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Submitted by Dr. Hesham Al-Inany, M.D. Lecturer, Gynaecology
& Obstetrics dept. Kasr El-Aini hospital, Cairo University, Egypt.
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During Gamete Micromanipulation sperms are injected into an ovum to assist in
union of the gametes.
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Ovarian Stimulation
The technical difficulties associated with ovum retrieval in spontaneous
cycles encourages us to evaluate ovarian stimulation for ART . Thus, it
is of major importance to be acquainted with the various protocols of
ovarian stimulation.
Clomiphene citrate C.C
100-150 mg daily for 5 days from the 5th day of the cycle. Starting
from the 3rd day will lead to low response.
HMG/FSH
HMG is given from cycle day 3 and daily follow up by serum estradiol
levels and ultrasonography of the ovaries. The addition of 150 iu of FSH
on day 3 and 4 of the cycle to patients who had previously exhibited poor
estradiol responses resulted in an increase in the number of oocytes retrieved
and improved pregnancy rates (Ron-EL et al,1993).
GnRH agonist
Many authors have suggested the use of GnRHa as a first-line treatment
in all women undergoing ovarian stimulation for ART . The total cost of
ART using GnRHa is higher due to the cost of GnRHa medication and the
larger HMG amount needed for ovarian stimulation. However , the significantly
lower cancellation rate, higher number of follicles achieved made the
combined GnRHa and HMG treatment the most commonly used regimen in ART
programs (Ron -EL et al, 1993).
The GnRHa is administered either in the luteal or early follicular phase
. The administration of HMG is started only when the required suppression
of the pituitary- gonadal axis has been achieved The average length of
this protocol is 25 days up to the HCG administration day (Ron-EL et al,1993).
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Oocyte retrieval
Laparoscopy was the first method used for oocyte retrieval. Although
the ovarian follicles are directly visualized at laparoscopy , it is an
invasive method and not without risk (Ron-EL et al,1993).
Lenz et al (1982) , introduced the ultrasound use for oocyte retrieval
either transvaginal, transuretheral or transvesical route using a special
transducer. Transvaginal oocyte retrieval has become the most popular
all over the world being easy procedure, very short puncturing distance,
untouched urinary bladder and no skin wound, minimal discomfort and is
performed as a day case (Ron-EL et al,1993).
Many centers use prophylactic antibiotic treatment , however, there is
no concessus as to the type of antibiotic, the timing or the duration
of therapy.
The average number of oocytes per successful retrieval using this approach
is 6.8-8.9 oocytes. Oocyte collection can be programmed 36 hours after
HCG administration when the leading follicle diameter measured by ultrasound
is 18-20 mm (Ron-EL et al, 1993).
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