LH activity administration during the

Size: px
Start display at page:

Download "LH activity administration during the"

Transcription

1 LH activity administration during the luteal-follicular transition Richard Fleming On behalf of the Luveris Pre-treatment group University of Glasgow Scotland

2 Androgens have a Paracrine action in the Early Follicular Phase LH (Hillier 2001) + FSH theca granulosa androgen Testosterone promotes aromatase expression in GCs (dose dependent) Testosterone promotes aromatase expression in GCs (dose dependent). LH promotes thecal androgen drive to the GCs

3 LH and Early Follicular Responses Primates treated with GnRH-Antagonist ZelinskyWootten Antide HCG 90 days r_hfsh r_hfsh + r_hlh Antide suppressed LH and E2 to levels seen in hypophysectomy r_hfsh Stimulation Days 12 Fertilized (%) 89 r_hfsh + r_hlh 9 52 Indications: 1. LH promotes improved early responses to FSH 2. LH has a negative impact in the peri-ovulatory period

4 Peri-menstrual transition: Study Aim Will LH administration, in the phase prior to FSH stimulation,,promote thecal drive to the GC of small antral follicles? and thereby: 1. promote more follicles to achieve appropriate p FSH sensitivity 2. improve oocyte quality by improving GC support for the oocyte

5 Study Design Cycle Day Day Day Day Day Gn15 Gn22 Gn29 HCG (Gn1) (L1) (S1) (S8) (SHCG) Depo Decapeptyl p (4.2mg) Downregulation check: Randomisation Response assessment Embryology # eggs, # 2PN embryos, # transferrable grade Luveris (300 IU/d, sc) (150 IU/ d, sc) Gonal F ( / d ) Dose adjustment

6 Demographics N Tubal Unxpl Male BMI FSH (%) (%) (%) (Kg/m 2 ) (IU/L) Control LH

7 Patient process Randomized Receiving HCG Control (n) 71 Luveris Pre-Tx (n) Cysts at downregulation - 2 OHSS Predicted d 1 1 Poor response 2 3 Premature luteinization i ti 1 1 Social / personal - 1 Violator (>FSH) 1 1 Total 5 9

8 LH Profiles No Pre-treatment LH Pre-treatment LH (IU/L) 6 4 P=0.01 P< L1 S1 S8 L1 S1 S8 Assessment stage

9 Changes during LH treatment Conversion of C 21 to C 19 (androgen) steroids 17αOH_Progesterone Testosterone No Pre-treatment LH Pre-treatment 2.0 P17 _ (ng/ml) 1.0 P=0.25 P=0.17 T. (ng/ml) 1.0 P=0.63 P= L1 S1 L1 S1 L1 S1 L1 S1 Assessment stage Assessment stage Between Groups: L1. p= 0.81 Between Groups: L1. p= 0.11 Between Groups: S1. p= 0.33 Between Groups: S1. p=

10 Changes during LH treatment Estradiol No Pre-treatment LH Pre-treatment P=0.29 P=0.82 E2 (pmol/l) L1 S1 L1 S1 Assessment stage Between Groups: L1. p= 0.15 Between Groups: S1. p= 0.14

11 Changes during LH treatment Anti-Mullerian Hormone No Pre-treatment LH Pre-treatment 100 *P=0.001 *P=0.001 *Paired t-test AMH (pmol/l) 50 0 L1 S1 L1 S1 Assessment stage Both groups showed an increase in AMH: 16% and 10%

12 Changes during LH treatment Antral follicle count No Pre-treatment LH Pre-treatment 15 P=0.45 P=0.007 AFC (n) L1 S1 L1 Assessment stage S1 Bt G L1 034 Between Groups: L1. p= 0.34 Between Groups: S1. p= 0.77

13 Changes during FSH treatment Demand for FSH FSH Days Total Dose Dose Increase Dose Decrease Control (55%) (4%) Luveris (55%) 3 (4%)

14 Changes during FSH treatment Follicle Profiles S8 SHCG 8 N FD 9-12mm FD >12 FD 9-14mm FD >15

15 Changes during FSH treatment Circulating Estradiol No Pre-treatment LH Pre-treatment Control Luveris E (pmol/l) S1 S8 HCG S1 S8 HCG Assessment stage

