PURIFIED URINARY FOLLICLE-STIMULATING-HORMONE INDUCES DIFFERENT HORMONE PROFILES COMPARED WITH MENOTROPHINS, DEPENDENT UPON THE ROUTE OF ADMINISTRATION AND ENDOGENOUS LUTEINIZING-HORMONE ACTIVITY

The effects of treatment of patients with gonadotrophin-releasing horm one analogue (GnRHa) combined with purified follicle stimulating hormo ne (FSH) for in-vitro fertilization (IVF) were investigated in detail to determine the influences of different administration routes and the degree of suppression of luteinizing hormone (LH), Responses to exoge nous gonadotrophins were studied in infertile women (n = 60) with norm al menstrual rhythm whose endogenous gonadotrophin activity was suppre ssed using a GnRHa in a long protocol, They were randomized to receive i.m. administration of human menopausal gonadotrophins (HMGim, Pergon al) or purified follicle stimulating hormone (FSH, Metrodin High Purit y) administered either i.m. (MHPim) or s.c. (MHPsc). Responses were as sessed by measuring plasma FSH, LH, oestradiol, testosterone and proge sterone. After stimulation day 4, the MHPsc group showed significantly higher circulating concentrations of FSH than either the MHPim or HMG im group. However, the HMG group showed significantly higher oestradio l concentrations after stimulation day 5 than either MHP group, The di fferences in cirrpdating oestradiol concentrations in the MHP-treated patients appeared to be strongly influenced by the mean circulating co ncentrations of LH in the follicular phase, The patients who showed me an follicular phase LH concentrations of <1 IU/l showed longer follicu lar phases, lower circulating oestradiol and testosterone concentratio ns and also lower follicular fluid concentrations of oestradiol and te stosterone, indicating a reduction in the normal follicular metabolism of progesterone to androgens and oestrogens under these conditions, T his group of patients also showed longer follicular phases, which may have consequences for future clinical management.