Human Reproduction, Vol. 16, No. 3, 449-456,
March 2001
© 2001 European Society of Human Reproduction and Embryology
Lipoprotein(a) changes during natural menstrual cycle and ovarian stimulation with recombinant and highly purified urinary FSH
1 UCO di Ginecologia e Ostetricia, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste, Istituto per l'Infanzia `Burlo Garofolo', I.R.C.C.S., Trieste and 2 Laboratorio Analisi, Istituto per l'Infanzia `Burlo Garofolo', I.R.C.C.S., Trieste, Italy
This prospective, randomized, controlled study compared the effects of recombinant human FSH (r-hFSH) and highly purified urinary FSH (u-hFSH HP) on lipoprotein(a) [Lp(a)] concentrations in women undergoing ovarian stimulation. Fifty infertile women were randomly allocated into two equally sized treatment groups (n = 25 per group). Thirty normal ovulation women were recruited as controls. The infertile women received u-hFSH or r-hFSH 150 IU/day starting on cycle day 2. From cycle day 6 the dose was adjusted according to ovarian response. Human chorionic gonadotrophin 10 000 IU was administered once there was at least one follicle 
18 mm in diameter. The luteal phase was supported with progesterone 50 mg/day for at least 15 days. Repeated measurements of Lp(a) concentrations were performed during both stimulated and natural cycles. A significant increase in luteal phase Lp(a) concentrations was detected in the stimulated cycles, whereas no significant changes in serum Lp(a) concentrations were observed during natural cycles. There were no significant differences between the urinary and recombinant FSH effects on serum Lp(a). The luteal Lp(a) increase was transitory because after 1 month Lp(a) concentrations returned to baseline values if pregnancy failed to occur; in pregnant women persistent increased Lp(a) concentrations were found at the 8th week. The percentage changes in serum Lp(a) were positively correlated with the luteal progesterone increase (r = 0.40, P < 0.05), but not with follicular or luteal oestradiol increase. The women with low baseline Lp(a) (
5 mg/dl) had a greater increase of the Lp(a) concentrations at midluteal phase than women with baseline Lp(a) >5 mg/dl. In conclusion, the recombinant or urinary hFSH administration does not directly influence Lp(a) concentrations. The luteal Lp(a) increase in stimulated cycles is not related to gonadotrophin treatment per se, but appears to be related to the high luteal progesterone concentrations, physiologically or pharmacologically determined. Our results also suggest that the sensitivity to the progesterone changes could be related to apolipoprotein(a) phenotype.
Key words: highly purified urinary FSH/lipoprotein(a)/ovarian stimulation/progesterone/recombinant FSH
3 To whom correspondence should be addressed at: UCO di Ginecologia e Ostetricia, Dipartimento di Scienze della Riproduzionee dello Sviluppo, Università di Trieste, Istituto per l'Infanzia `Burlo Garofolo', I.R.C.C.S., Via dell'Istria 65/1, 34137 Trieste, Italy.E-mail: ricci{at}burlo.trieste.it