16 Changes during FSH treatment Estradiol: AUC & Per Follicle AUC E2 E2 per Follicle E2 (pmol) P = 0.43 E2 (pmol) P = 0.18 Control Luveris Control Luveris

17 After HCG Oocytes & Embryos Oocyte Yield (mean) PN2 Embryos (mean) Control Luveris P* (*Unpaired t-test: Welch s correction)

18 After HCG Embryology 12 P=0.096 *P=0.038 P=0.64 P=0.19 Mean (n) * Oocytes Fertilization Early Embryos (2PN) Cleavage High Grade

19 Discussion Pre-conditioning with Luveris treatment (300IU daily) prior to FSH stimulation of follicular l growth in normal women, resulted in some interesting observations. Associated with the increased LH activity recorded, we observed: Increased small antral follicle count (AFC) No change in circulating 17αOHprogesterone No change in circulating testosterone AMH showed an increase in both groups

20 Discussion During FSH treatment (following Luveris pre-treatment) there was: No difference in follicular sensitivity to FSH growth No modulation in the E2 responses to FSH A (non-significant) increase in oocyte yield ( g f ) y y A significant increase in embryo yield

21 Conclusion Pre-treatment t tof normal women undergoing ART with Luveris (300IU/d), altered the profile of follicular development prior to the start tof ffsht treatment. t t It had no discernible effect upon ovarian hormone secretions or apparent demand for FSH. Luveris pre-treatment significantly increased the yield of viable embryos (from an average of 5.1 to 7.0 per patient: 37%).

22 Lossl et al, H.R Intrafollicular androgens and recruitment Aim: to increase intrafollicular androgen concentrations before FSH recruitment Methods: 45 patients undergoing IVF, forming 3 groups treated prior to FSH injection Cycle Day 2 Cycle Day Cycle Day 5 8 Cetrotide (3mg) Groups 1, 2, 3 FSH + GnRH-Antag Letrozole (2.5mg/d) Groups 2, 3 FSH + GnRH-Antag HCG (1250IU) Group 3 FSH + GnRH-Antag Aromatase inhibitor increased intra-follicular androgen concentrations (not serum) Androgen priming was associated with an increased yield of high grade embryos

23 Summary The period prior to FSH induced growth is important because follicles must develop FSH sensitivity. Paracrine intrafollicular androgen drive may enhance FSH sensitivity by direct or indirect effects upon GCs. The question of whether exogenous LH, in isolation, can induce significant changes in follicular responses remains to be proven. There is good evidence that addressing this issue may prove clinically beneficial in the future. Addendum: It is unlikely that this approach will increase the yield of follicles / oocytes in poor responder patients.

Effects of recombinant LH treatment on folliculogenesis and responsiveness to FSH stimulation

Effects of recombinant LH treatment on folliculogenesis and responsiveness to FSH stimulation Human Reproduction pp. 1 6, 2007 Hum. Reprod. Advance Access published December 15, 2007 doi:10.1093/humrep/dem388 Effects of recombinant LH treatment on folliculogenesis and responsiveness to FSH stimulation

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

Dr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain. Declared no potential conflict of interest

Dr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain. Declared no potential conflict of interest Dr. Ernesto Bosch Instituto Valenciano de Infertilidad Valencia, Spain Declared no potential conflict of interest Is there a role for LH in elderly patients? Dr. Ernesto Bosch Instituto Valenciano de Infertilidad.

More information

Principles of Ovarian Stimulation

Principles of Ovarian Stimulation Principles of Ovarian Stimulation Dr Genia Rozen Gynaecologist and Fertility Specialist Royal Women s Hospital and Melbourne IVF Learning objectives Why ovarian stimulation Recap physiology Ovarian cycle

More information

Raoul Orvieto. The Chaim Sheba Medical Center Tel Hashomer, Israel. Declared no potential conflict of interest

Raoul Orvieto. The Chaim Sheba Medical Center Tel Hashomer, Israel. Declared no potential conflict of interest Raoul Orvieto The Chaim Sheba Medical Center Tel Hashomer, Israel Declared no potential conflict of interest LH in antagonist cycles; is the story really written? Raoul Orvieto M.D. Israel Overview Role

More information

The emergence of Personalized Medicine protocols for IVF.

