Table 37 - uploaded by Colin M Howles
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Infertility treatment became available owing to developments in the characterization and purification of hormones. Treatment with gonadotropins and clomiphene citrate (CC) became available in 1961. The purpose of this chapter is to overview the development, structure, and mode of action of treatments for ovulation induction (OI) and controlled ovar...
Contexts in source publication
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... this develop- ment stimulated the formulation of numerous other aro- matase inhibitors that were described as fi rst-, second-, and third-generation inhibitors according to chronologic development. They were further classifi ed as type I (ste- roid analogs of androstenedione) and type II (nonsteroi- dal) (Table 37.1). ...
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... important, they have the same natural function, that is, to induce lutein- ization and support lutein cells. Major differences include the sequence of the beta subunit, the regulation of secretion of both hormones, and the pharmacokinetics of clearance of hCG as opposed to LH (Table 37.2). ...
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... fi rst urine extract of gonado- tropin contained LH and FSH and was named Pergonal, inspired by the Italian words "per gonadi" (for the gonads) (87). The approval to sell Pergonal was fi rst granted by the Italian authorities in 1950 (Table 37.3). Only in 1961, with Pergonal treatment, was the fi rst pregnancy achieved in a patient with secondary amenorrhea, which resulted with the birth (in 1962 in Israel) of the fi rst normal baby girl (88). ...
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... between analogs are mainly related to methods of administration and potency. The available data usually describe the relative potency of a certain GnRH agonist compared with native GnRH (Table 37.5). Direct comparison between the clinically available GnRH agonists under identical conditions has never been undertaken. ...
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... drug is formulated as not only better protected against enzymatic degrada- tion but also exhibit a higher receptor binding affi nity. The affi nity could be further increased by introduction of larger, hydrophobic, and more lipophilic amino acids at position number 6 (Table 37.4). The increased lipophilicity of the agonist is associated with a pro- longed half-life, which may be attributed to reduced renal excretion through increased plasma protein bind- ing, or fat tissue storage of nonionized fat-soluble com- pounds (181). ...
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... in all analogs, position 6 is substituted with a D-amino acid or a D-amino acid with different radicals. Insertion of D-amino acid blocks degradation and thus renders more stability and higher receptor affi nity (182) ( Table 37.4). The agonists leuprolide (D-Leu6,Pr9-NHEt) and buserelin [D-Ser(OtBu)6, Pr9-NHEt] contain an eth- ylamide, and goserelin [D-Ser(OtBu)6,Pro9-AzaGlyNH2] and histrelin (Nt-Bzl-D-His6,Pro9-AzaGlyNH2) contain azaglycine at position 10 and are, therefore, nonapep- tides. ...
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... Consequently, compared with agonistic ana- logs, a higher dose range of antagonists is required for effective pituitary suppression (Table 37.6). ...
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... ever, histamine release also increased, resulting in ana- phylactic reactions that prevented their clinical use. In third-generation antagonistic analogs, the undesirable risk of anaphylaxis and edema was eliminated by replac- ing the D-Arg at position 6 by neutral D-ureidoalkyl amino acids, to produce compounds such as cetrorelix, iturelix, azaline B, ganirelix, abarelix, and antarelix (Table 37.7) (192)(193)(194)(195)(196)(197)(198). ...
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It is generally accepted that intrauterine insemination (IUI) should be preferred to more invasive and expensive techniques of assisted reproduction and be offered as a first-choice treatment in cases of unexplained and moderate male factor subfertility. Scientific validation of this strategy is rather difficult because literature is rather confusi...
Citations
... During COS, combining gonadotropin with the aromatase inhibitor letrozole may reduce the total amount of gonadotropin needed for IVF. 29 Human menopausal gonadotropins (HMG), including highly pure HMG and recombinant folliclestimulating hormone (rFSH), have been used for COS. 30 Chapon et al. (2021) identified that rFSH was associated with a greater number of oocytes produced in comparison to HMG. 31 A study found that women using CC or HMG reported higher rates of psychological side effects, including irritability, restlessness, mood swings, feeling sad, and bloating. ...
This comprehensive review delves into the intricate world of assisted reproductive technologies (ART) and hormonal treatments, exploring their profound psychological effects on women undergoing IVF treatment. The psychological distress of infertility, combined with the demanding nature of ART, has been widely acknowledged, yet a comprehensive examination of the psychological impacts has remained elusive. This study examined the psychological repercussions of hormonal medications used in IVF, addressing the complex interplay of hormones and their effects in each stage of the IVF process. This review followed PRISMA guidelines and included studies from PubMed, Google Scholar, and ScienceDirect. A total of nine papers were collected. The findings of this study identified that depression, anxiety, mood swings, irritability, sleep disturbances, and cognitive changes were the most commonly seen medically induced psychological effects among the IVF patients. This review offers a holistic understanding of the psychological intricacies of IVF treatment, highlighting the imperative need for a more comprehensive approach to address the emotional wellbeing of individuals undergoing fertility procedures.
... Provided that the half-life of Lupride is 3 h, it is difficult to suggest any systemic effect at the time of establishment of uteroplacental circulation. [25] However, any indirect action of Lupride on embryos or on embryo-endometrium cross-talk cannot be completely refuted. ...
To evaluate whether three daily doses of GnRH agonist (Inj. Lupride 1 mg SC) administered 6 days after oocyte retrieval increases ongoing pregnancy rates following embryo transfer (ET) in cycles stimulated with the long GnRH agonist protocol.
Prospective randomized controlled study in a tertiary care center.
Four hundred and twenty six women undergoing ET following controlled ovarian stimulation with a long GnRH agonist protocol were included. In addition to routine luteal-phase support (LPS) with progesterone, women were randomized to receive three 1 mg doses of Lupride 6 days after oocyte retrieval. Computer-generated randomization was done on the day of ET. Ongoing pregnancy rate beyond 20(th) week of gestation was the primary outcome measure. The trial was powered to detect a 13% absolute increase from an assumed 27% ongoing pregnancy rate in the control group, with an alpha error level of 0.05 and a beta error level of 0.2.
There were 59 (27.69%) ongoing pregnancies in the GnRHa group, and 56 (26.29%) in the control group (P = 0.827). Implantation, clinical pregnancy and multiple pregnancy rates were likewise similar in the GnRHa and placebo groups.
Three 1 mg doses of Lupride administration 6 days after oocyte retrieval in the long protocol cycles does not result in an increase in ongoing pregnancy rates.
The luteal phase is defined as the period between ovulation and either the establishment of a pregnancy or the onset of menses two weeks later. Assisted reproductive technologies (ART), and in particular controlled ovarian stimulation (COS), negatively interfere with the endocrine mechanisms normally regulating the luteal phase. Up to now, there is no generally accepted opinion as to the most appropriate therapeutic schemes for luteal phase support in ART cycles. Progesterone-based protocols are the most frequently adopted, while alternative regimens including human chorionic gonadotropin (hCG) and GnRH agonists (GnRH-a) are controversial. A GnRH-a can be used instead of hCG for ovulation triggering and the effectiveness of luteal phase support in such new protocols is the object of a growing number of experimental studies. Currently, vaginal progesterone is considered as the first line therapy for luteal phase support (LPS). The starting-time and the duration of luteal phase supplementation after the onset of pregnancy are still debated. Despite the lack of clinical or biological evidence supporting the efficacy of luteal phase support in intrauterine insemination cycles, the use of progesterone has become a well-established practice.
