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Hum. Reprod. Advance Access published online on November 16, 2006
Human Reproduction, 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 The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
Received May 29, 2006
Revised October 10, 2006
Accepted October 19, 2006

Article

Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients

J. Smitz 1 *, A.N. Andersen 2, P. Devroey 3, and J.-C. Arce 4, 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
4 Ferring Pharmaceuticals A/S, Obstetrics & Gynaecology, Clinical Research & Development, Copenhagen, Denmark

* To whom correspondence should be addressed.
J. Smitz, E-mail: johan.smitz{at}az.vub.ac.be


  Abstract

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.

Keywords: endocrine/follicular fluid/IVF/highly purified menotrophin/recombinant FSH.

*Menotrophin versus Recombinant FSH in vitro Fertilisation Group


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