4 research outputs found
Is there a future for ovulation induction in the current era of assisted reproduction?
The clinical use of medical induction of ovulation in normogonadotrophic
anovulatory women (WHO II), including polycystic ovary syndrome, is
increasingly questioned. However, we believe that this treatment modality
still represents a highly effective means of fertility treatment in women
with low pregnancy chances without intervention. A conventional treatment
algorithm involving clomiphene citrate (CC) followed by FSH induction of
ovulation may result in a 71% cumulative singleton live birth rate. In
attempts to improve treatment outcome further and reduce complication
rates, new compounds such as insulin-sensitizing agents or aromatase
inhibitors are currently used increasingly. Approaches such as patient
selection for different treatment modalities on the basis of initial
screening characteristics and alternative protocols for FSH ovulation
induction may also be proposed to render treatment algorithms more patient
tailored and therefore improve overall outcomes. More research is needed
in this area, rather than referring these patients to assisted
reproduction prematurely. This may lead to a more individually tailored
approach for ovulation induction in a given patient, resulting in a
further improvement of the balance between chances for success versus
complications
Urinary follicle-stimulating hormone for normogonadotropic clomiphene-resistant anovulatory infertility: prospective, randomized comparison between low dose step-up and step-down dose regimens
A low dose step-up and step-down regimen for induction of ovulation using
urinary FSH was compared in a prospective randomized fashion in 37
normogonadotropic clomiphene-resistant oligo- or amenorrheic infertile
women. The objectives was to assess potential differences in duration of
treatment, ovarian stimulation (serum FSH levels), and response [serum
estradiol (E2) levels and number and size of follicles]. Monitoring (blood
sampling and transvaginal sonography) took place on the day of initiation
of treatment, the first day of ovarian response as assessed by ultrasound
(i.e. the first day a follicle > or = 10 mm could be recognized), the day
of hCG administration to induce ovulation, and 3 days thereafter. The
median duration of treatment in the low dose step-up group was 18 (range,
7-41) days compared to 9 (range, 4-16) days in the step-down group (P =
0.003), and the total numbers of ampules administered were 20 (range,
7-69) and 14 (range, 7-33), respectively (P = NS). Serum FSH levels from
the first day of sonographic ovarian response until the administration of
hCG were constant (median increase, 2%/day) in patients receiving the low
dose step-up protocol, but showed a decrease (median, 5%/day) in step-down
cycles (P < 0.001). Monofollicular growth, defined as not more than one
follicle 16 mm or larger on the day of hCG administration, was observed in
56% of low dose step-up and 88% of step-down cycles (P = 0.04). The
percentage of patients with normal range periovulatory E2 serum levels
(500-1500 pmol/L) was 33% in the low dose step-up group vs. 71% in the
step-down group (P = 0.03). We conclude that a step-down protocol for
gonadotropin induction of ovulation exhibits a more physiological, late
follicular phase FSH serum profile than a low dose step-up protocol. This
results in a shorter duration of treatment, a greater number of
monofollicular cycles, and more cycles with periovulatory E2 levels within
the normal range in the step-down protocol
Risk of cancer in children and young adults conceived by assisted reproductive technology
STUDY QUESTION: Do children conceived by ART have an increased risk of cancer?
SUMMARY ANSWER: Overall, ART-conceived children do not appear to have an increased risk of cancer.
WHAT IS KNOWN ALREADY: Despite the increasing use of ART, i.e. IVF or ICSI worldwide, information about possible long-term
health risks for children conceived by these techniques is scarce.
STUDY DESIGN, SIZE, DURATION: A nationwide historical cohort study with prospective follow-up (median 21 years), including all
live-born offspring from women treated with subfertility treatments between 1980 and 2001.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All offspring of a nationwide cohort of subfertile women (OMEGA study)
treated in one of the 12 Dutch IVF clinics or two fertility clinics. Of 47 690 live-born children, 24 269 were ART-conceived, 13 761 naturally
conceived and 9660 were conceived naturally or through fertility drugs, but not by ART. Information on the conception method of each child
and potential confounders were collected through the mothers’ questionnaires and medical records. Cancer incidence was ascertained
through linkage with The Netherlands Cancer Registry from 1 January 1989 until 1 November 2016. Cancer risk in ART-conceived children
was compared with risks in naturally conceived children from subfertile women (hazard ratios [HRs]) and with the general population (standardized incidence ratios [SIRs]).
MAIN RESULTS AND THE ROLE OF CHANCE: The median follow-up was 21 years (interquartile range (IQR): 17–25) and was shorter in ART-conceived children (20 years, IQR: 17–23) compared with naturally conceived children (24 years, IQR: 20–30). In total, 231 cancers were observed. Overall cancer risk was not increased in ART-conceived children, neither compared with naturally conceived children
from subfertile women (HR: 1.00, 95% CI 0.72–1.38) nor compared with the general population (SIR = 1.11, 95% CI: 0.90–1.36). From
18 years of age onwards, the HR of cancer in ART-conceived versus naturally conceived individuals was 1.25 (95% CI: 0.73–2.13). Slightly but
non-significantly increased risks were observed in children conceived by ICSI or cryopreservation (HR = 1.52, 95% CI: 0.81–2.85; 1.80, 95%
CI: 0.65–4.95, respectively). Risks of lymphoblastic leukemia (HR = 2.44, 95% CI: 0.81–7.37) and melanoma (HR = 1.86, 95% CI: 0