Management of ovulation induction and intrauterine insemination in infertile patients with hypogonadotropic hypogonadism

2019 ◽  
Vol 48 (10) ◽  
pp. 833-838 ◽  
Author(s):  
Kiyak Huseyin ◽  
Bulut Berk ◽  
Karacan Tolga ◽  
Ozyurek Eser ◽  
Gedikbasi Ali ◽  
...  
Keyword(s):  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Hypogonadotropic Hypogonadism ◽  
Infertile Patients

Infertility Treatment: Ovulation Induction and Insemination

2018 ◽  
Author(s):  
Quinton Katler ◽  
Jessica R Zolton ◽  
Alan H. DeCherney
Keyword(s):  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Intrauterine Insemination ◽  
Semen Analysis ◽  
Clomiphene Citrate ◽  
Hypogonadotropic Hypogonadism ◽  
Unexplained Infertility ◽  
Male Factor ◽  
Ovarian Syndrome

For the majority of infertility patients, ovulation induction is the initial therapy. Treatment is individualized for a couple based on ovarian reserve testing, semen analysis, and the presence of anatomic pathology. Candidates for ovulation induction include those who are anovulatory and couples with unexplained infertility. The majority of patients diagnosed with anovulation have polycystic ovarian syndrome. Treatment options include clomiphene citrate and letrozole. For patients with hypogonadotropic hypogonadism, treatment involves injections with gonadotropins. Treatment is typically combined with intrauterine insemination to maximize pregnancy rates, especially in patients with male factor infertility or unexplained infertility. A stepwise approach is necessary, as patients who are unsuccessful with less invasive and costly treatments may eventually require in vitro fertilization. This review contains 7 figures, 3 tables and 57 references Key Words: clomiphene citrate, gonadotropins, infertility, intrauterine insemination, letrozole, ovulation induction, polycystic ovarian syndrome, unexplained infertility

scholarly journals The effect of local endometrial injury on the success of intrauterine insemination

2021 ◽  
Vol 38 (4) ◽  
pp. 521-524
Author(s):  
Gazi YILDIZ ◽  
Didar KURT ◽  
Emre MAT ◽  
Pınar YILDIZ
Keyword(s):  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Study Group ◽  
Randomized Controlled ◽  
Endometrial Injury ◽  
Significant Difference ◽  
Infertile Patients

To determine the effect of local endometrial injury on implantation success in patients diagnosed with unexplained infertility and undergoing intrauterine insemination (IUI) after ovulation induction with gonadotropins. In this prospective randomized controlled trial, 82 infertile patients underwent IUI following ovulation induction with gonadotropin. In the study group (n:40), local endometrial injury (stratch) was performed to the posterior side of the endometrial cavity with a biopsy catheter between the 21-26th days of luteal phase of the cycle preceding ovarian stimulation. There was no statistically significant difference between the study and the control groups in terms of age of female, age of male, duration of infertility, BMI, serum FSH and LH levels, mean dose of gonadotropin and mean duration of ovulation induction (p>0.05). Clinical pregnancy was achieved in two patients (4.76%) in control group and four (10%) patients in the study group, with no significant difference between groups (p=0.18). All pregnancies achieved in the control and the study groups passed 12th gestational weeks and continued. Ectopic pregnancy, multiple pregnancy and abortion was not observed in any patient in both groups. In the study group, pain level immediately after endometrial biopsy procedure was evaluated with visual analog scale (VAS) and it was established that only one (2.5%) patient experienced severe pain after the procedure. Although local endometrial damage in the menstural period before ovulation induction and IUI cycle increases clinical pregnancy rates in the infertile patients, this increase is not statistically significant. Multi-center randomized controlled studies are needed for local endometrial damage to be recommended routinely in clinical practice.

scholarly journals Ovulation Induction and Intrauterine Insemination for Hypogonadotropic Hypogonadism

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Siwatch S ◽  
◽  
Suri V ◽  
Dhaliwal LK ◽  
Gainder S ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Hypogonadotropic Hypogonadism ◽  
Pregnancy Rates ◽  
Low Resource Settings ◽  
Low Resource ◽  
Reproductive Techniques ◽  
Anovulatory Infertility ◽  
Art Techniques

