Effect of baseline ovarian cysts on in vitro fertilization and gamete intrafallopian transfer cycles*
|
|
- Amie Parsons
- 5 years ago
- Views:
Transcription
1 FERTILITY AND STERILITY Copyright <> 1991 The American Fertility Society Printed on acid-free paper in U.S.A. Effect of baseline ovarian cysts on in vitro fertilization and gamete intrafallopian transfer cycles* Jeffrey M. Goldberg, M.D t Frederick A. Miller, M.S. Chad I. Friedman, M.D. William G. Dodds, M.D. Moon H. Kim, M.D. The Ohio State University, Columbus, Ohio The presence of ovarian cysts may compromise the success of in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). We prospectively studied 212 consecutive ovulation induction cycles in 120 patients for IVF and/or GIFT. A baseline cyst was defined as any intraovarian cystic structure ~ 12 mm noted on ultrasonography before superovulation. Cycle outcomes were compared between patients with cysts (n = 62) versus those with no cysts (n = 150). There were no differences in follicular or luteal pbase lengths or amount of human menopausal gonadotropins used. Peak estradiol (E 2 ) levels were significantly lower and cancellation rates significantly higher in the cyst group. For noncanceled cycles, there were no significant differences in peak E2 levels, the mean number of follicles ~ 12 mm, mature oocytes retrieved, or ova transferred for GIFT or embryos for IVF. The pregnancy rates overall and for noncanceled cycles were not significantly different. Fertil Steril55:319, 1991 The presence of ovarian cysts on the baseline ultrasound (US) examination 'is frequently a cause for canceling controlled ovarian hyperstimulation for in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). The concern is that the cysts may grow further, undergo torsion, rupture, or may compromise the potential for follicular development in response to gonadotropins. Postponing an IVF or GIFT cycle to await spontaneous resolution of the cyst is often a tremendous source of frustration and despair for the infertility patients who perceive these canceled cycles as lost opportunities for conception. Postponing a cycle is obviously preferable to canceling it after the patient has invested in it both financially and emotionally. Several investigators observed no differences be- Received April 23, 1990; revised and accepted October 19, * Presented at the 45th Annual Meeting of The American Fertility Society, San Francisco, California, November 11 to 16, t Reprint requests: Jeffrey M. Goldberg, M.D., Department of Obstetrics and Gynecology, The Ohio State University Hospitals, 1654 Upham Drive, Columbus, Ohio tween cycles with or without baseline cysts during superovulation alone 1 or for IVF. 2-4 Others have noted poorer outcomes of IVF cycles in the presence of baseline cysts. 5-7 It should be noted that the definition of what constituted a baseline cyst was not standardized between these studies. This prospective study was performed to determine if baseline ovarian cysts had any adverse effects on various parameters of IVF and GIFT cycles. MATERIALS AND METHODS Two hundred twelve consecutive controlled ovarian hyperstimulation cycles were evaluated prospectively in 120 infertility patients undergoing IVF and GIFT. A baseline ultrasonogram was performed before initiating controlled ovarian hyperstimulation using an ADR Ultramark 4 with a 5 MHz endovaginal transducer (Advanced Technology Laboratories, Inc., Bellevue, W A). A cyst was defined as any intraovarian cystic structure with a mean diameter ~ 12 mm. Controlled ovarian hyperstimulation was accomplished with human menopausal gonadotropins (hmg, Pergonal; Ser- Goldberg et ai. Ovarian cysts and IVF/GIFT 319
2 ono, Randolph, MA), two ampules per day beginning on cycle day 3. The dose of hmg was subsequently individualized according to the follicular response. In addition, some patients also received pure follicle-stimulating hormone (FSH, Metrodin; Serono), two ampules on each ofthe 1st 2 days of hmg, or clomiphene citrate (CC, Serophene; Serono) 100 mg on cycle days 3 through 7. Patients with previous canceled hmg cycles frequently underwent pituitary desensitization with the gonadotropin-releasing hormone agonist (GnRH-a) leuprolide acetate (LA, Lupron; TAP Pharmaceuticals, Chicago, IL) before administering hmg. The 1st day of hmg on LA was considered cycle day 3. The patients were monitored with serial ultrasonograms and serum estradiol (E2) levels measured by radioimmunoassay (Coat-a-Count Estradiol, Diagnostic Products Corp., Los Angeles, CA). In addition, serum luteinizing hormone (LH) was obtained to detect a premature LH surge. When;;::2 follicles were ;;::16 mm in mean diameter and E2 was ;;::500 pg/ml, 5,000 U of human chorionic gonadotropin (hcg, Profasi; Serono) was given intramuscularly. If these criteria were not met, a premature LH surge occurred, or the patient was felt to be at high risk for severe ovarian hyperstimulation, hcg was withheld, and the cycle canceled. Oocyte retrieval was performed by laparoscopy or transvaginal US-guided needle aspiration 34 hours later. The number and size of all follicles were recorded on the day ofhcg or the day of cancellation, as