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Esteves SC, Achermann APP, Miyaoka R, Verza S, Fregonesi A, Riccetto CLZ. Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia. Fertil Steril 2024:S0015-0282(24)00544-2. [PMID: 38909671 DOI: 10.1016/j.fertnstert.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA). DESIGN A cohort study. SETTING University-affiliated male reproductive health center. PATIENT(S) A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history. INTERVENTION(S) Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation. MAIN OUTCOME MEASURE(S) A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success. RESULT(S) The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic. CONCLUSION(S) This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair. CLINICAL TRIAL REGISTRATION NUMBER NCT05110391.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Arnold P P Achermann
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Ricardo Miyaoka
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sidney Verza
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil
| | - Adriano Fregonesi
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cassio L Z Riccetto
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
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Tang D, Song X, Du Y, Wang J, Lei Y, Chen B. Development of a reporter gene-based assay for the bioactivity determination of rhLH pharmaceutical products. Anal Biochem 2024; 686:115413. [PMID: 38040174 DOI: 10.1016/j.ab.2023.115413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023]
Abstract
To establish an in vitro biological activity detection method for luteinizing hormone (LH), the hLHCGR-CREB-HEK293 cell line was constructed to stably express human luteinizing hormone/chorionic gonadotropin receptor (hLHCGR). After optimization, the rhLH starting working concentration was 800 mIU/mL with 4-fold serial dilutions, 10 concentrations and an incubation time of 5 h. The method was confirmed to be highly specific, with good accuracy, precision and linearity, meeting the needs of process research and release testing, and can be used as a routine detection method for LH biological activity. With the increasing demand for research and development of rhLH biologically similar drugs, establishing a stable and simple activity assay method to evaluate the biological activity of rhLH can provide technical support for quality control of rhLH products and powerful tools for comparability research of similar products.
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Affiliation(s)
- Defang Tang
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China
| | - Xiufang Song
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China
| | - Yanjiao Du
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China
| | - Jiaxin Wang
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China
| | - Yuqing Lei
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China
| | - Bin Chen
- Chengdu Jingze Pharmaceutical Co., Ltd, No.1166 Shuangyan Road, Wenjiang District, Chengdu, 611137, China.
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Muneeba S, Acharya N, Mohammad S. The Role of Dydrogesterone in the Management of Luteal Phase Defect: A Comprehensive Review. Cureus 2023; 15:e48194. [PMID: 38050524 PMCID: PMC10693668 DOI: 10.7759/cureus.48194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
The luteal phase of the menstrual cycle is a pivotal period characterized by hormonal intricacies that lay the foundation for successful embryo implantation and early pregnancy development. Luteal phase defect (LPD), marked by abnormalities in luteal function, presents challenges that can impede reproductive outcomes. This comprehensive review article explores the role of dydrogesterone in LPD management, elucidating its mechanisms of action, evidence of efficacy, safety profile, and potential in combination therapies. Dydrogesterone, a synthetic progestogen, closely mirrors natural progesterone's actions, effectively supplementing the luteal phase and enhancing endometrial receptivity. Clinical studies demonstrate improved pregnancy rates, extended luteal phase support, and enhanced reproductive outcomes with dydrogesterone supplementation. Its favorable safety profile, minimal side effects, and reduced risk of unwanted hormonal effects contribute to its appeal. Furthermore, dydrogesterone's inclusion in international guidelines solidifies its importance in LPD management. Combination therapies, leveraging synergistic effects, offer a comprehensive approach. As gaps in knowledge persist, future research directions and personalized treatment strategies pave the way for a future where dydrogesterone stands as a beacon of hope in conquering the challenges of LPD and achieving successful reproductive outcomes.
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Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Di Marco F, Blümel G, Blöchl C, Wuhrer M, Huber CG. A semi-automated hybrid HPLC-MS approach for in-depth characterization of intact non-covalent heterodimer glycoforms of gonadotropin biopharmaceuticals. Anal Chim Acta 2023; 1274:341574. [PMID: 37455084 DOI: 10.1016/j.aca.2023.341574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gonadotropins are a class of heavily glycosylated protein hormones, thus extremely challenging to characterize by mass spectrometry. As biopharmaceuticals, gonadotropins are prescribed for the treatment of infertility and are derived from different sources: either from pooled urine of pregnant women or upon production in genetically modified Chinese Hamster Ovary cells. Human chorionic gonadotropin (hCG) is sold as a biopharmaceutical under the name Pregnyl® (urinary hCG, u-hCG) and Ovitrelle® (recombinant hCG, r-hCG), and recombinant human follicle stimulating hormone (r-hFSH) is marketed as Gonal-f®. Recently, we reported the exhaustive characterization of r-hCG at different structural levels. RESULTS We implement size exclusion (SE) HPLC-MS to automatize the acquisition of native mass spectra of r-hCG dimer, but also u-hCG and r-hFSH, comparing the drug products up to intact heterodimer level. A hybrid HPLC-MS approach was employed for the characterization of r-hCG, u-hCG and r-hFSH drug products at different structural levels. Released glycans were analyzed by porous graphitized carbon (PGC)-HPLC-MS/MS, glycopeptides by reversed-phase (RP)-HPLC-MS/MS, subunits by RP-HPLC-MS and finally the intact native heterodimers by semi-automated online buffer exchange SE-HPLC-MS. The data were integrated using bioinformatic tools, to finally unravel the composition of 1481 co-existing dimeric glycoforms for r-hCG, 1167 glycoforms for u-hCG, and 1440 glycoforms for r-hFSH, and to compare critical quality attributes of the different drug products such as their degree of sialylation and O-glycosylation. SIGNIFICANCE AND NOVELTY The strong alliance of bioanalytics and bioinformatics data integration at the different structural levels allowed the identification of more than thousand different glycoforms of r-hCG, u-hCG, and r-hFSH. The results showed that these biopharmaceuticals differ considerably in their glycosylation patterns and highlight the importance of in-depth characterization of biopharmaceuticals for quality control. © 2017 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Fiammetta Di Marco
- Department of Biosciences and Medical Biology, Bioanalytical Research Labs, University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Gabriele Blümel
- Department of Biosciences and Medical Biology, Bioanalytical Research Labs, University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Constantin Blöchl
- Department of Biosciences and Medical Biology, Bioanalytical Research Labs, University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria; Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Christian G Huber
- Department of Biosciences and Medical Biology, Bioanalytical Research Labs, University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria.
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Strezsak V, Allignol A, Bühler K, Fischer R, Hubbard J, Longobardi S, Lispi M, Schertz J, Verpillat P. Dosing Characteristics of Recombinant Human Luteinizing Hormone or Human Menopausal Gonadotrophin-Derived LH Activity in Patients Undergoing Ovarian Stimulation: A German Fertility Database Study. Gynecol Obstet Invest 2023; 88:214-225. [PMID: 37369184 PMCID: PMC10614274 DOI: 10.1159/000530360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate dosing of recombinant human luteinizing hormone (r-hLH) or human menopausal gonadotrophin (hMG)-derived medications with LH activity in ovarian stimulation (OS) cycles for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). DESIGN A non-interventional study was performed to analyse data from the German RecDate database (January 2007-December 2011). PARTICIPANTS/MATERIALS, SETTING, METHODS Starting/total r-hLH/hMG dose, OS duration/cycle number, r-hLH/hMG initiation day (first day of administration), and population/cycle characteristics were assessed in women (≥18 years) undergoing OS for IVF/ICSI using r-hLH or hMG-derived medications (excluding corifollitropin alfa, clomiphene citrate, letrozole, mini/micro-dose human chorionic gonadotrophin, and urofollitropin alone). Data were summarized descriptively. RESULTS 67,858 identified cycles utilized medications containing r-hLH (10,749), hMG (56,432), or both (677). Mean (standard deviation) OS duration with r-hLH and hMG was 10.1 (4.43) and 9.8 (6.16) days, respectively. Median (25th-75th percentile) r-hLH starting dose (75.0 [75.0-150.0] IU) was consistent across patients regardless of age, infertility diagnosis, or gonadotrophin-releasing hormone (GnRH) protocol. Median (25th-75th percentile) hMG-derived LH activity starting dose was 225.0 (150.0-300.0) IU, regardless of GnRH protocol, but was lower in women aged <35 years and those with ovulation disorders/polycystic ovary syndrome. Median (25th-75th percentile) total dose for r-hLH (750.0 [337.5-1,125.0] IU) and hMG-derived LH activity (1,575.0 [750.0-2,625.0] IU) varied according to patients' age, infertility diagnosis, cycle number, and r-hLH/hMG initiation day. GnRH antagonist use resulted in a numerically higher median total hMG-derived LH activity dose than GnRH agonist use. LIMITATIONS The data used in this study were taken from electronic medical records relating to a specific timeframe (2007-2011) and therefore may not accurately reflect current clinical practice; however, it is likely that the differences between the two compounds would be maintained. Additionally, secondary data sources may suffer from uniformity and quality issues. CONCLUSIONS The standard of care for OS cycles is described with respect to IVF/ICSI treatment including an LH component in Germany during the specified timeframe.
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Affiliation(s)
- Valerie Strezsak
- Global Clinical Development, Research and Development, EMD Serono Research and Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Arthur Allignol
- Global Epidemiology, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Klaus Bühler
- Department of Gynaecology and Reproductive Medicine, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
- Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, Saarbrücken, Germany
| | | | - Julie Hubbard
- Global Clinical Development, Research and Development, EMD Serono Research & Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Salvatore Longobardi
- Global Clinical Development, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Monica Lispi
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Unit of Endocrinology, PhD School of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Joan Schertz
- Global Clinical Development, Research and Development, EMD Serono Research & Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Patrice Verpillat
- Global Epidemiology, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
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6
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Grynberg M, Cedrin-Durnerin I, Raguideau F, Herquelot E, Luciani L, Porte F, Verpillat P, Helwig C, Schwarze JE, Paillet S, Castello-Bridoux C, D'Hooghe T, Benchaïb M. Comparative effectiveness of gonadotropins used for ovarian stimulation during assisted reproductive technologies (ART) in France: A real-world observational study from the French nationwide claims database (SNDS). Best Pract Res Clin Obstet Gynaecol 2023; 88:102308. [PMID: 36707343 DOI: 10.1016/j.bpobgyn.2022.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
This comparative non-interventional study using data from the French National Health Database (Système National des Données de Santé) investigated real-world (cumulative) live birth outcomes following ovarian stimulation, leading to oocyte pickup with either originator recombinant human follicle-stimulating hormone (r-hFSH) products (alfa or beta), r-hFSH alfa biosimilars, or urinaries including mainly HP-hMG (menotropins), and marginally u-hFSH-HP (urofollitropin). Using data from 245,534 stimulations (153,600 women), biosimilars resulted in a 19% lower live birth (adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.86) and a 14% lower cumulative live birth (adjusted hazard ratio (HR) 0.86, 95% CI 0.82-0.89); and urinaries resulted in a 7% lower live birth (adjusted OR 0.93, 95% CI 0.90-0.96) and an 11% lower cumulative live birth (adjusted HR 0.89, 95% CI 0.87-0.91) versus originator r-hFSH alfa. Results were consistent across strata (age and ART strategy), sensitivity analysis using propensity score matching, and with r-hFSH alfa and beta as the reference group.
