Introduction: The variable amounts of luteinizing hormones (LH) present in commercial gonadotrophin preparations have raised the questions whether 1) management of follicular stimulation should be adapted to the type of preparation used, 2) LH concentration has an incidence on oocyte quality and IVF outcome. IVF results obtained after ovarian stimulation with urinary human menopausal gonadotrophin (HMG; Pergonal, Serono) or highly purified follicle stimulating hormone (FSH-HP, Metrodin HP, Serono) were compared in cycles initiated in our unit between January 1993 and December 1995, a period during which most laboratory techniques remained unchanged. Material and methods: The IVF cycles were selected from an existent IVF database according to the following criteria: 1) stimulation with a starting dose of 150-225 UI/day gonadotrophin following pituitary down regulation with a GnRH analogue (Decapeptyl, Ferring) initiated on day 23 of the previous cycle, 2) female partner ≤ 35 years of age, 3) oocyte pick-up performed between the 11th and 16th day of stimulation. Ovulation induction (HCG, Profasi, Serono) was performed when vaginal ultrasounds showed ≥3 follicles above 17 mm. Serum estradiol concentrations (E2 in nmol/l; DELFIA, Wallac) were used to confirm the maturity stage of the follicles. In the HMG group, a E2 level of about 1 nmol/l/mature follicle was expected. In the FSH-HP group, this threshold value had to be reevaluated and clinical decision to induce ovulation was based mainly on US scans. Statistical analysis were performed using the unpaired two-tail Student's t-test or contingency tables. Results: HMG FSH-HP p Cycles 314 116 E2 at HCG (mean ± SD) 10.0 ± 5.7 7.1 ± 3.6 0.0001 Follicles (mean ± SD) 17.6 ± 7.2 16.3 ± 7.1 0.107 Oocytes (mean ± SD) 11.6 ± 6.6 11.3 ± 6.2 0.654 Ampoules (mean ± SD) 30.8 ± 5.9 26.6 ± 6.9 0.0001 Fertilization rate (mean ± SD) 57.7 ± 33.6 73.3 ± 24.3 0.0001 Embryo score (mean ± SD) 28.8 ± 12.3 27.1 ± 10.6 0.220 Transfers (%) 255 (81.2%) 107 (92.2%) 0.008 Pregnancies (%) 80 (25.5%) 28 (24.1%) 0.870 Conclusion: Compared to HMG, FSH-HP: 1) needs less ampoules to obtain a similar number of follicles and retrieved oocytes, 2) leads to a higher fertilization rate without affecting embryo quality and pregnancy rate, 3) induces lower serum E2 levels, with the consequence that the hormonal parameters for ovulation induction have to be readapted.

Ovarian stimulation with two urinary gonadotrophin HMG or FSH-HP: a retrospective analysis.

MARCI, Roberto;
1996

Abstract

Introduction: The variable amounts of luteinizing hormones (LH) present in commercial gonadotrophin preparations have raised the questions whether 1) management of follicular stimulation should be adapted to the type of preparation used, 2) LH concentration has an incidence on oocyte quality and IVF outcome. IVF results obtained after ovarian stimulation with urinary human menopausal gonadotrophin (HMG; Pergonal, Serono) or highly purified follicle stimulating hormone (FSH-HP, Metrodin HP, Serono) were compared in cycles initiated in our unit between January 1993 and December 1995, a period during which most laboratory techniques remained unchanged. Material and methods: The IVF cycles were selected from an existent IVF database according to the following criteria: 1) stimulation with a starting dose of 150-225 UI/day gonadotrophin following pituitary down regulation with a GnRH analogue (Decapeptyl, Ferring) initiated on day 23 of the previous cycle, 2) female partner ≤ 35 years of age, 3) oocyte pick-up performed between the 11th and 16th day of stimulation. Ovulation induction (HCG, Profasi, Serono) was performed when vaginal ultrasounds showed ≥3 follicles above 17 mm. Serum estradiol concentrations (E2 in nmol/l; DELFIA, Wallac) were used to confirm the maturity stage of the follicles. In the HMG group, a E2 level of about 1 nmol/l/mature follicle was expected. In the FSH-HP group, this threshold value had to be reevaluated and clinical decision to induce ovulation was based mainly on US scans. Statistical analysis were performed using the unpaired two-tail Student's t-test or contingency tables. Results: HMG FSH-HP p Cycles 314 116 E2 at HCG (mean ± SD) 10.0 ± 5.7 7.1 ± 3.6 0.0001 Follicles (mean ± SD) 17.6 ± 7.2 16.3 ± 7.1 0.107 Oocytes (mean ± SD) 11.6 ± 6.6 11.3 ± 6.2 0.654 Ampoules (mean ± SD) 30.8 ± 5.9 26.6 ± 6.9 0.0001 Fertilization rate (mean ± SD) 57.7 ± 33.6 73.3 ± 24.3 0.0001 Embryo score (mean ± SD) 28.8 ± 12.3 27.1 ± 10.6 0.220 Transfers (%) 255 (81.2%) 107 (92.2%) 0.008 Pregnancies (%) 80 (25.5%) 28 (24.1%) 0.870 Conclusion: Compared to HMG, FSH-HP: 1) needs less ampoules to obtain a similar number of follicles and retrieved oocytes, 2) leads to a higher fertilization rate without affecting embryo quality and pregnancy rate, 3) induces lower serum E2 levels, with the consequence that the hormonal parameters for ovulation induction have to be readapted.
1996
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/1611868
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