Effect of urinary versus recombinant follicle-stimulating hormone on platelet function and other hemostatic variables in controlled ovarian hyperstimulation.
OBJECTIVE
To determine the effect of urinary versus recombinant FSH on platelet function and hemostatic variables in women undergoing controlled ovarian hyperstimulation cycles.


METHODS
Randomized clinical study.


METHODS
Major university-based infertility and in vitro fertilization unit and hemostasis laboratory.


METHODS
Ten healthy women (in vitro study), and 24 women undergoing routine controlled ovarian hyperstimulation cycles (in vivo study), randomly assigned to receive either urinary (u-FSH) or recombinant gonadotropin (r-FSH).


METHODS
In vitro study: effect of preincubation of plasma with u-FSH or r-FSH, in the presence or absence of estradiol, on platelet function and coagulation parameters. In vivo study: Changes in platelet function and coagulation parameters after treatment with u-FSH or r-FSH during controlled ovarian hyperstimulation cycles.


METHODS
Platelet aggregation and ATP release, activated protein C resistance ratio, free protein S.


RESULTS
In vitro study: Platelet aggregation and ATP release were significantly inhibited by u-FSH relative to r-FSH in both the presence and absence of estradiol (P=.047). In vivo study: Platelet function was significantly inhibited after treatment with u-FSH (P=.05) but not with r-FSH. In both studies, small changes of minor clinical significance were noted in activated protein C resistance and free protein S levels.


CONCLUSIONS
The different platelet response to u-FSH and r-FSH may have clinical implications in selected patients, especially those at risk of thromboembolic complications, in decisions regarding the appropriate medication for controlled ovarian hyperstimulation cycles.
Bar
Jacob
J
Perinatal Division, Infertility and IVF Unit, Department of Obstetrics and Gynecology, and Hemostatic Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. jbar@clalit.org.il
Orvieto
Raoul
R
Lahav
Judith
J
Hod
Moshe
M
Kaplan
Boris
B
Fisch
Benjamin
B
D020016:Activated Protein C Resistance; D000255:Adenosine Triphosphate / Q000037:antagonists & inhibitors; D000328:Adult; D001792:Blood Platelets / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use / Q000652:urine; D043373:Follicle Stimulating Hormone, Human / Q000627:therapeutic use*; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D007246:Infertility / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D008596:Menotropins / Q000627:therapeutic use*; D010062:Ovulation Induction; D010974:Platelet Aggregation / Q000187:drug effects; D017293:Protein S / Q000378:metabolism; D011994:Recombinant Proteins / Q000627:therapeutic use
D043373:Follicle Stimulating Hormone, Human; D017293:Protein S; D011994:Recombinant Proteins; D004958:Estradiol; D008596:Menotropins; D000255:Adenosine Triphosphate; D005640:Follicle Stimulating Hormone