Simplification of assisted reproductive technology ; role of the clinician

Abstract EN

Objective : To assess the value of a single ultrasound scanning for cycle monitoring in IVF / ICSI cycles.

Design : A prospective clinical trial.

Material and Methods : Fifty couples underwent ART cycles during the period May-June 1999.

All patients were treated with GnRH agonists (GnRHa), long luteal phase protocol, which was administered on the 21st day of the cycle preceding, the IVF treatment cycle.

Ovarian stimulation with HMG injection ranging from 150 - 300 IU / day (Humegon ; Organon, Oss, the Netherlands), depending on age and indication for IVF / ICSI, starting the 3rd day of the cycle until the day of HMG injection.

In the study cases, the first US measurement was carried out after 7 days of HMG, and anticipating follicular growth of 1.5 to 2 mm / day, HCG injection and ovum pick up were scheduled provided > 25 % of the follicles have reached an average diameter of 14 mm., while stimulation is continued when necessary for up to 4 days without any additional US measurements.

When findings during the first US measurement did not meet the above-mentioned criteria, a routine follow up US measurement was performed.

In the routine practice, regular folliculometry was performed and human chorionic gonadotrophin (10.000 IU Pregnyl ; Organon) was given when > 50 % of the leading follicles have reached an average diameter 18 to 20mm.

Oocyte pick up was scheduled 34-36 hour's later transvaginally under US guidance.

Oocyte identification, isolation from the follicular aspirates and subsequent laboratory procedures were performed according to what has been described by Huisnan et al., (1992).

E.T.

was done 72 hours after egg collection.

For luteal support cyclogest 200 mg intravaginally twice daily was prescribed for 14 days.

A clinical pregnancy was defined by + ve serum (3-HCG combined with the finding of a gestational sac by US scan 2 weeks later.

Results: In the cases studied, where no patient selection took place, there were no cancellations for impending ovarian hyperstimulation syndrome (OHSS).

There was an obvious reduction in the number of scans, which resulted in 50 % reduction of patient visits to the hospital during the stimulation phase.

60 % of oocyte retrievals could be planned after one US measurements only.

The remaining patients needed an individual approach.

When compared to another group of patients who underwent routine monitoring (fifty couples had previous IVF/ICSI trials, analyzed retrospectively), there was no statistical significant difference in the number of stimulation days, or oocyte yields and clinical pregnancy rate.

Conclusion: A large group of patients need only one US measurement during monitoring of ovarian superstimulation.

Reducing ovarian stimulation monitoring will cause less stress and inconvenience to the patient.

Minimal monitoring gives a useful simplification of the clinical phase of IVF treatment, without adverse effects on treatment outcome and incidence of OHSS.