丙氨瑞林在诱导排卵中的应用

目的:探讨丙氨瑞林在对无排卵者诱导排卵中的应用。方法:回顾性分析WHO II型无排卵患者1155个周期,A组572个周期,月经周期d2开始使用hMG促排,至hCG日。B组583个周期,在A组方案基础上,d2开始肌注醋酸丙氨瑞林0.15mg/d至hCG日。二组均待有优势卵泡时注射hCG,指导同房或行IUI术,其后行黄体支持治疗。结果:A、B组患者的卵泡(直径≥16mm)数(2.7±2.3枚vs2.0±2.0枚)、排卵数(2.2±2.1vs1.8±1.8)、排卵日(12.2±2.5d vs12.5±2.1d)、hMG用量(10.8±2.3支,12.3±5.3支)、hCG日子宫内膜厚度(8.9±1.7mm vs9.3±1.7mm)、双胎妊娠率(16.6%vs13.7%)、三胎妊娠率(5.5%vs6.5%)和多胎妊娠率(22.1%vs20.2%)比较均无统计学差异,P>0.05;卵泡平均直径达到14mm日LH水平(7.5±3.9U/L vs4.1±3.9U/L)、周期取消率(17.8%vs2.6%)、流产率(26.8%vs4.6%)、轻度、中重度OHSS发生率(5.5%vs1.0%,0.5%vs0)、临床妊娠率(9.6%vs22.4%)间有显著性差异(P<0.05)。结论:hMG+丙氨瑞林诱导排卵方案与单用hMG比较,既能达到较好的临床妊娠率,又能降低周期取消率、流产率和OHSS的发生率。     

来曲唑联合促性腺激素用于行宫腔内人工授精的排卵障碍者的促排卵研究

目的:探讨来曲唑在促排卵过程中的功效。方法:100例不孕症常规检查确诊为女性排卵障碍并接受超促排卵及IUI的不孕患者,随机分为A组(50例):口服来曲唑(LE)+hMG,B组(50例):口服氯米芬(CC)+hMG,分别监测hCG注射日子宫内膜的厚度、形态、血E2、P水平,分别统计排卵率及妊娠率。结果:A组血清中雌激素水平明显较低,hCG注射日子宫内膜较厚。直径>17mm卵泡数组间无明显差异,临床妊娠率也无明显差异。结论:对因女性排卵障碍引起的不孕,用LE或CC促排卵,其获卵数和临床妊娠率无差异,但用LE促排卵,可以减少CC抗雌激素样作用对子宫内膜的不良影响,使子宫内膜有较好的容受性,有利于妊娠。     

CC/hMG/IUI、hMG/IUI与IVF-ET治疗多囊卵巢综合征的分析

目的 :探讨利用宫腔内人工受精和体外受精 胚胎移植治疗多囊卵巢综合征的临床效果。方法 :多囊卵巢综合征 5 6例 ,其中CC/hMG/IUI治疗组 2 8例 ,hMG/IUI治疗组 14例 ,IVF ET治疗组 14例。比较 3组患者的年龄、不孕年限、E2 水平、卵泡数及妊娠率。结果 :CC/hMG/IUI、hMG/IUI和IVF ET 3组的年龄及不孕年限无差异 (P >0 .0 5 )。CC/hMG/IUI组与hMG/IUI组的卵泡数无差异 (P >0 .0 5 ) ,两组的E2 水平与妊娠率也无差异 (P >0 .0 5 )。CC/hMG/IUI组的卵泡数明显少于IVF ET组 (P <0 .0 0 1) ,E2 水平也显著低于IVF ET组 (P <0 .0 0 1) ,CC/hMG/IUI组的妊娠率与IVF ET组无差异 (P >0 .0 5 )。hMG/IUI组的卵泡数显著低于IVF ET组 (P <0 .0 1) ,E2 水平也显著低于IVF ET组 (P <0 .0 0 1) ,hMG/IUI组与IVF ET组的妊娠率无差异 (P >0 .0 5 )。结论 :CC/hMG/IUI组与hMG/IUI方案在降低卵巢过激危险和治疗费用的同时可获得较高的妊娠率 ,有可能成为治疗多囊卵巢综合征较理想的治疗方案。     

