title: 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.
authors.affiliation: Institut Clínic of Gynecology, Obstetrics and Neonatology, and Hormonal Laboratory, Faculty of Medicine, University of Barcelona, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. jbalasch@medicina.ub.es
authors.forename: Juan
authors.initials: J
authors.lastname: Balasch
authors.forename: Joana
authors.initials: J
authors.lastname: Peñarrubia
authors.forename: Francisco
authors.initials: F
authors.lastname: Fábregues
authors.forename: Ester
authors.initials: E
authors.lastname: Vidal
authors.forename: Roser
authors.initials: R
authors.lastname: Casamitjana
authors.forename: Dolors
authors.initials: D
authors.lastname: Manau
authors.forename: Francisco
authors.initials: F
authors.lastname: Carmona
authors.forename: Montserrat
authors.initials: M
authors.lastname: Creus
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vanrell
mesh_terms: D000328:Adult; D019540:Area Under Curve; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D043373:Follicle Stimulating Hormone, Human / Q000494:pharmacology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007248:Infertility, Male; D008297:Male; D008596:Menotropins / Q000494:pharmacology*; D009865:Oocytes / Q000378:metabolism; D010053:Ovary / Q000187:drug effects*; D010060:Ovulation / Q000187:drug effects; D010062:Ovulation Induction; D010902:Pituitary Gland / Q000378:metabolism*; D010907:Pituitary Hormones / Q000378:metabolism; D011994:Recombinant Proteins / Q000494:pharmacology* / Q000627:therapeutic use; D027724:Reproductive Techniques, Assisted; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D043373:Follicle Stimulating Hormone, Human; D010907:Pituitary Hormones; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins