SIMPLIFICATION OF IVF - MINIMAL MONITORING AND THE USE OF SUBCUTANEOUS HIGHLY PURIFIED FSH ADMINISTRATION FOR OVULATION INDUCTION

During the past few years much effort has been put into simplifying th e clinical management of in-vitro fertilization/ embryo transfer cycle s. One important step was the introduction of transvaginal ultrasound- guided oocyte collection, as previously described. This study describe s further simplifications of the clinical management of ovarian stimul ation. During the period Ist January 1991 to 31st August 1993, three m ajor simplification steps were introduced. All cycles were down-regula ted with a gonadotrophin-releasing hormone (GnRH) agonist according to a long protocol permitting fairly precise programming of the oocyte c ollection. During period I (n = 329 cycles), closer monitoring by seve ral pelvic ultrasound scans and serum oestradiol was used for monitori ng the ovarian stimulation. During period II (n = 230 cycles), only on e ultrasound scan was used for monitoring the ovarian cycle; oocyte co llections during weekends were avoided. During period m (n = 386 cycle s), further simplification of the clinical management was introduced b y using a highly purified follicle stimulating hormone (FSH) (Fertinor m/Metrodin HP), which was self-administered s.c. for ovarian stimulati on. The take-home baby rates per started cycle for periods I, II and m were 16.4, 32.6 and 31.3% respectively. These figures indicate that w hen using long down-regulation,vith a GnRH agonist, simplification of the monitoring of the ovarian stimulation is possible without decreasi ng the pregnancy rate. Furthermore, the use of a highly purified FSH, self-administered s.c., greatly simplified treatment without compromis ing cycle outcome or increasing the risk of developing an ovarian hype rstimulation syndrome.