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Affiliation(s)
- M Grynberg
- Hôpital Antoine Béclère, Service de Médecine de La Reproduction et Préservation de La Fertilité, 92140, Clamart, France; Hôpital Jean Verdier, Service de Médecine de La Reproduction et Préservation de La Fertilité, 93140, Bondy, France.
| | - I Cedrin-Durnerin
- Hôpital Jean Verdier, Service de Médecine de La Reproduction et Préservation de La Fertilité, 93140, Bondy, France.
| | | | | | - L Luciani
- Direction des Affaires Médicales - Real-World Evidence, Merck Santé, 69008, Lyon, France.
| | - F Porte
- Direction des Affaires économiques - Market Access, Merck Santé, 69008, Lyon, France.
| | | | - C Helwig
- Merck Healthcare KGaA, Darmstadt, Germany.
| | | | - S Paillet
- Direction des Affaires Médicales - Fertilité, Merck Santé, 69008, Lyon, France.
| | - C Castello-Bridoux
- Direction des Affaires Médicales - Fertilité, Merck Santé, 69008, Lyon, France.
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Herestraat 49 - Box 805 | B-3000, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, 06510, USA.
| | - M Benchaïb
- Hôpital Mère Enfant, Service de Médecine de La Reproduction et Préservation de La Fertilité, 69500, Bron, France.
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Nevelli F, Palmese A, Gleixner R, Peroglio F, D'Acunto CW, Dadone A, D'Hooghe T, Lispi M. Biological Assay to Determine Gonadotropin Potency: From In Vivo to In Vitro Sustainable Method. Int J Mol Sci 2023; 24:ijms24098040. [PMID: 37175746 PMCID: PMC10178553 DOI: 10.3390/ijms24098040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Various preparations of follicle-stimulating hormone (FSH) are commercially available; however, they differ in glycoforms composition and purity owing to their respective sources. Additional chemical/physical changes can also be introduced during manufacturing and can impact their biological activity (biopotency), which is routinely assessed using an in vivo bioassay (Steelman-Pohley). This study aimed to determine whether an in vitro bioassay could assess biopotency by distinguishing between r-hFSH chemical/physical variants with similar ability to the in vivo bioassay. The specific activity (units of biological activity per mg of product) of variants of r-hFSH generated through enrichment (acidic/basic), stress (oxidative/acidic pH) and enzymatic treatment (desialylation and desialylation/degalactosylation) was compared using the in vivo and in vitro bioassays. The in vitro bioassay reliably detected potential chemical/physical modifications in r-hFSH variants that may impact biopotency. Overall, the methods demonstrated a comparable ability to detect changes in specific activities due to chemical/physical differences in r-hFSH variants. These data indicate that the in vitro bioassay is suitable to replace the in vivo bioassay.
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Affiliation(s)
- Francesco Nevelli
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Angelo Palmese
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Merck Serono S.p.A., Piazza del Pigneto, 9, 00176 Rome, Italy
| | - Ralf Gleixner
- Ares Trading S.A., Rue de l'Ouriette 151, 1170 Aubonne, Switzerland
| | - Flavio Peroglio
- GHO Ivrea QC & Scientific Excellence-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Cosimo-Walter D'Acunto
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Merck Serono S.p.A., Piazza del Pigneto, 9, 00176 Rome, Italy
| | - Aurora Dadone
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St., New Haven, CT 06510, USA
| | - Monica Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
- PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Viale A. Allegri 9, 42121 Reggio Emilia, Italy
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Male infertility and gonadotropin treatment: What can we learn from real-world data? Best Pract Res Clin Obstet Gynaecol 2023; 86:102310. [PMID: 36682942 DOI: 10.1016/j.bpobgyn.2022.102310] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Gonadotropin therapy to treat specific male infertility disorders associated with hypogonadotropic hypogonadism is evidence-based and effective in restoring spermatogenesis and fertility. In contrast, its use to improve fertility in men with idiopathic oligozoospermia or nonobstructive azoospermia remains controversial, despite being widely practiced. The existence of two major inter-related pathways for spermatogenesis, including FSH and intratesticular testosterone, provides a rationale for empiric hormone stimulation therapy in both eugonadal and hypogonadal males with idiopathic oligozoospermia or nonobstructive azoospermia. Real-world data (RWD) on gonadotropin stimulating for these patient subsets, mainly using human chorionic gonadotropin and follicle-stimulating hormone, accumulated gradually, showing a positive therapeutic effect in some patients, translated by increased sperm production, sperm quality, and sperm retrieval rates. Although more evidence is needed, current insights from RWD research indicate that selected male infertility patients might be managed more effectively using gonadotropin therapy, with potential gains for all parties involved.
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A Narrative Review Discussing the Efficiency of Personalized Dosing Algorithm of Follitropin Delta for Ovarian Stimulation and the Reproductive and Clinical Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13020177. [PMID: 36672987 PMCID: PMC9858569 DOI: 10.3390/diagnostics13020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this context, we aimed, in the present manuscript, to gather all available data published between 2018-2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Thus, all post hoc, derived analyses and subsets of patients that participated in subsequent studies support this statement. Conclusions: Despite the relatively limited spectrum of data in the current literature, most authors brought potent proof, supporting the subsequent use of this drug depending on the patient's profile and overcoming ethnic-related limitations. Although others contradict these observations, this topic and drug possess substantial potential, which is why additional studies are mandatory to fill the existing gaps in our knowledge and expand these experiences at a larger scale supported by the obtained reproductive and clinical outcomes that clearly indicate an overcoming of all limitations.
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Uzhviyuk S, Timganova V, Bochkova M, Khramtsov P, Zamorina S. Human Chorionic Gonadotropin in the Regulation of T-Helpers Type 17. BIO WEB OF CONFERENCES 2023. [DOI: 10.1051/bioconf/20235702008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Chorionic gonadotropin (hCG) is a key pregnancy hormone that regulates steroidogenesis and has immunomodulatory activity. We studied the effects of native and recombinant hCG on the differentiation, proliferation, and production of IL-17 and IFN-ɣ by T-helper cells induced into the phenotype of T-helper type 17 (Th17) in vitro. We found that hCG had no significant effects on the level of Th17 cells, as assessed by RORɣτ expression, and the proliferation of these cells (Ki-67+). In addition, no effects of hCG on the production of IL-17 and IFN-ɣ by T-helpers induced in the Th17 phenotype were found. At the same time, recombinant hCG (100 IU/mL) increased the number of non-Th17 T-helpers (RORγt-Ki-67+). Thus, hCG did not modulate Th17 cells in our experimental model.
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Sun X, Yao F, Yin C, Meng M, Lan Y, Yang M, Sun C, Liu L. Independent value of PMOI on hCG day in predicting pregnancy outcomes in IVF/ICSI cycles. Front Endocrinol (Lausanne) 2023; 14:1086998. [PMID: 36909315 PMCID: PMC9997210 DOI: 10.3389/fendo.2023.1086998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine whether, on the day of human chorionic gonadotropin (hCG) injection, the progesterone to number of mature oocytes index (PMOI) can be used alone or together with other parameters in a fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle to predict pregnancy outcome. METHODS This was a retrospective cohort study of all couples who underwent a clinical pregnancy and received a fresh IVE/ICSI cycle at a single large reproductive medical center between June 2019 and March 2022. The study involved a total of 1239 cycles. To analyze risk factors associated with pregnancy outcomes on the day of HCG injection, univariate and multivariate logistic regression analyses were used. The area under the curve (AUC) was determined, and PMOI and other factors were compared using receiver operating characteristic (ROC) curves. RESULTS The clinical pregnancy rate was significantly higher in group A (60.76%) than in the other groups (Group B: 52.92% and Group C:47.88%, respectively, p =0.0306). Univariate and multivariate logistic regression revealed that PMOI levels were significantly correlated with the probability of pregnancy outcome, independent of other risk factors. More importantly, PMOI levels independently predict the occurrence of pregnancy outcome, comparable to the model combining age. The optimal serum PMOI cutoff value for pregnancy outcome was 0.063 ug/L. CONCLUSION Our results suggest that PMOI levels have an independent predictive value for pregnancy outcome in fresh IVF/ICSI cycles.
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Affiliation(s)
- Xingyu Sun
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Reproductive Medicine Center, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Yao
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Muzi Meng
- United Kingdom (UK) Program Site, American University of the Caribbean School of Medicine, Preston, United Kingdom
- Bronxcare Health System, New York City, NY, United States
| | - Yunzhu Lan
- Obstetrics Department, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Hefei, China
| | - Ming Yang
- Obstetrics Department, The First Dongguan Affiliated Hospital Of Guangdong Medical University, Dongguan, China
| | - Chenyu Sun
- Department of Thyroid and Breast Surgery, The Second Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Chenyu Sun, ; Ling Liu,
| | - Ling Liu
- Reproductive Medicine Center, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- *Correspondence: Chenyu Sun, ; Ling Liu,
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12
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Vaiarelli A, Cimadomo D, Scarafia C, Innocenti F, Amendola MG, Fabozzi G, Casarini L, Conforti A, Alviggi C, Gennarelli G, Benedetto C, Guido M, Borini A, Rienzi L, Ubaldi FM. Metaphase-II oocyte competence is unlinked to the gonadotrophins used for ovarian stimulation: a matched case-control study in women of advanced maternal age. J Assist Reprod Genet 2023; 40:169-177. [PMID: 36586005 PMCID: PMC9840736 DOI: 10.1007/s10815-022-02684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/04/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE An impact of different gonadotrophins selection for ovarian stimulation (OS) on oocyte competence has yet to be defined. In this study, we asked whether an association exists between OS protocol and euploid blastocyst rate (EBR) per metaphase-II (MII) oocytes. METHODS Cycles of first preimplantation genetic testing for aneuploidies conducted by women ≥ 35 years old with their own metaphase-II oocytes inseminated in the absence of severe male factor (years 2014-2018) were clustered based on whether recombinant FSH (rec-FSH) or human menopausal gonadotrophin (HMG) was used for OS, then matched for the number of fresh inseminated eggs. Four groups were outlined: rec-FSH (N = 57), rec-FSH plus rec-LH (N = 55), rec-FSH plus HMG (N = 112), and HMG-only (N = 127). Intracytoplasmic sperm injection, continuous blastocyst culture, comprehensive chromosome testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid single embryo transfers (SETs) were performed. The primary outcome was the EBR per cohort of MII oocytes. The secondary outcome was the live birth rate (LBR) per first SETs. RESULTS Rec-FSH protocol was shorter and characterized by lower total gonadotrophin (Gn) dose. The linear regression model adjusted for maternal age showed no association between the Gn adopted for OS and EBR per cohort of MII oocytes. Similarly, no association was reported with the LBR per first SETs, even when adjusting for blastocyst quality and day of full blastulation. CONCLUSION In view of enhanced personalization in OS, clinicians shall focus on different endpoints or quantitative effects related to Gn action towards follicle recruitment, development, and atresia. Here, LH and/or hCG was administered exclusively to women with expected sub/poor response; therefore, we cannot exclude that specific Gn formulations may impact patient prognosis in other populations.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy.
