Abstract
A retrospective analysis was carried out to assess the outcome of gamete intrafallopian transfer (GIFT) in cycles when more than 10 oocytes were retrieved (superhigh responders) from October 1987 through June 1989. There were 276 (13%) cycles with more than 10 oocytes retrieved among all GIFT cycles initiated during the period. Clomiphene citrate and gonadotropin were employed for ovarian stimulation in 105 (38%) cycles, and gonadotropin releasing hormone agonist in the remaining 171 (62%) cycles, employing either the flare (104 cycles) or the pituitary down-regulation (67 cycles) protocol. A maximum number of four oocytes was transferred per GIFT (3.5±0.4). The mean number of oocytes retrieved was 14.7±4.4 (range, 11 to 35). A significantly younger age group (<30 years) of patients was noticed in the study (31.9), and fewer women aged 40 and over (6.2%), compared to the general population of our patients. The pregnancy rate was 33.3% (n=92) per cycle, with a delivery rate of 23.6% (n=64) per cycle; the pregnancy loss rate was 30.8%. The reproductive outcome was lower in women aged 40 and over (pregnancy rate was 23.5%, but delivery rate was only 5.8% per cycle). The delivery rate was lower in the clomiphene citrate- and gonadotropin-stimulated cycles (51.7% per pregnancy) in relation to gonadotropin-releasing analogue and gonadotropin cycles (76.6% per pregnancy) and significantly so compared with the putuitary down-regulation protocol (83.3% per pregnancy). We conclude that a superhigh response develops more in younger women, and in such circumstances, the use of pituitary down-regulation with gonadotropin-releasing hormone will improve the reproductive outcome.
Similar content being viewed by others
References
Loumaye E, Billion JM, Psalti I, Pensis M, Thomas K: Prediction of individual response to controlled ovarian hyperstimulation by means of a clomiphene citrate challenge test. Fertil Steril 1990;53:295–301
Muasher SD, Oehninger S, Simonetti S, Matta D, Ellis L, Liu HC, Jones GS, Rosenwaks Z: The value of basal and/or stimulated serum gonadotropin levels in prediction of stimulation response and in vitro fertilization outcome. Fertil Steril 1988;50:298–307
Jones HW Jr, Acosta A, Andrews MC, Garcia JE, Jones GS, Mantzavinos T, McDowell D, Sandow B, Veek L, Whibley T, Wilkes C, Wright G: The importance of the follicular phase to success and failure in vitro fertilization. Ferti Steril 1983;40:317–321
Levran D, Lopata A, Nayudu PL, Martin MJ, McBain JC, Bayly CM, Speirs AL, Johnston WIH. Analysis of the out-come of in vitro fertilization in relation to the timing of human chorionic gonadotropin administration by the duration of estradiol rise in stimulated cycles. Fertil Steril 1985 44:335–341
Diamond MP, Buchholz T, Boyers SP, Lavy G, Shapiro BS, DeCherney AH: Super high estradiol response to gonadotropin stimulation in patients undergoing in vitro fertilization. J Vitro Fert Embryo Transfer 1989;6:81–84
Testart J, Belaisch-Allart D, Frydmam R. Relationships between embryo transfer results and ovarian response and in vitro fertilization: Analysis of 186 human pregnancies. Fertil Steril 1986;45:237–243
Smith B, Porter R, Ahuja K, Craft I: Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program. J Vitro Fert Embryo Transfer 1984;1:223–238
Al-Shawaf T, Ah-Moye M, Fiamanya W, Smith B, Craft: Gamete intra-fallopian transfer in non-endometriotic pelvic adhesions. Hum Reprod 1990:5:434–438
Mettler L and Tavmergen EN: Significance of oestradiol values in IVF-ET under a combined GnRH analogue-desensitization and simultaneous gonadotrophin stimulation for the outcome of pregnancies. Hum Reprod 1989:4 (Suppl):59–64
Pellicer A, Ruiz A, Castellvi RM, Calatayud C, Ruiz M, Tarin JJ, Miro F, Bonilla-Musoles F: Is the retrieval of high numbers of oocytes desirable in patients treated with gonad-otrophin-releasing hormone analogues (GnRH-a) and gonad-otrophins? Hum Reprod 1989;4:536–540
Tarin JJ, Pellicer A: Consequences of high ovarian response to gonadotrophins: A cytogenetic analysis of unfertilized human oocytes. Fertil Steril 1990; 54:665–670
Craft I, Ah-Moye M, Al-Shawaf T, Fiamanya W, Lewis P, Robertson D, Serhal P, Simons E, Brindson P: Analysis of 1071 GIFT procedures—the case for flexible approach to treatment. Lancet 1988; 1:1094–1989
Lejeune B, Barlow P, Puissant F, Delvigne A, Vaurysselberg E, Leroy F: Use of buserelin acetate in an in vitro fertilization program: A comparison with classical cloniphene citrate-human menopausalgonadotropin treatment. Fertil Steril 1990;54:475–481
Fleming R, Haxton MJ, Hamilton MPR, McCune GS, Black WP, MacNaughton MC, Coutts JRT: Successful treatment of infertile women with oligomenorrhea using a combination of an LHRH agonist and exogenous gonadotrophins. Br J Obstet Gynaecol 1985;92:369
Ben-Rafael Z, Strauss JF, Mastroianni L, Flickinger GL: Differences in ovarian stimulation in human menopausal gonadotropin treated women may be related to folliclestimulating hormone accumulation. Fertil Steril 1986; 46:586–592
Regan L, Owen ES, Jacobs HS: Hypersecretion of luteinizing hormone, infertility and miscarriage. Lancet 1990; 2:1141–1144
Amso NN, Ahuja KK, Morris N, Shaw RW: The management of predicted ovarian hyperstimulation involving gonadotropin-releasing hormone analogue with elective cyropreservation of all pre-embryos. Fertil Steril 1990;53:1087–1090
Al-Shawaf T, Ah-Moye M, Junk S, Brindson P, Craft I: Fertilization of supernumerary oocytes following gamete intrafallopian transfer (GIFT): Correlation with outcome of GIFT treatment. J Vitro Fert Embryo Transfer 1990;7:98–102
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Al-Shawaf, T., Nolan, A., Nadkarni, P. et al. The reproductive outcome following a superhigh response to stimulation in gamete intrafallopian transfer program. J Assist Reprod Genet 8, 202–207 (1991). https://doi.org/10.1007/BF01130805
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01130805