Hypogonadotropic Hypogonadism (HH) is a rare gynae- endocrinological cause of anovulatory infertility. Gonadotropins are given to induce ovulation. Various ART techniques have been used for assisting conception in these women. In this study, we aimed to calculate the chances of success of ovulation and pregnancy rates after ovulation induction and intrauterine seminal insemination in HH women. We reviewed and analyzed the chances of success of ovulation and conception with ovulation induction and intrauterine seminal insemination in thirty two couples who underwent 56 intrauterine insemination cycles. The average age of these women was 27.2+/- 3.2 years. Ovulation was documented in 55/56 cycles. An average of 12.89+/-5.05 days of stimulation was required to induce ovulation. The pregnancy rate was 50%. Thus, intrauterine insemination offers a cheaper yet good alternate option of reproductive techniques in addition to ovulation induction with gonadotropins, in hypogonadotropic hypogonadism, especially in the low resource settings.

Optimal timing for intrauterine insemination (IUI) after administering HCG in ovulation induction IUI cycles

2016 ◽  
Vol 106 (3) ◽  
pp. e305-e306
Author(s):  
B.S. Hurst ◽  
K. Merriam ◽  
P. Marshburn ◽  
M. Matthews ◽  
R.S. Usadi
Keyword(s):  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Optimal Timing

scholarly journals Efficacy of letrozole versus clomiphene citrate for infertile women with polycystic ovary syndrome

2021 ◽  
Vol 10 (8) ◽  
pp. 2944
Author(s):  
Sinan S. Ay ◽  
Özer Birge ◽  
Mehmet S. Bakır ◽  
Ayşe E. Yumru
Keyword(s):  
Aromatase Inhibitor ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Ovary Syndrome ◽  
Infertile Women ◽  
Appropriate Treatment ◽  
The Mean ◽  
Infertility Patients ◽  
Infertile Patients

Background: The aim was to compare ovulation induction protocols in anovulatory patients, who make up a significant percentage of infertility patients, and to determine the most appropriate treatment for patients in the clinic based on the findings.Methods: The effectiveness of clomiphene citrate (CC) and letrozole (aromatase inhibitor) in ovulation induction treatments were retrospectively compared in patients who applied for infertility in the last 5 years and were found to be anovulatory. 20 of these patients were being treated with clomiphene citrate, while the 18 were being treated with letrozole.Results: The study included a total of 38 anovulatory infertile patients. The mean age of the patients was found to be 29.3. When the endometrial thicknesses (ET) after the treatment were compared, the first group's mean EC was 6.1, while that of the second group was 9.05. The endometrial thicknesses measured after the treatments were found to be significantly different, which were consistent with other studies in the literature. Post-treatment ovulation responses were similar with 55% in both groups. In the evaluation of pregnancy outcomes, 20% of pregnancy was achieved in the first group and 33% in the second group.Conclusions: The use of letrozole, an aromatase inhibitor, may be suggested as an alternative to CC in the ovulation induction protocol in our clinical practice, particularly in obese patients.

scholarly journals Discovery and Preclinical Development of Orally Active Small Molecules that Exhibit Highly Selective Follicle Stimulating Hormone Receptor Agonism

2021 ◽  
Vol 11 ◽  
Author(s):  
Selva Nataraja ◽  
Henry Yu ◽  
Joie Guner ◽  
Stephen Palmer
Keyword(s):  
Ovarian Stimulation ◽  
Hormone Receptor ◽  
Ovulation Induction ◽  
Low Dose ◽  
Intrauterine Insemination ◽  
Follicle Stimulating Hormone ◽  
Controlled Ovarian Stimulation ◽  
Orally Active ◽  
Stimulating Hormone

