Contemporary Pharmacological Manipulation in Assisted Reproduction

Huirne, Judith A F; Lambalk, Cornelis B.; Loenen, Andre C.D. van; Schats, R.; Hompes, Peter G.A.; Fauser, Bart C.J.M.; Macklon, Nick S.

doi:10.2165/00003495-200464030-00005

Cited by 68 publications

(45 citation statements)

References 187 publications

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“…The first is the application in assisted reproduction, aimed at desensitization of the pituitary during ovarian stimulation (1). The second area of interest is the administration of longacting GnRHa preparations in the treatment of early or precocious puberty, where prolonged suppression of pituitary gonadotrophin secretion is required.…”

Section: Introductionmentioning

confidence: 99%

The use of GnRH agonists in precocious puberty

Mul¹,

Hughes

2008

European Journal of Endocrinology

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In this review several aspects of gonadotrophin releasing hormone agonists (GnRHa) treatment in central precocious puberty (CPP) are highlighed. These include issues of the definition of precocity, assessment of CPP and thelarche variants. Indications for treatment with GnRH agonists are discussed, not only in CPP but also in children with other reasons to suppress central activation, e.g. adopted or developmental retardation. Finally, outcome data are summarized, both on growth and psychosocial parameters.European Journal of Endocrinology 159 S3-S8

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Section: Introductionmentioning

confidence: 99%

The use of GnRH agonists in precocious puberty

Mul¹,

Hughes

2008

European Journal of Endocrinology

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“…This protocol is often associated with multifollicular development, resulting in Huirne et al (2004) [2] by kind permission of Adis International.…”

Section: Anovulatory Infertilitymentioning

confidence: 99%

“…In contrast to ovulation-induction regimens for anovulatory infertility, the primary goal of ART is to obtain a high number of oocytes for IVF and intrauterine transfer, or cryopreservation of embryos. Although a number of regimens for ART have been developed, regimens that combine gonadotropins with gonadotropin-releasing hormone (GnRH) agonists have demonstrated superiority over gonadotropin-alone regimens [2]. Pituitary desensitization induced by the addition of a GnRH agonist results in improved folliculogenesis and inhibits the spontaneous LH surge.…”

Section: Assisted Reproductive Therapymentioning

confidence: 99%

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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“…GnRH agonist co-treatment has been the standard of care in IVF for the prevention of a premature rise in LH during ovarian hyperstimulation (13). Typically, GnRH agonist treatment is initiated in the luteal phase of the preceding cycle and continued until the late follicular phase.…”

Section: Introductionmentioning

confidence: 99%

The early luteal phase administration of estrogen and progesterone does not induce premature luteolysis in normo-ovulatory women

Beckers¹,

Platteau²,

Eijkemans³

et al. 2006

eur j endocrinol

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Objective: The luteal phase after ovarian hyperstimulation for in vitro fertilization (IVF) is insufficient. Therefore, luteal phase supplementation is routinely applied in IVF. It may be postulated that premature luteolysis after ovarian hyperstimulation is due to supraphysiological steroid levels in the early luteal phase. In the present study, high doses of steroids are administered after the LH surge in normo-ovulatory volunteers in order to investigate whether this intervention gives rise to endocrine changes and a shortening of the luteal phase. Design: Randomized controlled trial. Methods: Forty non-smoking, normal weight women, between 18 and 37 years of age, with a regular menstrual cycle (24-35 days), received either high dosages of estradiol (E 2 ), progesterone (P), E 2 CP or no medication. Blood sampling was performed every other day from the day of the LH surge until LHC 14. Duration of the luteal phase and endocrine profiles were the main study outcomes. Results: Early luteal phase steroid concentrations achieved by exogenous administration were comparable with levels observed following ovarian hyperstimulation for IVF. No difference in the luteal phase length was observed comparing all groups. However, a significant decrease in LH levels could be observed 6 days after the mid-cycle LH surge (P!0.001) in women receiving P, resulting in accelerated decrease of inhibin A production by the corpus luteum (PZ0.001). Conclusion:The present intervention of high-dose steroid administration shortly after the LH surge failed to induce a premature luteolysis regularly in cyclic women. It seems that the induced transient suppression in LH allowed for a timely recovery of corpus luteum function. Other additional factors may be held responsible for the distinct reduction in luteal phase length observed after ovarian hyperstimulation for IVF.

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Contemporary Pharmacological Manipulation in Assisted Reproduction

Cited by 68 publications

References 187 publications

The use of GnRH agonists in precocious puberty

The use of GnRH agonists in precocious puberty

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

The early luteal phase administration of estrogen and progesterone does not induce premature luteolysis in normo-ovulatory women

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