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Fulltext GnRH agonist and GnRH antagonist in intracytoplasmic injection cycles

Rashid MR, Ong FB, Omar MH, Ng SP, Nurshaireen A, Sharifah-Teh NS, et al.

Med J Malaysia, 2008 Jun;63(2):113-7.
PMID: 18942295 MyJurnal

The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.

Matched MeSH terms: Ovulation Induction/methods*
Fulltext Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol

Noorashikin M, Ong FB, Omar MH, Zainul-Rashid MR, Murad AZ, Shamsir A, et al.

J Assist Reprod Genet, 2008 Jul;25(7):297-303.
PMID: 18654847 DOI: 10.1007/s10815-008-9239-9

Low dose stimulation (LS) is emerging as an alternative regime in assisted reproductive technology (ART). This study aimed to compare the cost-effectiveness of LS to the high dose GnRH antagonist (Atg) regime.

Matched MeSH terms: Ovulation Induction/methods*
Fulltext Comparison of luteal phase ovulation induction and ultra-short gonadotropin-releasing hormone agonist protocols in older patients undergoing in vitro fertilization

Wang T, Sun Z, Lim JP, Yu Y

Libyan J Med, 2019 Dec;14(1):1597327.
PMID: 30935302 DOI: 10.1080/19932820.2019.1597327

Many undergoing in vitro fertilization-embryo transfer (IVF-ET) procedures treatments have been tried for older infertile patients, but still can not reverse the aging effect on oocyte, and infertility treatment is expensive, even for people in developed countries. The study aimed to compare outcomes following the application of luteal phase ovulation induction (LPOI) and ultra-short gonadotropin-releasing hormone agonist (GnRH-a) protocols in patients aged more than 40 years undergoing IVF-ET and to examine the effectiveness and feasibility of LPOI. A total of 266 IVF-ET cycles in 155 patients aged 40 years and over were retrospectively analyzed. Of these patients, 105 underwent the ultra-short GnRH-a protocol (GnRH-a group) and 50 underwent LPOI (LPOI group). Various clinical outcomes were compared between these two groups using either t-tests or the chi-square test. The study showed patients in the LPOI group required a higher dosage of human menopausal gonadotropin and a lower dosage of recombinant follicle stimulating hormone than those in the GnRH-a group. Furthermore, though the total dosage of gonadotropin was higher in the LPOI, its cost was lower. Finally, fertilization rates were higher and high-quality embryo rates were lower in the LPOI group, and the live birth rate of LPOI group is higher than (GnRH-a group) . These between-group differences were all significant (P

Matched MeSH terms: Ovulation Induction/methods*
Fulltext The empty follicle syndrome

Ng SP, Jamil MA, Nurshaireen A, Zainul MR

Med J Malaysia, 2006 Oct;61(4):499-500.
PMID: 17243533 MyJurnal

The empty follicle syndrome (EFS) is a rare complication of in vitro fertilization (IVF) treatment, leading to cycle cancellation. Low human chorionic gonadotropin (hCG) bioavailability and ovarian dysfunction have been implicated with this condition. This case report illustrates a typical case of EFS and several strategies suggested to overcome this problem.

Matched MeSH terms: Ovulation Induction/methods
Fulltext Assessing the status of intrauterine insemination before forming a medically assisted conception unit

Omar MH, Ong FB, Adeeb NN, Sharif JM, Nasri N, Yassin MJ

Med J Malaysia, 1999 Mar;54(1):65-71.
PMID: 10972007

A survey in 1996 of our female patients suggest that the three commonest causes of infertility were endometriosis, anovulation and idiopathic which comprises of about 70% of all the patients. In the male patients, sperm morphology evaluation by critical criteria showed that abnormal morphology was present in 71% while 87% of all the semen analysis were abnormal. The objective of this study was to assess the status of IUI before proceeding to formulate patient protocols for IVF in a tertiary infertility referral unit. A retrospective study of patients data was done from Jan 1995 to Dec 1996. Ovarian stimulation by clomiphene for anovulatory and idiopathic patients was performed on couples with at least one patent fallopian tube. Ovulation induction was by an intramuscular injection of 5000 i.u of HCG after follicular maturation. IUI was performed approximately 36-40 hours later. A total of 74 couples received 114 treatment cycles producing a total of 9 conceptions. The conception rate of IUI was therefore 7.89% per cycle and 12.16% per couple with the cumulative pregnancy rate of 28.21%. Associated success features of IUI found in this study were the age of the woman and the semen parameters of the husband.

