title: Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols.
abstract: BACKGROUND
  The World Helath Organization (WHO) Group I anovulation, or hypogonadotropic hypogonadism (HH), is characterized by reduced hypothalamic/pituitary activity which results in abnormally low serum FSH and LH levels and negligible estrogen activity.
  
  
  OBJECTIVE
  To compare the efficacy of human recombinant FSH (r-hFSH) plus human recombinant LH (r-hLH) in a 2:1 ratio with highly purified human menopausal gonadotropin (hMG-HP) urinary extract, containing LH-like activity, in women with HH.
  
  
  METHODS
  This two-arm randomized open-label study included 35 HH women (aged 25-36 yr) attending our Center. Eighteen patients received 150 IU hMG-HP (150 IU FSH + 150 IU LH-like activity) and seventeen received 150IU r-hFSH/75IU rhLH daily for a maximum of 16 days. Ovulation was induced by a single administration of hCG on the day after the last hMG-HP or r-hFSH/r-hLH.
  
  
  RESULTS
  The primary efficacy endpoint was ovulation induction as measured by follicle ≥17 mm, pre-ovulatory estradiol (E 2 ) ≥400 pmol/l and mid-luteal phase progesterone (P 4 ) ≥25 nmol/l. Secondary efficacy endpoints included E 2 levels/follicle at mid-cycle, number of follicles at mid-cycle and pregnancy rate (PR). Following a total of 70 cycles, 70% of r-hFSH/r-hLH treated patients met the primary endpoint vs 88% in hMG-HP group (p=0.11). However, PR in r-hFSH/r-hLH group was 55.6% compared to 23.3% in hMG-HP group (p=0.01).
  
  
  CONCLUSIONS
  The primary endpoint achievement did not correlate with PR. This study has shown the superiority of LH compared to hCG in supporting FSH-induced follicular development in HH women.
authors.affiliation: Center of Reproduction and Andrology (CREA), Taranto, Italy. d.carone@inwind.it
authors.forename: D
authors.initials: D
authors.lastname: Carone
authors.forename: C
authors.initials: C
authors.lastname: Caropreso
authors.forename: A
authors.initials: A
authors.lastname: Vitti
authors.forename: R
authors.initials: R
authors.lastname: Chiappetta
mesh_terms: D000328:Adult; D000858:Anovulation / Q000188:drug therapy*; D016009:Chi-Square Distribution; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D004338:Drug Combinations; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007986:Luteinizing Hormone / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006080:Ovarian Follicle / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011374:Progesterone / Q000097:blood
chemical_list: D006063:Chorionic Gonadotropin; D004338:Drug Combinations; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone