Clinical effects of recombinant versus urinary gonadotropins in ovulation induction
Authors:
R. Středa 1,2,3,4; D. Koryntová 2; Tonko Mardešič 1,2; V. Sobotka 1,2; J. Sobotková 3,4
Authors‘ workplace:
Sanatorium Pronatal, Praha, vedoucí lékař doc. MUDr. T. Mardešič, CSc.
1; Sanatorium Pronatal Plus, Praha, vedoucí lékař MUDr. D. Koryntová, CSc.
2; Pardubická krajská nemocnice a. s., přednosta doc. MUDr. M. Košťál, CSc.
3; Fakulta zdravotnických studií, Univerzita Pardubice
4
Published in:
Ceska Gynekol 2011; 76(2): 108-113
Overview
Objective:
To present an overview of trials and discussion focused on the clinical characteristics of recombinant gonadotropins compared with urinary ones in ovulation induction.
Subject:
Review article.
Setting:
Sanatorium Pronatal, Prague.
Subject and method:
The subject of the study is to compare the clinical characteristics of recombinant gonadotropins versus urinary ones focused on the daily dose of FSH achieving FSH threshold and the risk of multifollicular development in ovulation induction before intrauterine insemination, number of follicles and oocytes, the risk of ovarian hyperstimulation syndrome (OHSS), total consumption of FSH, cost effectiveness and expected pregnancy rate during in vitro fertilization technique.
The method is a MEDLINE research of articles from 1994 to 2010.
Conclusions:
Data demonstrates that recombinant FSH (rFSH) offers higher ovarian responce, less consumption of gonadotropins, lower risk of complications (multiple pregnancy and OHSS) compared with urinary FSH (uFSH). Expected pregnancy rate is probably comparable.
Key words:
ovulation induction, gonadotropins, recombinant FSH, urinary FSH, OHSS.
Sources
1. Al Inany, HG., Abou-Setta, AM., Aboulghar, MA., et al. Highly purified hMG achieves better pregnancy rates in IVF cycles but not ICSI cycles compared with recombinant FSH: a meta-analysis. Gynecol Endocrinol, 2009, 25, p. 372-378.
2. Andersen, AN., Devroey, P., Arce, JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial. Hum Reprod, 2006, 21, p. 3217-3227.
3. Balasch, J., Ballesca, JL., Pimentel, C., et al. Late low-dose pure follicle stimulating hormone for ovarian stimulation in intra-uterine insemination cycles. Hum Reprod, 1994, 9, p. 1863-1866.
4. Bayram, N., Wely, M. van d. Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev, 2001.
5. Bosch, E., Vidal, C., Labarta, E., et al. Highly purified hMG versus recombinant FSH in ovarian hyperstimulation with GnRH antagonists – a randomized study. Hum Reprod, 2008, 23, p. 2346-2351.
6. Brinsden, PR. A textbook of In Vitro Fertilization and Assisted Reproduction. New York: Parthenon Publishing, 1999, p. 94-107.
7. Calaf, AJ., Ruiz Balda, JA., Romeu, SA., et al. Ovulation induction with a starting dose of 50 IU of recombinant follicle stimulating hormone in WHO group II anovulatory women: the IO-50 study, a prospective, observational, multicentre, open trial. BJOG, 2003, 110, p. 1072-1077.
8. Christin-Maitre, S., Hugues, JN. A comparative randomized multicentric study comparing the step-up versus step-down protocol in polycystic ovary syndrome. Hum Reprod, 2003, 18, p. 1626-1631.
9. Coelingh Bennink, HJ., Fauser, BC., Out, HJ. Recombinant follicle-stimulating hormone (FSH; Puregon) is more efficient than urinary FSH (Metrodin) in women with clomiphene citrate-resistant, normogonadotropic, chronic anovulation: a prospective, multicenter, assessor-blind, randomized, clinical trial. European Puregon Collaborative Anovulation Study Group. Fertil Steril, 1998, 69, p. 19-25.
