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Monitoring Ovarian Stimulation: Current Perspectives

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Abstract

In the normal ovulatory cycle, the recruited cohort of antral follicles can be identified by cycle day 5–7, the dominant follicle emerges by day 8–12, grows approximately 1–3 mm per day thereafter (most rapidly over the 1–2 days immediately preceding ovulation), and measures approximately 20–24 mm in mean diameter when the luteinizing hormone (LH) surge occurs; lesser follicles rarely exceed approximately 14 mm in diameter. In 5–10 % of spontaneous cycles, two preovulatory follicles may develop. The ultrasound examination enables the follicle diameter and endometrial thickness to be measured, which evaluates the fecundity function by using blood-flow assessment and the combined three dimensional (3D) and blood-flow investigation.

Ovarian ultrasonography defines the size and number of follicles contributing to the measured estradiol (E2) level. Thus, in an ovulation induction cycle, ultrasound can tell us about the ovarian reserve and adequately monitor the process of downregulation, follicular and endometrial development, and timely administration of human chorionic hormone (hCG), with an increase in the overall pregnancy rates and decrease in the incidence of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy rate.

Baseline follicular stimulating hormone (FSH), antiMullerian hormone (AMH), and inhibin B levels on day 2 or 3 on menstrual cycle and dynamic tests can give information about the ovarian reserve. Monitoring LH, E2, and progesterone during ovulation induction can determine the follicular growth and its competency, predict poor and hyper-response, and diagnose premature LH surge, premature luteinization and luteal phase adequacy.

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Abbreviations

2 D:

2 Dimensional

3 D:

3 Dimensional

4 D:

4 Dimensional

AFC:

Antral follicle count

AMH:

Antimullerian hormone

ART:

Assisted reproductive technology

B:

Blood flow

BMI:

Body mass index

CC:

Clomiphene citrate

CCCT:

Clomiphene citrate challenge test

CL:

Corpus luteum

COS:

Controlled ovarian stimulation

E2:

Estradiol

EFORT:

Exogenous FSH ovarian reserve test

EP:

Ectopic pregnancy

ET:

Embryo transfer

FET:

Frozen embryo transfer

FI:

Flow index

FSH:

Follicular stimulating hormone

FVQ:

Flow vessel quotient

GnRH:

Gonadotropin-releasing hormone

GT:

Gonadotropins

hCG:

Human chorionic hormone

HRT:

Hormone replacement treatment

ICSI:

Intracytoplasmic sperm injection

IM:

Intramuscular

IR:

Implantation rate

IUI:

Intrauterine insemination

IUP:

Intrauterine pregnancy

IVF:

In vitro fertilization

LH:

Luteinizing hormone

LPD:

Luteal phase deficiency

LUF:

Luteinized unruptured follicle

MTX:

Methotrexate

NNT:

Numbers needed to treat

NPV:

Negative predictive value

OHSS:

Ovarian hyperstimulation syndrome

OI:

Ovulation induction

ORT:

Ovarian reserve test

P4:

Progesterone

PCOS:

Polycystic ovarian syndrome

PD:

Power Doppler

PDA:

Power Doppler angiography

PE:

Elevated progesterone

PFBF:

Perifollicular blood flow

PG:

Prostaglandin

PI:

Pulsatility index

POD:

Pouch of Douglas

PPV:

Positive predictive value

PSV:

Peak systolic velocity

PUL:

Pregnancy of unknown location

RI:

Resistance index

SC:

Subcutaneous

TAS:

Transabdominal scan

TVS:

Transvaginal ultrasound scan

USG:

Ultrasonography

VEGF:

Vascular endothelial growth factor

VFI:

Vascularization flow index

VI:

Vascularization index

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Authors and Affiliations

  1. Department of Reproductive Medicine, Dr. Patil’s Fertility and Endoscopy Clinic, No. 1 Uma Admiralty, First Floor, Bannerghatta Road, Bangalore, Karnataka, 560029, India

    Madhuri Patil MD, DGO, FCPS, DFP, FICOG

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  1. Madhuri Patil MD, DGO, FCPS, DFP, FICOG
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Correspondence to Madhuri Patil MD, DGO, FCPS, DFP, FICOG .

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  1. 1st floor, Rotunda-CHR 36, Mumbai, India

    Gautam N. Allahbadia

  2. IVF Namba Clinic, Osaka, Japan

    Yoshiharu Morimoto

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Patil, M. (2016). Monitoring Ovarian Stimulation: Current Perspectives. In: Allahbadia, G., Morimoto, Y. (eds) Ovarian Stimulation Protocols. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1121-1_2

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