An orally active follicle stimulating hormone receptor allosteric agonist would provide a preferred treatment for over 16 million infertile women of reproductive age in low complexity methods (ovulation induction-intrauterine insemination) or in high complexity methods (controlled ovarian stimulation-in vitro fertilization). We present two oral follicle stimulating hormone receptor allosteric agonist compounds that have the desired pharmacology, drug metabolism, pharmacokinetics, and safety profile for clinical use. These molecules provide a single agent suitable for ovulation induction-intrauterine insemination or controlled ovarian stimulation-in vitro fertilization that is more convenient for patients and achieves similar preclinical efficacy as rec-hFSH. TOP5668, TOP5300 were evaluated in vitro in Chinese hamster ovary cells transfected with individual glycoprotein receptors measuring cAMP (FSHR, LH/CGR, thyroid stimulating hormone receptor). TOP5668 was found to have solely follicle stimulating hormone receptor allosteric agonist activity while TOP5300 was found to have mixed follicle stimulating hormone receptor allosteric agonist and LHR-AA activity. Both compounds stimulated concentration-dependent increases in estradiol production from cultured rat granulosa cells in the presence or absence of low dose rec-hFSH, while only TOP5300 stimulated testosterone production from rat primary Leydig cells. In pooled human granulosa cells obtained from patients undergoing controlled ovarian stimulation-in vitro fertilization, TOP5300 stimulated 7-fold greater maximal estradiol response than rec-hFSH and TOP5668 was 10-fold more potent than TOP5300. Both TOP5300 and TOP5668 stimulated follicular development in immature rat to the same efficacy as recombinant follicle stimulating hormone. In mice treated with TOP5300, in the presence of low dose of follicle stimulating hormone, there were no differences in oocyte number, fertilization rate, and hatched blastocyst rate in mice with TOP5300 and low dose follicle stimulating hormone vs. reference proteins pregnant mare serum gonadotropin or high dose rec-hFSH. ADME/PK and safety profiles were favorable. In addition, there was no appreciable activity on thyroid hormones by TOP5300 in 14-days toxicological study in rat or dog. The selected lead compound, TOP5300 stimulated a more robust increase in estradiol production from granulosa-lutein cells from women with polycystic ovarian syndrome patient compared to rec-hFSH. Conclusions: Two novel oral FSHR allosteric agonist, TOP5668 and TOP5300, were found to mimic the biological activity of rec hFSH in preclinical studies. Both compounds led to folliculogenesis and superovulation in rat and mice. Specifically, TOP5300 led to a similar number of ovulated oocytes that fertilized and developed into hatched blastocysts in mice when compared to rec-hFSH. The safety profile demonstrated lack of toxicity.

Ovulation Induction for the Woman with Hypogonadotropic Hypogonadism

2020 ◽  
pp. 115-122
Author(s):  
Sezcan Mumusoglu ◽  
Pinar Tokdemir Calis ◽  
Gurkan Bozdag
Keyword(s):  
Ovulation Induction ◽  
Hypogonadotropic Hypogonadism

A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility

2021 ◽  
pp. 246-250
Author(s):  
Stephanie Rothenberg ◽  
Joseph Sanfilippo
Keyword(s):  
Ovulation Induction ◽  
Treatment Approach ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Unexplained Infertility ◽  
Additional Benefit ◽  
Multiple Gestation ◽  
Time To Pregnancy ◽  
Vitro Fertilization

The treatment of unexplained infertility has traditionally been comprised of a stepwise treatment approach, first with ovulation induction combined with intrauterine insemination (IUI) and then with in vitro fertilization (IVF). Ovulation induction is first attempted with clomiphene citrate, and, if unsuccessful, injectable gonadotropins are used. The value of ovulation induction with injectable gonadotropins in couples with unexplained infertility has been questioned, however, given the high risk of multiple gestation and the increasing efficacy of IVF. To address this, the FASTT trial randomized couples with unexplained infertility to a treatment arm that either included or omitted gonadotropin/IUI. They found that an accelerated treatment approach that involved 3 cycles of clomiphene citrate/IUI and then progressed immediately to IVF resulted in a decreased time to pregnancy compared to the group who underwent gonadotropin/IUI for 3 cycles, as well as decreased cost per live birth. Therefore, it was concluded that treatment of couples with unexplained infertility with gonadotropin/IUI was of no additional benefit.

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