well as the peak E2 levels, and the amount of hmg used. The follicular phase length extended from day 1 of the cycle to the day of hcg administration, and the luteal phase length from the day after hcg to the onset of menses. Pregnancy was defined as a rising serum ~-hcg level and the visualization of an intrauterine gestational sac on transvaginal US. Statistical analysis was performed using the Student's t-test and x2, with Yates correction or Fisher's exact test where appropriate. RESULTS A baseline cyst was present in 62 of the 212 cycles (29.2%). Ten patients had 2 or 3 cyst cycles accounting for 24 (38.7%) of all cyst cycles. In 17 cycles there were 2 cysts, and in 4 cycles there were 3 cysts on baseline transvaginal US. s ranged in size from 12 to 45 mm (mean 21.3 ± 8.2). There was no significant difference in the mean age of the patients :n the cyst versus the noncyst group, 32.4 Table 1 Infertility History (n = 62) (n = 150) Primary infertility 45 (72.6)b 82 (54.7) Secondary infertility 17 (27.4) 68 (45.3) Factors' Tubal 22 (35.5) 63 (42.0) Endometriosis 30 (48.4) 51 (34.0) Adhesions 14 (22.6) 42 (28.0) Ovulatory 19 (30.6) 31 (20.7) Male 6 (9.7) 21 (14.0) Luteal defect 7 (11.3) 7 (4.7) Cervical 8 (12.9) 14 (9.3) Uterine 1 (1.6) 2 (1.3) Immune 8 (12.9) 10 (6.7) Unexplained 4 (6.5) 10 (6.7) P<0.05. b Values in parentheses are percents. c Exceeds 100% because of patients with multifactorial infertility. versus 32.7 years, respectively. The mean duration of infertility in the cyst group, 5.3 years, was significantly different from the noncyst group, 4.4 years (P < 0.05). The percentage of patients with primary infertility was also greater in the cyst group. Analysis of infertility factors demonstrated a significant difference for endometriosis only, with more affected in the cyst group (Table 1). There were no differences between the groups in the percentage of patients receiving FSH, CC, or LA in addition to hmg. As well, no controlled ovarian hyperstimulation regimen had a statistically significant influence on cycle cancellation rates either between the cyst and noncyst groups, or compared with the other controlled ovarian hyperstimulation regimens within each group. No differences were observed for the follicular or luteal phase lengths or for the number of hmg ampules utilized. The peak serum E2 levels overall were significantly lower in the cyst group; however, when only noncanceled cycles were considered, this difference was abolished (Table 2). The overall cycle cancellation rate was 43.5% in the cyst group and 28.0% for noncyst cycles (P < 0.05). Most ofthe cancellations were because of dominant follicles or low E2 levels. As for the individual reasons for cancellation, only premature LH surge reached significance, though the number of cases was very small (Table 3). In a similar percentage of cycles, oocyte retrieval was performed by transvaginal US. There were no significant differences in the mean number of follicles aspirated, oocyte maturity, fertilization rate, or num- 320 Goldberg et al. Ovarian cysts and IVF/GIFT Fertility and Sterility
3 Table 2 Ovulation Induction No." Canceled No." Canceled HMGalone HMG+FSH HMG+LA HMG+FSH+LA HMG+CC Ampules of hcgb Day ofhcg injectionb Luteal phase length b Peak E2 (pg/ml)b.e E2 in noncanceled cycles b Follicles> 12 mm b 12 (19.4) 22 (35.5) 1 (1.6) 18 (29.0) 9 (14.5) , o (16.7) 70 (46.7) 6 (4.0) 31 (20.7) 19 (12.7) , " Values in parentheses are percents. b Values are means. e P<0.05. ber of embryos transferred for IVF or oocytes transferred for GIFT (Table 4). Table 5 summarizes the pregnancy data. There were no differences in the pregnancy rates (PRs) overall or for noncanceled cycles. The spontaneous abortion rate was approximately l in both groups. Only 8 cysts (12.9%) were noted to have a slight increase in size, whereas in the remainder an equal proportion, 43.5%, were either unchanged or actually decreased in size during stimulation with hmg. In only six cases (2.8%) was there confusion about cyst versus follicle on US monitoring. Eleven cysts were found to be endometriomas on aspiration. The remainder were follicular or lutein cysts. There were no episodes of adnexal torsion or cyst rupture. The presence of a cyst did not impair oocyte retrieval. There was no significant difference in the mean size of the largest cyst in canceled versus noncanceled cycles, 21.8 ± 9.5 and 20.9 ± 7.1 Table 3 Canceled Cycles Overall" Dominant follicle Poor development LowE 2 Premature LH surgee Hyperstimulation risk Other d 27 (43.5)b 19 (30.6) 2 (3.2) 10 (16.1) 4 (6.5) 42 (28.0) 33 (22.0) 1 (0.7) 15 (10.0) 1 (0.1) 2 (0.1) " P<0.05. b Values in parentheses are percents. e P< d One cycle was canceled at the patient's request. One was canceled because of a very poor semen specimen. These cycles were not included in the x 2 statistical analysis because they were unrelated to the superovulation outcome. mm, respectively. Similarly, the number of baseline cysts, from 1 to 3, did not affect the incidence of cycle cancellation. In retrospect, it might have been useful to obtain an E2 level at the time of the baseline scan. These data were available on 22 cyst cycles (12 on LA). One patient had an E2 of 72 pg/ml, all the others were :::;;40 pg/ml. There was no correlation between the baseline E2 levels and the number or size of the cysts, or cycle outcome. A subgroup of 18 patients had cycles with and without baseline cysts. These 52 cycles (21 with cysts) were further analyzed separately exactly as for the entire study population. With each patient serving as her own control, differences in duration of infertility, previous conception, and infertility factors were eliminated. In this more homogeneous group, there were no significant differences in any variable. Table 4 Oocyte Retrieval Follicles aspirated Mature Immature Atretic Fertilization rate (%) No. of embryos/etb No. of oocytes/gift transfer No. of embryos cryopreserved/et " No. of ET /noncanceled IVF cycles 16 (59.3)e No. of oocyte retrievals by transvaginal US 14 (22.6) " Values are means. bet, embryo transfer. e Values in parentheses are percents. " (51.7) 36 (24.0) Goldberg et al. Ovarian cysts and IVF/GIFT 321
4 Table 5 Pregnancy Overall 3 (4.8)a 17 (11.3) N oncanceled 3 (8.6) 17 (16.0) PerET 2 (12.5) 5 (12.5) Per GIFT 1 (11.1) 12 (26.1) b Term 2 (66.7) 11 (64.7)C Spontaneous abortion 1 (33.3) 6 (35.3)d a Values in parentheses are percents. b Two patients had combination IVF-ET/GIFT. These were counted as GIFT pregnanciers. C Includes one set of twins. d One set of quadruplets reduced to twins subsequently terminated because of spontaneous ruptured membranes at 20 weeks' gestation. DISCUSSION A 56% incidence of ovarian cyst (:2:15 mm) formation after hmg cycles was reported by Tummon et al. 4 These cysts resolved spontaneously within 2 cycles. If the serum E 2 1evel was :::;;85 pg/ml, repeat ovulation induction with hmg was initiated. In 15 cycles that met these criteria, folliculogenesis was unimpaired, the cysts decreased in size, and six pregnancies were established. The authors did note that the hmg requirements for cyst cycles were increased over controls. Grazi et al. l evaluated 42 nonconception hmg cycles in 21 patients who had cycles with and without the presence of a baseline cyst. There were no differences in any of the follicular response parameters to hmg, and all the cysts decreased or resolved. Ovarian cysts also developed in response to GnRH-a therapy before hmg superovulation for IVF.8 During down regulation, 29% of patients on decapeptyl and 22.7% on buserelin acetate developed ovarian cysts (>25 mm). These cysts did not change in size and did not interfere with ovulation induction, the number of oocytes obtained, or fertilization and PRs. In a retrospective study of 97 IVF cycles stimulated with hmg, Hornstein et al. 2 reported no difference in 21 cyst cycles (:2:10 mm and :::;;45 mm) versus 76 noncyst cycles in peak E2 levels, day of hcg, number of follicles, oocytes, and embryos transferred, cycle cancellation or PRs. The amount of hmg utilized was not provided. Hung et al. 3 compared 14 patients with large ovarian cysts, between 3 and 5 cm (8 remnant ovarian cysts and 6 endometriomas), with 51 noncyst cycles for IVF or GIFT. There was no or minimal growth of the cysts during controlled ovarian hyperstimulation. As well, there were no episodes of torsion or rupture. These large cysts did not influence folliculogenesis, fertilization, or PRs. Several studies, on the other hand, do suggest that baseline ovarian cysts may compromise controlled ovarian hyperstimulation for IVF. Thatcher et al. 5 observed no differences in the number of oocytes recovered, fertilization and cleavage, or PRs between cyst versus noncyst groups for noncanceled cycles. They reported that the 40 cyst cycles had significantly lower peak E2 levels and a higher cancellation rate than the 86 controls. Further, they found that cycles with cysts 16 to 29 mm had a significantly higher baseline E 2, which indicates hormonal activity. These cycles were more likely to be canceled because of a precipitous E2 drop. Cycles with 30 to 60 mm cysts had normal baseline E2 levels, and cancellations in these cycles were because of poor response. Last, two prospective randomized studies assessed the effect of transvaginal US cyst aspiration versus no aspiration before controlled ovarian hyperstimulation for IVF. Rizk et al. 6 stated that cyst aspiration contributed to a marginal improvement in the outcome of IVF by providing more oocytes at aspiration. There were no differences between the groups in E2 levels, ampules of hmg used, day of hcg administration, number of follicles, or fertilization rates. In addition, 2 patients developed infection after aspiration of hemorrhagic cysts, which led to the loss of one ovary. Aboulghar et al. 7 conducted a similar study in 64 patients with inflammatory cysts and/or hydrosalpinges. Aspiration resulted in a lower cancellation rate, more 00- cytes retrieved, and more embryos transferred. Fertilization and PRs were not significantly different between the groups. They postulated that these masses may have a deleterious effect on the ovarian response to controlled ovarian hyperstimulation by mechanically compromising the ovarian blood supply or by reducing the space for follicular enlargement. In addition, they noted that the presence of a mass made oocyte retrieval technically more difficult. In the present study, cycles with baseline ovarian cysts had a higher incidence of cancellation. However, when only noncanceled cycles were evaluated, there were no differences in any of the cycle variabies. The PRs overall, and for noncanceled cycles only, were not significantly different. Although this study is prospective and larger than the studies cited, the reader is cautioned about interpreting these results. We evaluated 212 consecutive cycles. 322 Goldberg et al. Ovarian cysts and IVF/GIFT Fertility and Sterility
5 No attempt was made to match the cycles in the cyst and noncyst groups. As it turned out, the patients who had cyst cycles had a longer duration of infertility and a greater incidence of primary infertility. A subgroup of 18 patients, who underwent controlled ovarian hyperstimulation cycles in the presence and absence of a baseline cyst, was further analyzed separately. No differences in any of the parameters were noted in this subgroup though obviously the numbers, and hence statistical power, were diminished. Although there were no differences between the cyst and noncyst groups in the percentage of cycles supplemented with FSH, CC, or LA, the ovulation induction protocol was not standardized. Each cycle was individualized based on the response during previous controlled ovarian hyperstimulation cycles. In a randomized prospective study, we found no difference in IVF or GIFT cycles with hmg alone versus a "sweetened" regimen with two ampules of FSH added the 1st 2 days of hmg therapy.9 This confirms the findings of Benadiva et al. 10 All patients who received FSH in the present study were included in this protocol. In summary, controlled ovarian hyperstimulation cycles for IVF and GIFT had a significantly higher cancellation rate if an ovarian cyst was present on baseline ultrasonography. If the cycle progressed to follicle aspiration, there were no differences in peak E2 levels, oocytes retrieved, or fertilization and PRs. In addition, the PRs overall were not significantly different. Further studies are needed to determine if transvaginal aspiration of these cysts before controlled ovarian hyperstimulation improves the cycle outcome. Acknowledgments. We gratefully acknowledge Larry Sachs, Ph.D., The Ohio State University, for assistance with the statistical.analysis. REFERENCES 1. Grazi R, Taney FH, Gagliardi CL, Khoury A, Von Hagen S, Weiss G, Schmidt CL: The presence of ovarian cysts does not alter ovarian stimulation with gonadotropins. (Abstr. 085) Presented at the 44th Annual Meeting of The American Fertility Society, Atlanta, Georgia, October 10 to 13, Published in the Program Supplement, by The American Fertility Society, 1988, p S29 2. Hornstein MD, Barbieri RL, Ravnikar VA, McShane PM: The effects of base-line ovarian cysts on the clinical response to controlled ovarian hyperstimulation in an in vitro fertilization program. Fertil Steril52:437, Hung TT, Tsuiki A: Noninterference of ovarian cysts or endometriomas with the outcome of ovulation induction in assisted reproduction. Presented at the 36th Annual Meeting of the American College of Obstetricians and Gynecologists, Boston, Massachusetts, May 2 to 5, Published in the Program Supplement, by the American College of Obstetricians and Gynecologists, 1988, p Tummon IS, Henig I, Radwanska E, Binor Z, Rawlins R, Dmowski WP: Persistent ovarian cysts following administration of huma~ menopausal and chorionic gonadotropins: an attenuated form of ovarian hyperstimulation syndrome. Fertil Steril 49:244, Thatcher SS, Jones E, DeCherney AH: Ovarian cysts decrease the success of controlled ovarian stimulation and in vitro fertilization. Fertil Steril52:812, Rizk B, Kingsland C, Steer C, Mason B: Does cyst aspiration prior to ovarian stimulation improve the outcome in in-vitro fertilization? A prospective randomized trial. (Abstr. P204) Presented at the 45th Annual Meeting of The American Fertility Society, San Francisco, California, November 11 to 16, Published in the Program Supplement, by The American Fertility Society, 1989, p S Aboulghar MA, Mansour RT, Serour GI, Satter MA, Awad MM, Amin Y: Transvaginal ultrasonic needle guided aspiration of pelvic inflammatory cystic masses before ovulation induction for in vitro fertilization. Fertil Steril 53:311, Feldberg D, Ashkenazi J, Dicker D, Yeshaya A, Goldman GA, Goldman JA: Ovarian cyst formation: a complication of gonadotropin-releasing hormone agonist therapy. Fertil Steril51:42, Dodds WG, Goldberg JM, Friedman CI, Kim MH: Unpublished data 10. Benadiva CA, Ben-Rafael Z, Blasco L, Tureck R, Mastroianni L, Jr, Flickenger GL: An increased initial follicle-stimulating hormone/luteinizing hormone ratio does not affect ovarian responses and the outcomes of in vitro fertilization. Fertil Steril 50:777, 1988 Goldberg et al. Ovarian cysts and IVF/GIFT 323
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
FERTILITY AND STERILITY Copyright 1992 The American Fertility Society Printed on acid-free paper in U.S.A. The effect of baseline complex ovarian cysts on in vitro fertilization outcome*t Elizabeth A.
