2018, Number 06
Results in IVF-ICSI cycles adding luteinizing hormone recombinant to follicle stimulating hormone recombinant with menotropins during ovarian stimulation in patients over 35 years-old
PDF size: 282.45 Kb.
ABSTRACTObjective:To evaluate the reproductive effects when recombinant luteinizing hormone is added and to compare two stimulation schemes by number of aspirated oocytes, mature oocytes, fertilization and implantation rates, live newborn and number of vitrified embryos.
Materials and Methods: Longitudinal, observational and retrospective study carried out in patients of the Hisparep Reproduction Clinic of the Spanish Hospital with diagnosis of infertility, over 35 years old, who received a controlled ovarian hyperstimulation cycle with IVF-ICSI during the period 2014-2016. The statistical analysis was carried out with the Student t test for independent samples. The studies were analyzed with the IBM SPSS statistical package, version 22.
Results: We analyzed 201 women with infertility, over 35 years of age. Group 1 (n = 101) of IVF-ICSI received stimulation with recombinant follicle-stimulating hormone and recombinant luteinizing hormone 2: 1 with menotropins (Pergoveris® and Merapur®) from the second day of the cycle. Group 2 (n = 100) received recombinant follicle stimulating hormone and menotropins (Gonal F® and Merapur®); in both schemes, GnRH antagonist was used from day 7 of the cycle. The average number of aspirated oocytes was 7.5 in Group 1 and 9.1 in Group 2 (p = 0.058). Mean mature oocytes were 6.2 in Group 1 vs 7.4 in Group 2 (p = 0.085). The fertilization rate in group 1 was 57 vs. 67% in Group 2 (p = 0.045). In Group 1 the implantation rate per embryo transferred fresh was 24.1 vs 10.3% in Group 2 (p = 0.40), the live newborn rate was 30% in Group 1 vs 20.6% in Group 2. The mean number of vitrified embryos in Group 1 was 1.47 vs 1.38 in Group 2.
Conclusions: The probable advantage of supplementation with recombinant follicle-stimulating hormone during ovarian stimulation in women over 35 years of age is of interest and its evaluation is required in subsequent studies.
Maia MC, Approbato MS, da Silva TM, et al. Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients. JBRA Assisted Reproduction 2016;20(2):78-81. doi: 10.5935/1518-0557.20160018.
Humaidan P, Schertz J, Fischer R. Efficacy and Safety of Pergoveris in Assisted Reproductive Technology-ESPART: rationale and design of a randomised controlled trial in poor ovarian responders undergoing IVF/ICSI treatment. BMJ Open. 2015 Jul 3;5(7):e008297. http://dx.doi.org/10.1136/ bmjopen-2015-008297.
Revelli A. Assisted reproduction technologies. Outcome of in vitro fertilization in patients with proven poor ovarian responsiveness after early vs mid-follicular LH exposure: a prospective, randomized, controlled study. J Assist Reprod Genet 2012; 29:869-75. doi.org/10.1007/s10815-012-9804-0.
Hill MJ, Levens ED, Levy G, Ryan ME, Csokmay JM, De- Cherney AH, Whitcomb BW. The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis. Fertil Steril. 2012 May;97:1108-1114. DOI: https://doi.org/10.1016/j. fertnstert.2012.01.130.
Behre H, Howles CM, Longobardi S. Randomized trial comparing luteinizing hormone supplementation timing strategies in older women undergoing ovarian stimulation. Reproductive BioMedicine 2015;31:339-46. DOI: https:// doi.org/10.1016/j.rbmo.2015.06.002.
Revelli A, Pettinau G, Basso G, et al. Controlled Ovarian Stimulation with recombinant-FSH plus recombinant-LH vs. human Menopausal Gonadotropin based on the number of retrieved oocytes: results from a routine clinical practice in a real-life population. Reprod Biol Endocrinol 2015; 13:77. https://doi.org/10.1186/s12958-015-0080-6.
Lehert Ph, Kolibianakis EM, Venetis Ca, et al. Recombinant human follicle-stimulating hormone (r-hFSH) plus recombinant luteinizing hormone versus r-hFSH alone for ovarian stimulation during assisted reproductive technology: systematic review and meta-analysis. Lehert et al. Reproductive Biology and Endocrinology 2014;12:17. https:// doi.org/10.1186/1477-7827-12-17.
Bosch E. Comment on “Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years old or older undergoing IVF/ICSI: a randomized controlled multicenter study”. Hum Reprod. 2014 Mar;29(3):636-7. https://pdfs.semanticscholar.org/87ad/ d8bd3df69eecadc0480cfba8caca1ac68b69.pdf
Moro F, Scarinci E, Palla C, et al. Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women ≥35 years: a RCT. Hum Reprod. 2015 Jan;30(1):179-85. doi: 10.1093/humrep/deu302.
Carone D, Caropreso C, Vitti A, et al. Efficacy of different gonadotropin combinations to support ovulation induction in who type I anovulation infertility: Clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols. Center of Reproduction and Andrology (CREA), Taranto, Italy. J. Endocrinol. Invest. 2012;35:996- 1002. https://link.springer.com/article/10.3275/8657.
Schwarze JE, Crosby JA, Zegers-Hochschild F. Addition of neither recombinant nor urinary luteinizing hormone was associated with an improvement in the outcome of autologous in vitro fertilization/intracytoplasmatic sperm injection cycles under regular clinical settings: a multicenter observational analysis. Fertil Steril. 2016 Dec;106(7):1714- 1717.e1. doi: https://www.fertstert.org/article/S0015- 0282(16)62793-0/fulltext
Vuong TN, Phung HT, Ho MT. Recombinant follicle-stimulating hormone and recombinant luteinizing hormone versus recombinant follicle-stimulating hormone alone during GnRH antagonist ovarian stimulation in patients aged ≥35 years: a randomized controlled trial. Hum Reprod. 2015 May;30(5):1188-95. doi: 10.1093/humrep/dev038.