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Query: UMLS:C0021359 (infertility)
 26,075 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among 599 trials of in-vitro fertilization (IVF) treatment, complicated ovarian hyperstimulation (OHSS) was diagnosed in 14 cases (2.5%) on the basis of heavy abdominal discomfort and echographic findings (ascites, ovarian enlargement with cysts). Among eight hospitalized patients, four presented with a haemoconcentration and/or electrolytic disturbances. OHSS cases were compared with two control groups for a series of criteria: age, aetiology of infertility, total dose of human menopausal gonadotrophin (HMG), day of oocyte collection, oestradiol (E2) peak level, rate of E2 increase, number of oocytes, number of embryos transferred and embryonic vitality scores. Comparison with a random group of normal IVF trials showed a significant difference for the following parameters: E2 peak level and rate of increase, E2/dose of HMG, E2/day of egg collection and number of oocytes. When OHSS cases were compared to another control group consisting only of high E2 responders (peak E2 greater than 2700 pg/ml), no significant difference was found for any of the above-mentioned criteria. In view of this lack of predictive power of individual criteria, stepwise discriminant analysis was applied, showing that this method might provide a predictive mathematical function for evaluating the risk of OHSS before human chorionic gonadotrophin (HCG) administration. Such a formula, however, should be validated by a multicentric study in which a greater number of OHSS cases would be tested.
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PMID:Are there predictive criteria of complicated ovarian hyperstimulation in IVF? 176 66

Ovarian hyperstimulation syndrome (OHSS) is a potentially fatal condition associated with the therapeutic induction of ovulation in infertility. Liver function abnormality has been previously reported in four patients, one of whom had ultrastructural abnormalities on liver biopsy. This paper describes a patient presenting with severe OHSS 16 days after ovulation had been induced. Liver function abnormality was apparent 11 days later, with a sustained rise in alkaline phosphatase and aspartate aminotransferase (AST) which lasted up to 2 months. A liver biopsy performed during the second month of her protracted hospital admission showed marked zonal fatty change (acinar zone 1) and associated inflammation, with mitochondrial crystalline inclusions and rough endoplasmic reticulum dilatation on electron microscopy. This report discusses the clinical features and possible aetiological factors.
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PMID:Liver abnormality in ovarian hyperstimulation syndrome. 198 4

Anovulatory infertility in 134 women was treated with gonadotropins for a total of 318 cycles. The patients were classified into WHO group I, hypothalamic-pituitary failure (72 patients), and WHO group II, hypothalamic-pituitary dysfunction (62 patients). All patients in this group had failed to achieve pregnancy with clomiphene citrate therapy in repeated cycles. The pregnancy rate in group I was 72.2% vs 17.7% in group II. The 'take home' baby rate was 57.1% in group I vs 13.1% in group II. The rate of miscarriages was 14.3% without any significant difference between the groups. Multiple pregnancies occurred only in group I patients (19.2%). The conception rate was highest in the first four cycles, whereas no patient became pregnant after the sixth treatment cycle. Ovarian hyperstimulation syndrome occurred most frequently in group II patients, however, overall only 2.2% of the patients needed hospitalization because of hyperstimulation. Gonadotropin therapy must be considered an efficient and successful treatment of infertility in patients with hypothalamic-pituitary failure, whereas the success rate is rather poor in patients with hypothalamic-pituitary dysfunction.
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PMID:Gonadotropin therapy of female infertility. 249 28

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction. It is most often associated with the administration of human menopausal gonadotropins (hMG) or purified preparation of follicle stimulating hormone (FSH), but has also been reported after clomiphene (CC) and in patients with hydatiform mole and chorioepithelioma. Moreover, OHSS has been observed in cases of multiple pregnancy unrelated to the use of fertility drugs. In recent years, the hormonal induction of ovulation has been practised to an increasing degree, partly due to the extended use in vitro fertilization (IVF) and gamete intra fallopian transfer (GIFT) techniques in the treatment of infertility. This trend will undoubtedly result in a growing number of patients with OHSS: For this reason, it is important to elucidate the pathophysiological mechanisms responsible for trigging this condition and discuss the treatment possibilities once it has arisen. We will present three patients who developed OHSS after different attempts at ovulation induction. Interestingly, aspiration of the follicles, which was carried out in two of the cases, did not influence the progress of the condition.
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PMID:Severe ovarian hyperstimulation syndrome. Case reports. 314 50

