Recombinant Human Follicle-stimulating Hormone for Ovulation Induction in Polycystic Ovary Syndrome: a Prospective, Randomized Trial of Two Starting Doses in a Chronic Low-dose Step-up Protocol

Overview

Journal J Assist Reprod Genet

Publisher Springer

Specialties Genetics
Reproductive Medicine

Date 2001 Feb 24

PMID 11209536

Citations 5

Authors

J Balasch

F Fabregues

M Creus

R Casamitjana

B Puerto

J A Vanrell

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim was to compare the follicular response to 37.5 and 50 IU of recombinant follicle-stimulating hormone (FSH) as starting doses for ovulation induction in patients with polycystic ovary syndrome (PCOS).

Methods: Prospective, randomized, crossover study including 15 women with clomiphene citrate-resistant chronic anovulatory infertility. Patients were treated with subcutaneous recombinant FSH at starting doses of 37.5 IU and 50 IU, respectively, according to a low-dose step-up protocol. Each woman received both treatments, in a randomized order, with an interval of > or = 1 month between treatments.

Results: All treatment cycles were ovulatory after an appropriate follicular response and hormone levels were similar with both treatments, although the total quantity of FSH required and the mean daily dose required to induce identical follicular development were significantly lower with a starting dose of 37.5 IU FSH. The mean duration of treatment to achieve ovulation was approximately 13 days with both treatments but treatment periods > or = 20 days were required in some patients.

Conclusions: In women with PCOS, a starting dose of 37.5 IU recombinant FSH may be adequate to induce follicular growth. However, the use of low starting doses may result in some cases in increased treatment periods and need for monitoring.

Citing Articles

Recombinant follicle-stimulating hormone (follitropin alfa) versus purified urinary follicle-stimulating hormone in a low-dose step-up regimen to induce ovulation in Japanese women with anti-estrogen-ineffective oligo- or anovulatory infertility:....

Taketani Y, Kelly E, Yoshimura Y, Hoshiai H, Irahara M, Mizunuma H Reprod Med Biol. 2018; 9(2):99-106.

PMID: 29699333 PMC: 5906845. DOI: 10.1007/s12522-010-0046-5.

Use of letrozole and clomiphene citrate combined with gonadotropins in clomiphene-resistant infertile women with polycystic ovary syndrome: a prospective study.

Xi W, Liu S, Mao H, Yang Y, Xue X, Lu X Drug Des Devel Ther. 2015; 9:6001-8.

PMID: 26648691 PMC: 4651359. DOI: 10.2147/DDDT.S83259.

Clomiphene citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial.

Ghanem M, Elboghdady L, Hassan M, Helal A, Gibreel A, Houssen M J Assist Reprod Genet. 2013; 30(11):1477-85.

PMID: 24014214 PMC: 3879942. DOI: 10.1007/s10815-013-0090-2.

Predicting the FSH threshold dose in women with WHO Group II anovulatory infertility failing to ovulate or conceive on clomiphene citrate.

Nyboe Andersen A, Balen A, Platteau P, Devroey P, Helmgaard L, Arce J Hum Reprod. 2008; 23(6):1424-30.

PMID: 18372254 PMC: 2387217. DOI: 10.1093/humrep/den089.

Contemporary pharmacological manipulation in assisted reproduction.

Huirne J, Lambalk C, van Loenen A, Schats R, Hompes P, Fauser B Drugs. 2004; 64(3):297-322.

PMID: 14871171 DOI: 10.2165/00003495-200464030-00005.

References

Groome N, OBrien M . Immunoassays for inhibin and its subunits. Further applications of the synthetic peptide approach. J Immunol Methods. 1993; 165(2):167-76. DOI: 10.1016/0022-1759(93)90342-5. View

Balasch J, Miro F, Burzaco I, Casamitjana R, Civico S, Ballesca J . The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod. 1995; 10(7):1678-83. DOI: 10.1093/oxfordjournals.humrep.a136154. View

Groome N, Illingworth P, OBrien M, Cooke I, Ganesan T, Baird D . Detection of dimeric inhibin throughout the human menstrual cycle by two-site enzyme immunoassay. Clin Endocrinol (Oxf). 1994; 40(6):717-23. DOI: 10.1111/j.1365-2265.1994.tb02504.x. View

Goa K, Wagstaff A . Follitropin alpha in infertility: a review. BioDrugs. 2007; 9(3):235-60. DOI: 10.2165/00063030-199809030-00006. View

