Assessment of the Role of Serum Luteinizing Hormone and Estradiol Response to Follicle-Stimulating Hormone on In Vitro Fertilization Treatment Outcome

Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques

OBJECTIVE

To investigate the role of exogenous LH in controlled ovarian hyperstimulation for assisted reproductive technologies.

DESIGN

Prospective randomized study.

SETTING

SISMER fertility unit.

PATIENT(S)

Women showing a hyporesponsiveness to FSH under GnRH agonist down-regulation were randomized into three groups: group A (n = 54) received an increased dosage of FSH; group B (n = 54) was administered recombinant LH in addition to the increased dose of FSH; group C (n = 22) was given additional FSH and LH using hMG as a combined drug. Fifty-four age-matched women with no need to increase the FSH dose were included as a control group (D).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Implantation and live birth rate per started cycles.

RESULT(S)

In group B, the pregnancy and implantation rates were statistically higher when compared with groups A and C and did not differ from the control group for normal response. The live birth rate was similar in groups B and D but was half as high in groups A and C.

CONCLUSION(S)

Hyporesponsiveness to FSH could be related to iatrogenic LH deficiency that, in turn, could affect oocyte competence. Addition of a small amount of recombinant LH is able to rescue oocyte competence to produce viable embryos.

Effect of highly purified urinary follicle-stimulating hormone on oocyte and embryo quality

OBJECTIVE

To determine the effects of ovarian stimulation with highly purified urofollitropin on oocyte and embryo quality.

DESIGN

Parallel randomized open-label clinical study.

SETTING

Assisted reproduction centers.

PATIENT(S)

Two hundred sixty-seven infertile couples undergoing IVF/ICSI.

INTERVENTION(S)

All participants underwent standard down-regulation with GnRH analogue. One hundred thirty-three participants received highly purified urinary FSH and 134 controls received recombinant FSH.

MAIN OUTCOME MEASURE(S)

Primary end points were number of morphologically mature oocytes retrieved, embryo quality, and pregnancy and implantation rates. Secondary end points were: total number of days of FSH stimulation, total dose of gonadotropin administered, fertilization rate per number of retrieved oocytes, embryo cleavage rate, live birth and miscarriage rates, endometrial thickness and estradiol level on the day of hCG administration, cancellation rate, and incidence of moderate or severe ovarian hyperstimulation syndrome.

RESULT(S)

Pregnancy and implantation rates were nonsignificantly higher in the urinary FSH group than the recombinant FSH group (46.5% vs. 36.8% and 22.1% vs. 15.8%, respectively). The grade 1 embryo score was significantly higher in the urinary FSH group than the recombinant FSH (42.1% vs. 33.5%), and the live birth rate was nonsignificantly higher in the former group.

CONCLUSION(S)

Highly purified urinary FSH is as effective, efficient, and safe for clinical use as recombinant FSH.