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Ovulation Bandung-Prof Anwar

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  28/09/20121 OVULATION INDUCTIONOVULATION INDUCTIONIN PERSPECTIVEIN PERSPECTIVE ocama nwar ocama nwar Division of Reproductive Endocrinology Division of Reproductive Endocrinology Department of Obstetrics and Department of Obstetrics and Gynecology Gadjah Mada UniversityGynecology Gadjah Mada University The overview of ovulation inductionThe overview of ovulation induction  The goal of any regimen of ovulation induction is The goal of any regimen of ovulation induction is yield numerous preovulatory oocyte suitable for yield numerous preovulatory oocyte suitable for transfer into the fallopian tube.transfer into the fallopian tube.  Ovulation induction has been one of the most Ovulation induction has been one of the most significant advances in the treatment of infertilitysignificant advances in the treatment of infertility , , , , no one protocol has proved to be more no one protocol has proved to be more beneficial than another.beneficial than another.  28/09/20122 Maturation FOLLICULOGENESIS Recruitment In the normal cycle In the normal cycle one one follicle follicle  is is uusually sually  “selected” to undergo  “selected” to undergo maturation during the maturation during the follicular phase. follicular phase. (Dominant follicle)(Dominant follicle)  At this stage, antral follicles become acutely …. In response to unknown signals, a hundreds of  primordial follicles is recruited to grow  The selected or dominant follicle was recruited together with other The selected or dominant follicle was recruited together with other folliclefolliclessabout 10 weeks prior to the onset of menstruation.about 10 weeks prior to the onset of menstruation. dependent on FSH for further development The physiology of The physiology of folliculogenesisfolliculogenesis  Although FSH is the primary regulator of  Although FSH is the primary regulator of DDominant ominant FFolicleolicledevelopment, it is now development, it is now clear that growth factors (GFs) produced clear that growth factors (GFs) produced by the follicle itself can act by autocrine by the follicle itself can act by autocrine andaracrinemechanismstomodulateandaracrinemechanismstomodulate either amplify or attenuate, FSH action.either amplify or attenuate, FSH action.  28/09/20123 DEVELOPMENT OF A HUMAN OOCYTE AND OVARIAN FOLLICLE anovulationanovulation The etiopathogenesis of anovulation is complex The etiopathogenesis of anovulation is complex and multifactorial.and multifactorial. WHO Hypothalamic-pituitary failureHypothalamic-pituitary dysfunction Group-1Group-2 1.Amenorrhea and do not bleed in response to progestin challenge.1.Variety of cycle disorders (amenorrhae, oligomenorrhae, anovulatory cycles and luteal phase difficiency)  Bleeding in 2.Endogenous estrogen deficient.3.With normal or low FSH or prolactin levels.response to progestin challenge.2.They are not endogenous estrogen deficient3.Normal FSH and prolactin levels.4.The most common cause is PCOS.  28/09/20124 WHO groupWHO group--33  Women in WHO groupWomen in WHO group--3 includes those 3 includes those primary ovarian failure mainly due to primary ovarian failure mainly due to diminished ovarian reserve and loss of diminished ovarian reserve and loss of ovarian follicles.ovarian follicles.  They are resistence to various methods of They are resistence to various methods of ..   And the best approach for their infertility is  And the best approach for their infertility is oocyte donation. oocyte donation. Control Ovarian Hyperstimulation Control Ovarian Hyperstimulation (COH)(COH)  Initially, drugs such as Clomiphene citrate (CC) Initially, drugs such as Clomiphene citrate (CC) and Human menoausal onadotroin hMG and Human menoausal onadotroin hMG were used for COHwere used for COH..   A premature endogenous LH surge was  A premature endogenous LH surge was observed in 40% of cycles, and was reported to observed in 40% of cycles, and was reported to have a negative effect on the IVF outcome in have a negative effect on the IVF outcome in terms of oocyte quality and pregnancy rate.terms of oocyte quality and pregnancy rate.  With he introduction of GnRH agonists for COH, With he introduction of GnRH agonists for COH, e ncence o premaure enogenous e ncence o premaure enogenous surge was reduced to less than 2%.surge was reduced to less than 2%.  With the advent of GnRH antagonists, new With the advent of GnRH antagonists, new perspectives for COH have been opened.perspectives for COH have been opened.
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