Schenker J . Prevention and treatment of ovarian hyperstimulation. Hum Reprod. 1993; 8(5):653-9. DOI: 10.1093/oxfordjournals.humrep.a138115. View

Balasch J, Tur R, Alvarez P, Bajo J, Bosch E, Bruna I . The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain. J Assist Reprod Genet. 1996; 13(7):551-6. DOI: 10.1007/BF02066607. View

Balasch J, Fabregues F, Penarrubia J, Creus M, Vidal R, Casamitjana R . Follicular development and hormonal levels following highly purified or recombinant follicle-stimulating hormone administration in ovulatory women and WHO group II anovulatory infertile patients. J Assist Reprod Genet. 1998; 15(9):552-9. PMC: 3454924. DOI: 10.1023/a:1022586221077. View

Andoh K, Mizunuma H, Liu X, Kamijo T, Yamada K, Ibuki Y . A comparative study of fixed-dose, step-down, and low-dose step-up regimens of human menopausal gonadotropin for patients with polycystic ovary syndrome. Fertil Steril. 1998; 70(5):840-6. DOI: 10.1016/s0015-0282(98)00308-2. View

Fauser B, van Heusden A . Manipulation of human ovarian function: physiological concepts and clinical consequences. Endocr Rev. 1997; 18(1):71-106. DOI: 10.1210/edrv.18.1.0290. View

10.

Franks S, Gilling-Smith C . Advances in induction of ovulation. Curr Opin Obstet Gynecol. 1994; 6(2):136-40. View

11.

Levene M, Wild J, Steer P . Higher multiple births and the modern management of infertility in Britain. The British Association of Perinatal Medicine. Br J Obstet Gynaecol. 1992; 99(7):607-13. DOI: 10.1111/j.1471-0528.1992.tb13831.x. View

12.

Shoham Z, Balen A, Patel A, Jacobs H . Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients. Fertil Steril. 1991; 56(6):1048-53. DOI: 10.1016/s0015-0282(16)54715-3. View

13.

Brown J . Pituitary control of ovarian function--concepts derived from gonadotrophin therapy. Aust N Z J Obstet Gynaecol. 1978; 18(1):46-54. DOI: 10.1111/j.1479-828x.1978.tb00011.x. View

14.

White D, Polson D, Kiddy D, Sagle P, Watson H, Gilling-Smith C . Induction of ovulation with low-dose gonadotropins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women. J Clin Endocrinol Metab. 1996; 81(11):3821-4. DOI: 10.1210/jcem.81.11.8923819. View

15.

Evans M, Littmann L, St Louis L, Leblanc L, Addis J, Johnson M . Evolving patterns of iatrogenic multifetal pregnancy generation: implications for aggressiveness of infertility treatments. Am J Obstet Gynecol. 1995; 172(6):1750-3; discussion 1753-5. DOI: 10.1016/0002-9378(95)91407-2. View

16.

Coelingh Bennink H, Fauser B, Out H . Recombinant follicle-stimulating hormone (FSH; Puregon) is more efficient than urinary FSH (Metrodin) in women with clomiphene citrate-resistant, normogonadotropic, chronic anovulation: a prospective, multicenter, assessor-blind, randomized,.... Fertil Steril. 1998; 69(1):19-25. DOI: 10.1016/s0015-0282(97)00423-8. View

17.

Hayden C, Rutherford A, Balen A . Induction of ovulation with the use of a starting dose of 50 units of recombinant human follicle-stimulating hormone (Puregon). Fertil Steril. 1999; 71(1):106-8. DOI: 10.1016/s0015-0282(98)00408-7. View

18.

Adams J, Polson D, Franks S . Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed). 1986; 293(6543):355-9. PMC: 1341046. DOI: 10.1136/bmj.293.6543.355. View

19.

Kettel L, Hummel W . Ovulation induction in the estrogenized anovulatory patient. Semin Reprod Endocrinol. 1996; 14(4):309-15. DOI: 10.1055/s-2008-1067976. View

20.

Balasch J, Fabregues F, Creus M, Penarrubia J, Vidal E, Carmona F . Follicular development and hormonal levels following highly purified or recombinant follicle-stimulating hormone administration in ovulatory women undergoing ovarian stimulation after pituitary suppression for in vitro fertilization: implications.... J Assist Reprod Genet. 2000; 17(1):20-7. PMC: 3455196. DOI: 10.1023/a:1009493829086. View