Optimal control of dosage decisions in controlled ovarian hyperstimulation
نویسندگان
چکیده
In the controlled ovarian hyperstimulation (COH) cycle of the in vitro fertilizationembryo transfer (IVF-ET) therapy, the clinicians observe the patients’ responses to gonadotropin dosages through closely monitoring their physiological states, to balance the trade-off between pregnancy rate and ovarian hyperstimulation syndrome (OHSS) risk. In this paper, we model the clinical practice in the COH treatment cycle as a stochastic dynamic program, to capture the dynamic decision process and to account for each individual patient’s stochastic responses to gonadotropin administration. We discretize the problem into a Markov decision process and solve it using a slightly modified backward dynamic programming algorithm. We then evaluate the policies using simulation and explore the impact of patient misclassification. More specifically, we focus on patients with polycystic ovary syndrome (PCOS) or potential, that is, the patients that tend to be more sensitive to gonadotropin administration.
منابع مشابه
Approximate dynamic programming algorithms for optimal dosage decisions in controlled ovarian hyperstimulation
In the controlled ovarian hyperstimulation (COH) treatment, clinicians monitor the patients’ physiological responses to gonadotropin administration to tradeoff between pregnancy probability and ovarian hyperstimulation syndrome (OHSS). We formulate the dosage control problem in the COH treatment as a stochastic dynamic program and design approximate dynamic programming (ADP) algorithms to overc...
متن کاملEffects of Steroid Hormone Levels on the Ultrasound Appearance of the Preovulatory Endometrium in Controlled Hyperstimulation Cycles Ovarian
متن کامل
میزان پاسخدهی تخمدان به تحریک تخمکگذاری در سیکل IVF متعاقب سیستکتومی لاپاراسکوپیک اندومتریومای تخمدان
Background: Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF (In vitro fertilization) cycle following laparoscopic unilateral cystectomy of endometriom...
متن کاملInvestigation of risk factors of ovarian hyperstimulation syndrom in infertile patients attending infertility center of shariati hospital in Tehran
Ovarian hyperstimulation syndrom(OHSS) is a serious complication of controlled overian hyperstimulation(COH).identifying risk factors of OHSS seems to be an important task because of two main reasons:increasing the incidence of infertility and the fact that around 1-7% of COH leade to OHSS.this study is a case-control study conducted in infertility center at Dr.shariati hospital.75 patients,co...
متن کاملRoles of follicle stimulating hormone and luteinizing hormone in controlled ovarian hyperstimulation.
With the advent of recombinant follicle stimulating hormone (FSH) and luteinizing hormone (LH), free from contamination with each other (Loumaye et al., 1995), it is possible to dissect the individual contributions of FSH and LH to the regulation of ovarian function and to define optimal gonadotrophin usage in controlled ovarian hyperstimulation (COH) (Hillier, 1994). Basic and clinical researc...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Annals OR
دوره 178 شماره
صفحات -
تاریخ انتشار 2010