The emergence of Personalized Medicine protocols for IVF. Individualising IVF: Introduction to the POSEIDON Concept Introduction The emergence of Personalized Medicine protocols for IVF. Differences between patients: age, ovarian reserve, BMI or presence of ovarian

More information

lbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour

lbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate

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 Human Ovarian Steroidogenesis and Gonadotrophin Stimulation Johan

More information

Do aromatase inhibitors have a place in IVF?

Do aromatase inhibitors have a place in IVF? Do aromatase inhibitors have a place in IVF? Roy Homburg Maccabi Medical Services and Barzilai Medical Centre, Ashkelon, Israel Antalya, September, 2009 Human Follicle Growth Primordial follicle 1 layer

More information

Female Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF

Female Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve

More information

AMH CUT-OFF VALUES FOR PREDICTING OVARIAN RESPONSE IN IVF. Nguyễn Xuân Hợi, MD, PhD Hoàng Văn Hùng MsC, MD

AMH CUT-OFF VALUES FOR PREDICTING OVARIAN RESPONSE IN IVF. Nguyễn Xuân Hợi, MD, PhD Hoàng Văn Hùng MsC, MD AMH CUT-OFF VALUES FOR PREDICTING OVARIAN RESPONSE IN IVF Nguyễn Xuân Hợi, MD, PhD Hoàng Văn Hùng MsC, MD INTRODUCTION Ovarian stimulation is an important process in IVF treatment, aiming at obtain a number

More information

The intra-follicular molecular biology mandating advancement of egg retrieval in some women

The intra-follicular molecular biology mandating advancement of egg retrieval in some women The intra-follicular molecular biology mandating advancement of egg retrieval in some women David H. Barad, USA Director of Assisted Reproductive Technology, The Center for Human Reproduction New York

More information

Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization

Milder is better? Advantages and disadvantages of mild ovarian stimulation for human in vitro fertilization Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization Revelli et al. Reproductive Biology and Endocrinology 2011, 9:25 Presenter: R2 孫怡虹 Background

More information

Treatment of Poor Responders

Treatment of Poor Responders Treatment of Poor Responders Pathophysiology of Poor Responders Deficiency in systemic IGF 1 levels (Bahceci, 2007) Lower intra ovarian T levels Reduced FSH receptor expression (Cai, 2007) Bahceci, 2007,

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

Clinical Study Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin in Normogonadotropic Infertile Patients

Clinical Study Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin in Normogonadotropic Infertile Patients International Reproductive Medicine Volume 2013, Article ID 135258, 4 pages http://dx.doi.org/10.1155/2013/135258 Clinical Study Clinical Effects of a Natural Extract of Urinary Human Menopausal Gonadotrophin

More information

Manish Banker. Declared receipt of grants; member of a company advisory board, board of director or similar group

Manish Banker. Declared receipt of grants; member of a company advisory board, board of director or similar group Manish Banker Nova IVI Fertility Pulse Women's Hospital Gujarat, India Declared receipt of grants; member of a company advisory board, board of director or similar group The Indian point of view Manish

More information

IVF (,, ) : (HP-hMG) - (IVF- ET) : GnRH, HP-hMG (HP-hMG )57, (rfsh )140, (Gn)

IVF (,, ) : (HP-hMG) - (IVF- ET) : GnRH, HP-hMG (HP-hMG )57, (rfsh )140, (Gn) 34 11 Vol.34 No.11 2014 11 Nov. 2014 Reproduction & Contraception doi: 10.7669/j.issn.0253-3X.2014.11.0892 E-mail: randc_journal@163.com IVF ( 710003) : (H-hMG) - (IVF- ET) : GnRH H-hMG (H-hMG ) (rfsh

More information

Progesterone and clinical outcomes

Progesterone and clinical outcomes Synchronization of Slowly Developing Embryos Restores Implantation Success Richard T. Scott, Jr, MD, HCLD Clinical and Scientific Director, Reproductive Medicine Associates of New Jersey Professor and