不同促排卵方法在卵巢储备功能下降患者中的应用

目的:探讨卵巢储备功能下降患者的促排卵优选方案。方法:GnRH-a/hMG/rFSH(Gn)长方案促排卵(A组)共39个周期,GnRH-a/hMG/rFSH(Gn)短方案促排卵(B组)46个周期,GnRH-A/hMG/rFSH(Gn)促排卵(C组)共35个周期,比较3组临床用药和临床结局情况。结果:A组Gn所用天数(12.4±1.51d)显著高于B组(9.5±1.7d)、C组(10.7±3.2),P<0.05,且Gn(75IU/支)所用支数(41.5±8.6支)也明显多于B组(34.7±9.7支)和C组(33.4±16.2支)(P<0.05)。B组Gn所用天数要少于C组(P<0.05),Gn所用总量与C组间无统计学差异(P>0.05)。hCG注射日的血清LH水平A组(1.20±1.02IU/L)显著低于B组(3.17±1.58IU/L)和C组(2.15±1.8IU/L)(P<0.05),B组与C组之间无统计学差异(P>0.05)。A组与C组注射hCG日的血清E2值(7958±4586pmol/L,6022±7852pmol/L)均低于B组(10145±5503pmol/L)(P<0.05)。3组种植率、临床妊娠率均无显著性差异。3组间hCG注射日内膜厚度、受精率、卵裂率均无统计学差异(P>0.05)。结论:短方案更适合于卵巢功能减退患者的促排卵治疗,长方案与GnRH-A方案促排卵也是可行方法。     

体外受精周期卵巢储备功能正常采用激动剂长方案与拮抗剂方案促排卵的临床结局比较

目的:探讨卵巢储备功能正常者采用激动剂长方案和拮抗剂方案促排卵对体外受精周期妊娠结局的影响。方法:回顾性分析卵巢储备功能正常者进行体外受精-胚胎移植(IVF-ET)的265个周期。根据促排卵方案不同将其分为:激动剂长方案促排卵组(长方案组,157个周期),拮抗剂方案组(拮抗剂组,108个周期)。结果:患者的年龄、不孕年限、体质量指数(BMI)、基础性激素水平等一般情况组间均无统计学差异(P>0.05)。hCG注射日直径14 mm以上的卵泡数、hCG注射日E2水平、平均移植胚胎数及胚胎质量、受精率、生化妊娠率、早期流产率等组间均亦无统计学差异(P>0.05);但获卵数(12.6±4.6 vs 10.8±4.6)、可用胚胎数(5.0±3.0 vs 4.2±2.7)、胚胎种植率(29.87%vs 20.98%)、临床妊娠率(42.76%vs 28.70%)长方案组明显高于拮抗剂组,差异有统计学意义(P<0.05)。结论:卵巢储备功能正常者拮抗剂促排卵,其胚胎种植率、临床妊娠率明显低于长方案组。     

不同促排卵方案来源胚胎冻融胚胎移植妊娠结局分析北大核心CSCD

目的探讨不同促排卵方案来源胚胎冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2016年1月至2021年5月在南通大学附属医院生殖医学中心接受体外受精或卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗,因鲜胚移植失败或全胚冷冻而要求FET的252个周期,根据刺激周期方案的不同将其分为5组:高孕激素促排卵(PPOS)组(n=26)、枸橼酸氯米芬+人绝经期促性腺激素(CC+hMG)组(n=50)、超短方案组(n=57)、拮抗剂组(n=78)及长方案组(n=41),分析各组的临床结局。结果 252个FET周期中,各组体重指数(BMI)、不孕年限、不孕类型、刺激周期时扳机日E2水平/扳机日直径≥14mm卵泡数、移植周期时转化日内膜厚度、转化日E2水平、移植D3胚胎或囊胚比例,差别均无统计学意义(P>0.05)。各组间患者年龄、基础FSH、获卵数、刺激周期Gn总量及平均移植胚胎数,差异有统计学意义(P<0.05)。各组间hCG阳性率、临床妊娠率、流产率及继续妊娠率差异无统计学意义(P>0.05)。但CC+hMG组hCG阳性率、临床妊娠率及继续妊娠率数值上最低,长方案组hCG阳性率、临床妊娠率及继续妊娠率数值上均最高。多因素logistic回归分析发现CC+hMG组FET临床妊娠率低于长方案组,差别有统计学意义(P<0.05),但与其他各组比较差异无统计学意义。其他4组间比较妊娠结局无明显差异(P>0.05)。结论 PPOS、超短方案、长方案、拮抗剂促排卵方案来源胚胎FET妊娠结局在数值上优于CC+hMG促排卵方案,其中长方案显著优于CC+hMG促排卵方案。     

