1
|
Huang X, Zhao J, Zhang Q, Wang Y, Li Y. Ovarian Stimulation Altered Uterine Fluid Extracellular Vesicles miRNA Affecting Implantation in Rats. Reprod Sci 2024; 31:1683-1694. [PMID: 38216776 DOI: 10.1007/s43032-023-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
Uterine fluid (UF) extracellular vesicle (EV) miRNA may affect implantation and could be the potential biomarker of endometrial receptivity (ER). Ovarian stimulation (OS) could damage the ER but its mechanism is still unclear. Here, we evaluate the affections of OS on UF EV miRNA expression and implantation. Female rats were divided into three groups: natural cycle or injection with GnRH-a following HP-HMG or u-FSH. UF was collected on the 5th day of gestation. Affinity membrane columns were utilized to isolate EVs from UF, obtained during implantation flushing. The EV miRNAs were sequenced, and five of them were validated by qRT-PCR. HTR-8/Svneo cells were transfected with miR-223-3p mimic and inhibitor, followed by conducting colony formation, invasion, migration, and adhesion assays to assess the cellular functions. In OS groups, the implantation rate decreased (p < 0.05), and the pinopode was damaged in the OS groups. The EVs were isolated from UF, and the differential expression key miRNAs were involved in several regulation pathways, such as cancer, endocrine, and cell cycles, which were correlated with ER and implantation. Among the miRNAs, miR-223-5p greatly differed and was most consistent with the sequencing results, followed by miR-223-3p and miR-98-5P. miR-223-3p promoted HTR-8/SVneo cells grow and ability of invasion, migration, and adhesion. OS altered UF EVs miRNAs affecting implantation in rats, and miR-223-3p might be the key molecule.
Collapse
Affiliation(s)
- Xi Huang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
| | - Jing Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
| | - Qiong Zhang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
| | - Yonggang Wang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China.
- Clinical Research Center for Women's Reproductive Health in Hunan Province, NO.87, Xiangya Road, Kaifu District, Changsha, Hunan, China.
| |
Collapse
|
2
|
Zhang X, Sui Y, Yu L, Zhou M, Zhang C, Liu D, Chen X, Yang L, Sui Y. Population Pharmacokinetic Analysis of Follicle-Stimulating Hormone During Ovarian Stimulation: Relation with Weight, Prolactin and Gene Polymorphism in THADA and ADIPOQ. Clin Pharmacokinet 2023; 62:1493-1507. [PMID: 37632631 DOI: 10.1007/s40262-023-01299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Personalisation strategies of ovarian stimulation for in vitro fertilisation (IVF)/ intracytoplasmic sperm injection (ICSI) treatments using exogenous follicle-stimulating hormone (FSH) have been extensively studied over the past 20 years. This research aimed to develop a FSH population pharmacokinetic (PPK) model taking into account the contribution of gene polymorphisms in Chinese reproductive-age women. METHODS Data from 173 patients undergoing GnRH agonist down-regulation long protocols of IVF/ICSI treatment were collected. PPK analysis was subsequently conducted using the nonlinear mixed-effect model (NONMEM) software. Several covariates, including 18 single nucleotide polymorphisms, demographic factors and biological characteristics, were evaluated. The final PPK model was extensively validated using bootstrapping and normalised prediction error distribution, as well as external validation on an independent group of 35 patients. RESULTS FSH PPK was accurately described by a one-compartment model with first-order absorption. The typical population value of apparent clearance was estimated to be 0.81 L/h [relative standard errors (RSE) 5.3%] with an inter-individual variability (IIV) of 16.0%. The typical apparent distribution volume was 8.36 L (RSE 9.7%, 59.7% IIV), and the absorption rate constant was estimated to be 0.0444 h-1 (RSE 9.1%). Body weight, basal prolactin concentration and the gene ADIPOQ (rs1501299) showed a significant covariate effect on the FSH clearance rate and exposure concentration. Genotypes of THADA (rs12478601) significantly influenced the distribution volume. Simulation results indicated that patients with the TT genotype of THADA (rs12478601) required a longer time to reach steady state and had less fluctuation in FSH levels. Model evaluations showed that the final model accurately and precisely described the observed data and demonstrated effective prediction performance. CONCLUSION PPK models of FSH have been developed, which could potentially be used for FSH dosage individualisation in the clinical setting. CLINICAL TRIAL REGISTRATION This study has been registered with the Chinese Clinical Trials Registry (ChiCTR2100049142).
Collapse
Affiliation(s)
- Xiaowei Zhang
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China.
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China.
| | - Yu Sui
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
- Key Laboratory of Medical Cell Biology of Ministry of Education, Institute of Health Sciences, China Medical University, Shenyang, China
| | - Lei Yu
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Zhou
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
| | - Chong Zhang
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
| | - Danhua Liu
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
| | - Xinren Chen
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
| | - Liqun Yang
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China
| | - Yang Sui
- NHC Key Laboratory of Reproductive Health and Medical Genetics, China Medical University, Shenyang, China.
- Reproductive Affiliated Hospital of China Medical University, PuHe Street 10, Huanggu District, Shenyang, 110031, China.
| |
Collapse
|
3
|
Li HQ, Pan XL, Su NJ, Lu XP, Chen JQ, Chen XW. Retrospective analysis: The application of human menopausal gonadotropin combined with letrozole for IUI in patients undergoing artificial insemination by husband due to unexplained or mild male factors. Front Endocrinol (Lausanne) 2022; 13:1038433. [PMID: 36605946 PMCID: PMC9810010 DOI: 10.3389/fendo.2022.1038433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the effects of human menopausal gonadotropin (HMG) combined with letrozole (LE) to HMG only for ovarian stimulation on pregnancy outcome of infertile patients undergoing artificial insemination by husband (AIH) due to unexplained or mild male factors. MATERIALS AND METHODS Infertile patients with unexplained or mild male factors treated from July 2015 to December 2021 were selected as subjects. The patients were divided into two groups according to the ovarian stimulation schemes they received, namely HMG combined with LE or HMG only. We analyzed the laboratory examination results before drug treatment (baseline) and during ovarian stimulation and compared the pregnancy outcomes of the two groups using univariable analysis and multivariable logistic regression analysis. RESULTS In total, 526 cycles of 372 couples were included. The univariate analysis showed that the clinical pregnancy rate of the HMG combined with LE group was 24.8%, significantly higher than that of the HMG group (14.8%, P = 0.007). The live birth rate (19.9%) of the HMG combined with LE group were also significantly higher than those of the HMG group (11.2%, respectively). In multivariate logistic analysis, the age of males was negatively associated with the clinical pregnancy rate (OR 0.874, 95% CI 0.793~0.963, P=0.006) and live birth (OR0.875, 95% CI 0.783~0.977, P=0.018). Moreover, ovarian stimulation with HMG+LE was the only beneficial factor significantly associated with clinical pregnancy (OR 1.929, 95% CI 1.068~3.485, P=0.029) and live birth (OR 2.255, 95% CI 1.188~4.282, P=0.013). CONCLUSION Ovarian stimulation using HMG combined with LE can increase the clinical outcomes (live birth and clinical pregnancy) among infertile patients undergoing AIH due to explained or mild male factors.
Collapse
Affiliation(s)
- Hua-qing Li
- Department of Reproductive Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Xin-ling Pan
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Nian-jun Su
- Department of Reproductive Health and Infertility, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xi-ping Lu
- Department of Reproductive Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Jun-qing Chen
- Department of Reproductive Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Xu-wei Chen
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
- *Correspondence: Xu-wei Chen,
| |
Collapse
|
4
|
Cicek OY, Demir M. The İmpact of gonadotropin type on controlled ovarian stimulation and İntrauterine İnsemination cycle outcomes. J Hum Reprod Sci 2022; 15:51-57. [PMID: 35494204 PMCID: PMC9053343 DOI: 10.4103/jhrs.jhrs_177_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Intrauterine insemination (IUI) combined with controlled ovarian stimulation (COS) results in higher pregnancy rates. However, there is still no consensus on the optimal COS protocol. Aims: In the present study, we aimed to analyse the effects of COS protocols with different gonadotropin types on IUI outcomes. Study Setting and Design: This was a retrospective cohort study conducted at the infertility clinic of a University hospital, including 237 COS + IUI cycles. Materials and Methods: Eligible cycles were divided into three groups according to the type of gonadotropin used for COS; cycles with recombinant follicle-stimulating hormone (rFSH) (group 1, n = 36), highly purified FSH (HP-FSH) (group 2, n = 178) and highly purified menotropin (HP-hMG) (group 3, n = 23). Clinical pregnancy rate (CPR) and live birth rate (LBR) per cycle were compared between groups. Statistical Analysis Used: The Mann–Whitney U test and Kruskal–Wallis test were used to compare numerical variables. Dunn test was used for multiple comparisons. Results: The duration of stimulation and total gonadotropin dose were similar between the three groups (P > 0.05). The CPR was 16.7% in rFSH group, 9.6% in HP-FSH group and 13.0% in HP-hMG group. The LBR was 16.7% in rFSH group, 8.4% in HP-FSH group and 13.0% in HP-hMG group. Both CPR and LBR were comparable in all three groups (P > 0.05). Conclusions: Ovarian stimulation with rFSH, HP-FSH and HP-hMG show similar COS characteristics. Furthermore, these three gonadotropin protocols for COS + IUI yielded comparable CPR and LBR. These findings suggest that all three gonadotropin types (rFSH, HP-FSH, HP-hMG) are similarly effective in COS + IUI cycles.