More information

NGUYEN QUOC ANH. M.D., M.Sc. Tu Du Hospital Vietnam

NGUYEN QUOC ANH. M.D., M.Sc. Tu Du Hospital Vietnam NGUYEN QUOC ANH M.D., M.Sc. Tu Du Hospital Vietnam FULLY AUTOMATED AMH TESTING OF OVARIAN RESPONSE IN IVF NGUYỄN QUỐC ANH MD. Infertility dep. Tudu hospital Index What is AMH? Standard AMH testing Fully

More information

www.iffs-reproduction.org @IntFertilitySoc Int@FedFertilitySoc Aims of male and female work-up To decide whether IVF is the right treatment To prepare the couple for IVF To predict response to stimulation

More information

Endocrinology of the Female Reproductive Axis

Endocrinology of the Female Reproductive Axis Endocrinology of the Female Reproductive Axis girlontheriver.com Geralyn Lambert-Messerlian, PhD, FACB Professor Women and Infants Hospital Alpert Medical School at Brown University Women & Infants BROWN

More information

Is it the seed or the soil? Arthur Leader, MD, FRCSC

Is it the seed or the soil? Arthur Leader, MD, FRCSC The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events

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

FERTILITY PRESERVATION IN BREAST CANCER PATIENTS: FOLLICULAR BIOMARKERS IN LETROZOLE ASSOCIATED OVARIAN HYPERSTIMULATION

FERTILITY PRESERVATION IN BREAST CANCER PATIENTS: FOLLICULAR BIOMARKERS IN LETROZOLE ASSOCIATED OVARIAN HYPERSTIMULATION FERTILITY PRESERVATION IN BREAST CANCER PATIENTS: FOLLICULAR BIOMARKERS IN LETROZOLE ASSOCIATED OVARIAN HYPERSTIMULATION Ornit GOLDRAT Research Laboratory in Human Reproduction, Fertility Clinic, Department

More information

STIMULATION AND OVULATION TRIGGERING

STIMULATION AND OVULATION TRIGGERING STIMULATION AND OVULATION TRIGGERING Professor IOANNIS E. MESSINIS MD, PhD (Aberdeen, UK), FRCOG (UK) Department of Obs/Gynae University of Thessaly Larissa, GREECE DISCLOSURE Nothing to disclose Learning

More information

Ivf day 6 estradiol level

Ivf day 6 estradiol level Ivf day 6 estradiol level Search It is also important to measure the estradiol on day 3. Day 2 is fine. The reason its day 3 is 15-20 years ago, the IVF medications were always started on day 3. Day 3

More information

(1.,, ) (2.,,, )

(1.,, ) (2.,,, ) 33 11 Vol.33 No.11 2013 11 Nov. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.11.0749 E-mail: randc_journal@163.com IVF-ET 1 2 1 1 1 1 1 (1. 510150) (2. 510150) : (COH) (premature

More information

Clinical Study Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

Clinical Study Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve Hindawi Publishing Corporation International Journal of Reproductive Medicine Volume 2014, Article ID 581451, 5 pages http://dx.doi.org/10.1155/2014/581451 Clinical Study Comparison of IVF Outcomes between

More information

10.7 The Reproductive Hormones

10.7 The Reproductive Hormones 10.7 The Reproductive Hormones December 10, 2013. Website survey?? QUESTION: Who is more complicated: men or women? The Female Reproductive System ovaries: produce gametes (eggs) produce estrogen (steroid

More information

Intérêt de l hcg et induction de l ovulation. Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium

Intérêt de l hcg et induction de l ovulation. Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium Intérêt de l hcg et induction de l ovulation Christophe Blockeel, MD, PhD Centre for Reproductive Medicine, Brussels, Belgium Conflict of interest The opinions expressed in this document are the opinions

More information

(Predictive. value) Soheila Ansaripour Fellowship of infertility Ai Avicena Research In

(Predictive. value) Soheila Ansaripour Fellowship of infertility Ai Avicena Research In Ovarian Rese erve Lab Tests In (Predictive IVF value) Soheila Ansaripour Fellowship of infertility Ai Avicena Research In nstitute t Case Presentation 29 y/o,primary inf 1.5yr, Hx of irregular menses (

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

Androgen priming using aromatase inhibitor and hcg during early-follicular-phase GnRH antagonist down-regulation in modified antagonist protocols

