title: Results of gonadotrophin stimulation with the option to convert cycles to in vitro fertilization in cases of multifollicular development.
abstract: BACKGROUND
  To avoid a high cancellation rate and/or a high multiple pregnancy rate due to multifollicular development in gonadotrophin stimulated cycles, such cycles were converted in the same cycle to in vitro fertilization/embryo transfer (IVF/ET). The results from a four year period using this strategy are summarized.
  
  
  METHODS
  Seventy-three anovulatory women (seven WHO group I, 66 WHO group II) were studied during this period. In a majority of the cycles a GnRH-analogue was used for down-regulation according to a long protocol, followed by stimulation with FSH and/or hMG.
  
  
  RESULTS
  Out of 154 WHO group II gonadotrophin stimulation cycles intended for ovulation induction, 25 cycles were converted to IVF. The pregnancy and delivery rates in the IVF-converted cycles were 50% and 41%, respectively, and 31% and 22% when gonadotrophin stimulation was followed by intercourse. The cancellation rate, including both ovulation induction and IVF cycles, was 15% and the multiple pregnancy rate was 30%, mainly twins. Lean women achieved better outcome than obese women. In WHO group I only 12 cycles were performed. One cycle was converted to IVF resulting in delivery and one cycle was cancelled. The pregnancy- and delivery rates were both 50% when gonadotrophin stimulation was followed by intercourse.
  
  
  CONCLUSIONS
  It is concluded that the option to convert a gonadotrophin stimulation cycle to IVF in the same cycle, in cases of multifollicular development, seemed to be a good alternative. The conversion results in a low cancellation rate and a low incidence of high order multiple pregnancies. Patients should be informed of this opportunity before entering ovulation stimulation.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Göteborg, Sahlgrenska Hospital, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Bergh
authors.forename: I
authors.initials: I
authors.lastname: Bryman
authors.forename: L
authors.initials: L
authors.lastname: Nilsson
authors.forename: P O
authors.initials: PO
authors.lastname: Janson
mesh_terms: D000328:Adult; D000858:Anovulation / Q000209:etiology / Q000628:therapy; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000150:complications; D011247:Pregnancy; D011272:Pregnancy, Multiple
chemical_list: D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D005640:Follicle Stimulating Hormone