Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients.
BACKGROUND
Highly purified menotrophin (HP-hMG) has been associated with fewer oocytes retrieved and a higher proportion of top-quality embryos compared with recombinant FSH (rFSH).


METHODS
A randomized, assessor-blind, multinational trial in 731 women undergoing IVF after stimulation with HP-hMG (MENOPUR) (n = 363) or rFSH (GONAL-F) (n = 368) following a long GnRH agonist protocol was conducted. Blood was collected before, during and after stimulation. Fluid was collected from follicles > or =17 mm.


RESULTS
Serum androstenedione, total testosterone and free androgen index (FAI) were higher (P < 0.001) with HP-hMG than with rFSH after starting stimulation. At the end of stimulation, serum estradiol was higher (P = 0.031) with HP-hMG, whereas progesterone was higher (P < 0.001) with rFSH, even after adjusting for ovarian response. Serum LH was not different between treatments. Mean mid- and end-follicular hCG levels in the HP-hMG group were 2.5 and 2.9 IU/l, respectively. Follicular fluid levels of FSH, LH, hCG, androstenedione, testosterone, FAI and estradiol and ratios of estradiol:androstenedione, estradiol:total testosterone and estradiol:progesterone were higher (P < 0.001) with HP-hMG, whereas progesterone was higher (P < 0.001) with rFSH.


CONCLUSIONS
Major differences in serum and follicular fluid endocrine profile exist after stimulation with HP-hMG or rFSH. Exogenous LH activity induces a differential endocrine environment influencing oocyte quantity and quality, which may be of relevance for clinical outcome.
Smitz
J
J
Follicle Biology Laboratory and Center for Reproductive Medicine, Academisch Ziekenhuis Vrije Universiteit Brussel, Belgium. johan.smitz@az.vub.ac.be
Andersen
A N
AN
Devroey
P
P
Arce
J-C
JC
D000328:Adult; D000728:Androgens / Q000032:analysis / Q000097:blood; D006063:Chorionic Gonadotropin / Q000032:analysis / Q000097:blood; D004958:Estradiol / Q000032:analysis / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use*; D015571:Follicular Fluid / Q000737:chemistry*; D006801:Humans; D008596:Menotropins / Q000627:therapeutic use*; D006080:Ovarian Follicle / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D011374:Progesterone / Q000032:analysis / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
D000728:Androgens; D006063:Chorionic Gonadotropin; D011994:Recombinant Proteins; D011374:Progesterone; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone