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Follicular Development and Hormonal Levels Following Highly Purified or Recombinant Follicle-Stimulating Hormone Administration in Ovulatory Women Undergoing Ovarian Stimulation After Pituitary Suppression for In Vitro Fertilization: Implications for Implantation Potential

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Abstract

Purpose: The main goal in the present study was to comparefollicular development and estradiol levels after ovarianstimulation in pituitary suppressed normally ovulatingwomen undergoing IVF, using highly purified urinary folliclestimulating hormone (FSH) (u-FSH-HP) and recombinantFSH (rec-FSH). A secondary variable in our study wasembryo implantation potential, which is closely related toappropriate follicular development and oocyte competence.

Methods: For the main purpose of this study, 30 IVF patients(group 1) were treated during IVF consecutive cycles, usingthe same stimulation protocol, with u-FSH-HP in the firsttreatment study cycle and rec-FSH in the second one. As acontrol group (group 2) for implantation rates obtained incycles treated with rec-FSH, 30 additional IVF patients wereincluded who underwent a second IVF attempt again with u-FSH-HP.

Results: The total dose of FSH used and ovarian responseobtained in terms of estradiol plasma levels and the totalnumber of growing follicles on the day of human chronicgonadotropin (HCG) injection were similar in both treatmentcycles in group 1 but better follicular dynamics and oocytematurity were obtained with rec-FSH. The implantation ratewas significantly higher in rec-FSH treated cycles in patientsin group 1 than in control women (group 2).

Conclusions: rec-FSH is more efficacious than u-FSH-HPwhen used in the same patient in inducing multiple folliculardevelopment in down-regulated cycles as indicated byovarian performance and oocyte maturity. In addition, rec-FSHyields significantly higher implantation rates thanu-FSH-HP when used in patients undergoing their second IVFattempt.

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REFERENCES

  1. Simoni M, Nieschlag E: FSH in therapy: Physiological basis, new preparations and clinical use. Reprod Med Rev 1995;4:163-177

    Google Scholar 

  2. Lunenfeld B, Lunenfeld E: Gonadotropic preparations-lessons learned. Fertil Steril 1997;67:812-814

    Google Scholar 

  3. Howles CM: Genetic engineering of human FSH (Gonal-F). Hum Reprod Update 1996;2:172-191.

    Google Scholar 

  4. Olijve W, de Boer W, Mulders JWM, van Wezenbeek PMGF: Molecular biology and biochemistry of human recombinant follicle stimulating hormone (Puregon). Mol Hum Reprod 1996;2:371-382

    Google Scholar 

  5. Daya S: hMG versus FSH: is there any difference? In Ovulation Induction-Update 898, M Filicori, C Flamigni (eds). New York, Parthenon, 1998, pp. 183-192

    Google Scholar 

  6. Out HJ, Mannaerts BMJL, Driessen SGAJ, Coelingh Bennink HJT: A prospective, randomized, assessor-blind, multicentre study comparing recombinant and urinary follicle stimulating hormone (Puregon versus Metrodin) in in-vitro fertilization. Hum Reprod 1995;10:2534-2540

    Google Scholar 

  7. Bergh C, Howles CM, Borg K, Hamberger L, Josefsson B, Nilsson L, Wikland M: Recombinant human follicle stimulating hormone (r-hFSH; Gonal F) versus highly purified urinary FSH (Metrodin HP): Results of a randomized comparative study in women undergoing assisted reproductive techniques. Hum Reprod 1997;12:2133-2139

    Google Scholar 

  8. Balasch J, Miró F, Burzaco I, Casamitjana R, Civico S, Ballescá JL, Puerto B, Vanrell JA: The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod 1995;10:1678-1683

    Google Scholar 

  9. Balasch J, Fábregues F, Peñarrubia J, Creus M, Vidal R, Casamitjana R, Manau D, Vanrell JA: Follicular development and hormonal levels following highly purified or recombinant follicle-stimulating hormone adminstration in ovulatory women and WHO group II anovulatory infertile patients. J Assist Reprod Genet 1998;15:552-559

    Google Scholar 

  10. Couzinet B, Lestrat N, Brailly S, Forest M, Schaison G: Stimulation of ovarian follicular maturation with pure follicle-stimulating hormone in women with gonadotropin deficiency. J Clin Endocrinol Metab 1988;66:552-556

    Google Scholar 

  11. Shoham Z, Balen A, Patel A, Jacobs HS: Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients. Fertil Steril 1991;56:1048-1053

    Google Scholar 

  12. Out HJ, Driessen SGAJ, Mannaerts BMJL, Coelingh Bennink HJT: Recombinant follicle-stimulating hormone (follitropin beta, Puregon*) yields higher pregnancy rates in in vitro fertilization than urinary gonadotropins. Fertil Steril 1997;68:138-142

    Google Scholar 

  13. Gregory L: Ovarian markers of implantation potential in assisted reproduction. Hum Reprod 1998;13 (Suppl. 4):117-132

    Google Scholar 

  14. Fábregues F, Balasch J, Creus M, Cívico S, Carmona F, Puerto B, Vanrell JA: Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program. Fertil Steril 1998;70:46-51

    Google Scholar 

  15. Veeck LL: Atlas of the Human Oocyte and Early Conceptus. Baltimore, Williams & Wilkins, 1986

    Google Scholar 

  16. Rodgers M, McLoughlin J, Peers N, Anderson J, Woods P, Mitchell GG, Robertson WR: Accumulation of human chorionic gonadotrophin in the serum of patients during in-vitro fertilization treatment cycles with Pergonal. Hum Reprod 1994;9:638-642

    Google Scholar 

  17. Hull MGR, Armatage RJ, McDermott A: Use of follicle-stimulating hormone alone (urofollitropin) to stimulate the ovaries for assisted conception after pituitary desensitization. Fertil Steril 1994;62:997-1003

    Google Scholar 

  18. Balasch J, Fábregues F, Creus M, Moreno V, Puerto B, Peñarrubia J, Carmona F, Vanrell JA: Pure and highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotrophin for ovarian stimulation after pituitary suppression in in-vitro fertilization. Hum Reprod 1996;11:2400-2404

    Google Scholar 

  19. Hedon B, Out HJ, Hugues JN, Camier B, Cohen J, Lopes P, Zorn JR, van der Heijden B, Coelingh Bennink HJT: Efficacy and safety of recombinant follicle stimulating hormone (Puregon) in infertile women pituitary-suppressed with triptorelin undergoing in-vitro fertilization: A prospective, randomized, assessor-blind, multicentre trial. Hum Reprod 1995;10:3102-3106

    Google Scholar 

  20. Frydman R, Avril C, Camier B, Carles F, Cornet D, Moreau L, Ragage JP, Sage JC, Thebault A, Howles CM, Truong F: A double-blind, randomized study comparing the efficacy of recombinant human follicle stimulating hormone (rhFSH-Gonal F) and highly purified urinary FSH (uhFSH/Metrodin HP) in inducing superovulation in women undergoing assisted reproductive techniques. 14th Annual Meeting of the European Society for Human Reproduction and Embriology, Göteborg. Hum Reprod 1998;13 (Abstract Book 1):94

  21. Rojas FJ: Effects of ovulation induction with gonadotrophins on the ovary and uterus and their implications for assisted reproduction. Hum Reprod 1995;10:2219-2224

    Google Scholar 

  22. Hillier SG: Current concepts of the roles of follicle stimulating hormone and luteinizing hormone in folliculogenesis. Hum Reprod 1994;9:188-191

    Google Scholar 

  23. Lolis DE, Tsolas O, Messinis IE: The follicle-stimulating hormone threshold level for follicle maturation in superovulated cycles. Fertil Steril 1995;63:1272-1277

    Google Scholar 

  24. Porchet HC, Le Cotonnec JY, Loumaye E: Clinical pharmacology studies of recombinant human follicle-stimulating hormone. III. Pharmacokinetic-pharmacodynamic modeling after repeated subcutaneous administration. Fertil Steril 1994;61:687-695

    Google Scholar 

  25. Ben-Rafael Z, Levy T, Schoemaker J: Pharmacokinetics of follicle stimulating hormone: clinical significance. Fertil Steril 1995;63:689-700

    Google Scholar 

  26. van Santbrink EJP, Hop WC, van Dessel TJHM, de Jong FH, Fauser BCJM: Decremental follicle-stimulating hormone and dominant follicle development during the normal menstrual cycle. Fertil Steril 1995;64:37-43

    Google Scholar 

  27. van Os HC, Alberda AT, Janssen-Caspers HAB, Leerentveld RA, Scholtes MCW, Zeilmaker GH: The influence of the interval between in vitro fertilization and embryo transfer and some other variables on treatment outcome. Fertil Steril 1989;51:360-362

    Google Scholar 

  28. Huisman GJ, Alberda AT, Leerentveld RA, Verhoeff A, Zeilmaker GH: A comparison of in vitro fertilization results after embryo transfer after 2, 3, and 4 days of embryo culture. Fertil Steril 1994;61:970-971

    Google Scholar 

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Authors and Affiliations

  1. Institute Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Juan Balasch, Francisco Fábregues, Montserrat Creus, Joana Peñarrubia, Esther Vidal, Francisco Carmona, Bienvenido Puerto & Juan A. Vanrell

  2. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, C/Casanova 143, 08036, Barcelona, Spain

    Juan Balasch

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  1. Juan Balasch
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  2. Francisco Fábregues
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  4. Joana Peñarrubia
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  5. Esther Vidal
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  6. Francisco Carmona
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  7. Bienvenido Puerto
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  8. Juan A. Vanrell
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Balasch, J., Fábregues, F., Creus, M. et al. Follicular Development and Hormonal Levels Following Highly Purified or Recombinant Follicle-Stimulating Hormone Administration in Ovulatory Women Undergoing Ovarian Stimulation After Pituitary Suppression for In Vitro Fertilization: Implications for Implantation Potential. J Assist Reprod Genet 17, 20–27 (2000). https://doi.org/10.1023/A:1009493829086

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