MINIMAL MONITORING OF OVARIAN HYPERSTIMULATION - A USEFUL SIMPLIFICATION OF THE CLINICAL-PHASE OF IN-VITRO FERTILIZATION TREATMENT

Objective: To investigate the feasibility of IVF treatment with minima l monitoring during ovarian hyperstimulation. Design: Retrospective an alysis and prospective study with real-time control group. Setting: Tr ansport IVF program with transport clinic and satellite clinics. Patie nts: One hundred consecutive IVF cycles monitored at a transport clini c and 100 concurrent consecutive cycles monitored at satellite clinics , using the same stimulation-monitoring protocol and resulting in oocy te aspiration, are compared retrospectively for the number of ultrasou nd (US) measurements carried out during monitoring and for results of IVF treatment. No patient selection took place. After introduction of a minimal monitoring protocol at a transport clinic, a prospective stu dy was started comparing 100 minimal monitoring cycles at a transport clinic with 100 concurrent conventional monitoring cycles at satellite clinics, all resulting in oocyte aspiration. Patients entered the ret rospective or prospective study only once. In all cases the same labor atory facility was used. Monitoring of ovarian hyperstimulation was do ne with US measurements only. Cycles were canceled for impending ovari an hyperstimulation syndrome (OHSS) when >35 follicles were seen to de velop during hyperstimulation. Results: Retrospective analysis shows n o difference for the average number of US measurements at transport an d satellite clinics (2.8 +/- 0.9 and 3.0 +/- 1.0; mean +/- SD). No dif ferences were found in the number of ongoing pregnancies obtained in t he two groups: 22 and 18, respectively. One case of severe OHSS occurr ed in the satellite clinic group. Introduction of minimal monitoring a t the transport clinic gives a significant reduction of the average nu mber of US measurements at the transport clinic compared with satellit e clinics, where conventional monitoring continued to be used (1.5 +/- 0.8 versus 2.8 +/- 0.9). Ongoing pregnancies at transport and satelli te clinics numbered 33 and 26, respectively. In both groups one patien t developed severe OHSS. Sixty-two percent of cycles at the transport clinic were monitored with one US measurement only. No cancellations f or impending OHSS occurred during the study period. Conclusion: A larg e group of patients need only one US measurement during monitoring of ovarian hyperstimulation. Minimal monitoring gives a useful further si mplification of the clinical phase of IVF treatment, without adverse e ffects on treatment outcome and incidence of OHSS.