诱导排卵周期子宫内膜厚度和类型与生育力的关系:单独应用氯菧酚胺及与hMG联合应用的影响

作者对271例474个宫腔内授精(IUI)周期前瞻性分析了注射hCG日阴道超声下子宫内膜厚度和类型与妊娠率、继续妊娠率、诱导排卵方案、优势卯泡数、血雌二醇(E_2)水平的关系。自然周期23个,诱导排卵周期451个,其中hMG周期49个,氯菧酚(CC)周期197个,hMG与CC合用255周期。四组平均年龄,不育期限,IUI指征及不育病因分布皆相仿。注射hCG指征为优势卵泡≥18mm(CC组)或≥15mm(hMG组及hCG CC联用组)。内膜厚度为阴道超声下通过宫体中心纵轴测得。内膜类型按Gonen和Casper法分为三型:A型多层     

超声下未成熟卵泡抽吸术治疗多囊卵巢综合征不孕的临床研究

目的　探讨超声下未成熟卵泡抽吸术(IMFA)对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及其内分泌功能的影响;观察IMFA后,应用人绝经期促性腺激素(hMG)促排卵治疗的效果、妊娠及并发症情况。方法　将71例PCOS不孕患者随机分为两组。组Ⅰ: 37例,穿刺前用少量hMG促排卵; 组Ⅱ: 34例,不用任何促排卵药物。在阴道超声引导下进行IMFA,检查穿刺后第2个周期患者的内分泌功能和卵巢基础窦卵泡计数,可连续2~3个周期进行穿刺。随后2组均用hMG常规促排卵治疗,随访其排卵及妊娠情况。结果　组Ⅰ进行了88个周期的穿刺治疗,经过2~3次穿刺后,睾酮水平、黄体生成素(LH )与卵泡刺激素(FSH)的比值均明显降低,与治疗前比较,差异有统计学意义(P<0. 01), 33例(89%, 33 /38)患者基础窦卵泡计数降至10个/卵巢以下。组Ⅱ进行了87个周期治疗,所有患者睾酮水平均显著降低,与治疗前比较,差异有统计学意义(P<0 01 ); 30例LH/FSH<2, 28例(82%, 28 /34)患者基础窦卵泡计数降到10个/卵巢以下。在IMFA之后, 诱发排卵时hMG用量组Ⅰ为(21±6)支,组Ⅱ(23±10)支,两组比较,差异无统计学意义(P>0 .05),在注射人绒毛膜促性腺激素(hCG)后均出现排卵, 组Ⅱ有2例发生轻度卵巢过度刺激综合征(OHSS)。连续促排卵治疗1 ~3个月后, 共36例(51% )     

