If gonadotropin therapy is chosen, it is of utmost importance to exclude ovarian incompetence because this type of treatment is very expensive and is not free of complications. Ultrasonography (US) should be done just before starting the therapy to exclude ovarian cysts. Liver function evaluation should precede CC therapy if history and physical examination findings suggest liver disease. One should rule out disorders of the pituitary, adrenal and thyroid which require specific treatment. This depends on many factors such as the patient’s endocrine profile and general health, her age and financial situation, and the physician’s previous experience.īefore prescribing clomiphene citrate (CC), the physician should be sure that the follicle stimulating hormone (FSH) is not abnormally elevated and that the patient is not hypoestrogenic. Before discussing different methods of monitoring, it is better to divide monitoring into three stages: before starting induction therapy, the period of induction and the period that follows completion of therapy.ĭuring this period, one has to think about which protocol should be offered to the patient. This chapter is concerned, however, with the time period of an IVF cycle which starts just before induction therapy and ends either by the establishment of a biochemical pregnancy, or failure of implantation. In our opinion, monitoring IVF patients begins with the initial infertility work-up, and continues until after delivery. On the other hand, monitoring our patients adds to the common pool of information which increases our knowledge and understanding of human reproduction. On the one hand, it helps the physician to choose the most suitable protocol, or to modify the dose and/or the approach for the protocol being applied in an attempt to obtain the best possible outcome and avoid complications of therapy or of the procedure as a whole. Why monitor the patient? Monitoring serves two purposes. The term " monitoring " means " close continuous observation ", so when we refer to monitoring an in vitro fertilization and embryo transfer (IVF-ET) cycle we mean close observation not only of a patient’s initial parameters and her own ovarian response to ovulation induction, but also events after completion of the therapy. University Cantonal Hospital, 1211 Geneva 14, Switzerland Infertility and Gynecologic Endocrinology Clinic, MONITORING IN VITRO FERTILIZATION (IVF) CYCLES
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