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2 results

  • 47A - Asymptomatic Polycystic Ultrasound Appearance of the Ovary Is Favourable for IVF Outcome

  • from Section IX - Hormones and the Environment
  • Edited by Roy Homburg, Adam H. Balen, Robert F. Casper
  • Book:
    50 Big Debates in Reproductive Medicine
    Published online:
    25 November 2021
    Print publication:
    16 December 2021, pp 244-246

  • Summary

    The significant advances in ultrasound technology have resulted in an increase in the prevalence of PCO morphological ultrasonographic criteria diagnosis. These patients have a live birth rate after undergoing up to three cycles of IVF treatment that is 82% higher than women with normal ovaries, requiring fewer ampules of gonadotrophins, producing more follicles and viable oocytes with similar fertilisation and miscarriage rates. Since these women exhibit an exaggerated response to gonadotrophin therapy regardless of COH protocol, the risk remains the increased prevalence of OHSS. Since no COH protocol is superior to manage these patients, protocols that trigger oocyte maturation with a GnRH agonist, with or without a ‘freeze-all’ approach, should be encouraged. Therefore, it is important that every patient undergoing IVF has a baseline ultrasound scan, antral follicle count and AMH levels as well as an assessment of ovarian morphology prior to ART treatments in order to assess risk and reduce complications.

  • Chapter 10 - Polycystic ovarian syndrome

  • from Section 3: - Difficulties and complication of ovarian stimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 87-102

  • Summary

    This chapter focuses on the indications for intrauterine insemination (IUI) in combination with mild ovarian hyperstimulation (MOH), its methods and risks. Optimal timing of the insemination is a crucial factor in IUI programs. After ovulation oocytes should be fertilized within several hours. Inseminated sperm (bypassing the cervix which acts as a reservoir for spermatozoa) has a limited period of survival, and sperm should therefore not be inseminated too early. When MOH is applied in IUI programs, one should strive after multifollicular growth of two to three dominant follicles to obtain the highest probability of conception with reasonable risks. When multiple pregnancies are kept to a minimum, MOH/IUI is more cost-effective compared with in vitro fertilization (IVF). Gonadotropins are the most effective drugs and should be offered in a low-dose, step-up protocol. Future randomized trials should investigate the cost-effectiveness of luteal support.