Ebook Biennial review of infertility (Vol 3): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Biennial review of infertility (Vol 3): Part 2
Ebook Biennial review of infertility (Vol 3): Part 2
Patient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2troduction to Assisted Reproductive TechnologyThe International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) have defined infertility as a disease of the reproductive system by failure to achieve a clinical pregnancy after at least 12 mon Ebook Biennial review of infertility (Vol 3): Part 2ths of regular unprotected sexual intercourse 11]. Of couples trying to conceive. 85-90 % conceives spontaneously within 12 months with most pregnanciEbook Biennial review of infertility (Vol 3): Part 2
es occurring within the first 6 months |2). Approximately 10-17 % of all couples need specialised fertility care once in their lives [2. 3|.InterventiPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2edures such as intrauterine insemination (IƯI) or in vitro fertilisation (IVF). w here the latter is considered to be the treatment of last resort. 1VF treatment consists of controlled ovarian stimulation to create multifollicular growth (COS), ovum pickup, in vitro fertilisation. embryo selection a Ebook Biennial review of infertility (Vol 3): Part 2nd embryo transfer. Medication used for ovarian stimulation for IVFT.c. van Tilburg. M.D. • F.J.M. Broekmans. M.D.• H.L. Torrance. M.S. • B.c. Fauser.Ebook Biennial review of infertility (Vol 3): Part 2
M.D.. Ph.D.(M) Department of Reproductive Medicine and Gynaecology. University Medical Center Utrecht. Heidelberglaan 1 (X). 3584 ex Utrecht, The NetPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2er Science+Business Media New York 2013has evolved from clomiphene citrate (CC), human menopausal gonadotropins (hMG). purified urinary follicle stimulating hormone (uFSH) to human recombinant FSH (rFSH). Recently, the efficacy and safety of a long-acting rFSH agonist has also been established [4. 5 Ebook Biennial review of infertility (Vol 3): Part 2]. Today, gonadotropins are the principal agents for cos with starting doses vary ing between 100 and 600 IU/ day (6]. Midcycle dose adjustments depenEbook Biennial review of infertility (Vol 3): Part 2
ding on the ovarian response are often performed despite the fact that solid evidence confirming positive effects of these dose adjustments is still lPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2o-treatment to reduce the chance of spontaneous ovulation during cos and human chorionic gonadotropin (hCG) administration before ovum pickup in order to increase the amount of mature oocytes [5]. In current practice, conventional maximal stimulation protocols, using GnRH agonists in a long suppress Ebook Biennial review of infertility (Vol 3): Part 2ion scheme, with high dosages of FSH. are still the standard treatment, based on the view that "more is better”. Mild ovarian stimulation, using the sEbook Biennial review of infertility (Vol 3): Part 2
pontaneous cycle as starting point, has focussed on a more moderate ovarian response. It aims to reduce side effects, complications I including ovariaPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2ohort of follicles sensitive to exogenous FSH. with the objective that in vivo137138T.c. van Tilborg et al.selection will enable more efficient in in vitro identification of the embryos with the best implantation potential.Despite all these developments, the implantation rate per embryo transferred Ebook Biennial review of infertility (Vol 3): Part 2is still disappointing with a maximum implantation rate of approximately 30 % [9]. This low efficiency seems in a large part due to embryo quality perEbook Biennial review of infertility (Vol 3): Part 2
se. However, endometrium receptivity may also contribute, as evidence exists that secretory endometrium development is often disrupted after COS in cPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2us of ovarian stimulation should move away from quantity and become directed at quality. With the cunent limitations in effective embryo selection, even for high-technology chromosome assessment on blastocysts III. 12]. aiming for a number of oocytes that represents the optimal range for the chance Ebook Biennial review of infertility (Vol 3): Part 2of obtaining a live birth seems a best way to go.10.2Ovarian PhysiologyOvarian function in the female adult is both autonomous and directed by the hypEbook Biennial review of infertility (Vol 3): Part 2
