Monitoring of in vitro fertilization-embryo transfer cycles by ultrasound versus by ultrasound and hormonal levels: a prospective, multicenter, randomized study.
OBJECTIVE
To determine whether cycle monitoring using both serum E(2) and ultrasound findings yields superior clinical pregnancy rates during IVF-embryo transfer (ET) compared to monitoring with ultrasound alone.


METHODS
Prospective, randomized, multicenter, patient-blinded study.


METHODS
Four assisted conception units in the United Kingdom.


METHODS
Two hundred ninety-seven women believed to be normal responders undergoing IVF treatment.


METHODS
Patients were randomly allocated on day 7 of stimulation to one of the two hCG administration criteria: [1] the E(2)-to-follicle > or =11 mm ratio was between 250 and 500 pmol/L/follicle and at least 2 follicles reached a mean diameter of 18 mm or [2] at least 2 follicles reached a mean diameter of 18 mm and the endometrium thickness was > or =8 mm.


METHODS
Duration and cumulative dose of recombinant human FSH, total number of growing follicles, oocytes retrieved, number and quality of embryos, pregnancy rates, and ovarian hyperstimulation syndrome (OHSS) rates.


RESULTS
Two hundred ninety-seven patients were randomized to one of the two criteria groups. Of these, 288 (97%) received urinary (u)-hCG (143 in group A and 145 in group B). One hundred three women in group A (72%) met both criteria for hCG administration. Pregnancy and OHSS rates were similar (34.3% vs. 31.4% and 4.9% vs. 4.1%, respectively).


CONCLUSIONS
The addition of E(2)/follicle criteria to ultrasound monitoring of IVF cycles in normal responders seldom changes the timing of hCG, and does not increase pregnancy rates or the risk of OHSS.
Lass
Amir
A
Bourn Hall Clinic, Cambridge, United Kingdom. amir.lass@serono.com
D000328:Adult; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D009865:Oocytes / Q000502:physiology; D006080:Ovarian Follicle / Q000000981:diagnostic imaging* / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography
D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone