A comparison of the efficacy and tolerability of two recombinant human follicle-stimulating hormone preparations in patients undergoing in vitro fertilization-embryo transfer

Brinsden, Peter; Akagbosu, Fidelis; Gibbons, Lisa M; Lancaster, Susan; Gourdon, Dominique; Engrand, Patrick; Loumaye, Ernest

doi:10.1016/s0015-0282(99)00450-1

Cited by 46 publications

(28 citation statements)

References 5 publications

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“…The average duration, total dose of rhFSH, and number of oocyte complexes retrieved were 10.8/12.0 days (p = 0.001), 1880/2226 IU (p<0.001), and 15.2/13.1, respectively, in the pen device and conventional syringe groups [44]. The findings of this study differ from previous studies that reported higher injection-site reactions of pain with follitropin β compared with follitropin α, both of which were administered with a conventional syringe and needle [40].…”

Section: Assisted Reproductive Therapycontrasting

confidence: 91%

Use of Follicle-Stimulating Hormone for the Treatment of Female Infertility – Current Concepts

Pang

2005

Womens Health (Lond Engl)

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Ovulatory dysfunction, which is common among women of reproductive age, often results in infertility. Over the last three decades, follicle-stimulating hormone (FSH), in the form of either urinary human menopausal gonadotropin or highly purified urinary FSH (uFSH), has been the mainstay in the treatment of women with ovulatory dysfunction. However, these preparations have several disadvantages, including variable composition, contamination with urinary proteins, and the limited availability of human menopausal urine from which uFSH is extracted. Recombinant human FSH (rhFSH) demonstrates higher purity and specific activity, and is suitable for subcutaneous administration. Additionally, rhFSH has facilitated the development of additional FSH products such as FSH-carboxy terminal peptide that possess different pharmacokinetic and pharmacodynamic properties and may provide more options in the treatment of ovulatory dysfunction and infertility. This article reviews the mechanism of action of FSH in folliculogenesis and ovulation, the current use of FSH in women for the medical management of infertility, and the published clinical experience to date with different rhFSH preparations.Infertility affects more than 6 million couples in the USA, or approximately 10 to 15% of couples in the reproductive population, with 30-40% of female infertility due to anovulatory disorders [1]. The current medical management of infertility frequently involves the use of gonadotropins in women.Gonadotropin hormones play a central role in the regulation of follicular development and ovulation. Inadequate levels of the gonadotropin, follicle-stimulating hormone (FSH), can result in the absence of ovulation.Urinary-derived preparations of FSH (uFSH) are extracted from the urine of menopausal women. They have been used successfully to induce ovulation in anovulatory women (World Health Organization [WHO] groups I and II) and to stimulate multifollicular development during ovarian stimulation regimens for in vitro fertilization (IVF) [2]. Although effective, uFSH has several disadvantages, including variable composition, contamination with urinary proteins, and limited supply of raw materials for purification [2,3]. Advances in purification techniques have resulted in the production of highly purified uFSH, which contains over 95% FSH. The introduction of recombinant human FSH (rhFSH) in the early 1990s has overcome some of the limitations of urinary-derived preparations. Recombinant human FSH demonstrates high potency, uniform composition, and high specific activity [4][5][6][7].This article reviews the mechanism of action of FSH in folliculogenesis and ovulation, the current use of FSH in women for the medical management of infertility, and published clinical experience to date with the use of different FSH preparations in women. Recent findings of studies evaluating the use of a pen device for selfadministration of rhFSH and novel long-lasting rhFSH agonists are also discussed. Role of FSH in folliculogenesisHuman FSH is composed of a fa...

