Hemodynamic changes induced by urinary human chorionic gonadotropin and recombinant luteinizing hormone used for inducing final follicular maturation and luteinization.
OBJECTIVE
To compare the safety of recombinant human luteinizing hormone (LH) with that of urinary hCG in terms of the hemodynamic changes when they are used to induce final follicular maturation in patients undergoing in vitro fertilization (IVF). A secondary end point was efficacy in terms of IVF outcome.


METHODS
Prospective, randomized clinical trial.


METHODS
University teaching hospital.


METHODS
Thirty IVF patients.


METHODS
Ovarian stimulation was induced with FSH under pituitary suppression. Patients were randomized to receive either hCG or recombinant human LH as a trigger of oocyte maturation (5,000 IU) and for luteal phase support (5,000 IU, 2,500 IU, and 2,500 IU on the day of follicular aspiration, 2 days later, and 5 days later, respectively).


METHODS
Mean arterial pressure, cardiac output, peripheral vascular resistance, and serum levels of progesterone, plasma concentrations of aldosterone, norepinephrine, and plasma renin activity were measured in all patients on postovulatory day 7 of the spontaneous menstrual cycle preceding IVF (baseline) and 7 days after the hCG/recombinant human LH ovulatory injection during the IVF cycle.


RESULTS
Ovarian response and IVF outcome (pregnancy rate, 60%) were similar in both treatment groups. On the seventh day after hCG/recombinant human LH administration, the peripheral vascular resistance was significantly lower and serum progesterone concentrations significantly higher in the hCG group as compared with the recombinant human LH group. The percentage change from baseline values during IVF cycles in all hemodynamic and neurohormonal variables investigated was higher (albeit not statistically different) in the group treated with hCG vs. the group treated with recombinant human LH.


CONCLUSIONS
Recombinant human LH is associated with less intense circulatory changes than hCG when it is given to induce final follicular maturation and luteal phase support in IVF procedures.
Manau
Dolors
D
Institut Clínic of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine-University of Barcelona, Barcelona, Spain.
Fábregues
Francisco
F
Arroyo
Vicente
V
Jiménez
Wladimiro
W
Vanrell
Juan A
JA
Balasch
Juan
J
D006063:Chorionic Gonadotropin / Q000627:therapeutic use* / Q000652:urine; D005260:Female; D005307:Fertilization in Vitro; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects; D034461:Luteinization / Q000502:physiology*; D007986:Luteinizing Hormone / Q000627:therapeutic use*; D018377:Neurotransmitter Agents / Q000097:blood; D006080:Ovarian Follicle / Q000502:physiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D014655:Vascular Resistance / Q000187:drug effects
D006063:Chorionic Gonadotropin; D018377:Neurotransmitter Agents; D011994:Recombinant Proteins; D011374:Progesterone; D007986:Luteinizing Hormone