Human Reproduction, Vol. 17, No. 7, 1676,
July 2002
© 2002 European Society of Human Reproduction and Embryology
Bye-bye urinary gonadotrophins?
Risk of infection is not the main problem
Department of Obstetrics and Gynaecology, University of Milan, Via della commenda 12, 20122 Milan, Italy. E-mail: piergiorgio.crosignani{at}unimi.it
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Abstract |
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The risk of infection from prion proteins in urinary preparations of human gonadotrophins is uncertain—and is of lesser importance than the risk of multiple pregnancies and issues of cost.
Key words: prion proteins/recombinant FSH/urinary gonadotrophins
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Introduction |
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Compared with recombinant FSH, urinary gonadotrophins have no clinical benefits (Daya and Gunby, 1999
; Matorras et al., 2000), but they are less expensive. In fact, in some countries the cost of the two preparations is consistently different. For all customers, but especially for the ‘public’ programmes of ovarian stimulation, this is an important limiting factor, since the higher cost reduces the resources for other health programmes.
In addition, the urinary preparations of human gonadotrophins have been widely used for 40 years and no infections have been associated with their injection, even in the past when the urinary extracts were rather ‘impure’ (Donini et al., 1949). No, the uncertain risk of infections currently does not represent the main problem of ovarian stimulation. Instead, the major concern is the real, well-known risk of twin pregnancies associated with the induced multiple ovulation (Gleicher et al., 2000).
So, bye-bye urinary gonadotrophins? I am sure that these preparations will disappear as soon as cheaper recombinant ones become available. On the contrary, the risk of iatrogenic twinning will continue until a milder form of ovarian stimulation is used (Edwards et al., 1997).
Curiously, reading the results of the publications in the area of gonadotrophin-induced cycles, multiple gestations are still wrongly reported as a therapeutic success. It is time to recategorize these as unwanted and feared complications.
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References |
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Daya, S, and Gunby, J. (1999) Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction. Hum. Reprod., 14, 2207–2215.
Donini, P. and Montezemolo, R. (1949) Gonadotropina preipofisaria e gonadotropina preipofisaria-simile umana. Rass. Clin. Terap. Sc. Affini, 48, 143–163.
Edwards, R.G., Lobo, R.A. and Bouchard, P. (1997) Why delay the obvious need for milder forms of ovarian stimulation? Hum. Reprod., 12, 399–401.[ISI][Medline]
Gleicher N., Oleske, D.M., Tur-Kaspa, I., Vidali, A. and Karande, V. (2000) Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins. N. Engl. J. Med., 343, 2–7.
Matorras, R., Recio, V., Corcóstegui, B. and Rodríguez-Escudero, F.J. (2000). Recombinant human FSH versus highly purified urinary FSH: a randomized study in intrauterine insemination with husbands' spermatozoa. Hum. Reprod., 15, 1231–1234.
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