| | - Danilo Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | - Carlotta Scarafia
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | - Federica Innocenti
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
| | | | - Gemma Fabozzi
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, 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
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluca Gennarelli
- Obstetrics and Gynecology 1U, Physiology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
- Livet, GeneraLife IVF, Turin, Italy
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Physiology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Maurizio Guido
- Department of Clinical Medicine, Public Health, Life Sciences and Environment (MeSVA), University of L'Aquila, L'Aquila, Italy
| | | | - Laura Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Via G. de Notaris 2B, 00197, Rome, Italy
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
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13
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Stutz H. Advances and applications of electromigration methods in the analysis of therapeutic and diagnostic recombinant proteins – A Review. J Pharm Biomed Anal 2022; 222:115089. [DOI: 10.1016/j.jpba.2022.115089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
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14
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Manzi L, Sepe N, Migliaccio W, Lanzoni L, Iozzino L, D’Angelo F, Colarusso L, Montenegro S, Palmese A, D’Hooghe T, Ulloa-Aguirre A, Koloda Y, Lispi M. Comparative Assessment of the Structural Features of Originator Recombinant Human Follitropin Alfa Versus Recombinant Human Follitropin Alfa Biosimilar Preparations Approved in Non-European Regions. Int J Mol Sci 2022; 23:ijms23126762. [PMID: 35743204 PMCID: PMC9223809 DOI: 10.3390/ijms23126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022] Open
Abstract
Although the full primary structures of the alfa and beta subunits of reference r-hFSH-alfa and its biosimilars are identical, cell context-dependent differences in the expressing cell lines and manufacturing process can lead to variations in glycosylation profiles. In the present study, we compared the structural features of reference r-hFSH-alfa with those of five biosimilar preparations approved in different global regions outside Europe (Primapur®, Jin Sai Heng®, Follitrope®, Folisurge®, and Corneumon®) with respect to glycosylation, macro- and microheterogeneity, and other post-translational modifications and higher order structure. The mean proportion of N-glycosylation-site occupancy was highest in reference r-hFSH-alfa, decreasing sequentially in Primapur, Jin Sai Heng, Corneumon, Follisurge and Follitrope, respectively. The level of antennarity showed slightly higher complexity in Corneumon, Primapur and Follitrope versus reference r-hFSH-alfa, whereas Jin Sai Heng and Folisurge were aligned with reference r-hFSH-alfa across all N-glycosylation sites. Sialylation level was higher in Corneumon and Follitrope, but small differences were detected in other biosimilar preparations compared with reference r-hFSH-alfa. Jin Sai Heng showed higher levels of N-glyconeuramic acid than the other preparations. Minor differences in oxidation levels were seen among the different products. Therefore, in summary, we identified var ious differences in N-glycosylation occupancy, antennarity, sialylation and oxidation between reference r-hFSH-alfa and the biosimilar preparations analyzed.
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Affiliation(s)
- Lucio Manzi
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Nunzio Sepe
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Walter Migliaccio
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Ludovica Lanzoni
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Luisa Iozzino
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Fabrizia D’Angelo
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Lucia Colarusso
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | | | - Angelo Palmese
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
- Correspondence: (A.P.); (T.D.)
| | - Thomas D’Hooghe
- Merck Healthcare KGaA, 64293 Darmstadt, Germany; (S.M.); (M.L.)
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Herestraat 49-Box 805, B-3000 Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT 06510, USA
- Correspondence: (A.P.); (T.D.)
| | - Alfredo Ulloa-Aguirre
- Research Support Network (RAI), Universidad Nacional Autónoma de México-Instituto Nacional de Ciencias Médicas y Nutrición SZ, Tlalpan, Mexico City 14000, Mexico;
| | - Yulia Koloda
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Centre of Reproduction “Life Line”, 121471 Moscow, Russia;
| | - Monica Lispi
- Merck Healthcare KGaA, 64293 Darmstadt, Germany; (S.M.); (M.L.)
- PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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15
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Laursen RJ, Alsbjerg B, Elbaek HO, Povlsen BB, Jensen KBS, Lykkegaard J, Esteves SC, Humaidan P. Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients – A proof of concept study. Int Braz J Urol 2022. [PMID: 35168313 PMCID: PMC9060167 DOI: 10.1590/s1677-5538.ibju.2022.99.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. Materials and Methods: We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. Results: After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. Conclusion: Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.
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Affiliation(s)
| | - Birgit Alsbjerg
- Skive Regional Hospital, Denmark; Universidade Estadual de Campinas, Brasil
| | | | | | | | | | - Sandro C. Esteves
- Universidade Estadual de Campinas, Brasil; Clínica de Andrologia e Reprodução Humana, Brasil; Aarhus University, Denmark
| | - Peter Humaidan
- Skive Regional Hospital, Denmark; Universidade Estadual de Campinas, Brasil
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16
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Laursen RJ, Alsbjerg B, Elbaek HO, Povlsen BB, Jensen KBS, Lykkegaard J, Esteves SC, Humaidan P. Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients - A proof of concept study. Int Braz J Urol 2022; 48:471-481. [PMID: 35168313 DOI: 10.1590/s1677-5538.ibju.2022.9913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. MATERIALS AND METHODS We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. RESULTS After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. CONCLUSION Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.
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Affiliation(s)
| | - Birgit Alsbjerg
- The Fertility Clinic Skive, Skive Regional Hospital, Denmark.,Departamento de Cirurgia, Divisão de Urologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
| | | | | | | | | | - Sandro C Esteves
- Departamento de Cirurgia, Divisão de Urologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil.,ANDROFERT, Clínica de Andrologia e Reprodução Humana, Campinas, SP, Brasil.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- The Fertility Clinic Skive, Skive Regional Hospital, Denmark.,Departamento de Cirurgia, Divisão de Urologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
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17
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Yoo SK, Mehdi SF, Pusapati S, Mathur N, Anipindi M, Lunenfeld B, Lowell B, Yang H, Metz CN, Khan SA, Leroith D, Roth J. Human Chorionic Gonadotropin and Related Peptides: Candidate Anti-Inflammatory Therapy in Early Stages of Sepsis. Front Immunol 2021; 12:714177. [PMID: 34589085 PMCID: PMC8475184 DOI: 10.3389/fimmu.2021.714177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Sepsis continues to be a major cause of morbidity, mortality, and post-recovery disability in patients with a wide range of non-infectious and infectious inflammatory disorders, including COVID-19. The clinical onset of sepsis is often marked by the explosive release into the extracellular fluids of a multiplicity of host-derived cytokines and other pro-inflammatory hormone-like messengers from endogenous sources ("cytokine storm"). In patients with sepsis, therapies to counter the pro-inflammatory torrent, even when administered early, typically fall short. The major focus of our proposed essay is to promote pre-clinical studies with hCG (human chorionic gonadotropin) as a potential anti-inflammatory therapy for sepsis.
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Affiliation(s)
- Sun Koo Yoo
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Syed Faizan Mehdi
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Suma Pusapati
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Nimisha Mathur
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Manasa Anipindi
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Barbara Lowell
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Huan Yang
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Christine Noel Metz
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Sawleha Arshi Khan
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
| | - Derek Leroith
- Division of Endocrinology, Diabetes & Bone Disease, Icahn School of Medicine at Mt. Sinai, New York, NY, United States
| | - Jesse Roth
- The Feinstein Institutes for Medical Research/Northwell Health, Manhasset, NY, United States
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18
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Bühler KF, Fischer R, Verpillat P, Allignol A, Guedes S, Boutmy E, Bilger W, Richter E, D'Hooghe T. Comparative effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG HP) in assisted reproductive technology (ART) treatments: a non-interventional study in Germany. Reprod Biol Endocrinol 2021; 19:90. [PMID: 34134695 PMCID: PMC8207759 DOI: 10.1186/s12958-021-00768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study compared the effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa; GONAL-f®) with urinary highly purified human menopausal gonadotropin (hMG HP; Menogon HP®), during assisted reproductive technology (ART) treatments in Germany. METHODS Data were collected from 71 German fertility centres between 01 January 2007 and 31 December 2012, for women undergoing a first stimulation cycle of ART treatment with r-hFSH-alfa or hMG HP. Primary outcomes were live birth, ongoing pregnancy and clinical pregnancy, based on cumulative data (fresh and frozen-thawed embryo transfers), analysed per patient (pP), per complete cycle (pCC) and per first complete cycle (pFC). Secondary outcomes were pregnancy loss (analysed per clinical pregnancy), cancelled cycles (analysed pCC), total drug usage per oocyte retrieved and time-to-live birth (TTLB; per calendar week and per cycle). RESULTS Twenty-eight thousand six hundred forty-one women initiated a first treatment cycle (r-hFSH-alfa: 17,725 [61.9%]; hMG HP: 10,916 [38.1%]). After adjustment for confounding variables, treatment with r-hFSH-alfa versus hMG HP was associated with a significantly higher probability of live birth (hazard ratio [HR]-pP [95% confidence interval (CI)]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; relative risk [RR]-pFC [95% CI]: 1.09 [1.05, 1.15], ongoing pregnancy (HR-pP [95% CI]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; RR-pFC [95% CI]: 1.10 [1.05, 1.15]) and clinical pregnancy (HR-pP [95% CI]: 1.10 [1.05, 1.14]; HR-pCC [95% CI]: 1.14 [1.10, 1.19]; RR-pFC [95% CI]: 1.10 [1.06, 1.14]). Women treated with r-hFSH-alfa versus hMG HP had no statistically significant difference in pregnancy loss (HR [95% CI]: 1.07 [0.98, 1.17], were less likely to have a cycle cancellation (HR [95% CI]: 0.91 [0.84, 0.99]) and had no statistically significant difference in TTLB when measured in weeks (HR [95% CI]: 1.02 [0.97, 1.07]; p = 0.548); however, r-hFSH-alfa was associated with a significantly shorter TTLB when measured in cycles versus hMG HP (HR [95% CI]: 1.07 [1.02, 1.13]; p = 0.003). There was an average of 47% less drug used per oocyte retrieved with r-hFSH-alfa versus hMG HP. CONCLUSIONS This large (> 28,000 women), real-world study demonstrated significantly higher rates of cumulative live birth, cumulative ongoing pregnancy and cumulative clinical pregnancy with r-hFSH-alfa versus hMG HP.
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Affiliation(s)
- Klaus F Bühler
- Department of Gynaecology, Jena-University Hospital-Friedrich Schiller University, 07737, Jena, Germany
- Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, 66121, Saarbrücken, Germany
| | - Robert Fischer
- Gynecological Endocrinology and Reproductive Medicine, Fertility Centre Hamburg, 20095, Hamburg, Germany
| | - Patrice Verpillat
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Arthur Allignol
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Sandra Guedes
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Emmanuelle Boutmy
- Global Epidemiology, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Wilma Bilger
- Medical Affairs Fertility, Endocrinology and General Medicine, Merck Serono GmbH, an affiliate of Merck KGaA, Darmstadt, Germany, Alsfelder Str. 17, 64289, Darmstadt, Germany
| | - Emilia Richter
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany.
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven (University of Leuven), Oude Markt 13, 3000, Leuven, Belgium.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St, New Haven, CT, 06510, USA.
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19
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Benmachiche A, Benbouhedja S, Zoghmar A, Al Humaidan PSH. The impact of preovulatory versus midluteal serum progesterone level on live birth rates during fresh embryo transfer. PLoS One 2021; 16:e0246440. [PMID: 33571260 PMCID: PMC7877612 DOI: 10.1371/journal.pone.0246440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conflicting evidence still prevails concerning the effect of preovulatory elevated progesterone (EP4) on reproductive outcomes in fresh embryo transfer (ET). However, few studies have analyzed the effect of EP4 on the likelihood of pregnancy using multivariate regression approach. The potential confounding factors tested in these studies were limited to either patient's characteristics or to stimulation related parameters. Yet, several studies have shown that postovulatory parameters such as midluteal progesterone (P4) level may be considered as a proxy variable of endometrial receptivity as well. OBJECTIVE The aim of the present study was to estimate the independent effect of preovulatory P4 effect, if any, on the probability of live birth (LB) by considering the midluteal endocrine profile when controlling for the potential confounding factors. METHODS This is a secondary data analysis of a cohort of fresh IVF/ICSI cycles triggered with GnRH agonist (n = 328) performed in a single IVF center during the period 2014-2016. Patients contributed only one cycle and were stratified into four groups according to preovulatory P4 quartiles. We assessed the association between preovulatory P4 and the odds of LB calculated by logistic regression analysis after controlling for the most clinically relevant confounders. The primary outcome measure: Live birth rates (LBR). RESULTS Both preovulatory and midluteal P4 were significantly correlated with the ovarian response. Logistic regression analysis showed that preovulatory serum P4 did not have a significant impact on LBR. In contrast, midluteal serum P4 level was an important independent factor associated with LBR. The optimal chance of LBR was achieved with midluteal serum P4 levels of 41-60 ng/ml, [OR: 2.73 (1.29-5.78); p< 0.008]. CONCLUSION The multivariate analysis suggests that the midluteal P4 level seems to impact LBR more than the preovulatory P4 level in women undergoing IVF treatment followed by fresh ET.
