Ivf pregnancy hcg levels twins,22 weeks pregnant with twins contractions,pregnancy twins gender,pregnancy nausea kit - 2016 Feature

Context: A critical body mass of adipose tissue is essential for the normal development of female reproductive functions. 25.Anifandis G, Koutselini E, Louridas K, Liakopoulos V, Leivaditis K, Mantzavinos T, et al.
In order to maximize success rates with in vitro fertilization we want a good number of high quality eggs from the woman.
There are several ovarian stimulation medication protocols that are used to "pump up" the ovaries to make enough follicles and eggs.
The commonly used stimulation regimens include injections of follicle stimulating hormone - FSH. The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.
With ovarian stimulation for in vitro fertilization, the goal is to get approximately 8 to 15 quality eggs at the egg retrieval procedure. We do not want to have overstimulation of the ovaries which can lead to significant discomfort for the woman and in rare cases can result in ovarian hyperstimulation syndrome, OHSS.
We also do not want the ovarian stimulation to be insufficient and only give us a few eggs if we might have been able to obtain more by using higher medication doses, etc.
In vitro fertilization can be successful with a very low number of eggs retrieved, but success rates are substantially higher when more eggs are recovered. Quality control throughout the entire process is very important with in vitro fertilization. We use a GE Voluson E8 ultrasound machine with a computer built-in that can outline and accurately measure the developing follicles. We have found that this method is more precise and reliable as compared to the traditional method - which is usually manual measurements in two dimensions. The HCG injection is given when the estrogen level and the follicle measurements look best for successful outcome.
The egg retrieval is planned for 34-35 hours after HCG injection - shortly before the woman's body might start to release the eggs (ovulate). The minimum number of follicles needed to proceed with in vitro fertilization treatment depends on several factors, including their sizes, age of the woman, results of previous stimulations and the willingness of the couple (and the doctor) to proceed with egg retrieval when there will be a low number of eggs obtained. Some doctors will say that you should have at least 5 that measure 14mm or greater while others might do the egg retrieval with only one follicle. Women that are more likely to be low responders to ovarian stimulation would be those that have low antral counts, those women who are older than about 37, women with elevated FSH levels, and women with other signs of reduced ovarian reserve. Leptin, an adipocyte-derived hormone encoded by the 'Ob' gene has been proposed as a peripheral signal indicating the adequacy of nutritional status for reproductive functions. Overt leptin response to controlled ovarian hyperstimulation negatively correlates with pregnancy outcome in in vitro fertilization­-embryo transfer cycle. Adiposity, plasma leptin concentration and reproductive function in active and sedentary females.
Decreased leptin levels in normal weight women with hypothalamic amenorrhea: The effects of body composition and nutritional intake.
Leptin attenuates follicular apoptosis and accelerates the onset of puberty in immature rats. The adipose gene product, leptin: Evidence of a direct inhibitory role in ovarian function. Synchronicity of frequently sampled 24 h concentrations of circulating leptin, luteinizing hormone and estradiol in healthy women.
Circulating leptin in women: A longitudinal study in the menstrual cycle and during pregnancy. Cloning and characterization of human leptin receptor using a biologically active leptin immunoadhesin. Baseline non-fasting serum leptin concentration to body mass index ratio is predictive of IVF outcomes.
Estradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization-embryo transfer cycles. Evidence that exclusive use of Follistin may produce better pregnancy results than the use of Gonal-F following in vitro fertilization (IVF) - embryo transfer (ET). Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Leptin and ovarian folliculogenesis: Implications for ovulation induction and ART outcomes. Gonadotropin stimulation reduces VEGF expression in the mouse uterus during the peri-implantation period.


Expression of leptin receptor in human endometrium and fluctuation during the menstrual cycle. Role of an estrogen-upregulated 64.0 KDa uterine fluid glycoprotein in improving fertility in women.
Oocyte influences on early development: The regulatory proteins leptin and STAT 3 are polarized in mouse and human oocytes and differentially distributed within the cell of the preimplantation stage embryo. Transvaginal ultrasound measurement of endometrial thickness as a biomarker for estrogen exposure. Clinical outcome of oocyte cryopreservation after slow cooling with a protocol utilizing a high sucrose concebtration. Orsi Molecular Reproduction and Development. Without stimulating medications, the ovaries make and release only 1 mature egg per menstrual cycle (month). Triggering to early or too late reduces success and can sometimes increase the risk for ovarian hyperstimulation (if triggered late).
One of the ways that we have improved quality control in our program is by using highly specialized ultrasound equipment.
However, sometimes the response of the ovaries is poor - and a low number of growing follicles are seen. Most IVF programs in the US want a minimum of about 3-4 mature (or close to mature) follicles. From the volume it calculates an average diameter for each follicle (as if it was a sphere).
Though leptin is widely present in reproductive tissues, its relationship to reproductive hormones is still poorly understood.
Aims: Present investigation attempts to explore ovarian response to secretory profile of leptin and its impact on pregnancy outcome in women undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer (IVF-ET). Settings and Design: Patients enrolled for IVF-ET underwent pituitary-ovarian suppression by 'Long Protocol' GnRH-agonist downregulation followed by ovarian stimulation. Materials and Methods: Sera were procured at different phases of IVF-ET for the assay of estradiol, progesterone, human chorionic gonadotropin, and for leptin. Luteinized granulosa cells were cultured in vitro to evaluate their steroidogenic potential.
Statistical Analysis Used: Statistical analyses were done by student's t-test, ANOVA, and Chi-square tests as applicable. Controversial results have been reported during hormone replacement therapy (HRT), oral contraceptive intake, and ovulatory disorders. Results: Positive correlation was observed between serum and ovarian follicular fluid leptin.
The present study is centered on the objective of evaluating the ovarian response to the circulating leptin level and its impact on pregnancy outcome in women undergoing COH for IVF-ET. A negative correlation was noted between the serum leptin levels and endometrial thickness. Conclusions: Elevated leptin response may exert adverse impacts on pregnancy success during IVF-ET possibly by modulating uterine receptivity. The investigations were performed with the approval from the institutional research ethics board. Gonadotrophin stimulation was commenced only when complete pituitary-ovarian suppression has been achieved by prior administration of GnRH-a. The stimulated cycles were monitored by daily transvaginal ultrasonography (TVS) and intermittent assessment of serum E 2 levels.
The daily dose of gonadotrophin was individualized according to an individual dose-response scheme.
LGCs from the FF of individual patients were collected by centrifugation of follicular contents at 1500 rpm for 10 minutes and pellets were washed two times with HAM F-10. Percoll (50%) column centrifugation was done at 500 rpm for 30 minutes followed by the aspiration of granulosa cells from the interface for culture. Cells were cultured in 15 mm 4-well culture plates (NUNC, Denmark) for 48 hours at 37°C in a humified, 95% air-5% CO 2 incubator (Forma Scientific).
Outcome measures Samples of maternal serum were collected on the day of hCG administration, at the time of oocyte retrieval, and on day 16 post-transfer. Sera were procured after centrifugation and stored at -40°C for the assay of estradiol, progesterone, hCG, and for leptin.
Moreover, based on morphology, oocytes were graded into high quality and dysmature oocytes and accordingly follicular aspirates were categorized under three groups: those yielding high quality oocytes, dysmature oocytes, or no oocyte.