Androgen priming using aromatase inhibitor and hcg during early-follicular-phase GnRH antagonist down-regulation in modified antagonist protocols Human Reproduction Vol.21, No.10 pp. 2593 2600, 2006 Advance Access publication June 19, 2006. doi:10.1093/humrep/del221 Androgen priming using aromatase inhibitor and hcg during early-follicular-phase

More information

Thrombosis during assisted reproduction. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology

Thrombosis during assisted reproduction. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology Thrombosis during assisted reproduction Scott Nelson Muirhead Chair in Obstetrics & Gynaecology ART can be as safe as natural pregnancy!! What used to be the risk of thrombosis in ART!! We can use AMH

More information

Relevance of LH activity supplementation

Relevance of LH activity supplementation Relevance of LH activity supplementation in ovulation induction Franco Lisi Servizio di Fisiopatologia della Riproduzione Clinica Villa Europa Roma, Italia Comprehension of the role of LH in follicular

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

Female Reproductive System. Lesson 10

Female Reproductive System. Lesson 10 Female Reproductive System Lesson 10 Learning Goals 1. What are the five hormones involved in the female reproductive system? 2. Understand the four phases of the menstrual cycle. Human Reproductive System

More information

Sample size a Main finding b Main limitations

Sample size a Main finding b Main limitations 1 Table 1. Available studies on the relation between endometriosis and miscarriage (1995-2015). Study (citation) Country Study period Study design Sample size a Main finding b Main limitations Matoras

More information

The serum estradiol/oocyte ratio in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins

The serum estradiol/oocyte ratio in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins Original Article Obstet Gynecol Sci 2018;61(2):242-246 https://doi.org/10.5468/ogs.2018.61.2.242 pissn 2287-8572 eissn 2287-8580 The serum estradiol/oocyte ratio in patients with breast cancer undergoing

More information

Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization

Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization Peter Kovacs, M.D., a Timea Kovats, M.D., a Artur Bernard,

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

MODULE 1: OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS

MODULE 1: OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS MODULE 1: OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS Contents OVULATION INDUCTION IN NORMAL RESPONDERS, POOR RESPONDERS, AND HYPERRESPONDERS Ovulation Induction.....................................................................

More information

In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome

In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Original Article Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Maryam Eftekhar, M.D. 1, Razieh Deghani Firoozabadi,

More information

Anti-Mullerian hormone (AMH) as predictor of ovarian reserve

Anti-Mullerian hormone (AMH) as predictor of ovarian reserve International Journal of Reproduction, Contraception, Obstetrics and Gynecology Shembekar CA et al. Int J Reprod Contracept Obstet Gynecol. 2017 Sep;6(9):4006-4010 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174053

More information

Minimising IVF related mortality and morbidity. Scott Nelson Muirhead Professor in Obstetrics & Gynaecology

Minimising IVF related mortality and morbidity. Scott Nelson Muirhead Professor in Obstetrics & Gynaecology Minimising IVF related mortality and morbidity Scott Nelson Muirhead Professor in Obstetrics & Gynaecology We rarely say no - so what I will cover today VTE as an example of a modifiable IVF complication

More information

Reproductive Hormones

Reproductive Hormones Reproductive Hormones Male gonads: testes produce male sex cells! sperm Female gonads: ovaries produce female sex cells! ovum The union of male and female sex cells during fertilization produces a zygote

More information

COMPARING AMH, AFC AND FSH FOR PREDICTING HIGH OVARIAN RESPONSE IN WOMEN UNDERGOING ANTAGONIST PROTOCOL

COMPARING AMH, AFC AND FSH FOR PREDICTING HIGH OVARIAN RESPONSE IN WOMEN UNDERGOING ANTAGONIST PROTOCOL COMPARING AMH, AFC AND FSH FOR PREDICTING HIGH OVARIAN RESPONSE IN WOMEN UNDERGOING ANTAGONIST PROTOCOL Nguyen Xuan Hoi1, Nguyen Manh Ha2 1 National Obstetrics and Gynecology Hospital, 2Hanoi Medical Unviversity

