Intracytoplasmic sperm injection after follicle stimulation with highly purified human follicle-stimulating hormone compared with human menopausal gonadotropin

Clinical effects of ovulation induction with recombinant follicle-stimulating hormone supplemented with recombinant luteinizing hormone or low-dose recombinant human chorionic gonadotropin in the midfollicular phase in microdose cycles in poor responders

OBJECTIVE

To assess the clinical effects of recombinant luteinizing hormone (LH) or low-dose recombinant human chorionic gonadotropin (hCG) supplementation administered in the midfollicular phase in microdose gonadotropin-releasing hormone analogue (GnRH-a) flare-up cycles.

DESIGN

Prospective randomized study.

SETTING

Private infertility clinic.

PATIENT(S)

A total of 170 women enrolled, with 145 women eligible for randomization.

INTERVENTION(S)

After randomization, 51 patients (group A) received only 600 IU of recombinant follicle-stimulating hormone (FSH) as the control group, 46 patients (group B) received 600 IU of recombinant FSH plus daily supplementation with 75 IU of recombinant luteinizing hormone, and 48 patients (group C) received 600 IU of recombinant FSH plus daily supplementation with 75 IU of recombinant hCG.

MAIN OUTCOME MEASURE(S)

Peak estradiol (E(2)) levels, days of stimulation with recombinant FSH, total recombinant FSH dosage, metaphase II oocytes retrieved, pregnancy rate (positive hCG levels), clinical pregnancy rate (positive fetal cardiac activity), and cancellation rates of stimulation and embryo transfer.

RESULT(S)

The pregnancy rates were 35.1%, 27.6% and 31.2% for groups A, B, and C, respectively. Clinical pregnancy rates were 27.1%, 27.5, and 21.8% for groups A, B, and C, respectively. There were no statistically significant differences in the age, peak serum E(2) concentration, total recombinant FSH dosage, days of stimulation with recombinant FSH, total number of metaphase II oocytes retrieved, number of embryos transferred, pregnancy rates, clinical pregnancy rates, or cancellation rates of stimulation and embryo transfer among the three groups.

CONCLUSION(S)

Additional exogenous LH activity in the form of either recombinant luteinizing hormone or low-dose recombinant hCG is unnecessary in microdose cycles to increase pregnancy rates.

Current concepts and novel applications of LH activity in ovarian stimulation

Luteinizing hormone (LH) is a crucial physiological regulator of the human menstrual cycle. LH activity is also contained in many medications used to treat anovulation and to stimulate multiple folliculogenesis for assisted reproduction techniques. However, LH activity had previously been regarded as just a contaminant of follicle-stimulating hormone (FSH)-containing products and deemed potentially detrimental for reproductive function. Novel experimental and clinical evidence now suggests that the administration of pharmacological amounts of LH activity, instead of being harmful, is therapeutically advantageous, particularly in the support and modulation of ovarian folliculogenesis. The aim of this article is to provide an overview of the effects of LH activity administration in ovarian stimulation and to outline novel unconventional gonadotropin regimens that might improve the efficacy, safety and convenience of ovulation induction.

Efficacy and safety of highly purified menotropin versus recombinant follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection cycles: a randomized, comparative trial

OBJECTIVE

To demonstrate that highly purified human menopausal gonadotropin (HP-hMG) is as efficient and safe as recombinant FSH in females undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles.

DESIGN

Multinational, open label, randomized, parallel group, comparative phase III trial.

SETTING

In 22 centers across six countries; Belgium (1 center), Germany (6 centers), Israel (6 centers), The Netherlands (2 centers), Switzerland (1 center) and the United Kingdom (6 centers).

PATIENT(S)

A total of 781 women were enrolled between May 1999 and November 2000.

INTERVENTION(S)

In the all-patients-treated population, 373 patients received HP-hMG and 354 received recombinant FSH. A long protocol GnRH agonist regimen was used.

MAIN OUTCOME MEASURE(S)

The primary end point was ongoing pregnancy rate following one IVF/ICSI treatment cycle. Safety was assessed as a secondary end point.

RESULT(S)

Ongoing pregnancy rates 10 weeks after ovum pickup in the per-protocol population were 25% (n = 85/344) in the HP-hMG group and 22% (n = 71/317) in the recombinant FSH group. The incidence of ovarian hyperstimulation syndrome, miscarriage, adverse events, and injection site reactions (tolerability) were similar in both treatment groups.

CONCLUSION(S)

We found HP-hMG to be as effective as recombinant FSH in terms of ongoing clinical pregnancy. Both treatments have a similar safety/tolerability profile.

Simplification of the clinical phase of IVF and ICSI treatment in programmed cycles

OBJECTIVE

To evaluate the success of a protocol for controlled ovarian hyperstimulation allowing patient self-selection into groups for ovulation stimulation planned 8 weeks and more in advance following cycle synchronization, drug self-administration as well as a reduced number of folliculometries.

METHODS

A total of 714 patients received the same stimulation protocol. In 260 cases GnRH-a was applied daily and in 454 as depot. In all patients FSH-HP was self-administered subcutaneously for ovarian stimulation. In 316 patients IVF and in 398 patients ICSI was performed.

RESULTS

The delivery rate per started cycle was higher in patients receiving depot GnRH-a in the IVF and ICSI group (30.2 vs. 23.4) than in those receiving subcutaneous GnRH-a (20.2 vs. 22.1).

CONCLUSION

Programming of the IVF/ICSI cycle greatly simplifies treatment. A comparison of pregnancy rate and delivery rate per cycle between depot and subcutaneous daily application of GnRh-a did not confirm any statistically significant difference.