Collapse
|
5
|
Chen MJ, Yi YC, Guu HF, Chen YF, Kung HF, Chang JC, Chuan ST, Chen LY. A retrospective, matched case-control study of recombinant LH versus hMG supplementation on FSH during controlled ovarian hyperstimulation in the GnRH-antagonist protocol. Front Endocrinol (Lausanne) 2022; 13:931756. [PMID: 36046790 PMCID: PMC9420867 DOI: 10.3389/fendo.2022.931756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/25/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The role of luteinizing hormone (LH) in controlled ovarian hyperstimulation (COH) requires more evidence for its efficacy. Several studies compared recombinant human LH (r-hLH) or human menopausal gonadotropin (hMG) in combination with recombinant human follicle-stimulating hormone (r-hFSH) but lack the results with GnRH-antagonist protocol and in Asians. METHODS This is a retrospective, single-center study inspecting women receiving GnRH antagonist protocol and r-hFSH+hMG or r-hFSH+r-hLH regimen for over five days for COH in the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle in Taiwan from 2013 to 2018. The outcomes of IVF/ICSI cycles were analyzed after propensity score matching between the two groups. A subgroup analysis was conducted in cycles in which women underwent their first embryo transfer (ET), including fresh ET and frozen ET (FET). RESULTS With a total of 503 cycles, the results revealed that the r-hFSH+r-hLH group performed better in terms of numbers of oocytes retrieved (r-hFSH+hMG vs. r-hFSH+r-hLH, 11.7 vs. 13.7, p=0.014), mature oocytes (8.7 vs. 10.9, p=0.001), and fertilized oocytes (8.3 vs. 9.8, p=0.022), while other outcomes were comparable. The analysis of first ET cycles also showed similar trends. Although the implantation rate (39% vs. 43%, p=0.37), pregnancy rate (52% vs. 53%, p=0.90), and live birth rate (39% vs. 45%, p=0.19) were not significantly different, the miscarriage rate was higher in the r-hFSH+hMG group than the r-hFSH+r-hLH group (26% vs. 15%, p<0.05) in first ET cycles. The cumulative pregnancy rate was significantly higher in the r-hFSH+r-hLH group (53% vs. 64%, p=0.02). No significant difference in rates of ovarian hyperstimulation syndrome (OHSS) was observed. CONCLUSION The results support the hypothesis that the treatment of r-hLH+r-hFSH improves COH clinical outcomes in the IVF/ICSI cycle.
Collapse
Affiliation(s)
- Ming-Jer Chen
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Ming-Jer Chen,
| | - Yu-Chiao Yi
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hwa-Fen Guu
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Fang Chen
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Fan Kung
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jui-Chun Chang
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ting Chuan
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Yu Chen
- Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
6
|
Cantineau AE, Rutten AG, Cohlen BJ. Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility. Cochrane Database Syst Rev 2021; 11:CD005356. [PMID: 34739136 PMCID: PMC8570324 DOI: 10.1002/14651858.cd005356.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intrauterine insemination (IUI), combined with ovarian stimulation (OS), has been demonstrated to be an effective treatment for infertile couples. Several agents for ovarian stimulation, combined with IUI, have been proposed, but it is still not clear which agents for stimulation are the most effective. This is an update of the review, first published in 2007. OBJECTIVES To assess the effects of agents for ovarian stimulation for intrauterine insemination in infertile ovulatory women. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trial registers from their inception to November 2020. We performed reference checking and contacted study authors and experts in the field to identify additional studies. SELECTION CRITERIA We included truly randomised controlled trials (RCTs) that compared different agents for ovarian stimulation combined with IUI for infertile ovulatory women concerning couples with unexplained infertility. mild male factor infertility and minimal to mild endometriosis. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. MAIN RESULTS In this updated review, we have included a total of 82 studies, involving 12,614 women. Due to the multitude of comparisons between different agents for ovarian stimulation, we highlight the seven most often reported here. Gonadotropins versus anti-oestrogens (13 studies) For live birth, the results of five studies were pooled and showed a probable improvement in the cumulative live birth rate for gonadotropins compared to anti-oestrogens (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.05 to 1.79; I2 = 30%; 5 studies, 1924 participants; moderate-certainty evidence). This suggests that if the chance of live birth following anti-oestrogens is assumed to be 22.8%, the chance following gonadotropins would be between 23.7% and 34.6%. The pooled effect of seven studies revealed that we are uncertain whether gonadotropins lead to a higher multiple pregnancy rate compared with anti-oestrogens (OR 1.58, 95% CI 0.60 to 4.17; I2 = 58%; 7 studies, 2139 participants; low-certainty evidence). Aromatase inhibitors versus anti-oestrogens (8 studies) One study reported live birth rates for this comparison. We are uncertain whether aromatase inhibitors improve live birth rate compared with anti-oestrogens (OR 0.75, CI 95% 0.51 to 1.11; 1 study, 599 participants; low-certainty evidence). This suggests that if the chance of live birth following anti-oestrogens is 23.4%, the chance following aromatase inhibitors would be between 13.5% and 25.3%. The results of pooling four studies revealed that we are uncertain whether aromatase inhibitors compared with anti-oestrogens lead to a higher multiple pregnancy rate (OR 1.28, CI 95% 0.61 to 2.68; I2 = 0%; 4 studies, 1000 participants; low-certainty evidence). Gonadotropins with GnRH (gonadotropin-releasing hormone) agonist versus gonadotropins alone (4 studies) No data were available for live birth. The pooled effect of two studies revealed that we are uncertain whether gonadotropins with GnRH agonist lead to a higher multiple pregnancy rate compared to gonadotropins alone (OR 2.53, 95% CI 0.82 to 7.86; I2 = 0; 2 studies, 264 participants; very low-certainty evidence). Gonadotropins with GnRH antagonist versus gonadotropins alone (14 studies) Three studies reported live birth rate per couple, and we are uncertain whether gonadotropins with GnRH antagonist improve live birth rate compared to gonadotropins (OR 1.5, 95% CI 0.52 to 4.39; I2 = 81%; 3 studies, 419 participants; very low-certainty evidence). This suggests that if the chance of a live birth following gonadotropins alone is 25.7%, the chance following gonadotropins combined with GnRH antagonist would be between 15.2% and 60.3%. We are also uncertain whether gonadotropins combined with GnRH antagonist lead to a higher multiple pregnancy rate compared with gonadotropins alone (OR 1.30, 95% CI 0.74 to 2.28; I2 = 0%; 10 studies, 2095 participants; moderate-certainty evidence). Gonadotropins with anti-oestrogens versus gonadotropins alone (2 studies) Neither of the studies reported data for live birth rate. We are uncertain whether gonadotropins combined with anti-oestrogens lead to a higher multiple pregnancy rate compared with gonadotropins alone, based on one study (OR 3.03, 95% CI 0.12 to 75.1; 1 study, 230 participants; low-certainty evidence). Aromatase inhibitors versus gonadotropins (6 studies) Two studies revealed that aromatase inhibitors may decrease live birth rate compared with gonadotropins (OR 0.49, 95% CI 0.34 to 0.71; I2=0%; 2 studies, 651 participants; low-certainty evidence). This suggests that if the chance of a live birth following gonadotropins alone is 31.9%, the chance of live birth following aromatase inhibitors would be between 13.7% and 25%. We are uncertain whether aromatase inhibitors compared with gonadotropins lead to a higher multiple pregnancy rate (OR 0.69, 95% CI 0.06 to 8.17; I2=77%; 3 studies, 731 participants; very low-certainty evidence). Aromatase inhibitors with gonadotropins versus anti-oestrogens with gonadotropins (8 studies) We are uncertain whether aromatase inhibitors combined with gonadotropins improve live birth rate compared with anti-oestrogens plus gonadotropins (OR 0.99, 95% CI 0.3 8 to 2.54; I2 = 69%; 3 studies, 708 participants; very low-certainty evidence). This suggests that if the chance of a live birth following anti-oestrogens plus gonadotropins is 13.8%, the chance following aromatase inhibitors plus gonadotropins would be between 5.7% and 28.9%. We are uncertain of the effect of aromatase inhibitors combined with gonadotropins compared to anti-oestrogens combined with gonadotropins on multiple pregnancy rate (OR 1.31, 95% CI 0.39 to 4.37; I2 = 0%; 5 studies, 901 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Based on the available results, gonadotropins probably improve cumulative live birth rate compared with anti-oestrogens (moderate-certainty evidence). Gonadotropins may also improve cumulative live birth rate when compared with aromatase inhibitors (low-certainty evidence). From the available data, there is no convincing evidence that aromatase inhibitors lead to higher live birth rates compared to anti-oestrogens. None of the agents compared lead to significantly higher multiple pregnancy rates. Based on low-certainty evidence, there does not seem to be a role for different combined therapies, nor for adding GnRH agonists or GnRH antagonists in IUI programs.
Collapse
Affiliation(s)
- Astrid Ep Cantineau
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Ben J Cohlen
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, Netherlands
| |
Collapse
|
7
|
Wang Y, Li L, Deng K, Liu J, Liu Y, Zou K, Hao G, Sun X. Comparison of the combination of recombinant follicle-stimulating hormone and recombinant luteinizing hormone protocol versus human menopausal gonadotropin protocol in controlled ovarian stimulation: A systematic review and meta-analysis. J Evid Based Med 2020; 13:215-226. [PMID: 32627395 DOI: 10.1111/jebm.12390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically review the efficacy of a combination of recombinant follicle-stimulating hormone (rFSH) and recombinant luteinizing hormone (rLH) protocol versus human menopausal gonadotropin (hMG) protocol in controlled ovarian stimulation (COS). METHODS PubMed, EMbase, The Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to collect studies published prior to January 2019 on the efficacy of rFSH combined with rLH versus hMG alone in COS. Two reviewers independently screened the literature, conducted the data extraction, and assessed the risk of bias for all selected studies. Then, Review Manager 5.3 software was used for the meta-analysis. RESULTS There were 2767 patients from 9 studies. The results showed that among patients aged >30 years for IUI, the combination of rFSH and rLH was superior to hMG alone in clinical pregnancy rate per patient (relative risk [RR] = 1.47, 95% confidence interval [CI] 1.02 to 2.12) and endometrial thickness (mean difference [MD] = 0.34, 95% CI 0.04 to 0.64). In patients over 30 years old who received IVF, the results tended to favor the combination of rFSH and rLH in clinical pregnancy rate per patient (RR = 4.48, 95% CI 1.15 to 17.46) and live birth rate per started cycle (RR = 1.69, 95% CI 1.96 to 2.71). In patients less than 30 years old who received IVF, the combination of rFSH and rLH was superior to hMG in the number of retrieved oocytes (MD = 3.70, 95% CI 3.27 to 4.13) and inferior to hMG in number of high-quality embryos (MD = -0.60, 95% CI -0.91 to -0.29). CONCLUSION The combination of rFSH and rLH may have better efficacy than hMG alone in COS. However, considering the limited sample size of the included studies, the current evidence is not definitive.