Stimulation outcome was assessed with respect to number of antral follicle produced, number of oocytes retrieved, gradation of oocytes, fertilization, and cleavage rates.
Embryo development was assessed on post-retrieval day 3 (three) on the basis of number and morphology of blastomeres. Among the whole patient population, basal leptin concentrations correlated with BMI [Figure 1].
Maternal serum leptin levels increased significantly from hCG-day to OPU day in ~80% of the patients [Table 2], while in the rest there were very negligible rise. In none of the patients who achieved pregnancy, leptin levels on OPU day increased over 50% of hCG day, and no patient with > 60% leptin increase achieved pregnancy.
There were no differences in the number of retrieved oocytes among women having low, medium, or high FF leptin levels on OPU day [Table 3]. Oocyte retrieval rates were also comparable between the medium and higher serum leptin group. 30% reduction in hCG-stimulated E 2 production was evidenced when granulosa cells were collected from follicles yielding no oocytes [Figure 3]. Rates of fertilization, cleavage, and embryo development were comparable between the oocyte populations collected from low, medium, and high serum or FF leptin levels [Table 3].
There was a gradual rise in E2 production in response to an increment in the hCG dose in all the three groups. The hypothalamic-pituitary control over ovarian functions however is precisely governed by a plethora of external and internal principles including many of ovarian origin. Leptin has emerged as a potential regulator of many reproductive functions including gametogenic and steroidogenic potential of ovary. The major highlights of the present findings include an overall adverse impact of leptin on pregnancy outcome in IVF-ET. During COH, a positive correlation between serum and FF leptin concentrations was noted, but between the follicles leptin level variation was commonly observed.
This signifies that follicles do not produce leptin and different follicles may differentially respond to a common systemic signal. Successful implantation and establishment of pregnancy is dependent on a synchronized interaction between the embryo and secretory endometrium. Impaired uterine receptivity may be a possible factor involved in the high leptin level-associated pregnancy failure. Endometrial thickness is considered an indirect marker of endometrial potential to support pregnancy.
Moreover, expression of leptin mRNA in human secretory endometrium [23] suggests that endometrium may be capable of responding to leptin.
An estrogen up-regulated 64.0 kDa uterine fluid protein is reported to correlate positively with endometrial thickness as well as its receptivity.
On the other hand, quality of transferred embryo plays a crucial role in implantation and pregnancy success. Reports [27] indicate that endometrial thickness bears positive correlation with follicular phase serum estradiol concentration. A significant difference was observed in the endometrial thickness between the three subgroups. We, therefore, hypothesize that increased leptin response to COH may exert adverse impacts on pregnancy success by way of modulating uterine receptivity. This hypothesis gets further support by the observation of successful pregnancy in the cycles characterized by low pre-transfer leptin levels. In our patient population, eight patients had more than one transfer cycles (maximum three) with cryopreserved [28] embryos because of pregnancy failure in the stimulated cycle. It was observed that pregnancy was achieved in the cycles when leptin levels dropped significantly from that of the stimulated cycle. Apparently, a positive correlation was noted between leptin and estradiol, while progesterone exhibited no correlation. In vitro culture studies to evaluate the steroidogenic potential of LGCs collected from follicles with similar leptin milieu but producing mature, immature oocytes or no oocyte responded identically to hCG in the absence of leptin. But a 30% reduction in hCG-induced estradiol production was evident in the presence of leptin when LGCs were collected from follicles producing no oocyte.Taken together, these observations provide possible indication of attenuating effects of leptin on endometrial bed preparation that may be involved in pregnancy failure in women with elevated leptin response. The small population size limits the statistical power to judge the precise correlation; however, elevated leptin response in COH exhibits a trend to adversely impact endometrial bed preparation and consequent pregnancy outcome.



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