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Human Reproduction, Vol. 18, No. 3, 476-482, March 2003
© 2003 European Society of Human Reproduction and Embryology

Bye-bye urinary gonadotrophins?

Recombinant FSH: A real progress in ovulation induction and IVF?*

Norbert Gleicher1,2,3,4, Mary Vietzke2 and Andrea Vidali1

1 The Center for Human Reproduction, New York, New York, 2 The Center for Human Reproduction, Chicago, Illinois and 3 The Foundation for Reproductive Medicine, Chicago, Illinois, USA

4 To whom correspondence should be addressed at: Center for Human Reproduction, 60 East Delaware Place, Suite 1400, Chicago, Illinois 60611, USA. e-mail: CHRJournal{at}aol.com

Whether recombinant gonadotrophin products do, indeed, represent progress for routine ovulation induction and IVF cycles, in comparison with urinary products, has remained controversial. Here we review published data with regard to respective risks, outcomes and cost for both medication options. Safety considerations favour recombinant products, while overall outcome and cost considerations favour urinary gonadotrophins. Outcome, however, appears to differ, based on age and ovarian function, with younger patients benefiting from the FSH/LH combination offered by urinary products, while older women and young women with ovarian resistance, apparently benefiting from pure FSH stimulation. Young women with poor ovarian reserve may be best stimulated with a pure FSH/antagonist protocol. We conclude that under current pricing structures in the United States, recombinant gonadotrophins do not represent a major progress for the treatments of ovulation induction and IVF. They, however, allow for an improved selectivity of stimulation protocols. The creation of recombinant FSH/LH products and cost adjustments for recombinant products, may affect these conclusions in favour of recombinant products.

Key words: gonadotrophins/infertility/IVF/ovulation induction

* Presented in part, by invitation at the Serono Symposium, May 10–11, 2002 in Turin, Italy.


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