10. Coomarasamy, A., Afnan, M., Cheema, D. van d, et al. Urinary hMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long down-regulation protocol in IVF or ICSI treatment: a systematic review and meta-analysis. Hum Reprod, 2008, 23, p. 310-315.
11. Daya, S., Gunby, J. Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction. Hum Reprod, 1999, 14, p. 2207-2215.
12. Daya, S., Gunby, J. Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction cycles. Cochrane Database Syst Rev, 2000.
13. Daya, S., Gunby, J. Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction cycles. Cochrane Database Syst Rev, 2007.
14. Demirol, A., Gurgan, T. Comparison of different gonadotrophin preparations in intrauterine insemination cycles for the treatment of unexplained infertility: a prospective, randomized study. Hum Reprod, 2007, 22, p. 97-100.
15. Gardner, DK., Weissman, A., Howles, CM., Shoham, Z. Textbook of assisted reproductive techniques, 1st ed. London: Martin Dunitz, 2001, p. 425-446.
16. Gerli, S., Casini, ML., Unfer, V., et al. Ovulation induction with urinary FSH or recombinant FSH in polycystic ovary syndrome patients: a prospective randomized analysis of cost-effectiveness. Reprod Biomed Online, 2004, 9, p. 494-499.
17. Gerli, S., Casini, ML., Unfer, V., et al. Recombinant versus urinary follicle-stimulating hormone in intrauterine insemination cycles: a prospective, randomized analysis of cost effectiveness. Fertil Steril, 2004, 82, p. 573-578.
18. Hayden, CJ., Rutherford, AJ., Balen, AH. Induction of ovulation with the use of a starting dose of 50 units of recombinant human follicle-stimulating hormone (Puregon). Fertil Steril, 1999, 71, p. 106-108.
19. Homburg, R., Howles, CM. Low-dose FSH therapy for anovulatory infertility associated with polycystic ovary syndrome: rationale, results, reflections and refinements. Hum Reprod Update, 1999, 5, p. 493-499.
20. Hompes, PG., Broekmans, FJ., Hoozemans, DA., Schats, R. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients. Fertil Steril, 2008, 89, p. 1685-1693.
21. Hugues, JN., Bstandig, B., Bry-Gauillard, H., et al. Comparison of the effectiveness of recombinant and urinary FSH preparations in the achievement of follicular selection in chronic anovulation. Reprod Biomed Online, 2001, 3, p. 195-198.
22. Hugues, JN., Cedrin-Durnerin, I., Howles, CM., et al. The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study. Hum Reprod, 2006, 21, p. 2817-2822.
23. Isaza, V., Requena, A., Garcia-Velasco, JA., et al. Recombinant vs. urinary follicle-stimulating hormone in couples undergoing intrauterine insemination. A randomized study. J Reprod Med, 2003, 48, p. 112-118.
24. Jansen, CA., van Os, HC., Out, HJ., Coelingh Bennink, HJ. A prospective randomized clinical trial comparing recombinant follicle stimulating hormone (Puregon) and human menopausal gonadotrophins (Humegon) in non-down-regulated in-vitro fertilization patients. Hum Reprod, 1998, 13, p. 2995-2999.
25. Keck, C., Tempfer, CB., Hugues, JN. Conservative infertility management. Informa Healthcare, 2007, p. 120-140.
26. Kettel, LM., Scholl, G., Bonaventura, L., et al. Evaluation of a pen device for self-administration of recombinant human FSH in clomiphene citrate-resistant anovulatory women undergoing ovulation induction. Reprod Biomed Online, 2004, 9, p. 373-380.
27. Leader, A. Improved monofollicular ovulation in anovulatory or oligo-ovulatory women after a low-dose step-up protocol with weekly increments of 25 international units of follicle-stimulating hormone. Fertil Steril, 2006, 85, p. 1766-1773.
