A comparison of menotropin, highly-purified menotropin and follitropin alfa in cycles of intracytoplasmic sperm injection

Abstract

Background: Over the last several decades, as a result of an evolution in manufacturing processes, a marked development has been made in the field of gonadotropins for ovarian stimulation. Initially, therapeutic gonadotropins were produced from a simple process of urine extraction and purification; now they are produced via a complex system involving recombinant technology, which yields gonadotropins with high levels of purity, quality, and consistency.

Efficacy, efficiency and effectiveness of gonadotropin therapy for infertility treatment

“…10,19 The higher the estradiol levels, the lower the FSH sialylation, as shown in Table 1. 3,20 Therefore, the pattern of circulating FSH during the menstrual cycle is dynamic with respect not only to its quantity (concentration) but also to isoform distribution (quality). 21 The isoform profile is more acidic during early follicular to midfollicular phase, and become more basic shortly before ovulation.…”

“…2 In 1999, purified hMG gonadotropins were introduced, allowing its subcutaneous (SC) administration. 3,20,21 Both conventional and highly-purified hMG (HP-hMG) are commercially available in an FSH:LH ratio of 1:1.…”

“…47 We have compared the effectiveness of different gonadotropin products for controlled ovarian stimulation in one of the largest observational studies to date. 20 Our study was intended to assess treatment effectiveness, which cannot be measured in controlled trials because the act of inclusion in a study is a distortion of usual practice. Effectiveness can be evaluated through observational studies of real practice, thus allowing practice to be assessed in qualitative as well as quantitative terms.…”

“…The difference in favor of rec-hFSH was also reflected in the amount of gonadotropin needed per live birth, as significantly less rechFSH was required compared with hMG (52% reduction) and HP-hMG (21% reduction). 20 In summary, when comparing gonadotropins it is important to take into account the amount of drug used, the number of oocytes/embryos produced, and the number of pregnancies obtained by transferring fresh and frozenthawed embryos. Assuming a similar quality, the quantity of oocytes and embryos produced, including those available for cryopreservation, will impact the chances of a patient to have a baby.…”

Gonadotropin in Assisted Reproduction: An Evolution Perspective

“…In 2000, recombinant human luteinizing hormone (rechLH) became available and, with the launch of recombinant human hCG (rec-hCG) in 2001, the complete recombinant gonadotropin portfolio was launched [2,3]. The most recent developments have been (i) the introduction of the filled-bymass (FbM) rec-hFSH formulation in 2004, which improved batch-to-batch consistency when compared with products quantified by the standard rat in vivo bioassay, (ii) the combination of rec-hFSH and rec-hLH in the same formulation in 2007, (iii) the long-acting FSH gonadotropin in 2010, and (iv) the novel family of pen injectors that deliver recombinant gonadotropins in 2011 [5][6][7][8][9][10][11].…”