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Chapter 12 - Adjuvant therapy to increase implantation rates

Published online by Cambridge University Press:  16 May 2011

By
David Meldrum
Edited by
David K. Gardner ,
Botros R. M. B. Rizk  and
Tommaso Falcone
David K. Gardner
Affiliation:
University of Melbourne
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Tommaso Falcone
Affiliation:
Cleveland Clinic Foundation
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Summary

Several medications have been found to increase implantation rates with in vitro fertilization (IVF) when given as adjuncts to follicle stimulating hormone (FSH) stimulation of the ovaries in preparation for oocyte retrieval. Gonadotropin-releasing hormone (GnRH) agonists, oral contraceptives (OCs), and estrogen pretreatment help to synchronize the follicular cohort resulting in an improved ovarian response. Metformin (MET) increases implantation in PCOS women having IVF and dramatically reduces the incidence of ovarian hyperstimulation syndrome (OHSS) in these women. Growth hormone (GH) markedly increases implantation in poor-responding women having IVF. Small doses of human chorionic gonadotropin (hCG) are used to provide LH activity allowing use of pure FSH products and the pen devices that deliver graduated FSH doses. Low-dose aspirin (ASA) increases ovarian response and implantation, and reduces the incidence of severe OHSS. Drugs such as letrozole that increase androgens may prove to be useful agents to increase ovarian response in poor responders.

Keywords

arcuate uterusAsherman's syndromeendometrial polypspretreatment cavity evaluationseptate uterusmyomasMüllerian anomaliesin vitro fertilizationuterine cavity abnormalities
Type
Chapter
Information
Human Assisted Reproductive Technology
Future Trends in Laboratory and Clinical Practice
 , pp. 119 - 126
Publisher: Cambridge University Press
Print publication year: 2011

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