Ovulation induction with minimal dose of follitropin alfa: a case series study

Comparison of two different starting doses of recombinant follicle stimulating hormone (rFSH) for intrauterine insemination (IUI) cycles in non-obese women with polycystic ovary syndrome (PCOS): a retrospective cohort study

We aimed to compare the efficacy of two different starting doses of recombinant follicle stimulating hormone (rFSH), 37.5 vs. 75 international units (IU) for intrauterine insemination (IUI) cycles in non-obese women with polycystic ovary syndrome (PCOS). A total of 109 women who underwent first rFSH stimulated IUI cycle were included in this retrospective cohort study. The primary outcome measure was the clinical pregnancy rate. No significant difference was found in terms of clinical pregnancy rate between the two groups (22% for the 37.5-IU group and 24% for the 75-IU group, respectively, p = .808). There was no significant difference in monofollicular development rate among the groups (p = .354). The total rFSH consumption was lower in the 37.5-IU group compared to the 75-IU group (p< .001). There was no statistically significant difference in pregnancy rates between the 37.5-IU and 75-IU groups in both normal weight (BMI: 19-24.9 kg/m²) and overweight (BMI: 25-29.9 kg/m²) women (p = .889 and .518, respectively). These results suggest that the starting doses of 37.5 and 75 IU of rFSH do not show significant difference in clinical pregnancy rates in non-obese PCOS women undergoing IUI cycles.Impact StatementWhat is already known on this subject? Low-dose gonadotropin treatment is advised for women with polycystic ovary syndrome (PCOS). However, there are few comparative data on the efficacy of different starting doses of recombinant follicle stimulating hormone (rFSH) for intrauterine insemination (IUI) cycles in PCOS women.What the results of this study add? There was no statistically significant difference in pregnancy rates of non-obese patients with PCOS having IUI whether rFSH was started at 37.5 or 75 international units (IU).What the implications are of these findings for clinical practice and/or further research? A starting dose of 37.5 IU of rFSH may be a reasonable approach for IUI cycles in non-obese PCOS women.

Mini review: The FDA-approved prescription drugs that induce ovulation in women with ovulatory problems

Infertility is defined as not being able to become pregnant after 12 months or more of unprotected sexual intercourse. Female infertility as a serious health issue can result from ovulation disorders, menstrual cycle problems, structural problems, and environmental factors. Ovulation occurs once a month between the time of menarche and menopause. The release of a mature egg from the ovary is controlled with the hypothalamic-pituitary-ovarian axis. Several hormones such as gonadotropin-releasing hormone (GnRH), FSH (follicle-stimulating hormone), LH (luteinizing hormone), estrogen, and progesterone play fundamental roles in the ovulation process. Both FSH and LH are the main treatment for women with ovulation disorders. Depending on the reasons for infertility, several different types of treatment are available for infertile women. Fertility drugs as an important part of treatment work like the natural hormones to treat infertility. Several fertility drugs can regulate ovulation and the release of an egg from the ovary in women with polycystic ovary syndrome (PCOS) or undergoing in vitro fertilization (IVF) treatment. This mini-review is about the FDA-approved prescription drugs that induce ovulation in women with ovulatory problems.

Pilot study of the optimal protocol of low dose step-up follicle stimulating hormone therapy for infertile women

PURPOSE

To evaluate the optimized protocol of low dose follicle-stimulating hormone (FSH) therapy that has a starting dose of 50 IU/62.5 IU with a small increment dose (12.5 IU) for women with World Health Organization (WHO) II ovulatory disorder and unexplained infertility.

METHODS

Anovulatory women with WHO group II ovulatory disorder (ovulation induction [OI] patients, n = 29), and with an unexplained infertility (ovarian stimulation [OS] patients, n = 21) were enrolled. The protocol of low dose step-up FSH therapy was optimized for the starting dose as 50 IU (body mass index [BMI] < 20 group) and 62.5 IU (BMI ≥ 20 group) with the increment dose of 12.5 IU. Study outcomes were ovulation, monofollicular development and other variables.

RESULTS

In the OIpatients, the ovulation rate was 100% (BMI < 20 group) and 90.9% (BMI ≥ 20 group). Monofollicular development was 80.0% (BMI < 20) and 77.3% (BMI ≥ 20). The pregnancy rate was 60% (3/5 BMI < 20) and 18.2% (4/22 BMI ≥ 20). There was no multiple pregnancy. In the OSpatients, the ovulation rate was 100%. Monofollicular development was 85.7% (BMI < 20) and 76.6% (BMI ≥ 20). No pregnancy was achieved in the OSpatients.

CONCLUSION

Optimized protocol of low dose FSH therapy setting a starting dose 50 IU/62.5 IU by BMI with an increment dose of 12.5 IU was safe and highly effective in WHO group II anovulatory patients. However, this protocol seemed uneffective for patients with unexplained infertility.

Phase IV, open-label, randomized study of low-dose recombinant human follicle-stimulating hormone protocols for ovulation induction

BACKGROUND

This Phase IV, open-label, multicentre, randomized study (MEnTOR) compared two low-dose recombinant human follicle-stimulating hormone (r-hFSH) protocols for ovulation induction.

METHODS

This study was conducted in six Middle Eastern countries between March 2009 and March 2011. Eligible women (18-37 years), with World Health Organization Group II anovulatory infertility, were randomized to receive r-hFSH (starting daily dose: 75 IU) as a chronic low-dose (CLD) (37.5 IU dose increase on Day 14) or low-dose (LD) (37.5 IU dose increase on Day 7) protocol if no follicles were ≥ 10 mm. The maximum r-hFSH daily dose permitted was 225 IU/day. The total length of ovarian stimulation could not exceed 35 days, unless ultrasound assessment suggested imminent follicular growth and maturation. Patients underwent only one treatment cycle. Primary endpoint: incidence of mono-follicular development. Secondary endpoints included: stimulation duration and rates of bi-follicular development; human chorionic gonadotrophin administration rate; clinical pregnancy; and cycle cancellation (owing to inadequate response). Adverse events (AEs) were recorded. The primary efficacy analysis was performed using data from all patients who received at least one dose of correct study medication, had at least one efficacy assessment, and no protocol violations at treatment start (CLD group, n=122; LD group, n=125).

RESULTS

Mono-follicular development rates (primary endpoint) were similar in both groups (CLD: 56.6% [69/122] versus LD: 55.2% [69/125], p=0.93; primary efficacy analysis population). Similarly, there were no significant differences between groups in bi-follicular development, clinical pregnancy or cycle cancellation (inadequate response) rates. In patients who received human chorionic gonadotrophin injections, the mean duration of stimulation was 13.7 days in the CLD group and 12.9 days in the LD group. Clinical pregnancy rates for those patients who received an hCG injection were similar in both groups (CLD: 20.2% [19/94] versus LD: 19.8% [18/91], p=0.94; primary efficacy analysis population). Most AEs were mild in severity. Only one case of ovarian hyperstimulation syndrome was reported (mild; CLD group).

CONCLUSIONS

Efficacy and safety outcomes were similar for the two protocols.