Διέγερση των ωοθηκών σε γυναίκες για εξωσωματική γονιμοποίηση και ενδοσαλπιγγική μεταφορά γαμετών

The first pregnancies obtained by IVF in humans were achieved with oocytes from natural (unstimulated) cycles. Nevertheless, the yield of ova in the natural cycle is usually low. Also, the success of in vitro fertilization-embryo transfer (IVF/ET) is greatly enhanced by the number of oocytes retrieved. Therefore, most IVF centres use various ovarian stimulation protocols in order to maximize the development of multiple oocytes in a given cycle, thus improving IVF results. Which stimulation protocols result in satisfactory pregnancy rates and finally which are the superior stimulation protocols for follicular development in an IVF program? In order to evaluate the efficacy of different regimes in ovulation induction we studied 512 women in 575 cycles from 1985 to 1989. From them, 347 were enrolled in the IVF/ET program, 107 in the GIFT and 58 in the ZIFT/TET program. The age of the patients varied from 23 to 40 years, while the duration of infertility from 3 to 12 years. The indications were mainly tubal factor, endometriosis, PCO, unexplained infertility and male factor. Ovulation was induced by the following protocols: Group I: (271 cycles). Buserelin (Β: 1 mg/day, intranasally) as short protocol (271 cycles) starting on cycle day I, accompanied by the administration of HMG (3 amp/day) from cycle day 3 until HCG administration or long protocol. According to this, Buserelin is given for at least 15 days until pituitary desensitization, followed by the administration of HMG. Group II: (45 cycles). Buserelin (B: 1 mg/day, intranasally) as short protocol with P-FSH (2 amp/day) and HMG (2 amp/day starting on cycle day 3 until the day of HCC administration (day 0) in a dose according to patient’s response. Group III: (24 cycles). HMG (2 amp/day) combined with the administration of clomiphene citrate (cc: 100 mg/day) from days 2 to 6. Then clomiphene was discontinued while HMG was given until day 0. Group IV: (122 cycles). HMG (3 amp/day) starting on cycle day 3 for 5-8 days. The dose was increased when necessary from day 8 in a stepwise manner, to 4-5 ampules/day) depending on the individual ovarian response. Group V: (113 cycles). HMG (3 amp/day) and prednisolone (DO.7.5 mg/day) from day 3 of the cycle combined with the administration of oral contraceptives (O.C.) for 18-21 days during the previous month. Follicular growth was assessed by ovarian ultrasonography and serum E₂ determination. When there were, at least, two follicles > 1.8 cm and E₂ concentrations were > 1000 pg/ml in groups I, II and III and two follicles > 1.5 cm and E₂ > 500 pg/ml in groups IV and V, 10.000 IU HCG were injected. Recovery of developed oocytes was carried out by laparoscopy or transvaginally after 36h. Our study resulted in the following findings: 1. The lower cycles cancellation rate (3.3%) was observed in group I and then in group V (9.7%). 2. The higher number of developed follicles was observed in group I (8.3±0.3) and then in group V (7.8±0.5) (mean value ± standard error). 3. The best correlation (r = 0.6502) between serum E₂ on day 0 and the total follicular volume at the same day was noticed in group I followed by group V (r = 0.5810). 4. The higher number of retrieved oocytes was observed in group I (7.2 ±0.3) (p < 0.001), which were of good quality based on oocyte maturity as well as on fertilization rate. 5. The administration of group I stimulation protocol resulted in higher number of embryos (4.5 ±0.3, p < 0.05). 6. The higher pregnancy rates were achieved in group II (25.9%) and I (17.5%), differences which were not statistically significant among all 5 groups. The administration of Buserelin (groups I, II) was followed by an increase (p < 0.05) in stimulation days as well as in the dose of exogenous gonadotrophins.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1990

Authors dc:creator

• Pados, Georgios
• Πάντος, Γεώργιος

• Ιατρική και Επιστήμες Υγείας
• Κλινική Ιατρική
• Medical and Health Sciences
• Clinical Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1447

OAI identifier oai:identifier

oai:10442/1447