T S Yang1, B C Wang, S P Chang, H T Ng. 1. Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Abstract
BACKGROUND: A pregnancy in patients treated with gonadotropin-releasing hormone agonists (GnRHa) using follicle-stimulating hormone (FSH) alone was first reported by Shaw et al. in 1991. Recently, several comparative trials have shown that FSH is as effective as human menopausal gonadotropin (hMG) in this indication. In other words, the residual endogenous levels of luteinizing hormone (LH) in GnRHa treated cycles may be generally sufficient to support FSH-induced follicular development to exempt from the co-administration of exogenous LH. METHODS: A total of 42 consecutive candidates for in vitro fertilization (IVF) participated in a prospective randomized study. In this study, the efficacy of two different gonadotropins (Pergonal and Metrodin, Serono, Italy) in inducing ovulation was investigated. All treated women were less than 40 years of age and had received a long desensitized protocol by aGnRHa (Leuprolide acetate, Takeda or Decapeptyl, Ferring). Ovarian inactivity was monitored by plasma estradiol and LH concentration. After the pituitary gland was down-regulated, all patients were given either hMG (n = 25) or FSH (n = 17) for controlled ovarian hyperstimulation (COH). RESULTS: The mean number of gonadotropin ampoules and the peak estradiol level were significantly higher in hMG group than in the FSH group. No significant differences were found between both groups in the incidence of cancelled cycles, failed oocyte recovery, mean number of oocytes recovered per patient, the fertilization and embryo cleavage-rate. However, the hMG group demonstrated a higher pregnancy and abortion rate. CONCLUSIONS: There is no significant difference between hMG and FSH stimulation when used following GnRHa desensitization for COH, so the cost should be considered.
RCT Entities:
BACKGROUND: A pregnancy in patients treated with gonadotropin-releasing hormone agonists (GnRHa) using follicle-stimulating hormone (FSH) alone was first reported by Shaw et al. in 1991. Recently, several comparative trials have shown that FSH is as effective as human menopausal gonadotropin (hMG) in this indication. In other words, the residual endogenous levels of luteinizing hormone (LH) in GnRHa treated cycles may be generally sufficient to support FSH-induced follicular development to exempt from the co-administration of exogenous LH. METHODS: A total of 42 consecutive candidates for in vitro fertilization (IVF) participated in a prospective randomized study. In this study, the efficacy of two different gonadotropins (Pergonal and Metrodin, Serono, Italy) in inducing ovulation was investigated. All treated women were less than 40 years of age and had received a long desensitized protocol by a GnRHa (Leuprolide acetate, Takeda or Decapeptyl, Ferring). Ovarian inactivity was monitored by plasma estradiol and LH concentration. After the pituitary gland was down-regulated, all patients were given either hMG (n = 25) or FSH (n = 17) for controlled ovarian hyperstimulation (COH). RESULTS: The mean number of gonadotropin ampoules and the peak estradiol level were significantly higher in hMG group than in the FSH group. No significant differences were found between both groups in the incidence of cancelled cycles, failed oocyte recovery, mean number of oocytes recovered per patient, the fertilization and embryo cleavage-rate. However, the hMG group demonstrated a higher pregnancy and abortion rate. CONCLUSIONS: There is no significant difference between hMG and FSH stimulation when used following GnRHa desensitization for COH, so the cost should be considered.