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Affiliation(s)
| | | | - Abdelali Zoghmar
- Center for Reproductive Medicine, Ibn-rochd, Constantine, Algeria
| | - Peter Samir Hesjaer Al Humaidan
- The Fertility Clinic, Skive Region Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Al Matari A, Goumenou A, Combès A, Fournier T, Pichon V, Delaunay N. Identification and semi-relative quantification of intact glycoforms of human chorionic gonadotropin alpha and beta subunits by nano liquid chromatography-Orbitrap mass spectrometry. J Chromatogr A 2021; 1640:461945. [PMID: 33556683 DOI: 10.1016/j.chroma.2021.461945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022]
Abstract
The human chorionic gonadotropin (hCG) protein belongs to a family of glycoprotein hormones called gonadotropins. It is a heterodimer made of two non-covalently linked subunits. The α-subunit structure, hCGα, has 2 N-glycosylation sites, while the beta subunit, hCGβ, has 2 N- and 4 O-glycosylation sites. This leads to numerous glycoforms. A method based on the analysis of hCG glycoforms at the intact level by nano-reversed phase liquid chromatography coupled to high resolution mass spectrometry (nanoLC-HRMS) with an Orbitrap analyzer was previously developed using a recombinant hCG-based drug, Ovitrelle®, as standard. It allowed the detection of about 30 hCGα glycoforms, but didn't allow the detection of hCGβ glycoforms. This method was thus here significantly modified (addition of a pre-concentration step of the sample to increase the sample volume from 70 nl to 1 µl, optimization of the gradient slope and the nature and content of the acidic additive in the mobile phase). It led to an improvement of the separation of hCGα and hCGβ glycoforms, which allowed for the first time the detection of 33 hCGβ glycoforms at intact level. In addition, a higher number of hCGα glycoforms (42 in total, i.e. a 40% increase) was detected. The figures of merit of this new method were next assessed. The relative standard deviations (RSDs) of the retention time ranged between 0.02 and 0.95% (n = 3), with an average value of 0.36% for the alpha glycoforms and between 0.01 and 1.08% (n = 3) with an average value of 0.23% for the beta glycoforms. The RSDs of the relative peak area measured on the extracted ion chromatogram of each glycoform were below 20% (n = 3), with an average value of 9.8%, thus allowing semi-relative quantification. Therefore, this method has a high potential for rapid quality control aiming for the detection and comparison of glycoforms present in glycoprotein-based pharmaceutical preparations.
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Affiliation(s)
- Amira Al Matari
- Laboratory of Analytical, Bioanalytical Sciences and Miniaturization, Chemistry, Biology and Innovation (CBI) UMR 8231, ESPCI Paris PSL, CNRS, PSL Research University, Paris, France
| | - Anastasia Goumenou
- Laboratory of Analytical, Bioanalytical Sciences and Miniaturization, Chemistry, Biology and Innovation (CBI) UMR 8231, ESPCI Paris PSL, CNRS, PSL Research University, Paris, France
| | - Audrey Combès
- Laboratory of Analytical, Bioanalytical Sciences and Miniaturization, Chemistry, Biology and Innovation (CBI) UMR 8231, ESPCI Paris PSL, CNRS, PSL Research University, Paris, France
| | - Thierry Fournier
- Université de Paris, INSERM, UMR-S1139, «Pathophysiology & Pharmacotoxicology of the Human Placenta, pre & postnatal Microbiota», 3PHM, F-75006 Paris, France
| | - Valérie Pichon
- Laboratory of Analytical, Bioanalytical Sciences and Miniaturization, Chemistry, Biology and Innovation (CBI) UMR 8231, ESPCI Paris PSL, CNRS, PSL Research University, Paris, France; Sorbonne Université, France
| | - Nathalie Delaunay
- Laboratory of Analytical, Bioanalytical Sciences and Miniaturization, Chemistry, Biology and Innovation (CBI) UMR 8231, ESPCI Paris PSL, CNRS, PSL Research University, Paris, France.
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21
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Dias JA, Ulloa-Aguirre A. New Human Follitropin Preparations: How Glycan Structural Differences May Affect Biochemical and Biological Function and Clinical Effect. Front Endocrinol (Lausanne) 2021; 12:636038. [PMID: 33815292 PMCID: PMC8018285 DOI: 10.3389/fendo.2021.636038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 12/21/2022] Open
Abstract
It is well accepted that pituitary follitropin is secreted into the circulation as a mixture of variants, which differ not in primary structure but rather at the level of glycosylation. These glycosidic forms vary in the number of glycosylation sites filled, complexity of glycosidic chains, and sialylation and sulfation. It is generally agreed that high sialylation, 2,3 sialic acid capping of terminal N-acetyl galactosamine or galactose leads to longer circulating half-life, by blocking binding of asialoglycoprotein receptor (ASGPR) in the liver. In contrast, 2,6 sialic acid found in humans does not prevent recognition of galactose and N-acetyl galactosamine by ASGPR. Few studies on clinical outcomes comparing differences in sialylation of follitropin found in commercially available preparations are available. Thus, there is a clear need for a consortium of open data to address this unmet need. Recently, FSH glycosylation, primarily on the β-subunit, which varies as women age, has emerged as a key modifier of follitropin action, with profound biological effects in vivo in animal models. To date, limited information of recombinant follitropin hormone preparations is available. Thus, most of the studies with FSH that is well characterized biochemically have been done in vitro, with engineered non gonadal host cells bearing recombinant receptors or in animal models. Since limited studies in human granulosa cells are available, a question is whether structural differences in glycosylation in commercially available follitropin affects biological function and clinical effect in humans. The presence of fucose, for example, has not been studied greatly even though, in the case of antibody therapy it has been shown to have a large effect on antibody targeting. This review on glycosidic variability of follitropin from the biochemical/structural point of view reflects on this question and presents an assessment in the context of available published data. If clinical differences are to be expected or not, the readers will have a better understanding of the evidence for and limitations of such expectations.
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Affiliation(s)
- James A. Dias
- Department of Biomedical Sciences, State University of New York at Albany, Albany, NY, United States
- *Correspondence: James A. Dias,
| | - Alfredo Ulloa-Aguirre
- Red de Apoyo a la Investigación, National University of Mexico-Instituto Nacional de Ciencias Médicas y Nutrición SZ., Mexico City, Mexico
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Molés G, Hausken K, Carrillo M, Zanuy S, Levavi-Sivan B, Gómez A. Generation and use of recombinant gonadotropins in fish. Gen Comp Endocrinol 2020; 299:113555. [PMID: 32687933 DOI: 10.1016/j.ygcen.2020.113555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 02/09/2023]
Abstract
Understanding the differential roles of the pituitary gonadotropins Fsh and Lh in gonad maturation is crucial for a successful manipulation of the reproductive process in fish, and requires species-specific tools and appropriate active hormones. With the increasing availability of fish cDNAs coding for gonadotropin subunits, the production of recombinant hormones in heterologous systems has gradually substituted the approach of isolating native hormones. These recombinant hormones can be continually produced without depending on the fish as starting material and no cross-contamination with other pituitary glycoproteins is assured. Recombinant gonadotropins should be produced in eukaryotic cells, which have glycosylation capacity, but this post-translational modification varies greatly depending on the cell system, influencing hormone activity and stability. The production of recombinant gonadotropin beta-subunits to be used as antigens for antibody production has allowed the development of immunoassays for quantification of gonadotropins in some fish species. The administration in vivo of dimeric homologous recombinant gonadotropins has been used in basic studies and as a biotechnological approach to induce gametogenesis. In addition, gene-based therapies using somatic transfer of the gonadotropin genes have been tested as an alternative for hormone delivery in vivo. In summary, the use of homologous hormonal treatments can open new strategies in aquaculture to solve reproductive problems or develop out-of-season breeding programs.
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Affiliation(s)
- G Molés
- Instituto de Acuicultura Torre de la Sal, Consejo Superior de Investigaciones Científicas (CSIC), Ribera de Cabanes s/n, 12595 Castelló, Spain
| | - K Hausken
- The Robert H. Smith Faculty of Agriculture, Food and Environment, Department of Animal Sciences, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - M Carrillo
- Instituto de Acuicultura Torre de la Sal, Consejo Superior de Investigaciones Científicas (CSIC), Ribera de Cabanes s/n, 12595 Castelló, Spain
| | - S Zanuy
- Instituto de Acuicultura Torre de la Sal, Consejo Superior de Investigaciones Científicas (CSIC), Ribera de Cabanes s/n, 12595 Castelló, Spain
| | - B Levavi-Sivan
- The Robert H. Smith Faculty of Agriculture, Food and Environment, Department of Animal Sciences, The Hebrew University of Jerusalem, Rehovot 76100, Israel.
| | - A Gómez
- Instituto de Acuicultura Torre de la Sal, Consejo Superior de Investigaciones Científicas (CSIC), Ribera de Cabanes s/n, 12595 Castelló, Spain.
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23
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Smitz J, Platteau P. Influence of human chorionic gonadotrophin during ovarian stimulation: an overview. Reprod Biol Endocrinol 2020; 18:80. [PMID: 32762698 PMCID: PMC7409634 DOI: 10.1186/s12958-020-00639-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
It is widely known that luteinising hormone (LH) and human chorionic gonadotrophin (hCG) are integral in the female reproductive lifecycle. Due to the common binding site and similarity in molecular structure, they were previously thought to have overlapping roles. However, with the development of both purified urinary-derived and recombinant gonadotrophins, the individual characteristics of these molecules have begun to be defined. There is evidence to suggest that LH and hCG preferentially activate different signalling cascades and display different receptor-binding kinetics. The data generated on the two molecules have led to an improved understanding of their distinct physiological functions, resulting in a debate among clinicians regarding the most beneficial use of LH- and hCG-containing products for ovarian stimulation (OS) in assisted reproductive technologies (ARTs). Over the past few decades, a number of trials have generated data supporting the use of hCG for OS in ART. Indeed, the data indicated that hCG plays an important role in folliculogenesis, leads to improved endometrial receptivity and is associated with a higher quality of embryos, while presenting a favourable safety profile. These observations support the increased use of hCG as a method to provide LH bioactivity during OS. This review summarises the molecular and functional differences between hCG and LH, and provides an overview of the clinical trial data surrounding the use of products for OS that contain LH bioactivity, examining their individual effect on outcomes such as endometrial receptivity, oocyte yield and embryo quality, as well as key pregnancy outcomes.