More informationBulent Urman, M.D.* Margo R. Fluker, M.D. Basil Ho Yuen, M.B., Ch.B.t
FERTILITY AND STERILITY Copyright c 1992 The American Fertility Society Vol. 57, No.6, June 1992 Printed on acid-free paper in U.S.A. The outcome of in vitro fertilization and embryo transfer in women
More informationDepartment of Gynaecology and Reproductive Medicine, University Hospital, University of Western Ontario, London, Ontario, Canada
FERTILITY AND STERILITY Copyright 1992 The American Fertility Society Printed on acid-free paper in U.S.A. Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene
More informationUtility of in vitro fertilization at diagnostic laparoscopy*
FERTILITY AND STERILITY Copyright" 1994 The American Fertility Society Printed on acid-free paper in U. S. A. Utility of in vitro fertilization at diagnostic laparoscopy* Paul R. Gindoff, M.D.t Jerry L.
More informationInfertility 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 informationOvarian 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 informationDepartment of Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
FERTILITY AND STERILITY Copyright 1991 The American Fertility Society Vol. 56, No. 2, August 1991 Printed on ocid-free paper in U.S.A. Follicular size at the time of human chorionic gonadotropin administration
More informationAssisted 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 informationTimur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D.
FERTILITY AND STEFULI~ Vol. 68, No. 3, September 1997 Copyright 1997 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Published by Elsevier Science Inc. Follicle-stimulating
More informationAssisted reproductive technology
Assisted reproductive technology FERTILITY AND STERILITY Vol. 60, No.2, August 1993 Copyright 'c; 199:~ The American Fertility Society Printed on acid-free paper in U. S. A. Natural cycle in vitro fertilization-embryo
More informationGonadotropin-releasing hormone agonist reduces the miscarriage rate for pregnancies achieved in women with polycystic ovarian syndrome
FERTILITY AND STERILITY Copyright e 1993 The American Fertility Society Vol. 59, No.3, March 1993 Printed on acid-free paper in U.S.A. Gonadotropin-releasing hormone agonist reduces the miscarriage rate
More informationDoes previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?
J Assist Reprod Genet (26) 23:427 431 DOI 1.17/s1815-6-965-x ASSISTED REPRODUCTION Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation
More informationDoes 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 informationFixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol
Yamanashi Med. J. 14(3), 77 ~ 82, 1999 Original Article Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol Tsuyoshi KASAI and Kazuhiko
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Infertility Injectables Table of Contents Coverage Policy... 1 General Background...16 Coding/Billing Information...20 References...20 Effective Date...
More informationCONTROLLED OVARIAN HYPERSTIMULATION AND OOCYTE RETRIEVAL : CLINICAL INPUTS. DR Priyanka Sinha MD OB-GYN MUMBAI, INDIA
CONTROLLED OVARIAN HYPERSTIMULATION AND OOCYTE RETRIEVAL : CLINICAL INPUTS DR Priyanka Sinha MD OB-GYN MUMBAI, INDIA LEARNING OBJECTIVE Introduction Ovarian stimulation protocols Comparison of different
More informationIn 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 informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationEgg donation in an in vitro fertilization program: an alternative approach to cycle synchronization and timing of embryo transfer
FERTILITY AND STERILITY Copyright tl 1989 The American Fertility Society Printed on acid-free paper in U. S.A. Egg donation in an in vitro fertilization program: an alternative approach to cycle synchronization
More informationInfertility. 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 informationProgramming in vitro fertilization for a 5- or 3-day week
Ass~st.d.reproductive tec"no'ogy FERTILITY AND STERILITY Copyright I[J 1991 The American Fertility Society Printed on acid-free paper in U.S.A. Programming in vitro fertilization for a 5- or 3-day week
More informationMedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.018.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2017
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.018.MH Infertility- Treatment This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar
More informationElena H. Yanushpolsky, M.D., a Shelley Hurwitz, Ph.D., b Eugene Tikh, B.S., c and Catherine Racowsky, Ph.D. a
FERTILITY AND STERILITY VOL. 80, NO. 1, JULY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Predictive usefulness of cycle
More informationEffects of functional ovarian cysts detected on the 7th day of gonadotropin-releasing hormone analog administration on the outcome of IVF treatment