Collapse
Affiliation(s)
- Yuning Wang
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ling Li
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ke Deng
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jiali Liu
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yanmei Liu
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Kang Zou
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| | - Guimin Hao
- Center of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xin Sun
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, PR China
| |
Collapse
|
8
|
Yu X, Cao Z, Hou W, Hu W, Yan G. Effects of letrozole combined with human menopausal gonadotrophin in ovarian stimulation for intrauterine insemination cycles. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:771. [PMID: 32042787 DOI: 10.21037/atm.2019.11.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The effects of letrozole plus human menopausal gonadotropin (HMG) on ovarian stimulation (OS) of intrauterine insemination (IUI) cycles were examined. Methods In all, 1,005 IUI cycles were included in this study. Couples underwent natural cycle (NC) IUI (n=150) or IUI after OS with letrozole (n=207) or IUI after OS with letrozole + HMG (n=648). Results The clinical pregnancy rates were 9.0%, 13.0%, and 17.0%, and the live birth rates were 7.0%, 9.0%, and 14.0% in the NC, letrozole, and letrozole + HMG IUI groups, respectively. The twin pregnancy rate of the letrozole + HMG group (11.0%) was higher than that of the NC (7.0%) and letrozole groups (4.0%). To date, the only triplet pregnancies to occur were in the letrozole + HMG group. On the day of human chorionic gonadotropin (hCG), the number of follicles with an average follicle diameter greater than 18 mm in the letrozole + HMG group (1.21±0.56) and letrozole group (1.14±0.48) was greater than that in the NC group (0.85±0.36). The thickness of the endometrium in the letrozole + HMG group (8.8±2.1 mm) was significantly greater than that in the letrozole group (7.3±1.6 mm). Conclusions The letrozole + HMG protocol of OS in IUI can improve follicular development, increase the thickness of endometrium, significantly increase the live birth rate, but not significantly increase the multiple pregnancy rate.
Collapse
Affiliation(s)
- Xiaoying Yu
- Center of Reproductive Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210000, China.,Center of Reproductive Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241002, China
| | - Zhiwen Cao
- Center of Reproductive Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241002, China
| | - Wenwen Hou
- Center of Reproductive Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241002, China
| | - Weihua Hu
- Center of Reproductive Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241002, China
| | - Guijun Yan
- Center of Reproductive Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210000, China
| |
Collapse
|
9
|
Mennini FS, Marcellusi A, Viti R, Bini C, Carosso A, Revelli A, Benedetto C. Probabilistic cost-effectiveness analysis of controlled ovarian stimulation with recombinant FSH plus recombinant LH vs. human menopausal gonadotropin for women undergoing IVF. Reprod Biol Endocrinol 2018; 16:68. [PMID: 30021630 PMCID: PMC6052706 DOI: 10.1186/s12958-018-0386-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of recombinant FSH plus recombinant LH in 2:1 ratio may be used not only to induce ovulation in anovulatory women with hypogonadotropic hypogonadism but also to achieve multiple follicular developments in human IVF. The aim of this analysis was to estimate the cost-effectiveness of Controlled Ovarian Stimulation (COS) with recombinant FSH (rFSH) plus recombinant LH (rLH) in comparison with highly purified human menopausal gonadotropin (HP-hMG) in the woman undergoing in vitro fertilization (IVF) in Italy. METHODS A probabilistic decision tree was developed to simulate patients undergoing IVF, either using r-FSH + r-LH or HP-hMG to obtain COS. The model considers the National Health System (NHS) perspective and a time horizon equal to two years. Simulations were reported considering the number of retrieved oocytes (5-9, 10-15 and > 15) and transition probabilities were estimated through specific analyses carried out on the population of 848 women enrolled in the real-life. RESULTS The model estimated that patients undertaking therapeutic protocol with r-FSH + r-LH increase the general success rate (+ 6.6% for pregnancy). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) of r-FSH + r-LH was below the willingness to pay set at €20,000 for all the considered scenarios. CONCLUSIONS The cost-utility analysis demonstrated that the r-FSH + r-LH is a cost-effective option for the Italian National Health System (NHS).
Collapse
Affiliation(s)
- F S Mennini
- Economic Evaluation and HTA (CEIS- EEHTA) - Faculty of Economics, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
- Institute for Leadership and Management in Health - Kingston Hill Campus, Kingston Hill, Kingston upon Thames, KT2 7LB, UK
| | - A Marcellusi
- Economic Evaluation and HTA (CEIS- EEHTA) - Faculty of Economics, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
- Institute for Leadership and Management in Health - Kingston Hill Campus, Kingston Hill, Kingston upon Thames, KT2 7LB, UK
| | - R Viti
- Economic Evaluation and HTA (CEIS- EEHTA) - Faculty of Economics, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
| | - C Bini
- Economic Evaluation and HTA (CEIS- EEHTA) - Faculty of Economics, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy.
