2012, Number 02
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Ginecol Obstet Mex 2012; 80 (02)
Preliminary results of effectiveness of two schemes of controlled ovarian hyperstimulation protocols with recombinant foliculle stimulating hormone in intrauterine insemination cycles
Barros DJC, Fiszman AR, Santibañez MÁ, Sánchez SV, Gaviño GF
Language: Spanish
References: 24
Page: 61-72
PDF size: 268.93 Kb.
ABSTRACT
Background: The intrauterine insemination (IUI) is the first line treatment in different infertility situations.
Objective: To compare the efficacy of two protocols of controlled ovarian hyper stimulation (COHS) with recombinant Follicle Stimulating hormone (rFSH) (75 vs.150 UI/day) plus IUI, in terms of pregnancy rate, multiple pregnancies, Ovarian Hyper Stimulation Syndrome and ovarian stimulation features.
Materials and Methods: Prospective study, sequential assignment, Included 35 patients that had 44 cycles of IUI. They were assigned in to two groups, group 1 that started controlled ovarian hiperestimulation with 75 and 2 with 150 UI/day of recombinant rFSH.
Results: We found statistically significant difference between groups in: dose of rFSH, amount of stimulation days, number of mature follicles and estradiol blood levels on the day of use of the GnRHant and hCG injection day. The pregnancy rate between group 1 and 2 were 9.1 vs. 27.2%, respectively. Of the 8 pregnancies, 75% were achieving in group 2. The twin pregnancy rate was 2.2% and there were no cases of OHSS.
Conclusions: Although without significant difference between groups we found a clear trend to achieve a better pregnancy rate with the 150UI/day protocol without a significant raise in multiple pregnancy rate nor OHSS. The multifollicular development was associated to group 2 seems to be related to the better pregnancy rate achieved by the same group.
REFERENCES
Barros D JC, Rojas R JC, Molina MAC, Villalobos AS, y col. Factores pronóstico de embarazo en Inseminación Intrauterina. Ginec Obstet Mex 2008;74:611-625.
Barros DJC, Trejo CH, Ormsby CE, Gaviño GF. Diferencia de respuesta a los antagonistas de GnRH en ciclos de hiperestimulación ovárica más inseminación intrauterina. Ginecol Obstet Mex 2010;78:15-28.
Ghesquiere SL, Castelain EG, Spiessens C, Mauleman CL, et al. Relationship between follicle number and (multiple) live birth rate after controlled ovarian hyperestimulation and intrauterine insemination. Am J Obstet Gynecol 2007;589. e1-589.e5.
Cantineua AEP, Cohlen BJ, Heineman MJ. Ovarian stimulations protocols (antiestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database of Systematic Reviews 2008, Issue. Art. No CD005356 D0I.
Gomez-Palomares JL, Acevedo MB, Chavez M, Manzanares MA, et al. Multifolicular recruitment in combination with gonadotropin-releasing hormone antagonist increased pregnancy rates in intrauterine insemination cycles. Fertil Steril 2008;89:620-624.
Sánchez I, Amorós D, Lucco F, González S, y col. Inseminación Artificial. En: Bellver J, Domingo J editores. Manual práctico de esterilidad y reproducción humana. Madrid: McGraw-Hill, 2008;23-40.
Romero I, García-Benites JL, Aragón M, Cohen I, y col. Desarrollo mono-bifolicular en la inducción de la ovulación en condiciones asistenciales habituales con folitropina alfa dosificada en masa. Estudio multicéntrico, observacional, prospectivo. Rev Iberoamericana de Fertilidad 2007;24:5-9.
Freiesleben NC, Lossl K, Bogstad J, Bredkjaer HE, et al. Individual versus standard dose of rFSH in a mild stimulation protocol for intrauterine insemination: a randomized study. Hum Reprod 2009;24: 2523-2530.
Leader A. Improved monofollicular ovulation in anovulatory or oligo-ovulatory women after a low-dose step-up protocol with weekly increments of 25 international units of folliclestimulating hormone. Fertil Steril 2006;85:1766-1773.
Hughes E, Collins JA, Gunby J. A randomized controlled trial of three low-dose gonadotrophin protocols for unexplained infertility. Hum Reprod 1998;13:1527-1531.
Orvieto R. Chronic ultra-low dose follicle-stimulating hormone regimen for patients with polycystic ovarian syndrome: one click, one follicle, and one pregnancy. Fertil Steril 2009;91:1533-1535.
Kabli N, Sylvestre C, Tulandi T, Bickett W. Comparison of daily and alternate recombinant follicle-stimulating hormone stimulation protocols for intrauterine insemination. Fertil Steril 2009;91:1141-1144.
Scholtes M, Schnittert B, van Hoogstraten D, Verhoeven C, et al. A comparison of 3 day 7 and daily follicle-stimulating hormone injections on stimulation days 1-6 in women undergoing controlled ovarian hyperstimulation. Fertil Steril 2004;81,996-1001.
Palmer R. Strategies to reduce multiple pregnancies due to ovulation stimulation. Fertil Steril 2009;91:1-17.
Streda R. Mono-follicular development- the objective of ovulation induction with follitropin beta combined with intrauterine insemination. Ceska Gynekol 2008;73:93-97.
Ragni G, Calari I, Nicolos AE, Arnoldi M, et al. Preventing high-order pregnancies during controlled ovarian hyperestimulation and intrauterine insemination: 3 years experience using low-dose recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril 2006;85:619-624.
Aboulghar M, Mansour RT, Serour GI, Amin YM, et al. Recombinant follicle-stimulating hormone in the treatment of patients with history of severe ovarian hyperstimulation syndrome. Fertil Steril 1998;69:72S-75S.
Merviel P, Heraud M, Grenier N, Lourdel E, et al. Prospective factor for pregnancy after intrauterine insemination (IUI): An analysis of 1038 cycles and a review of the literature. Fertil Steril 2010;93:79-88.
The ESHRE Capri Workshop Group. Intrauterine Insemination. Hum Reprod Update 2009;15: 265-277.
Iberico G, Vioque J, Ariza N, Loano J, et al Analysis of factors influencing pregnancy rates in homologus intrauterine insemination. Fertil Steril 2004;81:1308-1313.
Rohi M, Rasmussen P, Erb K, Broch S, et al. Homologous entrauterine insemination. An evaluation of pronostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand 2001;80:74-81.
Goverde AJ, Lambalk CB, McDonnell J, Schats R, et al. Further considerations on natural or mild hyper stimulation cycles for intrauterine insemination treatment: effects on pregnancy and multiple pregnancy rates. Hum Reprod 2005;20:3141-3146.
Steures P, van der Steeg, J Mol BW, Ejikemans M, et al. CECERM (Collaborative Effort in Clinical Evaluation in Reproductive Medicine) Prediction of an on going pregnancy after intrauterine insemination. Fertil Steril 2004;82:45-51.
Van Rumste MME, Crs LM, van der Veen F, van Wely, et al. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a metanalysis. Hum Reprod Update 2008;14:563-570.