Experience Using Preparations of Follicle-Stimulating Hormone Alone to Stimulate the Ovaries for Assisted Conception after Pituitary Desensitisation and Simplified Management of Treatment

Abstract

The results are reported of 2,204 cycles of treatment started for in vitro fertilisation and embryo transfer or gamete intrafallopian transfer, during 5 years, 1990-1994, using only follicle-stimulating hormone (FSH) preparations to stimulate the ovaries following pituitary desensitisation, combined with greatly simplified scheduling and monitoring of treatment. The physiological principles underlying these choices are discussed. In all women under 40 years of age and men with normal sperm, the use of unpurified urinary FSH in 1990-1993 resulted in oocyte collection in 94% of cycles started, pregnancy in 29% and live births in 23%. Using highly purified urinary FSH (uFSH-HP; Metrodin HP®) during 1994, the rate for oocyte collection was 97% and pregnancy 25% (birth rates not yet available). The difference compared with previous years was not significant. A study of 93 first cycles using uFSH-HP showed that the dosage required was usually (expressed as medians) 24 ampoules over 12 days (2 ampoules/day) resulting in 9 oocytes (range 2-36) of which 93% were mature and 64% resulted in cleaving embryos. The results are comparable with the best using human menopausal gonadotropin or unpurified FSH and classical detailed monitoring.

Comparison of highly purified FSH (Metrodin-High Purity) with Pergonal for IVF superovulation

“…The study by Wikland et al (9) obtained a 16.4% live birth rate using hMG and a calculated live birth rate of 31.3% using Metrodin-HP (not all patients had delivered by the completion of the study). Metrodin-HP alone gave a significantly higher pregnancy rate than a combination Metrodin-HP/Pergonal regime in a subsequent study (35 vs 18%) (10), whereas Hull et al (11) found comparable clinical pregnancy rates for Metrodin and Metrodin-HP of 29 and 25% per cycle, respectively. Our results suggest a higher pregnancy and live birth rate after Metrodin-HP, but this trend was not significant.…”

“…Metrodin-HP has previously been compared with other gonadotropin preparations by Wikland et al (9,10) and Hull et al (11). The study by Wikland et al (9) obtained a 16.4% live birth rate using hMG and a calculated live birth rate of 31.3% using Metrodin-HP (not all patients had delivered by the completion of the study).…”

Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF

“…Deep suppression of LH by GnRH agonists has been associated with an adverse reproductive outcome (Westergaard et al, 2000;Esposito et al, 2001;Coppola et al, 2003). Although this association is not universally accepted (Loumaye et al, 1997;Balasch et al, 2001), the potential benefit from LH supplementation (in the form of recombinant LH or by using gonadotrophin preparations containing both LH and FSH) has remained in the focus of interest (Daya et al, 1995;Hull et al, 1995;Westergaard et al, 1996;Levy et al, 2000).…”