来曲唑联合促卵泡素在PCOS患者IVF-ET中的应用及效价分析

目的:探讨来曲唑(LE)联合FSH在多囊卵巢综合征(PCOS)患者IVF-ET或ICSI中的应用及效价分析。方法:回顾性分析接受IVF-ET/ICSI治疗的170名PCOS不孕患者,分为LE组(LE-FSH组,n=59)与对照组(GnRHa-FSH组,n=111)。比较组间促排卵、妊娠结局、每周期治疗费用及药物效价比。结果:LE组和对照组FSH用药天数分别为6.3±1.9 d vs 13.0±2.3、用药量为615.6±284.6 IU vs l 504.9±424.9 IU,组间比较有显著性差异(P<0.01);hCG注射日E2值分别为1 965.3±1119.7 pmol/L vs 12 660.2±7 254.2 pmol/L,获卵数分别为6.5±3.3 vs16.6±7.9,组间比较均有显著性差异(P<0.01);受精率、胚胎种植率分别为66.1%vs71.6%,25.58%vs 23.63%,临床妊娠率为49.12%vs 34.48%,组间比较无显著性差异(P>0.05);中-重度OHSS发生率分别为O%和6.89%,组间比较差异有显著性(P<0.01)。LE组每刺激周期药费(2 877±1 240元)及每妊娠周期药费(3 014±1581元)显著低于对照组(6 561±1 852元、8774±1970元)(P<0.01),治疗效价比分别为5 959元vs 30 067元。结论:LE联合促卵泡素可有效运用于PCOS患者的IVF-ET中,较传统的GnRHa-FSH促排卵相比,无OHSS的发生、费用低、效价比高,且不影响妊娠率和种植率。     

三种促超排卵方案体外受精-胚胎移植临床妊娠率的分析

目的 :分析 3种促超排卵方案 (tropichyperovulationprogramme ,THOP)体外受精 -胚胎移植 (IVF -ET)的临床妊娠率。方法 :不孕症 136例分为 3组 :1组 5 1例 ,应用高纯促卵泡成熟激素 (HP -FSH ,商品名Metrodine -HP) ,递减给药促超排卵 ,应用促性腺激素释放激素兴奋剂 (GnRH -a ,商品名Buserelin)长方案降调节 ,从月经第 3天开始递减HP-FSH。 2组 5 0例 ,HP -FSH和人绝经期促性腺激素 (hMG)联合递减给药的促超排卵长方案降调节。 3组 35例 ,hMG递增给药促超排卵。分析 3种THOP的平均取卵数、受精后卵裂数、移植数、临床妊娠数及IVF -ET移植周期的临床妊娠率。结果 :(1) 1组 ,平均取卵数 10 .13± 4 .4 9,卵受精数 7.83± 4 .13,受精率 77.2 9% ,卵裂数 7.6 2± 4 .19,移植数3.88± 1.17及临床妊娠数 18,临床妊娠率 35 .2 9% ;(2 ) 2组 ,平均取卵数 9.16± 5 .4 9,卵受精数 6 .84± 4 .2 3,受精率 74 .6 7% ,卵裂数 6 .5± 4 .2 2 ,移植数 3.6 8± 0 .99及临床妊娠数15 ,临床妊娠率 30 .0 % ;(3) 3组 ,平均取卵数 11.31± 7.6 4 ,卵受精数 7.89± 5 .36 ,受精率 6 9.82 % ,卵裂数 7.75± 5 .94 ,移植数 3.6 8± 1.0 8及临床妊娠数 15 ,临床妊娠率4 2 .86 %。 1组与 2组用药安瓿比较 ,差异有高度显著性 (P     

Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective,simply randomized,clinical trial

OBJECTIVE: To study the efficacy of the aromatase inhibitor letrozole in controlled ovarian hyperstimulation (COH). MATERIAL AND METHODS: In this prospective simply randomized clinical trial, one hundred forty patients with unexplained infertility undergoing intrauterine insemination (IUI) therapy were randomized to receive either letrozole or clomiphene citrate (CC)-gonadotropin. The patients were selected among patients referred to one university hospital and one private infertility clinic. A letrozole dose of 5 mg/day (n = 70) was given on days 3-7 of the menstrual cycles. Clomiphen citrate a dose of 100 mg/day was given like letrozole but combined with human menopausal gonadotropin (hMG) dose of 75 IU/ml administered every day starting on day 6. Ovulation was triggered with urinary hCG (10,000 IU) when the leading follicle(s) reached 18 mm in diameter. A single IUI was performed 36 hours later. The luteal phase was supplemented with micronized progesterone vaginally. Ovarian stimulation response (E2 levels and number of follicles) was primary outcome. RESULTS: There were no differences in demographic characteristics between groups. The number of mature follicles (1.8 +/- 0.7 vs. 2.46 +/- 2.3; P = 0.042) and serum E2 level on the day of hCG (310 +/- 135.4 vs. 1,670.7 +/- 1021.8 pg/ml, respectively; P < 0.0001) were significantly lower in letrozole group. A significantly higher endometrial thickness was observed at the time of hCG administration in patients that received letrozole (9.7 +/- 1.6 mm vs. 7.8 +/- 2 mm; P < 0.001).Clinical pregnancy rates also were significantly higher in letrozole group (32.8% vs. 14.3%, respectively; P < 0.01). CONCLUSION: The aromatase inhibitor letrozole appears to constitute a good alternative to CC-gonadotropin in patients with unexplained infertility undergoing COH cycles combined with IUI therapy.     

