Assisted reproduction

Almost all males with CF are azoospermic due to congenital absence of the vas deferens with resultant obstruction however, conception still occurs occasionally. Conception can also occur through application of assisted reproductive technologies.9... 

Gonadotrophins are also used in assisted reproduction procedures. Here the aim is to administer therapeutic doses of FSH that exceed individual follicular FSH threshold requirements, thus stimulating multiple follicular growth. This, in turn, facilitates harvest of multiple eggs, which are then available for in vitro fertilization. This technique is often employed when a woman has a blocked fallopian tube or some other impediment to normal fertilization of the egg by a sperm cell. After treatment, the resultant eggs are collected, incubated in vitro with her partner s sperm, incubated in culture media until the embryonic blastocyst is formed, and then implanted into the mother s uterus. 

Ovitrelle (rhCG) Serono Used in selected assisted reproductive techniques... 

Ovitrelle (tradename in EU, sold as Ovidrel in the USA and also known as choriogonadotropin alfa) is a recombinant hCG approved for general medical use in the EU and USA in 2001. It is indicated for the treatment of female infertility due to anovulation and for patients undergoing assisted reproductive technology. It is used to trigger final follicle maturation and luteinization after follicle stimulation. 

Baker, E. R., Best, R. G., Manfredi, R. L., Demers, L. M., and Wolf, G. C. 1995. Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome. Journal of Assisted Reproduction and Genetics 12 205-209. 

Progesterone capsules and gel Progesterone supplementation or replacement as part of an Assisted Reproductive Technology (ART) treatment for infertile women with progesterone deficiency (8% gel). 

Hampton, T. (2004) Panel reviews health effects data for assisted reproductive technologies. The Journal of the American Medical Association, 292 (24), 2961-2962. 

Santbrink EJPV, Fauser BCJM. Is there a future for ovulation induction in the current era of assisted reproduction. Hum Reprod 2003 18(3) 2499-502. 

B. Indications and nse Follistim is indicated for the development of multiple follicles in ovulatory patients participating in an assisted reproductive technology program. It is also indicated for the induction of ovulation and pregnancy in anovulatory infertile patients in whom the cause of infertility is functional and not due to primary ovarian failure. 

Recommended dosage and monitoring requirements According to Micromedex, the usual starting dose of Follistim is 150 to 225 lU per day injected intramuscularly or subcutaneously, adjusted accordingly on an individual basis. The initial dose of 75 lU per day for 7 to 14 days is employed in anovulatory women who have not responded to clomiphene citrate treatment. The initial dose of 150 lU per day, followed by a maintenance dose of 75 to 375 lU per day for 6 to 12 days, is employed for controlled ovarian hyperstimulation followed by assisted reproduction. 

FSH, LH, and hCG are commercially available in several forms. They are used in states of infertility to stimulate spermatogenesis in men and to induce ovulation in women. Their most common clinical use is for the controlled ovulation hyperstimulation that is the cornerstone of assisted reproductive technologies such as in vitro fertilization (IVF, see below). 

Frydman R, Howies CM, Truong F. A double-blind, randomized study to compare recombinant human follicle stimulating hormone (FSH Gonal-F) with highly purified urinary FSH (Metrodin) HP) in women undergoing assisted reproductive techniques including intracytoplasmic sperm injection. The French Multicentre Trialists. Hum Reprod 2000 15(3) 520-5. 

Chang P, Kenley S, Burns T, Denton G, Currie K, DeVane G, O Dea L. Recombinant human chorionic gonadotropin (rhCG) in assisted reproductive technology results of a clinical trial comparing two doses of rhCG (Ovidrel) to urinary hCG (Profasi) for induction of final follicular maturation in in vitro fertilization-embryo transfer. Fertil Steril 2001 76(l) 67-74. 

Ludwig M, Katalinic A, Diedrich K. Use of GnRH antagonists in ovarian stimulation for assisted reproductive technologies compared to the long protocol. Meta-analysis. Arch Gynecol Obstet 2001 265(4) 175-82. 

Felberbaum RE, Albano C, Ludwig M, Riethmuller-Winzen H, Grigat M, Devroey P, Diedrich K. Ovarian stimulation for assisted reproduction with HMG and concomitant midcycle administration of the GnRH antagonist cetrorelix according to the multiple dose protocol a prospective uncontrolled phase III study. Hum Reprod 2000 15(5) 1015-20. 

Tomlinson, M. (2008) Risk management in cryopreservation associated with assisted reproduction. Cryo Lett 29, 165-174. 

Byers, S. L., Payson, S. J. and Taft, R. A. (2006) Performance of ten inbred mouse strains following assisted reproductive technologies (ARTs). Theriogenology 65, 1716-1726. 

Dos Reis R (1999) Familial risk among patients with endometriosis. Journal of Assisted Reproduction and Genetics 16 500-503. 

After the age of 35 in women, fecundity decreases sharply. Delaying childbearing until the age of 35 or beyond is therefore one of the major reasons why in the last decade attention has been drawn to the decline in fertility in older women (Gl, S8, S26, V2). The number of couples seeking help for infertility problems after their 30s and even 40s is increasing (P6). People of advancing age are destined to end up in a sort of age trap of declining fecundity and therefore the need for more time to conceive on the one hand and, on the other hand, less time available to conceive because of declining fecundity. The older the people are who need infertility treatment, the more they will feel the pressure to conceive within a short period of time (P7) the demand for assisted reproduction techniques, such as intrauterine insemination (IUI) after ovarian hyperstimulation or in-vitro fertilization (IVF) and embryo transfer, will therefore increase. 

With the use of assisted reproductive techniques, the need to assess the chance of success of the treatment has increased (SI8). Determining the chance of success serves two goals first, it can help the couple realize that assisted reproduction can in no way guarantee offspring and that a realistic approach toward infertility therapy means accepting the chance of failure. Second, it can lighten the burden of waiting 2 weeks between oocyte retrieval and embryo transfer in an IVF treatment. 

The chance of a spontaneous conception as well as the prognosis of infertility therapy can only be determined when there is some knowledge about the remaining capacity for reproduction (S8). Measuring ovarian reserve is the cornerstone of most tests designed to predict the success of infertility therapy. In Fig. 1, a representation of the hypothalamic-pituitary-ovarian axis is shown. However, there are more factors determining the chance of success in assisted reproduction. The... 

Some studies find a higher total number of ampoules of FSH administered before oocyte retrieval in patients with elevated FSH levels (SI9), but others do not (Cl, El, H16, S10). When the influence of age and FSH is compared, FSH is a better predictor for response in assisted reproduction than age (Cl, G8, T5), although this is not the case for predicting pregnancy in all studies (HI, S19). 

In no other study is basal LH related to treatment outcome in assisted reproduction, neither to ovarian response nor to pregnancy rates (Cl, El, H16, S10). It is claimed that this could be caused by the pulsatile excretion of LH compared with its short half-life, giving a misleading estimation of basal LH level when measured only once in serum (S10). Also, in modern treatment protocols using pituitary desensitization, elevated LH levels during the treatment cycle will not occur often. Thereby, the relation between LH and poor treatment oucome will be lost. 

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