HMG誘導排卵有助於減少排卵針劑量與時間

誘導排卵過程中添加LH (HMG)有助於減少誘導排卵之排卵針劑量與時間

http://jcem.endojournals.org/content/86/1/337.full

Luteinzing Hormone Activity in Menotropins Optimizes Folliculogenesis and Treatment in Controlled Ovarian Stimulation

1. M. Filicori, 
2. G. E. Cognigni, 
3. S. Taraborrelli, 
4. D. Spettoli, 
5. W. Ciampaglia,
6. C. Tabarelli de Fatis, 
7. P. Pocognoli, 
8. B. Cantelli and 
9. S. Boschi

-Author Affiliations

1. Reproductive Endocrinology Center (M.F., G.E.C., S.T., D.S., W.C., C.T.d.F., P.P., B.C.) and Department of Internal Medicine (S.B.), University of Bologna, 40138 Bologna, Italy

1. Address all correspondence and requests for reprints to: Marco Filicori, M.D., Reproductive Endocrinology Center, Department of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. E-mail: filicori@med.unibo.it.

 

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Abstract

Although the role that LH plays in folliculogenesis is still controversial, recent evidence points toward facilitatory actions of LH activity in ovulation induction. Thus, we compared the response to either highly purified FSH (75 IU FSH/ampoule; group A, 25 subjects) or human menopausal gonadotropin (75 IU FSH and 75 IU LH/ampoule; group B, 25 subjects) in normoovulatory GnRH agonist-suppressed women, candidates for intrauterine insemination. A fixed regimen of 2 daily ampoules of highly purified FSH or human menopausal gonadotropin was administered in the initial 14 days of treatment; menotropin dose adjustments were allowed thereafter. Treatment was monitored with daily blood samples for the measurement of LH, FSH, 17β-estradiol (E₂), progesterone, testosterone, hCG, inhibin A, and inhibin B, and transvaginal pelvic ultrasound was performed at 2-day intervals. Although preovulatory E₂ levels were similar, both the duration of treatment (16.1 ± 0.8 vs. 12.6 ± 0.5 days; P < 0.005) and the per cycle menotropin dose (33.6 ± 2.4 vs. 23.6 ± 1.1 ampoules; P < 0.005) were lower in group B. In the initial 14 treatment days the area under the curve of FSH, progesterone, testosterone, inhibin A, and inhibin B did not differ between the 2 groups, whereas LH, hCG, and E₂ areas under the curve were higher in group B. The occurrence of small follicles (<10 mm) and the inhibin B/A ratio in the late follicular phase were significantly reduced in group B. A nonsignificant trend toward a higher multiple gestation rate was present in group A (60% vs. 17%). We conclude that ovulation induction with LH activity-containing menotropins is associated with 1) shorter treatment duration, 2) lower menotropin consumption, and 3) reduced development of small ovarian follicles. These features can be exploited to develop regimens that optimize treatment outcome, lower costs, and reduce occurrence of complications such as multiple gestation and ovarian hyperstimulation.

Figure 1.

Number (mean ± SE) of small (<10-mm diameter), medium (10–14 mm), and large ovarian follicles (>14 mm) measured with transvaginal pelvic ultrasound during menotropin treatment at 2-day intervals. On treatment day 0 only small follicles were detected, whereas pelvic ultrasound was not performed on days 1–5. *, P < 0.05 or less. Results of group B (hMG) are not reported on days 16 and 18, as only two patients or less continued treatment beyond day 15 in this group.

Figure 2.

Daily gonadotropin and gonadal steroid serum levels (mean ± SE) in groups A (HP FSH) and B (hMG). Results of group B (hMG) are not reported on days 16–18, as only two patients or less continued treatment beyond day 15 in this group.