ABSTRACT
OBJECTIVE: To explore the effect of domestic recombinant follicle stimulating hormone(rFSH)in the course of controlled ovarian hyperstimulation using long protocol in patients with different ovarian reserve functions.METHODS: A retrospective cohort study was made on 1284 patients who were treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer with standard long protocol for ovulation induction from January 2016 to January 2018 in Reproductive Medicine Center,Yuhuangding Hospital of Yantai. According to their AMH level,they were divided into normal ovarian reserve group(AMH:1.2-4.5μg/L,678 patients)and high response group(AMH>4.5μg/L,606 patients).Each group was divided into domestic rFSH subgroup(Jinsaiheng)(340 patients in normal ovarian reserve group,330 patients in high response group)and imported rFSH subgroup(338 patients in normal ovarian reserve group,276 patients in high response group)according to the different use of gonadotrophin on the start-up day.The clinical and laboratory indexes of the two subgroups were compared under different ovarian reserve functions.RESULTS: Regardless of normal or high ovarian reserve function,there was no significant difference in Gn dosage[(1983.15±510.00)U vs.(1913.32±422.12)U,P=0.053;(1816.86±506.37)U vs.(1786.63±453.90)U,P=0.44],days of Gn[(8.96±1.33)days vs.(8.87±1.24)days,P=0.36;(9.45±1.51)days vs.(9.44±1.47)days,P=0.91],dosage of Hermetic[(144.20±67.39)U vs.(143.42±56.73)U,P=0.86;(149.52±62.38)U vs.(160.21±84.87)U,P=0.09],number of eggs obtained(8.14±3.57 vs.8.44±3.37,P=0.25;11.47±4.74 vs.11.66±4.49,P=0.62),MⅡoocyte rate(82.08% vs. 82.01%,P=0.96;82.78% vs. 82.94%,P=0.90),fertilization rate(82.17% vs. 80.98%,P=0.30;80.75% vs. 82.16%,P=0.33),cleavage rate(94.55% vs. 93.91%,P=0.52;94.12% vs. 94.84%,P=0.49),blastocyst formation rate(58.43% vs. 59.55%,P=0.69;61.14% vs. 63.09%,P=0.46),clinical pregnancy rate(59.49% vs. 56.54%,P=0.54;62.84% vs.58.70%,P=0.57),early abortion rate(7.36% vs. 6.80%,P=0.42;11.30% vs. 11.11%,P=0.93)or the incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS)(3.53% vs. 4.73%,P=0.71;7.58% vs. 9.06%,P=0.53)between the two subgroups.However,the daily LH level of HCG in domestic rFSH group was significantly higher than that in imported rFSH group[(2.83±1.31)U/L vs.(2.49±1.14)U/L,P=0.007;(2.35±1.10)U/L vs.(2.11±0.94)U/L,P=0.005].In the normal ovarian reserve group,the daily E2 concentration of HCG and the number of follicles above 1.6 cm in the domestic rFSH group were lower,but the rate of good quality embryos was significantly higher(67.23% vs. 62.51%,P=0.038),the difference being statistically significant(P=0.038).CONCLUSION: Domestic rFSH has the same clinical pregnancy outcome as imported rFSH after ovulation induction,but domestic rFSH has higher LH concentration on hCG day after ovulation induction,and patients with normal ovarian reserve have higher good quality embyro rate after using domestic rFSH.
ABSTRACT
Objective To compare the effectiveness and safety of recombinant luteinizing hormone (rLH) combined with recombinant follicle-stimulating hormone (rFSH) and rFSH alone in women undergoing in vitro fertilisation/intracytoplasmic sperm microinjection (IVF/ICSI) applied gonadotrophin-releasing hormone (GnRH) antagonist. Methods The databases including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, VIP and Wanfang Data were electronically searched to collect the randomized controlled trials (RCT) applied GnRH antagonist using rLH+rFSH or rFSH alone in IVF/ISCI cycles from inception to Dec. 2018. Following the Cochrane system evaluation and according to the criteria for inclusion and exclusion, two reviewers independently screened literature, extracted data and evaluated the bias risk for inclusion in studies, and then meta-analysis was conducted by RevMan 5.3 software. Results A total of 10 RCT studies involving 1965 patients were included, of them 988 cases in rFSH+rLH group and 977 cases in rFSH alone group. Meta-analysis showed no significant difference between rFSH alone group and rLH+rFSH group in clinical pregnancy rate (RR=1.02, 95%CI 0.82-1.27, P=0.85), ongoing pregnancy rate (RR=1.06, 95%CI 0.86-1.32, P=0.57), miscarriage rate (RR=1.38, 95%CI 0.75-2.54, P=0.29), incidence of adverse events canceled due to ovarian hyporesponsiveness (RR=0.90, 95%CI 0.42-1.93, P=0.78), and the incidence of adverse events canceled due to ovarian hyperstimulation syndrome (OHSS) (RR=1.06, 95%CI 0.56-1.99, P=0.86). Conclusions Current evidence shows that, compared with rFSH alone group, the rLH+rFSH group showed no effect on the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, incidence of adverse events canceled due to ovarian hyporesponsiveness, and the incidence of adverse events canceled due to OHSS. The above conclusions need to be verified by more high quality research since the quality and quantity limited of included studies.
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OBJECTIVE: To evaluate the effect of a gonadotropin-releasing hormone (GnRH) antagonist protocol using corifollitropin alfa in women undergoing assisted reproduction. METHODS: Six hundred and eighty-six in vitro fertilization-embryo transfer (IVF)/intracytoplasmic sperm injection (ICSI) cycles were analyzed. In 113 cycles, folliculogenesis was induced with corifollitropin alfa and recombinant follicle stimulating hormone (rFSH), and premature luteinizing hormone (LH) surges were prevented with a GnRH antagonist. In the control group (573 cycles), premature LH surges were prevented with GnRH agonist injection from the midluteal phase of the preceding cycle, and ovarian stimulation was started with rFSH. The treatment duration, quality of oocytes and embryos, number of embryo transfer (ET) cancelled cycles, risk of ovarian hyperstimulation syndrome (OHSS), and the chemical pregnancy rate were evaluated in the two ovarian stimulation protocols. RESULTS: There were no significant differences in age and infertility factors between treatment groups. The treatment duration was shorter in the corifollitropin alfa group than in the control group. Although not statistically significant, the mean numbers of matured (86.8% vs. 85.1%) and fertilized oocytes (84.2% vs. 83.1%), good embryos (62.4% vs. 60.3%), and chemical pregnancy rates (47.2% vs. 46.8%) were slightly higher in the corifollitropin alfa group than in the control group. In contrast, rates of ET cancelled cycles and the OHSS risk were slightly lower in the corifollitropin alfa group (6.2% and 2.7%) than in the control group (8.2% and 3.5%), although these differences were also not statistically significant. CONCLUSION: Although no significant differences were observed, the use of corifollitropin alfa seems to offer some advantages to patients because of its short treatment duration, safety, lower ET cancellation rate and reduced risk of OHSS.
Subject(s)
Female , Humans , Embryo Transfer , Embryonic Structures , Follicle Stimulating Hormone , Gonadotropin-Releasing Hormone , Infertility , Luteinizing Hormone , Oocytes , Ovarian Hyperstimulation Syndrome , Ovulation Induction , Pregnancy Rate , Reproduction , SpermatozoaABSTRACT
The study was carried out to compare the effectiveness of recombinant follicle stimulating hormone (recombinant FSH) and human menopausal gonadotrophin (HMG) in those with diminished ovarian reserve. A total of 106 ovarian stimulation cycles from 88 poor responders were included in this study. Either recombinant FHS or HMG was administered in order to stimulate the ovary for each cycle. The pregnancy rate of the recombinant FSH group (22.5%) was higher than that of the HMG group (9.1%). The cancellation rate of the recombinant FSH group (10.0%) was lower than that of the HMG group (19.7%). In in vitro fertilisation-embryo transfer (IVF-ET) cycles, the fertilisation rate of the recombinant FSH group (62.8%) was higher than that of the HMG group (51.8%). The pregnancy rate and the implantation rate of the recombinant FSH group (23.0 and 9.1%, respectively) were higher than those of the HMG group (13.6 and 5.9%, respectively). Although this did not achieve statistical significance, only the recombinant FSH group achieved pregnancies using gamete intrafallopian transfer (GIFT). In conclusion, recombinant FSH is probably more effective than HMG in improving the IVF and pregnancy rate in poor responders.
ABSTRACT
The study was carried out to compare the effectiveness of human menopausal gonadotrophin (HMG) and recombinant follicle-stimulating hormone (recombinant FSH) in term of in vitro fertilisation (IVF) and pregnancy outcome. A total of 238 patients who underwent IVF for infertility treatment were included in the study. The first attempt of controlled ovarian stimulation was recorded and evaluated. A long protocol of ovarian stimulation was performed with gonadotrophin releasing hormone analogue (GnRH-a) administration. Gonadotrophin, which was either HMG (group A) or recombinant FSH (group B), was administrated to each patient for ovarian stimulation. The results of this study showed no difference in the number of stimulation days, fertilised oocytes, transferred embryos and cycles with embryos available for freezing between the two groups. Although the starting doses of both gonadotrophins were similar, the total dosage of HMG was higher than that of recombinant FSH (48.8ฑ20.8 versus 42.9ฑ20.0, p = 0.03). The number of retrieved oocytes in group A was higher than that in group B (9.5ฑ4.4 versus 8.3ฑ4.3, p = 0.04). The differences in cancellation rate, fertilisation rate, pregnancy rate per cycle and per transfer, as well as implantation rate between the two groups was not statistically significant. In conclusion, patients who underwent ovarian stimulation with GnRH-a long down-regulation still benefit for HMG for their treatment. We did not find any difference in fertilisation rate or pregnancy rate as well as implantation rate between HMG and recombinant FSH. A greater number of oocytes were retrieved in patients treated with HMG. However, more ampoules of HMG were administrated to achieve ovarian stimulation, compared with recombinant FSH.
ABSTRACT
OBJECTIVE: To report the pregnancy which was made by in vitro fertilization using recombinant follicle stimulating hormone and gonadotropin releasing hormone antagonist. MATERIAL AND METHOD: Case report. RESULTS: Six oocytes were retrieved and all were fertilized by intracytoplasmic sperm injection. Six embryos were transferred and the pregnancy was confirmed. CONCLUSION: It is envisaged that the availability of recombinant gonadotropins and gonadotropin releasing hormone antagonists will ultimately lead to shorter, cheaper and safer treatments, using reduced dosages.