28. Levi Setti, PE. The importance of consistent FSH delivery in infertility treatment. Reprod Biomed Online, 2006, 12, p. 493‑499.
29. Lunenfeld, B. GnRH Analoques - the state of the art at the millenium. The Parthenon Publishing Group, 1999, p. 1-64.
30. Messinis, IE. Ovulation induction: a mini review. Hum Reprod, 2005, 20, p. 2688-2697.
31. Out, HJ., Mannaerts, BM., Driessen, SG., Bennink, HJ. A prospective, randomized, assessor-blind, multicentre study comparing recombinant and urinary follicle stimulating hormone (Puregon versus Metrodin) in in-vitro fertilization. Hum Reprod, 1995, 10, p. 2534-2540.
32. Palagiano, A., Nesti, E., Pace, L. FSH: urinary and recombinant. Eur J Obstet Gynecol Reprod Biol, 2004, 115, Suppl. 1:S30-S33.
33. Pang, SC. A pen injection device for self-administration of recombinant follicle-stimulating hormone for fertility treatments. Expert Rev Med Devices, 2005, 2, p. 27-32.
34. Papageorgiou, TC., Guibert, J., Savale, M., et al. Low dose recombinant FSH treatment may reduce multiple gestations caused by controlled ovarian hyperstimulation and intrauterine insemination. BJOG, 2004, 111, p. 1277-1282.
35. Platteau, P., Laurent, E., Albano, C., et al. An open, randomized single-centre study to compare the efficacy and convenience of follitropin beta administered by a pen device with follitropin alpha administered by a conventional syringe in women undergoing ovarian stimulation for IVF/ICSI. Hum Reprod, 2003, 18, p. 1200-1204.
36. Platteau, P., Andersen, AN., Balen, A., et al. Similar ovulation rates, but different follicular development with highly purified menotrophin compared with recombinant FSH in WHO Group II anovulatory infertility: a randomized controlled study. Hum Reprod, 2006, 21, p. 1798-1804.
37. Ragni, G., Caliari, I., Nicolosi, AE., et al. Preventing high-order multiple pregnancies during controlled ovarian hyperstimulation and intrauterine insemination: 3 years’ experience using low-dose recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril, 2006, 85, p. 619-624.
38. Romeu, A., Balasch, J., Ruiz Balda, JA., et al. Cost-effectiveness of recombinant versus urinary follicle-stimulating hormone in assisted reproduction techniques in the Spanish public health care system. J Assist Reprod Genet, 2003, 20, p. 294-300.
39. Sedbon, E., Wainer, R., Perves, C. Quality of life of patients undergoing ovarian stimulation with injectable drugs in relation to medical practice in France. Reprod Biomed Online, 2006, 12, p. 298-303.
40. Somkuti, SG., Schertz, JC., Moore, M., et al. Patient experience with follitropin alfa prefilled pen versus previously used injectable gonadotropins for ovulation induction in oligoanovulatory women. Curr Med Res Opin, 2006, 22, p. 1981‑1996.
41. van Wely, M., Westergaard, LG., van d Bossuyt, PM. Effectiveness of human menopausal gonadotropin versus recombinant follicle-stimulating hormone for controlled ovarian hyperstimulation in assisted reproductive cycles: a meta-analysis. Fertil Steril, 2003, 80, p. 1086-1093.
42. van Wely, M., van d Bayram, N. Recombinant FSH in alternative doses or versus urinary gonadotrophins for ovulation induction in subfertility associated with polycystic ovary syndrome: a systematic review based on a Cochrane review. Hum Reprod, 2003, 18, p. 1143-1149.
43. Ziebe, S., Lundin, K., Janssens, R., et al. Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF. Hum Reprod, 2007, 22, p. 2404-2413.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2011 Issue 2
Most read in this issue
- Extended embryo culture in IVF does not improve pregnancy rate
- Uterine fibroids and their treatment
- Decreased fertility and today’s possibility of examination in reproductive immunology
- Luteal support in the IVF/ET programme