OVULATION STIMULATION WITH GONADOTROPINS
How does one learn to stimulate ovulation? Often by oneself, when there is no opportunity to benefit from a mentor’s experience. But options abound regarding the evaluation strategy, protocol design, gonadotropin preparations, posology, treatment duration, and when and how to trigger ovulation. Proper, safe stimulation requires critical anticipation of ovarian reactions.
There seems to be little evidence-based consensus in the field of ovarian stimulation. Though they all face the same situation, there seem to be nearly as many procedures as there are clinicians in the field; as a result, approaches may vary within a given fertility center or even in the same team. Even though efforts have been made to arrive at a general consensus, the basic guidelines are often reinterpreted according to individual inclinations; hence the need to turn to experience-based decisions.
This book is based on the author’s experience gathered over forty years and more than 30,000 cycles of classical and IVF ovulation stimulations, particularly the thousand most recent cycles that resulted in a clinical pregnancy. It is not intended as a “perfect solution”, as other approaches certainly remain valid. Rather, the book presents the author’s own analysis and insights gained from managing thousands of stimulation cycles.
Foreword.- Preface.- Past and Present: Evolution of ideas.- Physiology: The ante-hypophysis – ovarian follicle couple.- Follicle Stimulating Hormone (FSH).- Luteinizing hormone (LH).- Human Chorionic Gonadotropin (hCG).- Which Gonadotropin? FSH. LH. hCG. Practical considerations.- Prior to the stimulation.- Looking for other infertility factors.- Assessment of the patient’s status.- Assessment of the ovarian status.- The Monitoring; Hormonal (functional) monitoring; Sonographic (morphological) monitoring; Monitoring post-hCG?.- The Triggering of Ovulation.- The ovulatory process.- Spontaneous triggering of ovulation.- Therapeutic triggering of ovulation.- The luteal phase support.- Mono- and pauci- follicular stimulation.- Multi-follicular stimulation.- The Prevention of Complications.- Multiple pregnancy.- The ovarian hyperstimulation syndrome.- Classic Stimulation.- mono-, bi- or pauci- follicular.- The objectives.- The means.- The Stimulation of the ovulatory Patient.- Monofollicular stimulation.- Bifollicular stimulation.- Paucifollicular stimulation.- The Stimulation of the anovulatory patient.- The diagnosis of anovulation; Hypogonadotropic anovulation.- Normogonadotropic anovulation.- Hypergonadotropic anovulation.- Multifollicular Stimulation.- Past and present.- Handling the multifollicular stimulation.- Poor ovarian responses.- Conclusion.
Jean-Claude Emperaire was born 1942 in Marseille (France). Medical Doctor 1969 Research Fellow at the Department of Endocrinology, Medical College of Georgia, Augusta, (USA) 1968-1969. Qualification in Medical Gynecology (1971), Internal Medicine (1975), Endocrinology and Metabolic Diseases (1988), and Ultrasonography in Gynecology and Obstetrics (1995). Medical Director of Bordeaux Human Sperm Bank (CECOS Aquitaine) 1974 – 1995. Medical Director of the IVF Center Saint Sernin (Bordeaux) 1982 -1996. Clinical Coordinator of the IVF Center Jean Villar (Bordeaux Bruges) 1997 – 2009. Current member of the IVF Center Jean Villar and private practice. He has published numerous scientific articles and books in the fields of Reproductive Endocrinology and Infertility in French and English.