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Hum. Reprod. Advance Access originally published online on November 16, 2006
Human Reproduction 2007 22(3):676-687; doi:10.1093/humrep/del445
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients

J. Smitz1,5, A.N. Andersen2, P. Devroey3, J.-C. Arce4 and for the MERIT Group*

1 Follicle Biology Laboratory and Center for Reproductive Medicine of the Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium 2 Rigshospitalet, Fertility Clinic, Copenhagen, Denmark 3 Center for Reproductive Medicine of the Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium and 4 Ferring Pharmaceuticals A/S, Obstetrics & Gynaecology, Clinical Research & Development, Copenhagen, Denmark

5 To whom correspondence should be addressed at: Follicle Biology Laboratory and Center for Reproductive Medicine of the Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: johan.smitz{at}az.vub.ac.be

BACKGROUND: Highly purified menotrophin (HP-hMG) has been associated with fewer oocytes retrieved and a higher proportion of top-quality embryos compared with recombinant FSH (rFSH). METHODS: A randomized, assessor-blind, multinational trial in 731 women undergoing IVF after stimulation with HP-hMG (MENOPUR) (n = 363) or rFSH (GONAL-F) (n = 368) following a long GnRH agonist protocol was conducted. Blood was collected before, during and after stimulation. Fluid was collected from follicles ≥17 mm. RESULTS: Serum androstenedione, total testosterone and free androgen index (FAI) were higher (P < 0.001) with HP-hMG than with rFSH after starting stimulation. At the end of stimulation, serum estradiol was higher (P = 0.031) with HP-hMG, whereas progesterone was higher (P < 0.001) with rFSH, even after adjusting for ovarian response. Serum LH was not different between treatments. Mean mid- and end-follicular hCG levels in the HP-hMG group were 2.5 and 2.9 IU/l, respectively. Follicular fluid levels of FSH, LH, hCG, androstenedione, testosterone, FAI and estradiol and ratios of estradiol : androstenedione, estradiol : total testosterone and estradiol : progesterone were higher (P < 0.001) with HP-hMG, whereas progesterone was higher (P < 0.001) with rFSH. CONCLUSION: Major differences in serum and follicular fluid endocrine profile exist after stimulation with HP-hMG or rFSH. Exogenous LH activity induces a differential endocrine environment influencing oocyte quantity and quality, which may be of relevance for clinical outcome.

Key words: endocrine/follicular fluid/IVF/highly purified menotrophin/recombinant FSH

Submitted on May 29, 2006; resubmitted on September 7, 2006; resubmitted on October 10, 2006; accepted on October 19, 2006.


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