The effects of HMG (Humegon)-HCG therapy in 6096 cycles in 2166 Japanese women with anovulatory infertility were examined. The rates of ovulation, pregnancy, the ovarian hyperstimulation syndrome, multiple pregnancy, abortion, and malformations in the newborn were recorded, and the possible factors of multiple pregnancies were analyzed. Ovulation occurred in 73.2% of the cases and 64.5% of the treatment cycles. Pregnancy occurred in 23.0% of the cases and 8.6% of the cycles. Ovarian hyperstimulation syndrome with grade I of WHO definition or more was observed in 10.3% of the cases and 5.3% of the cycles. The incidence of the ovarian hyperstimulation syndrome was high in amenorrheic patients, who respond to progestin with bleeding. The multiple pregnancy rate was 20.5%, of which 13.0% was twins and 7.5% triplets or more. The abortion rate was 22.0%, and the abortion rate in multiple pregnancy was significantly higher (P less than 0.05) than that in singleton pregnancy. The external malformation rate was 1.68% in the 594 newborn who could be examined. No significant differences were found in maternal factors, the treatment schedule, or the ovarian response to treatment in singleton and multiple pregnancy groups. This survey revealed that the efficacy and the incidence of adverse effects of Humegon-HCG therapy in a large number of Japanese women were not different from those in Caucasians except for a lower rate of multiple pregnancy, and no special causative factors for multiple pregnancy were found.
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PMID:Results of HMG (Humegon)-HCG therapy in 6096 treatment cycles of 2166 Japanese women with anovulatory infertility. 392 90

Ovarian hyperstimulation syndrome is well recognized clinically, usually in association with drug therapy for infertility. The ultrasonic appearance of the ovarian cystic enlargment in ten patients with the findings on follow-up in six patients is described. The role of ultrasound in this condition is shown to be in diagnosis, for staging, and follow-up.
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PMID:Ultrasound in the ovarian hyperstimulation syndrome. 679 6

The ovarian hyperstimulation syndrome is the most important iatrogenic complication of ovarian stimulation. Every drug used in the treatment of infertility such as FSH, HMG, CC, GnRHa, can lead to the syndrome. The authors of the article report the incidence of OHSS in their patients treated for an assisted conception program; the role of oestrogens, HCG and renin-angiotensin system; the classification, the therapy and how to prevent the syndrome.
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PMID:[The ovarian hyperstimulation syndrome]. 801 99

Based on data suggesting that higher serum LH levels during the follicular phase may decrease subsequent pregnancy rates and increase spontaneous abortion rates, the study presented herein was designed to compare the pregnancy and abortion rates in patients treated with gonadotrophin preparations with and without LH content. Infertile patients with luteal phase defects related to releasing eggs prior to complete follicular maturation were randomized into two treatment arcs: ultra-low-dose (75IU) human menopausal gonadotrophin (hMG) versus pure FSH. However, they were given the right to refuse the recommended treatment and use the other one if they preferred. Pregnancy and spontaneous abortion rates were determined for first cycle of therapy. The pregnancy rates for hMG versus pure FSH was 22.7 percent and 20.3 percent, respectively. The spontaneous abortion rates were also similar (8 percent and 9.1 percent). There were no multiple births resulting from these 36 pregnancies. Ovarian hyperstimulation syndrome was not observed in any of the 164 stimulation cycles. These data demonstrate that the use of an ultra-low-dose gonadotrophin stimulation regimen is an effective method of correcting infertility related to luteal phase defects related to follicular maturation defects since the overall pregnancy rate per first cycle of treatment was 22 percent despite a minimum of 10 months of infertility duration. Furthermore, an ultra-low-dose gonadotrophin regimen is safe for treating luteal phase defects in that there was no ovarian hyperstimulation or multiple births demonstrated. These results also show no advantage of choosing a preparation devoid of LH, thus giving the patient the opportunity to purchase the least expensive medication that is available.
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PMID:Low-dose gonadotrophin stimulation for luteal phase defects--does absence of LH help pregnancy rates? 863 12

