Ocol patients started daily recombinant FSH (rFSH) buy Flavopiridol Treatment with s.c
Ocol patients started daily recombinant FSH (rFSH) treatment with s.c injections of follitropin b (Puregon, Organon, The Netherlands, or Gonal-F, Merck-Serono, Switzerland), on dayNo presence of fluid Small amount of fluid, barely detectable by ultrasound in the pouch of Douglas Increased amount of fluid located in the small pelvis Large amount of fluid reaching the level of the umbilicus Significant accumulation of fluid reaching Morrison’s pouch Significant accumulation of fluid up to the level of the diaphragm with/without hydrothoraxThe classification of ascites used in our Unit is similar to previously published criteria [6,29] and distinguishes different levels of ascites, depending on the accumulation of ascetic fluid when the patient was at the anti-trendelenburg position. This classification system is reproducible and more clear compared to the subjective description “clinical or ultrasound evidence of ascites” mentioned in previous OHSS classifications [4,26-28,30].Lainas et al. Reproductive Biology and Endocrinology 2012, 10:69 http://www.rbej.com/content/10/1/Page 4 ofor day 3 of cycle that followed the discontinuation of the OCP. All patients had blood loss after discontinuation of the OCP. Daily s.c administration of 0.25 mg ganirelix (Orgalutran, Organon, The Netherlands) or 0.25 mg cetrorelix (Merck-Serono, Switzerland) was initiated when at least one of the following criteria were fulfilled: (i) the presence of at least one follicle measuring >14 mm; (ii) serum E2 levels >600 pg/ml; and (iii) serum LH levels >10 IU/l. Treatment with rFSH and PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/25432023 GnRH antagonist continued daily thereafter, until and including the day of triggering of final oocyte maturation. The starting dose of rFSH was 150 IU/day for all patients. This dose was adjusted after Day 5 of stimulation, depending on the ovarian response, as assessed by E2 levels and ultrasound.Triggering of final oocyte maturation and in vitro fertilizationmanagement was not feasible. Reasons for failure of outpatient management included: development of thrombosis, dyspnoea or tachypnea, severe abdominal pain or peritoneal signs, intractable nausea and vomiting that prevented ingestion of food or adequate fluids, severe oliguria or anuria, tense ascites, hypotension (relative to baseline), abnormal liver function tests, electrolyte imbalances, dizziness, or syncope [32]. Patients were instructed to contact the doctors immediately in case they fell unwell during the monitoring period for immediate admission to hospital. Secondary outcome measures included evaluation of changes in ovarian volume, ascites volume, hematocrit values and white blood cell count, which reflect progress or regression of severe OHSS. Moreover, serum oestradiol and progesterone levels were assessed following GnRH antagonist administration in the luteal phase.Statistical analysisFinal oocyte maturation was triggered when at least three follicles of diameter 17 mm were present. In patients who chose to proceed to oocyte retrieval and potentially embryo PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26024392 transfer, 5000 IU hCG (Pregnyl; Organon, The Netherlands) were administrated i.m. In patients who chose to trigger final oocyte maturation with GnRH agonists 0.2 mg of triptorelin (Arvekap, Ipsen, France) was injected i.m. Transvaginal ultrasound-guided oocyte retrieval was performed 36 h later by double lumen needle aspiration. ICSI was performed only in cases with severe male factor or previous fertilization failure. Embryos were cultured in sequential media.
