IMPLICATIONS OF USING FOLLICLE-STIMULATING-HORMONE PREPARATIONS DEPLETED OF LUTEINIZING-HORMONE TO ACHIEVE FOLLICULAR-GROWTH IN IN-VITRO FERTILIZATION

We aimed to compare the outcome of in vitro fertilization (IVF) treatm ent using follicle-stimulating hormone (FSH) containing gonadotropins with human menopausal gonadotropin (hMC) containing gonadotropins for ovarian stimulation. A retrospective analysis of 82 patients undergoin g IVF in a private fertility clinic was performed over a specific peri od of time. Eighteen women received hMG, 20 received Normegon(R) and 4 4 received FSH. In addition, 17 of these patients received hMG in one cycle and FSH in the other. The main outcome measures studied were dur ation of treatment, dose of gonadotropins required to achieve optimum follicular growth, number and size of follicles, endometrial thickness , serum estradiol concentrations, number of oocytes retrieved, pregnan cy rates and the incidence of ovarian hyperstimulation syndrome (OHSS) . At the time of administration of human chorionic gonadotropin (hCG), the mean (+/- SD) serum estradiol concentrations in patients treated with preparations containing FSH and luteinizing hormone (LH) in a rat io of 1:1 was 10044.3 +/- 5378.8 pmol/l compared with 6819.5 +/- 2597. 9 pmol/l in patients treated with preparations with FSH and LH in a ra tio of 3:1 and 7369 +/- 4300 pmol/l in patients treated with FSH. The differences between the first and the second two groups were significa nt (p < 0.05). Endometrial thickness in the three groups of patients w ere 11 +/- 1.7 mm, 11 +/- 1.5 mm and 9.7 +/- 1.5 mm, respectively (p < 0.001). Comparing cycles of treatment with hMG and FSH in the same pa tient, we found significantly higher estradiol levels, thicker endomet rium, move developing follicles and a shouter duration of treatment in the hMG-treated cycles compared with those in FSH-treated cycles. How ever, there were no differences between the incidence of OHSS or the p regnancy rates between the three treatment groups. With the advent of recombinant human FSH and the shortage of LH-containing preparations, it is important to note that serum estradiol concentrations on the day of administration of hCG underrepresent the degree of follicular matu ration. In the context of the use of a 'long' protocol of gonadotropin -releasing hormone (GnRH) analog therapy and LH-depleted gonadotropin preparations, serum estradiol is no longer a reliable marker of follic le development.