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

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients ORIGINAL ARTICLE Obstetrics & Gynecology http://dx.doi.org/10.3346/jkms.2015.30.3.290 J Korean Med Sci 2015; 30: 290-295 Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients Jee Hyun

More information

Use of in vitro maturation for fertility preservation

Use of in vitro maturation for fertility preservation Use of in vitro maturation for fertility preservation G. Arroyo Servei de Medicina de la Reproducció Departament d Obstetrícia, Ginecologia i Reproducció INSTITUT UNIVERSITARI DEXEUS MEDICAL STRATEGY TO

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

Hana Park, Chung-Hoon Kim, Eun-Young Kim, Jei-Won Moon, Sung-Hoon Kim, Hee-Dong Chae, Byung-Moon Kang

Hana Park, Chung-Hoon Kim, Eun-Young Kim, Jei-Won Moon, Sung-Hoon Kim, Hee-Dong Chae, Byung-Moon Kang Original Article Obstet Gynecol Sci 2015;58(6):481-486 http://dx.doi.org/10.5468/ogs.2015.58.6.481 pissn 2287-8572 eissn 2287-8580 Effect of second-line surgery on in vitro fertilization outcome in infertile

More information

LOW RESPONDERS. Poor Ovarian Response, Por

LOW RESPONDERS. Poor Ovarian Response, Por LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients

More information

Article Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist compared with natural cycles

Article Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist compared with natural cycles RBMOnline - Vol 13. No 3. 2006 326 330 Reproductive BioMedicine Online; www.rbmonline.com/article/1911 on web 13 June 2006 Article Luteal hormonal profile of oocyte donors stimulated with a GnRH antagonist

More information

HCG mode of action versus GnRHa action for triggering of final oocyte maturation

HCG mode of action versus GnRHa action for triggering of final oocyte maturation HCG mode of action versus GnRHa action for triggering of final oocyte maturation Nick Macklon Professor of Obstetrics and Gynaecology, University of Southampton A hammer to crack a nut hcg? How hard does

More information

What is the POSEIDON concept?

What is the POSEIDON concept? Improving Success in ART: how to define it and key strategies to get the best outcomes, Kiev, 21-09-2018 What is the POSEIDON concept? Alessandro Conforti Italy Objectives Unravel the definition of POR

More information

www.iffs-reproduction.org @IntFertilitySoc Int@FedFertilitySoc Conflict of interest none Outline Causes of ovulatory dysfunction Assessment of women with ovulatory dysfunction Management First line Second

More information

Biomarkers for Prediction of Pregnancy Outcome in Fertility Patients. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology

Biomarkers for Prediction of Pregnancy Outcome in Fertility Patients. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology Biomarkers for Prediction of Pregnancy Outcome in Fertility Patients Scott Nelson Muirhead Chair in Obstetrics & Gynaecology Why do we need to know ovarian response? Anna Sarah Just do IVF and see response

More information

ENDOCRINE CHARACTERISTICS OF ART CYCLES

ENDOCRINE CHARACTERISTICS OF ART CYCLES ENDOCRINE CHARACTERISTICS OF ART CYCLES DOÇ. DR. SEBİHA ÖZDEMİR ÖZKAN KOCAELI UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, IVF UNIT 30.04.2014, ANTALYA INTRODUCTION The endocrine

More information

Research Article. Jayakrishnan Krishnakumar 1, Akansha Agarwal 1, Divya Nambiar 1, Shankar Radhakrishnan 2 *

Research Article. Jayakrishnan Krishnakumar 1, Akansha Agarwal 1, Divya Nambiar 1, Shankar Radhakrishnan 2 * International Journal of Reproduction, Contraception, Obstetrics and Gynecology Krishnakumar J et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2762-2767 www.ijrcog.org pissn 2320-1770 eissn

More information

Natural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR)

Natural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR) Natural Cycle & Mild stimulation IVF/ICSI in women with Poor Ovarian Response (POR) Geeta Nargund Head of Reproductive Medicine St George s Hospital London ISMAAR Terminology Human Reprod Nargund et al

More information

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty

More information

Test Briefing on Hormonal Disorders and Infertility

Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders Common Tests FSH LH Progesterone Estradiol Prolactin Testosterone AFP AMH PCOS Panel FSH (Follicle Stimulating Hormone)

More information

L6: DuoStim: the alternative of oocytes/embryos accumulation programs Carlo Alviggi

L6: DuoStim: the alternative of oocytes/embryos accumulation programs Carlo Alviggi L6: DuoStim: the alternative of oocytes/embryos accumulation programs Carlo Alviggi Italy What is the aim of IVF? What is the measure of success in IVF? Cumulative live birth rate per started cycle Live

More information

2015 Mar.; 26(1):

2015 Mar.; 26(1): Journal of Reproduction & Contraception doi: 10.7669/j.issn.1001-7844.2015.01.0022 2015 Mar.; 26(1):22-30 E-mail: randc_journal@163.com Clinical outcomes of using three gonadatropins and medroxyprogestrone

More information

Low AMH and natural conception. Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013

Low AMH and natural conception. Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013 Low AMH and natural conception Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013 Anti Mullerian Hormone AMH levels are commonly measured in fertility clinics to assess ovarian reserve

More information

Individualized treatment based on ovarian reserve markers

Individualized treatment based on ovarian reserve markers Individualized treatment based on ovarian reserve markers Prof Dr. Nikolaos P. Polyzos M.D. PhD Professor and Medical Co- Director, Vrije Universiteit Brussel, UZ Brussel, Belgium Professor of Reproduc?ve

More information

Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M

Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic

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

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

Thesis. Mahmoud Sedki Yassin (MsC) Cairo University. Under supervision of

Thesis. Mahmoud Sedki Yassin (MsC) Cairo University. Under supervision of Serum anti-mullerian hormone level and antral follicle count in patients with endometriomas pre and post endometriotic surgery for assessment of ovarian reserve Thesis Submitted for partial fulfillment

More information

ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)

ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing

More information

Summary

Summary Summary 118 This thesis is focused on the background of elevated levels of FSH in the early follicular phase of women with regular menstrual cycles. In the introduction (chapter 1) we describe the characteristics

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 22 September 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 22 September 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 22 September 2010 100 µg/0.5 ml, solution for injection B/1 prefilled syringe + 1 needle (CIP code: 374 590-1) 150

More information

Mohammad. Renad zakaria ---

Mohammad. Renad zakaria --- 13 Mohammad Renad zakaria --- Before we start: - I didn t follow the record order, for organizing purposes. - I added extra information from our text box which is Guyton 12 th edition, pages 987-997, actually

More information

REPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings

REPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings REPRODUCCIÓN La idea fija How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development, birth

More information

Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome

Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome Yang et al. Reproductive Biology and Endocrinology (2018) 16:119 https://doi.org/10.1186/s12958-018-0438-7 RESEARCH Open Access Body mass index and basal androstenedione are independent risk factors for

More information

Effects of HCG and LH on ovarian stimulation. Are they bioequivalent?

Effects of HCG and LH on ovarian stimulation. Are they bioequivalent? Effects of HCG and LH on ovarian stimulation Are they bioequivalent? Know the type of gonadotrophin required to have enough oocytes of good quality to achieve a healthy child FSH MAXIMIZE EFFICIENCY MINIMIZE

More information

Prognosticating ovarian reserve by the new ovarian response prediction index

Prognosticating ovarian reserve by the new ovarian response prediction index International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tak A et al. Int J Reprod Contracept Obstet Gynecol. 2018 Mar;7(3):1196-1200 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180917

More information

REPRODUCTIVE CYCLE OF FEMALE MAMMAL

REPRODUCTIVE CYCLE OF FEMALE MAMMAL REPRODUCTIVE CYCLE OF FEMALE MAMMAL Fig. 8-12 Secondary follicles growing follicles increase in number of layers of granulosa cells Tertiary follicles maturing follicles antrum formation fluid filled space

More information

I. ART PROCEDURES. A. In Vitro Fertilization (IVF)

I. ART PROCEDURES. A. In Vitro Fertilization (IVF) DFW Fertility Associates ASSISTED REPRODUCTIVE TECHNOLOGY (ART) Welcome to DFW Fertility Associates/ Presbyterian-Harris Methodist Hospital ARTS program. This document provides an overview of treatment