Matched MeSH terms: Ovulation Induction/methods
Maternal thyroid function in women undergoing controlled ovarian hyperstimulation during in-vitro fertilization and its relation to reproductive outcome

Abdul Karim AK, Azrai Abu M, Chelliah B, Mohd Razi ZR, Omar MH, Othman H, et al.

Minerva Ginecol, 2017 Oct;69(5):431-437.
PMID: 28447444 DOI: 10.23736/S0026-4784.17.04069-2

BACKGROUND: We conducted a study to evaluate the changes in thyroid function during controlled ovarian hyperstimulation (COH) and its association with the outcome of assisted reproductive technique (ART).
METHODS: This is a prospective cohort study done in University Hospital Fertility Clinic for one year duration. A total of 88 euthyroid women who underwent COH as part of planned in-vitro fertilization (IVF) were invited to participate in this study. Serum thyroid function of each women will be monitored before stimulation (T1), day 10-13 of cycle (T2), during oocyte retrieval (T3), one week following embryo transfer (T4), and at four weeks after embryo transfer (T5). Reproductive outcome of IVF will be observed and documented.
RESULTS: Nine women had ongoing singleton pregnancy, seven suffered from miscarriage, while the rest had implantation failure. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) increased throughout stimulation, peaking at 32-36 hours after hCG administration compared to baseline (1.250 vs. 1.740 mIU/L and 13.94 vs. 15.25 pmol/L). It remains elevated until one week following embryo transfer. The increment of serum TSH exceeded the upper limit, acceptable for first trimester (<1.60 mIU/L). However, the evolution of serum TSH and fT4 did not significantly differ with pregnancy outcome.
CONCLUSIONS: In euthyroid women, thyroid function changed significantly during COH, but these changes were not different between the three reproductive outcomes. Thus, we do not suggest continuous thyroid function monitoring during COH.

Matched MeSH terms: Ovulation Induction/methods*
Fulltext Inhibition of progesterone secretion by oestradiol administered in the luteal phase of assisted conception cycles

Tay PYS, Lenton EA

Med J Malaysia, 2003 Jun;58(2):187-95.
PMID: 14569738

A prospective randomised study was done to assess the effect of supplemental oestradiol in addition to progesterone on the luteal steroid profiles and pregnancy outcome in stimulated cycles with and without pituitary down regulation. Women undergoing stimulated cycle IVF with GnRH-a and FSH (Group A, n = 63) or stimulated intrauterine insemination using CC and FSH (Group B, n = 55) were studied. These subjects were randomly allocated to receive either 400 mg daily of vaginally administrated Cyclogest (progesterone) alone or in combination with 2 mg daily of oral Oestradiol Valerate (E2V) during the luteal phase. Significant lower concentrations of plasma progesterone were observed in those subjects supplemented with both E2V and progesterone compared to those in whom progesterone only was given during the luteal phase (P < 0.05). Exogenous E2V had a minimal impact on plasma oestradiol concentrations and did not disguise the characterised mid luteal decline in oestradiol secretion. The suppressive effect of E2V on plasma progesterone was lost if implantation occurred normally because any small change in steroid concentrations was reversed by the rapidly increasing concentrations of HCG. Similar pregnancy rates were observed among subjects supplemented with or without oestradiol. The addition of oestradiol to the luteal supplement suppresses endogenous corpus luteum progesterone secretion irrespective of the type of assisted conception cycle and that its use is unlikely to be beneficial to the process of implantation.

Matched MeSH terms: Ovulation Induction/methods*
Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction, achievement of pregnancy, and live birth in Asian women with polycystic ovary syndrome: a randomized controlled trial

Zain MM, Jamaluddin R, Ibrahim A, Norman RJ

Fertil Steril, 2009 Feb;91(2):514-21.
PMID: 18321486 DOI: 10.1016/j.fertnstert.2007.12.002

To determine the first-line medication to be used in anovulatory patients with polycystic ovary syndrome (PCOS) for ovulation induction and pregnancy achievement.

Matched MeSH terms: Ovulation Induction/methods*