| | - A Carosso
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Via Ventimiglia 3, 10126, Torino, Italy
| | - A Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Via Ventimiglia 3, 10126, Torino, Italy
- LIVET Infertility and IVF Clinic, Via Tiziano Vecellio, 3, 10126, Torino, Italy
| | - C Benedetto
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, S. Anna Hospital, Via Ventimiglia 3, 10126, Torino, Italy
| |
Collapse
|
10
|
Vitagliano A, Noventa M, Saccone G, Gizzo S, Vitale SG, Laganà AS, Litta PS, Saccardi C, Nardelli GB, Di Spiezio Sardo A. Endometrial scratch injury before intrauterine insemination: is it time to re-evaluate its value? Evidence from a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2018; 109:84-96.e4. [DOI: 10.1016/j.fertnstert.2017.09.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
|
11
|
Effect of Gonadotropin Types and Indications on Homologous Intrauterine Insemination Success: A Study from 1251 Cycles and a Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3512784. [PMID: 29387719 PMCID: PMC5745683 DOI: 10.1155/2017/3512784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022]
Abstract
Objective To evaluate the IUI success factors relative to controlled ovarian stimulation (COS) and infertility type, this retrospective cohort study included 1251 couples undergoing homologous IUI. Results We achieved 13% clinical pregnancies and 11% live births. COS and infertility type do not have significant effect on IUI clinical outcomes with unstable intervention of various couples' parameters, including the female age, the IUI attempt rank, and the sperm quality. Conclusion Further, the COS used seemed a weak predictor for IUI success; therefore, the indications need more discussion, especially in unexplained infertility cases involving various factors. Indeed, the fourth IUI attempt, the female age over 40 years, and the total motile sperm count <5 × 106 were critical in decreasing the positive clinical outcomes of IUI. Those parameter cut-offs necessitate a larger analysis to give infertile couples more chances through IUI before carrying out other ART techniques.
Collapse
|
12
|
Bleau N, Agdi M, Son W, Tan S, Dahan MH. A Comparison of Outcomes from In Vitro Fertilization Cycles Stimulated with Follicle Stimulating Hormone Plus either Recombinant Luteinizing Hormone or Human Menopausal Gonadotropins in Subjects Treated with Long Gonadotropin Releasing Hormone Agonist Protocols. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:79-84. [PMID: 28670424 PMCID: PMC5347454 DOI: 10.22074/ijfs.2017.4759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study compared rates of pregnancy and in vitro fertilization (IVF) parameters in subjects stimulated with follicle stimulating hormone (FSH) plus either recombinant human luteinizing hormone (r-LH) or human menopausal gonadotropin (hMG) in a long gonadotropin releasing hormone (GnRH) agonist IVF protocol. MATERIALS AND METHODS This cohort study enrolled patients who underwent IVF stimu- lation with a long GnRH agonist protocol and received FSH plus r-LH or hMG. Outcomes measured included: FSH and LH doses, number of oocytes and embryos obtained, pregnancy rate per cycle, and clinical pregnancy rate per cycle. Stepwise logistic regression was performed on continuous and categorical variables to control for confounding effects between all variables analyzed. RESULTS There were 122 patients who underwent 122 IVF cycles with long GnRH agonist protocols. Similar baseline parameters existed between groups. Patients that received r-LH required a lower FSH dose (3207 ± 1300 IU) for stimulation compared to the group that received hMG (4213 ± 1576 IU, P=0.0001). The LH dose was also lower in these patients (1332 ± 587 IU) compared to the patients who received hMG (1938 ± 1110 IU, P=0.0001). The number of days of stimulation did not differ between groups (P=1.0). The group that received r-LH also had statistically higher numbers of oocytes (14.4 ± 6.3) and embryos (7.9 ± 4.8) compared to the hMG group with 11.0 ± 5.3 oocytes and 6.0 ± 3.7 embryos. Pregnancy rates per cycle start were higher for patients in the r-LH group (49%) compared to the hMG group (27%, P=0.025). Patients that received r-LH had higher implantation rates (62%) compared to the hMG group (33%, P=0.001). The r-LH group had a higher trend toward clinical pregnancy rates per cycle start (39%) compared to the hMG group (25%, P=0.065). CONCLUSION r-LH may offer benefits compared to hMG when combined with FSH for ovarian stimulation in long GnRH agonist protocols in good responders. Prospective studies should be undertaken to confirm these results.
Collapse
Affiliation(s)
- Nathalie Bleau
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Mohammed Agdi
- Department of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University,
Montreal, Quebec, Canada
| | - WeonYoung Son
- Department of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University,
Montreal, Quebec, Canada
| | - SeangLin Tan
- Department of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University,
Montreal, Quebec, Canada
| | - Michael H Dahan
- Department of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University,
Montreal, Quebec, Canada
| |
Collapse
|
13
|
Zhao Y, Ruan X, Mueck AO. Letrozole combined with low dose highly purified HMG for ovulation induction in clomiphene citrate-resistant infertile Chinese women with polycystic ovary syndrome: a prospective study. Gynecol Endocrinol 2017; 33:462-466. [PMID: 28277124 DOI: 10.1080/09513590.2017.1292241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND AIM There are still open questions about ovulation induction in clomiphene citrate-(CC)-resistant infertile women. Especially little is known about efficacy and safety of letrozole (LTZ) combined with low-dose highly purified human menopausal gonadotropin (Hp-HMG) in women with polycystic ovary syndrome (PCOS). METHODS Prospective, single-arm single-center trial in 200 infertile PCOS patients refractory for at least three CC-treatment cycles. Women with hyperandrogenism took Diane-35 for at least 3 months. All patients got LTZ on day 3 for 5 d in combination with Hp-HMG, starting with 75 IU from cycle day 7 and maintained for up to 3 d. The maximum dose was 150 IU. Primary end-points were ongoing and clinical pregnancy rate, secondary end-points mono-follicular development, ovulation rate, OHSS, multiple pregnancy and early pregnancy loss. Major safety end-point was the incidence of adverse events. RESULTS Within 395 cycles the ongoing pregnancy rate was 28.24%, for cycles 35.23%, for patients 68%. The rate of ovulation per cycle was 97.7%, percentage of mono-follicular development 70.9%. No severe OHSS, multiple pregnancy, local or systemic side effects were seen. CONCLUSIONS LTZ combined with low-dose Hp-HMG is an effective and safe choice for reducing hyperstimulation and increasing pregnancy rate in CC-resistant women with PCOS.