More information

IVF Protocols: Hyper & Hypo-Responders, Implantation

IVF Protocols: Hyper & Hypo-Responders, Implantation IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient

More information

Governing Body Meeting

Governing Body Meeting Agenda Item No: 13 Date of Meeting: 26 th November 2015 Governing Body Meeting Paper Title: East and North Hertfordshire CCG (ENHCCG) Policy on Fertility treatment and referral criteria for specialist

More information

Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? *

Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? * Middle East Fertility Society Journal Vol. 11, No. 2, 2006 Copyright Middle East Fertility Society Does triggering ovulation by 5000 IU of uhcg affect ICSI outcome? * Amany A.M. Shaltout, M.D. Mohamed

More information

Ovarian follicular dynamics and superovulation in cattle

Ovarian follicular dynamics and superovulation in cattle Ovarian follicular dynamics and superovulation in cattle John P Kastelic Professor of Theriogenology Head, Department of Production Animal Health University of Calgary Calgary, Alberta, Canada Factors

More information

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization? Bentov et al. Reproductive Biology and Endocrinology 2013, 11:12 RESEARCH Open Access Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

More information

S.Fisher 1,3, A.Grin 2, A.Paltoo 2 and H.M.Shapiro 2

S.Fisher 1,3, A.Grin 2, A.Paltoo 2 and H.M.Shapiro 2 Human Reproduction Vol.20, No.1 pp. 84 88, 2005 Advance Access publication October 15, 2004 doi:10.1093/humrep/deh543 Falling estradiol levels as a result of intentional reduction in gonadotrophin dose

More information

Folliculogenesis: Physiology and pathophysiology

Folliculogenesis: Physiology and pathophysiology DIMITRIOS LOUTRADIS Professor of Obstetrics and Gynaecology Head of 1st Department of Obstetrics and Gynaecology University of Athens Medical School Alexandra Hospital Folliculogenesis: Physiology and

More information

The old IVF patient: An evidence based approach. Stratis Kolibianakis MD MSc PhD

The old IVF patient: An evidence based approach. Stratis Kolibianakis MD MSc PhD The old IVF patient: An evidence based approach Stratis Kolibianakis MD MSc PhD Unit for Human Reproduction 1 st Dept Ob/Gyn Aristotle University of Thessaloniki No conflict of interest How old is old?

More information

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

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

CASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen?

CASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen? CASE 41 A 19-year-old woman presents to her gynecologist with complaints of not having had a period for 6 months. She reports having normal periods since menarche at age 12. She denies sexual activity,

More information

Drug Therapy Guidelines

Drug Therapy Guidelines Drug Therapy Guidelines Applicable Medical Benefit Effective: 8/15/18 Pharmacy- Formulary 1 x Next Review: 6/18 Pharmacy- Formulary 2 x Date of Origin: 7/00 Injectable Fertility Medications: Bravelle,

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

Scientific Highlights: First world conference on luteinizing hormone in ART: Landing in Asia Pacific

Scientific Highlights: First world conference on luteinizing hormone in ART: Landing in Asia Pacific This EXCEMED conference followed on from the First world conference on luteinizing hormone (LH) in ART, which took place in Naples in May 2016. Bringing the topic of LH to Asia Pacific provided an opportunity

More information

Liyan Duan 1, Shihua Bao 1, Kunming Li 1, Xiaoming Teng 1, Ling Hong 1 and Xiaoyu Zhao 2. Abstract. Introduction

Liyan Duan 1, Shihua Bao 1, Kunming Li 1, Xiaoming Teng 1, Ling Hong 1 and Xiaoyu Zhao 2. Abstract. Introduction doi:10.1111/jog.13305 J. Obstet. Gynaecol. Res. Vol. 43, No. 6: 1037 1042, June 2017 Comparing the long-acting and short-acting forms of gonadotropin-releasing hormone agonists in the long protocol of

More information

fertilization cycles: A pilot randomized clinical trial

fertilization cycles: A pilot randomized clinical trial Original Article The effect of testosterone gel on fertility outcomes in women with a poor response in in vitro fertilization cycles: A pilot randomized clinical trial Nasrin Saharkhiz, Shahrzad Zademodares,

More information