FERTILITY AND STERILITY VOL. 74, NO. 5, NOVEMBER 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Effects of functional
More informationIn vitro fertilization and embryo transfer for the treatment of infertility associated with polycystic ovary syndrome
Assisted reproductive techno.logy FERTILITY AND STERILITY Vol. 60, No.5, November 1993 Copyright 199a The American Fertility Society Printed on acid-free paper in U. S. A. In vitro fertilization and embryo
More informationRisk factors for spontaneous abortion in menotropintreated
FERTILITY AND STERILITY Copyright ~ 1987 The American Fertility Society Vol. 48, No. 4, October 1987 Printed in U.S.A. Risk factors for spontaneous abortion in menotropintreated women Michael Bohrer, M.D.*
More informationOvarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact
Human Reproduction Page 1 of 5 Hum. Reprod. Advance Access published October 27, 2005 doi:10.1093/humrep/dei371 Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and
More informationLOW 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 informationAssisted Reproduction. Rajeevi Madankumar, 1,2 James Tsang, 1 Martin L. Lesser, 1 Daniel Kenigsberg, 1 and Steven Brenner 1 INTRODUCTION
( C 2005) DOI: 10.1007/s10815-005-4912-8 Assisted Reproduction Clomiphene citrate induced ovulation and intrauterine insemination: effect of timing of human chorionic gonadotropin injection in relation
More informationArticle Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination
RBMOnline - Vol 13. No 2. 2006 208-212 Reproductive BioMedicine Online; www.rbmonline.com/article/2334 on web 30 May 2006 Article Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationA controlled study of gonadotropin-releasing hormone agonist (buserelin acetate*) for folliculogenesis in routine in vitro fertilization patients
FERTILITY AND STERILITY Copyright" 1991 The American Fertility Society Vol. 56, No. 3, September 1991 Printed on acid-free paper in U.S.A. A controlled study of gonadotropin-releasing hormone agonist (buserelin
More informationOvarian 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 informationPuerto 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 informationI. 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 informationOvulation induction in women age 40 and older: the importance of basal follicle-stimulating hormone level and chronological age*
FERTILITY AND STERILITY Vol. 58, No.4, October 1992 Copyright It! 1992 The American Fertility Society Printed on acid-free paper in U. S.A. Ovulation induction in women age 40 and older: the importance
More informationClinical consequences of ovarian stimulation in assisted conception and in PCOS Al-Inany, H.G.
UvA-DARE (Digital Academic Repository) Clinical consequences of ovarian stimulation in assisted conception and in PCOS Al-Inany, H.G. Link to publication Citation for published version (APA): Al-Inany,
More informationImpact of Varying Stages of Endometriosis on the Outcome of In Vitro Fertilization-Embryo Transfer
CLINICAL ASSISTED REPRODUCTION Impact of Varying Stages of Endometriosis on the Outcome of In Vitro Fertilization-Embryo Transfer LUBNA PAL,1,3 JAN L. SHIFREN,2 KEITH B. ISAACSON,1 YuCHIAO CHANG,2 LUCY
More informationSuperovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony*
aes FERTILITY AND STERILITY Vol. 61, No.4, April 1994 Copyright ee) 1994 The American Fertility Society Printed on acid-free paper in U. S. A. r I Superovulation with human menopausal gonadotropins is
More informationA prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery
FERTILITY AND STERILITY Vol. 58, No.2, August 1992 Copyright e 1992 The American Fertility Society Printed on acid-free paper in U.S.A. A prospective randomized study comparing aspiration only with aspiration
More information* Present address: Foothills Hospital, Calgary, Alberta, Canada.
FERTILITY AND STERILITY Copyright 1993 The American Fertility Society Vol. 59, No. 6, June 1993 Printed on acid-free paper in U.S.A. A randomized trial of in vitro fertilization versus conventional treatment
More informationIvf 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 informationArticle 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 informationPerformance of patients with a ''frozen pelvis" in an in vitro fertilization program
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in U.8A. Performance of patients with a ''frozen pelvis" in an in vitro fertilization program David Molloy, F.R.A.C.O.G.*t
More informationPremature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles
Arch Gynecol Obstet (2010) 281:747 752 DOI 10.1007/s00404-009-1248-0 REPRODUCTIVE MEDICINE Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles Esra
More informationClinical 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 informationOVULATION INDUCTION. Hsiang, Kaohsiung, Taiwan (FAX: ; adm.cgmh.org.tw).