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Affiliation(s)
- Johan Smitz
- Follicle Biology Laboratory, Vrije Universiteit Brussel, Laarbeeklaan, 103, 1090 Brussels, Belgium
| | - Peter Platteau
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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24
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Al Matari A, Combès A, Camperi J, Fournier T, Pichon V, Delaunay N. Identification and semi-relative quantification of intact glycoforms by nano-LC–(Orbitrap)MS: application to the α-subunit of human chorionic gonadotropin and follicle-stimulating hormone. Anal Bioanal Chem 2020; 412:5729-5741. [DOI: 10.1007/s00216-020-02794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022]
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Human Recombinant FSH and Its Biosimilars: Clinical Efficacy, Safety, and Cost-Effectiveness in Controlled Ovarian Stimulation for In Vitro Fertilization. Pharmaceuticals (Basel) 2020; 13:ph13070136. [PMID: 32605133 PMCID: PMC7407829 DOI: 10.3390/ph13070136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
Exogenous human follicle-stimulating hormone (hFSH), either derived from extraction and purification from the urine or obtained by recombinant technology in the form of follitropin α, β and δ (rFSH), has been used for decades in the treatment of infertility. The main applications of FSH treatment in the woman have been, and still are, ovulation induction in oligo-anovulatory subjects, and stimulation of the development of a cohort of follicles in patients undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF). In the last years, two biosimilars of follitropin alfa, rFSH compounds structurally and functionally similar to the originator, have been approved and marketed for clinical use in Europe. Moreover, some other rFSH biosimilars are currently under investigation. The objective of this article is to review the available evidences comparing the efficacy, safety, and cost-effectiveness of rFSH follitropin alpha originator with its biosimilars, discussing the clinical trials that allowed biosimilars to get registration and marketing authorization.
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Castiglione Morelli MA, Iuliano A, Schettini SCA, Petruzzi D, Ferri A, Colucci P, Viggiani L, Ostuni A. Metabolic changes in follicular fluids of patients treated with recombinant versus urinary human chorionic gonadotropin for triggering ovulation in assisted reproductive technologies: a metabolomics pilot study. Arch Gynecol Obstet 2020; 302:741-751. [PMID: 32462220 DOI: 10.1007/s00404-020-05609-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The main goal of this retrospective cohort study is the assessment of the effects of administration of recombinant-hCG (r-hCG) versus urinary-hCG (u-hCG) on follicular fluid (FF) composition of women who underwent in vitro fertilization (IVF) treatments. MATERIALS AND METHODS We selected 70 patients with infertility attributable to tubal diseases, unexplained infertility, and male factor. Metabolomics analysis of their FFs was performed by 1H nuclear magnetic resonance (1H NMR) spectroscopy in combination with multivariate analysis to interpret the spectral data. Univariate statistical analysis was applied to investigate the possible correlations between clinical parameters and between clinical parameters and metabolites identified by NMR. RESULTS According to the type of hCG used, significant differences were detected in FFs of women with male factor and unexplained infertility, both in qualitative and quantitative terms, for some metabolites as cholesterol, citrate, creatine, β-hydroxybutyrate, glycerol, lipids, amino acids (Glu, Gln, His, Val, Lys) and glucose. No significant difference was observed in women with tubal diseases. Besides, the number of MII oocytes in the u-hCG-treated groups correlates positively with glutamate in tubal disease and with glycerol in unexplained infertility. In the r-hCG-treated groups, the number of MII oocytes correlates positively with lipid in tubal disease, positively with citrate and negatively with glucose in male infertility. CONCLUSIONS Metabolite composition of FF changes according to different type of hCG treatment and this can be related to oocyte development and subsequent outcome. According to the data of this study, different types of hCG should be used in relation to the diagnosis of infertility to obtain better results in inducing oocyte maturation in women undergoing IVF.
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Affiliation(s)
| | - Assunta Iuliano
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | | | - Donatina Petruzzi
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Angela Ferri
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Paola Colucci
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Licia Viggiani
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Angela Ostuni
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy.
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Racca A, Drakopoulos P, Neves AR, Polyzos NP. Current Therapeutic Options for Controlled Ovarian Stimulation in Assisted Reproductive Technology. Drugs 2020; 80:973-994. [DOI: 10.1007/s40265-020-01324-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Vieira M, Glina FPA, Mizrahi FE, Perin PM, Mierzwa TC, Glina S. Is time since vasectomy more important as prognostic factor for pregnancy and live birth than female and laboratory variables when treating vasectomised man using ICSI? Andrologia 2020; 52:e13534. [DOI: 10.1111/and.13534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marcelo Vieira
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
| | | | | | | | - Tiago Cesar Mierzwa
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
| | - Sidney Glina
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
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Antonacci A, Scognamiglio V, Mazzaracchio V, Caratelli V, Fiore L, Moscone D, Arduini F. Paper-Based Electrochemical Devices for the Pharmaceutical Field: State of the Art and Perspectives. Front Bioeng Biotechnol 2020; 8:339. [PMID: 32391344 PMCID: PMC7190989 DOI: 10.3389/fbioe.2020.00339] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/27/2020] [Indexed: 12/19/2022] Open
Abstract
The current international pharmaceutical scenario encompasses several steps in drug production, with complex and extremely long procedures. In the last few decades, scientific research has been trying to offer valid and reliable solutions to replace or support conventional techniques, in order to facilitate drug development procedures. These innovative approaches may have extremely positive effects in the production chain, supplying fast, and cost-effective quality as well as safety tests on active pharmaceutical ingredients (APIs) and their excipients. In this context, the exploitation of electrochemical paper-based analytical devices (ePADs) is still in its infancy, but is particularly promising in the detection of APIs and excipients in tablets, capsules, suppositories, and injections, as well as for pharmacokinetic bioanalysis in real samples.
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Affiliation(s)
- Amina Antonacci
- Department of Chemical Sciences and Materials Technologies, Institute of Crystallography, National Research Council, Rome, Italy
| | - Viviana Scognamiglio
- Department of Chemical Sciences and Materials Technologies, Institute of Crystallography, National Research Council, Rome, Italy
| | - Vincenzo Mazzaracchio
- Department of Chemical Science and Technologies, Tor Vergata University, Rome, Italy
| | - Veronica Caratelli
- Department of Chemical Science and Technologies, Tor Vergata University, Rome, Italy
| | - Luca Fiore
- Department of Chemical Science and Technologies, Tor Vergata University, Rome, Italy
| | - Danila Moscone
- Department of Chemical Science and Technologies, Tor Vergata University, Rome, Italy
| | - Fabiana Arduini
- Department of Chemical Science and Technologies, Tor Vergata University, Rome, Italy.,SENSE4MED, Rome, Italy
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Decleer W, Comhaire F, Balduyck J, Ameye A, Osmanagaoglu K, Devroey P. Replacing HMG/FSH by low-dose HCG to complete corifollitropin alfa stimulation reduces cost per clinical pregnancy: a randomized pragmatic trial. Reprod Biomed Online 2020; 40:468-474. [PMID: 32057673 DOI: 10.1016/j.rbmo.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION The cost of IVF treatment remains high, among other factors because of the medication needed for ovarian stimulation. This study investigated the effect of using low-dose human chorionic gonadotrophin (HCG) for the second phase of follicular maturation after corifollitropin alfa induction, to replace the more expensive, either recombinant or human menopausal gonadotrophin (HMG), on the cost of ovarian stimulation. DESIGN One hundred and five patients were randomly divided into two groups: patients in the HCG group (n = 50) received low-dose HCG from Day 7 until the diameter of at least three follicles reached 17 mm or more, while patients in the FSH group (n = 55) received conventional ovarian stimulation with highly purified HMG injections. RESULTS The clinical pregnancy rate in the HCG group was 38% higher than in the FSH group (number needed to treat, NNT = 13). The cost per pregnancy needed for ovarian stimulation was reduced from €4902 in the FSH group to €2684 in the HCG group. Hence, the cost of ovarian stimulation medication to obtain 10 pregnancies using the conventional FSH protocol is sufficient to attain 18 pregnancies when applying the low-dose HCG protocol. CONCLUSION This study provides evidence that using HCG instead of HMG/FSH for ovarian stimulation results in a significant reduction in the cost of IVF with, at least, an equivalent pregnancy rate.
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Affiliation(s)
- Wim Decleer
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium; IVF Center, AZ Jan Palfijn Gent, Watersportlaan 5, Gent 9000, Belgium.
| | - Frank Comhaire
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium
| | | | - Alice Ameye
- KU Leuven, Oude Markt 13, Leuven 3000, Belgium
| | - Kaan Osmanagaoglu
- IVF Center, AZ Jan Palfijn Gent, Watersportlaan 5, Gent 9000, Belgium
| | - Paul Devroey
- Fertility Clinic, Weststraat 16-18, Aalter 9880, Belgium; Center for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, Jette 1090, Belgium
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Languille S, Massin N, Santulli P, Ozanon C, Kazdar N, Lechat X, Soriano E, Frantz-Blancpain S, Callec R, Guerif F, Anahory T, Rongières C, Chevalier N, Barrière P. Real-world effectiveness of Fertistartkit® treatment in women undergoing ART in French clinical practice: a retrospective multicentre study. Reprod Biomed Online 2020; 40:525-529. [PMID: 32201114 DOI: 10.1016/j.rbmo.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/10/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION What is the real-world effectiveness of Fertistartkit® in women undergoing assisted reproductive technology (ART)? DESIGN Retrospective cohort study including anonymized data of women undergoing ovarian stimulation for ART with Fertistartkit between April 2016 and November 2017 and follow-up of clinical outcomes up to February 2018. Data were collected from the electronic patient databases of 12 French ART centres. The main outcome was number of oocytes retrieved. All data were categorized according to female age (<25, 25-29, 30-34, 35-37, 38-39 and >39 years). RESULTS A total of 1006 cycles from 914 women treated with Fertistartkit were included. At the time of first ovarian stimulation in the study, women were 34.9 ± 5.0 years old, with a median body mass index of 22.7 kg/m². Couples had been infertile for more than 4 years, with all patterns of causes of infertility. Ovarian stimulation was started with a median dose of 300 IU (interquartile range [IQR]: 150-300 IU) of Fertistartkit for 10 days (IQR: 9-11 days), so a median total dose of 2700 IU (IQR: 1800-3300 IU). The mean number of oocytes retrieved per cycle was 9.5 ± 6.8, and the mean number of mature oocytes per cycle was 7.4 ± 5.5. The obtained ongoing pregnancy per started cycle was 26.0% (95% confidence interval [CI]: 24.1-27.9) and the obtained ongoing pregnancy per puncture was 27.0% (95% CI: 25.0-29.0). CONCLUSIONS This is the first cohort to describe Fertistartkit treatment management in real-life conditions. The real-world data show that Fertistartkit is an effective option for ovarian stimulation.
