Successful induction of ovulation and completed pregnancy using recombinant human luteinizing hormone and follicle stimulating hormone in a woman with Kallmann's syndrome

The induction of ovulation in women with hypogonado-trophic hypogonadism requires follicle stimulating hormone (FSH) for follicular growth and both FSH and luteinizing hormone (LH) to induce optimal follicular steroidogenesis. The development of human recombinant FSH and LH means that individually tailored doses of both hormones can be used with the aim of inducing unifollicular ovulation. This report describes the use of recombinant human FSH and LH for the induction of ovulation and conception in the second cycle of treatment, and subsequently a successfully completed pregnancy in a woman with Kallmann's syndrom

Discontinuation of rLH two days before hCG may increase the number of oocytes retrieved in IVF

<p>Abstract</p> <p>Background</p> <p>Administration of recombinant luteinizing hormone (rLH) in controlled ovarian hyperstimulation may benefit a subpopulation of patients. However, late follicular phase administration of high doses of rLH may also reduce the size of the follicular cohort and promote monofollicular development.</p> <p>Methods</p> <p>To determine if rLH in late follicular development had a negative impact on follicular growth and oocyte yield, IVF patients in our practice who received rFSH and rLH for the entire stimulation were retrospectively compared with those that had the rLH discontinued at least two days prior to hCG trigger.</p> <p>Results</p> <p>The two groups had similar baseline characteristics before stimulation with respect to age, FSH level and antral follicle count. However, the group which had the rLH discontinued at least two days prior to their hCG shot, had a significantly higher number of oocytes retrieved, including a higher number of MII oocytes and number of 2PN embryos.</p> <p>Conclusions</p> <p>When using rLH for controlled ovarian hyperstimulation, administering it from the start of stimulation and stopping it in the late follicular phase, at least two days prior to hCG trigger, may increase oocyte and embryo yield.</p

Effects of recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-agonist protocol: a matched case-control study

<p>Abstract</p> <p>Background</p> <p>Some studies have suggested that the suppression of endogenous LH secretion does not seem to affect the majority of patients who are undergoing assisted reproduction and stimulation with recombinant FSH (r-FSH). Other studies have indicated that a group of normogonadotrophic women down-regulated and stimulated with pure FSH preparations may experience low LH concentrations that compromise the IVF parameters. The present study aimed to compare the efficacy of recombinant LH (r-LH) supplementation for controlled ovarian stimulation in r-FSH and GnRH-agonist (GnRH-a) protocol in ICSI cycles.</p> <p>Methods</p> <p>A total of 244 patients without ovulatory dysfunction, aged <40 years and at the first ICSI cycle were divided into two groups matched by age according to an ovarian stimulation scheme: Group I (n = 122): Down-regulation with GnRH-a + r-FSH and Group II (n = 122): Down-regulation with GnRH-a + r-FSH and r-LH (beginning simultaneously).</p> <p>Result(s)</p> <p>The number of oocytes collected, the number of oocytes in metaphase II and fertilization rate were significantly lower in the Group I than in Group II (<it>P </it>= 0.036, <it>P </it>= 0.0014 and <it>P </it>= 0.017, respectively). In addition, the mean number of embryos produced per cycle and the mean number of frozen embryos per cycle were statistically lower (<it>P </it>= 0.0092 and <it>P </it>= 0.0008, respectively) in Group I than in Group II. Finally the cumulative implantation rate (fresh+thaw ed embryos) was significantly lower (<it>P </it>= 0.04) in Group I than in Group II. The other clinical and laboratory results analyzed did not show difference between groups.</p> <p>Conclusion</p> <p>These data support r-LH supplementation in ovarian stimulation protocols with r-FSH and GnRH-a for assisted reproduction treatment.</p

The Control of Endogenous Secretion of Lh By Gonadotropin-releasing Hormone Agonists During Ovarian Hyperstimulation for Invitro Fertilization and Embryo Transfer

Human infertility is regarded as a major health problem. About ten years ago, the first successful clinical application of extracorporal human oocyte fertilization, followed by the remplacement of the conceptus in the mother’s uterus, launched a new and rapidly expanding field of medically assisted reproduction (Stepoe and Ewards, 1978). Each year, in Western Europe, between 200 and 300 new couples per millions inhabitants could seek in vitro fertilization (IVF) or related procedures to obtain the child they desire (Hull et al., 1986). In the United States, there are currently at least 2.8 million infertile couples who want to have children. Due to the accumulation of unsolved cases over the years, the pool of patients who might benefit from IVF is now believed to exceed one million (Seibel, 1988). In addition to its therapeutic interest, IVF has provided a large amount of new data for the understanding of the physiology and pathology of human reproduction. This will contribute to the development of new methods of fertility control and to the prevention or improved treatment of certain diseases which lead to infertility. Medically assisted reproduction has also opened a large public debate on fundamental, social and economic choices that mankind must make for its future. In our catholic university, a permanent, specific ethical reflexion guides the clinical developments in this field (Loumaye and Malherbe, 1988). The IVF procedure requires the retrieval of healthy fetilisable oocyes from the female ovary. At first, the oocyte was collected from the preovulatory follicle by needle aspiration during a spontaneous cycle. However it became clear that the recovery of several oocyte during one procedure of oocyte recovery would increase the probability of pregnancy by (1) increasing the chance to have at least one embryo to transfer, and (2) allowing the replacement in the uterus of more than one embryo (Ewards and Stepoe, 1983; Wood et al., 1985). Drugs such as clomiphene citrate and human menopausal gonadotropin, which has been used for more than three decades to induce ovulation in anovulatory patients, were used successfully to provoke controlled ovarian hyperstimulation (COH) and simultaneous maturation of several oocytes (Trouson et al., 1981; Jones et al., 1982). The main female indications for IVF are inoperable or unsuccessfully operated tubal diseases, failure of medical and surgical treatment of endometriosis, cervical pathology, and unexplained infertility. In addition, more and more healthy women undergo IVF in order to solve the problem of their mal partner’s infertility. This means that the vast majority of these patients have a normal ovulatory cycle and that the COH is superimposed upon this cycle. IVF teams then realized that the persistence of endogenous secretion of LH during COH has negative consequences in the IVF success rate, on the treatment convenience for the patient and on the cost of the procedure. The availability of GnRH agonists for clinical use renders attractive the possibility of exploiting the paradoxical inhibition of these peptides upon pituitary gonadotrope cells to control the deleterious endogenous secretion of LH. The last few years have seen an extensive evaluation of the clinical suitability of the use of such agonists during COH for IVF. In this review, we will (1) summarize the mechanisms by which GnRH induces the secretion of LH, (2) study the endogenous secretion of LH during COH for IVF and its consequences upon IVF treatment, (3) characterized the control of LH secretion using GnRH analogs, (4) report on the information regarding the safety of the use of such compounds during the maturation of oocyte which have to be subsequently fertilized, and (5) report on and discuss the current clinical experience of the use of GnRH-a during COH for IVFThèse d'agrégation de l'enseignement supérieur (Faculté de médecine) -- UCL, 198