OVULATION INDUCTION Significantly superior response in the right ovary compared with the left ovary after stimulation with follicle-stimulating hormone in a pituitary down-regulation regimen Kuo-Chung
More informationAgonist 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 informationPhases of the Ovarian Cycle
OVARIAN CYCLE An ovary contains many follicles, and each one contains an immature egg called an oocyte. A female is born with as many as 2 million follicles, but the number is reduced to 300,000 to 400,000
More informationRelation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy
Relation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy Aseel Mosa Jabber M.SC.G.O. The department of Obstetrics and Gynecology, Faculty of Medicine Thi-qar university
More informationIranian Journal of Reproductive Medicine Vol. 2. No.1 pp 29-33, 2004
Efficacy of Low Dose, Long-acting Gonadotropin Releasing Hormone Analogues (GnRH-a) Compared with Daily Injections of Short-acting GnRH-a in ART Cycles Robabeh Taheripanah M.D. 1, Mohammad A. Karimzadeh
More information' ' ' ' ' ' ' ' COMPARISON BETWEEN HIGHLY PURIFIED--FSH AND HMG FOR SUPEROVULATION IN WOMEN UNDERGOING IN VITRO FERTILIZATION ORIGINAL RESEARCH
' ' ' ' ORIGINAL RESEARCH ' ' ' ' COMPARISON BETWEEN HIGHLY PURIFIED--FSH AND HMG FOR SUPEROVULATION IN WOMEN UNDERGOING IN VITRO FERTILIZATION Pierre Miron, MD, FRCSC, 1 Robert Casper, MD, FRCSC,2 Louise
More informationLUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY*
FERTILITY AND STERILITY Copyright c 1978 The American Fertility Society Vol. 29, No.3, March 1978 Printed in U.S.A. LUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY* JAROSLA V MARIK,
More informationCONSENT FORM FOR TREATMENT WITH OVULATION INDUCTION MEDICATIONS AND INTRAUTERINE INSEMINATIONS
CONSENT FORM FOR TREATMENT WITH OVULATION INDUCTION MEDICATIONS AND INTRAUTERINE INSEMINATIONS INSTRUCTIONS: This consent form provides a description of the treatment that you are undertaking. Read the
More informationin 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 informationFollicular diameters in conception cycles with and without multiple pregnancy after stimulated ovulation induction
Human Reproduction Page 1 of 5 Hum. Reprod. Advance Access published December 17, 2004 doi:10.1093/humrep/deh677 Follicular diameters in conception cycles with and without multiple pregnancy after stimulated
More informationIn Vitro Fertilization and Embryo Transfer
Acta Medica et Biologica Vol. 41, No.4, 171-176, 1993 The Influence of Low Ovarian Response on the Results of In Vitro Fertilization and Embryo Transfer Hirofumi HIRASAWA Department of Obstetrics and Gynecology,
More informationProspective study of short and ultrashort regimens of gonadotropinreleasing hormone agonist in an in vitro fertilization program
FERTILITY AND STERILITY Copyright 1992 The American Fertility Society Printed on acid-free paper in U.S.A. Prospective study of short and ultrashort regimens of gonadotropinreleasing hormone agonist in
More informationSignificance of basal follicle-stimulating hormone levels in women with one ovary in a program of in vitro fertilization*
FERTILITY AND STERILITY Copyright e 1992 The American Fertility Society Printed on acid-free paper in U.S.A. Significance of basal follicle-stimulating hormone levels in women with one ovary in a program
More informationModule 3. Infertility: Protocols and Patient Management
Module 3 Infertility: Protocols and Patient Management Ann Scalia, BSN, RN, CNOR Manager Clinical Education Specialists Mary Vietzke, BSN, RN Senior Clinical Educational Specialist Walgreens Faculty Ann
More informationJinan Bekir, M.D. Amma Kyei-Mensah, M.D. Seang-Lin Tan, M.D.
FERTILITY AND STERILITY Copyright ~ 1995 American Society for Reproductive Mediciue Vol. 64, No.4, October 1995 Printed on acid-free paper in U. S. A. Administration of progestogens to hasten pituitary
More informationMinimal stimulation achieves pregnancy rates comparable to human menopausal gonadotropins in the treatment of infertility*
FERTILITY AND STERILITY Copyright :Q' 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Minimal stimulation achieves pregnancy rates comparable to human menopausal
More informationVanessa N. Weitzman, M.D., Lawrence Engmann, M.D., Andrea DiLuigi, M.D., Donald Maier, M.D., John Nulsen, M.D., and Claudio Benadiva, M.D.
Comparison of luteal estradiol patch and gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation versus microdose gonadotropin-releasing hormone agonist protocol
More informationHana 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 informationPrinciples 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 informationComplete failure of fertilization in couples with unexplained infertility: implications for subsequent in vitro fertilization cycles
r FERTILITY AND STERILITY Copyright ~ 1993 The American Fertility Society Printed on acid-free paper in U.S.A. Complete failure of fertilization in couples with unexplained infertility: implications for
More informationPrognostic value of day 3 estradiol on in vitro fertilization outcome*
FERTILITY AND STERILITY Vol. 64, No.6, December 1995 Copyright 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Prognostic value of day 3 estradiol on in vitro fertilization
More informationOriginal Article. Fauzia HaqNawaz 1*, Saadia Virk 2, Tasleem Qadir 3, Saadia Imam 3, Javed Rizvi 2
Original Article Comparison of Letrozole and Clomiphene Citrate Efficacy along with Gonadotrophins in Controlled Ovarian Hyperstimulation for Intrauterine Insemination Cycles Fauzia HaqNawaz 1*, Saadia
More informationLuteal 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 informationDrug 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 informationEVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD
EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve
More informationUtility of color Doppler indices of dominant follicular
Ultrasound Obstet Gynecol 2002; 20: 592 596 Utility of color Doppler indices of dominant follicular Blackwell Science, Ltd blood flow for prediction of clinical factors in in vitro fertilization-embryo
More informationIVF Performance of Women Who Have Fluctuating Early Follicular FSH Levels 1
CLINICAL ASSISTED REPRODUCTION IVF Performance of Women Who Have Fluctuating Early Follicular FSH Levels 1 A. LASS, 2,3 A. GERRARD, 2 N. ABUSHEIKHA, 2 F. AKAGBOSU, 2 and P. BRINSDEN 2 Submitted: April
More informationDrug 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 informationInfertility Clinical Guideline
Infertility Clinical Guideline Ovarian Stimulation Guideline Purpose: To provide sufficient background regarding various ovarian stimulation protocols for In Vitro Fertilization cycles. Goal: To assist
More informationInfertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem?