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Affiliation(s)
- Solène Languille
- Monitoring Force Group, 38 Rue Jean Mermoz, Maisons-Laffitte 78600, France.
| | - Nathalie Massin
- Service de Gynécologie-Obstétrique et Reproduction, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est Val de Marne, 40 Avenue de Verdun, Créteil 94000, France
| | - Pietro Santulli
- Faculté de Médecine, Département de Gynécologie, Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, 123 Boulevard de Port-Royal, Paris 75014, France; Institut Cochin, INSERM U1016, Laboratoire d'Immunologie, Université Paris Descartes, Sorbonne Paris Cité, 22 Rue Mechain, Paris 75014, France
| | | | - Nadia Kazdar
- Laboratoire Eylau-Unilabs, Clinique Pierre-Cherest, 5 Rue Pierre-Cherest, Neuilly-sur-Seine 92200, France
| | - Xenia Lechat
- Polyclinique Jean Villar, Avenue Maryse Bastié, Bruges 33520, France
| | - Emilie Soriano
- Laboratoires Genevrier, 280 de Goa Street, ZI des Trois Moulins, Antibes 06600, France
| | - Sandrine Frantz-Blancpain
- Centre Hospitalier Universitaire de Bordeaux, Service de Gynécologie Obstétrique, Place Amélie Raba Léon, Bordeaux 33000, France
| | - Ronan Callec
- Clinique du Val d'Ouest, 39 Chemin de la Vernique, Écully 69130, France
| | - Fabrice Guerif
- Faculté de Médecine, Université de Tours, 10 Boulevard Tonnellé, Tours 37032, France; Service de Médecine et Biologie de la Reproduction, CHRU Bretonneau, 2 Boulevard Tonnellé, Tours 37044, France
| | - Tal Anahory
- Département de Gynécologie Obstétrique et Médecine de la Reproduction, CHU Arnaud-de-Villeneuve, Avenue du Doyen-Gaston-Giraud, Montpellier 34000, France
| | - Catherine Rongières
- Département de Gynécologie, Centre Médico-Chirurgical d'Obstétrique (CMCO), Hôpitaux Universitaires de Strasbourg, 19 Rue Louis Pasteur, Schiltigheim 67303, France
| | - Nicolas Chevalier
- Centre AMP Saint Roch, 550 Avenue du Colonel André Pavelet, Montpellier 34070, France
| | - Paul Barrière
- CHU Nantes, Service de Médecine et Biologie du Développement et de la Reproduction, Nantes Université, Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, 38 Boulevard Jean-Monnet, Nantes 44093, France
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Taheri F, Omidi M, Khalili MA, Agha-Rahimi A, Sabour M, Faramarzi A, Mangoli E. The Determination of Estradiol to Cumulus Oocyte Complex (COC) Number Ratio: Does it Predict the Outcomes of ART Cycles? J Reprod Infertil 2020; 21:11-16. [PMID: 32175261 PMCID: PMC7048692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of total serum E2 on the day of human chronic gonadotropin (hCG) administration and the serum E2 per oocyte ratio on the outcomes of assisted reproductive technology (ART) cycles. METHODS A total of 205 women were categorized into 3 groups according to the serum E2 levels: 1: ≤1500 pg/ml; 2: 1500-3000 pg/ml; 3: >3000 pg/ml. Another categorization included 3 groups according to E2/oocyte ratio: A: ≤150 pg/ml per oocyte; B: 150-200 pg/ml per oocyte; and C: >200 pg/ml per oocyte. The outcome compared between groups included laboratory and clinical characteristics. One-way analysis of variance (ANOVA), chi-square and Kruskal-Wallis, and multiple logistic regression model were performed, and appropriate differences were considered significant at p<0.05. RESULTS There was a significant difference between the groups based on the E2 levels with respect to laboratory parameters. In group C, the rates of chemical pregnancy (54.1%), clinical pregnancy (50%) and live birth (45.8%) were significantly higher, when compared to other groups. Moreover, according to E2/oocyte ratio, the rate of live birth was higher in group C compared with group A (18.3%, p=0.04), and group C (29.7%, p<0.0001). Logistic regression showed the number of good quality embryos was a positive predictor for live birth (odds ratio=2.03, 95% CI=1-4.1), but the level of E2 on day of HCG was a negative predictor (odds ratio=0.99, 95% CI=0.99-1). CONCLUSION Supraphysiological levels of E2 had no adverse effects on the quality of the embryos in IVF cycles, but may have adverse effect on live birth in fresh transfer. Also, it is confirmed that both the pregnancy and live birth rates were elevated with E2/oocyte ratio ≥200 pg/ml.
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Affiliation(s)
- Fatemeh Taheri
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Marjan Omidi
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Khalili
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azam Agha-Rahimi
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Corresponding Author: Azam Agha-Rahimi, Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Bouali Ave., Safaieh, Yazd, Iran, E-mail:
| | - Mojdeh Sabour
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azita Faramarzi
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Esmat Mangoli
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Lunenfeld B, Bilger W, Longobardi S, Alam V, D'Hooghe T, Sunkara SK. The Development of Gonadotropins for Clinical Use in the Treatment of Infertility. Front Endocrinol (Lausanne) 2019; 10:429. [PMID: 31333582 PMCID: PMC6616070 DOI: 10.3389/fendo.2019.00429] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/14/2019] [Indexed: 12/27/2022] Open
Abstract
The first commercially available gonadotropin product was a human chorionic gonadotropin (hCG) extract, followed by animal pituitary gonadotropin extracts. These extracts were effective, leading to the introduction of the two-step protocol, which involved ovarian stimulation using animal gonadotropins followed by ovulation triggering using hCG. However, ovarian response to animal gonadotropins was maintained for only a short period of time due to immune recognition. This prompted the development of human pituitary gonadotropins; however, supply problems, the risk for Creutzfeld-Jakob disease, and the advent of recombinant technology eventually led to the withdrawal of human pituitary gonadotropin from the market. Urinary human menopausal gonadotropin (hMG) preparations were also produced, with subsequent improvements in purification techniques enabling development of products with standardized proportions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity. In 1962 the first reported pregnancy following ovulation stimulation with hMG and ovulation induction with hCG was described, and this product was later established as part of the standard protocol for ART. Improvements in immunopurification techniques enabled the removal of LH from hMG preparations; however, unidentified urinary protein contaminants remained a problem. Subsequently, monoclonal FSH antibodies were used to produce a highly purified FSH preparation containing <0.1 IU of LH activity and <5% unidentified urinary proteins, enabling the formulation of smaller injection volumes that could be administered subcutaneously rather than intramuscularly. Ongoing issues with gonadotropins derived from urine donations, including batch-to-batch variability and a finite donor supply, were overcome by the development of recombinant gonadotropin products. The first recombinant human FSH molecules received marketing approvals in 1995 (follitropin alfa) and 1996 (follitropin beta). These had superior purity and a more homogenous glycosylation pattern compared with urinary or pituitary FSH. Subsequently recombinant versions of LH and hCG have been developed, and biosimilar versions of follitropin alfa have received marketing authorization. More recent developments include a recombinant FSH produced using a human cell line, and a long-acting FSH preparation. These state of the art products are administered subcutaneously via pen injection devices.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Wilma Bilger
- Medical Affairs Fertility, Endocrinology and General Medicine, Merck Serono GmbH, Darmstadt, Germany
| | | | - Veronica Alam
- Global Clinical Development, EMD Serono, Rockland, MA, United States
- A Business of Merck KGaA, Darmstadt, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
- Organ Systems, Group Biomedical Sciences, Department of Development and Regeneration, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, United States
| | - Sesh K. Sunkara
- Assisted Conception Unit, King's College London, Guy's Hospital, London, United Kingdom
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Majumdar A, Sachan R, Nandanwar YS, Mayekar RV, Soni N, Banker MR, Vaidya RS, Arora M, Godbole GP, Daftary GV, Divekar GH, John J. A Multicenter, Randomized, Equivalence Trial of a New Recombinant Human Chorionic Gonadotropin Preparation versus Ovitrelle ® for Ovulation in Women Undergoing Intrauterine Insemination Following Ovarian Stimulation. J Hum Reprod Sci 2019; 12:53-58. [PMID: 31007468 PMCID: PMC6472201 DOI: 10.4103/jhrs.jhrs_101_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Context: A new indigenous recombinant human chorionic gonadotropin (r-hCG) has been developed in India with a comparable pharmacological profile to that of Ovitrelle® (Merck Serono). Aims: This study aims to compare the efficacy and safety of the new r-hCG with that of Ovitrelle for induction of ovulation in women undergoing intrauterine insemination (IUI). Settings and Design: Randomized (2:1), multicenter, open-label, equivalence clinical trial conducted in India. Subjects and Methods: A total of 217 women, aged 20–37 years, undergoing IUI were administered the new r-hCG (test) 250 mcg or Ovitrelle 250 mcg (comparator) after ovarian stimulation with gonadotropins. The ovulation rate was compared as the primary outcome. In addition, pregnancy rates, incidence of adverse events (AEs), and development of immunogenicity were assessed. Statistical Analysis Used: The ovulation and pregnancy rates were compared using Chi-squared test with statistical significance at P < 0.05. Results: With 144 women in the test group and 73 in the comparator group, the ovulation rate (85.4% vs. 78.1%; P = 0.17) and pregnancy rate (serum β hCG test) (11.8% vs. 12.3%; P = 0.91) were similar in both groups. A total of 15 AEs were reported (11 in the test r-hCG group and 4 in the comparator group) in 11 women; none of these were serious, and all were judged to be unrelated to the study drug. No subject developed immunogenic reaction to the test drug. Conclusions: The new preparation of r-hCG was equivalent to the conventional preparation of r-HCG in the induction of ovulation in patients undergoing IUI.
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Affiliation(s)
- Abha Majumdar
- Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Yogeshwar S Nandanwar
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Rahul V Mayekar
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Neelu Soni
- Department of Obstetrics and Gynaecology, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | | | - Rajan S Vaidya
- Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - Manjeet Arora
- Department of Obstetrics and Gynaecology, Batra Hospital and Medical Research Centre, New Delhi, India
| | - Girish P Godbole
- Department of Obstetrics and Gynaecology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Gautam V Daftary
- Research and Development, Bharat Serums and Vaccines Limited, Navi Mumbai, Maharashtra, India
| | - Ganesh H Divekar
- Department of Clinical Research and Pharmacovigilance, Bharat Serums and Vaccines Limited, Navi Mumbai, Maharashtra, India
| | - James John
- Department of Clinical Research and Pharmacovigilance, Bharat Serums and Vaccines Limited, Navi Mumbai, Maharashtra, India
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Seita Y, Iwatani C, Tsuchiya H, Nakamura S, Kimura F, Murakami T, Ema M. Poor second ovarian stimulation in cynomolgus monkeys (Macaca fascicularis) is associated with the production of antibodies against human follicle-stimulating hormone. J Reprod Dev 2019; 65:267-273. [PMID: 30842351 PMCID: PMC6584176 DOI: 10.1262/jrd.2018-156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cynomolgus monkeys (Macaca fascicularis) are a valuable model organism for human disease modeling because human physiology and pathology are closer to those of cynomolgus
monkeys than rodents. It has been widely reported that mature oocytes can be recovered from cynomolgus monkeys through ovarian stimulation by human follicle-stimulating hormone (hFSH).
However, it is unknown whether mature oocytes can be effectively obtained through a second ovarian stimulation by hFSH. Here, we report that some ovaries (eight ovaries from 14 female
monkeys) were stimulated effectively by hFSH even after the first ovum pick up, whereas the others were stimulated poorly by hFSH. Furthermore, we found antibodies against hFSH only in the
serum of female monkeys with poorly stimulated ovaries. Collectively, these data suggest that anti-hFSH antibodies in serum may cause a poor ovarian response to hFSH stimulation. Finally,
detection of such antibodies as well as observation of the ovary over the course of hFSH administration might be useful to predict favorable second ovarian stimulation by hFSH.