A preliminary study on in vitro fertilization and embryo transfer

Forty-two women with infertility were enrolled in an in vitro fertilization and embryo transfer (IVF/ET) program, from July, 1986 to February, 1988, at the First Affiliated Hospital, Human Medical University. CC/hMG/hCG and hMG/hCG regimens for ovulation induction were used for 35 and 7 patients. Monitoring methods consisted of daily follicular ultrasonography and serum estradiol measurements. Human chorionic gonadotropin 10,000IU was administered when the leading follicle reached 18mm in diameter and serum E2 level was equal to or more than 1,480 pmol/L (400 pg/ml). Twenty-one laparoscopies and nineteen laparotomies for oocyte retrieval were performed. The IVF/ET results using CC/hMG/hCG for ovarian stimulation were as follows: an average of 6.1 follicles were aspirated and 3.5 oocytes recovered for one case. The recovery rate and fertilization rate was 57.0% and 60.1% respectively. In twenty-five women one to five embryos were transferred and a clinical pregnancy occurred in one who received three embryos. Laparotomy for oocyte retrieval showed that more oocytes could be obtained than laparoscopy. The purity of CO2 used for laparoscopy was considered to affect the IVF results.     

Recombinant vs. urinary follicle-stimulating hormone in couples undergoing intrauterine insemination. A randomized study

OBJECTIVE: To compare the results of ovulation induction in couples undergoing intrauterine insemination (IUI) with a standard daily dose of 100 IU of recombinant follicle-stimulating hormone (rFSH) vs. 150 IU of urinary follicle-stimulating hormone (uFSH). STUDY DESIGN: Prospectively, 118 cycles were randomized to rFSH and 106 cycles to uFSH. Ovarian response was compared on the human chorionic gonadotropin administration day by serum estradiol (E2) levels and number of ovarian follicles produced. RESULTS: In the rFSH group a significantly lower dose of FSH was administered (799.1 vs. 1,293.0 IU, P < .001), and a lower number of follicles > or = 12 mm (2.9 vs. 3.7, P < .001) and lower number of midsized follicles (12-16 mm) were observed (0.7 vs. 1.7, P < .001) as compared to the uFSH group. No difference was found between groups in the number of follicles > or = 17 mm or in serum E2 levels obtained. The E2/FSH dose ratio was significantly higher in the rFSH group (0.9 vs. 0.6, P < .001), and the ratio of E2/follicles > or = 17 mm was significantly lower in the rFSH group (308.9 vs. 406.5, P < .001). CONCLUSION: A standard daily dose of 100 IU of rFSH is more effective than uFSH in women undergoing IUI treatment since a more symmetric response is obtained.     

Oral contraceptive pills and follicular fluid hormones in an in vitro fertilization program

Fluids were collected from 136 ovarian follicles of 35 women undergoing in vitro fertilization and embryo transfer (IVF-ET). Fifteen women (76 follicles) received oral contraceptive pills (OCs) prior to ovulation induction. All women received human menopausal gonadotropins (hMG) for ovulation induction and in all cases follicular aspiration was performed 32 to 34 hours after an injection of human chorionic gonadotropin (hCG). The concentrations of follicular-stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), and 17 beta-estradiol (E2) in the follicular fluids (FF) were measured by radioimmunoassay (RIA). FSH concentration in the FF of the OCs group (15 women, 76 follicles) was significantly lower (2.1 mIU/mL) as compared to the FSH (15.9 mIU/mL) in the FF of the control group (20 women, 60 follicles). The LH FF concentrations after hCG injection were similar in the two groups. The E2/P ratio in the OCs group (9.6) was significantly lower than the E2/P ratio in the control group (20.6). OCs given to patients before induction of ovulation with hMG results in lower E2/P ratios and lower FSH concentration in the FF.     