othalamic-pituitary axis. The continuous recruitment ofprimordial follicles to develop towards the antral stages and the elimination of the vast majorPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2lerian hormone (AMH) [13. 14]. It is from the small antral stage of follicular development onwards, that pituitary gonadotropin hormones dictate the cyclic follicle recruitment that enables the occurrence of the menstrual cycle (Fig. 10.1) [15].The attainment of FSH sensitivity in antral follicles f Ebook Biennial review of infertility (Vol 3): Part 2rom the 1-2 mm stages onwards results from increasing numbers of membrane receptors on the granulosa cells, up to a follicle diameter of 5 mm only minEbook Biennial review of infertility (Vol 3): Part 2
ute amounts of gonadotropins are sufficient for follicle development [16. 17]. For the development into a dominant pre-ovulatory follicle, exposure toPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2st before ovulation [18].Although the number of follicles that are present in the ovary in the small antral stage (2-5 mm) can amount to 25. only one follicle is selected to become the dominant follicle that will subsequently ovulate. The mechanism underlying this single dominant follicle selection Ebook Biennial review of infertility (Vol 3): Part 2has become known as the threshold/window concept. CorpusHumanI m Ệ >120daya| 71 dayt I14 daysIGOSADOntOMS INDEPENDENTGONADOTROPIN RFSPONsniGONADOTROPIEbook Biennial review of infertility (Vol 3): Part 2
N DEPENDENTFig. 10.1 Schematic representation of life history of ovarian follicles: endowment and maintenance, initial recruitment, ovulation and exhaPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2in FSH concentrations exceeds (he threshold for recruitment of a cohort of follicles for further development. The number of follicles recruited is determined by the time ("window") for which the serum FSH is above the threshold at which recruitment occurs. FSH follicle stimulating hormone (Mackion a Ebook Biennial review of infertility (Vol 3): Part 2nd Fauser [20]. permission requested) [76]luteum demise at the end of the previous menstrual cycle and the resulting decrease in oestradiol (E2) and iEbook Biennial review of infertility (Vol 3): Part 2
nhibin A levels [21.22] will cause FSH levels to rise [23]. By surpassing a threshold [23-25]. the cohort of FSH-sensitive antral follicles will startPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2nhibin B [27] produced by the cohort of developing antral follicles. Decreasing FSH levels provide the occurrence of a window or time period in which the individual follicle FSH threshold can be surpassed [15. 28], The length of the time window and the hierarchy of FSH sensitivity of the various fol Ebook Biennial review of infertility (Vol 3): Part 2licles in the cohort w ill determine the number of follicles that are allowed to begin pre-ovulatory development (dominant follicle growth). In normalEbook Biennial review of infertility (Vol 3): Part 2
physiology. only one or sometimes two follicles will develop and ovulate. Increasing the FSH w indow by exogenous manipulation will therefore allow tPatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2mal ovarian physiology is disrupted by follicular phase exogenous gonadotropin administration. By administering compoundsthat increase the FSH serum concentration, the period in which the FSH threshold is exceeded w ill become extended [311. Although differences may exist in FSH sensitivity w ithin Ebook Biennial review of infertility (Vol 3): Part 2the cohort of follicles, overriding the endogenous FSH pattern by for instance exogenous FSH administration will easily lead to the grow th of severalEbook Biennial review of infertility (Vol 3): Part 2
follicles into dominance 125. 32].10.3.1Ovarian Stimulation AgentsThe first IVF baby was bom after natural cycle IVF [33]. Soon after this ground brePatient-Tailored Approaches to Ovarian Stimulation in ART10Theodora c. van Tilborg, Frank J.M. Broekmans, Helen L. Torrance, and Bart c. Fauser10.1Int Ebook Biennial review of infertility (Vol 3): Part 2 transfer rapidly resulted in higher pregnancy rates after 1VF treatment [34. 35]. In current clinical practice, gonadotropins administered in doses ranging from 100 to 600 IU/day combined with GnRH analogue co-treatment are the principal regimen for cos in IVF [5,6.36,37]. This combination is used Ebook Biennial review of infertility (Vol 3): Part 2because exogenous ovarian stimulation by gonadotropins causes a premature luteinizing hormone (LH) surge in 20-25 % of the stimulation cycles [5]. leaEbook Biennial review of infertility (Vol 3): Part 2
ding to high cancellation rates, untimely ovum pickup planning and lower pregnancy rates. This problem is largely solved by GnRH analogue co-treatmentGọi ngay
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