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Affiliation(s)
- Yasunari Seita
- Department of Stem Cells and Human Disease Models, Research Center for Animal Life Science, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Chizuru Iwatani
- Department of Stem Cells and Human Disease Models, Research Center for Animal Life Science, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Hideaki Tsuchiya
- Department of Stem Cells and Human Disease Models, Research Center for Animal Life Science, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Shinichiro Nakamura
- Department of Stem Cells and Human Disease Models, Research Center for Animal Life Science, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Masatsugu Ema
- Department of Stem Cells and Human Disease Models, Research Center for Animal Life Science, Shiga University of Medical Science, Shiga 520-2192, Japan.,Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto 606-8501, Japan
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Induction of superovulation in mature mice and rats using serum of spayed female dogs. Lab Anim Res 2019; 34:211-215. [PMID: 30671107 PMCID: PMC6333601 DOI: 10.5625/lar.2018.34.4.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022] Open
Abstract
The following experiments were designed to examine the effect of serum of spayed dogs on superovulation response in mice and rats. In Experiment 1, female mice at diestrus (n=30) were divided into three equal groups and superovulated with either administration of 5 IU pregnant mare serum gonadotropin (PMSG) or recombinant follicle stimulating hormone (rFSH) (reducing dose from 2.5 to 0.5 IU) and 5 IU human chorionic gonadotropin (hCG) administered 48h later. Serum of spayed dogs was administered intraperitoneally at a reduced dose from 0.1 to 0.025 mL in a 48 h period. In Experiment 2, female rats (n=30) at diestrus stage were divided into three equal groups. Superovulation was induced using either 30 IU PMSG, or a dose reduced from 5 to 1 IU rFSH and 25 IU hCG administered 48h later. Serum of spayed dogs was administered in a reduced dose from 0.6 to 0.1 mL in a 48 hour period. Female mice and rats were mated 24 h following hCG administration. On day 14 after mating, animals were euthanized and ovarian sections were fixed for histopathological evaluation and corpus luteum (CL) counting. No significant difference observed in mean (±SEM) number of CLs between the PMSG group and the mice that received serum of spayed dog (10.4±1.3 vs 9.2±1.0). Mean (±SEM) number of CLs tended to be lower in rats that received serum of spayed dog than those of rats which received either PMSG or rFSH (15.1±1.9 vs 23.6±3.1 and 23.1±2.9, P=0.06, respectively). In conclusion, serum of spayed dogs is able to induce a superovulatory response in mice and rats.
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Conforti A, Vaiarelli A, Cimadomo D, Bagnulo F, Peluso S, Carbone L, Di Rella F, De Placido G, Ubaldi FM, Huhtaniemi I, Alviggi C. Pharmacogenetics of FSH Action in the Female. Front Endocrinol (Lausanne) 2019; 10:398. [PMID: 31293516 PMCID: PMC6606727 DOI: 10.3389/fendo.2019.00398] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
The purpose of a pharmacogenomic approach is to tailor treatment on the basis of an individual human genotype. This strategy is becoming increasingly common in medicine, and important results have been obtained in oncologic and antimicrobial therapies. The rapid technological developments and availability of innovative methodologies have revealed the existence of numerous genotypes that can influence the action of medications and give rise to the idea that a true "individualized" approach could become in the future a reality in clinical practice. Moreover, compared to the past, genotype analyses are now more easily available at accessible cost. Concerning human reproduction, there is ample evidence that several variants of gonadotropins and their receptors influence female reproductive health and ovarian response to exogenous gonadotropins. In more detail, variants in genes of follicle-stimulating hormone β-chain (FSH-B) and its receptor (FSH-R) seem to be the most promising candidates for a pharmacogenomic approach to controlled ovarian stimulation in assisted reproductive technologies. In the present review, we summarize the evidence regarding FSH-B and FSH-R variants, with special reference to their impact on reproductive health and assisted reproductive technology treatments.
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Affiliation(s)
- Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
- *Correspondence: Alessandro Conforti
| | - Alberto Vaiarelli
- G.E.N.E.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Danilo Cimadomo
- G.E.N.E.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Francesca Bagnulo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Stefania Peluso
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesca Di Rella
- Medical Oncology, Department of Senology, National Cancer Institute, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giuseppe De Placido
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Filippo Maria Ubaldi
- G.E.N.E.R.A. Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Ilpo Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
- Istituto per l'Endocrinologia e l'Oncologia Sperimentale (IEOS) Consiglio Nazionale delle Ricerche, Naples, Italy
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Zhu X, Fu Y. Randomized, Controlled Pilot Study of Low-Dose Human Chorionic Gonadotropin Administration Beginning From the Early Follicular Phase for Women With Polycystic Ovarian Syndrome Undergoing Ovarian Stimulation Using the Progesterone Protocol. Front Endocrinol (Lausanne) 2019; 10:875. [PMID: 31920984 PMCID: PMC6923733 DOI: 10.3389/fendo.2019.00875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: To illustrate whether low-dose human chorionic gonadotropin (hCG) administration during the early follicular phase could reduce the number of large preovulatory follicles in women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation using the progesterone protocol. Methods: We performed a randomized, controlled pilot trial at a university-affiliated tertiary hospital. A total of 40 infertile women undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment with the freeze-all strategy were included. Human menopausal gonadotropin (hMG) and progesterone soft capsule 100 mg/d were added simultaneously beginning from menstrual cycle day 3 for all participants. Low-dose hCG (200 IU) was injected every 3 days in the study group from the first day of ovarian stimulation until trigger. The primary outcome was the number of large preovulatory follicles. Secondary outcomes included the incidence of ovarian hyperstimulation syndrome (OHSS); the number of oocytes retrieved, mature oocytes, and good-quality embryos; and clinical results after frozen-thawed embryo transfer (FET) cycles. Results: The study group had slightly more large preovulatory follicles than the control group (17.75 ± 10 vs. 13.2 ± 5.34; P > 0.05). None of the participants experienced severe OHSS. There were no statistically significant differences in the number of oocytes retrieved (15.9 ± 8.46 vs. 15.75 ± 6.96), mature oocytes (13.55 ± 6.56 vs. 13.4 ± 6.34), and good-quality embryos (5.5 ± 3.41 vs. 4.9 ± 2.99) between the two groups (P > 0.05). Clinical pregnancy rates (65.52 vs. 41.94%; P = 0.067) and live birth rates (48.28 vs. 35.48%; P = 0.315) per transfer following FET of the study group were higher than those of the control group, but without statistical significance. Conclusions: Administration of low-dose hCG from the early follicular phase for PCOS patients undergoing ovarian stimulation with progesterone protocol may lead to slightly more early preovulatory follicles and marginally, but not significantly, higher clinical pregnancy rates. A continuous trial should be performed to explore the effects of supplementation with different doses of hCG from the start of ovarian stimulation in PCOS patients using the progesterone protocol. Clinical Trial Registration: Chictr.org.cn, identifier: ChiCTR-IOR-15007165.
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Fischer R, Nakano FY, Roque M, Bento FC, Baukloh V, Esteves SC. A quality management approach to controlled ovarian stimulation in assisted reproductive technology: the "Fischer protocol". Panminerva Med 2019; 61:11-23. [DOI: 10.23736/s0031-0808.18.03549-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alviggi C, Conforti A, Esteves SC, Andersen CY, Bosch E, Bühler K, Ferraretti AP, De Placido G, Mollo A, Fischer R, Humaidan P. Recombinant luteinizing hormone supplementation in assisted reproductive technology: a systematic review. Fertil Steril 2018; 109:644-664. [PMID: 29653717 DOI: 10.1016/j.fertnstert.2018.01.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients. DESIGN Systematic review. SETTING Centers for reproductive care. PATIENT(S) Six populations were investigated: 1) women with a hyporesponse to recombinant human FSH (r-hFSH) monotherapy; 2) women at an advanced reproductive age; 3) women cotreated with the use of a GnRH antagonist; 4) women with profoundly suppressed LH levels after the administration of GnRH agonists; 5) normoresponder women to prevent ovarian hyperstimulation syndrome; and 6) women with a "poor response" to ovarian stimulation, including those who met the European Society for Human Reproduction and Embryology Bologna criteria. INTERVENTION(S) Systematic review. MAIN OUTCOME MEASURE(S) Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes. RESULT(S) Recombinant hLH supplementation appears to be beneficial in two subgroups of patients: 1) women with adequate prestimulation ovarian reserve parameters and an unexpected hyporesponse to r-hFSH monotherapy; and 2) women 36-39 years of age. Indeed, there is no evidence that r-hLH is beneficial in young (<35 y) normoresponders cotreated with the use of a GnRH antagonist. The use of r-hLH supplementation in women with suppressed endogenous LH levels caused by GnRH analogues and in poor responders remains controversial, whereas the use of r-hLH supplementation to prevent the development of ovarian hyperstimulation syndrome warrants further investigation. CONCLUSION(S) Recombinant hLH can be proposed for hyporesponders and women 36-39 years of age.
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Affiliation(s)
- Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, São Paulo, Brazil
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, University Hospital of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Klaus Bühler
- Center for Gynecology, Endocrinology, and Reproductive Medicine, Ulm and Stuttgart, Germany
| | | | - Giuseppe De Placido
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Peter Humaidan
- Fertility Clinic, Skive Regional Hospital, Skive, Denmark, and Faculty of Health, Aarhus University, Aarhus, Denmark
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Taheri F, Alemzadeh Mehrizi A, Khalili MA, Halvaei I. The influence of ovarian hyperstimulation drugs on morphometry and morphology of human oocytes in ICSI program. Taiwan J Obstet Gynecol 2018; 57:205-210. [PMID: 29673662 DOI: 10.1016/j.tjog.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the influences of controlled ovarian hyperstimulation (COH) drugs using recombinant follicular stimulating hormone (rFSH) versus human menopausal gonadotropins (hMG) on morphometry and morphology of MII oocytes in ICSI cycles. MATERIALS AND METHODS In this prospective study, 363 MII oocytes from 50 ICSI cycles with male factor infertility were evaluated. The patients were divided into two groups according to the protocols of COH: I- rFSH and II- hMG. The immature oocytes were excluded from the study. All oocytes were categorized into four morphological groups of normal, and those with single, double, or multiple defects. The inclusive morphometrical criteria were: areas and diameters of oocyte, ooplasm, and zona pellucida (ZP). Also, circumferences of oocyte and ooplasm were assessed. RESULTS The ZP area and ooplasm diameter for both normal and abnormal oocytes were significantly higher in group I (P: .05; P: .028, respectively) compared to group II (P: .023; P: .003, respectively). In abnormal oocytes, ooplasm diameter was higher in group I compared to group II. Furthermore, ooplasm area for abnormal oocytes was significantly higher in group I compared to group II. There was an increasing trend for number of mature oocytes, in abnormal oocytes, for group I (5.53 ± 3.1) in comparison with group II (4.4 ± 2.97; P = .25). The rate of oocytes with normal morphology was significantly higher in hMG, when compared to rFSH groups. CONCLUSION Morphometrical parameters were increased in rFSH group, but the normal morphology of oocytes were significantly enhanced in hMG group. Treatment with proper dosage of ovulation induction drugs may enhance the number of normal sized oocytes.
