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This chapter explores the essential features of embryo transfer (ET) catheters that may have an impact on the success of in vitro fertilization (IVF) in an evidence-based approach. ET catheters can be subdivided mainly on the basis of the material they are made of and whether they are equipped with, or without, an introducing cannula that facilitates the transfer procedure. Despite the wide variations in the design of ET catheters, the main features that have been studied and found to have a possible influence on the success of ET procedure include flexibility, with or without outer sheath, and echodensity. A more recent systematic review and meta-analysis comparing soft catheters with hard (TDT) catheters demonstrated an increased chance of clinical pregnancy when soft ET catheters were used. The use of ultrasound guidance to facilitate ET has proven useful in women with a previously difficult transfer.
To compare the effectiveness of recombinant follicle stimulating hormone (rFSH) with human menopausal gonadotropin (hMG), one should make this comparison for ovulation induction then for controlled ovarian hyperstimulation in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. This chapter compares rFSH with hMG in cryothawed cycles. A cost-effectiveness study of hMG compared to rFSH in a developing country setting was conducted which demonstrated that hMG is more cost-effective than rFSH. The cost saving using highly purified (HP)-hMG remained after varying model parameters in a probabilistic sensitivity analysis. Recently a long acting rFSH, corifollitropin alfa, has been proposed to be a suitable substitution for daily rFSH administration in women undergoing controlled ovarian stimulation in IVF/ICSI cycles. hMG and rFSH have been used to improve sperm parameters in idiopathic male infertility with the goal of increasing pregnancy rates.
This chapter compares the role of human menopausal gonadotrophin (hMG), follicle-stimulating harmone (FSH) agonist/antagonist and recombinant/urinary human chorionic gonadotrophin (hCG)/luteinizing hormone (LH)/gonadotrophin-releasing hormone agonist (GnRHa) in triggering ovulation. With the use of GnRHa, hCG was necessary to induce final follicular maturation and triggering of ovulation. Accordingly, in the 1980s, the use of gonadotrophins, GnRHa, and hCG became a standard successful protocol for ovulation induction in assisted conception cycles. The GnRH antagonists emerged as an alternative to GnRHa in preventing premature LH surges. Recombinant FSH (recombinant-human FSH), which is free of LH activity, is used in many cases of controlled ovarian hyperstimulation (COH) after downregulation with long protocol. The conclusions of the meta-analyses are that there is no advantage for either recombinant FSH or urinary FSH concerning the clinical pregnancy rate, miscarriage rate, or ovarian hyperstimulation syndrome (OHSS) rate.
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