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Principles of Pathophysiology of Infertility Assessment and Treatment*
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
A variety of treatment schedules for gonadotropin administration for induction of ovulation have been devised. Nearly all of those schedules are based on the fact that treatment with gonadotropin preparations results specifically in follicular growth and maturation. The “variable technique” has been used more commonly; the daily dosage and duration of therapy depend on individual response. Gonadotropin preparations are very active agents for stimulating the ovary to ovulate, and with adequate therapy ovulation is achieved in 80 to 90% of the patients, although pregnancy can be expected in only 40 to 60%. The conception rate depends on the selection of patients, dose, regimen, and number of treatment cycles. Gonadotropin therapy can be applied in combination with different agents like clomiphene, Gn-RH, dexamethasone, and parlodel.
Endocrine characteristics of assisted reproduction technology cycles
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Bulent Urman, Baris Ata, Hakan Yarali
Despite these theoretical concerns, findings from clinical trials of LH supplementation of ovarian stimulation are conflicting. Currently, three groups of commercially available gonadotropin preparations contain LH activity: (i) urinary human menopausal gonadotropins (hMGs), in which 95% of the LH activity is derived from hCG; (ii) LH glycoprotein produced by recombinant technology; and a combination of recombinant FSH (rFSH) and LH glycoproteins in a fixed ratio of 2:1.
What must be considered when prescribing hormonal pharmacotherapy for male infertility?
Published in Expert Opinion on Pharmacotherapy, 2022
Olivia Holtermann Entwistle, Aditi Sharma, Channa N. Jayasena
Exogenous gonadotropins such as FSH or human chorionic gonadotropin (hCG) seek to replicate the physiological action of FSH and LH, respectively. A Cochrane review of six RCTs investigating the effect of various gonadotropin preparations, such as hCG, human menopausal gonadotropin (HMG), purified and highly purified FSH and recombinant FSH, in idiopathic male infertility found a significant increase in spontaneous pregnancy rates in the treatment group [3]. One study examined the effect of a combination regimen of purified and highly purified FSH in couples undergoing IUI, starting 3 months prior to the first cycle and ending with the fifth cycle, in couples undergoing intra-uterine insemination (IUI), and another examined the effect of highly purified FSH treatment for 12 weeks on couples undergoing ICSI, both with non-significant results [3]. The authors note that gonadotropin preparations, treatment regimens, and treatment duration were heterogeneous across all the included studies. In view of this heterogeneity, and the small sample sizes of the studies, the authors conclude that although the pooled data showed a generally positive effects in terms of spontaneous pregnancy rates, there is insufficient data to draw conclusions about the superiority of any gonadotropin preparation, treatment regimen, or treatment duration [3].
Low-glycosylated forms of both FSH and LH play major roles in the natural ovarian stimulation
Published in Upsala Journal of Medical Sciences, 2018
Human gonadotropin preparations have now been used during six decades for the induction of ovulation in anovulatory women. A review of this treatment was presented in the introduction to our previous report (1). These treatments have been highly successful but also associated with a risk for ovarian hyperstimulation and multifetal pregnancies. Mono-ovulation is the aim in the treatment of anovulatory women. It has continuously been a desire to try to mimic the natural ovarian stimulation process more closely to achieve this goal. One prerequisite is then a thorough knowledge about the glycosylation and glycan compositions of serum FSH and LH during the normal menstrual cycle. The gonadotrophins are secreted episodically and both pulse frequency and amplitude do change during the cycle (28). This paper demonstrates for the first time that there are two circulating glycoforms of FSH and two of LH and that the low-glycosylated forms play major roles. All four glycoforms vary in serum concentration and in glycan structures with respect to content of SA and SU throughout the menstrual cycle. With this knowledge, a plausible future treatment alternative, which mimics the natural ovarian stimulation, is to administer mixtures of such recombinant glycoforms of FSH and LH subcutaneously in a pulsatile fashion using a pump.
Do poor-responder patients undergoing IVF benefit from splitting and increasing the daily gonadotropin dose?
Published in Gynecological Endocrinology, 2019
Osnat Ezra, Jigal Haas, Ravit Nahum, Ettie Maman, Yoram Cohen, Aliza Segev-Zahav, Raoul Orvieto
We reviewed the computerized files of all consecutive women admitted to our IVF unit and reached the ovum pick-up (OPU) stage. The elimination of bias in this selection, for the purposes of this study, was achieved by including only POR patients according to the Bologna criteria undergoing COH [3], using a starting daily gonadotropin dose of 450 IU, who received in their subsequent IVF cycle attempt, a starting daily gonadotropin dose of 300 IU twice a day. Other exclusion criteria were the use of donor oocytes or transfer of frozen-thawed embryos. The study was approved by our institutional review board. Patients used gonadotropin preparations containing LH-activity (MENOPUR- Ferring Pharmaceuticals, Copenhagen, Denmark; or, PERGOVERIS, Merck Serono, Darmstadt, Germany)