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Affiliation(s)
- Fatemeh Taheri
- Department of Reproductive Biology, Yazd Institute for Reproductive Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Mohammad Ali Khalili
- Department of Reproductive Biology, Yazd Institute for Reproductive Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Iman Halvaei
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Yahyaei M, Mehrnejad F, Naderi-manesh H, Rezayan AH. Protein adsorption onto polysaccharides: Comparison of chitosan and chitin polymers. Carbohydr Polym 2018; 191:191-197. [DOI: 10.1016/j.carbpol.2018.03.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/25/2017] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
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Esteves SC, Khastgir G, Shah J, Murdia K, Gupta SM, Rao DG, Dash S, Ingale K, Patil M, Moideen K, Thakor P, Dewda P. Association Between Progesterone Elevation on the Day of Human Chronic Gonadotropin Trigger and Pregnancy Outcomes After Fresh Embryo Transfer in In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles. Front Endocrinol (Lausanne) 2018; 9:201. [PMID: 29755412 PMCID: PMC5932157 DOI: 10.3389/fendo.2018.00201] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/10/2018] [Indexed: 11/14/2022] Open
Abstract
Progesterone elevation (PE) during the late follicular phase of controlled ovarian stimulation in fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection cycles has been claimed to be associated with decreased pregnancy rates. However, the evidence is not unequivocal, and clinicians still have questions about the clinical validity of measuring P levels during the follicular phase of stimulated cycles. We reviewed the existing literature aimed at answering four relevant clinical questions, namely (i) Is gonadotropin type associated with PE during the follicular phase of stimulated cycles? (ii) Is PE on the day of human chorionic gonadotropin (hCG) associated with negative fresh embryo transfer IVF/intracytoplasmic sperm injection (ICSI) cycles outcomes in all patient subgroups? (iii) Which P thresholds are best to identify patients at risk of implantation failure due to PE in a fresh embryo transfer? and (iv) Should a freeze all policy be adopted in all the cycles with PE on the day of hCG? The existing evidence indicates that late follicular phase progesterone rise in gonadotropin releasing analog cycles is mainly caused by the supraphysiological stimulation of granulosa cells with exogenous follicle-stimulating hormone. Yet, the type of gonadotropin used for stimulation seems to play no significant role on progesterone levels at the end of stimulation. Furthermore, PE is not a universal phenomenon with evidence indicating that its detrimental consequences on pregnancy outcomes do not affect all patient populations equally. Patients with high ovarian response to control ovarian stimulation are more prone to exhibit PE at the late follicular phase. However, in studies showing an overall detrimental effect of PE on pregnancy rates, the adverse effect of PE on endometrial receptivity seems to be offset, at least in part, by the availability of good quality embryo for transfer in women with a high ovarian response. Given the limitations of the currently available assays to measure progesterone at low ranges, caution should be applied to adopt specific cutoff values above which the effect of progesterone rise could be considered detrimental and to recommend "freeze-all" based solely on pre-defined cutoff points.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jatin Shah
- Mumbai Fertility Center – Kamala Polyclinic & Nursing Home, Mumbai, India
| | | | | | - Durga G. Rao
- Oasis Centre for Reproductive Medicine, Hyderabad, India
| | - Soumyaroop Dash
- Srishti Assisted Fertility & Advanced Laparoscopy Center, Srishti Hospital, Moolakulam, India
| | - Kundan Ingale
- Nirmiti Clinic, Centre for Assisted Reproduction, Chinchwad, India
| | | | | | | | - Pavitra Dewda
- Merck Limited, Mumbai, India
- *Correspondence: Pavitra Dewda,
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Patki A, Bavishi H, Kumari C, Kamraj J, Venugopal M, Kunjimoideen KU, Nadkarni P, Sankari S, Chaudhary S, Sangeeta MJ, Manjunath CS, Kumar P. Urinary Versus Recombinant Gonadotropins for Ovarian Stimulation in Women Undergoing Treatment with Assisted Reproductive Technology. J Hum Reprod Sci 2018; 11:119-124. [PMID: 30158806 PMCID: PMC6094533 DOI: 10.4103/jhrs.jhrs_79_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Globally, about 10%-15% couples are affected by infertility, with major role being played by the couple's lifestyle. Several gonadotropin preparations (urinary, purified urinary, recombinant, and biosimilars) are available for use. Purified urinary formulations offer numerous advantages over their predecessor, including lesser injection dose required, ability to be administered subcutaneously, less batch-to-batch variability, better efficacy, ability to individualize protocols as per patient's need, better control of developing follicles, less risk of multiple pregnancies, and hyperstimulation. Published results of Cochrane reviews and meta-analysis show no difference in efficacy or safety between urinary and recombinant gonadotropins. In the absence of any significant difference, cost plays an important role in deciding choice of gonadotropins. In this article, we have reviewed the results of comparative clinical trials, Cochrane analysis, and meta-analysis to derive consensus statements regarding efficacy, safety, and cost implications of urinary versus recombinant gonadotropin preparations.
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Affiliation(s)
- Ameet Patki
- Department of Reproductive Endocrinology, Fertility Associates, Mumbai, Maharashtra, India
| | - Himanshu Bavishi
- Department of Reproductive Endocrinology, Bavishi Fertility Institute, Ahmedabad, Gujarat, India
| | | | - Jayarani Kamraj
- Aakash Fertility Centre and Hospital, Chennai, Tamil Nadu, India
| | | | | | - Poornima Nadkarni
- Department of IVF, Nadkarni Hospital and 21 Century Hospitals, Surat, Gujarat, India
| | | | - Sunil Chaudhary
- Jammu Centre for Human Reproduction, Jammu, Jammu and Kashmir, India
| | - M J Sangeeta
- Caree Fertility Centre, Bengaluru, Karnataka, India
| | - C S Manjunath
- Mathrutva Fertility Center, Bengaluru, Karnataka, India
| | - Pratap Kumar
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India
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Karlström PO, Holte J, Hadziosmanovic N, Rodriguez-Wallberg KA, Olofsson JI. Does ovarian stimulation regimen affect IVF outcome? a two-centre, real-world retrospective study using predominantly cleavage-stage, single embryo transfer. Reprod Biomed Online 2017; 36:59-66. [PMID: 29233501 DOI: 10.1016/j.rbmo.2017.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/27/2022]
Abstract
In this study, ovarian stimulation using highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) for IVF were compared in two large assisted reproduction technique centres in Sweden. A total of 5902 women underwent 9631 oocyte retrievals leading to 8818 embryo transfers (7720 on day 2): single embryo transfers (74.2%); birth rate per embryo transfer (27.7%); multiple birth rate (5.0%); incidence of severe ovarian hyperstimulation syndrome (0.71%). Compared with ovarian stimulation with rFSH, women who received HP-HMG were older, had higher dosages of gonadotrophins administered, fewer oocytes retrieved and more embryos transferred. After multivariate analysis controlling for age and generalized estimating equation model, no differences were found in delivery outcomes per embryo transfers between HP-HMG and rFSH, independent of gonadotrophin releasing hormone analogue (GnRH) used. Logit curves for live birth rate suggested differences for various subgroups, most prominently for women with high oocyte yield or when high total doses were used. Differences were not significant, perhaps owing to skewed distributions of the FSH compounds versus age and other covariates. These 'real-life patients' had no differences in live birth rate between HP-HMG and rFSH overall or in subgroups of age, embryo score, ovarian sensitivity or use of GnRH analogue regimen.
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Affiliation(s)
- Per-Olof Karlström
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Jan Holte
- Carl von Linné Clinic, SE-751 83 Uppsala, Sweden
| | | | - Kenny A Rodriguez-Wallberg
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/ Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
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Yahyaei M, Mehrnejad F, Naderi-manesh H, Rezayan AH. Follicle-stimulating hormone encapsulation in the cholesterol-modified chitosan nanoparticles via molecular dynamics simulations and binding free energy calculations. Eur J Pharm Sci 2017; 107:126-137. [DOI: 10.1016/j.ejps.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/02/2017] [Accepted: 07/07/2017] [Indexed: 12/17/2022]
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The effect of human chorionic gonadotrophin contained in human menopausal gonadotropin on the clinical outcomes during progestin-primed ovarian stimulation. Oncotarget 2017; 8:87340-87352. [PMID: 29152085 PMCID: PMC5675637 DOI: 10.18632/oncotarget.20508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Progestin-primed ovarian stimulation (PPOS) protocol has recently been demonstrated to be an novel regimen for preventing premature LH surges during controlled ovarian hyperstimulation (COH) in combination with frozen-thawed embryo transfer (FET). Our prospective controlled study was to explore the effect of human chorionic gonadotropin (hCG) contained in human menopausal gonadotropin (hMG) on the clinical outcomes in normalovulatory women undergoing COH with PPOS. A total of 180 patients were allocated into three groups according to the gonadotropin (Gn) used: group A (human menopausal gonadotropin, hMG-A), group B (hMG-B) or group C (follicle stimulating hormone, FSH). The primary outcome measured was the number of oocytes retrieved. The number of oocytes retrieved in group A B C was 10.72±5.78 11.33±5.19and13.38±8.97, respectively, with no statistic significance (p>0.05). Other embryological indicators were also similar (p>0.05). The concentration of serum and urinary β-hCG on the trigger day in group A and B were not associated with embryo results (p>0.05). There was no significant differences in the clinical pregnancy rate (41.67% vs. 51.56% vs. 39.51%, p>0.05) and implantation rate (31.58%vs. 34.75%vs.25.33%) after FET among the three groups. Thus the clinical characteristics were not affected by the hCG contained in hMG in normalovulatory women treated with PPOS.
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Human Luteinizing Hormone and Chorionic Gonadotropin Display Biased Agonism at the LH and LH/CG Receptors. Sci Rep 2017; 7:940. [PMID: 28424471 PMCID: PMC5430435 DOI: 10.1038/s41598-017-01078-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
Abstract
Human luteinizing hormone (LH) and chorionic gonadotropin (hCG) have been considered biologically equivalent because of their structural similarities and their binding to the same receptor; the LH/CGR. However, accumulating evidence suggest that LH/CGR differentially responds to the two hormones triggering differential intracellular signaling and steroidogenesis. The mechanistic basis of such differential responses remains mostly unknown. Here, we compared the abilities of recombinant rhLH and rhCG to elicit cAMP, β-arrestin 2 activation, and steroidogenesis in HEK293 cells and mouse Leydig tumor cells (mLTC-1). For this, BRET and FRET technologies were used allowing quantitative analyses of hormone activities in real-time and in living cells. Our data indicate that rhLH and rhCG differentially promote cell responses mediated by LH/CGR revealing interesting divergences in their potencies, efficacies and kinetics: rhCG was more potent than rhLH in both HEK293 and mLTC-1 cells. Interestingly, partial effects of rhLH were found on β-arrestin recruitment and on progesterone production compared to rhCG. Such a link was further supported by knockdown experiments. These pharmacological differences demonstrate that rhLH and rhCG act as natural biased agonists. The discovery of novel mechanisms associated with gonadotropin-specific action may ultimately help improve and personalize assisted reproduction technologies.
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Koo HS, Kwon H, Choi DS, Han S, Seo JY, Yang KM. Clinical utility of newly developed highly purified human menopausal gonadotrophins: a randomized controlled trial. Reprod Biomed Online 2017; 34:499-505. [PMID: 28343757 DOI: 10.1016/j.rbmo.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of IVF-M HP, a newly developed highly purified human menopausal gonadotrophin preparation, for ovarian stimulation in women with infertility undergoing IVF, intracytoplasmic sperm injection (IVF-ICSI) and embryo transfer using a GnRH antagonist protocol. This was a multicentre, randomized, active-controlled, parallel design, open-label, non-inferiority clinical study. Of the 112 patients randomized for treatment using the GnRH antagonist protocol, 111 were treated. No significant difference was found in the number of oocytes retrieved from the IVF-M HP and Menopur groups (13.1 ± 7.6 versus 10.3 ± 6.7, respectively). The lower limit of the one-sided 97.5% confidence interval for the difference between the groups was -0.25, i.e., greater than the pre-defined non-inferiority margin (-5). Therefore, the IVF-M HP treatment was considered non-inferior to Menopur. Furthermore, no significant difference was observed between the groups in the number of good-quality oocytes, leading follicles, good-quality embryos, or in fertilization, implantation, positive beta-HCG and clinical pregnancy rates. The safety analysis revealed that 40.4% and 35.2% in the IVF-M HP and Menopur groups, respectively, reported adverse events. In conclusion, IVF-M HP had comparable clinical efficacy and safety profiles to Menopur.
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Affiliation(s)
- Hwa Seon Koo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, South Korea
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, CHA Fertility Center of Bundang CHA General Hospital, CHA University, Seongnam, South Korea
| | - Doo Seok Choi
- Infertility Clinic, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Song Han
- Clinical Development Department, LG Life Science, Seoul, South Korea
| | - Jung Youn Seo
- Clinical Development Department, LG Life Science, Seoul, South Korea
| | - Kwang Moon Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, South Korea.
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Borisova MA, Moiseenko DY, Smirnova OV. Human chorionic gonadotropin: Unknown about known. ACTA ACUST UNITED AC 2017. [DOI: 10.1134/s0362119716060050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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