Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial

Abstract

Superiority of HP-hMG over rFSH in ongoing pregnancy rate could not be concluded from this study, but non-inferiority was established. Pharmacodynamic differences in follicular development, oocyte/embryo quality, endocrine response and endometrial echogenicity exist between HP-hMG and rFSH preparations, which may be relevant for treatment outcome.

“Premature luteinization” in the era of GnRH analogue protocols: time to reconsider

“…Furthermore, LH co-administration to FSH, in this setting, is capable of reducing, rather than elevating P level. This has been recently demonstrated in a large prospective controlled study performed in young normogonadotropic infertile patients undergoing ART treatment [16]. These findings were suggested to be in accordance with twocell two-gonadotropin theory [3].…”

“…It is clear that P elevation in this setting is follicular and its occurrence is prior to hCG administration. It is also evident that in young normo-gonadotropic patients undergoing COH, P elevation does not develop in the early or the mid-follicular phase, but following day 6 of stimulation [16]. Whether the same mechanism and timing of P elevation is also the case in low ovarian reserve women is still in question [19,20].…”

“…Although most investigators still apply an absolute P level on hCG day as an indication for elevated P level, the cut-off point has differed considerably between one study and another ranging from 0.9 to 2.0 ng/mL [1,10]. Most recent studies have suggested that a cut-off point of 1.25 [16] or 1.5 ng/mL [2], may differentiate more properly in their detrimental effect on endometrial receptivity, however this should be investigated further taking into account the type of gonadotropin and GnRH analogue (agonist or antagonist) employed.…”

“…In addition, LH-like activity obtained from the hCG content of hMG, that has been previously suggested as a cause for elevated P level before hCG administration, presumably "premature luteinization" [17], has also been shown not to be the cause of this phenomenon [16].…”

“Follicular HCG endometrium priming for IVF patients experiencing resisting thin endometrium. A proof of concept study”

“…We constructed this hypothesis based on the fact that LH/ HCG receptor is present in endometrium [15] and therefore a positive interaction could be anticipated when HCG is administered in the proliferative phase of endometrial growth. Furthermore, in a previous study, where hMG (well known that renders its LH capacity due to low dose HCG contain) was compared to rec-FSH during ovarian stimulation, endometrium was more likely to be iso-echogenic and hypo-echogenic in the hMG group [1], also anticipating a possible positive role of HCG activity.…”