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Section: Assisted Reproductive Therapycontrasting

confidence: 91%

Use of Follicle-Stimulating Hormone for the Treatment of Female Infertility – Current Concepts

Pang

2005

Womens Health (Lond Engl)

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“…We do not think so, because no differences in effect between the preparations have been found so far [43,44] and we could not find differences between Groups I and II either ( Table 2).…”

Section: Discussioncontrasting

confidence: 52%

Ovarian Stimulation with Urofollitropin (uFSH) Results in a Lower Yield of Oocytes Compared to Recombinant FSH (rFSH), Nevertheless, uFSH is at Least as Effective as rFSH in Younger Patients: Preliminary Results of a Retrospective Study with Antagonist Protocols in an IVF/ICSI Program

Kemeter

Stroh-Weigert²,

Feichtinger³

2013

TORSJ

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Abstract:Objective: Differences in the mode of action between recombinant FSH (rFSH) and urinary derived FSH (uFSH) have been reported in cycles down-regulated by agonists. The aim of our study was to determine, if these differences also exist in cycles down-regulated by antagonists.Method: Antagonist cycles performed between 2009 -2012 were divided into two groups:1. Cycles stimulated with rFSH preparations: Follitropin alfa (n=203) and Follitropin beta (n=443) and 2. Cycles stimulated with Urofollitropin (n=405).Cetrorelix or Ganirelix were used as antagonists. All patients received 75 IU hMG additionally from day 6 of stimulation onwards up to the day of hCG administration.A logistic regression analysis was conducted to find the most significant parameters predicting hCG-positive pregnancy for 2471 IVF cycles. The results demonstrated that the predictors such as age of patients and number of cycles ever performed made negative contributions and number of oocytes retrieved and number of embryos transferred made positive contributions to prediction. Taking this into consideration, comparable groups could be created by including only firstever IVF cycles with more than 10 oocytes retrieved and 2 embryos transferred. Thus, the final sample for comparison included 98 patients in the rFSH-group and 27 patients in the uFSH group.Results: There were no differences in basic personal data and gonadotropin consumption between the groups. Stimulation with rFSH resulted in a higher yield of oocytes compared to uFSH (15,6 vs. 14,4), however, the results of the following reproductive outcome parameters were all in favor of uFSH when rFSH and uFSH were compared: oocyte maturation rate (76.5% vs. 79.0 %), fertilization rate (53,6% vs. 58,6%), embryo score 4 rate (25,7% vs.. 31,1%), hCG-positive pregnancy rate (43,9% vs. 59,3%), clinical pregnancy rate (33,7% vs. 44,4%), embryo-cryopreservation rate (19,3% vs. 30,5%) and abortion rate (14,0% vs. 12,5%). Conclusions:These results seem to support the concept that uFSH produces fewer oocytes than rFSH, but the oocytes produced by uFSH are, on an average, of better quality than those produced by rFSH. Basic studies have shown that different FSH isoforms with different elimination kinetics in the two gonadotropin preparations could be responsible for the different effects.However, the results have to be confirmed by well designed prospective randomized studies.

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“…Recently, Devroey et al in another RCT involving more than 700 patients compared HP-hMG ( n = 374) with rec-hFSH ( n = 375) in antagonist cycles with single blastocyst transfer. Again, more oocytes were retrieved in the group treated with rec-hFSH (10.6 ± 5.8 vs. 9.1 ± 5.2; p < 0.001), and ongoing pregnancy and live birth rates did not differ [126].…”

Section: Studies Comparing the Potency Of Different Gonadotropin Formmentioning

confidence: 87%

Gonadotropin in Assisted Reproduction: An Evolution Perspective

Leão¹,

Esteves²

2015

Unexplained Infertility

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A comparison of the efficacy and tolerability of two recombinant human follicle-stimulating hormone preparations in patients undergoing in vitro fertilization-embryo transfer

Cited by 46 publications

References 5 publications

Use of Follicle-Stimulating Hormone for the Treatment of Female Infertility – Current Concepts

Use of Follicle-Stimulating Hormone for the Treatment of Female Infertility – Current Concepts

Ovarian Stimulation with Urofollitropin (uFSH) Results in a Lower Yield of Oocytes Compared to Recombinant FSH (rFSH), Nevertheless, uFSH is at Least as Effective as rFSH in Younger Patients: Preliminary Results of a Retrospective Study with Antagonist Protocols in an IVF/ICSI Program

Gonadotropin in Assisted Reproduction: An Evolution Perspective

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