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women

Objective

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.

Study design

A comparative prospective study.

Patients and methods

Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10–14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.

Results

There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].

Conclusion

The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.     

Pregnancy rate after ovulation triggering with gonadotrophin releasing hormone agonist versus human chorionic gonadotrophin in women undergoing controlled ovarian stimulation/intrauterine insemination

BackgroundGnRHa is as effective as hCG for ovulation triggering, apart from LH surge, FSH surge is also induced.ObjectiveTo compare triggering of ovulation by inducing endogenous LH surge (GnRHa) or using hCG in hMG stimulated cycles for intrauterine insemination (IUI).SettingProspective randomized study.Materials and methodsOut of the three hundred and eighty patients scheduled for IUI, after exclusion of 28 women, 352 were assigned to two groups: hMG/GnRHa (study group, n = 176) were assigned for receiving HP hMG followed by triggering by GnRHa and hMG/hCG (control group, n = 176) were assigned for HP hMG followed by hCG for ovulation triggering. Intrauterine insemination was done using freshly prepared semen 36 h after triggering of ovulation. Luteal phase support was done by 1500 IU hCG, 12 h after the triggering of ovulation.ResultsLH levels significantly (p < 0.001) increased in the hMG/GnRHa group than in the hMG/hCG group. No significant differences were seen between the basal LH, progesterone levels before and 8 days after triggering in both groups. The duration of the luteal phase was similar in both groups. Pregnancy rates per cycle were 17.61% for GnRHa and 13.06% for hCG respectively (p = 0.23).ConclusionsThere is no difference between GnRHa and hCG as regards pregnancy rate in women undergoing hMG stimulation for IUI cycles.     

Inhibin activity of preovulatory follicles of gonadotropin-treated and untreated women

In order to determine whether treatment of endocrinologically normal women with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) led to alternations in follicular fluid inhibin activity and steroids, both inhibin activity and steroid levels were measured in follicular fluid of 10 follicles of 9 women treated with hMG/hCG and in follicular fluid of 15 preovulatory follicles of 15 untreated women. The women were given 150 IU hMG daily from day 3 until the serum estrogen levels were greater than 300 pg/ml, at which time hMG was discontinued and 10,000 IU hCG was given 50 hours later. Follicular fluid was aspirated from all visible follicles 36 hours after hCG. Women treated with hMG/hCG had multiple (two to five) follicles containing 1.5 to 4.5 ml of follicular fluid and a mature oocyte and elevated serum estrogen (400 to 800 pg/ml) on the day after hCG treatment. At the time of follicular fluid recovery, there was more inhibin activity (204 +/- 14 U/10 ml) in the hMG/hCG-stimulated follicles than in unstimulated follicles of a control group of women (65 +/- 14, mean +/- standard error, P less than 0.05). Follicular fluid from follicles of hMG/hCG-treated women had lower estrogen and progesterone levels, compared with normal preovulatory women. These data show that treatment of patients with hMG/hCG is associated with elevated follicular fluid inhibin activity.     

