CANCELLATION OF FRESH EMBRYO TRANSFER: FUTURE PERSPECTIVE

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AL HASANI S.

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Journal: Cell Journal (Yakhteh) Year:2008 | Volume:10 | Issue:SUPPLEMENT 1 Page(s): 11-12

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Title

CANCELLATION OF FRESH EMBRYO TRANSFER: FUTURE PERSPECTIVE

Author(s)

AL HASANI S.

Keywords

OVULATION

VITRIFICATION

Abstract

Ovarian hyperstimulation syndrome (OHSS) and multiple births are the two major complications associated with in vitro fertilization (IVF). The incidence of OHSS has been reported to be as high as 33%, with severe OHSS occurring in 0.5–4% of patients. Generally, OHSS is preceded by multiple follicular developments combined with a high serum estradiol concentration. Luteinization is essential for its development. Since the etiology of OHSS remains unknown and the pathophysiology is poorly understood, it is not surprising that no strategy has yet been shown to completely prevent the occurrence of severe OHSS, short of canceling the cycle. Many preventive methods have been evaluated including early ovarian puncture, glucocorticoids, intravenous albumin, and the prolonged use of gonadotrophin-releasing hormone agonist (GnRHa). No method has consistently demonstrated superiority in prevention of this syndrome. Triggering OVULATION in a Gn- RH-antagonist protocol using gonadotrophin-releasing hormone (GnRH) agonists instead of human chorionic gonadotrophin (HCG) was first introduced by Itskovitz et al (1988,1991), and has been used ever since with excellent results in terms of OHSS prevention.One approach which minimizes HCG exposure without forfeiting oocyte retrieval is the elective cryopreservation of all resulting pre-embryos, subsequently avoiding further HCG exposure during the cycle at risk. Verification of human oocytes and embryos became a more popular alternative to the slow rate freezing method due to reported comparable clinical and laboratory outcomes. In addition to recent publications which have suggested that GnRH agonist trigger may lead to significantly impaired implantation and ongoing pregnancy rates in fres embryo transfer (ET) cycles in normal responders, as well as in high responders.Based on this approach, we adopted a strategy where, final oocyte maturation with GnRH agonist is done, followed by elective nitrification of all two pronucleate (2 PN) oocytes and transfer of embryos in subsequent frozen– thawed embryo transfer cycle(s) (FT-ETs).Materials and Methods: In-vitro fertilization patients (n = 65) enrolled in this prospective study at the IVF University Unit, between December 2004 to August 2007 were identified as being at high risk of OHSS (based on (i) ³20 follicles ³10 mm or E2 ³ 4000 pg/ml at the time of induction of final oocyte maturation, (ii) history of cycle cancellation due to OHSS risk, (iii) the development of severe OHSS in a previous cycle). After Ovarian stimulation with GnRH-antagonist administration, final oocyte maturation was triggered by 0.2 mg triptorelin subcutaneously (s.c). All two pronucleate (2 PN) oocytes were cry preserved by verification, and frozen–thawed ETs (FT-ETs) were performed in programmed cycles using exogenous estrogen and progesterone for endometrial preparation. All patients were given warnings for severe OHSS and were followed carefully for up to two week’s post-retrieval.Results: Sixty five patients were triggered with GnRH agonist, and underwent FT-ETs. To date, 265 vitrified zygotes have been warmed. The post thaw survival rate was 97 % (258/ 265). The mean embryos transferred per cycle were 2.3. The clinical pregnancy rate was 46.2% (30/65) per patient and 27.8 %( 30/108) per thawed cycle. Up to date we have 13 deliveries (3 twin pregnancy) and no cases of moderate or severe OHSS were observed.Conclusion: The GnRH agonist triggering for the final oocyte maturation after GnRH antagonist co-treatment combined with elective vilification of 2 PN reduces the risk of moderate and severe OHSS in high-risk patients undergoing IVF/ICSI without affecting pregnancy rate. We conclude from our study that adequate stimulation in good responders with sufficient zygotes for verification, save the patients from further oocyte pick up.

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APA: Copy

AL HASANI, S.. (2008). CANCELLATION OF FRESH EMBRYO TRANSFER: FUTURE PERSPECTIVE. CELL JOURNAL (YAKHTEH), 10(SUPPLEMENT 1), 11-12. SID. https://sid.ir/paper/544073/en

Vancouver: Copy

AL HASANI S.. CANCELLATION OF FRESH EMBRYO TRANSFER: FUTURE PERSPECTIVE. CELL JOURNAL (YAKHTEH)[Internet]. 2008;10(SUPPLEMENT 1):11-12. Available from: https://sid.ir/paper/544073/en

IEEE: Copy

S. AL HASANI, “CANCELLATION OF FRESH EMBRYO TRANSFER: FUTURE PERSPECTIVE,” CELL JOURNAL (YAKHTEH), vol. 10, no. SUPPLEMENT 1, pp. 11–12, 2008, [Online]. Available: https://sid.ir/paper/544073/en

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