Submitted by Dr. Hesham Al-Inany, M.D. Lecturer, Gynaecology & Obstetrics dept. Kasr El-Aini hospital, Cairo University, Egypt.
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 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).
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).
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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