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Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: Clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols

Abstract

Background: The World Helath Organization (WHO) Group I anovulation, or hypogonadotropic hypogonadism (HH), is characterized by reduced hypothalamic/pituitary activity which results in abnormally low serum FSH and LH levels and negligible estrogen activity. Aim: To compare the efficacy of human recombinant FSH (r-hFSH) plus human recombinant LH (r-hLH) in a 2:1 ratio with highly purified human menopausal gonadotropin (hMG-HP) urinary extract, containing LH-like activity, in women with HH. Subjects and methods: This two-arm randomized open-label study included 35 HH women (aged 25–36 yr) attending our Center. Eighteen patients received 150 IU hMG-HP (150 IU FSH + 150 IU LH-like activity) and seventeen received 150IU r-hFSH/75IU r-hLH daily for a maximum of 16 days. Ovulation was induced by a single administration of hCG on the day after the last hMG-HP or r-hFSH/r-hLH. Results: The primary efficacy end-point was ovulation induction as measured by follicle ≥17 mm, pre-ovulatory estradiol (E2) ≥400 pmol/l and mid-luteal phase progesterone (P4) ≥25 nmol/l. Secondary efficacy end-points included E2 levels/follicle at mid-cycle, number of follicles at mid-cycle and pregnancy rate (PR). Following a total of 70 cycles, 70% of r-hFSH/r-hLH treated patients met the primary endpoint vs 88% in hMG-HP group (p=0.11). However, PR in r-hFSH/r-hLH group was 55.6% compared to 23.3% in hMG-HP group (p=0.01). Conclusions: The primary endpoint achievement did not correlate with PR. This study has shown the superiority of LH compared to hCG in supporting FSH-induced follicular development in HH women.

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Correspondence to D. Carone MD.

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Carone, D., Caropreso, C., Vitti, A. et al. Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: Clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols. J Endocrinol Invest 35, 996–1002 (2012). https://doi.org/10.3275/8657

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Key-words

  • Chorionic gonadotropin
  • hypogonadotropic hypogonadism
  • luteinizing hormone
  • ovulation induction