HIGHLY PURIFIED FSH FOR OVARIAN STIMULATI ON OF DOWN-REGULATED CYCLESIN IVF

Highly purified FSH (Fertinorm HP(R)) was used for follicle stimulatio n during one cycle of IVF in each of 112 women. In all cases, stimulat ion was begun with 150 IU FSH per day s.c. after pituitary down-regula tion with a GnRH analogue in a Long protocol. Sixteen (14.3%) of the 1 12 treatment cycles started were stopped before follicle aspiration. T he reasons for stopping stimulation were elevated progesterone values with premature luteinisation in 9 (8.0%) patients, inadequate follicle stimulation in 4 (3.6%) cases and threatened overstimulation in 3 (2. 7%) cases. The mean duration of stimulation was 11.8 days with 7.8 ooc ytes obtained per aspiration by the transvaginal rute. Embryo transfer was possible in 77 (68.7%) patients, with a mean of 2.3 embryos per t ransfer. A total of 23 clinical pregnancies resulted, with a pregnancy rate of 20.5% and 29.9% per cycle and embryo transfer, respectively. There were three cases of multiple pregnancy (13.0%), two (8.7%) misca rriages occurred and one patient (4.3%) had a tubal pregnancy. The rat e of successful pregnancies was thus 17.9% per cycle. Five patients (5 .2%) required treatment for overstimulation. There were not other trea tment complications. These results show that highly purified FSH can a lso be used successfully in IVF after pituitary down-regulation. The r emaining endogenous LH activity in these cases may be regarded as suff icient for follicular development and steroid synthesis. Highly purifi ed FSH can therefore be used for all stimulation protocols in patients with normal gonadotrophin levels. The relatively low rate of miscarri ages with this treatment is noteworthy.