Protocol with gonadotropins alone without agonist or antagonist:
Gonadotropin treatment begins after spontaneous menses. The gonadotropins (e.g. Menopur, 150-225IU) are injected daily from D2/3 of the cycle (Gonadotropin dose varies based on the follicular response). The moment to trigger ovulation by administration of HCG (e.g. Ovitrelle or Pregnyl, 10.000IU) is determined by monitoring ovulation (folliculogenesis) approximately 14 days after gonadotropins regimen and the presence of at least 3 follicles with 18 mm sizes and at least the levels of E2 reaches 250-300 pg/ml. 36 h after HCG triggering, the mature oocytes are retrieved.

Short GnRH agonist protocol:
For the short GnRH agonist protocol, the administration of gonadotropins begins at the same time as that of the agonist, which makes it possible to take advantage of the action of endogenous gonadotropins released by the flare-up effect of the agonist. A low dose of GnRH agonist (e.g., triptorelin (Decapeptyl 0.1mg/day)) is administered in parallel to gonadotropin (e.g. Menopur, 150-225 IU) daily starting on cycle-day 2 (Gonadotropin dose varies based on the follicular development). Continual administration of GnRH agonist and gonadotropin lasts until HCG triggering (e.g. Ovitrelle or Pregnyl, 10.000IU), ~14 days post GnRH agonist regimen when follicles size reached 16-18 mm and at least the levels of E2 reaches 250-300 pg/ml. 36 h after HCG triggering, the mature oocytes are retrieved.

Multiple-dose antagonist protocol:
For the GnRH antagonist protocol, a low dose of GnRH antagonist (0.25 mg/day) is administered. The protocol starts with the administration of gonadotropin (e.g. Menopur, 150-225 IU) daily which is initiated after monitoring of patients' follicles sizes on cycle-day 2/3 (Gonadotropin dose varies based on the follicular response). Almost after the 6th days of gonadotropin injection or when follicular size reaches more than or equal to 14 mm, GnRH antagonist (e.g., cetrorelix (cetrotide) or ganirelix (orgulatron) 0.25mg) begins by subcutaneous administration every day till HCG triggering (e.g. Ovitrelle or Pregnyl, 10.000IU). 36 h after HCG triggering, the mature oocytes are retrieved.

Long GnRH agonist protocol:
For the long GnRH agonist protocol, a low dose of GnRH agonist (e.g., triptorelin (Decapeptyl 0.1mg)) is administered on cycle-day 21 followed by gonadotropin (e.g. Menopur, 150-225 IU) daily starting on cycle-day 2 after menses (Gonadotropin dose varies based on the follicular development). Continual administration of GnRH agonist and gonadotropin lasts until HCG triggering (e.g. Ovitrelle or Pregnyl, 10.000IU), ~14 days post GnRH agonist regimen when follicles size reached 16-18 mm. 36 h after HCG triggering, the mature oocytes are retrieved.

Combined GnRH antagonist and agonist protocol:
For the combined protocol, it starts with the administration of gonadotropin (e.g. Menopur, 150-225 IU) daily which is initiated after monitoring of patients' follicles sizes on cycle-day 2/3 (Gonadotropin dose varies based on the follicular response). Almost after the 6th days of gonadotropin injection or when follicular size reaches more than or equal to 14 mm, GnRH antagonist (e.g., cetrorelix (cetrotide) or ganirelix (orgulatron) 0.25mg) begins by subcutaneous administration every day till GnRH agonist injection (e.g., triptorelin (Decapeptyl 0.1mg/day)). 36 h after agonist injection, the mature oocytes are retrieved.

Female Infertility

Female Infertility Due to Ovulatory Disorder

Premature Ovarian Failure

Polycystic Ovary Syndrome

Female Infertility of Tubal Origin

Ectopic Pregnancy

Salpingitis

Female Infertility Due to Tubal Block

Female Infertility Due to Tubal Occlusion

Hydrosalpinx

Female Infertility - Cervical/Vaginal

Female Infertility Endocrine

Endometriosis

Fibroids

Congenital Uterine Anomaly

Infections Uterine

Female Infertility of Other Origin

The average age of the population must be around 30 years old. Note that no one of the 264 women in this study should have any chromosomal abnormalities or mutated genes that affect ovarian function.

Administration of hCG (10.000IU) for ovulation triggering

Human Chorionic Gonadotropin (hCG)

Administration of Menotropin (hMG / FSH and LH at a 1:1 ratio) (150-225IU/day)

Gonadotropins

Administration of Triptorelin (0.1mg/day)

GNRH-A Triptorelin

Administration of cetrorelix (cetrotide) or ganirelix (orgulatron) (0.25mg/day)

GnRH antagonist

Lebanese University, faculty of sciences III

Comparative Study on the Efficacy of Ovarian Stimulation Protocols on the Success Rate of ICSI in Female Infertility

Comparative Study on the Efficacy of Ovarian Stimulation Protocols on the Success Rate of ICSI in Women With Infertility Problems

Monitoring of Ovulation Stimulation by trans-vaginal ultrasound determining the growth, number and appearance of the ovarian follicles as well as the maturation of the endometrium (measurement of its thickness); Follicles are considered mature when their diameter is greater than 18-20mm and each of them provides 250-300pg/mL of E2. When these criteria are obtained, ovulation is triggered

Selection of embryos for transfer depending on their morphology, and the regularity of blastomers

Determination of βHCG for positive results

Calculations of live birth rate are based on the number of live births in each group divided by all live births, multiplied by 100

Nehman Makdissy

Professor

Lebanese University

Twenty patients, known to us through care at Women's Surgery Center and the private practice of Dr. R. Scott Furr, will be invited to enroll based on a history of pelvic pain and a plan for surgical evaluation and intervention

Ten healthy female patients, without pelvic pain or history of autoimmune disease, will be asked to participate as controls.

lactulose:mannitol (L:M) oral challenge

Erlanger Medical Center

Women's Surgery Center

Intestinal Permeability and Endometriosis

Urine is collected over six hours and is then measured for ratio of L:M. An L:M ratio >0.10 is consistent with increased intestinal permeability. Normally the gut does not absorb lactulose unless permeability is present.

Pathology reported-- endometriosis or no endometriosis

University of Tennessee

Blood and saliva samples, placenta and cord blood collection

endometriosis/نيكوتين

Comparative Study on the Efficacy of Ovarian Stimulation Protocols on the Success Rate of ICSI in Female Infertility

Intestinal Permeability and Endometriosis

Perinatal Consequences of Endometriosis

قاعدة بيانات الأعشاب الطبية الأكثر اكتمالا التي يدعمها العلم