfsh, 90, :

- Meta. : (rfsh); (ufsh); (IVF); : R711.6 : A : X(2015) : hmg( FSH LH) [ufsh, (ufsh-p) (ufsh-hp)] (rfsh) [1] 80, rfsh, 90, : 35 2 Vol.35 No.2 2015 2 Feb. 2015 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2015.02.0099 E-mail: randc_journal@163.com (FSH) - Meta FSH ( 400010) : (IVF) (ICSI) (rfsh) (ufsh) (COS) : PubMed

More information

Articles Use of recombinant LH in a group of unselected IVF patients

Articles Use of recombinant LH in a group of unselected IVF patients RBMOnline - Vol 5. No 2. 104 108 Reproductive BioMedicine Online; www.rbmonline.com/article/642 on web 6 June 2002 Articles Use of recombinant LH in a group of unselected IVF patients Dr Franco Lisi was

More information

Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer?

Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer? Human Reproduction Vol.19, No.11 pp. 2550 2554, 2004 Advance Access publication August 6, 2004 doi:10.1093/humrep/deh447 Should we advise patients undergoing IVF to start a cycle leading to a day 3 or

More information

Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration

Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration Wu et al. Reproductive Biology and Endocrinology 2014, 12:96 RESEARCH Open Access Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH

More information