Comparison of controlled ovarian stimulation with human menopausal gonadotropin or recombinant follicle-stimulating hormone

OBJECTIVE: To carefully examine the features of controlled ovarian stimulation performed with recombinant FSH-alpha or hMG. DESIGN: Controlled, prospective, randomized comparison of fixed gonadotropin regimens. SETTING: Academic research institution. PATIENT(S): Fifty infertile patients who were candidates for IUI. INTERVENTION(S): Patients were randomized to receive a fixed regimen of recombinant FSH-alpha (150 IU/day, 25 patients) or hMG (150 IU/day, 25 patients), after GnRH-agonist suppression (long regimen). MAIN OUTCOME MEASURES: Daily measurements of serum LH, immunoreactive FSH, hCG, E(2), P, and T. Transvaginal pelvic ultrasound every 2 days. Pregnancy and abortion rates. Cost of medications.Two recombinant FSH-alpha-treated patients did not respond. Despite matched daily FSH dose, duration of treatment (hMG 10.8 +/- 0.4 vs. recombinant FSH-alpha 12.4 +/- 0.5 days), gonadotropin dose (21.7 +/- 0.8 vs. 25.3 +/- 1.3 ampoules), gonadotropin cost (288 +/- 10 vs. 1,299 +/- 66 /cycle), serum P levels, and small preovulatory follicle number were significantly lower, and LH, hCG, immunoreactive FSH levels, and larger follicles on day 8 were significantly higher in hMG-treated patients. The pregnancy, abortion, and twin pregnancy rates did not differ. CONCLUSION: The hMG administration was associated with: [1]. increased serum LH activity and immunoreactive FSH levels during treatment; [2]. reduced signs of premature luteinization; [3]. differential modulation of folliculogenesis; [4]. lower treatment duration, gonadotropin dose, and cost; and [5]. clinical outcome comparable to recombinant FSH-alpha.     

Intracytoplasmic sperm injection pregnancy after low-dose human chorionic gonadotropin alone to support ovarian folliculogenesis

OBJECTIVE: To prove that several days of low-dose hCG alone can be used to stimulate folliculogenesis, complete FSH-initiated follicle/oocyte maturation, and achieve pregnancy in assisted reproduction technology. DESIGN: Case report. SETTING: Reproductive endocrinology center at an academic institution. PATIENT(S): A 35-year-old female patient and her partner with male-related infertility. INTERVENTION(S): After an 8-day priming with hMG (225 IU/d), we administered low-dose hCG (200 IU/d) alone for 5 days in one GnRH-agonist suppressed patient until proper follicle development was obtained and intracytoplasmic sperm injection was performed. MAIN OUTCOME MEASURE(S): Daily serum levels of LH, FSH, hCG, E(2), P, and T; measurements of follicle number and size; oocytes retrieved and fertilized; pregnancy. RESULT(S): Although FSH levels rapidly declined after hMG discontinuation, E(2) and large follicles increased during hCG-only administration. Several good quality oocytes were retrieved and fertilized by intracytoplasmic sperm injection; three embryos were transferred and a twin pregnancy ensued. CONCLUSION(S): Replacement of FSH with low-dose hCG for several days in the late ovulation induction stages of assisted reproduction technology resulted in: [1] continued growth of large ovarian follicles and E(2); [2] an optimal preovulatory follicle pattern consisting of many large and few medium and small follicles; and [3] reproductively competent oocytes and pregnancy.     

Obstetric implications for and identification of women with a normal clomiphene citrate challenge test result who have a poor response to gonadotropins

OBJECTIVE: To determine the incidence and obstetric implications and to identify prospectively women with a poor response to hMG with a normal clomiphene citrate challenge test (CCCT) result. DESIGN: Retrospective chart review. SETTING: Tertiary fertility center. PATIENT(S): One hundred sixty-three women who underwent ovulation induction with hMG for IUI, and 266 women who underwent ovulation induction with GnRH analogue and hMG for IVF. All had a CCCT before stimulation. Seventy-five percent of IUI patients (123 of 163) and 89% of IVF patients (238 of 266) had normal CCCT results. A poor response to hMG was defined as a response less than the 90th percentile of women with an abnormal CCCT result (peak E(2) [pg/mL] level per ampule hMG used: 90th percentile 12 mIU/mL (IMx assay) on either day 3 or day 10 (normal 12 mIU/mL (IMx assay) or 20 mIU/mL (converted to the original RIA) will identify approximately 80% (IUI) and approximately 94% (IVF) of the women who will experience a poor response to hMG. When identified, the data suggest that these patients will benefit significantly from the more aggressive IVF.