Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting. Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day. Materials and Methods. It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR. Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were >2.5 IU/L (LBR: 32.5%, P = 0.045 and CPR: 36.9%, P = 0.027) compared to FSH <2.5 IU/L. The optimal FSH cut-off level for LBR and CPR is 5.6 IU/L on the hCG day. The optimal cutoff for coasting is 4 days. Conclusion(s). Coasting may be continued as long as either serum FSH level is > 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days

Clinical Study Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting. Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day. Materials and Methods. It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR. Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were &gt;2.5 IU/L (LBR: 32.5%, P = 0.045 and CPR: 36.9%, P = 0.027) compared to FSH &lt;2.5 IU/L. The optimal FSH cut-off level for LBR and CPR is 5.6 IU/L on the hCG day. The optimal cutoff for coasting is 4 days. Conclusion(s). Coasting may be continued as long as either serum FSH level is &gt; 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days

CASE REPORT - Successful pregnancy and delivery following IVF treatment in a patient with endometrial polyp diagnosed by saline infusion sonohysterography at oocyte retrieval

Background: There is lack of consensus regarding the management of patients diagnosed with endometrial polyp in assisted reproductive technology (ART) cycles. Saline infusion Sonohysterography (SIS) may provide more precise identification of endometrial pathology without need for hysteroscopy, cycle cancellation or cryopreservation of all embryos. Case: A 38 year-old woman with endometrial polyp diagnosed by saline infusion sonohysterography (SIS) during controlled ovarian hyperstimulation (COH) which necessitated the intervention where diagnosis was confirmed after oocyte retrieval. Several options were discussed with patient who opted for fresh embryo transfer that resulted in normal pregnancy and delivery. Conclusion: Normal pregnancy and deliver can be achieved in the presence of an endometrial polyp during IVF. Performing SIS near the time of embryo transfer did not prevent implantation

Luteal phase support in assisted reproduction: United Kingdom survey

Objective: Probing practices of luteal phase support in assisted reproductive technology (ART) centers in U.K. Materials and methods: A question survey was conducted via the recognized centre by the HFEA (Human Fertilization Embryology Authority) registry for year 2005. Questions covered importance, optimal hormone for luteal support and optimal route and length of progesterone and human chorionic gonadotrophin (hCG) administration for women undergoing assisted reproductive technologies. Main outcome measures: The main outcome measures were importance, optimal hormone, and optimal route, dose, length of progesterone, estrogen and hCG administration. Results: 82 centers licensed for in vitro fertilization / Donor insemination (IVF/DI) acknowledge receiving the survey. Of those, 69 centers perform in vitro fertilization / intra cytoplasmic sperm injection (IVF/ICSI). 60 (87%) centers replied. Luteal support was very important in 65% and important in 31%. 97% used it in long down regulation protocol. The routine use of luteal support following controlled ovarian hyperstimulation (COH) with all stimulated cycles was 80.6%. HCG was behind the progesterone in its use in this survey. Cyclogest (progesterone pessaries) was the first choice of those selected as a preference in 55%. 92% of IVF/ICSI centers that responded to the questionnaire use cyclogest. The commonest dose used is 400 mg twice daily (BD). The other leaders are intramuscular progesterone (42%), hCG (38%), and vaginal progesterone gel (25%). The common practice is to start luteal support from the day of oocyte collection (48%) and 48% centers continue support until 12 weeks gestation. Conclusion:Luteal phase support in ART is regarded as important by majority of specialist centre. Cyclogest is the most widely used luteal phase support