Human Reproduction, Vol. 16, No. 12, 2726,
December 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Subgroup analyses in Orgalutran trials
8-Moustepha Hassanin St, Manial, Cairo 11451, Egypt
Dear Sir,
I read with interest the European–Middle East Orgalutran trial (The European Orgalutran Study Group et al., 2000) and I noticed that the study extensively monitored hormonal assays (LH, FSH, oestradiol). It is well known that sufficient stimulation of both theca cells and granulosa cells by LH and FSH is required for adequate oestradiol biosynthesis (Short, 1962
; Schoot et al., 1992) and hence endometrial proliferation and receptivity. Recent in-vivo evidence also demonstrates that dominant follicle development and oestradiol production are also dependent on late-follicular phase LH concentrations (Zeleznik et al., 1974; Sullivan et al., 1999). However, in contrast to gonadotrophin-releasing hormone (GnRH) agonists, the suppression of LH secretion by GnRH antagonists is more pronounced than that of FSH (Hall et al., 1988). Whether this more pronounced suppression could have an impact on clinical outcome is still a matter of debate. I was wondering if a subgroup analysis was done in the antagonist-treated group (those who got pregnant and those who did not) based on the difference in ratios between basal FSH and LH and their concentrations on day of HCG administration.
References
Hall, J.E., Brodie, T.D., Badger, T.M. et al. (1988) Evidence of differential control of FSH and LH secretion by gonadotropin-releasing hormone (GnRH) from the use of a GnRH antagonist. J. Clin. Endocrinol. Metab., 67, 524–531.
Ortmann, O., Weiss, J.M. and Diedrich, K. (2001) Embryo implantation and GnRH antagonists: ovarian actions of GnRH antagonists. Hum. Reprod., 16, 608–611.
Mannaerts, B. and Gordon, K. (2000) Embryo implantation and GnRH antagonists: GnRH antagonists do not activate the GnRH receptor. Hum. Reprod., 15, 1882–1883.
Schoot, D.C., Coelingh Bennink, H.J., Mannaerts, B.M. et al. (1992) Human recombinant follicle-stimulating hormone induces growth of preovulatory follicles without concomitant increase in androgen and estrogen biosynthesis in a woman with isolated gonadotropin deficiency. J. Clin. Endocrinol. Metab., 74, 1471–1473.[Abstract]
Short, R.V. (1962) Steroids in the follicular fluid and the corpus luteum of the mare. A `two cell type' theory of ovarian steroid synthesis. J. Endocrinology, 24, 59–63.
Sullivan, M.W., Stewart-Akers, A., Krasnow, J.S. et al. (1999) Ovarian responses in women to recombinant follicle-stimulating hormone and luteinizing hormone (LH): a role for LH in the final stages of follicular maturation. J. Clin. Endocrinol. Metab., 84, 228–232.
The European Orgalutran Study Group, Borm, G. and Mannaerts, B. (2000) Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. Hum. Reprod., 15, 1490–1498.
Zeleznik, A.J., Midgley, A.R.J. and Reichert, L.E.J. (1974) Granulosa cell maturation in the rat: increased binding of human chorionic gonadotropin following treatment with follicle-stimulating hormone in vivo .Endocrinology, 95, 818–825.
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