[Selection and management of infertile patients].
The description, evaluation and management of the main problems emerging during ovulation stimulation in the in vitro fertilization (IVF) programs, include the guidelines to apply this methodology and to select the patients; the ovarian stimulation and oocyte recovery procedures, as well as to emphasize the importance of establish and know the rejection and cancellation rates in these programs. During ovulation stimulation, abnormalities can emerge at different times of the procedure. Basal serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels on cycle day 3, are helpful in prediction of patients stimulation response and IVF outcome. Patients with elevated FSH levels at the beginning of the menstrual cycle present a short follicular phase with a rapid spontaneous LH surge; likewise, the predominance of LH on day 3 produces a "multi-follicular response", when the usual stimulation protocol is used. All these patients behave poorly in terms of E2 response, quality of the oocytes retrieved and pregnancy rates. If the estrogen levels are low (less than 20 pg/ml) or very high (greater than 80-100 pg/ml) on cycle day 3, the response in terms of oocyte recovery and LH levels will not be adequate. On the other hand, during the developmental and/or codominance phase of stimulation, a sudden drop of estrogens levels may occur, which can lead to the cancellation of the cycle. In this manuscript there is also a reference about ovarian stimulation protocols, as well as the use conditions for gonadotropin releasing hormone (GnRH) agonists with this purpose.(ABSTRACT TRUNCATED AT 250 WORDS)
Acosta
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Howard and Georgeanna Jones Institute for Reproductive Medicine, Norfolk, Virginia 23507.
D000328:Adult; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle; D009865:Oocytes; D010062:Ovulation Induction
D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
Selección y manejo de pacientes infértiles.