Ovarian responses to recombinant FSH or HMG in normogonadotrophic women following pituitary desensitization by a depot GnRH agonist for assisted reproduction

Abstract

At present, there is considerable debate about the utility of supplemental LH in assisted reproduction treatment. In order to explore this, the present authors used a depot gonadotrophin-releasing hormone agonist (GnRHa) protocol combined with recombinant human FSH (rhFSH) or human menopausal gonadotrophin (HMG) in patients undergoing intracytoplasmic sperm injection (ICSI). The response to either rhFSH (75 IU FSH/ampoule; group rhFSH, 25 patients) or HMG (75 IU FSH and 75 IU LH/ampoule; group HMG, 25 patients) was compared in normo-ovulatory women suppressed with a depot triptorelin injection and candidates for ICSI. A fixed regimen of 150 IU rhFSH or HMG was administered in the first 14 days of treatment. Treatment was monitored with transvaginal pelvic ultrasonographic scans and serum measurement of FSH, LH, oestradiol, androstenedione, testosterone, progesterone, inhibin A, inhibin B and human chorionic gonadotrophin (HCG) at 2-day intervals. Although oestradiol serum concentrations on the day of HCG injection were similar, both the duration of treatment and the per cycle gonadotrophin dose were lower in group HMG. In the initial 16 days of gonadotrophin treatment, the area under the curve (AUC) of LH, oestradiol, androstenedione and inhibin B were higher in group HMG; no differences were seen for the remaining hormones measured, including the inhibin B:inhibin A ratio. The dynamics of ovarian follicle development during gonadotrophin treatment were similar in both study groups, but there were more leading follicles (>17 mm in diameter) on the day of HCG injection in the rhFSH group. The number of oocytes, mature oocytes and good quality zygotes and embryos obtained were significantly increased in the rhFSH group. It is concluded that in IVF patients undergoing pituitary desensitization with a depot agonist preparation, supplemental LH may be required in terms of treatment duration and gonadotrophin consumption. However, both oocyte, embryo yield and quality were significantly higher with the use of rhFSH.

Cumulative exposure to high estradiol levels during the follicular phase of IVF cycles negatively affects implantation

“…In a prospective study performed for evaluation of differences in ovarian responses to rFSH and hMG, Balasch et al found mean higher E 2 AUC levels for the patients in the hMG stimulated group (7096 pg/ml vs. 4511 pg/ml), but both oocyte and embryo qualities were lower in this group [27]. It is worth mentioning that both values were higher than the mean levels presented in the study by Levi et al However, the study design did not allow excluding the possibility that the type of gonadotropin preparation influenced oocyte/embryo quality.…”

Recombinant luteinizing hormone supplementation to recombinant follicle-stimulation hormone during induced ovarian stimulation in the GnRH-agonist protocol: A meta-analysis

“…De Placido et al [21] observed that the administration of a daily r-LH resulted in a significant decrease in that cumulative r-FSH amount and in a trend toward a reduction of the stimulation length. Balasch et al [22] reported that with a fixed regimen of 150IU r-FSH or HMG during the first 14 days of treatment, the duration of ovarian stimulation and the per cycle gonadotrophin amount dose were lower in group HMG.…”

The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis

“…Among infertile patients with hypogonadotropic hypogonadism, the administration of both exogenous LH and FSH are necessary to achieve successful outcomes in assisted reproduction technologies (ART) (4). However, numerous studies have demonstrated successful ART outcomes with the use of recombinant FSHonly protocols (5)(6)(7)(8)(9). Low levels of endogenous LH can persist despite pituitary down-regulation with GnRH analogues (10)(11)(12).…”