Collapse
Affiliation(s)
- Yue Zhao
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
| | - Xiangyan Ruan
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
- b Department of Women's Health , University Hospital and Faculty of Medicine of the Eberhard Karls University Tuebingen , Tuebingen , Germany
| | - Alfred O Mueck
- a Department of Gynecological Endocrinology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , PR China and
- b Department of Women's Health , University Hospital and Faculty of Medicine of the Eberhard Karls University Tuebingen , Tuebingen , Germany
| |
Collapse
|
14
|
Alsbjerg B, Elbaek HO, Laursen RJ, Povlsen BB, Haahr T, Yding Andersen C, Humaidan P. Bio-equivalent doses of recombinant HCG and recombinant LH during ovarian stimulation result in similar oestradiol output: a randomized controlled study. Reprod Biomed Online 2017; 35:232-238. [PMID: 28532660 DOI: 10.1016/j.rbmo.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
In nature, HCG is secreted by the implanting embryo from peri-implantation and onwards. In contrast, LH is mandatory for steroidogenesis and follicular development during the follicular phase, working in synergy with FSH. Moreover, LH is mandatory for the function of the corpus luteum. Although LH and HCG bind to the same receptor, significant molecular, structural and functional differences exist, inducing differences in bioactivity. This randomized controlled study compared the effect of recombinant FSH stimulation combined with daily either micro-dose recombinant HCG or recombinant LH supplementation in a 1:1 bioactivity ratio from day 1 of stimulation in a long gonadotrophin releasing hormone agonist down regulation protocol. A total of 100 patients from a public clinic completed the study. The primary end-point was the oestradiol level on the day of ovulation trigger and the median oestradiol level in the HCG supplemented group was 8662 pmol/l versus 9203 pmol/l in the recombinant LH supplemented group; therefore, no significant difference was found. Moreover, no differences were observed in the number of oocytes retrieved or in the live birth rate. We conclude that recombinant HCG and recombinant LH are equally effective in boosting oestradiol synthesis during ovarian stimulation when used in a 1:1 bioactivity ratio.
Collapse
Affiliation(s)
- Birgit Alsbjerg
- The Fertility Clinic Skive Region Hospital, Resenvej 25, 7870 Skive, Denmark; Faculty of Health, Aarhus Universitet, Nordre Ringgade 1, 8000 Aarhus C, Denmark
| | - Helle Olesen Elbaek
- The Fertility Clinic Skive Region Hospital, Resenvej 25, 7870 Skive, Denmark
| | | | - Betina Boel Povlsen
- The Fertility Clinic Skive Region Hospital, Resenvej 25, 7870 Skive, Denmark
| | - Thor Haahr
- The Fertility Clinic Skive Region Hospital, Resenvej 25, 7870 Skive, Denmark; Faculty of Health, Aarhus Universitet, Nordre Ringgade 1, 8000 Aarhus C, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Peter Humaidan
- The Fertility Clinic Skive Region Hospital, Resenvej 25, 7870 Skive, Denmark; Faculty of Health, Aarhus Universitet, Nordre Ringgade 1, 8000 Aarhus C, Denmark.
| |
Collapse
|
15
|
Santi D, Casarini L, Alviggi C, Simoni M. Efficacy of Follicle-Stimulating Hormone (FSH) Alone, FSH + Luteinizing Hormone, Human Menopausal Gonadotropin or FSH + Human Chorionic Gonadotropin on Assisted Reproductive Technology Outcomes in the "Personalized" Medicine Era: A Meta-analysis. Front Endocrinol (Lausanne) 2017; 8:114. [PMID: 28620352 PMCID: PMC5451514 DOI: 10.3389/fendo.2017.00114] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
SETTING Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) act on the same receptor, activating different signal transduction pathways. The role of LH or hCG addition to follicle-stimulating hormone (FSH) as well as menopausal gonadotropins (human menopausal gonadotropin; hMG) in controlled ovarian stimulation (COS) is debated. OBJECTIVE To compare FSH + LH, or FSH + hCG or hMG vs. FSH alone on COS outcomes. DESIGN A meta-analysis according to PRISMA statement and Cochrane Collaboration was performed, including prospective, controlled clinical trials published until July 2016, enrolling women treated with FSH alone or combined with other gonadotropins. Trials enrolling women with polycystic ovarian syndrome were excluded (PROSPERO registration no. CRD42016048404). RESULTS Considering 70 studies, the administration of FSH alone resulted in higher number of oocytes retrieved than FSH + LH or hMG. The MII oocytes number did not change when FSH alone was compared to FSH + LH, FSH + hCG, or hMG. Embryo number and implantation rate were higher when hMG was used instead of FSH alone. Pregnancy rate was significantly higher in FSH + LH-treated group vs. others. Only 12 studies reported live birth rate, not providing protocol-dependent differences. Patients' stratification by GnRH agonist/antagonist identified patient subgroups benefiting from specific drug combinations. CONCLUSION In COS, FSH alone results in higher oocyte number. HMG improves the collection of mature oocytes, embryos, and increases implantation rate. On the other hand, LH addition leads to higher pregnancy rate. This study supports the concept of a different clinical action of gonadotropins in COS, reflecting previous in vitro data.