Infertility (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.
More informationThe effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles
FERTILITY AND STERILITY Vol. 65, No.3, March 1996 Copyright t';, 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. The effects of prior gravidity on the outcomes of
More informationThe 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 informationSample 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 informationOvarian fecundity in patients with endometriosis can be estimated by the incidence of apoptotic bodies
FERTILITY AND STERILITY VOL. 69, NO. 5, MAY 1998 Copyright 1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Ovarian fecundity in patients
More informationA comparative study between agonist and antagonist protocol for ovarian stimulation in art cycles at a rural set up in South Gujarat
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Nadkarni PK et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):617-621 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationUnderstanding 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 informationDuration 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 informationFactors 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 informationConception rate after in vitro fertilization in patients who conceived in a previous cycle
FERTILITY AND STERILITY Copyright
More informationCore Safety Profile. Pharmaceutical form(s)/strength: Lyophilised powder for injection / 75 IU. Date of FAR:
Core Safety Profile Active substance: Urofollitropin Pharmaceutical form(s)/strength: Lyophilised powder for injection / 75 IU P - RMS: UK/H/PSUR/0059/001 Date of FAR: 04.12.2009 4.2 Posology and method
More informationCombined Electroejaculation and in Vitro Fertilization in the Evaluation and Treatment of Anejaculatory Infertility
Combined Electroejaculation and in Vitro Fertilization in the Evaluation and Treatment of Anejaculatory Infertility JOHN F. RANDOLPH, JR., 1'2 DANA A. OHL, 3 CAROL J. BENNETT, 4 JONATHAN W. T. AYERS, 5
More informationSetting The setting was secondary care. The economic study was carried out in Turkey.
Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination Baysoy A, Serdaroglu H, Jamal H, Karatekeli E, Ozornek H, Attar E Record Status This is a critical abstract
More informationBest 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 informationProspective study of a modified gonadotropin-releasing hormone agonist long protocol in an in vitro fertilization program
FERTILITY AND STERILITY Copyright 1994 The American Fertility Society Printed on acid-free paper in U. s. A. Prospective study of a modified gonadotropin-releasing hormone agonist long protocol in an in
More informationSupraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles
Human Reproduction Vol.17, No.1 pp. 83 87, 2002 Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles Joseph E.Peña, Peter L.Chang 1, Lai-King Chan, Khaled
More informationArticle Depot GnRH agonist versus the single dose GnRH antagonist regimen (cetrorelix, 3 mg) in patients undergoing assisted reproduction treatment
RBMOnline - Vol 7. No 2. 185 189 Reproductive BioMedicine Online; www.rbmonline.com/article/900 on web 18 June 2003 Article Depot GnRH agonist versus the single dose GnRH antagonist regimen (cetrorelix,
More informationA novel ovarian stimulation protocol for use with the assisted reproductive technologies*
FERTILITY AND STERILITY Vo!' 60, No.5, November 1993 Copyright 1993 The American Fertility Society Printed on acid-free paper in U. S. A. A novel ovarian protocol for use with the assisted reproductive
More informationK.W.Fuh, X.Wang, A.Tai, I.Wong and R.J.Norman 1
Human Reproduction vol.12 no.10 pp.2162 2166, 1997 Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and
More informationThe 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 informationART 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 informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Recombinant versus urinary follicle-stimulating hormone in intrauterine insemination cycles: a prospective, randomized analysis of cost effectiveness Gerli S, Casini M L, Unfer V, Costabile L, Bini V,
More informationThe Presence of Hydrosalpinx May Not Adversely Affect the Implantation and Pregnancy Rates in In Vitro Fertilization Treatment1
CLINICAL ASSISTED REPRODUCTION The Presence of Hydrosalpinx May Not Adversely Affect the Implantation and Pregnancy Rates in In Vitro Fertilization Treatment1 ERNEST HUNG-YU NG,2,3 WILLIAM SHU-BIU YEUNG,2
More information