Final maturation induction

Source: Wikipedia, the free encyclopedia.

Induction of final maturation of

pregnancy chances. It is basically a replacement for the luteinizing hormone (LH) surge whose effects include final maturation in natural menstrual cycles
.

The main medications used for induction of final maturation are

oocyte donation, use of GnRH agonists instead of hCG decreases the risk of ovarian hyperstimulation syndrome with no evidence of a difference in live birth rate.[1]

Usage with ovulation

Induction of final maturation also initiates the mechanisms that eventually result in

pharmaceutical drugs to induce final maturation is colloquially called giving a "trigger shot", even if the plan is to perform artificial oocyte retrieval before ovulation.[2]

Administration of a drug to trigger oocyte release without oocyte retrieval results in a predictable time of ovulation, with the interval from drug administration to ovulation depending on the type of drug. This avails for

intrauterine insemination (IUI) to conveniently be scheduled at ovulation, the most likely time to achieve pregnancy.[3]

In

LH surge tests.[4] Therefore, in such cases, triggering oocyte release is best reserved for women who require IUI and in whom LH monitoring proves difficult or unreliable.[4] It may also be used when LH monitoring hasn't shown an LH surge by cycle day 18 (where cycle day 1 is the first day of the preceding menstruation) and there is an ovarian follicle of over 20 mm in size.[5]

Usage with artificial oocyte retrieval

In

egg retrieval when the eggs are fully mature.[citation needed
]

In IVF, final maturation induction is preceded by controlled ovarian hyperstimulation. It is suggested that there should be a size of ovarian follicles of at least 15 mm, and serum estradiol level of 0.49 nmol/L before commencing final maturation induction. There are better prospects at a follicle size of 18 mm and serum estradiol level of 0.91 nmol/L.[6]

Medications

Medications used for final maturation and/or release of oocytes include:

HCG versus GnRH agonist

Final maturation induction using GnRH agonist results in a substantial decrease in the risk of

Cochrane review estimated that using GnRH agonist instead of hCG in IVF decreases the risk of mild, moderate or severe OHSS with an odds ratio of approximately 0.15. The review estimated that, for a woman with a 5% risk of mild, moderate or severe OHSS with the use of HCG, the risk of OHSS with the use of a GnRH agonist would be between 0 and 2%.[1]

However, using GnRH agonist has a lower

Final maturation induction using a GnRH agonist is recommended in women with cancer undergoing fertility preservation, because ovarian hyperstimulation syndrome is associated with an increased risk of arterial thrombotic events such as stroke, myocardial infarction and peripheral arterial embolism, and this risk can add to an already increased risk caused by the cancer.[11]

Using hCG versus GnRH agonist has no effect on the risk of

oocyte donation.[1]

References

  1. ^ .
  2. ^ "About.com". Archived from the original on 2012-11-18. Retrieved 2014-05-10.
  3. ^ IVF.com > Ovulation Induction Archived 2012-02-26 at the Wayback Machine Retrieved on Mars 7, 2010
  4. ^
    PMID 23809505
    .
  5. ^ Clomiphene Citrate, Clomid Archived 2014-05-10 at archive.today. By Robert B. McWilliams. The Center for Reproduction and Women's Health Care, Houston, Texas. Retrieved May 2014
  6. ^ Follicular monitoring from Radiopaedia. By Dr Praveen Jha et al.
  7. PMID 24639791.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  8. ^ HCG Injection After Ovulation Induction With Clomiphene Citrate at Medscape. By Peter Kovacs. Posted: 04/23/2004
  9. PMID 18556681.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  10. ^ .
  11. .