Abstract
Introduction
Improving pregnancy rates in intricate cases of ovarian stimulation remains a challenge during IVF and intracytoplasmic sperm injection (ICSI). Different protocols of ovulation induction have been proposed.
Methods
The short protocol of ovarian stimulation using recombinant follicle-stimulating hormone (rFSH) with or without the use of luteinizing hormone (LH) in IVF or ICSI outcome in patients with many failed attempts and maternity age ≥37 years was investigated. The prognostic significance of high but normal values of day 3 serum FSH concentrations was also evaluated.
Results
Results show that FSH levels of >9 mIU/ml are associated with poor results even with the use of human menopausal gonadotrophin (HMG). Results were generally comparable when rFSH was used alone or in combination with HMG, except for the quality and the number of embryos transferred, the later being better in the rFSH + HMG group.
Conclusion
In conclusion intricate cases have good chances for achieving a pregnancy using the short protocol and the outcome is further improved when LH is added from the beginning of ovarian stimulation. A slight elevation of day 3 FSH seems to be a strong prognostic factor for a poor outcome.
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References
Balasch J, Miro F, Buzzaro E (1995) The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod 10:1678–1683
Balasch J, Fabregues F, Creus M, Moreno V, Puerto B, Penarrubia J, Carmona F, Varnell JA (1996) Pure and highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotrophin for ovarian stimulation after pituitary suppression in in-vitro fertilization. Hum Reprod 11:2400–2404
Catt KJ, Dudau ML (1973) Spare gonadotrophin receptors in rat testis. Nat New Biol 244:219–221
Chappel S, Howles C (1999) Reevaluation of the roles of the luteinizing hormone and follicle stimulating hormone in the ovulatory process. Hum Reprod 6:1206–12121
Doerr P (1979) Relationship between saturation LH receptors and steroidogenic response in isolated rat granulosa cells. Horm Metab Res II:181–182
Drakakis P, Loutradis D, Kallianidis K, Zafiriou S, Liapi A, Milingos S, Dionyssiou-Asteriou A, Michalas S (2003) Small doses of LH are needed early in ovarian stimulation for better quality oocytes in IVF-ET. Reprod Fertil Dev (in press)
Esposito MA, Coutifaris C, Barnhart (2002) A moderately elevated day 3 FSH concentrations has limited predictive value, especially in younger women. Hum Reprod 17:118–123
Hull M, Corrigan E, Piazzi A (1994) Recombinant human luteinizing hormone: an effective new gonadotropin preparation. Lancet 344:344–345
Karande V, Morris R, Rinehart J, Miller C, Rao R, Gleicher N (1997) Limited success using the "flare" protocol in poor responders in cycles with low basal follicle-stimulating hormone levels during in vitro fertilization. Fertil Steril 67:344–345
Levy DP, Navarro JM, Schattman GL, Davis OK, Rosenwaks Z (2002) The role of LH in ovarian stimulation. Exogenous LH: Let's design the future. Hum Reprod 15:2258–2265
Loutradis D, Drakakis P, Kallianidis K, Milingos S, Dendrinos S, Michalas S (1999) Oocyte morphology correlates with embryo quality and pregnancy rate after intracytoplasmic sperm injection. Fertil Steril 72:240–244
Meo F, Ranieri DM, Khadum I, Serhal P (2002) Ovarian response and in vitro fertilization outcome in patients with reduced ovarian reserve who were stimulated with recombinant follicle-stimulating hormone or human menopausal gonadotrophin. Fertil Steril 77:630–631
Recombinant Human LH Study Group (1998) Recombinant human luteinization hormone (LH) to support recombinant human follicle-stimulating hormone (FSH) induced follicular development in LH-and FSH-deficient anovulatory women: a dose-finding study. J Clin Endocrinol 83:1507–1514
Ulloa-Aguirre A, Espinoza R, Damian-Matzmura P, Chappel SC (1988) Immunological and biological potencies of the different molecular species of gonadotrophins. Hum Reprod 3:491–501
Vihko KK, Kujansuu E, Morsku P, Huhtaniemi I, Punnonen R (1996) Gonadotropins and gonadotropin receptors during the perimenopause. Eur J Endocrinol 134:357–361
Weston AM, Zelinski-Wooten MB, Hutchison JS (1996) Developmental potential of embryos produced by in-vitro fertilization from gonadotropin-releasing hormone antagonist-treated macaques. Stimulated with recombinant follicle stimulating hormone alone or in combination with luteinizing hormone. Hum Reprod 11:608–613
Wide L, Hobson BM (1983) Qualitative difference in follicle-stimulating hormone activity in the pituitaries of young women compared to that of men and elderly women. J Clin Endocrinol Metab 56:371–375
Zelinski-Wooten MB, Hutchison JS, Hess DL (1995) Follicle stimulating hormone alone supports follicle growth and oocyte development in gonadotrophin-releasing hormone antagonist treated monkeys. Hum Reprod 10:1658–1666
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Loutradis, D., Elsheikh, A., Kallianidis, K. et al. Results of controlled ovarian stimulation for ART in poor responders according to the short protocol using different gonadotrophins combinations. Arch Gynecol Obstet 270, 223–226 (2004). https://doi.org/10.1007/s00404-003-0544-3
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DOI: https://doi.org/10.1007/s00404-003-0544-3