Ovarian hyperstimulation syndrome is a recognized complication of ovulation induction. Abnormalities in liver function have been considered to be a rare manifestation of the severe form of ovarian hyperstimulation syndrome (OHSS). A 28 year old woman with primary infertility underwent ovulation induction and intrauterine insemination. She was diagnosed with moderate OHSS and was followed as an outpatient. Early in her course of treatment she complained of upper right quadrant pain. Her work-up included an upper right quadrant ultrasound which showed only moderate ascites. Liver function tests at that time were elevated in a hepatocellular damage pattern. Liver function test elevations, as well as the ovarian hyperstimulation, resolved spontaneously in 10 days. Transient abnormalities in liver function do not appear to be limited to the most sever forms of OHSS.
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PMID:Elevated liver function tests in a case of moderate ovarian hyperstimulation syndrome. 867 Dec 72

In the last decade the potential importance of intraovarian regulators of follicular development has been recognized, and the effects of various growth factors on granulosa cell responses to gonadotropins have been extensively investigated. Ovarian responses to exogenous gonadotropins were improved by adjuvant growth hormone (GH) treatment of GH-deficient patients, and responses to hMG were apparently predicted by estimated GH reserve. However, the results of different studies of GH/hMG cotreatment were equivocal. Therefore, a randomized, prospective, cross-over study protocol between GH/hMG/hCG versus hMG/hCG was undertaken. Whereas 18 pregnancies were achieved in the 32 clonidine negative patients (56%) either in the GH/hMG cycle (13) or in the succeeding one (5), no benefit was detected in 10 clonidine positive patients from the GH/hMG combination. The recently described GH-binding protein (BP) may reflect the GH-receptor. GH-BP levels were evaluated in the sera and follicular fluids (FF) of patients undergoing ovulation induction with either hMG/hCG or GH/hMG/hCG. GH-BP increase in serum correlated with E2 and progesterone (P4) concentrations. The FF GH-BP correlated with serum GH-BP levels and was dose-dependent, highly specific, of high affinity, and low capacity. Lower FF GH-BP levels were measured in older compared to younger women, while increased values were obtained both in patients with elevated E2 concentrations in serum and in FF, and when more than 5 oocytes were retrieved. Longitudinal measurements of GH-BP levels showed an initial sharp increase during early gestation, followed by a gradual decrease from the 2nd trimester to term. The late gestational decrease in GH-BP levels may be attributed to the decreasing hCG concentrations, and/or to the increasing secretions of placental lactogen and GH with advancing gestation. Primary increased GH-BP in unexplained infertility may suggest a new mechanism whereby excessive GH-BP levels may prevent GH from binding to its receptor and thus decrease intraovarian IGF-1 production. Whereas GH-BP significantly increased in correlation with moderately (300-1500 pg/ml, 1100-5500 pmol/l), or with severely increased (> 1500 pg/ml, > 5500 pmol/l) E2 concentrations, the serum IGF-1 levels increased with moderately elevated but decreased at severely increased E2 concentrations, as measured in ovarian hyperstimulation (OHSS). This observation may suggest IGF-1's involvement in a mechanism by which OHSS is detrimental to early conception. The clonidine test may identify patients who may benefit from this combination, during the GH/hMG cycle and possibly also during the succeeding cycle.
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PMID:The role of growth hormone (GH), GH-receptor and GH-binding protein in reproduction and ovulation induction. 888 37


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