Collapse
Affiliation(s)
- Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda OU of Modena, Modena, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda OU of Modena, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
- *Correspondence: Manuela Simoni,
| |
Collapse
|
16
|
Rinaldi L, Selman H. Profile of follitropin alpha/lutropin alpha combination for the stimulation of follicular development in women with severe luteinizing hormone and follicle-stimulating hormone deficiency. Int J Womens Health 2016; 8:169-79. [PMID: 27307766 PMCID: PMC4888763 DOI: 10.2147/ijwh.s88904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A severe gonadotropin deficiency together with chronic estradiol deficiency leading to amenorrhea characterizes patients suffering from hypogonadotropic hypogonadism. Administration of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to these patients has been shown to be essential in achieving successful stimulation of follicular development, ovulation, and rescue of fertility. In recent years, the availability of both recombinant FSH (rFSH) and recombinant LH (rLH) has provided a new therapeutic option for the stimulation of follicular growth in hypopituitary–hypogonadotropic women (World Health Organization Group I). In this article, we review the data reported in the literature to highlight the role and the efficacy of using recombinant gonadotropins, rFSH and rLH, in the treatment of women with severe LH/FSH deficiency. Although the studies on this issue are limited and the experiences available in the literature are few due to the small number of such patients, it is clearly evident that the recombinant gonadotropins rFSH and rLH are efficient in treating patients affected by hypogonadotropic hypogonadism. The results observed in the studies reported in this review suggest that recombinant gonadotropins are able to induce proper follicular growth, oocyte maturation, and eventually pregnancy in this group of women. Moreover, the clinical use of recombinant gonadotropins in this type of patients has given more insight into some endocrinological aspects of ovarian function that have not yet been fully understood.
Collapse
|
17
|
Labarta E, Bosch E. Comparative study of highly purified HMG versus recombinant FSH+recombinant LH in ovulation induction for intrauterine insemination: A randomized controlled trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.medre.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Casarini L, Riccetti L, De Pascali F, Nicoli A, Tagliavini S, Trenti T, La Sala GB, Simoni M. Follicle-stimulating hormone potentiates the steroidogenic activity of chorionic gonadotropin and the anti-apoptotic activity of luteinizing hormone in human granulosa-lutein cells in vitro. Mol Cell Endocrinol 2016; 422:103-114. [PMID: 26690776 DOI: 10.1016/j.mce.2015.12.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 01/15/2023]
Abstract
Luteinizing hormone (LH) and choriogonadotropin (hCG) are glycoprotein hormones regulating ovarian function and pregnancy, respectively. Since these molecules act on the same receptor (LHCGR), they were traditionally assumed as equivalent in assisted reproduction techniques (ART), although differences between LH and hCG were demonstrated at molecular and physiological level. In this study, we demonstrated for the first time that co-treatment with a follicle-stimulating hormone (FSH) dose in the ART therapeutic range potentiates different LH- and hCG-dependent responses in vitro, measured in terms of cAMP, phospho-CREB, -ERK1/2 and -AKT activation, gene expression, progesterone and estradiol production in human granulosa-lutein cells (hGLC). We show that in the presence of FSH, hCG biopotency is about 5-fold increased, in the presence of FSH, in terms of cAMP activation. Accordingly, CREB phosphorylation and steroid production is increased under hCG and FSH co-treatment. LH effects, evaluated as steroidogenic cAMP/PKA pathway activation, do not change in the presence of FSH, which, however, increases LH-dependent ERK1/2 and AKT, but not CREB phosphorylation, resulting in anti-apoptotic effects. The different modulatory activity of FSH on LH and hCG action in vitro corresponds to their different physiological functions, reflecting proliferative effects exerted by LH during the follicular phase and before trophoblast development, and the high steroidogenic potential of hCG requested to sustain pregnancy from the luteal phase onwards.
Collapse
Affiliation(s)
- Livio Casarini
- Unit of Endocrinology, Dept. Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for the Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.
| | - Laura Riccetti
- Unit of Endocrinology, Dept. Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco De Pascali
- Unit of Endocrinology, Dept. Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Nicoli
- Unit of Obstetrics and Gynecology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | - Giovanni Battista La Sala
- Unit of Obstetrics and Gynecology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Dept. of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Dept. Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for the Genomic Research, University of Modena and Reggio Emilia, Modena, Italy; Dept. of Medicine, Endocrinology, Metabolism and Geriatrics, Azienda USL, Modena, Italy
| |
Collapse
|